Evaluasi Pelaksanaan Standar Asuhan Antenatal dengan Metode Manajemen Kebidanan oleh Bidan Puskesmas di Kabupaten Banyumas Tahun 2011

Abstract

Universtas Diponegoro Program Pascasarjana Program Magister Ilmu Kesehatan Masyarakat Kosentrasi Administrasi dan Kebijakan Kesehatan Minat Manajemen Kesehatan Ibu dan Anak 2011 ABSTRAK Elty Hilmiati Evaluasi Pelaksanaan Standar Asuhan Antenatal dengan Metode Manajemen Kebidanan oleh Bidan Puskesmas di Kabupaten Banyumas Tahun 2011 xiii + 141 halaman + 11 tabel Asuhan antenatal sebagai salah satu upaya dalam menurunkan Angka Kematian Ibu. Di Kabupaten Banyumas AKI cenderung masih tinggi yaitu 123,9/100.000 KH ditahun 2010. Ibu yang meninggal cenderung yang memeriksakan kehamilannya lebih dari 4 kali. Bidan dalam melakukan standar asuhan antenatal dengan metode manajemen kebidanan mulai dari pengkajian, perumusan diagnosa, perencanaan, pelaksanaan, evaluasi asuhan, pencatatan asuhan tidak dilakukan dengan lengkap sehingga bidan kurang dapat mendeteksi adanya komplikasi/penyakit penyerta pada ibu hamil. Tujuan penelitian adalah mengetahui dan mengevaluasi pelaksanaan standar asuhan antenatal dengan metode manajemen kebidanan oleh bidan puskesmas di Kabupaten Banyumas. Jenis penelitian observasional 2 tahap kuantitatif dan kualitatif, dengan pendekatan cross-sectional. Instrumen penelitian menggunakan kuesioner dan check list pada 78 responden yaitu bidan pelaksana KIA Puskesmas di Kabupaten Banyumas. Data primer maupun sekunder diolah dan dianalisis secara kuantitatif dengan metode unvariat dan cara kualitatif dengan melakukan Indept-Intervieu pada 3 orang bidan dan 1 orang kepala seksi KIA. Hasil penelitian menunjukkan bahwa responden berusia ≥ 35 tahun (69,25%). Tingkat pendidikan responden D III Kebidanan (71,8%) dengan masa kerja > 10 tahun (73,10%). Puskesmas yang memiliki fasilitas/alat kurang lengkap (64,15%). Proses pelaksanaan standar asuhan antenatal dengan metode manajemen kebidanan dengan kategori kurang pada item pengkajian data (54,90%), perumusan diagnosa atau masalah kebidanan (38,33%), pencatatan asuhan (21,0%), dan kategori cukup pada item perencanaan asuhan (59,16%), implementasi asuhan (64,4%), dan evaluasi asuhan antenatal (59,66%). Ketepatan bidan dalam pelaksanaan standar asuhan antenatal (52,75%) dengan kategori kurang. Hasil Indept-intervieu menunjukkan bahwa responden tidak pernah mendapatkan pelatihan standar asuhan antenatal dengan metode manajemen kebidanan hanya sebatas sosialisasi pada saat pertemuan bidan koordinator puskesmas. Disarankan untuk Dinas Kesehatan pelatihan standarisasi asuhan antenatal dalam hal, pengkajian data, perumusan diagnosa kebidanan dan pencatatan asuhan antenatal, pengadaan format pencatatan perkembangan ibu hamil dengan SOAP, pembinaan bidan secara rutin, monitoring dan evaluasi berfokus pada proses pelaksanaan asuhan antenatal. Kata Kunci : Standar Asuhan Antenatal, Metode Manajemen Kebidanan, Antenatal Care, Bidan Puskesmas Pustaka : 67 (1996 - 2011) 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 Elty Hilmiati Evaluation on the Implementation of Antenatal Care Service Standard through Midwivery Management Method by Primary Healthcare Center Midwives in Banyumas District, 2011 xiii + 141 pages + 11 tables Antenatal care was one of efforts to lower maternal mortality. In Banyumas district, maternal mortality rate (AKI) tended to stay at the high level that was 123.9/100.000 live birth in 2010. Maternal death tended to occur to those who did antenatal care more than 4 times. Midwives did not do completely an antenatal care standard using midwifery management method. This method was started from conducting investigation, diagnosis formulation, planning, implementation, antenatal care evaluation, recording the care. As a result, midwives were lack of ability to detect complication/ accompanying diseases in the pregnant women. The objective of the study was to know and to evaluate the implementation of antenatal care standard using midwifery management method by primary healthcare center (puskesmas) midwives in the district of Banyumas. This was an observational study with two phases of study, quantitative and qualitative, using cross sectional approach. Study instruments were questionnaire and check list. Study instruments were applied to 78 respondents. Those respondents were midwives who implemented puskesmas KIA program in the district of Banyumas. Primary and secondary data were managed and analyzed quantitatively using univariate method and qualitative data was collected by implementing in-depth interview to 3 midwives and 1 head of KIA section. Result of the study showed 69.25% of respondents was 35 years old or more, 71.8% of respondents was at D3 midwifery level of education and 73.10% of respondents with working period of more than 10 years. Puskesmas with not complete facilities was 64.15%. Implementation process of antenatal care standard using midwifery management method showed inadequate results on the item of data analysis (54.90%), diagnosis formulation or obstetrical problem formulation (38.33%), recording antenatal care (21.0%). Adequate category was showed by item antenatal care planning (59.16%), implementation of antenatal care (64.4%) and antenatal evaluation (59.66%). The accuracy of midwives in implementing antenatal care standard was 52.75% with inadequate category. Results of in-depth interview indicated that respondents had not received training on antenatal care standard using midwifery management method. They received information only limited to the form of socialization that was given in the puskesmas midwives coordinator meeting. It was suggested for district health office to conduct training on standardization of antenatal care with the topic on data analysis, obstetrical diagnosis formulation and antenatal care recording; to supply pregnant women recording form with SOAP; to do routine midwives assistance, to do monitoring and evaluation focusing on antenatal care implementation process. Key words : Antenatal care standard, midwifery management method, antenatal care, Puskesmas midwives Bibliography : 67 (1996 – 2011)