Prof. Dr.

Budi Anna Keliat, SKp, MAppSc

Dosen Fakultas Ilmu Keperawatan Universitas Indonesia
Hp. 08128100821; E_mail: budianna_keliat@yahoo.com;
www.budiannakeliat.com
Sumber:http://mercidieu3.blogspot.com/2012/05/quo-vadis-apa-arti-hidup-anda.html
 Leader
Tomorrow
Novice
Today
 N5-
Expert PK.5 PM.4 PP.3 PR.2
N4-
Proficien
t PK.4 PM.3 PP.2 PR.1
N3-
Competent
PK.3 PM.2 PP.1
N2-Advance
Beginner
PK.2 PM.1
MAKE
N1-Beginner/
Novice PK.1
YOUR
N 0-Fresh Graduated
DREAM

PK = PERAWAT KLINIK PP = PERAWAT PENDIDIK

PM = PERAWAT MANAJER PR = PERAWAT RISET
“ Yours professional self – image is
determined by the thoughts you
think on an ongoing basis”

“ Gambaran diri profesional

saudara ditentukan oleh apa yang
saudara pikirkan saat ini”
 • Related to the person’s thoughts
(hub dg apa yg dipikirkan)
85%

•Based on aptitude (bakat)

15 %
 POSITIVE •Positive thinkers
SELF-IMAGE (optimist)

NEGATIVE •Negative thinkers

SELF-IMAGE (pessimist)
 SETTING GOAL
(tetapkan tujuan)

Professional Self Responsibility

SELF
– Assessment for Yourself
(lakukan asesmen diri)
IMAGE (tg jawab diri)

A Professional Career Goal

(Tujuan karier profesional)
 WRITING
(tuliskan)

DAY
VERBALIZING
DREAMING
(ucapkan)
(mimpikan)

VISUALIZING AFFIRMATIONS
(visualisasikan) (afirmasikan)
 Hard worker
(pekerja keras)

Follow rule and

Self discipline
regulations
(disiplin diri)
(mengikuti regulasi dan aturan)

Respect for
authority
(menghargai otoritas)
 A goal is a • written down (tuliskan)
measurable, • mentally committed to
concrete objective (komitmen)

• You have the mental,

Enters your emotional and physical
conscious mind capability to accomplish
any idea on concept
◦ Knowledge (pengetahuan)
◦ Professional Practice (praktik)
◦ Physical & Personal Appearance
(penampilan)
◦ Compensation (kompensasi)
◦ Professional contributor (kontribusi
profesi)
◦ Professional communication
(komunikasi profesi)
◦ Self continue (pengembangan terus menerus)
 1. Let Go of the Past
(biarkan yg lalu berlalu)

4. Dream the 2. Remember

Big Dream 1-4 Success
(ingat sukses anda)
(mimpi besar)

3. Realize the
Possibilities
(sadar ada kesempatan)
 5. Thinking Your
Way to Change
(pikirkan mengubah cara anda)

6. A Daily
8. A Team
Sport 5-8 Habit to Begin
Today
(tim pendukung)
(mulai sekatang)

7. Mix It Up
(gabungkan)
 9. Get Excited About
What's to Come
(semangat menunggu hasil)

12. Write in a 10. Raise Your

Journal (tuliskan 9-12 Standards
pengalaman anda) (tingkatkan standar anda)

11. Take Ownership

(bertanggung jawab)
 13. Whom Do You
Admire? (siapa idola anda)

17. Keep a Notebook

in Goal-Creating
Areas
13- 14. The Moment
(ini saatnya)
16.What don't 17
you want? (apa yg
anda tdk suka)

15. A Friendly Brainstorming

Session (curah pendapat dg tim)
 HASIL
MOTIVASI
KINERJA
Be Motivated
TO BE
Profesional

1/2/2018 19
 Dr. Budi Anna Keliat, SKp, MAppSc
E_mail: budianna_keliat@yahoo.com; Hp: 08128100821
Disampaikan pada PELATIHAN MANAJEMEN KAMAR BEDAH,
24 – 27 November 2011, JAKARTA
 Prof. Dr. Budi Anna Keliat, SKp, MAppSc
E_mail: budianna_keliat@yahoo.com; Hp: 08128100821
Disampaikan pada PELATIHAN MANAJEMEN KAMAR BEDAH,
24 – 27 Mei 2012, JAKARTA
 Prof. Dr. Budi Anna Keliat, SKp, MAppSc
E_mail: budianna_keliat@yahoo.com; Hp: 08128100821
Disampaikan pada PELATIHAN MANAJEMEN KAMAR BEDAH,
18 APRIL 2012, JAKARTA
 Prof. Dr. Budi Anna Keliat, SKp, MAppSc
E_mail: budianna_keliat@yahoo.com; Hp: 08128100821
Disampaikan pada PELATIHAN MANAJEMEN KAMAR BEDAH,
7 September 2013, JAKARTA
 Mutu : - berkualitas
- efektif Provider
- efisien

 Memuaskan : - kebutuhan Pelanggan

- keinginan (customer)

“ BERI LEBIH DARI YANG

DIHARAPKAN PELANGGAN “
 COMPANY
( Management )

Internal Marketing External Marketing

( enabling the promise) ( setting the promise )

EMPLOYEES Interactive Marketing CUSTOMERS

( delivering the promise )
 Service
Organization

Efficiency Efficiency
versus versus
autonomy satisfaction

Contact
Customer
Personnel Perceived
control
 Information &
Operating room Decision support Intensive
Monitoring Care unit
Imaging Monitoring
Treatment

Diagnostics
Step down
Diagnostics
facility
Imaging
Monitoring

Follow Up
Pre-Hospital/
Home
Ambulance
Monitoring
Monitoring
 Hand Over Hand Over

1. Pulang ke
IGD / URI
Rumah
URJ
Ruangan - Ruangan 2. Rujuk YanKes

Hand Over
 STANDAR ASESMEN
KELUHAN UTAMA/ALASAN MASUK DIAGNOSIS

ASKEP/ASMED & PENDIDKAN KES

PASIEN KELUARGA

KOLABORASI
DOKTER/PERAWAT TIM KES LAIN: AHLI GIZI, FARMASI DLL
 Pemberi Asuhan Keperawatan;
 Penyuluh dan konselor bagi Klien;
 Pengelola Pelayanan Keperawatan;
 Peneliti Keperawatan;
 Pelaksana tugas berdasarkan pelimpahan
wewenang; dan/atau
 Pelaksana tugas dalam keadaan
keterbatasan tertentu.

 Semua dapat dilakukan oleh perawat profesi

 Untuk vakasi perlu dianalisis
 Melakukan pengkajian Keperawatan secara holistik
 Menetapkan diagnosis Keperawatan
 Merencanakan tindakan Keperawatan
 Melaksanakan tindakan Keperawatan
 Mengevaluasi hasil tindakan Keperawatan
 Melakukan rujukan
 Memberikan tindakan pada keadaan gawat darurat
sesuai dengan kompetensi
 Memberikan konsultasi Keperawatan dan
berkolaborasi dengan dokter
 Melakukan penyuluhan kesehatan dan konseling
 Melakukan penatalaksanaan pemberian obat kepada
Klien sesuai dengan resep tenaga medis atau obat
bebas dan obat bebas terbatas
 KAMAR RUANG RAWAT
PRA OPERASI RR/INTENSIF
OPERASI INTERMEDIATE
1. ………… 1. ………….
1………….. 1. ……………
(1 kali visit di 2……………
2. ………… 2. …………..
ruang rawat) (…..x Visit)
(Full Time) (1 kali visit)
 WRONG TREATMENT
 DELAY IN MEDICAL DIAGNOSIS
 LIFE-THREATENING ADVERCE EVENT
 PATIENT COMPLAINTS
 INCREASES HEALTH CARE EXPENDITURE
 INCREASED HOSPITAL LENGTH OF STAY
1
•FACE TO FACE

2
•TWO WAY COMMUNICATION

• VERBAL AND WRITTEN COMMUNICATION

3

• GIVE AS MUCH AS TIME NECESSARY

4
  Planned surgical  Antibiotics to be
Procedure given
 Universal Protocol  Significant medical
 Planned anesthesia history
type  Family contact
information
 Allergies
 Equipment needs
 Last voided
 Other issues (e.g.,
 Preop medications NPO, blood products available)

Courtesy of Tripler Army Medical Center. Adapted from OR Manager, April 2006.
 OR OR
• Procedure  Irrigation
• Surgeon Plan and  Medications
Preferences (where we  Instrumentation
are in the case) on and off field
• Anesthesia type  Specimens on
and off field
• Allergies
 Equipment needs
• Significant Medical  Tubes, Lines,
History Hoses
• Counts
Courtesy of Tripler Army Medical Center. Adapted from OR Manager, April 2006.
 OR Team PACU
 Surgical procedure  Significant medical
(completed vs. planned)
history (e.g., contact
 Anesthesia type precautions)

 Estimated Blood Loss  Family contact

 Input & Output information?
(e.g., straight catheter, foley)  Equipment needs
 Allergies (e.g., sequential compression
devices)
 Medications  Other issues (e.g., blood
(received intra-op) products, anesthesia concerns)

Courtesy of Tripler Army Medical Center. Adapted from OR Manager, April 2006.
 Rekomendasi dari:
AORN (ASSOCIATION OF PERIOPERATIVE RN)

 I-SBAR
I PASS THE BATON
 FIVE-Ps
 PACE
I •Introduction
S •Situation

B •Background

A •Assessment

R •Recommendation
 State your name and unit
 I am calling about
(patient name)

41
•Patient age
• Gender
• Pre-op diagnosis
• Procedure
• Mental status
pre-procedure
• Patient stable/unstable

42
• Pertinent medical history
• Allergies
• Sensory Impairment
• Family location
• Religion/culture
• Interpreter required
• Valuables deposition
43
• Meds given
• Blood given – units available
• Skin integrity
• Musculoskeletal restrictions
• Tubes/drains/catheters
• Dressings/cast/splints
• Counts correct
• Other – lab/path pending
44
•Vitals
• Isolation required
• Skin
• Risk factors
• Issues I am concerned
about

45
• Specific care required
immediately or soon
• Priority areas
⁻ Pain control
⁻ IV pump
⁻ Family communication

46
47
I - Introduction: Introduce yourself
P - Patient: Name: identifiers, age, sex location
A - Assessment: “The problem” procedure etc.
so far in the process
S - Situation: Current status/Circumstances,
uncertainty, recent changes
S - Safety concerns: Critical lab values/reports;
threats, pitfalls and alerts

48
B - background: Co-morbidities,
previous episodes, current meds, family
A - actions: What are the actions to be taken
and brief rational
T - Timing: Level of urgency, explicit timing,
prioritization of actions
O - Ownership: Who is responsible
(person/team) including patient/family
N - Next: What happens next? Anticipated
changes? Contingencies

49
 Ensures proper information is passed during patient
transfers or provider shifts change.
 Use the 5 Ps:
◦ Patient
◦ Plan
◦ Purpose
◦ Problems
◦ Precautions
 After instituting guidelines with the behavior-based
expectations, Sentara Health experienced a
21% increase in effective handoffs.

Gary Yates, Sentara Healthcare. Panel 1—Promising Quality Improvement Initiatives: Reports From the Field. AHRQ Summit—Improving Health Care
Quality for All Americans: Celebrating Success, Measuring Progress, Moving Forward ; 2004.
50
P
•PATIENT / PROBLEM

A
•ASSESSMENT / ACTION

C
•CONTINUING / CHANGE

E
•EVALUATION
P •PATIENT
P •PLAN
P •PURPOSE
P •PROBLEM
p
•PRECAUTION
Ps • PHYSICIAN (ASSIGNT TO COORDINATE)
 I: Selamat siang saya perawat Budi yang
merawat pasien Sofyan. Saya ingin
menyampaikan kondisi Ps Sofyan
 S: Sofyan panasnya tinggi, tindakan kep
sudah dilakukan: pakaian dan selimut
tipis, minum banyak dan kompres air
hangat
 B: Dia masuk tadi pagi dan sudah dua hari
panas di rumah
 A: asesmen yang sudah dilakukan: Sh: 39,
N: 84, R: 22, T: 130/70
 R: Dok, sepertinya Sofyan memerlukan
obat penurun panas
1/2/2018 53
 T : Tulis instruksi yang diberikan

 Ba : Baca ulang instruksi yang telah ditulis

dan jika perlu di- spelling

 K : Konfirmasi kembali
 T : Baik, saya tulis parasetamol 3 kali 500 mg

 Ba : Saya baca ulang ya dok, parasetamol 3

kali 500 mg ( spelling / eja )

 K : Sekali lagi saya konfirmasi ulang:

parasetamol 3 kali 500 mg untuk pasien
Sofyan yang suhunya 39 C
1. Reliability
dependable over time
2. Responsiveness
keeping customers waiting
3. Assurance
reputation, credentials, confidence, track
record
4. Empathy
being a good listener, putting yourself in
their place
5. Tangibles
cleanliness, physical appearance
 Customer Customer Satisfaction Customer
GAP 5
Perceptions Expectations

Managing the Customer / Understanding

Evidence Marketing Research the Customer
Communication
GAP 4 GAP 1
Management
Service
Perceptions
Delivery of Customer
Expectations
Conformance
Design GAP 2
GAP 3
Conformance Service Design
Service
Standards
 Word of Personal Past
mouth needs experience

Service Quality Expected

Dimensions service Service Quality Assessment
Reliability 1. Expectations exceeded
Responsiveness
Assurance Perceived ES<PS (Quality surprise)
Empathy service 2. Expectations met
Tangibles ES~PS (Satisfactory quality)
3. Expectations not met
ES>PS (Unacceptable quality)
CARE FOR CUSTOMERS

1/2/2018 71