Professional Documents
Culture Documents
Nikmatur Rohmah *
* Nursing Diploma Studies Program Faculty of Health Sciences, University of Muhammadiyah Jember,
E-mail: r_nikmatur@yahoo.co.id
ABSTRACT Introduction: Pain is a sensation of discomfort that most post-partum mothers complain about, in the case of
prolonged pain, the risk of post-partum blues is higher. The usage of evidence based practice method Gives a bigger
opportunity for nurse and medical attendants to think more critically in making decisions and in performing the Appropriate
treatment in accordance with the patient's problem and uniqueness. This research Aimed to applicate management of
non-invasive pain on postpartum mother through the approach of evidence-based practice. method: This was a case-study,
performed to the client Mrs. A post sectio caesarea A0 P1-1 day 1 as there is an indication of suspect cepalo secondary pelvic
disproportion arrest. Data were collected at maternity room, dr. Soebandi Regional General Hospital. Using interviews,
observation, and physical examination. Data analysis was conducted through a descriptive analysis. Result: Through a careful
nursing, it is found out that pain location and spreading that Generally spotted at the patient's back during the contraction in
the uterus, occurred around the shoulders when evidence-base practice is applied. The basic principle of applying an
intervention to non-invasive pain -base practice based on evidence are: cutaneous stimulation and distraction, while
massaging the area was set on the face, while the distraction of media was interaction with the baby. Evaluation on evidence
-based practice Showed that pain is reduced to scale 2, while face and mobilitation Become more relaxed. Discussion: Massage
was intended to stimulated the production of endorphine and dinorphine that play an important Roke to block the pain
transmission through the descendent control system. Interaction with the baby was intended to function as a distraction media
to dominate the incoming impulses into the ascendant control system, the which may further close the gate of the pain
transmitter. Both of the interventions were axpected to work synergically in reducing pain, since post-partum pain can be
relieved more quickly intervening when more than one technique are applied. Thus, to reduce post-partum pain, facial
massage and interaction with the baby as non -invasive are of important treatments, respectively.
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The opening of 2 cm, Saturday morning (05:30 postpartum clients do not yet know when it will start a
GMT) opening 4, at 18:00 pm, the opening 7 until relationship, "said the man when a new operation may
Sunday at 5:00 pm. still opening 7 cm, then refer to touch after 6 months." History of contraception and
hospitals. Given oxytocin drip at the hospital, waiting menstruation, menstrual married first time, in June 2007,
for 2 hours, at 07.00 pm. VT opening remains had never used contraceptives of any kind, is not
currently know want to come KB what?, because it has
7, then set up the SC operation. At 09:00 pm, not been informed about family planning. Menstrual
conducted SC LSCS with anesthesia SAB. Out of history of patients 13 years of age of menarche, irregular
the operating room at 10.00 hrs., Then go to the menstrual cycle, 28 days, the duration of 7 days, dismenorhoe
recovery room in the womb at 11.00 am., Therapies
that have been granted RL: D5 2: 3, cefotaxime 3 ×
1 gram, Antrain 3 × 1 amp, metergin 2 × 1 amp (IM), mild, sometimes fl uor albus, but in few, no smell, no
18:00 hours began to tilt right-left lateral, fl atus start itching. History of pregnancy and childbirth now check
at 07.00, sip start at 10.00 am, at this time the right patient to PKM regularly every month, drinking
shoulder pain, with a scale of 6, a sense of fatigue, frenamin start gestational age 4 months to 8 months,
though not moving, abdominal pain, only scar feels a TT 2 times the age of 1 and 2 months of pregnancy,
little "nyekit" when used to move, that silence does vomiting, nausea in pregnancy 6-7 months, and
not feel pain. frequent urination in pregnancy 8-9 months. Labor
history has now been done LSCS with SAB, a baby
boy born US 7-8 3500 BB salt, PB 49 cm.
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attainment role father, started the integration of the 2005; Potter and Perry, 2006; Rocmat, 2008).
effective breastfeeding (baby). and electronic journals obtained three articles among
others The Effects of Massage Therapy on Pain
Management in the Acute Care Setting by Adams,
White, and Beckett (2010), Effectiveness of visual
distraction and slow breathing rhythm in Lowering
Priority needs to be met is pain. Some basic Pain Due Injection by Rohmah (2007), and Pain by
considerations for the entry of pain to be a priority Rochmat (2008). The assessment worth reading
among other comforts are basic needs that fi each article carried on the clarity of the abstract,
siologis, the fulfillment of which is good not only can introduction, methods, results, discussion, and
reduce, decrease, or eliminate the pain, but also referansi. The third article shows kindness in his
increase the mobilization earlier, helping clients to writing. Furthermore, the interpretation of the three
work early, shortening the period of hospitalization articles, which include third-degree eviden of the
and reduce maintenance costs, pain that can not be article? how the study was conducted? what are the
overcome or controlled in the mother post partum results? whether the results are valid within and
may cause fatigue, anxiety and perception of pain outside the framework of research ?, and the
worse, so that early mobilization impeded, consistency of the results. Based on the results of
obstructed lactation, process bonding attacmant hampered, the screening conducted at the level eviden degree
disappointed for the inconvenience, disruption of 2b ( evidence derived from at least a quasi
sleep patterns, and even if prolonged pain will experimental study), whereas the results of research
increase the risk of postpartum blues (Hamilton menunujukkan consistent finding that massage and
1998: Carpenito, 2000; Bobak 2005; Potter and techniques non-invasive can be used for post-surgical
Perry, 2006; Rocmat, 2008). pain memanagemen including post-surgical obstetric
cases. The results also allow for applied research in
place.
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Non Invasive Pain Management Maternal post partum ( Nikmatur Rohmah)
can reduce the pain of the average level baby's condition there are no contraindications to do rooming-in.
5.18 (on a scale of 0-1 pain VAS) to 2.33 with value p
< 0.001. In this study using 65 samples and 26 of
them are from obstetric units. Implementation
Massase
Rochmat 2008 stated that although the A necessary tool among others in doing
available medications are effective, but the Massase are leaflets, oil taste ( baby oil).
post-surgical pain can not be treated properly,
approximately 50% of patients still experience pain. Preparation of the patient and family are the
Action non-invasive should first be done without or with first in which patients and families informed about the
pharmacological action, because of loss of post actions to be undertaken include: purpose, benefits,
partum pain can be accelerated if using more than willingness family (husband) to be actively involved in
one technique (Hamilton, 1998; Bobak, 2005; the implementation of the action. After approving the
Rochmat, 2008). patient and family to do the demonstration stage by
stage. Then the patient's family do redemonstrasi.
Research on differences in the expression of
pain in women and men showed no difference, but
women prefer to communicate pain compared to Implementation conducted on Tuesday, April
men (Rochmat, 22, 2008 at 09.30 am the first step is to place both
thumbs to the position facing each other between the
2008) .Penelitian about distraction proved to be an two eyebrows of the patient, the second step of
effective strategy to reduce pain (Rochmat, 2008). doing massage gently outwards until at the temples,
These results differ from Rohmah study (2007) apply pressure to the temple, do as much as 3 -5
times, the third step is to press lightly (can be
which states that the slow breathing rhythm is more
tailored to the patient's condition) on the bone at the
effective than distraction in reducing pain.
base of the nose. Press 3-5 ×, then massage
throughout os nasal the right and left until os
Transcutaneous stimulation technique was zigomaticus, do 3-5 times the next step memasase
reported by 50% of the patients report decreased mandible area 3-5 times, then give a rather strong
pain (Rochmat, 2008). While Doenges and pressure around the top of the head, ending with the
Moorhouse (2001) and Bobak (2005) states that pressure on the back of the head, do as much as 3-5
cutaneous stimulation techniques are used to reduce times and the massage last step is done on the
post-partum pain is a back rub. Early mobilization, upper back, which ended with the pressure on the
changes in patient positioning, mounting shoulders, do as much as 3-5 times.
wash cloth cold on the face and back massage with lotion
Refreshing can be very helpful in relieving
postoperative temporary inconvenience SC and
improve the effectiveness of medications (Rochmat
2008; Bobak, 2005).
Interaction with baby
See the study of theory and research results have been Implementation of mother-infant interaction
reviewed and based on evidence based conducted on Tuesday, April 22, 2008 hours 10:45
found can be applied to the two non-invasive pain management pm. First make approval and preparation of mothers
techniques that massage and interaction with the baby. Massage and fathers to do rooming, and the family agreed.
will be performed on the face and shoulders 1 times / day. Then collaboration with perinatology room for
Interaction mothers with babies will be done as soon as possible rooming: babies do rooming. Furthermore, do
after the mother and the baby is ready to accept the presence rooming,
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observe the process of integration infant in the family, stop activism fi bag. Other factors that also increase
teaching mothers how to suckle properly. Mothers barriers to labor mobilization is to act
capable suckle properly, the baby sucking strong, and
fast asleep after sucking. sectio caesarea. other impacts post sectio caesarea in
a state of pain, then reduce mobilization, will lead to
decreased blood circulation, and this will be a trigger
Evaluation for increased sensation of pain. The higher the
Evaluations were conducted on Tuesday, April perceived pain patients tend to further lower its
22, 2008, 14:00 pm there is a result that the activity, so that the blood circulation will be
subjective data of patients saying "Pain scale 2". decreased again. This condition is a cyclical circle
While the objective data showing the face of relaxed that one causes the other.
receiving his presence, receiving a baby happily as Pain that can not be addressed or controlled in the
do rooming, eye contact with the baby, touching the mother post partum may cause fatigue, anxiety and
baby's face, smiling as the baby sucking, breast perception of pain worse, so that early mobilization
softening after disusukan, breast milk colostrum out, impeded, obstructed lactation, process bonding
with the theory include: posture is maintained, post-natal sexual, personal care and baby. This
careful movements, and facial expressions tense. change needs in accordance with the concept of post
Meanwhile, blood pressure, pulse, respiration partum maternal care that emphasizes the physical to
unchanged, diaphoresis does not occur. Location the psychological recovery, improve maternal care for
and wide spread pain generally occurs when uterine themselves, and increase the mother's ability to care
contractions and felt in the back, but at evidence for baby. In addition nurses is expected to be set up
based felt in the shoulder, it is suspected because of over the responsibilities of the nurse in the family, so
the post-surgical immobility. Post-surgical immobility the nurse's role here is not only providers but rather
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control ascending so as to close the gate conductor pain. is the area complained of a painful area. (Hamilton,
Two of these interventions is expected to synergistically 1998; Bobak, 2005; Strong, et al,
reduce pain, for pain relief post partum can be 2002). Media distraction that is used is the
accelerated if using more than one technique (Hamilton interaction with babies, this media has many
1998: Carpenito, 2000; Bobak 2005; Potter and Perry, benefits, in addition to divert attention from the pain
2006; Rochmat, 2008; Adams, White, and Beckett center of the media can also be used to improve the
2010). The principle of the implementation of pain bonding attachment formation.
management in e vidence based in accordance with the
theoretical concept namely the principles of cutaneous Pain and discomfort in general will always be
stimulation and distraction (Carpenito, 2000; Potter and there, but the presence of loved ones, the closest,
Perry, 2006; Adams, White, and Beckett, 2010). but in evidence the trust will help minimize loneliness and fear, which
based there is a difference in the massage area and a can affect the perception of pain (Carpenito, 2000).
media distraction. Area massage is selected on the face Someone who focus on pain can influence the
and shoulders with the consideration that pain mapping perception of pain. The increased attention to the
areas 1, 2, 3, 4, and 5. Area 1 and 2 is the area of the pain will increase the pain. Efforts diversion
face which is an area that is always under stress at the (distraction) can reduce pain response.
time the pain lasted, by doing massage in this area
expected to be relaxed so that the cycle can break the
chain of fear-tension-pain. While the area 3,4,5
Interaction with a baby is a medium
bonding. bonding defined as a first mutual interest
between individuals, such as those between parents
and children, when
PAIN
pain decreased
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Suggestion
the baby, the principle of implementation Maternita s. Ed. VI. Jakarta: EGC.
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Non Invasive Pain Management Maternal post partum ( Nikmatur Rohmah)
Mansjoer, et al., 2002. capita Selecta Needs Convenience. College textbooks are not
Medical. Ed. 3 Jakarta: Media Ausculapius. published. Sucipto, JA 2007. Effect of Early
Manuaba 2004. Registrar of Clinical Obstetrics Mobilization
on Post-Surgical Pain. Unpublished thesis.
and Gynecology. Jakarta: EGC. Potter and Perry, Jember: Study Program S1 Nursing Fikes
2006. Textbook Fundamentals Unmuh Jember. Stolte, KM 2004. Nursing
Nursing Concepts, Processes and Practices. Ed. diagnoses
4, Vol 2, Jakarta: EGC Rochmat, R. 2008. pain, Ratihrochmat's.
Sejahtera (Wellness Nursing Diagnosis).
Weblog. accessed on January 2 Interpretation: Monica Esther. Jakarta: EGC.
2009. strong, et al., 2002. Pain a textbook of
Rohmah, N., 2007. Effectiveness of Distraction
Visual and Rhythm Breath Slow to Reduce therapists. Philadelphia: Churchill Livingstone.
Pain Due Injection. Smeltzer, SC, and Bare, BG, 2002. Textbooks
Journal of Nurses. 2 (1): 43-45. Rohmah, N., and
Walid, S. 2008. Care Medical Surgical Nursing Brunner & Suddarth. Ed.
Nursing in Meeting 8, Vol. 3, Jakarta: EGC.
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