Empowerment of PKK Team as Caregiver for Stroke Patient in

PB Selayang II Urban Village, Medan Selayang Sub-district

Haflin Soraya Hutagalung

, Irina Kemala Nasution

, Nenni Dwi Aprianti Lubis

Neurology Department; Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia

Nutrition Department; Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia

Keywords: Stroke, Caregiver

Abstract: As one of the degeneratives disease with high disability consequences, stroke with all of its consequences

will give physical, psychiatric and social burden on the patients, family and caregiver. One of the efforts to

lessen the burden is behavioral intervention of the support system in didactic discourse and workshop of

taking care post stroke patients at home. We use Wilcoxon Signed Rank bivariate test of several nursing

domain which evaluated pre and post test, such as bathing, oral hygiene, wound prevention, dressing and

feeding which giving changes that clinically and statistically significant (p < 0.01).

1 INTRODUCTION

Stroke is one of the non-contagious diseases that

causes death and disability with 7% on the diagnosis

of health workers (Riskesdas, 2013). The data

obtained in the research shows the hemiparesis

sinistra disability as many as 134 people (23.8%)

and right hemiparesis 133 people (23.7%) (Rambe et

al., 2012). This shows the high rate of post-stroke

disability is still a problem even after the patient is

treated at home (Nasution, 2007), (Misbach and

Jannis, 2011).

Family has a vital role in primary support in

terms of maintaining post-stroke health care during

recovery and rehabilitation periods, where the

absence of this support can result in significantly

reduced recovery (Julianti, 2013). Not only in terms

of health, the incidence of stroke that affects family

member also provides psychosocial effect for patient

and family and caregiver. In general, post-stroke

caregiver people have poor quality of life compared

to the general population, which is due to

depression, anxiety, limitations in social relation,

general health and even higher mortality (Rigby,

2009). The purpose of this community service

activity is to increase public knowledge, especially

cadres and Family Empowerment and Family

Welfare Movement Team (TP PKK) about stroke so

that it can act as a caregiver for stroke patients. The

knowledge and skills gained during this activity are

expected to be transmitted to other community

members.

2 METHODS

This activity was conducted by 3 lecturers and this is

an affiliation activity between Neurology

Department and Nutrition Department, Faculty of

Medicine, Universitas Sumatera Utara (USU) and

PB Selayang II Urban Village, Medan Selayang

Sub-District of assisted by students of Faculty of

Medicine USU. The method of service is carried out

by providing counseling and training to respondents

(i.e. cadres and TP PKK) of PB Selayang II Sub-

District of Medan Selayang, where the service is

also in line with the work program of group 4 (Pokja

4) TP PKK which is managing health program,

environmental sustainability and healthy planning.

The event was held at hall in Medan Selayang

and attended by 25 respondents. Generally, activities

were divided into 2 stages. Stage I (Counseling) was

conducted with a lecture system on the basic concept

of independent stroke nursing effectively. Prior to

the lecture, the respondents were asked to complete

a self-assessment questionnaire in the form of pre-

test before lecture and post-test after lecture. Stage II

(Training) was done by improving the skills of the

respondents as caregiver, especially in self-care. In

this stage II activity, the team was assisted in

Hutagalung, H., Nasution, I. and Lubis, N.

Empowerment of PKK Team as Caregiver for Stroke Patient in PB Selayang II Urban Village, Medan Selayang Sub-district.

DOI: 10.5220/0010073604670471

In Proceedings of the International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches (ICOSTEERR 2018) - Research in Industry 4.0, pages

467-471

ISBN: 978-989-758-449-7

467

training using standard patient acting as stroke (role-

play workshop).

Counseling and training materials include the

role of general stroke caregiver to basic training on

self-care, such as bathing, feeding and toileting. At

the end of the training period, it is expected that

respondents who have undergone training can

become skilled cadres who can care for stroke

patients independently and even become trainers of

trainers (TOT) by providing knowledge

dissemination of care that has been obtained in

surrounding communities.

The collected data will be analyzed using

Wilcoxon Signed Rank test. The Wilcoxon test is

used to analyze pairs of observed results from two

different whether or not data. Wilcoxon test is used

only for the type of interval or ratio data, and the

data is not normally distributed. The normality test

shows that knowledge and skill variables have

p<0.05, which means that all of the variables are not

normally distributed so that the data analysis is

feasible using the Wilcoxon test

3 RESULTS

Based on the characteristic variables of respondents,

as many as 25 respondents (100%) were women

with an average age of 43 years (age range 18-65

years). The occupation of most respondents was

housewife as many as 18 person (72%), 4 person

(16%) was self employed (2%) and enterpriser was

2 person (8%) and civil servant was 1 people (4%).

Referring to the lattest education, most of the

respondents were graduated from senior high school

as many as 22 person (88%), 2 person (8%) were

graduated from higher education (D3/ S1) and 1

person was graduated from elementary school (4%).

Marital status showed 20 respondents (80%) were

married, 4 respondents (16%) were unmarried and

one respondent (4%) had widow status. The average

number of children owned by total respondents was

as much as 2 people (range 0-6 people).

In terms of knowledge and information about

stroke, as many as 21 respondents (84%) did not

have a family who suffered a stroke, while as many

as 4 people (16%) had a family who had been

encountering or ever had encountered stroke. As

many as 20 people (80%) had heard or had learned

information about stroke, while 5 people (20%) had

not known or never know information about stroke.

Meanwhile, when viewed formal training aspect, as

many as 24 people (96%) had never received general

care training and stroke treatment, while 1

respondent (4%) had ever attended the training.

In the bivariate test, based on pre-test result, it

was found that the highest level of respondent

knowledge before given the extension was in fair

category as many as 13 people (52%), and in good

category as many as 12 people (38%). This shows

that the knowledge level of respondents as caregiver

in stroke sufferer still in fair category. Meanwhile,

after the post-test, the same results were obtained,

the highest level of knowledge of the respondents

after given extension was in fair category as many

as 13 people (52%), and in the good category as

many as 12 people (38%). Furthermore from the

analysis results obtained Z score of 0.001 with a p

value of 1,000 (p>0.05), so it was decided that there

is no difference in the level of knowledge of

respondents as caregivers in stroke patients before

and after given counseling (Table 1).

Table 1: Knowledge level of respondents before and after

counseling

Know-

ledge

Pre-test Post-test Z-

score

value

n % n %

Good 12 48 12 48

0.001

1.000

Fair 13 52 13 52

Poor 0 0 0 0

Total 25 100 25 100

Based on pre-test results obtained that all

respondents (100%) failed in the skill of bathing

procedure to the stroke patients. This shows that all

respondents were not skilled in bathing stroke

patients. Meanwhile, after the post-test, the results

obtained were different i.e, all respondents (100%)

were succeeded in the skill of bathing the stroke

patient. Furthermore from the analysis results

obtained Z score of -4.243 with a value of p value of

0.001 (p<0.05), so it was decided there is a

difference in the skills of respondents in the

procedure of bathing stroke patients before and after

training (Table 2).

Based on pre-test results obtained that almost all

respondents (84.0%) failed in the skills of oral

procedures for cleaning stroke patients. This shows

that there were still many respondents who were not

skilled in cleaning the mouth of stroke patients.

Meanwhile, after the post-test obtained different

results, as many as (88.0%) of respondents

succeeded in the oral procedure of cleaning the

mouth of stroke patients. Furthermore from the

analysis results obtained Z score of -4.243 with a

value of p value of 0.001 (p<0.05), so there were

differences in the skills of respondents in the oral

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

468

procedure of cleaning stroke patients before andafter

training (Table 3). Based on pre-test results obtained

that all respondents (100%) failed in skills or

procedures to prevent injury in people with stroke.

This shows that all respondents were not at all

skilled in preventing the occurrence of injuries in

people with stroke. Meanwhile, after post-test, there

were different results, all respondents (100%)

succeeded in skill of injury prevention procedure of

stroke patient. Furthermore from the analysis results

obtained Z score of -4.583 with a value of p value of

0.001 (p<0.05), so it was decided there was a

difference in the skills of respondents in the

procedure to prevent injury in stroke patients before

and after training (Table 2).

Based on pre-test results obtained that all

respondents (100%) failed in the skill of dressing

procedures in patients with stroke. This shows that

all respondents were not at all skilled in putting

clothes on stroke patients. Meanwhile, after the post-

test, there were different results, all respondents

(100%) succeeded in the skills of dressing procedure

in stroke patients. Furthermore, from the analysis

results obtained Z score of -5,000 with a value of p

value of 0.001 (p<0.05), so it was decided there was

a difference in the skills of respondents in the

procedure of dressing on stroke patients before and

after training (Table 2).

Based on pre-test results obtained that most

respondents (60.0%) failed in the of wearing

trousers procedure on stroke patients. This shows

that there were still many respondents who were not

skilled in putting pants on stroke patients.

Meanwhile, after the post-test, there were different

results, all respondents (100%) succeeded in the skill

of putting the pants on the stroke patient.

Furthermore from the analysis results obtained Z

score of -3.873 with a value of p value of 0.001

(p<0.05), so it was decided there was a difference in

the skills of respondents in the procedure of putting

pants on stroke patients before and after training

(Table 2).

Based on pre-test results obtained that almost all

respondents (96.0%) failed in the skills of giving

food an beverage procedure to stroke patient. This

shows that there were still many respondents who

were not skilled in giving food and beverage to

stroke patients. Meanwhile, after the post-test, there

were different results (80.0%) of respondents

succeeded in the skill of giving food and beverage

to stroke patient. Furthermore from the analysis

results obtained Z score of -4.359 with a value of p

value of 0.001 (p <0.05), so it was decided there was

a difference in the skills of respondents in the giving

food to stroke patients before and after training

(Table 2).

Table 2: Skill procedure of bathing stroke patients in respondents before and after training.

Skill variables Pre-test Post-test Z-score p-value

n % n %

Bathin

rocedure

Success 0 0 18 72

-4.243

0.001

Fail 25 100 7 28

Total 25 100 25 100

Mouth Cleansing

Success 4 16 22 88

-4.243

0.001

Fail 21 84 3 12

Total 25 100 25 100

Injury prevention procedure

Success 0 0 21 84

-4.583

0.001

Fail 25 100 4 21

Total 25 100 25 100

Dressin

rocedure

Success 0 0 25 100

-5.000

0.001

Fail 25 100 0 0

25 100 25 100

Puttin

ants

rocedure

Success 10 40 25 100

-3.873

0.001

Fail 15 60 0 0

Total 25 100 25 100

Giving food and beverage

Success 1 4 20 80

-4.359

0.001

Fail 24 96 5 20

Total 25 100 25 100

Empowerment of PKK Team as Caregiver for Stroke Patient in PB Selayang II Urban Village, Medan Selayang Sub-district

469

Based on pre-test results obtained that all

respondents (100%) failed in skills or procedures to

prevent injury in people with stroke. This shows that

all respondents were not at all skilled in preventing

the occurrence of injuries in people with stroke.

Meanwhile, after post-test, there were different

results, all respondents (100%) succeeded in skill of

injury prevention procedure of stroke patient.

Furthermore from the analysis results obtained Z

score of -4.583 with a value of p value of 0.001

(p<0.05), so it was decided there was a difference in

the skills of respondents in the procedure to prevent

injury in stroke patients before and after training

(Table 2).

Based on pre-test results obtained that all

respondents (100%) failed in the skill of dressing

procedures in patients with stroke. This shows that

all respondents were not at all skilled in putting

clothes on stroke patients. Meanwhile, after the post-

test, there were different results, all respondents

(100%) succeeded in the skills of dressing procedure

in stroke patients. Furthermore, from the analysis

results obtained Z score of -5,000 with a value of p

value of 0.001 (p<0.05), so it was decided there was

a difference in the skills of respondents in the

procedure of dressing on stroke patients before and

after training (Table 2).

Based on pre-test results obtained that most

respondents (60.0%) failed in the of wearing

trousers procedure on stroke patients. This shows

that there were still many respondents who were not

skilled in putting pants on stroke patients.

Meanwhile, after the post-test, there were different

results, all respondents (100%) succeeded in the skill

of putting the pants on the stroke patient.

Furthermore from the analysis results obtained Z

score of -3.873 with a value of p value of 0.001

(p<0.05), so it was decided there was a difference in

the skills of respondents in the procedure of putting

pants on stroke patients before and after training

(Table 2).

Based on pre-test results obtained that almost all

respondents (96.0%) failed in the skills of giving

food an beverage procedure to stroke patient. This

shows that there were still many respondents who

were not skilled in giving food and beverage to

stroke patients. Meanwhile, after the post-test, there

were different results (80.0%) of respondents

succeeded in the skill of giving food and beverage

to stroke patient. Furthermore from the analysis

results obtained Z score of -4.359 with a value of p

value of 0.001 (p <0.05), so it was decided there was

a difference in the skills of respondents in the giving

food to stroke patients before and after training

(Table 2).

4 DISCUSSION

Intensive training of knowledge interventions to

post-stroke caregiver will provide a higher rate of

qualitative knowledge than control group (Bakas,

2009). Skills are skills in performing tasks that are

the result of training and education (Dunnette,

2006). (Evita, 2013) concluded that the standard

training of infant growth monitoring on Puskesmas’

cadres increases knowledge, skills and compliance

when compared to only the modules (Priyono,

2017). Priyono's research results also explain the

difference of knowledge and skills before and after

emergency education at the MANTAP agent

(community responsive) (Evita, 2013). This is the

reason why empowerment and training of families

and caregivers especially in post-stroke care is

essential because good knowledge and skills will not

only speed up the patient's recovery but also avoid

families and caregivers from burnout due to lack of

knowledge and skills.

5 CONCLUSIONS

Intervention of caregiver behavior and knowledge of

stroke in this study provide statistically significant

differences in caregiver skills in caring for post-

stroke patients, so further research is needed to

assess the effect of long-term intervention.

ACKNOWLEDGEMENTS

If any, this community service is funded by

Universitas Sumatera Utara through Non PNBP and

BPPTN USU T.A. 2018 grant with Letter of

Assignment no. 396/UN5.2.3.2.1/PPM/2018 dated

16 April 2016.

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