PEMBELAJARAN KESELAMATAN PASIEN DALAM KEAMANAN OBAT MENGGUNAKAN DESAIN INSTRUKSIONAL FOUR COMPONENTS INSTRUCTIONAL DESIGN (4C/ID)UNTUK PENDIDIKAN NERS

LISA MUSHARYANTI, Prof. dr. Iwan Dwiprahasto, M.Med.Sc, PhD.; dr. Mora Claramita, MHPE, PhD.; Dr. Fitri Haryanti, S.Kp, M.Kes

2019 | Disertasi | DOKTOR ILMU KEDOKTERAN DAN KESEHATAN

Latar Belakang : Di antara masalah kesalahan medis, kesalahan obat memiliki prevalensi yang tinggi. Kesalahan obat melibatkan ners yang telah bekerja juga mahasiswa di pendidikan klinik. Pendidikan ners belum optimal dalam menyiapkan calon ners yang mendukung keselamatan pasien dan keamanan obat. Tujuan: Mengidentifikasi peran ners dalam keselamatan pasien dan keamanan obat, mengidentifikasi kesalahan obat dan faktor penyebabnya, mengembangkan desain instruksional pembelajaran keamanan obat dengan model 4C/ID, dan menerapkannya pada mahasiswa pendidikan ners. Metode: Rancangan penelitian mixed method exploratory sequential design. Penelitian dilakukan di PSIK UMY pada tahun 2016-2017. Tahap penelitian kualitatif dilanjutkan dengan penelitian kuantitatif randomized posttest only with non-equivalent control group design. Jumlah sampel penelitian kualitatif sebanyak 26 mahasiswa, 5 dosen, 4 ners pembimbing klinik, 2 dokter dan 1 apoteker. Responden penelitian kuantitatif berjumlah 95 orang mahasiswa (kelompok kontrol =40, kelompok perlakuan = 55) dengan response rate 89,62%. Pengumpulan data kualitatif menggunakan FGD dan wawancara, sedangkan pengumpulan data kuantitatif menggunakan intrumen CEQ, APSQ, tes MCQ dan check list untuk keterampilan pemberian obat. Data kualitatif dianalisis secara tematik, sedangkan data kuantitatif dianalisis dengan analisis deskriptif dan uji beda. Hasil: Hasil penelitian kualitatif terdapat tiga tema, yaitu 1) Ners berperan penting dalam keselamatan pasien dan keamanan obat, 2) Kesalahan obat yang dilakukan mahasiswa ners di pendidikan klinik, 3) Penyebab kesalahan obat di pendidikan klinik. Hasil penelitian kuantitatif menunjukkan perbedaan yang bermakna pada variabel pengetahuan, sikap dan keterampilan pemberian obat pada kelompok intervensi dibandingkan kelompok kontrol. Pembelajaran 4C/ID menghasilkan persepsi mahasiswa yang lebih baik dibandingkan metode pembelajaran konvensional. Kesimpulan: Peran ners penting dalam keselamatan dan keamanan obat namun kesalahan obat masih dilakukan oleh mahasiswa saat pendidikan klinik. Faktor yang mempengaruhi kesalahan obat (near miss) yaitu kurangnya pengetahuan, kurangnya role model dan kurangnya pendampingan/ supervisi. Pembelajaran keamanan obat dengan 4C/ID memiliki pengaruh dalam meningkatkan pengetahuan, sikap, dan keterampilan pemberian obat pada mahasiswa pendidikan ners.

Background: Medication errors involve nurses who have worked and involved the nursing students in the clinical rotation. This phenomena showed that patient safety and medication safety learning for nursing was not optimal in preparing nursing students to support medication safety. Objective: To identify the role of nurses in patient safety and drug safety, identify medication errors and their causal factors, develop instructional design for medication safety learning with the 4C/ID model, and apply it to nursing students. Method: This study was a mixed method exploratory sequential design, conducted at the School of Nursing UMY in 2016-2017. The qualitative research phase was continued by randomized quantitative research with posttest only non- equivalent control group design. The number of qualitative research samples is 26 students, 5 lecturers, 4 clinical supervisors, 2 doctors and 1 pharmacist. Quantitative research respondents were 95 students (control group = 40, treatment group = 55) with response rates of 89.62%. Qualitative data collection used FGD and interviews, while quantitative data collection used CEQ instruments, APSQ, MCQ tests and check lists for drug administration skills. Qualitative data were analyzed thematically, while quantitative data were analyzed by descriptive analysis and different tests. Results: The results of qualitative research were three themes, namely 1) Nurses played an important role in patient safety and drug safety, 2) Medication errors made by students in clinical rotation, 3) Causes of medication errors in clinical rotation. The results of quantitative research show that there are significant differences in the variables of knowledge, attitudes and skills of drug administration in the intervention group compared to the control group. 4C/ID learning also results in better perceptions of the students. Conclusion: The role of nurses is considered important in drug safety and security, but drug errors are still carried out by students during clinical rotation. Factors influencing near miss by students are lack of knowledge, lack of role models and lack of supervision. The medication safety learning model with 4C/ID can increase the knowledge, attitudes, and skills of oral drug administration and intramuscular drug administration.

Kata Kunci : keselamatan pasien, keamanan obat, pembelajaran keamanan obat, model 4C/ID, mahasiswa ners, patient safety, medication safety, medication safety learning, 4C/ID model, nursing students