Volume 3, Number 5, March 2022 e-ISSN: 2797-6068 and p-ISSN: 2777-0915
RELATIONSHIP
BETWEEN THE NURSE EDUCATORS ROLE AND NUTRITION INTAKE IN CHEMOTHERAPY PATIENTS
WHO HAVE NAUSEA
|
KEYWORDS Role of Nurse Educator, Nutrition Intake,
Chemotherapy, Nausea. ARTICLE
INFO Accepted: March, 10th 2022 Revised: March, 13th 2022 Approved: March,14th 2022 |
ABSTRACT Nausea is one of the effects of chemotherapy
that can interfere with nutritional intake so that it interferes with the
ongoing chemotherapy program. Lack of nutritional intake due to nausea can be
prevented by educating chemotherapy patients in reducing nausea. Nurses carry
out their role as educators in an effort to improve health through behavior
that supports health, one of which is educators. This study aims to determine
the relationship between the role of nurses and educators with nutritional
intake in chemotherapy patients who experience nausea at IRNA II RSUD Dr.
Saiful Anwar Malang. This type of research is an analytical survey using a
crisis sectional approach. The population of this study was chemo patients
who were nauseous within 1 month with the number of patients per month � 32
people. Data were taken on average for patients from January to May 2021 and
carried out in September. The sampling technique in this study was
non-probability sampling with purposive sampling technique. The research
instrument was a nurse educator role questionnaire consisting of 30 questions
and a nutrition intake questionnaire filled out 24 hours in the morning,
afternoon and evening. The results of the Spearman correlation test showed a
correlation value (r) of 0.463 (46.3%) and a p-value of 0.01. The value of
p<α (00.5), which means that there is a relationship between the role
of nurses as educators with nutritional intake in chemotherapy patients who
experience nausea in IRNA II RSUD Dr. Saiful Anwar Malang. |
INTRODUCTION
Nausea and
vomiting are one of the effects of chemotherapy in the treatment of cancer.
Nausea and vomiting if ignored can cause a decrease in nutritional intake and cause complications such as
electrolyte imbalance, anorexia, weight loss, dehydration, worsening of the
patient's general condition, decreased chemotherapy doses and patients may
refuse or leave treatment (Ahmad et al., 2015) .
The results
of the study (Escobar et al., 2015) at 19
hospitals in Spain there were 42% of patients who complained of nausea and
20.8% complained of vomiting while receiving chemotherapy. The results of the
study (Kottschade et al.,
2016) in America there are
35% of patients complaining of nausea and 19% complaining of vomiting while
receiving chemotherapy. Results research (Al Qadire, 2018) in Jordan
shows that although the
patient used antiemetic therapy, the overall incidence of nausea and vomiting
was still high, namely 71.4% and 57.3%, respectively. A previous study found
that there were 27% of patients who stopped chemotherapy treatment before time, 71% caused by
nausea and vomiting that has not been resolved properly (Marvell, 1992) .
According to
Aditama (2003) in (Implementation et al.,
2016) nursing is a form of
professional service in hospitals that plays an important role in the
implementation of efforts to maintain the quality of health services in
hospitals. Based on their role as nurse educators, nurses transfer knowledge, skills, and attitude
formation during patient-focused learning. Changes in behavior in patients
during the learning process in the form of changes in thought patterns,
attitudes, and specific skills. In nursing, health education is a form of
independent nursing intervention to help clients, both individuals, groups, and
communities in overcoming their health problems through learning activities in
which nurses act as nurse educators. According to research (Fahra et al., 2017) with the
title the relationship between the role of nurses as educators and self-care in
patients with diabetes mellitus. The research shows that the educational
results obtained by the patient affect the patient's motivation. Of the several nurse roles that exist, the
researcher will only take one nurse role, namely the role of educator.
From a
preliminary study conducted by researchers taking 5
patients undergoing chemotherapy at Saiful Anwar
Hospital Malang. Of the 5 patients, it was known that 60% of patients were not educated about how to meet nutritional intake due to
nausea and 40% were
educated about how to meet nutritional intake due
to nausea. for 24 hours the patient was given food 3 times
from the hospital nutrition and every meal it was found that 3 patients only
spent half portion of food from the ration provided by
nutrition, 1 people only a quarter portion of the ration and 1 people only eat a few spoonfuls because of
nausea. Of these 5 patients, even 3 people experienced
a decrease in Hb levels below 10 g/dl so that blood transfusions had to be
given first up to more than 10gr/dl because the chemotherapy requirements for
Hb had to be more than 10 g/dl. This matter This causes the length of hospitalization to be prolonged so
that the costs incurred also increase. The role of nurses as educators if
implemented properly and professionally may be used to overcome the lack of
nutritional intake in chemotherapy patients who experience nausea by educating
patients so that their nutritional intake is adequate. nutritional intake in
chemotherapy patients who experience nausea at IRNA II RSUD Dr. Saiful Anwar
Malang.
METHOD
RESEARCH�������������������������������
The design
of this research is observational. This type of research is an analytic survey
using a cross sectional approach. In this study, the researchers correlated the
role of the nurse educator with the nutritional intake of chemotherapy patients
who experienced nausea at IRNA II RSUD Dr. Saiful
Anwar Malang.
The
population in this study were chemotherapy patients who experienced nausea at
IRNA II RSUD Dr Saiful Anwar
Malang. The number of chemotherapy patients in the last 1 month with an average
number of patients per month was approximately 32 people. The data was taken
from the average patient from January to May 2021. The sample is part of the
population that is used as a subject in the study
through sampling. Determination of the size of the sample can
be formulated with the formula solvin and obtained
the number of 30 samples.
The sampling
technique used in this study was non-probability sampling with purposive
sampling technique. This purposive sampling technique is used
because of how to choose a sample from the population according to what the
researcher wants, so that the sample can represent the characteristics of the
previously known population. The sample taken in this study must meet the
inclusion and exclusion criteria. Inclusion criteria are criteria or
characteristics that need to be met by each member of
the population that can be taken as a sample, while exclusion criteria are
characteristics of population members who are not taken as samples. so that the sample can represent the characteristics of the
population that have been known previously. Inclusion criteria in this study
Patients undergoing chemotherapy, chemotherapy patients experiencing nausea,
able to communicate well, patients willing to be respondents, patients
undergoing chemotherapy treated at IRNA II RSSA Malang, patients at the time of
the study for 1 month in 2021, exclusion criteria In this study, the patient's
condition improved. The patient experienced physical discomfort such as severe
pain. The patient was in poor condition.
Variables in
this study the independent variable in this study was the role of nurse
educator and the dependent variable in this study was nutritional intake in
chemotherapy patients. The location of the research was carried out at IRNA II
General Hospital Dr. Saiful Anwar Malang, which was
on Jalan Attorney General Suprapto
No. 2 Malang, East Java Province and this research was conducted in September
2021
Research
Instruments, which is used in
the study to determine the implementation of the nurse's role as
an educator using a questionnaire prepared by. (Pratama, 2020) Consists of 30 question items with answer choices
using a Likert scale, namely: 1 = never 2= sometimes 3= often 4= always . The
role of nurses as educators consists of 6 indicators
consisting of: 1. Knowledge of chemotherapy patients 2. The
course of cancer so chemotherapy 3. Knowledge of chemotherapy effects 4. Monitoring of chemotherapy cycles 5.
Provision of Health Education according to Schedule and
Regularly 6. Self-Care for Chemotherapy patients (Pratama, 2020) . And in assessing
nutritional intake using 24-hour Food Recall (Dairy Nutrition). This 24 -hour
Food Recall (Dairy Nutrition) was adopted from the Indonesian Ministry of
Health 2018. The amount of energy intake and types of food was
measured using the 24 -hour food recall method. The researcher asked the
menu that the respondent had eaten the day before so that the respondent was expected not to forget the menu. In addition, the
researchers also asked the respondent's snacks and how to process the food
consumed, such as steaming, frying, and boiling. Thus, the food menu that will be processed by the Nutrisurvey
software is adjusted to the way the food is processed. The amount of food is expressed in Household Size (HS) in grams and compared with the
recommended NAR (Nutrition Adequacy Ratio). The type of food consumed is
known by calculating the proportion of carbohydrate, mineral, weak, protein
consumption in the average amount of energy intake in one day (Elliyana, 2020) . The assessment is
Sufficient if more than 80% or equal to 80% insufficient if less than 80%
Prior to
data collection, the researcher took care of the initial data collection letter
at the secretariat addressed to the training section of RSUD dr.
Saiful Anwar Malang. After obtaining the approval of
the research permit from the Director of the General Hospital, Dr. Saiful Anwar Malang data collection was done by selecting
respondents based on the inclusion criteria set by researchers at IRNA II RSUD
dr. Saiful Anwar Malang,
Data
collection is a process of approaching the subject and the process of
collecting the characteristics of the subject required in a study. (Nursalam, 2015) . The steps that will be taken when collecting data in this research are
Research Preparation starting with the study of submitting a preliminary study
permit to campus and home sick. The preliminary study was carried
out at IRNA II RSUD Saiful Anwar Malang by
asking for permission verbally from the head of IRNA II and the head of the
room where the data was collected. Then the researcher prepares a research
proposal. After that, the researcher conducts a research proposal exam after
the supervisor approves the research proposal. After conducting the proposal
exam, the researcher revised it and was then approved
by the supervisor and examiner to continue the research. Then the researcher
took care of the research permit to STIKES Maharani. After that, the researcher
submitted a letter of appropriate research ethics to the RSSA ethics team and
this research was declared ethically worthy. After
obtaining ethical approval, the researcher submitted a research permit to the
RSSA and then it was approved. After obtaining a
research permit from the RSSA, the researcher conducted a validity test at IRNA
II RSSA. Then the implementation is carried out. After
the validity test was carried out and the ethical
letter was issued, the researcher conducted a research by asking the Head of IRNA
II for permission. Data collection was carried out by the researcher himself
and questionnaires were given to patients while in the middle of the
chemotherapy process in phase 2 according to the protocol and questionnaires
for measuring nutritional intake were given in the initial phase of
chemotherapy until chemotherapy was completed according to the protocol. The
researcher then gave an explanation of the research conducted and an informed
consent sheet to the respondents. Data collection was carried out in August
2021. The researcher gave a questionnaire sheet to the respondent and explained
how to fill in and assist in filling out and assist in filling out the
questionnaire if the respondent did not understand it by asking questions to
the respondent. Then the results of the respondents' answers are
used to fill out the questionnaire. After 1 x 24 hours, the quasiner was given back. The
researcher rechecked the completeness of filling out the questionnaire, if any incomplete;
it can be clarified back to the respondent to be
completed. After the observation, data processing and data analysis were carried out. After processing and analyzing the data,
the researcher made chapters 5 and 6 and then consulted the supervisor. After
obtaining approval from the supervisor, the researcher conducts an examination
of the results of the research
������ Data processing in this study is
in the form of ordinal data for both variables. Ordinal data is data that shows
the level (Nursalam, 2015) . Editing is an attempt
to re-check the correctness of the data obtained or collected. Editing can be
done at the data collection stage or after the data has been collected. Editing
is done on filling out the questionnaire sheet. In
this study, the researcher edited after receiving the questionnaire that had been filled out by the respondent, checked for
correctness and completeness. If there are respondents who are incomplete in
filling out the questionnaire, the researcher asks the respondent to complete
it. Coding is an activity of assigning numeric codes (numbers) to data
consisting of several categories. Giving this code is very important when
processing and analyzing data using a computer, usually in coding, a list of
codes and their meanings is also made in one book to make it easier to see the
location and meaning of a code from a variable (Nursalam, 2015).
Data
analysis is an important part to achieve the objectives of the research in
answering research questions based on the required data (Notoatmodjo, 2012) . Univariate
analysis or descriptive analysis is an explanation of the characteristics of
the variables to be studied (Notoatmodjo, 2012) . Categorical data such
as gender, occupation, education and marital status were
analyzed in percentage form. Numerical data are age, the role of nurses
as educators and assessment of nutritional intake standard deviation, median,
minimum and maximum values. Data on the role of nurses as educators are also
presented into two categories, namely the good category with a score of 60-120
and the unfavorable category with a value of 30-60 and Sufficient intake data
if more than 80% or equal to 80% Not sufficient if less than 80%. From the data
above, the researcher used the Spearman statistical test. Bivariate
analysis was carried out to determine the relationship or correlation between
two variables. Bivariate analysis was used by researchers to determine the
relationship between the independent variable of the nurse's role as an
educator and the dependent variable of nutritional intake in chemotherapy
patients using the Spearman rank statistical test, which is a statistical test
that relates the two variables. The measurement scale of this study is the role
of nurses as educators (interval) and nutritional intake (ordinal). Statistical test of
correlation or relationship using the spearman rank test. The basis for decision making if p < 0.05
then Ha is accepted but if p > 0.05 then Ha fails to be accepted.
�������������������������������������������������������������������
RESULT AND DISCUSSION
Research result
The results
of this study will describe research and data analysis on the relationship
between the role of nurses as educators and nutritional intake in chemotherapy
patients who experience nausea at IRNA
II RSUD Dr. Saiful Anwar and through the
research ethics exam at the Health Research Ethics Committee of the Regional
General Hospital, dr. Saiful
Anwar Malang, that has received information that he has passed the ethical
review number 400/155/K.3/302/2021 on 2021.
Cross Tabulation of the Relationship between the Role of Nurses as
Educators and Nutrition Intake in Chemotherapy Patients Experiencing Nausea at IRNA II RSUD Dr. Saiful Anwar
Table 1 Cross-tabulation of the
Relationship of the Role of Nurses as Educators with Nutrition Intake in
Chemotherapy Patients Experiencing Nausea in IRNA II Hospital Dr. Saiful Anwar
|
Nurse's Role as Educator |
Nutrition Intake |
Total |
|
|
Not Enough |
Enough |
||
|
Bad |
9 (30%) |
11 (36.7%) |
20 (100%) |
|
Good |
0 (0%) |
10 (33.3%) |
10 (100%) |
|
Total |
9 (30%) |
21 (70%) |
30 (100%) |
�������������������������������������������������������������� Source:
Primary data
The results of the cross tabulation of the role of educator nurse
and nutritional intake showed that of the 20 respondents who stated that nurses
had a bad role, the majority of respondents had adequate nutritional intake as
many as 11 people or 36.7 percent of the total respondents observed. Then from
10 respondents who stated that nurses had a good role, the majority of
respondents had adequate nutritional intake as many as 10 people or 33.3
percent of the total respondents observed.
Relationship of the Role of Nurses as Educators with Nutrition Intake in Chemotherapy Patients Who
Experienced Nausea at Irna II Hospital Dr. Saiful Anwar
To test the relationship between the role of the nurse educator
with the ordinal data scale and the patient's nutritional intake with the
ordinal data scale, the Spearman correlation test was used with the following
results
Table 2 Correlation Test of the
Relationship of the Role of Nurses as Educators with Nutrition Intake in
Chemotherapy Patients Who Experienced Nausea at Irna
II Hospital Dr. Saiful Anwar
|
|
|
Nurse�s Education Role |
Nutrition Intake |
|
Nurse�s
Education Role |
Correlation Coefficient |
1.000 |
463** |
|
|
Sig. (2-tailed) |
|
010 |
|
|
N |
r30 |
30 |
|
Nutrition
Intake |
Correlation Coefficient |
463** |
1000 |
|
|
Sig. (2-tailed) |
.010 |
|
|
Total |
N |
30 |
|
�������������������������������������������������������������� Source:
Primary data
The results of the Spearman correlation test showed a correlation
value (r) of 0.463 (46.3%) and a p-value of 0.01. The p value < a(0.05), which means that there is a
relationship between the role of nurses as educators and nutritional intake in
chemotherapy patients who experience nausea at IRNA II RSUD Dr. Saiful Anwar
Malang. The closeness of the relationship (46.3%) in the low category. The
correlation is positive, the higher the educational role of nurses, the higher
the nutritional intake, in other words, the higher the role of nurses as
educators in nutrition education for chemotherapy patients, the higher the
nutritional intake for chemotherapy patients who experience nausea at IRNA II
RSUD Dr. Saiful Anwar Malang.
Discussion
Chemotherapy is the process of administering anti-cancer drugs in
the form of liquid pills or capsules or through infusions that aim to kill
cancer (Putra, 2015). Patients receiving chemotherapy often experience nausea
which causes a decrease in nutritional intake in chemotherapy patients,
especially patients who experience nausea and this occurs in patients
undergoing chemotherapy in the first, second and third stages, the management
that can be done as a nurse is patient education about how to overcome nausea
so that nutritional intake is achieved better. In this chapter, the researcher
will discuss the implementation of the nurse's role as an educator in
chemotherapy patients who experience nausea at IRNA II Saiful Anwar Hospital
Malang.
Implementation
of the Nurse Educator Role at IRNA II RSUD Saiful Anwar Malang
From the data found in this study, it was found that the nurse's
role as an educator was not rated well with the questionnaire data given to 30
respondents. In a good assessment, 10 respondents and 20 questionnaires were
obtained which were not good. Factors inhibiting patient education according to
(Pratiwi, 2016) .
Patient education perception This is due to work overload, lack of
policies and guidelines. With the wrong perception of education, patient
education is still a low priority, so nurses are still lacking in educating
patients, especially chemotherapy patients who experience nausea. This is in
accordance with the results of the nurse education questionnaire conducted by
researchers who obtained poor numbers.
Perception of the nurse's role in providing education The perception of the nurse's role in providing education
is caused by a lack of professional knowledge and skills, difficulty
communicating with patients, the belief that patient education is not the
nurse's responsibility. If the perception of
the nurse's role is to provide good education, it will increase the
knowledge and skills of professional nurses, reduce the difficulty of
communicating with patients, and increase the belief that education is part of
the nurse's responsibility (Pratiwi, 2016)
The low results of the questionnaire on education for chemotherapy
patients who experience nausea related to nutritional intake by nurses could be
due to a wrong perception from nurses that education is not the main task of
nurses but the task of nutritionists. With this wrong perception, nurses can
provide education related to nutrition for chemotherapy patients to
nutritionists. The high workload of
nurses is one of the factors that cause nurses
to lack education. Nurses feel they
have a workload that does not only provide education to patients, but also
works to care for patients such as helping to mobilize patients, giving and taking medicines,
cleaning the patient's body, coordinating with other staff, and so on. (Pratiwi, 2016)
The low results of nurse education for chemotherapy patients who
experience nausea can be caused because nurses have a very high workload. In
carrying out nursing care, nurses must also perform other tasks such as
delegation duties from the medical profession. This causes the time to perform
the role of education is very less. Especially if the number of nurses is very
less. Lack of managerial
attention to patient education . The manager's lack
of attention is the main cause of obstacles in providing education to patients.
Managers should
support actions in providing education, such as evaluating staff in the
implementation of the patient education process, providing appropriate
facilities and places for education, preparing an interactive atmosphere
between staff, and supporting the promotion and patient education process (Abdi
et al., 2014).
The lack of education carried out by nurses on chemotherapy
patients who experience nausea related to nutritional intake could be due to
the lack of managerial attention to nurse education to patients through audits.
Nurses carry out their role as educators in an effort to improve health through
behaviors that support their health (Asmadi, 2008) . In this study the role of nurses as educators
is still undervalued. Many factors cause the lack of a nurse's role in
education or as an educator. When this research was conducted in a situation
where there was a shortage of nurses in the hospital room because they were
assigned to handle COVID-19, this affected the nurse's role as educator. In
addition to the lack of nurses, the ability factor in nurses can also affect
this research. Nurses as educators must have the ability to assess the
strengths and consequences of providing information and desired behavior by
individuals (Efendi, 2008). The role of the educator nurse in overcoming
nausea in chemotherapy patients can lead to a lack of nutritional intake by
educating the patient or patient's family on how to deal with nausea during
chemotherapy. With the knowledge about how to deal with nausea in chemotherapy
patients, patients can overcome nausea during chemotherapy or overcome nausea
before and after chemotherapy. Nausea during chemotherapy can cause a lack of
appetite so that it can affect food intake in chemotherapy patients. The
importance of the role of educational nurses can overcome nausea in
chemotherapy patients so as to increase nutritional intake.
Nutrient
intake in chemotherapy patients who experience nausea at IRNA II RSUD Saiful
Anwar Malang
Nutrients are organic and inorganic materials found in food and
needed by the body to function properly. Nutrients are needed by the body to
obtain energy for body activities, as well as regulate various chemical
processes in the body. In fulfilling nutritional needs there is a system that
plays a role in it, namely the digestive system consisting of the digestive
tract and accessory organs. The digestive tract starts from the mouth to the
distal small intestine, while the accessory organs consist of the liver,
gallbladder and pancreas. (Haswita & Sulistyowati, 2017).
One of the effects of chemotherapy is that it can cause nausea and
cause nutritional intake in patients to be disturbed due to nausea. If the
intake of nutrients is disturbed, it can interfere with the chemotherapy
process. Because reduced intake makes the body weak and the lack of body
components such as Hb and albumin in the body so chemotherapy can be delayed
The results of this study found that the nutritional intake of 30
people who became the sample obtained 9 people or 30% had inadequate
nutritional intake and 21 people or 70% had adequate nutritional intake. These
results indicate that the majority of respondents in the sample have good
nutritional intake. Nutritional intake can be good because the patient and
family have been in chemotherapy more than once. An experience that can make
patients and their families obtain good nutritional intake.
Knowledge about the benefits of nutritious food can affect food
consumption patterns. This can be caused by a lack of information so that
errors can occur in understanding nutritional needs (Haswita &
Sulistyowati, 2017).
The results of the questionnaire on intake nuts from chemotherapy
patients who experienced nausea, out of a total of 30 respondents, 21
respondents received adequate nutritional intake, this is because the 21
respondents on average had undergone chemotherapy more than twice. Respondents
who have undergone chemotherapy twice will get more experience and broader
knowledge about how to deal with nausea so that nutritional intake is fulfilled
during chemotherapy. The knowledge obtained by respondents during the first
chemotherapy is very useful for fulfilling nutritional intake during
chemotherapy and nausea occurs. The knowledge conveyed by nurses about the
fulfillment of nutrition is very important for the fulfillment of the
respondent's nutritional intake.
In a sample of 9 people who experienced inadequate nutritional
intake on average were respondents with the first chemotherapy, this caused a
lack of knowledge compared to respondents who underwent chemotherapy more than
twice. In general, 70% of the 30 respondents or 21 people had their nutritional
intake fulfilled because they had undergone chemotherapy more than twice.
Economic status can affect changes in nutritional status because
the supply of nutritious food requires a lot of funding. People with high
economic conditions are able to suffice (Haswita & Sulistyowati, 2017).
Of the total number of respondents regarding the patient's
nutritional intake, 21 respondents, the adequate nutritional intake could be
due to economic factors. On average, the respondent's family can afford to buy
other food menus if the respondent does not consume the food from the hospital.
So the ability to buy food from outside can replace the adequate nutritional
intake of respondents who experience nausea during chemotherapy.
The importance of adequate nutritional intake in patients
undergoing chemotherapy can make the success of chemotherapy higher. Because
nutritional intake in chemotherapy patients is difficult to achieve because the
effect of chemotherapy causes nausea so that there is a decrease in appetite so
that nutritional intake is not fulfilled. One way to deal with nausea in
chemotherapy patients is to educate patients on how to deal with nausea or
their families so that they understand how to control nausea and reduce nausea
so that nutritional intake can be achieved.
The
Relationship between the Implementation of the Role of Nurse Educator And
Nutrition Intake in Chemotherapy Patients who Experience Nausea at Irna Ii hospital
Dr. Saiful Anwar Malang
In this study, the results of the Spearman correlation test showed
a correlation coefficient or correlation coefficient (r) of 0.463 (46.3%) and a
p-value of 0.01. The p value < a(0.05), which means that there is a
relationship between the role of nurses as educators and nutritional intake in
chemotherapy patients who experience nausea at IRNA II RSUD Dr. Saiful Anwar
Malang. In this study, it was found that patients had good nutritional intake
in patients who had undergone chemotherapy more than 2 times and patients who
experienced poor nutritional intake because they had only undergone
chemotherapy 1 to 2 times. The role of nurses as educators in this study is
said to be bad. Because there are many factors, one of which is the lack of
energy when doing research in a pandemic. Where many nurses are assigned to
handle COVID-19 patients.
In this study, there were many inhibiting factors that could not be
controlled by the researcher. According to (Pratiwi, 2016) there are several inhibiting factors that can
hinder the process of successful education. One of them is the perception of
patient education. This is due to the lack of policies and guidelines on patient
education, and patient education is still a low priority. The more nurses feel
that patient education is part of a professional nursing process, the fewer
obstacles there will be from nurses' difficulties in dealing with problems that
affect the perception of patient education .
One thing that makes the nurse educator role less than optimal is the perception of
the nurse's role in providing education due to the lack of professional
knowledge and skills, difficulty communicating with patients, the belief that
patient education is not the nurse's responsibility. If the perception of the nurse's role is to provide good
education, it will increase the knowledge and skills of professional nurses,
reduce the difficulty of communicating with patients, and increase the belief
that education is part of the nurse's responsibility. so that it is possible to increase the
virginity of nurses as educators.
The problem is that patients who have not been found in this study
exist if those who
are illiterate can cause the patient to be unable to read, write, and understand the information
provided by the nurse. Patients who are illiterate will also have lower
knowledge about health, such as delayed diagnosis, poor disease management
skills, and higher health care costs. Nurses are responsible for enhancing
skills, preferences, and providing health information.
In addition to the culture of the patient, the words and everyday
language used by the patient need to be known. Because if the nurse can know
the patient's speech and accent it will be easier to provide education. Nurses
have the challenge of knowing every language of a wide variety of patients. If
the language used by the patient is already attached and as the main language,
then this becomes an obstacle for nurses to communicate with patients. Usually
nurses use family members who are able to communicate in the language used by
nurses, but there are some terms in nursing that cannot be translated related
to the education provided by nurses.
In carrying out maximum education, there are many obstacles that
must be considered, one of which is physical barriers
and the patient 's environment . Physical factors play a role in how patients are able to
process health information. As the patient ages, visual clarity and auditory
acuity will decrease, making it difficult for the patient to receive
information, think and retain information. Changes in mental capacity due to
pathological disease processes, such as Alzheimer's disease or pharmacological
interventions can create barriers to providing effective education. Patients
who experience short-term memory loss and the amount of new information will
limit the sessions in providing education and the amount of information
provided. Patients who feel pain due to physical limitations will also inhibit
the patient's ability to receive information, as a result, patients feel
anticipation, anxiety, and fear due to lack of knowledge. Environmental factors
are also a determinant of success in the educational process. If the lighting
is bad, there is noise and the room temperature is
erratic, it will hinder the educational process. It is a challenge for nurses
to shorten patient care in hospitals by providing education during patient
health care.
Patient learning styles Nurses must understand the learning styles
of each patient. Patient assessment is very important for nurses to be
effective in providing education, because each patient has a different learning
style. The learning pattern of each patient is different depending on several
patterns that the patient likes, namely visual, auditory, and kinesthetic
learning patterns. Nurses need to study patient learning patterns so that
nurses are successful in conveying messages and building patient understanding
(Beagley, 2011).
The method of
education is very important for nurses to understand to provide education to
patients. The methods provided can be in the form of demonstration methods,
printed instruction methods (eg leaflets, pamphlets, etc.), and video methods.
These methods must be adapted to the patient's condition, before the nurse must
assess the patient's educational needs, then the nurse provides educational
interventions according to the method to be given.
During the pandemic, where this research took place, the number of
nurses in the room was reduced because they were assigned to treat COVID 19
patients. This made the workload even higher. Nurses feel they
have a workload that does not only provide education to patients, but also
works to care for patients such as helping to mobilize patients, giving and taking medicines,
cleaning the patient's body, coordinating with other staff, and so on.
Job dissatisfaction is a barrier to implementing patient education.
The existence of high job dissatisfaction is caused by lack of motivation,
insufficient salary, lack of appropriate opportunities to learn, lack of
medical staff, job stress, anxiety, depression and an unsupportive work
environment that worsens nurse satisfaction.
The factor that influences education outside of nurses and patients
is the lack of managerial
attention to patient education . The manager's lack of attention is the main cause of
obstacles in providing education to patients. Managers should support actions
in providing education, such as evaluating staff in the implementation of the
patient education process, providing appropriate facilities and places for
education, preparing an interactive atmosphere between staff, and supporting
the promotion and patient education process (Abdi et al., 2014). Differences in point
of view between educational staff Differences in point of view
between nurses and other medical staff, such as doctors, are an obstacle to educating
patients. Differences in point of view between staff to provide education to
patients due to lack of appropriate interaction and education between different staff, lack of coordination and
communication between staff can hinder the patient education process. To offer
the right treatment related to patient education, interaction and discussion
between staff is needed to determine what actions should be taken in an effort
to educate patients
In this study, nutrition in patients was said to be good for
patients undergoing chemotherapy. Because several factors can affect
nutritional intake in patients undergoing chemotherapy. Because in the case of
patients undergoing chemotherapy, the effects of chemotherapy can cause nausea,
thereby reducing appetite. Due to reduced appetite the data causes a lack of
nutritional intake.
Factors that can affect nutrition in this study are the patient's
knowledge and experience in undergoing chemotherapy. Knowledge of the patient
and the patient's family greatly influences the patient's nutritional intake.
Knowledge that can reduce nausea is usually obtained from experience or from
talking to patients who have undergone chemotherapy first. Meanwhile, lack of
experience and knowledge about the benefits of nutritious food can affect food
consumption patterns. This can be caused by a lack of information so that
errors can occur in understanding nutritional needs.
From the results of the cross tabulation, it was found that 20
respondents had poor education, but 11 respondents had adequate nutritional
intake and 9 respondents did not. In addition to the experience and knowledge
of the patient or the patient's family, the patient's feelings or prejudices,
both good and bad, can affect appetite and thus affect nutritional intake. Bad
prejudice against certain types of highly nutritious food can affect a person's
nutritional status. For example, in some areas, tempeh, which is the cheapest
source of protein, is not used as food that is fit to eat because people think
that consuming this food can lower their status. In research, patients can find
foods that do not increase nausea by talking or exchanging experiences with
other patients in the room or in the family waiting room so that it can have an
impact on the level of self-taught patient knowledge in dealing with nausea
while undergoing chemotherapy.
From the education that was not good, it was found that 11
respondents had adequate nutrition because even though nurses did not provide
education in all of the 30 total questions about nutrition education for
chemotherapy patients who experienced nausea, nurses had provided principles of
knowledge on how to overcome nausea so that nutritional intake was met during
chemotherapy and nausea occurs
Habits can affect nutritional intake The existence of harmful
habits or restrictions on certain foods can also affect nutritional status. For
example, in some areas, there is a ban on eating bananas and papayas for
teenage girls. In fact, these foods are a very good source of vitamins. Habits found
in this study that can affect the results so that they get good marks in
research are habits where patients always chat with other patients and exchange
experiences so that it becomes a good habit.
Preference and economy are additional factors in influencing intake
in chemotherapy patients. Excessive liking for a type of food can result in a
lack of variety in food, so that the body does not get enough of the substances
it needs. Likes can lead to a decline in nutrition in adolescents if the
nutritional value is not as expected. Economic status can affect changes in
nutritional status because the supply of nutritious food requires a lot of
funding. Communities with high economic conditions are able to suffice.
In this study, one of the factors that can affect nutritional
intake in chemo therapy patients is age, gender and type of drug or drug dose.
Age is clearly a determining factor in the study of nutritional intake in this
study. Because the younger the age, the better the immune system to withstand the
effects of chemotherapy, namely nausea. Gender in this study can also be said
to have an influence but not significantly. The type of drug in this study on
average uses 5fu but each drug has a different dose for patients undergoing
chemotherapy so that the drug dose may have an influence in this study.
Congenital diseases that can cause nausea in this study were not
disaggregated and could not be detected for example gastritis, vertigo, etc.
Diseases that can cause nausea before chemotherapy can affect the results in
this study. In addition to the patient factor, there are also nurse factors who
think that education about nutritional needs or nutritional intake in this
research is the task of nutritionists. So that it affects the results of this
study
The test results obtained a close relationship between the role of
nurses as educators and nutritional intake of (46.3%) in the low category. The
correlation is positive, the higher the educational role of nurses, the higher
the nutritional intake, in other words, the higher the role of nurses as
educators in nutrition education for chemotherapy patients, the higher the
nutritional intake for chemotherapy patients who experience nausea at IRNA II
RSUD Dr. Saiful Anwar Malang. This relationship proves that the role of nurses
as educators can affect the quality of patient's nutritional intake so that
patients can improve and improve the quality of nutritional intake, especially
when undergoing chemotherapy. Because if the nutritional intake is not met
properly it can disrupt the chemotherapy cycle that has been programmed,
therefore the role of the nurse educator is needed so that the chemotherapy
program can be implemented.
CONCLUSION
Based on the results of research and
discussion in this study, conclusions can be drawn regarding the relationship between the role of nurses as
educators on patient nutrition at IRNA II RSUD Dr. Saiful Anwar Malang, which is the result of identifying the role of nurses as
educators in chemotherapy patients who
experience nausea, the results are not good because many things, one of
which is at the time of research in the room there is a shortage of nurses so
that it affects the level of education in patients. Results of identifying nutritional intake in chemotherapy patients who experience nausea. It was
found that the nutritional intake of chemotherapy patients was said to be good.
From the results of the study, it was found that the nutrition of chemotherapy
patients was good due to several factors, one of which was because the patient
had experience undergoing chemotherapy or had undergone chemotherapy more than
twice. Meanwhile, patients who were still undergoing chemotherapy twice or once
experienced a decrease in nutritional intake and those who were more than two
times had good nutritional intake. The results of the analysis of the relationship between the implementation of the nurse's role as an
educator with nutritional intake in chemotherapy patients who experience
nausea. The role of nurses as educators has a significant effect in the low category
on the patient's nutritional intake. The results of the correlation are
positive, the higher the educational role of nurses, the higher the nutritional
intake, in other words, the higher the role of nurses as educators in nutrition
education for chemotherapy patients, the higher the nutritional intake for
chemotherapy patients who experience nausea at IRNA II RSUD Dr. Saiful Anwar
Malang.
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Copyright holders:
Eko Joko Susilo, Feriana Ira Handian, Achmad
Dafir Firdaus �(2022)
First publication right:
Devotion -
Journal of Community Service
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