View of Compliance With Safety and Self-Isolation Among Nursing Students Living in Dormitories During Pandemic

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Journal of Nursing Science Update

Vol. 11, No. 2, November 2023 e-ISSN: 2829-0003 DOI : http://dx.doi.org/10.21776/ub.jik.2023.011.02.02 p-ISSN: 2829-7075 Website : http://www.jik.ub.ac.id

@JNSU. This is an open access article under the CC BY-NC 4.0 license

117 Original Research

Compliance With Safety and Self-Isolation Among Nursing Students Living in Dormitories During Pandemic

Margaret Lase¹, Nisra Bate’e², John Waruwu³, Lani Natalia Watania^4*, Erniyati Fangidae⁵

1,2,3Student Nurse, Universitas Pelita Harapan

4,5Faculty of Nursing, Universitas Pelita Harapan

*Corresponding author:

Lani Natalia Watania

Faculty of Nursing, Universitas Pelita Harapan

Jl.M.H.Thamrin Boulevard 1100 Lippo Village Tangerang 15811 - Indonesia, Telp: 021- 5460901 Email: [email protected]

How to cite this article: Lase, M., Bate’e, N., Waruwu, J., Watania, L., & Fangidae, E. (2023). Compliance With Safety and Self-Isolation Among Nursing Students Living in Dormitories During Pandemic.

Journal of Nursing Science Update, 11(2), 117–124.

Article Info ABSTRACT

Article History:

Received 8 February 2023 Revised 22 June 2023 Accepted 15 November 2023

Compliance is an attitude or behaviour as an effort to carry out requests or orders from others. Self-isolation also applies to students living in Western Indonesian Private University dormitories. It is intended for people with symptoms of COVID-19, such as coughing, shortness of breath, fever, sore throat, runny nose, other respiratory diseases, and a history of contact with suspected patients. Research This study aims to identify a description of nursing students' compliance in independent isolation in a dormitory at a private university in Western Indonesia. This study uses a retrospective type of research that takes data from March to September 2021 using quantitative research methods and a descriptive approach with sampling using the Purposive Sampling technique. The population in this study were final-year students with a sample size of 88 respondents. The measuring instrument in this study is a questionnaire with 11 questions. This questionnaire was tested for validity and reliability by 30 respondents who were final-year students. Researchers used univariate data analysis to describe student compliance in self-isolation. The results show that the level of compliance of the respondents was 59.1%, and non-compliance was 40.9%. In conclusion, most of the students were obedient in carrying out self-isolation. However, implementing health protocols should be maintained as preventive action for COVID-19.

Keywords:

Compliance COVID-19 Nursing Student Self-Isolation

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Compliance With Safety and Self-Isolation …

118 Introduction

Coronavirus disease, or COVID-19, is a virus that attacks the respiratory tract caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) (WHO, 2020).

The confirmed prevalence of COVID-19 in the world based on data from the World Health Organization (WHO, 2021) as of September 29, 2021, as many as 232,636,622 people and 4,762,089 deaths. On March 2, 2020, a case of COVID-19 was reported in Indonesia by the Ministry of Health of the Republic of Indonesia.

Data from the Ministry of Health of the Republic of Indonesia (2021) as of September 29, 2021, showed 4,213,414 positives for COVID-19 and as many as 141,826 died of COVID-19. In the province of Banten in Indonesia, until September 29, 2021, 131,339 people were positively confirmed with 2,669 deaths (Banten Health Office, 2021). In the Tangerang City area, 30,156 people were confirmed positive, and 484 people died (Tangerang City Government, 2021). Based on the data above, it can be concluded that there is an increase in positive confirmed cases and cases of death due to COVID-19.

To reduce the spread of the virus, the government enforces health protocol policies such as the mandatory wearing of masks, maintaining hand hygiene, maintaining distance, cough etiquette, and limiting activities outside the home such as working from home or learning from home and self- isolation policies (Ministry of Health of the Republic of Indonesia, 2021).

Compliance with health protocols could also be related to mental health and wellbeing. However, empirical findings and prominent models of the relationship between positive affect and prosocial and health- promoting behaviour make contradictory predictions. On the one hand, sadness and anxiety are associated with less sociability, extraversion, and higher risk aversion, which may increase the desire to cooperate. The COVID-19 pandemic has been associated with increased anxiety, which is at least partially fuelled by particular concerns about contracting the virus. Data suggest that both these state concerns and trait anxiety levels may promote compliance. On the other hand, depression has been connected to, more

broadly, non-compliance with medical treatments and has been associated with decreased self-efficacy and lower generosity (Wright et al., 2021).

Self-isolation is a limitation of movement and a reduction in interactions between humans. Self-isolation aims to break the chain of the spread of COVID-19 for people who have symptoms that refer to COVID-19, such as cough, shortness of breath, fever, sore throat, runny nose, and other respiratory diseases, and who have a history of contact with suspected patients. It also helps to slow down the spreading of COVID-19 and protect others who might not have been exposed to the virus. Self-isolation means you should stay at home or a specific place, not go to public or school areas and avoid visitors to your home or place. It is essential to stay separate from people at home and stay in a well-ventilated room with a window that can be opened (Chtourou et al., 2020).

Self-isolation also applies to students living in Western Indonesian Private University dormitories. Based on the researcher's observations of students living in dormitories, when an antigen swab was carried out, most had reactive and symptomatic test results, and some who were not reactive continued to self-isolate. Students with the suspect category, both reactive and symptomatic test results and non-reactive test results, will still be separated from other students because they have been in close contact with reactive students. Therefore, the high infection rate among nursing students and limited space with shared bathrooms is becoming more severe with living together in dormitories during the pandemic.

Despite nursing students' knowledge, the fast spread of COVID-19 in dormitories reflects the students' compliance in carrying out health protocols. Based on the explanation above, the researchers are interested in researching how to determine students’

compliance with health protocol and self- isolation in a dormitory at one of the Western Indonesian private universities during the pandemic's peak.

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119 Method

This study uses a retrospective cohort study that takes data from March to September 2021 using quantitative research methods and descriptive approaches. This research was conducted in the dormitory of a private university in western Indonesia. The target population of this research is the final- year nursing students who have undergone independent isolation during the pandemic.

This research uses the purposive sampling technique. The purposive sampling technique is used to determine the research sample based on the researcher's considerations about which sample is the most useful and representative (Muchransyah et al., 2019). In determining the research subjects, researchers used inclusion and exclusion criteria. The inclusion criteria are third-year nursing students who had been self-isolated in the dormitory, had positive antigen tests or showed symptoms of COVID-19 and agreed to fill out the questionnaire with a total of 88 nursing students.

The measuring instrument is a questionnaire, a data collection tool that contains information by providing several written questions answered in writing by the respondents (Damayanti, 2014). The researcher made the questionnaire in this study based on the decision of the Ministry of Health (2020) regarding things that need to be done during self-isolation, which consists of 11 questions. Two experts first tested the questionnaire using the content validity index to construct the basic questions, which included 19 questions. Afterwards, a pilot study with 30 nursing students under the same criteria is conducted to measure the validity and reliability of the questions. Eight invalid questions are eliminated, and the final questionnaire contains 11 valid and reliable questions.

The procedure for collecting data that the researcher has carried out is as follows:

First, the researcher submits an ethical review form to the Researcher Community Service and Training Committee (RCTC) Faculty of

Nursing Team. After gaining ethical approval for ethical review, researchers apply for permission to conduct research. Afterwards, researchers got permission to do VR tests through CVI test questionnaires to expert lecturers and research, then conducted validity and reliability tests on 30 respondents. Ultimately, the researcher distributed the online data collection questionnaire using the Google Forms link.

Researchers used univariate data analysis, which is an analysis that describes the data collected in the form of values with the highest frequency, both categories and numerical. This univariate analysis aims to describe the level of student compliance in carrying out independent isolation (Leavy, 2017). In analyzing the data, the researcher used a support application, namely Microsoft Excel and the Statistical Package for the Social Sciences (SPSS) version 25; the researcher grouped the data through Microsoft Excel and then transferred the data to SPSS to perform univariate analysis to find the median value and percentage of the data.

In obtaining the results of the research measure, the researcher used the normality test to divide the data. The researcher used the data normality test using the Kolmogorov- Smirnov test tool to see the normality of the data. Kolmogorov-Smirnov test, if p < 0.05, then the data distribution is not normal, while if p 0.05, then the data distribution is normal (Suliyanto, 2017). Based on the normality test that has been carried out, the results obtained a significance value of <0.05. In determining the measuring scale for the compliance variable, the median value is nine. This research was approved by ethical board members of the Faculty of Nursing UPH with number No.110/KEPFON/I/2022. The ethical considerations are respect for the person by giving clear explanations related to the study and gaining informed consent based on their decisions, beneficence, and maleficence to prevent any harmful impact, justice, and anonymity by using initials only to keep the confidential aspects of the studies.

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120 Results and Discussion

The tables below describe the results of this study.

Table 1. Characteristics of Respondents in the Dormitory (n=88)

Characteristics of Respondents n %

Age

18-20 50 58.8

21-23 38 43.2

Gender

Women 61 69.3

Men 27 30.7

Based on Table 1, the respondents aged 18-21 years were 50 people (56.8%), and the majority of respondents were women respondents were 61 people or 69,3%.

Table 2. Nursing Students’ Compliance to Self-Isolation (n=88)

Compliance n %

Obey 52 59.1

Not Obey 36 40.9

Table 2 above describes the compliance of nursing students in carrying out independent isolation in the dormitory. The results show that 52 respondents (59.1%) obey independent isolation. As many as 36 respondents (40.9%) need to be more compliant in self-isolation related to lack of facilities.

Table 3. Questionnaire Analysis

Question YES NO

n % n %

Have students ever left the room during

self-isolation without wearing a mask? 26 29.5 62 70.5

Have students ever made direct physical contact (shake hands. borrow things) with fellow residents of the isolation room?

50 56.8 38 43.2

Do students maintain a distance of at least 1 meter from other people when self-isolating?

67 76.1 21 23.9

Do students use masks in the dormitory

during the self-isolation period? 77 74.8 11 12.5

During the self-isolation period. do students avoid eating utensils simultaneously (plates. spoons. forks.

glasses. etc.)?

76 86.4 12 13.6

Do students perform hand hygiene during isolation. wash their hands with soap and running water. and dry their hands?

85 96.6 3 3.4

Do students maintain the cleanliness of

the isolation rooms during self-isolation? 84 95.5 4 4.5

Do students contact the

Tracer/DP/RA team when symptoms worsen (such as shortness of breath.

cough and increased body temperature)

86 97.7 2 2.3

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121

Question YES NO

n % n %

for further treatment.

Do students use the same bathroom facilities as other isolation rooms (bathrooms and toilets)?

72 81.8 16 18.2

Do students huddle in front of the room

during self-isolation? 12 13.6 76 86.4

Do students take medication or vitamins

given during self-isolation? 85 96.6 3 3.4

Compliance is an attitude or behaviour used to carry out requests or orders from others (Fathimah et al., 2021). According to the Ministry of Health of the Republic of Indonesia (2021), self-isolation is an effort to separate someone who is sick and needs COVID-19 treatment or someone who is confirmed to have COVID-19 from a healthy person, which aims to reduce the risk of transmission. Self-isolation compliance is an obedient attitude and behaviour in carrying out a protocol that contains guidelines and information on self-isolation procedures (Irawati & Sukmawijaya, 2021).

Based on the normality test that has been carried out to see the distribution of the data and determine the mean and median values as the measurement results in this study, the distribution of data with a value of significance <0.05 so that the measurement results in this study used the median value of nine. Values above nine can be said to be compliant with 52 respondents (59.1%), and values below nine are said to be non- compliant with 36 respondents (40.9%).

The results of the study that are in line with this research are the research conducted by Irawati & Sukmawijaya (2021) on 46 respondents with suspected COVID-19 at Poli Ili RSUD Kota Tangerang regarding the analysis of factors that affect the level of compliance of suspected COVID-19 cases in carrying out the self-isolation protocol in the patient. The results obtained from this study are that most respondents comply with self- isolation, with a percentage of 63% and 27%

not complying with the self-isolation protocol.

According to the researcher, the findings of respondents who adhere to isolation are supported because of the information obtained, both available on social media and

according to the self-isolation protocol that applies in nursing student dormitories.

Another study conducted by Smith et al. (2020) differs from this study's results. The research conducted by Smith et al. (2020) is about factors associated with compliance with self-isolation and lockdown measures in the UK. The results of the study were 217 respondents (9.7%) reported that they or someone in their home had symptoms of COVID-19, such as fever or cough 75.,1% of them left the house, and 24.5% reported not having symptoms and going shopping even though in a non-urgent situation, which means that the respondent is not compliant in undergoing self-isolation.

The difference in the results of this study may be due to supporting factors such as the environment and the research conducted by Smith et al. (2020). Many go out to meet their daily needs, while the research conducted by researchers is on the compliance of nursing students in carrying out independent isolation because of the rules that require students to carry out the protocol so that most of them comply with self-isolation.

However, some do not comply due to predisposing factors such as attitudes and perceptions that need to follow the appropriate protocol.

The researcher argues that authority and a supportive environment are needed so students are willing to carry out the self- isolation procedure obediently. The existence of authority that makes students obedient in self-isolation impacts breaking the chain of the spread of the COVID-19 virus. However, according to researchers, whether there is an authority, students must continue to carry out self-isolation procedures obediently.

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122 The findings obtained by the researchers in this study were supported by the self-isolation procedure applied in the nursing faculty dormitory. The self-isolation procedure was obtained from the Tracing Team of the dormitory. This self-isolation procedure is used as a guide for self-isolation for students who have symptoms and have been in contact with confirmed patients and students who are waiting for the results of the COVID-19 test.

The self-isolation procedures that apply are not leaving the room, maintaining the cleanliness of the isolation room, implementing a clean and healthy life, always wearing a mask, keeping a distance from other people and not making physical contact, taking medication or vitamins as recommended and contacting the Tracer team if the symptoms worsen. This self-isolation procedure has been disseminated to students through Dorm Parents and the Tracer Team so that self- isolating students can learn how to self-isolate properly.

The research conducted in the nursing faculty dormitory that was on the self- isolation procedure, and the results of this study showed as many as 59.1% of respondents were obedient in carrying out self-isolation; this study implied that nursing students have studied and implemented self- isolation procedures properly to break the spread of COVID -19 in nursing faculty dormitory.

In the study results, two question items indicated that the respondent was not compliant in self-isolation. The two questions were about physical contact and using the same bathroom facilities as other isolation rooms. These two question items indicate that the respondent's non-compliance is due to limited facilities, such as using the bathroom or toilet, being in the same room, making interaction or contact easier. Other factors affecting respondent compliance are social norms and individuals' values towards health.

Social norms in the community often cause pressure to act similarly and impact how people behave in implementing healthcare protocols during the COVID-19 pandemic (Young & Goldstein, 2021; Hsing et al., 2021).

The other nine-question items indicate that

the respondent is obedient because students are not limited by facilities and only need the respondent's awareness to carry it out. So, the research results are that most nursing students are obedient in carrying out independent isolation in the dormitory of a private university in Western Indonesia (59.1%). Furthermore, individuals' values also play an essential role in health beliefs influencing their health-related actions or behaviour.

The high compliance with health protocols may also influenced by sufficient knowledge and exposure to information about COVID-19, while considering that they are nursing students who already learn about healthcare and health prevention in their nursing schools. Knowledge may increase motivation to comply with the protocols by increasing awareness of the risks of catching COVID-19. Further, such information may increase capabilities by offering strategies for compliance. Although empirical findings and influential models of the relationship between pleasant affect and prosocial and health- promoting behaviour offer contradictory predictions, compliance may also be related to mental health and wellbeing. Finally, there is reason to believe that time use during quarantine could be related to compliance, likely in a bi-directional way. Some activities may make compliance more pleasant, reducing boredom, improving wellbeing, and incentivizing people to stay at home or their places (Wright et al., 2021).

Nursing students in the dormitory seemed to understand the severity of Covid- 19's impact on their health and adapt well to the recommended precautions. They are likely to have high compliance related to their sufficient knowledge and tight procedures applied in the dormitory during the pandemic.

Despite all the factors that can increase the compliance of nursing students during self- isolation, the information in Question Number 10 shows that most of them still huddle in front of their rooms, increasing the possibility of transmitting the virus.

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123 Conclusion

Based on the results of research and discussion on the compliance of nursing students in self-isolation in the dormitory of a private university in Western Indonesia, 52 respondents (59.1%) were obedient in carrying out self-isolation, and 36 respondents (40.9%) did not comply self-isolation. Analysis of the questionnaire showed that as many as 50 respondents (56.8%) had physical contact.

As many as 72 respondents (81.8%) used the same bathroom facilities as other isolation rooms, which was interpreted as non- compliance.

Based on the study's results, most of the students were obedient in carrying out self-isolation. However, implementing health protocols should be maintained as preventive action for COVID-19.

Further study is needed to explore related factors on elf-isolation and health protocol compliance.

Limitations of the Study

This study has several limitations.

Firstly, the potential of unintentional recall bias by the respondent related to their experiences while in self-isolation. Second, all the data are collected with self-reported methods using online questionnaires, which may be susceptible to social bias. However, researchers tried to minimize all the potential biases by carefully developing the questionnaire concisely and clearly.

Acknowledgement

The authors thank the LPPM (Lembaga Penelitian dan Pengabdian Masyarakat) Universitas Pelita Harapan for financial support in publication.

Conflict of Interest

All authors declare no competing interest.

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