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Abstrak :
ABSTRAK
Tujuan penelitian ini adalah untuk mengetahui pengalaman keluarga membangun koping dalam merawat anggota keluarga dengan penyakit kronis. Metode penelitian yang digunakan adalah pendekatan fenomenologi deskriptif. Hasil penelitian menggambarkan koping keluarga dibentuk dari kekuatan keluarga, koping individu dan dukungan masyarakat. Tema dalam penelitian ini yaitu respon psikologis keluarga, upaya untuk mempertahankan kesehatan, perubahan status kesehatan penderita, perubahan sistem keluarga, aksesibilitas terhadap layanan kesehatan, cara merawat di rumah, mempertahankan keseimbangan keluarga, persepsi keluarga : layanan kesehatan kurang baik, harapan keluarga : jenis dan kualitas layanan baik dan keyakinan keluarga dalam menjalani hidup. Hasil penelitian ini diharapkan dapat menjadi masukan dalam meningkatkan asuhan keperawatan pada keluarga dengan penyakit kronis.

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ABSTRACT
The aim of this research is to describe the experience of family in developing coping family in treating family members with chronic disease. The research method used was a descriptive phenomenological approach. Results of this research is family strengths, individual coping and community support were related to adaptive response of family and depend on disease, prognosis and how long family caring member with chronic disease. There were ten main domains which are family psychological response, efforts to maintain health, changes in health status of patients, family system changes, accessibility to health care, how to care for at home, maintaining family balance, family perceptions of the service healthcare received, family’s hope for health care service, and family beliefs in life. The result is expected to be input in improving nursing care in families with chronic illness.

Abstrak :
Gangguan mental emosional dapat terjadi pada individu yang mengalami kondisi kesehatan yang kronis. Pasien yang sedang menjalani pengobatan medis ditemukan 25% diantaranya mengalami depresi dengan berbagai variasinya. Proses penyakit yang melemahkan juga merupakan hal yang berperan menyebabkan ketidakberdayaan klien dengan penyakit kronis. Ketidakberdayaan dan gejala depresi menunjukkan hubungan yang signifikan dan positif dengan ide untuk bunuh diri. Hasil pemberian tindakan keperawatan ners, terapi kognitif, psikoedukasi keluarga dan terapi suportif dapat menurunkan tanda gejala dan meningkatkan kemampuan klien penyakit kronis dengan ketidakberdayaan beserta keluarganya. Perlunya optimalisasi dan pengembangan pelayanan kesehatan jiwa kepada klien dengan masalah psikososial terkhusus klien dengan ketidakberdayaan di tatanan pelayanan puskesmas. ...... Mental emotional disorder can occur in individuals with chronic illness. Patients who are undergoing medical treatment was found 25% had depression with different variations. Debilitating disease process also plays the lead powerlessness clients with chronic illness. Hopelessness and depression symptoms showed a significant and positive relationship with the idea of suicide. Ners intervention, cognitive therapy, family psychoeducation and supportive therapy can reduce signs and symptoms, increase ability of clients chronic illness with hopelessness and their families. Optimization and development of mental health services needs to clients with psychosocial problems especially those of client with hopelessness in the primary health care center.

Abstrak :
ABSTRAK
Karya ilmiah akhir (KIA) ini merupakan laporan praktik residensi keperawatan medikal bedah yang terdiri dari pengelolaan kasus kanker dengan pendekatan chronic illness trajectory model, penerapan evidence based nursing penggunaan kipas angin untuk mengurangi sensasi dispnea dan melakukan proyek inovasi tentang pemantauan dan deteksi dini perburukan kondisi pasien menggunakan Modified Early Warning Score (MEWS). Konsep trajectory meyakini penyakit kronis memiliki suatu lintasan yang berbeda-berbeda dari waktu ke waktu sesuai fasenya dan dapat dikelola, serta berfokus pada perawatan suportif tanpa mengabaikan perawatan langsung pada pasien, sehingga dapat digunakan untuk pasien kanker yang akan membantu meningkatkan kemandirian dan kualitas hidup pasien. Penggunaan kipas angin efektif mengurangi sensasi dispnea pada pasien kanker, bersifat sederhana, murah, tanpa efek samping dan portable sehingga dapat dijadikan sebagai bagian dari perawatan di rumah atau paliatif. MEWS dapat dijadikan sebagai alat triase karena bersifat sederhana, membantu pemantauan parameter fisiologis pasien secara terstandar. Namun keefektifannya di bidang onkologi masih perlu dilakukan penelitian lebih lanjut.

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ABSTRACT
This final paper is a report of residency medical surgical nursing practice consisting of the management of the cancer cases with the approach of the chronic illnes trajectory models, application of evidence based nursing using fan to reduce dyspnea and innovation project on monitoring and early detection of deterioration patient?s conditions using the modified early warning score (MEWS). The concept of trajectory believe that chronic disease have trajectory, is different time to time according to the phase and can be shape, as well as focusing on supportive care without neglecting the direct care. So it is suitable for cancer patients which will help to improve the independence and patient?s quality of life. Dyspnea management using the fan is effective to reduce the dyspnea in cancer patient, simple, cheap, no adverse effect and portable so it can be used as parf of the palliative treatment. MEWS can be used as a triage tool because it is simple, helping to monitor physiological parameters of patients are standardized. The implementation and effectiveness in the oncology still needs further investigation.

Abstrak :
Falls are a serious consequence of declining physical function. Otago exercise is a strength and balance training program designed to prevent falls and enhance health status among the elderly. This study aimed to investigate the effect of a 12- week Otago exercise intended to reduce the risk of falls and health status among the elderly with chronic illness in the social elderly institution. This quasi-experimental study employed a pre- and post-test design using a control group. The study involved an intervention group (21 respondents) and a control group (21 respondents). The sample used in this study were elderly living in a social elderly institution. The sample was selected using simple random sampling. The data were analyzed using Mann–Whitney test, independent t-test, and Chi-square test. Otago exercise significantly reduced the respondents’ risk of falling and enhanced their health status. Significant differences were observed between the two groups in terms of the risk of fall (p= 0.041) and health status (p= 0.011). Otago exercise significantly improves the health status and reduces the risk of falling among elderly with chronic illness. The exercise can be recommended for older adults with chronic illness in social elderly institutions and communities.

Abstrak :
Karya ilmiah akhir KIA merupakan laporan praktik residensi keperawatan medikal bedah yang menganalisis peran perawat spesialis sebagai pemberi asuhan, peneliti, dan pembaharu. Peran-peran tersebut diterapkan dalam mengelola kasus pasien kanker dengan pendekatan chronic illness trajectory model, penerapan evidence based nursing program perawatan spiritual pada pasien leukemia untuk menurunkan depresi, dan melakukan proyek inovasi kelompok tentang manajemen edukasi bagi pasien yang menjalani perawatan isolasi radioaktif Iodine 131 di Ruang Isolasi Radio Aktif RIRA RSK Dharmais. Konsep trajectory merupakan salah satu teori keperawatan yang akan membantu memberdayakan pasien dan caregiver karena memberikan perawatan yang sesuai dengan tahapan atau fase penyakit pasien serta berfokus pada perawatan paliatif. Perawatan paliatif merupakan salah satu area fokus perawat spesialis pada bidang perawatan kanker yang akan membantu meningkatkan kemandirian dan kualitas hidup pasien. Penerapan perawatan program spiritual bersifat non-invasif, murah, aman, dan secara tehnis praktis dalam mengelola status depresi pasien. Edukasi dapat memperbaiki pemahaman pasien tentang radioterapi dan efek sampingnya sehingga dapat meningkatkan kualitas mutu pelayanan keperawatan.

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The final scientific paper is a report on the medical surgical nursing residency program that analyzes the role of nurse specialist as careprovider, researcher, and innovator. The roles are applied on nursing care of cancer patients that used the chronic illness trajectory model approach, application of evidence based nursing practise in spiritual care program on leukemia patients to reduce depression, and perform innovation group project on educational management for patients undergoing radioactive Iodine 131 in Radioactive Isolation Ward Dharmais Cancer Hospital. The trajectory concept is one of the nursing theories that assist patients and caregivers rsquo empowerment to provide appropriate care in the stage and phase of patient 39 s illness and focuses on palliative care. Palliative care is one of the focus areas of nurse specialist in the field of cancer care that will improve the patient 39 s independence and quality of life. The application of spiritual care program is non invasive, cheap, safe, and practically in managing the patient 39 s depression status. Education could improve patients 39 understanding of radiotherapy and its side effects to improve the quality of nursing care.

Abstrak :
Laporan praktik residensi keperawatan medikal bedah peminatan onkologi terdiri dari pengelolaan kasus limfoma hodkin dan 30 resume kasus dengan pendekatan chronic illness trajectory model, penerapan evidence based nursing walking exercise untuk mengatasi masalah fatigue pada pasien kanker, dan mengembangkan proyek inovasi J-Hati aplikasi untuk menurunkan tingkat fatigue pasien kanker. Chronic illness trajectory model dapat membantu mengelola kondisi kronis pada kasus limfoma hodkin dan 30 resume kasus kanker berdasarkan perjalanan penyakitnya dan interaksinya dari berbagai kondisi (medis, psikososial, dan budaya), karena kebutuhan dan tujuan perawatan pasien kanker berubah pada setiap fase yang dialami atau dilewati. Penerapan EBN walking exercise terbukti efektif untuk mengatasi masalah fatigue pasien kanker. Inovasi J-Hati aplikasi juga telah terbukti efektif menurunkan tingkat fatigue pasien kanker, dan dapat memfasilitasi, serta mendorong pasien kanker untuk latihan fisik dirumah, yang akhirnya dapat meningkatkan kualitas hidup pasien kanker. ......Report on medical surgical nursing residency practice specializing in oncology consisting of management of Hodgkin's lymphoma cases and 30 case resumes using the chronic illness trajectory model approach, application of evidence based nursing walking exercise to overcome fatigue in cancer, and developing the J-Hati application innovation project to reduce the level of fatigue in cancer. The chronic illness trajectory model can help manage chronic conditions in cases of hodgkin's lymphoma and 30 resumes of cancer cases based on the course of the disease and the interaction of various conditions (medical, psychosocial, and cultural), because the needs and goals of cancer patient care change in each phase they experience or go through. . The application of EBN walking exercise has been proven to be effective in overcoming the problem of fatigue in cancer patients. The J-Hati application innovation has also been proven to be effective in reducing the fatigue level of cancer patients, can facilitate, and encourage cancer patients to do physical exercise at home, which can ultimately improve the quality of life of cancer patients