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Khodiyatussolihah, Kemala Rita, Reza Hilmy (2022). Management Multiple Uterine Fibroids In
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ANALYSIS OF NURSE WORKLOAD ON IMPLEMENTATION OF PATIENT
SAFETY AND TEAMWORK WITH CARING BEHAVIOR AS MEDIATION
VARIABLES AT METRO HOSPITALS CIKUPA
Khodiyatussolihah, Kemala Rita, Reza Hilmy
Universitas Esa Unggul Jakarta, Indonesia
Email: nengdiyat79@gmail.com, [email protected],
[email protected]
Jurnal Health Sains: p–ISSN: 2723-4339 e-ISSN: 2548-1398
Vol. 3, No.11, November 2022
INFO ARTIKEL
Abstract
Diterima
27 Oktober 2022
Direvisi
17 November 2022
Disetujui
25 November 2022
The central issue of nursing is currently developing in the era
of globalization and the era of hospital competition is the
application of patient safety goals in hospitals. Most of the
components of implementing the six patient safety goals are in
the hands of nurses. Maintaining patient safety during
treatment cannot be separated from the workload and caring
attitude of a nurse who takes care of patients. Therefore, the
authors want to examine the extent to which the workload and
caring attitude of nurses and teamwork affect the application
of patient safety. The main purpose of this study was to
analyze the relationship between nurses' workload and
teamwork on the application of patient safety goals and
caring behavior as an intervening variable. The research
population was inpatient and outpatient nurses with a sample
number is 60 nurses. The research design uses quantitative
data with a causative approach, with a focus on cause-and-
effect relationships. Statistical methods for data analysis used
in this study were univariate statistics, three-box methods, and
path analysis to analyze the pattern of relationships between
variables. The results showed: 1). Workload had a
simultaneous effect on the variables of teamwork, caring
behavior, and goals. patient safety in the hospital 2). Nurse
workload has a positive effect on the variable implementation
of patient safety goals. 3). The nurse's workload has a positive
effect on the variable of the implementation of caring
behavior. 4). Caring behavior has a positive effect on the
variable of applying patient safety goals. 5). Nurse's workload
has a positive effect on the teamwork variable 6). The
teamwork variable did not significantly affect the variable
implementation of patient safety goals. Conclusion: nurses'
workload variables have a significant effect on teamwork,
caring behavior, and patient safety goals. Caring behavior
has a positive effect on patient safety goals, but teamwork
does not significantly affect the implementation of patient
safety goals.
Keywords:
Workload; Patient Safety
Goals, Teamwork, Caring
Behavior
Analysis Of Nurse Workload On Implementation Of Patient Safety And Teamwork With
Caring Behavior As Mediation Variables At Metro Hospitals Cikupa
Syntax Health Sains: Vol. 3, No. 11 November 2022 1611
Introduction
The central issue currently
developing for Indonesian nurses is the era
of globalization competition in it,
especially in increasing the role of caring
as a basis for improving the quality of
nursing services and patient safety. The
basic problem in the Indonesian nursing
profession is that nurses still have not
carried out the caring role professionally in
providing nursing care to clients.
Caring is the essence of nursing
that distinguishes it from other professions
and dominates, unites, and animates the
act of caring nursing as the core of nursing
science known as "human science and
human care" (Watson, 2012). Caring is a
force in improving the quality of service
and patient safety. Caring behavior that is
expected in nursing is a behavior based on
several aspects including:
1) human altruistic
(prioritizing values in human relations);
2) faith-hope (instilling
elements of trust and hope);
3) sensitivity (developing
sensitivity to oneself and others);4)
helping-trust (relationship of mutual
trust and mutual assistance);5)
expression of positive feelings and
negative feelings;6) systematic problem
solving;7) interpersonal teaching and
learning process; 8) supportive
environment; 9) fulfillment of basic
human needs, and 10) existential-
phenomenological (Watson, 2012).
Caring is one of the education that
nurses are required to know well to
implement and optimize patient safety as
caring education itself has a strong
influence in giving nurses awareness
according to.
Patient safety is a system that
makes patient care safer, including risk
assessment, patient risk identification, and
management, incident reporting and
analysis, the ability to learn from incidents
and their follow-up, as well as
implementing solutions to minimize risks .
Patient safety requires strategic action in
its application in hospitals.
Ineffective patient safety
implementation can occur in patient
identification, communication errors,
operating point errors, medication errors,
hospital infections, and patient falls.
Potential errors commonly occur in patient
identification, incorrect patient name,
communication during discharge planning
is incomplete, and lack of patient control
causing the patient to fall. The most
common mistakes in implementing patient
safety are ineffective communication.
(Eklof & Ahlborg Jr, 2016). Identification
of risks from the stage of service and the
patient's condition must be carried out to
determine risk reduction actions. Risk
control is a form of applying patient safety
according to standards that can improve
the quality of nursing care.
Nurse workload is all activities or
activities carried out by nurses during their
duties in a nursing service unit
(Tubbs‐Cooley et al., 2015). The nursing
workload in a unit can be estimated by
taking into account the components,
namely the number of patients treated per
day, per month, and year, the condition of
the patient, the average number of patients
treated, direct and indirect actions needed
by the patient, the frequency of each action
taken. required and the average time
required to act (Simeulu et al., 2013).
Khodiyatussolihah, Kemala Rita, Reza Hilmy
1612 Syntax Health Sains: Vol. 3, No. 11 November 2022
The workload is closely related to
the productivity of health workers, of
which 53.2% of the truly productive time
is used by direct health services and the
remaining 39.9% is used for supporting
activities (Ullatifa, 2017). Assessment of
the workload of nurses can be seen from 3
aspects, namely physical,
psychological/mental, and the use of time.
The physical aspect relates to the main
tasks, additional tasks, and the number of
patients being treated. Psychological
aspects are related to interpersonal
relationships between nurses and other
nurses, the head of the room, and the
patient. The aspect of working time is
related to the allocation of time used to
perform their duties every day. The
workload of nurses is an issue that is
always interesting to discuss in both
government and private health services
because the workload has different
characteristics between service units and
between hospitals (Hart & Warren, 2015).
In carrying out nursing duties
together, nurses are required to cooperate
and support each other with one. The
performance of an effective nursing team
will result in the achievement of maximum
service quality. The factors that influence
the emergence of service quality are quite
complex and intertwined with each other.
One of the factors that affect the quality of
service is teamwork. Teamwork is
The ability of individuals to form
and manage teams. Human behavior in
various work situations concludes that
human relationships among team members
are more important in determining
productivity than changes in working
conditions
The results of a preliminary study
conducted by researchers in January 2020
with a sample of 8 inpatient nurses,
showed the nursing workload (direct and
indirect nursing care activities), namely
77.14% indicating nursing activities and
22.85% indicating non-nursing activities.
(preparing forms, explanations about
filling out questionnaires, handling
complaints, photocopies of files for
guarantees, nursing still gets task
delegation from pharmacy and laboratories
for taking venous blood samples outside of
sampling hours, looking for doctors on
duty to write prescriptions, taking
medicines to the pharmacy, delivering
sample and take drug test results)
The results of the survey data on
the application of caring by nurses were
conducted by sampling in the inpatient
nurse's room to patients who have received
treatment for more than three days (Cho et
al., 2015), the number of samples is 20
inpatients distributing a question form
consisting of ten question items, the results
obtained are 91, 8% of nurses caring for
patients and 9.8% of nurses not caring for
patients.
Reports of incidents at Metro
Hospitals Cikupa that were reported in
2019 were potential injury events (KPC)
there were 56 incident reports, near-injury
events (KNC) were 47 incident reports,
non-injury events (KTC) had 19 incident
reports and 5 unexpected incidents, from
all incident reports that occurred the most
cause was a communication that was not
well established and did not identify
properly and correctly by officers.
Based on interview data from
customer service, there are many
complaints received from inpatient nurses,
including the nurses being sloppy, not
smiling, and taking a long time to come
when called by the patient.
The performance of this effective
nursing team has not been realized by
Analysis Of Nurse Workload On Implementation Of Patient Safety And Teamwork With
Caring Behavior As Mediation Variables At Metro Hospitals Cikupa
Syntax Health Sains: Vol. 3, No. 11 November 2022 1613
nurses at Metro Hospital Cikupa Hospital.
The results of interviews with several
nurses, staff, employees, and patients at
the Metro Hospitals Cikupa Hospital
provide information that reveals problems
that cause the service provided by the
hospital to be less than optimal. The
attitude of not caring, the lack of desire
and awareness to resolve conflicts, and the
lack of awareness of nurses on the
importance of cooperation and
communication often cause conflict, and
the relationship between nurses that is felt
to be less than harmonious which hinders
the establishment of cooperation is a
problem that is faced by the hospital.
Based on these problems, the
researchers wanted to study further the
workload of nurses, caring for nurses, and
the quality of service at Metro Hospitals
Cikupa, so a study was carried out with the
title "Analysis of the relationship between
nurse workloads on the application of
patient safety goals and teamwork and
caring behavior as an intervening variable
in hospitalization. inpatients and
polyclinics of Metro Hospitals Cikupa in
2020".
Research Methods
The methodology of this research
will use the Path Analysis model to
analyze the pattern of variable
relationships. The type of data used in this
research is quantitative data. The variables
in this path analysis consist of exogenous
variables (the dependent variable is (X)
and endogenous independent/ intervening
variables Z and Y. The dependent variable
is the Nurse Workload (X), the
independent variable (Y) is the application
of patient safety goals, the intervening
variable (Z1) is the Caring Behavior of
nurses, and (Z2) is Teamwork.
The population and sample in this
study were inpatient and polyclinic nurses
at XYZ Hospital who had worked for at
least 1 month totaling 60 nurses. Data
collection techniques in this study used a
questionnaire with a Likert scale (4 scales)
and a daily log form. The data analysis
method in this research is using the Path
Analysis data analysis method or path
analysis
Results And Discussion
1. Result
A. C
haracteristics of respondents
Based on the characteristics
of 60 respondents who are nurses at
XYZ Hospital, it can be seen that
47 people (78.3%) are 30 years old
and 13 people (21.7%) are > 30
years old. From these results, most
of the respondents were 30 years
old. Frequency distribution of
respondents based on education, 49
people (81.7%) have a diploma and
11 people (18.3%) have a
bachelor's degree. The frequency
distribution of respondents based
on gender obtained 60 people
(100.0%) of the sex female. The
frequency distribution of
respondents based on marital status
was obtained 38 people (63.3%)
are not married and 22 people
(36.7%) are married. From these
results, most of the respondents are
not married. The frequency
distribution of respondents based
on room/unit is spread from 6
rooms/unit, where most of them
Khodiyatussolihah, Kemala Rita, Reza Hilmy
1614 Syntax Health Sains: Vol. 3, No. 11 November 2022
come from polyclinic, sapphire, and topaz.
Table 1
Characteristics of Respondents
Description
Frequency
%
Age
47
13
78,3
21,7
Education
49
11
81,7
18,3
Gender
0
60
0,0
60,0
Maritas
Status
38
22
63,3
36,7
Room
14
5
4
5
14
18
23,3
8,3
6,7
8,3
23,3
30,0
B. Test validity and
reliability
The validity test according to
(Lampert et al., 2013) shows the degree
of accuracy between the data that
occurs on the object and the data
collected by the researcher. Validity
shows the extent to which a measuring
instrument measures what it wants to
measure. In this case, the researcher
uses a questionnaire in data collection,
the questionnaire that he has compiled
must measure what he wants to
measure. The validity test that is often
used is Pearson's product moment.
1. Nurse Caring
Behavior Variable Validity Test
The validity test of the nurse
caring behavior variable consisted of
25 statements. Based on data
processing using the SPSS program,
the results of the questionnaire
validity test above the entire value of
r count (r product moment) has a
value above r table (0.444), so it can
be concluded that all statements on
the Nurse Caring Behavior variable
are declared valid.
2. Teamwork Variable
Validity Test
The test of the validity of the
teamwork variable consists of 11
statements. Based on data processing
using the SPSS program, the results
of the questionnaire validity test
above the entire value of r count (r
product moment) have a value above
r table (0.444), so it can be
concluded that all statements on the
Teamwork variable are declared
valid.
3. Test the Validity of the
Implementation of Patient Safety
Goals Variables
Test the validity of the variable
application of patient safety goals
consists of 26 statements. Based on
Analysis Of Nurse Workload On Implementation Of Patient Safety And Teamwork With
Caring Behavior As Mediation Variables At Metro Hospitals Cikupa
Syntax Health Sains: Vol. 3, No. 11 November 2022 1615
data processing using the SPSS
program, the results of the
questionnaire validity test above the
entire value of r count (r product
moment) have a value above r table
(0.444), so it can be concluded that
Very Reliable is declared valid.
After the validity test has been
carried out, the next instrument test
is the reliability test. A reliability test
is used to measure the consistency of
a variable. The questions in the
variables are said to be reliable or
reliable if the respondent's answers
are consistent or stable from time to
time. A construct or variable is said
to be reliable if it gives Cronbach's
Alpha value of 0.70. The results of
the reliability test of the Nurse
Caring Behavior variable (Z1),
Teamwork (Z2), and the
Implementation of Patient Safety
Goals (Y) can be seen in the
following table.
Table 2
Reliability Test Results
Variabel
Cronbach’s
Alpha
Conslusion
Nurse Caring
Beharior (Z1)
0,966
Reliabel
Teamwork
0,939
Reliabel
Implementation
of Patient Safety
Goals (Y)
0,960
Reliabel
Based on the reliability test
results above, all variables can be
declared reliable because they have a
Cronbach's Alpha value greater than
0.7 (Cronbach's Alpha 0.7).
C. Description of Research Result Data
1. Descriptive statistics
Descriptive statistics for the variables
of nurse workload, nurse caring
behavior, teamwork, and application of
patient safety goals can be seen in the
table below.
Table 3
Descriptive statistics
a. Nurse Workload
This variable shows a
minimum value of 1,000 and a
maximum value of 4,000. The
average value of the nurse's
workload is 3.317, this shows that
Descriptive
Statistics
Nurse
Workload
Nurse Caring
Behavior
Teamwork
Implementation of
Patient Safety
N
60
60
60
60
Minimum
1,000
2,300
2,820
2,270
maximum
4,000
4,000
4,000
4,000
Mean
3,317
3,397
3,722
3,503
Std Devitation
0,792
0,480
0,312
0,449
Skewnes Statistic std
error
0,849
0,309
0,540
0,309
-1,450
0,309
0,892
0,309
Kurtosis Statistic std
error
0,170
0,608
0,580
0,608
1,503
0,608
0,028
0,608
Khodiyatussolihah, Kemala Rita, Reza Hilmy
1620 Syntax Health Sains: Vol. 3, No. 11 November 2022
the nurse's workload is at the light workload.
b. Nurse Caring Behavior
This variable shows a
minimum value of 2.360 and a
maximum value of 4,000. The
average value of nurse caring
behavior is 3.397, this shows that
nurses' caring behavior is often
carried out.
c. Nurse Workload
This variable shows a
minimum value of 1,000 and a
maximum value of 4,000. The
average value of the nurse's
workload is 3.317, this shows that
the nurse's workload is at the light
workload.
d. Nurse Caring Behavior
This variable shows a
minimum value of 2.360 and a
maximum value of 4,000. The
average value of nurse caring
behavior is 3.397, this shows that
nurses' caring behavior is often
carried out.
e. Teamwork
This variable shows a
minimum value of 2,820 and a
maximum value of 4,000. The
average value of teamwork is 3.722,
this shows that teamwork is almost
always done.
f. Implementation of Patient Safety
Goals
This variable shows a
minimum value of 2.270 and a
maximum value of 4,000. The
average value of the application of
patient safety goals is 3.503, this
shows that the application of patient
safety goals is often carried out.
D. Analysis three-box method
a. The results of the description of
respondents' answers about caring
behavior are as follows
Table 4
The results of the description of the respondents' answers about caring behavior
Code
Indicator
Indeks
Kesimpulan
PC 1
Shaping humanistic and
altruistik system values
55,3
High
PC 2
Maintaining honesty and hope
56
High
PC 3
Cultivate sensitivity to self and
others
54
High
PC 4
Enhance caring relationships
with helpful and trusting people
55,9
High
PC 5
Increase and accept the
expression of positive and
negative feelings
52,9
High
PC 6
Use a creative nursing problem-
solving process
50
High
PC 7
Improve transpersonal teaching
and learning
49
High
PC 8
Provide a supportive, protective
or improving mental, physical,
sociocultural and spiritual
41,8
Moderate
Analysis Of Nurse Workload On Implementation Of Patient Safety And Teamwork With
Caring Behavior As Mediation Variables At Metro Hospitals Cikupa
Syntax Health Sains: Vol. 3, No. 11 November 2022 1621
environment
PC 9
Helping to satisfy human needs
48,6
High
Based on the table above, it is
known that the average value of the
respondent's response tendency on
the nurse caring behavior variable is
per indicator, the highest average
indicator is PC02, PC04, and PC01
and the lowest average indicator is
PC08.
b. The results of the description of
respondents' answers about
teamwork are as follows:
Table 5
The Results Of The Description Of The Respondents' Answers About Teamwork
indicator
Index
Conclusion
Reponsibility
57,9
High
Contributing
54,1
High
Deployment
Capability
55,9
High
Based on the table above, it is
known that the average value of the
tendency of respondents' answers on
the Teamwork variable per indicator,
the average indicators from the
highest to the lowest are
responsibility, mobilization of
abilities, and mutual contribution.
c. The results of the description of
respondents' answers regarding the
implementation of patient safety
goals are as follows.
Tabel 6
The results of the description of the respondents' answers
Code
Indicator
Index
Conclusion
IPSG1
Identifity the
patient correctly
54,5
High
IPSG2
Remind effective
commucation
52,3
High
IPSG3
Improving the
safety of
medicines to
watch out for
43,8
Moderate
IPSG4
Reducing the risk
of infection due
to treatment
52,25
High
IPSG5
Reduces the risk
of patient injury
due to falls
48,4
High
Based on the table above, it is
known that the average value of the
respondent's response tendency on
the variable of implementing patient
safety goals is per indicator, the
highest average indicator is IPSG2
and the lowest average indicator is
IPSG3.
E. Variable Workload
After collecting the workload
questionnaire, the results of the answers
and analysis of the answer score index
Khodiyatussolihah, Kemala Rita, Reza Hilmy
1620 Syntax Health Sains: Vol. 3, No. 11 November 2022
on the nurse's workload variable are as follows:
Tabel 7
The results of the answers and analysis of the answer score index on the nurse's
workload variable
Nurse
Workload
frequency
%
Very Heavy
1
1,7
Weight
9
15,0
Medium
20
33,3
Light
30
50,0
Quantity
60
100,0
The table shows the results of
respondents' responses to the nurse's
workload from the results of the
questionnaire with the daily log form on
the light answer (4), namely 50.0%,
meaning that the excess working time is
<60 minutes, the moderate answer (3),
which is 33.3%, meaning that the hours
are overtime. 61-90 minutes of work,
heavy answer (2) means 91-180
minutes of extra work time, very heavy
answer (1) 1.7% means over 181
minutes of working hours. where the
average value of the workload is the
excess of working time, mostly under
60 minutes, meaning that the nurses
implementing inpatient and polyclinic
duties per shift on average are more
than 1 hour from the nurse's service
time.
2. Classic assumption test
1) Normality Test
The normality test is used to
test whether the relevant data is
normally distributed or not. The
regression model is normally
distributed if the critical ratio (cr)
value of each variable is less than
2.58. Based on the results of SEM -
AMOS, the results of the normality
test can be seen in the following
table.
Tabel 8
Normality test results
Variable
Min
Max
Skew
C,R
Kurtosis
C,R
Workload
1.000
5.000
-.531
-
1.680
3.282
5.189
Caring
3.000
5.000
.664
2.100
1.372
2.169
Teamwork
3.000
5.000
.086
.271
-1.146
-1.813
Ipsg
2.143
5.000
1.731
5.473
4.105
6.491
Multivariate
6.365
1.528
From the results of the table on
the normality test, it can be shown
that the significance level is less than
2.58. So that all the variables tested
in this study are normal.
2) Multicollinearity Test
Analysis Of Nurse Workload On Implementation Of Patient Safety And Teamwork With
Caring Behavior As Mediation Variables At Metro Hospitals Cikupa
Syntax Health Sains: Vol. 3, No. 11 November 2022 1619
The multicollinearity test aims
to test whether there is a correlation
between the independent variables in
the regression model. If there is a
correlation, it is called a
multicollinearity problem. A good
regression model should not
correlate with the independent
variables. The results of the
multicollinearity test in the AMOS
program are as follows
Condition number = 8.861
Eigenvalues
.868 .397 .169 .098
Determinant of sample covariance
matrix = .006
It can be seen from the
calculation above that the covariance
matrix value is 0.001, which means
that there is no correlation between
independent variables or all variables
in the model so it shows that there is
no multicollinearity problem.
3) Hypothesis Test
Hypothesis testing is statistical
proof of all that has been
hypothesized in theory-based
research. To test the hypothesis that
has been proposed and to detect the
effect of the mediating variable
(intervening variable) in mediating
the independent variable on the
dependent variable, descriptive
statistical analysis methods, three
box methods, path analysis,
simultaneous testing (f test) and
partial testing (t-test) are used. ).
There are 3 paths in the path analysis
of the structural equation model
(Structural Equation Model) with the
following description.
figure 1
paths in structural equation model path analys
4) Model Fit Test (Simultaneous
Test)
The results of the Hypothesis 1
test on the AMOS program are as
follows:
Minimum was achieved
Chi-square = 11,890
Degrees of freedom = 1
Probability level = .0711
Hypothesis 1 is accepted because
the Chi-square count shows a value
of 0.00 which is smaller than the
Chi-square table value. The results
of this very small Chi-square value
indicate that there is no difference
between the theory and the empirical
data environment so hypothesis 1 is
accepted. This means that the nurse
workload variable has a significant
Khodiyatussolihah, Kemala Rita, Reza Hilmy
1620 Syntax Health Sains: Vol. 3, No. 11 November 2022
effect on teamwork and caring
behavior and patient safety goals
because the arithmetic value has a
very small value compared to the
chi-square table value.
5) Coefficient of Determination
(R2)
The coefficient of
determination shows the value of
how much simultaneous influence
the independent and intervening
variables have on the dependent
variable. The value of the influence
of nurse workload, teamwork, and
caring behavior on patient safety
goals, in the hospital, is shown in the
table below.
The value of the influence of
workload on caring behavior is 0.155
or 15.5%. The effect of workload on
teamwork is 0.072 or 7.2% and the
effect of workload on patient safety
goals is 0.508 or 50.8%. In this case,
the nurse's workload as the
independent variable has a small
effect on the intervening variable of
teamwork and caring behavior, while
the nurse's workload has a large
influence on the dependent variable
of patient safety goals.
Discussion
1. Hypothesis 1: Workload
simultaneously affects teamwork,
caring behavior, and the application
of patient safety goals
The results showed that the
workload simultaneously affects
teamwork behavior, caring, and the
application of patient safety goals,
meaning that the lighter the nurse's
workload, the more team cooperation
and caring behavior of applying patient
safety goals will be better too.
This is different from the results
of previous research by (Kansong et al.,
2022) regarding the relationship
between the workload of nurses and the
application of patient safety in the
inpatient room at RSUD Dokter
Soedarso Pontianak to the data on the
workload of nurses in the heavy
category and the application of patient
safety in the less category means the
heavier the burden. The work carried
out by nurses has an impact on
decreasing the application of patient
safety goals.
A previous study by (Hartawan et
al., 2018) regarding the relationship
between nurse workload and caring
behavior in inpatient surgical
installations, shows that there is no
relationship between nurse workload
and nurse caring behavior in inpatient
installations in hospital operating rooms
because it is not forever. The heavy
workload of nurses shows poor caring
behavior because there are also nurses
who have a light workload but their
caring behavior is not good. . This is
not in line with this study because the
workload is light so caring behavior,
teamwork, and achieving patient safety
goals are high.
Previous research by (Manuho et
al., 2015) on the relationship between
workload and nurse performance in
providing nursing care in inpatient
installations at Prof DR.R.D Kandou
Hospital Manado that there is a
relationship between workload and
Analysis Of Nurse Workload On Implementation Of Patient Safety And Teamwork With
Caring Behavior As Mediation Variables At Metro Hospitals Cikupa
Syntax Health Sains: Vol. 3, No. 11 November 2022 1621
nurse performance in providing nursing
care. This is in line with this research
2. Hypothesis 2: Workload affects
the implementation of patient safety
goals
Hypothesis 2 is accepted because
from the results of the study the
workload variable has a significant
effect on patient safety goals. This
means that the workload of nurses is
light to provide the application of high
patient safety goals.
In theory, according to (Nelson et
al., 2015) the workload of nurses is all
activities or activities carried out by a
nurse while on duty in a nursing service
unit, the workload or workload is
defined as patient days which refers to
the number of procedures, and visits. on
the client. A high workload can
increase the occurrence of poor
communication between nurses and
patients, failure of collaboration
between nurses and doctors, nurse
discharges, and nurse job
dissatisfaction. To estimate the
workload of nurses in a unit, managers
must collect data on the number of
patients admitted to the unit
daily/month/year, the condition or level
of dependence of patients in the unit,
the average days of care, the type of
treatment required by the patient, the
frequency of each nursing action
performed, the average time required to
provide nursing actions (Simeulu et al.,
2013).
Previous research by (Hasanah &
Widiastuti, 2018) regarding the
workload of nurses in the inpatient
room at Raden Mattaher Jambi Hospital
showed that it was small, meaning that
the workload of nurses in the inpatient
room was low, the application of
patient safety in the inpatient room was
large, meaning the level of patient
safety in the inpatient room was high.
3. Hypothesis 3: Nurses'
workload affects the application of
caring behavior
Hypothesis 3 is accepted because
the results of this study have a
significant positive effect on caring
behavior. This means that the light
workload provides high nurse caring
behavior.
If the workload is too high,
according to Carayon and Gurses it will
lead to poor communication between
nurses and patients, failure of
collaboration between nurses and
patients, high nurse dropouts/turnovers,
and a sense of job dissatisfaction. To
find out the workload, the nursing
manager must understand the number
of patients per day/month/year, the
level of dependence, the average days
of care, the type of nursing action, and
the frequency of each action as well as
the average time required for each
action (Simeulu et al., 2013). According
to (Simeulu et al., 2013) the more
patients a nurse treats during a certain
period, the heavier or larger the nurse's
workload will be. Quality nursing
services can be achieved, one of which
depends on the balance between the
number of nurses and the workload.
4. Hypothesis 4: Caring behavior
affects the implementation of patient
safety goals
Hypothesis 4 is accepted because
the results of this study variable caring
behavior have a positive effect on the
variable application of patient safety
goals. This means that if the nurse's
Khodiyatussolihah, Kemala Rita, Reza Hilmy
1622 Syntax Health Sains: Vol. 3, No. 11 November 2022
caring behavior is high, the application
of patient safety goals must still be high
(Jha et al., 2013).
The six goals of managing patient
safety according to the Joint
Commission International include:
identifying patients correctly,
improving effective communication,
increasing the safety of high-alert
medications, ensuring the right place,
right procedure, and correct patient
surgery, reducing the risk of infection
from health workers, reducing the risk
of a worse error occurs in patients. Six
patient safety goals, Patient safety goals
(IPSG) in Indonesia refer to the
International Patient Safety Goals
(IPSG).
5. Hypothesis 5 is accepted
because from the results of this study
the workload variable has a
significant positive effect on patient
safety goals.
This means that the workload is
high, and the teamwork will also
increase. West (2008:97) stipulates the
indicators of cooperation as a
measuring tool as follows: 1) The joint
responsibility to complete the work,
namely by giving responsibilities can
create good cooperation; 2)
Contributing to each other, namely by
contributing to each other, both energy
and thought, will create cooperation; 3)
Maximum deployment of capabilities,
namely by mobilizing the abilities of
each team member to the maximum,
cooperation will be stronger and of
higher quality.
In this study, it is not in line with
previous research by (Yosiana et al.,
2020) it was found that the effect of
workload and organizational
commitment on nurse performance and
the role of teamwork as a mediating
variable obtained the effect of workload
on teamwork, obtained workload in
high category and teamwork variable
are in the very high category so that the
results of the hypothesis test indicate
that there is no significant relationship.
The results of this study showed
that the nurse's workload had a
significant effect on the Teamwork
variable. This means that the workload
of nurses is light, and teamwork will be
good.
Conclusion
Workload has a simultaneous effect
on the variables of teamwork, caring
behavior, and patient safety goals at Metro
Hospitals Cikupa because the workload of
hospital nurses is in a low category so that
nurses can carry out teamwork, caring
behavior, and safety goals well.
The workload of nurses has a
positive effect on the variables of
implementing patient safety goals at Metro
Hospitals Cikupa. This means that the
nurse's workload is light, medium, heavy,
and very heavy, the application of patient
safety goals must be carried out by nurses
to patients properly. In the results of this
study, it was found that the workload of
nurses at Cikupa Metro Hospitals was low
so that the implementation of safety goals
could be carried out properly.
The nurse's workload variable has a
positive effect on the variable of the
application of caring behavior at the
Cikupa Metro Hospital. This means that
the nurse's workload is light, medium,
heavy, and very heavy, caring behavior of
nurses must be carried out properly for
patients. From the results of this study, it
was found that the workload of nurses at
Metro Hospitals Cikupa was light so the
Analysis Of Nurse Workload On Implementation Of Patient Safety And Teamwork With
Caring Behavior As Mediation Variables At Metro Hospitals Cikupa
Syntax Health Sains: Vol. 3, No. 11 November 2022 1623
caring behavior of nurses was quite high.
The variable of caring behavior has
a positive effect on the variable of
implementing patient safety goals. This
means that the better the nurse's caring
behavior, the better the implementation of
the application of patient safety goals by
nurses will be.
The nurse's workload variable has a
positive effect on the Teamwork variable
(teamwork). This means that whether the
workload of nurses is light, medium,
heavy, or very heavy, teamwork will
remain good and be maintained.
Variable Teamwork (teamwork)
does not significantly affect the variable
implementation of patient safety goals.
This means that no matter how teamwork
is, the implementation of patient safety
goals remains a top priority in providing
services.
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