Table 2 Frequency Distribution Of Patients Hemodialisa With Self Esteem

Characteristic	Group		Group
	Intervention (n = 43 )		Control (n= 43)
	n	%	n	%
Gender a. Men b. Woman	24 19	55,8 44,2	19 24	44,2 55,8
Total	43	100	43	100
Education a. High b. Low	41 2	95,3 4,7	41 2	95,3 4,7
Total	43	100	43	100
Work a. Work b. Unwork	10 33	23,3 76,7	9 34	20,9 79,1
Total	43	100	43	100
Status Marriage a. Not married b. Married	2 41	4,7 95,3	8 35	18,6 81,4
Total	43	100	43	199

Based on the results of table 5.2 is known as a whole the majority of patients hemodialisa with low self esteem in the intervention group as much as 55.8% of men, and in the control group as much as 55.8% women. At both groups as much as 95.3% of the highly educated and work in the intervention group as much as 76.7% and 79.1% as much as the control group with the status not working. Marital status at 95.3% as much as the intervention group and the control group as many as 81.4% are married.

Table 3 Frequency distribution of motivation and meaning of life Hemodialisa Patients With low self esteem

Variabel	Group	Mean	SD	Min-Maks	95 %-CI
Motivation	Intervention	68,95	9,601	51-84	66-71,91
Motivation	Control	70,21	9,195	51-88	67,38-73,04
The Meaning Of Life	Intervention	46,26	3,566	40-58	45,16-47,35
The Meaning Of Life	Control	46	2,769	40-50	45,15-46,85

Based on table 5.3 shows the average patient motivation hemodialisa with low self esteem, prior to the intervention of logotherapy, medical ministry in the intervention group as much as 68.95, while the control group on average as much as 70.21. The average patient hemodialisa the meaning of life with low self esteem before the intervention done logotherapy medical ministry, in the intervention group as much as 46.26, whereas in the control group average by as much as 46. This can be conclude that motivation and meaning of life hemodialisa patients with low self esteem in a hospital in the city of Padang, the intervention group and the control group known to be almost the same.

Based on table 5.5 shows the average difference of motivation after given logotherapy medical ministry in the intervention group and the control group. Note average motivation after given logotherapy medical ministry in the intervention group was 104.44 and motivation in the control group average was 70.51. Can note the difference in motivation after the awarding of logotherapy medical ministry in the intervention group and a control group that is as much as 33.93. The results of further analysis showed there was a significant difference in motivation after given logotherapy medical ministry among the intervention group with a control group (p = 0.000; α = 0.05). It can be concluded that there is a difference in motivation between the intervention group and the control group after the granting of logotherapy medical ministry in a hospital in the city of Padang.

The results of the analysis also showed there is a difference in the meaning of life after being given a mean of logotherapy, medical ministry in the intervention group and the control group. Note average of the meaning of life after being given logotherapy medical ministry in the intervention group was 50.23 and average over the meaning of life in the control group was 46.37. Known difference in meaning of life after the awarding of logotherapy medical ministry in the intervention group and a control group that is as much as 3.86. The results of further analysis showed there was a significant difference in the meaning of life after being given logotherapy medical ministry among the intervention group with a control group (p = 0.000; α = 0.05). It can be concluded that there is a difference in meaning of life between the intervention group and the control group after the granting of logotherapy medical ministry in a hospital in the city of Padang.

DISCUSSION:

1. Characteristics of respondents:

Based on the age of respondents among the intervention group with a control group, the age of 30 at > intervention group obtained as much as 93%, while in the control group obtained as many as 81.4%. The two groups are at a developmental stage of adulthood. This can be due to changes in lifestyle, smoking, unhealthy diet and alcohol drinks that also trigger the onset of chronic kidney disease cases. Age is a factor that can describe the conditions and affect a person's health. The function of the renal and traktus urinarius will change along with increasing age. After the age of 40 will decline progressively glomerulus filtration rate until the age of 70 years, approximately 50% of normal. The function of the tubules and pemekatan reabsorption ability also diminished along with the increase in age (Smeltzer & Bare, 2002).

In addition to the physical problems in patients undergoing chronic renal disease hemodialisa, Stuart (2016) explained that in the development of the age of majority should be able to prepare for the next generation, pay attention to the needs of others in particular family, creative, capable in problem solving, productive in terms of being able to fill in spare time with things that are positive, able to adjust to her parents and felt comfortable with his family to reach the goal. It is supported by research Muliawati (2014) showed that the patient hemodialisa who experience low self esteem, 20.7% were aged ≤ 30 years and 79.3% age > 30 years. Aligned with the research done Setyaningsih (2011) showed that age of patients undergoing hemodialisa who experience low self esteem is at an early stage of development of adult age up to adulthood.

Gender in the intervention group more men who underwent hemodialisa with low self esteem that is as much as 55.8%, whereas in the control group more women undergoing hemodialisa with low self esteem that is as much as 55.8%. There are a number of factors affected by chronic kidney disease trend that is, the first factor trend to smoke and consume alcohol, if a long period will cause disease of hypertension and diabetes mellitus. The second trend factor, where the onset of deposition of substances in the urinary tract. A long deposition would cause the occurrence of rock on the urinary tract or kidney, plus it doesn't get penangana fast and right then it will cause interference on kidney function. Impaired renal function of old will resulting in chronic kidney disease, which penanggananya had to undergo hemodialisa.

This research was supported by Setyaningsih, Mustikasari, & Nuraini (2011) show that the gender of the respondent who undergo hemodialisa, gender male respondents i.e. 51.8% as much and as many as 48% of female respondents. According to research conducted by Wibowo (2017) showed that the gender of the respondents are relatively balanced between men and women, which in the get data respondents-sex male namely 51.9% and as much as the respondent a female sex that is as much as 58.1%.

Patient education hemodialisa with low self esteem in the intervention group and the control group, i.e. the same data is obtained as much as 95.3% of the highly educated. The research is aligned with research conducted by Setyaningsih (2011) showed that respondents with higher education as much as 55.5%. Education is often associated with knowledge, with the largest level of education was HIGH SCHOOL showed hemodialisa patients with low self esteem have higher education, and allows a lot of knowledge about menpunyai hemodialisa and be able to share information with the other respondents.

The results of this study do not fit with the theory that says that a person's education level may affect his ability to accept information provided, education became one of the milestones in a person's ability to interact with others effectively (Stuart, 2016). Low level of education a person will cause the person is experiencing low self esteem because of the problems that affect them, the higher the level of education will increasingly influence on patterns of thinking (Stuart, 2016).

Marital status data that is obtained with the status of being married in the intervention group that is as much as 95.3%, and a control group with the status of being married as many as 81.4%. It is also supported by research Setyaningsih (2011) that marital status in patients undergoing hemodialisa with low self esteem with the status of being married as much as 81.5% and unmarried status as much as 18.5%.

Characteristics of the work on the second more on does not work. The intervention group that is as much a 76.7%, whereas the control group as much as 79.1%. Based on the analysis of researchers can be caused, because the decline in productivity of patients hemodialisa with low self esteem are included in the job because of physical limitations of the respondents because of the chronic disease suffered. Other things that cause patients hemodialisa with low self esteem does not work because the client's view of himself and feeling pessimistic does not have the ability, decreased activity and sometimes restrict interaction with others. Such circumstances may cause the client at risk of experiencing depression, and finally a decrease in self esteem or low self esteem.

Based on the old hemodialisa in the intervention group underwent similar to control group IE ≤ 6 months. The intervention group ≤ 6 months IE as much as 62.8%, whereas the control group ≤ 6 months IE as much as 58.1%. According to Ross (1998) the last stage of the stages of losing is the Acceptance, that is, the stage of acceptance. Patients undergoing hemodialisa takes time to be able to accept that indeed suffering from chronic diseases, and reorder his life.

Based on the research of Setyaningsih (2011) when convicted should undergo hemodialisa patients will experience ansietas. For that it needs the ability in balancing myself from various circumstances caused by the disease. At first the individual would be difficulty in adjusting his life so that potentially pose a chronic ansietas, which ultimately can lead to other problems such as low self esteem. Based on the analysis of researchers that patients hemodialisa with low self esteem can take a while to accept conditions that are indeed suffering from a chronic disease, and had to undergo lifelong hemodialisa with any problems that arise because the hemodialisa process. The client needs to organize his life back because they have to undergo hemodialisa all his life.

2. Motivation of patients Hemodialisa with low self esteem:

Based on the results of the study motivation in the intervention group, patients hemodialisa with low self esteem in a hospital in Padang city, prior to the intervention of logotherapy, medical ministry showed motivation is low with an average of 68.95. The results of this study in accordance with the research conducted by Syamsiah (2011) show the motivation of patients chronic kidney disease who underwent hemodialisa as much as 53.3% 49.7%, low motivation motivation is high. Research Meistatika (2017) also showed motivation is low with an average of 66.71, about the motivation of the patient chronic kidney disease stage terminal which underwent hemodialisa. In addition, research conducted by Puspita (2011) shows a different thing, that the motivation of patients undergoing hemodialisa as much as 56.7% of positive motivation, 43.3% negative motivation.

Based on the analysis of researchers that the difference of motivation experienced by patients hemodialisa with low self esteem, because motivation is the impetus arising on a person consciously or unconsciously to perform action with the aim of (KBBI, 2017). Motivation leads to desire, the desire, drive and purpose of a particular behaviours and interactions with the environment. Big nothingness of motivation can increase, decrease or maintain behavior (Notoatmodjo, 2014). Based on the results of the research of low motivation, owned by patients undergoing hemodialisa with low self esteem, caused by its optimal client acceptance because of diseases suffered. The client still refused to undergo treatment procedures that require clients to live the hemodialisa, must be made within 2-3 x a week and conducted a lifelong patient. The client still pessimistic towards the treatment he or she lives.

Indirectly disclosed that the motivation of the client hemodialisa with low self esteem, influenced by various aspects of life such as health physically, psychological health and social relations. Client physically should run hemodialisa lifelong dialysis tools against dependency, and however, the tool is not cure chronic kidney disease. It can be inferred that the motivation is very important for hemodialisa patients with low self esteem, because with the motivation of hemodialisa patients with low self esteem can be evoked, directing, and solidify the behavior to a purpose, i.e. with regard to the treatment programme that will be suffered all his life.

3. The description of the meaning of life hemodialisa patients with low self esteem in a hospital in the city of Padang:

Based on the results of research in the control group, patients hemodialisa the meaning of life with low self esteem in a hospital in Padang City shows are with average 46. Whereas, in the intervention group patients hemodialisa the meaning of life with low self esteem, not much different from the control group. That the meaning of life hemodialisa patients with low self esteem in the intervention group at the hospital in Padang City shows are. This is supported by research conducted by Mariyanti et al (2013) revealed that a third of the subject there is a feeling of helplessness, pessimism is not confident and experience the feeling does not mean as well as the State of frustration. Feelings of helplessness and feeling he had a hassle his family and not feeling confident when her weight dropped drastically. Hemodialisa routines to make the subject feel the burden of physical, psychological, social and financial, so bring on a feeling of meaningless. This perceived state of the push to find the meaning over the suffering experienced by

According to Bastaman (2007) the meaning of life is something that is considered valuable and important so that it can be used as the destination in life. The meaning of life here including the purpose of life, belief and expectation that things need to be obtained in individual lives. According to v. E Frankl's in Bastaman (2007) revealed there are three values that diversity can be a source of meaning of life i.e. creative values (the value of creative), Experience value (the value of the experience) and attitudinal positions values (the value of attitude). Creative value (the value of creative) include work, work and create.

Based on the analysis of researchers that most respondents were still in the stage of the search process the meaning of life. This is because the suffering experienced by patients hemodialisa with low self esteem issues include physical, psychological, social, and financial. Multidimensinya issues facing patients hemodialisa with low self esteem, leading to a feeling of meaningless by feeling the presence of feeling helpless, pessimistic, feel confident and feel meaningless, empty and lonely. Based on the above problem can be summed up that feeling of meaningless perceived hemodialisa patients with low self esteem have an effect on the meaning of his life. The meaning of life can get in the way of forming the value, experience and attitude of suffering that cannot be dielakan.

4. Influence of Logotherapy Medical Ministry Towards motivation and meaning of life in the intervention group Patients Hemodialisa With low self esteem in a hospital in the city of Padang:

The results of the research on the motivation of hemodialisa patients with low self esteem in a hospital in Padang city, prior to logotherapy medical ministry showed motivation is low with an average of 68.95 logotherapy, after a medical ministry experience increased be 104.44, difference between an increase of 35.49. It can be concluded the motivation has increased significantly after the results of the medical ministry of logotherapy, with p value 0.000. Whereas, in the meaning of life hemodialisa patients with low self esteem in the intervention group after logotherapy medical ministry also has increased.

The meaning of life hemodialisa patients with low self esteem in a hospital in Padang city prior to logotherapy medical ministry, showed the meaning of life being with an average of 46.26, logotherapy after the Medical Ministry increase be 50.23, difference between an increase of 3.97. It can be inferred the meaning of life has increased significantly after the results of the medical ministry of logotherapy, with p value 0.000.

Intervention research is provided for the respondent in the intervention group was logotherapy individual medical ministry. Logotherapy is a type of psychotherapy that referring to spiritually, existensial, and therapy that concentrate in the search for the meaning of life (Wong. P, 2002). According to Bastaman (2007) therapy is logotherapy, which describes the pattern of psychological/psychiatric acknowledge the spiritual dimension in human beings. On logotherapy Marshall (2010) explains that there are some principles of logotherapy, namely that life still has a meaning or sense in any situation, even in suffering and pain though. Human beings have an almost unlimited freedom to find his own meaning of life, and every human being has the ability to take a stand against the suffering, and the tragic events that can not be inevitable that befell myself and the surrounding environment.

There are several methods of logotherapy engineering among others: paradoxical intention, dereflection, and a medical ministry. In this study researchers use dwarf logotherapy individual medical ministry, that help individuals find meaning of life by developing the right attitude, such as received with great fortitude, patience, courage the face shape suffering may be inevitable, such as pain that cannot be cured again.

Some research related to the success of logotherapy medical ministry include research conducted by Wahyuni (2007) an increase in self-esteem on the elderly in an Unfortunate werdha after being given a therapy group of logotherapy. Research on Kanine (2011) found a decrease in response a significant powerlessness on the group who get therapy generalist and logotherapy individuals than groups that are just getting therapy generalist. Other research results also showed an increase in 20-40 the meaning of life in individuals with a physical disability due to the better and the whole subject reported positive changes, such as a sense of the spirit of living a life, judging themselves valuable, and desire to develop themselves to be productive (Lestari, Mar, & Kartasasmita, 2017). Research Handayani, Hamid & Mustikasari (2017) showed there were changes in depression in patients hemodialisa, after getting therapy logotherapy medical ministry, seen by negative behavior towards positive change. The client has a high commitment to do hemodialisa and obedient therapy to treatment and care.

Researchers analyzed that the success of logotherapy medical ministry, against the patient's self esteem improved hemodialisa with low self esteem. Affect change in motivation and meaning of life hemodialisa patients with low self esteem. Because researchers have conducted activities in accordance with the steps/phases in his theory. According to Handayani, Hamid & Mustikasari (2017) there are 4 sessions the process of logotherapy medical ministry, namely: identifying the cause of the problem, identify client response to problems and the dwarf medical ministry as well as evaluation. As for the four stages applied in the two sessions of the meeting in the activities of logotherapy medical ministry, meeting with one i.e. sessions one and two, while for the second meeting of the IE sessions three and four.

Based on the process or stage of activity, logotherapy self-esteem increased and achievement motivation and meaning of life changes the respondents can be obtained. In session one and two first encounter patients hemodialisa with low self esteem, identify the cause of the problem and identify the response to problems encountered. While in the third session and four meetings to two, hemodialisa patients with low self esteem are trained for medical engineering ministry that is by the way think of anything ever experienced and contacting acquaintances who have experienced the same suffering.

Based on the documentation of the results of the activities of the workbook, in session one and two showed 75% of patients hemodialisa with low self esteem, can reveal problems and be able to identify the cause of the problem. Whereas, in three sessions and to the implementation of the medical engineering namely emapat ministry hemodialisa 90% of patients with low self esteem, being able to recall the suffering experienced and are able to obtain the meaning of life as more closer to Almighty God and assume hers pain is a warning against him. Then the patient contact acquaintances who have experienced the same suffering, here hemodialisa patients with low self esteem can share feelings and can reduce the suffering that is being experienced because of diseases suffered.

5. Influence of Logotherapy Medical Ministry Towards motivation and meaning of life in the control group of patients Hemodialisa With low self esteem motivation research results:

Based on a control group of patients hemodialisa with low self esteem, show the motivation is low with the average 70.21, after logotherapy medical ministry have elevated into 70.51, difference between an increase of 0.3. Can be inferred motivations do not experience increased significantly after done with the results of the medical ministry of logotherapy, the p value 0.171.

The meaning of life hemodialisa patients with low self esteem after the intervention of logotherapy, medical ministry, also in the control group experienced no meaningful changes. With an average of the meaning of life before logotherapy medical ministry 46, after logotherapy medical ministry become 46.37, the average difference in the meaning of life i.e. 0.37. Based on the results of the data analysis shows, that's not the case with significant value changes yg p value 0.058.

Based on the analysis, the researchers happened against increased motivation and meaning of life in patients with low self esteem but not significant. This is because changes in self-esteem in patients hemodialisa with low self esteem, not just obtained by the action of logotherapy, medical ministry only. There is an optimal client obtains support from families and environments so that the patients can afford to increase self-esteem. But it has not yet been fullest to improve self-esteem. Hence the need to give a particular nursing actions to improve self-esteem of patients undergoing hemodialisa. In the end increase the motivation and the search for the meaning of life, such as logotherapy medical ministry.

6. Difference in motivation and the meaning of life before and after the granting of Individual Medical interventions Logotherapy Ministry:

The results of the analysis showed there was a difference in motivation and meaning hiduppada the intervention group and the control group after the awarded logotherapy medical ministry. These results are supported by the average value of motivation, as much as 33.93 before and after intervention research is conducted with the highest p value 0.000. Whereas, in the meaning of life also showed changes in the intervention group before and after getting the intervention research. Supported by the average value of the meaning of life that is as much as 3.86 before and after intervention research is conducted with the highest p value 0.000.

Based on the results of the implementation documentation logotherapy medical ministry sessions one and two, obtained 70% of the respondents argued that the problem is related to the program running hemodialisa. They want to break away from the treatment program. Their lives depended against dialysis, making their lives become bored, helpless, and meaningless. The circumstances experienced by the respondents called existensial vacum. According to Bastaman (2007) someone who lost the meaning of his life will be at existensial vacum and subsequent existensial frustration. existensial frustration is the emotional response against the process of the loss of meaning and purpose in life. Research Romadhoni & Setyawati (2013) stated that there is a relationship between the conformity with the meaningfulness of life in chronic kidney sufferers in HOSPITALS Banyumas. Sufferers have a high adaptability then have the meaning of life is high, so is the opposite when adaptability is low then the meaning of life is also low.

In addition, perceived by patients hemodialisa with low self-esteem who lead hemodialisa is feeling demotivated in implementing hemodialisa. According to Videbeck (2008) patients undergoing hemodialisa who experience low self-esteem have no motivation to work and to be active. Examples of these problems will certainly inhibit patient in undergoing therapy (Djoko, 2008). It can be inferred that motivation can also be a very influential factor in running treatment programs.

According to Bastaman (2007) principles of logotherapy, medical ministry is a process of understanding and recognition that to be honest, is associated with source potential meanings that are owned (self knowledge), association with previous positive experience that gives meaning as well as integration with the influence of meaning to others. Next is the motivation or the desire of the respondent to take the decision in choosing the means or ability that can help him in finding a meaning (Wong. P, 2002). As for the process mentioned above, that motivation has also become an influential factor and determine beliefs as well as determine about the treatment program are accepted. On the research conducted in the intervention group, obtained that respondents showed motivation and meaning of life changes that are significant compared to the control group. That is because the members of the group have strong motivation and desire for meaningful in any situation which is the overall attitude of the respondent since the early start of logotherapy, medical ministry.

The situation is different with the control group, where changes in motivation and meaning of life gained is not too significant. In the control group performed no intervention, therefore needs to be done nursing actions for respondent hemodialisa with low self esteem, as this can also affect the treatment to be in control.

RECOMMENDATION:

This research is very important to improve the self-esteem of patients hemodialisa. Low self esteem will impact against a decrease in motivation and patient hemodialisa the meaning of life, which will hamper the treatment programme that will be suffered.

LIMITATION OF THE STUDY:

Requirements for completing a master's degree in nursing

ACKNOWLEDGEMENT:

The authors thank infinite to Prof. Dr. Dr. Rizanda Machmud, m. Kes, FISPH, FISCM, Dr. Yulastri m. Arif, Kep, Hema Malini, SKp, PHd, and MN. Heppi Sasmita, m., Kep Sp. Kep j. who has a lot of power, and taking time out of mind to Guide and provide advice and motivation in the completion of this study.

CONCLUSION:

The results of the research are already capable of answering the research hypothesis. Characteristics of the patients in this study the average 30-year-old >, sex is relatively balanced between men and women, not working, highly educated, and be married, as well as undergoing 6 months hemodialisa <. The motivation of the patient showed low motivation, whereas the meaning of life hemodialisa patients with low self esteem in a hospital in Padang city showed the meaning of life. There is the influence of logotherapy medical ministry in patients hemodialisa with low self esteem in the intervention group. There is a significant difference between motivation and meaning of life between the intervention group and the control group after the given logotherapy medical ministry.

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Received on 30.06.2018 Modified on 18.07.2018

Int. J. Nur. Edu. and Research. 2019; 7(1): 21-29.

DOI: 10.5958/2454-2660.2019.00005.X

Variabel	Group	Mean	SD	Min-Maks	95 % -CI
Age	Intervention	47,30	10,52	20-62	44,06 – 50,54
Age	Control	42,53	13,015	14-65	38,53- 46,54
The old implementation of hemodialisa	Intervensi	8,98	10,15	1-39	5,85-12,1
The old implementation of hemodialisa	Kontrol	8,74	9,006	1-41	5,97-11,52

Variabel	Motivation		*P Value*	The Meaning Of Life		*P value*
Variabel	Mean	95 % CI		Mean	95 % CI
Intervention
Pre	68,95	33,269-37,708	0.000	46,26	2,265-5,688	0.000
Post	104,44			50,23
Different	35,49			3,97
Control
Pre	70,21	0,136-0,740	0,171	46	0,014-0,758	0,058
Post	70,51			46,37
Different	0,3			0,37

Variabel	Motivation			P *value*	The Meaning of Life			P *value*
Variabel	Mean	SD	95 % CI	P *value*	Mean	SD	95 % CI	P *value*
Intervention	104,44	12,3	29,26-38,6	0,000	50,23	5,40	1,99-5,72	0,000
Control	70,51	9,24	29,25-38,60		46,37	2,91	1,99-5,73
Different	33,93				3,86