HEALTH LEARNING
MANAGEMENT AT NOONGAN
HOSPITAL, MINAHASA REGENCY
Pricilia P Mamuaja*, Deitje A Katuuk, Achmad Paturusi,
Jeffry S. J. Lengkong
Education Management,
Universitas Negeri Manado, North Sulawesi, Indonesia
Email:
[email protected]*
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Article
Information |
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ABSTRACT |
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Received:
February 16, 2023 Revised:
February 28, 2023 Approved: March 10, 2023 Online: March 16, 2023 |
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The purpose
of this study is to analyze and describe the management of health learning in
the community health center at Noongan Hospital, Minahasa Regency. Health
learning management is a form of learning management that focuses on nursing
care services in its role as an educator. The results showed that health
learning management has been carried out by Noongan Hospital, which is the
current research location. The stages of health learning are through the
assessment carried out by the nurse through the assessment of patients, the
planning made by the nurse referring to the results of the assessment, the
implementation of learning carried out by the nurse using demonstration
methods, instructions and videos and evaluations carried out by the
supervision team as well as periodic evaluations carried out by the head of
the room. Noongan Hospital has sufficient resources in the implementation of
health learning management, however, there are still weaknesses and
shortcomings that need to be addressed, especially by the hospital and
especially the head of the hospital so that health learning management can be
more optimized to support the improvement of more optimal health service
quality. ·
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Keywords |
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Health; Learning;
Management; Hospitals |
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INTRODUCTION
The hospital is a means of
providing health services to the community. Hospitals as institutions providing
comprehensive individual health services have a very strategic role in
realizing the highest degree of health (Law of the Republic of Indonesia No. 44
of 2009; Ministry of Health of the Republic of Indonesia [DEPKES RI] 2009).
Hospitals are required to provide quality services in accordance with
established standards and can reach all levels of society (Decree of the Minister
of Health No. 129 of 2008). Quality health services are one manifestation of
the demands of society in the current era of globalization. People who are
increasingly critical and educated are increasingly strengthening so that
health services are more responsive to community needs, implementing
transparent management, participatory and accountable (National Development
Planning Agency [BAPPENAS], 2011 in Komapo, 2013). In addition, the community
demands that hospitals must be able to provide health services related to
patient needs that must be served by hospitals easily, quickly, accurately, at
affordable costs (Yaslis, 2013).
The increasing demands of the
community for health facilities, especially in hospitals, continuously make
hospitals have to make efforts to improve the quality of health service
delivery. One of the quality of health services that must be continuously
improved is the quality of nursing services in hospitals (Depkes RI, 2012).
Every effort to improve the quality of hospital services must also be
accompanied by efforts to improve the quality of nursing services (Abdullah et al., 2013)Nursing
as a profession and professional staff is responsible for providing nursing
services according to the competence and authority possessed independently or
in collaboration with other members of the health team (Oyoh et al., 2017). In
the free market and liberalization era, professionalism is a superior
instrument to win competence, for this reason nursing staff must be more
competent and have high competitiveness regionally and globally (Ministry of
Health of the Republic of Indonesia [KEMENKES RI], 2010). Therefore nursing
services must be managed professionally in order to improve service quality
which is one indicator of nursing service management in hospitals.
Currently the world of
nursing in Indonesia is experiencing very rapid development. The health sector
has become an industry with extraordinary growth and by itself the need for
professional and competent nurses in their field has also increased (Surbakti, 2020). On
the one hand, this development is an opportunity for nursing staff in Indonesia
to increase their existence in the world of health, so they can stand side by
side with other professions. However, on the other hand, this development is
also a challenge for Indonesian nursing personnel to prove their abilities. If
Indonesian nursing staff do not immediately improve themselves both in terms of
competency and administration, then this opportunity cannot be used as
effectively as possible so that Indonesian nursing midwives will be left behind
compared to international trends.
Nurses in their duties and
functions have many obligations towards the health services provided. One of
their obligations is to provide health information (health education) needed by
the patient or in this case the nurse acts as an educator. The nurse is in
charge of increasing or developing the patient's level of understanding. This
is in accordance with the rights that should be received by patients, namely
receiving information related to their illness, starting from an understanding
of the disease, the procedure to be carried out to preparing the patient to go
home (Fatubun et al., 2022).
Fulfillment of client information needs, in this case health education, is an
indicator of the quality of health services in a hospital. The higher the level
of success in providing health education given or the higher the level of
patient satisfaction with the health education provided by nurses, the higher
the quality of health services in the hospital (Noprianty, 2019). The
Joint Commission on Accreditation of Healthcare Organizations has set standards
for patient health education. This is important because remembering that
patients are not always hospitalized so it is hoped that with health education,
patients and their families can carry out care at home. According to the
research results of the Health Service Medical Corporation, Inc., 1993, it is
estimated that around 80% of all health needs and problems can be addressed at
home, so the need to educate people about how to care for themselves does
exist. In addition, various studies note the fact that informed patients are
more likely to adhere to medical treatment plans and find innovative ways to
deal with the disease, to be better able to cope with the symptoms of the
disease, less likely to experience complications. This is in accordance with
the goal of health education, which is to help increase the degree of optimal
health. But in reality, the implementation of health education and the results
are not satisfactory. Only one-fifth of the 1500 nurses made preparations in
providing health education and with satisfactory results. A survey of 1,230
nurses in staff, administration and education positions regarding their
perceptions of the extent of nurse responsibility for health education and its
achievements found that they strongly believed that patient education was
basically the responsibility of 10 nurses, on the other hand the researchers
also found that health education activities that performed by nurses as a whole
the results were not satisfactory. In Indonesia, the frequency and satisfaction
of the results of providing health education by nurses in hospitals are not
known with certainty. It's just that if the frequency and results of providing
health education are associated with the percentage of nursing staff in
Indonesia (2004), namely SPK 49.2%, D3 44.5%, S1 5.4% and Masters non-nursing
0.9%, it can be seen that the The majority of nurses in Indonesia are still
educated in SPK. This greatly affects the provision of health education in
hospitals by nurses. it can be seen that the majority of nursing staff in
Indonesia are still educated in SPK. This greatly affects the provision of
health education in hospitals by nurses. it can be seen that the majority of
nursing staff in Indonesia are still educated in SPK. This greatly affects the
provision of health education in hospitals by nurses.
Nursing service is part of
the health service system in health service centers which has the function of
maintaining the quality of service, which is often used as a barometer by the
community, in assessing the quality of health service centers, thus demanding
the professionalism of nurses in their work as shown by the results of nurse
performance, both the implementing nurse and manager in providing nursing care
to clients. Maximum implementation of nurse work in quality health services
occurs when the system of implementation of nursing care that is carried out
supports professional nursing practice according to standards (Wahyuni, 2007).
Based on observations and
interviews at the initial data collection at the Noongan Regional General
Hospital, it was found that nurses rarely conduct health education on patients.
Health education that has been carried out so far has always been unprepared or
spontaneous and the results have been unsatisfactory. RSUD Noongan also does
not have a specific format for health education documentation. In addition,
supervisors, in this case the head of the room and the team leader, rarely
supervise or evaluate the implementation of health education, either directly
or indirectly. Provision of health education that is low and not optimal, often
causes problems, including: patients complain of anxiety and fear about their
illness or when a procedure will be carried out because previously they were
not given health education about their illness, many patients return to the hospital
with worsening disease conditions because previously nurses did not provide
health education about treating their illness while at home and it is difficult
to identify or evaluating the provision of health education indirectly due to
incomplete documentation or even no documentation. Seeing the various research
results and observations above, of course there are drivers or motivations for
nurses in providing health education in hospitals. This motivation will
determine and influence the provision of health education in terms of both
quality and quantity. Low motivation will certainly produce unsatisfactory
results and will ultimately reduce the quality of health services in a
hospital. This phenomenon attracted the interest of researchers to find out the
motivation of nurses at Noongan Hospital in conducting health education to
patients. Education is a system consisting of various elements, namely
educational goals or objectives, students, education administrators, and
structures or levels. Every component in the education system is interrelated
and influencing each other. The following data was obtained through the
Minahasa Regency BPS regarding the number of nursing staff in community health
service centers, especially at Noongan Hospital:
Table 1. Number of nursing staff in
community health service centers at Noongan Hospital
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No |
NURSING WORKERS |
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Work Unit/Regency/City |
Number of Personnel |
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1 |
Noongan Hospital |
168 |
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Total |
168 |
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The community has the right
to get health services with the best performance from health administrative
staff and other health workers (Syahrul et al., 2021).
However, affordable and quality health services at the Minahasa District
Community Health Center are still difficult to implement. A nurse should be
able to apply the knowledge she has learned in carrying out her health service
duties, including being able to implement learning management in health service
centers.
Health learning management in
question is clinical learning management in which a nurse is able to implement
all the clinical learning management theories she has acquired while studying
in lectures and practical periods. So far, when nurses start to enter the world
of work, they experience distraction about how the management of clinical
learning that they learn can be implemented in their work, especially in
nursing care. This learning management concerns how a nurse is able to plan,
organize, implement and make evaluations regarding clinical learning carried
out during the implementation of her professional duties.
Nurses' poor knowledge can be
associated with barriers from nurses and patients. Barriers from nurses and
patients include nurses not being ready to provide health education. This
unpreparedness can be caused by the inadequate education of nurses, the
personal character of nurses and time constraints. Inadequate education, lazy
and uncreative personal character make nurses less able to provide health
education according to patient needs.
It is not uncommon to hear
about the bad practice of services provided by health workers to the community.
There are health workers who do not do what they should do and there are health
workers who do something that they should not have the authority or competence
to do. It also often happens that apparatus or staff resources, especially
nurses at the Minahasa District Public Health Center do not have or lack the
competence of Human Resources. organizational operative work, to make decisions
or take appropriate actions, and help the smooth development of the
organization as a whole, and also in providing administrative services to the
community. However, to what extent this assumption is true, further research is
needed. In addition, the quality of service is said to be effective, when the
community gets easy service, as well as a short, fast, precise process and the
community as the recipient of the service is satisfied. Success in improving
the quality of public services is based on the government's ability to improve
the work obedience of service-providing employees, and of course it must be
carried out based on applicable rules or norms. Moreover, the
purpose of this study is to analyze and describe the management of health
learning in the community health center at Noongan Hospital, Minahasa Regency.
METHODS
This
research is classified as a qualitative research, as stated by Sugiyono (2017) that
qualitative research is a research method based on the philosophy of
positivism, used to research on natural object conditions, (as opposed to
experiments) where the researcher is the key instrument, data collection
techniques are carried out by triangulation (combined), data analysis is
inductive/ qualitative and the results of qualitative research emphasize
meaning rather than generalization (Abdussamad, 2022). In
line with Creswell's statement (2017),
qualitative research is methods to explore and understand the meaning that a
number of individuals or groups of people ascribe to social or humanitarian
issues.
Qualitative
research was chosen because this method is in accordance with the research
objectives so that it will be easier for researchers to determine the
formulation of problems and prepare reports. Furthermore, the descriptive
method was chosen because the data sought was in the form of a statement. In
addition, the descriptive method was chosen to make it easier for researchers
to collect data and to describe the data obtained from the field in the form of
descriptive data (not numbers or statistics). This research seeks to describe a
study which is a phenomenon or relationship related to howmanagement of nursing services in Minahasa
District.
The
location chosen by the author for this research is Sam Ratulangi Hospital and
Noongan HospitalWherePreviously
the authors had conducted an initial survey of the problems the authors
observed related to the management of nursing services. The author feels
interested in researching this matter, for that, the two RSUDs were chosen.
This research is a qualitative research so
that the key instruments are the researchers themselves and the supporting
instruments in the form of interviews and questionnaires.
The
data sources of this research consist of two kinds of sources, namely primary
and secondary data sources. The primary data source comes from interviews with
the Head Nurse of Sam Ratulangi Hospitaland Noongan Hospital.
Primary data sources also come from observations of the nursing service process
carried out in the two hospitals. Secondary data sources in this study were
obtained from various documents related to nursing services carried out inSam Ratulangi Hospital and Noongan Hospital.
These documents include patient care schedules, division of duty schedules,
documentation of nursing service activities, profiles of hospitals, and
circular letters. This
study will use a triangulation technique in which researchers will combine
three techniques, namely observing participants, conducting in-depth
interviews, studying documentation.
Data
collection
Interview
The
interview is a meeting of the informant (information provider) and the
interviewer (information seeker). This method will be used by the author to
find out data such as how to implement learning management or nurse education
for patients in hospitals. Esterberg stated that an interview or interview is a
meeting between two people to exchange information and ideas through questions
and answers, so that meaning can be constructed in a particular topic. The
informants that the researchers will interview are the head of the hospital,
the head nurse, and the nurses.
When
viewed from the implementation, interviews can be divided into two, namely; (1) structured
interviews are used as a data collection technique if the researcher or data
seeker already knows exactly what data or information he will obtain, and (2) unstructured
interviews, free interviews, where the researcher does not use various interview
guidelines that have been arranged in a coherent and systematic manner to
collect the data. This means that the interview guide used is only an outline
of the problem you want to ask. This study uses structured interviews to obtain
data. This technique was chosen because apart from providing clearer directions
it also avoids a lack of required data or obtaining unnecessary data.
Observation
Sutrisno
Hadi argued that observation is a complex process and is composed of various
biological and psychological processes. Two of the most important are the
processes of observation and memory. In terms of the process of implementing
data collection, observations can be divided into two, namely: (1) participant
observation, namely the researcher is involved with the daily activities of the
person being observed or used as a source and research, and (2) non-participant
observation, that is, the researcher is not directly involved with the
activities of the person being observed. In this type of observation the researcher
is not involved and is only an independent observer. Based on the instrument
aspect, the observation is divided into two parts, namely structured and
unstructured observation. Structured observation is an observation that has
been designed systematically, whether it is related to what is being observed
or when and where it is carried out. While unstructured observation is an
observation that is not prepared systematically about the things to be
observed. This study will use non-participant and structured observation.
Researchers will observe the process of planning and implementing learning both
online and offline as well as in the process of making learning media and
learning evaluation. Observations were made on the learning process, teachers, and
students involved in the learning.
Documentation
Documentation
is a record of events that have passed, in which the forms of documents may
include the following (1)
writing, for example diaries,
biographies, regulations, policies, history alive, etc., (2) images, can
be in the form of photographs, live images, sketches, etc., and (3) monumental
works, such as sculptures, films, paintings, etc.
Document
studies can be used as a complement to observations and interviews in a study.
Therefore, it is hoped that the research method used by the author is complete
and supports this research. The documents that researchers collect include
photos and data on learning activities originating from Google Classroom, Zoom,
learning tools, interview results, as well as learning media such as videos and
so on.
Data
Analysis
Bodgan
stated that data analysis is the process of systematically searching for and
compiling data obtained from interviews, field notes, and other materials, so
that it is easier for both oneself and others to understand, and the findings
can be informed to the general public. Data analysis is very important in a
research because the results of the analysis will produce information that can
later be understood in order to achieve the goal of conducting a scientific
research. For this reason, the data analysis that will be carried out by the
author this time will use analysis techniques that are in accordance with the
nature of the data that will be collected, namely qualitative data.
Data
collected from interviews, observations, or documentation and field notes will
be processed by researchers using descriptive methods. The results aim to
describe and explain an event systematically according to real conditions and
use language that is easier to understand. The systematics of data analysis is
carried out as follows:
1) Read,
analyze and study all data from various sources.
2) Conduct
data reduction which is done by making a core summary
3) as
well as an abstraction of the process and questions that are still needed in
it.
4) Compilation
of data according to the research procedures used.
5) Conduct
a re-examination of the validity of the data.
The data collection process
was carried out through three stages, namely
1) Preliminary
stage,
2) Screening
stage, and,
3) Insufficient
data completion stage.
From
this process, checking the validity of the data most often occurs at the data
filtering stage. Therefore, if there is data that is less relevant or
inaccurate, further data screening will be carried out in the field until it becomes
valid data. In research also needed a technique to check the validity of the
data. One technique of checking the validity of the data is triangulation.
Triangulation is checking the validity of data that interprets something other
than the need to check or compare data. The triangulation technique, which
examines through various sources, is the most frequently used technique. The
achievement of source triangulation can be achieved through comparing observed
data with interview results, comparing someone's words privately and when in
public, compare what people say during research and what they say over time,
compare opinions between respondents, and compare interview results with
related documents. An example of triangulation of data sources is by "comparing
and back-checking the degree of trust in information obtained through different
times and tools in qualitative methods". Another expression means that if
after going through the examination it turns out that the respondents' answers
are not the same or there are differences in the data or information found,
then the validity of the data obtained is doubtful. In such circumstances,
researchers must carry out further examinations, so that they will be able to
find out which information is more correct. In this study, researchers will use
data sources derived from interviews with the head of the Noongan Hospital,
Minahasa Regency.
RESULTS
As
much as 90% of services performed in hospitals are nursing services (Fricilia, 2020).
Nursing services provided will have an impact on patients as recipients of
nursing services. The impact that occurs if the nursing services provided are
not good, namely the patient will feel reluctant to return to the hospital for
treatment (Pertiwiwati & Rizany, 2017).
Nursing services are efforts made by nurses to meet basic human needs. In
addition, there is another role played by nurses in carrying out their duties,
namely by carrying out the role of educator. Interpersonal teaching is one of
the efforts made by nurses in carrying out their role as educators. The role of
the nurse as an educator is to provide education, teaching, training, direction
and guidance to clients and their families in overcoming health problems (Simamora, 2009).
Nurses as educators play a role in providing knowledge to clients about the
medical treatment received (Susanto, 2012). The
primary teaching role of the nurse is teaching the patient and the patient's
family (Hapsari, 2013).
Teaching nurses to patients is very important because the International Council
of Nurses (ICN) also argues that patient education is the main fundamental
aspect of providing nursing care.
Assessment
of Learning Materials
In
accordance with the stages of health learning in the hospital, the initial
stage is to conduct an assessment. This assessment was carried out for the
purpose of analyzing what needs need to be prepared in providing education for
patients and their families.
Education is something
that is consistently facilitated by the hospital, especially in areas that have
a high risk for patients. This is done by the hospital so that health functions
return to optimality. Education begins when the patient enters a healthcare
facility and continues throughout the treatment period, until after the patient
is discharged. Effective education begins with assessing the educational needs
of the patient and the patient's family. The implementation of patient
education is a challenge for health organizations, because it requires a
planned effort to prepare appropriate tools and resources to meet the actual
needs of patients. Education is most effective when it is carried out according
to the choice of learning and in accordance with cultural values, religion,
reading ability and the language used by the patient. Education includes the knowledge needed during
the care process as well as the knowledge needed after the patient is
discharged to another health service or home. Thus, education can include
information on resources in the community for additional services and follow-up
services if needed, as well as how to access emergency services if needed.
Effective education in a hospital should use visual and electronic formats, as
well as a variety of distance education and other techniques. Data obtained from
PR-A.1 suggests that:
The assessment is carried out in the early stages before planning
the lesson. This study was carried out in the form of an assessment of the
educational needs of the patient and the patient's family which included the
preparation of tools and resources according to what the patient and the
patient's family needed.
In nursing care, the assessment stage is the initial stage before
carrying out a learning plan for education for the patient and the patient's
family in order to find out what needs must be prepared regarding the learning
process that will be carried out.KR-A.1 stated that:
Our
hospital already has an SOP regarding the assessment of the educational needs
of patients and families, the hospital has earlier provided an SPO which
includes providing education to patients and their families both inpatients and
outpatients.
The
field of nursing at Noongan Hospital already has an SOP for assessing the
educational needs of patients and families as well as an SOP for providing
patient and family education both inpatient and outpatient.
Learning
Planning
Learning in the framework of education is planned to ensure that
each patient is given education according to his needs. The hospital determines
the effective and efficient organization of educational resources. Therefore,
hospitals need to establish a Hospital Health Promotion Organization (PKRS),
create educational services, and arrange the assignment of all staff who
provide education in a coordinated manner. The
organization in providing patient and family education is decentralized in
nature, where the authority that was originally centralized was divided into
several persons in charge. Each nursing staff has a job description according
to their clinical authority. Clinical authorization is an assignment
recommendation authorized by the hospital director. Clinical authority is a
reference from the nurse's job description used in providing patient and family
education. The difference in coverage in providing education is categorized
based on the PK owned by the nurse. Pre-Clinical Nurses (PK Pre-Clinical) carry
out the basic needs’ education process under supervision from superiors, while
Clinical Nurse 1 (PK I) carry out basic needs education independently, for
Clinical Nurses II (PKII) carry out educational needs in specific areas, then
carry out an evaluation and make a follow-up plan, and for Clinical Nurse III
(PKIII) the same as PK II plus preparing a learning plan in a specific area. As
raised by a senior nurse KR-A.2:
As nurses we must always be ready
to take the actions deemed necessary to provide information and education for
patients and even their families so that they feel comfortable and confident
about the medical actions that will be taken while at the same time informing
them that medical staff are carrying out their duties according to the SOP.
Based
on the results of the data collection carried out, it shows that the hospital
already has a plan regarding the provision of patient and family education.
Furthermore KR-A.2 confirms that:
We at Noongan Hospital have work
implementation standards which include providing education for patients and
patient families and that has been made in planning the implementation of work
for medical personnel, we do not only carry out medical procedures but also
provide education related to non-medical aspects.
In accordance with the stages of
planning nursing care is a stage that is no less important than the earlier
assessment carried out. In accordance with the MKE (Communication and Education
Management) guidebook that forplanning education is carried out an assessment which includes:
1) patient and family beliefs and values;
2) reading ability, level of education, and language used;
3) emotional and motivational blocks;
4) physical and cognitive limitations;
5) patient's willingness to receive information.
To understand the educational needs of each patient and family, an
assessment process is needed to identify the type of surgery, other invasive
procedures, action plans, treatment needs, and continuity of care after discharge
from the hospital. This assessment enables the care-giving professional (PPA)
to plan and implement the required education.
Implementation of Learning
In carrying out learning activities
in the hospital there is a hierarchical system according to the main tasks and
functions. The function of direction can be seen in providing directions for
Preclinical PK nurses who receive guidance or mentorship from PK I, II, or III
nurses in providing patient and family education. New beginner PK nurses will
be coached by PPJA and the Head of the Room in carrying out nursing
interventions, especially providing patient and family education. The coaching
lasts for one year and then novice PK nurses will follow credentials to obtain
clinical authority, clinical assignments, and placements in accordance with the
results of the credentials that have been carried out. In accordance with the
MKE (Communication and Education Management) guidebook RThe hospital uses standard patient education materials and processes on
at least the following topics:
1)
effective and safe use of medicines that patients get (not just
drugs prescribed to take home), including potential side effects of drugs;
2)
effective and safe use of medical equipment;
3)
potential interactions between prescription drugs and other drugs
including non-prescription drugs as well
4)
diet and nutrition;
5)
pain management;
6)
rehabilitation techniques;
7)
how to wash hands properly
From
the data obtained from interviews with one of the nurses caring for the KR-A.3
room, it was stated that: The
implementation of learning, namely the provision of education is mostly carried
out by senior nurses, the interpersonal skills of nurses with longer working
tenure pay close attention to the implementation of education for patients and
patient families, the stages of implementation are in accordance with the
planning that has been recorded in the nursing care guide.
A manager in carrying out the control
function will evaluate and monitor the job descriptions carried out by the
nursing staff. Evaluation and monitoring are based on standards, policies,
regulations, and clinical authority set by the hospital.
The control function in providing
patient and family education is not optimal. Supervision of educational
provision has been carried out but has not been scheduled and has not used
tools or instruments in supervising.
The assessment of the provision of
education has not been included in the monitoring report on the achievement of
quality indicators, patient safety and the performance of work units in the
field of nursing services or nursing committees which are evaluated
periodically. An assessment of the provision of existing education was carried out
by the Infection Control Prevention (PPI) team regarding education about hand
hygiene, pre- and post-surgery preparations that can be carried out by patients
and families in preventing infection. This report is collected every month, as
material for evaluation and verification of education carried out related to
infection transmission.
The new assessment focuses on the
quantity of achievement targets resulting from the implementation of education.
Recording of the outcomes of providing new education was carried out by the PPI
team, there has been no record made by the head of the room, or the committee
and the field of nursing services. This is because the implementation of
providing education has not yet become an assessment of service quality. The
data obtained confirmed through interviews with the person in charge of the
KR-A.4 room: In
this hospital there has been provision of education through a learning process
that has been planned for documentation in the hospital but that has not yet
become an assessment in the implementation of performance so that it is
sometimes ignored, especially by nurses whose tenure is still relatively short.
Learning Evaluation
The
learning evaluation stage is carried out as follows:
1) The hospital identifies existing community resources to support
ongoing health promotion and education to support ongoing patient care.
2) Patients and families
are referred to receive education and training needed to support ongoing
patient care, in order to achieve optimal care outcomes after leaving home
3) This continuous
education is given to patients whose discharge plans are complex.
Feedback
from patients and families is inseparable from the knowledge provided by nurses
to patients and families. Patients and families who initially did not know
became aware, as well as changes in healthy lifestyle behavior. In addition,
patients and families can be more careful in every action, both prevention and
treatment. This is illustrated in the PR-A.3 statement: "Patients who don't know
know, for example hepatitis patients, so that can be taken care of, how to
prevent infection and so on."
Changes
in patient and family behavior are also one of the feedbacks after the patient
and family get knowledge from the nurse. This can be seen in the nurse's statement
PR-A.3: "Yes,
the goal is to know more, and there is a change in healthy behavior. Maybe the
husband is sick, the wife is more careful to prevent the husband's illness from
recurring. For example, be careful in terms of food or daily life so that the
quality of the patient's health improves and is maintained.
From
the statements of all the nurses above, it can be seen that there is a picture
of knowledge towards an understanding of the benefits of the role of educator
for patients and their families. Nurses also expect feedback from patients and
families even though in this process no evaluation is carried out using certain
guidelines or standards. This is inseparable from how nurses perceive the
implementation of learning in providing education for patients and families.
To control the quality
of learning services, supervision is also carried out. Supervision is a process
of supervising, providing direction, correcting, guiding, evaluating carried
out by nursing supervisors in order to improve the ability of nursing staff so
that they can provide quality nursing care to patients. Most nursing staff
accept that supervision is important in supporting the implementation of
quality nursing care.
The conceptualization of
nursing supervision is basically related to the professional development of
nurses and always considers the concept of quality care provided to patients.
Supervision is a management function in controlling which is carried out to
direct nurses to behave effectively and efficiently in providing services.
Managers need to have a specific strategy in providing quality services, one of
which is by implementing the supervision of providing patient education.
Education or education is the basis of all learning processes whose
implementation is the responsibility of managers in an organization.
Education provided by
nurses will affect patient adherence in treatment, satisfaction with the
services patients receive during treatment, as well as understanding
information that is easier to understand which has an impact on reducing
hospitalization rates and patient readmissions. It is important for the health
team to be able to work closely with patients and families in identifying
educational needs needed to improve the patient's ability to care for himself.
Many studies and trends show that providing education and increasing patient
and family knowledge does not necessarily affect clinical outcomes or influence
how a person can use the information obtained to manage the patient's illness. The
results of the analysis of health learning management in the form of interviews
and observations of providing patient and family education at Noongan Hospital
were then analyzed, so it can be described as follows:
Table 2. Health
Learning Management at
Noongan Hospital
|
Aspect |
Focus |
Findings |
|
Health Learning Management in
Hospitals |
Assessment |
1.
SOP
for providing education is available 2.
The
educational needs assessment forms are still overlapping 3.
The
availability of learning media and teaching aids in each room is still
minimal, it needs to be optimized 4.
The
results of observations of the completeness of the documentation of the
provision of education are still limited to medical needs |
|
Planning |
1.
Lesson
planning has not been systematically planned 2.
Have
an SOP for learning needs assessment |
|
|
Implementation |
1.
The
implementation of learning in the context of education can be seen from the
documentation of patient and family education that has not been optimal 2.
There
are no entries in the nurse's log book for the implementation of patient and
family learning 3.
The
implementation is still voluntary because the provision of education has not
yet become an assessment of the performance of nurses at the hospital 4.
Non-nursing
duties are still carried out by nurses 5.
The
mobility of room attendants is high so that the implementation of learning is
often neglected |
|
|
Evaluation |
1.
Take
follow-up steps by collecting feedback from patients and families 2.
Assess
changes in behavior and attitudes of patients and families after learning 3.
Supervision
of the assessment of the implementation of patient and family learning that
is not optimal based on the standards set by the hospital |
The
cause of the problem is not optimally providing patient and family education
seen from the aspects of man, money, environment, material, method and machine. Aspects of man include not
optimal preparation of nurses in providing education, implementation
of educational supervision that is not routine, the qualifications of nurses
who are mostly educated are D3 Nursing (65%). Nurses still do a lot of
non-nursing tasks and the mobility of room nurses is high. The SPO for
providing education already exists in the Accreditation Documentation
Management Information System (Sismadak) in hospitals, overlapping educational
forms, the availability of different educational media in each room, and
incomplete documentation. The aspect of the method is not yet optimal in
implementing documentation and supervising the provision of education, filling
in the nurse's logbook which has not focused on providing education.
Nursing
is a health profession that considers patient education to be an important
component of nursing interventions by nurses. Florence Nightingale is the
founder of modern nursing and also a great educator. Not only being the first
person to establish a school of nursing, Florence Nightingale also devoted most
of her career to educating nurses, doctors and other health workers about the
importance of creating proper hospital and home environmental conditions to improve
the health status of patients.
The
care giver (PPA) must have the ability to provide education effective and efficient treatment
for patients and families. Increasing
PPA compliance in conducting education as needed is expected to be able to
reduce the readmission rate and provide a good understanding for patients and
families regarding conditions and further care which is the patient's right.
Nursing care includes a series of processes consisting of assessment, data
analysis, intervention, implementation, and evaluation. There are 4 types of
interventions carried out by nurses, namely observation, education, therapeutic
and collaboration. Nursing interventions are all treatments carried out by
nurses who have a basic knowledge and clinical judgment in realizing expected
results. Improving patient compliance is an important factor in care that
nurses can do by providing education regarding their condition. Education
carried out by nurses is an implementation that has a positive impact on
patient compliance. For example, in pulmonary TB patients, the education
provided makes the patient and family understand how to carry out care during
recovery, and in improving the quality of life after treatment is complete.
CONCLUSION
Learning in the context
of providing patient and family education is one of the intervention activities
carried out by the health team including nurses at Noongan Hospital, Minahasa
Regency. The phenomenon raised is the management of health learning in the
context of providing education. Having guidelines, guidelines, SOPs and
instruments is a way that can be done in optimizing the implementation of
providing education. The support and commitment of every managerial staff as
well as the concern and commitment of clinical nurses can build change for a
hospital. Implementation of supervision providing patient and family education
can improve the quality of nursing services so that it can be concluded that:
(1) the study of patient and family health learning at Noongan Hospital has
been carried out although it is still at a limited level and is still internal,
(2) patient and family health learning planning in two hospitals, namely
Noongan Hospital, has been carried out although it is still centralized and
still very limited at the hospital level, it has not yet reached the level of
rooms, (3) the implementation of patient health learning in two hospitals,
namely Noongan Hospital, is still not optimal because nurses see that in the
activity log book there is no menu entry about patient and family health
learning/education so this activity is considered as an activity that is not
mandatory, especially since this activity is not yet an assessment. performance
for nurses, (3) evaluation of patient and family health learning has been
carried out although it is still very limited because learning planning is not
made at the room level so this activity still does not answer the needs of each
room, although feedback from patients is often also asked to get feedback that
must be followed up for next activity, and (4) the challenges and obstacles
found are in the form of opposition from the health institution itself, namely
the lack of support from both the administration and the service system
provided as well as from the human resources in the hospital, there is still
limited knowledge about the management of health learning in the hospital so
that in the future the hospital is advised to can provide health learning
management guidelines so that all elements with an interest in health services
have a reference in implementing health learning management.
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