Perspektif Perawat Instalasi Gawat Darurat dalam Implementasi End Of Life Care Di Rumah Sakit Di Indonesia

MUHAMAD ASRUL ASMAN, Intansari Nurjannah, S.Kp., MN.Sc., Ph.D ; Syahirul Alim, S.Kp., M.Sc., Ph.D

2022 | Tesis | MAGISTER KEPERAWATAN

Latar belakang: Kebutuhan pemenuhan End of Life Care (EoLC) dalam praktik yang berkualitas pada pasien menjelang ajal di Instalasi Gawat Darurat (IGD) telah meningkat. Implementasi EoLC di IGD mengalami tantangan dan hambatan. Penelitian tentang implementasi EoLC di IGD Indonesia tentang sikap, pengalaman, pengetahuan dan perilaku perawat belum banyak dilakukan. Oleh karena itu, penelitian ini perlu dilakukan sebagai bahan pertimbangan dalam peningkatan kualitas EoLC di IGD. Tujuan: Penelitian dilakukan untuk mengetahui perspektif dalam implementasi EoLC tentang sikap, pengalaman, pengetahuan dan perilaku perawat IGD di Jambi. Metode: Penelitian ini menggunakan metode mixed method dengan desain convergent. Penelitian dilakukan di IGD RSUD Raden Mattaher Jambi dan IGD RSUD H. Abdul Manap Jambi. Data kuantitatif dikumpulkan menggunakan kuesioner. Jumlah responden pada pengambilan data kuantitatif sebanyak 54 perawat yang dihitung menggunakan instrumen Sample Size Calculator Raosoft. Pemilihan responden menggunakan teknik purposive sampling. Sedangkan, data kualitatif dikumpulkan melalui indepth interview pada 5 partisipan. Teknik sampling menggunakan snowball sampling. Selanjutnya, data dianalisis menggunakan triangulasi. Integrasi hasil pada ke dua data menggunakan pendekatan joint display. Hasil: Hasil penelitian kuantitatif meliputi sikap perawat dalam EoLC di IGD di dominasi sikap negatif (57,4%), pengetahuan perawat cukup (85,2%) dan perilaku perawat tergolong kurang (74,1%). Data kualitatif menunjukkan lima tema yaitu perawat memfasilitasi pelibatan keluarga dalam pengambilan keputusan dan kebutuhan spiritual, tanggapan perawat tentang perawatan EoL, reaksi emosional perawat, hambatan EoLC di IGD dan IGD bukan tempat yang baik bagi pasien EoL. Kesimpulan: Sikap negatif, pengetahuan cukup, perilaku kurang, adanya hambatan yang dialami perawat dan IGD bukanlah tempat yang baik bagi pasien kondisi EoL mengindikasikan perlunya peningkatan perspektif perawat IGD dalam implementasi EoLC.

Background: There is a need to fulfillment the quality practice of EoLC in dying patients especially in the Emergency Department (ED) has increased. The implementation of EoLC in the ER face challenges and obstacles. Research on the implementation of EoLC in the Indonesian Emergency Room regarding to the attitudes, experiences, knowledge and behavior of nurses has not been done much. Therefore, this study is important in regard as a consideration to improve the quality of EoLC in the ED. Objective: The study was conducted to determine the perspective of nurses attitude, experiences, knowledges and behaviors on the implementation of EoLC in emergency room nurses in Jambi. Methods: This is a mixed method using a convergent design. The study was conducted in the Emergency Room at Raden Mattaher Hospital Jambi and the Emergency Room at H. Abdul Manap Hospital Jambi. Quantitative data were collected using a questionnaire. The number of respondents in the quantitative data collection was 54 nurses who were calculated using the Raosoft Sample Size Calculator instrument. The selection of respondents using purposive sampling technique. Meanwhile, qualitative data were collected through in-depth interviews with 5 participants through snowball sampling. Furthermore, the data were analyzed using triangulation. The integration of the results on the two data uses a joint display approach. Result: The results of this quantitative study include the attitude of nurses in EoLC in the ER which is dominated by negative attitudes (57.4%), nurses' knowledge is sufficient (85.2%) and nurses' behavior is classified as lacking (74.1%). The qualitative data shows five themes, namely nurses facilitating family involvement in decision-making and spiritual needs, nurses' responses to EoL care, nurses' emotional reactions, barriers to EoLC in the ER and the ER is not a suitable place for EoL patients. Conclusion: Negative attitudes, insufficient knowledge, lack of behavior, obstacles experienced by nurses and the emergency room are not a suitable place for patients with EoL conditions indicate the need to increase the perspective of emergency room nurses in implementing EoLC.

Kata Kunci : sikap, pengalaman, pengetahuan, perilaku, perawat, perawatan End of Life, Instalasi Gawat Darurat