Available online on 15.11.2022 at http://jddtonline.info

Journal of Drug Delivery and Therapeutics

Open Access to Pharmaceutical and Medical Research

Copyright  © 2022 The   Author(s): This is an open-access article distributed under the terms of the CC BY-NC 4.0 which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use provided the original author and source are credited

Open Access  Full Text Article                                                                                                                                                                                             Research Article 

Experience Caring for Covid-19 Patients: Phenomenological Study

Yupi Supartini¹, Ni Made Riasmini², Agus Sri Sukoco³

^1,2,3Department of Nursing, Health Polytechnic of Jakarta III, Indonesia

INTRODUCTION

As we all know at the beginning of 2020, COVID-19 has become a global health problem. This case began with information from the World Health Organization (WHO) on December 31, 2019 which stated that there was a cluster case of pneumonia with unclear etiology in Wuhan City, Hubei Province, China. This case continued to grow until there were reports of deaths and imports outside China. On January 30, 2020, WHO declared COVID-19 a Public Health Emergency of International Concern (PHEIC). On February 12, 2020, WHO officially designated this novel coronavirus disease in humans as Coronavirus Disease (COVID19). On March 2, 2020, Indonesia has reported 2 confirmed cases of COVID-19. On March 11, 2020, WHO has declared COVID-19 as a pandemic.^1–3

Coronaviruses are a large family of viruses that cause illness ranging from mild to severe symptoms. There are at least two types of corona virus that are known to cause diseases that can cause severe symptoms such as Middle East Respiratory Syndrome (MERS) and severe acute respiratory syndrome (SARS). Coronavirus Disease 2019 (COVID-19) is a new type of disease that has never been previously identified in humans. The virus that causes COVID-19 is called Sars-CoV-2. Corona virus is zoonotic (transmitted between animals and humans). Research says that SARS was transmitted from civet cats to humans and MERS from camels to humans. Meanwhile, the animal that is the source of the transmission of COVID-19 is still unknown. Common signs and symptoms of COVID-19 infection include symptoms of acute respiratory distress such as fever, cough and shortness of breath. The average incubation period is 5-6 days with the longest incubation period being 14 days. In severe cases of COVID-19 it can cause pneumonia, acute respiratory syndrome, kidney failure, and even death. The clinical signs and symptoms reported in the majority of cases were fever, with some cases having difficulty breathing and X-rays showing extensive pneumonia infiltrates in both lungs. On December 31, 2019, the WHO China Country Office reported a case of pneumonia of unknown etiology in Wuhan City, Hubei Province, China. On January 7, 2020, China identified the pneumonia of unknown etiology as a new type of coronavirus (coronavirus disease, COVID-19). On January 30, 2020 WHO has declared it a Public Health Emergency of International Concern (KKMMD/PHEIC). The increase in the number of COVID-19 cases is happening quite quickly and has spread between countries.^4–6

The first COVID-19 was reported in Indonesia on March 2, 2020, with two cases. 9 Data on March 31, 2020 showed that there were 1,528 confirmed cases and 136 deaths. The COVID-19 mortality rate in Indonesia is 8.9%, this figure is the highest in Southeast Asia. As of May 2020, it was reported that 4,789,205 confirmed cases were found in the world, 318,789 deaths (CFR 6.7%), 215 infected countries and 190 local transmission countries. In Indonesia, the number of people being tested is 154,139, Positive COVID-19: 19,189, Recovered (Positive COVID-19): 4,575, Died (Positive COVID-19): 1,242 (CFR 6.5%) and Negative for COVID-19: 134,950. Based on scientific evidence, COVID-19 can be transmitted from human to human through coughing/sneezing droplets (droplets), not through the air. People who are most at risk of contracting this disease are people who are in close contact with COVID-19 patients, including those who care for COVID-19 patients.^7,8

Handling COVID-19 requires competent volunteers to provide services so that the spread of the disease can be minimized. Coordinator of the Volunteer Task Force for the Acceleration of Handling Covid-19, currently there are 30,098 people who are members of the volunteer task force team to help deal with the Covid-19 pandemic in Indonesia. The volunteers consist of medical and non-medical volunteers. Medical volunteers who are one of the front lines in handling the COVID-19 outbreak, with high enthusiasm, courage and dedication, treat patients until they recover from the deadly virus.

Nurses as health workers who take on the role of volunteers, have the most contact with patients and have a high risk of contracting COVID-19. The risk of contracting the disease can lead to fear and reluctance in nurses to contact and care for patients. This can affect the appearance of nurses in treating COVID-19 patients. Early preparation of nurses in the form of increasing knowledge and skills in caring for COVID-19 patients will have a positive impact in overcoming fears and problems that often arise in treating patients so that nurses as volunteers are able to provide optimal care.

The results of research by Yona on the experience of treating patients with Avian Influenza (AI) found that the majority of participants had a great sense of responsibility in caring for patients. Two main motivations were identified as the motivation that underlies the participants to continue caring for patients, namely internal motivation that comes from the respondent and external motivation, especially in the form of support from the environment. Some participants experienced extraordinary experiences while treating patients, for example, they were happy when patients who had tested positive for AI could recover. The results of Darwati et al research on the experience of nurses in carrying out nursing care for cardiac arrest patients seen from the psychological aspect, namely expressing a happy response, tiredness is not an obstacle, motivated to help and feeling more willing even though in the end the patient is not helped.^9,10

This qualitative research was conducted on volunteers from the Health Polytechnic of Jakarta III while treating COVID-19 patients at the Wisma Atlet Jakarta hospital. A deep understanding of the experience of caring for COVID-19 patient needs to be explored so that it can determine the needs of nursing personnel in care, obstacles and expectations for the health services provided so that patients can recover as usual. Qualitative research with descriptive phenomenological methods can be done because it involves direct exploration, analysis and description of certain phenomena that are carried out as freely as possible on untested presuppositions. This method can stimulate our perception of life experiences by emphasizing the richness, breadth and depth of these experiences.¹¹

MATERIALS AND METHODS

The research design used in this study was qualitative with phenomenological methods. The phenomenological method is a very in-depth, critical and systematic investigation of phenomena.¹¹ In this study, descriptive phenomenological methods were used to explore the depth and complexity of the experiences of health workers, families and the elderly in handling the elderly in the community based on the perspectives and experiences of participants.

The sample of this study were health workers (Employees and Students of the Jakarta Health Polytechnic III) who volunteered at the Wisma Atlit Jakarta Hospital. The sample selection was done through purposive sampling, namely selecting individual samples as participants in accordance with the objectives. The number of participants in this study were 12 people.

The research collection instrument used a tape recorder to record information from participants as well as interview guidelines which were used as a guide for researchers in asking questions according to the objectives. Field notes were used to record non-verbal responses displayed by participants as well as the environmental situation during the interview.

The stages of this research process begin with coordinating with volunteers to determine the time for conducting interviews. The first meeting was aimed at fostering a trusting relationship, providing informed consent, signing the consent form to participate in the research, filling in demographic data, and agreeing on when the interview would be conducted. The researcher also prepared the room where the interview was conducted.

At the time of the interview, the researcher used an in-depth interview technique with unstructured questions to explore the experiences of the participants. Interviews were conducted in a face-to-face position between the researcher and the participants to make it easier to assess the non-verbal responses of the participants. The average interview time for each participant was 45 - 60 minutes. After the interview was completed, the researcher and participants agreed to meet again to clarify the data. The data collected during the study were the results of in-depth interviews and the results of observations in the form of field notes. Data analysis in this study used the Colaizzi approach.

    RESULT

The participants in this study were 12 covid 19 volunteers who served at the Wisma Atlit Hospital, were students and employees of the Health Polytechnic of Jakarta III. The age of the participants varied from 20 years to 25 years, consisting of 1 male and 11 female.

After the data were analyzed using the Collaizi approach, 7 themes were found as a result of this study. The 7 (seven) themes and sub-themes are as follows:

Theme 1. Covid 19 is an infectious disease that threatens life

This theme has sub-themes of physical disorders, psychological problems and social problems. Each sub-theme is described as follows:

Physical disorders arise from the category of respiratory disorders, life threatening, risk of transmission, and have criteria based on symptoms. Participants said that the most common respiratory problems they experienced were shortness of breath and coughing, as expressed by the following participants:

“This disease quickly spreads, leading to a worldwide pandemic that attacks the upper respiratory tract causing shortness of breath and can be life-threatening” (P1,2)

“….the affected person has symptoms such as fever, dry cough, sore throat, and shortness of breath as evidenced by a positive swab test result” (P7,8)

Participants also said that COVID-19 patients often did not have symptoms as expressed by the following participants:

“….a lot of patients are positive but asymptomatic” (P6,9)

As many as 50% of participants said that COVID-19 was at risk of being transmitted and had symptoms with a positive swab.

Psychological problems arise from the category of stress arising from being away from family and fear of not surviving the disease, as stated by the following participants:

"They also experience other stress, stress away from family and also stress because they are afraid that they will not survive the disease" (P1)

Social problems arise because the patient is separated from his family, the patient feels isolated from the environment because of the period of self-isolation he is undergoing:

"stress experienced by patients due to being isolated from the environment" (P1), separated from family because they are in a period of social isolation independently at home or in hospital" (P4)

Theme 2: Nurses' feelings in caring for COVID-19 patients

Nurses' feelings emerge as psychological aspects in caring for covid patients which are expressed through feelings of sadness seeing the patient's condition, fear and worry about being exposed to covid 19 patients. This was expressed by the following participants:

"Sometimes I am sad to see their condition, their complaints are related to things that rub against psychological conditions" (P1)

"My feelings when dealing with this COVID-19 patient are very sad, because many patients feel hopeless with their situation" (P3)

“My feeling at the beginning of treating the patient was I was afraid, worried that I would be exposed too” (P7). Fear and worry were also expressed by 50% of participants as volunteers because the number of covid patients continued to increase, they were afraid of being exposed to covid and the risks that would occur (P7,9,10)

However, there are also feelings of pleasure and pride in being able to treat COVID-19 patients, as expressed by the following participants:

"Sometimes it's also nice to see patients who can still stay strong in dealing with their situation" (P1)

"When I first became a volunteer, I was very happy because I could help my colleagues in dealing with COVID-19, I was happy to get a lot of new experiences during my tenure"

“…proud and grateful to have the opportunity to treat patients with conditions that are not easy because at that time everything that happened was very new and there was no cure” (P2)

“I am proud to be part of the front line and dare to carry out my duties as a volunteer” (P9)

Theme 3: Supporting and inhibiting factors in treating COVID-19 patients

Supporting factors in treating COVID-19 patients are the availability of complete equipment, facilities and infrastructure for recreation, the availability of psychologists, the behavior of preventing transmission and handling of COVID-19 patients, good hospital management, quality human resources.

“….the first thing is complete health equipment, because to be able to carry out appropriate nursing actions you need complete equipment first, especially medical devices that are vital for Covid patients such as O2, Ventilator, Oxymeter, ECG, Monitor and equipment that is diagnostic nature such as the availability of laboratories, rapid tests / swabs, radiology and so on. Available equipment such as medical devices, swab checks and other supporting examinations” (P1)

“…what can speed up the healing of patients in my opinion are recreational facilities and infrastructure such as special places for patients to sunbathe and do sports” (P1, 12).

"The availability of psychologists is also very helpful for patients because they can express their feelings and find solutions" (P3).

"The successful handling of COVID-19 can be supported by good hospital management, professional and quality human resources, internal and inter-sectoral coordination, as well as monitoring and evaluation for continuous improvement without stopping" (P10)

In addition, participants also revealed that the patient's motivation to recover was also very supportive.

"...sincerely, accepting the condition will help the patient's healing" (P11)

"The support system from the patient himself, if the support system is good, the immunity is also good, the recovery rate is also fast" (P8)

Preventive behavior is also applied by nurses by continuing to apply health prevention protocols applied by nurses by keeping a distance, using PPE, maintaining immunity and avoiding stress.

“….prioritizing your own health, such as wearing the correct Personal Protective Equipment, maintaining personal hygiene, ensuring that patients keep their distance to minimize the spread of covid 19” (P2)

"I think the patient's discipline to take medication, implement and comply with health protocols, avoid stress and also provide support are important things to maintain the body's immune system" (P5).

Inhibiting factors in treating COVID-19 patients are the unsupportive social environment and the patient's psychological problems. This was expressed by the following participants:

"... hasty and uncontrollable anger will worsen the patient's situation and psyche" (P5)

        “….what does not support it is the bad stigma that exists in the environment” (P6).

Theme 4: Support for nurses and families for COVID-19 patients

Nurse support is focused on emotional support given to patients because patients must be isolated and not accompanied by their families, as stated by the following participants:

“….many patients are mentally down because they know that they are infected with covid 19 and have to isolate themselves in the hospital without being accompanied by their family” (P2)

"The feeling of sadness and denial of what they are experiencing is one of the inhibiting factors for their recovery, so nurse support for COVID-19 patients is very important" (P3).

“….support from nurses is quite important because there patients are often only close to nurses with nurse support both from bio-psychosocial from nurses” (P8)

Information support is also provided through counseling so that patients are willing to express their feelings, provide motivation to encourage patients to recover and monitor patients. This was expressed by the following participants:

“Nurse support is very important because it can provide motivation, counseling, and education for Covid patients. Monitoring the actual condition of the patient, as well as ensuring that various treatments are given to the patient according to his condition” (P10)

Families provide emotional support to patients so that they are enthusiastic in dealing with their illness, do not feel alone, do not feel bored and feel loved by their families, as expressed by the following participants:

“….family support is the most important, because the patient will be enthusiastic about taking care when negative stigma is not given to the patient and positive aspects are given by the family” (P11)

"Family support is an important component in the patient's healing process, the patient will feel that many love him and feel that his family longs to be with him" (P7)

Information support is provided by motivating patients to recover and increasing immunity, as revealed by the following participants:

"It is very important because it will increase the patient's motivation and will affect the patient's immunity" (P6). Family support gives the patient strength to recover.

Theme 5: Nurses' readiness in treating covid patients

The readiness of nurses in caring for COVID-19 patients is described with the sub-themes of physical, mental, social readiness; readiness of knowledge and skills and safety of nurses at work.

“….as a nurse before being able to help a patient with this condition, the nurse must first be prepared physically, mentally” (P1)

"The mental readiness of nurses is very important to be prepared, because in my opinion caring for Covid patients is a high workload, if the nurse's psychology is good, it can provide positive energy to the patient so that the patient's recovery can take place quickly" (P7)

“….with a strong and tough mentality, we will also be able to help patients recover” (P10)

“….nurses are health workers who spend more time interacting with patients, so it is important for nurses to have a strong mentality so that they can give positive things to patients” (P3)

Readiness of knowledge and skills through communication skills with patients, providing education about PHBS, critical thinking skills that are always ready to take action. This is in accordance with the following participant expressions:

"...with extensive knowledge, nurses can identify what actions should be given to patients appropriately, can think critically and provide targeted care" (P10)

"...Basically the nurse also acts as an educator if the nurse does not have the knowledge and skills readiness what will the nurse educate the patient?" (P5)

"Must think critically, nurses must be ready with all their actions" (P9)

"Nurses also apply skills by performing aseptic actions" (P2).

Nurse safety is carried out by maintaining health protocols in carrying out the duties expressed by all participants (100%). Participants also revealed the following:

“….nurses must keep positive thinking so they are not stressed, eat nutritious food, consume vitamins and drink 2 liters of water per day, continue to carry out health protocols” (P7)

"While treating patients, you should take care of your health by drinking vitamin C and also keeping clean" (P8)

"The safety of nurses is also prioritized here for PPE that will be provided in full so that nurses feel safe and must always exercise regularly when on official holidays" (P11).

Theme 6: Nursing services for COVID-19 patients

The services provided to COVID-19 patients are patient-oriented, integrated services, availability of facilities and infrastructure, availability of quality human resources and expanding access to services.

Patient-oriented services were expressed by 50% of participants while still paying attention to patient activities such as exercising, taking care of themselves by maintaining cleanliness and using masks, increasing nutritional intake, taking medication, vitamins and adequate rest. In addition, they must maintain a conducive patient environment by providing quality services and collaborating with other health workers for patient recovery, as revealed by the following participants:

"Nurses must be critical when giving action, move quickly, be responsive and careful in taking actions, collaborate with various other medical personnel in order to achieve patient recovery" (P6,9).

“Integrated service system, internet-based with minimal patient contact” (P5)

"The service system that can affect the speed of nursing services to patients is to look at indicators of patient health, a conducive environment, quality patient care" (P10)

Participants also expressed the importance of the availability of facilities and infrastructure as well as quality human resources in providing services, as expressed by the following participants:

"... in my opinion good service is the availability of adequate facilities and infrastructure and the availability of quality human resources" (P3)

"The availability of infrastructure is the use of smartphone applications for communication (P2.5) and applications for patient data" (P9).

"The availability of quality human resources is in accordance with the needs where the number of nurses must be sufficient because nurses are on duty 24 hours to treat patients" (P2,7).

Participants also revealed that they should expand access to services so that patients are able to reach services so as to reduce the number of COVID-19 cases

"It is necessary to expand access to reduce the number of COVID-19 cases and make it easier for patients to reach health services" (P12).

Theme 7: Efforts to prevent the spread of covid 19

This theme has 2 sub-themes, namely promotive efforts and preventive efforts

Promotive efforts are carried out through online or offline media in educating the public and always thinking positively, as expressed by the following participants:

“….to educate and re-emphasize to the public the importance of maintaining personal hygiene such as diligently washing hands, always wearing masks, always carrying hand sanitizer everywhere, maintaining a healthy diet and always taking a shower after leaving the house and social distancing (P3). health promotion related to the use of masks, PHBS and the like for patients who are still being treated, patients who will go home to the public through online or offline media” (P1)

“….contaminated properly and perfectly, and maintain to always think positively (P5)

"...using PPE properly and correctly, educating or sharing knowledge from the smallest environment such as family and friends" (P10)

Preventive efforts to prevent exposure to covid were expressed by 66% of participants through the correct use of PPE, 50% of participants said to maintain cleanliness by washing hands frequently, 50% of participants said by keeping a distance, 83% of participants said to use masks.

To prevent transmission, a high level of self-awareness is also needed, as expressed by the following participants:

“….but again all of that will not happen if there is no awareness in the individual” (P3)

"What is important for nurses and other health workers is regular health checks so that infected health workers will be detected more quickly so that they do not spread to other health workers" (P7).

DISCUSION

All participants explained that COVID19 is an infectious disease that attacks the respiratory system, causes shortness of breath and may or may not show symptoms. This is in accordance with the statement of Susilo that Corona Virus is an RNA virus measuring 120-180 nm, in humans it causes respiratory tract diseases ranging from the common cold to serious ones. Classification is divided into ODP, PDP, OTG and contaminated cases.^12,13

Participants also explained that psychological problems arise from the category of stress arising from being away from family and fear of not surviving the disease. This is supported by the results of research by Liu et al (2020) that many patients experience severe anxiety and need professional support.¹³

All participants said they felt sad to see the patient's condition and 50% of participants expressed fear and worry about being exposed to Covid 19 patients. This is supported by the results of research by Liu, et al which stated the same thing, namely the fear of being infected by the patient. Fatigue while caring is described next by Liu, et al due to handling so many patients and care activities do not stop.¹³

In addition to the above feelings, participants also experienced feelings of pleasure being able to treat COVID-19 patients. This is also supported by research by Liu et al (2020) that they feel happy and happy when the patient states there is progress and his condition is improving, getting healthier. Apart from these feelings, there were some participants who felt proud to be part of the team caring for COVID-19 patients, so they felt happy to do so. This is supported by research from Yona which suggests that the Caring aspect of Indonesian nurses is very high.⁹

Supporting factors in treating COVID-19 patients were explained by several participants, namely the availability of complete equipment, especially vital for patients, such as ventilators and for diagnosis, the availability of facilities and infrastructure for recreation, the availability of psychologists, the behavior of preventing transmission and handling of covid 19 patients, management good hospital, quality human resources. Liu et al  and research by Yona support this finding by explaining that a support system from hospitals is needed such as complete medical equipment, hospital management that accommodates patient needs and a sufficient number of human resources. Furthermore, it was found that Interprofessional Collaboration between nurses and a team of doctors will greatly determine the success of patient care, and research from Artawan supports the importance of collaboration aspects especially in critical patient conditions and emphasizes that collaboration determines patient safety.^9,13,14

Several participants explained that the inhibiting factors in treating COVID-19 patients were the unsupportive social environment and the patient's psychological problems, especially the bad stigma that existed in the environment. A comprehensive support system from the health team at the hospital is felt to be very helpful in reducing various psychological problems felt by nurses as part of the health team in critical patient situations, which can hinder the effectiveness of the care carried out.¹³

Several participants revealed that nurse support was focused on emotional support given to patients because patients had to isolate and not be accompanied by family, feelings of sadness and denial of what was experienced were one of the inhibiting factors for their recovery, so nurse support for COVID-19 patients was felt to be very important. Information support is also provided through counseling so that patients are willing to express their feelings, provide motivation to encourage patients to recover and monitor patients.

Several participants expressed family support in the form of emotional support to patients so that they are enthusiastic in dealing with their illness, do not feel alone, do not feel bored and feel loved by their families, so it is important for the patient's recovery. This research is supported by Liu et al. that it is important for patients COVID 19 to get psychological support, taking care of patients not only focusing on their illness but on themselves as a whole. A comprehensive support system from all parties including the patient's family is needed to accelerate the patient's recovery.¹³

Several participants explained the importance of readiness before carrying out health services to patients, both physical, mental and social readiness; knowledge and skills, while it was explained that "The mental readiness of nurses is very important to be prepared, because in my opinion caring for Covid patients is a high workload, if the nurse's psychology is good it can give positive energy to the patient so that the patient's recovery can take place quickly, nurses are health workers who have more time in interacting with patients, so it is important for nurses to have a strong mentality so that they can give positive things to patients.

All participants (100%) expressed the importance of knowledge and skill readiness through good communication skills with patients, to carry out the role of educators while maintaining good stamina in order to stay healthy in carrying out their duties. This research is supported by Liu et al. that in order to be able to treat COVID-19 patients well, nurses must have sufficient ability to treat COVID-19 patients, are highly trained in infection control and safety/personal protection by carrying out health protocols and have good collaboration skills with the nursing team and other health workers. It was further explained that nurses need professional training for mental strengthening in treating COVID-19 patients so that they can also provide nursing care with a comprehensive psychosocial approach.¹³

As many as 50% of participants explained that the services provided to COVID-19 patients must be patient-oriented, integrated services, availability of facilities and infrastructure, availability of quality human resources and expanding access to services. Patient-oriented services while still paying attention to patient activities such as exercising, taking care of yourself by maintaining cleanliness and using masks, increasing nutritional intake, taking medication, vitamins and adequate rest. Besides that, it must maintain a conducive patient environment by providing quality services and collaborating with other health workers for patient recovery. Nurses must be critical when giving action, move quickly, be responsive and careful in taking actions, collaborate with various other medical personnel in order to achieve patient recovery. Renate et al. support this statement and say in the results of their research that to get quality health services, it is very necessary to have an integrated and collaborative service approach and services that focus on patient needs by critically prioritizing patient needs.¹⁵

While Magnaye et al also support the results of this study by revealing that it is important for nurses to be alert in prioritizing actions that must be taken immediately, especially in emergency situations. Another study that supports this finding is Renate et al which states that nursing services that are oriented to patient needs can provide patient satisfaction.^15,16

Several participants revealed that prevention efforts that can be done are through online or offline media in educating the public and always thinking positively, and carrying out health protocols properly by using PPE which is important for protecting themselves and others. Tazakori et al support the results of this study and state protective behavior (self-protection with the protocol that is carried out) as an effort to prevent transmission of HIV-Aids patients as an infectious disease that is as contagious as COVID19. Research by Liu et al also supports this explanation that the transmission effort that must be done is to start with the nurses' own self-protection efforts so that they can protect the patient well. Liu et al revealed in their research that the prevention of transmission that nurses who treat COVID-19 patients can do is to strictly implement health protocols including the use of PPE and hand washing protocols, working in accordance with applicable standard procedures. monitor the health of nurses and other health workers by the Hospital and strictly enforce protocols for handling patients who die.^13,17

Regarding public education, research by Liu et al explains that online counseling can be used as a way to educate the public and even develop online counseling groups to provide psychological support to nurses or health professionals.¹³

CONCLUSION

This research resulted in 7 (seven) themes, 20 sub-themes and 44 categories, all of which focused on the experience of caring for COVID-19 patients and many important aspects extracted from the grounded (field), in the form of invaluable experiences for nurses regarding their understanding of COVID-19 patients and various Aspects that influence in carrying out nursing care include internal aspects of the nurse or external from outside the nurse

The implication of this research is that it is important that nurses have a good understanding of COVID19, various safe procedures in treating patients and the mental readiness of nurses so that they remain confident in carrying out nursing care correctly. The role of the hospital is very large in supporting the implementation of good and quality nursing care by providing full support to nurses to be able to carry out their duties in accordance with applicable procedures.

ACKNOWLEDGEMENTS

The authors thank to Health Polytechnic of Jakarta III for funding this research, all participants and research assistants.

CONFLICT OF INTEREST

The author declared that don’t have conflict of interest

ETHICAL CLEARANCE

This research has received ethical approval from the Research Ethics Committee, Health Polytechnic of Jakarta III No. KEPK-PKKJ3/S.74/VII/2020.

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