Tesis

Pelatihan dan Pendampingan Tata Kelola Klinis Kegawatdaruratan Neonatal dalam Meningkatkan Pengetahuan dan Keterampilan Petugas Kesehatan di Puskesmas: Studi Kuasi-Eksperimental dengan Pendalaman Kualitatif = Training and Clinical Governance Assistance for Neonatal Emergencies in Improving Knowledge and Skills of Health Workers in Public Health Centers: Quasi-Experimental Study with Qualitative Depth.

Latar belakang: Pengembangan pengetahuan dan keterampilan petugas kesehatan di Puskesmas masih belum rutin dilakukan, sehingga umumnya belum mampu melakukan tatalaksana awal pada bayi bermasalah. Tujuan: Mengetahui pengetahuan dan keterampilan petugas kesehatan di Puskesmas wilayah Tangerang mengenai resusitasi, stabilisasi, dan transportasi neonatal, menganalisis faktor-faktor yang memengaruhinya, serta mengetahui profil SNAPPE II neonatal yang dirujuk dari Puskesmas tersebut. Metode: Metode yang digunakan adalah mixed method yaitu penelitian kuantitatif desain kuasi-eksperimental (pretest-posttest) yang menilai pengetahuan dan keterampilan petugas kesehatan, serta SNAPPE II neonatal yang dirujuk sebelum dan sesudah intervensi, disertai pendalaman kualitatif melalui wawancara sistem kesehatan meso dan makro, serta focus group discussion sistem kesehatan mikro. Hasil: Penelitian dilakukan di 12 puskesmas wilayah Tangerang, dengan subjek 36 petugas kesehatan, dan wawancara mendalam kepada 17 sistem kesehatan meso dan makro. Pengetahuan dan keterampilan petugas kesehatan mengalami peningkatan bermakna sebelum dan sesudah pelatihan (p < 0,001 dan p=0,002), namun nilai rerata stabilisasi dibawah batas lulus. Dalam pemantauan selama 3 bulan pasca pelatihan, retensi keterampilan penanganan kegawatan neonatal cukup baik dan didapatkan perbedaan bermakna sebelum dan sesudah intervensi (p < 0,001). Pada VTP terdapat perbedaan bermakna dengan penurunan di bulan kedua (90,4 ± 9,0) dan meningkat kembali di bulan ketiga (93.5 ± 7,8), sedangkan nilai rerata pemberian CPAP dan stabilisasi selalu dibawah batas lulus. Nilai SNAPPE II pada neonatal yang dirujuk ke rumah sakit menunjukkan perbaikan prognosis yang bermakna secara statistik (p=0,013). Analisis kualitatif menemukan 3 akar masalah utama yaitu keterbatasan sumber daya manusia, kualifikasi SDM yang belum mengikuti pelatihan maupun resertifikasi, dan monitoring evaluasi berkelanjutan, dengan 3 alternatif solusi berupa pelatihan dan update klinis berbasis teknologi (daring), pendampingan Dokter Spesialis Anak (Konsultan Neonatologi), serta supervisi Dinas terkait bekerjasama dengan organisasi profesi. Simpulan: Terdapat perbedaan bermakna pengetahuan dan keterampilan petugas kesehatan di Puskesmas wilayah Tangerang mengenai resusitasi, stabilisasi, dan transportasi neonatal sebelum (pretest) dan sesudah (posttest) intervensi. Terdapat tiga faktor utama yang memengaruhi pengetahuan dan keterampilan petugas kesehatan antara lain jumlah SDM, kualifikasi SDM dan monitoring evaluasi yang berkesinambungan. Terdapat peningkatan profil SNAPPE II pada neonatal yang dirujuk ke rumah sakit oleh Puskesmas yang dilatih sesudah intervensi dibandingkan sebelumnya.
Kata kunci: Pengetahuan dan keterampilan petugas kesehatan, pelatihan, pendampingan tata kelola klinis, kegawatdaruratan neonatal.


Background: The development of knowledge and skills of health workers at public health centers is not yet routinely carried out, so generally they are not able to carry out initial management of neonatal emergencies. Objective: To determine the knowledge and skills of health workers at Tangerang district public health centers regarding neonatal resuscitation, stabilization and transportation, to analyze the influencing factors, and to determine the profile of SNAPPE II neonates referred from the public health centers. Methods: A mixed method, quantitative research with a quasi-experimental design (pretest-posttest) that assesses the knowledge and skills of health workers, SNAPPE II for referred neonates before and after intervention, accompanied by qualitative deepening through interviews of meso and macro health systems, and focus group discussion on micro health systems. Result: The study was conducted in 12 public health centers in Tangerang area, with 36 health workers as subjects, and in-depth interviews with 17 meso and macro health systems. Knowledge and skills of health workers experienced a significant increase before and after training (p < 0.001 and p=0.002), but the mean value of stabilization was below the pass threshold. In monitoring for 3 months after training, the retention of neonatal emergency handling skills was quite good and there were significant differences before and after intervention (p < 0.001). In VTP there is a significant difference with a decrease in the second month (90.4 ± 9.0) and increase again in the third month (93.5 ± 7.8), while the mean value of CPAP and stabilization is always below the pass limit. The SNAPPE II value for neonatal admissions to hospital showed a statistically significant improvement in prognosis (p=0.013). Qualitative analysis found 3 main root problems, namely limited human resources, qualifications of human resources who have not attended training or recertification, and continuous evaluation monitoring, with 3 alternative solutions in the form of training and technology-based clinical updates (online), assistance of Pediatricians (Neonatology Consultants), and the supervision of related agencies in collaboration with professional organizations. Conclusion: There were significant differences in the knowledge and skills of health workers at the Tangerang district public health centers regarding resuscitation, stabilization, and neonatal transportation before (pretest) and after (posttest) intervention. There are three main factors that affect the knowledge and skills of health workers, including the number of human resources, qualifications of human resources and continuous monitoring and evaluation. There is an increase in the SNAPPE II profile among neonates referred to hospital by public health centers trained after intervention compared to before.
Keywords: Knowledge and skills of health workers, training, clinical governance assistance, neonatal emergencies.