KUESIONER

KABID/KASI KEPERAWATAN
DI RSUD H. ABDUL MANAP
KOTA JAMBI

Dosen Pembimbing Akademik:

Dr. Yulastri Arif, M.Kep
Pembimbing Lahan/Klinik:
dr. H. Maulana, MKM

DISUSUN OLEH :
Jufri Alfajri
1421312043

PROGRAM STUDI MAGISTER KEPERAWATAN

FAKULTAS KEPERAWATAN UNIVERSITAS ANDALAS
2015

LEMBAR PENJELASAN PENGKAJIAN DATA

MANAJEMEN PELAYANAN KEPERAWATAN
DI RSUD H. ABDUL MANAP KOTA JAMBI
Assalamualaikum Wr, Wb.
Dalam rangka kegiatan residensi S2 keperawatan

peminatan Kepemimpinan dan

Manajemen Keperawatan Universitas Andalas Padang di RSUD H. Abdul Manap Kota

Jambi, bersama ini saya memohon kesediaan Bapak/Ibu untuk mengisi kuesioner ini dengan
jujur dan benar sesuai dengan apa yang dialami. Kuesioner ini tidak bertujuan untuk menilai
pengetahuan rekan-rekan, tetapi untuk memperoleh gambaran yang tepat tentang pelaksanaan
manajemen pelayanan dan asuhan keperawatan serta hambatan/kendala yang ditemukan
dalam pelaksanaan selama ini.
Hasil kajian yang diperoleh dari Bapak/Ibu merupakan masukan yang dapat digunakan
untuk meningkatkan kualitas pelayanan dan asuhan keperawatan di RSUD H. Abdul Manap
Kota Jambi.

Segala informasi yang diberikan akan dijamin kerahasiaannya dan akan

digunakan hanya untuk peningkatan mutu pelayanan keperawatan di rumah sakit ini.
Demikianlah penjelasan ini disampaikan, atas segala perhatian dan partisipasi dari
rekan-rekan semua diucapkan terima kasih.
Wassalamualaikum Wr, Wb

Mahasiswa Residen
Jufri Alfajri

A. Ketersediaan Pelayanan Rawat Jalan

1. Apakah ada perencanaan program untuk mendirikan Poliklinik Jiwa?
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2. Apakah ada kebijakan untuk mendirikan Poliklinik Jiwa ?
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3. Apakah ada pembentukan panitia pendirian Poliklinik Jiwa ?
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4. Apakah ada kejelasan wewenang dan tugas setiap panitia ?
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5. Apakah pimpinan memberikan bantuan dan dukungan yang mendukung program
pendirian Poliklinik Jiwa?
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6. Apakah ada pelatihan yang diberikan kepada seluruh staf terkait asuhan keperawatan
jiwa?
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7. Apakah ada penilaian tentang pentingnya Poliklinik Jiwa di rumah sakit ?

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8. Apakah proses penilaian dilakukan dengan membandingkan standar (badan
akreditasi/undang-undang) dengan praktek yang ada?
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B. Hak Pasien dan Keluarga
1. Apakah ada penyusunan hak pasien dan keluarga ?
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2. Apakah pemimpin rumah sakit bekerja sama untuk melindungi hak pasien dan
keluarga ?
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3. Apakah pimpinan mengarahkan untuk memastikan agar seluruh staf
bertanggungjawab melindungi hak pasien ?
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4. Apakah ada supervisi tentang hak pasien dan keluarga untuk staf ?
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C. Kegiatan Pencatatan dan Pelaporan Tuberkulosis di Rumah Sakit

1. Apakah ada penyusunan perencanaan pelayanan DOTS TB?

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Apakah ada kebijakan tentang pelayanan DOTS TB?
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Apakah ada proses/mekanisme dalam program pelayanan DOTS TB termasuk
pelaporannya ?
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Apakah terbentuk dan berfungsinya tim DOTS TB di rumah sakit ?
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Apakah rumah sakit memberikan dukungan penuh dalam pelayanan DOTS TB ?
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6. Apakah ada pelatihan untuk meningkatkan kemampuan teknis tim DOTS TB sesuai
standar ?
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7. Apakah ada monitoring dari sistem pelayanan DOTS TB di poliklinik ?
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D. Kualifikasi dan Pendidikan Staf
1. Apakah rencana susunan kepegawaian rumah sakit direview secara terus menerus
dan diperbaharui/di update sesuai kebutuhan ?

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Apakah susunan kepegawaian rumah sakit dikembangkan bersama-sam oleh para
pimpinan dengan menetapkan jumlah, jenis dan kualifikasi staf yang diinginkan?
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Apakah tanggung jawab setiap staf dideskripsikan/ditetapkan dalam uraian tugas ?
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Apakah pimpinan memberikan bantuan dan dukungan pengembangan pendidikan
dan kualifikasi staf ?
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Apakah efektifitas penempatan staf/susunan kepegawaian dimonitor secara terus
menerus ?
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E. Ketersediaan Tim Penanggulangan Bencana

1. Apakah rumah sakit ada membuat penyusunan dan memlihara rencana manajemen
kedaruratan, program bila terjadi kedaruratan komunitas seperti wabah dan bencana
alam/bencana lainnya ?

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2. Apakah ada identifikasi dan penugasan peran dan tanggung jawab pada staf ?
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3. Apakah rumah sakit memberikan dukungan dalam hal pembentukan tim penanggulan
bencana ?
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4. Apakah rumah sakit ada melakukan uji coba/simulasi penanganan/menanggapi
kedaruratan, wabah atau bencana ?
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F. Peningkatan Mutu dan Keselamatan Pasien
1. Apakah rumah sakit memiliki perencanaa program
peningkatan mutu dan
keselamatan pasien ?
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2. Apakah ada struktur dan pembagian wewenang program peningkatan mutu dan
keselamatan pasien ?
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3. Apakah pimpinan menetapkan proses atau mekanisme pengawasan program
peningkatan mutu dan keselamatan pasien ?
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4. Apakah pimpinan berpartissipasi dalam pelaksanaan monitoring program
peningkatan mutu keselamatan pasien ?
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5. Apakah program mutu dan keselamatan pasien dilaporkan oleh pimpinan rumah sakit
kepada pengelola (governance)?
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G. Kelengkapan SPO Pelayanan Gawat Darurat
1. Apakah rumah sakit memiliki perencanaan penyusunan SPO pelayanan di IGD ?
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2. Apakah ada struktur dan pembagian wewenang program penyusunan SPO pelayanan
di IGD ?
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3. Apakah pimpinan menetapkan atau membuat surat keputusan SPO pelayanan di IGD
yang sudah ada?
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4. Apakah ada monitoring pelaksanaan pelayanan terkait SPO yang ada di IGD ?
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Terima Kasih Atas Partisipasinya