The Relationship of Knowledge Level with Nurse Compliance in

Implementation of Patient Identification in Medan Hospital

Roymond H. Simamora

, Nurmaini

and Cholina Trisa Siregar

Faculty of Nurses Universitas Sumatera Utara., Jl. Prof. Ma’as No.3 Kampus USU, Kota Medan, Indonesia

Faculty Comunity of Health Universitas Sumatera Utara, Jl. Universitas No.32 Kampus USU,Kota Medan, Indonesia

Keywords: Knowledge, Compliance, Nurses, Identification of Patient.

Abstract: Patient identification is part of the goal of implementing patient safety. Identifying patients correctly can

reduce errors in the delivery of health services. The title of this research is part of the activity of developing

patient identification protocols in the implementation of patient safety by nurses in inpatient rooms at Medan

City Hospital. The purpose of this study was to determine the relationship of knowledge with nurses'

compliance in the implementation of patient identification. Six houses, selected as research locations,

Methods: Descriptive research. Data analysis used chi-square statistical test (α <0.05; CI = 95%). Sample

150 nurses. Results: 61.3% of categories of knowledge were not good and 38.7% were not good. there are

still nurses who are not obedient. Observation results: protocol for identifying patients is not available at

Nurse station, documents that have not been filled completely, there are patients who have not used

identification bracelets, because they have not received recognition, there are nurses who do not mention the

patient's name and date of birth, there are nurses still using the patient's room number as a marker. The nurse

did not re-examine the patient's identity bracelet. The P value (p-value 0.015) showed there was a

relationship of knowledge to nurses' compliance in the implementation of patient identification. Conclusion:

there is a relationship between nurses' knowledge and compliance in the implementation of patient

identification, Product Development can be continued. Suggestion: it is necessary to immediately prepare a

Patient Identification Implementation Protocol, dissemination to nurses and health teams. Hospital Director's

Policy, for implementation. Supervision and training are needed to oversee implementation. Daily reports

of the entire room, to achieve health service indicators and to become a work cult.

1 INTRODUCTION

Patient Safety (patient safety) is something that is

very better than patient care. Very helpful in patient

care. Unsafe behavior, forgetfulness, lack of

attention/motivation, carelessness, no abilities and

abilities that do not care for and care for patients who

are at risk of making mistakes and will cause injury

to patients, namely Close to Miss or subsequent

Adverse Events. Nurses must involve cognitive,

affective and actions that encourage patients (El

Jardali, 2016).

According to the Joint Commission

International/JCI (2013), Patient identification is a

system of identification of patients to distinguish

between one patient and another so as to facilitate or

facilitate the delivery of services to patients. The

safety of service in the hospital, one of which starts

from the accuracy of patient identification. The error

of identification of patients at the beginning of the

service will have an impact on service errors in the

next stage (WHO, 2009).

The patient identification process needs to be

done from the time the patient enters the hospital,

then the identity will always be confirmed in all

processes in the hospital, such as before giving

medication, blood or blood products or before taking

blood and other specimens for examination. Before

treatment and actions or procedures. This is done so

that there will be no misidentification of patients who

can later have fatal consequences if the patient

receives medical procedures that are not in

accordance with the patient's condition such as wrong

medication, wrong blood taking and even wrong

medical actions (Permenkes RI, 2017).The accuracy

of patient identification is important, even related to

patient safety. The mistake of being wrong about the

identity of the patient is very fatal and severe. A

760

Simamora, R., Nurmaini, . and Siregar, C.

The Relationship of Knowledge Level with Nurse Compliance in Implementation of Patient Identiﬁcation in Medan Hospital.

DOI: 10.5220/0010087707600765

In Proceedings of the International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches (ICOSTEERR 2018) - Research in Industry 4.0, pages

760-765

ISBN: 978-989-758-449-7

collaborative process is needed to improve the

identification process to reduce patient identification

errors. To prevent misidentification of patients,

nurses as health workers who are the longest and most

often interact and meet with patients must be well-

informed because every action taken must be based

on knowledge. Knowledge is an important thing that

must be fully owned by professional nurses to prevent

the occurrence of Unexpected Events, Events Near

Injury, Potential Injury Events (Anggraeni, 2014).

The World Health Organization (WHO) in 2004

collected hospital research figures in various

countries: the United States, Britain, Denmark, and

Australia, found an Unexpected Event with a range of

3.2-16.6%. These data make various countries trigger

immediate research and develop patient safety

systems. The Patient Safety Incident Report in

Indonesia by province found that out of 145 incidents

reported 55 cases (37.9%) occurred in the DKI

Jakarta area.

Based on the type of 145 reported incidents, there

were 69 cases (47.6%), 67 unexpected cases (46.2%),

and 9 cases (6.2%). From the collection of hospital

research figures in various countries, there was an

almost complete incidence of injury with a range of

3.2-16.6%. Patient Safety data on the incidence of

near injury and unexpected events in Indonesia are

still rare, but on the other hand there is an increase in

allegations of "practice malls" which are not

necessarily in accordance with the final proof.

Incidents of 28.3% patient safety violations were

carried out by nurses.

Guesthi et al. (2016) found that the prevalence of

patient safety in the Bekasi City General Hospital

from September 2015 to March 2016 was found to be

12.1% Unrecognized Events, 42.3% Events Nearly

Injured, 41.4% Potential Injury Events. From these

data, the incidence of near injury is the most common

occurrence, 42.3% of the incidence of near injury

caused by the identification error of 63.5% of

patients. Patient safety incident data in 2012 reported

an analysis of the causes of 46% incidents related to

misidentification, 36% due to ineffective

communication resulting in medication errors, 18%

because the procedure was not performed.

Joint Commission International/JCI (2012)

showed that 13% surgical error and 68% of blood

transfusions occur because of errors in the patient

identification stage of 68% of errors in blood

transfusion of 11 of them died. Based on the results

of the preliminary study above, it is necessary to

prepare the Patient Identification Protocol in Patient

Safety Implementation Efforts by the Hospital

Inpatient Nurses in Medan City, for this preparation

required data on the knowledge and knowledge of

nurses in the implementation of patient identification.

2 METHOD

This type of observational analytic study with cross

sectional survey design. The study was conducted at

six hospitals in the city of Medan. Non probality

sampling was taken with accidental sampling with a

sample of 150 nurses who met the inclusion criteria.

Collection of knowledge data using questionnaires,

and for compliance using observation sheets. The

analysis used is univariate analysis by calculating the

frequency distribution of each variable studied and

bivariate analysis to see the relationship between the

two variables using chi-square test with a significant

level (α) of 0.05 or 95% confidence level.

3 RESULT AND DISCUSSION

Obtained by the characteristics of the most

respondents in the 30-39 year age group as much as

54.7%. gender of the most female gender 93.3% of

people. the highest education level is D3 nursing as

many as 73.3% of people. Respondents mostly

worked for more than 3 years as many as 85.3% of

people.

3.1 Knowledge of Nurses in Patient

Identification Implementation

From the data collected, nurses' knowledge was

obtained in the implementation of patient

identification with 61.3% poor category and 38.7% in

the good category. The percentage level of

knowledge is the result of the data from the

questionnaire distributed by the researcher with 20

questions. Based on the score given to each question

in the questionnaire, the respondents' knowledge in

the identification of patients was in the unfavorable

category of 61.3%. The results of nurse knowledge

research in the implementation of patient

identification can be seen in the table below.

Table 1: Frequency Distribution and Percentage of Nurses

Knowledge in Patient Identification Implementation in

Medan City Hospital.

Characteristics Frequency (f) Percentage (%)

Not Good

61,3

Good

38,7

Total 150 100

The Relationship of Knowledge Level with Nurse Compliance in Implementation of Patient Identiﬁcation in Medan Hospital

761

3.2 Nurse Compliance in Patient

Identification Implementation

Observations were made in the inpatient room, to see

firsthand the implementation of patient identification

activities carried out by nurses. Observations showed

that there were nurses who were not compliant in the

implementation of patient identification of 54.7%,

this was evidenced by 39.3% of nurses who did not

identify before taking action / procedure, there were

38.7% of nurses did not identify before drug

administration, there were 40 , 2% nurses did not

identify before giving blood transfusion/blood

products, there were 39.3% nurses did not identify

before taking blood/specimens.

Table 2: Frequency Distribution and Percentage of Nurse

Compliance in Patient Identification Implementation in

Medan City Hospital.

Characteristics Frequency (f) Percentage (%)

Disobedience

54.7

Obedience

45,3

Total 150 100

3.3 Relationship of Knowledge with

Nurse's Compliance in the

Implementation of Identification of

Patients in Medan City Hospital

There is a relationship between knowledge and

nurses' compliance in the implementation of patient

identification in Medan City Hospital based on chi-

square test obtained p-value 0.015 (α <0.05). With

Prevalent ratio (PR) = 1.69 and CI = 1.16-2.48, it

means that nurses with good knowledge have 1.69

times the chance of experiencing adherence to the

implementation of patient identification in Medan

City Hospital.

Patient identification is an effort or effort carried

out in a health service as a process that is consistent,

procedures that have policies or have been agreed

upon, fully applied, followed and monitored to obtain

data that will be used in improving the identification

process and to differentiate one patient from others so

as to facilitate or facilitate the provision of services to

patients (Auatralian Commission on Safety and

Quality of Health Care, 2017). Accuracy in

identifying patients is an effort to reduce errors in

taking action on patients (WHO, 2009). Every action

taken by the nurse in the implementation of patient

identification must be based on knowledge.

Nursalam (2011) states that knowledge is the

result of "know", and this occurs after people sensing

a particular object. Sensing occurs through the five

senses of man, namely: the senses of sight, hearing,

smell, taste and touch. Knowledge is the main and

important foundation for health workers in the

implementation of health services. Nurses as health

workers who have primary responsibility in nursing

services and the implementation of holistic and

comprehensive nursing care are required to have high

knowledge in the nursing profession.

The variation in levels of knowledge is influenced

by factors that influence the level of knowledge,

namely age, education, length of work and sources of

information. Based on the research respondents with

age 55-59 years as much as 66.7%. As a person ages,

there is also an increase in one's experience involving

five senses that can influence knowlede. This is in

accordance with the theory which says that the more

age a person is, the level of maturity and strength of a

person will be more mature in thinking. Increasing

age of a person can affect the increased knowledge

gained, but at certain ages or towards old age the

ability to receive or remember a knowledge will

decrease (Notoadmodjo, 2012). the most gender is

female respondents as many as 93.3%. Respondents

who had good knowledge with female gender were

38.6%. Basically women are usually more diligent

than men, for example in attending a training or

seminar so that women can have better knowledge

and develop than men.

Berman (2009) states that individual variables

namely gender can affect performance (quality of

service). In line with the research conducted by

Megawati (2005) states that nurses with female

gender are better able to perform nursing services

better than male nurses. the quality of nursing

services is good so it is directly proportional to the

knowledge that someone has. The results showed that

more than half of the respondents had a D3

educational background of 73.3%. Respondents who

have good knowledge are at Ners education level,

namely 61.1%. Budiono (2014) states that education

is an important factor in determining one's work

ability. Therefore education is the first step to seeing

one's ability. Notoatmodjo (2012) states that

anotherthing that can influence knowledge is the level

of education. The higher a person's knowledge, the

better the knowledge possessed by the person.

But it needs to be emphasized that someone with

low education does not mean absolute low knowledge

because learning abilities can also influence

knowledge, with good learning ability one will tend

to get information more, both from other people and

from the mass media. The more information obtained,

the more knowledge is gained. Increased knowledge

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

762

is not necessarily obtained by formal education, but

can also be obtained in non-formal education such as

obtained from seminars or training and seeking

information from mass media such as the internet,

books, television. Knowledge can also be obtained

from experience, especially nurses' work experience.

Based on the most working time, 85.3% of

respondents had more than 3 years of work.

Respondents who have good knowledge with a

working period of more than 3 years are 42.2%. The

longer the nurse works the more things can be learned

through what is seen, heard and felt at work. This is

supported by research conducted by Arumaningrum

(2014) which states a positive correlation between the

level of knowledge of nurses and work experience.

Simamora (2012) states that work rotation has the

benefit of expanding knowledge. This is in

accordance with the opinion of Notoatmodjo (2012)

which states that one's knowledge will change along

with every thing that has been experienced by a

person for many years and knowledge is obtained

from one's own experience or someone else who

involves what is experienced by the five senses.

Based on the research above, it can be seen that the

nurse with good knowledge will obey in

implementing patient identification. This can happen

because the nurse has obtained information.

information is acquired knowledge.

Knowledge is the first stage that a person needs to

form a compliance behavior. Good knowledge about

when and how to carry out patient identification can

help nurses to think critically so that they can identify

patients in accordance with existing policies. Based

on the results of the study, the majority of respondents

did not comply with the implementation of patient

identification. according to Milgram (2007), a

person's compliance can be influenced by several

factors, including (1) location status, where at the

location of this research there is already an SPO

related to the implementation of patient identification.

(2) personal responsibility, where the respondent's

responsibility related to identification is still less

visible than the lack of respondent's compliance in the

identification of patient identification. (3) legitimacy

of authority figures, where as it is known that all

employees in the hospital receive a policy related to

patient identification. (4) Status of authority figures,

where it is known that the policy is issued by the

hospital. peer support, where peer or co-worker

support is still lacking.

Of all the factors above it can be seen that the

factors that influence nurses' disobedience in patient

identification are personal responsibility and peer

support. A good attitude can be realized if it is based

on responsibility for everything that has been chosen

by all risks which is the highest attitude. An attitude

is not necessarily automatically realized in an action

(overt behavior). To realize an attitude to be a real

action, a supporting factor or a possible condition is

needed, including motivation (Notoatmojo, 2003).

Nurses will be motivated in implementing a

procedure when they are evaluated individually or

according to fairness with respect that nurses receive

in balance with something they do. Nurses who

receive awards according to their role will increase

the work motivation of nurses to be more inclined to

carry out these procedures correctly and continuously

(Nursalam, 2012).

Based on Chi-square test, it was obtained p-value

0.015 (α <0.05). Which means there is a relationship

between the level of knowledge with nurses'

compliance in the implementation of patient

identification. With Prevalent ratio (PR) = 1.69 and

CI = 1.16-2.48, it means that nurses with good

knowledge have 1.69 times the chance of

experiencing adherence to the implementation of

patient identification. Factors that can influence

compliance include the location status, where there is

no SPO in the patient's identification procedure in the

hospital that must be performed when giving action

to the patient. Personal responsibility, where personal

responsibility is still lacking in nurses seen from the

many nurses who are not compliant in identifying

patients.

Legitimacy of authority figures, where as it is

known that all employees in hospitals both medical

and non-medical accept the policies issued by the

hospital, in this case especially nurses accept the

existence of SPOs related to patient identification.

And the last factor that can influence is peer support,

where during the study researchers saw lack of

support from fellow colleagues. This research is

supported by research conducted by Widaningrum

(2015) where the results of p = 0.001 where p> 0.05,

which means there is a relationship between

knowledge and nurse behavior. where nurse behavior

that can be observed and can be directly measured is

nurse compliance. In some cases, knowledge is

sufficient to change one's compliance behavior, but

not in some other cases. Not necessarily if someone

has knowledge is guaranteed to change behavior,

especially compliance.

4 CONCLUSIONS

Based on the results of the study on the correlation

between the level of knowledge of nurses and the

The Relationship of Knowledge Level with Nurse Compliance in Implementation of Patient Identiﬁcation in Medan Hospital

763

level of compliance of patients Identification in 6

Hospitals in Medan City, Development of Patient

Identification Protocols in Patient Safety

Implementation Efforts by Nurses Inpatient Hospitals

in Medan City can be supported by: many nurses who

have less knowledge. Many nurses do not adhere to

patient identification. There is a relationship between

the level of knowledge and compliance with patient

identification by nurses in the inpatient unit of Medan

Hospital. Suggestion: The organization must do: SPO

development Patient identification, socialization to

all health care teams, implementation policy for

patient identification, supervision and guidance,

Group Forum discussions, Case Reflections,

seminars, training, improving access to information

to take patient safety efforts articles, informative

poster to always remind, and apply a culture of patient

safety in the nursing work environment.

ACKNOWLEDGEMENTS

The research was funded by the Directorate of

Research and Community Service of the Directorate

General for Research and Technology Research and

Development of the Ministry of Research,

Technology and Higher Education in accordance with

the Funding Agreement for Research and Community

Service for the fiscal year 2018.

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