Analysis of Leadership’s Factors in Nursing Care Quality Effort at Hemodialysis Unit of B Class Hospital

Abstract

Layanan unit Hemodialisa sebagai layanan unggulan masih bermasalah pada komitmen dan
komunikasi kepemimpinan keperawatan. Penelitian ini betujuan untuk menjelaskan faktor
kepemimpinan : komunikasi dan komitmen dalam upaya pelayanan keperawatan yang
bermutu di Unit Hemodialisa di RS Tipe B. Penelitian ini dilakukan secara kualitatif dengan
metode wawancara mendalam dan observasi. Subjek penelitian terdiri dari 11 orang yaitu 3
orang informan utama (1 perawat kepala ruang dan 2 perawat) dan 8 orang informan
triangulasi (1 dokter penanggung jawab unit hemodialisa, 4 perawat dan 3 pasien). Observasi
dilakukan dengan menggunakan check list atau daftar tilik. Hasil penelitian menunjukkan
faktor komunikasi yang terdiri dari fungsi instruksi, konsultasi, partisipasi, delegasi dan
pengendalian sudah dilakukan oleh pimpinan. Fungsi instruksi dilaksanakan dengan
memberikan arahan tetapi strategi tidak disampaikan. Fungsi konsultasi sudah dilaksanakan
tetapi masukan tidak direspon oleh kepala ruang. Fungsi delegasi sudah dijalankan dari kepala
ruang
kepada kepala tim. Fungsi partisipasi sudah dilaksanakan. Fungsi pengendalian
dilaksanakan dengan pengawasan langsung tetapi belum ada mekanisme monitoring dan
evaluasi . Untuk faktor komitmen, yang sudah dilakukan adalah komitmen untuk menjadi
teladan dan pemberian motivasi sedangkan komitmen untuk melakukan monitoring dan
menjalankan SOP belum dilaksanakan. Pelayanan keperawatan sudah dirasakan cukup baik
oleh pasien dan kolaborasi antar petugas medis sudah berjalan dengan baik tetapi belum ada
penjaminan mutu pelayanan keperawatan. Sarana dan prasarana sesuai persyaratan dari
Depkes dan Pernefri belum dipenuhi. Simpulan, faktor komunikasi kepemimpinan belum
semuanya dilaksanakan oleh pimpinan keperawatan. Komitmen untuk menjadi teladan dan
memberikan motivasi sudah dilaksanakan. Komitmen untuk melaksanakan SOP serta
melakukan monitoring dan evaluasi belum dilaksanakan. Saran, kepemimpinan keperawatan
agar meningkatkan fungsi komunikasi, pelaksanaan SOP serta melakukan monitoring dan
evaluasi sebagai bentuk upaya penjaminan mutu pelayanan keperawatan.

Haemodialysis unit service as an eminent service had been still a problematic in nursing
leadership commitment and communication. This study objective was to explain the factors of
leadership : communication and commitment to quality nursing care effort in Haemodialysis
Unit at the Type B Hospital. The research was conducted in-depth qualitative interviews and
observation. Research subjects consisted of 11 people : 3 key informants (1 head room nurse
and 2 nurses) and 8 triangulation informants (1 physician responsible hemodialysis unit, 4
nurses and 3 patients). Observations carried out by using a check list.The results shows that
the communication factors consists of instruction, consultation, participation, delegation and
controlling functions have been done by the head room nurse. The instruction function has
been implemented by providing direction but the strategy has not been delivered yet.
Consulting function has been already implemented but the suggestion has not been responded
by the head room nurse. Delegation function has been functioning from the head room nurse
to the team head nurse. Participation function has been implemented. Controlling function
has been carried out under the direct supervision but there have been no monitoring and
evaluation mechanisms. Commitment factor has been a model and a motivation, while the
commitment to monitor and to do using SOP has not been implemented. The nursing care has
been perceived quite well by patients and collaboration among medical officers has been
good but there has no assurance of quality nursing care. Facilities and infrastructures
according to the requirements of the Department of Health and Pernefri have not been
fulfilled. Conclusion, leadership communication factors have not all done by nursing
leadership. Commitment to be a model and and a motivation have been implemented.
Commitment to implement the SOP and conduct monitoring and evaluation have not been
conducted. Suggestions, nursing leadership should improve the functioning of nursing
leadership communication, implementation of SOPs and conduct monitoring and evaluation
as an effort to guarantee quality of nursing care