Oleh:
FIKRI ULIL ALBAB, S.Kep.
NIM. 092311101007
PERSETUJUAN
Asuhan Keperawatan Pasien dengan Spinal Cord Injury Vertebra Thorakal XIXII telah dilaksanakan pada tanggal 21 April 2014 di Ruang Bedah Orthopedi
(R.Seruni) RSD Dr. Soebandi Jember.
Pembimbing Ruangan
Pembimbing Akademik
( .......... )
( ............. )
Kepala Ruangan,
( )
PERSETUJUAN
Pembimbing Ruangan
Pembimbing Akademik
( .......... )
( ............. )
Kepala Ruangan,
( )
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E (Evaluasi):
S (Subjektif):
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O (Objektif):
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A (analisa):
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P (Perencanaan):
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E (Evaluasi):
S (Subjektif):
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O (Objektif):
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A (analisa):
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P (Perencanaan):
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E (Evaluasi):
S (Subjektif):
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...............................................................................................................................................................................
O (Objektif):
...............................................................................................................................................................................
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...............................................................................................................................................................................
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A (analisa):
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P (Perencanaan):
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E (Evaluasi):
S (Subjektif):
...............................................................................................................................................................................
...............................................................................................................................................................................
...............................................................................................................................................................................
...............................................................................................................................................................................
O (Objektif):
...............................................................................................................................................................................
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A (analisa):
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P (Perencanaan):
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:
Nilai
Maksimal
No
Penyajian
a. Sesuai waktu yang di alokasikan
b. Menggunakan bahasa yang bisa di mengerti
c. Kelancaran dan kejelasan penyajian
d. Penampilan penyaji dalam penyuluhan
Isi Penyuluhan
a. Kesesuaian TIK dengan TIU
b. Kesesuaian materi dengan TIK
c. Kesesuaian kegiatan penyuluhan
d. Kesesuaian media/alat dan sumber
e. Kesesuaian alat evaluasi
Tanya Jawab
a. Ketepatan menjawab
b. Kemampuan mengemukakan argument
c. Sikap penyuluh menanggapi pertanyaan
Total
Nilai
40
30
30
100
., 2014
Pembimbing,
______________________________
NIP.
:
:
Nilai
Maksimal
No
Penyajian
e. Sesuai waktu yang di alokasikan
f. Menggunakan bahasa yang bisa di mengerti
g. Kelancaran dan kejelasan penyajian
h. Penampilan penyaji dalam penyuluhan
Isi Penyuluhan
f. Kesesuaian TIK dengan TIU
g. Kesesuaian materi dengan TIK
h. Kesesuaian kegiatan penyuluhan
i. Kesesuaian media/alat dan sumber
j. Kesesuaian alat evaluasi
Tanya Jawab
d. Ketepatan menjawab
e. Kemampuan mengemukakan argument
f. Sikap penyuluh menanggapi pertanyaan
Total
Nilai
40
30
30
100
., 2014
Pembimbing,
______________________________
NIP.
:
:
Nilai
Maksimal
No
Penyajian
i. Sesuai waktu yang di alokasikan
j. Menggunakan bahasa yang bisa di mengerti
k. Kelancaran dan kejelasan penyajian
l. Penampilan penyaji dalam penyuluhan
Isi Penyuluhan
k. Kesesuaian TIK dengan TIU
l. Kesesuaian materi dengan TIK
m. Kesesuaian kegiatan penyuluhan
n. Kesesuaian media/alat dan sumber
o. Kesesuaian alat evaluasi
Tanya Jawab
g. Ketepatan menjawab
h. Kemampuan mengemukakan argument
i. Sikap penyuluh menanggapi pertanyaan
Total
Nilai
40
30
30
100
., 2014
Pembimbing,
______________________________
NIP.
:
:
Nilai
Maksimal
No
Penyajian
m. Sesuai waktu yang di alokasikan
n. Menggunakan bahasa yang bisa di mengerti
o. Kelancaran dan kejelasan penyajian
p. Penampilan penyaji dalam penyuluhan
Isi Penyuluhan
p. Kesesuaian TIK dengan TIU
q. Kesesuaian materi dengan TIK
r. Kesesuaian kegiatan penyuluhan
s. Kesesuaian media/alat dan sumber
t. Kesesuaian alat evaluasi
Tanya Jawab
j. Ketepatan menjawab
k. Kemampuan mengemukakan argument
l. Sikap penyuluh menanggapi pertanyaan
Total
Nilai
40
30
30
100
., 2014
Pembimbing,
______________________________
NIP.
:
:
Nilai
Maksimal
No
Penyajian
q. Sesuai waktu yang di alokasikan
r. Menggunakan bahasa yang bisa di mengerti
s. Kelancaran dan kejelasan penyajian
t. Penampilan penyaji dalam penyuluhan
Isi Penyuluhan
u. Kesesuaian TIK dengan TIU
v. Kesesuaian materi dengan TIK
w. Kesesuaian kegiatan penyuluhan
x. Kesesuaian media/alat dan sumber
y. Kesesuaian alat evaluasi
Tanya Jawab
m. Ketepatan menjawab
n. Kemampuan mengemukakan argument
o. Sikap penyuluh menanggapi pertanyaan
Total
Nilai
40
30
30
100
., 2014
Pembimbing,
______________________________
NIP.
NAMA
ALAMAT
TANDA TANGAN
()
Pada hari ini, kamis 24 april 2014 pukul 09.00 WIB bertempat di ruang bedah
orthopedic (R.seruni) RSD dr. Soebandi Jember, telah melaksanakan penyuluhan
kesehatan tentang Pentingnya Nutrisi Proses Penyembuhan Luka Pada Pasien
Post Op oleh mahasiswa Program Pendidikan Profesi Ners stase Keperawatan
Medical Bedah Universitas Jember.
Jember, April 2014
Pembimbing Ruangan
Pembimbing Akademik
( .......... )
( ............. )
Kepala Ruangan,
()
Pada hari ini, Kamis 24 April 2014 pukul 09.00 WIB bertempat di Ruang Bedah
Orthopedic (R.Seruni) RSD dr. Soebandi Jember, telah melaksanakan penyuluhan
kesehatan tentang Pentingnya Nutrisi Proses Penyembuhan Luka Pada Pasien
Post Op oleh mahasiswa Program Pendidikan Profesi Ners stase Keperawatan
Medical Bedah Universitas Jember.
Jember, April 2014
Pembimbing Ruangan
Pembimbing Akademik
( .......... )
( ............. )
Kepala Ruangan,
()