TESIS ANALISIS FAKTOR YANG BERHUBUNGAN DENGAN PERILAKU PATUH DALAM PENGGUNAAN ALAT PELINDUNG DIRI (APD) (Studi Pada Perawat di Instalasi Rawat Inap RSU Haji Surabaya)

  

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TESIS

ANALISIS FAKTOR YANG BERHUBUNGAN DENGAN PERILAKU

  

PATUH DALAM PENGGUNAAN ALAT PELINDUNG DIRI (APD)

(Studi Pada Perawat di Instalasi Rawat Inap RSU Haji Surabaya)

LINA YULIANA

UNIVERSITAS AIRLANGGA

FAKULTAS KESEHATAN MASYARAKAT

PROGRAM MAGISTER

PROGRAM STUDI KESEHATAN DAN KESELAMATAN KERJA

SURABAYA

  

2016

  

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TESIS

ANALISIS FAKTOR YANG BERHUBUNGAN DENGAN PERILAKU

  

PATUH DALAM PENGGUNAAN ALAT PELINDUNG DIRI (APD)

(Studi Pada Perawat di Instalasi Rawat Inap RSU Haji Surabaya)

OLEH:

LINA YULIANA

  

NIM. 101324253002

UNIVERSITAS AIRLANGGA

FAKULTAS KESEHATAN MASYARAKAT

PROGRAM MAGISTER

PROGRAM STUDI KESEHATAN DAN KESELAMATAN KERJA

SURABAYA

2016

  

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TESIS

Untuk memperoleh gelar Magister Kesehatan dan Keselamatan Kerja

  

Program Studi Kesehatan dan Keselamatan Kerja

Fakultas Kesehatan Masyarakat

Universitas Airlangga

  

Oleh :

LINA YULIANA

NIM 101324253002

UNIVERSITAS AIRLANGGA

FAKULTAS KESEHATAN MASYARAKAT

PROGRAM MAGISTER

PROGRAM STUDI KESEHATAN DAN KESELAMATAN KERJA

SURABAYA

  

2016

  

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PENGESAHAN

Dipertahankan di depan Tim Penguji Tesis

  

Program Studi Kesehatan dan Keselamatan Kerja

Fakultas Kesehatan Masyarakat Universitas Airlangga

dan diterima untuk memenuhi persyaratan guna memperoleh gelar

Magister Kesehatan dan Keselamatan Kerja (M.KKK.)

  

Pada tanggal 21 Januari 2016

Mengesahkan

Universitas Airlangga

Fakultas Kesehatan Masyarakat

  

Dekan,

Prof. Dr. Tri Martiana, dr., M.S.

  

NIP 195603031987012001

  Tim Penguji: Ketua : Dr. Y. Denny Ardyanto W, Ir., M.S. Anggota : 1. Prof. Dr. Tjipto Suwandi, dr., MOH., Sp.Ok.

  2. Dr. M. Bagus Qomaruddin, Drs., M.Sc

  3. Dr. Neffretty Nilamsari, S.Sos., M.Kes

  4. Dr. Diah Indriani, S.Si., M.Si 5. dr. Tanya Elize Viyaya S, M.Kes

  

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  Puji syukur kehadirat Allah SWT, karena atas limpahan rahmat-Nya penulis dapat menyelesaikan tesis yang berjudul “Analisis Faktor yang Berhubungan

  

dengan Perilaku Patuh dalam Penggunaan Alat Pelindung Diri (APD) pada

Perawat di Instalasi Rawat Inap RSU Haji Surabaya”.

  Tesis ini berisikan mengenai faktor yang mempengaruhi perilaku penggunaan alat pelindung diri (APD) yang meliputi faktor intenal (usia, jenis kelamin, masa kerja, status kepegawaian, komitmen individu, pengetahuan, dan sikap) dan faktor eksternal (faktor pekerjaan dan shift kerja)) di RSU Haji Surabaya.

  Ucapan terima kasih yang tak terhingga saya sampaikan kepada Prof. Dr. Tjipto Suwandi, dr., MOH., Sp.Ok, selaku pembimbing yang telah dengan kesabaran dan perhatiannya dalam memberikan bimbingan. Ucapan terima kasih yang tak terhingga juga saya sampaikan kepada Dr. M. Bagus Qomaruddin, Drs., M.Sc selaku pembimbing kedua yang telah banyak meluangkan waktu untuk memberikan bimbingan, dengan sabar serta memotivasi dan saran demi kesempurnaan tesis ini.

  Dengan terselesaikan tesis ini, perkenankan saya mengucapkan terima kasih yang sebesar-besarnya kepada :

  1. Prof. Dr. Moh. Nasih, SE., MT., Ak. selaku Rektor Universitas Airlangga

  2. Prof. Dr. Tri Martiana, dr., M.S., selaku Dekan Fakultas Kesehatan Masyarakat, Universitas Airlangga.

  3. Dr. Abdul Rohim Tualeka, Drs., M.Kes selaku Ketua Program Studi Magister Kesehatan dan Keselamatan Kerja Periode Tahun 2016-2021 dan Dr. Y. Denny Ardyanto W, Ir., M.S selaku Ketua Program Studi Magister Kesehatan dan Keselamata Kerja Periode Tahun 2011-2015, Fakultas Kesehatan Masyarakat, Universitas Airlangga beserta dosen dan para staff.

  4. Ketua penguji Dr. Y. Denny Ardyanto W, Ir., M.S, dan anggota penguji Dr.

  Neffretty Nilamsari, S.Sos., M.Kes, Dr. Diah Indriani, S.Si., M.Si, dan dr. Tanya Elize Viyaya S, M.Kes, atas kesediaan menguji dan membimbing dalam perbaikan tesis ini.

  5. RSU Haji Surabaya, bagian Diklit, tim K3, tim PPI, dan seluruh responden penelitian di RSU Haji Surabaya yang telah membantu pelaksanaan penelitian.

  6. Bapak H. Muhammad, Ibu Hj. Faridah, Ahmad Husain Tohari, Putriku Hana Azzahrah Nadaatusyifa’ dan keluarga yang selalu mendo’akan dan motivasi.

  7. Teman seperjuangan S2 M.KKK angkatan 2013/2014 yang telah memberikan dukungan serta bantuan dalam penulisan usulan penelitian tesis ini.

  Demikian, semoga tesis ini bisa memberikan manfaat bagi diri kami sendiri dan pihak lain yang menggunakan.

  Surabaya, 21 Januari 2016 Penulis

  

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SUMMARY

THE ANALYSIS OF FACTORS RELATED TO A COMPLIANCE

  

BEHAVIOR IN USING PERSONAL PROTECTIVE EQUIPMENT (PPE)

(Study on Nurses in Inpatient Installation of RSU Haji Surabaya)

  Healthcare Associated Infections (HAIs) is one of workplace risks faced by health services. HAIs occur worldwide especially in third-world countries or developing countries. Several diseases are infected through blood and body fluids, such as: HIV and hepatitis. HIV, Hepatitis B and Virus Hepatitis C are the main hazards for health services. The high risk of Healthcare Associated Infections (HAIs) occurred in hospital leads to the effort of control in using Personal Protective Equipment (PPE). Thus, compliance behavior in using PPE is one of solutions in controlling the hazards caused by workplace illnesses and workplace injuries on health services especially nurses in hospital. This was based on spread of infectious diseases which is infected through blood and body fluids (excretion and secretion) during treatment. Using personal protective equipment (PPE) has been regulated in Standard Operational Procedure (SOP) designed by the hospital and in Infection Control and Prevention Guidelines. Behavioral health discompliance in using PPE will endanger one self, others and hospital.

  RSU Haji Surabaya is a B type education hospital owned by East Java Province government. This hospital has 257 hospital beds in inpatient installation. Furthermore, work hour for nurses in inpatient installation is divided into 3 shifts a day.

  Based on preliminary study obtained data about workplace injuries and health behavior in using PPE on nurses. The data of workplace injuries frequently occurred on nurses in Shofa Inpatient installation General Hospital of Haji Surabaya was exposed by patients’ body fluids and needle stick injury (NSI). The accident rates of exposed patients’s body fluids and needle tick injury were 51.1% and 46.7%. These numbers were relatively high and could influence of health status and productivity of the nurses. This study was aimed to analyze the factors related to a compliance behavior in using personal protective equipment (PPE) on nurses at RSU Haji Surabaya. Therefore, hospital management could prevent the occupational accidents and workplace illnessesfor the workers. This study used quantitative method using cross sectional approach and observational study. Collecting data held in November 2015.

  Population and sample in this study were 29 nurses in Sofa Inpatient Installation wards 3 and 4. Dependent variable in this study was compliance behavior in using PPE, while independent variable was internal factors (age, sex, work period, employment status, knowledge and attitude, and individual commitment)), external factors (work shift and occupation factor (Standard Operational Procedure, supervision, and facility of PPE))

  

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  The findings on coefficient correlation test between internal factors and complience behavior, such as: age (r= -0.170), sex (r=0.336), work period (r=0.051), employment status (r=0.340), knowledge (r=0.394), attitude (r=0.215), individual commitment (r=0.515). Coefficient correlation test between external factors and complience behavior, suh as occupational factor (r=0.378) and work shift (r=0.446). Ordinal regression test showed interaction variable of knowledge and individual commitment (p= 0.000) became influenced variables to compliance behavior in using PPE. Based on the value of Pseudo R-Square Nagelkerke, it was found that the interaction variables of knowledge and individual commitment were able to explain variation on compliance behavior in using PPE in the amount of 48.3%. Recommended to hospital management to increase the commitment and knowledge of the nurses with hold evaluation to the nurse who attended in workshop program and discussed in a forum about compliance behavior in using PPE to prevent healthcare associated infections (HAIs).

  

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ABSTRACT THE ANALYSIS OF FACTORS RELATED TO COMPLIANCE

  

BEHAVIOR IN USING PERSONAL PROTECTIVE EQUIPMENT (PPE)

(Study on Nurses in Inpatient Installation of RSU Haji Surabaya)

  Healthcare Associated Infections (HAIs) is one of risks for nurses in the hospital. Several diseases related to the HAIs, such as HIV and hepatitis. Compliance behavior in using PPE is one of prevention to control the hazards caused by illnesses and an occupational accidents. RSU Haji Surabaya is a hospital with B type education. Accident rates for patient’s body fluid and needle stick injury (NSI) were 51.1% ad 46.7%. This study was aimed to analyze factors related compliance behavior in using personal protective equipment (PPE) on nurses in inpatient installation.This research was a quantitative method with cross sectional study design and observational study. The data were collected on November 2015 with questionnaire and observation checklist. The total sample technique was used to get sample (n=29). The correlation coefficient of age (r=-0.170), sex (r=0.336), work period (r=0.051), employmenst status (r=0.340), knowledge (r=0.394), attitude (r=0.215), individual commitment (r=0.515), occupation factor (r=0.378), work shift (r=0.446). High Commitment caused the increased of the compliance level of using PPE on nurses. Work shift in the morning showed more comply than noon and night shift. Ordinal regression test showed interaction variable of knowledge and individual commitment became influenced variables to compliance behavior in using PPE. The ammount variation of the variable explained was 48.3%. Recommended to the hospital management to increase commitment and knowledge with with hold evaluation to the nurse who attended in workshop program and discussed the topic about compliance behavior in using PPE in a forum to prevent Healthcare Associated Infections (HAIs).

  Keywords: compliance behavior, personal protective equipment, hospital

  

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DAFTAR ISI

  18 2.5 Perilaku .....................................................................................

  44 3.2 Penjelasan Kerangka Konseptual...............................................

  37 BAB 3. KERANGKA KONSEPTUAL 3.1 Kerangka Konseptual ................................................................

  36 2.10 Alat Pelindung Diri (APD) .......................................................

  34 2.9 Instalasi Rawat Inap ...................................................................

  32 2.8 Komitmen Individu ...................................................................

  29 2.7 Model ABC ..............................................................................

  20 2.6 Konsep Perilaku Patuh ...............................................................

  18 2.4 Faktor Penyebab Kecelakaan Kerja ..........................................

  Halaman HALAMAN JUDUL ....................................................................................... ii PERSYARATAN GELAR . ............................................................................ iii PENGESAHAN . ............................................................................................. iv PERSETUJUAN .............................................................................................. v PERSYARATAN TENTANG ORISINALITAS ........................................... vi KATA PENGANTAR .................................................................................... vii SUMMARY .................................................................................................... viii ABSTRACT .................................................................................................... x DAFTAR ISI ................................................................................................... xi DAFTAR TABEL ........................................................................................... xiii DAFTAR GAMBAR ...................................................................................... xiv DAFTAR LAMPIRAN ................................................................................... xv DAFTAR ARTI LAMBANG DAN SINGKATAN ........................................ xvi

  15 2.3 Kecelakaan Kerja ......................................................................

  14 2.2 Penyakit Akibat Kerja ...............................................................

  13 BAB 2. TINJAUAN PUSTAKA 2.1 Kesehatan dan Keselamatan Kerja ............................................

  12 1.5 Manfaat Penelitian ......................................................................

  12 1.4 Tujuan Penelitian ........................................................................

  9 1.3 Rumusan Masalah .......................................................................

  1 1.2 Kajian Masalah ............................................................................

  BAB 1. PENDAHULUAN 1.1 Latar Belakang dan Identifikasi Masalah ....................................

  45

  

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  6.1 Perilaku Penggunaan APD di Instalasi Rawat Inap RSU Haji Surabaya. .................................................................................

  7.1 Kesimpulan .............................................................................. 109

  BAB 7. PENUTUP

  6.12 Keterbatasan Penelitian ............................................................ 108

  6.11 AnalisisRegresi Ordinal Faktor Internal dan Faktor Eksternal dengan Perilaku Patuh ............................................................. 104

  6.10 Hubungan Shift Kerja dengan Perilaku Patuh ......................... 102

  98

  97 6.9 Hubungan Faktor Pekerjaan dengan Perilaku Patuh ................

  96 6.8 Hubungan Sikap dengan perilaku Patuh ..................................

  93 6.7 Hubungan Pengetahuan dengan Perilaku Patuh ......................

  91 6.6 Hubungan Komitmen Individu dengan Perilaku Patuh ...........

  89 6.5 Hubungan Status Kepegawaian dengan Perilaku Patuh ...........

  89 6.4 Hubungan Masa Kerja dengan Perilaku Patuh ....................

  88 6.3 Hubungan Jenis Kelamin dengan Perilaku Patuh ...................

  84 6.2 Hubungan Usia dengan Perilaku Patuh .................................. .

  78 BAB 6. PEMBAHASAN

  BAB 4. METODE PENELITIAN 4.1 Jenis Penelitian...........................................................................

  76 5.5 Analisis Regresi Ordinal ..........................................................

  69 5.5 Hasil Observasi Perilaku Patuh Penggunaan APD ...................

  67 5.4 Uji Korelasi Variabel Penelitian ..............................................

  64 5.3 Analis Deskriptif Variabel Penelitian ......................................

  58 5.2 Gambaran Pekerjaan ................................................................

  56 BAB 5. HASIL DAN ANALISIS DATA 5.1 Gambaran Umum Rumah Sakit ...............................................

  54 4.8 Penyajian dan Analisis Data .....................................................

  49 4.7 Teknik dan Prosedur Pengumpulan data....................................

  4.6 Variabel Penelitian, Definisi Operasional, dan Cara Pengukuran Variabel..................................................................

  48

  47 4.5 Kerangka Operasional................................................................

  46 4.4 Populasi dan Sampel Penelitian ................................................

  46 4.3 Lokasi dan Waktu Penelitian .....................................................

  46 4.2 Rancang Bangun Penelitian ......................................................

  7.2 Saran ........................................................................................ 109 DAFTAR PUSTAKA ...................................................................................... 111 LAMPIRAN

  

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DAFTAR TABEL

  Nomor Judul Halaman

  1.1 Kecelakaan Kerja Perawat di Instalasi Rawat Inap Shofa RSU Haji Surabaya, April 2015 .......................................................................... . 7

  2.1 Bahaya Kesehatan Terkait Lokasi dan Pekerjaan di Rumah Sakit ...... 16

  4.1 Populasi dan Sampel Penelitian di Instalasi Rawat Inap Shofa RSU Haji Surabaya, Juni 2015 .................................................................... 47

  4.2 Variabel, Definisi Operasional, Skala Data, Instrumen, dan Kriteria Obyektif ............................................................................................... 49

  5.1 Observasi Tindakan Keperawatan di Instalasi Rawat Inap Shofa RSU Haji Surabaya, November 2015 ................................................... 65

  5.2 Fasilitas APD di Instalasi Rawat Inap Shofa RSU Haji Surabaya, November 2015 .................................................................................... 66

  5.3 Distribusi Frekuensi Faktor Internal .................................................... 68

  5.4 Distribusi Frekuensi Faktor Eksternal dan Perilaku Patuh ................... 68

  5.5 Hubungan Usia dengan Perilaku Patuh ................................................ 70

  5.6 Hubungan Jenis Kelamin dengan Perilaku Patuh ................................ 70

  5.7 Hubungan Masa Kerja dengan Perilaku Patuh .................................... 71

  5.8 Hubungan Status Kepegawaian dengan Perilaku Patuh ....................... 72

  5.9 Hubungan Komitmen Individu dengan Perilaku Patuh ........................ 73

  5.10 Hubungan Pengetahuan dengan Perilaku Patuh ................................... 74

  5.11 Hubungan Sikap dengan Perilaku Patuh .............................................. 74

  5.12 Hubungan Faktor Pekerjaan dengan Perilaku Patuh ............................ 75

  5.13 Hubungan Shift Kerja dengan Perilaku Patuh . .................................... 76

  5.14 Hasil Observasi Perilaku penggunaan APD . ....................................... 77

  5.15 Matriks Uji Korelasi Variabel Independen .......................................... 79

  5.16 Hasil Analisis Uji Regresi Ordinal. ...................................................... 80

  5.17 Nilai R Square Analisis Regresi Ordinal ............................................. 81

  5.18 Odd Ratio Variabel Interaksi Pengetahuan dan Komitmen Individ .... 81

  5.19 Koding Variabel Interaksi Pengetahuan dan Komitmen Individu. ....... 82

  5.20 Aplikatif Model Analisis Regresi Ordinal . .......................................... 83

  

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DAFTAR GAMBAR

  Nomor Judul Halaman

  1.1 Penggunaan Masker dan Sarung Tangan pada Perawat di Instalasi Rawat Inap Shofa RSU Haji Surabaya ................................................. 8

  2.1 Hubungan Antecendent, Behavior, dan Consequences ........................ 34

  3.1 Kerangka Konseptual Penelitian........................................................... 44

  4.5 Kerangka Operasional........................................................................... 48

  5.1 Struktur Organisasi K3S ...................................................................... 62

  5.2 Hubungan Tim K3RSU Haji Surabaya dengan Unit Terkait................ 63

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  Nomor Judul Halaman

  1. Sertifikat Uji Etik ........................................................................ 117

  2. Surat Ijin Penelitian ..................................................................... 118

  3. Lembar penjelasan Pelaksanaan Penelitian ................................. 119

  4. Informed Consent ........................................................................ 121

  5. Kuesioner Penelitian .................................................................... 122

  6. Checklist Observasi Fasilitas APD............................................... 133

  7. Checklist Observasi Perilaku Patuh dalam Penggunaan APD ..... 135

  8. Lembar Observasi Tindakan dan Kesesuaian APD...................... 136

  9. Hasil Uji Statistik ......................................................................... 138

  10. Dokumentasi Fasilitas APD dan Tindakan Keperawatan ............ 153

  

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  Daftar Arti Lambang > = lebih dari < = kurang dari % = persen Daftar Arti Singkatan APD = Alat Pelindung Diri EKG = Elektrokardiogram HAIs = Healthcare Associated Infections

  ICU = Intensive Care Unit

  IGD = Instalasi Gawat Darurat

  IPCLN = Infection Preventio Control Link Nurse

  IRNA = Instalasi Rawat Inap

  IV = Intravena K3 = Kesehatan dan Keselamatan Kerja K3RS = Kesehatan dan Keselamatan Kerja Rumah Sakit Kemenkes = Kementerian Kesehatan KRS = Keluar Rumah Sakit MRS = Masuk Rumah Sakit NGT = Nasogastric Tube NSC =National Safety Council PAK = Penyakit Akibat Kerja PPI = Pencegahan dan Pengendalian Infeksi Protap = Prosedur Tetap RI = Republik Indonesia RSU = Rumah Sakit Umum SK = Surat Keputusan SOP = Standard Operating Procedures SPO = Standar Prosedur Operasional UU = Undang-Undang WHO = World Health Organization