CONCEPT OF

MEDICAL SURGICAL NURSING

Dr. Ns. Yunie Armiyati, M.Kep, Sp.KMB

Adult Nursing Department - Unimus
DEFINITION

Medical Surgical Nursing is a professional service based

on the science and techniques of Medical Surgical
Nursing in the form of bio-psycho-socioculturalspiritual
services to adult clients to fullfilment basic human needs
in the form of increasing the abilities that exist in
individuals, preventing, correcting (promoting), and
rehabilitating from an individual's illness.
DEFINITON OF MEDICAL SURGICAL NURSING
CONSIST OF 4 COMPONENTS
• Professional services
Medical Surgical Nursing is a professional service based on the science and techniques of
Medical Surgical Nursing in the form of bio-psycho-socioculturalspiritual services to adult
clients to fullfilment basic human needs in the form of increasing the abilities that exist in
individuals, preventing, correcting (promoting), and rehabilitating from an individual's illness
• Based on the science
 Nurses take formal education before work.
 Provide nursing care based on the latest / updates nursing science
• Using scientific methode
 Carry out nursing care through the stages in the nursing process based on a scientific
approach.
 Using standardized nursing care (NANDA / SDKI, NIC / SIKI, NOC / SLKI).
• Based on nursing ethic
Nurses in carrying out their duties are required to be able to apply existing nursing ethical
principles, including the principles of Autonomy (respect patient rights/patient freedom),
Beneficience (beneficial to patients), Veracity (honesty), Justice (fairness)
MEDICAL SURGICAL NURSING
• Medical Surgical Nursing  nursing scientific group focuses
on the concepts and principles of medical surgical nursing 
medical nursing (non-surgical) and surgical nursing.
• Medical Surgical Nursing  discusses the application of
nursing science and technology in fulfillment the basic needs
of adult clients who experience physiological changes with or
without structural disorders.
SCOPE OF MEDICAL SURGICAL NURSING
RESPIRATORY
CARDIO
INTEGUMENT VASKULER

IMUNE HEMATOLOGY

ENDOKRIN
NCP DIGESTIVE

SENSORY URINARY
PERCEPTI
ON
MUSCULO NEURO
 MEDICAL SURGICAL NURSING
• Medical surgical nursing  nursing practice uses scientific
steps  assessment, diagnose, planning, implementation
and evaluation steps taking who consider the
interrelationships of the client's bio-psycho-sociocultural-
spiritual components in response to physiological
disturbances as a result of illness, trauma or disability.
• Medical surgical nursing also focuses on research activities in
the context of developing medical-surgical nursing science.
• Identify health problems analyze, synthesize relevant
information from various sources and pay attention to cross-
cultural perspectives.
MEDICAL SURGICAL NURSING GOAL
• Achieving the integrity of optimal body system function
َ ِ‫ ﺑـ َ َﺭﺃ َ ِﺑﺈِ ْﺫ ِﻥ ﷲ‬،‫ﺎﺏ ﺍﻟﺩ َﱠﻭﺍ ُء ﺍﻟﺩﱠﺍ َء‬
‫ﻋ ﱠﺯ َﻭ َﺟ ﱠﻝ‬ َ ‫ﺻ‬َ َ ‫ ﻓَﺈِﺫَﺍ ﺃ‬،‫ﻋﻥ ﺟﺎﺑﺭ ﺑﻥ ﻋﺑﺩ ﷲ ِﻟ ُﻛ ِّﻝ َﺩﺍءٍ َﺩ َﻭﺍ ٌء‬

“Every disease must have a cure. If a medicine matches his illness then He
will recover with permission from Allah Subhanahu wa Ta’ala.” (HR.
Muslim)
• Fullfilment basic needs
• Increase quality of life
• Help increase productivity
• Helping in the face of death
 MEDICAL SURGICAL NURSING SCOPE OF WORK

• The scope of nursing work  basic human needs,

deviations and interventions.
• The scope of work of medical surgical nursing  overcome
the disruption of the fulfillment of basic human needs that
occur due to physiological changes in one or various body
systems  with all modalities and handling efforts to
overcome
SCOPE OF MEDICAL SURGICAL NCP

• Maintain and restore normal patterns of various body functions,

• Treatment of individuals for comfort,
• Helping individuals improve and maintain their health,
• Prevention, detection and treatment of disease-related conditions,
• Provide and increase knowledge,
• Improve self-care skills,
• Improve ability in decision making,
• Strive for recovery until the client can reach its highest productive
capacity,
• Helping clients face death with dignity.
 FACE DEATH HAPPILY

.ُ‫ﻋ ْﺑﺩِﻱ ِﻟﻘَﺎ ِﺋﻲ ﺃ َ ْﺣﺑَ ْﺑﺕُ ِﻟﻘَﺎ َءﻩُ َﻭ ِﺇﺫَﺍ َﻛ ِﺭﻩَ ِﻟﻘَﺎ ِﺋﻲ َﻛ ِﺭ ْﻫﺕُ ِﻟﻘَﺎ َءﻩ‬ ‫ِﺇﺫَﺍ ﺃ َ َﺣ ﱠ‬
َ ‫ﺏ‬
“Bila hamba-Ku senang bertemu dengan Aku, maka Aku juga senang
bertemu dengannya. Bila hamba-Ku tidak senang bertemu dengan Aku,
maka Aku pun tidak senang bertemu dengannya.” [HR. Malik, Ahmad,
Bukhari dan Nasa’i]

Nurses of Medical surgical nursing

 help clients face death with dignity, accept the end
of life with a calm heart
ROLE OF MEDICAL SURGICAL NURSING NURSE

Care provider
Advocate
01

Educator 02 Collaborator

03 04
Reformer
Consultant
05 06
ROLE OF MEDICAL SURGIAL NURSING (1)

• Care provider
 Main role of nurse
 Role in providing nursing care with a problem-solving approach in accordance
with nursing methods and processes.

• Advocate
• Advocate for the best needs of the patient and to maintain the dignity of the
patient during care and treatment
• Helping patients making right decision
• The role of defending and protecting patients' rights which include the right to
the best possible care, the right to information about their illness, the right to
privacy, the right to self-determination and the right to receive compensation for
negligence.
ROLE OF MEDICAL SURGIAL NURSING (2)

• Educator
 Nurses are responsible for ensuring that patients understand their health, illness,
treatment, and care to the best of their ability.
 This role is performed for:
Increase the level of health knowledge and the ability of clients to cope with
their health,
Provide information and promote changes in client behavior,
• Colaborator
 Nurses work through a health team consisting of physiotherapists, nutritionists, and
others by trying to identify the nursing services needed, including discussions or
exchange of opinions in determining the form of further services.
 The role as the coordinator is carried out by directing, planning and organizing
health services from the health team so that the provision of health services can be
directed and in accordance with client needs
ROLE OF MEDICAL SURGIAL NURSING (3)

• Consultant
 As a place for consultation on problems or appropriate nursing actions to be
given.
 This role is carried out at the request of the client for information about the
purpose of nursing services provide.

• Reformer / Inovator (change agent)

The role as a reformer can be carried out by conducting planning, cooperation,
systematic and directed changes in accordance with the method of providing
nursing services.
 NURSING CARE PROCESS(NCP)
IN MEDICAL SURGICAL NURSING
NURSING CARE & NURSING CARE STANDARDS

Assestment

SLKI Evaluation Diagnose SDKI

SIKI
Implementation Intervention
SLKI
 INDONESIA’S NURSING CARE STANDARDS

Sign & symptom

Outcome criteria
Risk Factor

Diagnose Nursing goal

(SDKI) (SLKI)

Intervention
(SIKI)

Observation
Nursing care
Education
3S
SDKI-SLKI-SIKI
Collaboration
 STAGES OF ENFORCEMENT OF DIAGNOSIS, DETERMINATION OF
OUTCOMES & NURSING INTERVENTIONS

1 Analysis
Data • Compare data with normal values
• Data grouping

2 Identification
of problem
• Actual, Risk, Health promotion (wellness)

3formulation
Diagnosis  Three part (Aktual)
 Two part (Risk, Health promotion)

4determination
Outcome • Label & outcome criteria

5determination
Intervention • Label of Intervetion
dan activity
 FORMULATION
OF NURSING DIAGNOSIS
DIAGNOSTIC INDICATOR
Actual & Wellness
Diagnosis

Actual Diagnosis Risk Diagnosis

Sign/Symptom

Causa Risk Factor

(Etiology)

1) Bio-psycho-sosio
2) Efect of therapy &
action Diagnostic
3) Situational
4) Maturational Indicator
 PROSES DIAGNOSTIC
(DIAGNOSTIC PROCESS)

1 Analisis Data
• Bandingkan data dengan nilai normal
• Kelompokkan data

2 Identifikasi • Masalah Aktual, Risiko, Promkes

Masalah

3 Perumusan • Three part (Aktual)

Diagnosis • Two part (Risiko dan Promkes)
 DIAGNOSTIC PROCESS
Data Grouping Based on Category & Sub Category

Nursing Diagnosis

Fisiologis Psikologis Perilaku Relasional Lingkungan

Respirasi Interaksi Sosial Keamanan &
Nyeri dan Kebersihan Diri Proteksi
Kenyamanan
Sirkulasi
Penyuluhan &
Integritas Ego Pembelajaran
Nutrisi dan
Cairan
Pertumbuhan &
Eliminasi Perkembangan

Aktivitas dan
Istirahat

Neurosensori

Reproduksi dan
Seksualitas
NURSING DIAGNOSTIC FORMULATION

Three Part
• Diagnosis Aktual
Masalah berhubungan dengan Penyebab
dibuktikan dengan Tanda/Gejala (karakteristik mayor/minor)

Two Part
• Diagnosis Risiko
Masalah dibuktikan dengan Faktor Risiko

• Diagnosis Promosi Kesehatan

Masalah dibuktikan dengan Tanda/Gejala
 CONTOH
DIAGNOSIS KEPERAWATAN AKTUAL

Nomor Kode

Label/Masalah

Definisi

Penyebab

Tanda dan Gejala

Bersihan jalan napas tidak efektif

b/d spasme jalan napas d/d batuk
tidak efektif, sputum berlebih, mengi,
dispnea, gelisah
 CONTOH
DIAGNOSIS KEPERAWATAN RISIKO

Nomor Kode

Label/Masalah

Definisi

Faktor Risiko

Kondisi Klinis Terkait

Risiko aspirasi dibuktikan

dengan tingkat kesadaran
menurun
 CONTOH
DIAGNOSIS KEPERAWATAN PROMKES

Nomor Kode

Label/Masalah

Definisi

Tanda dan Gejala

Kesiapan peningkatan eliminasi urin

dibuktikan dengan pasien ingin
meningkatkan eliminasi urin, jumlah
dan karakteristik urin normal
 PERUMUSAN
LUARAN KEPERAWATAN
 PENETAPAN
LUARAN KEPERAWATAN
Penetapan luaran memenuhi prinsip SMART

S • Spesific Label dan indikator

M • Measurable distandarisasi

A • Achievable Disesuaikan kondisi

pasien dengan
R • Realistic menggunakan
clinical judgement
T • Timed perawat
JENIS LUARAN KEPERAWATAN

No Jenis Luaran Contoh Luaran

1 Positif (Perlu ditingkatkan) Bersihan Jalan Napas

Keseimbangan Cairan
Integritas Jaringan
Citra Tubuh
2 Negatif (Perlu diturunkan) Tingkat Nyeri
Tingkat Keletihan
Tingkat Ansietas
Tingkat Berduka
Respon Alergi
KOMPONEN LUARAN KEPERAWATAN

Label
• Nama luaran keperawatan berupa kata-kata kunci informasi luaran

Ekspektasi
• Penilaian terhadap hasil yang diharapkan
• Meningkat, menurun atau membaik

Kriteria Hasil
• Karakteristik pasien yang dapat diamati atau diukur
• Dijadikan sebagai dasar untuk menilai pencapaian hasil intervensi
• Menggunakan skor (1 s.d 3) pada pendokumentasian computer-based
EKSPEKTASI LUARAN KEPERAWATAN
No Ekspektasi Definisi Contoh Luaran
1 Meningkat Bertambah baik dalam ukuran, Bersihan jalan napas
jumlah maupun derajat atau Curah jantung
tingkatan Perawatan diri
Sirkulasi spontan
Status kenyamanan
2 Menurun Berkurang baik dalam ukuran, Tingkat keletihan
jumlah maupun derajat atau Tingkat ansietas
tingkatan Tingkat berduka
Tingkat perdarahan
3 Membaik Menimbulkan efek yang lebih baik, Eliminasi fekal
adekuat, atau efektif. Fungsi seksual
Identitas diri,
Penampiran peran
Proses pengasuhan
CONTOH LUARAN SLKI

Nomor Kode
Panggil

Label Luaran

Definisi Luaran

Ekspektasi
Luaran

Kriteria Hasil
dan Skor
PENERAPAN LUARAN KEPERAWATAN
Metode Dokumentasi Manual/Tertulis

Setelah dilakukan intervensi keperawatan selama ………….,

maka [Label] [Ekspektasi] dengan kriteria hasil:
- Kriteria 1 (hasil)
- Kriteria 2 (hasil)
- Kriteria 3 (hasil)
- dst

Contoh:
Setelah dilakukan intervensi selama 8 jam, maka Bersihan Jalan Napas
Meningkat, dengan kriteria hasil:
• Batuk efektif membaik
• Produksi sputum menurun
• Mengi menurun
• Frekuensi napas membaik (12 -20 kali/menit)
CONTOH LUARAN KEPERAWATAN (SLKI)
• Ekspektasi: Curah jantung meningkat
Penurunan curah • Kriteria: Kekuatan nadi perifer ↑, EF↑, palpitasi ↓,
bradikardi & takikardi ↓, lelah↓, distensi vena jugularis
jantung ↓, pucat/ sianosis ↓, suara jantung S3 S4 ↓, CRT
membaik, Tdmembaik, urine output ↑

• Ekspektasi: Tingkat ansietas menurun

• Kriteria: keluhan bingung dan khawatir ↓, perilaku
Ansietas gelisah ↓, palpitasi ↓, perilaku tegang ↓, konsentrasi
↑, pola tidur ↑, frekwensi nadi ↓, tekanan darah ↓.

• Ekspektasi: Toleransi aktifitas meningkat

• Kriteria: Kemudahan aktifitas ↑, kecepatan & jarak berjalan
Intoleransi aktifitas ↑, keluhan Lelah ↓, dispnea saat & setelah aktifitas ↓,
aritmia saat & setelah aktifitas ↓, RR membaik (12-20 x/mnt),
nadi membaik (80-100 x/mnt), SpO2 membaik
NURSING CARE FORMULATION
CLASSIFIATION SYSTEM OF NURSING CARE

Intervensi Keperawatan

Fisiologis Psikologis Perilaku Relasional Lingkungan

Respirasi Kebersihan Keamanan &
Nyeri dan
Kenyamanan Diri Interaksi Proteksi
Sirkulasi Sosial
Integritas Ego Penyuluhan &
Nutrisi dan
Cairan Pembelajaran

Eliminasi Pertumbuhan &

Perkembangan
Aktivitas dan
Istirahat
Adapted from:
Neurosensori Standar Praktik Keperawatan Indonesia (PPNI, 2005); SIKI (2018), Doenges
& Moorhouse’s Diagnostic Division of Nursing Diagnosis (Doenges et al,
Reproduksi dan 2019).
Seksualitas
5 CATEGORY OF NURSING CARE
1. Fisiologis
• Intervensi keperawatan untuk mendukung fungsi fisik dan regulasi homeostatik

2. Psikologis
• Intervensi keperawatan untuk mendukung fungsi mental, proses mental dan perilaku.

3. Perilaku
• Intervensi Keperawatan untuk mendukung perubahan perilaku atau gaya hidup

4. Relasional
• Intervensi keperawatan untuk mendukung hubungan interpersonal atau interaksi sosial

5. Lingkungan
• Intervensi keperawatan untuk mendukung keamanan lingkungan dan menurunkan risiko
gangguan kesehatan
14 SUB CATEGORY OF NURSING CARE
1. Respirasi
• Kelompok intervensi yang memulihkan fungsi pernapasan dan oksigenasi
2. Sirkulasi
• Kelompok intervensi yang memulihkan fungsi jantung dan pembuluh darah
3. Nutrisi dan Cairan
• Kelompok intervensi yang memulihkan fungsi gastrointestinal, metabolisme dan regulasi
cairan/elektrolit
4. Eliminasi
• Kelompok intervensi yang memulihkan fungsi eliminasi fekal dan urinaria
5. Aktivitas dan Istirahat
• Kelompok intervensi yang memulihkan fungsi muskuloskeletal, penggunaan energi serta
istirahat/tidur
6. Neurosensori
• Kelompok intervensi yang memulihkan fungsi otak dan saraf
7. Reproduksi dan Seksualitas
• Kelompok intervensi yang melibatkan fungsi reproduksi dan seksualitas
 14 SUB CATEGORY OF NURSING CARE
8. Nyeri dan Kenyamanan
• Kelompok intervensi yang memulihkan nyeri dan kenyamanan

9. Integritas Ego
• Kelompok intervensi yang memulihkan kesejahteraan dengan diri sendiri secara emosional

10. Pertumbuhan dan Perkembangan

• Kelompok intervensi yang memulihkan fungsi pertumbuhan dan perkembangan

11. Kebersihan Diri

• Kelompok intervensi yang memulihkan perilaku sehat dan merawat diri

12. Penyuluhan dan Pembelajaran

• Kelompok intervensi yang memulihkan peningkatan pengetahuan dan perubahan perilaku

13. Interaksi Sosial

• Kelompok intervensi yang memulihkan hubungan antarindividu dan individu dengan kelompok

14. Keamanan dan Proteksi

• Kelompok intervensi yang memulihkan keamanan dan menurunkan risiko cedera akibat
ancaman dari lingkungan internal maupun eksternal
NURSING INTERVENTION COMPONENT

Label

• Nama dari intervensi yang merupakan kata kunci untuk

memperoleh informasi tentang intervensi tersebut

Definisi

• Makna dari label intervensi berupa perilaku yang dilakukan

oleh perawat

Tindakan

• Rangkaian aktivitas yang dikerjakan oleh perawat untuk

mengimplementasikan intervensi keperawatan
NURSING INTERVENTION WRITING

Label Intervensi

Definisi Intervensi

Tindakan (Activity)

Referensi
INTERVENTION SELECTION CONSIDERATION
EXAMPLE OF SDKI- SIKI LINK
BIBLIOGRAPHY
• Hinkle JL, Cheever KH. (2018). Brunner and Suddarth's textbook of
medical surgical nursing. Philadelphia: Wolters Kluwer.
• NANDA International. (2020) Nursing Diagnosis Definition and
Classifcation 2020-2023. New York: Thieme
• Tim Pokja SDKI DPP PPNI (2017). Standar diagnosis keperawatan
indonesia: definisi dan indikator diagnostik. Edisi I. Jakarta: PPNI
• Tim Pokja SIKI DPP PPNI (2018). Standar luaran keperawatan indonesia:
definisi dan tindakan keperawatan. Edisi 1 cetakan II. Jakarta: PPNI
• Tim Pokja SLKI DPP PPNI (2018). Standar luaran keperawatan indonesia:
definisi dan kriteria hasil keperawatan. Edisi 1 cetakan II. Jakarta: PPNI
• Doenges, Moorehouse & Alice (2019). Nursing Care Plans Guidelines for
individualizing client care across the life span 10th edition. St. Louis :
Elsevier
• Perry, Potter, Stockert &Hall (2019). Essential for Nursing Practice 9th
edition. St. Louis : Elsevier
FOR QUESTION PLEASE CONTACT

: 081325700465
: yunie@unimus.ac.id
: Yunie Armiyati
: yunie.army
TERIMAKASIH