Vol. 5, No. 11, November 2024
E-ISSN: 2723 - 6692
P-ISSN: 2723 - 6595
http://jiss.publikasiindonesia.id/
Journal of Indonesian Social Sciences, Vol. 5, No. 11, November 2024 2890
Description of Stress and Cognitive Function in Patients Non-
Hemorrhagic Stroke at Tugurejo Hospital in 2022
Fathinah Hanin, Siti Istiqomah Khamsiyati, Romadhoni
Universitas Muhammadiyah Semarang, Indonesia
Email: fatinahhanin31@gmail.com, ekinistiqomahbaru@gmail.com
Correspondence: fatinahhanin31@gmail.com
*
KEYWORDS
ABSTRACT
Patient Safety Incident;
underreporting; Patient
Safety Culture; Perception;
Nurses
Stroke is the main cause of death in Indonesia, the incidence has
increased from 7% to 10%, of which 74% have ischemic strokes.
Stress is common in stroke patients. According to research
conducted, 58.8% of stroke survivors experienced severe stress, and
60% of stroke survivors experienced decreased or decreased
cognitive function after stroke. The research objective was to
describe stress and cognitive function in order to reduce stress
levels and cognitive function in non-hemorrhagic patients at
Tugurejo Hospital in 2022. This type of research is a quantitative
descriptive analysis with a cross sectional design. The study
population consisted of post-stroke patients who were diagnosed in
2022 by doctors at Tugurejo General Hospital and met the inclusion
criteria, namely the Mini Mental State Exam Test Questionnaire
(MMSE) and Depression Anxiety Stress Scales (DASS-21) as research
instruments, then the data were analyzed using univariate analysis.
The total sample consisted of 40 respondents who were analyzed by
univariate. The results of the study describing stress levels in non-
hemorrhagic stroke patients at Tugurejo Hospital in 2022 showed
that 35% had normal stress levels and 65% had abnormal stress
levels. while the picture of cognitive function in non-hemorrhagic
stroke patients showed normal results in 32% and impaired
cognitive function in 67.5%. Description of stress and cognitive
function in non-hemorrhagic stroke patients at Tuguurejo General
Hospital in 2022. Based on risk factors, gender, age, education,
occupation, pre-existing conditions and stroke onset, the results
showed abnormal levels of stress and disruption of cognitive
function.
Attribution-ShareAlike 4.0 International (CC BY-SA 4.0)
Introduction
Stress is an adaptive response that is individualized, so the stress response will differ from one
person to another. Stress is a response to the fight or flight, which is the body's response to something.
Stress is an abnormal condition of hemostasis that causes changes in physiological and emotional
balance, this is due to external stimuli to the physical. Repeated and sudden emotional stress, both
positive and negative, can trigger stroke and even worsen the situation in stroke patients.(Nasib Tua
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Lumban Gaol, 2016)
,
(Putri & Herlina, 2021)
,
(Z.Goldfinger et al., 2014) Stress is common in stroke patients.
According to a study of stroke patients, 58.8% of stroke patients experienced severe stress (Marbun
et al., 2016).
Stroke is a neurological dysfunction caused by non-traumatic or traumatic cerebral circulation
abnormalities. This neurological disorder causes symptoms such as paralysis of the face or limbs,
aphasia, slurred speech, altered consciousness, blurred vision, and so on (Lindsay et al., 2019). Based
on the number of major causes of disability, death and emergencies in neurological diseases is
occupied by stroke. Reporting from WHO (world health organization), stroke is the third most deadly
disease in the world. Meanwhile, according to RISKESDAS in 2018, showing that stroke is the number
one cause of death in Indonesia, the incidence of stroke has increased from 7% to 10% (Kim et al.,
2020).
Research conducted by Tarwoto in 2021 states that 97.5% of strokes occur at the age of over
35 years (Tarwoto, 2021). Non-hemorrhagic stroke or ischemic stroke is more common than
hemorrhagic stroke. From research conducted by Hsie on stroke patients, 74% of them experienced
ischemic stroke (Dudung et al., 2015). Stroke can cause dysfunction in the neurobehavioral areas of the
brain, which can result in psychiatric symptoms such as post-stroke depression. Depression occurs
as a result of post-stroke complications, which are then associated with impaired healing, activity or
social support, and cognitive function (Boletimi et al., 2021).
Behavioral neurology explains what cognitive function means. It is the process by which
sensory stimuli such as auditory and tactile stimuli are transformed, processed, stored, and used to
seamlessly connect interneurons. This allows people to think about sensory stimuli. 60% of stroke
survivors are affected by cognitive dysfunction or cognitive function abnormalities post-stroke.
The results of research conducted in November-December 2015 at the Neurology Polyclinic of
Arifin Ahmad Riau Hospital proved that 38 out of 41 respondents experienced impaired cognitive
function (Alsharif & Qurashi, 2021).
"Say in truth: My prayer, my worship, my life and my death are for Allah, the Lord of the
Worlds". (Q.S. Al-An'am: 162).
By prioritizing Allah SWT, it is expected that the body's hormones and reactions can move
normally and calmly. This will certainly respond positively to mental health, physical, cognitive
function and stress for stroke patients. So it is hoped that humans will always be positive thinking
(prejudiced) towards everything Allah's decree (Vogrig et al., 2021).
Previous studies, such as those conducted at the Neurology Polyclinic of Arifin Ahmad Riau
Hospital, have indicated a high prevalence of cognitive impairment among stroke patients. However,
most of these studies have only focused on general stroke populations or have primarily examined
hemorrhagic stroke without a detailed exploration of the factors affecting non-hemorrhagic stroke
patients specifically.
This study makes a significant contribution to the field by specifically focusing on non-
hemorrhagic stroke patients at Tugurejo Hospital, assessing both stress levels and cognitive function
in this particular population. The novelty of this research lies in its emphasis on understanding the
combined impact of stress and cognitive impairment in a specific setting and population, providing a
more tailored insight into the challenges faced by these patients.
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Unlike previous studies, this research utilizes the Mini Mental State Exam (MMSE) and
Depression Anxiety Stress Scales (DASS-21) for a comprehensive assessment of both cognitive
function and stress in non-hemorrhagic stroke patients. Additionally, this study investigates factors
such as gender, age, education, occupation, pre-existing conditions, and stroke onset to determine
their relationship with stress and cognitive outcomes.
This unique approach allows for a more in-depth understanding of the factors contributing to
cognitive and emotional health in post-stroke patients, particularly those with non-hemorrhagic
conditions, thereby highlighting the need for targeted interventions to address both psychological
and cognitive rehabilitation in this specific group.
Based on the description above, it has not been explained how the description of stress and
cognitive function in non-hemorrhagic patients will be carried out at Tugurejo Hospital in 2021-2022.
Therefore, it is necessary to carry out more in-depth research on stress and cognitive function in non-
hemorrhagic patients needed in stroke patients. This study aims to provide an overview of follow-up
research to reduce stress levels and cognitive function in non-hemorrhagic stroke patients at
Tugurejo Hospital in 2022.
Research Methods
This study was conducted in August 2022/September 2022 at RSUD Tugurejo Semarang. This
study is one of descriptive analytic research using cross sectional design. The population that will be
used is post-stroke patients diagnosed in 2022 by doctors at Tugurejo Hospital. Then obtained a
sample size determined using the Lemeshow formula, and the data obtained from the population in
the study required a sample of 40 people.
The sampling criteria were non-hemorrhagic post-stroke patients who were being treated at
Tugurejo Hospital, age >35 years, compos mentis. Exclusion criteria for research samples that were
excluded from the research sample were post-ischemic stroke patients who were mentally disabled,
had aphasia, and had hearing loss, such as ear infections and ear surgery.
The method in determining the sample uses purposive sampling. The variables used were
stress, cognitive function and post-stroke patients. The data collection method uses medical record
data consisting of age, gender, and history of disease, and stroke onset.
In this study, data analysis was performed using descriptive data analysis, namely univariate
analysis to describe the distribution and percentage of data simply to find the variables studied.
Ethical clearance was obtained from the ethical certificate of the ethics committee responsible for
health research (KEPK) from RSUD Tugurejo Semarang with No. 080/ KEPK.EC/ IX/ 2022.
Results and Discussion
Stress level of non-hemorrhagic stroke patients at RSUD Tugurejo
Table 1. Distribution of stress levels of non-hemorrhagic stroke patients
at Tugurejo Hospital
Stress Level
Frequency
Percentage (%)
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Gender
Stress Level
Total
Normal
Lightweight
Medium
Weight
Very Heavy
n
%
n
%
n
%
n
%
n
%
n
%
8
20
3
7,5
3
7,5
4
10
2
5
20
50
6
15
3
7,5
6
15
3
7,5
2
5
20
50
14
35
6
15
9
22,5
7
17,5
4
10
40
100
Table 3. Distribution of stress levels of non-hemorrhagic stroke patients based on age
Gender
Stress Level
Total
Normal
Lightweight
Medium
Weight
Very Heavy
n
%
n
%
n
%
n
%
n
%
n
%
40-49
1
2,5
0
0
0
0
1
2,5
0
0
2
5
50-59
3
7,5
3
7,5
7
17,5
3
7,5
3
7,5
19
47,5
60-69
7
17,5
3
7,5
1
2,5
3
7,5
1
2,5
15
37,5
> 69
3
7,5
0
0
1
2,5
0
0
0
0
4
10
40-49
14
35
6
15
9
22,5
7
17,5
4
10
40
100
1
2,5
0
0
0
0
1
2,5
0
0
2
5
Table 4. Distribution of stress levels of non-hemorrhagic stroke patients
based on education level
Education Level
Stress Level
Total
Normal
Lightweight
Medium
Weight
Very
Heavy
n
%
n
%
n
%
n
%
n
%
n
%
Not in school
did not finish
elementary school
2
5
0
0
1
2,5
1
2,5
0
0
4
10
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Elementary School
4
10
1
2,5
4
10
1
2,5
2
5
12
30
Junior High School
3
7,5
1
2,5
0
0
1
2,5
0
0
5
12,5
High School
4
10
2
5
3
7,5
4
10
2
5
15
37,5
College
Graduate/Bachelor's
Degree
1
2,5
2
5
1
2,5
0
0
0
0
4
10
14
35
6
15
9
22,5
7
17,5
4
10
40
100
Table 5. Distribution of stress levels of non-hemorrhagic stroke patients
based on type of work
Jobs
Stress Level
Total
Normal
Lightweight
Medium
Weight
Very
Heavy
n
%
n
%
n
%
n
%
n
%
n
%
Table 6. Distribution of stress levels of non-hemorrhagic stroke patients based on past
medical history
Disease History
Stress Level
Total
Normal
Lightweight
Medium
Weight
Very
Heavy
n
%
n
%
n
%
n
%
n
%
n
%
Seizures
11
%
n
%
n
%
n
%
n
%
n
%
Hyper tension
0
0
0
0
1
2,5
0
0
0
0
1
2,5
Vertigo
5
12,5
2
5
4
10
2
5
1
2,5
14
35
DM
0
0
0
0
1
2,5
0
0
0
0
1
2,5
Koles terol
3
7,5
3
7,5
3
7,5
4
10
0
0
13
32,5
Trauma
5
12,5
1
2,5
0
0
0
0
3
7,5
9
22,5
Total
1
2,5
0
0
0
0
1
2,5
0
0
2
5
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Table 7. Distribution of stress levels of non-hemorrhagic stroke patients based on
stroke onset
Cognitive function in non-hemorrhagic stroke patients at RSUD Tugurejo
Table 8. Distribution of cognitive function in non-hemorrhagic stroke patients
at Tugurejo Hospital
Level of Cognitive Function
Frequency
Percentage (%)
Table 9. Distribution of cognitive function of non-hemorrhagic stroke
patients based on gender
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Gender
Cognitive Function
Total
Normal
Lightweight
Medium
Weight
n
%
n
%
n
%
n
%
n
%
Table 10. Distribution of cognitive function of non-hemorrhagic stroke patients based on age
Age
Cognitive Function
Total
Normal
Lightweight
Medium
Weight
n
%
n
%
n
%
n
%
n
%
Table 11. Distribution of cognitive function in non-hemorrhagic stroke patients
according to education level
Education Level
Stress Level
Total
Normal
Lightweight
Medium
Weight
n
%
n
%
n
%
n
%
n
%
Not in school
did not finish
elementary school
0
0
0
0
2
5
2
5
4
10
Elementary School
1
2,5
3
7,5
5
12,5
3
7,5
12
30
Junior High School
1
2,5
2
5
2
5
0
0
5
12,5
High School
7
17,5
6
15
1
2,5
1
2,5
15
37,5
College
Graduate/Bachelor's
Degree
4
10
0
0
0
0
0
0
4
10
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Tabel 12. Distribution of cognitive function of non-hemorrhagic stroke patients based on
occupation
Jobs
Cognitive Function
Total
Normal
Lightweight
Medium
Weight
n
%
n
%
n
%
n
%
n
%
4
10
2
5
7
17,5
3
7,5
4
10
1
2,5
0
0
2
5
1
2,5
8
20
3
7,5
1
2,5
2
5
0
0
0
0
0
0
2
5
0
0
0
0
0
0
13
32,5
11
27,5
10
25
6
15
Table 13. Distribution of cognitive function in non-hemorrhagic stroke patients based
on history of previous disease
Past Medical
History
Cognitive Function
Total
Normal
Lightweight
Medium
Weight
n
%
n
%
n
%
n
%
n
%
Table 14. Distribution of cognitive function in non-hemorrhagic
stroke patients based on stroke onset
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Discussion
Description of the stress level of patients with non-hemorrhagic stroke at Tugurejo Hospital in
2022
(Purba, 2019).
(Purba, 2019)
(Pongantung & Rosdewi, 2022).
(Purba, 2019)
(Marbun et al., 2016)
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(Purba,
2019)
(Ananda, 2017)
(Dudung et al., 2015).
(Dudung et al., 2015)
(Ananda, 2017)
(Marbun et al., 2016)
(Pribadhi, 2019).
(Makarim, 2021).
(Ananda, 2017).
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(Morris et al., 2013)
(Nasib Tua Lumban Gaol, 2016).
(Nasib Tua Lumban Gaol, 2016).
(Sari, 2014)
Description of cognitive function in non-hemorrhagic stroke patients at Tugurejo Hospital in
2022
(Mustikawati, 2016)
(Anita & Linggi, 2020)
(Padu et al., 2022)
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(Pramudita & Pudjonarko, 2016)
(Khaerul, 2021)
(Ramadhani, 2020)
(Ramadhani, 2020)
(Kalaria, Akinyemi, 2016)
(Riasari,
2022)
(Boletimi et al., 2021)
(Manurung et al., 2016)
(Ramadhani, 2020)
(Riasari, 2022)
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(Riasari, 2022)
(Mustikawati, 2016)
(Manurung et al., 2016)
Conclusion
Based on research conducted at RSUD Tugurejo Semarang City, it can be concluded:
The level of stress in non-hemorrhagic stroke patients at Tugurejo Hospital in 2022 for the
normal stress category was 35.5%, mild stress was 15%, moderate stress was 22.5%, severe stress
was 17.5% and very severe stress was 10%. This shows that 65% of patients at Tugurejo Hospital
have abnormal stress levels.
Cognitive dysfunction in non-hemorrhagic stroke patients at Tugurejo Hospital in 2022 for the
normal category amounted to 32.5% and 67.5% others had impaired cognitive function, with the
distribution of mild cognitive function abnormalities by 27.5%, moderate cognitive function
abnormalities by 25%, and severe cognitive function abnormalities by 15%.
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