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Lampiran I
Target Keterampilan Praktek Peminatan

NILAI PENCAPAIAN (NILAI 1-4)

NO NAMA KOMPETENSI
Hari 1 Hari 2 Hari 3 Hari 4 Hari 5 Hari 6 Hari 7 Hari 8 Hari 9 Hari 10
Praktek Keperawatan Kritis (ICU)
1 Mahasiswa mampu melakukan perekamam EKG
2 Mahasiswa mampu melakukan managemen cairan
3 Mahasiswa mampu interpretasi EKG
4 Mahasiswa mampu melakukan intubasi
5 Mahasiswa mampu melakukan kalibrasi Ventilator
6 Mahasiswa mampu melakukan seting dalam persiapan ventilator
7 Mahasiswa mampu menggunakan Infus pump
8 Mahasiswa mampu menggunakan Syring Pump
9 Mahasiswa mampu berkolaborasi memberikan obat titrasi
10 Mahasiswa mampu mengambil darah arteri
11 Mahasiswa mampu interpretasi AGD
12 Mahasiswa mampu melakukan suction pasien dengan terpasang ventilator
13 Mahasiswa mampu memberikan terapi oksigen
14 Mahasiswa mampu memasang bed side monitor
Praktek Keperawatan Bedah (OK)
1 Mahasiswa mampu menjelaskan managemen kamar bedah
2 Mahasiswa mampu cuci tangan streril
3 Mahasiswa mampu memakai sarung tangan steril
4 Mahasiswa mampu memakaikan sarung tangan steril
5 Mahasiswa mampu memakaikan jas operasi
6 Mahasiswa mampu menyiapkan pasien pre operasi
7 Mahasiswa mampu menyiapkan mejaoperasi 14
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8 Mahasiswa mampu menyiapkan pasien dimeja operasi
9 Mahasiswa mampu berperan sebagai perawat on lop
10 Mahasiswa mampu menyiapkan instrument operasi
11 Mahasiswa membantu perawat instrument
12 Mahasiswa membantu perawat asisten
13 Mahasiswa mampu melakukan dekontaminasi alat
14 Mahasiswa mampu melakukan sterilisasi alat
Praktek Keperawatan Hemodialisa (HD)
1 Mahasiswa mampu menyiapkan pasien akan HD
2 Mahasiswa mampu menyiapkan tindakan HD (Priming)
3 Mahasiswa mampu melakukan Akses vaskuler
4 Mahasiswa mampu melakukan tindakan HD
5 Mahasiswa mampu mengakhiri tindakan HD
6 Mahasiswa mampu memberikan obat sesuai advice pada pasien HD
7 Mahasiswa mampu melakukan edukasi pada pasien HD
Keterangan Pengisian Pencapaian:

Skor 1 Mengetahui dan menjelaskan (Pengetahuan teoritis mengenai keterampilan ini, baik konsep, teori, prinsip, maupun indikasi, cara melakukan, komplikasi, dan sebagainya)
Skor 2 Pernah melihat atau pernah mendemonstrasikan (Memiliki pengetahuan teoritis mengenai keterampilan dan pernah melihat demonstrasinya).
Skor 3 Pernah melakukan atau pernah menerapkan di bawah supervisi (memiliki pengetahuan teoritis mengenai keterampilan dan pernah menerapkan keterampilan ini beberapa kali dibawah
supervisi.
Skor 4 Mampu melakukan secara mandiri (memiliki pengetahuan teoritis mengenai keterampilan ini dan memiliki pengalaman untuk menggunakan dan menerapkan keterampilan ini secara
mandiri

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Universitas Indonesia Maju
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 Lampiran 2

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VALIDASI
TINGKAT PEMBIMBING/
NO TEMPAT STASE HARI/TGL/JAM KEGIATAN/TINDAKAN KEPERAWATAN PENCAPAIAN PERSEPTOR/MENTOR
PRAKTEK PRAKTEK

Keterangan Pengisian Pencapaian:

Skor 1 Mengetahui dan menjelaskan (Pengetahuan teoritis mengenai keterampilan ini, baik konsep, teori, prinsip, maupun indikasi, cara melakukan, komplikasi, dan sebagainya)
Skor 2 Pernah melihat atau pernah mendemonstrasikan (Memiliki pengetahuan teoritis mengenai keterampilan dan pernah melihat demonstrasinya).
Skor 3 Pernah melakukan atau pernah menerapkan di bawah supervisi (memiliki pengetahuan teoritis mengenai keterampilan dan pernah menerapkan keterampilan ini beberapa kali dibawah
supervisi.
Skor 4 Mampu melakukan secara mandiri (memiliki pengetahuan teoritis mengenai keterampilan ini dan memiliki pengalaman untuk menggunakan dan menerapkan keterampilan ini secara
mandiri.

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 RESUME KEPERAWATAN KRITIS PADA Tn. ….
DENGAN GANGGUAN SISTIM ………………………:………………………………………………….
DI RUANG INTENSIVE CARE UNIT RS……………………………

Nama : No. Dokumen RM :

Alamat :
Umur :
Jenis Kelamin :

Keadaan saat dikaji : Tenang Gelisah Kesakitan Sesak

Nafas Anemis Lemah
Keluhan Utama :
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Riwayat Kesehatan Sekarang :
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Riwayat Kesehatan Dahulu :
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Riwayat Kesehatan Keluarga :
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Diagnosa Medis :
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Hasil Pengkajian :
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Fakultas Ilmu Kesehatan
Universitas Indonesia Maju
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Terapi Yang Diberikan :
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Diagnosa Keparawatan :
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Tindakan Keperawatan Yang Dilakukan :
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Evaluasi Keperawatan
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Nama dan Paraf Mahasiswa :

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Buku Pedoman Praktek Pilihan
Pendidikan Profesi Ners
Fakultas Ilmu Kesehatan
Universitas Indonesia Maju
 RESUME KEPERAWATAN HEMODIALISA PADA Tn. ….
DENGAN GANGGUAN SISTIM ………………………:………………………………………………….
DI RUANG UNIT HD RS……………………………

Nama : No. Dokumen RM :

Alamat :
Umur :
Jenis Kelamin :

Keadaan saat dikaji : Tenang Gelisah Kesakitan Sesak

Nafas Anemis Lemah
Keluhan Utama :
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Riwayat Kesehatan Sekarang :
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Riwayat Kesehatan Dahulu :
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Riwayat Kesehatan Keluarga :
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Diagnosa Medis :
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Hasil Pengkajian :
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Buku Pedoman Praktek Pilihan
Pendidikan Profesi Ners
Fakultas Ilmu Kesehatan
Universitas Indonesia Maju
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Terapi Yang Diberikan :
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Diagnosa Keparawatan :
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Tindakan Keperawatan Yang Dilakukan :
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Evaluasi Keperawatan
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Nama dan Paraf Mahasiswa :

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Buku Pedoman Praktek Pilihan
Pendidikan Profesi Ners
Fakultas Ilmu Kesehatan
Universitas Indonesia Maju
 RESUME KEPERAWATAN PERIOPERATIF PADA Tn. ….
DENGAN GANGGUAN SISTIM ……………………… :………………………………………………….
DI RUANG INSTALASI BEDAH SENTRAL RS……………………………

Nama : No. Dokumen RM :

Alamat :
Umur :
Jenis Kelamin :

Keadaan saat dikaji : Tenang Gelisah Kesakitan Sesak

Nafas Anemis Lemah
Keluhan Utama :
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Riwayat Kesehatan Sekarang :
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Riwayat Kesehatan Dahulu :
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Riwayat Kesehatan Keluarga :
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Diagnosa Medis :
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Hasil Pengkajian :
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Buku Pedoman Praktek Pilihan
Pendidikan Profesi Ners
Fakultas Ilmu Kesehatan
Universitas Indonesia Maju
 Terapi Yang Diberikan :
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Diagnosa Keparawatan : (Pre-Intra-Post)
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Tindakan Keperawatan Yang Dilakukan : (Pre-Intra-Post)
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Evaluasi Keperawatan
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Nama dan Paraf Mahasiswa :

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Buku Pedoman Praktek Pilihan
Pendidikan Profesi Ners
Fakultas Ilmu Kesehatan
Universitas Indonesia Maju