Praktek Perawat Keliling Studi Kasus Tiga Perawat di Kabupaten Indragiri Hulu Propinsi Riau

AFRIL, Zul, Prof. dr. Laksono Trisnantoro, MSc, PhD

2008 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar belakang: Pelayanan profesional di daerah terpencil sangat terbatas karena kebijakan penempatan tenaga dokter masih bias ke wilayah perkotaan. Perawat merupakan tenaga yang paling banyak berada di daerah terpencil dan dimanfaatkan masyarakat sebagai tenaga pengobatan sejak lama di Indonesia. Mereka telah bekerja keliling dari satu desa ke desa lain karena permintaan pasien yang menginginkan layanan cepat dan terjangkau. Secara hukum perawat keliling telah melanggar peraturan karena mereka belum mempunyai ijin praktek dan menyalahi peraturan karena melayani masyarakat di luar bidang kewenangannya. Sementara kehadiran perawat keliling sangat membantu pemerintah menyelesaikan masalah kesehatan di masyarakat. Tujuan penelitian: Penelitian ini bertujuan untuk mendeskripsikan pelayanan kesehatan yang diberikan perawat keliling di Kabupaten Indragiri Hulu Metode: Studi kasus ini dilaksanakan bulan Febuari–April 2008. Data dikumpulkan melalui observasi partisipatif dan wawancara mendalam. Peneliti mengikuti perawat yang diamati dengan persetujuan terbuka oleh responden. Peneliti mengikuti tiga perawat keliling yang melaksanakan kegiatannya. Hasil penelitian: Berdasarkan hasil penelitian didapatkan bahwa jenis pelayanan yang diberikan oleh perawat keliling di Kabupaten Indragiri Hulu cukup lengkap, dari pelayanan perawatan hingga pelayanan pengobatan, mudah dijangkau, murah dan pembayaran yang fleksibel serta mau melakukan pelayanan kesehatan sesuai keinginan pasien. Perawat melakukan praktek perawat keliling karena tenaga kesehatan yang tersedia di daerah marginal adalah perawat Hal tersebut menyebabkan permintaan (demand) terhadap pelayanan kesehatan pada perawat cukup tinggi, namun tidak terlindungi oleh regulasi karena belum ada regulasi yang mengatur perawat praktek di Indragiri Hulu. Regulasi yang melindungi hanya dari lembaga persatuan perawat nasional. Tidak adanya regulasi tersebut menyebabkan pengawasan terhadap praktek perawat keliling tidak dapat dijalankan. Pengawasan tersebut dibutuhkan untuk melindungi masyarakat dan pelayanan perawat keliling itu sendiri. Kesimpulan: Penelitian ini membuktikan bahwa ketidaktersediaan dokter telah mendudukkan peran sentral dari perawat sebagai pemberi pengobatan di daerah terpencil. Selain itu, alasan-alasan jemput bola yang dilakukan perawat merupakan faktor utama dari penerimaan mereka dalam masyarakat. Mengingat peran sentral itu, pemerintah disarankan membuat payung hukum administratif dan profesional agar kontrol mutu terhadap perawat dapat ditegakkan.

Background: Professional service in isolated areas is very limited because the policy on the placement of doctors tends to put priority on urban areas. Nurses are health staff most commonly available at isolated areas and utilized by the community as medical staff in Indonesia for a long time. They have been working on mobile basis from one village to another because the community needs express and affordable services. Legally, mobile nurses have infringed regulations because they do not have permit for their practice and they provide services beyond their expertise. Meanwhile, the presence of mobile nurses greatly helps the government in solving health problems in the community. Objective: The study aimed to describe health services provided by mobile nurses at District of Indragiri Hulu. Method: This case study was carried out in February – April 2008. Data were obtained through participative observation and indepth interview. The researcher followed the nurses observed with open agreement from respondents and studied the activities they carried out in their work. Result: The result of the study showed that types of services provided by mobile services at District of Indragiri Hulu were relatively complete, comprising service of care to medication. The service was accessible and inexpensive and payment method was flexible. These nurses were willing to provide health services as demanded by patients. They provided mobile service because health staff available in marginal areas were nurses. This caused high demand for health service provided by nurses; however this mobile service was not protected by regulations because so fan there was no regulation which concerned with practising nurses at District of Indragiri Hulu. The only regulation that protected them was issued by national association of nurses. Absence of regulation on nurses caused control to practice of mobile nurses could not be enacted. The control was needed to protect the community and the service of mobile nurses itself. Conclusion: The study proved that unavailability of doctors had put nurses in a central position as medication providers in isolated areas. Besides, proactive approaches made by the nurses had become major factor of acceptance to their presence in the community. Considering their control role, it was suggested that the government issued administrative and

Kata Kunci : Jenis Pelayanan Perawat Keliling,Motivasi Sosial,Keahlian,Ketersediaan Petugas Kesehatan,availability of health staff, mobile nurses, social motivation, isolated areas