Nurses' Knowledge and Attitudes in Implementing Policy to control the spread of Covid-19 outbreak in Tritya eye Clinic

Background: pandemic Covid – 19 infectious diseases in most of the world. In Indonesia there are 78 nurses who have died due to being infected with this virus. Policies in the implementation of controlling the spread of the Covid-19 pandemic at the Tritya Eye Clinic, have been written and implemented for all nursing staff who work at the Tritya Eye Clinic Emergency Outpatient Covid 19. Application of Standard Operational Procedures for controlling the spread of the Covid-19 pandemic still needs to be evaluated because there are still many nurses who forget or are overlooked in their application. Objective: This article is to look at nurses' knowledge and attitudes in the application of controlling the spread of the Covid 19 outbreak in Tritya Eye Clinic. Method: This research uses descriptive research method with Cross Sectional approach. With the number of samples are 12 nurses at the Eye Clinic of Tritya. research by distributing questionnaires online on April 28, 2020 Results: Some nurses have a good level of knowledge and some are sufficient but all nurses can have a positive attitude by implementing policies implementing the implementation of policies to control the spread of the Covid19 pandemic at the Tritya Eye Clinic even though not all nurses have good knowledge. Conclusion: Therefore understanding and attitudes about implementing policies are very important, considering this is considered important in order to reduce the risk of transmitting the Covid-19 pandemic to patients, among medical workers, and the families of the nurses themselves.


INTRODUCTION
In December 2019, a pneumonic outbreak caused by the new corona virus occurred in Wuhan, Hubei province, and had spread rapidly throughout China, at the risk of a continuing pandemic (Wang, 2020). Novel Coronavirus or 2019-nCov is a new virus that causes respiratory diseases. Coronavirus novel is a family with viruses that cause SARS and MERS (Prabowo, 2020). The outbreak of the Corona virus transmission was initially informed by Indonesian President Mr. Joko Widodo on Monday, March 2, 2020. The news spread from many media. According to the Minister of Health, Dr. Terawan, "the virus was originally brought by Japanese foreigners living in Malaysia. Since the beginning the Japanese foreigner was already infected with the COVID-19 virus when he came to Indonesia. He then took a fever-lowering drug so that when he arrived at Soekarno-Hatta Airport it was not detected using a thermo scanner. The Citizen of Sakura had a chance to meet her relatives, a woman (64 years) and her child (31 years) who settled in Depok. The citizenship status of that relative is unknown. Now, they have been isolated in a special hospital in Sulianti Saroso, Sunter, North Jakarta " (Putri, 2020). According to the Director General of Disease Prevention and Control who is also the spokesperson for the handling of Covid-19, Achmad Yurianto on Sunday afternoon (26/4) the trend of cure rates for Covid-19 patients continues to increase. Until now, the number of patients recovered by 1,107, 743 patients died and 8,882 positive patients. With the distribution area in 34 provinces and 283 regencies / cities. This number increased by 2 districts / cities from before. This number increased by 275 people in positive cases, cured cases increased by 65 and death cases increased by 23 people. Meanwhile, there are more than 72,000 specimens from 56,974 people suspected of being exposed to   Based on Info Grafis covid-19 in 26 april 2020 compiled by Gugus tugas Percepatan Penanganan Covid -19. There are positive cases in indonesia 8.882, Where increase 225 cases in than the day before. The patient has recovered from the covid 19 are 1.107 patients, Where increased 65 patients from the day before. While the death rate due to the corona outbreak was 743 cases, this number increased by 23 cases from the previous day. The increase from day to day makes the local and central government make a variety of policies that are implemented to reduce the spread of covid -19 outbreaks.
At present, the spread of SARS-CoV-2 from human to human is the main transmission source so that the spread becomes more aggressive. SARS-CoV-2 transmission from symptomatic patients occurs through droplets that come out when coughing or sneezing (Susilo et all, 2020 themselves can be invected. The nurse duty in an effort to save human lives in a co-19 pandemic situation is the concern of all parties. Particularly in dealing with Covid-19 patients has a high level of risk that is life threatening, considering that every day nurses often make direct contact with these patients. According to data obtained by DPD PPNI dated April 8, 2020 there were 8 nurses who died as a result of being infected by Covid -19 in Indonesia. PPNI DPP on various occasions always beg and expect the Indonesian government to continuously provide Personal Protective Equipment (PPE) for health workers, especially nurses, for security and safety in their duties.
Various interventions or action to be taken prevent it from happening coronavirus transmission. influenced by nurse behavior. one form of behavior influenced by predispoding factor, allows factor, and reinforcement factor. Predisposing factors which include knowledge, attitudes, traditions, and values. Supporting factors consists of availability infrastructure, while strengthening factors such as regulations, laws, attitudes and behavior of others health workers If his behavior based on science, awareness and positive attitude then the behavior will last. Lack of knowledge about certain objects due to lack information obtained. And the other, that knowledge of Standard Operating Procedures for controlling the spread of the Covid-19 pandemic. This knowledge is related to how to prevent the transmission of Covid 19 between patients, employees and doctors.
Policies in the implementation of efforts to control the spread of the Covid Outbreak -19 at the Tritya Eye Clinic, it has been written and implemented for all the special staff of nurses who work in the Covid Outpatient Emergency Clinic 19 Tritya Eye Clinic. Nurses who work there have the responsibility of ensuring that the Covid-19 virus is not infected by patients, or transmitting the Covid-19 Virus from one patient to another patient or paramedics and other Tritya Eye Clinic staff. After evaluating the implementation of the policy through direct observation by researchers, there were still many nurses who forgot or missed the application of Standard Operating Procedure or SOP that had been applied by management in controlling the spread of the Covid -19 outbreak in Tritya Eye Clinic.
The purpose of this study is to describe the nurses' knowledge and attitudes in applying the control of the spread of the Covid -19 outbreak in Tritya Eye Clinic. Where the application of this control has been stated in the Standard Operating Procedures that have been made in order to secure all aspects that exist in eye services at the Tritya Eye Clinic institution. Implementation of this policy is important because the Covid -19 outbreak has become a pandemic disease. A pandemic is an epidemic that occurs all over the world, or over a large area, across international boundaries and usually affects large numbers of people (W.Qiu; S. Rutherford; A. Mao; C. Chu, 2017)

METHOD
This research uses descriptive research method with Cross Sectional approach because this research is conducted simultaneously in a certain time (Notoatmodjo, 2012). The population of the research is all nurse who served in emergency outpatient covid -19 at the Tritya Eye Clinic as many 12 people. When the research was conducted from April 24, 2020 to April 26, 2020. The sampling technique used in this study was the Total Sampling technique. Total Sampling is a sampling technique where total sampling is equal to the population (Sugiyono, 2011).
The location of the study was at the Tritya Eye Clinic, at Bratang Plaza Ruko Jalan Baratajaya 59 Blok A-3 Surabaya East Java. The variable in this study is a description of the level of knowledge and attitudes of nurses in the application of policies to control the spread of the Covid Outbreak 19 at the Tritya Eye Clinic.
Data collected in this study are primary data. Data collected by questionnaire and as an instrument is a list of questions. This list of questions comes from the Standard Operating Procedures that have been made by the management of the Tritya Eye Clinic in order Implementing policies to control the spread of covid 19. After all data has been collected, the researcher carries out data processing through several stages, namely checking the accuracy and completeness of the data. Data is presented in the form of frequency distribution. Analysis of the data used in this study is univariate. Univariate analysis in this study was conducted to determine and obtain results on the knowledge and attitudes of nurses in the application of the Policy to control the spread of Covid -19 outbreak in Tritya Eye Clinic.

Policy to control the spread of the Covid Outbreak -19 at the Tritya Eye Clinic.
The greater the impact of the spread of the Covid-19 virus in Indonesia, making good health services Hospitals implement a policy pattern in controlling the spread in health care institutions. This is in accordance with the Decree of the Minister of Health of the Republic of Indonesia Number Hk.01.07 / Menkes / 104/2020 Concerning Determination of Novel Coronavirus Infection (Infection 2019-Ncov) that Covid-19 As A Disease That Can Cause An Epidemic And Its Mitigation Efforts that in connection with the widespread spread of Novel Infection Coronavirus (Infection 2019-nCoV) to various countries with the risk of spreading to Indonesia related to population mobility, prevention efforts are needed in the form of increased early alertness, preparedness, as well as anticipatory measures for prevention, detection, treatment, and other response needed. According to the minister's decision, the Tritya Eye Clinic, as an eye health service clinic, created 5 Standard Operating Procedures (SOPs) to minimize the risk of the spread of the covid outbreak in the Eye Tritya clinic. The SOP consists of Covid 19 Emergency Outpatient SOP, SOP on how to use PPE when the Covid outbreak 19, SOP on how to remove PPE when the 19th Covid outbreak, SOP on how to make Disinfectant Solution When Covid 19, SOP Operational Procedure How to Disinfect Surface when Covid Outbreak 19. The five Standard Operating Procedures serve as guidelines for medical personnel in providing services, guidelines for preventing Covid 19 transmission between officers, doctors and patients. The purpose of making this SOP is to prevent the spread of Covid 19 for patients, medics, nurses, paramedics and staff. These Standard Operating Procedures are as a basic guideline for paramedics in providing health services in the field of eye. Standard Operating Procedure (SOP) is a guide used to ensure the operational activities of an organization or company run smoothly (Sailendra 2015). In terms of the application of this SOP, it is necessary to have a basis of knowledge and a good attitude regarding this policy. Due to the incorrect application of SOPs, there is a risk of transmission of the Covid -19 outbreak to patients, nurses, paramedics and staff.

Overview of Nurses' Knowledge and Attitudes in Policy Implementation
To find out the level of knowledge from nurses, questionnaires were distributed through a qualitative approach. The questionnaire sheet has been given a value to find out the total number of all questions from each workforce, which is grouped in this table. In Table 1. it can be seen that the level of knowledge of nurses in emergency outpatient care -19 in the eye clinic shows that 6 nurses or 50% of nurses have good knowledge. While 6 other nurses have sufficient knowledge. In terms of the nurse's knowledge about the purpose of making this SPO, all nurses have understood it. On average, many nurses are still wrong about the correct sequence of steps for using self-protection tools. This needs to be evaluated again because it is important in reducing the risk of transmission of Covid 19. It can be seen that the application of this SOP is half the nurses on duty do not fully understand the policies made. This SOP is not just a rule, but the existence of an SOP in a company will be very helpful in the company's development process. Even SOPs also affect the company's progress. Because if SOP is not implemented properly, the impact will also be on HR performance. In the end the quality of production is also not good (Firmansyah, 2019). In Outpatient Covid -19 at the Tritya Eye Clinic, all policies in the form of SOPs have been implemented, but understanding of SOPs is not only important for institutional progress and HR performance. What's more is to ensure safety and break the chain of the spread of the Covid Outbreak -19. Table 2. Distribution of Questionnaire Answers on the correct application of policies at the Tritya Eye Clinic.
If seen in table 2, the level of knowledge in nurses at the Tritya Eye Clinic only 1 or 8,3% nurses understanding of all standard operating procedures while there were errors in other 11 nurse or 91,67%. With the wrong answers the researchers can know that there are errors in the application of this SOP. Knowledge of SOP is something that workers need to know in implementing and implementing work procedures in accordance with their respective fields of work. Knowledge about SOP is one of the factors that can be related to compliance, because behavior based on knowledge will be longer than behavior that is not based on knowledge (Dewi, 2010 39 Media Gizi Kesmas, Vol. 9, No. 2, Desember 2020 : Halaman : 35-40 An error occurred in the implementation of the policy controlling the spread of the Covid Outbreak -19 at the Tritya Eye Clinic very risky to transmit the medical personnel to the covid outbreak -19. If seen from Table 3. Distribution of Nurses According to their attitude towards the adoption of policies at Tritya Eye Clinic. It seems that all nurses can behave well with the implementation of the policy. Nurses are willing to implement PPE in carrying out services and nurses are willing to try to reduce the risk of covid 19 transmission. Attitude is one of the factors that can be related to workers' compliance in implementing SOP. Attitude is the reaction of individuals to stimuli or stimuli provided by certain objects (Prabawati et al., 2019). Individual attitudes in providing responses from certain objects can be different from each other individual. Nurses can accept this policy because it is felt important in efforts to control the spread of the covid outbreak -19

CONCLUSION
Policies in the implementation of efforts to control the spread of the Covid-19 Pandemic at the Tritya Eye Clinic, can be seen from the level of knowledge about policy implementation at the Tritya Eye Clinic, it can be seen that half or 50% of the nurses on duty have not fully understood the policies made. then the researcher can find out that there are errors in the application of this SOP. Where an understanding of SOPs is not only important for institutional progress and HR performance. More than that, ensure security and break the chain of spread of the Covid -19 pandemic.
Regarding the distribution of nurses in accordance with the attitude towards policy implementation at the Tritya Eye Clinic. It seems that all nurses can behave well with the implementation of this policy. Nurses can accept this policy because it is considered important in efforts to control the spread of covid-19. It can be concluded that all nurses serving in the Covid-19 outpatient emergency unit at the Tritya Eye Clinic accept the policy. However, almost all of them have not mastered the level of knowledge or understanding of the procedures or procedures for implementing SOPs.
Therefore it is necessary to hold training or restatement of policies issued by management. To absorb understanding, the team of nurses on the Covid-19 emergency outpatient department at the Tritya Eye Clinic can accept it more. Therefore this is considered important in order to reduce the risk of transmitting the Covid-19 outbreak to patients, both between medical personnel, staff and the nurse's own family.