Tingkat Pengetahuan, Sikap, dan Motivasi terhadap Kepatuhan Pelaksanaan Ventilator Associated Pneumonia Bundle di Ruang Intensive Care Unit
Abstract
Latar Belakang: Ventilator Associated Pneumonia (VAP) menjadi salah satu infeksi paling umum di ICU yang terjadi akibat pemakaian ventilator selama lebih dari 48 jam. Dampak VAP pada pasien yaitu memperpanjang hari rawat, meningkatkan biaya perawatan, dan risiko kematian. Kejadian VAP dapat dicegah dengan VAP Bundle yang telah terbukti dapat menurunkan angka kejadian VAP. Pelaksanaan VAP Bundle merupakan indikator mutu pelayanan keperawatan di ruang ICU. Salah satu faktor keberhasilan dari VAP Bundle adalah kepatuhan melakukan perawatan. Penelitiannini bertujuan untukkmenganalisis hubunganipengetahuan, sikap, danimotivasi perawattdengan kepatuhan pelaksanaan VAP Bundle.
Metode: Metode yang digunakan yaitu cross sectional dilakukan pada Mei-Juni 2022. Sampel sebanyak 30 perawat ICU di RS X Bogor dipilih secara total sampling. Wawancara daring mengenai pengetahuan, sikap, motivasi, dan kepatuhan pelaksanaan VAP Bundle dikumpulkan menggunakan kuesioner. Data tersebut diuji menggunakan Fisher’s exact.
Hasil: Studi ini menemukan hubungan yang signifikan antara pengetahuan dengan kepatuhan pelaksanaan VAP Bundle (p=0,0001), sedangkan sikap dan motivasi tidak berhubungan dengan kepatuhan (p=0,418; 0,694).
Kesimpulan: Terdapat hubungan yang signifikan antara pengetahuan dengan kepatuhan dalam pelaksanaan VAP Bundle di ruang ICU. Perlunya monitoring secara berkala oleh manajer keperawatan terkait kepatuhan pelaksanaan VAP Bundle. Sistem reward dan punishment serta refreshing melalui pelatihan menjadi upaya yang esensial untuk mengurangi kejadian VAP di ruang ICU.
Kata Kunci: Kepatuhan, Motivasi, Pengetahuan, Sikap, VAP Bundle
Level of knowledge, Attitudes and Motivation with Compliance of the Implementation of Ventilator-associated Pneumonia Bundle in the Intensive Care Unit
Background: Ventilator-Associated Pneumonia (VAP) is one of the most common infections in the ICU that occurs as a result of using a ventilator for more than 48 hours. The impact of VAP on patients is extending the day of stay, increasing the cost of treatment, and the risk of death. VAP incidents can be prevented with the VAP Bundle which has been proven to reduce the number of VAP. Implementation of the VAP Bundle is an indicator of the quality of nursing services in the ICU. One of the success factors of the VAP Bundle is adherence to maintenance. This study aimed to analyze the relationship between knowledge, attitudes, and motivation of nurses with compliance with VAP Bundle implementation.
Method: A cross sectional study performed during May-June 2022. About 30 ICU nurses at RS X Bogor was selected using total sampling. Online interviews regarding knowledge, attitudes, motivation and compliance with the implementation of the VAP Bundle were collected using a questionnaire. The data was tested with Fisher's exact.
Results: This study found a significant relationship between knowledge and compliance with the VAP Bundle implementation (p = 0.0001), while attitudes and motivation were not related to compliance (p = 0.418; 0.694).
Conclusion: There is a significant relationship between knowledge and compliance in the implementation of the VAP Bundle in the ICU. The need for regular monitoring by nursing managers regarding compliance with the implementation of the VAP Bundle. The reward and punishment system as well as refreshing through training are essential efforts to reduce the incidence of VAP in the ICU.
Keywords: Attitude, Compliance, Knowledge, Motivation VAP Bundle
References
Rosenthal VD, Al-Abdely HM, El-Kholy AA, AlKhawaja SAA, Leblebicioglu H, Mehta Y, et al. International Nosocomial Infection Control Consortium report, data summary of 50 countries for 2010-2015: Device-associated module. Am J Infect Control. 2016;44(12):1495–504.
Kemenkes RI. Peraturan Menteri Kesehatan Republik Indonesia Nomor 27 Tahun 2017 Tentang Pedoman Pencegahan Dan Pengendalian Infeksi Di Fasilitas Pelayanan Kesehatan. 2017.
CDC. National and state healthcare associated infections progress report. 2016.
Khan HA, Baig FK, Mehboob R. Nosocomial infections: Epidemiology, prevention, control and surveillance. Asian Pac J Trop Biomed. 2017;7(5):478–82.
Khayati N, Rohana N, Apriana R. Faktor-Faktor Yang Berhubungan Dengan Kejadian Ventilator Associated Pneumonia (Vap) Pada Pasien Yang Menggunakan Ventilator Mekanik. Jurnal Ners Widya Husada. 2017;4(3):85–94.
Putri, Budiono. Hubungan Antara Lama Penggunaan Ventilator Mekanik Dengan Kejadian Ventilator Associated Pneumonia (VAP) Pada Pasien Nonsepsis di ICU RSUP Dr. Kariadi Semarang. Jurnal UNDIP. 2013;
Rahmawati. Angka Kejadian Pneumonia Pada Pasien Sepsis di ICU RSUP Dr.Kariadi Semarang. Jurnal Medika Muda UNDIP Semarang. 2014;3(1).
Zubair S, Ali H, Zafar F, Beg A, Sial A, Naveed S. Ventilator-associated pneumonia (VAP): Clinical strategies, treatment challenges and economic concerns. J Bioequivalence Bioavailab. 2017;9(4):432–6.
But A, Yetkin MA, Kanyilmaz D, Aslaner H, Baştuğ A, Aypak A, et al. Analysis of epidemiology and risk factors for mortality in ventilator-associated pneumonia attacks in intensive care unit patients. Turk J Med Sci. 2017;47:812–6.
Xu Y, Lai C, Xu G, Meng W, Zhang J, Hou H, et al. Risk factors of ventilator-associated pneumonia in elderly patients receiving mechanical ventilation. Clin Interv Aging. 2019;14:1027–38.
Saensom D, Merchant A, Ruaisungnoen W, Pitiphat W. Oral Health and Ventilator-Associated Pneumonia among Critically ill Patients : A Prospective Study. June. 2016;709–14.
Wang L, Li X, Yang Z, Tang X, Yuan Q, Deng L, et al. Semi-recumbent position versus supine position for the prevention of ventilator-associated pneumonia in adults requiring mechanical ventilation. Cochrane Database of Systematic Reviews. 2016;2016(1).
IHI (Institute for Healthcare Improvement). How-to Guide: Prevent Ventilator- Associated Pneumonia. 2012;(February).
Okgün Alcan A, Demir Korkmaz F, Uyar M. Prevention of ventilator-associated pneumonia: Use of the care bundle approach. Am J Infect Control. 2016;44(10):e173–6.
Kao CC, Chiang HT, Chen CY, Hung CT, Chen YC, Su LH, et al. National bundle care program implementation to reduce ventilator-associated pneumonia in intensive care units in Taiwan. Journal of Microbiology, Immunology and Infection. 2017;1–6.
Sadli MF, Tavianto D, Redjeki IS. Gambaran Pengetahuan Klinisi Ruang Rawat Intensif mengenai Ventilator Associated Pneumonia (VAP) Bundle di Ruang Rawat Intensif RSUP Dr. Hasan Sadikin Bandung. Jurnal Anestesi Perioperatif. 2017;5(2):85.
Saodah S. Knowledge of Guideline VAP Bundle Improves Nurse Compliance Levels in Preventing Associated Pneumonia (VAP) Ventilation in the Intensive Care Unit. Media Keperawatan Indonesia. 2019;2(3):113.
Kemenkes RI. Peraturan Menteri Kesehatan Republik Indonesia Nomor 27 Tahun 2017 Tentang Pedoman Pencegahan Dan Pengendalian Infeksi Di Fasilitas Pelayanan Kesehatan. 2017.
Ratnawati L, Sianturi S. Faktor – faktor yang berhubungan dengan kepatuhan dalam menerapkan hand hygiene. 2018;9(2):148–54.
Solikin S, Adi MS, Arso SP. Analisis faktor-faktor yang mempengaruhi kepatuhan mengikuti pedoman perawatan Bundle Ventilator Associated Pneumonia (VAP). Holistik Jurnal Kesehatan. 2021;15(3):430–42.
Kusnanto, Suadyani NK, Wahyuni ED, Arifin H. Theory of Planned Behavior Development Model to Compliance Behavior in Vap Prevention at ICU. Jurnal Keperawatan Soedirman. 2020;15(1):41–51.
Ningrum UW, Astrid M. Faktor-faktor yang Berhubungan dengan Kepatuhan perawat Dalam Melakukan Perawatan Central Venous Cathethers (CVC) di Ruang ICU RS X Jakarta. Jambura Nursing Journal. 2020;2(2):184–96.
Notoadmodjo S. Promosi Kesehatan dan Perilaku Kesehatan. Jakarta: Rineka Cipta; 2012.
Aryani DF, Durhayati Y. Gambaran Tingkat Kepatuhan dan Faktor-Faktor yang Memengaruhi Kepatuhan Perawat dalam Penerapan Bundle Ventilator Associated Pneumonia. Jurnal Riset Kesehatan Nasional. 2018;2(2).
Team Pokja Modul Pelatihan HIPERCCI Pusat. Modul Pelatihan Keperawatan Intensif Dasar - Edisi Revisi. 3rd ed. Dewi A, Sukendar A, Herwansyah B, editors. Bogor: IN MEDIA; 2014.
Hammad H, Rizani K, Agisti R. Tingkat Kelelahan Perawat Di Ruang Icu. Dunia Keperawatan. 2018;6(1):27.
Khairul R, Silaban G, Handayani F, Magister A, Masyarakat K. Faktor-Faktor Terkait Kepatuhan Keperawatan Dalam Pelaksanaan Standar Pelayanan RSU AL-Azis. Jurnal Kajian Kesehatan Masyarakat. 2019;1(1):35–43.
Idawaty S, Huriani E, Gusti RP. Tingkat Pengetahuan Perawat Dan Penerapan Ventilator Associated Pneumonia Bundle Di Ruang Perawatan Intensif. NERS Jurnal Keperawatan. 2017;13(1):34.
Umansky J, Rantanen E. Workload in nursing. Proceedings of the Human Factors and Ergonomics Society. 2016;551–5.
Musdalipah, Syam Y, Tahir T. Kepatuhan Perawat Dalam Melakukan Oral Hygiene Di Unit Perawatan Intensif. Jurnal Keperawatan Silampari. 2021;4:576–86.
Risanti RD, Purwanti E, Novyriana E. Faktor yang Berhubungan dengan Kepatuhan Perawat dalam Penerapan Surgical Safety Checklist di Instalasi Bedah Sentral. Jurnal Berita Ilmu Keperawatan. 2021;14(2):16–27.
Wawan A, Dewi M. Teori Dan Pengukuran pengetahuan, sikap, dan perilaku manusia: Di lengkapi contoh kuesioner. Yogyakarta: Nuha Medika; 2010.
Nuryani E, Dwiantoro L, Nurmalia D. Faktor-faktor yang meningkatkan kepatuhan perawat dalam penerapan prinsip enam benar pemberian obat. Jurnal Kepemimpinan dan Manajemen Keperawatan. 2021;4(1).
Wahyu Widhiarso. Berurusan dengan Outliers. widhiarso.staff.ugm.ac.id. 2011.
Suharto, Suminar R. The Relation of Knowledge and Attitude on Nurses With Infection Controls in The ICU Ward Hospital. Jurnal Riset Hesti Medan. 2016;1(1):1–10.
Robbins SP, Judge TA. Perilaku Organisasi. 16th ed. Jakarta: Salemba Empat; 2015.
Nursery SMC, Jamini T. Hubungan Motivasi Perawat Dengan Kepatuhan Pelaksanaan Pemberian Obat Oral. Jurnal Keperawatan Suaka Insan (JKSI). 2022;7(1).
Handayani S, Ariani N, Maemunah N. Hubungan Antara Pengetahuan Dan Motivasi Perawat Dengan Pelaksanaan Standar Prosedur Operasional (SPO) Assesment Nyeri Ulang di Ruang Rawat Inap Dewasa Rumah Sakit Panti Waluya Sawahan Malang. Nurs News. 2017;2(3):21–33.
Agustini T, Mulya CA. Hubungan Motivasi Kerja dan Imbalan yang di Terima Perawat dalam Kepatuhan Pendokumentasian Flowsheet. Jurnal Ilmiah Kesehatan Pencerah. 2019;8.
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