INTERNASIONAL CONFERENCE ON
MULTIDISCIPLINARY APPROACHES IN HEALTH SCIENCE
VOLUME 2 .
ISSN 3032-4408 (Onlin.
https://ejournal.
poltekkes-denpasar.
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php/icmahs Homecare Clinic Services For Foreign Patient Travelers In Bali Niluh Nyoman Tantri S1*.
Duwi PudjiAstuti2 STIKES Bina Usada Bali Poltekkes Surakarta Corresponding author: niluhnyoman23@gmail.
Article history Posted :
Reviewed :
Received :
2024-12-09
2024-10-29
2024-10-05
ABSTRACT
Various health risks in tourism depend on the traveler's physical condition, and type of travel.
Bali is a favorite tourist spot chosen by foreign tourists for vacation.
An increase in the number of tourists will be followed by an increase in health risks, so a tourist clinic is needed.
home care is a form of nursing service which is community nursing care carried out at home.
This research is a descriptive research with qualitative methods.
The informants in this study are nurses who work at the homecare clinic of foreign tourists.
Researchers will explore information on informants related to homecare clinic services for foreign tourists.
The results showed that foreign tourist patients will be handled by a team that includes a doctor, nurse and driver.
The home care team carries medicines and backpacks containing patient care equipment.
The homecare team gets foreign tourist patients through oncall and will go directly to the location of the foreign tourist patient.
Regarding service assessment or evaluation, foreign tourist patients have not been able to assess the evaluation of the home care services they get, only limited to providing comments from social media.
The conclusion of this study is that there is a need for operational standards in handling foreign tourist patients and home care service evaluation or assessment forms, so as to provide improved quality of home care services.
Keywords: Home Care, foreign patient, services Niluh Nyoman Tantri S et all : Homecare Clinic Services For Foreign Patient Travelers In Bali INTERNASIONAL CONFERENCE ON MULTIDISCIPLINARY APPROACHES IN HEALTH SCIENCE VOLUME 2 .
ISSN 3032-4408 (Onlin.
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php/icmahs Introduction Tourism objects in Bali have a wide variety, including marine tourism, nature tourism, and cultural tourism.
About 54 tourist attraction locations in Bali are spread across eight districts in Bali.
(Somantri, 2.
Based on the Central Bureau of Statistics of Bali Province, the number of foreign tourists to Bali by region .
in 2023 was 5,273,258.
(BPS, 2.
The average length of stay of foreign tourists in Bali star hotels in July 2024, the shortest length of stay was nine days and the longest was up to 98 (BPS, 2.
Health problems in foreign tourists in Bali who visit health care centers include acute pharyngitis, rhinopharyngitis, and other respiratory diseases.
(Gandamayu, 2.
Care of patients is an important responsibility of health care organizations and their medical staff in terms of providing safe and effective care and services for all patients.
The scope of care of patients in tourist site health services includes care delivery, high risk services, resuscitation services, nutritional support, pain management, and end-of-life aspects.
(Millati, 2.
The function of homecare nurses visiting foreign patients in Bali certainly has a different service platform in the provision of nursing service functions in Indonesia.
Armed with the high sector of foreign tourists, homecare nurse visits in Bali are in the spotlight for nurses to master the health service economy based on homecare nurse visits.
Nowadays, travelers show high interest in health services.
Various countries in the world around 130 countries are competing to be the winner in the global business share in the field of medical tourism.
On a global scale, it is estimated that the profits obtained have increased by an average of 20% per year or reached 40 billion US dollars (Tantri, 2.
In some developed countries, home care is not a new concept.
This concept has been developed by William Rathon since 1859 in Liverpool called home care in the form of nursing visits to the home to treat patients who are sick and not willing to be taken to the Florence Nightingale also practiced home care by providing care to patients who were sick, especially for patients with low economic status, sanitary conditions, personal and environmental hygiene and poor nutrition so that they were at risk of various types of infections commonly found in the community.
Apart from not being willing to be taken to the hospital, home care can also be follow-up care from the hospital that is already in the discharge plan .
ishcharge plannin.
and can be carried out by nurses from the original hospital or community nurses or nursing teams that specialize in home care.
(Utari P.
Home care or home visits conducted by nurses can reduce the number of hospitalizations, as nurses can provide preventive measures for risky situations.
(Kadar, 2.
Home visits have a positive effect by improving quality of life.
Nurses make visits to patients with a team of other health (Ergin, 2.
Home care service users include adult patients, children, the elderly, infants, toddlers, pregnant women.
Home care is care that is not continuous, for example with daily or weekly visits.
Cooperation or contact with doctors is relatively rare and the administrative burden per hour is quite high.
The lack of coordination of care in homecare will hinder the delivery of health The existence of such barriers results in poor treatment, which is related to inconsistent care coordination.
Patients also attribute care problems such as inappropriate care plans, or incorrect medication to inadequate care coordination.
(Mockli, 2.
Patient satisfaction in homecare services is an outcome of good health services.
Patient satisfaction is one of the goals of improving the quality of health services (Health Service Unit of the Indonesian Ministry of Health, 2.
Keeping the quality of homecare services good is important.
Patient satisfaction not only affects the trust of consumers but can also affect the reputation of Homecare service Niluh Nyoman Tantri S et all : Homecare Clinic Services For Foreign Patient Travelers In Bali INTERNASIONAL CONFERENCE ON MULTIDISCIPLINARY APPROACHES IN HEALTH SCIENCE VOLUME 2 .
ISSN 3032-4408 (Onlin.
https://ejournal.
poltekkes-denpasar.
id/index.
php/icmahs providers and the ability to refer patients to other interested patients.
In health care, patient satisfaction is one of the benchmarks of health care success.
(Rambu, 2.
Research Method This type of research is descriptive with an approach using qualitative research methods, which to explore information about the description of the implementation of homecare services performed on foreign patients in the Kuta Bali area, using the indepth interview Key informants in this study are home care nurses who work at the Homecare Clinic for foreign patients in Kuta Bali, and supporting informants are patients who have used home care services.
In this study, the researcher took 1 informant who will be involved, among others:
nurses who work at the Kuta Bali tourism homecare clinic.
Informants in this study are nurses who care for foreign patients, both men and women, from adults to children, with a length of work of more than 3 years, nurses with a Bachelor of Nursing education and already Ners, with experience caring for foreign patients who have at least 5 different countries.
Researchers sought data through questions to informants to explore data in each of the 6 questions in the interview.
The questions were related to the informant's experience, methods in carrying out service delivery, obstacles faced, how to overcome, and evaluation methods carried out to patients.
Researchers gave participants the freedom to tell all experiences and problems in the service, through in-depth interviews, which then the results of the interviews were classified to identify the main problems in homecare services with the results of in-depth interviews that had been carried out.
As one of the qualitative data processing techniques, triangulation according to Sugiyono .
is defined as a technique that combines various data collection techniques and data sources that already exist.
Researchers do triangulation, of course, there are certain intentions that want to be done.
In addition to researchers collecting data that will be used in research, it also simultaneously tests the credibility of data through various data collection techniques and various data sources.
The purpose of triangulation is to trace the inequality between the data obtained from one informant .
he informan.
and other informants.
Therefore, a technique is needed that can unite the differences in data in order to draw accurate and precise conclusions.
This research uses an interview with one of the managers or owners of a clinic for foreign tourists in Kuta Bali, as one of the informants as a form of triangulation method, which determines the accuracy of the research, besides that it is followed by a discussion of theories that are binding in the research conducted.
Results and Discussions Assessment of the homecare picture of foreign patients, is a systematic description of health care workers who devote themselves to the health sector in providing independent nursing services.
In the home care service in accordance with the schedule which consists of 1 doctor, 1 nurse and a driver.
where the officers who go down in the field are only 3 people consisting of a doctor, nurse and a driver but do not provide much assistance because they only focus on transportation.
On preparation in the implementation of homecare services still needs to be corroborated by key informants as follows: AuAuthe medicine we need, sometimes there is e.
not complete and ready .
finally the patient has to wait for us to buy the medicine first .
or we don't just give a prescription because if it doesn't happen, we have to go back and forth, it's a hassleAy The informant explained.
Auso far the standard service process is that we get a call from the call center, then we are directed to homevisit with the doctor, armed with 1 backpack of medicines and tools for patient care.
Ay AuFor example, if Niluh Nyoman Tantri S et all : Homecare Clinic Services For Foreign Patient Travelers In Bali INTERNASIONAL CONFERENCE ON MULTIDISCIPLINARY APPROACHES IN HEALTH SCIENCE VOLUME 2 .
ISSN 3032-4408 (Onlin.
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php/icmahs something is missed, one of us sacrifices to go to the nearest pharmacy to buy the items that were left behind.
Ay On the standard of homecare visits to homes, especially foreign patients, informants do not understand the applicable references.
Auno.
I haven't heard of any standards from the government for patient homecare services .
because so far we have only followed the standards from the workplace anyway and indeed the average obstacle is the same in preparation is often lackingAy.
Based on the results of interviews with managers.
Auso far, the reference in services for SOPs when we see patients has not been contained in a module or official guidelines.
use the accreditation guidelines under the Health Office through the Puskesmas as a network of assessment teams for clinic eligibility in accordance with standard rules.
Ay This is emphasized by the answer: AuActually, it would be better to create an SOP module such as a checklist form or a special format when we will visit a patient, starting from when we receive an oncall .
then when and where we plan to meet, until later what is mandatory and must be prepared during the visit .
after all this is different from the hospital, if you miss just one item, you can get into Ay The results in the interview also in the process of evaluating the service of the informant as the nurse in charge of homecare said that all tasks in an activity are in accordance with the protocol of duties and procedures that apply, but there are still often many patients complaining about the service: AuThere are just guests, complaining that sometimes there is traffic jam so they come late .
there are also those who say that the treatment is considered too expensive sometimes.
The informant also emphasized.
Au.
I have never given a foreign patient satisfaction evaluation form, most criticisms on social media, so the complaints have not been measured properly so far, as far as I personally understand.
Ay The description of the standard competency skills of nursing staff who are determined to provide services to foreign patients is not yet understood for standardization, as follows the interview excerpt:
Au.
There is nothing about specific skill competency rules and especially communication training in providing services to patients and families of patients health workers use language that can be understood, we also learn by So, usually if the nurse explains the medicine if the language, for example, cannot be understood, the doctor explains to the patient how to take the medicine, it's more flexible.
Ay Au.
Sometimes during the telecommunication appointment process, the explanation is considered by patients to be unclear, especially when the price range requested is in US dollars, resulting in complaints, sometimes just because of the difference in language understanding between patients and nurses, sometimes there is often a miss of communication and Ay This is confirmed by the results of an interview with the manager.
Au.
Indeed.
I am currently recruiting nurses with standards, at least nurses are able to speak English passively, so far it still feels safe.
For competency skills, there is nothing special either, after all, only services to patients such as handling mild and standard emergencies, and even then it is done in collaboration with doctors.
The type of disease is not severe, if it is severe, it must be directly referred to the hospital .
Au Explanation of prices.
Ay.
there is actually a regulation from the Regional Regulation for foreign patient rates, which can be up to 3 times the local service standard price.
So it's okay to use a more expensive rate, because basically everything can be claimed to the patient's insurance for the medical certificate sheet.
Ay Evaluation has not been applied properly, according to the informant's data.
Au.
there has been no evaluation using a form like in a hm, yes so far it is still through the trip advisor if they make a tweet.
But actually it is more painful, because those who read the ugliness of our clinic are seen all over Niluh Nyoman Tantri S et all : Homecare Clinic Services For Foreign Patient Travelers In Bali INTERNASIONAL CONFERENCE ON MULTIDISCIPLINARY APPROACHES IN HEALTH SCIENCE VOLUME 2 .
ISSN 3032-4408 (Onlin.
https://ejournal.
poltekkes-denpasar.
id/index.
php/icmahs the world, actually it is really necessary like standard forms for evaluation so that not random guests will write about our lack of Au The data is sharpened by the lack of standardization in the reference form which should be tailored to the needs of the service has not been properly equipped, data from the manager informant.
Ayyes .
indeed so far there is nothing, at most feedback if they want to complain or want to show their appreciation they comment to email, or just to social media.
But yes, some of them are not all that we Ay Nurses need a well-organized nursing service planning system where the expectations that are desired in a process of preparing various nursing interventions, especially when visiting patients' homes, must be well prepared.
This is needed to prevent, reduce, and mitigate client Planning is the third step in creating a nursing process.
Planning is part of the organizing phase of the nursing process as a guide to direct nursing actions in an effort to help, alleviate, solve problems or to meet client A well-written plan will give direction and meaning to nursing care because planning is a source of information for all those involved in the client's nursing care.
The homecare planning process can begin with contacting patients via smartphone.
Technology experts estimate that 90% of adults will have access to smartphones by 2020 (VOA Indonesia, 2.
This condition greatly allows the application of telehealth technology to support the remote communication system between nurses and patients, besides the concept in planning care actions does not experience obstacles if communication can run with remote communication media as a tool.
Preparation of medical devices and drugs according to the doctor's advice, along with the appropriateness of PPE to forms for inform consent, satisfaction, etc.
, requires high responsibility, where nurses and doctors will come together in providing care to patients.
Thus, nurses are required to have readiness and accuracy in bringing the necessary medical devices, in accordance with the SOP of nursing care, and the possible actions that will be taken by the doctor in charge.
According to Lopez Eva, in the journal IHSS .
n Home supportive servic.
2007 on The Home Checlist Visit Plan, homecare treatment requires a preparation that is divided into 2 things, namely, before the visit and during the The mechanism in visiting the patient certainly begins with communication through telecommunication aids to discuss the situation and prepare tools and items before visiting the Then during the visit is also carried out in accordance with the procedure, and ends with the outcome results in the form of the next plan.
If there is a special assessment for referral and others, immediately inform the patient.
The results of the researcher's theoretical review of the section that regulates the rules in planning homecare visits in emergency and first aid there is still no standardized SOP rules.
According to the rules of the Bali Governor Regulation.
Article 56 explains that the development of services includes tourist medical services.
Where it becomes a description of the regional regulation that oversees the rules in the homecare visit tourism service, where the content also suggests that the method of service can follow the standards of the head / head of the relevant agency.
As for the service rates themselves through Perbup No.
9 th.
2020 concerning medical service rates Article 37 that foreign national services apply at a rate of 2 .
times the domestic rate.
According to WHO 2019, monitoring and evaluation allow program managers to assess the effectiveness of control initiatives and must be carried out continuously.
The specific objectives of program evaluation are to measure program achievement and progress, dedicate effectiveness and efficiency, direct program resource allocation and collect information needed to revise policies.
Al-Assaf .
9 in Nyoman Gejir 2.
explains that quality can Niluh Nyoman Tantri S et all : Homecare Clinic Services For Foreign Patient Travelers In Bali INTERNASIONAL CONFERENCE ON MULTIDISCIPLINARY APPROACHES IN HEALTH SCIENCE VOLUME 2 .
ISSN 3032-4408 (Onlin.
https://ejournal.
poltekkes-denpasar.
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php/icmahs also be measured.
A system usually consists of three components: input, process, and output.
The quality of input .
can be measured.
Input includes the quality of personnel, supplies, equipment, and physical resources.
The quality of running the process can also be measured.
Therefore, the system components, namely input, process and outcome, have certain quality characteristics that can be measured and are important in measuring quality in a system.
So in this case, evaluation in the form of patient satisfaction is very important to process during the service process.
Conclusion In the Planning of The Home Checklist Visit Plan method, it is necessary to prepare for handling homecare which is divided into 2 things, namely, before the visit and during the Indonesia currently does not have a standard SOP checklist, suggestions for subsequent researchers to develop from the theory used in foreign countries.
Basic English communication with courses or training is not a standard in recruiting nurses, so they only get knowledge during university education.
According to the Bali gubernatorial regulation, article 56 explains where the development of Puskesmas services includes medical tourism services.
Where this is the one that oversees the rules in tourism homecare visit services, where the contents also state that the SOP method in its services can follow the standards of the head/leader of the relevant The system components, namely input, process and outcome cannot be measured yet.
There is no special guideline form for requesting satisfaction and criticism as an outcome of homecare services, so in this case evaluation in the form of patient satisfaction is very important to process during the service process.
Acknowledgement A thank you to the agencies and parties who supported this research.
Conflic of Interest The author.
declare that they have no conflict of interest.
Reference