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Kemoterapi adalah salah satu pengobatan kanker yang memiliki efek samping immunosupressan yang menekan sistem imun tubuh sehingga tubuh mudah terinfeksi. Pendekatan teori yang dapat diaplikasikan pada anak kanker adalah teori caring Swanson. Konsep teori caring Swanson menyerupai dengan alur proses keperawatan. Karya Ilmiah ini bertujuan untuk mendeskripsikan aplikasi teori keperawatan Caring Swanson pada anak dengan kanker yang mengalami masalah risiko penyebaran infeksi. Metode yang digunakan adalah studi kasus. Kebutuhan pada 5 kasus kelolaan dikaji berdasarkan lima konsep caring Swanson yaitu knowing yaitu pengkajian dan diagnosa keperawatan. Pengkajian yang dapat dilakukan menggunakan instrumen “telephone triage oncology” versi Indonesia untuk mengetahui secara cepat masalah pada anak kanker. Intervensi keperawatan diberikan dengan melakukan doing for, being with, enabling dan maintaining belief. Evaluasi tindakan dilakukan berdasarkan nursing outcome sesuai dengan diagnosa keperawatan yang telah ditegakkan. Hasil studi aplikasi teori caring Swanson pada anak kanker yang mengalami risiko penyebaran infeksi berdampak pada kepuasan pasien dan keluarga atas pelayanan keperawatan yang telah diberikan.

 

Kata Kunci: Kanker, risiko penyebaran infeksi, Teori Caring Swanson

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Chemotherapy is a cancer treatment that has immunosupressant side effects that suppress the body's immune system so that the body is easily infected. The theoretical approach that can be applied to cancer children is the theory of Swanson caring. The concept of Swanson caring theory resembles that of the nursing process. This Scientific Work aims to describe the application of Caring Swanson's theory of nursing in children with cancer who experience problems with the risk of spreading infection. The method used is a case study. The need for 5 cases under management was examined based on five Swanson caring concepts, namely knowing, namely the assessment and diagnosis of nursing. Assessments that can be carried out using the Indonesian version of the "telephone triage oncology" instrument to quickly identify problems in children with cancer. Nursing interventions are given by doing for, being with, enabling and maintaining belief. Action evaluation is based on the nursing outcome in accordance with the nursing diagnosis that has been enforced. The study results of the application of Swanson's caring theory in cancer children who experience the risk of spreading infection have an impact on patient and family satisfaction with the nursing services that have been given.

 

Keywords: Cancer, risk of spread of infection, Swanson Caring Theory

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"Infeksi yang terjadi pada anak merupakan perhatian penting pada kesehatan anak di dunia. Kondisi ini membutuhkan pelayanan dan perawatan jangka panjangsehingga dilakukan tindakan invasif pada anak, salah satunya pemasangan central venous catheter (CVC), tindakan ini meningkatkan potensial komplikasi yang memperberat kondisi infeksi pada anak. Pendekatan asuhan keperawatan menggunakan teori caring Swanson dapat diterapkan. Teori ini sesuai denganproses keperawatan dan sejalan dengan family centered care (FCC) yang merupakan paradigma keperawatan anak. Karya ilmiah spesialis ini bertujuanmemberikan gambaran asuhan keperawatan berdasarkan teori caring Swanson pada anak dengan masalah infeksi. Metode yang digunakan adalah studi kasus.Kebutuhan pada 5 kasus kelolaan dikaji berdasarkan 5 konsep caring Swanson yaitu knowing meliputi pengkajian dan diagnosis keperawatan. Intervensikeperawatan diberikan dengan melakukan doing for, being with, enablingempowering, dan maintaining belief . Salah satu intervensi yang dilakukan adalah pemantauan dan perawatan CVC menggunakan CVC exit-site infection score untuk menurunkan kejadian infeksi. Evaluasi tindakan dilakukan berdasarkan nursing outcome sesuai dengan diagnosis keperawatan yang telah ditegakkan. Hasil studi aplikasi teori caring Swanson pada anak dengan masalah infeksi, berdampak pada penurunan kondisi infeksi CVC dan kepuasan pasien dan keluarga atas pelayanan yang diberikan.

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Infection that occurs in children is an important concern for children's health in the world. This condition requires long-term care and treatment so that invasive measures are taken on children, one of which is the installation of a central venous

catheter (CVC), this action increases the potential for complications that aggravate the condition of infection in children. Nursing care approach using Swanson's caring theory can be applied. This theory is in accordance with the nursing process and is in line with family centered care (FCC) which is the paradigm of pediatric

nursing. The scientific work of this specialist is aimed at providing an overview of nursing care based on Swanson's theory of caring for children with infectious problems. The method used is a case study. The needs of the 5 cases under management were studied based on Swanson's 5 caring concepts, namely knowing covering nursing assessment and diagnosis. Nursing intervention is given by doing for, being with, enabling-empowering, and maintaining belief. One of the interventions carried out is CVC monitoring and treatment using CVC exit-site infection score to reduce the incidence of infection. Evaluation of actions is carried out based on nursing outcomes in accordance with the Nursing diagnosis that has been established. The results of the study of the application of Swanson's caring theory in children with infection problems, have an impact on reducing the condition of CVC infection and patient and family satisfaction with the services

provided."

"Kanker menimbulkan masalah pada anak baik fisik maupun psikologis.Teori kenyamanan Kolcaba memberikan arahan dalam pemenuhan rasa nyaman pada pasien anak kanker dengan masalah fatigue. Karya ilmiah ini bertujuan untuk menganalisis penerapan teori kenyamanan Kolcaba pada 5 kasus kelolaan sebagai upaya mengoptimalisasi pemberian asuhan keperawatan pada anak kanker yang menjalani kemoterapi dengan masalah fatigue. Asuhan Keperawatan dilakukan berdasarkan tahapan kenyamanan, yaitu pengkajian (kenyamanan fisik, psikospiritual, sosiokultural dan lingkungan), merumuskan diagnose keperawatan, menetapkan intervensi (berdasarkan standard comfort, coaching dan comfort food for the soul), implementasi dan evaluasi. Teori kenyamanan Kolcaba dapat diterapkan pada anak kanker dengan masalah fatigue. Hal ini perlu diterapkan pada kasus yang lebih besar

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Cancer provokes physical and psychological problems. Kolcaba's comfort theory gives direction in fulfilling comfort feeling in children with cancer that have fatigue issue. This case study aims is to analyze application of Kolcaba comfort in 5 cases of management theory regarding optimizing nursing care for children with cancer that having chemotherapy and fatigue issue. Nursing care was applied based on comfort level such as assessment (physical comfort, psychospiritual, sociocultural and environmental), nursing diagnoses , determine interventions (based on comfort standards, coaching and comfort food for the soul), implementation and evaluation. Kolcaba comfort theory mau apply for children with cancer that having fatigue issue. Experience of children with cancer that have been hospitalized because of fatigue issue could be explored. This needs to be applied to a larger case."

"Kanker pada anak terus meningkat jumlahnya setiap tahun, masalah nutrisi merupakan masalah yang sering dikeluhkan oleh anak dan keluarga sehingga, diperlukan asuhan keperawatan untuk mengatasi masalah tersebut. Karya Ilmiah Akhir ini bertujuan untuk memberikan gambaran aplikasi teori Comfort Kolcaba dalam asuhan keperawatan pada anak kanker dengan masalah nutrisi dan pencapaian kompetensi baik sebagai pemberi asuhan, advocator, counselor, educator, colaborator, dan agen perubah. Terdapat lima kasus kelolaan yang menjadi pembahasan dalam karya ilmiah ini, kelima kasus kelolaan mengalami masalah nutrisi. Masalah nutrisi didapatkan dari basil pengkajian berdasarkan pendekatan teori Comfort Kolcaba yaitu pengkajian fisik, psikospiritual, sosiokultural dan Iingkungan. Intervensi menggunakan tiga tipe perawatan standar comfort, coaching dan Comfort food for the soul. Tidak semua masalah nutrisi pada lima kasus kelolaan dapat teratasi dengan cepat, untuk menyelesaikan masalah nutrisi pada anak kanker dibutuhkan waktu dan kerjasama tim yang baik antara ibu, anak, dokter dan dietesien serta perawat.

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Pediatric cancer always increase every year, the problem of nutrition is often complained by the child and their family, so nursing care is required to solve the issue. This research aims to provide an overview of the application of theory Comfort Kolcaba in cancer nursing care in children with nutritional problems and the competence achievement as a caregiver, advocator, counselor, educator, colaborator, and agent of change. There were five cases managed that discussed in this research, and in five cases managed all experiencing nutritional problems. Nutrient problems obtained from the results of the assessment approach based on the theory of Comfort Kolcaba such as physical examination, psikospiritual, sociocultural and environmental. Interventions use three types of standard comfort care, coaching and Comfort food for the soul. Not all nutritional problems in the management of five cases can be resolved quickly, to solve the problem of childhood cancer nutrition takes time and good teamwork among mother, child, and dietision, doctors, and nurses."

"Kanker pada anak merupakan masalah kesehatan utama dengan angka kesakitan dan kematian yang tinggi. Masalah yang ditimbulkan oleh kanker diantaranya masalah tidur dan kelelahan. Karya Ilmiah Akhir Spesialistik ini bertujuan untuk menganalisis gambaran aplikasi teori comfort Kolcaba pada anak kanker dengan gangguan tidur dan kelelahan dan penerapan edukasi tidur sehat serta terapi musik untuk mengatasi masalah tersebut. Penerapan asuhan keperawatan diterapkan dengan metode studi kasus yang didapatkan dari lima kasus terpilih. Lima kasus tersebut, semua mengalami gangguan tidur dan kelelahan. Teori comfort mampu memfasilitasi perawat untuk menggali masalah dan kebutuhan anak kanker secara sistematis. Penerapan edukasi tidur sehat dan terapi musik sebagai salah satu intervensi keperawatan juga terbukti dapat mengatasi gangguan tidur dan kelelahan. Penerapan teori kenyamanan dan pemberian edukasi tidur sehat serta terapi musik diharapkan dapat menjadi komponen pemberian asuhan keperawatan anak kanker dengan gangguan tidur dan kelelahan.

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Cancer in children is a major health problem with high morbidity and mortality. Problems caused by cancer include sleep problems and fatigue. This Specialist Final Scientific work aims to analyze the application of Kolcaba's comfort theory on sleep problems and fatigue in children with cancer by implementing sleep hygiene  and music therapy, which aims to overcome these problems. The application of nursing care was applied with the case study method from five selected cases. With the same symptoms, they were namely sleep problems and fatigue. The theory of comfort could facilitate nurses to find problems and needs of cancer in children systematically. The application of sleep hygiene and music therapy as one of the nursing interventions had proven to be able to overcome sleep problems and fatigue. And this was expected to be a component in providing cancer nursing care to children with sleep problems and fatigue."

"ABSTRAKMalnutrisi, kaheksia, dan obesitas/overweight merupakan masalah nutrisi yang sering ditemui pada anak kanker akibat dari proses penyakit dan efek kemoterapi. Karya Ilmiah Akhir ini bertujuan memberikan gambaran praktek ners spesialis dalam mengaplikasikan model adaptasi Roy pada asuhan keperawatan anak kanker yang mengalami masalah nutrisi. Praktek ners spesialis dilakukan untuk mencapai kompetensi sesuai peran perawat. Aplikasi model adaptasi Roy tertuang dalam lima kasus terpilih dengan masalah yang ditemukan adalah ketidakseimbangan nutrisi kurang dari kebutuhan tubuh, risiko nutrisi kurang dari kebutuhan tubuh dan obesitas. Pendidikan kesehatan berbasis pembuktian ilmiah digunakan sebagai salah satu intervensi keperawatan untuk meningkatkan adaptasi anak sehingga dapat bertoleransi terhadap pemenuhan kebutuhan nutrisi. Evaluasi keperawatan lima kasus tersebut adalah satu kasus beradaptasi secara integrasi, empat kasus beradaptasi secara kompensasi. Karya ilmiah ini merekomendasikan teori model adaptasi Roy dapat diaplikasikan pada asuhan keperawatan anak kanker dengan masalah nutrisi.

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ABSTRACTMalnutrition, cachexia, and obesity/overweight, is a common nutritional problem in children who have cancer as a result of the disease process and the effects of chemotherapy. The aim of this final assignment was to provide an overview of the practice specialist nurses by applying the Roy adaptation model in nursing care of children who have cancer with nutritional problems. Practice spesialis nurses to achieve competency according the role of nurses. Roy adaptation model was applied in five selected cases and the nursing problem found was imbalance nutrition less than the body needs, risk imbalance nutrition less than the body needs and obesity. Health education is evidence based practice be used as a nursing intervention to improve the adaptation level of the child so that it can tolerate the fulfillment of nutrition needs. Nursing evaluation in five selected cases was one case integrated adaptation level and four cases compensatory adaptation level. This paper recommend Roy adaptation model theory can be applied to nursing care in children who have cancer with nutrition problems.;"

"Infeksi yang terjadi pada anak merupakan perhatian penting pada kesehatan anak di dunia saat ini. Candida merupakan flora alami atau mikroba terdapat dalam rongga mulut, namun apabila daya tahan tubuh inang melemah maka berpotensi berubah menjadi patogen sehingga disebut infeksi oportunistik. Oral candidiasis bukan merupakan suatu penyakit yang membahayakan bagi anak. Namun, jika keadaan ini diabaikan terus-menerus, anak akan merasakan ketidaknyaman, bahkan dapat menyebabkan terganggunya tumbuh kembang anak. Pendekatan asuhan keperawatan menggunakan model adaptasi Calista Roy dapat diterapkan. Karya ilmiah spesialis ini bertujuan memberikan gambaran asuhan keperawatan berdasarkan teori adaptasi Calista Roy pada anak dengan masalah infeksi. Metode yang digunakan adalah studi kasus. Kebutuhan pada lima kasus kelolaan dikaji berdasarkan konsep adaptasi Calista Roy yaitu pengkajian perilaku meliputi mode regulator dan cognator dan pengkajian stimulus meliputi focal, kontekstual dan residual. Diagnosis keperawatan berfokus pada kerusakan membran mukosa oral dimana salah satu intervensi yang dilakukan adalah melakukan oral hygiene dengan menggunakan chlorhekxidine 0,12% untuk menurunkan kejadian infeksi. Evaluasi tindakan dilakukan untuk melihat penurunan skor Winkel Tongue Coating Indeks (WTCI). Hasil studi aplikasi model adaptasi Calista Roy pada anak dengan masalah infeksi, perbaikan kondisi infeksi dan kepuasan pasien dan keluarga atas pelayanan yang diberikan.

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Infections that occur in children are an important concern for children's health in the world today. Candida is a natural flora or microbe found in the oral cavity, but if the host's immune system is weakened, it has the potential to turn into a pathogen, so it is called an opportunistic infection. Oral candidiasis is not a dangerous disease for children. However, if this situation is continuously ignored, the child will feel uncomfortable, and it can even cause disruption to the child's growth and development. The nursing care approach using the Calista Roy adaptation model can be applied. This specialist scientific work aims to provide an overview of nursing care based on Calista Roy's adaptation theory for children with infectious problems. The method used is a case study. The needs in the 5 management cases were assessed based on Calista Roy's adaptation concept, namely behavioral assessment including regulator and cognator modes and stimulus assessment including focal, contextual and residual. Nursing diagnosis focuses on damage to the oral mucosal membranes where one of the interventions carried out is carrying out oral hygiene using 0.12% chlorhexidine to reduce the incidence of infection. Action evaluation was carried out to see a decrease in the Winkel Tongue Coating Index (WTCI) score. The results of the study of the application of the Calista Roy adaptation model to children with infection problems, have an impact on reducing the condition of infection and satisfaction of patients and families with the services provided."

"Nyeri saat pemasangan intravena kateter masih menjadi salah satu aspek yang paling membuat stres selama rawat inap pada anak. Penggunaan terapi non farmakologis membantu untuk mengurangi nyeri saat pemasangan intravena kateter pada anak sehingga dapat menurunkan tingkat nyeri pada anak, meningkatkan pelayanan diruang rawat inap. Teori kenyamanan Kolcaba membantu perawat untuk memberikan asuhan keperawatan secara holistik melalui pengkajian fisik, psikospiritual, sosiokultural dan lingkungan dengan mengevaluasi menggunakan tiga taksonomi yaitu relief, ease dan transcendence. Tujuan penulisan karya ilmiah akhir spesialis ini adalah memberikan gambaran mengenai aplikasi teori kenyamanan Kolcaba dalam pemenuhan kebutuhan nyeri dan kenyamanan pada anak dirawat di ruang infeksi. Berdasarkan hasil pengkajian pada lima anak dengan gangguan nyeri saat pemasangan intravena kateter didapatkan hasil bahwa terdapat penurunan skoring nyeri pada anak. Penerapan quality improvement project dengan pemberian ice gel untuk menurunkan nyeri pada saat pemasngan intravena kateter terbukti efektif yang menunjukkan bahwa terdapat penurunan tingkat nyeri pada anak setelah pemberian ice gel pada saat pemasangan intravena kateter (venapunture) dengan p value < 0.005 (p= 0.001). Kesimpulan aplikasi teori kenyamanan Kolcaba dapat diterapkan pada anak dengan gangguan nyeri dan kenyamanan di ruang rawat infeksi.

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Pain during intravenous catheter insertion is still one of the most stressful aspects of hospitalization in children. The use of non-pharmacological therapy helps to reduce pain when installing an intravenous catheter in children so that it can reduce the level of pain in children, improve services in inpatient rooms. Kolcaba's comfort theory helps nurses to provide holistic nursing care through physical, psychospiritual, sociocultural and environmental assessments by evaluating using three taxonomies, namely relief, ease and transcendence. The aim of writing this final specialist scientific paper is to provide an overview of the application of Kolcaba's comfort theory in meeting the pain and comfort needs of children treated in the infection room. Based on the results of a study on five children with pain disorders during intravenous catheter, it was found that there was a decrease in pain scoring in children. The implementation of the quality improvement project by administering ice gel to reduce pain during intravenous catheter has proven to be effective, showing that there is a reduction in the level of pain in children after giving ice gel when installing an intravenous catheter (venapuncture) with a p value < 0.005 (p= 0.001). Conclusion: The application of Kolcaba's comfort theory can be applied to children with pain and comfort disorders in the infection ward."

"[ABSTRAKNyeri merupakan salah satu masalah utama pada pasien kanker anak. Karya Ilmiah Akhir ini bertujuan memberikan gambaran penerapan, analisis Comfort Theory Kolcaba pada pasien kanker anak dengan nyeri, dan pencapaian kompetensi ners spesialis keperawatan anak. Penerapan teori dilakukan pada lima pasien, menggunakan pendekatan proses keperawatan. Pengkajian dan penetapan masalah keperawatan menggunakan struktur taksonomi Kolcaba. Intervensi dan implementasi menggunakan intervensi kenyamanan standar, coaching, dan comfort food for the soul. Evaluasi menggunakan comfort behavior scale menunjukkan hasil diakhir perawatan, nyeri berkurang, terkontrol, dan kenyamanan bertambah. Kompetensi tercapai sesuai target. Comfort Theory bisa menjadi pilihan dalam merawat pasien kanker anak dengan nyeri.

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ABSTRACTPain is one of main problems in children with cancer. This study aimed to describe and to analyze: (1) the application of Kolcaba's Comfort Theory on children with cancer who experience pain, and (2) the competencies achieved by pediatric clinical nurse specialist. The theory was applied to five patients using nursing process approach. The assessment and decision of the nursing problem was conducted using Kolcaba's taxonomic structure. The intervention and implementation using standard comfort intervention, coaching, and comfort food for the soul. Comfort behavior scale was used for the evaluation. The results showed that at the end of the nursing implementation, pain was reduced, controlled, and the comfort was increased. The targeted competencies were achieved. Comfort Theory can be recommended for caring children with cancer.;Pain is one of main problems in children with cancer. This study aimed to describe and to analyze: (1) the application of Kolcaba's Comfort Theory on children with cancer who experience pain, and (2) the competencies achieved by pediatric clinical nurse specialist. The theory was applied to five patients using nursing process approach. The assessment and decision of the nursing problem was conducted using Kolcaba's taxonomic structure. The intervention and implementation using standard comfort intervention, coaching, and comfort food for the soul. Comfort behavior scale was used for the evaluation. The results showed that at the end of the nursing implementation, pain was reduced, controlled, and the comfort was increased. The targeted competencies were achieved. Comfort Theory can be recommended for caring children with cancer., Pain is one of main problems in children with cancer. This study aimed to describe and to analyze: (1) the application of Kolcaba's Comfort Theory on children with cancer who experience pain, and (2) the competencies achieved by pediatric clinical nurse specialist. The theory was applied to five patients using nursing process approach. The assessment and decision of the nursing problem was conducted using Kolcaba's taxonomic structure. The intervention and implementation using standard comfort intervention, coaching, and comfort food for the soul. Comfort behavior scale was used for the evaluation. The results showed that at the end of the nursing implementation, pain was reduced, controlled, and the comfort was increased. The targeted competencies were achieved. Comfort Theory can be recommended for caring children with cancer.]"

"ABSTRAKStudi ilmiah ini menggambarkan aplikasi teori caring Swanson dalam pemberian asuhan keperawatan anak dengan stoma.Lima kasus anak dengan stoma diberikan asuhan keperawatan berdasarkan lima prinsip dasar caring Swanson yaitu knowing, being with, enabling/empower-ing, doing for, dan maintaining belief. Asuhan keperawatan diberikan pada anak dan keluarga dengan menerapkan konsep family centered of care. Hasil dari aplikasi teori caring Swanson yaitu anak dengan stoma mendapatkan keperawatan yang komprehensif, kebutuhan pasien selama perawatan di rumah sakit terpenuhi, pemberian edukasi dan pendampingan orang tua dalam mencegah komplikasi kulit peristomal dan perawatan stoma anak di rumah, orang tua dapat mempertahankan keyakinan dan harapan untuk perawatan anak selanjutnya di rumah serta mempersiapkan kondisi anak untuk tindakan definitif.Lima prinsip teori caring Swanson merupakan dasar bagi perawat dalam menerapkan proses keperawatan, teori caring dapat melengkapi teori keperawatan lain yang menjelaskan secara spesifik tahapan dalam proses keperawatan.

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ABSTRACTThe aim of study was to apply of Swanson 39;s caring theory in nursing care of children with stoma. Five cases of children with stoma were given nursing care based on the five basic principles of Swanson caring: knowing, being with, enabling / empowering, doing for, and maintaining belief. Nursing care is given to children and families by applying the concept of family centered of care. The result of the Swanson caring theory application is that children with stoma get comprehensive nursing, the patient 39;s need during hospitalization is fulfilled, giving education and parental guidance in preventing peristomal skin complications and stoma care of children at home, parents can maintain the belief and hope to further child care at home as well as preparing the child 39;s condition for definitive treatment. The five principles of the Swanson caring theory are the basis for nurses in applying the nursing process, caring theory can complement other nursing theories that explain the specific stages in the nursing process. "