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"ABSTRAK Praktik residensi keperawatan medikal bedah merupakan bagian dari proses pendidikan yang berfokus pada pengembangan ketrampilan klinik, khususnya pada area respirasi di RSUP Persahabatan Jakarta. Peran yang diterapkan sebagai pemberi asuhan keperawatan, edukator, peneliti, dan inovator. Peran sebagai pemberi asuhan keperawatan dengan mengelola 30 pasien gangguan sistem respirasi dengan menggunakan pendekatan model konsep teori Virginia Henderson. Masalah keperawatan yang sering muncul yaitu ketidakefektifan bersihan jalan napas. Peran sebagai peneliti ditunjukkan dalam penerapan evidence based nursing practice berupa penerapan breathing retraining untuk mengurangi sesak napas pada pasien kanker paru. Dan peran sebagai inovator dan edukator yaitu melakukan pendidikan kesehatan dengan diskusi interaktif kelompok untuk meningkatkan pengetahuan dan motivasi serta telenursing dengan sms reminder untuk meningkatkan kepatuhan minum obat pada pasien tuberkulosis di poliklinik paru.ABSTRACT Residency practice is a part of clinical education in medical surgical nursing specialist programme, especially for respiratory nursing. It was conducted at Persahabatan Hospital Jakarta. Residents based their practice on Henderson Nursing Theory with role modes as care provider, educator, researcher, and innovator. Role as a care provider was held on 30 cases with Henderson theory approach. The main nursing problem found during the clinical practice was ineffective airway clearance. Role as a researcher was conducted through clinical research which investigates the effectiveness breathing retraining to minimize dyspnea. Role as an innovator that is conducted health education with interactive group discussion to increase knowledge and motivation, and telenursing with sms reminder to increase medication adherence in patient with tuberculosis.;Residency practice is a part of clinical education in medical surgical nursing specialist programme, especially for respiratory nursing. It was conducted at Persahabatan Hospital Jakarta. Residents based their practice on Henderson Nursing Theory with role modes as care provider, educator, researcher, and innovator. Role as a care provider was held on 30 cases with Henderson theory approach. The main nursing problem found during the clinical practice was ineffective airway clearance. Role as a researcher was conducted through clinical research which investigates the effectiveness breathing retraining to minimize dyspnea. Role as an innovator that is conducted health education with interactive group discussion to increase knowledge and motivation, and telenursing with sms reminder to increase medication adherence in patient with tuberculosis.;Residency practice is a part of clinical education in medical surgical nursing specialist programme, especially for respiratory nursing. It was conducted at Persahabatan Hospital Jakarta. Residents based their practice on Henderson Nursing Theory with role modes as care provider, educator, researcher, and innovator. Role as a care provider was held on 30 cases with Henderson theory approach. The main nursing problem found during the clinical practice was ineffective airway clearance. Role as a researcher was conducted through clinical research which investigates the effectiveness breathing retraining to minimize dyspnea. Role as an innovator that is conducted health education with interactive group discussion to increase knowledge and motivation, and telenursing with sms reminder to increase medication adherence in patient with tuberculosis.;Residency practice is a part of clinical education in medical surgical nursing specialist programme, especially for respiratory nursing. It was conducted at Persahabatan Hospital Jakarta. Residents based their practice on Henderson Nursing Theory with role modes as care provider, educator, researcher, and innovator. Role as a care provider was held on 30 cases with Henderson theory approach. The main nursing problem found during the clinical practice was ineffective airway clearance. Role as a researcher was conducted through clinical research which investigates the effectiveness breathing retraining to minimize dyspnea. Role as an innovator that is conducted health education with interactive group discussion to increase knowledge and motivation, and telenursing with sms reminder to increase medication adherence in patient with tuberculosis.;Residency practice is a part of clinical education in medical surgical nursing specialist programme, especially for respiratory nursing. It was conducted at Persahabatan Hospital Jakarta. Residents based their practice on Henderson Nursing Theory with role modes as care provider, educator, researcher, and innovator. Role as a care provider was held on 30 cases with Henderson theory approach. The main nursing problem found during the clinical practice was ineffective airway clearance. Role as a researcher was conducted through clinical research which investigates the effectiveness breathing retraining to minimize dyspnea. Role as an innovator that is conducted health education with interactive group discussion to increase knowledge and motivation, and telenursing with sms reminder to increase medication adherence in patient with tuberculosis."

"Praktik keperawatan residensi yang dilakukan di Rumah Sakit Persahabatan dengan kekhususan respirasi diharapkan dapat mengatasi masalah pernapasan. Selama menjalani proses residensi, residen berperan menjadi seorang Clinical Care Manajer (CCM) yang bertugas sebagai konsultan keperawatan bagi staf keperawatan dan pemberi terapi keperawatan kepada pasien, sebagai peneliti serta pendidik dalam rangka pemberi asuhan keperawatan untuk meningkatkan mutu atau kualitas asuhan keperawatan. Dalam memberikan asuhan keperawatan, residen menerapkan model adaptasi Roy baik pada kasus kelolaan dengan diagnosa sarkoma dinding dada maupun pada 30 kasus resume, pada kasus resume ini didapatkan diagnosa medis terbanyak adalah kanker paru, diagnosa keperawatan terbanyak pola napas tidak efektif dan intervensi keperawatan yang paling banyak adalah manajemen airway. Penerapan model adaptasi Roy menunjukkan peran perawat sebagai pemberi asuhan keperawatan dalam membantu individu, baik dalam kondisi sakit maupun pada proses penyembuhan dan peningkatan pemeliharaan kesehatan di setiap mode fisiologis, konsep diri, fungsi peran dan interdependen. Selama melakukan asuhan keperawatan, masalah keperawatan yang banyak muncul yaitu pada mode fisiologis berupa masalah gangguan oksigenasi. Hasil analisis praktik residensi keperawatan didapatkan bahwa asuhan keperawatan menggunakan pendekatan model adaptasi Roy bertujuan untuk membantu individu sesegera mungkin beradaptasi terhadap stimulus baik stimulus internal maupun stimulus eksternal. Pada penerapan Evidence Base Nursing (EBN), residen melakukan penerapan teknik relaksasi benson pada pasien dengan PPOK yang bertujuan untuk mengurangi derajat dyspnea dan kecemasan. Hasil penerapan EBN menunjukan bahwa relaksasi benson signifikan dalam menurunkan derajat dyspnea dan kecemasan pasien PPOK. Pada proyek inovasi, dilakukan program peningkatan kemampuan perawat dalam melakukan perawatan trakeostomi pada pasien dewasa dengan 6 elemen bundle trakeostomi yang telah terstandar, berbasis bukti, sistematis dan terstruktur. Tujuan dari inovasi ini untuk meningkatkan kemampuan dan pengetahuan perawat dalam melakukan perawatan trakeostomi dan terciptanya booklet bundle tracheostomy sebagai pedoman standar intervensi perawatan trakeostomi.

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Residency nursing practice carried out at Persahabatan Hospital with a respiratory specialty is expected to be able to overcome respiratory problems. During the residency process, the resident plays the role of a Clinical Care Manager (CCM) who serves as a nursing consultant for nursing staff and provides nursing therapy to patients, as a researcher and educator in the context of providing nursing care to improve the quality of nursing care. In providing nursing care, residents apply Roy's adaptation model both in cases managed with a diagnosis of chest wall sarcoma and in 30 resume cases, in these resume cases the most medical diagnoses were lung cancer, the most nursing diagnoses were ineffective breathing patterns and the most nursing interventions is airway management. The application of Roy's adaptation model shows the role of nurses as providers of nursing care in helping individuals, both in sick conditions and in the healing process and improving health maintenance in every physiological, self-concept, role and interdependent mode. During nursing care, nursing problems that often arise are in the physiological mode in the form of problems with oxygenation disorders. The results of the analysis of nursing residency practice showed that nursing care using the Roy adaptation model approach aims to help individuals adapt as quickly as possible to stimuli, both internal and external stimuli. In the application of Evidence Base Nursing (EBN), residents apply the Benson relaxation technique to patients with COPD which aims to reduce the degree of dyspnea and anxiety. The results of applying EBN show that Benson relaxation is significant in reducing the degree of dyspnea and anxiety in COPD patients. In the innovation project, a program was carried out to increase nurses' abilities in carrying out tracheostomy care for adult patients with 6 elements of a tracheostomy bundle that were standardized, evidence-based, systematic and structured. The aim of this innovation is to increase the ability and knowledge of nurses in carrying out tracheostomy care and to create a tracheostomy bundle booklet as a standard guideline for tracheostomy care interventions."

"Laporan praktik spesialis Keperawatan Medikal Bedah bertujuan untuk melakukan analisis praktik residen dalam mengimplementasikan peran perawat spesialis sehingga dapat memiliki kemampuan yang belandaskan ilmu-ilmu pengetahuan dan praktik profesional keperawatan. Peran perawat spesialis sebagai pemberi asuhan keperawatan diimplementasikan pada pasien-pasien dengan gangguan sistem perkemihan yang terdiri dari satu kasus kelolaan utama yaitu pasien dengan urolithiasis dan 30 kasus resume. Selain itu, peran perawat spesialis sebagai pendidik dan konselor juga diimplementasikan dalam mengelola pasien kelolaan utama dan resume. Peran perawat spesialis sebagai peneliti dilakukan dengan membuat litelature review sebagai bagian dari pelaksanan Evidanve Based Nursing Practice. Hal ini dilakukan dengan membuat litelature review mengenai akupresur pada titik Hugo untuk mengatasi nyeri penusukan akses arteriovenous fistula pada pasien hemodialisis dan abdominal massage untuk mengatasi konstipasi pada pasien di Intensive Care Unit. Peran sebagai inovator diimplementasikan dengan melakukan proyek inovasi berupa Buku Harian Pasien HD untuk mengendalikan Interdialytic Weight Gains (IDWG), dimana dalam pelaksanaannya residen menggunakan pendekatan interpesonal dan leadership.

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Medical Surgical Nursing specialist practice aims to analyze of resident practice in implementing the role of Nurse Specialist so that they can have skills that are based on science and professional nursing practice. The role of specialist nurses as nursing care providers is implemented in patients urinary system disorders consisting of one main managed case, namely patients with urolithiasis and 30 resume cases. In addition, the role of specialist nurses as educators and counselors is also implemented in managing patients with urolithaisis and resume cases. The role of specialist nurses as researchers is carried out by making a literature review as part of the implementation of Evidence Based Nursing Practice (EBN). The litelture review about acupressure at Hugo point to reduce pain arteriovenous fistula puncutre and abdominal massage to reduce constipation in intensive care unit patients. The role of an innovator is implemented by conducting an nursing innovation project called Buku Harian Pasien HD to control Interdialytic Weight Gains (IDWG), where in its implementation residents use an interpesonal and leadership approach"

"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."

"Praktik keperawatan residensi yang dilakukan di Rumah Sakit Umum Pusat Persahabatan dengan kekhususan respirasi diharapkan dapat mengatasi masalah pernapasan. Selama proses residensi menerapkan intervensi berdasarkan evidence based nursing, mampu menjadi seorang Clinical Care Manager (CCM) sebagai konsultan staf keperawatan, dan memberikan terapi keperawatan yang profesional. Dalam memberikan asuhan keperawatan pada kasus kelolaan pasien dengan Bronkiektasis dan 30 kasus resume menggunakan teori Henderson 14 kebutuhan dasar manusia yang menunjukkan peran perawat sebagai pemberi asuhan keperawatan dalam membantu individu baik dalam keadaan sehat maupun sakit, melalui usahanya melakukan berbagai aktivitas guna mendukung kesehatan dan penyembuhan individu atau proses meninggal dengan damai. Masalah keperawatan yang banyak muncul yaitu tentang pemenuhan kebutuhan bernapas normal. Penerapan EBN cold application dan latihan napas dan batuk untuk menurunkan tingkat nyeri pada pasien terpasang chest tube. Pelaksanaan proyek inovasi pengembangkan video edukasi monitoring dan perawatan di rumah pasien terpasang WSD sebagai media self-management bagi perawat ruang rawat dan pasien yang terpasang WSD. Hasil analisis praktik residensi keperawatan didapatkan bahwa asuhan keperawatan menggunakan pendekatan teori Henderson bertujuan untuk membantu sesegera mungkin kemandirian pasien. Penerapan cold application dan latihan napas dan batuk dapat menurunkan skor nyeri pasien terpasang chest tube. Proyek inovasi video edukasi monitoring dan perawatan di rumah pasien terpasang WSD sebagai media self-management meningkatkan pengetahuan perawat dan kemandirian pasien.

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The practice of residency nursing conducted at RSUP Persahabatan with the specificity of respiration is expected to overcome respiratory problems. During the residency process apply interventions based on evidence-based nursing, be able to become a Clinical Care Manager (CCM) as a nursing staff consultant, and provide profesional nursing therapy. In providing nursing care in cases managed by patients with bronchiectasis and 30 resume cases using Henderson's theory 14 basic human needs that show the role of nurses as nursing care providers in helping individuals both in health and illness, through their efforts to carry out various activities to support the health and healing of individuals or the process of dying peacefully. Many nursing problems arise are about meeting the needs of normal breathing. Application of EBN cold application and breathing and coughing exercises to reduce pain levels in chest tube patients. The implementation of an innovation project to develop educational videos for monitoring and care at home of WSD-installed patients as a self-management medium for nurses, inpatient rooms and patients installed with WSD. The results of the analysis of nursing residency practice found that nursing care using Henderson's theoretical approach aims to help as soon as possible the independence of patients. The application of cold application and breathing and coughing exercises can reduce the pain score of patients attached to the chest tube. Educational video innovation project, monitoring and care at home installed with WSD as a self-management medium increases nurses' knowledge and patient independence."

"ABSTRAK Nama Ratna Sari DinaryantiProgram studi Ners Spesialis Keperawatan Medika BedahJudul Analisis Praktik Residensi Keperawatan Medikal Bedah dengan Pendekatan Teori Model Self Care Orem pada Pasien dengan Gangguan Sistem Respirasi Gagal Napas e c Destroyed Lung dan Bekas Tuberkulosis Paru di RSUP Persahabatan Jakarta 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 residens mengelola kasus utama pasien dengan diagnosa gagal napas e c destroyed lung dan bekas TB Paru 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 pemberian posisi semirecumbent 45o pada pasien yang terpasang ventilasi mekanik untuk mencegah terjadinya Ventilator Associated Pneumonia VAP Inovasi keperawatan yang dilakukan yaitu penerapam pedidikan kesehatan dengan metode diskusi interaktif kelompok untuk meningkatkan pengetahuan dan motivasi serta telenursing dengan sms reminder untuk meningkatkan kepatuhan minum obat pada pasien tuberkulosis di Poli Paru RSUP Persahabatan Jakarta Kata kunci Praktik Keperawatan Medikal Bedah Sistem Respirasi Teori Self care Orem Ventilator Associated Pneumonia VAP Posisi Semirecumbent 45o Pendiidkan kesehatan Telenursing ABSTRACT ABSTRACT Name Ratna Sari DinaryantiStudy Programme Medical Surgical Nurse SpecialistTitle Analysis on Medical Surgical Nursing Residency Practice with Orem Self Care Theory Model Approach on Patient with Respiratory Disorders Respiratory Failure e c Destroyed Lung and Tuberculocis in Persahabatan Hospital Jakarta 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 respiratory failure e c destroyed lung and tuberculosis 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 semirecumbent 45o position to prevent Ventilator Associated Pneumonia VAP in patient with mechanical ventilation As an innovator resident had made a health education with interactive group discussion to increase knowledge and motivation and telenursing with sms reminder to increase medication adherence in patient with tuberculosis Keyword Medical Surgical Nursing Practice Respiration System Orem Self Care Theory Ventilator Associated Pneumonia VAP Semirecumbent 45o position Health Education Telenursing"