FACTORS ASSOCIATED WITH STUDENTS COMPLIANCE TO THE USE OF PERSONAL PROTECTIVE EQUIPMENT DURING CLINICAL PRACTICE AMONG ANESTHESIOLOGY NURSING STUDENTS

Personal Protective Equipment (PPE) is a set of required protective clothing to ensure worker safety. PPE is an essential need for healthcare staff that handles patients. PPE is one of the measures to control and prevent infections and protect health professionals from occupational safety and health hazards. During clinical practice in hospitals, using PPE when in contact with patients is crucial in preventing the spread of diseases and infections between students and patients. This study aims to determine the factors associated with Anesthesiology Nursing students' compliance to the use of personal protective equipment during clinical practice. This method of quantitative research takes a cross-sectional approach. The available data are presented as frequency distribution and cross-tabulation, then analyzed statistically using the pearson test. This research led to the submission of an article in a Shinta-indexed journal


Introduction
Society uses the hospital as a referral service following the public health center to seek medical treatment for their illness.Hospitals are one of the health care services that provide a variety of individual services, including inpatient, outpatient, and emergency treatments, according to Minister of Health Regulation Number 30 of 2019.People believe the quality of hospital services will help them overcome their health problems (Listiyono, 2015).The hospital environment has a detrimental effect on the disease's spread.The dangers can be carried on by biological (viruses, bacteria, fungi, and parasites), chemical (antiseptics, regents, anesthetic gas), ergonomic (work environment, improper working posture), physical (temperature, light, noise, vibration, and radiation), and psychological (rotating work, workload, labor relations, relationships between workers and superiors) factors, which can lead to the development of occupational diseases (Zahara et al., 2017).When performing anesthesia, exposure to fluids and blood from the patient is inseparable.
Infection prevention and control in hospitals can be accomplished by improving standard alert behaviors such as hand hygiene, PPE use, wound prevention from sharp objects, waste management, cleaning, disinfection, and sterilization of patient care equipment, and cleaning and disinfection of the environment performed by health workers (WHO, 2004).Knowledge, motivation, attitudes, communication, availability of PPE, and behavior are all factors that influence hospital workers' use of PPE (Wasty dkk., 2021) (Haryani et al., 2014).Using personal protective equipment (PPE) when in contact with patients is essential in reducing the transmission of illnesses and infections to students and patients (Pratiwi et al., 2016).Students of anesthesiology nursing participate in providing anesthetic nursing care during clinical practices in the operating room; given the prevalence of infection transmission, this must be emphasized and considered a standard precaution.

Method
It is quantitative research with a crosssectional approach.The attitude is the free variable, while the variable is linked to the level of compliance.
Students from the Anesthesiology Nursing study program at 'Aisyiyah University in Yogyakarta who had learned through a clinical method, totaling 234 individuals, served as the study population in this study.A non-probability sampling group with a purposive sampling type is employed as a sampling technique.The sample size for this study was set at 150 participants.Sample was found using Slovin formula.
The compliance level questionnaire instrument was adopted from a study by Baunsele (2020).The motivation questionnaire instrument was adopted from Pratiwi's research (2016).The attitude and knowledge questionnaire instrument was adopted from the research conducted by Putra (2012).The questionnaire has been uploaded to a Google form.Specifically, pearson tests are used in data analysis to perform bivariate analysis to determine the relationship between free variables and bound variables.The study was conducted when it was determined as ethically viable with the numbers 2000/KEP-UNISA/III/2022.According to Table 3, the average knowledge level of respondents was 11.15, with 7 representing the lowest knowledge score and 14 representing the highest.The respondents' average attitude score was 69.20, ranging from 53 for the lowest attitude score to 76 for the highest.The respondents' motivation scores ranged from 45 to 80, with an average of 72.12 as the lowest and highest scores, respectively.The average compliance score for respondents was 21.37; the lowest compliance score was 16, and the highest was 22. Health professionals use personal protective equipment (PPE) to protect themselves while performing their duties.Similarly, students conducting the clinical practice in hospitals cannot be separated from the risk of exposure to various microorganisms.To prevent and control the spread of infection, students who interact directly with patients in hospitals are emphasized the importance of compliance.

Characteristics of
According to Astuti et al., (2018), knowledge is not the only element influencing compliance in using PPE; there are other supporting and driving variables.Although the level of knowledge is high, if the availability of existing facilities does not support it, it cannot be utilized appropriately.A person's attitude can be significantly influenced by the availability of helpful and accessible services.When covid-19 cases are rising, there is a shortage of personal protective equipment (PPE) among students practicing clinics at hospitals.Another study by Dewi et al., (2019) found that although people know about using personal protective equipment (PPE) before performing necessary actions, compliance with using PPE does not happen naturally.Instead, compliance with using PPE is supported by the presence of a strong driver as a person's willingness in accordance with the knowledge possessed.
The attitude a person has when performing a crucial task is taken into account when making decisions, according to research by Sulistyawati et al., (2021), and good decisions affect good behavior.Janah and Nur Janah et al., (2021) found that respondents with a positive attitude toward PPE use were aware of the risks posed by not wearing complete PPE and avoided the possibility of transmitting infectious diseases while in the hospital.They are aware of the dangers they may encounter when operating clinics in hospitals because they are health students.The attitude encourages students to respond positively to compliance with the use of PPE.
There are several things that might affect someone's motivation, and one of them is something inside of them.Because high motivation can have an effect on better behavior in the use of PPE, internal variables themselves can take the shape of experience and education gained while working as well as from prior educational experiences (Kustriyani et al., 2018).Due to the fact that students practice in a hospital, Mau & Prayogi (2018) claim that strong motivation is required to increase compliance in the usage of PPE.This is because students must realize and understand that the work they are doing is risky.External factors, such as the practice area's rules requiring students to wear PPE when interacting with patients, serve to further motivate students.Motivation as a driving element in engaging students to carry out clinical practice in hospitals.Since motivation plays a significant part in the learning process, it's possible for students who are highly motivated to follow the regulations that have been established when offering services to patients.The strength and weakness of a person's motivation can show how much responsibility he has for his work.

Conclusions and suggestions
This study concludes a relationship between respondents' attitudes and PPE compliance during clinical practice.While in the variables of knowledge and motivation, there is no relationship with respondents' compliance with using PPE during clinical practice.

Table 1 .
Respondents Characteristics of Respondents According to Gender and Practice Hospitals

Table 2 .
Characteristics of Respondents According to AgeTable 2 indicates that the average age of the respondent is 21.23 with the youngest and oldest ages being 20 and 25, respectively.

Table 3 .
Average Scores for Knowledge, Attitude, Motivation, and Compliance Level

Table 4 .
Cross-tabulation of the Relationship of Knowledge, Attitude, and Motivation Regarding Personal Protective Equipment (PPE) to Compliance of Personal Protective Equipment (PPE)