Faktor-Faktor yang Berpengaruh terhadap Kinerja Bidan Desa dalam Penerapan Standar Asuhan Persalinan Normal pada Kala III dan Kala IV di Kabupaten Grobogan

Abstract

Universitas Diponegoro Program Pascasarjana Program Magister Ilmu Kesehatan Masyarakat Konsentrasi Administrasi dan Kebijakan Kesehatan Minat Manajemen Kesehatan Ibu dan Anak Semarang 2011 ABSTRAK Panca Indriarti Wiliarti Faktor-Faktor yang Berpengaruh terhadap Kinerja Bidan Desa dalam Penerapan Standar Asuhan Persalinan Normal pada Kala III dan Kala IV di Kabupaten Grobogan xiii + 134 hal + 28 tabel + 3 gambar + 14 lampiran Angka Kematian Ibu (AKI) di Kabupaten Grobogan dalam beberapa tahun terakhir termasuk dalam kategori tinggi di Provinsi Jawa Tengah. Penyebab kematian ibu terbesar dalam kurun waktu 3 tahun terakhir antara tahun 2007 sampai tahun 2009 adalah eklamsi dan perdarahan serta menurut status ibu didapatkan terjadinya kematian terbanyak waktu bersalin dan nifas. Hal ini dapat dicegah apabila bidan menerapkan standar APN.Penelitian ini dilakukan untuk mengidentifikasi faktor-faktor apakah yang berpengaruh terhadap kinerja bidan desa dalam penerapan standar Asuhan Persalinan Normal pada kala III dan kala IV di Kabupaten Grobogan. Penelitian deskriptif analitik ini dengan pendekatan belah lintang dengan sampel 85 bidan desa yang diambil dengan proportional random sampling dari populasi 108 bidan desa yang telah dilatih APN dan selang kepercayaan 95%. Variabel terikat dalam penelitian ini adalah kinerja bidan desa dalam penerapan standar APN pada kala III dan kala IV dan variabel bebas adalah pengetahuan bidan desa tentang APN, sikap bidan desa terhadap APN, motivasi bidan desa untuk melaksanakan APN dan persepsi terhadap supervisi. Hasil penelitian menunjukkan bahwa 58,8% bidan mempunyai pengetahuan yang baik tentang penerapan standar APN pada kala III dan kala IV, 56,5% bidan mempunyai sikap mendukung terhadap penerapan standar APN pada kala III dan kala IV, 62,4% bidan mempunyai motivasi yang baik terhadap penerapan standar APN pada kala III dan kala IV, dan 68,2% bidan mempunyai persepsi yang baik terhadap supervisi penerapan standar APN pada kala III dan kala IV. Uji chi square menunjukkan bahwa variabel yang berhubungan secara signifikan dengan kinerja dalam penerapan standar APN pada kala III dan kala IV adalah pengetahuan (x2=5,791, p=0,016), sikap (x2=3,944, p=0,047), motivasi (x2=4,685, p=0,030) dan persepsi bidan terhadap supervisi APN (x2 =5,712, p=0,017). Hasil analisis multivariat menunjukkan bahwa persepsi terhadap supervisi APN merupakan variabel yang mempunyai pengaruh paling signifikan terhadap kinerja dalam penerapan standar APN pada kala III dan kala IV dengan nilai p=0,027 (p<0,05), dan nilai Exp.(B)=3,054. Disarankan kepada Dinas Kesehatan untuk melakukan monitoring pada pelaksanaan supervisi bidan koordinator Puskesmas dan organisasi profesi IBI untuk melakukan pendekatan dan perubahan pola supervisi pada bidan sehingga supervisi tersebut merupakan pembinaan penerapan langkah standar APN kala III dan IV secara urut dan benar. Organisasi IBI perlu mengkaji ulang langkah-langkah dalam pelaksanaan standar APN sehingga bidan tidak merasa pelaksanaan APN terlalu rumit dan tidak praktis dan merasa nyaman. Kata kunci : bidan desa, kinerja, Asuhan Persalinan Normal. Kepustakaan : 44, 1985-2009 Diponegoro University Postgraduate Program Master’s Program in Public Health Majoring in Health Policy Administration Sub Majoring in Maternal and Child Health Management 2011 ABSTRACT Panca Indriarti Wiliarti Factors Affecting Village Midwives Work Performance in Applying Normal Delivery Assistance Standard at Phase III and Phase IV in Grobogan District xiii + 134 pages + 28 tables + 3 figures + 14 enclosures Maternal mortality rate in Grobogan district in the last few years fell in the high category in Central Java province. The main causes of maternal mortality in the last 3 years, 2007 – 2009, were eclamsia and hemmorrhage. Based on the maternal status, the maternal mortality was mostly when they were giving birth and when they were in post delivery period. These could be prevented if midwives applied standard of normal delivery assistance (APN). This study was conducted to identify factors that influenced village midwives work performance in applying normal delivery assistance standard at phase III and phase IV in Grobogan district. This was a descriptive analytical study with cross sectional approach using 85 village midwives. This samples were selected from 185 village midwives who had beed trained about APN by using proportional random sampling method with 95% confidence interval. The dependent variable in this study was village midwives work performance in applying APN standard at phase II and phase IV. Independent variables were knowledge of village midwives about APN, attitude of village midwives towards APN, motivation of village midwives to implement APN and perception towards supervision. Results of the study showed that 58.8% of midwives had good knowledge on applying APN standard at phase III and phase IV, 56.5% of midwives had attitude to support the application of APN standard at phase III and phase IV, 62.4% of midwives had good motivation towards application of APN standard at phase III and phase IV and 68.2% of midwives had good perception on supervision on the application of APN standard at phase II and phase IV. Chi-square test showed variables that were associated significantly with work performance of midwives in applying APN standard at phase II and phase IV. Those variables were knowledge (x2=5,791, p=0,016), attitude (x2=3,944, p=0,047), motivation (x2=4,685, p=0,030) and perception of midwives towards APN supervision (x2 =5,712, p=0,017). Result of multivariate analysis showed that perception towards APN supervision was the variable that had most significant influence to work performance of midwives in applying APN standard at phase II and phase IV with the p value of 0.027 and the Exp (B) value of 3.054. It was suggested to the district health office to do monitoring the implementation of puskesmas midwives coordinator supervision. Indonesian midwifery association (IBI) as a professional organization had to approach and to revise supervision pattern to midwives in order to be able to use that supervision to assist the steps in applying APN standard at phase III and phase IV in the right sequence and in the correct way. IBI organization needed to review steps in implementing APN standard in order to avoid complicated and impractical implementation of APN by midwives. Key words : village midwives, normal delivery assistance Bibliography : 44, 1985 - 2009