KUALITAS PERAWATAN PALIATIF PASIEN KRITIS DI ICU RSUP DR. SARDJITO YOGYAKARTA

SYARAH RYSTY SURYATY, Sri Setiyarini, S.kp, M.Kes.

2013 | Skripsi | ILMU KEPERAWATAN

Latar Belakang: Saat ini jumlah pasien kritis yang membutuhkan perawatan paliatif di ICU meningkat. Akan tetapi, masih ada beberapa masalah yang diterima pasien kritis dan keluarganya seperti tingginya angka kematian, konflik antara pasien, keluarga dan klinisi, kurangnya pemahaman keluarga dan klinisi mengenai perawatan paliatif, sehingga perlu adanya penilaian kualitas perawatan paliatif yang telah diberikan oleh klinisi terutama perawat dan dokter di ICU. Tujuan: Penelitian ini bertujuan untuk Menggambarkan dan membandingkan kualitas perawatan paliatif yang telah diberikan di ICU RSUP Dr. sardjito Yogyakarta berdasarkan penilaian perawat dan dokter terhadap masing-masing profesinya meliputi 7 domain kualitas perawatan paliatif di ICU. Metode: Penelitian ini melibatkan 11 responden dokter dan 22 responden perawat di ICU RSUP Dr. Sardjito, Yogyakarta. Pada penelitian ini digunakan self-report questionnaire yang diisi oleh perawat dan dokter di ICU RSUP Dr. Sardjito dengan jumlah pertanyaan sebanyak 10 item yang mewakili 7 domain perawatan paliatif di ICU. Masing-masing pertanyaan menggunakan rentang antara 0-10 (angka 0 mengindikasikan kemungkinanan penilaian terburuk dan angka 10 mengindikasikan kemungkinan penilaian terbaik). Hasil: Hasil menunjukkan bahwa perawat dan dokter di ICU RSUP Dr. Sardjito sama-sama memberikan penilaian dengan skor yang tinggi pada beberapa domain yaitu komunikasi tentang tujuan perawatan, pengambilan keputusan yang berpusat pada pasien dan keluarga, perawatan yang berkesinambungan, manajemen gejala dan pemberian rasa nyaman, sedangkan untuk skor paling rendah mereka berikan pada domain terkait dukungan emosional dan organisasi bagi perawat dan dokter di ICU terutama terkait penyediaan pendidikan bagi klinisi ICU. Dalam penelitian ini juga didapatkan hasil bahwa terdapat perbedaan dalam penilaian perawatan paliatif yang telah diberikan antara perawat dan dokter di ICU. Perawat dalam menilai kualitas perawatan paliatif yang telah diberikan oleh profesinya secara signifikan (P<0,05; effect size antara 0,36-0,84) lebih tinggi dibanding dokter pada dua domain yaitu dukungan praktik dan emosional untuk pasien dan keluarga serta manajemen gejala dan perawatan rasa nyaman bagi pasien dan keluarga. Kesimpulan : Masih perlu adanya peningkatan terkait dukungan emosional bagi perawat dan dokter di ICU. Lebih lanjut lagi masih terdapat perbedaan antara perawat dan dokter dalam menilai kualitas perawatan paliatif di ICU.

Background: The number of critical patients in need of palliative care in the ICU was increase. However, there are still some issues that received critical patients and their families such as the high number of deaths, the conflict between patients, families and clinicians, lack of understanding of families and clinicians regarding palliative care, so it is a need for assessment of the quality of palliative care provided by clinicians especially the doctor and nurse in the ICU. Objective: This study aims to describe and compare the palliative care provided by nurses and doctors in the ICU Dr. Sardjito Hospital based on assessment of nurses and doctors against each profession includes 7 domains of quality palliative care in the ICU. Method: This study involved 11 doctors and 22 nurses in the ICU Dr. Sardjito hospital, Yogyakarta as respondent. In this study used self-report questionnaire filled by nurses and doctors in the ICU Dr. Sardjito hospital, with as many as 10 questions the amount of items that represent the 7 domain palliative care in the ICU. Each question using a 0-10 scale (0 indicating the worst possible and 10 indicating the best possible). Results: The results show that the nurses and doctors in the ICU was Dr. Sardjito equally rated with a score that high on a few domains that communications about the goals of care, decision making based on patients and families, continuity of care, symptom management and comfort care, while for the lowest score they gave on domain related emotional support and organization for nurses and doctors in the ICU are mainly related to the provision of education for clinicians ICU. The study also found that there was a difference in the results of the assessment of palliative care that has been given among the nurses and doctors in the ICU. Nurses in assessing the quality of palliative care provided by his profession were significantly (P<0.05; effect size between 0.36-0.84) higher than doctors in the two domains of practice and emotional support to patients and families and symptom management and comfort care to patients and families. Conclusion: Still need an increase in related emotional support and organization for nurses and doctors in the ICU. Further still, there is a difference between nurses and physicians in assessing the quality of palliative care in the ICU.

Kata Kunci : perawatan paliatif, kualitas perawatan, Intensive Care Unit, perawat, dokter