Implementasi of Triage on the Role Attitude of Emergency Instalation

Triage is a process to determine which patients should receive treatment first based on the severity of the injury or illness. In triage, patients are grouped into 6 categories, blue label, red label, yellow label, green label, white label, and black label. The highest priority is patients with emergency conditions accompanied by disturbances in the airway, breathing, circulation, which are labeled in blue. The second priority is patients with emergency conditions, which are labeled in red. The third priority is given to patients with minimal emergency conditions, which are labeled in yellow. The next priority is cases without emergencies, but if they are not treated immediately they will have a negative impact on the patient, which is labeled in green. The next priority is the white label given to patients whose conditions are not serious, not emergency, and do not require immediate treatment. Last priority is given to patients who died or had serious irreversible injuries who were labeled in black. The purpose of this study was to determine the relationship between the roles and attitudes of emergency room nurses and the implementation of triage based on priority. The research method used is descriptive correlational with cross sectional design. The results showed that the majority of the role of nurses was good with the implementation of triage as many as 25 people (65.8%), the majority of positive attitudes with the implementation of triage as many as 23 people (60.5%) and the majority carried out triage according to SOP as many as 30 people (78.9%) . The results of the study with the chi-square test p-value <0.05. In conclusion, there is a relationship between the role and attitude of the emergency room nurse and the implementation of triage based on priority.


Introduction
According to the World Health Organization, a hospital is a social organization that functions as a service provider both preventively, curatively and comprehensively to the community.The Emergency Room (IGD) is an important element in a hospital that plays a role in providing first aid to sick and injured patients with acute conditions who need immediate help (Ashour et al, 2012).
In general, there has been an increase in the number of patient visits to the emergency room around the world with conditions varying from life-threatening to mild conditions that have increased from year to year where 50% of them are visits with nonurgent conditions (Qureshi, 2010).In Indonesia, data on patient visits to the emergency room reached 4,402,205 (Decree of the Minister of Health, 2009) while regionally, in Central Java, visits to the emergency room increased from 98.80% to 100% in the period 2011-2012 (Provincial Health Office Central Java, 2014).
The high number of visits to the emergency room, both by patients with urgent and non-urgent conditions, is the main cause of overcrowding in the emergency department so that sometimes patients with critical conditions cannot be treated on time and to minimize this, triage is necessary (Schuetz et al, 2013).
The assumption that someone who comes first is the one who has the right to get service first (Fields, 2009), the patient's ignorance about the system of working in the emergency room and their varied backgrounds, according to Igede in Budiaji (2016), makes their perception of the emergency room services less fast.and less satisfactory when they do not immediately get service.In addition to patient satisfaction, the factor of knowledge about management procedures in the emergency room also causes anxiety in patients (Qureshi, 2010).
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Research Method
This research is a quantitative research with a descriptive correlational research design cross sectional design.The sample size is 38 people using total sampling technique.The data collection used is a questionnaire sheet and observation sheet.Data analysis was performed using the chi-square test.

Results And Discussions
a. Result     Triage is taken from the French word Trier which means to group or select.
This system was first introduced and developed on the battlefield and is used when disaster strikes.On the battlefield, triage was used to determine priority handling during the first world war.This classification is used by soldiers of war to identify soldiers who are victims of war who experience minor injuries with the aim that after handling measures they can return to the battlefield (Kartikawati, 2013).
From the research that has been done, it was found that out of the 27 respondents who performed a good role in carrying out triage based on priorities according to the procedure, there were 25 respondents (65.8%).The results of the chisquare correlation test statistic obtained a p-value <α (0.002 <0.05) so there is a relationship between the role of nurses and the implementation of triage in the IGD X District Hospital.The role of nurses is measured by their abilities and work skills.
Where it can be obtained through education, training and years of service, the longer the time a person spends on education and training, the higher his performance will be.
Based on the research that has been done, it was found that of the 24 respondents who had a positive attitude who carried out triage based on priorities according to the procedure, there were 23 respondents (60.5%).The results of the chisquare test statistic obtained a p value < α (0.004 < 0.05) so that there is a relationship between the attitudes of the ER nurses and the implementation of triage based on priority.According to Notoatmodjo (2014) said that the actions taken by individuals tend to be influenced by the information and knowledge they have.A positive attitude towards information received by a person can influence every action he will take.
Someone who has a positive attitude will tend to correctly understand any available information or knowledge, whereas a negative attitude will sometimes give wrong information.

Mubarak ( 2012 )
explains that length of work can make a person gain knowledge either directly or indirectly, knowledge can be obtained from experience while working.Researchers argue that work experience can affect one's knowledge.Work experience is a source of knowledge or a way to prove the knowledge that International Journal of Health Sciences is licensed under a Creative Commons Attribution 4.0 International License someone already has.Experience is also something that is experienced by someone directly.Someone through his experience gains many new things.New things that are found while working can add to their knowledge in doing the job.

5 .
majority of nurses have a positive attitude with the implementation of triage and most of the nurses carry out triage in accordance with the SOP.b) The results showed that there was a relationship between the roles and attitudes of the emergency room nurses and the implementation of triage based on priority.The results of multiple linear regression analysis show that the role variable shows the strongest relationship to the implementation of triage seen from the OR value of 2,702.Compliance with ethical standards International Journal of Health Sciences is licensed under a Creative Commons Attribution 4.0 International License

Table. 1 Characteristics of Respondents by Age
Based on table 1 shows the frequency distribution of respondents based on age, namely the majority aged 21-34 years totaling 35 (92.1%).

Table 2
shows the distribution of the frequency of respondents based on their level of education, namely the Bachelor's Degree in Nursing Profession totaling 17 (44.7%)people, Bachelor's Degree in Nursing totaling 3 (7.9%)people and with D3 nursing education level totaling 18 (47.4%)people.

Table 4 Attitudes of Emergency Room Nurses (IGD) with the Implementation of Triage Based on Priority
Based on table4shows the distribution of the frequency of respondents based on the attitude of the nurse, namely a negative attitude totaling 14 (36.8%)people and with a positive attitude totaling 24 (63.2%)people.

Table 5 Implementation of Triage for Emergency Room Nurses (IGD) with Triage Based on Priority
the implementation of triage, namely implementation that is not appropriate, totaling 8 (21.1%) people and with appropriate triage implementation, totaling 30 (78.9%) people.

Table 6 Multiple Linear Regression Analysis between Nurse's Attitudes and Roles and Triage Implementation
Budiman & Riyanto (2014)gorized based on the theory put forward byWong, et al (2008)which is divided into early adulthood (21-34 years), middle adulthood (35-64 years) and late adulthood (≥ 65 years).In this study, the majority of respondents were in the age range of 21-34 years with 35 people (92.1%) and 3 people aged 35-64 years (7.9%).According toBudiman & Riyanto (2014)and Notoatmodjo (2014) age affects one's comprehension and mindset, the older one gets, the more one's comprehension and mindset develop.