The Infl uence Of Stimulus And Coping Mechanism To Hiv / Aids Patient Adaptation Based On Callista Roy Theory In Regional Public Hospital Kota Probolinggo

HIV/AIDS patients experienced various problems thatreviewed of adaptation models such as physical, psychological, social and dependency problems. The adaptation process can be infl uenced by stimulus andcoopmechanism, one of stimulus which appearto HIV/AIDS client is negative stigma from the community, the surrounding environment and family rejection. The research objective is to analyze the effect of stimulus andcoping mechanism toHIV / AIDS patient adaptationbased on Callista Roy theory inregional public hospital Kota Probolinggo. The design of this study is correlation with the cross-sectional approach l. The populations are 68 respondents; the sample size of 58 respondents was taken by purposive sampling technique. This research instrument used a questionnaire;Data was analyzed using path analysis. The results showed that 1) Focal stimulus infl uences 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


AIDS (Acquired Immune Deficiency
Syndrome) is a group of symptoms of immune system damage.AIDS is not a congenital disease but obtained from the results of transmission.This disease is caused by HIV (Human Immunodefi ciency Virus).HIV/IDS is an international problem because in a relatively short time there has been increasing of patients and has affected many countries.Until now there has not been found a vaccine or drug that is relatively effective for AIDS, causing anxiety in the world.(1) HIV/AIDS patienthave problems related to stimulate and coping mechanisms that can affect the adaptation process.One stimulus that appears on HIV/AIDS patientis a negative stigma from society, surrounding environment and family rejection.Stigma against ODHA (People withHIV/ AIDS) appears related to someone not knowing about the of HIV / AIDS transmission mechanism.
Misunderstanding or lack of public knowledge about HIV/AIDS often has an impact on people's fear of ODHA, so there is a rejection of ODHA.
their life and even isolating themselves from the environment.With the psychological disorders HIV/AIDS patientcan lead to a decline in immune system and changes negativecoopmechanisms.

MATERIALS AND METHODS
This research design used a correlation research design with a cross-sectional approach.
This study was chosen to measure the dependent and independent variables once, not measured   According to Nursalam research (2014) said the regulator coping used by HIV / AIDS patients is through the HPA-Axis pathway (hypothalamus, pituitary and adrenal).Body effects produced when the body's response is good, the physiological state of the body will be good.The physiological integrity produced is the client will experience a good physiological state and adapt to the illness well.Therefore, clients with a regulatory subsystem both on HIV / AIDS clients will improve physiological integrity and adapt well (7).
Regulator subsystem analysis has a significant contribution to interdependent adaptation.The resulting effect is a positive effect, so that when the regulator subsystem is good it will increase the effect of the interdependent, so that the better the coping, the better the   In addition, family assistance is also needed in improving the HIV / AIDS client adaptation process (7).

CONCLUSION AND RECOMENDATION
Stimulus that affected the coping mechanism of HIV / AIDS clients, among others: at the same time, and explain the results of the effects of a research variable.The population in this study is in accordance with the number of respondents who received ARV therapyin genaral hospital Kota as many as 68 respondents.The samples in this study were 58 respondents according to the inclusion criteria set by the researcher, namely: 1) Clients who are willing to become respondents and sign informed consent; 2) Clients who have been diagnosed for ≤ 1 year; 3) old clients aged (21-45 years).The research data was obtained by using a data collection tool in the form of a questionnaire based on existing theories.Questionnaires consist of stimulus (focal, contextual and residual), coping mechanisms (regulator and cognator) and adaptation (physiological, selfconcept, role and interdependent functions), consisting of 59 statement items.Validity and reliability testing for the questionnaire was tested to 15 respondents.The stimulus instrument, coping mechanism and adaptation have been tested for validity with values r count>value r table (0,514)then declared valid, for reliability testing shows value cronbach's alpha above 0,70.Datataken in this study is by giving questionnaires to respondents accompanied by researchers and nurses who served in the hospital.Data analysis method in this study uses path analysis model.RESULTS AND DISCUSSIONBased on the results of research conducted on HIV/AIDS clients in Regional General Hospital Kota Probolinggoas follow:The picture above is an estimate of the path analysis model on HIV / AIDS clients which consists of stimulus variables, coping mechanisms and adaptation.The stimulus variable analyzed consists of sub variables of focal stimulus, contextual stimulus and residual stimulus.The coping mechanism variables analyzed consisted of the sub-variables of the regulator coping mechanism and cognatorcoping mechanism.The adaptation variables analyzed consist of sub-variables of physiological adaptation, selfconcept adaptation, adaptation of role functions and interdependent adaptation.Path analysis conducted in this model estimation includes stimulus variables (focal, contextual and residual) towards coping mechanisms (regulator and cognator), and coping mechanism (regulator and cognator) variables towards adaptation (physiological, selfconcept, role and interdependent functions).Based on picture 1 showed the estimation results of the path analysis model have met the criteriagoodness of fi tthat good.value Chi-square as big as 36,282 , Df as big as 20, probabilityy model or p value as big as 0,014 and GFI as big as 0,866.The stimulus path analysis of coping mechanisms that showed signifi cant contributions, among others, focal stimuli affect coping cognition (p = 0,000).Stimulus contextual infl uence on regulator coping (p = 0,047) and cognition coping(p = 0,000),.Stimulus residual infl uences coping cognition (p = 0,004 Based on observations in primary and secondary data obtained, these are still some HIV / AIDS clients who feel shunned by their family, friends and society because of their current illness, they feel excluded, and do not get support from family, friends or the community .Whereasclients who suffer from HIV / AIDS are in desperate need of moral and spiritual support from family, friends and the community, so that they can help clients towards adaptive coping mechanisms.In addition, clients also often experience stressors and even depression due to their illness, client lacks confi dence in the ability to overcome the problem.HIV/AIDS client who did treatment in RSUD Dr. Moh.Saleh feels comfortable with the treatments who arecurrently taking, because treatment can extend life cycle.Health workers play an important role in helping to improve adaptive coping mechanisms, one of which is to provide assistance to newly diagnosed clients, with assistance to HIV / AIDS clients can reduce the stressors experienced by clients, thereby reducing the negative stimulus caused by clients.In addition, health workers need to conduct counseling for clients and families, with counseling clients and families can increase knowledge about the disease process experienced.Analysis of the coping mechanism on adaptation pathways that showed significant infl uence, among others, coping regulators affect physiological adaptation (p = 0,006), role function adaptation (p = 0,040), interdependent adaptation (p = 0,004).CognatorCoping affect physiological adaptation (p = 0,006), self-concept adaptation (p = 0,000), role function adaptation (p = 0,000), interdependent adaptation (p = 0,008).
interdependent effect.Erawatiningsih (2009) n her study said that there was a significant infl uence between the duration of illness and treatment disobedience.The result showed a negative relationship, meaning that the longer the complaint suffered by the patient, the more disobedient to come for treatment.Clients who have a lot of complaints need family support to improve compliance with the treatment process for client recovery.Sianturi (2014) said that client who has good family support will improve recovery and prevent recurrence.Therefore, clients who have good coping need good family support to improve their adaptation (8).Cognition subsystem analysis of the physiological integrity of patients who infl uence HIV / AIDS who didtreatment in Dr. Moh.Saleh Hospital KotaProbolinggo.Physiological integrity can be influenced by subsystems controlled by most clients in this study is to have basic education.Pasek & Satyawan (2013) said that the higher the knowledge of the client, the client will be obedient in pursuing treatment.Obedient clients will facilitate clients towards recovery.This will reduce stress hormones which reduce cortisol and will increase T-helper to improve the immune system in the process of treating HIV / AIDS.Therefore, a signifi cant infl uence can be caused by the average education factor of senior high school, where education will help improve the physiological adaptation function of HIV / AIDS clients(7).Cognitive subsystem analysis of selfconcept integrity showed a signifi cant contribution to HIV / AIDS clients.According to Sutarno& Utama (2013), said that the fact that clients of male types were motivated to be treated relatively better than female patients.Coping from male clients is better than women, so motivation in getting healing or treatment is higher for male clients.The client considers that with the treatment the client can be active and carry out daily activities again.According to Tintin, Nursalam, Eka, Candra and Misutarno (2016) the results of the study said the psychological responses that often occur to HIV / AIDS clients include anger, feeling guilty, feeling tired of what happened.Social stigma and discrimination are rooted in psychological responses, ranging the cognator subsystem contributed signifi cantly to the integrity of the role function.The role function in HIV / AIDS clients is in client alignment with the social environment in living their daily lives in accordance with their roles.The role function as an actor in society, the role function is closely related to the role as income earner in the family.Eryatningsih (2009) in her study said that there was a signifi cant infl uence between family income on treatment disobedience in TB clients.Very low family income can determine patient disobedience for treatment.The role function in family life and the social environment must continue to improve the adaptation process accordingly (8).According to Nurhayati (2012) the results of the study said the environment is a stimulus in providing stimulus in individuals.The external environment will affect a person's social response.Social response is from condition internal and external which infl uenced and resulted in the development and behavior of a person and group.HIV / AIDS is often associated with problems that are considered immoral and sinful, this misunderstanding will lead to social stigma and discrimination in the form of excessive prejudice, negative attitudes, and direct mistreatment from both the family and the surrounding environment in all of life (10).According to Tintin, Nursalam, Eka, Candra and Misutarno's research (2016), peer support groups can increase social support for HIV / AIDS clients.In peer group support sessions, information sharing is carried out that will be large the knowledge of HIV / AIDS patient, thereby increasing the client's confidence.Emotional assistance and support will further increase the feeling of being open and accepted by the environment, this can reduce feelings of negativity in patients (11).The cognator subsystem does not provide an interdependent direct effect.In this study coping mechanism consists of direct efforts to overcome self-threats, controlling problems and adjusting to stress.The HIV / AIDS client cannot identify the threat of the problem, so the client cannot adapt interdependently.In addition the client also cannot control the problem and adjust to the stress experienced, so that the client is unable to adapt interdependently.According to Nursalam's research (2014) the level of adaptation of a person is infl uenced by individual development and the use of coping mechanisms.The maximum coping mechanism results in positive adaptation and is able to respond well to stimuli.HIV / AIDS client adaptation is infl uenced by various factors such as drug side effects, treatment experience, body response and coping mechanisms used by clients.It is necessary to provide counseling to families and clients who experience HIV / AIDS to increase knowledge in the HIV / AIDS client adaptation process.

Focal stimulus infl uenced
cognitive cognition.Contextual stimulusus effected on regulator coping and cognitive cognition.Residual stimulus affects cognitive cognition.Coping mechanisms that influence the adaptation of HIV / AIDS clients include: the coping mechanism of the regulator infl uences physiological adaptation, The Infl uence of Stimulus and Coping Mechanism to Hiv/Aids Patient Adaptation Based on Callista Roy Theory 139 role function adaptation, and interdependent adaptation.Cognitive coping mechanism affected 4 components of the adaptation process (physiological, self-concept, role function, and interdependent.HIV/AIDS client adaptation is infl uenced by various factors such as drug side effects, treatment experience, body response and coping mechanisms used by clients.It is necessary to provide counseling to families and clients who experience HIV / AIDS to increase knowledge in the HIV / AIDS client adaptation process.In addition, family assistance is also needed in improving the HIV / AIDS client adaptation process.

Result of Path Analysis Model Estimates
).
adaptive coping mechanism.Contextual stimulus is a stimulus that can support the occurrence of illness, while a residual stimulus is a person's Picture 1.