The Analysis of Factors Associated with the Effectiveness of Nurse Communication to Patients in the Inpatient Room of Teungku Fakinah Hospital, Banda Aceh

The number of fundamental changes occur in the world of nursing and nursing services. Nurses who used to help carry out the duties of doctors, became part of efforts to achieve clinical service goals, now they want independent nursing services as an effort to achieve nursing care goals. Nursing services in various hospitals do not yet reflect the practice of professional services. The method of providing nursing care that is implemented is not entirely oriented towards efforts to meet the needs of patients, but rather is oriented towards the implementation of the routine duties of a nurse (Anas, 2014). Communication plays a role in the healing of patients associated with collaboration between nurses and other health professionals, and also affects patient and family satisfaction. This makes communication needed in every form of service available at the Hospital (Suryani, 2014). Nurses are a profession that is focused on caring for individual families and communities so that they can achieve, maintain or restore optimal health and quality of life from birth to death (Aripuddin, 2014). The quality of communication in interactions between nurses and patients has a big influence on the patient's healing. To support the development of effective nursing communication in clinical practice, a good understanding of what is communicating will be very helpful (Anjaswarni, 2016). Abstract

The effectiveness of communication is central to care services and this is considered a necessity from time to time. To be able to communicate effectively, we need to know the factors that influence it. Nurses must communicate effectively to carry out their roles as educators, case managers and active members of the health care team (Prasetyaningtyas, 2015).
Communication planning is the first step for all types of activities. Including starting development activities, communication planning is a very important part. Sean MacBride negates that communication becomes a cultural tool that causes social integration. With communication, attitudes and motivations someone will be encouraged or influenced to behave, and it will extend to other environments. That is why, individuals with their awareness will play a major role in development. (Kholil, 2019) A nurse is required to have the ability to communicate well especially work activities carried out involving interactions with others. Communication is an important part of human life because we as humans interact with other humans through communication. We can see this from everyday how people communicate every day to exchange information or even find information and learn how to communicate well. Such as through verbal and nonverbal language (Damaiyanti, 2014).

Definition of Communication
The term communication comes from the Latin language, namely communicatus which means sharing or shared. The adjective communis which means general or together. Thus communication according to Lexicographer (language dictionary expert), refers to an effort aimed at sharing to achieve togetherness (Fajar, 2009).
According to Onong Cahyana Effendi (2003), communication is the process of delivering a message by someone to someone else to tell, change attitudes, opinions, or behavior, either by oral (direct) or indirect (through the media). Meanwhile, according to Anjaswarni (2016) communication is the overall exchange of behavior from the communicator to the communicant, whether realized or not realized, verbal or written speech, movements, facial expressions, and everything in the communicator with the aim to influence others. Communication is a dynamic process and always changes according to the changing circumstances and environmental conditions.

Communication Process
The development of communication science, a component in the communication process was introduced by David K Berlo (1960) and quoted by Cangara H. (2004). The concept is famous for the concept of "SMCR" which is source (sender). message, channel (media-channel), and receiver (receiver). The latest development is the emergence of the views of Joseph de Vito, et al who value that environmental factors are an important element in supporting the communication process. So that the complete elements in communication include Source, Message, Channel, Receiver, effects, and environment. The relationship between these elements is illustrated in the following chart:

Figure 1
David K Berlo Communication Process (1960) Based on Figure 1, it can be explained that the Berlo model emphasizes communication as a process and emphasizes the meaning of messages sent to people who receive messages rather than the words of the message itself. In other words, that message interpretation mainly depends on the word or message interpreted by the sender or the recipient (Cangara, 2004).

Therapeutic Communication
communication occurs at every level in health care delivery arrangements. This phenomenon in medical practice turns out to be one of the most common causes of errors (Shitu et al, 2018).
According to Manojlovich (2017) one of the main problems that cause medication errors is ineffective communication between patients and health care workers. To produce relevant information based on an understanding of the importance of communication in the treatment process, this paper aims to examine communication problems in the health care environment and how medication errors can be corrected for effective communication.
It is important to highlight the problem of errors in the delivery of health services to raise awareness about the need to improve patient safety (World Health Organization, 2016). Interrupted communication can jeopardize the safety and quality of health services and ultimately lead to medication errors and disruption of patient safety and satisfaction (Ghahramanian et al., 2017) The main communication error is to assume communication has occurred and successfully passed. Professionals tend to use technical language at work because they assume the tone of communication is always professional. Communication intended for the executive must be concise and appropriate because the executive does not have the time to explore it. However, communication between patients and health care workers must be simple and clear because health care practitioners must assume the responsibility to communicate according to the patient's health knowledge (Rajah et al, 2017).
Miscommunication between patients and health care providers is an important concern. This contributes to the use of unsafe drugs, bad practices, and puts patients at risk of medication errors (Wang, 2017).

III. Research Method
The type of research is quantitative analytic with cross sectional study approach. The research location is in the inpatient room of Teungku Fakinah Hospital in Banda Aceh. Timing of the study will be carried out from February to March 2020.
Calculation of the number of samples using the Slovin formula, ie: n = N o (1+Ne 2 ) Information: n = number of samples N = total population e = significance level (this research uses 0,05) Thus the number of samples of this study is n = 300 0 (1+300x0,05 2 ) = 171,43 = 171 (rounded off) To avoid bias, an additional 10% sample is added so that the samples obtained are: 171 + (171 x 10%) = 188 people

Operational Variables and Definitions
To make it easier to understand the meaning of the variables in this study, it will be explained in the operational definitions in table 1 and table 2:  The multivariate test that will be used is the logistic regression test. The requirements for this test are: 1. Dependent variables must be dichotomous (2 categories) 2. Independent variables do not have to have the same diversity between groups of variables. 3. Categories in the independent variables must be separate from each other or exclusive. 4. Samples are needed in relatively large quantities, a minimum of up to 50 data samples is required for a predictor variable (independent).

Logistic Regression Equation Formula
Ln = Natural logarithm B0 + B1X = Equations commonly known in regression models. The value of Exp (B) can be interpreted as follows: Value Exp (B) the effect of openness, empathy, equality, audible (right) and humble (humble) on the effectiveness of communication.

IV. Discussion
This research was conducted in the inpatient room of Teungku Fakinah Hospital in Banda Aceh. This research was conducted in the period March 2020 to May 2020. Data collection was conducted in the period March 2020 to April 2020.
This study was to determine the factors associated with the effectiveness of nurse communication in patients in the inpatient room of Teungku Fakinah Hospital. This research was conducted by obtaining the results of quantitative research by filling out questionnaires by patients and taking data from hospital medical records. Primary data collection was collected by distributing questionnaires to 188 respondents. This study uses 5 independent variables, namely openness, empathy, equality, audible (right), and humble (humble).

Characteristics of Respondents
Characteristics of respondents are a variety of backgrounds that are owned by respondents themselves. From the results of filling out the questionnaire by the patient obtained the following patient characteristics: Based on table 3 above, this study used respondents as many as 188 patient samples where from the sample selected in terms of sex as a whole the sample was female as much as 54% and the remaining male as much as 46%. In terms of age, most respondents aged 18-40 years were 55% and the remaining 45% respondents were aged 41-60 years.

Univariate results
Unvariat test was conducted to find out the distribution of each variable studied. The variables studied include the effectiveness of communication, openness, empathy, equality, audible (right) and humble (humble).
There were 188 patients who met the inclusion criteria during the months of March 2020 to April 2020. The distribution of the subjects of this study is in table 4 Based on the table above shows that the level of effectiveness of nurse communication in patients in the inpatient room of Teungku Fakinah Hospital is in the category of good that is 89%. The level of openness is good at 90%. The level of empathy is 99% good. The level of equality is 99% good. Audible rate (right) is in the good category of 95%. And the humble rate is at a good 98%. The 169 respondents who stated the level of openness was good, it appeared that most of the effectiveness of nurse communication was also in the good category at 99%. Of the 19 respondents who stated the level of openness was not good it turned out there was also a level of effectiveness of nurse communication in the good category at 1%.

Bivariate Results a. The Relationship between Openness and the Effectiveness of Nurse Communication
Statistical test results show that the value of p value is 0.00 meaning that it is smaller than the value of α. It can be concluded that there is a relationship between openness and the level of effectiveness of nurse communication among patients at Teungku Fakinah Hospital. The 186 respondents who stated that the level of empathy was good, the effectiveness of nurse communication in the good category was 100%. Of the 2 respondents who stated the level of empathy was not good, the level of effectiveness of nurse communication in the good category was 0%.

b. Relationship between Empathy Attitude and Nurse Communication Effectiveness
Statistical test results show that the value of p value is 0.00 meaning that it is smaller than the value of α. It can be concluded that there is a relationship between empathy and the level of effectiveness of nurse communication in patients at Teungku Fakinah Hospital. The 187 respondents who stated the level of equality was good it turned out that the effectiveness of nurse communication in the good category was 100%. From 1 respondent whose equality is not good, the level of effectiveness of nurses' communication is good in the category of 0%

c. Relationship of Equality with the Effectiveness of Nurse Communication.
Statistical test results show that the value of p value is 0.04, which means it is smaller than α value. It can be concluded that there is a relationship between equality with the level of effectiveness of nurse communication in patients at Teungku Fakinah Hospital. The 178 respondents who stated that the audible (right) was good it turned out that most of the effectiveness of nurse communication in the good category was 99%. Of the 10 respondents who are audible (right) are not good, the level of effectiveness of nurse communication in the good category is 1%

d. Relationship Audible (Right) With the Effectiveness of Nurse Communication.
Statistical test results show that the P value of the Values is 0.00 which means it is smaller than the α value. It can be concluded that there is a relationship between audible (right) with the level of effectiveness of nurse communication in patients at Teungku Fakinah Hospital.
e. Humble Relationship with the Effectiveness of Nurse Communication. The 185 respondents who stated humble (good humility) turned out to be effective communication nurses in the good category that is 100%. Of the 3 respondents who are humble (humble) are not good, the level of effectiveness of nurse communication in the good category is 0% Statistical test results show that the value of p value is 0.00 meaning that it is smaller than the value of α. It can be concluded that there is a relationship between humble and the level of effectiveness of nurse communication among patients at Teungku Fakinah Hospital.

Multivariate results
The tool used in testing this hypothesis is logisitic regression. This analysis is used to measure the strength of the relationship between the independent variables and the dependent variable, and to show the direction of the relationship of these variables. This analysis will form an equation that can explain the results below: Based on table 10 above shows the coefficient β value is a form of a regression equation that can be generated as follows: Effectiveness of nurse communication = constant + β level of openness + β level of empathy + β level of equality + β level of audible (exact) + β level of (humble) = -21,152 + 18,898 (openness) + 21,845 (empathy) + 19,411 (equality) + 18,542 (right) + 22,943 (humble)