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"Latar Belakang: Pembedahan merupakan peristiwa yang menimbulkan kecemasan besar bagi sebagian besar pasien. Hingga saat ini, studi antara kecemasan dan nyeri pascaoperasi masih kurang memadai. Maka, tujuan dari penelitian ini adalah untuk mengetahui hubungan antara ambang nyeri dan toleransi nyeri praoperasi terhadap derajat nyeri pascaoperasi pada pasien yang cemas dan tidak cemas.Metode: Penelitian ini merupakan studi kohort prospektif di RSCM yang berlangsung pada periode 25 April 2019 hingga 10 Maret 2020 dan melibatkan 63 pasien sesuai dengan kriteria inklusi yang telah dijadwalkan untuk menjalani operasi tulang panjang elektif. Semua peserta menyelesaikan kuesioner skala kecemasan praoperasi (APAIS) Amsterdam Preoperative and Information Scale dan menjalani evaluasi penilaian sensitivitas nyeri praoperatif dengan penilaian ambang nyeri dan toleransi nyeri menggunakan algometer. Evaluasi nyeri pascaoperasi menggunakan penggaris Visual analog scale (VAS) pada jam ke 4, 6 dan 24 pascaoperasi.Hasil: Studi ini melibatkan 63 pasien dengan usia rerata 37,68 ± 15,67 tahun (17-68 tahun); terdiri atas 42 laki-laki (67%) dan 21 perempuan (33%). Mayoritas dari subyek tidak cemas 45 (71,4%), sedangkan 18 (28,6%) adalah kelompok cemas. Studi ini menemukan pengurangan signifikan nilai rerata ambang nyeri maupun toleransi nyeri pada kelompok cemas. Kelompok cemas memiliki ambang nyeri dan toleransi nyeri rerata 3,43 ± 1,04 kgf /cm2 dan 4,96 ± 1,11 kgf /cm2 dibandingkan dengan kelompok tidak cemas yaitu 4,63 ± 1,25 kgf /cm2 dan 7,14 ± 2,23 kgf /cm2. Individu yang cemas cenderung memiliki ambang nyeri yang rendah (p 0,0001) dan toleransi nyeri yang rendah (p 0,0002) dengan skor VAS yang lebih tinggi, pascaoperasi.Simpulan: Kecemasan mengurangi ambang nyeri dan toleransi nyeri praoperasi dan memiliki korelasi signifikan dengan skor VAS pascaoperasi pada jam ke-4. Oleh sebab itu, penilaian kecemasan praoperasi dapat berguna untuk mengidentifikasi individu yang rentan terhadap rasa sakit berlebihan pascaoperasi.

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Background: Hospitalization and surgery are critical life events that bring about considerable anxiety to most patients. There is paucity of information on anxiety and its relation to postoperative pain. The goal of this study was to evaluate whether anxiety influences preoperative pain threshold and pain tolerance values and its correlation to postoperative surgical pain. Methods: A hospital-based prospective cohort study from April 25, 2019 to March 10, 2020 involving sixty-three patients who matched the inclusion criteria and scheduled for elective long bone surgery were enrolled into the study. All participants completed the Amsterdam preoperative anxiety and information scale (APAIS) questionnaire and underwent evaluation of their pre-operative pain sensitivity assessment: pain threshold and tolerance with an algometer. Visual analog scale (VAS) ruler was used to assess pain at 4th, 6th and 24th hour postoperative. Results: A total of 63 patients with mean age 37.68 ± 15.67 years (range 17 to 68 years), consisting of 42 males (67%) and 21 females (33%) were included in this study. Majority of the subjects were not anxious 45 (71.4%), while the remainder 18 (28.6%) were anxious. This study found significant reduction in mean pressure pain threshold and pain tolerance amongst anxious individuals compared to non-anxious individual. Anxious individuals had a mean pain threshold and tolerance of 3.43 ± 1.04 kgf /cm2 and 4.96 ± 1.11 kgf /cm2 compared to non-anxious individuals at 4.63 ± 1.25 kgf /cm2 and 7.14 ± 2.23 kgf /cm2. Anxious individuals were likely to have low pain threshold (p 0.0001) and low pain tolerance (p 0.0002) with higher VAS scores, postoperatively.

Conclusion: Anxiety reduces both preoperative pain threshold and tolerance and has significant correlation to postoperative VAS score during the 4th hour. Hence, assessment of anxiety is a simple and useful tool in identifying those susceptible to exaggerated postoperative pain."

"Kecemasan preoperasi pada pasien bedah anak merupakan komponen penting dalam operasi bedah anak. Tujuan penelitian yaitu untuk mengidentifikasi tingkat kecemasan pasien anak yang menjalani perawatan preoperasi sebelum dan setelah diberikan intervensi edukasi preoperasi dengan media audiovisual. Penerapan intervensi diberikan dengan memperlihatkan video edukasi preoperasi pada pasien anak dan orangtua yang menjelaskan prosedur preoperasi, teknik relaksasi tarik nafas dalam, dan batuk efektif. Tingkat kecemasan pada pasien anak diukur dengan Revised Children Manifest Anxiety Scale. Hasil penelitian didapatkan terdapat perbedaan tingkat kecemasan pada pasien bedah anak sebelum dan sesudah diberikan edukasi preoperasi dengan media audiovisual yang dimana skor RCMAS sebelum dilakukan intervensi mencapai 22 yang menunjukkan adanya kecemasan klinis. Setelah pasien bedah anak diberikan intervensi skor RCMAS turun menjadi 12 sampai dengan 19 yang menunjukkan kecemasan normal. Kesimpulannya yaitu pemberian edukasi preoperasi dengan media audiovisual dapat diberikan kepada pasien bedah anak untuk menurunkan kecemasan. Rekomendasi untuk penelitian selanjutnya dapat dikaji lebih lanjut perbedaan secara signifikan tingkat kecemasan pada pasien bedah anak dengan media audiovisual, dengan jumlah sampel yang lebih besar.

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Preoperative anxiety in pediatric surgical patients is an important component of pediatric surgery. The purpose of the study was to identify the level of anxiety of pediatric patients who underwent preoperative treatment before and after being given preoperative education interventions with audiovisual media. Implementation of the intervention was given by showing preoperative educational videos to pediatric patients and parents explaining preoperative procedures, deep breathing relaxation techniques, and effective coughing. The level of anxiety in pediatric patients was measured by the Revised Children Manifest Anxiety Scale. The results showed that there were differences in the level of anxiety in pediatric surgical patients before and after being given preoperative education with audiovisual media where the RCMAS score before the intervention reached 22 which indicated the presence of clinical anxiety. After pediatric surgery patients were given intervention the RCMAS score dropped to 12 to 19 which indicates normal anxiety. The conclusion is that preoperative education with audiovisual media can be given to pediatric surgery patients to reduce anxiety. Recommendations for further research can be further studied the significant difference in anxiety levels in pediatric surgery patients with audiovisual media, with a larger sample size"

"Latar belakang angka kejadian mual muntah pascaoperasi 20-30% pada pembedahan umum dan pada pembedahan payudara 50-65%. Salah satu cara nonfarmakologi yang dapat dilakukan untuk menurunkan mual munth pascaoperasi adalah dengan pemberian cairan praoperatif. Penelitian ini bertujuan untuk mengetahui efektifitas pemberian cairan praoperatif Ringer Laktat 2 cc/kg bb/jam puasa untuk menurunkan angka kejadian mual muntah pascaoperasi pada pasien yang menjalani pembedahan mastektomi.Metode Dilakukan pembiusan umum pada 109 pasien ASA 1-2 yang menjalani pembedahan mastektomi. Tujuh pasien dikeluarkan, hidrasi 51, kontrol 51 sampel Pada kelompok perlakukan diberikan cairan praoperatif Ringer laktat 2 cc/kg bb/jam puasa sedangkan pada kelompok kontrol tidak diberikan. Seluruh sampel tidak diberikan antiemetik. Dilakukan pencatatan angka kejadian mual muntah selama 0-1 jam pascaoperasi di ruang pulih dan 1-24 jam di ruang rawat inap. Hasil Angka kekerapan mual 0-1 jam pascaoperasi kelompok hidrasi 19,6% (10), kontrol 39,2% (20) Angka kekerapan muntah 0-1 jam pascaoperasi kelompok hidrasi 13,7% (7), kontrol 11,8% (6). Angka kekerapan mual 1-24 jam pasca operasi kelompok hidrasi 11,8% (6), kontrol 23,5% (12). Angka kekerapan muntah 1-24 jam pasca operasi kelompok hidrasi 5,9% (3) kontrol 5,9% (3). Angka kekerapan mual 0-24 jam pascaoperasi kelompok hidrasi 21,6% (11) kontrol 41,2% (21). Angka kekerapan muntah 0-24 jam pascaoperasi kelompok hidrasi13,7%(7) kontrol 13,7% (7). Risiko relatif untuk terjadinya mual muntah pascaoperasi adalah 0,52 (0,28-0,97)Kesimpulan pemberian cairan praoperatif Ringer laktat 2 cc/kg bb/jam puasa efektif untuk menurunkan angka kejadian mual pascaoperasi mastektomi pada 1 jam pertama pasca operasi.

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Background: The incidence of postoperative nausea and vomiting 20-30% in all general surgery for breast surgery 50-65%. One of non pharmacology approach using preoperative hydration. This research try to find the effectivity of preoperative ringer lactate hydration 2 cc/kg bw/fasting hour to decrease postoperative nausea and vomiting in mastectomy surgery.

Method: General anesthesia perform for 109 sample ASA1-2 plan to perform mastectomy surgery. Seven samples exclude, hidration 51, kontrol 51 samples Hydration group given preoperative ringer lactate 2 cc/kg bw/fasting hour and control group none. None antiemetic given. Monitoring and recording the incidence of nausea and vomiting one hour postoperation in the recovery room and one until 24 hours in the ward.

Result: The nausea incidence 0-1 hour postoperative 19,6% (hydration group) vs 39,2% (control group). The vomiting incidence 0-1 hours postoperative 13,7% (hydration group) vs 11,8% (control group). The nausea incidence 1-24 hour postoperative 11,8% (hydration group) vs 23,5% (control group). The vomiting incidence 1-24 hours post operative 5,9% (hydration group) vs 5,9% (control group) the nausea incidence 0-24 hours post operative 21,6% (hydration group) vs 41,2% (control group). The vomiting incidence 0-24 hours post operative 13,7% (hydration group) vs 13,7%(control group). Relative risk for post operative nausea and vomiting using preoperative hydration ringer lactate 2 cc/kg bw/fasting hour 0,52.

Conclusion: Preoperative ringer lactate 2 cc/kg bw/fasting hour effectively reducing the incidence of post operative nausea one hour post operative.

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"Kecemasan pra operasi merupakan kondisi yang lazim dialami oleh pasien yang akan menjalani tindakan pembedahan. Tingkat kecemasan pra operasi yang tinggi dapat memberikan dampak negatif terhadap pasien. Penelitian ini bertujuan untuk menganalisis faktor-faktor yang mempengaruhi tingkat kecemasan pra operasi pada pasien-pasien yang menjalani operasi di Instalasi Pelayanan Bedah Terpadu RSUPN dr. Cipto Mangunkusumo. Penelitian ini menggunakan desain cross- sectional dengan 393 responden yang diseleksi melalui metode consecutive sampling. Skala kecemasan menggunakan The Amsterdam Preoperative and Anxiety Scale (APAIS). Data dianalisis dengan menggunakan analisis bivariat dan multivariat. Gambaran tingkat kecemasan pra operasi sebesar 54.2%. Tidak ada hubungan signifikan antara usia, jenis kelamin, tingkat pendidikan, status pekerjaan, pernikahan, jenis operasi, dan pembiusan terhadap tingkat kecemasan pra operasi (p > 0.05). Jenis operasi merupakan variabel yang paling berpengaruh terhadap tingkat kecemasan pra operasi (OR = 3.501;CI = 95%). Studi lebih lanjut dibutuhkan untuk mengidentifikasi faktor yang secara spesifik berpengaruh terhadap tingkat kecemasan pra operasi.

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Preoperative anxiety is a common condition experienced by patients who will undergo a surgery. High levels of preoperative anxiety can cause negative impacts on patients. This study aims to analyze the factors that influence the level of preoperative anxiety in patients undergoing surgery at the Integrated Surgical Service of Cipto Mangunkusumo National Center Hospital. This study used a cross-sectional design with 393 respondents selected through consecutive sampling method. The anxiety scale are measured by The Amsterdam Preoperative and Anxiety Scale (APAIS). Data were analyzed using bivariate and multivariate analysis. The description of the level of preoperative anxiety was 54.2%. There was no significant relationship between age, gender, education level, employment status, marriage, type of surgery, and anesthesia on the level of preoperative anxiety (p > 0.05). Types of surgery is the variable that mostly influenced the level of preoperative anxiety (OR = 3.501; CI = 95%). Further studies are needed to identify factors that specifically influence the level of preoperative anxiety."

"Global Status Report on Road Safety 2019 yang dibuat oleh World HealthOrganization (WHO), sebanyak 1,24 juta korban meninggal tiap tahunnya diseluruh dunia akibat kecelakaan lalu lintas. Sedangkan di Indonesia rata-rata 3orang meninggal setiap jam akibat kecelakaan lalu lintas pada tahun 2019.Kecelakaan lalu lintas menyebabkan trauma sehingga produktivitas seseorangdapat menurun selain itu dapat menyebabkan kecacatan sementara hinggapermanen. Fraktur atau sering dikenal dengan patah tulang adalah hilangnyakontinuitas tulang, retak atau patahnya tulang yang semulanya utuh. Dampak yangditimbulkan oleh trauma pada fraktur diantranya terbatasnya aktivitas, karena rasanyeri akibat tregeseknya saraf motorik dan sensorik pada luka fraktur. Salah satutatalaksana dari fraktur adalah tindakan operasi dengan metode Open ReductionExternal Fixation (OREF). Nyeri post operasi pemasangan OREF sangatdirasakan oleh pasien. Nyeri adalah sesuatu hal yang bersifat subjektif. Rasa nyerimenghambat pasien untuk memulai menggerakkan ekstermitas yang cedera.Range Of Motion adalah tindakan keperawatan. ROM dapat menurunkanintensitas nyeri karena memperlancar sirkulasi darah, dan memelihara mobilitaspersendian, mengurangi ketegangan, serta meningkatkan relaksasi (Brunner &Suddarth, 2018).

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Global Status Report on Road Safety 2019 which was made by World Health

Organization (WHO), as many as 1,24 million people die every yearof

worldwide duee to traffic accidents. While in Indonesia an average of 3 people

die every hour due to traffic accident in 2019 pada tahun 2019. The traffic

accident cause the trauma, so that the productivity's someone can decrease. In

addition it can cause temporary to permanent disability. Fractures or often

known as fractures are the loss of continuity of bone, cracks or fractures of

bones that were originally intact. The impact caused by trauma to fractures

includes limited activity, because of the pain caused by the friction of the motor

and sensory nerves in the fracture wound. One of the treatments for fractures is

surgery using the Open Reduction External Fixation (OREF) method. The

patient feels the postoperative pain of OREF installation. Pain is something that

is subjective. Pain prevents the patient start moving the injured extremity.

Range Of Motion is a nursing action. ROM can reduce pain intensity because it

facilitates blood circulation, and maintains joint mobility, reduces tension, and

increases relaxation (Brunner & Suddarth, 2018).

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"Rekomendasi pemberian cairan karbohidrat sebelum operasi pada populasi diabetes melitus tipe 2 (DMT2) masih lemah. Penelitian ini bertujuan untuk mengetahui pengaruh pemberian CHO terhadap profil gula darah perioperatif dan resistensi insulin pada populasi DMT2. Penelitian ini merupakan uji klinis acak tersamar ganda yang melibatkan 44 pasien dewasa dengan DMT2 yang menjalani operasi elektif kategori minor. Subjek dibagi menjadi kelompok kontrol dan kelompok CHO. Pencatatan terhadap kadar gula darah (GD) pada empat titik waktu pengukuran, yaitu prabedah, intrabedah, pascabedah, dan 1 hari pascabedah, serta kadar insulin sebelum dan sesudah operasi. Komplikasi yang direkam meliputi kejadian mual, muntah, aspirasi, infeksi, serta pemajangan lama rawat. Kelompok CHO memiliki profil gula darah yang lebih stabil dibandingkan kelompok kontrol (p=0,003) terutama 1 hari pascabedah dengan median lebih rendah (137,5 (79–248) vs. 147,0 (88­–228)). Kelompok kontrol memiliki fluktuasi gula darah signifikan. Resistensi insulin kelompok CHO menurun signifikan dari nilai prabedah (p=0,01). Insiden hiperglikemi sebesar 65% pada kelompok CHO dibanding 45% pada kontrol dengan insiden hipoglikemia 10% pada kelompok kontrol. Tidak ada komplikasi dalam penelitian ini. Pasien DMT2 yang mendapat CHO memiliki profil GD lebih stabil dan penurunan resistensi insulin pascabedah.

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Preoperative carbohydrate loading (CHO) recommendations in type 2 diabetes (T2DM) patients are still controversial. This study aimed to evaluate the effects of CHO towards perioperative blood glucose (BG) and insulin resistance in T2DM underwent elective surgery. Forty-four patients were allocated randomly to control group and CHO group. Blood glucose was examined at four time points: preloading, intraoperative, end of surgery and 1-day post-surgery. Insulin was examined at preloading and end of surgery. Complications recorded including nausea, vomiting, aspiration, infection and prolong hospital stay. The CHO group had a more stable BG compared to control (p=0,003) notably at 1-day post-surgery with lower BG median in CHO (137,5 (79–248) vs. 147,0 (88­–228) while control group had significant BG fluctuation. Insulin resistance trend between group were not statistically significant (p=0,34), however insulin resistance in CHO group was significantly lower compared to preloading (p=0,01). About 65% subjects in CHO group had hyperglycemia compared to 45% in control group. There were 10% subjects with hypoglycemia in control group. There were no complications observed during this study. T2DM patients receiving CHO had more stable perioperative BG profile and could lower insulin resistance due to surgery."

"Nyeri merupakan keluhan utama yang terjadi pada pasien pascapembedahan. Manajemen nyeri yang tidak efektif akan mempengaruhi kualitas pelayanan rumah sakit. Hal ini merupakan tantangan bagi rumah sakit untuk mempertahankan pencapaian kualitas pelayanan yang paripurna. Penelitian ini bertujuan untuk mengetahui hasil evaluasi manajemen nyeri terhadap pasien pascapembedahan. Metode penelitian ini adalah cross sectional yang dilakukan dengan melibatkan 96 pasien pascapembedahan selama bulan Juni 2017. Kuesioner American Pain Society Patient Outcome Questionnaire Revised APSPOQR yang dimodifikasi Cronbach ?=0,720 digunakan untuk mengkaji pengalaman nyeri pasien. Kejadian nyeri pada pasien pascapembedahan adalah 86,5. Intensitas nyeri pada skala 1-10, terendah rata-rata pada skala 2,27, terberat rata-rata pada skala 4,35 ; dan berkurang dalam 24jam pertama sebesar 67,6. Pengaruh nyeri terhadap aktivitas, istirahat dan mood: ringan le;3,47 dari skala 1-10 ; efek samping obat: ringan le;1,54 dari skala 1-10 ; partisipasi dan kepuasan pasien dalam pengobatan berturut-turut 7,59 dan 7,92 dari skala 1-10 ; besar informasi pengobatan nyeri dapat membantu 7,01 dari skala 1-10 ; penggunaan manajemen nonfarmakologi sebesar 70,8.

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Pain is a major problem post operative patients. Ineffective pain management may affect the quality of health care services in hospital. Thus, hospital management should address this challenge to provide better quality service. This study aimed to evaluate pain management given in post operative patients. The method of this study was a cross sectional study involving 96 post operative patients during June 2017. The modified American Pain Society Patient Outcome Questionnaire Revised APSPOQR Cronbach 0,720 was used to assess the patient 39 s pain experience. The incidence of pain in post operative patients was 86.5 In the first 24 hours, the pain was decreased 67.6 On a scale of 1 10, lowest pain 2.27, severe pain 4.35 the impact of pain on activity, sleep and emotion mild le 3,47 side effects of treatment mild le 1,54 ability to participate in pain treatment 7.59 Pain treatment information may be helpful 7.01 Patient satisfaction 7,92 use of nonpharmacological strategies 72,9."

"[ABSTRAKNyeri pembedahan menimbulkan cemas, takut dan perubahan perilaku maladaptif anak. Perlu asuhan keperawatan berkualitas dalam mengatasi nyeri anak. Karya ilmiah akhir bertujuan menggambarkan aplikasi comfort theory Kolcaba dalam memberikan asuhan keperawatan pasien pasca bedah yang mengalami nyeri. Intervensi ditentukan berdasarkan comfort theory yaitu mengukur skala nyeri, memberikan posisi nyaman, memberikan madu, mengajarkan keluarga manajemen nyeri serta memberikan reinforcement positif keterlibatan keluarga dalam perawatan. Evaluasi hasil menunjukkan aplikasi comfort theory dalam keperawatan perlu ditunjang faktor-faktor lain seperti kondisi pasien, lingkungan dan tim pelayanan kesehatan dalam mencegah dan mengatasi nyeri. Rekomendasi karya ilmiah ini adalah teori keperawatan sebaiknya diaplikasikan dalam asuhan keperawatan.

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ABSTRACTSurgical pain causes anxiety, fear and change in children's behaviours. A good quality of nursing care is needed to overcome children's pain. This scientific paper aimed to illustrate the application of comfort theory Kolcaba in providing nursing care to patients suffered post-surgical pain. Intervention was determined based on comfort theory which included: measure pain scale, provide a comfortable position, offer honey, teach families management of pain, and give positive reinforcement on family involvement during the care. Result's evaluation indicated thet comfort application in nursing theory need to be supported by other factors such as the condition of the patient, the environment and health care team to prevent and overcome pain. This scientific paper recommends the application of nursing theory in providing nursing care., Surgical pain causes anxiety, fear and change in children's behaviours. A good quality of nursing care is needed to overcome children's pain. This scientific paper aimed to illustrate the application of comfort theory Kolcaba in providing nursing care to patients suffered post-surgical pain. Intervention was determined based on comfort theory which included: measure pain scale, provide a comfortable position, offer honey, teach families management of pain, and give positive reinforcement on family involvement during the care. Result's evaluation indicated thet comfort application in nursing theory need to be supported by other factors such as the condition of the patient, the environment and health care team to prevent and overcome pain. This scientific paper recommends the application of nursing theory in providing nursing care.]"

"Pelayanan pre operatif anestesi merupakan tahap pertama dari seluruh tindakan anestesi. Dikatakan bahwa 40% risiko kematian atau komplikasi akibat tindakan anestesi yang berkaitan dengan masalah gangguan jalan nafas dapat dicegah dengan pengkajian pre operatif anestesi. Namun hingga saat ini pelaksanaan pre operatif anestesi yang tidak pernah mencapai 100% menjadi masalah yang dihadapi hampir semua rumah sakit tidak terkecuali Rumah Sakit Myria Palembang. Sebuah kerangka berpikir keselamatan pasien “swiss cheese model” yang lebih mengutamakan pendekatan sistem digunakan untuk analisis pre operatif anestesi. Identifikasi celah dalam setiap proses pelayanan pre operatif anestesi digunakan sebagai dasar untuk melakukan perbaikan. Penelitian ini bertujuan untuk melakukan analisis pelayanan pre operatif anestesi dengan pendekatan mixed method. Analisis deskriptif dilakukan dengan menggunakan kuesioner yang dibagikan kepada 106 responden. Data kualitatif didapatkan melalui wawancara mendalam, fokus group discussion, telaah literatur dan dokumen terkait untuk mendapatkan analisis yang lebih komprehensif terhadap pengaruh organisasi, supervisi, teknologi, prekondisi dan perilaku individu pada pre operatif anestesi. Hasil analisis deskriptif didapatkan capaian pre operatif anestesi sebesar 61.3%; keseluruhan pre operatif anestesi dilakukan di hari yang sama dengan hari operasi; terdapat ketidaksesuaian regulasi yang ditetapkan manajemen rumah sakit; lemahnya supervisi pelaksanaan pre operatif anestesi; kurangnya pemanfaatan teknologi; sikap pasif pasien terhadap pelaksanaan pre operatif anestesi tergambar dari tanggapan responden terhadap variabel prekondisi termasuk dalam kategori rendah; operasi tetap berjalan meskipun tidak dilakukan pre operatif anestesi; budaya keselamatan pasien yang rendah pada perawat dan penata anestesi; proses admisi dan pelaporan pasien yang terlalu malam; perilaku individu tidak aman dokter spesialis anestesi dengan tidak melakukan pre operatif anestesi. Strategi rumah sakit sebagai pemecahan masalah rendahnya pelaksanaan pre operatif anestesi antara lain perbaikan regulasi; peningkatan supervisi; optimalisasi pemanfaatan sistem informasi rumah sakit; memperbaiki proses admisi pasien dan pelaporan pasien; meningkatkan kerja sama dengan operator bedah untuk kemudahan pelaksanaan pre operatif anestesi serta meningkatkan komitmen dokter spesialis anestesi untuk melakukan pre operatif anestesi.

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Preoperative anesthesia is the first stage of any anesthetic procedure. It is said that the 40% risk of death or complications from anesthesia related to airway obstruction can be prevented by recovering from preoperative anesthesia. However, until now the implementation of preoperative anesthesia which has never reached 100% is a problem faced by almost all hospitals, Myria Palembang Hospital is no exception. A “Swiss cheese model” patient safety framework supporting the systems approach was used to analyze preoperative anesthesia. Identification of gaps in each process of preoperative anesthesia services is used as a basis for making improvements. This study aims to analyze preoperative anesthesia services using a mixed methods approach. Statistical tests were carried out using a questionnaire which was distributed to 106 respondents. Qualitative data were obtained through in-depth interviews, focus group discussions, literature review and related documents to obtain a more comprehensive analysis of the influence of organization, supervision, technology, conditions and individual behavior on preoperative anesthesia. The results showed that the preoperative anesthetic performance was 61.3%; Overall preoperative anesthesia was carried out on the same day as the day of surgery; there is a non-compliance with the regulations set by the hospital management; weak supervision of the implementation of preoperative anesthesia; lack of utilization of technology; the patient's passive attitude towards the implementation of preoperative anesthesia is reflected in the respondents' responses to the precondition variables included in the low category; the operation continues even though preoperative anesthesia is not performed; low patient safety culture among nurses and anesthesiologists; late admission process and patient reporting; Unsafe individual behavior of anesthesiologists by not performing preoperative anesthesia. The hospital's strategy as a solution to the problem of low implementation of preoperative anesthesia includes regulatory improvements; increased supervision; optimizing the utilization of hospital information systems; improve admission and patient reporting processes; increase cooperation with surgical operators to facilitate the implementation of preoperative anesthesia and increase the commitment of anesthesiologists to perform preoperative anesthesia."

"[ABSTRAKKecemasan merupakan hal yang sering dilaporkan ketika anak dihadapkan pada prosesoperasi. Penelitian ini bertujuan mengidentifikasi dampak penggunaan buku ceritabergambar terhadap kecemasan sebelum operasi. Design Penelitian adalah quasieksperiment:Post test-only non equivalen control group. Sampel penelitian adalah 34anak usia sekolah yang akan menjalani operasi, dipilih dengan teknik Consecutivesampling. Kelompok intervensi diberikan informasi dengan buku cerita bergambar dankelompok kontrol mendapatkan informasi rutin rumah sakit. Hasil penelitianmenunjukan anak yang mendapatkan persiapan dengan buku cerita bergambarmengalami kecemasan sebelum operasi lebih rendah (p=0,003). Penelitian inimerekomendasikan pemberian informasi dengan buku cerita bergambar sebagai salahsatu intervensi persiapan operasi

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ABSTRACTAnxiety is often reported among preoperative children. This study aimed to identify theimpact of story book on preoperative anxiety among school-age children. Researchdesign was quasi experiment: Post test -only non equivalent control group toward 34which were selected with consecutive sampling technique. Children on interventiongroup were prepared with pictured story book, while children on control group wereprepared with hospital routine information. The result showed that children whoseprepared with pictured story book experienced less preoperative anxiety (p=0,003). Thisresearch recommends pictured story book as one of interventions for preoperativepreparation;Anxiety is often reported among preoperative children. This study aimed to identify theimpact of story book on preoperative anxiety among school-age children. Researchdesign was quasi experiment: Post test -only non equivalent control group toward 34which were selected with consecutive sampling technique. Children on interventiongroup were prepared with pictured story book, while children on control group wereprepared with hospital routine information. The result showed that children whoseprepared with pictured story book experienced less preoperative anxiety (p=0,003). Thisresearch recommends pictured story book as one of interventions for preoperativepreparation., Anxiety is often reported among preoperative children. This study aimed to identify theimpact of story book on preoperative anxiety among school-age children. Researchdesign was quasi experiment: Post test -only non equivalent control group toward 34which were selected with consecutive sampling technique. Children on interventiongroup were prepared with pictured story book, while children on control group wereprepared with hospital routine information. The result showed that children whoseprepared with pictured story book experienced less preoperative anxiety (p=0,003). Thisresearch recommends pictured story book as one of interventions for preoperativepreparation.]"