RELATIONSHIP OF KNOWLEDGE AND WORK MOTIVATION OF NURSES WITH ATTITUDES TO SUPPORT THE APPLICATION OF PATIENT SAFETY INPATIENT ROOM OF WONOSARI YOGYAKARTA GENERAL HOSPITAL

The high incidence of patient safety in the hospital illustrates that nurses still lack understanding of the importance of patient safety. This research is to know the relationship between the level of knowledge and work motivation of nurses with the attitude of supporting the implementation of patient safety goals in the inpatient room of RSUD Wonosari Yogyakarta. This research is a quantitative analytic descriptive correlation study with a cross sectional approach. The samples in this study were 60 nurses at Wonosari Yogyakarta Hospital. The sampling technique used stratified random sampling, and data analysis used the Spearman Rank. The results of the spearman rank correlation test stated that there was no relationship between the level of knowledge and attitudes to support the implementation of patient safety targets by nurses in the inpatient room with p value of 0.323> 0.05. There is a relationship between the work motivation of nurses and the attitude of supporting the implementation of patient safety goals in the inpatient room with p value of 0.049 <0.05.There is no relationship between the level of knowledge and attitudes to support the implementation of patient safety goals by nurses in the inpatient room. There is a relationship between the work motivation of nurses and the attitude of supporting the implementation of patient safety goals in the inpatient room.


Introduction
Patient safety is a mandatory system that must be applied in hospitals as patient safety standards. This matter proven to be regulated in Hospital Law Number 44 Year 2009 Article 43 which states that every hospital is obligatory apply the patient safety standart. More complete terms patient safety is regulated in a Ministerial Regulation Health of Indonesia Number 11 of 2017 Article 1 which stated that hospital patient safety is a system that make patient care safer, including risk assessment, identification and management of patient risks, reporting and analysis incident, the ability to learn from the incident and its follow-up, as well implementation of solutions to minimize risks and prevent the occurrence of injuries caused by faulty consequences carry out an action or not take that action supposed to be taken.
The hospital service indicator can be seen from the BOR (Bed Occupancy Ratio) ideal value is between 70-85%, BTO (Bed Turn Over) ideal value between 5-45 days or 40-50 times per one place sleep / year, TOI (Turn Over Interval) ideal value between 1-3 days place 2 empty bed, LOS (Length Of Stay) ideal value between 7-10 days (complications, nosocomial infections, emergency department, level of contaminationin blood, error rate, and patient satisfaction). Increasingthe number of BOR, TOI, BTO and the decrease in the LOS number are hospital service indicators have increased. This hospital service must be followed by implementation patient safety so that the quality of health services at home the pain gets better (WHO, 2006). Patient safety is an indicator of service quality in the hospital. Quality improvement and patient safety are mutual related, the higher the patient's safety, and the better the quality of a hospital. Patient safety and hospital quality positively correlated (Sumarni, 2017 Based on Minister of Health Regulations (2011), the implementation of patient safety, must implement six patient safety goals (SKP), namely 1) accuracy of patient identification, 2) enhancement of effective communication, 3) increasing the safety of drugs that need to be watched, 4) certainty precise location, precise procedure, precise patient surgery, 5) reduction risk of infection, 6) reduction of the patient's risk of falling.The low assessment of patient safety in the hospital will increase the risk of errors such as not occurring expected (KTD), near injury (KNC), potential conditions injuries (KPC), patient safety incidents (IKP), and incidents sentinel. The high number of KTD, KNC, KPC, and Sentinel incidents in health services. It also has an impact on increasing the length of patient care days and certainly will happen increased maintenance expenses. Besides, it can impact on the emergence of conflict between health workers, non health or patient, family, who could potentially result law violations and ethical violations (Ministry of Health, 2011).
Unexpected events (KTD) in various countries are estimated 4.0-16.6% and nearly 50% of them are estimated to be incidents which can be prevented (KPP-RS, 2008). National patient safety agency (2017) reported on the January-December 2016 timeframe the reported patient safety incidence rates in the UK are 1,879,822 events and in Europe the incidence of patients with 4 83.5% risk of infection and evidence of medical error showed 72.3%. Ministry of Health (2014) Malaysia reported patient safety incidence rates in the January timeframe December 2013, there were 2,769 incidents (KKP-RS, 2017). Incident patient safety is most common in many countries related to patient safety is an unexpected event (KTD) such as surgical procedures, medication errors and infections related to health care (WHO, 2017). Report of patient safety incidents in Indonesia, 2008 based on the type according to the Indonesian Ministry of Health (2011) of 145 incidents which reported unexpected events (KTD) as many as 67 cases (46.2%), the incidence of near injury (KNC) was as much 69 cases (47.6%), and others as many as 9 cases (6.2%). Report patient safety incidents by province in 2008 by KKPRS (Hospital Patient Safety Commission) reported DKI Jakarta province ranks the highest, namely 37.9% other provinces, namely Central Java 15.9%, DIY 18.8%, East Java 11.7%, Aceh 10.7%, South Sumatra 6.9%, West Java 2.8%, Bali 1.4%, and South Sulawesi 0.7% (KKP-RS, 2008). Therefore health workers must be aware of their role so that they can participate actively in realizing patient safety (John, 2018).
The practice of patient safety is something very important important in health care and is a standard of safety patient to prevent patient safety incidents such as KTD, KNC, KPC, and Sentinel therefore power health is required to implement six safety objectives patient in hospital. Health workers who apply six patient safety targets, namely nurses, doctors, and personnel health services (DepKes RI, 2006). Nurses play a very important role towards application of patient safety because nurses play a 24 hour role beside the patient so that nurses are required to understand and care on the application of patient safety. Based on research Setiyajati (2014), knowledge, motivation and attitudes of nurses height relates to patient safety especially with early prevention, early detection, correction of abnormalities, therapeutic drug or fluid administration procedures, readings dosage, side effects, self-protection, and contraindications.
Based on research conducted by Ariyani (2009), on analysis of knowledge and work motivation of nurses with attitudes support the implementation of the patient safety program at Moewardi Hospital Surakarta, states that there is a relationship between knowledge and work motivation of nurses with a supportive attitude towards implementation 6 patient safety program at Moewardi Hospital, Surakarta. Enhancement the level of knowledge is important with attitude support the application of patient safety. Determination of an attitude based on knowledge will allow to increase it awareness and sense of responsibility in the nurse's personality, while good work motivation in a nurse willmanifesting an attitude that is directed at the goal to achievethe target is patient safety (Ariyani, 2009). Increase the level of knowledge, work motivation and attitude in thesupporting the application of patient safety is an endeavor done by nurses to minimize unexpected events which will lead to a legal process that can reduce the image and quality of services in hospitals such as prolongation of patient hospitalization, increasing injuries and death, blaming behavior among service workers health, conflict between health care workers and the patient and the patient's family.
Based on the results of preliminary studies by researchers at the hospital Wonosari District General, 5 (five) nurses said the incident patient safety that often occurs in the inpatient room adverse events (KTD) such as patients experiencing phlebitis and the nurse mistakenly provides therapy to the patient. Based on the results the report, also obtained patient safety incident data 7 in 2018 in the inpatient room of Dahlia I and Dahlia II Rumah Wonosari Regional General Hospital, shows there are 37 (thirty seven) cases of unexpected events (KTD), 10 (ten) cases near injury incidence (KNC), 12 (twelve) cases of potential events injury (KPC), and 9 (nine) cases of non-injury (KTC). The high incidence of patient safety in the hospital illustrates that health care Copyright ©2021, Jurnal Keperawatan Respati Yogyakarta, p-ISSN: 2088-8872; e-ISSN: 2541-2728 workers are nurses there is still a lack of understanding of the importance of patient safety (KKP-RS, 2017). Although there have been reports of safety incidents obtained patient, calculation of associated events with patient safety is still very limited because it is still many nurses either covered up or did not report incidents patient safety (PERSI Congress, 2012).

Method
This research is a descriptive quantitative research analytic with cross sectional approach, where measurement the research variables were carried out at the same time.This research was conducted in the inpatient room of the General Hospital Yogyakarta Wonosarion July 2020.The population in this study are all nurses who work in the inpatient room of the House Yogyakarta Wonosari Regional General Hospital, with 148 nurses who work in each inpatient ward of the General Hospital Yogyakarta Wonosari area.The number of research samples was 60 people and the sampling was done by using stratified random technique sampling is the process of taking the sample through a process the division of the population into strata, selecting samples at random simple from each startum and combine them into a sample to estimate its population parameters.

Results and discussion
The results of research conducted on 60 respondents in the room Hospitalization of Wonosari Yogyakarta Hospital shows that most of the respondents' knowledge is good as many as 57 respondents (95.0%) and a small proportion of them have less knowledge as much as 1 respondent (1.7%). Based on the results of this study indicates the level of knowledge of the respondents mostly fall into the good category in supporting the implementation of targets patient safety.According to the assumptions of the researcher, the level of knowledge of the nurse entered in good category this is due to the nurses at RSUD Wonosari Yogyakarta has received training, seminars, and socialization about patient safety in 2019 when RSUD Wonosari Yogyakarta carried out full accreditation 91 on July 25, 2019, every inpatient room already exists manual or SOP on patient safety systems so all components must know about it and available hospital libraries, especially library sources about patient safety (patient safety) as well as with progress technology and information today nurses can access at internet so that nurses can develop knowledge of the application of patient safety goals.
The results of research conducted on 60 respondents in the room most of the motivation for inpatient treatment at RSUD Wonosari Yogyakarta the work of strong nurses as many as 56 respondents (93.3%) and some small work motivation is weak as much as 1 respondent (1.7%) ( Based on the results of this study, the work motivation of nurses is located in the category of strong work motivation in supporting implementation patient safety goals. According to the researchers' assumptions, the work motivation of nurses is included strong category due to nurses in carrying out their duties shows varying performance by level abilities they have, but the nurse remains carry out their duties and responsibilities according to the procedure patient safety measures or SOPs in each room hospitalized so that patients avoid injury when given nursing services. The results of research conducted on 60 respondents in the room most of the inpatients at Wonosari Yogyakarta Hospital were attitudes support nurses in implementing safety goals patients were good as many as 52 respondents (86.7%) and some small attitudes support nurses in the application of targets patient safety is less than 2 respondents (3.3%). Based on the research results show a supportive attitude the application of the patient's Safety Goals was included in the categories good. According to the researchers' assumptions, attitudes support the application of targetspatient safety is in the good category as evidenced bythere is a manual on patient and nurse safetyhave received training on patient safety ateach inpatient ward.

Conclution and suggestion
Based on the results of data analysis and discussion of researchthe relationship between the level of knowledge and work motivation of nurses with attitudes support the application of patient safety goals in the room inpatient Hospital Wonosari Yogyakarta, conclusions can be drawn as follows:The level of knowledge of the nurses in the inpatient ward of Wonosari Hospital most of Yogyakarta's knowledge is in the good category (95.0%), Work motivation of the nurses in the inpatient ward of Wonosari Hospital Yogyakarta, most of the work motivation is in the category strong (93.3%), Attitude supports the implementation of patient safety goals by part of the inpatient nurse of RSUD Wonosari Yogyakarta great attitude supports the implementation of patient safety goals are in the good category (86.7%), There is no relationship between knowledge level and supportive attitude application of patient safety targets in the inpatient room of the RSUD Wonosari Yogyakarta, There is a relationship between the work motivation of nurses and a supportive attitude application of patient safety targets in the inpatient room of the RSUD Wonosari Yogyakarta, There is no joint relationship between levels knowledge and work motivation of nurses with a supportive attitude application of patient safety targets in the inpatient room of the RSUD Wonosari Yogyakarta.