Yuniastutiningsih, Hesti and Dr. Diadjeng Setya Wardani,, S.Si.T., M.Ke and Dr. dr. Novida Ariani,, M. Kes., SpOG (2022) Hubungan Dukungan Keluarga Dan Prosedur Rujukan Terhadap Keterlambatan Rujukan Kegawatdaruratan Maternal Di Rsud Tamiang Layang Kabupaten Barito Timur. Magister thesis, Universitas Brawijaya.
Abstract
Keterlambatan rujukan pada kasus kegawatdaruratan maternal merupakan salah satu penyebab tingginya Angka Kematian Ibu (AKI). Data Badan Pusat Statistik tahun 2016 melaporkan AKI di Indonesia berada pada posisi tertinggi di Asia Tenggara, yaitu 305 per 100.000 kelahiran hidup. Kasus kematian ibu di Provinsi Kalimantan Tengah dari tahun ke tahun mengalami fluktuasi. Pada rentang tahun 2015-2019, jumlah kasus kematian maternal dilaporkan berturut-turut sebanyak 80 kasus, 74 kasus, 54 kasus, 81 dan 82 kasus. Pelayanan kasus kegawatdaruratan di RSUD Tamiang Layang selama Tahun 2021 adalah berjumlah 276 kasus, dan 221 kasus diantaranya (80,07%) merupakan kasus rujukan. Dari total kasus rujukan kegawatdaruratan, tercatat 29 kasus yang mengalami komplikasi pada ibu maupun janin akibat keterlambatan rujukan. Berdasarkan hasil wawancara dengan kepala Ruangan UGD Kebidanan RSUD Tamiang Layang, masalah yang hampir selalu timbul dalam proses rujukan di wilayah ini adalah terlambatnya pengambilan keputusan untuk dirujuk. Perundingan antar anggota keluarga (orangtua, suami, anak, atau saudara) cukup menyita waktu dalam memutuskan persetujuan dirujuk, sehingga menyebabkan keterlambatan yang mengakibatkan ibu dan atau bayi jatuh dalam kondisi yang buruk. Selain permasalahan tersebut, kasus kegawatdaruratan maternal yang gagal ditangani umumnya disebabkan karena kurang tepatnya pelaksanaan prosedur rujukan kegawatdaruratan oleh bidan atau puskesmas perujuk. Penelitian ini mencoba menggali secara bersamaan fakta aktual dan dominan yang saling berhubungan satu sama lain sebagai prediktor munculnya masalah yang ada di wilayah Kabupaten Barito Timur yaitu berupa dukungan keluarga dan prosedur rujukan oleh bidan yang diperantarai keterlambatan pengambilan keputusan persetujuan dirujuk oleh ibu maupun keluarganya. Penelitian ini adalah penelitian observasional analitik crosecctional, dilaksanakan pada bulan April sampai Mei 2022 di RSUD Tamiang Layang Kabupaten Barito Timur. Sampel adalah ibu yang dirujuk ke RSUD Tamiang Layang yang memenuhi kategori kegawatdaruratan dan bidan perujuk yang sesuai dengan kriteria inklusi yang ditetapkan peneliti, masing-masing berjumlah 92 responden. Teknik pengambilan sampel dilakukan dengan teknik accidental sampling. Setiap ibu yang memenuhi kategori diberikan kuesioner untuk mendapatkan data, kepada bidan perujuk dilakukan wawancara terstruktur dengan menggunakan checklist oleh peneliti. Penelitian dilakukan secara langsung oleh peneliti. Analisis data dilakukan dengan uji multivariat untuk menganalisis pola hubungan sebab akibat, dengan tujuan menerangkan hubungan langsung atau tidak langsung antar variabel eksogen dan variabel endogen. Jenis analisis yang dilakukan adalah path analysis. Penelitian ini membuktikan bahwa dari 92 responden yang berpartisipasi menunjukkan 57 (61,9%) responden yang mengalami keterlambatan pengambilan keputusan di berbagai tingkatan waktu (15-30 menit, dan >30 menit). Responden terbanyak mengalami keterlambatan >30 menit (40,2%). Pada variabel keterlambatan rujukan, terdapat 8 responden (8,7%) yang mengalami keterlambatan rujukan (>120 menit). Secara statistik terdapat hubungan signifikan pada beberapa jalur, yaitu: dukungan keluarga dengan keterlambatan rujukan (p=0,007), dukungan keluarga terhadap keterlambatan pengambilan keputusan (p=0,000), prosedur rujukan dengan keterlambatan pengambilan keputusan (p=0,006), dan keterlambatan pengambilan keputusan dengan keterlambatan rujukan (p=0,029) serta dukungan keluarga dan prosedur rujukan terhadap keterlambatan rujukan melalui keterlambatan pengambilan keputusan (p=0,024). vii Sementara pada beberapa jalur lainnya, tidak didapatkan hubungan signifikan yaitu: faktor predisposisi (umur, pendidikan, pendapatan, paritas, frekuensi pemeriksaan kehamilan) terhadap keterlambatan rujukan dan prosedur rujukan terhadap keterlambatan rujukan (p=>0,05). Kesimpulan penelitian ini adalah dukungan keluarga berhubungan dengan keterlambatan rujukan dan keterlambatan pengambilan keputusan, prosedur rujukan berhubungan dengan keterlambatan pengambilan keputusan namun tidak berhubungan sinifikan dengan keterlambatan rujukan. Dukungan keluarga dan prosedur rujukan jika diuji secara bersama-sama melalui keterlambatan pengambilan keputusan, ditemukan berhubungan signifikan terhadap keterlambatan rujukan. Saran bagi pemerintah daerah agar dapat membuat panduan atau checklist, yang dapat digunakan sebagai alat pemantauan kinerja rujukan, menyediakan fasilitas pendukung misalnya penyediaan bank darah, penyediaan obat-obat emergensi profilaksis untuk langkah awal stabilisasi sebelum dilakukan rujukan, dan peningkatan pengetahuan bagi tenaga kesehatan tentang prinsip dasar merujuk kegawatdaruratan. Bagi tenaga kesehatan agar dapat meningkatkan teknik prosedur rujukan, penerapan program P4K, peningkatan edukasi dan komunikasi persuasif kepada ibu hamil beserta keluarganya
English Abstract
Delay in referrals in cases of maternal emergencies is one of the causes of the high maternal mortality rate (MMR). Data from the Central Statistics Agency in 2016 reported that MMR in Indonesia is at the highest position in Southeast Asia, at 305 per 100,000 live births. Maternal mortality cases in Central Kalimantan Province from year to year have fluctuated. In the 2015-2019 period, the number of maternal deaths reported consecutively was 80 cases, 74 cases, 54 cases, 81 and 82 cases. Emergency case services at Tamiang Layang Regional Hospital during 2021 amounted to 276 cases, and 221 of them (80.07%) were referral cases. Of the total emergency referral cases, 29 cases were recorded that experienced complications in the mother and fetus due to delays in referrals. Based on the results of an interview with the head of the Obstetrics Emergency Room at Tamiang Layang Hospital, the problem that almost always arises in the referral process in this region is the late decision making to be referred. Negotiations between family members (parents, husbands, children, or relatives) are quite time-consuming in deciding on consent, causing delays that result in the mother and or baby falling into poor condition. In addition to these problems, maternal emergency cases that fail to be handled are generally caused by the improper implementation of emergency referral procedures by midwives or referring health centers. This study tries to explore simultaneously the actual and dominant facts that are interconnected with each other as predictors of the emergence of problems that exist in the East Barito Regency area, namely in the form of family support and referral procedures by midwives mediated by delays in making consent decisions referred to by mothers and their families. This research is a cross-sectional analytical observational study, carried out from April to May 2022 at Tamiang Layang Regional Hospital, East Barito Regency. The sample was mothers who were referred to Tamiang Layang Hospital who met the emergency category and referring midwives who were in accordance with the inclusion criteria set by the researcher, each of which amounted to 92 respondents. The sampling technique is carried out by accidental sampling technique. Each mother who meets the category is given a questionnaire to obtain data, to the midwife, a structured interview is conducted using a checklist by the researcher. The result of the interview is in the form of a checklist. The research was conducted directly by the researcher. Data analysis was carried out by multivariate tests to analyze patterns of causal relationships, with the aim of explaining the direct or indirect relationship between exogenous variables and endogenous variables. In this study, the authors wanted to analyze and ascertain whether there was a relationship of family support and referral procedures to delays in decision making and their impact on referral delays. The type of analysis carried out is path analysis. This study proved that of the 92 respondents who participated, 57 (61.9%) respondents experienced delays in decision making at various time levels (15-30 minutes, and >30 minutes). The most respondents experienced a delay of >30 minutes (40.2%). In the referral delay variable, there were 8 respondents (8.7%) who experienced referral delays (>120 minutes). Statisticeously, there was a significant relationship in several pathways, namely: family support with late referral (p=0.007), family support for late decision making (p=0.000), referral procedures with delayed decision making (p=0.006), and family support and referral procedures for late referrals through late decision making (p=0.024). Meanwhile, in several other pathways, no significant relationship was obtained, ix namely: predisposing factors (age, education, income, parity, frequency of pregnancy examinations) to late referrals and late decision making with late referral (p = >0.05). The conclusion of this study is that family support is related to late referrals and delays in decision making, referral procedures are related to delays in decision making but not related to delays in referrals. Family support and referral procedures, if tested jointly through delays in decision-making, were found to be not significantly related to referral delays. Suggestions for local governments to be able to make referral performance monitoring tools in the form of guides or checklists, providing supporting facilities such as the provision of blood banks, the provision of prophylactic emergency medicines for the first step of stabilization before referral, and increasing knowledge for health workers about the basic principles of referring to emergencies. Health workers are expected to improve referral procedure techniques, the implementation of the P4K program, increase education and persuasive communication to pregnant women and their families
Other obstract
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| Item Type: | Thesis (Magister) |
|---|---|
| Identification Number: | 0422060070 |
| Subjects: | 600 Technology (Applied sciences) > 618 Gynecology, obstetrics, pediatrics, geriatrics > 618.2 Obstetrics |
| Divisions: | S2/S3 > Magister Kebidanan, Fakultas Kedokteran |
| Depositing User: | Nur Cholis |
| Date Deposited: | 18 Nov 2022 09:06 |
| Last Modified: | 18 Nov 2022 09:26 |
| URI: | http://repository.ub.ac.id/id/eprint/196406 |
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