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"Praktek klinik lanjut selama praktek residensi keperawatan pada system neurologi dimaksudkan untuk mampu memberikan asuhan keperawatan, menerapkan Evidence Based Nursing (EBN) serta mampu berperan sebagai innovator dan edukator di ruang perawatan. Peran pemberi asuhan keperawatan dilakukan dengan menggunakan model adaptasi Roy pada pasien dengan cedera kepala dan 30 pasien lainnyadengan berbagai gangguan sistem neurologi atau persarafan. Perilaku maladaptive 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 Repetitive Facilitative Exercise (RFE) pada empat pasien stroke fase subakut menunjukkan keefektifan dalam meningkatkan fungsi motorik ekstremitas atas pasien stroke. Program inovasi keperawatan berupa penerapan program pencegahan kejadian jatuh pada pasien neurologi di rawat inap.

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Advanced clinical practice during nursing residency practice in the neurology system is intended to be able to provide nursing care, implement Evidence Based Nursing (EBN) and be able to act as innovators and educators in the treatment room. The role of the nursing care provider was carried out using Roy's adaptation model in patients with head injuries and 30 other patients with various neurological or neurological system disorders. Maladaptive behavior is the most common mode of physiological adaptation, which is the ineffectiveness of cerebral tissue perfusion. Nursing interventions in the form of cerebral edema management are aimed at increasing patient adaptation in enhancing ceredral tissue perfusion. The application of EBN Repetitive Facilitative Exercise (RFE) in four stroke patients in the subacute phase showed effectiveness in improving motor function of the upper limb of stroke patients. The nursing innovation program is in the form of a fall prevention program in neurology patients hospitalized."

"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 status epileptikus 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 diagonally aligned sitting training (DAST) pada empat pasien stroke menunjukkan keefektifan DAST dalam meningkatkan keseimbangan duduk pasien fase awal pasca 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 status epilepticus 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: diagonally aligned sitting training (DAST) in four patients with stroke can improve the sitting balance of the patients in the early post stroke phase. Implementation of the fall prevention program can be used for prevent the patient’s fall risk. Keywords: neurological disorder, status epilepticus, prevent risk, diagonally aligned sitting training, Roy Adaptation Model."

"Peran perawat spesialis diperlukan untuk peningkatan kualitas pelayanan asuhan keperawatan yang kompleks dan akurat sebagai pemberi asuhan keperawatan tingkat lanjut kasus neurosain, pendidik, advokat, serta agen pembaharu melalui penerapan evidence based nursing (EBN) dan proyek inovasi. Asuhan keperawatan tingkat lanjut menggunakan teori Adaptasi Roy yaitu pengelolaan pasien meningitis tuberkulosis sebagai kasus utama dan 30 resume gangguan sistem neurologi. Teori Roy banyak bertujuan meningkatkan perilaku adaptif dan mengubah perilaku inefektif. Diagnosis keperawatan yang paling banyak ditemukan pada pasien gangguan sistem neurologi adalah ketidakefektifan perfusi jaringan serebral dan hambatan mobilitas fisik. Penerapan EBN dilakukan pada pasien stroke yang mengalami disfagia. Pasien diberikan latihan menelan shaker exercise hasilnya menunjukkan peningkatan kemampuan menelan dan tidak terjadi aspirasi. Proyek inovasi kelompok menerapkan Pengembangan Media Edukasi Perawatan Pasien Brain Tumor Craniotomy. Penerapan proyek inovasi meningkatkan pengetahuan pasien, keterampilan pasien latihan napas dalam dan mobilisasi setelah operasi, dan menambah kepercayaan diri perawat saat memberikan edukasi. Pengalaman praktik residensi diharapkan menambah kompetensi dan peran perawat spesialis di lahan klinik.

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The role of nurse specialists is needed to improve the quality of complex and accurate nursing care services as providers of advanced nursing care in cases of neuroscience, educators, advocates, and agents of reform through the application of evidence based nursing (EBN) and innovation projects. Advanced nursing care uses Roy's Adaptation theory, which is the management of meningitis tuberculosis patients as the main case and 30 resumes of neurological system disorders. Roys theory aims to improve adaptive behavior and change ineffective behavior. The most common nursing diagnoses found in patients with neurological system disorders are ineffective perfusion of cerebral tissue and barriers to physical mobility.

EBN application is performed on stroke patients who have dysphagia. The patient is given training to swallow the exercise shaker, which results in increased swallowing ability and no aspiration. The group innovation project applies Development of Educational Media for Nursing Brain Tumor Craniotomy Patients. The application of innovation projects increases patient knowledge, the skills of patients in deep breathing exercises and mobilization after surgery, and increases nurse confidence when providing education. The residency practice experience is expected to increase the competency and role of specialist nurses on the clinic grounds."

"Peran perawat spesialis neurosains dalam praktik keperawatan antara lain sebagai pemberi asuhan keperawatan lanjut, melaksanakan pembuktian ilmiah, pendidik, advokat, kolaborator, dan agen pembaharu. Asuhan keperawatan lanjut dilaksanakan pada pasien dengan kasus tumor otak dan 30 pasien gangguan neurologi menggunakan pendekatan model adaptasi Roy. Perilaku maladaptif paling banyak terganggu pada mode fisiologis dengan diagnosis ketidakefektifan perfusi jaringan serebral. Penerapan Evidence Based Nursing berupa latihan Range of Motion (ROM) pasif bilateral ekstremitas atas pada dua pasien stroke akut dengan hemiparese menunjukkan hasil peningkatan fungsi ekstremitas atas dan Activity of Daily Living (ADL). Program inovasi pengembangan media edukasi perawatan pasien kraniotomi pengangkatan tumor menunjukkan peningkatan pengetahuan pasien secara signifikan (p=0,038) dan memudahkan perawat dalam memberikan edukasi secara efektif.

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The role of nurse specialist in nursing practice consist of advanced nursing care providers, conduct scientific evidence, educator, advocat, collaborator, and change agent. Advanced nursing care is done by Roy Adaptation Models approach on brain tumor and 30 other neurological disorders patients. Maladaptive behavior at most in a physiological mode with ineffective cerebral perfusion nursing diagnosis.

Evidence Based Nursing was performed by applying bilateral passive Range of Motion (ROM) of upper extremity at two acute stroke patient with hemiplegi and it showed an increase in function of upper extremities and the activity of daily living. The innovation programme by develop an education media for caring patient with craniotomy removal tumor showed significant increase in patient knowledge (p=0,038) and help nurses to give an effective education."

"Praktik klinik lanjut di ruang neurologi bertujuan memberikan asuhan keperawatan pada pasien gangguan neurologi khususnya spondilitis TB menggunakan teori keperawatan Model Adaptasi Roy, menerapkan paraktik keperawatan berdasarkan pembuktian dan melakukan inovasi keperawatan. Masalah keperawatan yang sering muncul akibat perilaku inefektif pada mode adaptasi fisiologis yaitu perfusi jaringan serebral tidak efektif, mode adaptasi konsep diri yaitu kecemasan, sedangkan mode fungsi peran yaitu pemeliharan kesehatan tidak efektif. Intervensi keperawatan berdasarkan pembuktian yaitu Pemakaian Bantal dekubitus untuk mencegah terjadinya ulkus tekan pada tumit. Inovasi keperawatan yaitu program bladder training pada pasien gangguan neurologis setelah pelepasan kateter. Perawat dapat menerapkan Model Adaptasi Roy, pemakaian bantal dekubitus untuk mencegah terjadinya luka tekan pada tumit dalam memberikan asuha keperawatan pada gangguan neurologi.

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Advanced clinical practice on patient with neurogical system disorder specialy Spondylosis Tuberculluse using Roy’s Adaptation theory is implementataion of nursing practice based on evidence and implementation of nursing innovation. The most frequent nursing problem occurred was ineffective cerebral tissue perfusion caused by ineffective behaviour response on physical adaptation mode, anxiety from self-esteem mode. Ineffective self-care management was nursing problem from role function mode. Nursing intervention based on evidence based practice on Using heel pressure cushion to prevent heel pressure. Nursing innovation in this clinical practice was Bladder training programme for neurological system disorder. Nurse can implement Roy’s Adaptation Theory with using heel pressure cushion, and innovation activities in delivering nursing care on neurogical disorder"

"Hernia Nukleus Pulposus (HNP) adalah salah satu penyakit tulang belakang yang paling umum. HNP merupakan keadaan dimana nukleus pulposus keluar menonjol untuk kemudian menekan ke arah kanalis spinalis melalui anulus fibrosus yang robek. HNP paling sering ditemukan di vertebra lumbalis dan hanya sebagian kecil ditemukan di daerah servikal. HNP lumbal paling sering pada daerah L4-L5 atau L5-S1. Dampak dan masalah keperawatan yang muncul pada pasien dengan HNP dapat mengakibatkan gangguan pada fungsi fisilogis, psikologis, dan sosial serta kemandirian dalam berpartipasi dalam aktivitas sehari-hari. Berdasarkan hal tersebut diperlukan suatu pengkajian yang luas dalam menilai perubahan fungsional tersebut. Tujuan penulisan studi kasus ini yaitu menganalisis proses keperawatan pada pasien HNP L5-S1 paskaoperasi mikrodisektomi dengan pendekatan teori adaptasi Roy. Studi ini menggambarkan proses keperawatan secara komprehensif pada pasien HNP L5-S1 paskaoperasi mikrodisektomi. Proses keperawatan berdasarkan teori adaptasi Roy yang telah dilakukan pada pasien dengan HNP menunjukkan bahwa melalui pembentukan perilaku adaptif maka pasien dapat mencapai tujuan pengendalian penyakit dan komplikasinya. Partisipasi aktif pasien selama proses keperawatan membantu mencapai adaptasi secara fisik dan psikologis.

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Hernia Nucleus Pulposus (HNP) is among the most prevalent spinal conditions. HNP is a condition in which the nucleus pulposus protrudes through the torn annulus fibrosus and presses against the spinal canal. The majority of HNP is located in the lumbar vertebrae, while only a small percentage is found in the cervical region. Lumbar HNP is most prevalent in the L4-L5 and L5-S1 regions. Patients with HNP may experience disturbances in their physiological, psychological, and social functions, as well as their independence in participating in daily activities, as a result of the impact and nursing issues they experience. Based on this, a comprehensive evaluation is required to assess these functional changes. The purpose of this case study is to apply Roy's adaptation theory to analyze the nursing process in HNP L5-S1 patients following microdiscectomy surgery. This study describes in detail the nursing process for HNP L5-S1 patients following microdiscectomy surgery. The nursing process based on Roy's adaptation theory that has been implemented with HNP patients demonstrates that the patient can control the disease and its complications through the development of adaptive behavior. Active participation of the patient in the nursing process facilitates physical and psychological adaptation."

"[ABSTRAKLatar Belakang: Kusta merupakan penyakit infeksi penyebab neuropati perifer paling sering. Neuropati otonom merupakan salah satu neuropati perifer yang perlu dideteksi dini dengan pemeriksaan sederhana untuk mencegah kecacatan lebih lanjut karena memiliki gejala subklinis. Tujuan: Menguji sensitivitas dan spesifisitas pemeriksaan Stimulated Skin Wrinkle (SSW) terhadap Sudoscan dalam mendeteksi neuropati otonom pada kusta multibasiler. Metode penelitian: Penelitian menggunakan uji diagnostik pemeriksaan SSW terhadap Sudoscan pada penderita kusta multibasiler yang telah didiagnosis di poliklinik Kulit dan Kelamin RS Cipto Mangunkusumo, Jakarta. Penelitian dilakukan selama tiga bulan (Maret-Mei 2015). Anamnesis, pemeriksaan fisik, SSW dengan krim Eutectic mixture of local anesthetic (EMLA), dan Sudoscan dilakukan pada setiap subjek penelitian. Hasil dianalisis untuk mendapatkan nilai sensitivitas dan spesifisitas. Hasil: Diperoleh 70 subyek penelitian. Prevalensi gangguan otonom berdasarkan pemeriksaan SSW, Sudoscan dan klinis berturut-turut sebesar 64.3%, 32.9% dan 85.7%. Berdasarkan kurva ROC pemeriksaan SSW terhadap Sudoscan, didapatkan nilai AUC sebesar 0,779. Setelah diuji dengan tabel 2x2 didapatkan nilai sensitivitas 95.7%, spesifisitas 51.1%, nilai prediksi positif 48.9% dan nilai prediksi negatif 96%. Kesimpulan: Pemeriksaan SSW dapat menjadi pemeriksaan penyaring yang sederhana dalam mendeteksi neuropati otonom pada kusta tipe multibasiler, dengan sensitivitas yang tinggi.

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ABSTRACTBackground: Leprosy is the commonest infectious disease causes peripheral neuropathy. Autonomic neuropathy is a peripheral neuropathy that is important to detect with a simple examination to prevent further disability because the subclinical manifestation. Objective: Examine the sensitivity and specificity of Stimulated Skin Wrinkle (SSW) examination against Sudoscan to detect autonomic neuropathy in multibacillary leprosy. Method: The study consists of diagnostic test of SSW examination upon Sudoscan among multibacillary leprosy patients previously diagnosed in the Dermatology & Venerealogy Clinic in Cipto Mangunkusumo Hospital, Jakarta. The study was conducted in three months (March-May 2015). History, physical examination, SSW with Eutectic mixture of local anesthetic (EMLA) cream, and Sudoscan was performed upon every subject. Results are analyzed to obtain sensitivity and specificity level. Results: There are 70 subjects participated. Prevalence of autonomic disturbance by SSW, Sudoscan and clinical are 64.3%, 32.9% and 85.7% respectively. Based on ROC curve of the SSW examination against Sudoscan, the obtained AUC value is 0.779. After testing with chi-square, the following values were obtained: sensitivity 95.7%, specificity 51.1%, positive predictive value 48.9%, and negative predictive value 96%. Conclusion: SSW examination is a simple screening test that can detect autonomic neuropathy among multibacillary leprosy, with high sensitivity.;Background: Leprosy is the commonest infectious disease causes peripheral neuropathy. Autonomic neuropathy is a peripheral neuropathy that is important to detect with a simple examination to prevent further disability because the subclinical manifestation. Objective: Examine the sensitivity and specificity of Stimulated Skin Wrinkle (SSW) examination against Sudoscan to detect autonomic neuropathy in multibacillary leprosy. Method: The study consists of diagnostic test of SSW examination upon Sudoscan among multibacillary leprosy patients previously diagnosed in the Dermatology & Venerealogy Clinic in Cipto Mangunkusumo Hospital, Jakarta. The study was conducted in three months (March-May 2015). History, physical examination, SSW with Eutectic mixture of local anesthetic (EMLA) cream, and Sudoscan was performed upon every subject. Results are analyzed to obtain sensitivity and specificity level. Results: There are 70 subjects participated. Prevalence of autonomic disturbance by SSW, Sudoscan and clinical are 64.3%, 32.9% and 85.7% respectively. Based on ROC curve of the SSW examination against Sudoscan, the obtained AUC value is 0.779. After testing with chi-square, the following values were obtained: sensitivity 95.7%, specificity 51.1%, positive predictive value 48.9%, and negative predictive value 96%. Conclusion: SSW examination is a simple screening test that can detect autonomic neuropathy among multibacillary leprosy, with high sensitivity., Background: Leprosy is the commonest infectious disease causes peripheral neuropathy. Autonomic neuropathy is a peripheral neuropathy that is important to detect with a simple examination to prevent further disability because the subclinical manifestation. Objective: Examine the sensitivity and specificity of Stimulated Skin Wrinkle (SSW) examination against Sudoscan to detect autonomic neuropathy in multibacillary leprosy. Method: The study consists of diagnostic test of SSW examination upon Sudoscan among multibacillary leprosy patients previously diagnosed in the Dermatology & Venerealogy Clinic in Cipto Mangunkusumo Hospital, Jakarta. The study was conducted in three months (March-May 2015). History, physical examination, SSW with Eutectic mixture of local anesthetic (EMLA) cream, and Sudoscan was performed upon every subject. Results are analyzed to obtain sensitivity and specificity level. Results: There are 70 subjects participated. Prevalence of autonomic disturbance by SSW, Sudoscan and clinical are 64.3%, 32.9% and 85.7% respectively. Based on ROC curve of the SSW examination against Sudoscan, the obtained AUC value is 0.779. After testing with chi-square, the following values were obtained: sensitivity 95.7%, specificity 51.1%, positive predictive value 48.9%, and negative predictive value 96%. Conclusion: SSW examination is a simple screening test that can detect autonomic neuropathy among multibacillary leprosy, with high sensitivity.]"