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Jurnal Keperawatan Indonesia
Published by Universitas Indonesia
ISSN : 14104490     EISSN : 23549203     DOI : https://doi.org/10.7454/jki
Core Subject : Health,
Focus and Scope Jurnal Keperawatan Indonesia (JKI, or Nursing Journal of Indonesia) contributes to the dissemination of information related to nursing research and evidence-based study on urban nursing issues in low-middle income countries. The scope of this journal is broadly multi-perspective in nursing areas such as Nursing Education, Clinical Practice, Community Health Care, Management and Health System, Health Informatics, and Transcultural Nursing, with a focus on urban nursing issues in low-middle income countries. JKI is committed to communicating and being open to the discussion of ideas, facts, and issues related to health across a wide range of disciplines. The journal accepts original research articles, synthesized literature, and best practice reports or case reports that use the quantitative, qualitative, or mixed-method approach. JKI adheres to journalistic standards that require transparency of real and potential conflicts of interest that authors and editors may have. It follows publishing standards set by the International Committee of Medical Journal Editors (ICMJE), the World Association of Medical Editors (WAME), and the Committee on Publication Ethics (COPE). Letters and commentaries about our published articles are welcome. All submitted contributions will undergo a blind peer-review process according to appropriate criteria.
Articles 8 Documents
Search results for , issue "Vol 22, No 3 (2019): November" : 8 Documents clear
Risiko Penyakit Kardiovaskuler pada Peserta Program Pengelolaan Penyakit Kronis (Prolanis) di Puskesmas Kota Bima: Korelasinya dengan Ankle Brachial Index dan Obesitas Martiningsih Martiningsih; Abdul Haris
Jurnal Keperawatan Indonesia Vol 22, No 3 (2019): November
Publisher : Faculty of Nursing Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.7454/jki.v22i3.880

Abstract

Penyakit kardiovaskular (PKV) adalah penyakit yang disebabkan oleh gangguan fungsi jantung dan pembuluh darah. PKV dapat dicegah terutama pada kelompok berisiko, diantaranya dengan penilaian risiko menggunakan Framingham Risk Score (FRS). Tujuan penelitian ini adalah untuk menganalisis risiko PKV dan korelasinya dengan Ankle Brachial Index (ABI) dan obesitas pada peserta Prolanis di Kota Bima. Pengambilan data menggunakan instrumen Framingham Risk Score, pengukuran tekanan darah, indeks massa tubuh, lingkar lengan, dan lingkar perut. Jenis penelitian ini adalah penelitian deskriptif analitik dengan rancangan cross-sectional. Pemilihan sampel ditentukan secara consecutive sampling pada semua responden yang aktif mengikuti kegiatan Prolanis dan memenuhi kriteria inklusi di lima Puskesmas di Kota Bima tahun 2018. Analisis data dengan uji parametrik Spearman. Hasil penelitian menunjukkan kelompok risiko tinggi 33 orang (40,7%), risiko sedang 28 orang (34,6%), dan risiko rendah 20 orang (24,7%). Tidak terdapat korelasi antara risiko PKV dengan ABI dan obesitas. Temuan lain dalam penelitian ini mengindikasikan adanya korelasi antara risiko PKV dengan subvariabel obesitas sentral walaupun tidak ditemukan adanya signifikansi (p> 0,05). Pada penelitian selanjutnya, disarankan jumlah sampel yang lebih banyak di komunitas dengan proporsi laki-laki dan perempuan yang berimbang. Kata Kunci: ABI, Framingham, kardiovaskuler, obesitas Abstract Risk of Cardiovascular Disease at Chronic Disease Management Program Participants in The Community Health Centers of Bima Town: The Correlation with Ankle Brachial Index and Obesity. Cardiovascular disease (CVD) is a disease caused by impaired heart and blood vessel function, which can be prevented, especially in risk groups that can be risk assessed using the Framingham Risk Score (FRS). The purpose of this study was to analyze the risk of CVD and the correlation with ABI and obesity in Prolanis participants at Bima City. Data collection was done by using the instrument FRS and measuring systolic blood pressure, body mass index, arm circumference, and waist circumference. This study was a descriptive-analytic study with a cross-sectional design. The sample selection was determined by consecutive sampling for all respondents who actively participated in Prolanis activities and fulfilled the inclusion criteria in five community health center at Bima City in 2018. Data analyzed with Spearmen parametric test. The results of research showed high risk group was 33 peoples (40.7%), moderate risk was 28 peoples (34.6%), and low risk was 20 peoples (24.7%). There was no correlation between risk of CVD  with ABI and obesity. Other findings in this study indicate a correlation between CVD risk and subvariable central obesity, although no significance was found (p> 0.05). In further research, it is recommended that a larger number of samples in the general community with a balanced proportion of men and women. Keywords:  ABI, cardiovaskuler, Framingham, obesity
The Effect of Monitoring Education on Menstrual Health Awareness Among College Students in Banten Dora Samaria; Theresia Theresia; Doralita Doralita
Jurnal Keperawatan Indonesia Vol 22, No 3 (2019): November
Publisher : Faculty of Nursing Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.7454/jki.v22i3.706

Abstract

Previous studies have shown that female college students have a low awareness of menstrual health. This situation must be resolved to prevent negative effects on their reproductive health. The objective of this study was to identify the effect of menstrual flow monitoring education on menstrual health awareness using lectures, demonstrations, and exercises. The researcher used menstrual flow charts and menstrual calendars as learning media. This study used a quasi-experimental design with only one group pretest and posttest. The sample was made up of 117 female college students from the Economic Education Study Program at University X; the individuals were selected by a purposive sampling technique. The data were analyzed using a paired t-test. There was a significant difference in menstrual health awareness score between pretest and posttest (p= 0.017). The researchers recommend that future study should include the performance of a randomized control trial on a larger population. Keywords: menstrual health awareness, menstrual flow monitoring, education Abstrak Pengaruh Edukasi Monitoring Terhadap Kesadaran Kesehatan Menstruasi pada Mahasiswa di Banten. Penelitian sebelumnya menunjukkan bahwa mahasiswi memiliki kesadaran rendah akan kesehatan menstruasi. Kondisi ini harus diselesaikan untuk mencegah dampak negatif pada kesehatan reproduksi mereka. Tujuan dari penelitian ini adalah untuk mengidentifikasi pengaruh pengaruh edukasi menstrual flow monitoring terhadap kesadaran kesehatan menstruasi menggunakan ceramah, demonstrasi, dan latihan. Peneliti menggunakan menstrual flow chart dan kalender menstruasi sebagai media pembelajaran. Desain penelitian ini adalah kuasi eksperimen dengan satu kelompok pretest dan posttest. Sampel penelitian meliputi 117 mahasiswi Program Studi Pendidikan Ekonomi, Universitas X yang diseleksi menggunakan teknik purposive sampling. Data dianalisis menggunakan Paired t-test. Terdapat perbedaan yang signifikan skor kesadaran kesehatan menstruasi antara pretest dan posttest (p = 0.017). Peneliti merekomendasikan desain randomized control trial pada populasi yang lebih besar untuk penelitian selanjutnya. Kata kunci: kesadaran kesehatan menstruasi, menstrual flow monitoring, edukasi
Pemberian Posisi (Positioning) dan Nesting pada Bayi Prematur: Evaluasi Implementasi Perawatan di Neonatal Intensive Care Unit (NICU) Defi Efendi; Dian Sari; Yanti Riyantini; Novardian Novardian; Dian Anggur; Pipit Lestari
Jurnal Keperawatan Indonesia Vol 22, No 3 (2019): November
Publisher : Faculty of Nursing Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.7454/jki.v22i3.619

Abstract

Pemberian posisi yang salah dapat meningkatkan risiko morbiditas dan mortalitas. Artikel ini bertujuan untuk menggali pemberian posisi (positioning) dan nesting pada bayi prematur di NICU. Penelitian ini berupa studi literatur tahun 2007-2017, serta pengalaman penulis dalam aplikasi pemberian posisi dan nest di dua rumah sakit rujukan nasional dalam lima tahun terakhir. Hasil studi ini menunjukkan beberapa posisi yang dapat diberikan pada bayi prematur di antaranya adalah posisi supinasi, lateral kiri, lateral kanan, pronasi, dan quarter/semi pronasi. Posisi pronasi dan kuarter/semi pronasi direkomendasikan untuk bayi prematur dengan Respiratory Distress Syndrome (RDS). Posisi lateral kanan direkomendasikan untuk bayi prematur dengan Gastroesofageal reflux (GER). Posisi supinasi merupakan alternatif terakhir pemberian posisi pada bayi prematur dengan kontraindikasi posisi pronasi, kuarter/semi pronasi, dan lateral. Pembuatan nest dapat dimodifikasi dari potongan beberapa kain yang digulung. Perawat hendaknya meningkatkan pengetahuan dan keterampilan agar mampu memberikan variasi posisi sesuai kondisi dan indikasi bayi yang dirawat di NICU. Kata Kunci: Bayi prematur, pemberian posisi, nest, perawatan intensif  Abstract Positioning and Nesting for the Preterm Infant: Evaluation for Nursing Care in Neonatal Intensive Care Unit  (NICU). Incorrect positioning may increase the risk of morbidity and mortality. This article aims to explore positioning and nesting in a preterm infant in NICU. This study is a literature study in 2007-2017, as well as documentation of the application of positioning and nest at two national top referral hospitals in the last five years. The alternative position for preterm infants include supine, left lateral, right lateral, pronation, and quarter/semi-prone positions. The pronation and quarter/semi-prone are recommended for preterm infants with Respiratory Distress Syndrome (RDS). Right lateral positions are recommended for preterm infants with Gastroesophageal reflux (GER). The supination is the last alternative when the other positions are contraindicated. The nurses can modify nest from pieces of some rolled fabric. Nurses should increase their knowledge and skills in order to be able to provide proper position according to the conditions and indications of the infant cared in NICU. Keywords: intensive care, nest, positioning, preterm infant
Peningkatan Melek Kesehatan Perawat Melalui Pengarahan Kepala Ruang Menggunakan Program Internalisasi Hasil Evaluasi Belajar Perawat Munezarah Munezarah; Hanny Handiyani; Tuti Nuraini
Jurnal Keperawatan Indonesia Vol 22, No 3 (2019): November
Publisher : Faculty of Nursing Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.7454/jki.v22i3.575

Abstract

Melek kesehatan (health literacy) sangat penting bagi keselamatan perawat. Rendahnya melek kesehatan perawat merupakan salah satu faktor yang berperan pada insiden cedera jarum suntik pada perawat di rumah sakit. Upaya mengoptimalkan melek kesehatan perawat dapat dilakukan melalui pengarahan yang inovatif, yaitu melalui program internalisasi hasil evaluasi belajar perawat (Pin Hebat). Penelitian ini bertujuan menguji pengaruh Pin Hebat terhadap melek kesehatan perawat, melalui metode penelitian pre-eksperiment dengan perbandingan kelompok statis (static group comparison). Teknik pengambilan sampel menggunakan consecutive sampling, dengan sampel 88 perawat perawat pelaksana. Perawat pelaksana pada kelompok intervensi dinilai melek kesehatannya sesudah dilaksanakan pengarahan oleh kepala ruangan menggunakan Pin Hebat. Pada waktu yang sama kelompok kontrol langsung di nilai melek kesehatannya tanpa diberikan intervensi. Hasil penelitian dianalisa menggunakan Independen t tes menunjukkan bahwa ada perbedaan yang bermakna pada melek kesehatan perawat pelaksana (p= 0,001) setelah diterapkan pengarahan menggunakan Pin Hebat. Pengarahan kepala ruang menggunakan Pin Hebat memberi dampak pada melek kesehatan sebesar 27%. Adanya penetapan kebijakan pelaksanaan pengarahan menggunakan Pin Hebat oleh kepala ruang di rumah sakit sangat dibutuhkan agar dapat dilaksanakan secara berkelanjutan. Kata kunci: melek kesehatan, pengarahan, pin hebat Abstract Increasing Nurses’ Health Literacy Using Direction with Internalization of Nurses Study Evaluation Result “Program Internalisasi Hasil Belajar Perawat (PIN Hebat)”. Health literacy is very important for nurses’ safety. The low of nurses’ health literacy is one of the factors in increasing injury reports of needlestick injury in hospitals. The efforts to optimize nurse’s health literacy can be done through an innovative direction that is internalization of nurses study evaluation result “program internalisasi hasil evaluasi belajar perawat (Pin Hebat)”. The aim of this research was examining impact of Pin Hebat toward nurse health literacy. Research method was pre-experiment with pretest and posttest control group approach. The sampling technic was consecutive sampling, with 88 practitioner nurses as a sample. Nurse practitioner would be examined about their health literacy after giving health literacy direction by head Nurse using Pin Hebat. For knowing the result of this research was analyzed by independent t-test, and the result was found that there was a difference between after head nurse direction using Pin Hebat (p=0,001). Head nurse direction give impact up to 27%. Need the permanent regulation for this head ward direction using Pin Hebat to be done sustainably in the hospital.   Keywords: direction, health literacy, pin hebat
Medication Beliefs in Patients Following Percutaneous Coronary Intervention: A Cross-sectional Study Prima Agustia Nova; Ching-Huey Chen
Jurnal Keperawatan Indonesia Vol 22, No 3 (2019): November
Publisher : Faculty of Nursing Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.7454/jki.v22i3.1092

Abstract

Patients post percutaneous coronary intervention need to take medication for their health. Beliefs about medication influence patients’ adherence in taking their medication regimens. Therefore, the study aimed to identify medication beliefs in patients following percutaneous coronary intervention in Indonesia. This research used a cross-sectional study with the convenience sampling method. A total of 132 adult patients following Percutaneous Coronary Intervention participated in this study. This study used The Beliefs about Medicines Questionnaire to identify patients’ beliefs about medication. The majority of respondents were male (85.6%) with a mean age of 60 years. Beliefs about general overuse were found to be the highest among other categories; specific-necessity, specific concern, and general harm. Elucidating patients’ beliefs about the medication will provide health care providers with a better understanding of patient medication behaviors after percutaneous coronary intervention. Recognition of patients’ beliefs may aid in targeting specific intervention programs to improve patients’ adherence to medication following Percutaneous Coronary Intervention procedure. Keywords: medication beliefs, percutaneous coronary intervention (PCI) Abstrak  Keyakinan Pengobatan pada Pasien yang Menjalani Intervensi Coronary Percutaneous: A Cross-Sectional Study. Pasien pasca intervensi koroner perkutan atau percutaneous coronary intervention (PCI) perlu minum obat untuk kesehatannya. Keyakinan terhadap pengobatan berpengaruh pada kepatuhan pasien dalam menjalani rejimen pengobatan. Penelitian ini bertujuan untuk mengidentifikasi keyakinan pengobatan pada pasien yang mengikuti PCI di Indonesia. Penelitian ini menggunakan studi cross-sectional dengan metode convenience sampling. Sebanyak 132 pasien dewasa yang menjalani prosedur PCI berpartisipasi dalam penelitian ini. Penelitian ini menggunakan The Beliefs about Medicines Questionnaire untuk mengidentifikasi keyakinan pasien tentang pengobatan. Mayoritas responden adalah laki-laki (85,6%) dengan usia rata-rata 60 tahun. Keyakinan tentang penggunaan berlebihan secara umum ditemukan sebagai yang tertinggi di antara kategori lainnya yaitu kebutuhan-spesifik, perhatian khusus, dan bahaya umum. Informasi mengenai keyakinan pasien tentang pengobatan akan memberikan pemahaman yang lebih baik bagi penyedia layanan kesehatan tentang perilaku pengobatan pasien setelah prosedur PCI. Pengakuan keyakinan pasien dapat membantu dalam menargetkan program intervensi khusus untuk meningkatkan kepatuhan pasien terhadap pengobatan setelah prosedur PCI. Kata Kunci: keyakinan pengobatan, percutaneous coronary intervention (PCI)
Pengaruh Aplikasi Model “Simbol Andi” Terhadap Pengetahuan, Sikap dan Keterampilan Anak Usia Sekolah dengan Risiko Cedera di Kota Depok Ressa Andriyani Utami; Agus Setiawan; Poppy Fitriyani
Jurnal Keperawatan Indonesia Vol 22, No 3 (2019): November
Publisher : Faculty of Nursing Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.7454/jki.v22i3.592

Abstract

Cedera menyebabkan 5,8 juta kematian di dunia dan 16% kasus cedera menyebabkan kecacatan. Faktor perilaku anak usia sekolah yang meliputi pengetahuan, sikap dan keterampilan terkait pencegahan cedera berpengaruh terhadap kejadian cedera. Strategi pencegahan cedera yang dilakukan adalah dengan Model Sandi (Simbol Andi) menggunakan video animasi dengan tokoh bernama Andi. Penelitian ini bertujuan untuk menganalisis penerapan Model Sandi dalam pencegahan cedera pada tatanan komunitas, khususnya di lingkungan sekolah. Desain penelitian ini adalah quasi experiment pre-post test without control group. Jumlah sampel penelitian sebanyak 136 anak usia sekolah berusia 11-12 tahun yang dipilih melalui teknik cluster sampling. Pengetahuan mengenai pencegahan dan penanganan cedera meningkat sebesar 2,18 poin dengan SD=1,60, sikap mengenai pencegahan dan penanganan cedera meningkat sebesar 1,97 poin dengan nilai SD=0,99 dan keterampilan mengenai pencegahan dan penanganan cedera meningkat sebesar 2,06 poin dengan nilai SD=2,19. Hasil analisis menujukkan adanya perubahan yang bermakna pada pengetahuan, sikap dan keterampilan sebelum dan sesudah diberikan intervensi (p <0,05). Intervensi Model Sandi diharapkan dapat dijadikan salah satu pendekatan intervensi keperawatan dalam menyelesaikan permasalahan risiko cedera pada anak usia sekolah. Kata kunci: anak usia sekolah, intervensi keperawatan, model simbol, risiko cedera Abstract The influence of "Simbol Andi" Model Application of Knowledge, Attitude, and Skills of School Ages with Injury Risk in Depok City. Injuries caused 5.8 million deaths worldwide and 16% of injury cases caused disability. Behavioral of school age children that include knowledge, attitudes and skills affect the incidence of injury in school-aged children. “Sandi” Symbolic Modelling is an injury prevention using video animation for injury prevention. This study aimed to an analysis of the application of Model Sandi (Simbol Andi) in the prevention of injury to the community. The design of this study was a quasi-experiment pre nd posttest without control group. A total sample 136 school-aged children at 11 and 12 years old involved in this study. Sampling method used cluster sampling technique. Results knowledge on prevention and treatment of injury increased by 2.18 points, attitude on prevention and treatment of injury increased by 1.97 points and skill on prevention and treatment of injury increased by 2.06 points. The results showed significant changes in knowledge, attitude and skills before and after intervention (p<0.05). Model Sandi Intervention is expected to be one of the approaches of nursing intervention in solving the problem of risk of injury in school-aged children at school. Keywords: Symbolic modeling, nursing intervention, risk of injury, school-aged children
The Impact of Vegetarian Diets and Body Mass Index on Hypertension Tri Mariha; Wiwin Wiarsih
Jurnal Keperawatan Indonesia Vol 22, No 3 (2019): November
Publisher : Faculty of Nursing Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.7454/jki.v22i3.726

Abstract

A vegetarian diet is believed to prevent hypertension. This study aims to identify the impact of vegetarian diets, including fat, salt, potassium, and body mass index (BMI), on hypertension. Data was taken by systematic random sampling method from 173 vegetarians and analyzed using chi-square. The result showed that there is no significant association between the intake of fat, sodium, and potassium with hypertension in vegetarians (p> 0.05). However, there is a significant relationship between BMI with the incidence of hypertension (p= 0.025), where overweight res-pondents are 3.837 more likely to have hypertension (OR 3.837; 95% CI= 1,256–11,721). It implies that vegetarians tend to have a safe intake of fat, salt, and potassium, and therefore, this condition prevents hypertension. Thus, health promotion about the selection of sources of fat, regulation of salt, potassium intake, and weight management will be beneficial for vegetarians in preventing hypertension. Keywords: BMI, diet, hypertension, vegetarian Abstrak Dampak Diet Vegetarian dan Indeks Massa Tubuh terhadap Hipertensi. Diet vegetarian diyakini dapat mencegah hipertensi. Penelitian ini bertujuan untuk mengetahui dampak diet vegetarian, meliputi asupan lemak, garam, kalium, dan Indeks Massa Tubuh (IMT) terhadap hipertensi. Data diperoleh melalui metode systematic random sampling pada 173 vegetarian dan dianalisis menggunakan chi-square. Tidak ada hubungan yang signifikan antara asupan lemak, garam, dan kalium pada vegetarian dengan hipertensi (p> 0.05). Namun, terdapat hubungan yang signifikan antara IMT dengan kejadian hipertensi (p= 0.025), dimana responden dengan berat badan berlebih 3.837 kali berpeluang lebih besar untuk mengalami hipertensi (OR 3.37; 95% CI= 1.256–11.721). Hal ini menunjukkan bahwa vegetarian cenderung memiliki asupan lemak, garam, dan kalium yang aman sehingga kondisi ini dapat mencegah hipertensi. Dengan demikian, promosi kesehatan mengenai pemilihan sumber lemak, pengaturan asupan garam:kalium, dan manajemen berat badan akan sangat bermanfaat bagi vegetarian untuk mencegah hipertensi.  Kata kunci: diet, hipertensi, IMT, vegetarian
Studi Fenomenologi: Mekanisme Koping Perempuan yang Belum Mempunyai Keturunan Ditinjau dari Aspek Budaya Minangkabau Rahmaniza Rahmaniza; Ni Made Riasmini; Netrida Netrida
Jurnal Keperawatan Indonesia Vol 22, No 3 (2019): November
Publisher : Faculty of Nursing Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.7454/jki.v22i3.845

Abstract

Phenomenology Study: Coping Mechanism of Women No Heredity Viewed by Minangkabau Culture. The Minangkabau tribe adheres to the matrilineal kinship system. Based on this system, when a woman suffers infertility, so it means the family has not the next generation, and the line of descent will cut off. This condition makes the women need to have a coping mechanism to avoid psychology problems, including depression, anxiety, stress, neglected, discrimination, under pressure to divorce, and perceive abused. The study aimed to explore the coping mechanism of infertility women in the context of Minangkabau culture. This phenomenology study applied an in-depth interview, which involved ten women who were selected through a snowball sampling technique. Collaizi’s analysis method resulted in six themes. Those themes are through psychological and social change, obtain a response from others, the views of Minangkabau culture, adaptive coping used by women no heredity, the families were main source support, community social support. The findings strengthen the justification to involve psycho-social aspects in the infertility treatment.Keywords: Coping mechanism, infertile women, Minangkabau culture Abstrak Suku Minangkabau menganut sistem kekerabatan matrilineal. Berdasarkan sistem ini, ketika seorang wanita menderita kemandulan, itu berarti keluarga tidak memiliki generasi berikutnya, dan garis keturunan akan terputus. Kondisi ini membuat perempuan perlu memiliki mekanisme koping untuk menghindari masalah psikologi, termasuk depresi, kecemasan, stres, diabaikan, diskriminasi, di bawah tekanan untuk bercerai, dan juga merasa dilecehkan. Penelitian ini bertujuan untuk mengeksplorasi mekanisme koping wanita infertilitas dalam konteks budaya Minangkabau. Studi fenomenologi ini menerapkan wawancara mendalam yang melibatkan sepuluh wanita yang dipilih melalui teknik pengambilan sampel bola salju. Melalui metode analisis dari Collaizi, menghasilkan enam tema. Tema-tema tersebut termasuk Mengalami perubahan psikologis dan perubahan sosial, mendapat  respon dari orang sekitarnya, pandangan budaya Minangkabau, koping adaptif yang digunakan oleh perempuan belum mempunyai keturunan, keluarga menjadi sumber dukungan utama, dukungan sosial dari masyarakat. Temuan ini memperkuat pembenaran untuk melibatkan aspek psiko-sosial dalam pengobatan infertilitas. Kata kunci: Budaya Mingkabau, mekanisme koping, perempuan infertile

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