Eka Mishbahatul Mar’ah Has*, Elida Ulfiana*, Retno Indarwati*
*Lecturer, Department of Psyhiatriy and Community Health Nursing Community and Family Health Nursing Division, Faculty of Nursing
Universitas Airlangga, Surabaya, East Java, Indonesia E-mail: [email protected]
ABSTRACT
Introduction: Leprosy is a chronic infectious disease that has stigmatised people affected since ancient times until now. Misconceptions about the disease have contributed to the development of negative attitudes to leprosy affected persons. Increasing community’s awareness to eliminate the negative stigma for leprosy patients and former leprosy patients can be done by empowering community. Training for health volunteers are expected can enhance their role as a change agent of leprosy stigma in the community. Method: Training was conducted on 30 health volunteers at Puskesmas Mulyorejo, Surabaya. Training method includes lectures, discussion, and demonstration.
The evaluation was conducted to health volunteer’s knowledge about leprosy, rehabilitation of leprosy patients and former leprosys patients, and education as an agent of change on leprosy’s stigmatization by using questionnaire. The result of evaluation then presented in frequency distribution and percentage. Result: The result showed that before training, 25 (83,3%) health volunteers had less knowledge about leprosy, and the rest had enough. After training, 24 (80%) had good knowledge, the rest had enough, but there were 2 (6,7%) still had less knowledge. The comparison between pre and post score had shown an increase of 25-50 points on 20 health volunteers (66,7%), with the highest score differences was 72 points. However, there were still 1 health volunteers (3.3%) who had no increase. Discussion: Training can enhance health volunteer’s knowledge about leprosy. The enhancement of health volunteer’s knowledge are expected to enhance their ability, willingness, and role as an agent of change leprosy stigmatization in their community. Training for health volunteers need a follow up such as providing media as a tool for them to promote the elimination of stigmatization on leprosy patients and former leprosy patients in their community. Beside that, supervision from community health nurses also needed.
Key words: training, leprosy related stigma, health volunteers INTRODUCTION
Disability suffered by leprosy patients and former leprosy patients is often considered terrify by others. It will lead to leprophobia.
Although they already finished their treatment and declared cured by medical team, the community still labelled them with leprosy for all their life. A leprosy’s label which given by the community underlying psychological problems suffered by leprosy patients and former leprosy patients, so that they feel fear, disappointed, depressed, unconfident, shame, worthless, useless, and worry for been isolated
by others. Community awareness for did not exclude the leprosy patients is still low. Big efforts and a couple of time are needed to eliminate that stigma. So that, an effort to change community’s view about leprosy patients should begin immediately (Depkes RI, 2013).
Based on WHO report in 2013, the prevalence of leprosy in four early months in 2013 from 115 countries was 189.018 cases. While new cases in 2012 was 232.857 cases. Depkes RI
Global Nursing Challenges in The Free Trade Era 65 (2013) stated that number of leprosy patients in
Indonesia was still high. Indonesia still becomes the big three countries with highest leprosy cases in the world, after India and Brazil. At 2011, Indonesia reported 20.023 new cases of leprosy. Based on that report, the number of cases with 2nd grade of disability (visible defect), was 2.015 people (10,11%).
Leprosy related stigma can cause their rights as a human being and as a part of the community are not being met.
Leprosy has wide effect on the patient’s life start from marriage, occupation, personal relationship, business activity, until their attendance at religious events as well as community events. Leprosy related stigma happens because lack of knowledge, misconception, and wrong belief about leprosy as a disease. Misperception about this disease is believed as a main cause of stigma (Leprosy Review, 2005).
One of intervention which conducted by Ministry of Health, Republic of Indonesia in order to cut off leprosy was to eliminate leprosy related stigma by changing people’s view about leprosy through intensive health education about leprosy (Depkes RI, 2005).
But, there are still some problem, such as lack of human resources at public health center make this program runs slowly. In order to improve the successfulness of this program, help from the community is needed. People’s view about leprosy must be changed by empowering the community. The community needs more information and education about leprosy, especially the motor of health on each community, the health volunteers. So that, they can promote leprosy to another family in their area. By eliminating stigma and discrimination to leprosy patient and former leprosy patients, community’s behavior to accept them can be increased. This is very important to enhance self confidence of patients and families in their lives.
The health volunteers were a part of community which chosen by and from the
community in order to enable people to be more healthy (Efendi & Makhfudli, 2009).
Until todays, Puskesmas Mulyorejo already have active health volunteers which run posyandu for under five years and the elders.
But, there are no health volunteers who specifically undertaken leprosy’s problem in the community. So that, socialization about leprosy for health volunteers is needed. So they can also enhance their role and give correct information about leprosy and take part to eliminate leprosy related stigma.
Improving health volunteers’ understanding about leprosy was given thorough training, with self management education approach. Self management education was defined as health education which given in a group, multidicipline, based on adult learning style, supported by media such as handbook, booklet, manual, etc., And also provide support and supervision from health workers after all of session finished (Barlow, Wright, Sheasby, Turner, & Hainsworth, 2002). In this training, self management education was given in order to change community’s perception and induce positive view about leprosy patients and former leprosy patients. Through this training, health volunteers are expected to optimize their role as agent of change leprosy related stigma.
RESEARCH METHOD
This training was conducted at Puskesmas Mulyorejo area. Target of this training was health volunteers who runs posyandu for under five years, 30 health volunteers were involved.
Training using self management education approach. Teaching and learning method used was: 1) lectures; 2) discussion; and 3) demonstration. The evaluation was conducted to health volunteer’s knowledge about leprosy, rehabilitation of leprosy patients and former leprosys patients, and education as an agent of change on leprosy’s stigmatization by using questionnaire. The result of evaluation then presented in frequency distribution and percentage.
Global Nursing Challenges in The Free Trade Era 66 RESULT
Table 1 The tabulation of health volunteers score before and after training
Score
Knowledge
Total Good Enough Less
n % n % n % n %
Pre 0 0 5 16.7 25 83.3 30 100 Post 24 80 4 13.3 1 6.7 30 100
Tabel 2 Score differences before and after training
Differences n %
>50 4 13,3
25-50 20 66,7
<25 5 16,7
none 1 3,3
Table 1 had informed that before training as many as 25 (88,23%) health volunteers have less knowledge, as many as 5 (16,7%) health volunteers have enough knowledge, and none health volunteer have good knowledge about leprosy. But after training, there were 24 (80%) health volunteers have good knowledge, 1 (6,7%) health volunteer still have less knowledge about leprosy, while the rest have enough knowledge.
Based on table 2, known that the comparison between pre and post score had shown an increase of 25-50 points on 20 health volunteers (66,7%), with the highest score differences was 72 points. However, there were still 1 health volunteers (3.3%) who had no increase.
DISCUSSION
The results showed that in the beginning health volunteer has less knowledge about leprosy. It can be proved by a fact that most of health volunteers have low scores and there is no health volunteers who have knowledge in a good category. After training, can be seen that most of health volunteers have good knowledge, although there were still 2 health volunteers on less knowledge category.
The same training about health volunteers’ role as an agent of change on leprosy related stigma never conducted at Puskesmas Mulyorejo. A report from the public health center at 2014 had shown that there were none cases of
leprosy who still on a treatment program. But there still some of former leprosy patients. This condition makes health volunteers in this area do not have experience and knowledge about how to manage leprosy patient and former leprosy patients in the community. So that, they have low scores on the pretest.
Training was one of health education. Health education is a process of learning from individuals, groups, communities, from do not know ‘till become aware, from unable to overcome a health problem becomes capable.
Knowledge happens after people perform sensing on a specific object. Sensing occurs through the human senses: sight, hearing, smell, taste and touch. Most human knowledge is obtained through the eyes and ears.
Cognitive knowledge is a very important domain in shaping a person's actions (Notoatmojo, 2010).
The result of this training was suitable with that theory, health volunteers’ knowledge was increased, as indicated by participants who mostly have less and enough knowledge before training, becomes mostly have good and enough knowledge after training. There are some factors which influenced this change, includes: 1) individual factors, who focus along training and active along discussion session; 2) presenter’s factors, who clearly explain about the topics, doing demonstration interactively, and facilitate discussion well; and 3) environment factors, where already set up to facilitate learning optimally. Provision of comfortable rooms, adequate audio-visual aid, varied method and media, good preparation, minimize distraction and optimize sensory function to reach understanding.
There were one health volunteers (number 28) who didn’t increase in score. Before and after training keep gets 68 points, mean having enough knowledge. It can happen because of learning obstacles that can’t be avoided, such as lack of focus in receiving materials and leave the room when the training done with a
Global Nursing Challenges in The Free Trade Era 67 specific purpose, so that the sensing process
becomes less optimal.
This training gives chance for health volunteers to review and enhance their understanding about leprosy, rehabilitation for leprosy patients and former leprosy patients, eliminate leprosy related stigma, and also about education as an agent of change leprosy related stigma in the community. Health volunteers were the first line in managing health at the community. Along training, health volunteers also seen a demonstration about how the way to educate and promote community to eliminate leprosy related stigma. A training like this was beneficial to enhance health volunteers’ role in eliminating leprosy related stigma. After training, health volunteers were given a task to educate ten people about leprosy, then report it to the person in charge of this program at Puskesmas Mulyorejo.
CONCLUSION
Training can enhance health volunteer’s knowledge about leprosy. The enhancement of health volunteer’s knowledge are expected to enhance their ability, willingness, and role as an agent of change leprosy stigmatization in their community. Training for health volunteers need a follow up such as providing media as a tool for them to promote the elimination of stigmatization on leprosy patients and former leprosy patients in their community. Beside that, supervision from community health nurses also needed.
REFFERENCES
Barlow, J., Wright, C., Sheasby, J., Turner, A.,
& Hainsworth, J. (2002). Self- management approachs for people with chronic conditions: a review. Patient education and counseling, 48 , 177-187.
Leprosy Review. (2005). A journal contributing to better understanding leprosy and its control. Leprosy Review, Vol 76, No 2 , 34-37.
Dayakisni Tri, Hudaniah. (2003). Psikologi Sosial. Edisi Revisi. UMM-Press.
Malang.
Departemen Kesehatan RI. (2005). Direktorat Jendral Pemberantasan Penyakit Menular dan Penyehatan Lingkungan.
Pedoman Nasional Pemberantasan Penyakit Kusta. Cetakan XVII.
Depkes RI. (2013, Februari 13). Hapus stigma dan diskriminasi terhadap kusta.
Retrieved Oktober 28, 2013, from www.depkes.go.id:
http://www.depkes.go.id/index.php?vw=
2&id=2225
Depkes RI. (2007). Kepmenkes 812/Menkes/SK/VII/2007 tentang Kebijakan Perawatan Paliatif.
Sirmrittirong, S & Brakel, WHV. (2014).
Stigma in leprosy: concepts, causes, and determinants. Lepr Rev, Vol 85, 36-47.
WHO. (2013, Januari). Leprosy today.
Retrieved Oktober 28, 2013, from www.who.int:
http://www.who.int/lep/en/
Global Nursing Challenges in The Free Trade Era 68
PERCEPTION AFFECTS THe HSP 70 FAMILY MEMBERS WHO CARE FOR SUFFERERS OF TUBERCULOSIS
Chilyatiz Zahroh
Faculty of Nursing and Midwifery, Nahdlatul Ulama University of Surabaya SMEA Streets, 57 Surabaya, East Java, Indonesia
e-mail: [email protected]
ABSTRACT
Introduction: Tuberculosis (TB) takes a long-time and family-involving treatment. The available program of family involvement is merely as medication-taking assistance. The family was not given the way to protect their self from contracting the disease. This paper explores the results of a research conducted to analyze the perception affects the heat shock protein (Hsp70) family members who took care for sufferers of tuberculosis. Method: this research was conducted using cross sectional approach.
The sample was 20 respondents obtained through total sampling techniques. The independent variable was perception, while the dependent variable was the Hsp70. The data were collected by questionnaire for perception, and the Hsp70 was measured using blood sample. The data were then analyzed with t- test. Results: The average score of the respondents’ perception was 64.15 and the average level of Hsp70 was 240.1 g/dl. The statistical T-test result showed p<0.05, indicating that perception influences the Hsp70 level of the respondents. Discussion: The Hsp70 is very expressive to changes, whether physical or mental, including perception. Positive perception is needed to optimize the work of Hsp70 as the protector of cells in the immune system. The nurse must be able to establish a positive perception of the family members who care for tuberculosis patients. Perception can be given in the religious dimension is delivered through therapeutic communication.
Key words: Tuberculosis, perception, Hsp70
INTRODUCTION
Efforts to deal with and prevent transmission of the disease tuberculosis (TB) is still performed by the Government of Indonesia, primarily through the Department of health. Strategy for treatment of Tuberculosis DOTS have been applied in Indonesia since 1995 with the approach of advocacy, communication and social mobilization.
Prevention of TB has been done through the program STOP TB. This progam is to target people with TB sufferers and families.
However, only family engaging in surveillance efforts are taking medication (PMO).
The family that took care of the sufferers have a higher risk of contracting TB.
Tuberculosis treatment in terms of treatment takes at least six months. Families caring for TB sufferers only given way to prevent transmission of TB physically, not mentally.
Prevention of mentally is seen more effectively to stop the chain of transmission of TB, i.e. by increasing the positive perception. Family members caring for sufferers of TUBERCULOSIS sufferers are expected to take care with the patient and sincere so that positive perception formed. The perception of a positive impact on the gene expression potein in blood, namely, Hsp70. But until recently how perception influences the Hsp 70 family who take care of TB sufferers have yet to be explained.
Global Nursing Challenges in The Free Trade Era 69 The number of tuberculosis in
Indonesia increased each year. The data shows an improvement of tuberculisis in Puskesmas Wonokromo every year. In 2011 as many as 42 people, 2012 as many as 46 people, as many as 47 people, the 2013 and 2014 as many as 52 people.
Tuberculosis treatment in terms of treatment takes at least six months. TB is also a disease that can be transmitted in droplets. It can be a stressor for sufferers and family members who care for sufferers. Sufferers must comply the treatmen is running, and the families who care for sufferers should have patience and keihlasan for realizing a positive perception.
Nurses have a huge role so that the perception of families caring for sufferers of tuberculosis is becoming more positive. The perception of religious approach can be delivered through therapeutic communication techniques for nursing interacts with the sufferers and the families who care for TB.
The nearest relatives are expected to improve perception, patient and sincere in caring for sufferers of tuberculosis, so that family members can manage stress so that is not easily contracted.
RESEARCH METHOD
Design research was the correlation with the approach of cross sectional. The population of this research was the whole family members caring for sufferers of tuberculosis in Puskesmas Wonokromo Surabaya, 14 people.
This research sample obtained using total sampling, 14 respondents. The independent variable was the perception and the dependent was Hsp 70. The instruments in this study was a detailed questionnaire (for measuring perception) and blood samples (to measure the Hsp70). The data were analyzed using T-test.
The research was carried out in week three of March 2012 at Puskesmas Wonokromo Surabaya. Researchers carry out research process after getting permission from the City Health Office in Surabaya.
RESULTS
Nearly half of respondents ages 21 – 35 years old (see figure 1), where almost all respondents have only finished their senior high school (figure 2).
Figure 1 the characteristics of the age of respondent
Figure 2 the characteristics of education respondents
Specific Data
Table 1 Data perceptions and Hsp 70 Persepsi Hsp 70
Mean 64,15 240,1
T Test P<0,05 DISCUSSION
Pareek (1996) in Sobur (2011) says the perception can be defined as the process of receiving, selecting, organizing, identify, test, and provide a reaction to pancaindra stimuli or data. Chrousos and Gold (1992) says that the condition of the body due to the good adaptation of positive or negative are known as biological perceptions. If the body is faced
0 2 4 6 8
21 - 35 36 - 50 51 - 65
0 5 10 15
Tinggi Menengah Dasar
Global Nursing Challenges in The Free Trade Era 70 with a stressor in persistent and body failed to
maintain the balance of biological perception then that appears is the State of pathological or diseased (Putra, 2011).
The refinement of the concept of stress by Dabbar-McEwen stated that stress consists of stress perception and stress response. Stress perception is the result of a learning process to select, organize, and interpret the mengintepretasi stressor correctly. Stress perception in addition to engaging the intellect, the experience was also emotional. Based it so then the accuracy of these perceptions will create stress response be appropriate anyway.
The concept of this stress in accordance with the concept of the psychology of the moment, stress pesepsi can be considered to reflect the change of cognition and stress response reflects the biological and physiological changes. Thus each individual received stressor will be studied carefully so that it produces the correct perception that would eventually responded correctly anyway (Putra, 2011).
Heat shock proteins are a class of proteins involved in protein folding. Hsp70 was instrumental in the prevention of necrosis in a cell and have the domain of N-and C- terminal that provides the relevant expression of the presence of antigens to the immune system. HSP function as molecular chaperon, which played an important role in protein folding, intracellular protein traffic, self- defense against denaturation of the protein due to heat stress and other (Asea, 2010).
Extracellular Hsp70 was instrumental in protecting the cells.
Perceptions of respondents about the dimension of prevention of transmission of TB and the religious dimension is very varied.
Lowest highest score of 50 and 70. Age and education factors appear to exert influence.
The oldest age obtained the lowest score even though middle-level educated. But there are also the respondents with the oldest age obtained the highest score with a high level of education.
Perception is influenced by the background (education), experience, personality, belief and acceptance of self.
External factors that affect the perception is the intensity, contrast, movement, Deuteronomy, familiarity, and something new (Sobur, 2003).
Factors of self-acceptance is covered in the dimension of spirituality, therefore the approach used researchers not only cognitive but also in spiritual approach to improving self-acceptance of respondents.
The respondents should be patient in trying to accept and live the exams given by God, IE in the form of care for sufferers of TUBERCULOSIS. Respondents who are more patient and sincere exams (TB sufferer) and difficulties will be able to think much megatasi looking for solutions to problems or difficulties encountered. Ikhlas is a condition for the admissibility of a charity by God, either batiniyah or lahiriyah charity (Sa'adu, 2011).
A person's perception of perception can be changed, that is not good or negative regarding the prevention of transmission of TB disease knowledge and spiritual being good or positive perception. The goal of therapeutic communication is to change and improve the perception of the respondent's knowledge about the prevention of the transmission of TB disease and spirituality in the care of a sick member of the family TB. A more positive perception of the changes after a therapeutic communication also increases levels of Hsp70.
This happens because the Hsp70 protein molecules is a small and very sensitive so it can quickly terekspresi to changes in the situation experienced by the body both physically and mentally. The increase in Hsp70 (within the normal range) will give a good influence for the respondent, that play a role in protecting cells, protecting the surface and into the cells.
SUMMARY
The perceptions of family members who care for TB sufferers, with an averaged 64.15, and theHsp70 family members caring