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"Perdarahan postpartum merupakan penyokong utama kematian ibu secara global, dan memiliki implikasi fisiologis dan psikososial bagi ibu, bayi, keluarga dan masyarakat serta penyedia pelayanan kesehatan. Laporan praktik residensi ners spesialis maternitas ini, menerapkan peran dan fungsi perawat dan teori model keperawatan Need for Help Wiedenbach dan Comfort Kolcaba pada kasus perdarahan postpartum. Penerapan teori Wiedenbach dan Kolcaba pada kelima kasus kelolaan dapat diterapkan dan memenuhi kebutuhan pertolongan segera dan kenyamanan klien sehingga pelayanan asuhan keperawatan sesuai dengan harapan klien. Kekuatan teori Wiedenbach pda fase akut berfokus pada kebutuhan "here and now" yang dibutuhkan klien dengan segera, fokus pengkajian adalah fisik dan psikologis. Teori Comfort Kolcaba melengkapi dengan pengkajian aspek fisik, psikospiritual, lingkungan dan sosial, dengan intervensi yang dilakukan meliputi standart comfort intervention, coaching dan comfort food for thr soul. Perawat spesialis maternitas perlu meningkatkan peran dan fungsinya di tatanan pelayanan kesehatan, baik sebagai pemberi pelayanan, edukator, advokat, pengelola, kolaborator, dan komunikator.

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Postpartum Haemmoragic and maternal mortality have physiological and psychosocial implications. This Reports residency practice nurses maternity specialist, is a report for one year by applying roles and functions of nurses and nursing model theory Need for Help Wiedenbach and Comfort Kolcaba in case of postpartum hemorrhage. The application of the theory Wiedenbach and Kolcaba in five cases under management can be applied and meet the immediate relief needs and comfort of the client so that the nursing care services in accordance with the expectations of its clients. The Strength of the theory Wiedenbach on acute phase focuses on the needs of "here and now" that takes the client immediately, the focus of the assessment is physical and psychological.

Comfort Kolcaba complements theory with an assessment of the physical, psychospiritual, environmental and social, with interventions include standard comfort intervention, coaching and comfort food for thr soul. Maternity specialist nurses need to enhance the role and functions in order of health care, both as service providers, educators, lawyers, managers, collaborators and communicators."

"Angka kematian ibu (AKI) merupakan salah satu indikator untuk menentukan derajat kesehatan ibu. AKI secara nasional masih relatif tinggi. Penyebab AKI antara lain perdarahan setelah persalinan, eklamsia, dan infeksi. Selain itu, AKI juga disebabkan oleh faktor tiga terlambat dan empat terlalu. Perdarahan menempati persentase tertinggi penyebab kematian ibu. Laporan ini memberikan gambaran tentang pelaksanaan praktik residensi Ners Spesialis Keperawatan Maternitas fokus pada kasus perdarahan postpartum dengan penerapan kedua teori yaitu "Need for Help Wiedenbach" pada keadaan emergensi dan teori "Conservation Levine" untuk pemulihan ibu postpartum dengan perdarahan. Fokus teori keperawatan “Need for Help Wiedenbach” adalah memberikan pertolongan sesuai dengan kebutuhan pasien saat ini yaitu pada kasus ini saat terjadi perdarahan. Kemudian setelah fase akut teratasi, asuhan keperawatan diberikan untuk mempertahankan keseimbangan energi ibu postpartum setelah mengalami perdarahan. Perawat perlu memahami dan melaksanakan perannya sebagai pemberi asuhan keperawatan, pendidik, konselor, advokat, koordinator, kolaborator, peneliti, dan agen pembaharu dalam pelayanan praktik keperawatan.

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MMR is still relatively high nationally. The causes of MMR may include postpartum hemorrhage, eclampsia, and infection. In addition, MMR is also caused by the “three delays” and “four frequently occurring factors” among women. Bleeding is the highest percentage of the causes of maternal death. This report provided an overview of the practice implementation by resident maternity nursing specialist focused on the application theories of Need for Help from Wiedenbach during acute stage and Conservation from Levine during recovery stage with postpartum hemorrhage. The nursing theory of "Need for Help Wiedenbach" is indented to provide help in accordance with the needs of patients here and now in case of postpartum hemorrhage. Then after the acute phase is managed, the nursing care is given to maintain energy balance of postpartum women after bleeding. The nurses need to understand and carry out their roles as providers of nursing cares, educator, counselor, advocate, coordinator, collaborator, researcher, and innovator in the nursing maternity practices."

"Indikator capaian dari SDG’s salah satunya menurunkan angka kematian ibu dan bayi. Indonesia akan berusaha menurunkan angka kematian ibu menjadi kurang dari 70 kematian per 100.000 kelahiran hidup pada tahun 2030. Kematian ibu dan bayi disebabkan terjadinya persalinan prematur. Persalinan prematur dapat disebabkan adanya kontraksi uterus sehingga terjadi dilatasi serviks pada usia kehamilan 20-36 minggu. Ancaman persalinan prematur akan mengakibatkan gawat janin dan komplikasi pada bayi baru lahir. Study kasus pada lima ibu hamil yang mengalami kontraksi dini dengan fokus mengimplementasikan teori need for help pada keadaan emergency dan penerapan teori comfort Kolcaba pada tahap pemulihan. Ibu hamil akan mendapatkan intervensi tatalaksana tokolitik dan terapi relaksasi dengan self-hypnosis yang membantu ibu untuk mengontrol ketidaknyamanan dan menurunkan kecemasan selama di rumah sakit. Aplikasi tersebut berhasil membantu ibu hamil melalui tahap kegawatan dan meningkatkan kenyamanan serta mencegah kontraksi uterus berulang sehingga ibu dapat mempertahankan kehamilan sampai usia kehamilan aterm.

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The achievement indicators of SDG’s are one of them reducing maternal and infant mortality. Indonesia will try to reduce maternal mortality to less than 70 deaths per 100,000 live births by 2030. Maternal and neonatal deaths are caused by preterm labor. Premature labor can be caused by uterine contractions resulting in cervical dilatation at 20-36 weeks' gestation. The threat of preterm labor will result in fetal distress and complications in newborns. Case studies on five pregnant women who experienced premature contractions with a focus on implementing the need for help theory in an emergency and the application of the Kolcaba comfort theory in the recovery phase. Pregnant women will get a tocolytic management intervention and relaxation therapy with self-hypnosis that helps the mother to control discomfort and reduce anxiety during the hospital. The application is successful in helping pregnant women go through the emergency phase and increase comfort and prevent repeated uterine contractions so that the mother can maintain the pregnancy until the term gestational age."

"Persalinan kala dua memanjang merupakan kondisi yang memerlukan penanganan perawat agar tidak terjadi dehidrasi atau kelelahan pada ibu dan mencegah gawat janin. Penatalaksanaan keperawatan pada ibu yang mengalami persalinan kala dua memanjang dengan memberikan asuhan keperawatan secara fisik dan psikologis. Metode yang digunakan adalah studi kasus dengan fokus penerapan teori need for help Wiedenbach dan comfort Kolcaba pada asuhan keperawatan ibu yang mengalami persalinan kala dua memanjang. Aplikasi teori need for help Wiedenbach dan comfort Kolcaba efektif diterapkan pada kelima kasus yang berfokus pada masa intranatal baik secara fisik dan psikologis, mencegah dampak persalinan kala dua memanjang terhadap kondisi ibu dan janin serta mengkaji pernyataan klien tentang bantuan yang dibutuhkan kepada perawat. Dengan intervensi keperawatan yang sesuai dengan bantuan yang dibutuhkan klien maka masalah klien dalam keadaan emergency teratasi dan kebutuhan rasa nyaman dapat terpenuhi.

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Prolonged second stage of labor is a condition requiring nurse handling to avoid dehydration or fatigue of the mother and prevent fetal distress. Management of nursing in mother who experience prolonged labor by giving physical and psychological nursing care. The method used is case study with focus on the application of the theory of need for help Wiedenbach and comfort Kolcaba on nursing care in mother who experienced prolonged second stage of labor. The application of need for help Wiedenbach and comfort Kolcaba theories effectively applied to the five cases that focused on intranatal phase both physically and psychological, prevent the impact of prolonged second stage of labor in mother and fetus condition, as well as reviewing the clients statement about the assistance needed to the nurse. Appropriate nursing interventions can address client problems in an emergency and comfort needs can be met."

"Perdarahan postpartum merupakan salah satu situasi kegawatan maternal yangmembutuhkan penanganan segera. Penanganan kegawatan diprioritaskan untukmencegah syok hipovolemia yang mengancam jiwa. Setelah stabil, klien akan mendapatperawatan lanjutan untuk pemulihan. Di masa pemulihan, klien masih membutuhkanbantuan untuk mengatasi gangguan yang masih muncul, merawat diri, danmempersiapkan diri untuk memulai peran barunya. Penerapan integrasi modelkeperawatan Need For Help Wiedenbach dan Konsep Adaptasi Roy merupakan formatpengkajian yang sesuai untuk kondisi pada lima kasus yang dikelola Residen. Residenmengaplikasikan Evidence-Based Practice Nursing (EBPN) dalam perawatan klienperdarahan postpartum fase pemulihan. EBPN yang digunakan bertujuan untukmengatasi kecemasan klien akibat trauma dan hospitalisasi. EBPN yang digunakansebagai intervensi keperawatan adalah teknik afirmasi positif. Teknik Afirmasi positifdalam pengelolaan lima kasus kelolaan berpengaruh signifikan dalam menurunkan nilaikecemasan klien. Teknik afirmasi efektif untuk membantu klien menghadapi masalahpsikologis pasca perdarahan postpartum yang menimbulkan stres dan trauma. Perawatyang bertugas mengelola klien-klien dengan perdarahan postpartum fase pemulihandapat menggunakan integrasi model keperawatan sebagai acuan bagi perawatankliennya. Perawat maternitas juga dapat menggunakan teknik afirmasi positif untukmenurunkan tingkat kecemasan pada klien-klien dengan gangguan perdarahanpostpartum.

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Postpartum hemorrhage is one of the maternal emergencies which need immediate

treatment. The emergency management is prioritized to avoid hypovolemic shock which

can be life threatening. Once stable, clients will receive further treatment for recovery.

During the recovery period, clients still need help to overcome problems that still occur,

to take care of themselves, and to prepare to start their new roles. The application of

Needs Help Wiedenbach nursing model integration and Roy's Adaptation Concept is an

assessment format that is suitable for the conditions of the five cases managed by the

Resident. Resident applies EvidenceBased Practice Nursing (EBPN) in the treatment of

postpartum hemorrhage clients in the recovery phase. EBPN is used to treat clients’

anxiety caused by trauma and hospitalization. The use of EBPN as a nursing

intervention is a positive affirmation technique. Positive affirmation technique in the

five managed cases management significantly affects in reducing clients’ anxiety. The

affirmation technique is effective to help clients to face psychological issues after

postpartum hemorrhage which causes stress and trauma. Nurses who are in charge of

supporting clients with postpartum hemorrhage in the recovery phase can use the

nursing model integration as a reference for treatment for their patients. Maternity

nurses can use positive affirmation techniques as well to reduce anxiety levels of clients

with postpartum hemorrhage disorders."

"Kehamilan diharapkan dapat berlangsung aman dan lancar hingga melahirkan. Akan tetapi wanita hamil sangat beresiko mengalami penyulit atau komplikasi yang tidak diinginkan, salah satunya adalah abortus inkomplit. Fenomena tersebut mendorong profesi keperawatan untuk terus mengembangkan ilmu sejalan dengan tuntutan masyarakat terhadap pelayanan kesehatan yang berkualitas. Laporan ini bertujuan menggambarkan pelaksanaan praktek residensi keperawatan maternitas selama satu tahun, meliputi asuhan keperawatan pada masa childbearing normal dan resiko tinggi, bayi baru lahir normal dan resiko tinggi, perempuan yang mengalami masalah reproduksi dan ginekologi di tatanan klinik maupun di komunitas. Residen juga melakukan asuhan keperawatan pada kasus focus of interest yaitu abortus inkomplit dengan mengaplikasikan teori need for help yang dikombinasikan dengan teori social support. Laporan ini juga mengemukakan hambatan dan dukungan pada pelaksanaan praktek residensi. Selain itu, laporan ini juga memaparkan tentang kegiatan pencapaian kompetensi perawat spesialis maternitas melalui penerapan peran sebagai pemberi perawatan, pendidik, konselor, koordinator, komunikator, advokat, agen perubahan dan peneliti.

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Pregnancy is expected to take place safely and smoothly until delivery. However, pregnant women are particularly at risk to experience complications or unwanted complications, one of which is an incomplete abortion. This phenomenon encourages the nursing profession to continue to develop in line with the science community demands for quality health care. This report aims to describe the implementation of maternity nursing practice residency for one year, covers nursing care during the childbearing normal and high-risk, normal newborns and high-risk women who have problems in reproductive and gynecological clinic and in the community structure. Resident also performs nursing care on a case that is the focus of interest by applying the theory of incomplete abortion need for help is combined with the theory of social support. The report also noted the barriers and support the implementation of the practice residency. In addition, this report also describes about the activities of achievement of competencies through the application maternity nurse specialist role as caregiver, educator, counselor, coordinator, communicator, advocate, change agent and researcher."

"Praktik residensi keperawatan maternitas dalam pengelolan ibu postpartum dengan histerektomi atas indikasi plasenta akreta membutuhkan pengkajian dan intervensi keperawatans secara holistik sehingga dapat membantu pasien menangani setiap masalahnya serta kondisinya saat ini. Masalah yang sering muncul pada ibu postpartum bervariasi, baik fisik, psikologis, sosial dan spitirualnya. Masalah fisik dan psikologis adalah amsalah yang menonjol pada kasus ini dikarenakan adanya perubahan-perubahan dalam diri baik secara internal dan eksternal, terutama dengan kondisi histerektomi dimana penilaian atau persepsi ibu serta kondisi seksual akan mengalami perubahan sehingga diharapkan mampu beradaptasi dengan kondisi tersebut. Mendapatkan kenyamanan dalam menghadapi proses adaptasi juga merupakan salah satu usaha meningkatkan konsep diri ibu paska histsrektomi. Sehingga penerapan teori adaptasi Roy dan kenyamanan Kolcaba pada lima kasus ibu postpartum dengan histerektomi atas indikasi plasenta akreta mampu memberikan asuhan keperawatan yang komprehensif. Penerapan teori Roy dan Kolcaba mampu mengidentifikasi koping, stimulus, level dari kenyamanan pasien dan memberikan intervensi berbasis evidence based nursing practice yang sesuai dengan kebutuhan ibu postpartum dengan histerektomi.

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The practice of maternity nursing residency in the management of postpartum mothers with hysterectomy for placenta accreta indications requires holistic assessment and nursing interventions so that they can help patients deal with any problems and their current condition. Problems that often arise in postpartum mothers vary, both physically, psychologically, socially and spiritually. Physical and psychological problems are problems that stand out in this case due to changes in themselves both internally and externally, especially with the hysterectomy condition where the assessment or perception of the mother and sexual condition will change so that it is expected to be able to adapt to these conditions. Getting comfortable in the face of the adaptation process is also one of the efforts to improve the self-concept of the mother after hertectomy. So that the application of Roy's adaptation theory and Kolcaba's comfort in five cases of postpartum mothers with hysterectomy for placenta accreta indications was able to provide comprehensive nursing care. The application of Roy and Kolcaba's theory is able to identify coping, stimulus, level of patient comfort and provide evidence-based nursing practice-based interventions that are in accordance with the needs of postpartum with hysterectomy."

"ABSTRAK Angka kematian ibu (AKI) merupakan salah satu indikator penting dari derajatkesehatan masyarakat. AKI menggambarkan jumlah wanita meninggal dari suatupenyebab kematian terkait dengan gangguan kehamilan atau penanganannya selamakehamilan, melahirkan dan selama nifas. Kasus perdarahan sebagai penyebab utamakematian ibu dapat terjadi pada masa kehamilan, persalinan dan masa nifas. Salahsatu penyebab perdarahan diantaranya adalah plasenta previa. Plasenta previamerupakan salah satu keadaan yang menjadi penyebab perdarahan yang memerlukantindakan segera tenaga kesehatan terkait dengan kondisi ibu dan janin yangdikandungnya. Perawat sebagai salah satu tenaga kesehatan yang memberikan asuhankeperawatan secara komprehensif berperan dalam melakukan pemantauan secaraberkesinambungan kondisi ibu dan janin serta proses persalinan yang akan dihadapi .Tujuan penulisan laporan KIA ini adalah menjelaskan tentang aplikasi konsep danteori keperawatan dalam pemberian asuhan keperawatan pada ibu hamil denganplasenta previa totalis,serta menjelaskan peran perawat maternitas sebagai pemberiasuhan keperawatan, educator, konselor, advokator, pengelola, kolaborator, agenpembaharu (innovator), komunikator dan koordinator serta peneliti dalammemberikan asuhan keperawatan pada ibu hamil dengan plasenta previa. Pemilihankonsep dan teori keperawatan berdasarkan kepada kontek klien yang dalam kondisimengalami komplikasi yang berakibat kecemasan, dibutuhkan pendekatan perawatyang mampu memberikan asuhan secara komprehensif. Oleh karena itu konsep danteori need for help Wiedenbach dan teori of caring Swanson tepat digunakan dalampemberian asuhan keperawatan pada ibu hamil dengan plasenta previa totalis.Dengan harapan kondisi ibu hamil dengan plasenta previa totalis tetap optimal,mampu beradaptasi secara fisik maupun pskologis serta siap terhadap proses persalinan yang akan dihadapi. ABSTRACT The maternal mortality rate (MMR) is one of important indicators of the communityhealth. MMR describes the number of women death caused by problems associatedwith pregnancy or the treatment during pregnancy, childbirth and postpartum period.Hemorrhagic cases as the main cause of maternal death occur during pregnancy,childbirth and postpartum period. One of hemorrhagic causes is placenta previa.Placenta previa is a condition that causes bleeding which requires healthprofessionals? immediate interventions related to the maternal and fetal condition. Anurse as one of health professionals who provides a comprehensive nursing care has arole in monitoring continuously the maternal and fetal condition as well as the laborand birth process. The purpose of this final scientific work was to explain about theapplication of the nursing concepts and theories in providing nursing care to pregnantwomen with placenta previa totalis, as well as to explain the role of maternity nursesas a caregiver, an educator, a counselor, an advocate, a manager, a collaborator, aninnovator, a communicator and a coordinator as well as a researcher in providingnursing care to pregnant women with placenta previa. The selection of nursingconcepts and theories was based on the context of the client experiencedcomplications causing anxiety, nurses? approach that can provide comprehensive carewas needed. Therefore, Wiedenbach need for help concept and theory and Swansontheory of caring were appropriate to be used in the provision of nursing care topregnant women with placenta previa totalis. Hopefully the conditions of pregnantwomen with placenta previa totalis remain optimal, able to adapt physically and psychologically and ready to face the labor process. ;The maternal mortality rate (MMR) is one of important indicators of the communityhealth. MMR describes the number of women death caused by problems associatedwith pregnancy or the treatment during pregnancy, childbirth and postpartum period.Hemorrhagic cases as the main cause of maternal death occur during pregnancy,childbirth and postpartum period. One of hemorrhagic causes is placenta previa.Placenta previa is a condition that causes bleeding which requires healthprofessionals? immediate interventions related to the maternal and fetal condition. Anurse as one of health professionals who provides a comprehensive nursing care has arole in monitoring continuously the maternal and fetal condition as well as the laborand birth process. The purpose of this final scientific work was to explain about theapplication of the nursing concepts and theories in providing nursing care to pregnantwomen with placenta previa totalis, as well as to explain the role of maternity nursesas a caregiver, an educator, a counselor, an advocate, a manager, a collaborator, aninnovator, a communicator and a coordinator as well as a researcher in providingnursing care to pregnant women with placenta previa. The selection of nursingconcepts and theories was based on the context of the client experiencedcomplications causing anxiety, nurses? approach that can provide comprehensive carewas needed. Therefore, Wiedenbach need for help concept and theory and Swansontheory of caring were appropriate to be used in the provision of nursing care topregnant women with placenta previa totalis. Hopefully the conditions of pregnantwomen with placenta previa totalis remain optimal, able to adapt physically and psychologically and ready to face the labor process. "

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Retensi urin postpartum merupakan ketidakmampuan mengosongkan kandung kemih secara spontan setelah melahirkan dengan residu urin lebih dari 200 ml. Komplikasi yang dapat terjadi yaitu distensi kandung kemih, kontraksi uterus terhambat, perdarahan, otot detrusor melemah, kateterisasi intermiten dan disfungsi berkemih permanen. Penatalaksanaan keperawatan pada retensi urin postpartum dengan memberikan asuhan keperawatan secara holistik menggunakan studi kasus dan penerapan teori keperawatan. Penerapan teori self care Orem dan comfort Kolcaba pada lima kasus retensi urin postpartum dengan membahas permasalahan yang dialami dan menguraikan peran perawat pada kasus tersebut, dengan tujuan kebutuhan kenyamanan dan kemandirian pasien dapat terpenuhi. Kejadian retensi urin dapat diatasi dengan menerapkan evidence based nursing practice kegel excercise dan bladder training. Studi kasus yang dilakukan pada lima ibu postpartum yang mengalami retensi urin didapatkan bahwa kegel exercise dan bladder training mampu mengatasi retensi urin secara signifikan, menurunkan tingkat nyeri, dan meningkatkan self care.

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Postpartum urinary retention is the inability to empty the bladder spontaneously after giving birth with more than 200 ml urine residue. Complications that can occur are distention of the bladder, obstructed uterine contractions, bleeding, weak detrusor muscles, intermittent catheterization and permanent voiding dysfunction. Nursing management in postpartum urinary retention by providing nursing care holistically uses case studies and the application of nursing theory. Application of self care Orem and Comfort Kolcaba theory in five cases of postpartum urine retention by discussing the problems experienced and outlining the role of nurses in the case, with the aim of comfort and independence of patients can be fulfilled. Urinary retention can be overcome by applying evidence based nursing practice kegel excercise and bladder training. Case studies conducted on five postpartum mothers who experienced urinary retention found that kegel exercise and bladder training were able to overcome urinary retention significantly, reduce pain levels, and improve self care.

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"Praktik residensi keperawatan maternitas diselenggarakan untuk menghasilkan perawat maternitas yang menguasai aplikasi teori keperawatan maternitas dan memiliki keterampilan khusus untuk melakukan perawatan maternitas baik di rumah sakit maupun di komunitas. Laporan residensi ini menjelaskan tentang pelaksanaan praktik residensi maternitas, peran dan fungsi perawat maternitas, pencapaian kompetensi praktik dan upaya untuk memodifikasi hambatan yang dihadapi. Laporan residensi ini fokus pada penerapan teori need for help Wiedenbach dan self care Orem pada ibu hamil dengan tuberculosis multi drug resistance. Perawat maternitas perlu meningkatkan pengetahuan dan keterampilan klinik secara berkelanjutan sehingga mampu meningkatkan kualitas asuhan keperawatan maternitas.

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Maternity nursing practice residency organized to produce nurse of maternity who master the application of nursing theory and have special skills to do a good maternity care in hospitals and in the community. This residency final report describes the implementation of the practice residency maternity, roles and functions of nurses maternity, the attainment of practice and attempts to modify the barriers. Focus of this final report is application of theory need for help Wiedenbach and self care Orem in pregnant women with tuberculosis multi drug resistance. Nurse maternity needs to improve knowledge and clinical skills on an ongoing basis to improve the quality of maternity nursing care. "