Background: End-stage renal disease (ESRD) patients undergoing hemodialysis require essential self-management to lifestyle changes to minimize the risk of complications, morbidity, and mortality. Efforts made to improve self-management of hemodialysis patients in previous studies were carried out by health workers that may not provide 'real' knowledge, while peer support programs carried out by patients as peers to share their experiences may provide more benefits.Purpose: The purpose of this study was to determine the effects of peer support programs on improving self-management in patients with ESRD undergoing hemodialysis.Methods: This study employed a quasi-experimental design and involved a total of 33 patients in the control group and 32 patients in the intervention group, who met the inclusion and exclusion criteria. The samples were recruited consecutively. The intervention of peer support programs was implemented through information support, emotional support, and mutual reciprocity in groups of 10-12 people to share experiences related to their self-management. The intervention was given for six sessions; each lasted for 30-45 minutes. The data were collected using the Indonesian version of the hemodialysis self-management instrument (HDSMI) and analyzed using a paired-sample t-test and independent-sample t-test.Results: The results showed that after the intervention, the mean score of self-management in the intervention group increased from 79.47±7.919 to 90.75±7.089, and in the control group, the mean increased from 81.88±8.291 to 82.12±7.692. After the implementation of peer support programs, there was a significant difference in the score of self-management between the intervention and control groups (p<0.001).Conclusion: Peer support programs gave an effect on increasing self-management in patients with ESRD undergoing hemodialysis. Peer support programs should be introduced early to ESRD patients undergoing hemodialysis so that they can learn about self-management from other patients.

Background: Insomnia is a sleep disturbance which commonly occurs in haemodialysis patients. Some factors contribute to insomnia in dialysis patients such as demographic, biological, psychological, lifestyle, and dialysis factors. However, there are limited studies which investigate the relating factors of insomnia in haemodialysis patients in Indonesia. Purpose:This study aimed to analyze the relating factors of insomnia in haemodialysis patients in Semarang, Central Java, Indonesia. Methods: This study was a cross-sectional study which involved 102 samples recruited by consecutive sampling technique from two dialysis units in Semarang, Central Java. Data were collected by questionnaires and analyzed using Chi-square and multiple logistic regression to know the most relating factors of insomnia. Results: The result showed that insomnia occurred in 63 respondents (61.8%). Further analysis indicated that insomnia was related to anxiety (p=0.034, OR=2.36) and age (p=0.049; OR=1.75). There was no relationship between insomnia and the other factors such as gender, education level, occupation status, marital status, haemoglobin level, smoking and coffee consumption habit, and dialysis factor (period of dialysis). Moreover, anxiety was the most relating factors of insomnia among haemodyalsis patients. Conclusion: This study concluded that anxiety and age were independent factors related to insomnia. This study recommends that anxiety screening should be performed on haemodialysis patients. Anxiety in haemodialysis patients needs to be treated properly so that it will not develop into insomnia.

Diabetic Foot Ulcer (DFU) is one of the complications often experienced by patients with diabetes mellitus (DM). This is a serious problem that leads to disability, morbidity, and mortality among diabetic patients. However, in Indonesia, studies about DFU characteristics are very limited. This study aimed to describe DFU characteristics among patients with DM. A consecutive sampling involved patients who met inclusion criteria was performed in Tugurejo Hospital; Islamic Sultan Agung Hospital, and Dr. Moewardi Hospital. Their demographic characteristics, clinical condition, and wound appearances were noted and documented. Diabetic Foot Ulcer Assessment Scale (DFUAS) that consists of 11 characteristics was used to observe the wound features. The data were quantitatively analyzed to elucidate the result. A total of 73 patients participated in this study. It was revealed that 50.7% were females and 75.3% have been diagnosed with hyperglycemia. The average age of the respondents was 53.26 years. Observation of DFU characteristics showed that depth of wound was identified more in subcutaneous/ dermis to fatty tissue (40 patients; 54.8%) than in other layers. Moreover, our findings indicated that most of the respondents were identified at a severe level of the wound (55; 75.3%). It is concluded that DFU characteristics vary among patients with DM. Early identification and intensive surveillance are important to improve the management of DFU and to avoid lower limb amputation.

AbstrakTerapi hemodialisis tidak hanya memberikan masalah pada pasien, namun juga memberikan dampak pada kehidupan keluarga pasien. Tekanan yang dihadapi oleh keluarga menyebabkan stres yang cukup berat, sehingga resiliensi keluarga menjadi sangat dibutuhkan. Penelitian ini bertujuan untuk melihat gambaran resiliensi keluarga yang meliputi system keyakinan, pola organisasi keluarga dan komunikasi antar unit keluarga dalam merawat pasien hemodialisis di Kota Semarang. Penelitian ini menggunakan metode kualitatif fenomenologi dengan metode indepht interview. Informan dalam penelitian ini adalah keluarga pasien hemodialisis yang didapatkan dengan purposive sampling. Data yang dikumpulkan berupa hasil rekaman wawancara dan catatan lapangan yang dianalisis dengan metode analisa Colaizzi. Penelitian ini menghasilkan bahwa resiliensi keluarga bergantung pada sumber-sumber daya yang ada untuk digunakan dalam menyelesaikan permasalahan pasien penyakit ginjal kronik. Keluarga dianggap resilien jika mampu beradaptasi dan mencapai keseimbangan dalam keluarga, sehingga untuk mewujudkan resiliensi keluarga dibutuhkan peran aktif setiap anggota keluarga dalam memberikan perawatan pada pasien. Dukungan perawat juga diperlukan, diharapkan perawat melakukan skrining awal dan memberikan konseling pada keluarga pasien. Kata Kunci: resiliensi, keluarga, hemodialisis AbstractDescription of family resilience which includes belief systems, family organizational patterns and communication between family units in treating hemodialysis patients. Hemodialysis therapy not only gives problems to patients, but also has an impact on the patient's family life. The pressure faced by the family causes considerable stress, so the resilience of the family becomes urgently needed. This study aims to look at description of family resilience which includes belief systems, family organizational patterns and communication between family units in treating hemodialysis patients in Semarang City. This study uses qualitative phenomenological method with indepth interview method. The informants in this study were families of hemodialysis patients who were obtained by purposive sampling. Data collected in the form of interview records and field notes were analyzed by Colaizzi analysis method. This study resulted in family resilience depending on available resources to be used in solving the problems of patients with chronic kidney disease. The family is considered resilient if it is able to adapt and achieve balance in the family, so to realize family resilience it takes an active role for each family member in providing care to patients. Nurse support is also needed, it is hoped that nurses conduct initial screening and provide counseling to the patient's family. Keywords: resilience, family, hemodialysis

Diabetic ulcers is one of diabetic complications often experienced by patients with diabetes mellitus (DM). This problem lead to serious condition which usually have an effect on patients' quality of life. Application and research about wound care management in diabetic ulcer, specifically in ozone and olive oil, have been done already. However, exploration of how does the therapeutic effect of ozonized olive oils still limited. The purpose of this literature review is to determine the effectiveness of ozonized olive oil as topical treatment in diabetic ulcer. Source of databases in this literature review are Science direct, PubMed, and Google scholar. Articles were limited for 10 years from January 2009 to May 2019 which can be accessed full text in English. Type of literature included were review articles and research articles which the research area is in human. A qualitative analysis was performed to interpret the data. There were 5847 articles based on the keywords. Four studies met the inclusion criteria then were analyzed. Results of this review stated that it has been recently proved that ozonized olive oils are effective to care diabetic ulcer. It is useful as antiseptic, anti-fungal, topical antibiotics, anti-infections, and continued to be healing stimulator. This review provides clinical evidence which supports and recommends the benefits of ozonized olive oil in diabetic ulcer healing.