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"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

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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.

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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."

"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 Reccurrent nonsustained VT, anterior RVOT origin, stable ec. idiopathic dd/ brady induced VT (short-long-short sequence) G1, hamil 7 minggu, blighted ovum anembryonic pregnancy dan 30 kasus resume. Penerapan Evidance Based Nursing (EBN) dengan menggunakan intervensi pemberian early oral hydration untuk mengurangi postoperative thirsty pada pasien bedah kardiovaskular. Residensi juga melakukan inovasi keperawatan dalam melakukan asuhan keperawatan pada pasien CHF dengan masalah intoleransi aktifitas yaitu penerapan aplikasi 6MWD berbasis web dan android sebagai test untuk mengukur kemampuan kapasitas fungsional dalam melakukan aktifitas fisik dan latihan fisik sehingga pasien dan perawat mengetahui jenis rekomendasi aktifitas fisik dan latihan fisik saat discharge planning.

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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 Reccurrent nonsustained VT, anterior RVOT origin, stable ec. idiopathic dd/ brady induced VT (short-long-short sequence) G1, 7 weeks pregnancy,blighted ovum anembryonic pregnancy and 30 cases resumed. Evidence Based Nursing (EBN) implemented with early oral hydration to reduce postoperative thirst in cardiovascular surgery patients. The residency also made innovations in web android based, namely the 6mwd in CHF applications which can measure functional capacity in carrying out physical activities and physical exercise so that patients and nurses know the types of recommendations for physical activity and physical exercise. during discharge planning."

"Program spesialis keperawatan harus mampu memberikan kebutuhan bio-psiko-sosial- spiritual secara holistik, memberikan rasa aman dan nyaman, mengutamakan keselamatan pasien, mengelola asuhan keperawatan dengan trampil dan inovatif dan mengupayakan promotive, preventif, kuratif dan rehabilitative, serta melakukan riset berbasis bukti klinik serta menjawab pertanyaan sain, teknologi sesuai dengan bidang spesialisnya. Kompetensi yang harus dipenuhi meliputi tiga hal yaitu pemberian asuhan keperawatan pada pasien kelolaan utama dan resume, kemudian menerapkan Eviden Based Nursing (EBN)dan pembuatan proyek inovasi terkait kebutuhan pasien dan lahan praktik. Penerapan teori keperawatan Virginia Henderson dipilih sebagai teori dalam memberikan asuhan keperawatan pada kasus kelolaan utama di ruang rawat untuk dapat membantu pasien dalam mencapai kemandiriannya terhadap kesehatan dan pemulihannya dan 30 kasus resume pasien HIV/AIDS dengan berbagai infeksi oportunistik. Sebagai peneliti, mahasiswa residensi mengaplikasikan Teknik Jacobson’s Progresive Muscle Relaxation (JPMR) dan hasilnya menunjukkan bahwa JPMR dapat menurunkan Tingkat kecemasan dan depresi pada pasien HIV di poliklinik Wijaya Kusuma. Sedangkan sebagai innovator, telah dilakukan inovasi edukasi dan informasi melalui optimalisasi teknologi digital dalam meningkatkan kepatuhan minum obat ARV pada pasien HIV/AIDS melalui web page, flayer yang dapat diberikan melalui daring dan luring serta banner dan kode kris. Dan hasil penerapan proyek inovasi menunjukkan hasil yang signifikan terhadap peningkatan pengetahuan dan sikap terhadap kepatuhan dalam minum obat pada ODHA.

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Nursing specialist programs must be able to provide holistic bio-psycho-social-spiritual needs, provide a sense of security and comfort, prioritize patient safety, manage nursing care skillfully and innovatively and make promotive, preventive, curative and rehabilitative efforts, as well as conducting clinical evidence-based research as well as answering science and technology questions according to their specialist field. The competencies that must be met include three things, namely providing nursing care to primary care patients and resumes, then implementing Evidence Based Nursing (EBN) and creating innovation projects related to patient needs and practice areas. The application of Virginia Henderson's nursing theory was chosen as a theory in providing nursing care to primary management cases in the ward to be able to help patients achieve independence regarding their health and recovery and 30 resume cases of HIV/AIDS patients with various opportunistic infections. As researchers, residency students apply the Jacobson's Progressive Muscle Relaxation (JPMR) technique and the results show that JPMR can reduce levels of anxiety and depression in HIV patients at the Wijaya Kusuma polyclinic. Meanwhile, as an innovator, he has carried out educational and information innovations through optimizing digital technology to increase adherence to ARV medication in HIV/AIDS patients through web pages, flayers that can be provided online and offline as well as banners and crisis codes. And the results of implementing the innovation project show significant results in increasing knowledge and attitudes towards medication adherence among PLWHA."

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Praktik ilmu keperawatan didasarkan hasil riset dan inovasi terbaru. Kualitas asuhan keperawatan ditentukan dari level pendidikan perawat. Perawat spesialis keperawatan medikal peminatan sistem kardiovaskuler berperan pemberi asuhan, edukator, peneliti, dan inovator. Praktik residensi Ners spesialis dilaksanakan selama 2 semester yang bertujuan melakukan peran ners spesialis dengan pendekatan konservasi. Asuhan keperawatan pada gangguan sistem kardiovaskuler menggunakan pendekatan model konsep konservasi Myra Estrin Levine. Asuhan keperawatan pada 30 kasus resume dan 1 kasus utama pada ADHF. Active Cycle of Breathing Technique (ACBT) diterapkan pada pasien paska bedah jantung untuk pemulihkan fungsi paru paska bedah jantung. Proyek inovasi rehabilitasi jantung fase I pada pasien sindrom koroner akut untuk pemulihan toleransi aktivitas. Hasil analisis praktik bahwa model konsep konservasi efektif diterapkan pada gangguan sistem kardiovaskuler untuk mempertahankan konservasi holistik, ACBT mampu memulihkan fungsi paru pasien paska bedah jantung, dan penerapan rehabilitasi jantung fase I mampu toleran terhadap aktivitas, dan standard prosedur operasional dapat dipahami, mudah dilaksanakan oleh pasien dan perawat.

The nursing science practice is based on research results and the most current innovations. The quality of nursing care is determined by the nurses education level. Nurses of medical surgical nursing specialist, whose specialty are for cardiovascular system disorder, have some roles which are as a care provider, educator, researcher, and innovator. The clinical residency practice is conducted for 2 semesters and aims to implement the roles of specialist nurse by applying a conservation model approach. The nursing care on cardiovascular system disorders is using Myra Levine Conservation model approach to 30 patients with various cardiovasculer disorders, which the primary case is ADHF. The active cycle of breathing technique is applied to postoperative cardiac surgery patients for pulmonary function recovery after a cardiac surgery. The phase I of cardiac rehabilitation is applied to acute coronary syndrome patients for activity tolerance recovery. The analysis practice result shows  that the conservation model might be applied effectively to the nursing care for cardiovasculer disorders in order to maintain a holism conservation. The active cycle of breathing technique is able to aid pulmonary function recovery post cardiac surgery and the phase I of cardiac rehabilitation is able to aid for activities tolerance, and the standard operating procedures is able to be easily understood and implemented by the patients and nurses."

"Kecemasan dan nyeri merupakan masalah paling umum pada pasca operasi bedah jantung terbuka. Kedua hal tersebut akan menimbulkan efek negatif seperti meningkatkan penggunaan analgetik, komplikasi paru, gangguan tidur, waktu penyembuhan luka, lama serta biaya perawatan rumah sakit. Pranayama alternate nostril breathing merupakan terapi non-farmakologi yang dapat menurunkan kecemasan dan nyeri pasca bedah jantung. Evidence based nursing practice (EBNP) bertujuan menilai pengaruh pranayama alternate nostril breathing terhadap kecemasan dan nyeri pada pasien pasca bedah jantung. Subjek penelitian sebanyak 44 orang dibagi menjadi kelompok intervensi sejumlah 22 orang dan kelompok kontrol 22 orang. Kelompok intervensi mendapat perlakuan pranayama alternate nostril breathing sedangkan kelompok kontrol berupa relaksasi napas dalam. Penilaian kecemasan menggunakan The State-Trait Anxiety Inventory (STAI) sedangkan penilaian nyeri menggunakan Visual Analog Scale (VAS) 0-100 mm. Uji statistik penelitian menggunkan analisis bivariat dengan uji paired t test dan independent t test. Hasil penelitian menunjukkan pranayama alternate nostril breathing dapat menurunkan intensitas kecemasan dan nyeri pada kelompok intervensi (p-value <0,05) dibandingkan kelompok kontrol. Pranayama alternate nostril breathing merupakan intervensi non-farmakologi dalam menurunkan kecemasan dan nyeri pasien pasca bedah jantung yang bersifat sederhana, murah, efektif, efesien, dan fleksibel. Penelitian lanjutan perlu dilakukan dengan menggunakan sampel lebih besar serta instrumen penilaian kecemasan pasca operasi yang lebih spesifik.

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Anxiety and pain are the most common problems after open heart surgery. Both of them causes negative effects such as increasing the use of analgesics, pulmonary complications, sleep disturbances, wound healing time, hospital length of stay and cost. Pranayama alternate nostril breathing is a non-pharmacological therapy that can reduce anxiety and pain in post-cardiac surgery patients. Evidence based nursing practice (EBNP) aims to assess the effect of Pranayama alternate nostril breathing on anxiety and pain in post-cardiac surgery. The subjects were 44 people who divided into an intervention group of 22 people and a control group of 22 people. The intervention group received Pranayama alternate nostril breathing while the control group was get deep breathing relaxation. The State-Trait Anxiety Inventory (STAI) was used for anxiety assessment while the Visual Analog Scale (VAS) for pain assesment. The statistic test used bivariate analysis with paired t test and independent t test. Pranayama alternate nostril breathing could reduce the intensity of anxiety and pain in the intervention group (p-value <0.05) compared to the control group. Pranayama alternate nostril breathing is a non-pharmacological intervention for reducing anxiety and pain in post-cardiac surgery patients that is simple, inexpensive, effective, efficient, and flexible. Further research needs to be done using a larger sample and a more specific postoperative anxiety assessment instrument."

"ABSTRAK Saat ini perkembangan ilmu dan pengetahuan keperawatan akan kesehatan beriringan dengan usaha untuk meningkatkan pelayanan bagi pasien. Tingginya prevalensi kasus kardiovaskuler menjadi perhatian sekaligus tantangan bagi tenaga kesehatan dalam memberikan pelayanan dan melakukan program pencegahan. Perawat diharapkan berkontribusi dalam upaya penanganan dengan menjalankan peran sebagai pemberi asuhan, pendidik, peneliti, dan inovator. Peran sebagai pemberi asuhan keperawatan dan pendidik diterapkan pada 31 pasien dengan berbagai kasus kardiovaskuler baik medikal maupun surgical. Pendekatan teori model yang digunakan adalah teori Self Care Dorothea Orem. Peran sebagai pendidik tidak hanya dijalankan untuk pasien dan keluarga, tetapi juga dijalankan dengan melakukan journal reading bagi rekan sejawat. Hasil analisis praktik menunjukkan bahwa teori Self Care dapat diterapkan pada asuhan keperawatan pada pasien dengan gangguan kardiovaskuler. Peran sebagai peneliti dilakukan pada saat penerapan tindakan keperawatan berbasis bukti ilmiah, dengan intervensi Progressive Muscle Relaxation PMR untuk mengatasi fatigue. Hasil penerapan didapatkan bahwa PMR dapat menurunkan level fatigue. Peran sebagai inovator dijalankan dengan menyusun Form Discharge Planning, dengan hasil evaluasi didapatkan bahwa form layak untuk digunakan. Kata kunci: praktik residensi, keperawatan medikal bedah, kardiovaskuler, teori Self Care Dorothea Orem, Progressive Muscle Relaxation, fatigue, Discharge Planning ABSTRACT Nowadays development of nursing science in line with the effort to improve patient rsquo s service. The high prevalence of patients with cardiovascular diseases makes a concern as well as a challenge for health provider to give treatments and prevention programs. Nurses are expected to contribute in health services by performing their roles as a care provider, educator, researcher, and innovator. The role as a care giver and educator was applied in 31 patients with various case in medical and surgical cases. The nursing theory model approach used is Dorothea Orem 39 s Self Care Theory. The role as a educator not only perfomed by educating patients and family, but also doing reading journal for other nurses. The analysis showed that Dorothea Orem 39 s Self Care Theory can be applied in nursing care to patients with cardiovascular diseases. The role as a researcher was excuted by applying evidence based nursing practice with the topic is Progressive Muscle Relaxation PMR to resolve fatigue. The analysis showed that PMR can decrease fatigue level. As a innovator, the practician trying to created Discharge Planning Form, with the evaluation showed that the form is acceptable. Keywords Recidency practise, medical surgical nursing, cardiovascular, Dorothea Orem 39 s Self Care Theory, Progressive Muscle Relaxation, fatigue, Discharge Planning "