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"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."

"[ABSTRAKNyeri pembedahan menimbulkan cemas, takut dan perubahan perilaku maladaptif anak. Perlu asuhan keperawatan berkualitas dalam mengatasi nyeri anak. Karya ilmiah akhir bertujuan menggambarkan aplikasi comfort theory Kolcaba dalam memberikan asuhan keperawatan pasien pasca bedah yang mengalami nyeri. Intervensi ditentukan berdasarkan comfort theory yaitu mengukur skala nyeri, memberikan posisi nyaman, memberikan madu, mengajarkan keluarga manajemen nyeri serta memberikan reinforcement positif keterlibatan keluarga dalam perawatan. Evaluasi hasil menunjukkan aplikasi comfort theory dalam keperawatan perlu ditunjang faktor-faktor lain seperti kondisi pasien, lingkungan dan tim pelayanan kesehatan dalam mencegah dan mengatasi nyeri. Rekomendasi karya ilmiah ini adalah teori keperawatan sebaiknya diaplikasikan dalam asuhan keperawatan.

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ABSTRACTSurgical pain causes anxiety, fear and change in children's behaviours. A good quality of nursing care is needed to overcome children's pain. This scientific paper aimed to illustrate the application of comfort theory Kolcaba in providing nursing care to patients suffered post-surgical pain. Intervention was determined based on comfort theory which included: measure pain scale, provide a comfortable position, offer honey, teach families management of pain, and give positive reinforcement on family involvement during the care. Result's evaluation indicated thet comfort application in nursing theory need to be supported by other factors such as the condition of the patient, the environment and health care team to prevent and overcome pain. This scientific paper recommends the application of nursing theory in providing nursing care., Surgical pain causes anxiety, fear and change in children's behaviours. A good quality of nursing care is needed to overcome children's pain. This scientific paper aimed to illustrate the application of comfort theory Kolcaba in providing nursing care to patients suffered post-surgical pain. Intervention was determined based on comfort theory which included: measure pain scale, provide a comfortable position, offer honey, teach families management of pain, and give positive reinforcement on family involvement during the care. Result's evaluation indicated thet comfort application in nursing theory need to be supported by other factors such as the condition of the patient, the environment and health care team to prevent and overcome pain. This scientific paper recommends the application of nursing theory in providing nursing care.]"

"[ABSTRAKNyeri merupakan salah satu masalah utama pada pasien kanker anak. Karya Ilmiah Akhir ini bertujuan memberikan gambaran penerapan, analisis Comfort Theory Kolcaba pada pasien kanker anak dengan nyeri, dan pencapaian kompetensi ners spesialis keperawatan anak. Penerapan teori dilakukan pada lima pasien, menggunakan pendekatan proses keperawatan. Pengkajian dan penetapan masalah keperawatan menggunakan struktur taksonomi Kolcaba. Intervensi dan implementasi menggunakan intervensi kenyamanan standar, coaching, dan comfort food for the soul. Evaluasi menggunakan comfort behavior scale menunjukkan hasil diakhir perawatan, nyeri berkurang, terkontrol, dan kenyamanan bertambah. Kompetensi tercapai sesuai target. Comfort Theory bisa menjadi pilihan dalam merawat pasien kanker anak dengan nyeri.

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ABSTRACTPain is one of main problems in children with cancer. This study aimed to describe and to analyze: (1) the application of Kolcaba's Comfort Theory on children with cancer who experience pain, and (2) the competencies achieved by pediatric clinical nurse specialist. The theory was applied to five patients using nursing process approach. The assessment and decision of the nursing problem was conducted using Kolcaba's taxonomic structure. The intervention and implementation using standard comfort intervention, coaching, and comfort food for the soul. Comfort behavior scale was used for the evaluation. The results showed that at the end of the nursing implementation, pain was reduced, controlled, and the comfort was increased. The targeted competencies were achieved. Comfort Theory can be recommended for caring children with cancer.;Pain is one of main problems in children with cancer. This study aimed to describe and to analyze: (1) the application of Kolcaba's Comfort Theory on children with cancer who experience pain, and (2) the competencies achieved by pediatric clinical nurse specialist. The theory was applied to five patients using nursing process approach. The assessment and decision of the nursing problem was conducted using Kolcaba's taxonomic structure. The intervention and implementation using standard comfort intervention, coaching, and comfort food for the soul. Comfort behavior scale was used for the evaluation. The results showed that at the end of the nursing implementation, pain was reduced, controlled, and the comfort was increased. The targeted competencies were achieved. Comfort Theory can be recommended for caring children with cancer., Pain is one of main problems in children with cancer. This study aimed to describe and to analyze: (1) the application of Kolcaba's Comfort Theory on children with cancer who experience pain, and (2) the competencies achieved by pediatric clinical nurse specialist. The theory was applied to five patients using nursing process approach. The assessment and decision of the nursing problem was conducted using Kolcaba's taxonomic structure. The intervention and implementation using standard comfort intervention, coaching, and comfort food for the soul. Comfort behavior scale was used for the evaluation. The results showed that at the end of the nursing implementation, pain was reduced, controlled, and the comfort was increased. The targeted competencies were achieved. Comfort Theory can be recommended for caring children with cancer.]"

"Penerapan teori Comfort Kolcaba ini dilakukan pada 5 kasus kelolaan yang berbeda untuk memenuhi kebutuhan rasa nyaman nyeri yang berfokus pada faktor fisik, psikospiritual, sosiokultural, dan lingkungan. Asuhan keperawatan untuk memenuhi kebutuhan rasa nyaman nyeri tersebut dilakukan dengan menggunakan intervensi standard comfort, coaching dan comfort food for the soul, yaitu dengan memberikan guided imagery sehingga pasien dapat mencapai tingkat kenyamanan relief, ease, dan transcendence. Evaluasi menggunakan numeric rating scale menunjukkan hasil diakhir perawatan nyeri berkurang, terkontrol dan peningkatan kenyamanan. Residen menyarankan agar meningkatkan peran kemitraan antara perawat, petugas kesehatan lainnya dan keluarga serta melakukan asuhan keperawatan berbasis evidence based practice dalam memberikan asuhan keperawatan pada pasien kanker anak yang mengalami nyeri.

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The application of this theory is done in 5 different managed cases to fulfil the needs of pain-comfort senses which is focused on physical, psychospiritual, sociocultural, and environmental factors. This nursing care uses standard comfort, coaching and comfort food for the soul to fulfil the needs of pain-comfort senses, that the clients can achieve relief, ease, and transcendence comfort. Resident suggests increasing the role of the partnership between nurses, other health workers and family and do nursing care based on evidence based practice."

"Pasca pembedahan, anak berisiko mengalami gangguan keamanan yaitu risiko aspirasi akibat pemberian minum sebelum tingkat kesadarannya pulih. Gangguan keamanan tersebut akan mengakibatkan ketidaknyamanan pada anak berupa rasa nyeri dan sesak di daerah dada. Teori Comfort dari Kolcaba memberikan arahan dalam pemenuhan rasa nyaman pada pasien. Karya ilmiah ini bertujuan memberikan gambaran asuhan keperawatan pada anak pasca pembedahan dengan mengaplikasikan teori comfort Kolcaba yang berfokus pada pemenuhan kebutuhan keamanan. Asuhan keperawatan dilakukan berdasarkan tahapan comfort yaitu pengkajian (kenyamanan fisik, psikospiritual, lingkungan dan sosiokultural), merumuskan diagnosa keperawatan, menetapkan intervensi (berdasarkan standar comfort, coaching, dan comfort food for the soul), implementasi dan evaluasi. Pada lima pasien kelolaan yang berisiko mengalami aspirasi pasca pembedahan, empat pasien tidak mengalami aspirasi dan satu pasien mengalami aspirasi. Aspirasi terjadi dikarenakan kenyamanan sosiokultural tidak terpenuhi yaitu dukungan dan keterlibatan dari orangtua dalam perawatan anaknya. Sehingga terlihat bahwa ke empat aspek kenyamanan harus saling mendukung untuk pencapaian kenyamanan secara holistik.

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Post surgery children are in risk for safety problem such as aspiration becouse of fluid intake before they are fully conscious. The aspiration will cause comfort problem which manifestated as chest pain and chest tightness. Comfort theory from Kolcaba provides direction on meeting patient need of comfort. This paper aims to give an overview of post surgical children focused on meeting the need of safety. Nursing care was provided throught the stages of comfort assessment (physical comfort, psychospiritual, environtment and sociocultural), nursing diagnosis formulation, interventions plan (based on standard comfort, coaching, and comfort food for the soul), implementation and evaluation. Among five post surgical children which were in risk of aspiration, four children didn’t experience aspiration and one patient experienced aspiration. The aspiration was happened becouse of sociocultural comfort was not satisfied, where the support and involvement from parents in the care of their children was not adequate. So that the four aspects of comfort should be mutually supportive to the achievement of holistic comfort."

"Kanker pada anak terus meningkat jumlahnya setiap tahun, masalah nutrisi merupakan masalah yang sering dikeluhkan oleh anak dan keluarga sehingga, diperlukan asuhan keperawatan untuk mengatasi masalah tersebut. Karya Ilmiah Akhir ini bertujuan untuk memberikan gambaran aplikasi teori Comfort Kolcaba dalam asuhan keperawatan pada anak kanker dengan masalah nutrisi dan pencapaian kompetensi baik sebagai pemberi asuhan, advocator, counselor, educator, colaborator, dan agen perubah. Terdapat lima kasus kelolaan yang menjadi pembahasan dalam karya ilmiah ini, kelima kasus kelolaan mengalami masalah nutrisi. Masalah nutrisi didapatkan dari basil pengkajian berdasarkan pendekatan teori Comfort Kolcaba yaitu pengkajian fisik, psikospiritual, sosiokultural dan Iingkungan. Intervensi menggunakan tiga tipe perawatan standar comfort, coaching dan Comfort food for the soul. Tidak semua masalah nutrisi pada lima kasus kelolaan dapat teratasi dengan cepat, untuk menyelesaikan masalah nutrisi pada anak kanker dibutuhkan waktu dan kerjasama tim yang baik antara ibu, anak, dokter dan dietesien serta perawat.

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Pediatric cancer always increase every year, the problem of nutrition is often complained by the child and their family, so nursing care is required to solve the issue. This research aims to provide an overview of the application of theory Comfort Kolcaba in cancer nursing care in children with nutritional problems and the competence achievement as a caregiver, advocator, counselor, educator, colaborator, and agent of change. There were five cases managed that discussed in this research, and in five cases managed all experiencing nutritional problems. Nutrient problems obtained from the results of the assessment approach based on the theory of Comfort Kolcaba such as physical examination, psikospiritual, sociocultural and environmental. Interventions use three types of standard comfort care, coaching and Comfort food for the soul. Not all nutritional problems in the management of five cases can be resolved quickly, to solve the problem of childhood cancer nutrition takes time and good teamwork among mother, child, and dietision, doctors, and nurses."

"Pasien yang dilakukan pembedahan hampir seluruhnya mengalami nyeri. Nyeri yang dialami oleh pasien pasca pembedahan dapat mempengaruhi kestabilan hemodinamik dan dapat menurunkan imunitas tubuh sehingga mengganggu proses penyembuhan. Tujuan dari karya akhir ilmiah ini adalah untuk memberikan gambaran penerapan teori keperawatan Comfort Kolcaba dan pendekatan Family Centered Care dalam mengatasi nyeri pada anak pasca pembedahan laparatomi. Penerapan teori comfort dalam melakukan asuhan keperawatan pada pasien pasca pembedahan dapat meningkatkan kepuasan keluarga dan efektif menurunkan nyeri pada pasien nyeri yang dipengaruhi faktor kecemasan. Aplikasi teori comfort yang ada belum menggunakan ceklist comfort karena perawatan difokuskan pada masalah nyeri sehingga evaluasi yang dipilih menggunakan skala nyeri FLACC dan VAS. Teori comfort dapat diaplikasikan terutama pada pasien yang mengalami nyeri ringan dan pasien dengan peningkatan skala nyeri yang dipengaruhi kecemasan.

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Patients who undergo surgery almost entirely feel pain. Pain experienced by patients after surgery could affect the stability of hemodynamic and decrease the body's immunity which can interrupt the healing process. The purpose of this study is to provide an overview of the application of nursing theory Comfort Kolcaba and Family Centered Care approach in dealing with post-surgical pain in children laparotomy. The application of the comfort theory in performing nursing care to patients after surgery can improve family satisfaction and effectively reduce pain in patients which influenced by anxiety. Recently, the application of comfort theory has not been implementing of an evaluation using a checklist comfort because the treatment is focused on the problem so that the evaluation of selected pain using the VAS pain scale and FLACC. Comfort theory can be applied, especially in patients with mild pain and increase pain scale which influenced by anxiety."

"Mual muntah merupakan gangguan rasa nyaman yang dialami oleh sebagian besar anak pasca operasi. Mual muntah dapat mengakibatkan gangguan keseimbangan cairan merupakan resiko yang dapat terjadi pada hampir sebagian besar anak yang telah mengalami pembedahan. Gangguan keseimbangan cairan dan elektrolit pasca pembedahan dapat menyebabkan perburukan pada kondisi anak yang pada akhirnya menghambat proses pemulihan luka pembedahan. Tujuan dari penulisan karya ilmiah akhir ini adalah untuk memberikan gambaran aplikasi konsep Teori Comfort dalam asuhan keperawatan pada anak pasca pembedahan yang memiliki kebutuhan akan cairan dan elektrolit. Penggunaan teori comfort dapat meningkatkan kesadaran perawat akan kebutuhan-kebutuhan klien terhadap kenyamanan di setiap aspek fisik, psikospiritual, lingkungan, dan sosiokultural baik yang dikeluhkan oleh klien maupun hasil dari analisa perawat. Melalui aplikasi teori yang telah dilaksanakan perawat dapat mengetahui perubahan tingkat kenyamanan sebelum dan sesudah dilakukannya intervensi keperawatan. Disarankan agar aplikasi teori Comfort dipertahankan pelaksanaannya di lahan praktik asuhan keperawatan.

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Uncomfortable condition such as nausea and vomiting are experienced by most of postoperative children. This uncomfortable may lead to fluid and electrolyte imbalance. Fluid and electrolyte imbalance can lead to deterioration in the condition of the child, which in turn inhibits the surgical wound healing process. The purpose of this final scientific writing is to provide an overview about the application of Comfort theory concept in postoperative children nursing care. The application of comfort theory is expected to increase nurses awareness on the need of patient comfort which include physical, psycho spritiual, social cultural, and enviormental. With the application of theories nurse can made a comparison of the comfort level before and after intervention for each case. It is recommended that application of the theory of Comfort retained its implementation in the field of nursing care practices."

"Anak pasca bedah mengalami peningkatan risiko terpapar mikroorganisme penyebab infeksi. Karya ilmiah akhir ini bertujuan memberikan gambaran aplikasi Model Konservasi Levine pada asuhan keperawatan anak pasca bedah dengan risiko infeksi, pencapaian kompetensi baik sebagai pemberi asuhan, advocator, counselor, educator, colaborator dan agen perubah selama praktik residensi. Terdapat lima kasus kelolaan yang menjadi pembahasan dalam Karya ilmiah akhir ini. Pada lima kasus kelolaan tersebut ditemukan adanya trophicognosis risiko infeksi sampai dengan sepsis. Hipotesis yang diberikan berdasarkan prinsip-prinsip konservasi. Hasil secara umum aplikasi model konservasi Levine kepada lima kasus terpilih adalah baik, sehingga diharapkan seorang ners spesialis keperawatan anak selalu mengembangkan kemampuan dalam meningkatkan kompetensinya.

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Children at increased risk of postoperative exposure to microorganisms that causes them infections. Final Scientific aims to give an overview on the Levine Conservation Model application nursing child with the risk of postoperative infection, the achievement of competency as both a caregiver, advocator, counselor, educator, colaborator and agent of change for practice residency. There are five cases to be managed in the discussions in the Final Scientific Works. In these five cases were found the trophicognosis managed the risk of infection to sepsis. Hypotheses were based on the principles of conservation. The results generally Levine conservation model application to the five cases selected were good, so expect a nurse specialist nursing child always develops the ability to improve their competence. "

"Karya Ilmiah Akhir ini memaparkan kegiatan praktik residensi spesialis keperawatan anak, mencakup pemberian asuhan keperawatan dan pencapaian kompetensi. Penerapan asuhan keperawatan berfokus pada perawatan anak dengan klien yang terpasang kolostomi. Masalah yang paling sering terjadi adalah risiko kerusakan integritas kulit. Masalah risiko kerusakan integritas kulit adalah berisiko mengalami perubahan kulit yang buruk. Aplikasi Model Adaptasi Roy dapat menyelesaikan masalah klien dengan risiko kerusakan integritas kulit untuk mencapai respon yang adaptif. Keberhasilan asuhan keperawatan ditunjang oleh kompetensi perawat anak melalui berbagai perannya, yaitu sebagai pemberi pelayanan, pendidik, manager, serta peneliti. Pelaksanaan asuhan keperawatan dengan pendekatan Model Adaptasi Roy diharapkan dapat diaplikasikan secara komprehensif dalam mengatasi masalah klien dengan kasus bedah dengan pendekatan konsep family centered care.

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The final Scientific paper describes activities specialist nursing practice residency of pediatric, includes the provision of nursing care and the achievement of competence. Application of nursing care focuses on treatment clients of children with colostomy bag attached. The most common problem is the risk of impairment to skin integrity. The risk of impairment to skin integrity problems are at risk of a bad skin changes. Roy Adaptation Model application can resolve the issue with the client's risk of damage to skin integrity to achieve the adaptive response. The success of nursing care supported by pediatric nurse competencies through a variety of roles, namely as service providers, educators, managers, and researchers. Implementation of nursing care by Roy Adaptation Model approach is expected to be applied comprehensively to address client issues with surgical cases involving the family as the embodiment of the concept of family centered care."