TESIS ANALISIS FAKTOR YANG BERHUBUNGAN …repository.unair.ac.id/29499/1/HALAMAN DEPAN .pdf · Untuk memperoleh gelar Magister Kesehatan dan Keselamatan Kerja Program Studi Kesehatan

ADLN – PERPUSTAKAAN UNIVERSITAS AIRLANGGA

iTESIS ANALISIS FAKTOR YANG ... LINA YULIANA

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 AIRLANGGAFAKULTAS KESEHATAN MASYARAKAT

PROGRAM MAGISTERPROGRAM STUDI KESEHATAN DAN KESELAMATAN KERJA

SURABAYA2016


iiTESIS ANALISIS FAKTOR YANG ... LINA YULIANA

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



SURABAYA2016


iiiTESIS ANALISIS FAKTOR YANG ... LINA YULIANA

TESIS

Untuk memperoleh gelar Magister Kesehatan dan Keselamatan KerjaProgram Studi Kesehatan dan Keselamatan Kerja

Fakultas Kesehatan MasyarakatUniversitas Airlangga

Oleh :

LINA YULIANANIM 101324253002



SURABAYA2016


ivTESIS ANALISIS FAKTOR YANG ... LINA YULIANA

PENGESAHAN

Dipertahankan di depan Tim Penguji TesisProgram Studi Kesehatan dan Keselamatan Kerja

Fakultas Kesehatan Masyarakat Universitas Airlanggadan diterima untuk memenuhi persyaratan guna memperoleh gelar

Magister Kesehatan dan Keselamatan Kerja (M.KKK.)Pada tanggal 21 Januari 2016

Mengesahkan

Universitas AirlanggaFakultas 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.Sc3. Dr. Neffretty Nilamsari, S.Sos., M.Kes4. Dr. Diah Indriani, S.Si., M.Si5. dr. Tanya Elize Viyaya S, M.Kes


vTESIS ANALISIS FAKTOR YANG ... LINA YULIANA


viTESIS ANALISIS FAKTOR YANG ... LINA YULIANA


viiTESIS ANALISIS FAKTOR YANG ... LINA YULIANA

KATA PENGANTAR

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 Airlangga2. 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 danpihak lain yang menggunakan.

Surabaya, 21 Januari 2016

Penulis


viiiTESIS ANALISIS FAKTOR YANG ... LINA YULIANA

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))


ixTESIS ANALISIS FAKTOR YANG ... LINA YULIANA

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).


xTESIS ANALISIS FAKTOR YANG ... LINA YULIANA

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


xiTESIS ANALISIS FAKTOR YANG ... LINA YULIANA

DAFTAR ISI

HalamanHALAMAN JUDUL ....................................................................................... iiPERSYARATAN GELAR . ............................................................................ iiiPENGESAHAN . ............................................................................................. ivPERSETUJUAN .............................................................................................. vPERSYARATAN TENTANG ORISINALITAS ........................................... viKATA PENGANTAR .................................................................................... viiSUMMARY .................................................................................................... viiiABSTRACT .................................................................................................... xDAFTAR ISI ................................................................................................... xiDAFTAR TABEL ........................................................................................... xiiiDAFTAR GAMBAR ...................................................................................... xivDAFTAR LAMPIRAN ................................................................................... xvDAFTAR ARTI LAMBANG DAN SINGKATAN ........................................ xvi

BAB 1. PENDAHULUAN1.1 Latar Belakang dan Identifikasi Masalah .................................... 11.2 Kajian Masalah ............................................................................ 91.3 Rumusan Masalah ....................................................................... 121.4 Tujuan Penelitian ........................................................................ 121.5 Manfaat Penelitian ...................................................................... 13

BAB 2. TINJAUAN PUSTAKA2.1 Kesehatan dan Keselamatan Kerja ............................................ 142.2 Penyakit Akibat Kerja ............................................................... 152.3 Kecelakaan Kerja ...................................................................... 182.4 Faktor Penyebab Kecelakaan Kerja .......................................... 182.5 Perilaku ..................................................................................... 202.6 Konsep Perilaku Patuh............................................................... 292.7 Model ABC .............................................................................. 322.8 Komitmen Individu ................................................................... 342.9 Instalasi Rawat Inap................................................................... 362.10 Alat Pelindung Diri (APD) ....................................................... 37

BAB 3. KERANGKA KONSEPTUAL 3.1 Kerangka Konseptual ................................................................ 44

3.2 Penjelasan Kerangka Konseptual............................................... 45


xiiTESIS ANALISIS FAKTOR YANG ... LINA YULIANA

BAB 4. METODE PENELITIAN4.1 Jenis Penelitian........................................................................... 464.2 Rancang Bangun Penelitian ...................................................... 464.3 Lokasi dan Waktu Penelitian ..................................................... 464.4 Populasi dan Sampel Penelitian ................................................ 474.5 Kerangka Operasional................................................................ 484.6 Variabel Penelitian, Definisi Operasional, dan Cara Pengukuran Variabel.................................................................. 494.7 Teknik dan Prosedur Pengumpulan data.................................... 544.8 Penyajian dan Analisis Data ..................................................... 56

BAB 5. HASIL DAN ANALISIS DATA5.1 Gambaran Umum Rumah Sakit ............................................... 585.2 Gambaran Pekerjaan ................................................................ 645.3 Analis Deskriptif Variabel Penelitian ...................................... 675.4 Uji Korelasi Variabel Penelitian .............................................. 695.5 Hasil Observasi Perilaku Patuh Penggunaan APD ................... 765.5 Analisis Regresi Ordinal .......................................................... 78

BAB 6. PEMBAHASAN6.1 Perilaku Penggunaan APD di Instalasi Rawat Inap RSU Haji

Surabaya. ................................................................................ . 846.2 Hubungan Usia dengan Perilaku Patuh .................................. . 886.3 Hubungan Jenis Kelamin dengan Perilaku Patuh ................... 896.4 Hubungan Masa Kerja dengan Perilaku Patuh .................... 896.5 Hubungan Status Kepegawaian dengan Perilaku Patuh ........... 916.6 Hubungan Komitmen Individu dengan Perilaku Patuh ........... 936.7 Hubungan Pengetahuan dengan Perilaku Patuh ...................... 966.8 Hubungan Sikap dengan perilaku Patuh .................................. 976.9 Hubungan Faktor Pekerjaan dengan Perilaku Patuh ................ 986.10 Hubungan Shift Kerja dengan Perilaku Patuh ......................... 1026.11 AnalisisRegresi Ordinal Faktor Internal dan Faktor Eksternal

dengan Perilaku Patuh ............................................................. 1046.12 Keterbatasan Penelitian ............................................................ 108

BAB 7. PENUTUP7.1 Kesimpulan .............................................................................. 1097.2 Saran ........................................................................................ 109

DAFTAR PUSTAKA ...................................................................................... 111LAMPIRAN


xiiiTESIS ANALISIS FAKTOR YANG ... LINA YULIANA

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 ...... 164.1 Populasi dan Sampel Penelitian di Instalasi Rawat Inap Shofa RSU

Haji Surabaya, Juni 2015 .................................................................... 474.2 Variabel, Definisi Operasional, Skala Data, Instrumen, dan Kriteria

Obyektif ............................................................................................... 495.1 Observasi Tindakan Keperawatan di Instalasi Rawat Inap Shofa

RSU Haji Surabaya, November 2015 ................................................... 655.2 Fasilitas APD di Instalasi Rawat Inap Shofa RSU Haji Surabaya,

November 2015 .................................................................................... 665.3 Distribusi Frekuensi Faktor Internal .................................................... 685.4 Distribusi Frekuensi Faktor Eksternal dan Perilaku Patuh ................... 685.5 Hubungan Usia dengan Perilaku Patuh ................................................ 705.6 Hubungan Jenis Kelamin dengan Perilaku Patuh ................................ 705.7 Hubungan Masa Kerja dengan Perilaku Patuh .................................... 715.8 Hubungan Status Kepegawaian dengan Perilaku Patuh ....................... 725.9 Hubungan Komitmen Individu dengan Perilaku Patuh ........................ 735.10 Hubungan Pengetahuan dengan Perilaku Patuh ................................... 745.11 Hubungan Sikap dengan Perilaku Patuh .............................................. 745.12 Hubungan Faktor Pekerjaan dengan Perilaku Patuh ............................ 755.13 Hubungan Shift Kerja dengan Perilaku Patuh . .................................... 765.14 Hasil Observasi Perilaku penggunaan APD . ....................................... 775.15 Matriks Uji Korelasi Variabel Independen .......................................... 795.16 Hasil Analisis Uji Regresi Ordinal. ...................................................... 805.17 Nilai R Square Analisis Regresi Ordinal ............................................. 815.18 Odd Ratio Variabel Interaksi Pengetahuan dan Komitmen Individ .... 815.19 Koding Variabel Interaksi Pengetahuan dan Komitmen Individu. ....... 825.20 Aplikatif Model Analisis Regresi Ordinal . .......................................... 83


xivTESIS ANALISIS FAKTOR YANG ... LINA YULIANA

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 ........................ 343.1 Kerangka Konseptual Penelitian........................................................... 444.5 Kerangka Operasional........................................................................... 485.1 Struktur Organisasi K3S ...................................................................... 625.2 Hubungan Tim K3RSU Haji Surabaya dengan Unit Terkait................ 63


xvTESIS ANALISIS FAKTOR YANG ... LINA YULIANA

DAFTAR LAMPIRAN

Nomor Judul Halaman 1. Sertifikat Uji Etik ........................................................................ 1172. Surat Ijin Penelitian ..................................................................... 1183. Lembar penjelasan Pelaksanaan Penelitian ................................. 1194. Informed Consent ........................................................................ 1215. Kuesioner Penelitian .................................................................... 1226. Checklist Observasi Fasilitas APD............................................... 1337. Checklist Observasi Perilaku Patuh dalam Penggunaan APD ..... 135 8. Lembar Observasi Tindakan dan Kesesuaian APD...................... 136 9. Hasil Uji Statistik ......................................................................... 13810. Dokumentasi Fasilitas APD dan Tindakan Keperawatan ............ 153


xviTESIS ANALISIS FAKTOR YANG ... LINA YULIANA

DAFTAR LAMBANG DAN SINGKATAN

Daftar Arti Lambang

> = lebih dari< = kurang dari% = persen

Daftar Arti Singkatan

APD = Alat Pelindung DiriEKG = ElektrokardiogramHAIs = Healthcare Associated InfectionsICU = Intensive Care UnitIGD = Instalasi Gawat DaruratIPCLN = Infection Preventio Control Link NurseIRNA = Instalasi Rawat InapIV = IntravenaK3 = Kesehatan dan Keselamatan KerjaK3RS = Kesehatan dan Keselamatan Kerja Rumah SakitKemenkes = Kementerian KesehatanKRS = Keluar Rumah SakitMRS = Masuk Rumah SakitNGT = Nasogastric TubeNSC =National Safety CouncilPAK = Penyakit Akibat KerjaPPI = Pencegahan dan Pengendalian InfeksiProtap = Prosedur TetapRI = Republik IndonesiaRSU = Rumah Sakit UmumSK = Surat KeputusanSOP = Standard Operating ProceduresSPO = Standar Prosedur OperasionalUU = Undang-UndangWHO = World Health Organization

Documents

TESIS ANALISIS FAKTOR YANG BERHUBUNGAN …repository.unair.ac.id/29499/1/HALAMAN DEPAN .pdf · Untuk memperoleh gelar Magister Kesehatan dan Keselamatan Kerja Program Studi Kesehatan