The Effect of Application of Discharge Planning Seci Model on The Completeness of Discharge Planning Documentation for Tuberculosis

Background: The implementation of discharge planning must be documented completely. Preliminary study found that 90% of discharge planning implementation is not documented. The weakness of the intervention that has been done by previous researchers is that it does not focus on increasing the completeness of documentation, especially on the documentation of discharge planning, the application of discharge planning based on knowledge management SECI model as an intervention applied to improve the completeness of documentation on discharge planning. Objectives: The purpose of this study was to determine the effect of discharge planning based on knowledge management SECI model on the completeness of documentation of discharge planning for tuberculosis. Methods: This research is quantitative research with quasi-experimental approach with post-test only design with nonequivalent control group. The number of samples was 34 medical records with a diagnosis of pulmonary TB, each of which consisted of 17 samples in the control group and 17 samples in the intervention group. The intervention in this research is the implementation of discharge planning based on knowledge management SECI model. The data were taken using the discharge planning SECI model observation sheet and the documentation completeness observation sheet which had been tested by expert and analyzed using the Mann-Whitney test. Results: The results showed p value is 0.000 < 0.05. Conclusion: Application of discharge planning based on knowledge management SECI model has a significant effect on the completeness of documentation of discharge planning for tuberculosis (TB). Nurses must become to manage knowledge, good time management, and be a role model in providing nursing care.


INTRODUCTION
Factors that support an increase in patient knowledge related to their illness is through the knowledge applied by nurses in carrying out discharge planning.
Rahimi's Knowledge management is very important to apply in creating innovation (Rahimi et al., 2017).Knowledge management is a system developed by conceptual model that is needed to increase the knowledge based (Darudiato and Setiawan, 2013;Jonsson, 2015;Judrups, 2015).Partnership, 2015;Bijani M et al., 2016) .
The preliminary study found that ± 90% of the implementation of discharge planning was not documented and the results of interviews with five nurses in internal medicine wards indicated that the implementation of discharge planning was not fully documented due to the busyness of the rooms.

Study Design
This study used a quasi-experimental research design with a posttest-only design with nonequivalent control group.

Setting
This study was conducted from February to May 2021 in the internal medicine inpatient room at Salatiga Hospital as the intervention group and the internal medicine inpatient room at Dr. R. Soedjati Grobogan as the control group.

Research Subject
The population in this study is all medical records of TB patients in internal medicine

Characteristic of nurses
The characteristics of nurses analyzed were age, gender, education level, and length of service.Each type of variable is analyzed using frequency and percentage.
Nurse characteristic data according to demographic data can be explained as follows: Table

The effect of implementing the SECI model discharge planning on the completeness of discharge planning documentation for TB disease
The analysis carried out to determine the influence of implementing the SECI discharge planning model on the completeness of discharge planning documentation for TB disease was carried out by bivariate analysis.The Nursing services must prioritize the needs of patients.The needs of patients in the process of nursing care carried out by nurses, namely the implementation of discharge planning.Discharge planning is the main function and an important part of the patient nursing program that must be carried out by nurses.It is dynamic and systematic which begins immediately after the patient enters the hospital, starting with identification, assessment, goal setting, planning, implementation, evaluation and coordination carried out to provide easy supervision of health services and social services before and after discharge (Gonçalves-Bradley et al., 2022).Implementation of discharge planning at the hospital has not been optimally implemented.It is only in the form of resume records of patients returning home and information on control schedules which are briefly carried out when the patient is about to go home (Agustin, 2017a).In addition, Abdul-Kareem, Lindo and Stennett (2019) research that nurses rarely start discharge planning within the first 24 hours of admission in proven because only 6,9% of documented evidence of discharge planning implementation.
result of conversion of tacit and explicit knowledge.SECI model is a inpatient rooms in 2021.While the sample in this study was the medical records of TB patients in internal medicine inpatient rooms which were determined based on inclusion criteria.The inclusion criteria in this study were documentation of inpatient medical records with a medical diagnosis of TB in both the intervention group and the control group from the internal medicine ward.Sampling used non-probability sampling technique, type of consecutive sampling.The reason the researcher used consecutive sampling was to fulfill the required number of samples within the time period determined by the researcher.The sample size in this study was taken from the population based on the number of medical records of patients diagnosed with tuberculosis who were treated in internal medicine inpatient rooms.Calculation of the research sample using the method of power size and effect size based on Kappa Kohen.The sample in this study consisted of 34 medical records divided into 17 medical records in the control group and 17 medical records in the intervention group.Instruments The instrument used by the researcher used by the searcher was developed from the Indonesia Ministry of Health regarding the evaluation instrument for the implementation of standard nursing care in hospitals and the NCSS (National Council of Social Service) which then being modified by the researcher.
results of the Mann-Whitney test for completeness of discharge planning documentation in the control group showed that the mean completeness of documentation was 3.117 < the mean completeness of documentation in the intervention group was 10.294 with a mean difference of 7.177.This difference illustrates the difference in results between the control group that was not given the SECI model discharge planning treatment and the intervention group that was given the SECI model discharge planning treatment.The significance (meaningfulness) of the difference is proven from the results of the Mann-Whitney test, namely the p value (Asymp.Sig) = 0.000 < 0.05.Based on the results of the Mann-Whitney test, it can be concluded that there is a significant difference between the control group which was not given the SECI model discharge planning treatment and the intervention group which was given the SECI model discharge planning treatment, which means that Ha is accepted, that is, there is an effect of the SECI knowledge managementthe completeness of the discharge planning documentation in the control group and the intervention group in this study were statistically indicated by the average results between the control group, which the group that was not given treatment and the intervention group.The group that was given treatment using the SECI discharge planning model, which had a mean difference in completeness of 7.17 and p value = 0.000 so that this difference is significant with p value <0.05.These results become the basis for answering the research hypothesis and drawing conclusions that the application of SECI knowledge management-based discharge planning model has a positive and significant effect on improving the completeness of discharge planning documentation.This increase in the completeness of discharge planning documentation is because in the application of knowledge management-based discharge planning there are four models that must be applied by nurses in carrying out discharge planning, namely socialization where on this indicator nurses provide health education in the form of nursing implementation to patients and families based on the plan.nursing that has been determined according to the discharge planning diagnosis obtained from the results of the assessment according to the patient's needs.Providing discharge planning to patients and families must be in accordance with the patient's needs obtained through the assessment (Ahsan et al., 2019; Søndergaard et al., 2019).The nurse externalization stage applies and documents the education that has been carried out for patients and families.So that the externalization stage includes the completeness of discharge planning documentation on implementation indicators.The combination stage, in which the nurse re-evaluates the education given to the patient and family.the nurse has innovation or new ideas in providing discharge planning to patients so that at this stage it includes indicators of intervention or re-planning in accordance with the education needed by the patient.The implementation of the application of discharge planning must be structured so that it is closely related to the nursing SECI model, this research is in line with research conducted by Saleh Almuayqil et al, which concluded that the application of the SECI model provides best practices for nurses and increases effectiveness in providing health education (Bijani M et al., 2016).Raihany in his research explained that the documentation of discharge planning implementation can be used as an indicator of the quality of nursing care and reflects the quality of care provided by nurses (Raihany, 2017).Nurses are very important to sit down to discuss spending time with patients or families and be patient to identify the needs of patients and families to agree on a treatment plan (Rahayu, Hartiti and Rofi'i, 2017).Providing discharge planning does not only rely on knowledge possessed from academics, but also must be continuously updated through experience gained while providing nursing care.Therefore, through knowledge management base nurses can manage all obstacles, such as incomplete documentation of discharge planning with limited time to improve nurse performance and quality of nursing care.based on the SECI model has a significant effect on the completeness of discharge planning documentation for tuberculosis (TB) with p value = 0.000 <0.05.SUGGESTIONS The application of the SECI model as a result of knowledge conversion is expected to be used as teaching material for quality improvement for nursing students in applying nursing practice, especially for the concentration of Nursing Leadership and Management which has outputs as leaders, educators, and role models.For future researchers, further development is needed regarding the timing of the implementation of the SECI knowledge management-based discharge planning model with changes in nurse behavior, and its relation to patient satisfaction, and evaluating the length of stay and the effect of the SECI model discharge planning from a nurse's point of view.

of documentation of discharge planning for TB disease in the control group
1. Distribution of the frequency and percentage of nurse characteristics in the control group and the intervention group February -May 2021

Table 2 .
Completeness of discharge planning documentation in medical records of TB patients based on observations in the control group

Table 4 .
Test of differences in completeness of TB discharge planning documentation in the control group at RSUD Dr. R. Soedjati Purwodadi and the intervention group at RSUD Salatiga