Journal of Telenursing (JOTING)
Vol 5 No 2 (2023): Journal of Telenursing (JOTING)

Optimalisasi Penegakan Diagnosis Keperawatan Sesuai Standar Asuhan Keperawatan di Rumah Sakit X

Mu'minah Mu'minah (Universitas Indonesia)
Tuti Afriani (Universitas Indonesia)
Krisna Yetti (Universitas Indonesia)
Dudi Mashudi (Rumah Sakit Umum Pusat Fatmawati)
Khairul Nasri (Rumah Sakit Umum Pusat Fatmawati)



Article Info

Publish Date
30 Sep 2023

Abstract

This study aims to analyze the enforcement of nursing diagnoses according to the Nursing Care Standards of X Hospital Jakarta. The research method uses a case study approach with interviews, document review and observation, and performs problem analysis using fishbone analysis. The results showed that the enforcement of nursing diagnoses in accordance with the Standards of Nursing Care was not optimal, so that it had an impact on the quality of care and its documentation. Nursing diagnoses that are in accordance with Nursing Care Standards are 48.6%. Lack of supervision from managers, assessments using personal assumptions and the standard of writing diagnoses in the local Hospital Information System (SIRS) has not been facilitated. Through strengthening the directing function with SAK media innovation, there was an increase in writing nursing diagnoses according to SAK to 62.3%. In conclusion, optimizing the enforcement of nursing diagnoses in accordance with Nursing Care Standards can be implemented with SAK media innovations (Softfiles on the Google Form Platform and flipcharts) which are given to implementing nurses at X Hospital. Keywords: Diagnosis, Nursing Documentation, Quality, Nursing Care Standards

Copyrights © 2023






Journal Info

Abbrev

JOTING

Publisher

Subject

Health Professions Nursing

Description

Journal of Telenursing (JOTING) accepts articles in quantitative, qualitative, mixed method approaches related to nursing field, such as pediatric nursing, management of nursing, medical surgical nursing, maternity nursing, psychiatrics nursing, community nursing, emergency nursing, gerontology ...