Kecemasan sering ditemukan terjadi pada klien Chronic Kidney Disease (CKD) yang menjalani hemodialisis. Kecemasan berlebih akan menurunkan mood dan motivasi menjalankan hemodialisis, meningkatkan kesakitan, dan kematian lebih dini. Kondisi ini membutuhkan perawatan lanjut dengan pendekatan psikoedukatif-supportif untuk mengubah persepsi negatif terhadap hemodialisis. oleh karena itu dikembangkan sebuag model berbasis Psikoneuroimunologi (PNI) yang terinspirasi dari intervensi Advance Care Planning (ACP), yaitu Model Perencanaan Perawatan Akhir Hayat (PPAH). Model PPAH disintesis dari konsep spiritualitas, model pemberdayaan keluarga, komunikasi terapeutik, serta teori keperawatan caring Jean Watson, dan peaceful end of life Ruland & Moore. Penelitian ini menggunakan desain quasi eksperimen pre and post test with control group. Hasil Wilcoxon tes (2 tailed) pada kelompok intervensi adalah P value 0,000, artinya ada perbedaan tingkat kecemasan antara kelompok pre dan post intervensi. Hasil Mann-Whitney (1 tailed) adalah P value 0,005, artinya ada perbedaan tingkat kecemasan antara kelompok intervensi dan kontrol. Umumnya, kecemasan dirasakan oleh klien yang baru menjalani hemodialisis karena pemahamannya yang masih kurang mengenai prognosis penyakit sehingga memiliki persepsi negatif terhadap hemodialisis. Persepsi negatif menyebabkan koping melemah, menurunkan personal kontrol, dan meningkatkan respon emosional. Kesimpulan penelitian ini adalah intervensi PPAH berbasis PNI diberikan untuk mengubah persepsi negatif sehingga mampu meningkatkan mekanisme koping klien dalam mengatasi kecemasan. Saran untuk penelitian selanjutnya adalah ada pengembangan alat ukur secara objektif untuk menilai tingkat kecemasan klien melalu pemeriksaan biologis agar hasil lebih tepat. Kata kunci: Kecemasan, Model Perencanaan Perawatan Akhir Hayat (PPAH) Model, CKD yang menjalani hemodialisis ABSTRACT Anxiety is often found to occur on Chronic Kidney Disease (CKD) clients who are undergoing hemodialysis. The excess anxiety will lower the mood and motivation undergoing hemodialysis, increase the morbidity and premature mortality. This condition needs treatment with psychoeducative-supportive approach to change negative perception toward hemodialysis. Therefore developed a model based Psychoneuroimmunology (PNI), inspired by Advance Care Planning (ACP) intervention, namely Perencanaan Perawatan Akhir Hayat (PPAH) model. PPAH model was synthesized from the concept of spirituality, family empowerment model, therapeutic communication, caring by Watson and peaceful end of life by Ruland & Moore’s nursing theory. This study using quasy experimental with pre and post test control group design. The Wilcoxon’s result (2 tailed) in intervention group is P value 0,000, it means there are the difference in the anxiety level between pre and post group. The Mann-Whitney’s result (1 tailed) is P value 0,005, it means there are the difference in the anxiety level between intervention and control group. Generally, anxiety perceived by new clients undergoing hemodialysis because their insight were lacking about prognosis and then they have negative perception to hemodialysis. A negative perception causes coping weakened, lowering personal control, and increase an emotional response. The conclusion of this research is PPAH’s intervention based PNI given to change the perception negative that can improve clients’s mechanism coping within overcome anxiety. The suggestion for the next research is the development of the tool measuring objectively to clients’s anxiety with biological test that more results right. Keywords: Anxiety, Perencanaan Perawatan Akhir Hayat (PPAH) Model, CKD undergoing hemodialysis DAFTAR PUSTAKA Alligood, M.R. 2014. Nursing theorists and their work Eighth edition. Elsevier Mosby. United States of America. Berton, T.C. 2015. Increasing comfort with end-of-life discussions. University of Nevada. Las Vegas Bristowe, Horsley, Shepherd, Brown, Carey, Mattews, O’Donoghue, Vinen, Murtagh, 2015. Thinking ahead – the need for early Advance Care Planning for people on haemodialysis : A qualitative interview study, 28(8), pp.1000-1025. Clarke, Yates, Smith, Chilcot. 2016. Patient’s perceptions of chronic kidney disease and their association with psychosocial and clinical outcomes:a narrative review, pp.1–9 Fradeloz, Tzavella, Koukia, Papathanasiou, Alikari, Stathoulis, Panoutsopoulos, Zyga. Integrating Chronic Kidney Disease Patient’s Spirituality in Their Care: Health Benefits and Research Perspectives. Mater Sociomed, 27(5), pp.354-358. Gerogianni, S & Babatsikou, Fotoula. 2014. Psychological aspects in chronic renal failure. Health Science Journal, 8(2). Ghazavi, Minooei, Abdeyazdan, Gheissari. 2014. Effect of family empowerment model on quality of life in children with chronic kidney disease. Iranian Journal of Nursing and Midwifery Reasearch, 19(4), pp. 371-375 Graves, NK & Shelton, T. 2007. Family empowerment as a mediator between family-centered systems of care and changes in child functioning: identifying an important mechanism of change. Springer science business media. Hidayat, K. 2009. PSIKOLOGI KEMATIAN: Mengubah ketakutan menjadi optimisme. Hikmah ()PT Mizan Publika. Bandung. John, J.F, Thomas, V.J. Research article the psychososial experience of patients with end-stage renal disease and its impact on quality of life: findings from a needs assessment to shape a service. Hindawi publishing corporation, 2013(8). Kidney Disease: Improving Global Outcomes (KDIGO). 2013. Kidney International Supplements: Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Official journal of the international society of nephrolofy, 3(1). Kidney Disease Outcomes Quality Initiative (K/DOQI). 2002. Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification. New Yorl: National Kidney Foundation. Latief, S. 2008. Psikologi fenomenologi eksistensialisme. Pustaka Ilalang. Lamongan Listyanti, A.S. 2013. Penderita Gagal Ginjal Makin Didominasi Kaum Muda. http://m.tempo.co/read/news/2013/07. Diakses 27 Desember 2016, 08.05 WIB. Lin, Chen Wu, Anderson, Sung Chang, Chen Chang, Jyh Hwang, Chun Chen 2012. The Chronic Kidney Disease Self-Efficacy (CKD-SE) instrument: development and psychometric evaluation. Nephrol Dial Transplant, vol 2012,1-6 Lund, Richardson, May. Barriers to advance care planning at the end of life: An explanatory systematic review of Implementation Studies. PLOS ONE, 10(2): e0116629. doi:10.1371/ journal.pone.0116629. Macaron, Fahed, Matar, Khalil, Kazour, Chlela, Richa. 2014. Anxiety, Depression and Suicidal Ideation in Lebanese Patients Undergoing Hemodialysis, pp.235–238. Maulidia, R. 2015. Penurunan kecemasan dan koping orang tua dalam merawat anak yang mengalami hospitalisasi melalui penerapan caring swanson di RS Mardi Waluyo Blitar. Universitas Airlangga, Surabaya. Ministry of Health. 2016. My Advance Care Plan & Guide: Plan the healthcare you want in the future and for the end of your life. New Zealand. 2006. Komunikasi Keperawatan Aplikasi dalam Pelayanan. Graha Ilmu. Yogyakarta. National Kidney Foundation (NKF). 2013b. Advance Directives: A Guide for Patients and Their Families. New York. National Kidney Disease Education Program (NKDEP). 2015. Chronic Kidney Disease (CKD) and Diet: Assessment, Management, and Treatment Revised. Nihayati, H.E. 2015. Perubahan Persepsi Positif dan Penurunan Kadar Kortisol pada Penderita Kanker Payudara yang diberi Asuhan Keperawatan SEHAT (Syukur Selalu Hati dan Tubuh). Universitas Airlangga, Surabaya. 2016. Metodologi Penelitian Ilmu Keperawatan Pendekatan Praktis Ed.4. Salemba Medika, Jakarta. 2014. 7th Report of Indonesian Renal Registry. Indonesian Renal Registry. Pratama, JH. 2012. Pengaruh Komunikasi Terapeutik terhadap Harga Diri Klien dengan Gagal Ginjal Kronis di Unit Hemodialisis Rumah Sakit Umum Provinsi NTB. Universitas Airlangga, Surabaya. Putra, S, Taat. 2011. Psikoneuroimunologi Kedokteran Ed. 2. Pusat Penerbitan dan Percetakan Unair, Surabaya. Sheldon, L.K. 2009. Communication for Nurses: Talking with Patients, 2nd Jones & Bartlett Publishers. England Shinde, M. & Mane, S.P., 2014. Stressors and the Coping Strategies among Patients Undergoing Hemodialysis, 3(2), pp.266–276. Stoppelenburg, Rietjens, Heide. The effects of advance care planning on end-of-life-care: A systematic review. Palliative Medicinne, 28(8), pp.1000-1025. 2009. Penyakit Ginjal Kronis: Buku Ajar Ilmu Penyakit Dalam. Departemen llmu Penyakit Dalam FK Universitas Indonesia, Jakarta. Hal 571-573. Taylor, F & Combes, G. 2014. Supporting the emotional and psychological needs of end- stage renal disease patients Study Report Appendix 6 : Literature Review Authors : Acknowledgements, pp.1–66. 2012. Pendekatan Kognitif-Perilaku untuk Mengurangi Kecemasan pada Pasien Gagal Ginjal Terminal. Tesis. Universitas Indonesia, Jakarta. Zahrofi. 2013. Publikasi Skripsi. Pengaruh Pemberian Terapi Murottal Alquran terhadap Tingkat Kecemasan pada Pasien Hemodialisa di RS PKU Muhammadiyah Surakarta. Fakutas Ilmu Kesehatan Universitas Muhammadiyah Surakarta, Surakarta DOWNLOAD FULL TEXT PDF