Upaya peningkatan mutu pelayanan keperawatan anak melalui pelatihan manajemen terpadu balita sakit (MTBS) pada tatanan rumah sakit di Rumah Sakit Cut Nyak Dhien-Meulaboh pasca bencana

HARYANTI, Fitri, Promotor Prof. dr. Mohamad Hakimi, Sp.OG(K)., PhD

2010 | Disertasi | S3 Ilmu Kedokteran

Latar belakang: Masalah kesehatan anak merupakan salah satu fokus penting dalam penanganan permasalahan akibat bencana. Perawat sebagai tenaga kesehatan terbesar, diharapkan dapat memberikan kontribusi dalam meningkatkan mutu pelayanan keperawatan anak di RS dengan kompetensi yang dapat dipertanggungjawabkan melalui pelatihan manajemen terpadu balita sakit (MTBS) pada tatanan RS. Tujuan: untuk menilai efektifitas pelatihan MTBS tatanan RS terhadap kompetensi perawat di RS Cut Nyak Dhien-Meulaboh, Aceh Barat, setelah tiga tahun bencana tsunami. Metode: Rancangan penelitian adalah stepped wedge design, yang berlangsung sejak Juli 2007 hingga Juni 2008. Subjek penelitian sejumlah 31 orang perawat yang seharihari bekerja melakukan pelayanan keperawatan anak di ruang UGD, ruang anak, ruang ICU, ruang VIP dan ruang utama RS Cut Nyak Dhien. Pada tahap awal, subjek mendapat diseminasi MTBS puskesmas selama dua hari. Peserta pelatihan adalah dokter, perawat dan bidan, sebanyak 76 orang, dibagi dalam tiga kelompok angkatan pelatihan. Pelatihan MTBS tatanan RS dilaksanakan selama empat hari, dengan fasilitator dokter spesialis anak. Materi pelatihan dengan menggunakan pocket book hospital care for children (WHO, 2005) yang sedang dalam proses diadaptasi oleh WHO, IDAI, dan Depkes RI. Pengumpulan data dilakukan dengan observasi terbuka yang dinilai oleh individu perawat, rekan kerja dan atasan langsung; kuesioner motivasi, karakteristik perawat (keahlian, pendidikan, usia, lama kerja, status menikah), dan kepuasan pasien, dilengkapi dengan FGD dokter yang belum dan yang sudah dilatih serta manajer perawat. Analisis data menggunakan linear mixed model (untuk melihat efek waktu pengukuran), dan analisis kualitatif. Hasil: Karakteristik subjek perawat dengan latar belakang pendidikan DIII Keperawatan 22 orang (71%), SPK 9 orang (29%); rentang lama kerja (1-28 tahun); jenis kelamin lai-laki 10 orang (32,3%), perempuan 21 orang (67,3%); status kawin 22 orang (71%), tidak kawin 9 orang (29%); rentang usia (23-50 tahun); asal unit kerja perawat dari IGD 8 orang (25,8%), ruang anak 8 orang (25,8%), ruang VIP 6 orang (19,4%), ruang utama 5 orang (16,1%), dan ruang ICU 4 orang (12,9%). Rentang pencapaian skor motivasi (64-80%), rentang skor keahlian (65-85%, dan rentang skor pelatihan 65-83. Evaluasi pelatihan level 1 menunjukkan bahwa pelatihan MTBS tatanan RS sangat bermanfaat dalam pekerjaan perawat sehari-hari. Ketersediaan pasien, fasilitas yang menunjang pelayanan dan penyegaran pelatihan diperlukan untuk meningkatkan kompetensi perawat. Kepedulian perawat terhadap pasien dirasakan masih kurang. Evaluasi pelatihan level 2 menunjukkan sebagian besar peserta sudah benar dalam menjawab penilaian tanda kegawatdaruratan dan prioritas, pemantauan pasien, dan perawatan pendukung. Evaluasi pelatihan level 3 menunjukkan bahwa kompetensi perawat dalam penilaian tanda kegawatdaruratan, tata laksana demam, masalah gizi, pemantauan pasien, dan perencanaan pemulangan pasien mempunyai skor lebih tinggi setelah mendapat pelatihan MTBS tatanan RS. Waktu pengukuran berpengaruh terhadap skor kompetensi perawat dalam tata laksana batuk atau sukar bernapas, tata laksana demam, tata laksana diare, perawatan pendukung, dan perencanaan pemulangan pasien. Evaluasi pelatihan level 4 menunjukkan kepuasan pasien pada perhatian perawat dalam melakukan pemantauan anak sakit. Kesimpulan: Pelatihan MTBS tatanan RS dapat dilaksanakan di daerah pasca bencana dan dapat meningkatkan skor kompetensi perawat dalam tata laksana anak sakit.

Background: Children health problem is an essential focus in management of problems derived from disaster. Nurses as the most health care provider, are expected to give contribution in promoting pediatric care quality in hospital using accounted nursing competences through Integrated Management of Childhood Illness (IMCI) training in hospital setting. Aim: The aim of this research is to evaluate the effectiveness of hospital-based IMCI training towards nurse’s competences in Cut Nyak Dien Hospital, Meulaboh, West Aceh, three years after tsunami. Method: The research design was stepped wedge design, which lasted since July 2007 to June 2008. Research subject were 31 nurses whose the daily activity is to taking care of children in Emergency Unit, Pediatric ward, Intensive Care Unit (ICU), VIP and main rooms for pediatric patients in Cut Nyak Dien Hospital. In the initial phase, subject were given dissemination about Community Health Center or Puskesmas-based IMCI for two days. Participants comprised physician (pediatrician), nurses and midwifes as many as 76 people. They were divided into three different training groups. The hospital-based IMCI training was given for 4 days, facilitated by pediatricians. Training material for hospital-based IMCI training was The Pocket Book Hospital Care for Children (WHO, 2005) which were still under adaptation process by the WHO, the Indonesian Pediatrician Association, and the Ministry of Health, Republic of Indonesia. The data gathering was done by open observation which was assessed by the nurse itself, peers, and their manager; using motivation questionnaire, nurse characteristics form (expertise, education level, age, work period, and marital status), and patient’s satisfaction questionnaire, completed by focus group discussion for physicians who were not yet trained and trained physicians and the nurse manager. Data were analyzed using linear mixed model (to know the effect of measurement period) and qualitative analysis method. Results: Nurse respondents’ characteristics with educational background of Diploma in Nursing or D III Nursing comprises 22 nurses (71%), 9 nurses (29%) graduated from Secondary School for Nursing; length of work period varied for all nurse respondents range from one to 28 years; ten respondents (32.3%) are men and the other 21 respondents (67.3%) are women; marital status married are 22 respondents (71%) and the rest 9 respondents (29%) are not married; and age rate range from 23 to 50 years old. 8 respondents (25.8%) are working in Emergency Unit, 8 respondents (25.8%) work in pediatric ward, 6 respondents (19,4%) work in VIP room, 5 respondents (16,1%) work in main room for hospitalization, and another 4 respondents (12,9%) work in ICU. The rate of motivation score achievement range from 64% to 80%, the rate of expertise score range from 65% to 85%, and training score rate range from 65-83.The result of first level training indicated the hospital-based IMCI training is very beneficent for nurse’s daily work. The availability of patient, facility that supports the health services and refreshment training are needed for promoting nurse’s competences. Nurse’s concern towards patients is still lack. The evaluation of the second level training indicated that most of participants were able to answer questions regarding the assessment of priority and emergency signs, monitor the client and administering supportive care correctly. The evaluation result of the third level training showed that the nurses’ competence in assessing emergency signs, fever management, nutrition problem management, patient monitoring, and discharge planning for patients showed higher score after receiving hospital-based IMCI training. The measurement period influenced the nurses’ competence score in the management of cough or breathing difficulty, fever, diarrhea, supportive care, and patient’s discharge planning. The evaluation result of the fourth level training represented patients’ satisfaction towards nurse monitoring of sick children. Conclusion: The hospital-based IMCI training can be done in post disaster area and it is possible to promote nurse competence score in management of sick children.

Kata Kunci : Kompetensi,Pelatihan,Evaluasi pelatihan,MTBS,Mutu pelayanan,Keperawatan anak, competence, training, training evaluation, IMCI, service quality, pediatric nursing