NURSING HISTORY

A. Introduction

Related to the history of nursing, history which is also called

history etymologically means alaam symptoms or human

symptoms which are a series of events or an event or fact in

the past. And the history of the development of knowledge or science

can support the development of civilization (Al Anang, 2019).

Currently, the development of science and technology has

experienced a very massive increase. These various developments

demand changes in community efforts to adapt. Nursing as a science

related to the profession is faced with complex and global problems.

Various learnings must be able to be carried out continuously or

never ending process. This is in accordance with the background of

the development of nursing history that follows the dynamics or life

cycle of humans (Lusk, 2018). The core of nursing is the sense of

caring or also known as the mother instinct. These changes

continued to develop until the emergence of modern civilizations

such as Florence Nightingale who was a nursing figure from the

United Kingdom (Komarudin, 2018).

The concept of the meaning of caring which is the core

character of nursing is interpreted by several experts into several

components as follows:

Nursing Theory Defined Theories

Roach Human beings have love, alturistic, willingness

CHAPTER I

NURSING HISTORY

to be present in a condition

Linen Giving birth to a form of culturally sensitive

nursing service

Boyken and

Schoenhofer

Nurses' creativity in developing nursing in a

stronger dimension

Mayeroff The essence of caring focuses on the

relationship or connection between the

provider and the patient

(Alshmemri and Ramaiah, 2021)

B. History of Nursing in the World

The various types of nursing practice in the Islamic world are a

combination of preventive services (prevention) with curative or

treatment. At first, nursing practice did not have any differences and

characteristics from medical practice. Various forms of health

services are carried out by doctors and nurses in cooperation with

each other. However, the classification of jobs had not yet been raised

at that time.

In fact, the development of world health services is not only

developing from the health of the western world but also from the

eastern region, especially from Islamic civilization. The basic

principles of western care and medicine that developed from a

hippocrates, prioritize the concept of disease evolution, diet and

lifestyle (Saputra, Kusdiana and Rahmatillah, 2020).

In the 19th century, it had not experienced qualified

development and was still underestimated by the public. In those

days, nurses were played by slaves whose notabene was a convict

woman who had no education and was forced to do the job of caring

for patients. However, various unfavorable conditions such as the

existence of wars actually grow the world of nursing. The existence

of the crusade which caused the impact of the emergence of various

diseases because many victims were injured, starved, and killed

actually increased the need for health care.

In contrast to the western world, the development of health in

the eastern world is greatly influenced by the development of Islam.

In the 7th century the presence of Islam was followed by the

development of exact sciences such as chemistry, pharmacy or

medicine and sharing forms of nursing services. The reference for

the importance of maintaining health has been clearly illustrated in

the Qur'an which reads the importance of maintaining personal

hygiene, the environment, and the place of residence. The Islamic

figure who became the figure of the emergence of the century is

rufaidah (Titha and Nubuwah, 2010).

Meanwhile, the development of nursing in China arises from

the development of various sexually transmitted cases such as

syphilis and gonorrhea. The country is trying to overcome the

disease by carrying out alternative treatments derived from plants

and minerals. The medical figure who came from China was Seng

Lung. The themes that are often raised are see, hear, ask and taste.

This concept is the basic banner for the development of nursing

theories related to physical examinations such as inspection and

palpation.

In contrast to the development of nursing in China, the

development of nursing in Europe developed thanks to the struggle

of nursing figure Florence Nightangle. She is often referred to as the

"lady lamp" thanks to her struggle and hard work in advancing the

nursing profession. As for progress in the United Kingdom, it can be

seen with the formation of nursing schools such as the British Nurse

Association (ANA) by a figure named Erenwick in 1987. She then

formed a nursing institution called the International Council Of Nurse

(ICN). From this point on, nursing figures and nursing theories

emerged (Titha and Nubuwah, 2010).

C. History of nursing in Indonesia

The journey of nursing in Indonesia, in line with the struggle for

colonialism by European countries such as colonialism in the days of

the Dutch, Japanese, Japanese, and British accompanied the

development of the nursing profession. Dutch colonialism is identical

With the existence of missionaries who gave birth to nursing

education in the form of care, starting from the scope of the church,

internships developed into ministry in hospitals.

Health services, especially nursing, began with medical

services by the Dutch East Indies colonizers. The Dutch East Indies

Doctors studied with internship programs spread across several

hospitals in Indonesia. Starting from this, the nursing profession

began to be born even though it did not have a clear identity. Starting

with the establishment of the PPNI professional organization, on

April 17, 1972, although recognition as a professional organization

could only be realized in the 80s with the first national conference

precisely in 1983. However, this is the formation of a nursing

professional community. However, to get recognition from cross-

sectors or other professions has not been obtained. Recognition was

only obtained after entering 1992 with the formation of law number

23 on health (Komarudin, 2018).

Broadly speaking, the development of nursing in Indonesia is

divided into nursing developments, namely:

1. Pre-Independence Era

In the period before independence or in the Dutch colonial era,

a hospital called Binen Hospital was established in 1799. In the

period before independence, health workers, especially nurses,

were taken from the indigenous population whose main

purpose was to take care of the sick. At that time, the army and

people's health service was formed which became the pioneer

in improving the health system at that time was Raffles (during

the British colonial period). The Raffles Motto which is the

provision for the development of health in Indonesia is that

health is the right of every human being. With that provision,

various efforts are made and developed to maintain health.

However, on the eve of independence and the defeat of the

allied armies, around 1942-1945 became a period of crisis

accompanied by a setback in the health sector due to various

programs focusing on efforts to legalize Indonesian

independence (Titha and Nubuwah, 2010).

2. The post-independence era.

In the post-independence era, around 1949, only this year did

Indonesia rise from the crisis by starting to establish various

hospitals and health centers. Then, in 1952, it began to

establish basic nursing education. And in 1962, it developed

even higher into nursing education at the undergraduate level

or level. The first university to open a nursing school at the

level of a serjana is the University of Indonesia, followed by

nursing education established in Surabaya, Bandung and other

areas.

With these developments, the recognition of the nursing

profession is getting stronger by the nursing profession both

from the community and from other professions. The nursing

profession has developed so rapidly that it is no longer

dependent on other professions. The various nursing

processes provided are based on clear and scientific methods

and concepts to answer patient needs and solve problems

faced by patients. The method provided is also called providing

nursing care. The stages of nursing care start from the study,

determination of diagnosis, planning, implementation of the

nursing process evaluation era (Titha and Nubuwah, 2010).

As for the various forms of nursing development, if conclusions

are drawn, these various forms of development are greatly

influenced by the development of nursing education. Nursing

education forms the character, and scientific guidelines for the

nursing profession. Another factor is the development of human

structure and civilization. Starting from the form of animism belief,

the spread of various forms

big religion and beliefs with various strata and conditions of society

(Budiono, 2016).

In addition, another factor is the development of the status and

economy of the community also supports the development of the

nursing profession with increasing public awareness of the need for

nursing professional services that not only focus on curing but also

caring. Caring for nurses can be an added value that can motivate

patients to be able to recover quickly from their illness and reduce

the length of treatment and accelerate the improvement of patients'

health status (D'Antonio et al., 2010).

Various forms of modern nursing services that are

comprehensive in the form of providing physical, psychological, and

socio-cultural health services by providing optimal services, which

can increase patient self-esteem, respect and affection between

others. Not only that, various nursing technologies are also

experiencing developments such as tele nursing or tele health which

supports nursing not only in close proximity but also allows long-

distance communication that will facilitate or improve the quality of

care (Smith, 2020).

The nursing process today is a systematic and clearly

organized process. The provision of nursing care is carried out by

first looking at the patient's response and complaints which is then

followed by analyzing the problem and determining the nursing plan

based on clear, structured and detailed guidelines and methods.

These various things, of course, will increase the degree of nursing in

the community as a respectable and professional profession with

optimal servants (Lisamanda, 2010).

A. Definition of philosophy of ilsafat comes from the Greek,

philosophia and philoshophos. According to the form of the

word, philosophia is taken from the words philos and shopia

CHAPTER 2

NURSING PHILOSOPHY AND PRADIGMA

or philos and sophos. Philos means love and shopia or shopos means

wisdom, knowledge, and wisdom. In this sense, a person can be said

to have philosophized if all his words and behaviors contain meaning

and characteristics as a person who loves wisdom, knowledge and

wisdom.

Harun (2011), argues that philosophy is taken from the Greek

language, philosophy. The structure of the word comes from the

word philosofien which means to love wisdom, that is, a person can

be called philosophical when he actively acquires wisdom.

Philosophy means thinking according to order (logic) freely (not

bound by tradition, dogma and religion) and with the deepest depth

so that it gets to the basics of the problem. On that basis, according to

Aaron, etymologically philosophy can be defined as:

1. Knowledge of wisdom

2. Knowledge of principles or foundations

3. Finding the truth

4. Discuss the basics of what is discussed

B. Definition of Philosophy of Science

To understand the meaning and significance of the philosophy of

science, the definition of philosophy of science from several experts

summarized in the Philosophy of Science, compiled by Ismaun

(2001)

Robert Ackerman "philosophy of science in one aspect as a

critique of current scientific opinions by comparison to proven past

views, but such a philosophy of science is clearly not a discipline

autonomous of actual scientific paractice". (Philosophy of science is

in some respects a critical review of today's scientific opinions by

comparison with the criteria developed from them, but philosophy of

science is certainly not an independent branch of science from actual

scientific practice.

Lewis White Beck "Philosophy of science questions and

evaluates the methods of scientific thinking and tries to determine

the value and significance of scientific enterprise as a whole.

(Philosophy of science discusses and evaluates methods of scientific

thought and tries to discover and the importance of scientific

endeavor as a whole)

Michael V. Berry "The study of the inner logic if scientific

theories, and the relations between experiment and theory, i.e. of

scientific methods". (The study of the internal logic of scientific

theories and the relationships between experiments and theories,

i.e., the scientific method.)

Stephen R. Toulmin "As a discipline, the philosophy of science

attempts, first, to elucidate the elements involved in the process of

scientific inquiry observational procedures, patens of argument,

methods of representation and calculation, metaphysical

presuppositions, and so on and then to veluate the grounds of their

validity from the points of view of formal logic, practical

methodology and metaphysics". (As a branch of science, philosophy

of science tries to first explain the elements involved in the process

of scientific inquiry of observational procedures, animal patterns,

methods of substitution and calculation, metaphysical

presuppositions, and so on and then assesses the foundations for its

errors from the perspectives of formal logic, practical methodology,

and metaphysics.)

Based on the above opinion, it is possible to obtain an

overview that philosophy is a philosophical study that wants to

answer questions about the nature of science, which is reviewed

from its ontological, epistemelogical and axiological aspects.

C. Function of Philosophy of Science

Philosophy of science is one of the branches of philosophy. Therefore,

the function of philosophy of science cannot be separated from the

function of philosophy as a whole, namely:

1. As a tool to find the truth of all existing phenomena.

2. Defending, supporting and opposing or standing neutral to

other philosophical views.

3. Providing an understanding of the way of life, outlook on life

and worldview.

4. Providing teachings on morals and ethics that are useful in life

5. It is a source of inspiration and guidance for life in various

aspects of life itself, such as economics, politics, law and so on.

Extracted from Agraha Suhandi (1989)

Meanwhile, Ismaun (2001) stated that the function of

philosophy of science is to provide a philosophical foundation in

understanding, sharing concepts and theories of a discipline and

equipping the ability to build scientific theories. Furthermore, it is

also said that the philosophy of science grows in two functions,

namely: as confirmatory theories, which seeks to decrypt the

normative relationship between hypotheses and evidence, and

theory of explanation, which seeks to explain various small or large

phenomena in a simple way.

D. Definition of Nursing Philosophy

Philosophy is a belief in values that are guidelines for achieving a

goal and are used as a view of life. Philosophy is the main

characteristic of a community, both large and small-scale

communities, one of which is the nursing profession community. The

nursing philosophy is the nurse's belief in nursing values which is a

guideline in providing nursing care, both to individuals, families,

groups and communities. Belief in the value of nursing must be the

grip of every nurse, including you today.

As a nurse, it is mandatory for you to hold and instill nursing

values in you when you associate with the community or when you

provide nursing services to patients.

The nursing philosophy is not something that must be

memorized, but an artifact or value that is inherent in nurses. In

other words, the nursing philosophy is the "soul" of every nurse.

Therefore, the nursing philosophy must be a guideline for nurses in

carrying out their work.

As a nurse, of course, in carrying out the nursing profession,

you must always use nursing values in serving patients. On another

aspect, the philosophy of nursing can be used to examine the causes

and laws of the law that underlie reality. In the nursing philosophy,

patients are seen as holistic beings, which must meet all their needs,

both biological, psychological, social and spiritual needs that are

provided comprehensively. Nursing services always pay attention to

the humanitarian aspect of every patient has the right to receive

treatment without any difference.

Nursing services are an integral part of the nursing service

system, making patients an active partner, in good health and illness,

especially focusing on their response to the situation.

The philosophy of nursing according to Roy (Mc Quiston,

1995) is divided into eight elements, four based on the philosophy of

humanism and four based on the principle of veritivity. The

philosophy of humanism/humanity is "to recognize human beings

and the subjective side of human beings and their experiences as the

center of curiosity and appreciation". So he argues that an individual:

1. Sharing each other in the ability to think creatively is used to

find out the problems faced in finding solutions.

2. Behaving to achieve a certain goal, not just fulfilling the law of

action-reaction.

3. Have intrinsic holism.

4. Struggle to maintain integrity and understand the need to have

relationships with others veritivity.

E. Definition of nursing paradigm

In general, paradigama is defined as a way of seeing, seeing, thinking,

interpreting, responding, and choosing actions on existing problems

or phenomena. Paradigm can also be interpreted as a diagram or

frame of mind of a person in explaining a problem or phenomenon of

an event. The nursing paradigm is a global way of view that is

embraced or used by the majority of nursing groups or connects

various theories that form an arrangement that regulates the

relationship between theories in order to develop conceptual models

and nursing theories as a nursing framework.

Several experts in the field of nursing have their own opinions

about the meaning of the nursing paradigm. According to Gaffar

(1997), the nursing paradigm is a fundamental perspective or the

way we see, think, give meaning, respond and choose actions to

various phenomena that exist in nursing. Thus, the nursing paradigm

serves as a reference or basis in carrying out nursing practice.

F. Components of the nursing paradigm

The nursing paradigm is formed on four elements, namely: human or

client, environment, health and nursing. These four components are

interconnected and affect each other, namely:

1. Human or nursing care reception (individual, family, group and

community);

2. Environment (internal and external circumstances affecting

the client);

3. Health;

4. Nursing (Characteristics and Action from nursing

care).

5. The relationship between the four components can be seen in

the following figure:

1. Human

Human beings in the concept of the nursing paradigm, are seen as

whole and complex individuals (holistic beings) consisting of bio-

psycho-socio-spiritual. Humans are the second element in the

nursing paradigm. Humans act or behave verbally and nonverbally,

sometimes in certain situations humans in meeting their needs need

help, and will experience distress if they are unable to do so. This is

the basis for the statement that a professional nurse must relate to

someone who cannot help him or her in meeting his needs, and that

human beings must be seen as whole and complex individuals

(holistic beings) who cannot be separated.

Abraham Maslow (1908-1970), formulated a theory about

basic human needs that can be used by nurses to meet basic human

needs when providing nursing care to clients.

2. Healthy-sick

The definition of healthy in each individual is different and each

person has a concept that depends on a person's viewpoint and

background and social level in interpreting healthy. To make it easier

and understand the concept of health, it is necessary to provide a

broad meaning of health which is often named as a healthy

paradigm.

The healthy paradigm is a person's perspective or mindset

about health that is holistic, proactive and anticipatory, by seeing

health problems as problems that are influenced by many factors

dynamically and cross-sectorally, which are oriented towards

increasing maintenance and protection against diseases to stay

healthy and not just curing the sick. In general, most individuals in

society think that being healthy is not sick, meaning that if there are

no symptoms of illness that are felt, it means that our body is healthy.

Even though such an opinion is incorrect, because there are

some diseases that do not cause symptoms first, after the disease is

severe enough to appear or cause symptoms, such as cancer that is

known after an advanced stage.

3. Milieu

The environment is the fourth element of the nursing paradigm. The

environment in the nursing paradigm is defined as the aggregate of

all conditions and external influences that affect the client's life and

development. The environment in general can be divided into two

physical environments and non-physical environments.

The physical environment, which is the natural environment

around humans. This physical environment includes many things

such as weather, seasons, geographical circumstances, geological

structures, and others.

Non-physical environment, which is an environment that

arises due to interaction between people. This non-physical

environment includes socio-culture, norms, values, customs, and

others.

4. Nursing

Nursing is an art and science that includes various concepts and

skills related to various disciplines. The science of nursing is used to

help individuals with unique processes, which are featured by

performing activities aimed at curing diseases, helping clients regain

independence, even helping clients get a peaceful death.

Nursing is a basic element of the nursing paradigm, which is

provided in the form of professional health services. In accordance

with the results of the agreement of the national nursing workshop

on the concept of nursing, namely, Nursing is an integral part of

health services based on nursing science and tips.

This service is in the form of a comprehensive bio-psycho-

socio-spiritual service aimed at individuals, families, groups and

communities both healthy and sick covering the entire process of

community life (National Nursing Workshop, 1983).

Nursing services as an integral part of health services have the

same position as other health professions (e.g. doctors), namely as

partners. This situation is supported by nursing science which has its

own scientific body, besides that nursing also has a distinctive and

unique form of service.

The duties and functions of nurses in general provide

assistance to patients (from the individual, family to community

level), both in sick and healthy conditions, in order to achieve

optimal health through nursing services.

The provision of this service must be based on expertise in

providing nursing care, which is supported by mastery of clinical

knowledge, experience, interpreting clinical situations in making

complex decisions.

Based on the Decree of the Minister of Health of the Republic of

Indonesia, Number: 647/Menkes/SK/IV/2000 concerning

Registration and Practice of Nursing, which was later updated with

the Ministry of Health of the Republic of Indonesia

No.1239/SK/XI/2001, it is explained that nurses are people who

have graduated from nursing education, both at home and abroad, in

accordance with the provisions of applicable laws and regulations.

Furthermore, nurses are an independent profession that has

the right to provide nursing services independently, and not as a

physician's assistant profession.

G. Nursing Concepts

Nursing services are an integral part of the health profession in

providing health services to patients. As an integral part of health

services, the position of nurses with other health professions (e.g.

doctors) is the same, namely as partners. This, of course, must also

be accompanied by recognition and respect for the nursing

profession.

The duties and functions of nurses in general provide

assistance or services to patients (from the individual, family to

community level), both in sick and healthy conditions, in order to

achieve optimal health through nursing services.

Expertise in providing nursing care is the result of the

knowledge and clinical experience possessed by a nurse. The

expertise required to interpret clinical situations and make complex

decisions is at the core of nursing care and forms the basis for the

development of nursing practice and nursing science.

The general public considers nurses to be people who work in

hospitals or health centers by wearing white uniforms. There are

also those who say that nurses are people who work as physician

assistants.

A. Definition of the Nursing Profession According to the Great

Dictionary of Indonesian (KBBI), profession means a field

of work based on certain expertise education (skills,

vocational, and so on), while nurses are health

professionals who are in charge of providing care to

clients or patients in the form of biological, psychological,

social, and spiritual aspects using the nursing process. Nurse and

nursing according to Nursing Law No. 38 of 2014, Nurse is someone

who has graduated from higher education in Nursing, both in and out

of the country which is recognized by the Government in accordance

with the provisions of Laws and Regulations (PPNI, 2015).

Nursing as an integral part of the health care system, includes

health promotion, disease prevention, and care for the physically ill,

mentally ill, and disabled people of all ages. Nursing provides nursing

care in all health care settings. In this broad spectrum of health care,

specialized care to be provided to individuals, families and groups

against actual or potential health problems (Cherie et al., 2005)

Based on the definitions that have been outlined above, it can

be concluded that the nursing profession is one of the health

professions that has expertise in providing care to patients or clients

holistically based on nursing skills education. Nurses are the most

frequent health workers

Basic Nursing Concepts

CHAPTER 3

NURSING PROFESSION

Meeting with patients, they take turns caring for and caring for

patients for 24 hours, so practically nurses are health workers who

meet patients most often.

B. Types of Nurses

The nursing law in Indonesia states 2 types of nurses that are

recognized in Indonesia, the first is vocational nurses, and the

second is professional nurses. Included in the nurse profession are

nurses and specialist nurses. Nurses are nurses who have graduated

from nursing professional education (after a bachelor's degree in

nursing) and specialist nurses are nurses who have graduated from

nursing specialists (after a master's degree in nursing). Vocational

nurses are nurses who have graduated from the nursing diploma

program, with a minimum of three diplomas in nursing. To carry out

their role as a nurse, a nurse in Indonesia is required to have a

registration certificate (STR) (PPNI, 2015).

C. Nursing Education in Indonesia

Indonesian nursing education has been started since the 1800s in a

hospital in Batavia which is now known as PGI Cikini Hospital

Jakarta. In 1953, the Nursing Regulatory School (SPR) was opened

with a junior high school background and a 3-year education period

which was opened in 3 regions, namely Jakarta, Bandung and

Surabaya. In 1955, the Health Officer School (SDK) was opened with

a basic education background (People's school) plus one year. At this

time, it seems that the development of nursing is still very lagging

behind so that in the 1950s there were more than 20 types of nurses.

Hospital-based nursing education is more aimed at meeting

the needs of local hospitals, they work under the supervision of other

health workers. Because the scientific foundation is not solid, the

services provided are more complementary and become less

accountable personnel. This situation encourages the Ministry of

Health to develop more appropriate nursing education to meet the

needs of services with the establishment of the Nursing Academy in

the

Ciptomangunkusumo Hospital Jakarta in L962 (formerly known as

Centraol Burgerlijke Ziekenkhuis, CBZ) with a high school education

background plus 3 years of nursing education (DPR RI, 2011).

The development of nursing education in order to reach the

level of professionalism is not enough to reach the diploma level,

inspired by the desire of the nursing profession to continue to

develop education, the Bachelor of Nursing Program of the Faculty of

Medicine, University of Indonesia (PSIK FK Ul) was established in

1985. Furthermore, in 1999, the postgraduate program of the Faculty

of Nursing was established. Nursing is currently also divided into

several focus fields, namely, psychiatric nursing, medical surgical

nursing, maternity nursing, community nursing, and pediatric

nursing, at least that's what is developing in Indonesian nursing. We

can take this division as an example that confirms that the role of the

nurse is very broad and covers the entire human life cycle from the

fetal period to the terminal period (before death). Nursing Education

is an institution that has a big role in developing and creating the

professionalization process of nursing staff. Nursing education is

able to provide a form and pattern of energy that in turn has a level

of ability and is able to facilitate the formation of the nursing

community in providing a voice and contribution to the profession

and society.

Since the 1990s, nursing education in Indonesia has been one

step better than the previous period. Of the 38 State Health

Polytechnics under the Ministry of Health that organize the D III

Nursing study program, the trend of D III Nursing graduates tends to

decrease compared to 2014 (6,909 people), down 1.07% in 2015 and

decreased again in 2016 by 6.89% compared to 2015 ((Ministry of

Health of the Republic of Indonesia, 2017). And every year the

number of nurse graduates is increasing, this shows that nurse

education in Indonesia with nurse graduates is increasing. Currently,

the results of benchmarking in various countries show that the

nursing education system and the nursing service system have

developed very well, because it is supported by the manpower

system and credentialing system that refers to the Nursing Law in

these countries.

In general, Nursing Education in Indonesia refers to Law (UU)

Number 20 of 2003 concerning the National Education System and

Law of the Republic of Indonesia No. 35 of 2014 in Chapter 5

concerning nursing higher education which includes three stages,

namely:

1. Vocational Education, which is a type of Diploma Three (D3)

Nursing Education organized by nursing higher education to

produce graduates who have competence as implementers of

nursing care;

2. Academic Education, which is higher education for

undergraduate and postgraduate programs directed mainly at

mastering certain scientific disciplines;

3. Professional Education, which is higher education after

undergraduate programs that prepares students to have jobs

with special skill requirements (specialist programs and

nursing doctors).

Nursing education is organized based on the need for nursing

services, as stated in Law No. 36 of 2009 concerning Health Article 1

Paragraph (6), which states that health workers are every person

who devotes themselves to the health sector and has knowledge

and/or skills through education in the health sector which for certain

types requires the authority to carry out health efforts. The title

designations for nursing higher education are:

1. D3 nursing level education graduates received the designation

of Associate Nursing Expert (AMD. Kep);

2. Nurse (Nurse) level education, namely (Bachelor's level plus

Profession), graduates get the title of Nurse (Nurse), the title

(Ns);

3. Education at the Master of Nursing level, graduates get a

degree (M.Kep);

4. Nursing specialist level education, consisting of:

a. Medical Surgical Nursing Specialist, its graduates (Sp.

KMB);

b. Maternity Nursing Specialist, graduates (Sp.Kep.Mat);

c. Community Nursing Specialist, its graduates (Sp.Kep.

Kom);

d. Pediatric Nursing Specialist, graduates (Sp.Kep.Anak);

e. Psychiatric Nursing Specialist, graduates (Sp. Kep.Jiwa);

f. Education at the Doctoral level in Nursing, graduates (Dr.

Kep).

The master of nursing program is a postgraduate academic

education program that aims to produce masters who have the

following abilities: 1) Developing and upgrading science and

technology by mastering and understanding, approaches, methods,

scientific principles along with their application skills; 2) Solving

problems in the field of nursing through research and development

activities based on scientific principles; and (3) Developing their

professional performance which is shown by the sharpness of

problem analysis, review coverage, cohesion of problem solving or

similar professions. The nursing specialist program is directed at the

results of graduates who have the following abilities: 1) Developing

and upgrading science and technology by mastering and

understanding, approaches, methods, scientific principles along with

their application skills; 2) Solving problems in the field of nursing

through research and development activities based on scientific

principles; and 3) Develop their professional performance which is

shown by the sharpness of problem analysis, review coverage,

cohesion of problem solving or similar professions.

The Nursing doctoral program is directed at the results of

graduates who have the following abilities: 1) Developing new

concepts of science, technology and/or art in their field of expertise

through research, 2) Managing, leading and developing research

programs; and 3) Interdisciplinary approach in working in the field

of nursing (Lestari, 2014)

D. Duties and Responsibilities of Nurses

In Indonesia, the nursing profession is an important profession in

helping to improve the degree of individual health and public health.

Nurses are part of the hospital system and have an important role in

determining the quality of a hospital. A hospital will not develop and

run well if there are no professional and reliable nurses in it. A nurse

has quite a lot of duties, ranging from the independent duties of

nurses in providing nursing care, to overflowing duties from other

health workers. This overflowing task provides a burden for nurses,

so that nurses sometimes forget to carry out their main task, which

is to take care of patients (Mulyadi & Hannan, 2015), and nursing

services are an integral part of the health service system organized

in hospitals.

In the Law of the Republic of Indonesia No. 38 of 2014

concerning nursing article 29, it is explained that the duties and

authorities of nurses in the implementation of nursing practice are

as follows:

1. nursing care providers;

2. extension and counselor for Clients;

3. nursing service managers;

4. nursing researchers;

5. executors based on the delegation of authority; and/or

6. Performing duties in certain limited circumstances.

Meanwhile, according to the International Council of Nurses

(ICN), nurses take a leading role in determining and implementing

acceptable clinical nursing practice standards, management,

research and education. Nurses are active in developing professional

knowledge-based research cores that support evidence-based

practice. Nurses are active in developing and maintaining the core of

professional values. Nurses, acting through professional

organizations, participate in creating a positive practice environment

and maintain safe, equitable social and economic conditions in

nursing. (Nurses, 2012).

E. The Role of Nurses in General

The Health Data and Information Center of the Indonesian Ministry

of Health (2017) states that the role of nurses in general is as

follows:

1. Care providers , namely in providing services in the form of

nursing care, nurses are required to apply critical thinking

skills and a systems approach to problem solving and nursing

decision-making in the context of providing comprehensive

and holistic nursing care based on ethical and legal aspects.

2. Manager and Community leader (community leader) is in

carrying out the role of a nurse in a community/community

group, nurses can sometimes carry out leadership roles, both

professional communities and social communities and can also

apply leadership and nursing management in client care.

3. Educators , namely in carrying out their roles as clinical nurses,

community nurses, and individuals, nurses must be able to

play the role of educators. Clients and families are his

responsibility.

4. Advocate (Defender), namely in carrying out their role, nurses

are expected to be able to advocate or provide defense and

protection to patients or the community in accordance with

their knowledge and authority.

5. Researchers , namely with various competencies and

intellectual abilities, nurses are also expected to be able to

conduct simple research in the field of nursing by fostering

ideas and curiosity and finding answers to phenomena that

occur in clients in the community and clinically. With the hope

of applying the results of the study in order to help realize

Evidence Based Nursing Practice

(EBNP). (Ministry of Health of the Republic of Indonesia, 2017)

F. Scope of Work of Professional Nurses

The scope of work of registered nurses includes (Darmawan, 2013):

1. Hospital nurse. Nurses who provide nursing care and nursing

care in hospitals.

2. Clinic nurse. Providing nursing care to patients who are

undergoing outpatient treatment or at polyclinics.

3. Nursing core focility / nursing service facilities. Nurses manage

patient care, assess the health of the population, develop

treatment plans, supervise the work of "Licensed Practical

Nurses" and "Nursing Aides" and perform invasive procedures

such as inserting IVs. They work in special departments such as

unlt rehabilitation, radiotherapy, and others.

4. Home health nurse (Providing nursing services at home) is a

nurse who provides nursing services widely and as a case

manager. Nurses study the patient's environment and provide

instructions to the patient and his family.

5. Public health nurses. Work for government and private agencies

including clinics, schools, retirement communities, and

community services.

6. Occupotional health nurse/ lndustrial nurse. Providing nursing

services in workplaces where there are employees who have a

work accident or are sick.

7. Head nurse or nurse supervisor (nursing manager). Regulating

nursing service activities, especially hospitals.

8. Nurse practitioner. Providing basic primary health services.

Nurse practitioners may prescribe medications that are

permitted by the local government.

9. Clinical nurse specialist, certified nurse anesthetists and cerified

nurse midwives. This rate is the highest in the scope of nursing

work. These nursing specialists/clinicians must pursue higher

education and have long and extensive clinical experience.

G. Summary

Nursing as a profession requires nursing services to be provided

professionally by nurses with competencies that meet standards and

pay attention to ethical and moral principles, so that the community

is protected because they receive quality nursing services and care.

Nursing as a profession also has a clear body of knowledge.

Nurses as the front line of health services and as partners of

doctors are required to be able to be professional. Nurses should be

able to provide maximum health services supported by health

sciences, especially nursing. Moreover, the condition of clients and

their families who are increasingly critical of health service efforts,

especially in the field of nursing. In addition, nurses as a professional

workforce working abroad are also one of the nation's assets, which

can bring in a promising source of foreign exchange.

Caring is a person who has graduated from nursing higher education

(vocational, academic or professional), both at home and abroad

recognized by the Government in accordance with the provisions of

Laws and Regulations that provide care to individuals, families,

groups, or the community, whether sick or healthy (Law of the

Republic of Indonesia Number 38 of 2014).

Nursing Services are professional services that are an integral

part of health services that are based on nursing knowledge and tips

and are aimed at individuals, families, groups or communities both

healthy and sick. (Nursing Law No. 38 of 2014).

Gilles (1989) said that nursing services are a form of

professional service that is an integral part of health services and is

based on comprehensive knowledge and tips of care in the form of

comprehensive biological, psychological, social, and spiritual services

aimed at individuals, families, and communities, both sick and

healthy, which includes the entire process of human life in achieving

optimal health. (Gaffar 1999 in UmiKalsum 2016).

Nursing practice is a service provided by nurses in the form of

nursing care where there is interaction between nurses and clients

and their environment in order to achieve the goal of meeting the

needs and independence of clients in caring for themselves, where in

practice it must be based on humanity, scientific values, ethics and

professionalism, benefits,

justice, protection, health and safety of clients (Law of the Republic

of Indonesia Number 38 of 2014).

Virginia Henderson Nursing Concept Model. Harmer and

Henderson (1995, in Potter, 2005: 274) proposed that Virginia

CHAPTER 4

NURSING CONCEPT MODEL

Henderson's nursing theory covers all the basic needs of a human

being. Henderson (1964, in Potter, 2005: 274) defines nursing as

assisting sick and healthy individuals in carrying out activities that

contribute to their health and healing, where the individual will be

able to do it without assistance if he or she has the necessary

strength, willpower, and knowledge. This is done by helping to regain

their independence as quickly as possible.

Basic Human Needs According to Virginia Henderson.

1. Breathe normally.

2. Eat and drink enough.

3. Removing body waste.

4. Move and maintain the desired position.

5. Sleep and rest.

6. Choosing the right clothes.

7. Worship according to faith.

8. Work with procedures that contain elements of achievement.

9. Play or engage in various recreational activities.

10. Learn to know or satisfy the curiosity that leads to normal

development and health and use the available health facilities.

11. Keeping body temperature within normal limits by adjusting

clothes and changing the environment.

12. Keeping the body clean and well-maintained and protecting

the integument.

13. Avoid environmental hazards that can injure you.

14. Communicating with others in expressing emotions, needs,

fears or opinions.

Henderson (1964, in Potter, 2005) mentioned that the fourteen

basic human needs above can be classified into four components,

namely biological, psychological, sociological and spiritual

components. The basic needs in points 1-9 include the components

of biological needs. Points 10 and 14 include the psychological needs

component. Then in point 11 it includes the spiritual component.

Meanwhile, points 12 and 13 include the components of sociological

needs.

Based on the above theory and the title of this study, the

researcher only uses the basic needs in point 11 which are the

spiritual component. Spirituality, religion, and existential concerns

are also the main components of health related quality of life

(HRQOL). In this HRQOL, there is a questionnaire containing eight

aspects of spirituality, religion, and personal beliefs (related to

spirituality or strength, meaning of life, admiration, integrity and

integration, spiritual strength, inner peace/tranquility/harmony,

hope and optimism, and faith) (Krageloh et al., 2015). Koenig et al (in

Moeini et al, 2016) believe that spirituality can affect one's social

function and one's emotions and in turn also affect the immune

system and endocrine glands. Therefore, spiritual beliefs and

practices are associated with healthy behaviors, stronger immune

function, better cardiovascular conditions, and longer lives. The

nursing model above also explains that the nurse's job is to help

individuals by increasing their independence as quickly as possible

and helping healthy and sick individuals carry out various activities

to support individual health and healing (Harmer and Henderson

(1995, in Potter, 2005: 274).

Florence Nightingale (1859) stated that nursing is seen as a

noncurative action, that is, to put the client in the best condition

naturally, through the provision of an environment conducive to the

occurrence of the reparative process. Meanwhile, nursing

intervention according to Florence Nightingale is to make the patient

in the best condition naturally. The concept of Florence Nightingale's

model focuses on the environment adapted from Murray and

Zentner's concept which states that the environment can prevent,

suppress and encourage a disease, accident or death, which is an

external condition and has an impact on life and development. Focus

on the central concept

Wibowo Hanafi Ari Susanto, M. Kep., et al.

These are the existence of 5 essential things in maintaining health,

namely: fresh air, clean water, efficient drainage, cleanliness,

light/ventilation. Nightingale also feels that nurses must use

common sense to achieve these conditions but must be accompanied

by perseverance, observation and intelligence. Nightingale considers

that someone who wants to be healthy, nurses, nature and that

person must work together so that the reparative process can run.

Examples of nursing applications:

1. provides a comfortable patient room, enough ventilation

2. availability of clean water both in community and indoor

nursing

3. Putting the patient in a situation and condition that is

conducive to achieving the recovery process.

According to the Ministry of Health of the Republic of

Indonesia (1999) the scope of nursing services is a complete nursing

care aimed at four levels of health service users, namely individuals,

families, groups and communities in various nursing service settings

regardless of educational background, socio-economic, gender,

ethnicity, religion, and others, and also health conditions aimed at

promoting or improving health. preventive or disease prevention,

curative or treatment and rehabilitative or health recovery that is

comprehensive, integrated and sustainable.

The nursing code of ethics is a statement of professional

standards that is used as a code of conduct and as a framework for

making decisions. The code of ethics contains professional norms,

values and rules that state what is right and good, as well as what is

not right and not good for professionals. The code of ethics states

what is right and wrong, what should be done and what should be

avoided. The purpose of the code of ethics is for all professionals to

provide the best service to service users, so that the code of ethics

will protect unprofessional acts (PPNI, 2010)

A. The definition of nursing roses is a series of critical thinking and

clinical reasoning activities that nurses use when providing

services to patients (LeMone, 2016). Nurses provide care to

patients by combining scientific problem-solving methods

with critical thinking skills to provide care through the

nursing process (Rosdahl, 2014)

B. Purpose

The objectives of the nursing process include:

1. Identifying various human needs that are incapable of doing,

unwilling to do, or do not know how to do it

2. Determine diagnosis Nursing after

Identification is carried out

3. Determining an action plan after a nursing diagnosis is

established

4. Carry out nursing care after planning

5. Knowing the patient's progression from the various actions

that have been taken to determine the success rate

Basic Nursing Concepts

C. Characteristics of the nursing process

The nursing process has unique characteristics that allow it to

respond to changes in the patient's health status. Characteristics of

the nursing process include:

1. The cyclic and dynamic nature of the nursing process

The cyclic in question is an activity or event that repeats

regularly or a sequence of events (cycles) that continuously

changes (dynamic), not static (static)

2. Patient-centric

CHAPTER 5

NURSING PROCESS CONCEPT

Nurses organize care plans based on patient problems, not

nursing goals. Patient-centered care is also called Patient

Centered Care (PCC) which has been widely applied in several

health services. This model is a new paradigm in health

services that positions the patient as the center of service.

There are 7 (seven) dimensions in PCC according to Riskiyah et

al, 2017 , namely: 1) respecting the patient's values, choices

and needs, 2) emphasizing care coordination and nurse

integration, 3) informing, communicating and educating

patients and their families, 4) ensuring physical comfort, 5)

providing emotional support, reducing fear and anxiety, 6)

engaging family and friends, 7) promoting continuous care

among providers and institutions

3. Focuses on problem-solving and decision-making

Problem solving in the nursing process can be done by several

approaches, namely trial and error (trying several approaches

until finding a solution), intuition (knowledge of unknown

things obtained through unconscious thinking processes,

occurring quickly, suddenly, based on data sourced from

emotional states or emotional reactions to past experiences to

direct the right behavior), research process (systematic,

logical) and scientific method/modified scientific method. The

nursing process focuses or is specifically aimed at the patient's

response to illness and illness while the medical process

focuses on physiological systems and disease processes. Although

these two processes begin with the process of data collection, data

analysis and then medical diagnosis and nursing diagnosis will be

obtained.

Decision-making in the nursing process can be applied in

every stage of the nursing process. Nurses are required to be

creative in determining when and how to use data to make

decisions. For example, when a nurse meets with a patient to get

data about pain, the nurse will look for other pain-specific data,

not only from facial expressions but from other data such as when

the pain appears aggravated and reduced, what kind of pain

quality, pain location, pain scale and duration and others. After

getting the data, the nurse will determine the nursing diagnosis

that will be raised from the data and then make a plan from the

nursing diagnosis that appears.

4. Interpersonal and collaborative

The nursing process requires nurses to deliver directly and

consistently to patients and families to meet their needs. These

demands require nurses to collaborate with other health teams, in

a joint effort to provide quality client care

5. Universally applicable and critical thinking use

Universally applicable nursing processes mean that they are used

as a framework for nursing care in all types of healthcare settings,

with patients of all age groups. Nurses must use various critical

thinking skills to carry out the nursing process. The following is a

scheme of critical thinking in implementing the nursing process:

D. Stages in the nursing process

The stages of the nursing process are as follows:

1. Assessment Level a. Data collection

Assessment is the first step in the nursing process through data

collection activities or obtaining accurate data from patients to find

out various existing problems. The data needed includes data on

biopsychosocial and spiritual or data related to patient problems as

well as data on factors that affect patient problems. In data

collection, the device or format can be adjusted to the patient's

needs. Data collection is carried out by means of interviews (through

communication to get a response from the patient face-to-face),

observation (making observations visually or directly to the patient),

consultation (consulting experts or specialists), and physical

examination (inspection through direct observation of the organ

being examined, palpation by palpation by palpation of the organ

examined, percussion by tapping using the index finger or hammer

in neurological examinations and auscultation by listening to the

sounds of the organs being examined, laboratory examinations and

X-rays, and others.

B. Data validation

Data validation is an effort to provide justification for the data that

has been collected by comparing subjective data and objective data

collected from various sources based on normal value standards, to

find the possibility of re-assessment or additional assessment of

existing data.

There are two types of data, namely subjective data and

objective data. Subjective data is also called symptoms or closed and

visible data on the individual who experiences it so that it can be

explained or verified only by the individual. For example, the patient

said that he could not do daily activities such as eating and drinking

because his hands were swollen and it was difficult to move his

fingers. Objective data is also called sign or open data, which is data

obtained from observation results or measurement results. For

example, changes in skin color, blood pressure measurements,

muscle strength and others. During the physical examination, nurses

obtain objective data to validate subjective data and complete the

assessment phase of the nursing process.

There are two sources of data, namely primary and secondary.

The patient is the primary source of data, while the secondary source

of data can be from family members, friends, medical records and the

health team that manages the patient during treatment c. Identify

patterns/problems

It is the last activity of the assessment stage after validating the data.

Through the identification of patterns or problems, it is possible to

identify nursing disorders or problems that exist in health functions,

such as in the perception of health management, exercise activity

patterns, metabolic nutrition patterns, and others

2. Nursing diagnosis stage a. Definition of Nursing

Diagnosis

Nursing diagnosis is a clinical assessment of the patient's response to

health problems or life processes that he or she is experiencing, both

actual and potential. b. Purpose of Nursing Diagnosis

The goal of nursing diagnosis is to identify the response of the

patient individually, family and community to health-related

situations.

c. Classification of nursing diagnosis

The International Council of Nurses (ICN) since 1991 has developed a

classification system called the International Nurses Council

International Classification For Nursing Practice. (ICNP). This

classification system not only includes the classification of nursing

diagnoses, but also includes nursing interventions and outcomes .

This classification system is compiled to harmonize nursing

terminology used in various countries including Clinical Care

Clasification (CCC), North American Nursing Diagnosis Association

(NANDA), Home Health Care Clasification (HHCC), Systematized

nomenclature of medicine clinical terms (SNOMED CT), International

Classification of functioning, disability and health (ICF), Nursing

Diagnostic system of the centre for nursing development and research

(ZEFP) and ombaha system (Hardikar et al, 2011)

d. Types of nursing diagnosis

Types of nursing diagnosis can be broken down as follows:

1. Actual diagnosis

This diagnosis describes the client's response to a health

condition or life process that causes the patient to experience

health problems. Major and minor signs/symptoms can be

found and validated in patients

2. Risk diagnosis

This diagnosis describes the patient's response to health

conditions or life processes that can cause the patient to be at

risk of experiencing health problems. No major or minor

signs/symptoms were found in the patient, but the patient had

risk factors for experiencing health problems.

3. Health promotion diagnosis

This diagnosis describes the patient's desire and motivation to

improve his or her health condition to a better or optimal level.

e. Components of nursing diagnosis

Nursing diagnosis has two main components, namely problems or

diagnosis labels and diagnostic indicators. Each component is

described as follows:

1. Problem

Problems are nursing diagnosis labels that describe the core

and response of patients to their health conditions or life

processes. Diagnosis labels consist of

over descriptors or explainers and diagnostic focus

A descriptor is a statement that explains how a focus of

diagnosis occurs. Some of the descriptors used in nursing

diagnosis are in the following table:

It Descriptor Diagnostic Focus

1 Ineffective Anfas road cleaning

2 Distractions Gas exchange

3 Decline Cardiac output

4 Intolerance Activity

5 Deficit Knowledge

While a descriptor is a statement that explains how a

diagnosis focus occurs. Some of the descriptors used in nursing

diagnosis are in the following table:

It Descriptor Definition

1 Deficit Not enough, not enough

2 Dysfunction Does not function normally

3 Effective Causes the desired effect

4 Gangguan Experiencing obstacles

5 More Above normal values or

Needed

6 Decline Reduced both in size, quantity

or degree

7 Low is below normal or the

Needed

8 Ineffective Does not cause the desired effect

2. Diagnostic indicators

Diagnostic indicators consist of causes, signs/symptoms, and risk

signs with the following description: a. Etiology

These are factors that affect changes in health status. Etiology

can include four categories, namely: a) physiological, biological

or psychological, b) therapeutic effects/actions, c) situational

(environmental or personal) and d) maturasional

b. Signs and symptoms

Signs are objective data obtained from the results of

physical examinations, laboratory examinations and

diagnoses, while symptoms are subjective data obtained

from the results of anamnesis. Signs/symptoms are

grouped into two categories, namely: 1) Major:

signs/symptoms are found 80100% for diagnosis

validation, 2) Minor: signs/symptoms are not only found,

but if found can establish the diagnosis

c. Risk factors

It is a condition or situation that can increase the

vulnerability of patients to experiencing health problems.

In actual diagnosis, the diagnostic indicators consist of causes

and signs/symptoms. The risk diagnosis does not have causes and

signs/symptoms. It only has a risk factor. Meanwhile, in health

promotion diagnosis, there are only signs/symptoms that show the

client's readiness to achieve a more optimal condition

f. Nursing diagnosis enforcement process

There are three stages, namely:

1. Data analysis

Data analysis is carried out by comparing data with normal

values and grouping data

2. Identify the problem

After the data is analyzed, nurses and patients jointly identify

actual problems, risks and/or health promotion. Health

problem statement refers to a nursing diagnosis label

3. Formulation of the diagnosis.

The formulation is adjusted to the type of nursing diagnosis.

There are two methods of formulating nursing diagnoses,

namely:

a. Writing three parts

This writing method consists of problems, causes and

signs/symptoms. This writing method is only carried out on the

actual diagnosis, with the following formulation:

Problems related to the cause are evident

with signs/symptoms

The phrase 'related to' can be abbreviated b.d and

'proven by' can be abbreviated as d.d

b. Two-part writing

This writing method is carried out on risk diagnosis and health

promotion diagnosis, with the following formulation

(1) Risk diagnosis

The problem is evidenced by the risk factor

Example of writing a diagnosis:

The risk of aspiration is evidenced by a decreased level of

awareness

(2) Health promotion diagnosis

The problem is evidenced by signs/symptoms

Example: readiness to increase urine eliximation as evidenced

by the patient's desire to increase urine elimination, normal

urine volume and characteristics

The diagnostic components of each type of nursing diagnosis

and the method of writing the diagnosis can be seen in the

table below:

It Types of diagnosis Components and writing

Nursing Diagnosis

1 Actual diagnosis Problem b.d cause d.d

Signs/Symptoms

2 Risk diagnosis Problem d.d Risk factors

3 Health promotion diagnosis Problems d.d

Signs/symptoms

Description: b.d (related to), d.d (proven by)

3. Planning Stage

This stage is the process of preparing various nursing interventions

needed to prevent, eliminate, or reduce patient problems. This stage

also means all treatments carried out by nurses which are based on

clinical knowledge and assessment to achieve the expected

outcomes. Planning stage activities can be carried out with various

activities as follows:

a. Prioritizing nursing diagnoses

The determination of the priority of this nursing diagnosis is carried

out after the nursing diagnosis stage. The prioritization of problems

can be based on the severity (life-threatening) and based on human

needs.

1. Based on the severity (life-threatening)

This is motivated by the principle of first aid, which is to divide

high priorities (if it reflects a situation that threatens a person's

life so that action needs to be taken first, such as the problem of

airway cleaning), medium (when describing a situation that is not

urgent and does not threaten the patient's life such as hygiene

problems) and low (when describing a situation that is not

directly related to the prognosis of a specific disease such as a

problem finance or others) 2. Based on the level of the pyramid of

Maslow's basic needs

The 5 (five) basic human needs Maslow's basic needs include

physiological needs (respiratory, circulation, temperature,

nutrition, pain, skin care fluids, mobility, elimination, and

others), security and safety needs (environmental problems,

living conditions, protection, clothing, and others), the need to

love and be loved (problems with affection, sexuality, affiliation

in groups, and relationships between people), and the need for

self-esteem (respect problems from family, feelings of self-

respect), the need for self-actualization (the problem of

satisfaction with the environment)

b. Determine the goals and expected outcomes

The goal is the outcome to be achieved to overcome the problem of

nursing diagnosis. In other words, the objective is a synonym for the

outcome criterion which has the following components: S (subject),

P (predicate), Kr (criterion), Kd (condition), and W (time), with the

following description:

S; Observed patient behavior

P; Conditions that complement the patient

Kr: A quantifiable verb to determine the achievement of a goal

Kd: Something that causes parenting

W: Time to reach

The outcome criterion (expected outcome) is an evaluation

standard which is an overview of the factors that can provide clues

that the goal is achieved and is used in making considerations with

the following characteristics:

1. Each outcome criterion relates to a set goal

2. The results set out in the outcome criteria are achievable

3. The outcome criterion is a statement of one specific thing, it

must be as concrete as possible to facilitate measurement

4. Criteria are measurable and results can be seen, felt and heard

5. Criteria for using positive words, not negative words

In the discussion of goal determination, it is also necessary to

know the nursing output. Nursing outcomes are aspects that can be

observed and measured including conditions, behaviors, or

perceptions of patients, families, or communities in response to

nursing interventions. The nursing output component has three

main components, namely labels, expectations and outcome criteria.

Each component is described as follows: 1) Label:

Nursing output labels are conditions of patient behavior or

perception that can be changed or overcome by nursing

interventions. The nursing intervention label consists of several

words (1 word to 4 words) which begins with a noun (noun) which

functions as a descriptor or explanation of nursing outcomes, 2)

Expectations: Expectations are an assessment of the expected results

achieved. Expectations describe what the patient's condition,

behavior or perception will change after being given a nursing

intervention. There are three possible expectations, including

increased which means an increase in size, number, degree or level,

decreased which means a decrease in size, number, degree or level,

improved (causing a better, adequate, or effective effect, 3) Outcome

criteria: Outcome criteria are patient characteristics that can be

observed or measured by nurses and used as a basis for assessing

the achievement of nursing intervention outcomes. Outcome criteria

can also be referred to as indicators because they describe the

changes to be achieved after nursing interventions.

c. Define an action plan

Actions in nursing interventions consist of observation, therapy,

education and collaboration

1. Observational actions

Actions aimed at collecting and analyzing data on the patient's

health status. This action generally uses the words 'check',

'monitor'. It is recommended to avoid using the word 'review'

because it is similar to the initial stage of the nursing process

and so as not to be confused with nursing actions which is the

post-diagnosis stage, while the assessment is the pre-diagnosis

stage

2. Therapeutic action

Actions that can directly have the effect of restoring the

patient's health status or can prevent the worsening of the

patient's health problems. This action generally uses the words

'give', 'do' and other words

3. Educational actions

Actions aimed at improving the patient's ability to care for

himself or herself by helping the patient acquire new

behaviors that can overcome the problem. This generally uses

the words 'teach', 'encourage', or

'Train'

4. Collaborative actions

Actions that require cooperation both with other nurses and

with other health professions. This action requires a

combination of knowledge and skills from various health

professions. This action is only done if the nurse needs further

treatment. This action generally uses the words 'collaboration',

'refer', or 'consult'.

4. Implementation Stage

It is the fourth stage in the nursing process by implementing various

nursing strategies (nursing actions) that have been planned. In this

stage, nurses must know various things, including physical danger

and protection to patients, communication techniques, ability in

action procedures, understanding of patient rights, patient

development level. In the implementation stage, there are two

actions, namely independent actions and collaborative actions

Here are examples of independent nursing actions

(independent actions) and collaborative actions (interdependent

actions)

a. Identifying coughing abilities (self-acting)

b. Setting the position of the semi fowler or fowler (self-action)

c. Recommend inhaling through the nose for 4 seconds, holding

for 2 seconds, then exhaling from the mouth with pursed

(rounded) lips for 8 seconds (self-action)

d. Collaborating on the provision of mucolytics or expectations

(collaborative actions)

5. Evaluation Stage

The evaluation stage is the last stage of the nursing process by

assessing the extent to which the goals of the nursing plan are

achieved or not. In evaluating, nurses must have the knowledge and

ability to understand the response to nursing interventions, the

ability to describe conclusions about the goals achieved, and the

ability to relate nursing actions to outcome criteria. This evaluation

stage consists of two components, namely process evaluation and

result evaluation. Process evaluation is carried out during the

treatment process or assessing the patient's response, while the

result evaluation is carried out on the expected goal target.

Evaluations can be classified as follows:

a. Formative evaluation

The evaluation is carried out at the time of providing the

intervention with an immediate response.

Example:

Identification of coughing ability

Evaluation results: based on the results of the assessment of

the cough patient, the patient seemed to have difficulty

excreting sputum

b. Summative evaluation

It is a recapitulation of the results of observation and analysis

of the patient's status at a certain time based on the planned

goals at the planning stage. In addition, evaluation is also a

measure of goals that have certain criteria to prove whether

the goal is achieved, not achieved or partially achieved

c. Evaluation achieved

This goal is said to be achieved if the patient has shown

changes and progress in accordance with the criteria that have

been set

Example:

Nursing diagnosis: Breath cleaning is ineffective

Objective: the patient is able to clear secretions or airway

obstructions Evaluation:

S (Subjective): The patient says he can pass his phlegm

O (Objective) : Clear lungs at the time of adoption

A (Assessment or assessment): The disruption of the cleaning of the

asphalt road has been resolved

P (Planning or plan) : Home visits are stopped

SUMMARY:

1. The stages of the nursing process include assessment, nursing

diagnosis, intervention, implementation and evaluation

2. The assessment stage consists of data collection, data validation

and identification of patterns/problems

3. The stages of nursing diagnosis consist of data analysis activities,

problem identification and formulation of nursing diagnosis

4. The stages of the intervention consist of prioritizing the diagnosis,

determining the goals and expected outcomes, determining the

action plan

5. The implementation phase consists of self-nursing actions and

collaborative nursing actions

6. The evaluation stage consists of process evaluation and result

evaluation

ASSIGNMENT

1. What are the 5 stages of the nursing process?

2. What are the 3 types of nursing diagnoses?

3. What is a nursing outcome?

4. What is therapeutic action in nursing intervention?

5. Give examples of self-care actions when acute pain nursing

problems arise!

A. The preemption of health development is aimed at increasing

awareness, willingness and ability to live a healthy life for

everyone in order to achieve an optimal degree of health

as stipulated in the 1945 Constitution. Section 63

paragraph (4) of the Health Law No. 36 of 2009

concerning health, states that the implementation of

treatment and/or treatment based on medical science and

nursing science can only be carried out by health workers who

have expertise and authority. Nurses are one of the health

workers in every health service. Nurses are the frontline in

health services in hospitals,. Nurses are a profession that devotes

themselves to handling nursing care for patients, always has an

CHAPTER 6

RIGHTS AND OBLIGATIONS OF NURSES

excessive workload and often also performs activities that are

not their main task, for example in the inpatient room can play

an administrative role. Nurses in hospitals provide 24-hour

service, but there are also nurses on duty in inpatient,

outpatient, and polyclinic service rooms. Nurses have the

authority based on their competence to provide nursing care to

individuals, families and communities in government and

independent health services. A nurse according to the

International Council of Nursing (ICN 1965) is a person who has

completed a qualified nursing education and is authorized in the

country concerned to provide nursing services and is

responsible for improving health, disease prevention and

services.

sick patients. Meanwhile, according to the Nursing Law no. 38 of

2014, a nurse is someone who has graduated from Nursing higher

education both at home and abroad which is recognized by the

Government in accordance with the provisions of the Legislation. As

a nurse, she will provide nursing services in the form of professional

services which are an integral part of health services based on

knowledge and tips aimed at individuals, families, groups, and the

community, both healthy and sick. In carrying out nursing services, a

nurse provides nursing care, with a series of interactions between

nurses and clients and their environment to achieve the goal of

meeting the needs and independence of clients in caring for

themselves. Before fulfilling the rights and obligations, nurses must

take a competency test, namely the measurement process and

knowledge, skills and behavior of students at universities that

organize nursing study programs.then graduate and have a

certificate of competence, to practice nursing, which then has a

registration certificate (STR) as written evidence given by the

nursing council to nurses who have been registered. In carrying out

the rights and obligations of nurses in Indonesia, based on the

Nursing Law no. 38 of 2014 concerning nursing, KMK no.

01.07/Menkes/425/2020 dated July 13, 2020 concerning the

standards of the Nursing Profession then, Permenkes no. 26 of 2019

concerning the Implementation Regulation of Law no. 38 of 2014

concerning Nursing dated August 9, 2019. For this reason, it is

necessary to be addressed by every nurse to add insight in fulfilling

rights and obligations, and also follow the rules that have been made

by the standards made by policy makers, in their respective work

areas, we know, that the rules that are set always refer to the rules

and regulations above them

B. Rights and Obligations of Nurses.

Understanding of rights differs depending on the perspective

, but by experts there is a definition and definition of rights

Rights are words that we often hear in daily life, even in the

smallest organizational activities, for example, social gatherings,

harmony is challenged, there are always words rights and

obligations, every individual has the right to do something and have

something, make decisions, protect themselves, act, express

opinions, receive information, but rights can also make each

individual aware of the limitations in determining what is allowed

and not allowed. Likewise, nurses as competent health workers have

rules about the rights and obligations of nurses that must be

understood by every nurse, so that they do not experience problems

in carrying out nursing care.

1. Definition of Rights

a. Rights according to language or KBBI are a form of authority or

a power that allows an individual to act (on the basis of the law

because it has been regulated and determined by certain laws

or rules) and absolute power based on something or is used to

demand something.

b. Rights According to Prof. Dr. Notonegoro

It is a power or ability of an individual to be able to carry out

several activities such as, receive, do, and have something that

should be accepted, done and owned by the individual.

c. Rights According to Prof.R.M.T.Sukamto Notonagoro

It is an authority where an individual has the authority to

receive or do something that is cold to him and should be

accepted or done by the individual. This right cannot and

cannot be given to other individuals, so it cannot be exercised

and accepted by other individuals.

d. Rights according to C Fagin (1975)

It is a demand for something that a person has rights to, such

as power and privilege in the form of demands based on

justice, morality, or legality.

2. Types of types of rights.

a. Absolute Rights

It is a right that has absolute or landslide without exception,

the right of absold can be applied anywhere as long as it is not

affected by certain situations and circumstances.

b. Welfare Rights

A legally granted right for things that are specific safety

standards in a particular building or area. For example, the

right of patients to obtain nursing care, the right of residents to

receive health services at health service facilities, e.g. to seek

treatment at the health center, receive health protection during

the covid 19 pandemic, through the covid 19 vaccine, utilizing

BPJS health services.

c. Legislative Rights

Legislative rights are applied by law based on the concept of

justice. For example, a woman experiences violence from her

husband so that the woman will exercise her right to legislate.

According to Badman and Badman (1985), legislative rights

have four roles in society, namely making regulations, changing

regulations, limiting morals against unfair regulations, giving

court decisions or resolving disputes.

Factors that affect the development of the personal concept of

a person's rights

a. Social relations with the family, between families and with the

environment,

b. Education from parents, for example, respects and appreciates

the opinions of families who, helping others, help with

homework. is a behavior in creating harmony, which can affect

a person's life in serving and acting

c. Culture influences us to follow certain patterns of behavior that

have been created.

d. Regional factors can affect an individual's personality, for

example in providing care, for example to mention the client's

name in Indonesian starting with the word "Mother" "Father",

or in the Batak tribe with "Amang" for father, or "Inang" for

mother

e. The information obtained, obtained by nurses, of course

through education and also through experience in the field will

affect every action of a person, if positive information is

obtained, the person concerned will do it well guided by the

operational standards that have been established

Nurses' Rights according to the Nursing Law no. 38 of 2014

Part one article 36

Nurses' Rights, According to the Minister of Health Regulation

No. 26 of 2019 concerning the Implementation Regulation of Law No.

38 of 2014 part five Article 35

In carrying out nursing practice, nurses have the following

rights:

a. Obtain legal protection while carrying out their work in

accordance with professional standards, service standards,

operational procedure standards and the provisions of laws

and regulations.

b. Obtain true, clear, and honest information from the client

and/or his family.

c. Carry out duties in accordance with competence and authority

d. Receive a service reward for the Nursing Services that have

been provided.

e. Rejecting the wishes of clients or other parties that are

contrary to the code of ethics, service standards, professional

standards, and operational procedure standards.

f. Obtaining work facilities in accordance with standards

g. Obtain protection for occupational safety and health, treatment

in accordance with human dignity and dignity, morals, morality

and religious values.

1. Obtain other rights in accordance with the provisions of

regulations and laws.

2. Nurses are also entitled to receive remuneration for services

provided for health services provided. Article 36

1. In carrying out Nursing Practice, Nurses have obligations

a. Maintaining the confidentiality of clients' health

b. Obtaining consent from the client or his family for the actions

given.

c. Complement the recommendations and infrastructure of Sesusi

Nursing Services with nursing service standards and provisions of

laws and regulations for nurses who practice independently.

d. Providing Nursing Services in accordance with the code of ethics

for Nursing Service standards, professional standards, operational

procedure standards and legal provisions.

e. Refer clients who cannot be handled to nurses or other health

workers who are more appropriate according to their scope and

level of competence.

f. Documenting Nursing Care in accordance with standards.

g. Providing complete, honest, true, clear and easy-to-understand

information about nursing actions to clients and/or their families

in accordance with the limits of their authority.

h. carry out actions of delegating authority from other health

professionals in accordance with the competence of nurses

i. Implement Assignment special that Set by the

government.

The Rights of Nurses according to Claire Fagin (1975)

a. The right to obtain dignity in order to express and improve

oneself through special use and in accordance with one's

educational background.

b. The right to obtain recognition in relation to contributions

through the stipulations provided by the environment for the

practice carried out as well as economic rewards in relation to

professionals.

c. The right to a work environment with minimal physical and

emotional stress and work risks.,

d. The right to carry out professional practices within the limits

of the applicable law.

e. The right to set quality standards in the care carried out.

f. The right to participate in policy-making that affects care.

g. The right to participate in social and political organizations

that represent nurses in improving health care.

Meanwhile, according to Ismani 2014 in the book Nursing

Ethics, it is stated that the Rights of Nurses:

a. Nurses have the right to get huku protection in carrying out

their duties in accordance with their profession.

b. Nurses have the right to develop themselves through

specialized abilities in accordance with their educational

background.

c. Nurses have the right to reject the wishes of patients/clients

that are contrary to laws and regulations, as well as

professional standards and codes of ethics.

d. Nurses have the right to receive specific information from

patients/clients or their families about their complaints and

dissatisfaction with the services provided.

e. Nurses have the right to improve their knowledge based on

science and technology in the field of nursing/health

continuously.

f. Nurses have the right to be treated fairly and honestly by

service institutions and clients/patients.

g. Nurses are entitled to a guarantee of protection against

occupational risks that can cause physical harm or emotional

stress.

h. Nurses have the right to be included in the preparation and

determination of health service policies.

i. Nurses have the right to privacy and have the right to sue if

their good name is defamed by patients/clients and/or their

families and other health workers.

j. Nurses have the right to refuse to be transferred to another

place of duty, either through advice or written announcement

because it is necessary to take actions that are contrary to

professional standards or the nursing code of ethics or other

laws and regulations.

k. Nurses have the right to receive appropriate awards and

rewards from professional services provided based on

certificates or applicable provisions at the service institution

concerned

l. Nurses have the right to get opportunities, develop their

careers in accordance with their professional fields.

m. Obligation according to 1, John Salmond: Something that must

be done by a person and if he does not do it, he will be

sanctioned.

According to Prof. R.M.T.Sukamto Notonegoro, the obligations

are; Something that must be done by the tensed party with a sense of

responsibility and with principles that can be forcibly demanded by

interested parties.

Obligation :P care. Iswani 2000, in Nursing Ethics:

a. Nurses are obliged to comply with all regulations of the

institution concerned.

b. Nurses are required to provide nursing services or care in

accordance with professional standards and use limits.

c. Nurses are obliged to respect the rights of patients/clients.

d. Nurses are obliged to refer patients/clients to nurses or other

health workers who have better skills or abilities, if the person

concerned cannot cope with it.

e. Nurses provide opportunities for patients/clients to have

contact with their families, as long as they do not conflict with

existing regulations or professional standards.

f. Nurses are obliged to provide opportunities for

patients/clients to carry out their religious worship, in

accordance with their respective religions or beliefs as long as

they do not interfere with other patients

g. Nurses are required to collaborate with medical personnel or

other health workers in providing health and nursing services

to patients.

h. Nurses are obliged to provide accurate information regarding

nursing actions given to patients or their families according to

the limits of their abilities.

i. Nurses are obliged to improve the quality of their services in

accordance with the standards of the nursing profession for

patient satisfaction.

j. Nurses are required to follow the documentation of nursing

care accurately and continuously.

k. Nurses are required to follow the development of nursing

science and technology or health continuously.

l. Nurses are obliged to carry out emergency services as a

humanitarian duty in accordance with the limits of their

authority.

m. Nurses are obliged to keep everything known about the patient

confidential unless requested for information by the

authorities.

n. Nurses are obliged to fulfill matters that have been agreed

upon or agreements that have been made beforehand, to the

institution where they work.

From some of the rights and obligations above, that during the

covid 19 pandemic since 2019 the obligation of nurses is very large

in providing services. Obtain legal protection while carrying out their

work in accordance with professional standards, service standards,

operational procedure standards and the provisions of laws and

regulations.

A. Understanding according to the Ministry of Health (2002) home

care is a service health that ustainable and

comprehensive provided to individuals and families in

their place of residence with the aim of enhancing,

maintaining or restoring health or maximizing the level of

independence and minimizing the consequences of illness.

Home Health Care is a system where health services and social

services are provided at home to people who are disabled or people

who have to stay at home due to their health conditions (Neis and

Mc.Ewen, 2001)

According to Habbs and Perrin, 1985 (in Lerman D. & Eric B.L,

1993) Home Care is a health service that is carried out in the

patient's home, so home care in nursing is a nursing service in the

patient's home that has gone through a long history.

In some developed countries, " home care " is not a new

concept, but it has been developed by William Rathbon since 1859

where he called home care in the form of nursing personnel visiting

homes to treat sick and unwilling clients in the hospital.

From some literature, the meaning of " home care " is:

1. Ministry of Health).

Basic Nursing Concepts

CHAPTER 7

BASIC CONCEPTS HOME CARE

B. Nursing Model Concepts/Theories Supporting Home Care

According to Hidayat (2004), nursing models / theories that support

home care include:

1. Environmental Theory (Florence Nightingale)

The environment according to Nightingale refers to the external

physical environment that affects the healing and health process

which includes the five most important environmental components

in maintaining the health of an individual which includes:

a. Clean air,

b. Clean water

c. Efficient maintenance

d. Hygiene

e. Lighting/lighting

Nightingale emphasizes more on the physical environment

than on the social and psychological environment which is explored

in more detail in his writings. His emphasis on the environment is

very clear through his statement that if you want to predict health

problems, then what must be done is to study the condition of the

house, the condition and the way of life of a person rather than

examining his physical/body.

2. Theory of the concept of man as a unit (Martha E. Rogers)

In understanding the concept of this model and theory, Rogers

assumes that human beings are a whole whole, which has different

traits and characters. In the dynamic process of human life, humans

in the process of human life each individual will be different from

each other and humans are created with their own characteristics

and uniqueness. This assumption is based on the forces that develop

naturally, namely the integrity of humans and the environment, then

the availability system as a whole and the process of human life

based on the concept of homeodynamics consisting of integrity,

resonance and helicy.

Integrity means that individuals as a whole with an

environment that cannot be separated, and influence each other.

Resonance means that the life process between individuals and the

environment takes place rhythmically with varying frequencies and

helicy is the process of interaction between humans and the

environment will change, either slowly or quickly.

According to Rogers (1970), the goal of nursing is to maintain

and improve health, prevent pain, and treat and rehabilitate sick and

incapable clients with a humanistic approach to nursing. According

to Rogers, 1979 Framework of Practice: "Whole human beings"

encompass the process throughout life. The client is constantly

changing and aligning with his environment.

3. Theory Transkultural nursing (Leininger)

Leininger believed that the purpose of this theory was to provide a

culturally based service. She believes that nurses must work with the

principle of "care" and a deep understanding of "care" so that the

culture s care‟, values, beliefs, and lifestyles provide a realistic and

accurate foundation for effective planning and implementation of

services in a particular culture. She believes that a nurse cannot

separate the way in which the worldview, social structure and

cultural beliefs (ordinary and professional) of health, well-being,

sickness, or service while working in a particular community group,

because these factors are interconnected with each other. Social

structures such as trust, politics, economics and kinship are

significant forces that have an impact on "care" and affect well-being

and sick conditions.

4. Theory of Human Caring (Watson, 1979)

This theory emphasizes that caring as a type of relationship and

transaction is necessary between the provider and the recipient of

care to enhance and protect the patient as a human being, thereby

affecting the patient's ability to heal.

This view of Jean Watson's theory understands that humans

have four branches of human needs that are interconnected,

including basic biophysical needs (the need for life) which includes

the need for food and fluids, the need for elimination and the need

for ventilation, psychophysical needs (functional needs) which

include the need for activity and rest, sexual needs, psychosocial

needs (the need for integration) which includes the need to achieve,

organizational needs, and intra and interpersonal needs (needs for

development), namely the need for self-actualization.

5. Theory Self Care (Dorothea Orem)

Orem's theoretical view in the nursing service order is aimed at the

needs of individuals in carrying out independent nursing actions and

regulating their needs. In the concept of nursing practice, Orem

develops two forms of Self Care theory, including:

a. Self Care

1) Self Care: is an activity and initiative of the individual and

carried out by the individual himself in fulfilling and

maintaining life, health and welfare.

2) Self Care Agency: is an individual's ability to take care of

themselves, which can be influenced by age, development,

sociocultural, health and others.

3) Theurapetic Self Care Demand: a demand or demand in self-

care which is a self-action that is carried out within a

certain time for self-care by using methods and tools in

appropriate action.

4) Self Care Requisites: the need for self-care is an action aimed

at providing and caring for oneself that is universal and

related to the process of human life and in an effort to

maintain body functions. Self Care Requisites consist of

several types, namely: Universal Self Care Requisites

(universal human needs that are basic needs),

Developmental Self Care Requisites (needs related to

individual development) and Health Deviation Requisites

(needs that arise as a result of the patient's condition).

b. Self Care Challenged

Self Care Deficit is an important part of general care where all

nursing planning is given when care is needed. Nursing is

needed by a person when they are unable or limited to do their

self-care continuously. Self-care deficit can be applied to

immature children, or needs that exceed their abilities as well

as an estimated decrease in ability in care and demands in

increasing self-care, both in quality and quantity.

In fulfilling self-care and assisting in the problem-solving

process, Orem has methods for the process, including acting or

doing for others, as a guide to others, providing support,

improving the development of the environment for personal

development and teaching or educating others.

c. Teori Dinamic dan Self Determination for Self Care (Rice)

Nurses as facilitators and coordinators of healthy pain balance

choices set by patients.

C. Legal Basis Home Care

1. Legal functions in Nurse Practice:

a. Provides a framework for determining which nursing

actions are in accordance with the law

b. Differentiating the responsibilities of nurses from other

professions

c. Helping to determine the limits of authority for

independent nursing actions

d. Helping to maintain standards of nursing practice by

placing nurses accountable under the law.

2. Legal basis:

a. Law Number 29 of 2004 concerning medical practice

b. Law Number 32 of 2004 concerning local government

c. Law Number 36 of 2009 concerning health

d. Government Regulation Number 32 of 1996 concerning health

workers

e. Government Regulation Number 25 of 2000 concerning the

financial balance of the central and regional governments.

f. Government Regulation Number 47 of 2006 concerning

functional positions of doctors, dentists, pharmacists,

ass.pharmacists, lab.kes institutions. Health epidemiology,

health entomology, sanitarians, health administrators, health

counselors, dental nurses, nutritionists, midwives, nurses,

radiographers, medical recorders, and electromedicine

technicians.

g. Decree of the Minister of Agriculture Number 94/KEP/M.

PAN/11/2001 concerning the functional position of nurses.

h. Ministry of Health Number 128 of 2004 concerning the basic

policy of the health center

i. Ministry of Health Number 279 of 2006 concerning guidelines

for the implementation of Perkesmas.

j. Ministry of Health Number 374 of 2009 concerning Health

System

National

k. Ministry of Health Number 267 of 2010 concerning the

determination of the roadmap for health reform.

l. Permenkes Number 920 of 1986 concerning private medical

services

m. Permenkes Number 148 of 2010 concerning the licensing and

implementation of nursing practice

D. Scope of Service Home care

According to Nuryandari (2004), the scope of home care services is:

1. Medical services and nursing care

2. Social services and efforts to create a therapeutic environment

3. Rehabilitation and physical therapy services

4. Information and referral services

5. Education, training and health counseling

6. Hygiene and sanitation of individuals and the environment

7. Improvement services for social activities

According to Rice (2001), the types of cases that can be served

in home health care include common cases after hospital treatment

and special cases found in the community.

1. Common cases that are post-treatment in the hospital are:

a. Clients with chronic pulmonary obstructive disease

b. Clients with heart failure

c. Clients with impaired oxygenation

d. Clients with chronic injuries

e. Clients with diabetes

f. Clients with impaired functionality

g. Clients with health recovery or rehabilitation conditions

h. Clients with infusion fluid therapy at home

i. Clients with impaired neurological function

j. Clients with HIV/AIDS

2. Meanwhile, cases with special conditions include:

a. Clients with post partum

b. Clients with mental health disorders

c. Clients with advanced age conditions

d. Client with terminal condition

E. Basic Skills that Nurses Must Master

Based on the Decree of the Director General of YAN MED Number:

HK. 00.06.5.1.311 states that there are 23 independent nursing

actions that can be carried out by home care nurses, including:

1. Vital sign

2. Installing a nasogastric tube

3. Installing a large milk hose

4. Installing the cateter

5. Replacement of breathing tube

6. Treating decubitus wounds

7. Suction

8. Installing O2 equipment

9. Injection (IV,IM, IC,SC)

10. Installation of infusions and drugs

11. Preparation

12. Granting huknah/laxative

13. Personal hygiene

14. Exercises in the context of medical rehabilitation

15. Client transfer for the implementation of diagnostic checks

16. Health education

17. Terminal case counseling

18. Consultation/phone

19. Facilitation to referring doctors

20. Preparing food menus

21. Cleaning the Patient's Bed

22. Facilitate patient social activities

23. Facilitation of client facility repair.

Basic Competencies

1. Understand the basics of anatomy, physiology, body pathology

in general.

a. Explain anatomy, physiology, pathology as a general body

system

b. Explain the basic concepts of homeostasis, and

pathogenesis.

2. Carry out the administration of drugs to clients/patients

a. Explain how to administer medication to patients

b. Administer medication to patients according to the doctor's

prescription.

3. Understand the types of basic laboratory tests required by

clients/patients

a. Describe the basic types of laboratory tests required by the

client/patient

b. Explaining the preparation of the client/patient to be

examined in the laboratory

c. Deliver clients/patients for examination in the laboratory.

4. Demonstrate the ability to conduct therapeutic communication

a. Explaining the definition of therapeutic communication

b. Explain the functions, and benefits of therapeutic

communication

c. Carry out every nursing action using therapeutic

communication.

5. Showing the ability to take care of babies, toddlers, children,

and the elderly according to their developmental level.

a. Building human relationships

b. Optimizing therapeutic communication

c. Identifying basic human needs

d. Planning basic human needs

6. Demonstrate the ability to serve clients/patients with mild

illnesses

a. Building human relationships

b. Optimizing therapeutic communication

c. Identify the basic needs of clients/patients

d. Plan the basic needs of the client/patient

e. Carry out the basic needs of clients/patients

7. Documenting the results of implementing the needs of sick

patients/clients.

8. Implementing Safety, Occupational Health and Environment

Life (K3LH)

a. Describe occupational safety and health (K3)

b. Implementing OSH procedures

c. Applying environmental concepts

d. Apply first aid provisions to accidents

9. Understanding the health-sick continuum

a. Explaining the balance of the normal human body

b. Explaining the definition of healthy-sick

c. Explaining healthy and sick models

d. Explain the values that affect health

e. Explain Increased healthand Disease prevention

f. Explaining risk factors in human life

g. Explain the impact of illness on clients/patients and families.

10. Understand the basics of simple diseases that are common in

society

a. Explain the diseases of the simple integument system that are

common in society

b. Explain simple diseases of the gastrointestinal system that

are common in the community.

c. Explain diseases of the genitourinary system that are

common in the community

d. Explain simple respiratory system diseases that are common

in the community

e. Explain simple cardiovascular system diseases that are

common in the community

f. Explain simple nervous system diseases that are common in

society

g. Explain simple reproductive system diseases that are

common in society. 11. Understand health improvement and

key health services

h. Explain health improvement and disease prevention

measures

i. Explain key health care actions

j. Explain the role of nursing assistants in the delivery of

primary care.

11. Understanding medication administration

a. Explaining the nomenclature and form of oral medication

b. Explain the factors that affect the action of drugs

c. Explain the ability to administer oral medications.

12. Understanding interpersonal and mass abilities

a. Explain the different levels of communication

b. Explain the communication process

c. Explain the forms of communication

d. Explain the factors that affect communication

e. Discussing therapeutic communication

f. Explain the help in communicating.

13. Principles of human development

a. Explaining the theory of human growth and development

b. Explain phase growth andHuman development

c. Explaining conception

d. Explain the birth process.

14. Understanding the stages of human development

a. Explaining the development of infancy

b. Explaining the development of toddlerhood

c. Explain the development of school-age children

d. Explaining adolescent development

e. Explaining the progression of time

15. Young adults

a. Explaining adult development

b. Explain the development of old age.

16. Understand the attitude of nurse services according to the stages

of development

a. Explain the nurse's attitude towards the client/patient

according to the developmental stage.

b. Explain community health care services and orphanages.

17. Understanding about stress

a. Explain the concept of stress

b. Explaining adaptation to stress

c. Explaining the response to stress

d. Explain the nursing process and adaptation to stress.

18. Understanding basic human needs

a. Explain human physiological needs

b. Explain safety and security needs

c. Explaining the need for love and belonging

d. Explain the need for appreciation and self-esteem

e. Explain the need for self-actualization.

19. Understanding reproductive health

a. Explaining the concept of reproductive health

b. Explain the anatomy and physiology of the reproductive

organs

c. Explain issues related to reproductive health.

20. Understanding empathic behavior

a. Explain an empathetic attitude towards loss, death, grief

when performing e-treatment actions

b. Explain the assistance provided in accordance with the

religion, and the client's ritual needs.

21. Performing vital signs checks

a. Explain guidelines for measuring vital signs

b. Explaining body temperature measurement

c. Performing breath measurements

d. Performs pulse measurement.

22. Passive mobilization of clients/patients

a. Explain about mobilization and movement regulation

b. Explaining mobilization disruptions

c. Explaining mobilization exercises

d. Demonstrate the ability to perform passive and active

mobilization

e. Explain the disruption of mobilization.

23. Providing nutrition

a. Explaining balanced nutrition

b. Demonstrated the ability to provide oral feeding to

patients/clients.

24. Carry out documentation of nursing actions

a. Explain multidisciplinary communication in teams

b. Create documentation according to the guidelines.

25. Carrying out duties in accordance with nursing ethics, and legal

rules

a. Explain the importance of nursing ethics and law in carrying

out duties.

b. Conduct nursing assistant performance behavior in

accordance with nursing ethics and laws.

A. Nurse Professional Organization The nursing profession in

Indonesia is PPNI which is short for National Nurses

Association

Indonesia. PPNI was born on March 17, 1974 as a determination of

the same spirit triggered by nurse pioneers that nursing personnel

must be in the forum of the Indonesian nursing profession

organization. PPNI is committed to providing protection for the

community and the nursing profession by drafting a nursing law. In

its age, which is classified as a productive age, PPNI has grown to

become an independent organization.

The Indonesian National Nurses Association (PPNI) is a

professional organization that gathers nurses nationally and is a

legal entity in accordance with the provisions of laws and regulations

which has the purpose of improving the knowledge and skills of the

dignity and ethics of the nursing profession, as mandated in article

41 in Law No. 38 of 2014 concerning nursing.

B. Roles and Functions of Professional Organizations

The role of PPNI as a forum that gathers nurses nationally

encourages the birth of policies for the interests and welfare of

Indonesian nurses. The function of PPNI as a unifier, coach,

development and supervisor of nursing in Indonesia. and PPNI is

also mandated to function as a unifier, coach, developer and

supervisor of nursing in Indonesia. In order to achieve these goals

and in order to carry out these functions, one of them is that PPNI is

obliged to develop standards that includ

OCHAPTER 8

THE ROLE OF PROFESSIONAL ORGANIZATIONS

competency standards, nursing care standards, and professional

performance standards.

Some of the roles performed by nurse organizations

1. Fighting for various laws and regulations

Nursing professional organizations have championed various

supporting laws and regulations, and credential systems for

nursing.

2. Strengthening nursing professional service standards

Professional organizations to ensure the implementation of

nursing services in the country, set standards for nursing

professional services. Professional service standards regulate

input standards, environmental standards, process standards,

nursing service output standards, and the authority of nurses.

3. Develop mechanism Monitoring Nursing Services

Nursing professional organizations in an effort to monitor

nursing services have developed a monitoring mechanism and

also formed the Nursing Ethics Honorary Council (MKEK).

4. Strengthening the service fee system

Nursing professional organizations fight for a decent amount

of remuneration for nurses in accordance with the authority

and services provided

5. Improving the organization of the nursing profession

The active role of professional organizations in setting various

professional education and training standards, various

professional service standards, and various professional

service supervision mechanisms.

6. Nursing organization coaching

PPNI is tasked with fostering institutions, members, leadership

cadres, law, public relations and the preparation of nursing

policies. This role is carried out by determining the

qualifications of members, establishing legislation and codes of

ethics, and developing the career and welfare of members.

7. Nursing education and training

PPNI is tasked with improving the reach and quality of nursing

education and or training. In order to develop the

implementation of professional nursing care, nursing personnel

need to be prepared through the national higher education

system. The orientation of higher education is on science,

technology and society

8. Nursing service coaching

PPNI aims to increase the coverage and quality of nursing

services and ensure quality and accountable nursing services.

Here PPNI carries out the formulation of standards, registration

and licensing for professions.

9. Science and Technology Construction

The role of professional organizations (PPNI) is to develop

nursing research, nursing development, IT application

development, and publication of research results. This research

needs to be improved so that the theory and concepts in nursing

are more reliable, and the quality of nursing services is

increasing.

10. Member Welfare Development

PPNI is in charge of fostering the welfare of members and

fostering other business entities, fostering foundations and

nursing cooperatives

11. Investigate and recommend the resolution of problems related

to violations of the nursing profession code of ethics in

accordance with the articles of association and bylaws.

C. Competency standards

Nurse competency standards are a reflection of expectations for the

competencies possessed by individual nurses who will work in

nursing services. Nurse competency standards are equivalent to

standards that apply to the health industry sector and can be applied

internationally.

Competency standards aim

1. For Nursing Education and Training Institutions

a. Providing information and references for the development

and curriculum of nursing education

b. Providing information and reference for the development

and curriculum of nursing training

2. For the Business/Health Industry and Users

a. Determination of job descriptions for health workers

b. Recruitment of nurses

c. Performance Assessment

d. Development of specific training programs

3. For institutions that provide testing and certification of nurses

Reference in formulating certification program packages

according to qualifications and types.

Domain and Unit of Nurse Competence

Main Areas of Nurse Competence Nurse competencies are grouped

into 3 main areas, namely:

1. Professional, ethical, legal and culturally sensitive practices

a. Responsible for professional practices

b. Carry out nursing practice (ethically and culturally)

c. Carry out legal practice

2. Provision of nursing care and care management.

a. Apply the basic principles in the provision and management

of nursing care

b. Carry out health promotion efforts in nursing services

c. Conducting a nursing assessment

d. Developing a nursing plan

e. Carry out nursing actions as planned

f. Evaluating nursing care measures

g. Using therapeutic communication and interpersonal

relationships in the delivery of ministry

h. Creating and maintaining a safe environment

i. Using interprofessional relationships in nursing/health

services

j. Using delegation and supervision in nursing care services

3. Professional development

a. Carry out professional improvement in nursing practice

b. Improving the quality of nursing services and nursing care

c. Participating in continuing education as a form of

professional responsibility

D. Standard of Nursing Care

Standard 1 Data collection on the health status of clients/patients

is carried out systematically and continuously. Data

can be obtained, communicated and recorded

Standard 2 Nursing Diagnosis

Standard 3 Nursing care plans include objectives that are made

based on nursing diagnoses

Standard 4 The nursing care plan includes the priorities and

approaches of nursing action that are set to achieve the

goals that are compiled based on the nursing diagnosis

Standard 5 Nursing practices provide an opportunity for

clients/patients to participate in health improvement,

maintenance, and restoration

Standard 6 Nursing actions help clients/patients to optimize their

ability to live a healthy life

Standard 7 Whether or not there is progress in achieving the goals

is determined by the client/patient and the nurse

Standard 8 Whether or not there is progress in achieving the

objectives provides direction to conduct a review,

rearrange the order of priorities, set new goals and

improve the nursing care plan

Indonesian Nursing Diagnostic Standards (SDKI)

Standard nursing diagnostics are needed to control the

implementation of optimal nursing care for clients, families, and the

community. Nursing diagnosis is a clinical assessment of the

experience/response of an individual, family or community to a

health problem, to the risk of a health problem or to the course of

life. Nursing diagnosis is a vital part of determining appropriate

nursing care to help clients achieve optimal health.

The standard objectives of nursing diagnosis are as follows:

1. To be a guide or reference for nurses in enforcing nursing

diagnoses

2. Increasing nurses' autonomy in providing health services

3. Facilitate intraprofessional and interprofessional

communication with the use of uniform and standardized

terminology

4. Improving the quality of nursing care

Nursing diagnosis is divided into 2 types, namely negative

diagnosis and positive diagnosis. A negative diagnosis indicates that

the client is sick or at risk of becoming sick, so the enforcement of

this diagnosis will direct the provision of nursing interventions that

are curative, recovery and prevention. A negative diagnosis consists

of an actual diagnosis and a risk diagnosis. Actual diagnosis

describes the client's response to a health condition or life process

that causes the client to experience health problems. Major and

minor signs/symptoms can be found and validated in the client. Risk

Diagnosis describes the client's response to a health condition or life

process that puts the client at risk of developing health problems. No

major and minor signs/symptoms were found but had risk factors

for experiencing health problems. Health Promotion Diagnosis

describes the desire and motivation of the client to improve his or

her health condition to a better or optimal level.

The Indonesian Nursing Diagnosis Standard (SDKI), consists of 5

categories, namely

1. Categories Physiology

2. Psychological Categories

3. Categories Behavior

4. Categories Relational

5. Categories Environment

Categories Physiology

1. Subcategory Respiration

2. Circulation Subcategory

3. Subcategories of Nutrition and Fluids

4. Subcategory Elimination

5. Activity and Rest Subcategories

6. Subkategori Neurosensors

7. Subcategories of Reproduction and Sexuality

Subcategory Respiration Circulation Subcategory

D.0001 Ineffective airway

clearance

D.0007 Circulatory Disorders

Spontaneous

D.0002 Weaning Disorder

Ventilator

D.0008 Decrease in Bulk

Heart

D.0003 Exchange Disruption

Gas

D.0009 Peripheral perfusion

is ineffective

D.0004 Ventilation

Disturbances

Spontaneous

D.00010 Risk of Disruption

Spontaneous

Circulation

D.0005 Ineffective Breathing

Patterns

D.0006 Aspiration Risks D.00011 Downside Risk

Cardiac Drainage

Subcategories of Nutrition and

Fluids

D.00012 Risk of Bleeding

D.00018 Overweight D.00013 Risk of Ineffective

Gastointestinal

Perfusion

D.00019 Nutritional deficit

D.00020 Diarrhea D.00014 Risk of ineffective

myocardial perfusion

D.00021 Motility Dysfunction

Gastrointestinal

D.00015 Risk of ineffective

peripheral perfusion

D.00022 Hypervolemia D.00016 Risk of ineffective

renal perfusion

D.00023 Hypovolemia D.00017 Risk of ineffective

cerebral perfusion

D.00024 Ichterik Neonatus Subcategory Elimination

D.00025 Upgrade Readiness

Fluid balance

D.00040 Urinary elimination

disorder

D.00041 Fecal incontinence

D.00026 Upgrade Readiness

Nutrients

D.00042 Urinary incontinence

continues

D.00027 Up to quetidacstable

Blood Glucose

D.00043 Incontinence yourin

Excess

D.00044 Incontinence yourin

Functional

D.00028 Effective

Breastfeeding

D.00045 Incontinence yourin

Reflex

D.00029 Ineffective

breastfeeding

D.00046 Incontinence yourin

Stress

D.00030 Obesity D.00047 Incontinence yourin

Urgency

D.00031 Risk of overweight D.00048 Readiness

Increased

Urine elimination

D.00032 Risk of nutritional

differentiation

D.00033 Risk of

gastrointestinal

motility dysfunction

D.00049 Constipation

D.00050 Urine Retention

D.00034 Risiko Hippovolemia D.00051 Risk of Incontinence

Urinal Urgency

D.00035 Risk Icterik

Neonate

D.00052 Risk of Constipation

D.00036 Risk Icterik

Neonate

Subcategories of Activities and

Rest

D.00037 Risk

Fluid imbalance

D.00053 Infant behavioral

disorganization

D.00038 Risk

Imbalance

Electrolyte

D.00054 Mobility disorders

physical

D.00055 Sleep pattern

disorders

D.00039 Risk of Shock D.00056 Activity intolerance

D.00057 Fatigue

D.00058 Readiness for

increased sleep

D.00059 Risk of infant

behavioral

disorganization

D.00060 Risk of activity

intolerance

Psychological Categories

1. Subcategories of Pain and Comfort

2. Ego Integrity Subcategory

3. Growth and Development Subcategory

Subcategories of Pain and Comfort

D.00074 Taste Disorders

Comfortable

D.00077 Acute Pain

D.00075 Postpartum discomfort D.00078 Chronic Pain

D.00076 Nausea D.00079 Pain in Childbirth

Growth and Development Subcategory

D.00106 Growth and

development disorders

D.00108 Risk of growth

disorders

D.00107 Risk of developmental

disorders

Ego Integrity Subcategory

D.00080 Anxiety D.00093 Family coping

inabilityD.00081 Grieving

D.00082 Distress Spiritual D.00094 Defensive Coping

D.00083 Body Image Disorders D.00095 Community Coping

is ineffective

D.00084 Self-Identity Disorder D.00096 Coping is not

effective

D.00085 Perception Disorders

Sensors

D.00097 Decrease in family

coping

D.00086 Low Self-Esteem

Kronis

D.00098 Ineffective denial

D.00087 Situational low self-

esteem

D.00099 Health behaviors

tend to be at risk

D.00088 Hopelessness

D.00089 Readiness to improve

self-concept

D.00100 Risk of spiritual

distress

D.00101 Risk of chronic low

self-esteem

D.00090 Readiness to improve

family coping

D.00102 Situational low self-

esteem risk

D.00091 Readiness to improve

community coping

D.00103 Risk

Powerlessness

D.00104 Pasca trauma

syndrome

D.00092 Powerlessness D.00105 Waham

Categories Behavior

1. Subcategory Personal hygiene

2. Subcategory Extension and learning

Subcategory Personal hygiene

D.00109 Self-care deficit

Subcategory Extension and learning

D.00110 Community health

deficit

D.00114 Disobedience

D.00111 Knowledge deficit D.00115 Ineffective family

health management

D.00112 Upgrade Readiness

Management

Health

D.00116 Health management

ineffective

D.00113 Readiness to increase

knowledge

D.00117 Ineffective health

maintenance

Categories Relational

D.00118 Social interaction

disorder

D.00124 The strain of the role

of caregivers

D.00119 Verbal communication

disorders

D.00120 Disorders of family

processes

D.00125 Ineffective role

performance

D.00121 Social isolation D.00126 Role appearance of

parenthood

D.00122 Readiness to improve

parenthood

D.00127 Risk of attachment

disorders

D.00123 Readiness to improve

family processes

D.00128 The risk of the

parenting process is

not

effective

Categories Environment

D.00129 Disorders of

skin/tissue integrity

D.00136 Risk will yield

D.00130 Hyperthermia D.00137 Risk of injury to the

mother

D.00131 Hypothermia D.00138 Risk of injury to the

fetus

D.00132 Violent behavior D.00139 Risk of skin/tissue

integrity disorders

D.00133 Slowdown in

postoperative

recovery

D.00134 Allergy risk D.00140 Risiko hipotermia

D.00135 Risk of suicide D.00141 Risk of perioperative

hypothermia

Subcategory Security and protection

D.00142 Risk of infection D.00146 Risk of violent

behavior

D.00143 Risk of Falling D.00147 Risk of slowing down

postoperative

recovery

D.00144 Risk of Pressure Cuts

D.00145 Risk of Self-Mutilation D.00148 Risk of ineffective

thermoregulation

D.00149 Ineffective

thermoregulation

Indonesian Nursing Intervention Standards (SIKI)

SIKI is a benchmark used as a guide in the preparation of nursing

interventions in order to provide safe, effective and ethical nursing

care. This standard is a nursing commitment in providing protection

to the community as a nursing care client carried out by the nursing

profession. The nursing intervention standards in its preparation

have been adjusted and developed from the Indonesian nursing

practice standards issued by PPNI in 2009.

The Nursing Intervention Standard is one of the professional

standards needed in carrying out nursing practice in Indonesia.

Nursing intervention is any form of therapy carried out by nurses

based on clinical knowledge and assessment to achieve the

improvement, prevention and recovery of the health of individual,

family and community clients.

The nursing intervention standard includes comprehensive

nursing interventions that include at various levels of practice

(generalists and specialists), various categories (physiological and

psychological), various health efforts (curative, preventive and

promotive), different types of clients (individual, family, community),

types of intervention (independent and collaborative) as well as

complementary and alternative interventions.

Objectives of the Indonesian Nursing Intervention Standards

aim to:

1. To be a guide or reference for nurses in compiling nursing

interventions

2. Increasing nurses' autonomy in providing health services

3. Facilitate intraprofessional and interprofessional

communication with the use of uniform and standardized

nursing intervention terms

4. Improving the quality of care

The SIKI Classification System consists of 5 categories and 15

subcategories, namely

No. Category Subcategories

1. Physiological Respiration

Sirkulasi

Nutrients and fluids

Elimination

Activities and rest

Neurosensors

Reproduction and sexuality

2. Psikologis Pain and comfort

Ego Integrity

Growth and development

3. Behaviour Personal hygiene

Counseling and learning

4. Relational Social interaction

5. Milieu Security and Protection

Physiological

The category of nursing interventions aimed at supporting the

physical and regulatory regulation of homeostasis, consists of:

respiration, circulation, nutrition and fluids, elimination, activity and

rest, neurosensory and reproductive and sexuality.

1. Respiration, contains intervention groups that function to

restore respiratory and oxygenation functions.

2. Circulation, containing intervention groups that restore heart

and blood vessel function

3. Nutrition and fluids, containing intervention groups that

restore gastrointestinal function, metabolism, and regulation of

electrolyte fluids

4. Elimination, containing intervention groups that restore fecal

and urinary elimination function

5. Activity and rest, containing intervention groups that restore

musculoskeletal function, energy use and sleep rest

6. Neurosensory, contains intervention groups that function to

restore brain and nerve function

7. Reproduction and sexuality, containing intervention groups

involving reproductive function and sexuality

8. Drug management, containing intervention groups that

improve the precision and safety of pharmacological agent

administration

Psikologis

The category of nursing interventions aimed at supporting mental

function and processes, consists of: pain and comfort, ego integrity,

and growth and development.

1. Pain and safety, containing intervention groups that relieve

pain and improve comfort

2. Ego Integrity, contains intervention groups that restore one's

emotional well-being

3. Growth and development, containing intervention groups that

restore growth and development function.

Behaviour

A category of nursing interventions aimed at supporting behavioral

changes or healthy lifestyles. Consists of personal hygiene and

counseling and learning

1. Personal hygiene, containing intervention groups that promote

healthy behaviors and self-care

2. Counseling and development, including intervention groups

that increase knowledge and change healthy behaviors

Relational

The category of nursing interventions aimed at supporting

interpersonal relationships or social interactions, consists of: Social

interactions, containing intervention groups that restore

relationships between individuals and other individuals

Milieu

A category of nursing interventions aimed at supporting

environmental safety and lowering the risk of disruption and

lowering the risk of health impairment. It consists of: Safety and

protection, contains intervention groups that improve safety and

reduce the risk of injury due to threats from the internal and external

environment.

Nursing Intervention consists of components

1. Label

This component is the name of the nursing intervention which

is the keyword to obtain information related to the nursing

intervention. Nursing intervention labels consist of one or

more words that begin with a noun (nominal) instead of a verb

(verbal), which serves as a descriptor or explainer of nursing

intervention.

2. Definition

This component explains the meaning of the nursing

intervention label. The definition of a nursing intervention

label begins with a verb in the form of behavior carried out by

the nurse, not the patient's behavior.

3. Action

This component is a series of behaviors and activities carried

out by nurses to implement nursing interventions. Actions in

nursing interventions consist of observation, therapy,

education and collaboration.

Observational actions

This action is aimed at collecting and analyzing the patient's health

status. Actions generally use the words "check", "identification" or

"monitor". Avoid using the word "review", so as not to be confused

with nursing actions in the post-diagnosis stage

Therapeutic Action

Nursing actions that directly have the effect of restoring the patient's

health status or preventing the worsening of the patient's health

problems. This action generally uses the words "give", "do" and or

other words.

Educational actions

Actions aimed at improving the patient's ability to care for himself or

herself by helping the patient acquire new behaviors that can

overcome the problem. This generally uses the words "teach",

"encourage" or "train"

Collaborative Actions

Actions that require cooperation both with other nurses and with

other health professions. This action requires a combination of

knowledge, skills and skills from various health professions. This

action is only done if the nurse needs further treatment. This action

generally uses the words "collaboration", "refer", "consult".

Standard Operating Procedures (SPO)

Standard Operating Procedures (SPO) is one of the standards needed

in carrying out nursing practice in Indonesia. PPNI as a nursing

organization that is nationally responsible for improving the

professionalism of nurses and the quality of nursing care

implementation, it is considered necessary to issue a nursing SPO in

order to create uniformity in the process of implementing effective,

efficient and safe nursing procedures and ensure the convergence of

nursing services provided to the community.

Nursing procedures are a set of instructions or steps to

complete routine work processes carried out by nurses to achieve

the goal of meeting the needs and independence of patients/clients

in caring for themselves. Nursing procedures are carried out in order

to carry out nursing practices in the form of nursing care that must

be provided effectively, efficiently and safely.

The Standard Operational Procedure Guidelines (SPO) cover

nursing procedures in various branches of nursing disciplines such

as maternity, pediatric, medical, emergency, critical psychiatry,

gerontic, family, community, various levels of generalist and

specialist practice, various categories of basic needs of

biopsychosocial, cultural spirituality, various curative, preventive and

promotive health efforts and various types of individual, family and

community clients as well as procedures complementary and

alternative therapies.

Nursing operational standards aim to:

1. As a reference for carrying out effective, eupient, and safe

nursing procedures

2. As a reference in supervision, coaching and improving the

quality of nursing services

3. To protect the public from practices that are not in accordance

with standards

4. To protect the profession from unnatural public demands

E. Standard kinerja professional.

1. Quality assurance

2. Education

3. Performance appraisal

4. Equality

5. Ethics

6. Research

7. Resource utilization

F. Nursing Service Standards

Standard 1 The nursing division has a philosophy and structure

that ensures the provision of high-quality nursing care

and is a means to solve various problems of nursing

practice in all nursing care institutions/services

Standard 2 The Nursing Division is led by qualified executive

nurses and board members

Standard 3 The policies and practices of the nursing division

ensure equitable and continuous nursing services that

recognize religious, socio-cultural, and economic

differences among clients/patients in healthcare

institutions

Standard 4 The nursing division guarantees that the nursing

process is used to design and provide care to meet the

individual needs of the client/patient in a family

context.

Standard 5 The Division of Nursing creates an environment that

guarantees the effectiveness of nursing practice

Standard 6 The nursing division ensures the development of

various educational programs to support the

implementation of high-quality nursing care

Standard 7 The nursing division initiates, utilizes and participates

in reviews or various research projects for the

improvement of client/patient nursing care

Nursing Education Standards

Standard 1 Nursing education institutions are within higher

education institutions

Standard 2 Nursing education institutions have a philosophy that

reflects the mission of the parent institution and is

stated in the curriculum

Standard 3 Nursing education institutions are consistent with the

administrative structure of the parent institution and

clearly describe the lines of organizational

relationships, responsibilities and communication

Standard 4 The standards of human, financial and material

resources of nursing education institutions meet the

requirements in quality and quantity to facilitate the

educational process

Standard 5 The policies of nursing education institutions that

regulate the admission, selection and advancement of

students reflect the philosophy and standards of the

institution, guided by the rules that apply to a higher

education institution

Standard 6 The environment of nursing education institutions

ensures the implementation of the tridharma of higher

education, professional involvement and leadership

development of teaching staff and students, as well as

providing opportunities for the development of

students' talents and interests

Standard 7 Maintenance education Nursing using

Curriculum that Issued by the

authorized institution and developed in accordance

with the philosophy and mission of the educational

institution concerned

Standard 8 The goals and curriculum design of professional

nursing education reflect the philosophy of nursing

education and prepare for the development of special

attitudes and competencies for its graduates.

Standard 9 Nursing education institutions participate in systematic

internal and external evaluation programs

Standard

Graduates of professional nursing education carry out

professional responsibilities according to the level of

education

G. Continuing Education Standards

Standard 1 All organizations and administrations of the continuing

education organizing unit are consistent with the

philosophy of the purpose and objectives of the

organizing institution and in accordance with the

standards of nursing education, nursing practice and

continuing education issued by the national nursing

professional organization.

Standard 2 Qualified teaching leaders, resource persons, and

support staff are included in the achievement of the

goals of the continuing education organizing unit

Standard 3 Students participate in identifying their learning needs

and in planning continuing education to meet these

needs

Standard 4 The continuing education design for each program

consists of learning experiences that are planned,

organized and evaluated based on adult educational

principles

Standard 5 Material resources and facilities are adequate to

achieve the goals and carry out the functions of all

continuing education organizing units

Standard 7 Evaluation is an integral quality control process that is

continuous, systematic regarding the continuing

education organizing unit of each program

Evaluation includes measuring the impact on students

and where possible on health care organizations

A. Decision

CHAPTER 9

NURSING ETHICS DECISION

Ethical legal decision-making is a way of making decisions from a

problem that is adjusted to the validity of a decision-making

procedure either in general or in particular.

1. Basic Theory of Decision Making

a. Teleological Theories

b. Deontological Theory

2. Teleologi

Teleology is a doctrine that explains phenomena based on the results

produced.

Teleology is divided into:

a. Rule Utilitarianism

b. Act Utilitarianism

3. Deontology

Deontology is based on the principle of action or action, attention is

focused on the act of performing moral responsibility which can

determine whether something is right or wrong.

Decision-making is an action that involves various components

that must be carefully considered by nurses, especially those related

to problems

Basic Nursing Concepts

in the clinic setting. This is very closely related to the development of

increasingly complex nursing practices, the demand for health

service efficiency in the midst of an ever-changing situation, and the

development of the existing culture that makes the task of decision-

making more difficult. The impact of making the right decisions will

be paid a high price for both the individual who decides and the

institution in which the individual works.

In Sumijatun (2009), it is said that decision-making is always

associated with a problem or a difficulty, in the sense that the

decision and its application are expected to answer the problem or

resolve the conflict. Kepner and George's opinion on decision-making

is "A decision is always choice between various ways of getting a

particular thing done on end accomplished". Decision-making is a

series of activities to choose alternatives or possibilities.

Decision making in nursing is applied by building models from

several disciplines, including economics, philosophy, politics,

psychology, sociology, culture, health, and nursing science itself.

4. Critical Thinking

To be able to make the right decisions, nurses must be able to apply

critical thinking patterns. Marriner A-Tomey (1996) states that

critical thinking is elements that come from the basic dimension that

provide general logic for a reason why the activity is carried out.

These elements include the objectives, the center of the problem or

question that leads to the developing issue, the viewpoint or frame of

reference, the empirical dimension, the conceptual dimension,

assumptions, implications and consequences, and conclusions.

5. Critical Analysis

Critical analysis is an instrument used in critical thinking by

developing several questions about the issue at hand and its validity,

because these questions can help in analyzing the stages in decision-

making.

6. Logical and creative thinking

Hernacki M. and Bobbi D.P (2001) stated that logical and creative

thinking has advantages such as maximizing creative problem-

solving processes, allowing the right brain to work in challenging

situations, understanding the role of personal paradigms in creative

processes, learning how brainstorming can provide innovative

solutions to various problems, and finding success in "outcome

thinking".

7. Troubleshooting

Marriner A-Tomey (1996), in Sumijatun (2009) stated that the

thinking mechanism of the human brain has been conceptualized in

two sides, the right side is intuitive and conceptualwhich is used to

encourage creativity in thinking; while the left side is analysis and

networks.

Hernacki M. and Bobbi D.P (2001) stated that problem solving

is known to have 7 terms that are often used, namely vertical

thinking, lateral, critical, analytical, strategic, thinking about results,

and also creative thinking.

8. The Position of Ethics in Decision Making

Ethical decision-making is one of the processes of decision-making,

in which there is knowledge, position, and ethics. This process

includes problem solving, situations of problems and/or dilemmas

that can be achieved. So the decision-making process is the same

thing and is found in various problematic situations, thus the

situation is very dependent on the norms that society refers to such

as ethics, social interaction, and contextual situational.

9. Ethical Principles as a Guide to Decision Making

In Sumijatun (2009) it is said that nursing practice involves a

complex interaction between individual, social and political values,

as well as their relationship with a particular society. As a result,

nurses often experience situations that are contrary to their

conscience. Nevertheless, nurses will still maintain their obligations

as service providers that are more humane. In making decisions,

nurses will adhere to a rational mindset and moral responsibility by

establishing ethical principles and applicable laws.

10. Ethical Decision-Making Model

a. Kozier, dkk(1997)

1) Identify specific facts and situations

2) Applying the principles and theories of nursing ethics

3) Referring to the nursing code of ethics

4) Seeing and considering its suitability for clients

5) Refers to the values embraced

6) Consider other factors such as values, culture, expectations,

commitment, use of time, lack of experience, ignorance or

anxiety about the law, and loyalty to the public.

b. Potter and Perry (2005)

1) Showing good intentions, having the assumption that

everyone has good intentions to explain the problem at

hand.

2) Identifying all important people, assuming that everyone

involved in the decision-making process is important and

needs to be heard.

3) Gather relevant information, relevant information includes

data on client choices, family systems, medical diagnosis

and prognosis, social considerations, and environmental

support.

4) Identify ethical principles that are considered important

5) Proposing alternative actions

6) Perform a selected action

11. Indonesian Nurse Code of Ethics

Decision of the VI PPNI National Congress in Bandung, Number:

09/MUNAS-VI/PPNI/2000 concerning the Indonesian Code of

Nursing Ethics. That is:

a. Nurses and Clients

b. Nurses and Practices

c. Nurses and the Community

d. Nurses and Peers

e. Nurses and Professions

12. Ethical Principles

According to the Code for Nurses with Interpretive Statement (ANA,

1985), in Potter and Perry (1997) and also PPNI (2003) in Sumijatun

(2009), ethical principles include the following.

a. Respect Behaviour nurse that Respect client

and his family.

b. Autonomy is related to a person's right to regulate and make

their own decisions, although there are still various limitations.

c. Beneficence (Kemurahan Hati)

d. Non-malaficence This principle relates to the obligation of the

nurse not to cause loss or injury to her clients.

e. Veracity

f. Confidentiality

g. Fidelity

h. Justice (Keadilan)

13. Stages of Decision Making

a. Identify problems.

b. Collect problem data.

c. Identify all options/alternatives

d. Think about ethical issues continuously.

e. Making decisions

f. Taking action and reviewing decisions and results of action

evaluation.

14. Factors Influencing Ethical Decision Making In Nursing

Practice

a. Factors of religion and customs

b. Factor sosial

c. Science and Technology Factor

d. Factors of Legislation and Juridical Decisions

e. Funding or financial factor

f. Job factor or position of the client or nurse

g. Factor nursing code of ethics

B. Nursing Ethics

Nursing is one of the professions that provides care to individuals,

families, groups or communities both in sick and healthy conditions.

One of the indicators of the hospital's success is the performance of

nursing staff in providing good health services in accordance with

nursing service standards. The nursing profession in Indonesia has a

relatively large proportion, namely 40% of the number of health

workers in Indonesia, so that the good and bad performance of

nurses is one of the main indicators of the quality of nursing care in

hospitals or other health institutions (Saragih, 2011, p.1).

The nursing profession has a social contract with the

community, which means that the community trusts nurses as a

workforce to provide the needed health services. Nurses are always

faced with ethical situations or dilemmas in both research and

clinical practice.

Decision-making is an action that involves various components

that must be carefully considered by nurses, especially those related

to problems in the clinic order. This is very closely related to the

development of increasingly complex nursing practices, the demand

for efficient health services in the midst of an ever-changing

situation, and the development of the existing culture that makes the

task of decision-making more difficult. The impact of making the

right decisions will be paid a high price for both the individual who

decides and the institution in which the individual works. The main

goal of the nursing profession is to serve as a problem solver, which

is to solve the health problems of their patients using problem-

solving methods. Problem-solving methods are used as a framework

for nurses to make ethical decisions.

In Sumijatun (2009), it is said that decision-making is always

associated with a problem or a difficulty, in the sense that the

decision and its application are expected to answer the problem or

resolve the conflict. Kepner and George's opinion on decision-making

is "A decision is always choice between various ways of getting a

particular thing done on end accomplished". Decision-making is a

series of activities to choose alternatives or possibilities.

Ethical decisions are made based on an agreement between

the patient and the nurse. Therefore, a nurse must be able to

convince patients that ethical decisions are based on careful analysis

and consideration. An agreement between the patient, the patient,

and the nurse about the decision of action can be in the form of

informed consent so that there is strong evidence that the ethical

decision was taken based on mutual agreement. In every ethical

decision-making, the role of nurses is as counselors and advocates,

meaning that nurses must provide information about the conditions

and situations that occur, and involve patients and families in the

decision-making process.

As an advocate, it means that nurses protect patients' right to

receive beneficial and non-detrimental care.

In Sumijatun (2009) it is said that nursing practice involves a

complex interaction between individual, social and political values,

as well as their relationship with a particular society. As a result,

nurses often experience situations that are contrary to their

conscience. Even though they are emikian, nurses will still maintain

their obligations as health service providers which are certainly

more humane. In making decisions, nurses will adhere to a rational

mindset and moral responsibility by establishing ethical principles

and applicable laws.

In the process of ethical decision-making, several theories are

known that can be justified for an ethical decision, namely teleology

and deontology theories. Theology comes from the word telos which

means goal, in this case ethical decisions are based on the goals to be

achieved. What is the impact if an action is taken, whether it has a

good impact, an action is considered good if the action has a good

purpose. The second theory is the theory of deonyology, which is a

concept that focuses on morals and obligations. Deontology speaks of

what should be done. In the above case, from the perspective of

teleological theory, information related to the patient's disease does

not have to be notified considering the risk that the family fears

when the patient knows the disease, the patient will experience

depression or rejection.

Regardless of the purpose of the action, nurses are considered

not to carry out the obligations of a profession that must be subject

to the applicable code of ethics and regulations.

Broadly this theory has been developed into ethical principles.

The approach to problems in decision-making based on ethical

principles expressed by Nursalam (2008) which includes; Justice, the

principle of respecting autonomy, the principle of benefience and

non-malefiency, the principle of veracity, as well as the principle of

confidentiality and commitment (Fidelity) can be described as

follows;

1. The first principle is Justice, or justice. This means that nurses

are required to provide care according to the needs of patients.

The care provided must be in accordance with the standards of

nursing practice professionally and in accordance with

applicable law. If viewed from this perspective, the actions of

the nurses in the above case actually violated justice because

they acted outside their authority, not in accordance with the

applicable law.

2. The second principle is Autonomy which means respecting the

ability of individuals who have self-esteem and dignity, who are

able to decide for themselves matters related to themselves.

Autonomous is capable of regulating or determining itself.

Autonomy is rooted in respect for the individual.

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