AV fistula allows external vascular access for hemodialysis patients. Because hemodialysis patients experience puncture wounds and stabbing pain approximately 300 times a year, development of methods to decrease pain intensity are of great importance. Some techniques, such as the Valsalva maneuver, are known to reduce pain. This study aims to assess the effect of the Valsalva maneuver on decreasing the intensity of AV fistula pain in patients receiving hemodialysis. The quasi-experimental research of pre and post without control applying consecutive sampling to get as many as 63 respondents. Pain intensity was measured by using the Numerical Pain Rating Scale (NPRS). The Valsalva maneuver was performed during insertion of the AV fistula needle for 16-20 seconds. The results showed significant differences in pain intensity between before and after the intervention with the difference in mean that is 1.35 (SD= 0.54), t= 19.70, p= 0.001. The Valsalva maneuver is effective in reducing the pain of AV fistula insertion because it stimulates the vagus nerve to induce an antinociceptive effect. Nurses are highly recommended to teach the Valsalva maneuver to patients undergoing routine hemodialysis.

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AV fistula allows external vascular access for hemodialysis patients. Because hemodialysis patients experience puncture wounds and stabbing pain approximately 300 times a year, development of methods to decrease pain intensity are of great importance. Some techniques, such as the Valsalva maneuver, are known to reduce pain. This study aims to assess the effect of the Valsalva maneuver on decreasing the intensity of AV fistula pain in patients receiving hemodialysis. The quasi-experimental research of pre and post without control applying consecutive sampling to get as many as 63 respondents. Pain intensity was measured by using the Numerical Pain Rating Scale (NPRS). The Valsalva maneuver was performed during insertion of the AV fistula needle for 16-20 seconds. The results showed significant differences in pain intensity between before and after the intervention with the difference in mean that is 1.35 (SD= 0.54), t= 19.70, p= 0.001. The Valsalva maneuver is effective in reducing the pain of AV fistula insertion because it stimulates the vagus nerve to induce an antinociceptive effect. Nurses are highly recommended to teach the Valsalva maneuver to patients undergoing routine hemodialysis.

Stroke sufferers continue to increase every year and become polemic in various countries. Stroke is the second most common cause of death after heart disease. Stroke sufferers cause disruption of physical mobility, so they need help to carry out daily activities, one of which is the implementation of oral care, which is still minimal. The study aimed to describe the perception of family caregivers in implementing oral care among stroke patients in Medan city areas. A qualitative with phenomenology approach was applied in this study. The study was conducted in the Health Centre of Medan Deli, in April-August 2018. Twelve participants were recruited using purposive sampling. Data collection used focus group discussion (FGD). We analyzed the data by using the thematic analysis. The results of the study found that four themes, namely: 1) Caregiver knowledge in the implementation of oral care for stroke patients at home is not good, 2) The process of implementing oral care by caregiver for stroke patients at home is less optimal, 3) Family obstacles in carrying out oral care for stroke patients at home, 4) Expectations and suggestions in the implementation of oral care for stroke patients at home. Expected of research to developing or making a guide to the implementation of oral care as health education for families as caregivers in treating stroke patients at home, so that problems of oral care for stroke patients can be minimized.  Keywords: oral care, families caregivers, and stroke patients.

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