Educational Media Leaflet Increases Nurses' Knowledge about Nursing Documentation Audit
Keywords:
Documentation audit, leaflet media, nurse knowledgeAbstract
Background: The nursing management process starts with planning, organizing, commanding/coordinating, and controlling. One part of the controlling function is the nursing documentation audit. Nursing documentation audit is a professional evaluation process on the quality of nursing services which have been carried out by the nursing and midwifery profession against patients, namely through patient medical records.
Objective: Nurses can implement nursing documentation audits at Ar-Raudah 1 room of Makassar Hajj Hospital.
Methods: This study used a case study method. This study implemented education through leaflet media to enhance nurses' knowledge in implementing nursing documentation audits. A total of 14 nurses participated in this study. Data collection was obtained from interviews, observations and questionnaires.
Results: The findings showed that the pre-test nurses' knowledge on P3 as many as 10 nurses (71.4%) answered correctly and as many as 4 nurses (28.6%) answered incorrectly. As for P7, 14 nurses (100%) answered incorrect. An increase in knowledge occurred during the post test, namely P3 (100%) and P7 (100%). After nursing implementation, namely education through leaflet media, it showed that nurses' knowledge increased in the application of nursing documentation audits.
Conclusion: Nurses at Ar-Raudah 1 room of Makassar Hajj Hospital show an increase knowledge about nursing documentation audits.
References
Al-Mahalli, I. J., & As-Suyuti, I. J. (2010). Terjemahan Tafsir Jalalain Berikut Asbabun Nuzul Jilid 2. Bandung: Sinar Baru Algensindo.
Ardenny, & Idayanti. (2017). Faktor-Faktor yang Mempengaruhi Kelengkapan Pendokumentasian di Ruang Rawat Inap Rumah Sakit Madani. Poltekkes Kemenkes Riau, 178–186.
Arimbawa, E. (2022). Sosialisasi Penggunaan Leaflet Dalam Peningkatan Pemahaman Penggunaan Obat Herbal Untuk Penyakit Kronis Di Kota Denpasar. Prima : Portal Riset Dan Inovasi Pengabdian Masyarakat, 1(2), 31–38. https://doi.org/10.55047/prima.v1i2.169
Artika, Y. (2016). Gambaran pelaksanaan pendokumentasian asuhan keperawatan di bangsal Bougenvil Rumah Sakit Umum Daerah Penembahan Senopati Bantul Yogyakarta. Yogyakarta: PSIK Stikes Jendral Achmad Yani.
Asmuji. (2014). Manajemen Keperawatan Konsep & Aplikasi. Yogyakarta: Ar-Ruzz Media.
Berman, A., Snyder, S., & Fradsen, G. (2016). Kozier & Erb’s Fundamental on Nursing. USA: Pearson Education.
Brima, N., Sevdalis, N., Daoh, K., Deen, B., Kamara, T. B., Wurie, H., & Leather, A. J. M. (2021). Improving nursing documentation for surgical patients in a referral hospital in Freetown, Sierra Leone:protocol for assessing feasibilityof a pilot multifaceted quality improvement hybrid type project. Pilot and Feasibility Studies, 7(1), 1–14.
Damanik, M., Fahmy, R., & Merdawati, L. (2020). Gambaran Keakuratan Dokumentasi Asuhan Keperawatan. Jurnal Kesehatan Andalas, 8(4138–144).
Dewi, I. K., & Mashar, A. (2019). Nilai - Nilai Profetik dalam Kepemimpinan Modern pada Manajemen Kinerja. Lampung: CV Gre Publishing.
Firadika, A. N. R. (2020). Hubungan Pengetahuan Perawat tentang Dokumentasi Asuhan Keperawatan dengan Kelengkapan Pengisian Dokumentasi Asuhan Keperawatan di RS Islam Faisal Makassar. Journal Keperawatan, 8(5), 55.
Gani, H. ., Istiaji, E., & Kusuma, A. . (2014). Perbedaan Efektivitas Leaflet dan Poster Produk Komisi Penanggulangan AIDS Kabupaten Jember Dalam Perilaku Pencegahan HIV/AIDS. Jurnal IKESMA, 10(1), 31–48. Jurnal IKESMA, 10(1), 31–48.
Hut-Mossel, L., Ahaus, K., Welker, G., & Gans, R. (2021). Understanding How and Why Audits Work in Improving the Quality of Hospital Care: A Systematic Realist Review. PLoS ONE, 16(3), 1–25.
Irawan, M. (2016). Studi pendokumentasian asuhan keperawatan pada pasien rawatinap di ruang mawar RSUD Kota Kendari. Karya Tulis Ilmiah. Kendari: Poltekes Kemenkes Kendari.
Juniarti, R., Somantri, I., & Nurhakim, F. (2020). Gambaran kualitas dokumentasi asuhan keperawatan di Ruang Rawat Inap RSUD Dr. Slamet Garut. Jurnal Keperawatan BSI, 8(2).
Maurissa, A., Yuswardi, & Atika, S. (2020). Kualitas Kinerja Perawat dan Dokumentasi Asuhan Keperawatan di Ruang Rawat Inap Rumah Sakit Umum Pemerintah Aceh. Idea Nursing Journal, 11(2), 62–65.
Menteri Kesehatan RI. (2013). Peraturan Menteri Kesehatan Republik Indonesia Nomor 49 Tahun 2013 tentang Komite Keperawatan Rumah Sakit.
Mugianti, S. (2016). Manajemen dan Kepemimpinan dalam Praktik Keperawatan. Jakarta: Kementerian Kesehatan RI Pusdik SDM Kesehatan.
Murtiningsih, Lusianah, & Nurainun. (2021). Pelatihan Asuhan Keperawatan Spiritual Menggunakan Buku Panduan Persatuan Perawat Nasional Indonesia melalui Teleconference Bagi Perawat dan Bidan RSUD Depok. Kesehatan dan Kedokteran, 5(2), 33–38.
Nellisa, D., Rachmah, & Mahdarsari, M. (2022). Pendokumentasian Keperawatan di Ruang Rawat Inap Rumah Sakit. JIM Fkep, I(4).
Nurjannah, S. (2013). Gambaran kelengkapan pendokumentasian asuhan keperawatan di RSUD Pandan Arang Boyolali. Surakarta: Fakultas Ilmu Kesehatan Universitas Muhammadiyah.
Saraswasta, I. W. G., Tutik, R., Hariyati, S., & Fatmawati, U. (2020). Pelaksanaan Dokumentasi Asuhan Keperawatan Di Ruang Rawat Inap Rumah Sakit X Jakarta : Pilot Study. : : Jurnal Keperawatan dan Kesehatan, 8(2), 199–207. https://doi.org/10.20527/dk.v8i1.8024
Seniwati, I. dkk. (2022). Buku Ajar Manajemen Keperawatan. Sul-Teng: CV. Feniks Muda Sejahtera.
Setyawan, F. ., & Supriyanto, S. (2019). Manajemen Rumah Sakit. Zifatama Jawara.
Siswanto, L. ., Hariyati, T. ., & Sukihananto. (2013). Faktor-Faktor yang Berhubungan dengan kelengkapan pendokumentasian asuhan keperawatan. Jurnal Keperawatan Indonesia, 16(2), 77–84.
Tasew, H., Mariye, T., & Teklay, G. (2019). Nursing Documentation Practice and Associated Factors among Nurses in Public Hospitals, Tigray, Ethiopia. BMC Research Notes, 12(1), 612–617.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Omni Nursing Journal
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
CC Attribution-NonCommercial-ShareAlike 4.0
