The Effect of Nurse Mental Workload of Patient Compliance Risk

Prevention Falling in Aisyiyah Islamic Hospital of Malang

Zahid Fikri

, Nur Komaria

Department of Nursing, Faculty of Health Science, University of Muhammadiyah Malang, Jalan Bendungan Sutami

No. 188A, Malang, East Java, Indonesia

Islamic Hospital Aisyiyah Malang, Jalan Sulawesi No. 16, Malang, East Java, Indonesia

Keywords: Mental workload, risk prevention, patient falls.

Abstract: Workload felt by a worker is not only a physical workload, but a collection of physical workload, mental

workload and social workload. Patient safety is one of the principles of nursing practice. in providing

services where nurses are required to have high professionalism, professionalism is impacting workload.

A mental workload is one burden that a nurse must responsibility and can have an effect on his actions.

The study objective was to analyze the influence of mental workload of nurses on patient compliance risk

prevention fall. There were significant influence between mental workload of nurses on patient compliance

risk prevention fall P = 0.000. The burden of mental work of nurses under moderate conditions this proves

the nurse is able to control the amount of pressure that is not only physically but also mentally so it can

still provide quality nursing care to patients, as evidenced by compliance risk prevention patient falls that

are in most categories are enough.



1 INTRODUCTION

Workload felt by a worker is not only a physical

workload but a collection of physical workload,

mental workload, and social workload (Lisbeth

Fagerström & Saarela, 2017). The physical workload

has been measured by the WISN (Workload

Indicators of Staffing Need) method and has been met

according to calculations, while the workload has not

been mentally measured (WHO, 2015). SPO

(standard operating procedure) prevention of the risk

of falling patients has been around since 2015 but

until 2018 compliance with the risk of falling patients

has not gone according to the standard as evidenced

by the high incidence of falling patients.

Excessive mental workload will lead to

forgetfulness, difficulty concentrating, anxiety,

anxiety, irritability, irritability, anxiety, and despair

(Afriansyah, 2017). Along with the existence of a

health insurance provider body in Indonesia, the

number of patients from each year has increased in

the inpatient services of Islamic Hospital Aisyiyah

Malang. In 2013 - 2014 there was an increase in

inpatients by 21.2%, in 2014-2015 it was 13.1% and

in 2015-2016 there was an increase in inpatients by

11%. Psychological or mental effects that occur due

to nurses must serve patients who are excessively

irritable, easily offended to patients and nurses in a

hurry in serving patients so that patient safety tends

to be neglected as well as preventing the risk of falling

patients that should be done properly and correctly.

About 0.1% of cases of patients falling in the USA

are 30% - 50% of which have injuries (Peter Van

Bogaert, Danny Van heusden, Stijn Slootmans, Ingrid

Roosen, Paul Van Aken, 2018). While reports of

patient safety incidents or Unwanted Events of

Hospitals in Indonesia amounted to 96.67% for

general hospitals and 33.2% for specialty hospitals

with incidents of patients falling therein (Nurihsan,

2018). Hospital Patient Safety Committee Report, in

several provinces in Indonesia from January 2010 to

April 2011, reported as many as 137 incidents. East

Java Province ranks highest at 27% among eleven

other provinces (Nurjanah, Sakka, & Paridah, 2017).

Along with the development of increasingly

advanced technology causes more critical society to

choose and assess the health services received. The

expected service is excellent, exceeding the

expectations of the community itself. The increase in

patient complaints as a result of suboptimal service

Fikri, Z. and Komaria, N.

The Effect of Nurse Mental Workload of Patient Compliance Risk Prevention Falling in Aisyiyah Islamic Hospital of Malang.

DOI: 10.5220/0009119800150020

In Proceedings of the 2nd Health Science International Conference (HSIC 2019), pages 15-20

ISBN: 978-989-758-462-6

which results in a high number of patient safety

incidents will reduce the quality and credibility of the

hospital in the eyes of the public. So that the workload

of nurses should not only be calculated based on

physical workload alone, the mental workload must

also be calculated to improve the quality of nursing

practice. One of these nursing practices is based on

patient health and safety (UU, 2014).

Mental workload affects patient satisfaction. If

nurses have a high mental workload, it can affect

nurses' compliance in taking action according to

established standard procedures, this will certainly

affect the quality of nursing services, reducing the

quality of hospitals and reducing public trust in

hospital credibility (Werdani, 2016).

2 METHODS

The design in this study is cross-sectional. The

population in this study were all employees of Islamic

Hospital Aisyiyah Malang, the total sample of 30

nurses obtained using purposive sampling techniques

that met the inclusion criteria as follows: nurses who

received new patients from the emergency room,

nurses who received patients transferred from other

rooms, all nurses who work in one shift work, and

nurses who have worked at least 1 year at the Islamic

Hospital Aisyiyah Malang (Nursalam, 2016).

The study was conducted at the Islamic Hospital

of Aisyiyah Malang in the range of June - July 2018.

After giving informed consent percent, the nurses'

mental workload questionnaire was distributed to

nurse respondents in the general care room, while the

observation checklist was filled out by researchers

when the respondent received new patients. After the

questionnaire has been collected, editing, scoring, and

coding are performed, then the spearman rank test is

performed to determine the effect of the independent

variable on the dependent variable with a confidence

level of 95%.

The independent variable in this study is the

mental workload of nurses. The research instrument

used to measure the independent variable was a

mental workload questionnaire from NASA-TLX

with 6 dimensions, namely the mental dimension,

physical dimension, time dimension, level of effort,

stress level and performance. This questionnaire was

tested for validity with the results of correlation using

the Pearson Product Moment of 1-0.746 and

reliability testing with Cronbach's alpha 0.963. While

the dependent variable is compliance with the

prevention of falling patient risk, the instrument used

to measure is the observation checklist which is

adjusted to the SPO of falling patient risk prevention

which has been used at the Islamic Hospital of

Aisyiyah Malang (SG, 1986).

This research uses bivariate analysis which is an

analysis of two variables, this analysis is conducted

to determine the effect and prove the research

hypothesis (Notoatmojo, 2010). Bivariate analysis in

this study was conducted to determine the effect of

nurses' mental workloads on adherence to the

prevention of the risk of patients falling in the Islamic

hospital in Aisyiyah Malang by using the Spearman

Rank (Sugiyono, 2012). So as to produce a p value

<0.05 to answer the hypothesis.

3 RESULTS AND DISCUSSION

Table 1: Characteristics of respondents based on a

workspace in the Islamic Hospital of Aisyiyah Malang in

2018.

Workspace Frequency Percentage

(%)

Umar 2 7

Abu bakar 1 3

Husein 3 10

Hasan 3 10

Ustman 6 20

Ali 6 20

Salman 5 17

Khadijah 4 13

Total 30 100

Based on Table 1, most respondents were from

Ustman and Ali's rooms by 20% (6 respondents) and

the fewest respondents were in the Abu Bakar room,

namely 3% (1 respondent).

Table 2: Characteristics of respondents by age at Malang

Aisyiyah Islamic Hospital in 2018.

Age

(years)

Mean± SD Min Max

22–40 25.30±3.752 22 40

Based on table 2, the average age of respondents

is 25 years old, this age is included in the category of

early adulthood.

Based on table 3, it can be seen that most of the

career paths of respondents were Clinical Nurse 1 by

60% (18 respondents) and the lowest was Clinical

Nurse 3 by 3% (respondents).

Based on table 4, it can be seen that the sex of the

most respondents is female, namely 80% (24

respondents).

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Table 3: Characteristics of respondents based on a career

path at the Islamic Hospital of Aisyiyah Malang in 2018.

Category Frequency

(f)

Percentage

(%)

Clinical Nursing 1 18 60

Clinical Nursing 2 11 37

Clinical Nursing 3 1 1

Total 30 100

Table 4: Characteristics by sex in Malang Aisyiyah Islamic

Hospital in 2018.

Sex Frequency (f) Percentage

(%)

Female 24 80

Male 6 20

Total 30 100

Table 5: Characteristics of respondents based on respondent

education level at Aisyiyah Islamic Hospital Malang in

2018

Category Frequency (f) Percentage

(%)

Diploma 29 97

Bachelor 1 3

Total 30 100

Based on table 5, it can be seen that the education

level of most respondents is D3 nursing, namely 90%

(29 respondents).

Table 6: Characteristics of respondents based on the length

of work of respondents in Malang Islamic Hospital

Aisyiyah in 2018.

Category Frequency

(f)

Percentage

(%)

1-3 years of work 20 67

Working period> 3-

7 years

6 20

Working time is 7-

13 years

3 10

Working time> 13

years

1 3

Total 30 100

Based on table 6, it can be seen that the most of

respondents' work time is> 1-3 years (20 respondents)

and the least length of work> 13 years is 3% (1

respondent).

Table 7: Characteristics of respondents based on marital

status in the Islamic Hospital of Aisyiyah Malang in 2018.

Category Frequency (f) Percentage

(%)

Married 11 37

Single 19 63

Total 30 100

Based on table 7, it can be seen that many

respondents are still unmarried, namely 63% (19

respondents)

Table 8: Characteristics of respondents based on the amount

of income at the Islamic Hospital of Aisyiyah Malang in

2018.

Category Frequency (f) Percentage

(%)

>2,5 million 6 20

1-2,5 million 24 80

Total 30 100

Based on table 8 most respondents' income is 1-

2.5 million, 80% (24 respondents).

Table 9: characteristics of respondents based on the

physical work environment at the Islamic Hospital of

Aisyiyah Malang in 2018.

Category Frequency (f) Percentage

(%)

Well 15 50

Enough 12 40

Less 3 10

Total 30 100

Based on table 9 it can be seen that the physical

work environment is considered sufficient by 50% of

respondents (15 respondents) and 10% of respondents

(3 respondents) consider it less.

Table 10: Characteristics of respondents based on the non-

physical work environment in the Islamic Hospital of

Aisyiyah Malang in 2018.

Category Frequency (f) Percentage

(%)

Good 20 67

Enough 10 33

Less 0 0

Total 30 100

Based on table 10 it can be seen that the non-

physical work environment is considered good by

67% of respondents (20 respondents).

Table 11: Characteristics of respondents based on work

distance in Malang Islamic Hospital Aisyiyah in 2018.

Category Frequency

(f)

Percentage (%)

<1 KM 12 40

1-5 KM 9 30

>5 KM 9 30

Total 30 100

The Effect of Nurse Mental Workload of Patient Compliance Risk Prevention Falling in Aisyiyah Islamic Hospital of Malang

Based on table 11, it can be seen the distance from

the house to the place where most respondents work

is <1 KM, which is 40% (12 respondents).

Table 12: Nurse mental workload in Malang Aisyiyah

Islamic Hospital in 2018.

Category Frequency (f) Percentage

(%)

Severe 8 26.7

Moderate 19 63.3

Mild 3 10

Total 30 100

Based on table 12 it can be seen that the mental

workload felt by most respondents is in the medium

category, amounting to 63.3% (19 respondents).

Table 13: Compliance with the prevention of the risk of

patients falling at the Islamic Hospital of Aisyiyah Malang

in 2018.

Category Frequency Percentage

Good 4 13.3

Enough 19 63.3

Less 7 23.3

Not good 0 0

Total 30 100

Based on table 13 it can be seen that compliance

with falling risk prevention by respondents is

sufficient, amounting to 63.3% (19 respondents).

Table 14: Hypothesis test results of nurses' mental workload

variables on compliance with the prevention of the risk of

falling patients at the Islamic Hospital of Aisyiyah Malang

in 2018.

Variable Significance Coefficient

Mental workload

Compliance

prevents the risk

of falling patients

0.000 -0.768

Based on table 14 it can be seen that there is a

very significant influence between the mental

workload of nurses with adherence to the prevention

of the risk of falling patients with a significance value

of 0,000 and a coefficient of 0.768 and with a negative

direction.

Based on the results of research on the mental

workload of nurses at Aisyiyah Islamic Hospital in

Malang, it was found that the majority of respondents

were in the moderate category of 63.3% (19

respondents). This can be caused by the average age

of nurses less than 26 years, where the age is included

in early adulthood, age-related to maturity, maturity,

and ability to work. Increasing age more able to show

the maturity of the soul and the more appropriate to

think rationally, able to make decisions, the wiser and

able to control emotions. the younger the nurses the

more vulnerable they become a burden in dealing

with the stressors in the service. Mental workload

experienced by nurses can also be caused by gender,

wherefrom the results of research the most

respondents' gender is female, 80% (24 respondents)

gender is a developing issue in the world of work,

gender differences can affect mentality nurses when

the demands of work or work pressure are high

especially for women causing mental workload, this

is supported by Ayu's research, 2017 which contains

gender indicators which include behavior, roles,

emotional characteristics and mentality which all

affect employee performance.

From the results of the study obtained data that

90% (29 respondents) educated D3 nursing,

education provides knowledge that is not only

directly with the implementation of the task, but also

the foundation to develop themselves and the ability

to carry out work, the higher the level of education is

expected nurses more capable in managing problems

that are the source of workload, in addition to the

length of service of nurses also affect the mental

workload of nurses themselves, from the research

results obtained data 72% (21 respondents) are nurses

with a working period of 1-3 years, nurses who are

still new of course not fully experienced in

overcoming problems or conflicts in the service,

nurses with long working periods are expected to be

more experienced and senior, where seniority and

work productivity is positively related (Arikunto,

2016).

In addition, the environment of the nurses

themselves also influences the mental workload, the

environment not only physically but also non-

physical environment from the study obtained data

that 50% of respondents (15 respondents) consider

the physical work environment to be in the sufficient

category and 67% of respondents (20 respondents )

considers the non-physical work environment is

good, the work environment can affect employee

emotions, nurses will feel comfortable and calm in

carrying out their duties if the work environment is

supportive, a conducive environment allows

employees to work optimally so that work time will

be more effective, this is according to research

Sholehah, 2014 which states that there is a significant

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influence between the work environment on

employee morale (Fithri & Anisa, 2017).

Based on data in compliance with the prevention

of the risk of falling patients in Islamic Hospital

Aisyiyah Malang, it was found that most nurses'

compliance was in the sufficient category of 63.3%

(19 respondents. This was due to the level of

education of nurses, most of whom were D3 Nursing,

the higher the education of a nurse, is expected to

have better knowledge, skills, and abilities in carrying

out the work, it is expected that after the education

level of the most respondents is S1 Kep then

compliance with falling patient risk prevention will

be better with the emergence of ideas to improve and

simplify the process or procedure for patient risk

prevention In addition, adherence is also influenced

by gender, wherein the results of the study of the

majority of respondents' gender are women namely

80% (24 respondents), women are more focused on

carrying out their duties properly and harmonious

work relationships, so that the women tend to be more

obedient to the rules and tasks assigned to them.

From the study there were 37% (11 respondents)

who were married and married people were more

obedient compared to single people, married people

tended to be more attached to groups or communities

so that they would avoid actions that could lead to

social sanctions, marital status is also closely related

to the use of income which affects the performance of

a nurse, from research data it is found that employee

income is 1-2.5 million as much as 80% (24

respondents). Income is related to motivation, where

motivation is the motivation of a nurse to do or act

according to the procedure, which in turn nurses will

get rewarded for what they have tried to meet their

needs.

The results of the study mentioned 12 respondents

(40%) had the most distance from home to the

workplace is <1 KM. Distance of residence that

causes nurses to be more obedient in carrying out a

procedure because they come with conditions that are

fit and strong motivation in carrying out their role as

caregiver of patients, including in terms of patient

safety, especially prevention of the risk of falling,

mentions the distance domicile influential on

employee performance (Kurniadi, 2013).

In this study, the data obtained that there is a very

significant influence between mental workload of

nurses on compliance with prevention of falling

patient risk, this is indicated by the significance value

of p-value 0,000, which can be interpreted as H1

accepted, namely there is an influence of nurses'

mental workload on risk prevention compliance the

patient fell in Malang Aisyiyah Islamic Hospital. The

correlation coefficient value of -768 indicates the

degree of a strong relationship and with this negative

direction, causing if the mental workload increases,

compliance with the prevention of falling patient risk

will decrease, as well as vice versa if the mental

workload decreases, the compliance to prevent the

risk of falling patients will increase. However, the

results of the study found 2 nurses with heavy mental

workloads were still able to implement compliance

risk prevention patients fell in the sufficient category

and there were 1 nurse with mental workloads were

showing compliance prevention risk of patients

falling in the good category, this was due to nurses

able to control the amount of mental pressure so as to

still be able to provide quality nursing care to patients,

do not show the real impact of the mental workload

they feel, be able to hold and maintain emotions, try

to stay concentrated, continue to provide quality

nursing services including preventative procedures

the risk of falling patients, through the process of

assessment, planning, management and evaluation,

nurses implement the risk of falling risks to prevent

patient safety incidents ie patients falling, so that the

patient safety quality indicators are in accordance

with the expected standards. Hospital quality that is

maintained will cause patients to be satisfied with

what is received, the public believes in the credibility

of the hospital.

This is in line with research conducted by

Werdani (2016). Which explains the results of his

research that the mental workload of nurses affects

patient satisfaction. Patient satisfaction is an

outcome. Compliance with the prevention of falling

patient risk is the output produced by nurses who

carry out a process that if done well, the output will

be good too.

4 CONCLUSIONS

There is a very significant influence between the

mental workload of nurses on compliance with the

prevention of the risk of falling patients in Aisyiyah

Islamic Hospital. The degree of a strong relationship

and with this negative direction, cause if the mental

workload increases, compliance with the prevention

of the risk of falling patients will decrease.

ACKNOWLEDGEMENT

The research authors would like to thank the research

assistants, nursing and technician who assisted in the

The Effect of Nurse Mental Workload of Patient Compliance Risk Prevention Falling in Aisyiyah Islamic Hospital of Malang

data collection, and Islamic hospital in Aisyiyah

Malang who partook in the study.

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