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"Karya Ilmiah Akhir ini merupakan laporan selama melakukan praktik residensi ners spesialis Keperawatan Medikal Bedah. Kegiatan utama yang dilakukan selama praktik yaitu asuhan keperawatan pada pasien dengan berbagai gangguan sistem kardiovaskular, praktik keperawatan berdasarkan bukti serta pelaksanaan proyek inovasi keperawatan. Asuhan keperawatan yang dilakukan dengan menerapkan Comfort Theory Katharine Kolcaba. Pengkajian difokuskan pada 4 konteks kenyamanan yaitu fisik, psikospiritual lingkungan dan sosiokultural. Diagnosa keperawatan yang umum terjadi adalah penurunan curah jantung, intoleransi aktifitas, ansietas, nyeri akut, resiko jatuh, ketidakefektifan bersihan jalan nafas, gangguan rasa nyaman, kelebihan volume cairan, kesiapan meningkatkan pengetahuan dan gangguan pertukaran gas. Intervensi keperawatan yang diberikan berupa standard comfort intervention, coaching dan comfort food for the soul. Pelaksanaan praktik keperawatan berdasarkan bukti (EBNP) dilakukan dengan menerapkan pengaturan posisi istirahat lateral kanan pada pasien gagal jantung.Hasil penerapan EBNP ini terbukti memberikan efek yang signifikan pada TDS (p value 0.004), TDD (p value 0.002), MAP (p value 0.002), SaO2 (p value 0.032) dan kenyamanan (p value 0.001) pasien gagal jantung. Pelaksanaan inovasi keperawatan berupa pengembangan media edukasi pada pasien yang akan melakukan pemasangan peralatan medis. Hasil penerapan inovasi ini terbukti dapat meningkatkan pengetahuan pasien mengenai pemasangan alat medis (p value 0.0001). Penerapan comfort theory Kolcaba terbukti dapat diterapkan pada pasien gangguan kardiovaskular, serta pengaturan posisi lateral kanan dapat menjaga kestabilan hemodinamik dan meningkatkan kenyamanan pasien gagal jantung. Pemberian edukasi dengan media leaflet pada pasien yang akan melakukan pemasangan alat medis terbukti dapat meningkatkan pengetahuan.

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The final scientific paper was a report during residence practice of Medical Surgical Nursing. The main activities performed during practice such as provided nursing care for patients with various disorders of the cardiovascular system, evidence-based nursing practice and implemented nursing innovation. Nursing care were performed by applied Comfort Theory Katharine Kolcaba. Assessment focused on four contexts of comfort: physical, psychospiritual, environmental and socio-cultural. Nursing diagnosis that often occurred were decrease cardiac output, activity intolerance, anxiety, acute pain, risk for falls, ineffective airway clearance, impaired comfort, excess fluid volume, readiness for enhance knowledge and impaired gas exchange. Nursing interventions provided consist of standard comfort intervention, coaching and comfort food for the soul. Implementation of evidence-based nursing practice is implemented by setting right lateral resting position on patients with heart failure.

The results of this study showed there are significant effects on systolic blood pressure (p value 0.004), diastolic blood pressure (p value 0.002), MAP (p value 0.002), SaO2 (p value 0.032) and level of comfort (p value 0.001). Nursing innovation was done by developed of education media for patients who will perform the fixing of medical device. The results of the application of this innovation has been proved increase patient knowledge about the fixing of medical devices (p value 0.0001). The application of comfort theory Kolcaba shown can be applied in patients with cardiovascular disorders. Right lateral resting position effected on stabilized hemodynamic and increased level of comfort heart failure patients. The provision of education with leaflets for patients who will perform the fixing of medical devices shown increase patient knowledge."

"Prevalensi luka tekan pada pasien semakin meningkat dari tahun ke tahun. Luka tekan merupakan salah satu komplikasi dari pasien yang mengalami tirah baring lama yang sering terjadi pada pasien yang di rawat di rumah sakit maupun di rumah. Penelitian ini bertujuan untuk mengetahui hubungan antara mobilisasi terhadap terjadinya luka tekan pada pasien tirah baring di Rumah Sakit di Jakarta. Desain penelitian yang digunakan dalam penelitian ini adalah analitik dengan pendekatan cross sectional. Jumlah responden dalam penelitian ini adalah 29 responden. Hasil menunjukkan ada hubungan mobilisasi (p = 0,001) terhadap timbulnya luka tekan. Saran untuk penelitian selanjutnya agar memperluas instrument penelitian dengan variabel yang lebih bervariasi dengan jumlah sampel yang lebih banyak, dan untuk rumah sakit membuat kebijakan, agar meningkatkan standar mutu pelayanan keperawatan rumah sakit.

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The prevalence of pressure ulcer in patients increasing from year to year. Pressure ulcer is one of the complications of patients witness bedrest is often the case in patients treated in the hospital and at home. This study aimed to determine the correlation between the occurrence of pressure ulcer mobilization in patients bedrest in the Jakarta hospital. The research design used in this study is a cross sectional analytic. The number of respondents in this study were 29 respondents. The results showed there were a between correlation mobilization (p = 0.001) and the incidence of pressure ulcer. Suggestions for further research is to expand the research instrument with more varied variable and samples and for hospitals establish of policies, in order to improve the quality standards of nursing care hospital."

"Dokumentasi asuhan keperawatan terkomputerisasi merupakan upaya untuk meningkatkan mutu dokumentasi Penelitian ini bertujuan mengetahui determinan akseptasi perawat dalam penerapan dokumentasi asuhan keperawatan berbasis komputer dan pengaruh dokumentasi terkomputerisasi terhadap kelengkapan dokumentasi dan efisiensi biaya Desain penelitian determinan akseptasi menggunakan deskriptif korelasi dengan pendekatan cross sectional sedangkan untuk mengukur kelengkapan dokumentasi dan efisiensi biaya dengan menggunakan pre experiment one group pre and post test Data dianalisis dengan uji chi square dan regresi logistik berganda menunjukkan bahwa ada hubungan yang bermakna persepsi kelayakan dengan akseptasi perawat dalam penerapan dokumentasi asuhan keperawatan berbasis komputer p 0 022 dan ada pengaruh yang bermakna dokumentasi terkomputerisasi terhadap kelengkapan dokumentasi dan efisiensi biaya p.

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Computerized nursing documentation is an effort to improve the quality of documentation This study aims to determine the determinant of acceptance of nurses in the application of computer based documentation of nursing care and the effect of computerized documentation on completeness of documentation and cost efficiency Design determinants of acceptance using descriptive research with cross sectional correlation whereas to measure the completeness of the documentation and cost efficiency by using pre experiment one group pre and post test Data were analyzed by chi square test and multiple logistic regression showed that there was a significant relationship with acceptances feasibility perception of nurses in the application of computer based documentation of nursing care p 0 022 and no significant effect on the completeness of the documentation computerized documentation and cost efficiency p."

"ABSTRAKDo Not Resuscitate (DNR) menjadi keputusan yang tidak mudah diambil oleh dokter dan membutuhkan pertimbangan dan rekomendasi dari perawat. Keterbatasan pengalaman, pengetahuan dan informasi DNR, kriteria IGD yang lebih berfokus pada perawatan gawat darurat menyebabkan tidak dapat maksimalnya peran perawat dalam perawatan menjelang ajal. Tujuan penelitian ini adalah mengeksplorasi pengalaman perawat di IGD dalam merawat pasien DNR di ruang IGD. Desain Penelitian dengan metode Kualitatif pendekatan Fenomenologi interpretif, partisipan empat perawat IGD. Data dikumpulkan melalui Indepth interview, menggunakan analisis tematik Braun dan Clark. Hasil Penelitian empat tema yaitu 1. Memahami kegagalan resusitasi merupakan pasien DNR, 2. Melakukan resusitasi sebagai Protap Penanganan awal, 3. Berkolaborasi mengambil keputusan DNR, 4. Menyiapkan kematian pasien dengan baik. Kesimpulannya yaitu pengambilan keputusan DNR (Do Not Resuscitate) membutuhkan pertimbangan dan pemahaman pada kriteria DNR, selain itu perawat harus terlibat dalam kolaborasi dengan tim yang merawat pasien, sehingga keputusan DNR tepat. Perawatan DNR di IGD memberikan resusitasi sebagai tindakan awal dan mempersiapkan kematian pasien dengan baik dengan melibatkan keluarga pasien."

"Status gizi kurang yang dialami pasien selama rawat inap di rumah sakit akan berdampak pada rendahnya penyembuhan pasien dari penyakit yang diderita dan berujung pada hari rawat yang lebih lama, angka kesakitan dan biaya rawat meningkat. Perawat berada di salah satu posisi terbaik untuk memastikan nutrisi yang cukup karena peran caring yang dimiliki oleh perawat. Penelitian ini bertujuan untuk mengetahui gambaran pengetahuan, sikap, dan praktik perawat dalam pemenuhan kebutuhan nutrisi pada pasien rawat inap. Metode penelitian yang digunakan pada penelitian ini adalah survey deskriptif dengan rancangan penelitian deskriptif. Hasil penelitian menunjukkan bahwa sebanyak 63% memiliki tingkat pengetahuan cukup tentang pemenuhan kebutuhan nutrisi. Sikap responden bertentangan dengan praktik mereka. Responden tidak tahu peran utama mereka dalam perawatan gizi. 5,6% menyatakan sangat setuju bahwa menilai status gizi pasien adalah tanggung jawab perawat dibandingkan dengan 75,7% Sangat Setuju bahwa itu adalah tanggung jawab ahli gizi dan 24,3% sangat setuju tanggung jawab dokter. Penelitian ini merekomendasikan adanya peningkatan pengetahuan tentang manajemen nutrisi bagi staf perawat dengan cara mengikuti seminar atau pelatihan yang berkaitan dengan pemenuhan kebutuhan nutrisi pada pasien secara berkesinambungan. Perlu diadakannya evaluasi dan monitoring penerapan manajemen nutrisi terhadap perawat yang telah dilatih tentang nutrisi.

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Malnutrition status experienced by patients during hospitalization at the hospital will result in low patient recovery from illness and lead to a longer hospitalization days, morbidity and cost of care increases. Nurses are in one of the best position to ensure adequate nutrition because of their holistic caring role. The aim of the study was to determine the level of knowledge, attitudes, and practices of nurses in meeting the nutritional needs of inpatients. The method used in this study was a descriptive survey with a descriptive research design. The results showed that as many as 63% have sufficient knowledge about the level of fulfillment of nutritional needs. They contradicted themselves on their beliefs in relation to their practices. They did not know their primary role in nutrition care. 5.6% strongly agreed that is the nurse’s responsibility to assess the nutritional status of the patient compared to 75.7% who strongly agreed it was the dietitians responsibility and 24.3% who strongly agreed it was the doctors’ responsibility. The study recommends an increase in knowledge of nutrition management for the nursing staff by following the seminar or training related to the fulfillment of the patient's nutritional needs on an ongoing basis. Need holding of evaluation and monitoring of the implementation of nutrient management on nurses who have been trained in nutrition."

"Kegiatan edukasi merupakan bagian dari proses pemberian asuhan keperawatan yang harus diperhatikan. Salah satu tujuan pemberian edukasi adalah menurunkan kejadian rawat inap berulang dengan diagnosis yang sama. Penelitian ini bertujuan mengidentifikasi gambaran kegiatan edukasi perawat di ruang rawat inap di sebuah rumah sakit di Jakarta. Kegiatan edukasi meliputi 4 komponen yaitu pengkajian, perencanaan, pelaksanaan, dan evaluasi. Penelitian ini merupakan penelitian deskriptif dengan pendekatan potong lintang. Sampel penelitian ini adalah 134 perawat pelaksana yang dipilih menggunakan teknik stratified random sampling. Pengumpulan data menggunakan kuesioner yang telah dilakukan uji validitas dan reliabilitas dengan Alpha Cronbach rsquo;s 0,946. Hasil penelitian menunjukkan nilai tengah gambaran kegiatan edukasi perawat secara umum 4,0 min-maks=1,9-5,0; IK95 3,9-4,2 , dengan nilai komponen perencanaan tertinggi 4,2 min-maks=2,2-5,0; IK95 4,0-4,3 dan nilai komponen pelaksanaan terendah 3,8 min-maks=1,6-5,0; IK95 3,7-4,0 . Pelaksanaan kegiatan edukasi perlu dioptimalkan dengan pemenuhan fasilitas dan media yang dibutuhkan, serta penjadwalan secara terstruktur dan monitoring dari pihak manajemen. Penelitian ini merekomendasikan dilakukan penelitian lebih lanjut mengenai faktor-faktor yang mempengaruhi pelaksanaan kegiatan edukasi di rumah sakit.Kata kunci: edukasi, perawat pelaksana, rencana pemulangan.

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Education is an integral part of nursing care to the patients. Education plays a vital role in reducing patient rsquo s rehospitalization with the same diagnoses. This study aimed to explore the education activities performed by nurses in inpatient units of a private hospital in Jakarta, Indonesia. The education activities are divided into 4 stages of assessment, planning, implementation, and evaluation. This cross sectional study involved 134 nurses selected by using stratified random sampling. Data were collected using questionnaires. Prior to data collection, validity and reliability tests were conducted, with the Alpha Cronbach rsquo s score of 0,946. Results of the study demontrated that the overall median score of education was 4,0 min maks 1,9 5,0 CI95 3,9 4,2 . The analysis further showed that the median score was highest during the planning stage 4,2 min maks 2,2 5,0 CI95 4,0 4,3 whereas it was lowest during the implementation stage 3,8 min maks 1,6 5,0 IK95 3,7 4,0 . The educational activities require adequate facilities, appropriate media, planned schedules, and continuous supports and supervision from nursing leaders managers to encourage their staffs to carefully perform the 4 stages of education activities. This study recommended continuous research to explore factors education activities application at hospital.Keyword discharge planning, educational activities, nurses."

"[ABSTRAKPrevalensi pasien dengan gangguan sistem kardiovaskular semakin meningkat. Perawat diharapkan memiliki kontribusi dalam penanganan pasien dengan gangguan sistem kardiovaskular dengan menjalankan peran sebagai pemberi asuhan, pendidik, peneliti dan inovator. Praktik residensi spesialis keperawatan medical bedah yang telah dilaksanakan selama 1 tahun (2 semester) bertujuan untuk melakukan penerapan dan pendalaman pada peran-peran tersebut dengan pendekatan model 14 pemenuhan kebutuhan dasar manusia Virginia Henderson. Peran sebagai pemberi asuhan diterapkan pada 30 pasien dengan berbagai gangguan kardiovaskular dan satu pasien kasus kelolaan utama dengan NSTEMI. Peran sebagai pendidik dijalankan dengan pembimbingan perawat sejawat dan mahasiswa keperawatan. Peran sebagai peneliti dijalankan dengan menerapkan tindakan keperawatan berbasis pembuktian ilmiah (evidence-based nursing) yaitu tindakan dukungan sosial keluarga dan intimasi untuk menurun tingkat persepsi nyeri pada pasien infark miokard. Peran sebagai inovator dijalankan dengan menerapkan pengembangan media edukasi pada pasien dengan alat kesehatan yang dipasang dalam tubuh. Hasil analisis praktik menunjukan bahwa 14 KDM Henderson efektif digunakan sebagai pendekatan dalam asuhan keperawatan pada pasien dengan gangguan sistem kardiovaskular. Penerapan tindakan dukungan keluarga dan intimasi efektif dalam penurunan tingkat persepsi nyeri pasien infark miokard. Media edukasi berupa leaflet dapat meningkatkan pemahaman pasien dengan alat medis yang terpasang dalam tubuhnya.

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ABSTRACTThe prevalence of patients with cardiovascular disorders is increasing. Nurses are expected to contribute on management of patients with cardiovascular disorders by running their roles as a care giver, educator, researcher and innovator. Residency clinical practice of medical-surgical nursing specialist had been carried out for 1 year (2 semesters) and aimed to implement and explore these roles with 14 Basic Human Needs Virginia Henderson Model approach. The role as a care giver was applied to 30 patient with various cardiovascular disorders and a patient with NSTEMI as the primary case. The role as an educator was performed by educating patients, nurses, and nursing students. The role as a researcher was carried out by applying the evidence-based nursing, Family Social Support and Intimacy to Pain Perception on Patient with Acute Miocard Infarc. The role as an innovator was executed by applying the development of educational media in patients with medical devices implantated in the body. The analysis showed that the 14 basic human needs can be applied effectively in nursing care for patient with cardiovascular diseases. Social support and intimacy as effective to decrease pain perception on patient with myocardial infarction. In addition Media education in the form of leaflets can improve understanding of a patient with a medical instrument implantated in his body., The prevalence of patients with cardiovascular disorders is increasing. Nurses are expected to contribute on management of patients with cardiovascular disorders by running their roles as a care giver, educator, researcher and innovator. Residency clinical practice of medical-surgical nursing specialist had been carried out for 1 year (2 semesters) and aimed to implement and explore these roles with 14 Basic Human Needs Virginia Henderson Model approach. The role as a care giver was applied to 30 patient with various cardiovascular disorders and a patient with NSTEMI as the primary case. The role as an educator was performed by educating patients, nurses, and nursing students. The role as a researcher was carried out by applying the evidence-based nursing, Family Social Support and Intimacy to Pain Perception on Patient with Acute Miocard Infarc. The role as an innovator was executed by applying the development of educational media in patients with medical devices implantated in the body. The analysis showed that the 14 basic human needs can be applied effectively in nursing care for patient with cardiovascular diseases. Social support and intimacy as effective to decrease pain perception on patient with myocardial infarction. In addition Media education in the form of leaflets can improve understanding of a patient with a medical instrument implantated in his body.]"

"[ABSTRAKGangguan pada sistem endokrin merupakan masalah kesehatan yang cukup tinggi di Indonesia, khususnya Diabetes Melitus (DM) tipe 2 dengan prevalensinya mencapai 2,1% dari total penduduk, dengan 60% dari total prevalensi adalah kasus neuropati. Kadar glukosa darah yang tidak terkontrol menyebabkan tingginya kejadian komplikasi DM baik akut maupun kronis. Pencegahan komplikasi tersebut memerlukan penanganan yang tepat dari berbagai multidisiplin ilmu, salahsatunya adalah peran perawat ners spesialis medikal bedah kekhususan endokrin sebagai praktisi keperawaan untuk ikut memberikan asuhan melalui berbagai pendekatan teori keperawatan seperti penerapan model adaptasi Roy secara holistik menggunakan pengkajian perilaku dan stimulus sehingga tercapai perilaku adaptif. Selain itu penerapan praktek keperawatan berbasis pembuktian ilmiah (evidence based nursing) seperti senam kaki diabetes dapat menjadi acuan intervensi dalam mencegah terjadinya polineuropati dan komplikasi lanjut seperti ulkus diabetik. Sebagai agen pembaharu/inovator, perawat spesialis juga membuat inovasi tentang self health assesment dan booklet sahabat diabetes bagi para diabetesi untuk meningkatkan promosi kesehatan terhadap pengelolaan dan penatalaksanaan DM.

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ABSTRACTDisorders of the endocrine system is a health problem that is quite high in Indonesia, in particular diabetes mellitus (DM) type 2 prevalence was at 2.1% of the total population, with 60% of the total prevalence of neuropathy cases. Blood glucose levels are poorly controlled diabetes leading to high incidence of complications both acute and chronic. Prevention of these complications requires proper handling of various multidisciplinary, one of them is the role of medical-surgical nurse specialist nurses endocrine specificity as keperawaan practitioners to help provide care through a variety of approaches such as the application of nursing theory holistically Roy adaptation model uses behavioral assessment and stimulus in order to reach adaptive behavior, Besides the application of scientific evidence-based nursing practice (evidence-based nursing) such as diabetic foot gymnastics can be a reference for intervention in preventing the occurrence opolyneuropathy and further complications such as diabetic ulcers. As an agent reformer/innovators, nurse specialist also made innovations on health self-assessment and companion booklet diabetes for diabetics to improve health promotion for the management and treatment of diabetes., Disorders of the endocrine system is a health problem that is quite high in Indonesia, in particular diabetes mellitus (DM) type 2 prevalence was at 2.1% of the total population, with 60% of the total prevalence of neuropathy cases. Blood glucose levels are poorly controlled diabetes leading to high incidence of complications both acute and chronic. Prevention of these complications requires proper handling of various multidisciplinary, one of them is the role of medical-surgical nurse specialist nurses endocrine specificity as keperawaan practitioners to help provide care through a variety of approaches such as the application of nursing theory holistically Roy adaptation model uses behavioral assessment and stimulus in order to reach adaptive behavior, Besides the application of scientific evidence-based nursing practice (evidence-based nursing) such as diabetic foot gymnastics can be a reference for intervention in preventing the occurrence opolyneuropathy and further complications such as diabetic ulcers. As an agent reformer/innovators, nurse specialist also made innovations on health self-assessment and companion booklet diabetes for diabetics to improve health promotion for the management and treatment of diabetes.]"