International Journal of Scientific and Research Publications, Volume 5, Issue 2, February 2015 1ISSN 2250-3153
Duties Family in The Prevention of Acute RespiratoryInfectious Disease (ARI) in Children in Society based onLeinenger Theory Approach
Nuzul Qur'aniati, S.Kep., Ns., M.Ng, Iqlima Dwi K, S.Kep., Ns., M.Kep, Aria Aulia N, S.Kep., Ns., M.Kep
Maternity and Child Nursing Department, Faculty of Nursing Universitas Airlangga Surabaya
Abstract
- Introduction:
Infectious diseases are the secondhighest cause of infant mortality in the world. In Indonesia acuterespiratory infection (ARI) is one of infectious diseases whichcauses many deaths, especially in infants and toddlers. Efforts toovercome these, nurses are expected to have a role to performfive tasks assessment families with adopted culture.Understanding of the culture can be carried through nursingtranscultural approach that explains awareness and appreciationof cultural differences. This study aims to describe the familyexperience in the implementation of tasks in the family healthand disease prevention of infectious diseases due to lifestyle based on Leininger's theory.
Methodology:
This study used themethod of qualitative with phenomenological study approach. Inthis study consist of six participants who met the inclusioncriteria. Data were analyzed using Collaizi method.
Results:
Theresults obtained consist of five themes. Theme 1 is a familiar problem. Theme 2 is how to make decisions. Theme 3 is caringfor a sick member. Theme 4 is modification of the physicalenvironment and compliance. Theme 5 is the use of existinghealth facilities.
Discussion:
Family has implemented five familyduties in the prevention of infectious diseases in children withrelatively simple home treatment for prevention of transmission,utilizing the nearby health facilities such as health centers,doctors clinique, and hospitals beside utilizing alternativetreatments such as massage and treatment to the traditional healeras the influence of cultural values Java. Application of theirfamily duties largely influenced by economic conditions andlower-middle education and the influence of Javanese culture.The results of this study recommends that communityempowerment in the prevention of infectious diseases in childrenwith operational research methods is essential.
Index Terms
- ARI in children, five family duties, transculturalnursing approach
I.
I
NTRODUCTION
ealth development in the health ministry's strategic plan for2010-2014 focuses on eight priorities, one of which is thecontrol of infectious diseases and non-communicable diseasesand followed with environmental sanitation (Ministry of Healthof Indonesia, 2012). Infectious diseases and lifestyle diseases arethe diseases that can be prevented, but the incidence of thedisease remains high in the world, especially in developingcountries.Infectious diseases are a major cause of morbidity andmortality in infants and children that are especially common indeveloping countries, including Indonesia. In 2000,
the World Health Organitatios
(WHO) reported that infectious diseases arethe second highest cause of infant mortality in the world wherethe
Proportional Mortality Rate
(PMR) Acute RespiratoryInfections (ARIs) are 19% and 13% for diarrhea. Information oninfectious diseases in 2013, Basic Health Research (calledRiskesdas) report that period prevalence of ARI Indonesia(25.0%) is not much different from 2007 (25.5%). Characteristicsof the population with the highest ARI occur in the age group 1-4years (25.8%). By sex, did not differ between men and women.The disease is more experienced in population groups with thelowest quintile of the index and middle ownership down.The family is becoming one of the focus of intervention innursing as a family is an important resource in the provision ofservices for individuals and families that are proven to increasethe effectiveness of treatment (Gillis and Davis in Friedman,Bowden and Jones, 2003). A family can function well if each provides motivation, freedom and to provide protection andsecurity to achieve the potential for family members so that thefamily also has a duty of care for family members includingrecognizing health problems, making good decisions, able to provide an environment conducive to health maintenance andgrowth of individuals and families are able to use health facilities(Maglaya et. al, 2009). Nurses have a role to start improving the health status and isexpected to advocate for the needs of the community. To achievethis required a good assessment capability in determining themost obvious problems. Assesment that can be done is throughthe study of five tasks families with adopted culture.Understanding of the culture can be carried through in nursingtranscultural approach that explains awareness and appreciationof cultural differences. This means that professional nurses havethe knowledge and practice that are based on the concept ofculture and to practice planning.II.
MATERIALS
AND
METHODS
This study used the method of qualitative with phenomenological study approach. This study used the initialstep in phenomenological research is to explore the directdescriptive phenomenology, analyze and describe the phenomenon of family on family duties in the prevention ofinfectious diseases in children in the community.
H
International Journal of Scientific and Research Publications, Volume 5, Issue 2, February 2015 2ISSN 2250-3153
The population in this study were families with childrenwho suffer from infectious diseases in the health center inAugust-September 2014. The sample in this study were six participants who meet the inclusion and exclusion criteria inrecruitment. Participants in this study is a mother with a childsuffering from infectious diseases, are willing to become participants by giving consent and signed a consent form.Although only amounted to six participants it is in line with thetheory Polit and Hungler (1999) explains that in qualitativeresearch the number of participants is determined by thesaturation of the data, namely the participants reached asaturation point where no new information has been obtained andrepeatability can be achieved. It is also appropriate that describedRiemen (1986) in Creswell (1998) which states that the idealnumber of participants in the qualitative study with phenomenological method consists of 3 to 10 people.Collecting data in this study used the research instrument inthe form of a structured interview based on the prevention ofinfectious diseases Leinenger theory developed by researchersusing recorder and
field notes
.Data validation is done by checking the correctness of thedata based on the results recorded, performing a comparativeanalysis to ensure research results. Data analysis in this studyused Collaizi method because this method provides the steps aresimple, clear, and detailed. The process of transcription is donethrough (1) play the recording and writing the word-for-wordinto a computer file; (2) rechecking the results of the interviewtranscript to listen to the recording while reading the transcript;(3) Results of field notes in the form of non-verbal responsesduring the interview integrated accordance; (4) Researchers readthe transcript repeatable results and determine the significantstatements; (5) Keywords are identified through screening astatement-statements and keywords that have the same relativesense formulated in one category; (6) The same category aregrouped into sub-themes that are more common. The theme ofthe grouping formed several sub-themes which implies equal.Prior to the study conducted by researchers has completed ethicalcleareace, and letter permit from health district officer andcommunity health center itself.III.
THE
RESULTS
All participants in this study are housewives with range ofage 25-40 years of age. All participants are Muslims. At the timeof the interview participants was accompanied by his son. 4 outof 6 participants are living in the boarding family, with unhealthyenvironment, lots of birds and near the river.Based on the results of the data analysis are resulted fivethemes that emerged from the content analysis performed.
Theme 1: Know the problem
This theme discusses the structure and contents of the perception of the family in caring for a child with ARI.More than two third participants mentioned varies opinionrelated to the causes of disease such as exhaustion, contractedfrom other family members, the influence of weather, dust andunhealthy environment. In addition to the average participantalso mentioned eating too much ice so his endurance down, eatsnacks containong MSG, and unconscionus (called sawananJavanese) with a clown, a cat as the etiology of fever, cough andrunny nose.Almost the majority of participants said that children whoare experience sick tend to be fussy, crying and asking carriedon.
Theme 2: Taking decisions
Looking at the changes that occurs in the health status offamily members, usually a family member who lives at home orwho is given the responsibility to make a decision to save hisfamily. Family also look after their family based on their personal experience or to treat his or her family member in hisown way. In addition, the family also seek information fromanother family member, neighbor or coworker.
Theme 3: Caring for a sick member
Family will be responsible for looking after their memberwho is sick. Both the nuclear family and the extended family will provide the necessary care by family members. The familyrealized that ARI will often experienced by their children due tolack of immunity. At this stage, the family is able to care for sickfamily members, knowing the state of illness, treatment isneeded, the existence of the necessary medical facilities.Family describes the efforts made by the family if a familymember is sick. Most of the family state that giving paracetamol,traditional medicine in the form of a mixture of ginger, lemon juice, a little salt, onion, and sratching with oil Telone
(calledkerokkan).
Small families also mention compresses, givingantibiotics, and drinking water convulsions as alternative.The results of the interview explains that the majority offunding sources of treatment comes from personal payment.Only one (1) person used prudential insurance. The averageincome of the participants are ranged in the range of 1.5 to 2million rupiah.
Theme 4 is Modification of the physical environmentand
fulfillment environmental conditions
Family seeks to create a supportive environment forchildren who are sick. Efforts were mentioned by familyassociated with transmission is to use a mask, limitation to playig, always hand washing, separating cutlery, givingmultivitamins, isolating from sick chidren to health children, donot drink ice.
Theme 5: use of health facilities
Families are able to use public resources in order tomaintain health. Public perceptions of the health-illness closelyrelated to the health seeking behavior showed that family stillseeks to health care and alternative medicine to treat their family.Transportation used to to place health facilities are ridingmotorcycles, catching public transportation, and on footdepending on distance.The results of the interview also mentioned that the participants have the expectation to health workers in order to polite, friendly and able to provide an explanation of thecondition of the disease without being asked.IV.
DISCUSSION
There are two basic functions of the family that are physicaland psychosocial well-being needs. Physical well-being includes
International Journal of Scientific and Research Publications, Volume 5, Issue 2, February 2015 3ISSN 2250-3153
the requirement for food, clothing, safety and physical health.Psychosocial well-being is being able to be a family when the basic framework structure or psychosocial growth and growingfamilies who successfully underwent psychosocial well. Familywill be well-function when meet both the basic functions of thisfamily such as to carry out the task with good family health.While transcultural approach is a nursing service that focuses onthe analysis and comparative study of cultural differences whichfocused on the behavior of individuals or groups, as well as the process for maintaining or improving health behaviors and physical illness behavior and psychocultural appropriate withcultural background (Leininger, 1978). What was found in thisstudy are consistent with that proposed by Angel and Thoits(1987) in which a person or family's perception of the disease isinfluenced by culture or values are reflected in theimplementation of local and family duties.At this stage the results showed that the family is able torecognize family health problems by identifying the health problems faced by the family. Based on the results of indepthinterviews, the majority of participants said that the cause of painin children are drinking ice cold, tea box, and contracting of his brother. The majority of participants' responses who theirchildren are sick child are fussy, crying, asking carrying.According to Nelson (2002) that the upper respiratory tractinfection (ARI) is an infection caused by viruses and bacteria,including nasopharyngitis or common cold, rhinitis, sinusitis.According to the Ministry of Health (MOH) (2005) ARI may becaused by the behavior of individuals such as physical sanitaryhome and lack of availability of clean water. This is supportedalso by the results of participant observation in their homeenvironment. 4 out of 6 participants living in the boarding familyroom live in a room with width of about 3 x 2 m2, whereenvironmental conditions much poultry, birds and close to theriver. The location of the shelf plate under the bird cage. Theenvironment of participants are also many sellers of ice that arenot clean for example ice cubes made from raw water, syrup withartificial sweeteners, and glass washed using water in a basin thatis used over and over again.The second stage of the family's ability is to make decisionsin taking appropriate action. Individuals make decisions after a phase of experience or recognition of symptoms
(the symtonexperience).
Then the family began trying to treat theirself intheir own way. In addition, they began to seek information fromanother family member, neighbor or co-worker.At this stage the family is able to care for sick familymembers, knowing the state of illness, treatment is needed, theexistence of health facilities required and the resources availablein the family (Effendi, 2009).Families are people who play an important role very close tothe people and is considered the most widely know the conditionof the patient and is considered the most influence on the patient,so that the family is very important in the treatment and cure of patients (Hariyanto
et al.
2002).Source of medical expenses that are generally utilizedalmost all participants in solving health problems areindependent sources, and only one uses health insurance, another participant also mentions getting help from parents The averageincome is the range of 1.5 to 2 million and the main earner is thehusband who works as a driver or private. Economic factors canalso determine the patient or his family treated. According toFriedman (2010) suggests that the task of the components offamily health care for family members caring for the sick is notonly in the physical but the family has a family support andeconomic support within the health services covered by thefamily. In addition, the majority of participants are primary andsecondary education so that it is aligned with the results ofresearch in which there are almost half of the participants are believed to bring to an irrational treatment of convulsions. Inaddition, a slightly different case with proposed by Friedman(2010) that a person who only has basic education but high socialsense of the people will affect everyday behavior and thought processes to seek information on the community. Familyeducation is one of the inputs in the process of formation of anew unit of output behaviors that affect the family's ability to perform as expected action (Notoadmojo, 2003). Leinenger(1984) explains that the process of confronting and solving problems started from a family where the higher educationclients, the conviction must be supported by scientific evidencethat rational and can learn to adapt to the culture in accordancewith their health condition. Another opinion explains thateducation and income are components of socioeconomic andfamily factors play an important role in regulating familymembers (Ma, 2009). Friedman, Bowden & Jones (2003)explains that the income generated by the family will be used tomeet the expenditure of which is to meet the needs of familyhealth. The results showed that the participants also mentionedthat at the moment there are family members who are sick parentwill provide assistance. This is in line with the manner described by Hanson (2005) in Kaakinen, et. Al, 2010)The environmental factors greatly affect the client's psychological condition. According to Gordon and Le Richt(1950), environment that is the aggregate of all conditions andexternal influences affect the life and development of anorganization. In general, environmental factors include physicaland non-physical environment. The physical environment is anatural environment that are around humans, while non-physicalis the environment arising from the interaction between people(Mansjoer
et al
., 2001).In terms of environental factor, the family should be able tomaintain a home environment that can affect health and personaldevelopment of members of the family. The environmentcontinues to be a concept in the health care of family members.The availability of a healthy environment in the form of adequateshelter is an aspect of family care functions. Home environmentneeds to be adapted to the development and the familycircumstances as well as the overall health of family members(Friedman, 2010). Provision of physical and non-physicalenvironment indirectly interconnected with economic factors.Families are able to use public resources in order tomaintain health. Public perceptions of the health-illness closelyrelated to the health seeking behavior. This is in line with thefindings that there are participants who use non-medicaltreatment through expert convulsions although also went to thefacility or healthcare facility. Both the subject matter will affecton the health facilities used or not provided.This study showed that the majority of participants embracethe values of Javanese culture, ranging from Java languagehabits, the use of traditional medicines and therapies convulsions
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