FORMAT PENILAIAN PRAKTIK PRE NERS

MAHASISWA SEKOLAH TINGGI ILMU KESEHATAN MUHAMMADIYAH BANJARMASIN

TAHUN AKADEMIK 2015/2016

NAMA MAHASISWA : Karina Handayani

NPM : 12142011030
Rumah Sakit : Rumah Sakit Islam Banjarmasin

NILAI
NO ASPEK YANG DINILAI BOBOT KET
1 2 3
1 Ketelitian dalam melaksanakan tugas
2 Tanggungjawab terhadap tugas yang diberikan
3 Inisiatif dan partisipasi aktif dalam tugas
4 Kedisiplinan
5 Melaksanakan tugas sesuai dengan wewenang
6 Melaksanakan tugas sesuai dengan prosedur
7 Kejujuran
8 Sikap pada sesama teman sejawat
9 Sikap terhadap tim kesehatan / staf di lahan praktik
10 Sikap terhadap pasien dan keluarga
11 Menjaga kerahasiaan
12 Aktif melakukan konsultasi dengan pembimbing
13 Laporan dikerjakan sesuai waktu
14 Pengumpulan laporan sesuai waktu
15 Kerapihan dan kebersihan
16 Kelengkapan atribut
Jumlah

Keterangan :
1 = Tidak dilakukan (2.00-2.50)
2 = Hanya sebagian dilakukan (3.00-3.50)
3 = Dilakukan dengan baik (4.00)

Banjarmasin, ................................. 2016

Pembimbing Klinik

( .................................................... )
 LEMBAR EVALUASI KETERAMPILAN MAHASISWA
PRAKTIK PRENERS STIKES MUHAMMADIYAH BANJARMASIN

NAMA MAHASISWA : Lutfiana Eka Juliani

NPM : 12142011034
Rumah Sakit : Rumah Sakit Islam Banjarmasin

No Hari/Tanggal/Jam Jenis Tindakan Paraf CI Keterangan

 LAPORAM ANALISA SINTESA TINDAKAN KEPERAWATAN

NAMA MAHASISWA : Lia fitriani

NPM : 12142011032
Tanggal :
Tempat : Rumah Sakit Islam Banjarmasin

1. Tindakan keperawatan yang dilakukan :

.............................................................................................................................................................
.............................................................................................................................................................
.............................................................................................................................................................
.............................................................................................................................................................

2. Diagnosa keperawatan :
.............................................................................................................................................................
.............................................................................................................................................................
.............................................................................................................................................................

3. Prinsip-prinsip tindakan dan rasional :

.............................................................................................................................................................
.............................................................................................................................................................
.............................................................................................................................................................
.............................................................................................................................................................
.............................................................................................................................................................
.............................................................................................................................................................

4. Bahaya-bahaya yang mungkin terjadi akibat tindakan tersebut dan cara pencegahaannya :
.............................................................................................................................................................
.............................................................................................................................................................
.............................................................................................................................................................
.............................................................................................................................................................
.............................................................................................................................................................

5. Tujuan tindakan tersebut dilakukan :

.............................................................................................................................................................
.............................................................................................................................................................
.............................................................................................................................................................
.............................................................................................................................................................

6. Hasil yang didapat dan maknannya :

.............................................................................................................................................................
.............................................................................................................................................................
.............................................................................................................................................................
.............................................................................................................................................................

7. Identifikasi tindakan keperawatan lainnya yang dapat dialakukan untuk mengatasi masalah
tindakan tersebut (mandiri dan kolaborasi) :
.............................................................................................................................................................
.............................................................................................................................................................
.............................................................................................................................................................
.............................................................................................................................................................
.............................................................................................................................................................
.............................................................................................................................................................
.............................................................................................................................................................
.............................................................................................................................................................

8. Evaluasi diri :
.............................................................................................................................................................
.............................................................................................................................................................
.............................................................................................................................................................