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"Perawat spesialis kardiovaskuler berperan dalam praktik keperawatan berupa pemberi asuhan keperawatan tingkat lanjut, melakukan pembuktian ilmiah keperawatan dan agen pembaharu. Asuhan keperawatan dilakukan pada kasus pasien post operasi bedah jantung MVR (Mitral Valve Replacement) dan 30 pasien gangguan sistem kardiovaskuler dengan pendekatan model konservasi Levine. Model konservasi Levine efektif digunakan pada pasien dengan gangguan sistem kardiovaskuler. Evidence based nursing dilakukan dengan menerapkan edukasi berdasarkan kebutuhan pasien Acute Coronary Syndrome (ACS) untuk menurunkan kecemasan dengan hasil yang signifikan (p value 0,000). Proyek inovasi menerapkan format handover dengan metode SBAR (Situation, Background, Assessment, Recommendation).

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Cardiovascular specialist nurses play a role in nursing practice in the form of advanced nursing care providers, scientific proof of nursing and change agents. Nursing care is performed in the case of postoperative heart surgery patients MVR (Mitral Valve Replacement) and 30 patients with cardiovascular system disorder with Levine conservation model approach. Levine's conservation model is effective in patients with cardiovascular system disorders. Evidence-based nursing is done by applying education based on patient Acute Coronary Syndrome (ACS) needs of learning to decrease anxiety with significant results (p value 0,000). The innovation project applies the handover format using the SBAR (Situation, Background, Assessment, Recommendation) method."

"Karya Ilmiah Akhir ini merupakan analisis pengalaman residen selama pelaksanaan praktik residensi keperawatan medikal bedah peminatan kardiovaskular meliputi pemberian asuhan keperawatan dengan pendekatan proses keperawatan menggunakan teori keperawatan Model Sistem Neuman, penerapan praktik keperawatan berdasarkan pembuktian dan pelaksanaan inovasi keperawatan. Teori keperawatan Model Sistem Neuman ini berfokus pada individu dan persepsi serta reaksi terhadap stressor termasuk faktor yang mempengaruhinya, yang memungkinkan perawat untuk dapat memberikan asuhan keperawatan yang kreatif melalui intervensi keperawatan mengurangi stressor baik intervensi pencegah primer, sekunder maupun tersier. Masalah keperawatan yang paling sering muncul adalah penurunan curah jantung, intoleransi aktifitas, ansietas, kelebihan volume cairan tubuh dan nyeri. Pelaksanaan praktik keperawatan berdasarkan pembuktian yang telah diterapkan yaitu tehnik Progressive Muscle Relaxation terhadap ansietas dan depresi pasien gagal jantung. Pelaksanaan inovasi keperawatan berupa penyusunan formulir penilaian dan intervensi risiko jatuh.

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The final paper is an analysis of resident experience during implementation of medical-surgical nursing practice the specialization of residency cardiovascular include nursing care using the nursing process approach to nursing theory Neuman Systems Model, the application of evidence-based nursing practice and nursing innovation implementation. Neuman Systems Model nursing theory focuses on the individual and their perceptions and reactions to stressors include factors that influence it, which allows nurses to provide nursing care through creative nursing interventions prevention interventions reduce stressors both primary, secondary and tertiary. Nursing problem most often arises is the decrease in cardiac output, activity intolerance, anxiety, excess body fluid volume and pain. Implementation of evidence-based nursing practice that has been implemented is Progressive Muscle Relaxation techniques against anxiety and depression patients with heart failure. Implementation of nursing innovations in the form of preparation of risk assessment forms and interventions fall."

"schemic Heart Disease merupakan salah satu penyebab kematian paling umum di dunia dan frekuensinya terus meningkat setiap tahunnya. Hal ini menjadi tantangan yang besar bagi seorang Ners dalam pelayanan kesehatan di Indonesia. Praktik ilmu keperawatan yang berkualitas harus diimbangi dengan pembuktian secara Evidence Base Nursing (EBN) karena EBN bisa menjadi landasan dalam melaksanakan peran pemberi asuhan, pendidik, peneliti, dan innovator yang profesional. Praktik residensi telah memberikan pengalaman dan menambah pengetahuan residensi tentang keperawatan kardiovaskular. Penerapan teori Lydia Hall: Care, Core, dan Cure dilakukan oleh residensi pada 30 kasus resume dan satu kasus kelolaan yaitu pada pasien dengan STEMI. Peran peneliti telah dilakukan dengan menerapkan EBN tentang penerapan Slow Deep Breathing Relaxation Exercise (SDBRE) setelah chest tube removal pada pasien yang menjalani CABG di Ruang Intermediate Ward Bedah. Penerapan SDBRE didapatkan efektif dalam menurunkan nyeri setelah chest tube removal. Peran Inovasi dilakukan dengan menyusun protokol Munro Scale untuk mencegah kejadian Perioperative Related Pressure Injury pada pasien Bedah jantung. Munro Scale didapatkan mampu mendeteksi adanya resiko Pressure Injury, mudah dipahami oleh perawat, dan mudah dilaksanakan oleh perawat kamar bedah dalam perawatan. Namun sebaiknya follow up pengkajian Munro Scale dilakukan di ruangan ICU bedah, IW Bedah, dan Rawat Inap.

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Ischemic Heart Disease is one of the most common causes of death in the world and its frequency continues to increase every year. This is a big challenge for a nurse in health services in Indonesia. Quality nursing practice must be balanced with Evidence Based Nursing (EBN) evidence because EBN can be the basis for carrying out the role of professional caregivers, educators, researchers, and innovators. Residency practice has provided experience and increased residency knowledge about cardiovascular nursing. The application of Lydia Hall's theory: Care, Core, and Cure was carried out by residencies in 30 resume cases and one managed case, namely in patients with STEMI. The role of researchers has been carried out by applying EBN regarding the application of Slow Deep Breathing Relaxation Exercise (SDBRE) after chest tube removal in patients undergoing CABG in the Intermediate Ward of Surgery. The application of SDBRE was found to be effective in reducing pain after chest tube removal. The role of innovation is carried out by compiling the Munro Scale protocol to prevent Perioperative Related Pressure Injury in cardiac surgery patients. The Munro Scale was found to be able to detect the risk of Pressure Injury, easily understood by nurses, and easily implemented by operating room nurses in treatment. However, follow-up studies of the Munro Scale should be carried out in the surgical ICU, IW Surgery, and Inpatient rooms."

"Pendekatan teori keperawatan Model Sistem Betty Neuman (MSBN) digunakan pada praktik residensi Keperawatan Medikal Bedah ini dalam penerapan asuhan keperawatan pasien dengan ACS dengan tindakan PCI. Betty Neuman melihat bahwa manusia dalam hal ini pasien secara holistik terdiri dari faktor fisiologis, psikologis, sosial budaya, faktor perkembangan serta faktor spiritual. Perawat sebagai spesialis KMB seharusnya menjalankan peran sebagai pemberi asuhan keperawatan, pendidik, peneliti dan sebagai inovator. Teori MSBN digunakan sebagai pendekatan penyelesaian masalah 30 (tiga puluh) kasus yang dibuat dalam bentuk resume, meliputi kasus STEMI, NSTEMI, UAP, CHF/ ADHF karena masalah katup, Post/Pre-CABG. Peran perawat spesialis sebagai pemberi asuhan diterapkan Residen pada pasien dengan ACS dengan PCI. Perawat dalam pelayanan keperawatan dibantu untuk menilaii stressor pasien dan diberi pedoman untuk melakukan intervensi mengatasinya. Model ini dapat juga dimanfaatkan dalam pendidikan, penelitian serta manajemen keperawatan. Prinsip etis, legal dan pendekatan humanistik digunakan dalam penerapan teori MSBN ini. Peran perawat spesialis sebagai peneliti diterapkan Residen dengan melakukan EBNP back-rub untuk membuktikan bahwa back-rub dapat menurunkan tingkat kecemasan dan meningkatkan rasa nyaman pasien pre-coronary angiography. Inovasi yang dilakukan Residen adalah mengembangkan leaflet sebagai media edukasi alat-alat medis meliputi 4 (empat) materi: PPM, TEVAR, Katup Buatan dan Stent, untuk meningkatkan pengetahuan pasien sehingga pasien dapat bekerjasama dalam perawatan dirinya.

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The Neuman Systems Model of the nursing theory approach is used in this recidential practice of Surgical Medical Nursing on the nursing care for ACS patient with PCI intervention. Betty Neuman saw that human in this case patients, holistically consist of physiological, psychological, social cultural, developmental and spiritual factors. Nurses as Surgical Medical Nursing Specialist should play the role of nursing care practitioner, educator, researcher and innovator.

The theory of the Neuman Systems Model was used, as an approach for problem solving in 30 cases which was made in form of resume consisting of cases of STEMI, NSTEMI, UAP, CHF/ ADHF with valve problem, Post/Pre-CABG with PCI intervention. The role of specialist nurses as nursing care practitioners is applied by Resident on patients with ACS, intervened with PCI. Nurses in bursing care are guided by this theory to determine patients? stressor and to conduct appropriate interventions. The theory can also be benefecial in education, research and nursing management. Ethical, legal principal and humanistic approach are used in the application of the Neuman Systems Model.

The role of specialist nurses as researchers is applied by the Resident by conducting EBNP back-rub intervention as approval in lowering the level of anxiety and increasing the comfort on patients before coronary angiography. Innovation completed by the Resident was developing leaflets as educational media about using medical devices including PPM, TEVAR/EVAR, artificial valve and Stent, improving patients? knowledge, as to be co-operative on how to take care of themselves."

"Praktik spesialis Keperawatan Medikal Bedah peminatan kardiovaskuler ini bertujuan untuk melakukan praktik dengan mengaplikasikan peran perawat melalui pendekatan Model Adaptasi Roy. Peran sebagai pemberi asuhan keperawatan diterapkan pada 30 orang pasien gangguan kardiovaskuler dan satu orang pasien kelolaan utama yaitu pasien post operasi Coronary Artery Bypass Graft (CABG). Peran sebagai peneliti dalam melakukan penerapan tindakan keperawatan yang berbasis pembuktian ilmiah (evidence based nursing practice) yaitu dengan membuktikan pijat kaki dan tangan sebagai salah satu teknik pengurangan nyeri dan respon fisiologis pasien post operasi CABG. Peran sebagai inovator melalui penyusunan pedoman intervensi keperawatan Sindrom Koroner Akut (SKA) yang bertujuan untuk memudahkan perawat dalam menentukan intervensi keperawatan, dan meningkatkan kualitas asuhan keperawatan. Hasil praktik ini menunjukan bahwa Model Adaptasi Roy efektif digunakan pada pasien gangguan kardiovaskuler, dan pijat kaki dan tangan efektif untuk mengurangi nyeri dan menstabilkan respon fisiologis pasien post CABG, selain itu buku pedoman intervensi pasien SKA dapat diterapkan perawat dalam melakukan asuhan keperawatan.

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Medical Surgical Nursing Practice specialist in cardiovascular aims to practice by applying the role of nurses through the Roy Adaptation Model approach. Role as nursing care was applied to 30 patients of cardiovascular disorders and a patient with postoperative Coronary Artery Bypass Graft (CABG) is the main case. Role as researcher was caried out by applying evidence based nursing practice to prove the foot and hand massage as a pain reduction techniques and physiological responses of patients post CABG. Role as an innovator through the development of guidelines for nursing interventions Acute Coronary Syndrome (ACS), which aims to facilitate nurses in determining nursing interventions, and improve the quality of nursing care. The results of this practice shows that Roy Adaptation Model effectively used on patients of cardiovascular disorders, foot and hand massage effectively to reduce pain and stabilize the patient's physiological response on patients of post CABG. In addition, the interventions guidelines Acute Coronary Syndrome (ACS) can be applied to nurses in performing nursing care."

"Prevalensi kematian yang disebabkan oleh gangguan sistem kardiovaskuler semakin meningkat. Perawat spesialis dapat berperan sebagai pemberi asuhan keperawatan, pendidik, konsultan, dan peneliti untuk mencegah peningkatan jumlah morbiditas dan mortalitas pasien CAD. Praktik residensi spesialis keperawatan medikal bedah selama 1 tahun 2 semester bertujuan untuk menerapkan dan mendalami peran perawat spesialis dengan pendekatan Theory of Comfort Katharine Kolcaba. Peran sebagai pemberi asuhan keperawatan diterapkan pada 30 pasien gangguan sistem kardiovaskuler dan satu pasien kasus kelolaan utama STEMI dengan IVS ruptur yang menjalani CABG dan repair IVS rupture. Peran sebagai pendidik dijalankan dengan pembimbingan perawat sejawat dan mahasiswa keperawatan. Peran sebagai peneliti dijalankan dengan menerapkan tindakan keperawatan berbasis pembuktian ilmia evidence-based nursing yaitu tindakan guided imagery untuk menurunkan respon psikofisiologis kecemasan pasien yang menjalani kateterisasi jantung elektif. Peran sebagai inovator dijalankan dengan menerapkan format pengkajian awal, intervensi, implementasi, dan monitoring kecemasan pasien yang menjalani CABG. Hasil analisis praktik residensi menunjukkan bahwa Theory of Comfort efektif digunakan sebagai pendekatan dalam gangguan sistem kardiovaskuler pada pasien dengan gangguan sistem kardiovaskuler untuk meningkatkan tingkat kenyamanan dan terapi guided imagery efektif diterapkan untuk menurunkan respon psikofisiologis kecemasan pasien yang menjalani kateterisasi jantung elektif. Selain itu, format pengkajian awal, intervensi, implementasi, dan monitoring kecemasan dapat diterapkan untuk pasien yang menjalani CABG.

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Abstract The prevalence of deaths caused by cardiovascular disorders are increasing. Specialist nurses can take the role as care provider, educator, consultant, and researcher in order to prevent an increase of morbidities and mortalities of patients with Coronary Artery Disease. Practice of medical surgical nursing residency held for 1 year 2 semesters aims to implement and explore the role of specialist nurses. Role as care providers applied to 30 patients with disorders of the cardiovascular system and the main case patients managed with IVS rupture STEMI who underwent CABG and repair IVS rupture. Role as educators is performed by coaching colleagues and nursing students. Role as researchers is performed by implementing evidence based nursing in the form of guided imagery to reduce the psychophysiological anxiety responses of patients undergoing elective cardiac catheterization. Role as an innovator is accomplished by the format of the initial assessment, intervention, implementation, and monitoring the anxiety of patients undergoing CABG. Results of the analysis showed that the residency practice using Kolcaba rsquo s Comfort Theory effectively to increase the level of comfort on patients with disorders cardiovascular system. Guided imagery therapy effectively to reduce psychophysiological anxiety response of patients undergoing elective cardiac catheterization. The format of the initial assessment, intervention, implementation, and monitoring of anxiety can be applied to patients undergoing CABG."

"Penyakit jantung koroner merupakan penyebab kematian nomor satu di Amerika Serikat. Penyakit jantung koroner disertai peyakit pembuluh darah otak merupakan penyebab kematian nomor 1 di ikuti oleh penyakit penyerta stroke (16,8%), tekanan darah tinggi(9,4%) dan penyakit arteri (3,1%). Perawat spesialis merupakan bagian dari tim kesehatan yang berperan memberikan asuhan keperawatan komprehensif sehingga menurunkan angka morbiditas dan mortalitas pasien. Perawat spesialis memiliki peran sebagai pelaksana asuhan keperawatan langsung, educator dan peneliti keperawatan. Pelaksana asuhan keperawatan langsung dilakukan dengan memberikan asuhan keperawatan kepada 30 pasien resume dan 1 pasien kelolaan utama yang mengalami masalah gangguan kardiovaskuler. peran sebagai educator dilakukan dengan memberikan edukasi kepada pasien dan keluarga tentang penyakit jantung dan perawatannya baik di rumah sakit maupun di rumah setelah pulang rawat. Peran sebagai perawat peneliti dilaksanakan dengan penerapan EBN dan proyek inovasi selama proses residensi. Hasil akhir dari proses residensi ini menunjukkan bahwa Teori Selfcare Deficit dari Orem relevan dan sangat bermanfaat untuk diterapkan pada pasien dengan gangguan kardiovaskuler, EBN dapat diterapkan dengan memberikan terapi oksigen sesuai kebutuhan pasien dan hasil dari proyek inovasi dapat diterapkan pada pasien SKA, khususnya STEMI paska PCI, untuk mempertahankan fungsi jantung secara optimal.

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Coronary heart disease (CHD) is the number one cause of death in United States of America. CHD accompanied by cerebral vascular disease is the number one cause of death, followed by stroke (16,8%), hypertension heart disease (9,4%) and arterial disease (3,1%). Specialist nurse are part of the health team whose role is to provide comprehensive nursing care to reduce patients morbidity and mortality. Specialist nurses have a role as a direct nursing care, as a educator and researcher nurses. Direct nursing care do by given nursing care for 30 resume patients and one major case patient. Nurse educator doing by give education for patients and family about heart disease and how to care in hospital and home. Nurse researcher role implemented through Evidence Based Nursing and innovation project during residention process.The end result of residency practice shown that Selfcare Deficit Theory Orem relevant and very good to implemented foor patients with cardiovascular disorder, EBN can implemented with given oksigen therapy according patients needs and resut of innovation project can implemented to ACS patients, especially STEMI post PCI, to maintenance optimally heart function.

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"Praktik klinik lanjut selama praktik residensi keperawatan pada sistem kardiovaskular dimaksudkan untuk mampu memberikan asuhan keperawatan dengan menerapkan EBN serta mampu berperan sebagai innovator. Peran pemberi asuhan dilakukan dengan menggunakan model konservasi Levine pada kasus PVOL pada pasien pasca CABG dan 30 pasien lain dengan gangguan sistem kardiovaskular. Penerapan EBN Early mobilization pada 20 pasien pasca bedah jantung menunjukan hasil yang sangat efektif untuk mencegah terjadi nya atelectasis pada pasien pasca bedah jantung. Program inovasi keperawatan dilakukan dengan metode restrospektif terhadap 179 pasien pasca bedah jantung.

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Advanced clinical practice during nursing residency practice in the cardiovascular system is intended to be able to provide nursing care by applying EBN and being able to act as an innovator. The role of caregivers was carried out using the Levine conservation model in the case of PVOL in post CABG patients and 30 other patients with cardiovascular system disorders. The application of EBN Early mobilization in 20 post-cardiac surgery patients showed very effective results to prevent atelectasis in post-cardiac surgery patients. The nursing innovation program was conducted using a retrospective method for 179 post-cardiac surgery patients."

"The book begins with a synopsis of the fundamentals aspects of fluid mechanics to give the reader the essential background to address the proceeding chapters. Then the fundamental elements of vortex dynamics will be discussed, explaining the conditions for their formation and the rules governing their dynamics. The main equations are accompanied by mathematical models. Cardiovascular vortex formation is first analyzed in physiological, healthy conditions in the heart chambers and in the large arterial vessels. The analysis is initially presented with an intuitive appeal grounded on the physical phenomena and a focus on its clinical significance.In the proceeding chapters, the knowledge gained from either clinical or basic science literature will be discussed. The corresponding mathematical elements will finally be presented to ensure the adequate diligence. The proceeding chapters ensue to the analysis of pathological conditions, when the reader may have developed the ability to recognize normal from abnormal vortex formation phenomenon. Pathological vortex formation represents vortices that develop at sites where normally laminar flow should exist, e.g. stenosis and aneurisms. This analysis naturally leads to the interaction of vortices due to the surgical procedures with respect to prediction of changes in vortex formation. The existing techniques, from medical imaging to numerical simulations, to explore vortex flows in the cardiovascular systems will also be described. "