IKLIM, INTENSI DAN PERFORMANSI KESELAMATAN DAN KESEHATAN KERJA (K3) TERKAIT CEDERA TERTUSUK DAN TERSAYAT (CTS), Kajian Penerapan the Theory of Planned Behavior (TPB) di RSUP Dr. Sardjito Yogyakarta

KETUT IMA ISMARA, Prof. Dr. dr. KRT. Adi Heru Husodo, M.Sc.; Prof. Dra. Yayi Suryo Prabandari, M.Si., Ph.D.; 8. Dr. Widodo Hariyono, ST., M.Kes

2018 | Disertasi | DOKTOR ILMU KEDOKTERAN DAN KESEHATAN

Latar Belakang: Rumah sakit memiliki potensi sumber bahaya bagi keselamatan dan kesehatan kerja (K3). Salah satunya adalah infeksi HCV, HBV, atau HIV, yang disebabkan oleh cedera tertusuk dan atau tersayat (CTS). Penelitian berawal dari data laporan unit K3 di RS Dr. Sardjito Yogyakarta di tahun 2013, terdapat 33 kasus, kejadian yang dialami oleh perawat. Data hasil penelitian pendahuluan tentang iklim K3 terhadap 100 responden di tahun 2014 menunjukkan 68% pernah mengalami CTS, dan hanya 38% saja yang melaporkan. Pihak yang berpengaruh untuk pencegahan CTS 52% adalah Unit K3, 27% oleh rekan sejawat dan sebesar 16% dipengaruhi oleh pimpinan. Tujuan penelitian ini adalah menganalisis hubungan antara iklim K3 yang terdiri atas sikap, norma dan persepsi kontrol perilaku dengan performansi melalui intensi sebagai model pencegahan CTS di RSUP Dr. Sardjito Yogyakarta berdasarkan Theory of Planned Behavior. Metode penelitian: secara keseluruhan penelitian ini menggunakan mixed method exploratory sequence design. Penelitian utama menggunakan konvergen mixed method karena data kuantitatif diperkuat dengan data kualitatif melalui FGD. Pengaruh antar variabel dianalisis menggunakan SEM dari data ex-post facto. Data kualitatif hasil pengamatan mendalam dan wawancara digunakan untuk mengembangkan kuesioner. Perilaku yang hendak diteliti dideskripsikan berdasarkan prinsip TACT (target, action, context, time) dari Theory of Planned Behavior. Populasi penelitian ini adalah perawat di RSUP Dr. Sardjito pada tahun 2016 sejumlah 1.042 dengan sampel 360 responden ditentukan secara multi stage sampling dengan taraf ketelitian 5%. Hasil penelitian: Sikap, norma dan persepsi kontrol perilaku memiliki hubungan erat yang dapat berperan membangkitkan intensi untuk berperilaku melaksanakan prosedur pencegahan CTS di RSUP Dr. Sardjito, sedangkan intensi berhubungan erat dengan performansi K3 berupa perilaku melaksanakan prosedur pencegahan CTS, namun persepsi kontrol perilaku tidak berhubungan langsung dengan performansi K3 karena indikator SMK3 tidak memiliki hubungan langsung terhadap performansi. Iklim K3 yang terdiri atas sikap, norma, dan persepsi kontrol perilaku memiliki hubungan tidak langsung terhadap performansi melalui intensi. Hubungan antar variabel menunjukan bahwa norma subjektif dapat terbentuk dari tugas pokok dan kegiatan pendukung. Variabel pembentuk intensi yaitu komitmen pimpinan, kemampuan diri, dan persepsi terhadap risiko. Kesimpulan: Performansi K3 terdiri dari perilaku pelaksanaan tugas pokok dan kegiatan pendukung berhubungan erat dengan iklim K3 melalui intensi untuk melaksanakan prosedur pencegahan CTS.

Introduction: Hospital jobs have high risks to occupational health and safety (OHS). One example is the risk of infection caused by needlestick/sharps injuries (NSI) such as hepatitis C virus (HCV), hepatitis B virus (HBV) and human immunodeficiency virus (HIV). According to the report from the unit of Occupational Health and Safety (OHS) at Dr. Sardjito hospital in 2013, there were 33 cases of NSI incidents mostly experienced by nurses. It was found that 68% of the respondents experienced NSI and only 38% of them reported their incidents. The report also showed that NSI prevention is considerably influenced by the OSH unit it self (52%). The colleagues and leaders came next as the influential parties for NSI prevention at 27% and 16% respectively. This study aimed to analyze the relationship between OSH climate (consisting of attitude, norm and perceived behavior control) and performance through behavioral intention as the NSI prevention model at Dr. Sardjito hospital based on the Theory of Planned Behavior (TPB). Method: Overall study used a mixed method with an exploratory sequence design. Main research used Konvergence mixed method. The influence between variables was analyzed by using the Structural Equation Model (SEM) analysis from the ex post facto data. The qualitative data obtained from the observations and in-depth interviews were utilized to develop a questionnaire. The behavior being investigated was decribed based on the TACT principle (target, action, context, time) following the Theory of Planned Behavior. The sample of this study consisted of 360 respondents, drawn from the population of 1.042 nurses at Dr. Sardjito Hospital in 2016 using multi stage sampling with the accuracy level of 5%. Results: Attitude, norm and perceived behavior control have a closely related with intention to behave following the procedures of NSI prevention at Dr. Sardjito. Meanwhile, the intention was closely related to the OHS performance in the form of behavior to perform the procedures of NSI prevention. The perceived behavior control, by contrast, was not directly related to the OHS performance as the indicator of SMK3 had no direct influence on performance. The OHS climate consisting of attitude, norm and perceived behavior control had indirect influence on performance through intention. The relationship between variables showed that the subjective norm was created from the main tasks and supporting activities. The variables to create intention included the leaders commitment, self-ability and perceptions towards risks. Conclusion: The occupational health and safety (OHS) performance consisting of the main tasks and supporting activities is closely related to the OSH climate through intention in implementing the procedures of NSI prevention.

Kata Kunci : perawat, CTS, Iklim, performansi, K3, nurse, NSI, climate, performance, safety