LULUK WIDARTI, 090710151D (2011) PENGARUH MODEL HOME CARE HOLISTIC TERHADAP PERUBAHAN KECEMASAN, DEPRESI, KADAR CORTISOL, IFN- DAN TNF- PADA PASIEN STROKE ISKEMIK. Disertasi thesis, UNIVERSITAS AIRLANGGA.

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Abstract

Stroke is the main cause of long-term disability. It was reported that one third out of stroke survivors showed dementia in three months after stroke. Moreover, a dementia that causes psychological disorder such as anxiety is shown by over fear or worry about their disability or feeling useless. Stroke patients need medication and palliative caring so that home-care is highly recommended. In Indonesia, home-care nursing for ischemic stroke has not yet been optimal. Because of that reason, a new nursing model called holistic with bio-psycho-social-spiritual components is offered. An experimental research with quasi experimental design specifically nonrandomized pre test-post test control group design was applied in this study. The Study was conducted in the area of Surabaya by selecting ischemic stroke patients after being hospitalized at ”A-Seruni room, Medic IRNA, Dr. Soetomo hospital”. A sample of size 40 patients was divided equally into two groups, control and treatment groups. The treatment and control groups respectively received holistic home care and home care. The depression and anxiety level were measured by using questionnaires and observation technique, while Cortisol level, IFN- and TNF- levels were measured by using ELISA quantitative technique. The data were analyzed by using Levene’s test for homogeneity of variance, T-test and Correlation test. The statistical analysis shows there was a significant difference between psychological response in control group after intervension with p = 0,000 for anxiety, and p = 0,000 for depression. For biological response, there is a significant difference p = 0,007 for cortisol and p = 0,000 for TNF- . However, there is no significant difference in IFN- with p = 0,425. The correlation test result shows there was significant correlations between anxiety and biological responses such as Cortisol with r = 0,724 and p = 0,038; IFN- with r = 0,475 and p = 0,034; TNF- with r = 0,592 and p = 0.006. Furthermore, there was positive correlation between depression and biological responses such as Cortisol with r = 0,705 and p = 0.033; IFN- with r = 0,454 and p = 0.044, TNF- with r = 0,561 and p = 0.010. It was concluded that holistic home care could improve the psychological responses by decreasing anxiety and depression level and also could improve biological responses by the decreasing Cortisol, IFN- and TNF- level in ischemic stroke patients. It is recommended to make standard operational procedure of holistic home care that can be implemented by all health personnel who take care ischemic stroke patients.

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