Literature Review: Use of Virgin Coconut Oil in Prevention of Decubitus

Wounds in Immobility Patients

Jesica G. Rukmana1, Renata Komalasari2, Shinta Yuliana Hasibuan3

1. Students of the Faculty of Nursing and Health Sciences
2. Lecturer at the Faculty of Nursing and Health Sciences, Pelita Harapan University
3. Clinical Educator, Faculty of Nursing and Health Sciences, Pelita Harapan University,
Karawaci 15811 Tangerang
E-mail: jessica.rukmana@gmail.com

ABSTRACT
Virgin Coconut Oil (VCO) is pure coconut oil which contains fatty acids that can soften the skin and act as a
moisturizer that can increase skin hydration. This literature review aims to review the effectiveness of using
virgin coconut oil in the prevention of pressure sores in immobility patients. This research method is a
literature review. Keywords used to conduct literature search included virgin coconut oil, decubitus wounds,
immobility patients, virgin coconut oil, decubitus ulcers, immobility patients. The databases used are the
Garuda Portal and Google Scholar. Of the xxx articles identified, five eligible articles for review. The analysis
method used was thematic analysis: simplified approach. The results of this study identified four themes,
including massage methods that are effective in preventing pressure sores, the use of VCO to prevent the
incidence of pressure sores, the use of VCO to reduce the effects of friction and pressure and the use of VCO
to inhibit fungal and bacterial infections. In conclusion, VCO is effective in preventing pressure sores in
immobility patients. Further research can be conducted research to examine the factors that influence the
effectiveness of VCO in the prevention of pressure sores.

Keywords: Decubitus Wounds, Immobility Patients, Virgin Coconut Oil

ABSTRACT
Virgin Coconut Oil (VCO) is a pure coconut oil which contains fatty acids that can soften the skin and serve as
a moisturizer that can improve the hydration of the skin. This literature review was aimed at exploring the
application of virgin coconut oil in the decubitus ulcer prevention for immobile patients. The keywords used
consisted of pure coconut oil, decubitus ulcers, immobile patients (immobility patients), virgin coconut oil. The
databases included Portal Garuda and, Google Scholar. Of xx Total articles identified, five were reviewed.
The method of analysis used thematic analysis: simplified approach. The results of this study found four
themes, namely effective massage methods to prevent decubitus ulcers, the use of VCO to prevent the incidence
of decubitus ulcer, the use of VCO reduces the effects of friction and pressure and the use of VCO inhibits
candidas and bacterial infections. It can be concluded that VCO is effective to prevent sores in immobile
patients. Future study is needed to identify factors affecting VCO effectiveness in the prevention of decubitus
ulcers.

Keywords: Decubitus Ulcer, Immobility Patients, Virgin Coconut Oil

One of the integrity of the skin is pressure

PRELIMINARY
A situation where a person cannot move
actively or freely due to conditions that
interfere with activity can be called
immobility or bed rest (Rismawan, 2014).
The negative impact of immobility on the
physical is damage
ulcers or pressure sores (Asmadi, 2008).
Rismawan (2014) revealed that several
conditions can lead to immobilization,
including joint and bone disorders, diseases
related to nerves,

62 Nursing Current Vol. 5 No. 1, January 2017 - June

2017
associated with heart and respiration as well skin care measures that are at risk of damage
as critical illness that requires bed rest. to skin integrity, especially in areas that

Decubitus is often found in patients with experience pressure or protrusions (Uliyah &

bed rest or immobility for a long time ( Hidayat, 2008). Caring for the skin by

Rubenstein et al, 2007). providing a topical which functions to

moisturize the skin in areas at risk of pressure

Potter & Perry (2013) revealed that pressure sores.

sores, pressure sores or bedsores are a
disturbance in the integrity of the skin Virgin Coconut Oil (VCO) is pure coconut

associated with prolonged and unrelenting oil produced from the processing of coconut

pressure. Decubitus or pressure sores are flesh without heating or heating at low

the conditions most often experienced by temperatures so as to produce oil with a

individuals who experience prolonged clear color and free from free radicals due

immobility (Marrelli, 2007). Pressure and to heating (Handayani et al, 2011). Lucida

tissue tolerance can cause pressure sores or et al (2008) revealed that the content of

pressure sores (Setiani, 2014). Bryant (2007 fatty acids (especially lauric and oleic acids

) states that the pathophysiology of the ) in VCO has properties that can soften the

formation of pressure sores is primarily due skin. VCO is effectively used as a

to prolonged constant pressure from outside moisturizer on the skin so that it can

. Areas where pressure sores are common increase skin hydration and accelerate

are bony ridges that are subjected to or healing of the skin (Agero & Verallo-

experience pressure. Decubitus ulcers occur Rowell, 2004; Lucida et al, 2008).

above the bony prominence of the pelvis as

much as 95% (Marrelli, 2007). Based on the author's observations during
his practice in the Intensive Care Unit of

Several attempts can be made as an Siloam Hospitals Kebon Jeruk, almost all of

intervention to prevent pressure sores, such the patients treated were immobility or

as wound care, topical drugs, therapeutic prolonged bed rest.

mattresses and education (Mutia et al, 2015

). Caring for the skin is a

2 Nursing Current Vol. 5 No. 1, January 2017 - June

2017
 The length of stay in the ICU varies, from a
week to three months of treatment days.
The disease conditions experienced by the
Kebon Jeruk ICU patients are bone injuries,
diseases related to nerves, diseases related
to the heart and respiration, and critical
illnesses that require rest such as sepsis.
Since the first time I served in the ICU (08
May 2017) until now (30 June 2017), the
author has observed after every shower and
changing the right-to-left tilt position (every
two hours), the back of each patient is
always smeared with VCO. Some patients
use lotion or olive oil, but nurses in the ICU
use VCO more because it is available in the
ICU room at Siloam Hospitals Kebon Jeruk.
Several researchers have proven the
effectiveness of virgin coconut oil for
preventing pressure sores in patients in the
Intensive Care Unit (Setiani, 2014) and in
patients treated with immobilization (
Sihombing et al, 2016). These
considerations have attracted the author to
conduct a study on the effectiveness of
using virgin coconut oil in preventing
pressure sores in immobility patients.
Nursing Current Vol. 5 No. 1, January 2017 - June
2017
METHODOLOGY
This research is a quantitative study
literature review with experimental design
in order to obtain the effectiveness of using
virgin coconut oil in preventing pressure
sores in immobility patients. The keywords
used to conduct literature search in the
database were the first key "Decubitus
Wounds AND Pure Coconut Oil AND
Immobility Patients" and the second
keyword "Decubitus Ulcer AND Virgin
Coconut Oil AND Immobility Patients".
The database used includes the Garuda
Portal and Google Scholar. The results of
the literature search will be documented in
the PRISMA chart.
The inclusion criteria in this literature
review are articles in full-text, in Indonesian
and English, published in the last 10 years (
2007-2017), articles using quantitative
research methods and the study sample is
adult patients who are immobility and do
not have decubitus sores . The exclusion
criteria were articles that were expert
opinions or expert comments, literature
reviews and research samples were
pediatric patients.
3
According to Wager and Wiffen (2011), data from respondents or participants. This

there are several ethical standards when literature review is the result of evaluation

conducting literature reviews. First, avoid and analysis of various literatures obtained

duplicate publications by selecting the same by authors from various databases.

articles in each database used to prevent Therefore, the author received a legality

double counting. The author includes a permit from the Faculty of Nursing, Pelita

literature review in the title to show that the Harapan University through an ethical test

research carried out is a literature review. of Research Community Service and

Second, avoid plagiarism by citing the Technical Service.

results of other people's research. The

author uses in-text or end-text citation and After developing a search strategy and

includes references using the APA style ethical research considerations, the authors

provisions to prevent plagiarism. determined a method for analyzing the data

in order to answer the research questions

Third, it ensures that published data is from this literature review. Data analysis in

extracted accurately and that there is no the literature review begins with Aveyard's

indication to try to lean the data in a critical appraisal (2010). To do a critical

particular direction. Fourth, transparency is appraisal, the writer needs an instrument to

by describing everything that happens assess the articles that the author uses. In

during the research clearly and openly, for this study, the authors used seven questions

example in terms of funding or the reasons from Woolliams et al in Aveyard (2010) to

why the author prefers one article over perform a critical appraisal.

another (Wager & Wiffen, 2011). The

author will use this ethical standard to The approach used in analyzing the data

conduct a literature review. that has been criticized in this study is the
simplified approach. According to Aveyard

In making this literature review, the author (2010), this approach is an approach that

does not use retrieval aims to conclude quality articles with

different methods of use

4 Nursing Current Vol. 5 No. 1, January 2017 - June

2017
 answer literature review research questions RESULTS
for beginners, which are usually used by The literature review was conducted from
students or undergraduate to conduct mid-November 2017 to early January 2018.
literature reviews in the health and social The total articles obtained from searching
fields. using the first and second keywords through
three databases were 143 articles and the
articles analyzed were five articles. The
search results are also presented in the chart
form below as suggested by PRISMA (2009
).
Diagram 1
Flow diagram of literature search results and study selection. Source Moher D, Liberati A, Tetzlaff J, Altman
DG, the PRISMA Group (2009).

Garuda Portal (4) UPH Library (1) Google Scholar (138)

Exclusion articles:

Articles (n = 143) Title and abstract do not

match (n = 114)

Exclusion articles:
non full-text (n = 18
)

Exclusion articles (n = 6):

 5 case reports
11 eligible articles  1 article has no journal

name, volume number

and page number

Full text
screening
(n = 29)

5 full-text
articles
reviewed

Nursing Current Vol. 5 No. 1, January 2017 - June 5

2017
In the process of searching for articles, This literature review uses four research

there were 114 articles that did not match articles with a quasi-experimental design

the title and purpose of the study, 18 articles and one study with an experimental

that were not full-text, which were then longitudinal design. Four studies were

removed from the list of articles to be conducted on the Indonesian population and

studied, so that there were 11 full-text one on the Indian population. The total

articles to be studied from the abstract and sample involved in the study was 188

titles with criteria inclusion. Based on the participants. The themes found are based on

results of the study, 6 full-text articles were the statements of research results that

issued, namely five case reports and one answer the literature review questions that

article without the journal name, volume the author has summarized in the first stage

number and page number. After the of the simplified approach analysis in the

selection, five full-text articles that match literature review table.

the inclusion criteria were obtained and will

be used in conducting a literature review.

Table 1
Results of the Literature Review

Use of VCO to Use of VCO

Massage Methods Use of VCO to
Researc prevent injury Reduces the Inhibit Fungal and
That Are
her, Year, Title events Effects of Friction Bacterial
Effective In Infections
Decubitus And
Preventing
Pressure
Decubitus Sores
Author: Effleurage massage There were no VCO could used as Fatty acids
Setiani. (2014) with VCO in the injuries press on a lubricant so as to antisepticon
area of ​the scapula, respondents. reduce the effects oil coconut help
Title: sacrum and heels. of friction and prevent infection
Effectiveness pressure. fungi and bacteria.
Massage with
Virgin Coconut Oil
Against Prevention
Wound Press on the
Intensive Care Unit

6 Nursing Current Vol. 5 No. 1, January 2017 - June

2017
 Author: Massage Effleurage There were no Inside content VCO Topical VCO can
Handayani et al. ( in the area of ​the injuries press on could help reduce inhibit it infection
2011) scapula,sacrum, respondents. effect friction and mushrooms as a
and heels. pressure. factor that reduces
Title: tissue resistance.
Prevention Wound
Press Through
Massage Using
Virgin Coconut Oil

Author: Massage back by There was a

Sihombing et al. ( using the VCO pressure wound as
2016) reduce the risk of much 5
occurrence respondents of 25
Title: wound press.
The Effectiveness total respondents.

Of Back Massage
Using Virgin
Coconut Oil and
White Petroleum
Jelly To Prevent
Pressure Sores

Author: Massage back by There were no

Dhikhil, et al. usingVCO. injuries press on
(2014) respondents.

Title
Effect of Coconut
Oil Usage in Risk
of Pressure Ulcers
Among Bedridden
Patients of Selected
Hospitals in North
India

Nursing Current Vol. 5 No. 1, January 2017 - June 7

2017
Author: Massage using There were no
Marina et al. (2013) VCO at the point of injuries press on
bone prominence, respondents.
Title: namely the earlobe,
Prevention the scapula,elbw,
Incident Wound sacrum, buttocks,
PressThrough hip,knee, ankles and
Virgin Coconut Oil heels.
Massage for
Patients with
Immobilization

decubitus. The use of VCO with massage

DISCUSSION
can not only increase muscle relaxation and
Massage Methods That Are Effective In
increase circulation, but can also increase
Preventing Decubitus Sores
the absorption of VCO biological content
In this literature review, there are five
through the skin (Handayani et al, 2011 &
articles that discuss the types of massage
Sihombing et al, 2016).
using virgin coconut oil. There are two
research articles which reveal that the
The use of VCO prevents the incidence of
intervention carried out is effleurage
decubitus sores
massage with VCO (Setiani, 2014 &
Based on the results of the study on the five
Handayani et al, 2011). Two research
research articles, it was found that the
articles that report the interventions carried
average range of incidence of decubitus
out, namely back massage using VCO (
sores was zero (0) respondents to five (5)
Sihombing et al, 2016 & Dhikhil et al, 2016
respondents. Four articles stated that there
). There is one article which states that the
were no pressure sores in the VCO group
intervention carried out is massage at the
respondents. One research article stated that
points of bone prominence (Marina et al,
there were five (5) respondents out of a
2013).
total of 25 respondents who had pressure
sores.
Mituhu et al (2011) stated that back
massage measures can change the pressure
Decubitus sores can be caused by exposure
and improve blood circulation in stressed
to sweat, blood, urine and feces (Al
areas so as to prevent

8 Nursing Current Vol. 5 No. 1, January 2017 - June

2017
 Rasyid & Misbach, 2015). Immobility The use of VCO reduces the effects of

patients are particularly susceptible to friction and pressure

exposure to urine or fecal sweat because of In this literature review, there are two

the inability to move. Virgin Coconut Oil articles that discuss the use of VCO to

can be given as a topical ingredient which reduce the effects of friction and pressure (

functions as a moisturizer to prevent dry Setiani, 2014 & Handayani et al, 2011).

skin and as a topical ingredient to minimize According to the National Guideline

exposure to excessive sweat, urine or feces Clearinghouse (NGC) & Institute for

because of its nature as an oil that cannot be Clinical Systems Improvement (ICSI) (

mixed with water (Setiani, 2014). 2010), one of the prevention of pressure
sores is to reduce or eliminate friction and

National Guideline Clearinghouse (NGC) pressure. Periodically, use hypoallergenic

& Institute for Clinical Systems lubricating oils, creams or lotions that can

Improvement (ICSI) (2010) reduce pressure and friction (National

revealed that one of the prevention of Guideline Clearinghouse & Institute for

pressure sores is to provide topicals such as Clinical Systems Improvement, 2010).

creams, lubricating oils or ointments needed Virgin coconut oil can be used as a topical

to protect and treat intact skin, or to treat prevention of pressure sores because of its

non-intact cells. Lucida et al (2008) also various ingredients.

stated that the content of fatty acids (

especially lauric and oleic acids) in VCO Use of VCO to Inhibit Fungal and

has properties that can soften the skin. In Bacterial Infections

addition, the small medium chain fatty acids In this literature review, there are two

(MCFA) molecules in VCO are easily articles discussing the use of VCO in

absorbed by the skin surface (Handayani et immobility patients to inhibit infection

al, 2011).

Nursing Current Vol. 5 No. 1, January 2017 - June 9

2017

fungi and bacteria (Setiani, 2014 &
Handayani et al, 2011). Research by Rajan
et al (2016) explains that virgin coconut oil
is extracted and purified by a filtration
method which proves that virgin coconut oil
can inhibit the development of fungi.
According to Setiani (2014), the fatty acids
contained in coconut oil do not directly
function as anti-microbes but will react with
skin bacteria to form free fatty acids such as
those contained in sebum (sebum contains
uric acid and lactic acid). In this theme, it
was concluded that topical VCO could
inhibit fungal and bacterial infections in
preventing pressure sores.
CONCLUSION
This literature review research has reviewed
five articles obtained from three databases using
several keywords. From the search results, there
were 143 articles which were then checked
again using inclusion and exclusion criteria,
leaving five articles. All articles used in this
literature review describe research using
research methods
10
quantitative with experimental and quasi-
experimental longitudinal designs.
In this literature review, it was found that the
average range of incidence of decubitus sores in
immobility patients using VCO was zero to five
respondents. This shows that virgin coconut oil
is effective in preventing pressure sores in
immobility patients because it can reduce the
effects of friction and pressure. In addition,
VCO can be an inhibitor for fungal and
bacterial infections to prevent infection. Based
on the conclusion of the literature review, virgin
coconut oil is recommended for use in
immobility patients with low, moderate and
high risk of falling.
SUGGESTION
Further research can be carried out research
to investigate the factors that influence the
effectiveness of VCO in the prevention of
pressure sores. Based on this review, it is
necessary to make an SOP for the
prevention of pressure sores using VCO in
immobility patients in Indonesia because it
can prevent the incidence of pressure sores,
thereby reducing the length of stay and
treatment costs.
Nursing Current Vol. 5 No. 1, January 2017 - June
2017
 REFERENCES
Agero, A.L & Verallo-Rowell, VM (2004). A Randomized Double-Blind Controlled Trial
Comparing Extra Virgin Coconut Oil As A Moisturizer For Mild To Moderate Xerosis
. Dermatitis, 15 (3), 109-116.

Alrasyid & Misbach, J. (2016). Medical and Administrative Complications. Jakarta: FKUI
Publishing Agency.

Asmadi. (2008). Nursing Procedural Techniques: Concepts and Applications of Client's

Basic Needs. Jakarta: Salemba Medika.

Aveyard, H. (2010). Doing a Literature Review in Health and Social Care: A Practical
Guide. 2nd ed. Maidenhead: McGraw-Hill Open University Press.

Bryant, RA (2007). Acute and Chronic Wounds Nursing Management, Second Edition.
Missouri: Mosby Inc.

Dhikhil, et al. (2007). Effect of Coconut Oil Usage in Risk of Pressure Ulcers Among
Bedridden Patients of Selected Hospitals in North India. Dhikhil CD et al, iP-Planet,
Vol 1 (2), 71-78, 2014.

Handayani et al. (2011). Wound Prevention Press Through Massage Using Virgin Coconut
Oil. Indonesian Nursing Journal, Volume 14, No. 3, November 2011; Thing. 141-148.

Lucida et al. (2008). Test the Penetration Enhancing Power of Virgin Coconut Oil (VCO) in
a Cream Base. Journal of Pharmaceutical Science and Technology, Vol. 13, No. 1,
2008, p. 23-30.

Marina et al. (2015). Prevention of pressure sores through virgin coconut oil massage in
patients with immobilization. Nursing Current Vol. January 1, 2013-June 2013.

Marrelli, TM (2007). Nursing Documentation Pocket Book, Ed. 3. Jakarta: EGC.

Mituhu et al. (2011). The Effectiveness of Giving Back Massage on the Prevention of
Decubitus in Patients with Bed Rest at Kajen Regional Hospital, Pekalongan Regency.
J. Nursing and Midwifery (JIKK). Vol. I No. 4, June 2011: 196-204

Mutia et al. (2015). Profiles of Patients with Decubitus Ulcers Who Underwent Bed Rest in
the Inpatient Room of the Arifin Achmad Hospital, Riau Province for the period
January 2011- December 2013. JOM FK Volume 2 No. 2 things. 1-11. 2015.

National Guideline Clearinghouse (NGC) & Institute for Clinical Systems Improvement (
ICSI). 2010. Pressure ulcer prevention and treatment. Health Care Protocol.
Bloomington (MN): Institute for Clinical Systems Improvement (ICSI).

Potter, P. A & Perry, AG (2013). Fundamental of Nursing, Eight Edition. Canada: Mosby
Elsevier.

Nursing Current Vol. 5 No. 1, January 2017 - June 11

2017
Rajan et al. (2016). A Study on In-Vitro Antimicrobial Activity of Coconut Water and
Coconut Oil on Candida Species. Rajan et al., World J Pharm Sci 2016; 4 (12): 266-
268

Rismawan, W. (2014). The Relationship of Client's Family Knowledge Level About

Decubitus Prevention Against Decubitus Incidence in Total Bedrest Patients at Dr.
Soekardjo Tasikmalaya, Tasikmalaya City. Journal of Health Evidence Shoots Husada
Volume 12 No. 1, pg. 112-127.

Rubenstein et al. (2007). Lecture Notes: Clinical Medicine, Sixth Edition. Jakarta: Erlangga.

Setiani, D. (2014). Effectiveness of Massage with Virgin Coconut Oil Against Press Wound
Prevention in the Intensive Care Unit. Husada Mahakam Journal Volume III No. 8, pg
. 389-442.

Sihombing et al. (2016). The Effectiveness of Back Massage Using Virgin Coconut Oil and
White Petroleum Jelly To Prevent Pressure Sores. Muhammadiyah Nursing Journal, 1
(2), p. 1-9.

Uliyah, M & Hidayat, AAA (2008). Practicum Basic Skills Clinical Practice: Basic
Application of Midwifery Practice. Jakarta: Salemba Medika.

Wager, E & Wiffen, PJ (2011). Ethical issues in preparing and publishing systematic
reviews. Journal of Evidence-Based Medicine, 4 (2), p. 130- 134.

12 Nursing Current Vol. 5 No. 1, January 2017 - June

2017
 Kajian Literatur: Penggunaan Virgin Coconut Oil Dalam Pencegahan
Luka Dekubitus Pada Pasien Imobilitas

Jesica G. Rukmana1, Renata Komalasari2, Shinta Yuliana Hasibuan3

1. Mahasiswa Fakultas Keperawatan dan Ilmu Kesehatan
2. Dosen Fakultas Keperawatan dan Ilmu Kesehatan Universitas Pelita Harapan
3. Clinical Educator Fakultas Keperawatan dan Ilmu Kesehatan Universitas Pelita Harapan
Karawaci 15811 Tangerang
E-mail: jessica.rukmana@gmail.com

ABSTRAK
Virgin Coconut Oil (VCO) merupakan minyak kelapa murni yang mengandung asam lemak yang dapat
melembutkan kulit dan sebagai moisturizer yang dapat meningkatkan hidrasi kulit. Kajian literatur ini
bertujuan untuk meninjau efektivitas penggunaan virgin coconut oil dalam pencegahan luka dekubitus pada
pasien imobilitas. Metode penelitian ini merupakan sebuah kajian literatur. Kata kunci yang digunakan untuk
melakukan pencarian literatur meliputi minyak kelapa murni, luka dekubitus, pasien imobilitas, virgin coconut
oil, decubitus ulcer, immobility patients. Database yang digunakan adalah Portal Garuda dan Google Scholar.
Dari xxx artikel yang teridentifikasi, lima artikel eligible untuk direview Metode analisis yang digunakan
thematic analysis: simplified approach. Hasil penelitian ini mengidentifikasi empat tema, meliputi metode
pijat yang efektif mencegah luka dekubitus, penggunaan VCO mencegah kejadian luka dekubitus, penggunaan
VCO mengurangi efek gesekan dan tekanan serta penggunaan VCO menghambat infeksi jamur dan bakteri.
Dapat disimpulkan, VCO efektif dalam pencegahan luka dekubitus pada pasien imobilitas. Penelitian
selanjutnya dapat dilakukan penelitian untuk meneliti faktor-faktor yang mempengaruhi keefektifan VCO
dalam pencegahan luka dekubitus.

Kata Kunci: Luka Dekubitus, Pasien Imobilitas, Virgin Coconut Oil

ABSTRACT
Virgin Coconut Oil (VCO) is a pure coconut oil which contains fatty acids that can soften the skin and serve as
a moisturizer that can improve the hydration of the skin. This literature review was aimed at exploring the
application of virgin coconut oil in the decubitus ulcer prevention for immobile patients. The keywords used
consisted of pure coconut oil (minyak kelapa murni), decubitus ulcers (luka dekubitus), immobile patients
(pasien imobilitas), virgin coconut oil.. The databases included Portal Garuda and, Google Scholar. Of xx
Total articles identified, five were reviewed. The method of analysis used thematic analysis: simplified
approach. The results of this study found four themes, namely effective massage methods to prevent decubitus
ulcers, the use of VCO to prevent the incidence of decubitus ulcer, the use of VCO reduces the effects of
friction and pressure and the use of VCO inhibits candidas and bacterial infections. It can be concluded that
VCO is effective to prevent sores in immobile patients. Future study is needed to identify factors affecting VCO
effectiveness in the prevention of decubitus ulcers.

Keywords: Decubitus Ulcer, Immobility Patients, Virgin Coconut Oil

PENDAHULUAN integritas kulit salah satunya yaitu ulkus

Keadaan dimana seseorang tidak dapat dekubitus atau luka tekan (Asmadi, 2008).

bergerak secara aktif atau bebas Rismawan (2014) mengungkapkan,

dikarenakan kondisi yang mengganggu beberapa kondisi dapat menyebabkan

aktivitas dapat disebut imobilitas atau tirah terjadinya imobilisasi diantaranya gangguan

baring (Rismawan, 2014). Dampak negatif sendi dan tulang, penyakit yang

imobilitas terhadap fisik yaitu kerusakan berhubungan dengan saraf, penyakit yang

62 Nursing Current Vol. 5 No. 1, Januari 2017 – Juni 2017

berhubungan dengan jantung dan tindakan perawatan pada kulit yang berisiko
pernapasan serta penyakit kritis yang terjadi kerusakan integritas kulit, khususnya
memerlukan tirah baring. Dekubitus sering pada daerah yang mengalami tekanan atau
ditemukan pada pasien tirah baring atau tonjolan (Uliyah & Hidayat, 2008).
imobilitas dalam waktu lama (Rubenstein et Merawat kulit dengan memberikan topikal
al, 2007). yang berfungsi untuk melembabkan kulit
pada daerah yang berisiko terjadinya luka
Potter & Perry (2013) mengungkapkan tekan.
bahwa luka tekanan, luka dekubitus atau
luka baring adalah gangguan integritas kulit Virgin Coconut Oil (VCO) merupakan
berhubungan dengan tekanan yang lama minyak kelapa murni yang dihasilkan dari
dan tak henti-henti. Luka dekubitus atau proses pengolahan daging buah kelapa
luka tekan merupakan kondisi yang paling tanpa melakukan pemanasan atau melalui
sering dialami oleh individu yang pemanasan dengan suhu rendah sehingga
mengalami imobilitas lama (Marrelli, menghasilkan minyak dengan warna yang
2007). Tekanan dan toleransi jaringan dapat jernih serta bebas dari radikal bebas akibat
menyebabkan luka tekan atau luka pemanasan (Handayani et al, 2011). Lucida
dekubitus (Setiani, 2014). Bryant (2007) et al (2008) mengungkapkan kandungan
menyatakan patofisiologi terbentuknya luka asam lemak (terutama asam laurat dan
tekan secara primer disebabkan tekanan oleat) dalam VCO memiliki sifat yang
konstan yang cukup lama dari luar. Daerah dapat melembutkan kulit. VCO efektif
yang sering terjadi luka tekan adalah digunakan sebagai moisturizer pada kulit
tonjolan tulang yang mendapat atau sehingga dapat meningkatkan hidrasi kulit
mengalami tekanan. Ulkus dekubitus terjadi dan mempercepat penyembuhan pada kulit
di atas tonjolan tulang pelvis sebanyak 95% (Agero & Verallo-Rowell, 2004; Lucida et
(Marrelli, 2007). al, 2008).

Beberapa usaha dapat dilakukan sebagai Berdasarkan pengamatan penulis selama

tindakan intervensi pencegahan luka praktik di ruang Intensive Care Unit Siloam
dekubitus seperti perawatan luka, obat Hospitals Kebon Jeruk, hampir semua
topikal, kasur terapeutik dan edukasi (Mutia pasien yang dirawat adalah pasien dalam
et al, 2015). Merawat kulit merupakan keadaan imobilitas atau tirah baring lama.

Nursing Current Vol. 5 No. 1, Januari 2017 – Juni 2017 63

Lama rawat pasien di ICU beragam, dari METODOLOGI
seminggu sampai tiga bulan hari perawatan. Penelitian ini merupakan kajian literatur
Kondisi penyakit yang dialami pasien ICU studi kuantitatif dengan experimental
Kebon Jeruk adalah cedera tulang, penyakit design guna memperoleh keefektifan
yang berhubungan dengan saraf, penyakit penggunaan virgin coconut oil dalam
yang berhubungan dengan jantung dan pencegahan luka dekubitus pada pasien
pernapasan, serta penyakit kritis yang imobilitas. Kata kunci yang digunakan
memerlukan istirahat seperti sepsis. Sejak untuk melakukan pencarian literatur
pertama kali dinas di ruangan ICU (08 Mei didatabase adalah kunci pertama “Luka
2017) sampai saat ini (30 Juni 2017), Dekubitus AND Minyak Kelapa Murni
penulis telah mengamati setiap setelah AND Pasien Imobilitas’” dan kata kunci
mandi dan merubah posisi miring kanan- kedua ”Decubitus Ulcer AND Virgin
miring kiri (dua jam sekali), tubuh bagian Coconut Oil AND Immobility Patients”.
belakang setiap pasien selalu diolesi VCO. Database yang digunakan meliputi Portal
Sebagian pasien memakai lotion atau Garuda dan Google Scholar. Hasil dari
minyak zaitun, tetapi perawat di ruang ICU pencarian literatur akan penulis
lebih banyak memakai VCO karena tersedia dokumentasikan ke dalam bagan PRISMA.
di ruang ICU Siloam Hospitals Kebon
Jeruk. Kriteria inklusi dalam kajian literatur ini
adalah artikel dalam berbentuk full-text,
Beberapa peneliti telah membuktikan berbahasa Indonesia dan Inggris yang
efektivitas virgin coconut oil untuk diterbitkan dalam rentang 10 tahun terakhir
mencegah luka dekubitus pada pasien di (2007-2017), artikel menggunakan metode
Intensive Care Unit (Setiani, 2014) dan penelitian kuantitatif dan sampel penelitian
pada pasien yang dirawat dengan adalah pasien dewasa yang mengalami
imobilisasi (Sihombing et al, 2016). imobilitas dan belum memiliki luka
Pertimbangan-pertimbangan ini yang dekubitus. Kriteria eksklusinya adalah
menarik minat penulis untuk melakukan artikel yang merupakan pendapat ahli atau
penelitian mengenai efektivitas penggunan komentar pakar, literature review dan
virgin coconut oil terhadap pencegahan sampel penelitian adalah pasien anak.
luka dekubitus pada pasien imobilitas.

64 Nursing Current Vol. 5 No. 1, Januari 2017 – Juni 2017

Menurut Wager dan Wiffen (2011) terdapat data dari responden atau partisipan. Kajian
beberapa standar etik ketika melakukan literatur ini merupakan hasil evaluasi dan
kajian literatur. Pertama, hindari duplikat analisa dari berbagai literatur yang
publikasi dengan cara menyeleksi artikel didapatkan oleh penulis dari berbagai
yang sama pada setiap database yang database. Oleh karena itu, penulis
digunakan agar tidak terjadi double mendapat izin legalitas dari Fakultas Ilmu
counting. Penulis mencantumkan kajian Keperawatan Universitas Pelita Harapan
literatur pada judul untuk menunjukan melalui uji etik Research Comunity Service
penelitian yang dilakukan adalah kajian and Technical Service.
literatur. Kedua, hindari plagiat dengan cara
mengutip hasil penelitian orang lain. Setelah menyusun strategi pencarian dan
Penulis menggunakan sitasi in-text atau pertimbangan etik penelitian, penulis
end-text dan mencantumkan referensi menentukan metode untuk menganalisa
dengan menggunakan ketentuan APA style data guna menjawab pertanyaan penelitian
untuk mencegah plagiarisme. dari literature review ini. Analisa data pada
kajian literatur dimulai dengan critical
Ke tiga, mememastikan data yang appraisal dari Aveyard (2010). Untuk
dipublikasikan telah diekstraksi secara melakukan critical appraisal, penulis
akurat dan tidak adanya indikasi untuk membutuhkan instrumen untuk menilai
mencoba mencondongkan data ke arah artikel-artikel yang penulis gunakan. Dalam
tertentu. Keempat, transparansi dengan cara penelitian ini, penulis menggunakan tujuh
memaparkan segala sesuatu yang terjadi pertanyaan dari Woolliams et al dalam
selama penelitian dengan jelas dan terbuka, Aveyard (2010) untuk melakukan critical
misalnya dalam hal pendanaan atau alasan appraisal.
penulis lebih memilih artikel satu dibanding
yang lainnya (Wager & Wiffen, 2011). Pendekatan yang digunakan dalam
Standar etik inilah yang akan penulis menganalisa data yang telah dikritisi pada
gunakan untuk melakukan literature penelitian ini adalah simplified approach.
review. Menurut Aveyard (2010), pendekatan ini
adalah sebuah pendekatan bertujuan untuk
Dalam pembuatan kajian literatur ini, menyimpulkan artikel yang berkualitas
penulis tidak menggunakan pengambilan dengan metode yang berbeda guna

Nursing Current Vol. 5 No. 1, Januari 2017 – Juni 2017 65

menjawab pertanyaan penelitian kajian HASIL
literatur bagi pemula, yang biasanya Kajian literatur dilakukan dari pertengahan
digunakan oleh mahasiswa atau bulan November 2017 hingga awal bulan
undergraduate untuk melakukan kajian Januari 2018. Total artikel yang didapatkan
literatur dibidang kesehatan maupun sosial. dari pencarian menggunakan kata kunci
pertama dan kedua melalui tiga database
adalah 143 artikel dan artikel yang
dianalisis berjumlah lima artikel. Hasil
pencarian juga disajikan dalam bentuk
bagan di bawah ini seperti yang disarankan
oleh PRISMA (2009).

Diagram 1
Flow diagram hasil pencarian literatur dan pemilihan studi. Sumber Moher D, Liberati A, Tetzlaff J, Altman
DG, the PRISMA Group (2009).

Portal Garuda (4) UPH Library (1) Google Scholar (138)

Artikel eksklusi:

Artikel (n=143) Judul dan abstrak tidak

sesuai (n=114)

Skrining full text Artikel eksklusi:

(n= 29) non full-text (n=18)

Artikel eksklusi (n=6):

• 5 laporan kasus
11 artikel eligibel
• 1 artikel tidak ada nama
jurnal, nomor volume dan
nomor halaman

5 artikel full-text
direview

66 Nursing Current Vol. 5 No. 1, Januari 2017 – Juni 2017

Pada proses pencarian artikel, ditemukan Kajian literatur ini menggunakan empat
sebanyak 114 artikel yang tidak sesuai judul artikel penelitian dengan desain quasi-
dan tujuan penelitian, 18 artikel yang tidak experimental dan satu penelitian dengan
full-text, yang kemudian dikeluarkan dari desain longitudinal eksperimental. Empat
daftar artikel yang akan dikaji, sehingga penelitian dilakukan pada populasi
tersisa 11 artikel full-text untuk dikaji dari Indonesia dan satu penelitian pada populasi
abstrak dan judul dengan kriteria inklusi. India. Total sampel yang terlibat dalam
Berdasarkan hasil pengkajian, terdapat 6 penelitian adalah 188 partisipan. Tema yang
artikel full-text yang dikeluarkan, yaitu lima ditemukan berdasarkan pernyataan hasil
laporan kasus dan satu artikel yang tidak penelitian yang menjawab pertanyaan
ada nama jurnal, nomor volume dan nomor literature review yang telah penulis
halaman. Setelah dilakukan seleksi, rangkum pada tahap pertama analisis
didapatkan lima artikel full-text yang sesuai simplified approach dalam tabel hasil
dengan kriteria inklusi dan akan digunakan literature review.
dalam melakukan kajian literatur.

Tabel 1
Hasil Literatur Review

Penggunaan VCO Penggunaan VCO

Metode Pijat Yang Penggunaan VCO
Peneliti, Mencegah Mengurangi Efek Menghambat
Efektif Mencegah
Tahun, Judul Kejadian Luka Gesekan Dan Infeksi Jamur dan
Luka Dekubitus Bakteri
Dekubitus Tekanan
Penulis: Massage effleurage Tidak terjadi luka VCO dapat Asam lemak
Setiani. (2014) dengan VCO di tekan pada digunakan sebagai antiseptik pada
daerah skapula, responden. pelumas sehingga minyak kelapa
Judul: sakrum dan tumit. dapat mengurangi membantu
Efektivitas efek gesekan dan mencegah infeksi
Massage dengan tekanan. jamur dan bakteri.
Virgin Coconut Oil
Terhadap
Pencegahan Luka
Tekan di Intensive
Care Unit

Nursing Current Vol. 5 No. 1, Januari 2017 – Juni 2017 67

Penulis: Massage Effleurage Tidak terjadi luka Kandungan dalam VCO secara topikal
Handayani et al. di daerah skapula, tekan pada VCO dapat dapat menghambat
(2011) sakrum, dan tumit. responden. membantu infeksi jamur
mengurangi efek sebagai faktor yang
Judul: gesekan dan menurunkan
Pencegahan Luka tekanan. resistensi jaringan.
Tekan Melalui Pijat
Menggunakan
Virgin Coconut Oil

Penulis: Pijat punggung Terjadi luka tekan

Sihombing et al. dengan sebanyak 5
(2016) menggunakan VCO responden dari 25
menurunkan resiko total responden.
Judul: terjadinya luka
The Effectiveness tekan.
Of Back Massage
Using Virgin
Coconut Oil and
White Petroleum
Jelly To Prevent
Pressure Sores

Penulis: Pijat punggung Tidak terjadi luka

Dhikhil, et al. dengan tekan pada
(2014) menggunakan responden.
VCO.
Judul
Effect of Coconut
Oil Usage in Risk
of Pressure Ulcers
Among Bedridden
Patients of Selected
Hospitals in North
India

68 Nursing Current Vol. 5 No. 1, Januari 2017 – Juni 2017

Penulis: Pijat mengunakan Tidak terjadi luka
Marina et al. (2013) VCO pada titik tekan pada
penonjolan tulang, responden.
Judul: yaitu daun telinga,
Pencegahan skapula, siku,
Kejadian Luka sakrum, bokong,
Tekan Melalui pinggul, lutut,
Masase Virgin pergelangan kaki
Coconut Oil Pada dan tumit.
Pasien dengan
Imobilisasi

PEMBAHASAN dekubitus. Penggunaan VCO dengan pijat

Metode Pijat Yang Efektif Mencegah tidak hanya dapat meningkatkan relaksasi

Luka Dekubitus otot dan meningkatkan sirkulasi, tetapi juga

Pada kajian literatur ini terdapat lima artikel dapat meningkatkan absorbsi kandungan

yang membahas jenis pijat menggunakan biologis VCO melalui kulit (Handayani et

virgin coconut oil. Terdapat dua artikel al , 2011 & Sihombing et al, 2016).

penelitian yang mengungkapkan bahwa

intervensi yang dilakukan yaitu massage Penggunaan VCO Mencegah Kejadian

effleurage dengan VCO (Setiani, 2014 & Luka Dekubitus

Handayani et al, 2011). Dua artikel Berdasarkan hasil pengkajian pada kelima

penelitian yang melaporkan intervensi yang artikel penelitian, didapatkan rentang rata-

dilakukan yaitu pijat punggung rata kejadian luka dekubitus adalah nol (0)

menggunakan VCO (Sihombing et al, 2016 responden sampai lima (5) responden.

& Dhikhil et al, 2016). Terdapat satu artikel Empat artikel mengatakan tidak ada terjadi

yang menyatakan bahwa intervensi yang luka dekubitus pada responden kelompok

dilakukan adalah pijat pada titik-titik VCO. Satu artikel artikel penelitian

penonjolan tulang (Marina et al, 2013). menyatakan kejadian luka dekubitus

sebanyak lima (5) responden dari total 25

Mituhu et al (2011) menyatakan bahwa responden.

tindakan masase punggung dapat merubah

tekanan dan melancarkan peredaran darah Luka dekubitus dapat disebabkan oleh

pada area tertekan sehingga mencegah paparan keringat, darah, urin dan feses (Al

Nursing Current Vol. 5 No. 1, Januari 2017 – Juni 2017 69

Rasyid & Misbach, 2015). Pasien imobilitas Penggunaan VCO Mengurangi Efek
sangat rentan untuk terkena paparan Gesekan Dan Tekanan
keringat urine atau feses karena Pada kajian literatur ini terdapat dua artikel
ketidakmampuan untuk mobilitas. Virgin yang membahas penggunaan VCO dapat
Coconut Oil dapat diberikan sebagai bahan mengurangi efek gesekan dan tekanan
topikal yang berfungsi menjadi pelembab (Setiani, 2014 & Handayani et al, 2011).
untuk mencegah kulit kering dan sebagai Menurut National Guideline Clearinghouse
bahan topikal untuk meminimalkan paparan (NGC) & Institute for Clinical Systems
keringat berlebihan, urin atau feses karena Improvement (ICSI) (2010), salah satu
sifatnya sebagai minyak yang tidak dapat pencegahan luka dekubitus adalah
bercampur dengan air (Setiani, 2014). memperkecil atau menghilangkan gesekan
dan tekanan. Secara berkala, gunakan
National Guideline Clearinghouse (NGC) minyak pelumas hypoallergenic, krim atau
& Institute for Clinical Systems lotion yang dapat menurunkan tekanan dan
Improvement (ICSI) (2010) gesekan (National Guideline Clearinghouse
mengungkapkan bahwa salah satu & Institute for Clinical Systems
pencegahan luka dekubitus adalah Improvement, 2010). Virgin coconut oil
memberikan topikal seperti krim, minyak dapat digunakan sebagai topikal
pelumas atau salep yang diperlukan untuk pencegahan luka dekubitus karena
melindungi dan merawat kulit utuh, atau kandungan yang beragam. Proses
untuk merawat sel yang tidak utuh. Lucida pembuatan VCO yang diolah dengan
et al (2008) juga menyatakan bahwa minimal pemanasan atau tanpa pemanasan
kandungan asam lemak (terutama asam sama sekali dapat menghasilkan minyak
laurat dan oleat) dalam VCO memiliki sifat kelapa dengan tekstur yang lembut dan
yang dapat melembutkan kulit. Selain itu, berwarna jernih serta beraroma kelapa segar
molekul medium chain fatty acids (MCFA) (Handayani et al, 2011).
yang kecil dalam VCO mudah diabsorbsi
permukaan kulit (Handayani et al, 2011). Penggunaan VCO Menghambat Infeksi
Jamur dan Bakteri
Pada kajian literatur ini terdapat dua artikel
yang membahas penggunaan VCO pada
pasien imobilitas untuk menghambat infeksi

70 Nursing Current Vol. 5 No. 1, Januari 2017 – Juni 2017

jamur dan bakteri (Setiani, 2014 & kuantitatif dengan desain longitudinal
Handayani et al, 2011). Penelitian oleh eksperimental dan quasi eksperimental.

Rajan et al (2016), menerangkan bahwa Pada kajian literatur ini, didapatkan hasil bahwa
rentang rata-rata kejadian luka dekubitus pada
minyak kelapa murni diekstrak dan
pasien imobilitas yang menggunakan VCO
dijernihkan dengan metode filtrasi yang
adalah nol sampai lima responden. Hal itu
membuktikan bahwa minyak kelapa murni
menunjukkan bahwa virgin coconut oil efektif
telah dapat menghambat perkembangan
dalam pencegahan luka dekubitus pada pasien
jamur. Menurut Setiani (2014), asam lemak
imobilitas karena dapat mengurangi efek
yang terkandung pada minyak kelapa tidak gesekan dan tekanan. Selain itu, VCO dapat
langsung berfungsi sebagai anti-mikroba menjadi penghambat infeksi jamur dan bakteri
namun akan bereaksi dengan bakteri-bakteri untuk mencegah adanya infeksi. Berdasarkan
kulit menjadi bentuk asam lemak bebas kesimpulan kajian literatur, maka virgin
seperti yang terkandung dalam sebum coconut oil direkomendasikan untuk digunakan

(sebum mengandung uric acid dan asam pada pasien imobilitas dengan resiko jatuh
rendah, sedang dan tinggi.
laktat). Pada tema ini disimpulkan bahwa
topikal VCO dapat menghambat infeksi
jamur dan bakteri dalam pencegahan luka
SARAN
dekubitus. Penelitian selanjutnya dapat dilakukan
penelitian untuk meneliti faktor-faktor yang
mempengaruhi keefektifan VCO dalam
KESIMPULAN
pencegahan luka dekubitus. Berdasarkan
Penelitian kajian literatur ini telah mengkaji
review ini, dibutuhkan pembuatan SOP
lima artikel yang didapatkan dari tiga database
dengan menggunakan beberapa kata kunci. Dari pencegahan luka dekubitus dengan
hasil pencarian, didapatkan 143 artikel yang menggunakan VCO pada pasien imobilitas
kemudian diperiksa kembali menggunakan di Indonesia karena dapat mencegah
kriteria inklusi dan eksklusi hingga menyisakan kejadian luka dekubitus, sehingga dapat
lima artikel. Seluruh artikel yang digunakan mengurangi lama hari rawat dan biaya
dalam kajian literatur ini menjelaskan penelitian pengobatan.
yang menggunakan metode penelitian

Nursing Current Vol. 5 No. 1, Januari 2017 – Juni 2017 71

DAFTAR PUSTAKA
Agero, A. L & Verallo-Rowell, V. M. (2004). A Randomized Double-Blind Controlled
Trial Comparing Extra Virgin Coconut Oil As A Moisturizer For Mild To Moderate
Xerosis. Dermatitis, 15 (3), 109-116.

Alrasyid & Misbach, J. (2016). Komplikasi Medis dan Tata Laksana. Jakarta: Badan
Penerbit FKUI.

Asmadi. (2008). Teknik Prosedural Keperawatan: Konsep dan Aplikasi Kebutuhan Dasar
Klien. Jakarta: Salemba Medika.

Aveyard, H. (2010). Doing a Literature Review in Health and Social Care: A Practical
Guide. 2nd ed. Maidenhead: McGraw-Hill Open University Press.

Bryant, R. A. (2007). Acute and Chronic Wounds Nursing Management, Second Edition.
Missouri: Mosby Inc.

Dhikhil, et al. (2007). Effect of Coconut Oil Usage in Risk of Pressure Ulcers Among
Bedridden Patients of Selected Hospitals in North India. Dhikhil C D et al, iP-Planet,
Vol 1 (2), 71-78, 2014.

Handayani et al. (2011). Pencegahan Luka Tekan Melalui Pijat Menggunakan Virgin
Coconut Oil. Jurnal Keperawatan Indonesia, Volume 14, No. 3, November 2011; hal.
141-148.

Lucida et al. (2008). Uji Daya Peningkat Penetrasi Virgin Coconut Oil (VCO) Dalam Basis
Krim. Jurnal Sains dan Teknologi Farmasi, Vol. 13, No. 1, 2008, hal. 23-30.

Marina et al. (2015). Pencegahan Kejadian Luka Tekan Melalui Masase Virgin Coconut Oil
Pada Pasien dengan Imobilisasi. Nursing Current Vol. 1 Januari 2013-Juni 2013.

Marrelli, T. M. (2007). Buku Saku Dokumentasi Keperawatan, Ed. 3. Jakarta: EGC.

Mituhu et al. (2011). Efektifitas Pemberian Masase Punggung Terhadap Pencegahan

Dekubitus Pada Pasien Tirah Baringdi RSUD Kajen Kab Pekalongan. J. Keperawatan
dan Kebidanan (JIKK). Vol. I No. 4, Juni 2011 : 196-204

Mutia et al. (2015). Profil Penderita Ulkus Dekubitus Yang Menjalani Tirah Baring Di
Ruang Rawat Inap RSUD Arifin Achmad Provinsi Riau Periode Januari 2011-
Desember 2013. JOM FK Volume 2 No. 2 hal. 1-11. 2015.

National Guideline Clearinghouse (NGC) & Institute for Clinical Systems Improvement
(ICSI). 2010. Pressure ulcer prevention and treatment. Health Care Protocol.
Bloomington (MN): Institute for Clinical Systems Improvement (ICSI).

Potter, P. A & Perry, A. G. (2013). Fundamental of Nursing, Eight Edition. Canada: Mosby
Elsevier.

72 Nursing Current Vol. 5 No. 1, Januari 2017 – Juni 2017

Rajan et al. (2016). A Study on In-Vitro Antimicrobial Activity of Coconut Water and
Coconut Oil on Candida Species. Rajan et al., World J Pharm Sci 2016; 4(12): 266-
268

Rismawan, W. (2014). Hubungan Tingkat Pengetahuan Keluarga Klien Tentang

Pencegahan Dekubitus Terhadap Kejadian Dekubitus Pada Pasien Bedrest Total Di
RS Dr. Soekardjo Tasikmalaya Kota Tasikmalaya. Jurnal Kesehatan Bukti Tunas
Husada Volume 12 No. 1, hal. 112-127.

Rubenstein et al. (2007). Lecture Notes: Kedokteran Klinis, Edisi Keenam. Jakarta:
Erlangga.

Setiani, D. (2014). Efektivitas Massage Dengan Virgin Coconut Oil Terhadap Pencegahan
Luka Tekan Di Intensive Care Unit. Jurnal Husada Mahakam Volume III No. 8, hal.
389-442.

Sihombing et al. (2016). The Effectiveness of Back Massage Using Virgin Coconut Oil and
White Petroleum Jelly To Prevent Pressure Sores. Jurnal Keperawatan
Muhammadiyah, 1(2), hal. 1-9.

Uliyah, M & Hidayat, A. A. A. (2008). Praktikum Keterampilan Dasar Praktik Klinik:

Aplikasi Dasar-dasar Praktik Kebidanan. Jakarta: Salemba Medika.

Wager, E & Wiffen, P. J. (2011). Ethical issues in preparing and publishing systematic
reviews. Journal of Evidence-Based Medicine, 4(2), hal. 130- 134.

Nursing Current Vol. 5 No. 1, Januari 2017 – Juni 2017 73