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"[ABSTRAKBayi prematur dapat mengalami hambatan kenaikan berat badan yang disebabkan oleh usia gestasi, penyakit penyerta, dan pengalaman nyeri atau stres. Hambatan kenaikan berat badan dapat diatasi dengan asuhan keperawatan yang tepat dalam pemenuhan kebutuhan nutrisi pada bayi prematur. Asuhan keperawatan dengan Model Konservasi Levine telah digunakan pada aplikasi praktik residensi di Ruang Neonatus Rumah Sakit Cipto Mangunkusumo dalam menganalisis kenaikan berat badan bayi prematur pada lima kasus terpilih mulai dari Bulan Maret-Mei tahun 2015. Analisis kasus didapatkan dari tahap pengkajian, tropikognosis, hipotesis, intervensi, dan evaluasi. Tropikognosis yang telah teridentifikasi yaitu risiko gangguan pemenuhan kebutuhan nutrisi. Intervensi telah dilakukan berdasarkan prinsip konservasi dan hasil evaluasinya yaitu bayi prematur mengalami kenaikan berat badan dengan konservasi energi. Kenaikan berat badan pada bayi prematur menunjukkan keberhasilan dari penerapan asuhan keperawatan berbasis Model Konservasi Levine.

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ABSTRACTThe preterm infant can has an obstacle of increasing weight which is caused by gestational age, health problems which followed and pain/ stress experience. The obstacle of increasing weight can be handled with giving nursing care in proper nutrition needs. Nursing care with Levine?s Conservation Model has been applied in residence practice application in neonates wards Cipto Mangunkusumo hospital to analyze increasing weight of preterm infant in five selected cases start from March until May 2015. Case analyze is founded from assessment, trophicognosis, hypothesis, intervention, and evaluation. Trophicognosis which identified was disturbance risk in fullfil nutrition needs. Intervention were done based on conservation principle and the result of evaluation that preterm infant has increasing weight with energy conservation. Increasing weight in preterm infant showed a successful application of nursing care based on Levine?s Conservation Model. ;The preterm infant can has an obstacle of increasing weight which is caused by gestational age, health problems which followed and pain/ stress experience. The obstacle of increasing weight can be handled with giving nursing care in proper nutrition needs. Nursing care with Levine?s Conservation Model has been applied in residence practice application in neonates wards Cipto Mangunkusumo hospital to analyze increasing weight of preterm infant in five selected cases start from March until May 2015. Case analyze is founded from assessment, trophicognosis, hypothesis, intervention, and evaluation. Trophicognosis which identified was disturbance risk in fullfil nutrition needs. Intervention were done based on conservation principle and the result of evaluation that preterm infant has increasing weight with energy conservation. Increasing weight in preterm infant showed a successful application of nursing care based on Levine?s Conservation Model. , The preterm infant can has an obstacle of increasing weight which is caused by gestational age, health problems which followed and pain/ stress experience. The obstacle of increasing weight can be handled with giving nursing care in proper nutrition needs. Nursing care with Levine’s Conservation Model has been applied in residence practice application in neonates wards Cipto Mangunkusumo hospital to analyze increasing weight of preterm infant in five selected cases start from March until May 2015. Case analyze is founded from assessment, trophicognosis, hypothesis, intervention, and evaluation. Trophicognosis which identified was disturbance risk in fullfil nutrition needs. Intervention were done based on conservation principle and the result of evaluation that preterm infant has increasing weight with energy conservation. Increasing weight in preterm infant showed a successful application of nursing care based on Levine’s Conservation Model. ]"

"Karya ilmiah ini merupakan analisis pelaksanaan praktik residensi keperawatan anak selama dua semester. Kegiatan utama yang dilakukan antara lain memberikan asuhan keperawatan pada bayi prematur dan praktik keperawatan berbasis pembuktian. Asuhan keperawatan pada bayi prematur menggunakan teori comfort Kolcaba. Diagnosis keperawatan yang sering muncul pada bayi prematur adalah nyeri prosedural, gangguan termoregulasi, nutrisi kurang dari kebutuhan tubuh dan risiko infeksi. Intervensi dengan teknik mengukur kenyamanan, edukasi pada orangtua, dan melalui tindakan menenangkan jiwa. Praktik keperawatan berbasis pembuktian dilakukan melalui facilitated tucking disertai "hadir-berbicara" untuk menurunkan skor nyeri prosedural. Hasil menunjukkan bahwa intervensi berbasis teori comfort Kolcaba efektif untuk meningkatkan kenyamanan. Disarankan agar teori comfort Kolcaba dapat diterapkan dalam pemberian asuhan keperawatan pada bayi prematur.

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This scientific paper is an analysis of the implementation of pediatric nursing practice residency during two semesters. Main activities were providing nursing care to premature`s infant and doing evidence based nursing practice. Nursing care had been premature`s infant using a Kolcaba comfort`s theory. Nursing problem usually occured in premature`s infant were acute procedural pain, ineffective thermoregulation, imbalanced nutrition: less than body, risk for infection. Intervention done by technical comfort measures, parent`s coaching, and comfort food the soul. Evidence done by doing facilitated tucking and "talking to-being with" to decrease score of acute procedural pain. The result showed the evidence based on Kolcaba comfort`s theory effective to increase comfort. It is suggested that Kolcaba comfort`s theory can applied in the provision of nursing care to premature`s infant."

"ABSTRAKBayi prematur sangat sensitif terhadap stimulus nyeri. Tujuan dari studi kasus ini adalah menganalisis efektivitas penerapan asuhan keperawatan pada bayi dengan gangguan pemenuhan kebutuhan kenyamanan melalui intervensi stimulasi multisensori menggunakan model Comfort Kolcaba di ruang perinatologi. Lima kasus terpilih menunjukkan terjadinya gangguan kenyamanan dan nyeri akut pada bayi prematur akibat terpapar dengan prosedur invasif. Intervensi dilakukan dengan mengkaji skor nyeri, pemberian stimulasi multisensori, serta perlibatan orang tua dalam intervensi melalui sentuhan dan kontak kulit ke kulit. Intervensi keperawatan berdasarkan evidence based nursing melalui tindakan stimulasi multisensori dilakukan untuk menurunkan skor nyeri. Hasil menunjukkan bahwa intervensi berbasis teori Comfort Kolcaba efektif untuk meningkatkan kenyamanan. Disarankan agar teori Comfort Kolcaba dapat diterapkan dalam pemberian asuhan keperawatan pada bayi prematur.

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ABSTRACTPremature infants are particularly sensitive to pain stimulus. The purpose of this case study is to analyze the effectiveness of nursing care in infants with impaired fulfillment of comfort through multisensory stimulation intervention in the perinatology room using Comfort Kolcaba model. Five cases selected show disruption of comfort and acute pain in preterm infants from exposure to invasive procedures. The intervention is done by assessing pain scores, multisensory stimulation, as well as the involvement of parents in the intervention through touch and skin-to-skin contact. Nursing interventions based on evidence based nursing through multisensory stimulation measures taken to decrease the pain score. The results show that the theory-based intervention Comfort Kolcaba effective to increase comfort. Application of Comfort Kolcaba theory can be applied in the provision of nursing care in premature infants. ;;"

"Intoleransi pemberian minum enteral merupakan masalah yang sering terjadi pada bayi berat lahir rendah. Tujuan dari studi kasus ini adalah melakukan analisis optimalisasi pemenuhan kebutuhan nutrisi enteral pada bayi berat lahir rendah melalui pengaturan posisi dengan pendekatan Teori Konservasi Levine. Lima kasus terpilih menunjukkan terjadi masalah keperawatan ketidakseimbangan nutrisi kurang dari kebutuhan tubuh. Pendekatan Teori Konservasi Levine dilakukan dengan menggunakan prinsip konservasi energi, konservasi integritas struktural, konservasi integritas personal, dan konservasi integritas sosial. Hasil penerapan intervensi pengaturan posisi dengan pendekatan Teori Konservasi Levine dapat menurunkan kejadian desaturasi, distensi abdomen, dan frekuensi muntah. Perawat dapat menjadikan intervensi tersebut sebagai standar prosedur operasional pada bayi berat lahir rendah yang mengalami intoleransi pemberian minum enteral.

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Enteral feeding intolerance is a problem that often occurs in low birth weight infants. The objective of this case study was to analyze the optimization of the fulfillment of enteral nutrition in low birth weight infants through positioning with Levine`s Conservation Theory. Five cases were selected due to nursing problems in nutrition which is less than body requirements. Levine`s Conservation Theory was used by applying the principle of energy conservation, structural integrity conservation, personal integrity conservation, and social integrity conservation. The results showed that implementation of positioning with Levine`s Conservation Theory can reduce the incidence of desaturation, abdominal distension, and frequency of vomiting. Nurses can make the intervention as a standard operating procedure in low birth weight infants who experience enteral feeding intolerance."

"Nyeri merupakan salat satu ketidaknyamanan yang sering dialami bayi yang dirawat di rumah sakit. Tujuan dari studi kasus ini adalah untuk mendapatkan gambaran tentang pemenuhan rasa nyaman neoantus dengan Non-nutritive Sucking (NNS) dan pijat ekstremitas berdasarkan penerapan Model Konservasi Levine. Model ini mempertimbangkan konservasi bayi saat prosedur ketidaknyamanan, peningkatan adaptasi bayi untuk mencapai keutuhan. Lima bayi dengan berbagai kondisi yang mengalami masalah nyeri akut diberikan asuhan keperawatan dengan pendekatan model konservasi Levine. Masalah keperawatan lain yang ditemukan adalah ketidakefektifan pola nafas, ketidakefektifan termoregulasi, ikterik neonatus, risiko cidera, risiko pertumbuhan tidak proporsional, ketidakcukupan ASI, dan risiko keterlambatan perkembangan. Masalah-masalah tersebut berisiko meningkatkan ketidaknyamanan dan menghambat proses adaptasi neonatus dalam mencapai keutuhan.

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Pain is a discomfort sensational that felt by hospitalized neonates. The purpose of this case study is to get description about the fulfill comfort of neoantus with Non Nutritive Sucking (NNS) and extremities massage based Levine Conservation Model application. This model considers the conservation of the baby during discomfort procedures, increased infant adaptation to achieve the wholeness. Five infants with various conditions experienced acute pain problems given nursing care with levine conservation model approach. Another nursing problems found were ineffective breathing patterns, neonatal jaundice, ineffective thermoregulation, risk of injury, risk of disproportionate growth, insufficient breastfeeding and risk of developmental delay. Such problems are at increased risk of discomfort and inhibit the neonatal adaptation process in achieving neonatal wholeness."

"Neonatus mengalami kondisi ketidaknyamanan selama mendapatkan perawatan di ruang intensif. Tujuan penulisan untuk menganalisis aplikasi teori Comfort Kolcaba pada bayi baru lahir dengan masalah kenyamanan dan pernapasan. Studi kasus dilakukan terhadap lima bayi di ruang perinatologi. Asuhan keperawatan berfokus pada kenyamanan fisik, psikospiritual, sosiokultural, dan lingkungan. Pengisapan lendir teknik empat tangan sebagai salah satu intervensi kenyamanan yang dievaluasi dengan Pediatric Comfort Assessment. Penerapan teori Comfort Kolcaba memberikan hasil yang baik terhadap kenyamanan kelima bayi. Kenyamanan psikospiritual dan sosiokultural dapat terpenuhi; sedangkan kenyamanan fisik dipengaruhi oleh berbagai faktor. Simpulan dari studi ini yaitu teori keperawatan Comfort Kolcaba sangat komprehensif sehingga sangat direkomendasikan untuk diterapkan pada bayi secara simultan dan berkesinambungan.

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Newborn was discomfort in the intensive care unit. The purpose of this writing is to provide an analysis of Kolcaba comfort theory applications in nursing care for newborns with comfort and respiratory problems. Case study method was used in 5 infants treated in perinatology. Nursing care given using the assessment of physical comfort, psychospiritual, socio-cultural, and environmental. The implementation of four-handed suction technique as one of the comfort intervention which evaluated by pediatric comfort assessment tool. The application of the Kolcaba comfort theory gives good results towards the comfort of five infants. Psychospiritual comfort and sociocultural be fulfilled; whereas physical comfort is influenced by various factors. The conclusion of this study is Kolcaba nursing comfort theory has very comprehensive aspects therefore highly recommended for newborns' comfort through simultaneous and continuous implementation."

"Masalah kesehatan yang paling sering dialami oleh bayi prematur adalah masalah sistem pencernaan sehingga peningkatan berat badan sesuai target tidak dapat tercapai. Tujuan dari studi kasus ini adalah melakukan analisis peranan jenis nutrisi terhadap peningkatan berat badan bayi prematur dengan masalah defisit nutrisi melalui pendekatan Teori Konservasi Levine. Lima kasus terpilih menunjukkan terjadi masalah keperawatan defisit nutrisi. Pendekatan Teori Konservasi Levine dilakukan dengan menggunakan prinsip konservasi energi, konservasi integritas struktural, konservasi integritas personal, dan konservasi integritas sosial. Hasil pemberian asuhan keperawatan menunjukkan bahwa Teori Konservasi Levine mempengaruhi peningakatan berat bayi prematur. Bayi prematur yang diberikan ASI terjadi peningatan berat badan 10-15 gram per hari, sedangkan bayi prematur yang diberikan susu formula terjadi peningatan berat badan 5-10 gram per hari. Perawat anak dapat mengoptimalkan pemberian ASI kepada bayi prematur untuk meningkatkan berat badan.

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The most common health problems experienced by premature infants is the problem of the digestive system so that weight gain on target cannot be achieved. The purpose of this case study is to analyze the role of nutrients to premature infant weight gain with nutritional deficits through the Levine Conservation Theory approach. Five selected cases indicate a nutritional deficit nursing problem. The Levine Conservation Theory Approach is conducted using energy conservation principles, structural integrity conservation, conservation of personal integrity, and conservation of social integrity. The results of nursing care show that Levine Conservation Theory influences the weighting of premature infants. Premature infants given breastfeeding weight 10 15 grams per day, whereas premature infants given formula milk occured weight gain 5 10 grams per day. Child nurses can optimize breastfeeding for premature babies to gain weight."

"Masalah kerusakan integritas kulit seperti cedera kulit, luka tekan, dan ruam popokbisa dialami oleh bayi baru lahir. Kerusakan kulit ini bisa menyebabkan infeksisistemik, berdampak psikososial, peningkatan morbiditas, dan peningkatan biayaperawatan. Asuhan keperawatan yang tepat sangat dibutuhkan dalam mengatasimasalah kerusakan integritas kulit pada bayi baru lahir. Karya ilmiah akhir inibertujuan untuk memberikan gambaran penerapan model konservasi Levine dalam memberikan asuhan keperawatan pada bayi baru lahir yang mengalami kerusakan integritas kulit. Trophicognosis kerusakan integritas kulit merupakan masalah pada lima kasus yang dibahas dalam karya ilmiah ini. Konservasi struktural dilakukan dengan mempertahankan keutuhan struktur kulit atau integritas kulit. Evaluasi pada kelima kasus trophicognosis menunjukkan masalah kerusakan integritas kulit dapatteratasi, tetapi pada satu kasus mengalami perbaikan yang lambat karena bayi menderita sepsis. Rekomendasi dari karya ilmiah ini adalah model konservasi Levinedapat diterapkan dalam memberikan asuhan keperawatan pada bayi yang mengalami kerusakan integritas kulit.

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Impared to skin integrity problems such as skin injury, pressure sores, and diaper rashcan be experienced by the newborn. This skin damage can cause systemic infections,psychosocial impact, increased morbidity, and increased maintenance costs. Propernursing care is needed in addressing the problem of damage to skin integrity innewborns. End scientific work aims to illustrate the application of conservation modelLevine in providing nursing care in newborns who suffered damage to skin integrity.Trophicognosis damage to skin integrity is an issue in the five cases discussed in thispaper. Structural conservation by maintaining the structural integrity of the skin or skinintegrity. Evaluation of the five cases trophicognosis indicate damage to skin integrityissues can be resolved, but in one case suffered a slow improvement for infantssuffering from sepsis. Recommendations from this paper is a model of conservationLevine can be applied in providing nursing care to infants who suffered impared toskin integrity.Keywords Levine Conservation, Newborn, Pressure Ulcer, and Skin integrity."

"Bayi prematur dengan alat bantu nafas ventilasi mekanik memerlukan tindakan bersihan jalan napas. Penelitian menggunakan quasy experiment pada dua kelompok A dan B untuk mengetahui perubahan saturasi sebelum, selama dan setelah tindakan bersihan jalan napas. Kelompok A open suction dan B closed suction masing-masing 30 dan 10 bayi prematur. Analisis menggunakan uji statistik repeated Anova yang dilanjutkan dengan post hoc paired wise comparison. Tindakan bersihan jalan napas menggunakan open suction nilai p kurang 0,001 secara statistik terdapat perbedaan rerata yang bermakna terhadap perubahan saturasi, sedangkan closed suction nilai p kurang 0,001 terdapat perbedaan rerata yang bermakna terhadap perubahan saturasi. Penggunaan alat pengisap lendir closed suction menunjukan keadaan saturasi oksigen lebih stabil, sehingga lebih disarankan untuk tindakan bersihan jalan napas pada bayi prematur. Penggunaan closed suction akan efektif pada keadaan sekret yang encer.

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Premature infant with a mechanical ventilation need airway clearance. The study used quasy experiment in two groups A and B to provide information before and after airway clearance. Group A open suction and B closed suction each of 30 and 10 premature infants. The analysis used the statistical repeated Anova test followed by post hoc paired wise comparison. Airway clearance using an open suction with p.value 0.001, statistically, there is a mean actually oxygen saturation, while closed suction p value of less than 0.001 is the average actually oxygen saturation. The used closed suction shows a more stable oxygen saturation state, more for airway clearance in premature infants. The use of the closed suction will be effective in the state of dilute secretions."

"Neonatus merupakan periode yang sangat rentan untuk mengalami masalah kesehatan, salah satunya yaitu gangguan sistem pernapasan. Gangguan sistem pernapasan pada neonatus dapat mengakibatkan gangguan dalam pemenuhan kebutuhan oksigen hingga dibutuhkan pemasangan alat bantu napas invasif dan pemasangan pipa endotrakel. Tujuan dari studi kasus ini adalah untuk menganalisis optimalisai pemenuhan oksigenasi pada neonatus melalui tindakan penghisapan lendir dengan hiperoksigenasi dengan pendekatan teori Konservasi Levine. Lima kasus terpilih mengalami gangguan pemenuhan oksigenasi akibat penumpukan lendir pada saluran napas. Pendekatan Teori Konservasi Levine dilakukan dengan menggunakan prinsip konservasi energi, konservasi integritas struktural, konservasi integritas personal, dan konservasi integritas sosial. Tindakan keperawatan berbasis pembuktian yang dilakukan melalui penghisapan lendir dengan hiperoksigenasi terbukti efektif dalam mencegah hipoksemia selama prosedur penghisapan lendir pada neonatus sehingga pemenuhan kebutuhan oksigen dapat optimal. Prosedur penghisapan lendir dengan hiperoksigenasi dengan menggunakan pendekatan teori Konservasi Levine dapat diterapkan dalam pemberian asuhan keperawatan yang berkualitas pada neonatus dengan gangguan pemenuhan oksigenasi.

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Neonates are a very vulnerable period to experience health problems, one of which is respiratory system disorders that may result in impairment in the fulfillment of oxygen. Assisted mechanical ventilation is the mainstay of management of a variety of respiratory condition in neonates through an inserted endotracheal tube ETT connecting the individual to the ventilator. The purpose of this case study was to analyze the optimization of oxygen fulfillment in neonates through suctioning with hyperoxygenation with the Levine Conservation theory approach. The five selected cases suffered from oxygen fulfillment impairment induced obstruction due to mucus accumulation in the airways. Levine's conservation model of nursing provides an ideal conceptual framework for this condition that Evidence-based nursing intervention by suctioning with hyperoxygenation has been shown to be effective in preventing hypoxemia during suctioning in neonates. The suctioning with hyperoxygenation by using the Levine Conservation theory approach can be applied in the provision of quality nursing care in neonates with oxygenation fulfillment impairment."