Proceeding JINC

PROCEEDING
2nd JAVA INTERNATIONAL NURSING CONFERENCE 2012
East Meets West on Holistic Nursing

Prof. Soedharto Building, Diponegoro University
Semarang, 6-7 November 2012
Secretariat:
School of Nursing
Faculty of Medicine, Diponegoro University
Jln. Prof. H. Soedharto, SH, Tembalang, Semarang-Indonesia
Phone: +6224 76480919 Fax: +6224 76486849
Email: keperawatan@undip.ac.id
Website: www.keperawatan.undip.ac.id
Organized By:
PROCEEDING 2ND JAVA INTERNATIONAL NURSING CONFERENCE 2012

EAST MEETS WEST IN HOLISTIC NURSING
CONTENT EDITOR: Sarah Ulliya, S.Kp., M.Kes; Ns. Reni Sulung Utami, S.Kep., M.Sc
LAYOUT EDITOR: Nur Laili Fithriana, AMK
COVER DESIGN: Bekti Iskandar, S.Hum
PUBLISHED BY PSIK FK UNDIP

JL PROF SUDHARTO SH
TEMBALANG, SEMARANG
No part of this work may be reproduced, stored, or transmitted in any means, electronic, mechanical,
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Proceeding 2nd Java International Nursing Conference 2012

East Meets West in Holistic Nursing
Semarang: PSIK FK UNDIP, 2012

1 exemplar, 120 pages, 8.27 x 11.69 inch
ISBN 978-602-97846-1-9
We are thank you to our reviewer team:
Wongchan Petpichetchian (Prince of Songkla University, Thailand)

F. Jerome G. Babate (Beta Nu Delta Nursing Society, Philiphina)
Ploenpit Wattananon (Prince of Songkla University, Thailand)
Urai Haithakit (Prince of Songkla University, Thailand)
Edwards Cruz (Centennial Colleage, Toronto, Canada)
Fitria Handayani (Diponegoro University)
Wahyu Hidayati (Diponegoro University)
Setiawan (University of North Sumatra)
Suhartini (Diponegoro University)
iii
PPREFACE
Nowadays, holistic health service has been developed in various parts of both western and
eastern worlds and is regarded as a necessity by most public health services users. Attention
to physical well-being of biological, psychological, social environmental aspects and belief of
developing local knowledge proves to be accepted by society so as to restore the health status
of individuals who are sick in a faster time. High demand of the community on holistic health
care is a challenge for health providers to be able to continue to develop themselves in the
search of quality service forms which are scientifically proven.
Nurses as one of the many health professionals who, in many times, stay close to clients
should always develop themselves in order to provide optimal nursing care and keep up with
development of technology and science of nursing. This is of course to meet the high demand
of public on better and quality health care services. The logical consequence of the magnitude
of people's demand for quality services is the nurses opened insights to the progress of
science and technology both in the field of health in general and nursing. To do so, complete
and diverse rides and facilities are needed to be able to access the latest science emerging in
the world of nursing.
The development of modern information technology increasingly facilitates nurses to access

the latest science and technology that occurs in parts of both western and eastern world
without having to move to a place where science was developed. However, exchange
opinions about science and experience in the nursing field directly in a scientific forum is a
very effective medium to share science and knowledge because it allows direct confirmation
with the concerned researchers, practitioners, and other information resources. This can
minimize the possibility of misinterpretation of one individual to another individual.
Answering the need of information as mentioned above, the Java International Nursing
Conference 2012 (JINC 2012) is conceived as a form of a scientific forum that aims to bridge
the exchange of science, knowledge and ideas related to the advancement of holistic nursing
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which occurs in parts of the western and eastern world. It then can be developed together for
the progress of nursing science which will certainly result in high quality nursing service to
the community. The Java International Nursing Conference 2012 is the succession of the first
similar conference organized in October 2012. The conference is opened to all participants
from Indonesian and foreign countries that concern with the development of nursing and
health care services.
Organizing Committee

The organizing committee includes the following people:
Project Manager
: Ns. Meira Erawati, S.Kep., M.Si.Med
Vice Project Manager
: Ns. Giyatmo, S.Kep
Secretary
: Ns. Elis Hartati, S.Kep., M.Kep

Etty Nurul Afidah, AMK
Treasurer
: Hirsan
Indah Mustika Dewi, SE
H. Marsito, S.Kp., M.Kep.Sp.Kom
Program Committee
: Nur Setiawati D., S.Kp.,M.Kep. Sp.Kom

M. Hasib Ardani, S.Kp., M.Kes
Asih Nurakhir, S.Pd
Sari Sudarmiati, M.Kep.Sp.Mat
Dwi Susilawati, M.Kep. Sp.Mat
Rinna Prasmawati, AMK
Ns. M. Madkhan Anis, S.Kep
Ns. Cahyu Septiwi, S.Kep., M.Kep.Sp.KMB
Herniyatun, S.Kp., M.Kep.Sp.Mat
Scientific committee
: Sarah Ulliya, S.Kp., M.Kes

Wahyu Hidayati, S.Kp., M.Kep. Sp.KMB
Ns. Reni Sulung Utami, S.Kep., M.Sc
Nur Laili Fithriana, AMK
Publication & Documentation
: Ns. Elsa Naviati, S.Kep., M.Kep

Bekti Iskandar, S.Hum
Ns. Siti Apriliani, S.Kep
Margiyono, AMd
Ns. Safrudin, S.Kep., M.Kep
Sponsorships
: Madya Sulisno, S.Kp., M.Kes

Ns. Dhinamita Nivalinda, S.Kep
vi
Facility and Equipment
: Candra Bagus Ropyanto, S.Kp., M.Kep

Pramuji, S.Kom
Evi Silitoma Kriswanto
Wakidjo
Food and baverage
: Septi Harni W., AMK

Titin Supriyanti, S.Kom
Transportation
: Wahyu Erlangga
Abu Mansur
Heri Krisnanto
vii
TABLE OF CONTENTS
ACKNOWLEDGEMENT
PREFACE
CONFERENCE COMMITTE
TABLE OF CONTENT
A WELCOME SPEECH BY THE PROJECT MANAGER
KEYNOTE PRESENTATION
Nursing Knowledge and Nursing Philosophy of Holistic Nursing
PLENARY SESSION I
A. Holistic Nursing: Advancing The Discipline
Marguirete J. Purnell, Ph.D, RN; AHN-BC
B. Development and Implementation of Holistic Nursing in Thailand
Ass Prof. Urai Hatthakit, RN, Ph.D
PLENARY SESSION II
A. Detoxification in Yoga: Traditional Perspective and Contemporary Practices for The
Application of Yoga Therapy
Dr. Hiroshi Aikata
B. The Concept of Holistic Therapy in Indonesia
Ahmad Yani, S.Gz
C. Bringing The Nursing School, Faculty Of Medicine, Diponegoro University to The
Holistic Campus
Fitria Handayani, S.Kp.M.Kep.Sp.KMB
ORAL PRESENTATION
Nursing Intervention, Complementary and Alternative Therapy
Nursing Management
Cultural Diversity in Nursing Care Process
Quality of Nursing Care
Spirituality
Nursing Policies
Nursing Education
POSTER PRESENTATION
ATTACHMENTS
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Welcome Speech
A WELCOME SPEECH BY THE PROJECT MANAGER

Assalamualaikum warahmatullaahi wabarokaatuh
First of all, lets us thank God who has given us his blessings and also a great opportunity so
that we can be here in good health to attend the 2nd Java International Nursing Conference
2012 held in Prof. Soedarto building of Diponegoro University, Semarang, Indonesia.
On behalf of the organizing committee, I would like to welcome all attendees who have been
here this morning and give their valuable contribution towards the running of this event. The
2nd Java International Nursing Conference 2012 is proudly presented by School of Nursing,
Faculty of Medicine, Diponegoro University in collaboration with School of Health Sciences
of Muhammadiyah Gombong, Central Java, Indonesia.
This year conference is the succession of the 1st Java International Nursing Conference which
was organized two years ago on October 2010. The last conference had been successful to
play its significant role as a forum which gathered researchers and practitioners from local
and international to share their knowledge, ideas, innovations, experiences and many others as
well as to establish good networking. All those benefits showed that conference is one of the
effective scientific forums to disseminate any advancement of science especially nursing.
We also hope that this years conference is also successful to bridge the sharing of
information and advancement of nursing among all attendees. East Meets West on Holistic
Nursing has been chosen as the theme of the conference with regards the current issues of
nursing advances which view that efforts to improve human health should be done by
considering all aspects holistically.
The view of the eastern and western countries towards holistic nursing service gives us clear
idea that any nursing care provided to patients should pay attention to local cultures and
wisdoms prevailing in the society. It is with an aim that nursing services we provide will be in
line with the culture and faith of the community. By this year conference, we hope to be able
to address the needs of nursing both for the eastern and the western so as to provide the best
Welcome Speech
service for the community. By the spirit togetherness, we believe that we can contribute to
nursing development in the world.
The 2nd Java International Nursing Conference 2012 is attended by many participants from
diverse cities, regions and islands from Indonesia and some countries abroad. The conference
presents the speakers who are expert in their fields from Indonesia, Thailand, Japan and USA.
We really appreciate and thank them for all their contributions.
This conference would be impossible without great support from Undip, Central Java and
Semarang city government, participants, members of organizing committee, and all
collaboration parties. And on this very special occasion, I would like to thank the Vice
Governor of Central Java, the Rector of Diponegoro University, the Dean of Faculty of
Medicine of Diponegoro University, the Head of Nursing School of Diponegoro University,
all invited speakers, guests, and all participants both local and international for their great
supports on the organization of this conference.
As the chairperson of this conference, I would also thank all members of the organizing
committee who have worked so hard to seek for the best for the running of this conference.
Personally I would apologize for any inconvenience that you may have along with the
preparation of this conference. I hope this conference will develop our insights on advanced
nursing sciences and practices and become a foundation for nursing development in the
future.
Finally, on behalf of the organizing committee, I would like to request the Vice Governor of
Central Java to officially open this conference. I wish you all a successful conference and
very pleasant stay in Semarang, Central Java. Thank you very much.
Wassalamualaikum warahmatullaahi wabarakaatuh
Sincerely yours,
Meira Erawati, Ns.,S.Kep.,MSi.Med

JINC 2012, the Project Manager
Keynote Presentation and Plenary Session
KEYNOTE PRESENTATION
HOLISTIC NURSING: SCOPE AND STANDARDS OF PRACTICE10, 11

OF THE AMERICAN HOLISTIC NURSES ASSOCIATION
(ABRIDGED)
The complete and comprehensive statements of standards of holistic nursing practice are available
from: American Holistic Nurses Association (AHNA),
323 N. San Francisco Street, Suite 201, Flagstaff, Arizona 86001, USA
Marguirete J. Purnell1
SCOPE OF HOLISTIC NURSING

Holistic Nursing is defined as all nursing practice that has healing the whole person as its goal 5,10,11
CORE VALUES OF HOLISTIC NURSING
These core values summarize the ideals and principles of the specialty.
Core Value 1. Philosophy, Theory, and Ethics
Core Value 2. Caring Process
Core Value 3. Holistic Communication, Therapeutic Environment, and Cultural Diversity
Core Value 4. Holistic Education and Research
Core Value 5. Holistic Nurse Self-Care
STANDARDS OF HOLISTIC NURSING PRACTICE
Overarching Principles pertain to Person, Healing and Health, Practice, Nursing Roles, and Self Care.
Standard 1. ASSESSMENT: The holistic nurse collects comprehensive data pertinent to the persons
health or situation.
Standard 2. DIAGNOSIS OR HEALTH ISSUES: The holistic nurse analyzes the assessment data
to determine the diagnosis or issues expressed as actual or potential patterns/problems/needs that are
related to health, wellness, disease, or illness.
Standard 3. OUTCOMES IDENTIFICATION: The holistic registered nurse identifies outcomes
for a plan individualized to the person or the situation. The holistic nurse values the evolution and the
process of healing as it unfolds. This implies that the specific unfolding outcomes may not be evident
immediately because of the non-linear nature of the healing process so that both expected, anticipated,
and evolving outcomes are considered.
Standard 4. PLANNING: The holistic registered nurse develops a plan that identifies strategies and
alternatives to obtain outcomes.
Standard 5. IMPLEMENTATION: The holistic registered nurse implements in partnership with the
person the identified plan.
Standard 5A. COORDINATION OF CARE: The holistic registered nurse coordinates care
delivery.
Standard 5B. HEALTH TEACHING AND HEALTH PROMOTION: The holistic registered
nurse employs strategies to promote holistic health, wellness, and a safe environment.
Standard 5C. CONSULTATION: The holistic advanced practice registered nurse provides
consultation to influence the identified plan, enhance the abilities of others, and effect change.
Standard 5D. PRESCRIPTIVE AUTHORITY AND TREATMENT: The holistic advanced
practice registered nurse uses prescriptive authority, procedures, referrals, treatments, and therapies in
accordance with state and federal laws and regulations.
Standard 6. EVALUATION: The holistic registered nurse evaluates progress toward attainment of
outcomes while recognizing and honoring the continuing holistic nature of the healing process.
Associate Professor, Christine E. Lynn College of Nursing, Florida Atlantic University,

Boca Raton, Florida, U.S.A.
3
Standard 7. QUALITY OF PRACTICE: The holistic registered nurse systematically enhances the
quality and effectiveness of holistic nursing practice.
Standard 8. EDUCATION: The holistic registered nurse attains knowledge and competency that
reflects current nursing practice.
Standard 9. PROFESSIONAL PRACTICE EVALUATION: The holistic registered nurse
evaluates ones own nursing practice in relation to professional practice standards and guidelines,
relevant statutes, rules, and regulations. The holistic registered nurses practice reflects the application
of knowledge of current practice standards, guidelines, statutes, rules, and regulations.
Standard 10. COLLEGIALITY: The holistic registered nurse interacts with and contributes to the
professional development of peers and colleagues.
Standard 11. COLLABORATION: The holistic registered nurse collaborates with the person,
family, and others in the conduct of holistic nursing practice.
Standard 12. ETHICS: The holistic registered nurse integrates ethical provisions in all areas of
practice.
Standard 13. RESEARCH: The holistic registered nurse integrates research into practice.
Standard 14. RESOURCE UTILIZATION: The holistic registered nurse considers factors related
to safety, effectiveness, cost, and impact on practice in the planning and delivery of nursing services.
Standard 15. LEADERSHIP: The holistic registered nurse provides leadership in the professional
practice setting and the profession.
PLENARY SESSION I
Presentation 1
Holistic Nursing: Advancing The Discipline

Marguirete J. Purnell1
Associate Professor, Christine E. Lynn College of Nursing, Florida Atlantic University,

Boca Raton, Florida, U.S.A
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PLENARY SESSION I
Presentation 2
Development and Implementation of Holistic Nursing in Thailand

Urai Hatthakit1
This paper aims to describe and discuss the development and implementation of holistic nursing in
Thailand. The paper discusses about: 1) situation of health problems; health care, the use of
complementary therapy, and holistic nursing; 2) application of holistic nursing in education, practice,
and research in Thailand; 3) evidence-based practice of holistic nursing and complementary therapy;
and 4) the challenges and strategies in applying holistic nursing.
Situation of health problems, health care, the use of complementary therapy, and holistic
nursing
A shift of health problems from infectious acute diseases to noninfectious chronic diseases that are
caused mainly by unhealthy lifestyle such as overwork, unhealthy diet, lack of exercise, and lack of
stress management skills calls more attention on holistic health care and an integration of
complementary therapy to care. Holism is viewed more than an absence of disease. It is a state of
balance of physical, emotional, social and spiritual/ intellectual health. In order to battle with
noninfectious chronic diseases, the Thai government has implemented a new strategy called the
Thailand Healthy lifestyle Strategic Plan (BE 2550-2559) that is a contented lifeway and the use of
Thai Traditional Medicine to promote a healthy and peaceful life. Currently, complementary therapy
especially Thai Traditional Medicine have been fully integrated into all aspects of healthcare. The
governmental hospitals are encouraged to provide Thai Traditional Medicine such as massage, sauna
and spa, and some Thai herbal medicines approved by the government, where appropriate to serve the
demand of the clients. Health insurance covers some complementary therapies such as massage, and
some Thai herbal medicines. Formal education in Thai Traditional Medicine and complementary
therapy is available at the university level. The Department of Thai Traditional Medicine has recently
launched a project to build Thai Traditional Medicine Hospitals in every region of the country. The
first Thai Traditional Hospital is undergoing construction in North Eastern region of the country. This
reflects that complementary therapy has been well accepted by the country health authority. However,
in the area of nursing at the national level in Thailand, issues of policy, and regulation related to
complementary therapy are still lacking. The aspects of nursing education, practice and research have
been initiated and made a great progress by many universities including PSU.
Holistic nursing and integrated care: practice, education and research in Thailand
Holistic nursing has been identified as an essence and unique feature of nursing. It is called upon as
justification for the use of alternative therapies, as instruction to good practice, and as a unique
professional identity in nursing. Within holistic nursing practice, caring is considered as an integral
component that aims to foster healing and wholeness while complementary therapy is used where
appropriate to manage health problems, facilitate holism and promote self-reliance on health.
Caring means connectedness or involvement. It is a fundamental principle of the profession of nursing
and unique to the care expressed through the practice of nursing. The components of 3 H in nursing
(Head, Hand, Heart) representing knowledge, touch, and compassion/ presence are essential to the
construct of caring. The effect of caring expressed through knowledge, touch, and compassion helps
unite body, mind, and spirit to create healing. This holistic caring process results in more holistic
patient care and greater nurse satisfaction.
Knowledge: Within the science and art of nursing, nurse uses knowledge of health, medication, health
technology, complementary therapy, social sciences, and knowledge in philosophy, art, music,
language, religion, history, and ethics including professional values. This knowledge informs the
1
Associate Professor, Faculty of Nursing, Prince of Songkla University

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holistic nurses understanding of health and healing and applying the knowledge about complementary
therapy and practice that a client might use to improve their health. Nurses also can help in providing
information about complementary therapy that is beneficial for the clients in decision making in using
complementary therapy for their health. Hence, nurses equipped with good knowledge and high
nursing competency contribute to the trust and respect on nurses and positive health outcomes of the
clients while unsatisfactory level of nurses knowledge leads to negative health outcomes (Simonsen,
et al, 2011; WHO, 2010).
Touch: The use of touch is an inherent component of the provision of nursing care (Lawler, 1991). A
number of studies have explored touch within nursing practice from different perspectives and have
emphasized it to be a very powerful means of communication that is an aspect of caring central to
nursing practice (Bottorff, 1993; Sims, 1988; Weiss, 1979). Touch can enhance communications and
facilitate social interaction including information giving and the expression of feelings (Fraser & Ross
Kerr, 1993; Tutton, 1987; Sims, 1988). Touch in nursing is an integral aspect of day-to-day care
(Estabrooks& Morse, 1992). This nursing touch is considered as an instrumental touch (Estabrooks&
Morse, 1992) performed through nursing procedures, and as expressive touch (Vickers, 1996)
performed to comforting and calming (Fisher, Gilbert, 1995; Joseph, 1989; Routasalo, Isoal, 1996)
reassuring, caring others (Sammons, 2011). Studies of massage showed positive effects on pain,
symptom distress, and sleep difficulty while studies of therapeutic touch (off-body/gentle touch)
showed to facilitate the flow of energy resulting pain relief. However, it should be aware of culture
and patients attitude on touch.
Compassion: Compassion is a fundamental element of nursing care (Dietze, Orb, 2007). It is care
provision in a dignified manner, warm, sensitive and compassionate way to enhance healing, comfort,
satisfaction, peace, acceptance, confidence, and reassurance (Cingel, 2009; Gibert, 2010). Compassion
means sensitivity to the pain and suffering of another. In Buddhist view, compassion is the desire to
act upon the suffering of other. It is an ethical behavior involving patience and generosity in action
(Michie, 2008). It challenges us to cry out with those in misery, to mourn with those who are lonely, to
weep with those in tears. Compassion requires us to be weak with the weak, vulnerable with the
vulnerable, and powerless with the powerless (Smith, 2010). Similarly, Schantz (2007) states that
compassion impels and empowers people to not only acknowledge, but also action. This involves
focusing on another persons needs and channelling the emotion generated by their predicament into
an active response.
Boykin and Schoenhofer in their theory of Nursing as Caring describe hearing and responding to the
call for nursing. This call doesnt need to be for nursing.it can be the call for service in any given
situation. Again, listening is a key. We must awaken be wide awake to hear the call.listen with our
eyes, ears and hearts. Because messages come in many ways. Respond to the call. It may not be fixing
something.it may be bearing witness to the suffering and being a sojourner with the other on the
suffering journey.
Presence: Presence is important in healing relationship. It is giving full attention to the other in the
moment. Watson and Smith state that transpersonal caring is communicated via the nurses energetic
patterns of consciousness, intentionality and authentic presence in a caring relationship. True presence
is more than just showing up, it is a capability to empathize, listen, reflect, and observe - to be with the
client at that moment (Potter and Frisch, 2007). Being-with or presence is one of Swansons caring
processes. She says it is being fully present to the other involves simply being there, conveying
ongoing availability. She warns that being with is tempered so that the one caring does not burden the
one cared for or that presence isnt sharing information about self or using the other to get ones own
needs met.
Integration of complementary therapy into nursing practice is not a new idea. Nurses in many
countries including the USA, England widely use them to accomplish the goals of nursing. The
position of complementary therapy and guideline of using complementary therapy in nursing have
been stated clearly by nursing organizations in many countries. In Thailand, I and my colleagues have
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conducted a survey on factors influencing integration of complementary therapy into nursing practice
in the southern region of Thailand (Hatthakit et al., 2011). The study was conducted with 557 nurses
working in primary, secondary and tertiary health care settings. The findings indicated that about 40%
of the nurses have obtained some trainings related to complementary therapy. The most frequent
training of complementary therapy taken by them was meditation (27.8%). The extent of integration of
complementary therapy into care was reported in 3 roles: as a healer, a facilitator and a coordinator.
All of these roles as well as the overall level of integration were at a moderate level even though their
attitude and knowledge related to complementary therapy were at a high level. This was probably due
to inadequate skills, supporting policies and health resources related to complementary therapy
available at their workplace. It has been documented that organizational policy was very important to
influence the integration of complementary therapy into the care. Importantly, the nurses perceived
barriers of integrated nursing practice are lack of a clear practice guideline, and lack of incentives/
motivations.
Application of holistic nursing and complementary therapy in nursing: education, practice and
research
Integration of holistic nursing concept and complementary therapy in nursing curriculum
It is clear that the concept of holistic nursing has been integrated into curricula for all the bachelor
degrees in nursing in Thailand with different extent. Most nursing programs have integrated holistic
nursing concept in the subjects such as nursing theories, health promotion, community health nursing,
and etc. However there is no specific program on holistic nursing provided. Some nursing institutions
provide selective courses emphasizing on holistic nursing and complementary therapy.
Faculty of Nursing, Prince of Songkla University has also integrated holistic nursing and
complementary therapy into its all nursing programs; the undergraduate andgraduate programs. There
are several related selective subjects have been offered for graduate program such as Complementary
Therapies and Nursing Therapeutics, and Holistic Nursing and Eastern Healthcare Modalities. The
success of the teaching requires many strategies involving both the practice and policy level such as
curriculum encompassing holistic nursing in education and practice, creating healing-caring
environment, and policyand facilities supporting holistic nursing practice.
Research in holistic nursing and complementary therapy
Research in the area of holistic nursing and complementary therapy has been widely conducted in
Thailand. Most of them explores the effects of complementary therapies in particular the eastern
therapies on health, for examples, meditation, massage, relaxation techniques, yoga and taichi.
However, there are still not many randomized, control trials studies conducted to evaluate the
therapeutic benefits of the therapies.
An attempt to facilitate the research studies in the area of holistic nursing and integrated care, the
Faculty of Nursing, Prince of Songkla University has established the Center for Holistic Health and
Eastern Wisdom. It serves the Facultys vision in promoting the integration of holistic nursing and
complementary therapy/ Eastern Wisdom in nursing as well as to serve the university vision as a
Research University. The primary focus of the center includes research, education, complementary
therapy training, and outreach. The center plays important role in strengthening the research related to
holistic nursing and Eastern Wisdom and research team. Many body and mind activities are provided
at the center to promote holistic health for both insiders (staff, and students) and outsiders (people
living near the university). It is also a placement for training on complementary therapy skills. The
center promotes a culture of mutual community service through working with community experts/
masters in complementary therapy (healers, monks, etc.). The sustainability of the services is through
active network of community experts, masters in complementary therapy and key members of the
center.
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There is growing awareness of the potential value of knowledge in holistic nursing and
complementary therapy in promoting health of people. To make sure that new knowledge is of the
maximum benefit, we need to look at carefully how the research is funded, communicated and
institutionalized. Translation the new knowledge generated by research to policy and practice is also
an issue of concern. Knowledge mostly disseminated through publications may fail to have significant
and sustained impact on policy and practice. A direct engagement with policy-makers, and a
preparedness to translate research findings into a form that could be utilized by policy-makers and
practitioners are found to be most influencing factors.
Integration of holistic nursing and complementary therapy in nursing practice
Holistic and integrated care have been valued by nurses, however the practice in clinical settings is so
diverse especially the integration of complementary therapy into care. Complementary therapy has
been used more extensively in community setting, especially in healthy people to promote health and
in chronically ill patients to manage their health problems and maintain balance in life. There was a
project supported by the Health Promotion Foundation to train nurses in the community to use
qualitative research to promote health and solve health problems in the community. Under the project,
nurses were trained to seek participation of the community in identifying problems and needs of the
community. They were taught to collect data qualitatively and use them to solve the problems. They
were also encouraged to integrate mind body interventions such as meditation, imagery, therapeutic
touch and humor to reduce stress, and to promote self control and positive well-being of the people in
the community (Somjit, 2012). In hospital setting where the Thai Traditional Medicine and
complementary therapies have been integrated into the government hospitals as a separate unit of
service nurses who work in those units practice more integrated care while others do less. Nurses
need to reassess their roles and open themselves to incorporate the beliefs, cultures and demands of the
service users into the care.
Evidence-based practice of holistic nursing and complementary therapy
It is recognized that the intended use of caring and holistic modalities benefit patients, self, and
colleagues as they participate in a caring-healing encounter. Jean Watson (2001) stated that when
nurses include caring and love into their work, they discover that nursing is not just a job but a lifegiving and life receiving career for a lifetime of growth and learning. Research studies exploring
caring among nurses have indicated that nurse caring is a key motivational factor impacting
compassion satisfaction, job satisfaction, recruitment and retention of the nurses. A caring model
developed for the critically ill patients was found to help increase the patients and family satisfaction
as well as nurse job satisfaction (Setiawan, 2010).
A substantial research on the use of complementary therapy for health benefits has been carried out
and many of them showed potential efficacy in reducing many health problems. There are many
research studies reporting the benefits of the body and mind therapies such as yoga, meditation, music
and art therapies that can effectively help relieve both mental and physical health problems. However,
there are still few randomized, control trials supporting therapeutic benefits. There have been many
studies related to yoga conducted, yet there were not many efficacy studies of yoga with strong
research methodology reported. Most of them evaluated the health outcomes as a result of their yoga
intervention often with a small sample size that could not be generalized to larger populations. Trails
may not easy with holistic modalities. It is not only a requirement of substantial commitment from the
participants but the strong research control also could be conflicting with the nature of holistic
approach being used. Holistic approach usually employs multi-modalities rather than single
therapeutic method to serve users healthcare needs.
However, there are some good controlled studies supporting usefulness of yoga and meditation
techniques in diseases like asthma, musculo-skeletal and psychological conditions such as stress,
anxiety and depression (Javnbakht, 2009). In a few experimental studies on cancer patients, the
participants suggested that a yoga program is feasible for patients with cancer and they significantly
improve fatigue (Butthong, Petpichetchian, &Hatthakit, 2009) and sleep-related outcomes. It is
evident that acupuncture, massage and energy therapies play role in managing many physical health
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problems such as pain, and muscle strain. Additionally, there are some of other complementary
therapies that offer a safer, better and cost effective alternative; guided imagery reduces pain, and
anxiety (Sangchart, 2003), music reduces pre and post-operative anxiety, post-operative pain
sensation, and pain distress (Hook, Songwathana, and Petpichetchian, 2008), and Taichi promotes
balance control, flexibility and cardiovascular fitness in older patients with chronic conditions (Wang,
Collect, and Lau, 2004).
The challenges and strategies in applying holistic and integrated care
1) Lack of well-established policies or regulatory issues at both the professional and practice level
to support holistic and integrated care
Clear policy stated the scope of nursing practice related to holistic and integrated care is
required at both the professional and practice level.
2) Lack of clear nursing guidelines for practice regarding holistic and integrated care.
Care provision should be based on research evidence while keeping balance in the
integration of individual experience into care.
Practice guideline is needed to develop to guide the practice.
3) Lack of support and motivation for nurses
Holistic and integrated care should be valued and recognized as a primary nursing action.
Proper incentive and reward should be given, and appreciation should be expressed to
support and encourage the practice.
Nurses themselves have to appreciate that clinical practice is changing and will continue to
do so, and need to recognize that advanced clinical skills and compassionate care are not
mutually exclusive; high tech does not have to mean low care (Davison, & Williams,
2009).
4) Limited availability and suboptimal performance of human resources
Training related to holistic and integrated care should be provided especially to those
senior nurses who had little background knowledge related to holistic nursing and
complementary therapy in their formal training or education.
5) Lack of adequate and strong research evidence regarding the safety and effectiveness of
complementary therapies.
There is usually a rapid expansion of the use of complementary therapies among the users
through direct communication without much concern about harms or risks that may occur.
Strong research design is needed to test the safety and effectiveness of complementary
therapies and make sure that this information is accessible by the users.
Since there are a wide range of complementary therapy, screening for levels of
complementary therapy is necessary. Safety is a primary concern regarding the use of
complementary therapies. Thus, safety evaluations should be conducted to ensure that the
right quality of materials or modality with the health condition needed to be treated.
More systematic research in these areas is needed to multiply these effects on a larger
scale.
6) Nursing curricula are still embedded the medical model, and only few nurse administrators in
health care settings recognize the important of holistic nursing
It is a need to work on the curricula and it is needed to document what nurse really does.
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PLENARY SESSION II
Presentation 1
Detoxification in Yoga: Traditional Perspective and Contemporary Practices for The
Application of Yoga Therapy
Hiroshi Aikata1
1. Introduction
1.1 Knowledge-based approach to Yoga
The term Yoga may be the most well-known Sanskrit word in the world today, and the practical
aspects of Yoga as an Indian fitness system have become a global phenomenon in the past a few
decades among wellness conscious people. Yoga has been evolving as a holistic subject related to
all aspects of human life, physical, mental, social, and spiritual, and also drawing the interests of
professionals in the field of healthcare and education.
The term of Yoga is derived from the Sanskrit root 'yuj' which means to unite or integrate.
Originally Yoga is an ancient system of self-discipline for integration of personality, which is
rooted in a philosophical view of human body, mind and soul in Indian tradition. It was part of
self-mortification practices among Indian ascetics who aspired to achieve the transcendental
experience (samadhi), and strictly preserved within secluded religious communities. However, the
results of scientific research carried on several Yogic methods since 1920s have proved its utility
as a science of health and healing which could be applied for anyone in some modified forms.
Today Yoga is mostly practiced in various modes for the promotion of positive health, the
management of stress and the healing of chronic disorders in psychosomatic nature.
Since Yoga has a long history and distinct cultural background which is very diverse in India, it is
necessary to discern the difference between essential part of Yoga and its ancillary elements. It is
important to take a careful knowledge-based approach based on the theoretical background of
Yoga and scientific interpretation of Yogic techniques, to keep the core of Yoga separated from
any religious doctrine or specific belief system, and to adopted it as methods for the health
promotion and personality development open to all people belonging to any religious faith or
philosophical orientation including atheists. By applying Yoga backed by the knowledge-based
approach in our daily life, we can expect to identify the disturbing elements which cause
unbalance and ill-health in our body-mind complex and to neutralize their negative effects by
adopting appropriate Yogic techniques. We can learn how to lead a balanced and positive way of
life.
1.2 History of Yoga
Yoga has a long history, probably dated back to the origin of Indian civilization. In ancient India,
the wide range of philosophical thoughts and religious traditions had flourished, and along with
them Yoga had developed and functioned as a path of spiritual enquiry, awakened by the desire
for having a deeper understanding of the entire phenomenon of the nature and the meaning of
human life in it.
The oldest treatise on Yoga available to us is Yoga Sutra compiled by Patanjali (probably around
3rd B.C.), which gives the theoretical framework of Yoga. It defines Yoga as cittavrttinirodha, the
cessation of functional modification of mind (= samadhi), which opens the door to the
transcendental experience beyond the phenomenal world. It teaches how to bring ordinal functions
of mind, i.e., cognition (manas), identification (ahamkhara), and determination (buddhi) under
control by the systematic self-discipline over a long time. Through this process, eventually one
can acquire the total control of mental function and also activate the latent faculty of mind
(siddhi). Yoga Sutra influenced almost all of Indian philosophical schools as a theory of mind.
1
Co-director, MCB Foundation Thai Yoga Institute, Bangkok, Thailand

26
In medieval time, technical aspects of Yoga had more evolved as Hatha-Yoga school mainly under
the influence of Tantra movement which dealt with large number of subjects associated with
practical aspects of human life. Ha means sun, tha means moon, which signifies two opposite
forces working in the nature, and Hatha-Yoga means the union of two opposite life forces in the
human body. This school laid a great emphasis on preparing the body as a great vehicle for the
higher spiritual experiences and became very popular among spiritual seekers in those days. This
medieval Hatha-Yoga provides the resource of various technical aspects of Yoga and by now its
modified methods have become very popular throughout the world.
1.3 Modern development of Yoga since 1920's
The new development of Yoga has initiated since 1920s in India and several personalities
contributed to the advancement of Yoga in modern times. Among them, Swami Kuvalayananda
(1883-1966) was a pioneer of scientific research in Yoga and laid the foundation for the further
development of Yoga Research, Yoga Education and Yoga Therapy. He tried to investigate the
physiological effects of Hatha-Yoga techniques on the human body in the laboratory, in the scope
that the age-old system of Yogic discipline would help in promoting the well-being of even
ordinal people, if understood through the modern scientific experimental approach and
disseminated its knowledge through the official channels to the public. He also embarked on
philosophico-literary research in traditional Yoga texts to ensure the authenticity of Yogic
techniques. He initiated knowledge-based approach to Yoga and tried to make Yoga a relevant
science which could play a positive role in the society, particularly in the field of Healthcare and
Education.
He established the Kaivalyadhama Yoga institute in 1924 at Lonavla in Maharashtra State, India,
which was the first research institute in Yoga, and started publishing the journal Yoga-Mimamsato
present the findings of research work undertaken at the institute. In 1950, for the promotion of
Yoga Education, he opened the first college specializing in Yoga, G.S.College of Yoga & Cultural
Synthesis, in order to train qualified Yoga teachers who could teach Yoga at school and college
level. In 1961, he found the Yogic Hospital, a first ever hospital of this kind, devoted exclusively
to Yoga Therapy for the treatment of chronic ailments. In 1964-65 the first research project on the
clinical application of Yoga in the management of Bronchial Asthma was undertaken at that
hospital with the financial help of the government. At present, the institute is recognized by Pune
University as an Institute for Research & Development in Yoga and also carry on Ph.D. program
in Physical Education (Yoga).
1.4 Yoga in the policy level
At the policy level in Indian Government, Yoga combined with Naturopathy is promoted as one of
National System of Medicines at the Department of AYUSH (Ayurveda, Yoga & naturopathy,
Unani, Siddha, and Homeopathy), Ministry of Health & Family Welfare, and two organizations
under the AYUSH are responsible for research, development and promotion of Yoga in
healthcare, namely CCRYN (Central Council of Research in Yoga and Naturopathy) and
MDNIY(Morarji Desai National Institute of Yoga).
Also, at present Yoga is a compulsory subject in school education in many states in India, and
many universities are creating the Department of Yoga and the Yoga center inside the campus all
over the country. The Department of School Education and Literacy, Ministry of HRD (Human
Resource Development), is responsible for promotion of Yoga in education.
2. Yogic Techniques
Yogic techniques for common people which contribute to the well-being and personality
development can be classified into six categories. The nature of all these Yogic techniques is
psycho-physical, and different Yogic techniques are complementary, bringing to similar effects
using different approaches and channels in the body.
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1) Asana (Posture)
2) Pranayama (Breathing)
3) Mudra and Bandha (Gesture and Lock)
4) Kriya (Cleasing)
5) Dhyana (Meditation)
6) Yama and Niyama (Life-style)
2.1 Asana (Posture)

Asana is the technique which deals with special patterns of postures that stabilizes the body and
mind through static stretching. They form the basis of other Yogic practices by preparing an
adequate background for the further development. The aim of asana is to establish proper rhythm
in the neuromuscular tonic impulses and improve the general muscle tone. The two fundamental
principles governing the performance of asana are stability and comfort. It is performed
effortlessly and maintained for a comfortable time. The nature of asana is not only physical, but
psycho-physical and the effect on the mind is also important. There should be no violent
movements and no undue fatigue after the performance of asana. It is further classified in three
groups, i.e., asana for meditation, for conditioning, and for relaxation.
2.1.1 Asana for meditation
This group of asanas is a sitting posture which maintains the body in a steady and
comfortable condition. They are formed by various arrangements of the legs and hands to
keep the head, neck and trunk erect.
2.1.2 Asana for conditioning
They involve static stretching which bring about proper tone of the muscles and contribute
to the flexibility of the spine and render back and spinal muscles stronger. They also
stimulate proper working of the vital organs in the thoracic and abdominal cavities. There
are many varieties which are performed in sitting, lying and standing positions. Usually the
practice of this group of asanas is perceived as the practice of Yoga for the majority of
people.
2.1.3 Asana for relaxation
These asanas are performed in the lying position and are meant for giving rest to the body
and mind. They are few in number but important to attain the total relaxation.
2.2
Pranayama (Breathing)
Pranayama is the breathing technique to bring control over the respiratory impulses which form
one of the channels of the flow of autonomic nerve impulses. The main purpose is to gain
control over the Autonomic Nervous System (ANS) and through it influence the mental
function. It is useful in preparation for higher practices like meditation. There are many varieties
which use different breathing techniques through one or two nostrils or sometimes inspiration
through the mouth. The essential technique of pranayama is to hold the breath for a prolonged
and comfortable time, but in the initial stage, the practice of controlled inspiration and expiration
with a time ratio of 1:1 and 1:2 is emphasized.
2.3
Mudra and Banda (Gesture and Lock)

These are the peculiar techniques in Hatha-Yoga, to form locks and holds of the semi-voluntary
and involuntary muscles in the body. They decongest the vital organs, improve circulation and
nutrition by pressure manipulations and contribute to general health and emotional stability.
Mudras that are used in pranayama are usually called bandhas because they bind and channelize
a particular nervous activity in a particular place or direction. Jalandhara (chin lock), Uddiyana
(abdominal lock) and Mula (pelvic lock) are important bandhas, and Viparitakarani (inverted
position) is an important Mudra for the common purpose.
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2.4
Kriya (Cleansing)
Kriya is the technique to stimulate purification processes usually classified into six divisions,
i.e., dhauti, basti, neti, trataka, nauli and kapalabhati, and each one of which consists of many
subsections. The aim of kriya is to increase the range of adaptability of the tissues forming
various organs and systems and to raise the threshold of their reactivity. They bring control on
different reflexes and establish the better psycho-physiological balance.The modes of
purification in kriyas are air, water, frictional manipulating movements, and the regions of
cleansing are nasopharyngeal, cranial, gastroesophageal, intestinal and rectal.
2.5
Dhyana (Meditation)
Dhyana is the technique directly involving the control of mental functions. It starts from the
initial withdrawal of the senses from external objects to the complete oblivion of the
environment. It is a process of internal absorption in which the individual tries to turn his
attention to dwell upon a single object, sound, concept, or experience. It works as a great
tranquilizer. The principle of dhyana is to develop inner awareness of our mental processes
including the thoughts, emotions, memory etc., to realize how the restless mind causes the
feeling of emotional stress, constant fear and insecurity. The regular practice of dhyana
gradually restores the psycho-physiological functions back to its healthy, harmonious and
balanced state.
2.6
Yama and Niyama (Life-style):

Yama is self-imposed restrictions to govern our behavior and niyama is positive life-style
training which would help in building up our personality in tune with universal value such as
non-violence, non-stealing, truthfulness, contentment, simplicity, cleanliness, patience, etc. The
positive changes in our attitude, behavior and life-style would help in inducing the feeling of
sharing, love and respect in relationship with other people and with the whole world around.
These build up the basis of all the Yogic practices to lead an integrated way of living.
3. Detoxification and Yoga

3.1 Shodhanakriya (Internal cleansing)
Sodhana is a concept in Yoga which is relevant to detoxification in modern context. It is an
important part of Hatha-Yoga. Literally sodhana means an internal cleansing or a purification,
but in a wider sense of the term it also includes the meaning of conditioning or strengthening. To
ensure the steady progress in a spiritual pursuit, it was the first priority for Yogi (Yoga
practitioner) to maintain the body healthy and be free from diseases, and therefore various
methods to eliminate toxic substances which hinder the normal functions of body were well
developed.
In a broader sense, all Yogic methods contribute to the cleansing the body-mind complex but in
a restricted sense, the Yogic techniques for detoxification are called Kriya (cleansing) or Shatkarma (six cleansing processes). These detoxification methods are the special feature of HathaYoga and very elaborately developed in its curriculum. They not only remove the toxic matter
inside the body but also bring about an increased range of adaptability of the tissues forming
various organs and systems, as well as raising the threshold of their reactivity, establishing better
voluntary control on different reflexes.
The most important text of Hatha-Yoga, Hathapradipika(14th AD), explains the necessity of the
internal cleansing practices to restore the balance of humors inside the body, and described these
six classes of techniques as Shat-karma, i.e., dhauti, basti, neti, trataka, nauli, kapalabhati.
29
II-21. Those having an excess of fat (meda) or phlegm (shleshma) must practise the six internal
cleansing processes first (before attempting pranayama). Those in whom the three humours
(doshas) are in a state of equilibrium need not practice them.
II-22.Dhauti, Basti, Neti, Trataka, Nauli and Kapalabhati are called Shat-karmas.
3.2 Concept of Nadi and Nadisuddhi

More specifically, the concept of detoxification appears in Hatha-Yoga texts as Nadisuddhi,
purification of the channels (nadis) inside the body through which the vital energy (prana) flows,
according to the traditional Indian anatomy and physiology. Shat-karma is part of Nadisuddhi in
a gross and preparatory level, and in a subtler and advanced level, it is done through breathing
techniques (pranayama + mudra). In the traditional view, the nadis in the body are often filled
with impurities or the toxic substances (malas) because of irregular schedules of meals, sleep,
stress, pollution, infections and other disrupting factors both internal as well as external, and due
to the accumulation of malas the flow of prana may be obstructed, causing a disturbance in
functioning the organs and an imbalance of body-mind coordination. The purification processes
of nadis are mandatory not only to maintain sound health of Yogi but also for the further
progress towards the goal of Yoga.
II-4. If the Nadis are full of impurities, Maruta(= prana) does not travel along the middle path.
How can (then) one attain the state of Unmani(= samadhi), how can one succeed in one's aim ?
30
II-5. It is only when the whole group of Nadis which are (ordinary) full of impurities, gets
purified that the Yogi becomes capable of (properly) regulating Prana.
3.3 Effects of NadiSuddhi

The effects of Nadisuddhi are mentioned in Hathapradipika as these 6 points.
1) Kayasyakrsata.............slimness of the body
2) Kantistatha....................beauty, loveliness, desirous outlook
3) Vayuhdharanam...........holding breath easily, attaining stability
4) Analasyapradipanam...stimulating digestive power
5) Nadaabhivyaktir............manifestation of nada (internal sound)
6) Arogyam........................free from disease
II-19. When the nadis get purified, appearance of external signs like slimness of the body and
lustre, are certain.
II-20. By purifying the nadis, one is able to retain breath with ease, the (gastric) heat is
increased, and experience of (internally aroused) sound and good health are secured.
4. Techniques of Kriya or Shat-karma
4.1 Dhauti (cleansing the upper digestive track)
Dhauti works for cleansing the upper digestive track. There are three types of dhautis
prominently practised, namely, Vamanadhauti, Dandadhauti and Vastradhauti.
4.1.1 Vamanadhauti (vomiting)
[Method] Drink tepid salty water to fill the stomach completely and insert the three
middle fingers into the throat and tickle it to vomit out the water. Repeat vomiting till all
water is thrown out.
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[Effect] This technique removes the contents inside the stomach including excess
secretions and undigested food.
4.1.2 Dandadhauti (cleansing the stomach using water & tube)
[Method] Take a 2 feet long rubber catheter of 1/8 inches diameter. Drink a couple of
glasses of water. Swallow one end of the tube. When it passes through the gullet push it
further. After about half the length of the tube enters in the stomach, lean forward and
inhales a little. The water from the tube will start flowing out. When the flow stops push
the tube back and forth so that enough water is thrown out.
[Effect] It is useful in overcoming the tendency of biliousness and acidity. It also relieves
respiratory discomfort.
4.1.3 Vastradhauti (cleansing the stomach using the cloth)
[Method] A strip of fine cotton cloth measuring 3 inches in width and 20 feet in length,
The moist cloth is slowly swallowed and the intermittent vomiting reflexes are
controlled. With persistent efforts one is able to swallow the whole cloth easily. When
the whole cloth is swallowed, one gently pulls out the cloth.
[Effect] It effectively remove excess mucus lingering on the esophageal walls and in the
stomach, also reflexively stimulates the respiratory function. It has been found very
effective all the respiratory problems especially asthma.
4.2 Basti (cleansing the lower digestive track)

Basti works for cleansing the lower digestive track.There are two types of basti, i.e., Jalabasti
and Vatabasti.
4.2.1 Jala basti (cleansing the colon using water)
[Method] It is a type of enema but require the active effort. One inserts into the anal canal
a wooden tube of about 3/8 inches diameter and 6 inches in length, which is well
lubricated. One third portion of the tube is inserted in the anus and 2/3 is kept out. The
outer end is dipped into the water when one sits in a squatting position. Then one practices
Madhya nauli (isolation of recti) which helps in sucking the water into the rectum. When
sufficient water is sucked withdraws the tube and evacuates the contents inside.
[Effect] It removes the fecal matter lingering on the walls of the rectum. By reflex
stimulation the large intestines are relieved of congestion and it contributes to the feeling
of well-being.
4.2.2 Vata Basti (cleansing the colon using air )
[Method] It is done by sucking the air instead of water, most suitably done in a back-lying
position. One has to raise the buttocks by folding the thighs on the chest and support them
with hands. Then with repeated attempts of Madhya nauli (isolation of recti). One sucks
the air into the rectum and throws it out by releasing the Nauli (isolation of recti).
[Effect] It removes the fowl gases lingering in the rectum and relieves one of the toxic
effects.
4.3 Neti (cleansing the nasal cavity)

Neti works for cleansing inside the nasal cavity. There are two forms of neti, i.e., Jalaneti and
Sutra neti. Both types are useful in the care and prevention of complaints related to the ear, nose
and throat, particularly helpful in chronic respiratory conditions.
4.3.1 Jalaneti (cleansing the nasal cavity with water)
[Method] Take tepid salty water in a feeding cup or a small pot having a nozzle. Insert
the nozzle in one of the nostrils. Bend the head a little sidewards and pour the water
slowly into the nostril. If the water is not swallowed it comes out through the other
nostril. Then repeat the same procedure with other nostril. Thus the nasal cavity is
cleansed with the water.
32
[Effect] It removes excess mucus and impurities in the nose, reduces inflammatory
conditions and builds up resistance to the sensitivity of inclemency of weather and
pollution in the atmosphere.
4.3.2 Sutra neti (cleansing the nasal cavity with the string)
[Method] It is another form of making the nasal mucosa resistant by giving a friction
effect through a string or rubber catheter. After sterilizing the catheter in the antiseptic
solution or in boiling water, insert the smaller end into one nostril and when it reaches the
throat pull it out of mouth with the fingers. Then holding two ends in two hands give a
few gentle frictions and pull it out from the mouth. Repeat it on the other side.
[Effect] It is very effective in removing any antigen particles lying along the nasal
mucosa. Thus the nasal air passage becomes clear.
4.4 Trataka (cleansing the eyes)

[Method] It is still-gazing at a point selected in the form of a black dot on the paper, or an
unwavering flame or any other object of choice. One has to continue still-gazing until tears roll
down.
[Effect] It improves the eyesight and tones up the visual mechanism, also helps in concentration.
4.5 Nauli (cleansing the entire abdominal area)

[Method] It is described as isolation and rolling manipulation of the abdominal recti. One stands
with feet apart. Then he breathes out completely and leans forward. He holds his breath out and
without allowing the air to let in expands his thorax. This results in forming a depression in the
abdomen (which is known as Uddiyanabandha). After stabilising in this stage for a few seconds
to relax the abdominal wall, he presses on the knees with the hands without contracting the
abdominal muscles, resulting in isolation of the two abdominal recti. This is known as Madhya
nauli (central nauli). After this practice when he presses his hand on one side and releases the
pressure on the other he gets isolation either on the right or left side. This is called Daksina (left)
or Vama (right) nauli respectively. When he practices different stages in the following sequence
he is able to rotate Nauli which is termed as Naulicalana (rotating nauli). Depending on ones
breath holding capacity one may practise number of turns of Naulicalana.
[Effect] It removes constipation and improves digestion, promotes the efficiency of the
abdominal organs and bestows a feeling of well - being.
4.6 Kapalabhati (cleansing the respiratory track)

[Method] It involves forceful and fast diaphragmatic breathing. In a comfortable sitting position
one exhale forcefully by contracting the abdomen and inhales. The exhalations and inhalations
accompanied by the abdominal movements are undergone in quick succession for a number of
times depending on ones capacity in the speed of 120 rounds per minute.
[Effect] It is a great cleanser of the respiratory passages including the sinuses. It improves
respiratory function and promotes blood circulation.
5. Yoga Therapy
5.1 Principle of Yoga Therapy
Based on many scientific studies since 1920s, it is established that Yoga can be effective as an
alternative and/or complimentary therapy for chronic functional disorders. Chronic diseases
occur when the body is not able to cope with the external disturbing factors or some internal
maladjustment, due to lack of cooperation between the different systems and organs in the body.
The fundamental principle of Yogic therapy is to make the body healthy by putting up an
effective resistance against the disease processes by correcting imbalances. Our body has innate
capacity in adapting to the changing environment (homeostasis), and it can be directed towards
putting up an effective defense against physical and mental diseases. The various traditional
Yogic practices provide the methods for training the organ and re-establishing proper
33
coordination and harmony between the functions of the body and the mind. Chronic psychophysiological disturbances that affect the conditions of the muscles and viscera could be set right
through such processes. Yogic therapy responds positively to these ailments.
5.2 Therapeutic value of Yogic detoxification process (shat-karma)

Yogic detoxification processes (shat-karma) are part of methods of modern Yogic therapy and
are actively applied for the treatment of chronic functional disorders. Autonomic and
proprioceptive neuromuscular reactions have an important bearing in bringing about these
results, and better voluntary control is established on different reflexes through the practices of
Shat-karma. For example, dhauti is used to gain control over vomiting reflex. This reflex is
controlled by two methods, by inhibition during Dandadhauti and Vastradhauti, and by
stimulation as in Vomandhauti. They are effective in regaining psycho-physiological balance,
and supportive of other Yogic practices like asana, pranayama and meditational techniques for
strengthening and tranquilizing the psycho-physiological complex structure.
5.3 Steps for Yogic therapy

An all-around and complete Yogic therapy consists of four steps. It is rather an educational
program and the active participation of patients is required. The best possible results are
expected in a residential facility during the treatment and learning period.
1) To cultivate the correct psychological attitude.
2) To recondition the neuromuscular and neurograndular systems
3) To enable them to withstand greater stresses and strains of life.
4) To encourage the various natural eliminating processes of the body to work efficiently,
5) To regulate the diet and day-to-day behavior.
5.4 .Example of the weekly program

This is an example of one-week residential Yogic Therapy program at the Healthcare center in
Kaivalyadhama Yoga Institute, Lonavla, India. Common Yogic detoxification processes like
neti or dhauti are practiced in the morning, and trataka for a few times in the evening. Apart
from Yoga class (asasa, pranayama, mudra &bandha) twice a day, morning and afternoon, some
treatments of Naturopathy or Ayurveda (Indian traditional medicine) are prescribed in the
daytime, also some lectures are given after the dinner.
34
The whole treatment process is supervised by the team of doctors and Yoga instructors with
daily consultation with them. Patients may stay at the center for at least a week or longer
according to the necessity and the health condition to be improved through Yogic therapy. They
and expected to continue some Yogic practices at home learnt during the stay at the center. Time
Sunday Monday Tuesday Wednesday
6. Conclusion
Yoga is a popular phenomenon all over the world and keeps on drawing the interest of health
conscious people. With the careful knowledge-based approach, Yoga can be an effective method
for the promotion of health and the healing of chronic functional disorders. Yogic practices for
detoxification (shat-karma) are an important part of Yogic therapy. These detoxification practices
not only facilitate the elimination of the toxic matter from the body but also establish better
voluntary control on different reflexes, making the body healthy by putting up an effective
resistance against the disease processes. In the holistic healthcare, various Yogic methods may be
more explored and applied for the benefits of people who are searching for the alternative
approaches.
35
Reference:
1. Kuvalayananda, S. Asana.Lonavla:Kaivalyadhama S.M.Y.M.Samiti,1933.
2. Kuvalayananda, S. Pranayama.Lonavla: Kaivalyadhama S.M.Y.M.Samiti, 1931.
3. Kuvalayananda, S.andVinekar,S.L. Yogic Therapy; Its Basic Principles and Methods. New
Delhi: Central Health Education Bureau,Directorate General of Health Services, Ministry of
Health, Government of India,1963.
4. Gharote, M.L. and Ganguly, S.K.; Teaching Methods of Yogic Practices. Lonavla:
Kaivalyadhama S.M.Y.M.Samiti, 1988.
5. Gharote, M.L. Yogic Techniques. Lonavla:Lonavla Yoga Institute,1999.
6. Digambar, S. and Kokaje, R.S. Hathapradipika Ed. Lonavla:Kaivalyadhama
S.M.Y.M.Samiti,1970.
7. Digambar, S. and Gharote, M.L. GherandaSamhita Ed. Lonavla:Kaivalyadhama
S.M.Y.M.Samiti,1978.
8. Gharote, M.M.andJha,V.K.et al. Therapeutic References in Traditional Yoga Texts.
Lonavla:Lonavla Yoga Institute,2010.
9. Gore, M.M. Anatomy and Physiology of Yogic Practices. Lonavla: KanchanPrakashan, 1984.
10. Sahay, G.S. and Tiwari, S. Yoga Modules for Institutions of higher Learning. Lonavla:
Kaivalyadhama Yoga Institute, 2009.
Website
1. Department of AYUSH, Ministry of Health and Family Welfare, Government of India.
http://indianmedicine.nic.in/
2. Central Council of Research in Yoga and Naturopathy, New Delhi. http://www.ccryn.org/
3. Morarji Desai National Institute of Yoga, New Delhi. http://www.yogamdniy.com/
4. Kaivalyadhama Yoga Institute, Lonavla. http://www.kdham.com/
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PLENARY SESSION II
Presentation 2
THE CONCEPT OF HOLISTIC MEDICAL TREATMENT
Ahmad Yani1
Nowadays, health service is a major requirement in preparing a productive community effectively and
efficiently as the main role of a nation's progress. Indonesia with 230 million people require a
professional health service. The existing conventional health services have not been able to reach the
largest part of the population, thereof there must be a preparation of health services design that are
effective, safe, easy, and affordable. Besides, it is necessary to consider in avoiding the use of
conventional medicines having bad effects and the materials are depending on the market share owned
by the foreign pharmaceutical companies.
Therefore, it is needed to have an effective, save, easy and economic concept of health services i.e.
the concept of holistic health services by using natural medicine ingredients. Health is the most
expensive wealth. To be totally healthy, it is depending on us, rather than on doctors and medicine.
Therefore, we should be able to communicate with our bodies, so that we can treat our body tactfully.
When the body becomes sick, the disharmony of the body appears, such as pain, weak, disgrasp, loss
of appetite, fever or other common complaints that we feel. Those indications are not a disease.
However, it is how the body is communicating to us. All of the indications are the body signals in
communicating to us, the owner of the body. It is aimed to tell us that there must be troubles which
can danger our body if they are ignored.
Food as the Principal Medicine
The body tells us that the balance of nutritions has long been disturbed, or the acumulation of toxic
(poison) come to the peak. Frequently, those indications are the representative of the body signal in
demanding its rights and needs such as nutrition. In fact, the nutrition is a positive signal in which the
body is not able to do the routine tasks. Therefore, it is better for us to welcome the body complaint
rather than stuff it with various drugs.
Holistic Medicine is one of self-discipline consisting of a combination of various treatments (including
the system of western medicine / conventional treatment and east / eastern medicine) that can be
accounted for body treating medically and science as a whole body of work by restoring the working
balance of organs optimally which involve physical, psychological, mental, and emotional
emphasizing on food / diet as the main medicine. The concept of holistic health includes the overall
effort of preventive and promotive that has been abandoned by the health services in Indonesia
generally, besides, the curative and rehabilitative. Holistic Health Concepts emphasize on the efforts in
eliminating the cause of disease instead of the indications, and restore the normal function of the body
which has perfect body mechanism defense and self-repairing system (a system that allows the body to
repair itself). A healthy diet (diet) is the basis of holistic treatment.
If we take a look closely,the real functioning of all body functions is determined by a balanced
nutritional intake and which is obtained by setting a good diet. Unhealthy diet will cause disruption to
the system / body functions which lead to a sick body. Therefore, the disrupted system will cause
impaired immune system powerless to stem the disease from outside and as the result, the body will
get sick. However, health is not only about the physical, in this case, WHO determined that it is
included healthy physical, mental, social, and economic. This is that so called as good healthy
mentally and physically!
1
Practitioner and Holistic Nutrition Consultant, Holistik Purwakarta Hospital Delegation of International
Holistic Tourism Hospital, Purwakarta.
37
As we know, the concept of conventional medicine is getting far away from achieving this healthy
standard as a whole. The pharmaceutical factories are competing to produce chemical synthesis drugs
which are intentionally directed to relieve the symptoms of the disease rather than the cause. This is
due to the market demand (consumers) who want instant drugs. The health concept has been
conquered by the wrong market demand! Healthy is an asset that should be preserved and maintained.
Mostly, every person will try his best to keep healthy, because our body is entrusted by GOD to keep
it.
The Basic Principles of Holistic Treatment
Holistic treatment is a medical treatment based on the natural law consisting of some parts depending
on one another. The nature consits of water, air, plant, animal, etc. which are all related to one another.
The nuisance in one part will affect other parts, causing an imbalance. The same thing happens to the
human body consisting of parts of physical, mental, emotional, social and spiritual which is a united
and can not be separated from one another. When one part is disturbed or not working properly, it will
affect the other. It also happens between the natural to the human body.
In Holistic medical treatment, individuals will be trained to communicate with the body. A
disharmony occurs in the body will signal out of the body in the form of symptoms and signs.
Therefore, in a holistic manner, the signs and symptoms should not be suppressed, but it is used for
the guidance to know the illness / imbalance occurs, and the symptoms will be going away on its own
if the main cause is solved. The advantages of applying holistic principles and holistic approach has a
higher position than just prevent the disease. A holistic approach will support the person's vitality, a
persons psychological to live with optimal quality.
Referensi
1. Husen A. Bajry Tubuh Anda Adalah Dokter yang Terbaik PT. Karya Kita, Bandung 2008
2. Berne S. Siegel Peace, Love & Healing Rider Arrow Edition, London 1991
3. Http://www.holisticindonesia.com
4. Http://www.bps.go.id
38
PLENARY SESSION II
Presentation 3
BRINGING THE NURSING SCHOOL, FACULTY OF MEDICINE, DIPONEGORO
UNIVERSITY TO THE HOLISTIC CAMPUS
FitriaHandayani1
Holistic Nursing Team
Faculty of Medicine, Diponegoro University,
Semarang, Indonesia
This paper aims to describe and discuss the implementation of holistic nursing in Nursing School,
Faculty of Medicine, Diponegoro University, Indonesia in bringing the school to the holistic campus.
The paper discusses about: 1) policy making; 2) integration of holistic nursing into education,
research, and community service; 3) holistic nursing project.
The vision and mission in running the education in nursing school has been changed since October
2010. The school has its vision and missions to strive to the holistic nursing. The statement of the
vision is that School of Nursing Faculty of Medicine Diponegoro University becomes a center of
holistic nursing development which is able to compete nationally and internationally in 2020. In the
efforts to achieve the vision, School of Nursing Diponegoro University defines its five missions,
which are (1) developing a center of holistic nursing education in global level, (2) developing a
research center of holistic nursing, (3) developing a center of holistic nursing activities and services,
(4) producing patents in nursing particularly holistic nursing, and (5) developing a complete nursing
care. The change of this policy has influenced the whole programs and activities in the school.
The Undips School of Nursing implements the holistic nursing in strategic planning which involve
creating holistic environment and integrating holistic nursing concept into education, research,
community services. To focus on holistic improvement, nursing school conducts the holistic project to
facilitate the whole activities in the school related to holistic nursing. In creating the holistic
environment, we have and preserve a value for all the members of the campus. The value is Mendidik
dengan Hati, Bekerja dengan Cinta (educating with heart and working with love). This value is
embodied in the whole staffs and students. In order to embody this value, all members of the school
bring the value into the real world in activity of daily livings. Every person trains themselves to be
aware and respect with oneself, others and the environment.
There are four elements in integrating the holistic nursing into education in our school, which are; 1)
integrating holistic nursing into the curriculum; 2) conducting scientific meetings and activities related
to holistic nursing; 3) conducting the teaching and learning activities in holistic environment; and 4)
facilitating students activities to build their positive characters. Nursing school integrates the holistic
nursing into the curriculum since the vision and missions in holistic nursing were established. The
holistic concept is integrated in every subject, and specific credits in holistic nursing studies are also
provided. The credits are six credits. The subject of holistic nursing was provided with CAM
(Complementary Alternative Modality). CAM therapy is expanding the strategies that nurses can
employ independently in providing holistic, body-mind-spirit-care (Dossey, Lynn, & Cathie, 2005).
Related to the implementation of teaching and learning in clinical settings, the students attempt to use
CAM as nursing intervention, which can be in the form of music intervention, SEFT, and
hypnonursing.
In relation with the scientific meetings and activities related to holistic nursing, the school attempts to
conduct holistic nursing conference in which the first was organized in October 2010. Beside that,
there are also many lecturers and students who join the CAM trainings, which include SEFT, hypnobirthing, hypno-nursing, and many others to enhance their capabilities in holistic nursing. The students
1
Lecturer of School of Nursing, Diponegoro University

39
are also given opportunity to have study visit to the holistic hospital to learn to engage holistic services
in nursing care delivery. Students also have opportunity to have study visit to other universities abroad
which have the same vision, for example the Prince of Songkhla University, Thailand.
The teaching and learning as the center of activities in nursing school lead to the improvement of
holistic campus activities. It is done by considering the students as the subject of the process. This is in
line with the profile determined by the university for all its graduates which is COMPLETE which
stands for Communicator, Professional, Entrepreneur, Thinker, and Educator. This concept supports
the integration the holistic nursing to the teaching learning process. Since students are the center of the
teaching learning process, the method of the process in class focuses on students centered-learning. A
number of techniques are applied such as interactive skill station, seven jumps, mind mapping,
cooperative learning, small group discussion and many others. These techniques allow student to learn
how to know, to learn how to be, to learn how to do, and to learn how to live together with others.
Student centered learning makes students be more active and have more chances to build their positive
characters. Lecturers have more chances to observe students characters during the learning process.
Characters are also a part of the assessment of the learning. The examples of the characters which
students develop are empathy, caring, responsible, discipline, respect and trust, and many others.
In the school, the research is led to the holistic nursing theme. The lecturers and students gain many
topics in holistic nursing, for example:
Effectiveness of hypnotherapy towards pain for post surgical ovary cystic
Effectiveness of hypnotherapy toward pains in cervical cancer
Music intervention in various clinical settings
Effectiveness SEFT in alteration of mental health
Effectiveness of SEFT in elderly with depression
Javanese people beliefs about suggestions and prohibitions during pregnancy and post
partum
Loosing process in Javanese family with stroke patients
Family burden in client of stroke rehabilitation
The community services are also given a focus on the implementation of holistic nursing. The
lecturers and students conduct a number of social activities, which can be in the form of:
Sowan Method in promoting health status in community
Trauma healing for earth quake and volcanic eruption disasters
Rheumatic exercises
DM Type II exercises
Elderly exercises
Playing therapy,
and many others
To focus on holistic improvement, nursing school conducts holistic projects to facilitate the whole
activities in the school. The aims of the project are:
To develop holistic nursing healing in context of complementary nursing intervention
To spread the information and services in holistic nursing healing
To gain the body of knowledge in holistic nursing
To conduct some researches in holistic nursing
Some activities related with holistic nursing which are continuously organized are:
Yoga which is running every week
Meditation and spiritual program
Rest and sleep therapy
Cupping
LCD (loving in cultural diversity)
40
There are many challenges meet since holistic nursing was established. The examples of those
challenges are 1) diversity of students and staff culture and values in campus; 2) different perception
and knowledge in applying holistic nursing; 3) the lack of resources in embodying holistic nursing,
such as lack of human resources with CAM capabilities, lack of holistic nursing books in library; 4)
Lack of research utilization in teaching learning and clinical setting; 5) lack of networking with
institution in holistic nursing area. Considering all those challenges, the school should then have
particular policy, activities and programs to solve the challenges.
Reference:
Dossey, BM, Lynn K, Cathie, GE. (2005). Holistic Nursing: a Hand Book for Practice. Canada: Jones
and Bartlett Publishers.
41
Nursing Intervention, Complementary, and Alternative Therapy
EFFECT OF PROGRESSIVE MUSCLE RELAXATION TECHNIQUE ON BLOOD SUGAR

LEVEL IN PATIENTS WITH TYPE 2 DIABETES MELLITUS
Tika Yuliani, Wenny Savitri, Masta Hutasoit
Ahmad Yani School of Health Sciences, Yogyakarta
ABSTRACT
Background: Diabetes Mellitus is a degenerative disease that is often identified until complications
arise. It is also known that Diabetes Mellitus is a chronic disease that cant be cured, so that it needs
continuous treatment to control hyperglycemia to avoid the complications. One of the precipitating
factors of hyperglycemia in patients with Diabetes Mellitus Type 2 is stress. Stress could participate in
the release of epinephrine, which increase the conversion of glycogen to blood sugar. Many
complementary therapies can be used by nurses to overcome the balance of emotional distress. One of
the interventions is progressive muscle relaxation technique. Purpose: To identify the effect of
progressive muscle relaxation techniques on blood sugar in patients who have type 2 Diabetes Mellitus.
Method: A quasi experiment research design with pre- post intervention with control and experimental
groups was utilized in this study. Twelve participants who met the inclusion criteria were recruited for
each group. Data was analyzed using Paired sample t-tests with p <0.05. Result: The reduction of blood
sugar levels in intervention group (t= 5.177, p=0.000) was higher than blood sugar levels in control
group (t= 3.833, p=0.003). Conclusion: Progressive muscle relaxation technique was effective to reduce
blood sugar level in patient with type 2 Diabetes Mellitus.
Keywords: Diabetes Mellitus, Progressive Muscle Relaxation Technique, Complementary Therapy.
EFFECTIVENESS OF COMBINATION OF MARMET TECHNIQUES AND OXYTOCIN

MASSAGES TO BREAST MILK PRODUCTION ON POST CESAREAN SECTION WOMEN
AT CENTRAL JAVA HOSPITAL
Eko Mardiyaningsih, Setyowati, Luknis Sabri
ABSTRACT
Background: The research background was the deflation of breast-milk production during the first
days after bearing because of the incision pain. Purposes: The objective of this research was to test
the effectiveness of combination of marmet techniques and oxytocin massage to breast-milk
production on post cesarean section women. Method: This was a quasi-experiment research using
post-test only design with a control group. Fifty four respondents were recruited using consecutive
sampling, a non-probability sampling technique. Respondents were divided into two groups; 27
respondents in control group and 27 respondents in treatment group. The intervention was performed
in the 1st, 2nd, 3rd day post cesarean section. Data was statistically analyzed using Chi-square. Result:
The result showed a difference between the proportion of breast milk production among controlled
group and intervention group (p value=0.000). This study also showed that post cesarean section
women who had given combination of marmet technique and oxytocin massage had 11.5 greater
opportunity to have smooth breast milk production compared to controlled group (OR= 11.500).
Conclusion: The intervention can be applied in hospital as an effort to increase breast milk production
on post cesarean section women. It is recomended for further research in controlling nutrition and
psychological factors of breastfeeding mother.
Keywords: Marmet Technique, Oxytocin Massage, Breast-Milk Production.
43
A COMPARISON BETWEEN THE EFFECTS OF GENERATIVE AND CONCENTRATIVE

MEDITATION ON HIGH SCHOOL STUDENTS MENTAL HEALTH
Agustina Ari Handayani
An-Nur School of Health Science, Purwodadi
ABSTRACT
Background: An estimation of 10-20% teenagers has experience with mental health problem.
Commonly, mental health problem was presented with depressed mood, loss of interest or pleasure,
feelings of guilt or low self-worth, sleep disturbance, loss of appetite, low energy, and poor
concentration. Then, those could lead to cause disability. Meditation is a mind-body practice in
complementary and alternative medicine. Meditation is a mental practice to put the body and mind
into a state of relaxation and rest. It is a recommended intervention for stress reduction, depression,
anxiety, insomnia, expand awareness, and well-being improvement. Purpose: The study was to
compare the effects of generative and concentrative meditation on high school students mental health
Method: A pre and post test design was used to measure students mental health and efficiency of two
categories meditation intervention. Sample was randomized for 40 students (20 receiving generative
meditation intervention and 20 receiving concentrative meditation intervention). Forty students
completed the General Health Questionnaire (GHQ-12) before and after intervention. Paired sampled t
test were used to assess mental health during meditation intervention. Independent sample t test was
used to examine the difference between two types of meditation. Respondents were trained twice a
week for two sixty minutes. Immediate outcomes were obtained at daily for two days. Results: There
was a significant improvement from pre to post mental health for generative meditation (p value 0.00
< 0.05) and concentrative meditation (p value 0.00 < 0.05). The two types of meditation can improve
students mental health. Moreover, no difference in quality was found between two types of
meditation. Yet, students in both groups reported receiving adequate intervention. The investigation of
potentially meditating effects of meditation skills on long term outcome is very much needed.
Conclusion: The meditation intervention (generative and concentrative) can improve quality of
students mental health.
Keywords: Generative Meditation, Concentrative Meditation, High School Students, GHQ-12,
Mental Health
44
THE EFFECT OF BALLOONS BLOWING EXERCISE TO LUNG CAPACITY CHANGES

ON BRONCHIAL ASTHMATIC PATIENTS
Takdir Tahir, Silvia Malasari, Sainab Kika
School of Nursing, Hasanuddin University
ABSTRACT
Background: Asthma continues to be one of major health problems in the world. It is the third noncommunicable disease in Makassar province-Indonesia. Treatments of asthma have become focus of
study for years. One of the treatments is blowing a balloon. It could help lung expansion in enhancing
resting lung ventilation of asthmatic patients. Purpose: This study aims to determine whether there is
an influence of practicing blowing a balloon on lung capacity of patients with bronchial asthma.
Method: This was a quasi experimental study with pre-post test design on one group of intervention.
The primary data were retrieved from patients medical records in Dr. Wahidin Sudirohusodo
Hospital, from January-June 2011. Fifteen bronchial asthmatic patients who met the inclusion criteria
were selected and given a balloon blowing exercise for 30 minutes (Five times of blowing a balloon)
and done twice a day during two weeks. The balloon had 10 cm of diameter and 200% or more of its
flexibility. All respondents received same treatment and then their lung capacity was measured by
Spirometry (Spiroanalyzer ST-250). Results: By using Wilcoxon test, there was a significant
difference between the Force Expiratory Volume in One second (FEV1) of asthmatic patients before
and afterdoing the exercise. The value of FEV1 before exercises was lower than the value of FEV1
after exercises (p=0.001). This means that there was a positive influence of balloon blowing exercise
on the changes of lungs capacity. Conclusion: Balloon blowing exercise increased lung capacity of
asthmatic patients. So the patients could do the exercise in order to improve their lung capacity.
Moreover, further research should focus on the effects of exercise towards asthma attacks and add
more samples to be a control group.
Keywords: Balloon Blowing Exercise, Lung Capacity, FEV1 and Bronchial Asthma
45
EFFECT OF ROSE AROMATHERAPY ON NURSING STUDENTS STRESS LEVEL IN

CLINICAL LEARNING
Nelwati, Sri Wahyuni
Faculty of Nursing, Andalas University, West Sumatera Indonesia
ABSTRACT
Background: Clinical learning is an essential part of the nursing education program. It aims to
achieve a set of competencies, integrate the theory with practice and enhance critical thinking and
decision making abilities in the clinical setting. However, hospital clinical learning has been
recognized to be perceived as a stressful event by student nurses. Clinical stress of student nurses is
caused by tasks related to clinical competencies including written clinical assignments, performing
clinical procedures and clinical evaluation, initial clinical experiences as well as building relationships
and communication. Administering relaxation as non-pharmacology interventions of nurses could be
used independently to reduce stress level of student nurses in clinical learning. One of relaxation
methods is by aromatherapy. Purpose: This study was aimed to examine the effect of rose
aromatherapy inhalation on reducing stress level of student nurses in hospital clinical learning.
Method: A quasi experiment study with pre and posttest one group approach was used. A group of
twenty student nurses undertaking hospital clinical placement and fulfilling the inclusive criterion was
selected to participate in this study. The research setting was in hospital of M. Djamil Padang. Preintervention, stress level of each students was measured. Then, the intervention was implemented to
each student nurse by inhaling rose aromatherapy for three seconds. Post-intervention, fifteen minutes
later the level of stress was measured by Perceived Stress Scale that measured stres from taking care
of patients, stress from teachers and nursing staff, stres from assignments and workload, stress from
peers and daily life, stress from lack of professional knowledge and skills and stress from the
environment. Data collected was analyzed univariately and bivariately by distribution frequencies and
Wilcoxon Signed Ranged respectively. Results: The results showed that pre-intervention, the
respondents experienced moderate stress level (100%) and post-intervention, the respondents
experienced mild stress level (100%). There was a change in the stress level of students nurses pre and
post-intervention. It is indicated that rose aromatherapy inhalation could significantly reduce stress
level of student nurses in clinical learning (p=0,000). Conclusion: It is suggested that student nurses
could use rose aromatherapy inhalation during hospital clinical learning in order to relieve the stress
experiences and enhance concentration in hospital clinical learning. The rose aromatherapy could be
appropriate intervention for student nurses experiencing stress in Padang.
Keywords: Clinical Learning, Aromatherapy, Stress Level, Student Nurses
46
EFFECTIVENESS OF SPIRITUAL EMOTIONAL FREEDOM TECHNIQUE (SEFT)

INTERVENTION IN SCHIZOPHRENIA WITH DEPRESSION ANXIETY STRESS
Ike Puspitaningrum, Diyan Yuli W.
School of Nursing, Diponegoro University, Semarang
ABSTRACT
Background: Patients with mental illness, such schizophrenia is characterized by profound disruption
in cognition and emotion, affecting the most fundamental human attributes: language, thought,
perception, affect, and sense of self. Negative emotions in schizophrenia (Stress, anxiety, depressed,
anger, guilt, express otherwise, despair, worry, excessive joy, very sad, crying and helpless) should be
changed to positive emotions that alter a person's behavior becomes more adaptive. SEFT is an
intervention given to changing negative emotions into positive emotions. SEFT is self-development
techniques with spiritual strength to overcome a variety of physical problems, emotions, thoughts,
attitudes, motivation and behavior. SEFT consists of three stages are setup, tune in and tapping. SetUp is to ensure that our body's energy flow directed appropriately. The Tune-In is done by thinking of
certain specific events that may evoke negative emotions that we want to eliminate. Tune-In with
tapping will neutralize negative emotions. SEFT has been effective in reducing the level of stress in
patients with chronic disease but have not done the research on mental patients. Purposes: The
purpose of this study is to determine the effectiveness of SEFT to reduce negative emotion in patients
with mental illness. The negative emotion can be measure with depression anxiety stress scale
(DASS). Method: The types and study designs in this research used pre-experimental study with pretest post-test one group design. Firstly, respondents were given a pre-test with DASS questionnaire.
Secondly, they were given 3 times SEFT interventions and lastly, post-test with DASS questionnaire
was performed. The population in this study was all patients who were treated at Larasati room of dr
Amino Gondhohutomo Psychiatric Hospital Semarang. Number of patients in Larasati room is 17
patients. Total sampling technique with inclusion-exclusion criteria was used and five respondents
were recruited. Data were collected by DASS questionnaire and were tested with paired sample t-test.
Result: The results of statistical tests concluded that the variables had a significant result (0.017). It
can be concluded that SEFT intervention was effective to reduce depression anxiety stress levels in
patients with schizophrenia. Conclusion: Nurses at the dr Amino Gondhohutomo Psychiatric Hospital
Semarang were expected that they can apply SEFT intervention to reduce stress levels in patients. For
further research is recommended to use a bigger sample sizes.
Keywords: SEFT, Schizophrenia, Depression Anxiety Stress
47
EFFECTIVENESS OF HYPNOBIRTHING IN REDUCING ANXIETY LEVEL OF

PREGNANT WOMEN IN FACING LABOR OR CHILDBIRTH
Desi Resmayani, Atun Raudotul Marifah, Suci Khasanah
Harapan Bangsa School of Health Science, Purwokerto
ABSTRACT
Background: The pregnant womens anxiety is an unhappiness feeling with physiological symptoms.
If the high level of anxiety cannot be handled, it can cause complications on pregnancy and childbirth.
In some countries such as United States, non-pharmacological methods have been developed to deal
with childbirth hypnobirthing. Hypnobirthing is a natural method used to relieve fear, panic, stress and
other pressures which haunt mothers during labor. Purpose: The study aimed to know the
effectiveness of hypnobirthing technique to the primigravida pregnant womens anxiety levels
Method: This study was pre-experimental with one-group pre-post test design using quantitative
approaches. Data were obtained through questionnaire. The sample of the study was 16 primigravida
pregnant women. The researcher applied Wilcoxon signed rank test with signification = 0.05.
Result: The result of statistical analysis showed that the hypnobirthing technique has a significant
effect on primigravida pregnant womens anxiety with p=0,000 (p < 0.05). The average level of
anxiety on respondents before given hypnobirthing was 27.31 and after given hypnobirthing was 12.12
with the difference at 15.188. Conclusion: The finding of this study showed that hypnobirthing
technique is effective to reduce primigravida pregnant womens anxiety level in dealing with labor.
Keywords: Hypnobirthing, Anxiety, Primigravida Pregnant Women
THE EFFECT OF KANGAROO METHOD APPLICATION TO BODY TEMPERATURE OF

BABY WITH LOW BIRTH WEIGHT (LBW)
Kadek Ayu Erika, Marlina P. Pattipeilohy
School of Nursing, Hasanuddin University, Makassar
ABSTRACT
Background: Low Birth Weight (LBW) care in Indonesia is still prioritizing the use of incubators but
its presence is still very limited. Kangaroo method is now starting to be used as an alternative to
incubator that is economically efficient and effective. Purpose: This study aimed to determine the
effect of the application of the kangaroo method to body temperature of baby with LBW. Method:
This research was conducted at the Hospital Prof. DR. W.Z. Johannes Kupang with a sample of 25
low birth weight infants using accidental sampling. Research design was quasi-experimental with one
group pretest and post test design. Babys temperature was measured before the intervention then baby
kangaroo method was applied for 3 days. Kangaroo Care method was carried out for 2 hours each day
and then the baby's body temperature was measured after that. The results are tested using paired Ttest with a significance level of = 0.05. Results: The results obtained LBW baby's body temperature
before the kangaroo care method was on average 36.6 0C and body temperature LBW babies after the
kangaroo care method was on average 37.10C. The application of the kangaroo method increased the
body temperature of baby with LBW (p =0.000). Conclusion: There was an influence on the increase
in body temperature after being given LBW kangaroo care method. For health care workers was
expected to continue to provide education about the effectiveness of kangaroo method to increase
babies body temperature.
Keywords: Kangaroo Care Method, Temperature, Low Birth Weight (LBW).
48
THE EFFECT OF CHEWING XYLITOL GUM ON THE CHANGES OF THIRST IN

CHRONIC KIDNEY DISEASE (CKD) PATIENTS WITH HEMODIALYSIS
Dinny Atin Amanah, Wahyu Hidayati
School of Nursing, Diponegoro University
ABSTRACT
Background: Chronic Kidney Disease (CKD) is a slow and progressive kidney disease. There is an
irreversible decline of kidney function in CKD patients that requiring replacement therapy such as
hemodialysis. Patients who undergo hemodialysis are generally complained of thirst and dry mouth.
Conditions of dry mouth and thirst due to reduction in the secretion of saliva which is estimated occur
in 17-19% of patients with hemodialysis. Chewing gum is one of treatment that can be given to
hemodialysis patients who feel thirsty. Chewing xylitol gum is proven to increase the quantity of
saliva higher than the chewing non-xylitolgum. Purpose: This research aimed to determine the effect
of chewing xylitol gum on the change of thirst in CKD patients with hemodialysis. Method: This
research represented a quasi-experimental quantitative research with one group pretest-posttest design.
Population in this study was all of CKD patients with hemodialysis in Hemodialysis Unit. The samples
were 33 respondents recruited by purposive sampling method and the data will be taken by VAS
(visual analogue scale) for thirst perception. Result: The results of statistical test used paired sample tTest had obtained p value = 0.000. It means the p value < (0.05) with mean of the changes scale of
thirty was 3.8697. The results showed that there was an effect of chewing xylitol gum on changes of
thirst in CKD patients with hemodialysis. Conclusion: Nurses can use the intervention of chewing
xylitol gum as an alternative intervention to relieve thirst of CKD patients with hemodialysis for selfoptimizing nursing therapy when caring for CKD patients with hemodialysis in clinics, hospitals, or in
the community.
Keywords: Chewing Xylitolgum, Thirst, Chronic Kidney Disease (CKD) on Hemodialysis
49
A COMPARISON OF BABYS SLEEP PATTERNS WHO GOT BABY MASSAGE

AND BABY SPA
Falasifah Ani Yuniarti, Suryadi Arianata
Faculty of Nursing, University of Muhammadiyah Yogyakarta
ABSTRACT
Background: Sleep activity is one of the stimulation of growth and development of babies who need
special thoughtfulness. Sleep pattern disturbance in infants often make parents frequently to take
mistakes in put sleep their babies. One of the solutions is to take baby massage or baby spa. Purpose:
To find differences of baby's sleep patterns, include duration, sleep frequency and sleep pattern, before
and after getting baby massage and baby spa. Methods: The research methodology was preexperimental by comparing pre and posttest. Two groups were treated equally. The subjects of the
research were 30 babies at the age of 3-12 months. Samples were divided into two groups; the
respondent of 15 respondents per groups was taken by accidental sampling. Research instrument was a
questioner. The data was analyzed using Shapiro Wilk normality test (<50) for distribution test.
Paired t-test was implied to test the difference of frequency before and after experiment, while
Wilcoxon test used to test the sleeping and duration and pattern. Mann Whitney test and independent
sample test was used to find out the difference between two groups. Results: The results showed no
significant differences in infant sleep patterns before and after intervention of baby massage and baby
spa on the duration (p = 0.817), routine and frequency (p = 0.118 and p = 0.292). Conclusion: There
was difference in sleeping patterns before and after baby massage and baby spa. There was no
significant difference between baby massage and baby spa in duration, routine and frequency of sleep
patterns infants in Clinic Srikandi Rumah Bunda Yogyakarta. If baby's sleep patterns were disrupted,
parents could give baby massage or baby spa as an alternative intervention to optimize the baby's sleep
patterns.
Keywords: Babys Sleep Patterns, Baby Massage, Baby Spa
50
THE EFFECTIVENESS OF HEALTH EDUCATION IN INCREASING SOCIAL SUPPORT

FOR CRITICALLY ILL PATIENTS IN INTENSIVE CARE UNIT
Isma Yuniar, Helwiyah Ropi, Wiwi Mardiyah
Muhammadiyah School of Health Science, Gombong
ABSTRACT
Background: Most of patients who were hospitalized in ICU got stressed and anxious. Giving social
support to ICU patients has positive effects to their health such as decreasing stress, deceasing anxiety,
increasing emotional adaptation, giving safe feeling, and increasing life desire. Giving health
education about social support is one of nurses roles as an educator. Purpose: This research aims to
know the effectiveness of health education against the increasing of social support to ICU patients.
Method: The research design used pre-experimental with static group comparison type. The samples
were taken by using consecutive sampling, a non-probability sampling technique. Thirty six
respondents were recruited and they were divided into control group and intervention group. The
respondents were family and patient. The inclusion criteria for family were adults, the main of family
members, agree to be respondents, and can read and write. In other side, the inclusion criteria for
patient were adults, in conscious condition, and minimally hospitalized for three days. Intervention
group was given health education about family social support to the family. Intervention was given in
second day of hospitalization. It was given for one time in 15 minutes by the researcher team. After
the patients were allowed to leave ICU, the measurement of social supports that patients got was done
by using Berlin Social Support Scale (BSSS) questionnaire with Actually Received Social Support sub
section. The data were analyzed by Mann Whitney U Test. It was non-parametric test that is used to
compare two population means. This test was used to know the difference between social support
score for the group that was given the health education and the group that was not given the health
education. Result: The result of research showed a meaningful difference. There was an increase in
giving social support in intervention group as compared to control group (p<0.05). Conclusion: The
implication of this research is giving the health education intervention can increase the health behavior
related to social support which given effectively to patients and it should be done regularly to all
patients family in hospital
Keywords: Social Support, Health Education, ICU.
51
THE INFLUENCE OF BREATHING EXERCISE TO THE FATIGUE LEVEL OF

HEMODIALYSIS PATIENTS
Cahyu Septiwi
Muhammadiyah School of Health Science, Gombong
ABSTRACT
Background: The dependence of kidney failure patients on dialysis machine for the rest of his life,
malnutrition and anemia can create fatigue for the patients. Fatigue can cause a decrease in
concentration, malaise, sleep disturbances, emotional disturbances, and the patient's ability to perform
daily activities, which can reduce the quality of life. Purpose: This study aimed to determine the
influence of breathing exercise to the fatigue level of hemodialysis patients. Method: The study used a
quasi-experimental research with pre and post test approach design, and purposive sampling technique
in accordance with the inclusion criteria was applied. The fatigue level was measured by the Fatigue
Visual Numeric Scale. Result: The results showed that the average fatigue level of respondents before
given breathing exercise was at 5.70 with the standard deviation of 0.95. The average fatigue level of
respondents after given the breathing exercise was at 3.80 with a standard deviation of 1.23. The
difference in the mean level of fatigue before and after the breathing exercise was 1.90. The results of
paired T test (paired t test) obtained p value of 0.000 (p <0.05) indicated that there were a significant
differences between the levels of fatigue before and after breathing exercise. Those results indicated
that breathing exercises influence the fatigue level of hemodialysis patients. Conclusion: Nurses need
to improve the quality of nursing care by implementing effective and efficient nursing interventions to
solve the problem of hemodialysis patients and improve their quality of life.
Keywords: Fatigue Level, Breathing Exercise, Influence
52
THE CORRELATION BETWEEN TOILET TRAINING STIMULATION BY MOTHER AND

TOILETING ABILITY OF PRESCHOOLERS AT BALUNG LOR VILLAGE, JEMBER
Anisah Ardiana, Eka Windian W
School of Nursing, University of Jember
ABSTRACT
Background: Toilet training is a developmental task that impacts families with small children. Toilet
training stimulation is a way to train a child to be able to control fecal and urinal disposal (Hidayat,
2005). The toilet training stimulation should be started well early. Parent stimulation is essential factor
in a success toilet training. Purpose: This research was to recognize the correlation between the toilet
training stimulation by mother with the toileting ability of preschoolers. Method: This is a descriptive
correlation research. The sample was 125 mothers with preschoolers age 3-6 years old at Balung Lor
village, with cluster sampling. Data analysis used Chi Square test. Result: The result showed that the
toilet training stimulation by mother is significantly associated with the toileting ability of
preschoolers (p= 0.001; = 0.05). At 73 mothers who give good toilet training stimulation, as many as
52 children can do toileting well. Mother who delivers early toilet training stimulation has opportunity
3,962 times more their children can do toileting independently in pre-school age. Conclusion: Toilet
training stimulation is a way to train a child to able to control fecal and urinal disposal. This
stimulation need a maturity of anal and urinal muscle. The toilet training stimulation should start well
early. Training often starts between 21 and 36 months of age, and that only 40 to 60 percent of
children complete toilet training by 36 months of age (Bakker, 2000, in Choby & George, 2008). The
children who get a regular and directional stimulation will grow faster than children who get less or no
stimulation. Warner (2003) believes parent stimulation is essential factor in a success toilet training.
Nurses should provide parents guidance about toilet-training methods so they could give early toilet
training stimulation, thus children have good toileting ability when they are in pre-school age.
Keywords: The Ability of Toileting, Preschooler, Toilet Training Stimulation
53
ANALYSIS OF CIRCADIAN RHYTHM ON INFARCT SIZE IN PATIENTS

WITH ACUTE MYOCARDIAL INFARCT
Anugerah Eka Purwanti, Mifetika Lukitasari, Arina Madjidi, Diah Kristianisah Rahayu, Fitri Ayuning Ulansari,
Mohammad Saifur Rohman
School of Nursing, Faculty of Medicine, University of Brawijaya, Malang
ABSTRACT
Background: Circadian rhythm of acute myocardial infarction onset has been investigated in many
studies and may carry important pathophysiological implications. Conversely, the effect of the time of
acute myocardial infarction (AMI) onset on infarct size has not been systematically explored.
Purpose: To analyze the existance and the impact of circadian rhythm of myocardial infarction on
infarct size. Methods: This study was conducted at Emergency Department of Saiful Anwar General
Hospital Malang. Forty five patients with myocardial infarction (61.03+12.28 years, 55.6% men) were
randomly selected during August 2011 to January 2012. AMI was diagnosed based on the presence of
at least two of the following criteria: 1) clinical symptoms suggestive of myocardial ischemia, 2)
electrocardiographic (ECG) abnormalities (new ST-T wave changes, new left bundle branch block, or
the development of new pathologic Q waves), and 3) rise and/or fall of cardiac enzymes. Circadian
rhythm was divided into four 6-hour periods based on previous study (first period: midnight-6.00
hour; second period: 6.00-noon (dark-to-light transition); third period: noon-18.00 hour; fourth period:
18.00-midnight). Infarct size was estimated by Troponin I on admission. The relationship between
infarct size and circadian rhythm were analyzed using Pearson Correlation. Results: Mostly patients
with acute myocardial infarction were admitted to Emergency Department in the third period (noon18.00 hour) (42.2%). The blood samples of troponin I were measured on admission to Emergency
Department (2.89+6.55 ng/ml). Infarct size was larger in patients admitted in the second period/darkto-light transition (4.69+6.78 ng/ml). However, it was not achieved any statistical significance
(p=0,436). These results were similar with another study in Spain. Hence, further study with greater
sample is needed to determine the circadian variations of infarct size in patients with AMI. Discussion
Cardiovascular physiology is significantly modulated by the circadian rhythm. The results of the study
was consistent with prior studies (Suarez-barrientos et al., 2011) in the literature which larger infarct
size was found in the onset of AMI in the dark-to-light transition as evaluated by peak rise in enzyme
concentrations. Conclusion: A circadian rhythm on infarct size in patients with AMI was not found.
But this study suggested that larger infarct size was found in patients with AMI admitted at the third
period.
Keywords: Circadian Rhythm, Infarct Size, Myocardial Infarction
54
DOOR-TO-ELECTROCARDIOGRAM (ECG) DURATION CONTRIBUTED TO MORE

THAN A HALF OF DIAGNOSING ACUTE MYOCARDIAL INFARCTION (AMI)
INTERVAL
Fitri Ayuning Ulansari, Anugerah Eka Purwanti, Mifetika Lukitasari, M. Saifur Rohman
School of Nursing. Faculty of Medicine. University of Brawijaya.
Department of Cardiovascular.Faculty of Medicine.University of Brawijaya, Saiful Anwar General
Hospital Malang.
ABSTRACT
Background: The American Heart Association (AHA) recommends a benchmark door-toelectrocardiogram (ECG) time of 10 minutes for acute myocardial infarction (AMI) patients. Door-toECG time improve rapid diagnose and rapid reperfusion. Consequently, the risk of morbidity and
mortality will be decreased significantly. Purposes: This study aimed to determine door-to-ECG
duration in patients who attended to emergency department (ED) and its contribution to the interval of
diagnosing AMI. Method: A descriptive observational study was conducted in Saiful Anwar General
Hospital Malang during August 2011-June 2012. The duration of ECG measurement and the interval
time to diagnose AMI in patient with chest pain suggestive AMI were documented by healthcare
professionals using a digital watch. The data were regarding time of admission in the ED, time of ECG
completion, and time of diagnosing AMI were documented in a sheet. Door-to-ECG duration and
door-to-diagnosing AMI was calculated by subtracting ECG time with time of admission and
diagnosing time with time of admission. Results: A total of hundred and six patients with the mean
age of 60.94 12.98 years old and a half (57.5%) of the sample were male. Door-to-ECG duration
was 14:17 06:16 and only 1.2% of ECG implementations were completed within 10 minutes. Doorto-diagnose AMI was 24:02 16:30 minutes. Hence, it revealed that nurses spent more than a half of
diagnosing AMI interval to accomplish ECG diagnostic procedure in the ED. Discussion: The long
duration of door-to-ECG in ED might be due to several factors including number of nurses in the ED,
atypical chest pain presentation, and number of patients at the same time. Therefore, it is interesting to
analyze the contribution of these factors on door-to-ECG duration. Further study is needed to address
this issue with greater number of samples. Conclusion: This study suggested that door-to-ECG
duration was 14:17 06:16 and contributed to more than a half of diagnosing AMI interval to
accomplish ECG diagnostic procedure in the ED.
Keywords: Door-to-ECG Duration, Acute Myocardial Infarction (AMI) Diagnose, Emergency
Department
55
THE EXPRESSION OF CYCLOOXYGENASE (COX-2) , THE THICKNESS OF

ENDOMETRIUM AND THE NUMBER OF EPITHELIAL CELL OF LUMINAL UTERUS
AS AN EFFECT OF THE GIVING OF CURCUMA IN RATTUSNORVEGICUS STRAIN
SPRAGUE DAWLEY AFTER RECEIVING LUTEINIZING HORMONE STIMULATION
Ery Purwanti, Sri Kadarsih Soejono, Djaswadi Dasuki
Program of Basic Medical Sciences and Biomedical Engineering, Gadjah Mada University
ABSTRACT
Background: Curcuma is a natural substance that has various kinds of biological activities, such as
anti fertility. However, until recently, there have been no any studies that investigate curcuma effects,
especially those that are related to LH stimulation in endometrium. Purpose: This study aimed to
investigate the expression of COX-2 enzyme, the thickness of endometrium and the number of
epithelial cells of luminal uterus as an effect of the giving of curcuma after LH stimulation. Method:
The study was done with post-test control randomized group design toward 30 female
Rattusnorvegicus Strain Sprague Dawley, which were 28 days of age, divided into 6 groups, induced
the ovulation with PMSG, and then given treatments as follows: (G1) aquades, (G2) LH 10 IU +
aquades, (G3) CMC 1 ml, (G4) LH 10 IU + CMC 1ml , (G5) curcuma 100 mg/kg Body Weight +
CMC 1 ml and (G6) LH 10 IU + curcuma 100mg/kg Body Weight + CMC 1 ml. Curcuma was given
orally for 4 days and LH was given through intramuscular injection once at the first day of ovulation.
The rats were then slain to be taken their uterus and it was used to make HE microscopic preparation
to measure the thickness of endometrium and IHC to measure the expression of COX-2 and the
number of epithelial cells of luminal uterus. The statistical analysis used one-way Anova, followed by
DMRT (Duncans Multiple Range Test). To know the influential treatments, multiple comparison
analysis was used. The statistical analysis of COX-2 expression showed a significant increase in
Group 5 and Group 6 (p<0.05) while a significant decrease was shown in Group 4 and Group 6
(p<0.05). The analysis result of multiple comparison showed that LH, curcuma, curcuma + LH and in
glandular ephitelia, LH and curcuma were influential toward the expression of COX-2 in luminal
ephitelia. The thickness of endometrium showed a decrease but insignificant (p>0.05) in Group 6 and
Group 4. Result: The result of multiple comparison showed that curcuma was affecting the thickness
of endometrium. Based on the statistical analysis, the number of epithelial cells of luminal uterus also
showed a decrease although it was insignificant (p>0.05) which happened in Group 6 and Group
4.Conclusion: It could be concluded that curcuma 100 mg/kg Body Weight after the stimulation of
LH 10 IU reduced the expression of COX-2 both in luminal epithelia and in glandular epithelia
through one of lines of LH stimulation, but did not reduce the thickness of endometrium and the
number of epithelial cells of luminal uterus of Rattusnorvegicus Strain Sprague Dawley.
Keywords: Cyclooxygenase, Kurkumin, Luteinizing Hormone
56
THE INTENSITY OF MENSTRUAL PAIN AFTER RHYTHMIC AND SLOW PACKAGE

INTERVENTION
Fiega Tresna Asfury, Restuning Widiasih, Ermiati
Faculty of Nursing, Padjadjaran University, Indonesia
ABSTRACT
Background: A Problem that often occurs during womens menstruation is a pain during
menstruation. The symptoms of pain during menstruation are individual, unpleasant and subjective.
The pain can lead to stress and anxiety in women who experience it. It can turn into a risk factor for
both physiological and psychological conditions. There are many methods to solve menstrual pain
such as relaxation, and distraction methods. Rhythmic and Slow Package is a nursing intervention to
reduce the menstrual pain intensity. The intervention is a combination between deep breath and
abdominal massage to relax and distract the menstrual pain. Purpose: The purpose of this study was
to determine the intensity of menstrual pain before and after rhythmic and slow package"
intervention. Method: The research method was Quasi Experiment with one group pre-test and posttest design, the study population were female students in Faculty of Nursing who were having
menstrual pain experience. The sampling technique was purposive sampling accounted for 20
respondents. Visual Analog Scale, the intensity of pain measured before and after rhythmic and slow
package intervention was used as a research instruments. The intervention was done for 15 minutes
each respondent on the first day of menstruation. Data were collected on April-May 2010. Data were
analyzed using univariate analysis for pain intensity description and bivariate analysis, t-test, to
determine the effect of interventions. Result: The intensity of pain in pre-test showed that the
frequency of respondents who experienced moderate pain and severe pain were 65%, 35 %
respectively. On the other hand, the post-test showed that the frequency of respondents who
experienced easy pain was 25% and was 75% for moderate pain. T - test values resulted in t - count
for 11.775 with = 0,05. Conclusion: There were significant differences in menstrual pain intensity
between before and after rhythmic and slow package intervention.
Keywords: Menstrual, Pain, Rhythmic and Slow Package
57
THE DIFFERENCE OF MUCOSITIS SCORE IN CHILDREN WITH CANCER

UNDERGOING CHEMOTHERAPY PROTOCOL IN DR. CIPTO MANGUNKUSUMO
HOSPITAL JAKARTA
Ikeu Nurhidayah
Faculty of Nursing, Padjadjaran University
ABSTRACT
Background: Cancer is known as a one of serious disease that threat health in children. Cancer in
children should be managed appropriately. Chemotherapy is one of effective interventions in
managing children with cancer. Chemotherapy shown high effectiveness, but it has harmful side
effects and required further intervention. Mucositis is known as a one common of side effects of
chemotherapy. Purpose: This study aimed to identify the difference of mucositis score in children
with cancer undergoing chemotherapy in Dr. Cipto Mangunkusumo, Jakarta. Method: The study was
descriptive exploration. A consecutive sampling was used with 96 patients were observation.
Mucositis score was evaluated by using an Oral Assessment Guide (OAG). Data were analyzed using
dependent t-test. Result: The result of this study showed that there was a significant increases in the
average of mucositis score after chemotherapy (p=0,000). Child with cancer who exposed cytotoxcic
cancer therapy has a higher risk to develop mucositis. It is happened because mouth mucosal cell
lining are vulnerable to the cytotocix or proliferative-limiting effects of stomatotoxic chemotherapy.
Cancer chemotherapy agents are used in treatment to destroy, suppress, or prevent the spread of
malignant cells, which have a high proliferative rate, but chemotherapeutic agents are not specifically
targeted against cancer cells. They also adversely affect normal host cells that have a high mitotic
index, include those of the oral and gastrointestinal mucosa. Chemotherapy may also cause salivary
changes and sensory neuropathies. Besides that, many cytotoxic drugs will cause a degree of
myelosuppression secondary to therapy. That factor lead children who received chemotherapy will
experience mucositis. Based on the findings, it is recommended to do appropriate assessment and
intervention managing chemotherapy induces mucositis to reduce overall morbidity and improve the
quality of life in children with cancer.
Keywords: Mucositis, Chemotherapy, Oral Assessment Guide (OAG), Children
58
A LITERATURE REVIEW: THE EFFECTIVENESS OF NUTRITION EDUCATION TO

PREVENT MALNUTRITION IN DEVELOPING COUNTRIES
Ferika Indarwati
Nursing Study Program, Faculty of Medicine and Health Sciences
University of Muhammadiyah Yogyakarta
ABSTRACT
Background: Malnutrition in children has been a significant issue for many decades in developing
country. Indonesia as one of the developing countries in South East Asia faced the same problem.
According to the National Economic and Social Survey 2005 Central Bureau of Statistics Indonesia,
the percentage of children fewer than five by nutritional status are 8.80% severely malnourished,
19.24% lack of nourishment, 68.48% moderately nourished and only 3.48% well nourished.
Furthermore UNICEF in 2006 also reported that the prevalence of underweight children in Indonesia
is 28 % and it is contribute 4.2 % of total underweight children in the world. In Indonesia, protocols
and programs were established particularly in dietary management to treat children who suffer from
malnutrition however these programs still can not thoroughly solve the problem. Method: A
Literature review was conducted to find the effectiveness of nutrition education to prevent
malnutrition in developing countries. Six data bases: ProQuest, Informit, CINAHL, Science Direct,
Cochrane, and Scopus were searched. The inclusion criteria are the articles were published from 2000
2012. The research was conducted in developing countries and had minimum level III-3 according to
NHMRC level. Finally 15 articles were found. All studies included in this literature review were
analyzed for strengths and weaknesses using the relevant appraisal tools. The qualitative studies were
critically appraised by a Critical Appraisal Skills Program (CASP) tool. Quantitative studies were
analyzed with Health Care Practice Research and Development Unit (HCPRDU). After critical
appraisal, the articles were analyzed to define the level of evidence using National Health and Medical
Research Council (NHMRC) levels of evidence and grades for recommendation (2009). Result: The
results showed that an intensive nutrition education can significantly improves the nutritional status of
children with malnutrition. The evidence obtained from the articles indicates that these evidence
support the use of nutritional education intervention as a treatment to improve child growth and
development especially children with malnutrition. Conclusion: even though this evidence is only at
level II based on the hierarchy of evidence and not at the highest level of the hierarchy of evidence,
this finding still can be used to support the nursing practice and can be trusted to guide practice in
most situation according to NHMRC (2009). The implementation of the evidence should be integrated
with other government programs and need a strong effort of each element that involved in malnutrition
management in Indonesia so that the effectiveness of this program can be achieved.
Keywords: Malnutrition, Nutrition Education
59
The Influence of the Warm Compress Technique on Patients Pain Scale Following Caesarean
Section Surgery in Sleman
Yuliana Reginaldis Rosali Krowa, Wenny Savitri, Sulistyaningsih
Program Study of Nursing Science, STIKES A. Yani Yogyakarta
ABSTRACT
Background: Pain is an unpleasant emotional and sensory experience which is caused by the actual
damage of body tissue. The pain experience by mothers after Caesarean Section highly affects the
ability of mothers to look after and breastfeed the baby. It leads to a dysfunctional family process.
Many complementary therapies can be used to decrease patients pain scale. One of the therapies is
warm compress technique but the effectiveness of this technique has not been identified in Sleman.
Purpose: The study aimed to identify the effectiveness of the warm compress technique on patients
pain scale following Caesarean Section surgery. Method: A quasi-experiment with pre-test and posttest using control group was utilized in this study. 15 participants who met inclusion criteria were
recruited for each group. The intervention group obtained the usual care from hospital and also was
given warm compress intervention. The temperature of the compress was 40C - 43C and it was put
10 centimeters above the incision area within 5-10 minutes for each intervention. The intervention was
given one time per day and lasted in 3 days at the same time for each day. The control group only
obtained the usual care from hospital without complementary therapy. The Numerical Rating Scale
was used to measure the pain scale before and after the intervention. Data were analyzed using
Independent Sample T-test with p < 0.05. Results: The result of Independent Sample T-test between
intervention group and controlled group was t = -3.445, p = 0.002. The average of pain scale in the
intervention group was 5.80 compared to control group, as much as 6.87 (scale of 1-10). Conclusion:
Warm compress technique can significantly decrease patients pain scale following Caesarean Section
surgery. Therefore, the use of this technique for such population needs to be implemented as one of
complementary therapies in clinical setting.
Keywords: Warm compress technique, pain, complementary therapy.
60
Nursing Management
THE EFFECTIVENESS OF COMPUTER-BASED NURSING DOCUMENTATION SYSTEM

PROTOTYPE IN DOCUMENTING NURSING CARE PLAN
Aji Sayogo Ary Wibowo, Wenny Savitri, Igoon
A. Yani College of Health Science, Yogyakarta
ABSTRACT
Background: The nursing process consists of five steps namely assessment, diagnosis, planning,
implementation and evaluation. Throughout the process, the nurse has to document data and
information concerning the progress of the patients condition. Nowadays, most of nurses in Indonesia
still document the nursing care manually on papers which takes a lot of time and less accurate.
Although some hospital have started to implement electronic health record, but nursing documentation
system is not specifically included. In other country, nurses use nursing documentation system facility
to document the nursing care. The use of nursing documentation system is one among many factors to
support the effectivity and efficiency of nursing performance. Purpose: To identify the effectiveness
of computer-based nursing documentation system prototype as compared to paper based
documentation on the time duration in documentating the nursing care plan and the quality of nursing
documentation. Method: A quasi experiment with randomized post-test only control group design was
conducted in July 2012 on 20 nursing students from STIKES A. Yani Yogyakarta who met the
inclusion criteria. The students were grouped into control and experimental group. The control group
documented the nursing care plan manually on paper and the experimental group on the computerbased nursing documentation system prototype. The prototype was built based on Gordons functional
health pattern to assess patients data and NANDA, NOC, and NIC to diagnose and plan the nursing
intervention. The data were analyzed with independent t-test and Mann-Whitney test, respectively.
Results: There were a significant differences between experimental and control group in the time
duration in documentating nursing care plan (p = 0.000) and the quality of nursing documentation (p =
0.000). Conclusion: Computer-based nursing documentation system prototype was effective to reduce
the time duration in documentating the nursing care plan and to improve the quality of nursing
documentation.
Keywords: Nursing Documentation, Nursing Care Plan, Nursing Information System.
61
Nursing Management
A COMBINED METHOD OF CLASSICAL TEACHING, MODULE, VIDEO, AND

PROFESSIONAL MENTORING AS REQUIREMENT ON FAMILIES EDUCATION TO
MEET CHILDRENS GROWTH AND DEVELOPMENT NEEDS
Haryatiningsih Purwandari, Wastu Adi Mulyono, Suryanto
School of Nursing, Jenderal Soedirman University, Purwokerto
ABSTRACT
Background: First five years old is a golden period in life where children growth and develop
optimally. However, there are 74% cases of children with lack of nutrition reported at Banyumas
Residence in 2009. A recent study showed an increasing infant growth and development score after
intervening families in Baturraden District. The proper method of education is required for families in
order to facilitate childrens growth and development in order to carry out role of educator. Purpose:
This research was to identify family need to stimulate children growth and development as well as a
proper method for family education. Understanding family need on education would be beneficial in
the nursing advancement-role as educator in the community field. Methods: A descriptive study was
conducted at the first step to identify education need for families in Baturraden District. Thirty-six
mothers were selected purposively in Rempoah village as respondents. After explaining procedures,
benefits, and confidential guarantee of the research, all respondents voluntarily agreed to participate.
Only 34 of 36 respondents participated completely in the research activity due to move to another
area. A descriptive analysis applied for interpreting collected data. Chi Square test was used to identify
different proportion between groups who choose the combined method. Results: Respondents age
was 29.08 years old in average which were mostly housewives (85.29%). Majority had finished
elementary school (32.35%) and high school (32.35%). Families incomes were mostly between three
quarters and a million rupiah (53%). All respondents needed information on growth and development
stimulation. Most of them needed mentorship (64.70%), routinely (52.94%) twice a month (94.11%),
using book, video, and health professionals (67.65%). Respondents who preferred to combine those
methods were (67.6%) while 32.4% of respondents preferred to split the methods. Score of knowledge
and skill test was on average 83.66% and 78.43 % respectively. Chi square test of combined-method
option showed a significant different (p=0.04). Conclusion and Recommendation: Families need
education to meet children growth and stimulation needs. A combined method of education by using
book, video, and health professional mentoring, which conducted routinely twice a week, would be
beneficial for family education.
62
Nursing Management
EFFECTIVENESS OF POSTOPERATIVE WOUND CARE TRAINING IN APPLYING

STANDARD OPERATIONAL PROCEDURE (SOP)
Oci Etri Nursany, Fitri Arofiati
Hospital Management Masters Degree, Muhammadiyah Yogyakarta University
ABSTRACT
Background: Nurse is a vital element of hospital service systems. In International Patient Safety
Goals (SIKP) 5, hospital is required to minimize medical infection risk. One of ways is to apply
Standard Operational Procedure in implementing postoperative wound care. The PKU
Muhammadiyah Bantul Hospital has nurses who had taken internal wound care training, but the
hospital has not evaluated desirable findings. Methods: This research was quantitative approach with
Quasi Experiment. Respondents of the research were nurses who working in the Adult Inpatient
Installation of the PKU Muhammadiyah Bantul Hospital. Total samples were 30 respondents who
recruited by purposive sampling. Data were collected by using observational Checklist. Instrument of
analysis was paired t-test with 5% on significance interval. Results and Conclusion: The
postoperative wound care training was effective to increase the application of Standard Operational
Procedure in PKU Muhammadiyah Bantul Hospital with p-value = 0.002. Evaluation of respondents
who applied Standard Operational Procedure of Pre-Post Training was in good category. It means that
overall respondents had applied the Standard Operational Procedure. But, in Pre Training, there were
still 8 respondents; and, in Post Training, there were 3 respondents, in adequate category.
Keywords: Effectiveness, Training, Postoperative Wound, Standard Operational Procedure
EVALUATION OF APPLICATION PARENTERAL DRUG ADMINISTRATION IN

COORDINATING PATIENT SAFETY IN INPATIENT INSTALLATION, PKU
MUHAMMADIYAH BANTUL HOSPITAL
Sri Yani, Fitri Arofiati
Hospital Management Masters Degree, Muhammadiyah Yogyakarta University
ABSTRACT
Background: The results of interview with head of nursing in PKU Muhammadiyah Bantul Hospital
indicated that several errors had occurred while nurses administering oral and parenteral drugs
especially on the types of injection. These errors were intradermal, subcutaneous, intramuscular, and
intravenous injections. Avoidance of injection errors could result in medical error, so nurses had to
consider 10 true principles of drug administration. Purpose: This research objective was to understand
the application of 10 true principles of parenteral drug administration in coordinating Patient Safety in
the Inpatient Installation of PKU Muhammadiyah Bantul Hospital. Method: The type of research was
mix method research using combination between quantitative method with cross-sectional design and
qualitative method with case study design. Respondents of this research were 78 nurses in the
Inpatient Installation of PKU Muhammadiyah Bantul Hospital. Samples were taken from 30
respondents. The samples were taken by accidental sampling. Data were collected by observational
method and interview. Result: The result showed that the application of 10 true principles in drug
administration in the Inpatient Installation of PKU Muhammadiyah Bantul Hospital was good. Nurses
did well in identifying the identity of patients and in performing an examination/assessment.
However, they had poor performance in documentation, education of health, rights to reject, and
evaluation.
Keywords: Application of 10 True Principles, Parenteral, Patient Safety.
63
Nursing Management
IMPLEMENTATION OF SOWAN METHOD FOR INCREASING

SELF CARE IN TB PATIENTS
Meidiana Dwidiyanti
ABSTRACT
Background: Patients with chronic diseases such as Tuberculosis is qualitatively still a burden on
society because there are still emerging psychosocial problems such as out of work due to
embarrassment, social isolation due to fear of infectious disease and the problem of treatment so that
patients become resistant to drugs. To handle non adherence treatment, home visit is one of the
nursing service at the BKPM (Public Health Center for Pulmonary TB) but there is no the holistic
nursing service. The patients should be able to help their self. Purpose: The purpose of this study was
to identify the patient problems with holistic aspect and to develop helping method to solve the
problems. Method: The research method used qualitative method with the cases study. Result: The
results of this study are: 1. The patients problems are cognitive, psychological, physical, emotion and
social problems. 2. The step of helping method is building trust, to get this step in Mr. Sowan. We
have to make self-awareness to recognize by his self with caring touch. 3. From helping method, selfawareness and caring touch we call with sowan method. Recommendation: Recommendation is
sowan method can be used to improve self care patient through the patient's holistic health card.
Key words: Sowan Method, Self Care, Patients Holistic Health Card.
PRESCHOOL TEACHERS EXPERIENCE IN THE IMPLEMENTATION OF DENVER II
SCREENING FOR PRESCHOOL CHILDREN
Rizki Cintya Dewi, Meira Erawati
ABSTRACT
Background: Pendidikan Anak Usia Dini (PAUD) is equivalent to kindergarten. Early age is golden period in
children because it is the most rapid growth and development stage in human. An early detection to the children
in this period is very important to be conducted because if there were any developmental delays, children would
get early stimulations as needed. Teachers in PAUD are one of those who should know how to recognize
developmental problems in children to help parents in order to optimize children development. Denver II
screening is one of the tools to detect developmental delays in children since they are born at the sixth of age.
Teachers in PAUD at Semarang had been trained to use Denver II but many difficulties were found to implement
it to their students. Purpose: This study aimed to explore the experience of preschool teachers in the
implementation of the Denver II screening in preschool. Method: This study was a qualitative study with
phenomenological approach. The population of this study was all teachers in preschool who followed the
training of Denver II screening. The samples were 8 informants taken by a purposive sampling. The data were
collected by focus group discussion and in depth-interview. They were analyzed using Miles and Huberman
which included data reduction, data display, verification, and conclusion. Result: The result of this study were
six major themes which were language developmental of preschool children, effective methods to implement
Denver II screening for preschool children, the benefit of Denver II screening for developmental preschool
children, supports or facilities obtained by teachers in the implementation of Denver II screening, obstacles
found by the teachers and the expectations of preschool teachers in the implementation of Denver II screening in
the preschool. Conclusion: Nurses as health providers in community should be more concerned in the
developmental needs of children by early stimulation, detection and intervention. PAUD institutions should be
able to establish a system to screen the development of students by setting up facilities, enhancing the ability of
teacher and working close with parents.
Keywords: Denver II Screening, Preschool Children, Preschool Teacher

64
Nursing Management
THE EXPERIENCE OF HEAD OF NURSE IN MANAGING IMPLEMENTATION OF

PATIENT SAFETY: A PHENOMENOLOGY STUDY
Safrudin Agus Nursalim, Hanny Handiyani, Yati Afiyanti
School of Health Science, Muhammadiyah Gombong
ABSTRACT
Background: Safety and security are one of the basic human need that has been become a
global concern. WHO had initiated patient safety program because safety is the basic principle in
patient care and become an important component of management. Purpose: This study aimed to
obtain an overview of head of nurses performance in implementing patient safety management.
Method: Design of this study was a phenomenology study. Seven head of nurses were recruited in
this study. Result: The results showed that the head of nurse has undertaken the function of
organizing, staffing and directing. But, they were still not optimal in carrying out the function of
planning and controling in the management of patient safety. Conclusion: Hospital management
needs to improve the ability of head of nurse in planning and controlling patient safety management.
Keywords: Head of Nurse, Management of Patient Safety
DESCRIPTION OF KNOWLEDGE AND ATTITUDE IN CONTROLLING THE RELAPSE

OF ASTHMA TOWARD THE BRONCHIAL ASTHMA OUTPATIENTS IN LUNG
HOSPITAL, SALATIGA
Lily Wolagole, Sakti Oktaria Batubara, Aziz Azwar
Faculty of Health Sciences, Satya Wacana Christian University, Salatiga
ABSTRACT
Background: Asthma is a disease that is very close to society and has growing population. According
to The Global Initiative for Asthma (GINA) in 2004 found that the case of asthma in all over the world
can reach 300 millions of people and it is predicted to reach 400 millions of people in 2025. The data
from World Health Organization (WHO) also indicates the same things that the amount of the asthma
sufferers may increase about 180,000 per year. In Salatiga, based on the data from Lung Hospital Dr.
Ario Wirawan Salatiga, it shows that in 2009 and 2010, asthma always becomes 10 big classifications
and has the 3rd and 4th ranks for both hospitalized and outpatients. Purpose: The purpose of this
research is to describe the patients knowledge and attitude about the relapse of asthma management
and to identify the number of controlled and uncontrolled bronchial asthma outpatients Method: The
method of the research was descriptive-quantitative method. The sample of the research was 75
asthma outpatients who had their health checked. To these samples, the researcher applied ethical
actions i. e. informed consent, anonymity, and confidentiality. Result: The result of this research
showed that the patients knowledge was good (60%), moderate (28%), and low (12%). The attitudes
in controlling the asthma relapse were positive (61.3%) and negative (38.7%). The respondent for
controlled asthma was as many as 65% and uncontrolled asthma was as many as 34.7%. Conclusion:
From the results, it is suggested for health services (hospital) to defend its good service especially in
giving information that deals with the disease of the patient. The hospital can increase the service by
giving information to the patients, particularly to the family so that the patients can get support in
managing the asthma.
Keywords: Knowledge, Attitude, Asthma Relapse
65
Nursing Management
SOCIAL SUPPORT AND SELF-EFFICACY OF PATIENTS WITH

CORONARY HEART DISEASE (CHD)
Wantiyah
ABSTRACT
Background: Coronary Heart Disease (CHD) is a chronic disease and has become the leading cause of death in
most developed countries. Self-efficacy is required for patients with CHD to manage the disease independently
and to increase the quality of life. Self efficacy for patients with CHD is related to their ability to perform a
planned behaviour that can affect their life to help the patients control the risk factors. The patients need social
support to maintain the ability to manage the disease. Purpose: This study identified the relationship between
social support and self efficacy of patients with CHD. Method: This study was an analytical research with a
cross-sectional approach. This study was conducted in Jember using a simple random sampling to obtain 107
respondents. Inclusion criteria were patients with CHD who were able to communicate well, were not having a
heart attack and were willing to get involved in the study. The instruments used were questionnaires about
respondent characteristics, social support and self efficacy. The questionnaire of self efficacy consisted of
general self efficacy (GSE), cardiac self efficacy (CSE), and cardiac diet self efficacy (CDSE) that had been
modified by researcher. All of the questionnaires were valid and reliable with alpha cronbach between 0,77 and
0,88. Chi-Square within 95 % CI was used as a statistical analysis. Result: The study identified that more than a
half of respondents were male (59,8 %) and obtained social support (57 %). All of the respondents were married
(100 %), and more than a half of respondents showed the self efficacy at good category (53.3 %). The statistical
analysis showed that there was a significance relationship between social support and selfefficacy (p Value: 0.
006 : 0. 05). Conclusion: The study concluded that there was a relationship between social support and selfefficacy of the patients with CHD. When the patients obtain social support, their self efficacy will increase.
Nurses can improve patients self efficacy by facilitating the social support from the patients family, significant
others or by themselves. More studies are needed to improve the social support for patients with CHD and to
identify the other factors that contribute to the patients self efficacy.
Keywords: Coronary Heart Disease (CHD), Self-Efficacy, Social Support
66
Nursing Management
THE COST ASSESSMENT AND THE INFLUENCE OF PERSONAL FACTORS ON

SICKNESS ABSENCE
Yu C.W.1; Hassan Ali2
School of Nursing, Faculty of Health Sciences, AIMST University, Malaysia.
2
Executive Director, Cooperative and Entrepreneur Development Institute, Universiti Utara Malaysia, Kedah,
Malaysia.
1
ABSTRACT
Background: Sickness absence is the growing concerns among employers and organizations in health
care industry owing to greater awareness of the costs incurred as a result of absence. This withdrawal
behaviour in health services especially among the nurses has an inevitable impact on productivity and
on economic and financial costs on the organization. The recent survey on sickness absence by The
Chartered Institute of Personnel and Development in UK revealed that around 150 million working
days are lost each year to sickness absence and it costs the UK economy of over 100 billion per year
(CIPD, 2010). It is estimated that sickness absence among nurses in UK costs 90.5 million per year
and 714 million per year when all National Health Service (NHS) costs are considered (Williams,
Michie&Pattani, 1998). With the average cost of absence from sickness running at 692 per employee
in UK, many organizations are taking radical action to keep staff at work (CIPD, 2008). Despite the
growing concern over sickness absence, virtually no robust data exists in many organizations to
calculate its costs. Majority of the organizations appear fundamentally ill equipped to estimate or form
a comprehensive view of their absence costs. So far there is no study that estimates financial cost of
sickness absence among nurses in public hospitals in local context. Purpose: This study is to estimate
the financial costs incurred due to sickness absence among the hospital nurses. Besides, this study will
also examine the links between personal factors and sickness absence. Method: This study was
carried out using questionnaire survey to obtain baseline personal and socio-demographic information
and the access to organizational archival record for sick leave usage. A total of 1300 nurses from six
regional hospitals located in northern part of Peninsular Malaysia participated in the study. Time lost
and duration measures were employed to calculate sickness absence rate and the financial cost was
estimated based on direct costing due to sickness absence. Multiple regression analysis was conducted
to examine the association between personal and socio-demographic factors and sickness absence. The
research had obtained ethical approval from Medical Research and Ethical Committee, Ministry of
Health Malaysia and registered with National Medical Research Registry. Results: The results of the
study revealed that sickness absence rate of 3.2% and the average of 7.56 days of sick leave taken by
each employee per year, almost in equal comparable to many western countries. Most of the personal
and socio-demographic variables did not relate to sickness absence. However mean scheduled work
day was related significantly with sickness absence. The financial cost per employee per year was
estimated at RM 4,376.68 per employee per year. The overall cost to ministry level was RM 237.82
million and could reach RM 299.14 million for the whole nurse population in Malaysia. Conclusion:
Costing sickness absence in this study help managers to determine the scale of the problem, and can
put into context the costs of introducing methods of reducing absence. The financial cost to the
organization would pose extra burden to organizational financial performance as organization needs to
retrain new or replacement staff or paying extra overtime to staff who do the cover. All this can affect
organization productivity and effectiveness in providing service to the public. The costs of nurse
absence are too large to be ignored, but have to be viewed in the broader context of the impact of
absence on care quality and continuity. Managing nurse absence is one element of management
practice where there is a real prospect of securing quality improvement and cost reduction through
effective and considerate action.
Keyword: Sickness Absence, Sick Leave, Nurse, Absence Costs
67
Nursing Management
NURSING TRIAGE DURATION IN PATIENT WITH CHEST PAIN: SHORTER TRIAGELEVEL DESIGNATION INTERVAL IN ACUTE MYOCARDIAL INFARCTION
Diah Kristianisah Rahayu1, Mifetika Lukitasari1, Arina Madjidi2, Anugerah Eka Purwanti1, Fitri Ayuning
Ulansari1, Mohammad Saifur Rohman2
1
Department of Nursing, Faculty of Medicine, University of Brawijaya Malang
2
Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Brawijaya Malang
ABSTRACT
Background: Accurate triage assessment in the Emergency Department (ED) can reduce mortality
and morbidity. The goal of triage level designation indicating urgency of symptoms is within 2 to 5
minutes. However, there is no data regarding this issue in Indonesia. Objective: This study aimed to
analyze the difference of door to triage-level designation interval between AMI and no-AMI patient in
the ED. Method: An observational study was conducted in the ED, dr. Saiful Anwar General
Hospital. Trained observers were recruited to measure door to triage interval in patient with chest pain.
Thirty eight patients with chest pain (57.0013.97 years old; 52.6% man) were randomly selected
among patients admitted to ED dr. Saiful Anwar General Hospital during August 2011 to January
2012. AMI was defined based on European Society of Cardiology definition as the presence of at least
two of the following criteria: typical chest pain, electrocardiographic (ECG) abnormalities (new ST-T
wave changes, new left bundle branch block, or the development of new pathologic Q waves), and
elevated values of biochemical markers (biomarkers) of myocardial necrosis. Results: Among patients
with chest pain, triage response time in AMI patients was 18.7544.98 minutes and 22.8553.02
minutes in non-AMI patients. The door to triage interval was significantly shorter in AMI patients than
that of non-AMI patients (P =0.032). The number of questions that used to assess AMI patients may
contribute to this shorter interval (11.229.14). Triage nurses in emergency department were able to
give quicker response to patient in AMI. However, this response time still far from the recommended
goal. Hence, further study with a greater sample size is needed to address this issue. Conclusion: This
study suggested that triage nurses in the ED were able to give significantly shorter door to triage
designation interval to AMI patients.
Keywords: Chest Pain, Door to Triage Interval, Acute Myocardial Infraction
HOLISTIC NURSING CARE OF CHILDRENS WITH DISABILITIES:
A PSYCHOLOGY ASPECT TO IMPROVING THE HEALTH QUALITY
Chairun Nasirin
College of Health Sciencies, Mataram-Indonesia
ABSTRACT
Introduction: The health care of children with disabilities has serious effects on childrens life, and it
is serious social phenomenon in Mataram. The holistic nursing function of health care to children with
disabilities focused on wellness and integrated to nursing knowledge that implicate to quality of
childrens life. Purpose: To determine the significance function of holistic nursing preventive on
disabilities childrens health. Method: Qualitative methods was applied to remarks issues of
disabilities childrens health. Nineteen children with disabilities, range of age from 8 to 19 years,
participated in the study. Data were collected by participatory observation. Results: The holistic
nursing program should be implemented to adequate quality of health care for disabilities children.
Conclusion: Department of Health should be able to evaluate the effectiveness of implementation of
disabilities children health policies. Moreover, they also need to create regulation in the form of how
to legalize holistic nursing program for disabilities children and create a clear health policies to
increase the health quality of children with disabilities.
Keywords: Holistic Nursing, Disabilities Children, Health Care
68
A PHENOMONOLOGY STUDY OF MOTHERS EXPERIENCE

IN CARING PREMATURE BABIES
Eka Riyanti
Faculty of Nursing, University of Indonesia
ABSTRACT
Background: The cases of premature babies tend to increase. Care of premature babies transitioning
from hospital to home often makes women anxious in caring the baby at home. Purpose: This
research aimed to determine maternal experience of caring a premature baby at home. Method: This
study used a phenomenology research design. Data were analyzed by thematic content analysis from
the interviews of 9 participants. Result: The researcher found seven themes, which were mothers
stress of the appearance of the baby, specificity of baby care, support to the mother, the difficulties
experienced during the care of the baby, the joy of caring for babies, premature baby care needs, and
the expectations of mothers to the premature baby. Conclusion: Mothers who had preterm infants
needed supports such as home visits and health promotion concerning the care of premature babies.
These mothers needed a support system of caring for premature babies at home.
Keywords: baby premature, mother, caring baby premature at home
THE RISK FACTORS OF LABOR AND DELIVERY COMPLICATIONS ON WORKING

MOTHERS IN FATMAWATI CENTER PUBLIC HOSPITAL OF JAKARTA
Yuni Puji Widiastuti, Setyowati, Yati Afiyanti
Kendal School of Health Science
ABSTRACT
Background: Labor complication was one of the causes of maternal death in Indonesia. One factor
contributing to mothers experiencing labor complication was activity when the mother was working.
Purpose: This study aimed to identify the risk factors of labor complication on the working mothers.
Method: The study used case-control design and retrospective design. The sampling method used
consecutive sampling. Result: The result of the study showed that the activity of prolonged sitting
(exp B=2,201; 95% CI: 0,445-10,896) and pregnancy complication (exp B=6,596;95% CI:1,90122,894) was the risk factors which caused labor complication. Conclusion: This finding gave
scientific evidence that the working mothers need to pay attention to their activities during their
working.
Keywords: Kind of Occupation, Work Activity, Labor and Delivery Complication.
69
NURSES CULTURAL COMPETENCY IN PROVIDING CULTURALLY SENSITIVE

NURSING CARE FOR DIABETIC PATIENT AT FATMAWATI HOSPITAL JAKARTA
Enie Novieastari, Azrul Azwar, Dewi Irawaty and Sudarti
ABSTRACT
Background: In providing nursing care, nurses need to consider every aspect of their patients
including their cultural dimension. This perspective is in line with the nursing paradigm that every
person is a unique and holistic human being which consist of bio-psycho-socio-spiritual-cultural
dimensions. It is believed that culture influence the attitude and behavior of every person in their life
including their behavior during illness and hospitalization. Therefore nurses must have a cultural
competency in order to provide culturally sensitive nursing care for their patients needs. Without this
competency, nurses would have some problems in fullfilling the patients need and the satisfaction
will decreased. Purpose: The purpose of this article is to describe the cultural competency of nurses
at Fatmawati Hospital after completing the training of culturally sensitive nursing care for diabetic
patients. Method: A quasi-experimental design with pre and post test without group was used to
explore the effectiveness of Asuhan Keperawatan Peka Budaya/AKPB Training (culturally sensitive
nursing care training) in increasing nurses cultural competency. Sixty-two nurses who work at
General Ward (Fifth Floor Ward IRNA B) Fatmawati Hospital Jakarta participated in this research.
The modules for the training and the instruments for this research were developed by the researchers
and being reviewed by a number of related nursing experts through expert meeting. Result: Based on
paired t-test analysis, the cultural competency of the participants are statistically different in
knowledge, skill and attitude aspect of nurses cultural competency before and after completing the
training of culturally sensitive nursing care. Conclusion: The AKPB training is an effective method
for increasing nurses cultural competency in order to provide culturally sensitive nursing care.
Keywords: AKPB Training, Cultural Competency, Culturally Sensitive Nursing Care
70
THE RELATIONSHIPS BETWEEN CHARACTERISTICS OF ADOLESCENTS, THE ROLE

OF PEERS, AND EXPOSURE TO PORNOGRAPHY WITH SEXUAL BEHAVIOR OF
ADOLESCENTS
Ari Pristiana Dewi, Junaiti Sahar, Dewi Gayatri
ABSTRACT
Background: Aspects of the growth and development of adolescents are characteristics of physical,
psychological and social. The three aspects make the adolescent as a group at risk for health problems
including sexual behavior. The existence of the negative influence of peers and exposure to a vulgar
pornography may increase the risk of adolescent sexual behavior. Purpose: The purpose of this study
was to identify characteristics of adolescent relationships, the role of peers and exposure to
pornography on the sexual behavior of young people in Pasir Gunung Selatan, Depok. Method: This
research was a quantitative study using cross sectional. Data was collected by using cluster
proportional sampling with the number of samples were 280 adolescents. The data was analyzed using
the chi square test and logistic regression. Result: The results showed significant relationships
between: gender (x2=106;=0.00), education level (x2=5.8;=0.02), age of first dating (=0.00), the
frequency of dating (x2=7.98;=0.007), religious norms (x2=44.97;=0.00), family norm
(x2=6.85;=0.013), peer influences (x2=4.95;=0.035), and internet media (x2=24.2;=0.00) with
adolescent sexual behavior. Dominant factors that influence adolescent sexual behavior were gender
(OR=35.95 CI 95%), religious norms (OR=10.30), peer influence (OR=2.99), sources of information
(OR=0.13) and mass media exposure to pornography (OR=23.37). Gender was the most dominant
variable associated with adolescent sexual behavior. Conclusion: It was suggested that community
nursing services need to develop promotional programs and prevention through adolescents
empowerment in both peer counselors and peer educators on the prevention of sexual risk behavior in
adolescents. According to the theory of Preceede-Procede, male adolescents ideally should be given
the program earlier so that by health promotion they can control themselves against risky sexual
behavior. Parents need to supervise adolescent relationships with peers. Teachers should instill values
and morality in the prevention of adolescent sexual behavior. Society should have rules against teen
promiscuity, especially adolescent boys and girls. Government and leaders at any level need to tighten
supervision of Internet cafs in terms of access and time, especially in school hours.
Keywords: Characteristics of Adolescents, Peers, Pornography, Sexual Behavior.
71
THE DIFFERENCES OF WOMEN BODY IMAGE AMONG THE USAGE VARIANCE

HORMONAL CONTRACEPTIVE AGENTS
Nurfika Asmaningrum, Siswoyo, Anis Nur Farida
ABSTRACT
Background: Body image is ones attitude consciously or unconsciously towards his/her own body.
These attitudes include perception and feeling over his/her body size, shape, function, appearance.The
women body image contributed by many factors. The side effects usage of the hormonal contraceptive
may influence the womenphysiologic changes that could have an impact on their body performances.
Purpose: The research objective to analyze the differences of women body image on the usage
variance hormonal contraceptive agents (injections, pills, and implantmethods) Method: Research
design was analytical observational study. The sample used 90 women divided on 3 groups were
assigned with proportionate random sampling. Women body image measured on a self report with the
Multidimensional Body Self Relation Questionnaire Appearance Scale (MBRSQ-AS). This scale
contains five dimensions such as appearance evaluation, appearance orientation, satisfaction over
certain part of body, anxiety of becoming overweight, and perception on the body size. After that the
data analyzed used chi-square test. Result: The resultsshow the women body image on the usage of the variance
hormonal contraceptive among pills, injection and implant methods have a significant difference (p-value
0.013, 95% CI). On majority, the usage pills method 53, 3% were positive body image, the usage of
injection method 63,3 % have a positive body image, and the last the usage implant contraceptive
73,3% are positive too. Negative or positive body image indicated women satisfaction or
dissatisfaction on their feeling and perception about the changing performance as well as potential
existing. Conclusion: The findings provide needed more information on the women about the real
side effects of the variance on hormonal contraceptive. The accuracy information from the health
workers, discussion and family support system, are important things to influence women attitudes on
the usage hormonal contraceptive. The expectation many women think more positively about their
alterationbody performances, so the probability drop out number of contraceptive be able prevented.
Keywords: Body Image, Hormonal Contraceptive
72
SEX WORKERS PERCEPTION ON HEALTH BEHAVIOR FOR PREVENTING

SEXUALLY TRANSMITTED INFECTIONS (STIS) IN GAMBILANGU BROTHEL HOUSE,
CENTRAL JAVA
Novita Pusparini, Dwi Susilawati
ABSTRACT
Background: Reproductive health care is very important particularly for FSWs (Female Sex
Workers). FSWs are at high risk to expose reproductive health problems. FSWs are mainly women
who sell sexual services regularly as their job. Purpose: The aim of this study is determine the
perception of FSWs on healthy behaviors to prevent STIs. Method: This study use qualitative method,
with phenomenological approach. There were five samples in accordance with inclusion criteria. The
data collection was using in-depth interviews with semi-structure interview. Result: The results show
that the perceptions of FSWs about STIs include the definition of STIs, sign and symptom of STIs,
FSWs perception on how to prevent STIs through faithfulnes, condoms use and also personal hygiene
maintenance. FSWs perceptions of healthy behaviors include activities, habits to prevent STIs
transmission, obey the rules that apply at brothel house. FSWs perceptions about the real form of
health behaviors to prevent STIs are consuming medicine orderly when ill, using condom orderly,
screening routinly, maintaining personal hygiene, including vaginal and vulvae hygiene. FSWs
perceptions about the obstacles in the healthy behavior that is divided into two external constraints in
the form of trouble on the customer and the boyfriend refused to wear condoms. Internal difficulties
were in the form of personal difficulties in the form of economical motivation, divorcement, and afraid
of losing customers. Conclusion: Perception for solutions to problems in healthy behavior through
two types of ways that is positive and negative perception. Positive perceptions include flattering
customers, adding services and also provide bonus. Negative perceptions include belief in boyfriends
and customer free from STIs.
Keywords: Female Sex Workers (FSWs), Perception, Health Behavior
73
PERCEPTIONS OF HYPERTENSIVE ELDERLY ON HEALTH CARE

Nurullya Rachma
Nursing School, Medical Faculty, Diponegoro University
ABSTRACT
Background: Hypertension requires treatments with respect to risk factors that influence it
continuously. Health care teams play an important role in providing health services for the treatment
of hypertension in the elderly. The goal is to improve the health of elderly with hypertension. As a part
of healthcare teams, nurses focus on hypertension prevention and health promotion as well as
maintaining the elderly. To achieve this goal, nurses involve three levels of prevention, such as
primary, secondary and tertiary preventions. Purpose: The purpose of research was to get an in-depth
understanding of the significance and meaning of health services received by elderly with
hypertension. Method: The research design was descriptive phenomenology through in-depth
interviews. Participants were selected by purposive sampling technique. Data were saturated with sixth
participants. The data were analyzed using the phase analysis by Collaizi. Result: Experience of
elderly people with hypertension who received health care was individualistic. The results identified
three themes which were the place chosen by the elderly for checking blood pressure, health care team
behaviours, and that a hypertension treatment program was needed by elderly. The place chosen for
the elderly to check blood pressure are posyandu, community health centers, and private physicians.
Perceptions of the elderly on health behaviours included positive and negative aspects of health team
behaviours who served them when they visited the health facilities. The program needed for the
treatment of elderly hypertension was scheduled regular check ups to health centers and home visits
from health care teams. Conclusions: Healthcare teams were needed to support elderly in order to
respond adaptively to the physical and psychosocial impact due to hypertension. They were expected
to give more attention to hypertension suffered by the elderly, and to meet the needs of health
information related to hypertension in the elderly.
Keywords: Perception, hypertensive elderly, health care
74
CORRELATION BETWEEN THE FAMILY UPBRINGING PATTERNS WITH THE

PERCEPTION OF ADOLESCENTS ABOUT PRE-MARITAL SEXUAL BEHAVIORS
Marsito, Hendri Tamara Yudha
Muhammadiyah College of Health Science, Gombong
ABSTRACT
Background: An interview conducted to a Counseling Teacher in Gombong I State High School
found that 1 student (0.002%) was dropped out for violating school discipline, such as misconduct and
5% of students did socially ethical violations friendship with the opposite sex in the school. Purpose:
The study aims to identify correlation between the family upbringing pattern with the perception of
adolescents about pre-marital sexual behaviors. Method: The study used descriptive correlation
design with cross sectional approach among the variables of democracy, permissive, and authoritarian
parenting with the perception of adolescents about pre-marital sexual behavior. 226 samples were
taken using total sampling technique. Result: The findings show that 221 respondents (97.8%) had
democracy family upbringing patterns, 221 respondents (97.8%) had permissive family upbringing
patterns, 152 respondents (67.3) had authoritarian family upbringing patterns, 190 respondents
(84.1%) had good perceptions about pre-marital sexual behavior. The chi square test shows correlation
between permissive upbringing patterns with perceptions about pre-marital sex with p = 0.006,
while democratic upbringing pattern and authoritarian upbringing patterns have no correlation with
perception of pre-marital sexual behavior with p = 0.801 and p = 0.213. Conclusion: Thus the role of
parents is considered very important in the care of adolescents. Therefore parents have an important
role to be able to apply appropriate parenting for their children. Community nurses have roles in
providing input for the parents to choose the right upbringing patterns for adolescents appropriate with
their development phase.
Keywords: Pattern, Adolescent, Sexual Behaviors, Perceptions, Pre-Marital
COPING MECHANISM IN CULTURE DIFFERENCES OF OUTER REGION STUDENTS

IN THE FIRST YEAR
Maria Wisnu Kanita, Nur Setiawati Dewi
ABSTRACT
Background: First year student is one of population who susceptible to become stress. One of the
causes of stress was culture differences between hometown and the new region where they took
education. Students used coping mechanism to cope the culture differences. Purpose: To describe the
coping mechanism of first year student on culture differences issue. Method: This research was a
qualitative study with phenomenological approach using in-depth interview method. The research
involved five outer region students in the first year that never stayed in Java. Result: This research
showed that there were differences between respondents home town and Java, such as: cultures,
infrastructures, environment, and community, which made problems and various feelings. In solving
the problems, they used positive and negative coping mechanism. Based on their experience, internal
and external aspects were being the self-preparation. Conclusion: Culture differences which have
never known by students caused problems and various feelings and afterwards turned up the coping
mechanism to solve it. Quality of nurse role as a counselor, care giver and rehabilitator can increase
the optimum self function of the outer region students in the first year.
Keywords: Coping Mechanism, Culture Differences, First Year Students.
75
SEXUAL BEHAVIOR AND AWARENESS OF INDONESIAN HIGH SCHOOL STUDENTS

IN TRANSITION WITH IMPLIED RISK OF HIV INFECTION: A CROSS-SECTIONAL
STUDY
Untung Sujianto
ABSTRACT
Background: The HIV/AIDS epidemic has killed over two million people since it was first
recognized in 1981. It is estimated that the number of people living with HIV worldwide at
about 34 million in 2010. Purposes: To determine the knowledge, attitudes, life skills and sexual
behavior related to HIV/AIDS among adolescents. Methods: This cross sectional study was
conducted in seven randomly selected secondary schools in Semarang district (central Java),
Indonesian. Data was collected using a standardized pre-tested self-administrated questionnaire and
analyzed using SPSS version 19. Results: The response rate was 100%. Majority of the respondents
(57.1%) were male. The overall mean age of the 340 respondents was 16.3 years (95% CI 16.2 -16.4;
1.1 SD). The mean age of males did not differ significantly as compared to the females (p>0.05).
Majority of respondents were Indonesians (69.7.4%) followed by Chinese (30.3%). The overall
knowledge about HIV/AIDS transmission and life skills was low. Only 165 out of the 340 respondents
(48.5%) had sound knowledge. There was a significant association between knowledge and life skills
(p =0.01). The overall general life skills were poor and the overall mean life skills score was 60.8
(95% CI = 59.9 - 61.8). The overall attitudes were poor and the overall mean attitude score was 39.9
(95% CI = 39.3 - 40.4). Although the mean attitude score for the females was significantly higher
(40.4) as compared to the males (40), the difference was very small. There was a significant
relationship between attitude scores related to HIV/AIDS and gender, life skills to avoid
smoking, media pornography, drugs abuse, premarital sex, using contraception, pregnancy, abortion
and sexually transmitted diseases, HIV/AIDS (p<0.05). Almost 52 students (15.3%) have had already
experienced sexual intercourse and 11.5% oral sex and 11.8% anal sex. The overall mean age at first
sexual intercourse was 15 years old (95% CI 14 - 17). The difference in the mean age at first
sexual intercourse between males and females was not statistically significant (p >0.05). Only
8.5% of respondents stated that they used condom during last sexual intercourse. Only 6.8% of
respondents stated that they had consumed alcohol before having sex. Conclusions: Levels of
knowledge and life skills relating HIV/AIDS transmission and prevention among adolescents was
relatively low and serious misconceptions was exist with regards to prevention. The respondents seem
to have unfavorable attitude on the prevention of HIV/AIDS. There is a need for a life skills training
sex education and reproductive health in schools which include promotion of safe sexual behavior.
Keywords: Knowledge, Attitudes, Life Skills, Sexual Behavior, HIV/AIDS, Adolescents, Indonesian
76
THE RELATIONSHIP BETWEEN KNOWLEGDE AND BEHAVIOR OF ADOLESCENT

ABOUT GENITAL HYGIENE DURING MENSTRUASTION PERIOD
Suzana Octavia, Sari Sudarmiati
ABSTRACT
Background: Maintaining the hygiene of genitals during menstruation period needs more attention.
There are several factors that influence, namely knowledge and behavior among adolescent, education,
age, interests and experiences. There will cause problems if the perineal hygiene is not maintained.
There are burning sensation, itching on the vagina, irritation and odor. Purpose: The aim of the
research was to determine the relationship between knowledge and behavior of adolescent about the
hygiene of genitalia during menstruation period. Methods: The type of this research was a quantitative
non-experimental study by using correlation. The number of sample was about 195 respondents.
Respondents were recruited by using proportional random sampling. The data was collected by using a
questionnaire and analyzed using the Chi Square test. Results: There were 42.3% (63 respondents)
with good knowledge and good behavior, 42.3% (63 respondents) had moderate knowledge and good
behavior, 15.4% (30 respondents) had poor knowledge and good behavior, 16.5% (16 respondents)
had good knowledge and bad behavior, 16.5% (16 respondents) had moderate knowledge and bad
behavior, and 35.1% (7 respondents) had poor knowledge and bad behavior. Chi square test resulted p
value at 0.038 (=0.05). It reflected that there was a significant relationship between knowledge and
behavior of adolescents in maintaining genital hygiene during menstruation period. Conclusion: There
was relationship between knowledge and behavior of adolescents in maintaining genitalia hygiene
during menstruation period. School is expected to provide health education about genital hygiene
maintenance during menstruation period.
Keywords: Knowledge, Behavior, Hygiene of Genital, Menstruation
77
QUALITY OF PRESSURE ULCER CARE IN INDONESIAN HOSPITALS:

FIRST YEAR MEASUREMENT USING LPZ QUESTIONNAIRES
Yufitriana Amir1, Ruud J.G. Halfens2, Christa Lohrmann3, JosSchols2
1
University of Riau, Indonesia
2
Maastricht University, The Netherlands, 3Medical University of Graz, Austria
ABSTRACT
Background: Pressure ulcers (PUs) frequently occur in hospitalized patients. PUs has impact on
health-related quality of life and length of hospitalization. The necessary extra nursing time leads to
high health care costs. However, limited information is available about the PU-prevalence rate in
hospitals in Indonesia and it is unclear whether the quality of care regarding PUs can be enhanced.
Purpose: The first aim of this study is to assess the feasibility of using The International Prevalence
Measurement of Care Problems/Landelijke Prevalentiemeting Zorgproblemen questionnaire (LPZ
questionnaires) to measure the prevalence of PUs and the quality of PU care in Indonesian hospitals
(Halfens, Meijers et al.2011). The LPZ questionnaire is based on the Donabedian model (Donabedian
1988), measuring the prevalence (outcome) on patient level, prevention and treatment (process) and
quality indicators on ward and institutional level (structure). The second aim of this study is to provide
data about the first year measurement of the PU prevalence in several Indonesian hospitals. Methods:
Indonesian experts evaluated the content validity of LPZ Indonesian version included the clarity of
wording and the appropriateness for Indonesian hospitalized patient, using a Delphi method. The data
collection procedure is based on the LPZ method. General hospitals in Indonesia will be invited.The
ethic committee of each hospital will be asked for permission to conduct this study. In each
participating hospital nurses will be trained to carry out the prevalence measurement. Each patient will
be assessed by two trained nurses with respect to patient characteristics, pressure ulcer grade and
prevention and treatment of PUs performed. Only patients who give their informed consent will be
included. Results: The Indonesian version of the LPZ questionnaire is feasible to measure the
prevalence of PUs and the quality of PU care in Indonesian hospitals. The prevalence of PUs in
several Indonesian hospitals and the quality of PU care will be presented during the conference.
Conclusions: This study shows the feasibility of using the international LPZ questionnaire to measure
the quality of PU care in Indonesian hospitals and to provide feedback on the possibility to enhance
the quality of PU care.
Keywords: Quality of Care, Pressure Ulcers, Prevalence
78
QUALITY OF LIFE DIABETIC ULCER PATIENT AT SERANG GENERAL HOSPITAL

Aji Firman, Indah Wulandari, Dadang Rochman
Faletehan School of Health, Serang
ABSTRACT
Background: Diabetes mellitus is a disease that can affect all organs of the body and cause a variety
of complication and can interfere with lifestyle or quality of life. One of the late complications of
diabetes mellitus is diabetic ulcer. Diabetic ulcers are sores that characterized by deep scar, wide,
tissue death, and even the long healing process that will influence patient`s quality of life. Purpose:
The aim of this study was to identify quality of life patient with diabetic ulcer. Quality of Life
Instrument in this research includes four dimensions such as physical health dimensions,
psychological health dimensions, social relationships dimensions, and environment dimensions.
Method: Design of this research was descriptive quantitative. Sixty diabetic ulcer patients were
recruited in the study. Sample was obtained by accidental technique. The quality of life was measured
using the WHO QOL Brief which consists of 26 questions. Technical analysis in this research was
univariate analysis and percentage distribution. Result: In term of physical health dimension, the
majority of respondents felt disturbed in terms of medical treatment. They feel uncomfortable at
carried out, the pain, and sleep pattern disturbance (50%). Respondents who felt physically impaired
quality of life in general in terms of activity, medical therapy, and rest. In dimensions of psychological
health, respondent frequently have negative feelings, decreased self-esteem and negative body image
(65%). Diabetic outpatients were complaining of the feeling of upset, frustrated, and feel bored
because their daily care must undergo for long time, and has impacted their financial. The result from
social relationships and environment dimensions showed that patients feel more satisfied on social and
environment support (25% for each). Conclusion: The quality of life of diabetic ulcer patients is more
in psychological health dimension compare with other dimensions. This is due to the cultural
characteristics of Serang people which provide full support even morally and materially. But it is
undeniable that individual patients experience on fatigue treatment affects long a psychological
condition. It is recommended for the hospital to develop Standard Operation Procedures education as a
means of prevention and promotion in patients' psychological problems.
Keywords: Quality of Life, Diabetic Ulcer
79
PERCEPTION AND MOTIVATION OF NURSES IN FACILITATING BREASTFEEDING

IN PERINATOLOGY ROOM
Yenni Suryadi, Ermiati, Restuning Widiasih
Faculty of Nursing, Padjadjaran University, Indonesia
ABSTRACT
Background Breast Milk is a basic need for every babies and it is the best food that will support the
optimal growth and development of baby. Recently, the percentage of giving milk through a bottle as
breastmilk substitutes by nurses is still high in the perinatology room. On the other hand, hospital has
policy that every baby should recieve breastmilk and forbidden to give baby feed by bottle. Purpose:
This study aims to describe the perception and motivation of nurses in facilitating breastfeeding in
Perinatology Room. Method: Descriptive explanatory was conducted in Perinatology Room, Dr.
Hasan Sadikin Hospital, Bandung. It started from November January 2012. Total sampling method
was used. Twelve nurses who work in Perinatology Room were recruited as respondent. Data were
collected use a questionaire that arrange by researcher. Proportion methods is used to analyze the data.
Results: The results showed that nurses had appropriate and inappropriate perception of brestfeeding
facilitate, about 66.7% and 33.3 %, respectively. Meanwhile, motivation of nurses to facilitate
breastfeeding is about 75% in high motivation and 25% in low motivation. Conclusion: Most of
nurses have appropriate perception and high motivation in facilitating breastfeeding process in
perinatology room.
Keywords: Perception, Motivation, Breast Milk.
COMPARATIVE FIGURES ON THE INCIDENCE OF PHLEBITIS IN INTRAVENOUS

CATHETERS INSTALLATION ON THE DOMINANT HAND
WITH NON-DOMINANT HAND
Tino Dianto1, Sakti Oktaria Batubara1, Aziz Anwar2
Satya Wacana of Christian University, 2Nurses of Dr. Ario Wirawan Hospital Salatiga
ABSTRACT
Background: Intravenous therapy is an invasive action, which become competencies that must be
mastered by nurses. In the invasive action, no matter how small the action, it can lead to a risk of
complications. One of the most common complications of intravenous therapy is phlebitis. If phlebitis
does not manage properly, it will lead to serious complications such as thrombophlebitis, sepsis,
thrombosis, or even cause death. Phlebitis can be caused by chemical, mechanical, and bacterial. One
of the mechanicals factors of phlebitis is the location of the intravenous catheter. Critical thinking is
required in selecting the location of intravenous catheter, because it affects the efficiency and the
treatment of the therapy. Purpose: This study aimed to get to know the comparative figures on the
incidence of phlebitis on the intravenous catheter in dominant hand with non-dominant hand. Method:
This research is a comparative research using prospective cohort study design. Consecutive sampling
was used to take the samples. Data collection was performed using the observation sheet for 1 month.
Then, the data is processed using Chi-Square test statistics. Result: The results of this study is taken
from the studied of 456 cannulations. The incidence of phlebitis in the dominant hand was 23.13% (34
of 147) and 24.92% (77 of 309) for the non-dominant hand. By the results of Chi-square count (0.083)
is less than Chi-square table with df1 (3.841) and the p-value 0.773 (>0.05). Conclusion: The
conclusion of this study is that there was no significant difference between the incidences of phlebitis
in the dominant hand with non-dominant hand.
Keywords: Phlebitis, Location of Installation, Dominant Hand, Non-Dominant Hand
80
THE RELATIONSHIP BETWEEN DEPRESSION AND FAMILY SUPPORT TOWARD

QUALITY OF LIVE AMONG HIV/AIDS PATIENTS WHO TAKE HEALTH CARE AT
CIPTO MANGUNKUSUMO HOSPITAL IN JAKARTA
Henni Kusuma, Elly Nurrachmah, Dewi Gayatri
ABSTRACT
Background: Quality of life (QOL) of patients with HIV / AIDS become a main concern since this
chronic and progressive illness known that can impact in all aspects of patients life, includes physical,
psychological, social, and spiritual. Psychosocial problems especially depression and lack of family
support are frequently faced by patients which can effect in reducing their quality of life. Purpose:
The purposes of this study are to identify and to explain the relationship between depression and
family support towards quality of life of HIV / AIDS patients. Method: This study uses crosssectional study design, with 92 respondents (from outpatients on clinic for HIV/AIDS patient, AugustDecember, 2011) who recruited with a purposive sampling technique. The data was collected by using
questionnaires which are developed by researcher (such as demography questionnaire, modification of
CES-D questionnaire, family support questionnaire, and modification of WHOQOL-HIV BREF). In
bivariate analysis, this study uses two kinds of method to measured correlation between independent
variable with dependent variable. First, for measured correlation between depression, family support,
gender, marital status, education, work status, income, and stage of disease with QOL, are using chisquare test. Second, to measure correlation between age and length of illness with QOL is using t-test
independent. Finally, for multivariate analysis, this study uses multiple logistic regressions. Each
variable beside age and length of illness was dichotomized by criteria that suitable for them. Results:
The results show that the majority of respondents who have poor quality of life (63%), depression
(51.1%), lack of family support (55.4%), male (70.7%), higher education level(93.5%), work (79.3%),
unmarried (52.2%), have higher income (68.5%), in advanced stage of disease (80.4%), with an
average age of 30.43 years old, and the average length of illness is 37.09 months. The analysis of the
correlation show that there is a significant relationship between depression and family support toward
quality of life (depression: p=0.000, =0.05, OR=12.1, CI=4.34-33.8, family support: p=0.000,
=0.05, OR=21.5, CI=6.49-71.2). Further analysis with logistic regression test demonstrates that
respondents who perceive depression and non-supportive family are risk to have poor quality of life
after being controlled by gender, marital status, and stage of disease. In addition, this analysis show
that family support is the most influential factors which impact to the quality of life of patients with
HIV / AIDS with OR=12.06 (=0.05, CI=4.08-35.87). Conclusion: Family support and depression are
the main problems which can reduce QOL of HIV / AIDS patients. So, empower family in order to
continuously provide support to them is very important to improve their quality of life. Beside that
effort, preventive and resolve problem of depression are also need to be done because it can decrease
QOL of them too.
Keywords: Depression, Family Support, Quality of Live, HIV/AIDS.
81
FACTORS ASSOCIATED WITH ESSENTIAL HYPERTENSION IN MIDDLE ADULT AGE

GROUPS IN CARDIAC CLINIC, PEKANBARU
Rizka Febtrina
ABSTRACT
Background: Hypertension is a disease that often occur without symptoms, many people are not
aware of hypertension beafore checking. The cause of hypertension that can be changed include stress,
excessive salt intake and eat foods high in fat, obesity (overweight), lack of exercise, smoking, and
alcohol. Prevention of hypertension can be done by running a healthy lifestyle. Hypertension resulting
from the interaction of many factors. Purpose: This research purpose is to determine the factors
associated with essential hypertension in middle adult age groups in Cardiac Clinic Arifin Achmad
Regional Hospital (RSUD) Pekanbaru. Method: The design of the research is description correlation.
Samples were taken with accidental sampling technique by considering inclusion and exclusion
criteria, gained as much as 30 respondents. Measuring instrument used was a questionnaire with 27
questions, and for the obesity used BMI. Analysis was performed univariate and bivariate analysis
with Chi-Square test. Result: The results showed that there is a relationship between stress factors (pvalue = 0.033), consumption of excessive salt and fat (p-value = 0.023) and smoking (p-value = 0.042)
with essential hypertension, while the factor of lack of exercise (p-value = 0.461) and obesity (p-value
= 0.06) did not show an association with essential hypertension. Based on these research, the
suggestions for the Hospital is expected cooperation from health workers to provide information or
counseling about hypertension and how to control blood pressure through the better lifestyle changes.
Keywords: Stress, Consumption of Excessive Salt and Fat, Smoking, Lack of Exercise, Obesity
Essential Hypertension, Middle Adult Age
82
DIFFERENCE OF LIFE QUALITY IN SOCIAL DOMAIN BETWEEN PATIENTS POST

STROKE REHABILITATION AND NON REHABILITATION
Ika Chandra Nuryana, Fitria Handayani
ABSTRACT
Background: Social interaction was decreased in patient post stroke. Rehabilitation of stroke patients
should be conducted immediately after patient through the acute phase in order to return the quality of
life of patients optimally as possible. However, not all of patients post-stroke receive rehabilitation
care. Purpose: The study objective was to determine differences in mean scores of quality of life in
social domain between patient post-stroke rehabilitation and non-rehabilitation. Method: This
research was quantitative methods with comparative design. The sample was taken with purposive
sampling. The study involved 30 respondents, consisting of 15 patients of post-stroke rehabilitation
and 15 of non-rehabilitation adjusted by Rule of Thumb sample size and Poisson. Quality of life was
measured by WHOQOL-Bref questionnaire which proven valid (r=0.89 to 0.95) and reliable (R=0.66
to 0.87). Analysis the results of the study were tested by independent sample t-test with significance
level = 0.05. Results: The study showed a significant differences in quality of life among patients
post-stroke rehabilitation and non-rehabilitation in psychological domain (p=0,042, 10 + 1,852 to 9 +
1,069). Conclusion: There was a significant different in mean score of quality of life patients poststroke rehabilitation and non-rehabilitation both in social domain. Further assessment and intervention
among the patients post stroke should be considered in gaining quality of life.
Keywords: Quality of Life, Social Domain, Post Stroke
83
Spirituality
THE SPIRITUALITY NEEDS OF TERMINALLY IIL PATIENTS: A LITERATURE

REVIEW
Aan Nuraeni, Kusman Ibrahim, Hana Rizmadewi
Faculty of Nursing, Padjajaran University
ABSTRACT
Background: Spiritual care is important and should be fulfilled by caregivers, especially for
terminally ill patients, however many of the caregivers are still focusing on their physical problems
rather than meeting spiritual needs. Moreover many nurses in Indonesia have perspective that
spirituality has the same meaning as religion. Purpose: To conduct a review about spiritual needs of
terminally ill patients in relation to clinical practice. Method: A literature search was conducted
through MEDLINE and CINAHL by using the key words meaning or essence of spirituality, spiritual
care and critical care or dying or terminal illness or serious illness. It found 55 articles; consist of 35
articles with qualitative research method and 15 articles with quantitative research method. Only eight
articles meet the criteria, namely: 1). Full text; 2). Using qualitative research methods; 3). Participants
were patients with terminal illness or serious illness 4). Hospital based. Result: The spiritual journey
of terminally ill patient is initiated with the experience of spiritual pain, and terminated with spiritual
comfort. In order to get their spiritual comfort, the patients with terminal illness need to fullfill their
spiritual necessity which are consist of the need for answers about the meaning and purpose of life
and needs to be loved and needs related to transcendence. To assist patients achieve their spiritual
needs and comfort, nurses and caregivers could facilitate through being present, opening eyes and
concreting. Discussion: Spiritual needs of terminal ill patients not only emerge from religion or
transendence. To achieve spirituality comfort in terminal illness patients is required conectedness
between transcendence and others. Human needs to be loved, cared for and give to others. Thus to
meet their spiritual needs, nurses have to facilitate not only their worship but also empathy, love, and
caring to the patients. Ultimately it is expected that patients might die in peace and dignity.
Conclusion: The spirituality needs of terminally ill patients consist of the realization about meaning
and purpose of life, the connectedness with others and transendence either. Nurses could deliver the
spirituality needs through being present, opening eyes and cocreating.
Keywords : Needs, Spirituality,Terminal Illness
84
Nursing Policies
THE EVALUATION OF KNOWLEDGE, BEHAVIOR AND IMPLEMENTATION OF THE

INDONESIAN MINISTER OF HEALTH REGULATION (PERMENKES) NUMBER 1464
2010 BY MIDWIVES IN KEBUMEN, CENTRAL JAVA
Eni Indrayani, Mohammad Hakimi, Shinta Prawitasari
Muhammadiyah College of Health Science, Gombong
ABSTRACT
Background: A midwife as an officer to provide maternal health services is expected to be skilled in
providing quality services in the community because the midwife had positive and powerful positions
in society. In providing health care, midwives will have to understand the authority, rights and
obligations. Midwives should also be able to carry out their duties and functions as professionals in
their field. In carrying out the practice of independent midwives, the Minister of Health based on the
regulation No 1464/menkes/per/x/2010 regulate Registration and Practice of Midwives. Purposes: To
evaluate and identify the knowledge, behavior and implementation of the Indonesian minister of health
regulation (Permenkes) number 1464 2010 by midwives in Kebumen district. Method: This is a type
of quantitative and qualitative research with a cross-sectional design. This research was supported by
the qualitative data. The research was conducted in the Department of Health in Kebumen. One
hundred fifty two midwives who owned private midwifery clinic were recruited as respondent. The
dependent variable was the knowledge about Permenkes No 1464 and the independent variable is the
compliance of the midwives to the tools, practice and administration. External variables were the
behavior, level of education, age and formation. Data were collected using a questionnaire and indepth interviews and were analyzed using univariate analysis, bivariate analysis, the chi square with p
<0.05 and 95% CI, and multivariate analysis with multiple logistic regression. Results: No significant
correlation between knowledge of compliance tools. This correlation was not statistically significant
(p = 0.21 and RP value of 0.9 (CI95% = 0.76 to 1.06)). There is a significant correlation between
knowledge of the administrative compliance. This correlation was statistically significant which can
be seen from the value of p = 0.016 and RP value of 0.69 (CI95% = 0.50 to 0.95). There is a
significant correlation between knowledge of the compliance practices. Knowledge of statistical
significance and practical adherence practices can be seen from the value of p = 0.007 and RP value of
2.66 (CI95% = 1.27 to 5.59). There is no significant correlation between external variables that
attitude, age, education and guidance to the independent variable knowledge. In multiple logistic
regression analysis, the results show a statistically significant correlation between knowledge and
practical with compliance practices after the controlled variables of education, training and the manner
in which the value of OR = 3.08 and 95% CI = 1.21 to 7.83 and the value of R2 = 0.149. Conclusion:
The compliance of midwives to the administration and tools is better for midwives who had good
knowledge. Factors influencing knowledge of compliance tools are age and development. Factors
influencing the administration are age, education and training. Factors influencing the compliance of
the practice are training, coaching and behavior. The results of multivariable analysis with show no
significant correlation among the compliance, knowledge with practice. Controlling the variables of
education, training and behavior can contribute 149% the compliance of practices.
Keywords: Knowledge, The Minister of Health Regulation No 1464, Compliance Tools, And
Administrative Practices, Private Midwifery Clinic.
85
Nursing Policies
AN ANALYSIS OF THE TRIAGE SYSTEM IN EMERGENCY DEPARTMENTS IN

INDONESIA
Nana Rochana, Virginia Plummer, Julia Morphet
Postgraduate student of School of Nursing and Midwifery, Monash University
ABSTRACT
Background: Triage systems have rapidly developed in some countries in the last three decades in
order to respond to demand for emergency services by growing populations and emergency health
needs. However, this development in triage systems does not appear to have been matched in
Indonesian hospitals. The triage system in Indonesia remains obscure. There may be many systems in
use and this is likely to impact on both patient care and workforce issues. No published research on
triage practices in Indonesia has been identified. Therefore, this paper reports on a study which aims to
capture and analyze the views of those who work with the triage systems in EDs in Indonesia from a
range of different perspectives. The research question developed in this study was What are the
current triage systems in Emergency Departments in Indonesia? Methods: The research design of
this study was descriptive qualitative using semi-structured interviews of twelve policy makers or
persons responsible from five different organizations which informed triage practice in Indonesia,
particularly in Central Java. The inclusion criteria also described that the participants should have had
at least two years experience working in emergency care setting, or at least one year experience as
policy makers or persons responsible for health care policy. Results: Participants reported that the
most broadly used triage system in Indonesia was a four-level triage system according to the decree of
the Health Minister in 1992. However, an evaluation of this system has never been published. They
also described that there was inadequate implementation of the Indonesian triage system even though
some benefits from the current triage system were reported. Triage doctors were reported as the main
trieurs in Indonesian triage practice though there was a good precedent to use triage nurses in the
future. Four steps of triage process ranging from receiving to prioritizing were reported as the triaging
procedures in Indonesia which were almost similar to the international literature except for a re-triage
step. In addition, participants explained to the difficulties associated with the qualifications and roles
of trieurs. Finally, bed access block, which increased ED workload and decreased the quality of
emergency care service including triage, was revealed as a significant factor in the patient flow.
Conclusion: Some recommendations were made for the stakeholders. First, evaluation of the current
triage system should be carried out before implementing new triage systems. Second, a new health
policy in triage practice with a national approach and setting the guideline, standards, and quality
indicators for evaluation should be carried out by The Ministry of Health. Third, the roles of nurses in
the triage practice and in the policy making positions should be developed by including these roles in
the curriculum of nursing education. Last, the accuracy of triage decisions should be improved by
endorsing some qualifications for trieurs and preparing emergency practitioners for the role of trieurs
through triage education.
Keywords: Triage System, Triage Practice, Triage Process, Trieurs, Emergency Department
86
Nursing Policies
HOW SHOULD PEDIATRIC NURSES SUPPORT THE PROBLEMS AND CHALLENGES

TO SCHOOL RE-ENTRY OF YOUNGER CHILDREN WITH CHILDHOOD CANCER?
Rie Wakimizu1), Noriko Hiraga1)2), Kayuri Furuya 1)
1)Department of Child Health Care and Nursing, Institute of Nursing Sciences, Graduate School of
Comprehensive Human Sciences, University of Tsukuba, Japan
2) Department of Nursing, Ibaraki Children's Hospital, Mito, Japan
ABSTRACT
Background: In Japan, Children with childhood cancer hospitalized for about 10 months, in general.
Many schoolchildren with cancer enroll in the class-hospital after diagnosis. There are many
problems and challenges to return to school after completing the treatment. Purpose: To identify the
real-time determination of actual problems and challenges of returning to school in lower-grade school
children hospitalized for childhood cancer. Method: The subjects were three school children
immediately before or after being discharged from the hospital and their parents, attending physicians,
hospital class teachers, and primary nurses (PNs). We conducted a semi-structured interview for about
30 minutes with each subject and recorded it verbatim to perform the summarizing content analysis
proposed by Mayring (2004). The parts of the interview were abstracted and coded where childrens
problems and challenges in returning to school and required professional support were expressed.
Then, the similarity and difference of content were reviewed and categorized. This study was
conducted with the approval of the ethics review board of the university hospital. Result: The three
categories extracted as the problems and challenges of lower grade school returnees with childhood
cancer after extended hospitalization were delay in learning already present at discharge, difficulty
creating life images after returning to school, and parental concern about whether or not the
returning child will be accepted in the class due to significant changes in body image. Children with
poor academic performance from the beginning had a more significant learning delay at discharge.
Their academic performance and disease awareness were proportional, and those with low disease
awareness (regardless of repeated explanations from PNs) tended to have more difficulty in imagining
how their life would be after returning to school. Parents were more sensitive than children
themselves to changes in their body images such as hair loss and skin pigmentation due to the adverse
reactions of chemotherapy and worried about peer acceptance after returning to school. Conclusion:
Our study results suggest that pediatric nurses should support children with childhood cancer and the
family from the hospitalization period by promoting learning, creating an education environment,
developing disease awareness and life image after returning to school, and addressing anxiety in
parents. In this process it is also important to share the common perspective of children and family
soon returning to their previous life among multiple professionals including hospital class teachers,
social workers, psychotherapists, and physicians, as well as to continue support after discharge.
Keywords: Childhood Cancer, Returning to School, Holistic Nursing, Pediatric Nursing
87
Nursing Education
IMPLEMENTATION OF MENTORSHIP PRECEPTORSHIP METHOD IN STUDENTS

OF MATERNITY NURSING INTERNSHIP
Fatikhu Yatuni Asmara, Meira Erawati, Anggorowati
ABSTRACT
Background: Nurses are responsible to improve their capability and knowledge in giving nursing
care, including sharing their skills and knowledge to junior nurses and nursing students. This
professional development can be done by applying mentorship and preceptorship method supported by
management. Mentors and preceptors having big roles in this method can help nursing students in
transition and integration process into clinical setting and working area. They also support nursing
students to achieve competencies and self confidence, and to be involved in professional life.
Purpose: The objective of this research is to know the experiences of mentors, preceptors and nursing
students when they apply this method during learning process in internship program. Method: The
study design was an evaluation study which focused on implementation of a method. The data was
collected by using focus group discussion from seven participants; they are 1 mentor, 2 preceptors,
and 4 students. Result: The result show that each component knows well about their roles even though
there are obstacles during conduct the method, such as: the number of mentors and preceptors is
limited, and the number of students in each of shift is not same. Since they feel that this method is
effective, they have solving problem which will be done, for instance: adding the number of mentor
and preceptors, using co-preceptors in order to make the number of students in each shift equally. This
method also helps students to achieve their competencies easily, and they feel more confident during
giving nursing care for the patients. Conclusion: It is important for clinical instructors (CI) to get
skills how to implement mentorship preceptorship method in order to apply it in internship learning
process by joining training and scientific meeting how to applying this method in better way.
Keywords: Implementation, Mentorship Preceptorship Method, Nursing Student
THE DESCRIPTION OF NURSING STUDENTS RECREATION NEEDS
Fitri Nur Khotimah, Sarah Ulliya
ABSTRACT
Background: There are many problems which experienced by students. The result from previous
research about problem of students during implementation of Student Center Learning (SCL) method
showed that 64% of respondent felt stress, 54% felt bored, and 78% felt fatigue. Recreation is one
alternative way that could be done to minimize stress on student because it has benefits for calm the
mind and eliminate boredom. Purpose: To know the meaning, aim, benefit and types of recreation.
Method: This research was using qualitative method with phenomenology approach, purposive
sampling technique, and in-depth interview method. The total of participants was six nursing students.
Result: The results showed that students interpreted recreation as activity to refresh and to relax the
mind and to reduce stress. It can be done by spend a few minutes doing pleasure or enjoy activities.
The aims of the recreation are to close the social relationship, to have the life variation, to vanish the
tiredness, to have fun, to refresh and relax the mind. Recreation make healthy mind, positive emotion,
closes social relationship, freshness, increase spiritual, and add insight and new thing. Recreation can
be indoor, outdoor. Conclusion: Recreation is pleasure activities which can be done by spend a few
minutes and have a lot of goods aim and benefit, so that every student needs recreation to refresh and
relax their mind.
Keywords: Recreation Needs, Students
88
Nursing Education
AN EXPERIMENTAL APPROACH TO ENHANCE SOFT SKILLS DEALING WITH

ETHICAL ISSUES IN NURSING EDUCATION.
Rr. Sri Endang Pujiastuti, Samsudi, Heru Supriyatno
Nursing Program, Health Polytechnic of Semarang, Central Java
ABSTRACT
Background: Ethics issues are taking an increasingly prominent place in health care services. Nurses
must think critically and enhance their soft skills to provide effective care whilst coping with the
expansion in role associated with the complexities of ethical issues. Nursing students have opportunity
to participate in the decision with current health care systems. Purpose: The purpose was to describe
an experimental approach to enhance soft skills about ethical issues in nursing education. Method:
Two hundred and twenty five nursing students were recruited in this study. This study was conducted
during one semester while ethics course was given. Data were collected by self report questionnaires
including Ethical Issues in Clinical Practice (EICP), Soft Skills to Deal with Ethical Issues (SSDEI)
and Focus Group Discussion (FGD) about soft skills to deal with ethical issues. Results: The result of
this study revealed that all ethical issues were as follows: (1) lack of autonomy as nursing students, (2)
values conflicts in professional roles, (3) lack of cooperation, (4) low level to maintain standard of
care, and (5) neglect of patient care. Therefore, the emotional consequences of the ethical issues such
as feeling uncomfortable regarding professional obligation, being unsure regarding transmitted
diseases, and being emotional regarding low quality of care. The finding of this study regarding soft
skills to deal ethical issues was: (1) taking moral action (Mean =2.81), (2) develop critical thinking
(Mean= 2.63), (3) good communication (Mean= 2.59), (4) positive self concepts (Mean= 2.48), (5)
improve students competences (Mean= 2.43). In addition, most nursing students used problem based
learning and role play to enhance their soft skills. Soft skills which used to deal with ethical issues
included advocating for patient, willing to speak on behalf of the patients rights and helping patient to
quality care. Conclusion: the result of this study would be used as information to enhance soft skills
nursing students to participate in ethical decision making in nursing education.
Keywords: Soft Skills, Ethical Issues, Nursing Student
89
Nursing Education
A CONGRUENCY MODEL TOWARD AN ENVIRONMENTALLY

BASED NURSING PROGRAM
Portia Zoleta-Vitug
ABSTRACT
Background: The state of the environment is a global concern that affects the lives of people. The
drawbacks of the environmental exploitation have drastically become evident. Air pollution poses
impediments and develops chronic illnesses such as lung cancer. Many organizations have formulated
measures and refined the curriculum concerning health and environment; the causal links between
environmental change and human health are too complex that people have to find a way of forestalling
the negative effects of environmental hazards and providing an avenue of a wedded interest on health
and environment. Purpose: This study is an attempt to rationalize the importance of globallycompetitive environmental nursing curriculum in view of benchmarking with international schools.
Method: The author utilized a congruency model to review the current nursing curriculum in the
Philippines and selected foreign curricula in an attempt to integrate the 7 environmental principles in
the core subjects of the current Philippine Nursing Program using. Futhermore, the author made use of
the Delphi method. Result: The study yielded the following conclusions: 1.) The profile of the
Nursing curriculum in the Philippines matches the need for inclusion of health and environment
principles. All nursing major subjects based on the course description are congruent to the external
process. Some nursing subjects however, do not contain environmental principles. 2.) The external
process system in the benchmark schools allotted more time for major subjects during college years.
This must be considered and studied further. 3.) The inclusion of seven environmental principles to the
nursing profession is congruent to the need for a competent environmental nurse. 4.) The high average
weighted means and percentage show a strong awareness and appreciation of the 7 environmental
principles which shall form part of the proposed core subjects in the nursing program.
Keywords: Environmental Nursing, Delphi Study, 7 Environmental Principles
THE BASED- HEALTH BELIEF MODEL FOR RECREATIONAL NEED AMONG

BACHELOR DEGREE STUDENTS
Asri Wijayati Mutmainah, Madya Sulisno
School of Nursing, Faculty of Medicine, Diponegoro University
ABSTRACT
Background: Recreational need is the need for a sense of harmonious feeling that forming by
closeness between the self with others, nature, and the highest life. However, the persons decision for
doing recreations is greatly influenced by one's own beliefs as found in the theory of The Health Belief
Model. Purpose: The purpose of this research was to distinguish the recreational needs of bachelor
degree student based on the Health Belief Model Theory. Method: The research used qualitative
methods with a phenomenological approach. The samples were taken by purposive sampling method
involving four informants. Results: The result of this research showed that the bachelor degree student
needs recreation to return their physical, mental, emotional and spiritual condition in facing their daily
activities. The driving factors to fulfill the recreational needs were susceptibility or seriousness
conditions, benefits, media and self efficacy while the barrier factors were money, times and
transportations. These factors influenced the student's conviction in making decision to get recreation.
Conclusion: Nurses were recommended to role as counselors or educators for bachelor degree
students who have problem in meeting recreational needs.
Keywords: Student, Recreational Need, the Health Belief Model
90
Poster Presentation
INJECTING DRUG USERS (IDU) FAMILY EXPERIENCES TO ADMINISTER FAMILY

CENTERED NURSING CARE INTERVENTION WHO HAS BEEN UNDERGOING CEASE
SMOKING PROGRAM AT METHADONE PROGRAM THERAPY (PTRM)
Suhariyanto, Trisna Safriana, Ida Rosyada, Fatmawati
PTRM Clinic, Dr. Abdul Aziz Hospital, Singkawang
ABSTRACT
Background: Active smokers with IDU will be likely to experience difficulty to stop the smoking
habit. About 70% of smokers want to stop smoking but only 3% who got successfully. In Asia, as
much as1.3 -2 million people are injecting drug users. Aftermath of smoking behavior is to be the first
entrance of alcohol and illicit drugs. Social support and support from close person is needed to
participate in the program to stop smoking when the smoker suffers critical time during therapy.
Purpose: The study was carried out to know the experiences of family Injecting drug users (IDU) in
the implementation of family-centered nursing care intervention are who has been undergoing cease
smoking program. Method: The study design was a qualitative research with phenomenological
approach. This research has been done to three participants using in-depth interview technique. Ethical
consideration of this study is to use the initials (not real name), storing the data in a locked closet, and
do not discuss the results of research by unauthorized persons. Result: The results showed the
implementation of family-centered nursing care interventions include assessment, physical
examination, psychological assistance, stops thinking therapy, progressive relaxation, and scheduling
activities. Implementation of family-centered nursing care have an impact on the return of the spirit,
the family was able to control tobacco consumption IDU, IDU were able to make plans to stop
smoking. Problems experienced less cooperative between IDU and family while nursing interventions,
IDU were still smoking without the knowledge of nurses 5-10 cigarettes a day. Conclusion: To handle
the problem, nurses are expected to identify the response of the IDU and the family. Interventions
should be implemented start from the assessment, analysis, planning, implementation and evaluation.
Families are expected to be independent to apply the undergoing cease smoking program to injecting
drug users.
Keywords: Experiences, Family Centered Care, Smoking Ceasing Program
92
Poster Presentation
COMMUNITY EMPOWERMENT AS FALLS PREVENTION STRATEGY FOR

ELDERLY AGGREGATE AT RATUJAYA DISTRICT
Raden Siti Maryam, Junaiti Sahar, Astuti Yuni Nursasi
Community Health Nursing Specialist
ABSTRACT
Background: Community empowerment is a community organizing process that started from identify
problem, arrange of problem priority, searching and determine resources either in community or
outside community. Purpose: Final target of scientific paper is to improve community empowerment
to prevent fall at older people aggregate. Result: The result has proven that community empowerment
was effective in service management and community nursing at older people aggregate to prevent fall
with existence of various of successfullness attainments like knowledge improvement and skill in
prevention fall, call rate improvement to Posbindu and forming elderly support group (Kelompok
Peduli Lansia), existence of supervision on one's part district, and join partnership with private sector.
Conclusion: Officer in public health center cooperated with Kader Posbindu is expected to continue
monitoring older people with home-safety assessment. Moreover, health department should make a
fixed procedure or a technical guideline for nurse about community nursing service pattern, which
related to falls prevention at older people, in order to guarantee the continuity of various prevention
efforts that have been conducted and integrated with RW Siaga program.
Keywords: Empowerment, Older People, Risk of Falls, Support Group
THE DESCRIPTION OF NURSESS EXCELLENT SERVICES AT TUGUREJO HOSPITAL

Hendrik Kurniawan, Agus Santoso
ABSTRACT
Background: All hospital employees should applied service excellence for customers both internal
and external customers/ public customers. The nurse service excellence is services of nursing
characterized with high performance, professional, fast, clean, hospitality, keep patient confidential,
more than the standard and done extra services to support patient cured and patient satisfactory.
Purposes: The purpose of this research is to describe nurse service excellence in Tugurejo Hospital
Semarang. Method: This research used quantitative method with observational descriptive. One
hundred respondents in the inpatient room Tugurejo Hospital Semarang were recruited as research
subject. Four themes were measured in this study which is service excellence, attitude, attention and
action of nurses. Then, data was analyzed using frequency distribution. Results: The research result
stated that the nurses who done a good service excellence was 90 percent and only 10 percent nurses
who done poor service excellence. There were 96 percent nurses with good attitude and 4 percent
nurses with poor attitude. There were 81 percent nurses with good attention and 19 percent nurses with
poor attention. There were 81 percent nurses with good action and 19 percent nurses with poor action.
Conclusion: Almost nurses in Tugurejo hospital have performed a good service excellent.
Keywords: Service Excellence, Attitude, Attention and Action of Nurses.
93
Poster Presentation
EFFECT OF BALANCE EXERCISE ON POSTURAL BALANCE IN ELDERLY AT

NURSING HOME WENING WERDOYO UNGARAN
Evi Kurniawati, Muhammad Hasib Ardani
Ngudi Waluyo School of Health Science
Schoo of Nursing, Faculty of Medicine , Diponegoro University
ABSTRACT
Background: Elderly is age of 65 or over. Elderly is not a disease, but an advanced stage of a process
of life marked by decreased ability of the body to adapt to environmental stress. The process of aging
can interfere with some of the system include: neuro system, hearing and vision system, the
cardiovascular system, the musculoskeletal system and impaired postural balance. Postural balance
can be addressed by doing some exercises like aerobic, resistance, and balance tai chi chuan exercise.
Balance exercises can improve muscle strength of the extremities carried, so as to be better postural
balance. Purpose: To determine the effect of balance exercise on postural balance in elderly in
nursing home Method: The research method was experimental pretest-posttest control group design
with the entire elderly population who is living in nursing home Wening Werdoyo Ungaran. Twenty
two respondents were recruited and divided into two groups; treatment group (11 respondents) and
control group (11 respondents). The study was started on 7 April 2010. Data was collected using
observation data such as tables, standard operating procedures, and guidelines for balance exercise.
Result: The results showed that balance exercises can be done by all respondents. By using an
independent t test and the post-treatment control, the results obtained p-Value = 0.001 when compared
with (0.05). It means that balance exercise have influence on postural balance in the elderly. The pvalue of difference between pre- and post-control with dependent t test was 0.167. It means that there
is no difference in exercise of the balance postural balance in the elderly in a nursing home Wening
Werdoyo Ungaran. While pre-treatment and post-treatment with the dependent t test p-Value = 0.006
then there is the influence of exercise on postural balance in the elderly in a nursing home Wening
Werdoyo Ungaran. Conclusion: Balance exercises should be done continuously to improve postural
balance and reduce the risk of falls in elderly.
Keywords: Balance Exercise, Postural Balance, Elderly
94
Poster Presentation
JAVANESE WOMENS BELIEF ABOUT RECOMMENDED AND UNRECOMMENDED

FOODS AND DRINKS IN THE PREGNANCY AND POST PARTUM PERIOD
Muhamad Rofi'i
School of Nursing, Faculty of Medicine, Diponegoro University
ABSTRACT
Background: Javanese women in Indonesia have different beliefs during pregnancy and postpartum
period. This belief was adopted because of the influence of cultures from their parents. Purpose: This
study aimed to determine the Javanese women's belief regarding recommended and un-recommended
food or drinks during pregnancy and postpartum period. Method: The research used a qualitative
design with in-depth interview and phenomenological approach. The samples were 4 women who had
been pregnant and given birth. Results: This study had eight categories which were recommended
food in the pregnancy, un-recommended food in the pregnancy, recommended food in the post partum
period, un-recommended food in the post partum period, recommended drink in the pregnancy, unrecommended drink in the pregnancy, recommended drink in the post partum period, and unrecommended drink in the post partum period. Javanese women believed that the recommended food
during pregnancy was rice, vegetables, fruit, and side-dishes. They had to meet the demands of
cravings (desire to eat) of certain foods whenever they wanted. Food which was taboo or not
recommended during pregnancy was durian, chilli, fermented cassava, eel, pineapple, sugar cane,
sweet meals, beef sate, catfish, shrimps, and plenty of hot and spicy food. Recommended food after
childbirth was nutritious food, katu leaves, spinach, corn fritters, braised tofu and tempeh. Food which
was not recommended in postpartum was chili, spicy food, hot and sour food, egg and fish.
Meanwhile, the drinks recommended during pregnancy were maternal milk, coconut water, water,
herbal drink and honey mixed with chicken egg. The un-recommended drinks during pregnancy
included ice, herbs and sweet drinks, while the drinks recommended after childbirth were herbal
drinks for breast milk production. During postpartum period, women were not recommended to have
iced drinks. Conclusion: Community nurses provide services in accordance with the beliefs that are
contrary to the concept of health and also support the ones which are in line with it.
Keywords: Community Nurses, Pregnancy, Postpartum, Recommended Foods, Un-recommended
Drinks
95
Poster Presentation
DIFFERENCE OF LIFE QUALITY IN PSYCHOLOGICAL DOMAIN BETWEEN

PATIENTS POST STROKE REHABILITATION AND NON REHABILITATION
Ika Chandra, Fitria Handayani
ABSTRACT
Background: Psychological alteration, such as stress, depression, and anxiety were occurred in post
stroke. Rehabilitation of stroke patients should be conducted immediately after patient through the
acute phase in order to return the quality of life of patients optimally as possible. However, not all of
patients post-stroke receive rehabilitation care. Purpose: The study objective was to determine
differences in mean scores of quality of life in psychological domain between patient post-stroke
rehabilitation and non-rehabilitation. Method: Research was quantitative methods with comparative
design. The sample was taken with purposive sampling. Rule of The study involved 30 respondents,
consisting of 15 patients of post-stroke rehabilitation, and 15 of non-rehabilitation adjusted by Rule of
Thumb sample size and Poisson. Quality of life was measured by WHOQOL-Bref questioner proven
valid (r=0.89 to 0.95) and reliable (R=0.66 to 0.87). Analysis the results of the study were tested by
independent sample t-test with significance level = 0.05. Results: The study showed significant
differences in quality of life among patients post-stroke rehabilitation and non-rehabilitation in
psychological domain (p=0.024, 19.73 + 2.915 to 17.47 + 2.264). Conclusion: It means, there was
significant different in mean score of quality of life patients post-stroke rehabilitation and nonrehabilitation both in psychological domain. Further assessment and intervention among the patients
post stroke should be considered in gaining quality of life.
Keywords: Quality Of Life, Psychological Domain, Post Stroke
SELF-CARE EXPERIENCE OF PATIENTS WITH CHRONIC KIDNEY DISEASE (CKD)

WHO UNDERWENT HEMODIALYSIS: BASED ON OREM THEORY
Kiki Wahyuni, Wahyu Hidayati
ABSTRACT
Background: Hemodialysis patients generally have a complex problem and require a holistic
fulfillment of needs. It is closely related to the motivation and self-care abilities of chronic kidney
disease patients to maintain an optimal quality of life. Purpose: The purpose of this study was to
describe the self-care application of hemodialysis patients. Method: This study used a qualitative
research design with a phenomenological approach. Five patients were chosen through inclusion
criteria and were interviewed using in depth interview with semi-structure design. Result: The result
showed a good understanding of the patients about chronic kidney disease through an understanding of
the history of past experience. Coping mechanisms to minimize the occurrence of patients were do
self-care deficit and efforts in meeting the needs of hemodialysis patients and optimization of different
body condition. Patients showed different ways to do coping mechanism in minimizing self care
deficit; in meeting their needs and in optimizing their body condition. Conclusion: The analysis of
patients experience is necessary in order to control the enabling and inhibiting factors of body
condition. Hemodialysis patients are expected to meet the need of self-care by having discipline to
control fluids and nutrients balance in the body.
Keywords: Chronic Kidney Disease, Self-Care, Holistic
96
Poster Presentation
INFLUENCING FACTORS OF MENSTRUATION CYCLE IRREGULARITY ON 20-29

YEARS OLD WOMEN IN KALITENGAH VILLAGE, GOMBONG
Herniyatun, Barenda Yuni Mawarti, Hastin Ika Indriyastuti
School of Midwifery, Muhammadiyah School of Health Science, Gombong
ABSTRACT
Background: A woman automatically will have normal menstruation cycles in their life. If there is
any change in their life, she will be disturbed especially if her menstruation becomes longer or more
than usual, irregular, too often or no menstruation at all. The irregularity menstruation cycles at the
woman age between 20-29 years old in Kalitengah village, Gombong residence, at Kebumen regency
influenced by several factor such as anxiety, irregularity and nutrition. The problem of this research is
what the factor which influence the irregularity menstruation cycles at woman age between 20-29
years old. Purpose: The aim of this research is to know the factor which influence the irregularity
menstruation cycles at woman age between 20-29 years old. Method: The type of this research is
descriptive using cross sectional approach. The populations are woman age between 20-29 years old in
Kalitengah village, Gombong. The total population is 173 women. Total sample are 30 women and an
observation sheet was used as instrument in this research. Data was analyzed by using chi square with
significant point at 0,005. Results: The result showed that there is no correlation between anxiety and
irregularity menstruation cycles with p score=0,118 (>.005). Moreover, there is also no correlation
between nutrition and irregularity menstruation cycles with p score=0,258 (>0.05). However, there is
correlation between disorder of menstruation and irregularity menstruation cycles with p score=0,000
(< 0.05).
Keywords: Factor, Irregularity, Menstruation Cycles.
THE INFLUENCING FACTORS OF EXCLUSIVE BREASTFEEDING ON MOTHER IN
THE PUBLIC HEALTH CENTER, YOGYAKARTA.
Dewi C.K, Rahmah
School of Nursing Muhammadiyah University of Yogyakarta
ABSTRACT
Background: National data from Health Ministry of Indonesia showed that the growth of exclusive
breastfeeding for baby 0-6 month decreased for about 28,6 % in 2007 and 24,3 % in 2008. Exclusive
breastfeeding is defined as breastfeeding to baby age 0-6 month without any supplement of food and
drink to their baby. Purpose: The main purpose of this research was to identify the influencing factors
of exclusive breastfeeding to the mother in the public health center in Yogyakarta. The identified
factors were the age of the mother, the number of child, the level of knowledge, the educational level,
working mother, family income, family support, and information from health workers. Method: The
method research was retrospective study while data were analyzed by Chi-Square test and Logistic
Regression. The population in this study were mothers who had children in age 7 to 12 months in
Public Health Center, Yogyakarta. The sampling technique was purposive sampling with 65
respondents. The research was conducted from April to Mei 2012. Result: The result showed that 28
mothers (43,1%) gave exclusive breastfeeding while 37 mothers (56,9%) gave non exclusive
breastfeeding. Bivariate analysis using Chi-Square test showed that there was a significant relation
among working mother (p = 0,004), family support (p = 0,000), and the level of knowledge (p =
0,037) with exclusive breastfeeding. Multivariate analysis by Logistic Regression test showed that
family support was the dominant factor influencing exclusive breastfeeding. Conclusion: There was a
significant relation between working mother; the level of knowledge; family support and exclusive
breastfeeding. Family support was the dominant factor influencing exclusive breastfeeding.
Keywords: Giving Exclusive Breastfeeding, The Factors Influence that Mother
97
Poster Presentation
FACTORS AFFECTING ESTIMATED FETAL WEIGHT TRIMESTER III PREGNANT

WOMEN IN PALANGKARAYA
Christine Aden
Health Nursing Department Polytechnic Palangkaraya
ABSTRACT
Background: During pregnancy is expected to increase the growth and development of the fetus in
order to prevent low birth weight or less than 2500gr. According to many experts, internal and external
factors can affect the mother's fetal growth towards the end of pregnancy. There are a gestational age,
spacing pregnancies, parity, maternal nutritional status, number of prenatal care, educational
background, number of family members and knowledge of nutrition during pregnancy. These factors
are often used by medical practitioners to know about it. Purpose: This study aims to identify factors
that affect the estimated fetal weight (EFW) such as gestational age, spacing pregnancies, parity,
maternal nutritional status, prenatal care, educational background, number of family members, and
knowledge of nutrition during pregnancy on maternal trimester III in Palangkaraya. Method: The
design of this study was quantitative descriptive with univariate analysis to analyze the characteristics
of pregnant women based on age, education, number of family members, parity, number of prenatal
care, pregnancy spacing, maternal nutrition knowledge and knowledge about nutrition during
pregnancy. Bivariate analysis is used to determine the factors that influence fetal weight estimates
using Pearson correlation test, unpaired t-test and ANOVA test. Furthermore, the factors that most
affect the estimated fetal weight were analyzed using linear regression. The study was conducted on
330 pregnant women, mothers with inclusion criteria with gestational age 28-42 weeks, singleton
pregnancy, willing to be a respondent, can read and write and live in Palangkaraya. The data relating
to maternal characteristics were collected by questionnaires, maternal nutritional status is known by
the record of weight gain during pregnancy, maternal knowledge measured by the number of questions
about the nutrition of pregnant women, while the estimated fetal weight was measured by an increase
of fundus height. Result: There was found no correlation between the EFW with maternal age (p>
0.05.), the distance EFW pregnancy (p> 0.058), antenatal care (p = 0.05), the number of family
member (p = 0.146), and with gestational age (p = 0.000). Moreover, there was correlation between
the EFW with parity (p = 0.018), maternal nutrition EFW (p = 0.000), maternal education (p = 0.001),
and the maternals knowledge about nutrition during pregnancy (p = 0.021). Gestational age, maternal
nutritional status, and education level were able to explain 39.3% of EFW (R2 = 0.393) and the
remaining 60.7% is explained by other factors. Conclusion: Hopefully this research can provide an
improvement of services and benefits to the nutritional status of pregnant women to increase the
estimated fetal weight in the third trimester of pregnancy.
Keywords: Estimated Fetal Weight, Pregnancy Trimester III
98
Poster Presentation
EVALUATION OF IMPLEMENTATION HOME CARE VISIT IN COMMUNITY

HEALTH CENTER IN KEBUMEN
Basirun
Muhammadiyah College of Health Sciences, Gombong
ABSTRACT
Backgrounds: There is an emerging of complaint among community and realty there were very
needs treatment on family health nursing at the client have been not pay hospital. Not all the
community Health Care implement the health care family according to concept, this matter among
other things there is not same perception in implementation level about elementary concept health care
family. Objective: To evaluate the implementation home care visit. Methods: This research was a
descriptive quantitative. This research population was all Community Health Center in Region of
Kebumen Regency. Thirty three coordinators of community health nursing were recruited as
respondent. The data was analyzed using descriptive analysis which is frequency distribution. Results:
The result showed that 48.48% respondents implement home care visit, 63.63% respondent accept
the incentive fund for family care, and only be telling most (78,79%) insufficient. Data about the form
of family care have not been documented in all Community Health Center. One hundred percent of
respondent said that their community health centres have a coordinator community health nursing and
30.30% respondent have done training about community health nursing. Conclusion: Family home
care visit have been done by 48.48% of community health nurses at community health center.
Keywords: Family Nursing, Home Care Visit, Nursing Health.
THE STUDENTS SATISFACTION ON GETTING CLINICAL TEACHING DURING

CLINICAL PRACTICE
Dicky Helmi Susilo, Agus Santoso
ABSTRACT
Background: Clinical practice was one of the important parts in nursing students educational
process. It gave a lot of experience to the student about truly learning. Clinical practice was one of
function that should be available in professional practitioner, especially in service area like nursing.
Clinical instructor participation on clinical teaching influenced student clinical performance.
Purposes: The purpose of this research is to explore the satisfaction of nursing students in having
clinical teaching during clinical practice process. Method: This research was a kind of qualitative
research design with phenomenological approach and undergraduate bachelor degree nursing students
as informant. The number of informant was 6 students. The research conducted on May 2011, by
focus group discussion (FGD) method. The informants were taken by purposive sampling. Result:
The research showed that clinical teaching process had a lot of benefits in giving direction and
guidance to the students during practice. Characteristic of the guide, time and intensity of teaching
influenced clinical teaching during practice. The students felt satisfy about clinical teaching process
they got during nursing clinical practice. Conclusion: There is still need introspection activity between
clinical instructor and students in order to make close, honest and open relationship. Clinical instructor
selection is a need, to get a good character of instructor. Increasing amount of outside town clinical
instructor consider to intensify clinical teaching.
Keywords: Students Satisfaction, Clinical Teaching, Clinical Practice
99
TIME SCHEDULE OF JAVA INTERNATIONAL NURSING CONFERENCE 2012

Semarang, 6 7 Nopember 2012
1st Day: Tuesday, 6 Nopember 2012
Time
Activity
07.30 08.30
08.30 10.00
Registrasi
Opening Ceremony
10.00 10.15
10.15 11.15
11.15 11.45
Coffee Break
Keynote Speech : Nursing
Knowledge and Nursing
Philosophy of Holistic Nursing
Poster presentation
11.45 - 12.45
Lunch break
12.45 14.15
(Panel)
Global Evidence: Development
and Implementation of Holistic
Nursing in Western Countries.
Global Evidence: Development
and Implementation of Holistic
Nursing in Eastern Countries.
PIC
Secretary
Project Manager
Rector of Undip
Vice Governor of Central Java
Marguerite J. Purnell, Ph.D.,RN AHN-BC
(Christine E.Lynn College of Nursing Florida
Atlantic University)
Marguerite J. Purnell, Ph.D.,RN AHN-BC

(Christine E.Lynn College of Nursing Florida
Atlantic University)
Asst. Prof.Dr. Urai Hathaitakit, Ph.D.,RN
(Head of Holistic Nursing Center and eastern
wisdom, Faculty of Nursing Prince of Songkla
University)
Moderator: Prof. Dr. Edi Darmana, Ph.D,Sp. Park

14.15 15.45
Concurrent Session 1
15.45 16.00
Coffee Break
16.00 17.30
Concurrent Session 2
17.30 - 17.40
Penutup
19.30 - 22.00
Gala dinner
2nd Day: Wednesday, 7 Nopember 2012

Waktu
Kegiatan
08.30 10.30
Implementations of Holistic Nursing

in Academic and Clinical Settings.
(Panel)
- Alternative and Complimentary
Medicine (CAM) in Holistic
Hospital
PIC
Ahmad Yani
(Delegation of Indonesia Holistic Tourism
Hospital Purwakarta)
Implementing Yoga Detoxication
Dr. Hiroshi Aikata(M.A., D.Y.Ed.)

(Yoga lecturer)
Aplication of holistic program at

Diponegoro Universitys nursing
school
Fitria Handayani, S.Kp, M.Kep, Sp.KMB
Moderator: Meidiana Dwidiyanti, S.Kp.,M.Sc

10.30 10.45
Coffee break
10.45 12.15
Concurrent session 1
12.15 13.45
Lunch
13.45 15.15
Concurrent session 2
15.15 15.30
Coffe break
15.30 16.00
Closing Ceremony
TIME SCHEDULE OF CONCURRENT SESSION

2ND JAVA INTERNATIONAL NURSING CONFERNCE 2012
6 NOVEMBER 2012, CONCURRENT SESSION 1
ROOM 1
Moderator : Reni Sulung Utami
No
1.
Title
Author
NURSING INTERVENSI AND COMPLEMENTARY AND
ALTERNATIVE THERAPY
Effect of progressive muscle relaxation Tika Yuliani,
technique on blood sugar level in patients with Wenny
S.,
type 2 Diabetes Mellitus
Masta h.
ROOM 2
Moderator : Heni Kusuma
N
o
Title
Author
ALTERNATIVE THERAPY
1 Effect of rose aromatherapy on nursing Nelwati,
Sri
students stress level in clinical learning
Wahyuni
ROOM 3
Moderator : Sawiji
N
o Title
NURSING MANAGEMENT
The experience of head of nurse in managing
implemention of
patient safety: A
phenomonology study
Author
Safrudin Agus
Nursalim,
Hanny
Handiyani, Yati
Afiyanti
Sri Yani, Fitri
Arofah
2.
Efficiency of meditation technique and

comparison of generative and concentrative
meditation on high school studentss mental
health
Agustina Ari H.
The correlation between toilet training

stimulation by mother and the toileting ability
of preschoolers at Balung Lor village, Jember
regency
Anisah Ardiana,
Eka Windian
Evaluation of application of parenteral drug

administration in coordinating patient safety in
inpatient
installation
of
PKU
MuhammadiyahBantul hospital
3.
Effectiveness of combination of marmet

techniques and oxytocin massages to breast milk
production on post cesarean section women at
Central Java hospital
Eko
Mardiyaningsih
,
Setyowati,
Luknis .
Effectiveness of hypnobirthing in reducing

anxiety level of pregnant women in facing
labor or childbirth
Desi Resmatani,
Atun Roudlotul
Marifah,
Suci
Kahsanah
The effectiveness of computer-based nursing

documentation
system
prototype
in
documenting nursing care plan
Aji
Sayogo,
Wenny Savitri,
Igoon
4.
The effect of pregnancy service knowledge and

its implementation of the pregnancy maturity
and its effectiveness on the pregnant mothers
with the risk of premature labor in Jakarta
Christine Aden
The intensity of menstrual pain after rhythmic

and slow package intervention
Fiega Tresna
Asfuri, Restuning
Widiasih, Ermiati
A combined method of classical teaching,

module, video, and professional mentoring as
requirement on families education to meet
childrens growth and development needs
5.
The effect of balloons blowing exercise to lung

capacity changes on bronchial asthmatic patients
Takdir Tahir,
Silvia Malasari,
Sainab K.
Analysisi of circadian rhythm on infarct size in

patients with acute myocardial infart
Anugerah Eka,
Mifetika
Lukitasari, et al
Holistic Nursing Care of Childrens Disabilities

Health: A Psychology Aspect to Improving the
Health Quality
Haryatiningsih
Purwandari,
Wastu
Adimulyono,
Suryanto
Chairun Nasirin
6.
The influence of the warm compress technique

on patients pain scale following sectio
caesarean surgery in sleman district general
hospital
Yuliana Krowa,
Wenny
s.,
Sulistyaningsih
The fffect of kangaroo method application to

body temperature at the baby weight low birth
(LBW)
Kadek Ayu Erika,

Marlina p.
Effectiveness of postoperative wound care

training in applying standard operational
procedure (SOP)
Oci
Nursany,
Arofah
Etri
Fitri

ROOM 1
Moderator : Diyan Yuli W
No
.
Title
Author
CULTURAL DIVERSITY IN NURSING CARE PROCESS
ROOM 2
Moderator : Isma Yuniar
N
o. Title
A phenomonolgy study of mothers experience in

caring premature babies
Eka Riyanti
The differences of women body image on the

usage variance hormonal contraceptive agents
The relationships between characteristics of

adolescents, the role of peers, and exposure to
pornography with sexual behavior of adolescents
Nurfika
Asmaningrum,
Siswoyo, Anis
Nur Farida
Ari Pristiana
Dewi, Junaiti
S ahar, Dewi
Gayatri
The Relationship between Knowlegde and

Behavior of Adolescent about Genital Hygiene
During Menstruastion Period
Suzana
Octavia, Sari
Sudarmiati
4
Perceptions of hypertensive elderly on health care
Nurullya
Rachma
NURSING MANAGEMENT
Preschool teachers experience in the
implementation of denver II screening
for preschool children
Author
ROOM 3
Moderator : Safrudin Ahmad
No
.
Title
QUALITY OF NURSING CARE
Author
Rizki Cintya Dewi,

Meira Erawati
Quality of pressure ulcer care in Indonesian

hospitals: first year measurement using LPZ
instruments
Yufitriani Amir,
Ruud H., Christa
l., Jos s.
Implementation of Sowan method for

increasing self care in TB patients
Meidiana Dwidiyanti
Quality of life diabetic ulcer patient at Serang

general hospital
Social support and self-efficacy of

patients with coronary heart disease
(CHD)
Wantiyah
erception and motivation of nurses in

facilitating breastfeeding in perinatology room
Aji
Firman,
Indah Wulandari,
Dadang
Rochman
Yenni Suryadi,
Ermiati,
Restuning
Widiasih
Nursing triage duration in patient with

chest pain: shorter triage-level
designation interval in acute myocardial
infarction
Diahkristianisah
rahayu,
Mifetika
Lukitasari,
Arina
Madjidi, Anugerah Eka
Purwanti, Fitri Ayuning
Ulansari, Mohammad
Saifur Rohman
Yu CW, Hasan Ali
The relationship between depression and

family support towards quality of live among
HIV/AIDs patientswho take health care at
Ciptomangunkusumo hospital in Jakarta
The cost assessment and the influence

of personal factors on sickness absence
Henni Kusuma,
Elly
Nurrachmah,
Dewi Gayatri
Nursing Education
A
congruency
model
toward
environmentally based nursing program
an
Portia Villafuerte
Zoleta-Vitug

ROOM 1
Moderator : Sarah Ulliya
ROOM 2
Moderator : Farida
ROOM 3
Moderator : Oci Tri
No.
No.
No.
Title
Author
ALTERNATIVE THERAPY
A Comparison of babys sleep patterns baby
Suryadi
who got baby massage and baby SPA
Arianata,
Falasifah
Aniyuniarti
Effectiveness of SEFT (spiritual emotional

freedom technique ) intervention in
schizophrenia with depression anxiety stress
Ike Puspitaningrum
CULTURAL DIVERSITY IN NURSING CARE PROCES
The influence of breathing exercise to the

fatigue level of hemodialisys patients
Cahyu Septiwi
Coping Mechanism in Culture Differences of

Outer Region Students in the First Year
Door to electrocardiogram (EGC) duration

contributed to more than a half diagnosing
acute myocardial infaction (AMI) interval
Nurses cultural competency in providing

culturally sensitive nursing care for diabetic
patient at Fatmawati hospital Jakarta
The expression of Cylooxygenese (COX-2),

the thickness of endometrium and the
number of epithel cell of luminal uterus as
an effect on the giving og curcuma in
ratusnorvegicus strain Sprague dawley after
receiving luteinizing hormone stimulation
Fitri
Ayuning
Ulansari, Anugerah
Eka,
Mifetika
Lukitasari,
Mohammad
Saifurrohman
Ery Purwanti, Sri
Kadarsih Soejono,
Djaswadi Dasuki
Sexual behavior and awareness of Indonesia

high school students in transition with implied
risk of HIV infections
Ike Nurhidayah
The difference of mucositis score in children

with cancer undergoing chemotherapy protocol
in dr. Cipto Mangunkusumo hospital Jakarta
Title
Author
ALTERNATIVE THERAPY
The effect of chewing xylitol gum on the
Dinny Atin Amanah,
changes of thirst in chronic kidney disease
Wahyu Hidayati
(CKD) patients with hemodialysis
Maria
WisnuKanita,
Nur Setiawati
Dewi
Enie
Novieastari,
Azrul Azwar,
Dewi Irawaty,
Sudarti
Untung Sujianto
Title
Author
CULTURAL DIVERSITY IN NURSING CARE PROCESS
The risk factors of labor and delivery
complications on working mothers in
Fatmawati center public hospital of
Jakarta
Yuni
Dwidiastuti,
Setyowati,
Afiyanti
Puji
Yati
Sex workers perception on health

Novita
Pusparini,
behavior for preventing sexuality
Dwi Susiliwati
transmitted infection (STIs) in
Gambilangu Brithel house Mangkang
Central Java
Correlation between the family up Marsito,Hendri
bringing pattern with the perception off Tamara
adolescent about pre marital sexual
behavior
NURSING INTERVENSION AND COMPLEMENTARY
AND ALTERNATIVE THERAPY
A literature review: the effectiveness of

nutrition
education
to
prevent
malnutrition in developing countries
Ferika Indarwati
Description of knowledge and attitude in

controlling the relapse of asthma toward
the bronchial asthma outpatients in lung
hospital, Salatiga
Lily Wolagale,
Sakkti Oktaria B,
Aziz Anwar

ROOM 1
Moderator : Siti Apriliani
No.
Title
NURSING EDUCATION
Author
The description of students recreation

needs at nursing school
Fitri
Nur
Khotimah, Sarah
Ulliya
The based health belief model for

recreational need among bachelor degree
student
Asri Wijayati M,
Madya Sulisno
An Experimental Approach to Enhance

Soft Skills dealing with Ethical Issues in
Nursing Education
Rr. Sri Endang

Puji Astuti,
Samsudi, Heru
Supriyanto
Implementation
of
mentorship
preceptorship method in students of
maternity nursing internship
Fatikhu Y. ,
Meira
E.,
Anggorowati
ROOM 2
Moderator : Cahyu Septiwi
No
.
Title
NURSING POLICE
Author
Eni
Indrayani,
Mohammad Hakimi,
Shinta Prawitasari
The Spirituality Needs of Terminally Ill

patients: a literature review
SPIRITUALITY
Author
QUALITY OF NURSING CARE
Rie Wakimizu
How should pediatric nurses support
the problems and challenges to school
re-entry of younger children with
childhood cancer?
Rochana,
An analysis of the triage system in Nana
Virginia P, Julia M.
emergency departments in Indonesia
The evaluation of knowledge, behavior

and implementation of the Indonesian
minister of health regulation(Permenkes)
number 1464 2010 by midwives in
Kebumen district Central Java
ROOM 3
Moderator : Sriyani
No
.
Title
Aan Nuraeni
Comparative figures on the incidence

of phlebitis in intravenous catheter
installation on the dominat hand with
non domint hand
Factors associated with essential
hypertension in middle adult age
groups in cardiac clinic Pekanbaru
Tino Adianto, Sakti

Oktaria B, Aziz
Anwar
The effectiveness of health education

in increasing social support for
critically ill patients in intensive care
unit
Isma Yuniar,
Helwiyahropi,
Wiwimardiyah
Differences
of
life
quality
in
psychological domain between patients
post stroke rehabilitation and non
rehabilitatiton
Ika Chandra, Fitria

Handayani
Rizka Febtriana
THE LIST OF POSTER PRESENTATIONS

2 JAVA INTERNATIONAL NURSING CONFERENCE 2012
nd
No Title
Author
Injecting drug users (IDU) family experiences to administer

family centered nursing care intervention who has been
1
undergoing cease smoking program at methadone program
Suhariyanto,
trisnasafriana,
idarosyada, fatmawati,
therapy (PTRM)
Raden siti maryam,
junaiti sahar, astuti
yuni nursasi
Herniyatun,
barendayunimawarti,
hastinika
Community empowerment as falls prevention strategy for

elderly aggregate at Ratujaya district Depok city
Influencing factors for the menstruation cycle irregularity on

20-29 years old women in Kalitengah village Gombong
Javanese womensbelief about recommended and

unrecommended foods and drinks in the pregnancy and post
partum period
Muhammad rofii
Difference of life quality in psychological domain between

patients post stroke rehabilitation and non rehabilitation
Ika Chandra, Fitria

Handayani
Self care experience of patient with chronic kidney disease

(CKD) who underwent hemodialisysbaesd on orem theory
Kiki Wahyuni, Wahyu

Hidayati
The Influencing factors of exclusive Breastfeeding on mother

in Public Health Center, Yogyakarta..
Dewi, C.K., Rahmah
Effect of balance exercise on postural balance in elderly at

8
nursing home Wening Werdoyo Ungaran
Evi kurniawati,
muhammad hasib
ardani
The students satisfaction on getting clinical teaching during

clinical practice
Dicky Helmi Susilo,

Agus Santoso
10
Evaluations on implementation home care visit in

community health center
Basirun
11
The Description of nurse s excellent services at Tugurejo

hospital
Hendrik Kurniawan,
AgusSantoso
12
Factors that Affect the estimated fetal weight in the third

trimester pregnant women in Palangkaraya
Christina aden

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PROCEEDING

2nd JAVA INTERNATIONAL NURSING CONFERENCE 2012

East Meets West on Holistic Nursing

PROCEEDING 2ND JAVA INTERNATIONAL NURSING CONFERENCE 2012

PUBLISHED BY PSIK FK UNDIP

Proceeding 2nd Java International Nursing Conference 2012

Semarang: PSIK FK UNDIP, 2012

2nd JAVA INTERNATIONAL NURSING CONFERENCE 2012

East Meets West on Holistic Nursing

We are thank you to our reviewer team:

Wongchan Petpichetchian (Prince of Songkla University, Thailand)

The development of modern information technology increasingly facilitates nurses to access

2nd JAVA INTERNATIONAL NURSING CONFERENCE 2012

East Meets West on Holistic Nursing

: Ns. Meira Erawati, S.Kep., M.Si.Med

Vice Project Manager

: Ns. Giyatmo, S.Kep

: Ns. Elis Hartati, S.Kep., M.Kep

: Nur Setiawati D., S.Kp.,M.Kep. Sp.Kom

: Sarah Ulliya, S.Kp., M.Kes

Publication & Documentation

: Ns. Elsa Naviati, S.Kep., M.Kep

: Madya Sulisno, S.Kp., M.Kes

Facility and Equipment

: Candra Bagus Ropyanto, S.Kp., M.Kep

Food and baverage

: Septi Harni W., AMK

A WELCOME SPEECH BY THE PROJECT MANAGER

Wassalamualaikum warahmatullaahi wabarakaatuh

Meira Erawati, Ns.,S.Kep.,MSi.Med

Keynote Presentation and Plenary Session

HOLISTIC NURSING: SCOPE AND STANDARDS OF PRACTICE10, 11

SCOPE OF HOLISTIC NURSING

Associate Professor, Christine E. Lynn College of Nursing, Florida Atlantic University,

Keynote Presentation and Plenary Session

Keynote Presentation and Plenary Session

Holistic Nursing: Advancing The Discipline

Associate Professor, Christine E. Lynn College of Nursing, Florida Atlantic University,

Keynote Presentation and Plenary Session

Keynote Presentation and Plenary Session

Keynote Presentation and Plenary Session

Keynote Presentation and Plenary Session

Keynote Presentation and Plenary Session

Keynote Presentation and Plenary Session

Keynote Presentation and Plenary Session

Keynote Presentation and Plenary Session

Keynote Presentation and Plenary Session

Keynote Presentation and Plenary Session

Keynote Presentation and Plenary Session

Keynote Presentation and Plenary Session

Keynote Presentation and Plenary Session

Keynote Presentation and Plenary Session

Keynote Presentation and Plenary Session

Keynote Presentation and Plenary Session

Development and Implementation of Holistic Nursing in Thailand

Associate Professor, Faculty of Nursing, Prince of Songkla University

Keynote Presentation and Plenary Session

Keynote Presentation and Plenary Session

Keynote Presentation and Plenary Session

Keynote Presentation and Plenary Session

Keynote Presentation and Plenary Session

Co-director, MCB Foundation Thai Yoga Institute, Bangkok, Thailand

Keynote Presentation and Plenary Session

Keynote Presentation and Plenary Session