LITERATURE REVIEW: APPLICATION OF POSITIVE ABILITY EXERCISES TO INCREASE LOW SELF-ESTEEM IN CLIENTS WITH SCHIZOPHRENIA

Introduction: Positive ability is the ability or positive aspect of an individual to identify the ability that exists in the individual so that clients can choose activities according to their abilities. Patients with low self-esteem see that they are not helpful and feel unable to; by practising positive abilities, they can explore aspects of their positive abilities so that they are expected to see themselves as valuable and become good individuals. Methods: The study used was a literature review of positive ability exercises. Searching for the article is done by Google Scholar or Google Scholar, published from 2015 to 2020, accessed full text in PDF format. Of the five studies used, three used the case study method, one used the Quasi-Experimental Pre-post without control method, and the other used the lecture and discussion method. The search strategy in this literature study uses databases, including Science Direct, Google Scholar and Garuda. Results : A literature review of 7 articles showed that positive ability training varied widely. Conclusions: Positive ability training can overcome nursing problems in patients with schizophrenia with impaired self-concept and low self-esteem.


INTRODUCTION
Schizophrenia is a serious mental disorder characterized by changes in a person's perceptions, thoughts, emotions, and actions. Symptoms of schizophrenia can be seen as an inability to care for oneself, express emotions, loss of spontaneity and curiosity, decreased motivation, and decreased ability to perform daily activities (Hendarmawan, 2018). This condition has a significant impact on the patient's self-esteem and tends to be low, with low self-esteem and persistent low self-esteem due to a sense of worthlessness, meaninglessness, and a negative assessment of oneself and one's abilities (Hendarmawan, 2018).In fact, normal individuals in general can interact and live socially in their environment, even each individual has advantages or potentials that can be developed into a work. For individuals who are unable to achieve self-esteem by completing their actions or are labeled as having low self-esteem, this results in their inability to relate to their social situations. Therefore, it is expected that people with low self-esteem in schizophrenia will be able to confidently develop their potential and participate in society (Hendarmawan, 2018).
The world's mental health problem is a serious problem. Based on WHO data (2016), 21 million people suffer from schizophrenia, a mental disorder with low self-esteem. Based on the results of the 2013 Indonesian Health Survey, the prevalence of mental disorders such as 4,444 schizophrenia is 0.17% or around 400,000 people (Ministry of Health, 2016). Many of these things indicate that there are many mental disorders in society. According to mental health data from mental hospitals, the number of patients was 340, including cases of sensory disturbances, up to 277 hallucinations (81.47%), up to 7 (2.05%) social isolation and self-care disorders. Delusions up to 7 people (2.05%) Violent behavior up to 3 people (0.88%), low self-esteem 26 people, and up to 20 people (7.64%). Data collection was carried out from July to December 2015.
Low self-esteem is awareness of loss of selfesteem, feelings of not being able to fulfill one's desires in accordance with their goals, awareness of worthlessness, feelings of meaninglessness, and persistent low self-esteem due to negative selfesteem. , or human abilities ( (Fauzi, 2019). Signs and symptoms of low self-esteem include self-criticism, inadequate emotions, a pessimistic outlook on life, reduced activity, and denial of selfdevelopment. In addition to the signs and symptoms above, observe the emergence of people with low self-esteem, low self-interest, bad clothes, lack of appetite, and reluctance to look at other people and speak slowly and quietly., (Rahma, 2019).
Positive abilities are abilities or positive aspects that identify abilities that exist in individuals and allow clients to choose an activity according to their abilities. They consider themselves useful people and are expected to be good people. According to a survey conducted (Rahma, 2019) Ways to control low self-esteem include discussing the patient's skills and their positive aspects, helping patients evaluate existing skills, helping patients choose skills to practice, or preferred skills. which includes deciding to practice and helping schedule implementation, training the patient to do other activities depending on the patient's ability (Kerja, 2019).
The purpose of this study was to determine the application of positive ability training in helping to overcome the problem of low self-esteem in patients with mental disorders.

MATERIALS AND METHODS
The search strategy in this literature study uses data bases including Sciene Direct, Google Scholar and Garuda. At the initial search stage found ( Science Direct=500, Google Scholar=1,100 Garuda=1), after filtering from 2018 -January 2022 and focusing the search on the desired destination there is (Science Direct=32, Google Scholar=736 ,Garuda=1 ). After that, they selected 82 articles with titles and abstracts. And there are 14 duplicate articles. The total number of articles that can be reviewed is 7 articles. The literature used in this literature review is still in the form of Original Research or has never been reviewed with quality indexed by Scimago Q1-Q4, in order to speed up or facilitate selection based on study area, title, and abstract using the Mendeley application. With this application, you will find the number of search results, duplicate journal articles from the direct science database, google scholar and garuda. Below is a diagram image sorted from initial search results, duplicates, selection based on studies, titles, abstracts and selected or reviewed journals. The nurse discusses SP 1, recognizes its positive aspects, and asks for skills which Tr. J suspiciously. Her skills include making beds, cleaning, folding clothes, and sewing. During the discussion there was no eye contact and selection/determination of ability to receive training continued. Mr. J chose an activity that was still possible, namely sewing. Evidence that the values in both groups are sig (both sides) smaller than alpha (p). This is the result of the value of the intervention group p = 0.004 & lt;. 0.05 and control p-value = 0.001 & lt;0.05 were patients with low pre-treatment (pre-test) and post-treatment (post-test) self-esteem in both the intervention and control groups who received positive affirmative therapy . is a significant change in the value of life in the group receiving SP (standard practice) therapy who have low self-esteem.

Waya Ayisna
Wandono (2017) Efforts to increase low self-esteem in depressed patients Obtained through nursing studies for patients with low self-esteem.
The rule used in this paper is descriptive by focusing on case studies, namely making nursing care to clients with low self-esteem starting from assessment, intervention, implementation and evaluation.
The finding that was received in this situation was that after the patient was given action, SP1 discussed the positive direction the patient had and SP2 by forming the skills that the patient had chosen with the client's reaction to be able to imitate the activity usefully. Average score (before treatment) of the cognitive-behavioral group therapy program that stimulates perception of 7.94 (SD ± 2.838) (post-treatment) at 10.50 (SD ± 2.203). The test result yielded a pvalue = 0.000. Therefore, the group's cognitive-behavioral therapy program has significant effectiveness in reducing the risk of violence in individuals with schizophrenia.

DISCUSSION
Based on the results of the analysis in article 1, the author found that by applying positive ability exercises, it can increase low self-esteem so that clients are able to become good individuals. According to research conducted by Pupuh, (2006) in the journal (Setiyawati and Susilaningsih, 2019) by sewing this method is very effective to apply, because it will help Mr. J to think to find out answers based on real questions and facts and made it easier for Mr. J to understand what he had done. According to the author's assumption that the application of sewing activities to one respondent, namely Mr. Mr. J with low self-esteem is able to do sewing activities independently, Mr. J is seen previously preparing tools for sewing, preparing materials to be sewn, doing sewing steps correctly, Mr. J being able to do sewing activities independently seen do not hesitate anymore, eye contact can be maintained, not moody, clear voice and does not look down. Mr. J incorporates activities into the daily schedule.
Based on the results of the analysis in article 2 according to the authors, it was found that by applying positive ability exercises, it can increase low self-esteem so that clients are able to become good individuals. According to research conducted by (Malfasari, Yeni Devita, Nurul Afifah Nensih and Herniyanti, 2021) in the journal the Qur'anic therapy method is very effective in increasing the self-esteem of schizophrenic patients. Because by reading the Qur'an one can avoid mental illness, because the Qur'an can serve as advice, preventive and protective measures, as well as treatment and healing measures, reading the Qur'an can also make feelings calm and calm. soul is at peace. According to the author's assumption, 8 respondents with low self-esteem had problems with al-Qur'an therapy which was very influential in increasing self-esteem of schiz ophrenic patients because reading the Qur'an could provide a therapeutic effect that could be used to overcome emotional, cognitive and emotional problems. individual social welfare as well as giving a relaxing effect and being a nonpharmacological treatment for various diseases.
Based on the results of the analysis in article 3 according to the authors, it was found that by applying positive ability exercises, it can increase low self-esteem so that clients are able to become good individuals. According to research (Herman, 2011) in the journal (Kerja, 2019) self-makeup activities to increase self-esteem in patients with low self-esteem, patients are able to assess abilities that can still be used, help patients choose or determine abilities to be trained, train their abilities that have been selected and arrange a schedule for the implementation of the abilities that have been trained in the daily plan, train the patient to do other activities according to the patient's ability. According to the author's assumption that the effort to make up activities with low self-esteem problems with 3 respondents, namely Nn.D, Ny.S, Mrs.T with make-up increases the abilities of the patient with activities (combing hair, wearing powder, wearing lipstick, making eyebrows, wearing a blouse) the results of the patient being able to make up themselves well independently, the patient was able to apply powder, wear lipstick, make eyebrows, wear a blouse on independently.
Based on the results of the analysis in article 4 according to the authors, it was found that by applying positive ability exercises it can increase low self-esteem so that clients are able to become good individuals. According to research conducted by (Nasir and Muhith in 2011) in the journal (Mulyawan and Agustina, 2019) said 60% of the factors that determine a person's health are environmental conditions. Environmental therapy which consists of recreational therapy, art creation therapy can help patients to develop a sense of selfesteem, develop the ability to perform activities in patients with low self-esteem. According to the author's assumption that the creative art of drawing therapy with low self-esteem problems with 33 respondents showed that the ability to carry out activities of low self-esteem respondents after being given the art of drawing creation therapy was the most in the capable category, namely 28 respondents (84.8%) and the unable category after 5 (15.2%) of 33 respondents were given the art of drawing creation therapy. So patients with low selfesteem are able to mention positive activities and can carry out activities independently and record them into a daily activity schedule book and the art of drawing creation therapy has a significant effect on the ability to carry out activities for clients with low self-esteem.
Based on the results of the analysis in article 5 according to the authors, it was found that by applying positive ability exercises, it can increase low self-esteem so that clients are able to become good individuals. According to research conducted by (Harris, Harris, & Miles, 2017) in the journal (Diri et al., no date) stated that positive affirmation therapy has a positive influence on cognitive in changes in behavior. With positive thinking, it is hoped that it can replace negative thoughts into positive thoughts so that patients are able to make decisions and achieve realistic goals in their lives and control their helplessness by controlling situations that patients can still do on their own (Harris, Harris, & Miles, 2017). According to the author's assumption that positive affirmation therapy with low self-esteem problems with respondents based on age in the range of 18-61 years, positive affirmation therapy is able to effectively improve the quality of life of schizophrenic patients with low self-esteem, meaning that by practicing positive affirmations it can also prevent the occurrence of severity in patients.
Based on the results of the analysis in article 6 according to the authors, it was found that by applying positive ability exercises, it can increase low self-esteem so that clients are able to become good individuals. According to research (Turkington and Kingdon, 2006) in the journal (Maryatun, Effendy and Mardhiyah, 2021) in this study, it turns out that in schizophrenia patients, cognitive and behavioral responses can also be changed to be positive if given cognitive behavior therapy (CBT). in the process, patients still receive antipsychotic therapy, but patients can think rationally and can be trained to solve problems through the help of flashcards containing positive thoughts. According to the author's assumption, based on the characteristics of the respondents in this study, most of the respondents were 30.46 years old with the most gender being 70% male, 48% not working, 50% unmarried status, having a high school education level 44 %, no history of mental disorders 58% and frequency of hospitalization more than 2 times as much as 58%. The level of low self-esteem in the intervention group before and after being given Cognitive Behavioral Therapy (CBT) with flashcards decreased by more than 50% in the low category. While in the control group, there was a decrease of 15% of the signs of low selfesteem of respondents in the moderate category. Both groups experienced significant changes with a decrease in signs and symptoms of low self-esteem but a greater decrease was obtained in the intervention group given Cognitive Behavioral Therapy (CBT) than the control group. The effectiveness of Cognitive Behavioral Therapy (CBT) with flashcards in reducing signs of low selfesteem is 67.6%.
Based on the results of the analysis in article 7 according to the authors, it was found that by thinking about stopping to increase low self-esteem, it can increase positive abilities so that clients are able to become good individuals. According to research (Agustratika & Nasution, 2011) (Supriati, Keliat, & Nuraini, 2014). in the journal (Teguh, Sulastri and Putri, 2020)contained in the therapist draft module, thought stopping is one example of cognitive behavioral psychotherapy techniques that can be used to help change thought processes and thought processes are important for a therapist to maintain client feelings and can greatly affect patterns and thought processes. According to the author's assumption that by stopping thinking, 90 respondents were divided into 30 respondents as the intervention group (group I) and 60 respondents as the control group (group II). The results obtained were a significant improvement in patients in the control group and the intervention group after stopping the mind.

CONCLUSIONS
Based on the literature review in the 1st journal to the 7th journal evaluation of the 7 articles, it shows that skill training varies greatly. The positive skill exercises in question consist of selfmakeup activities, sewing therapy, reading the Qur'an, art creations, Effects of positive affirmation therapy, Use of Flashcard Games in the Application of Cognitive Behavior Therapy (CBT), Thought stop increasing self-esteem of people with schizophrenia. Significantly shows that all positive ability exercises can improve and maintain the abilities that clients still have.