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Valsalva Maneuver to Decrease Pain Intensity During Arteriovenous Fistula Insertion in Hemodialysis Patients Mahruri Saputra; Ikhsanuddin Ahmad Harahap; Sutomo Kasiman
Jurnal Keperawatan Indonesia Vol 23, No 2 (2020): July
Publisher : Faculty of Nursing Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.7454/jki.v23i2.645

AV fistula allows external vascular access for hemodialysis patients. Because hemodialysis patients experience puncture wounds and stabbing pain approximately 300 times a year, development of methods to decrease pain intensity are of great importance. Some techniques, such as the Valsalva maneuver, are known to reduce pain. This study aims to assess the effect of the Valsalva maneuver on decreasing the intensity of AV fistula pain in patients receiving hemodialysis. The quasi-experimental research of pre and post without control applying consecutive sampling to get as many as 63 respondents. Pain intensity was measured by using the Numerical Pain Rating Scale (NPRS). The Valsalva maneuver was performed during insertion of the AV fistula needle for 16–20 seconds. The results showed significant differences in pain intensity between before and after the intervention with the difference in mean that is 1.35 (SD = 0.54), t = 19.70, p = 0.001. The Valsalva maneuver is effective in reducing the pain of AV fistula insertion because it stimulates the vagus nerve to induce an antinociceptive effect. Nurses are highly recommended to teach the Valsalva maneuver to patients undergoing routine hemodialysis. Abstrak Pemberian Teknik Manuver Valsalva terhadap Penurunan Intensitas Nyeri Penusukan Arteriovenous Fistula pada Pasien Hemodialisis. Arteriovenous (AV) fistula merupakan akses vaskuler eksternal pasien hemodialisis. Pasien hemodialisis mengalami luka tusuk dan nyeri akibat penusukan sekitar 300 kali setahun sehingga perlu diberi tindakan untuk membantu mengatasinya. Beberapa teknik diketahui dapat menurunkan nyeri seperti teknik Valsalva manuver. Penelitian ini bertujuan menilai efek teknik Valsalva manuver terhadap penurunan intensitas nyeri penusukan AV fistula pada pasien hemodialisis. Penelitian quasi eksperimen pre dan post tanpa kontrol menerapkan consecutive sampling untuk mendapatkan sebanyak 63 responden. Intensitas nyeri diukur menggunakan Numerical Pain Rating Scale (NPRS). Valsalva manuver dilakukan saat penusukan jarum AV fistula selama 16-20 detik. Hasil penelitian menunjukkan terdapat perbedaan signifikan antara sebelum dan sesudah intervensi dengan selisih mean yaitu 1,35 (SD=0,54), t=19,70, p=0,001. Valsalva manuver efektif menurunkan nyeri penusukan AV fistula karena menstimulasi saraf vagus dalam menginduksi efek antinociceptif. Teknik Valsalva manuver sangat direkomendasikan kepada perawat untuk mengajarkan teknik ini pada pasien yang menjalani hemodialisis rutin. Kata Kunci: AV fistula, hemodialisis, intensitas nyeri, Valsalva manuver

DO OUR NURSES HAVE SUFFICIENT KNOWLEDGE OF PAIN? A DESCRIPTIVE STUDY IN HAJI ADAM MALIK HOSPITAL MEDAN- INDONESIA Ikhsanuddin Ahmad Harahap
UNEJ e-Proceeding the 3rd International Conference on Economics, Business, and Accounting Studies
Publisher : UPT Penerbitan Universitas Jember

Show Abstract | Download Original | Original Source | Check in Google Scholar

Background: Pain treatments are closely related to pain assessment. Pain is probably one of the most common clinical phenomenon faced by nurses. Therefore, nurses are required to have adequate knowledge, skills and attitudes about pain, pain assessment and pain management. The objective of this descriptive explorative study was to identify the nurse's knowledge of pain, Methods: The samples were 33 nurses selected using convenience sampling method from medical surgical wards in selected hospital in Medan. Data were collected by using demography questionnaires and pain knowledge question sheet 30 items, Results: Subjects knowledge of pain ranged from 5 to 20 with average knowledge 11,33 (SD=3,33). Based on pain knowledge categories, more than half subjects (63,7%) were in moderate level, low level (33,3%), and only 3,0% in high level. Furthermore, based on subscales of pain knowledge, it was found moderate level of pain categories (M=3,82;SD=1,33) and pain mechanism’s subscales (M=2,03;SD=1,05). However, this study also found that pain definition (M=0,97;SD=0,98), pain behaviours (M=1,52;SD=1,09), and pain assessment’s subscales (M=3,00;SD=1,54) were in low level. In order to improve nurses knowledge of pain as well as the accuracy of pain assessment assessed by nurses, therefore nurses knowledge of pain need to be updated, Conclusions: this study found that nurses knowledge of pain was sufficient in moderate level, however need to be improved especially in three areas of knowledge including: pain definition, pain behaviours, and pain assessment. Keywords: pain, knowledge, nurse

PERCEPTION OF FAMILY AS CAREGIVER ABOUT THE IMPLEMENTATION OF ORAL CARE IN CARING FOR STROKE PATIENTS IN MEDAN CITY: A PRELIMINARY ACTION RESEARCH Bitcar Dalimunthe; Setiawan Setiawan; Cholina Trisa Siregar; Dudut Tanjung; Ikhsanuddin Ahmad Harahap
International Journal of Nursing and Health Services (IJNHS) Vol. 2 No. 3 (2019): International Journal of Nursing and Health Services (IJHNS)
Publisher : Alta Dharma Publisher

Stroke sufferers continue to increase every year and become polemic in various countries. Stroke is the second most common cause of death after heart disease. Stroke sufferers cause disruption of physical mobility, so they need help to carry out daily activities, one of which is the implementation of oral care, which is still minimal. The study aimed to describe the perception of family caregivers in implementing oral care among stroke patients in Medan city areas. A qualitative with phenomenology approach was applied in this study. The study was conducted in the Health Centre of Medan Deli, in April-August 2018. Twelve participants were recruited using purposive sampling. Data collection used focus group discussion (FGD). We analyzed the data by using the thematic analysis. The results of the study found that four themes, namely: 1) Caregiver knowledge in the implementation of oral care for stroke patients at home is not good, 2) The process of implementing oral care by caregiver for stroke patients at home is less optimal, 3) Family obstacles in carrying out oral care for stroke patients at home, 4) Expectations and suggestions in the implementation of oral care for stroke patients at home. Expected of research to developing or making a guide to the implementation of oral care as health education for families as caregivers in treating stroke patients at home, so that problems of oral care for stroke patients can be minimized. Keywords: oral care, families caregivers, and stroke patients.

The Effect of Distraction Technique on Pain Intensity among Patients Undergoing Circumcision Anesthetic in Medan Syamsul Idris; Ikhsanuddin Ahmad Harahap; Ridha Dharmajaya
International Journal of Nursing and Health Services (IJNHS) Vol. 3 No. 2 (2020): International Journal of Nursing and Health Services (IJHNS)
Publisher : Alta Dharma Publisher

Circumcision actions often cause pain complaints when the anesthetic injection and post-circumcision are given to patients. Distraction aims to reduce pain response. Distraction by seeing and holding a needle is referred to as audiovisual distraction, which is a combination of hearing distraction (audio) and visual distraction to distract the patient's attention from the pain. This study aims to determine the effect of distraction technique on pain intensity among patients undergoing circumcision anesthetic. This study was a quasi-experimental design by using Two groups, pre-test, and post-test with the non-equivalent control group. The research sample consisted of 98 respondents who were divided into two groups taken by purposive sampling technique. The instrument used was the Wong-Baker Faces Pain Scale (WBFPS). Data analysis used was Bivariate Analysis by using Mann Whitney U Test. The result showed that the application of distraction technique to see and to hold a needle in the intervention group was influential in reducing the intensity of injection pain/anesthetic injections on circumcision clients compared to the control group (z = -8,881; p = 0,000). Based on the result of the study, it can be concluded that the application of a distraction technique to see and to hold needle affects to reduce the intensity of injection pain/anesthetic injections on circumcision clients. It is expected that the distraction technique of viewing and holding needle becomes an independent nursing intervention for an invasive procedure such as undergoing circumcision anesthetic

Valsalva Maneuver to Decrease Pain Intensity During Arteriovenous Fistula Insertion in Hemodialysis Patients Mahruri Saputra; Ikhsanuddin Ahmad Harahap; Sutomo Kasiman
Jurnal Keperawatan Indonesia Vol 23 No 2 (2020): July
Publisher : Fakultas Ilmu Keperawatan Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.7454/jki.v23i2.645

AV fistula allows external vascular access for hemodialysis patients. Because hemodialysis patients experience puncture wounds and stabbing pain approximately 300 times a year, development of methods to decrease pain intensity are of great importance. Some techniques, such as the Valsalva maneuver, are known to reduce pain. This study aims to assess the effect of the Valsalva maneuver on decreasing the intensity of AV fistula pain in patients receiving hemodialysis. The quasi-experimental research of pre and post without control applying consecutive sampling to get as many as 63 respondents. Pain intensity was measured by using the Numerical Pain Rating Scale (NPRS). The Valsalva maneuver was performed during insertion of the AV fistula needle for 16–20 seconds. The results showed significant differences in pain intensity between before and after the intervention with the difference in mean that is 1.35 (SD= 0.54), t= 19.70, p= 0.001. The Valsalva maneuver is effective in reducing the pain of AV fistula insertion because it stimulates the vagus nerve to induce an antinociceptive effect. Nurses are highly recommended to teach the Valsalva maneuver to patients undergoing routine hemodialysis. Abstrak Pemberian Teknik Manuver Valsalva terhadap Penurunan Intensitas Nyeri Penusukan Arteriovenous Fistula pada Pasien Hemodialisis. Arteriovenous (AV) fistula merupakan akses vaskuler eksternal pasien hemodialisis. Pasien hemodialisis mengalami luka tusuk dan nyeri akibat penusukan sekitar 300 kali setahun sehingga perlu diberi tindakan untuk membantu mengatasinya. Beberapa teknik diketahui dapat menurunkan nyeri seperti teknik Valsalva manuver. Penelitian ini bertujuan menilai efek teknik Valsalva manuver terhadap penurunan intensitas nyeri penusukan AV fistula pada pasien hemodialisis. Penelitian quasi eksperimen pre dan post tanpa kontrol menerapkan consecutive sampling untuk mendapatkan sebanyak 63 responden. Intensitas nyeri diukur menggunakan Numerical Pain Rating Scale (NPRS). Valsalva manuver dilakukan saat penusukan jarum AV fistula selama 16-20 detik. Hasil penelitian menunjukkan terdapat perbedaan signifikan antara sebelum dan sesudah intervensi dengan selisih mean yaitu 1,35 (SD= 0,54), t= 19,70, p= 0,001. Valsalva manuver efektif menurunkan nyeri penusukan AV fistula karena menstimulasi saraf vagus dalam menginduksi efek antinociceptif. Teknik Valsalva manuver sangat direkomendasikan kepada perawat untuk mengajarkan teknik ini pada pasien yang menjalani hemodialisis rutin. Kata Kunci: AV fistula, hemodialisis, intensitas nyeri, Valsalva manuver

PEMBERDAYAAN MASYARAKAT DALAM MEWUJUDKAN DESA TANGGUH BENCANA BERBASIS MASYARAKAT DI DESA SUMBUL KECAMATAN STM HILIR DELI SERDANG Ismayadi Ismayadi; Dudut Tanjung; Yesi Ariani; Ikhsanuddin Ahmad Harahap
Prosiding COSECANT : Community Service and Engagement Seminar Vol 1, No 2 (2021)
Publisher : Universitas telkom

Indonesia merupakan negara kepulauan yang terletak pada pertemuan tiga lempeng bumi (Eurasia, Indo-Australia dan Pasifik) dan dilalui deretan gunung berapi dan lautan. Keadaan tersebut membuat Indonesia memiliki beragam sumber daya alam dan budaya namun juga beresiko rentan terhadap bencana alam. Begitu juga di Propinsi Sumatera Utara, sebanyak 33 wilayah kabupaten dan kota yang ada di Sumatera Utara masuk sebagai wilayah rawan bencana. Dalam kontek pengurangan risiko bencana, pengabdian masyarakat perguruan tinggi dilaksanakan untuk mendorong terciptanya desa dan masyarakat yang aman dan tangguh terhadap bencana. Desa Sumbul merupakan salah satu desa yang ada di Kecamatan Sinembah Tanjung Muda (STM) Hilir, Kabupaten Deli Serdang, provinsi Sumatra Utara. Masyarakat desa Sumbul masih belum memahami seutuhnya tentang bencana alam, daerah ini merupakan salah satu wilayah yang rawan akan terajadinya bencana alam. Oleh Karena itu tim dari Fakultas Keperawatan Universitas Sumatera Utara memberikan jalan keluar untuk permasalahan ini dengan cara memberikan pelatihan pemberdayaan masyarakat dalam mewujudkan desa tangguh bencana berbasis masyarakat sebagai objek pengabdian pada masyarakat agar desa tersebut menjadi desa tangguh bencana. Tujuan desa tangguh bencana adalah untuk penguatan pengetahuan, keterampilan, dan perilaku pengurangan resiko terhadap bencana alam maupun bencana yang bersifat human error. Kegiatan pengabdian pada masyarakat ini dilaksanakan dalam waktu 1 bulan yaitu bulan Agustus 2019, dengan kegiatan berupa pemberian materi tentang kebencanaan, diskusi kelompok, latihan dan simulasi pemasangan tenda pengungsi dan teknik evakuasi. Pelatihan kesiapsiagaan bencana ini merupakan awal dari usaha membentuk desa tangguh bencana.

The Effect of Hypnosis on Pain Management in Cancer Patients: A Systematic Review Harahap, Ikhsanuddin Ahmad
Caring: Indonesian Journal of Nursing Science Vol. 6 No. 1 (2024): Caring: Indonesian Journal of Nursing Science
Publisher : Talenta Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32734/ijns.v6i1.16179

This review article aimed to find current evidence about the effect of hypnosis in reducing pain in cancer patients. The titles and abstracts of relevant articles were reviewed on digital databases, including PubMed, ScienceDirect, and ProQuest, between 2016 and 2021 (last 5 years) using the search terms hypnosis AND cancer pain. The inclusion criteria for this review included English-language research articles with either a Randomized Control Trial, Non-Randomized Trial, experimental design, or case-control with full-text access to a population of cancer patients with hypnosis intervention, and the output was pain. The reviewer has independently evaluated 5 articles; 3 have a Randomized Control Trial design, and 2 are Non-Randomized Trials. The pain was measured using PNRS, VAS, and the combination of PNRS-VAS. 3 articles stated that hypnosis was significantly different between groups in terms of pain, and 2 articles stated no significant difference. In addition, hypnosis therapy also has a beneficial effect on inhibiting all cancer modalities. Different hypnosis methods are used.

Improving Community Preparedness Through Disaster Management Training in Sukaraja Village, Medan Maimun District, Medan City Ismayadi; Ikhsanuddin Ahmad Harahap
ABDIMAS TALENTA: Jurnal Pengabdian Kepada Masyarakat Vol. 9 No. 2 (2024): ABDIMAS TALENTA: Jurnal Pengabdian Kepada Masyarakat
Publisher : Talenta Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32734/abdimastalenta.v9i2.18865

Disaster mitigation is generally implemented to reduce losses caused by potential disasters, including both loss of life and property damage, which can significantly impact human activities and livelihoods. In Sukaraja Village, the community’s understanding of disaster response is limited to basic actions such as evacuating to higher and safer ground during floods. However, the community often faces challenges in evacuating vulnerable groups, such as women, the elderly, and children, due to the densely populated area and limited evacuation space. This service program aimed to address these challenges by conducting a comprehensive training on disaster mitigation, focusing on evacuation and first aid for flood victims by the members of the Disaster-Resilient Village Forum (Keltana). The method employed in this community service program included structured training sessions and simulations, comprising: (1) educational sessions on knowledge, attitudes, and actions required during flood emergencies, (2) hands-on training on evacuation procedures and first aid techniques for disaster mitigation, and (3) Communication, Information, and Education (CIE) activities on emergency response strategies targeted at Keltana members. The results showed a significant improvement in the participants’ understanding and skills. The training increased the knowledge level of Keltana members on flood evacuation and first aid from 55% to 93%. Additionally, the program enhanced their practical skills in evacuating flood victims and administering first aid for injuries, including fractures and bleeding. In conclusion, the disaster mitigation training program successfully strengthened the community’s capacity in flood response, contributing to improved resilience and preparedness in Sukaraja Village. The approach and outcomes of this program can serve as a model for similar high-risk areas to enhance community-based disaster mitigation efforts.

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