FORMAT

STRATEGI PELAKSANAAN TINDAKAN KEPERAWATAN

(Dibuat setiap kali sebelum interaksi/ pertemuan dengan klien)
Hari _________ , tanggal

A. PROSES KEPERAWATAN
1. Kondisi Klien :
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2. Diagnosa Keperawatan
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3. Tujuan Khusus (TUK)

4. Tindakan Keperawatan

B. STRATEGI KOMUNIKASI DALAM PELAKSANAAN TINDAKAN KEPERAWATAN

a. Fase Orientasi
1. Salam Terapeutik
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2. Evaluasi/ Validasi
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3. Kontrak
Topik : ..............................................................................................................
Waktu : ..............................................................................................................
Tempat : ..............................................................................................................

b. Fase Kerja
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c. Fase Terminasi
1. Evaluasi respon klien terhadap tindakan keperawatan
Evaluasi subjektif (Klien)
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Evaluasi objektif (Perawat)
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2. Rencna Tindakan Lanjutan
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3. Kontrak yang Akan Datang
Topik : ............................................................................................................
Waktu : ............................................................................................................
Tempat : ............................................................................................................
 IMPLEMENTASI DAN EVALUASI

Nama : Ruang : No. RM :

No. Tanggal & IMPLEMENTASI EVALUASI
Dx Jam KEPERAWATAN KEPERAWATAN