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"Praktik Keperawatan Klinik lanjut di ruang penyakit dalam dan poli UPT Pokdisus HIV AIDS untuk memberikan asuhan keperawatan pada klien gangguan sistem imun menggunakan model teori keperawatan Orem's Self Care Deficit menerapkan praktik keperawatan berdasarkan pembuktian Masalah keperawatan terbanyak akibat penyimpangan self care perkembangan adalah risiko infeksi dan kurang pengetahuan tentang regimen pengobatan Intervensi berdasarkan pembuktian yang diterapkan yaitu pendekatan nurse as coach menggunakan coaching technique Inovasi keperawatan yaitu penatalaksanaan aplikasi short message services sms untuk dukungan terhadap peningkatan kepatuhan terapi antireroviral Perawat menerapkan mode Self Care Deficit Orem menerapkan coaching technique untuk meningkatkan kemandirian klien dalam perawatan dirinya serta melakukan kegiatan inovatif dalam pemberian asuhan keperawatan pada klien dengan gangguan imun Kata kunci Gangguan sistem imun model Orem's self Care Deficit asuhan keperawatan

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Advance clinical practice on client with immune system disorders using model theory of Orem's Self Care Deficit is implementation of nursing practice based on evidence of nursing practice and implementing nursing innovation at the inpatient and outpatient ward setting The most frequent nursing issues occured was risk of infection and lack of knowledge about treatment of medication Nursing intervention based on evidence based practices is the the role of nurse as a coach using a coaching technique that very useful to promoting improving independency of self management Innovation of nusing in this clinical practice was using aplication of mobile phone of short message service SMS to promote the improvement of client adherence to ART Nurses apply the model of Orem's Self care Deficit apply a coaching technique to increase the independence of the client in her his care and conduct innovative activities in the provision of nursing care to clients with impaired immune systems "

"Residensi Keperawatan Medikal Bedah merupakan aplikasi praktek pada program spesialis yang menggali ilmu sesuai dengan peminatan, dalam hal ini adalah sistem pernapasan. Kegiatan yang dilakukan selama residensi adalah melaksanakan asuhan keperawatan dengan pendekatan model teori self care deficit Dorothea Orem. Masalah keperawatan yang sering muncul pada pasien dengan gangguan sistem respirasi adalah batuk, sesak, nyeri, demam, gangguan nutrisi dan kelelahan. Kegiatan berikutnya adalah pemberian intervensi berbasis bukti (evidence based nursing) dengan memberikan latihan napas pursed lip breathing pada pasien Penyakit Paru Obstruksi Kronik (PPOK).Hasilnya adalah pursed lip breathing dapat menurunkan frekwensi pernapasan, meningkatkan arus puncak respirasi dan saturasi oksigen. Kegiatan berikutnya adalah dan melaksanakan program inovasi tentang water seal drainage 1 botol. Hasilnya adalah sangat direkomendasikan untuk digunakan pada pasien yang memerlukan pemasangan water seal drainage dilihat dari keamanan dan estetika penglihatan.Disimpulkan bahwa model Teori self care deficit Dorothea Orem dapat diterapkan dalam pelaksanaan asuhan keperawatan pada pasien gangguan sistem respirasi, pursed lip breathing pada pasien penyakit paru obstruksi kronik, dan penggunaan water seal drainage 1 botol inovasi sangat direkomendasikan dapat memberi keamanan bagi pasien dan baik secara estetika penglihatan.

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Medical surgical nursing residency is the practice in the application of specialist practice where student explore a new science a technologi related to, in the respiratory system. The activities that always do during the residency is carring out nursing care with theoretical approach model self care deficit Dorothea Orem.

The nursing problem that always appears to patient with disorder of respiratory system are coughing, tightness, pain, fever, nutrisional disorders and fatique. The next step is giving evidence based nursing by giving breathing excercise is pursed lip breathing to Chronic Obstruction Pulmonary Disease (COPD).

The result is pursed lip breathing that make be able to lower frequency breathing , increasing the current peak of respiration and oxygen saturation. The next activity is creating a new innovation program about water seal drainage one bottle. The result is highly recommended for use by patients who need the installation of a water seal drainage in the context of safety and visual aesthetics.

Concluded that the theory of model self care deficit dorothea orem can be applied in the implementation of nursing care for with disorders of respiration system, pursed lip breathing for patients chronic obstruction pulmonary disease and the user of water seal drainage one bottle of innovation is very recommended and it can give for patients and it?s better also from visual aesthetics."

"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."

"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."

"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."

"Diabetes mellitus (DM) merupakan kasus yang terbanyak pada gangguan sistem endokrin. Perawat berperan dalam memberi asuhan keperawatan dengan pendekatan teori Self Care Orem yang sistematis memandirikan pasien DM melakukan manajemen DM yang tepat dan terintegrasi dalam kehidupan sehari-hari.Residensi keperawatan medikal bedah peminatan keperawatan endokrin bertujuan untuk menganalisis kegiatan praktek dengan pendekatan teori Self Care Orem berdasarkan peran sebagai care provider, peneliti, innovator, fasilitator, narasumber, koordinator, dan role model. Hasil penerapan evidence based bahwa three layer bandage (3LB) dapat mempercepat penyembuhan ulkus kaki diabetes sehingga menurunkan length of stay.Hasil kegiatan inovasi adalah panduan pengkajian psikososial pasien DM sebagai acuan dalam menentukan intervensi yang tepat dapat diterapkan dan mengurangi kejadian gangguan psikososial di RSUP Fatmawati.Disarankan bagi pelayanan keperawatan bahwa perlu peningkatan pengetahuan perawat secara berkala tentang asuhan keperawatan pada pasien dengan gangguan sistem endokrin berdasarkan evidence based dan terintegrasi dengan teori Self Care Orem.

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Diabetes mellitus (DM) is the most common disturbance in endocrine system. Nurses have a role in giving nursing care using systemically Self Care Orem Theory in order to make diabetes?s patient self-cared and integrated in managing his daily life condition.The purpose of practical residency in Medical Surgical Nursing Focusing on Patient with endocrine disturbance is to analyze practical using Self Care Orem Theory in performing the role of care provider, researcher, innovator, facilitator, resource person, coordinator, & role model.The result of the implementation of evidence based on three layer bandage (3LB) can improve healing process on diabetic foot ulcer where it can decrease length of stay. The result of the innovation program is the guidance book in diabetic patient assessment in psychosocial issue in determining the proper nursing intervention to decrease psychosocial problem in diabetic patient in Fatmawati hospital.It is suggested to improve nurses? knowledge periodically on nursing care patient with endocrine system disturbance using evidence based practice that integrated with Self Care Orem Theory."

"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."

"[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.]"