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"Praktek klinik lanjut selama praktek residensi keperawatan pada sistem muskuloskeletal dimaksudkan untuk mampu memberikan asuhan keperawatan, menerapkan praktik Keperawatan Berbasis Bukti serta mampu berperan sebagai inovator di ruang perawatan. Peran pemberi asuhan keperawatan dilakukan dengan menggunakan model adaptasi Roy pada pasien dengan Spinal Cord Injury dan 30 pasien lainnya dengan berbagai gangguan sistem muskuloskeletal. Perilaku maladaptif paling banyak adalah mode adaptasi fisiologi, yaitu gangguan mobilitas fisik. Intervensi keperawatan berupa manajemen mobilisasi fisik ditujukkan untuk meningkatkan adaptasi pasien dalam meningkatkan kebutuhan aktivitas. Penerapan praktik Keperawatan Berbasis Bukti difokuskan pada Respiratory Muscle Training pada lima pasien Spinal Cord Injury menunjukkan keefektifan Respiratory Muscle Training dalam meningkatkan fungsi pernapasan. Program inovasi keperawatan berupa pemberian edukasi pra dan pasca pada pasien yang akan menjalani tindakan Total Knee Arhtroplasty

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Advanced clinical practice during a nursing residency on the musculoskeletal system is intended to provide nursing care, apply the evidence-based practice, and act as an innovator in the treatment room. The role of nursing care providers is carried out using Roy's adaptation model in patients with Spinal Cord Injury and 30 other patients with various disorders of the musculoskeletal system. Most maladaptive behaviour is a model of physiological adaptation, namely impaired physical mobility. Nursing interventions in physical mobilization management are intended to improve patient adaptation to increasing activity needs. The implementation of Evidence-Based Nursing practice focused on Respiratory Muscle Training in five Spinal Cord Injury patients demonstrated the effectiveness of Respiratory Muscle Training in improving respiratory function. The nursing innovation program provides pre- and post-education to patients who will undergo Total Knee Arthroplasty."

"Latar belakang: kasus multiple fraktur ekstremitas menjadi permasalahan yang kompleks dengan adanya kerusakan struktur tulang, jaringan lunak, kerusakan neurovaskuler maupun dari sisi tingkat keparahan dan lokasi trauma yang terjadi. Kondisi ini berpotensi menimbulkan masalah infeksi, perdarahan, mal union, amputasi hingga kecacatan permanen. Teori adaptasi roy dapat digunakan oleh perawatan sebagai salah satu pendekatan model dalam memberikan asuhan keperawatan pada pasien dengan multiple fraktur ekstremitas.Tujuan: menerapkan teori adaptasi roy dalam asuhan keperawatan pada pasien dengan multiple fraktur ekstremitas.Metode: case study dengan pembahasan melalui studi literaturHasil: Pengkajian melalui 4 mode adaptasi roy pada kasus dengan multiple fraktur ekstremitas didapatkan  masalah keperawatan yaitu nyeri akut, ketidakefektifan perfusi jaringan perifer, resiko infeksi luka operasi, resiko perdarahan, gangguan mobilitas fisik, defisit perawatan diri, kesiapan peningkatan konsep diri, cemas dan resiko disfungsi neurovaskuler perifer,  Intervensi diberikan pada pasien meliputi manajemen nyeri, perawatan sirkulasi: insuffisiensi arteri, manajemen sensasi, incicion site care, pencegahan perdarahan, bed rest care, traction/immobilization care, bantuan perawatan diri, peningkatan koping, peningkatan kesadaran diri dan pengurangan cemas. Evaluasi menunjukkan adanya penurunan gejala yang muncul pada pasien multiple fraktur ekstremitas.Kesimpulan: pendekatan adaptasi roy membantu dalam mengidentifikasi permasalahan yang muncul pada pasien dengan multiple fraktur ekstremitas melalui 4 mode adaptasi dengan berbagai stimulus yang ada. Pendekatan ini dapat dijadikan acuan untuk mengubah respon pasien kearah respon yang adaptif.

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Background: multiple fractures of extremities become a complex problem with damage to bone structures, soft tissues, neurovascular damage as well as in terms of the severity and location of the trauma that occurred. This condition has the potential to cause problems of infection, bleeding, mal union, amputation to permanent disability. Roy's adaptation theory can be used as a model approach in providing nursing care to patients with multiple fractures of extremities.

Objective: to apply Roy's adaptation theory in nursing care for patients with multiple fractures of extremities.

Method: case study with discussion through literature study

Results: Assessment through 4 modes of Roy adaptation in cases with multiple fractures of extremities found  nursing problems: acute pain, ineffective peripheral tissue perfusion, risk of surgical site infection, risk of bleeding, impaired physical mobility, self-care deficit, readiness for enhanced self-concept, anxiety and risk for neurovascular dysfunction. Interventions given to patients include pain management, circulation care: arterial insufficiency, sensation management, incision site care, bleeding prevention, bed rest care, traction/immobilization care, self-care assistance, coping enhancement, self awareness enhancement and anxiety reduction. Evaluation shows a decrease in symptoms that appear in patients with multiple fractures of extremities.

Conclusion: Roy's adaptation approach helps in identifying the problems that arise in patients with multiple fractures of extremities through 4 modes of adaptation to various existing stimuli. This approach can be used as a reference to change the patient's response towards an adaptive response."

"Karya Ilmiah akhir (KIA) adalah serangkaian kegiatan yang telah dilakukan selama parktik, yang dirangkum dalam satu laporan akhir praktik keperawatan medikal bedah dengan mengelola kasus orthopaedi yaitu  Osteoarthritis (OA) menggunakan pendekatan teori Virginia Avenel Henderson’s, mengkategorikan kegiatan keperawatan menjadi empat belas komponen berdasarkan kebutuhan manusia. Henderson’s menekankan pentingnya kemandirian klien agar  terus mengalami kemajuan setelah keluar dari rumah sakit. Penerapan Evidence Based Nursing Leg position dapat  untuk mengurangi kehilangan darah dan meningkatkan fungsional ROM pada klien post Total Knee Arthroplasty (TKA).Elevasi 60 derajat dengan Fleksi 60 derajat , membantu  pemulihan fungsional pada awal pasca operasi. Untuk dapat memandirikan klien, dibutuhkan tindakan ambulasi dini seperti melakukan exercise : kekuatan otot quadriceps, ankle pump. Kelompok melakukan Pengembangan Media Video Edukasi Preoperasi Pada Klien TKA yang merupakan proyek inovasi. Video sebagai sarana berkomunikasi dengan klien, meningkatkan minat dan merubah perilaku.

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Final Scientific Work is a series of activities that have been carried out during practice, which are summarized in one final report on medical surgical nursing practice by managing orthopedic cases, namely Osteoarthritis (OA) using Virginia Avenel Henderson's theoretical approach, categorizing nursing activities into fourteen components based on human needs. Henderson's emphasizes the importance of the client's independence in order to continue to progress after discharge from the hospital. The application of evidence based nursing leg position can reduce blood loss and improve functional ROM in post Total Knee Arthroplasty (TKA) clients. 60 degrees elevation with 60 degrees flexion, assists early postoperative functional recovery. To be able to make the client independent, early ambulation is needed, such as doing exercises: quadriceps muscle strength, ankle pump. The group carried out the Development of Preoperational Educational Video Media for Foreign Workers Clients which was an innovation project. Video as a means of communicating with clients, increasing interest and changing behavior."

"Praktek residensi spesialis keperawatan medikal bedah peminatan muskuloskeletal bertujuan untuk mengaplikasikan peran perawat sebagai pemberi asuhan, pengelola pendidik, dan peneliti. Peran sebagai pemberi asuhan dilakukan dengan mengelola 30 pasien dengan gangguan muskuloskeletal dan satu kasus kelolaan dengan OA HIP due Dysplasia left HIP menggunakan teori keperawatan adaptasi Roy. Penerapan intervensi keperawatan berbasis bukti ilmiah merujuk pada peran perawat sebagai peneliti dalam hal ini adalah penerapan assessment RCSQ dalam menilai kualitas tidur pasien pre operasi sebelum menjalankan operasi. Peran perawat sebagai pengelola sekaligus pendidikan teraplikasikan dalam inovasi edukasi dengan menggunakan video edukasi pre operasi pada pasien yang menjalani operasi Total Knee arthroplasty. Keseluruhan rangkaian kegiatan ini bertujuan untuk mewujudkan kualitas asuhan keperawatan yang komprehensif.

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The practice of medical surgical nursing specialist residency with muskuloskeletal specialization aims to apply the role of nurses as caregivers, educators, and researchers.The role as a caregiver is carried out by managing 30 patients with musculoskeletal disorders and managing one case with OA HIP due to Dysplasia left HIP using Roy's adaptation nursing theory. The application of scientific evidence-based nursing interventions refers to the role of nurses as researchers in this case is the application of the RCSQ assessment in assessing the sleep quality of preoperative patients before carrying out surgery. The role of nurses as managers as well as educators is applied in educational innovation by using preoperative educational videos for patients undergoing Total Knee arthroplasty surgery. This entire series of activities aims to realize the quality of comprehensive nursing care."

"Spinal Cord Injury (SCI) adalah kerusakan sumsum tulang belakang yang mengakibatkan gangguan neurologis, yang disebabkan oleh cedera tulang belakang taumatik (TSCI) dan cedera tulang belakang non-traumatik (NTSCI). SCI mengakibatkan gangguan fisik jangka panjang, gangguan fungsi tubuh, status psikologis dan sosial ekonomi. SCI secara drastis mempengaruhi independensi dan kualitas kehidupan. Salah satu penyebab utama cedera medulla spinalis secara non-trauma adalah adanya tumor yang dapat menekan medula spinalis. Klasifikasi tumor di medulla spinalis berdasarkan lokasi tumor pasien yakni intradural-intramedullary, intradural-extramedullary dan extradural. Tumor medulla spinaliis secara garis besar terbagi dua jenis yakni Benign Spinal Cord Tumors, dan Malignant Spinal Cord Tumor. Tujuan: Menganalisis praktik residensi keperawatan medikal bedah dengan menerapkan peran sebagai pemberi asuhan keperawatan dan melakukan analisis pemberian asuhan keperawatan pada pasien dengan masalah muskuloskeletal khususnya SCI dengan pendekatan konsep Need Theory Virginia Henderson. Metode: Studi kasus yang dilakukan pada praktik residensi spesialis keperawatan medikal bedah terhadap pasien spinal cord injury dengan pendekatan teori kebutuhan Virginia Henderson. Hasil: Penulis melakukan asuhan keperawatan kepada 17 (dari total 30 kasus resume) pasien dengan SCI yang disebabkan oleh trauma dan non trauma. Proses asuhan keperawatan menurut Henderson berfokus pada pasien dan keluarga. Virginia Henderson memandang pasien sebagai individu yang membutuhkan bantuan dalam pemenuhan kebutuhannya untuk mencapai kebebasan dan keutuhan tubuh serta pikiran.

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SCI is spinal cord damage that results in neurological disorders, caused by traumatic spinal cord injury (TSCI) and non-traumatic spinal cord injury (NTSCI). SCI results in long-term physical impairment, impaired bodily function, psychological and socioeconomic status. Due to functional limitations in the sensory and motor systems, involving lower and upper extremity function, SCI drastically affects independence and quality of life. One of the main causes of non-traumatic spinal cord injury is the presence of tumors that can compress the spinal cord in patients (New et al., 2017). The classification of tumors in the spinal cord is based on the location of the patient's tumor, namely intradural-intramedullary, intradural-extramedullary and extradural (Kumar et al., 2020). Spinal cord tumors are broadly divided into two types, namely benign spinal cord tumors and malignant spinal cord tumors.

Objectives: To analyze the practice of medical surgical nursing residency by applying the role as a nursing care provider and to perform a nursing analysis of providing nursing care to patients with musculoskeletal problems, especially SCI with Virginia Henderson's Need Theory concept approach.

Methods: The author's case study was carried out in this medical surgical nursing specialist residency practice for spinal cord injury patients with a virginia Henderson needs theory approach.

Results: The author provided nursing care to 17 (out of a total of 30 cases resumed) patients with SCI caused by trauma and non-trauma. The nursing care process according to Henderson focuses on the patient and family. Virginia Henderson views patients as individuals who need assistance in meeting their needs to achieve freedom and wholeness of body and mind."

"Ketepatan aktivasi kode trauma dan tindakan keperawatan emergensi yang terstruktur merupakan salah satu faktor dalam keberhasilan penanganan pasien politrauma. Penanganan pasien politrauma yang segera dan terstruktur dapat menurunkan risiko perburukan kondisi pasien, menurunkan angka kecacatan dan menyelamatkan nyawa pasien. Ketidaktepatan penapisan pasien politrauma di triage disebabkan karena belum adanya instrumen penapisan dengan indikator yang sensitif dan spesifik. Selain itu, kompleksitas kondisi pasien politrauma menuntut adanya penanganan yang cepat, tepat, komprehensif, dan terstruktur. Oleh karena itu, penelitian ini bertujuan untuk mengembangkan instrumen skrining politrauma di triage yang sensitif dan spesifik serta melakukan restrukturisasi intervensi keperawatan emergensi untuk pasien trauma yang disebut ELLASI. Penelitian ini menggunakan metode sequential exploratory mixed method yang meliputi 3 tahap. Tahap I: pengembangan instrumen Skrining Politrauma Universitas Indonesia – Cipto Mangunkusumo (SPIC) melalui literature review, studi kualitatif, diskusi pakar (pannel expert), dan studi kuantitatif (pembuatan model skoring). Tahap II: uji nilai diagnostik instrumen SPIC dalam menapis politrauma dengan uji formulasi model skoring. Tahap III: uji efektivitas kombinasi instrumen SPIC+ELLASI dibandingkan SPIC+non ELLASI menggunakan randomized control trial (RCT) single blind. Penelitian ini menghasilkan instrumen SPIC yang sensitif (91%) dan telah mendapatkan HKI. Kombinasi instrumen SPIC dan ELLASI terbukti lebih efektif dalam meningkatkan waktu respons (p = 0,000), mencegah kondisi perburukan pasien (skor EWS p = 0,000), dan menjaga status metabolik pasien (pH p = 0,04; HCO3 p = 0,03) dibandingkan dengan kombinasi instrumen SPIC dan non ELLASI. SPIC dapat digunakan sebagai instrumen penapisan pasien politrauma di triage. Kombinasi SPIC dan ELLASI dapat meningkatkan luaran pasien.

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Code trauma activation and emergency nursing intervention are factors affecting the success of polytrauma patient management. These factors can help prevent deterioration and death. There is no instrument to screen polytrauma patients in triage. The complexity of polytrauma patients’ condition requires fast, correct, comprehensive and structured intervention. This study aims to develop a polytrauma screening instrument and standardized emergency nursing intervention called ELLASI. This study used a sequential exploratory mixed method, which consisted of 3 phases. Phase 1: To develop an instrument of Skrining Politrauma Universitas Indonesia – Cipto Mangunkusumo (SPIC) by using literature review, qualitative study, pannel expert, and quantitative. Phase 2: To test the diagnostic value of SPIC to screen polytrauma patients. Phase 3: To examine the effectiveness of SPIC and ELLASI in preventing deterioration, increasing response time, and maintaining the metabolic status of polytrauma patients using randomized control trials (RCT) single blind. This study produced SPIC with high sensitivity (91%). SPIC and ELLASI are effective in increasing response time (p = 0,000), preventing deterioration (EWS score p = 0,000), and maintaining metabolic status (pH p = 0,04; HCO3 p = 0,03) of polytrauma patients compare to SPIC and non ELLASI. SPIC can be used as a screening tool for polytrauma patients in Triage. SPIC and ELLASI can increase patients outcome."

"Upaya peningkatan kompetensi peserta didik keperawatan hingga saat ini masih menjadi masalah bagi sebagian besar institusi pendidikan keperawatan di Indonesia. Hal ini disebabkan kolaborasi yang belum optimal dengan rumah sakit karena belum didukung oleh kebijakan yang memadai pendekatan crossectional survey dan melibatkan 384 sampel bertempat di lima Rumah Sakit (Fatmawati. Oleh karena itu riset ini bertujuan untuk menghasilkan model kolaborasi yang tepat guna meningkatkan kompetensi peserta didik tersebut. Model ini didisain berdasarkan riset kuantitatif dan kualitatif. Penelitian kuantitatif dilakukan bulan September 2012-Februari 2013 dengan Jakarta, Hasan Sadikin Bandung, Kariadi Semarang, Sardjito Yogyakarta, Soetomo Surabaya) dan lima Institusi pendidikan (FIK Univ. Muhammadiyah Jakarta, FIK Univ.Padjajaran, PSIK FK Univ. Gadjah Mada, PSIK FK Univ. Diponegoro dan FIK Univ. Airlangga). Penelitian kualitatif dilaksanakan di RS Fatmawati dan FIK UMJ. Data dianalisa dengan Multiple Regresi Logistik yang menghasilkan formula yaitu: Role Model, uraian tugas pendidik klinik, keahlian staff fakultas, kemitraan kesejawatan, variasi kasus dan pendidikan. Persamaan model didapatkan: -431+0,733*Keahlian Staf Fakultas +1,215*kemitraan +1,086*Variasi Kasus +0,802*uraian tugas +0,824*RoleModel -0,594*Pendidikan (Ners dan Magister/ spesialis) -1,113*Pendidikan (S3). Terhadap peluang pencapaian kompetensi peserta didik maka; variabel keahlian staf fakultas sebesar 2,082 kali, kemitraan kesejawatan sebesar 3,369 kali, ketersediaan variasi kasus di klinik sebesar 2,961 kali, uraian tugas pendidik klinik sebesar 2,300 kali dan role model di klinik 2,280 kali. Model ini selanjutnya dilakukan validasi melalui riset tahap 2 (dua) dengan disain riset quasi experimental di RS. Islam Jakarta Pusat sebagai kelompok perlakuan dan RS. Islam Jakarta Timur sebagai kontrol dengan institusi pendidikan mitra yaitu FIK Univ. Muhammadiyah Jakarta. Melibatkan 25 responden kelompok perlakuaan dan 25 responden kelompok control. Analisa data dilakukan dengan General Linier Model – Repeated Meassure dan terbukti bahwa capaian kompetensi berbeda bermakna pada tiap tahap pengukuran dan antar kelompok pengukuran. Riset ini membuktikan bahwa model ini valid dan dapat meningkatkan pencapaian kompetensi peserta didik. Capaian kompetensi (pengetahuan, keterampilan dan sikap) menunjukkan percepatan 4 minggu di bandingkankan dengan kelompok control. Hasil riset ini diharapkan dapat digunakan oleh institusi pendidikan keperawatan, rumah sakit dan pemerintah untuk menata model pendidikan keperawatan dan menjadi standar bagi penyelenggaraan pendidikan keperawatan di Indonesia agar pencapaian kompetensi peserta didik lebih efektif, efisien dan optimal.

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Nowadays the effort to improve students competence is a problem for almost all nursing school in Indonesia. It is probably related to nonoptimal collaboration between nursing school and hospital since no support of an appropriate policies. The aim of this study was to build collaboration model in order to improving students competence. This study was using quantitative and qualitative research approach. The Cross sectional survey was started in September 2012 until February 2013, carried out 384 samples in five hospitals (Fatmawati Jakarta, Hasan Sadikin Bandung, Kariadi Semarang, Sardjito Yogyakarta, Soetomo Surabaya) and five nursing schools (FIK Univ. Muhammadiyah Jakarta, FIK Univ.Padjajaran, PSIK FK Univ. Gadjah Mada, PSIK FK Univ. Diponegoro dan FIK Univ. Airlangga). The qualitative study was held in Fatmawati Hospital and FIK UMJ. Performing multiple logistic regression analysis showed that Role model, clinical instructor job description, the expertise of lecturer, nursing staff partnership, the variety of cases and schools. More over, the model was illustrate -431+ +0,733* the expertise of faculty’s staff +1,215* Partnership +1,086* the variety of cases +0,802* job description+0,824* RoleModel -0,594* school (Ners and Magister/spesialis) -1,113*school (doctoral). The expertise of faculty’s staff has chance 2.082 times to achieve student competence, so does the chance of the nursing staff partnership has up to 3.369, the existence of variety of cases 2,961 times, clinical instructur job description 2,300 times and role model in clinical setting 2,280 times. A secondary study by research in Islamic hospital was done to validate the model. The sample consist of Islamic hospital in Central Jakarta and Islamic Hospital in East Jakarta as control group. Both of the samples has collaboration with FIK Muhammadiyah University of Jakarta. By using General Linier Model – Repeated Measurement showed significant result of student competence achievement in each group. This indicates that the model is valid and can increase the achievement of student competency. The result of this study can be used for nursing schools, hospitals, and government to adjust nursing education model in the interest of preferable student competence accomplishment"

"Sistem informasi keperawatan adalah salah satu elemen penting dalam pelaksanaan asuhan keperawatan. Sistem informasi keperawatan di Indonesia saat ini masih belum optimal dan umumnya masih bersifat manual. Riset dimulai dengan mengidentifikasi dan dilanjutkan pengembangan model sistem informasi manajemen keperawatan oleh Roro ("SIMPRO") yang disesuaikan dengan kondisi rumah sakit. Model "SIMPRO" yang telah dicustomization diujicobakan di dua rumah sakit dengan karakteristik yang berbeda yaitu rumah sakit swasta dan rumah sakit pemerintah. Setelah implementasi, dilaksanakan evaluasi dengan desain pre- post test without control group. Jumlah sampel dokumentasi yang digunakan untuk mengevaluasi kinerja "SIMPRO" adalah 219 dokumentasi dari setiap kelompok rumah sakit. Hasil riset menyampaikan ada perbedaan kinerja sebelum dan sesudah menggunakan "SIMPRO" yang diidentifikasikan dari perbedaan kualitas, kelengkapan, kesinambungan, bukti aspek legal dan fungsi membantu membuat keputusan (p=0.001). Ada perbedaan efisiensi waktu: baik di Rumah Sakit Ibu dan Anak Bunda Jakarta dan RS. Fatmawati (p= 0.01). Setelah menggunakan "SIMPRO" waktu yang diperlukan untuk melaksanakan dokumentasi di RS Fatmawati adalah 40.29 menit atau 25.27% dari total waktu dalam satu shift, sedangkan di RS Ibu dan Anak Bunda Jakarta membutuhkan waktu 24.62 menit atau 9.60% dari total waktu dalam satu shift. "SIMPRO" juga mempengaruhi efisiensi biaya, dimana dengan "SIMPRO" dokumentasi tidak setiap waktu harus dicetak. "SIMPRO" menjamin continuity of care dari asuhan keperawatan, sebagai bukti aspek legal, membantu mengambil keputusan dan meningkatkan keselamatan pasien. "SIMPRO" mengefisiensikan waktu dokumentasi sehingga waktu perawatan langsung ke pasien lebih optimal. "SIMPRO" juga meningkatkan edukasi kesehatan kepada pasien dan keluarga."Pada riset ini "SIMPRO" juga dapat meningkatkan peran manajer keperawatan dalam melaksanakan fungsi manajemen terutama pada peran pemberiaan motivasi, pengarahan, evaluasi dan monitoring terhadap pelaksanaan asuhan keperawatan. Dukungan aspek perawat, aspek manajemen dan teknik dapat mengoptimalkan kinerja "SIMPRO" sehingga dapat meningkatkan kualitas pelayanan keperawatan. Berdasarkan manfaat dari "SIMPRO", maka sistem ini dapat direkomendasikan untuk digunakan di setiap Rumah Sakit serta dapat mendukung peningkatan kualitas mutu pelayanan keperawatan dan kesehatan.

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Nursing Information System is an important element in nursing process. Current nursing system in Indonesia is still manual and less optimal. However, manual system has weaknesses, such as data slip or even lost, which may potentially lead a nurse in the legal risk. This research was an operational research. It was started by problem identification in order to identify needs for development of nursing information system. The second stage was Sistem Informasi Manajemen Keperawatan oleh Roro ("SIMPRO"), in other words, Development of Nursing Management Information System by Roro. "SIMPRO" has been adjusted and customized with the conditions of the hospitals. Coordination of management, human resources, and infrastructure as well as trainings and assistance were conducted prior to trial of "SIMPRO". Then, trial of "SIMPRO" was conducted at two hospitals, which represent the characteristics of both public and private hospitals. Pretest and posttest without control were done after the implementation. Numbers of nursing documentation as samples were 219 documentations from each hospital group. It was used to evaluate the effectiveness of system performance before and after the implementation of "SIMPRO". Result of the research was difference of performance before and after the implementation of "SIMPRO", which was identified by differences on quality, completeness, continuity, aspect legal function and decision support system (p=0.001). Hospital with good management and infrastructure supports demonstrated higher level of effectiveness than another one. There was difference on time effectiveness before and after the implementation of "SIMPRO", both at Bunda Hospital (p=0.010) and Fatmawati General Hospital (p=0.010). Duration of documentation at Fatmawati General Hospital was 40.29 minutes or about 25.27 percent of total duration in one shift. Meanwhile, duration of documentation at Bunda Hospital was 24.62 minutes or about 9.60 percent of total duration in one shift. "SIMPRO" affected cost effectiveness since no printed documentation produced. In addition, "SIMPRO" guaranteed the continuity of nursing process. Thus, it guaranteed legal aspect and enhanced patient safety as well. This research implicated to the enhancement of quality, completeness, relevance, aspect legal function and decision support system. It also implicated to time efficiency on documentation, thus direct care to patients can be more optimal. "SIMPRO" can enhance the quality of nursing care by supports of nurses, management and technical aspects.;Nursing Information System is an important element in nursing process. Current nursing system in Indonesia is still manual and less optimal. However, manual system has weaknesses, such as data slip or even lost, which may potentially lead a nurse in the legal risk. This research was an operational research. It was started by problem identification in order to identify needs for development of nursing information system. The second stage was Sistem Informasi Manajemen Keperawatan oleh Roro ("SIMPRO"), in other words, Development of Nursing Management Information System by Roro. "SIMPRO" has been adjusted and customized with the conditions of the hospitals. Coordination of management, human resources, and infrastructure as well as trainings and assistance were conducted prior to trial of "SIMPRO". Then, trial of "SIMPRO" was conducted at two hospitals, which represent the characteristics of both public and private hospitals. Pretest and posttest without control were done after the implementation. Numbers of nursing documentation as samples were 219 documentations from each hospital group. It was used to evaluate the effectiveness of system performance before and after the implementation of "SIMPRO". Result of the research was difference of performance before and after the implementation of "SIMPRO", which was identified by differences on quality, completeness, continuity, aspect legal function and decision support system (p=0.001). Hospital with good management and infrastructure supports demonstrated higher level of effectiveness than another one. There was difference on time effectiveness before and after the implementation of "SIMPRO", both at Bunda Hospital (p=0.010) and Fatmawati General Hospital (p=0.010). Duration of documentation at Fatmawati General Hospital was 40.29 minutes or about 25.27 percent of total duration in one shift. Meanwhile, duration of documentation at Bunda Hospital was 24.62 minutes or about 9.60 percent of total duration in one shift. "SIMPRO" affected cost effectiveness since no printed documentation produced. In addition, "SIMPRO" guaranteed the continuity of nursing process. Thus, it guaranteed legal aspect and enhanced patient safety as well. This research implicated to the enhancement of quality, completeness, relevance, aspect legal function and decision support system. It also implicated to time efficiency on documentation, thus direct care to patients can be more optimal. "SIMPRO" can enhance the quality of nursing care by supports of nurses, management and technical aspects.;Nursing Information System is an important element in nursing process. Current nursing system in Indonesia is still manual and less optimal. However, manual system has weaknesses, such as data slip or even lost, which may potentially lead a nurse in the legal risk. This research was an operational research. It was started by problem identification in order to identify needs for development of nursing information system. The second stage was Sistem Informasi Manajemen Keperawatan oleh Roro ("SIMPRO"), in other words, Development of Nursing Management Information System by Roro. "SIMPRO" has been adjusted and customized with the conditions of the hospitals. Coordination of management, human resources, and infrastructure as well as trainings and assistance were conducted prior to trial of "SIMPRO". Then, trial of "SIMPRO" was conducted at two hospitals, which represent the characteristics of both public and private hospitals. Pretest and posttest without control were done after the implementation. Numbers of nursing documentation as samples were 219 documentations from each hospital group. It was used to evaluate the effectiveness of system performance before and after the implementation of "SIMPRO". Result of the research was difference of performance before and after the implementation of "SIMPRO", which was identified by differences on quality, completeness, continuity, aspect legal function and decision support system (p=0.001). Hospital with good management and infrastructure supports demonstrated higher level of effectiveness than another one. There was difference on time effectiveness before and after the implementation of "SIMPRO", both at Bunda Hospital (p=0.010) and Fatmawati General Hospital (p=0.010). Duration of documentation at Fatmawati General Hospital was 40.29 minutes or about 25.27 percent of total duration in one shift. Meanwhile, duration of documentation at Bunda Hospital was 24.62 minutes or about 9.60 percent of total duration in one shift. "SIMPRO" affected cost effectiveness since no printed documentation produced. In addition, "SIMPRO" guaranteed the continuity of nursing process. Thus, it guaranteed legal aspect and enhanced patient safety as well. This research implicated to the enhancement of quality, completeness, relevance, aspect legal function and decision support system. It also implicated to time efficiency on documentation, thus direct care to patients can be more optimal. "SIMPRO" can enhance the quality of nursing care by supports of nurses, management and technical aspects.;Nursing Information System is an important element in nursing process. Current nursing system in Indonesia is still manual and less optimal. However, manual system has weaknesses, such as data slip or even lost, which may potentially lead a nurse in the legal risk. This research was an operational research. It was started by problem identification in order to identify needs for development of nursing information system. The second stage was Sistem Informasi Manajemen Keperawatan oleh Roro ("SIMPRO"), in other words, Development of Nursing Management Information System by Roro. "SIMPRO" has been adjusted and customized with the conditions of the hospitals. Coordination of management, human resources, and infrastructure as well as trainings and assistance were conducted prior to trial of "SIMPRO". Then, trial of "SIMPRO" was conducted at two hospitals, which represent the characteristics of both public and private hospitals. Pretest and posttest without control were done after the implementation. Numbers of nursing documentation as samples were 219 documentations from each hospital group. It was used to evaluate the effectiveness of system performance before and after the implementation of "SIMPRO". Result of the research was difference of performance before and after the implementation of "SIMPRO", which was identified by differences on quality, completeness, continuity, aspect legal function and decision support system (p=0.001). Hospital with good management and infrastructure supports demonstrated higher level of effectiveness than another one. There was difference on time effectiveness before and after the implementation of "SIMPRO", both at Bunda Hospital (p=0.010) and Fatmawati General Hospital (p=0.010). Duration of documentation at Fatmawati General Hospital was 40.29 minutes or about 25.27 percent of total duration in one shift. Meanwhile, duration of documentation at Bunda Hospital was 24.62 minutes or about 9.60 percent of total duration in one shift. "SIMPRO" affected cost effectiveness since no printed documentation produced. In addition, "SIMPRO" guaranteed the continuity of nursing process. Thus, it guaranteed legal aspect and enhanced patient safety as well. This research implicated to the enhancement of quality, completeness, relevance, aspect legal function and decision support system. It also implicated to time efficiency on documentation, thus direct care to patients can be more optimal. "SIMPRO" can enhance the quality of nursing care by supports of nurses, management and technical aspects."

"Sistem informasi keperawatan adalah salah satu elemen penting dalam pelaksanaan asuhan keperawatan. Sistem informasi keperawatan di Indonesia saat ini masih belum optimal dan umumnya masih bersifat manual. Riset dimulai dengan mengidentifikasi dan dilanjutkan pengembangan model sistem informasi manajemen keperawatan oleh Roro ("SIMPRO") yang disesuaikan dengan kondisi rumah sakit. Model "SIMPRO" yang telah dicustomization diujicobakan di dua rumah sakit dengan karakteristik yang berbeda yaitu rumah sakit swasta dan rumah sakit pemerintah. Setelah implementasi, dilaksanakan evaluasi dengan desain prepost test without control group. Jumlah sampel dokumentasi yang digunakan untuk mengevaluasi kinerja "SIMPRO" adalah 219 dokumentasi dari setiap kelompok rumah sakit. Hasil riset menyampaikan ada perbedaan kinerja sebelum dan sesudah menggunakan "SIMPRO" yang diidentifikasikan dari perbedaan kualitas, kelengkapan, kesinambungan, bukti aspek legal dan fungsi membantu membuat keputusan (p=0.001). Ada perbedaan efisiensi waktu: baik di Rumah Sakit Ibu dan Anak Bunda Jakarta dan RS. Fatmawati (p= 0.01). Setelah menggunakan "SIMPRO" waktu yang diperlukan untuk melaksanakan dokumentasi di RS Fatmawati adalah 40.29 menit atau 25.27% dari total waktu dalam satu shift, sedangkan di RS Ibu dan Anak Bunda Jakarta membutuhkan waktu 24.62 menit atau 9.60% dari total waktu dalam satu shift. "SIMPRO" juga mempengaruhi efisiensi biaya, dimana dengan "SIMPRO" dokumentasi tidak setiap waktu harus dicetak. "SIMPRO" menjamin continuity of care dari asuhan keperawatan, sebagai bukti aspek legal, membantu mengambil keputusan dan meningkatkan keselamatan pasien. "SIMPRO" mengefisiensikan waktu dokumentasi sehingga waktu perawatan langsung ke pasien lebih optimal. "SIMPRO" juga meningkatkan edukasi kesehatan kepada pasien dan keluarga.?Pada riset ini "SIMPRO" juga dapat meningkatkan peran manajer keperawatan dalam melaksanakan fungsi manajemen terutama pada peran pemberiaan motivasi, pengarahan, evaluasi dan monitoring terhadap pelaksanaan asuhan keperawatan. Dukungan aspek perawat, aspek manajemen dan teknik dapat mengoptimalkan kinerja "SIMPRO" sehingga dapat meningkatkan kualitas pelayanan keperawatan. Berdasarkan manfaat dari "SIMPRO", maka sistem ini dapat direkomendasikan untuk digunakan di setiap Rumah Sakit serta dapat mendukung peningkatan kualitas mutu pelayanan keperawatan dan kesehatan.

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Nursing Information System is an important element in nursing process. Current nursing system in Indonesia is still manual and less optimal. However, manual system has weaknesses, such as data slip or even lost, which may potentially lead a nurse in the legal risk. This research was an operational research. It was started by problem identification in order to identify needs for development of nursing information system. The second stage was Sistem Informasi Manajemen Keperawatan oleh Roro ("SIMPRO"), in other words, Development of Nursing Management Information System by Roro. "SIMPRO" has been adjusted and customized with the conditions of the hospitals. Coordination of management, human resources, and infrastructure as well as trainings and assistance were conducted prior to trial of "SIMPRO". Then, trial of "SIMPRO" was conducted at two hospitals, which represent the characteristics of both public and private hospitals. Pretest and posttest without control were done after the implementation. Numbers of nursing documentation as samples were 219 documentations from each hospital group. It was used to evaluate the effectiveness of system performance before and after the implementation of "SIMPRO". Result of the research was difference of performance before and after the implementation of "SIMPRO", which was identified by differences on quality, completeness, continuity, aspect legal function and decision support system (p=0.001). Hospital with good management and infrastructure supports demonstrated higher level of effectiveness than another one. There was difference on time effectiveness before and after the implementation of "SIMPRO", both at Bunda Hospital (p=0.010) and Fatmawati General Hospital (p=0.010). Duration of documentation at Fatmawati General Hospital was 40.29 minutes or about 25.27 percent of total duration in one shift. Meanwhile, duration of documentation at Bunda Hospital was 24.62 minutes or about 9.60 percent of total duration in one shift. "SIMPRO" affected cost effectiveness since no printed documentation produced. In addition, "SIMPRO" guaranteed the continuity of nursing process. Thus, it guaranteed legal aspect and enhanced patient safety as well. This research implicated to the enhancement of quality, completeness, relevance, aspect legal function and decision support system. It also implicated to time efficiency on documentation, thus direct care to patients can be more optimal. "SIMPRO" can enhance the quality of nursing care by supports of nurses, management and technical aspects."

"Disertasi ini membahas tentang Model Adaptasi Psikologis Keperawatan Jiwa bagi Perawat Survivor yang Mengalami Post Traumatic Stress Syndrome (PTSS) Pasca Bencana Gempa Bumi di Kabupaten Tasikmalaya. Penelitian ini menggunakanoperational research, yang terdiri dari 3 tahap: 1) tahap I: identifikasi masalah melalui wawancara mendalam; 2) tahap 2: pengembangan model merupakan hasil integrasi tahap I, studi literatur dan seminar pakar; dan 3) tahap 3: validasi model yaitu ujicoba model. Hasil penelitian didapatkan: 1)tahap I terdapat 5 tema; 2) tahap II dihasilkan model adaptasi psikologis keperawatan jiwa bagi perawat survivor, alat uji model yaitu modul penanganan PTSS dan instrumen pengukuran kemampuan perawat survivor; dan 3) tahap III terdapat peningkatan kemampuan perawat survivor yang meliputi analisis kesadaran diri, komunikasi, mekanisme koping, dan motivasi intrinsik setelah mendapatkan intervensi penanganan PTSS. Rekomendasi: 1) modul ini dapat digunakan bagi perawat survivor baik yang mengalami PTSS maupun tidak serta dapat digunakan untuk menolong diri sendiri dan orang lain; 2) model adaptasi psikologis Keperawatan Jiwa bagi perawat survivor bisa digunakan untuk dasar pengembangan teori Keperawatan aspek budaya dan spiritual; 3) model dan modul perlu dijadikan acuan bagi organisasi profesi perawat guna penyusunan standar dan position statement perlindungan perawat kepada pemerintah; 4) modul ini bisa digunakan lembaga swadaya masyarakat, asosiasi, institusi pelayanan kesehatan dan organisasi lainnya untuk melakukan pelatihan, workshop, seminar dan lainnya; dan 5) penelitian lanjut dengan metodologi kualitatif (aspek budaya dan spiritual) dan kuantitatif (quasi experimental pre-post test with control group).

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This dissertation was concerned about the Psychiatric Nursing Psychological Adaptation Model for Nurse Survivor Experiencing Post Traumatic Stress Syndrome After Earthquake in Tasikmalaya District. This study utilized the operational research consisted of 3 (three) phases: 1) first phase: identification of problems through in-depth interview; second phase:development of model based on integration of base line data generated from the first phase of this research, literature study and the expert seminar; and third phase: validation of model by trying out the model.

The results ofthe first phase of this study revealed 5 themes; second phase was found the psychiatric nursing psychological adaptation model for nurse survivor, tried out instrument of model, module for the use of tried outmodel in handling PTSS and instrument used to measure the capacity of nurse survivor, and; third phase has shown the improvement of nurse survivor capability covering the self-awareness analysis, communication or interaction, coping mechanisms, and intrinsic motivation after receiving the PTSS treatment intervention.

Recommendations: 1) This module could be used for either nursesurvivor having experience on PTSS or not having experience on PTSS, as well as for helping themselves and others, 2)the psychiatric nursing psychological adaptation model for nurse survivor could be utilized as the basis for nursing theory development focusing on cultural and spiritual aspect; 3) model and module need to be developed as a reference for nursing professional association to establish the standards; 4) this module can be used by non-governmental organizations, associations, health care institutions and other organizations for training, workshops, seminars and other and; 5) further qualitative research on cultural and spiritual aspects and quantitative methodologies (quasi experimental pre-post test with control group) were recommended."