Nurse Caring Behavior Analysis with Fall Risk Patient Safety in Surgical Care of Mokoyurli Hospital Buol District

ABSTRACT


Introduction
Patients falling are one of the most frequent incidents in the hospital setting. The incidence of falling patients has a detrimental impact on patients, one of the adverse effects of which is the impact of physical injury which includes abrasions, torn wounds, bruises, even in some severe cases of falls which can result in fractures, bleeding, and head injuries (Deniro et al., 2017;Sanjaya et al., 2017;Timur et al., 2020). Increased incidence of falls due behavior caring to low towards patients. behavior Caring is central to nursing practice. Needs, pressures and deadlines in the health service environment are in a small space of caring practices (Potter, 2005(Potter, , 2014. Caring is a dynamic approach, where nurses work to increase their concern for clients, especially patients at risk of falling, where caring is also the key to the quality of nursing care services  The United States said In Utah and Colorado found an unwanted incidence of 2.9%, of which 6.6% of them died. Whereas in New York KTD (Unwanted Events) is 3.7% with a mortality rate of 13.6%. The mortality rate from KTD in hospitalized patients throughout the United States, which amounts to 33.6 million per year ranges from 44,000 -98,000 per year. England and Wales in 2013, around 152,000 fell reported in acute hospitals each year, with more than 26,000 reported from mental health units and 28,000 from community hospitals. Persi XXI in 2012 reported that the incidence of patients fell in Indonesia by 14%. This makes the percentage of patients fall including the top five medical incidents in addition to medicine error (Riung, 2018;Safitri & Murharyati, 2018;Silaban, 2018). Results of a preliminary study found that the average patient in the hospital room Surgical Care Mokoyurli Buol last 3 months of 80 patients the risk of falling, of the 10 patients there were six patients said that nurses have behavior Caring to provide services is lacking.
The results of a study conducted by Hussein stated that 90% of patients said they did not feel comfortable talking to nurses, 84% of these had negative experiences because nurses did not pay attention to patients' needs, especially at night (Husein, 2006). In addition, research conducted by Khairina et al. in RSUD Kota Bandung stated that as much as 52.64% of implementing nurses did not carry out caring when managing post infusion. This is supported by a study conducted by Nuryaningsih in Cengkareng Hospital, West Jakarta. It was concluded that respondents stated that nurses had not cared for 47.7%, with a poor presence of 45.5%, in providing poor comfort 38.6%, in giving a touch not good 47.7%, in listening is not good 43.25%, in knowing patients is not good 40.9%, the application of prevention of patients the risk of falling is less good as much as 40.9% 5. Caring behavior of nurses certainly will greatly affect the quality of service to clients.
Educational factors influence work behavior, the higher education will be directly proportional to one's work behavior (Baris et al., 2018). Work behavior is the response or reaction of someone who arises in the form of actions or attitudes or assumptions of someone towards his work (Piau et al., 2020;H. Simamora, 2007;R. H. Simamora & Siregar, 2019). Then education will influence the work behavior of nurses, namely in providing nursing services to patients. Things that can influence behavior of caring nurses are age, years of service, gender and level of education (Robbins, 2008). Behavior Caring in line with the education level of nurses is nursing higher education that can cause significant changes to the way nurses view nursing care and gradually shift from nursing to task-oriented to goal-oriented focusing on effective nursing care with a holistic approach and nursing process. This is in accordance with the demands of the community at this time, namely to expect quality nursing services. Caring as a goaloriented process helps others grow and actualize themselves (Bayramzadeh et al., 2019;Purwaningsih, 2018) The impact that patients can have when nurses behave caring is that patients will feel safe and comfortable, increase patient self-esteem, and improve orientation about reality (Potter, 2009). When nurses are able to apply caring by understanding clients, patients will get personal service about therapies provided by nurses so that reducing the risks and negative impacts is one of the risks of falling patients.
Behavior of Caring nurses in nursing services is very important to improve the janh.candle.or.id ~ 30 ~ quality of service and patient safety, especially patients at risk of falling. The risk of falling in patients can be prevented by behavior caring good nurse. Patient Safety risks fall if managed properly, the risk of falling will not occur. Patient Safety Risk of Falling will also reduce KTD in the hospital. Nurses who are educated with higher performance will be better because they already have broader knowledge and insights than those with less educated nurses (Standby, 2010). Based on research conducted by Mulyaningsih stated that the level of nurse education influences the critical thinking of nurses as indicated by behavior caring. Based on this background the researchers were interested in researching with the title Behavior Analysis of Caring Nurses with Patient Safety at the Risk of Falling in the Surgical Treatment Room of Mokoyurli Regional Hospital, Buol Regency.

Method
The research method used in the study was cross sectional. Population is all patients at risk of falling. The sample size is 67 respondents using Purposive sampling technique. Independent variable of research is Caring Behavior. The dependent variable is Patient safety risk of falling. Data was collected using a questionnaire, then the data were analyzed using the Spearman Rho test, with a significance level of p value ≤ 0.05. The results showed that more than half of the respondents had good nurse caring behavior as many as 35 respondents (52.2%). The results of the study showed that the majority of respondents aged 36-45 years were 35 respondents (52.2%). Research Results it was found that the majority of respondents were 44 respondents (65.7%). The results of the study showed that most respondents had 27 employee jobs (40.3%). The results showed that more than half of the respondents had good nurse caring behavior as many as 35 respondents (52.2%). The results of the study showed that almost half of the respondents had a patient safety risk of fall which was enough as many as 30 respondents (44.8%). The results of the study found that most respondents had sufficient caring behavior ratings with Sufficient patient safety risk falls as many as 26 respondents (38.8%). The results showed that p = 0,000

Discussion
The results of the study showed that at most respondents had adequate caring behavior assessment with sufficient patient safety risk of 26 respondents (38.8%). The results showed that p <0,000 with a = 0,05 (p value <α), which means that there is a relationship between Behavior Caring Nurse and Patient Safety Risk of Falling in Surgical Treatment Room at Mokoyurli Hospital Buol District Patient falls are one of the most frequent incidents occur within the scope of the hospital. The incidence of falling patients has a detrimental impact on patients, one of the adverse effects of which is the impact of physical injury which includes abrasions, torn wounds, bruises, even in some severe cases of falls which can result in fractures, bleeding, and head injuries . Increased incidence of falls due behavior caring to low towards patients. Behavior Caring is central to nursing practice. Needs, pressures and deadlines in the health service environment are in a small space of caring practices (Potter, 2005;Potter et al., 2014). Caring is a dynamic approach, where nurses work to increase their concern for clients, especially patients at risk of falling, where caring is also the key to the quality of nursing care services .
Based on the results of the study there is a significant relationship between patient safety and caring behavior. Nurses help participate, help obtain knowledge and improve health, according to what expressed which states that caring is a relationship and transaction between the giver and recipient of care to improve and protect patients as humans. Such care affects the patient's ability to recover Caring is the essence of nursing which also means the accountability of the relationship between the nurse-client. In accordance with (Alligood, 2014) which states that caring is human knowledge, the core of nursing practice is ethical and philosophical. Caring is an action aimed at providing physical care and attention to emotions while increasing client security and safety. Caring is that care is given continuously focused on physical and mental care and increasing patient safety. Nurses are competent in providing nursing care to patients by imposing patients as human beings who always want to be respected and valued. Behavior of Caring nurses in nursing services is very important to improve the quality of service and patient safety, especially patients at risk of falling.
Patient safety is a system where hospitals make patient care safer. These include: risk assessment, identification and management of matters relating to patient risk, reporting and analysis of incidents, the ability to learn from incidents and their follow-up and implementation of solutions to minimize risk. Patient Safety risks fall if managed properly, the risk of falling will not occur. Patient Safety Risk of Falling will also reduce KTD in the hospital. Nurses who are educated with higher performance will be better because they already have broader knowledge and insights than those with less educated nurses. The risk of falling in patients can be prevented by behavior caring good nurse. Caring behavior and prevention efforts for falling patients are very mutually supportive to improve the quality of nursing services (Sanjaya et al., 2017 ). This shows that the better the implementation of caring behavior, the patient safety risk falls, the better the small, thus the quality of nursing care services becomes better. Patients at risk of falls need to be continuously assessed and evaluated, giving a patient's mark or bracelet to distinguish patients from the risk of falling with other patients, this makes it easier to carry out treatment actions that are risky and threaten patient safety. Nurses also need to assess the patient's muscle strength, joint range or prognosis that affects the patient's condition and other risks.

Conclusion
The results showed that more than half of the respondents had good nurse caring behavior as many as 35 respondents. The results showed that almost half of the respondents had a patient safety risk which fell as much as 30 respondents. The results showed that p = 0,000 with a <0,05, which means that there was a relationship between Behavior of Caring Nurses and Patient Safety at the Risk of Falling in the Surgical Treatment Room of Mokoyurli Hospital Buol Regency