MANAJEMEN RISIKO KELELAHAN DAN GANGGUAN POLA TIDUR PADA PASIEN CA MAMMAE BERBASIS TEORI OREM
Main Article Content
Abstract
Kanker payudara adalah salah satu jenis kanker yang paling banyak dialami oleh perempuan, dan proses pengobatannya, seperti kemoterapi, sering menyebabkan kelelahan berlebihan dan gangguan pola tidur. Kondisi ini dapat menurunkan kualitas hidup pasien, mengganggu proses pemulihan, serta meningkatkan risiko komplikasi psikologis dan fisik. Oleh karena itu, dibutuhkan manajemen risiko keperawatan yang tepat untuk membantu pasien mengatasi masalah tersebut. Salah satu pendekatan yang dapat digunakan adalah Teori Self-Care Deficit dari Dorothea Orem. Teori ini menekankan pentingnya membantu pasien dalam merawat dirinya sendiri (self-care), terutama ketika pasien belum mampu sepenuhnya mandiri karena kondisi penyakit. Dalam teori ini, perawat berperan memberikan bantuan, edukasi, dan dukungan sesuai kebutuhan pasien. Penelitian ini dilakukan melalui studi kasus terhadap seorang pasien kanker payudara usia 46 tahun yang mengalami kelelahan dan sulit tidur akibat kemoterapi. Setelah dilakukan intervensi keperawatan selama lima hari, termasuk edukasi tentang kebersihan tidur, latihan pernapasan dalam, dan manajemen aktivitas sehari-hari, kondisi pasien menunjukkan perbaikan. Tingkat kelelahan menurun, durasi tidur meningkat, dan pasien menjadi lebih mampu melakukan perawatan diri secara mandiri. Hasil ini menunjukkan bahwa teori Orem dapat digunakan sebagai dasar dalam menyusun intervensi keperawatan yang efektif dan tepat sasaran untuk mengurangi kelelahan dan memperbaiki pola tidur pasien kanker. Pendekatan ini juga membantu meningkatkan motivasi dan semangat pasien dalam menjalani pengobatan.
Article Details
How to Cite
[1]
R. Z. L. Lubis and N. Huda, “MANAJEMEN RISIKO KELELAHAN DAN GANGGUAN POLA TIDUR PADA PASIEN CA MAMMAE BERBASIS TEORI OREM”, JURNAL EDUCATION AND DEVELOPMENT, vol. 14, no. 2, pp. 569-579, May 2026.
Section
Artikel
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
References
Afrasiabifar, A., Mehri, Z., Javad Sadat, S., & Ghaffarian Shirazi, H. R. (2016). The Effect of Orem’s Self-Care Model on Fatigue in Patients With Multiple Sclerosis: A Single Blind Randomized Clinical Trial Study. Iranian Red Crescent Medical Journal, 18(8), e31955. https://doi.org/10.5812/ircmj.31955
Aliakbari, F., Moosaviean, Z., Masoudi, R., & Kheiri, S. (2021). The Effect of Orem Self-Care Program on Sleep Quality, Daily Activities, and Lower Extremity Edema in Patients Undergoing Coronary Artery Bypass Graft Surgery. Advanced Biomedical Research, 10, 29. https://doi.org/10.4103/abr.abr_54_20
Badowska-Kozakiewicz, A. M., Liszcz, A., Sobol, M., & Patera, J. (2017). Retrospective evaluation of histopathological examinations in invasive ductal breast cancer of no special type: an analysis of 691 patients. Archives of Medical Science : AMS, 13(6), 1408–1415. https://doi.org/10.5114/aoms.2015.53964
Barsevick, A. M., Newhall, T., & Brown, S. (2008). Management of cancer-related fatigue. Clinical Journal of Oncology Nursing, 12(5 Suppl), 21–25. https://doi.org/10.1188/08.CJON.S2.21-25
Bower, J. E., Lacchetti, C., Alici, Y., Barton, D. L., Bruner, D., Canin, B. E., Escalante, C. P., Ganz, P. A., Garland, S. N., Gupta, S., Jim, H., Ligibel, J. A., Loh, K. P., Peppone, L., Tripathy, D., Yennu, S., Zick, S., & Mustian, K. (2024). Management of Fatigue in Adult Survivors of Cancer: ASCO–Society for Integrative Oncology Guideline Update. Journal of Clinical Oncology, 42(20), 2456–2487. https://doi.org/10.1200/JCO.24.00541
Bower, J. E., & Lamkin, D. M. (2013). Inflammation and cancer-related fatigue: Mechanisms, contributing factors, and treatment implications. Brain, Behavior, and Immunity, 30, S48–S57. https://doi.org/https://doi.org/10.1016/j.bbi.2012.06.011
Bray, F., Laversanne, M., Sung, H., Ferlay, J., Siegel, R. L., Soerjomataram, I., & Jemal, A. (2024). Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 74(3), 229–263. https://doi.org/10.3322/caac.21834
Deng, Q., Kang, L., Zhu, S., Luo, W., Qing, J., Zhong, S., Wu, Y., Lu, J., & Dong, H. (2021). Effects of nursing based on Orem’s self-care model on self-care efficacy, quality of life and adverse emotions in patients with advanced lung cancer. American Journal of Translational Research, 13(4), 2983–2989.
Dionisi, S., DI Muzio, M., Giannetta, N., DI Simone, E., Gallina, B., Napoli, C., & Orsi, G. B. (2021). Nursing students’ experience of risk assessment, prevention and management: a systematic review. Journal of Preventive Medicine and Hygiene, 62(1), E122–E131. https://doi.org/10.15167/2421-4248/jpmh2021.62.1.1698
Finan, P. H., Goodin, B. R., & Smith, M. T. (2013). The association of sleep and pain: an update and a path forward. The Journal of Pain, 14(12), 1539–1552. https://doi.org/10.1016/j.jpain.2013.08.007
Hendy, A., Ibrahim, R. K., Darwish, A., Al Sabbah, S., Shalby, A. Y. M., Khubrani, R., Alawad, A. E., Abdelaliem, S. M. F., & Wahba, N. M. I. (2025). Sleep disturbance, cancer-related fatigue, and depression as determinants of quality of life among breast cancer patients undergoing chemotherapy: a cross-sectional study. BMC Cancer, 25(1), 1122. https://doi.org/10.1186/s12885-025-14538-6
Imanian, M., Imanian, M., & Karimyar, M. (2019). Sleep Quality and Fatigue among Breast Cancer Patients Undergoing Chemotherapy. International Journal of Hematology-Oncology and Stem Cell Research, 13(4), 196–200.
Izgu, N., Metin, Z. G., Eroglu, H., Semerci, R., & Pars, H. (2024). Impact of spiritual interventions in individuals with cancer: A systematic review and meta-analysis. European Journal of Oncology Nursing, 71, 102646. https://doi.org/https://doi.org/10.1016/j.ejon.2024.102646
Jakobsen, G., Gjeilo, K. H., Hjermstad, M. J., & Klepstad, P. (2022). An Update on Prevalence, Assessment, and Risk Factors for Sleep Disturbances in Patients with Advanced Cancer—Implications for Health Care Providers and Clinical Research. Cancers, 14(16). https://doi.org/10.3390/cancers14163933
Jeanifer, U. M., Mediawati, A. S., Somantri, I., & Umboh21001@mail.unpad.ac.id1, U. P. (2023). STRATEGI IMPLEMENTASI DIAGNOSIS, INTERVENSI DAN LUARAN KEPERAWATAN INDONESIA TERHADAP PERAWAT. Journal of Telenursing (JOTING), 5(2 SE-Articles), 2338–2346. https://doi.org/10.31539/joting.v5i2.5994
Kaku, A., Nishinoue, N., Takano, T., Eto, R., Kato, N., Ono, Y., & Tanaka, K. (2011). Randomized Controlled Trial on the Effects of a Combined Sleep Hygiene Education and Behavioral Approach Program on Sleep Quality in Workers with Insomnia. Industrial Health, 50, 52–59. https://doi.org/10.2486/indhealth.MS1318
Kang, Y.-E., Yoon, J.-H., Park, N., Ahn, Y.-C., Lee, E.-J., & Son, C.-G. (2023). Prevalence of cancer-related fatigue based on severity: a systematic review and meta-analysis. Scientific Reports, 13(1), 12815. https://doi.org/10.1038/s41598-023-39046-0
Khademian, Z., Kazemi Ara, F., & Gholamzadeh, S. (2020). The Effect of Self Care Education Based on Orem’s Nursing Theory on Quality of Life and Self-Efficacy in Patients with Hypertension: A Quasi-Experimental Study. International Journal of Community Based Nursing and Midwifery, 8(2), 140–149. https://doi.org/10.30476/IJCBNM.2020.81690.0
Mahdieh, M., Hossein, F., Fatemeh, F., & Mohammad, M. (2021). Sleep Quality and Cancer-Related Fatigue in Patients with Cancer. J Caring SCI, 10(3), 145–152. https://doi.org/10.1186/s12912-025-02886-4
Maqbali Al, & Mohammed. (2020). Sleep disturbance in patients with cancer. Journal of Integrative Nursing, 2(4). https://journals.lww.com/jinm/fulltext/2020/02040/sleep_disturbance_in_patients_with_cancer.1.aspx
Nancie Petrucelli, M., Mary B Daly, MD, P., & Tuya Pal, M. (2025). BRCA1- and BRCA2-Associated Hereditary Breast and Ovarian Cancer Synonym: BRCA1- and BRCA2-Associated HBOC. Cancers, 31. https://doi.org/10.3390/cancers13174287
Nguyen, L. T., Alexander, K., & Yates, P. (2018). Psychoeducational Intervention for Symptom Management of Fatigue, Pain, and Sleep Disturbance Cluster Among Cancer Patients: A Pilot Quasi-Experimental Study. Journal of Pain and Symptom Management, 55(6), 1459–1472. https://doi.org/10.1016/j.jpainsymman.2018.02.019
Paramita, N., Nusdwinuringtyas, N., Nuhonni, S. A., Atmakusuma, T. D., Ismail, R. I., Mendoza, T. R., & Cleeland, C. S. (2016). Validity and Reliability of the Indonesian Version of the Brief Fatigue Inventory in Cancer Patients. Journal of Pain and Symptom Management, 52(5), 744–751. https://doi.org/10.1016/j.jpainsymman.2016.04.011
Qu, L., Zhu, J., Mei, X., Yi, Z., Luo, N., Yuan, S., Liu, X., Liu, M., Xie, H., Hu, X., Pan, L., Liang, Q., Li, Y., Zou, Q., Zhou, Q., Zhang, D., Zhou, M., Pei, L., Qian, K., … Yi, W. (2025). Evaluating axillary lymph node metastasis risks in breast cancer patients via Semi-ALNP: a multicenter study. EClinicalMedicine, 85. https://doi.org/10.1016/j.eclinm.2025.103311
Rakhshani, T., Najafi, S., Javady, F., Taghian dasht bozorg, A., Mohammadkhah, F., & Khani Jeihooni, A. (2022). The effect of Orem-based self-care education on improving self-care ability of patients undergoing chemotherapy: a randomized clinical trial. BMC Cancer, 22(1), 770. https://doi.org/10.1186/s12885-022-09881-x
Rusmiati, T., & Maria, L. (2023). HUBUNGAN DUKUNGAN KELUARGA TERHADAP MOTIVASI PASIEN KANKER PAYUDARA YANG TELAH KEMOTERAPI. Jurnal Kesehatan Dan Pembangunan, 13(23), 159–169. https://doi.org/10.1016/j.pmn.2018.09.005
Sari, D. A., Waluyo, A., Alfianti, Y., & Putri, Y. S. E. (2025). EFEKTIFITAS TERAPI NON-FARMAKOLOGI PADA GANGGUAN TIDUR PASIEN KANKER: SYSTEMATIC REVIEW. Jurnal Menara Medika, 7(2723–6862), 2622-657X. https://doi.org/10.1046/j.1365-2648.2003.02768.x
Seyednazari, M. A., Amini, K., Ramezani-Badr, F., & Markani, A. K. (2025). Effect of a structured Orem’s self-care model nursing intervention on sleep quality and academic self-efficacy in nursing students. BMC Nursing, 24(1), 248. https://doi.org/10.1186/s12912-025-02886-4
So, W. K. W., Dodgson, J., & Tai, J. W. M. (2003). Fatigue and Quality of Life Among Chinese Patients With Hematologic Malignancy After Bone Marrow Transplantation. Cancer Nursing, 26(3). https://journals.lww.com/cancernursingonline/fulltext/2003/06000/fatigue_and_quality_of_life_among_chinese_patients.6.aspx
Tao, L., Lv, J., Zhong, T., Zeng, X., Han, M., Fu, L., & Chen, H. (2024). Effects of sleep disturbance, cancer-related fatigue, and psychological distress on breast cancer patients’ quality of life: a prospective longitudinal observational study. Scientific Reports, 14(1), 8632. https://doi.org/10.1038/s41598-024-59214-0
Toussaint, L., Nguyen, Q. A., Roettger, C., Dixon, K., Offenbächer, M., Kohls, N., Hirsch, J., & Sirois, F. (2021). Effectiveness of Progressive Muscle Relaxation, Deep Breathing, and Guided Imagery in Promoting Psychological and Physiological States of Relaxation. Evidence-Based Complementary and Alternative Medicine : ECAM, 2021, 5924040. https://doi.org/10.1155/2021/5924040
Urtekin, D., & Eroglu, S. A. (2024). Effect of training based on Orem’s self-care deficit theory on breast cancer patients’ management of chemotherapy-related side effects and self-care behaviors: A randomized controlled trial. European Journal of Oncology Nursing : The Official Journal of European Oncology Nursing Society, 73, 102698. https://doi.org/10.1016/j.ejon.2024.102698
Valente, S. A., ElSherif, A., Tran, J., Tu, C., & Kruse, M. (2023). Pada stadium lanjut, dapat ditemukan luka terbuka, nyeri hebat, dan pembesaran kelenjar getah bening di ketiak. Pemeriksaan penunjang seperti mammografi, biopsi, dan pemeriksaan histopatologi diperlukan untuk menegakkan diagnosis dan menentukan derajat ke. The American Journal of Surgery, 225(3), 549–552. https://doi.org/https://doi.org/10.1016/j.amjsurg.2022.11.017
Van Dyk, K., Joffe, H., & Carroll, J. E. (2021). Sleep and endocrine therapy in breast cancer. Current Opinion in Endocrine and Metabolic Research, 18, 165–170. https://doi.org/10.1016/j.coemr.2021.03.007
Varadharasu, S., & Das, N. (2024). Sleep hygiene efficacy on quality of sleep and mental ability among insomniac patients. Journal of Family Medicine and Primary Care, 13(10), 4693–4698. https://doi.org/10.4103/jfmpc.jfmpc_48_24
Wagner, L. I., & Cella, D. (2004). Fatigue and cancer: causes, prevalence and treatment approaches. British Journal of Cancer, 91(5), 822–828. https://doi.org/10.1038/sj.bjc.6602012
Wang, J., & Wu, S.-G. (2023). Breast Cancer: An Overview of Current Therapeutic Strategies, Challenge, and Perspectives. Breast Cancer (Dove Medical Press), 15, 721–730. https://doi.org/10.2147/BCTT.S432526
Xu, J., Li, Q., Gao, Z., Ji, P., Ji, Q., Song, M., Chen, Y., Sun, H., Wang, X., Zhang, L., & Guo, L. (2025). Impact of cancer-related fatigue on quality of life in patients with cancer: multiple mediating roles of psychological coherence and stigma. BMC Cancer, 25(1), 64. https://doi.org/10.1186/s12885-025-13468-7
Zhao, N., Lund, H. N., & Jespersen, K. V. (2024). A systematic review and meta-analysis of music interventions to improve sleep in adults with mental health problems. European Psychiatry : The Journal of the Association of European Psychiatrists, 67(1), e62. https://doi.org/10.1192/j.eurpsy.2024.1773
Aliakbari, F., Moosaviean, Z., Masoudi, R., & Kheiri, S. (2021). The Effect of Orem Self-Care Program on Sleep Quality, Daily Activities, and Lower Extremity Edema in Patients Undergoing Coronary Artery Bypass Graft Surgery. Advanced Biomedical Research, 10, 29. https://doi.org/10.4103/abr.abr_54_20
Badowska-Kozakiewicz, A. M., Liszcz, A., Sobol, M., & Patera, J. (2017). Retrospective evaluation of histopathological examinations in invasive ductal breast cancer of no special type: an analysis of 691 patients. Archives of Medical Science : AMS, 13(6), 1408–1415. https://doi.org/10.5114/aoms.2015.53964
Barsevick, A. M., Newhall, T., & Brown, S. (2008). Management of cancer-related fatigue. Clinical Journal of Oncology Nursing, 12(5 Suppl), 21–25. https://doi.org/10.1188/08.CJON.S2.21-25
Bower, J. E., Lacchetti, C., Alici, Y., Barton, D. L., Bruner, D., Canin, B. E., Escalante, C. P., Ganz, P. A., Garland, S. N., Gupta, S., Jim, H., Ligibel, J. A., Loh, K. P., Peppone, L., Tripathy, D., Yennu, S., Zick, S., & Mustian, K. (2024). Management of Fatigue in Adult Survivors of Cancer: ASCO–Society for Integrative Oncology Guideline Update. Journal of Clinical Oncology, 42(20), 2456–2487. https://doi.org/10.1200/JCO.24.00541
Bower, J. E., & Lamkin, D. M. (2013). Inflammation and cancer-related fatigue: Mechanisms, contributing factors, and treatment implications. Brain, Behavior, and Immunity, 30, S48–S57. https://doi.org/https://doi.org/10.1016/j.bbi.2012.06.011
Bray, F., Laversanne, M., Sung, H., Ferlay, J., Siegel, R. L., Soerjomataram, I., & Jemal, A. (2024). Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 74(3), 229–263. https://doi.org/10.3322/caac.21834
Deng, Q., Kang, L., Zhu, S., Luo, W., Qing, J., Zhong, S., Wu, Y., Lu, J., & Dong, H. (2021). Effects of nursing based on Orem’s self-care model on self-care efficacy, quality of life and adverse emotions in patients with advanced lung cancer. American Journal of Translational Research, 13(4), 2983–2989.
Dionisi, S., DI Muzio, M., Giannetta, N., DI Simone, E., Gallina, B., Napoli, C., & Orsi, G. B. (2021). Nursing students’ experience of risk assessment, prevention and management: a systematic review. Journal of Preventive Medicine and Hygiene, 62(1), E122–E131. https://doi.org/10.15167/2421-4248/jpmh2021.62.1.1698
Finan, P. H., Goodin, B. R., & Smith, M. T. (2013). The association of sleep and pain: an update and a path forward. The Journal of Pain, 14(12), 1539–1552. https://doi.org/10.1016/j.jpain.2013.08.007
Hendy, A., Ibrahim, R. K., Darwish, A., Al Sabbah, S., Shalby, A. Y. M., Khubrani, R., Alawad, A. E., Abdelaliem, S. M. F., & Wahba, N. M. I. (2025). Sleep disturbance, cancer-related fatigue, and depression as determinants of quality of life among breast cancer patients undergoing chemotherapy: a cross-sectional study. BMC Cancer, 25(1), 1122. https://doi.org/10.1186/s12885-025-14538-6
Imanian, M., Imanian, M., & Karimyar, M. (2019). Sleep Quality and Fatigue among Breast Cancer Patients Undergoing Chemotherapy. International Journal of Hematology-Oncology and Stem Cell Research, 13(4), 196–200.
Izgu, N., Metin, Z. G., Eroglu, H., Semerci, R., & Pars, H. (2024). Impact of spiritual interventions in individuals with cancer: A systematic review and meta-analysis. European Journal of Oncology Nursing, 71, 102646. https://doi.org/https://doi.org/10.1016/j.ejon.2024.102646
Jakobsen, G., Gjeilo, K. H., Hjermstad, M. J., & Klepstad, P. (2022). An Update on Prevalence, Assessment, and Risk Factors for Sleep Disturbances in Patients with Advanced Cancer—Implications for Health Care Providers and Clinical Research. Cancers, 14(16). https://doi.org/10.3390/cancers14163933
Jeanifer, U. M., Mediawati, A. S., Somantri, I., & Umboh21001@mail.unpad.ac.id1, U. P. (2023). STRATEGI IMPLEMENTASI DIAGNOSIS, INTERVENSI DAN LUARAN KEPERAWATAN INDONESIA TERHADAP PERAWAT. Journal of Telenursing (JOTING), 5(2 SE-Articles), 2338–2346. https://doi.org/10.31539/joting.v5i2.5994
Kaku, A., Nishinoue, N., Takano, T., Eto, R., Kato, N., Ono, Y., & Tanaka, K. (2011). Randomized Controlled Trial on the Effects of a Combined Sleep Hygiene Education and Behavioral Approach Program on Sleep Quality in Workers with Insomnia. Industrial Health, 50, 52–59. https://doi.org/10.2486/indhealth.MS1318
Kang, Y.-E., Yoon, J.-H., Park, N., Ahn, Y.-C., Lee, E.-J., & Son, C.-G. (2023). Prevalence of cancer-related fatigue based on severity: a systematic review and meta-analysis. Scientific Reports, 13(1), 12815. https://doi.org/10.1038/s41598-023-39046-0
Khademian, Z., Kazemi Ara, F., & Gholamzadeh, S. (2020). The Effect of Self Care Education Based on Orem’s Nursing Theory on Quality of Life and Self-Efficacy in Patients with Hypertension: A Quasi-Experimental Study. International Journal of Community Based Nursing and Midwifery, 8(2), 140–149. https://doi.org/10.30476/IJCBNM.2020.81690.0
Mahdieh, M., Hossein, F., Fatemeh, F., & Mohammad, M. (2021). Sleep Quality and Cancer-Related Fatigue in Patients with Cancer. J Caring SCI, 10(3), 145–152. https://doi.org/10.1186/s12912-025-02886-4
Maqbali Al, & Mohammed. (2020). Sleep disturbance in patients with cancer. Journal of Integrative Nursing, 2(4). https://journals.lww.com/jinm/fulltext/2020/02040/sleep_disturbance_in_patients_with_cancer.1.aspx
Nancie Petrucelli, M., Mary B Daly, MD, P., & Tuya Pal, M. (2025). BRCA1- and BRCA2-Associated Hereditary Breast and Ovarian Cancer Synonym: BRCA1- and BRCA2-Associated HBOC. Cancers, 31. https://doi.org/10.3390/cancers13174287
Nguyen, L. T., Alexander, K., & Yates, P. (2018). Psychoeducational Intervention for Symptom Management of Fatigue, Pain, and Sleep Disturbance Cluster Among Cancer Patients: A Pilot Quasi-Experimental Study. Journal of Pain and Symptom Management, 55(6), 1459–1472. https://doi.org/10.1016/j.jpainsymman.2018.02.019
Paramita, N., Nusdwinuringtyas, N., Nuhonni, S. A., Atmakusuma, T. D., Ismail, R. I., Mendoza, T. R., & Cleeland, C. S. (2016). Validity and Reliability of the Indonesian Version of the Brief Fatigue Inventory in Cancer Patients. Journal of Pain and Symptom Management, 52(5), 744–751. https://doi.org/10.1016/j.jpainsymman.2016.04.011
Qu, L., Zhu, J., Mei, X., Yi, Z., Luo, N., Yuan, S., Liu, X., Liu, M., Xie, H., Hu, X., Pan, L., Liang, Q., Li, Y., Zou, Q., Zhou, Q., Zhang, D., Zhou, M., Pei, L., Qian, K., … Yi, W. (2025). Evaluating axillary lymph node metastasis risks in breast cancer patients via Semi-ALNP: a multicenter study. EClinicalMedicine, 85. https://doi.org/10.1016/j.eclinm.2025.103311
Rakhshani, T., Najafi, S., Javady, F., Taghian dasht bozorg, A., Mohammadkhah, F., & Khani Jeihooni, A. (2022). The effect of Orem-based self-care education on improving self-care ability of patients undergoing chemotherapy: a randomized clinical trial. BMC Cancer, 22(1), 770. https://doi.org/10.1186/s12885-022-09881-x
Rusmiati, T., & Maria, L. (2023). HUBUNGAN DUKUNGAN KELUARGA TERHADAP MOTIVASI PASIEN KANKER PAYUDARA YANG TELAH KEMOTERAPI. Jurnal Kesehatan Dan Pembangunan, 13(23), 159–169. https://doi.org/10.1016/j.pmn.2018.09.005
Sari, D. A., Waluyo, A., Alfianti, Y., & Putri, Y. S. E. (2025). EFEKTIFITAS TERAPI NON-FARMAKOLOGI PADA GANGGUAN TIDUR PASIEN KANKER: SYSTEMATIC REVIEW. Jurnal Menara Medika, 7(2723–6862), 2622-657X. https://doi.org/10.1046/j.1365-2648.2003.02768.x
Seyednazari, M. A., Amini, K., Ramezani-Badr, F., & Markani, A. K. (2025). Effect of a structured Orem’s self-care model nursing intervention on sleep quality and academic self-efficacy in nursing students. BMC Nursing, 24(1), 248. https://doi.org/10.1186/s12912-025-02886-4
So, W. K. W., Dodgson, J., & Tai, J. W. M. (2003). Fatigue and Quality of Life Among Chinese Patients With Hematologic Malignancy After Bone Marrow Transplantation. Cancer Nursing, 26(3). https://journals.lww.com/cancernursingonline/fulltext/2003/06000/fatigue_and_quality_of_life_among_chinese_patients.6.aspx
Tao, L., Lv, J., Zhong, T., Zeng, X., Han, M., Fu, L., & Chen, H. (2024). Effects of sleep disturbance, cancer-related fatigue, and psychological distress on breast cancer patients’ quality of life: a prospective longitudinal observational study. Scientific Reports, 14(1), 8632. https://doi.org/10.1038/s41598-024-59214-0
Toussaint, L., Nguyen, Q. A., Roettger, C., Dixon, K., Offenbächer, M., Kohls, N., Hirsch, J., & Sirois, F. (2021). Effectiveness of Progressive Muscle Relaxation, Deep Breathing, and Guided Imagery in Promoting Psychological and Physiological States of Relaxation. Evidence-Based Complementary and Alternative Medicine : ECAM, 2021, 5924040. https://doi.org/10.1155/2021/5924040
Urtekin, D., & Eroglu, S. A. (2024). Effect of training based on Orem’s self-care deficit theory on breast cancer patients’ management of chemotherapy-related side effects and self-care behaviors: A randomized controlled trial. European Journal of Oncology Nursing : The Official Journal of European Oncology Nursing Society, 73, 102698. https://doi.org/10.1016/j.ejon.2024.102698
Valente, S. A., ElSherif, A., Tran, J., Tu, C., & Kruse, M. (2023). Pada stadium lanjut, dapat ditemukan luka terbuka, nyeri hebat, dan pembesaran kelenjar getah bening di ketiak. Pemeriksaan penunjang seperti mammografi, biopsi, dan pemeriksaan histopatologi diperlukan untuk menegakkan diagnosis dan menentukan derajat ke. The American Journal of Surgery, 225(3), 549–552. https://doi.org/https://doi.org/10.1016/j.amjsurg.2022.11.017
Van Dyk, K., Joffe, H., & Carroll, J. E. (2021). Sleep and endocrine therapy in breast cancer. Current Opinion in Endocrine and Metabolic Research, 18, 165–170. https://doi.org/10.1016/j.coemr.2021.03.007
Varadharasu, S., & Das, N. (2024). Sleep hygiene efficacy on quality of sleep and mental ability among insomniac patients. Journal of Family Medicine and Primary Care, 13(10), 4693–4698. https://doi.org/10.4103/jfmpc.jfmpc_48_24
Wagner, L. I., & Cella, D. (2004). Fatigue and cancer: causes, prevalence and treatment approaches. British Journal of Cancer, 91(5), 822–828. https://doi.org/10.1038/sj.bjc.6602012
Wang, J., & Wu, S.-G. (2023). Breast Cancer: An Overview of Current Therapeutic Strategies, Challenge, and Perspectives. Breast Cancer (Dove Medical Press), 15, 721–730. https://doi.org/10.2147/BCTT.S432526
Xu, J., Li, Q., Gao, Z., Ji, P., Ji, Q., Song, M., Chen, Y., Sun, H., Wang, X., Zhang, L., & Guo, L. (2025). Impact of cancer-related fatigue on quality of life in patients with cancer: multiple mediating roles of psychological coherence and stigma. BMC Cancer, 25(1), 64. https://doi.org/10.1186/s12885-025-13468-7
Zhao, N., Lund, H. N., & Jespersen, K. V. (2024). A systematic review and meta-analysis of music interventions to improve sleep in adults with mental health problems. European Psychiatry : The Journal of the Association of European Psychiatrists, 67(1), e62. https://doi.org/10.1192/j.eurpsy.2024.1773