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"ABSTRAK Perawat merupakan profesi yang memiliki tingkat stres tinggi dan berisiko burnout. Tujuan penelitian ini yaitu mengembangkan model lingkungan kerja perawat berbasis caring serta mengidentifikasi pengaruhnya terhadap burnout perawat pelaksana. Penelitian ini secara keseluruhan dilakukan dalam dua tahap. Tahap satu yaitu pengembangan model yang diawali dengan penelitian kuantitatif tentang persepsi perawat pelaksana terhadap lingkungan kerja dan burnout. Model kemudian dikembangkan dengan cara melakukan uji statistic pemodelan, studi literatur dan konsultasi pakar. Tahap kedua yaitu uji coba model untuk menentukan pengaruh terhadap burnout. Penelitian tahap dua merupakan penelitian kuasi eksperimen menggunakan desain post test with control group. Perawat yang berpartisipasi dalam penelitian ini sejumlah 485 perawat untuk tahap 1,  85 perawat kelompok intervensi dan 85 perawat kelompok kontrol untuk tahap 2. Hasil penelitian tahap satu diketahui perilaku caring kepala ruangan , beban kerja, kendali, penghargaan mempengaruhi kelelahan emosional (p<0.005) dan dihasilkan model lingkungan kerja perawat berbasis caring. Hasil penelitian tahap dua membuktikan adanya penurunan skor kelelahan emosional, depersonalisasi, dan berkurangnya penurunan pencapaian prestasi secara signifikan (p<0.001) dibandingkan skor awal. Kesimpulan hasil penelitian yaitu model lingkungan kerja perawat berbasis caring menurunkan gejala burnout pada perawat dan direkomendasikan digunakan oleh kepala ruangan dalam pengelolaan lingkungan kerja.

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ABSTRACT

Nurses are professions that have high stress levels and cause susceptibility to burnout. The purpose of this reserach is to develop a nurse work environment based on caring model and identify its effectiveness on burnout among nurses. This study conducted in two stages. First stages acknowledge constructing a model by integrating the results of quantitative study about perception of work environment and burnout among nurses. Model was developed using statistic modeling test, literature review, and expert review. The second stage identified the influence the model on reducing burnout. The second stage of this study used quasi experimental research using post test with control group design. The number of nurses who participated in this study is 85 nurses in intervention group and 85 nurses in control group. The results of the first stage study found that the nurse manager caring behavior (p=0.0001), workload (p=0.0001), control (p=0.0001), rewards (p=0.004) affect emotional exhaustion. The second stage of research proved the significant decrease in emotional exhaustion, depersonalization, and increase personal accomplishment (p=0.0001) after intervention compared with in control group. The conclusion of the research is that nurses work environment based on caring models reduce symptoms of burnout in nurses and it is recommended for use by the nurse manager in managing the work environment.

 

Keyword: nurses work environment based on caring mode; emotional exhaustion; depersonalization; reduce personal accomplishment.

 

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"ABSTRAKPenerapan asuhan keperawatan di rawat jalan rumah sakit umum saat ini belum optimal. Masalah yang ditemukan di rawat jalan adalah klien belum mampu merawat diri, belum puas terhadap asuhan keperawatan, dan belum mendapatkan informasi tentang perawatan diri. Penelitian ini bertujuan untuk mengidentifikasi pengaruh implementasi model asuhan keperawatan rawat jalan Inayah (AKRJI) terhadap perawatan diri dan kepuasan klien di rawat jalan rumah sakit umum. Penelitian ini menggunakan metode kuantitatif dengan metoda quasi eksperimen dan analisis Uji-T Paired, Uji-T Unpaired, analisis regresi linier ganda dan R Square untuk menilai Kesesuaian Fit Model. Penelitian ini dilakukan di Rawat Jalan Rumah Sakit Umum. Intervensi dilakukan pada 9 perawat pelaksana di rawat jalan medikal bedah yang dilatih menggunakan model AKRJI, setelah itu perawat tersebut melaksanakannya pada 1000 klien rawat jalan. Sampel penelitian ini 2000 klien untuk kelompok kontrol dan kelompok intervensi rawat jalan medikal bedah.Hasil penelitian memperlihatkan kenaikan kemampuan perawatan diri dan kepuasan secara bermakna pada klien intervensi yang menunjukkan lebih tinggi hasilnya dibandingkan kelompok kontrol. Faktor yang paling berpengaruh adalah pelaksanaan Model AKRJI. Kesesuaian model AKRJI fit menjelaskan model yang dapat meningkatkan perawatan diri dan kepuasan klien. Saran Model AKRJI dapat dilaksanakan pada pelayanan keperawatan di rawat jalan rumah sakit umum.

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ABSTRACT

Application of nursing care in outpatient general hospital currently not optimal. Problems were found in outpatient client is not able to care for themselves, not satisfied with the nursing care, and no information about self care. This study aimed to identify the effect of implementasion Inayah outpatient nursing care models (IONC) to self care and satisfaction in outpatient general hospital. This study uses the quantitative method with quasi-experimental and analysis T Test, multiple linear regression analysis and R Square to assess the suitability Fit Model. This research was conducted at the Outpatient General Hospital. Interventions conducted on 9 nurses in medical-surgical outpatient, who trained using IONC model, after which the nurse implement at 1000 outpatient clients. The research sample is 2000 clients for the control group and the intervention group outpatient medical-surgical.

The results showed the increase in the ability of self care and satisfaction significantly in the intervention showed a higher result than the control group. The most influential factor is the implementation of the IONC Model. IONC fit fitness model describes a model that can improve self care and satisfaction. Suggestions the IONC Model can be carried out on an outpatient nursing care in general hospitals."

"Keselamatan dan kepuasan pasien merupakan indikator kualitas pelayanan belum terpenuhi secara optimal. Model budaya belajar perawat membentuk perawat kompeten dalam penerapan sasaran keselamatan pasien. Penelitian bertujuan mengidentifikasi budaya belajar tentang keselamatan pasien, mengembangkan model budaya belajar perawat dan mengidentifikasi pengaruhnya terhadap kompetensi perawat, keselamatan dan kepuasan pasien. Desain operasional riset, tahap pertama kualitatif fenomenologi dengan sembilan partisipan, tahap kedua pengembangan model, dan tahap ketiga desain quasi eksperiment pre-post test design with control group dengan 139 responden perawat dan 240 responden pasien.Hasil penelitian tahap pertama didapat sembilan tema yaitu arti keselamatan, persiapan penerapan, fokus keselamatan, implemetasi, masalah, tahapan budaya belajar, aktivitas pembelajaran dan dukungan pengembangan budaya belajar. Tahap kedua diperoleh model budaya belajar "SAYA perawat" tentang sasaran keselamatan pasien dengan komponen, perawat; Sistem dukungan, aktivitas pembelajaran dan tahapan budaya belajar. Tahap ketiga model budaya belajar "SAYA Perawat" tentang sasaran keselamatan pasien berpengaruh secara bermakna terhadap kompetensi perawat dalam penerapan sasaran keselamatan pasien (p 0,0001), keselamatan (p 0,0001) dan kepuasan pasien (p 0,0001). Terdapat hubungan bermakna kompetensi perawat dalam penerapan keselamatan pasien dengan keselamatan (p 0,0001) dan kepuasan pasien (p 0,0001). Model budaya belajar ini agar dapat diimplementasikan di ruang perawatan untuk memenuhi keselamatan dan kepuasan pasien.

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Safety and patient satisfaction which are indicators of quality cannot be optimaly fulfilled. Learning culture models about patient safety form nurses competent in the application of patient safety. This study aims to identify nurses learning culture about patient safety, develop a model of nurse learning culture and identify its affect on nurses competency, patient safety and satisfaction. The research design used operational research, the first phase used qualitative phenomenology with nine participants, the second stage is the development of the model, and the third stage is the quasi experimental design pre-post test design with control group with 139 nurses and 240 patient respondents.

The results of the first phase of research obtained nine themes, namely the meaning of safety, preparation for application, focus on safety, implementation, problems, stages of learning culture, learning activities and support for the development of a learning culture. The second stage was obtained learning culture models "SAYA Nurses" about patient safety goals is fit and valid there have components, nurses as the subject of development; support systems, learning activities and the learning culture stage . The third stage of the learning culture model "SAYA Nurses about patient safety goals has a significant effect on nurses' competence (p 0,0001), patient safety (p 0,0001) and satisfaction (p 0,0001). There is a significant relationship between nurses' competence with patient safety (p 0,0001) and satisfaction (p 0,0001). The learning culture models to be implemented in the ward to safety and satisfaction."

"Proses pemulangan bayi berat badan lahir rendah (BBLR) dari rumah sakit ke rumah menjadi proses transisi yang sulit bagi orang tua. Ibu yang memiliki BBLR cenderung memiliki kepercayaan diri rendah dan mengalami stres dalam melakukan perawatan bayi. Tujuan penelitian ini adalah menganalisis efektifitas perencanaan pulang bayi berat lahir rendah berbasis aplikasi mobile terhadap stres ibu, kepercayaan diri ibu dan kesehatan bayi. Penelitian ini menggunakan desain penelitian dengan sequential exploratory mixed methods. Penelitian tahap pertama menggunakan pendekatan deskriptif kualitatif dengan delapan ibu yang memiliki BBLR yang dipilih secara purposive sampling. Aplikasi perencanaan pulang BBLR dibangun dari hasil penelitian kualitatif, studi literatur dan konsultasi pakar. Penelitian tahap kedua menggunakan desain quasi experiment pre-post test with control group, melibatkan 42 responden pada kelompok perlakuan dan 42 responden kelompok kontrol. Hasil penelitian kualitatif menemukan tiga tema yaitu (a) informasi perawatan rutin bayi (b) variasi sumber informasi (c) jenis komunikasi yang diperlukan. Hasil uji Generalized Linear Models Repeated Measures (GLM RM), secara simultan menunjukkan perbedaan pengaruh perencanaan pulang BBLR berbasis aplikasi mobile pada keseluruhan waktu pengamatan saat masuk RS, keluar RS dan setelah empat minggu keluar RS (p < 0.05). Hasil independent t-test didapatkan bahwa ada pengaruh perlakuan secara signifikan terhadap stres ibu dan kepercayaan diri ibu dan hasil Mann-Whitney U test menunjukkan pengaruh perlakuan terhadap kesehatan bayi setelah empat minggu keluar RS (p < 0.05). Perencanaan pulang yang ditindak lanjuti dengan asuhan berkelanjutan dapat digunakan di tatanan layanan kesehatan untuk membantu ibu dalam menyiapkan kepulangan BBLR ke rumah dan memandirikan ibu dalam perawatan bayi di rumah.

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The discharge process of low birth weight (LBW) babies from the hospital to home is a difficult transition process for parents. Mothers with LBW tend to lack confidence and face stressful situations in caring for their babies. The purpose of this study is to analyze the effectivity of mobile application-based LBW discharge planning and follow up care on maternal stress, confidence, and the baby's health. This study uses sequential exploratory mixed methods as the research design. The first phase of this research used qualitative descriptive approach with 8 participants consisting of mothers with LBW, selected with purposive sampling method. The LBW discharge planning application was built from the results of qualitative research, literature studies, and expert consultations. While the second phase used a quasi-experiment pre-post test with control groups, involved 42 respondents that belonged to treatment group and 42 other that belonged to control group. The results of the qualitative research found 3 themes: a) routine baby care information, b) information source variations, and c) type of communication needed. The results of the Generalized Linear Models Repeated Measures (GLM RM) test simultaneously show differences in the effect of mobile application-based LBW discharge planning on the overall observation time at hospital admission, hospital discharge, and after four weeks of hospital discharge (p <0.05). The results of the independent t-test found that there was a significant effect of treatment on the mother's stress and self-confidence, and the results of the Mann-Whitney U test showed the effect of treatment on the baby's health after four weeks of discharge from the hospital (p <0.05). Discharge planning, reinforced by follow-up care, can be carried out in a healthcare setting to assist mothers in preparing for the return of LBW to their homes and empower them to care for babies at home."

"Penanggulangan tuberkulosis paru (TB) membutuhkan sistem pelayanan Keperawatan terpadu oleh perawat, Keluarga, dan Masyarakat. Untuk meningkatkan pelayanan dengan melibatkan tim partisipasi menggunakan model manajemen Pelayanan keperawatan dengan kerangka kualitas Malcolm Baldrige performance. Komunikasi dan pelaporan melalui aplikasi Android-mobile untuk meningkatkan akses dan kontrol. Studi ini menggunakan kuasi-eksperimental dengan pre dan post-tes desain yang melibatkan dua kelompok. Studi ini dilakukan di dua tempat yaitu puskesmas di Kabupaten Sidoarjo dengan kasus TB tertinggi. Penelitian ini terdiri dari studi eksploratif, pengembangan model dan pengujian efektivitas model. Sampel diambil secara purposive sebanyak 400 penderita TB, terdiri dari 200 responden dalam kelompok kontrol dan 200 responden dalam kelompok intervensi. Hasil penelitian menunjukkan bahwa model intervensi efektif dalam meningkatkan evaluasi diri pemeriksaan rutin hingga 86%, kepatuhan obat hingga 99%, kecukupan gizi menjadi 82%, batuk efektif hingga 88%, dan manajemen dahak menjadi 19%. Model ini perlu didukung oleh kebijakan perawatan kesehatan dari Dinas Kesehatan.

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Management of pulmonary tuberculosis (TB) requires an integrated nursing service system by nurses, family, and community participation. To improve participation team of family nursing services by using a quality-nursing care management model using Malcolm Baldrige's framework through an android-mobile application to prevent treatment interruption. This study used a quasi-experimental with pre and post-test design involving two groups. The study was conducted in two places that are clinics in Sidoarjo Regency with the highest TB cases. This research consisted of model development and testing the effectiveness of the model. Samples were taken purposively as many as 400, consisting of 200 respondents in control groups and 200 respondents in intervention groups. The results showed that the intervention model was valuable in increasing checkups routine up to 86%, medicine adherence up to 99%, nutrition adequacy to 82%, effective cough to 88%, and sputum management to 19%. This model needs to be supported by health care policies from the Public health Office."

"Sumber Daya Manusia (SDM) Keperawatan adalah komponen penting dalam pengelolaan kesehatan karena sumber daya manusia yang mengelola sumber daya kesehatan lainnya dan memberikan pelayanan kesehatan kepada masyarakat. Informasi SDM keperawatan yang cepat, tepat, lengkap dan terbaharui tentang jumlah, jenis dan distribusi SDM keperawatan di suatu wilayah atau fasilitas pelayanan kesehatan penting dimiliki untuk mendukung pengambilan keputusan manajemen SDM keperawatan terkait perencanaan, penempatan dan pengembangan SDM keperawatan. Pada saat ini informasi SDM keperawatan berbeda-beda sesuai dengan lembaga yang merilisnya. Penelitian ini bertujuan untuk mengetahui implementasi model sistem informasi manajemen sumber daya manusia keperawatan. Penelitian ini menggunakan pendekatan operational research yang terdiri dari tiga tahap, yaitu: tahap pertama studi eksploratif dengan disain kualitatif, tahap kedua pengembangan model, dan tahap ketiga implementasi dan evaluasi model dengan desain pra-eksperimen one group posttest only design. Implementasi model dievaluasi menggunakan framework kesesuaian faktor manusia organisasi dan teknologi (HOT-Fit-factors). Besar sampel sebanyak 123 responden. Intervensi berupa pelatihan, pendampingan dan penerapan SI-NURSE. Hasil penelitian ada hubungan yang signifikan antara variabel masa kerja, kemampuan adaptasi, aspek dukungan manajemen, aspek tehnik dan kualitas informasi dengan kepuasan pengguna. Kualitas informasi dan kemampuan teknologi informasi secara bursama-sama berperan dalam menentukan kepuasan pengguna sistem informasi sumber daya manusia keperawatan SI-NURSE.

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Human Resources (HR) Nursing is an important component in health management because human resources manage other health resources and provide health services to the community. Fast, precise, complete and updated nursing HR information about the number, type and distribution of nursing human resources in an area or health care facility is important to have to support nursing HR management decision making related to planning, placing and developing nursing human resources. At this time, nursing HR information varies according to the institution that released it. This study aims to determine the implementation of the nursing human resource management information system model. This research uses an operational research approach consisting of three stages, namely: the first stage of exploratory study with qualitative design, the second stage of model development, and the third stage of model implementation and evaluation with a pre-experimental design of one group posttest only design. The implementation of the model was evaluated using the framework of the suitability of the human factor of the organization and technology (HOT-Fit-factors). The sample was 123 respondents. Interventions in the form of training, mentoring and application of SI-NURSE. The results of the study there is a significant relationship between the variables of service life, adaptability, aspects of management support, technical aspects and quality of information with user satisfaction. The quality of information and the ability of information technology equally play a role in determining the satisfaction of users of the SI-NURSE nursing human resources information system."

"Latar Belakang:Mortalitas dan morbiditas pasien di rumah sakit masih tinggi akibat kurangnya keselamatan pasien. Strategi terpenting untuk meningkatkan keselamatan pasien adalah denganmembangun budaya keselamatan pasien. Tujuandari penelitian ini adalah untuk mengukur pengaruh model budaya positif keselamatan pasien “IDA” terhadap pelaksanaan keselamatan pasien di rumah sakit. Metode.Design adalahaction riset yang terdiri dari: Tahap pertama adalah identifikasi masalah, tahap kedua adalah pengembangan model, tahap ketiga evaluasi efektivitas model. Data dikumpulkan secara kuantitatif dan kualitatif. Kualitatif dengan FGD dan wawancara pada 26 pimpinan dihasilkan empat tema. Penelitian kuantitatif dengan menggunakan instrumen safety attitude questionnaire, quality and safety self efficacy scale, hospital survey on patient safety culture, safety motivation questionnaire scale, safety consciousness scale, dan kuesioner pelaksanaan keselamatan pasien. Tahap dua pengembangan model hasil dari elaborasi tiga teori dan penerapannya dilaksanakan pada 192 orang perawat pelaksana dan 18 orang kepala ruangan di tiga rumah sakit yang telah terakrediatsi paripurna. Tahap tiga diukur efektivitas model pada pelaksanaan keselamatan pasien pada 192 responden kelompok intervensi dan 191 responden kelompok kontrol, sampel diambil dengan cluster random sampling. Hasil Penelitian: Model budaya positif keselamatan pasien “IDA” berpengaruh terhadap dimensi individu: pengetahuan perawat, sikap, motivasi, kesadaran, safety self efficacydan pelaksanaan keselamatan pasien (p<0,05) dan terhadap dimensi individu kepala ruangan: pengetahuan dan sikap kepala ruangan (p<0,05). Pengaruh positif juga terhadap dimensi organisasi dan dimensi lingkungan. Sebagai dampaknya maka terdapat perbedaan secara bermakna pada sasaran keselamatan pasien sebelum dan setelah dilakukan intervensi model “IDA”. Model “IDA” juga diukur efektivitasnya terhadap kelompok kontrol dan semua variabel berbeda bermakna (p<0,05). Kesimpulan dan Saran: model “IDA” berpengaruh terhadap perilaku keselamatan pasien dan capaian sasaran keselamatan pasien oleh perawat. Model “IDA”perlu diterapkan dirumah sakit agar keselamatan pasien tercapai.

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Background: The mortality and morbidity of patients in the hospital are still high due to the lack of patient safety. The most important strategy for improving patient safety is to build a culture of patient safety. The purpose of this study was to measure the effect of a positive culture model of patient safety "IDA" on the implementation of patient safety in hospitals. Method.Design is an action research consisting of: The first stage is problem identification, the second stage is the development of the model, the third stage is the evaluation of the effectiveness of the model. Data were collected quantitatively and qualitatively. Qualitative with FGD and interviews with 26 leaders resulted in four themes. Quantitative research using the instrument safety attitude questionnaire, quality and safety self-efficacy scale, hospital survey on patient safety culture, safety motivation questionnaire scale, safety consciousness scale, and patient safety implementation questionnaire. The second stage of the development of the model results from the elaboration of three theories and its application was carried out on 192 implementing nurses and 18 heads of rooms in three hospitals who had been fully accredited. Stage three measured the effectiveness of the model in the implementation of patient safety in 192 respondents in the intervention group and 191 respondents in the control group, the sample was taken by cluster random sampling. Results: The positive culture model of patient safety "IDA" affects the individual dimensions: knowledge of nurses, attitudes, motivation, awareness, safety self efficacy and implementation of patient safety (p <0.05) and on the individual dimensions of the head of the room: knowledge and attitude of the head. room (p <0.05). The positive influence is also on the organizational and environmental dimensions. As a result, there are significant differences in patient safety goals before and after the "IDA" model intervention. The effectiveness of the "IDA" model was also measured against the control group and all variables were significantly different (p <0.05). Conclusions and suggestions: the "IDA" model affects the implementation and achievement of patient safety goals. The "IDA" model needs to be applied in hospitals so that patient safety is achieved."

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Nama	: Mira Asmirajanti
Program Studi	: Doktor Keperawatan, Fakultas Ilmu Keperawatan UI
Judul	: Sistem Nursing Activity Based Costing Mira (N-ABC Mira)

 

Aktivitas Perawat merupakan semua kegiatan pemberian asuhan keperawatan terhadap pasien yang dilakukan dan dicatat oleh perawat. Aktivitas perawat meliputi asesmen, penetapan diagnosis, pembuatan perencanaan, pelaksanaan tindakan dan evaluasi. Perawat, tenaga profesional di rumah sakit yang terus menerus bersama pasien, tetapi aktivitasnya belum dijadikan dasar dalam perhitungan poin penghargaan pada remunerasi. Pembiayaan aktivitas perawat dalam pemberian asuhan keperawatan masih menjadi permasalahan utama profesi keperawatan. Tujuan penelitian ini mengevaluasi sistem nursing activity based costing Mira (N-ABC Mira). Penelitian dilakukan di RSP Jakarta dan RSDK Semarang. Penelitian ini menggunakan desain penelitian operasional dengan tiga tahap penelitian. Tahap 1 mengidentifikasi aktivitas perawat berdasarkan dokumentasi asuhan keperawatan, kepuasan perawat dan faktor perancu melalui penelitian kuantitatif dengan studi cross-sectional dan penelitian kualitatif analisis dari fokus grup diskusi. Tahap 2 mengembangkan sistem nursing activity based costing Mira (N-ABC Mira). Tahap 3 evaluasi dan uji coba sistem N-ABC Mira menggunakan kuasi eksperimen dengan pendekatan pengukuran berulang sebelum implementasi, uji coba 1, uji coba 2 dan uji coba 3. Sampel penelitian kuantitatif sebanyak 226, 199, 161 dan 92 perawat pelaksana dengan masa kerja minimal 1 tahun yang diambil secara acak dan dokumentasi pasien dengan jumlah mengikuti sampel perawat pada tahun 2018 secara insidental dari bulan Juli - bulan Desember yang diambil dari 10 penyakit terbanyak. Data dikumpulkan dari dokumentasi hasil uji coba sistem N-ABC Mira dan kuesioner. Analisis data menggunakan  GLM RM, t-Test, Anova, Korelasi Pearson’s. Pada penelitian ini didapatkan bahwa sistem N-ABC Mira antara sebelum dan sesudah implementasi, aktivitas perawat berdasarkan dokumentasi asuhan keperawatan ada perbedaan yang bermakna (15.269, p=0.0001); ada perbedaan yang bermakna kepuasan perawat terhadap aktivitas perawat (6.657, p=0.0001); ada perbedaan yang bermakna kepuasan perawat terhadap pengambilan keputusan (2.999, p=0.0001) dan ada perbedaan yang bermakna kepuasan perawat terhadap poin penghargaan (6.585, p=0.0001). Sistem N-ABC Mira untuk Aktivitas perawat berdasarkan dokumentasi asuhan keperawatan dan kepuasan perawat terhadap aktivitas perawat; pengambilan keputusan serta poin penghargaan dipengaruhi oleh aspek perawat, dukungan manajemen dan dukungan tehnik. Kesimpulan dari implementasi sistem N-ABC Mira, yaitu terdapat perbedaan aktivitas perawat berdasarkan dokumentasi asuhan keperawatan dan kepuasan perawat terhadap aktivitas perawat, pengambilan keputusan serta poin penghargaan perawat sehingga dapat meningkatkan kepuasan perawat dan kepuasan pasien, sehingga merekomendasikan sistem N-ABC Mira untuk dapat digunakan di setiap rumah sakit.

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Name	: Mira Asmirajanti
Study Program	: Doctoral Nursing Doctoral, Faculty of Nursing Universitas Indonesia
Title	: Nursing Activity Based Costing Mira (N-ABC Mira) System

 

Nursing activities are all activities of giving nursing care to patients performed and recorded by nurses. Nursing activities include assessment, determination of diagnosis, planning, implementation of actions and evaluation. Nurses are professionals in the hospital whose presence is continuously on the patient's side, but their activities have not been used as the basis for calculating reward points for remuneration. Financing nursing activities in nursing care is still a major problem in the nursing profession. The purpose of this study is to evaluate the nursing activity based costing Mira (M-N-ABC) system. The study was conducted at the Jakarta Pelabuhan Hospital and Semarang RSDK Hospital. This research was conducted using operational research design with three research stages. Stage 1 is identifying nurse activities based on nursing care documentation, nurse satisfaction and confounding factors through quantitative research with cross-sectional studies and qualitative research through analysis of focus group discussions. Stage 2 is to develop a nursing activity based costing Mira (M-N-ABC) system. Stage 3 is evaluating and testing the Mira N-ABC system using quasi-experiments with repeated measurement approaches before implementation, trial 1, trial 2 and trial 3. Quantitative research samples were 226, 199, 161 and 92 nurses with minimum of 1 year work experience period taken randomly. Incidental numbers of patient documentation were included based on participating nurses in 2018 from July to December by taking 10 most frequent diseases. Data were collected from results documentation of the N-ABC Mira system trial and questionnaire. Data analysis was done using RM GLM, t-Test, Anova, Pearson's Correlation. In this study it was found that between before and after the implementation of the Mira N-ABC system, there were significant differences in nursing activity based on care documentation (15,269, p = 0,0001); there was also a significant difference between nurses’ satisfaction with nursing activity (6,657, p = 0,0001); In addition, there was a significant difference between nurses’ satisfaction with decision making (2.999, p = 0.0001) and also between nurses’ satisfaction with award points (6,585, p = 0,0001). Mira N-ABC system for nursing activities is proposed based on nursing care documentation and nurses’ satisfaction on nursing activities; Decision-making variables and award points were influenced by aspects of nurses, management support and technical support. The conclusion of the Mira N-ABC system implementation is that there are differences between nurse activities based on nursing care documentation with nurses’ satisfaction on nursing activities, decision making and nurse award points. The Mira N-ABC system is recommended for everyday usage in hospital to improve nurses and patient satisfaction.

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