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Abstrak :
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. ......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.

Abstrak :
Praktik Residensi Keperawatan Medikal Bedah merupakan suatu rangkaian kegiatan megister dan Spesialis Keperawatan yang dilaksanakan di tempat pelayanan Kesehatan. Praktik residensi keperawatan medikal bedah berfokus pada penerapan ilmu, riset dan teknologi keperawatan dalam memenuhi kebutuhan dasar pada pasien dewasa dengan gangguan kardiovaskuler secara komprehensif. Praktik klinik keperawatan medical bedah peminatan kardiovaskuler dilaksanakan di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita (RSJPHK) Jakarta, dengan pemberian asuhan keperawatan menggunakan pendekatan teori Virginia Henderson pada satu kasus kelolaan dengan diagnose medis UAP TIMI 2/7 GRACE 139 CRUSADE 57, AV Block derajat 1, LBBB ect NSTEMI Dengan Riwayat CABG x2 (SVG-OM, SVG-LAD) dan AVR mekanikAV block grade I dan 30 kasus resume. Penerapan Evidance Based Nursing (EBN) dengan menggunakan intervensi single session 20-minute mindful Breathing untuk mengurangi keluhan dyspnea pada pasien cute Decompensatio Heart Failure (ADHF). Residensi juga melakukan inovasi yaitu penerapan aplikasi assasement pressure injury pada pasien perioperative menggunakan Scale Munro sebagai instrument pencegahan terjadinya pressure injury pada pasien rencana operasi bedah jantung ......Medical Surgical Nursing Residency Practice is a series of activities for megisters and Nursing Specialists carried out in Health care facilities. The practice of medical surgical nursing residency focuses on the application of science, research and nursing technology in meeting the basic needs of adult patients with cardiovascular disorders in a comprehensive manner. Cardiovascular medical surgical nursing clinical practice is carried out at Heart and Vascular Hospital Harapan Kita (RSJPHK) Jakarta, by providing nursing care using the Virginia Henderson theoretical approach in one managed case with a medical diagnosis of UAP TIMI 2/7 GRACE 139 CRUSADE 57, AV Block degree 1, LBBB ect NSTEMI With History of CABG x2 (SVG-OM, SVG-LAD) and mechanical AVRAV block grade I and 30 cases resumed. Implementation of Evidence Based Nursing (EBN) using a single session 20-minute mindful breathing intervention to reduce complaints of dyspnea in cute Decompensation Heart Failure (ADHF) patients. The residency also made innovations, namely the application of pressure injury assessment applications in perioperative patients using the Munro scale as an instrument for preventing pressure injury in patients planning cardiac surgery.

Abstrak :
Praktek klinik lanjut selama praktek residensi keperawatan pada sistem neurologi dimaksudkan untuk mampu memberikan asuhan keperawatan, menerapkan Evidence Based Nursing (EBN) serta mampu berperan sebagai innovator di ruang perawatan. Peran pemberi asuhan keperawatan dilakukan dengan menggunakan model adaptasi Roy pada pasien dengan cedera kepala dan 30 pasien lainnya dengan berbagai gangguan sistem persarafan. Perilaku maladaptif paling banyak adalah mode adaptasi fisiologi, yaitu ketidakefektifan perfusi jaringan cerebral. Intervensi keperawatan berupa manajemen edema cerebral ditujukkan untuk meningkatkan adaptasi pasien dalam meningkatkan perfusi jaringan cerebral. Penerapan EBN skrinning tool Trunk Impairment Scale. Program inovasi keperawatan berupa edukasi terhadap perawat dalam manajemen pasien pasca craniotomy dengan protokol ERAS. ......Advanced clinical practice during the nursing residency practice in the neurological system is intended to be able to provide nursing care, implement Evidence Based Nursing (EBN) and be able to act as an innovator in the treatment room. The role of nursing caregivers was carried out using Roy's adaptation model in patients with head injuries and 30 other patients with various nervous system disorders. The most maladaptive behavior is physiological adaptation mode, namely ineffective cerebral tissue perfusion. Nursing intervention in the form of cerebral edema management is intended to improve patient adaptation in increasing cerebral tissue perfusion. Application of the EBN screening tool Trunk Impairment Scale. Nursing innovation program in the form of education to nurses in post-craniotomy patient management with the ERAS protocol.

Abstrak :
ABSTRAK
Praktek klinik spesialis keperawatan medikal bedah pada sistem perkemihan secara keseluruhan bertujuan untuk memberikan asuhan keperawatan tingkat lanjut, menerapkan praktek keperawatan berbasis bukti serta berperan sebagai agen pembaharu di ruang perawatan. Peran sebagai pemberi asuhan keperawatan dilakukan dengan menggunakan pendekatan Model Adaptasi Roy pada 30 pasien gangguan sistem perkemihan dan pada pasien urolithiasis sebagai kasus utama. Peran sebagai peneliti dilakukan melalui penerapan Evidence Based Nursing berupa penerapan format DSI Dialysis Symptom Index pada 164 pasien hemodialisis terbukti memudahkan perawat dalam mengidentifikasi keseluruhan sindroma hemodialisis yang dialami pasien. Peran sebagai inovator dilakukan dengan menerapkan latihan ROM Range of Motion terbukti dapat menurunkan nilai fatigue yang diukur dengan format FACIT-F Functional Assessment of Chronic Illness Therapy- Fatigue

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ABSTRACT
Clinical practice of medical surgical nursing specialist in urinary system aimed to provide the advance nursing care to implement the evidence based nursing and to act as an innovator in the treatment room. The role as a caregiver in nursing process was carried out using Roy rsquo s Adaptation Theory toward 30 patients with urinary system disorder and toward an urolithiasis patient as a main case. The role as a researcher was carried out by implementing evidence based nursing about assessment of hemodialysis syndrome by using DSI Dialysis Symptom Index on 164 hemodialysis patients that can facilitate nurses to identify all of patient rsquo s hemodialysis syndrome. The role as an innovator was carried out by doing Range of Motion ROM exercise that was proven to reduce fatigue level measuring by FACIT F Functional Assessment of Chronic Illness Therapy Fatigue .

Abstrak :
PURPOSE: The aim of this study was to determine the risk factors for anastomotic leakage after laparoscopic rectal surgery.

METHODS: We conducted a prospective trial involving 395 patients with stage 0/I rectal carcinoma who underwent laparoscopic low anterior resection using a double stapling technique. Data concerning variables related to patient background, tumors and surgical factors were evaluated. The outcomes with respect to anastomotic leakage were recorded, and univariate and multivariate analyses were performed to identify relevant risk factors.

RESULTS: The overall anastomotic leakage rate was 8.4%. A univariate analysis showed male gender (P = 0.006) and preoperative blood sugar level (P = 0.0034) to be significantly associated with anastomotic leakage. The variables of gender, preoperative blood sugar level, American Society of Anesthesiologists (ASA) classification (P = 0.15), transanal decompression tube (P = 0.06) and number of stapler cartridges used for rectal transection (P = 0.18) were selected for the multivariate analysis because of their P values being <0.2. The multivariate analysis identified male gender (odds ratio 4.12, P = 0.006) and the absence of a transanal decompression tube (odds ratio 3.11, P = 0.0484) as independent risk factors predicting anastomotic leakage.

CONCLUSIONS: Male gender and the absence of a transanal decompression tube appeared to be independent risk factors for anastomotic leakage. Insertion of a transanal decompression tube may help prevent anastomotic leakage after low anterior resection, particularly in male patients.