Sistem Penugasan Keperawatan, Berdasarkan Model Asuhan Keperawatan Professional

Banyak model system penugasan yang dapat digunakan dalam asuhan keperawatan, namun untuk memiliih salah satu dan menggunakanya diperlukan sumber daya yang cukup baik, seperti sumber daya pengetahuan, staf dan sarana pendukung lainnya. Grant dan Massey (1997) serta Marquis dan Huston (1998), terdapat lima model asuhan keperawatan professional (MAKP) yang sudah ada, terdiri dari :

1. Fungsional

Model fungsional digunakan sebagai pilihan utama pada masa perang dunia kedua. Hal ini karena keterbatasan jumlah dan kemampuan perawat. Setiap perawat melakukan 1-2 jenis intervensi keperawatan misalnya satu perawat hanya melakukan perawatan luka kepada semua pasien di bangsal rawat inap.

Kelebihan dari model ini, yaitu :

  1. Menerapkan manajemen klasik yang menekankan efisiensi, pembagian yang jelas, dan pengawasan yang baik.
  2. Perawat senior menyibukan diri dengan tugas manajerial, sedangkan perawatan pasien diserahkan kepada perawat junior dan/atau perawat yang belum berpengalaman.
  3. Sangat cocok untuk rumah sakit yang kekurangan tenaga.

Kelemahan dari model ini, yaitu :

  1. Tidak memberikan kepuasan kepada pasien maupun perawat
  2. Pelayanan keperawatan terpisah pisah, tidak dapat menerapkan proses asuhan keperawatan
  3. Persepsi perawat cenderung kepada Tindakan yang berkaitan dengan keterampilan saja.
2. Keperawatan Tim

Model ini menggunakan tim yang terdiri atas anggota yang berbeda deda dalam memberikan asuhan keperawatan terhadap sekelompok pasien. Perawat ruangan dibagi menjadi dua atau tiga tim atau group yang terdiri atas tenaga professional, tenaga teknis dan pembantu dalam satu group kecil yang saling membantu.

Kelebihan dari model ini, yaitu :

  1. Memungkinkan pelayanan keperawatan yang menyeluruh
  2. Mendukung pelaksanaan proses keperawatan
  3. Memungkinkan komunikasi antar tim, sehingga konflik mudah diatasi
  4. Memberi kepuasan kepada anggota tim

Kelemahan dari model ini, yaitu :

  1. Komunikasi antar anggota tim terbentuk terutama dalam bentuk konferensi tim, yang biasanya membutuhkan waktu karena sulit untuk melaksanakanya pada waktu waktu sibuk.

Konsep keperawatan tim terdiri dari beberpa point yang harus dilaksanakan :

  1. Ketua tim sebegai perawat professional harus mampu menggunakan berbagai metode kepemimpinan
  2. Komunikasi yang efektif untuk mempertahankan kontinuitas rencana asuhan keperawatan
  3. Anggota tim harus menghargai kepemimpinan ketua tim

Tanggung jawab anggota tim :

  1. Memberikan asuhan keperawatan yang ada dibawah naunganya
  2. Bekerjasama antar anggota tim dan antar tim
  3. Memberikan laporan

Tanggung jawab ketua tim

  1. Membuat perencanaan
  2. Membuat penugasan, supervise dan evaluasi
  3. Mengenal/mengetahui kondisi pasien dan dapat menilai tingkat kebutuhan pasien
  4. Mengembangkan kemampuan anggita
  5. Menyelenggarakan konferennsi
3. Keperawatan Primer

Metode penugasan dimana satu orang perawat bertanggung jawab penuh selama 24 jam terhadap asuhan keperawatan pasien. Dilakukan mulai pasien masuk sampai ke luar rumah sakit. Terdapat kejelasan antara si pembuat rencana asuhandan pelaksana.

Kelebihan dari model ini, yaitu :

  1. Bersifat kontinu dan komprhensif
  2. Perawat primer mendapatkan akuntabilitas yang tinggi terhadap hasil dan memungkinkan pengembangan diri
  3. Pasien merasa dihargai karena kebutuhanya terpenuhi secara individu
  4. Asuhan yang dihasilkan bermutu tinggi

Kelemahan dari model ini, yaitu :

  1. Hanya dapat dilakukan oleh perawat yang memiliki pengalaman dan pengetahuan yang memadai dengan kriteria asertif, self direction, memiliki kemampuan untuk mengambil keputusan yang tepat, menguasai keperawatan klinik, akuntable, serta mampu berkolaborasi dengan berbagai disiplin.

Konsep dasar keperawatan primer :

  1. Ada tanggung jawab dan tanggung gugat
  2. Ada otonomi
  3. Ada keterlibatan pasien dan keluarga

Tugas perawat primer :

  1. Menerima pasien dan mengkaji kebutuhan pasien secara komprhensif
  2. Membuat tujuan dan rencana keperawatan
  3. Melaksanakan rencana yang telah dibuat selama berdinas
  4. Mengomunikasikan dan mengoordinasikan pelayanan yang diberikan oleh disiplin lain maupun perawat lain
  5. Menngevaluasi keberhasilan yang dicapai
  6. Menerima dan menyesuaikan rencana
  7. Menyiapkan penyuluhan dan kepulangan pasien
  8. Melakukan rujukan kepada pekerja sosial dengan cara kontak dengan Lembaga sosial di masyarakat
  9. Membuat jadwal perjanjian klinik
  10. Mengadakan kunjungan rumah

Peran kepala ruangan :

  1. Menjadi konsultan dan pengendali mutu perawat primer
  2. Memberi orientasi dan merencanakan karyawan baru
  3. Menyusun jadwal dinas dan memberikan penugasan kepada perawat asisten
  4. Melakukan evaluasi kerja
  5. Merencanakan dan menyelenggarakan pengembangan staf
  6. Membuat 1-2 pasien untuk model  agar mengenal hambatan yang terjadi

Ketenagakerjaan dalam keperawatan primer adalah :

  1. Setiap perawat priner adalah perawat bed side
  2. Beban kasus 4 – 6 pasien untuk satu perawat
  3. Penugasan ditentukan oleh kepala bangsal
  4. Perawat primer dibantu oleh perawat professional mauaun perawat nonprofessional sebagai perawat asisten
4. Manajemen Kasus

Penugasan ini digunakan dengan model satu perawat satu pasien. Umumnya dilaksanakan diruangan khusus seperti ruangan ICU.

Kelebihan dari model ini, yaitu :

  1. Perawat lebih memahami kasus perkasus
  2. System evaluasi dan manajerial menjadi mudah

Kelemahan dari model ini, yaitu :

  1. Perawat penangunng jawab belum teridentifikasi
  2. Pelru tenaga yang cukup banyak dengan kemamppaun dasar yang sama
5. Modifikasi Keperawatan TIM-Primer

Penerapan model ini karena beberapa alasanya, yaitu :

  1. Metode keperawatan primer tidak digunakan secara murni, karena perawat primer memerlukan perawat dengan latar belakang Pendidikan S1 keperawatan dan ners.
  2. Metode perawatan tim tidak digunakan secara murni, karena tanggung jawab asuhan keperawatan pasien tersegmentasi pada berbagai tim dengan kombinasi dua meodel tersebut, diharapkan komunitas asuhan dan akuntabelitas asuha keperawatan  terdapat pada perawat primer

Daftar Pustaka

Suarli. S., Manajemenn Keperawatan dengan pendekatan praktis., Erlangga : Jakarta

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