Format Analisa Tindakan Keperawatan

Nama :........................................................................
NIM :........................................................................
Jenis Tindakan :........................................................................

1. Identitas pasien
Nama :........................................................................
Umur :........................................................................
Jenis Kelamin :........................................................................
Pekerjaan :........................................................................
Agama :........................................................................
Tanggal masuk :........................................................................
Alasan masuk :........................................................................
Dx Medis :........................................................................

2. Tahap Persiapan
Persiapan pasien :.....................................................................................
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Persiapan :.....................................................................................
lingkungan ......................................................................................
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Persiapan Alat :.....................................................................................
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3. Tahap Pelaksanaan
No Pelaksanaan
4. Tahap Akhir

Terminasi :.........................................................................................
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Evaluasi :.........................................................................................
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Dokumentasi :.........................................................................................
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5. Analisa Materi Tindakan

Pengertian Tindakan :..............................................................................
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Tujuan Tindakan :..............................................................................
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6. Evaluasi Hasil Tindakan

Hasil Tindakan :.......................................................................................
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7. Evaluasi Diri
Evaluasi Diri :.......................................................................................
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Singaraja,..........................2022
Mahasiswa,

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