The Factors Related to the Level of Anxiety in the Regular Students of Nursing Science Program when Facing the First Clinical Practice

      
Created by: Dody Setyawan

     Anxiety is a subjective experience marked by restlessness or worry (worry, apprehensive expectation, anticitipatory anxiety) and vigilance. This phenomenon can be seen when someone is claimed to receive or do new things that have not been done before as the one experienced by regular students when facing the first clinical practice. Many factors affect the level of individual anxiety involving external factors such as potential stressor (unreadiness and fear), social cultural and environment and internal factors such as maturity, education, physical condition, personality type, age and gender. The goal of this research was to analyze the correlation between each of the factors related to the level of anxiety including age, personality type, unreadiness and fear towards the level of anxiety of regular students when facing the first clinical practice.

     The research was a quantitative research using correlational descriptive method with cross sectional approach using questionnaires as the research instrument. The population of this research were all the regular students of 2007 in health institution in which the samples were taken by purposive sampling method to 40 respondents in accordance with the inclution and exclution criteria defined by the researcher.

       The research result with SAI measurement using the Spearman test found p value ≤ 0.05 for the variable of age (p=0.038), using the Chi Square test was of p value < 0.05 for variable of personality type (p=0.009), unreadiness (p=0.013) and fear (p=0.019). Meanwhile, the measurement of TAI with Spearman test found p value > 0.05 for the variable of age (p=0.104) and with Chi Square test of p value > 0.05 for the unreadiness variable (p=0.074), p value < 0.05 for the personality type (p=0.019) and fear (p=0.020).

       The research concluded that based on the SAI measurement, there was a correlation between the level of students’ anxiety with the factors of age, personality type, unreadiness and students’ fear. Based on the TAI measurement, it was showed that there was no correlation between the level of students’ anxiety with the factors of age and students’ unreadiness. Further, there was correlation between the level of students’ anxiety with the factors of personality type and fear.

Need more information: send mail to dody_psikfkundip@hotmail.com

Yoga For Health

THE ADVANTAGE OF YOGA FOR HEALTH

(Picture Source: http://www.mindfulness-voorburg.nl/)

The healthy body have become the dream for all people in the world since  a long   time. To get a healthy body, we can go to the gymnastic place. Because it is be best choice for all people in this time. But by exercise the gymnastic we can only form physically of our body. It is not make our soul be healthier. To get good physic and healthy soul, there is a good alternative for us. It is by exercise yoga. Yoga is a practical aid, not a religion. Yoga derives its philosophy from Indian metaphysical beliefs. The word yoga comes from Sanskrit language and means union or merger ( union between the limited self and the Divine Self ). The aim of Yoga is not really to unite us with anything for we are already united. It is to help us realize our identity with the Divine Self, to make us know and tune into our intrinsic nature⁽³⁾. Yoga is an ancient art based on a harmonizing system of development for the body, mind, and spirit. To achieve this, yoga uses movement, breath, posture, relaxation and meditation in order to establish a healthy, lively and balanced approach to life⁽²⁾. Most people think that yoga just involved stretching and flexibility exercises, but there is more to yoga than just these, yoga is more about creating balance in the body and mind. The different poses in yoga has specific physical benefits. The practice of yoga makes the body strong and flexible, it also improves the functioning of the respiratory, circulatory, digestive, and hormonal systems. Yoga brings about emotional stability and clarity of mind⁽¹⁾. So it is important for us to know about the advantage of yoga for our health.

Yoga can prevent our body from disease so it has a lot of advantage for our health⁽⁴⁾. The advantage of yoga is increasing flexibility. Yoga can increase flexibility because yoga has positions and movement that make our body can be limber. Stretching our tight body in new ways will help it to become more flexible, bringing greater range of motion to muscles and joints. Over time, we can expect to gain flexibility in our hamstrings, back, shoulders, and hips⁽⁵⁾. Beside that it can increase lubrication of the joint, ligaments and tendons. Likewise, the well researched yoga positions exercise the different tendons and ligaments of the body. Surprisingly it has been found that the body which may have been quite rigid starts experiencing a remarkable flexibility in even those parts which have not been consciously work upon. It is here that the remarkable research behind yoga positions proves its mettle. Seemingly unrelated "non strenuous" yoga positions act upon certain parts of the body in an interrelated manner. When done together, they work in harmony to create a situation where flexibility is attained relatively easily⁽⁴⁾. Yoga can also massaging all organs of the body. Yoga is perhaps the only form of activity which massages all the internal glands and organs of the body in a thorough manner, including those, such as the prostate that hardly get externally stimulated during our entire lifetime. Yoga acts in a wholesome manner on the various body parts. This stimulation and massage of the organs in turn benefits us by keeping away disease and providing a forewarning at the first possible instance of a likely onset of disease or disorder⁽⁴⁾. The other advantage of yoga is stopping detoxification⁽⁵⁾. By gently stretching muscles and joints as well as massaging the various organs, yoga ensures the optimum blood supply to various parts of the body. This helps in the flushing out of toxins from every nook and cranny as well as providing nourishment up to the last point. This leads to benefits such as delayed ageing, energy and a remarkable zest for life. Now, almost people in the world especially in Indonesia have a job. They are very busy with their job. They have to finishing their schedule that they have. So, everyone sometimes feel boring and stress. Stress can be reduced by yoga too⁽¹⁾. Because, it can make their mind fresh by the position and movement in yoga. So if their mind are fresh, they will fell comfort and stress can be lost. Physical activity is good for relieving stress, and this is particularly true of yoga. Because of the concentration required, our daily troubles, both large and small, seem to melt away during the time we are doing yoga. This provides a much needed break from our stressors, as well as helping put things into perspective. The emphasis yoga places on being in the moment can also help relieve stress, as we learn not to dwell on past events or anticipate the future. Yoga can also prevent the causes of some types of back pain by increase flexibility and strength⁽⁴⁾. If our body are flexible and strength, our back can kept from pain because our body can be limber and the back is not become rigid. Beside that yoga will give us an increased awareness of our own body. we are often called upon to make small, subtle movements to improve our alignment. Over time, this will increase our level of comfort in our own body. This can lead to improved posture and greater self confidence. Most of us breathe very shallowly into the lungs and don't give much thought to how we breathe. Yoga breathing exercises, called Pranayama yoga, focus the attention on the breath and teach us how to better use our lungs, which benefits the entire body. Certain types of breath can also help clear the nasal passages and even calm the central nervous system, which has both physical and mental benefits⁽⁵⁾.

(Picture Source: http://www.indiyogastudio.com.au/indiyoga/)

Because the cost of medication is too expensive, yoga is the best alternative to keep in good health. Yoga can keep our body from diseases⁽⁴⁾. The practice of yoga makes the body strong and flexible, it also improves the functioning of the respiratory, circulatory, digestive, and hormonal systems⁽¹⁾. Yoga brings about emotional stability and clarity of mind. By doing movement and position in yoga can make the blood circulation in our body become fluent. So it can make our body healthy and look fresh. Yoga can not did promiscuously, it is dangerous for beginner. So we need a teacher who have a skill about it. Beside that if we doing yoga, we must step by step to get a good result. If we exercise yoga regularly, it can be useful for our health. So try it regularly⁽¹⁾.

LITERATURE

1.      http//www.google.com/yoga/nop 12^th 2008/at 07.00 pm

2.      http//www.google.com/the definition of yoga/October 25^th 2008

3.      http//www.google.com/the introduction of yoga/august 9^th 2008

4.      http//www.yahoo.com/yoga and health/august 1^st 2008

5.      http//www.yahoo.com/the benefit of yoga/September 3^rd 2008

OPEN PNEUMOTHORAX

   (Picture Source: http://www.fprmed.com/)

OPEN PNEUMOTHORAX MANAGEMENT

      The incidence of chest injuries is one of the trauma that often in the some case, if not handled properly, will lead to death. Chest trauma incident occurred about a quarter of the number of deaths due to trauma that occurred, as well as about a third of the deaths that occurred in some hospitals. (1,2) Some chest injuries that can occur, they are tension pneumothorax, open pneumothorax, flail chest, hematothoraks, cardiac tamponade. Pneumothorax is a common chest injuries found on the incidence of trauma outside of the hospital, as well as an emergency medical service that should be given as soon as possible to avoid the handling of death. Lack of knowledge to know the signs and symptoms of pneumothorax pressed causing many patients died of a once or on the way to hospital.(3) Actual handling of urgency pneumothorax can be done with basic life support without the need for surgery, before sending the patient to the nearest medical care center, so that knowledge required here for the early identification of symptoms of pneumothoraks, provide basic life support, and send them to the nearest medical services, to reduce the rate of morbidity and mortality. Pneumothorak can be caused by the following:

1. Tearing pleural visceralis, so when inspiration comes from the alveolar air will enter the pleural cavity. This type is called a closed pneumothorax. If the leak pleural visceralis function as valves, then the incoming air when inspiration will not be able to get out of the pleural cavity at the time of expiration. As a result, the longer the more air that push towards the contralateral mediastinal and cause tension pneumothorax.
2. Tearing of the chest wall and parietal pleura, so that there is a relationship between the pleural cavity and the outside world. If the hole is larger than 2/3 the diameter of the trachea, the air tends to be passed through the hole than the respiratory tract. At the moment of inspiration, pressure in the chest cavity to decrease, so that outside air into the pleural cavity through the hole and cause the collapse of the ipsilateral lung. On expiration, chest cavity pressure increases, as a result of air from the pleural cavity out through the hole. This condition is referred to as an open pneumothorax.

Open pneumotorak due to penetrating trauma. Injury can be incomplete (limited to the parietal pleura) or complete (parietal pleura and visceralis). If there is an open pneumotorak incomplete at the time of inspiration outside air will enter into the pleural cavity. As a result, the lungs can not inflate because of the pressure intrapleura not negative. The effect will occur hyperexpansion pressing mediastinal pleural cavity to the healthy lungs.

(Picture Source: https://www.youtube.com/watch?v=IjXtfWWt3jM)

When open pneumotorak complete the moment of inspiration can occur hyperexpansion urged mediastinal pleural cavity to the side of healthy lungs and expiratory air trapped in the pleural cavity and the lung due to injury valve is closed. Furthermore, there was an emphasis vena cava, shuntingudara to healthy lungs, and airway obstruction. Consequently can make symptoms of pre-shock or shock due to the emphasis vena cava. This incident is known as tension pneumotorak.

In the open pneumothorax, looks like the symptoms pneumothoraks coupled with the sucking wound in the chest cavity. Also not obtained insistence mediastinum, but because there are people with severe ventilation disorder seemed very crowded, rapid breathing, cyanosis and possibly shock. If this is allowed, ended with the death of patient

How is the management?(4)

Principle

•         Primary survey-secondary survey

•         Standard diagnostic examinations (which can only be done when the patient is stable), are: portable x-ray, portable blood examination, portable bronchoscope. Not justified to examination by moving patients from the emergency room.

•         Handling patients not to diagnose but to find a life-threatening problems and perform life-saving actions.

•         Taking anamnesis (history) and physical examination performed after handling procedures trauma.

Primary Survey

Airway

Pay attention to airway patency, listen to the sound of his breathing

Management:

•         Do chin-lift and jaw thrust, remove objects blocking the airway

•         Re-positioning of the head, we suspect a cervical fracture, post-neck collar

•     Do cricothyroidotomy or traheostomi or intubation (oral / nasal) if the airway can not be patente

Breathing

Check the respiratory rate, respiration and movement note, notice the retraction of the respiratory muscles and chest wall movement

Management:

•         Perform assisted ventilation if there is indication

•         Perform emergency surgery if necessary

Circulation

Check the heart rate and pulse, check your blood pressure, pulse check oxymetri, check the neck veins and skin color (cyanosis)

Management:

•         Fluid resuscitation with installing two IV lines

•         Thoracotomy emergency when necessary

•         Exploration of vascular emergency surgery if necessary

Disability

Check the patient's level of consciousness

Specific handling Open pneumothorax

Outside Hospital

In the open pneumothorax with sucking chest wound, to stop air entering the thoracic cavity through the wound, immediately close the wound on three sides. Destination leaves one side of the wound remains open is that when expiratory air can still go out through the open side, whereas when inspiration gauze dressings impede air into the thoracic cavity (a one-way valve or ventiles opposite of tension pneumothorax). (3)

(Picture Source: http://imgsoup.com/)

In the Emergency Room

•         The wound should not be closed tightly (to create a mechanism ventiles)

•         Install WSD (Water Sealed Drainage) first and cover the wound

•         Get rid of the injury / laceration of the lungs or other organs of intra thoracic.

Seal Water Drainage (WSD) is a drainage system that uses a water seal to drain air or fluid from the pleural cavity (pleural cavity)

Purpose:

•         Drain / drainage of air or fluid from the pleural cavity to maintain the negative pressure cavity

•         Under normal circumstances the pleural cavity has a negative pressure and only slightly filled pleural fluid / lubrican.

Sources

1. American Colege Of Surgeons Commite On Trauma, Student Course Manual 7^th Editon : advanced Trauma Life Suport for Doctors : Bab 5 Trauma Thoraks: 11- 127.
2. De jong W., Sjamsuhidajat R., Karnadihardja W. Prasetyono T.O, Rudiman R. : Buku Ajar Ilmu Bedah; Bab 28: 498-513
3. Sharma A, Jindal P : Priciples of diagnosis and management of traumatic pneumothorax. 208 ;34 – 40
4. Idres M.M, Ingleby A.M, Wali S.O : Evalution and Managemet of Pneumothorax. Saudi Med J 203; vol.24(5):47