PRAKTIK MANDIRI PERAWAT

Kepmenkes No. 1239 tahun 2001 tenta

ng Registrasi dan Praktek Perawat merupakan angin segar bagi perawat dalam aktualisasi praktik profesionalnya, namun dalam pelaksanaannya banyak kendala yang dihadapi sampai saat ini, salah satunya adalah kebanyakan Perda didaerah belum begitu merespon. Salah satu faktor penyebab respon yang lambat tersebut adalah lemahnya organisasi profesi untuk memperjuangkan aktualisasi dari dasar hukum yang telah ada dari kementrian tersebut. Disamping itu perawat sendiri belum memahami secara utuh implementasi dari UU tersebut.
Ironis sekali dengan profesi lainnya yang sudah eksis atau saat ini marak sekali kursus - kursus terapi atau perawatan kesehatan yang hanya memerlukan waktu 6 bulan - 1 tahun kemudian para lulusan kursus dapat langsung buka praktek pengobatan atau terapi tanpa memalui proses perundangan - undangan yang berliku - liku, padahal resiko kesalahan terapi atau akibat kelalaian praktik tersebut dapat mengakibatkan kerugian pada pasien atau masyarakat.
Coba telaah kembali perawat - perawat yang telah mencoba mengimplementasikan praktik mandiri ini, walaupun payung undang - undang sudah ada, tetapi praktiknya seperti yang pernah terjadi pada kasus dikab. Gunungkidul , dengan kebijakan yang arogan dari pihak kepolisian telah mengharamkan praktik keperawatan, dikabupaten Klaten banyak sejawat profesi kita yang diintimidasi bahkan diperas oleh aparat berkenaan dengan kegiatan praktiknya..
Mudah-mudahan seiring waktu berjalan dan melalui PPNI terus berupaya untuk menggolkan implementasi UU tersebut... SELAMAT HARI PERAWAT SEDUNIA 12 MEI 2009

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Spiritual dan Imunitas

Spiritual mempunyai pengaruh terhadap kesehatan fisik seseorang. Dalam keadaan distre

ss spiritual tubuh akan melepaskan hormon Adenocorticotropic Hormon atau ACTH. ACTH yang meningkat dapat mengaktifkan korteks adrenal untuk mensekresi hormon glukokortikoid, terutama kortisol. Kortisol memobilisasi zat yang diperlukan untuk metabolisme sel. Kortisol berperan sebagai penekan sintesis protein, termasuk menekan imunoglobulin, menurunkan populasi eosionofil, basofil, limfosit dan makrofag dalam darah tepi. Dosis kortisol yang tinggi dalam darah dapat menimbulkan atropi jaringan limfosit dalam tymus, limfa dan kelenjar limfe akibatnya daya tahan tubuh akan semakin turun. Namun seseorang yang memiliki komitmen agama yang kuat saat ditimpa musibah atau sakit maka amigdala (pusat emosi dalam otak) menstimulasi hipothalamus agar mensekresi corticotropic releasing factor (CRF) . CRF akan mengaktifkan pituitari anterior untuk mensekresi opiat alamiah yang disebut enkephalin dan endorphin yang berperan sebagai penghilang rasa sakit dan nyeri, disamping itu sekresi ACTH akan menurun, kemudian ACTH akan memberikan umpan balik pada adrenal korteks untuk mengendalikan sekresi kortisol. Menurunnya sekresi ACTH dan kortisol menyebabkan respon imun akan meningkat.

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Manajemen ASI bagi Ibu Bekerja

Seringkali ibu-ibu bekerja mengalami dilema antara ingin memberikan ASI eksklusif kepada bayinya dengan memberikan susu formula. Dengan alasan yang klasik ibu-ibu bekerja memilih untuk memberikan susu formula kepada bayinya.

Disini diuraikan mengenai bagaimana kita dapat mengelola ASI dengan berbagai jenis alat bantu. Dengan sedikit bersusah payah kelak ibu dan anak dapat memperoleh manfaat yang besar.

Memeras ASI bermanfaat untuk:
• memberikan makan BBLR
• menghilangkan bendungan
• menjaga pasokan ASI saat ibu sakit
• meninggalkan ASI untuk bayi saat ibu pergi atau bekerja
• menghilangkan rembesan ASI

A. Memeras ASI dengan tangan
Semua ibu harus belajar memeras ASI. Ibu dapat mulai belajar selama kehamilan dan dapat menerapkannya segera setelah melahirkan. Memeras dengan tangan tidak memerlukan alat bantu sehingga seorang wanita dapat melakukannya dimana saja dan kapan saja. Memeras dengan tangan mudah dilakukan bila payudara lunak. Lebih sulit lagi bila payudara sangat terbendung dan nyeri.

B. Cara memeras ASI dengan tangan
• Siapkan cangkir, gelas atau mangkuk yang sangat bersih. Cuci dengan air sabun dan keringkan dengan tissue/lap yang bersih. Tuangkan air mendidih ke dalam cangkir dan biarkan selama beberapa menit. Bila sudah siap untuk memeras ASI, buang air dari cangkir.
• Cuci tangan dengan seksama
• Letakkan cangkir di meja atau pegang dengan satu tangan lain untuk menampung ASIP.
• Badan condong ke depan dan sangga payudara dengan tangan
• Letakkan ibu jari sekitar areola di atas puting susu dan jari telunjuk pada areola di bawah puting susu.
• Pijat ibu jari dan telunjuk ke dalam menuju dinding dada.
• Sekarang pijat areola di belakang puting susu di antara jari dan ibu jari. Ibu harus memijat sinus laktiferus di bawah areola.
• Tekan dan lepas, tekan dan lepas. Pada mulanya tidak ada ASI yang keluar, tetapi setelah diperas beberapa kali, ASI mulai menetes. ASI bisa juga memancar bila refleks pengeluaran aktif.
• Peras areola dengan cara yang sama dari semua sisi agar yakin ASI diperas dari semua segmen payudara.
• Jangan memijat puting susu itu sendiri. Jangan menggerakkan jari sepanjang puting susu. Menekan atau menarik puting susu tidak dapat memeras ASI. Ini merupakan hal yang sama terjadi bila bayi mengisap dari puting susu saja.
* Memeras ASI untuk BBLR atau bayi sakit
Ibu harus memeras sebanyak mungkin ASI setiap kali bayi perlu disusui. Bagi BBLR adalah 8 kali atau lebih sehari. Penting untuk memeras sesering dan sebanyak mungkin untuk mempertahankan pasokan ASI. Bila ibu memeras ASI lebih banyak daripada yang diperlukan bayi, ASIP dapat diberikan bagi bayi lain yang ibunya tidak dapat memeras cukup, atau berikan pada BBLR yang ibunya belum keluar ASI.
* Untuk mempertahankan pasokan ASI saat ibu atau bayi sakit
Ibu harus memeras ASI sebanyak dan sesering mungkin yang diinginkan bayi. Berikan pada bayi bila mungkin.
* Menghilangkan bendungan
Peraslah sesering dan sebanyak mungkin yang diperlukan agar payudara tetap nyaman dan menjaga kelenturan puting susu bagi isapan bayi. Beberapa ibu mungkin perlu memeras setiap kali sebelum menyusui. Pada ibu yang lain mungkin hanya perlu memeras satu atau dua kali sehari. Beberapa ibu mendapatkan bahwa kompres hangat atau pijatan lembut membantu ASI mengalir.
* Menghilangkan penetesan ASI
Memeras ASI cukup banyak untuk mengurangi tekanan pada payudara. Tidak perlu untuk memeras ASI banyak sekali.

C. Pompa listrik
Pompa listrik ASI lebih efisien dan cocok bagi pemakaian di rumah sakit. Tetapi, semua pompa mudah membawa infeksi. Hal ini sangat berbahaya bila lebih dari satu ibu menggunakan pompa yang sama.

D. Cara botol hangat
Ini merupakan teknik yang bermanfaat untuk menghilangkan bendungan, terutama bila payudara sangat nyeri dan puting susu tegang.
Cara menggunakan teknik botol hangat adalah:
- Cari botol besar (misalnya berukuran 1 liter, 700 ml, atau 3 liter) dengan leher lebar (bila mungkin).
- Mintalah keluarga untuk memanaskan sejumlah air dan isilah botol dengan air panas. Biarkan beberapa menit, untuk menghangatkan kaca botol.
- Bungkus botol dengan kain dan buang air panas.
- Dinginkan leher botol dan masukkan ke dalam puting susu sampai menyentuh kulit di sekelilingnya dengan ketat.
- Pegang kuat botol tersebut, setelah beberapa menit botol mendingin dan menimbulkan isapan lembut maka akan menarik puting susu.
- Rasa hangat membantu refleks pengeluaran, dan ASI mulai mengalir dan mengisap botol. Kadang-kadang bila wanita pertama kali merasa isapan ini, ia akan kaget dan menarik botol. Sehingga harus ditaruh lagi air panas dalam botol dan mulai kembali.
- Setelah beberapa saat, nyeri pada payudara berkurang dan memeras dengan tangan atau isapan sudah bisa dilakukan

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GRIEF

--> When someone experiences a loss, they go through a normal process called grieving. Grieving is a natural and expected process which, over time, can allow a person to

accept and understand their loss. Grieving involves feeling many different emotions over a period of time, all of which eventually help the person to come to terms with the loss of a loved one.
Bereavement and mourning are two other words that are commonly used to describe the grieving process. Bereavement is what a person experiences when someone close to them dies. It is the state of having suffered a loss. Mourning is the expression of one's loss and grief. Mourning includes behaviors and rituals that are specific to each person's culture and religion
-->Phases of Grief --> Many people think of grief as a single instance or very short period of pain or sadness in reaction to a loss - for example, the tears shed at a loved one's funeral. However, the term grieving refers to the entire emotional process of coping with a loss. Normal grieving allows us eventually to let a loved one go and continue with our lives in a healthy way. Though grieving is painful, it is important that those who have suffered a loss be allowed to express their grief, and that they be supported throughout the process. Each person's way of grieving for a loved one will be different. The length and intensity of the emotions people experience will also vary from person to person.
It is normal for people to feel better for a period of time, only to become sad again soon afterward. Sometimes, people wonder how long the grieving process will last for them, and when they can expect to experience some relief. Although there is no one answer to this question, it may help to know some of the factors that can contribute to the intensity and length of grieving. The kind of relationship you had with the person who died, the circumstances of their death, and your own life experiences will all play a part in determining your individual grieving process.
Researchers have studied grief to better understand the ways that people work through a loss and eventually accept it. They have identified several phases, or emotional states, that people can experience while grieving. The first phase involves a period of shock or numbness. This phase is often followed by a period of emotional upheaval, which can involve feelings of anger, loneliness, disbelief, or denial. The final phase of grief is the one in which people find some way to come to terms with the loss.
The First Phase of Grief
Often, people's initial reaction to a loss is one of shock, disbelief, and numbness, which can last anywhere from a few hours to days or weeks. During this time, the bereaved may feel emotionally "shut off" from the world. However, their numbness may be disturbed by waves of distress from time to time. During these periods of distress, which are often triggered by reminders of the deceased, they may feel agitated or weak, cry, engage in aimless activities, or become preoccupied with thoughts or images of the deceased.
The rituals of mourning - receiving friends, preparing for the funeral, and burial - often structure this time for people. They are seldom left alone. Sometimes the sense of numbness persists, leaving the person feeling as though they are mechanically going through the rituals.
The Second Phase of Grief
At some point the reality of the loss becomes painfully apparent, and the numbness wears off. This phase of grief, sometimes called confrontation, is when the feelings of loss are most intense and painful. It is during this phase that one must confront the loss and cope with the changes it has brought about in their lives.
People have many different ways of confronting loss, so this time can involve many different, equally intense emotions. This time of grief, with its characteristic waves of distress and difficulty concentrating and functioning, can last for weeks to months. The length of time can vary greatly.
You or Your Loved Ones May See Some or All of the Following in a Person Who is Grieving:

• Withdraws socially
• Has difficulty concentrating
• Becomes restless and anxious at times
• Has little appetite
• Carries a sad appearance
• Has a depressed mood
• Dreams of the deceased (may even have hallucinations of hearing or seeing the deceased)
• Loses weight
• Has difficulty sleeping
• Experiences fatigue or weakness
• Becomes preoccupied with death or events surrounding death
• Searches for reasons for the loss (sometimes with irrational results)
• Dwells on mistakes, real or imagined, that he or she made with the deceased
• Feels somehow guilty for the loss
• Feels distant from others
• Expresses anger or envy at seeing others united with loved ones

It is often during this time that a grieving person needs the most emotional support. Finding sources of support, whether they are family members, friends, support groups, or community organizations, can be the key to a person's eventual recovery and acceptance of the loss.
The Third Phase of Grief
The first two phases of grief are designed to help people come to terms with the loss in some way. Usually, one comes to accept a loss gradually over the months that follow it. Like the first and second phases, acceptance does not happen overnight. It is not uncommon for it to take as long as a year or more for someone to resolve the emotional and life changes that result from the death of a loved one. Although the intensity of the loss may lessen, it is common for people to continue to feel emotionally involved with the deceased for many years after their death.
-->Loss After A Long-Term Illness -->Grief is experienced somewhat differently when the loss occurs after a long-term illness rather than suddenly. When someone is terminally ill, their loved ones often grieve in anticipation of the loss. This anticipatory grief is a normal response, and it helps to prepare them for the actual loss. Usually, the period just before the person's death is one of physical and emotional preparation for those close to them. During this time, the urge to withdraw oneself emotionally from the person who is ill is normal. For most people, the actual death brings about the beginning of the normal grieving process. Many people believe they will feel prepared for the loss when it is expected. However, when the death actually occurs, it can still be a shock and bring about unexpected feelings of sadness and loss. -->Major Depression and Complicated Grief --> It is common for people to experience sadness, pain, anger, bouts of crying, and a depressed mood after the death of a loved one. It is important to learn to distinguish these normal grief responses from clinical depression, as grief can lead to clinical depression. About 20% of bereaved people will develop major depression, a condition requiring medical intervention. People at particular risk for developing clinical depression include those who have a history of depression or alcohol abuse, an inadequate support system, or those who have other significant life stresses.
Symptoms of Major Depression Not Explained by the Normal Bereavement Process may Include:

• Continual thoughts of worthlessness or hopelessness
• Continual thoughts of death or thoughts of suicide
• Persistent inability to perform day-to-day activities successfully
• Delusions (beliefs that are not true)
• Excessive or uncontrolled crying
• Slowed physical responses and reactions
• Extreme weight loss

In some people, the grieving process can go on for a long period of time. This is most often caused by attempts to deny or get away from the pain or to avoid letting go. If normal mourning does not occur, or if the mourning continues for a long period of time without any progress toward resolution, it is called unresolved or complicated grief.
Symptoms of this may include:

• Continued disbelief in the death of the loved one
• Inability to accept the death
• Persistent flashbacks, nightmares, intrusive memories
• Magnified and prolonged grief symptoms
• Maintenance of a fantasy relationship with the deceased with feelings that he/she is always present and watching
• Continuous yearning and searching for the deceased
• Breaking off all ties to social contact

If any of the above symptoms of major depression or complicated grief occur, they should be discussed with a qualified health or mental health professional.
(adapted from American Cancer Society)

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