Relation of Family Support with Emotional Response of Post Stroke Patient in Polyclinic of Neurology at RSUD Koja North Jakarta

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1 8th Iteratioal Nursig Coferece (INC 2017) Relatio of Family with Emotioal Respose of Post Stroke Patiet i Polycliic of Neurology at RSUD Koja North Jakarta Supriyadi Master Degree of Nursig Postgraduate School of Muhammadiyah Uiversity Jakarta Jakarta, Idoesia Supriyadi.stikesyarsi@gmail.com Abstract Stroke is a cliical sydrome with symptoms of disturbace cerebral fuctio i global or vocal scale. That case could cause death or disorder which would happe more tha 24 hours without ay causes. Post stroke s patiet would suffer emotioal disturbace due to the chage of physical. Family support could help the patiet who suffers that disease. The purpose of this research is to fid the relatio betwee family support with the emotioal respose of post stroke s patiet that have cotrolled with cofoudig variable (age, geder, educatio, occupatio, ad ethic group) i Polycliic of Neurological at RSUD Koja. The desig of this research is descriptive aalytic by usig cross-sectioal study approach. The umber of samples is 168 respodets by usig cosecutive samplig. The variable of this research is family support (dimesio of iformatio, the dimesio of emotio, the dimesio of istrumetal, the dimesio of appreciatio) ad emotioal respose. The data collected by usig questioaires. The result of this research is cotaied sigificat relatio betwee dimesio of emotio (QR= 1.9), dimesio of istrumetal (QR= 1.212), dimesio of iformatio (QR= 0,345) ad dimesio of appreciatio (QR= 0.022) with emotioal respose. The coclusio of this research is the relatioship betwee family support with emotioal respose of post stroke patiet to emotioal dimesio, istrumetal dimesio, iformatio dimesio, ad apresias dimesio Keywords: stroke, family support, emotioal respose I. INTRODUCTION Stroke is a fuctioal disorder of the cetral ervous system which occurs as a result of ormal blood supply to the brai is disrupted as i [1]. Accordig to the World Health Orgaizatio (WHO), stroke is a cliical sydrome with symptoms of focal or global brai dysfuctio which ca cause death or abormalities persistig for more tha 24 hours without causig others except for vascular disorders as i [2]. Accordig to Soe i Hartati (2002) who adds that family support ca help patiets to face of illess due to the ivolvemet of family members ad ca provide social support ad ecouragemet to follow a healthier lifestyle. Deterioratio of mobility or reductio i physical stregth, difficulties i work ad the reducig of cogitive fuctio is a trigger factor occurrig psychological problem such as depressio i patiets with post-stroke. It was reported that depressio occurs i some vulerable people as i [3] approximately of stroke cliets allegedly showig cliical symptoms of depressio. Occurrig disability or the remaiig of post-stroke ot oly causes psychological problems such as depressio but also a great risk to social problems. The patiet is ot able to work as usual, ad most of the post-stroke patiets become a burde to the family. Approximately 50 of stroke patiets who are still alive caot work aymore as i [4]. Therefore, it ca be cocluded that post-stroke patiets have a greater risk the occurrece of physical, social ad psychological problems, ad ideed this will affect the cliet's health status ad the quality of life as i [5]. Vulerability occurred i post-stroke patiets ca be the combiatio of poor health as a result of stroke, high risk, ad limited resources belogig; hece, the family support is eeded i the recovery of post-stroke patiets. The family is a importat resource i the provisio of health services, both i terms of idividuals ad families. As i [6] states that family ivolvemet has bee show to icrease the effectiveess carig of the patiet because family plays a supportive role i healig ad recovery. If the support does ot appear, the the success of healig or recovery become difficult to achieve [7]. Family support is defied as a process occurred throughout life with the ature ad type of social support that varies o each cycle of family life [6] that the family has four support fuctios icludig iformatioal support (family serves as a search ad dissemiator iformatio), esteem support (family acts as a systems supervisor feedback, guides ad helps to solve problems ad is a source as well as the validator idetity family members), istrumetal support (the family as a source of practical assistace ad cocrete) ad emotioal support (family helps mastery of emotioal ad improves family moral). The icidece of stroke varies amog coutries. Stroke is the third largest i the developed coutries ad the third leadig cause of death after heart attack ad cacer, with a Copyright 2017, the Authors. Published by Atlatis Press. This is a ope access article uder the CC BY-NC licese ( 8

2 mortality rate of 18 to 37 for the first stroke ad 62 for recurret stroke as i [8]. The results of RISKESDAS diagosis i 2007 by health professioals ad the symptoms state that atioal prevalece stroke is as much as 0.8, the 11 provices were reported to have a stroke prevalece of the atioal prevalece, oe of which is Jakarta. Based o the survey data of treated patiet i the Polycliic of Neurological of Koja Hospital North Jakarta i Jauary 2012 to December 2012, data obtaied: the umber of visits i the cliic erves was as much as cliets, with the details of post-stroke patiets were as may as 3,2 patiets (31.97), ad post-stroke patiets raked the first out of te eurological disease. The researcher also coducted a iterview i the post-stroke patiets ad their families. Seve out of te post-stroke patiets were iterviewed at the eurological cliic i the hospital stated that the emotioal post-stroke patiets extremely ustable ad eve more after the patiet's discharge from the hospital or after a stroke attacked. Accordig ref[9], she states that approximately 80 to 90 post-stroke patiets experiece emotioal problems. TABLE I. TABLE 1. CHARACTERISTICS RESPONDENT Characteristics Total Family a. Iformatioal b. Emotioal c. Istrumetal Adaptive Mal-adaptive < 55 Years Old Years Old Female Male c. Educatio Low High d. Occupatio Uemployed Employed Betawi d. Esteem 2. Emotioal Respose 3. Covariate II. METHOD This research is a descriptive aalytic usig cross-sectioal study approach that the researcher took measuremets or research at a time. The specific objective of the cross-sectioal study was to describe the pheomeo or effect of various pheomea or ifluece betwee idepedet variables ad depedet variable i a time or a momet [10]. This research uses cross-sectioal approach because it is to kow whether there is correlatio or ifluece betwee depedet variable to a idepedet variable i usig a questioaire to the respodet. Populatio i this study was 785 patiets, who were post-stroke patiets visited i Jauary to April 2013 ad the sample obtaied was 84 people. However, this study uses both the family support ad the emotioal resposes. Therefore miimum sample is multiplied by two, hece sample required i this study were 168 poststroke patiets who visited the Polycliic of Neurological agai. I this study, multiple logistic regressio aalysis was carried out to see whether the variable family support (emotioal support, iformatioal support, esteems support ad istrumetal support) ad characteristics of cliets that icludig, age, geder, educatio, occupatio ad ethicity as a factor which is domiat i ifluecig the treatmet i poststroke patiets, the a cofoudig assessmet, by omittig a covariate variable / cofoudig oe by oe startig from the biggest P value (P value), after beig omitted which is obtaied by the differece OR factor (primary variable) betwee before ad after the covariate variable had bee omitted more tha 10, the the variable is stated as cofoudig ad should remai i the model. III. RESULT The result of this research o the relatioship of family support with the emotioal resposes i post-stroke patiets i the Polycliic of Neurology a. Age b. Geder e. Ethic Jawa Batak Madura Based o the aalysis i Table I respodets accordig to the Idepedet s, for the Family, it shows the distributio which ca be see that the respodets have the most iformatio with the category iformatio good of 98 people (58.3), emotioal support respodet has a emotioal most with category good of 92 people (54.8), the support of the respodet has a istrumet with the highest category istrumet poor of 90 people (53.6), ad the esteem support respodet has the highest esteem category poor of 107 people (63.7). Based o the depedet variable, for the variable maladaptive emotioal respose with the umber of 93 people (55.4) ad respodets with adaptive emotioal resposes were 75 people (44.6). While based o the Covariates, for Covariates variable, it shows the distributio which ca be see based o the age, obtaied respodets mostly categorized aged > 55 years of 107 (63.7), the average age of respodets was 9

3 55.66 years with the lowest age was 33 years ad the highest age was 72 years. By geder, most respodets were male with the umber of 105 people (62.5), whereas female respodets with the umber of 63 (37. 5). Based o educatio, more respodets had low educatio with the umber of 88 people (52.4), while respodets with higher educatio were 80 people (47.6), ad based o the occupatio more respodets were employed with the umber of 124 people (73.8), while the respodet was uemployed were 44 (26.2). Most ethic tribes were Madura (32.7). TABLE II. TABLE 2. THE ANALYSIS OF THE RELATIONSHIP BETWEEN FAMILY SUPPORT AND EMOTIONAL RESPONSE Iformatioal Emotioal Respose Adaptive Maladapti ve pvalue OR (95 CI) o sigificat relatioship betwee the istrumet ad the emotioal respose. Based o the aalysis of the relatio betwee family support ad emotioal respose, it shows that there were 3 people (4.9) were good esteem o the adaptive emotioal respose, while the poor esteem were 72 people (67.3) o the adaptive emotioal respose. The statistical test result was obtaied by value p = ; hece, it ca be cocluded there is a sigificat relatioship betwee the esteem ad the emotioal respose. TABLE III. TABLE 3. THE ANALYSIS OF THE RELATIONSHIP BETWEEN THE CONFOUNDING FACTOR AND THE EMOTIONAL RESPONSE Emotioal Respose Adaptive Maladapti ve pvalue OR (95 CI) < 55 Years Old ( ) > 55 Years Old Geder Female ( ) Male Low ( ) High Uemployed ( ) Employed Betawi & Jawa ( ) Batak & Madura Age , ( ) Emotioal ( ) Educatio Istrumetal ( ) Occupatio Esteem , ( ) Accordig to the table 2 the aalysis of the relatio betwee the family support ad the emotioal respose shows that there were 34 people (34.7) had better iformatio o adaptive emotioal respose, while the poor iformatio obtaied was 41 people (58.6) toward the adaptive emotioal respose. Statistical test result was obtaied by value p = 0.002; therefore, it ca be cocluded there is a sigificat relatioship betwee the iformatio ad emotioal respose. For aalysis of the relatioship betwee family support ad emotioal respose. Statistical test results was obtaied by value p = ; hece, it ca be cocluded that there is a sigificat relatioship betwee a emotioal with emotioal respose. For aalysis of the relatioship betwee family support ad emotioal respose shows that the statistical test result was obtaied by value p = 0.070; hece, it ca be cocluded there is Ethic Based o Table 3, the result aalysis of the relatioship betwee the cofoudig ad the emotioal respose i poststroke patiets i polycliic erves of RSUD Jakarta Utara obtaied that age, educatio, occupatio ad ethicity factor do ot have a sigificat relatioship to the emotioal respose because the p value> 0.05, while the geder factor has a sigificat relatioship because the p value was <0.05. For the aalysis of the relatioship betwee the age factor ad emotioal respose. The statistical test result was obtaied by p-value = 0.7; therefore, it ca be cocluded there is o sigificat relatioship betwee age ad emotioal respose. Based o the aalysis of the relatio betwee geder factor ad emotioal respose. The statistical test result was obtaied by p-value = 0.003; hece, it ca be cocluded that there is a 10

4 sigificat respose. relatioship betwee geder TABLE V. ad emotioal Based o the aalysis of the relatio betwee educatio factor ad emotioal respose. The statistical test result was obtaied by p-value = 0.594; hece, it ca be cocluded there is o sigificat relatioship betwee educatio ad emotioal respose. TABLE 4. THE SELECTION OF BIVARIATE INDEPENDENT VARIABLE AND CONFOUNDING P Value Coefficiet P value OR (95 CI) Geder -1,068 0,012 0,344 (0,149-0,791) -1,052 0,038 0,349 (0,1-0,943) 0,309 0,547 1,361 (0,499-3,713) 0,098 0,818 1,103 (0,478--2,548) -3,831 0,022 (0,006-0,083) Costata Iformatioal I Emotioal Istrumetal Esteem TABLE VI.. TABLE IV. variable Step Based o the aalysis of the correlatio betwee employmet status ad emotioal respose. The statistical test result was obtaied by p-value = 0,900; hece, it ca be cocluded there is o sigificat relatioship betwee geder ad emotioal respose. Based o the aalysis of the relatio betwee the ethic ad emotioal respose, it shows that there were people (40.8) of Betawi ad Jawa tribe o the adaptive emotioal respose, while the Batak tribe ad Madura were people (47.4) o the adaptive emotioal respose. The statistical test result was obtaied by p-value = As a result, the coclusio is that there is a sigificat relatioship betwee geder ad emotioal respose. TABLE 5. THE BEGINNING MODEL OF INDEPENDENT VARIABLES AND EMOTIONAL RESPONSE TABLE 6. FINAL MODEL OF INDEPENDENT VARIABLE AND EMOTIONAL RESPONSE Step coefficiet P Value OR (95 CI) Step Iformatioal ,034 0,345 (0,1-0,921) 0,261 0,603 1,9 (0,484-3,483) 0,192 0,645 1,212 (0,535-2,7) ,022 (0,006-0,084) Cofoudig Emosioal Age 0.7 Geder Educatio Istrumetal Occupatio 0.9 Ethic Esteem Idepedet Iformatioal Emotioal Istrumetal 0.07 Esteem Based o the Table. 4, the results of the bivariate aalysis p value for the variable were age (p = 0.7), geder (p = 0.003), educatio (p = 0.594), occupatio (p = 0.900), ethic (p = 0.391), iformatio (p = 0.002), emotioal (p = 0.000), istrumets (p = 0.070) ad esteems (p = 0.000). From these results, the coclusio is that there is a relatioship betwee geder, iformatio, emotioal, istrumetal ad reward has a value of p <0.25; Thus, these five variables ca eter ito multivariate modelig. However, age, educatio, employmet, ad error variables ca ot eter ito multivariate modelig because p> Costata From the results of the multivariate aalysis i Table 5 usig eter method, there are 3 steps to get the result. Multivariate aalysis is carried out with the iitial selectio to determie whether a variable ca be ivolved i the modelig. It obtaied the fourth biggest variable is geder (P.value = 0,012) who were subsequetly expelled from the secod modelig, the biggest variable 1,2 ad 3 are still ivolved i subsequet modelig ad will ot be omitted as a compoet of the variable family support i substace. The ext step is to simplify the model by testig aalysis of multivariate by observig chages i the value of OR i the variable by reducig the variable that its ifluece is ot exceeded sigificat, startig from the biggest p-value, if the chage is more tha 10 percet, the the variable is cosidered as cofouder Based o the fial model relatioship of family support ad emotioal respose i the post-stroke patiets, it is obtaied that 1) the respodet with good emotioal support had risk/probability of adaptive emotioal resposes as 1,9 times 11

5 compared to those havig poor emotioal support (95 CI: to 3483 ), 2) the respodet with good istrumetal support had risk/probability of adaptive emotioal respose as 1,212 times compared to poor istrumetal support (95 CI: ), 3) the respodet with good iformatioal support had risk/probability of adaptive emotioal respose as times compared to poor iformatioal support (95 CI: ) 4) respodets with good esteem support had risk / probability of adaptive emotioal respose as 0022 times compared to the poor esteem support (95 CI: ). The order stregth of family support compoet with the emotioal resposes of the most powerful is the emotioal support, istrumetal support, iformatioal support, ad esteem support. IV. DISCUSSION The relatioship betwee Emotioal support ad emotioal respose i the post-stroke patiets is very sigificat. I this study, it shows that there was a sigificat associatio betwee emotioal support ad emotioal respose i the post-stroke patiets usig statistical test result obtaied by the P value <0.05. The Relatioships ca be uderstood from the value of OR = 1,9 which meas that respodets with good emotioal support have a risk/probability of adaptive emotioal resposes 1,9 times tha those with poor emotioal support (95 CI: to 3483). Emotioal support had the strogest relatioship; this is possible because the emotioal is closely related to oe's emotioal respose. The joural ref [11] which states that the emotioal aspect eeds support of those who is closest to the family, i this case, is a requiremet cosidered as a very importat role i the process of recovery of the stroke patiet. Aother study coducted ref [12] states that there is a relatioship of emotioal support family ad hypertesio i the elderly behavior i cotrollig health. [2]) states that emotioal support is a importat aspect of the patiet ad ca affect fuctioal status. Family emotioal support will help cliets to achieve costructive copig [13]. Accordig to Roth as i [6] emotioal support is cosidered to reduce or prevet the stress effects ad improve metal health of a idividual or family directly. Reducig stress occurred is oe ecessary factor i the treatmet of post-stroke to achieve healig ad prevetio of recurrece. The relatios istrumetal support resposes i patiets with post-stroke. with emotioal I this study, it shows that there was a sigificat associatio betwee istrumetal support ad emotioal respose i the post-stroke patiets based o statistical test results obtaied by the P value < The relatioship ca be kow from the OR value = 1,212 which meas that respodets with good istrumetal support had risk/probabilities of adaptive emotioal respose as 1,212 times compared to the poor istrumetal support (95 CI: ). The results of research coducted by ref [14] states that the ifluece of the empowermet role of the family could icrease the idepedece of post-stroke cliets. Accordig ref [15] states that the family is a source of practical ad cocrete assistace for cliets both at home ad i the hospital. Istrumetal support is the domiat factor i the treatmet of post-stroke at home. That statemet is i lie with the statemet of ref [16] that he says the istrumetal support ad emotioal support are highly most beeficial for stroke patiets. Factors causig the istrumetal support of family as the domiat factor i carig post-stroke patiet at home ca be caused by the post-stroke remaiig symptoms. Cliets post-stroke usually experieced varyig dysfuctio, such as motoric dysfuctio, sesory dysfuctio, cogitive disorders, commuicatio disorders ad problem i swallowig as i [17]. The impaired fuctio ca be temporary ad permaet as i [4]. Iformatioal support relatioships ad emotioal resposes i patiets with post-stroke. I this study, it shows that there was a sigificat relatioship betwee the iformatioal support ad emotioal respose i post-stroke patiets usig statistical test result obtaied by the P values < Research by ref [12] stated there is a sigificat relatioship betwee the iformatioal support families ad behavior of elderly hypertesio i cotrollig the health. Provide positive iformatio ad advice to people who kow or do ot as i [18]. Families fuctio as collectors ad dissemiate iformatio because the iformatio provided ca cotribute to the idividual as i [15]. Activities udertake may iclude sharig resources (books, websites, the ame of the service provider), providig educatio o family members as eeded for the family members ad iformatio about group support. These fidigs show that iformatioal support provided by the family will affect family members. Therefore, i givig the iformatio by health officer also should ivolve the family. The atioal stroke associatio i the UK affirms that the importace of providig iformatio to families ad istitutios recommeds (1) Families eed to get iformatio because families are ivolved i decisio makig ad plaig, therefore Provide support to family members should be from the begiig (2) give iformatio to the families The Relatioship betwee esteem support ad emotioal respose i post-stroke patiets. I this study showed that there is a sigificat relatioship betwee the esteem support ad emotioal respose i poststroke patiets with statistical test results obtaied by the P values <0.05. Post-stroke cliets are ecouraged to carry o their hobby, do recreatio ad use of leisure time ad iteract with their frieds as i [1]. Iteract with their frieds is oe way of helpig the cliet havig a stroke to reduce their saturatio ad reduces the stress that ca occur as a result of the illess. The cliet should be valued o the ability he has doe because it will ecourage cliets to icrease his activity, icluded i social activities through participatio ad ivolvemet i the 12

6 activities udertake. Aggregate adult post-stroke are valued i coductig their activities ad coditio after a stroke will make them thik positively ad icrease the motivatio i their life activity. I adulthood, someoe usually has more attetio to the pursuit of work ad social, tryig to prove to their socioecoomic status as i [19]. V. [6] [7] [8] [9] CONCLUSION The study result of the relatioship betwee family support ad emotioal respose i post-stroke patiets i polycliic erve Koja Hospital - Jakarta Utara showed that the most respodets characteristics are categorized age > 55 years, the most geder was male, the low educatio ad employed. The research variables showed that most respodets had good iformatioal support, good emotioal support, poor istrumetal support, poor esteem support ad maladaptive emotioal respose. [10] [11] [12] [13] Family support (iformatioal support, emotioal support, istrumetal support ad esteem support) had a sigificat associatio with emotioal respose. Emotioal support had the strogest associatio with emotioal respose. [14] Cofoudig factors are age, geder, educatio, employmet ad the tribe did ot have a sigificat relatioship to a emotioal respose. [16] Health public ceters ad hospitals as a health care istitutio i geeral ad ursig care istitutios, i particular, ca develop service to improve family support, especially iformatioal support, emotioal support, ad esteem support i carig for stroke patiets so that they ca defed emotioal respose adaptively. As a professioal health caretaker, it is the obligatio to educate ad do a couselig to patiets ad families. [15] [17] [18] [19] B. & J. Friedma, M.M., Family ursig: Research, Theory, ad Practice, 5th ed. Coecticut: Appleto & Lage, E.. Friema, M.M., Bowde, V.R., & Joes., Family Nursig: Research, theory & practice (6th ed). Coeticut: Appleto & Lage, M.. Busta, Epidimiologi peyakit tidak meular. Jakarta: Rieka Cipta, C. Damayati, Megatasai masalah emosioal bagi pasie pasca stroke., [Olie]. Available: Jural http.lotar.ui. [Accessed: 01Dec-2011]. S. Sastroasmoro, S., & Ismael, Dasar dasar metodologi peelitia kliis. Edisi 3. Jakarta. Jakarta: sagug seto, Gross da Joh, Idividual Differeces i Two Emotio Regulatio Processes: Implicatios for Affect, Relatioships, ad Well-Beig., J. Pers. Soc. Psychol., vol. 85, o. 2, p , Yaslia, Hubuga dukuga keluarga, program pemulaga dari RS da karakteristik klie dega perawata di rumah pada aggregate dewasa pasca stroke di kota Bukit Tiggi., Lewis Hughes, A Guide for Traiig Voluteers (Part A), [Olie]. Available: Miarti, Pegaruh pemberdayaa klie da keluarga dalam melakuka rehabilitasi fisik terhadap kemadiria klie pasca stroke di kota Surabaya., Tidak dipublikasika, J. R. et al. Kaakie, Family Health Care Nursig: Theory, Practice & Research., 4th Editio. Philadelphia: : Davis Compay., P.. Boomar, Promotig Health I Families Applyig Familily Research & Theory To Nursig Practice. Welmigto: Sauders. Hudak & Gallo, Keperawata Kritis, edisi VI. Jakarta: EGC, S. E. Taylor, Health Psychology. Sigapore: Mc Graw Hill. Ic, A.. Potter, P.A, Perry, Buku Ajar Fudametal Keperawata : Kosep, Proses, da Praktik..Volume 2.Alih Bahasa : Reata Komalasari,dkk., Edisi 4. Jakarta: EGC, Educatioal istitutios ca use the results of this study as oe of the studies that are beeficial to the learers ad ca develop ursig care i stroke patiets with the attetio ad icrease collaborative approach with the family to maitai adaptive emotioal respose i stroke patiets. This study has resulted i a umber of data which ca be used as a referece for other researchers to develop ad carry out more research o the emotioal respose i stroke patiets with other quatitative ad qualitative research such as mixed methods research or cohort study desig. REFERENCES [1] [2] [3] [4] [5] B.. Smelzer, S.C.,M Bare, Bruer & Suddart : Textbook of medical surgical ursig, 10 th editio. Lippicott William & Wilkis, S. Notoatmodjo, Pegatar Pedidika Kesehata da Ilmu Perilaku. Jakarta: Rieka Cipta., C. M. Meurer, F.A., & Smith, Commuity Public Health Nursig Practice: Health for families ad populatio (3 t ed). Baltimore: Elsevier Sauders., S.. Lumbatobig, Stroke Becaa Peredara Darah Otak. Jakarta: Fakultas Kedoktera UI, S. Kae et al., Limits ad opportuities to commuity health worker empowermet: A multi-coutry comparative study, Soc. Sci. Med., vol. 164, pp , Sep