Journal of Multidisciplinary Applied Natural Science

A Biochemical Perspective: Influence Implementation of

PFCC-Based Bedside Handover Module on Increased
Patient Safety and Satisfaction Patients in Hospital
1
Ismuntania, 2Nursalam, 3Retno Indarwati, 4Kartika
1
Doctorate Degree Program in Nursing, Faculty of Nursing, Universitas Airlangga, Surabaya 60115,
Indonesia
2
Department of Basic, Critical and Medical Surgery, Faculty of Nursing, Universitas Airlangga, Surabaya
60115, Indonesia
3
Department of Advanced Nursing, Faculty of Nursing, Universitas Airlangga, Surabaya 60115, Indonesia
4
Doctorate Degree Program in Nursing, Faculty of Public Health, Universitas Airlangga, Surabaya 60115,
Indonesia

Corresponding author: [email protected]

Abstract. Unstable human psychology can trigger the emergence of disease and unstable
patient psychology can also slow down the process of patient care and recovery in the
hospital. Therefore, health workers, especially nurses, must be able to stabilize psychology
and relax patients. Nurses are one of the health workers who interact very intensely with
patients to provide medication, control IV fluids, maintain diet, and control the development
of patient health. Therefore, they must be able to communicate empathetically with patients
and must communicate complete records of patient health development when there is a
change between nurses. Study this will study the influence of the implementation of bedside
handover based on Patient Family Centered Care (PFCC). The Research use quasi-
experimental with group control and group experiments are observed before the intervention
is done and then observed again after the intervention is finished. Data analysis methods are
carried out using descriptive and inferential analysis. The analysis results will be depicted as
table distribution frequency, the central tendency mean, median, and standard deviation.
Result shows implementation the bedside handover module increase patient safety and
satisfaction. Besides that, intervention through 8-week PFCC-based bedside handover
training can significantly influence the group intervention at Tgk Chik Di Tiro Regional
Hospital. A bedside handover module that is well controlled by PFCC can improve the
psychological stability of patients so that the treatment process can run smoothly and patient
recovery can be achieved more quickly. This is because the psychological stability of patients
prevents the activation of the amino acid tryptophan through the kynurenine pathway and the
activation of the hormone epinephrine through the glycolysis signal transduction pathway
which can slow down patient recovery due to the patient's psychological instability.
 Journal of Multidisciplinary Applied Natural Science

Keywords: Patient psychology; nurse; bedside handover module; patient family centered
care
1. INTRODUCTION

One of the factors that influences accelerating patient recovery is patient psychology.
When the patient's psychology is good, the level of compliance will increase, and the patient
will follow the treatment they are undergoing properly so that recovery can be obtained more
quickly. When the patient's psychology is good, communication between the patient and
health workers will be more open and constructive so that health workers will try to provide
the best ability for patient safety and patients will feel satisfied with the quality of health
services they receive. Thus, patient psychology can indirectly help identify and reduce risks
to patient safety [1], [2], [3]. Several things that affect patient psychology include breakdown
orientation, openness of communication, and team dynamics. Breakdown orientation is in the
form of disclosing the patient's true condition so that it can provide a sense of security for
health workers in improving patient safety practices (Bahadurzada et al., 2024). Transparent
communication can act as a medium to strengthen the relationship between health workers
and patients, influence the results of patient examinations because they are related to
complaints that are only felt by patients, and influence patient psychology so that patients
will tend to comply with examinations carried out by medical personnel. The last factor that
affects patient psychology is a team of health workers who work effectively. The cooperation
of the health worker team in the patient care process in the hospital must be well coordinated
to ensure patient recovery and safety. When the health worker team provides good service
and the patient's care response is also good, the patient will answer related complaints in an
open manner and the patient will also comply with the series of treatments that must be
undergone (Sadighi et al., 2021). In addition, improving patient safety can be done by
fostering a good work environment so that health workers have a sense of security and can
communicate openly and be involved in the breakdown problems experienced by patients.
The mental and psychological health of health workers can reduce stress and fatigue levels,
increase effective teamwork, and ensure a supportive attitude so that it can help improve
patient safety (Bahadurzada et al., 2024; Iloh et al., 2020; MW Lin et al., 2023).
The patient's psychology also influences the patient's satisfaction level. The elements that
affect it are communication, the ability to trust patients, and empathy for doctors.
Communication effectively plays a vital role in providing accurate patient data and support.
 Journal of Multidisciplinary Applied Natural Science

For healing, it improves compliance to treatment, can become therapeutic, and can help
patient therapy psychiatry [8]. The ability of doctors to manage the psychological
maintenance of patients is essential for forming effective medical practice [9]. A doctor can
manage aspect psychological patients with increased skills, strong communication, adequate
psychological training, and collaboration with psychologists to ensure patient care [10]. Trust
patients are formed based on how the service house the pain given during the patient
treatment. If the service is suitable and effective for the patient, the patient will also own
good psychology, increasing the patient's satisfaction (O'Kane et al., 2024; Romanowicz et
al., 2022). Lastly, empathy for doctors in the patient relationship is vital for increasing patient
satisfaction. Empathy with doctors can improve patient satisfaction because they feel more
understood and appreciated [13], [14].
Satisfaction with patients during their treatment at home sickness becomes essential
because it will affect the recovery period physique and the patient's mental state [8].
Satisfaction with patients influences several matters, like compliance with the treatment they
underwent, and can reduce pain and fatigue during periods beginning post-operation [15],
[16]. World Health Organization (WHO) 2021 data shows the level satisfaction patient at
home in various countries, the highest of which is Sweden. with index satisfaction reached
92.37%, Finland (91.92%), Norway (90.75%), USA (89.33%), Denmark (89.29%), while the
level satisfaction patient lowest namely Kenya (40.4) and India (34.4%) [17]. Based on data
from the Central Statistics Agency (2020), it is known that from 17,280 respondents
throughout Indonesia, as many as 81% stated that they were satisfied with the services
provided by BPJS.
Patient safety is an important thing to do. A patient in the middle is treated at home sick
[18]. Patient safety is needed. To ensure safety, patients will minimize the risk of injury,
medical error, and danger and give service proper health with standards and procedures that
have been set [19], [20]. Patient safety is essential because it can increase patients' health,
reduce complications, increase patient satisfaction, increase efficiency danger, and increase
confidence in power medical. Patient safety is known to prevent the occurrence of harm to
the patient with a method that builds culture safety in-service health [21]. Cultural safety this
is done with existing reporting in a way periodic will condition the patient report
development patient or errors and incidents that can occur to cause patient critical [22], [23].
Patient satisfaction and safety during treatment in hospital are largely determined by the good
or bad practice of beside handover between nurses who are responsible for controlling the
level of recovery and health of patients.
 Journal of Multidisciplinary Applied Natural Science

Bedside handover is a procedure medical staff use to fulfill their responsibility to power
other medical staff at the moment of shift change. This bedside handover process also needs
to pay attention to the psychological aspect. The bedside handover process needs to be
noticed in psychology patients because the patient's condition and involvement are essential
for the handover process to ensure effective communication and continuity of care.
Involvement of active patients in the handover process with the exchange of information to
power medical increases security and continuity of care. Involvement is actively supported by
the patient's needs to ensure that the care received is effective and sustainable (Flink Öhlén et
al., 2012). Their trust influences the patient's openness during the handover process in the
nurse. When the patient feels safe and trustworthy to the nurse, they will give vital
information to facilitate the handover process (Flink, Öhlén et al., 2012). The psychological
condition influences the handover process when the patient feels anxious and stressed,
affecting the medium handover quality. Stress and anxiety in patients can influence effective
communication, resulting in miscommunication and errors during the treatment period [25].
Preferences patients during the treatment period influence quality care, where patients who
feel their preference is accepted will participate more actively to increase handover quality
(Flink, Hesselink, et al., 2012; Waters et al., 2015).
A European study shows that communication moment implementation of responsible
handover answers above 25% to 40% of detrimental and dangerous patient events.
Communication that is not effective becomes the reason for the occurrence of something
hazardous to patients at home sick [28]. A study by Bigani and Correia (2018) showed that
bedside handovers were not consistent and were associated with various incidents at home
sick, like errors that can occur prevented, incidents not suspected, serious injuries, and even
death.
One of the reasons for the occurrence of patient safety incidents is communication that is
not effective, especially at the time of implementation of bedside handover [29]. Handover,
as a process of transferring not quite enough answers, is considered a crucial moment in
giving quality nursing care. Bedside handover transfers insufficient answer treatment
between nurses who have finished on duty, which will serve as a place of sleep and involve
the patient. Bedside handover requires integrated development with Patient Family Centered
Care (PFCC). PFCC needs to be integrated into the implementation of bedside handover so
that patients and families are involved in the final treatment impact on safety as well as
patient satisfaction [28].
 Journal of Multidisciplinary Applied Natural Science

Study this will study the influence of the implementation of bedside handover based on
Patient Family Centered Care (PFCC). PFCC theory is used because it focuses on the
essential implementation of patient- and family-focused services. PFCC views patients and
families as part of services involved in a way that is active throughout the treatment process.
Every form services will be given through the confirmation process with patients and families
(Khan et al, 2018). Various information that is not easily dug up will be obtained via bedside
handover because the connection nurse-patient-family daily will be more robust so that the
patient has high confidence in nurses and does not hesitate to convey all actual conditions
[31].
Handover is the process of exchanging information and responsibilities from nurse to
nurse with the objective of conveying the condition to the patient in real-time. The initial
handover implementation only done at the nurse station has become bedside handover and is
done on the side place of the patient [32]. The problem is the implementation of bedside
handover at RSUD. Tgk Chik Di Tiro needs to be by what it should be. The process of
transferring information, in addition to sleeping patients, involves patients and families.
Nurses do not excavate information and conditions of current patients deeply. However, they
only ask for news. This PFCC-based bedside handover was rated appropriate in the room
hospital care. Tgk Chik Di Tiro with the Care Model Nursing Professional (MAKP) team.
The MAKP team model involves several teams every time maintenance supports the
implementation of bedside handover. Every team contributes to managing information about
the patient with the same goal, namely achieving safety for the patient and complete
satisfaction.
Based on the analysis, the implementation of bedside handover based on Patient-Family-
Centered Care (PFCC), was identified as capable of lowering incident patient safety and
improving patient satisfaction. Therefore, researchers are interested in doing a study about the
influence of the PFCC-based bedside handover model on increasing patient safety and
satisfaction at home.
2. METHODS

2.1. research design.

The research design used is an experiment to know the connection because of the
consequence of the technique involving a control group and group experimental/intervention
[33]. Quasi-experimental research is group control, and group experiments are observed
before the intervention is done and then observed again after the intervention is finished.
 Journal of Multidisciplinary Applied Natural Science

Research design implementation process this, moreover formerly, will do measurement pre-
tests in group experiments and group control; then, group experiments give treatment through
training in a direct way [34].

O1 X O2

O3 -- O4

Figure 1. Quasi-Experimental Research with Control Group Design (Purwasih et al., 2017).
Information:
O1 = Assessment early bedside handover
X = implementation of bedside handover based on the PFCC model
O2 = Assessment end of bedside handover
O3 = Assessment early bedside handover
O4 = Assessment end of bedside handover
2.2. Population and sample
Population and sample from study this is taken from nurses and patients at Tgk Chik
Di Tiro Regional Hospital. The nurse sample was taken with the use of a probability
sampling technique with a simple random sampling type with criteria that the nurse has
finished formal nursing education, is a minimum DI nurse practitioner or functional, and has
been working at home sick for a minimum of 1 year. The process of determining the samples
was done using a hypothesis test equation. The difference between the two proportions
resulted in 52 samples. Next, sample patients taken with purposive sampling technique with
criteria minimum age of 15 years can coordinate with good moment research and be
responsive with GCS values 13-15 and a minimum treatment period of 1 x 24 hours. The
purposive sampling technique makes patients who meet the requirements criteria be made
into a sample until the amount of sample fulfills the space provided.
2.3 Research variables
Variables in research this is in the table following:
Table 1. Variables Study
Variables Parameter
X1
PFCC-based bedside
handover module
 Journal of Multidisciplinary Applied Natural Science

Y1 Y1.1 Accuracy identification of patient

Patient safety Y1.2 improvement in effective communication
Y1.3 Improvements security necessary medication be aware
Y1.4 Reduction of risk infection-related service health
Y1.5 Reduction risk of patient fall
Y2 Y2.1 Reliability
Satisfaction patient Y2.2 Assurance
Y2.3 Tangibles
Y2.4 Empathy
Y3.5 Responsiveness

2.4. Data collection.

Data collection was carried out through a questionnaire given to respondent through
several stages following:
1. Stage preparation
Stage 1: This started with an introduction by the next researcher, who explained the
objectives and procedures of the research. Respondents were then given informed consent
to sign if the candidate was willing to become a respondent.
2. Stage implementation
Stage implementation this started with giving a pre-test questionnaire to respondent good.
It's in the group control and also group intervention. Stage implementation is to be
continued in the room that has been provided, and researchers play a role as facilitators.
The stages are divided into four sessions as follows:
a. Session 1: Preparation participant for 10 minutes
In the session, the researcher introduces, conveys objective research, and gives an
apperception of topics discussed with method rainfall opinion with the participant.
b. Session 2: Explanation of PFCC-based bedside handover increasing patient safety and
satisfaction for 3 hours
In the session, this researcher explained all related concepts related to PFCC-based
bedside handover to increase patient safety and satisfaction.
c. Session 3: 1-hour bedside handover simulation
At this stage, respondents do PFCC-based bedside handover practice with a sifting
system, and some Respondents play roles as headroom, chairman of the team nurse
implementer, and patients and families. Session simulation this is done in accordance
 Journal of Multidisciplinary Applied Natural Science

with the bedside handover procedure that has been explained at the beginning of the
session.
d. Session 4: Session termination for 10 minutes
Stage termination is done after the session simulation finishes. Participants who have
followed the simulation then return to their respective seats for a follow-up discussion
about the simulation that has been done.
Activity this has been in progress for 6 weeks. In the week's first group intervention,
read and summarize the module for about one hour daily. Sunday's second group intervention
is practicing PFCC-based bedside handover when on duty in shift exchange, which takes
about 20 minutes without assistance from the researcher. Sunday, the third group intervention
was a practice repeat with accompanied researchers, and the researcher participated share in
practice. On sunday, the fourth group intervention was practiced with the accompanying
researcher, but this researcher did not participate in the practice process. Sunday, the fifth
group intervention practice with the accompanying researcher. However, the researcher did
not give intervention to the participants, so participants carried out the practice independently
by module. In week six, the group intervention will be practiced separately from and without
accompanied by researchers.
2.5. Data analysis.
Data analysis methods are carried out using descriptive and inferential analysis. The
analysis results will be depicted as table distribution frequency, the central tendency mean,
median, and standard deviation. Analysis of inferential use in the study this is a non-
parametric inferential analysis. This is done using the Wilcoxon signed rank test, which is the
rule that decides on the probability p value Asym. Sig 2 fails < α 0.05, then H 0 is rejected,
which means there is influence between the implementation bedside handover module to
PFCC, while If mark probability p value Asym.sig 2 failed > 0.05, then H 0 is accepted, which
means no there is influence from PFCC- based bedside handover to patient safety and
satisfaction patient [35].
Homogeneous data are required for Wilcoxon signed rank test analysis. The equality
test used is the t-test for objective equality from each sample, while the data used is pre-test
data.
Before the equivalence test was conducted using the t-test, mainly the formerly prerequisite
test conducted that includes normality and homogeneity tests, namely:
1. Equality test: the variables that are suspected consolidation of demographic data and
equivalence tests for measured variables (pre-test).
 Journal of Multidisciplinary Applied Natural Science

2. Before and after test treatment: Wilcoxon

Inter-test group treatment and group control with Mann Whitney u test. This test is a non-
parametric test used to determine the difference of medians of 2 groups free with variable
data, the scale bound being ordinal. The data sources must be two groups: nurses, who are
used as group control and intervention.
3. Relationship test between variables using the Spearmen rank test
Table 2. Analysis inferential
Data Data Withdrawal
No Variables Indicator Type of test
analysis scale conclusion
1 Equivalence Demographi Age Ratio Independent HO rejected if
test sample cs nurse t-test sig <0.05
Gender Nominal Chi-square
Level of education Ordinal Chi-square
Experience Work Ordinal Chi-square
Knowledge Ordinal Chi-square

Demographi Age Ratio Independent HO rejected if

cs patient t-test sig <0.05
Gender Nominal Chi-square
Dependency level Ordinal Chi-square
Treatment room Ordinal Chi-square
Skills nurse Communication Ordinal Chi-square HO rejected if
Effective sig <0.05
Mastery Ordinal Chi-square
terminology health
Accommodate Ordinal Chi-square
record medical
Patient analysis Ordinal Chi-square
Procedure clinic Ordinal Chi-square
System Policy Ordinal Chi-square HO rejected if
service sig <0.05
SOUP Ordinal Chi-square
Infrastructure Ordinal Chi-square
Documentation Ordinal Chi-square
Bedside Preparation Ordinal Chi-square HO rejected if
handover Introduction Ordinal Chi-square sig <0.05

Exchange Ordinal Chi-square

information
Involvement Ordinal Chi-square
patient
 Journal of Multidisciplinary Applied Natural Science

Data Data Withdrawal

No Variables Indicator Type of test
analysis scale conclusion
Safety patient
PFCC Dignity and respect Ordinal Chi-square HO rejected if
Share information sig <0.05

Participation Ordinal Chi-square

Collaboration Ordinal Chi-square
Ordinal Chi-square
3 Influence
test
Difference Variables: 1. Accuracy Ordinal Wilcoxon HO rejected if
test pre-test Y1 patient identification signed-rank sig <0.05
and post-test safety patient test
group pairs 2. Improvement
control and communicatio Ordinal
treatment n effective
3. Improvement Ordinal
high alert
medication
precautions
4. Subtraction Ordinal
risk infection Ordinal
5. Subtraction
risk patient fall
Difference Variables: 1. Accuracy Ordinal Mann HO rejected if
test Y1 Behavior identification Whitney U sig <0.05
post- prevent patient Test
test ion 2. Improvement
value obesity communication Ordinal
betwee in effective
n group childre 3. Improvement
control n Ordinal
and high alert
treatme medication
nt precautions
4. Subtraction risk Ordinal
infection
5. Subtraction risk Ordinal
patient fall
4 Relationship Variables: 1. Accuracy Ordinal Spearman rho HO rejected if
test Y1 Patient identification test sig <0.05
safety patient
2. Improvement
communication Ordinal
effective
3. Improvement Ordinal
high alert drug
 Journal of Multidisciplinary Applied Natural Science

Data Data Withdrawal

No Variables Indicator Type of test
analysis scale conclusion
caution beware
4. Subtraction risk
infection Ordinal
5. Subtraction risk Ordinal
patient fall
1. Reliability
Ordinal
2. Assurance
Ordinal
3. Tangibles
Ordinal
4. Empathy
Ordinal
5. Responsiveness
Variable Y2 Ordinal
Satisfaction
patient

4. RESULTS
Tests used in the study this is a non-parametric test through the Wilcoxon signed rank
test to analyze the influence of the bedside handover model through the implementation of a
based bedside handover module on patient safety and satisfaction patient. This test can dones
because of the existing data ordinal scale or categorical. So, this test is to see the difference
between pre-test and post-test scores of group intervention and group control. Next, use the
Mann-Whitney test to know the difference in post-test scores between group intervention and
control groups.
Data presentation regarding the influence of implementation of- a based bedside
handover module on patient safety and satisfaction from every indicator variable safety
patient and satisfaction patient can see in the following table:
Table 3. Distribution description pre-test and post-test results on implementation of- based bedside
handover module on group Interventions and group control with patient safety variable (n=52)

Group Intervention Group Control

Categor Percentag Percentag
Indicator Test Frequenc Frequenc
y e e
y (f) y (f)
(%) (%)
Accuracy Pre-test Low 5 19 5 19
identification
Currentl 4 16 5 19
patient
y
 Journal of Multidisciplinary Applied Natural Science

Tall 17 65 16 62
Total 26 100.0 26 100.0
Post- Low 2 8 4 16
tes
t
Currentl 5 19 6 22
y
Tall 19 73 16 62
Total 26 100.0 26 100.0
Improvement Pre-test Low 4 16 4 16
effective
Currentl 4 16 3 11
communicati
y
on
Tall 18 68 19 73
Total 26 100.0 26 100.0
Post- Low 2 8 5 19
tes
t
Currentl 4 16 4 16
y
Tall 20 76 17 65
Total 26 100.0 26 100.0
Improvement Pre-test Low 3 11 3 12
security
Currentl 3 12 3 12
necessary
y
medication be
aware Tall 20 77 20 77
Total 26 100.0 26 100.0
Post- Low 3 11 4 16
tes
t
Currentl 2 8 2 8
y
Tall 21 81 20 76
Total 26 100.0 26 100.0
Subtraction risk Pre-test Low 4 16 3 11
infection-
Currentl 5 19 6 23
related
y
service health
Tall 17 65 17 66
Total 26 100.0 26 100.0
Post- Low 1 4 5 19
tes
t
Currentl 1 4 5 19
y
Tall 24 92 16 62
Total 26 100.0 26 100.0
 Journal of Multidisciplinary Applied Natural Science

Subtraction risk Pre-test Low 4 15 5 19

patient fall
Currentl 6 23 2 8
y
Tall 16 62 19 73
Total 26 100.0 26 100.0
Post- Low 0 0 4 16
tes
t
Currentl 1 4 4 16
y
Tall 25 96 18 68
Total 26 100.0 26 100.0
Table 3 compares the fifth pre-test and post-test scores of patient safety indicators in
groups with an intervention majority increase. The percentage in a category is tall where
before the implementation, the bedside handover module only worth in a way consecutive are
65%, 68%, 77%, 85%, and 62%, but after the implementation module mark percentage fifth
patient safety indicators occur improvement as follows are 73%, 76%, 81%, 92%, and 96%.
In the group control, no significant changes occurred. The value pre-test percentages
of the fifth patient safety indicator were 62%, 65%, 76%, 62%, and 68%. After the
implementation module was finished in the group control, the mark presentation from the
post-test results on the fifth patient safety indicator from the group control was consecutive,
as the following were 62%, 73%, 77%, 66%, and 73%. The results of these decreases and
increases were not regular.
Table 4. Distribution description pre-test and post-test results on implementation of- based bedside
handover module on group Interventions and group control with variable satisfaction patients (n=52)

Intervention Control
Indicator Test Category Frequency Percentage Frequency Percentage
(f) (%) (f) (%)
Realizability Pre-test Low 3 11 5 19
Currently 4 16 5 19
Tall 19 73 16 62
Total 26 100.0 26 100.0
Post-test Low 2 8 4 16
Currently 4 16 5 19
Tall 20 76 17 65
Total 26 100.0 26 100.0
Assurance Pre-test Low 4 16 4 16
Currently 4 16 4 16
Tall 18 68 18 68
 Journal of Multidisciplinary Applied Natural Science

Total 26 100.0 26 100.0

Post-test Low 3 11 5 19
Currently 2 8 5 19
Tall 21 81 16 62
Total 26 100.0 26 100.0
Tangibles Pre-test Low 4 16 4 16
Currently 5 19 7 27
Tall 17 65 15 57
Total 26 100.0 26 100.0
Post-test Low 2 8 4 16
Currently 2 8 7 27
Tall 22 84 15 57
Total 26 100.0 26 100.0
Empathy Pre-test Low 3 11 3 11
Currently 3 12 5 19
Tall 20 77 18 70
Total 26 100.0 26 100.0
Post-test Low 1 4 4 16
Currently 2 8 5 27
Tall 23 88 17 57
Total 26 100.0 26 100.0
Responsiven Pre-test Low 2 8 5 19
ess
Currently 3 11 5 19
Tall 21 81 16 62
Total 26 100.0 26 100.0
Post-test Low 1 4 5 19
Currently 1 4 6 23
Tall 24 92 15 58
Total 26 100.0 26 100.0

Table 4 shows a comparison between the fifth pre-test and post-test scores, which
indicate that the satisfaction of patients in the group intervention majority happened to
increase. The percentage in a category is tall where before the implementation of the bedside
handover module, only worth in a way consecutive are 73%, 68%, 65%, 77%, and 81%, but
after the implementation module so mark percentage fifth indicator of satisfaction patient
improvement as the following are 76%, 81%, 84%, 88%, and 92%.
In the group control, no significant changes occurred; value pre-test percentages of
the fifth indicator satisfaction patient were 62%, 68%, 57%, 70%, and 62%; after finishing
 Journal of Multidisciplinary Applied Natural Science

the implementation module in group control, then mark presentation from the post-test results
on the fifth indicator satisfaction patient from group control is in a way consecutive as
following these are 65%, 62%, 57%, 57%, and 58%, the results This happen decreases and
increases are not regular.
Table 5. Results of the Pre-test and Post-test Difference Test on the Influence Implementation of
PFCC- based bedside handover module for patient safety in groups Intervention and control (n=52)
Indicator Group Intervention Group Control
patient safety Mean ± SD ∆ P Mean ± SD ∆ P
Pre Post Mean Value Pre Post Mean Value
Accuracy 31.2±8.9 36.6±8.3 5.4 0,000 34.7 ±8.8 31.2 ±9.4 -3.5 0.131
identification patient
Improvement 14.7±3.5 17.3 ±3.3 2.6 0,000 14.6 ±4.5 14.2 ±4.6 -0.4 0.528
effective
communication
Improvement 15.0±3.5 17.5 ±3.6 2.5 0,000 16.2 ±3.2 14.5 ±4.8 -1.7 0.144
security necessary
medication be aware
Subtraction risk 10.2 ±2.9 13.7 ±2.0 3.5 0,000 11.2±2.0 10.8±3.2 -0.4 0.707
infection-related
service health
Subtraction risk 25.0±5.6 32.4 ±2.4 7.4 0,000 26.4 ±7.3 25.1±8.6 -1.3 0.864
patient fall

Table 5 above shows that the difference between test values of the pre-test and post-
test group intervention from the fifth patient safety indicator is P value < 0.05, and the
difference test between the post-test and post-test shows that the P sig value < 0.05, and the
mean value of the fifth indicators the pre-test to post-test all there is an improvement. This
means that implementing the PFCC-based bedside handover module significantly influences
patient safety in the group intervention at RSUD. Tgk Chik Di Tiro compared with group
control, The P sig value is > 0.05, and the mean of the fifth indicator is no addition mark but
precisely experiences decline. It means there is no influence from the implementation of the-
based bedside handover module on patient safety in the group control of Meuraxa Regional
Hospital. Therefore, it is said that giving intervention through 8-week PFCC-based bedside
handover training can significantly influence the group intervention at Tgk Chik Di Tiro
Regional Hospital.
Reviewed from the mark delta mean difference in group intervention, indicators of
subtraction risk patients own the most considerable mean delta value, namely 7.4, and the
indicator improvement to drugs to watch out for with the smallest mean delta value of 2.5.
This shows improvement in the above indicators after giving the action training module to
group intervention. In the group control, the most considerable mean delta difference in the
indicator accuracy identification patient big is -0.3, and the smallest value on the indicator
 Journal of Multidisciplinary Applied Natural Science

improvement communication practical is -3.5. This means that decreased patient safety in the
group control.
Table 6. Implementation of- based bedside handover module on patient safety in the group
intervention and control
Group Wilcoxon signed
Indicator test rank
Intervention Control
Pre Post ∆ Pre Post ∆ Pre Post ∆
Accuracy 31.2 36.6 5.4 34.7 31.2 -3.5 0,000 0.131 -0.131
identification
patient
Improvement 14.7 17.3 2.6 14.6 14.2 -0.4 0,000 0.528 -0.528
effective
communication
Improvement 15.0 17.5 2.5 16.2 14.5 -1.7 0,000 0.144 -0.144
security necessary
medication be
aware
Subtraction risk 10.2 13.7 3.5 11.2 10.8 -0.4 0,000 0.707 -0.707
infection-related
service health
Subtraction risk 25.0 32.4 7.4 26.4 25.1 -1.3 0,000 0.864 -0.864
patient fall

Based on table 6 above shows that the delta value in group intervention experiences
improvement with a positive mark. In the group control, there was no significant change. The
table shows that the mean delta is negative, which means the subtraction value on the post-
test. Wilcoxon signed test result test rank shows that the delta value in the post-test is
significant in group intervention compared to the control group. This means that
implementing activity on the PFCC-based bedside handover module will cause an
improvement in patient safety at the home hospital. Tgk Chik Di Tiro.
Table 7. Results of the Pre-test and Post-test Difference Test on the Influence Implementation of
PFCC- based bedside handover module on satisfaction patients in the group Intervention and control
(n=52)
Group Intervention Group Control
Indicator Mean ± SD ∆ P Mean ± SD ∆ P
Pre Post Mean Value Pre Post Mean Value
Reliability 18.9 ±3.6 21.0±3.2 2.1 0.001 19.4 ±4.1 19.9 ±3.9 0.5 0.915
Assurance 16.1 ±3.7 18.6 ±3.3 2.5 0,000 17.0 ±3.9 16.6 ±3.6 -0.4 0.721
Tangibles 21.0 ±4.4 23.3 ±3.8 2.3 0,000 20.5 ±4.5 20.4 ±4.9 -0.1 0.964
Empathy 9.5 ±1.8 11.1 ±1.4 1.6 0,000 9.7 ±2.1 9.5 ±2.1 -0.2 0.987
Responsiveness 12.4 ±2.1 13.9 ±1.8 1.5 0,000 11.1 ±2.9 11.4 ±3.1 0.3 0.783

Table 7 shows reviewed from the mark difference in mean delta, in groups,
intervention assurance indicators have the most considerable mean delta value, namely 2.5,
 Journal of Multidisciplinary Applied Natural Science

and the smallest value for the responsiveness indicator is 1.5. This shows improvement in
indicators after the given action training module is given to group intervention. Meanwhile,
in the group control mark, the most considerable mean delta difference in the reliability
indicator is 0.5, and the smallest value in the assurance indicator is 0.5. of -0.4. This means
there was a decline in patient satisfaction in the group control.
Table 8. Implementation of based bedside handover module to satisfaction patients in the group
intervention and control
Indicator Group Wilcoxon signed
test rank
Intervention Control
Pre Post ∆ Pre Post ∆ Pre Post ∆
Reliability 18.9 21.0 2.1 19.4 19.9 0.5 0.001 0.915 -0.914
Assurance 16.1 18.6 2.5 17.0 16.6 -0.4 0,000 0.721 -0.721
Tangibles 21.0 23.3 2.3 20.5 20.4 -0.1 0,000 0.964 -0.964
Empathy 9.5 11.1 1.6 9.7 9.5 -0.2 0,000 0.987 -0.987
Responsiveness 12.4 13.9 1.5 11.1 11.4 0.3 0,000 0.783 -0.783

Based on table 8 above shows that the delta value in group intervention experiences
improvement with a positive value. In the group control, there was no significant change. The
table shows that the mark is not enough from 1, even if there is a negative mark. This means
that the subtraction value happens on the post-test. Wilcoxon signed test result test rank
shows the delta value on the post-test is significant in the group intervention compared to the
group control. Implementing the PFCC-based bedside handover module substantially
increases patients' satisfaction at Tgk Chik Di Tiro Regional Hospital.

5. DISCUSSIONS

3.1. Influence PFCC-based bedside handover factors on patient safety.

Influence PFCC-based bedside handover factors (dignity and respect, sharing)
information, participation, and collaboration) towards patient safety: accuracy identification
of the patient, improvement of effective communication, improvement of security necessary
medication awareness, reduction risk of related service health, and reduction risk of patient
fall. There is a significant influence between PFCC-based bedside handover factors and
patient safety. Research results this is in line with the results of research conducted by
(Wong, 2023 ), which states that bedside handover enhances the efficiency and accountability
 Journal of Multidisciplinary Applied Natural Science

of nurses who are increasingly working for The same team, improving score satisfaction
among patients and declining incident patients.
The study also disclosed that the results of the Spearman Rank correlation test show a
connection between the accuracy of accepting nurses with incident safety patient take care
stay house disease X in Malang is significant (sig<0.05). The relationship of 25.6% (0.256) is
negative (-), which means the more the accuracy accepted nurse, the more low incident safety
patients. The more low-incident safety patients can do so, the more tall-safety patients will be
hospitalized at hospital X in Malang [37].
Furthermore, according to the study results (Nursapriani et al., 2023), bedside
handover is closely related to the implementation target of patient safety. When nurses do
handovers according to the procedure, they can more easily understand the intervention
nursing that will be done to the patient because if the procedure in handover is not done
correctly, it will impact the safety of the patient.
Patients were observed through shift reports, on-site sleep, improvement results, and
education. This ensures the continuity of patient maintenance and optimizes their safety.
They reported that when patients participate actively in shift reports on-site sleep, they
produce subtraction incident patients who produce results better [39]. After implementing
bedside handover, patient fall and error treatment decreased in a clinical way, although there
are no significant statistics. For example, the level of subtraction patients falls by 35% per
month during shift changes in seven medical-surgical units, showing that patient falls
decreased from 20 to 13 post-implementation. In addition, overall error treatment is reduced
by up to 50%, from 20 to 10 post-implementation [40]. In line with that, Brown-Deveaux et
al. (2022) found that patient safety improved, resulting in a 60% decrease in case fall patients
in the science unit nerves. Activity use of bells in the room such as patients use bells during
reduced shift changes up to 33% in 3 months after implementation shift report on the side
place sleep.
Packaged bedside handover implementation with the PFCC concept will involve
patients and families in an active way in the ongoing treatment process. Therefore, when
performing bedside handovers, the PFCC model principle will impact the patient's well-being
because the involvement of patients and families will facilitate the confirmation process
about ongoing treatment, both lived and planned, so that miscommunication can be avoided
as much as possible. Thus, all information about the clinical conditions and problems of
nursing patients can be confirmed to create high data accuracy that can support improving
patient safety.
 Journal of Multidisciplinary Applied Natural Science

Connection is well intertwined between a nurse and patients and families in a way that
directly creates a culture of excellent new improvement quality service nursing. Nurses also
create an atmosphere that is collaborative with patients and families. Nurses invite patients
and families to make policies, planning, implementation, and evaluation of foster care.
Blending in series planning, implementation, and assessment nursing is the honor that is
highest for patients and families. Patients and families will feel proud to position those who
are placed no as object to the treatment, who must be ready no ready for, submit and obey all
rules, and precisely become center-attention-filled with such a position valued. This is what
makes it the implementation of PFFC theory on the safety of patients and comfort
accompanying family patients during maintenance.

3.2. The effect of PFCC-based bedside handover on the satisfaction of patient

Influence PFCC-based bedside handover factor with satisfaction patient: reliability,
assurance, tangibles, empathy, and responsiveness. Research results in a way statistics show
that there is a significant influence between PFCC-based bedside handover and satisfaction
among patients. This aligns with research conducted by Brown et al. (2022 ), which showed
improved patient score satisfaction with handover right next to place sleep. Patient become
more informed and involved in plan maintenance. The study reported by Sand-Jecklin and
Sherman (2013) and Brown at al. (2022) detected the existence of improvement in a way
statistics in the involvement of patients in discussion reports (p-0.017) because of the
perception of patient to improve current information between nurses and patients. Bedside
handover acknowledges and opens facts about skills you have as a nurse in nursing care,
implementation professionalism, humanity profession nursing, ensuring safety, satisfaction,
and trust in the care received, and promoting maintenance of individula nursing [40].
Study results show that satisfaction patients with handover accept patients with
traditional methods to fulfill hope patients by 70.17%. This result is lower compared to the
satisfaction patient about hand over accept patients with the bedside handover method, which
is capable of fulfilling hope patients by 88.24%. Handover right next to the patient increases
the patient's involvement in making decisions related to the conditions of his illness up to
date and improves the caring and communication relationship between patient and nurse
(Aisyah Nur et al., 2019).
Satisfaction patient is the level of feeling of patients who arise as a consequence of
the performance of the service health obtained after the patient compares what has been
received with what he expected. Satisfaction is viewed as evaluation or evaluation after the
 Journal of Multidisciplinary Applied Natural Science

use of a service that selected service at least fulfills or exceeds hope (Kullberg et al., 2017).
Patients and families feel significant satisfaction in implementing bedside handover because
they are involved with totality. Harmonious and healthy interaction between nurse and patient
and family in the treatment process satisfies patients and families with the services provided.
Feelings of satisfaction are triggered by feeling valued when patients and families ask for
opinions and are given a chance to ask about the patient's condition. As a man, being treated
with excellent and humane care will foster a sense of satisfaction that is not expressed. This is
the reason why the involvement of patients and families in accepting treatment is significant
satisfaction.
Structured communication and framework structured work can help reduce
psychological barriers to patients during the bedside handover process. For example,
implementing the SBAR (Situation, Background, Assessment, Recommendation) framework
provides a precise handover process and can reduce patients' cognitive burden [43]. The
handover process is based on guidelines or standards that can help increase readiness and
psychological power in the handover process to help smooth the handover process [27].
Quality from the handover carried out by the nurse directly influences patient safety behavior.
A quality handover process that involves existing involvement between patients in an active
way can reduce the risk of errors and improve patient safety overall [44]. The handover
process takes into account the condition of the psychological patient. It ensures that the
information provided is correct and honest, leading to the continuity of reasonable care and
reducing the emergence of symptoms recurrent in patients [43].
Aspects of psychological influence on the bedside handover process, especially in
patients treated in emergency units. Patients treated in the emergency unit are critical for
constant monitoring in real-time regarding the development of the situation, so the bedside
handover process must be practical [6]. The psychological condition affects patient safety and
satisfaction during the treatment period. Aspect psychological patients can assist with the
presence and support of family [45]. This matter is related to the patient's mental condition,
where the existence of support from the family patient so will speed up the recovery time.
The patient is healing physically and psychologically. Support family is essential for patients
with cancer because of their role in increasing compliance with medical. The study's results
also showed that environment-supportive families could help patients comply with the
regimen treatment [46]. For COVID-19 patients, a support family in the form of emotional,
informational, and instrumental support can significantly increase recovery time [47]. Not
only for patients with sick physical but also with mentality, it is also necessary to support
 Journal of Multidisciplinary Applied Natural Science

family because the influence of twelve love helps the self reduce the severity of symptoms
and improve social and work functions, perception recovery, and life satisfaction [48].
Engagement with family in decision care and network support is significant for the recovery
and improvement of the patient's quality of life [49]. Interventions based on family for
patients are known to be more effective in increasing results like reducing pain, distress,
efficacy, self, and function compared to patient-oriented interventions; interventions based on
the family are also known to reduce anxiety and depression [50]. As for some, the impact
given from the existing support family to the patient is:
1. Support emotional
Emotional support helps patients feel noticed and understood, increasing mental
resilience and obedience toward the treatment process [47], [51].
2. Support information
The presence of relevant information can help patients make the right decision regarding
the treatment process, influencing better health results good [47].
3. Instrumental support
Instrumental support in the form of assistance with daily activities, as well as needed
medical, can improve patient focus and the treatment procedure so that the patient can
focus on healing without stress [47]. Support families can also cultivate self-compassion
patients who can increase psychological and functional results [51].
Patient psychology has a significant influence on the process of patient care and
recovery in hospitals because it is related to hormones, metabolism, signal transduction
pathways, and various other biochemical activities in the body's cells. For example, delirium,
an acute psychological marked by confusion, lack of attention, and low spirit, regularly
appears in patients with critical disease. This delirium can extend the treatment period for
patients who are sick at home, so delirium is one of the inhibitors for patients to speed up
recovery [52]. One of the influences this delirium exerts is a disturbance on the line
tryptophan, where tryptophan forms serotonin hormones, melatonin, and vitamin B 6 in the
body [53]. This serotonin hormone plays a role in the arrangement of the atmosphere heart
and prevents the emergence of mental disorders (Kroshus et al., 2021). Tryptophan is a
compound derivative from amino acids that have two metabolic pathways, namely the
serotonin pathway and kynurenine pathway, for the synthesis of several metabolic
neuroactive like kynurenic acid, 3-hydroxy anthranilic acid, acid picolinic acid, 5-hydroxy
anthranilic acid, xanthurenic acid, to kynurenine.
 Journal of Multidisciplinary Applied Natural Science

Several metabolites at the end of the kynurenine pathway indicate anti-stimulatory

activity, while others show pro-excitatory and pro-convulsive properties. Kynurenine acid,
antagonist spectrum broad endogenous excitatory amino acid with activity neuroprotective
received in a general way, blocking introduction sites glycine, which is not sensitive to
strychnine at NMDA receptors and increased function GABAergic induced choline at
nanomolar and micromolar concentrations physiological, respectively. Increased kynurenine
acid concentration is associated with damaged myelin, which causes dysfunction in nerves.
Accumulation of brain kynurenine acid concentration induces functional learning and
memory, and the level of deducting significantly increases cognitive function. So, that can
conclude that physiological kynurenine acid concentration in the brain is neuroprotective,
whereas increased kynurenine acid induces cognitive disturbance [55], [56].
Patient psychology in the form of anxiety, depression, and stress during treatment in
hospital can also be responded to by the hormone epinephrine as a form of pressure.
Epinephrine hormone is a hormone released by the medulla of the adrenal glands in response
to pressure, both internal and external. A pressure is responded to by the epinephrine
hormone by activating signal transduction pathways to accelerate muscle activity including
acceleration of heart rate, enlargement of smooth muscle tissue and initiation of degradation
of energy reserves such as glycogen and fatty acids. The hormone epinephrine is stored in
chromaffin vesicles found in the cells of the adrenal medulla. Nerve impulses received by the
adrenal medulla cause exocytosis of the hormone epinephrine with a concentration a
thousand times greater than normal from the chromaffin vesicles into the surrounding
extracellular fluid and then into the bloodstream.

external stimuli

central nervous system

adrenal medulla

epinephrine hormone
epinephrine receptor

liver cells
adenylate cyclase
 Journal of Multidisciplinary Applied Natural Science

Figure 2. Epinephrine hormone signal transduction pathway

The epinephrine hormone signal transduction pathway begins with the binding of
epinephrine hormone by the β-adrenergic receptor. The β-adrenergic receptor that binds
epinephrine hormone causes a conformational change in the domain facing the cytoplasm that
results in a conformational change in the G protein. The inactive G protein, namely the G
protein that binds GDP, is composed of α subunits (Gα) that function to bind nucleotides. The
α subunit and γ subunit are bound to the membrane through covalent bonds with fatty acids.
The interaction between the epinephrine-β-adrenergic receptor complex and the G protein
results in the opening of the GTP binding site and GTP immediately replaces GDP. GTP
binding causes the α subunit to dissociate from the βγ dimer (Gβγ), where the α subunit that
is released and binds GTP continues the signal transduction transmission to the next stage.
 Journal of Multidisciplinary Applied Natural Science

One epinephrine-β-adrenergic receptor complex can stimulate a change in the shape of a G

protein that binds GDP to a G protein that binds significant amounts of GTP. The α subunit
(Gα) of the G protein that binds GTP loses affinity for the βγ dimer so that it is released and
bound to another protein, the adenylate cyclase enzyme. The adenylate cyclase enzyme
contains 12 α-helical structures that circle the membrane, where two of them are large
domains as the catalytic side of the enzyme facing the cytoplasm. The interaction between the
α subunit of the G protein (Gα) and the adenylate cyclase enzyme causes a conformational
change so that the catalytic side is more active by using ATP bound to the α subunit of the G
protein to produce cAMP. The production of cAMP provides a second signal transduction to
convert a lot of ATP to produce cAMP in large quantities.
High cAMP concentrations of about 10-6 M carry out the second signal transduction
for various cellular activities. High cAMP concentrations in muscles promote the production
of ATP as an energy source for muscle contraction. High cAMP concentrations in other cells
promote the degradation of glycogen and fatty acids, increase acid secretion by the gastric
mucosa, facilitate the dispersion of melanin pigment granules, reduce blood platelet
aggregation, and induce the opening of chloride ion channels. All of these cell activities are
due to the activation of protein kinase A by cAMP. Protein kinase A has two regulatory (R)
sites and two catalytic (C) sites. When there is no cAMP, the R2C2 protein kinase A complex
is catalytically inactive. Binding of cAMP to the regulatory site results in the formation of the
R2-cAMP complex and the release and activation of the catalytic site. Activated protein
kinase A phosphorylates using ATP against the serine residue on the inactive kinase
phosphorylase enzyme (dephospho form) to produce the active kinase phosphorylase enzyme
(phospho form). Active phosphorylase kinase enzyme with the help of Ca 2+ ions catalyzes the
phosphorylation reaction by using ATP to convert the inactive phosphorylase b enzyme into
the active phosphorylase a enzyme. The active phosphorylase a enzyme then catalyzes the
breakdown of glycogen at high speed to produce glucose 1-phosphate. The resulting glucose
1-phosphate is converted into glucose 6-phosphate by the phosphoglucomutase enzyme.
Glucose 6-phosphate is catalyzed by the glucose 6-phosphatase enzyme to produce glucose,
then glucose is transferred to the bloodstream and glycolysis is carried out to obtain energy
quickly and in sufficient quantities to respond to stimuli received by the adrenal medulla by
fighting or running away.
Based on the description above, the aspect of psychology and the involvement of
patients in the handover process have an important role. Ensuring that patients feel
empowered, trusted, and supported can significantly increase handover quality, leading to
 Journal of Multidisciplinary Applied Natural Science

patient safety and satisfaction. Support family plays a role in recovering patients with various
health conditions. Whether it is supported in an emotional, informational, or instrumental
way, it is very influential in increasing health results so that recovery time for patients can be
improved. Lack of support from family or environment patient to patient can influence the
patient's mental condition, such as the existence of disturbance in the path tryptophan, which
affects the hormone serotonin, which has a role in the setting atmosphere, heart patient, when
patient own disturbance This will hinder recovery patient so that necessary For pay attention
and make sure environment patient support it.

4. CONCLUSIONS

Training a PFCC-based bedside handover module is known to significantly improve

patient safety in the group intervention and not influence the group control. This shows that a
PFCC-based bedside handover module is effective for improving patient safety. Based on the
research that has been done, it turns out that implementing a PFCC-based bedside handover
module can also significantly increase the level of patient satisfaction.

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