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Pengalaman Perawat Dalam Menghadapi Dilema Etik Pada Pasien Paliative Di ICU: A Scoping Review Rizkianti, Intan; Freitas, Lurdes Acorta; Sesilia, Fitri; Kurhayati, Kurhayati; Reis, Silvestre Dos; Nasrullah, Kurnia; Trisyani, Yanny
MAHESA : Malahayati Health Student Journal Vol 5, No 7 (2025): Volume 5 Nomor 7 (2025)
Publisher : Universitas Malahayati

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33024/mahesa.v5i7.18922

ABSTRACT Nurses in intensive care units (ICU) often face ethical dilemmas when caring for palliative patients. Decisions made at this late stage of a patient's life have a major impact on the quality of life of the patient and their family, and can trigger conflicts between professional values, patient expectations, and family needs. This study aimed toexplore the experiences of ICU nurses in facing ethical dilemmas in palliative patients and to map the main ethicalissues faced. Methods: This study used a scoping review approach with literature search through several databases, such as Pubmed, Ebsco, and Science Direct. The article searches and analysis was from November to December 2024. Inclusion criteria included studies published from 2014-2024 related to ethical dilemmas in palliative care in the ICU, with experimental, case study, and qualitative descriptive research designs. Relevant articles were screened following PRISMA guidelines and analyzed qualitatively descriptively. Of the 19,765 articles identified, 8 articles metthe inclusion criteria and were analyzed further. Nurses faced ethical dilemmas that included conflicts in carrying outprofessional roles, feeling sandwiched between patient wishes and family expectations, and organizational policylimitations. The two main categories found were conflict within the professional role and conflict between personal autonomy and external demands, including pressure from family and coworkers. The importance of improvingeffective communication, emotional support, multidisciplinary teamwork, clinical ethics training and education, developing adaptive coping strategies, and support policies in an effort to minimize the stress experienced by nurses infacing ethical dilemmas in caring for palliative patients. Keywords: Ethics, Nurse, Palliative Care ABSTRAK Perawat di unit perawatan intensif (ICU) sering menghadapi dilema etik ketika merawat pasien paliatif. Keputusan yang diambil pada tahap akhir kehidupan pasien ini memiliki dampak besar terhadap kualitas hidup pasien dan keluarganya, serta dapat memicu konflik antara nilai profesional, harapan pasien, dan kebutuhan keluarga. Penelitian ini bertujuan untuk menggali pengalaman perawat ICU dalam menghadapi dilema etis pada pasien paliatif dan dalammemetakan isu-isu etika utama yang dihadapi. Studi ini menggunakan metode pendekatan scoping review dengan pencarian literature melalui beberapa database, seperti Pubmed, Ebsco, dan Science Direct. Pencarian serta analisis artikel dilakukan bulan November hingga Desember 2024. Dengan Kriteria inklusi meliputi studi yang dipublikasikansejak 2014-2024 yang berkaitan dengan dilema etika dalam perawatan paliatif di ICU, dengan desain penelitian eksperimental, studi kasus, dan deskriptif kualitatif. Artikel yang relevan diseleksi mengikuti pedoman PRISMA dan dianalisis secara kualitatif deskriptif. Dari 19.765 artikel yang teridentifikasi, 8 artikel memenuhi kriteria inklusi dan dianalisis lebih lanjut. Perawat menghadapi dilema etis yang mencakup konflik dalam melaksanakan peran profesional, perasaan terjepit antara keinginan pasien dan harapan keluarga, serta keterbatasan kebijakan organisasi.Dua kategori utama yang ditemukan adalah konflik dalam peran profesional dan konflik antara otonomi pribadi dengan tuntutan eksternal, termasuk tekanan dari keluarga dan rekan kerja. Pentingnya peningkatan komunikasi efektif, dukungan emosional, kerja sama tim multidisplin, pelatihan dan edukasi etik klinik, pengembangan strategi koping adaptif, dan dukungan organisasi dalam upaya meminimalisir stress yang dialami oleh perawat dalam menghadapi dilema etik merawat pasien paliatif. Kata Kunci: Dilema Etik, Perawat, Perawatan Paliatif

Tamponade Jantung sebagai Komplikasi Efusi Pleura pada Pasien Chronic Kidney Disease (CKD): Laporan Kasus Pratitis, Izzati Adha; Kurhayati, Kurhayati; Nasrullah, Kurnia; Priambodo, Ayu Prawesti; Mirwanti, Ristina
MAHESA : Malahayati Health Student Journal Vol 6, No 3 (2026): Volume 6 Nomor 3 (2026)
Publisher : Universitas Malahayati

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33024/mahesa.v6i3.21316

ABSTRACT Chronic Kidney Disease (CKD) frequently presents multisystem complications, including pleural effusion and severe cardiovascular manifestations such as cardiac tamponade. Cardiac tamponade induced by massive pleural effusion is rare but life-threatening if not promptly managed. A 17-year-old male patient presented to the emergency department with complaints of shortness of breath, bilateral lower extremity edema for four months, high-grade fever, and foamy urine. History revealed poorly controlled post-infectious glomerulonephritis complicated by heart failure. Physical examination demonstrated fluid overload, gallop rhythm, muffled heart sounds, subcostal retractions, and pulmonary edema. The patient's condition rapidly deteriorated, leading to cardiogenic shock due to cardiac tamponade and bilateral pleural effusions. Bilateral chest tube placement, furosemide therapy, and vasopressor support led to significant clinical improvement. This case illustrates the complex interplay between chronic kidney disease, pleural effusion, and severe cardiac complications. Although pleural effusions in CKD patients are commonly transudative, massive bilateral effusions can cause extrinsic pressure sufficient to induce cardiac tamponade. Prompt and comprehensive management, patient education, and adherence to long-term treatment are crucial. This case highlights the importance of a multidisciplinary approach in managing multisystem complications of CKD, particularly acute situations such as cardiogenic shock resulting from cardiac tamponade induced by bilateral pleural effusion. Aggressive management, including pleural and pericardial drainage, supportive therapy, and adherence to regular follow-up, are essential for favorable long-term outcomes. Keywords: CKD, Pleural Effusion, Cardiac Tamponade, Cardiogenic Shock, Nephrotic Syndrome. ABSTRAK Penyakit Ginjal Kronis (Chronic Kidney Disease/CKD) dapat menimbulkan komplikasi multisistem, termasuk efusi pleura dan gangguan kardiovaskular berat seperti tamponade jantung. Tamponade jantung akibat efusi pleura masif merupakan kasus yang jarang terjadi tetapi dapat mengancam jiwa apabila terlambat ditangani. Pasien remaja laki-laki berusia 17 tahun datang ke IGD dengan keluhan sesak napas, edema ekstremitas bawah selama empat bulan, demam tinggi, dan urin berbusa. Riwayat menunjukkan glomerulonefritis pasca infeksi disertai gagal jantung yang tidak terkontrol secara teratur. Pemeriksaan fisik menunjukkan tanda overload cairan, gallop, suara jantung teredam, retraksi subkostal, dan edema paru. Pasien mengalami perburukan kondisi dengan syok kardiogenik akibat tamponade jantung serta efusi pleura bilateral. Intervensi berupa pemasangan chest tube bilateral, pemberian furosemid, dan terapi vasopresor menghasilkan perbaikan signifikan. Kasus ini menegaskan hubungan kompleks antara gangguan ginjal kronis, efusi pleura, dan komplikasi jantung yang serius. Efusi pleura pada CKD sebagian besar bersifat transudatif, namun kondisi ini dapat berkembang menjadi eksaserbasi akut berupa tamponade jantung akibat tekanan eksternal dari efusi pleura masif. Penanganan harus cepat, komprehensif, serta didukung edukasi keluarga dan kepatuhan pasien terhadap pengobatan jangka panjang. Kasus ini memperlihatkan pentingnya pendekatan multidisiplin dalam pengelolaan komplikasi multisistem CKD, terutama dalam situasi klinis akut seperti syok kardiogenik akibat tamponade jantung yang dipicu efusi pleura bilateral. Penatalaksanaan agresif yang mencakup drainase cairan pleura dan perikardial, terapi suportif, serta kepatuhan kontrol rutin adalah kunci utama keberhasilan terapi jangka panjang. Kata Kunci: CKD, Efusi Pleura, Tamponade Jantung, Syok Kardiogenik, Sindrom Nefrotik.

Persepsi Perawat tentang Kesiapsiagaan dan Tantangan dalam Merawat Penyintas Bencana: Tinjauan Literatur Kurhayati, Kurhayati; Saban, Faiza Zulfikar; Putri, Saparingga Dasti; Setyawan, Y Dodi; Nasrullah, Kurnia; Kosasih, Cecep Eli; Trisyani, Yanny
MAHESA : Malahayati Health Student Journal Vol 6, No 3 (2026): Volume 6 Nomor 3 (2026)
Publisher : Universitas Malahayati

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33024/mahesa.v6i3.21002

ABSTRACT Natural disasters and health crises have experienced a significant increase in the last decade. Nurses have a role in disaster mitigation and response, including providing holistic care to victims in every phase of response. Previous studies reported that nurses are often faced with various situations and challenges in every phase of emergency response such as limited resources and low preparedness. Previous studies have focused more on evaluating disaster preparedness training programs or the effectiveness of standard protocol-based nursing interventions, but have not sufficiently explored how nurses' direct experiences shape their perceptions of preparedness and the challenges they face. This study aims to explore nurses' perceptions of preparedness and challenges in caring for disaster survivors. This study method uses a scoping review approach with the Arksey O'Malley methodology framework. Literature searches were conducted on the Scopus, PubMed, EBSCOhost, and ScienceDirect databases for the journal period 2015 - 2025 resulting in 791 articles. In the process of screening and selecting articles, a systematic approach followed the PRISMA protocol. The process of selecting studies and reporting results followed the PRISMA-ScR guidelines. Of the 791 articles found, 10 final articles met all inclusion criteria. This study identified three nurses' perceptions of preparedness and challenges in caring for disaster survivors, namely perceptions of lack of preparedness, perceptions of limited resources and coordination, and perceptions of emotional distress during the disaster response process. Conclusions: Nurses face psychosocial and technical barriers when caring for disaster survivors. Resource support plays a role in supporting nurses' preparedness in the field. These results emphasize the need for increased disaster training programs and policy development to strengthen nurses' preparedness in dealing with crisis situations. Keywords: Nurse Preparedness, Disaster Survivors, Nurse Perception, Disaster Response, Nursing Challenges. ABSTRAK Bencana alam dan krisis kesehatan mengalami proses peningkatan yang signifikan dalam dekade terakhir, Perawat mempunyai peran dalam mitigasi dan respon bencana, termasuk memberikan perawatan holistik pada korban dalam setiap fase penanggulangan. Studi terdahulu melaporkan bahwa perawat sering dihadapi berbagai situasi dan tantangan dalam setiap fase tanggap darurat seperti keterbatasan sumberdaya dan kesiapsiagaan yang rendah. Penelitian terdahulu lebih menitikberatkan pada evaluasi program pelatihan kesiapsiagaan bencana atau efektivitas intervensi keperawatan berbasis protokol standar, namun belum cukup menggali bagaimana pengalaman langsung perawat membentuk persepsi mereka terhadap kesiapsiagaan dan tantangan yang dihadapi. Penelitian ini bertujuan untuk mengeksplorasi persepsi perawat terhadap kesiapsiagaan dan tantangan dalam merawat penyintas bencana. Metode kajian ini menggunakan pendekatan scoping review dengan kerangka metodologi Arksey O’Malley. Pencarian literatur dilakukan pada basis data Scopus, PubMed, EBSCOhost, dan ScienceDirect untuk tahun jurnal periode 2015 - 2025 menghasilkan 791 artikel. Dalam proses screening dan seleksi artikel, pendekatan sistematis mengikuti protokol PRISMA. Proses seleksi studi dan pelaporan hasil mengikuti pedoman PRISMA-ScR. Dari 791 artikel yang ditemukan, ada 10 artikel final yang memenuhi semua kriteria inklusi. Penelitian ini mengidentifikasi tiga persepsi perawat terhadap kesiapsiagaan dan tantangan dalam merawat penyintas bencana yaitu ppersepsi tentang kurangnya kesiapsiagaan, persepsi tentang keterbatasan sumber daya dan koordinasi, serta persepsi tentang tekanan emosional selama proses tanggap bencana. Perawat menghadapi hambatan dari aspek psikososial dan teknis saat merawat penyintas bencana. Dukungan sumber daya berperan dalam mendukung kesiapsiagaan perawat di lapangan. Hasil ini menegaskan perlu adanya peningkatan program pelatihan bencana dan pengembangan kebijakan guna memperkuat kesiapan perawat dalam menghadapi situasi krisis. Kata Kunci: Kesiapsiagaan Perawat, Penyintas Bencana, Persepsi Perawat, Tanggap Bencana, Tantangan Keperawatan.

Valsalva Maneuver For The Early Management Of Supra-Ventricular Tachycardia In Emergency Department Settings: Scoping Review Pratitis, Izzati Adha; Peni, Inggried Angelica Valentina Wiliyams; Kurhayati, Kurhayati; Priambodo, Ayu Prawesti
Media Keperawatan Indonesia Vol 9, No 1 (2026)
Publisher : Universitas Muhammadiyah Semarang

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26714/mki.9.1.2026.71-80

Supraventricular tachycardia (SVT) is a common arrhythmia, and early management is crucial to prevent complications. The Valsalva maneuver, a non-invasive technique, has proven effective as a first-line therapy, with modifications enhancing its success. This scoping review explores evidence on the use of the Valsalva maneuver in managing SVT in emergency and pre-hospital settings, with a search in Scopus and PubMed using relevant keywords. Data were extracted independently from 16 articles that met inclusion criteria. The modified Valsalva maneuver significantly improves the success rate of converting SVT to sinus rhythm, with minimal side effects. Postural modifications were more effective than the standard maneuver and reduced reliance on pharmacological treatments. The modified Valsalva maneuver is effective, safe, and cost-efficient in managing SVT. However, its implementation requires more standardized protocols and better training for healthcare professionals.

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