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"Perdarahan postpartum merupakan penyokong utama kematian ibu secara global, dan memiliki implikasi fisiologis dan psikososial bagi ibu, bayi, keluarga dan masyarakat serta penyedia pelayanan kesehatan. Laporan praktik residensi ners spesialis maternitas ini, menerapkan peran dan fungsi perawat dan teori model keperawatan Need for Help Wiedenbach dan Comfort Kolcaba pada kasus perdarahan postpartum. Penerapan teori Wiedenbach dan Kolcaba pada kelima kasus kelolaan dapat diterapkan dan memenuhi kebutuhan pertolongan segera dan kenyamanan klien sehingga pelayanan asuhan keperawatan sesuai dengan harapan klien. Kekuatan teori Wiedenbach pda fase akut berfokus pada kebutuhan "here and now" yang dibutuhkan klien dengan segera, fokus pengkajian adalah fisik dan psikologis. Teori Comfort Kolcaba melengkapi dengan pengkajian aspek fisik, psikospiritual, lingkungan dan sosial, dengan intervensi yang dilakukan meliputi standart comfort intervention, coaching dan comfort food for thr soul. Perawat spesialis maternitas perlu meningkatkan peran dan fungsinya di tatanan pelayanan kesehatan, baik sebagai pemberi pelayanan, edukator, advokat, pengelola, kolaborator, dan komunikator.

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Postpartum Haemmoragic and maternal mortality have physiological and psychosocial implications. This Reports residency practice nurses maternity specialist, is a report for one year by applying roles and functions of nurses and nursing model theory Need for Help Wiedenbach and Comfort Kolcaba in case of postpartum hemorrhage. The application of the theory Wiedenbach and Kolcaba in five cases under management can be applied and meet the immediate relief needs and comfort of the client so that the nursing care services in accordance with the expectations of its clients. The Strength of the theory Wiedenbach on acute phase focuses on the needs of "here and now" that takes the client immediately, the focus of the assessment is physical and psychological.

Comfort Kolcaba complements theory with an assessment of the physical, psychospiritual, environmental and social, with interventions include standard comfort intervention, coaching and comfort food for thr soul. Maternity specialist nurses need to enhance the role and functions in order of health care, both as service providers, educators, lawyers, managers, collaborators and communicators."

"Program Kesehatan Ibu dan Anak sudah merupakan program perioritas dan angka cakupan persalinan oleh tenaga kesehatan semakin tinggi. Tetapi di Wilayah Jakarta Selatan kematian ibu bersalin meningkat dari 5 kematian ibu pada tahun 2007 menjadi 11 kematian ibu pada tahun 2008, sebanyak 10 dari 11 kematian ibu tersebut akibat perdarahan postpartum. Sementara semua bidan yang berpraktek sudah lulus uji kompetensi. Sehingga peneliti merasa perlu mengetahui berapa besar proporsi kompetensi bidan dalam menanggulangi perdarahan postpartum dan juga ingin mengetahui hubungan antara motivasi dan supervisi dengan kompetensi bidan dalam menanggulangi perdarahan postpartum. Penelitian ini adalah penelitian kuantitatif dengan desain studi potong lintang. Sampel adalah 69 bidan yang berpraktik menolong persalinan. Hasil penelitian didapatkan, kompetensi bidan dalam menanggulangi PP adalah rendah (23.2%), ternyata motivasi dan supervisi sangat berpengaruh terhadap kompetensi bidan dengan masing-masing nilai p 0,02 dan 0,03 dan OR 10,6 dan 4,85. Sehingga diperlukan upaya penguatan dari Sudin Kesehatan Jakarta Selatan terhadap Bikor Puskesmas dalam memahami, mempraktekkan dan melembagakan sistem motivasi dan sistem supervisi dalam bentuk pelatihan dengan pendekatan jaminan mutu. Intensitas supervisi di setiap program terutama untuk meningkatkan kompetensi bidan mutlak diperlukan, karena supervisi bisa menjadi kontrol, membimbing dan memfasilitasi seluruh kegiatan yang diperlukan. Perlu dilakukan penganggaran untuk kegiatan supervisi yang didukung oleh pembentukan tim supervisi melalui Surat Keputusan Kepala Suku Dinas Kesehatan Jakarta Selatan.

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Mother and child health program has been prioritized and the statistic of child delivery that is handled by health workers is increasing. Despite those facts, in South Jakarta alone, maternal mortality rate has been increasing. There had been 5 maternal death in 2007 and 11 maternal death in 2008 in which 10 out of it were due to postpartum haemorrhage. All practice midwives have passed the competency test. And that is why the writer need to find out how much midwife's competency plays its role in handling postpartum haemorrhage and also the relationship between motivation and supervision, and midwife's competency in handling postpartum haemorrhage. This is a quantitative study with cross sectional design. Samples are 69 midwives who have helped with delivery.

The study resulted a low competency in handling postpartum haemorrhage (23.2%), and that motivation and supervision played a very important role in affecting midwives' competency with each has the p value 0.02 and 0.03 and OR 10.6 and 48,5. Thus, effort of reinforcement from Sudin kesehatan South Jakarta upon Bikor Puskesmas is needed in order to understand, practice and institutionalize the supervision and motivation system in the form of training and quality assurance. Progressively and continuously. The intensity of supervision in every program, mainly to increase the midwife's competency, is absolutely needed, because supervision is capable of being control and guidance and also of facilitating all the required activitie. All this supervision activity needs budgeting that should be supported by team of supervision formed legally by Head officer Suku Dinas Kesehatan South Jakarta."

"Angka kematian ibu (AKI) merupakan salah satu indikator untuk menentukan derajat kesehatan ibu. AKI secara nasional masih relatif tinggi. Penyebab AKI antara lain perdarahan setelah persalinan, eklamsia, dan infeksi. Selain itu, AKI juga disebabkan oleh faktor tiga terlambat dan empat terlalu. Perdarahan menempati persentase tertinggi penyebab kematian ibu. Laporan ini memberikan gambaran tentang pelaksanaan praktik residensi Ners Spesialis Keperawatan Maternitas fokus pada kasus perdarahan postpartum dengan penerapan kedua teori yaitu "Need for Help Wiedenbach" pada keadaan emergensi dan teori "Conservation Levine" untuk pemulihan ibu postpartum dengan perdarahan. Fokus teori keperawatan “Need for Help Wiedenbach” adalah memberikan pertolongan sesuai dengan kebutuhan pasien saat ini yaitu pada kasus ini saat terjadi perdarahan. Kemudian setelah fase akut teratasi, asuhan keperawatan diberikan untuk mempertahankan keseimbangan energi ibu postpartum setelah mengalami perdarahan. Perawat perlu memahami dan melaksanakan perannya sebagai pemberi asuhan keperawatan, pendidik, konselor, advokat, koordinator, kolaborator, peneliti, dan agen pembaharu dalam pelayanan praktik keperawatan.

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MMR is still relatively high nationally. The causes of MMR may include postpartum hemorrhage, eclampsia, and infection. In addition, MMR is also caused by the “three delays” and “four frequently occurring factors” among women. Bleeding is the highest percentage of the causes of maternal death. This report provided an overview of the practice implementation by resident maternity nursing specialist focused on the application theories of Need for Help from Wiedenbach during acute stage and Conservation from Levine during recovery stage with postpartum hemorrhage. The nursing theory of "Need for Help Wiedenbach" is indented to provide help in accordance with the needs of patients here and now in case of postpartum hemorrhage. Then after the acute phase is managed, the nursing care is given to maintain energy balance of postpartum women after bleeding. The nurses need to understand and carry out their roles as providers of nursing cares, educator, counselor, advocate, coordinator, collaborator, researcher, and innovator in the nursing maternity practices."

"Angka Kematian Ibu (AKI) harus diturunkan untuk mencapai kesejahteraan masyarakat di suatu negara. Perdarahan postpartum menjadi penyebab kematian ibu paling besar di dunia dan Indonesia. Upaya penurunan angka kematian ibu perlu dilakukan dengan mencegah kejadian perdarahan postpartum. Pelayanan kesehatan ibu berperan dalam upaya menurunkan kematian ibu serta dengan adanya temuan bahwa tingginya kematian ibu di Kawasan Timur Indonesia diikuti dengan akses dan kualitas pelayanan kesehatan ibu yang lebih rendah dari Kawasan Barat Indonesia. Penelitian ini bertujuan untuk mengetahui hubungan antara pelayanan kesehatan ibu dengan kejadian perdarahan postpartum di Kawasan Timur dan Barat Indonesia. Penelitian adalah penelitian kuantitatif dengan desain studi cross sectional dan memanfaatkan data Survei Demografi dan Kesehatan Indonesia (SDKI) tahun 2017. Analisis dilakukan dengan uji Chi Square dan Uji Regresi Logistik Berganda. Hasil penelitian menunjukkan bahwa proporsi perdarahan postpartum di Indonesia adalah 7,1% (95% CI (6,6% 7,7%)) dan lebih tinggi di Kawasan Barat Indonesia 7,4% (95% CI (6,8% - 8%)) dibandingkan di Kawasan Timur Indonesia 5,6% (95% CI (4,8%-6,5%)). Tidak ditemukan hubungan yang bermakna antara variabel-variabel pelayanan kesehatan ibu dengan kejadian perdarahan postpartum, kecuali pada variabel penggunaan KB di Kawasan Timur Indonesia yang memiliki hubungan signifikan dengan kejadian perdarahan postpartum, namun hubungan tersebut bersifat negatif (p-value = 0,045; COR = 0,664 (95% CI (0,444-0,993)). Kunjungan ANC memiliki hubungan sebagai faktor risiko perdarahan postpartum, meskipun hubungan tersebut tidak signifikan secara statistik. Variabel yang berhubungan terhadap kejadian perdarahan postpartum adalah riwayat komplikasi kehamilan dan jarak ke fasilitas kesehatan di Kawasan Timur Indonesia serta riwayat komplikasi kehamilan dan pendidikan di Kawasan Barat Indonesia. Oleh karena itu, pelayanan kesehatan perlu penguatan terkait dengan variabel-variabel tersebut.

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The Maternal Mortality Rate (MMR) must be reduced in order to achieve public welfare in a country. Postpartum hemorrhage is the main cause of maternal death in the world and Indonesia. Efforts to reduce maternal mortality need to be done by preventing the incidence of postpartum hemorrhage. Maternal health services have a role to reduce maternal mortality as the finding shows that high maternal mortality in East Indonesia is followed by lower access and quality of maternal healthcare than West Indonesia. This study aims to determine the relationship between maternal health services and the incidence of postpartum hemorrhage in East and West Indonesia. This study is a quantitative study with a cross sectional study design and utilizes data from the 2017 Indonesian Demographic and Health Survey (IDHS). The analysis was performed using Chi Square Test and Multiple Logistics Regression Test. The results showed that the proportion of postpartum hemorrhage in Indonesia was 7.1% (95% CI (6.6% 7.7%)) and was higher in West Indonesia 7.4% (95% CI (6.8% - 8%)) compared to East Indonesia 5,6% (95% CI (4.8%-6.5%).) No significant relationship was found between the variables of maternal healthcare and the incidence of postpartum hemorrhage, except for the use of family planning in East Indonesia which had a significant relationship with the incidence of postpartum hemorrhage, but the relationship was negative (p-value = 0.045; COR = 0.664 (95% CI (0.444-0.993). ANC visits have an association as a risk factor of postpartum hemorrhage, although the relationship is not statistically significant. Variable that associated with the incidence of postpartum hemorrhage are history of pregnancy complications and distance to health facilities problems in East Indonesia and then history of pregnancy complications and education level in West Indonesia. Therefore, healthcare services needs to strengthen the aspect related to those variables."