RUMAH SAKIT MAWAR DRM : 52

JL SDPS 16 SURABAYA NO.RM :............................

EDUKASI PASIEN DAN KELUARGA TERINTEGRASI

Nama :..................................................L/P Pendidikan : SD SMP SMA D3 S1 .................................

Umur/tgl lahir :.................................................. Hambatan : Tdk ada Penglihatan Emosi Gangguan Bicara
Agama /Suku :.................................................. Kognitif Pendengaran lain-lain.........................................................
Ruangan :.................................................. Bahasa : Indonesia Asing :................... Daerah :........................................................
. Perlu penterjemah : Ya Tidak
ALAT
METODA EVALUASI SASARAN EDUKATOR TINDAK LANJUT
EDUKASI
DURASI A. Diskusi A.Leaflet
NO MATERI EDUKASI TGL A.Mengerti A.Reedukasi
(MNT ) B. Ceramah Nama /banner
B.Kurang mengerti paraf Nama paraf B.ReDemons TGL
C. Praktek px/kel B.Food
C.Tdk mengerti trasi
D. Demo model, dll
1. Hak dan Kewajiban pasien/kel
a.Peraturan & tata tertib Rmh sakit
b. Hak-hak pasien
2. Keperawatan
a.Prosedur tindakan keperawatan
/kebidanan & tujuannya
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3. Cuci tangan sesuai prosedur
4 Manajemen nyeri :
a.Relaxasi
b.Distraksi
c.Mobilisasi
d.Kolaborasi
 ALAT
METODA EVALUASI SASARAN EDUKATOR TINDAK LANJUT
EDUKASI
DURASI A.Diskusi A.Mengerti A.Leaflet /
NO MATERI EDUKASI TGL A.Reedukasi
(MNT ) B.Ceramah B.Kurang Nama banner
paraf Nama paraf B.ReDemons TGL
C.Praktek mengerti px/kel B.Food
trasi
D.Demo C.Tdk mengerti model,dll
5. Dokter Spesialis/DPJP
a.Perjalanan penyakit
b.Diagnosa
c.Hasil pemeriksaan
d.Tindakan medis
b.Komplikasi
c. Perkiraan hari perawatan
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6. Diet & Nutrisi
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7. Rehabmed
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8. Farmasi
a.Kegunaan obat
b.Aturan pakai
c. Efek samping
d.Interaksi obat & makanan
9. Psikologi
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10. Pelayanan Rohani :.................................
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11. Info yg diminta pasien/Keluarga
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