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NURSING MANAGEMENT MODEL

FOR IMPROVING QUALITY OF CARE AND PATIENT SAFETY
IMPLEMENTED IN AIRLANGGA HOSPTAL

By: Prof. Dr. Nursalam, M.Nurs (Hons)

Professor in Nursing Faculty and Hospital Nursing Manager of
Airlangga University

ABTRACT
Introduction. Nursing management is performing leadership functions of
governance and decision-making within organizations employing nurses. It
includes processes common to all management like planning, organizing, staffing,
directing and controlling. The objective of the article is to to improve quality and
patient safety through implementing model of nursing care approach. Methods.
Design used in this study was literature review and observational on implementation of
model of nursing care approach in Airlangga University hospital and others. A purposive
sample nurses were performed in the study. Data were analysed by descripive. Result.
The effectiveness of nursing care can be demonstrated by its effect on patient
outcomes, namely quality and paient safety as the key indicator for nurse
contribution ini nursing care. Much evidence exists to demonstrate links between
nurse staffing and skill-mix and adverse patient outcomes. Developmental of
nursing service quality model through the development of organisation
characteristic, especially organisation culture and reward system by supporting
of hospital policy in task and authority of nurse. Nurse. Discussion and
conclusion. Nursing management on patient through implementation of Nursing
care model (MAKP) increase quality of care and patient safety by looking of
STEEP (safe, timely, effective, efficient, equity, and patient center. The safety can be
seen on implementation 0f 6 IPSGs.

Keywords :nursing management model, quality, patient safety

Background
Nursing management is performing leadership functions of governance
and decision-making within organizations employing nurses. It includes processes
common to all management like planning, organizing, staffing, directing and
controlling. Nursing management lead nurses to improve quality and patient
safety. To increase a qualty of services, hospital should facilitate health worker to
improve tehir performace effectivelly. Performance is defined as a record of the
output from staff assignment in certain period (Bernadian and Russel cited in
Nursalam, 2014). As a strategy to improve nurse performace needs to apply
MAKP. This Model assured as an effective way in nursing service in the hospital
setting.
Quality and safety are the responsibility of all employees of a healthcare
facility. Unsafe health care represent a serious problem at the global and regional
levels despite significant progress made in recent decades in improving quality
and patient safety, but there are still many gaps as well as high rates of injury to
patients from accidents resulting from health care. The quality of nursing care has
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become a basic need for customer. Nurses try to improve services by improving
the quality of nursing care, resources, model of care, and information system. If
the need of customer is low, it will lead to nurse not optimally perform in caring
for patient. Customer perceived unsatisfaction feel in the quality of nursing care
due to unresponsivenes in the need of patient and low quality of service.
The contribution of nurses to the health and wellbeing of any community,
society or nation is almost incalculable. From its inception, nursing has been a
profession which has promoted public health, eased pain and suffering, advocated
for the weak and the vulnerable, and educated the community, to achieve a better
quality of life. An increasing the need of people regarding nursing service and
inceasing sciences and technolgy, methods of delivery care system model
(MAKP) should be optimally applied in service. Mc Laughin, Thomas & Barterm
(1995) cited in Nursalam (2014) explain that there are 8 models and common
models such as Team, Primary Nursing, Moduler, Case Model and combined. In
some hospitals, MAKP has been applied as a model of nursing service, however
its implementation has not optimally carried out. These were caused by many
factors such as lack of support from organisation, job characteristis are not
designed well, and nurse charactersitics theirselves due to lack of motivation,
mental model, and less commitment to give the best service.In this paper, I try to
explain a model of development nursing care to improve quality and patient safety
based on International Patient Safety Goals (IPSG).

Methods
The methodology analysis of nursing management for quality and patient
safety peer-reviewed and literature, as well as specific technical and policy reports
identified by the quality is to do the right thing, right from the first time and every
time. It is a continuous improvement process. Peer-reviewed and literature that
met the inclusion criteria was further assessed in the following way:Indicator of
quality nursing care services;(1) Patient safety based on IPSG, (2) patient
satisfaction, (3) personal care, (4) comfortable (free of pain), (5) anxiety, and (6)
knowledge. Data were analysed by descriptive.

Result
The effectiveness of nursing care can be demonstrated by its effect on
patient outcomes. Much evidence exists to demonstrate links between nurse
staffing and skill-mix and adverse patient outcomes. There are significant risks to
patients of understaffing and inadequate skill-mix, including compromised safety
and diminished quality of care; increasing morbidity (incidence of disease) and
mortality (death rate); and an increased occurrence of adverse or sentinel events
(injury or death resulting from a health care intervention, not the underlying
condition of the patient). These factors can also increase the length of stay for
patients in health care settings.
Nurses generally are experiencing high rates of emotional exhaustion, and
they have high job dissatisfaction rates, primarily related to inadequate staffing.
There are strong links, as indicated above, between higher job burnout and job
dissatisfaction and workload, with an increase in the number of patients per nurse
increasing the probability of burnout and job dissatisfaction.
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Nursing professional performance manifestation of integration skills of

nurses, intelectual, technical, and interaction and communication; namely: caring,
collaboration, emphathy, responsiveness, courtesy dan sincerity. These skill
should become a new value in delivering nursing care. In addition, it also needs
to build a nursing culture team that can be focused on market orientation as well
as remuneration consedered on the principles of justice, appropritenes,
competency and supporting leadeship (Muhith, 2012). Independencies in
carrying out nursing care is as manifestation of responsibility for nurses to
inmprove quality of nursing care. In the future, hospital management and nursing
profession should support an increasing nurse performance in nursing care
Quality
Quality of nursing care service can be measured from input, process, and
output (Nursalam, 2014);
1) Input (structur), are related to human resources and capital, organisational,
and work characteristics.
2) Process, is an interaction and transaction among nurses, patient and other
stakeholder in providing profesional care. Designing and implementing the
quality of nursing care, namely; program of patient safety, applying method
of evidence based practice, developing accreditation ISO, JCI and others
and finally applying the principles of ethics; J-A-B-V-C (justice
Autonomy Beneficiency and nonmaleficiency veracity and
Confientiality).
3) Output/Outcome is result of nursing service. Indicator of quality nursing
care services (Nursalam, 2012);
(1) Patient safety (medication error, patient fall, bedsore, plebitis,
nosocomial infection); (2) patient satisfaction; (3) personal care; (4)
comfortable (free of pain); (5) Anxiety; and (6) Knowledge
Quality is to do the right thing, right from the first time and every time. It
is a continuous improvement process. Quality of nursing care is the degree to
which nurses for individuals and populations increase the likelihood of desired
health outcomes and are consistent with current professional knowledge.
Nurses are then legally able to use the title for which they were educated,
and which prescribes their scope of practice. A set of national competency
standards relevant to their educational level further defines the standards to which
their practice must comply in order to remain registered, authorised or enrolled,
and thus able to practise.
The quality of care is recommended by JCI applied in all of Indonesian hospital, that
inculde on STEEEP:
1) Safe: avoiding injuries to patients from the care that is intended to help them
2) Timely: reducing waits and sometimes harmful delays for both those who receive
and those who give care
3) Effective: providing services based on scientific knowledge to all who could
benefit and refraining from providing services to those not likely to benefit
(avoiding underuse and overuse)
4) Efficient: avoiding waste, in particular waste of equipment, supplies, ideas, and
energy
5) Equitable: fair, providing care that does not vary in quality because of personal
characteristics such as gender, ethnicity, geographic location, and socioeconomic
status
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6) Patient-centered: providing care that is respectful of and responsive to

a. individual patient preferences, needs, and values and ensuring that patient
values guide all clinical decisions

IMPLEMENTATION OF NURSING QUALITY INDICATORS IN AIRLANGGA

HOSPTAL

Jenis KEY PERFORMANCE INDICATOR Pengu Penangg

Periode
No Pelayan mpul- ung
Analisa
an Dasar Profil Indikator Nilai an data jawab
Angka keterlambatan pelayanan pertama
5% 1 bulan 3 bulan PJ IGD
Gawat Darurat ( > 5 menit )
Instalasi Angka kegagalan pemasangan infus ( > 2x ) 5% 1 bulan 3 bulan PJ IGD
1. Gawat Angka kesalahan transfer pasien 7% 1 bulan 3 bulan PJ IGD
Darurat
Angka kesalahan pengambilan darah 0% 1 bulan 3 bulan PJ IGD
Angka kesalahan pemberian obat 0% 1 bulan 3 bulan PJ IGD
Angka Kejadian Phlebitis 5% 1 bulan 3 bulan PJ IRNA

1,5% 1 bulan 3 bulan PJ IRNA

Angka Kejadian Decubitus
0% 1 bulan 3 bulan PJ IRNA
Instalasi Angka Kejadian Pasien Jatuh
2. Rawat
Inap Angka kesalahan pemberian obat 0% 1 bulan 3 bulan PJ IRNA

Tingkat Kepuasan pasien terhadap pelayanan 75% 1 bulan 3 bulan PJ IRNA

perawat
0% 1 bulan 3 bulan PJ IRNA
Angka kesalahan pengambilan darah
Angka kegagalan pengambilan sampling BGA
10% 1 bulan 3 bulan PJ ICU
( > 3x)
5% 1 bulan 3 bulan PJ ICU
Angka Kejadian Phlebitis
1,5% 1 bulan 3 bulan PJ ICU
Angka Kejadian Decubitus
Intensive
3. 0% 1 bulan 3 bulan PJ ICU
Care Unit Angka Kejadian Pasien Jatuh
0% 1 bulan 3 bulan PJ ICU
Angka kesalahan pemberian obat
Angka kejadian cedera akibat restrain 2% 1 bulan 3 bulan PJ ICU

Angka kejadian terekstubasi 2% 1 bulan 3 bulan PJ ICU

4. OK
1 bulan 3 bulan PJ OK
Insiden kesalahan identifikasi pasien 0%
1 bulan 3 bulan PJ OK
Insiden tertinggalnya kain kasa 0%
5% 1 bulan 3 bulan PJ OK
Angka terjadinya salah penjadwalan operasi
0% 1 bulan 3 bulan PJ OK
Insiden tertinggalnya instrument
Angka kesalahan pemberian obat 0% 1 bulan 3 bulan
PJ OK
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0% 1 bulan 3 bulan PJ OK
Angka kejadian pasien jatuh
respon time penyiapan ruangan operasi 1 bulan 3 bulan PJ OK
100%
emergency ( < 60 menit )
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SBAR

Conclusion and Recommendation

Nursing management on patient through implementation of Nursing care
model (MAKP) increase quality of care and patient safety by looking of STEEP
(safe, timely, effective, efficient, equity, and patient center. The safety can be seen on
implementation 0f 6 IPSGs: 1) Improve Accuracy of Patient Identifications; 2)
Effectiveness of communication; 3) Safety of High-Alert medication; 4) Ensure
correct patient, procedure, site surgery; 5) Reduce of Infection; 6) Reduce of
patients fall nad otther indicators such as satisfaction, ADL, comfort, anxiety and
patient behavior.
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