Development of Caring-based Nurse Performance Assessment

Protocols at Santa Elisabeth Hospital Medan

Eridha Putra

, Nurmaini

and Roymond H. Simamora

Faculty of Nurses, Universitas Sumatera Utara., Jl. Prof. Ma’as No.3 Kampus USU, Kota Medan, Indonesia.

Faculty Comunity of Health , Universitas Sumatera Utara, Jl. Universitas No.32 Kampus USU, Kota Medan, Indonesia.

Keywords: Performance Appraisal Protocol, Caring, Action Research.

Abstract: The caring-based nurse performance appraisal protocol is a performance appraisal instrument of nurse

developed to measure the performance of a nurse daily based on the nurses' behaviour. The purpose of this

study was to develop a caring-based nursing assessment protocol at Santa Elizabeth Hospital Medan.

Methods: This research uses action research approach. The study was conducted from July 2017 to February

2018 with focus group discussion (FGD) method and questionnaire. Participants in this study amounted to 8

persons of managerial nurses. Data were analyzed qualitatively using content analysis and quantitatively using

descriptive statistic test. Results: The results of this study indicate that managerial knowledge about caring-

based nurse performance appraisal protocol prior to the implementation of protocol preparation is 62.5% have

good knowledge, while after the preparation of the protocol increased to 87.5% have a good knowledge and

the existence of a caring nurse-based performance appraisal protocol. ConclusionThe results of this study are

recommended for managerial to apply the nurse-based caring performance appraisal protocol, this protocol

can assist management in measuring the performance of nurses more specifically, so as to reduce complaints

from patients on hospital services and can improve the quality of nursing care.

1 INTRODUCTION

Hospital health services are the most important part

of the health system. The hospital serves as a referral

center in serving patients who come with various

types of diseases. One of the keys to the successful

attainment of quality service in hospitals is the result

of nurse performance. Nurse performance becomes

one of the indicators of hospital performance as a

service industry that always rely on human resource

competence (Guntur P, Wahono, 2012). The

performance of nurses greatly contributes in

supporting the implementation of health services in

hospitals (Marquis, B.L., & Huston, C. J, 2010).

Nurse performance is nurse activity in

implementing the best of authority, duties and

responsibilities in the context of the achievement of

the main task of the profession and realization of

organizational goals and objectives. The nurse's

performance becomes very important and need to be

the attention of managers because it will affect the

work performance of the hospital. Similarly, the

measurement of nurse performance is measured

based on open objective standards and can be

communicated just like employee performance in the

company. Therefore, if the nurse is given the attention

and appreciation of the superior/superior, then the

nurse will be more motivated to achieve achievement

at a higher level (Faizin, Ahmad & Winarsih, 2008).

The nurse is “The Caring Profession” which has

an important position in producing quality health

services in hospitals, because the unique service is

carried out for 24 hours and sustainability is a distinct

advantage over other types of services. It should be in

the hospital to have a well-performing nurse, who will

support the hospital's performance so as to achieve

customer or client satisfaction (Arofiati, Fitri &

Wahyuni, 2011).

Caring in nursing care is part of the nurse's

performance in caring for the patient. The caring

behavior of the nurse becomes a guarantee of whether

a qualified nurse or not, then the caring should be

measured on the assessment of nurse's performance

in the hospital. Caring assessment tool that aims to

measure the caring activities of nurses already

developed by Duffy is caring assesment tools (Duffy.

J, 2008). This measuring instrument is designed to

reflect the nurse staff's perception of the managers

Putra, E., Nurmaini, . and Simamora, R.

Development of Caring-based Nurse Performance Assessment Protocols at Santa Elisabeth Hospital Medan.

DOI: 10.5220/0010088207690774

In Proceedings of the International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches (ICOSTEERR 2018) - Research in Industry 4.0, pages

769-774

ISBN: 978-989-758-449-7

769

used for research in the field of nursing

administration (Watson. Jean, 2009).

Considering that nurses have a huge role in

improving clinical quality and nursing services, so

hospitals must conduct a process to evaluate the

performance of individual nurses. That way if the

results of assessments of nurses' performance are

considered questionable in the measurement of caring

behavior. Then the nurse can be given guidance again

or provide a warning to raise awareness in caring

behavior. This study aims to develop a caring-based

nurse performance assessment protocol at Santa

Elisabeth Hospital Medan.

2 METHODS

The research design used in this research is action

research with 1 cycle, starting from data collection

from July 2017 to February 2018 at Santa Elizabeth

Hospital Medan. Sampling in this research by

purposive sampling. Criteria of participants in this

study is nurse managerial amounting to 8 people. The

data collection tool in this research used Focus Group

Discussion (FGD) method and questionnaire. Data

were analyzed qualitatively using content analysis

and quantitatively using descriptive statistical test.

3 RESULTS

The process of developing a caring-based

performance appraisal protocol is outlined in 1 action

research cycle. The first stage is reconnaissance, this

stage describes from the approach to interested parties

in the research field up to get the problem to be

studied. The next stage describes the phase of the

action research cycle from planning, action, and

observation and reflection.

3.1 Reconnaissance Stage

Reconnaissance stage conducted by researchers from

July to September 2017. Data collection at the

reconnaissance stage through FGD and questionnaire

distribution resulted in two main subjects: 1)

Managerial perspectives on the implementation of

performance assessment of nurses at Santa Elisabeth

Hospital Medan and 2) Knowledge of the

managerial nurse on caring-based nurse performance

assessment. The results of the FGD activities and the

dissemination of the reconnaissance stage

questionnaire are as follows:

Table 1: Characteristics of Participant Demography.

Characteristics Frequency

(f)

Percentage

(%)

Age

>31 years

100

Gender

Man

Women

12,5

87,5

Education

Nursing Diploma

Bachelor of Nursing

50,0

Working period

5 - 10 years

15 - 20

ears

12,5

87,5

Posisition

Head of the room

Nursing committee

Nursing supervisor

60,2

10,5

29,3

Based on the characteristics of the participants it

is known that, the majority (100%) of participants

aged 31 years and over, mayor (87.5%) participants

were female, for education level (50%) participants

have diploma education and (50%) participants have

a bachelor of nursing, the majority (87.5%) of

participants worked for 15 to 20 years and the

majority (%) of participants had positions as head of

the room.

3.1.1 Managerial Perspectives on the

Implementation of Performance

Assessment of Nurses at Santa

Elisabeth Hospital Medan

Based on the results of interviews with FGD

techniques on participants in the reconnaissance

stage, there are 2 (two) subject themes: 1)

Implementation of performance appraisal that has not

been optimal and 2) Indicators of assessed nurse

performance. Broadly speaking there are some

problems that arise at the reconnaissance stage, that

is: 1) The absence of caring-based nursing

performance assessment protocol, and 2) The timing

of performance appraisal is not yet effective.

3.1.2 Knowledge of the Managerial Nurse on

Caring-based Nurse Performance

Assessment

Table 2: Managerial knowledge about caring-based nurse

performance assessment before the preparation of protocols

is as follows.

Knowledge Frequency (f) Percentage (%)

Good 5 62,5

Not good 3 37,5

Total 8 100

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Based on the results of filling out the managerial

knowledge questionnaire at the Reconnaissance stage

about caring-based nurse performance appraisal at

Santa Elizabeth Hospital Medan, distributed to 8

participants the results obtained are 5 participants

(62.5%) who have good knowledge and 3 participants

(37.5%) have not good knowledge.

3.2 Planning Stage

At the planning stage the researcher formulates the

planning in the development of a caring-based nurse

performance assessment protocol. To achieve the

purpose of the researcher plan some activities are: 1)

Planning for the initial preparation of the protocol, 2)

Plan the formation of a protocol drafting team, 3)

Planning a protocol drafting schedule, and 4)

Planning discussion and exposure of protocol drafting

results with the drafting team.

3.3 Action Stage and Observation

Plans that have been prepared in the next planning

stage carried out in the action stage.

3.3.1 Initial preparation of the caring-based

nursing performance appraisal protocol

conducted by researchers on December 7 to

20 November 2017. Aims to review the

review literature or materials to be used in

the preparation of the protocol.

3.3.2 The formation of a drafting team the caring-

based nursing performance appraisal

protocol has been formed by researchers

when conducting focus group discussion

activities (FGD) on 21 October 2017, this is

done by the researchers through the

recommendations and consent of

participants who aim to avoid a busy

schedule.

3.3.3 Preparation of the caring-based nursing

performance appraisal protocol was

conducted on 20 November 2017 to 29

January 2018. The protocol team is a

participant consisting of the head of the

room, the chairman of the nursing

committee and the head of the inpatient

room.

3.3.4 Implementation of the results of the

compilation of the caring-based nursing

performance appraisal protocol,

implemented in accordance with the

planning that researchers have done that is

on 14 January 2018 in the training room of

Santa Elisabeth Hospital Medan which was

attended by the drafting team.

3.4 Reflection Stage

At the reflecting stage the researchers conducted FGD

on 13 February 2018. The purpose of this stage is to

explore related information: 1) Managerial

perspective on the caring-based nursing performance

appraisal protocol and 2) Managerial knowledge

about caring-based nurse performance assessment

after the preparation of the protocol. The results of the

FGD activities and the reflecting stage questionnaire

are as follows:

3.4.1 Managerial Perspective on the

Caring-based Nursing Performance

Appraisal Protocol

Based on the results of interviews with FGD

techniques on participants in the reflecting stage,

there are 3 (three) subject themes: 1) Benefits of

caring-based nurse performance appraisal, 2)

Obstacles related to the caring-based nurse

performance appraisal protocol, 3) Management

expectations related to caring-based caring

performance appraisal protocol.

3.4.2 Knowledge of the Managerial Nurse on

Caring-based Nurse Performance

Assessment

Tabel 3: Managerial knowledge about caring-based nurse

performance assessment after the preparation of the

protocol are as follows.

Knowledge Frequency (f) Percentage (%)

Good 7 87,5

Not good 1 12,5

Total 8 100

Based on the results of filling out the managerial

knowledge questionnaire at the reflecting stage about

caring-based nurse performance appraisal at Santa

Elizabeth Hospital Medan, distributed to 8

participants the results obtained are 7 participants

(87.5%) who have good knowledge and 1 participants

(12.5%) have not good knowledge.

Tabel 4: Knowledge of the managerial nurse on caring-

based nurse performance assessment before and after the

preparation of protocols are as follows.

Knowledge f Percentage

(%) before

formulation

f Percentage

(%) after

formulation

Good 5 62,5 7 87,5

Not good 3 37,5 1 12,5

Development of Caring-based Nurse Performance Assessment Protocols at Santa Elisabeth Hospital Medan

771

The results of data collection through a

questionnaire about managerial knowledge after the

preparation of caring-based nurse performance

appraisal protocols have increased. With the

presentation value before the preparation of caring-

based nurse performance appraisal protocol is

(62.5%) which states the level of knowledge of the

participants in a good category, whereas after the

preparation of caring-based nurse performance

appraisal protocols increased to (87.5%) which states

the level of knowledge of the participants in a good

category.

Researchers summarize the theme at

reconnaissance and Reflection stages into a

combination theme of Focus Group Discussion

(FGD) about caring-based nurse performance

appraisal, which researchers have done with

participants. The theme at reconnaissance and

Reflection stage, researchers combine into 5 (five)

themes.

Implementation of Performance Appraisal

That Has Not Been Optimal

Participants say that performance appraisal has

not been effective, the assessment time is too long,

other than that performance appraisal instruments are

still general. The following interview excerpt from

the participants:

“if we are here, if the local hospital

regulations say 3 years once for recredition, but

here, with a very busy managerial schedule done

once every 4 years, we see it as management that

the performance assessment is once every 4 years,

it is not effective...” (P4, L73)

“the length of time is very long, performance

appraisal that day we see, that's my response, the

days we see the person working, performance

evaluation, days of developing or not ” (P4, L79)

“performance appraisal instruments already

available, but it is very common, because we refer

to DP3, there are some things that are assessed

but very common and applicable to all

employees”. (P4, L68)

Indicators of Assessed Nurse Performance

According to the participants, the indicators

assessed from the performance of nurses so far are:

nursing skills, and nurse knowledge in the work. In

addition participants said the need for caring elements

listed in the assessment of nurse performance. This is

in accordance with the following participant

statement quotation:

“nurse knowledge needs to be assessed, the

action is in accordance with standard operating

procedures or not, and how he did nursing care

how, that is what should be assessed” (P6, L162)

“there is no element of caringnya it, in the

performance appraisal instrument has been used,

so it must be made, let this caring nurse same

patient” (P5, L155) “

Benefits of the Caring-based Nursing

Performance Appraisal Protocol

Participants say that if applied later the caring-

based nursing performance appraisal protocol can

reduce complaints from patients due to caring of each

nurse's actions, and be a guide in assessing the

performance of nurses. This is in accordance with

some participant statements as follows:

“It is true, this if for example we carry out this

caring, most likely complaints in this hospital

must be reduced, because, caring this is what is

expected in action nursing” (P1, L6)

“which is evident in the presence of this

protocol, very helpful in the performance

assessment for the future later, and we can also

supplement the science of the results of this

research.” (P4, L).

Obstacles Related to the Preparation of the

Caring-based Nursing Performance Appraisal

Protocol

Some obstacles in the preparation the caring-

based nursing performance appraisal protocol is a

language adjustment section, and for its

implementation is constrained by the number of

nurses who are still lacking. This is in accordance

with the participant's statement as follows:

“obstacles in preparing the rubric, it's hard to

translate this caring language into its

performance indicators. The language must be

fully understood” (P3, L187).

“if later we caring-based performance

assessment, with the current number of nurses,

could be our value is all low, because it is our

communication that should be 10 minutes, we

shorten it to 3 minutes, finally we can not achieve

good value” (P4, L61).

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Management Expectations Related of the

Caring-based Nursing Performance Appraisal

Protocol

Management expectations related of the caring-

based nursing performance appraisal protocol is a

protocol that has been formed can be applied, produce

good impact and caring application is done. This is in

accordance with the participant's statement as

follows:

“after the results of research made by

researchers, we will try directly this new formula.

We will see, whether to generate something from

this new performance appraisal formula” (P3,

L259).

“hope from us, related to our products, we can

still do it, but still facilitated from the leadership,

which is adjusted to the adequacy of manpower,

this target is the way” (P5, L267).

3.4.3 Output Development Protocol for

Caring-based Nurses Performance

Assessment

The nursing caring-based performance assessment

protocol has been prepared based on the results of

discussions or meetings between the drafting team

and researchers, which produce: 1) The concept

of assessment and caring, 2) Standard of operational

procedures and the flow of caring-based on

performance, 3) Explanation of the implementation

and explanatory assessment, 4) assessment rubric,

which consists of: a) nurse performance rubric and b)

rubric of work behavior of nurse, 4) assessment

format.

4 DISCUSSION

The results of this study have similarities with the

results of research conducted by Nikpeyma, Saeedi,

Azargashb, and Majd on the issue of assessing the

performance of clinical nurses in the teaching

hospitals of the city of Tehran: 1) Contextual

issues (incompatibility between nursing standards

and duties), 2) Performance appraisal structure

(subjective judgment and the gap between theory and

clinical practice), 3) Assessment process (managers

lack supervision, unfair assessment and no follow-

up), and 4) Rating result (incorrect feedback)

(Nikpeyma, N., Saeedi, Z. A., Azargashb, E., & Majd,

H. A, 2013).

The concepts or materials that researchers obtain

are: 1) Concept of performance appraisal, 2) Caring

concept, 3) The concept of nursing care the concept

of nursing care and 4) Related research journals on

caring applications and performance appraisal of

nurses. For the process of drafting the nurse

performance appraisal protocol, furthermore the

researchers conducted the formation of a drafting

team consisting of: 1) Chairman of the nursing

committee, 2) Head of the inpatient room and 3)

The head of the room. The team has the right and

authority to carry out a nurse's performance

assessment and will continue to evaluate the caring-

based nurses performance assessment protocol,

although the research process that researchers do at

the hospital Santa Elisabeth Medan has been

completed.

There are several obstacles during the preparation

of the caring-based nursing performance appraisal

protocol, among others: 1) Time of the participants,

so that discussion activities can not be done

continuously, researchers took the initiative to meet

the drafting team separately for a discussion. 2)

Adjustment of the performance appraisal rubric,

where the compilation of rubrics using the caring

code dimension, developed by Lee, Fang, Kuo, and

Turton, are: 1) Assistance during patient reception, 2)

Professional behavior, 3) Communication, 4)

Empathy, 5) Sincerity, and 6) Appreciate (Lee-Hsieh,

J., Fang, Y.Y., Kuo, C.L., & Turton, M.A, 2004).

These six dimensions of caring code have been

combined in accordance with the sequence that is

linked to the concept of nursing care consisting of:

assessment, nursing diagnoses, nursing action

planning, implementation of nursing actions,

evaluation of nursing actions and documentation.

The advantages of this caring -based nurse

performance appraisal protocol are, before

finalization to be presented, researchers do a protocol

validation in advance with three experts, especially

regarding the grammatical editors that can not be

clearly understood by the participants. This process is

similar to Zaki, Fekr and El-Hamed's research, after

the development of a nurse performance appraisal

system, the questionnaire questionnaire developed is

submitted to the expert group to assess the relevance,

validity and application (Zaki, Isis Fawzy., Fekr,

Nehad Ezz-Eldin & El-Hamed, Magda Abd, 2018).

After the validation process from the expert, then

the researchers and participants do the exposure of the

results of the caring -based nurse performance

appraisal protocol. This exposure was made to equate

perceptions with the drafting team before the research

process ended. The disadvantage of this stage is that

the caring-based performance appraisal protocol has

not been tested. This is because researchers only do 1

Development of Caring-based Nurse Performance Assessment Protocols at Santa Elisabeth Hospital Medan

773

stage of action research process, other than that the

managerial just finished doing the credentials to the

nurses. Participant busyness is also one of the factors

inhibiting the research process, so that the research

process becomes longer if the protocol is tested.

5 CONCLUSIONS

This study aims to develop a caring-based nursing

performance appraisal protocol at Santa Elisabeth

Hospital Medan. The contents of this caring-based

nurse performance appraisal protocol are:1) The

concept of assessment and caring, 2) Standard

of operational procedures and the flow of caring-

based on performance, 3) Explanation of the

implementation and explanatory assessment, 4)

Assessment rubric, which consists of: a) nurse

performance rubric and b) rubric of work behavior of

nurse, 5) Assessment format.

For the hospital as a place of study, expected to

leadership, The management and the heads of the

hospital units to be able to apply the caring-based

nurse performance assessment protocol as a guideline

for performance appraisal.

For nursing practice, it is expected that the

performance appraisal team has strong commitment

and motivation to run and implement the caring-based

performance appraisal protocol.

For the next researcher, is expected to measure the

impact of the implementation of the caring-based

nursing performance appraisal protocol. In addition,

the researcher hopes that the results of this research

become one of the research data of nursing (evidence

based) that can be developed as input of further

research thus the limitations in this research can be

overcome in the next research cycle in action research

research.

ACKNOWLEDGEMENTS

This article is the result of my thesis research,

therefore I would like to thank:

Master of Nursing Study Program, Thesis

Examination Committee, Supervisor Lecturer,

Research Expert, Director and Staff of Santa

Elisabeth Medan Hospital and participants who

participated in this study.

I also want to thank both my parents and family,

who have provided moral support and motivation in

completing this article.

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