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Priskariansi*, Meilitha Carolina**, Etri Taviane ***

Sekolah Tinggi Ilmu Kesehatan STIKes Eka Harap Palangka Raya

Program Studi Sarjana Keperawatan



Emergency room (ER) is a unit of hospital providing first service to the patient
who requires an immediate intervention for life saving and preventing further
disability. The condition faced by nurses working at Emergency Unit naturally
unpredicted and cannot be scheduled and demanding immediate and appropriate
nursing responses to the patients. The decision made requires appropriate and
complete data, so that it is important to utilize the form and guideline.

The purpose of this research was to identify the effect of the utilization of
integrated emergency nursing care form and guideline to the accuracy and
completeness of nursing documentation at emergency unit in the Hospital of
Palangka Raya. Quasy experiment design was used to determine the effect of
integrated emergency form and guideline to the accuracy and completeness of
nursing documentation in the hospital emergency unit, Palangka Raya. There were
39 respondents divided into two groups. Experimental Group consisted of 25
respondents and Control Group consisted of 14 respondents. The result of the
study revealed that there was a significant effect of the nursing care format and
guideline utilization to the accuracy and completeness of nursing documentation
in the hospital emergency unit, Palangka Raya.

The nursing implication of this study was for emergency nursing care can provide
immediate treatment while maintaining quality of care and nursing
documentation. Form and guidelines integrated emergency nursing care can be
used to facilitate nurses in nursing care documentation. For management as the
manager can evaluate performance of nursing, improving the standard of
competence, and provide facilities with the client’s needs.

Keywords: the format and guide nursing care, nursing documentation accuracy,
completeness nursing documentation.

INTRODUCTION that are conducted so that it requires its own
motivation and special therapy to focus attention
Hyperactive children have difficulty concentrating, especially in the learning process at school.
their minds go everywhere. Hyperactive children
or known as Attention Deficit Hyperactivity The number of children with special needs each
Disorder (ADHD) is a concentration of attention year is increasing, ADHD is the most common
disorder where patients have difficulty psychological problem lately, about 3-10% occur
concentrating and staying in one job at a certain in the United States, 3-7% in Germany, 5-10% in
time. Each disorder requires motivation in a Canada and New Zealand. The population of
different form, especially in the teaching and elementary school children who experience ADHD
learning process, with the exception of hyperactive in Indonesia amounted to 16.3% of the total
children. population of 25.85 million children. Based on
these data it is estimated that there are 9000 new
Motivation is a management process to influence cases of ADHD. (Rusmawati and Dewi, 2011: 74).
human behavior based on knowledge about According to the Ministry of Education and
feelings that make people move (Nursalam 2015: Culture of Schools with Special Needs throughout
106). Besides being unable to concentrate Indonesia in Central Kalimantan, the number of
hyperactivity patients also have difficulty students enrolled in Special Schools (SLB) for the
controlling body movements. Three types of 2014/2015 school year is 184 people with
therapy are used for handling hyperactive children, hyperactive students ranging from 74 children.
namely speech therapy, behavior, play, and sensory
integration therapy. The results of the preliminary survey on February
27, 2018 on 7 (seven) parents of hyperactive
Learning for hyperactive children is essentially the children using short interviews at TK Melati Ceria
same as learning for other normal students. Palangka Raya all parents said their children never
Mudjiman (2007: 43) said that in the child's focus on one thing being done. 3 (30%) said that if
learning process there are several factors that a child is not focused on learning then the parents
influence the formation of learning motivation will scold the child and teach to pay attention, and
including knowledge factors, learning needs, 4 (70%) of them say that they teach slowly and if
ability to take action, pleasure in ideas, learning the child is unable then he will leave it because
implementation, learning outcomes, satisfaction they believe that the child is able study
with results and decision making. independently.

Learning motivation of hyperactive children is a This study aims to find out how the effect of
psychological condition that is expected to Puzzle Play Therapy on Increasing Learning
encourage them to learn happily and study Motivation of Children with Attention
seriously, which in the end they are able to (Hyperactive) Concentration Disorders in TK
systematically concentrate on student learning Melati Ceria Palangka Raya
processes and complete activities.
According to Ismail (2011: 19) A child who is The design in this study is pre-experimental,
hyperactive usually often shows signs of acute namely "one group pre test and post test design"
anxiety Students who experience hyperactivity which is a research design that is used by giving
from childhood will be sustained during the initial tests and final tests on a single group
development of their adolescence, for example research sample (Nursalam, 2013: 165).
children may not be independent, not confident,
lack self-concept clear and have antisocial The sample in this study used a total sampling of
behavior so as not to rule out the possibility that 20 children with a disorder of hyperactive attention
every school, there are children who experience concentration in TK Melati Ceria Palangka Raya.
deviant behavior, such as hyperactivity behavior.
Research time is the period of time needed by the
Disorders of the hyperactive child if allowed to writer to obtain research data carried out, namely
continue can be detrimental to various parties such on May 28-June 31 2018.
as parents, teachers, friends and also themselves.
This research instrument uses a questionnaire made
The phenomenon obtained in hyperactive children by the researcher so that it needs to be tested for
tends to be incapable of focusing on the lessons validity. Validity test was conducted to prove the

validity of worksheets from 20 valid questions, Enough 5 25%
only 17 items were considered valid and able to be Less 14 70%
included in the study. Total 20 100 %

Data analysis was carried out by univeriat and Based on the above table it can be seen that before
bivariate analysis. Univariate analysis (proportion playing puzzle therapy the level of motivation of
and central tendency) is done on the characteristics children in learning is at most from 20 respondents
of respondents consisting of gender and age. (100%) namely with less motivation as many as 14
Bivariate analysis is done to see the difference of respondents (70%), and then 5 respondents (25%)
each dependent and independent variables, the with sufficient motivation and who lastly with
difference is considered significant if the p value is good motivation 1 respondent (5%).
<level of significance (<0.05). Data analysis using
the Wilcoxon Test). Table 2 Results of identification of the level of
The principle of research ethics is still done to motivation of children with attention deficit disorder
(hyperactivity) after being given a puzzle play therapy
protect research subjects.
at tk Melati Ceria Palangka Raya.
Child Frekuensi Persen (%)
The analysis was carried out before and after doing Good 13 65%
puzzle play therapy in children with disruption of Enough 6 30%
hyperactive attention concentration at TK Melati Less 1 5%
Ceria Palangka Raya.
Total 20 100 %
Diagram 1 Characteristics of respondents based on
Based on the above table it can be seen that after
age at Kindergarten Melati Ceria Palangka Raya in
playing the puzzle play therapy the highest
motivation level of children in learning is with
strong motivation as many as 13 respondents
(65%), and then with enough motivation 6
respondents (30%) and the least with less
motivation as much as 1 respondents (5%) with a
total of 20 respondents (100%).
Based on the pie chart above of 20 respondents
(100%), aged 5-6 years, namely 13 respondents
(65%) and at least 3-4 years old as many as 27 Table 3 Results of the analysis of the Wilcoxson Signed
Ranks Test to see the effect of motivation of children
respondents (35%).
with attention deficit disorder (hyperactivity) after being
given puzzle play therapy at TK Melati Ceria Palangka
Diagram 2 Characteristics of respondents based on Raya in 2018.
gender in Kindergarten Melati Ceria Palangka Test Statisticsa
Raya in 2018. Children's Learning Motivation Pre - Post
Therapy Test for Puzzle Playing
Z -3,697b
Asymp. Sig. (2-tailed) ,000

Based on the above table it can be seen that the

Based on the pie chart above of 20 respondents results of the analysis obtained a value of Z of
(100%) of male sex as many as 10 respondents 3.697 with a p value of Sig. (2-tailed) 0.000 which
(50%) and the same as female gender amounted to means smaller than the alpha value of 0.05 so it
10 respondents (50%). can be concluded that the p value is significant
(0.000 <0.05). Then H0 is rejected and H1 is
Table 1 Results of identification of the level of accepted, meaning there is an effect of puzzle play
motivation of children with attention deficit disorder therapy on increasing the learning motivation of
(hyperactivity) before a puzzle play therapy at TK children with attention deficit disorder
Melati Ceria Palangka Raya in 2018. (hyperactivity) in TK Melati Ceria Palangka Raya.

Child Frekuensi Persen (%) DISCUSSION

Good 1 5%

Motivation is anything that encourages someone to Cognitive skills relate to the ability to learn and
do something. Motivation is a feeling or mind that solve problems. Hyperactive children are children
encourages someone to do work or exercise power, who experience a concentration of attention with
especially in behaving (Nursalam, 2014: 105). hyperactivity which will have an impact on the
Motivation serves as an impetus to act, determine emergence of physical, psychological and social
the direction of action and select actions or problems (Zaviera, 2010: 14).
determine what actions must be done in harmony
to achieve goals by setting aside actions that are Motivation can come from two sources, namely
not useful for the purpose (Majid 2013: 209). from inside which is called intrinsic and from the
outside which is called extrinsic (Rahmat, 2009:
Factors that influence learning motivation are 118).
knowledge factors, learning needs factors, learning
ability factors, pleasure factors for learning Hyperactive children are children who experience
activities, learning activities, learning outcomes, a concentration of attention with hyperactivity
personal characteristics and supporting factors in which will have an impact on the emergence of
the decision making process. Hyperactive children physical, psychological and social problems
are the condition of children who show traits or (Zaviera, 2010: 14). The benefits of media puzzles
symptoms of lack of concentration, a lot of in learning, namely improving cognitive skills,
movement, explosive emotions, easily discouraged improving fine motor skills, training reasoning and
and discouraged that will result in children not memory skills, exercising patience, increasing
having friends (Baihaqi & Sugiarmin, 2011: 23). knowledge, and improving students' social skills.
When playing puzzles, children will train their
Learning motivation is the driving force for actions brain cells to develop their thinking abilities and
that students do to achieve their goals or goals. So concentrate on completing the pieces of the image.
that the indicators of learning motivation that
students have are reflected in the efforts to Based on the facts and theories above, the level of
generate motivation from the students themselves. learning motivation of children after being given a
puzzle play therapy shows the motivation to learn
Play therapy for hyperactive children aims to with a lower percent value compared to the value
minimize or eliminate aggressive behavior in order of the percent level of learning motivation before
to be able to concentrate more during the learning being given a therapy intervention to play puzzle.
process, reduce self-harm behavior, and eliminate Analysis of research data with statistical tests using
excess useless behavior. This can be done by Wilcoxon Signed Rank Test obtained Z value of
training certain movements to children, such as 3.697 with a p value of Sig. (2-tailed) 0.000 which
applause, playing puzzles, arranging blocks, means smaller than the alpha value of 0.05 so it
playing with peers, and other playing tools (Ismail, can be concluded that the p value is significant
2011: 25). (0.000 <0 05) and it can be concluded that there is
an increase in learning motivation in children
Playing is an enjoyable activity for children and is before and after the therapeutic intervention is
a method of how they know the world. For playing a puzzle with a significant p value.
children to play is not just filling in time, but is a
child's need as well as food, care, love and others. This means that giving therapy to play puzzle
Puzzle games are thin pieces consisting of 2-3 or affects the level of learning motivation in children.
more pieces made of wood or cardboard slabs. Based on the table above, H1 is accepted, meaning
Satisfaction obtained by students when solving there is an effect of puzzle play therapy on
puzzles is one way to generate students' motivation increasing the learning motivation of children with
for new things (Azizy, 2010: 35). attention deficit disorder (hyperactivity) in TK
Melati Ceria Palangka Raya.
Puzzles are designed to teach skills such as
recognizing shapes, sizes, quantities, colors,
similarities and differences (Nielsen, 2008: 98). CONCLUSION
The benefits of media puzzles in learning, namely There is an influence between the motivation of
improving cognitive skills, improving fine motor children with attention deficit disorder
skills, training reasoning and memory skills, (hyperactivity) after being given puzzle play
exercising patience, increasing knowledge, and therapy at TK Raya Melati Ceria Palangka raya in
improving students' social skills. 2018.

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