Inisiasi penyusunan panduan asuhan keperawatan pasca tindakan percutaneus coronary intervention (PCI) untuk peningkatan perencanaan pulang di unit rawat inap

Abstract

Background: Discharge planning for patients following percutaneous coronary intervention (PCI) is suboptimal due to limited guidelines, nurse competencies, and support systems. This situation impacts patient outcomes, including an increased risk of readmission. Therefore, the development of evidence-based guidelines is needed to standardize discharge planning and improve the quality of care.

Purpose: To describe the process of developing nursing care guidelines following percutaneous coronary intervention (PCI).

Method: This study used Kotter's eight-step plan approach to change, which consists of eight steps: building a sense of urgency, forming a coalition, creating a new vision, communicating the vision, removing obstacles, planning for short-term wins, building change, and sustaining change. The study was conducted at hospitals in Depok City from May 27 to June 30, 2025.

Results: Problem identification through interviews, questionnaires, and observations of 107 nurses indicated suboptimal post-PCI discharge planning. SWOT and fishbone analyses revealed the primary causes to be limited technical guidelines, nurse competencies, and system support and collaboration. The initial implementation of John P. Kotter's change model resulted in the formation of a coalition, the development of a Plan of Action, and the formulation of a vision for change. Guideline socialization was conducted as the initial step in implementation. Subsequent stages will be followed up with a hospital-based follow-up plan.

Conclusion: Optimizing post-PCI patient discharge planning can be achieved through a structured change approach using John P. Kotter's model, which effectively identifies root causes, such as guideline limitations, nurse competency, and system support.

Suggestion: Hospitals can continue implementing changes through steps five through eight of Kotter's change model to ensure post-PCI nursing care guidelines are optimally integrated into clinical practice.

Keywords: Discharge Planning; Inpatient Unit; Nursing Care Guidelines; Percutaneous Coronary Intervention (PCI).

Pendahuluan: Perencanaan pulang pasien pasca tindakan Percutaneous Coronary Intervention (PCI) belum optimal akibat keterbatasan panduan, kompetensi perawat, dan sistem pendukung. Kondisi ini berdampak pada luaran pasien, termasuk peningkatan risiko readmisi. Oleh karena itu, diperlukan pengembangan panduan berbasis bukti untuk menstandarisasi perencanaan pulang dan meningkatkan kualitas pelayanan.

Tujuan: Untuk mendeskripsikan proses penyusunan panduan asuhan keperawatan pasca tindakan percutaneus coronary intervention (PCI).

Metode: Penelitian dengan pendekatan perubahan Kotter’s eight-step plan yang terdiri dari delapan langkah yaitu membangun rasa urgensi, membentuk koalisi, menciptakan visi baru, mengomunikasikan visi, menghilangkan hambatan, merencanakan kemenangan jangka pendek, membangun perubahan, dan mempertahankan perubahan. Penelitian dilaksanakan di rumah sakit di Kota Depok pada 27 Mei-30 Juni 2025.

Hasil: Identifikasi masalah melalui wawancara, kuesioner, dan observasi pada 107 perawat, menunjukkan perencanaan pulang pasca tindakan PCI belum optimal. Analisis SWOT dan fishbone mengungkap penyebab utama berupa keterbatasan panduan teknis, kompetensi perawat, serta dukungan sistem dan kolaborasi. Penerapan tahap awal model perubahan John P. Kotter menghasilkan pembentukan koalisi, penyusunan Plan of Action, serta perumusan visi perubahan. Sosialisasi panduan dilakukan sebagai langkah awal implementasi. Tahapan selanjutnya akan dilanjutkan melalui rencana tindak lanjut di rumah sakit.

Simpulan: Optimalisasi perencanaan pulang pasien pasca tindakan PCI dapat dilakukan melalui pendekatan perubahan terstruktur menggunakan model John P. Kotter yang efektif mengidentifikasi akar masalah, seperti keterbatasan panduan, kompetensi perawat, dan dukungan sistem.

Saran: Rumah sakit dapat melanjutkan implementasi perubahan hingga langkah kelima sampai dengan langkah kedelapan dalam model perubahan Kotter guna memastikan panduan asuhan keperawatan pasca tindakan PCI terintegrasi secara optimal dalam praktik klinik.

Kata Kunci: Unit Rawat Inap; Panduan Asuhan Keperawatan (PAK); Percutaneus Coronary Intervention (PCI); Perencanaan Pulang.