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Abstrak :

Rendahnya pengetahuan keluarga dan tidak adanya pengawasan dari petugas kesehatan pasca rawat inap, dapat menyebabkan anak mengalami berbagai masalah kesehatan dan berisiko untuk rawat ulang. Tujuan penelitian ini adalah  terbentuknya model asuhan keperawatan mandiri keluarga dengan anak balita pneumonia (ASTANIA) dan pengaruhnya terhadap  kemandirian keluarga dalam merawat anak balita dengan pneumonia. Penelitian ini menggunakan metode kualitatif dan kuantitatif melalui tiga tahapan; Tahap I yaitu mengidentifikasi kebutuhan keluarga dengan balita pneumonia melalui wawancara mendalam terhadap 10 orangtua anak dengan pneumonia yang dirawat di rumah sakit, data dianalisis secara tematik; Tahap II yaitu pengembangan model asuhan keperawatan mandiri keluarga dengan balita pneumonia berdasarkan hasil penelitian tahap I; Tahap III yaitu uji coba model ASTANIA, dengan metode quasi eksperimen pre-post test with control group terhadap 38 responden kelompok intervensi dan 38 responden kelompok kontrol. Hasil analisis data membuktikan bahwa setelah dilakukan intervensi selama tiga  bulan terjadi peningkatan perilaku (pengetahuan, persepsi dan keterampilan) dan kemandirian keluarga dalam merawat balita dengan pneumonia. Kesimpulan: Model ASTANIA berpengaruh pada perilaku dan tingkat kemandirian keluarga dengan balita pneumonia. Rekomendasi: perlunya  pelatihan bagi perawat di rumah sakit tentang perencanaan pulang yang terstruktur dan komprehensif khususnya pada balita dengan pneumonia dan perlunya komitmen perawat kesehatan masyarakat dalam memantau kesehatan balita pasca rawat melalui kunjungan rumah secara terjadwal untuk meningkatkan kemandirian keluarga dan mencegah terjadinya kekambuhan.

 

Kata Kunci: ASTANIA; Kemandirian keluarga; Anak dengan pneumonia; Perkesmas.

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Low family knowledge and lack of supervision from post-hospitalized health workers, can cause children to experience various health problems and in risk for re-admission. The purpose of this study is the establishment of a model of family independent care for children under five with pneumonia (ASTANIA) and its effect on family independence in caring for children under five with pneumonia. This research uses qualitative and quantitative methods through three stages; Phase I is identifying family needs of children with pneumonia through in-depth interviews with 10 parents of children with pneumonia who were hospitalized, the data were analyzed thematically; Phase II, namely the development of a model of family independent nursing care for children under five with pneumonia based on the results of the Phase I research; Phase III is the ASTANIA model trial, with a quasi-experimental method pre-post test with control group of 38 respondents in the intervention group and 38 respondents in the control group. The results of data analysis prove that after three months of intervention there has been an increase in behavior (knowledge, perception and skills) and family independence in caring for infants with pneumonia. Conclusion: The ASTANIA model influences the behavior and level of independence of families with children with pneumonia. Recommendations: the need for training for nurses in hospitals on structured and comprehensive discharge planning especially for children under five years with pneumonia and the need for community health nurse commitments in monitoring post-hospitalized chilcren health through scheduled home visits to increase family independence and prevent recurrence.

 

Keywords: ASTANIA; Family independence; Children with pneumonia; Public Relations.

Abstrak :
Manuver rekrutmen paru (MRP) adalah strategi mencegah kerusakan paru saat bayi menggunakan ventilator mekanis (VM). Dengan meningkatkan tekanan akhir ekspirasi (TAE) secara bertahap, MRP membuka alveolus, menurunkan kebutuhan oksigen hirup (FiO2) sekaligus meningkatkan ambilan oksigen paru. Hingga kini, belum cukup bukti ilmiah terkait pengaruh MRP menggunakan VM terhadap luaran bayi prematur. Penelitian ini adalah uji klinis tidak tersamar, dilakukan di RS Cipto Mangunkusumo dan RSIA Bunda Menteng, bertujuan mencari hubungan MRP dengan kejadian DBP dan atau kematian, curah jantung, cedera alveolus-endotel, penurunan diameter duktus arteriosus (DA), dan mikrosirkulasi kulit. Penelitian berlangsung Maret 2021–April 2022. Subjek penelitian adalah bayi prematur 24–32 minggu yang menggunakan ventilator mekanis saat usia < 48 jam. Protein surfaktan-D (SP-D) diukur menggunakan metode ELISA, mikropartikel endotel (CD-31+/CD-42–) menggunakan flowsitometri, curah jantung dan diameter DA menggunakan ekokardiografi, TcCO2–PaCO2, TcO2/PaO2 menggunakan monitor gas darah transkutan dan gas darah arteri, strong ion difference (SID) menggunakan elektrolit darah arteri. Pada usia koreksi 36 minggu, tidak terdapat perbedaan bermakna kejadian DBP atau kematian antara kelompok MRP dan tanpa MRP 38 (69,09%) vs. 43 (78,18%), p = 0,216. Pada 72 jam pasca-penggunaan VM, tidak didapati perbedaan kadar SP-D, CD 31+, Diameter DA, curah jantung, TcCO2 gap dan SID antara kelompok MRP dan tanpa MRP . Terdapat perbedaan bermakna TcO2 indeks 1,00 (1,00; 1,02) vs. 1,00 (0,99; 1,00), p = 0,009* antara kelompok MRP dibanding tanpa MRP. Pada bayi penyintas, MRP mempercepat waktu untuk mencapai FiO2 ter-rendah 60,0 (54,00; 75,00) vs. 435,00 (375,00; 495,00) menit, p < 0,0001 dan lama penggunaan alat bantu napas 25,0 (19,00; 37,00) vs. 36,83 (SB 19,11) hari, p = 0,044. Simpulan, MRP bayi prematur tidak terbukti mengurangi kejadian DBP dan atau kematian pada usia 36 minggu. Tidak ada perbedaan cedera alveolar-endotel, curah jantung kiri-kanan, dan diameter DA pada usia 72 jam. Tindakan MRP meningkatkan mikrosirkulasi. Pada kelompok penyintas, MRP mempersingkat waktu mencapai FiO2 terendah dan penggunaan alat bantu napas. ......Lung recruitment maneuver (LRM) is a strategy during mechanical ventilation which aim to open collapsed alveolus in order to increased oxygenation. This maneuver could be done by application of a stepwise increments of positive end expiratory pressure (PEEP) until lowest FiO2 (< 30%) is achieved. There is still lack of evidence regarding relationship between LRM and neonatal outcome. This study aimed to evaluate effectivity of LRM in order to reduce chronic lung disease and it’s influence to neonatal hemodynamic as well. This was unblinded randomized clinical trial which aimed to investigate relationship between LRM and neonatal death, bronchopulmonary dysplasia (BPD), cardiac output, reduction of ductus arteriosus (DA) diameter, skin microcirculations and alveolar-endotel injury. The study was conducted on March 2021 until April 2022 in Cipto Mangunkusumo and Bunda Menteng Hospital. Plasma surfactant protein-D (SP-D) was measured with ELISA, Microparticel endotel (CD-31+) with flowcytometri, left and right cardiac output (LVO and RVO) and DA diameter were measured by echocardiography, TcCO2–PaCO2, tcO2/PaO2 were measured form arterial blood gas and transcutaneous monitor and strong ion difference (SID) from plasma electrolyte. At 36 weeks follow up, there ware no significant difference of incident of DBP and/or death between MRP vs. without MRP groups 38 (69.09%) vs. 43 (78.18%), p = 0.216 (CI 95% 0.141–0.295). There were no difference between MRP and without MRP group at 72 hours, regarding : plasma SP-D, microparticle endotel, cardiac output, DA diameter, tcCO2 gap and SID. At. 72 hours, tcO2 index was better in MRP compared to control group 1.00 (1.00; 1.02) vs. 1.00 (0.99; 1.00), p = 0.009. There were no significant difference regarding other neonatal morbidity between the two group. Among survival subject, LRM reduced time to achieved lowest FiO2 60.00 (54.00; 75.00) vs. 435.00 (375.00; 495.00) hours, p < 0.0001 and length of respiratoy support 25.0 (19.00; 37.00) vs. 36.83 (SD 19.11) days, p=0.044. Conclusion When applied to 24–32 weeks preterm baby with invasive mechanical ventilation, LRM could not reduced DBP or death at 36 weeks of age. There was no any difference at 72 hours regarding alveolar and endothelial injury, left and right cardiac output and diameter DA. LRM was associated with better microcirculation. Among the survivor, LRM reduced high oxygen concentration exposure time and length of respiratory support.