Tugas BSN (paper bagi yg absennya < 80% )

Pertemuan ke....
1. metabolisme tubuh
2. fluida
3. biotermal
4. organela sel
5. genetika, replikasi DNA, biosintesis protein dalam sel
6. faktor yang memebgaruhi oksigenasi
7. keseimbangan energi
8. pengkajian dan diagnosis keperawatan respirasi
9. perubahan pada fungsi respirasi dan sirkulasi
10. metabolisme karbohidrat dan lemak
11. metabolisme protein, metabolisme nukleotida
12. Faktor yg mempengaruhi kebutuhan nutrisi, gangguan kebutuhan nutrisi
13. mutasi pd onkogenesis
14. siklus sel
15. Diet harian
16. pengkajian dan interupsi keperawatan pada diet harian.

catatan: pertemuan 9dan10 serta 13dan14 dijadikan 1 hari namun dianggap 2 pertemuan (bernilai 2 tanda tangan)


yang absen:
npm 7: pertemuan ke2, 13 dan 14
npm 16: pertemuan ke 8 dan 16
npm 23: pertemuan ke 13 dan 14
npm 41: pertemuan ke 8 dan 16
npm 45: pertemuan ke 13 dan 14
npm 68: pertemuan ke 13 dan 14
npm 81: pertemuan ke 8 dan 16
npm 86: pertemuan ke 6 dan 8
npm 95: pertemuan ke 13, 14 dan 15
npm 118: pertemuan ke 13, 14 dan 15
npm 126: pertemuan ke 13 dan 14
npm 134: pertemuan ke 13, 14 dan 15
npm 152: pertemuan ke 8 dan 16
npm 156: pertemuan ke 15 dan 16

Tugas BSN

teman... udah tau dan ngerti tentang tugas BSN yg dikasih kan? Bu Dian ngasih slide yang bisa menambah referensi untuk tugas tersebut. Maaf, baru memberitahu karena saya baru membuka e-mail. Slide tersebut bisa di unduh di sini, sini, dan di sini

silakan didownload masing-masing ya kawan. terima kasih dan tetap semangat!! :D

nb: bu Dian pesen, kalau kesulitan nyari referensi bisa pinjem ke beliau. Beliau ada di rshs hari Senin. Mungkin yg merasa rumahnya dekat mau meminjamkan untuk kita? hehehe

Tugas Personality Development

temen fkep 2011...

ini penjelasan tugas personality development:

1. tugas analisis jurnal: masing-masing individu mencari jurnal yang berkaitan dengan personality development, judul bebas, kemudian di analisis.
cara menganalisis: kita beri kritikan dan saran pada setiap bagian-bagian yang ada di jurnalnya, pada umumnya di jurnal itu ada: abstrak, pendahuluan yang isinya latar belakang,tujuan penelitian, manfaat penelitian, metode penelitian, hasil dan pembahasan penelitian, nah yang itu semua kita analisis, beri komentar temen-temen, gmana mengenai yang diteliti tersebut. truss..terakhir temen2 kasih kelebihan dan kekurangannya. analisis jurnalnya diketik, tidak perlu di kasih kata pengantar, langsung aja analisisnya, misal: analisis jurnal management waktu, trus lngsung enter,trus abstrak. menurut saya abstrak yang dipaparkan peneliti ini...................
gitu aja..:), semoga ngerti ya..

2. tugas bikin blog: untuk blog dibikin di wordpress, weblog wajib memuat:
A.foto mahasiswa,logo unpad, logo fakultas keperawatan, foto dosen mata kuliah(foto ibunya menyusul).
B.alamat weblog wajib di link dengan website unpad atau fik (untuk prosedurnya menyusul, yg pnting bikin aja blognya dulu ya..:)).
C.penilaian meliputi: kemudahan mencari weblog melalui search engine, isi materi fokus, tampilan asesoris dan desain, referensi yang digunakan dan jumlahnya, foto dan gambar, originalitas, ketepatan waktu (maksudnya tepat waktu mengumpulkannya), dan identitas peserta (nama pnjang, nama panggilan, ttl, agama, kewarganegaraan,status, alamat rumah dan kost, nmr hp, email, fb, hobi, motto).

3. prosedur pengumpulan tugas: temen2.. untuk tugas jurnalnya di kirim ke alamat email: darulmuaqaamah.jannah@gmail.com, tolong dikirimkan dalam bentuk file dengan nama filenya NAMA dan NPM temen2 masing2, mengirimnya disertai jurnal asli dan untuk cover analisis jurnalnya: judul jurnal, logo unpad, nama dan NPM, fakultas keperawatan universitas padjadjaran 2011.

sekian penjelasannya, jika ada yang mau ditanyakan,sms aja ke:085376195787 (ipad).

temen2....tetap semangat yaa...:) mkasih atas perhatiannya, semoga bermanfaat..:)

BASIC CONCEPTS OF NURSING, NURSING CONCEPTS AND TRENDS

Nursing as an integral part of health services, in determining determines the quality of health services. Nursing personnel dominate the overall number of existing health personnel, in which nursing provides a unique contribution to the form of health care as an integral relative, sustained, coordinated and advocate. Nursing as a profession emphasizes the form of professional services in accordance with the standards by observing the rules of ethics and morals so that services provided can be accepted by the community well.

A. History of Nursing

Nursing as an occupation has existed since humans exist on this earth, nursing continues to evolve in accordance with the progress of technological civilization and culture. The concept of nursing through the ages continues to grow, here is the development of nursing in the world:

1. Mother instinct
The work of nursing has been around since man was created, there is nursing as an instinct (instinct). Every human being on this stage to use his mind to maintain reasonable health, less stimulus, caring for children, feeding children and the behavior of many other behaviors.

2. Animism
Humans at this stage have a belief that sickness is caused by the ghosts / spirits that exist in humans who have died or are living in humans or in nature (large rocks, trees, mountains, rivers, fire, etc.). To seek healing or care for a sick man then be expelled evil spirits, the shaman to seek the healing process by trying to seek knowledge about the spirit of something that affects the health of the sick. Once considered a capability, the shaman seeks to cast spells by using or medicines derived from nature.

3. Nursing disease caused by the anger of the gods
At this stage, humans already have a belief about the existence of gods, humans who are sick due to anger the gods. To help the healing of the sick performed the worship of the gods in the temple (the temple), thus it can be said that the temple is a place of health care.

4. Physician
Begin to develop possible since the ± 14 century BC, the period has been known for splinting techniques, general hygiene, and human anatomy.




5. Deaconess and Philanthropic
Evolving from ± 400 BC, the deaconess providing care services provided from house to house, their job is to help pastors provide services to the community and in this period is the forerunner of the development of public health nursing science. Philander is a group on retreat from the bustle of the world, where they constitute the core staff who provide services at the health center (RS) at the time.

6. The development of Islamic medicine
In the year 632 AD, the religion of Islam through the Prophet Muhammad SAW and his followers spread Islam to all corners of the world. In addition to spreading religious teachings, he also spread the knowledge about the behavior and treatment of disease (medicine).

7. Educated nurses (600 - 1583)
At this time of nursing education began to emerge, in which the program produces educated nurses. Nursing education begins at the Lion Hotel Dien and France which later developed into the largest hospital there. Initially educated nurses were selected from the followers of the religion in which their labor is conjunct the treatment of post-war activities of the cross. Nurses are well-known figure at the time (1182 - 1226) it was St. Fransiscas of Assisi Italy.

8. Professional Nurses (age 18-19)
Increasingly rapid developments in science this century, including medicine and nursing. Florence Nightingale (1820-1910) was an instrumental figure in the development of nursing science, he founded the modern nursing school in 1960 at St. Thomas in London. See the development of nursing in the world with his progress from the most classic stage up to the creation of a professional nursing staff and recognized by the international community can certainly be a reflection for the development of nursing in Indonesia.
Following developments in the world of nursing, nursing in Indonesia also continues to grow, while its development is as follows:

1. As well as the development of nursing in the world, in Indonesia in the first care services are still based on instinct, and then evolved into the flow of animism, and the wise men of religion.

2. Carers for the sick (POS / zieken oppasser)
Since the entry of Vereenigge Oost Indische Compagine in Indonesia began to set up hospitals, Binnen Hospital is the first hospital, founded in 1799, health workers serving the surgeons, nurses drawn from son. Nurse jobs at the time it was not generous or intellectual work, but that only a decent job done by the soldiers who served on the Company. Duties of nurses at the time it is cooking and cleaning (domestic work), controlled patient, keeping the patient in order not to run / patient psychiatric disorders.

3. Vocational nursing models (age 19)
Development of non-formal nursing education, education provided through vocational training model and combined with job training.

4. Curative nursing model (1920)
Comprehensive treatment services for the community performed by nurses as immunization / vaccination, and treatment of sexually transmitted diseases.

5. Semi-professional nursing
Demands the need for health services (nursing) is qualified by the public, making the nursing staff encouraged to increase their knowledge and skills in the field of nursing. Education-basic nursing education with a system of apprenticeship for 4 years for primary school graduates began to appear.

6. Preventive nursing
Government considers the need for hygiene and sanitation and education in prevention and outbreak control efforts, the government also realized that the only curative measures have minimal impact to the community and is only intended for those who are sick. In 1937 the school was established in Purwokerto hygiene orderlies, education is focused on the health care environment and is not a treatment.

7. Towards a professional nursing
Indonesia since independence (1945) real growth began with the establishment of nursing school nurse regulator (SPR) and midwife school in a large hospital which aims to support health services in hospitals. Education for those graduates that for junior plus education for 3 years, besides that it also established a school for teachers of nurses and midwives to become teachers in the SPR. The development of nursing organizations increasingly evident with the establishment of Indonesian National Nurses Association in 1974.

8. Professional nursing
Through a national workshop with the cooperation between MOEC nursing RI, MOH and the DPP PPNI, set definitions, tasks, functions and competence of professional nurses in Indonesia. Inspired by the results of the workshop was then founded the academy of nursing, then followed by the establishment PSIK FK-UI (1985) and later also established post-graduate program (1999).

B. Definition of Nursing

In 1983 a national workshop agreed the following definition of nursing, nursing is a professional service which is an integral part of health care based on knowledge and tips nursing, bio-psycho-shaped service of a comprehensive socio-spiritual, addressed to individuals, groups and communities both sick and healthy which includes the whole process of human life. Florence Nightingale (1895) defines nursing as follows: place the patient nature of nursing is the best condition for nature and its contents to act. Calilista Roy (1976) defines nursing is oriented to the scientific definition of nursing practice that has a bunch of know-how to provide services to clients.
From some of the definitions above can be concluded that the efforts to provide nursing services / care that is humanistic and professional, holistic and tips based on science, the standard of service to adhere to the code of ethics that underlie professional nurses independently or through collaborative effort.

C. Definition Nurses

Definition of nurses according to the law of Indonesia. No. 23 year 1992 on health care, nurses are those who have the ability and authority to act on his knowledge of nursing obtained through nursing education.
Tyalor C Lillis C Lemone (1989) defines a nurse is someone who plays a role in caring or nurturing, helping to protect a person because of illness, injury and aging process.
The definition of nurses by ICN (International Council of nursing) in 1965, a nurse is someone who has completed a nursing education are eligible as well as authorities in the country concerned to provide nursing services yan responsible for improving health, disease prevention and patient care hospital.

D. Nursing Trends

After 2000, the world's nations, especially Indonesia entered an era of globalization, in 2003 the era of the start of the ASEAN free market where a lot of professionals out there and get into the country. At the time it started happening a transition / shift patterns of community life where traditional patterns of community life turns into an advanced society. Circumstances that cause various effects on particular aspects of community life in the form of better health aspects urbanization problems, pollution, accidents, in addition to the increasing incidence of classic disease associated with infection, malnutrition, and lack of healthy housing for the residents. Shifting patterns in family values and life expectancy is increasing also pose health problems associated with the elderly as well as degenerative diseases.
In societies toward modern, there is increased opportunity to increase higher education, higher income and increased public awareness of the law and make society more critically. Conditions that affect the health service where people are critical and require quality services provided by health professionals. This situation implies that health workers, especially nursing can meet global standards in providing international health care / nursing, professional ability, intellectual ability and technique and sensitive to the social aspects of culture, has extensive knowledge and mastering science and technology development.
However, efforts to create a professional nurse in Indonesia is still not encouraging, many factors that could cause the low rate of professional nursing roles, including:

1. Delay in recognition of professional nursing body of knowledge. S1 nursing education in 1985 was first opened in the UI, whereas in western countries in 1869.
2. Delays in the development of professional nurse education.
3. Delay in nursing care system., (Standard, form of nursing practice, licensing)
Recognizing the role of the nursing profession is still low in the health world will negatively affect the quality of health services for the achievement of health goals "health for all by 2010", then the solution must be implemented is:

1. Development of nursing education.
Higher education system is crucial in the development of nursing care professionals, nursing technology development, professional development and continuing nursing education. Academy of Nursing is a nursing education that produces professional in the field of nursing care. Until now this level is still laid out in terms of teaching human resources, land practices and educational facilities and supporting infrastructure.

2. Strengthening the system of professional care services
Department of Health is currently preparing to registration, licensing and certification of nursing practice. Besides all of the application of professional nursing practice model in delivering nursing care must be done to ensure the satisfaction of consumer / client.

3. Completion of nursing organizations.
Nursing professional organizations require a rapid and dynamic change and the ability to accommodate each individual's interests to the interests of the organization and integrating it into a series of activities that can be felt. Restructuring the nursing organization is the right choice in order to create an independent professional organization and able to support its members through performance of quality assurance efforts and hope for the future a better and improved.
Nurse's commitment to provide quality nursing services either independently or through a path of collaboration with other health professionals is essential in the realization of professional nursing services. Values underlying professional nursing practice can be grouped into:
1. The value of intellectual
Practice intellectual value in nursing consists of
a. Body of Knowledge
b. Education specialization (continued)
c. Using knowledge in thinking critically and creatively.
2. Commitment to moral values
The nursing care given to the concept of altruistic, and pay attention to ethical codes of nursing. According to Beauchamp & Walters (1989) professional services to the community requires integrity, moral commitment and ethical responsibility.
Aspects which should be the foundation of moral behavior is a nurse:
a. Beneficence
always seek a decision made based on the desire to do the best and not detrimental to the client. (Johnstone, 1994)
b. Fair
Not discriminate clients based on religion, race, social culture, economic situation and so on, but treat clients as individuals who need assistance with the uniqueness.
c. Fidelity
Behaving caring (caring, compassion, feeling of wanting to help), always trying to keep his promises, give the proper expectations, moral commitment and attention to spiritual needs of clients.
3. Autonomy, control and accountability
Autonomy is the freedom and authority to act independently. The right of autonomy refers to self-control life, which means that nurses have control over their functions. Autonomy involves self-reliance, willingness to take risks and responsibility and accountability to his actions as a regulator and determinant itself as well as yourself.
Full regulation or directive has implications toward something or someone. For the nursing profession, there must be authority to control the practice, assign roles, functions and responsibilities of members of the profession.
Accountability means that nurses are responsible for any act done on the client.

Nurses Caring Attitude

Quality of nursing care provided by nurses can be achieved when nurses can demonstrate an attitude of "caring" to the client. In providing care, nurses use the expertise, the words of a gentle, touch, provide hope, always stands beside the client, and the attitude of "caring" as a medium of carer (Curruth, Steele, Moffet, Rehmeyer, Cooper, & Burroughs, 1999) . The nurses can be asked to care for, but they can not be ordered to provide care by using the spirit of "caring".

Spirit of "caring" should be grown from within the nurses and nurses came from the deepest heart.Spritit "caring" is not only showing what is done perawata which is a physical act, but also reflects who he is. Therefore, each nurse can show you how that was when providing care to clients.

"Caring" is the knowledge of humanity, the core of nursing practice that is ethical and philosophical."Caring" is not merely behavior. "Caring" is a way that has meaning and motivate action (Marriner-Tomey, 1994). "Caring" is also defined as an action that aims to provide physical care and emotional look while increasing safety and the safety of the client (Carruth et al, 1999).

This attitude is given by honesty, trust, and goodwill. Behavior of "caring" to help clients enhance the positive changes in physical, psychological, spiritual, and social. Believed to be "caring" for clients and work together with clients from different environments is the essence of nursing.

Watson emphasized the attitude of "caring" should be reflected ten curative factors namely:
- The establishment of the humanistic and altruistic value system. Nurses develop a sense of satisfaction for being able to give something to the client. In addition, nurses also showed Traffic ourselves by providing health education to the client.
- Provide confidence - hope by facilitating and improving the holistic nursing care. In addition, nurses improve client behavior in seeking health pertolngan.
- Growing sensitifan against self and others. Nurses learn to appreciate the sensitivities and feelings to the client, so that he himself may become more sensitive, pure, and be fair to others.
- To develop a trusting relationship. Nurses provide information honestly, and show empathy with the feeling that what is experienced by the client.
- Promote and accept the expression of positive and negative feelings the client. The nurse gave her time to listen to all complaints and feelings of the client.
- The use of systematic methods for decision making penyalesaian problem. Nurses use the nursing process as a method of thinking and approach to client care.
- Improved interpersonal learning and teaching, providing care independently, setting personal needs, and provide opportunities for personal growth of clients.
- Creating an environment of physical, mental, sociocultural, and spiritual support. Nurses need to recognize the environment affects the internal and external clients on the health condition of client's illness.
- Give guidance in satisfying the needs manisiawi.Nurses need to recognize the need for comprehensive self and client. Meeting the needs of the most basic need to accomplished before switching to the next level.
- Allow a pressure that is fenomologis for self growth and maturity of the client's life can be achieved.Sometimes clients need someone faced with the experience / thoughts that are profokatif. The goal is to enhance a deeper understanding about themselves.

Future Nurses Abroad Very Good

Needs of Professional Nurses (Registered Nurse) in the World 2020. Nurse manpower needs in developed countries such as America, Canada, Europe, Australia, Japan and the Middle East jumped dramatically since 1980. It is estimated that energy demand in the U.S. in 1980 about 200,000 nurses, and this demand will soar to 500,000 nurse Ditahun 2020 to support the needs of health care in America. For all developed countries over the need for nurses is estimated to reach 1 million nurses by 2020 (Atienza, 2004).

Two main causes of the increasing need for nurses is the aging population of developed countries, first because of the increasing age of the health care needs will also increase, which means increasing needs of Nurses. Second, the declining supply of nurses developed countries because the developed countries younger generation prefers to wrestle the world of business, IT or communications and are not interested to become a nurse again. Other causes of the increasing need for nursing personnel is a natural disaster / riots that occurred in several places in the world, such as the bombing at the World Trade Center bombing in Saudi Arabia, Tsunami, Katrina, and all the riots / of this disaster will increase the need for nursing personnel .

Nursing needs are met by nurses from developing countries who have nursing personnel in accordance with world standards. Three main sources are from the world of nursing tenaqga Phillippine, India and China. Indonesia as the country with the world's fourth largest population, the nursing staff should be able to export in accordance with the needs of the world above.

Why can not we send the nursing staff with world standards above? Nurse Indonesia has so far not able to compete with Philippine nurses and India, because of English as a medium of communication in the country of destination. English is measured by the value of Test IELTS (International English Language Testing System) with Overall value is 6.5. IELTS test consists of four components: a. Hearing (30 minutes), b) Reading (60 minutes), c) Writing (60 minutes), and d) Speaking (15 minutes). In Indonesia IELTS tests are conducted in IDP Education Australia on the road Kuningan Jakarta, and the British Council in Jakarta.

The second factor is the International Nursing Certification. Nurses standards in the world is a graduate of the University who holds a Bachelor of Science in Nursing (BSN), and has a Certification RN (Registered Nurse). Nurse RN from India, Malaysia will be recognized certification by the Commonwealth negara2 because standard nursing education has been made equal with international standards. Likewise Phillippine nurse, so they pass their BSN RN took in Philippine Certification that is recognized by the international community. English is not a problem for them, for their daily use English as their second language.

Indonesia has just developed a Bachelor of Nursing program since 5 years ago, and in its education programs separate the Graduate Nursing Education Program (4 years) where graduates hold SKP (Bachelor of Nursing). After graduating from the SKP take Professions Nursing Education Program (1.5 years) who graduate degree nurses. The problem, degree SKP and nurses are only applicable in Indonesia, and is not recognized internationally.

To measure the competence of nurses are graduates of different countries, the United States make the Competency Standards of Nursing by NCLEX-RN Exam (National Council License Examination - Registered Nurse). This exam is for Asia is still done in Hong Kong. This test is to measure the competence of nurses whether they have the knowledge and skills to work at the Hospital in Developed Countries.

In order for our Nurses are able to pass the IELTS with a value of 6.5 and pass the NCLEX-RN exam, we must do several things:

a) Upgrading of professional nurse education standards to conform with International Nurses,
b) Upgrading of clinical skills training nurses to be able to work at International Hospital, and
c) Sending nurses to the Developed Countries in need.

Maintaning Mental Health

Maintaining Mental Health

1. Exercise. Research shows that exercise is more effective in preventing and
treating depression than drugs.

2. Express your love. Giving and getting love make our lives happier.
Pour out love to the family, relatives and others is the key to happiness
spiritual. Helping others makes our lives more meaningful and our presence
expected.

3. Reduce Watching Television, Film and Video / Online Games. Watching television, movies or
playing games can affect our mental health. Violence in
news shows, action movies, and games can reduce emotional balance, make
depression and affect our emotional response. After seeing so much violence, we
could no longer recognize it as violence. A glimpse of television commercials can also cause
senses and our brains overload and fatigue.
Many films are entertaining, but there is also that evokes negative emotions for most
people. For people who are sensitive or have ever experienced such a trauma in his life,
reduce the time and intensity of watching that triggered his emotions will help
maintain mental balance.
Focus on positive things. Try reading the news, rather than watching television news.
Read more gentle effect on the mind and we can be more selective. Try
avoid violent or sensational impressions, choose only the television programs
and positive film.

4. Appreciate and make art. Enjoys painting, photography, art music,
dance and other art forms could be a natural mood stabilizer and
useful clarity of thought. Produce works of art that can be enjoyed by people also
help one to build self-esteem, something that is important for health
mental.
Try listening to soft music. Many of the frenetic music that can precisely
result in mental overload. Many of the types of music that can bring
feeling depressed or hollow. The music is soft and melodious to balance the process
chemicals in our brains.

5. Worship. Conducting worship and pray regularly meet our spiritual needs,
which is a vital component in the welfare of the soul. Ignoring the spiritual needs
make our soul restless and unsettled. Praying is an effective means of
prevent and combat mental health problems.
6. Recreation outside the home. Try to stay away from the routine by spending time in
nature. "Green therapy" could be one effective way to find inner peace,
and calm our minds, to find enlightenment and release from negative thoughts.

7. Avoid isolating yourself. Being part of the community who give each other support
and meet on a regular basis can greatly help us through the crisis and remain positive.

8. Maintain a balance diet. Diet can aggravate the symptoms of various diseases
including autism, schizophrenia, depression, anxiety and panic attacks. Foods that
needed for good mental health is the fruit and vegetables and foods
contains essential fatty acids, like fish Belida, cob, squash and beans.
Milk and chocolate are also believed to calming the mind.

9. Avoid pornography. Sexual stimulation may contribute to the growth of pornography
emotional void that can cause depression, bipolar disorder and health
other mental. Only a sexual relationship with a legitimate partner and mutual mengasihilah
which can fill our emotional and physical needs.

10. Perform activities that build self-confidence. Learning to play a musical instrument
such as piano or violin, mastering martial skills, get a prize contest, etc.
greatly help the children build self-confidence.
If you have family members who experience mental health problems, it is important
once to always keep a positive attitude and not give up. Do not berate or
mocks that made him feel inferior and perpetuate feelings of hate
yourself. This is also true for those with eating disorder tendencies.
Show your love and understanding to them.

11. Keep your mind is always active with reading. Reading can be a strengthening activities
mentally, especially if we focus on the positive reading. Subscribe to some magazines or
buy books that educate biography beneficial for your mental health.
12. Be more organized person. Do not procrastinate, and
clean and Arrange your possessions. Get rid of clutter. Remove items
unused, complete or delegate work to hang, and if necessary,
get someone else to solve your homework.

Is Nursing a Profession?

A profession has a unique body of knowledge and values - and a perspective to go with it.
Nursing DOES have a unique body of knowledge and values, but all too often adopts the medical perspective over its own; most acadamic nurses these days don't try very hard to inject new nurses with any values other than the medical model (Yes, there are exceptions!). In that sense, nursing can only ever be a 'profession allied to medicine', not a true profession in its own right.
A profession has controlled entry to the group eg registration
Nursing does have controlled entry - most countries have a legally-enforced registration. This is beyond doubt, but of questionnable value, to some degree, it's a cheat - "Nursing is a profession because the law says it is".
A profession demonstrates a high degree of autonomous practice.
Nursing has a variable degree of autonomy, but for the most part (Yes, there are exceptions!), has very little real freedom; indeed, nursing management, with it's 'cost saving' mentality, does its utmost to strangle any independent thought or action, for fear of expensive litigation; there are 'protocols' for everything, these days, and woe betide the nurse who dares to use initiative (Yes, there are exceptions!). Nurse practitioners (etc.) usually take orders from docs and are accountable to them, because their specialties are branches of medicine. But in many areas, nurses are responsible for *nursing* and in that sense are (still) independent of doctors. It is a shame - but historically beyond doubt, that nurses tend to give away the areas they are most expert in; physiotherapy and occupational therapy both grew out of a nursing role, respiratory therapy is going the same way. Stoma therapy is an area that utilizes many core nursing skills; how long before it breaks off to become a profession in its own right? Perversely, wound management was, until recently, a medical responsibility, though nurses applied almost 100% of dressings. Now, specialist nurses are teaching others the principles of wound care.
A profession has its own disciplinary system.
In many countries, Nursing does have its own disciplinary system - but in many of them, this is being eroded in favour of making nurses "accountable to the public" - understandable, but reflecting a view that nurses "cannot be trusted" to deal with there own problems - this is a diminution of professional resect and value.
A profession enjoys the Recognition and Respect of the wider community.
Nurses are recognized as 'nice', 'deserving better' and 'sexy' - the jury is out on whether any of those assist in the definition of 'professional'. External recognition is vital, just as the legal side is 'so what' - few people would ever argue with doctor and lawyers as 'true' professionals; when the 'Church was one, united, catholic church', priests were similarly respected - I'm not so sure that's generally true any more; individual clergymen are respected by individuals, and by their own community; as are individual nurses. But both fall shy of general respect to the level required, sadly. (Though both are streets ahead of journalists, real estate agents and heating engineers!). To conclude, part of the problem is the poor self respect of nursing; just twenty years ago, the Process of Nursing, care plans and nursing diagnosis looked set to sweep in an era of nursing confidence and a bright, professional future.

NURSING

According to willesky, profession is a job that needs science as basics to a sistematic theory development to face new challenges, takes education and training for a long time, and has ethical code with service as the main focus. So is nurse, nurse is also a profession. To be a professional nurse, she / he must be abe to give nursing service based on the nursing ethical code. Beside that, a nurse has to be a college graduate and able to manage the nursing field.

Nursing is a study abaut how nurse gives health services to the patient. It can be said that nursing is an activity done by nurse to the patient on the purpose of giving health service. There are four components in nursing that can’t be separated from one another. There are people / patient / client, environment, health, and nurse. On nursing view, people / patient / client is a nursing central focus, where later on nurse has to understand and treal them wholeheartedly, unique, and humane. The environment is said as external condition that involves somebody’s life, influences life and the growth of organism, human, and society behavior. The environment also influences body health. Healthy describe a whole someone’s condition which is multidimensional and involved five dimensions. They are physical health, mental health, social function, and common perception about well being. At this time the role of nursing is needed.

Now days, many people still think that nurse is a doctor’s assistant. Actually, it is not true and this paradigm should be changed. Basically, doctor and nurse have different task and field. Maybe it is true that there are some nurse help doctor’s doing their job. But, it actually means that nurse helps the patient indirectly, not the doctor.

Basically, the nurse job is to give services to the patients basic need. According to Virginia Henderson, there are 14 human’s basic needs, they are :

1. Breathing normally ;

2. Enough food and drink ;

3. Throwing out body unimportant substances ;

4. Acting, moving, and positionizing comfortably ;

5. Sleeping and taking rest ;

6. Fulfilling clothing needs ;

7. Paying attention to the body temperature ;

8. Keeping the body clean ;

9. Preventing from danger and hurt ;

10. Communicating with other ;

11. Defending him self / her self ;

12. Working ;

13. Playing and recreating ;

14. Studying and adventuring.

But actually a nurse job is just to help all the things. Which really can’t be done by the patient. So, if the patient is still able to do things, such as eating by him / her self, than the nurse shouldn’t help him / her. It doesn’t mean that the nurse doesn’t take care of the patient, but at the time the patient is trained to be independent and hopedto be able to do all the basic needs by him / her self, without depending on others. We can conclude that nurse in nursing practical has it is own purpose to keep the patient stay able to do his / her own self care based on his/ her ability, increase patients ability and fulfilling self care need and take care of the patient by giving self care need help if the patient is not able to do it by his / her own.

The Benefits of Positive Thinking

Optimism is the attitude always have good expectations in every way and the tendency to expect a pleasant outcome. Optimism can also be interpreted to think positive. So the optimism is more of a paradigm or way of thinking.
A positive-minded optimists or think does not consider failure is permanent. This does not mean that he was reluctant to accept reality. Instead, he received and examined the problem. Then, as far as circumstances permit, it acts to alter or improve the situation.
Contrary to optimistic, pessimistic view would consider the failure of the bad side. Generally a pessimist often blame themselves for their misery. He considers that the misfortune is permanent and it happened because it was fate, stupidity, incompetence, or ugliness. As a result, he resigned and would not attempt.
Positive thinking is also a key to success for managing stress. Optimism will make a person faces an unpleasant situation with a positive and productive manner.
Scientists have made the conclusions of research for decades about the benefits of positive thinking and optimism on health. Research shows that a healthier and more optimistic longevity than others especially compared with the pessimists. The researchers also noticed that the more optimistic people who can handle stress and less likely to experience depression. Here are some benefits of being optimistic and positive thinking often.
• Longer life
• More rarely experience depression
• The stress level is smaller
• Have a body resistance against disease better
• It is both physically and mentally
• Reduce risk of heart disease
• Able to overcome difficulties and cope with stress
Why are these benefits can be obtained for those who are optimistic and positive thinking? Because usually people who are optimistic will avoid activities that people do a pessimist in the face of stress and pressures of life. Pessimists when faced with stress will divert attention to activities such as smoking, alcohol consumption, and enjoy food without control. While an optimist would do more physical activity, follow a healthy diet and reducing smoking and alcohol.
If you often think negatively of others or of serious situations, it does not mean you can not think positive. You can change negative thinking into positive. It is not difficult to do, but it takes time and practice to create a new habit. Here are some ways to be more optimistic and have positive thoughts and attitudes.
• Check yourself
• Follow a healthy lifestyle
• Enjoy work
• Find a positive peer
• Face and accept
• Have a sense of humor
• Record of good things
Do not say anything to yourself something that does not want to say to someone else.
It is to be optimistic is not easy. Natural disasters, live load, and also disaster could occur that make many people find it hard to think positive. But by trying to be optimistic and positive thinking will produce a healthier life and more fulfilling. Do not give up!

7 Habits of Healthty Sleep

Rest and Sleep Being a Basic Human Needs
Basic human needs are the elements required by humans in maintaining the physiological and psychological equilibrium, which is aiming to maintain life and health. Basic human needs according to Abraham Maslow's Hierarchy Maslow's Theory, states that every human being has five basic needs are physiological needs, safety, love, self-esteem, and self-actualization.
Physiological needs are the most basic needs, one needs rest and sleep. To be able to function optimally, each person needs rest and sleep well. No exception is also the person who is sick, they also need adequate rest and sleep.
The word "Rest" has a broader meaning that includes sanngat relax, refresh yourself, still unemployed after doing the activity, and any escape from a boring, difficult and annoying, as such, can be said that the break is a quiet activity, emotional stress and relax without bebes of anxiety. While sleep is a status change of consciousness when the individual's perception of and reaction to the environment decreased. Sleep is characterized by minimal physical activity, level of consciousness varies, changing the body's physiological processes, and decreased response to external stimuli.
7 Habits of Healthy Sleep

1. Create a conducive environment
Remove objects such as radio and television from the bedroom. Room is a place to sleep, instead of watching television. People will easily fall asleep when the room is cooler than warmer. Therefore, create a cool room.

Turn off the lights, because the brain is easier to prepare the body to sleep in a dark room. Make sure the sheets are always clean. Pillows, bolsters, mattresses should also be comfortable so that we can sleep soundly.

2. Set sleep and wake times consistent
Every person has a biological clock that records and tracks sleeping patterns. When the body has a regular sleep pattern, your brain will automatically send signals to the body to relax and go to sleep. The body will automatically wake up when it was enough to get a break.

3. Stay away from sleeping pills
Stay away from caffeine and nicotine at night because it can interfere with rest. Caffeine is a stimulant that activates the brain, while nicotine speeds up metabolism, so that your body is still energetic. Choose milk or hot chocolate before going to bed.

4. Regular exercise
Avoid heavy exercise close to bedtime because it will increase body temperature keeps you awake. Ideally, exercise done 4-6 hours before going to bed. To stay healthy and sleep well, move your body 20 minutes a day.

5. Lower temperature
People tend to quickly fall asleep when the body temperature decreases. So, really hot bath before bed it does not accelerate.

6. Do not force yourself to sleep.
If you can not sleep, try to get out of the room and do something that in time they make you drowsy. For example watching television, reading.

7. Avoid napping.
Naps can disrupt your sleep patterns. Napping ensure you get enough rest day, so that your evening was awake.

Community Mental Health Nursing in Alberta, Canada: An Oral History

Community Mental Health Nursing creating new professional roles in the community and transgressing traditional institutional boundaries, community mental health nurses had a central role in the construction of new rehabilitative practices and community mental health services in the 1960s and 1970s.

We have only scant historical knowledge of nurses’ work in this transformative process; however; historiography on the history of community mental health nursing is limited, and existing work on
mental health nursing history concentrates on the history of nursing and nursing education in the mental hospital.

In Canada, a first historical study of community mental health nursing was conducted in the 1980s by Dorothy Sillars.

As both Church and Sillars observe, the (public) mental health movement was an important context for the early development of (community) mental health nursing. In the United States in the 1940s, this process stimulated the integration of psychiatric and mental health nursing in nursing curricula at hospital training schools and emerging university programs. The emerging body of Canadian historiography on psychiatric mental health nursing reveals that in Canada, the response was more divided.

General and mental hospital nurse training was also integrated in the eastern Canadian provinces, bridging the traditional gap between them. Historiography on mental health care in Quebec indicates early and increasing strategic interaction between institutional staff and families, showing the fluidity of boundaries between institutions and community.

In the western provinces, mental hospitals did not establish schools for psychiatric nursing until the 1930s. Professionalization of these nurses was met with resistance from existing professional nursing organizations; as a result, graduates from these mental hospital schools formed their own professional organization and licensing bodies in the 1950s.

These graduates contributed in important ways to the expanding scope of psychiatric mental health nursing practice during the 1960s and 1970s. In the 1960s, a trend toward community-based mental health care and rehabilitation occurred in Canada, as throughout North America and Western
Europe.
The changing therapeutic climate within mental hospitals affected the roles of nurses, and as I will show, their involvement with community care expanded. The ways the movement toward rehabilitation generated a new professional identity and practice in the Alberta mental hospitals, similar to the change in professional orientation Ann Sheridan described for Ireland and Peter Nolan for Britain.

The implementation of a National Health Service in 1948 and a new mental health act in 1959 changed the course of mental health care in Britain toward more outpatient and community care, and transfer of long-term hospitalized patients into the community increased. Not until the mid-1970s, however, was specialized training in community care 106 Geertje Boschma implemented for psychiatric nurses, with the introduction of new programs for community psychiatric nurses, expanding their scope of practice and professional recognition.

Sheridan’s analysis of psychiatric nursing in Ireland points out that the field profoundly changed during the 1970s because of the formation of the European Union, which brought new directives on professional and academic education, and an emerging philosophy of rehabilitation and community
care.

During the 1980s, the Irish psychiatric nursing education curriculum was reoriented toward community-based service and education in rehabilitation, and therapeutic techniques were expanded. However, the question of how nurses constructed their work in the community as the emphasis shifted toward community-based mental health care in the 1960s is only recently
receiving more detailed historical analysis.

The changing circumstances of work and mental health care shaped their new role and professional identity.

DEVELOPMENT OF NURSING IN INDONESIA

The quality of nursing care in hospitals depends on the speed, convenience, and accuracy in performing nursing actions nursing service also means depending on the efficiency and effectiveness that exist in the overall structural system of a hospital. Hospital services at least divided into two major parts namely the medical care and services that are non-medical, for example, medical services may consist of drug administration, feeding, nursing care, medical diagnostics, and others. There are also non-medical services such as the admissions process, payment process, until the administrative process associated with the client being treated is a form of service is no less important. Medical services that are specifically in nursing services has developed technology that is very helpful information in the nursing process starts from the digital data input into a computer that could facilitate further studies, what interventions are in accordance with previously established diagnosis of yan is, until the output what is expected by the nurse after the client receives nursing care, and all these processes must be in accordance with the NANDA, NIC, and NOC which have previously been entered into the database application program being used. But there are things that need to be re-understood by all health professionals who use information technology are all rapidly developing technology is merely a tool that is useless without the intellect of the user in this case is a nurse with all the knowledge of nursing science.

The development of nursing as a professional service backed by science and technology gained from the education and training of targeted and planned. In Indonesia, nursing has achieved very significant progress even was a leap that far ahead. This stems from an agreement reached at the National Workshop on Nursing in January 1983 who received nursing as professional services (professional services) and nursing education as the education profession (professional education). Nursing personnel which is the largest number of health workers should be able to contribute essential to the success of health development. For that nursing personnel are required to be able to improve their professional ability to be able to play an active role in health development, especially in professional nursing services. Professional nursing service development can not be separated by a professional education in nursing. Nursing education is no longer a vocational education / vocational but it aims to generate power to master science nursing nursing who are ready and able to carry out the service / professional nursing care to the Community Sector. Level of nursing education has even reached the doctoral level. This belief is a factor driving the development of nursing education in Indonesia in higher education, which actually has started since 1962 with the opening of the Academy of Nursing is the first in Jakarta. This process continues in line with the evolving nature of nursing professionalism. In Workshop on Nursing in 1983, has been formulated and developed the basics of the development of Higher Education Nursing. As the realization of educational programs developed curricula D-III Nursing, and continued with the preparation of educational curricula Bachelor (S1) Nursing. Higher education nursing nursing professionals are expected to produce power that is able to make updates and improvements to quality of care / nursing care, as well as structuring the development of the life of the nursing profession. Higher education nursing nursing professionals are expected to produce power that is able to hold the renewal and improvement of quality of care / nursing care, as well as structuring the development of the life of the nursing profession. Nursing as a profession, in performing the duties and responsibilities must be capable of independent pengembanggannya. For it requires a container that has a primary function to establish, regulate and control various matters relating to professions such as setting the rights and limits of authority, standards of practice, standards of education, legislation, codes of ethics and other regulations relating to the nursing profession. It is estimated that future demand kebutuhann health services including nursing services will continue to rise both in terms of quality and affordability and coverage. This is due to increasing public awareness of health resulting from increased public awareness in general, and the increase in power entailed the increasing complexity of economic and public health problems facing society. People are increasingly aware of the law so as to encourage the demand availability of health services including nursing services with quality that can reach all levels of society. Thus, nursing should continue to experience change and development in line with the changes that occur in various other fields. The development of nursing not only because of the shift in public health issues, but also the pressure development of science and technology nursing and the development of the nursing profession in the era of globalization. In the future demands memnghadapi the concrete steps that must be done include: setting standards of practice and standards of care / nursing care as the cornerstone of quality control in professional nursing services, nursing personnel pemberdayagunaan system arrangement in accordance with the expertise, management of nursing education system capable of producing professional nursing and nursing legilasi structuring system to regulate the rights and limits of authority, duties, responsibilities of nursing personnel in nursing practice.

Nursing

History of nursing
Nursing was not an established part of Japan's healthcare system until 1899 with the Midwives Ordinance. From there the Registered Nurse Ordinance came into play in 1915. This established a legal substantiation to registered nurses all over Japan. A new law geared towards nurses was created during World War II. This law was titled the Public Health Nurse, Midwife and Nurse Law and it was established in 1948. It established educational requirements, standards and licensure. There has been a continued effort to improve nursing in Japan. In 1992 the Nursing Human Resource Law was passed. This law created the development of new university programs for nurses. Those programs were designed to raise the education level of the nurses so that they could be better suited for taking care of the public.

Nursing as a profession
The authority for the practice of nursing is based upon a social contract that delineates professional rights and responsibilities as well as mechanisms for public accountability. In almost all countries, nursing practice is defined and governed by law, and entrance to the profession is regulated at the national or state level.
The aim of the nursing community worldwide is for its professionals to ensure quality care for all, while maintaining their credentials, code of ethics, standards, and competencies, and continuing their education. There are a number of educational paths to becoming a professional nurse, which vary greatly worldwide, but all involve extensive study of nursing theory and practice, and training in clinical skills.
Nurses care for individuals of all ages and cultural backgrounds who are healthy and ill in a holistic manner based on the individual's physical, emotional, psychological, intellectual, social, and spiritual needs. The profession combines physical science, social science, nursing theory, and technology in caring for those individuals.

Nursing theory and process
Nursing practice is the actual provision of nursing care. In providing care, nurses implement the nursing care plan using the nursing process. This is based around a specific nursing theory which is selected based on the care setting and population served. In providing nursing care, the nurse uses both nursing theory and best practice derived from nursing research.
In general terms, the nursing process is the method used to assess and diagnose needs, plan outcomes and interventions, implement interventions, and evaluate the outcomes of the care provided. Like other disciplines, the profession has developed different theories derived from sometimes diverse philosophical beliefs and paradigms or worldviews to help nurses direct their activities to accomplish specific goals.

Practice settings
Nurses practice in a wide range of settings, from hospitals to visiting people in their homes and caring for them in schools to research in pharmaceutical companies. Nurses work in occupational health settings (also called industrial health settings), free-standing clinics and physician offices, nurse-led clinics, long-term care facilities and camps. They also work on cruise ships and in military service. Nurses act as advisers and consultants to the health care and insurance industries. Many nurses also work in the health advocacy and patient advocacy fields at companies such as Health Advocate, Inc. helping in a variety of clinical and administrative issues. Some are attorneys and others work with attorneys as legal nurse consultants, reviewing patient records to assure that adequate care was provided and testifying in court. Nurses can work on a temporary basis, which involves doing shifts without a contract in a variety of settings, sometimes known as per diem nursing, agency nursingor travel nursing. Nurses work as researchers in laboratories, universities, and research institutions.

Quality of Nursing Service

Understanding the quality of nursing services

To conduct a quality service, many things that need to be understood, one of which considered to have a very important role is about what is meant by quality of service.
The quality of health services held by many healthcare institutions are almost always able to satisfy patients, and therefore often referred to as quality health care. One definition states that the quality of health care usually refers to the ability of hospitals, provide services in accordance with professional standards of health and acceptable to patients.

In carrying out efforts to maintain the quality of health care in the hospital can not be separated from the nursing profession that plays an important role. By the standards of evaluation and quality control is explained that the nursing service ensure high-quality nursing care by continuously involving themselves in quality control programs in hospitals.
According Wiedenback (in Lumenta, 1989) nurse is someone who has a profession based on scientific knowledge, skills and work attitude based on a sense of responsibility and devotion. Meanwhile, according to Karsinah (in Wirawan, 1998) nurses is one vital element in the hospital, nurses, physicians, and patients are most in need of a single entity and can not be separated.

Nursing services provided because of the physical and mental weakness, lack of knowledge and lack of understanding of the patient's ability to carry out activities independently. Activities were conducted in an attempt to achieve improved health with an emphasis on health care effort that allows each individual to achieve the ability to live healthy and productive (Aditama, 2002).

It can be concluded that understanding of quality professional nursing services is the attitude of nurses who provide a feeling of comfort, protected on every patient undergoing the healing process in which this attitude is a compensation for the providers and the expected rise in self-complacency patients.

2. Aspects of quality of nursing services

According to Parasuraman (in Tjiptono, 1997) aspects of quality or service quality are:
a. Reliability
The ability to deliver the promised services with immediate, accurate and satisfactory, fair, safe, timely availability. This relates to the overall confidence in the service in relation to time.
b. Responsiveness
Namely the desire of the employee or employees to help consumers and provide it with services responsive to consumer needs, quickly take notice and address the needs.
c. Assurance
Encompasses the skills, knowledge, courtesy and trustworthiness in an employee-owned, free from danger, risk, doubt, have the competence, confidence and lead to the belief of truth (objective).
d. Empathy or concern
Include the ease of having good communication and understanding of consumer needs that materialize in the full attention to each customer, serving customers with friendly and attractive, to understand the aspirations of consumers, to communicate the good and right and being in sympathy.
e. Direct evidence or intangible
Include physical facilities, equipment personnel, hygiene (health), good room orderly, well-dressed and harmonious appearance of employees or equipment and communication devices.

Joewono (2003) mentions the existence of eight aspects that need to be in service, namely:
a. Concern, how much companies pay attention to emotions or feelings.
b. Physical environment, this aspect shows the level of cleanliness of the environment that will be enjoyed by consumers, when they use the product.
c. Quick response, which indicates the speed aspect of the company in response to consumer needs.
d. Ease of transacting, how easily consumers conducting transactions with service providers.
e. Ease of obtaining information, how much attention the company to present information fast food.
f. Ease of access, how easily consumers can access the service provider when the consumer needs it.
g. The procedure, how well the procedures that must be run by consumers when dealing with the company.
h. Price, aspects that determine the value of the experience of service perceived by consumers when interacting with companies.

Sleep Pattern & Its Disturbances: Nursing Implications

Sleep is the state of natural rest observed throughout the animal kingdom, in all mammals and birds, and in many reptiles, amphibians, and fish. In humans, other mammals, and many other animals that have been studied - such as fish, birds, ants, and fruit-flies - regular sleep is necessary for survival. The capability for arousal from sleep is a protective mechanism and also necessary for health and survival.
Sleep can e defined as a normal state of altered consciousness during which the body rests; it is characterized by decreased responsiveness to the environment, and a person can be aroused from it by external stimuli.
Sleep is generally characterized by a reduction in voluntary body movement, temporary blindness, decreased reaction to external stimuli, loss of consciousness, a reduction in audio receptivity, an increased rate of anabolism (the synthesis of cell structures), and a decreased rate of catabolism (the breakdown of cell structures.
Almost a third of the general population has some problems with sleep during any given year. More than half of the 9000 participants in a study of sleep in elderly persons (65 years or older) reported the following as sleep pattern disturbance that they experience most of the time:
* Trouble falling asleep
* Frequent awakening
* Waking too early
* Needing to nap
* Not feeling rested
These disturbances may be secondary to situational, environmental or developmental stressors, or they may be associated with illness or with pre-existing disorders. The relationship is often reciprocal, in that the disorder decreases sleep & the decreased sleep affects the disorder.
The purpose of sleep is still unclear. Theories suggest that:
* It is a time of restoration and preparation for the next period of wakefulness
* During NREM stage 4 body releases human growth hormone for the repair and renewal of epithelial and specialized cells such as brain cells
* Protein synthesis and cell division for the renewal of tissues occur during rest and sleep
* REM sleep appears to be important for cognitive restoration
The benefits of sleep often go unnoticed until a person develops a problem resulting from sleep deprivation. A loss of REM sleep leads to feelings of confusion. Various body functions ( eg. Motor performance, memory and immune function) alter when prolonged sleep loss occurs
Sleep duration and quality vary among persons of all age groups
* Infants 16 Hours /Day
* Toddlers 12 Hours /Day
* Preschoolers 11 Hours /Day
* Schoolers 9 - 10 hours /day
* Adolescents 8 – 9 hours /day
* Adults 6 – 8 hours /day
As people age, their circadian clock advances, causing advanced sleep phase syndrome. The syndrome is common in older adults and often is the reason behind the complaint of waking early in the morning and unable to get back to sleep. They get sleepy early in the evening.
A number of factors affect the quality and quantity of of sleep. Often more than one factor combined to cause a sleep problem.
* Physical illness (eg. Nausea, mood disorders, breathing difficulty, pain)
* Drugs and substances (eg. Tryptophan)
* Lifestyle (eg. Daily routines, exercises)
* Usual sleep patterns and excessive daytime sleepiness
* Emotional stress
* Environment ( ventilation)
* Sound
* Exercise and fatigue
* Food and caloric intake

Nursing Paradigm

Nursing paradigm is a way to see from a nursing profession to see some condition and phenoment that linked to the activity in that profession.

Nursing paradigma really important in the nursing world. Because, for a long time, general people (and sometimes from the nurse itself), nurse often be claimed as an assistent which always only accept an instruction from a doctor. Because fo that paradigm helped people and the nursing profession itself for act and solve any problem in the nursing location.

The function of paradigm for nursing:
1. Act and solve any problems in nursing location as an education aspect and nursing serve, practice, and profession organization.
2. Helping a person and people to understand and help a nurse to understands every phenoment that happen in around us.

The example for the phenoment in the nursing is human. Human or client can we see as a person, family, and society.

Person is a part in a family that really unique as an unity of a biology, pshycologi, social, spiritual, and culture. The role of nurse for a person as a client, basically to serve the Basic Human Need. Human as a person is also called as a person that someone who has a personality such as behaviour and emotion, culture, motivation, ability, and a different physics structure for each other. The colaboration from all of that things will influence someone to think, feel, and act in the situation which they face it. Person is a colaboration from genetic interaction and his/her experience of life. It was influenced by identity, body concept, perception, basic need, defend mechanism, and grow develop.

Family is a group of person that have some communicate constantly and have some interaction for each other, as an individual or a group, in their environments or a whole society. The role of nurse to help a family is help the family to raise their ability for solve the healthe problem, caring to a member of the family who get sicks, family health service coordinator, fasilitator, educator, and consultant in healths problem.

Society is a group that made because there’s some interaction between human and culture, dinamyc and consist of person, family, group, community which have some same target and norm as a value. Society have some influence to increase and prevention a dissease.There is six factor that influence the society in a health for the member of the society. Which is availability of health care facilities, education and recreation facilities, transport and communication facilities, social facilities such as police and fire departments and community values and beliefs.

KUALITAS PELAYANAN KEPERAWATAN

Pengertian kualitas pelayanan keperawatan
ntuk dapat menyelenggarakan pelayanan yang berkualitas, banyak hal yang perlu dipahami, salah satu diantaranya yang dinilai mempunyai peranan yang amat penting adalah tentang apa yang dimaksud dengan kualitas pelayanan.
Kualitas pelayanan kesehatan yang diselenggarakan oleh banyak institusi kesehatan hampir selalu dapat memuaskan pasien, maka dari itu sering disebut sebagai pelayanan kesehatan yang berkualitas. Salah satu definisi menyatakan bahwa kualitas pelayanan kesehatan biasanya mengacu pada kemampuan rumah sakit, memberi pelayanan yang sesuai dengan standar profesi kesehatan dan dapat diterima oleh pasiennya. Menurut Azwar (1996) kualitas pelayanan kesehatan adalah yang menunjukkan tingkat kesempurnaan pelayanan kesehatan dalam menimbulkan rasa puas pada diri setiap pasien. Makin sempurna kepuasan tersebut, makin baik pula kualitas pelayanan kesehatan.
Dalam menyelenggarakan upaya menjaga kualitas pelayanan kesehatan dirumah sakit tidak terlepas dari profesi keperawatan yang berperan penting. Berdasarkan standar tentang evaluasi dan pengendalian kualitas dijelaskan bahwa pelayanan keperawatan menjamin adanya asuhan keperawatan yang berkualitas tinggi dengan terus menerus melibatkan diri dalam program pengendalian kualitas di rumah sakit.
Menurut Wiedenback (dalam Lumenta, 1989) perawat adalah seseorang yang mempunyai profesi berdasarkan pengetahuan ilmiah, ketrampilan serta sikap kerja yang dilandasi oleh rasa tanggung jawab dan pengabdian. Sedangkan menurut Karsinah (dalam Wirawan, 1998) perawat adalah salah satu unsur vital dalam rumah sakit, perawat, dokter, dan pasien merupakan satu kesatuan yang paling membutuhkan dan tidak dapat dipisahkan. Tanpa perawat tugas dokter akan semakin berat dalam menangani pasien. Tanpa perawat, kesejahteraan pasien juga terabaikan karena perawat adalah penjalin kontak pertama dan terlama dengan pasien mengingat pelayanan keperawatan berlangsung terus menerus selama 24 jam sehari.
Departemen kesehatan mendefinisikan perawat adalah seseorang yang memberikan pelayanan kesehatan secara profesional dimana pelayanan tersebut berbentuk pelayanan biologis, psikologis sosial, spiritual yang ditujukan kepada individu, keluarga dan masyarakat. Pelayanan keperawatan diberikan karena adanya kelemahan fisik dan mental, keterbatasan pengetahuan serta kurangnya pengertian pasien akan kemampuan melaksanakan kegiatan secara mandiri. Kegiatan itu dilakukan dalam usaha mencapai peningkatan kesehatan dengan penekanan pada upaya pelayanan kesehatan yang memungkinkan setiap individu mencapai kemampuan hidup sehat dan produktif (Aditama, 2002).
Dari batasan-batasan mengenai pengertian tersebut diatas, maka dapat disimpulkan pengertian kualitas pelayanan keperawatan adalah sikap profesional perawat yang memberikan perasaan nyaman, terlindungi pada diri setiap pasien yang sedang menjalani proses penyembuhan dimana sikap ini merupakan kompensasi sebagai pemberi layanan dan diharapkan menimbulkan perasaan puas pada diri pasien.

2. Aspek-aspek kualitas pelayanan keperawatan
Menurut Parasuraman (dalam Tjiptono, 1997) aspek-aspek mutu atau kualitas pelayanan adalah :
a. Keandalan (reliability)
Yaitu kemampuan memberikan pelayanan yang dijanjikan dengan segera, akurat dan memuaskan, jujur, aman, tepat waktu, ketersediaan. Keseluruhan ini berhubungan dengan kepercayaan terhadap pelayanan dalam kaitannya dengan waktu.
b. Ketanggapan (responsiveness)
Yaitu keinginan para pegawai atau karyawan membantu konsumen dan memberikan pelayanan itu dengan tanggap terhadap kebutuhan konsumen, cepat memperhatikan dan mengatasi kebutuhan-kebutuhan.
c. Jaminan (assurance)
Mencangkup kemampuan, pengetahuan, kesopanan dan sifat dapat dipercaya yang dimiliki pada karyawan, bebas dari bahaya, resiko, keragu-raguan, memiliki kompetensi, percaya diri dan menimbulkan keyakinan kebenaran (obyektif).
d. Empati atau kepedulian (emphaty)
Meliputi kemudahan dalam melakukan hubungan komunikasi yang baik dan memahami kebutuhan konsumen yang terwujud dalam penuh perhatian terhadap setiap konsumen, melayani konsumen dengan ramah dan menarik, memahami aspirasi konsumen, berkomunikasi yang baik dan benar serta bersikap dengan penuh simpati.
e. Bukti langsung atau berujud (tangibles)
Meliputi fasilitas fisik, peralatan pegawai, kebersihan (kesehatan), ruangan baik teratur rapi, berpakaian rapi dan harmonis, penampilan karyawan atau peralatannya dan alat komunikasi.
Sedangkan menurut Depkes RI (dalam Onny, 1985) telah menetapkan bahwa pelayanan perawatan dikatakan berkualitas baik apabila perawat dalam memberikan pelayanan kepada pasien sesuai dengan aspek-aspek dasar perawatan. Aspek dasar tersebut meliputi aspek penerimaan, perhatian, tanggung jawab, komuniksi dan kerjasama. Selanjutnya masing-masing aspek dijelaskan sebagai berikut:
a. Aspek penerimaan
spek ini meliputi sikap perawat yang selalu ramah, periang, selalu tersenyum, menyapa semua pasien. Perawat perlu memiliki minat terhadap orang lain, menerima pasien tanpa membedakan golongan, pangkat, latar belakang sosial ekonomi dan budaya, sehingga pribadi utuh. Agar dapat melakukan pelayanan sesuai aspek penerimaan perawat harus memiliki minat terhadap orang lain dan memiliki wawasan luas.
b. Aspek perhatian
spek ini meliputi sikap perawat dalam memberikan pelayanan keperawatan perlu bersikap sabar, murah hati dalam arti bersedia memberikan bantuan dan pertolongan kepada pasien dengan sukarela tanpa mengharapkan imbalan, memiliki sensitivitas dan peka terhadap setiap perubahan pasien, mau mengerti terhadap kecemasan dan ketakutan pasien.
. Aspek komunikasi
Aspek ini meliputi sikap perawat yang harus bisa melakukan komunikasi yang baik dengan pasien, dan keluarga pasien. Adanya komunikasi yang saling berinteraksi antara pasien dengan perawat, dan adanya hubungan yang baik dengan keluarga pasien.
d. Aspek kerjasama
Aspek ini meliputi sikap perawat yang harus mampu melakukan kerjasama yang baik dengan pasien dan keluarga pasien.
e. Aspek tanggung jawab
spek ini meliputi sikap perawat yang jujur, tekun dalam tugas, mampu mencurahkan waktu dan perhatian, sportif dalam tugas, konsisten serta tepat dalam bertindak.
Joewono (2003) menyebutkan adanya delapan aspek yang perlu diperhatikan dalam pelayanan yaitu :
a. Kepedulian, seberapa jauh perusahaan memperhatikan emosi atau perasaan konsumen.
b. Lingkungan fisik, aspek ini menunjukkan tingkat kebersihan dari lingkungan yang akan dinikmati konsumen, ketika mereka menggunakan produk.
c. Cepat tanggap, aspek yang menunjukkan kecepatan perusahaan dalam menanggapi kebutuhan konsumen.
d. Kemudahan bertransaksi, seberapa mudah konsumen melakukan transaksi dengan pemberi servis.
e. Kemudahan memperoleh informasi, seberapa besar perhatian perusahaan untuk menyajikan informasi siap saji.
f. Kemudahan mengakses, seberapa mudah konsumen dapat mengakses penyedia servis pada saat konsumen memerlukannya.
g. Prosedur, seberapa baik prosedur yang harus dijalankan oleh konsumen saat berurusan dengan perusahaan.
h. Harga, aspek yang menentukan nilai pengalaman servis yang dirasakan oleh konsumen saat berinteraksi dengan perusahaan.
Sedangkan Soegiarto (1999) menyebutkan lima aspek yang harus dimiliki Industri jasa pelayanan, yaitu :
. Cepat, waktu yang digunakan dalam melayani tamu minimal sama dengan batas waktu standar. Merupakan batas waktu kunjung dirumah sakit yang sudah ditentukan waktunya.
. Tepat, kecepatan tanpa ketepatan dalam bekerja tidak menjamin kepuasan konsumen. Bagaimana perawat dalam memberikan pelayanan kepada pasien yaitu tepat memberikan bantuan dengan keluhan-keluhan dari pasien.
. Aman, rasa aman meliputi aman secara fisik dan psikis selama pengkonsumsian suatu poduk atau. Dalam memberikan pelayanan jasa yaitu memperhatikan keamanan pasien dan memberikan keyakinan dan kepercayaan kepada pasien sehingga memberikan rasa aman kepada pasien.
. Ramah tamah, menghargai dan menghormati konsumen, bahkan pada saat pelanggan menyampaikan keluhan. Perawat selalu ramah dalam menerima keluhan tanpa emosi yang tinggi sehingga pasien akan merasa senang dan menyukai pelayanan dari perawat.
. Nyaman, rasa nyaman timbul jika seseorang merasa diterima apa adanya. Pasien yang membutuhkan kenyaman baik dari ruang rawat inap maupun situasi dan kondisi yang nyaman sehingga pasien akan merasakan kenyamanan dalam proses penyembuhannya.
erdasarkan pandangan beberapa ahli diatas dapat disimpulkan bahwa aspek-aspek kualitas pelayanan keperawatan adalah sebagai berikut : (a) penerimaan meliputi sikap perawat yang selalu ramah, periang, selalu tersenyum, menyapa semua pasien. Perawat perlu memiliki minat terhadap orang lain, menerima pasien tanpa membedakan golongan, pangkat, latar belakang sosial ekonomi dan budaya, sehingga pribadi utuh. Agar dapat melakukan pelayanan sesuai aspek penerimaan perawat harus memiliki minat terhadap orang lain dan memiliki wawasan luas. (b) perhatian, meliputi sikap perawat dalam memberikan pelayanan keperawatan perlu bersikap sabar, murah hati dalam arti bersedia memberikan bantuan dan pertolongan kepada pasien dengan sukarela tanpa mengharapkan imbalan, memiliki sensitivitas dan peka terhadap setiap perubahan pasien, mau mengerti terhadap kecemasan dan ketakutan pasien. (c) komunikasi, meliputi sikap perawat yang harus bisa melakukan komunikasi yang baik dengan pasien, dan keluarga pasien. Adanya komunikasi yang saling berinteraksi antara pasien dengan perawat, dan adanya hubungan yang baik dengan keluarga pasien.(d) kerjasama, meliputi sikap perawat yang harus mampu melakukan kerjasama yang baik dengan pasien dan keluarga pasien. (e) tanggung jawab, meliputi sikap perawat yang jujur, tekun dalam tugas, mampu mencurahkan waktu dan perhatian, sportif dalam tugas, konsisten serta tepat dalam bertindak.

TREN DAN ISU MUTAKHIR PRAKTEK PERAWAT

Minggu, 05 Oktober 08 - Dian Roslan Hidayat M.Kes
Upaya-upaya bidang kesehatan selama ini seperti preventif, promoti, kuratif dan rehabilitatif rupanya perlu mendapatkan refleksi dari perawat. Kritisi tersebut bukan untuk menggugat cakupan pelayanan kesehatan, melainkan perawat perlu menciptakan model praktik pelayanan perawatan yang khas dan berbeda, sehingga meskipun perannya tidak langsung berdampak terhadap peningkatan indeks pembangunan manusia, namun tetap berarti (mengisi sektor yang kosong/tidak tergarap) karena perannya tidak identik dengan profesi lain atau sebagai sub sistem tenaga kesehatan lainnya.

Mengingat hal – hal tersebut kita perlu mencermati beberapa peristiwa di belahan dunia lain, akan perubahan – perubahan konsep dan pengembangan kesehatan. Khususnya di negara maju seperti Amerika, hasil riset yang dikemukakan oleh Bournet (dalam Jurnal Riset) tentang perkembangan “Hospital At Home” atau perawatan pasien di rumah mereka sendiri, secara kuantitatif menunjukan peningkatan dari tahun ke tahunnya. Pada tahun 1970an rasionya adalah 291 ; 1 , kemudian tahun 1990an perbandingannya sekitar 120 ; 1 dan terakhir penelitian pada tahun 2004 perbedaannya menjadi semakin tipis yaitu 12 ; 1. Masih penelitian tentang Hospital At Home dan di Amerika menunjukan bahwa, tingkat kepuasan pasien yang di rawat di rumahnya sendiri lebih memuaskan pasien dan keluarga dibandingkan dengan mereka yang dirawat di rumah sakit. Bila kita melihat tren dan isu di negara lain tersebut kita dapat membuat satu analisis bahwa, Hospital At Home akan menjadi salah satu model anyar yang perkembangannya akan sangat pesat.

Implikasinya bagi perawat dan praktek keperawatan jelas hal ini merupakan angin surga, karena dengan praktik dalam model Hospital At Home, perawat akan menunjukan eksistensinya. Keuntungannya dalam meningkatkan peran perawat antara lain; (1) Otonomi praktik keperawatan akan jelas dibutuhkan dan dibuktikan, mengingat kedatangan perawat ke rumah pasien memikul tanggung jawab profesi, (2) Perawat dimungkinkan menjadi manager/ leader dalam menentukan atau memberikan pandangan kepada pasien tentang pilihan – pilihan tindakan atau rujukan yang sebaiknya ditempuh pasien, (3) Patnership, berdasarkan pengalaman di lapangan kebersamaan dan penghargaan dengan sesama rekan sejawat serta profesi lain memperlihatkan ke-egaliterannya , (4) Riset dan Pengembangan Ilmu, hal ini yang paling penting, dengan adanya konsistensi terhadap keperawatan nampak fenomena keunggulan dari Hospital At Home ini, ketika perawat mengasuh pasien dengan jumlah paling ideal yaitu satu pasien dalam satu waktu, interaksi tersebut selain memberikan tingkat kepuasan yang baik juga memberikan dorongan kepada perawat untuk memecahkan masalah secara scientific approach.

Berdasarkan uraian tersebut jelaslah bahwa ruang kosong praktek Hospital At Home ini menjadi peluang bidang garap yang akan menambah tegas betapa perawat memiliki peran yang tidak identik dan tidak tergantikan. Pengalaman di lapangan membuktikan tentang betapa tingginya animo masyarakat akan kehadiran Hospital At Home (Nursing At Home), hanya saja ada beberapa tantangan yang menuntut keseriusan untuk segera mengembangkan model ini. Tantanga tersebut diantaranya adalah Infrastruktur Hospital At Home yang sangat mahal, salahsatunya adalah keberadaan alat kesehatan, dengan konsep one tools one patien/home, maka bisa dibayangkan kebutuhan alat kesehatan ini akan semakin membengkak, baik kebutuhan secara jumlah ataupun mahalnya alat tersebut. Kedua adalah sosialisasi, perlu adanya perumusan metoda sosialisasi yang efektif, ethic dan legal dalam mengenalkan model pelayanan Hospital At Home tersebut agar tidak terjadi misinterpretasi dan miskomunikasi.


Dian Roslan Hidayat S.Kep M.Kes
Direktur Utama Intan Nursing Center Garut
Dosen Stikes Karsa Husada Garut