THESIS

KNOWLEDGE, ATTITUDE, AND SPIRITUAL INTELLEGENCE TOWARD

QUALITY OF WORK LIFE AND THE IMPACT ON NURSES’
PERFORMANCE OF PATIENT SAFETY SYSTEMS IMPLEMENTATION IN
IKHLAS PEMALANG HOSPITAL
dr. Alviane Tiara Putri, MMR

HOSPITAL MANAGEMENT STUDY PROGRAM

POST GRADUATE PROGRAM
MUHAMMADIYAH UNIVERSITY OF YOGYAKARTA
(2018)
 A. BACKGROUND

INTRODUCTION
• Hospitals have a risk of medical errors
• Number of medical error events in various countries according to WHO
• Number of medical eror events in Indonesia according to permenkes RI
• Incidence of patient safety
• Incidence of patient safety are done by the nurse
• Performance of nurses
• Problems in Ikhlas Islamic Hospital
B. PROBLEM FORMULATION

How the influence of knowledge, attitude, and spiritual intelegence toward quality of work life and the impact on
nurses’ performance of patient safety systems implementation in islamic ikhlas pemalang hospital?
 C. RESEARCH OBJECTIVE
• To analyzed the influence of knowledge toward nurses’ performance of patient safety systems implementation

• To analyzed the influence of knowledge toward quality of work life and its impact on nurses’ performance of patient safety
systems implementation

• To analyzed the influence of attitude toward nurses’ performance of patient safety systems implementation

• To analyzed the influence of attitude toward quality of work life and its impact on nurses’ performance of patient safety
systems implementation

• To analyzed the influence of spiritual intelegence toward nurses’ performance of patient safety systems implementation

• To analyzed the influence of spiritual intelegence toward quality of work life and its impact on nurses’ performance of
patient safety systems implementation
D. RESEARCH BENEFIT

• Teoritical

• Hospital

• Academic

• Researcher
 A. Literature Review
1. NURSE PERFORMANCE
Definition
LITERATURE
Nursing performance evaluation parameters according to Kuncoro (2012)
REVIEW
Patient safety international standard version of IPSG

2. KNOWLEDGE
Definition
Level of knowledge according to Notoadmojo (2010)
3. ATTITUDE

Definition
Component attitude according to Azwar (2011)

4. SPIRITUAL INTELEGENCE

Definition
Components of spiritual intelegence according to Zohar and Marshall (2005)

5. THE QUALITY OF WORK LIFE

Definition
Components of quality of work life according to Cascio in Nawawi (2008)
B. Current Research
Researcher Title Research Method Research Result Differences
Almaramhy Knowledge and This research used cross The results showed that the Variable quality
Attitude Towards sectional approach. majority of respondents were of work life,
Patient Safety Among Samples as many 150 well-informed and agreed on spiritual
a Group of people. Measuring tool the importance of patient quotient and
Undergraduate with learning method. safety. nurse
Medical Students in performance
Saudi Arabia
Brasaitė Health Care Descriptive research with Professional health safety Variables of
Professionals’ cross sectional approach. knowledge had a significant knowledge, type
Knowledge and Samples as many 1082 positive relationship with all of research and
Attitudes Regarding people. Data collecting safety attitudes and safety data analysis
Patient Safety and technique used scales skills used in the techniques
Skills for Safe Patient questioner. Data analysis evaluation
Care used ANOVA
 Researcher Title Research Method Research Result Differences

Bawelle Correlation between Design research was analytic survey The result of the research showed that Variable quality of work
Knowledge And Nurse with cross sectional design. there was correlation between nurse life, spiritual quotient
Attitude With Patient Selection of sample with purposive knowledge and patient safety and there and nurse performance
sampling counted 65 respondents was correlation between nurse attitude
Safety Implementation In
and patient safety implementation at
Inpatient Room Rsud Liun Inpatient Room of RSUD Liun Kendage
Kendage Year A Tahuna

Ibrahim The Influence Of Emotional This type of research was an The results showed that emotional Variable knowledge,
Intelligence To explanatory study of the intelligence significantly influence the attitude of quality of
Organizational Citizenship relationship between the variables organizational citizenship behavior of work life, spiritual
studied. Sample selection with nurses, OCB had a significant effect on
Behavior And Its Impact quotient and patient
proportional random sampling nurse performance, emotional
On The Performance Of counted 157 intelligence significantly affects the safety
Nurse Anutapura General performance of nurses Anutapura
Hospital & Hospital Of General Hospital and RS Undata Palu
Palu Undata
C. Theoretical basis

This research use theoreticals from Notoadmojo

(2010), Azwar (2011), Cascio in nawawi (2008),

Kuncoro (2012), Zohar and marshall (2005), Helmiatin

(2013), Mubarak (2008), Wibowo (2012).

D. Theoretical framework
Nurse
Knowledge Spiritual
1. IPSG 1 Knowledge
Attitude
2. IPSG 2 1. 1. Ability to be flexible
1. IPSG 1
3. IPSG 3 2. High self-awareness
2. IPSG 2
4. IPSG 4 3. Ability to deal with and
3. IPSG 3 exploit suffering
5. IPSG 5 4. IPSG IPSG 4 4. Ability to deal with and
6. IPSG 6 5. IPSG 5 overcome pain
7. Panduan nasional 6. IPSG 6 5. Reluctance to cause
7. Panduan nasional unnecessary losses
6. Quality of life
7. Holistic View
8. The tendency to ask
questions
9. Independent field

Quality of work life

Nurses performance in Patient
1. Employee involvement / partitioning Safety Implementation
2. Security in the job 1. Accuracy
3. Safety of work environment
4. Troubleshooting
2. Achievements
5. Communication 3. Administration
4. Communication
5. Competence
6. Cooperation
7. Interpersonal skills
8. Learning

Picture 2.1. thoreticalframework modificated form Mubarak (2008), Notoatmodjo (2010), Azwar (2011), Cascio dalam nawawi (2008), Kuncoro
(2012), Zohar dan Marshall (2005), Helmiatin (2013) and Wibowo (2012)
E. Conceptual framework
Knowledge
H1

H2

H3
Quality of work Nurses
Attitude life performance in
Patient Safety
H4 Implementation

H6

H5
Spiritual
Knowledge Picture 2.2
Conceptual framework
F. Research Hypothesis
Nurses performance in
Patient Safety Implementation
•
“
There is an influence of knowledge toward nurses’ performance of patient safety systems implementation
• There is an influence of knowledge toward quality of work life and its impact on nurses’ performance of patient
safety systems implementation
• There is an influence of attitude toward nurses’ performance of patient safety systems implementation
• There is an influence of attitude toward quality of work life and its impact on nurses’ performance of patient safety
systems implementation
• There is an influence of spiritual intelegence toward nurses’ performance of patient safety systems implementation
• There is an influence of spiritual intelegence toward quality of work life and its impact on nurses’ performance of
patient safety systems implementation
 A. Types and Research Design
decscriptive qualitative and quantitative research with cross sectional research design
RESEARCH
B. Subjects and objects of research
METHOD
subjects in this study were nurses woking at Ikhlas Pemalang Hospital
objects in this study are all variable
the time of research is completed in june 2017
the location of research in Ikhlas Pemalang Hospital
C. Population, samples and sampling techniques
the population is all nurses who work in Ikhlas Pemalang Hospital as many as 40 nurses
the sample are nurses who are on duty at Ikhlas Pemalang Hospital 40 people
the sampling technique use the total sampling
a. Inclusion criteria
b. Exclusion criteria

D. Research Variables
Independent variables: knowledge, attitude, spiritual intelligence
Dependent variable: nurse performance
Intervening variable: quality of work life
 E. Operational definition
Variable Definition Method Tools Results Scale
Knowledge Nurses' understanding level related Questionnaire Questionnaire with number Very good 55-64 Interval
to patient safety system material. assessment Good 45-54
The material of patient safety Fair 35-44
system in this research are the 4 = Strongly Agree Poor 25 -34
national guidelines of patient 3 = Agree Very poor 15-24
safety in the hospital, the report 2 = Disagree
guidelines of Patient Safety 1 = Strongly Disagree
Incidency, and the national
standard of material from Joint
Commision International / JCI.
(Kuncoro, 2012)
 Variable Definition Method Tools Results Scale
Attitude Assessment based on nurses' Questionnaire Questionnaire with number Very good 55-64 Interval
perception about patient assessment Good 45-54
safety system material bsed Fair 35-44
on national guadlines, 4 =Strongly Agree Poor 25 -34
repoted system of IKP and 3 = Agree Very poor 15-24
IPSG 1 s/d 6 (Kuncoro, 2 = Disagree
2012) 1 = Strongly Disagree

Spiritual Nurses' belief toward the Questionnaire Questionnaire with number Very good 55-64 Interval
Intelegence ability to give a spiritual assessment Good 45-54
meaning on every behaviour Fair 35-44
and activity with 9 4 =Strongly Agree Poor 25 -34
indicator and thought which 3 = Agree Very poor 15-24
is fitrah with asmaul husna 2 = Disagree
(Zohar dan Marshall, 2005) 1 = Strongly Disagree
 Variable Definition Methods Tools Results Scale
Quality of Assessment based on nurses' Questionnaire Questionnaire with number assessment Very good 55-64 Interval
Work Life perception that has been felt Good 45-54
and experienced toward 4 =Strongly Agree Fair 35-44
hospital's work environment 3 = Agree Poor 25 -34
which consist of 5 2 = Disagree Very poor 15-24
components. (Kuncoro, 2012) 1 = Strongly Disagree

Performance The nurses' results Questionnaire Questionnaire with number assessment Very good 55-64 Interval
assessment related to patient Good 45-54
safety system material. It 4 =Strongly Agree Fair 35-44
uses 8 indicators (Kuncoro, 3 = Agree Poor 25 -34
2012) 2 = Disagree Very poor 15-24
1 = Strongly Disagree
F. RESEARCH INSTRUMENT

1. Questionnaire

• Part A about nurses' knowledge consist of 21 question

• Part B about nurses' behaviour consist of 25 question
• Part C about nurses' spiritual intelegence consist of 27 question
• Part D about nurses' quality of work life consist of 21 question
• Part E about nurses' performance consist of 29 question

2. Documentation

the format of research data is document, from book, archieve, photo etc.
G. Test validity and reliability test
My quetionare based on Teguh Kuncoro, 2012, ESQ Zohar and Marshall, 2005 that has validated before.

H. Data Analysis
Data analysis using SEM structural equation modeling with Regression weight technique and using data
analysis tool PLS partial least square

I. Research stages
• Preparation
• Implementation
• Data analysis and reporting

J. Research ethics
Informed consent >>> Anomity >>> Confidentiality
 A. Description of respondent
RESEARCH prosentati
No. Characteristics of respondent Frecuency
RESULT AND on
1. Gender
DISCUSSION a. Male 12 30,0
a. Female 28 70,0
2. Age
a. < 25 yo 16 40,0
a. 25 – 30 yo 22 55,0
a. > 30 yo 2 5,0
Total 40 100,0
 B. Descriptive statistic
Minimu Maximu Std.
m m Mean Dev
Knowledge of nurses 55,0 83,0 65,02 6,78
Attitude of nurses 58,0 95,0 77,47 8,33
Intelegence spiritual 61,0 104,0 87,27 9,02
Quality worklife 54,0 82,0 65,80 7,72
Performance of nurses 62,0 116,0 86,07 10,63
1. Knowledge of nurses
Frecue Prosentase
Category Score interval
ncy (%)
Very good X > 77 3 7,5
Good 63 < X < 76 20 50,0
Fair 49 < X < 62 17 42,5
Poor 35 < X < 48 0 0
Very poor X < 34 0 0
40 100
2. Attitude of nurses
Frecue Prosentase
Category Score interval
ncy (%)
Very good X > 89 4 10,0
Good 73 < X < 88 27 67,5
Fair 57 < X < 72 9 22,5
Poor 41 < X < 56 0 0
Very poor X < 40 0 0
40 100
3. Intelegence spiritual
Frecu Prosentase
Category Score interval
ency (%)
Very good X > 95 9 22,5
Good 78 < X < 94 27 67,5
Fair 61 < X < 77 4 10,0
Poor 44 < X < 60 0 0
Very poor X < 43 0 0
40 100
4. Quality of worklife
Frecuen Prosentase
Category Score interval
cy (%)
Very good X > 77 6 15,0
Good 63 < X < 76 19 47,5
Fair 49 < X < 62 15 37,5
Poor 35 < X < 48 0 0
Very poor X < 34 0 0
40 100
 5. Performance of nurses
Frecuen Prosentase
Category Score interval
cy (%)
Very good X > 105 3 7,5
Good 86 < X < 104 19 47,5
Fair 67 < X < 85 17 42,5
Poor 48 < X < 66 1 2,5
Very poor X < 47 0 0
40 100
C. Data analysis using PLS
Data analysis using SEM structural equation modeling with Regression weight technique and
using data analysis tool PLS partial least square

1. Testing outer model

 Convergent validity and discriminant validity

Knowledge : 11 item valid

Attitude : 15 item valid

Intelegence spiritual : 16 item valid

Quality of worklife : 13 item valid

Performance : 24 item valid

 Realibility
Composite Cronbac
Reliability hs Alpha
Knowledge 0,915 0,898
Attitude 0,914 0,897
Intelegence spiritual 0,921 0,907
Quality of worklife 0,918 0,903
Performance of nurses 0,947 0,941

Realibility test is done by looking at the value of Cronbach alpha and composite
realibility. The value of realibility >0,70, it means the instrument realibility is
fulfilled
2. Testing of structural models (inner model)
Standard P
Original Sample T Statistics
Deviation
Sample (O) Mean (M) (|O/STERR|)
(STDEV) Values

Knowledeg -> Nurse 0,228 0,244 0,081 2,820 0,005

Performance

Knoewledege->
0,282 0,286 0,101 2,784 0,006

Quality Of Life Job

Attitude->
0,077 0,098 0,139 0,553 0,580

Nurse Performance
Attitude->
0,649 0,669 0,145 4,488 0,000
Quality of Job Life

0,199 0,185 0,135 1,475 0,141

Spiritual Intelligence ->
Nurse Performance

Sprirtual Intelligence-> 0,017 0,004 0,162 0,103 0,918

Quality of Job Life

0,510 0,501 0,119 4,279 0,000

Quality of Job Life ->
Nurse Performance
 H1: The influence of knowledge toward nurses’ performance of patient safety systems implementation in Al-Ikhlas Pemalang Hospital

The result of t test is got the value of t arithmetic equal to 2,820 with coefficient value (original sample) equal to 0,228, because t count> t table
(2,820> 1,960) hence hypothesis that "knowledge influence to nurse performance Al-ikhlas Pemalang Hospital"supported”.

H2: The influence of knowledge toward quality of work life and its impact on nurses’ performance of patient safety systems implementation in Al-
ikhlas Pemalang Hospital

Based on the results in Table ,the hypothesis that "knowledge” influence to the quality of work life at Al-ikhlas Pemlang Hospital "is supported. This
is evidenced because it has a value of t arithmetic respectively of 2.784 and 4.279.

H3: The influence of attitude toward nurses’ performance of patient safety systems implementation Al-ikhlas Pemalang Hospital

The result of t test statistic obtained by t value 0,553 with coefficient value (original sample) 0,077, because t count <t table (0,553 <1,960) hence
hypothesis that " on the performance of nurses in the influence of patient safety systems at Al-ikhlas Pemalang Hospital "is not supported.
 H4: The influence of attitude toward quality of work life and its impact on nurses’ performance of patient safety systems implementation Al-ihlas
Pemalang Hospital

Based on the results in Table,the hypothesis stating that ”influence of attitude towrd quality of work life and its impact on the performance of nurses
in the implentation of patient safety systems Pemalang Hospital " is supported. This is evidenced because it has t value respectively of 4,488 and
4,279.

H5: The influence of spiritual intelegence toward nurses’ performance of patient safety systems implementation Al-ikhlas Pemalang Hospital

The result of t test statistic ,obtained t value equal to 1,475 with coefficient value (original sample) equal to 0,199, because t count <t table (1,475
<1,960) hence hypothesis stating that " spiritual influence on the performance of nurses in the implementation of patient safety systems at Al-ikhlas
Pemalang Hospital "is not supported.

H6: The influence of spiritual intelegence toward quality of work life and its impact on nurses’ performance of patient safety systems implementation
Al-ikhlas Pemalang Hospital

Based on the results in Table, the hypothesis that "spiritual intelligence influence to the quality of work life and its impact on nurse performance in
implementationof patient safety system at Al-ikhlas Pemalang Hospital " is not supported. It is proved by spiritual intelligence does not influence the
quality of work life because the value of t arithmetic <t table (0.103 <1.960).
D. Discussion
 a. The influence of knowledge toward nurses’ performance of patient safety systems implementation in Al-Ikhlas Pemalang Hospital

Based on the results of previous research theories and research can be stated that knowledge affects the performance of nurses in the implementation
of patient safety systems. A person's knowledge has an important role to play in performance. When the knowledge is good then the performance of
the nurse in implementation to the patient's safety system will increase.

b. The influence of knowledge toward quality of work life and its impact on nurses’ performance of patient safety systems implementation in Al-ikhlas
Pemalang Hospital

Based on the results of research can be stated that knowledge synergize with the quality of work life to improve the performance of nurses.
Knowledge can be a supporter's capacity for nurses to improve the quality of work and performance either directly or indirectly, thereby the
knowledge of the nurse becomes an important base in carrying out the mandatory activities in accordance with the nurse’s performance in the
implemetation of patient safety system at Al-ikhlas Pemalang Hospital.

c. The influence of attitude toward nurses’ performance of patient safety systems implementation Al-ikhlas Pemalang Hospital

Based on the results of research stated that the attitude does not influence the performance of nurses. Nurses who have a positive attitude impact on
the performance of nurses in implementation patient safety systems. Attitudes can indirectly affect the performance of nurses with the existence of
other variables such as quality of work life in implementation of patient safety systems at Al-ikhlas Pemalang Hospital.
 d. The influence of attitudes towards quality of work life and its impact on nurses performance of patient safety systems implementation in Al-ikhlas Pemalang Hospital

Based on the result of research, it is stated that the attitude has an indirect effect on the performance of the mediated nurse through the quality of work life. Attitudes are
able to provide carrying capacity in the presence of mediating variables and impact on the performance of nurses in the implementation of patient safety systems at Al-ikhlas
Pemalang Hospital.

e. The influence of spiritual intelligence toward on nurses performance of patient safety system implementation in Al-ikhlas Pemalang Hospital.

Based on the results of research can be stated that spiritual intelligence does not affect the performance of nurses. This means that the spiritual ability of each nurse is almost
the same. Spiritual intelligence mostly with good category supports the improvement of employee performance with the same quality of work against the background of all
Muslim nurses working at Al-ikhlas Pemalang Hospital with religious values. The spiritual intelligence of a person makes a habit with responsibility to others and to Allah in
work, thus becoming a culture between nurses in the implemenattion of patient safety systems at Al-ikhlas Pemalang Hospital.

f. The influence of spiritual intelligence towards the quality of work life and its impact on nurses performance of patient safety systems impenetation in Al-ikhlas Pemalang
Hospital

Based on the results of research can be stated that spiritual intelligence has no direct or indirect effect on the performance of nurses. The nurse's spiritual intelligence
possessed with an awareness to help and worship to Allah, so that all nurses will work together. Therefore, the nurse's spiritual intelligence is needed in a sustainable manner,
with awareness built from the beliefs of worship with others and to Allah in the implementation of patient safety system at Al-ikhlas Pemalang Hospital
 1. Knowledge influence to the performance of nurses in the implementation
of patient safety system at Al-ikhlas Pemalang Hospital. The higher the
knowledge of a person, the performance of the patient safety
CONCLUSION implementation is increasing.

2. Knowledge influencethe quality of work life and has an impact on the

performance of nurses. Nurses who have a good quality of work life impact
on improving the performance of nurses in the implementation of patient
safety systems.

3. Nurse attitude does not influence to the performance of nurses at Al-

ikhlas Pemalang Hospital. Attitudes are able to provide a carrying capacity
in the presence of mediating variables and their impact on performance
urses in the implementation of patient safety system at Al-ikhlas Pemalang
Hospital.

4. The attitude of nurses influence to the quality of work life and have an
impact on the performance of nurses.

5. Spiritual intelligence does not influence the performance of nurses at Al-

Ikhlas Pemalang Hospital

6. Spiritual intelligence does not influence the quality of work life and has an
 T
Thank You
Any question?