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"Ners spesialis adalah pemimpin klinis dalam bidang praktik keperawatan. Pengetahuan dan keterampilan tingkat lanjut sebagai Ners Spesialis ini mencakup keahlian klinis,  evidence based nursing, kolaborasi, konsultasi, pendidikan, pendampingan, dan perubahan kepemimpinan. Ners spesialis bertanggung jawab untuk berkolaborasi dengan anggota tim perawatan kesehatan untuk merancang, mengimplementasikan, dan mengukur strategi perawatan berbasis bukti yang aman, efektif biaya, dan terbukti. Kegiatan yang dilakukan dalam menjalani praktik residensi Ners Spesialis Keperawatan Medikal Bedah peminatan respirasi terdiri dari mengelola kasus kanker paru menggunakan model adaptasi Roy, mengelola tiga puluh resume kasus, melaksanakan evidence based nursing (EBN) efektifitas Foot Reflexologi terhadap tingkat kecemasan dan perubahan fisiologis pada pasien yang akan dilakukan tindakan Bronkoskopi, serta melakukan penerapan inovasi keperawatan penggunaan Respiratory Distres Observation Scale (RDOS) untuk menilai berat ringannya dispnea pasien dengan gangguan pernapasan.

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Specialist nurses are clinical leaders in the field of nursing practice. Advanced knowledge and skills as Ners Specialists include clinical expertise, evidence based nursing, collaboration, consultation, education, mentoring, and leadership change. Specialists are responsible for collaborating with members of the health care team to design, implement, and measure evidence-based care strategies that are safe, cost-effective and proven. Activities carried out in undergoing residency practice Ners Medical Nursing Specialists Respiratory specialization surgery consists of managing lung cancer cases using Roy`s adaptation model, managing thirty case resumes, implementing evidence based nursing (EBN) Foot Reflexology effectiveness against anxiety levels and physiological changes in patients who Bronchoscopy will be carried out, as well as implementing nursing innovations using the Respiratory Distres Observation Scale (RDOS) to assess the mild severity of dyspnea in patients with respiratory disorders."

"Analisis praktik residensi merupakan laporan rangkaian kegiatan Ners SpesialisKeperawatan Medikal Bedah dengan penerapan Model Adaptasi Roy pada prosesasuhan keperawatan pasien gangguan sistem pencernaan, penerapan praktikkeperawatan berdasarkan evidence based serta melakukan inovasi keperawatan.Pengkajian kasus utama terhadap pasien karsinoma gaster dan 30 kasus resume pasienbedah digestif, gastrointestinal serta hepatobilier berfokus pada respon adaptif darimodel adaptasi Roy. Pelaksanaan evidence based dilakukan untuk mengelolakecemasan pasien sebelum menjalani operasi bedah digestif sebanyak 8 orang, denganintervensi mendengarkan Al-Qur`an Surah Al Waqi’ah dan terjemahannya selama 30menit. Program inovasi keperawatan dilakukan, terhadap 7 orang pasien yangdirencanakan menjalani operasi kolostomi berupa optimalisasi pemberian edukasimelalui media video. Kesimpulan: mendengarkan Al-Qur`an Surah Al Waqi’ah danterjemahannya dapat menurunkan tingkat kecemasan pasien sebelum operasi danedukasi melalui media video terhadap pasien yang akan menjalani operasi kolostomidapat meningkatkan pengetahuan pasien yang sangat memengaruhi terhadap keputusanpersetujuan pasien menjalani operasi.

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The residency practice analysis is a series of reports on the activities of Surgical

Medical Nursing Specialists with the application of Roy's Adaptation Model in the

nursing care process of patients with digestive system disorders, the application of

evidence-based nursing practices and nursing innovations. Major case studies of gastric

carcinoma patients and 30 cases of digestive, gastrointestinal and hepatobiliary surgery

resumes focused on the adaptive response of Roy's adaptation model. Evidence based

implementation was carried out to manage the anxiety of patients before undergoing

digestive surgery as many as 8 people, with the intervention of listening to Al-Qur'an

Surah Al Waqi'ah and its translation for 30 minutes. Nursing innovation program

carried out, for 7 patients who were planned to undergo colostomy surgery in the form

of optimizing the provision of education through video media. Conclusion: listening to

Al-Qur'an Surah Al Waqi'ah and its translation can reduce the level of patient anxiety

before surgery and education through video media for patients who will undergo

colostomy surgery can increase patient knowledge which greatly influences the decision

of consent for patients undergoing surgery."

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Pendekatan teori keperawatan dalam pelaksanaan pemberian asuhan keperawatan merupakan salah satu tujuan dari pelaksanan program ners spesialis keperawatan medikal bedah. Teori keperawatan dapat diterapkan dalam berbagai masalah yang dihadapi oleh pasien, seperti halnya masalah pada pasien dengan gangguan sistim perkemihan. Pasien dengan masalah gangguan pada sistim perkemihan akan mengalami berbagai perubahan pada sistim keseimbangan tubuh, sehingga tubuh memerlukan suatu proses adaptasi. Pendekatan teori adaptasi Roy, melalui mekanisme koping, sistim regulator dan kognator dapat mengatasi perilaku adaptif maupun maladaptif yang dialami oleh pasien berdasarkan hasil pengkajian perilaku dan stimulus. Pelaksanaan penerapan Evidence Based Nursing: melalui pemberian intervensi keperawatan non farmakologi: Aerobic Exercise Intradialytic pada pasien Chronic Kidney Disease Stage V yang menjalani hemodialisis, terbukti dapat meningkatkan pencapaian adekuasi dialisis pasien. Hasil penerapan proyek inovasi penggunaan model the activated health education melalui media edukasi flipchart mengenai terapi pengganti ginjal terbukti berpengaruh dan mampu meningkat pengetahuan pasien mengenai terapi pengganti ginjal.

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The concept of nursing care implementation is one of the objectives medical nursing specialist medical programs. Nursing theory can be applied to various problems issued by patients, as well as problems in patients with urinary system problems. Patients with problems in the urinary system will be changes in the bodys balance system, so the body needs an adaptation process. Roys adaptation theory, through coping regulations, regulator and kognator system can overcome the adaptation and maladaptive problems needed by patients based on the results of behavioral and stimulus assesment. Nursing-Based Evidence Implementation: through the implementation of non-pharmacological nursing interventions: Intradialytic Aerobic Exercise in patients with Chronic Kidney Disease Stage V on hemodialysis, can improve patient dialysis adequacy. The model of health education application the activated through flipchart education media on kidney prevention therapy has been able to increase patient knowledge about kidney therapy.

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"Praktik residensi keperawatan medikal bedah adalah bagian dari pendidikan profesi yang mempunyai tujuan untuk menghasilkan perawat spesialis. Perawat spesialis diharapkan dapat melaksanakan perannya dalam memberikan pelayanan keperawatan pada kasus dengan gangguan sistem pernapasan. Peran tersebut sejalan dengan kompetensi yang harus dicapai selama praktik residensi berupa pemberian asuhan keperawatan, penerapan praktik keperawatan berbasis bukti dan proyek inovasi. Pemberian asuhan keperawatan diterapkan kepada satu pasien kelolaan utama dengan kasus PPOK dan 30 kasus resume menggunakan pendekatan model adaptasi Roy. Penerapan tindakan keperawatan berbasis bukti ilmiah yang dilakukan yaitu pemberian posisi condong kedepan dan Latihan nafas pursed lips breathing pada pasien dyspnea dengan penyakit paru. Proyek inovasi yang diterapkan yaitu Pengembangan Self Manajemen Dengan Video Latihan Breathing Exercise : ACBT Dalam Meningkatkan Airway Clearance Pada Pasien Dengan Penyakit Paru Obstruksi Kronis (PPOK). Hasil analisis praktik menunjukkan bahwa model adaptasi Roy dapat digunakan sebagai pendekatan dalam asuhan keperawatan pasien dengan gangguan sistem pernapasan untuk mengembangkan mekanisme adaptif pasien. Pemberian posisi condong kedepan dan Latihan nafas pursed lips breathing dapat menurunkan sesak napas pada pasien dengan penyakit paru. Selain itu, Latihan Breathing Exercise : ACBT Dalam Meningkatkan Airway Clearance Pada Pasien mendapat evaluasi yang positif dan dapat diterapkan di tatanan klinis sebagai inovasi pengkajian dan manajemen keperawatan mandiri pada pasien PPOK selama di rumah.

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Medical surgical nursing residency practice is part of professional education that aims to produce specialist nurses. Specialist nurses are expected to carry out their role in providing nursing services in cases with respiratory system disorders. The role is in line with the competencies to be achieved during residency practice in the form of providing nursing care, implementing evidence-based nursing practice and innovation projects. Nursing care was applied to one primarily managed patient with a case of COPD and 30 resume cases using Roy's adaptation model approach. The application of scientific evidence-based nursing actions carried out is the provision of a forward leaning position and pursed lips breathing exercises in dyspnea patients with lung disease. The innovation project applied is the Development of Self Management with Video Breathing Exercise: ACBT in Increasing Airway Clearance in Patients with Chronic Obstructive Pulmonary Disease (COPD). The results of the practice analysis show that Roy's adaptation model can be used as an approach in nursing care of patients with respiratory system disorders to develop patient adaptive mechanisms. Forward leaning and pursed lips breathing exercises can reduce shortness of breath in patients with lung disease. In addition, Breathing Exercise: ACBT in Increasing Airway Clearance in Patients received a positive evaluation and can be applied in clinical settings as an innovation in self-assessment and nursing management in COPD patients while at home."

"[ABSTRAKPraktik Spesialis Keperawatan Medikal Bedah Kekhususan Respirasi di RSUP Persahabatan Jakarta bertujuan untuk mengaplikasikan peranners spesialis da1am mengelola pasien dengan gangguan sistem respirasi melalui pendekatan Model Adaptasi Roy (MAR). Seorang ners spesialis memiliki target memberikan asuhan keperawatan sebanyak 30 pasien sebagai resume dan 1 pasien sebagai laporan kelolaan utama pada pasien kanker paro. Peran ners spesialis juga menerapkan tindakan keperawatan berbasis bukti ilmiah (evidence based musing practice) dengan memberikan latihan progressive muscle relaclation (PMR) dalam mengontrol breathlessness pada pasien kanker peru, Selain itu ners spesialis sebagai pembaharu melakukan inovasi Water Seal Drainoge (WSD) Pionir 1 botol, etas dasar aspek estetika, quality and safety guna meningkatkan kualitas pelayanan keperawatan dan rumah sakit. Hasil praktik menunjukkan bahwa MAR. Efektif digunakan pada pasien dengan gangguan sistem respirasi dan PMR memiliki kecenderungan mengon1ro1 breathlessness pada pasien kanker pam dan kegiatan inovasi mendapat respon positif dari pibak rumah sakit untuk menjadi agenda penelitian bersama.

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ABSTRACTSurgical Nursing Residency Practice in Respiratory Speciality aims to apply of nurse specialist in caring and supervising respiratory disorders patients through Roy Adaptation Model (RAM) approach at Persahabatan Hospital Jakarta. A nurse specialist has a target to give nursing care to thirty patients as resume and one lung cancer case as primary patient. The other role of nurse specialist is implementing evidence based nursing practice by providing Progressive Muscle Relactation (PMR) exercise in terms of controlling breathlessness especially to lung cancer patient. Furthermore, the other role of nurse specialist is to be an innovator and a change agent on Water Seal Drainage (WSD) Pioneer program based on aesthetic, quality, and safety aspect in order to improve nursing and hospital services. The result shows that RAM is effective to respiratory disorders patients and PMR tends to control breathlessness of lung cancerpatients. Conclusion, this innovative activity gels a positive response from the hospital to be a joint researchagenda., Surgical Nursing Residency Practice in Respiratory Speciality aims to apply of nurse specialist in caring and supervising respiratory disorders patients through Roy Adaptation Model (RAM) approach at Persahabatan Hospital Jakarta. A nurse specialist has a target to give nursing care to thirty patients as resume and one lung cancer case as primary patient. The other role of nurse specialist is implementing evidence based nursing practice by providing Progressive Muscle Relactation (PMR) exercise in terms of controlling breathlessness especially to lung cancer patient. Furthermore, the other role of nurse specialist is to be an innovator and a change agent on Water Seal Drainage (WSD) Pioneer program based on aesthetic, quality, and safety aspect in order to improve nursing and hospital services. The result shows that RAM is effective to respiratory disorders patients and PMR tends to control breathlessness of lung cancerpatients. Conclusion, this innovative activity gels a positive response from the hospital to be a joint researchagenda.]"

"Praktek Spesialis Keperawatan merupakan bagian penting dari pendidikan profesi dalam rangka mengaplikasikan peran perawat spesialis untuk meningkatkan kualitas pelayanan. Praktek spesialis keperawatan dilakukan dan dikembangkan berdasarkan ilmu dan teknologi. Kompetensi yang harus dicapai selama praktek residensi keperawatan medikal bedah adalah memberikan asuhan keperawatan dengan menggunakan teori model keperawatan, penerapan tindakan keperawatan berbasis bukti ilmiah (evidence based nursing practice) dan melakukan proyek inovasi. Peran sebagai pemberi asuhan keperawatan, residen melakukan asuhan keperawatan dengan menggunakan pendekatan teori Model Adaptasi Roy pada  30 pasien dengan gangguan sistem respirasi. Target kompetensi dalam hal penerapan tindakan keperawatan berbasis bukti ilmiah adalah penerapan terapi akupresur untuk mengurangi mual muntah pada pasien kanker paru yang menjalani kemoterapi.Hasil penerapan menunjukkan bahwa akupresur efektif mengurangi mual muntah pada pasien kanker paru yang menjalani kemoterapi. Peran selanjutnya sebagai innovator, proyek inovasi yang dilakukan berupa penggunaan mobile phone application untuk pengkajian dan manajemen keperawatan mandiri pada pasien kanker paru. Hasil penerapan menunjukkan bahwa mobile phone application bermanfaat bagi pasien dalam manajemen gejala secara mandiri.

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Nursing Specialist Practice is an important part of professional education in order to apply the role of specialist nurses to improve service quality. Nursing specialist practice is carried out and developed based on science and technology. Competency that must be achieved during the residency practice of surgical medical nursing is to provide nursing care using the theory of nursing models, application of scientific evidence-based nursing practice, and do innovation projects. Role as a provider of nursing care, resident carries out nursing care using the Roy Adaptation Model theory approach in 30 patients with respiratory system disorders. The competency target in the application of scientific evidence-based nursing actions is the application of acupressure therapy to reduce nausea and vomiting in lung cancer patients undergoing chemotherapy.

The results of the application showed that acupressure effectively reduced nausea and vomiting on patients with lung cancer undergoing chemotherapy. The next role as an innovator, innovation projects carried out in the form of the use of mobile phone applications for the assessment and management of independent nursing on patients with lung cancer. The results of the application show that mobile phone applications are beneficial for patients in symptom management independently."

"Pendahuluan:perforasi ileum merupakan suatu kegawatdaruratan dalam sistem gastrointestinal. Perforasi ileum terjadi akibat tumor ileum. Tujuan:untuk menampilkan asuhan keperawatan, penerapan evidence based nursing dan proyek inovasi. Peran perawat spesialis sebagai pemberi asuhan keperawatan lanjut, edukator, advokat, konselor, kolaborator, pembaharu dan peneliti. Metode:karya ilmiah ini menggunakan pendekatan studi kasus. Hasil: ada 1 kasus utama yaitu perforasi massa ileum dan 30 kasus resume sistem gastrointestinal dan hepatobilier. Ada 2 pasien dilakukan penerapan evidence based nursing practice mengunyah permen karet. Adanya efektifitas dari pemberian mengunyah permen karet untuk meningkatkan motilitas usus. Program inovasi kelompok berupa panduan peningkatan pemulihan setelah operasi enhanced after recovery surgery pada pasien yang menjalani pembedahan sistem pencernaan berupa pemberian maltodekstri sebelum operasi yaitu berjumlah 2 pasien, dan mobilisasi dini post operasi berjumlah 4 orang serta mengunyah permen karet setelah operasi berjumlah 2 orang. Kesimpulan: perilaku maladaptif pasien Tn.SMS yaitu gangguan body image. Mengunyah permen karet dapat meningkatkan motilitas usus, pemberian maltodektsrin pre operasi dapat mengurangi mual dan muntah serta nyeri post operasi dan mobilisasi dini 2 jam post operasi dapat mengurangi nyeri bahu pasien.

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Analysis of Medical Surgical Nursing Residency Practice and Case Study of Nursing Care Delivery on Patient with Perforated Ileal Mass Using Roy Adaptation Model RohmaniJuly 2018 Introduction: ileal perforation is an emergency in the gastrointestinal system. Perforation of ileum occurs due to ileal tumors. Purpose: to present nursing care, the application of evidence-based nursing and innovation projects. The role of specialist nurse as a nursing care nurse, educator, advocate, counselor, collaborator, reformer and researcher. Method: This paper uses a case study approach. Results: There were 1 major cases of ileal mass perforation and 30 cases of gastrointestinal and hepatobilier resume systems. There were 2 patients conducted the application of evidence based nursing practice chewing gum. The effectiveness of chewing gum to increase bowel motility. The group innovation program is an enhanced after recovery surgery guideline for patients undergoing gastrointestinal surgery in the form of preoperative maltodextrine, 2 patients, and postoperative early mobilization of 4 people and chewing gum after surgery of 2 people. Conclusion: maladaptive behavior of patient of Mr.SMS are body image disorder. Chewing gum can improve bowel motility, preoperative maltodextrine administration may reduce nausea and vomiting and postoperative pain and early mobilization 2 hours postoperatively may reduce shoulder pain of the patient. Key words: Roy adaptation model, Tumour of Ileum, Chewing Gum, Maltodextrin, D early mobilization, Enhanced recovery After Surgery. "

"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 tumor otak 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 ceredral. Penerapan EBN respiratory muscle training (RMT) pada tiga pasien stroke menunjukkan keefektifan RMT dalam meningkatkan fungsi pernafasan pasien stroke. Program inovasi keperawatan berupa penerapan program pencegahan kejadian jatuh pada pasien neurologi di rawat inap.

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Advance clinical practice in neurological system during residency period is proposed to be able to provide nursing care, implement the evidence based nursing (EBN) and be able to act as innovator in the treatment room. The role of nurse care provider was made using Roy`s adaptation model in patients with brain tumor and 30 other patients with various neural system disorders. The most maladaptive behavior is the physiological adaptation mode is the ineffective cerebral tissue perfusion, The nursing management intervention was cerebral edema management to improve patient adaptation in enchancing cerebral tissue perfusion. Implementation of EBN: respiratory muscle training (RMT) in three patients with stroke can improve the respiratory function of the stroke patients. Implementation of the fall prevention program can be used for prevent the patient`s fall risk."

"Penyakit Paru Obstruksi Kronis (PPOK) merupakan penyakit paru yang menetap yang dapat dicegah dan diobati, ditandai dengan adanya keterbatasan aliran udara yang menetap dan bersifat progresif dikarenakan abnormalitas saluran napas dan/atau alveolus yang biasanya disebabkan oleh pajanan gas atau partikel berbahaya. Laporan ini dimaksudkan untuk menganalisis pemberian Asuhan Keperawatan dengan penerapan Model Adaptasi Roy pada pasien kelolaan utama dan 30 pasien resume dengan menggunakan metode studi kasus, laporan tentang penerapan latihan pernapasan untuk mengurangi sesak dan meningkatkan toleransi aktivitas pada pasien PPOK dan penerapan RDOS untuk menilai tanda-tanda distres pernapasan. Hasil menunjukkan masalah keperawatan yang muncul adalah hambatan pertukaran gas, nutrisi kurang dari kebutuhan tubuh, ketiddakberdayaan dan ketidakefektifan manajemen kesehatan. Model Adaptasi Roy dapat diterapkan dalam asuhan keperawatan pada pasien PPOK untuk mampu beradaptasi terhadap penyakitnya.

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Chronic Obstructive Pulmonary Disease (COPD) is a persistent lung disease that can be prevented and treated, characterized by limited persistent and progressive air flow due to airway abnormalities and / or alveoli which is usually caused by exposure to harmful gases or particles. This report aims to analyze the apllication of Roy Adaptation Model to primary care nursing and the 30 patient resumes using case study methods, the application of respiratory training to reduce dispnea and increase activity tolerance in COPD patients and the application of RDOS to assess the signs of respiratory distress. The results showed nursing problems arise were impaired gas exchange, imbalanced nutrition less than body requirements, powerlessness and ineffective health management. Roy  Adaptation Model can be applied in nursing care for patients with COPD  to adapted the ability of their the disease."

"Kanker paru merupakan penyakit kanker yang paling mematikan dan sering terjadi pada laki-laki. Dalam melakukan asuhan keperawatan kanker perlu dilakukan pendekatan teori. Karya ilmiah akhir yang dibuat saat melakukan residensi keperawatan medikal bedah kekhususan onkologi dilakukan di rumah sakit kanker Dharmais Jakarta meliputi analisis residensi kanker paru dengan pendekatan teori Self Care Orem, penerapan Evidence Based Nursing efektifitas pemberian aromaterapi lavender fleur oil terhadap penurunan kecemasan pada pasien kanker payudara yang akan dilakukan pembedahan dan kegiatan proyek inovasi tentang format pengkjian khusus pada luka kanker dengan menggunakan Malignant Wound Assesment Tools MWAT. Kesimpulan teori Self Care Orem mampu dilakukan pada pasien kanker paru. Intervensi lavender fleur oil dapat menurunkan kecemasan sembelum dilakuakan pembedahan payudara dan format pengkajian MWAT dapat diterapkan dalam pengkajian pasien dengan luka kanker.

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Lung Cancer is the most deadly cancers, and often occurs in men. In doing cancer nursing care necessary theoretical approach. The scientific work of late made while doing a residency medical surgical nursing specificity oncology conducted in a cancer hospital Dharmais Jakarta include analysis residency lung cancer with the theoretical approach of Self Care Orem, application of Evidence Based Nursing effectiveness of aromatherapy lavender fleur oil to decrease anxiety in patients with breast cancer will do the surgery and about the innovation project activity pengkjian format specifically on cancer by using Malignant wounds wound Assessment Tools MWAT. Conclusions Self Care Orem theory capable performed in patients with lung cancer. Intervention fleur lavender oil can reduce anxiety sembelum dilakuakan breast surgery and format MWAT assessment can be applied in the assessment of patients with cancer sores."