LAPORAN PENDAHULUAN

KEPALA RUANGAN

A. Fungsi Perencanaan (Planning)

1. Perawat ruangan
Jumlah perawat
a. Dinas Pagi = ......... Orang
b. Dinas Sore = ......... Orang
c. Dinas Malam = ......... Orang
2. Pasien
a. Jumlah Pasien = ......... Orang
b. Tingkat Ketergantungan
1) Minimal = ......... Orang
2) Parsial = ......... Orang
3) Total = ......... Orang
c. Pasien Menurut Ruangan
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3. Mahasiswa Keperawatan
a. Jumlah = ......... Orang
1) Dinas Pagi = ......... Orang
2) Dinas Siang = ......... Orang
3) Dinas Malam= ......... Orang

B. Fungsi Pengorganisasian (Organizing)

1. Metode Penugasan : ...........................................................
2. Struktur Organisasi
 3. Waktu Pelaksanaan
a. Overan : Pkl. ........................... WIB
b. Pre-conference : Pkl. ........................... WIB
c. Post-conference :Pkl. ........................... WIB

C. Fungsi Ketenagaan (Staffing)

1. Jumlah tenaga yang dibutuhkan : ...............................................
Dinas Pagi

Dinas Sore

Dinas Malam

2. Jumlah tenaga yang tersedia : ...............................................

 Dinas Pagi

Dinas Sore

Dinas Malam

D. Fungsi Pengarahan (Actuating)

1. Supervisi dan Pengarahan Karu
a. Jadwal Supervisi : ...............................................
b. Topik Supervisi : ...................................................................................

2. Ronde
a. Jadwal Ronde : ...................................................................................
b. Topik Ronde : ...................................................................................

3. Diskusi Refleksi Kasus

a. Jadwal : ………………………………………………………
b. Topik : ………………………………………………………

E. Fungsi Pengawasan (Controlling)

1. Pelaksanaan Pre-Conference
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2. Pelaksanaan Post-Conference :
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 LAPORAN PENDAHULUAN

KETUA TIM.......

A. Jumlah Pasien :

Pasien Orang
Ruangan :

Jenis Kelamin:
Laki-laki Orang
Perempuan Orang

B. Tingkat Ketergantungan

Tingkat Ketergantungan Jumlah

Total Care
Parsial Care
Minimal Care

C. Jumlah Diagnosa Keperawatan :

Diagnosa Keperawatan Jumlah

Aktual
Resiko
Promosi Kesehatan

D. Jumlah Intervensi Keperawatan :

Intervensi Keperawatan Jumlah

Pengkajian berkelanjutan
Intervensi Keperawatan mandiri
Pendidikan kesehatan
Kolaborasi

E. Jumlah Aktivitas Keperawatan

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F. Masalah yang Teratasi
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G. Masalah yang Belum Teratasi
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H. Aktivitas yang Terlaksana
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I. Aktivitas yang Tidak Terlaksana
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