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"Latar belakang. Prematuritas adalah salah satu kondisi yang menyebabkan gagalnya pemberian air susu ibu (ASI). Program peningkatan kualitas (quality improvement) seperti bundles care intervensi berbasis bukti telah terbukti dapat memberikan luaran yang lebih baik dan meningkatkan kesempatan pemberian ASI pada bayi prematur.Metode. Penelitian quasy experimental yang dilakukan di Unit Neonatal RSCM pada 51 subyek maternal dan bayi dengan usia gestasi <32 minggu selama periode Maret-Juni 2024. Intervensi bundles care dilakukan dengan menggunakan daftar tilik pemberian ASI prematur yang dikembangkan. Intervensi dilakukan sejak 24 jam pertama pasca-persalinan. Luaran intervensi dinilai dari rerata angka cakupan ASI prematur di Unit Neonatal RSCM sesudah intervensi dibandingkan dengan sebelum intervensi.Hasil penelitian. Cakupan pemberian ASI selama periode intervensi pada bayi <32 minggu yang lahir di RSCM di bulan April meningkat menjadi 74,69% dan 74,94% di bulan Mei dibandingkan dengan bulan Februari (40,55%) dan Maret (37,42%), p = 0,009. Rerata volume ASI dalam satu minggu pertama adalah 213,34 ± 61,13 ml, dengan waktu mencapai full feeding adalah 8 (5-32) hari pada bayi very preterm dan 11,5 (8-21) hari pada bayi extreme preterm. Faktor yang memengaruhi keberhasilan ASI adalah inisiasi perah dini dalam 24 jam pertama pasca-persalinan.Kesimpulan. Penerapan bundles care ASI melalui penggunaan daftar tilik pemberian ASI prematur dapat meningkatkan cakupan pemberian ASI bayi prematur di Unit Neonatal RSUPN Cipto Mangunkusumo. Penelitian ini merupakan penelitian pertama yang mengajukan penggunaan daftar tilik terstandard dalam bundles care pemberian ASI pada bayi prematur.

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Background. Prematurity is one of adverse conditions that causes failure to provide breast milk (BM). Quality improvement (QI) programs such as evidence-based intervention care bundles have been proven to provide better outcomes and increase opportunities for having mother’s breastmilk in premature babies.

Method. Quasy-experimental study that was conducted at the Cipto Mangunkusumo Hospital Neonatology Unit to 51 maternal and babies with gestational age below 32 weeks. We developed a breastmilk checklist for premature baby and care bundles intervention was implemented using that checklist since the first 24 hours after delivery. The rate of breast milk in Neonatology Unit after intervention was compared with the rate before intervention.

Result. Breastmilk rate during the intervention period for babies <32 weeks born at hospital increased to 74.69% and 74.94% respectively in April and May, compared with February (40.55%) and March (37.42%), p = 0.009. The average volume of breast milk in the first week was 213.34 ± 61.13 ml, with the time to reach full feeding being 8 (5-32) days in very preterm babies and 11.5 (8-21) days in extreme preterm babies.

Conclusion. The implementation of breast milk care bundles by using a breastmilk checklist for premature baby can increase the rate of breastmilk for premature babies in the Neonatal Unit of Cipto Mangunkusumo Hospital. This is the first study to propose the use of a standardized checklist in breastfeeding care bundle for premature babies."

"[ABSTRAKBayi prematur dapat mengalami hambatan kenaikan berat badan yang disebabkan oleh usia gestasi, penyakit penyerta, dan pengalaman nyeri atau stres. Hambatan kenaikan berat badan dapat diatasi dengan asuhan keperawatan yang tepat dalam pemenuhan kebutuhan nutrisi pada bayi prematur. Asuhan keperawatan dengan Model Konservasi Levine telah digunakan pada aplikasi praktik residensi di Ruang Neonatus Rumah Sakit Cipto Mangunkusumo dalam menganalisis kenaikan berat badan bayi prematur pada lima kasus terpilih mulai dari Bulan Maret-Mei tahun 2015. Analisis kasus didapatkan dari tahap pengkajian, tropikognosis, hipotesis, intervensi, dan evaluasi. Tropikognosis yang telah teridentifikasi yaitu risiko gangguan pemenuhan kebutuhan nutrisi. Intervensi telah dilakukan berdasarkan prinsip konservasi dan hasil evaluasinya yaitu bayi prematur mengalami kenaikan berat badan dengan konservasi energi. Kenaikan berat badan pada bayi prematur menunjukkan keberhasilan dari penerapan asuhan keperawatan berbasis Model Konservasi Levine.

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ABSTRACTThe preterm infant can has an obstacle of increasing weight which is caused by gestational age, health problems which followed and pain/ stress experience. The obstacle of increasing weight can be handled with giving nursing care in proper nutrition needs. Nursing care with Levine?s Conservation Model has been applied in residence practice application in neonates wards Cipto Mangunkusumo hospital to analyze increasing weight of preterm infant in five selected cases start from March until May 2015. Case analyze is founded from assessment, trophicognosis, hypothesis, intervention, and evaluation. Trophicognosis which identified was disturbance risk in fullfil nutrition needs. Intervention were done based on conservation principle and the result of evaluation that preterm infant has increasing weight with energy conservation. Increasing weight in preterm infant showed a successful application of nursing care based on Levine?s Conservation Model. ;The preterm infant can has an obstacle of increasing weight which is caused by gestational age, health problems which followed and pain/ stress experience. The obstacle of increasing weight can be handled with giving nursing care in proper nutrition needs. Nursing care with Levine?s Conservation Model has been applied in residence practice application in neonates wards Cipto Mangunkusumo hospital to analyze increasing weight of preterm infant in five selected cases start from March until May 2015. Case analyze is founded from assessment, trophicognosis, hypothesis, intervention, and evaluation. Trophicognosis which identified was disturbance risk in fullfil nutrition needs. Intervention were done based on conservation principle and the result of evaluation that preterm infant has increasing weight with energy conservation. Increasing weight in preterm infant showed a successful application of nursing care based on Levine?s Conservation Model. , The preterm infant can has an obstacle of increasing weight which is caused by gestational age, health problems which followed and pain/ stress experience. The obstacle of increasing weight can be handled with giving nursing care in proper nutrition needs. Nursing care with Levine’s Conservation Model has been applied in residence practice application in neonates wards Cipto Mangunkusumo hospital to analyze increasing weight of preterm infant in five selected cases start from March until May 2015. Case analyze is founded from assessment, trophicognosis, hypothesis, intervention, and evaluation. Trophicognosis which identified was disturbance risk in fullfil nutrition needs. Intervention were done based on conservation principle and the result of evaluation that preterm infant has increasing weight with energy conservation. Increasing weight in preterm infant showed a successful application of nursing care based on Levine’s Conservation Model. ]"

"Kesulitan menyusu merupakan masalah yang sering terjadi pada bayi prematur. Tujuan dari studi kasus ini adalah melakukan analisis optimalisasi pemenuhan kebutuhan nutrisi oral pada bayi prematur melalui edukasi perencanaan pulang pada orang tua dengan pendekatan Teori Konservasi Levine. Lima kasus terpilih menunjukkan terjadi masalah keperawatan defisit nutrisi dan menyusui tida efektif. Pendekatan Teori Konservasi Levine dilakukan dengan menggunakan prinsip konservasi energi, konservasi integritas struktural, konservasi integritas personal, dan konservasi integritas sosial. Hasil pemberian asuhan keperawatan menunjukkan bahwa pengetahuan dan keterampilan ibu menyusui bayi meningkat sehingga pemenuhan kebutuhan nutrisi bayi terpenuhi dan meningkatkan berat badan bayi melalui edukasi perencanaan pulang. Perawat dapat menjadikan intervensi tersebut sebagai standar prosedur operasional pada bayi prematur yang mengalami kesulitan menyusu.

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Having difficulty in breastfeeding is a common problem on premature infants. The purpose of this study is to analyze the optimization of the oral fulfillment of nutritional needs in premature infants through discharge planning education for the parents using Levine rsquo s Conservation Theory. Five chosen cases shows the occurrences of nutritional deficit nursing problems. Levine rsquo s Conversation Theory approach is done using energy conservation principle, structural integrity conservation, personal integrity conservation, and social integrity conservation.

The research result from the intervention of discharge planning education with Levine rsquo s Conservation Theory could improve the mothers rsquo knowledge and skills so that the fulfillment of nutritional needs of the infants fulfilled and also increasing the infants rsquo weight. Nurse could make the intervention as a standard procedure for premature infants who experienced breastfeeding difficulty."

"Bayi prematur sangat rentan mengalami gangguan integritas kulit berupa lukatekan terutama pada telinga. Tujuan penelitian ini adalah untuk mengetahuiefektivitas penggunaan bantal kacang untuk pencegahan luka tekan grade I padatelinga bayi prematur. Desain penelitian ini menggunakan “quasi experimentposttest only with control group”, yang melibatkan 30 bayi prematur di ruangperinatologi. Hasilnya menunjukkan tidak ada perbedaan yang bermakna proporsikejadian luka tekan grade I pada telinga bayi prematur pada kelompok intervensidan kelompok kontrol (p value=0,65, α=0,05). Rekomendasi dari penelitian iniadalahperawatan dengan bantal tetap bermanfaat namun perlu dilakukanoptimalisasi alih baring.

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Preterm baby was very vulnerable to get skin integrity breakdown as pressure

ulcer particularly on the ear. The purposed of this study was to identify the

effectiveness using peanut pillow to prevent pressure ulcer on ears of preterm

baby. The design of this study was “experiment posttest only with control group”,

involving 30 preterm baby in the neonatology unit. The result showed there was

no significant differences proportion of pressure ulcer in the intervention group

and control group (p value=0,65, α=0,05). This study recommended that using

peanut pillow give the advantages but it is needed to optimize changing position."

"Bayi prematur lahir dengan berbagai permasalahan kesehatan dan membutuhkan perawatan khusus yang dapat menyebabkan kecemasan dan stres orang tua. Kualitas asuhan keperawatan yang bermutu dengan menerapkan asuhan perkembangan dapat dinilai dengan kepuasan orang tua. Penelitian ini bertujuan mengetahui hubungan penerapan asuhan perkembangan yang dipersepsikan oleh perawat dengan kepuasan orang tua bayi prematur di ruang neonatus. Penelitian kuantitatif dengan desain cross sectional ini menggunakan sampel berjumlah 52 perawat dan 52 orang tua bayi prematur. Tehnik pengambilan sampel yang digunakan adalah consecutive sampling Data dikumpulkan menggunakan kuesioner dan dianalisis menggunakan pearson. Hasil analisis menunjukkan terdapat hubungan yang bermaksna antara penerapan asuhan perkembangan dengan kepuasan orang tua bayi prematur (p value <0,001, p<0,05). Penerapan asuhan perkembangan yang baik dapat meningkatkan kualitas perawatan terhadap bayi dan juga meningkatkan kepuasan orang tua. Asuhan perkembangan perlu diterapkan di ruang neonatus sebagai upaya meningkatkan asuhan keperawatan pada bayi dan kepuasan orang tua.

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Premature infants born with several of health problems and needs special care can cause anxiety and stress of parents. A qualified nursing care by implementing developmental care can be assessed through parent satisfaction of premature infants. This study aims to recognize the relationship of developmental care application perceived by nurse with parental satisfaction of premature infants in neonatus care unit. This quantitative study used cross sectional design. The sample included 52 neonatus nurses and 52 parents of premature infants used consecutive sampling method. Data were collected using a questioners and analyzed using Pearson.

The analysis results show that there is significant relationship between developmental care applications with parent satisfaction of premature infants (p value=<0,001, p<0,05). The application of developmental care in premature infants may improve the quality of care and increase parens satisfaction. Developmental care need to be implemented as an effort to improve nursing care of infants and parents satisfaction."

"Kelahiran bayi prematur dan perawatan di ruang rawat intensif neonatusmerupakan peristiwa yang menyebabkan sumber stres pada orang tua khususnyaibu. Penelitian ini bertujuan untuk mendapatkan pemahaman yang mendalammengenai pengalaman ibu selama perawatan masa awal kehidupan bayi prematurdi ruang rawat intensif neonatus RSUP Dr. Soeradji Tirtonegoro Klaten. Desain penelitian kualitatif dengan pendekatan fenomenologi ini pada delapan partisipan. Analisis data menggunakan metode Colaizzi dan menghasilkan tujuh tema penelitian, yaitu: reaksi ibu, proses berduka, dampak perawatan bayi prematur, koping diri ibu, upaya ibu untuk meningkatkan hubungan kelekatan (bonding attachment), dukungan terhadap ibu, dan harapan selama perawatan bayi prematur.

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The birth and treatment of premature infants in the neonatal intensive care unit is the event that makes it the source of stress to parents especially the mother. This study aims to gain a deeper understanding of the experience of mother during the early life of premature infants in the neonatal intensive care unit of Dr. Soeradji

Tirtonegoro Central Hospital, Klaten. This qualitative research design with phenomenology approach took eight participants. The data analysis uses Colaizzi method and produced seven research themes, namely: the mothers? reaction, the grieving process, the impact of premature infant care, mother?s self ?coping efforts, the mothers? attempts to improve the close and attached relationship (bonding attachment), the support for the mother, and expectations for the care of premature infants.

"

"ABSTRAKBaliMed Karangasem Bali dengan Pendekatan Lean Tahun 2018Proses pemulangan pasien rawat inap merupakan proses kompleks yang melibatkan banyak unit dalam pelaksanaannya. Pendekatan lean merupakan pendekatan terhadap proses yang menembus sekat antar unit dan dapat memberikan gambaran jelas pelaksanaan proses dari awal sampai akhir serta dapat memberikan pembenahan. Penelitian ini dilakukan untuk menganalisis proses pemulangan pasien rawat inap BPJS Kesehatan naik kelas perawatan di Rumah Sakit BaliMed Karangasem dengan pendekatan lean. Hasil penelitian kualitatif yang menggunakan metode pengumpulan data observasi, telaah dokumen dan wawancara mendalam ini mendapatkan lama proses pemulangan pasien BPJS Kesehatan naik kelas perawatan mencapai 192,9 menit dengan kegiatan value added sebesar 29,6 % dan non value added sebesar 70,4% dengan 15 kegiatan yang merupakan waste. Usulan perbaikan yang dilakukan dengan pendekatan lean mampu meningkatkan persentase kegiatan value added menjadi 70,2 % dan menekan kegiatan non value added menjadi 29,8% serta merampingkan kegiatan proses pemulangan dari 21 kegiatan menjadi 15 kegiatan.

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ABSTRACT

Karangasem Bali With Lean Approach in 2018

The discharge process of inpatients is a complex process that involves many units in its implementation. The lean approach is an approach to production processes that penetrate the boundaries between units and can provide a clear picture of the process from the beginning to the end and can provide improvements. This study was conducted to analyze the discharge process of inpatients BPJS Kesehatan upgrade class patients at BaliMed. Hospital Karangasem with a lean approach. The results of the qualitative research using observational data collection methods, document review and in-depth interviews received a long process of discharge process reaching 192.9 minutes with 29.6% value added activities and 70.4% non value added activity with 15 activities which are waste. The proposed improvements made with a lean approach were able to increase the percentage of value added activities to 70.2% and suppress non value added activities to 29.8% and streamline the return process activities from 21 activities to 15 activities."

"ABSTRAKRumah Sakit YPK Mandiri Menteng merupakan rumah sakit yang mengedepankanpelayanan kesehatan ibu dan anak sebagai pelayanan unggulannya. Kunjungan pasienantenatal care di usia kehamilan >36 minggu pada tahun 2016 di Poliklinikkebidanan dan kandungan Rumah Sakit YPK Mandiri cukup tinggi, namun angkapersalinan masih rendah dan belum pernah diteliti apa penyebabnya. Penelitian iniadalah jenis penelitianstudi kasus dengan pendekatan kualitatif.Pengumpulan datadilakukan melalui wawancara mendalam kepada pasien bersalin dan tidak bersalin diRumah Sakit YPK Mandiri serta informan yang merupakan triangulasi. Hasilpenelitian menunjukkan bahwa sebagian besar keputusan pasien memanfaatkanpelayanan persalinan adalah karena pengalaman dan dokter, sedangkan faktor yangberhubungan dengan keputusan pasien tidak memanfaatkan pelayanan persalinan diRumah Sakit YPK Mandiri adalah keberadaan keluarga, jarak, dan tarif persalinan.Bagian pemasaran perlu lebih mengoptimalkan media promosi yang sudah ada sepertiSMS, Banner, Flyer serta website rumah sakit terutama untuk mempromosikanpelayanan unggulan, memberikan infromasi terbaru dan lengkap terkait produk ataujasa layanan yang ditawarkan kepada pelanggan, serta menjalin kerjasama denganrekanan perusahaan atauHRD perusahaan yang berada disekitar wilayah Rumah SakitYPK melalui pemberian leaflet atau brosur guna memperluas jangkauan pemanfaatanpelayanan di rumah sakit.

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ABSTRACTYPK Mandiri Hospital Menteng is a hospital that prioritizes mother and child healthservices as its superior service. The visit of antenatal care patients at gestational age>36 weeks in 2016 in obstetric clinics and YPK Mandiri Hospital content is quite high,but the birth rate is still low and has not been studied what causes it. This research isa case study research with a qualitative approach. Data collection was conductedthrough in-depth interviews with maternity and unborn patients at YPK MandiriHospital and informants who were triangulated. The results showed that most of thepatient's decision to utilize delivery service was due to experience and doctors, whilefactors related to the decision of the patient did not utilize the delivery service at YPKMandiri Hospital were the existence of the family, distance, and delivery rates. Themarketing department needs to further optimize the existing promotional media suchas SMS, Banner, Flyer and hospital website, especially to promote superior services,provide the latest and complete information related to the products or services offeredto customers, and establish cooperation with corporate partners or corporate HRDWhich is located around the area of YPK Hospital through the provision of leaflets orbrochures to expand the reach of utilization of services in the hospital."

"Breastmilk is the best nutrition for infant but giving only breastmilk for preamature infants older than 2 weeks could not comply the needs and has to be fortified Human milk fortifier HMF is very recommended to fortify breastmilk In west Sumatera including DR M Djamil Hospital HMF was unreachable and expensive At certain hospital in Africa and several Hospital in United States they exclusively use fortified breastmilk with Post Discharge Formula PDF Objective To compare the weight gain among premature infants receiving fortified breastmilk with PDF and premature formula milk and also to observe the adverse event Methods A 4 weeks experimental study on premature infants gestational age ge 28 until 37 weeks who receive fortified breastmilk with PDF and some of them received premature formula milk acted as a control from March until December 2015 in DR M Djamil Hospital West Sumatera Results Data was obtained from 30 sample for each group intervention and control Sample baseline characteristic such as sex gestational age GA birth weight and previous illness history was indifferent statistically The mean of birth weight in control group was 1643 grams the mean of weight at the initial study was 1631 grams and the mean of birth weight at the end of study 4 weeks was 2573 grams The mean of birth weight in intervention group was 1682 grams the mean of weight at the initial study was 1722 grams and the mean of birth weight at the end of study 4 weeks was 2775 grams The mean of time to reach full feed condition initial study in control group was 14 days and 18 days in intervention group The mean of weight gain during 4 weeks was 958 grams in control group and 1053 grams in intervention group p 0 22 There was no adverse event found in infants received both breastmilk fortified with PDF and premature formula milk Conclusion It appears that weight gain of premature infants who receive breastmilk fortified with PDF is indifferent statistically compared with premature infants who receive formula milk There is no adverse event found in this study"

"Intoleransi minum merupakan masalah yang umum terjadi pada bayi prematur. Tujuan penulisan Karya Ilmiah Akhir ini adalah memberikan gambaran penerapan Model Konservasi Levine pada bayi prematur dengan intoleransi minum dan gambaran pelaksanaan Praktik Residensi Keperawatan Anak. Model Konservasi Levine berfokus pada peningkatan adaptasi melalui prinsip konservasi untuk mencapai integritas diri. Penerapan Model Konservasi Levine tertuang dalam lima kasus terpilih. Pada lima kasus terpilih tersebut ditemukan masalah gangguan pemenuhan kebutuhan nutrisi yang disebabkan oleh intoleransi minum. Adapun masalah keperawatan lainnya adalah bersihan jalan napas tidak efektif, gangguan pola napas, gangguan termoregulasi, risiko infeksi, risiko gangguan perkembangan dan gangguan proses keluarga. Masalah-masalah tersebut dapat memperberat intoleransi minum dan menghambat proses pemulihan pada bayi prematur. Asuhan keperawatan pada kasus terpilih diberikan oleh residen dengan melaksanakan perannya sebagai pemberi asuhan, pendidik, konsultan, koordinator, pengambil keputusan etik, legal, dan sebagai peneliti.

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Feeding intolerance is a common problem in premature infants. The purpose of this Final Scientific Work is to describe the application of Levine Conservation Model in preterm infants with feeding intolerance and the implementation of Pediatric Nursing Residency Practice. Levine Conservation Model focuses on the adaptation improvement through conservation principles to achieve wholeness. Levine Conservation Model was implemented in five selected cases. In the five selected cases, there was a nutritional intake problem caused by feeding intolerance. The other problems were ineffective airway clearance, ineffective breathing pattern, ineffective thermoregulation, risk for infection, risk for developmental disorder and altered family process. These problems can aggravate the feeding intolerance and inhibit the healing process of premature infants. The nursing care to selected cases was given by the resident by implementing the roles as a caregiver, an educator, a consultant, a coordinator, an ethical and legal decision maker, and a researcher."