EFEKTIVITAS PELATIHAN 3S (SDKI, SLKI, SIKI) PADA PERAWAT PELAKSANA TERHADAP KESESUAIAN PENDOKUMENTASIAN ASUHAN KEPERAWATAN DI RS X JAKARTA DAN BOGOR
Authors: Wahyuliati Tri , Novita Regina Vidya Trias , Supardi Sudibyo 
Published: December 2024

ABSTRAKPendokumentasian asuhan keperawatan menggunakan 3S, yaitu SDKI, SLKI, dan SIKI yang baik dan benar merupakan syarat medico-legal yang sangat penting dalam praktik keperawatan yang aman, etis, dan efektif. Namun, implementasi dokumentasi keperawatan yang belum sesuai dengan standar 3S masih banyak ditemukan. Tujuan penelitian: mengetahui efektivitas pelatihan 3S terhadap peningkatan pendokumentasian asuhan keperawatan. Metode: quasi experimental two groups pretest posttest with control. Responden dipilih menggunakan consecutive sampling dan kriteria inklusi untuk merekrut 33 partisipan intervensi dan 28 kontrol. Kuesioner dan tools audit asuhan keperawatan digunakan untuk mengumpulkan data. Data dianalisis secara univariat, bivariat, dan multivariat. Hasil: Terdapat efektivitas pelatihan 3S (p = 0,000) terhadap peningkatan kesesuaian pendokumentasian asuhan keperawatan secara statistik bermakna. Pelatihan asuhan keperawatan 3S berpengaruh signifikan terhadap pemberian asuhan keperawatan sesuai dengan standar 3S. Setelah pelatihan 3S, perawat yang berpendidikan nersmempunyai kemungkinan tiga kali kesesuaian pendokumentasian meningkat dibandingkan dengan D-3 keperawatan, dikontrol variabel masa kerja. Perawat yang mempunyai masa kerja lima tahun atau lebih mempunyai kemungkinan tujuh kali kesesuaian pendokumentasian meningkatdibandingkan dengan masa kerja kurang dari lima tahun, dikontrol variabel pendidikan. Diskusi: Terdapat peningkatan yang signifikan perihal kesesuaian pendokumentasian asuhan keperawatan pada kelompok intervensi yang diberikan pelatihan 3S karena pelatihan yang diberikan dengan metode ceramah, studi kasus, dan simulasi dapat dipahami oleh responden. Kesimpulan: Pelatihan 3S secara signifikan meningkatkan kemampuan perawat dalam dokumentasi. Monitoring dan evaluasi dengan audit asuhan keperawatan dan hasil capaian dijadikan salah satu key performance indicator. Rumah sakit diharapkan menyelenggarakan pelatihan secara berkala yang diikuti oleh semua perawat. Kata Kunci: dokumentasi, layanan keperawatan, pelatihan, SDKI, SLKI, SIKI Effectiveness of 3S Training (SDKI, SLKI, SIKI) for Nurses on the Comformity of Nursing Care Documentation at Hospital X Jakarta ABSTRACTDocumentation of nursing care using 3S, namely SDKI, SLKI and SIKI, is a medico-legal requirement that is very important in safe, ethical and effective nursing practice, electronically. However, the implementation of nursing documentation that is not in accordance with the 3S standard is still widely found. Objective: To determine the effectiveness of 3S training on improving nursing care documentation. Methods: Quasi-experimental two group pretest posttest with control. Consecutive sampling and inclusion criteria were used to recruit 33 intervention participants and 28 control participants. Questionnaires and nursing care audit tools were used to collect data. Data were analyzed univariately, bivariately, and multivariately. The results: The effectiveness of 3S training (p=0.000) on improving the appropriateness of nursing care documentation was statistically significant. 3S nursing care training has a significant effect on the provision of nursing care in accordance with the 3S standard. The training carried out is effective in increasing nurses' knowledge of nursing care documentation using 3S. After the 3S training, nurses with an ners education were 3 times more likely to improve the appropriateness of nursing care documentation compared to those with a D-3 nursing, controlling for tenure. Nurses with 5 or more years of service were 7 times more likely to improve the appropriateness of nursing care documentation than those with less than 5 years, controlling for education. Discussion: There was a significant increase in the suitability of nursing care documentation in the intervention group given 3S training because the training provided using lecture methods, case studies and simulations could be understood by respondents. The control group that was not given the intervention did not have a significant increase in the suitability of nursing care documentation. Recomendation: The hospital should conduct 3S training for all nurses gradually, both new nurses andnurses who have been working for a long time. The nursing committees are expected to carry out monitoring and evaluation by auditing nursing care and making the results as one of the key performance indicators. Keywords: documentation; nursing service, training; SDKI, SLKI, SIKI