Indah Mei Rahajeng

Bio: Indah Mei Rahajeng is an academic researcher from Udayana University. The author has contributed to research in topics: Psychology & Respondent. The author has an hindex of 2, co-authored 5 publications receiving 5 citations.

THE APPLICATION OF CLINICAL JUDGMENT AND DECISION MAKING OF CRITICAL CARE NURSES IN INTENSIVE CARE UNITS (ICUs)

Abstract: Background Intensive Care Unit (ICU) is the hospital setting in which applied specific application of clinical decision making and judgement. The critical patient conditions in ICU may drive nurses to make decision and clinical judgement in short period of time. The approach of clinical decision making which appropriate to be applied in the critical circumstances is important to be identified, thus it could become a guidance for novice and expert critical nurses. Aim The aim of this study was to explain how clinical decision making is applied in Intensive Care Unit (ICU) Method A systematic review of 22 articles was carried out, articles were retrieved from CINAHL, MEDLINE, PUBMED and DISCOVERED databases. The articles were critically reviewed and analized to answer this study's aim. Result The critically review of the articles were categorized in themes: 1) application of Tanner's clinical judgment model in ICU, 2) Types of decisions in ICU, 3) Theoretical approach: implementation of decision-making in ICU, 4) Case illustration of decision-making scheme in ICU, 5) Influencing factors of decision-making in ICU, 6) Supporting tools for clinical decision-making in ICU, 7) Understanding of attributes and concepts may enhance the quality of the clinical decision-making process in ICU, 8) Implications for nursing education and practice of understanding clinical decision making in ICU. Conclusions Critical care nurses usually combine different techniques in making decisions; analytical methods including the hypothetic-deductive method, pattern recognition, intuition, narrative thinking, and decision analysis theory are potentially applied. Clinical decision activities in ICU appear in many clinical situations, such as intervention decisions, communication decisions, and evaluation decisions. There are several factors influencing clinical decision-making in intensive care units, including nurses' experience, the patient's situation, the layout of the ICU, shift work, inter-professional collaboration practice, physical and personnel resources. The application of clinical decision making could be supported by systematic tools, and the nurses' knowledge about the concepts and attributes used in ICUs affect their clinical decision-making abilities. Keywords: clicinal decision making, critical care nurse, ICU

Clinical-immunological assessment failure on initial combination use of zidovudine-lamivudine nevirapine in children with HIV/AIDS at Sanglah Hospital Bali

Abstract: Background: Assessing clinical progression and CD4 + level were important in determining the efficacy of antiretroviral (ARV) and switching to other regimens, especially when viral-load data were not available. This research aims to assess combination of zidovudine-lamivudine-nevirapine (Co-ZLN) failure using WHO 2010 criteria on clinical failure (CF) and immunological failure (IF), single or together, to determine correlation between CF and IF; and to evaluate two failure categories (CF alone and combination of CF-IF) in making decision to switch to second-line of ARV. Methods: Children at Sanglah General Hospital, who gain initial treatment of Co-ZLN in period of March 2006–March 2013 were selected. Cross sectional study was applied. The ARV response was assessed twice. First period (P1) and second period (P2) of evaluation were conducted after patients received the Co-ZLN at least 6 and 12 months. Results: Forty five patients were included in this study. After at least 6 and 12 months of therapy, more patients showed IF (10 and 9 children in P1 and P2) than those in CF (4 and 2 patients in P1 and P2). Only one child met to CF-IF category in P2. The low clinical condition (HIV stage 4) did not always associate with deteriorating immunologic marker in the treatment-failure (TF). The patients who fit on CF and CF-IF based decision to switch regimen criteria were different. In resource-limited hospital, CF-IF based decision could give a better picture of patients’ condition and be used as an indicator to assess TF compared to single CF criteria.

Protecting families: A qualitative study on the implementation of protective measures to prevent COVID-19 transmission

Abstract: BACKGROUND: Health protocol compliance among family members can help curb the spread of COVID-19. However, not all families or family members can easily navigate the changes brought about by the pandemic;hence, minimizing virus transmission remains a challenge. AIM: Therefore, observing how families implement health protocols in daily life will reveal the challenges and opportunities, and inform public health policies. METHODS: We conducted a qualitative study by collecting data through phone interviews from November 2020 to February 2021. Eighteen families with a total of 30 individuals participated in this study. The interview data were transcribed verbatim and analyzed using thematic analysis. RESULTS: The analysis shows that participants were actively involved in implementing protective measures to prevent transmission among their family members. Five themes emerged from the data, namely fundamental concerns, restraints and constraints, pandemic roles, compromises, and intergenerational attitudes. The themes described the families’ lives during the pandemic, their efforts in protecting family members, and the dynamic within the families related to the implementation of COVID-19 protective measures. CONCLUSION: This study indicates that families could play a key role in both protecting and compromising the health of their family members. Families respond to the health crisis actively, but at times increase the risk to virus exposure because they have to continue going about their daily lives. © 2021 Ni Komang Ari Sawitri, Indah Mei Rahajeng, Luh Putu Eva Yanti, Ida Ayu Agung Novi Jayanti.

Hubungan dukungan sosial teman sebaya dengan prokrastinasi akademik pada mahasiswa keperawatan

Abstract: College students have a roles, responsibilities, various tasks and academic non-academic activities while studying in the university. These may cause them tend to delay on completing their task and assignments or it can be called academic procrastination. Peer social support is the one of important factors that may influence academic procrastination among college students. This study aimed to determine the correlation between peer social support with academic procrastination among nursing students at Udayana University. This study was a quantitative study with cross-sectional design. The research respondents were 160 nursing students at Faculty of Medicine in Udayana University, in 2, 4, 6, and 8 semester. The sampling technique was proportionate stratified random sampling. Data collection used a peer social support instrument adopted from Dinata (2019) and academic procrastination instrument adopted from Harkinawati (2019). Spearman Rank was used to analyze the data. The result showed that the description of peer social support in nursing students was mostly at the moderate level (77,5%), the description of academic procrastination in nursing students was mostly at the moderate level (97,5%), and there was a moderate and negative correlation between peer social support and academic procrastination in nursing students (r = -0,404; p = 0,000; ? = 0,05). Conclusion of this study is peer social support can affect academic procrastination. This research is expected to be a reference in minimize academic procrastination through health promotion programs to increase peer social support in nursing students.

Research ethics : a philosophical guide to the responsible conduct of research

Abstract: Education in the responsible conduct of research typically takes the form of online instructions about rules, regulations, and policies. Research Ethics takes a novel approach and emphasizes the art of philosophical decision-making. Part A introduces egoism and explains that it is in the individual's own interest to avoid misconduct, fabrication of data, plagiarism and bias. Part B explains contractualism and covers issues of authorship, peer review and responsible use of statistics. Part C introduces moral rights as the basis of informed consent, the use of humans in research, mentoring, intellectual property and conflicts of interests. Part D uses two-level utilitarianism to explore the possibilities and limits of the experimental use of animals, duties to the environment and future generations, and the social responsibilities of researchers. This book brings a fresh perspective to research ethics and will engage the moral imaginations of graduate students in all disciplines.

Lama rawatan dan mortalitas pasien intensive care unit (icu) rs dr. djamil padang ditinjau dari beberapa aspek

Abstract: Abstrak Intensive Care Unit (ICU) merupakan bagian yang sangat penting dari suatu rumah sakit. ICU sangat berperan dalam penatalaksanaan pasien dengan penyakit kritis dan segala komplikasinya yang meliputi ICU medik dan ICU bedah. Penatalaksanaan pasien ICU ini tidak hanya memerlukan keahlian dan keterampilan medis yang tinggi tapi juga memerlukan sarana dan peralatan dengan teknologi lebih tinggi dan relatif mahal. Oleh karena itu sangat perlu dipertimbangkan efektifitas biaya yang digunakan pada perawatan ICU, lama rawatan dan juga resiko martalitas. Penelitian ini merupakan studi retrospektif di ICU dan Bagian Anestesiologi dan Reanimasi RS M Djamil Padang dengan menggunakan data catatan medis pasien. Data-data dikumpulkan selama dua tahun sejak ICU baru di RS M Djamil digunakan (Periode Mei 2002-April 2004). Tujuan penelitian ini adalah untuk melihat bagaimanakah mortalitas dan lama rawatan pasien di ICU. Juga untuk melihat bagaimana hubungan antara umur pasien dan kelompok diagnosis dengan lama rawatan dan mortalitas. Ditemukan angka mortalitas pasien di ICU 25,6% dan lama rawatan yang lebih dari 7 hari 14,8% dari total 454 pasien. Ditemukan pasien dengan usia >50 tahun cendrung memerlukan rawatan lebih lama (p 50 tahun (p<0,05). Pada kelompok diagnosis gangguan kesadaran dan gangguan kardiovaskular-sirkulasi terlihat memerlukan rawatan lebih lama. Terlihat juga pada kelompok diagnosis gangguan kesadaran dan gagal nafas mempunyai angka mortalitas yang lebih tinggi. Namun tidak dapat disimpulkan apakah ada kecendrungan yang bermakna secara statistik pada kelompok diagnosis tersebut. Pasien anak-anak dan usia lanjut lebih rentan untuk jatuh pada kondisi yang buruk dibandingkan dengan kelompok usia lainnya. Disamping itu, pasien dengan gangguan kardiovaskuler, penurunan kesadaran dan gagal nafas juga membutuhkan perhatian khusus. Kata Kunci: Pasien ICU, lama rawatan dan mortalitas Abstract The Intensive Care Unit (ICU) is an important part of the hospital. The ICU is dedicated to manage patients with life-threatening illnesses, injuries, and complications. The services of ICU include medical and surgical intensive care area. The treatment for these conditions needs high tech, high skill, and expensive equipments. These have directly impacts on cost of the patients care. Therefore, it should be considered cost effective, length of hospital stay and risk of mortality. ARTIKEL PENELITIAN 143 A retrospective study was conducted in The Department of Anesthesiology and Intensive Care M Djamil Hospital. This study collected all of ICU patients in M. Djamil Hospital two year period since the new ICU in the hospital has been established (May 2002 – April 2004). The aim of the study is to look at mortality and length of hospital stay ICU patients. The study is also to determine correlation between age of patient, diagnosis related groups (DRG) and length of hospital stay and risk of mortality. In the study, there was found 14.8% patients which length of stay more than 7 days and 25.6% mortality rate from total 454 ICU patients. There was also tendency of old patients (more than 50 years) have more length of hospital stay (p<0.05). There was tendency of high mortality rate in age patients less than 10 years and more than 50 years (p<0.05). Length of hospital stay in DRG consciousness disorders and cardiovascular-circulations disorders were relatively higher than other diseases. The mortality rate in DRG consciousness disorders and respiratory failure were also relatively higher. However, it couldn’t conclude the tendency of some DRG to length of hospital stay and to mortality rate. Children and old patient are more vulnerable than other age groups if they are hospitalized in ICU. Also, the critical conditions with cardiovascular illnesses, consciousness disorders and respiratory failure need more special attention. Keywords: ICU patients, length of hospital stay and mortality

Causes of virological failure in a population of 1895 HIV-infected patients: the experience of an infectious diseases service in Lisbon, Portugal

Abstract: Despite the increasing optimization of combined antiretroviral therapy (cART) regimens in the last decades, a significant percentage of patients still do not achieve viral replication control. We present a retrospective analysis focusing on human immunodeficiency virus (HIV)-infected population on cART, followed at our ambulatory care clinic between 1st January and 31st December 2011, in order to identify the causes of virological failure. From the 1895 patients in our population we included 1854 in the study. Ten percent (187) of the included patients had detectable HIV RNA (≥40 cp/mL) at the time of last laboratory evaluation: 70,1% were males, mean age was 46 years and 72,7% were Portuguese. Patients with detectable HIV RNA were divided into group A (HIV RNA < 200 cp/mL) - 78 (41,7%) patients and group B (HIV RNA ≥200 cp/mL) 109 (58,3%) patients. The comparison of both groups revealed an higher mean count of TCD4+ (568 vs 334 cells/mm 3 ; p<0,001) in group A, although similar mean TCD4+ count at time of cART initiation (276 vs 262 cells/mm 3 ; p=0,412). Group A patients experienced longer exposure to cART (10 vs 8 years; p<0,05) and have undergone, on average, 3 previous regimens (p<0,05). With regard to cARV current regimen: 32,1% patients in group A and 30,3% in group B were prescribed non-nucleoside reverse transcriptase inhibitors based regimes and 51,3% patients in Group A and 59,6% in group B were under cARV based on Protease inhibitors. The identified causes of virologic failure for patients with detectable HIV RNA were: poor adherence (54%); unsuccessful retention in care (14,4%); sporadic detectable HIV RNA (40≤ viral load <200), "blips" (14,4%); mutations of resistance to ARVs (13,4%); intolerance to the current regimen (2,1%) and pharmacokinetics drug interactions (1,6%). The estimated rate of virological failure was 10,1% in this population. Insufficient adherence and unsuccessful retention in care were identified in 68,4% of treatment failed patients as main causes of virological failure. Failure of therapy due to intolerance or adverse effects was reported in 2,1% of cases, reflecting a better safety profile and tolerability of recent prescribed regimens. Early identification of causes of virologic failure, timely adjustment of therapeutic regimens, and the adoption of measures to promote adherence and retention in care are key factors for successful treatment of HIV-infected patients. (Published: 11 November) Citation: Abstracts of the Eleventh International Congress on Drug Therapy in HIV Infection Moneti V et al. Journal of the International AIDS Society 2012, 15 (Suppl 4):18065 http://www.jiasociety.org/index.php/jias/article/view/18065 | http://dx.doi.org/10.7448/IAS.15.6.18065