Pengalaman Perawat Klinis I (PK I) sebagai Perawat Relawan di Ruang ICU Covid-19 RS Kota Malang dan Batu

Rizkilia, Vebby Astri and Dr. Asti Melani Astari,, S.Kep. M.Kep, Sp.Mat and Dr. Ns. Dina Dewi Sartika Lestari I.,, M.Kep (2023) Pengalaman Perawat Klinis I (PK I) sebagai Perawat Relawan di Ruang ICU Covid-19 RS Kota Malang dan Batu. Magister thesis, Universitas Brawijaya.

Abstract

Kebutuhan ruang ICU covid-19 dan tenaga profesional perawat di ruang ICU covid-19 meningkat sejalan dengan peningkatan kasus covid-19 derajat kritis. Akan tetapi, sebagian besar rumah sakit rujukan covid-19 di seluruh dunia termasuk Indonesia tidak mampu memenuhi tuntutan jumlah kebutuhan tenaga perawat tersebut. Hal ini menyebabkan pemanfaatan sumber daya manusia termasuk perawat melebihi batas kemampuan. Hal ini memberikan dampak pada fisik dan psikologis perawat ICU covid-19 seperti terjadinya burnout, stress, depresi, kecemasan, ketakutan, mudah marah, peningkatan SSD (Somatic Symptom Disorder), dan peningkatan PTSD (Post Traumatic Stress Disorder). Salah upaya Pemerintah Indonesia untuk mengatasi masalah kekurangan jumlah tenaga perawat yang terjadi secara nasional di saat pandemi adalah dengan melakukan rekruitmen perawat relawan. Dalam melakukan proses rekruitmen tenaga perawat relawan, ada beberapa tuntutan yang harus dipenuhi, yaitu rumah sakit harus mencari staf dengan dasar kemampuan perawatan kritis dan melakukan orientasi atau pendampingan kepada perawat relawan dengan waktu yang singkat. Akan tetapi, banyak rumah sakit rujukan covid-19 di Indonesia terpaksa merekrut perawat relawan ICU covid-19 dengan kategori novice nurse atau perawat klinis level I (PK I) dan tanpa dasar pelatihan ICU dan pengalaman bekerja di ruang ICU sebelumnya. Selain itu, terjadi keterbatasan dalam pelaksanaan pelatihan dan pengiriman tenaga perawat relawan untuk mendapat pelatihan sehingga mereka mengandalkan orientasi dan bimbingan dari senior. Periode transisi untuk bekerja ke ruang ICU covid-19 memiliki tantangan dan beban kerja lebih berat dibandingkan bekerja ke ruang ICU biasa. Periode transisi di ruang ICU covid-19 merupakan kondisi yang berat bagi perawat expert dari ruang bangsal rawat inap yang ditugaskan ke ruang ICU covid-19 tanpa persiapan dan pelatihan perawatan pasien kritis sebelumnya. Tantangan adaptasi pada periode transisi di ruang ICU covid-19 akan dirasakan lebih berat oleh PK I dibandingkan dengan perawat expert. Bagi PK I yang tidak memiliki pengalaman bekerja di ICU atau pelatihan ICU sebelumnya, beban ini akan bertambah lebih berat lagi. Perawat relawan yang memiliki keterampilan yang rendah akan meningkatkan beban kerja perawat senior. Apabila ada perawat baru yang tidak mendapatkan bimbingan dari senior, mereka beresiko melakukan kesalahan fatal dalam tindakan. Selain itu, kasus komplikasi serius dan tingkat kematian meningkat saat ada perawat baru yang bekerja di ruang ICU. Periode transisi ini merupakan masa penyesuaian dan menjadi faktor penentu apakah seorang perawat pemula akan tetap bekerja dan berkomitmen dengan organisasi tempat bekerja. Sebagian besar perawat relawan ICU covid-19 dari 2 RS rujukan covid-19 terbesar di Kota Malang dan Batu merupakan kategori PK I tanpa pengalaman bekerja di ruang ICU dan pelatihan ICU. Mereka mengalami keterbatasan pengiriman dan pelaksanaan pelatihan ICU. Kedua RS ini merupakan rumah sakit rujukan covid-19 yang memiliki ketersediaan ruang isolasi tekanan negatif dengan ventilator terbanyak di Kota Malang dan Batu per Desember 2021. Angka mortalitas kasus Covid-19 ARDS (CARDS) di kedua ini sampai dengan Bulan November 2020 mencapai 47% - 87% (82-190 pasien). RS rujukan covid-19 di Kota Malang ini merupakan rumah sakit dengan fasilitas, kemampuan, dan penunjang klinik yang lebih lengkap dibandingkan dengan rumah sakit rujukan covid-19 lainnya. RS ini juga membuka beberapa gelombang pendaftaran rekruitmen perawat relawan dengan kuota penerimaan yang banyak. Sedangkan rumah sakit rujukan covid-19 di Kota Batu ini merupakan rumah sakit rujukan covid-19 satu-satunya di Kota tersebut. Dua orang perawat relawan ICU covid-19 mengungkapkan bahwa mereka merasa terbebani bekerja di ruang ICU covid-19 tanpa bekal pengalaman dan pelatihan ICU sebelumnya. Mereka merasa cemas, khawatir, dan mengalami berbagai tantangan yang dirasa berat bahkan keinginan mengundurkan diri saat bertugas di ruang ICU covid-19 Berdasarkan permasalahan utama, yaitu: (1) perawat relawan ICU covid-19 adalah PK I tanpa pengalaman bekerja di ICU dan pelatihan ICU sebelumnya; (2) Terdapat keterbatasan dalam pelaksanaan dan pengiriman pelatihan ICU; (3) Beban Kerja di ruang ICU covid-19 lebih besar dari ruang ICU reguler; dan (4) Dampak fisik dan psikologis perawat relawan ICU covid-19, diperlukan eksplorasi mendalam mengenai pengalaman PK I sebagai perawat relawan di ruang ICU covid-19 RS Kota Malang dan Batu. Penelitian ini menggunakan desain penelitian kualitatif dengan pendekatan studi fenomenologi. Pemilihan partisipan dilakukan dengan metode purposive sampling dengan menerapkan beberapa kriteria inklusi. Partisipan di dalam penelitian ini berjumlah 10 orang yang terdiri dari masing-masing 5 orang perawat relawan ICU covid-19 dari RS rujukan covid-19 di Kota Malang dan Kota Batu. Untuk mencapai saturasi data, peneliti menambah 5 partisipan dari RS rujukan covid-19 di Kota Batu yang memenuhi kriteria inklusi. Peneliti menggunakan pedoman wawancara untuk melakukan wawancara mendalam semi terstruktur dalam pengumpulan data. Hasil penelitian kemudian dianalisis menggunakan metode Interpretative Psychological Analysis. Terdapat 12 tema yang ditemukan dalam penelitian ini, meliputi: (1) Keadaan yang memaksa untuk menjadi perawat relawan covid-19; (2) Adanya fasilitas dan keuntungan sebagai perawat relawan covid-19; (3) Motivasi dari dalam diri sendiri; (4) Menghadapi kendala perijinan dari orang tua; (5) Merasa tidak percaya diri untuk bekerja di ruang ICU covid-19; (6) menghadapi tuntutan adaptasi cepat saat awal bertugas di ruang ICU covid-19; (7) Merasa Membutuhkan Pelatihan sebagai Perawat Relawan ICU Covid-19; (8) Teguh bertahan dengan kondisi yang dialami selama menjadi perawat relawan ICU covid-19; (9) Kalut dan Gundah saat bertugas di Ruang ICU Covid-19; (10) Berusaha tegar dalam menghadapi keluarga pasien; (11) Bersyukur memiliki kesempatan menjadi relawan ICU covid-19; dan (12) Mengharapkan perbaikan karir dan kehidupan di masa depan setelah selesai menjalani masa tugas sebagai perawat relawan ICU covid-19 Beberapa hal yang mendasari PK I mendaftar menjadi perawat relawan covid-19 adalah adanya motivasi terdesak, motivasi intrinsik, dan motivasi ekstrinsik yang tergambar pada tema 1 - 3. Akan tetapi, mereka harus menghadapi kendala perijinan orang tua saat akan mendaftar menjadi perawat relawan covid-19 (tema 4). Ijin dari orang tua atau pasangan merupakan syarat utama untuk mendaftar menjadai perawat relawan covid-19. Dukungan keluarga merupakan hal penting yang harus dimiliki perawat relawan covid-19 karena dapat meningkatkan produktivitas dan performa pekerjaan. Setelah mereka berhasil mendapatkan ijin dari orang tua dan menjadi perawat relawan ICU covid-19, mereka harus menghadapi berbagai kondisi yang melelahkan fisik dan mental selama merawat pasien di ruang ICU covid-19. Berbagai pengalaman tersebut tergambar dalam tema 5-10. Salah satu tantangan pada periode transisi di ruang ICU adalah kurangnya konfidensi. Semakin besar beban kerja, tuntutan konfidensi semakin tinggi. Salah satu upaya untuk meningkatkan konfidensi adalah pelatihan, pengalaman berulang, dan dukungan suasana kerja suportif. Perawat relawan ICU covid-19 berhadapan pada tuntutan adaptasi pada 5 hal utama, yaitu (1) Komunikasi; (2) Kerjasama tim; (3) kepercayaan diri; (4) pengetahuan; dan (5) Skill praktik. Pengalaman ini tergambar pada tema ke 6, 8, dan 9. Meskipun perawat relawan ICU covid-19 memiliki pengalaman yang melelahkan secara fisik dan mental, mereka tetap bersyukur telah memiliki kesempatan itu dan mereka memiliki harapan perbaikan karir dan masa depan setelah selesai menjalani masa tugas. Diperlukan dukungan fisik dan psikologis bagi PK I sebagai perawat relawan selama merawat pasien di ruang ICU covid-19. Dukungan psikologis dapat berupa (1) upaya untuk meningkatkan motivasi, keperayaan diri, dan semangat seperti ‘motivational message’; (2) pembekalan manajemen stress atau terapi kesehatan mental; (3) dukungan kerja sama tim dan hubungan interpersonal yang positif dengan sejawat. Dukungan fisik yang dapat diberikan adalah pogram transisi atau pelatihan berbasis kebutuhan yang lebih terencana.

English Abstract

The need for covid-19 ICU rooms and nursing professionals in covid-19 ICU rooms increases in line with the increase in critical degree covid-19 cases. However, most covid-19 referral hospitals worldwide, including Indonesia, cannot meet the demands of the high number of trained nurse personnel needs. This situation causes the utilization of human resources, including nurses, to exceed the limits of ability. This utilization impacts the physical and psychological well-being of covid-19 ICU nurses such as burnout, stress, depression, anxiety, fear, irritability, increased SSD (Somatic Symptom Disorder), and increased PTSD (Post Traumatic Stress Disorder). One of the Indonesian Government's efforts to overcome the problem of the shortage of nurses that occurred nationally during the pandemic was to recruit volunteer nurses. Hospitals must complete several demands in carrying out the recruitment process for volunteer nurses. Namely, hospitals must find staff with basic critical care skills and conduct orientation or mentoring for volunteer nurses in a short time. However, many covid-19 referral hospitals in Indonesia are forced to recruit volunteer nurses with the category of novice nurse or level I clinical nurse (PK I) and without basic ICU training and previous experience working in the ICU room to work in the covid-19 ICU room. In addition, there are limitations in sending these volunteer nurses to receive training, so they rely on orientation and guidance from seniors to carry out their duties properly in the covid-19 ICU room. Volunteer nurses are required to be able to adapt quickly to the transition period in the covid-19 ICU room. The transition to working in the covid-19 ICU room has more challenges and workloads than working in a regular ICU room. The transition period in the covid-19 ICU room is challenging for expert nurses from the inpatient ward room who are assigned to the covid-19 ICU room without prior preparation and training in critical patient care. The challenges of adaptation in the transition period in the covid-19 ICU room will be felt more heavily by novice nurses or level 1 clinical nurses (PK I) compared to expert nurses. ICU training or previous experience working in the ICU room can be the primary capital for covid-19 ICU volunteer nurses to be able to accelerate the transition period. However, for volunteer nurses who still need to get these two provisions, the adaptation process in the transition period is complicated. The transition period will also be more difficult if they do not receive immediate training. New nurses who do not receive guidance from seniors are also at risk of making fatal errors in action. Volunteer nurses who have low skills will increase the workload of senior nurses. In addition, cases of severe complications and mortality rates increase when new nurses work in the ICU. This transition period is a time of adjustment and a determining factor in whether a novice nurse will remain employed and committed to the organization. Most of the covid-19 ICU volunteer nurses from the two largest covid-19 referral hospitals in Malang and Batu City are PK I category without experience working in the ICU room and ICU training. In addition, they experienced limited delivery and implementation of ICU training. These two hospitals are covid-19 referral hospitals with the highest availability of unfavourable pressure isolation rooms with ventilators in Malang and Batu City as of December 2021. In addition, the mortality rate of Covid-19 ARDS (CARDS) cases in these two hospitals until November 2020 reached 47% - 87% (82-190 patients). This covid-19 referral hospital in Malang City has more complete facilities, capabilities, and clinical support than other covid-19 referral hospitals. This hospital also opened several batches of volunteer nurse recruitment registration with a large acceptance quota. Meanwhile, the covid-19 referral hospital in Batu City is the only covid-19 referral hospital in the city. Two covid-19 ICU volunteer nurses revealed they felt burdened working in the covid-19 ICU without previous experience or training. They felt anxious and worried, experienced severe challenges, and even wanted to resign while on duty in the covid-19 ICU room. Based on the main problems, including: (1) covid-19 ICU volunteer nurses are PK I without previous experience working in the ICU and ICU training; (2) There are limitations in the implementation and delivery of ICU training; (3) The workload in the covid-19 ICU room is greater than the common ICU room; and (4) The physical and psychological impact of covid-19 ICU volunteer nurses, an in-depth exploration of the PK I experience as a volunteer nurse in the covid-19 ICU room of Malang and Batu City Hospitals is needed. This study used a qualitative research design with a phenomenological study approach. The participants were selected by purposive sampling by applying several inclusion criteria. The participants in this study amounted to 10 people consisting of 5 covid-19 ICU volunteer nurses each from covid-19 referral hospitals in Malang City and Batu City. To achieve data saturation, researchers added 5 participants from covid-19 referral hospitals in Batu City who met the inclusion criteria. Researchers used interview guidelines to conduct semi-structured in-depth interviews in data collection. The study results were then analyzed using the Interpretative Psychological Analysis method. There are 12 themes found in this study, including (1) Circumstances that force one to become a covid-19 volunteer nurse; (2) The existence of facilities and benefits as a covid-19 volunteer nurse; (3) Motivation from within oneself; (4) Facing obstacles to permission from parents; (5) Feeling insecure about working in the covid-19 ICU room; (6) facing the demands of rapid adaptation when initially assigned to the covid-19 ICU room; (7) Feeling the need for training as a Covid-19 ICU Volunteer Nurse; (8) Steadfastly enduring the conditions experienced during his time as a covid-19 ICU volunteer nurse; (9) Frustrated and upset when on duty in the Covid-19 ICU Room; (10) Trying to be strong in dealing with the patient's family; (11) Grateful to have the opportunity to become a covid-19 ICU volunteer; and (12) Expecting career and life improvements in the future after completing his duty period as a covid-19 ICU volunteer nurse. Some of the things that underlie PK I to register as a covid-19 volunteer nurse are urgent, intrinsic, and extrinsic motivation, as illustrated in themes 1 - 3. However, they had to face obstacles with parental permission when they were about to register as a covid-19 volunteer nurse (theme 4). Permission from parents or spouses is the main requirement to register as a covid-19 volunteer nurse. In addition, family support is an important thing that covid-19 volunteer nurses must have because it can increase productivity and job performance. After they got their parents' permission and became covid-19 ICU volunteer nurses, they had to face various physically and mentally exhausting conditions while caring for patients in the covid-19 ICU room. These experiences are described in themes 5-10. One of the challenges in the transition period in the ICU room is the need for more confidence. The greater the workload, the higher the demand for confidence. One of the efforts to increase confidence is training, repeated experiences, and a supportive work environment. ICU covid-19 volunteer nurses face adaptation demands on five main things, namely (1) Communication; (2) Teamwork; (3) confidence; (4) knowledge; and (5) Practice skills. This experience is illustrated in themes 6, 8, and 9. Although covid-19 ICU volunteer nurses have a physically and mentally exhausting experience, they are still grateful to have had the opportunity. They have hopes for career and future improvements after completing their tour of duty. As volunteer nurses, PK I need physical and psychological support while caring for patients in the covid-19 ICU room. Psychological support can be in the form of (1) efforts to increase motivation, confidence, and enthusiasm, such as 'motivational messages'; (2) provision of stress management or mental health therapy; (3) support for teamwork and positive interpersonal relationships with colleagues. Physical support can include transition programs or more planned needs-based training.

Item Type:	Thesis (Magister)
Identification Number:	0423160040
Subjects:	600 Technology (Applied sciences) > 610 Medicine and health > 610.7 Education, research, nursing, services of allied health personnel > 610.73 Nursing and services of allied health personnel
Divisions:	S2/S3 > Magister Keperawatan, Fakultas Kedokteran
Depositing User:	soegeng sugeng
Date Deposited:	17 Jul 2023 01:27
Last Modified:	17 Jul 2023 01:27
URI:	http://repository.ub.ac.id/id/eprint/201860

Text (DALAM MASA EMBARGO) Vebby Astri Rizkilia.pdf Restricted to Registered users only until 31 December 2025. Download (8MB)

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