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"Intoleransi minum merupakan masalah yang umum terjadi pada bayi prematur. Tujuan penulisan Karya Ilmiah Akhir ini adalah memberikan gambaran penerapan Model Konservasi Levine pada bayi prematur dengan intoleransi minum dan gambaran pelaksanaan Praktik Residensi Keperawatan Anak. Model Konservasi Levine berfokus pada peningkatan adaptasi melalui prinsip konservasi untuk mencapai integritas diri. Penerapan Model Konservasi Levine tertuang dalam lima kasus terpilih. Pada lima kasus terpilih tersebut ditemukan masalah gangguan pemenuhan kebutuhan nutrisi yang disebabkan oleh intoleransi minum. Adapun masalah keperawatan lainnya adalah bersihan jalan napas tidak efektif, gangguan pola napas, gangguan termoregulasi, risiko infeksi, risiko gangguan perkembangan dan gangguan proses keluarga. Masalah-masalah tersebut dapat memperberat intoleransi minum dan menghambat proses pemulihan pada bayi prematur. Asuhan keperawatan pada kasus terpilih diberikan oleh residen dengan melaksanakan perannya sebagai pemberi asuhan, pendidik, konsultan, koordinator, pengambil keputusan etik, legal, dan sebagai peneliti.

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Feeding intolerance is a common problem in premature infants. The purpose of this Final Scientific Work is to describe the application of Levine Conservation Model in preterm infants with feeding intolerance and the implementation of Pediatric Nursing Residency Practice. Levine Conservation Model focuses on the adaptation improvement through conservation principles to achieve wholeness. Levine Conservation Model was implemented in five selected cases. In the five selected cases, there was a nutritional intake problem caused by feeding intolerance. The other problems were ineffective airway clearance, ineffective breathing pattern, ineffective thermoregulation, risk for infection, risk for developmental disorder and altered family process. These problems can aggravate the feeding intolerance and inhibit the healing process of premature infants. The nursing care to selected cases was given by the resident by implementing the roles as a caregiver, an educator, a consultant, a coordinator, an ethical and legal decision maker, and a researcher."

"Intoleransi minum merupakan masalah yang umum terjadi pada bayi prematur Tujuan penulisan Karya Ilmiah Akhir ini adalah memberikan gambaran penerapan Model Konservasi Levine pada bayi prematur dengan intoleransi minum dan gambaran pelaksanaan Praktik Residensi Keperawatan Anak Model Konservasi Levine berfokus pada peningkatan adaptasi melalui prinsip konservasi untuk mencapai integritas diri Penerapan Model Konservasi Levine tertuang dalam lima kasus terpilih Pada lima kasus terpilih tersebut ditemukan masalah gangguan pemenuhan kebutuhan nutrisi yang disebabkan oleh intoleransi minum Adapun masalah keperawatan lainnya adalah bersihan jalan napas tidak efektif gangguan pola napas gangguan termoregulasi risiko infeksi risiko gangguan perkembangan dan gangguan proses keluarga Masalah masalah tersebut dapat memperberat intoleransi minum dan menghambat proses pemulihan pada bayi prematur Asuhan keperawatan pada kasus terpilih diberikan oleh residen dengan melaksanakan perannya sebagai pemberi asuhan pendidik konsultan koordinator pengambil keputusan etik legal dan sebagai peneliti.

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Feeding intolerance is a common problem in premature infants The purpose of this Final Scientific Work is to describe the application of Levine Conservation Model in preterm infants with feeding intolerance and the implementation of Pediatric Nursing Residency Practice Levine Conservation Model focuses on the adaptation improvement through conservation principles to achieve wholeness Levine Conservation Model was implemented in five selected cases In the five selected cases there was a nutritional intake problem caused by feeding intolerance The other problems were ineffective airway clearance ineffective breathing pattern ineffective thermoregulation risk for infection risk for developmental disorder and altered family process These problems can aggravate the feeding intolerance and inhibit the healing process of premature infants The nursing care to selected cases was given by the resident by implementing the roles as a caregiver an educator a consultant a coordinator an ethical and legal decision maker and a researcher"

"Latar belakang. Indonesia merupakan salah satu dari 11 negara di dunia yang memiliki angka kelahiran prematur terbanyak. Salah satu morbiditas bayi prematur yang umum dijumpai adalah anemia. Hal ini menyebabkan mereka sering mendapatkan transfusi darah di minggu-minggu pertama kehidupannya. Mencegah beratnya anemia akan mengurangi kemungkinan tranfusi dan risiko komplikasinya. Tujuan. Mengetahui karakteristik bayi prematur yang mengalami anemia sebelum usia kronologis 4 minggu di unit Perinatologi Departemen Ilmu Kesehatan Anak RSCM Jakarta. Metode. Studi deskriptif retrospektif terhadap rekam medis semua bayi baru lahir prematur yang menjalani perawatan di unit perinatologi RSCM periode 1 Januari 2012 sampai dengan 31 Desember 2013. Pemilihan subyek penelitian secara simple random sampling. Penilaian karakteristik bayi prematur meliputi kadar Hb, berat lahir, usia gestasi, riwayat tranfusi PRC, status sepsis, lama rawat dan status keluar. Hasil. Sebanyak 393 subjek memenuhi kriteria penelitian, terdapat 94 (23,9%) subjek yang mengalami anemia dan 123 (31,3%) subjek yang mendapatkan transfusi PRC minimal satu kali. Frekuensi tersering anemia adalah 4 kali sedangkan frekuensi tersering pemberian PRC adalah 7 kali. Usia pertama kali anemia paling banyak ditemukan pada usia ≤7 hari (66%) serupa halnya dengan usia pertama kali mendapatkan transfusi PRC (51,2%). Perbedaan proporsi karakteristik antara bayi prematur yang mengalami anemia dengan yang tidak mengalami anemia menunjukkan hasil yang bermakna secara statistik pada variabel jenis kelamin, usia gestasi, berat lahir, transfusi PRC, status sepsis, lama rawat, dan status keluar. Hampir sama dengan hal tersebut, perbedaan proporsi karakteristik bayi prematur yang mendapatkan transfusi PRC dengan yang tidak mendapatkan transfusi PRC menunjukkan hasil yang bermakna secara statistik pada variabel usia gestasi, berat lahir, status sepsis, lama rawat, dan status keluar. Simpulan. Insidens bayi prematur yang mengalami anemia adalah 23,9% sedangkan insidens transfusi PRC adalah 31,3%. Kejadian anemia dan transfusi PRC paling banyak dialami pada satu minggu pertama kehidupan. Perbedaan proporsi antar variabel untuk kejadian anemia dan kejadian transfusi PRC secara statistik bermakna ditemukan pada variabel yang sama yaitu usia gestasi, berat lahir, status sepsis, lama rawat, dan status keluar.

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Background. Indonesia is one of 11 countries with high number of premature birth rate. One of the morbidity commonly seen ini premature infants is anemia This cause frequent blood transfusion on their first weeks of life. Anemia prevention will reduce transfusion and its complication.

Objectives. To study characteristics of premature infants with anemia before 4 weeks chronological age in Perinatology Unit Cipto Mangunkusumo Hospital, Jakarta.

Methods. A retrospective descriptive study from medical records of premature infants who had hospitalized from January 1st 2012 until Desember 31st 2013 in Perinatology Unit Cipto Mangunkusumo Hospital, Jakarta. Subjects was selected by simple random sampling. Characteristics evaluation include Hb concentration, birth body weight, gestational age, length of stay, history of PRC transfusion, septic status, and discharge status.

Results. There were 393 subjects fulfilled research criteria. Incidence of anemia was 23,9%, while PRC transfusion was done in 31,3% subjects. The most frequent anemia episode is 4 times and PRC transfusion is 7 times. First episode anemia is mostly found at age ≤7 days (66%) as well as PRC transfusion (51,2%). Proportion difference of characteristic between premature infants with anemia and not anemia revealed statistically significant in gestational age, birth weight, PRC transfusion, septic status, length of stay, and discharge status. Proportion difference of premature infants with PRC transfusioan also statistically significant in gestational age, birth weight, PRC transfusion, septic status, length of stay, and discharge status.

Conclusions. Incidence of anemia in premature infants 23,9% while incidence of PRC transfusion is 31,3%. Anemia and PRC transfusion most frequently happened at first week of life. Characteristic proportion difference with significant result between premature infants who had anemia and got PRC transfusion was similar in gestational age, birth weight, PRC transfusion, septic status, length of stay, and discharge status."

"Karya ilmiah akhir ini memberikan gambaran penerapan Model Konservasi Levine pada asuhan keperawatan pada bayi dengan risiko kerusakan integritas kulit dan pencapaian kompetensi sebagai spesialis keperawatan anak. Trophicognosis risiko kerusakan integritas kulit menurut Levine merupakan gangguan pada integritas struktur. Intervensi keperawatan dilakukan untuk mengatasi masalah integritas struktur tersebut dengan memperhatikan pula konservasi energi, konservasi integritas personal dan konservasi integritas sosial. Intervensi dilakukan dengan menerapkan aspek perawatan kulit dan cara memposisikan yang benar. Evaluasi yang dilakukan dengan mengkaji respon organismik bayi, menunjukkan bahwa belum semua bayi mampu mencapai wholeness yang ditandai dengan cedera pada nares, namun sudah mengalami perbaikan. Perawat memegang peranan yang sangat penting dalam pencegahan cedera pada nares yaitu pemilihan alat yang tepat, pemantauan dan pemenuhan kenyamanan bayi sehingga bayi tidak banyak bergerak dan mempercepat proses penyapihan continuous positive airway pressure (CPAP).

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This Final Assignment gave an overview about the application of Levine's Conservation Model in nursing care of baby with risk of skin integrity breakdown and competency achievement as a pediatric nurse specialist. According to Levine, trophicognosis of skin integrity breakdown was the structure integrity impaiment. Nursing interventions was undertaken to solve structure integrity problem, and also energy conservation, personal conservation and social conservation. Nursing interventions applied the skin care aspetcs and positioning. Evaluation had been done by evaluate the organismic responses of the baby, showed that not all the baby got wholenes, was marked by nares injury, but getting better. Nurse had the crucial role to prevent nares injury, that to choise the appropriate tool, monitored ang gave baby’s comfort so the baby did not much to move and weaned the continuous positive airway pressure (CPAP) as soon as possible."

"Penulisan karya ilmiah akhir ini bertujuan untuk mengaplikasikan teori Konservasi pada pemenuhan kebutuhan psikologis orang tua dengan bayi prematur. Pemenuhan kebutuhan psikologis orang tua dapat dilakukan melalui komunikasi terapeutik, pendampingan keluarga dan pemberian pendidikan kesehatan, memfasilitasi ikatan dan kelekatan orang tua-bayi, perencanaan pulang, asuhan berpusat pada keluarga, serta pendekatan asuhan perkembangan. Pemenuhan kebutuhan psikologis dapat membantu orang tua dalam proses adaptasi dalam pencapaian konservasi, yaitu konservasi melalui integritas personal sosial untuk mengoptimalkan peran orang tua dalam meningkatkan tumbuh kembang bayi prematur. Selama memberikan asuhan keperawatan, orang tua menunjukkan kondisi psikologis yang stabil, komunikasi dan kontak fisik dengan bayinya, pengetahuan dan keterampilan orang tua meningkat, serta adanya keterlibatan dalam perawatan bayi di RS

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This study aims to apply Conservation theory to fulfill psychological needs of parents with premature infants. The fulfillment of psychological needs can be done through therapeutic communication, family counseling and provision of health education, facilitating the bonding and parents-infant attachment, discharge planning, family centered-care, as well as developmental care approach. The fulfillment of psychological needs help parents in the process of adaptation to achieve conservation, in this case the conservation of social-personal integrity to optimize the role of parents in improving the growth and development of premature infants. During the nursing care, parents showed a stable psychological condition, communication and physical contact with the baby, the increase in parenting knowledge and skills, as well as involvement in the infant care in the hospital"

"[ABSTRAKBayi prematur dapat mengalami hambatan kenaikan berat badan yang disebabkan oleh usia gestasi, penyakit penyerta, dan pengalaman nyeri atau stres. Hambatan kenaikan berat badan dapat diatasi dengan asuhan keperawatan yang tepat dalam pemenuhan kebutuhan nutrisi pada bayi prematur. Asuhan keperawatan dengan Model Konservasi Levine telah digunakan pada aplikasi praktik residensi di Ruang Neonatus Rumah Sakit Cipto Mangunkusumo dalam menganalisis kenaikan berat badan bayi prematur pada lima kasus terpilih mulai dari Bulan Maret-Mei tahun 2015. Analisis kasus didapatkan dari tahap pengkajian, tropikognosis, hipotesis, intervensi, dan evaluasi. Tropikognosis yang telah teridentifikasi yaitu risiko gangguan pemenuhan kebutuhan nutrisi. Intervensi telah dilakukan berdasarkan prinsip konservasi dan hasil evaluasinya yaitu bayi prematur mengalami kenaikan berat badan dengan konservasi energi. Kenaikan berat badan pada bayi prematur menunjukkan keberhasilan dari penerapan asuhan keperawatan berbasis Model Konservasi Levine.

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ABSTRACTThe preterm infant can has an obstacle of increasing weight which is caused by gestational age, health problems which followed and pain/ stress experience. The obstacle of increasing weight can be handled with giving nursing care in proper nutrition needs. Nursing care with Levine?s Conservation Model has been applied in residence practice application in neonates wards Cipto Mangunkusumo hospital to analyze increasing weight of preterm infant in five selected cases start from March until May 2015. Case analyze is founded from assessment, trophicognosis, hypothesis, intervention, and evaluation. Trophicognosis which identified was disturbance risk in fullfil nutrition needs. Intervention were done based on conservation principle and the result of evaluation that preterm infant has increasing weight with energy conservation. Increasing weight in preterm infant showed a successful application of nursing care based on Levine?s Conservation Model. ;The preterm infant can has an obstacle of increasing weight which is caused by gestational age, health problems which followed and pain/ stress experience. The obstacle of increasing weight can be handled with giving nursing care in proper nutrition needs. Nursing care with Levine?s Conservation Model has been applied in residence practice application in neonates wards Cipto Mangunkusumo hospital to analyze increasing weight of preterm infant in five selected cases start from March until May 2015. Case analyze is founded from assessment, trophicognosis, hypothesis, intervention, and evaluation. Trophicognosis which identified was disturbance risk in fullfil nutrition needs. Intervention were done based on conservation principle and the result of evaluation that preterm infant has increasing weight with energy conservation. Increasing weight in preterm infant showed a successful application of nursing care based on Levine?s Conservation Model. , The preterm infant can has an obstacle of increasing weight which is caused by gestational age, health problems which followed and pain/ stress experience. The obstacle of increasing weight can be handled with giving nursing care in proper nutrition needs. Nursing care with Levine’s Conservation Model has been applied in residence practice application in neonates wards Cipto Mangunkusumo hospital to analyze increasing weight of preterm infant in five selected cases start from March until May 2015. Case analyze is founded from assessment, trophicognosis, hypothesis, intervention, and evaluation. Trophicognosis which identified was disturbance risk in fullfil nutrition needs. Intervention were done based on conservation principle and the result of evaluation that preterm infant has increasing weight with energy conservation. Increasing weight in preterm infant showed a successful application of nursing care based on Levine’s Conservation Model. ]"

"Bayi prematur menghadapi banyak tantangan ketidakseimbangan cairan untuk bertahan di lingkungan ekstrauterin, sehingga membutuhkan pendekatan asuhan keperawatan yang komprehensif. Studi kasus ini menggambarkan proses keperawatan menggunakan model Konservasi Levine untuk merawat lima bayi prematur dengan ancaman keseimbangan cairan. Pengkajian mengidentifikasi triphocognosis meliputi risiko kekurangan volume cairan dan masalah cairan lainnya. Perawat anak merawat sesuai kompetensi, seperti pemantauan kesesuaian cairan masuk dan kebutuhan, pengurangan jumlah insensible water loss, blood management, dan peningkatan kemampuan minum melalui mulut. Intervensi membantu bayi prematur dan keluarga berhasil beradaptasi untuk mencapai wholeness. Penerapan model ini menyediakan pengalaman asuhan keperawatan yang komprehensif sebagai referensi untuk kasus serupa selanjutnya.

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Preterm infants faces many challenges of fluid imbalance for survive in the extrauterine environment. It needs comprehensive nursing care approach. This study describes a nursing process using Levine’s Conservation model to care five preterm infants with threat to fluids imbalance. The assessments identified triphocognosis including risk of deficient fluid volume and other related problems. Pediatric nurse care according to competencies, such as monitoring the suitability of fluid intake and requirement, reducing the amount of insensible water loss, blood management, and increased oral feeding ability. The interventions helped the preterm infant and family adapt successfully to achieve wholeness. This application of model provides a comprehensive nursing care experience as reference for future similar cases."

"Pengetahuan dan keterampilan perawat dalam melakukan posisi prone pada bayi prematur memiliki peran penting karena apabila tidak dilakukan dengan tepat dapat berpengaruh terhadap pertumbuhan dan perkembangan bayi tersebut. Penelitian ini dilakukan untuk mengetahui efektivitas video posisi prone berbasis telefon pintar terhadap pengetahuan, sikap dan keterampilan perawat dalam melakukan posisi prone dengan tepat. Penelitian ini menggunakan desain randomized control trial dengan melibatkan 58 perawat NICU-Perinatologi pada salah satu Rumah Sakit Rujukan di Jakarta yang diambil menggunakan teknik purposive sampling. Hasil penelitian menunjukkan intervensi video posisi prone berbasis telefon pintar terbukti efektif meningkatkan pengetahuan, sikap dan keterampilan perawat dalam melakukan posisi prone pada bayi prematur (p<0,001, α<0,05). Penelitian memberikan saran supaya hasil penelitian ini dapat menjadi rujukan optimalisasi pengetahuan, sikap, dan keterampilan perawat dengan pemanfaatan teknologi informasi yaitu video tujuh langkah melakukan posisi prone dengan tepat berbasis telefon pintar yang dirancang dengan menarik dan memungkinkan akses secara fleksibel.

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Nurses' knowledge and skills in prone positions on premature babies have an important role because if it is not done properly, it can affect the growth and development of the baby. This study was conducted to determine the effectiveness of smartphone-based prone position videos on nurses' knowledge, attitudes, and skills in performing the prone position correctly. This study used a randomized control trial design involving 58 NICU-Perinatology nurses at a Referral Hospital in Jakarta taken using a purposive sampling technique. The results showed that the smartphone-based prone position video intervention improved nurses' knowledge, attitudes, and skills in performing positions. prone in premature infants (p<0.001, <0.05). The study provides suggestions so that the results of this study can be a reference for optimizing the knowledge, attitudes, and skills of nurses by utilizing information technology, namely a seven-step video of doing the correct prone position based on a designed smartphone attractively and allows flexible access."

"Bayi kurang bulan yang dirawat di rumah sakit seringkali mengalami nyeri yang disebabkan oleh prosedur diagnostik dan terapeutik. Tujuan dari studi kasus ini adalah memberikan gambaran aplikasi Model Konservasi Levine pada bayi kurang bulan dengan masalah nyeri. Model Konservasi Levine berfokus pada peningkatan adaptasi melalui prinsip konservasi untuk mencapai wholeness. Metode penelitian ini adalah studi kasus. Lima bayi kurang bulan yang mengalami masalah nyeri akut dirawat dengan pendekatan proses keperawatan berdasarkan teori Model Konservasi Levine. Masalah keperawatan lain yang ditemukan adalah pemenuhan nutrisi kurang dari keutuhan tubuh, risiko volume cairan kurang dari kebutuhan tubuh, risiko infeksi, ikterik neonaturum, gangguan pertumbuhan dan perkembangan risiko gangguan perlekatan orang tua dan bayi. Masalah-masalah tersebut dapat memperberat rasa nyeri dan menghambat proses adaptasi bayi kurang bulan dalam mencapai integritas diri.

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Preterm infants who is hospitalized, experience pain frequently that caused by diagnostic and procedure treatment. This study aim to describe the application of Levine’s Conservation Model in preterm infants who experienced pain. Levine's Conservation Model focuses on improving adaptation through conservation principles to achieve wholeness. This research method is case study with nursing process approach. Levine’s Conservation Model applied in five selected cases that have problem acute pain. The other nursing problems are nutrition less than body requirements, risk for deficient fluid volume, risk of infection, neonaturum icteric, impaired growth and development, risk of attachment disorder between parents and babies. All of the problems can aggravate pain and inhibit the process of adaptation in preterm infant to reaches wholeness."

"ABSTRAKBayi prematur sangat sensitif terhadap stimulus nyeri. Tujuan dari studi kasus ini adalah menganalisis efektivitas penerapan asuhan keperawatan pada bayi dengan gangguan pemenuhan kebutuhan kenyamanan melalui intervensi stimulasi multisensori menggunakan model Comfort Kolcaba di ruang perinatologi. Lima kasus terpilih menunjukkan terjadinya gangguan kenyamanan dan nyeri akut pada bayi prematur akibat terpapar dengan prosedur invasif. Intervensi dilakukan dengan mengkaji skor nyeri, pemberian stimulasi multisensori, serta perlibatan orang tua dalam intervensi melalui sentuhan dan kontak kulit ke kulit. Intervensi keperawatan berdasarkan evidence based nursing melalui tindakan stimulasi multisensori dilakukan untuk menurunkan skor nyeri. Hasil menunjukkan bahwa intervensi berbasis teori Comfort Kolcaba efektif untuk meningkatkan kenyamanan. Disarankan agar teori Comfort Kolcaba dapat diterapkan dalam pemberian asuhan keperawatan pada bayi prematur.

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ABSTRACTPremature infants are particularly sensitive to pain stimulus. The purpose of this case study is to analyze the effectiveness of nursing care in infants with impaired fulfillment of comfort through multisensory stimulation intervention in the perinatology room using Comfort Kolcaba model. Five cases selected show disruption of comfort and acute pain in preterm infants from exposure to invasive procedures. The intervention is done by assessing pain scores, multisensory stimulation, as well as the involvement of parents in the intervention through touch and skin-to-skin contact. Nursing interventions based on evidence based nursing through multisensory stimulation measures taken to decrease the pain score. The results show that the theory-based intervention Comfort Kolcaba effective to increase comfort. Application of Comfort Kolcaba theory can be applied in the provision of nursing care in premature infants. ;;"