JRSSEM 2022, Vol. 02 No. 3, 291– 300

E-ISSN: 2807 - 6311, P-ISSN: 2807 - 6494

DOI: 10.36418/jrssem.v2i03.269 https://jrssem.publikasiindonesia.id/index.php/jrssem/index

RELATIONSHIP ANALYSIS OF SUPERVISION

IMPLEMENTATION OF CPPT IN GENERAL HOSPITAL

UNIVERSITY RIAU

Vivi Wanti

Yulastri Arif

Dewi Murni

1,2,3

Master of Nursing Study Program, Faculty of Nursing, Andalas University

e-mail: viviwanti76@gmail.com, yulastri.arif@gmail.com, dewimurni.mk[email protected]

*Correspondence: : viviwanti76@gmail.com

Submitted: 28 September 2022 Revised: 15 October 2022 Accepted: 22 October 2022

Abstract: Documentation is a means of affective communication between health professions.

The low quality of integrated record documentation in Indonesia includes incomplete CPPT

where patient identity, date and time of visit are not filled in, PPA's signature and full name,

and lack of discipline in filling out medical records by PPA. Supervision is carried out in stages

in the preparation, implementation and evaluation phases. The preparation phase contains the

planning of the supervision program that will be carried out. The implementation phase is the

nurse's assessment by the supervisor while the last phase is the evaluation of the supervision

assessment (from the results of direct and indirect observations from the CPPT. The purpose

of the thesis is to analyze the relationship between the implementation of supervision on CPPT

at the Riau University General Hospital. This study was conducted with a cross sectional

approach and is a quantitative study. The research sample is 33 people with total sampling

sampling technique. The study uses questionnaires and observation sheets that have been

tested for validity and reliability. Through statistics there is a relationship between the

preparation phase (p value 0.000), the implementation phase (p value 0.001) and the evaluation

(p value 0.000) clinical supervision model 4S with CPPT. Researchers recommend the role of

supervision to improve service quality and completeness of integrated recording

documentation, carried out by increasing the frequency of supervision and assessment of the

implementation of the document integrated logging entity.

Keywords:

Supervisor Characteristics, Supervision 4S model.

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INTRODUCTION

Nurse performance can be seen from

the documentation of integrated notes,

which are notes or

outcomes

produced by

a nurse (Pramithasari, 2016). Research by

Blair & Smith (2012), explained that

documentation globally is still low, where

America is at 32.7%, Europe at 32.3% and

New Zealand at 52%. Compared to

America, Europe and New Zealand, in

Indonesia the quality of integrated record

documentation is slightly higher at (47%).

The low quality of documenting

integrated records in Indonesia includes

incomplete filling out the Integrated

Patient Development Record (CPPT) form

where the patient's identity is not filled in,

the name and signature of the Care

Provider Professional (PPA), as well as the

lack of PPA discipline in filling out medical

records and integrated records. The

characteristics of the nurse are individual

factors that affect the performance of

documentation while the characteristics of

the supervisor are organizational factors

that affect the performance of

documentation. Supervisor characteristics

consist of ideal 4K characteristics (character,

cooperative, competent and

communicative) (Siswanto et al., 2013).

According to the Ministry of Health of

the Republic of Indonesia (2017) the

standard elements of assessment of

integrated record documentation include

CPPT, actions of nurses and patient service

managers (MPP). CPPT contains patient

response information, which is based on

subjective data (S), objective data (O), Data

Analysis (A), and action plan / Planning (P).

The nurse's action form contains the date,

time and description of the activities that

have been carried out. To improve the

quality of service in the hospital, a strategy

is needed in order to be able to carry out

the service process with a focus on

improving service quality and patient

satisfaction, one of which is the Patient

Service Manager (MPP).

Incomplete documentation of

integrated records shows that the nursing

care process is not going well and

continuously, there is no good

communication between nurses and other

health workers due to the absence of clear

written communication. To carry out

integrated recording, it is necessary to

support the nursing leadership as

supervisors who have leadership abilities

and skills in directing and supervising the

course of nursing services in order to create

effective and efficient nursing services

(Personal, 2009),

According to Oktariani et al., (2020)

said the 4S supervision process is a

structured (

structure

), be it schemes,

policies and time used where a supervisor

must have good

skills

. Supervisors are able

to provide support which makes

supervision more conducive to improving

and improving the performance of nurses.

Supervisors carry out activities that are

supervised continuously (

sustainable).

According to Milne (2007), 4S

supervision is a supervision focused on

nurses to improve knowledge and skills in

293 | Relationship Analysis of Supervision Implementation of CPPT In General Hospital

University Riau

the documentation of integrated recording.

4S supervision is more complex in nature

not only improving the performance of

nurses, but more about improving the

quality of nursing services. Where 4S

supervision is an effective strategy for

supervisors in motivating and improving

nurse performance through structured

strategies, and having skills and support

that are carried out continuously and

carried out gradually in the supervision

phases, namely the preparation phase, the

implementation phase and the evaluation

phase.

RSU (RSU) Riau University is a

government-owned hospital managed by

Riau University. The Quality Picture of Riau

University RSU, for BOR of 15.76%, is very

far from the paramater value of IDEAL BOR.

AvLOS was 14.96 days, BTO until August

was 1.37 times and TOI until August was

18.30 days with the number of places there

were 51 beds. Through the observations of

researchers during a preliminary study at

RSU Universitas Riau, it was seen that the

documenting of nurses in integrated

records in the inpatient room was not

optimal. Of the 10 CPPT documentations, it

appears that 3 CPPT are not carried out on

an ongoing basis, 7 of which do not have

continuity in soap (IER) recording and do

not have a

Treatment Goal

for the

achievement of the time when each

diagnosis must be completed.

Researchers assessed that

supervision activities were still not carried

out by the head of the room, such as when

nurses would discuss CPPT, unscheduled

supervision implementation and were

often combined with nurses'

receiving/passing activities, and were not

well documented. Based on the

researcher's interview with the head of the

inpatient room, said that supervision is

usually only carried out by the nursing

field, and during the pandemic supervision

is not carried out.

Based on the background, the impact

of the above phenomenon, it is necessary

to solve problems by improving the

performance of nurses by increasing the

clinical supervision ability of a manager by

providing 4S supervision training so that

integrated recording documentation can

run well. 4S supervision is indispensable in

performance monitoring and problem

solving related to the quality of nursing

services. For this reason, researchers are

interested in conducting research on

"Analysis of the relationship between the

implementation of supervision to CPPT at

the Riau University General Hospital".

MATERIALS AND METHODS

This research was conducted with a

cross-sectional

approach and is a

quantitative study. This research was

conducted from June 29, 2022 to July 8,

2022 at the Riau University Hospital. Where

the population in this study was all

implementing nurses who had received 4S

supervision as many as 35 people.

Sampling is carried out by

the probability

sampling method of total sampling

. The

questionnaire used in the study consisted

of a questionnaire for the implementation

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of clinical supervision model 4S (

Structure,

Skill, Support And Sustainable

consisting of

26 questions) and a monitoring sheet for

the implementation of documenting

integrated records consisting of subjective

(current complaints, previous history, family

disease history), objective (TTV, TB, BB, lab,

rad etc.), assessment, planning, date, hour,

name and signature of the PPA. This study

used univariate analysis and bivariate

analysis using

logistic regression analysis

RESULTS AND DISCUSSION

The results showed that most of the

implementing nurses at the Riau University

hospital were educated in D3 Nursing

(63.60%) and had a service period of more

than 3 years (60.60%). while the age of

nurses is almost entirely in the early adult

category (81.80%) and all nurses have

undergone training related to nursing

documentation (100%).

Through research, it is known that all

supervisors are educated in S1 Ners (100%)

and have a service period of more than 3

years (100%), half of the nurse's age is in the

category of early adult (50.00%) and middle

adult (50.00%) and all nurses have

undergone training related to nursing

supervision (100%). Most supervisors have

the character of integrity (69.70%),

competent (75.80%) and communicative

(72.70%) and are almost entirely

cooperative (84.80%).

The implementation of Model 4S

Clinical Supervision at Riau University

Hospital shows that most of the

preparatory phases (57.60%)

implementation (54.50%) and evaluation

(57.60%) of the implementation of model

4S clinical supervision in the category are

carried out appropriately.

CPPT's integrated recording

documenting indicators show that most of

the subjective (72.70%) and objective

(63.60%) data are carried out in full and

almost all assessment data (93.90%),

planning (93.90%), dates (97.00%), hours

(81.80%), signatures (90.90%) fall into the

complete category. Most of the activity

descriptions are filled in completely (69.7%)

and almost all action forms (87.90%) and

hour filling (87.90%) in the existing

category are filled in completely.

Table 1.

Relationship of Supervision Preparation for CPPT at Riau University General Hospital

(n=33)

Preparation

CPPT

Total

value

Odd Ratio

(OR)

Complete

Incomplete

Properly Executed

57,60

3,00

60,60

0,000

42,75

(4,15-439)

Implemented

Incorrectly

12,10

27,30

39,40

295 | Relationship Analysis of Supervision Implementation of CPPT In General Hospital

University Riau

Total

69,70

30,30

100

Table 1 in the implementation of

supervision obtained data, from 20

preparations for the implementation of

supervision carried out correctly, 19 CPPT

were carried out completely (57.60%) while

from 13 preparations for the

implementation of supervision that were

carried out incorrectly, 9 CPPT were carried

out incompletely (27.30%). Through the

statistical test above,

a p value

= 0.000 was

obtained, meaning that through statistical

tests,

a p value

= 0.000 was obtained, which

means that there is a relationship between

the implementation of supervision

preparations for CPPT at the Riau University

General Hospital. Through OR, a score of

42.75 was obtained, meaning that someone

who prepares for supervision appropriately

has a 42.75 times better chance of carrying

out CPPT compared to someone who

prepares for supervision incorrectly.

Table 2.

Relationship of Supervision Implementation of CPPT at Riau University General

Hospital (n=33)

Implementation

CPPT

Total

p value

Odd Ratio

(OR)

Complete

Incomplete

Properly

Executed

51,50

54,50

0,001

25,50

(2,64-245)

Implemented

Incorrectly

18,20

45,40

Total

69,70

30,30

100

Table 2 of the supervision

implementation obtained data, from 18

supervision implementations that were

carried out appropriately, 17 CPPT were

carried out completely (51.50%) while of the

15 supervision implementations that were

carried out incorrectly, 9 CPPT were carried

out incompletely (45.40%). Through the

statistical test above,

a p value = 0.001

statistical test obtained

a p value

= 0.001,

meaning that there is a relationship between

the implementation of supervision and CPPT

at the Riau University General Hospital.

Through OR, a value of 25.50 is obtained,

meaning that someone who carries out

supervision appropriately has a 25.50 times

better opportunity to carry out CPPT

compared to someone who carries out

supervision incorrectly.

Table 3.

Relationship of Supervision Evaluation of CPPT at Riau University General Hospital

(n=33)

Evaluation

CPPT

Total

p value

Odd Ratio

(OR)

Complete

Incomplete

Properly Executed

57,60

0,000

3,5

(1,52-

Implemented

12,10

30,30

42,40

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Incorrectly

8,01)

Total

69,70

30,30

100

Table 3 of the supervision evaluation

obtained data, from 19 supervision

evaluations carried out correctly, 19 CPPT

were carried out completely (57.60%) while of

the 14 supervision implementations carried

out incorrectly, 10 CPPT were carried out

incompletely (30.30%). Through statistical

tests,

a p value = 0.000

was obtained,

meaning that there is a relationship between

the evaluation of supervision of CPPT at the

Riau University General Hospital. Through

OR, a value of 3.5 is obtained, which means

that someone who carries out the supervision

evaluation correctly has a 3.5 times better

chance of carrying out CPPT compared to

someone who carries out supervision

incorrectly

DISCUSSION

1. Relationship of Supervision

Implementation of CPPT at Riau

University General Hospital.

Through research, it can be seen

that there is a relationship between the

implementation of supervision (

p value

= 0.000) to CPPT. This is in line with the

research of Suarli & Bachtiar (2010),

saying that the supervision of the head

of the room is one of the factors that

affect the compliance of nurses in

carrying out their duties in the hospital.

The supervision implementation phase

is a phase where a supervisor is able to

assess the performance of nurses based

on instruments and measuring

instruments that have been prepared.

Supervisors are able to supervise

directly and periodically which if

problems are found in nursing, they can

immediately be given direct assistance

to overcome existing problems.

According to Santoso (2019), the

implementation of supervision is

carried out by direct visits through

direct observation activities where the

supervisor conducts inspections and

question and answer interviews with

nurses. Nursing supervision aims to

assist implementing nurses in

developing professionalism so that the

appearance and performance of nurses

in providing nursing care can increase,

especially in carrying out integrated

recording. Supervision is related to the

satisfaction of the nurse's work where

the nurse will feel the support of the

supervisor and can be sueprvisi

properly so that in carrying out their

work will be more satisfied with the

results of their work.

The results of the study showedthat

the implementation of supervision in

this study was where a supervisor

would provide an opportunity for the

implementing nurse to convey

problems that arose related to the

documentation of integrated recording

(63.60%), the supervisor gave an

obligation to the supervisor to give the

obligation to the nurse to carry out the

integrated documentation

appropriately (51.50%), the supervisor

would supervise when supervising

(72.70%), a the supervisor will guide

the nurse on making appropriately

297 | Relationship Analysis of Supervision Implementation of CPPT In General Hospital

University Riau

integrated documentation (66.7%), the

supervisor will direct the nurse to work

in accordance with the existing SPO

(57.60%), in improving the

appropriately integrated recording, the

supervisor provides support to the

nurse (60.60%), the supervisor explains

about the implementation of the

correct integrated documentation

recording (57.60%), the supervisor

provides support to improve the nurse's

knowledge of the nurse about proper

integrated documentation recording

(66.70%), supervisors provide support

and opportunities for implementing

nurses to take part in training and

seminars on integrated documenting

records (45.50%), when supervision of

supervised nurses provides input

(57.60%), supervisors remind nurses in

carrying out nursing actions to always

document into integrated recording

(51.50%) and supervisors provide

examples in implementing the correct

integrated documenting records

(60.60%).

Based on mua's research (2011) it is

known that there is an influence of head

room clinic supervision training on job

satisfaction and performance of

implementing nurses in the inpatient

room of

Woodward

palu hospital where

the p value

= 0.000. This is in line with

the research of Oktariani et all (2020)

which said that 4S-based clinical

supervision of the application of patient

safety by the intervention group at

Raden Mattaher Jambi Hospital (0.012)

which was carried out appropriately

would significantly affect the

satisfaction of nurse performance (

value = 0.000

Researchers assume that the

implementation of nursing supervision

must be in accordance with the

objectives of the implementation of

supervision, support the improvement

of the quality of nursing services, carry

out control, supervision using problem

solving techniques. The

implementation of the supervision of

the head of the room must be

scheduled and structured and carried

out continuously in order to ensure that

the implementation of nursing care is in

accordance with nursing practice

standards and can be well documented.

A nursing supervisor must have

reliable managerial abilities to be able

to carry out supervision so that he can

carry out the role of a planner, director,

coach and assessor.

2. The Relationship between Supervision

Evaluation of CPPT at Riau University

General Hospital

From the results of the study, it can

be seen that there is a relationship

between supervision evaluation (

value

= 0.000) and CPPT. The last phase

of supervision activities is evaluation

where in providing a supervisory

assessment (

F-fair

) a supervisor can be

carried out from direct and indirect

observations where the supervisor will

provide

feedback

and clarification on

the implementation of supervision

activities and provide

reinforcement

and

follow-up

improvements that are

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positive (Santoso, 2015).

According to the Director General

of Health Efforts at RSUP Persahabatan

(2015), CPPT is a series of information

that records all the patient's condition

and development, as well as the

treatment and actions received by the

patient. CPPT is used by PPAs in

planning, monitoring and evaluating

the patient's condition. Supervision not

only functions as a supervisory process

but also as a structured guidance

process, staff support, good

brainstorming facilities, continuity and

can improve the quality of service after

nursing evaluation.

The results of the study showed that

thesupervisor's evaluation in this study

was that the supervisor provided

feedback on the results of supervision

(63.60%), the supervisor would provide

alternative problem solving not in

accordance with the integrated

documentation of managed patients

without involving the implementing

nurse (57.60%), the supervisor provided

reinforcement

if the nurse complies

with implementing integrated

documentation recording correctly

(60.60%), the supervisor checks the

results of the nurse's work according to

predetermined standards (63.60%), and

the nurse will be penalized if he does

not apply the integrated

documentation recording correctly by

the supervisor (45.50%).

Through research, it can be seen

that the evaluation phase also affects

the completeness of CPPT. The

evaluation phase, CPPT which is a

means of communication between

health professions in providing services

to patients, where the communication

in question is effective communication

between professions which aims to

prevent misinformation,

interdisciplinary coordination, prevent

repeated information and also assist

nurses in service time management.

Evaluation of the implementation of

supervision in this study is not only to

carry out control but also includes

determining the personal and material

conditions or requirements needed to

achieve the goals of nursing asuahn

effectively and efficiently. Evaluation of

the implementation of supervision is

very important where the improvement

of CPPT documentation in the future

will refer to solving existing problems

Based on the researcher's assumptions,

the evaluation phase has a close

relationship with CPPT and the evaluation

assessment must always be improved in

order to get optimal improvement. To carry

out integrated recording, it is necessary to

support the nursing leadership as

supervisors who have leadership abilities

and skills in directing and supervising the

course of nursing services in order to create

effective and efficient nursing services.

CONCLUSIONS

This study proves that there is a

relationship between the preparation

phase

(p-value = 0.000

), the

implementation phase

(p value = 0.001

299 | Relationship Analysis of Supervision Implementation of CPPT In General Hospital 
University Riau
 
 
and the evaluation phase (
p value = 0.000
) 
of 4S model clinical supervision with CPPT 
at RSU Universitas Riau. The results of this 
study  are  suggested to  be  a  reference  in 
improving the quality of hospital services 
by  increasing  the  ability  of  nurses  to 
document  integrated  records.  The 
supervising nurse is expected to be able to 
improve the ideal 4K supervision ability and 
the clinic's understanding of the 4S model, 
in order to supervise the implementation of 
nursing care documentation appropriately. 
 
 
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