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"Keperawatan medikal bedah merupakan bidang praktik khusus dalam keperawatan profesional yang fokus dalam perawatan respon pasien terhadap masalah kesehatan aktual maupun potensial. Clinical nurse specialist (CNS) didefinisikan sebagai clinical leader dalam praktik keperawatan yang memiliki pengetahuan dan keterampilan tingkat lanjut seperti keahlian klinis dalam bidang tertentu, praktik berbasis bukti, kolaborasi, konsultasi, edukator, mentoring, dan manajemen. Peran CNS meliputi direct patient care, nursing practice, dan organization atau system. Peran perawat direct patient care diterapkan pada 31 pasien kasus kardiovaskuler baik medikal maupun bedah dengan pendekatan Model Adaptasi Roy. Hasil analisis praktik menunjukkan bahwa Model Adaptasi Roy dapat diterapkan dalam memberikan asuhan keperawatan pasien dengan gangguan sistem kardiovaskuler. Penerapan peran perawat nursing practice, yaitu perawat menerapkan praktik yang berbasis bukti (evidence) adalah efektivitas cold therapy sebelum latihan napas dalam (deep breathing) dan batuk efektif (coughing) terhadap nyeri akut pada pasien post cardiac surgery. Penerapan peran perawat organisation atau system, yaitu perawat membuat pengembangan profesional melalui inovasi terbaru untuk perkembangan asuhan keperawatan dengan menyusun SPO rehabilitasi jantung fase 1 pada pasien sindrom koroner akut (SKA).......Medical surgical nursing is a special area of nursing profesional practice that focuses on the care of patient s response to actual and potential health problems. Clinical nurse specialist (CNS) is defined as a clinical leader in nursing practice that has advance knowledge and skill such as clinical expertise in a particular area, evidence-based practice, collaboration, consulting, eduvator, menoting, and management. The role of CNS included direct patient care, nursing practice, and organization or system. The role as a direct patient care was applied to 31 cardiovascular patients both medical and surgical with the Roy s Adaptation Model approach. The result of practice analysis showed that Roy s Adaptation Model could be applied in providing nursing care in cardiovascular disease. The application of nursing practice nursing role, that nurse applied evidence-based practice that was effectiveness of cold therapy before deep breathing and coughing for acute pain post cardiac surgery patient. Aplication of the role of nurse organization or system, that nurses made professional development through the innovation for the development of nursing care. It was 1st phase cardiac rehabilitation in patient with acute coronary syndrome by formed standard operational procedure (SOP)."

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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."