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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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"[ABSTRAKAngka kematian ibu saat ini masih tinggi yang disebabkan karena komplikasi pada kehamilan dan persalinan, oleh karena itu perlunya peran tenaga kesehatan yang terkait termasuk perawat maternitas untuk memberikan pelayanan kesehatan profesional. Perawat spesialis maternitas dituntut mampu menjalankan perannya secara komprehensif. Laporan ini bertujuan untuk menggambarkan praktik residensi ners spesialis maternitas meliputi asuhan keperawatan pada masa prenatal, intranatal, dan postnatal normal dan berisiko serta bayi baru lahir normal dan berisiko, serta perempuan dengan masalah reproduksi dan ginekologi. Residen juga melakukan asuhan keperawatan dengan focus penerapan teori need for help dan comfort pada ibu bersalin dengan persalinan memanjang. Hasil menunjukkan bahwa kedua model efektif dapat diterapkan pada keenam kasus ibu bersalin dengan persalinan memanjang. Pencapaian kompetensi perawat spesialis maternitas dilakukan dengan penerapan peran perawat secara komprehensif.

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ABSTRACTMaternal mortality rate is still high due to pregnancy and labor complication, therefore the role of health professionals including maternity nurses is needed to provide a professional health care. Maternity nursing specialists are demanded to be able to perform their roles comprehensively. This report aimed to describe the residency practice of maternity nursing specialist including nursing care of normal and high risk prenatal, intranatal, and postnatal as well as normal and high risk newborns, and women with reproductive and gynecological problems. Resident also performed nursing care focused on the application of Wiedenbach Need for Help and Kolcaba Comfort Theory on intrapartum mothers with prolonged labor. Results showed that both models could be applied effectively to the six cases of intrapartum mothers with prolonged labor. The achievement of maternity nursing specialist competencies was conducted by the implementation of the nurse's roles comprehensively., Maternal mortality rate is still high due to pregnancy and labor complication, therefore the role of health professionals including maternity nurses is needed to provide a professional health care. Maternity nursing specialists are demanded to be able to perform their roles comprehensively. This report aimed to describe the residency practice of maternity nursing specialist including nursing care of normal and high risk prenatal, intranatal, and postnatal as well as normal and high risk newborns, and women with reproductive and gynecological problems. Resident also performed nursing care focused on the application of Wiedenbach Need for Help and Kolcaba Comfort Theory on intrapartum mothers with prolonged labor. Results showed that both models could be applied effectively to the six cases of intrapartum mothers with prolonged labor. The achievement of maternity nursing specialist competencies was conducted by the implementation of the nurse's roles comprehensively.]"

"Karya ilmiah akhir ini disusun sebagai laporan dari praktik residensi spesialis keperawatan Maternitas yang berfokus pada penerapan teori keperawatan Need for Help Wiedenbach dan Comfort Kolcaba pada asuhan keperawatan ibu yang mengalami partus lama Tujuan penulisan laporan ini untuk memberikan gambaran pelaksanaan praktik Spesialis Keperawatan Maternitas dalam menjalankan perannya sebagai pemberi pelayanan keperawatan edukator konselor advokat pengelola kolaborator komunikator dan koordinator agen perubah dan peneliti dalam memberikan asuhan keperawatan pada perempuan sepanjang periode kehidupannya dengan menerapkan teori keperawatan Aplikasi teori keperawatan need for help Wiedenbach dan Theory of Comfort Kolcaba efektif dilakukan pada enam ibu dengan partus lama Aplikasi teori tersebut berhasil membantu menyelesaikan masalah keperawatan dan meningkatkan kenyamanan klien selama persalinan Setelah melaksanakan praktik residensi spesialis keperawatan maternitas penulis mampu mencapai target kompetensi dengan baik Kata kunci asuhan keperawatan partus lama teori keperawatan 'comfort' teori keperawatan 'need for help'

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This final scientific report aimed to report the clinical practice of maternity nursing specialist which focus on the application of Wiedenbach's theory of the need for help and Kolcaba's theory of comfort in the nursing care to clients who experience prolonged labour The purpose of this report is to describe the implementation of maternity nursing specialist practices in their role as care giver educator counselor advocate collaborator communicator coordinator innovators and researchers The competencies also achieved through application of nursing theory in the nursing care The application of Wiedenbach's theory of need for help and Kolcaba's theory of comfort in the nursing care was effective to resolve client's health problem and increased the comfort of the mother during labour After finishing residential practice of maternity nursing specialist the competencies was achieved with a good result Keyword nursing process nursing theory of comfort nursing theory of need for help prolonged labour "

"Program residensi spesialis keperawatan maternitas dilakukan dalam rangka menerapkan peran dan fungsi perawat maternitas pada asuhan keperawatan secara profesional. Laporan ini bertujuan memberi gambaran pelaksanaan praktik residensi ners spesialis keperawatan maternitas, meliputi asuhan keperawatan sistem reproduksi perempuan normal dan resiko tinggi di klinik dan komunitas. Adapun kasus focus of interest yang dikelola selama melakukan praktik residensi adalah penerapan teori model keperawatan self care dan comfort pada ibu post partum dengan payudara bengkak, dengan tujuan kenyamanan disertai kemampuan merawat diri. Dengan demikian, penerapan teori model self care dan comfort merupakan pendekatan tepat untuk kenyamanan dan memandirikan klien. Residen membahas kesenjangan asuhan keperawatan dibandingkan teori, menguraikan peran dan fungsi perawat, mengemukakan hambatan serta dukungan pelaksanaan praktek residensi.

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Specialist maternity nursing residency program conducted in order to implement the roles and functions of nurses in the maternity nursing care in a professional manner. This report aims to illustrate the implementation of specialist nursing practice residency for nurses in maternity nursing specialist namely the nursing care for normal and high risk female reproductive system in clinic and community. The focus of interest case administered during a residency practice is the application of the theory of self care and comfort model of nursing in postpartum mothers with breast engorgement, with the goal of comfort with selfcare skills. Thus, the application of theoretical models of self care and comfort is the right approach to client’s convenience and self help. Resident discusses the gaps in nursing care compared to the theory, outlines the roles and functions of nurses, and exposes the barriers and support in the implementation of residency practice."

"Program MDGs mempuyai tujuan untuk meningkatkan kesehatan ibu dengan menurunkan angka kematian ibu (AKI) dan meningkatkan kesehatan reproduksi untuk perempuan pada tahun 2015. Oleh sebab itu pemerintah membuat berbagai program untuk mencapai tujuan MDGs tersebut. Persalinan dengan tindakan seksio sesarea dan tubektomi merupakan upaya tindakan untuk menyelamatkan kondisi ibu dan bayinya yang mengalami resiko, yang tidak bisa melahirkan dengan cara pervaginam. Kelahiran dengan seksio sesarea dapat beresiko terjadinya komplikasi 25 kali lebih besar dibanding persalinan pervaginam dan juga tindakan tubektomi dapat menimbulkan masalah psikososial pada ibu. Peran ners spesialis keperawatan maternitas sebagai pemberi perawatan, pendidik, konselor, koordinator, komunikator, advokat, agen perubahan dan peneliti sangat diperlukan untuk mengurangi terjadinya komplikasi akibat efek pembedahan seksio sesarea pasca partum dan melaksanakan perannya pada pelayanan keperawatan maternitas untuk membantu menurunkan AKI. Tujuan umum dari penulisan ini adalah memberikan gambaran kegiatan pelaksanaan praktek residensi Ners Spesialis Keperawatan Maternitas fokus pada kasus ibu postpartum seksio sesarea dan tubektomi dengan penerapan teori selfcare dan teori comfort. Aplikasi teori tersebut berhasil membantu permasalahan yang dialami pasien secara biopsikososial. Pelaksanaan praktek residensi spesialis keperawatan maternitas telah dilakukan sesuai kompetensi, sehingga mampu mencapai target kompetensi dengan baik.

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Program MDGs is to goals increase maternal health by reducing maternal mortality rate (MMR) and increase to reproductive health for women in 2015. Therefore government made programs to target The goals MDGs. Delivery by cesarean section and tubectomy are the attempts to save the state of the mother, who are in risk condition and cannot give vaginal delivery and the risky baby. Births by cesarean section can cause risk complications at 25 times than vaginal delivery, in the other hand tubectomy may cause psychosocial problem.

The role of maternity nursing specialist nurse as caregiver, educator, counselor, coordinator, communicator, advocate, the agent of change and researcher is needed to reduce the occurrence of complications due to the effects of postpartum cesarean surgery and do its role in maternity nursing services to contribute on reducing the MMR.

The purpose of this study was to depict the implementation of the nurses? residency practice of Maternity Nursing Specialist nurse which focuses on the case of Caesarean section and maternal postpartum tubectomy selfcare with the application of theory and the theory of comfort. The application of the theory succeeds in helping the problems experienced by the patient bio-psychosocially. Doing the practice of residency maternity nursing specialists have done appropriate competencies, so that able to achieve the competencies very well."

"Ketuban pecah prematur adalah suatu kondisi yang berhubungan dengan ketuban spontan pecah sebelum tanda-tanda persalinan aktif dibawah usia kehamilan 37 minggu. Ketuban pecah prematur dapat meningkatkan risiko komplikasi pada kesehatan ibu dan janin. Pengelolaan pada ibu hamil ketuban pecah prematur dengan mengaplikasikan teori Konservasi Levine dan Kenyamanan Kolcaba bertujuan untuk mempertahankan kehamilan sampai aterm dan mengatasi ketidaknyamanan. Pendekatan proses keperawatan mulai dari pengkajian sampai evaluasi  diterapkan  pada  kelima  ibu  hamil dengan  ketuban pecah prematur.  Beberapa  masalah keperawatan  yang  muncul  adalah  risiko  infeksi , risiko cidera  janin, kesiapan  peningkatan  kenyamanan, ansietas,  dan  peningkatan  support  sistem. Melalui  konservasi  energi,  konservasi  integritas  struktur,  konservasi  integritas personal dan konservasi integritas sosial kelima ibu hamil dengan ketuban pecah prematur dapat terhindar dari komplikasi  dengan  perawatan  konservatif.  Hasil  ini  dapat  digunakan  untuk  mengelola  ibu  hamil ketuban pecah prematur pada area maternitas.

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Preterm Premature Rupture of Membranes is a condition associated with spontaneous rupture before signs of active labor under 37 weeks of gestation. Premature rupture of membranes can increase the risk of complications in maternal and fetal health. Management of premature rupture of amniotic mothers by applying the theory of Levine Conservation and Comfort Kolcaba aims to maintain pregnancy to term and overcome discomfort. The nursing process approach from assessment to evaluation is applied to the five pregnant women with Preterm Premature Rupture Of Membranes. Some nursing problems that arise are the risk of infection, the risk of fetal injury, readiness for increased comfort, anxiety, and increased support for the system. Through energy conservation, structural integrity conservation, personal integrity conservation and social integrity conservation of five pregnant women with Preterm Premature Rupture Of Membranes can avoid complications with conservative care. This result can be used to manage pregnant women Preterm Premature Rupture Of Membranes in the maternity area."

"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."

"Perawat spesialis maternitas berperan dalam menurunkan Angka Kematian Ibu AKI akibat komplikasi kehamilan dan persalinan. Salah satu peran perawat adalah memberikan asuhan keperawatan yang komprehensif dengan mengidentifikasi dan mengatasi masalah pasien perdarahan post partum dengan pedekatan teori keperawatan. Penerapan model need for help Wiedenbach diterapkan pada fase akut untuk mefasilitasi ibu mengatasi masalah perdarahan yang dialami dan teori self care Orem diterapkan pada fase pemulihan untuk memfasilitasi pasien meningkatkan kemampuan dalam merawat dirinya. Lima kasus kelolaan pasien memiliki masalah yang berbeda beda sesuai hasil pengkajian model need for help Wiedenbach dan self care Orem. Kasus yang dilaporkan adalah pasien perdarahan post partum akibat retensio plasenta dengan keluhan perdarahan aktif, lemas, pusing. Masalah keperawatan yang ditemukan pada fase akut adalah perdarahan, kurang volume cairan, resiko gangguan perfusi jaringan, kecemasan, sedangkan masalah keperawatan pada fase pemeliharaan adalah defisit perawatan diri, risiko cidera, nyeri, kecemasan, dan berduka. Intervensi keperawatan yang dilakukan pada fase akut adalah untuk mengatasi masalah kegawatan dengan menghentikan perdarahan dan resusitasi cairan. Sedangkan intervensi keperawatan pada fase pemulihan adalah untuk meningkatkan kemandirian pasien dalam melakukan perawatan dirinya. Evaluasi yang didapatkan adalah perdarahan teratasi dan pasien mandiri dalam melakukan perawatan dirinya

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The Final Report of residential of Maternity Nursing Specialist which focus on application Theori of need for Help Wiedenbach and Self Care orem of Women with Post Partum Haemorhagae AbstrackMaternity nursing specialists have role in reducing maternal mortality due to complication of pregnancy and childbirth. One of the nurses 39 roles is to provide comprehensive nursing care by identifying and resolving patient problems with postpartum hemorrhage using nursing theories. The application of "the need for help" Wiedenbach theory in the acute phase is to facilitate mother in overcoming the bleeding problem and "the self care" Orem theory is applied in the recovery phase to facilitate patient having self care. Five cases of postpartum hemorrhage patients have different problems according to the results of "the need for help" theory of Wiedenbach and "self care" theory of Orem.

Reported cases were postpartum hemorrhage patients due to placental retention with active bleeding, weakness and dizziness complaints. Nursing problems found in the acute phase are bleeding, lack of fluid volume and risk of tissue perfusion disorders, while the problems in the recovery phase are self care deficits, risk of injury, pain, anxiety and grief. In the acute phase, nursing interventions is conducted to overcome emergency problem by stopping bleeding and fluid resusitation. While in the recovery phase, the nursing interventions is conducted to facilitate patients in doing self care. Evaluation obtained is bleeding resolved and having self care patients. "

"[ABSTRAKPelayanan keperawatan merupakan bagian integral dari pelayanan kesehatan dan masalah kesehatan reproduksi perempuan menjadi bagian yang tak terpisahkan dari sistim pelayanan kesehatan secara keseluruhan. Residen keperawatan maternitas dalam melaksanakan perannya dituntut mampu memberikan asuhan keperawatan sesuai dengan kebutuhan masyarakat di berbagai tatanan pelayanan kesehatan. Dalam upaya memberikan asuhan keperawatan, residen mengelola tujuh pasien dengan kista ovarium di dua rumah sakit yang berbeda dengan menggunakan pendekatan teori Adaptasi Roy. Dari ketujuh kasus tersebut, lima kasus jenis kista coklat dengan karakteristik munculnya keluhan dipengaruhi oleh siklus menstruasi dan dua kasus lain berjenis kista denoma. Dengan adanya berbagai perubahan dalam diri penderita kista ovarium, maka teori keperawatan Adaptasi Roy dianggap tepat diterapkan pada pasien dengan kista ovarium. Laporan akhir residensi juga memapartkan capaian 100% untuk target kompetensi pada tiga lahan praktek dan berusaha memodifikasi setiap hambatan yang ada selama pelaksanaan praktik residensi.

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ABSTRACTNursing service is an integral part of healthcare services and women's reproductive health problems become an integral part of the overall healthcare system. Maternity nursing resident in performing its role is demanded to provide nursing care in accordance with the needs of the community in a variety of healthcare structures. In providing nursing care, resident managed seven patients with ovarian cysts at two different hospitals using Roy Adaptation Theory approach. Of the seven cases, five cases were chocolate cyst type characterized by the emergence of complaints influenced by menstrual cycle and two other cases were denoma cyst. Since ovarian cysts patients experienced various changes, Roy Adaptation Nursing Theory was considered appropriate to be applied on patients with ovarian cysts. The final report also described the achievement of 100% of the target competencies in the three fields of practice and try to modify any existing obstacles during the residency practice., Nursing service is an integral part of healthcare services and women's reproductive health problems become an integral part of the overall healthcare system. Maternity nursing resident in performing its role is demanded to provide nursing care in accordance with the needs of the community in a variety of healthcare structures. In providing nursing care, resident managed seven patients with ovarian cysts at two different hospitals using Roy Adaptation Theory approach. Of the seven cases, five cases were chocolate cyst type characterized by the emergence of complaints influenced by menstrual cycle and two other cases were denoma cyst. Since ovarian cysts patients experienced various changes, Roy Adaptation Nursing Theory was considered appropriate to be applied on patients with ovarian cysts. The final report also described the achievement of 100% of the target competencies in the three fields of practice and try to modify any existing obstacles during the residency practice.]"

"Upaya untuk menurunkan AKI di Indonesia adalah menjamin setiap ibu mampu mengakses pelayanan kesehatan ibu yang berkualitas. Pada kondisi ibu dan janin dalam keadaan berisiko maka dilakukan tindakan bedah sesar untuk mencegah bahaya pada ibu dan bayi. Persalinan bedah sesar pada primipara memberikan efek baik fisik maupun psikologis. Peran ners spesialis keperawatan maternitas sebagai pemberi perawatan, pendidik, konselor, koordinator, advocate, agen pembaharu, peneliti, kolaborator sangat diperlukan dalam membantu pasien mengurangi efek yang terjadi. Tujuan dari penulisan ini adalah untuk memberikan gambaran tentang pelaksanaan praktik residensi Ners Spesialis keperawatan maternitas dengan berfokus pada aplikasi teori Self Care Orem dan Comfort Kolcaba pada ibu pasca bedah sesar primipara. Aplikasi teori ini telah membantu pasien memperoleh kenyamanan, menurunkan nyeri dan meningkatkan kemandirian pasien pasca bedah sesar melakukan perawatan diri dan bayi baru lahir.

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Efforts to reduce maternal mortality rate in Indonesia is to ensure that every mother is able to access quality maternal health services. On the condition of mother and fetus in risky circumstances, the action is taken of cesarean section to prevent harm mother and baby. Cesarean section delivery in primiparous provide both physical and psychological effects. The role of specialist nurses nursing maternity as a caregiver, educator, counselor, coordinator, advocate, agent reformer, researchers, collaborators is indispensable in helping patients reduce their effect.

The objective of this paper is to provide an overview of the implementation of specialist nurses practice nursing residency maternity by focusing on the application of the theory of Orem Self Care and Comfort Kolcaba maternal post cesarean section primiparas. Application of this theory has helped patients receive comfort and independence of postoperative cesarean perform self care and newborn. "