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"Penurunan kesadaran merupakan salah satu kondisi kritis yang perlu mendapatkan penanganan dan intervensi yang cepat dan tepat. Kecepatan dan ketepatan intervensi akan mencegah berbagai komplikasi jangka pendek dan jangka panjang pada pasien. Penelitian ini bertujuan mengidentifikasi pengaruh intervensi stimulasi sensori berbasis teori caring dan uncertainty terhadap proses pemulihan pasien penurunan kesadaran. Penelitian ini terbagi atas dua tahap yaitu penelitian kualitatif (fenomenologi dan diskusi kelompok terfokus) yang melibatkan 24 informan, kemudian dilanjutkan dengan penyusunan intervensi stimulasi sensori dan penelitian kuantitatif (quasi eksperimen) yang melibatkan 63 responden secara consecutive sampling, yang dibagi dalam kelompok intervensi 1 dan 2 serta kelompok kontrol. Penelitian tahap ini dilakukan di tiga Rumah sakit, 2 di Jakarta dan 1 di Bengkulu. Hasil penelitian tahap satu didapatkan 5 tema dari hasil wawancara mendalam dan diskusi kelompok terfokus yang dijadikan sebagai salah sumber untuk menyusun intervensi stimulasi sensori yang dirangkum dalam buku panduan intervensi stimulasi sensori untuk pasien dan perawat dan keluarga. Hasil penelitian tahap dua didapatkan bahwa stimulasi sensori memberikan perbedaan bermakna pada tingkat kesadaran, fungsi sensori dan hemodinamik laju pernapasan dan saturasi okdigen dengan nilai (P<0.05. Tetapi tidak memberikan perbedaan secara bermakna secara uji statistik (P>0.05) pada indikator hemodinamik yang lainnya di antara 3 kelompok terhadap proses pemulihan kesadaran. Meskipun demikian secara klinis terlihat dapat memperpendek masa proses pemulihan kesadaran berdasarkan nilai mean tiap kelompok. Kesimpulan hasil penelitian yaitu intervensi stimulasi sensori dapat mempersingkat proses pemulihan kesadaran pasien.

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Decreased awareness is a critical condition that needs to get fast and appropriate treatment and intervention. Speed ​​and accuracy of intervention will prevent various short-term and long-term complications in patients. This study aims to identify the effect of sensory stimulation interventions based on caring theory and uncertainty on the recovery process of patients with reduced consciousness. This study was divided into two stages, namely qualitative research (phenomenology and focus group discussions) involving 24 informants, then followed by the preparation of sensory stimulation interventions and quantitative research (quasi experiments). involving 63 respondents respectively consecutive sampling, divided into intervention groups 1 and 2 as well as the control group. This stage of the research was conducted in three hospitals, 2 in Jakarta and 1 in Bengkulu. The results of the first phase of the study obtained 5 themes from the results of in-depth interviews and focus group discussions which were used as a source for developing sensory stimulation interventions which are summarized in a sensory stimulation intervention manual for patients and caregivers and families. The results of the second phase of the study found that sensory stimulation provided significant differences in the level of consciousness and hemodynamics of respiratory rate and oxygen saturation with a value of (P<0.05. However, it did not provide significant statistical differences (P>0.05) in sensory function and other hemodynamic indicators among the 3 groups on the process of recovering consciousness. However, clinically it appears to shorten the period of consciousness recovery based on the mean value of each group. The conclusion of the results of the study is that sensory stimulation interventions can shorten the process of restoring patient consciousness."

"Pengekangan fisik merupakan salah satu intervensi yang sering digunakan di instalasi gawat darurat (IGD) dimana karakteristik umum pasien yang datang mengalami penurunan kesadaran dan perubahan perilaku. Kondisi tersebut rentan terjadi pada pasien lanjut usia (lansia), terlebih pada situasi akut akibat infeksi Corona Virus Disease-2019 (COVID-19). Studi ini mengeksplorasi pengekangan fisik pada lansia perempuan berusia 75 tahun dengan COVID-19 yang datang ke IGD akibat desaturasi oksigen dan penurunan kesadaran. Pasien berhasil dipasangkan akses intravena, selang makan, dan kateter urin yang bertujuan untuk pemberian medikasi, nutrisi, dan pemantauan keseimbangan cairan. Pasien diberikan pengekangan fisik untuk membatasi pergerakan ekstremitas atas untuk mencegahnya mengganggu perawatan dan mencabut selang-selang tersebut. Intervensi pengekangan fisik berhasil membuat pasien lebih kondusif saat diberikan medikasi dan nutrisi sehingga pasien lebih cepat stabil. Namun, pengekangan menimbulkan jejas kemerahan pada lengan dan infiltrasi cairan infus, sehingga diperlukan pemantauan secara berkala terhadap respon dan kondisi bagian tubuh yang terpasang pengekang fisik. Pengambilan data dilakukan melalui observasi saat pasien dirawat di IGD. Intervensi pengekangan fisik akan lebih efektif apabila dilakukan sesuai dengan indikasi, hasil pemantauan didokumentasikan pada formulir pengekangan fisik, serta dibutuhkan adanya panduan spesifik terhadap pengurangan penggunaan atau deeskalasi pengekangan fisik.

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Physical restraint is one of a commonly used interventions in emergency care, where the patients are mostly admitted with altered consciousness level and behavioral changes. Older adults are vulnerable to those acute symptoms especially those who are infected with Corona Virus Disease-2019 (COVID-19). This study explores the use of physical restraint on 75 years-old elderly woman in emergency department (ED) with COVID-19, low oxygen saturation, and altered consciousness status. Both of her wrists were restrained and nurse can finally inserted IV catheter, nasogastric tube, and urinary catheter for medication, feeding, and fluid balance monitoring. Restraints were used as a preventive measure so she could not self-removing any invasive tubes and interrupting the treatment. Restraints were effective to develop a condusive environment for the patient to receive medication and food in order to stabilize her. But, restraints left soreness on her skin and infiltration on the intravenous catheter area, therefore this intervention needs regular monitoring towards patient’s response and restrained extremities. Data were collected from observation during the treatment in ED. Physical restraint would be more effective if it is based on the right indication, monitored and documented on the restraint monitoring form, and a specific guidelines from institution is needed to reduce the use of restraint."

"Latar Belakang. Penilaian derajat kesadaran penting dilakukan pada pasien di Unit Gawat Darurat untuk memperkirakan prognosis. Banyak sistem penilaian dipakai untuk mengevaluasi pasien, masing-masing dengan kelebihan dan kekurangannya. Sistem penilaian yang baru, yaitu Full Outline of Unresponsiveness (FOUR )Score, dapat digunakan menilai derajat kesadaran dan memprediksi prognosis pasien. FOUR Score dapat memberikan data neurologis yang lebih detail dan dapat digunakan pada pasien yang terintubasi. Belum ada penelitian yang menilai validitas FOUR Score sebagai prediktor outcome pada pasien dengan penurunan kesadaran di IGD RSCM sebelumnya. Metode. Penelitian kohort prospektif observasional pada pasien dengan penurunan kesadaran yang dirawat di IGD RSCM. Evaluasi FOUR Score dilakukan terhadap 120 pasien baru yang dirawat di IGD RSCM. Outcome pasien dicatat setelah perawatan 72 jam. Analisis bivariat digunakan untuk menentukan hubungan FOUR Score terhadap outcome. Analisis regresi logistik untuk menentukan hubungan komponen FOUR Score terhadap outcome. Nilai area di bawah kurva (AUC) digunakan untuk sebagai uji dsikriminasi FOUR Score terhadap outcome. Hasil. Terdapat hubungan yang bermakna antara nilai FOUR Score dengan outcome (p <0,001). Komponen respon membuka mata (FOUR-E) dan pola respirasi (FOUR-R) adalah komponen yang mempunyai nilai prediksi terhadap outcome. AUC FOUR Score adalah 0,864 (95% IK 0,784-0,928). Uji kesesuaian antarpenilai antara dokter dan perawat menunjukkan kesesuaian yang sangat baik dengan κ = 0,836 (95% IK 0,786- 0,894), p <0,001.

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Background. Asssessment of conciousness is important in patients in emergency room to estimate prognosis. Many scoring systems used to evaluate patients? level of conciousness, each with their advantages and disadvantages Full Outline of Unresponsiveness (FOUR) Score is a new system to assess patients?s level of conciousness and future prognosis. FOUR Score can provide a detailed neurological data and can be used in patients who are intubated. There have never been done a research on validity of FOUR Score as a predictor of outcome in RSCM?s ER before.

Method. Observational, prospective cohort study in patients with decreased of conciousness treated in the RSCM?s ER. FOUR Score?s evaluation conducted on 120 new patients. Patient?s outcome was recorded after 72 hours of treatment, and classified as dead or alive. Bivariate analysis conducted to determine the relation between FOUR Score and outcome. Logistic regression analysis was performed to determine the relation between components of the FOUR Score and the outcome, and the value of area under the curve (AUC) of the FOUR Score to outcome was determined to measure discrimination of FOUR Score.

Results. There is a significant correlation statistically between the value of the FOUR Score with the outcome (p <0.001). From all the components had been measured, the eye response (FOUR-E) and respiratory pattern (FOUR-R) had predictive value related to the outcome. AUC of the FOUR Score is 0,864 (95% CI 0,784-0,928). Inter-rater agreement between doctor and nurse shows a very good strength of agreement wtith κ = 0,836 (95% CI 0,786- 0,894), p <0,001.

Conclusion. FOUR Score can accurately predict the outcome of patients with decreased of consciousness in the RSCM's ER after 72 hours of treatment."