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"Praktik spesialis keperawatan medikal bedah peminatan sistem perkemihan ini bertujuan untuk melakukan praktik dengan mengaplikasikan peran perawat melalui pendekatan Model Adaptasi Roy. Peran sebagai pemberi asuhan keperawatan diterapkan pada 30 pasien gangguan sistem perkemihan dan satu orang pasien kelolaan utama yaitu pasien stiktur ureter. Peran sebagai peneliti dalam melakukan penerapan tindakan keperawatan yang berbasis pembuktian ilmiah (evidence based nursing practice) yaitu dengan membuktikan akupresur sebagai salah satu tehnik menurunkan keletihan. Peran sebagai inovator melalui penggunaan booklet sebagai media edukasi manajemen pasien hemodialisis yang bertujuan untuk memberikan arahan yang sistematis tindakan mandiri yang dilakukan oleh pasien yang menjalani terapi hemodialisis dan meningkatkan kualitas asuhan keperawatan. Hasil praktik ini menunjukkan bahwa Model Adaptasi Roy efektif digunakan pada pasien gangguan sistem perkemihan, dan akupresur efektif untuk mengurangi keletihan, selain itu penggunaan booklet manajemen pasien hemodialisis dapat diterapkan perawat dalam melakukan asuhan keperawatan.

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Medical Surgical Nursing Practice specialist in urinary system aim to practice by applying the role of nurse through the Roy Adaptation Model approach. Role as nursing care was applied to 30 patient of urinary disorders and a patient with ureter stricture is the main case. Role as researcher was carried out by applying evidence based nursing practice to prove acupressure as a fatique reduction techniques of hemodialysis patient. Role as an innovator through booklet used as media education of hemodialysis patient management, which aims to provide guidance on a systematic action that is performed independently by patients undergoing hemodialysis therapy and improve the quality of nursing care. The results of this practice shows that Roy Adaption Model effectively used on patient of urinary system disorder, acupressure effectively to reduce fatique. In addition, booklet on hemodialysis patient management can be applied to nurses in performing nursing care."

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Pendekatan teori keperawatan dalam pelaksanaan pemberian asuhan keperawatan merupakan salah satu tujuan dari pelaksanan program ners spesialis keperawatan medikal bedah. Teori keperawatan dapat diterapkan dalam berbagai masalah yang dihadapi oleh pasien, seperti halnya masalah pada pasien dengan gangguan sistim perkemihan. Pasien dengan masalah gangguan pada sistim perkemihan akan mengalami berbagai perubahan pada sistim keseimbangan tubuh, sehingga tubuh memerlukan suatu proses adaptasi. Pendekatan teori adaptasi Roy, melalui mekanisme koping, sistim regulator dan kognator dapat mengatasi perilaku adaptif maupun maladaptif yang dialami oleh pasien berdasarkan hasil pengkajian perilaku dan stimulus. Pelaksanaan penerapan Evidence Based Nursing: melalui pemberian intervensi keperawatan non farmakologi: Aerobic Exercise Intradialytic pada pasien Chronic Kidney Disease Stage V yang menjalani hemodialisis, terbukti dapat meningkatkan pencapaian adekuasi dialisis pasien. Hasil penerapan proyek inovasi penggunaan model the activated health education melalui media edukasi flipchart mengenai terapi pengganti ginjal terbukti berpengaruh dan mampu meningkat pengetahuan pasien mengenai terapi pengganti ginjal.

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The concept of nursing care implementation is one of the objectives medical nursing specialist medical programs. Nursing theory can be applied to various problems issued by patients, as well as problems in patients with urinary system problems. Patients with problems in the urinary system will be changes in the bodys balance system, so the body needs an adaptation process. Roys adaptation theory, through coping regulations, regulator and kognator system can overcome the adaptation and maladaptive problems needed by patients based on the results of behavioral and stimulus assesment. Nursing-Based Evidence Implementation: through the implementation of non-pharmacological nursing interventions: Intradialytic Aerobic Exercise in patients with Chronic Kidney Disease Stage V on hemodialysis, can improve patient dialysis adequacy. The model of health education application the activated through flipchart education media on kidney prevention therapy has been able to increase patient knowledge about kidney therapy.

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"Praktik residensi keperawatan medikal bedah adalah bagian dari pendidikan profesi yang mempunyai tujuan untuk menghasilkan perawat spesialis. Perawat spesialis diharapkan dapat melaksanakan perannya dalam memberikan pelayanan keperawatan pada kasus dengan gangguan sistem pernapasan. Peran tersebut sejalan dengan kompetensi yang harus dicapai selama praktik residensi berupa pemberian asuhan keperawatan, penerapan praktik keperawatan berbasis bukti dan proyek inovasi. Pemberian asuhan keperawatan diterapkan kepada satu pasien kelolaan utama dengan kasus PPOK dan 30 kasus resume menggunakan pendekatan model adaptasi Roy. Penerapan tindakan keperawatan berbasis bukti ilmiah yang dilakukan yaitu pemberian posisi condong kedepan dan Latihan nafas pursed lips breathing pada pasien dyspnea dengan penyakit paru. Proyek inovasi yang diterapkan yaitu Pengembangan Self Manajemen Dengan Video Latihan Breathing Exercise : ACBT Dalam Meningkatkan Airway Clearance Pada Pasien Dengan Penyakit Paru Obstruksi Kronis (PPOK). Hasil analisis praktik menunjukkan bahwa model adaptasi Roy dapat digunakan sebagai pendekatan dalam asuhan keperawatan pasien dengan gangguan sistem pernapasan untuk mengembangkan mekanisme adaptif pasien. Pemberian posisi condong kedepan dan Latihan nafas pursed lips breathing dapat menurunkan sesak napas pada pasien dengan penyakit paru. Selain itu, Latihan Breathing Exercise : ACBT Dalam Meningkatkan Airway Clearance Pada Pasien mendapat evaluasi yang positif dan dapat diterapkan di tatanan klinis sebagai inovasi pengkajian dan manajemen keperawatan mandiri pada pasien PPOK selama di rumah.

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Medical surgical nursing residency practice is part of professional education that aims to produce specialist nurses. Specialist nurses are expected to carry out their role in providing nursing services in cases with respiratory system disorders. The role is in line with the competencies to be achieved during residency practice in the form of providing nursing care, implementing evidence-based nursing practice and innovation projects. Nursing care was applied to one primarily managed patient with a case of COPD and 30 resume cases using Roy's adaptation model approach. The application of scientific evidence-based nursing actions carried out is the provision of a forward leaning position and pursed lips breathing exercises in dyspnea patients with lung disease. The innovation project applied is the Development of Self Management with Video Breathing Exercise: ACBT in Increasing Airway Clearance in Patients with Chronic Obstructive Pulmonary Disease (COPD). The results of the practice analysis show that Roy's adaptation model can be used as an approach in nursing care of patients with respiratory system disorders to develop patient adaptive mechanisms. Forward leaning and pursed lips breathing exercises can reduce shortness of breath in patients with lung disease. In addition, Breathing Exercise: ACBT in Increasing Airway Clearance in Patients received a positive evaluation and can be applied in clinical settings as an innovation in self-assessment and nursing management in COPD patients while at home."

"Praktek klinik spesialis keperawatan medikal bedah pada sistem perkemihan secara keseluruhan bertujuan untuk memberikan asuhan keperawatan tingkat lanjut, menerapkan praktek keperawatan berbasis bukti serta berperan sebagai agen pembaharu di ruang perawatan. Peran sebagai pemberi asuhan keperawatan dilakukan dengan menggunakan pendekatan Model Adaptasi Roy pada 30 pasien gangguan sistem perkemihan dan pada pasien urolithiasis sebagai kasus utama. Peran sebagai peneliti dilakukan melalui penerapan Evidence Based Nursing berupa penerapan format DSI Dialysis Symptom Index pada 164 pasien hemodialisis terbukti memudahkan perawat dalam mengidentifikasi keseluruhan sindroma hemodialisis yang dialami pasien. Peran sebagai inovator dilakukan dengan menerapkan latihan ROM Range of Motion terbukti dapat menurunkan nilai fatigue yang diukur dengan format FACIT-F Functional Assessment of Chronic Illness Therapy- Fatigue

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Clinical practice of medical surgical nursing specialist in urinary system aimed to provide the advance nursing care to implement the evidence based nursing and to act as an innovator in the treatment room. The role as a caregiver in nursing process was carried out using Roy's Adaptation Theory toward 30 patients with urinary system disorder and toward an urolithiasis patient as a main case. The role as a researcher was carried out by implementing evidence based nursing about assessment of hemodialysis syndrome by using DSI Dialysis Symptom Index on 164 hemodialysis patients that can facilitate nurses to identify all of patient's hemodialysis syndrome. The role as an innovator was carried out by doing Range of Motion ROM exercise that was proven to reduce fatigue level measuring by FACIT F Functional Assessment of Chronic Illness Therapy Fatigue."

"Program spesialis keperawatan medikal bedah khususnya neurologi dimaksudkan untuk menjadikan seorang perawat spesialis neurosains yang berperan dalam praktik keperawatan berupa pemberi asuhan keperawatan lanjut, melakukan pembuktian ilmiah dan agen pembaharu. Asuhan keperawatan dilakukan pada kasus pasien dengan cedera kepala dan 31 pasien dengan gangguan neurologis dengan pendekatan Model adaptasi Roy (RAM). Perilaku maladaptif paling banyak terganggu pada mode fisologis dengan diagnosis penurunan kapasitas adaptif intrakranial. Evidence Based Nursing dilakukan dengan menerapkan sistematik oral care pada 12 pasien gangguan neurologis dengan hasil yang signifikan (p value 0,004). Program inovasi menerapkan pemberdayaan caregiver pasien stroke dengan hasil perbedaan pengetahuan dan keterampilan caregiver melalui edukasi dan demonstrasi (p value <0.005). Pengkajian perilaku dan stimulus pada RAM perlu diterapkan pada pengkajian pada pasien gangguan neurologis. Intervensi keperawatan diharapkan berbasis pada evidence based nursing. Pemberdayaan caregiver pada pasien gangguan neurologis khususnya stroke perlu dilakukan sejak dini untuk menyiapkan caregiver dalam merawat pasien gangguan neurologis.

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Nurse specialist program of medical surgical nursing especially neurological nurses proposed neuroscience nurse specialist play role in nursing practice as advanced nursing care providers, conduct scientific evidence and innovator. Roy adaptation model approach was used in the nursing care of the head injury patients and 31 patients of neurological disorders cases. Decreased intracranial adaptive capacity was the most often of nursing diagnosis enforced which was caused maladaptive behavior in physiological mode. Evidence based nursing was implemented by practice systematic oral care in 12 neurological disorders patients that showed oral assessment score differed significantly (p value 0,004). Role as an innovator was implemented by engage caregiver empowerment through education and demonstration in stroke patients that showed there was differences in the knowledge and skills of the caregivers (p value <0.005). Roy adaptation model can be one effective approach for the assessment of the neurological disorders patients. Nursing interventions are expected to always be based on evidence based nursing. Early caregiver empowerment in neurological disorders patients especially stroke is required to set up the caregivers in caring of the patients."

"Praktek klinik lanjut selama praktek residensi keperawatan pada sistem neurologi dimaksudkan untuk mampu memberikan asuhan keperawatan, menerapkan Evidence Based Nursing (EBN) serta mampu berperan sebagai innovator di ruang perawatan. Peran pemberi asuhan keperawatan dilakukan dengan menggunakan model adaptasi Roy pada pasien dengan tumor otak dan 30 pasien lainnya dengan berbagai gangguan sistem persarafan. Perilaku maladaptif paling banyak adalah mode adaptasi fisiologi, yaitu ketidakefektifan perfusi jaringan cerebral.Intervensi keperawatan berupa manajemen edema cerebral ditujukkan untuk meningkatkan adaptasi pasien dalam meningkatkan perfusi jaringan ceredral. Penerapan EBN respiratory muscle training (RMT) pada tiga pasien stroke menunjukkan keefektifan RMT dalam meningkatkan fungsi pernafasan pasien stroke. Program inovasi keperawatan berupa penerapan program pencegahan kejadian jatuh pada pasien neurologi di rawat inap.

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Advance clinical practice in neurological system during residency period is proposed to be able to provide nursing care, implement the evidence based nursing (EBN) and be able to act as innovator in the treatment room. The role of nurse care provider was made using Roy`s adaptation model in patients with brain tumor and 30 other patients with various neural system disorders. The most maladaptive behavior is the physiological adaptation mode is the ineffective cerebral tissue perfusion, The nursing management intervention was cerebral edema management to improve patient adaptation in enchancing cerebral tissue perfusion. Implementation of EBN: respiratory muscle training (RMT) in three patients with stroke can improve the respiratory function of the stroke patients. Implementation of the fall prevention program can be used for prevent the patient`s fall risk."

"Karya ilmiah akhir ini merupakan laporan praktik residensi keperawatan medikal bedah yang terdiri dari pengelolaan kasus stroke hemoragik dan 30 kasus resume dengan pendekatan Model Adaptasi Roy MAR , penerapan evidence based nursing EBN untuk skrining penegakan diagnosa gangguan menelan pada pasien stroke fase akut dan melakukan proyek inovasi tentang pemberdayaan caregiver pada pasien stroke dengan edukasi terstruktur. Perilaku maladaptif paling banyak terdapat pada mode fisiologis dengan masalah keperawatan resiko ketidakefektifan perfusi jaringan serebral. Pengkajian dengan pendekatan MAR bisa diterapkan pada pasien dengan gangguan neurologi di ruangan. The Barnes-Jewish Hospital Stroke Dysphagia Screen BJH-SDS bisa diterapkan dengan memiliki sensitivitas 100 dan spesivisitas 100 . Budaya pengembangan intervensi keperawatan berdasarkan EBN diharapkan bisa terus terbangun di tatanan klinik. Pada inovasi keperawatan terdapat peningkatan rata-rata pengetahuan dan ketrampilan caregiver setelah pemberian edukasi terstruktur pValue.

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This final scientific paper is a report of medical surgical nursing of residency practice which consists of the management of cases of hemorrhagic stroke and 30 cases of resume with the approach Roy rsquo s Adaptation Model RAM , the application of evidence based nursing EBN to screen for enforcement diagnosis of swallowing disorders in stroke patients in the acute phase and undertake innovation projects on empowering caregivers in stroke patients with a structured education. Maladaptive behavior are most numerous in the physiological mode with nursing problems ineffectiveness risk of cerebral tissue perfusion. RAM assessment approach can be applied to patients with neurological disorders in the hospital. The Barnes Jewish Hospital Dysphagia Stroke Screen BJH SDS can be applied with a sensitivity of 100 and specificity of 100. Cultural development of nursing interventions based EBN is expected to continue to awaken in order clinic. On the innovation of nursing there is an average increase knowledge and skills caregiver after administration of structured education pvalue."

"Ners spesialis adalah pemimpin klinis dalam bidang praktik keperawatan. Pengetahuan dan keterampilan tingkat lanjut sebagai Ners Spesialis ini mencakup keahlian klinis,  evidence based nursing, kolaborasi, konsultasi, pendidikan, pendampingan, dan perubahan kepemimpinan. Ners spesialis bertanggung jawab untuk berkolaborasi dengan anggota tim perawatan kesehatan untuk merancang, mengimplementasikan, dan mengukur strategi perawatan berbasis bukti yang aman, efektif biaya, dan terbukti. Kegiatan yang dilakukan dalam menjalani praktik residensi Ners Spesialis Keperawatan Medikal Bedah peminatan respirasi terdiri dari mengelola kasus kanker paru menggunakan model adaptasi Roy, mengelola tiga puluh resume kasus, melaksanakan evidence based nursing (EBN) efektifitas Foot Reflexologi terhadap tingkat kecemasan dan perubahan fisiologis pada pasien yang akan dilakukan tindakan Bronkoskopi, serta melakukan penerapan inovasi keperawatan penggunaan Respiratory Distres Observation Scale (RDOS) untuk menilai berat ringannya dispnea pasien dengan gangguan pernapasan.

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Specialist nurses are clinical leaders in the field of nursing practice. Advanced knowledge and skills as Ners Specialists include clinical expertise, evidence based nursing, collaboration, consultation, education, mentoring, and leadership change. Specialists are responsible for collaborating with members of the health care team to design, implement, and measure evidence-based care strategies that are safe, cost-effective and proven. Activities carried out in undergoing residency practice Ners Medical Nursing Specialists Respiratory specialization surgery consists of managing lung cancer cases using Roy`s adaptation model, managing thirty case resumes, implementing evidence based nursing (EBN) Foot Reflexology effectiveness against anxiety levels and physiological changes in patients who Bronchoscopy will be carried out, as well as implementing nursing innovations using the Respiratory Distres Observation Scale (RDOS) to assess the mild severity of dyspnea in patients with respiratory disorders."

"Analisis praktik residensi merupakan laporan rangkaian kegiatan Ners SpesialisKeperawatan Medikal Bedah dengan penerapan Model Adaptasi Roy pada prosesasuhan keperawatan pasien gangguan sistem pencernaan, penerapan praktikkeperawatan berdasarkan evidence based serta melakukan inovasi keperawatan.Pengkajian kasus utama terhadap pasien karsinoma gaster dan 30 kasus resume pasienbedah digestif, gastrointestinal serta hepatobilier berfokus pada respon adaptif darimodel adaptasi Roy. Pelaksanaan evidence based dilakukan untuk mengelolakecemasan pasien sebelum menjalani operasi bedah digestif sebanyak 8 orang, denganintervensi mendengarkan Al-Qur`an Surah Al Waqi’ah dan terjemahannya selama 30menit. Program inovasi keperawatan dilakukan, terhadap 7 orang pasien yangdirencanakan menjalani operasi kolostomi berupa optimalisasi pemberian edukasimelalui media video. Kesimpulan: mendengarkan Al-Qur`an Surah Al Waqi’ah danterjemahannya dapat menurunkan tingkat kecemasan pasien sebelum operasi danedukasi melalui media video terhadap pasien yang akan menjalani operasi kolostomidapat meningkatkan pengetahuan pasien yang sangat memengaruhi terhadap keputusanpersetujuan pasien menjalani operasi.

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The residency practice analysis is a series of reports on the activities of Surgical

Medical Nursing Specialists with the application of Roy's Adaptation Model in the

nursing care process of patients with digestive system disorders, the application of

evidence-based nursing practices and nursing innovations. Major case studies of gastric

carcinoma patients and 30 cases of digestive, gastrointestinal and hepatobiliary surgery

resumes focused on the adaptive response of Roy's adaptation model. Evidence based

implementation was carried out to manage the anxiety of patients before undergoing

digestive surgery as many as 8 people, with the intervention of listening to Al-Qur'an

Surah Al Waqi'ah and its translation for 30 minutes. Nursing innovation program

carried out, for 7 patients who were planned to undergo colostomy surgery in the form

of optimizing the provision of education through video media. Conclusion: listening to

Al-Qur'an Surah Al Waqi'ah and its translation can reduce the level of patient anxiety

before surgery and education through video media for patients who will undergo

colostomy surgery can increase patient knowledge which greatly influences the decision

of consent for patients undergoing surgery."

"Praktik spesialis keperawatan medikal bedah bertujuan menerapkan peran perawat spesialis dalam memberikan asuhan keperawatan medikal bedah lanjut dalam menangani pasien sesuai dengan spesialisasinya untuk meningkatkan mutu pelayanan keperawatan. Praktik spesialisasi yang dilaksanakan menggunakan pendekatan teori model adaptasi Roy. Residen dalam pelasanaan praktik spesialisasi ini berperan dalam memberikan asuhan keperawatan pada satu kasus kelolaan dan 30 kasus resume pada pasien dengan gangguan sistem perkemihan. Peran residen yang berperan sebagai peneliti yaitu menerapkan tindakan keperawatan berdasarkan pada pembuktian ilmiah (evidence based nursing ) yaitu intervensi Auricular Acupressure terhadap xerostomia pada pasien gagal ginjal yang menjalani hemodialisis. Peran residen sebagai agen perubahan dalam pengembangan keperawatan yaitu melakukan kegiatan inovasi yaitu untuk meningkatkan kepatuhan pasien dalam membatasi cairan dengan judul sehat dengan pembatasan cairan (“SE-GARAN”).

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Practice of Medical surgical nursing specialist aims to implement the role of specialist nurses in providing advanced medical surgical nursing care in treating patients based on the suitable specialization in order to improve the quality of nursing services. Specialization practice is carried out by using theoretical approach of Roy's adaptation model. Residents in this specialization practice give the role in providing nursing care in one managed case and 30 resume cases in patients with urinary system disorders. The resident role who acts as a researcher is to implement nursing actions based on scientific evidence (evidence based nursing), namely the Auricular Acupressure intervention for xerostomia in kidney failure patients that undergoing hemodialysis. The resident's role as a change agent in nursing development is to carry out innovative activities, namely to increase patient compliance in limiting fluids by using the healthy term with fluid restrictions ("SE-GARAN")."