Hasil Pencarian  ::  Simpan CSV :: Kembali

"PURPOSE: The aim of this study was to determine the risk factors for anastomotic leakage after laparoscopic rectal surgery.METHODS: We conducted a prospective trial involving 395 patients with stage 0/I rectal carcinoma who underwent laparoscopic low anterior resection using a double stapling technique. Data concerning variables related to patient background, tumors and surgical factors were evaluated. The outcomes with respect to anastomotic leakage were recorded, and univariate and multivariate analyses were performed to identify relevant risk factors.RESULTS: The overall anastomotic leakage rate was 8.4%. A univariate analysis showed male gender (P = 0.006) and preoperative blood sugar level (P = 0.0034) to be significantly associated with anastomotic leakage. The variables of gender, preoperative blood sugar level, American Society of Anesthesiologists (ASA) classification (P = 0.15), transanal decompression tube (P = 0.06) and number of stapler cartridges used for rectal transection (P = 0.18) were selected for the multivariate analysis because of their P values being <0.2. The multivariate analysis identified male gender (odds ratio 4.12, P = 0.006) and the absence of a transanal decompression tube (odds ratio 3.11, P = 0.0484) as independent risk factors predicting anastomotic leakage.CONCLUSIONS: Male gender and the absence of a transanal decompression tube appeared to be independent risk factors for anastomotic leakage. Insertion of a transanal decompression tube may help prevent anastomotic leakage after low anterior resection, particularly in male patients."

"Praktik Residensi Keperawatan Medikal Bedah merupakan suatu rangkaian kegiatan megister dan Spesialis Keperawatan yang dilaksanakan di tempat pelayanan Kesehatan. Praktik residensi keperawatan medikal bedah berfokus pada penerapan ilmu, riset dan teknologi keperawatan dalam memenuhi kebutuhan dasar pada pasien dewasa dengan gangguan kardiovaskuler secara komprehensif. Praktik klinik keperawatan medical bedah peminatan kardiovaskuler dilaksanakan di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita (RSJPHK) Jakarta, dengan pemberian asuhan keperawatan menggunakan pendekatan teori Virginia Henderson pada satu kasus kelolaan dengan diagnose medis UAP TIMI 2/7 GRACE 139 CRUSADE 57, AV Block derajat 1, LBBB ect NSTEMI Dengan Riwayat CABG x2 (SVG-OM, SVG-LAD) dan AVR mekanikAV block grade I dan 30 kasus resume. Penerapan Evidance Based Nursing (EBN) dengan menggunakan intervensi single session 20-minute mindful Breathing untuk mengurangi keluhan dyspnea pada pasien cute Decompensatio Heart Failure (ADHF). Residensi juga melakukan inovasi yaitu penerapan aplikasi assasement pressure injury pada pasien perioperative menggunakan Scale Munro sebagai instrument pencegahan terjadinya pressure injury pada pasien rencana operasi bedah jantung

---

Medical Surgical Nursing Residency Practice is a series of activities for megisters and Nursing Specialists carried out in Health care facilities. The practice of medical surgical nursing residency focuses on the application of science, research and nursing technology in meeting the basic needs of adult patients with cardiovascular disorders in a comprehensive manner. Cardiovascular medical surgical nursing clinical practice is carried out at Heart and Vascular Hospital Harapan Kita (RSJPHK) Jakarta, by providing nursing care using the Virginia Henderson theoretical approach in one managed case with a medical diagnosis of UAP TIMI 2/7 GRACE 139 CRUSADE 57, AV Block degree 1, LBBB ect NSTEMI With History of CABG x2 (SVG-OM, SVG-LAD) and mechanical AVRAV block grade I and 30 cases resumed. Implementation of Evidence Based Nursing (EBN) using a single session 20-minute mindful breathing intervention to reduce complaints of dyspnea in cute Decompensation Heart Failure (ADHF) patients. The residency also made innovations, namely the application of pressure injury assessment applications in perioperative patients using the Munro scale as an instrument for preventing pressure injury in patients planning cardiac surgery."

"Perawat yang memiliki minat pada bidang keperawatan medikal bedah memiliki peran sebagai advokat, konsultan, agen pembaharu, pendidik, peneliti dan pemberi layanan asuhan keperawatan. Seorang perawat dapat mengikuti program pendidikan residensi setelah menyelesaikan pendidikan pada level magister untuk dapat menjalankan perannya sebagai seorang perawat spesialis. Praktik residensi keperawatan medikal bedah dengan bidang peminatan sistem kardiovaskuler telah memfasilitasi mahasiswa residensi untuk menjalankan perannya sebagai seorang perawat spesialis. Pasien dengan gangguan sistem kardiovaskuler dapat mengalami penurunan kapasitas fisik maupun psikologis. Sehingga dipilih Model konservasi Levine menjadi kerangka kerja dalam memberikan asuhan keperawatan pada pasien kelolaan utama dengan NSTEMI yang dilakukan tindakan Coronary Artery ByPass Grafting dan tiga puluh kasus resume untuk mendukung proses adaptasinya melalui empat prinsip konservasi, dan diharapkan pasien dapat mencapai derajat kesehatan yang optimal (wholeness). Untuk meningkatkan mutu layanan, maka asuhan keperawatan yang diberikan harus berbasis bukti (evidence-based practice). Edukasi yang terintegrasi dengan konseling menggunakan Model "PrOMiSe" dipilih dalam penerapan (evidencebased practice). Residen menjalankan peran sebagai seorang agen pembaharu dengan melakukan proyek inovasi membuat formulir dokumentasi hand over antar shift Model "FAST" menggunakan format yang terintegrasi dengan metode Situation-Background-Assessment-Recommendation (SBAR) untuk meningkatkan efektifitas komunikasi perawat yang dapat berdampak pada peningkatan keamanan pasien.

---

A nurses who have an interest in the field of medical-surgical nursing has a role as an advocate, consultant, agent reformers, educators, researchers and providers of nursing care. A nurse can conduct the residency education program after completing education at the magister level to fulfill their role as a specialist nurse. Residency medical-surgical nursing practice with a specialization in the field of cardiovascular system has facilitated resident to perform the role as a specialist nurse. Patients with cardiovascular disorder may decreased physical and psychological capacities. Conservation Levine was selected models as a framework in providing nursing care at the primary case managed patients NSTEMI with post operative coronary artery bypass grafting and thirty resume case to support patients through the process of adaptation to the four principles of conservation. Patients is expected to achieve optimally health status (wholeness). To improve service quality, the nursing should be based on evidence (evidencebased practice). The education to integrated with counseling using the "Promise" model selected in the application (evidence-based practice). In the role as an agent reformer, residents perform projects of innovation by creating a form of hand over documentation the "FAST" model using format that is integrated with method of Situation-Background-Assessment-Recommendation (SBAR) to improve the effectiveness of communication among nurses who can impact for improving patient safety."

"Praktek klinik lanjut selama praktek residensi keperawatan pada sistem neurologi dimaksudkan untuk mampu memberikan asuhan keperawatan, menerapkan Evidence Based Nursing (EBN) serta mampu berperan sebagai innovator di ruang perawatan. Peran pemberi asuhan keperawatan dilakukan dengan menggunakan model adaptasi Roy pada pasien dengan cedera kepala dan 30 pasien lainnya dengan berbagai gangguan sistem persarafan. Perilaku maladaptif paling banyak adalah mode adaptasi fisiologi, yaitu ketidakefektifan perfusi jaringan cerebral. Intervensi keperawatan berupa manajemen edema cerebral ditujukkan untuk meningkatkan adaptasi pasien dalam meningkatkan perfusi jaringan cerebral. Penerapan EBN skrinning tool Trunk Impairment Scale. Program inovasi keperawatan berupa edukasi terhadap perawat dalam manajemen pasien pasca craniotomy dengan protokol ERAS.

---

Advanced clinical practice during the nursing residency practice in the neurological system is intended to be able to provide nursing care, implement Evidence Based Nursing (EBN) and be able to act as an innovator in the treatment room. The role of nursing caregivers was carried out using Roy's adaptation model in patients with head injuries and 30 other patients with various nervous system disorders. The most maladaptive behavior is physiological adaptation mode, namely ineffective cerebral tissue perfusion. Nursing intervention in the form of cerebral edema management is intended to improve patient adaptation in increasing cerebral tissue perfusion. Application of the EBN screening tool Trunk Impairment Scale. Nursing innovation program in the form of education to nurses in post-craniotomy patient management with the ERAS protocol."

"Praktek klinik spesialis keperawatan medikal bedah pada sistem perkemihan secara keseluruhan bertujuan untuk memberikan asuhan keperawatan tingkat lanjut, menerapkan praktek keperawatan berbasis bukti serta berperan sebagai agen pembaharu di ruang perawatan. Peran sebagai pemberi asuhan keperawatan dilakukan dengan menggunakan pendekatan Model Adaptasi Roy pada 30 pasien gangguan sistem perkemihan dan pada pasien urolithiasis sebagai kasus utama. Peran sebagai peneliti dilakukan melalui penerapan Evidence Based Nursing berupa penerapan format DSI Dialysis Symptom Index pada 164 pasien hemodialisis terbukti memudahkan perawat dalam mengidentifikasi keseluruhan sindroma hemodialisis yang dialami pasien. Peran sebagai inovator dilakukan dengan menerapkan latihan ROM Range of Motion terbukti dapat menurunkan nilai fatigue yang diukur dengan format FACIT-F Functional Assessment of Chronic Illness Therapy- Fatigue

---

Clinical practice of medical surgical nursing specialist in urinary system aimed to provide the advance nursing care to implement the evidence based nursing and to act as an innovator in the treatment room. The role as a caregiver in nursing process was carried out using Roy's Adaptation Theory toward 30 patients with urinary system disorder and toward an urolithiasis patient as a main case. The role as a researcher was carried out by implementing evidence based nursing about assessment of hemodialysis syndrome by using DSI Dialysis Symptom Index on 164 hemodialysis patients that can facilitate nurses to identify all of patient's hemodialysis syndrome. The role as an innovator was carried out by doing Range of Motion ROM exercise that was proven to reduce fatigue level measuring by FACIT F Functional Assessment of Chronic Illness Therapy Fatigue."

"Praktek klinik lanjut selama praktek residensi keperawatan pada sistem imunologi dimaksudkan untuk mampu memberikan asuhan keperawatan, menerapkan Evidence Based Nursing (EBN) serta mampu berperan sebagai inovator di ruang perawatan. Residen melakukan asuhan keperawatan dengan kasus kelolaan utama menggunakan pendekatan teori adaptasi Roy dan 30 kasus resume menggunakan pendekatan teori Bandura. Dari hasil kasus kelolaan utama, diagnosa keperawatan utama yang muncul adalah defisit nutrisi sehingga intervensi utama keperawatan fokus pada manajemen nutrisi. Dari kasus resume masalah keperawatan yang paling banyak ditemukan yaitu ketidakpatuhan pengobatan. Intervensi keperawatan dukungan kepatuhan program pengobatan ditujukkan untuk meningkatkan kepatuhan pengobatan. Selain itu, intervensi yang dilakukan adalah melakukan proyek inovasi keperawatan berupa penerapan konseling pengobatan ART terstruktur dalam meningkatkan kepercayaan diri perawat serta kepatuhan pengobatan pasien. Evidence Based Nursing yang telag dilakukan residen adalah melakukan uji validitas dan reliabilitas PHQ-9 untuk skrining depresi yang menunjukkan bahwa PHQ-9 valid dan reliabel dalam mendeteksi depresi pada pasien dengan HIV.

---

Advanced clinical practice during nursing residency practice in the immunology system is intended to be able to provide nursing care, implement Evidence Based Nursing (EBN) and as an innovator. Resident conducts nursing care with main cases using Roy's adaptation theory approach and 30 cases resumes using Bandura theory approach. From the results of the main case, the main nursing diagnosis was nutritional deficit so nursing interventions focused on nutritional management. From the case of resume, the most common nursing problem found was non-adherence. Nursing interventions is adherence support are aimed to improve treatment adherence. In addition, the nursing intervention was innovation project structured ART treatment counseling to increase nurse confidence and patient treatment compliance. Evidence Based Nursing that has been done by residents is to test the validity and reliability of PHQ-9 for depression screening which shows that PHQ-9 is valid and reliable in detecting depression in patients with HIV."

"Praktik keperawatan residensi yang dilakukan di Rumah Sakit Umum Pusat Persahabatan dengan kekhususan respirasi diharapkan dapat mengatasi masalah pernapasan. Selama proses residensi menerapkan intervensi berdasarkan evidence based nursing, mampu menjadi seorang Clinical Care Manager (CCM) sebagai konsultan staf keperawatan, dan memberikan terapi keperawatan yang profesional. Dalam memberikan asuhan keperawatan pada kasus kelolaan pasien dengan Bronkiektasis dan 30 kasus resume menggunakan teori Henderson 14 kebutuhan dasar manusia yang menunjukkan peran perawat sebagai pemberi asuhan keperawatan dalam membantu individu baik dalam keadaan sehat maupun sakit, melalui usahanya melakukan berbagai aktivitas guna mendukung kesehatan dan penyembuhan individu atau proses meninggal dengan damai. Masalah keperawatan yang banyak muncul yaitu tentang pemenuhan kebutuhan bernapas normal. Penerapan EBN cold application dan latihan napas dan batuk untuk menurunkan tingkat nyeri pada pasien terpasang chest tube. Pelaksanaan proyek inovasi pengembangkan video edukasi monitoring dan perawatan di rumah pasien terpasang WSD sebagai media self-management bagi perawat ruang rawat dan pasien yang terpasang WSD. Hasil analisis praktik residensi keperawatan didapatkan bahwa asuhan keperawatan menggunakan pendekatan teori Henderson bertujuan untuk membantu sesegera mungkin kemandirian pasien. Penerapan cold application dan latihan napas dan batuk dapat menurunkan skor nyeri pasien terpasang chest tube. Proyek inovasi video edukasi monitoring dan perawatan di rumah pasien terpasang WSD sebagai media self-management meningkatkan pengetahuan perawat dan kemandirian pasien.

---

The practice of residency nursing conducted at RSUP Persahabatan with the specificity of respiration is expected to overcome respiratory problems. During the residency process apply interventions based on evidence-based nursing, be able to become a Clinical Care Manager (CCM) as a nursing staff consultant, and provide profesional nursing therapy. In providing nursing care in cases managed by patients with bronchiectasis and 30 resume cases using Henderson's theory 14 basic human needs that show the role of nurses as nursing care providers in helping individuals both in health and illness, through their efforts to carry out various activities to support the health and healing of individuals or the process of dying peacefully. Many nursing problems arise are about meeting the needs of normal breathing. Application of EBN cold application and breathing and coughing exercises to reduce pain levels in chest tube patients. The implementation of an innovation project to develop educational videos for monitoring and care at home of WSD-installed patients as a self-management medium for nurses, inpatient rooms and patients installed with WSD. The results of the analysis of nursing residency practice found that nursing care using Henderson's theoretical approach aims to help as soon as possible the independence of patients. The application of cold application and breathing and coughing exercises can reduce the pain score of patients attached to the chest tube. Educational video innovation project, monitoring and care at home installed with WSD as a self-management medium increases nurses' knowledge and patient independence."

"Professionalime ilmu keperawatan adalah bagian disiplin ilmu keperawatan sampai dengan keperawatan sub spesialisasi dimana perawat spesialis sebagai seorang perawat yang dipersiapkan melampaui level seorang perawat generalis yang berwenang untuk praktek sebagai spesialis dengan keahlian dalam cabang bidang keperawatan. Ners spesialis keperawatan medikal bedah dengan peminatan muskuloskletal berperan dalam perawatan kekhususan masalah dan kasus kelolaan yang berkaitan dengan orthopedi atau muskuloskletal. Tujuan utama memberikan asuhan keperawatan secara komprehensif pada pasien kasus Spinal Cord Injury dengan trauma melalui pendekatan keperawatan model teori self-care Orem. Asuhan berupa pengelolaan 1 kasus kelolaan uatam dan 30 resume yang terdiri 3 bagian kasus besar yaitu kasus Spine, ekstremitas atas, dan ekstremitas atas dengan menggunakan teori model keperawatan Self-Care Orem yang menekankan tentang kebutuhan perawatan diri. Pencegahan terjadinya luka tekan dengan pemberian Aloe vera gel sebagai bagian dari tindakan mandiri keperawatan berdasarkan bukti penelitian ilmiah. Proyek inovasi berupa pengkajian resiko DVT dengan menggunakan Autar Scale adalah bentuk pengembangan dari intervensi keperawatan untuk pencegahan resiko terjadinya DVT pada pasien dengan kasus muskuloskletal. Tujuan seluruh kegiatan yang dilakukan selama kegiatan residensi adalah mewujudkan asuhan keperawatan yang komprehensif berdasarkan bukti ilmiah terkini.

---

Professional expertise is part of the discipline of expertise up to sub-specialization where specialist nurses as nurses who are prepared go beyond the level of a generalist nurse who is classified to practice as a specialist with expertise in their field of expertise. Medical surgeon specialist nurses with specialization in musculoskeletal play a role in treating specific problems and managing cases related to orthopedics or musculoskeletal issues. The main goal is to provide comprehensive care assistance to patients with spinal cord injury cases with trauma through the Orem self-care model of therapy. The care is in the form of managing 1 main case and 30 resumes consisting of 3 major case sections namely the Spine, upper extremity and upper extremity cases using a theoretical model including Orem's Self Care who is depressed about the need for self-care. Prevention of pressure sores by administering Aloe Vera Gel as part of an independent act of kindness based on scientific research evidence. The innovation project in the form of DVT risk assessment using the Autar Scale is a form of developing interventions to prevent the risk of DVT in patients with musculoskeletal cases. The aim of all activities carried out during the residency activities is to realize comprehensive group care based on the latest scientific evidence."

"Analisis praktik residensi keperawatan medikal bedah ini merupakan karya ilmiah akhir Pendidikan Ners Spesialis yang bertujuan memberikan gambaran proses praktik residensi melalui pengelolaan kasus utama, kasus resume, penerapan evidence based nursing (EBN) dan proyek inovasi. Kasus utama yang dilaporkan adalah asuhan keperawatan pasien dengan tumor spinal menggunakan Model Adaptasi Roy (MAR) dengan diagnosis utama pada pre-operatif adalah nyeri kronik berhubungan dengan kompresi dan sensitisasi persepsi nyeri dan masalah keperawatan utama post-operasi adalah nyeri, gangguan mobilisasi fisik dan inkontinensia urine refleks. Sebanyak 30 kasus resume didapatkan rerata usia pasien adalah 52,40 (SD 14.51), mayoritas perempuan (53,3%), dan terbanyak dengan pendidikan menengah (56,7%). Masalah keperawatan terbanyak pada kasus resume adalah risiko perfusi serebral tidak efektif, gangguan mobilitas fisik, dan nyeri akut. Penerapan EBN yang dipilih adalah Implementasi Reduksi Mechanical Bowel Preparation pada Pasien yang Menjalani Pembedahan Elektif Tulang Belakang dan terbukti bahwa tidak memberikan dampak penurunan luaran klinis pasien sehingga dapat dilanjutkan untuk diterapkan. Proyek inovasi yang diimplementasikan secara berkelompok oleh mahasiswa residen adalah Penerapan Nurse-Led Early Mobilization pada Pasien Pasca Pembedahan elektif Tulang Belakang yang berdasarkan analisis situasi dapat dikembangkan dan diterapkan sebagai intervensi mandiri perawat.

---

This analysis of medical surgical nursing residency practice is the final scientific paper of specialist nurse education program which aims to provide an overview of the residency practice process through management of main cases, case resumes, implementation of evidence based nursing (EBN) and innovation projects. The main case reported was nursing care of patients with spinal tumors using the Roy Adaptation Model (MAR) with the main pre-operative diagnosis is chronic pain associated with compression and sensitization of pain perception and the main post-operative nursing problems are pain, impaired physical mobilization and incontinence reflex urine. In a total of 30 cases of resumes, the average age of the patients was 52.40 (SD 14.51), the majority were women (53.3%), and most of them had secondary education (56.7%). The most common nursing problems in cases of resumes are the risk of ineffective cerebral perfusion, impaired physical mobility, and acute pain. The chosen application of EBN is the Implementation of Mechanical Bowel Preparation Reduction in Patients Undergoing Elective Spine Surgery and it is proven that it has no benefit for the patient's clinical outcome so that it can be continued to be implemented. An innovation project implemented in groups by resident students is the Application of Nurse-Led Early Mobilization in Post-Elective Spine Surgery Patients which based on situational analysis can be developed and implemented as an independent nurse intervention."