pengembangan model keselamatan pasien berbasis caring …
TRANSCRIPT
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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.
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DISERTASI PENGEMBANGAN MODEL... MENAP
kan bahwa klien yang mmenengggalami adaadvevverse events dan tempora13,5% (Daniel, 202020201010101 ).).).). HaHaHasisisilll sus rvrvrvrveieie kekekepupupuasasasa an pasien terha
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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 R2adalah 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
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DISERTASI PENGEMBANGAN MODEL... MENAP
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matan PaPaPaPasisisis enenene B BBerrrrbababaasisisiis ss s CaCaaCariririringnggng tetetetelalalaahhh h mememem memememenunununuhihhh peere sysysysyarararratan
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si keselamatan pasisisienenen d d dalalamamam p p pelelelakkakaksanaan asuhan kep
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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). The pat
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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
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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 analis
p 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 55,5
tyyy >>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 sisiii
Keseseselalalalamamamamataaatan 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 nnngg
matan 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. Pen
kan 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 of
Patient 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 the
hypothesis test is valid and significance. R2
value 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
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d by questionnnnananan iririreeee ananddd obobobo seseservrvrvatattioioioion.
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ssisis teete tststs isiss vavavalilililidddd ananannddd sisisigngngnnifififficiicaance. RRRR222
RR 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%)%)%)...
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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