Analysis of Factors Affected to Community Nurses’s Role in
Promotive and Preventive Care
Sismulyanto, Nursalam and Ferry Efendi
Faculty of Nursing Universitas Airlangga, Kampus C Mulyorejo, Surabaya, Indonesia
Keywords: Promotive, Preventive Care, Community Nurses’s Role
Abstract: Community nurses had important role in promotive and preventive care in community. Aim of the study
was to identify community nurses role in promotive and preventive care, identify factors affected to
community nurses role, analysis of factors affected to community nurses’s role in promotive and preventive
care in community based on Health Promotion Model (HPM). Design of the study was explanatory with
cross sectional approach. Sum of participant was 161. This study was conducted in 11 Public Health Center
in Banyuwangi at 1 January to 30 January 2018. Methods of data collection was cluster sampling. The
results showed behavior related cognition and effect of nurses had affected to commitment of nurses (t-
stat=19,575); commitment (t-stat=4,490), interpersonal influences (t-stat=3,747), and situational influences
(t-stat=5,796) directly had affected to community nurses role. That was important to enhance of community
nurses role capacity through modifying commitment of nurses, interpersonal influence factors and
situational influence factors.
1 BACKROUND
Health Promotion and prevention was a part of
primary health care services conducted by
community nurses to individu, family and
community to achieve a higher quality of health
through enhancing the ability, fulfilling basic
personal need and self actualization (Pender, 2011).
Health promotion and prevention was a part of
primary programmes in Public Health Center to
enhance the community’ abilities to implement their
health promoting lifestyle behaviors and preventing
community illness (Ministry of Health Indonesia,
2007).
Health Promotion was an effort of communities’
empowerment through counselling the community to
promote health lifestyle choices. Implementing of
health promoting behaviors include: taking
responsibility for one's health, exercise and physical
activity, spiritual involvement, proper nutrition,
stress management, techniques and satisfying
interpersonal relationship (Fuller, 2015). Meanwhile,
health prevention was a kind of health care services
that focusing on disease prevention (primary,
secondary and tertiary level) through implementing
of healthy lifestyle, conducting early disease
screening, early disease treating, reducing impact of
disease and rehabilitation (Thomas et al., 2014).
Incidence of Dengue Haemoragic Fever (DHF)
in Banyuwangi during the period 2016 reached
1300 cases with 11 cases of them was died. This
number was increasing compared to 2015, which
was 900 cases with 9 cases of which died
worldwide. The High incidence of
Dengue Haemoragic Fever (DHF) in community
was caused by failure of implementation of health
promotion and prevention in community.
Kumat- Thome et al. (2017) reported that failure
of implementation of health promotion and
prevention in community caused by lack of
community nurses’s role to promote health lifestyle
behaviors to community and unable to conduct
intervention to prevent sickness. Whiehead (2017)
proved that majority of community nurses who
giving health promotion in the community did not be
supported by availability of regulation from regional
government and community. Leak of sopporting
system like poor of time, poor availability of
facilities like computer etc.
The purpose of the study was to (1) identify
community nurses role in health promotion and
prevention, (2) identify factors affected to
community nurses role, (3) analyse factors affected
to community nurses’s role in health promotion and
Sismulyanto, ., Nursalam, . and Efendi, F.
Analysis of Factors Affected to Community Nurses’s Role in Promotive and Preventive Care.
DOI: 10.5220/0008322401830187
In Proceedings of the 9th International Nursing Conference (INC 2018), pages 183-187
ISBN: 978-989-758-336-0
Copyright
c
 2018 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved
183

prevention in community based on Health
Promotion Model (HPM).
2 METHODS
2.1 Design
This study used explanatory reseach design and
cross sectional approach.
2.2 Instrument
We used questionnare that was developed upon
Health Promotion Model (HPM) as instrument to
measure community nurses role and factors affected
to community nurses role that consisted of personal
factors, behavior related cogntion and effect,
interpersonal influences, situational influences, and
commitment of nurses. 1) Personal factors
questionnare consisted of age, sex, education level
and working period. 2) behavior related cognition
and effect questionnare consisted of cognitive aspect
with 8 close ended questions and affective aspect
with 10 close ended questions. 3) Interpersonal
influences questionnare contained 16 close ended
questions, 4) Situational influences questionnare
contained 6 close ended questions. 5) commitment
contained 6 close ended questions, 6) community
nurses role questionnare contained 7 close ended
questions.
2.3 Data Collection
In January 2018, 161 registered nurses working at 11
Public Health Center in Banyuwangi, Indonesia
were invited to participate this study. Questionnare
sheet that consisted of personal factors, behavior
related cognition and effect, interpersonal influence,
situational influence, commitment and community
nurses role were distributed to nurses after willing as
a participant. A participant must be met the inclusion
criteria. Inclusion criteria were a nurse who worked
at least one year experience in Public Health Center
(PUSKESMAS) in Banyuwangi and having a health
phyisic and mental condition.
2.4 Analysis
2.4.1 Descriptive
Descriptive analysis was conducted by displaying
frequency distribution of each variable on the tables
that consisted of frequency and percentage of each
variable.
2.4.2 Inferencial Analysis
We used smartPLS software to analysis of influence
of independen variables (personal factors, behavior
related cognition and effect, interpersonal influence,
situational influence, commitment) to dependen
variable (community nurses role in health promoting
and preventing services). Result of this analysis was
classified into two section: there was influence if t-
stat value was more than 1,96, there was not
influence if t-stat value was less than 1,96.
Table 1: Personal factors of community nurses
in Public Health Center- Banyuwangi at January
2018.
Personal
factors
variable
Category
F
%
Age
21-30 years
53
32,9
31-40 years
74
46,0
40-50 years
27
16,8
> 50 years
7
4,3
Sex
Man
87
54
Women
74
46
Education
level
Senior high
school
16
9,9
Diploma
113
70,2
Bachelor
32
19,9
Working
period
1-10 years
61
37,9
11-20 years
73
45,3
21-30 years
27
27
Table 2: Behavior related cognition and effect of
community nurses in Public health Center
Banyuwangi at Januari 2018.
Behavior related
cognition and
effect variable
Category
f
%
Cognitive
Low
34
21,1
Moderate
36
22,4
High
91
56,5
Affective
Negative
32
19,9
Positive
129
80,1
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3 RESULTS
3.1 Characteristic of Respondents
3.1.1 Personal Factors
Personal factors consisted of age, sex, education
level, and working period as presented in this table
1:
Table 1 personal factors showed that majority of
participant was age on range 31-40 years, sex was
man, level of education was diploma of nursing, and
working period was on the range 11-20 years.
3.1.2 Behavior Related Cognition and Effect
Behavior related cognition and effect variable
consisted of cognitive and affective as presented in
the table 2:
Table 2 showed that majority of participant
cognition was on the high level, whereas participant
affection was on the positive level.
3.1.3 Interpersonal Influences
Interpersonal Influences variable consisted of
supported by colleague, other health professional,
chairman of Public health Center and community as
presented in the table 3.
Table 3 showed that majority of supported by
colleague was on the moderate level, supported by
other health professional was on the moderate level,
supported by chairman of public health center was
on the moderate level, and supported by community
was on the moderate level too.
3.1.4 Situational Influences
Situational Influences variable consisted of
regulation and facilities as presented in this table
below:
Table 4 showed that majority of regulation was
on the high level, and the availability of facilities
was on the high level.
3.1.5 Commitment
Commitment variable consisted of affective,
normative dan contiunance as presented in the table
5:
Table 5 showed that majority of affective
indicator was on the positive level, normative
indicator was on the positive level, dan contiunance
indicator was on the positive level too. It indicated
Table 3: Interpersonal influences of community nurses
in public health center- Banyuwangi at Januari 2018
Interpersonal
Influences variable
Category
F
%
Supported by
colleague
Low
33
20,5
Moderate
67
41,6
High
61
37,9
Supported by other
health professional
Low
38
23,6
Moderate
84
52,2
High
39
24,2
Supported by
chairman of Public
Health Center
Low
32
19,9
Moderate
77
47,8
High
52
32,3
Supported by
community
Low
34
21,1
Moderate
62
38,5
High
65
40,4
Table 4 Situational influences of community nurses in
public health center- Banyuwangi at January 2018
Variabel
Situational
Influences
Category
f
%
Regulation
Low
33
20,5
Moderate
44
27,3
High
64
52,2
Facilities
Low
25
15,5
Moderate
43
26,7
High
93
57,8
Table 5: Commitment of community nurses in public
health center- Banyuwangi at Januari 2018.
Commitment
variable
Category
F
%
Affective
Negative
36
22,4
Positive
125
77,6
Normative
Negative
36
22,4
Positive
125
77,6
Contiunance
Negative
22
13,7
Positive
139
86,3
Table 6 Community nurses role in public health center-
Banyuwangi at Januari 2018.
Community nurses
role variable
Category
f
%
Promotive
Low
53
32,9
Moderate
85
52,8
High
23
14,3
Preventive
Low
50
31,1
Moderate
80
49,7
High
31
19,3
Analysis of Factors Affected to Community Nurses’s Role in Promotive and Preventive Care
185

that community nurses had positive commitment to
conduct health promoting dan preventing services to
community.
3.1.6 Community Nurses Role
Community nurses role variable consisted of
promotive dan preventive services as presented in
table 6:
Table 6 showed that majority of promotive
efforts that conducted by community nurses was on
the moderate level, and preventive services that
conducted by community nurses was on the
mederate level too. It indicated that community
nurses conducted promotive and preventive services
to community goodly enough.
3.1.7 Analysis of Factors Affected to
Community Nurses Role
The table showed that there was affected of the two
variables if t-stat value (>1,96), there was not
affecting of the variables if t-stat value (<1,96). By
the above tables could be concluded that
commitment (t-stat=19,575), commitment (t-
stat=4,490), interpersonal influences (t-stat=3,747),
and situational influences (t-stat=5,796) influenced
community nurses role.
4 DISCUSSION
4.1 Affected of Commitment of Nurses
to Community Nurses Role
Study result showed that commitment affected to
community nurses role (t-stat=4,490). commitment
of nurses also showed on the positive level, that
mean community nurses had a positive commitment
to conduct their role on health promotive and
preventive care to the community.
The result of study was relevance with previous
study that implementation of health promoting
services in the community was influenced by
commitment of community nurses and supported by
organization culture (Garry et al., 2017).
Commitment could encourage a person to work fully
dedication, having deseart to give his power and
ability to work fully on purpose of organization so
that could reach the optimum level (Maijala et al.,
2017).
Poghosyan et al. (2017) also showed that
commitment of nurse had contribute to achievement
of promotive and preventive care in community.
Nurses that had commitment to their self,
organisation, and society could present a good
promotive and preventive care behavior.
Commitment was as a part of importance role of
community nurses in giving promotive and
preventive care to community. So that was needed
an effort to enhance commitment of nurses.
4.2 Affected of Interpersonal
Influences to Community Nurses
Role
Study result showed that interpersonal influences
affected to community nurses role (t-stat=3,747).
Interpersonal influences on the study also showed on
the moderate level, that mean community nurses had
a chance to conduct their role in giving health
promotion and prevention services to community
because they was supported by their nurses collegue,
other health professional, chief of Public Health
Center and community.
That was relevance with Pender (2011) statement
that the goal of health promoting and preventing
efforts were depended by interpersonal influences
that consisted of supporting of colleague, other
health professional and community. Grant et al.
(2017) also reported supporting from colleague,
Table 7: Parameter of path coefficient to latent
construct as direct influence and indirect influence.
Affected of
independen variable
to dependent
variable
Path
Coeffienct
Parameter
T-Stat
Value
P
value
affected of behavior
related cognition
and effect to
commitment
0,812
19,575
0,000
affected of
commitment to
community nurses
role
0,297
4,490
0,000
affected of personal
factors to
community nurses
role
0,062
1,294
0,197
affected of
interpersonal
influences to
community nurses
role
0,263
3,747
0,000
affected of
situational
influences to
community nurses
role
0,433
5,796
0,000
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186

other health profession, and community could
optimise the community nurses role in giving
promotive and preventive care to community and
enhancing of community awareness to implement
health life style behaviors (Kurnat-Thoma et al.,
2017) .
Interpersonal influence that consisted of
supporting from colleague, other health profession,
and community was the factors that affected to
commnity nurses role in giving promotive and
preventive care to community. That was important
to encourage community nurses always making
good relationship with colleague, other profession
and community.
4.3 Affected of Situational Influences to
Community Nurses Role
Study result showed that situational influences
affected to community nurses role (t-stat=5,796).
Situational influences on the study also showed on
the high category, that mean there were regulation
related to implementation of health promotive and
preventive services in the community and
availability of facilities that supported promoting
and preventing efforts.
That was relevance with Pender (2011) statement
that the goal of health promoting and preventing
efforts were depended by situational influences that
consisted of availability of regulation and facilities.
Thomas et al. (2014) reported that situational
influences that support implementation of promotive
and preventive care in community was regulation
and availabilty of facilities. Regulation could guide
the community nurses about the scope that should be
done and ensure the community nurses from many
kinds of duty accident (Tingvoll et al., 2016).
Whitehead (2017) also proved that availability of
regulation and facilties had influenced to
implementation of promotive and preventive care in
community.
Situational influences that consisted of regulation
and facilities was a part of importance role of
community nurses in promotive and preventive care.
To enhance affected of situational influences, could
be done by ensure of availabity of regulation and
facilities.
5 CONCLUSION
Community nurses of Public Health Center
(PUSKESMAS) in Banyuwangi conducted
promotive and preventive care to community goodly
enough. Commitment of nurses, interpersonal
influences, and situational influences were factors
that affected to community nurses role in promotive
and preventive care. It was considered to enhance of
community nurses role capacity through modifying
commitment of nurses, interpersonal influence
factors and situational influence factors.
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