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"Laporan Praktek Spesialis Keperawatan Maternitas Fokus Pada Penerapan Teori Keperawatan Need For Help 'Wiedenbach' Dan Goal Attainment 'King' Pada Asuhan Keperawatan Ibu Hamil Dengan Plasenta Previa ABSTRAK Petugas kesehatan termasuk perawat spesialis maternitas bertanggung jawab dalam upaya menurunkan angka kematian ibu Program Ners Spesialis Keperawatan Maternitas merupakan program pendidikan yang bertujuan untuk memberikan pengetahuan keterampilan serta sikap untuk dapat menjalankan peran dan fungsi dalam memberikan asuhan keperawatan Melalui program ini para calon Ners Spesialis Keperawatan Maternitas melaksanakan peran dan fungsinya sebagai care giver edukator konselor komunikator pengelola advokat kolabolator change agent dan peneliti baik ditatanan klinik maupun di komunitas Salah satu fungsi yang dilaksanakan adalah memberikan asuhan keperawatan dengan penerapan teori keperawatan need for help 'Wiedenbach' dan teori goal attainment 'King' pada ibu hamil dengan plasenta previa Integrasi kedua teori ini tepat digunakan dalam membantu mempertahankan kesehatan ibu dan janin serta mencegah terjadinya komplikasi Kata kunci Plasenta previa need for help goal attainment

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Maternity Nursing Specialist Practice Report Focused on the Application of Wiedenbach's 'Need For Help' and King's 'Goal Attainment' Nursing theory in Nursing Care of Pregnant Women with Placenta Previa ABSTRACT Health professionals including maternity nursing specialist are responsible in an attempt to reduce maternal mortality rate Maternity Nursing Specialist Program is an educational program that aims to provide the knowledge skills and attitudes to be able to perform the role and functions in providing nursing care Through this program the candidates of Maternity Nursing Specialist performed the role and function as a care giver an educator a counselor a communicator a manager an advocate a collaborator a change agent and a researcher both in the clinical area and in the community One of the functions implemented was providing nursing care with the application of Wiedenbach's 'Need For Help' and King's 'Goal Attainment' Nursing theory to pregnant women with placenta previa The integration of both theories was appropriate to maintain the health of the mother and fetus and to avoid complications Keywords Placenta previa need for help goal attainment "

"ABSTRAK Angka kematian ibu (AKI) merupakan salah satu indikator penting dari derajatkesehatan masyarakat. AKI menggambarkan jumlah wanita meninggal dari suatupenyebab kematian terkait dengan gangguan kehamilan atau penanganannya selamakehamilan, melahirkan dan selama nifas. Kasus perdarahan sebagai penyebab utamakematian ibu dapat terjadi pada masa kehamilan, persalinan dan masa nifas. Salahsatu penyebab perdarahan diantaranya adalah plasenta previa. Plasenta previamerupakan salah satu keadaan yang menjadi penyebab perdarahan yang memerlukantindakan segera tenaga kesehatan terkait dengan kondisi ibu dan janin yangdikandungnya. Perawat sebagai salah satu tenaga kesehatan yang memberikan asuhankeperawatan secara komprehensif berperan dalam melakukan pemantauan secaraberkesinambungan kondisi ibu dan janin serta proses persalinan yang akan dihadapi .Tujuan penulisan laporan KIA ini adalah menjelaskan tentang aplikasi konsep danteori keperawatan dalam pemberian asuhan keperawatan pada ibu hamil denganplasenta previa totalis,serta menjelaskan peran perawat maternitas sebagai pemberiasuhan keperawatan, educator, konselor, advokator, pengelola, kolaborator, agenpembaharu (innovator), komunikator dan koordinator serta peneliti dalammemberikan asuhan keperawatan pada ibu hamil dengan plasenta previa. Pemilihankonsep dan teori keperawatan berdasarkan kepada kontek klien yang dalam kondisimengalami komplikasi yang berakibat kecemasan, dibutuhkan pendekatan perawatyang mampu memberikan asuhan secara komprehensif. Oleh karena itu konsep danteori need for help Wiedenbach dan teori of caring Swanson tepat digunakan dalampemberian asuhan keperawatan pada ibu hamil dengan plasenta previa totalis.Dengan harapan kondisi ibu hamil dengan plasenta previa totalis tetap optimal,mampu beradaptasi secara fisik maupun pskologis serta siap terhadap proses persalinan yang akan dihadapi. ABSTRACT The maternal mortality rate (MMR) is one of important indicators of the communityhealth. MMR describes the number of women death caused by problems associatedwith pregnancy or the treatment during pregnancy, childbirth and postpartum period.Hemorrhagic cases as the main cause of maternal death occur during pregnancy,childbirth and postpartum period. One of hemorrhagic causes is placenta previa.Placenta previa is a condition that causes bleeding which requires healthprofessionals? immediate interventions related to the maternal and fetal condition. Anurse as one of health professionals who provides a comprehensive nursing care has arole in monitoring continuously the maternal and fetal condition as well as the laborand birth process. The purpose of this final scientific work was to explain about theapplication of the nursing concepts and theories in providing nursing care to pregnantwomen with placenta previa totalis, as well as to explain the role of maternity nursesas a caregiver, an educator, a counselor, an advocate, a manager, a collaborator, aninnovator, a communicator and a coordinator as well as a researcher in providingnursing care to pregnant women with placenta previa. The selection of nursingconcepts and theories was based on the context of the client experiencedcomplications causing anxiety, nurses? approach that can provide comprehensive carewas needed. Therefore, Wiedenbach need for help concept and theory and Swansontheory of caring were appropriate to be used in the provision of nursing care topregnant women with placenta previa totalis. Hopefully the conditions of pregnantwomen with placenta previa totalis remain optimal, able to adapt physically and psychologically and ready to face the labor process. ;The maternal mortality rate (MMR) is one of important indicators of the communityhealth. MMR describes the number of women death caused by problems associatedwith pregnancy or the treatment during pregnancy, childbirth and postpartum period.Hemorrhagic cases as the main cause of maternal death occur during pregnancy,childbirth and postpartum period. One of hemorrhagic causes is placenta previa.Placenta previa is a condition that causes bleeding which requires healthprofessionals? immediate interventions related to the maternal and fetal condition. Anurse as one of health professionals who provides a comprehensive nursing care has arole in monitoring continuously the maternal and fetal condition as well as the laborand birth process. The purpose of this final scientific work was to explain about theapplication of the nursing concepts and theories in providing nursing care to pregnantwomen with placenta previa totalis, as well as to explain the role of maternity nursesas a caregiver, an educator, a counselor, an advocate, a manager, a collaborator, aninnovator, a communicator and a coordinator as well as a researcher in providingnursing care to pregnant women with placenta previa. The selection of nursingconcepts and theories was based on the context of the client experiencedcomplications causing anxiety, nurses? approach that can provide comprehensive carewas needed. Therefore, Wiedenbach need for help concept and theory and Swansontheory of caring were appropriate to be used in the provision of nursing care topregnant women with placenta previa totalis. Hopefully the conditions of pregnantwomen with placenta previa totalis remain optimal, able to adapt physically and psychologically and ready to face the labor process. "

"Kesehatan reproduksi merupakan masalah penting untuk diperhatikan dalam rangka meningkatkan derajat kesehatan perempuan. Sebagai salah satu usaha untuk mencapai tujuan tersebut, dilaksanakanlah program ners spesialis keperawatan maternitas. Karya ilmiah akhir ini bertujuan untuk memberikan gambaran pelaksanaan praktek residensi ners spesialis keperawatan maternitas dengan fokus penerapan model konsep need for help Wiedenbach pada fase akut dan self care Orem pada fase pemeliharaan pada asuhan keperawatan klien dengan retensio plasenta. Masalah keperawatan pada tahap akut yaitu kekurangan volume cairan, gangguan integritas jaringan, dan kecemasan, sementara pada tahap pemeliharaan adalah gangguan pemenuhan kebutuhan sehari-hari, ketidakefektifan proses menyusui, dan risiko infeksi. Tindakan yang dilakukan meliputi resusitasi cairan, pengeluaran plasenta, perbaikan kontraksi uterus, dan pendidikan kesehatan tentang perawatan pada ibu dan bayi. Evaluasi pada fase akut yaitu perdarahan berkurang, kontraksi uterus kuat, dan pada fase pemeliharaan yaitu peningkatan kemandirian klien.

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Reproductive health is a critical problem that needs attentions in order to increase the female health level. As an attempt to reach this goal, a maternity nursing specialist program is performed. This final scientific work aimed to describe the residential practice of maternity nursing specialist which focused on the application of Wiedenbach's concept of need for help during the acute phase and Orem's self care model during the maintenance phase in the nursing care to a client with placenta retention.

Nursing problems in the acute stage were fluid volume deficit, impaired tissue integrity, and anxiety, while in the maintenance stage were daily needs fulfillment, ineffective breastfeeding, and risk of infection. The nursing intervention included fluid resuscitation, placenta delivery, uterine contraction improvement, and health education related to mother and baby care. The evaluation in the acute phase included reduced bleeding and good uterine contraction, while in the maintenance phase included the enhancement of client's independency."

"[ABSTRAKAngka kematian ibu saat ini masih tinggi yang disebabkan karena komplikasi pada kehamilan dan persalinan, oleh karena itu perlunya peran tenaga kesehatan yang terkait termasuk perawat maternitas untuk memberikan pelayanan kesehatan profesional. Perawat spesialis maternitas dituntut mampu menjalankan perannya secara komprehensif. Laporan ini bertujuan untuk menggambarkan praktik residensi ners spesialis maternitas meliputi asuhan keperawatan pada masa prenatal, intranatal, dan postnatal normal dan berisiko serta bayi baru lahir normal dan berisiko, serta perempuan dengan masalah reproduksi dan ginekologi. Residen juga melakukan asuhan keperawatan dengan focus penerapan teori need for help dan comfort pada ibu bersalin dengan persalinan memanjang. Hasil menunjukkan bahwa kedua model efektif dapat diterapkan pada keenam kasus ibu bersalin dengan persalinan memanjang. Pencapaian kompetensi perawat spesialis maternitas dilakukan dengan penerapan peran perawat secara komprehensif.

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ABSTRACTMaternal mortality rate is still high due to pregnancy and labor complication, therefore the role of health professionals including maternity nurses is needed to provide a professional health care. Maternity nursing specialists are demanded to be able to perform their roles comprehensively. This report aimed to describe the residency practice of maternity nursing specialist including nursing care of normal and high risk prenatal, intranatal, and postnatal as well as normal and high risk newborns, and women with reproductive and gynecological problems. Resident also performed nursing care focused on the application of Wiedenbach Need for Help and Kolcaba Comfort Theory on intrapartum mothers with prolonged labor. Results showed that both models could be applied effectively to the six cases of intrapartum mothers with prolonged labor. The achievement of maternity nursing specialist competencies was conducted by the implementation of the nurse's roles comprehensively., Maternal mortality rate is still high due to pregnancy and labor complication, therefore the role of health professionals including maternity nurses is needed to provide a professional health care. Maternity nursing specialists are demanded to be able to perform their roles comprehensively. This report aimed to describe the residency practice of maternity nursing specialist including nursing care of normal and high risk prenatal, intranatal, and postnatal as well as normal and high risk newborns, and women with reproductive and gynecological problems. Resident also performed nursing care focused on the application of Wiedenbach Need for Help and Kolcaba Comfort Theory on intrapartum mothers with prolonged labor. Results showed that both models could be applied effectively to the six cases of intrapartum mothers with prolonged labor. The achievement of maternity nursing specialist competencies was conducted by the implementation of the nurse's roles comprehensively.]"

"Karya ilmiah akhir disusun sebagai laporan praktik residensi ners spesialis keperawatan maternitas yang menggambarkan pencapaian kompetensi ners spesialis keperawatan maternitas dengan fokus pada aplikasi teori keperawatan need for help dan symptom management pada ibu hamil dengan preeklampsia berat. Kompetensi ners spesialis keperawatan maternitas diwujudkan dengan penerapan peran dan fungsi perawat sebagai pemberi pelayanan keperawatan, advokat. manajer, rehabilitator, komunikator, edukator, kolaborator, dan agen perubah. Aplikasi teori keperawatan need for help Wiedenbach dan symptom management Humphreys pada ibu hamil dengan preeklampsia berat dapat mengatasi masalah keperawatan selama fase akut dan pemeliharaan.

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This final report is created as a report of maternity nursing specialist residency practice which describes the achievement of maternity nursing specialist's competencies focused on the application of 'need for help' and 'symptom management' nursing theory to pregnant women with severe preeclampsia. The competencies of a maternity nursing specialist were actualized by the implementation of roles and functions as a nursing care provider, an advocate, a manager, a rehabilitator, a communicator, an educator, a collaborator, and a change agent The application of Wiedenbach's 'need for help' nursing theory and Humphreys theory of symptom management to pregnant w9men with severe preeclampsia could solve the nursing problems during acute and maintenance phase."

"[Karya ilmiah akhir ini disusun sebagai laporan dari praktik residensi spesialis keperawatan Maternitas yang berfokus pada penerapan teori keperawatan Need for Help Wiedenbach dan Comfort Kolcaba pada asuhan keperawatan ibu yang mengalami retensio plasenta. Tujuan penulisan laporan ini untuk memberikan gambaran aplikasi teori Wiedenbach dan Kolcaba pada kasus retensio plasenta serta memberikan gambaran pelaksanaan praktik Spesialis Keperawatan Maternitas dalam menjalankan perannya sebagai pemberi pelayanan keperawatan, edukator, konselor, advokat, pengelola, kolaborator, komunikator dan koordinator, agen perubah dan peneliti dalam memberikan asuhan keperawatan pada perempuan sepanjang periode kehidupannya dengan menerapkan teori keperawatan. Aplikasi teori keperawatan need for help Wiedenbach dan Theory of Comfort Kolcaba efektif dilakukan pada lima ibu dengan retensio plasenta. Teori keperawatan Need for Help dari Wiedenbach menjadi pilihan untuk kasus retensio plasenta diruang gawat darurat. Penekanan teori ini berdasarkan kebutuhan ibu harus segera dipenuhi yang sifatnya gawat darurat. Labor is a holistic event and Comfort is a holistic phenomenon. Kenyamanan adalah fenomena holistik dan kebutuhan dasar manusia. Oleh karena itu perawat berupaya mengatasi kelemahan teori need for help Wiedenbach dengan menggabungkannya dengan Theory of Comfort Kolcaba. Teori keperawatan ini untuk mengatasi ketidaknyamanan dari aspek fisik, psikospiritual, sosial dan lingkungan sehingga asuhan keperawatan secara komprehensif dapat diberikan. Theory of Comfort Kolkaba terintegrasi dalam penerapan teori need for help Wiedenbach pada asuhan keperawatan ibu dengan retensio plasenta., This final scientific report aimed to report the clinical practice of maternity nursing specialist which focus on the application of Wiedenbach’s theory of the need for help and Kolcaba’s theory of comfort in the nursing care to clients who experience retained placenta. The purpose of this report to provide an overview of the application and Kolcaba Wiedenbach theory in the case of retained placenta and describe the implementation of maternity nursing specialist practices in their role as care giver, educator, counselor, advocate, collaborator, communicator, coordinator, innovators and researchers. Application of nursing theory need for help Wiedenbach and theory of Comfort Kolcaba effectively done in five women with retained placenta. Nursing theory Need for Help from Wiedenbach be an option for retained placenta cases in emergency ward. The emphasis of this theory is based on the needs of the mother must be met emergency nature. Labor is a holistic event and Comfort is a holistic phenomenon. Comfort is a holistic phenomenon and basic human needs. Therefore, the nurse tried to address the weaknesses of the theory of the need for help Wiedenbach combine with theory of Comfort Kolcaba. This nursing theory to address the discomfort of physical aspects, phsycospiritual, social and environment so comprehensively nursing care can be given. Theory of Comfort Kolcaba integrated in the application of the theory of the need for help Wiedenbach nursing mothers with retained placenta .]"

"Karya ilmiah akhir ini disusun sebagai laporan dari praktik residensi spesialis keperawatan Maternitas yang berfokus pada penerapan teori keperawatan Need for Help Wiedenbach dan Comfort Kolcaba pada asuhan keperawatan ibu yang mengalami partus lama Tujuan penulisan laporan ini untuk memberikan gambaran pelaksanaan praktik Spesialis Keperawatan Maternitas dalam menjalankan perannya sebagai pemberi pelayanan keperawatan edukator konselor advokat pengelola kolaborator komunikator dan koordinator agen perubah dan peneliti dalam memberikan asuhan keperawatan pada perempuan sepanjang periode kehidupannya dengan menerapkan teori keperawatan Aplikasi teori keperawatan need for help Wiedenbach dan Theory of Comfort Kolcaba efektif dilakukan pada enam ibu dengan partus lama Aplikasi teori tersebut berhasil membantu menyelesaikan masalah keperawatan dan meningkatkan kenyamanan klien selama persalinan Setelah melaksanakan praktik residensi spesialis keperawatan maternitas penulis mampu mencapai target kompetensi dengan baik Kata kunci asuhan keperawatan partus lama teori keperawatan 'comfort' teori keperawatan 'need for help'

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This final scientific report aimed to report the clinical practice of maternity nursing specialist which focus on the application of Wiedenbach's theory of the need for help and Kolcaba's theory of comfort in the nursing care to clients who experience prolonged labour The purpose of this report is to describe the implementation of maternity nursing specialist practices in their role as care giver educator counselor advocate collaborator communicator coordinator innovators and researchers The competencies also achieved through application of nursing theory in the nursing care The application of Wiedenbach's theory of need for help and Kolcaba's theory of comfort in the nursing care was effective to resolve client's health problem and increased the comfort of the mother during labour After finishing residential practice of maternity nursing specialist the competencies was achieved with a good result Keyword nursing process nursing theory of comfort nursing theory of need for help prolonged labour "

"[ABSTRAKPermasalahan kesehatan di Indonesia diantaranya seputar kesehatan ibu dan kesehatan perempuan. Ners spesialis keperawatan maternitas yang memiliki peran dan fungsi pada kesehatan perempuan diharapkan dapat berperan dalam mengatasi permasalahan kesehatan perempuan. Karya ilmiah akhir ini bertujuan untuk memberikan gambaran pelaksanaan praktek residensi ners spesialis keperawatan maternitas dengan fokus penerapan teori keperawatan "need for help Wiedenbach" pada fase akut dan "conservation Levine" pada fase pemeliharaan dalam asuhan keperawatan tujuh kasus perdarahan akibat kanker serviks. Masalah keperawatan prioritas pada tahap akut adalah resiko hipovolemi. Masalah pada tahap konservasi adalah gangguan perfusi jaringan, gangguan nutrisi dan kelemahan. Evaluasi pada tahap akut adalah tidak terjadi syok hipovolemi. Evaluasi pada tahap konservasi adalah gangguan perfusi jaringan teratasi, klien dapat meningkatkan asupan nutrisi dan dapat meningkatkan kemampuan beraktifitas. Kompetensi selama pelaksanaan praktek keperawatan maternitas dapat dicapai. Ners spesialis keperawatan maternitas diharapkan mampu menerapkan teori model keperawatan dalam pelaksanaan asuhan keperawatan sesuai dengan kondisi dan kebutuhan pasien.

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ABSTRACTHealth problems in Indonesia are including maternal and women's health. Maternity nursing specialists who have the role and function on the women's health are expected to play a role in addressing women's health problems. This final scientific work aimed to describe the implementation of maternity nursing specialist residency practice focused on the application of Wiedenbach Need for Help Theory which was performed in the acute phase and Levine Conservation Theory which was done in the maintenance phase in nursing care of cervical cancer bleeding was performed on seven patients. The prior nursing problem in the acute phase was risk for hypovolemic. The problems in the conservation stage were tissue perfusion disorder, altered nutrition, and weakness. The evaluation in the acute phase was hipovolemic shock did not occur. The evaluations in the conservation phase were the tissue perfusion disorder was resolved, as well as the client can increase the nutritional intake and the ability to do the activity. The maternity nursing specialist competencies were achieved during the residency practice. The maternity nursing specialists are expected to be able to apply the nursing model theory in the implementation of nursing care in accordance with the patient's conditions and needs., Health problems in Indonesia are including maternal and women's health. Maternity nursing specialists who have the role and function on the women’s health are expected to play a role in addressing women's health problems. This final scientific work aimed to describe the implementation of maternity nursing specialist residency practice focused on the application of Wiedenbach Need for Help Theory which was performed in the acute phase and Levine Conservation Theory which was done in the maintenance phase in nursing care of cervical cancer bleeding was performed on seven patients. The prior nursing problem in the acute phase was risk for hypovolemic. The problems in the conservation stage were tissue perfusion disorder, altered nutrition, and weakness. The evaluation in the acute phase was hipovolemic shock did not occur. The evaluations in the conservation phase were the tissue perfusion disorder was resolved, as well as the client can increase the nutritional intake and the ability to do the activity. The maternity nursing specialist competencies were achieved during the residency practice. The maternity nursing specialists are expected to be able to apply the nursing model theory in the implementation of nursing care in accordance with the patient’s conditions and needs.]"

"Karya ilmiah akhir disusun sebagai laporan praktik residensi ners spesialis keperawatan maternitas yang menggambarkan pencapaian kompetensi ners spesialis keperawatan maternitas dengan fokus pada aplikasi teori keperawatan need for help dan symptom management pada ibu hamil dengan preeklampsia berat. Kompetensi ners spesialis keperawatan maternitas diwujudkan dengan penerapan peran dan fungsi perawat sebagai pemberi pelayanan keperawatan, advokat, manajer, rehabilitator, komunikator, edukator, kolaborator, dan agen perubah. Aplikasi teori keperawatan need for help Wiedenbach dan symptom management Humphreys pada ibu hamil dengan preeklampsia berat dapat mengatasi masalah keperawatan selama fase akut dan pemeliharaan.

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This final report is created as a report of maternity nursing specialist residency practice which describes the achievement of maternity nursing specialist’s competencies focused on the application of ‘need for help’ and ‘symptom management’ nursing theory to pregnant women with severe preeclampsia. The competencies of a maternity nursing specialist were actualized by the implementation of roles and functions as a nursing care provider, an advocate, a manager, a rehabilitator, a communicator, an educator, a collaborator, and a change agent. The application of Wiedenbach’s ‘need for help’ nursing theory and Humphreys theory of symptom management to pregnant women with severe preeclampsia could solve the nursing problems during acute and maintenance phase."

"Indikator capaian dari SDG’s salah satunya menurunkan angka kematian ibu dan bayi. Indonesia akan berusaha menurunkan angka kematian ibu menjadi kurang dari 70 kematian per 100.000 kelahiran hidup pada tahun 2030. Kematian ibu dan bayi disebabkan terjadinya persalinan prematur. Persalinan prematur dapat disebabkan adanya kontraksi uterus sehingga terjadi dilatasi serviks pada usia kehamilan 20-36 minggu. Ancaman persalinan prematur akan mengakibatkan gawat janin dan komplikasi pada bayi baru lahir. Study kasus pada lima ibu hamil yang mengalami kontraksi dini dengan fokus mengimplementasikan teori need for help pada keadaan emergency dan penerapan teori comfort Kolcaba pada tahap pemulihan. Ibu hamil akan mendapatkan intervensi tatalaksana tokolitik dan terapi relaksasi dengan self-hypnosis yang membantu ibu untuk mengontrol ketidaknyamanan dan menurunkan kecemasan selama di rumah sakit. Aplikasi tersebut berhasil membantu ibu hamil melalui tahap kegawatan dan meningkatkan kenyamanan serta mencegah kontraksi uterus berulang sehingga ibu dapat mempertahankan kehamilan sampai usia kehamilan aterm.

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The achievement indicators of SDG’s are one of them reducing maternal and infant mortality. Indonesia will try to reduce maternal mortality to less than 70 deaths per 100,000 live births by 2030. Maternal and neonatal deaths are caused by preterm labor. Premature labor can be caused by uterine contractions resulting in cervical dilatation at 20-36 weeks' gestation. The threat of preterm labor will result in fetal distress and complications in newborns. Case studies on five pregnant women who experienced premature contractions with a focus on implementing the need for help theory in an emergency and the application of the Kolcaba comfort theory in the recovery phase. Pregnant women will get a tocolytic management intervention and relaxation therapy with self-hypnosis that helps the mother to control discomfort and reduce anxiety during the hospital. The application is successful in helping pregnant women go through the emergency phase and increase comfort and prevent repeated uterine contractions so that the mother can maintain the pregnancy until the term gestational age."