Application of Primary Methods in the Treatment Room in Order to Improve the Quality of Nursing Care Services

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Published on International Journal of Health, Nursing, & Medicine
Publication Date: May 7, 2019

Elly Marce Titihalawa, Agus Suradika & Tri Kuniati
Postgraduate Master of Nursing Programme Faculty of Nursing, Muhammadiyah University Jakarta
Faculty of Nursing, Muhammadiyah University Jakarta
Indonesia

Journal Full Text PDF: Application of Primary Methods in the Treatment Room in Order to Improve the Quality of Nursing Care Services (Study at Hermina Hospital Bekasi).

Abstract
The Primary Method is a method of providing care that produces professional, effective, adaptive and competitive value, and still considers quality standards and deals with patient safety. The primary method can improve the nurse’s critical thinking skills in performing nursing care from assessment to evaluation. The design of this research is qualitative phenomenology with a descriptive approach that aims to obtain a description of primary nurse’s experience in performing primary methods at Hermina Hospital Bekasi. The results of this study indicate that, five participants revealed that the Primary Nurse was the nurse responsible for the patient. Three of the five participants thought the Primary Method was a form of nursing application and is a term often used in primary methods. One in five participants found satisfaction with nursing care activities in the room. Four participants thought that applying the Primary Method was the responsibility of the nurse, with different patient characteristics, as well as the type of nursing and documentation actions that a primary nurse should take. From some of the participants’ opinions above indicates that primary methods are well suited to be applied, nurses become more patient-focused, more comprehensive in providing nursing care to patients. The conclusion of this study is that Primary Method is a form of comprehensive implementation of nursing care for patients conducted by the Primary Nurse. Nurse satisfaction in applying the Primary Method is that nurses feel needed by the patient. The challenges and obstacles faced by nurses in applying the main method are the insufficient number of nurses, overtime hours, insufficient tools. The application of nursing care using the Primary Method has an impact on the quality of nursing care that is more comprehensive. The recommendations in this study are the addition of the number of nurses is very important in conducting the primary method. For the next research can do further research using quantitative methods.

Keywords: Quality of Service, Nursing Care, Primary Method.

1. INTRODUCTION
Implementation Nursing management cannot be separated from the running of management functions effectively and efficiently. (Terry) suggests that management functions include planning, organizing, actuating and controlling. Each management function is interrelated and can be applied top, middle and lower managers. In the nursing, ranks can be applied ranging from Head of Nursing to Head of Nursing Room (Nursalam, 2014).
The Nursing and Head of Nursing Room performs nursing management functions which include nursing service management and nursing care management. Implementation of nursing care management is supported by the organization of nursing care through the method of nursing care as part of the organizing function (S. Suarli, 2012).
The method of nursing care is part of the organizing function. Methods of providing nursing care include functional, case, team, modular and primary (Marquis and Huston). Team method is a method of nursing care used by the hospital but Primary Method is a method of giving nursing care that show professional value, effective, more adaptive and competitive, and still consider quality standard and closely related to patient safety. The primary method can improve the nurse’s critical thinking ability in performing nursing care from assessment to evaluation. Primary method in accordance with the needs of services that can meet the needs of patients because the nurse is directly responsible to the patient.
The result of an interview with Nursing Committee of Hermina Bekasi Hospital has previously applied Primary Method which is in child room and applied for two years. In fact, the application of the Primary Method requires a lot of power and impact on the use of costs so that the hospital decides the application of Primary Methods without associate nurses, but its application is modified by using one Primary Nurse responsible for five patients in each treatment room until now.
To improve the quality of the nurses, the hospital provides training on Primary Methods and improves nurse education in higher education with nursing and nursing education, and there are nurses with nursing diploma education background, for example one treatment room of 18 nurses, one people with Bachelor and Ners education while 17 nurses still have a nursing Diploma education. Based on the above phenomenon, this research entitled “Application of Primary Methods in the treatment room in order to improve the quality of nursing care services at Hermina Hospital Bekasi”.

2. METHODOLOGY
This research uses qualitative research design of phenomenology with descriptive approach. Researchers use qualitative methods that aim to obtain the primary nurse’s experience form of primary methods at Hermina Bekasi Hospital. Experience is an event that has been experienced and felt by everyone and this is very different. For that, the experience of primary nurses needs to be explored in depth to determine how the success of the primary method is done. The time of research begins in the first week of June 2018.
Researchers try not to have any perception in an attempt to deal with the statement naturally. Intuiting is a researcher able to unite totally with the phenomenon studied and explore the phenomena described by participants. Analyzing is extracting significant statements, grouping and understanding the significance of phenomena. In this study using Colaizzi analysis technique.
The final step is Describing ie researchers understand and define the phenomenon, then communicated and gave a broad and deep written description of the phenomenon. At this stage researchers describe Primary Nurses in applying the Primary Method in written form, communicating the meaning of the experience of primary nurses in applying the primary method at Hermina Hospital Bekasi.
How to recruit participants through a process of cooperation with Head of Nursing and Head of Nursing Room about primary nurse as a participant. Participants are Primary Nurses who are in the care of Hermina Bekasi Hospital. The reason for choosing the nursing room has been to implement Nursing Care using the primary method and have a primary nurse with Nursing Strata education and Ners. The number of participants in this study was determined based on the saturation obtained by the researcher during the interview with the participants if the result of the in-depth interview with the participant was found to be the meaning of the participant’s answer to each question equally then the number of participants will be terminated or sufficient.

3. RESULTS
1. Theme 1: Understanding Nurses About Primary Nurses
Five participants who revealed that the Primary Nurse is the nurse responsible for the patient. The primary nurse’s responsibility is to provide nursing care from assessing patient needs, planning actions, taking actions, and evaluating nursing actions directly to patients. This was revealed by a nurse who had worked for three years and six months and a nurse who worked four months. While one participant with a long working eleven months said the Primary Nurse is conducting independent, collaborative, and invasive nursing actions.
2. Theme 2: Nurse’s understanding of the Primary Method
Three of the five participants thought the Primary Method was the way of applying nursing care and the term often used in the primary method. The nurse’s activities in performing the overall action to the patient in charge, this opinion is expressed by four participants.
3. Theme 3: Nurse’s satisfaction in applying the Primary Method
Two out of five participants thought nursing care was a nursing action performed by the nurse on the patient who was in charge in accordance with the nursing plan and one participant was satisfied while one participant was not satisfied. The results of interviews with five participants, two participants said sometimes there were patients who protested to the nurse because it was considered late in response to his call. One participant expressed dissatisfaction focusing on nurses in insufficient space. The opinion of participants about satisfaction about the Primary Method which is carried out with no opinion that states satisfied but there are not satisfied in running the primary method.
4. Theme 4: The challenges and obstacles facing the Primary Nurse in conducting the Primary Method
Four of the five participants argued that applying the patient’s Primary Method was the responsibility of the nurse, as well as the type of nursing and documentation action that a primary nurse. Another opinion is that three of five participants who reveal the number of nurses and tools can be challenges and obstacles in carrying out the Primary Method.
5. Theme 5: Nursing Care Quality
The patient is the person who receives and feels the nursing care provided by the primary Nurse. can have an impact on patient and nurse satisfaction. the participants’ opinions above suggest that the primary method is suitable for the application, the nurse becomes more patient-focused, more comprehensive in providing nursing care and being close to the patient, care, being a source of information about the patient’s condition.

4. DISCUSSION
1. Theme 1: Understanding Nurses About Primary Nurses
Participants revealed that the primary nurse was the nurse responsible for five patients and provided a comprehensive range of comprehensive nursing care to the patient from the action plan to the implementation of both independent, collaborative and invasive action.
Participants also revealed that the duties and characteristics of the Primary Nurses have been implemented in the treatment room of Hermina Bekasi Hospital. This is supported by prior work in the treatment room participants have been trained how to become Primary Nurses through education and training and continued internship in the inpatient room.
The results of interviews with the Chairman of the Nursing Committee of Hermina Bekasi Hospital explained before the nurses work must undergo training on the concept of nursing used throughout the Hospital by the education and training. Thus the participants already have knowledge and experience as primary nurse and have an understanding of the meaning, duties and characteristics of the Primary Nurse. This is also supported by the participants ‘opinions on the meaning, of the primary nurse and the participants’ opinions about the duties of the Primary Nurses.
2. Theme 2: Nurse’s understanding of the Primary Method
Primary Method is one model of professional nursing practice used in providing comprehensive nursing care to patients. The results of the interview with the Chairman of the Nursing Committee of Hermina Bekasi Hospital stated Primary Method has been done that is using Primary Nurse’s and associate nurses, but due to shortage of nurses, the hospital decided to implement the primary method by means of a primary nurse responsible for five patients without associate nurse, in other words, the primary method is nothing new for the nurse in giving nursing care to the patient, thus five participants already have knowledge of the Primary method.
The opinion expressed that the primary method is a form of the implementation of nursing care thoroughly in patients conducted by primary nurses and is the responsibility of the nurse. One in five participants was able to see the weakness of the Primary Method. Three of the five participants argued that in addition to the responsibilities of the primary method has advantages over team methods. One in five participants was able to see the extent of deficiencies in using the primary method. The advantages of the primary method are described by the participants as an action focused on the patient while the shortcomings are that the nurse does not know the other patient’s situation that is not his responsibility. The opinion of all participants states the quality of the level of knowledge in understanding the Primary Method.
3. Theme 3: Nurse’s satisfaction in applying the Primary Method
In this study, there are several reasons for the opinion of participants who are satisfied in applying the Primary Method. Satisfaction occurs because the nurse can perform nursing care to the patient who is in charge in accordance with the nursing plan that has been made. Satisfaction is felt by the nurse because it is needed by the patient who becomes the managers in fulfilling the patient’s needs. Satisfaction is also experienced by nurses when managing five patients who all have a minimal dependency.
Some participants who are not satisfied in carrying out the Primary Method and have a reasonably strong enough. Dissatisfaction is due to the fact that in dealing with five patients with different levels of dependence, this may occur because of the experience of four months of participant work that has not had enough experience in handling the patient. Not satisfied also occurred due to work done nurse is still perceived as a monotonous work, this is revealed by two of the five participants. In addition, in implementing nursing care by using the primary method is still perceived as a routine job and nurses are still lacking the critical way of thinking in implementing nursing care.
This is supported by the nursing theory of Patricia Benner, where a nurse is said to be an expert is able to realize the Know-How process (how he should work and what he should do). Not only has experience and higher education but is able to provide nursing care especially using primary methods are professionally sensitive to the patient’s condition and able to anticipate what will happen to the patient.
4. Theme 4: The challenges and obstacles facing primary nurses in performing primary methods
Challenges or obstacles is something that can make the plan cannot run properly or can be an impetus to perform an action properly, especially the implementation of the Primary Method. The opinion of three of the five participants in this study about the challenges and obstacles faced by primary care nurses in Primary Method method is that the patient is the responsibility of Primary nurses in handling the five patients themselves is a difficult start because the level of dependence of different patients and have different characteristics.
The nurse must be able to identify the patient’s overall situation and make the nursing documentation as evidence of the nursing care implementation performed by the nurse on the patient. Another constraint of the number of nurses available in the room is not yet in accordance with the number of patients so that the nurse must still be ejected for re-service and coupled with the number of tools required in performing maintenance measures, not sufficient such as a thermometer.