Nursalam (2024) Efek Model Pendekatan Asuhan Keperawatan (Pakar) terhadap Perbaikan Respons Kognisi dan Biologis pada Pasien Terinfeksi HIV. Disertasi thesis, UNIVERSITAS AIRLANGGA.

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Abstract

PAKAR model that focused on coping strategy and social support (nurse, family and patients) lead to positive coping mechanism through the learning process. The purpose of the study is to examine the effect of PAKAR toward cognitive and Biological responses on PWH infection. Psychoneuroimmunology paradigm was used in this study. Quasy-experimental pre-post test non randomized control group design was used in this study. Forty (40) PWH infections in Intermediate Department Care for Infection Disease (UP/PI) Dr. Soetomo hospital in Surabaya were selected and nonrandomized assignment divided into 2 groups of 20, experiment and control group. In vitro- test were used to measure biological response change: cortical, CD4, IFNy, and Anti-HIV. The cognitive responses; spiritual, social, and self-acceptance were measured and observed by using questionnaires, in depth interview and Focus Group Discussion. A Multivariate analysis was used to evaluate the data of biological response, while non-parametric test: Wilcoxon and Mann Whitney were used to measure cognitive response. Result showed that there were significantly differences on cognitive responses between PAKAR and Standard, namely; spiritual response on be patient, social response on emotional stable, and self-acceptance responses on anger and bargaining. In addition, biological response were significantly differences between the groups with F = 0.497 and p= 0.000. The cortical and Anti-HIV variables were the pattem contribution between the groups, with 77.5%. The increase the number of CD4 was found to be the dominance factor that was correlated toward the positive of cognitive response caused by PAKAR. The increase of CD4 caused the increase IFN-y that was able to increase cytotoxic ofNK-cell. Conclusion: PAKAR model is able to treat cognitive response by building the positive coping style in order to solve their problems. This leads to induce immune response modulation that showed by the increase of the number of CD4. So, the damage of CD4 will be stabilized by PAKAR model that in turn can cause the increase ofCD4. Recommendation: PAKAR model is necessarily needed to be applied in nursing care PWH infection in all setting of health services in Indonesia. The model can be applied to care patient with chronic illnesses such as cancer, diabetes mellitus etc. It is recommended to conduct research towards the effect of PAKAR on stress biological, especially HSP 70 and others in order to protect apoptosis through cytokine mechanism.

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