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"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."

"Program Ners Spesialis Keperawatan Medikal Bedah kekhususan Kardiovaskuler merupakan serangkaian kegiatan pendidikan yang berfungsi untuk menerapkan teori keperawatan dalam upaya untuk memberikan asuhan keperawatan pada pasien dengan gagguan sistem kardiovaskuler. Peran sebagai care giver dilakuka oleh residen dengan mengelola 30 pasien resume dan I pasien utama dengan menggunakan teori adaptasi roy, peran sebagai researcher dilakukan dengan menerapkan Evidence Based Nursing Practice (EBNP) yaitu memberikan terapi ?Music & Nature Sounds? untuk mengatasi kecemasan dan nyeri paska dilakukannya operasi bedah jantung (CABG dan katup jantung). Peran sebagai innovator diwujudkan dengan membuat karya innovasi berupa format dan teknik dokumentasi operan shift dengan menggunakan pendekatan SBAR (Situation, Background, Analysis, and Recommendation). Hasilnya adalah: 1. Model konsep adaptasi Roy efektif diterapkan sebagai upaya untuk memberikan asuhan keperawatan pada pasien gangguan sistem kardiovaskuler, 2. Music & Nature Sound efektif dalam menurunkan atau menguragi cemas dan nyeri pada pasien paska bedah jantung, dan 3. Model dokumentasi operan jaga dengan menggunakan pendekatan SBAR efektif diterapkan diruang ICVCU PJNHK Jakarta.

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Nurses Program Specialist Medical Surgery Cardiovascular specificity is a series of educational activities that serve to apply the theory of nursing in an effort to provide nursing care to patients with cardiovascular system dissorder. Role as a care giver are doing by the resident to manage the 30 patients resume and 1 patient primary by using the theory of adaptation roy, role as a researcher performed by applying Evidence Based Nursing Practice (EBNP) that provide therapy "Music & Nature Sounds" to cope with anxiety and pain post doing open-heart surgery (CABG and heart valve). Role as an innovator is realized by making the work of innovation and engineering documentation in a Handover by using the approach of SBAR (Situation, Background, Analysis, and Recommendation). The result is: 1. Model Roy effective adaptation concept is applied in an effort to provide nursing care in patients with cardiovascular system disorders, 2. Music & Nature Sound effective in reducing or reduces anxiety and pain in patients after cardiac surgery, and 3. Documentation of Handover is using the SBAR approach effectively applied diruang ICVCU PJNHK Jakarta."

"Program spesialis keperawatan medikal bedah khususnya neurologi dimaksudkan untuk menjadikan seorang perawat spesialis neurosains yang berperan dalam praktik keperawatan berupa pemberi asuhan keperawatan lanjut, melakukan pembuktian ilmiah dan agen pembaharu. Asuhan keperawatan dilakukan pada kasus pasien dengan cedera kepala dan 31 pasien dengan gangguan neurologis dengan pendekatan Model adaptasi Roy (RAM). Perilaku maladaptif paling banyak terganggu pada mode fisologis dengan diagnosis penurunan kapasitas adaptif intrakranial. Evidence Based Nursing dilakukan dengan menerapkan sistematik oral care pada 12 pasien gangguan neurologis dengan hasil yang signifikan (p value 0,004). Program inovasi menerapkan pemberdayaan caregiver pasien stroke dengan hasil perbedaan pengetahuan dan keterampilan caregiver melalui edukasi dan demonstrasi (p value <0.005). Pengkajian perilaku dan stimulus pada RAM perlu diterapkan pada pengkajian pada pasien gangguan neurologis. Intervensi keperawatan diharapkan berbasis pada evidence based nursing. Pemberdayaan caregiver pada pasien gangguan neurologis khususnya stroke perlu dilakukan sejak dini untuk menyiapkan caregiver dalam merawat pasien gangguan neurologis.

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Nurse specialist program of medical surgical nursing especially neurological nurses proposed neuroscience nurse specialist play role in nursing practice as advanced nursing care providers, conduct scientific evidence and innovator. Roy adaptation model approach was used in the nursing care of the head injury patients and 31 patients of neurological disorders cases. Decreased intracranial adaptive capacity was the most often of nursing diagnosis enforced which was caused maladaptive behavior in physiological mode. Evidence based nursing was implemented by practice systematic oral care in 12 neurological disorders patients that showed oral assessment score differed significantly (p value 0,004). Role as an innovator was implemented by engage caregiver empowerment through education and demonstration in stroke patients that showed there was differences in the knowledge and skills of the caregivers (p value <0.005). Roy adaptation model can be one effective approach for the assessment of the neurological disorders patients. Nursing interventions are expected to always be based on evidence based nursing. Early caregiver empowerment in neurological disorders patients especially stroke is required to set up the caregivers in caring of the patients."

"Peran perawat spesialis diperlukan untuk peningkatan kualitas pelayanan asuhan keperawatan yang kompleks dan akurat sebagai pemberi asuhan keperawatan tingkat lanjut kasus neurosain, pendidik, advokat, serta agen pembaharu melalui penerapan evidence based nursing (EBN) dan proyek inovasi. Asuhan keperawatan tingkat lanjut menggunakan teori Adaptasi Roy yaitu pengelolaan pasien meningitis tuberkulosis sebagai kasus utama dan 30 resume gangguan sistem neurologi. Teori Roy banyak bertujuan meningkatkan perilaku adaptif dan mengubah perilaku inefektif. Diagnosis keperawatan yang paling banyak ditemukan pada pasien gangguan sistem neurologi adalah ketidakefektifan perfusi jaringan serebral dan hambatan mobilitas fisik. Penerapan EBN dilakukan pada pasien stroke yang mengalami disfagia. Pasien diberikan latihan menelan shaker exercise hasilnya menunjukkan peningkatan kemampuan menelan dan tidak terjadi aspirasi. Proyek inovasi kelompok menerapkan Pengembangan Media Edukasi Perawatan Pasien Brain Tumor Craniotomy. Penerapan proyek inovasi meningkatkan pengetahuan pasien, keterampilan pasien latihan napas dalam dan mobilisasi setelah operasi, dan menambah kepercayaan diri perawat saat memberikan edukasi. Pengalaman praktik residensi diharapkan menambah kompetensi dan peran perawat spesialis di lahan klinik.

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The role of nurse specialists is needed to improve the quality of complex and accurate nursing care services as providers of advanced nursing care in cases of neuroscience, educators, advocates, and agents of reform through the application of evidence based nursing (EBN) and innovation projects. Advanced nursing care uses Roy's Adaptation theory, which is the management of meningitis tuberculosis patients as the main case and 30 resumes of neurological system disorders. Roys theory aims to improve adaptive behavior and change ineffective behavior. The most common nursing diagnoses found in patients with neurological system disorders are ineffective perfusion of cerebral tissue and barriers to physical mobility.

EBN application is performed on stroke patients who have dysphagia. The patient is given training to swallow the exercise shaker, which results in increased swallowing ability and no aspiration. The group innovation project applies Development of Educational Media for Nursing Brain Tumor Craniotomy Patients. The application of innovation projects increases patient knowledge, the skills of patients in deep breathing exercises and mobilization after surgery, and increases nurse confidence when providing education. The residency practice experience is expected to increase the competency and role of specialist nurses on the clinic grounds."