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"Background: Several risk factors related to the COVID-19 mortality rate have been identified, including old age, male, smoking, and having comorbidities. Among many comorbidities, cardiovascular disease is known as the leading cause of death in the world. This study aims to determine the relationship between a history of heart disease and mortality in COVID-19 patients.

Method: This cross-sectional study was conducted at The National Cardiovascular Center Harapan Kita, North Bambu City, West Jakarta. The data for this study were taken from the COVID-19 registry from the period June to August 2021.

Results: Of the 439 patients included in the study, 238 patients (54.2%) had at least one history of heart disease and 201 patients (45.8%) had no history of heart disease. 134 patients (30.5%) were reported to have died and 305 patients (69.5%) were reported to be alive. Bivariate analysis showed that old age (p = 0.000; OR = 2.27), rapid heart rate (p = 0.017; OR = 1.69), low oxygen saturation (p = 0.000; OR = 4.62), high NLR (p = 0.000 ; OR = 3.10), high D-dimer (p = 0.001; OR = 2.07), CAD (p = 0.018; OR = 1.64), hypertension (p = 0.008; OR = 1.76), and diabetes (p = 0.001; OR = 2.00) had statistically significant associations with mortality in COVID-19 patients. In addition, the odds of death in COVID-19 patients increased when two or more risk factors were present (p = 0.001; OR = 2.42). After other factors were controlled, oxygen saturation (AOR = 5.06), NLR (AOR = 3.12), heart failure (AOR = 2.90), and diabetes (AOR = 2.63) were found to be more significant independently.

Conclusion: Some pre-existing cardiovascular diseases were associated with death in COVID-19 patients. In addition, risk factors and patients’ clinical profiles also play a role in higher mortality rate.

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Latar Belakang: Beberapa faktor risiko terkait dengan angka kematian COVID-19 telah diidentifikasi, antara lain usia tua, laki-laki, perokok, dan memiliki komorbiditas. Di antara banyak penyakit penyerta, penyakit kardiovaskular dikenal sebagai penyebab utama kematian di dunia. Penelitian ini bertujuan untuk mengetahui hubungan antara riwayat penyakit jantung dan angka kematian pada pasien COVID-19.

Metode: Studi potong lintang ini dilakukan di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita, Kota Bambu Utara, Jakarta Barat. Data penelitian ini diambil dari registri COVID-19 periode Juni hingga Agustus 2021.

Hasil: Dari 439 pasien yang dilibatkan dalam penelitian, 238 pasien (54.2%) memiliki setidaknya satu riwayat penyakit jantung dan 201 pasien lainnya (45.8%) tidak memiliki riwayat penyakit jantung. 134 pasien (30,5%) dilaporkan meninggal dan 305 pasien (69,5%) dilaporkan masih hidup. Analisis bivariat menunjukkan bahwa usia tua (p = 0.000; OR = 2.27), denyut nadi cepat (p = 0.017; OR = 1.69), saturasi oksigen rendah (p = 0.000; OR = 4.62), NLR tinggi (p = 0.000; OR = 3.10), D-dimer tinggi (p = 0.001; OR = 2.07), PJK (p = 0.018; OR = 1.64), hipertensi (p = 0.008; OR = 1.76), dan diabetes (p = 0.001; OR = 2.00) memiliki hubungan yang signifikan secara statistik dengan kematian pada pasien COVID-19. Selain itu, peluang kematian pada pasien COVID-19 meningkat ketika terdapat dua atau lebih faktor risiko (p = 0.001; OR = 2.42). Setelah faktor-faktor lain dikendalikan, saturasi oksigen (AOR = 5.06), NLR (AOR = 3.12), gagal jantung (AOR = 2.90), dan diabetes (AOR = 2.63) ditemukan lebih signifikan secara independent.

Kesimpulan: Beberapa riwayat penyakit jantung berhubungan dengan kematian pada pasien COVID-19. Di samping itu, faktor resiko dan profil klinis pasien juga berperan dalam tingkat kematian yang lebih tinggi."

"Penyakit kardiovaskuler merupakan penyebab kematian utama penduduk dunia (30%). Untuk menghadapi masalah ini perlu diketahui distribusi penyakit kardiovaskuler terhadap faktor-faktor risikonya secara lebih spesifik. Penelitian ini bertujuan untuk mengetahui gambaran penyakit kardiovaskuler pada pasien rawat inap di Rumah Sakit Jantung dan Pembuluh Darah (RSJPD) Harapan Kita Tahun 2012. Penelitian ini menggunakan data sekunder dari rekam medik RSJPD Harapan Kita menggunakan desain studi cross sectional dengan jumlah sampel 339 orang dianalisis secara univariat. Hasil menunjukkan Ischemic Heart Diseases merupakan penyakit dengan proporsi terbesar yaitu 43,36%. Berdasarkan letak lesi, penyakit jantung memiliki proporsi terbesar yaitu 87,02%. Penyakit kardiovaskuler cenderung mengenai kelompok usia 51-60 tahun dengan proporsi 29,79%. Penyakit kardiovaskuler cenderung menyerang laki-laki dan orang dengan tingkat pendidikan menengah. Diketahui bahwa proporsi pasien hipertensi dan diabetes mellitus cenderung lebih besar di antara pasien penyakit pembuluh darah otak daripada pada pasien penyakit jantung ataupun pasien penyakit pembuluh darah perifer.

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Cardiovascular disease is the most common death cause (30%) . To face the problem it’s necessary to know the distribution of cardiovascular disease specifically to its risk factors. This research aims to describe the cardiovascular disease among the hospitalized patients in Harapan Kita Cardiovascular Hospital in 2012. This research uses the secondary data from Harapan Kita Cardiovascular Disease medical record and also uses cross sectional design with 339 sample and analyzed in univariate.

The results show that among the cardiovascular diseases in inpatient unit in Harapan Kita Cardiovascular Hospital, Ischemic Heart Diseases is the diseases with the biggest proportion which is 43,36%. According to lesion location, heart disease has the biggest proportion which is 87,02%. Cardiovascular diseases tend to affect the 51-60 years old group of age by 29,79% among other age groups. Cardiovascular diseases tend to affect men and those who have middle educational level. The results also show that proportion of patients with hypertension and Diabetes Melitus tends to be bigger among cererovascular diseases patients than heart diseases patients or peripheral vascular diseases patients."

"Dampak dari penyakit kardiovaskular tidak hanya dirasakan oleh individu namun juga secara global. Pencegahan dan pengawasan perlu dilakukan untuk menurunkan beban yang dihadapi akibat penyakit kardiovaskular dengan pendekatan populasi dan individu. Perawat memiliki peran penting dalam hal promotif, preventif, dan rehabilitatif. Residen mengelola 31 kasus dengan menggunakan pendekatan teori Care, Core, dan Cure dalam memberikan asuhan keperawatan pada pasien dengan gangguan kardiovaskular sebagai cerminan dari peran ners spesialis sebagai pemberi pelayanan dan pendidik. Peran ners spesialis sebagai peneliti dijalani oleh residen dalam menerapkan tindakan keperawatan yang berbasis bukti atau Evidence Based Nurisng EBN berupa pengukuran keterlibatan pasien dengan Patient Activation Measure PAM. Sebagai inovator dan pemimpin kelompok, residen mengembangkan proyek membuat format perencanaan pemulangan pasien dengan pendekatan lima model.

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The impact of cardiovascular disease is not only felt by individuals but also globally. Prevention and supervision have to do to reduce the cardiovascular disease burden by population and individual approach. Nurses have an important role in promotive, preventive, and rehabilitative. Resident manages 31 cases using Care, Core, and Cure theory approaches in providing nursing care to patients with cardiovascular disease as a reflection of the role of specialist ners as service providers and educators. The role of a specialist ners as a researcher is undertaken by the resident in implementing Evidence Based Nursing EBN by measuring patient engagement with Patient Activation Measure PAM . As an innovator and community leader, the resident developed the project to make a discharge planning format using a five model approach."

"Kejadian penyakit kelainan katup masih menjadi masalah dan angka kejadiannya terus mengalami peningkatan di negara berkembang termasuk di Indonesia Dari tahun ke tahun angka kesakitan dan kematian terus mengalami peningkatan seiring dengan tingginya angka kejadian demam rematik di negara dengan iklim tropis dan subtropis Selain itu karena berbagai faktor lainnya seperti ekonomi dan lingkungan Kelainan katup stenosis mitral dapat menyebabkan berbagai komplikasi termasuk diantaranya gagal jantung dan edema paru Perawat sebagai salah satu tenaga kesehatan yang paling penting di unit pelayanan kesehatan diharapkan mampu mendeteksi secara dini timbulnya komplikasi yang akan muncul akibat penyakit jantung Sedangkan perawat spesialis sangat berperan penting dalam memberikan asuhan keperawatan kepada pasien terutama pasien dengan penyakit kardiovaskular yang kompleks Praktik residensi keperawatan medikal bedah bertujuan untuk melaksanakan peran perawat spesialis yang mencakup pemberian asuhan keperawatan dengan pendekatan konsep konservasi Myra Estrin Levine pada pasien dengan gangguan sistem kardiovaskular terutama pada pasien dengan stenosis katup mitral penerapan tindakan pemberian latihan aktifitas fisik rehabilitasi jantung fase 1 untuk mempercepat proses penyembuhan dan stabilisasi status hemodinamik serta berperan aktif dalam program inovasi pengembangan media edukasi pada pasien dengan pemasangan alat medis Hasil analisis praktik menunjukkan bahwa model konservasi Levine dapat diterapkan pada pasien dengan gangguan kardiovaskular untuk mengoptimalkan derajat kesehatan pasien pemberian latihan aktifitas fisik rehabilitasi jantung fase 1 menunjukkan tidak ada perubahan yang signifikan dalam perubahan hemodinamik dan pengembangan media edukasi pada pasien dengan pemasangan alat medis membantu pasien dalam meningkatkan pengetahuan mengenai alat medis.

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Incidence of cardiac valve abnormalities still a problem and the number of events is increasing in developing countries including Indonesia From year to year the morbidity and mortality continues to increase in line with by a high incidence of rheumatic fever in countries with tropical and subtropical climates Moreover because of many other factors such as the economy and environment Abnormalities of the mitral valve stenosis can cause a variety of complications including heart failure and pulmonary edema The nurse as one of the most important health personnel in the health care unit is expected to detect early onset of complications that would arise as a result of valve disease Meanwhile nurse specialist plays an important role in providing nursing care to patients especially patients with complicated cardiovascular disease

The practice of medical surgical nursing residency aimed to carry out the role of nurse specialist includes providing nursing care by implementing the concept of conservation of Myra Estrin Levine to patients with cardiovascular disorders especially those with mitral valve stenosis The implementation of measures to provide cardiac rehabilitation exercise physical activity to accelerate the phase 1 healing process and stabilization of hemodynamic status as well as an active role in the development of educational media innovation program in patients with implanted medical devices

Results of the analysis showed that the model of conservation practices Levine can be applied in patients with cardiovascular disorders to optimize the health status of patients provision of cardiac rehabilitation exercise physical activity Phase 1 showed no significant changes in hemodynamic changes and the development of educational media in patients with implanted medical devices help patients to improve knowledge of medical devices."

"Prevalensi kematian yang disebabkan oleh gangguan sistem kardiovaskuler semakin meningkat. Perawat spesialis dapat berperan sebagai pemberi asuhan keperawatan, pendidik, konsultan, dan peneliti untuk mencegah peningkatan jumlah morbiditas dan mortalitas pasien CAD. Praktik residensi spesialis keperawatan medikal bedah selama 1 tahun 2 semester bertujuan untuk menerapkan dan mendalami peran perawat spesialis dengan pendekatan Theory of Comfort Katharine Kolcaba. Peran sebagai pemberi asuhan keperawatan diterapkan pada 30 pasien gangguan sistem kardiovaskuler dan satu pasien kasus kelolaan utama STEMI dengan IVS ruptur yang menjalani CABG dan repair IVS rupture. Peran sebagai pendidik dijalankan dengan pembimbingan perawat sejawat dan mahasiswa keperawatan. Peran sebagai peneliti dijalankan dengan menerapkan tindakan keperawatan berbasis pembuktian ilmia evidence-based nursing yaitu tindakan guided imagery untuk menurunkan respon psikofisiologis kecemasan pasien yang menjalani kateterisasi jantung elektif. Peran sebagai inovator dijalankan dengan menerapkan format pengkajian awal, intervensi, implementasi, dan monitoring kecemasan pasien yang menjalani CABG. Hasil analisis praktik residensi menunjukkan bahwa Theory of Comfort efektif digunakan sebagai pendekatan dalam gangguan sistem kardiovaskuler pada pasien dengan gangguan sistem kardiovaskuler untuk meningkatkan tingkat kenyamanan dan terapi guided imagery efektif diterapkan untuk menurunkan respon psikofisiologis kecemasan pasien yang menjalani kateterisasi jantung elektif. Selain itu, format pengkajian awal, intervensi, implementasi, dan monitoring kecemasan dapat diterapkan untuk pasien yang menjalani CABG.

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Abstract The prevalence of deaths caused by cardiovascular disorders are increasing. Specialist nurses can take the role as care provider, educator, consultant, and researcher in order to prevent an increase of morbidities and mortalities of patients with Coronary Artery Disease. Practice of medical surgical nursing residency held for 1 year 2 semesters aims to implement and explore the role of specialist nurses. Role as care providers applied to 30 patients with disorders of the cardiovascular system and the main case patients managed with IVS rupture STEMI who underwent CABG and repair IVS rupture. Role as educators is performed by coaching colleagues and nursing students. Role as researchers is performed by implementing evidence based nursing in the form of guided imagery to reduce the psychophysiological anxiety responses of patients undergoing elective cardiac catheterization. Role as an innovator is accomplished by the format of the initial assessment, intervention, implementation, and monitoring the anxiety of patients undergoing CABG. Results of the analysis showed that the residency practice using Kolcaba rsquo s Comfort Theory effectively to increase the level of comfort on patients with disorders cardiovascular system. Guided imagery therapy effectively to reduce psychophysiological anxiety response of patients undergoing elective cardiac catheterization. The format of the initial assessment, intervention, implementation, and monitoring of anxiety can be applied to patients undergoing CABG."

"Karya Ilmiah Akhir ini merupakan analisis pengalaman residen selama pelaksanaan praktik residensi keperawatan medikal bedah peminatan kardiovaskular meliputi pemberian asuhan keperawatan dengan pendekatan proses keperawatan menggunakan teori keperawatan Model Sistem Neuman, penerapan praktik keperawatan berdasarkan pembuktian dan pelaksanaan inovasi keperawatan. Teori keperawatan Model Sistem Neuman ini berfokus pada individu dan persepsi serta reaksi terhadap stressor termasuk faktor yang mempengaruhinya, yang memungkinkan perawat untuk dapat memberikan asuhan keperawatan yang kreatif melalui intervensi keperawatan mengurangi stressor baik intervensi pencegah primer, sekunder maupun tersier. Masalah keperawatan yang paling sering muncul adalah penurunan curah jantung, intoleransi aktifitas, ansietas, kelebihan volume cairan tubuh dan nyeri. Pelaksanaan praktik keperawatan berdasarkan pembuktian yang telah diterapkan yaitu tehnik Progressive Muscle Relaxation terhadap ansietas dan depresi pasien gagal jantung. Pelaksanaan inovasi keperawatan berupa penyusunan formulir penilaian dan intervensi risiko jatuh.

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The final paper is an analysis of resident experience during implementation of medical-surgical nursing practice the specialization of residency cardiovascular include nursing care using the nursing process approach to nursing theory Neuman Systems Model, the application of evidence-based nursing practice and nursing innovation implementation. Neuman Systems Model nursing theory focuses on the individual and their perceptions and reactions to stressors include factors that influence it, which allows nurses to provide nursing care through creative nursing interventions prevention interventions reduce stressors both primary, secondary and tertiary. Nursing problem most often arises is the decrease in cardiac output, activity intolerance, anxiety, excess body fluid volume and pain. Implementation of evidence-based nursing practice that has been implemented is Progressive Muscle Relaxation techniques against anxiety and depression patients with heart failure. Implementation of nursing innovations in the form of preparation of risk assessment forms and interventions fall."

"Penyakit kardiovaskular menjadi salah satu penyebab kematian tertinggi di tingkat global. Upaya tindakan pencegahan dan tatalaksana terus dikembangkan untuk mengatasi permasalahan ini. Perawat spesialis memiliki peran sebagai pemberi asuhan keperawatan langsung, menerapkan evidence base nursing dan melakukan inovasi keperawatan. Praktik residensi spesialis keperawatan medikal bedah telah dilaksanakan untuk mengaplikasikan peran tersebut. Peran sebagai pemberi asuhan keperawatan langsung dilakukan dengan memberikan asuhan keperawatan pada 30 kasus kelolaan resume dan kasus kelolaan utama ADHF dengan teori Model Adaptasi Roy. Peran sebagai peneliti dijalankan dengan melakukan edukasi self-care pasien gagal jantung menggunakan metode teach-back. Peran perawat sebagai inovator dilakukan dengan menyusun proyek inovasi tentang penggunaan Munro Pressure injury Risk Assessment Scale untuk mencegah kejadian Perioperative related Pressure injury. Hasil analisis praktik menunjukkan bahwa Model Adaptasi Roy efektif digunakan untuk pasien dengan gangguan sistem kardiovaskular, edukasi self-care pada pasien gagal jantung dengan metode teach-back dapat meningkatkan pengetahuan, efikasi diri dan kemampuan self-care. Selain itu Munro Pressure injury Risk Assessment Scale dapat diterapkan untuk mencegah kejadian Perioperative related Presure Injury.

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Cardiovascular disease is one of the leading causes of death globally. Efforts to carry out management and prevention are always being developed to overcome this problem. Nurse specialists have a role as direct nursing care providers, applying evidence-based nursing and carrying out nursing innovations. The residency practice of medical-surgical nursing specialists has been implemented to apply for this role. The role of a direct nursing care provider is carried out by providing nursing care in 30 resume cases and ADHF main cases with Roy’s Adaptation Model theory. The role of a researcher is carried out by conducting self-care education for heart failure patients with the teach-back method. The role of nurses as innovators is carried out by developing an innovative project, namely "Using the Munro Pressure Injury Risk Assessment Scale to Prevent Perioperative-Related Pressure Injury." The results of practice analysis show that the Roy Adaptation Model is effective for patients with cardiovascular system disorders, and self-care education in heart failure patients with the teach-back method can improve knowledge, self-efficacy, and self-care abilities. In addition, the Munro Pressure Injury Risk Assessment Scale can be applied to prevent perioperative-related Pressure injury events."

"Ners spesialis merupakan perawat lulusan program spesialis keperawatan yang mempunyai keahlian khusus dalam asuhan keperawatan. Perawat spesialis keperawatan medikal bedah peminatan kardiovaskular harus mempunyai kompetensi keperawatan inti dan keperawatan berbagai masalah kardiovaskular. Pendidikan residensi spesialis dilakukan selama 2 semester dengan tujuan utama melakukan asuhan keperawatan medikal bedah khususnya sistem kardiovaskular dengan menggunakan pendekatan teori kenservasi Levine. Asuhan keperawatan pada 1 kasus utama post operasi total koreksi TOF dan 30 kasus resume yang terdiri dari 6 kasus besar gangguan sistem kardovaskular meliputi kasus sindrom koroner akut, kelainan katup jantung, kelainan pembuluh darah, gagal jantung, kasus bedah (katup, CABG) dan disritmia. model konsep konservasi Levine dapat diterapkan pada pasien gangguan sistem kardiovaskular untuk mempertahankan wholeness dan adaptasi. Pemberian ice cube absorption dapat mengurangi sore throat pasca ekstubasi pasien bedah jantung. Proyek inovasi penerapan Awakening and Spontaneous Breathing Trial (SBT) Protocol pada pasien pasca bedah jantung yang terpasang ventilasi mekanik dan sedasi. Protokol mudah dipahami dan membantu perawat dalam proses weaning ventilasi mekanik.

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Nurse Specialist is an advanced practice nurse and have special skill in nursing care, graduate from the nursing specialist program. Nurse Specialist medical surgical nursing in cardiovascular specialization must have core nursing competencies and nursing of various cardiovascular problems. Specialist residency education is carried out two semesters with the aim of providing medical-surgical nursing care, especially the cardiovascular system, using Levine's conservation theory approach. Nursing care of one main case in after total correction TOF and thirty resume cases consisting of six major cases of cardiovascular system disorders: acute coronary syndrome, heart valve disorders, blood vessel disorders, heart failure, surgical cases (valve, CABG) and dysrhythmia. Levine's conservation concept model can be applied to patients with cardiovascular system disorders to maintain wholeness and adaptation. Ice cube absorption can reduce sore throat after extubation of cardiac surgery. An innovation project for the application of the Awakening and Spontaneous Breathing Trial (SBT) Protocol in post-cardiac surgery patients who are mechanically ventilated and sedated. The protocol is easy to understand and helps nurses in the process of weaning mechanical ventilation."

"Penyakit kardiovaskular merupakan sekumpulan penyakit yang mempengaruhi sistem peredaran darah termasuk jantung dan pembuluh darah, disebabkan oleh banyak faktor yang mencakup penyakit bawaan dan didapat. Penyakit kardiovaskular yang disebabkan oleh aterosklerosis meliputi penyakit arteri koroner, penyakit arteri serebral, dan penyakit arteri perifer dengan dua komplikasi utama infark miokard dan stroke iskemik. Perawat spesialis memiliki peran penting sebagai pemberi asuhan keperawatan langsung, peneliti, dan inovator. Peran sebagai pemberi asuhan keperawatan langsung dijalankan dengan mengelola satu kasus utama tentang asuhan keperawatan pada pasien pascaoperasi CABG dengan Low Ejection Fraction, PMI, dan topangan IABP serta 30 kasus resume keperawatan. Peran sebagai peneliti dijalankan melalui penerapan EBN tentang penggunaan gel ice pack untuk mengurangi nyeri pada pasien pascaoperasi jantung yang menjalani chest tube removal. Peran sebagai inovator dijalankan dalam penyusunan proyek inovasi tentang penerapan FICA Spiritual Assessment Tool untuk memenuhi kebutuhan spiritual pasien dengan gangguan sistem kardiovaskular. Hasil analisis praktik residensi menunjukkan bahwa pendekatan teori model konservasi Levine dapat diterapkan dalam pemberian asuhan keperawatan pada pasien dengan gangguan sistem kardiovaskular, pengaplikasian gel ice pack dapat mengurangi nyeri saat dilakukan chest tube removal pada pasien pascaoperasi jantung, dan instrumen FICA Spiritual Assessment Tool mudah untuk diterapkan sebagai upaya pemenuhan kebutuhan spiritual pasien dengan gangguan sistem kardiovaskular.

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Cardiovascular diseases are a group of diseases that affect the circulatory system, including the heart and blood vessels, caused by many factors that include congenital and acquired diseases. Cardiovascular diseases caused by atherosclerosis include coronary artery disease, cerebral artery disease, and peripheral artery disease, with two major complications: myocardial infarction and ischemic stroke. Specialist nurses play an important role as direct nursing care providers, researchers, and innovators. The role of direct nursing care providers is carried out by managing a major case of nursing care for post-CABG patients with Low Ejection Fraction, PMI, and IABP support, as well as 30 nursing resume cases. The role of researchers is carried out through the application of EBN on the use of ice pack gel to reduce pain in post-cardiac surgery patients undergoing chest tube removal. The role of innovators is carried out in the preparation of innovation projects on the application of the FICA Spiritual Assessment Tool to meet the spiritual needs of patients with cardiovascular disorders. The results of the residency practice analysis show that Levine's conservation model theory approach can be applied in providing nursing care to patients with cardiovascular disorders, the application of ice pack gel can reduce pain during chest tube removal in post-cardiac surgery patients, and the FICA Spiritual Assessment Tool is easy to apply as an effort to meet the spiritual needs of patients with cardiovascular disorders."

"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."