The Relationship of Nurse ’ s Workload and Caring in Internal Disease Ward and Surgery Ward in Regional Public Hospital

Caring is an attempt by the nurse to be close to the client, knowing the client's problem so as to provide appropriate intervention according to the problem experienced. One that causes improper nurses' caring behaviours is their imbalanced workload. The objective of this research was to fi nd out the correlation between workload and nurses' caring behaviours in internal disease ward and surgical ward of Dr. Tjitrowardojo Regional Public Hospital, Purworejo. This research is a quantitative research with cross sectional design. The population in this study were all of the nurses working in Internal Disease Ward and Surgical Ward in the hospital. The total sample was 65 nurses using total sampling technique. The research instruments for workload was NASA-TLX questionnaire and nurses' caring behaviours was a questionnaire. The data was processed with Kendall's tau statistical test. The results showed that the majority of respondents with a high workload implemented caring behaviours in the category of enough by 19 respondents (29.2%), while the respondents with very high workload implemented caring behaviours in the category of less by 9 respondents (13.8%). The Kendall's tau analysis showed the results of p=0.000 (p<0.05) and r=-0.618, meaning that there was a correlation between ISSN 2354-7642 (Print), ISSN 2503-1856 (Online) Jurnal Ners dan Kebidanan Indonesia Tersedia online pada: http://ejournal.almaata.ac.id/index.php/JNKI INDONESIAN JOURNAL OF NURSING AND MIDWIFERY


INTRODUCTION
will cover any shortage of hospital.But the impact if caring behavior is not achieved is the decrease in the quality of nursing services that will directly affect the discontentment of clients with health services at the hospital.One of the causes of caring behavior of poor nurses is the workload and nurses' caring behaviours in internal disease ward and surgical ward of Dr. Tjitrowardojo Regional Public Hospital, Purworejo with strong correlation and negative correlation, meaning that the higher the workload, then the lower the caring behaviours.
In conclusion, there was a correlation between workload and nurses' caring behaviours in internal disease ward and surgical ward of Dr.

This research is not in accordance with
Hidayat's research which states that the infl uence of the workload is the physical needs and the performance (success rate) is because in the research is one of the activities that make the nurse burdened in terms of performance that nurses are required to work quickly so that all patients can be served (19).This study is in accordance with the theory that explains that the workload of nurses is all activities or activities undertaken by nurses in a nursing service unit (20).

Nurses' Caring Behavior
The frequency distribution of nurses' caring behavior in the Internal Disease and Surgical wards, Tjitrowardojo Hospital, Purworejo is presented in Table 3.  Table 3 shows that nurses' caring behavior best category is occupied by as many as 31 respondents (47.7%) while bad caring behavior is done by 11 respondents (16.9%).The results show that the average of caring behavior is quite good and is still found in the wards.Though it was still found bad caring behavior but with a small percentage.This is consistent with the theories of   (19).

CONCLUSION AND RECOMMENDATION
Health workers such as nurses are the key to the successful achievement of health development.Health workers contribute up to 80% of successful development and good health services (1).Nurses in health services are health workers who continuously provide nursing care to patients, good caring management in health services provided by nurses to patients greatly determine the quality and image of the service (2).Caring as the essence of nursing means also the accountability of the nurse and client relationships in which the nurse helps acquire knowledge and improve health (3).Caring is an attempt by the nurse to be close to the client, knowing the client's problem so as to provide appropriate intervention according to the problem experienced.Manifestations of caring behavior include full attendance, good communication, a touch that calms the client, listens to what the client says and understanding (4).Caring behavior is indispensable in nursing services because it displayed in nursing service others and human life(21).Measurement of caring behavior with reference to the development of curative factors that include the formation of humanistic and altruistic values, inculcates hopeful attitudes, sensitivities, mutual trust and relationships, enhances and accepts positive and negative feelings of expression, uses systematic problem-solving methods, improves lessons and teaching interpersonal relationships, creating a supportive physical, socio-cultural and spiritual environment, helping to meet basic human needs and developing existential-phenomenological factors.
Based on the results of research conducted, it can be concluded that the characteristics of the majority of nurses at Internal Disease and Surgical Wards at RSUD Dr. Tjitrowardojo, Purworejo whom aged at 31-40, female gender, nursing education D3, working period 1-5 years with nurse assignment Nurse Major (PA) included in high category workload while their nursing behavior is categorized in with good category.The bivariate test showed that there was a correlation between workload and caring behavior of the nurses.The closeness of relationships which is strong with negative direction relationship means that the higher the workload, the less the nurses caring behavior quality will be.Based on the research result, the researcher suggest the head of hospital Nursing Department to maintain caring behavior and keep doing guidance to the room which still to minimize caring less behavior, by doing routine supervision and encourage good caring behavior as their habit, entrusting the effort of service improvement, giving reward to nurse who perform good caring behavior.To all nurses, especially those who works at Internal Disease and Surgery Wards, RSUD Dr. Tjitrowardojo Purworejo, the researcher want to suggest them to maintain good caring behavior.

Respondents' Characteristics Surgical and inner disease wards Table 1. Respondents' Distribution at Internal Disease Ward and Surgical Ward at RSUD Dr. Tjitrowardojo Purworejo
Tjitrowardojo Regional Public Hospital, Purworejo.theywillfirst know the states and complaints experienced by patients.Emotional problems of patients such as anxiety, irritability, anger and lack of concentration can occur due to pain, not knowing the diagnosis of the disease and have not received treatment therapy.Under these circumstances, the patient desperately needs the attention, sensitivity and caring attitude of the nurse to respond to her complaints.The average condition of the patients treated in the Internal and Surgical Ward varies from weakness, pain, limited space up to psychological problems due to surgery.Therefore, the caring behavior of the nurses to meet the patients' needs such as eating, drinking, bathing, reducing pain, obtaining information about the disease and treatment to the data collection, there was one nurse who was on leave so it was not included as the research sample.Data analysis used in this research were univariate and bivariate analysis with kendall's tau test.Independent variable of this research is work load while dependent variable is caring behavior of the nurses.Primary data were taken by using questionnaires include workload data and caring behavior of nurses.Workload questionnaires used NASA-TLX adopted from Achmad Fandi (10).Caring behavior questionnaire was adopted from Rolita Sari research (11).The NASA-TLX workload instrument has been tested for validity at Dr. RSPAU.Hardjolukito with a score of 0.with work that fi ts and fi ts the nature of a more patient, gentle and caring woman (14).This is consistent with the theory that one of the factors affecting workload is gender (12).

Table 2 . Frequency Distribution of Respondents' Workloads in Internal Diseases and Inner Surgery Wards, Tjitrowardojo Hospital, Purworejo
Source: Primer Data, year 2017 Based on Table2, it shows that the most high category workload is 34 respondents (52.3%) and the workload is at least very high category as many as 17 respondents(21.5%).The data indicate that most of the nurse implementers feel the workload is higher than the primary nurse.