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"Praktik residensi di ruang ortopedi untuk memberikan asuhan keperawatan pada gangguan muskuloskeletal menggunakan teori keperawatan Self Care Orems, menerapkan praktik keperawatan berdasarkan pembuktian, dan melakukan inovasi keperawatan. Kasus kelolaan utama pada gangguan sistem muskuloskeletal adalah osteomielitis kronis. Masalah keperawatan paling banyak adalah nyeri dan mobilitas fisik untuk universal self care requisites serta kurang pengetahuan untuk developmental self care requisites. Intervensi keperawatan berdasarkan pembuktian yang telah diterapkan adalah cold compression therapy yang dapat meningkatkan proses penyembuhan dengan indikator penurunan nyeri dan edema, serta peningkatan rentang gerak sendi. Inovasi keperawatan yaitu penggunaan Clinical Practice Guidline untuk melakukan asuhan keperawatan berdasarkan clinical pathway pada pasca ORIF ekstremitas bawah. Perawat dapat menerapkan teori Self Care Orems, cold compression therapy, serta melakukan kegiatan inovasi untuk meningkatkan kompetensi perawat dan kualitas pelayanan keperawatan.

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The advanced clinical practice in orthopaedic ward involved the planning of nursing care for musculoskeletal disorders patients with Orem?s Self Care theory, the implementation of evidenced based nursing practice, and the implentation of nursing innovations. The primary case management of the musculoskeletal system disorders is chronic osteomyelitis. Most nursing problems for the universal selfcare requisites are pain and physical mobility, while for the developmental self care requisites is knowledge deficit. The evidence based nursing intervention implemented was cold compression therapy. It can improve the healing process with the indicators of decreased pain and edema, and increased range of motion. The nursing innovation implemented was the use of Clinical Nursing Practice Guidline in giving nursing care based on the clinical pathways post-ORIF lower extremities. Nurses can apply the Orem?s Self Care Theory, cold compression therapy, and innovation activities to improve their competency and also quality of nursing services."

"Laporan ini bertujuan untuk menganalisis tentang pengalaman praktik residensi spesialis keperawatan medika bedah dalam menjalankan peran perawat selama praktik keperawatan. Perawat berperan sebagai pemberi asuhan keperawatan, peneliti, pendidik dan innovator di RSUP fatmawati Jakarta. Sebagai pemberi asuhan keperawatan, penulis mengaplikasikan penerapan model self care Orem dalam memberikan asuhan keperawatan pada pasien dengan gangguan system musculoskeletal. Laporan analisis ini juga menerapkan praktik keperawatan berbasis bukti (Evidence Based Nursing) untuk mengurangi nyeri post operasi ORIF dengan menggunakan tehnik terapi music. Terapi music efektif diterapkan untuk mengurangi nyeri pasien post operasi ORIF. Peran perawat sebagai innovator mencoba menerapkan Clinical Practice Guideline (CPG) pada klien post operasi ektremitas bawah. Penerapan CPG ini melibatkan tim ruangan tempat lahan praktik. Rumah sakit sebagai institusi pelayanana kesehatan diharapkan dapat mengembangkan sumber daya perawat melalui pendidikan yang berkelannjutan, pelatihan dan pertemuan ilmiah khususnya dibidang ortopedi untuk meningkatkan pelayanan keperawatan yang berkualitas, cepat dan tepat.

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This report was aimed to analyze about the experience of specialist nursing practice residency medical surgical nursing in performing the role of nurses during the nursing practice. Nurse's role as provider of nursing care, researcher, educator and innovator in Fatmawati General Hospital Center Jakarta. As a provider of nursing care, the practician applied the model application Orem self care in providing nursing care to patients with f the musculoskeletal system disorder. The analysis report also implemented evidencebased nursing practice (Evidence Based Nursing) to reduce postoperative pain ORIF using music therapy techniques. Music therapy effectively applied to reduce postoperative pain patients ORIF. The role of the nurse as an innovator trying to implement Clinical Practice Guideline (CPG) on the client postoperative at lower extremity. This involves of the application of CPG team room where the place of practices. Hospital as an institution is expected to develop the service of health resources through continuing education nurse, training and scientific meetings in the field of orthopedics in particular to improve the quality of nursing services, progressive and accurately."

"Laporan ini bertujuan menganalisis pelaksanaan praktik tahap residensi keperawatan di RSUP Fatmawati Jakarta dan RSO Prof. Soelarso Surakarta. Sebagai pengelola pelayanan keperawatan, penulis melakukan asuhan keperawatan pada pasien pasca bedah fraktur ekstremitas bawah dengan menerapkan Teori Self care Orem. Laporan ini juga menganalisis pelaksanaan praktik keperawatan berbasis bukti (Evidence Based Practice Nursing) melalui intervensi keperawatan tehnik relaksasi Benson untuk menurunkan nyeri pasca bedah fraktur ekstremitas bawah. Hasil yang didapatkan bahwa relaksasi Benson efektif untuk menurunkan nyeri pasien pasca bedah fraktur ekstremitas bawah. Sebagai innovator, penulis melakukan kegiatan inovasi berupa edukasi terstruktur menggunakan bookleat. Kegiatan ini dilakukan bersama-sama dengan perawat di ruangan praktik. Dalam melaksanakan asuhan keperawatan pada pasien pasca bedah fraktur ekstremitas bawah, perawat harus memahami konsep dasar penyakit dan melakukan intervensi berdasarkan pembuktian ilmiah. Hal ini dapat dilakukan dengan melibatkan manajemen rumah sakit sebagai pengambil kebijakan.

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This report aims to analyze the implementation of nursing practice residency stage in Fatmawati General Hospital Jakarta and RSO Prof. Soelarso Surakarta. As a manager of nursing services, the authors conducted a nursing care in patients with post-surgical lower limb fractures by applying the theory of Orem self care. The report also analyzes the implementation of evidence-based nursing practice through nursing interventions Benson relaxation techniques to reduce postoperative pain lower extremity fractures.

The results showed that the relaxation Benson effective in reducing postoperative pain lower extremity fractures. As an innovator, author of innovation activities in the form of structured education using bookleat. This activity was carried out together with the nurses in the practice room. In implementing nursing care in patients with post-surgical lower limb fractures, nurses must understand the basic concepts of disease and interventions based on scientific evidence. This can be done by involving hospital management as policy makers."

"Residensi keperawatan medikal bedah dilaksanakan selama mengikuti program spesialis keperawatan medikal bedah dengan menerapkan asuhan keperawatan pada pasien dengan gangguan sistem perkemihan. Teori keperawatan yang digunakan adalah teori self care Orem yang merupakan suatu pendekatan dinamis dimana perawat bertugas mengembangkan kemampuan pasien dan keluarga untuk memenuhi kebutuhan self care pasien. Masalah keperawatan utama pada pasien dengan gangguan sistem perkemihan adalah kelebihan volume cairan, ketidakseimbangan nutrisi: kurang dari kebutuhan tubuh, ketidakpatuhan, kelemahan dan cemas. Perencanaan diberikan berdasarkan tingkat ketergantungan pasien meliputi: bantuan seluruhnya, bantuan sebagian dan support edukasi. Evaluasi keperawatan berfokus pada kemampuan pasien untuk mempertahankan kebutuhan self care, kemampuan untuk mengatasi deficit self care dan sampai sejauhmana perkembangan kemandirian pasien, serta kemampuan keluarga dalam memberikan bantuan self care jika pasien tidak mampu. Pelaksanaan evidence based nursing practice berupa penerapan intervensi edukasi dalam merencanakan inisiasi dialisis pada pasien penyakit ginjal kronik. Dari 11 pasien yang diberikan edukasi terdapat 7 pasien (63,6%) menerima yang terdiri dari 5 pasien menjalankan inisasi dialisis karena sudah ada indikasi untuk inisiasi dialisis, dan 2 pasien akan mengikuti pengobatan secara teratur dan menjalankan perilaku hidup sehat. Sedangkan 4 pasien (36,4%) menolak walaupun sudah ada indikasi untuk inisiasi dialisis. Kegiatan inovasi adalah mengembangkan media edukasi berupa leaflet, booklet dan video untuk merencanakan inisiasi dialisis pada pasien penyakit ginjal kronik.

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Medical surgical nursing residency program implemented during specialist medical surgical nursing care focuses on patient with urinary system disorders. Nursing theory using self care Orem theory which is a dynamic approach in which the nurse on duty to develop the ability of the patient and the family to meet the needs of the patient's self care.

Major nursing problems in patients with the urinary system disorders are excess fluid volume, imbalance nutrition: less than body requirements, non compliance, weakness and anxiety. Planning is given based on the patient is level of dependence include the wholly compensatory nursing system, partially compensatory nursing system and support educative compensatory.

Evaluation of nursing focuses on the patient's ability to over come self care deficit and the extent to which development of patient autonomy and the ability to overcome self care deficit and the ability of families to provide assistance in self care if the patient is incapacitated. Implementation of evidence based nursing practice is the application of education on chronic kidney disease patient's plans to initiate dialysis.

The results obtained from 11 patients who were given education, there were 7 patients (63,6%) received consisting of 5 patient's plans to initiate dialysis because already an indication for initiate dialysis and 2 patients will follow the treatment regularly and implement healthy behavior. Whereas 4 patients (36,4%) refused although there has been an indication for initiate dialysis. Innovation activities was to develop educational media such as leaflets, booklets and videos on chronic kidney disease patient's plans to initiate dialysis."

"Praktik klinik residensi keperawatan medikal bedah pada pasien osteomielitis bertujuan untuk mengembangkan dan mengimplementasikan peran perawat spesialis sebagai pemberi asuhan keperawatan profesional, edukator, peneliti, dan pembaharu inovator. Peran pemberi asuhan keperawatan dilakukan dengan menggunakan pendekatan Teori Self Care Orem pada pasien Infected union of left tibia post debridement and bone graft application from iliac wing dan 30 pasien lainnya dengan berbagai gangguan sistem muskuloskeletal. Peran sebagai edukator dan peneliti dilakukan oleh perawat spesialis terhadap pasien dan juga rekan sejawat di tatanan pelayanan rumah sakit. Penerapan EBN (Evidence Based Nursing) yaitu dengan mengaplikasikan intervensi diaphragmatic breathing exercise pada pasien pasca operasi Total Knee Replacement untuk mengurangi nyeri dan kecemasan. Proyek inovasi juga dilakukan sebagai perwujudan peran sebagai pembaharu atau inovator yaitu melalui pelaksanaan berupa Pengkajian Risiko DVT skala Autar dalam rangka meningkatkan kualitas asuhan keperawatan profesional di rumah sakit.

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The clinical practice of medical-surgical nursing residency in osteomyelitis patients aims to develop and implement the role of specialist nurses as professional nursing care providers, educators, researchers, and reformers innovators. The role of nursing care provider is carried out using the Orem Self Care Theory approach in patients with infected union of left tibia post debridement and bone graft application from iliac wing and 30 other patients with various musculoskeletal system disorders. The role of educator and researcher is carried out by specialist nurses to patients and also colleagues in hospital service settings. The implementation of EBN (Evidence Based Nursing) is by applying diaphragmatic breathing exercise interventions in postoperative Total Knee Replacement patients to reduce pain and anxiety. Innovation projects are also carried out as a manifestation of the role as a reformer or innovator, namely through the implementation of the Autar scale DVT Risk Assessment in order to improve the quality of professional nursing care in the hospital."

"Karya ilmiah akhir ini disusun untuk memberikan gambaran tentang pelaksanaan praktek residensi keperawatan medikal bedah yang telah dilaksanakan selama dua semester. Kegiatan utama yang telah dilaksanakan diantaranya memberikan asuhan keperawatan pada pasien dengan gangguan sistem perkemihan, praktek keperawatan berbasis pembuktian, dan inovasi keperawatan. Asuhan keperawatan yang dilakukan pada pasien dengan gangguan sistem perkemihan menggunakan konsep teori Self Care Orem. Masalah keperawatan yang paling sering terjadi pada pasien dengan gangguan perkemihan diantaranya kelebihan volume cairan, intoleran aktifitas, ketidakseimbangan nutrisi kurang dari kebutuhan tubuh. Untuk mengatasi masalah tersebut telah dilakukan berbagai intervensi keperawatan berdasarkan sistem keperawatan sesuai dengan kemampuan pasien dalam memenuhi kebutuhannya. Penerapan praktek keperawatan berbasis pembuktian dilaksanakan dengan memberikan latihan fisik saat hemodialisis untuk meningkatkan adekuasi hemodialisis. Tujuan latihan fisik ini adalah untuk meningkatkan pengeluaran ureum yang merupakan zat toksik dalam tubuh, sehingga adekuasi dicapai secara optimal. Hasil menunjukkan adekuasi hemodialisis meningkat sebesar 70,2 %. Inovasi keperawatan dilakukan dengan melaksanakan edukasi manajemen pasien hemodialisi dengan memberikan booklet pada pasien yang menjalani hemodialisis. Hasil program inovasi menunjukkan bahwa pengetahuan pasien meningkatkan. Dapat disimpulkan bahwa teori Self Care yang diterapkan pada pasien dengan gangguan perkemihan mengoptimalkan kemampuan pasien dalam mempertahankan kebutuhannya. Disarankan agar teori Self Care Orem ini dapat diterapkan dalam memberikan asuhan keperawatan pada pasien dengan gangguan sistem perkemihan, latihan fisik saat hemodialisis dapat diberikan sebagai terapi keperawatan dalam meningkatkan adekuasi hemodialisis serta melakukan edukasi pada pasien untuk meningkatkan pengetahuannya sehingga kesehatan yang optimal dapat tercapai.

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This final scientific work is made to provide an overview of the implementation of medical-surgical nursing practice residency which has been held for two semesters. The main activities have been implemented, including providing nursing care to patients with disorders of the urinary system, evidence-based nursing practice, and nursing innovation. Nursing care in patients with urinary system disorders using theoretical concepts Orem Self Care.

Nursing problems often occur in patients with urinary disorders, such excess fluid volume, activity intolerance, imbalance nutritional less, than body requirements. To overcome these problems have been made based nursing interventions nursing system, in accordance with the patient's ability to meet their needs. Application of evidence-based nursing practice implemented by giving physical exercise to improve the adequacy of current hemodialysis. The purpose of this exercise is to increase spending urea which is a toxic substance in the body, so that the adequacy achieved optimally.

Results indicate adequacy of hemodialysis increased by 70.2%. Nursing Innovation is done by carrying out management education hemodialysis patient by providing a booklet in patients undergoing hemodialysis. The results innovation program showed that the patient knowledge improves. It can be concluded that the theory of Self Care is applied in patients with urinary disorders, optimizing the patient's ability to sustain its needs.

It is suggested that the theory of Orem's Self Care can be applied in providing nursing care to patients with disorders of the urinary system, physical exercise while hemodialysis can be given as therapy to improve the adequacy of hemodialysis nursing and educating patients to improve knowledge so that optimum health can be achieved."

"Osteoartritis pada lutut (OA genu) merupakan OA yang bersifat idiopatik, yang ditandai dengan degenerasi tulang rawan lutut yang berdampak terhadap terjadinya kecacatan atau disability. Akibat disability yang dialaminya, pasien kesulitan untuk melakukan perawatan diri atau self care. Terkait hal tersebut, peran perawat spesialis keperawatan medical bedah diperlukan dalam pemberian asuhan keperawatan dengan pendekatan teori self care Orem pada pasien dengan osteoartritis genu. Peran perawat juga diperlukan dalam penelitian antara lain menerapkan praktik keperawatan berbasis bukti (Evidence based practice nursing) pada pasien ortopedi yang akan menjalani pembedahan dengan anestesi umum untuk mencegah pneumonia post operasi melalui intervensi oral hygiene dengan chlorhexidine mouthwash 0.12%. Hasil penerapan EBN ini efektif yaitu dapat mencegah infeksi pneumonia post operasi pada seluruh partisipan. Sebagai inovator, kegiatan inovasi yang dilakukan adalah membuat buku panduan komunikasi SBAR (Situation, Background, Assesment, Recommendation) yang fokus kepada masalah-masalah keperawatan pada kasus ortopedi untuk digunakan oleh perawat di ruangan pada saat handover.

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Osteoarthritis of the knee (OA genu) is an idiopathic OA, which is characterized by degeneration of knee cartilage that may cause disability. Due to the disability they experienced, patient found it difficult to perform self-care. Related to this, the role of medical-surgical nurse specialist are needed in providing nursing care based on Orem?s theory of self care in patients with osteoarthritis of the knee.

The role of the nurse is also required in research, for example, applying evidence-based nursing practice in patients undergoing orthopedic surgery under general anesthesia to prevent postoperative pneumonia through the intervention of oral hygiene with a 0.12% chlorhexidine mouthwash.

The results of the implementation of this EBN was effective to prevent postoperative pneumonia infection among participants. As an innovator, the innovation activity was a SBAR (Situation, Background, Assessment, Recommendation) communication guide book which focused on the problems of nursing in orthopedic cases to be used by nurses in the ward while they do handover."

"Fraktur merupakan masalah sistem muskuloskeletal yang paling sering terjadi. Penanganan fraktur yang tidak tepat dapat mengakibatkan osteomielitis. Osteomielitis tibia merupakan osteomielitis terbanyak kedua setelah femur. Perawat berperan sebagai pemberi asuhan keperawatan, peneliti dan innovator. Peran sebagai pemberi asuhan keperawatan dilakukan dengan pendekatan self care deficit theory pada klien osteomielitis. Masalah yang paling sering terjadi pada klien dengan gangguan sistem muskuloskeletal adalah konstipasi, peran sebagai peneliti dilakukan dengan praktik berbasis bukti (evidence based nursing) yaitu bowel management untuk mencegah konstipasi pada klien pasca Total Hip Replacement (THR) dan Total Knee Replacement (TKR). Inovasi pada tempat praktik dilakukan dengan menyediakan panduan komunikasi dengan metode SBAR pada kasus dengan gangguan sistem muskuloskeletal untuk mendukung komunikasi efektif inter-intra disiplin saat handover maupun komunikasi melalui telepon.

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Fractures are musculoskeletal system problems that most frequently occur. Fracture improper handling can lead to osteomyelitis. Tibial osteomyelitis is the second largest after the femoral osteomyelitis. Nurses act as care providers, researchers and innovators. Nurse as care provider use Orem's self-care deficit theory approach for client with osteomyelitis. Nurse as researcher found that the most often problem that occurs in clients with musculoskeletal system dysorder attempt Total Hip Replacement (THR) and Total Knee Replacement (TKR) is constipation that need to be performed bowel management as evidence based nursing. Nurse as innovator provides guidance communication using SBAR method in cases musculoskeletal system dysorder to support effective communication inter-intra discipline when handover or communication by telephone."

"[ABSTRAK Praktik residensi keperawatan medikal bedah peminatan sistem respirasi memiliki tujuan untuk menjalankan tiga peran ners spesialis. Peran sebagai manajer kasus, pemberi layanan dan inovator. Sebagai manajer kasus, residen mengelola kasus utama pasien tuberculosis dan diabetes mellitus, dan 30 kasus resume dengan menggunakan Teori Self-Care Orem. Masalah keperawatan utama yang paling sering muncul adalah ketidakefektifan bersihan jalan napas. Sebagai pemberi layanan, residen telah menerapkan intervensi keperawatan berdasarkan pembuktian yaitu oral hygiene dengan chlorhexidine 0,12% yang dapat mencegah terjadinya Ventilator Associated Pneumonia (VAP). Inovasi keperawatan yang dilakukan yaitu modifikasi Water Seal Drainage (WSD) 1 botol yang telah mendapatkan respon yang baik dari para ahli dibidangnya untuk meningkatkan keselamatan pasien dan keselamatan pekerja atau petugas kesehatan dalam proses asuhan keperawatan.ABSTRACT The purpose of medical-surgical nurse resident in respiratory system clinical practice is to perform three roles of a nurse specialist as a case manager, healthcare provider and innovator. As a case manager, the resident managed a case of Tuberculosis and Diabetes Mellitus patient, and 30 resume cases with Orem Self-Care theory approach. The main nursing problem found during the clinical practice was ineffective airway clearance. As a healthcare provider, the resident had applied an evidence-based nursing intervention that has been using chlorhexidine 0,12% in oral hygiene procedure that can prevent Ventilator Associated Pneumonia (VAP). As an innovator, resident had made a modification of one bottle water-sealed drainage that has received good response from the experts to increase patients and employers or healthcare provider safety during the nursing care process.;The purpose of medical-surgical nurse resident in respiratory system clinical practice is to perform three roles of a nurse specialist as a case manager, healthcare provider and innovator. As a case manager, the resident managed a case of Tuberculosis and Diabetes Mellitus patient, and 30 resume cases with Orem Self-Care theory approach. The main nursing problem found during the clinical practice was ineffective airway clearance. As a healthcare provider, the resident had applied an evidence-based nursing intervention that has been using chlorhexidine 0,12% in oral hygiene procedure that can prevent Ventilator Associated Pneumonia (VAP). As an innovator, resident had made a modification of one bottle water-sealed drainage that has received good response from the experts to increase patients and employers or healthcare provider safety during the nursing care process., The purpose of medical-surgical nurse resident in respiratory system clinical practice is to perform three roles of a nurse specialist as a case manager, healthcare provider and innovator. As a case manager, the resident managed a case of Tuberculosis and Diabetes Mellitus patient, and 30 resume cases with Orem Self-Care theory approach. The main nursing problem found during the clinical practice was ineffective airway clearance. As a healthcare provider, the resident had applied an evidence-based nursing intervention that has been using chlorhexidine 0,12% in oral hygiene procedure that can prevent Ventilator Associated Pneumonia (VAP). As an innovator, resident had made a modification of one bottle water-sealed drainage that has received good response from the experts to increase patients and employers or healthcare provider safety during the nursing care process.]"