The Princess Srinagarindra Award

Part I: THE NOMINATION

I/We hereby nominate for the Princess Srinagarindra Award 2019

Marhesya Syani

Please check one: individual sponsor or organizational sponsor

√

Ministry of Health of the Republic of Indonesia

Relationship of sponsor to the nominee: Medical Workers at Public Health Center of DKI

Jakarta Province

Address of sponsor: H.R.Rasuna Said Street, Block X.5 Kav. 4-9, South Jakarta, DKI

Jakarta City 12950

Phone number: 021-5201590 Fax number: (021) 52921669

Website: http://www.kemkes.go.id/ Email address: kontak@kemkes.go.id

Signature of individual sponsor or authorized representative of organizational sponsor:

__________Signature_______________ _________Date___________________

__________(Typed name)____________ ___________(Typed title)______________

 The Princess Srinagarindra Award

PART II: NOMINEE PROFILE

A. Nominee’s Personal Data

Name: Marhesya Syani

Preferred title: Mr. Mrs. Ms. Miss. Dr. Other_________________

Date of Birth: March, 15th 1990 Nationality: Indonesian Official Language: Bahasa

Indonesia

Home Address: Kuricang XXI, Mahawarman Street, Block A No. 18-19, Pondok Ranji –

East Ciputat , South Tangerang 15412

Mailing address if different from home address:

_______________(No.)______________ ____________(Street)______________

________(City)____________________ _______(State/Province/Country)_______

________(Post Code)____________ ______________(Country)__________________

Office Phone: (021) 22715588 Home/office Fax: (021) 22716699

Mobile phone: +6281906197343 Email address: marhesya15@gmail.com

B. Nominee’s Employment (if applicable):

Name of Organization: Public Health Center of Sub-district Mampang Prapatan, South Jakarta

Address: Liliana Street, Block C 24-25, Pela Mampang – Mampang Prapatan, South

Jakarta

Office Phone: (021) 22715588 Home/office Fax: (021) 22716699

 The Princess Srinagarindra Award

PART III: SPONSOR STATEMENT

To be completed by the individual or organization making the nomination

Name:_______________(individual or organization making the nomination)___________________

In your view, please comment briefly on the reason for the nomination, including the nominee’s
work or contribution to the work, the outcome and the significant impact of this work for the
development of the nursing and/or midwifery profession and improvement of the quality of life
and health of the people. One additional page may be added.

Signature of individual sponsor or authorized representative of the organizational sponsor

(this must be the same person who signed in Part I):

____________Signature_____________ ___________Date________________
 The Princess Srinagarindra Award

PART IV: NOMINEE STATEMENT

Adolescence is a period of growth and development that occurs dynamically and

rapidly both physical, psychological, intellectual, social, sexual behavior that is associated with
the onset of puberty. This period is also the transition period from childhood to adulthood. This
characteristic characteristic of rapid growth and development causes teenagers to have a
great curiosity, love adventure and challenges and tend to dare to take risks without careful
consideration. Judging from the characteristics formed, there are many problems and crises
that occur in adolescence. Various problems that occur in adolescents are influenced by
various dimensions of life in themselves, both biological, cognitive, moral and psychological
dimensions and influences from the surrounding environment. Currently the most prominent
thing in adolescents is that from a health point of view it mentions the growing development of
adolescent reproductive health problems, which involve free sex, spread of venereal disease,
extramarital pregnancy or unwanted pregnancy, abortion, and young marriage.

As one form of concern for the Indonesian government in adolescents where

adolescents in the future who will be the next generation of the government through the health
department promote the PKPR (Youth Care Health Services) program. Where the distinctive
characteristics of health care for adolescents are counseling services and improvement in the
ability of adolescents to implement Healthy Life Education and Skills (PKHS). PKPR can be
implemented optimally when forming networks and integration with cross-programs, cross-
sectors, private organizations, and NGOs related to adolescent health. Adolescent Health
Services (PKPR) can be carried out in health facility buildings and outside health facility
buildings. PKPR can be carried out at Puskesmas, hospitals, schools, youth centers, or other
places where youth gather. Since the Puskesmas is a basic health service center that can
reach all levels of society, including adolescents and the availability of health workers, PKPR
is very potential to be implemented in the Puskesmas. The need for collaboration from all
health personnel in supporting the services needed by adolescents.

Seeing this condition, I as a nurse, a health nurse caring for teenagers, has made
innovations that optimize the role of nurses in meeting the needs of adolescents. Youth
Friendly Services "TEENS HEALTH CARE" is a collaborative solution with a direct approach
to adolescents to improve the quality of health care services for young people. Youth-Friendly
Service Innovation "TEENS HEALTH CARE" has been carried out by the PKPR Team
(integration of UKS programs, Health Promotion, Nutrition and Health, and Psychology) with
4 components of activities, namely: My Health Clinic (Treatment / Curative Service), Come on
Motion Ayo Sehat (Gymnastics, lunch and fruit together), NGOBRAS (Chat with Health
problems) and US (Innovative Benefits Active Cadres). These four programs are facilities that
can be accessed by adolescents, so that adolescents are easy to consult with what they feel
and get the right information.
 By optimizing the role of nurses in collaborating with other health workers, providing
nursing care, education, counseling and becoming a driver and reformer in improving
GERMAS (Movement for Healthy Living Communities) in the school setting, especially
adolescents, the quality of adolescent health services will increase and can produce the
nation's next generation that is creative, productive, responsible and ready to compete with
foreign countries.

I/We hereby consent to have my/our nomination submitted for the Princess Srinagarindra

Award

____________Signature_____________ ___________Date_________________

____________Signature_____________ ___________Date_______________

____________Signature_____________ ___________Date_________________
 The Princess Srinagarindra Award

PART V: OTHER ENTITIES AWARE OF/SUPPORT OR HAVE NO OBJECTION TO THE

NOMINATION

To be completed by the National Nursing/Midwifery Office, President of the Nursing/Midwifery

Council or President of the Nurses’ or Midwives’ Natonal Association (It must be signed by 2
organizations other than the nominating one, where these exist)

I have been informed about the nomination of _____________(Nominee’s name)____________

by______(Name individual or organization sponsoring the nomination)__________

to receive the Princess Srinagarindra Award and have no objection.

_______________________________________________________________________

Name(Print)_______(National Nursing/Midwifery

Officer)___________

(Signature)______________

Date______________

Name(Print)_______(President of Nursing/Midwifery

Council)_________

(Signature)______________

Date______________

Name(Print)_______(President of Nurses’s or Midwives’

Association)___

(Signature)______________

Date______________
 The Princess Srinagarindra Award

PART VI: CERTIFIED STATEMENT

The application must be certified by national/State/Provincial Nursing Council (NNC) or

National/State/Provincial Regulation Authority (NRA).

Name of the National/State/Provincial Council or National/State/Provincial Regulation

Authority

_________________________________________________________________________

Address: ____________(No.)______

____________(Street)___________________

________(City)_______________ _______(State/Province/Country)__________

________(Post Code)____________ ______________(Country)__________________

Office Phone: Fax:

___(Country Code/Area Code/Number)____ ___(Country Code/Area Code/Number)____________

Website: Email address:

_______________________________ _________________________________

We hereby certify that____________(name of nominee)___________________________

Is a Registred Nurse (first level) or Registered Midwife and a current member of our NNC or
NRA or is retired or has resigned with good standing. (we should add an asterisk here
and define good standing)

Signature of the President, Executive Director, or other duty authorized representative of the
NNC or NRA.

____________Signature_____________ ___________Date_______________

_______(Typed name) _____________ ______(Typed title) _______________

All part of these forms must be completed in English, in full, signed where indicated, and
returned to Princess Srinagarindra Award Foundation
to arrive no later than May 31, 2019
Princess Srinagarindra Award Foundation (PSAF)
Nagarindharasri Building,
C/O Thailend Nursing and Midwifery Council C/O Ministry of Public Health
Tiwanin Road, Amphur Muang, Nonthaburii 11000
THAILAND
 The Annex 1: the CV document

The Princess Srinagarindra Award

CURRICULUM VITAE

A. Full name of the nominee (in capital letters) as it appears in your passport or on your
birth certificate.

Name : Marhesya Syani

B. Educational background: identify year of graduation, diploma(s)/degree(s),

school/university, country. Please start with lowest to highest qualification in relation to
nursing and midwifery.

1996 – 2002 : Al Mubarak Elementary School – Pondok Aren

2002 – 2005 : An-Nisa’a Junior High School – Pondok Aren
2005 – 2008 : 86 Senior High School – South Jakarta
2008 – 2011 : Jayakarta Nursing Academy (Diploma III Program) – East Jakarta

C. Working experience: identify year, position, place of work. Please start from the current
one.

2014 – Now : Nurse - Public Health Center of Sub-district Mampang Prapatan

2014 : Speaker – PKPR Health Workers Meeting
2014 – Now : Indonesian Civil Servant (PNS) – DKI Jakarta Public Health Office
2011 – 2014 : Administration Staff - PT. Platon Niaga Berjangka
 The Princess Srinagarindra Award

D. Administrative position (if any), years in the position, workplace

Years Position Workplace

2014 – Now Coordinator of School Public Health Center of Sub-

Health Unit (UKS) and Youth district Mampang Prapatan
Care Health Service (PKPR)
2015 – Now Nurse of Youth Friendly Public Health Center of Sub-
Health Service Unit district Mampang Prapatan
2016 – Now Secretary of PPNI Public Health Center of Sub-
district Mampang Prapatan
2018 – Now Quality Accreditation’s Public Health Center of Sub-
Auditor district Mampang Prapatan
2016 – 2018 Coordinator Mortality Public Health Center of Sub-
Program district Mampang Prapatan

E. Awards: The year you received the award, name of the award, the award recognition (on
what achievements), and organization giving the award.

Years Name of the In recognition of Organization

Award/recognition

2018 South Jakarta Health 1st Place – Best South Jakarta Health
Worker’s Award Nurse of South Department
Jakarta Health
Department
2018 DKI Jakarta Province 1st Place – Best DKI Jakarta Public
Health Worker’s Award Nurse of DKI Jakarta Health Office

Public Health Office

2018 National Health 6th Place – Best Ministry of Health of

Worker’s Award National Health the Republic of
Workers Indonesia
 The Princess Srinagarindra Award

F. Research publication: List not more than 10 key research reports or publications.

A research report: identify name of author, year, title, place of printing, country.
Marhesya Syani, 2018, Optimalisasi Peran Perawat Dalam Pelayanan Kesehatan
Peduli Remaja Dengan Layanan Ramah Remaja “Teens Health Care” Di Sekolah
Wilayah Kecamatan Mampang Prapatan, Jakarta Selatan, Indonesia.

Key Words : Remaja, Teens Health Care, PKPR, Klinik Sehat-Ku, NGOBRAS,
Perawat

All part of these forms must be completed in English, in full, signed where indicated, and
returned to Princess Srinagarindra Award Foundation
to arrive no later than May 31, 2019
Princess Srinagarindra Award Foundation (PSAF)
Nagarindharasri Building,
C/O Thailend Nursing and Midwifery Council C/O Ministry of Public Health
Tiwanin Road, Amphur Muang, Nonthaburii 11000

THAILAND