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ix
RINGKASAN
PENGEMBANGAN MODEL KESELAMATAN PASIEN BERBASIS CARING SEBAGAI
UPAYA MENURUNKAN ADVERSE EVENT DI RUMAH SAKIT
UMUM DAERAH (RSUD) KABUPATEN LOMBOK BARAT DAN LOMBOK TIMUR
PROVINSI NTB
Keselamatan pasien merupakan salah satu komponen utama dari
kualitas pelayanan
rumah sakit tetapi secara umum belum memenuhi standar. Kondisi
tersebut
ditunjukkan oleh data bahwa 54,48% rumah sakit di Indonesia dan
58,49 rumah sakit
di Provinsi Nusa Tenggara Barat belum memenuhi standar
akreditasi dan standar
keselamatan pasien (Kemenkes RI, 2012). Banyak kasus adverse
event (AE) yang terjadi di rumah sakit tetapi belum dilaporkan.
Menurut WHO (2004), jumlah pasien
yang mengalami AE di beberapa rumah sakit di dunia adalah 3,2% -
16,6%. Demikian
juga Department of Health and Human Services (Office of
Inspector General)melaporkan bahwa klien yang mengalami adverse
events dan temporary harm events sebesar 13,5% (Daniel, 2010).
Hasil survei kepuasan pasien terhadap pelayanan
keperawatan di Rumah Sakit Umum Provinsi Nusa Tenggara Barat dan
di beberapa
Rumah Sakit Umum Daerah di Lombok pada tahun 2010 adalah 65%
(RSUP NTB,
2011), lebih rendah dari standar minimal kepuasan pasien yaitu
80% (Kemenkes,
2010). Kepuasan pasien tersebut berkaitan dengan aspek sikap dan
perilaku serta
kepatuhan terhadap standar prosedur operasional dan aspek
tersebut berkaitan erat
dengan keselamatan pasien. Kondisi itu hampir sama dengan yang
disampaikan oleh
Agency for Healthcare Research and Quality (AHRQ) pada tahun
2011 bahwa hampir 50% keluhan (complaints) dari klien berkaitan
dengan komunikasi, sikap dan perilaku, kurangnya rasa kasih (lack
of compassion) serta sikap kurang peduli (uncaring).Tujuan
penelitian ini adalah menyusun model keselamatan pasien berbasis
caring dalam keperawatan sebagai upaya mengurangi adverse event di
Rumah Sakit Umum Daerah Kabupaten Lombok Timur dan Rumah Sakit Umum
Daerah Kabupaten
Lombok Barat. Konsep model tersebut mengacu kepada Swanson’s
Caring Theory dan International Patient Safety Goals dari JCI.
Swanson’s Caring terdiri atas 1)maintaining belief; 2) knowing; 3)
being with; 4) doing for; 5) enabling (Caroline, 2011).
International patient safety goals atau Sasaran Keselamatan Pasien
(SKP) dari Joint Commossion International (JCI, 2011) merupakan
variabel keselamatan pasien terdiri atas: 1) ketepatan dalam
identifikasi pasien; 2) komunikasi yang efektif; 3)
terjaminnya tepat lokasi, tepat prosedur dan tepat pasien dalam
tindakan
operasi/tindakan invasif; 4) keamanan obat high alert; 5)
pengurangan risiko infeksi nosokomial; 6) pengurangan risiko pasien
jatuh.
Metode penelitian ini dirancang menjadi dua tahap yaitu tahap
pertama eksplanasi
(explanatory research) untuk menjelaskan hubungan kausal antara
variabel karakteristik perawat dengan perilaku caring dan sasaran
keselamatan pasien berdasarkan jawaban responden. Isu strategis
yang dihasilkan dari tahap explanatory research ini dibahas dalam
focus group discussion (FGD) dengan melibatkan pakar untuk menyusun
Model Keselamatan Pasien Berbasis Caring. Tahap kedua adalah
eksperimen dalam bentuk pelatihan untuk penerapan model keselamatan
pasien
berbasis caring dalam asuhan keperawatan di ruang rawat inap dan
menganalisis pengaruhnya terhadap penurunan adverse event (AE)
.yang terdiri atas medication error, flebitis, dekubitus, infeksi
daerah operasi dan risiko pasien jatuh sebagai indikator
keselamatan pasien.
ADLN-PERPUSTAKAAN UNIVERSITAS AIRLANGGA
DISERTASI PENGEMBANGAN MODEL... MENAP
kan bahwa klien yang mmenengggalami adaadvevverse events dan
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ketepatatatat n nn dadadadalalalaam mm m
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dadadann tepat pasien d
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x
Populasi dalam penelitian ini adalah seluruh perawat dan pasien
di semua unit rawat
inap di Rumah Sakit Umum Daerah (RSUD) A di Kabupaten Lombok
Barat dan
RSUD B di Kabupaten Lombok Timur Propinsi Nusa Tenggara Barat
(NTB). Unit
rawat inap di RSUD A dan RSUD B berjumlah 16 unit. Kapasitas
unit rawat inap
yang tersedia adalah 342 tempat tidur. Tenaga perawat yang ada
berjumlah 281 orang
(Profil RSUD A dan RSUD B, 2013). Sampel adalah unit rawat inap
yang memenuhi
kriteria inklusi yaitu menerapkan manajemen asuhan keperawatan
profesional dan
merawat pasien dengan tindakan pembedahan/operasi. Besar sampel
yang diperoleh
dari RS A dan RS B pada tahap eksperimen berdasarkan ketentuan
di atas adalah 8
orang kepala ruangan, 48 orang perawat pelaksana, sedangkan
besar sampel pada
tahap eksplanasi sebanyak 82. Variabel penelitian ini terdiri
atas variabel indpenden
dan variabel dependen beserta sub variabel yaitu Karakteristik
Perawat, Caring, Safety Caring Model, Sasaran Keselamatan Pasien
dan Adverse EventInstrumen pengumpulan data terdiri atas kuesioner
dan lembar check list yakni kuesioner caring dimension inventory
(CDI), pedoman wawancara caring professional scale (CPS), carative
factors untuk meneliti pengetahuan perawat, kuesioner International
Patient Safety Goals, lembar observasi (check list) Norton Scale
untuk Dekubitus (Decubitus Ulcer Rate), Vip Score (Visual Infusion
Phlebitis Score) untuk Phlebitis, Southampton Scoring System untuk
Infeksi Daerah Operasi (IDO), Morse Fall Scale dan Humpty Dumpty
Scale untuk risiko jatuh, dan NCC MERP indeks for Categorizing
Medication Error. Analisis data secara deskriptif untuk memperoleh
gambaran mengenai karakteristik
responden dan distribusi karakteristik perawat yaitu pengetahuan
(X1), sikap (X2) dan
pengalaman (X3) serta distribusi pelaksanaan caring (Y1) dan Y2
yaitu sasaran keselamatan pasien (SKP). Metode analisis partial
least square (PLS) yaitu analisis persamaan struktural berbasis
varian yang secara simultan dapat melakukan pengujian
model pengukuran sekaligus pengujian model struktural yang
dilakukan
menggunakan software SmartPLS.Hasil dan kesimpulan penelitian.
Nilai outer loading dan AVE > 0.5, nilai composite reliability
0. > 6 dan T statistik > 1,96 menunjukkan bahwa uji hipotesis
adalah valid dan signifikans. Nilai uji R2 adalah 0.490, maka dapat
disimpulkan bahwa Model Keselamatan Pasien Berbasis Caring telah
memenuhi persyaratan sebagai sebuah model yang baik.
Temuan baru yang dihasilkan adalah Model Keselamatan Pasien
Berbasis Caring yang dinamakan Model Safety Caring Model (SCM).
Komponen dari caring yang melandasi keselamatan pasien dalam
pelaksanaan asuhan keperawatan dan
pelaksanaan caring yang berorientasi serta memiliki indikator
keselamatan pasien secara terukur dalam menurunkan AE membedakan
SCM dengan model lain.
Kontribusi SCM terhadap keilmuan yakni menambah dan melengkapi
Bidang Ilmu
Keperawatan, Manajemen Rumah Sakit (Clinical Management) dan
Teori Manajemen Mutu .Direkomendasikan untuk menggunakan Model
Keselamatan Pasien Berbasis Caring sebagai salah upaya meningkatkan
mutu pelayanan RS dan perlu penelitian lebih
lanjut mengenai keselamatan pasien ditinjau dari clinical
pathway keperawatan. Untuk Institusi Pendidikan Keperawatan perlu
menambah muatan kurikulum tentang
caring dan keselamatan pasien maupun keselamatan kerja bagi
perawat
ADLN-PERPUSTAKAAN UNIVERSITAS AIRLANGGA
DISERTASI PENGEMBANGAN MODEL... MENAP
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xi
SUMMARY
MODEL OF PATIENT SAFETY BASED ON CARING AS EFFORTS TO REDUCE
ADVERSE EVENT IN DISTRICT GENERAL HOSPITAL OF WEST AND EAST LOMBOK,
WEST NUSA TENGGARA PROVINCE
Patient safety is one of the main components of the quality of
hospital services but
generally not meet the standards because 54.48% of all hospitals
in Indonesia and
58.49 hospitals in the province of West Nusa Tenggara (NTB) has
not met the
accreditation standards and patient safety standards (MoH RI,
2012)
Many problems of adverse event (AE) or unexpected events but not
yet reported.
WHO (2004) noted that based on the results of the study, 3.2% -
16.6% of patients
experienced AE in hospitals. The same is delivered by the
Department of Health and
Human Services (Office of Inspector General) that a client who
experienced adverse
events and temporary harm events by 13.5% (Daniel, 2010). The
patient satisfaction
survey department of NTB and in some hospitals in Lombok in
2010, patient
satisfaction with hospital services, especially nursing services
was only 65% (RSUP
NTB, 2011), lower than the minimum standard of patient
satisfaction was 80%
(Ministry of Health, 2010) , The problem of low rates of patient
satisfaction is related
to aspects of the attitudes and behavior as well as adherence to
standard operating
procedures and the conditions closely related to aspects of
patient safety. It was in line
with the Agency for Healthcare Research and Quality (AHRQ) that
deliver research
results in 2011 that almost 50% of complaints from clients
related to communication,
attitudes and behavior, lack of compassion and uncaring.
The purpose of this study was to develop a model-based patient
safety caring in
nursing as an effort to reduce adverse event (AE) at Hospital B
in East Lombok
district and hospital A in West Lombok, West Nusa Tenggara
Province. The concept
of the model refers to Swanson's Caring Theory and International
Patient Safety Goals
(IPSG) from JCI. Swanson's Caring consists of five (5)
components, namely 1).
maintaining belief; 2) knowing; 3) being with; 4) doing for; 5)
enabling (Caroline,
2011). International patient safety goals (IPSG) from Joint
Commossion International
(JCI, 2011) was a hospital patient safety variables consist of:
1) accuracy in the
identification of patients; 2) effective communication; 3) the
right-location, right-
procedure, right-patient surgery; 4) high drug safety alerts; 5)
reduction in the risk of
nosocomial infection; 6) reduction in the risk of patient
falls
Methods this study was designed in two phases: the first
explanation (esplanatory
research) to explain the causal relationship between the
variable characteristics caring
nurses with the implementation of the targeted patient safety
based on respondents'
answers. Strategic issues resulting from phase explanatory
research is discussed in the
focus group discussion (FGD) with the involvement of experts to
draw up Model-
Based Patient Safety Caring. The second stage was an experiment
in the form of
implementation of the new model in nursing care in the inpatient
unit and analyze the
effects on reduction in adverse event (AE) which was composed of
medication errors,
phlebitis, pressure sores, infections operating area and the
risk of patient falls as
indicators of patient safety.
The population in this study was all nurses and patients in all
inpatient units at
Regional General Hospital (Hospital) in West Lombok A and
Hospital B in East
Lombok, West Nusa Tenggara. Inpatient units in hospitals A and
Hospital B
amounted to 16 units. Inpatient unit capacity available is 342
beds. There were nurses
who totaled 281 people (Profile of Hospital A and Hospital B,
2013). Samples were
ADLN-PERPUSTAKAAN UNIVERSITAS AIRLANGGA
DISERTASI PENGEMBANGAN MODEL... MENAP
nd temporary harm eveentntss bbby 13.5%55% ( ((Daniel, 2010).
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alalalalererrertststss;; 555) reductio
mial infection; 666)) ) rererer dududuductctctctioioioi nn n in
thththhe riririi kskk o o offff papapapatitititienenenent t tt
fafafalls
s this study was desisigngngng ededed iiiinnn twtwtwooo
phphphasasesese :: the first explanati
-
xii
inpatient units that meet the inclusion criteria that apply
professional nursing care
management and care of patients with surgery / operation. Sample
size obtained from
hospital A and hospital B in the experimental stage were 8
peoples of head room, 48
nurses and sample size in the explanatory stage were 82.
Variables of this study
consisted of indpenden variables and the dependent variable and
its sub variables
were Characteristics of Nurse, Caring, Safety Caring Model,
Patient Safety Goals and
Adverse Event
Data collection instruments consisted of a questionnaire and
checklist sheets namely
questionnaire of caring dimension inventory (CDI), interview
caring professional
scale (CPS), carative factors to examine the knowledge of
nurses, questionnaires
International Patient Safety Goals, the observation sheet (check
list) Norton Scale for
pressure sores (Decubitus Ulcer Rate), Vip Score (Visual
Infusion phlebitis Score) for
phlebitis, Southampton Scoring System for Infectious Regional
Operations, Morse
Fall Scale and Humpty Dumpty Scale for fall risk, and NCC MERP
index for
categorizing Medication Error.
Descriptive analysis of the data to get a picture of the
characteristics of respondents
and distribution characteristics of nurses that is knowledge
(X1), attitude (X2) and
experience (X3) and the distribution of caring implementation
(Y1) and Y2 is patient
safety goals. The method of analysis partial least square (PLS)
is a variant based
analysis of structural equations that can simultaneously test
the measurement model
once the structural model testing performed using software
SmartPLS.
Results and conclusions of the study. Value of outer loading and
AVE > 0.5,
composite reliability values > 0.6 and T statistics > 1.96
indicates that the test of
hypothesis was valid and significance. Value of goodness-of-fit
R2 test was 0.490, it
can be concluded that Safety Caring Model (SCM) has met the
goodness-of-fit
The new findings generated was caring based patient safety
safety model, called
Safety Caring Model (SCM). Components of caring that underlying
for patient safety
in the implementation of nursing care and caring implementation
oriented and has a
measurable indicator of patient safety to reduce AE was
distinguish SCM with other
models.
Recommended for use Safety Caring Model as an effort to improve
the quality of
hospital services and the need for further research on the
safety of patients in terms of
clinical nursing pathway. For Nursing Education Institutions
need to increase the
curriculum of caring and patient safety as well as safety for
nurses
ADLN-PERPUSTAKAAN UNIVERSITAS AIRLANGGA
DISERTASI PENGEMBANGAN MODEL... MENAP
zing Medication Error.
ive analysis of tthehehee dd ddatatata aa toto g g g ttet aaaa p
pppicicicictututurerere o oof f f thththt e e characteristics
ribution charararaactctcterererrisisisistiiticscscss o o of ff
nununursssseeese ttthahahat isisiss kk knoonoowlwlwlwlededede gegg
(X1), at
nce (X3) anananand d d d ththththee e dididid stststriribububub
titiitionononon o o ooff f f cacacariririringngngng i i impmpmpm
lelelemememem ntntntntatatatatioioioion nnn (Y1) an
oals. ThThThhe e e mmmethththhododod ooof f f
ananannalalalalysysysysisissis pp pparararartitititialalal ll
lleaeaeaststst squququaaare e (P(P(P(PLLSL ) is
of sttttruruructctctturururu alall
eeequququuatatatatioioioonsnsnsns t t tthahahahat t t t cacacannn n
sisisis mumumultltltltananananeoeoeoeousususu lylyly ttttesesee t
tt thththt e eee memm as
he sssstrtrtrtrucuccctutututurararaal ll l momomomodedededel lll
tetetetestststs inininng g g g perfffforororormememem ddd d
ususususinininnggg g sososooftftftf wa
annnddd cooooncncncn lululuusisisis ononono ssss ofoo tttheee s
s sstututut dydydyy... VaVaVaValululueeee ofofofo ouououo
teteteerrrr lololoadadaddinininngggg aana
teeee rerereelilliabababbilililitititityyy vavavavalulululuese
> 0.0.0.666 ananananddd TTTT statataa isisisstitititicscscsc
>>> > 1.1.1.9696969 ininnindididicaaaatetetess
sisisi ww wasss vavavavalililiidddd ananananddd sisisis gngngng
ififificicicancee. VVValuuueee offf gogogogoodododo nenenen
ssssssss-ofofoff-ff ffiff t t t R2R2R2R2 te
ononnclclududududededd thtthatatat SaSaSaS fefefeetytyty C C
Carararrinininngg MoM deel l (((S( CMCMCMM) hahahah ss s mememeet t
t ththththeee gogoggoodododnne
ww fifiindndndininngsgsgs gegegegenenenenerararateteeeddd
wawawaasss cacc riiing bababab seddd papapapatititiienenentt t
sasasafefefetytyty sasasaafefef ttyt
Caariringngngn MoMoMoodededeelll ((((SCSCSCSCM)M)M).
CCCompmpmpponononenenenntststss ofofofof cacacaririringngngng tt
tthahaahattt unununndededederlrlrlyiyiy ngngng fo
mpmpplelelelememem nttntatatattioioioon nn n offoff nursssining
cacacaarererer ananandddd cacc ririringngng
implplpllememememenenentatatatitt ononnon orororiiii
blelele inininindidididicatotototorrrr ofofofo p p
patattatieieiei nt sssafafaffetetetetyyyy totototo r
rrededededucucuce AEAEAEE wawawaw s sss dididdistststs
ininininguguguguisisisi hhhh S
mendededed d d d fofofoorr usususseee SaSaSaSafefefef tytytyty
CaCaCaC ririringngngng MoMoMoM dededed l ll asasass ananann ee
eefffffororororttt t totototo ii impmpmpmprrrove
servicececessss anananand dd ththhe neneneeedededd fofofof r rr
fufufufurtrtrtheheheher rr rerereseseses arararchchchch onononon t
thehehehe saaafefefetytytyty ooooff pati
nursing papapapathththwawawaw yyyy. FoFoFoForrrr
NuNuNuurssrsinining gg EdEdEducucucu atatttioioonnn
InInInststititittutututu ioioioionsnsn need
um of caringngngg anananand d d papapp tiienenent ttt sass
fefefefettty asasa w wwwelelelelll l asasasa sasasas feeetytytyy
fofofofor r r nnunn rses
-
xiii
ABSTRAK
Latar belakang. Keselamatan pasien merupakan komponen utama dari
kualitas pelayanan rumah sakit tetapi secara umum belum memenuhi
standar karena 54,48%
rumah sakit di Indonesia dan 58,49 rumah sakit di Provinsi Nusa
Tenggara Barat
(NTB) belum memenuhi standar akreditasi dan standar keselamatan
pasien
(Kemenkes RI, 2012) sehingga banyak masalah adverse event (AE)
tetapi belum dilaporkan seperti yang disampaikan WHO (2004) bahwa
3,2% - 16,6% pasien di
rumah sakit mengalami AE. Kepuasan pasien terhadap layanan
layanan keperawatan
di rumah sakit hanya 65% (RSUP NTB, 2011), lebih rendah dari
standar minimal
(80% ) dan hal itu berkaitan erat dengan aspek keselamatan
pasien serta sekitar 50%
keluhan klien berkaitan dengan komunikasi, sikap dan perilaku
uncaring.Tujuan penelitian ini adalah menyusun model keselamatan
pasien berbasis caringdan menguji pengaruhnya terhadap penurunan
adverse event.Metode penelitian yang digunakan adalah eksplanasi
(esplanatory research) untuk menjelaskan hubungan kausal antar
variabel dan eksperimen berupa penerapan Model
Keselamatan Berbasis Caring di ruang rawat inap dan menganalisis
pengaruhnya terhadap penurunan adverse event (AE) .Populasi dalam
penelitian ini adalah seluruh perawat dan pasien di semua unit
rawat inap di Rumah Sakit A Kabupaten Lombok
Barat dan RS B di Kabupaten Lombok Timur sebanyak 16 unit, 342
tempat tidur,
281 orang perawat. Besar sampel untuk tahap eksplanasi adalah 82
dan untuk tahap
eksperimen 56. Analisis deskriptif dilakukan untuk memperoleh
gambaran mengenai
karakteristik responden dan distribusi frekwensi variabel.
Metode analisis partial least square (PLS) untuk pengujian model
pengukuran dan pengujian model struktural. Hasil penelitian dan
kesimpulan. Nilai outer loading dan AVE >0.5, nilai composite
reliability >0. 6 dan T statistik > 1,96 menunjukkan bahwa
uji hipotesis adalah valid dan signifikans. Nilai uji
goodness-of-fit R2 = 0.490, maka dapat disimpulkan bahwa Model
Keselamatan Pasien Berbasis Caring telah memenuhi
goodness-of-fitDirekomendasikan untuk meningkatkan keselamatan
pasien menggunakan Model Keselamatan Pasien Berbasis Caring dan
kepada institusi pendidikan perlu manambah muatan kurikulum tentang
caring dan patient safety. Penelitian ini perlu dilanjutkan dengan
ruang lingkup yang lebih luas.
Kata kunci: Perawat, Caring, Model keselamatan pasien, Adverse
event
ADLN-PERPUSTAKAAN UNIVERSITAS AIRLANGGA
DISERTASI PENGEMBANGAN MODEL... MENAP
nguji pengaruhnya terhadadadapap p penurununanan ada verse
event.e penelitian yangng dd digigigigunununakaka ananan a
dadadadalallah hhh ekekkkspspspplalalanananan sis (esplanatory
rskan hubungggananann kk kauauauausaasal ll ananana tatatar r vvav
riririiabababa elele dddannn ee ekskskspepepep ririririmememem n
berupa pe
matan Berbrbrbrbasasasa isisiss CaCaCaCaririringngngg didiidi r
uauauauangngngn r r rrawawawawatataat i i inananappp p dadadaan nn
n memememengn analisp penurunununnananan dadddveeerse e ee
evevevenenenent tt t (A(A(A(AE)E)E)E) . .PoPoPoPopupupup
lalalaasisisi dd ddalaala amamam p enenennelelelitititian in
dan papapap sisisiienenenen dddii ii sesesemumumumua a a a
ununununitititit r r rrawawawawatatatat inannn p pp didididi R R
RRumumumumahahah SSSSakakakitititit A A AA Kab
an RSRSRSS B B BB dd ddi iii KaKaKaKabubububupapapapateteteten
nnn LoLoLoLombmbmbm okokokok Timurururur s s
ssebebebebananananyayayayak k k k 16161616 uuunininin t,t,t,t 3
4
ng g pepeperaaawawawaw t.t.t. BBBBeseseesararaar ssammmmpepepel
ll unununu tututukk k k tatataahaaaap p p
ekekekekspspspsplalalalanananasisisisi a dadadalalalal hh hh 828282
d
menenene 5656565 . AnAnAnAnalalallisisisisisisisis d
dddeskriiiptptptp ifififf d d ddililillakakakkukukukukannn uu
untntntntukukukuk m m mmemememmpepepep rororor lelellehhh gagagag
mmm
isssstitik kk k respspsponononondedededen n n n dadadann nn
dididistststririribbub siii ffffrererekkkwenenensi vvvararara
iaiaiaabebebeel.l.l. MeMeMMetotototodedede aaaanananan lll
PPLSLS) ) ) ) uuuntntukukuk ppppenenengugugujijijij ananan m m
mododododelel pengugukukukuk raaaan nn daaadann n
pepepengngngngujujuju iaiaiaian n nn momomodede
enennelililittiananan dddananann k k k kesesese
imimimmpupupulaalalan.n.n. NNNilai outttet r
loooadadaddinininingggg dadadaan n n AVAVAVEEE
>>>>0.0.0 55,5tyyy >>0.00.0. 6 6 6 dadadad nn n n
T T T T stststtatatatisisi tititikkk >> > 1,1,1,,969696 m
m mmenenennunununu jujujujukkkkkkkanan b bbbahahaha wawawawa u
uuujijijji hipippototo e
niffffikikiki annnns.s NNNililililaiaiaiai uujiji goggg
odododdnennn sss---ofofofofffff fifififittttfffff-ff RRRR222 =
0.0.0.0 44490, mmmakakakaka aa dadadad papapattt didid
sisiiiKeseseselalalalamamamamataaatan nn PaPaPaPasisisienenen B B
BBeree bababasisiiis s ss CaCaCaCariririr ngngngng tetetetelalalah
mememememememenunununuhihihih gogogogoododododnennen
sssssmendndndasasasasikikikananana unununu tutututuk k kk
memememeninininingngngkakakak tktktkananann k k
keseseselelelamamama atatattananann p p ppasasaa ieieieiennn n
mememm nnnggmatan nn PaPaPaP sisisienenene BB
BBerererbababbasisisis s ss CaCaCaCariririr ngngng dadadan n nn
kekekek papapapadaddada ii i nsnsnsstititititutututusisisisi pe
ah muauauaatatatatan nn n kukukurririkukukuk lulululum m mm
tetetet ntntntntananana g g gg cacacacariririingngngn dadadadan nnn
papapap titit ennnnt sasasaafefefefetytytyy. Penkan denganananan r
rruauauau ngngng l l lininningkgkgkkupupup y y yyanangg lelel bibih
hh lululuasasass.
nci: Perawat, Caring,t MoMoMoM dedededell l
kkkeseseselelelamamama atata ananan pasien, Adverse evekkkk
-
xiv
ABSTRACT
Background. There were many adverse events in hospitals globally
(3.2% - 16.6%), patient satisfaction with nursing care at the
General Hospital of West Nusa Tenggara
and the District General Hospital in Lombok is still low (65%)
and about 50% of
patients complaints related to communication, attitude and
uncaring behavior. The
issues are closely related to patient safety. This study aimed
to develop a Model ofPatient Safety Based on Caring and was tested
its effect for reducing adverse events in
District General Hospital of East and West Lombok.
The design of this study in first stage was explanatory research
with descriptive and partial least square (PLS) analysis to
formulate model of Patient Safety, while in
second stage was used experimental method with risk reduction
analysis to test its
effect to reduce the adverse events. The population was nurses
and patients in all
inpatient units and sample size for first stage was 82 nurses
and for the experimental
phase of 60 nurses and 41 patients was drawn by simple random
sampling. Data were
collected by questionnaire and observation.
Results of descriptive research, all elements of caring more
dominant (35% - 50%) categorized sufficient and less, except the
elements knowing more (51.2%) were
categorized good. Knowledge about caring majority (78%)
considered good, while the
attitude and experience 64% and 48% were categorized sufficient.
All elements of
patient safety more than 50% were categorized sufficient except
the elements
reduction in infection. PLS analysis, generating outer loading
value and AVE value
> 0.5, composite reliability value > 0. 6 and t-
statistics > 1.96 indicates that thehypothesis test is valid and
significance. R
2value of caring was 0411 and Patient
Safety was 0.490, the value of Q2
was 0.700 indicated the model had proven to
qualify goodness. From the risk reduction analysis had proven
that adverse events
decreased significance (35% - 45%).
Conclution and recomendation. It is concluded that Model of
Patient Safety Based on Caring is a good model for reducing adverse
event. It is recommended to
implement this model on broader scope and services quality
improvement more
focused on patient safety. Educational institutions is
recomended to increase caring
and paient safety in curriculum safety to produce a double
effect on the health sector.
Keywords: Nurse, Caring, Model of Patient Safety, Adverse
event
ADLN-PERPUSTAKAAN UNIVERSITAS AIRLANGGA
DISERTASI PENGEMBANGAN MODEL... MENAP
t units and sample size fofoorr fffirst stagaagee waww s 82
nurses and for th
f 60 nurses and 44111 papapapatititienenentstst wwawas s drdrdrd
awwawwn n n bybybyb sisisimpmpmpm le random samp
d by questionnnnananan iririreeee ananddd obobobo
seseservrvrvatattioioioion.
of descripipipptititit vevevee rerereseseses araa chchhh,,
alalalall elelellemememe enenenentststss o o offff
cacacaririiringngngn momomomorererere d ominan
zed suffffffficicicicieieiei nt annnddd lelelessssss,
exexexexcecececeptptptt tt tthehehehe elelelemememe enenenentststs
knknknowowowwinininggg more
zed gogogooodododd.. KnKnKnK owowowo leleleedgdgdgdgeeee
ababababououououtttt cacacac riririingngngng
mamamajojojojoriririritytytyy (( ((7878787 %)%)%)%) cocoonsnsnsn
idididideree ed
anddd exexexexpepepeeriririienenenncececec 64646464% % %%
ananandddd 4848484 %%%% were
ccccatatatategegegegororororizizizizedededed
susususufffffffficicicieieieiennntn .
safefefetytyty momomom rererr t ttthahahahannnn 50000% % wewewew
rerere cacacatettt gogogog ririririzezezezedddd
sususufffffffficicici ieieientntntt eexcxcxcx eepe
n innn ininini fefefefectctcttioioioonnnn. .. PLPLPLPLS
annnalalala ysysyssisisisis, ,, gegegegeneneneneratititt ngngngng
ouououo teteteter rr r lololooadadada ininini g ggg
vaaaalululuee
oooompmpmppossititeee rerererelililiiababababilililititittyyyy
vavavalululuee > 0000. 666 annnddd t- stststatatata
isisisstititiicscscsc > > > > 1..9696696 inininissisis
teete tststs isiss vavavalilililidddd ananannddd
sisisigngngnnifififficiicaance. RRRR
222RR vavavav lue e e e ofofoff cc ccararararininining g g
wawawaw sss 004
wawaass 0.0.49494900,,, ththththe e e e vavavaluluuuee e ofoffof
QQQQ2
was 0.0.0..70000 inininndididid cacacac teteteedddd ththhee
momomoodededel
gogooododddnnnessssss. ... FrFrFrFromomomom t ttheheh riii kskk
rerereeduduductctcttioioioionnnn anananaaalysysysysisis hahaahaddd
prprprp ovovovo enee thththaat
eddd sisisis gngngnifiifi iccicanananancececec (((33335%55 -
45%)%)%)...
iononon aa aandndndnd rececececomomomomenenendadadadatitt onnn.
ItItItIt i i iiss s cocococoncncncclulululudededed thththhatatatat
M M MMododododelelell o ooof f f PaPaPaatititieeneeng isisis a a a
g gggoooooood d d d momomodedededell l fofofofor rrr
rereredududucicicic ngngngn adadadveveversrsrsr e e ee
evevevvenenent.ttt Ittt issisis re
ent thththt isisiss m m mmodododo elelelel onononon b bbbrororor
adadaddererer s s scococopepepe a aannnd d d d seseses
rvrvrvvicicicicesesess q q quauauaualilililitytytyty i iiimp
on patatatieieieientntntnt s ssafafafetetety.yy.y E E
EEdudududucacacatititiononono alalall i i iinsnsnsn tititititututut
titititiononnons sss isisi r receceecommmenenene dedededed to
nt safety yy inininin cucucuurrrrrricicicululullumumumum
sasasafefefefetytyt ttto oo prprp odododducucucce e e a aa
dododoububu lelelee eeeffffffffececece t on the
ds: Nurse, Cariririingngng, MoMoMoModedededel ll ofofofof
PaPaPatiiienenennt SaSaSaS fefefefetytytyty, ,, AdAdAdAdvevevev rse
event