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"Praktik klinik lanjut di ruang neurologi bertujuan memberikan asuhan keperawatan pada pasien gangguan neurologi khususnya spondilitis TB menggunakan teori keperawatan Model Adaptasi Roy, menerapkan paraktik keperawatan berdasarkan pembuktian dan melakukan inovasi keperawatan. Masalah keperawatan yang sering muncul akibat perilaku inefektif pada mode adaptasi fisiologis yaitu perfusi jaringan serebral tidak efektif, mode adaptasi konsep diri yaitu kecemasan, sedangkan mode fungsi peran yaitu pemeliharan kesehatan tidak efektif. Intervensi keperawatan berdasarkan pembuktian yaitu Pemakaian Bantal dekubitus untuk mencegah terjadinya ulkus tekan pada tumit. Inovasi keperawatan yaitu program bladder training pada pasien gangguan neurologis setelah pelepasan kateter. Perawat dapat menerapkan Model Adaptasi Roy, pemakaian bantal dekubitus untuk mencegah terjadinya luka tekan pada tumit dalam memberikan asuha keperawatan pada gangguan neurologi.

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Advanced clinical practice on patient with neurogical system disorder specialy Spondylosis Tuberculluse using Roy’s Adaptation theory is implementataion of nursing practice based on evidence and implementation of nursing innovation. The most frequent nursing problem occurred was ineffective cerebral tissue perfusion caused by ineffective behaviour response on physical adaptation mode, anxiety from self-esteem mode. Ineffective self-care management was nursing problem from role function mode. Nursing intervention based on evidence based practice on Using heel pressure cushion to prevent heel pressure. Nursing innovation in this clinical practice was Bladder training programme for neurological system disorder. Nurse can implement Roy’s Adaptation Theory with using heel pressure cushion, and innovation activities in delivering nursing care on neurogical disorder"

"Praktik spesialis Keperawatan Medikal Bedah peminatan sistem persyarafan ini bertujuan untuk melakukan praktik dengan mengaplikasikan peran perawat melalui pendekatan Model Adaptasi Roy. Masalah keperawatan terbanyak akibat respon perilaku inefektif pada mode adaptasi fisiologis yaitu ketidakefektifan perfusi jaringan otak, mode adaptasi psikologis yaitu ansietas, sedangkan mode fungsi peran yaitu manajemen kesehatan diri tidak efektif. Intervensi keperawatan berdasarkan pembuktian yang telah diterapkan yaitu Progressive Muscle Relaxation (PMR) dalam menurunkan tekanan darah, nadi dan kecemasan pada pasien stroke. Kegiatan inovasi keperawatan berupa penggunaan Bladder Training sebagai salah satu upaya untuk melatih kandung kemih dan mengembalikan pola normal perkemihan dengan menghambat atau menstimulasi pengeluaran air kemih melalui kegiatan seperti conditioning, pemberian cairan, stimulasi dan latihan kegel. Perawat dapat menerapkan Model Adaptasi Roy, menerapkan PMR untuk meningkatkan relaksasi serta melakukan kegiatan inovatif dalam memberikan asuhan keperawatan pada gangguan neurologi.

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Medical Surgical Nursing Practice Specialist in neurology system aims in practice by applying the role of nurses through the Roy Adaptation Model Approach. The most frequent nursing problems occured was ineffective cerebral tissue perfusion caused by ineffective behavior response on physical adaptation mode, and anxiety from psychological adaptation mode. Ineffective self-care management was the nursing problem from role function mode. Nursing intervention based on evidence based practice on Progressive Muscle Relaxation in reducing blood pressure, heart beat and anxiety. Nursing innovation in this clinical practice was the use of bladder training program to regulate sensation urgency and void according to a timetable by using many activities include conditioning, increasing fluid intake, stimulation and kegel exercise. Nurse can implement Roy’s Adaptation Theory with Progressive Muscle Relaxation (PMR) application to improve relaxation, and at the same time can execute innovation activities in delivering nursing care on neurological disorder."

"Praktek klinik dilakukan dengan memberikan asuhan keperawatan pada pasien dengan gangguan sistem persarafan menggunakan Model adaptasi Roy. Asuhan keperawatan kelolaan diberikan pada pasien dengan Meningtis-Ensefalitis Tuberculosa. Pengkajian keperawatan menunjukkan masalah pada mode adaptasi fisiologi, yaitu: ketidakefektifan perfusi jaringan serebri. Intervensi keperawatan ditujukan untuk meningkatkan adaptasi pasien dalam meningkatkan perfusi jaringan serebri. Peran sebagai peneliti dan pendidikan dilakukan dengan menerapkan Evidance Based Nursing: memberikan back massage: cooper model yang setelah pelaksanaan terbukti mampu mencegah kejadian ulkus decubitus. Peran praktikan sebagai inovator, dilakukan dengan mengaplikasikan kegiatan inovasi Bladder training pada pasien yang terpasang kateter urin. Dengan hasil evaluasi bahwa bladder training mampu meninngkatkan kemampuan berkemih pasien dan mencegah pemasangan kateter urin yang tidak perlu.

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The clinical practice is conducted by providing nursing care for patients with nervous system disorders by using Roy Adaptation Model. Nursing care focus is given to patients with meningitis-encephalitis Tuberculosa. Nursing assessment indicates a problem on the mode of adaptation physiology, which are: ineffective cerebral tissue perfusion. Nursing interventions are aimed to improve patient adaptation in increasing cerebral tissue perfusion. Role as a researcher and education is conducted by application of Evidence based nursing: giving back massage: cooper model as implementation to prevent decubitus ulcers. Practitioner role as an innovator is done by applying the Bladder training to patients with a urinary catheter inserted. With the results of the evaluation that bladder training is able to increase voiding ability of patients and prevent unnecessary use of urinary catheters."

"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."

"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 status epileptikus 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 ceredral. Penerapan EBN diagonally aligned sitting training (DAST) pada empat pasien stroke menunjukkan keefektifan DAST dalam meningkatkan keseimbangan duduk pasien fase awal pasca stroke. Program inovasi keperawatan berupa penerapan program pencegahan kejadian jatuh pada pasien neurologi di rawat inap.

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Advance clinical practice in neurological system during residency period is proposed to be able to provide nursing care, implement the evidence based nursing (EBN) and be able to act as innovator in the treatment room. The role of nurse care provider was made using Roy’s adaptation model in patients with status epilepticus and 30 other patients with various neural system disorders. The most maladaptive behavior is the physiological adaptation mode is the ineffective cerebral tissue perfusion, The nursing management intervention was cerebral edema management to improve patient adaptation in enchancing cerebral tissue perfusion. Implementation of EBN: diagonally aligned sitting training (DAST) in four patients with stroke can improve the sitting balance of the patients in the early post stroke phase. Implementation of the fall prevention program can be used for prevent the patient’s fall risk. Keywords: neurological disorder, status epilepticus, prevent risk, diagonally aligned sitting training, Roy Adaptation Model."

"Sistem persarafan manusia adalah sistem khusus yang mengontrol dan mengintegrasi bermacam aktivitas sel tubuh. Gangguan sistem saraf merupakan Global Burden of Disease (GBD) karena dapat menyebabkan kecacatan dan kematian. Praktik Residensi Keperawatan Medikal Bedah merupakan wadah untuk menerapkan peran sebagai Advanced Practice Nurse (APN) dalam memberikan asuhan keperawatan pada pasien dengan gangguan neurologi. Pada asuhan keperawatan pada Stroke iskemik dan gangguan sistem saraf dengan pendekatan Model Adaptasi Roy ditemukan masalah keperawatan akibat perilaku tidak adaptif pada mode fisiologis adalah risiko ketidakefektifan jaringan perfusi serebral, kerusakan mobilitas fisik dan padamode adaptasi psikologis adalah ansietas. Hasil penerapan Evidence Based Nursing (EBN) menunjukkan bahwa minyak lada hitam meningkatkan kemampuan menelan pasien stroke. Hasil penerapan inovasi bladder trainingdapat meningkatkan fungsi berkemih pasien dengan gangguan neurologi.

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Human nervous system is a special system that controls and integrates a variety of body function activity through electrical impulses. Neurological disorder is the Global Burden of Disease (GBD) as it can cause disability and mortality. Medical Surgical Nursing Practice Residency is a chance to apply the role of Advanced Practice Nurse (APN) to provide nursing care to patients with neurological disorders. In nursing care to Ischemic stroke and number of neurological disorder to approach Roy Adaptation Model nursing due to behavioral problems are found to be ineffective at physiological mode is the risk of cerebral perfusion ineffective tissue, impaired pyhsical mobility and the psychological adaptation mode is anxiety. The results of the application of Evidence Based Nursing (EBN) show that black pepper oil improve swallowing ability of stroke patients. The results of the application of innovation bladder training can improve voiding function of patients with neurological disorders."

"Praktik klinik lanjut di ruang neurologi untuk memberikan asuhan keperawatan pada pasien gangguan neurologi menggunakan teori keperawatan Model Adaptasi Roy, menerapkan praktik keperawatan berdasarkan pembuktian dan melakukan inovasi keperawatan. Masalah keperawatan terbanyak akibat respon perilaku inefektif pada mode adaptasi fisiologis yaitu perfusi jaringan serebral tidak efektif, mode adaptasi psikologis yaitu ansietas dan berduka, sedangkan mode fungsi peran yaitu manajemen kesehatan diri tidak efektif. Intervensi keperawatan berdasarkan pembuktian yang telah diterapkan yaitu Slow-Stoke Back Massage (SSBM) yang dapat meningkatkan relaksasi pada pasien stroke. Inovasi keperawatan yaitu penggunaan pengkajian indeks barthel untuk menegakkan diagnosa keperawatan yang berhubungan dengan ketidakmampuan fungsional. Perawat dapat menerapkan Model Adaptasi Roy, menerapkan SSBM untuk meningkatkan relaksasi serta melakukan kegiatan inovatif dalam memberikan asuhan keperawatan pada gangguan neurologi.

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Advanced clinical practice on patient with neurological system disorder using Roy's Adaptation theory is the implementation of nursing practice based on evidence and implementation of nursing innovation. The most frequent nursing problems occured was ineffective cerebral tissue perfusion caused by ineffective behavior response on physical adaptation mode, and anxiety and grieving from psychological adaptation mode. Ineffective self-care management was the nursing problem from role function mode. Nursing intervention based on evidence based practice on Slow-Stoke Back Massage (SSBM) can improve relaxation on stroke patient. Nursing innovation in this clinical practice was the use of Barthel index assessment to formulate nursing diagnosis that related with functional disability. Nurse can implement Roy’s Adaptation Theory with Slow-Stoke Back Massage (SSBM) application to improve relaxation, and at the same time can execute innovation activities in delivering nursing care on neurological disorder."

"Peran perawat spesialis neurosains dalam praktik keperawatan antara lain sebagai pemberi asuhan keperawatan lanjut, melaksanakan pembuktian ilmiah, pendidik, advokat, kolaborator, dan agen pembaharu. Asuhan keperawatan lanjut dilaksanakan pada pasien dengan kasus tumor otak dan 30 pasien gangguan neurologi menggunakan pendekatan model adaptasi Roy. Perilaku maladaptif paling banyak terganggu pada mode fisiologis dengan diagnosis ketidakefektifan perfusi jaringan serebral. Penerapan Evidence Based Nursing berupa latihan Range of Motion (ROM) pasif bilateral ekstremitas atas pada dua pasien stroke akut dengan hemiparese menunjukkan hasil peningkatan fungsi ekstremitas atas dan Activity of Daily Living (ADL). Program inovasi pengembangan media edukasi perawatan pasien kraniotomi pengangkatan tumor menunjukkan peningkatan pengetahuan pasien secara signifikan (p=0,038) dan memudahkan perawat dalam memberikan edukasi secara efektif.

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The role of nurse specialist in nursing practice consist of advanced nursing care providers, conduct scientific evidence, educator, advocat, collaborator, and change agent. Advanced nursing care is done by Roy Adaptation Models approach on brain tumor and 30 other neurological disorders patients. Maladaptive behavior at most in a physiological mode with ineffective cerebral perfusion nursing diagnosis.

Evidence Based Nursing was performed by applying bilateral passive Range of Motion (ROM) of upper extremity at two acute stroke patient with hemiplegi and it showed an increase in function of upper extremities and the activity of daily living. The innovation programme by develop an education media for caring patient with craniotomy removal tumor showed significant increase in patient knowledge (p=0,038) and help nurses to give an effective education."

"Praktik klinik lanjut di ruang neurologi untuk memberikan asuhan keperawatan pada pasien gangguan neurologi menggunakan teori keperawatan Model Adaptasi Roy, menerapkan praktik keperawatan berdasarkan pembuktian dan melakukan inovasi keperawatan. Masalah keperawatan terbanyak akibat respon perilaku inefektif pada mode adaptasi fisiologis yaitu perfusi jaringan serebral tidak efektif, dan mode fungsi peran yaitu manajemen kesehatan diri tidak efektif. Intervensi keperawatan berdasarkan pembuktian yang telah diterapkan yaitu Skrining Malnutrisi menggunakan Mini Nutrional Assesment (MNA) dan Barthel Index (BI) yang dapat mendeteksi risiko kejadian malnutrisi pada pasien gangguan neurologi yang di rawat inap, sehingga dapat mencegah malnutrisi dengan kolaborasi dengan tim gizi. Inovasi keperawatan yaitu Bladder Training dengan menggunakan chart Bladder diary untuk mencegah kejadian infeksi nosokomial dan melatih pasien gangguan neurologi agar dapat berkemih mandiri tanpa bantuan alat. Perawat dapat menerapkan Model Adaptasi Roy, menerapkan skrining malnutrisi untuk mendeteksi awal risiko kejadian malnutrisi serta melakukan kegiatan inovatif dalam memberikan asuhan keperawatan pada gangguan neurologi.

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Advanced clinical practice in neurology ward is conducted to give nursing implementation on patients with neurological system disorder by using Roy’s Adaptation theory, implementing nursing practice based on evidence and implementation of nursing innovation. The most frequent nursing problems that occurred resulted from ineffective behavior response on physical adaptation mode were ineffective cerebral tissue perfusion and role function mode, ineffective self-care management. Nursing intervention based on evidence-based practice on Malnutrition Screening by using Mini Nutritional Assesment (MNA) and Barthel Index (BI) is used to know the risk of malnutrition on patients with neurological in the ward, so we can prevent malnutrition by collaborating with the nutrition team. Nursing innovation with Bladder Training by using Bladder diary is used to prevent infection in hospital and to train patients with neurological system disorder, so that the patients can be autonomous without using any equipment. Nurses can implement Roy’s Adaptation Theory with Malnutrition Screening application to prevent malnutrition, and at the same time it can execute innovation in nursing implementation on patients with neurological system."

"Karya Ilmiah Akhir ini bertujuan untuk menjelaskan seluruh rangkaian kegiatan praktik residensi keperawatan medikal bedah dalam memberikan asuhan keperawatan pada pasien dengan berbagai macam gangguan sistem persarafan dengan pendekatan teori Adaptasi Roy, kegiatan penerapan evidence based nursing practice berupa efektifitas penggunaan Patient Health Questionnaire 9 (PHQ-9) untuk skrining depresi pada pasien post cedera kepala dan kegiatan inovasi keperawatan berupa penggunaan Barthel Indeks untuk mengkaji status fungsional pasien. Seluruh rangkaian kegiatan tersebut diharapkan dapat meningkatkan kualitas asuhan keperawatan pada pasien neurologi dimasa yang akan datang.

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The purpose of this final scientific report is to describe series of activities in clinical practice residency in medical surgical nursing in providing nursing care on patient with various neurological system disorders using Roy’s Adaptation theory. Another activities includes implementation of evidence based nursing practice on the effect of Patient Health Questionnaire 9 (PHQ-9) to screen the depression level on post head injury patients, and the innovation activity was on the use of Barthel index assessment to assess patient’s functional status. From those series activities, it is expected to improve nursing care quality on patient with neurological disorder in the future."