NURSING
MANAGEMENT.
Management of nursing care is part of the nursing service management is the implementation of the nursing process using concepts-concepts of management such as planning, organizing, mobilizing and control or evaluation (Gillies, 1994).
Head room as manager of the unit (ward) is a nursing personnel who are given the responsibility and authority to manage the activities of nursing care in a hospital ward. Therefore, the responsibility of nursing care management is decentralized to the head room, so it is a full-Chief authority to regulate all activities room nursing care that is authority for decision-making, improve the quality of nursing care continuously for 24 hours, increasing the intra and inter-unit communication / part, creating good interpersonal relationships so that members would be more creative how to improve nursing care.
PROFESSIONAL NURSING PRACTICE MODEL
Development of this model aims to improve the quality of nursing care through the structuring of nursing care. through this model can be defined plan needs in a professional nursing staff, nursing care methods are used and how to document nursing care.
Professional Nursing Practice Model is a model that provided an opportunity for professional nurses to implement autonomy in designing, implementing, and evaluating care / nursing care provided to patients. This model has always sought the form of services and nursing care that can meet the needs of patients through a variety of approaches. Nursing care in the model space based on professional values that indicate the presence of autonomy, akontabilitas nurses, and professional development that focuses the efforts of nursing in nursing high care quality. Teamwork, collaboration, and consultation carried out consistently to improve the professional relationship ..
MANAGEMENT IN THE MODEL OF PROFESSIONAL NURSING PRACTICE
Professional nursing practice model consists of four main components, namely:
1. Nursing Workforce
2.
Methods
for nursing care
3.
Nursing
Process
4. Documentation of Nursing
1. NURSING WORKFORCE
In a professional service, the amount of energy required depends on:
The number of patients and the degree of dependence of patients (Douglas, 1984). According Loveridge and Cummings (1996) classification of the degree of dependence of the patients divided into 3 categories, namely:
The Time Classification
|
Morning
|
Afternoon
|
Evening
|
Minimal
Partial
Total
|
0,17
0,27
0,36
|
0,14
0,15
0,30
|
0,10
0,07
0,20
|
a. Minimal maintenance: it takes 1-2 hours / 24 hours .:
ü Personal hygiene, bathing, dressing
done alone.
ü
Eating
and drinking done alone
ü
ambulation
with supervision
ü
Observation
vital signs carried out every shift.
ü
Treatment
minimal, stable psychological status.
ü
Preparation
procedure requires treatment.
b. Intermediate care: it takes 3-4
hours / 24 hours .:
ü Personal hygiene assistan, eat drink assisted
ü Observation of vital signs every 4
hours
ü
Assisted ambulation, treatment more than once
ü Voley catheter / intake recorded
output
ü Client with infusion, medication
preparation, require procedures
c. Maximum Care / total: takes 5-6
hours / 24 hours:
ü Any given / assisted
ü Position yag set, observation ytanda
vital signs every 2 hours
ü Eat require NGT, using intravenous
therapy Use of suction
ü Restless / disorientation
ü According to Douglas (1984), there
are several criteria required number of nurses per patient for service in the
morning, afternoon and evening.
For example:
Surgical treatment room, there are 30 patients, which consists of a minimum of 10 patients, 15 patients with partial, and 5 patients in total. So the number of nurses needed to keep the morning is:
10 x 0.17 = 1.7
15 x 0.27 = 4.05
5 x 0.36 = 1.8
--------------------
8 nurses needed for the morning service.à7.55
To determine the actual needs nursing care diruang should be done every day for at least 22 days, and in the same time.
For example, the average nurse needed in Surgery Room by Douglas calculations are 10 nurses, then the required amount in the space is
Surgical treatment room, there are 30 patients, which consists of a minimum of 10 patients, 15 patients with partial, and 5 patients in total. So the number of nurses needed to keep the morning is:
10 x 0.17 = 1.7
15 x 0.27 = 4.05
5 x 0.36 = 1.8
--------------------
8 nurses needed for the morning service.à7.55
To determine the actual needs nursing care diruang should be done every day for at least 22 days, and in the same time.
For example, the average nurse needed in Surgery Room by Douglas calculations are 10 nurses, then the required amount in the space is
v Shift Nurses: 10 people
v holiday leave: 5 people
v Team leader: 3 people
v Head Room: 1 person
------------------------------------
19 people.
------------------------------------
19 people.
2. METHOD FOR NURSING CARE:
System of nursing care is an approach to nursing care effectively and efficiently to a number of patients. Each method has its advantages and disadvantages of each.
There are 3 patterns are often used in the provision of nursing care, namely functional assignment, the assignment of the team, the primary assignment.
a) Functional
Nursing Assignment:
This assignment system oriented on the task with which a certain
nursing functions assigned to each nurse, for example, a nurse is assigned
specifically to the actions of drug administration, another nurse to replace
verband, injection, observation of vital signs, and so on. This action is
distributed based on the ability level of each nurse. Therefore, the head room
to first identify the level of difficulty of the action, the next set of nurses
who will be responsible for working on the intended action. Each nurse is
directly responsible to the head of the room. No nurses are solely responsible
for nursing care in a patient.
Advantage:
v Complete much employment in a short
time.
v Right this method if wards have
limitations / lack of professional nursing staff.
v Nurses are more skilled, because the
orientation of the direct action and always repeatedly done.
Disadvantages:
v Sorting through nursing care by each
nurse.
v Lowering of accountability and
responsibility.
v nurse-patient relationship is
difficult to form.
v Services are not professional.
v monotonous work, lack of challenge.
b) Assignment
Nursing Team:
Is a form of system / method of
assignment of nursing care, where the head of the room dividing nurses in some
group or team, which is headed by a professional nurse / experienced. This
method digunaklan when nurses consists of a variety of educational backgrounds
and abilities.
The team leader has the responsibility for coordinating all activities of nursing care in the responsibility of the team members' activities. The objective method of assignment nursing team to provide patient-centered nursing. Chairman of the review and plan nursing on each patient, and the members of the team responsible for implementing nursing care based on the nursing care plan that has been made. Therefore, the activities carried out together in a group, then the team leader is often a meeting with members of the team (team meeting) to discuss the events encountered in the delivery of nursing care.
The team leader has the responsibility for coordinating all activities of nursing care in the responsibility of the team members' activities. The objective method of assignment nursing team to provide patient-centered nursing. Chairman of the review and plan nursing on each patient, and the members of the team responsible for implementing nursing care based on the nursing care plan that has been made. Therefore, the activities carried out together in a group, then the team leader is often a meeting with members of the team (team meeting) to discuss the events encountered in the delivery of nursing care.
Advantage:
v Involve all members of the team in
nursing care of patients.
v Will produce quality nursing care
dapaty accountable.
v Requires less cost / low, compared
to other assignment system.
v Services obtained the patient is a
form of professional services.
Disadvantages:
v Can cause fragmented in nursing.
v It is difficult to determine when
can a meeting / conference room, because its members are divided in shifts.
v The team leader is responsible and
has the authority, in comparison with team members.
c)
Primary Nursing Assignment
Primary Nursing is a method of
nursing care where nurses perofesional responsible and accountable for the
nursing care of patients during 24 hours / day. Responsibilities include
patient assessment, planning, implementation, and evaluation of nursing care
from admission to hospital until the patient is declared home, this is the main
task of the primary nurse, assisted by nurses asosiet.
The primary nurse will create an agreement to provide comprehensive nursing care, where nursing care to patient-oriented.
Assessment and plan nursing care of patients under the responsibility of the primary nurse, and nurse asosiet will plan of nursing care in nursing actions.
The primary nurse will create an agreement to provide comprehensive nursing care, where nursing care to patient-oriented.
Assessment and plan nursing care of patients under the responsibility of the primary nurse, and nurse asosiet will plan of nursing care in nursing actions.
Advantage:
v Autonomy nurses increased, because
the motivation, responsibility and accountability increases.
v Ensure continuity of nursing care.
v Increasing the relationship between
nurses and patients.
v The creation of a good
collaboration.
v Freeing nurses from tasks that are helping.
v This method supports professional
services.
v Mastery of the patient by a primary
nurse.
Disadvantages:
v The room does not require that all
nurses need professional nurse.
v The cost of the required lot.
NURSING PROCESS
The nursing process is a decision-making process undertaken in preparing the nursing care activities gradually. Needs and problems of the patient is the central point in the decision. Fragmatis scientific approach in decision-making are:
The nursing process is a decision-making process undertaken in preparing the nursing care activities gradually. Needs and problems of the patient is the central point in the decision. Fragmatis scientific approach in decision-making are:
1) Identify the problem,
2) develop alternative settlement
problems,
3) the selection of the proper way
penyelesdaian problems and implement them,
4) evaluation of the results of the
implementation of problem solving alternatives.
The whole decision-making step is contained in the steps of the nursing process, namely:
1) the assessment focused on the main
complaint and more holistic exploration,
2) diagnosis that establishes the
causal relationship of the problem of nursing problems,
3) a plan of action to resolve the
problem,
4) implementation plan and
5) evaluation of the results of the
action.
DOCUMENTATION
OF NURSING
Nursing documentation is an important element in the system of nursing services, because through good documentation, then the information on the state of health of the patient can be determined on an ongoing basis. In addition, documentation is a legal document regarding the provision of nursing care. More specifically, the documentation serves as a means of communication between health professionals, the data source for the provision of nursing care, the source of data for research, as a proof of responsibility and accountability of nursing care.
Document prepared by solving the problems of patients. Documentation based on the problem consists of formatting assessment, care plan, nursing action records, and patient progress notes.
Nursing documentation is an important element in the system of nursing services, because through good documentation, then the information on the state of health of the patient can be determined on an ongoing basis. In addition, documentation is a legal document regarding the provision of nursing care. More specifically, the documentation serves as a means of communication between health professionals, the data source for the provision of nursing care, the source of data for research, as a proof of responsibility and accountability of nursing care.
Document prepared by solving the problems of patients. Documentation based on the problem consists of formatting assessment, care plan, nursing action records, and patient progress notes.
in Indonesian
Manajemen Asuhan Keperawatan.
Manajemen asuhan keperawatan adalah
bagian dari manajemen pelayanan keperawatan yang merupakan pelaksanaan proses
keperawatan dengan menggunakan konsep-konsep-konsep manajemen seperti
perencanaan, pengorganisasian, penggerakkan dan pengendalian atau evaluasi
(Gillies, 1994).
Kepala Ruangan sebagai manajer unit
(ruang rawat) adalah seorang tenaga keperawatan yang diberi tanggung jawab dan
kewenangan dalam mengelola kegiatan pelayanan keperawatan di satu ruang rawat
di rumah sakit. Oleh karena itu tanggung jawab manajemen asuhan keperawatan
telah didesentralisasikan kepada Kepala Ruangan, sehingga merupakan kewenangan
penuh Kepala Ruangan untuk mengatur seluruh aktifitas asuhan keperawatan yaitu
kewenangan untuk pengambilan keputusan, meningkatkan mutu asuhan keperawatan
secara terus menerus dalam 24 jam, meningkatkan komunikasi intra dan antar
unit/bagian, menciptakan hubungan interpersonal yang baik sehingga anggota akan
lebih kreatif bagaimana meningkatkan asuhan keperawatan.
MODEL PRAKTEK KEPERAWATAN PROFESIONAL
Pengembangan model ini bertujuan meningkatkan mutu
asuhan keperawatan melalui penataan sistem pemberian asuhan keperawatan .
melalui model ini dapat ditetapkan rencana kebutuhan tenaga keperawatan
secara profesional, metoda pemberian asuhan keperawatan yang digunakan dan cara
pendokumentasian asuhan keperawatan.
Model Praktek Keperawatan
Profesional merupakan suatu model yang memberi kesempatan kepada para perawat
profesional untuk menerapkan otonominya dalam mendesain, melaksanakan, dan mengevaluasi
pelayanan/asuhan keperawatan yang diberikan kepada pasien. Model ini selalu
mengupayakan bentuk pelayanan dan asuhan keperawatan yang dapat memenuhi
kebutuhan pasien melalui berbagai pendekatan. Pemberian asuhan keperawatan di
ruang model ini berlandaskan nilai-nilai professional yang menunjukkan adanya
otonomi, akontabilitas perawat, dan pengembangan profesi yang memfokuskan
setiap upaya keperawatan pada kulaitas pelayanan keperawatan yang tinggi. Kerja
tim, kolaborasi, dan konsultasi dijalankan secara konsisten untuk meningkatkan
hubungan professional..
PENGELOLAAN DI RUANG MODEL PRAKTEK
KEPERAWATAN PROFESIONAL
Model praktek keperawatan
professional terdiri dari 4 komponen utama, yaitu :
1. Ketenagaan
Keperawatan
2. Metoda
pemberian asuhan keperawatan
3. Proses
Keperawatan
4. Dokumentasi
Keperawatan
Ketenagaan Keperawatan
Pada suatu pelayanan profesional,
jumlah tenaga yang diperlukan tergantung pada :
Jumlah pasien dan derajat
ketergantungan pasien (Douglas, 1984). Menurut Loveridge & Cummings
(1996) klasifikasi derajat ketergantungan pasien dibagi 3 kategori,
yaitu :
Waktu
Klasifikasi
|
Pagi
|
Sore
|
Malam
|
Minimal
Partial
Total
|
0,17
0,27
0,36
|
0,14
0,15
0,30
|
0,10
0,07
0,20
|
a. Perawatan
minimal : memerlukan waktu 1 – 2 jam/24 jam.:
Ø Kebersihan
diri, mandi, ganti pakaian dilakukan sendiri.
Ø Makan dan
minum dilakukan sendiri
Ø Ambulasi
dengan pengawasan
Ø Observasi
tanda-tanda vital dilakukan setiap shift.
Ø Pengobatan
minimal, status psikologis stabil.
Ø Persiapan
prosedur memerlukan pengobatan.
b. Perawatan
intermediet : memerlukan waktu 3 – 4 jam/24 jam.:
Ø Kebersihan
diri dibantu, makan minum dibantu
Ø Observasi
tanda-tanda vital tiap 4 jam
Ø Ambulasi
dibantu, pengobatan lebih dari sekali
Ø Voley
kateter/intake output dicatat
Ø Klien dengan
pemasangan infus, persiapan pengobatan, memerlukan prosedur
c. Perawatan
maksimal/total : memerlukan waktu 5 – 6 jam/24 jam :
Ø Segala
diberikan/dibantu
Ø Posisi yag
diatur, observasi ytanda-tanda vital setiap 2 jam
Ø Makan
memerlukan NGT, menggunakan terapi intravena
Ø Pemakaian
suction
Ø Gelisah/disorientasi
Menurut Douglas (1984) ada
beberapa kriteria jumlah perawat yang dibutuhkan perpasien untuk dinas pagi,
sore dan malam.
Sebagai
contoh :
Ruang
perawatan bedah terdapat 30 pasien, yang terdiri dari 10 pasien minimal, 15
pasien partial, dan 5 pasien total. Maka jumlah perawat yang diperlukan untuk
jaga pagi adalah :
10 x 0,17 =
1,7
15 x 0,27 =
4,05
5 x 0,36 =
1,8
--------------------
7,55 à 8 orang perawat yang dibutuhkan
untuk dinas pagi.
Untuk
mengetahui kebutuhan aktual tenaga keperawatan diruang perawatan sebaiknya
dilakukan setiap hari selama minimal 22 hari, dan dalam waktu yang sama.
Misalnya
rata-rata perawat yang diperlukan di Ruang Bedah menurut perhitungan Douglas
adalah 10 orang perawat, maka jumlah yang diperlukan pada ruang tersebut adalah
Ø Perawat
shift : 10 orang
Ø Libur cuti :
5 orang
Ø Ketua tim :
3 orang
Ø Kepala
Ruangan : 1 orang
------------------------------------
19 orang.
Metoda pemberian asuhan keperawatan
:
Sistem pemberian asuhan keperawatan
adalah suatu pendekatan pemberian asuhan keperawatan secara efektif dan efisien
kepada sejumlah pasien. Setiap metoda memiliki keuntungan dan kerugian
masing-masing.
Terdapat 3 pola yang sering
digunakan dalam pemberian asuhan keperawatan, yaitu penugasan fungsional,
penugasan tim , penugasan primer.
a. Penugasan
Keperawatan Fungsional :
Sistem
penugasan ini berorinetasi pada tugas dinama fungsi keperawatan tertentu ditugaskan
pada setiap perawat pelaksana, misalnya seorang perawat ditugaskan khusus untuk
tindakan pemberian obat, perawat yang lain untuk mengganti verband,
penyuntikan, observasi tanda-tanda vital, dan sebagainya. Tindakan ini
didistribusikan berdasarkan tingkat kemampuan masing-masing perawat pelaksana.
Oleh karena itu kepala Ruangan terlebih dahulu mengidentifikasi tingkat
kesulitan tindakan tersebut, selanjutnya ditetapkan perawat yang akan
bertanggung jawab mengerjakan tindakan yang dimaksudkan. Setiap perawat
pelaksana bertanggung jawab langsung kepada kepala Ruangan. Tidak ada perawat
pelaksana yang bertanggung jawab penuh untuk asuhan keperawatan pada seorang
pasien.
Keuntungan :
· Menyelesaikan banyak pekerjaaan dalam waktu singkat.
· Tepat metoda ini bila ruang rawat memiliki keterbatasan/kurang tenaga
keperawatan professional.
· Perawat lebih terampil, karena orientasi pada tindakan langsung dan selalu
berulang-ulang dikerjakan.
Kerugian :
· Memilah-milah asuhan keperawatan oleh masing-masing perawat.
· Menurunkan tanggung gugat dan tanggung jawab.
· Hubungan perawat-pasien sulit terbentuk.
· Pelayanan tidak professional.
· Pekerjaan monoton, kurang tantangan.
b. Penugasan Keperawatan Tim :
Adalah suatu
bentuk sistem/metoda penugasan pemberian asuhan keperawatan, dimana Kepala
Ruangan membagi perawat pelaksana dalam beberapa kelompok atau tim, yang
diketuai oleh seorang perawat professional/berpengalaman. Metoda ini digunaklan
bila perawat pelaksana terdiri dari berbagai latar belakang pendidikan dan
kemampuannya.
Ketua tim
mempunyai tanggung jawab untuk mengkoordinasikan seluruh kegiatan asuhan
keperawatan dalam tanggung jawab kegiatan anggota tim. Tujuan metoda penugasan
keperawatan tim untuk memberikan keperawatan yang berpusat kepada pasien. Ketua
Tim melakukan pengkajian dan menyusun rencana keperawatan pada setiap pasien,
dan anggota tim bertanggung jawab melaksanakan asuhan keperawatan berdasarkan
rencana asuhan keperawatan yang telah dibuat. Oleh karena kegiatan dilakukan
bersama-sama dalam kelompok, maka ketua tim seringkali melakukan pertemuan
bersama dengan anggota timnya (konferensi tim) guna membahas kejadian-kejadian
yang dihadapi dalam pemberian asuhan keperawatan.
Keuntungan :
· Melibatkan semua anggota tim dalam asuhan keperawatan pasien.
· Akan menghasilkan kualitas asuhan keperawatan yang dapaty dipertanggung
jawabkan.
· Membutuhkan biaya lebih sedikit/murah, dibanding sistem penugasan lain.
· Pelayanan yang diperoleh pasien adalah bentuk pelayanan professional.
Kerugian :
· Dapat menimbulkan pragmentasi dalam keperawatan.
· Sulit untuk menentukan kapan dapat diadakan pertemuan/konferensi, karena
anggotanya terbagi-bagi dalam shift.
· Ketua tim lebih bertanggung jawab dan memiliki otoritas, dibandingkan
dengan anggota tim.
c. Penugasan Keperawatan Primer
Keperawat
primer adalah suatu metoda pemberian asuhan keperawatan dimana perawat
perofesional bertanggung jawab dan bertanggung gugat terhadap asuhan
keperawatan pasien selama 24 jam/hari. Tanggung jawab meliputi pengkajian
pasien, perencanaan , implementasi, dan evaluasi asuhan keperawatan dari sejak
pasien masuk rumah sakit hingga pasien dinyatakan pulang, ini merupakan tugas
utama perawat primer yang dibantu oleh perawat asosiet.
Keperawat
primer ini akan menciptakan kesepakatan untuk memberikan asuhan keperawatan
yang komprehensif, dimana asuhan keperawatan berorientasi kepada pasien.
Pengkajian
dan menyusun rencana asuhan keperawatan pasien di bawah tanggung jawab perawat
primer , dan perawat asosiet yang akan mengimplementasikan rencana asuhan
keperawatan dalam tindakan
keperawatan.
Keuntungan :
· Otonomi perawat meningkat, karena motivasi, tanggung jawab dan tanggung
gugat meningkat.
· Menjamin kontinuitas asuhan keperawatan.
· Meningkatnya hubungan antara perawat dan pasien.
· Terciptanya kolaborasi yang baik.
· Membebaskan perawat dari tugas-tugas yang bersifat membantuan.
· Metoda ini mendukung pelayanan professional.
· Penguasaan pasien oleh seorang perawat primer.
Kerugian :
· Ruangan tidak memerlukan bahwa semua perawat pelaksana harus perawat
professional.
· Biaya yang diperlukan banyak.
PROSES KEPERAWATAN
Proses keperawatan merupakan proses
pengambilan keputusan yang dilakukan perawat dalam menyusun kegiatan asuhan
secara bertahap. Kebutuhan dan masalah pasien merupakan titik sentral dalam
pengambilan keputusan. Pendekatan ilmiah yang fragmatis dalam pengambilan
keputusan adalah :
1). Identifikasi masalah,
2) menyusun alternatif
penyelesaikan masalah,
3) pemilihan cara penyelesdaian masalah yang tepat dan
melaksanakannya, 4) evaluasi hasil dari pelaksanaan alternatif penyelesaian
masalah.
Seluruh langkah pengambilan
keputusan ini tertuang pada langkah-langkah proses keperawatan yaitu :
1)
pengkajian fokus pada keluhan utama dan eksplorasi lebih holistik,
2) diagnosis
yaitu menetapkan hubungan sebab akibat dari masalah masalah keperawatan,
3)
rencana tindakan untuk menyelesaikan masalah,
4) implementasi rencana dan
5)
evaluasi hasil tindakan.
DOKUMENTASI KEPERAWATAN
Dokumentasi
keperawatan merupakan unsur penting dalam sistem pelayanan keperawatan, karena
melalui pendokumentasian yang baik, maka informasi mengenai keadaan Kesehatan
pasien dapat diketahui secara berkesinambungan. Disamping itu, dokumentasi
merupakan dokumen legal tentang pemberian asuhan keperawatan. Secara lebih
spesifik, dokumentasi berfungsi sebagai sarana komunikasi antar profesi
Kesehatan, sumber data untuk pemberian asuhan keperawatan, sumber data untuk
penelitian, sebagai bahan bukti pertanggung jawaban dan pertanggung gugatan
asuhan keperawatan.
Dokumen
dibuat berdasarkan pemecahan masalah pasien. Dokumentasi berdasarkan masalah
terdiri dari format pengkajian, rencana keperawatan, catatan tindakan
keperawatan, dan catatan perkembangan pasien.