TUGAS KEPERAWATAN LANJUT II PENERAPAN KEPERAWATAN LANJUT PALLIATIVE CARE : HOSPICE, PALLIATIVE HOME CARE, PALLIATIVE COMBINED CARE
KATA PENGANTAR
Pui s$u#ur atas #e'a&irat Alla' $a,g a'a Esa atas segala ra'at &a, #aru,ia$a se'i,gga a#ala' 4Pene!"!n Ke"e!#!$!n L!n%&$ P!''(!$()e C!e : H*+"(e, P!''(!$()e H*-e C!e, P!''(!$()e C*-.(ne/ C!e &a6at
selesai 6a&a 7a#tu,$a. a#ala' i,i &i8uat u,tu# ee,u'i tugas Ke6era7ata, La,ut . Kai sela#u 6e,ulis e,$a&ari 8a'7a tia&a sesuatu $a,g se6ur,a &i &u,ia i,i 8egitu 6ula a#ala' $a,g tela' #ai 8uat i,i 8ai# &la segi isi au6u, 6e,ulisa,,$a. Kriti# &a, sara, sa,gat #ai 'ara6#a, &ei #ese6ur,aa, #ese6ur,aa, a#ala' #ai sela,ut,$a. era#'ir era#'ir 6e,$usu, 8er'ara6 agar a#ala' i,i &a6at e8eri#a, e 8eri#a, 6e,geta'ua, &a, 8era,faat 8agi seua ;al, 6era7at &a, as$ara#at 6a&a uu,$a.
DAFTAR ISI Kata Pe,ga,tar
uusa, asala' 1.3 uua, 1.! a,faat BAB 2 ?A=A P=SAKA 2.1 Pe,gertia, 6era7ata, 6aliatif 2.2 uua, Pera7ata, Paliatif 2.3 Sasara, 6era7ata, Paliatif 2.! e6at Pera7ata, Paliatif 2.! Pela#sa,a Pera7ata, Paliatif 2.! i,&a#a, Pera7ata, Paliatif 2.! i
Per
Paliatif
i ii
1.1 LAA> BELAKA@ Pe,$a#it #a,#er eru6a#a, sala' satu 6e,$a#it ti&a# e,ular $a,g e,a&i asala' #ese'ata, as$ara#at 8ai# &i &u,ia au6u, &i ,egara 8er#e8a,g se6erti ,&,esia. e,urut +HO &a, Ba,# < et al 200-). Pr6rsi #ea&ia, #a,#er &i &u,ia $a,g le8i' ti,ggi tera&i &i &aera' #ura,g
e,$e8u'#a, 6e,g8ata, 'a,$a 8ersifat e,;ega' #ea&aa, se a#i, e8uru#. =,tu# itu &i'a&ir#a, 6era7ata, 6aliatif se8agai 6e,u,a,g &isa6i,g 6e,a,ga,a, &i8i&a,g e&is. e,urut +HO ta'u, 2013 6era7ata, 6aliatif a&ala' 6e,&e#ata, u,tu# e,i,g#at#a, #ualitas 'i&u6 6asie, &a, #eluarga ere#a e,g'a&a6i asala' ter#ait &e,ga, 6e,$a#it $a,g e,ga,;a i7a elalui 6e,;ega'a, se6ur,a &a, 6e,g8ata, rasa sa#it &a, asala' lai, fisi# 6si#ssial &a, s6iritual. Pasie, 6aliatif a&ala' ra,g $a,g se&a,g e,&erita sa#it &ia,a ti,g#at sa#it,$a tela' e,;a6ai sta&iu la,ut se'i,gga 6e,g8ata, e&is su&a' ti&a# u,g#i, &a6at e,$e8u'#a, lagi. Ole' #are,a itu 6era7ata, 6aliatif 8ersifat ere&a#a, geala 6e,$a#it 8u#a, 8erfu,gsi u,tu# e,$e8u'#a,. ?a&i fu,gsi 6era7ata, 6aliatif a&ala' e,ge,&ali#a, ,$eri $a,g &irasa#a, serta #elu'a, #elu'a, lai,,$a &a, ei,ialisir asala' esi ssial &a, s6iritual $a,g &i'a&a6i 6asie, (ea7i,ata 2000 &ala 'usairi 2001). Pe,elasa, terse8ut e,gi,&i#asi#a, 8a'7a 6asie, 6li 6era7ata, 6aliatif
ea,g sala' satu 6erala,a, &ala re,ta,g #e'i&u6a, a,usia $a,g 6asti a#a, tera&i. A#a, teta6i 6rses e,uu #e6a&a #eatia, asi,gasi,g i,&i*i&u ti&a# a#a, a&a $a,g saa. Pasie, 6aliatif sea#a,a#a, &i'arus#a, e,g'a&a6i 6rses #eatia, &e,ga, se8ua' 6e,&eritaa, $a,g sa,gat 8erat #are,a ere#a 'arus e,&erita sa#it ,$eri $a,g sa,gat 'e8at. Sea#i, laa re,ta,g asa sa#it ere#a se8elu ati e8uat sea#i, 8erat 8e8a, 6si#lgis ere#a e,g'a&a6i 6rses #eatia,.
13 T&%&!n Pene'($(!n 131 T&%&!n U-&-
e,ga,alisis 6e,era6a, 6aliatif &i i,&,esia 132T&%&!n K&+&+
1. 2. 3. !.
e,geta'ui #,se6 6era7ata, 6aliatif. e,geta'ui 6e,era6a, 6era7ata, 6aliatif &i luar ,egeri. e,geta'ui 6e,era6a, 6aliatif &i ,&,esia. e,gi&e,tifi#asi 6e,ge8a,ga, i,*asi 6era7ata, 6aliatif &i ,&,esia.
13 M!n!!$ Pene'($(!n
1)
#eatia, &a, e,a,ga,i #e'ila,ga,. Se8agai refle#si &ari #elu'a, 6asie, 6e,garu' 6e,$a#it &a, 6e,garu' &ari as6e# i,&i*i&u (#). uua, &ari 6era7ata, 6aliatif a&ala' e8eri#a, &u#u,ga, &a, 6era7ata, 6a&a 6asie, &ala sta&iu a#'ir &ari 6e,$a#it se'i,gga utu 'i&u6 6asie, ti,ggi &a, ,$aa, (>8ert 1995). 23 S!+!!n Pe!#!$!n P!'(!$( Seluru' 6asie, (&e7asa &a, a,a#) &a, a,ggta #eluarga li,g#u,ga, $a,g eerlu#a, 6era7ata, 6aliatif &i a,a 6u, 6asie, 8era&a &i seluru' ,&,esia. Pera7ata, 6aliatif ti&a# se#e&ar te,ta,g #a,#er 6era7ata, i,i sea#i, 8a,$a# &ila#u#a, u,tu# 6asie, $a,g e,galai segala a;a 6e,$a#it &ege,eratif isal,$a A
ela#u#a, 6era7ata, 6aliatif a&ala': a. >ua' sa#it : =,tu# 6asie, $a,g 'arus e,&a6at#a, 6era7ata, $a,g eerlu#a, 6e,ga7asa, #etat ti,&a#a, #'usus atau 6eralata, #'usus. 8. Pus#esas : =,tu# 6asie, $a,g eerlu#a, 6ela$a,a, ra7at ala,. ;. >ua' si,gga'6a,ti ('s6is) : =,tu# 6asie, $a,g ti&a# eerlu#a,
217 T("e Pe'!8!n!n Pe!#!$!n P!'(!$(
es#i6u, 8erf#us 6a&a 6ela$a,a, &i rua' se8agia, 8esar 6ela$a,a, 6era7ata, 6aliatif 6a&a =K e$ara,#a, u,tu# : 1. Pera7at s6e;ial home care. 2. K,sultasi : &i rua' &e,ga, 6ra;tisi,er uu 6a&a 8a,gsal &a, rua' sa#it. 3. Pasie, ra7at ala,. 4. Day care. 5. Pasie, ra7at i,a6. 6.
Pe,&i&i#a, &a, 6e,elitia, Belaar te,ta,g 8agaia,a era7at le8i' 8ai# 8agi 6asie, $g ati. e,urut ,ati,al i,stitute fr ;li,i;al e;elle,t ta'u, 200! 8er&asar#a,
6el,elitia, D6e,elitia, se8elu,$a a&a 8e8era6a 6era7ata, 6aliatif $a,g 8isa &itera6#a, $a#,i : 1. r&i,ate f ;are Bu#ti &asar : ela' a&a stu&i 13 i,&i*i&u $a,g &ila#u#a, i,ter*e,si u,tu# e,i,g#at#a, #r&i,asi 6ela$a,a,.seua stu&i i,i 8er#ualitas 8ai#. E,a stu&i $a,g &ila#u#a, &i i,ggris satu &i s#tla,&ia &ua &i aeri#a utara satu &i #a,a&a &ua &i ,r7egia &a, satu &i 8ela,&a. ?e,is i,ter*e,si : a&ala' i,ter*e,si $a,g &ira,;a,g u,tu# era,gsa,g 6e8elaara, a#tif &e,ga, e,e6at#a, sis7a &ala 'u8u,ga, satu sis7a satu 6asie, 6a&a #a,#er $a,g e,ala,i tera6i a#tif atau 6era7ata, 6aliatif. Prgra 6e,&i&i#a, $a,g &ita7ar#a, se8agai 8agia, &ari i,ter*e,si u,tu# 6ara 6rfesi,al as$ara#at .i,ter*e,si i,i &if#us#a, 6a&a 6era7ata, &i rua'. ?r&'$ e,era6#a, i,ter*e,si 6era7ata, 6aliatif e,$e&ia#a, la$a,a, u,tu#
3.
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e,$e&i'#a,. erasu# e8eri#a, #a8ar 8uru# #e6a&a 6asie,. / Ketera6ila, #u,i#asi #eti#a 8er'a&a6a, &e,ga, 6asie, #a,#er $a,g
sa#it 6ara'. e efasilitasi #u,i#asi a,tara 6asie, &a, 6rfesi #ese'ata, lai,
terasu# se;ara tertulis e6er#e,al#a, et&e ulti&isi6li, 6ra#tif
e Se8ua' re#aa, geser 6ersia6a, u,tu# e,&i&i# 6asie, se8elu 6r;e&ures
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9 Se8ua' *i&e 6e,&i&i#a, u,tu# &i8a7a 6ula,g setela' #,sultasi 6ertaa. ele6, 8a,tua, u,tu#
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5 Se8ua' ti i,ter&isi6li,er $a,g e,$e&ia#a, i,frati, '
,ter*e,si 6era7at $a,g terstru#tur
5. Ps$;'lgi;al su66rt ser*i;e ?e,is i,ter*e,si : ,ter*e,si 6si#lgis 8agi 6e,&erita #a,#er ea,faat#a, 6e,&e#ata, $a,g 8er8e&a:
/ Siegel e,ge8a,g#a, i,ter*e,si $a,g ter&iri &ari siste tele6,
6e,a,g#aua, tatis &ita8a' &e,ga, 8a,tua, 6e#era ssial te6at 7a#tu. e e,&r,g 6asie, ela6r#a, #e8utu'a, 6era7ata, #a,#er #ualitas 'i&u6
&a, i,ter*e,si 6si#ssial terse&ia 8agi ti 6era7ata, #ese'ata,
e,a7ar#a, &u#u,ga, i,ter*e,si 6a&a &aera' $a,g au' &ari 6era7ata, e&is sta,&ar 6rgra i,i se;ara ruti, eli8at#a, la$a,a, &u#u,ga, 6si#ssial &e,ga, 6e,g8ata, e&is.
9 K,selr ,#lgi e8eri#a, &u#u,ga, &a, i,frasi selaa ra7at i,a6 Sera,g 6e#era ssial e8eri#a, #r&i,asi &a, #,ti,uitas 6ela$a,a,
a,tara rua' sa#it &a, as$ara#at. /. S6iritual su66rt ser*i;e ?e,is i,ter*e,si : re*ie7 sisteati# ;;'ra,e e6u,$ai 8$e# s6esifi# u,tu# eli'at efe#ti*itas &ala 8er&a se8agai i,ter*e,si ta8a'a, 6a&a asala' #ese'ata, 6a&a ra,gra,g $a,g su&a' e,eria sa,&art la$a,a,a, e&is. Se8ua' re*ie7 literatur &a, 'u8u,ga, a,tara 6e#era 's6i;e &a, ulaa &i a7al ta'u, 90a, u,tu# e,gerti e*aluasi &ari teri &a, 6ra#te# &ari
! i s6esialis 6era7ata, 6aliatif 8e#era &ala 6era7ata, &i rua'
6era7ata, rua' sa#it u,it ra7at i,a6 &a, 's6i;es ra7at i,a6 ter6a&u. .
as6e# 6era7ata, se&a,g#a, &ala 6era7ata, ,egara lai, &i8agi a,tara ti 6era7ata, 6aliatif &a, 6rfesi,al lai,,$a. S6esialis la$a,a, tera6i 6aliatif S6esialis 6era7ata, 6aliatif 'ari &i&efi,isi#a, se8agai la$a,a, $a,g e,i,g#at#a, #ea,&iria, &a, #ualitas 'i&u6 6asie, elalui re'a8ilitasi tera6i #u6asi fisitera6i 6e,gellaa, &a, 6ea,taua, geala &a, 6e,$e&iaa, &u#u,ga, 6si#ssial. Hal i,i &iatur &ala #,te#s i,tera#si ssial sali,g e,&u#u,g &a, 6ersa'a8ata, &a, &a6at e8eri#a, 8e8era6a 6era7ata, fisi# &a, ta,ggu'. 10. >e'a8ilitati, ser*i;es i6e i,ter*e,si : >e'a8ilitasi #a,#er ti&a# &a6at &i8agi #e &ala #ategri #are,a ere#a seri,g ea,faat#a, #8i,asi i,ter*e,si $a,g 8er8e&a:
11. 6lee,tar$ t'era6$ ser*i;es i6e i,ter*e,si
!) i,aua, sisteatis $a,g &ila#u#a, le' fell7es eeri#sa 8u#ti8u#ti u,tu# efe#ti*itas aratera6i &a, 6iat &ala e,i,g#at#a, fisi# &a, #esea'teraa, 6si#lgis 6a&a 6asie, &e,ga, #a,#er. Se8ila, stu&i $a,g &iserta#a, tuu' &i a,tara,$a se;ara a;a# ter#,trl. 5) @a8les eeri#sa 8u#ti u,tu# efe#ti*itas refle#slgi &ala e,i,g#at#a, fisi# &a, #esea'teraa, 6si#lgis 6a&a 6asie, &e,ga, #a,#er. iga stu&i terasu# &ala #aia, i,i $a,g #e&ua se;ara a;a# ter#,trl. ") >e*ie7 $a,g &ila#u#a, le' ;assilet' I 8r7, eeri#sa e,is 8at #a,#er $a,g ter8u#ti e,;a6ai 66ularitas &i aeri#a 8ersaa &e,ga, efe# sa6i,g,$a. >e*ie7 $a,g &ila#u#a, le' er,st &i8e&a#a, a,tara 6e,g8ata, #a,#er alter,atif (a;t) &a, 6era7ata, su6rtif 6ele,g#a6 (;s;) &a, uga &i&efi,isi#a, 6era, ere#a &ala a,aee, #a,#er &er, atas &asar 8u#ti $a,g &iter8it#a,. /) >e*ie7 $a,g &ila#u#a, le' tris8urg et al e,eliti efe# &ari 6e,g8ata, 6si#lgis 6a&a 6asie, #a,#er. Pe,elitia, i,i eli6uti 6e,g8ata, 6asie,
!. =,tu# e,;8a u,tu# e,gu8a' e#a,ise #e#e8ala, &e,ga, a#su& u,tu# e,i,g#at#a, 6rg,sis. a. +al#er ela#u#a, r;t (ra,& ;,trl trial) 6rs6e#tif u,tu# e,$eli&i#i efe# rela#sasi &i#8i,asi#a, &e,ga, ;itra &i6a,&u ter'a&a6 #ualitas 'i&u6 &a, res6, ter'a&a6 #etera6i 6rier a,tara 9" 7a,ita &e,ga, #a,#er 6a$u&ara $a,g 8aru &i&iag,sa 8esar atau sta&iu la,ut 8. Se8ua' 6e,elitia, ere,u,g#a, la$a,a, ,#lgi 6si#ssial 8agi 6ere6ua, &e,ga, 6a$u&ara #a,#er eusat#a, 6er'atia, 6a&a i&e,tifi#asi 6ere6ua, 6a&a risi# asala' 6si#lgis &a, #ei7aa,. Para 6e,ulis eli'at 6la 6erila#u 6e,;aria, 6e,g8ata, le' 6asie, &e,ga, #a,#er 6a$u&ara &a, 6e,ggu,aa, tera6i #6lee,ter. ;. Pe,elitia, le' ;l*er e,gga8ar#a, 6asie, #a,#er $a,g e,g'a&iri la$a,a, tera6i #6lee,ter &a, e,gu#ur &a6a#
1. e,gga8u,g#a, 6era7ata, rua' &a$ ;are &a, ta,ggu' &ie*aluasi se8agai la$a,a, tu,ggal. 2. Se8ua' 6rgra 6si#e&u#asi u,tu# 6e,gasu' #a,#er &ila#sa,a#a, le' 6era7at &a, 6e#era ssial &ie*aluasi $a,g &ituu#a, 6a&a a,aee, geala &u#u,ga, 6si#ssial &a, su8er &a$a i&e,tifi#asi. eua, e,g#,firasi sifat #r,is &a, ea#a, #a,#er 6e,gasu'a,. Pe,$e&iaa, 6era7at
31 Pe5e-.!n9!n Pe!#!$!n P!'(!$( /( D&n(!
Siste rga,isasi &ari assiasi ,asi,al su&a' sa,gat 8ai# $aitu 8eru6a fasilitas #u,i#asi a,tara 6e,ggu,a terasu# #,fere,si ,ati,al ta'u,a,. Peili'a, uu 6a&a ta'u, 200- &a, 6eru8a'a, 6eeri,ta' 8era,i a#a, e,i,g#at#a, &u#u,ga, u,tu# 's6i;e &a, 6aliatif ;are. Pela$a,a, 's6i;e 6ertaa &i Australia &i8u#a &i St. 'rist6'erJs &i L,&, (19"9) $a,g ter#ait &e,ga, sris' Sisters f 'arit$ f Hs6i;e &i S$&,e$ (1-90) &a, el8ur,e (193-).
a. Priar$ le*el 1. Pera7ata, 6rfesi,al 6aliatif 6asie, &i >S atau &i 's6i;e 2. Pasie, $a,g eerlu#a, 6e,g8ata, 6aliati* ;are ser*i;e teta6i ti&a# 8era&a &irua' sa#it atau 'e ;are. 3. Pe,&e#ata, ulti&is;li6li,ar$ &. Pera7ata, 6aliatif &i i,ggris Paliatif ;are &i i,ggris & i6el6ri le' &ae ;i;el$ sau&,ers 6a&a ta'u, 19"/.
Pela#sa,aa, 6era7ata, 6aliatif $a,g &ila#u#a, &i 6usat 6e,ge8a,ga, 6aliatif &a, 8e8as ,$eri &i >S S eili#i la$a,a, 6era7ata, 6aliatif. >S $a,g su&a' eili#i 6era7ata, 6aliatif &ia,tara,$a a&ala' : >S S i6t a,gu,#usu (?a#arta) >S #a,#er <'aris (?a#arta) >S +a'i&i, su&ir'us& (a#asar) >S S Sa,gla' (
e,;ega' &a, eri,ga,#a, 6e,&eritaa, elalui i&e,tifi#asi a7al &a, 6e,ilaia, serta tera6i rasa sa#it &a, asala' lai,D8ai# fisi# 6si#ssial au6u, s6iritual. Pera7ata, 6aliatif sa,gat 8er#e8a,g &i luar egara ,&,esia se6erti a,a&a Australia Er6a &a, ,ggris.
A,,$. 2012. ases f HG AK .6&f A,,$. HPO fa;t a,& figure : 's6i;e ;are i, Aeri;a. 2012 A,,i. 2012. Palliati*e He are. ,li,eM 'tt6:777.6alliati*e.rg,e76;a8ut7'atis's6i;e;are.'tl &ia#ses 6a&a ta,ggal 2- aret 2013 6u#ul 15.00 +B. A,,i. 2012. Pera7ata, Paliatif. ,li,eM. 'tt6:i;are;li,i;.;la$a,a, #ai6era7ata,6aliatif. I $le . 200/. et8# f Palliati*e ursi,g 2 ,& e&. e7 %r# : Ofr& 'as ?. Sis. 200/. Pers6e;ti*e , t'e e,& f life : 's6i;e ;are. 'tt6:777.e&s;a6e.;*ie7arti;le5!9/023.
An!'(+(+ P;I;C;O;T
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