The Description of Diabetics ’ Acceptance Stage Toward Diabetes Mellitus ’ Diagnoses

Diabetes Mellitus (DM) is a chronic condition which requires various kinds of lifetime treatment which cause grief. Grief has stages which can be passed though normally with the attainment of acceptance stage. Acceptance attainment renders a description maintaining that grief in its process is undergone normally through uncomplicated grief reaction and emotional responsiveness. A diabetics who manages to attain the acceptance stage will have a better glycemic control, while a diabetics with a low acceptance stage may experience an ineffective coping, improper self-treatment, and distress increase, all of which end up in a bad glycemic control which causes physical complications. This suggests that a description of s’ acceptance stage is important to identify. Accordingly, the ISSN 2354-7642 (Print), ISSN 2503-1856 (Online) Jurnal Ners dan Kebidanan Indonesia Tersedia online pada: http://ejournal.almaata.ac.id/index.php/JNKI INDONESIAN JOURNAL OF NURSING AND MIDWIFERY


INTRODUCTION
According to the International of Diabetic Federation (IDF), the global prevalence of Diabetes Mellitus (DM) in 2014 is 8.3% with the amount of 387 million cases (1).World Health Organization (WHO) in 2016 stated that DM is one death case in Indonesia (2).The report Semarang City Health Offi ce in 2015, noted that the number of cases of diabetes in Semarang is ranked second highest (3,4).In 2013 to 2015 there was an increased the number of diabetes cases in the city, from 13 112 cases to 17,900 cases (3,4).
Diabetes Mellitus (DM) is a chronic condition that affects every aspect of life of the sufferer one of which is the psychological aspect (5,6).
The previous research mentioned that diabetics are psychologically disturbed will affect their physical condition (6,7).This can be caused due to diabetic patient requires a wide range of lifestyle changes during the life of sufferers (8,9).
The changes are intended on the regularity in controlling blood sugar levels, physical activity on aim of this research is to identify and analyze the description of diabetics' acceptance of DM diagnoses.The method utilized is descriptive-observational, the data collected using the Various changes to do a long-term stressor for patients with diabetes mellitus (10), and raises the bereaved (grief).Based on grief theory, grievied has stages (stages of grief) (11)(12)(13)(14)(15). Patients who are diagnosed with chronic conditions should be able to complete each stage of the grieving, so that eventually reaches the stage of acceptance.Marjorie explained that the success of adaptation to chronic disease diagnosis is when an individual can complete the grieving that happened (16).This is shown through individual ability in accepting their disease rationally.(16).Acceptance gives description that that the mourning in the process passed with the normal (adaptive) is uncomplicated grief reaction and emotional responsiveness (17).Diabetics require high acceptance yang to the condition to be able to perform self-care and glycemic control (18,19).Reception high against diseases experienced has a correlation with the adaptability (19).self-management is high (20), and a better quality of life in people with diabetes (21).Diabetes that can reach the acceptance stage, will have the better glycemic control than diabetics who rejected the conditions and depress (22).
Based on the previous explanation, the low acceptance has implications on ineffective coping, low self-esteem treatment, distress increased, and end to poor glycemic control (23).Uncontrolled blood glucose causes various physical complications such as retinopathy, chronic renal failure, heart disease, foot perfusion disorders and amputation (24).WHO states that there are many physical complications that can result from diabetes such as retinopathy, chronic kidney failure, heart disease, and the incidence of reperfusion foot amputations (25).These various complications can increase the cost of care (26), and lead to a decrease in quality of life even death (24).Based on these phenomena, this study aims to identify the stage of achievement admission to diagnosis of diabetes mellitus.

MATERIALS AND METHODS
The method used is descriptive observational (27).The sampling technique used is consecutive sampling (28).Data collection was by surveys or direct observation using Acceptance of Disease and Impairments Questionnaire (ADIQ) (29,30).ADIQ consists of four (4) items that interpret the stages of grief with a total of 14 questions.Denial consists of four items of questions, the resistance 3 item questions, Sorrow 3 item questions and the acceptanc four items of questions (29).Each item has a selection of scores answer questions 1, 2, 3 and 4. Answer 1"disagree", 2 "slightly agree", 3" strongly agree", and the r" entirely agree".Scoring in ADIQ not using "cut of point", because there is no right or false .Data Analysis used in this research using descriptive analysis (univariate) (31).Data collection was conducted for 5 days on 20 diabetics in Tugurejo Hospitals Semarang.In accordance with the theories and studies already mentioned, failure to achieve acceptance one of them is focused on the stage of denial that is often ignored.This is consistent with research that says that denial can last a long time, it was associated with the presence of symptoms and disorders are often overlooked, because the condition of aging or poor physical condition (29).

RESULTS AND DISCUSSION
The resistance stage shows as much as 10%.The dominant resistance stage of emotion is frustration and anger (29).At this stage of resistance patients are very aware that they are sick and distracted but refuse to adapt (29).
Anger is more emphasized in treatment-related demands (36), because it feels the value (health, safety and future plans) taken from life (37).The results of the survey from the patients shows the existence of anger when he realized his condition and frustrated over his illness.It accordance with previous research it is said that anger can addressed one of them to a situation or condition (33,38,39).Diabetics have anger and frustration to the condition of the illness that is diagnosed with chronic diseases that require lifelong care.

Figure 1 .
Figure 1.Acceptance of Disease and Impairments in diabetes people 'Acceptance of Disease and Impairments Questionnaire' (ADIQ).The analysis employed in this research is a descriptive analysis.The sampling technique used is consecutive sampling.The research result shows that, based on the diagram of ADIQ administered on 20 s, there are 30% found to be in the stage of acceptance, while there exist 70% to be in the stage of not yet attaining acceptance, which comprises denial (20%), resistance

TABLE 1 . Frequency Distribution Acceptance of Disease and Impairments in people with diabetes
physical, spiritual, social and intellectual person.The health loss response is a valuable part of an individual's life.In accordance with The Grief to Thus, people who have reached or who have not achieved acceptance will have the risk to experience maladaptive coping because of the nature of chronic DM so as to provide a cycle of susceptibility for the sufferer to return in a state of grief as early.CONCLUSIONBased on the research result that people with diabetes are diagnosed diabetes mellitus is more dominated on unreached acceptance stage.In addition, although people with diabetes who have achieved acceptance, will still have the risk to experience a maladaptive response that can trigger the occurrence of depression, anxiety, deteriorating physical health, stop selfcare, helplessness, low self-esteem, to social isolation and even suicidal desires.Caused by grieving fl uctuated in which each individual can contribute in any stages that describe his condition.Therefore, it is necessary to have an advanced research related to the correlation of the stages of grief experienced by diabetics with maladaptive effect responses such as depression or another, so it can be seen how far the acceptance stage affect diabetes.