How to cite:
Hasudungan, R, S., Wahidi, K.R., Yudhya,E., (2022). Ementation Of Patient Safety Objectives With Nurse
Caring Attitude As A Variable Mediation In Rs-X Jurnal Health Sains 3 (9) http// 10.46799/jhs.v3i10.636
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2723-6927
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Ridwan Institute
Jurnal Health Sains: pISSN: 2723-4339 e-ISSN: 2548-1398
Vol. 3, No. 10, Oktober 2022
EMENTATION OF PATIENT SAFETY OBJECTIVES WITH NURSE CARING
ATTITUDE AS A VARIABLE MEDIATION IN RS-X
Ramli Saibun Hasudungan, Kemala Rita Wahidi, Erry Yudhya
Universitas Esa Unggul, Jakarta, Indonesia
ARTIKEL INFO
ABSTRACT
Diterima:
02 September 2022
Direvisi:
September 2022
Dipublish:
October 2022
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.
Keywords:
Leadership Style;
Career Leveling,
Caring;
Implementation of
Patient Safety Goal
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
Ementation Of Patient Safety Objectives With Nurse Caring Attitude As A Variable
Mediation In Rs-X
Jurnal Health Sains, Vol. 3, No. 10, Oktober 2022 1519
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
Ramli Saibun Hasudungan, Kemala Rita Wahidi, Erry Yudhya
1520 Jurnal Health Sains, Vol. 3, No. 10, Oktober 2022
Figure 1
Test Results of the Measurement Model (Outer Model)
Table 1
Outer Model (Outer Loading )
Variabel
Konstruk
Outer Loadings
Leadership Style
Tranformasional
0,813
Transaksional
0,874
Laissez-Faire
0,892
Clinical Career
Leveling
Career Level
1,000
Nurse Caring Attitude
SCP1
0,942
SCP2
0,901
SCP3
0,889
SCP4
0,917
SCP5
0,951
Application of SKP
KSP1
0,969
KSP2
0,892
KSP3
0,877
KSP4
0,950
KSP5
0,906
KSP6
0,881
Table 2
Ementation Of Patient Safety Objectives With Nurse Caring Attitude As A Variable
Mediation In Rs-X
Jurnal Health Sains, Vol. 3, No. 10, Oktober 2022 1521
Cross Loading Value of Each Variable and Research Model Construct
Leadership
Style
Clinical
Career
Leveling
Nurse
Caring
Attitude
Application
of SKP
Tranformasional
0,813
0,118
0,482
0,614
Transaksional
0,874
0,107
0,342
0,440
Laissez-Faire
0,892
0,169
0,470
0,535
Career Level
0,155
1,000
0,402
0,532
SCP1
0,416
0,372
0,942
0,683
SCP2
0,382
0,409
0,901
0,725
SCP3
0,563
0,332
0,889
0,613
SCP4
0,545
0,353
0,917
0,640
SCP5
0,457
0,383
0,951
0,732
KSP1
0,615
0,511
0,722
0,969
KSP2
0,614
0,453
0,638
0,892
KSP3
0,556
0,386
0,677
0,877
KSP4
0,596
0,506
0,721
0,950
KSP5
0,548
0,423
0,656
0,906
KSP6
0,515
0,626
0,627
0,881
Table 3
Average Variance Extracted (AVE) Research Model
Variable
AVE
Leadership Style (X
1
)
0.740
Clinical Career Leveling (X
2
)
1.000
Nurse Caring Attitude (Z)
0.834
Application of SKP (Y)
0.847
Table 4
Construct Reliability and Validity
Variable
C Cronbach’s
Alpha
Composit
e
Reability
Information
Gaya Leadership Style (X
1
)
0.825
0.895
Reliabel
Clinical Career Leveling (X
2
)
1.000
1.000
Reliabel
Sikap Nurse Caring Attitude (Z)
0.955
0.965
Reliabel
Application of SKP (Y)
0.960
0.968
Reliabel
Ramli Saibun Hasudungan, Kemala Rita Wahidi, Erry Yudhya
1522 Jurnal Health Sains, Vol. 3, No. 10, Oktober 2022
Figure 2
Results of the Structural Model (Inner Model)
Table 5
Results of the Coefficient of Determination
Variable
R-Square
Nurse Caring Attitude (Z)
0,370
Application of SKP (Y)
0,707
Table 6
Test Results of Direct and Indirect Effects of Research Variables
Pengaruh Antar Variabel
Koefisien
Regresi
T
Statisti
k
P
Value
s
Informatio
n
Leadership Style Nurse Caring
Attitude
0,462
5,598
0,000
Significant
Clinical Career Leveling Nurse
Caring Attitude
0,331
3,593
0,000
Significant
Leadership Style SKP
0,361
4,855
0,000
Significant
Clinical Career Leveling SKP
0,303
3,917
0,000
Significant
Nurse Caring Attitude SKP
0,431
5,139
0,000
Significant
Leadership Style Nurse Caring
Attitude SKP
0,199
3,563
0,000
Significant
Clinical Career Leveling Nurse
Caring Attitude SKP
0,143
2,858
0,004
Significant
A. Discussion
1. The effect of nurse clinical career
leveling on the application of
patient safety goals with nurse
caring attitude as a mediation
The results showed that the
clinical career leveling of nurses
indirectly significantly affected the
Ementation Of Patient Safety Objectives With Nurse Caring Attitude As A Variable
Mediation In Rs-X
Jurnal Health Sains, Vol. 3, No. 10, Oktober 2022 1523
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.
2. 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.
Ramli Saibun Hasudungan, Kemala Rita Wahidi, Erry Yudhya
1524 Jurnal Health Sains, Vol. 3, No. 10, Oktober 2022
3. 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.
4. 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.
5. 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
Ementation Of Patient Safety Objectives With Nurse Caring Attitude As A Variable
Mediation In Rs-X
Jurnal Health Sains, Vol. 3, No. 10, Oktober 2022 1525
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.
6. 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.
7. 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.
Ramli Saibun Hasudungan, Kemala Rita Wahidi, Erry Yudhya
1526 Jurnal Health Sains, Vol. 3, No. 10, Oktober 2022
Conclusion
1. Nursing clinical career leveling indirectly
significantly influences the implementation
of patient safety goals through nurses' caring
attitude.
2. The leadership style of the ward head
significantly affects the caring attitude of
nurses.
3. Clinical career leveling significantly affects
nurses' caring attitude.
4. The leadership style of the head of the room
significantly affects the Implementation of
Patient Safety Goals.
5. Clinical career leveling significantly affects
the implementation of patient safety goals.
6. The caring attitude of nurses significantly
affects the implementation of patient safety
goals.
7. The leadership style of the ward head
indirectly significantly affects the
implementation of patient safety goals
through the caring attitude of nurses.
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