MODEL PEMBELAJARAN MTBS DENGAN METODE EXPERIENTIAL LEARNING PADA MAHASISWA DIPLOMA III KEPERAWATAN ACEH

WIRDA HAYATI, Prof. dr. Sri Suparyati Soenarto, Sp.A(K)., PhD.,; DR. Fitri Haryanti, S.Kp., M.Kes.; Prof. Dra. RA. Yayi Suryo Prabandari, MSi., PhD.

2018 | Disertasi | S3 Ilmu Kedokteran

Latar belakang : Episode penyakit pada bayi dan anak menunjukkan lebih dari satu tanda dan gejala, karena itu harus ditangani secara terpadu melalui tatalaksana manajemen terpadu balita sakit (MTBS). Saat ini program pemerintah mewajibkan 60% bayi dan anak sakit yang dibawa ke puskesmas harus ditangani dengan tatalaksanan MTBS. Mahasiswa diploma III keperawatan sebagai calon perawat harus memiliki kompetensi mampu melaksanakan tatalaksana MTBS, dan hal tersebut dapat dilakukan melalui penyelenggaraan proses pembelajaran MTBS pada masa perkuliahan sebagai pelaksanaan MTBS pre service. Saat ini proses pembelajaran MTBS pada diploma III keperawatan Aceh, masih berlangsung secara konvensional, hanya dua kali pertemuan dengan durasi 100 menit, materi yang diberikan hanya bagan MTBS dan belum ada kompetensi wajib MTBS pada mahasiswa, sehingga sebagain mahasiswa mendapatkan pengalaman belajar praktik MTBS di puskesmas dan sebagian lainnya tidak. Oleh karena itu perlu adanya model pembelajaran MTBS yang aktif dan seimbang antara pembelajaran dikelas dan di klinik. Tujuan:Mengidentifikasi model pembelajaran MTBS dengan metode experiential learning pada mahasiswa diploma III keperawatan Aceh. Metode: Disain penelitian mixed methode dengan explanatory sequential design, yang diawali dengan study kualitatif pada sembilan partisipan dan empat informan kunci. Jumlah sampel 92 orang (46 kelompok kontrol dan 46 kelompok intervensi), tempat penelitian pada prodi keperawatan poltekeks Banda Aceh dan enam puskesmas wilayah kota Banda Aceh. Waktu penelitian 5 Oktober 2016 - 5 Mei 2017, pengumpulan data menggunakan instrument pengetahuan MTBS, pengetahuan prosedural, sikap, student autonomy, student engagement, efikasi diri, kasus, format penilaian ketrampilan tatalaksana MTBS, checklist penampilan praktik MTBS anak dan bayi, serta format evaluasi proses pembelajaran. Hasil : Model pembelajaran MTBS dengan metode experiential learning terdiri dari tiga siklus, setiap siklus meliputi pembentukan pengalaman nyata, yaitu; proses pembelajaran secara interective learning, study guide dan peer tutor, observasi refleksi, konseptualisasi abstrak dan eksperimentasi aktif. Persepsi dosen pengajar, instruktur klinik dan anggota kelompok keilmuan: kompetensi MTBS penting bagi mahasiswa diploma III keperawatan, mapping materi MTBS yaitu ketrampilan menilai batuk pilek, malaria, DHF, campak, diare, masalah telinga, anemia, penilaian dan klasifikasi serta pengobatan pada bayi muda dan bagan MTBS, metode pembelajaran MTBS memerlukan pembelajaran di kelas dan di klinik, sikap mahasiswa belum percaya diri dalam praktik MTBS. Skor pengetahuan MTBS, pengetahuan prosedural, sikap, student autonomy dan student engagement pada siklus kedua lebih tinggi setelah perlakuan pada kelompok intervensi dibandingkan kelompok kontrol p <.0,05, sedangkan skor student engagement siklus pertama dan kedua lebih rendah setelah perlakuan. Skor pengetahuan MTBS, pengetahuan prosedural, sikap, student autonomy, student engagement, ketrampilan tatalaksana MTBS, efikasi diri dan praktik MTBS lebih tinggi pada kelompok perlakuan di bandingkan kelompok kontrol p < 0,05, siklus pertama dan ketiga skor student engagement, siklus kedua dan ketiga skor sikap lebih rendah atau hampir sama dengan kelompok kontrol p > 0,05. Semakin tinggi skor pengetahuan MTBS, maka semakin tinggi skor ketrampilan tatalaksana MTBS pada kelompok intervensi dibandingkan kelompok kontrol. Semakin tinggi skor pengetahuan MTBS, maka semakin tinggi skor praktik MTBS anak dan bayi pada kelompok intervensi dibandingkan kelompok kontrol p < 0,05. Faktor ketrampilan tatalaksana MTBS memiliki pengaruh yang dominan terhadap praktik MTBS pada kelompok perlakuan. Kesimpulan : Metode pembelajaran MTBS dengan metode experiential leraning memiliki signifikasi terhadap peningakatan skor pengetahuan, pengetahuan prosedural, sikap, student autonomy, student engagement, ketrampilan tatalaksana MTBS, efikasi diri dan praktik MTBS. Saran: Perlu merancang program pembelajaran aktif dengan pengalaman belajar mahasiswa melalui metode interactive learning, study guide dan peer teaching.

Background: Illness episode in infants and children generally shows more than one sign and symptom, hence it should be managed through Integrated Management of Childhood Illness (IMCI). Currently, government programs require that 60% sick infants and children be brought to Puskesmas and managed through IMCI. Nursing diploma graduates must be competent to perform IMCI management which must be learned during their study course as pre-service IMCI. Currently, IMCI learning in nursing diploma students still take place conventionally, only twice with a duration of 100 minutes each. The subject given was only IMCI charts and there was no compulsory competence for students, resulting in varying competence between graduates as some could learn through practice in Puskesmas while others could not. Therefore, an active IMCI learning model is needed and the model must be balanced between theoretical and practical learning. Objective: Identification of IMCI learning model through experiential learning method on nursing diploma students in Aceh. Methods: This was a mixed methode study with explanatory sequential design was preceded by a qualitative study with 9 participants and 4 key informans. In quantitative study involved 92 subjects (46 control group and 46 intervention group), located at nursing department Banda Aceh Health Polytechnic and 6 Puskesmas in Banda Aceh city. The study was conducted from 5 October 2016 to 5 th May 2017. Data was collected through IMCI knowledge instrument, procedural knowledge, attitude, student autonomy, student engagement, self-efficacy, case, IMCI management skill evaluation format, IMCI practical performance checklist on infants and children, and learning process evaluation format. Result: IMCI learning model through experiential learning method consisted of three cycles, each of which involved real-life experience formation, namely: interactive learning process, study guide and peer tutor, reflection observation, abstract conceptualization and active experimentation. The perception of teachers, clinical instructors and academicians: IMCI competence is important for nursing diploma students; mapping of IMCI components such as skill in evaluating cough and flu, malaria, dengue hemorrhagic fever, measles, diarrhea, ear problems, anemia; evaluation, classification and management of young infants and IMCI charts; IMCI learning necessitates learning in the class and clinics; the students were not confident to practice IMCI. IMCI knowledge score, procedural knowledge, attitude, student autonomy and student engagement in the second cycle was higher after intervention in the intervention group compared to control group (p <0.05), while the student engagement score in the first and second cycles were lower after intervention. IMCI knowledge score, procedural knowledge, attitude, student autonomy, student engagement, IMCI management skill, selfefficacy and IMCI practice was higher among the intervention group compared to the control group (p <0.05). The difference between student engagement scores of the first and third cycles and the second and third cycles were lower or similar to control group (p >0.05). The higher the IMCI knowledge score, the higher the IMCI management skill score in the intervention group compared to the control group. The higher the IMCI knowledge score, the higher the IMCI practical score on infants and children in the intervention group compared to the control group (p < 0.05). IMCI management skill had a dominant impact on IMCI practice in the intervention group. Conclusion: IMCI learning method through experiential learning method was significant towards the increase in knowledge score, procedural knowledge, attitude, student autonomy, student engagement, IMCI management skill, self-efficacy and IMCI practice. Suggestion: An active learning program is needed to enrich studentslearning experience through interactive learning, study guide and peer teaching.

Kata Kunci : pembelajaran, MTBS, experiential learning, interactive learning, study guide, peer teaching, pengetahuan, pengetahuan prosedural, sikap, student autonomy, student engagement, efikasi diri, ketrampilan, praktik MTBS, learning, IMCI, experiential learnin