View of Implementation of Health Protocol on Nursing Students in The Dormitory 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.2023.011.02.09 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

179 Original Research

Implementation of Health Protocol on Nursing Students in The Dormitory During Pandemic

Marya Listiana Simamora¹, Tuti Melinda Anggreini Purba², Jose Leonardo³, Lani Natalia Watania⁴, Catharina Guinda Diannita⁵*

1,2Siloam Hospitals

3,4,5Universitas Pelita Harapan

*Corresponding author:

Catharina Guinda Diannita Universitas Pelita Harapan

Faculty of Nursing, Universitas Pelita Harapan. Jl. Jend. Sudirman No.20, Bencongan, Kec. Klp. Dua, Kabupaten Tangerang, Banten, Indonesia

Email: [email protected]

How to cite this article: Simamora, M. L., Purba, T. M. A., Leonardo, J., Watania, L. N., & Diannita, C. G.

(2023). Implementation of Health Protocol on Nursing Students in The Dormitory During Pandemic.

Journal of Nursing Science Update, 11(2), 179–186.

Article Info ABSTRACT

Article History:

Received 8 February 2023 Revised 1 October 2023 Accepted 30 November 2023

Global prevalence data released by WHO (2021) shows a decrease in positive cases of COVID-19 in Indonesia by 18%. One of the government's policy efforts to prevent the spread of the COVID-19 virus is establishing health protocols, including physical distancing, wearing masks, and hand washing. There is an increase in the number of dormitory residents at one of the western Indonesian universities, which causes a decrease in the effectiveness of implementing health protocols. The study aims to identify the application of health protocols, including physical distancing, wearing masks, and hand washing among nursing students. This study uses descriptive quantitative research methods. The instrument used is an online questionnaire, a random sampling technique with univariate data.

The results showed that the 2019 and 2020 nursing students, 232 respondents (99.1%) and two respondents (0.9%) did not apply health protocols properly. In conclusion, most nursing students in Western Indonesian universities applied health protocols.

Suggestions for students are expected to be able to maintain and improve the implementation of health protocols in dormitories to prevent the increase in the spread of COVID-19 or other infections.

For further research, we are expected to use bivariate analysis to suppress the increase in respiratory infection cases.

Keywords:

Covid-19 Health Protocols Students

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Implementation of Health Protocol …

180 Introduction

Coronavirus Disease 2019, often called COVID-19, is one of the infectious diseases currently sweeping the world. COVID-19 is a disease that attacks the respiratory tract caused by Severe Acute Respiratory Syndrome (SARS). The virus that causes COVID-19 is called SARS–CoV–2. (Kemenkes RI, 2020). The COVID-19 virus can be transmitted via droplets emitted from an infected person's mouth or nose to those nearby, either through tiny particles in the air or by touching contaminated surfaces (Sari, 2020). The signs and symptoms experienced by patients contaminated with the COVID-19 virus consist of mild symptoms (fever, cough, difficulty breathing), moderate symptoms (fatigue, myalgia, severe tightness) to severe symptoms such as Acute Respiratory Distress Syndrome (ARDS), septic shock, sepsis, and even death (Kemenkes RI, 2020).

Data obtained from the COVID-19 Task Force in November nationally, there were 15,211 deaths (3.26%) above the world average (2.42%), and the cure rate reached 391,991 (83.92%), which was above the world average (69.68%). The number of active cases of 59,911 (12.83%) was below the world average (27.90%). The number of active cases of 59,911 (12.83%) is below the world average (27.90%). Cumulative data from districts/cities in Banten in November there were 2,527 active cases (23.00%), 298 deaths (2.71%), and 8,165 recovered cases (74.29%).

Global prevalence data released by WHO 2021 on August 10 showed a decrease in positive cases of COVID-19 in Indonesia by 18%.

Health protocols are one way to minimise the spread and transmission of the COVID-19 virus. The government implemented health protocols to prevent and control COVID-19 as written in circular HK.01.07/MENKES/382/2020 (Handayani .et al., 2020). Kemenkes RI (2020), the most effective preventive ways to control the spread of the coronavirus are washing hands with running water, using soap or hand sanitisers, applying cough and sneezing etiquette by using upper arms or tissue, wearing medical masks when leaving the home environment and maintaining a distance (at least one meter) (Rofifah, 2020). Physical distancing regulates the distance between individuals (at least one meter) in each activity

(Kemenkes RI, 2020). As an effort to minimise the spread of COVID-19, washing hands using soap or hand sanitiser is one of the essential health protocols to reduce microorganisms attached to the hands so that it can reduce the spread of germs to others or to the environment that may be transmitted from hands (Panirman, 2021). Wearing a mask is one of the health protocols that need to be implemented to break the chain of transmission of COVID-19, minimising the risk of contracting and transmitting the COVID-19 virus. The use of masks can be a form of self- protection by covering the nose, mouth, and chin, and one needs to pay attention to the use of masks recommended by the government (Kemenkes RI, 2020).

According to Hulukati and Djibran (2018), a student is studying or undergoing education in higher education. Students 18-25 years old who have a productive age should be able to become role models in society as agents of change based on knowledge, level of education, and thinking patterns (Wairata, 2020). Nursing students, including health workers, should have more knowledge of COVID-19, what COVID-19 is, and how to prevent it. Nursing students must not only know but also provide information related to COVID-19 to reduce coronavirus transmission (Hidayat .et al., 2020). Therefore, students are expected to be good societal role models through knowledge, attitudes, and behaviours in preventing COVID–19.

Student dormitories are a place to live for students during their education and usually have a location for specific agencies to improve academics and develop student personalities (Safutra, 2016). At the beginning of September 2021, there was an increase in the number of dormitory residents, where previously the dormitory was inhabited by the class of 2019 and dorm parents. However, since September, the arrival of new students of the class of 2020, the dormitory has been increasingly crowded. Based on the results of researchers' observations for one week in the dormitory of the faculty of nursing at one of the Western Indonesian universities, it was found that students did not implement health protocols properly where six out of ten students did not apply physical distancing, such as not keeping their distance (giving a distance of less than one meter) when queuing

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181 to take food and queue for elevators, like to swarm while walking, and likes to get together more than three people. When washing hands after throwing garbage or doing activities, as many as six out of nine students rarely use hand rubs or wash their hands before eating.

For the wearing of masks themselves, as many as nine out of ten students always use masks when leaving the room or when travelling; this shows that compliance with wearing masks is good.

Based on the researchers' observations, there are some differences in implementing health protocols before and after adding students to the same. The observations show that the implementation of health protocols is decreasing, so the risk of spreading COVID-19 in dormitories is high enough. Consequently, researchers are interested in describing the implementation of health protocols in nursing students in the dormitory of one of the Western Indonesian universities.

Method

Research design

This study uses a descriptive quantitative research design. The study was conducted in a nursing student dormitory of one of the Western Indonesia universities from January to April 2022.

Sampling

Sampling in this study used probability sampling techniques with a simple random sampling model or sampling from a random population. The number of research samples was determined using the Slovin formula, with an error tolerance of 5%, so the number of samples studied was 234 people from students.

Participants

Nursing students, male and female, enrolled in the faculty of nursing at one of the Western Indonesian universities were the participants in this study. The eligible criteria used for this study were 1) nursing students from the class of 2019 or the class of 2020 and 2) nursing students who live in the dormitory.

The study was conducted with 234 nursing students who met the inclusion criteria and agreed to participate.

Instruments

The research instrument in this study was a questionnaire using online forms distributed through the WhatsApp group, and respondents' answers were measured using the Likert scale. The questionnaire consisted of 21 positive statements. This study used a questionnaire developed by the researcher, which included demographic data, statements about the application of physical distancing, statements regarding the application of hand washing, and statements regarding the use of masks in students. The alternative answer to each instrument item in this study is always, often, sometimes, and never. To ensure accuracy and reliability, researchers did the content validity index (CVI), furthermore validity and reliability. The questionnaire showed high consistency with a Cronbach's alpha of 0,882.

Ethical Considerations

The ethics committees approved conducting the research (ethics number 109/KEPFON/1/2022). Electronic informed consent was obtained from the respondents.

Researchers maintain confidentiality and safeguard anonymity.

Statistical Analysis

Data processing in this study is carried out in several steps, such as editing (carried out because of the possibility of incoming data not meeting the requirements or not by needs), coding (the process of providing specific codes on each data including providing categories for the same type of data), data tabulation (the process of placing data in the form of tables by creating tables containing data according to analysis needs), processing (statistical data processing), and data cleaning (re-examining data and presenting in the form of tables and percentages), using SPSS statistics 25 computerised programming. This study uses a univariate analysis method, where it summarises the collection of measurement results so that the set of measurement results is such that the data set turns into helpful information.

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182 Results and Discussion

Table 1. Categories of Respondents By Gender

Characteristic Frequency (n) Percentage (%) Gender

Male 39 16.67

Female 195 83.33

Table 2. Categories of Respondents By Class Level

Frequency (n) Percentage (%)

Class of 2019 119 50.85

Class of 2020 115 49.15

Table 3. Categories of Respondents By Age Age Frequency (n) Percentage (%) 17-25 years

(Late

Adolescence)

234 100.00

The majority of respondents in this study were female, as many as 195 people (83.33%), while men were 39 people (16.67%). The category of respondents in the class of 2019 was 119 respondents (50.85%). The class of 2020 was, 115 people (49.15%) of the total respondents, as many as 234 with inclusion criteria. All respondents (100%) are in the age range of 17-25 years, classified as late adolescence (Hakim, 2020).

Table 4. Distribution of Implementation Overviews Based on Indicators

Percentage

(%) Categories Physical

Distancing 73.69 Applied

Wearing a mask 85/02 Applied Hand Washing 88.12 Applied

Table 5. Distribution of Overview of the Implementation of Health Protocols for

Nursing Students (n = 234) Implementation

of Health Protocols

Number of

respondents Percentage (%)

Applied 232 99.1

Not Applied 2 0.9

According to the study result, it was found that 232 students (99.1%) applied the health protocol, and as many as two students (0.9%) did not apply the health protocol. The data obtained that the physical distancing health protocol in the dormitory is included in

the category applied by students; this is indicated by the results of the assessment on each statement of the physical distancing indicator which contains ten statements, namely, statement 1 of 78.31%, statement 2 of 50.00 %, statement 3 is 72.12%, statement 4 is 86.75%, statement 5 is 72.54%, statement 6 is 82.26%, statement 7 is 68.27%, statement 8 is 78.63%, statement 9 is 73.18%, and statement 10 is 74.79%. Also obtained was the average assessment of the ten statements, which was 73.69%.

The data on the mask-wearing indicator found that students implemented the health protocol for wearing masks in the dormitory.

This is indicated by the results of the assessment on each statement of the mask- wearing indicator, which contains six statements, namely statement 1 of 94.12%, statement 2 of 93.80%, statement 3 of 75.64%, statement 4 of 87.29%, statement 5 is 85.36%, statement 6 is 73, 93%. Also obtained was an average rating of the six statements of 85.02%.

The study from hand washing indicator found that students implemented the hand washing health protocol in the dormitory. This is indicated by the assessment results on each statement of the hand washing indicator, which contains five statements, namely, statement 1 of 90.06%, statement 2 of 88.78%, statement 3 of 85.04%, statement 4 of 90.17%, and statement 5 of 86.54%. Also obtained were the average assessment results of the five statements, 88.12%. Based on the data, the assessment of each indicator and each statement falls into the applied category.

This research is supported by Fitri .et al. (2020) on "Implementation of Health Protocols in the Prevention of COVID-19". The study results indicate that students have

"implemented" health protocols, namely physical distancing with a score of 80.4%, using masks with a score of 97.8%, and washing hands with a score of 94.8%. It can be concluded that nursing students at the University of Muhammadiyah Pontianak have implemented health protocols well.

The research examined how students followed health protocols and maintained daily health habits across three periods:

before the pandemic (pre-pandemic), during the pandemic, and after. The findings revealed a notable increase in students' adherence to health protocols and daily habits, particularly

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183 during the pandemic's peak (Daniel .et al., 2022). Most of those surveyed followed the practices of handwashing and mask-wearing, driven by the belief that these actions could effectively decrease the spread of COVID-19.

Students demonstrated sufficient awareness regarding the significance of handwashing and mask-wearing in mitigating the transmission of the virus (Larebo & Abame, 2021). When the perceived benefits are high, people are more likely to adhere to health protocols, leading to greater compliance. People tend to take steps to control disease transmission when they perceive that the benefits surpass the obstacles or costs associated with those actions. Adolescents may be likelier to engage in healthy behaviour with high self-efficacy and motivation (Hidayat .et al., 2022).

Physical distancing diminishes the transmission of infectious substances by respiratory-produced droplets and aerosol particles. Everyday respiratory activities, like breathing and typical speech, generate particles of micron and submicron dimensions, capable of lingering in the air for several minutes to an hour. By comparison, coughing, loud speech, and singing can expel aerosols and droplets across extended distances, potentially heightening the transmission of pathogens. (Qian .et al., 2021).

During the pandemic, maintaining a minimum distance of one meter through physical distancing and implementing universal masking measures restrict exposure to SARS- CoV-2 within indoor settings (Coyle .et al., 2022).

Hand hygiene through washing is an efficacious method for diminishing the transmission of pathogens. Medical students, whether studying medicine or nursing, generally exhibit elevated scores in knowledge related to hand washing (Mbouthieu Teumta .et al., 2019). Nursing students demonstrate a robust understanding of hand hygiene, fostering a favourable disposition towards adhering to hand hygiene practices. This phenomenon might stem from the elevated expectations placed upon individuals typically supervised in hospital environments. Medical students are knowledgeable and more likely to practice hand washing excellently because they are aware of the risk of non-compliance with hand washing practice.

Universal masking decreases respiratory

aerosol exposure through source control.

Correct mask wearing is defined as wearing a mask that covers the nose and mouth. Mask- wearing is recommended in indoor public spaces and outdoors when physical distancing greater than one meter cannot be maintained.

Wearing a mask restricts the dissemination of infectious respiratory droplets and aerosol particles into the surrounding environment, concurrently affording the mask wearer some level of protection against aerosols. (Coyle .et al., 2022).

This study diverges from the research conducted by Putra .et al. in 2021 on "The Compliance Level of Health Students in Health Protocols After More Than One Year of the Covid-19 Pandemic Period". After the research, the results were obtained from 150 students of the health study program; as many as 52 respondents (35%) were declared compliant, and 98 respondents (65%) were declared non-compliant. The decrease in the percentage level of compliance in this study was influenced by several factors, such as indifference or indifference to oneself and others, dissatisfaction with the implementation of government regulations, and boredom with government policies that did not solve the problem. It is hoped that students will be more obedient in implementing health protocols to prevent the increasing spread of the COVID-19 virus.

Health protocols encompass guidelines and regulations essential for all involved parties to safely conduct activities during a pandemic, aiming to preempt the spread and escalation of the COVID-19 virus (Kemenkes RI, 2020). Some examples of health protocols in question include maintaining distance, wearing masks, and washing hands. Keeping a distance (physical distancing) is a practical step to reduce and prevent the spread of the COVID-19 virus, and this action aims to protect yourself and others so as not to transmit and be infected by the virus (Deby .et al., 2020).

Wearing a mask is part of a comprehensive package of measures to prevent and control the spread of COVID-19. Several types of masks are recommended: medical and non- medical (Supinganto .et al., 2021). Hand washing is a significant measure in controlling the infection. Hand washing is the cheapest and easiest way to protect individuals from contracting the disease (Ratna, 2021).

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184 Research on the application of health protocols to nursing students is essential because students have many vital roles as a group of educated people. These roles include an agent of change and social control.

Students, especially nursing students, can be a group that helps handle COVID-19 and offers instruction on the significance of mask usage to prevent and mitigate the risk of contracting COVID-19. According to Atmojo .et al. (2020), it is crucial to consider their advantages;

however, single-layer cloth masks like scuba and buff types are not advised. For optimal protection amid a pandemic, masks should be complemented by adhering to additional health protocols, such as maintaining distance and rigorously practising hand hygiene. Masks are part of a larger package of preventive and control strategies to help restrict the spread of respiratory viral infection. The mask can be used to protect healthy people when in touch with an infected person or as a source of control to prevent onward transmission by an infected person or both (Larebo & Abame, 2021; Mahrofi, 2021).

Conclusion

According to the study results, it can be concluded that :

1) The health protocol was applied by students of the Faculty of Nursing in a private university in Western Indonesia dormitory with 99.1% results.

2) Physical distancing health protocols can be appropriately implemented by Nursing Faculty students in dormitories at a private university in Western Indonesia with a percentage of 73.69%

3) Students of the Faculty of Nursing apply the health protocol of wearing masks in a dormitory at a private university in Western Indonesia with a percentage of 85.02%

4) Students of the Faculty of Nursing apply the hand washing health protocol in a dormitory at a private university in Western Indonesia with a percentage of 88.12%

According to the study result, researchers have some suggestions. Nursing students are expected to increase the use and application of health protocols in dormitories to prevent the spread of COVID-19 or other respiratory infections.

It is hoped that educational institutions can use this research to apply health protocols to nursing students. This research can be an evaluation and advice for educational institutions to maintain the application of suitable health protocols such as physical distancing, hand washing and wearing masks. Another suggestion for educational institutions is to tighten regulations in implementing health protocols.

It is hoped that this research can be an input and reference for further researchers to review the application of health protocols, especially for nursing students, in suppressing the increase in respiratory infection cases by using bivariate analysis.

Limitations of the study

The study merely uses univariate analyses, and the respondents' characteristics are limited to Late Adolescence.

Acknowledgement

We thank the students who participated in this study.

Conflict of Interest

There are no potential conflicts of interest concerning this article's research, authorship, and publication.

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