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ABSTRACT
Introduction: Schizophrenia is a disease which affects the brain, causing impaired perception, thought, emotion, movement,
and behavior, such as self-care deficit. Self-care deficit is an impaired ability to bathing, dressing, eating and toileting.
Modeling participant is a technique required to address the problem of self-care deficit where clients are taught and trained to
meet the needs of self-care. The purpose of this study was to analyze the influence of participants modeling on self-care
ability in schizophrenic clients with self-care deficit. Method: This study used quasi-experimental design. Sampling was
carried out with total sampling to all affordable population comprising 20 respondents in Dr. Radjiman Wediodiningrat
Mental Hospital, Lawang. This study analyzed by Wilcoxon Signed Rank Test and Mann-Whitney Test with a significance
level of p < 0.05. Result: The results showed the influence of participants modeling on self-care ability in schizophrenic
clients with self-care deficit. Wilcoxon Signed Rank Test in treatment group showed p = 0.005 and control group showed p =
0,206. Mann-Whitney Test showed p = 0.030. Modeling participant improved self-care ability in schizophrenic clients with
self-care deficit. Analysis: Modeling participant will improve cognitive, self-confidence and motivation of schizophrenic
clients so that their ability to bathing, dressing, eating and toileting will increase. Discussion: Modeling participant can be
applied as a technique to improve self-care ability in schizophrenic clients with self-care deficit. For further research can be
explored further implementation of the modeling of participants in the group activity therapy.
Keywords: modeling participant, self-care, schizophrenia.
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Jurnal Ners Vol. 12 No. 1 April 2017: 41-48
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Modelling Participants Towards Self Care Deficit (Ah Yusuf et.al)
significance level established p <0.05. Mann- assisted in dressing and rarely given an
Whitney is used to determine differences in opportunity to do it independently. In eating
self-care ability of schizophrenic client with ability of respondents require assistance in
self-care deficit in treatment group and control preparing equipment and food. The ability of
group with significance level established p respondents bowels/urinate need help to go to
<0.05. the toilet, wipe after a bowel/urinate with clean
water, and flush toilets cleanly and not smell.
RESULTS Many respondents are urinated no in the
bathroom, not wipe and flush the toilet after a
Self care ability before modeling participant
bowel /urinate. Respondents argued lazy to do
treatment
so.
80% 70%70%
Self-care ability after modeling participant
60% treatment
40%
20% 20%
20% 10% 10% 150%
100%
0%
100%
Good Moderate Low 60%
50% 30%
Treatment Control
0% 0% 10%
0%
Good Moderate Low
Figure 1 Self Care Ability Before Modeling
Treatment Control
Participants Treatment.
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Jurnal Ners Vol. 12 No. 1 April 2017: 41-48
Table 1 Self-care ability level before and after given modeling participant treatment in control and
treatment group at Dr. Radjiman Wediodiningrat Mental Hospital Lawang
Treatment Treatment
No Criteria Before Before Before After
% % % %
1 Good 1 10 10 100 2 20 6 20
2 Moderate 7 70 0 0 7 70 3 70
3 Low 2 20 0 0 1 10 1 10
Total 10 100 10 100 10 100 10 100
p = 0.005 p = 0.206
Wilcoxon Signed Rank Test Wilcoxon Signed Rank Test
Statistics
p = 0.030
Mann-Whitney Test
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Modelling Participants Towards Self Care Deficit (Ah Yusuf et.al)
times treated. Research of Andayani (2012) All respondents of treatment group after
concluded that there is a significant correlation modeling participant treatment has increased to
between frequency of respondents treated and be a good level of self-care ability. The age
self-care ability. Stuart and Laraia (2005) states range respondents of treatment group are 18-55
that timing and duration of schizophrenic client years or adulthood. According to Siagian
exposure by stressor impact in the (1995) in Parendrawati (2008), the older person
independence of self-care. A new schizophrenic related to technical maturity, psychological
client while first time exposing stressor require maturity which shows the soul maturity, it
intensive efforts as primary prevention. means more wisdom, able to think rationally,
Respondents with 1-2 times treated require control emotions and considerate of others.
intensive effort involving backup sources which Respondent age affects to decision-making
owned by individuals, preventing self-care ability and take action for self-care
deficit becomes more difficult to overcome. improvement.
Respondents with enough and less self- As many as 90% of respondents in the
care ability level as many 82% are treatment group with good self-care ability ever
schizophrenia hebephrenic clients. get one time of care frequency. Stuart and
Schizophrenia hebephrenic characteristic is Laraia (2005) states that timing and duration of
irresponsible and unpredictability behavior, stressor exposure influence the achievement of
mannerism, tendency to be alone, hollow and self-care independent in schizophrenic clients.
empty feeling. Affective, encouragement A new schizophrenic client when first time
impulse, and thought processes disorders exposed stressor requires intensive efforts as
prominent (Amin 2009). These symptoms will primary prevention. Modeling participant is one
influence to clients self-care ability. of intensive efforts to prevent self-care deficit
As many as 66% of respondents with less problems from becoming more complex. The
self-care ability receive combination therapy of treatment group was trained intensively to take
typical and atypical antipsychotics. Typical care for themselves as bathing, dressing, eating,
antipsychotic overcomes positive signs of and bowel/urinate and trained to practice these
schizophrenia such as delusions, hallucinations, capabilities. Self-care ability of control group in
thought disorder, and other psychotic enough and less level have 2-3 times treated
symptoms, but does not have a visible effect on frequency and unmarried status. This indicates
negative signs. Atypical antipsychotics can the client tendency to relapse due to lack of
reduce psychotic symptoms and useful to family support. Unmarried respondents lived
reduce negative symptoms such as not having with their parents, but the case is the parents too
the wish and motivation, social withdrawal and old, so an intensive effort to overcome self-care
anhedonia (Videbeck, 2008). Schizophrenia deficit problems at home are less than optimal.
handling is not only by psychopharmacy but As many as 70% of respondents in the
also by nursing care. The goal of nursing care treatment group with good self-care ability have
in self-care deficit client is improving clients elementary school education level. Ajzen and
knowledge and self-care ability. Fishbein (1980) in Parendrawati (2008)
The majority of clients self-care ability suggests the theory of reasoned which
before given modeling participant treatment are cognitive process is people basis to decide or
enough level and adequate enough to take care take appropriate behavior, systematically using
of them, but should be helped and motivated by nearby available information. The nurse duties
the nurse. This is due to clients condition who as an educator are providing self-care
are still experiencing positive and negative knowledge on the schizophrenic client. In this
symptoms of schizophrenia such as study, respondents were taught how to take care
hallucinations, fragmented thoughts or ideas, of themselves well so that respondent can
careless feeling of people, activities, events, improve their self-care ability.
tendency to be very little speaking or poor Self-care ability in treatment group
meaning, unenjoyment living, activities, or increases significantly at 20% respondents,
relationships, loss of motivation to act or which previously in less ability level to be good
perform the tasks, lack of desire, ambition or ability level. Type of drugs taken by
motivation, dull or limited circumstances respondents is typical and atypical combination
emotional feeling, social withdrawal. therapy. Typical antipsychotic overcomes
positive signs of schizophrenia such as
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Jurnal Ners Vol. 12 No. 1 April 2017: 41-48
delusions, hallucinations, thought disorder, and changes appears from not capable to be able.
other psychotic symptoms, but does not have a Modeling participants is a technique used in the
visible effect on negative signs. Atypical treatment group to improve knowledge and
antipsychotics can reduce psychotic and ability. Researchers the model who have
negative symptoms such as low motivation, similarity characteristics with respondents so
social withdrawal, and anhedonia (Littrell & can motivate treatment groups to perform self-
Littrell, 1998, in Videbeck, 2008). The main care independently, and changes in self-care
goal of combination therapy is improving the ability became significantly.
effectiveness of antipsychosis and treatment Modeling participant implementation
outcome in resistant patients, strengthen purpose improving cognitive, self-confident,
antipsychosis potential effect, reducing the risk and motivation through implementing basic
of side effects in certain combinations components of modeling participant such
(Revenger 2010). Giving antipsychotics may rational, modeling, guided participation and
reduce negative symptoms and positive successful experience/reinforcement. Modeling
symptoms, moreover support a better participants as techniques used to form a new
understanding of modeling participants. behavior, improve skills and minimize
In the control group are found 10% avoidable behavior. In this study, new
respondents who experience decreased self-care behaviors and skills which improved is the self-
ability. These respondents get typical care ability (Iswanti 2012). Modeling
antipsychotic. Typical antipsychotic overcomes participants also help clients performing a new
positive signs of schizophrenia such as behavior which obtains through appropriate
delusions, hallucinations, thought disorder, and way and time (Junaedi & Nursalim 2011).
other psychotic symptoms, but does not have a Researchers are applying modeling participants
visible effect on the negative signs (Littrell & to change the maladaptive behavior of
Littrell, 1998, in Videbeck, 2008). Atypical respondents to be more adaptive.
antipsychotics are better in improving the Modeling participants consist of four
performance of client function than typical topics; bathing, dressing, eating, toileting. One
antipsychotics because it affects larger negative topic is given in one day, and every topic is
symptom improvement (Revenger, 2010). repeated twice. In practice, researchers explain
Antipsychotic treatment affects schizophrenia the benefits of proper self-care (bathing,
symptoms, so it will influence respondents to dressing, eating, and toileting) also related tools
understand the modeling participants. which needed. It makes respondents get a better
In general, self-care ability of the understand about the importance of self-care.
treatment group and the control group had Furthermore, Independent schizophrenia model
increased. It because both treatment group and demonstrates self-care ability and respondent
control group respondents get nursing care and are giving attention. Researchers also
psychopharmacy therapy. Increasing self-care demonstrate self-care ability again as
ability in the control group was not significant reinforcement. The model who has to resemble
compared treatment group. character with respondent increase respondent
Modeling participants in the treatment motivation. These explanation and
group were given two times in meeting for each demonstration improve respondent-cognitive
topic as bathing, dressing, eating, and ability as knowing benefits and proper self-care
bowel/urinate. Every topic is given in a single manner.
day. Models in this study is schizophrenic Respondent is practicing self-care ability
clients with independent self-care ability and such as bathing, dressing, eating, bowel/urinate
one same room with respondent. Researchers guided by researchers. Researchers also give
also conducted demonstrations to re- positive feedback when respondents
strengthening of topics were taught. The main successfully practice self-care ability properly.
focus of nursing care in self-care deficit client Some respondents get difficulties when
consists of two things: increase clients self- practicing self-care ability, but researchers
care knowledge and ability, and assist clients on continue to guide and motivate them by the
their limitations and give caring which client state that model which respondent friends can
cant do (Wilkinson & Ahern 2013). Purwanto do. It increases respondents self-confidence and
(1999) in Parendrawati (2008) characteristic of motivation to try again.
learning is the change in people who learn,
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Modelling Participants Towards Self Care Deficit (Ah Yusuf et.al)
Increased self-care ability in treatment Attention means before imitating the model,
groups after given modeling participant was respondent should pay attention or observe
appropriated with Iswanti study (2012), which model behavior to learn. Recall (retention) is
indicates differences adherence medication in the ability to retain information is essential for
the treatment group who received behavior the learning process. Clients must record this
therapy as modeling participants, whereas no event in their memory. Reproduction of motion
differences in the control group. Research of (reproduction) means after client knows and
Ningsih & Sutjiono (2011) concluded modeling learn a behavior, clients can show their ability
participant strategy increase student opinion or produce which stored in the form of
ability in class. behavior. Mental exercise, direct application,
Bandura (1969) in Corey (2009), states and corrective feedback reinforce this behavior
that learning can be obtained through direct imitation. Motivation; motivation is important
experience, also can be obtained indirectly by as clients driving to continue doing something.
observing other person behavior and Vicarious reinforcement and punishment
consequences. There are two types of learning influence this process. Learning process in
through observation, first learning through modeling participants improves self-care ability
observation can be occurred by other people in the treatment group.
circumstances/conditions. Second; learning
through imitate observation by model behavior CONCLUSION
(Boeis 2007; Winarto 2011). Respondents are
There are significant differences of
schizophrenic clients with cognitive and
respondent self-care ability in treatment group
perceptions disorder, so it will be easier for
before and after given modeling participants.
respondents to learn by watching and imitating.
Modeling participants can be used as
In modeling participants, respondents learn to
supporting therapy to improve self-care ability
observe model behavior who schizophrenic
in a schizophrenic client with self-care deficit
client with independent self-care performance.
problem.
The most efficient model was using the
therapist as a model, but bigger advantage
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