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"ABSTRAKAnalisis Praktik Residensi Keperawatan Medikal Bedah pada Kanker Lambung dengan Pendekatan Model Adaptasi Roy di Rumah Sakit Kanker Dharmais dan Cipto Mangunkusumo Jakarta Karya ilmiah ini bertujuan memberikan gambaran analisis praktik residensi Keperawatan Medikal Bedah selama 2 semester tentang penerapan teori model keperawatan dalam studi kasus, dan analisis hasil penerapan tindakan mandiri keperawatan berbasis pembuktian ilmiah (evidence based nursing practice), serta analisis hasil inovasi kelompok terhadap fenomena yang ditemui selama praktik residensi. Penerapan peran perawat profesional dalam proses asuhan keperawatan dengan menggunakan teori adaptasi Roy dilakukan pada kasus karsinoma nasofaring dan berbagai kasus keganasan lainnya terbukti bermanfaat membantu dan meningkatkan kemampuan adaptasi pasien terhadap stimulus internal dan esternal yang dialami. Kegiatan aplikasi tindakan mandiri keperawatan berdasarkan pembuktian ilmiah pelaksanaan guided imagery dan progressive muscle relaxation bukti bermanfaat untuk mengurangi nyeri dan meningkatkan kualitas hidup pasien. Pada proyek inovasi manajemen nyeri pada pasien kanker yang menjalani kemoterapi di ruang rawat inap dengan memfasilitasi pembuatan multi media video guided imagery dan progressive muscle relaxation perawat dalam manajemen nyeri. Peran perawat profesional dapat dijalankan dalam setiap tahap kegiatan praktik residensi keperawatan medikal bedah peminatan onkologi secara holistik dan komprehensif meliputi upaya promotif, reventif, kuratif, dan rehabilitatif. Kata kunci: Adaptasi Roy, kanker, guided imagery dan progressive muscle relaxation, Manajemen nyeri.

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ABSTRACTractice Analysis of Medical Surgical Nursing Surgery on Stomach Cancer with Roy's Adaptation Model Approach at Dharmais Cancer Hospital and Cipto Mangunkusumo Jakarta This paper aims to provide an overview of residency medical Surgical Nursing residency analysis for 2 semesters on the application of nursing model theory in case study, and analysis of the results of the implementation of scientifically based nursing based action (evidence based nursing practice), and analysis of group innovation results on the phenomenon encountered during residency practice. The application of the role of professional nurses in the nursing care process using Roy's adaptation theory was done in cases of nasopharyngeal carcinoma and other malignant cases proved helpful in improving the patient's adaptability to internal and esternal stimuli. The activities of self-directed nursing action based on scientific proof of guided imagery and progressive muscle relaxation are useful to reduce pain and improve patient's quality of life. In the pain management innovation project in cancer patients undergoing chemotherapy in the inpatient room by facilitating the creation of multi media video guided imagery and progressive muscle relaxation nurses in pain management. The role of professional nurse can be carried out in every stage of medical residency practice of medical surgical treatment of oncology specialization holistically and comprehensively covering promotive, reventif, curative and rehabilitative efforts. Keywords: Roy's adaptation, cancer, guided imagery and progressive muscle relaxation, pain management"

"ABSTRAKPelaksanaan praktek klinik selama masa residensi keperawatan peminatan onkologi bertujuan untuk mampu menampilkan peran perawat spesialis sebagai pemberi asuhan keperawatan lanjut, pendidik, advokat, konselor, kolaborator, pembaharu dan peneliti, Peran pemberi asuhan keperawatan lanjut dilakukan dengan menggunakan Model Adaptasi Roy pada pasien Leiomyosarcoma Uterus dan 30 pasien kanker lainnya. Perilaku maladaptif paling banyak adalah mode adaptasi fisiologis dengan diagnosa keperawatan nyeri kronis. Intervensi keperawatan berupa manajemen nyeri ditujukan untuk meningkatkan adaptasi pasien dalam mengontrol nyeri kanker. Evidence Based Nursing dilakukan dengan menerapkan instrumen pengkajian MASCC Antiemesis Tool pada tujuh belas pasien yang menjalani program kemoterapi dan mengalami keluhan mual muntah akibat kemoterapi dengan hasil MASCC Antiemesis Tool merupakan instrumen pengkajian yang spesifik dan sensitif untuk mengkaji mual muntah akibat kemoterapi. Program inovasi kelompok berupa pembuatan media video panduan dan pelaksanaan intervensi kombinasi Progressive Muscle Relaxation dan Guided Imagery terbukti efektif sebagai tindakan mandiri keperawatan dalam manajemen nyeri kanker.

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ABSTRACT<>br>Implementation of clinical practice during the residency of nursing oncology aims to be able to showcase the role of specialist nurse as advanced nursing care provider , educator, advocator, counselor, collaborator, innovator and researcher. Role of specialist as advance nursing care provider is done by using Roy Adaptation Model on Leiomyosarcoma Uterus and 30 other cancer patients. Maladaptive behavior at most is a physiological adaptation mode with a chronic pain nursing diagnosis. Nursing outcome of pain management are aimed at improving patient adaptation in controlling cancer pain. Evidence Based Nursing was performed by applying the MASCC Antiemesis Tool assessment instrument to seventeen patients undergoing chemotherapy and experiencing chemotherapy induced nausea and vomiting. The MASCC Antiemesis Tool is a specific and sensitive instrument for assessing chemotherapy induced nausea and vomiting. The innovation program was making of video guide media and implementation of combination interventions of Progressive Muscle Relaxation and Guided Imagery proved effective as nursing intervention in the management of cancer pain."

"Karya ilmiah akhir ini merupakan kumpulan dari laporan praktik residensi keperawatan medikal bedah yang terdiri dari laporan kasus utama kanker nasofaring dan 30 kasus resume, penerapan Evidence Based Nursing EBN terapi musik dan progressive muscle relaxation, dan laporan inovasi pengkajian luka kanker yang dimodifikasi dari Malignat Wound Assassement Tool MWAT . Praktik ini menerapkan asuhan keperawatan pada pasien kanker dengan menggunakan pendekatan teori Roy Adaptation Model. Masalah keperawatan terbanyak akibat perilaku maladaptif adalah nyeri, resiko infeksi, kecemasan, kebutuhan nutrisi kurang dari kebutuhan tubuh dan ketidakefektifan pola napas. Terapi musik dan progressive muscle relaxation secara signifikan menurunkan depresi dan kecemasan pada pasien kanker payudara setelah menjalani mastektomi. Pengkajian luka kanker modifikasi MWAT mengkaji masalah fisik, psikis, sosial pasien dengan luka kanker. Perawat diharapkan mampu menerapkan teori keperawatan, melaksanakan tindakan berdasarkan EBN, dan melakukan inovasi untuk meningkatkan asuhan keperawatan yang berkualitas.

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The scientific report was a compilation of the report medical surgical nursing residency practice which consists of the main report of nasopharyngeal cancer cases and 30 summaries, the application of music therapy and progressive muscle relaxation on evidence based nursing EBN , and innovation reports of wound cancer assessment tool, that modified from Malignant Wound Assassement Tool MWAT. This practice applying nursing care in cancer patients with approach Roy rsquo s Adaptation Model. Most nursing problems due to maladaptive behavior was pain, risk for infection, anxiety, imbalanced nutrition less than body requirements, and breathing pattern ineffective. The music therapy and progressive muscle relaxation may reduces depression and anxiety in female breast cancer patients after radical mastectomy. MWAT modifications assessment tool, assess physic psychologic social problems in patients with wound cancer. Nurses was expected to apply nursing theory, intervention based on EBN, and innovations to improve the quality of nursing care."

"ABSTRAK Profesi keperawatan untuk dapat memberikan layanan keperawatan yang berkualitas, diperlukan kemampuan perawat yang mampu mengintegrasikan ilmu pengetahuan dan seni dalam melakukan pelayanan keperawatan dan menjalankan peran perawat profesional. Spesialis keperawatan medikal bedah peminatan onkologi memiliki tanggung jawab sebagai pemberi asuhan keperawatan, peneliti, pendidik, advokat, dan inovator juga menjadi tuntutan penting untuk dijalankan. Peran pemberi asuhan keperawatan dilakukan pada pasien Kanker Nasofaring dengan faktor penyulit TB Paru dan Infeksi dengan menggunakan Model Adaptasi Roy. Disamping itu terdapat 30 pasien lainnya yang juga mendapat penerapan dari model keperawatan ini. Penerapan EBN yang dilakukan adalah akupresur P6 dan edukasi perawat untuk menagtasi mual muntah pasien kemoterapi. Program inovasi kelompok adalah penerapan terapi kombinasi Guided Imagery dan Progressive Muscle Relaxation untuk mengatasi nyeri pada pasien kanker.Kata kunci : akupresur, kemoterapi, mual muntah, Model Adaptasi Roy, nyeri ABSTRACT Nursing professions to be able to provide quality nursing services, nurses are required capable of integrating science and art in performing nursing services and perform the role of professional nurses. Specialized medical nursing specialist oncology specialists have responsibilities as nursing caregivers, researchers, educators, advocates, and innovators are also important demands to run. The role of nurse care caregivers is done in patients with Nasopharyngeal Cancer factors of Pulmonary TB and Infection by using the Roy Adaptation Model. In addition there are 30 other patients who also received the application of this nursing model. Implementation of EBN conducted is acupressure P6 and nurse education to mensing the nausea vomiting chemotherapy patients. Group innovation program is the application of combination therapy Guided Imagery and Progressive Muscle Relaxation to overcome the pain in cancer patients.Keywords acupressure, chemotherapy, nausea, pain, Roy 39 s Adaptation Model, vomiting "

"Keganasan kolorektal membuat pasien mengalami perubahan status kesehatan yang signifikan dan sangat mempengaruhi kehidupannya. Status kesehatan pasien mengarah kepada kondisi kronis dan membutuhkan adaptasi dari pasien terhadap keadaannya untuk bisa memperoleh kondisi kesehatan yang maksimal. Pasien Tn. S dengan kanker kolorektal post laparatomi hemikolektomi, stoma ileokolotransversal dengan komplikasi efusi pleura mengalami perdarahan pada haluaran stoma, dan alkalosis respiratorik. Diagnosa keperawatan utama yang diangkat adalah gangguan pertukaran gas dan kekurangan volume cairan, dengan intervensi manajemen asam basa dan manajemen cairan dan elektrolit.

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Colorectal malignancies make patients experience significant changes in health status and greatly affect their lives. The patient's health status leads to chronic conditions and requires adaptation from the patient to his condition to be able to obtain maximum health conditions. Patient Mr. S with post laparatomy hemicolectomy colorectal cancer, ileokolotransversal stoma with complications of pleural effusion experiencing bleeding at the stoma output, and respiratory alkalosis. The main nursing diagnoses raised were interruption of gas exchange and lack of fluid volume, with acid base management interventions and fluid and electrolyte management."

"Karya ilmiah ini bertujuan memberikan gambaran analisis praktik residensi Keperawatan Medikal Bedah selama 2 semester tentang penerapan teori model keperawatan dalam studi kasus, dan analisis hasil penerapan tindakan mandiri keperawatan berbasis pembuktian ilmiah evidence based nursing practice, serta analisis hasil inovasi kelompok terhadap fenomena yang ditemui selama praktik residensi. Penerapan peran perawat profesional dalam proses asuhan keperawatan dengan menggunakan teori adaptasi Roy dilakukan pada kasus karsinoma nasofaring dan berbagai kasus keganasan lainnya terbukti bermanfaat membantu dan meningkatkan kemampuan adaptasi pasien terhadap stimulus internal dan esternal yang dialami. Kegiatan aplikasi tindakan mandiri keperawatan berdasarkan pembuktian ilmiah pengunaan madu terbukti bermanfaat untuk mencegah dan mengatasi mukositis oral akibat kemoterapi dan atau radioterapi pada pasien karsinoma nasofaring. Pada proyek inovasi manajemen edukasi pada pasien kanker tiroid yang menjalani terapi I-131 di ruang isolasi radioaktif terlaksana dengan memfasilitasi pembuatan multi media edukasi, peningkatan pengetahuan dan keterampilan perawat dalam manajemen edukasi. Peran perawat profesional dapat dijalankan dalam setiap tahap kegiatan praktik residensi keperawatan medikal bedah peminatan onkologi secara holistik dan komprehensif meliputi upaya promotif, reventif, kuratif, dan rehabilitatif.

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This paper aims to provide an overview of medical surgical nursing residency residency proces for 2 semesters on the application of nursing model theory in case study, and analysis of the results of the implementation of evidence based nursing, and analysis of group innovation results on the phenomenon encountered during residency practice. The application of the role of professional nurses in the nursing care process using Roy 39 s adaptation theory was done in the primary case of nasopharyngeal carcinoma and other malignant cases proved helpful in improving the adaptability of the patient to the internal and esternal stimuli experienced.

The activity of self directed nursing action application based on scientific evidence that use of honey proved useful to prevent and overcome oral mucositis due to chemotherapy and or radiotherapy in patients nasopharyngeal carcinoma. In an educational management innovation project in thyroid cancer patients undergoing I 131 therapy in radioactive isolation room was done by facilitating the making of multi media education, improvement of nurse knowledge and skill in education management. The role of professional nurse can be carried out in every stage of medical residency practice of medical surgery oncology surgery on holistically and comprehensively include promotive, reventif, curative and rehabilitative."

"Praktek Spesialis Keperawatan Medikal Bedah merupakan proses penting dari pendidikan profesi dalam rangka mengaplikasikan ilmu dan peran perawat spesialis dalam memberikan asuhan keperawatan yang profesional kepada pasien. Dalam menjalankan praktek Praktek Spesialis Keperawatan Medikal Bedah, residen juga menerapkan  Evidence Based Nursing. Evidence Based Nursing yang dilakukan adalah dengan menerapkan intervensi Jacobson Progressive Muscle Relaxation, serta  menjalankan peran sebagai inovator di lahan praktek. Residen telah melakukan asuhan keperawatan pada pasien dengan HIV/AIDS, dengan 1 kasus kelolaan utama yang menggunakan pendekatan Teori Roy dan 30 kasus resume kelolaan menggunakan pendekatan  Teori Bandura untuk ruang rawat jalan pada kasus HIV. Dari hasil kelolaan kasus utama, pasien HIV yang dirawat di ruang rawat memiliki diagnosa keperawatan utama gangguan perfusi jaringan serebral sehingga intervensi utama keperawatan fokus pada manajemen tekanan intrakranial. Dari kasus resume rawat jalan, masalah keperawatan yang paling banyak ditemukan adalah ketidakpatuhan akan pengobatan, sehingga Intervensi keperawatan yang dilakukan adalah dengan melakukan proyek inovasi Counseling Minum Obat ARV yang berisikan konseling secara terstruktur pengobatan ART dalam upaya meningkatkan self confidence perawat serta meningkatkan kepatuhan pasien.

Kata kunci: HIV, teori Roy, teori Bandura, ketidakpatuhan, konseling, Jacobson Progressive Muscle Relaxation.

 

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Practice of Medical Surgical Nursing Specialist is an important process of professional education in order to apply the knowledge and role of specialist nurses in providing professional nursing care to patients. In carrying out the practice of Medical Surgical Nursing Specialist, the resident also applies Evidence Based Nursing. Evidence Based Nursing is carried out by applying the Jacobson Progressive Muscle Relaxation intervention, and playing the role of an innovator in the practical field. Resident has provided nursing care to patients with HIV / AIDS, with 1 main case managed using the Roy Theory approach and 30 cases managed resumes using the Bandura Theory approach for outpatient rooms in HIV cases. From the results of the main case management, HIV patients who were treated in the ward had a major nursing diagnosis of cerebral tissue perfusion disorders so that the main nursing interventions focused on the management of intracranial pressure. From outpatient resume cases, the most common nursing problem found was non-adherence to treatment, so that the nursing intervention was carried out by conducting the innovative ARV Medication Counseling project which contained structured counseling on ART treatment in an effort to increase nurses' self-confidence and increase patient compliance.

 

 

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"Analisis praktik residensi keperawatan medikal bedah merupakan karya ilmiah akhir ners spesialis. Analisis ini terdiri dari asuhan keperawatan pada gangguan sistem neurologi dengan kasus utama meningoencephalitis tuberkulosis dan 30 kasus resume menggunakan pendekatan model adaptasi Roy, penerapan evidence based nursing tentang intervensi hemifield eye-patching, dan penerapan proyek inovasi tentang program pencegahan kejadian jatuh pada pasien dewasa di ruang neurologi. Teori model adaptasi Roy bertujuan untuk memodifikasi dan mengubah stimulus sehingga pasien dapat adaptif terhadap kondisi kesehatannya. Meningoensefalitis tuberkulosis adalah keadaan darurat neurologis yang merupakan bentuk paling parah infeksi oleh Mycobacterium tuberculosis. Hemifield eye-patching merupakan intervensi yang mudah digunakan dan terbukti dapat mengatasi pengabaian visuo-spasial pada pasien stroke. Proyek Inovasi program pencegahan kejadian jatuh dapat meningkatkan pengetahuan dan kesadaran perawat, pasien, dan keluarga dalam pencegahan kejadian jatuh.

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Analysis of medical surgical nursing residency practice is the final scientific work of nursing specialist. This analysis consisted of nursing care in neurological system disorders with major cases of tuberculosis meningoencephalitis and 30 cases resuming using Roy's adaptation model approach, applying evidence-based nursing about eye-patching hemifield interventions, and implementing an innovative project about falling fall prevention programs in adult patients in neurology ward. Roy's adaptation model theory aims to modify and change the stimulus so that patients can be adaptive to their health conditions. Tuberculosis meningoencephalitis is a neurological emergency that is the most severe form of infection by Mycobacterium tuberculosis. Hemifield eye-patching is an easy-to-use intervention and is proven to overcome visuo-spatial neglect in stroke patients. The Innovation project for the prevention of falls can improve the knowledge and awareness of nurses, patients and families in preventing falls."

"Praktek klinik lanjut pada kasus gangguan sistem neurologi untuk memberikan asuhan keperawatan, berperan dalam menerapkan Evidence Based Nursing (EBN) serta peran sebagai inovator. Peran pemberi asuhan keperawatan dilakuan pada pasien dengan gangguan sistem persarafan menggunakan Model adaptasi Roy. Asuhan keperawatan kelolaan diberikan pada pasien dengan Meningtis TB dan ditemukan masalah pada mode adaptasi fisiologi, yaitu: risiko ketidakefektifan perfusi jaringan serebral. Intervensi keperawatan ditujukan untuk meningkatkan adaptasi pasien dalam meningkatkan perfusi jaringan serebri. Penerapan EBN massase abdomen yang dilakukan pada 6 orang pasien stroke selama 2 minggu menunjukkan bahwa massase abdomen efektif dalam mengatasi konstipasi. Program inovasi ini didapatkan hasil bahwa seluruh caregiver mengalami peningkatan pengetahuan dan ketrampilan khususnya dalam merawat anggota keluarganya yang terserang stroke setelah dilakukan edukasi terstuktur dalam pemberdayaan caregiver.

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Advanced clinical practice in cases of neurological disorders to provide nursing care, play a role in implementing the Evidence Based Nursing (EBN) and the role as an innovator. The role of nursing care giver in patients with disorders of the nervous system using Roy?s Adaptation Model. Nursing care to patients with TB meningitis had found problems on physiology adaptation mode, which are : risk of cerebral tissue perfusion ineffectiveness. Nursing interventions are aimed to improve to improve patient adaptation in increasing cerebral tissue perfusion. Application of EBN Massase abdomen performed in 6 patients with stroke for 2 weeks showed that effective abdominal Massase preformance constipation. This innovative program showed that all caregivers have increased knowledge and skills, especially in the care of family members who had a stroke after a structured education in the empowerment of caregiver."

"[ABSTRAKPraktik Spesialis Keperawatan Medikal Bedah Kekhususan Respirasi di RSUP Persahabatan Jakarta bertujuan untuk mengaplikasikan peranners spesialis da1am mengelola pasien dengan gangguan sistem respirasi melalui pendekatan Model Adaptasi Roy (MAR). Seorang ners spesialis memiliki target memberikan asuhan keperawatan sebanyak 30 pasien sebagai resume dan 1 pasien sebagai laporan kelolaan utama pada pasien kanker paro. Peran ners spesialis juga menerapkan tindakan keperawatan berbasis bukti ilmiah (evidence based musing practice) dengan memberikan latihan progressive muscle relaclation (PMR) dalam mengontrol breathlessness pada pasien kanker peru, Selain itu ners spesialis sebagai pembaharu melakukan inovasi Water Seal Drainoge (WSD) Pionir 1 botol, etas dasar aspek estetika, quality and safety guna meningkatkan kualitas pelayanan keperawatan dan rumah sakit. Hasil praktik menunjukkan bahwa MAR. Efektif digunakan pada pasien dengan gangguan sistem respirasi dan PMR memiliki kecenderungan mengon1ro1 breathlessness pada pasien kanker pam dan kegiatan inovasi mendapat respon positif dari pibak rumah sakit untuk menjadi agenda penelitian bersama.

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ABSTRACTSurgical Nursing Residency Practice in Respiratory Speciality aims to apply of nurse specialist in caring and supervising respiratory disorders patients through Roy Adaptation Model (RAM) approach at Persahabatan Hospital Jakarta. A nurse specialist has a target to give nursing care to thirty patients as resume and one lung cancer case as primary patient. The other role of nurse specialist is implementing evidence based nursing practice by providing Progressive Muscle Relactation (PMR) exercise in terms of controlling breathlessness especially to lung cancer patient. Furthermore, the other role of nurse specialist is to be an innovator and a change agent on Water Seal Drainage (WSD) Pioneer program based on aesthetic, quality, and safety aspect in order to improve nursing and hospital services. The result shows that RAM is effective to respiratory disorders patients and PMR tends to control breathlessness of lung cancerpatients. Conclusion, this innovative activity gels a positive response from the hospital to be a joint researchagenda., Surgical Nursing Residency Practice in Respiratory Speciality aims to apply of nurse specialist in caring and supervising respiratory disorders patients through Roy Adaptation Model (RAM) approach at Persahabatan Hospital Jakarta. A nurse specialist has a target to give nursing care to thirty patients as resume and one lung cancer case as primary patient. The other role of nurse specialist is implementing evidence based nursing practice by providing Progressive Muscle Relactation (PMR) exercise in terms of controlling breathlessness especially to lung cancer patient. Furthermore, the other role of nurse specialist is to be an innovator and a change agent on Water Seal Drainage (WSD) Pioneer program based on aesthetic, quality, and safety aspect in order to improve nursing and hospital services. The result shows that RAM is effective to respiratory disorders patients and PMR tends to control breathlessness of lung cancerpatients. Conclusion, this innovative activity gels a positive response from the hospital to be a joint researchagenda.]"