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"Anak dengan penyakit kronik sering mengalami gangguan rasa nyaman akibat perjalanan penyakit, pemeriksaan diagnostik dan proses pengobatan, sehingga membutuhkan asuhan keperawatan yang tepat. Karya Ilmiah Akhir ini disusun dengan tujuan untuk menggambarkan aplikasi Theory of Unpleasant Symptoms (TOUS) pada anak dengan penyakit kronik yang mengalami gangguan rasa nyaman serta menganalisis keefektifannya. TOUS memiliki tiga komponen yaitu gejala, faktor yang mempengaruhi dan performance akhir klien. Ketiganya dapat saling mempengaruhi dan dapat diintegrasikan dalam asuhan keperawatan anak. TOUS dapat diaplikasikan pada asuhan keperawatan anak penyakit kronik dengan gangguan rasa nyaman karena melalui manajemen gejala berbasis TOUS, kebutuhan rasa nyaman anak akan terpenuhi meski gejala tak menyenangkan masih muncul. Aplikasi TOUS pada asuhan keperawatan anak hendaknya memperhatikan aspek tumbuh kembang dan aspek psikologis anak. Saat mengaplikasikan konsep TOUS, Ners spesialis telah dapat melakukan berbagai peran diantaranya sebagai praktisi, edukator, kolaborator, peneliti serta advokat bagi klien dan keluarga.

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Chronically ill children often experience uncomfortable issue due to the disease pathophysiology, the diagnostic examination and medication process, so the child needs proper nursing care. This Scientific Final Assignment was arranged to describe the application of Theory of Unpleasant Symptoms (TOUS) to chronically ill children who have uncomfortable issues and also to analyze its effectiveness. TOUS has three main components which are symptoms, influencing factors and performance outcomes. Those three components influence each other and can be integrated in pediatric nursing process. TOUS can be applied in chronically ill children nursing process especially child with uncomfortable issue because through symptoms management based on TOUS, the comfort need of children can be fulfilled even the unpleasant symptoms still occur. The application of TOUS should pay attention to growth and development aspects of the children and also to the psychological aspect. When the specialist pediatric nurse applied TOUS concept, the nurse has done many role such as nurse practitioner, educator, collaborator, researcher and advocate for client and the family. "

"Kunjungan anak-anak yang memiliki berbagai keluhan kesehatan serius ke rumah sakit, seringkali tidak tertolong pada 24 jam pertama, dan menyebabkan kematian. Faktor potensial yang dapat mengakibatkan tingginya angka kematian anak yaitu keterlambatan atau kegagalan, dalam mengidentifikasi gejala anak yang mengalami kegawatdaruratan. Kegawatdaruratan pada anak didefinisikan sebagai sebuah kondisi yang mengancam kesehatan anak karena suatu penyakit atau cedera parah, serta dapat menyebabkan kerusakan permanen. Masalah kegawatdaruratan pada anak salah satunya dapat berkaitan dengan kasus hematologi. Gejala yang ditimbulkan dari permasalahan kegawatdaruratan hematologi sangat beragam. Perawat memainkan peran penting dalam mengidentifikasi, memantau, dan memanajemen keluhan dan gejala anak secara spesifik. Theory of Unpleasant Symptoms (TOUS), telah dikembangkan untuk meningkatkan pemahaman tentang gejala yang dialami oleh pasien. Pengaplikasian TOUS pada pelaksanaan asuhan keperawatan anak dengan kondisi gawat darurat, khususnya kasus hematologi, layak untuk ditelaah.

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Visits of children with serious health complaints to the hospital are often not helped in the first 24 hours and cause death. Potential factors that can lead to high child mortality rates are delays or failures in identifying the symptoms of children who are experiencing an emergency. An emergency in a child is defined as a condition that threatens a child's health due to a severe illness or injury and can cause permanent damage. One of the emergency problems in children can be related to hematological cases. The symptoms caused by emergency hematology problems are very diverse. Nurses are essential in identifying, monitoring, and managing the child's complaints and symptoms. The Theory of Unpleasant Symptoms (TOUS) has been developed to improve understanding of the symptoms experienced by patients. The application of TOUS in implementing pediatric nursing care with emergency conditions, especially hematological cases, deserves to be studied."

"Periode postpartum merupakan periode kritis pada kesehatan maternal. Peningkatan prevalensi persalinan gemelli menjadi tantangan tersendiri bagi perawat maternitas untuk memberikan asuhan yang paripurna. Studi kasus dilakukan dengan fokus penerapan teori Self Care dan Unpleasant Symptoms (TOUS) pada asuhan keperawatan ibu postpartum dengan gemelli. Aplikasi teori difokuskan pada kelima kasus yang berfokus pada pengkajian gejala ketidaknyamanan dan kemampuan perawatan diri ibu postpartum dengan gemelli. Intervensi keperawatan yang optimal dan sesuai dapat membantu klien mencapai kemandirian dalam perawatan diri sendiri dan pencapaian kenyamanan pada periode postpartum. Ibu postpartum dengan gemelli harus memiliki self dan time management yang baik agar perawatan postpartum menjadi optimal.

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Postpartum period is a critical period of maternal health. Inreasing prevalence of twin delivery is a challenge for maternity nurse to serve holistic care. Case study is applied with focus on the application of Self Care theory and Theory of Unpleasant Symptoms (TOUS) on nursing care in postpartum women with twin. The application of Self Care and TOUS effectively applied to five cases that focused on identification unpleasant symptoms and self care ability of postpartum women with twin. Optimum and appropriate interventions could help client to receive self care independently and feel comfort during postpartum period. Postpartum mother with twin should have appropriate self and time management so that optimum postpartum self care will be reached."

"Karya Ilmiah Akhir ini memberikan gambaran tentang pelaksanaan Program Residensi Ners Spesialis Keperawatan Anak dalam bentuk kegiatan praktik residensi 1 dan 2. Karya Ilmiah Akhir ini bertujuan untuk memberikan gambaran aplikasi teori keperawatan “Comfort Theory” dari Katharine Kolcaba pada asuhan keperawatan anak dengan stoma dan pencapaian kompetensi baik sebagai pemberi asuhan, advocator, conselor, educator, colaborator, dan change agent selama praktik residensi. Salah satu komplikasi yang dapat terjadi pada anak dengan stoma adalah adanya kerusakan kulit peristoma. Masalah integritas kulit merupakan masalah keperawatan yang sering dijumpai pada anak dengan stoma sebagai akibat dari adanya kontak kulit dengan feses. Masalah integritas kulit dapat bersifat aktual maupun risiko seperti yang ditemukan pada lima kasus kelolaan. Tiga kategori intervensi keperawatan berdasarkan comfort theory telah diberikan untuk mengatasi masalah integritas kulit. Hasil evaluasi pada akhir perawatan menunjukkan bahwa tidak semua masalah integritas kulit ini dapat teratasi. Masih dibutuhkan banyak dukungan agar intervensi keperawatan dapat dilaksanakan secara optimal guna mencegah dan mengatasi masalah integritas kulit pada anak dengan stoma agar kebutuhan klien akan kenyamanan terpenuhi.

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Final assignment provides an overview about the implementation of the Residency Specialist Pediatric Ners Program in the form of practical activities residency 1 and 2. The aims from this final assignment is to provide an overview the application of nursing theory "Comfort Theory" Katharine Kolcaba on nursing care of children with a stoma and the achievement of competence well as caregivers, advocator, counselor, educator, colaborator, and change agent during practice residency. One of the stoma complications is periostomal skin damage that can occur among pediatric patients. The skin integrity is a common problem in children with a stoma as a result of stool contamination. Skin integrity problems can be actual or risk such as those found in five cases managed. Three categories of nursing interventions based on comfort theory has been given to solve the skin integrity problems. There are five pediatric patients with stoma were included in this study. The result of the study showed that not all of the skin integrity problems could be solved. In order to prevent and overcome of the skin integrity problem in children with stoma, a good quality and supports of the nursing interventions are needed that affects in fulfill of comfort needs."

"Gangguan rasa nyaman adalah perasaan kurang senang, lega dan sempurna dalam dimensi fisik, psikospiritual, lingkungan dan sosial. Perawat perlu menggunakan beberapa metode dalam mengurangi ketidaknyamanan anak saat di rumah sakit agar tidak memberikan dampak negatif dan trauma dimasa yang akan datang. Tujuan karya tulis ilmiah ini adalah untuk menganalisis penerapan Teori Comfort Kolcaba dalam proses asuhan keperawatan pada anak dengan masalah gangguan rasa nayaman. Metode karya ilmiah ini adalah studi kasus. Terdapat lima kasus anak di ruang IGD anak zona kuning yang diberikan asuhan keperawatan dengan pendekatan Teori Comfort Kolcaba. Aplikasi Comfort Kolcaba membagi tingkat kenyamanan dalam empat konteks yaitu kenyamanan fisik, psikospiritual, lingkungan dan sosiokultural. Intervensi keperawatan yang dilakukan adalah berdasarkan pendekatan berbasis bukti seperti distraksi, modifikasi lingkungan dan keterlibatan keluarga untuk meningkatkan kenyamanan anak. Penggunaan skerem bermotif kartun terbukti kurang efektif dalam menurunkan kecemasan anak saat dilakukan prosedur penusukan vena.

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Comfort disorders is feeling less happy, relieved, and perfect in physical, psychospiritual, environmental, and social dimensions. Nurses need to use several ways to reduce the child's discomfort while in hospital so that it does not have a negative impact and trauma in the future. The purpose of scientific writing is to analyze the application of Kolcaba's Comfort Theory in the nursing care process for children with comfort problems. The method of this scientific work is a case study. There are five cases of children in the yellow zone children's ER who were given nursing care with the Kolcaba Comfort Theory approach. The Comfort Kolcaba application divides the comfort level into four contexts: physical comfort, psychospiritual, environmental, and socio-cultural. Nursing interventions that are carried out are based on evidence-based approaches such as distraction, environmental modification, and family involvement to increase child comfort. The use of cartoon-patterned series proved to be less effective in reducing children's anxiety during the venipuncture procedure."

"Karya Ilmiah Akhir ini memberikan gambaran tentang pelaksanaan Program Residensi Ners Spesialis Keperawatan Anak dalam bentuk kegiatan praktik Residensi I dan II. Karya Ilmiah Akhir ini bertujuan untuk memberikan gambaran aplikasi Model Konservasi Myra E. Levine pada asuhan keperawatan anak dengan penyakit infeksi dan pencapaian kompetensi baik sebagai pemberi asuhan, advocator, conselor, educator, colaborator, dan agen perubah selama praktik residensi. Ada lima kasus kelolaan yang menjadi pembahasan dalam karya ilmiah ini, dan dari kelima kasus terpilih ditemukan adanya masalah ketidakseimbangan nutrisi kurang dari kebutuhan. Intervensi yang diberikan berdasarkan pinsip-prinsip konservasi sudah mencakup semua masalah yang ditemukan pada klien, walaupun tidak semua masalah dapat terselesaikan Hasil evaluasi pada akhir perawatan dari trophicognosis ketidakseimbangan nutrisi kurang dari kebutuhan pada kelima kasus terpilih, menunjukkan ada yang teratasi, belum teratasi tetapi sudah menunjukkan perbaikan, dan ada juga yang belum teratasi.

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This final assignment provides an overview about the implementation residency practices of the specialist pediatric nurse program in the form practical activities residency I and II. The aim of this final assignment is provide overview application Conservation Model Myra E. Levine on nursing care of children with infectious diseases and the achievement of competencies such as a caregiver advocator, counselor, educator, collaborator, and change agents during practice. There are five cases that discussed in this final assignment, and of the five selected cases found a problem with imbalance nutrition less than demand. Interventions provided by conservation principles have covered all the problems found on the client, although not all problems can be resolved. The evaluation results of trophicognosis imbalance nutrition less than the needs of the five selected cases, indicating there are resolved, not resolved but has shown improvement, and there are also unresolved."

"Karya Ilmiah Akhir ini memberikan gambaran tentang pelaksanaan Program Residensi Ners Spesialis Keperawatan Anak dalam bentuk kegiatan praktik Residensi I dan II. Karya Ilmiah Akhir ini bertujuan untuk memberikan gambaran aplikasi Model Konservasi Myra E. Levine pada asuhan keperawatan anak dengan penyakit infeksi dan pencapaian kompetensi baik sebagai pemberi asuhan, advocator, conselor, educator, colaborator, dan agen perubah selama praktik residensi. Menurut model konservasi Levin, trophicognosis peningkatan suhu tubuh (demam) merupakan gangguan pada integritas struktur. Intervensi keperwatan dilakukan untuk mengkonservasi integritas struktur tersebut, yang berdampak pada konservasi energi, integritas personal dan integritas sosial. Pada kondisi demam intervensi yang dilakukan adalah mempertahankan agar lingkungan tetap nyaman dan sejuk, mengurangi aktivitas yang melelahkan, meningkatkan istirahat, memberikan asupan nutrisi yang adekuat. Konsep lain yang diterapkan dalam asuhan keperawatan dengan demam ini adalah konsep family centered care (FCC), kemudian melaksanakan ners spesialis sebagai inovator, residen melaksanakan proyek inovasi berupa pembuatan format dischar planning dan optimalisasi ruang bermain.

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This final assignment provides an overview about the implementation residency practices of the specialist pediatric nurse program in the form practical activities residency I and II. The aim of this final assignment is provide overview application Conservation Model Myra E. Levine on nursing care of children with infectious diseases and the achievement of competencies such as a caregiver advocator, counselor, educator, collaborator, and change agents during practice residency. According to Levin conservation models, trophicognosis increase in body temperature (fever) is an interference with the integrity of the structure. Nursing interventions undertaken to conserve the integrity of these structures, which have an impact on energy conservation, personal integrity and social integrity. In the intervention condition of fever is to preserve the environment in order to stay comfortable and cool, reducing the exhausting activity, increased rest, providing adequate nutrition. Another concept that is applied in nursing care with a fever is the concept of family centered care (FCC), then carry out specialist nurses as an innovator, a resident carrying out innovation projects making planning and optimization dischar format playroom."

"Kehamilan postterm adalah usia kehamilan yang memanjang sampai 42 minggu atau lebih yang dapat disebabkan oleh berbagai faktor seperti hormonal dan genetik. Meskipun angka kejadian kehamilan postterm sedikit, namun kehamilan postterm dapat memberikan dampak yang besar tehadap ibu dan janin. Oleh karena itu, penanganan kehamilan postterm dengan mengaplikasikan pendekatan yang efektif seperti Teori Model Keperawatan Need for Help sangat diperlukan dalam melakukan pengkajian, observasi dan tindakan yang cepat dan tepat selama proses persalinan. Selain itu, Theory of Unpleasant Symptoms dapat juga diaplikasikan untuk membantu mengurangi gejala-gejala ketidaknyaman dari segala aspek baik aspek fisik, psikologis, dan situasional selama proses persalinan. Kelima kasus kelolaan mengalami gejala-gejala ketidaknyaman yang saling mempengaruhi setiap gejala dan membutuhkan penanganan segera. Setelah dilakukan terminasi kehamilan melalui induksi persalinan, ditemukan hasil yang berbeda di setiap kasus. Kasus dua sampai lima setelah diinduksi maka dapat melalui persalinan secara pervaginam sedangkan kasus satu berakhir dengan tindakan seksio sesaria karena terjadi gawat janin. Peran perawat khususnya perawat spesialis maternitas sangat diperlukan pada masa terminasi kehamilan tersebut dalam memberikan asuhan keperawatan untuk mengatasi masalah pada ibu dengan dengan kehamilan postterm.

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Post-term pregnancy is a prolonged pregnancy period till 42 weeks or more that can be caused by varied factors such as hormonal and genetic. Although the incident rate is considerably small, it can bring negative impacts to mother and her baby. Thus, it is important to manage the post-term pregnancy by applying effective approaches such as Need for Help Nursing Theory to ensure rapid and precise assessment, observation and immediate intervention carried out during delivery process. In addition, The Theory of Unpleasant Symptoms can also be applied to minimize unpleasant symptoms either physically or psychologically and situational discomfort during the labor. The five study cases revealed that the mothers experienced unpleasant symptoms that affected each other and required immediate treatment. After termination with labor induction were conducted, different results were found among the cases. Case two to five after be indiuced, they gave birth trough vaginal birth, whil case one ended with caesarean section because of fetal distress. Nurse role especially maternity nursing specialist is imperative during the gravidity termination period in performing nursing care to overcome problems experienced by mother with post-term pregnancy."

"Kanker merupakan penyakit degeneratif yang dapat diderita oleh orang dewasa dan anak-anak dengan angka kejadian cukup tinggi di dunia. Sebanyak 50 anak dengan kanker mengalami gangguan dalam melaksanakan aktivitas perawatan diri sebagai akibat dari kanker tersebut maupun efek samping dari terapi kanker. Tujuan dari pembuatan karya ilmiah akhir ini adalah untuk memberikan gambaran mengenai aplikasi teori self-care Orem pada klien anak dengan kanker yang mengalami defisit perawatan diri: perawatan mulut di RSUPN Dr Cipto Mangunkusumo Jakarta. Selain itu, karya ilmiah akhir ini juga bertujuan untuk memberikan gambaran mengenai peran perawat spesialis anak di ruang rawat anak non infeksi. Terdapat lima kasus kelolaan yang dibahas dalam karya ilmiah ini yang semuanya memiliki masalah defisit perawatan diri: perawatan mulut. Asuhan keperawatan diberikan menggunakan pendekatan teori self-care Orem mulai dari pengkajian sampai dengan evaluasi. Hasil evaluasi menunjukkan ada klien yang dapat lebih mandiri dalam melakukan higiene oral namun ada pula yang tidak berhasil. Penulis merekomendasikan untuk memperhatikan usia dan tahap tumbuh kembang klien yang akan diberikan intervensi dengan aplikasi teori self-care karena hal tersebut berpengaruh terhadap keberhasilan intervensi.

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Cancer is a degenerative illness suffered by adults and children with high incidence in the world. Around 50 children with cancer are having difficulties in performing daily activities as a result of cancer itself or side effect of cancer therapy. This final report is a description of Internship Pediatric Nursing Program clinical practice. The aim of this final report is to give a brief description about the application of Orem rsquo s self care theory on children with cancer performing self care deficit oral hygiene thus giving description about the role of pediatric nurse in non infection children ward. There are five cases of children who are performing self care deficit oral hygiene explained here. Nursing care was performed using self care theory approach from assessment to evaluation. The result is that there are children who finally able to do oral hygiene independently, but there are also children who can not do oral hygiene independently. The recommendation of this report is that the children must be selected based on their age and developmental stage because those two factors contribute to the success of intervention."

"ABSTRAK Dehidrasi dapat menyebabkan terjadinya hipovolemia, kegagalan organ, danbahkan berakhir dengan kematian. Asuhan keperawatan yang berkualitas sangatdiperlukan dalam mengatasi masalah gangguan cairan pada anak. Karya ilmiahakhir ini bertujuan untuk memberikan gambaran aplikasi Model KonservasiMyra E. Levine dalam memberikan asuhan keperawatan pada anak dengan kankeryang mengalami ketidakseimbangan cairan. Intervensi berdasarkan modelkonservasi Levine yaitu mengkaji tanda-tanda dehidrasi, memantau adanyamuntah, diare dan demam, mengukur tanda-tanda vital, mengukur intake outputcairan dan melakukan analisis terhadap balance cairan. Evaluasi setelahdilakukan intervensi keperawatan pada kasus 1, 2, dan 3 masalah risikokekurangan volume cairan tubuh tidak terjadi, sedangkan pada kasus 4 sampaidengan 5, masalah ketidakseimbangan cairan teratasi. Rekomendasi karya ilmiahini adalah dalam memberikan asuhan keperawatan pada anak dengan kasushemato-onkologi yang mengalami ketidakseimbangan cairan kepada pasien dapatmenerapkan teori keperawatan model konservasi Myra E. Levine.ABSTRACT Dehydration can lead to hypovolemia, organ failure, and even death. Qualitynursing care is of high importance in addressing the problem of fluid imbalancein children. This paper aimed to describe the application of Levine?sConservation Model in providing nursing care to children with cancer whoexperience fluid imbalance. Based on this model, the interventions includereviewing signs of dehydration, monitoring vomiting, diarrhea, and fever,measuring vital signs, measuring the fluid intake and output and analyzing thefluid balance. After the nursing intervention, the problem of risk of body fluidvolume deficiency did not occur in cases number 1, 2, and 3; while in the casesnumber 4 and 5 in which fluid imbalance already happened, this imbalanceproblem was resolved. It can be concluded that Levine?s model is an effectiveapproach to manage the fluid imbalance problem in children with hematooncologycases.;Dehydration can lead to hypovolemia, organ failure, and even death. Qualitynursing care is of high importance in addressing the problem of fluid imbalancein children. This paper aimed to describe the application of Levine?sConservation Model in providing nursing care to children with cancer whoexperience fluid imbalance. Based on this model, the interventions includereviewing signs of dehydration, monitoring vomiting, diarrhea, and fever,measuring vital signs, measuring the fluid intake and output and analyzing thefluid balance. After the nursing intervention, the problem of risk of body fluidvolume deficiency did not occur in cases number 1, 2, and 3; while in the casesnumber 4 and 5 in which fluid imbalance already happened, this imbalanceproblem was resolved. It can be concluded that Levine?s model is an effectiveapproach to manage the fluid imbalance problem in children with hematooncologycases.;Dehydration can lead to hypovolemia, organ failure, and even death. Qualitynursing care is of high importance in addressing the problem of fluid imbalancein children. This paper aimed to describe the application of Levine?sConservation Model in providing nursing care to children with cancer whoexperience fluid imbalance. Based on this model, the interventions includereviewing signs of dehydration, monitoring vomiting, diarrhea, and fever,measuring vital signs, measuring the fluid intake and output and analyzing thefluid balance. After the nursing intervention, the problem of risk of body fluidvolume deficiency did not occur in cases number 1, 2, and 3; while in the casesnumber 4 and 5 in which fluid imbalance already happened, this imbalanceproblem was resolved. It can be concluded that Levine?s model is an effectiveapproach to manage the fluid imbalance problem in children with hematooncologycases.;Dehydration can lead to hypovolemia, organ failure, and even death. Qualitynursing care is of high importance in addressing the problem of fluid imbalancein children. This paper aimed to describe the application of Levine?sConservation Model in providing nursing care to children with cancer whoexperience fluid imbalance. Based on this model, the interventions includereviewing signs of dehydration, monitoring vomiting, diarrhea, and fever,measuring vital signs, measuring the fluid intake and output and analyzing thefluid balance. After the nursing intervention, the problem of risk of body fluidvolume deficiency did not occur in cases number 1, 2, and 3; while in the casesnumber 4 and 5 in which fluid imbalance already happened, this imbalanceproblem was resolved. It can be concluded that Levine?s model is an effectiveapproach to manage the fluid imbalance problem in children with hematooncologycases.;Dehydration can lead to hypovolemia, organ failure, and even death. Qualitynursing care is of high importance in addressing the problem of fluid imbalancein children. This paper aimed to describe the application of Levine?sConservation Model in providing nursing care to children with cancer whoexperience fluid imbalance. Based on this model, the interventions includereviewing signs of dehydration, monitoring vomiting, diarrhea, and fever,measuring vital signs, measuring the fluid intake and output and analyzing thefluid balance. After the nursing intervention, the problem of risk of body fluidvolume deficiency did not occur in cases number 1, 2, and 3; while in the casesnumber 4 and 5 in which fluid imbalance already happened, this imbalanceproblem was resolved. It can be concluded that Levine?s model is an effectiveapproach to manage the fluid imbalance problem in children with hematooncologycases."