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"Karya ilmiah akhir ini disusun sebagai laporan dari praktik residensi spesialis keperawatan Maternitas yang berfokus pada penerapan teori keperawatan adaptasi Roy dan lost and grieving Kubler-Rose pada asuhan keperawatan ibu hamil yang mengalami intra uterine fetal death (IUFD). Tujuan penulisan laporan ini untuk memberikan gambaran pelaksanaan praktik Spesialis Keperawatan Maternitas dalam menjalankan perannya sebagai pemberi pelayanan keperawatan, edukator, konselor, advokat, pengelola, kolaborator, komunikator dan koordinator, agen perubah dan peneliti dalam memberikan asuhan keperawatan pada perempuan sepanjang periode kehidupannya dengan menerapkan teori keperawatan serta pencapaian target kompetensi. Aplikasi teori keperawatan adaptasi Roy dan lost and grieving Kubler-Rose efektif dilakukan pada lima kasus ibu hamil dengan IUFD. Aplikasi teori tersebut berhasil membantu menyelesaikan masalah keperawatan dan meningkatkan adaptasi klien.

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This final scientific report aimed to report the clinical practice of maternity nursing specialist which focus on the application of Roy?s theory of adaptation and Kubler-Rose?s theory of lost and grieving in the nursing care to clients who experience intra uterine fetal death (IUFD). The purpose of this report is to describe the implementation of maternity nursing specialist practices in their role as care giver, educator, counselor, advocate, collaborator, communicator, coordinator, innovators and researchers. The competencies also achieved through application of nursing theory in the nursing care. The application of Roy?s theory and Kubler-Rose?s theory in the nursing care was effective to resolve client?s health problem and increased the adaptation of the mother during pregnancy."

"ABSTRAKIntrauterine fetal death (IUFD) adalah janin yang mati dalam rahim dengan berat 500 gram atau lebih atau kematian janin dalam rahim pada kehamilan 20 minggu atau lebih. Terdapat beberapa faktor penyebab IUFD yaitu maternal, fetal, dan plasenta. Kematian janin akan berdampak pada fisik maupun psikologis ibu sehingga dapat memengaruhi adaptasi mereka terhadap lingkungan. Teori adaptasi Roy dan Loss and Grieving Kubler  Ross  mengkaji  dan  menganalisa secara mendalam respon seseorang dalam beradaptasi terhadap perubahan serta membantu seseorang dalam mencapai adpatasinya baik secara fisiologis maupun psikologis. Penerapan teori  adaptasi Roy dan Kubler  Ross  dalam lima  kasus ini ditemukan masalah keperawatan berkaitan dengan fisik dan psikologis. Diagnosa yang muncul pada ibu post partum dengan IUFD sesuai dengan literatur diantara nya gangguan rasa nyaman nyeri, berduka dan kehilangan, gangguan istirahat dan tidur, defisit nutrisi, inefektif menyusui, resiko infeksi, gangguan keseimbangan volume cairan. Hasil intervensi yang dilakukan berdasarkan prinsip adaptasi Roy dan Loss and Grieving Klubler Ross pada kelima kasus menunjukkan bahwa aplikasi teori tersebut berhasil membantu menyelesaikan masalah keperawatan dan meningkatkan adaptasi dan mekanisme koping klien.

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ABSTRACTIntrauterine fetal death (IUFD) is a dead fetus in the womb with the weight 500 grams or more or death of the fetus in the womb at 20 weeks or more. There are several factors causing IUFD that is maternal, fetal, and placenta. Fetal death will have an impact on the physical and psychological mothers so as to influence their adaptation to the environment. Roy and Loss and Grieving's adaptation theory Kubler Ross examines and analyzes in depth a person's response to adaptation to change and helps one achieve his or her adaptation both physiologically and psychologically. The application of the theory of adaptation Roy and Kubler Ross in these five cases found nursing problems related to physical and psychological. Diagnosis that occurs in the post-partum mother with IUFD in accordance with the literature between the discomfort of pain,loss and grieving, rest and sleep disorders, nutritional deficits, inefective breastfeeding, infection risk, disturbance of fluid volume balance. The results of the intervention based on Roy's adaptation principle and Loss and Grieving Klubler Ross in the five cases indicate that the application of the theory successfully helped solve nursing problems and improve client's coping and adaptation mechanisms.

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"Salah satu tujuan dari MDGs adalah menurunkan angka kematian ibu dan bayi. Upaya penurunan angka kematian ibu dan bayi di Indonesia belum memuaskan, target Indonesia menurunkan angka kematian ibu 102 per 100.000 kelahiran hidup pada tahun 2015. Peran ners spesialis keperawatan maternitas sebagai praktisi keperawatan, pendidik, konselor, advokat, pengelola, koordinator, kolaborator, peneliti dan agen pembaharu sangat diperlukan untuk menurunkan angka kematian ibu dan bayi. Tujuan umum pembuatan laporan akhir praktik residensi adalah untuk memberikan gambaran pelaksanaan kegiatan praktik residensi dengan fokus penerapan model keperawatan Need for Help Wiedenbach dan Self Care Orem pada asuhan keperawatan ibu hamil dengan kontraksi dini. Aplikasi teori keperawatan Need for Help Wiedenbach dan Self Care Orem efektif dilakukan pada lima ibu hamil dengan kontraksi dini. Integrasi model keperawatan Need for Help Wiedenbach diterapkan pada fase akut. Sedangkan pada fase pemeliharaan dilakukan asuhan keperawatan dengan Self Care Orem. Aplikasi teori tersebut berhasil membantu menyelesaikan masalah keperawatan dan menghentikan kontraksi uterus sampai usia kehamilan aterm. Setelah melaksanakan praktik residensi spesialis keperawatan maternitas, penulis mampu mencapai target kompetensi dengan baik.

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One of the MDGs goals is to lower maternal and infant mortality rate. Efforts to lessen maternal and infant mortality rate in Indonesia are unsatisfactory. Indonesia's target is to reduce maternal mortality to 102 per 100,000 live births in 2015. Roles of maternity nursing specialist nurses as care givers, educators, counselors, advocates, coordinators, managers, collaborators, researchers and change agents are needed to lower maternal and infant mortality rate.

The goal of the residency practice final report is to provide an overview of the implementation of residency practice focused on Wiedenbach Need for Help and Orem Self Care Nursing Model on nursing care of pregnant women with early contractions.

The application of Wiedenbach Need for Help and Orem Self Care nursing theory was effectively done to five pregnant women with early contractions. The integration of Wiedenbach Need for Help nursing model was applied in the acute phase. While in the maintenance phase, Orem Self Care nursing care was performed. The application of the theory was successfully help to solve nursing problems and to stop the uterine contractions until term gestation. After performing the maternity nursing specialist residency practice, the author was able to achieve the competency targets well."

"Program MDGs mempuyai tujuan untuk meningkatkan kesehatan ibu dengan menurunkan angka kematian ibu (AKI) dan meningkatkan kesehatan reproduksi untuk perempuan pada tahun 2015. Oleh sebab itu pemerintah membuat berbagai program untuk mencapai tujuan MDGs tersebut. Persalinan dengan tindakan seksio sesarea dan tubektomi merupakan upaya tindakan untuk menyelamatkan kondisi ibu dan bayinya yang mengalami resiko, yang tidak bisa melahirkan dengan cara pervaginam. Kelahiran dengan seksio sesarea dapat beresiko terjadinya komplikasi 25 kali lebih besar dibanding persalinan pervaginam dan juga tindakan tubektomi dapat menimbulkan masalah psikososial pada ibu. Peran ners spesialis keperawatan maternitas sebagai pemberi perawatan, pendidik, konselor, koordinator, komunikator, advokat, agen perubahan dan peneliti sangat diperlukan untuk mengurangi terjadinya komplikasi akibat efek pembedahan seksio sesarea pasca partum dan melaksanakan perannya pada pelayanan keperawatan maternitas untuk membantu menurunkan AKI. Tujuan umum dari penulisan ini adalah memberikan gambaran kegiatan pelaksanaan praktek residensi Ners Spesialis Keperawatan Maternitas fokus pada kasus ibu postpartum seksio sesarea dan tubektomi dengan penerapan teori selfcare dan teori comfort. Aplikasi teori tersebut berhasil membantu permasalahan yang dialami pasien secara biopsikososial. Pelaksanaan praktek residensi spesialis keperawatan maternitas telah dilakukan sesuai kompetensi, sehingga mampu mencapai target kompetensi dengan baik.

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Program MDGs is to goals increase maternal health by reducing maternal mortality rate (MMR) and increase to reproductive health for women in 2015. Therefore government made programs to target The goals MDGs. Delivery by cesarean section and tubectomy are the attempts to save the state of the mother, who are in risk condition and cannot give vaginal delivery and the risky baby. Births by cesarean section can cause risk complications at 25 times than vaginal delivery, in the other hand tubectomy may cause psychosocial problem.

The role of maternity nursing specialist nurse as caregiver, educator, counselor, coordinator, communicator, advocate, the agent of change and researcher is needed to reduce the occurrence of complications due to the effects of postpartum cesarean surgery and do its role in maternity nursing services to contribute on reducing the MMR.

The purpose of this study was to depict the implementation of the nurses? residency practice of Maternity Nursing Specialist nurse which focuses on the case of Caesarean section and maternal postpartum tubectomy selfcare with the application of theory and the theory of comfort. The application of the theory succeeds in helping the problems experienced by the patient bio-psychosocially. Doing the practice of residency maternity nursing specialists have done appropriate competencies, so that able to achieve the competencies very well."

"Intra Uterine Fetal Death (IUFD) merupakan peristiwa kehilangan yang dapat memengaruhi kondisi emosional ibu secara signifikan, yang berpengaruh terhadap status kesehatan secara keseluruhan, sehingga dibutuhan asuhan keperawatan untuk mencapai kesehatan dan kesejahteraan ibu baik fisik, psikologis, sosiokultural dan spiritualnya. Karya ilmiah akhir spesialis ini membahas penerapan teori Health Care System dan Loss and Grieving pada ibu yang mengalami Intra Uterine Fetal Death (IUFD) pada kehamilan yang diharapkan, serta penerapan Evidence Based Nursing Practice yaitu Mindfulness-Based Spiritual Therapy sebagai salah satu alternatif intervensi yang dapat digunakan untuk meningkatkan garis pertahan ibu dan memfasilitasi pemulihan emosional dan spiritual ibu. Penelitian ini merupakan clinical case report pada 5 orang ibu yang mengalami IUFD di dua rumah sakit yang berbeda. Hasil studi didapatkan bahwa teori Health Care System dan Loss and Grieving dapat diintegrasikan untuk membantu memahami pengalaman ibu dan memberikan perawatan yang sesuai. Melalui terapi psikologis dan dukungan emosional yang adekuat, ibu dapat mengatasi kesedihan dan trauma yang terkait dengan kehilangan, dan melalui proses berduka dengan adaptif.

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Intra Uterine Fetal Death (IUFD) is a loss event that can significantly affect the mother's emotional well-being, which in turn influences her overall health status. Therefore, nursing care is needed to achieve the physical, psychological, sociocultural, and spiritual health and well-being of the mother. This paper discusses the application of the Health Care System and Loss and Grieving theories in mothers experiencing Intra Uterine Fetal Death (IUFD) during expected pregnancies, as well as the implementation of Evidence- Based Nursing Practice, namely Mindfulness-Based Spiritual Therapy, as one of the alternative interventions that can be used to enhance maternal coping and facilitate emotional and spiritual recovery.

This study is a clinical case report of five mothers who experienced IUFD in two different hospitals. The study's findings revealed that the Health Care System and Loss and Grieving theories can be integrated to help understand mothers' experiences and provide appropriate care. Through psychological therapy and adequate emotional support, mothers can cope with the grief and trauma related to the loss and proceed with adaptive grieving."

"Kemampuan dalam bidang pengetahuan, ketrampilan dan sikap harus dimiliki oleh seorang perawat spesialis keperawatan maternitas. Kemampuan ini diperlukan supaya seorang perawat spesialis keperawatan maternitas dapat memberikan pelayanan kepada masyarakat baik secara mandiri maupun berkolaborasi. Seorang perawat spesialis keperawatan maternitas dalam memberikan pelayanan kepada masyarakat berperan sebagai seorang pelaksana, pendidik, konsultan, advokat, pengelola asuhan keperawatan maternitas, peneliti, kolaborator, komunikator dan koordinator, serta pembaharu dalam bidang keperawatan maternitas. Laporan ini menguraikan kegiatan pencapaian kompetensi selama praktek residensi dengan fokus penerapan teori keperawatan "Need for Help" dan Loss & Grief pada ibu intra partum dengan kematian janin. Kompetensi yang diharapkan dapat tercapai selama praktek dan teori keperawatan "Need for Help" dan Loss & Grief dapat diterapkan pada penanganan kasus intra partum dengan intra uterine fetal death.

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A maternal nursing specialist must be well knowledgeable, possess good relevant skills and attitudes to be able to provide good health service to the society both independently and through collaboration. A maternal nursing specialist play an important role as a health practitioner, an educator, a consultant, an advocate, a communicator, an administrator in maternal nursing care, a researcher, a collaborator, a communicator and coordinator, and a reformer in maternal nursing. This report ellaborates the activities in attempts to achieve the intended competence during the resident practice, focused on the application of nursing theories '' Need for Help'' and '' Losss and Grief'' on mothers with intra partum and fetal death. This expected competence can be put into practice in handling a case of intra partum with intra urine fetal death."

"[ABSTRAKKesehatan reproduksi merupakan masalah yang perlu diperhatikan dalam meningkatkan kesehatan perempuan. Ners spesialis keperawatan maternitas mempunyai peranan untuk mencapai upaya tersebut. laporan ini bertujuan menggambarkan praktik residensi ners spesialis keperawatan maternitas meliputi asuhan keperawatan pada masa prenatal, intranatal, dan post natal serta masalah reproduksi perempuan. Residen juga melakukan asuhan keperawatan dengan fokus penerapan model konsep need for help Wiedenbach dan Lost and grief Kubler Ross pada ibu bersalin dengan IUFD. masalah keperawatan yang mungkin muncul diakitkan dengan tahapan persalinan yang dibutuhkan klien. perbedaan yang terjadi pada klien berkaitan dengan psikologisnya yaitu dapat beradaptasi dengan cepat dan mengalami tahap penerimaan lebih cepat, dan ada yang proses penerimaannya membutuhkan waktu yang lama dan mengalami tahap tawar menawar serta penolakan yang lebih lama. selama praktik residensi ini kompetensi yang tercapai menjadikan pengalaman yang berarti dalam peningkatan keterampilan residen maternitas.

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ABSTRACTReproductive health is an issue that needs to be consideredto improve women's health. maternity nursing specialist has a role to achieve this goal. this report aimed to describe the residency practice of maternity nursing specialist, including prenatal, intranatal, and post natal nursing care and female reproductive problems. resident also performed nursing care focussed on the aplication of wiedenbach need for help and kubler ross lost and grief conceptual model on intrapartum mother with IUFD. nursing problems that arose were associated with the stages of labor complained of by the client. the diffrencess that occur on the clients were related to their psycological condition, some clients were able to adapt quickly and experience a faster acceptance stage, while some clients look a long process of acceptance and experiened a longer bargaining and refusal phase. during this residency practice the achieved competencies become a mainingful expeience in improving the skills of maternity resident., Reproductive health is an issue that needs to be consideredto improve women's health. maternity nursing specialist has a role to achieve this goal. this report aimed to describe the residency practice of maternity nursing specialist, including prenatal, intranatal, and post natal nursing care and female reproductive problems. resident also performed nursing care focussed on the aplication of wiedenbach need for help and kubler ross lost and grief conceptual model on intrapartum mother with IUFD. nursing problems that arose were associated with the stages of labor complained of by the client. the diffrencess that occur on the clients were related to their psycological condition, some clients were able to adapt quickly and experience a faster acceptance stage, while some clients look a long process of acceptance and experiened a longer bargaining and refusal phase. during this residency practice the achieved competencies become a mainingful expeience in improving the skills of maternity resident.]"

"Anak yang mengalami penyakit ginjal kronis (PGK) dapat mengalami gangguan ketidakseimbangan cairan. Karya ilmiah akhir ini bertujuan untuk memberikan gambaran aplikasi Model Adaptasi Roy (MAR) dalam memberikan asuhan keperawatan pada anak penyakit ginjal kronis yang mengalami ketidakseimbangan cairan. Teori Roy mengkonseptualisasikan proses keperawatan menjadi enam langkah yaitu pengkajian perilaku, pengkajian stimulus, diagnosis keperawatan, penetapan tujuan, intervensi, dan evaluasi. Metode karya ilmiah ini adalah studi kasus yang terdiri atas lima kasus anak PGK yang menjalani hemodialisis yang diberikan asuhan keperawatan dengan pendekatan Model Adaptasi Roy. Berdasarkan hasil pengkajian pala lima anak masalah yang muncul yaitu ketidakseimbangan cairan, selain itu masalah lainya seperti gangguan tumbuh kembang, penampilan peran tidak efektif, risiko penurunan curah jantung, risiko perdarahan, risiko infeksi, defisit pengetahuan. Intervensi keperawatan yang diberikan pada masalah ketidakseimbangan cairan yaitu menimbang berat badan pra HD, mengkaji berat badan kering, berat badan sebelumnya, melakukan perawatan akses kateter dan memberikan edukasi tentang edukasi kebutuhan gizi, cairan dan perawatan akses menggunakan video. Kesimpulan aplikasi teori Roy dapat diterapkan pada anak penyakit ginjal kronis dengan masalah ketidaseimbangan cairan.

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Children with chronic kidney disease (CKD) can experience imbalance disorders. Fluid restriction is one of the nursing interventions to overcome fluid balance disorders. This final scientific work aims to provide an overview of the application of the Roy Adaptation Model (MAR) in providing nursing care to children with chronic kidney disease who experience fluid imbalance. Roy's theory conceptualizes the nursing process into six steps, namely behavioral assessment, stimulus assessment, nursing diagnosis, goal setting, intervention, evaluation. Provides an overview of the application of nursing care to children with chronic kidney disease who experience fluid imbalance in the dialysis unit using the Roy Adaptation Model approach. The method of this scientific work is a case study consisting of five cases of CKD children undergoing hemodialysis who were given nursing care using the Roy Adaptation Model approach. The nursing intervention provided based on evidence-based practice is providing education about nutritional needs, fluids and access care using videos. Implementing a quality improvement project by providing effective education increases the knowledge of caregivers of children with chronic kidney disease undergoing hemolysis. The conclusion is that the application of Roy's theory can be applied to children with chronic kidney disease who have fluid imbalance problems."