Monday, October 29, 2007

Men Get Breast Cancer Too

Men Get Breast Cancer Too

Brian Place didn't think about breast cancer when he found a lump near his left nipple. He thought about rugby. The lump, he figured, might be an injury from colliding with another player.
Place's doctor didn't think much of the lump either, but recommended a mammogram nonetheless. After that came an ultrasound of the breast and a biopsy, and then, finally, a diagnosis: breast cancer. "I was completely numb," says Place, 41 at the time. "I let my colleagues know," he says — mostly men, as he's a communications technician for the Royal Air Force in Britain. "They were as dumbfounded as I was." Even at his local breast clinic, when Place would arrive, he says, some staff assumed he was accompanying a female patient.

The confusion is understandable. Only a tiny fraction of breast cancers diagnosed — less than 1% — occur in men. And because it happens so infrequently, much is still unknown about male breast cancer. "In women, we have studies based on hundreds of thousands of patients," says Dr. Larissa Korde, staff clinician at the National Cancer Institute's clinical genetics branch. For men, there are simply no studies of that scale. Though much can be extrapolated from research in women, Korde says, often "it's a little bit harder to make recommendations for men based on evidence."

Perhaps the surest risk factor — in both women and men — is family history. By the time Place was diagnosed, for example, two of his female relatives had died of breast cancer and a third of ovarian cancer. Although there are certainly several genes that contribute to breast cancer, mutations in two of them — BRCA1 and BRCA2 — are known to increase the odds of both breast and ovarian cancers. So while most men might never even meet a man with breast cancer, those who have several relatives diagnosed with it should be on the lookout for signs of their own breast tumors. Studies suggest that certain populations with an unusually high proportion of people carrying BRCA2 mutations — in Sweden, Hungary, Iceland, and among Ashkenazi Jews — may have a higher incidence rate of breast cancer in men.

Survival rates for men and women are similar, adjusting for stage of the disease at diagnosis — but men are more likely to be diagnosed at a later stage. That's probably because women undergo regular screening, Korde says. In men, "because it's not on their radar, [a lump] might not be something they get seen immediately." In men, as in women, treatment usually includes surgery followed by some combination of radiotherapy, chemotherapy and — because almost all men with breast cancer have tumors characterized as hormone-receptor-positive — hormone treatment.

Two years after his diagnosis, Place is well. His mastectomy was a success, and he's opted to stop taking hormone treatment, a relief, he says, because he found the side-effects, including hot flashes, unpleasant. Today he tries to answer questions from male breast-cancer patients in online cancer forums, and talks with people who contact him through the U.K. nonprofit Breast Cancer Care. But there's no doubt that even a relatively positive experience with male breast cancer can be isolating — even for women. As Place looked for information in online forums, he found that women were used to treating breast cancer sites as women's-only safehouses, a place to discuss their bodies with other women. Some, he says now, "can get quite aggressive that we're invading their area, if you will." But as with breast cancer in women, awareness can make the difference.

Boiled nuts help protect against illness

Boiled nuts help protect against illness

BIRMINGHAM, Ala. - For lovers of boiled peanuts, there's some good news from the health front. A new study by a group of Huntsville researchers found that boiled peanuts bring out up to four times more chemicals that help protect against disease than raw, dry or oil-roasted nuts.

Lloyd Walker, chair of Alabama A&M University's Department of Food and Animal Sciences who co-authored the study, said these phytochemicals have antioxidant qualities that protect cells against the risk of degenerative diseases, including cancers, diabetes and heart disease.

"Boiling is a better method of preparing peanuts in order to preserve these phytochemicals," Walker said.
The study will appear in Wednesday's edition of the American Chemical Society's Journal of Agricultural and Food Chemistry. The other co-authors in the study are A&M researchers Yvonne Chukwumah and Martha Verghese, as well as University of Alabama in Huntsville researcher Bernhard Vogler.

Walker said peanuts and other plants use phytochemicals for things such as helping avoid disease and insect attacks.

"These things are not nutrients; at the same time they have health benefits to humans," he told The Birmingham News. "The trick is to keep those health benefits, not to process them out of the foods."
According to Walker, water and heat penetrate the nuts, releasing beneficial chemicals to a certain point. Overcooking the nuts destroys the useful elements.

Alabama is third in the nation in the amount of peanuts produced with a crop valued at more than $67 million last year.

Medical-bill errors increasingly common

Medical-bill errors increasingly common

WASHINGTON - Don't assume that your complicated medical bill is correct. Errors on bills for doctors, medical tests or hospitals can result in overcharges that run from a few dollars to tens of thousands of dollars.

Husband and wife Ron and Marilyn Hess, from Homer, Alaska, were left facing a bill of about $10,000 from a hospital after Marilyn needed an appendectomy. The hospital bill was about $45,000, of which her insurer agreed to pay $35,000.
After obtaining an itemized bill and with the help of a medical-billing advocate, the couple uncovered procedures billed that weren't performed.
And on her appendectomy and the second clean-up surgery, Marilyn was charged separately for each item used rather than a set fee for a surgical packet.

"We were outraged when we saw the itemized statement from the hospital," Ron said.
Nora Johnson, director of education and hospital billing compliance for Medical Billing Advocates of America, who advocated for Marilyn Hess, estimates "eight out of every 10" hospital bills she scrutinizes contain multiple errors. And while bills from doctors' offices and labs tend to contain fewer mistakes, consumers can still end up paying unnecessarily.

Six out of 10 Americans with health insurance said they are paying more out of pocket for medical expenses, according to a recent survey by the Employee Benefit Research Institute, or EBRI. And the higher costs are hurting their household finances, with one-third reporting difficulty paying for basic necessities.

"These results show the impact of rising health care costs is widespread and growing," said EBRI President Dallas Salisbury.
Against this backdrop, it is more important than ever to assure you aren't paying more than you owe for medical services. You can take steps to protect your finances, but you need to be mindful of deadlines.
It helps to watch for common types of errors.
For instance, Johnson says consumers with high-deductible health plans can take a hit if their insurer fails to apply discounted group rates — which insurers negotiate with health-care providers — to charges incurred within the deductible. Deductibles in these plans can run from a thousand dollars to more than $10,000.

Other common blunders include medical-coding errors, mistakes in how annual deductibles are applied and confusion over which providers are in or out of network. Fraudulent activity by some unscrupulous health care providers and medical-identity theft are other bugaboos, experts say.

Deciphering medical bills isn't always easy. Paula Fryland, manager of the national health care group at PNC Financial Services Group Inc., says one in three Americans reported having trouble understanding the explanation of health benefits in a recent study the company conducted. An explanation of benefits, or EOB, is the statement your insurer sends you after you have received health-care services.

One in four consumers polled by PNC said they believe their insurer had denied a legitimate claim, and, of those, one in five paid the claim out of their own pocket (consumer advocates say the fear of getting their credit damaged motivates many). But persistence pays off: More than half of consumers got their insurer to pay all or part of the claim.

Reviewing your EOB before you get a bill is the best way to track your medical expenses. If your insurer offers you the ability to review your EOBs online, sign up; if you can receive e-mail alerts, even better.
Susan Johnson, a senior consultant at Watson Wyatt Worldwide, advises checking that the name, address, insurance group and identification numbers are correct. If they are inaccurate, it might mean that you have received someone else's EOB by mistake, or, more worryingly, that someone is using your health benefits without your consent.
Next, check the claim activity to ensure that the name of the health care provider, services rendered and dates tally with your recollection.
"Sometimes you can get billed for tests you didn't have," says Johnson.

Often this is due to a clerical error; however, multiple procedures for which you have no memory of receiving and/or surprisingly high charges can signal insurance fraud.
Mark Rucci, a senior vice president at Apex Management Group, a division of Gallagher Benefit Services Inc., says consumers should also track the contributions they have made toward their annual deductible. Alert your insurer if your EOB erroneously says you haven't met your deductible.

Make sure to get credit for using an in-network health care provider. HMO plans can hit you with the full cost of out-of-network treatment. PPO plans require higher coinsurance payments out of network.
If you notice discrepancies in your EOB, call your insurer's toll-free customer service line, advises Dr. Charles Cutler, Aetna Inc.'s chief medical director. You will find the numbers on your EOB, your insurance ID card or your insurer's Web site. Avoid calling on Mondays, as they are notoriously busy.

If all or part of a claim is denied, it is usually because the insurer didn't receive all the information required or because it believes the procedure isn't covered or medically necessary.
You can appeal such decisions over the phone, but it is best to do so in writing, supply supporting evidence and keep copies of correspondence. Generally, your insurer has 30 days to reply (within days if it involves urgent care). Most insurers have a multilevel appeals process, and you may also be entitled to an external review. It is important to find out what your plan's rules — and deadlines — are.

You might want to enlist the help of outside experts. Your state insurance department or state health department can offer guidance.

Consider hiring an advocate. For example, unbeknownst to you, your insurer might decide your bypass surgery wasn't medically necessary because, instead of entering the code for "heart attack," which is what you had, an administrator mistakenly entered the diagnosis code for "broken leg." Typically, advocates charge an hourly fee (from $25 to $75) plus a percentage of any savings. You can find listings at

As for the Hess family, it took 18 months of lobbying, but the hospital finally wrote off their bill.

Friday, October 26, 2007

Nursing Sensitive Outcome Indicators

Nursing Sensitive Outcome Indicators

Along with health care reform, the quest for cost-effectiveness and quality of care and the growing sophistication of health care systems, has come an increased emphasis on evidence and outcomes. These elements, together with a growing concern about changes in skill mix, prompted nursing to focus on identifying outcome indicators sensitive to nursing inputs and staffing levels.

Nursing Sensitive Patient Outcomes
Outcomes define the end results of nursing interventions and are indicators of problem resolution or progress toward problem or symptom resolution. i The ICNP® defines a nursing outcome as the measure or status of a nursing diagnosis at points in time after a nursing intervention, while ii nursing-sensitive outcomes are defined as changes in health status upon which nursing care has had a direct influence. iii Variables affecting patient outcomes include diagnosis, socio-economic factors, family support, age and gender, and the quality of care provided by other professionals and support workers.

Commonly Used Nursing Sensitive Outcome Indicators
The following patient outcomes are commonly used nursing sensitive indicators: iv
1) Patient complications, such as urinary tract infections, skin pressure ulcers, hospital acquired pneumonia and deep vein thrombosis/pulmonary embolism.
2) A group of exploratory measures, comprising upper gastrointestional bleeding, central nervous system complications, sepsis and shock/cardiac arrest.
3) Complications among surgical patients such as wound infection, pulmonary failure and metabolic derangement.
4) Patient length of stay, and failure to rescue (failure to respond to patients' urgent conditions such as shock, cardiac arrest and deep vein thrombosis, potentially resulting in increased morbidity and/or mortality).In addition, an inventory of patient outcomes has been identified related to the scope of practice and staff mix in a health facility. These include:
- Symptom control and change in symptom severity.
- Functional status.
- Knowledge of condition and treatment.
- Patient satisfaction with care.
- Unplanned emergency department visits.
- Unplanned hospital readmissions.
- Strength of treatment alliance.
What is the Importance of Nurse Sensitive Indicators?
Use of nursing sensitive outcome indicators helps focus attention on the safety and quality of patient care and the measurement of care outcomes. vi It is important that nurses and health facilities collect data to monitor the ongoing cost and quality of patient care. Using nursing sensitive outcome indicators is crucial to effectively demonstrate that nurses make the critical, cost-effective difference in providing safe, high-quality patient care.

The importance of articulating nursing sensitive quality indicators cannot be overstated. Such articulation and the correlation of nursing activities with health outcomes provide strong support for appropriate allocation of health care resources. For example, studies comparing staffing levels and patient outcomes show that when there are more registered nurses, patients’ experience fewer complications, shorter lengths of stay, decreased mortality rates and even lower overall costs. vii Similarly, a strong and consistent relationship has been found between nurse staffing and five patient outcomes in medical patients: urinary tract infections, pneumonia, length of stay, upper gastrointestinal bleeding and shock. viii This means higher levels of nurse staffing are associated with less adverse effects.
Nursing sensitive outcome indicators are intended to draw correlations between nursing intervention patients have received and their resulting health status. They are an attempt to measure the effectiveness of nursing care by measuring patient outcomes. Linkages are more easily seen when diagnosis, intervention and outcomes are identified. Since nurses are an integral part of the health care delivery system, nursing sensitive indicators capture what nurses do, what outcomes they achieve and at what cost. This is an important step in appropriate allocation of health care resources and in making nursing contribution to health care visible.
The International Council of Nurses (ICN) is a federation of 129 national nurses' associations representing the millions of nurses worldwide. Operated by nurses for nurses since 1899, ICN is the international voice of nursing and works to ensure quality care for all and sound health policies globally.
i ANA Web site
ii International Council of Nurses (2001) International Classification for Nursing Practice – Beta 2 version. Geneva, ICN.
iii Ke-Ping A. Yang; Lillian M. Simms; Jeo-Chen T. Yin (1999) Factors Influencing Nursing-Sensitive Outcomes in Taiwanese Nursing Homes, Online Journal of Issues in Nursing , Article published August 3, 1999
v Calgary Health Region.
vi American Nurses Association.
vii American Nurses Association (1997), Implementing Nursing's Report Card: A Study of RN Staffing Length of Stay and Patient Outcomes. ANA Web site
viii American Nurses Association.

Nurses and Overtime*

Nurses and Overtime*

Nurses are increasingly working overtime. Nurses' overtime (mandatory** or voluntary) has been used as a measure to reduce the impact of the critical shortage of nurses and/or the downsizing of nursing departments in both private and public health facilities. However, the increasing amount of overtime threatens nurses' ability to provide safe and individualised care for patients.
While in many countries federal regulations define the maximum hours that can be worked in sectors having a direct impact on public safety (e.g. aviation, transportation), nurses and other health care workers are rarely protected. A few examples have been selected to provide an overview of existing situations.

* Overtime is time worked in addition to the normal or regular contracted hours.

** Mandatory overtime is obligatory, compulsory or imposed by the employer leaving no choice to the employee.

1. USA - mandatory overtime

Promoted by hospital management as a way to staff effectively during an emergency, mandatory overtime has become instead a means to cover routine personnel shortages.
In a large number of hospitals nurses report the existence of a documented policy that imposes mandatory overtime. Overtime may be from 4 to 16 hours (or more) and nurses are included in a duty roster to perform the overtime after their regular shift. Depending on the state where the nurses are employed, they may be paid extra money (not always) but do not get any extra time off.
In January 2001 the "Registered Nurse and Protection Act" was introduced to the US Congress. It aims to limit the number of hours that licensed health care workers, including registered nurses (RNs), would be obliged to work. The bill will amend the Fair Labour Standards Act to bar mandatory overtime beyond 8 hours in a workday or 80 hours in any 14-day work period. Exceptions are accepted in cases of natural disasters or in the event of a state of emergency declared by the authorities. A licensed health care employee may however voluntarily work beyond 8 hours in any given workday.

2. Australia

Australian nurses report a significant increase in their workload over the past five years. A recent report shows an increasing amount of regularly worked overtime. On 23 June 2000, Australian Nursing Federation (ANF) ACT Branch members voted unanimously to outlaw the working of 16 and 18-hour shifts, and ban recall shifts when individual nurses considered them to be unsafe.

3. Europe

Nurses within the EU are protected by law from being forced to do overtime, but it is still common practice in almost all countries that nurses do work overtime. To date, the directive that exists has not been implemented in all European countries. According to the Working Time Regulations, work time must not average more than 48 hours per week over a standard averaging period of 17 weeks. It is possible however to extend this period to 26 weeks or a year if agreement is reached by employers and employees. Daily and weekly rest entitlements are also specified in the regulations:

Daily rest: Employees are entitled to a rest period of not less than 11 consecutive hours in each period of 24 hours during which the employee works for the employer.
Weekly rest period: Employees are entitled to an uninterrupted rest period of not less than 24 hours in each 7-day period. This is in addition to the daily rest period.
Breaks: Employees are entitled to a rest break when daily working time exceeds 6 hours.

United Kingdom: A national survey of registered nurses commissioned by the Royal College of Nursing (RCN) and carried out by the Institute for Employment Studies (IES) in 1999 showed that 59% of the respondents report that they work an average of 6.6 of excess hours per week. In 1998, the average was 5.8 hours/week. Twenty-eight percent of the nurses report undertaking paid work in addition to their main job. They work an average of 6.6 hours a week in these additional jobs. The increased income is the main reason given for taking on this secondary employment.

4. Japan

A 1997 survey by the Japanese Nursing Association showed that 4,636 nursing personnel reported working an average of 12 hours 36 minutes of overtime each month. More than 70% of hospital employees were required to work rotating night shifts (Japanese Nursing Association News, 1998).

It is common practice that individuals in certain positions (e.g. management) work overtime without specific compensation or benefits. Most often however this overtime is not mandatory and the risk to public safety is not present. Perceptions about the number of hours constituting long hours vary according to the type of work. However some employees work 100 hours per week or more. British employees are reported to work some of the longest hours in Europe.

Rationale for working long hours:

The main reasons for working long hours are:

  • Work pressure - arising from heavier workloads, increasing demand, fewer staff and tighter budgets.
  • Work organisation - in some cases lack of prioritisation or individual inefficiency can increase the workload
  • Long hours culture - generated by the example of managers working long hours, peer pressure, job insecurity, individuals feel their presence at work is critical for the realisation of the organisation's mission.
  • A strong commitment amongst individuals towards their work, colleagues, customers or clients.
  • A need to increase take-home pay

Some, if not all, of these reasons are relevant to nurses

Effect on health

When no limits are set on overtime work and no guidelines exist for the rest period following extended hours of work, the burden of these physical and mental demands will have a negative affect on patients as well as nurses. Extensive overtime (voluntarily or mandatory) may put patients and nurses at risk.


A limited number of studies demonstrate the relationship between extended shifts (more than eight hours) and fatigue as well as increased safety risks. The negative consequences are not limited to physical health, e.g. fatigue, headache, sleeplessness. Disruptions and stressed dynamics within the social and family life are also reported.


Extensive overtime puts patients at risk, due to:
- Nurses being less alert to changes in patients' condition.
- Nurses having slower reactions.
- Medication errors - adverse drug events (ADEs).
- Errors in clinical judgement.
- Increase in nosocomial infections.
- Increase in decubiti.

All the above potential consequences are likely to lead to deterioration in the quality of care provided.

What Nurses can do
  • A professional nurse is the best judge of her own capability. If she cannot provide safe care in a given situation, she must inform her supervisor.
  • Research on the subject of extended overtime and related health issues and the influence on medical errors should be undertaken so that more comprehensive data is available.
  • The public should be informed about the working conditions in health care settings - not to frighten them but to alert them about the actual situation and generate support for constructive change
  • National nurses' associations should work together with other health professional organisations to ensure appropriate regulation of overtime
  • National nurses' association should provide the ethical framework for nurses' overtime practices, especially in cases where nurses reject an assignment due to physical exhaustion or mental stress.
For further information please contact ICN at

Fact sheet/Nurses and Overtime

Considine G. and Buchanan J.: The hidden cost of understaffing: An analysis of contemporary nurses working conditions in Victoria, report for the ANF Vic Branch by the Australian Centre for Industrial Relations Research and Training, University of Sydney, 1999, p.2

Commission of the European Community: State of Implementation of Council Directive 93/104/EC of 23 November 1993, in force since October 1, 1998

On the Agenda: changing nurses careers in 1999, Robinson D, Buchan J, Hayday, IES Report 360, 1999. ISBN 1-85184-289

Breaking the long hours culture. , J Kodz, B Kersley, M T Strebler, S O'Regan. IES Report 352, 1998. ISBN 1-85184-281-0

Nursing around the world: Japan - preparing for the century of the elderly, Janet Primomo PhD, RN may 31,2000. Online Journal of issues in Nursing. Vol.5, No.2, Manuscript 1.

Harrington JM (2001). Health effects of shift work and extended hours of work. Occup. Environ med. 58: 68-72

Rosa, Roger R, (1995) Extended work shifts and excessive fatigue. Journal Sleep Research 4, Supll.2, 51-56

Spurgeon M, Cooper AJ, Cary L, (1997, June) Health and safety problems associated with long working hours. A review of the current position. Occupational and Environmental medicine, vol.54, no.6, 367-375.

Kohn L.T, Corrigan J.M, Donaldson M.S, eds. (1999)To Err is Human: Building a Safer Health System. Washington, DC: National Academy Press

ICN on Preventing Needlestick Injuries

ICN on Preventing Needlestick Injuries

Facts and Issues
At least one in eight health care workers receives a needlestick injury potentially exposing them to serious or fatal infections.
Accidental needlestick injuries are the predominant sharps-related problem in industrialized countries. American health workers suffer 800,000 to 1 million needlesticks annually, not including the vast number that go unreported. There are more than 100,000 needlestick injuries in UK hospitals each year. Needlesticks are virtually undocumented in developing countries, but probably equal or exceed those in the industrial world. More than 20 blood borne diseases can be transmitted as a result of exposure to blood. Inadequate waste disposal systems extend the problem beyond health workers to cleaners, laundry workers, porters, 'rag pickers' and the general community2.
This is a true scenario.
How can it be prevented?

An AIDS patient became agitated and tried to remove the intravenous catheters. Hospital staff struggled to restrain the patient. During the struggle, an IV infusion line was pulled, exposing the connector needle. A nurse recovered the connector needle at the end of the IV line and attempted to reinsert it. The patient kicked her arm, pushing the needle into the hand of the second nurse. Three months later, the nurse who sustained the needlestick injury tested positive for HIV1.

In some countries, health care providers feel obliged to give injections to satisfy their clients` perceptions of proper treatment. Three studies in Sub-Saharan Africa and Asia found that between 60 and 80% of all injections given were unnecessary and sometimes dangerous. The most frequently injected medications were antibiotics2.

Impact on nurses
Nurses have the highest rate of needlestick injury among health care workers. A health worker's risk of infection from a needlestick injury depends on the pathogen involved, the immune status of the worker, and the severity of the needlestick. The probability that a single needlestick will result in disease is 3 to 5 chances in 1 000 for HIV, 300 chances in 1 000 for Hepatitis B, and 20 to 50 chances in 1 000 for Hepatitis C.

Accidental needlesticks account for 86% of all occupationally related infectious disease transmission. The emotional impact of a needlestick injury can be severe, even when a serious infection is not transmitted, particularly when the injury involves exposure to HIV. In one study of 20 health care workers with an HIV exposure, 11 reported acute severe distress, 7 had persistent moderate distress, and 6 quit their jobs as a result of their exposure3.
The economics of needlestick injuries
According to the American Hospital Association, one case of serious infection by bloodborne pathogens can result in $1 million of employer costs related to testing, follow-up, lost time and disability payments. The cost of follow-up for a high-risk exposure is almost $3 000 per needle stick injury even when no infection occurs. Safe needle devices cost only 28¢ more than standard devices. Hospitals in California are expected to save over $100 million per year after implementing legislation requiring safe needle devices4.

Nurses` Rights
According to the International Labour Organization (ILO) all appropriate measures should be taken to prevent, reduce or eliminate risks to the health of nursing personnel.
This includes5:
- A comprehensive national policy on occupational health.
- The establishment of occupational health services.
- Access to health surveillance, preferably during working hours and at no cost to the worker concerned.
- Medical confidentiality of health surveillance.
- Financial compensation for those exposed to special risks.
- Participation in all aspects of protection provisions.

What you can do to protect yourself and others:
- Avoid the use of needles where safe and effective alternatives are available.
- Avoid recapping needles.
- Participate in blood borne pathogen training and follow recommended infection prevention practices, including hepatitis B vaccination.
- Report all needlestick and other sharps related injuries to ensure that you receive appropriate follow-up care.
- Advocate for monitoring and safe work practices, including data collection.
- Educate and lobby for the development of safer technology.
- Advocate for screening, post exposure counseling, prophylaxis, legal aid, and support groups.
- Use purchasing power to buy safe equipment.
- Create/maintain a safe, comprehensive disposal system.
- Promote safety awareness.
- Evaluate prevention efforts and provide feedback on performance.

For further information please contact
ICN at

July 2000 ____________________
1 National Institute for Occupational Health and Safety (NIOSH). Preventing Needlestick Injuries in Health Care Settings. November, 1999. Publication NR. 2000-108.
2 WHO Safe Injection Global Network
3 Henry et al., 1990. NIOSH Preventing Needle Stick Injuries in Health Care Settings
4 American Nurses Association, Nursing Facts: Needlestick Injury, 1998
5 ILO Recommendation 157: Employment and conditions of work and life of nursing personnel

Efektivitas Penggunaan Gelar ˜Ners"

Efektivitas Penggunaan Gelar *Ners*
Oleh: Syaifoel Hardy & Nurhadi

Latar Belakang
Menengok sejarah dunia nursing secara umum pastilah akan dihubungkan dengan tokoh Florence Nightingale (FN) di abad ke 19, sekalipun di Islam telah berkembang pada abad ke 7 jauh sebelum FN dikenal (Grippando & Mitchell, 1989). Nurses pada saat itu, meski tanpa embel-embel gelar, telah diakui sumbangan ilmiahnya dalam masyarakat. Kemajuan yang diperoleh adalah berkat ketekunan para tokoh tersebut untuk selalu melakukan perbaikan melalui proses riset dan cara pembelajaran ilmiah lainnya.
Proses riset yang kuntinyu tersebut membuahkan dunia profesi nursing terus berkembang, seiring dengan perkembangan ilmu dan tekhnologi lainnya, meskipun tidak sepesat profesi kesehatan lain misalnya kedokteran. Dari segi disiplin ilmu, profesi ini pun telah memasuki jenjang sub spesialis. Untuk mendukung kemajuan tersebut, metode riset dan critical thinking sudah menjadi bagian dari pola pendidikan nursing.
Profesi nursing di Indonesia yang tergolong masih muda dibandingkan dengan di negara Barat memang tertinggal jauh. Bahkan di antara negara-negara Asia sekalipun. Meskipun demikian, geliat perubahan yang dimulai sejak tujuh tahun terakhir di tanah air merupakan upaya positif yang sudah pasti memerlukan dukungan semua pihak. Tetapi yang lebih penting adalah dukungan pemikiran-pemikiran kritis terutama dari nurses itu sendiri.
Pola pikir kritis ini merupakan tindakan yang mendasari evidence-based practice dunia nursing yang memerlukan proses pembuktian sebagaimana proses riset ilmiah. Pola pikir tersebut bukan berarti mengharuskan setiap individu menjadi peneliti/researcher. Sebaliknya, sebagai landasan dalam praktek nursing sehari-hari.
Dengan demikian kemampuan merefleksikan kenyataan praktis lapangan dengan dasar ilmu nursing ataupun disiplin ilmu lainnya, baik dalam nursing proses kepada pasien ataupun dalam melaksanakan program pendidikan nursing, sudah seharusnya menyatu dalam intelektualitas nurses. Termasuk bagaimana menyikapi penggunaan istilah "Ners" misalnya.
Pemakaian istilah "Ners" sebagai bentuk "penghargaan" sesudah pencapaian jenjang pendidikan S1 merupakan issue yang perlu kita kritisi. Kita sebut sebagai issue, karena peletakannya sebagai suatu gelar bagi sebuah profesi bisa menuai perdebatan. Tinjauan literatur pemakaian istilah yang "menyabot" dari Bahasa Inggris: Nurse yang sebenarnya memang sebuah profesi, bukan gelar, adalah persoalan pertama. Yang kedua, penggunaan istilah ners ditinjau dari kacamata internationalisation. Dan yang ketiga legitimasi pemakaian gelar Ners.
Ketiga hal tersebut menjadi fokus essay ini. Tujuannya tidak lain adalah mengajak kita, nurses, untuk selalu berpikir kritis, agar implementasi dunia nursing sebagai disiplin ilmu mengedepankan evidence, bukan semata-mata slogan.
Sejauh ini, lulusan S1 Keperawatan di Indonesia dikenal sebagai penyandang gelar Sarjana keperawatan (SKep). Program ini kemudian menambahkan gelar profesi nursing yang disebut Ners, sesudah menempuh sejumlah sistem kredit semester dalam studinya. Apakah gelar tersebut merupakan gelar akademik, gelar profesional ataukah predikat lainnya semisal Registered Nurse (RN)? Di bawah ini analisanya.
1. Etimologi
Menurut Wikipedia (Online, 2007), kata nurse yang diucapkan /ners/ (Webster, Ninth Collegiate Dictionary, 1993), berasal dari Bahasa Inggris, Bahasa Perancis nourice, dan Bahasa Latin nutricia, berarti: person that nourishes, is a health care professional who is engaged in the practice of nursing.
Dari definisi tersebut berarti bahwa untuk menjadi seorang nurse yang profesional memerlukan pendidikan tertentu. Sesudah menyelesaikan pendidikan, kemudian mempraktikkan hasil pengetahuan dan ketrampilannya. Dari definisi tersebut juga sudah jelas, sekalipun tanpa gelar ners, nurse sendiri sudah profesional.
Perbendaharaan kata dalam kamus Bahasa Indonesia, dalam sejarahnya banyak sekali menyerap dari bahasa asing dalam bidang ilmu pengetahuan. Kata ilmu, jadwal, miskin, awal, akhir saja misalnya, berasal dari bahasa Arab. Biologi (biology), matematika (mathematics), geologi (geology), geografi (geography), etika (ethics) dari Bahasa Inggris. Purnama, mega, samudera (ketiga-tiganya Bahasa Sansekerta), dan lain-lain. Kata-kata tersebut, kini sudah tidak asing kedengaran di telinga dan kita manfaatkan dalam percakapan sehari-hari. Kata-kata tersebut sepanjang tidak ada padanan yang pas, mengalami asimilasi sesuai dengan kaidah Bahasa Indonesia.
Kaidah Bahasa Indonesia tidak mengenal konsonan rangkap, kecuali istilah asing yang diindonesiakan, misalnya kata exponent menjadi eskponen; science menjadi sains, climax menjadi klimaks.
Berangkat dari sini, memang tidak tertutup kemungkinan bahwa kata nurse kemudian diasimilasikan ke dalam Bahasa Indonesia menjadi ners. Tapi apakah ini tidak menyalahi aturan, karena kata nurse tidak mendapatkan perlakuan yang sama dengan kata modern yang dalam Bahasa Indonesia menjadi moderen, mendapat sisipan e . Disamping itu kata moderen sudah mendapatkan definisi yang baku dalam kamus kita yang berarti mutakhir atau baru ( Sedangkan ners tidak demikian halnya. Kata ners belum menjadi perbendaharaan kata yang baku dalam kamus kita, apakah itu kata benda, kata kerja ataukah istilah. Berbeda juga dengan kata perawat misalnya, dari segi etimologi, kata ners tidak berdasar dan terkesan mengada-ada.
2. Internationalisasi
Dalam kamus-kamus internasional disebutkan bahwa sebutan nurse ini bukanlah sebuah gelar, melainkan profesi (Webster, Ninth Collegiate Dictionary, 1993; Webster, Newworld Dictionary, 2000; Oxford Advanced Learner, Dictionary, 2000) yang berarti: a person who is trained or skilled in caring for the sick. Demikian pula yang sebutkan dalam kamus Inggris-Indonesia (Echols J.M. & Shadily, H. 1975, Kamus Inggris Indonesia). Dalam kamus-kamus tersebut nurse bisa berarti pula kata kerja.
Akan halnya gelar yang menyertai seorang nurse, di Amerika Serikat Registered Nurse (RN) terpisah dari gelar akademik. Gelar profesi RN tidak dikeluarkan oleh sekolah tinggi atau universitas dari mana perawat tersebut ditempa pendidikannya. RN dikeluarkan oleh sebuah komite tertentu yang disebut N-CLEX (National Committee on Licensure Examination). Di Filipina sebutan RN juga dikeluarkan oleh Nursing Board sesudah menjalani test. Di Inggris RGN demikian juga. Tidak terkecuali pula di negara-negara lain seperti Belanda, India, Singapore dan lain-lain. "Gelar" RN tidak dikeluarkan oleh lembaga pendidikan di mana yang bersangkutan belajar, melainkan oleh lembaga profesional independen.
Gelar Ners di Indonesia diberikan bersamaan dengan gelar akademik oleh lembaga pendidikan yang menelorkan sarjana. Padahal keduanya ini mestinya terpisah ditinjau dari pemanfaatan di dunia internasional. Lembaga pendidikan S1 Keperawatan saat ini memberlakukan "Dual Degrees" yang di dunia internasional pendidikan nursing tidak dikenal. Gelar ners dalam percaturan nursing internasional bisa membingungkan.
3. Legitimasi
Dari sisi aturan perundangan, menurut Surat Keputusan Menteri Pendidikan Nasional No: 178/U/2001 tentang "Gelar dan Lulusan Perguruan Tinggi" tidak menyiratkan sedikitpun tentang pemakaian Ners untuk gelar akademik maupun profesional. Dalam Bab III : Jenis Gelar Akademik Pasal 6 menyebutkan, bahwa: "Gelar akademik terdiri atas Sarjana, Magister dan Doktor".
Dijabarkan lebih lanjut dalam Pasal 7: "Penggunaan gelar Sarjana dan Magister ditempatkan di belakang nama yang berhak atas gelar yang bersangkutan dengan mencantumkan huruf S., untuk Sarjana dan huruf M., untuk Magister disertai singkatan nama kelompok bidang keahlian". Jadi bagi penyandang sarjana keperawatan, kita bisa saja gunakan SKp atau SKep tidak masalah, tergantung "kesepakatan" pihak pengambil kebijakan.
Sedangkan dalam Bab IV: Jenis Sebutan Profesional Pasal 11 ayat (1) disebutkan bahwa sebutan profesional lulusan Program Diploma terdiri atas:
i. Ahli Pratama untuk Program Diploma I disingkat A.P.
ii. Ahli Muda untuk Program Diploma II disingkat A. Ma.
iii. Ahli Madya untuk Program Diploma III disingkat A. Md.iv. Sarjana Sains Terapan untuk Program Diploma IV disingkat SST.
Gelar Ners di Indonesia diberikan bersamaan dengan gelar akademik. Di Diknas, penggunaan gelar sudah diatur sebagaimana tersebut diatas. Masalahnya, mengapa policy ini hanya berlaku pada S1 Keperawatan? Memperoleh gelar akademik sekaligus profesi. Profesional lain di program kesehatan misalnya Kedokteran, Gizi atau Kesehatan Masyarakat, apalagi non-kesehatan, tidak mendapatkan perlakuan serupa: double degrees.
Walaupun dalam SK Mendiknas Nomer 178/U/2001, Pasal 21, Ayat 3, menyebutkan bahwa "Gelar akademik dan sebutan profesional lulusan perguruan tinggi di Indonesia tidak dibenarkan untuk disesuaikan dan/atau diterjemahkan menjadi gelar akademik dan/atau sebutan profesional yang diberikan oleh perguruan tinggi di luar negeri", itu bukan berarti bahwa kita tidak memiliki "keleluasaan" untuk berkaca kepada percaturan sistem pendidikan nursing internasional. Karena dalam Fungsi dan Tujuan diselenggarakannya pendidikan tinggi sebagaimana disebutkan dalam Rancangan PP (pasal 51) tentang Pengelolaan dan Penyelenggraan Pendidikan adalah: mengembangkan kemampuan dan membentuk watak serta peradaban bangsa yang bermartabat dalam rangka mencerdaskan kehidupan bangsa (, maka sebagai profesi yang berwawasan internasional, watak serta peradaban nurses kita akan diakui oleh dunia internasional jika kita mampu bergaul dalam percaturan nursing yang mengacu pada standard internasional. Dunia internasional mengakui profesi kedokteran kita dengan gelar dr, mengakui sarjana kita: engineer, mengakui ahli gizi: nutritionist. Siapa yang mengenal Ners?
Registrasi dan Spesialisasi
Sudah seharusnya jika lulusan pendidikan nursing setingkat sarjana akan lebih memiliki bobot baik dari segi penguasaan ilmu nursing yang bisa dipadukan dengan disiplin ilmu lainnya. Menjamurnya program pendidikan Strata 1 Keperawatan di seluruh Indonesia berarti akan semakin banyak nurses setingkat sarjana.
Dalam kenyataan sehari-hari dominasi dunia kedokteran dalam bidang kesehatan memang masih besar sekali (Germov, 1998). Jika dilihat dari sejarah pendirian maupun dari susunan personel lembaga pendidikan nursing di Indonesia, peran profesi kesehatan lain masih sangat dominan. Berbeda dengan di negara-negara seperti Australia, Amerika Serikat, Inggris, juga di India ataupun Philippines, dimana faculty of nursing nya independen (Bridget Hospital School of Nursing, San Juan College, Regents College Nursing, Cheridan College Nursing Program, dll); atau di bawah Faculty of Sciences (Department of Nursing University of Southern Queensland; Department of Nursing of the University of the Philippines, dll). Kenyataan ini yang menjadi kendala hingga di tingkat pusat, di mana kita tidak memiliki kemandirian di bawah Departemen Kesehatan (depkes.2007, Online).
Berbicara masalah jenjang profesi dan karir, tidak bisa dilepaskan dari dua tinjauan yang mendasar yaitu tinjauan akademik dan tinjauan profesional. Berdasarkan tinjauan akademik, di negara-negara yang dicontohkan di atas, jenjang pendidikannya dibagi tiga kelompok yaitu undergraduate, post graduate dan doctorate. Undergraduate yaitu jenjang pendidikan Strata 1 dengan gelar BSN/BN atau dibawahnya, post graduate setara dengan Strata 2 dengan gelar MSN/MN, dan doctorate dengan gelar DSN/DN.
Masing-masing strata memiliki sistem pendidikan, gelar serta peran dan tanggungjawab terhadap profesi yang sudah baku dan jelas. Misalnya untuk program diploma selama perkuliahannnya yang ditempuh antara 2 - 3 tahun, tidak mendapatkan mata kuliah riset sebagai indikator jenjang yang lebih tinggi ataupun kalau dapat hanyalah sekedar pengantar riset, karena lulusannya memang tidak dituntut untuk menjadi peneliti. Tetapi paling tidak bisa ikut andil dalam membantu proses riset atau mengerti pemakaian hasil riset.
Dari tinjauan profesional, nurses bisa dikatakan profesional jika memiliki bukti registrasi yang mengontrol kompetensi nurses (Germov, 1998). Dengan sistem registrasi yang baku memungkinkan pengawasan terhadap kemampuan nurses sehingga senantiasa sesuai dengan perkembangan ilmu nursing yang terbaru sebagai persyaratan untuk mendapatkan registrasi. Jenjang spesialisasi bagi nurses bisa ditempuh tanpa memandang latar belakang akademik, apakah itu Diploma, BSN, atau MN.
Di Australia, India, Philippines, Amerika, Inggris, New Zealand serta negara Barat lainnya, pemberian gelar RN merupakan pengakuan yang berkekuatan hukum terhadap kompetensi profesi yang diberikan oleh Nursing Board/Nursing Council (Edginton, 1995). Nursing Board dibentuk berdasarkan Peraturan Pemerintah [Department of Education, Science and Training (DEST)-Australia, 2003, online] dan di bawah kontrol Menteri Kesehatan (Edginton, 1995).
Untuk memperoleh predikat RN, nurses harus memenuhi beberapa persyaratan. Di beberapa negara aturannya lebih ketat dengan menyaratkan harus mengikuti ujian registrasi seperti di AS dengan NCLEX-RN nya atau di Philippine dengan Registration Examination. Di Inggris menyaratkan pelaksanakan praktek nursing selama lima tahun terakhir, dan bila sudah teregistrasi pun harus selalu meng-up date ilmu setiap dua tahun sekali yang jika tidak terpenuhi status registrasinya bisa dicabut (NMC, 2007).
Registrasi tersebut memiliki nomer dan masa berlaku yang ditentukan oleh Nursing Board. Sistem registrasi memiliki pengaruh terhadap status pekerjaannya di mana setiap individu untuk bisa bekerja sebagai nurses harus memiliki bukti registrasi tersebut. Jika dia bekerja tanpa memiliki bukti register tersebut bisa dianggap sebagai melanggar hukum (Edginton, 1995).
Peningkatan profesi lain, selain dalam bentuk RN, bisa juga berupa misalnya: CRNA (Certified Registered Nurse Anaesthetist) untuk nurse anastesi, CRNP (Certified Registered Nurse Practitioner) untuk Nurse Practitioner, CNOR (Certified Nurse of Operating Room) untuk nurse kamar operasi , dsb.
Jadi seorang nurse memungkinkan untuk memiliki gelar RN, CNOR dll dibelakang namanya bukan hanya karena telah merampungkan jenjang pendidikan tertentu dan dalam masa tertentu saja, namun juga melalui test/seleksi yang diselenggarakan oleh badan registrasi serta memiliki dasar hukum yang jelas.
Bagi penyandang Strata 2, gelarnya adalah MSN (Master of Science of Nursing) dan diikuti dengan gelar spesialisasi tersebut di atas, misalnya MSN, CRNP tanpa harus mencantumkan gelar BSN karena gelar MSN tersebut lebih tinggi stratanya, kecuali jika gelar masternya adalah di luar disiplin ilmu keperawatan maka gelar BSN nya tetap dicantumkan (Untuk aturan di Indonesia, lihat SK Mendiknas).
Sedangkan Inggris dan negara-negara yang berafiliasi dengannya seperti India, Pakistan, beberapa negara Arab dan Afrika, serta Australia menggunakan pola yang sama dengan Amerika hanya saja tanpa huruf S untuk gelar BSN dan MSNnya. Jadi gelar yang dipakai hanya BN atau MN. Sedang gelar spesialisasinya akan ditulis di dalam kurung mengikuti gelar utamanya. Misal MN (Adv Prac) untuk gelar Master of Nursing spesialis Advance Practice; MN (Edu) untuk Master Nursing dengan spesialis Education, dsb.
Berdasarkan dari apa dan bagaimana penempatan RN serta gelar spesialisasi di atas, maka pemakaian gelar Ners semakin susah untuk ditempatkan. Jika dipakai sebagai gelar registered tidak pas lantaran lembaga yang mengeluarkannya. Demikian pula bila dipakai untuk gelar spesialisasi, Ners tidak mengindikasikan spesialisasi tertentu.
Tren Globalisasi
Tahun 2010 adalah awal era globalisasi, pasar terbuka. Tren globalisasi yang tidak mengenal batas negara memiliki pengaruh yang luas di segala bidang. Tenaga kerja asing termasuk nurses juga mulai merambat bursa tenaga kerja Indonesia yang harus bersaing dengan nurses di tingkat lokal (misalnya di Freeport, Irian Barat, nursesnya multinational).
Di dunia pendidikan kerja sama antar perguruan tinggi antar negara, merupakan salah satu kiat untuk mengahadapi tren di atas. Kerjasama antara Stikes Binawan dan Universitas Indonesia dengan University of Technology Sydney untuk program PSIK (Buletin of Central Sydney Area Mental Health, 2007, online) merupakan contoh inovatif yang bisa ditiru. Tujuan program-program internasionalisasi ini tidak lain supaya mendapatkan pengakuan di mata internasional, baik dari segi pengetahuan maupun ketrampilan.
Diperkirakan lebih dari 4000 tenaga nurses kita di negara-negara Timur Tengah, dan sejumlah kecil di Eropa, Australia, Jepang dan Amerika serta di negara tetangga Malaysia dan Brunei. Bedanya, status nurses kita yang di luar negeri dengan foreign nurses yang ada di negeri kita adalah, jika nurses asing yang masuk ke negara kita tersebut memiliki pos yang tinggi, sedangkan nurses kita yang ada di negara asing mayoritas masih menduduki peringkat kelas bawah sekalipun dia adalah lulusan S1 (Dian S, Pers. Comm, 2007).
Fenomena di atas menunjukkan bahwa keberadaan dan status nurses kita memang masih belum bisa disejajarkan dengan negara-negara lain. Salah satu penyebabnya adalah kita belum memiliki sistem pengaturan profesi yang baku. Nursing council/board yang berskala nasional belum eksis di Indonesia. Secara umum, tugas nursing council ini menangani legalitas kompetensi profesi nurses di Indonesia yang dikemas dalam bentuk registrasi.
Menurut Germov (1998), syarat bisa dikatakan profesi adalah jika memiliki otonomi sendiri untuk mengatur standar tugas dan tanggungjawabnya, statusnya dan sistem keuangannya menurut badan profesi yang diakui secara nasional ataupun internasional. Di sinilah Nursing Board/Council kembali berperan. Sedangkan badan tersebut belum kita miliki.
Keberadaan Persatuan Persatuan Perawat Nasional Indonesia (PPNI) belum bisa dikatakan sebagai Nursing Board. Sebaliknya, PPNI hanya merupakan organisasi yang memiliki fungsi sebagai wadah profesi nursing yang memiliki persamaan kehendak sesuai dengan jenis/profesi dan lingkungan kerja untuk mencapai tujuan organisasi (PPNI, 2007, Online).
Dalam buku karya Kenworthy, Snowley, dan Gilling (2002) berjudul Common Foundation Studies in Nursing, konsep nursing itu dibangun dari empat unsur yaitu client, health, environment, serta nursing. Dari keempat unsur ini para peneliti kemudian mengembangkan, sehingga muncul berbagai macam teori nursing. Di antara teori-teori yang baru tersebut, yang paling penting adalah peletakan konsep di tengah-tengah disiplin ilmu yang lain sebagai suatu evidence-based practice, sebuah disiplin ilmu yang berdasar kepada bukti-bukti ilmiah, bukan semata-mata turunan, atau tiruan dari disiplin ilmu yang lain.
Penggunaan Ners di Indonesia, dari uraian diatas, pada hemat penulis perlu dicermati kembali. Gelar Ners perlu mendapatkan perhatian, jika masih terlalu "ekstrim" untuk dikatakan koreksi. Dari berbagai tinjauan di atas juga membuktikan, baik dari segi akademik, profesi maupun segi hukum, kurang mendukung penerapannya.
Sebagai sebuah cabang profesi, nursing membutuhkan dasar pendidikan yang layak. Pendidikan ini membutuhkan dukungan teori serta praktek. Berbagai referensi mengemukakan teori dan parktek yang amat bervariasi. Teori-teori tersebut diajarkan di berbagai perguruan tinggi yang di dalamnya terdapat independensi (USQ-Australia, New Castle University-Australia, Regent- College of Nursing-USA, dll), bukan di bawah payung fakultas kesehatan lain. Perguruan tinggi ini menawarkan beberapa program pendidikan nursing, mulai dari Associate Degree hingga Post Graduate of Nursing. Meski demikian, pemberian gelar profesional (RN) terhadap para lulusan perguruan tinggi di berbagai negara tersebut tidak dikeluarkan oleh universitas yang meluluskan, namun oleh Nursing Council / Nursing Board.
Pemberian gelar registered nurse, mestinya tidak perlu didiskriminasikan, apalagi oleh lembaga pendidikan. Sebaliknya, terlepas dari apakah itu lulusan diploma, sarjana, atau pasca sarjana, mereka berhak mengajukan perolehan registrasi pada sebuah lembaga independen yang mengurusinya. Di negeri kita, kalau hanya lulusan S1 yang berhak mendapatkan gelar profesi Ners, apakah lulusan diploma 3 tidak berhak mendapatkan gelar profesi serupa hanya karena tingkat pendidikannya yang satu level di bawahnya?
Oleh sebab itu, prinsip yang sama bisa diterapkan di Indonesia. Mengusulkan kepada Pemerintah lewat Departemen Kesehatan untuk membentuk Nursing Council yang sudah mendesak kebutuhannya. Nursing council ini tidak menutup kemungkinannya bisa dibentuk secara independen. Sudah waktunya pula PPNI, sebagai satu-satunya organisasi nursing, mewujudkan impian anggotanya.
Uraian diatas membuktikan bahwa gelar Ners tidak bisa disejajarkan dengan RN sebagaimana yang ada di luar negeri semisal AS atau RGN di Inggris, khususnya jika ditinjau dari aspek akademik, aturan peletakan gelar serta pengakuan hukum.
Hanya saja, sebagian besar warga profesi kita sudah terlanjur terbiasa mudah ikutan (latah) tanpa berpikir kritis terhadap segala konsekuensinya. Tidak terkecuali menyikapi pemakaian gelar. Gelar Ners begitu saja ditelan tanpa mempertimbangkan apakah tepat atau tidak penggunaannya.
Dalam wawancara dengan salah satu stasiun TV, pada 7 Juni 2004, pakar ekonomi dari Harvard University, Hartojo Wignjowijoto (Husaini, 2004, online), menyatakan, "Problem mendasar bangsa Indonesia adalah "tidak memiliki kepercayaan diri" dan "tidak mau kerja keras". Tidak percaya diri, malas bekerja, malas belajar, malas mencari ilmu, mau dapat gelar tanpa bekerja keras merupakan kendala besar kita. Lihatlah, begitu banyaknya program yang menawarkan gelar magister, doktor, dari berbagai institusi pendidikan, tetapi tidak memperhatikan kualitas penerima gelar. Sekarang, sudah sampai di kampung-kampung, orang menawarkan program mudah untuk mendapatkan gelar magister atau doktor."
Akankah kita sebagai nurses, mau disejajarkan dengan kelompok tersebut? Sudah tentu tidak! Hanya saja hal ini perlu bukti. Setidaknya, gelar profesional ini tidak hanya slogan yang ada di belakang nama penyandangnya. Tanpa Ners pun, melalui pola kerja kita yang kompeten, klien akan tahu, bahwa profesional yang ada di sampingnya bukan seperti yang disebutkan oleh pakar ekonomi dari Harvard di atas.
Email:Syaifoel Hardy: hardy.syaifoel@gmail.comNurhadi:
BIHS, n.d., Nursing study program: introduction, Academic Information, [Online], Available from URL:, Accessed on 29/06/2004
Buletin of Central Sydney Area Mental Health, 2003, Nursing Curriculum Development with Binawan Institute, University of Indonesia and University of Technology Sydney (UTS), [Online], available from URL:, Accessed on 29/06/2004.DEST - Australia, 2003, �€˜ Nursing legislation and regulation�€™, National Review of Nursing Education , [Online], available from URL:, Accessed on 04/10/2003.
Departeken Kesehatan RI, 2007, Domain Depkes, Online, Available at URL, [Accessed on 20 June 2007].
Dikti, 2003, Daftar Program Studi Yang Telah Terakreditasi s/d 2003, [Online], Available from URL:, accessed on 26 June 2004.
Edginton, J., 1995, �€˜Nurses�€™ registration�€™, Law for the Nursing Profession and Allied Health Care Professionals, 3rd edn., CCH Aust. Ltd, North Ryde, ch. 5.
Fakultas Kedokteran Universitas Kedokteran, 2002, �€˜Profil program studi ilmu keperawatan�€™, Program Study Ilmu Keperawatan, [Online], Available from URL:, Accessed on 26/06/2004.
Germov, J. 1998, �€˜Challenges to medical dominance�€™, Second Opinion: An Inroduction to Health Sociology, ed. J. Germov, Oxford, Melbourne pp. 230-48.
Gripando, G.M. & Mitchell, P.R., 1989, Nursing Perspectives and Issues, 4th edn., Delmar Publishers Inc., New York, pp. 2 �€“ 3.
Husaini, A., 2004, Opini, [Online], available from URL:// modules.php?name=News&file=article&sid=1237, accessed on 26 June 2004.
Kenworthy, N., Snowley, G., Gilling, C., 2002, The context of practice, Common Foundation Studies in Nursing, 3rd edn, Churchill Livingstone, Edinburgh, pp. 42-75.
Maslen, G., 2000, Graduates pocket the benefits of study�€™, Campuss Review, Jun 14-20, p. 4.
NMC, 2007, Home page UKCC, [Online], Available from URL: http://www.nmc- [Accessed on 30/05/2007].
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West, W., 2000, �€˜Do degrees put money in the bank?�€™, Campuss Review, Sep. 13 �€“ 19, pp. 19 �€“ 20.

Press Release: New Health Crisis of Our Young Generation:

Press Release: New Health Crisis of Our Young Generation:Surveillance Finds Many School Students Are Emotionally Disturbed
(March 2002)

A large-scale surveillance conducted by the Centre of Health Education and Promotion of The Chinese University of Hong Kong revealed that many of our younger generation are emotionally disturbed and good school environment is conducive to the health of adolescents.

This study on youth health risk behaviours was conducted in late 2001 on 1,906 primary school students and 5,286 secondary school students aged 10 to 16 from 34 schools. It examined self-rated academic performance, health status, life satisfaction and depressive symptoms; and their correlation with other health risk behaviours (i.e., physical inactiveness, unhealthy diet, smoking, alcohol drinking and taking illicit drug).

The key findings include:
27% of students disagreed that they had satisfactory life.
26% of students felt hopeless and 10% felt lonely most of the time.
14.7% of students have considered suicide and nearly 10% have planned for it.
Less than 40% would seek help form parents and only about one quarter of students would seek help from teachers or social workers when they had suicidal ideation.
35.8% of students had depressive symptoms.
The median Life Satisfaction Score was found to be 19 on a scale of 5 to 30 with higher scores being more satisfied with life (in this study the minimum score was 5, maximum score was 30, and 50% of the subjects ranged 15 to 23).

Depressive symptoms are associated with a number of factors. Amongst those with depressive symptoms, only 31.7% performed exercise regularly whilst for those without 68.3% did so. Around 25% of students with depressive symptoms had considered suicide and hurt themselves versus less than 10% amongst those without depressive symptoms. Those with depressive symptoms were more likely to have unhealthy eating habits, smoke, drink alcohol or take illicit drugs. They were more likely to report being threatened at schools or involved in fighting.

Amongst those students who self-rated themselves distinction in academic performance, only 23.2% had depressive symptoms whilst 55% of those with poor self-rated academic performance had such symptoms. Similarly, those considered themselves distinctive in academic performance had higher life satisfaction scores than those rating themselves poor in academic performance. Students who are taking regular exercise, healthy diet, non-drinkers, non-smokers, not taking illicit drugs, and no fighting or receiving threats of being injured had higher life satisfaction scores.

Schools with lower depression scores were found to differ in certain aspects of school social environment and community partnership from those with higher scores. These were: a supportive social environment, school ethos promoting closer relationship between staff and students, and follow up action plans for unforeseeable events. These schools rewarded students for academic improvement and participation in community services and created a positive climate for youth development.

The Centre for Health Education and Health Promotion conducted the first territory wide student health surveillance survey in 1999. Over 10% students reported their normal daily activities interfered because of their poor physical and emotional health. Over 50% school children did not perform vigorous exercise regularly. The results aroused the public attention to the health of our young generation. This present study shows that the proportion of students feeling hopeless has increased from 14% in 1999 to 25% in 2001.

This present study further proves that the health of children and adolescents will affect their ability to learn. As early as 1998, the Centre launched the "Healthy Schools"/Health Promoting Schools Programme. The concept of Health Promoting School helps to develop a safe social and physical environment for the 'total population' of the school. The school environment has a direct impact on the self-esteem, educational achievement, and health of its pupils and staff. The Hong Kong Healthy Schools Award Scheme builds on the concept of health promoting school to encourage educational achievement, better health and emotional well-being; thereby supporting pupils in improving the quality of their lives. It also promotes staff development, parental education, involvement of whole school community, and linkage with different stakeholders so as to improve the health and well-being of the students, parents and staff, and the community at large. With increasing number of students with emotional problems and health risk behaviours, an integrated, holistic and school-based approach to promote youth health is needed. This study has shown that eliminating one health risk behaviour would improve the overall physical and emotional well being of the students.

Catatan Harian Seorang Pramugari

Saya adalah seorang pramugari biasa dari China Airline, karena bergabung dengan perusahaan penerbangan hanya beberapa tahun dan tidak mempunyai pengalaman yang mengesankan, setiap hari hanya melayani penumpang dan melakukan pekerjaan yang monoton.

Pada tanggal 7 Juni yang lalu saya menjumpai suatu pengalaman yang membuat perubahan pandangan saya terhadap pekerjaan maupun hidup saya.

Hari ini jadwal perjalanan kami adalah dari Shanghai menuju Peking, penumpang sangat penuh pada hari ini.

Di antara penumpang saya melihat seorang kakek dari desa, merangkul sebuah karung tua dan terlihat jelas sekali gaya desanya, pada saat itu saya yang berdiri dipintu pesawat menyambut penumpang kesan pertama dari pikiran saya ialah zaman sekarang sungguh sudah maju seorang dari desa sudah mempunyai uang untuk naik pesawat.

Ketika pesawat sudah terbang, kami mulai menyajikan minuman, ketika melewati baris ke 20, saya melihat kembali kakek tua tersebut, dia duduk dengan tegak dan kaku ditempat duduknya dengan memangku karung tua bagaikan patung.

Kami menanyakannya mau minum apa, dengan terkejut dia melambaikan tangan menolak, kami hendak membantunya meletakkan karung tua diatas bagasi tempat duduk juga ditolak olehnya, lalu kami membiarkannya duduk dengan tenang, menjelang pembagian makanan kami melihat dia duduk dengan tegang di tempat duduknya, kami menawarkan makanan juga ditolak olehnya.

Akhirnya kepala pramugari dengan akrab bertanya kepadanya apakah dia sakit, dengan suara kecil dia menjawab bahwa dia hendak ke toilet tetapi dia takut apakah di pesawat boleh bergerak sembarangan, takut merusak barang didalam pesawat.

Kami menjelaskan kepadanya bahwa dia boleh bergerak sesuka hatinya dan menyuruh seorang pramugara mengantar dia ke toilet, pada saat menyajikan minuman yang kedua kali, kami melihat dia melirik ke penumpang di sebelahnya dan menelan ludah, dengan tidak menanyakannya kami meletakan segelas minuman teh di meja dia, ternyata gerakan kami mengejutkannya, dengan terkejut dia mengatakan tidak usah, tidak usah. Kami mengatakan engkau sudah haus minumlah, pada saat ini dengan spontan dari sakunya dikeluarkan segenggam uang logam yang disodorkan kepada kami, kami menjelaskan kepadanya minumannya gratis, dia tidak percaya, katanya saat dia dalam perjalanan menuju bandara, merasa haus dan meminta air kepada penjual makanan dipinggir jalan dia tidak diladeni malah diusir.Pada saat itu kami mengetahui demi menghemat biaya perjalanan dari desa dia berjalan kaki sampai mendekati bandara baru naik mobil, karena uang yang dibawa sangat sedikit, hanya dapat meminta minunam kepada penjual makanan dipinggir jalan itupun kebanyakan ditolak dan dianggap sebagai pengemis.

Setelah kami membujuk dia terakhir dia percaya dan duduk dengan tenang meminum secangkir teh, kami menawarkan makanan tetapi ditolak olehnya.

Dia bercerita bahwa dia mempunyai dua orang putra yang sangat baik, putra sulung sudah bekerja di kota dan yang bungsu sedang kuliah ditingkat tiga di Peking. anak sulung yang bekerja di kota menjemput kedua orang tuanya untuk tinggal bersama di kota tetapi kedua orang tua tersebut tidak biasa tinggal di kota akhirnya pindah kembali ke desa, sekali ini orang tua tersebut hendak menjenguk putra bungsunya di Peking, anak sulungnya tidak tega orang tua tersebut naik mobil begitu jauh, sehingga membeli tiket pesawat dan menawarkan menemani bapaknya bersama-sama ke Peking, tetapi ditolak olehnya karena dianggap terlalu boros dan tiket pesawat sangat mahal dia bersikeras dapat pergi sendiri akhirnya dengan terpaksa disetujui anaknya.

Dengan merangkul sekarung penuh ubi kering yang disukai anak bungsunya, ketika melewati pemeriksaan keamanan dibandara, dia disuruh menitipkan karung tersebut di tempat bagasi tetapi dia bersikeras membawa sendiri, katanya jika ditaruh ditempat bagasi ubi tersebut akan hancur dan anaknya tidak suka makan ubi yang sudah hancur, akhirnya kami membujuknya meletakkan karung tersebut di atas bagasi tempat duduk, akhirnya dia bersedia dengan hati-hati dia meletakan karung tersebut.

Saat dalam penerbangan kami terus menambah minuman untuknya, dia selalu membalas dengan ucapan terima kasih yang tulus, tetapi dia tetap tidak mau makan, meskipun kami mengetahui sesungguhnya dia sudah sangat lapar, saat pesawat hendak mendarat dengan suara kecil dia menanyakan saya apakah ada kantongan kecil? dan meminta saya meletakkan makanannya di kantong tersebut. Dia mengatakan bahwa dia belum pernah melihat makanan yang begitu enak, dia ingin membawa makanan tersebut untuk anaknya, kami semua sangat kaget.

Menurut kami yang setiap hari melihat makanan yang begitu biasa di mata seorang desa menjadi begitu berharga.

Dengan menahan lapar disisihkan makanan tersebut demi anaknya, dengan terharu kami mengumpulkan makanan yang masih tersisa yang belum kami bagikan kepada penumpang ditaruh di dalam suatu kantongan yang akan kami berikan kepada kakek tersebut, tetapi di luar dugaan dia menolak pemberian kami, dia hanya menghendaki bagian dia yang belum dimakan tidak menghendaki yang bukan miliknya sendiri, perbuatan yang tulus tersebut benar-benar membuat saya terharu dan menjadi pelajaran berharga bagi saya.

Sebenarnya kami menganggap semua hal tersebut sudah berlalu, tetapi siapa menduga pada saat semua penumpang sudah turun dari pesawat, dia yang terakhir berada di pesawat. Kami membantunya keluar dari pintu pesawat, sebelum keluar dia melakukan sesuatu hal yang sangat tidak bisa saya lupakan seumur hidup saya, yaitu dia berlutut dan menyembah kami, mengucapkan terima kasih dengan bertubi-tubi.Dia mengatakan bahwa kami semua adalah orang yang paling baik yang dijumpai, “kami di desa hanya makan sehari sekali dan tidak pernah meminum air yang begitu manis dan makanan yang begitu enak, hari ini kalian tidak memandang hina terhadap saya dan meladeni saya dengan sangat baik, saya tidak tahu bagaimana mengucapkan terima kasih kepada kalian. Semoga Tuhan membalas kebaikan kalian,” dengan menyembah dan menangis dia mengucapkan perkataannya. Kami semua dengan terharu memapahnya dan menyuruh seorang anggota yang bekerja di lapangan membantunya keluar dari lapangan terbang.

Selama 5 tahun bekerja sebagai pramugari, beragam-ragam penumpang sudah saya jumpai, yang banyak tingkah, yang cerewet dan lain-lain, tetapi belum pernah menjumpai orang yang menyembah kami, kami hanya menjalankan tugas kami dengan rutin dan tidak ada keistimewaan yang kami berikan, hanya menyajikan minuman dan makanan, tetapi kakek tua yang berumur 70 tahun tersebut sampai menyembah kami mengucapkan terima kasih, sambil merangkul karung tua yang berisi ubi kering dan menahan lapar menyisihkan makanannya untuk anak tercinta, dan tidak bersedia menerima makanan yang bukan bagiannya, perbuatan tersebut membuat saya sangat terharu dan menjadi pengalaman yang sangat berharga buat saya dimasa datang yaitu jangan memandang orang dari penampilan luar tetapi harus tetap menghargai setiap orang dan mensyukuri apa yang kita dapat.
(article copied from a blog)

Thursday, October 25, 2007



New York, Oct 24 2007 9:00AM
Aiming to help parents and policymakers, the United Nations World Health Organization (WHO) today published the first internationally agreed classification code for assessing the health of children.
The International Classification of Functioning, Disability and Health for Children and Youth is considered a breakthrough initiative. "For the first time, we now have a tool that enables us to track and compare the health of children and youth between countries and over time," said Nenad Kostanjsek of WHO's Measurement and Health Information team.
He said it "will allow countries and the international community to take informed action to improve children's health, education and rights, by treating their health as a function of the environment that adults provide."
The Classification addresses hundreds of bodily functions and structures, activities and participation, and various environmental factors that restrict or allow young people to function in an array of every day activities. WHO said it will have has important implications globally for research, standard setting and mobilizing resources.
The classification also covers developmental delay, the agency said. Children who achieve certain milestones later than their peers may be at increased risk of disability. Using this classification, health practitioners, parents and teachers can describe these delays precisely in order to plan for health and educational needs and frame policy debates.
For more details go to UN News Centre at
To listen to news and in-depth programmes from UN Radio go to:

Wednesday, October 24, 2007


Minggu, 17 Juni 2007

Ratusan Mahasiswa Tolak D4 Keperawatan
Ratusan mahasiswa yang tergabung Aliansi Mahasiswa Peduli Profesi Keperawatan menggelar demo di Poltekkes Negeri Semarang, Tembalang, Sabtu (16/6). Aksi mahasiswa dari Undip, Unsoed, UGM, UMY, Stikes Ngudi Waluyo, Unibraw, dan Ikatan Lembaga Mahasiswa Ilmu Keperawatan Indonesia (ILMIKI) itu, pada intinya menolak berdirinya D4 keperawatan. Selain itu, mereka juga menuntut dilakukan pembubaran terhadap program D4 keperawatan yang dinilai telah berjalan tanpa legalitas. Koordinator aksi Risko Karim mengatakan, lahirnya jenjang pendidikan D4 Keperawatan itu merupakan suatu langkah tidak menghargai dan menghormati perawat sebagai sebuah profesi.''
Profesi keperawatan dipandang tidak lebih dari lahan empuk dan subur untuk dijadikan tumbal dan dapat menghasilkan keuntungan. D4 Keperawatan tidak tercantum dalam dunia profesi. Selain itu, merupakan duri yang menyayat hati profesi keperawatan,'' kata dia di sela-sela orasinya.
Aksi yang digelar mulai pukul 08:30 di Gedung Serba Guna (GSG) Tembalang itu, kemudian dilanjutkan ke kampus Poltekkes. Ratusan mahasiswa berjalan sejauh 500 meter sembari mengusung keranda sebagai simbol rasa duka cita terhadap profesi keperawatan.
Risko menambahkan, hasil lokakarya PPNI tahun 1983, menyepakati keperawatan adalah pelayanan profesional. Undang-Undang Sisdiknas Nomor 20 Tahun 2003 tentang Pendidikan Kedinasan memaparkan, pendirian Poltekkes dalam wewenang Depkes bertujuan mendidik pegawai negeri atau calon pegawai negeri di bidang kesehatan.
Ketua Jurusan Keperawatan Politeknik Kesehatan Negeri Semarang, H Purwanto Wardhono SKM DPHN MM mengatakan, penyelenggaraan program D4 Keperawatan sudah menjadi kebijakan Depkes. ''D4 diadakan setelah melalui studi dan penelitian cukup panjang, di mana kebutuhan tenaga terampil tingkat lanjut pasca D3 sangat dibutuhkan,'' kata dia. (Apr, J14-56)

Berhentilah Merokok, Sekarang!

Berhentilah Merokok, Sekarang!
Minggu, 07 Januari 2007

Bagi para perokok, merokok bisa jadi merupakan aktivitas ringan nan menyenangkan. Namun, tidakkah terpikir oleh mereka bahwa merokok bisa merangsang munculnya 25 macam penyakit serius? Tak tahukah mereka bahwa dalam setiap menit ada delapan nyawa melayang akibat rokok?

Fakta-fakta itu bakal kian panjang bila diurai lebih jauh. Apalagi, seperti dikatakan dokter Tjandra Yoga Aditama SpP, spesialis paru dari Bagian Pulmonologi dan Ilmu Kedokteran Respirasi Fakultas Kedokteran Universitas Indonesia/Rumah Sakit Persahabatan Jakarta, populasi perokok tetap saja tinggi. Tak hanya laki-laki dan perempuan dewasa, kebiasaan merokok pun merajalela di kalangan remaja. ''Bahkan, sekitar 9,3 persen mahasiswa fakultas kedokteran di Indonesia merupakan perokok aktif,'' ungkapnya dalam workshop yang diselenggarakan oleh Yayasan Konsumen Indonesia (YLKI) dan Public Health Advocacy Institute (PHAI) di Jakarta, beberapa waktu lalu.

Data dari The Tobacco Atlas menyebutkan, pada 2002 Indonesia masuk dalam kelompok lima besar 'negara perokok'. Cina berada di urutan pertama dengan konsumsi 1.643 miliar batang, disusul Amerika Serikat 451 miliar batang, Jepang 328 miliar batang, Rusia 258 miliar batang, dan Indonesia di urutan ke lima dengan konsumsi sebanyak 215 miliar batang. Data ini tentu sangat memprihatinkan. Sebab, merokok bukanlah aktivitas yang menyehatkan, tapi sebaliknya mengundang penyakit.

Lebih lanjut Tjandra menjelaskan, pada asap rokok terdapat sekitar 4.000 bahan kimia berbahaya. Asap ini terbagi dua, yaitu asap utama (main stream smoke) yang keluar dari pangkal rokok dan asap sampingan (side stream smoke) yang keluar dari ujung rokok. Zat-zat berbahaya dari asap rokok tersebut antara lain: aseton (cat), ammonia (pembersih lantai), arsen (racun), butane (bahan bakar ringan), cadmium (aki mobil), karbon monoksida (asap knalpot), DDT (insektisida), hidrogen sianida (gas beracun), methanol (bensin roket), naftalen (kamper), toluene (pelarut industri), dan vinil chloride (plastik).

Penyakit-penyakit yang diakibatkan oleh rokok antara lain: paru-paru, jantung, kanker, gangguan kehamilan, dan sejumlah penyakit lainnya. Pada paru-paru, zat-zat berbahaya dari asap rokok bisa menimbulkan sejumlah penyakit serius seperti penyakit paru obstruktif kronis, kanker paru, dan penurunan faal paru. Pada jantung, ungkap aktivis Lembaga Menanggulangi Masalah Merokok (LM-3) ini, seorang perokok berisiko tiga kali lebih besar terkena serangan jantung dibandingkan mereka yang bukan perokok.

Bagaimana dengan penyakit kanker? Para perokok, kata Tjandra, berisiko terkena kanker mulut lima kali lebih besar karena asap rokok dihisap melalui mulut. Kemungkinan terserang kanker tenggorokan tidak kalah besarnya, yakni sembilan kali lebih besar dibanding mereka yang tidak merokok. Selain itu, perokok juga berisiko terserang beberapa jenis kanker lainnya seperti kanker kandung kemih (risiko 2-3 kali lebih besar), kanker bibir, pipi, lidah, pankreas, esofagus, dan kanker leher rahim.

Perokok perempuan berusia 35 tahun ke atas berisiko meninggal akibat kanker paru 12 kali lebih besar ketimbang perempuan yang tidak merokok. Di Amerika, kematian perempuan akibat kanker paru pada 1987 sudah lebih tinggi ketimbang kematian perempuan akibat kanker payudara. ''Bukan tidak mungkin hal yang sama akan terjadi juga di Indonesia,'' tuturnya.

Rokok juga bisa mengakibatkan gangguan reproduksi pada pria maupun wanita. Gangguan reproduksi pada pria dapat berupa impotensi, kemandulan, dan gangguan sperma. Sedangkan pada wanita berupa nyeri haid, menopause lebih awal, dan kemandulan. Di masa kehamilan, rokok meningkatkan risiko keguguran, kelahiran prematur, bayi lahir mati, berat badan janin turun sebesar 40-400 gram, gangguan tumbuh kembang, gangguan oksigenasi, dan gangguan enzim pernapasan pada janin. ''Dan bila ibu hamil merokok lebih dari 10 batang per hari, maka anak yang dilahirkan berisiko dua kali lebih besar untuk menderita penyakit asma.''

Di Amerika, dia melanjutkan, sekitar 12 persen ibu hamil tetap saja merokok. Akibatnya, nikotin, karbondioksida, dan 4.000 bahan kimia lain yang dihisap sang ibu akan dihisap pula oleh janinnya lewat plasenta. Alhasil, janin di rahim pun terpapar zat-zat berbahaya dari rokok. ''Bayi baru baru lahir pun 'ikut merokok' kalau ibu yang menyusui adalah perokok,'' tuturnya.

Deretan jenis masalah akibat rokok ternyata masih panjang. Rambut Anda yang indah, akan berbau dan kusam akibat asap rokok. Sementara mata Anda yang semula jernih akan menjadi berair, sering berkedip, dan lebih cepat terkena katarak. Dan Anda yang ingin selalu tampil dengan kulit yang cantik, sebaiknya jauhilah asap rokok. ''Sebab asap rokok membuat kulit cepat keriput dan cepat kelihatan tua.''

Anda tentu tak mau mengalami semua masalah itu, bukan? Maka, tak ada jalan lain kecuali segera menghentikan kebiasaan merokok. ''Kalau tak bisa serta merta, cobalah menghentikannya secara berangsur. Yang pasti, harus ada motivasi yang kuat.''
(bur )

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