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"Karya Ilmiah ini merupakan hasil analisis pengalaman praktik residensi spesialis keperawatan medikal bedah kekhususan peminatan neurologi. Laporan ini bertujuan untuk memberikan gambaran pengalaman praktik residensi spesialis keperawatan medikal bedah dalam mengolola berbagai kasus dengan gangguan neurologis. Karya ilmiah ini terdiri asuhan keperawatan pada kasus kelolaan utama pada klien dengan tuberculosis of spine dengan menggunakan pendekatan model adaptasi Roy, penerapan Evidence Based Nursing (EBN) dengan intervensi mengunyah permen karet untuk pemulihan gastrointestinal pasca operasi tulang belakang, proyek inovasi nurse-led early mobilization, dan analisis pada 30 kasus resume pada klien dengan gangguan neurologis. Hasil analisis diagnosa pada 30 kasus resume ditemukam tiga diagnose keperawatan yang paling sering pada klien dengan gangguan neurologis yaitu penurunan kapasitas adaptif intrakranial, hambatan mobilitas fisik dan nyeri. Intervensi keperawatan yang paling sering dilakukan dalam menjalankan asuhan keperawatan diantaranya promosi perfusi serebral, pemantauan tekanan intrakranial, dan terapi fisik: kontrol otot.

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This scientific work is the result of an analysis of the practical experience of a medical surgical nursing specialist residency with a specialization in neurology. This report aims to provide an overview of medical surgical nursing specialist residency experience in managing various cases with neurological disorders. This scientific work consists of nursing care in primary managed cases for clients with tuberculosis of the spine using the Roy Adaptation Model approach, application of Evidence Based Nursing (EBN) with chewing gum interventions for gastrointestinal recovery post operative spine surgery, nurse-led early mobilization innovation projects, and analysis on 30 case resumes on clients with neurological disorders. The results of the analysis of diagnoses in 30 resume cases found the three most common nursing diagnoses in clients with neurological disorders, namely decreased intracranial adaptive capacity, impaired physical mobility, and pain. The most frequently performed nursing interventions in carrying out nursing care include promoting cerebral perfusion, monitoring intracranial pressure, and physical therapy: muscle control.

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"Ruang lingkup pelaksanaan program residensi adalah pencapaian kompetensi klinis dan penerapan peran ners spesialis dalam praktik keperawatan lanjut. Proses ini dilaksanakan dengan penerapan pendekatan teori Keperawatan Virginia Henderson pada sistem onkologi, penerapan Evidence Based Nursing terapi musik mengurangi nyeri kanker, dan penerapan inovasi protokol ERAS pada pasien mastektomi dan tiroidektomi di RSUP Cipto Mangunkusumo Jakarta. Pendekatan teori virginia Henderson sangat cocok diterapkan dalam memenuhi kebutuhan pasien dengan keganasan yang kompleks karena bersifat komprehensif dan holistik mencakup kebutuhan fisik, psikologis, sosial, dan spiritual. Penerapan evidence based nursing terapi musik menunjukan bahwa terjadi penurunan nyeri setelah diberikan terapi musik. Inovasi ERAS protokol menunjukan terjadi penurunan jumlah hari rawat dan berkurangnya komplikasi pasca bedah. Disarankan kepada perawat agar lebih mengembangkan penggunaan pendekatan teori Virginia Henderson dalam memenuhi kebutuhan pasien yang holistik dan menjadikan terapi musik sebagai alternatif pilihan dalam mengurangi nyeri kanker serta mengembangkan ERAS protokol pada pembedahan mastektomi dan tiroidektomi.

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The scope of the implementation of the residency program is the achievement of clinical competencies and the application of the role of specialist nurses in advanced nursing practice. This process was carried out with the application of Virginia Henderson's Nursing theory approach to the oncology system, the application of Evidence Based Nursing music therapy to reduce cancer pain, and the application of innovation to the ERAS protocol in mastectomy and thyroidectomy patients at Cipto Mangunkusumo General Hospital, Jakarta.

The Henderson virginian theory approach is very suitable to be applied in meeting the needs of patients with complex malignancies because it is comprehensive and holistic including physical, psychological, social, and spiritual needs. The application of evidence based nursing music therapy shows that there is a decrease in pain after being given music therapy. The ERAS innovation protocol shows a decrease in the number of care days and a reduction in postoperative complications.

It is suggested to nurses to further develop the use of Virginia Henderson's theoretical approach in meeting patients' holistic needs and making music therapy an alternative choice in reducing cancer pain and developing ERAS protocols for mastectomy and thyroidectomy surgery."

"Intra Uterine Fetal Death (IUFD) merupakan peristiwa kehilangan yang dapat memengaruhi kondisi emosional ibu secara signifikan, yang berpengaruh terhadap status kesehatan secara keseluruhan, sehingga dibutuhan asuhan keperawatan untuk mencapai kesehatan dan kesejahteraan ibu baik fisik, psikologis, sosiokultural dan spiritualnya. Karya ilmiah akhir spesialis ini membahas penerapan teori Health Care System dan Loss and Grieving pada ibu yang mengalami Intra Uterine Fetal Death (IUFD) pada kehamilan yang diharapkan, serta penerapan Evidence Based Nursing Practice yaitu Mindfulness-Based Spiritual Therapy sebagai salah satu alternatif intervensi yang dapat digunakan untuk meningkatkan garis pertahan ibu dan memfasilitasi pemulihan emosional dan spiritual ibu. Penelitian ini merupakan clinical case report pada 5 orang ibu yang mengalami IUFD di dua rumah sakit yang berbeda. Hasil studi didapatkan bahwa teori Health Care System dan Loss and Grieving dapat diintegrasikan untuk membantu memahami pengalaman ibu dan memberikan perawatan yang sesuai. Melalui terapi psikologis dan dukungan emosional yang adekuat, ibu dapat mengatasi kesedihan dan trauma yang terkait dengan kehilangan, dan melalui proses berduka dengan adaptif.

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Intra Uterine Fetal Death (IUFD) is a loss event that can significantly affect the mother's emotional well-being, which in turn influences her overall health status. Therefore, nursing care is needed to achieve the physical, psychological, sociocultural, and spiritual health and well-being of the mother. This paper discusses the application of the Health Care System and Loss and Grieving theories in mothers experiencing Intra Uterine Fetal Death (IUFD) during expected pregnancies, as well as the implementation of Evidence- Based Nursing Practice, namely Mindfulness-Based Spiritual Therapy, as one of the alternative interventions that can be used to enhance maternal coping and facilitate emotional and spiritual recovery.

This study is a clinical case report of five mothers who experienced IUFD in two different hospitals. The study's findings revealed that the Health Care System and Loss and Grieving theories can be integrated to help understand mothers' experiences and provide appropriate care. Through psychological therapy and adequate emotional support, mothers can cope with the grief and trauma related to the loss and proceed with adaptive grieving."

"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."