EMENTATION OF PATIENT SAFETY OBJECTIVES WITH NURSE CARING ATTITUDE AS A VARIABLE MEDIATION IN RS-X

Patient safety is an important part of health services. Patient safety is determined by the implementation of patient safety goals. Implementation of patient safety goals plays an important role in the prevention and reduction of risks, errors and injuries that may occur during service. The application of optimal patient safety goals can be determined by the nurse's behavioral factors. Nurse behavior is influenced by several factors, namely individual factors, organizational factors, and psychological factors. Research Objectives: This study aims to analyze the relationship between the leadership style of the head of the room and the clinical career leveling of nurses on the application of patient safety goals with the caring attitude of nurses as a mediating variable. Research method: quantitative explanatory because to determine the relationship between variables based on the previous hypothesis that has been put forward by previous researchers. The sample in this study was a total sampling, that is, all the nurses were 80 people. The analysis technique uses path analysis. The results of the study: (1) the leadership style of the ward head significantly affects the caring attitude of nurses; (2) Clinical career leveling significantly influences nurses' caring attitude; (3) The leadership style of the ward head significantly influences the Implementation of Patient Safety Goals; (4) Clinical career leveling significantly affects the implementation of patient safety goals; (5) The caring attitude of nurses significantly affects the implementation of patient safety goals; (6) The leadership style of the ward head indirectly significantly affects the implementation of patient safety goals through the caring attitude of nurses; and (7) Nurse's clinical career leveling indirectly significantly influences the implementation of patient safety goals through nurses' caring attitude.


Introduction
This type of research is quantitative explanative. The quantitative approach is a research approach that uses data in the form of numbers from survey answers that are distributed to the research sample and analyzed using statistical analysis techniques. Explanatory or explanatory research is research that intends to Patient safety is an important part of health care. Patient safety is determined by the complexity of the health care system and the increasing harm to patients in health care settings. Patient safety plays an important role in the prevention and reduction of risks, errors and injuries that may occur during services. Patient safety is described as the collaborative effort of healthcare providers in an integrated system to prevent avoidable medical errors or injuries designed to protect patients.
Patient safety is the first important step to improve the quality of service. The World Health Organization reports that 134 million injuries occur in low-and middle-income countries each year, with a death rate of 2.6 million, but 50% of injuries are preventable. Injuries that cause death in the United States between 44,000-98,000 people indirectly exceed the number of traffic accidents, breast cancer, and HIV AIDS deaths, while the European healthcare-associated infection (HAI) estimate is 1 in 20 patients in the United States. home (estimated 4.1 million patients). At the same time, the risk of HAI is 2-20 times higher in developing countries (Organization, 2015).
The head of the room is a nurse who has the responsibility and authority to regulate and control care activities in the ward. Head nurses with strong leadership skills must be a resource for other nurses, anticipate problems, and provide continuous care. Leaders are very important in every organization to achieve patient safety and a healthy work environment (Alilyyani, Wong, & Cummings, 2018). The role of the leadership style of the head of the room is important in a hospital. The role in maintaining a stable composition of nurses by satisfying the needs of nurses. The leadership style exhibited by managers has been associated with the presence of a safety culture (McFadden, Stock, & Gowen, 2014). Managers' leadership style can be very important in health care settings, but very few studies have focused on it (Saleh, 2018). Positive leadership attributes (transformational style, manager support, staff involvement with decision-making, relationship-oriented leadership, positive work environment) were associated with an improved safety climate, better work environment, better safety outcomes, increased patient satisfaction, and reduction of side effects (Merrill, 2015). The results of the study by (Padauleng, Sidin, & Ansariadi, 2020) show that transactional leadership has a positive impact in building the application of a patient safety culture. While research by (Merrill, 2015) shows that transformational leadership style is shown to be a positive contributor to the safety climate, while laissez-faire leadership style is shown to contribute negatively to patient safety culture. The research results of (Saleh, 2018) found that the leadership style used by nurse managers had a major impact on nurse satisfaction, turnover, and the quality of patient care provided.

Research methods
Explain the position of the variables studied and the relationship between one variable and another (Creswell & Creswell, 2017) Results and Discussion     The results showed that the clinical career leveling of nurses indirectly significantly affected the implementation of patient safety goals through the caring attitude of nurses. This explains that a high caring attitude can encourage the influence of nurses' clinical career leveling on the implementation of patient safety goals. it is known that the clinical career leveling of nurses at hospital X is still at the lowest level, while the caring attitude of nurses is high, so that it can have an impact on the high application of patient safety goals.
The results of this study are in line with the theory that leveling a nurse's clinical career can improve the caring attitude of nurses, which in turn has an impact on the accuracy of the practice of patient safety goals (Ausserhofer et al., 2014). in line with the opinion of caring attitude is in line with nurse education level. Nursing higher education can cause significant changes to the nurse's perspective on effective nursing care with a holistic approach. That is, caring as a goal-oriented process of helping others responsibly.
Nurse's clinical career towards the application of patient safety goals with the caring attitude of nurses as mediation.
The results showed that the clinical career leveling of nurses indirectly significantly affected the implementation of patient safety goals through the caring attitude of nurses. This explains that a high caring attitude can encourage the influence of nurses' clinical career leveling on the implementation of patient safety goals. it is known that the clinical career leveling of nurses at hospital X is still at the lowest level, while the caring attitude of nurses is high, so that it can have an impact on the high application of patient safety goals.
The results of this study are in line with the theory that leveling a nurse's clinical career can improve the caring attitude of nurses, which in turn has an impact on the accuracy of the practice of patient safety goals. in line with the opinion of caring attitude is in line with nurse education level. Nursing higher education can cause significant changes to the nurse's perspective on effective nursing care with a holistic approach. That is, caring as a goal-oriented process of helping others responsibly.

The influence of the leadership style of the head of the room on the caring attitude of nurses
The results showed that the leadership style of the head of the room significantly influenced the caring attitude of nurses (Wong & Laschinger, 2013). This explains that the appropriate leadership style of the head of the room can increase the caring attitude of nurses. The highest leadership style of ward head in X Hospital according to the nurse's perception is transactional leadership style. Transactional leaders focus on organizational goals, with a directive style that sets expectations for team members and motivates with rewards. With this type of leadership, it is possible that the interaction is not necessarily in line with the expectations of subordinates (nurses).
In this study, the theory proved that the leadership style of the head of the room significantly influenced the caring attitude of nurses in Hospital X. Respondents in this study believed that the presence of the right leadership style of the head of the room could increase the caring attitude of nurses. The results of this study support previous research conducted by (Suweko & Dwiantoro, 2019) showing leadership style has a positive effect on caring for nurses.

The effect of nurse clinical career leveling on nurses' caring attitude
The results showed that clinical career leveling significantly affected nurses' caring attitude. This explains that the higher the level of a nurse's clinical career can increase the caring attitude of the nurse. The clinical career level of nurses at Hospital X is mostly PK I with a majority education of D3, so that it can affect the caring attitude of nurses.
In this study, the theory proved that the leveling of clinical careers of nurses significantly affected the caring attitude of nurses in Hospital X. Respondents in this study believed that with high leveling of clinical careers, nurses' caring attitudes could be increased. The results of this study are supported by the research of (Cho et al., 2016). show that the level of nursing staff has an influence on the quality of patient care.

The influence of the leadership style of the head of the room on the Implementation of Patient Safety Goals
The results showed that the leadership style of the ward head significantly affected the implementation of patient safety goals. This explains that the leadership style shown by the head of the room has been associated with the presence of a safety culture. Positive leadership attributes (transformational, transactional, and laissez-faire styles are associated with improved patient identification skills, effective communication, increased safety of over-the-counter medications, ensuring correct surgical site, correct procedure, correct patient surgery, reducing risk infections due to health care; and reduce the risk of patient injury from falls. In this study, it was proven that the ward leadership style significantly affected the implementation of patient safety goals in Hospital X. Respondents in this study believed that the presence of the right ward leadership style could improve the application of patient safety goals. The results of this study support previous research conducted by (Sri, Muliyadi, & Anita, 2015). showed that there was a relationship between leadership and nurse performance in the application of patient safety. The results of research by (Boamah, Laschinger, Wong, & Clarke, 2018) show managers' transformational leadership as a useful strategy in creating workplace conditions that promote better safety outcomes for patients and caregivers. (Padauleng et al., 2020) show that transactional leadership has a positive impact in building the application of a patient safety culture. The results (Saleh, 2018) found that the leadership style used by nurse managers had a major impact on nurse satisfaction, turnover, and the quality of patient care provided. While (Merrill, 2015) research shows that transformational leadership style is shown to be a positive contributor to the safety climate, while laissez-faire leadership style is shown to negatively contribute to unit socialization and blame culture.

The effect of nurse clinical career leveling on the implementation of patient safety goals
The results showed that clinical career leveling significantly affected the implementation of patient safety goals. This explains that the higher the level of a nurse's clinical career can increase the application of patient safety goals. The clinical career level of nurses at Hospital X is mostly PK I with the majority of education being D3, so that it can affect the implementation of patient safety goals.
In this study, it is proven that the leveling of clinical careers of nurses significantly affects the practice of patient safety goals at Hospital X. Respondents in this study believe that with a high level of clinical careers, they can improve the practice of patient safety goals.
The results of the study support the research of which stated that there was an effect of clinical competence on patient safety standards among nursing staff. With higher levels of clinical career nursing staff are more likely to take advantage of patient safety practices. Thus, the results of this study indicate that a stronger safety culture is significantly associated with better nurse outcomes. Nursing competence has the potential to affect the safety and quality of nursing care provided to patients.

The influence of the caring attitude of nurses on the implementation of patient safety goals
The results showed that the caring attitude of nurses significantly influenced the implementation of patient safety goals. This explains that nurses who have a touch of compassion, listening, understanding clients, caring in spiritual, and caring acts of care can improve the practice of patient safety goals.
In this study, the theory proved that the caring attitude of nurses significantly affected the practice of patient safety goals in Hospital X. Respondents in this study believed that a high nurse caring attitude could improve the practice of patient safety goals. The results of this study are supported by research conducted by (Galleryzki, Hariyati, & Afriani, 2021) showed that there was a significant relationship between safety attitudes and the implementation of nurses' safety. The results of also show that nurses' caring behavior with patient safety at risk of falling has a significant relationship, because caring behavior provides direct and responsive care for each patient's condition. (Ambarika & Anggraini, 2021). in their research showed that there was a relationship between nurse caring behavior and patient safety risk of falling. Nurse caring behavior with patient safety risk of falling has a significant relationship, because caring behavior provides direct care, and responds to each patient's condition.

The influence of the leadership style of the head of the room on the application of patient safety goals with the caring attitude of nurses as mediation
The results showed that the leadership style of the ward head indirectly significantly affected the implementation of patient safety goals through the caring attitude of nurses. This explains that a high caring attitude can encourage the influence of the ward leadership style on the implementation of patient safety goals. In fact, the leadership style of the ward head at hospital X is still not optimal. This condition is caused by a transactional style that tends to be authoritarian, so that employees find it difficult to implement patient safety goals because of the lack of support from the head of the room.
Based on the description above, it shows that the caring attitude of nurses has an important role in bridging the influence of the leadership style of the head of the room on the practice of patient safety goals. A less than optimal leadership style can be mediated by the caring attitude of nurses so that it has an impact on increasing the application of patient safety goals.