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"Praktik residensi keperawatan medical bedah memberikan kesempatan kepada residen untuk mengimplementasikan fungsi implementator, educator, innovator dan peneliti asuhan keperawatan spesialistik pada gangguan kardiovaskular. Residen menerapkan proses keperawatan dengan pendekatan teori konservasi Levine pada 30 kasus kelolaan resume dan satu kasus kelolaan utama. Implementasi asuhan keperawatan berbasis bukti dengan intervensi akupresur pada acupoints Shenmen dan Yengchuan untuk meningkatkan kualitas tidur pada pasien acute coronanry syndrome. Sebagai inovator residen menginovasi awakening and spontaneous breathing trial protocol untuk memandu perawat dalam mengkaji kesiapan weaning ventilator pada pasien post operasi jantung yang tersedasi dan menggunakan ventilator. Akupresur pada acupoins Shenmen dan Yengchuan secara significant meningkatkan kualitas tidur pada kelompok intervensi (p = 0,009). Awakening and spontaneous breathing trial protocol mudah diterapkan sebagai prosedur pengakajian kesiapan weaning ventilator, mudah dipahami dan memberikan manfaat bagi perawat dan pasien.

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The practice of surgical and medical nursing residency provides an opportunity for resident to implement the functions of implementer, educator, innovator and researcher in specialistic nursing care in cardiovascular disorders.Resident applyed the nursing process using Levine's conservation theory approach by managing 30 resume cases and one main case. Implementation of evidence-based nursing care by applying of acupressure intervention on Shenmen and Yengchuan acupoints to improve sleep quality in patients with acute coronary syndrome. As an innovator, resident innovated the awakening and spontaneous breathing trial protocol to guide nurses in assessing weaning ventilator readiness in sedated and ventilated postoperative cardiac patients. Applying acupressure on the Shenmen and Yengchuan acupoints significantly improved sleep quality in the intervention group (p = 0.009). Awakening and spontaneous breathing trial protocols are easy to implement as a procedure to assess weaning ventilator readiness beside easy to understand and beneficial for nurses and patients."

"Kejadian penyakit kelainan katup masih menjadi masalah dan angka kejadiannya terus mengalami peningkatan di negara berkembang termasuk di Indonesia Dari tahun ke tahun angka kesakitan dan kematian terus mengalami peningkatan seiring dengan tingginya angka kejadian demam rematik di negara dengan iklim tropis dan subtropis Selain itu karena berbagai faktor lainnya seperti ekonomi dan lingkungan Kelainan katup stenosis mitral dapat menyebabkan berbagai komplikasi termasuk diantaranya gagal jantung dan edema paru Perawat sebagai salah satu tenaga kesehatan yang paling penting di unit pelayanan kesehatan diharapkan mampu mendeteksi secara dini timbulnya komplikasi yang akan muncul akibat penyakit jantung Sedangkan perawat spesialis sangat berperan penting dalam memberikan asuhan keperawatan kepada pasien terutama pasien dengan penyakit kardiovaskular yang kompleks Praktik residensi keperawatan medikal bedah bertujuan untuk melaksanakan peran perawat spesialis yang mencakup pemberian asuhan keperawatan dengan pendekatan konsep konservasi Myra Estrin Levine pada pasien dengan gangguan sistem kardiovaskular terutama pada pasien dengan stenosis katup mitral penerapan tindakan pemberian latihan aktifitas fisik rehabilitasi jantung fase 1 untuk mempercepat proses penyembuhan dan stabilisasi status hemodinamik serta berperan aktif dalam program inovasi pengembangan media edukasi pada pasien dengan pemasangan alat medis Hasil analisis praktik menunjukkan bahwa model konservasi Levine dapat diterapkan pada pasien dengan gangguan kardiovaskular untuk mengoptimalkan derajat kesehatan pasien pemberian latihan aktifitas fisik rehabilitasi jantung fase 1 menunjukkan tidak ada perubahan yang signifikan dalam perubahan hemodinamik dan pengembangan media edukasi pada pasien dengan pemasangan alat medis membantu pasien dalam meningkatkan pengetahuan mengenai alat medis.

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Incidence of cardiac valve abnormalities still a problem and the number of events is increasing in developing countries including Indonesia From year to year the morbidity and mortality continues to increase in line with by a high incidence of rheumatic fever in countries with tropical and subtropical climates Moreover because of many other factors such as the economy and environment Abnormalities of the mitral valve stenosis can cause a variety of complications including heart failure and pulmonary edema The nurse as one of the most important health personnel in the health care unit is expected to detect early onset of complications that would arise as a result of valve disease Meanwhile nurse specialist plays an important role in providing nursing care to patients especially patients with complicated cardiovascular disease

The practice of medical surgical nursing residency aimed to carry out the role of nurse specialist includes providing nursing care by implementing the concept of conservation of Myra Estrin Levine to patients with cardiovascular disorders especially those with mitral valve stenosis The implementation of measures to provide cardiac rehabilitation exercise physical activity to accelerate the phase 1 healing process and stabilization of hemodynamic status as well as an active role in the development of educational media innovation program in patients with implanted medical devices

Results of the analysis showed that the model of conservation practices Levine can be applied in patients with cardiovascular disorders to optimize the health status of patients provision of cardiac rehabilitation exercise physical activity Phase 1 showed no significant changes in hemodynamic changes and the development of educational media in patients with implanted medical devices help patients to improve knowledge of medical devices."

"Kecemasan dan nyeri merupakan masalah paling umum pada pasca operasi bedah jantung terbuka. Kedua hal tersebut akan menimbulkan efek negatif seperti meningkatkan penggunaan analgetik, komplikasi paru, gangguan tidur, waktu penyembuhan luka, lama serta biaya perawatan rumah sakit. Pranayama alternate nostril breathing merupakan terapi non-farmakologi yang dapat menurunkan kecemasan dan nyeri pasca bedah jantung. Evidence based nursing practice (EBNP) bertujuan menilai pengaruh pranayama alternate nostril breathing terhadap kecemasan dan nyeri pada pasien pasca bedah jantung. Subjek penelitian sebanyak 44 orang dibagi menjadi kelompok intervensi sejumlah 22 orang dan kelompok kontrol 22 orang. Kelompok intervensi mendapat perlakuan pranayama alternate nostril breathing sedangkan kelompok kontrol berupa relaksasi napas dalam. Penilaian kecemasan menggunakan The State-Trait Anxiety Inventory (STAI) sedangkan penilaian nyeri menggunakan Visual Analog Scale (VAS) 0-100 mm. Uji statistik penelitian menggunkan analisis bivariat dengan uji paired t test dan independent t test. Hasil penelitian menunjukkan pranayama alternate nostril breathing dapat menurunkan intensitas kecemasan dan nyeri pada kelompok intervensi (p-value <0,05) dibandingkan kelompok kontrol. Pranayama alternate nostril breathing merupakan intervensi non-farmakologi dalam menurunkan kecemasan dan nyeri pasien pasca bedah jantung yang bersifat sederhana, murah, efektif, efesien, dan fleksibel. Penelitian lanjutan perlu dilakukan dengan menggunakan sampel lebih besar serta instrumen penilaian kecemasan pasca operasi yang lebih spesifik.

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Anxiety and pain are the most common problems after open heart surgery. Both of them causes negative effects such as increasing the use of analgesics, pulmonary complications, sleep disturbances, wound healing time, hospital length of stay and cost. Pranayama alternate nostril breathing is a non-pharmacological therapy that can reduce anxiety and pain in post-cardiac surgery patients. Evidence based nursing practice (EBNP) aims to assess the effect of Pranayama alternate nostril breathing on anxiety and pain in post-cardiac surgery. The subjects were 44 people who divided into an intervention group of 22 people and a control group of 22 people. The intervention group received Pranayama alternate nostril breathing while the control group was get deep breathing relaxation. The State-Trait Anxiety Inventory (STAI) was used for anxiety assessment while the Visual Analog Scale (VAS) for pain assesment. The statistic test used bivariate analysis with paired t test and independent t test. Pranayama alternate nostril breathing could reduce the intensity of anxiety and pain in the intervention group (p-value <0.05) compared to the control group. Pranayama alternate nostril breathing is a non-pharmacological intervention for reducing anxiety and pain in post-cardiac surgery patients that is simple, inexpensive, effective, efficient, and flexible. Further research needs to be done using a larger sample and a more specific postoperative anxiety assessment instrument."

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Praktik ilmu keperawatan didasarkan hasil riset dan inovasi terbaru. Kualitas asuhan keperawatan ditentukan dari level pendidikan perawat. Perawat spesialis keperawatan medikal peminatan sistem kardiovaskuler berperan pemberi asuhan, edukator, peneliti, dan inovator. Praktik residensi Ners spesialis dilaksanakan selama 2 semester yang bertujuan melakukan peran ners spesialis dengan pendekatan konservasi. Asuhan keperawatan pada gangguan sistem kardiovaskuler menggunakan pendekatan model konsep konservasi Myra Estrin Levine. Asuhan keperawatan pada 30 kasus resume dan 1 kasus utama pada ADHF. Active Cycle of Breathing Technique (ACBT) diterapkan pada pasien paska bedah jantung untuk pemulihkan fungsi paru paska bedah jantung. Proyek inovasi rehabilitasi jantung fase I pada pasien sindrom koroner akut untuk pemulihan toleransi aktivitas. Hasil analisis praktik bahwa model konsep konservasi efektif diterapkan pada gangguan sistem kardiovaskuler untuk mempertahankan konservasi holistik, ACBT mampu memulihkan fungsi paru pasien paska bedah jantung, dan penerapan rehabilitasi jantung fase I mampu toleran terhadap aktivitas, dan standard prosedur operasional dapat dipahami, mudah dilaksanakan oleh pasien dan perawat.

The nursing science practice is based on research results and the most current innovations. The quality of nursing care is determined by the nurses education level. Nurses of medical surgical nursing specialist, whose specialty are for cardiovascular system disorder, have some roles which are as a care provider, educator, researcher, and innovator. The clinical residency practice is conducted for 2 semesters and aims to implement the roles of specialist nurse by applying a conservation model approach. The nursing care on cardiovascular system disorders is using Myra Levine Conservation model approach to 30 patients with various cardiovasculer disorders, which the primary case is ADHF. The active cycle of breathing technique is applied to postoperative cardiac surgery patients for pulmonary function recovery after a cardiac surgery. The phase I of cardiac rehabilitation is applied to acute coronary syndrome patients for activity tolerance recovery. The analysis practice result shows  that the conservation model might be applied effectively to the nursing care for cardiovasculer disorders in order to maintain a holism conservation. The active cycle of breathing technique is able to aid pulmonary function recovery post cardiac surgery and the phase I of cardiac rehabilitation is able to aid for activities tolerance, and the standard operating procedures is able to be easily understood and implemented by the patients and nurses."

"Praktik klinik lanjut selama praktik residensi keperawatan pada sistem kardiovaskular dimaksudkan untuk mampu memberikan asuhan keperawatan dengan menerapkan EBN serta mampu berperan sebagai innovator. Peran pemberi asuhan dilakukan dengan menggunakan model konservasi Levine pada kasus PVOL pada pasien pasca CABG dan 30 pasien lain dengan gangguan sistem kardiovaskular. Penerapan EBN Early mobilization pada 20 pasien pasca bedah jantung menunjukan hasil yang sangat efektif untuk mencegah terjadi nya atelectasis pada pasien pasca bedah jantung. Program inovasi keperawatan dilakukan dengan metode restrospektif terhadap 179 pasien pasca bedah jantung.

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Advanced clinical practice during nursing residency practice in the cardiovascular system is intended to be able to provide nursing care by applying EBN and being able to act as an innovator. The role of caregivers was carried out using the Levine conservation model in the case of PVOL in post CABG patients and 30 other patients with cardiovascular system disorders. The application of EBN Early mobilization in 20 post-cardiac surgery patients showed very effective results to prevent atelectasis in post-cardiac surgery patients. The nursing innovation program was conducted using a retrospective method for 179 post-cardiac surgery patients."

"Karya Ilmiah Akhir menggambarkan pelaksanaan praktik residensi Ners Spesialis KMB, dengan kegiatan menerapkan model Konservasi Myra E. Levine pada proses keperawatan pasien dengan gangguan kardiovaskular, menerapkan praktik keperawatan berdasarkan pembuktian, dan melakukan inovasi keperawatan. Trophicognosis yang paling sering dialami pasien adalah penurunan curah jantung dan gangguan perfusi jaringan: miokard. Intervensi keperawatan dilakukan untuk meningkatkan adaptasi dan mempertahankan wholeness. Pelaksanaan praktik keperawatan berdasarkan pembuktian, dengan memberikan aromaterapi inhalasi lavender selama 10 menit sebelum prosedur PCI untuk menurunkan kecemasan. Pelaksanaan inovasi keperawatan berupa penerapan panduan dan standar prosedur operasional pemberian obat kewaspadaan tinggi (adrenalin, propofol, dan KCl 7,4%) di ICU dewasa.

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The final paper described an overview about implementation of residency practices of Medical Surgical Nurse Specialist using Myra E. Levine’s Conservation Model on nursing process with cardiovascular disorder, implementation of nursing practice based on evidence, and implementation of nursing innovation. The most frequent trophicognosis were decreased cardiac output and tissue perfusion disorder: myocard. Nursing intervention was intended to promote adaptation and maintain wholeness. Implementation of evidence based nursing practice was administering aromatherapy lavender inhalation to decrease pra PCI anxiety. Nursing innovation was implementation the guideline and procedure standard of administering high alert medication (adrenaline, propofol, and KCl 7,4%) in adult ICU."

"Kejadian penyakit jantung koroner merupakan masalah kesehatan utama yang terjadi didunia, termasuk di Indonesia. Dari tahun ke tahun angka kesakitan dan kematian terus mengalami peningkatan seiring dengan adanya perubahan gaya hidup masyarakat di Indonesia yang juga merupakan salah satu faktor predisposisi penyakit jantung koroner. Angka kematian STEMI sangat tinggi, bahkan beberapa pasien tidak sempat mendapatkan pertolongan medis. Oleh karena itu peran perawat spesialis keperawatan medikal bedah sangat penting dalam pemberian asuhan keperawatan untuk meningkatkan status kesehatan pasien dengan STEMI. Praktik residensi keperawatan medikal bedah bertujuan untuk melaksanakan peran perawat spesialis yang mencakup pemberian asuhan keperawatan dengan pendekatan konsep konservasi Myra E. Levine pada pasien dengan gangguan sistem kardiovaskular terutama pada pasien dengan STEMI, penerapan tindakan pemberian terapi musik untuk menurunkan nyeri dan stabilisasi status hemodinamik, serta berperan aktif dalam program inovasi penyusunan pedoman pemberian obat kewaspadaan tinggi (high alert medications). Hasil analisis praktik menunjukkan bahwa model konservasi Levine dapat digunakan pada pasien dengan panyakit jantung koroner untuk mengoptimalkan derajat kesehatan pasien, pemberian terapi musik dapat membantu pasien mengurangi nyeri, tekanan darah dan denyut jantung, penyusuan panduan dan standar operasional prosedur pemberian obat kewaspadaan tinggi membantu perawat dalam memberikan obat untuk mengurangi kesalahan dan meningkatkan kualitas asuhan keperawatan kepada pasien.

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Incidence of coronary heart disease is a major health problem that occours in the world, including in Indonesia. Morbidity and mortality is increasing rapidly related to community lifestyle changes in Indonesia, which is also one of the predisposing factors of coronary heart disease. Mortality of STEMI is very high, even some patients are not able to get medical help. Therefore the role of medical-surgical nurse specialist are very important in the provision of nursing care to improve the health status of the STEMI patient.

Medical-surgical nursing practice residency aimed to implement the role of the nurse specialist include provided nursing care with model of Myra E. Levine conservation approach in patients with cardiovascular system disorders, especially in patients with STEMI, application of music therapy to reduce pain and stabilization of hemodynamic status, and contributed in a program of innovation to develop a guideline of high alert medications delivery.

Results of analysis practice showed that the model of Levine conservation can be used in patients with coronary heart disesase to optimize the health of patients, providing music therapy can help patients to reduce pain, blood pressure and heart rate, guidelines and standard operating procedures of high alert medications helped nurse to reduce error when they give medications to patient and improve quality of nursing care to patients."

"Perawat yang memiliki minat pada bidang keperawatan medikal bedah memiliki peran sebagai advokat, konsultan, agen pembaharu, pendidik, peneliti dan pemberi layanan asuhan keperawatan. Seorang perawat dapat mengikuti program pendidikan residensi setelah menyelesaikan pendidikan pada level magister untuk dapat menjalankan perannya sebagai seorang perawat spesialis. Praktik residensi keperawatan medikal bedah dengan bidang peminatan sistem kardiovaskuler telah memfasilitasi mahasiswa residensi untuk menjalankan perannya sebagai seorang perawat spesialis. Pasien dengan gangguan sistem kardiovaskuler dapat mengalami penurunan kapasitas fisik maupun psikologis. Sehingga dipilih Model konservasi Levine menjadi kerangka kerja dalam memberikan asuhan keperawatan pada pasien kelolaan utama dengan NSTEMI yang dilakukan tindakan Coronary Artery ByPass Grafting dan tiga puluh kasus resume untuk mendukung proses adaptasinya melalui empat prinsip konservasi, dan diharapkan pasien dapat mencapai derajat kesehatan yang optimal (wholeness). Untuk meningkatkan mutu layanan, maka asuhan keperawatan yang diberikan harus berbasis bukti (evidence-based practice). Edukasi yang terintegrasi dengan konseling menggunakan Model "PrOMiSe" dipilih dalam penerapan (evidencebased practice). Residen menjalankan peran sebagai seorang agen pembaharu dengan melakukan proyek inovasi membuat formulir dokumentasi hand over antar shift Model "FAST" menggunakan format yang terintegrasi dengan metode Situation-Background-Assessment-Recommendation (SBAR) untuk meningkatkan efektifitas komunikasi perawat yang dapat berdampak pada peningkatan keamanan pasien.

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A nurses who have an interest in the field of medical-surgical nursing has a role as an advocate, consultant, agent reformers, educators, researchers and providers of nursing care. A nurse can conduct the residency education program after completing education at the magister level to fulfill their role as a specialist nurse. Residency medical-surgical nursing practice with a specialization in the field of cardiovascular system has facilitated resident to perform the role as a specialist nurse. Patients with cardiovascular disorder may decreased physical and psychological capacities. Conservation Levine was selected models as a framework in providing nursing care at the primary case managed patients NSTEMI with post operative coronary artery bypass grafting and thirty resume case to support patients through the process of adaptation to the four principles of conservation. Patients is expected to achieve optimally health status (wholeness). To improve service quality, the nursing should be based on evidence (evidencebased practice). The education to integrated with counseling using the "Promise" model selected in the application (evidence-based practice). In the role as an agent reformer, residents perform projects of innovation by creating a form of hand over documentation the "FAST" model using format that is integrated with method of Situation-Background-Assessment-Recommendation (SBAR) to improve the effectiveness of communication among nurses who can impact for improving patient safety."

"Ners Spesialis peminatan kardiovaskular didapatkan setelah melalui program praktik residensi keperawatan. Praktek residensi keperawatan terdiri dari 2 program yaitu praktek residen umum dan praktek residensi peminatan yaitu kardiovaskular. Kegiatan praktek residensi peminatan termasuk peran perawat sebagai pemberi asuhan keperawatan, peneliti, dan inovator. Peran pemberi asuhan keperawatan yaitu melakukan asuhan keperawatan pada 1 kasus utama dan 30 kasus resume pasien gangguan sistem kardiovaskular menggunakan model konservasi Levine. Peran peneliti adalah melakukan penerapan EBN yaitu akupresur terhadap kecemasan pasien preoperasi jantung. Hasil penerapan EBN; akupresur sebagai intervensi nonfarmakologi, nonivasif, mudah, sederhana dan aman dapat menurunkan kecemasan preoperasi jantung. Terakhir, peran inovator yaitu penggunaan skala Munro untuk mencegah kejadian perioperative related pressure injury pada pasien bedah jantung. Instrumen skala Munro sebagai pengkajian risiko pressure injury spesifik pada perioperatif, dilakukan 3 tahapan (preoperatif, intraoperatif, dan postoperatif), valid dan reliabel. Instrumen dapat digunakan sebagai bagian dari satuan intervensi pencegahan perioperative related pressure injury bersama dengan pengkajian kulit.

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Nurse Specialist in cardiovascular is obtained after going through a nursing residency practice program. Nursing residensy practice consists of 2 programs, namely general residency practice and specialization residency practice, namely cardiovascular. Specialization residency practice activities include the roel of nurses as nursing care providers, researchers and innovators. The role of nursing care provder is to manage nursing care in 1 main case and 30 resume cases of pastients with cardiovascular system disorders using Levine conservation model. The role of researcher is to implement EBN, namely acupressure on the anxiety of preoperative cardiac patients.

Results of the EBN application; acupressure as a non-pharmacological intervention, non-invasive, simple, easy and safe can reduce anxiety of preoperative cardiac. Finally, the rola of an innovator is the use of Munro scale to prevent perioperative related pressure injury in cardiac surgery patients. Instrument of Munro scale as an assessment of the risk of specific in perioperative pressure injury, carried out 3 stages (preoperative, intraoperative, dan postoperative), valid and reliable. Instrument can be used as bundle of an intervention for the prevention of perioperative related pressure injury along with skin assessment."

"Ners spesialis merupakan perawat lulusan program spesialis keperawatan yang mempunyai keahlian khusus dalam asuhan keperawatan. Perawat spesialis keperawatan medikal bedah peminatan kardiovaskular harus mempunyai kompetensi keperawatan inti dan keperawatan berbagai masalah kardiovaskular. Pendidikan residensi spesialis dilakukan selama 2 semester dengan tujuan utama melakukan asuhan keperawatan medikal bedah khususnya sistem kardiovaskular dengan menggunakan pendekatan teori kenservasi Levine. Asuhan keperawatan pada 1 kasus utama post operasi total koreksi TOF dan 30 kasus resume yang terdiri dari 6 kasus besar gangguan sistem kardovaskular meliputi kasus sindrom koroner akut, kelainan katup jantung, kelainan pembuluh darah, gagal jantung, kasus bedah (katup, CABG) dan disritmia. model konsep konservasi Levine dapat diterapkan pada pasien gangguan sistem kardiovaskular untuk mempertahankan wholeness dan adaptasi. Pemberian ice cube absorption dapat mengurangi sore throat pasca ekstubasi pasien bedah jantung. Proyek inovasi penerapan Awakening and Spontaneous Breathing Trial (SBT) Protocol pada pasien pasca bedah jantung yang terpasang ventilasi mekanik dan sedasi. Protokol mudah dipahami dan membantu perawat dalam proses weaning ventilasi mekanik.

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Nurse Specialist is an advanced practice nurse and have special skill in nursing care, graduate from the nursing specialist program. Nurse Specialist medical surgical nursing in cardiovascular specialization must have core nursing competencies and nursing of various cardiovascular problems. Specialist residency education is carried out two semesters with the aim of providing medical-surgical nursing care, especially the cardiovascular system, using Levine's conservation theory approach. Nursing care of one main case in after total correction TOF and thirty resume cases consisting of six major cases of cardiovascular system disorders: acute coronary syndrome, heart valve disorders, blood vessel disorders, heart failure, surgical cases (valve, CABG) and dysrhythmia. Levine's conservation concept model can be applied to patients with cardiovascular system disorders to maintain wholeness and adaptation. Ice cube absorption can reduce sore throat after extubation of cardiac surgery. An innovation project for the application of the Awakening and Spontaneous Breathing Trial (SBT) Protocol in post-cardiac surgery patients who are mechanically ventilated and sedated. The protocol is easy to understand and helps nurses in the process of weaning mechanical ventilation."