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TAHAPAN PROSES

KEPERAWATAN
Dewi Puspita
Copyright 2013 by Mosby
Elsevier Inc
• Proses keperawatan dan langkah2nya
• Lima karakteristik proses keperawatan
• Keterampilan-keterampilan penting dalam proses keperawatan
• Critical thinking dan critical reasoning dalam proses keperawatan
• Manfaat proses keperawatan bagi perawat dan bagi pasien
• Konsep holistic : biopsikososio, kultural dan spiritual dalam proses
keperawatan
Pengantar

• Ilmu Keperawatan adalah seni dan ilmu pengetahuan.


• Praktik Ilmu Keperawatan didasarkan pada suatu kesatuan ilmu
pengetahuan yang terus berubah dengan penemuan-penemuan baru
dan inovasi.
• Ketika Anda mengintegrasikan ilmu dan seni Keperawatan kedalam
praktik Anda, kualitas perawatan yang Anda berikan kepada pasien
Anda adalah pada tingkat keunggulan yang menguntungkan pasien
dan keluarga mereka.
• Pasien adalah centre.
• Pasien adalah……
• memiliki berbagai macam
kebutuhan perawatan
kesehatan, pengalaman,
kerentanan, dan harapan.
• Ketika memberikan perawatan, sangat penting untuk menyediakan
layanan yg sesuai dengan standar praktik dan mengikuti kode etik
(American Nurses Association, Asosiasi [ANA], 2008, 2010b).
• Praktek profesional mencakup pengetahuan dari sosial dan ilmu-ilmu
perilaku, ilmu biologi dan fisiologis dan teori-teori Keperawatan.
Proses keperawatan dan langkah2nya

• Pengkajian
• Diagnosa Keperawatan
• Perencanaan (+ rasionalisasi)
• Implementasi
• Evaluasi
Lima karakteristik proses keperawatan

• Merupakan kerangka berpikir dalam memberikan asuhan


keperawatan kepada klien, keluarga, dan komunitas.
• Bersifat teratur dan sistematis.
• Bersifat saling bergantung satu dengan yang lain
• Memberikan asuhan keperawatan secara individual
• Klien menjadi pusat dan menghargai kekuatan klien
• Dapat digunakan dalam keadaan apapun
• Tujuan : memiliki tujuan jelas yaitu untuk meningkatkan kualitas asuhan
keperawatan pada klien
• Sistematik: menggunakan pendekatan yang terorganisir dalam mencapai tujuan.
Sehingga dapat meningkatkan kualitas pelayanan serta menghindari terjadinya
kesalahan
• Dinamik: proses keperawatan dilakukan secaraberkesinambungan. Serta
ditujukan untuk mengatasi perubahan respon klien yang diidentikan melalui
hubungan antara perawat dengan klien
• Interaktif: proses keperawatan memiliki dasar hubungan yaituhubungan timbal
balik antara perawat, klien, keluarga, dan tenaga kesehatan lain.
• Fleksibel: fleksibilitas proses keperawatan ini dapat dilihat dalam dua konteks,
yaitu:
Dapat diadopsi dalam praktek keperawatan dalam situasi apapun, baik
dalam kaitannya dengan individu, keluarga, atau masyarakat
Tahapannya dapat dilakukan berurutan sesuai dengan persetujuan kedua
belah pihak.
• Teoritis : setiap langkah dalam keperawatan selalu berdasarkan pada konsep ilmu
keperawatan.
Berdasarkan karakter teoritis ini, maka asuhan
keperawatan pada klien hendaknya menekankan pada
tiga aspek penting, antara lain
a. Humanistic : memandang dan memperlakukan klien sebagai manusia
b. Holistic : intervensi keperawatan harus memenuhi kebutuhan dasar
manusia secara utuh, yakni bio-psiko-sosio-spiritual.
c. Care: asuhan keperawatan yang diberikan hendaknya berlandaskan
pada standar praktek keperawatan dan kode etik keperawatan.
NURSING AS A PROFESSION

• Memerlukan liberal fondasi dasar dan pendidikan lanjutan dari para


anggotanya.
• Memiliki body of knowledge yang mengarah ke keterampilan,
kemampuan dan norma-norma.
• Menyediakan layanan tertentu.
• Anggota profesi yang memiliki otonomi dalam pengambilan
keputusan dan praktek.
• Profesi secara keseluruhan memiliki kode etik untuk praktek.
Karakteristik Profesi
Gary dan Pratt (1991), Kiozer Erb dan Wilkinson (1995) mengemukakan
karakteristik professional sebagai berikut :

a. Konsep misi yang terbuka terhadap perubahan


b. Penguasaan dan penggunaan pengetahuan teoritis
c. Kemampuan menyelesaikan masalah
d. Pengembangan diri secara berkesinambungan
e. Pendidikan formal
f. System pengesahan terhadap kompetensi
g. Penguatan secara legal terhadap standart professional
h. Praktik berdasarkan etik
i. Hukum terhadap malpraktik
j. Penerimaan dan pelayanan pada masyarakat
k. Perbedaan peran antara pekerja professional dengan pekerjaan lain dan
membolehkan praktik yang otonom.
Scope and Standards of Practice
• The goal of this document is to improve the health and well-being of
all individuals, communities, and populations through the significant
and visible contributions of registered nursing using standardbased
practice (ANA, 2010b).
Standards of Practice
• The Standards of Practice describe a competent level of nursing care
(Box 1-1). The levels of care are demonstrated by the critical thinking
model known as the nursing process: assessment, diagnosis,
outcomes identification and planning, implementation, and
evaluation (ANA, 2010b). The nursing process is the foundation of
clinical decision making and includes all significant actions taken by
nurses in providing care to patients (see Unit 3).
Standards of Professional Performance.
• The ANA Standards of Professional Performance (Box 1-2) describe a
competent level of behavior in the professional role (ANA, 2010b).
These standards provide objective guidelines for nurses to be
accountable for their actions, their patients, and their peers. The
standards provide a method to assure patients that they are receiving
highquality care, that the nurses know exactly what is necessary to
provide nursing care, and that measures are in place to determine
whether care meets the standards.
Code of Ethics
• The code of ethics is the philosophical ideals of right and wrong that
define the principles you will use to provide care to your patients. It is
important for you to also incorporate your own values and ethics into
your practice. As you incorporate these values, you explore what type
of nurse you will be and how you will function within the discipline
(ANA, 2008, 2010c).
• The Code of Ethics for Nurses with Interpretive Statements is a guide
for carrying out nursing responsibilities that provide quality nursing
care; it also outlines the ethical obligations of the profession (ANA,
2008).
NURSING EDUCATION

• Most nurses agree that nursing education is important to practice and


that education needs to respond to changes in health care created by
scientific and technological advances. There are various education
preparations for an individual intending to be an RN. In addition,
there is graduate nurse education and continuing and in-service
education for practicing nurses.
Professional Registered Nurse Education
• Currently in the United States the most frequent way to become a
registered nurse (RN) is either through completion of an associate or
baccalaureate degree program. Graduates of both programs are eligible to
take the National Council Licensure Examination for Registered Nurses
(NCLEX-RN®) to become RNs in the state in which they will practice.
• The associate degree program in the United States is a 2-year program that
is usually offered by a university or community college. This program
focuses on the basic sciences and theoretical and clinical courses related to
the practice of nursing.
• The baccalaureate degree program usually includes 4 years of study in a
college or university. The program focuses on the basic sciences;
theoretical and clinical courses; and courses in the social sciences, arts, and
humanities to support nursing theory
Graduate Education
• After obtaining a baccalaureate degree in nursing, you can pursue
graduate education leading to a master’s or doctoral degree in any
number of graduate fields, including nursing.
• A nurse completing a graduate program can receive a master’s degree
in nursing. The graduate degree provides the advanced clinician with
strong skills in nursing science and theory, with emphasis on the basic
sciences and research-based clinical practice. A master’s degree in
nursing is important for the roles of nurse educator and nurse
administrator, and it is required for an advanced practice registered
nurse (APRN).
Doctoral Preparation
• Professional doctoral programs in nursing (DSN or DNSc) prepare
graduates to apply research findings to clinical nursing. Other doctoral
programs emphasize more basic research and theory and award the
research-oriented Doctor of Philosophy (PhD) in nursing. Recently the
AACN recommended the Doctor of Nursing Practice (DNP) as the
terminal practice degree and required preparation for all APRNs by
2015 (Chase and Pruitt, 2006). The DNP is a practice-focused
doctorate. It provides skills in obtaining expanded knowledge through
the formulation and interpretations of evidence-based practice
(Chism, 2010).
Continuing and In-Service Education
• Continuing education programs are one way to promote and maintain
current nursing skills, gain new knowledge and theory, and obtain
new skills reflecting the changes in the health care delivery system
(Hale et al., 2010).
• Continuing education involves formal, organized educational
programs offered by universities, hospitals, state nurses associations,
professional nursing organizations, and educational and health care
institutions. An example is a program on caring for older adults with
dementia offered by a university or a program on safe medication
practices offered by a hospital. Continuing education updates your
knowledge about the latest research and practice developments,
helps you to specialize in a particular area of practice, and teaches
you new skills and techniques (Hale et al., 2010).
In-service education programs
• are instruction or training provided by a health care agency or
institution. An in-service program is held in the institution and is
designed to increase the knowledge, skills, and competencies of
nurses and other health care professionals employed by the
institution.
NURSING PRACTICE
Licensure and Certification
• Licensure. In the United States RN candidates must pass the NCLEX-RN®
examination administered by the individual State Boards of Nursing.
Regardless of educational preparation, the examination for RN licensure is
exactly the same in every state in the United States. This provides a
standardized minimum knowledge base for nurses.
• Certification. Beyond the NCLEX-RN®, the nurse may choose to work
toward certification in a specific area of nursing practice. Minimum
practice requirements are set, based on the certification the nurse seeks.
National nursing organizations such as the ANA have many types of
certification to enhance your career such as certification in medical surgical
or geriatric nursing. After passing the initial examination, you maintain
your certification by ongoing continuing education and clinical or
administrative practice
Science and Art of Nursing Practice
• Because nursing is both an art and a science, nursing practice requires
a blend of the most current knowledge and practice standards with
an insightful and compassionate approach to patient care. Your
patients’ health care needs are multidimensional. Thus your care will
reflect the needs and values of society and professional standards of
care and performance, meet the needs of each patient, and integrate
evidence-based findings to provide the highest level of care.
• Nursing has a specific body of knowledge; however, it is essential that
you socialize within the profession and practice to fully understand
and apply the nursing knowledge base and develop professional
expertise.
Body of knowledge = Ilmu Keperawatan
• Pengembangan pendidikan keperawatan bertolak dari pengertian
dasar tentang ilmu keperawatan seperti yang dirumuskan oleh
Konsorsium Ilmu kesehatan (1991) yaitu : “ Ilmu keperawatan
mencakup ilmu-ilmu dasar seperti ilmu alam, ilmu social, ilmu
perilaku, ilmu biomedik, ilmu kesehatan masyarakat, ilmu dasar
keperawatan, ilmu keperawatan komunitas dan ilmu keperawatan
klinik, yang aplikasinya menggunakan pendekatan dan metode
penyelesaian masalah secara ilmiah, ditujukan untuk
mempertahankan, menopang, memelihara dan meningkatkan
integritas seluruh kebutuhan dasar manusia “.
PROFESSIONAL RESPONSIBILITIES AND ROLES
• Sebagai seorang perawat, Anda bertanggung jawab untuk
mendapatkan dan memelihara tertentu pengetahuan dan
keterampilan untuk berbagai profesional peran dan tanggung jawab.
Perawat memberikan perawatan dan kenyamanan untuk pasien
dalam semua pengaturan perawatan kesehatan.
• Perawat perhatian untuk memenuhi kebutuhan pasien tetap sama
apakah perawatan berfokus pada kesehatan promosi dan penyakit
pencegahan, manajemen penyakit dan gejala, dukungan keluarga,
atau end of life
PROFESSIONAL RESPONSIBILITIES AND ROLES

• Autonomy and Accountability


Autonomy is an essential element of professional nursing that involves
the initiation of independent nursing interventions without medical
orders.
Accountability means that you are responsible, professionally and
legally, for the type and quality of nursing care provided.
• Caregiver
As caregiver, you help patients maintain and regain health, manage
disease and symptoms, and attain a maximal level function and
independence through the healing process.
• Advocate
you protect your patient’s human and legal rights and provide assistance in
asserting these rights if the need arises.
• Educator
As an educator you explain concepts and facts about health, describe the
reason for routine care activities, demonstrate procedures such as self-care
activities, reinforce learning or patient behavior, and evaluate the patient’s
progress in learning.
• Communicator
It allows you to know your patients, including their strengths and
weaknesses, and their needs.
• Manager
The manager uses appropriate leadership styles to
create a nursing environment for the patients and staff that reflect the
mission and values of the health care organization
• Career Development
Nursing provides an opportunity for you to commit to lifelong learning
and career development to provide patients the state-ofthe-art care
they need.
Critical thinking dan critical reasoning dalam
proses keperawatan
• Berpikir kritis dalam keperawatan merupakan komponen dasar dalam
mempertanggungjawabkan profesi dan kualitas perawatan. Pemikir
kritis keperawatan menunjukkan kebiasaan mereka dalam berpikir,
kepercayaan diri, kreativitas, fleksibiltas, pemeriksaan penyebab
(anamnesa), integritas intelektual, intuisi, pola piker terbuka,
pemeliharaan dan refleksi. Pemikir kritis keperawatan
mempraktekkan keterampilan kognitif meliputi analisa, menerapkan
standar, prioritas, penggalian data, rasional tindakan, prediksi, dan
sesuai dengan ilmu pengetahuan.
• Proses berpikir ini dilakukan sepanjang waktu sejalan dengan
keterlibatan kita dalam pengalaman baru dan menerapkan
pengetahuan yang kita miliki, kita menjadi lebih mampu untuk
membentuk asumsi, ide-ide dan membuat kesimpulan yang valid,
semua proses tersebut tidak terlepas dari sebuah proses berpikir dan
belajar.
• Keterampilan kognitif yang digunakan dalam berpikir kualitas tinggi
memerlukan disiplin intelektual, evaluasi diri, berpikir ulang, oposisi,
tantangan dan dukungan.
• NOC NIC
Manfaat proses keperawatan bagi perawat dan
bagi pasien
1. Profesi
• Secara professional, profesi keperawatan melalui 5 tahapan menyajikan lingkup praktik keperawatan yang
secara terus menerus mendefinisikan perannya baik terhadap klien maupun profesi kesehatan lainnya.
• Dengan demikian perawat bekerja melakukan sesuatu bukan hanya sekedar melaksanakan perintah dokter,
melainkan melalui perencanaan keperawatan yang matang.

2. Klien
• Proses keperawatan mendorong klien dan keluarga berpartisifasi aktif dan terlibat ke dalam 5 tahapan
proses tersebut.
• Selama pengkajian, klien menyediakan informasi yang dibutuhkan, selanjutnya memberikan validasi
diagnosa keperawatan, dan menyediakan umpan balik selama evaluasi.
3. Perawat
• Beberapa hal yang dapat diperoleh dari proses keperawatan, antara lain:
• Meningkatkan kepuasan dan perkembangan profesionalisasi perawat
• Meningkatkan hubungan antara klien dengan perawat.
• Meningkatkan pengembangan kreativitas dalam penyelesaian masalah klien
Konsep holistic :
• Bio
• Psiko
• sosio
• kultural dan
• spiritual dalam proses keperawatan