The Relationship of Policy and Supervision with Nurse’s Compliance with The Application of Early Warning Score (EWS) in Inpatients at Tgk Abdullah Syafi'i Hospital

Background: The speed and accuracy of a nurse's initial assessment can determine the success of care in emergency patients. Patient emergencies can occur not only outside the Hospital, but also during the patient's hospitalization Objective : The purpose of this study is to determine the relationship between policy and supervision with nurses' compliance with the implementation of the Early Warning Score (EWS) in inpatient patients Method: The design of this study uses a colleration analytical design with a crossecsional approach, the population in this study is all nurses in the room The inpatient rawap at RSUD Tgk Abdullah Syafi'I totaled 254 nurses. The sampling technique in this study used a simple technique Random Side of 110 nurses. Result and Discussion: the results of this study show that there is a significant relationship between policy and nurses' compliance with the application of early warning score (EWS) with a p-value of 0.020<0.05. There is a significant relationship between supervision and nurse compliance with the application of the Early Warning Score (EWS) with a p-value of 0.013<0.05. Conclusions: There is a significant relationship between policy and supervision and nurses' adherence to the application of early warning score (EWS) in inpatients.


Introduction
Early Warning Score (EWS) is a system that asks for help to solve a patient's health problem early.EWS is based on assessing changes in patient status by systematically monitoring all physiological changes in patients.This system is the concept of a proactive approach to improving patient safety and improving clinical outcomes for patients by standardizing the assessment approach and establishing a simple assessment of physiological parameters.EWS is a physiological assessment system commonly used in medical surgical departments before a patient encounters an emergency.The EWS assessment is accompanied by an algorithm of actions based on the results of the assessment of the patient.Parameters in the EWS method: level of consciousness, respiratory or respiratory, oxygen saturation, supplemental oxygen, temperature, pulse and systolic blood pressure (Zuhri & Nurmalia, 2018) (Pertiwi et al., 2020) Some of the advantages of this system are that it can be used to adequately assess acute illness, changes in the patient's condition and clinical response.EWS offers evaluations that can later be used as physiological parameters of the patient (Subhan et al., 2019).The physiological parameters mixed in the system are systolic blood pressure, pulse rate, body temperature, blood oxygen saturation, oxygen assistance, urine production, and the patient's conscious status.This parameter can be used to monitor the deterioration of the patient's condition or alertness (Rajagukguk & Widani, 2020) Nurses as the front line who are always with the patient, need to be trained to detect or recognize changes in the patient's deteriorating condition, as well as be able to perform appropriate nursing actions.In addition, the policy of the head of the room and supervision is one of the factors in the running of the EWS (Dame et al., 2018).With good policies and evaluations, EWS will be able to run in accordance with procedures, even though the Hospital has conducted training on EWS in accordance with the policy, but the success of EWS is influenced by the policies of each head of the room and also supervision, therefore good implementation of the EWS instrument in accordance with the established guidelines will proceed according to procedure (SEPTIARIANI, 2020)

Method
Research uses quantitative methods using colleration analytical design with a cross sectional approach.The time and place of the study is planned to be carried out from May to August 2022 for 4 months at Tgk Abdullah Syafi'I Hospital which is one of the type C Government Hospitals in Pidie Regency (Purwanto & Sulistyasturi, 2017).The population in this study was all nurses in the Inpatient Treatment Room at Tgk Abdullah Syafi'I Hospital, totaling 254 nurses.The sampling technique in this study used a simple technique Random Side of 110 nurses.Data Analysis carried out is Univariate analysis and Bivariate Analysis used, namely the Sci Square test.(Duncan et al., 2012) Based on a preliminary study conducted on the nurses of Tgk.Abdullah Syafi'I Hospital Based on the results of an initial survey conducted on 20 nurses, 13 nurses said they had never done EWS in an inpatient room due to the absence of policies from the head of the room and the absence of supervision in the field of medical services.Therefore, nurse's does not do EWS in the inpatient room Research Specific Objectives: To identify whether or not there is a relationship between policy and supervision and nurse compliance with the application of the Early Warning Score (EWS) in hospitalized patients 1. Identifying the head of the room policy towards the application of the Early Warning Score (EWS) in hospitalized patients 2. Identifying supervision in the field of medical services to the application of Early Warning Score (EWS) pada pasien rawap inap Urgency/Primacy of Research The virtue of this study is to see whether or not there is a policy of the head of the room and supervision in the field of medical services towards the implementation of EWS and the readiness of nurses in carrying out immediate nursing actions on patients in the inpatient room.

Result and Discussion
Overview of Nurses' Policies, Supervision and Compliance with the Application of Early Warning Score (EWS) in Inpatients at Tgk Abdullah Syafi'i Hospital Source: primary data 2021.
Based on the table above, it can be seen that the EWS implementation policy supports as many as 42 respondents with a percentage of 38% and for less supportive policies as many as 68 respondents with a percentage of 62%.Source: primary data 2021.
Based on the table above, it can be seen that there are 35 respondents in the supervision of EWS implementation with a percentage of 32% and for supervision there are no 75 respondents with a percentage of 68%.Source: primary data 2021.
Based on the table above, it can be seen that nurse's compliance with the implementation of EWS is compliant as many as 47 respondents with a percentage of 42% and for nurses' compliance with the implementation of non-compliant ews as many as 63 respondents with a percentage of 58%.  5, it can be seen that the results of the Chi Square test analysis show that there is a relationship between supervision and nurse compliance with the implementation of EWS with a p value of < 0.05.

Policy with nurse compliance with EWS implementation
Based on the results of the research that has been confirmed, there is a significant relationship between the policy and the compliance of nurses with the implementation of EWS in the inpatient room.From these results, it is proven that the P value obtained is 0.020.
The application of EWS is very important for the safety of patients in the hospital.Currently, almost all hospitals in the country have issued policies on the implementation of EWS but there are still nurses' non-compliance in the implementation of EWS.Policy should be understood as a series of activities that more or less relate to the consequences for those concerned rather than as stand-alone decisions (Foley & Dowling, 2019) The results of this study are in accordance with the results of research conducted by Yetty (2017) health policies have a significant influence on the effectiveness of nurses in hospitals in increasing inpatients.In this study, it was also stated that there are factors that influence the implementation of policies such as communication, resources, disposition or attitude of implementers and bureaucratic structures towards the effectiveness of hospital organizations in improving inpatient services (Rohita & Yetti, 2017) Researchers assume that the policies issued by hospitals towards the implementation of EWS require regular monitoring and evaluation to improve services in hospitals.The Rumah Sakit also needs to conduct special training for nurses to improve the knowledge and skills of the medical team in terms of implementing EWS.

Supervision with nurse compliance with the implementation of EWS
Based on the results of the research that has been confirmed, there is a significant relationship between supervision and nurse compliance with the implementation of EWS in the inpatient room.From these results, it is proven that the P value obtained is 0.013.
Supervision is very important to the absorption of EWS in the Hospital.With supervision, there is an increase in performance and minimizes the risk of errors.In its implementation, supervision is not only supervising whether the entire medical team is carrying out their duties as well as possible in accordance with the instructions or provisions that have been set, but together how to improve the process that is being carried out (Widhori et al, 2014).
The results of this study are in line with the results of research conducted by Rachmawati (2015) on the relationship between supervision and nurse compliance in carrying out SOPs.In the study, it was explained that there is a need for supervision aimed at improving the performance of nurses through a systematic process including providing motivation, communication and guidance (Fitrirachmawati, 2018) Researchers assume that supervision should be done well in the Hospital to plan, direct and evaluate continuously in each nurse who provides care to clients so that they are compliant in implementing EWS.

Connclusion
There is a relationship between policy and supervision with nurse's compliance with the application of early warning score (EWS) on inpatient patients at tgk abdullah syafi'i hospital with a correlation value obtained < 0.05 Asri Bashir, Safrullah/KESANS The Relationship of Policy and Supervision with Nurses' Compliance with The Application of Early Warning Score (EWS) in Inpatients at Tgk Abdullah Syafi'i Hospital

Table 1
Policy Overview of Early Warning Score (EWS) implementation In Inpatients

Table 2
Overview of Supervision of Early Warning Score (EWS) implementation in Inpatients

Table 3
Overview of Nurse Compliance with the application of Early Warning Score (EWS) in Inpatients

Table 4
Policy collation data with nurse compliance with EWS implementationBased on table 4, it can be seen that the results of the Chi Square test analysis show that there is a relationship between policy and nurse compliance with the implementation of EWS with a p value of < 0.05.

Relationship of Policy and Supervision with Nurses' Compliance with The Application of Early Warning Score (EWS) in Inpatients at Tgk Abdullah Syafi'i Hospital KESANS, Vol. 02, No. 01, 2022 16 The relationship of supervision with nurse compliance with the implementation of EWS Table 5
Supervised collation data with nurse compliance with EWS implementation