LAPORAN PENDAHULUAN PENDAHU LUAN ASUHAN ASUHA N KEPERAWA KEPERAWATAN PADA PASIE PASIE TERMINAL A. Peng Penger erti tian an 1. Pengertian Penyakit Terminal
Keadaan Terminal adalah suatu keadaan sakit dimana menurut akal sehat tidak tidak ada harapan harapan lagi lagi bagi si sakit sakit untuk untuk sembuh. sembuh. Keadaan Keadaan sakit sakit itu dapat dapat disebabkan oleh suatu penyakit atau suatu kecelakaan. Kondisi terminal adalah suatu proses yang progresif menuju kematian berjalan melalui suatu tahapan proses penurunan fisik, psikososial dan spiritual bagi individu (Kubler-Ross, 1!". Kondis Kondisii termin terminal al adalah adalah suatu suatu proses proses yang yang progre progresif sif menuju menuju kemati kematian an berjalan melalui suatu tahapan proses penurunan fisik, psikososial dan spiritual bagi individu (#arpenito, 1". $enyakit yang tidak dapat disembuhkan dan tidak ada obatnya, kematian tidak dapat dihindari dihindari dalam %aktu %aktu yang bervariasi. bervariasi. (&tuard (&tuard ' &undeen, &undeen, 1". $enyakit $enyakit pada stadiu stadium m lanjut lanjut,, penyaki penyakitt utama utama tidak tidak dapat dapat diobat diobati, i, bersi bersifat fat progresif, pengobatan hanya bersifat paliatif (mengurangi gejala dan keluhan, memperbaiki kualitas hidup". ( Tim Tim medis R& Kanker )armais, )armais, 1!" $ada stadium lanjut, pasien dengan penyakit kronis tidak hanya mengalami berbagai masalah fisik seperti nyeri, sesak nafas, penurunan berat badan, gangguan gangguan aktivitas aktivitas tetapi tetapi juga mengalami gangguan psikososi psikososial al dan spiritual spiritual yang mempengaruhi mempengaruhi kualitas kualitas hidup pasien dan keluarganya keluarganya.. *aka kebutuhan pasien pada stadium lanjut suatu penyakit tidak hanya pemenuhan+ pengobatan gejala fisik,, namun juga pentingnya dukungan terhadap kebutuhan psikologis, sosial dan spiritual yang dilakukandengan pendekatan interdisiplin yang dikenal sebagai pera%atan paliatif. ()oyle ' *acdonald, "
1
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$ada pasien penyakit terminal akan melalui fase / fase berduka akibat kekh%atiran kekh%atiran akan penyakitny penyakitnya. a. &ering &ering kali penyakit terminal memba%a efek psikologis terhadap klien, seperti kekha%atiran berlebihan akan penyakit atau kondisis yang akan dialami, serta keka%atiran akan kematian yang disebabkan oleh penyakitnya. penyakitnya. Kehilangan Kehilangan aspek diri biasanya biasanya dialami dialami oleh pasien terminal, terminal, akibat akibat kondisi kondisi tubuh tubuh yang yang semaki semakin n melema melemah, h, terjad terjadii penuru penurunan nan kemamp kemampuan uan fisik, dan diikuti perubahan citra tubuh, yang menyebabkan kehilangan pada aspek diri klien. $era%a $era%atan tan termi terminal nal dapat dapat dimula dimulaii pada minggu minggu-mi -minggu nggu,, hari-h hari-hari ari dan jaminan terakhir kehidupan dimana bertujuan0 1.
*empertahankan hidup
.
*enurunkan stress
.
*er *eringa ingank nkan an dan mempe memperrtaha tahank nkan an keny kenyam aman anan an sel selama ama mungk ungkiin
(eisman" &ecar &ecaraa umum umum kema kemati tian an adal adalah ah seba sebagi gian an pros proses es dari dari kehid kehidupa upan n yang yang dialami oleh siapa saja meskipun demikian, hal tersebut tetap saja menimbulkan perasaan nyeri dan takut, tidak hanya pasien akan juga keluarganya bahkan pada pad a mereka yang mera%at dan mengurusnya. $enderita yang akan meninggal tidak akan kembali lagi ke tengah keluarga, kenyataa kenyataan n ini sangat sangat berat berat bagi keluar keluarga ga yang yang akan diting ditinggal galkan kannya nya 2ntuk 2ntuk menghindari hal diatas bukan hanya keluarganya saja yang berduka bahkan klien lebih tertekan dengan penyakit yang dideritanya. 2. akt!r Pre"i#$!#i#i
a. 2sia b. 3ingkungan sosial dan budaya 4akt 4aktor or 5 is Kel Kel in
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g. 4akto 4aktorr 3am 3amaa Ra% Ra%at at 7nap 7nap h. 4akto 4aktorr #ari #aring ng $era $era%a %att %. Kla#i&ika#i
1 $enyakit $enyakit-pen -penyak yakit it kanker kanker stadiu stadium m akhir. akhir. $enya $enyaki kitt-pe peny nyaki akitt infe infeks ksi. i. #onge #ongest stif if Rena Renall 4al 4alur uree (#R (#R4" 4".. 8 &tro &troke ke *ult *ultip iple le &kl &kler eros osis is.. 9kib 9kibat at kece kecela laka kaan an fata fatal. l. ! 97)& : )iab )iabet etes es *il *ilit itus us Tipe 77 77 '. (e (e)a )ala la "an "an Tan"a *iri + *iri Penyakit Terminal
a. b. c. d. e. f.
$enyakit $enyakit tidak dapat disembuhkan disembuhkan *engarah pada kematian )iagnos )iagnosaa medis medis sudah sudah jelas jelas Tidak Tidak ada obat untuk untuk menyem menyembuhkan buhkan $rogn $rognos osis is jel jelek ek ;ers ;ersif ifat at progr progres esif if
i#ik
a.
dan ujung jari 9ktifitas dari <7 berkurang Reflek Reflek mula mulaii menghi menghilan lang g Kulit Kulit kebir kebiruan uan dan dan pucat pucat )enyut )enyut nadi tidak teratur teratur dan lemah =afas =afas berbun berbunyi yi keras keras dan cepat cepat ngoro ngorok k $engli $englihat hatan an mulai mulai kabur kabur Klien Klien kadang-kadang kadang-kadang keliha kelihatan tan rasa rasa nyeri nyeri Klien Klien dapat dapat tidak tidak sadar sadarkan kan diri diri
P#ik!#!#ial
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a.
Re#$!n ke,ilangan
1" Rasa takut diungkapkan dengan ekspresi ekspresi %ajah , keakutan, cara tertentu untuk mengatur tangan " #emas diungkapkan dengan cara menggerakan otot rahang dan kemudian mengendor " Rasa sedih diungkapkan dengan mata setengah terbuka + menangis -.
H-ngan "engan !rang lain
Kecemasan timbul akibat ketakutan akan ketidakmampuan untuk berhubungan secara interpersnal serta akibat penolakan. )r.6lisabeth )r.6lisabeth KublerrRoss telah mengidentifikasi lima tahap berduka yang dap at terjadi pada pasien dengan penyakit terminal 0 1/ Denial 0 Pengingkaran /
Tidak Tidak percay percayaa telah telah terjad terjadii kehila kehilangan ngan.. Tidak Tidak siap siap mengat mengatasi asi masala masalah h praktis, seperti pasien yang mengalami penyakit terminal tidak siap atau tidak dapat menerima bah%a dirinya terkena penyakit terminal. ;iasanya klien dapat menunjukan keceriaan palsu sehingga memperlama penyangkalan. Reak#i $a"a a#e Denial P#ik!l!gi
a" b" c" d"
&yok Tidak percaya Tidak Tidak tahu tahu harus harus berbuat berbuat apa *engingkari *engingkari Kenyataan Kenyataan
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b" c" d" e" f" g" h" i"
3emah $ucat *ual )iare *enan enangi giss
$ada fase ini pasien pasien dapat mengarahkan mengarahkan kemarahan kemarahan kepada petugas petugas medis atau atau pera% pera%at at yang yang mela melaku kukan kan kegia kegiata tan n atau atau tind tindak akan an norma normall yang yang tidak tidak mengganggu mereka. Reak#i $a"a &a#e anger Perilak
a" b" c" d" e"
9gresif ;icara kasar *enye *enyerang rang oran orang g lain lain *enola *enolak k pengobata pengobatan n *enuduh *enuduh dokter atau atau pera%at pera%at tidak tidak kompeten kompeten
i#ik
a" b" c" d" e"
*uka *uka mera merah h )enyut nadi cepat
%/ 'argaining 'argaini ng 0Taar3Menaar/ 0Taar3Menaar/
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penyakitnya. Klien mengalami masa ketakutan akibat rasa bersalah atau dosa apabila dia mengalami kematian akibat penyakit terminalnya. 4/ De$reti!n 0 De$re#i /
4ase 4ase dima dimana na keti ketika ka klie klien n mengi menginga ngatt akan akan kondi kondisi si penya penyaki kitny tnya, a, dan dan memiki memikirka rkan n dan mendapa mendapatka tkan n tekana tekanan n dari dari kondisi kondisinya nya.. $ada fase fase ini klien klien biasanya mengingat hal / hal menarik dalam hidupnya, dan takut kehilangan semua momen atau hal tersebut apabila klien harus meninggalkan semuanya akibat penyakit terminal yang ia derita. Klien biasanya cenderung menutup diri, cemas, dan menangis, serta klien dapat menarik diri dari lingkungan sosial. Perilak
a" b" c" d" e" f"
*enunjukan *enunjukan sikap menarik menarik diri diri Kadang bersikap sangat penurut Tidak Tidak mau bicara bicara *enyatakan *enyatakan keputusasaan keputusasaan Rasa Rasa tidak tidak berhar berharga ga ;isa muncul muncul keingin keinginan an bunuh bunuh diri
(e)ala &i#ik
a" b" c" d"
menol menolak ak maka makan n susah tidur letih libid libido o turun turun 5/ A66e$tan6e 0 Penerimaan/
$ada $ada fas fase membutu membutuhka hkan n
ini bias biasan any ya
kli klien telah elah mener enerim imaa
kond kondiisiny sinya. a. Kli Klien
perhat perhatian ian dari orang / orang orang terdeka terdekatny tnya, a, untuk untuk memoti memotivas vasii
psikologis klien dalam menghadapi menghadap i penyakit terminal nya, dan juga menghadapi
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Reak#i $a"a &a#e a66e$tan6e 0
a" Reorganis Reorganisasi asi perasaa perasaan n kehilangan kehilangan b" $ikiran tentang objek yang hilang akan mulai berkurang atau hilang beralih ke objek baru. c" *enerima *enerima kenyataan kenyataan kehilangan kehilangan d" *ulai *ulai memandan memandang g ke depan.
*. P!,! P!,!n n Ma# Ma#al ala, a,
$enyakit Terminal
4ase )enial
4ase 9nger
4ase ;argaining
4ase )e resi
&yok
*arah
Ta%ar
ubungan
4ase 9cceptance
*enerima Kondisi
Sosial
*engingkari Kondisi
Takut 9kan )osa
*erasa
*empersiap
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4aktor 2sia
4aktor 6konomi
)ukacita
4aktor 3ingkungan &osial dan ;uda a
4aktor 5enis Kelamin
4aktor Tingkat $endidikan
4aktor $engetahuan
4aktor 3ama Ra%at 7nap
4aktor #aring $era%at
Kehilangan
Ketidak
Ketidak
efektifan
mampuan
koping
koping keluar a
D. Pemerik Pemerik#aan #aan Diagn!# Diagn!#tik tik
2ntuk 2ntuk mengkaji mengkaji pemenuha pemenuhan n kebutuh kebutuhan an pasien pasien menjel menjelang ang ajal. pemeriksaan diagnostik yang dapat dilakukan yaitu 0
5enis 5enis
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a. Kemu Kemund ndur uran an dal dalam am sen sensa sasi si.. b. #yanosis pada daerah ekstermitas. c. Kulit Kulit dingin, dingin, pertama pertama kali kali pada daerah daerah kaki, kemudia kemudian n tangan tangan,, telinga telinga dan hidung. . $emeri $emeriksa ksaan an tanda-t tanda-tand andaa vital vital $erubahan-perubahan tanda vital yaitu 0 a. =adi =adi lam lamba batt dan dan lema lemah. h. b. Tekanan Tekanan darah turun. c. $ernaf $ernafasa asan n cepat, cepat, cepat dangka dangkall dan tidak tidak teratu teratur. r. 8. $eme $emeri riks ksaan aan &enso &ensori riaa
9suhan pera%atan klien terminal tidaklah mudah. $era%at membantu klien klien untuk untuk meraih meraih kembal kembalii martab martabatn atnya. ya. $era%a $era%att dapat dapat berbag berbagii penderitaan klien menjelang ajal dan melakukan intervensi yang dapat meningkatkan kualitas hidup, klien harus dira%at dengan respek dan perhatian penuh. )alam melakukan pera%atan keluarga dan orang terdeka terdekatt klien klien harus harus diliba dilibatka tkan, n, bimbin bimbingan gan dan konsult konsultasi asi tentan tentang g pera%atan diperlukan.
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$emb $ember eria ian n keny kenyam amana anan n bagi bagi klie klien n term termin inal al juga juga menc mencaku akup p pengendalian gejala penyakit dan pemberian terapi. Klien mungkin akan bergantung pada pera%at dan keluarganya keluarganya untuk pemenuhan kebu kebutu tuha han n
dasa dasarn rny ya,
sehi sehing ngga ga
pera pera%a %att
bisa bisa
membe emberi rika kan n
bimbingan dan konseling bagi keluarga tentang bagaimana cara memberikan kenyamanan pada klien. " $emeli $emelihar haran an Kemandi Kemandiria rian n Tempat mpat pera% pera%at atan an yang yang tepat tepat untu untuk k pasi pasien en term termin inal al adal adalah ah pera%atan intensif, pilihan lain adalah pera%atan hospice hospice yang memungkinkan memungkinkan pera%atan komprehensi komprehensiff di rumah. rumah. $era%at $era%at harus memberikan informasi tentang pilihan ini kepada keluarga dank lien. &ebagian besar klien terminal ingin mandiri dalam melakukan akti aktivi vita tasn sny ya.
*eng *engi@ i@in inka kan n
pasi pasien en
untu untuk k
mela melaku kuka kan n
tuga tugass
sederhana sederhana seperti seperti mandi, mandi, makan, makan, membaca, membaca, akan meningkatka meningkatkan n martabat martabat klien. klien. $era%at $era%at tidak boleh memaksakan memaksakan partisipas partisipasii klien terutama terutama jika ketidakmam ketidakmampuan puan secara secara fisik fisik membuat membuat partisipas partisipasii tersebut menjadi sulit. $era%at bisa memberikan dorongan kepada keluarga untuk membiarkan klien membuat keputusan. " $encega $encegahan han Kese Kesepia pian n dan 7solas 7solasii $era%at membutuhkan kesabaran dan pengalaman untuk merespon secara secara efekti efektiff terhada terhadap p klien klien menjel menjelang ang ajal. ajal. 2ntuk 2ntuk mencega mencegah h kesepi kesepi
dan
imp
i,
t
ginter ginter
i
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$eningkatan $eningkatan ketenangan spiritual spiritual mempunyai mempunyai arti lebih besar dari sekedar meminta rohania%an. Ketika kematian mendekat, Klien sering mencari ketenangan. $era%at dan keluarga dapat membantu klien mengekspresikan nilai dan keyakinannya. Klien menjelang ajal mungkin mencari untuk menemukan tujuan dan makna hidup sebelum menyerahkan diri kepada kematian. Klien mungkin minta pengampunan baik dari yang maha kuasa atau dari anggota keluarga. &elain kebutuhan spiritual ada juga harapn dan cinta, cinta cinta dapat dapat dieksp diekspres resika ikan n dengan dengan baik baik melalu melaluii pera%a pera%atan tan yang yang tulus dan penuh simpati dari pera%at dan keluarga. $era%at $era%at
dan keluarga keluarga memberika memberikan n ketenangan ketenangan spiritual spiritual dengan
menggun menggunaka akan n ketram ketrampil pilan an komunik komunikasi asi,, empati empati,, berdoa berdoa dengan dengan klien, membaca kitab suci, atau mendengarkan musik. " )ukunga )ukungan n untuk untuk keluar keluarga ga yang yang berduka berduka 9nggota 9nggota keluarga keluarga harus didukung mele%ati %aktu menjelang menjelang ajal dan kemati kematian an dari dari orang orang yang yang merek merekaa cintai cintai.. &emua &emua tindak tindakan an medi medis, s, peral peralat atan an yang yang digu digunak nakan an pada pada klie klien n haru haruss diber diberik ikan an penjelasan,
seperti
alat
;antu
nafas
atau
pacu
jantung.
Kemungkinan yang terjadi selama fase kritis pasien terminal harus dijelaskan pada keluarga. -. Pr!#e"r Pr!#e"r 'im-ingan 'im-ingan "an "an K!n#eling K!n#eling $a"a $a#ien terminal
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$enyakit terminal menempatan tuntutan yang besar pada sumber social dan finansial. Keluarga mungkin takut berkomunikasi dengan klien, banyak hal sulit yang dialami keluarga untuk mengatasi kondisi angg anggot otaa kelua keluarg rgany anyaa yang yang term termin inal al.. >al >al ini ini menc mencaku akup p lama lamany nyaa periode menjelang ajal, gejala yang sulit dikontrol, penampilan dan bau yang tidak menyenangkan, sumber koping yang terbatas, dan buruknya hubungan dengan pemberi pera%atan. 9lternatif 9lternatif pera%atan bisa dilaksanakan di rumah, dikenal dengan $era%atan Hospice. $era%atan Hospice. $era $era%a %ata tan n Hospice adalah adalah progra program m pera%a pera%atan tan yang yang berpus berpusat at pada keluarga yang dirancang untuk membantu klien terminal dapat hidup nyam nyaman an
dan dan
memp memper erta taha hank nkan an gay gaya
hidu hidup p
seno senorm rmal al mung mungki kin n
sepanjang proses menjelang ajal. &ebagian besar klien dalam program hospice mempunyai hospice mempunyai %aktu hidup ! bulan atau kurang. $rogram ini dimulai di 7rlandia tahun 1A:, yang kemudian di 7nggris, amerika, dan #anada pada tahun 1:-an. Komponen $era%atan Hospice $era%atan Hospice yaitu:
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pera%atan
primer,
pemberian
medikasi
dan
pengobatan,
tim
interdisiplin memberikan sumber psikologis dan fisik yang diperlukan untuk mendukung keluarga. -. Si#t Si#tem em R) R)k kan an
)ala )alam m
pela pelay yanan anan ruju rujuka kan, n, ruju rujuka kan n
pasi pasien en haru haruss
dibu dibuat at oleh oleh
penanggung ja%ab pera%atan. )iluar negeri Registered nurses (R=", mempunyai ke%enangan untuk merujuk pasien ke system pelayanan yang yang lebih lebih tinggi tinggi lagi. )alam )alam pera%a pera%atan tan pasien pasien di rumah, rumah, syste system m rujukan bisa dibuat, dimana pera%atan klien oleh pera%at home care diba%ah diba%ah yurisdiksi yurisdiksi Registered Registered nurses nurses (R=". R= membuat membuat delegasi delegasi tuga tugass-tu tuga gass
pera pera%a %ata tan n
yang ang
haru haruss
dila dilaks ksan anak akan an oleh oleh pera pera%a %att
pelaksana yang telah mempunyai i@in (lisenced" dari lembaga ber%enang. $rinsip )elegasi+Rujukan0 1" $era $era%a %att pela pelaks ksan anaa seca secara ra hukum hukum berta bertang nggu gung ng ja%a ja%ab b langs langsung ung untuk mera%at klien.
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keny kenyam amana anan n
bagi bagi klie klien, n, peni pening ngkat katan an kema kemandi ndiri rian an,,
Kesepian dan 7solasi, peningkatan ketenagan spiritual. . Peng Pengka) ka)ian ian Ke$e Ke$era raat atan an
$engkajian terhadap identitas klien 1" " " 8" " !" :" A" " 1" 1" 11" 1" 1" 1"
=ama 2mur 5enis Kelamin 9gama &uku ;angsa 9lamat )B *edis &umber ;iaya &um &umber ber 7nfor nform masi asi =o . R * Tangga nggall *asu *asuk k Ruma Rumah h &aki &akitt Ruangan
$enc $encega egaha han n
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1" " " 8" " !" :" A" " 1" 11" 11" 1" 1" 18"
;ernapas *akan dan minum
e. *elakukan pemeriksaan fisik pada klien
f. *engkaji data penunjang klien
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" 4ase ;argainin ;argaining g (Ta%ar (Ta%ar *ena%ar" *ena%ar" $era%at dapat mengkaji gejala pada tahap bargaining (ta%ar mena%ar" yang ditunj ditunjukan ukan keluar keluarga ga klien klien pada saat saat mendeng mendengar ar kondisi kondisi klien klien dengan dengan penyak penyakit it terminal, yang kemudian dicocokan dengan tanda dan gejala pada fase ini sesuai teori. $ada fase ini pera%at masih bisa mengkaji klien dengan %a%ancara namun perhatikan kuantitas serta kulitas pertanyaan untuk menjaga kestabilan kondisi keluarga klien.
8" 4ase 4ase )epre )epresi si $era%at dapat mengkaji gejala pada tahap depresi yang ditunjukan keluarga klien pada saat mendengar kondisi klien dengan penyakit terminal, yang kemudian dicocokan dengan tanda dan gejala pada fase ini sesuai teori. $ada tahap ini pera%at dapat dapat mengka mengkaji ji keluar keluarga ga klien klien namun namun sediki sedikit, t, dan terkad terkadang ang tidak tidak mendapa mendapatka tkan n respon respon sebab sebab kondis kondisii keluar keluarga ga klien klien dalam dalam keadaan keadaan tertek tertekan, an, dan pera%a pera%att dapat dapat
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kehilangan yang aktual, adaptif, atau dipersepsikan kedalam kehidupan sehari / hari mereka. 'ata#an Karakteri#tik
1" " " 8" " !" :" A" "
$eru $eruba baha han n ting tingka katt akt aktivi ivitas tas $erubahan pola mimpi $erubahan fu fungsi im imun
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!" :" A" " 1" 11" 1" 1" 18" 1" 1" 1!"
Keti Ketida dakm kmam ampu puan an mem memen enuh uhii kebu kebutu tuha han n dasa dasar r Keti Ketida dak k mam mampu puan an meme memenu nuhi hi hara harapa pan n per peran an $eme $emeca caha han n mas masal alah ah yang ang tid tidak ak adek adekua uatt Kura Kurang ngny nyaa peril perilak aku u yang yang berf berfok okus us pada pada penc pencapa apaia ian n tujua tujuan n Kura Kurang ngny nyaa reso resolu lusi si masa masala lah h Kons Konsen enttrasi rasi buru buruk k *engun *engungkap gkapkan kan ketida ketidakma kmampu mpuan an memi meminta nta bantua bantuan n *engun *engungkap gkapkan kan keti ketidakm dakmamp ampuan uan untuk untuk mengat mengatasi asi masa masalah lah $enga $engamb mbil ilan an resi resiko, ko, gan ganggu gguan an tid tidur ur $eny $enyal alah ahgu guna naan an @at @at *enggu *enggunaka nakan n koping koping yang yang meng menggang ganggu gu peril perilaku aku adapt adaptif if
akt!r yang -er,-ngan
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A" " 1" 1" 11" 11"
$eri $erila laku ku kel kelua uarg rgaa yang yang meng menggan ganggu ggu kese keseja jaht hter eraa aan n $ermusuhan
1" 1" 18" 1" 1!" 1:" 1A"
sendiri 7ntoleran pera%a pera%atan tan yang yang mengaba mengabaika ikan n klien klien dalam hal hal kebutuha kebutuhan n dasar manus manusia ia hubunga hubungan n yang yang meng mengabai abaikan kan angg anggota ota keluar keluarga ga lain lain terlal terlalu u kha%ati kha%atirr terus terus meneru meneruss mengen mengenai ai klien klien psikosomatis penolakan mera merasa saka kan n tan tanda da penya penyaki kitt kli klien en
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serta
dalam
pekerjaan dan 9K&
empati
dan
terapeutik.
perhatian. 5ujur dan tepati semua janji " $e $erl rlih ihat atka kan n sika si kap p menerima
dan
membolehkan pasien
" &ikap menerima menunjukkan kepada pasien bah%a anda
untuk
yakin bah%a ia
mengekspresikan
merupakan
perasaannya
seseorang pribadi
secara
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motorik motor ik kasar (mis, joging, bola voli,dll" !"$engetahuan !" 9jarkan tentang tentang perasaantahap-tahap tahaptahap berduk berdukaa perasaan yang yang normal dan %ajar yang perilaku yang berhubungan berhubungan dengan dengan berduka setiap tahap. yang normal dapat menolong
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bah%a
menangis
merupakan hal yang dapat diterima.
menghadapi kehilangan "2mpan balik
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tent tentan ang g
kopi koping ng
meningkatkan
yang efektif
perasaan
kontrol
*engatakan
dan harga diri.
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nilai kehidupan
selama
situasi
krisis "2ntu "2ntuk k
menga mengata tasi si
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pasien " *eng *engha harrgai gai " *eme *emenu nuhi hi
kehidu kehidupan pan klien klien
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hubungan
untu untuk k
memb memban antu tu
yang positif
pera%atan
antara
pascahospitalisasi
8"*emb 8"*embant antu u
oran orang g
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