Method of Handling Aggressive Behavior of School-aged Children

with Holistic Approach in Medan

Wardiyah Daulay

, Sri Eka Wah

uni

and Mahnum Lailan

Faculty of Nursing Universitas Sumatera Utara, Jl. Prof.Maas No. 03 Kampus USU, Medan, Indonesia

Keywords: Aggressive, School-aged children, Holistic approach

Abstract : Aggressiveness is a type of behavior aiming to harm other people, verbally or non-verbally,

physically or psychologically and directly or indirectly. Aggressiveness in school-aged children

is caused by social factors, personal characters and situational factors. The worst impact which

can take place if this aggressive behavior is not handled is the children can put their friends or

other kids in danger. This research aims to identify the influence of aggressiveness-handling

method with holistic approachwhich involves biological, psychological, socio-cultural and

spiritual dimension towards the aggressiveness of school-aged children.This research was

conducted in 2 Private Primary School in Medan. The samples were 60 people who were divided

into two groups, namely intervention group and control group. The instrument was made by the

researchers themselves based on literature review. Analysis result shows the children’s

aggressiveness score before holistic handling 11.40 and after it becomes 8.93 (2.47 in

difference). The change of the score shows significant decline, meaning that the aggressiveness

in school-agedchildren has declined. These data are supported with test result of t dependent, it

obtains p value 0.000 and alpha 0.05.This signifies that there is significant influence between

holistic handling and aggressive behavior of school-aged children.

1 INTRODUCTION

School is adetermining factor for children’s

personality development, in their way of thinking,

attitude and their behavior (Hurlock, 1986 in

Syamsu & Juntika, 2005). The development stage of

primary-school children sometimes are faced with

obstacles that they do inappropriate behavior which

harms themselves and other. One of the digressing

behaviors is aggressiveness.

The phenomena of aggressiveness in school-

aged children have increased nowadaysin Indonesia.

This is supported by the research result conducted

by Azizah (2013), that the scholars especially

primary-5 male students are aggressive. There are

49% boys who do physical aggressiveness, such as

hitting, kicking, grabbing others’ belongings and

attacking other people. 49% out of 14 students is 7

students. Then, there are these 7 students showing

aggressive physical behavior. Meanwhile, verbal

aggressiveness such as yelling in the class, scolding,

being angry out of no reason, ordering older people

and threatening friends, is shown by 70% students or

if it is compared with the number of the students

which is 14 students, then there are 10 students who

have verbal aggressive behavior.Prosperity of

Indonesian Children (YKAI) shows that there are

5% children doing aggressive behavior when a

conflict takes place. For instance, children will get

angry and do not want to apologize when doing a

mistake. Moreover, 21.6% children will repay by

behaving aggressively if there is any of their friends

who makes them angry because they consider that

aggressiveness is a common and ordinary thing.

(YKAI, 2010). Nursing holistic is giving care to

treatment for bio welfare-psychosocial and spiritual

individual, family and society (Ilit, 2016). This

holistic approach keeps on its principlethat nursing

treatment provided must pay attention to all

dimensions so that intervention given to this

Daulay, W., Wahyuni, S. and Lailan, M.

Method of Handling Aggressive Behavior of School-aged Children with Holistic Approach in Medan.

DOI: 10.5220/0008791502490254

In Proceedings of the 2nd Syiah Kuala International Conference on Medicine and Health Sciences (SKIC-MHS 2018), pages 249-254

ISBN: 978-989-758-438-1

249

research will refer to all dimensions. For

psychological dimension with emotion control such

as recognizing signs, situation,the effect and

aggressiveness alternative, In biological dimension,

a way to express anger constructively is provided.

The way is deep breathing practice and doing sports.

In socio-cultural dimension, it teaches the way to

express anger verbally, such as rejecting politely,

asking politely and expressing feelings in a fine way.

Meanwhile, for spiritual dimension, children will be

taught to do spiritual activity based on their belief.

2 RESEARCH METODHS

This research aims to see aggressive behavior in

school-aged children before and after treatment with

a holistic approach. The experiment research

designis done to two groups. The study was

conducted in two private primary schools in Medan.

The sample was taken by purposive sampling with a

sample of 60 people, divided into 2 groups: the

intervention group and the control group. The

instruments used are made by researchers based on

literature review. The instrument has been tested for

validity and reliability. Results of testing the validity

of the instrument to 3 (three) expert mental nursing

with a CVI value of 0.9. The instrument was also

tested for reliability in public elementary schools as

many as 40 students with a result of 0.88. The study

was conducted after obtaining approval from the

Ethics Committee of the Faculty of Nursing, North

Sumatra University. Data are analyzed using t test.

3 RESEARCH RESULT

The result shows that school-aged children who

behave aggressively are mostly males (88%), with

mostly 11 years-old (38%) and majority of

Bataknese (48%). The characteristics of the 60

students can be seen in this following Tabel 1:

Table 1. Characteristics of School-Aged Children who

Have Aggressiveness in Intervention Group and Control

Group(n = 60)

Characteristic

Interventi

on Grou

Control

Grou

Total

F (%) F (%) f (%)

Age

9 yea

2 7 4 13 6 10

10 yea

9 30 8 27 17 28

12 40 11 37 23 38

7 23 7 23 14 24

Sex

Male 28 93 25 83 53 88

Female 2 7 5 17 7 22

Tribe

Bataknese 4 47 15 50 29 48

Acehnese 5 17 5 17 10 17

Javanese 7 23 7 23 14 23

Mala

4 13 3 10 7 12

Religion

Isla

30 100 30 100 60 100

Aggressiveness in school-aged children before the

holistic treatment is conducted in the intervention

group and control by comparing the mean score. The

difference in mean score of before the intervention is

0.1 and after the intervention, the score turns into a

mean score difference of -2.27. To see the difference

between the children’s aggressiveness between

intervention and control groups, independent t test is

conducted. Theresult is p-value 0.939 before

treatment and after treatment, value is 0.014. This

value isbetween the intervention and control groups,

which can be seen in Table 2.

Table 2. Difference Analysis of Children’s Aggressiveness

between Intervention Group and Control (N=60)

Children’s

Aggressiveness

Mean SD SE P

value

Before Holistic

Treatment

- Intervention Group

- Control Group

Mean in Difference

11.40

11.33

0.1

3.539

3.198

0.646

0.584

0.939

After Holistic

Treatment

- Intervention Group

- Control Group

Mean in Difference

8.93

11.20

-2.27

3.648

3.305

0.666

0.603

0.014

SKIC-MHS 2018 - The 2nd Syiah Kuala International Conference on Medicine and Health Sciences

250

The difference in mean scores before and after on

intervention group as is much as 2.47 and the control

group’s difference in mean score is 12:13. To see the

difference ofchildren’s aggressiveness before and

after between intervention and control group, t

dependent test is performed. The result obtained is

p-value of 0.005 on the intervention group and 0.442

on the control group, which can be seen in Table 3.

Table 3. Analysis of Children’s Aggressiveness Difference

Before and After Holistic Treatment (N=60)

Children’s

Aggressiveness

Mean SD SE P

value

Intervention

Group

- Before

- After

The difference

in mean

11.40

8.93

2.47

3.539

3.648

0.646

0.666

0.005

Control Group

- Before

- After

The difference

in mean

11.33

11.20

0.13

3.198

3.305

0.584

0.603

0.442

The analysis shows a score of children’s aggressive

before holistic treatment 11:40 and thereafter

become 8.93 (the difference of the score is 2.47).

The score change shows a significant decrease,

meaning that there is a decrease in aggressive

behavior in school-aged children. This data is

supported by the results obtained dependent t-test p

value 0.000; alpha of 0.05. This value indicates that

there is a significant effect between holistic

treatment and aggressive behavior of school-aged

children.

This holistic treatment consists of several

sessions. The first session is for the psychological

dimension. In this session, children are taught to

manage emotions with psychological self-

adjustment capability, in which individuals are able

to identify, recognize and able to manage it.

Managing emotions is an act to regulate the

thoughts, feelings, passion of anger in an appropriate

and positive manner and socially-accepted as well. It

is expected to prevent something bad or prevent

them from harming themselves and others. After

being given an intervention, children begin to get to

know and manage their emotions.

According to Goleman (1997), recognizing the

emotion of anger is the ability to identify feelings of

anger when anger arises, so that one is not controlled

by anger. Someone who has the ability to recognize

emotion of anger can react appropriately against

rising anger at the right time. Recognizing the

emotion of anger can be done by identifying the

early signs that comes with anger.

In addition, a person can also be more sensitive

to recognize the emotion of anger by identifying

situations or things which become the triggerof

anger (Hershorn, 2005). The lack of ability to

recognize emotion of anger can make individual

unable to control his emotions and react

inappropriately and excessively. Incapacity to

recognize the emotion of anger also results in

confusion in identifying the exact emotions he is

experiencing, so the person often reacts

inappropriately to emotional situations (Goleman,

1997).

In two sessions, school-aged children are taught

to practice deep breathing. Deep breathing relaxation

can reduce tension and give you peace. Deep

breathing relaxation stimulates the body to release

opioids endogenous, namely endorphins and

enkephalins. The release of endorphins can

strengthen the immune system, keeping the brain

cells of young, anti-aging, lowering aggressiveness

in human relationships, improving moral and

creativity (Smeltzer& Bare, 2002). Supporting

research is the research conducted by Sumirta (2013)

on deep breathing relaxation to control client’s anger

with violent behavior. The result of the study reports

that deep breathing relaxation has a significant

influence on the control of anger.

On the third session,scholars are taught how to

prevent verbal aggressiveness in a way that is

expressing anger, asking for and refusing properly.

Verbal way is also called assertive behavior.

Assertive behavior is expressing ideas, wishes,

desires, disapproval directly to the child. The

purpose of assertive behavior is to communicate

something in the atmosphere of mutual trust

(Novianti, 2010). Aggressive behavior is one of the

non-assertive behaviors. Assertive training is one of

the ways in Anger Management which aims to

remove the feelings, thoughts and beliefs which

cause anger as well to other people (Reilly,

Shopshire, Durazzo & Campbell, 2002).

Assertive communication is one skill which can

be learned by individuals. Assertive is one way to

cope with aggressive behavior. Assertive teaches

how to communicate by paying attention to the

principle of respecting other people,. Individuals are

also taught to express feelings honestly and care for

other people (Larkin, 2005).

At the fourth session, spiritual way is taught to

control anger. Spiritual approach is conducted by

doing spiritual activities. Spiritual is associated with

Method of Handling Aggressive Behavior of School-aged Children with Holistic Approach in Medan

251

belief in such things as: nature, science, religion or

higher power that helps people achieve goals of life.

It covers morals, values and ethics of a person.

Therapy which can be done is the therapy of

motivating children to conduct spiritual activities.

Spiritual activities undertaken are to motivate

children to perform religious activities, improve the

relationship with themselves, other people and the

environment. Children are encouraged to

improvedoing religious activities such as prayer or

other religious activities. Based on previous

research, a lot of spiritual activities are doneby

people. One of them is meditation which can lessen

the the individual’s anger. Meditation is one therapy

conducted in the Anger Management Program which

aims to train individuals to control and overcome the

upset experienced (Borland, 1981). Beside

meditation, spiritual activity others can be taught is

by praying and sholat.

Religious activities such as praying and sholat

prayer, is a positive activity that can raise

expectations and a positive impact and improve the

healing process in individuals (Gore, 2013). Results

of previous studies have also shown that prayer is

one of the coping mechanisms which are often used.

It is usually effective because praying makes a

person uncomfortable, getting directions or

guidelines as well as to strengthen the powers of the

individual (Gore, 2013).

Schools are advised to apply method of

aggressiveness handling in schools throughSchool

Health Program and also train the tutors such as

teachers and family, especially mothers so that they

are able to conduct this handling method

independently at home and school.

4 RESEARCH DISCUSSION

Aggressive behavior is considered as a type of

behavior aiming to hurt other people, verbally or

non-verbally, physically or psychologically and

directly or indirectly (Anantasari, 2006). Baron (in

Dayakisni & Hudaniah, 2009) states that

aggressiveness is individual’s behavioraiming to

hurt or harm other individuals do not wish the

behavior to exist. This definition covers four

behavior factors, namely aiming to hurt or harm, the

individual becoming the suspect, the individual

becoming the victim and victim’s unwillingnessin

accepting the suspect’s behavior.

Betty Neuman (inMarriner-Tomey, 1994) sees

human (client) as a whole which its parts influence

one another and interact dynamically. The parts

cover physiological, psychological, socio-cultural

and spiritual. Kozier (1995) states that in holistic, all

organism lives are seen as interactions.Any

disturbance on one part will disturb a system wholly.

In other words, if there is any part distracted, other

parts will get its effect overall. Erikson, Tomlin and

Swain (inMarriner-Tomey, 1994) also state about

holism, which sees a human as a whole individual

who consists of a lot of sub-systems which are

dependent to one another and unable to be

separated.This is related with generic issues and

spiritual control. Body, mind, emotions and spirit are

the core which is dynamic. Influencing and

controlling one another. The interaction of this

various sub-systems cannot be separated, which

eventually produce holism.Holistic is related with

wellness which is believed to have effect towards

human’s health status. Anspaugh (inKozier, 1995)

signifies that to reach health and wealth, there are

five dimensions which are related and dependent one

another. These dimensions are also had by each

individual, namely biological, psychological, socio-

cultural and spiritual dimension.

Holistic approach method, in lessening the

aggressiveness, is started with biological dimension,

which is giving deep breathing technique.

Handoyo’s (2005) states that before given deep

breathing technique, the respondents who are able to

control violence behavior are only 6 people (15.4%)

while those who are unable with it are 33 people

(84.6%). After the therapy, the numbers of

respondents who were unable decreased into 3

people (7.7%) while the ones who were able

increased into 36 people (92.3%). Deep breathing

relaxation technique does not only calm the

respondents down physically but also their mind.

Research conducted by Kustamti& Widodo (2008)

also signifies that there is the influence of the

relaxation technique which relates to the aggressive

patients. One of the techniques is deep breathing

relaxation and that research concludes that the

influence indeed exists. It happens also with

Zelianti’s research result which obtains p value

0,000 and that the research result signifies that it has

the influence to change, before and after the deep

breathing relaxation technique.

Socio-cultural approach is given by conducting

verbal practice. Verbal practice is conducted

bytraining the skills of asking something politely,

declining a request and expressing feelings.

Moreover, the children are also taught to give

compliments, complain due to disagreement, strive

for personal rights, give advice to others, solve

problems and collaborate with others (MqQuaid,

2000).The children will also be taught how to

SKIC-MHS 2018 - The 2nd Syiah Kuala International Conference on Medicine and Health Sciences

252

habituate effective words which can minimalize the

aggressiveness, such as ‘sorry’, ‘thank you’ and

‘please’. Apologizing, expressing gratitude and

saying sorry are local absorptivity from Indonesian

culture which should be maintained (Shiradj, 2013).

Psychological approach is conducted through

emotion managing by doing actions which can

control mind, feelings and anger in effective,

positive and socially-accepted so it can prevent

anything bad happening or harm themselves and

others. There are some aspects of managing

emotions, such as identifying anger. According to

Goleman (1997), identifying anger means an ability

to identify anger when the anger takes over so a

person is not controlled by anger. A person who has

the ability to identify anger can react to the anger

effectively and in the right time. Identifying anger

can be done by recognizing early signs which come

along the anger, such as fast-beating pulse, fast-

beating heart, stiff jaw, strained muscles, feeling hot

in all over the body, making a fist, walking back-

and-forth, being restless, talking faster or

considering to rage violently or committing revenge,

etc.

Moreover, a person can be more sensitive to

recognize anger by identifying situations or any

matters which can trigger the anger(Hershorn,

2005).Lack of the ability to recognize can cause a

person unable to control his/her emotions and make

him/her react inappropriately and exaggeratedly.

Inability in recognizing anger also affect to

confusion in identifying emotions felt by the person

so he/she often reacts improperly towards emotional

situations (Goleman, 1997).Someone who can

control his anger will not let the anger dominates

him. He can control his emotions and keep the

balance of the emotions so the anger will get out of

control and happen in high intensity (Goleman,

1997).

Easing the anger is the ability to calm oneself

after being angry. According to Tice (in Goleman,

1997), one of the effective strategiescommonly done

to ease the anger is going somewherealone. The

other alternative is having an errand far away from

home. Someone will face difficulty to ease his anger

if his mind is till full of anger. How small the

thought about the anger is can trigger bigger anger.

To stop the thought of anger, we can do it

bydistracting attention from the trigger of the anger.

Spiritual approach covers spiritual activities.

Spiritual is associated with belief in such things as:

nature, science, religion or higher power which helps

people achieve their goals of life. It includes morals,

values and ethics of a person. Therapy which can be

done is the therapy of motivating children to conduct

spiritual activities.

5 CONCLUSIONS

Schools are advised to apply method of

aggressiveness handling in schools throughSchool

Health Program and also train the tutors such as

teachers and family, especially mothers so that they

are able to conduct this handling method

independently at home and school.

ACKNOWLEDGEMENTS

The author would like to thank the Ministry of

Research and Technology Higher Education of the

Republic of Indonesia, Prof. Dr. Runtung, SH,

M.Hum as the Rector of University of North

Sumatera.

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