Transkrip Prima

#8
Judul File Audio: GMT20220711-030246_Recording

Nama ISI
Prima Let’s start the interview, ma’am. Perhaps you can explain more, since Mrs. XXX
has been around for 7 years in the ward, working at PKU Gamping. Could you
please tell us, Ma'am, what has been your role since you first entered the hospital
until now. Some daily tasks.
R8 So, I entered PKU Gamping for the first time in 2009. Previously, I was in Naim
Ward as an executive nurse. After about 3 years I became the Shift Coordinator
until now at Zaitun Ward.
Prima What are the daily tasks, Ma’am, as the managing nurse and Shift Coordinator?
R8 The daily duties, as an implementing nurse are like, checking vital signs, doing
the injections, bathing patients, accompanying doctor visits, making medical
assistants, making shifts.
Prima Is there more, ma’am?
R8 Doing the blood sampling. Yes, I think that also included.
Prima What about the Co-Shift nurse?
R8 The Co-Shift nurse reports to the consultant doctor, accompanying doctor visits,
things like that. Later if there is a complaint, I will try to resolve it. If I can't
finish, I will convey the issue to the Supervisor.
Prima Are the Co-Shift nurses the same as Primary nurses, Ma’am?
R8 They are different. The Primary nurses have a daily shift from morning until
noon, while nurses like myself have the night shift.
Prima In terms of roles and responsibilities, what are the differences, Ma'am, between
Primary nurses and Co-Shift nurses?
R8 Primary nurses have more responsibility, such as ummm—I think it is still under
the Supervisor, like that, who is responsible for the patient.
Prima I see, what abou the Co-Shift nurses?
R8 I think my role is like replacing the role of Supervisor. But if it is a Supervisor,
 she will have to do a morning shift at all times, while the Co-Shift nurses will do
the day and night shifts.
Prima So, there are also managerial duties, Ma'am, for the Co-Shift nurses. Not only to
nursing care.
R8 Yes
Prima Can you tell me, Ma'am, how was the treatment process of DM patients that
entered the Zaitun ward for the first time until he went home?
R8 If we accept a DM patient, let’s say a new patient, he is brought in by the
emergency department nurse or the outpatient department nurse to do check the
vital signs. First, we do some introductions. Then, we check the vital signs. Then
review the history of the disease. For example, if the patient has had DM for a
long time, we will examine what medicines are routinely used, where do they
usually go for checks, things like that. Then, when we already have the lab
results, we will report them to the consultant doctor. After we report to the
consultant doctor, we will provide therapy which is advised by the consultant
doctor. Next, we will collaborate with a nutritionist, later the nutritionist will
come to provide counseling about the diet of DM patients.
Prima And then, is there more, Ma’am?
R8 After that, the doctor usually advises, later he will give DM therapy, as well as
check the random blood glucose according to the program.
Prima And then?
R8 If it is only a new DM patient, then we need to creating nursing care and
discharge planning. like that. Something that can be filled.
Prima Well, you mentioned about how to make a Discharge Planning. Can you tell me,
Ma'am, how is the Discharge Planning process and what is the documentation
like?
R8 Discharge Planning itu karena kami sudah menggunakan EMR jadi ngga nulis di
status itu lagi. Nanti dikaji di Discharge Planning itu nanti diagnosa masuknya
apa, keluhannya masuk apa, obat-obatan yang selama di rumah sakit yang
diberikan apa, kayak gitu. Trus, nanti kolaborasinya sama ahli gizi. Kayak gitu,
Mbak.
 Discharge Planning is done because we already use EMR so we don't write on
that status anymore. Later the patients will be reviewed at Discharge Planning,
what will be diagnosed later, what complaints will come in, what medicines will
be given while in the hospital. Then, it will be the collaboration with a
nutritionist. Like that, Miss.
Prima Okay. So, when did the Discharge Planning start?
R8 As soon as the patient comes in, right, we'll have an assessment. Then, for
Discharge Planning, there will be an initial diagnosis. That's it, it's already written
from the emergency room, we'll fill it in later. Such as, what will the complaints
be when you are admitted to the hospital. What drugs were given? Later when the
patient goes home, all he has to do is completing if, for example, there are
additional drugs, controls, like that.
Prima Is there more, Ma’am?
R8 That’s all
Prima You mentioned the collaboration with nutritionist to talk about the patients’ diet.
Is there any more collaboration with another profession, Ma’am?
R8 If DM patients, it usually deals with nutritionist. Only that. While nurses are
merely checking the random blood glucose. Only the doctor gave DM therapy.
Prima Do the Nutritionists have the responsibility to report in the Discharge Planning’s
EMR, Ma'am?
R8 No, Nutritionists only reports in the Patient Integrated Care Record
Prima Then, is it true that only nurses who write in Discharge Planning?
R8 Yes
Prima I see
R8 Nutritionists usually writes in the Patient Integrated Care Record only
Prima I see, those who document the discharge planning is only nurses, right?
R8 Yes
Prima What about the physiotherapy ma’am? Has it ever been involved? For example, a
DM e patient has a wound or something like that.
R8
 The involvement of Physiotherapy is rare only for DM patients, sist. It means
there are no complications, or for example, if the patient turns out to have a
stroke, weakness, well, that's new. But it's only DM patients, then physiotherapy
isn’t really involved here.
Prima How about from Pharmacy department, ma'am?
R8 Pharmacy is involved usually when the patient goes home. When you go home,
you have to take insulin for example, it will be given by the Pharmacy later.
Then, sometimes the pharmacy also examines the patient. What are the
medicines, what are the drinks like? They also write later at Patient Integrated
Care Record.
Prima So they also don’t write in the Discharge Planning, right ma’am?
R8 No. So far, the one who completes it and the one who copies it too, is the nurse.
Prima Including the doctor?
R8 No, the doctor only writes in the Patient Integrated Care Record.
Prima I see, but the doctor’s signature needs to be used in the discharge planning, right?
R8 Yes
Prima Although the one, who document it, is the nurse.
R8 Yes
Prima Then, who is in charge to determine that the patient can go home, Ma'am?
R8 The doctor
Prima Based on what?
R8 Based on the patient's general condition, lab results, vital signs, like that. For
example in DM patients, if the random blood glucose is stable, they can go home.
There are no complaints, then you can go home. like that.
Prima If for example the patient's readiness to go home, for example, is seen in terms of
knowledge, skills, has it been studied and taken into consideration whether the
patient may go home, ma'am?
R8 Yes Sometimes, the doctor will see if the patients can go home when they can
inject insulin. So, showing to the patients first, then the nurse will teach them.
The Pharmacy also inform to the patients again when handing over the medicine.
Prima It means that the nurse also has a role or provides advice or input to the doctor,
 for example, is the patient ready to go home or not, ma'am?
R8 Yes, to inform, miss. If the nurse knows what the patient's activities are like, "the
patient is already like this, Doc." "Oh yeah, if that's the case, it's done, it's okay to
go home," like that.
Prima For example, in giving some basic information to patients before going home,
what kinds of topics that they usually give?
R8 The information is basically about taking the medicine regularly, explaining the
controls, then reminding again what the food will be like what the nutritionist has
said, like that.
Prima Is there more, ma’am?
R8 To do some activities, some exercise. Things like that, miss.
Prima As for foot care, Ma'am, to prevent injuries?
R8 We usually inform, for example, in sports you must wear footwear. Then, later
on, at PKU there will be a DM Gymnastics application, later the patient’s family
will be informed that there is an application like this at PKU Gamping Online to
search DM Gymnastics. In that application, the complete guideline is already
given.
Prima It means that in PKU Gamping Online, what contents can be accessed by
patients?
R8 For example, contents for DM patients and heart patients. While for DM patients
cover some information such DM Gymnastics.
Prima Do you know how the patients access it? Has it ever been checked?
R8 We haven't cross-checked, it only informs us if there is an exercise guide.
Usually the information for heart patients is complete, Ma'am. What medicine
will you take in the morning, it is already in the form of checklist, like that, you
know. While information for patients with DM, stroke, is still not complete.
Prima What you told me earlier, the process from entering hospital until going home, is
there any operational standard or a guide for discharged planning from the
hospital?
R8 I haven’t read the guide, but I have ever filled it.
Prima As if you were once told to fill the Discharge Planning, or perhaps involved in a
 workshop about it
R8 Yes, there was a workshop about this and everyone is invited
Prima Who were involved, ma’am? The co-shift nurses or the associate nurses as well?
R8 The associate nurses as well, we are all invited
Prima The event is held on the ward?
R8 No, the venue is similar with the usual seminar or workshop. So we are all
invited in the workshop discussing EMR as the first topic.
Prima When was it, ma’am?
R8 It’s been a long time
Prima How many years?
R8 I think it’s been 4 years, miss.
Prima So, it means, the event had invited almost everyone, right? This include the
primary nurses, co-shift nurses, supervisors.
R8 Yes.
Prima If the new nurses have just entered here, are they also involved and invited in the
workshop, ma’am?
R8 Yes, the recently accepted nurses were taught by supervisor or primary nurses.
Prima So, those who have the authority to fill out Discharge Planning are all the nurses
in the ward or …
R8 Co-shift is responsible for filling out the discharge planning. However, when it
comes to the replacing shift, the associate nurses are also responsible for it. But at
the end, it still has to be verified by co-shift or the primary nurses.
Prima So, everyone involved must fill it out, but still needs to be verified by primary
nurse or the co-shift nurse, right?
R8 Yes.
Prima In terms of informing the patients, who is in charge, ma’am?
R8 Co-shift nurse and the primary nurse
Prima Is it done before the patient goes home or while being treated, ma'am?
R8 When the patient is hospitalized, the orientation is carried out by primary nurses
and co-shift. Besides, they are also in charge of patient’s discharge preparation.
Prima So the associate nurse only give less information, ma’am?
R8 They only remind the patients, miss.
Prima Reminding the patients?
R8 Yes.
Prima Is there any media or teaching materials used to educate patients, ma’am?
R8 We usually use only leaflet, miss.
Prima What is the leaflet about?
R8 It is usually about DM, such as the basic knowledge and what activities related to
DM, as well as information about nutrition.
Prima Is it usually given before asking the patients about the illness?
R8 Yes, we ask the patients, miss.
Prima Is there any form to collect information from patients or just …
R8 We don’t have such form. The patients are only asked about the illness then we
give them the leaflets and documentations.
Prima Is there any designated education document for the patients?
R8 Yes, we have the education section on the Electronic Medical Record.
Prima What about for the DM patients? Is there any form to be filled?
R8 Nutrition department have provided education on diet such as the DM diet. We
will then confirm it and fill in the EMR to check the involvement of patient's
family, how to give insulin, how to inject it.
Prima In terms of a patient’s preparation and assesment to go home, can you tell me the
operation standard for patient discharge preparation, ma’am?
R8 The assessment is about readiness to go home, for example, how to inject insulin
so that patients will be able to practice of injecting themselves. We supervise the
patients during the process.
Prima Is there more, ma’am?
R8 That’s all
Prima So, there is a checklist to know whether patients are fulfilling the preparations?
R8 We don’t have such checklist
Prima Does that mean that it can be different from one DM patient to another, to assess
their readiness to go home?
R8 Usually, the standard is carried out if the condition is good, the family or the
 patient can already manage insulin, then they can go home.
Prima So, the focus is more on practicing insulin injection and medication, ma’am?
R8 Yes, and also managing the diet.
Prima So it is about insulin, medicines, and diet, is that right?
R8 Yes.
Prima If the patient is ready to go home, what things that will be provided to the
patients as documentation, ma’am?
R8 We give them the discharge planning and the medicine.
Prima What is the content, ma’am? That means the summary or resume?
R8 Resume.
Prima Oh, resumes. What's in the resume, ma'am?
R8 The resume contains diagnosis, medication, and control date. Then, what
activities will you do later, including suggestions for control, suggestions for
activities at home.
Prima It means there are suggestions too, ugh, in that resume. What should or should be
done by the patient, that is.
R8 Yes, indeed.
Prima Is there any documentation for patient’s after returning home to monitor the
patient's recommendation, ma'am?
R8 No, we don’t have that
Prima It means that when you go home, you've completely cut off from the wards,
right?
R8 Nggih. Kan, nanti paling gantian sama perawat poli to, mbak, mungkin yang
mengkaji lagi.

It will take turns with nurse from outpatient department, perhaps the one who
will check the patients again.
Prima So, the medical follow-up is carried out after returning from outpatient
department, isn’t it?
R8 Yes.
Prima Do the nurses in the outpatient department provide the knowledge again to the
 patients, such as cross-checking the basic knowledge?
R8 I don’t think so
Prima Can you tell me, ma'am, according to you, what is a good Discharge Planning,
which can really prepare patients to go home and not return to the hospital again,
Ma'am?
R8 Most of them come back again
Prima According to your experience, how do you stop them from returning to the
hospital?
R8 I think patients only understand the easiest part that can be done, the obstacles
occur when patients don’t do and follow up the crosscheck
Prima I know PKU Gamping Online was only for the heart patients, Ma'am, the one
with these fillings already? Is there more education service, Ma'am, according to
you, apart from being easy to understand, easy for patients to do? The process
while in the hospital maybe.
R8 I think the process can be varied such as assessing and educating the patients, and
it will be re-evaluated in the ward.
Prima So far, based on your experience being the co-shift, who provided more
discharge planning? Has the implementation been ideal or what might need to be
improved, Ma'am?
R8 I think it still needs to be improved, miss.
Prima In what part, ma’am?
R8 Sometimes, the process becomes not that optimal when having a lot of patients,
for example educating the patients just a moment before going home.
Prima Is there more, ma’am?
R8 That’s all
Prima What do you think to overcome such problems, ma’am?
R8 To overcome this, co-shifts need to increase their cooperation. For example, what
has not been implemented will be conveyed later, what hasn't been done yet, we'll
pass it on to the other co-shifts or to primary nurses.
Prima So to communicate and pass on the next-to-do to the other co-shifts, right?
R8 Yes.
Prima Is there more, ma’am?
R8 That’s all
Prima If that is coming from the internal ward which is the arrangement between Co
Shifts, what can the hospital do, ma'am?
R8 Apa ya. Biasanya nek kadang, kan, yang jaga kalau pas pasiennya-- kalau saya di
Zaitun itu misalnya pasien penuh nanti kadang yang jaga pas kurang atau gimana
itu nanti jadi ngga maksimal.

For example, if there is a full patient at Zaitun ward, sometimes it is not optimal
because of the lack of human resource
Prima what can the hospital do, ma'am?
R8 I think adding more human resource, miss.
Prima In term of nurses, or…
R8 Yes, adding more nurses
Prima Because patients think that there should be more nurses
R8 Yes
Prima Is there any training that are useful, to encourage or to further improve Discharge
Planning to be more effective?
R8 Such training is rare, miss.
Prima So what can you propose to improve it better in the future?
R8 I think a training with the focus of discharge planning. What can you think of?
Prima For example it can be started with a training for a more effective discharge
planning?
R8 What's effective is what the patients do well. When they are educated and can go
home.
Prima It means is communication is part of the education. So, what can be done to make
the implementation better? What kind of training is needed?
R8 I think it deals with the hospital collaboration. The hospital must be able to
provide so that the patient can still be monitored, that's how it is, miss. The
hospital facilitates it, so how can the patient be monitored from what has been
taught in the ward. So, it doesn't stop. Sometimes there are patients who come
 back because they took their medicine, it turns out that yesterday they never
injected insulin, things like that.
Prima Is there more, ma’am?
R8 That’s all
Prima In terms of communication between nurses and other professions, with fellow
nurses, what has been the process so far, ma'am?
R8 Communication for patient development is carried out through the nurse shift
change and the Patient integrated care record
Prima It means all professions will see the Patient integrated care record, ma'am?
Anyone who writes in the Patient integrated care record will be read, right?
R8 Yes.
Prima For example, communication with doctors, reports and so on, apart from using
the Patient integrated care record, what other platform is used, ma'am?
R8 Using phone or WhatsApp
Prima According to you, was there any difference in the Discharge Planning process
before when you first entered in 2009 until now?
R8 It was just issued when the patient came home. Then, the report was still on
paper. However, it's already in the form of electronic medical record for now.
Prima Is there more, ma’am?
R8 What it is now is more complete. It was once like a resume.
Prima Okay. Now it's more complete in EMR. Is there any difference in terms of
conveying to the patient, ma’am?
R8 Yes. There were very few nurses whose job was to educate patients while now
we have more of them. It was also rare to collaborate with nutritionists. A patient
who wanted to consult, then we manually conveyed it to a nutritionist. Now, we
know a DM patient because they are reported from a nutritionist. They can also
access patient integrated care record. They can read it later and re-visited in the
ward.
Prima Oh, that means now you don't need to call the nutritionist, right?
R8 Yes. The nutritionist already knows if there is like DM and heart patients, they'll
have to be visited later. Those patients are visited at least once to be educated.
Prima Great. That the electronic medical record for nutritionist. The EMR for nurses is
different or is it the same, ma'am?
R8 The same
Prima The same in terms of the display
R8 Yes.
Prima Then, how do they know that in certain ward there is a DM patient need to be
visited?
R8 They see the progress every day in terms of which ward will this patient be in,
which ward will this lady be in.
Prima It means that there are indeed those who go around the ward every day, that's
how it is, monitoring.
R8 The pharmacy staff is now around.
Prima Pharmacy, nutrition department. How about a physiotherapist too?
R8 For physiotherapy, if there is a consultation service, they will stand by. For
example, the doctor wants a physiotherapy for the patients, we will convey it
later.
Prima Does that mean it's the physiotherapy that needs to be called by the nurse?
R8 Yes.
Prima Oh. The pharmacy and nutrition have been automatically around directly.
While the pharmacy only visits those who use insulin or those who take oral
medication, Ma'am?
R8 Oral medication as well
Prima How many times does the pharmacy usually come here? As for Nutrition, right,
that was at least once. How about Pharmacy?
R8 It is the same at least once for pharmacy. Sometimes if there are patients who are
old, what are their routine medicines, they review them again. Later the medicine
must be conveyed to the doctor such as what will be continued.
Prima Oh, that means Pharmacy and Nutrition also communicate with doctors dealing
with the patient care, that's it.
R8 Yes
Prima Including the Discharge Planning as well as communication with the doctor?
R8 I think it is the same. Later, the doctor will read the patient integrated care record
written by the nutritionist and the pharmacist.
Prima How many years have you had really good collaborations like what you said
earlier?
R8 I think there has been a good collaboration in the last three years
Prima in the last three years, ma’am.
R8 Yes.
Prima Great. Including the Discharge Planning documentation…
R8 It can be more than three years in that regard. The patient integrated care record
was once written in a book.
Prima Kalau yang form Discharge Planningnya lebih lengkap itu juga sejak ada EMR
niku nggih?

As for the Discharge Planning form, is it more complete since there's electronic
medical record, ma’am?
R8 Yes
Prima And it has been filled in completely or there is documentation but sometimes it's
not filled in, ma'am?
R8 It was completely filled. At the beginning it was partially filled. Later, for
example, it will be complete again when the patients go home.
Prima It means the Discharge Planning form has been filled in since the beginning of
the patient's admission, and when the patients go home it will be filled again?
R8 It is filled before they go home
Prima Does that have an impact on the implementation of Discharge Planning? For
example, does the policy of Indonesian National Health Insurance or hospital
accreditation have a lasting impact on the implementation of discharge planning?
R8 It has impact most on the accreditation. Dealing with the form completion.
Prima Does it have impact on in Indonesian National Health Insurance?
R8 I don’t think so
Prima So, whatever the scheme, all patients get Discharge Planning.
R8 Yes.
Prima What do you know about accreditation policy that is related to Discharge
Planning, Ma'am?
R8 It deals with the form completion.
Prima Oh, the form completion.
R8 Maybe some are messy or not thorough, like that, the contents in the form really
have to be completed.
Prima Do the authority, the one who is responsible, have impact on the accreditation,
ma'am?
R8 I don’t think so
Prima But have you ever read, Ma'am, the accreditation rules regarding Discharge
Planning?
R8 No, I haven’t
Prima In the implementation of Discharge Planning, can you tell me how is the
involvement of family?
R8 The family is involved during the sharing knowledge. For example, if the patient
is elderly, then the family will also educate them later.
Prima Have you ever, Ma'am, met a patient whose problem was so complex that it was
rather difficult to go home? Such as…
R8 Yes.
Prima Can you tell me, ma’am?
R8 In terms of what aspect? Is it from the disease?
Prima It can be the disease, family issues, financial issues, or other things
R8 Usually the complex one is diagnosis of the disease, which is already
complicated. In terms of family, there is no one family consisting only elderly
patients. There are couple of grandparents and their child was far away which
make the things more complicated.
Prima In that case, how is the impact on the discharge planning, ma’am?
R8 It is difficult to manage, miss. Educating the elderly is very challenging.
Prima Are there any alternative solutions?
R8 We usually request the patient to be accompanied by a younger family member.
We convey the information through it.
Prima Is there more, ma’am?
R8 That’s all
Prima Is there any department or designated unit from the hospital that can help if the
patient is having complicated issue?
R8 The network connection is not good, miss.
Prima Oh, sorry.
Is there any department or unit from the hospital that can be asked for help if
there is having a complicated issue on the ward?
R8 Yes
Prima Who is it?
R8 Nanti itu di MPP yang menyelesaikan, yang membantu. Misalnya, kok,
pasiennya sudah lama banget opnamenya, kayak gitu, dari BPJS plafonnya sudah
banyak sekali, melebihi, itu nanti ada MPP, yang menyampaikan ke DPJP
baiknya gimana, apa dirujuk apa gimana.

It will be assisted by patient case manager. For example, patient case manager
will assist if the patient has been hospitalized for a very long time, as well as
issues regarding patients’ Indonesian national health insurance. The manager also
reports to the consultant doctor regarding if there is any patient’s referral.
Prima What is patient case manager, ma’am?
R8 There are many forms of patient case manager located in every ward. Their job is
to conveys the patient's problem to other parties, such as a doctor, pharmacy
department. For example, how come it's related to a drug that doesn't appear to be
included in patients’ Indonesian national health insurance.
Prima Does the patient case manager consist of nurses?
R8 It doesn’t have to be a nurse but mostly from nurses.
Prima It doesn’t have to be a nurse, right?
R8 The patient case manager consists of nurse and midwife so far.
Prima That means every ward will be visited by patient case manager every day or they
must be reported first.
R8 They visit one wards to another.
Prima How many team members from the patient case manager?
R8 It usually consists of 4 people
Prima Is that for one hospital?
R8 Yes.
Prima How is the role of patient case manager to assist the discharge planning, ma’am?
R8 The patient case manager doesn’t usually assist in the discharge planning,
because this is usually carried out in the managerial level.
Prima In Discharge Planning itself, according to you, who is the one who assist the
most ma'am?
R8 I think the nurse is
Prima Can you explain what kind of roles, ma’am?
R8 Those who often meet patients and educate them are mostly nurses, as well as
accompanying the patient for 24 hours.
Prima What about other professions, ma'am? Doctor, pharmacist, physiotherapist?
R8 Not really
Prima Lastly, Ma'am, do you have any suggestion for the hospital or in the ward so that
the Discharge Planning can be carried out more effective?
R8 Dicarikan solusi supaya komunikasinya ngga terputus setelah pasien itu pulang,
gitu lho, Mbak. Gimana caranya supaya tetap terkontrol dari apa yang sudah
disampaikan di bangsal, trus pasiennya itu sudah melakukan apa belum. Selama
ini, kan, ngga ada. Itu nanti dicarikan bagaimana caranya supaya itu ada gitu, lho.

The hospital needs to work on a solution so the communication is not interrupted

after the patient returns. How do you keep control of what has been conveyed in
the ward, then what has the patient done or not? So far it hasn’t been resolved.
Prima Is there more, ma’am?
R8 That’s all.
Prima Okay. I think I have asked everything to Mrs. XXX. Thank you very much as this
is very useful. Hopefully in the future the Discharge Planning can be carried out
much easier, more efficiently, and the patient won't come back again, ma’am.
R8 Yes, miss. Amen.
Prima Thank you very much for your time. Later, please allow me to continue through
WhatsApp, ma'am. Thank you very much, ma'am. Assalamualaikum
warahmatullahi wabarakatuh.

***