Arifin, Mohammad Fahrul and Dr. Ns. Heri Kristianto, S.Kep.,M.Kep.,Sp.Kep.MB and Prof. Dr. dr. Loeki Enggar Fitri, M.Kes.,Sp.ParK (2022) Efektivitas Stroke Education Program (SEP) Berbasis Telerehabilitation Dengan Pendekatan Teori Self Care Orem Terhadap Activities of Daily Living (ADL) Dan Mobilisasi Pasien Pasca Stroke. Magister thesis, Universitas Brawijaya.
Abstract
Stroke merupakan penyakit gangguan saraf yang datang tiba-tiba dan dapat menyerang siapa saja tanpa memandang usia maupun status ekonomi, terjadi akibat terganggunya peredaran darah ke otak yang terjadi sekitar 24 jam atau lebih. Pasien pasca stroke akan mengalami kelemahan dan kesulitan dalam melakukan ADL dan mobilisasi sehingga memerlukan bantuan untuk memenuhi kehidupan sehari-hari sehingga untuk mengantisipasi kejadian defisit self care pada pasien pasca stroke harus dilakukan rehabilitasi sedini mungkin. Pasien pasca stroke perlu mendapatkan telerehabilitation untuk meningkatkan mobilisasi dan kemampuan ADL, telerehabilitation dengan pendekatan teori self care Orem adalah metode untuk meningkatkan mobilitas dan aktivitas kehidupan sehari-hari pasien dan juga untuk merubah gaya hidup pasien lewat olahraga sehingga stroke berulang akan sangat diminimalisir. Metode penelitian ini adalah Quasi Experimental dengan pendekatan pre-post test design dan teknik purposive sampling. Subyek penelitian ini adalah pasien pasca stroke di poli Saraf dan di ruang Anggrek RSUD dr. R Koesma Tuban berjumlah 50 pasien yang dibagi 25 orang masuk dalam kelompok kontrol diberikan edukasi berbentuk leaflet di aplikasi Edures-SCO dan 25 orang masuk kelompok intervensi diberikan video animasi edukasi dan rehabilitasi. Dilakukan uji chi square dan uji normalitas dan analisa data menggunkan uji Mann Whitney karena data tidak normal. Data demografi responden usia mayoritas responden adalah >50 Tahun 33 (66%), jenis kelamin mayoritas responden adalah Laki-laki berjumlah 39 (78%), lama di rumah sakit mayoritas adalah < 7 Hari sebanyak 40 (80%), dan lama stroke mayoritas responden adalah < 6 Bulan sejumlah 44 (88%), dan rata-rata responden yang menderita stroke adalah terjadi stroke ke 1 sebanyak 40 (80%), Adapun homogenitas responden pada usia p value = 0,370, jenis kelamin p value = 0,088, lama di RS p value = 0,034, lama stroke p value = 0,667, dan terjadi stroke ke berapa p value = 1,000. Nilai median Activity Daily Living (ADL) pada saat pre test kelompok kontrol adalah 65 (45-90), sedangkan kelompok intervensi dengan nilai median 65 (45-90). Adapun analisis uji beda memberikan nilai p value 0,953. Artinya tidak ada perbedaan nilai pre test antara kelompok intervensi dan kelompok kontrol sehingga pada pre test data ADL kelompok kontrol dan intervensi menjadi homogen. Nilai median Activity Daily Living (ADL) pada saat post test kelompok kontrol adalah 70 (55-90), sedangkan pada kelompok intervensi dengan nilai median 85 (55-100). Hasil analisis uji beda memberikan nilai p value = 0,000. Artinya ada perbedaan nilai saat post test antara kelompok intervensi dan kelompok kontrol. Nilai yang di dapat pada kelompok intervensi lebih besar secara signifikan dari kelompok kontrol. Nilai median mobilisasi pada saat pre test kelompok kontrol adalah 67 (36-100), sedangkan kelompok intervensi dengan nilai median 77 (36-107). Analisis uji beda menghasilkan nilai p value = 0,381, yang artinya tidak ada perbedaan nilai pre test antara kelompok intervensi dan kelompok kontrol sehingga datanya menjadi homogen. Nilai median mobilisasi pada saat post test kelompok kontrol adalah 67 (36-107), sedangkan nilai median pada kelompok intervensi adalah 64 (36-107). Analisis uji beda menghasilkan nilai value = 0,002, yang artinya ada perbedaan nilai saat post test antara kelompok intervensi dan kelompok kontrol. Nilai yang di dapat antara kelompok intervensi lebih kecil sehingga lebih signifikan hasilnya dari kelompok kontrol. Berdasarkan hasil penelitian ini ditemukan adanya peningkatan yang signifikan pada skor ADL dan mobilisasi setelah diberikan telerehabilitation aplikasi Edures-SCO pada kelompok intervensi. Hal ini berarti pemberian aplikasi video edukasi dan rehabilitasi pasien pasca stroke efektif meningkatkan ADL dan mobilisasi pasien. Aplikasi Edures-SCO didesain dengan menggunakan teori self care Orem dengan 3 konsep yaitu wholly kompensatory system, partly kompensatory system, dan supportif educatif system, dengan disesuaikan untuk pasien pasca stroke sehingga mampu meningkatkan ADL dan mobilisasi secara baik. Langkah yang dilakukan agar intervensi efektif meningkatkan hasil post test adalah dengan melibatkan keluarga yang merawat pasien tersebut. Implikasi dalam bidang keperawatan adalah perawat dapat memonitor rehabilitasi pasien melalui jarak jauh dengan aplikasi Edures-SCO. Monitoring dapat dilakukan secara harian dengan aplikasi sehingga perawat tidak sesering mungkin bertatap muka dengan pasien. Implikasi klinis dalam penelitian ini adalah aplikasi Edures-SCO dapat diintegrasikan dalam program rehabilitasi di rumah sakit. Tenaga kesehatan dapat memberikan edukasi terlebih dahulu kepada pasien mengenai cara penggunaan aplikasi pada saat discharge planning.
English Abstract
Stroke is a neurological disorder that comes suddenly and can attack anyone regardless of age or economic status, occurs due to disruption of blood circulation to the brain for about 24 hours or more. Post-stroke patients will experience weakness and difficulty in performing ADL and mobilization so that they need assistance to fulfill daily life so that to anticipate the occurrence of self-care deficits in post-stroke patients, rehabilitation should be carried out as early as possible. Post-stroke patients need to get telerehabilitation to improve mobilization and ADL ability, telerehabilitation with Orem's self-care theory approach is a method to improve mobility and activities of patients' daily lives and also to change the patient's lifestyle through repetitive stroke sports will be greatly minimized. This research method is Quasi Experimental with pre-post test design approach and purposive sampling technique. The subjects of this study were post-stroke patients at the Neurology Polyclinic and the Orchid Room at RSUD dr. R Koesma Tuban totaling 50 patients divided by 25 people in the control group were given education in the form of leaflets in the Edures-SCO application and 25 people in the intervention group were given animated education and rehabilitation videos. Chi square test and normality test were carried out and data analysis using the Mann Whitney test because the data was not normal. Demographic data of respondents, the age of the majority of respondents is > 50 years 33 (66%), the gender of the majority of respondents is 39 (78%), the majority of the length of stay in the hospital is < 7 days as much as 40 (80%), and the length of stroke the majority of respondents were < 6 months, 44 (88%), and the average respondent who suffered a stroke was the 1st stroke was 40 (80%), while the homogeneity of respondents was at age p value = 0.370, gender p value = 0.088, length of stay in RS p value = 0.034, length of stroke p value = 0.667, and how many strokes occurred p value = 1,000. The median value of Activity Daily Living (ADL) at the time of the pre-test for the control group was 65 (45-90), while the median value for the intervention group was 65 (45-90). The analysis of the difference test gives a p value of 0.953. This means that there is no difference in pre-test scores between the intervention group and the control group, so that the pre-test ADL data between the control and intervention groups became homogeneous. The median value of Activity Daily Living (ADL) at the time of the control group's post test was 70 (55-90), while the median value of the intervention group was 85 (55-100). The results of the analysis of the difference test give a p value = 0.000. This means that there is a difference in the value of the post test between the intervention group and the control group. The value obtained in the intervention group was significantly greater than the control group. The median value of mobilization at the time of the control group pre-test was 67 (36-100), while the intervention group had a median value of 77 (36-107). The analysis of the difference test resulted in a p value = 0.381, which means that there was no difference in the pre-test value between the intervention group and the control group so that the data became homogeneous. The median value of mobilization at the time of post-test control group was 67 (36-107), while the median value in the intervention group was 64 (36-107). The analysis of the difference test resulted in a value of = 0.002, which means that there was a difference in the value of the post-test between the intervention group and the control group. The value obtained between the intervention group is smaller so that the results are more significant than the control group. Based on the results of this study, it was found that there was a significant increase in ADL scores and mobilization after being given telerehabilitation with the Edures-SCO application in the intervention group. This means that the provision of educational video applications and rehabilitation of post-stroke patients is effective in increasing ADL and patient mobilization. The Edures-SCO application is designed using Orem's self-care theory with 3 concepts, namely a wholly compensatory system, partly compensatory system, and a supportive educative system, adjusted for post-stroke patients so as to improve ADL and good mobilization. The steps taken so that the intervention is effective in improving post test results is to involve the family who cares for the patient. The implication in the field of nursing is that nurses can monitor patient rehabilitation remotely with the Edures-SCO application. Monitoring can be done on a daily basis with the application so that nurses do not meet face-to-face with patients as often as possible. The clinical implication in this study is that the Edures-SCO application can be integrated into a rehabilitation program in a hospital. Health workers can provide education to patients in advance about how to use the application during discharge planning.
| Item Type: | Thesis (Magister) |
|---|---|
| Identification Number: | 0422160031 |
| Subjects: | 600 Technology (Applied sciences) > 610 Medicine and health > 610.7 Education, research, nursing, services of allied health personnel > 610.73 Nursing and services of allied health personnel |
| Divisions: | S2/S3 > Magister Keperawatan, Fakultas Kedokteran |
| Depositing User: | soegeng sugeng |
| Date Deposited: | 14 Jun 2023 06:41 |
| Last Modified: | 14 Jun 2023 06:41 |
| URI: | http://repository.ub.ac.id/id/eprint/201630 |
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