MANAGING A PROFESSIONAL

NURSING CARE

By : Dr. Sri Mugianti, S.Kep. Ns.,M.Kep

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 INTRODUCTION
Nursing is a clinical practice discipline
Professional nurses want autonomy in their own
practice
They want to apply their nursing knowledge and
skill
They work together with other professional of
health
They use the body of nursing knowledge (theory)
to practice nursing
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 MANAJEMEN
ASUHAN KEPERAWATAN

Suatu Proses Keperawatan yg menggunakan konsep-

konsep manajemen di dalamnya seperti : perencanaan,
pengorganisasan, implementasi, pengendalian dan
evaluasi

Proses Keperawatan merupakan proses pemecahan

masalah yg menekankan pada pengambilan keputusan
ttg keterlibatan perawat yg dibutuhkan pasien

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 Cont’d
 Meningkatkan profesionalisme kerja
 Meningkatkan hubungan profesional P-K
yang memungkinkan terlaksananya asuhan
profesional keperawatan
 Implementasi standard asuhan keperawatan
(Standard of Nursing Care)

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Aspects in Professional Nursing
Practice
Use of nursing theory
Modalities of nursing practice (Nursing Care
Delivery System)
Ethical & Moral Concerns
Nurses Professional
Nurse’s roles
Professional accountability
Standard of Nursing Care (SAK)
Standard Operational Procedure (SOP)
Documentation & Supervision
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Tujuan Pengelolaan Bangsal
 Pencapaian tujuan Unit / Bangsal
 Perencanaan dan
pengorganisasian sumber-sumber
secara efektif dan efisien
terutama peralatan dan sumber
daya manusia (SDM)
 Melakukan pembagian tugas dan
pertanggungjawaban yang efektif
antara perorangan dan kelompok.
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 Tujuan (cont’d)
 Pengambilan keputusan secara
tepat
 Pengawasan kegiatan-kegiatan
unit / bangsal melalui supervisi.
 Evaluasi terhadap kegiatan unit /

bangsal dan melakukan

penyesuaian-penyesuaian yang
penting.
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 MPKP

 Adalah suatu sistem yang memungkinkan

perawat profesional mengatur pemberian
asuhan keperawatan termasuk lingkungan
yang dapat menopang pemberian asuhan
tersebut (Hoffart & Woods, 1996 dalam
Sitorus, 2006)

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 5 Komponen MPKP
(Hoffart & Woods, 1996 dalam Sitorus, 2006)

 Nilai-nilai Profesional
 Pendekatan manajemen
 Metode Pemberian asuhan Keperawatan
 Hubungan Profesional
 Sistem KOmpensasi dan Penghargaan

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 Nursing Care Delivery System

Adalah suatu pendekatan dalam pemberian

asuhan keperawatan secara efektif dan
efisien kepada sejumlah pasien
Functional Nursing
Team Nursing
Primary Nursing
Case Method
Case Management
Moduler
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 Functional Method
By the 1930s
Metode pemberian asuhan keperawatan yang
menekankan pada penyelesaian tugas dan prosedur
keperawatan.
Fungsi keperawatan ttt (mis : pemberian obat, injeksi,
rawat luka, ukur tanda vital, dll) ditugaskan pada satu
perawat pelaksana.
Pendistribusian tindakan / tugas tsb didasarkan pada
tingkat kemampuan masing-masing perawat
Satu org perawat bertugas utk semua pasien dg satu atau
lebih tugas yg dikuasainya.
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 Functional Method
Prioritas utama adalah pemenuhan kebutuhan
fisik pasien & kurang menekankan kebutuhan
pasien secara holistik shg askep terfragmentasi.
Tidak ada perawat yang mengetahui kondisi klien
secara komprehensif shg klien sering merasa
tidak puas dg pelayanan yg diberikan.
Klien sering mendapat jawaban yg tidak tepat thd
masalah yg dihadapinya.
Komunikasi antara perawat terbatas
Setiap Perawat Pelaksana (PP) bertanggung
jawab langsung kepada KR
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 Keuntungan & Kerugian
Keuntungan Kerugian
Efisieni waktu kerja Memilah2 askep (askep
(lebih singkat) terfragmentasi)
Efektif jika ruang rawat Orientasi pada tugas, bukan
kurang tenaga pada klien
keperawatan profesional Menurunkan tanggung jawab &
Promote worker tanggung gugat
autonomy Hubungan P – K sulit terbentuk
Perawat lbh terampil krn Pelayanan tdk profesional,
orientasi pd satu tindakan monoton & kurang tantangan.
langsung & selalu Patients don’t know who their
diulang-ulang nurse is.
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 Team Nursing Method
Design by Lambertson (1953)
Adalah bentuk sistem / metode penugasan dimana KR
membagi perawat pelaksana (PP) dlm kelompok (tim)
diketuai oleh perawat profesional (RNs) dengan anggota
tim : tenaga teknikal (LPNs = Licensed Practical Nurse)
& pembantu perawat (CAN = Certified Nursing
Assistants)
Tujuan : Memberikan keperawatan berpusat pada klien
Ketua tim melakukan pengkajian & menyusun rencana
kep. setiap pasien, & anggota tim bertanggung jwb
melaksanakan tindakan keperawatan sesuai rencana.
Kegiatan dilakukan secara bersama2 dlm kelompok shg
ketua tim sering melakukan pertemuan bersama anggota
tim (konferensi tim)Nursing
guna Caremembahas
Delivery System masalah2 dlm 14
pemberian askep. (MAKP)
 Keuntungan & Kerugian
Keuntungan Kerugian
Melibatkan semua anggota Dapat menimbulkan
tim dlm askep fragmentasi dalam askep
Setiap anggota tim bekerja Sulit menentukan wkt
saling komplementer konferensi karena
menjadi satu kesatuan anggota terbagi dlm shift
(comprehensive care) Ketua tim lebih
Meningkatkan komunikasi bertanggung jawab
antar perawat(building dibanding anggota tim
team spirit)
Promotes job satisfaction
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 Keuntungan & Kerugian

Keuntungan Kerugian
mengatasi konflik dg Ketua tim lebih
segera melalui konferensi mempunyai otoritas
askep berkualitas dibanding anggota tim
Dpt dipertanggung- Team Composition varies
Jawabkan krn dilaks from day to day, which can
secara komprehensif be confusing and
Biaya lebih murah disruptive)
Pasien memperoleh
bentuk pelayanan
profesional
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Team Nursing Model

Focus on two based concept

Leadership

Effective Communication

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 Primary Nursing
Develop by Manthey 1980
Adalah metode pemberian askep dimana perawat
profesional / Perawat Primer = PP (RNs)
bertanggung jawab & bertanggung gugat thd
askep pasien selama 24 jam/hari
Tugas utama PP / tg jwb : pengkajian – evaluasi
sejak klien MRS s.d pulang
Dibantu oleh perawat asosiet (PA) = other RNs or
LPNs, aides, technician.
Tujuan : memberikan askep yg konsisten &
komprehensive dg seorang perawat yg
bertanggung jawab penuh
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 Primary Nursing
There is continuing relationship between
professional nurse and the clients
Promotes both autonomy and accountability
because one nurse is responsible for all the
nursing care for the clients.
Primary Nurse (PN /PP) communicate
effectively with associate nurses on other
shift & with other unit (operating room,
ICU, etc)
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 Keuntungan & Kerugian

Keuntungan Kerugian
High client & family Nurses don’t know other
satisfaction clients
Promotes RN Stimulate stress response
responsibility & authority
Heavy responsibility,
Promote good relationship
Nurse – Client especially for new nurses
Cost effective Perawat pelaksana tidak
Promotes professionalism harus perawat profesional
Promotes job satisfaction
Continuing nursing Nursing
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 Case Method

Provide for one to one RN to client ratio

Provide constant care for a specified period
of time
Private duty : Intensive care and community
health nurses
This method similar to that of primary
nursing, except that relief nurses on other
shift are not associate RNs

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 Case Management Nursing
Begun in the late 1980s
Focus on entire episode of illness all setting
Setting : acute care setting and outpatient
services, within the wall case management
and beyond the wall case management (for
chronic ill or follow up client)
Incorporate manage care
Care is coordinated by a case manager
Second generation primary nursing
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Case Management Nursing (Cont.)
Critical path : Various analyses, inter shift
report, case consultation
Health care team meeting provide
Interdisciplinary approach to problem
solving
The case manager call the meeting to order,
state the goal, initiates discussion,
documents the plan, and sets time limits for
follow through.
Promotes Quality assurance
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 Keuntungan & Kerugian

Keuntungan Kerugian
Nurse has increase Requires additional
responsibility training
Promotes collaboration Requires nurses to be off
with other health unit for periods of time
professional
Cost effective Time consuming
Eases patient’s transition Modular Nursing
from hospital to
community service

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 Modular Nursing

Is a modification of team and primary nursing

Used when there are not enough RNs to
practice primary nursing.
Each RNs, assisted by paraprofessionals,
delivers as much care as possible to a group of
the clients.
The RNs plans the care, delivers as much of it
as possible, and directs the paraprofessional for
the more technical aspects of care
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 Modular Nursing

The RNs Role is : a coordinator and

informatory
Decrease of isolation & unrealistic expectation
often associates primary nursing.
More time maybe spent in direct care
It is less costly than primary nursing care

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 Five Professional Accountability
Inherent In The Role of
The Professional Nurse

Practice
Quality Improvement
Research
Education (Competency)
Management
(Porter O’Grady T, 1992 in Chitty, 1997,
p : 294)
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 Nurse’s Role
On The Health Care Team

Care Provider
Educator
Counselor
Manager
Researcher
Collaborator
Change Agent (Intrapreneur)
Entrepreneur
Patient Advocate
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Implementation of Professional
Nursing Care Model

Three Component

Staff Planning Nursing Care Delivery System

Documentation

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