The Effect of Quality of Nursing Service to Patients Satisfaction Level in Hospitality of Partial Reliance and Total Hospital of Sundari General Hospital

The quality of health services is one of the basic needs that everyone needs. The low quality of nursing services is in line with the low level of patient satisfaction so it is necessary to improve the quality of nursing services in order to increase patient satisfaction. This study aims to determine the effect of the quality of nursing services of the level satisfaction of partial and total dependence inpatient midwifery in Sundari General Hospital in 2020. The type of research is a descriptiveanalytic survey with cross-sectional research. The population in the study were all partial and total dependence inpatient midwifery RSU Sundari Medan and the sample of 72 people. Methods of data analysis by means of univariate analysis, bivariate analysis, and multivariate analysis with multiple logistic regression tests. The results of the study statistically showed safety, hygiene of body care, comfort, and anxiety affect the level satisfaction of partial and total dependence inpatient midwifery (p <0.05). The results of multiple logistic regression tests found variables that the most influence patient satisfaction is safety and comfort. Safety is the most dominant factor in influencing patient satisfaction. It can be concluded that there is an effect of safety, hygiene of body care, comfort, and anxiety of the level satisfaction of partial and total dependence inpatient midwifery. Suggested by the hospital, it is necessary to increased training in safety during postnatal care through providing actions to patients so that safety measures provide satisfaction. Training needs to be provided to provide relaxation techniques that are appropriate for nursing instructions so feel comfortable.


Introduction
Customer satisfaction has its own place and is very important for the survival of a hospital. Satisfaction will occur if the expectations of the customer can be fulfilled properly from the services provided by the hospital so that it needs to be considered and evaluated continuously on customer satisfaction and expectations and followed by service improvements and effective and efficient management will make the hospital have endurance and high competitiveness to be able to maintain the continuity of hospital operation in the long term where the government needs to further regulate hospital policies so that the existing competition is healthy JOURNAL LA MEDIHEALTICO VOL. 01, ISSUE 04 (024-032), 2020 DOI: 10.37899/journallamedihealtico.v1i4.138 WHO data shows that in Europe patients with an infection risk of 83.5% and evidence of medical errors show that 50-72.3% are collected in-hospital study figures in various countries. (Oxyandi, 2019). Data from several research results indicate the level of patient satisfaction in various countries. The level of patient satisfaction according to Ndambuki in 2013 in Kenya stated 40.4%, patient satisfaction in Bakhtapur India according to Twayana was 34.4%, while in Indonesia it showed a patient satisfaction rate of 42.8% in Central Maluku and 44.4% in West Sumatra ( Frisilia, 2020). Based on these data, it can be concluded that the patient satisfaction rate is still low The low quality of nursing services is in line with the low level of patient satisfaction, so it is necessary to improve the quality of nursing services in order to increase patient satisfaction. The components of nursing service quality indicators are specified in several references. The Ministry of Health states the indicators of the quality of nursing services, namely: patient safety (incidence of infection, pressure sores, falling patients); patient comfort in care (incidence of forced discharge, pain management); patient knowledge of the treatment information received; patient satisfaction with standard care of more than 90%; patient skills in personal hygiene; and reduce patient anxiety. These indicators are objective, measured based on the patient's experience during treatment. (Latupono et al., 2014).
Patient satisfaction is the most important thing in all services. Patient satisfaction with services is a comparison between their perceptions of the services received and their expectations before getting the treatment (Andaleeb, 2001;Findik, et al., 2010).
Total dependent patients are patients who need 5-7 hours of direct care per 24 hours, some of their daily needs cannot be done alone, all are assisted by nurses. Partial dependent patients, namely patients who need 3-4 hours of direct care per 24 hours, some of their daily needs cannot be done alone, must be assisted by nurses.
Based on a preliminary survey conducted at the Sundari General Hospital, Medan, from interviews conducted with 8 patients who were being hospitalized, it revealed that the patient's dissatisfaction with nurse services included that there were 4 patients who said that the nurse responded and responded to the situation. and the complaints experienced by the patient did not give satisfaction, there were 5 patients who said that the nurse only gave sufficient explanation according to the patient's question. Nurses pay less attention to explaining good positions for postoperative patients. Doctors often provide limited information about diseases and medications. There were 4 patients who said that nurses are sometimes picky about their behavior. When you recognize a patient and his family, he will tend to be kinder, more polite, and more considerate. Interviews with patients regarding the satisfaction of the services received were 5 patients who were not satisfied with the services received. Nurses lack initiative in providing care such as changing infusions that will run out, helping patient hygiene. The nurse explains the correct relaxation technique when the patient asks questions after postoperatively. The purpose of this study was to analyze the effect of the quality of nursing services on the satisfaction level of partial and total dependence of obstetric inpatients at Sundari General Hospital Medan.

Methods
This type of research is an analytic survey using a cross-sectional design. This study analyzed how the influence of the quality of nursing services on the level of satisfaction of partial and total dependency of obstetric inpatients. The population in this study were all partial dependency obstetric inpatients and a total of 253 people in December 2019 -April 2020 at Sundari General Hospital Medan. The sample size is 72 people. The sampling technique used was accidental sampling. The tool for data collection is a questionnaire, and for in-depth interviews, an interview guide is needed, while the data collection techniques are primary and secondary data. Data analysis was performed using univariate analysis, bivariate analysis using the chi-square test, and multivariate analysis using multiple logistic regression tests.

Univariate Analysis
Based on the research, it shows that the frequency distribution of respondents according to age at the Sundari Medan General Hospital in 2020 is mostly with the age of 29-39 years, namely 41 respondents. The frequency distribution according to the education of respondents at the Medan Sundari General Hospital in 2020 is mostly with high school education, namely 40 respondents (55.6%). The frequency distribution according to the occupation of respondents at the Medan Sundari General Hospital in 2020, most of the IRTs were 31 respondents (43.1%). The results showed that the frequency distribution based on safety was mostly not at risk, namely 48 respondents (66.7%) and as many as 2 respondents (33.3%) with safety at risk. Based on personal hygiene, most of it was fulfilled, namely 43 respondents (59.7%) and as many as 29 respondents (40.3%) with personal hygiene not fulfilled. Based on convenience, most of it was applied, namely 42 respondents (58.3%) and as many as 30 respondents (41.7%) with comfort not being applied. Based on most of the anxiety resolved, namely 44 respondents (61.1%) and as many as 28 respondents (38.9%) with unresolved anxiety. The results showed that the distribution of frequency based on patient satisfaction at Sundari General Hospital Medan was mostly satisfied, namely 47 respondents (65.3%) and as many as 25 respondents (34.7%) with less satisfied satisfaction. Based on the results of the study showed that the results of statistical tests with the Chi-Square test showed that there was a relationship between safety and satisfaction levels of partial and total dependence of obstetric inpatients (p <0.05). From this analysis, it was also obtained that the value of RP (Prevalence Ratio) = 2.16 with CI = 1.17-3.99, meaning that the risk of safety is 2.16 times greater with the level of satisfaction that is less satisfied than satisfied. The results of statistical tests with the Chi-Square test showed that there was a relationship between personal hygiene and the level of satisfaction of the obstetric in patients with partial and total dependence (p <0.05). This analysis also obtained the value of RP (Ratio Prevalence) = 1.88 with CI = 1.01-3.55, meaning that personal hygiene is not fulfilled 1.88 times greater with the level of satisfaction that is less satisfied than satisfied. The results of statistical tests with the Chi-Square test showed that there was a relationship between comfort and satisfaction levels of partial and total dependence of obstetric inpatients (p <0.05). From this analysis, it is also obtained that the value of RP (Prevalence Ratio) = 2.10 with CI = 1.09-4.01, meaning that the comfort that is not applied is 2.10 times greater with the level of satisfaction that is less satisfied than those who are satisfied. The results of statistical tests with the Chi-Square test showed that there was a relationship between anxiety and satisfaction levels of partial and total dependency of obstetric inpatients (p <0.05). From this analysis, it is also obtained that the value of RP (Prevalence Ratio) = 2.00 with CI = 1.06-3.76, meaning that moderate/severe anxiety is 2.00 times greater with the level of satisfaction that is less satisfied than those who are satisfied.

Multivariate Analysis
Based on the results of logistic regression analysis, the variables of safety with a value of p = 0.014 and comfort with a value of p = 0.019 had an effect on the satisfaction level of obstetric in patients with partial and total dependence. The variable with the most dominant influence on the level of satisfaction is the safety variable with a value of RP (Prevalence Ratio) = 4.014, meaning that the risk of safety is 4.014 times greater with the level of satisfaction less satisfied than satisfied.

Effect of Safety on Satisfaction Levels of Partial and Total Dependency of Inpatient Midwifery
The results showed that there was a significant relationship between safety and satisfaction levels of partial and total dependence of obstetric inpatients (p <0.05). This study is supported by the results of Widiasari's research in 2019, it was found that there was a relationship between the application of patient safety and patient satisfaction (p = 0.001; OR = 1.216; α = 0.05) (Widiasari et al., 2019). This research is in line with Miftahul's research in 2019, it was found that patient satisfaction is very influential with the actions of implementing patient safety by nurses (Jannah, 2019).
Competent nurses must involve cognitive, affective, and action that prioritizes patient safety. Patient safety is something that is far more important than just the efficiency of service. Nurse behavior with the ability of nurses is very important in implementing patient safety. Unsafe behavior, forgetfulness, lack of attention/motivation, carelessness, carelessness, and the ability to ignore and maintain patient safety are at risk of errors and will result in injury to patients (Lombogia, 2016).
Hospital patient safety is a system where the hospital makes patient care safer which includes risk assessment, identification, and management of things related to patient risk, reporting, and analysis of events, the ability to learn from events, and their follow-up and implementation of solutions to minimize their occurrence. risk and prevent injuries caused by mistakes due to carrying out an action or not taking the action that should be taken (PerMenKes RI No. 1691/MenKes/Per/VIII/2011 concerning hospital patient safety).
Nurses must realize the importance of providing good nursing services, especially in identifying patients correctly, in addition to focusing on health conditions all actions must have a satisfying impact on patients. Patient satisfaction is the level of service satisfaction and perception of the patient or immediate family. Patient satisfaction has a close relationship with whether or not nurses identify patients. This shows that it is very important for nurses to pay attention to nursing services to patients, especially in implementing patient safety, because nursing services to patients, especially to identify patients correctly and precisely, and to identify patients have a relationship with patient satisfaction. Therefore, before taking action, the nurse must identify the patient first (Umaternate et al., 2015).

The Effect of Personal Hygiene on Satisfaction Levels of Partial and Total Dependency of Inpatient Obstetrics
The results showed that there was a significant relationship between personal hygiene and the level of satisfaction of the midwifery in patients with partial and total dependence (p <0.05).
The results of this study are in line with Sandyarman & Gede (2013) which states that nurses always get used to carrying out personal hygiene measures in accordance with SOP and are skilled in providing services so that patients feel satisfied and get maximum results.
Immobilized patients are unable to move freely so they need more attention from nurses in maintaining personal hygiene. One of the direct effects of immobilization is personal hygiene that is not fulfilled due to the limited ability to fulfill it. Helping to maintain personal hygiene is useful for preventing certain diseases as a result of prolonged pressure on the body so that vascularization to stressed areas is interrupted/stopped. In addition, helping to maintain personal hygiene in immobilized patients can help prevent tissue injury from becoming necrotic which is called decubitus and prevents the occurrence of several nosocomial diseases and prevents the continuation of a person's immobility (Haryanti, 2000).

The Effect of Comfort on Satisfaction Levels of Partial and Total Dependence of Inpatient Midwifery
The results showed that there was a significant relationship between comfort and satisfaction level of partial and total dependency obstetric inpatients (p <0.05).
In providing nursing care actions, nurses provide comfort to patients so that patients are satisfied with the actions of the nurses given (Johnston & Smith, 2006). The results of this study are supported by research conducted by Hardianti et al (2014) at Syekh Yusuf Hospital, Gowa Regency which states that there is a significant relationship between nurse service factors and patient satisfaction, where the better nurse service is related to the ability of nurses to provide explanations about matters related to medical action, as well as the ability to provide a sense of security such as relieving pain through relaxation measures in providing services to patients, the more satisfied the patient is as a service recipient. Rahmawati et al (2014) explained that the signs and symptoms of discomfort are a pain. A person experiences pain physically and mentally, the feeling of pain creates tension so that the discomfort comes from physical and psychological aspects. This uncomfortable behavior, for example, the patient does not feel comfortable being treated and wants to go home immediately. Nurses always create patient comfort to get welfare with the situation, conditions and avoid tension and discomfort, therefore comfort is an important reason for patients in choosing a place of service when they need treatment.
According to Wilson & Kolcaba (2004) anxiety is the main cause of decreased comfort. Psychological comfort is a psychological condition that is free from fear and stress. This condition is stress that affects the patient's psychological comfort.
Excessive anxiety can have a negative impact on the patient where the patient can show a hostile attitude, the response to the environment is decreased or even non-existent so it is difficult to work with nurses, especially if the nurse is tired (Berger et al., 2015). Patients with mild levels of anxiety are often overcome without serious examination, to the extent of moderate and severe anxiety levels will cause two types of coping mechanisms, namely taskoriented reactions, and ego defence mechanisms.
The patient's anxiety is caused by the patient feeling threatened by physiological abilities or disruption of basic needs such as self-mobilization. The patient feels helpless and has to rely on others to meet his basic needs. The patient feels unable and unable to be of use to himself and others. These threats can cause anxiety and if not resolved will cause anxiety at a heavier level and cause physical problems. This condition of course will interfere with the healing process of the recovery of stitches or surgical wounds suffered by patients (Sepriani, 2017;Amirah, 2019). Nursalam (2007) stated that nurses do not only act as providers of nursing care to clients in obtaining disease healing but also play a role in fulfilling clients' health needs holistically, through technical skills, emotional, psychological, spiritual, and social support. Nurses can also provide assistance to individuals or advocate for individuals who are unable to meet their basic needs.

Conclusion
The results of this study concluded that there was an effect of safety, personal hygiene, comfort, and anxiety on the satisfaction level of partial and total dependency obstetric inpatients at Sundari General Hospital Medan.