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Literasi Kesehatan Husada: Jurnal Informasi Ilmu Kesehatan
Published by Sekolah Tinggi Ilmu Kesehatan Husada Jombang
ISSN : 30252512     EISSN : 30253047     DOI : -
Core Subject : Health,
Health Professions Medicine & Pharmacology Nursing Public Health
"Literasi Kesehatan Husada: Jurnal Informasi Ilmu Kesehatan" merupakan jurnal ilmiah yang dikelola oleh Unit Perpustakaan Sekolah Tinggi Ilmu Kesehatan Husada Jombang. Fokus dan ruang lingkup dari jurnal ini adalah semua informasi yang berkaitan dengan bidang kesehatan, baik keperawatan, kebidanan, gizi, kesehatan masyarakat, promosi kesehatan, dan lain sebagainya. Jurnal ini terbit sebanyak 3 kali dalam setahun, yaitu Februari, Juni, dan Oktober. Setiap terbitan berisikan minimal 5 artikel.
Arjuna Subject : Profesi Kesehatan - Profesi Kesehatan (Lain-Lain)
Articles 47 Documents
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ANALISIS ASUHAN KEPERAWATAN PADA PASIEN DENGAN DIAGNOSA MEDIS CONGESTIVE HEART FAILURE (CHF) DENGAN PENERAPAN DUKUNGAN VENTILASI UNTUK MENGATASI MASALAH KEPERAWATAN POLA NAFAS TIDAK EFEKTIF DI RUANG ICU RSI JEMURSARI SURABAYA Fitria Ratna Sari
Literasi Kesehatan Husada: Jurnal Informasi Ilmu Kesehatan Vol 7 No 2 (2023): Volume 7 Issue 2, Juni 2023, Literasi Kesehatan Husada: Jurnal Informasi Ilmu Kes
Publisher : Library Unit of the College of Health Science Husada Jombang

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.60050/lkh.v7i2.12

Abstract

Pendahuluan: Congestive Heart Failure (CHF) merupakan kegagalan kardiovaskuler dalam memompa dan membawa oksigen ke tubuh sehingga tidak terpenuhi dengan baik. Manifestasi klinis yang terjadi salah satunya adalah pola napas tidak efektif. Dukungan ventilasi merupakan salah satu intervensi dalam masalah keperawatan pola nafas tidak efektif. Tujuan Penelitian: Tujuan pelaksanaan penelitian ini adalah untuk menganalisa asuhan keperawatan pada pasien dengan diagnosa medis Congestive Heart Failure (CHF) dengan penerapan dukungan ventilasi untuk mengatasi masalah keperawatan pola napas tidak efektif di Ruang ICU RSi Jemursari Surabaya. Metode: Desain penelitian ini adalah metode studi kasus dengan pendekatan asuhan keperawatan pada tanggal 25 Juni sampai 27 Juni 2023 di ruang ICU RSI Jemursari Surabaya. Penelitian ini menggunakan lembar asuhan keperawatan, wawancara, dan observasi. Hasil Penelitian: Sebelum dilakukan intervensi dukungan ventilasi muncul gejala pada pasien yaitu dispnea RR 25x/menit dengan nasal kanul, pernafasan cuping hidung, dan takikardia HR 121x/menit. Intervensi meliputi pemberian oksigen NRM 10 lpm dan memposisikan semi fowler 30⁰, relaksasi nafas dalam selama 5 menit, monitor status pernafasan. Setelah implementasi selama 3 hari didapatkan hasil masalah teratasi dengan kriteria dispnea skala 5 (menurun) RR 18x/meint, pernapasan cuping hidung skala 5 (menurun), takikardia skala 5 (membaik) membaik HR 102x/menit. Pasien dilanjutkan dengan pemberian oksigen simple mask 7 lpm di ruang rawat inap Zahira. Kesimpulan: Penerapan intervensi dukungan ventilasi pada pasien CHF terbukti efektif untuk dipertimbangkan sebagai salah satu intervensi dalam mengatasi ketidakefektifakn pola nafas. Diharapkan perawat mampu menerapkan intervensi dukungan ventilasi sesuai SOP untuk meningkatkan mutu asuhan keperawatan.
ASUHAN KEPERAWATAN PASIEN STROKE NON HEMORAGIK DENGAN PENERAPAN LATIHAN ROM AKTIF CYLINDRICAL GRIP TERHADAP KELEMAHAN OTOT EKSTREMITAS ATAS DENGAN MASALAH GANGGUAN IMOBILITAS FISIK DI RUANG LANTAI 6 RUMAH SAKIT HUSADA UTAMA SURABAYA Issa Allfatikah Farikesit; Vendi Eko Kurniawan; Dwi Uswatun Sholikhah; Sylvie Puspita
Literasi Kesehatan Husada: Jurnal Informasi Ilmu Kesehatan Vol 7 No 2 (2023): Volume 7 Issue 2, Juni 2023, Literasi Kesehatan Husada: Jurnal Informasi Ilmu Kes
Publisher : Library Unit of the College of Health Science Husada Jombang

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.60050/lkh.v7i2.13

Abstract

Pendahuluan: Penyakit stroke menimbulkan kerusakan otak pada sisi tertentu yang menyebabkan tidak ada impuls yang dikirimkan ke jari-jari tangan, sehingga kekuatan otot jari-jari tangan akan menurun dan mengalami ketergantungan dalam melaksanakan aktivitas sehari-hari dan mengakibatkan menurunnya kualitas hidup pasien. Oleh karena itu dilakukan suatu upaya rehabilitasi berupa pemberian latihan ROM aktif Cylindrical Grip. Tujuan Penelitian: Tujuan penelitian ini adalah menerapkan asuhan keperawatan pada pasien dengan masalah gangguan mobilitas fisik terhadap penurunan kekuatan otot ekstremitas atas pasien stroke non hemoragik Di Ruang Lantai 6 RS Husada Utama. Metode: Desain penelitian adalah studi kasus, waktu penelitian mulai tanggal 08 Juni sampai dengan 19 Juni 2023 di ruang lantai 6. Subyek yang digunakan 2 pasien stroke non hemoragik (Ny. A) dan (Ny. B) dengan diagnosa keperawatan gangguan mobilitas fisik. Penelitian dilakukan dengan wawancara pasien disertai pemeriksaan fisik, observasi, dan dokumentasi. Asuhan keperawatan yang diberikan pada pasien dengan pendekatan proses keperawatan meliputi pengkajian, diagnosa keperawatan, intervensi, implementasi dan evaluasi. Hasil Penelitian: Hasil studi kasus didapatkan pasien mengalami kelemahan ekstremitas atas kiri dengan kekuatan otot skala 3. Evaluasi hasil asuhan keperawatan dengan latihan cylindrical grip selama 5 hari dalam waktu 2x sehari selama 15 menit, terdapat hasil pergerakan ekstremitas meningkat, kekuatan otot cukup meningkat, gerakan terbatas cukup menurun, dan kelemahan fisik cukup menurun. Kesimpulan: Terapi cylindrical grip dapat meningkatkan kekuatan otot pada ekstremitas atas pasien stroke non hemoragik. Perawat diharapkan mampu menerapkan terapi cylindrical grip terhadap pasien agar tercapai tindakan yang optimal dan pasien dapat melakukannya dengan mandiri.
THE RELATIONSHIP OF THE NUTRITIONAL STATUS OF PREGNANT WOMEN AND STUNTING IN TODDLER AT THE HUSADA CLINIC, JOMBANG Kristian, Ike; Semi; Masyayih, Warda Anil
Literasi Kesehatan Husada: Jurnal Informasi Ilmu Kesehatan Vol 7 No 3 (2023): Volume 7 Issue 3, Oktober 2023, Literasi Kesehatan Husada: Jurnal Informasi Ilmu
Publisher : Library Unit collaborates with the Institute for Research and Community Service, College of Health Sciences Husada Jombang

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.60050/lkh.v7i3.14

Abstract

Background: The occurrence of failure to thrive in children under five is caused by chronic malnutrition so that children under five are short according to their age, which is usually called stunting. One of the factors causing stunting is pregnancy. Pregnant women with CED (Chronic Energy Deficiency) cause the reserves of nutrients needed by the fetus in the womb to be weak. Objective: This study aimed to determine the relationship between the nutritional status of pregnant women and stunting in toddlers at the Husada Clinic, Jombang. Method: This research was conducted in July at the Husada Clinic, Jombang. This type of research is retrospective analytical. The population in this study was 55 toddlers with a sample of 33 toddlers. The sampling technique is simple random sampling. The independent variable in this research is the Nutritional Status of Pregnant Women, the dependent variable is Stunting in Toddlers. The instrument in this research is a questionnaire. Results: The results of the research from 33 respondents at the Husada Clinic showed that the majority of toddlers, 59.22%, had the status of pregnant women with CED (Chronic Energy Deficiency). The majority of toddlers, 62.14%, experienced stunting in the short category. Data analysis from the Chi-Square correlation test and asymptotic significance (2-sided) resulted in a p-value of 0.02 < 0.05. The conclusion is that there is a relationship between the nutritional status of pregnant women and stunting in toddlers at the Husada Clinic, Jombang. Conclusion: Based on this research, it can provide input and information to health workers to provide education about nutrition for pregnant women through activities, namely pregnant women's classes and posyandu so that health workers play a big role in efforts to prevent stunting.
THE RELATIONSHIP BETWEEN FAMILY SUPPORT AND INTERNET DEPENDENCE IN ADOLESCENTS AT PATRIOT VOCATIONAL SCHOOL, MANCAR, PETERONGAN, JOMBANG Sapulete, Evanly Y.; Rustanti, Elly; Setiawan, Roni
Literasi Kesehatan Husada: Jurnal Informasi Ilmu Kesehatan Vol 7 No 3 (2023): Volume 7 Issue 3, Oktober 2023, Literasi Kesehatan Husada: Jurnal Informasi Ilmu
Publisher : Library Unit collaborates with the Institute for Research and Community Service, College of Health Sciences Husada Jombang

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.60050/lkh.v7i3.15

Abstract

Background: Family support has an important role in developing adolescents' social skills by providing pleasant interactions. Adolescents who feel they have tenuous ties to family support may have lower social skills and less appropriate coping strategies. One way for adolescents to fulfill these needs is through the internet which can facilitate them to establish interpersonal relationships with other people. Internet addiction can cause an inability to control the desire to use the internet, experiencing problems such as depression, feeling disturbed, and not being able to stand it when you stop using the internet. Objective: The aim of this research was to determine the relationship between family support and internet dependence among adolescents at Patriot Vocational School, Mancar, Peterongan, Jombang. Method: The design of this research is analytic-cross sectional. The population in this study were all adolescents at Patriot Vocational School, Mancar, Peterongan, Jombang, mostly using purposive sampling techniques with a sample size of 36 respondents. Data collection used a questionnaire and data analysis used Spearman Rho. Results: The research results showed that the majority of respondents had good family support, 23 respondents (63.9%) and the majority of respondents had moderate internet dependence, 20 respondents (55.6%). The results of the Spearman rho data analysis obtained p < α= 0.00 and the error level or α is 0.05, so p < α (0.00 < 0.05) so that H1 is accepted, there is a relationship between family support and internet dependence in teenagers. . Conclusion: Based on the research results obtained, it can be concluded that there is a relationship between family support and internet dependence, so with this research it is hoped that teenagers can obtain good information in preventing internet dependence.
AGE, EDUCATIONAL LEVEL, ANXIETY LEVEL, AND SLEEP PATTERNS OF CERVICAL CANCER PATIENTS UNDERGOING EXTERNAL RADIOTHERAPY TREATMENT Hidayah, Hilda Nur; Puspita, Sylvie; Sari, Gevi Melliya; Putra, Kusuma Wijaya Ridi; Sasmito, Nanang Bagus
Literasi Kesehatan Husada: Jurnal Informasi Ilmu Kesehatan Vol 7 No 3 (2023): Volume 7 Issue 3, Oktober 2023, Literasi Kesehatan Husada: Jurnal Informasi Ilmu
Publisher : Library Unit collaborates with the Institute for Research and Community Service, College of Health Sciences Husada Jombang

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.60050/lkh.v7i3.16

Abstract

Background: Treatment for cervical cancer includes surgery, radiotherapy or chemotherapy. Quite a lot of cancer sufferers who go to hospitals receive radiation therapy. The diagnosis and treatment of cervical cancer is always accompanied by psychological challenges, namely anxiety, which causes sleep pattern disturbances in the patient. Objective: This study aimed to determine the relationship between age, education level, anxiety level, and sleep patterns in cervical cancer patients undergoing external radiotherapy treatment. Method: The research method used a cross sectional approach design by collecting data on independent variables and dependent variables. The sampling technique in this research used Total Sampling. The sample consisted of 20 cervical cancer respondents who underwent external radiation, then the data collected was processed using the Spearmen Rho test. Results: Based on the research results, it was found that only anxiety level was related to sleep pattern (r = .519, p < .05). Meanwhile, age and education level have no relationship with sleep patterns. Conclusion: The anxiety level of cervical cancer patients in facing external radiotherapy treatment can affect their sleep patterns, so understanding is needed by a health worker to reduce the patient's anxiety.
THE RELATIONSHIP OF KNOWLEDGE LEVEL ABOUT CLEAN AND HEALTHY LIVING BEHAVIOR WITH THE INCIDENCE OF DIARRHEA IN CHILDREN AT LENTENG TIMUR 1 PUBLIC ELEMENTARY SCHOOL DISTRICT LENTENG SUMENEP MADURA Choles, Shilviana Nur; Sasmito, Nanang Bagus; Zatihulwani, Eliza Zihni; Puspita, Enny
Literasi Kesehatan Husada: Jurnal Informasi Ilmu Kesehatan Vol 7 No 3 (2023): Volume 7 Issue 3, Oktober 2023, Literasi Kesehatan Husada: Jurnal Informasi Ilmu
Publisher : Library Unit collaborates with the Institute for Research and Community Service, College of Health Sciences Husada Jombang

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.60050/lkh.v7i3.17

Abstract

Background: Diarrhea disease is included in the Extraordinary Events category in various parts of Indonesia that needs attention. Globally, data on the incidence of diarrhea in the world are still very high, namely 1.7 billion cases every year or the second cause of death that attacks children (WHO, 2017). The study revealed that approximately 8 out of every 10 sixth-grade students at Lenteng Timur 1 Public Elementary School had encountered instances of diarrhea. Objective: The aim of this research was to establish a correlation between the degree of understanding regarding knowledge about clean and halthy living behavior and the occurrence of diarrhea among children. Method: The chosen research methodology is analytical correlation employing a cross-sectional approach design. This research was carried out in Lenteng Timur 1 Public Elementary School, Lenteng District, Sumenep Regency, Madura on Wednesday 24 May 2023. This investigation selected a sample of 42 students, gathering data through a comprehensive sampling technique. The research instrument used in this study was Medi Arjoni's (2021) knowledge level questionnaire. The statistical analysis employed for this study was SPSS version 20 for Windows 11. Results: The results showed that the level of knowledge about clean and healthy living behavior was less than 18 students (42.9%), the incidence of diarrhea during the last 3 months was 25 students (59.5%). Analysis of the extent of understanding in relation to the occurrence of diarrhea p- value<α, namely 0.001<0.05. The conclusion of this study is that there is a relationship between the lack of knowledge about clean and healthy living behavior and the incidence of diarrhea in class VI children of Lenteng Timur 1 Public Elementary School. Conclusion: The suggestion from the researchers aims to enhance comprehension regarding clean and healthy living behavior to support the productivity of a healthy body and a clean environment in everyday life so that they are not easily exposed to disease and reduce the incidence of diarrhea in children.
IS ANTENATAL CARE (ANC) EXAMINATION IMPORTANT FOR THE HEALTH OF THE MOTHER AND BABIES? Sari, Wahyu Anjas; Nurwati, Ida
Literasi Kesehatan Husada: Jurnal Informasi Ilmu Kesehatan Vol 7 No 3 (2023): Volume 7 Issue 3, Oktober 2023, Literasi Kesehatan Husada: Jurnal Informasi Ilmu
Publisher : Library Unit collaborates with the Institute for Research and Community Service, College of Health Sciences Husada Jombang

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.60050/lkh.v7i3.18

Abstract

Background: Maternal mortality and infant mortality are conditions that require special attention and immediate treatment. The antenatal care program is one way to reduce the increase in maternal mortality and infant mortality. Objective: This study aims to determine the importance of antenatal care examinations on the health of mothers and babies. Design: Scoping review was used in preparing this literature review. Data Sources: The researchers conducted a search using several search engines, including Google Scholar, DOAJ, Pubmed, EBSCO, and Sciencedirect with several inclusion criteria, including 1) Year of publication between 2019-2023, 2) Articles in English and Indonesian, and 3) Original articles, full text, and open access. Review Methods: The researchers carried out descriptive analysis and synthesis of the contents of all the articles, so that the researchers would be able to conclude the results of each research used as material in preparing this literature review. Results: Based on the results of the search conducted by the researchers, it was found that 5 articles were in accordance with the objectives of preparing this literature review. These articles show the importance of antenatal care (ANC) examinations for the health of mothers and babies, both during pregnancy and after birth. Conclusion: Implementing antenatal care services for pregnant women is very important because it can be related to the health of the mother and baby right up to the birth process. Apart from that, antenatal care services can detect early postnatal health problems, such as Low Birth Weight (LBW), Stunting, and so on.
SOCIAL ANXIETY SCALE FOR ADOLESCENTS (SAS-A): RELIABILITY TEST Kurniawan, Vendi Eko; Putra, Kusuma Wijaya Ridi; Sari, Gevi Melliya; Vidhiastutik, Yusiana
Literasi Kesehatan Husada: Jurnal Informasi Ilmu Kesehatan Vol 8 No 1 (2024): Volume 8 Issue 1, February 2024, Literasi Kesehatan Husada: Jurnal Informasi Ilmu
Publisher : Library Unit collaborates with the Institute for Research and Community Service, College of Health Sciences Husada Jombang

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.60050/lkh.v8i1.19

Abstract

Background: Adolescents often experience social anxiety caused by acts of body shaming carried out by their friends. This condition causes adolescents to feel that they are not accepted by their surrounding environment. Objectives: This study aimed to analyze the reliability of the Social Anxiety Scale for Adolescents (SAS-A). Design: This research uses descriptive analysis research with a cross-sectional approach. Methods: This research was conducted on May 15, 2023 at Madrasah Aliyah Raden Rahmat, Mojowarno, Jombang. The research instrument used was the Social Anxiety Scale for Adolescents which was adopted from Firdausi (2018) which consists of 18 favorable questions. The research instrument consists of three components, including Fear of Negative Evaluation (FNE), Social Avoidance and Distress with New Social Situation and Unfamiliar Peers (SAD-New), and Social Avoidance and Distance General (SAD-G). Data analysis carried out was Mean, Standard Deviation (SD), and reliability test (Cronbach Alpha) using SPSS 21. Results: Based on the research results, it was found that the Social Anxiety Scale for Adolescents had high reliability test results marked by a Cronbach's Alpha value of .855 (Min = 40.0; Max = 77.0; Mean = 57.94; SD = 10.216). Conclusion: The results of this study indicate that the Social Anxiety Scale for Adolescents is very suitable for use in assessing social anxiety in adolescents at Madrasah Aliyah.
THE EFFECTIVENESS OF ACUPRESSURE THERAPY FOR DYSMENORRHEA IN ADOLESCENT GIRLS Hidayah, Ardiyanti; Anggraini, Rista Dian; Farida, Siti Nur
Literasi Kesehatan Husada: Jurnal Informasi Ilmu Kesehatan Vol 8 No 1 (2024): Volume 8 Issue 1, February 2024, Literasi Kesehatan Husada: Jurnal Informasi Ilmu
Publisher : Library Unit collaborates with the Institute for Research and Community Service, College of Health Sciences Husada Jombang

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.60050/lkh.v8i1.20

Abstract

Background: Dysmenorrhea is pain during menstruation. There are 2 types of dysmenorrhea, namely primary dysmenorrhoea and secondary dysmenorrhoea. Primary dysmenorrhea is dysmenorrhea without any abnormalities in the genital organs. Secondary dysmenorrhea is dysmenorrhea in the presence of abnormalities in the genital organs, such as tumors, inflammation, etc. Acupressure is a development of massage therapy pressing on acupuncture points which increases oxygen saturation and causes muscle relaxation effects. Objectives: This study aims to determine the effectiveness of acupressure therapy for dysmenorrhea pain that occurs in adolescent girls. Design: This research used a one group pretest-posttest design. Methods: This research was conducted in June-October 2020 using primary and secondary data at Patriot Peterongan High School, Jombang Regency. The population of this study was all 60 young women attending Patriot Peterongan High School, Jombang Regency. The sampling technique used in this research was purposive sampling, so that the total research sample was 42 respondents. Data was collected using a pain intensity questionnaire in the form of a numerical VAS (Visual Analog Scale) with an intensity scale (0-10). Acupressure therapy is carried out at the bilateral LI 4 (hegu) and ST 36 pressure points 30 times for 3 consecutive days during menstruation. Data analysis used the Wilcoxon test. Results: The results of the study showed a decrease in the quality of dysmenorrhea pain, namely before therapy, it was 2.67 and SD 0.687. Meanwhile, after acupressure therapy for 3 consecutive days, the average result of dysmenorrhea pain intensity was 1.19 and SD 0.552. The results of the Wilcoxon test showed a decrease in the average intensity of dysmenorrhea pain on day 1, namely 0.22, day 2, namely 0.43 and day 3, namely 0.83 with a P value = 0.00, which means acupressure therapy at point LI 4 ( Hegu) and bilateral ST 36 are effective in reducing dysmenorrhea in adolescent girls. Conclusion: Acupressure therapy at points LI4 and ST 36 is effective in reducing dysmenorrhea in adolescents. As for suggestions for future researchers, this research can be combined with other therapies so that it can be more effective in reducing pain.
THE EFFECT OF COMPLEMENTARY BACK MASSAGE THERAPY ON BLOOD PRESSURE IN ELDERLY WITH HYPERTENSION Anggraini, Rista Dian; Hidayah, Ardiyanti; Farida, Siti Nur
Literasi Kesehatan Husada: Jurnal Informasi Ilmu Kesehatan Vol 8 No 1 (2024): Volume 8 Issue 1, February 2024, Literasi Kesehatan Husada: Jurnal Informasi Ilmu
Publisher : Library Unit collaborates with the Institute for Research and Community Service, College of Health Sciences Husada Jombang

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.60050/lkh.v8i1.21

Abstract

Background: According to the World Health Organization, hypertension is a condition where the blood vessels have high blood pressure (systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥ 90 mmHg). Hypertension in the elderly is differentiated into hypertension where the systolic pressure is equal to or greater than 140 mmHg and/or diastolic pressure is equal to or greater than 90 mmHg, as well as isolated systolic hypertension where the systolic pressure is greater than 160 mmHg and the diastolic pressure is lower than 90 mmHg (NOC, 2015). Objectives: This study aimed to analyze the effect of complementary back massage therapy on blood pressure in elderly people with hypertension. Design: The research design used a quasi-experiment with a pretest-posttest control group design approach. Methods: This research was carried out from April to October 2023 at the Posyandu for the Elderly in Candimulyo Village, Jombang Regency. The population in this study were all elderly people who attended the Posyandu for the Elderly in Candimulyo Village, Jombang Regency. The sampling technique used in this research is purposive sampling, by establishing several criteria. The sample size for each group was 20 respondents. The research data were analyzed using the Wilcoxon and Mann-Whitney tests. Results: The Wilcoxon test showed that there was a significant difference in blood pressure in the treatment groups with the systole p-value being 0.000, the diastole p-value 0.025. There was no significant difference in blood pressure in the control group, both in systole with a p-value of 0.086 and a diastole p-value of 0.140. There is a significant effect of complementary back massage therapy on systolic blood pressure with a p-value of 0.000 and a diastolic p-value of 0.028. Conclusion: Based on the results of this research, back massage therapy is recommended as a non-pharmacological therapy to stabilize blood pressure and prevent cardiovascular complications in the elderly.

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