THE RELATIONSHIP OF THE IMPLEMENTATION OF IDA JEAN ORLANDO NURSING PROCESS TO

IMPROVING THE QUALITY OF SERVICE IN THE IGD AND ICU CRITICAL CARE ROOM OF
PANGKAJENE AND ISLAND REGENCY

Relationship Of The Implementation Of Nursing Ida Jean Orlando's Process On Improving The
Quality Of Service In The Critical Care Unit And Intensive Care Unit Of Pangkajene And Islands
District Hospital

Amanah Restuyana Zainal, Julianus Ake, Syahrir Pasinringi Master of Nursing Study Program at
Hasanuddin University Makassar Email: amanahrestuyana@ymail.com

ABSTRACT
Nurses as one of the health workers in hospitals play an important role in efforts to achieve
health development goals. The success of health services depends on the participation of
nurses in providing quality nursing care for patients, in order to realize high-quality and high-
performance services that are required by professional nursing staff, have intellectual,
interpersonal technical abilities, work according to standard practice, and pay attention to
ethical and moral principles. One of the best models of the application of nursing care is to
provide an immediate response to patients, this can improve the quality of nursing services
through the assessment of patient satisfaction with nurses as one indicator of service quality.
The purpose of this study was to determine the relationship between the application of Ida
Jean Orlando's nursing process and improving the quality of service in the Critical Care Room of
the ED and ICU at Pangkajene and Islands District Hospital. The design of this study used Cross
Sectional method, the sampling method used was purposive sampling. A sample of 56 nurses
and 129 patients who met the inclusion criteria. The variables studied were independent
variables, namely the nursing process: nurse's responsibility, recognizing patient behavior,
immediate reaction, discipline in nursing and evaluating the progress of the patient's condition,
the dependent variable was patient satisfaction. Data were collected using a questionnaire and
analyzed by using the Linear Regression Correlation statistical test with a significance level of
0.05. The results showed that nurses in carrying out their responsibilities quite well at 87.60%,
nurses knew good behavior at 68.99%, nurses who reacted immediately well as much as
56.59%, nurses had implemented discipline in nursing care well by 56.59%, and nurses who
evaluate the progress of the patient's condition well are 90.70%. Patient satisfaction data is
75.81% based on the calculation of the Community Satisfaction Index with the quality of
nursing services considered good. The results of the linear regression statistical test show the
value of sig.p = 0.000 (p <0.05). From the results of this study, the Pangkajene and Kepulauan
District Public Hospital can further improve the quality of services by further improving nursing
services in critical care rooms or in other service spaces by focusing on the nursing process
immediately.
Keywords: Orlando Nursing Process, Patient Satisfaction, Emergency Room Critical Care and ICU
PRELIMINARY
Nursing in Indonesia, continues to develop
itself as a profession that in the long run is
expected to meet the demands and
expectations of the community
(Nursalam, 2016). In line with the Nursing
Act No. 38 of 2014 which describes nursing
practice, the form of services organized by
nurses is
nursing care consisting of assessment,
determination of nursing diagnoses,
planning, implementation, and evaluation.
This form of service is a series of nursing
processes that are the basis of nursing care
for patients as individuals, families or
communities (President of the Republic of
Indonesia, 2014). In carrying out their
duties, nurses always refer to the applicable
Operational Procedure Standards (SPO), in
order to get job guarantees and safety at
work, so that the community can feel
quality service or provide its own
satisfaction for the community, as quoted
from Kurniati and Abidin's research results.
(2018). Pursuant to Law Number 44 Year
2009 concerning Hospitals which explains
the 18 Rights of Patients and Families while
in the Hospital, respecting and protecting
the rights of patients, where one of the
patient's rights is "Obtaining quality health
services in accordance with professional
standards and operational procedure
standards. "So it is very important for the
Care Giving Profession (PPA) to provide
quality services, especially nurses in
providing the best nursing care to patients
and patients' families. Community
Satisfaction as a measure of the success of
service delivery which is a measure to
assess the quality of public services, so that
every year the government evaluates the
applicable laws and regulations in
accordance with community needs and
targets to be achieved, starting from
MENPAN Decree No. 25/2004, MENPANRB
Regulation No. 16 2014 to
MENPANRB Regulation Number 14 of 2017
which governs the Community Satisfaction
Survey. Nurses carry out nursing care based
on clinical authority possessed from their
career path and based on the nursing unit
they occupy. The nursing care process
carried out also differs according to each
work unit, such as the nursing process in
the inpatient room is different from the
nursing process in critical care or in the
outpatient installation. From the data
obtained at the hospital, in an effort to
improve service quality, it can be prioritized
in nursing services to patients, especially in
critical care such as emergency room and
ICU which are still low in patient
satisfaction. In the field of nursing, there is
an applicable nursing theory that can be
applied in the critical care room of the
emergency room and ICU, namely nursing
care based on the application of Ida Jean
Orlando, this nursing theory is one form of
application of nursing care that can be used
because it is very concerned about the
responsibilities of nurses in providing
service, recognize patient behavior, provide
immediate reaction in serving patients,
discipline in the nursing process and control
the progress / improvement of the patient's
condition. With the application of the
Orlando nursing process in the emergency
room of the emergency room and ICU, it is
hoped that patients can be served well and
provide positive assessments for nurses
who work and for hospitals.
By providing appropriate nursing care, it is
expected that the quality of nursing services
can improve, in particular
in critical care of the emergency
department and ICU. Based on this, the
study focused on the relationship between
the application of the nursing process of Ida
Jean Orlando and the improvement in the
quality of nursing services in the critical care
room of the emergency room and ICU of
Pangkajene and Kepulauan Regency
hospitals.
METHODS
The research design or research design used
in this study is correlational research. This
study aims to find, explain a correlative
relationship between variables and test
based on existing theories. The research
design used in this research is descriptive
analytic with cross sectional study approach
that emphasizes the measurement /
observation time of independent and
dependent variable data only once at a time
(Nursalam, 2013) For the results of patient
satisfaction surveys, the method of analysis
uses descriptive statistics and correlation
test Linear regression and IKM calculations
in accordance with KepmenPAN & RB This
study was conducted in the Critical Care
Room of the Emergency Room and ICU of
the Pangkajene and Kepulauan Regional
General Hospital. When this research was
conducted in May 2017 until June 2018,
starting from writing a proposal, collecting
data, writing a research report. The sample
in this study was the nurses implementing
the inpatient room of Pangkajene and
Kepulauan Regency hospitals which were
assessed by the room head. The number of
samples in this study were 56 nurses and
129 patients. The analysis of the data used
is the Linear Regression Correlation Test
with 0.05 significance using SPSS 22.0
RESULTS AND DISCUSSION Results 1) Nurses
'Responsibilities Table 1: Nurses'
responsibilities
Respond en
Responsibilities of the Nurse Not Good
Enough Good Good n% n% n%
129 4 3.10 113 87.6 12 9.3
The table above shows that the
characteristics of nurses who have a
perception of responsibility in the
unfavorable category are 3.10%, the
category is quite good at 87.60% and the
good category is 9.30%.
2) Getting to Know Patient Behavior Table
2: Patient Behavior
Respond en
Getting to Know the Patient's Behavior Not
Good Enough Good Good n% n% n% 129 0
0, 40 31.01 89 68.99
The table above shows that the
characteristics of nurses who have
perceptions in Knowing Patient Behavior,
the category is quite good by 31.01%, good
category by 68.99%
3) Immediate reaction Table 3: Immediate
reaction of the nurse
Responder
Immediate Reaction
Not good
Fairly Good Fair n% n% n% 129 0 0 56 43.41
73 56.59
The table above shows that the nurses'
characteristics of an immediate reaction in
taking action to patients, which are included
in the category quite well amounted to
43.41% and the good category amounted to
56.59%.
4) Discipline in the Nursing Process Table 4:
Discipline in the nursing process
Den response
Progress / Improvement of Patient's
Condition
Respond en
Evaluation of the Progress of Patient
Conditions Not Good Enough Good Good
n% n% n% 129 0 0.0 12 9.30 117 90.70
The table above shows that the
characteristics of nurses who have the
perception to know the progress of the
condition of patients treated are as many as
9.30% which is included in the good enough
category and as much as 90.70% in the
good category.
6) Analysis of Respondents' Perceptions of
the Quality of Nursing Services based on the
Community Satisfaction Index (IKM)
Table 6: Average Patient Satisfaction with
the Quality of Nursing Services in the
Special Unit of the Emergency Unit and ICU
of Pangkajene and Kepulauan District
Hospitals

Discipline in Nursing Care Is Not Good Service Elements

Enough Good Good n% n% n% 129 0 0.00
Average Value of Service Elements
56 43.41 73 56.59
Weighted Value
The table above shows that the
characteristics of nurses who carry out Service Unit Index Value nan
discipline in the nursing process, which is
Service Procedure 2.84 0.111 0.315 Service
included in the quite good category
Requirements 3.09 0.111 0.343 Clarity of
amounted to 43.41% and good category
nurses serving 3.37 0.111 0.374 Discipline of
amounted to 56.59%.
nurses in serving 3.14 0.111 0.348 Nurses
'responsibilities 2.84 0.111 0.316 Nurses
ability 3.18 0.111 0.353 Speed of service of
5) Knowing the Progress / Improvement of
nurses 3.97 0.111 0.330 Fairness of service
Patient's Condition Table 5: Knowing the
2.71 0.111 0.348 Nurses' responsibilities
2.84 0.111 0.316 Ability of nurses 3.18
0.111 0.353 Speed of service of nurses 2.97
0.111 0.330 3.18 0.111 0.353 Total Index
Value 3.032 IKM Value after conversion =
Index Value x Base Value 75.81
The table above shows that in the special
unit of IGD and ICU, it has good service
quality with IKM value of 75.81, where the
best elemental value is the clarity of nurses
in serving that is 3.37. But the main concern
is the three lowest elements, namely
service procedures (2.84), nurse
responsibilities (2.84), and fairness in
getting services (2.71).
7) Correlation Test Between the Orlando
Nursing Process and Patient Satisfaction
Table 7: Results of the Pearson Correlation
Analysis Between the Orlando Nursing
Process with Patient Satisfaction in the
Critical Care Room of the Emergency Room
and ICU Hospital of Pangkajene Regency
and Islands Nursing Process Value of p
Value of Nurses Responsibility to Know
Patient Behavior Immediate Reaction 0,000
(p <α) 0,000 (p <α) 0,000 (p <α) 0,692 0,585
0,813 Discipline in the Nursing Process
0,000 (p <α) 0,519 Progress / Improvement
of the Patient's Condition 0,000 (p <α) 0,755
The results of the bivariate analysis based
on the Pearson correlation test show that
the nursing process consisting of nurses'
responsibilities, recognizing patient
behavior, discipline in the nursing process
and evaluating the progress of improving
the patient's condition to the quality of
nursing services through patient satisfaction
surveys, has a strong relationship of the five
independent variables to the dependent
variable , where the significance value is
0,000 (p <0.05). In addition, the table above
also shows that the highest correlation is
immediate reaction (r = 0.813), then the
next strongest relationship is the evaluation
of the progress of the patient's condition (r
= 0.755), the nurse's responsibility (r =
0.692), recognizing the patient's behavior (r
= 0.585) and the weakest relationship is
discipline in nursing care (r = 519).
8) Resume Analysis of Linear Regression
Between the Responsibilities of Nurses,
Knowing Patient Behavior, Immediate
Reaction, Discipline in Nursing and the
Progress of Patient Conditions with Patient
Satisfaction in the Critical Care Room of the
Emergency Room and ICU at Pangkajene
and Kepulauan District Hospital.
10) Test of Nurse Responsibility, Knowing
Patient Behavior, Immediate Reaction,
Discipline in Nursing and Progress of Patient
Conditions with Patient Satisfaction in the
Critical Care Room of the Emergency Room
and ICU at Pangkajene and Kepulauan
Regency Hospital
Discussion
1. Analysis of Nurses' Responsibilities to
Patient Satisfaction in the Critical Care
Room of the Emergency Room and ICU of
Pangkajene and Kepulauan Regency
Hospital The results of research on the
responsibilities of nurses in the critical care
room of the IGD and ICU Hospital of
Pangkaejne and Kepulauan Regency,
showed that most nurses carry out
responsibilities with pretty good at 87.60%,
but there are still nurses who have less
responsibility at 3.10% and there are nurses
who carry out their responsibilities well at
9.30%. This explains that the majority of
nurses in the critical care room perform
their duties quite well, but still need to be
improved in terms of response and care for
patients, not just carrying out obligations,
but nurses should show more caring
attitude from patients entering the room
until the patient is moved to the ward.
Responsibility is an important aspect in
building nurse ethics. Responsibility is the
willingness of someone to prepare
themselves to face even the worst risks,
providing compensation or information on
tasks that have been carried out. Nurses are
obliged to take responsibility for any actions
taken, such as the responsibility of nurses
during duty, perform
patient operand well, perform nursing
procedures well to the patient, responsible
for documenting nursing care, responsible
for maintaining patient safety, in observing
the conditions of patient development. The
nurse's responsibility is closely related to
the duties of the nurse where the nurse's
duty in general is to meet the patient's basic
needs. Nurses are expected to see patients
as being unique and comprehensive in
providing care. Comprehensive means in
meeting the basic needs of patients, not
only focusing on the fulfillment of
physiological and psychological, but all
aspects that are the impact of complaints
felt by patients (Iyus, 2009).
The results of the bivariate analysis
between the responsibilities of nurses and
patient satisfaction from the results of the
regression test, the p value in the column is
significant, obtained a value of 0,000 (p
<0.05), explaining that there is a
relationship between the responsibilities of
nurses to patient satisfaction. These results
are consistent with Sari & Saraswati's
(2013) study which states that doctors,
nurses, pharmacy have an important role in
determining the quality of hospital services.
These three types of resources are the main
core in the process of service in the
hospital, because they are directly related
to the patient's recovery. Doctors are
responsible for treatment, nurses are fully
responsible for patient care and pharmacy
is responsible for the supply of drugs. The
quality of service processes in hospitals
through patient satisfaction which includes
the quality of service processes by doctors,
nurses, pharmacy staff and
administration. This study found that the
quality of service processes for doctors and
nurses had an impact on patient
satisfaction, while the quality of service
processes by pharmaceutical staff and
administrative ease did not affect patient
satisfaction (Sari & Saraswati, 2013).
Padma, et al. (2010) found that
simultaneously dimensions of service
quality had an impact on satisfaction, while
partially testing the dimensions of service
quality (personal quality, clinical care, image
and trust in hospitals) had an impact on
patient satisfaction, while the dimensions of
service quality did not affect patient
satisfaction is the quality of infrastructure,
administrative procedures, safety, and
social responsibility.
2. Analysis of Knowing Patient Behavior
towards patient satisfaction in the Critical
Care Room of the ER and ICU of Pangkajene
and Kepulauan Regency Hospital The results
of the study of the extent to which nurses
recognize the behavior of patients in the
critical care room of the IGD and ICU
Hospital of Pangkajene and Kepulauan
Regency, explained that in providing nursing
care, nurses know the patient's behavior
first by 68.99% doing well, and by 31.01%
doing well enough. This explains that nurses
in the critical care room have largely
understood and carried out the stages of
nursing assessment by recognizing the
patient's behavior first before establishing
the nursing diagnosis, by recognizing the
patient's response to pain, comfort,
nutritional status, elimination status and
biopsychosocial response and other
spiritual which is a complaint felt by the
patient.
Nurses must view patients as whole and
unique human beings. Whole means that all
patients have complex basic needs and are
interrelated to one another's needs. Unique
means that each individual is unique and
cannot be compared to other individuals, so
that it requires a special approach, by
getting to know the patient from his
behavior, from his history such as birth
history, childhood history, education,
hobbies, parenting, environment, traumatic
experiences and dreams different mind. The
nurse's ability to understand patient
behavior and history is known as the
Holistic Ability to know Life span History.
The results of the bivariate analysis
between recognizing patient behavior
towards patient satisfaction from the
results of the regression test, the p value in
the column is significant, obtained a value
of 0,000 (p <0.05), explaining that there is a
relationship between knowing patient
behavior towards patient satisfaction.
These results are consistent with research
by Tutu and NurAini (2018), which explains
that nurses are the spearhead of health
services. Satisfied or not the patient to
health care is an indicator and one of the
determinants of the good and bad quality of
nursing services. Professional and qualified
nurses must have hard skills and soft skills.
Soft skills include the ability to
communicate, empathize and care. Caring is
a caring, respectful and respectful attitude
of others. In fact there are many nurses
who do not reflect caring behavior in
providing nursing care to clients. The
purpose of this study is to provide
intervention in the form of therapeutic
communication to develop or
improve nurses caring behavior so that this
will have an impact on the quality of nursing
services & patient satisfaction. The results
obtained are an increase in nurses caring
behavior especially in communication and
increasing patient satisfaction after nursing
care is given by nurses who have received
caring behavior training. Caring nurses can
be implemented into the stages of nursing
care that is to recognize the behavior of
patients treated.
3. Immediate Reaction from Nurses to
Patient Satisfaction in the Critical Care
Room of the ER and ICU of Pangkajene and
Kepulauan Regency Hospitals.
The results of research on the extent of the
immediate reaction of nurses to patient
satisfaction in the emergency room and ICU
critical care Pangkajene and Kepulauan
Regency hospitals, explained that nurses
who gave an immediate reaction well as
much as 56.59%, and responded quite well
by 43.41%. From these data, it can be
explained that nurses in the emergency
room and ICU have an immediate reaction
or response time which is mostly good,
where nurses in taking immediate nursing
actions, use an average time of ≤ 5 minutes.
Response time is the response time of
nurses in providing immediate action to
patients. A good response time for patients
is <5 minutes. Nurse is a profession that has
an autonomous function that is defined as a
professional nursing function. The
professional function is to help identify and
find patients' needs that are immediate. It is
the nurse's responsibility to know the needs
of patients and
help fulfill it (Schmieding, 1993). The results
of the bivariate analysis between the
nurse's immediate reaction to patient
satisfaction from the results of the
regression test, the p value in the column is
significant, obtained a value of 0.000 (p
<0.05), explaining that there is a
relationship between the nurse's immediate
reaction to patient satisfaction. This result is
in line with research conducted by Rembet,
et al (2015) which explains that patient trust
in nurses is easier to grow among people
who have the same interests and goals,
making it easier to change individual beliefs
than to change a belief group, this study
analyzed the relationship between Nurse
Response Time and the Level of Patient
Family Confidence in the Emergency Room
at GMIM General Hospital Kalooran
Amurang, the results of the study using the
chi-square test obtained p value = 0.008
(<0.05). Which explains that there is a
significant relationship between the
response time of nurses with the level of
patient's family confidence in the
Emergency Room of the General Hospital
GMIM Kalooran Amurang, with the growth
of trust from the patient's family, then this
will provide satisfaction to patients and
families who have received good service by
nurse. In addition, Pisu, et al (2015),
explained the results of his study about the
relationship between nurse response time
and patient satisfaction. The categories
used are fast and satisfied response time
categories, as many as 19 people (51.4%),
11 people less satisfied (29.7%), while 7
people (18.9) are dissatisfied while
response time
slow dissatisfaction 10 (43.5%), less
satisfied 9 people (39.1%), and satisfied 4
people (17.4%), so it can be concluded that
this study explains that there is a significant
relationship between nurse response time
with satisfaction patients, the faster the
nurse's response time the more satisfied
the patient is, and conversely the slower
the nurse's response time, the more
diPerception, thinking, and feeling occur
automatically and almost simultaneously.
Therefore nurses must learn to identify
each part of their reaction. This will help in
analyzing the reactions that determine why
nurses must respond immediately. Nurses
must be able to use their reactions to help
patients (Tomey, 2006). Based on the MOH
Guidelines, (1990), states that the
competencies that must be possessed by
nurses in the critical care room are the
nurse's ability to open and free the airway,
the ability to provide ventilators, the ability
to perform pulmonary resuscitation, the
ability to stop bleeding, splint dressing and
transportation skills, the ability to recognize
and use resuscitation drugs and the ability
to record and read patient ECG results. 4.
Discipline in the nursing process of patient
satisfaction in the Critical Care Room of the
Emergency Room and ICU of Pangkajene
and Kepulauan Regency Regional Hospital
The results of research on the extent of
discipline in nursing care, which explains the
discipline in documenting nursing care by
nurses in the critical care room of the ER
and ICU of RSUD Regency Hospital
Pangkajene and
Islands, namely the majority of nurses had
carried out discipline in nursing care well by
56.59% and by 43.41% quite well. This
proves that nurses in the emergency room
and ICU of Pangkajene and Kepulauan
District hospitals have carried out the
documentation of nursing care well, but
there are still nurses who have not been
disciplined in its implementation, this can
be caused by the number of patients
treated at the time of guard, patients who
entered requires maximum / total action, so
the time to document nursing care is
reduced ssatisfied the patient will be.
According to George (1995), discipline in
the nursing process is a total interaction
(totally interactive) which is carried out step
by step, what happens between nurses and
patients in a particular relationship, patient
behavior, nurses' reactions to these
behaviors and actions to be taken,
identifying needs the patient to help him
and to do the right action, so that if the
nurse can carry out the action properly,
then the patient will also feel the benefits.
Based on the results of the regression test,
explaining that the results of the p value in
the column are significant, obtained a value
of 0.000, (p <0.05) which indicates a
significant relationship between discipline
in nursing on patient satisfaction. The more
disciplined nurses are in carrying out
nursing care properly, then the patient will
feel enormous benefits. These results are in
line with research conducted by Tamaka, et
al (2015), which links the burden
work by documenting nursing care, the
results of the workload test by documenting
nursing care are obtained as p value =
0.008, explaining that there is a relationship
of workload with documentation in the
Hospital Emergency Medical Installation.
Prof. Dr. RD Kandou Manado, so that this
study supports the independent variables of
nurses at Pangkajene and Kepulauan
Regency hospitals that still document
incomplete / quite good nursing care at
43.41% due to the high workload in critical
care, where the average patient admission
is 35 patients per day . If related to patient
satisfaction, the weakest relationship is the
variable of discipline in nursing care
compared to other variables, where
patients do not have enough perception to
be able to assess the discipline of nurses in
documenting nursing care in the room, but
still have a significant relationship where if
nurses increasingly discipline in
documenting askep, then the patient's
development will be able to be measured at
the time of the nurse, so that it will have an
impact on patient satisfaction with nursing
services. The discipline of the nursing
process includes the nurse's communication
to the patient that is immediate, identifying
the client's problems conveyed to the
nurse, asking for validation or Planned actions, after the complete action
improvement. Nursing discipline is based on is carried out, the nurse must evaluate its
"the process of how a person acts." The success. The evaluation of nursing care is
purpose of the disciplinary process when focused on
used between nurses and patients is to help
changes in the patient's behavior towards
meet the needs of patients. Increased
the ability to help himself to overcome his
positive behavior from patients is an
inability. Evaluation is carried out after
indication of fulfillment of needs as
nursing actions are implemented
expected results (Tomey, 2006). 5. Progress
(Nursalam, 2001). According to Wilkinson
/ improvement of the patient's condition to
(2007) in Rohmah (2012), explaining that in
patient satisfaction in the Critical Care
the nursing process, evaluation is an activity
Room of the ER and ICU of Pangkajene and
that is planned continuously, is a deliberate
Kepulauan District Hospital The results of
and systematic activity to assess the quality
research on the extent to which nurses
of services provided compared to existing
evaluate the progress of the patient's
care standards. Based on the results of the
condition and its relationship with patient
regression test, explaining that the results
satisfaction, namely there is a nurse
of the p value in the column are significant,
behavior that evaluates the progress of the
a value of 0.000 (p <0.05) indicates a
patient's condition as well as 90.70% and
significant relationship between evaluating
quite good at 9.30%. This explains that the
the progress of the patient's condition and
care of nurses to evaluate the progress of
patient satisfaction. These results are in line
the patient's condition after nursing actions,
with research conducted by Nurhidayah
is very good, although there are still some
(2014) which explains that the evaluation of
nurses whose frequency of evaluation of
the progress of the patient's condition is
patients is still lacking, due to several
one of the stages of the process of nursing
factors such as teamwork, sometimes each
care to patients, where the process of
uses a functional method, where nurses the
nursing care is one of the factors that
duty is to anamnesa, there is a duty to
influence patient satisfaction at the
provide independent action and some are
Hospital. The results of the analysis show
tasked to observe after the other nurses
that Nursing Care for patients is directly
take action to the patient, so that the nurse
proportional to improving the quality of
whose focus is in charge of evaluating will
health services and patient satisfaction at
get a better rating than nurses who are not
Hospital.
assigned to evaluate . However, nurses
must be seen as nurses as a whole, who are DAFTAR PUSTAKA
able to identify the progress of the patient's
Afriani N, (2012), Analysis of Customer
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Complaints Handling by Marketing and
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they care for. Evaluation in the action phase
of the disciplinary process is inseparable.
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