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Format Analisa Tindakan Keperawatan

Nama : Putu Febri Winanda


NIM : 16089014049
Jenis Tindakan :........................................................................

1. Identitas pasien
Nama :........................................................................
Umur :........................................................................
Jenis Kelamin :........................................................................
Pekerjaan :........................................................................
Agama :........................................................................
Tanggal masuk :........................................................................
Alasan masuk :........................................................................
Dx Medis :........................................................................

2. Tahap Persiapan

Persiapan pasien :.....................................................................................


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Persiapan :.....................................................................................
lingkungan ......................................................................................
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Persiapan Alat :.....................................................................................


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3. Tahap Pelaksanaan

No Pelaksanaan
4. Tahap Akhir

Terminasi :.........................................................................................
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Evaluasi :.........................................................................................
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Dokumentasi :.........................................................................................
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5. Analisa Materi Tindakan

Pengertian Tindakan :..............................................................................


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Tujuan Tindakan :..............................................................................


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6. Evaluasi Hasil Tindakan

Hasil Tindakan :.......................................................................................


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7. Evaluasi Diri

Evalauasi Diri :.......................................................................................


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Singaraja,..........................2019
Mahasiswa,

.Putu Febri Winanda


NIM 16089014049
Menyetujui,
Clinical Instruktur (CI) Clinical Teacher (CT)
Ruang ................................................. STIKES Buleleng

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NIP....................................................... NIK...............................................