FORMAT

ASUHAN KEPERAWATAN JIWA

XIV. POHON MASALAH

PALANGKA RAYA, ..........................

PERAWAT,

............................................................
ANALISA DATA

NO DATA DIAGNOSA KEPERAWATAN

DS :

DO :

DS :

DO :

DS :

DO :

DS :

DO :
 RENCANA TINDAKAN KEPERAWATAN
KLIEN DENGAN ...................................................................
Nama klien : Diagnosis Medis :
No. CM : Ruangan :

No Diagnosa keperawatan Perencanaan

Tujuan Kriteria hasil Intervensi
TUM

TUK
DOKUMENTASI HASIL ASUHAN KEPERAWATAN
TINDAKAN KEPERAWATAN EVALUASI
 90

FORMAT
ANALISA PROSES INTERAKSI

Inisial klien : ........................................................ Nama Mahasiswa : ......................................................

Status interaksi perawat – kien : ........................................................ Tanggal : ......................................................
Lingkungan : ........................................................ Jam : ......................................................
Deskripsi Klien : ........................................................ Bangsal : ......................................................
Tujuan (Berorientasi pada klien): .......................................................

ANALISA BERPUSAT PADA ANALISA BERPUSAT PADA

KOMUNIKASI VERBAL KAMUNIKASI NON VERBAL RASIONAL
PERAWAT KLIEN
.
P: ............................................ P: ........................................... ................................................ ................................................ ...............................

K: .......................................... K: .......................................... ................................................. ................................................. ...............................

P: ............................................ P: ............................................ ................................................. ................................................. ...............................

K: .......................................... K: .......................................... ................................................. ................................................ ...............................

. .
P: ............................................ P: ............................................ ................................................ ................................................ ...............................
 91

K: .......................................... K: .......................................... ................................................. ................................................. ...............................

. .
P: ............................................ P: ............................................ ................................................ ................................................ ...............................

K: .......................................... K: .......................................... ................................................. ................................................. ...............................

Kesan Perawat :
.....................................................................................................................................................................................................................................................................................................
.....................................................................................................................................................................................................................................................
 19

FORMAT
STRATEGI PELAKSANAAN TINDAKAN KEPERAWATAN
(Dibuat setiap kali sebelum interaksi / pertemuan dengan klien)

A. PROSES KEPERAWATAN.

1. Kondisi Klien:
.......................................................................................................................................................
.............................................................................................................................
2. Diagnosa Keperawatan.
..........................................................................................................................................

3. Tujuan Khusus (TUK)

.......................................................................................................................................................
.............................................................................................................................
4. Tindakan Keperawatan
.......................................................................................................................................................
.............................................................................................................................

B. STRATEGI KOMUNIKASI DALAM PELAKSANAAN TINDAKAN KEPERAWATAN

a. FASE ORIENTASI

1. Salam Terapeutik
..................................................................................................................................................
..........................................................................................................................

2. Evaluasi / validasi
..................................................................................................................................................
..........................................................................................................................
3. Kontrak
Topik : ............................................................................................................
Waktu : ...........................................................................................................
Tempat : ...........................................................................................................

b. FASE KERJA
.......................................................................................................................................................
.......................................................................................................................................................
.......................................................................................................................................................
.......................................................................................................................................................
......................................................................................
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c. FASE TERMINASI
1. Evaluasi respon klien terhadap tindakan keperawatan
Evaluasi Subyektif (Klien)
..................................................................................................................................................
.........................................................................................................................
Evaluasi Obyekti (Perawat)
..................................................................................................................................................
..........................................................................................................................
2. Rencana Tindak Lanjut
..................................................................................................................................................
..........................................................................................................................
3. Kontrak yang akan datang
Topik : ............................................................................................................
Waktu : ...........................................................................................................
Tempat : ...........................................................................................................
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IMPLEMENTASI DAN EVALUASI

Nama : Ruang :

No Tanggal & jam Implementasi keperawatan Evaluasi