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"Karya Ilmiah Akhir ini merupakan laporan dari rangkaian kegiatan praktik residensi Ners Spesialis Keperawatan Medikal Bedah, dengan penerapan Teori Virginia Henderson pada proses keperawatan pasien gangguan sistem kardiovaskular, penerapan praktik keperawatan berdasarkan pembuktian, dan melakukan inovasi keperawatan. Pengkajian pasien dengan teori Virginia Henderson berfokus pada 14 kebutuhan dasar pasien. Dimana kebutuhan pasien sama dengan kebutuhan pada manusia sehat umumnya. Asumsi utama dalam teori Orlando sesuai dengan konsep utama yaitu person (manusia), kesehatan dan keperawatan dan lingkungan. Kebutuhan untuk dibantu (diagnosis keperawatan) yang umum terjadi pada pasien antara lain : penurunan curah jantung, gangguan pertukaran gas, inefektif bersihan jalan napas, risiko perdarahan, nyeri akut dan risiko infeksi. Pelaksanaan praktik keperawatan berdasarkan pembuktian, dilakukan untuk pengelolaan kecemasan pada pasien ACS. Intervensi dilakukan dengan memberikan stimulasi murottal Al-Qur`an dengan durasi 30 menit. Pelaksanaan inovasi keperawatan berupa optimalisasi pemberian asuhan keperawatan dimensi spiritual pasien dengan gangguan sistem kardiovaskular di ICVCU RSJPDHK.

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This scientific work is report from series of practice residency Nurse Medical Surgical Nursing Specialist, by implementing The Virginia Henderson`s Theory at nursing process with cardiovascular disorder, implementation of nursing practical based on evidence and making innovation in nursing. Assessment to patient with Virgini Henderson`s Theory was focusing fourteen  basic patient  needs. Where are same basic need of patients with healthy human needs. The assumption in Virginia Henderson`s theory according with the main concept, i.e person (human), environment, health and nurse. The need to get help (diagnostic of nursing) generally happened to patient, i.e.: decreased of cardiac output, impaired gas exchange, ineffective airway clearance, risk of hemorrhage, acute pain, and risk for infection. Implementation of nursing practical based on evidence, has to done to reducing patient anxiety Acute Coronary Syndrome. Intervention was done Al-Qur`an stimulation up to 30 minutes. Implementation of nursing innovation in form of optimization of the spiritual dimension of nursing care at patient with Cardiovascular`s system disorder in cardiovascular Hospital Harapan Kita Jakarta."

"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."

"Penyakit jantung koroner merupakan penyebab kematian nomor satu di Amerika Serikat. Penyakit jantung koroner disertai peyakit pembuluh darah otak merupakan penyebab kematian nomor 1 di ikuti oleh penyakit penyerta stroke (16,8%), tekanan darah tinggi(9,4%) dan penyakit arteri (3,1%). Perawat spesialis merupakan bagian dari tim kesehatan yang berperan memberikan asuhan keperawatan komprehensif sehingga menurunkan angka morbiditas dan mortalitas pasien. Perawat spesialis memiliki peran sebagai pelaksana asuhan keperawatan langsung, educator dan peneliti keperawatan. Pelaksana asuhan keperawatan langsung dilakukan dengan memberikan asuhan keperawatan kepada 30 pasien resume dan 1 pasien kelolaan utama yang mengalami masalah gangguan kardiovaskuler. peran sebagai educator dilakukan dengan memberikan edukasi kepada pasien dan keluarga tentang penyakit jantung dan perawatannya baik di rumah sakit maupun di rumah setelah pulang rawat. Peran sebagai perawat peneliti dilaksanakan dengan penerapan EBN dan proyek inovasi selama proses residensi. Hasil akhir dari proses residensi ini menunjukkan bahwa Teori Selfcare Deficit dari Orem relevan dan sangat bermanfaat untuk diterapkan pada pasien dengan gangguan kardiovaskuler, EBN dapat diterapkan dengan memberikan terapi oksigen sesuai kebutuhan pasien dan hasil dari proyek inovasi dapat diterapkan pada pasien SKA, khususnya STEMI paska PCI, untuk mempertahankan fungsi jantung secara optimal.

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Coronary heart disease (CHD) is the number one cause of death in United States of America. CHD accompanied by cerebral vascular disease is the number one cause of death, followed by stroke (16,8%), hypertension heart disease (9,4%) and arterial disease (3,1%). Specialist nurse are part of the health team whose role is to provide comprehensive nursing care to reduce patients morbidity and mortality. Specialist nurses have a role as a direct nursing care, as a educator and researcher nurses. Direct nursing care do by given nursing care for 30 resume patients and one major case patient. Nurse educator doing by give education for patients and family about heart disease and how to care in hospital and home. Nurse researcher role implemented through Evidence Based Nursing and innovation project during residention process.The end result of residency practice shown that Selfcare Deficit Theory Orem relevant and very good to implemented foor patients with cardiovascular disorder, EBN can implemented with given oksigen therapy according patients needs and resut of innovation project can implemented to ACS patients, especially STEMI post PCI, to maintenance optimally heart function.

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"Ners Spesialis peminatan kardiovaskular didapatkan setelah melalui program praktik residensi keperawatan. Praktek residensi keperawatan terdiri dari 2 program yaitu praktek residen umum dan praktek residensi peminatan yaitu kardiovaskular. Kegiatan praktek residensi peminatan termasuk peran perawat sebagai pemberi asuhan keperawatan, peneliti, dan inovator. Peran pemberi asuhan keperawatan yaitu melakukan asuhan keperawatan pada 1 kasus utama dan 30 kasus resume pasien gangguan sistem kardiovaskular menggunakan model konservasi Levine. Peran peneliti adalah melakukan penerapan EBN yaitu akupresur terhadap kecemasan pasien preoperasi jantung. Hasil penerapan EBN; akupresur sebagai intervensi nonfarmakologi, nonivasif, mudah, sederhana dan aman dapat menurunkan kecemasan preoperasi jantung. Terakhir, peran inovator yaitu penggunaan skala Munro untuk mencegah kejadian perioperative related pressure injury pada pasien bedah jantung. Instrumen skala Munro sebagai pengkajian risiko pressure injury spesifik pada perioperatif, dilakukan 3 tahapan (preoperatif, intraoperatif, dan postoperatif), valid dan reliabel. Instrumen dapat digunakan sebagai bagian dari satuan intervensi pencegahan perioperative related pressure injury bersama dengan pengkajian kulit.

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Nurse Specialist in cardiovascular is obtained after going through a nursing residency practice program. Nursing residensy practice consists of 2 programs, namely general residency practice and specialization residency practice, namely cardiovascular. Specialization residency practice activities include the roel of nurses as nursing care providers, researchers and innovators. The role of nursing care provder is to manage nursing care in 1 main case and 30 resume cases of pastients with cardiovascular system disorders using Levine conservation model. The role of researcher is to implement EBN, namely acupressure on the anxiety of preoperative cardiac patients.

Results of the EBN application; acupressure as a non-pharmacological intervention, non-invasive, simple, easy and safe can reduce anxiety of preoperative cardiac. Finally, the rola of an innovator is the use of Munro scale to prevent perioperative related pressure injury in cardiac surgery patients. Instrument of Munro scale as an assessment of the risk of specific in perioperative pressure injury, carried out 3 stages (preoperative, intraoperative, dan postoperative), valid and reliable. Instrument can be used as bundle of an intervention for the prevention of perioperative related pressure injury along with skin assessment."

"Penyakit kardiovaskular menjadi penyebab kematian terbesar di seluruh. Komplikasi yang sering terjadi pada pasien penyakit kardiovaskular antara lain kebutuhan untuk hospitalisasi yang lebih lama, rehospitalisasi, penurunan kapasitas fungsional dan peningkatan biaya perawatan. Perawat spesialis mempunyai peran penting sebagai pemberi asuhan keperawatan, peneliti, dan inovator dalam menangani penyakit kardiovaskular tersebut. Peran perawat spesialis sebagai pemberi asuhan keperawatan telah dilaksanakan residen dengan mengelola 31 kasus pasien dengan gangguan kardiovaskular yang terdiri dari 1 kasus kelolaan utama dan 30 kasus resume menggunakan pendekatan teori keperawatan Model Adaptasi Roy (MAR). Kasus utama yang dikelola oleh residen adalah asuhan keperawatan pada pasien dengan Acute Decompensated Hart Failure (ADHF). Peran sebagai peneliti dilakukan oleh residen dengan melaksanakan penerapan EBN, yaitu pemberian terapi musik untuk menurunkan cemas pada pasien pasca bedah jantung. Peran sebagai inovator dilaksanakan oleh residen melalui proyek inovasi Aplikasi 6 Minute Walking Distance (6MWD) pada pasien gagal jantung. Hasil analisis praktik residensi ini menunjukkan bahwa MAR cocok dan efektif diterapkan pada pasien dengan gangguan sistem kardiovaskular, terapi musik klasik dapat menurunkan cemas pada pasien pasca operasi bedah jantung, dan aplikasi 6MWD dapat diterapkan untuk memudahkan perawat dalam mengkaji kapasitas fungsional dan merekomendasikan latihan fisik pada pasien gagal jantung.

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Cardiovascular disease is the leading cause of death worldwide. Common complications in patients with cardiovascular disease include the need for longer hospitalization, rehospitalization, decreased functional capacity, and increased costs of care. Specialist nurses have an important role as providers of disease care, researchers, and innovators in dealing with cardiovascular disease. The role of specialist nurses as providers of rescue care has been implemented by managing 31 cases of patients with cardiovascular disorders consisting of 1 primary care case and 30 resume cases using the Roy Adaptation Model (MAR) approach. The main case managed by the resident is nursing care for patients with Acute Decompensated Heart Failure (ADHF). The role as a researcher carried out by the resident implements the application of EBN, namely providing music therapy to reduce anxiety in patients after heart surgery. The role as an innovator is carried out by residents through the 6 Minute Walking Distance (6MWD) Application innovation project in heart failure patients. The results of this residency practice analysis show that MAR is suitable and effective for patients with cardiovascular system disorders, classical music therapy can reduce anxiety in post-cardiac surgery patients, and the 6MWD application can be applied to make it easier for nurses to assess functional capacity and recommend physical exercise in heart failure patients."

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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."

"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."

"Praktik Spesialis Keperawatan Medikal Bedah Peminatan Kardiovaskular di RS Jantung dan Pembuluh Darah Harapan Kita bertujuan untuk menerapkan dan mempraktikan peran dan fungsi sebagai calon ners spesialis dalam melakukan pengelolaan pasien gangguan sistem kardiovaskular menggunakan pendekatan model Konservasi Levine. Calon ners spesialis memberikan dan menganalisis komprehensif  kasus utama berupa pasien post ASD closure, mitral valve replacement (MVR), tricuspid valve repair (TVR) dengan penyerta hipertensi pulmonal. Capaian lain pada praktik residensi adalah memberikan asuhan keperawatan pada 30 kasus kardiovaskular yang dianalisis sebagai resume.. Peran lain sebagai calon ners spesialis adalah  menerapkan intervensi keperawatan berbasis bukti ilmiah (evidance based practice) berupa aplikasi cryoanalgesia berupa kompres es batu untuk mengurangi nyeri pasien yang menjalani punksi darah arteri untuk pemeriksaan analisa gas darah (AGD). Selain itu calon ners spesialis dituntut sebagai inovator yang memberikan ide dan gagasan untuk perubahan yang lebih baik yaitu dengan penerapan protokol GASAL Aweakening and Spontaneous Breathing Trial yang bertujuan untuk memberikan panduan perawat dalam menyapih pasien yang terpasang ventilator mekanik. Hasil praktik residensi menunjukan model Konservasi Levine terbukti efektif diterapkan pada pasien dengan gangguan kardiovaskular. Penerapan EBN terbukti efektif menurunkan nyeri pasien yang menjalani punksi arteri untuk pemeriksaan AGD. Kegiatan inovasi mendapat respon positif dan terbukti memiliki kemanfaatan bagi perawat dalam proses weaning pasien terpasang ventilasi mekanik.

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The Practice of Medical Nursing Specialist with Cardiovascular Specialization at National Cardiovascular Center Harapan Kita aims to implement and practice the role and function as a candidate for specialist nurses in managing patients with cardiovascular system disorders using the Levine Conservation model approach. The specialist nurse candidates provide and comprehensively analyze the main cases in the form of post ASD closure patients, mitral valve replacement (MVR), tricuspid valve repair (TVR) with pulmonary hypertension co-occurring. Another achievement in residency practice is providing nursing care for 30 cardiovascular cases which were analyzed as a resume. Another role as a candidate for specialist nurses is to apply evidence-based nursing interventions (evidance based practice) in the form of cryoanalgesia applications in the form of ice packs to reduce pain in patients undergoing arterial blood puncture for examination of blood gas analysis (AGD). In addition, prospective nurse specialists are required to be innovators who provide ideas and ideas for better changes, namely the application of the GASAL Aweakening and Spontaneous Breathing Trial protocol which aims to provide guidance for nurses in weaning patients who is attached to a mechanical ventilator. The results of the residency practice show that the Levine Conservation model has proven to be effective in applying to patients with cardiovascular disorders. The application of EBN has proven to be effective in reducing pain in patients undergoing arterial puncture for AGD examination. The innovation activity received a positive response and was proven to have benefits for nurses in the weaning process of patients with mechanical ventilation."

"Keperawatan medikal bedah merupakan bidang praktik khusus dalam keperawatan profesional yang fokus dalam perawatan respon pasien terhadap masalah kesehatan aktual maupun potensial. Clinical nurse specialist (CNS) didefinisikan sebagai clinical leader dalam praktik keperawatan yang memiliki pengetahuan dan keterampilan tingkat lanjut seperti keahlian klinis dalam bidang tertentu, praktik berbasis bukti, kolaborasi, konsultasi, edukator, mentoring, dan manajemen. Peran CNS meliputi direct patient care, nursing practice, dan organization atau system. Peran perawat direct patient care diterapkan pada 31 pasien kasus kardiovaskuler baik medikal maupun bedah dengan pendekatan Model Adaptasi Roy. Hasil analisis praktik menunjukkan bahwa Model Adaptasi Roy dapat diterapkan dalam memberikan asuhan keperawatan pasien dengan gangguan sistem kardiovaskuler. Penerapan peran perawat nursing practice, yaitu perawat menerapkan praktik yang berbasis bukti (evidence) adalah efektivitas cold therapy sebelum latihan napas dalam (deep breathing) dan batuk efektif (coughing) terhadap nyeri akut pada pasien post cardiac surgery. Penerapan peran perawat organisation atau system, yaitu perawat membuat pengembangan profesional melalui inovasi terbaru untuk perkembangan asuhan keperawatan dengan menyusun SPO rehabilitasi jantung fase 1 pada pasien sindrom koroner akut (SKA).

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Medical surgical nursing is a special area of nursing profesional practice that focuses on the care of patient s response to actual and potential health problems. Clinical nurse specialist (CNS) is defined as a clinical leader in nursing practice that has advance knowledge and skill such as clinical expertise in a particular area, evidence-based practice, collaboration, consulting, eduvator, menoting, and management. The role of CNS included direct patient care, nursing practice, and organization or system. The role as a direct patient care was applied to 31 cardiovascular patients both medical and surgical with the Roy s Adaptation Model approach. The result of practice analysis showed that Roy s Adaptation Model could be applied in providing nursing care in cardiovascular disease. The application of nursing practice nursing role, that nurse applied evidence-based practice that was effectiveness of cold therapy before deep breathing and coughing for acute pain post cardiac surgery patient. Aplication of the role of nurse organization or system, that nurses made professional development through the innovation for the development of nursing care. It was 1st phase cardiac rehabilitation in patient with acute coronary syndrome by formed standard operational procedure (SOP)."

"Praktik residensi keperawatan medical bedah memberikan kesempatan kepada residen untuk mengimplementasikan fungsi implementator, educator, innovator dan peneliti asuhan keperawatan spesialistik pada gangguan kardiovaskular. Residen menerapkan proses keperawatan dengan pendekatan teori konservasi Levine pada 30 kasus kelolaan resume dan satu kasus kelolaan utama. Implementasi asuhan keperawatan berbasis bukti dengan intervensi akupresur pada acupoints Shenmen dan Yengchuan untuk meningkatkan kualitas tidur pada pasien acute coronanry syndrome. Sebagai inovator residen menginovasi awakening and spontaneous breathing trial protocol untuk memandu perawat dalam mengkaji kesiapan weaning ventilator pada pasien post operasi jantung yang tersedasi dan menggunakan ventilator. Akupresur pada acupoins Shenmen dan Yengchuan secara significant meningkatkan kualitas tidur pada kelompok intervensi (p = 0,009). Awakening and spontaneous breathing trial protocol mudah diterapkan sebagai prosedur pengakajian kesiapan weaning ventilator, mudah dipahami dan memberikan manfaat bagi perawat dan pasien.

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The practice of surgical and medical nursing residency provides an opportunity for resident to implement the functions of implementer, educator, innovator and researcher in specialistic nursing care in cardiovascular disorders.Resident applyed the nursing process using Levine's conservation theory approach by managing 30 resume cases and one main case. Implementation of evidence-based nursing care by applying of acupressure intervention on Shenmen and Yengchuan acupoints to improve sleep quality in patients with acute coronary syndrome. As an innovator, resident innovated the awakening and spontaneous breathing trial protocol to guide nurses in assessing weaning ventilator readiness in sedated and ventilated postoperative cardiac patients. Applying acupressure on the Shenmen and Yengchuan acupoints significantly improved sleep quality in the intervention group (p = 0.009). Awakening and spontaneous breathing trial protocols are easy to implement as a procedure to assess weaning ventilator readiness beside easy to understand and beneficial for nurses and patients."