Aims : Violent behavior is one of the positive signs and symptoms that appear in schizophrenic patients. One of the actions that can be done on schizophrenic patients with violent behavior problems is by conducting assertive training. The purpose of this study was to analyze previous research on the effect of Asertive Training in Reducing Symptoms in Violent Behavior: Literature Review
 
Methdos : This study was a literature review. The journal obtained from two data based, namely Google Scholar and Pubmed. The keywords used in the data based on Google Scholar were combination between assertive training, assertive training, schizophrenia, and violent behavior. Meanwhile, the keywords used in the data based on Pubmed were assertive training, assertive skills, schizophenia, mental illness, violence behavior. The inclusion criteria were studies conducted on patient with schizophrenia, with assertive training interventions. Journal in bahasa Indonesia and English included, randomized control trial or quasi experimental studies, and free full text.
Results The results were obtained as many as 676 journals based on a combination of keywords, then screened through titles, abstracts, and also inclusion criteria, only six journals were reviewed.
 
Conclusions : Based on the results showed that assertive training was able to reduce violent behavior in schizophrenic patients

Anak Agung Ayu Ratih Satya Utami

Heni Purnama

Ibrahim, Masdum

English

Jurnal Keperawatan Komprehensif (JKK)

90 p-ISSN : 2354 8428 | e-ISSN:  2598 8727    Jurnal Keperawatan Komprehensif │    Vol. 7 Special Edition Agustus 2021│     https://doi.org/10.33755/jkk   Original Article  The Effect Of Assertive Training For Reducing Violence Behavior In Skizofrenia Patients: Literature Review  Anak Agung Ayu Ratih Satya Utami1   │   Masdum Ibrahim2*   │  Heni Purnama3  1Student, STIKEP PPNI Jawa Barat, Bandung, West Java-Indonesia 2 Department of Mental Health Nursing, STIKEP PPNI Jawa Barat, Bandung, West Java-Indonesia 3 Department of Mental Health Nursing, STIKEP PPNI Jawa Barat, Bandung, West Java-Indonesia   *contact masdumibrahim@gmail.com  Received : 048/07/2021 Revised : 12/07/2021 Accepted : 16/07/2021 Online : 23/07/2021 Published : 31/08/2021   Abstract Aims : Violent behavior is one of the positive  symptoms that appear in a schizophrenic patients. The actions that can be done on schizophrenic patients with violent behavior problems is by conducting assertive training. The purpose of this study was to analyze previous research that has been done on the effect of Asertive Training in Reducing Symptoms in Violent Behavior: Literature Review Methdos : This study was a literature review. The journal obtained from two data based, namely Google Scholar and Pubmed. The keywords used in the data based on Google Scholar were combination between assertive training, assertive training, schizophrenia, and violent behavior. Meanwhile, the keywords used in the data based on Pubmed were assertive training, assertive skills, schizophenia, mental illness, violence behavior. The inclusion criteria were are studies conducted on a patient with schizophrenia, use assertive training interventions. Journal in bahasa Indonesia and English included, randomized control trial or quasi experimental studies, and free full text. Results The results were obtained as many as 676 journals based on a combination of keywords, then screened through titles, abstracts, and also inclusion criteria, only six journals were reviewed.  Conclusions : Based on the results showed that assertive training was able to reduce violent behavior in schizophrenic patients.  Keyword  : assertive training, schizophrenia, violent behavior, literature review  INTRODUCTION Schizophrenia is  psychiatric disorder with characterized  a significant disorganization of thought process and is manifested by communication and cognition problems as well as impaired perception of reality which is manifested by hallucinations, delusions, and sometimes also a significant decrease in function (1). Schizophrenia is a severe mental disorder that can have an impact on cognitive, perception, and behavior so that it often causes clients to behave angry and carry out violent behavior both injuring themselves, others and the environment (2). According to Videbeck (2015) a symptoms of schizophrenia are divided into two, positive  and negative symptoms.  Positive symptoms 91 p-ISSN : 2354 8428 | e-ISSN:  2598 8727    Jurnal Keperawatan Komprehensif │    Vol. 7 Special Edition Agustus 2021│      https://doi.org/10.33755/jkk   can arise in schizophrenia is the risk of experiencing behavioral disorders such as violent behavior. The violent behavior is more often perpetrated by schizophrenic mental disorder patients compared to those with other psychiatric illnesses (3) Violent behavior is defined as a state of loss of control over one's behavior directed at oneself, others, or the environment (4). The signs and symptoms of violent behavior according to (4) are expressions in the form of threats and harsh words, red and tense faces, sharp eyes, clenching hands, high voice or shouting. (5) said the impact on patients with violent behavior was injuring themselves to commit suicide, hitting and even injuring others, and damaging the environment. Management to overcome violent behavior can be done with psychopharmaceutical therapy, and nursing actions. According to (6) the implementation of this nursing action refers to a range of strategic approaches to handling violent behavior starting from prevention strategies such as self-awareness, client education and assertive training, continuing with anticipatory strategies such as communication exercises, environmental change, behavioral therapy, and treatment program Assertive action is anger or disagreement that is expressed or expressed without hurting others (2) openly to oneself and others, being  to be assertive, and mutual respect between individuals (7). Based on this statement, assertive actions can help patients at risk of violent behavior to express their anger to others without hurting others and help patients to overcome violent behavior. Assertive behavior is the best way to express anger without hurting the other people’s for physically or psychologically. Besides, the assertive behavior can also be used for the  self-development client's (8). The assertive training is useful for training individuals who cannot express their anger and irritation, increase self-esteem, and also improve decision-making abilities (9). According to (10), the implementation of assertive training is quite simple, and can be carried out in groups. (11) said that the application of assertive actions was carried out on patients who had entered a period of (maintenance) where the patient had been treated with physical violence such as deep breathing and hitting pillows. Previous research conducted by (12) showed that violent behavior in the group that received generalist therapy and assertiveness training experienced a significantly lower decrease than the group that only received generalist therapy. Another study conducted by (13) regarding the effect of assertive training on parental violent behavior in children in Karawang district shows assertive training was effective in increasing ability  parents to reduce violent behavior in children. The research conducted by (14) shows the results, namely by giving assertive training actions to patients a risk of violent behavior, making ability patients  to control their anger and increasing the patient's y to overcome the risk of violent behavior. (16) said that the actions that nurses usually take in reducing violent behavior by using implementation strategies include controlling violent behavior physically by deep breathing and hitting the pillow, taking medication regularly, verbal training by expressing, asking and refusing properly. , and in a spiritual way. According to (17), assertive training is included in the implementation strategy for verbally violent behavior by expressing feelings well, refusing and asking well. 92 p-ISSN : 2354 8428 | e-ISSN:  2598 8727    Jurnal Keperawatan Komprehensif │    Vol. 7 Special Edition Agustus 2021│     https://doi.org/10.33755/jkk   Assertive training is a combination of social skills training therapy and cognitive behavior so it is very effective for use on violent behavior problems (16).   METHODS This study is a literature review,  existing literature to determine the results of previous studies regarding the effect of assertive training in reducing symptoms of violent behavior. The research was conducted by searching for literature sources through data based on Google Scholar, and Pubmed. The keywords used in searching for literature on Google Scholar data are a combination of assertive training, assertive training, schizophrenia, and violent behavior. While the keywords used in the Pubmed based data are assertive training, assertive skills, schizophrenia, mental illness, violence behavior. Search for articles in databased using the boolean operators "AND" and "OR" which are used to expanded or narrow the search, making was easier to determine the articles to be used.  RESULTS Based on the search results was conducted through the Google Scholar database as much 655 journals with a combination of keywords assertive training, assertive training, schizophrenia, and violent behavior. and databased Pubmed as  much 21 journals obtained with a combination of keywords assertive training, schizophrenia, mental illness, violence behavior. Of the 676 journals obtained, the researchers read the title of each article and only 38 articles matched the theme that the researcher wanted. Then 24 journals were excluded because they were not full text and not in the schizophrenic population. Then as many as 14 journals were reviewed, journals that did not meet the inclusion criteria were issued as many as 8 journals, so that only 6 full text journals published in the last 10 years (2013-2020) were reviewed.  Based on 6 articles that have been analyzed regarding the effect of assertive training on schizophrenic patients with violent behavior that has been carried out in different places such as Semarang, Lawang, Surabaya, and Cilacap, it shows that the assertive training is reduce violent behavior in schizophrenic.  (18) showed that was a significant the effect between assertive group activity therapy on behavior change in patients with violent behavior as seen from the p value of 0.000 (p < 0.05), behavior change from bad to good seemed on the decline in outcomes before and after treatment. This is in line with research conducted by (16) which showed that there was a more significant decrease in behavioral, social, cognitive, and physical responses in the group given the assertive training intervention. The inclusion criteria in the research conducted by (16) were patients aged 18-60 years, and patients at risk of violent behavior who were treated in the maintenance room  93 p-ISSN : 2354 8428 | e-ISSN:  2598 8727    Jurnal Keperawatan Komprehensif │    Vol. 7 Special Edition Agustus 2021│      https://doi.org/10.33755/jkk   Search Result Summary  flowchart PRISMA.               Another study conducted by (19) in the Intensive Psyciatric Care Unit (IPCU) RSJ. Dr.Radjiman Wediodiningrat Lawang showed that the assertive training was proven to reduced  intensive phase and also reduce symptoms of violent behavior which was greater in the treatments group than the control group with p<0.001. Assertive exercises are carried out in 4 meeting sessions, namely in session 1 patients are trained to be able to recognize themselves, change thoughts and feelings and practice assertive behavior, in session 2 patients are trained to express their wants and needs and how to fulfill them, in session 3 patients are trained to establish social relationships in meeting their needs. , in session 4 patients were trained to maintain assertive behavior changes in various situations. Each meeting was held for 45 minutes (19). The research conducted by (20) at the inpatient installation of Grhasia Hospital Yogyakarta showed an increase in the ability to express anger assertively from the pre test to post test of the intervention group through the Wilcoxon test with p value 0.000 (p < 0.05) which means that there is influence assertive training to ability anger assertively. The inclusions criteria in this study were schizophrenic patients was a history of violent behavior who had been screened with Assault And Violence Assessment Tools with a score of 3-8 (moderate risk precaution), patients could communicate verbally quite well, and cooperative patients and good physical condition ( Suyanta and Murti. 2015) Subsequent research conducted by (17) said that using assertive training, especially role playing in schizophrenia patients with violent behavior, increased the ability to control anger  the intervention group with p value = 0.000. The latest research conducted by (21) Number studied (n = 14) Number of eligible journals n=6 Screening by • Free Fulltext • Population of schizophrenic patients Journal excluded (n = 24) Screening Eligbility  Included Filtered amount (n = 38)  Inclusion Criteria • Assertive training interventions • Research RCT/Quasy Experiment Journal excluded n = 8) Number of journals obtained by Google Scholar and Pubmed (n = 676 ) Identification  638 articles were excluded after title evaluation by theme 94 p-ISSN : 2354 8428 | e-ISSN:  2598 8727    Jurnal Keperawatan Komprehensif │    Vol. 7 Special Edition Agustus 2021│     https://doi.org/10.33755/jkk   by dividing respondents into 4 groups, namely three treatment groups given Assertive Training (AT), Acceptance Commitment Therapy (ACT), and Assertive Acceptance Commitment Therapy (AACT) interventions, while the control group was given intervention implementation strategy according to hospital standards. The intervention was carried out for three days with a time of 45 minutes. This study showed the results that assertive training is able to control the patient's violent behavior, but the assertive acceptance commitment therapy treatment group can control violent behavior better because assertive acceptance commitment therapy equips patients with the skills to behave assertively, then will accept problems with adaptive behavior and finally have a commitment. to maintain adaptive behavior Based on the results of the research journal above, is proven that the assertive training can reduced violent behavior in schizophrenic patients. Some of the studies above (19,21) conducted assertive training with a time of 45 minutes, this is in accordance with Lange and Jakubowski (1983) in (13) who said that in the implementation of assertiv training the duration The implementation of each stage is 30-45 minutes. There are 4 stages in the application of assertive exercises, namely Describing, Learning, Practicing, and Role Playing. Assertive training needs to be done consistently in order to maximally reduce violent behavior in schizophrenic patients and prevent recurrence Assertive training itself is a therapy to train one's ability to convey rights, feelings, opinions honestly, firmly and openly without feelings of anxiety and without insulting, offending, insulting or hurting the feelings of others (7). In assertive practice there is a learning process and there is additional knowledge of how to express anger, and exercises to express anger appropriately. Schizophrenic patients with violent behavior who are given assertive training will gain knowledge on how to express anger appropriately, so that their ability to express anger becomes better than before. The learning process in this assertive exercise can provide a cognitive stimulus that indirectly builds the client's confidence.   DISCUSSION After analyzing the 6 articles regarding the effect of assertive training on violent behavior patients with schizophrenic with r with a range  2013 – 2020 conducted in several places such as Semarang, Lawang, Surabaya, and Cilacap, it was found that assertive training can effectively reduced violent behavior in patients with schizophrenia. . In assertive training there is a learning process and there is additional knowledge on how to express anger in the right way.  CONCLUSION Based on the results showed that assertive training was able to reduce violent behavior in schizophrenic patients. 95 p-ISSN : 2354 8428 | e-ISSN:  2598 8727    Jurnal Keperawatan Komprehensif │    Vol. 7 Special Edition Agustus 2021│      https://doi.org/10.33755/jkk   REFERENCES 1. Patricia, Et Al. (2014). Keperawatan Kesehatan Jiwa Psikiatrik; Teori & Praktik. Jakarta : EGC. 2. Yosep, I. (2009). Keperawatan Jiwa. Bandung: Refika Aditama 3. Knezevic, V. et al. 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The Effect Of Assertive Training For Reducing Violence Behavior In Skizofrenia Patients: Literature Review

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The Effect Of Assertive Training For Reducing Violence Behavior In Skizofrenia Patients: Literature Review

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