FORMAT LAPORAN INOVASI PENGELOLAAN ASKEP

Nama Mahasiswa :
NIM :
Ruanga Praktik :

A. LATAR BELAKANG
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________

B. IDENTIFIKASI MASALAH / DIAGNOSA KEPERAWATAN

_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
C. PENJELASAN ARTIKEL JURNAL PILIHAN (JURNAL ASLI
DILAMPIRKAN)
1.Judul
______________________________________________________________
______________________________________________________________
______________________________________________________________
2.Penulis
______________________________________________________________
______________________________________________________________

3.Tempat Publikasi
______________________________________________________________
______________________________________________________________
4.Abstrak
a. latar Belakang
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________

b. Tujuan
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
c. Metode
______________________________________________________________
______________________________________________________________
______________________________________________________________
 ______________________________________________________________
______________________________________________________________
______________________________________________________________
d. Hasil
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________

e. Kesimpulan

______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________

D. RENCANA PELAKSANAAN INOVASI

1. Subjek
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
2. Waktu & Tempat

__________________________________________________________________

__________________________________________________________________
3. Prosedur Inovasi
a.Fase orientasi
______________________________________________________________
______________________________________________________________
 ______________________________________________________________
______________________________________________________________

b.Fase Interaksi (Kerja)

______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________

c.Fase Terminasi
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
E. HASIL PELAKSANAAN INOVASI
Fase Orientasi
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
Fase Interaksi (Kerja)
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
Fase Terminasi
_________________________________________________________________
_________________________________________________________________
F.RENCANA TINDAK LANJUT
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
 DAFTAR HADIR PRAKTIK
NAMA MAHASISWA :
NIM :
RUMAH SAKIT :

JAM TANDA TANGAN

No RUANGAN Preceptor
DATANG PULANG Mahasiswa Dosen
/Ka.Ru
 KEGIATAN AKTIVITAS HARIAN / LOGBOOK
NO HARI/ RESPON TTD TTD
AKTIVITAS KENDALA RTL
. TGL/JAM PASIEN MHS PEMB