Caring Behavior of Nurses Increase Level of Client’s Satisfaction in Clinical Area

Background: Nurse caring behavior is one aspect that is very related to nursing services, because caring includes human relationships and affects the quality of service and patient satisfaction. Patient satisfaction is the result of an assessment in the form of an emotional response (feeling happy and satisfied) to the patient because of the fulfillment of expectations or desires in using and receiving nurse services. Patient satisfaction is an evaluation or assessment after using a service that the selected service at least meets or exceeds expectations. The research design used is a descriptive correlational quantitative research method using a cross sectional approach; sampling technique is purposive sampling. The numbers of sampling were 41 respondents. Data collection instruments using a questionnaire Chi-Square test with a significance level α = 0, 05. Based on the Fisher’s Exact Test, p value = 0.018

Caring nurses in the eyes of most people today are not well developed. This situation is caused by the professionalism values of nurses that have not been applied in nursing service activities, including caring behavior as the core of nursing. Broadly speaking, people perceive professional nurses if nurses have ethics and caring in nursing services [4].
Patient satisfaction is a very important factor for evaluating the quality of nursing services performed by nurses in hospitals. Nurse caring behavior is one that is related to nursing services, caring includes human relationships and affects the quality of service and patient satisfaction. Patient satisfaction can be assessed from several dimensions including: tangible, reliability, responsiveness, assurance and empathy [5].
Makassar survey results in the South Sulawesi region with the number of respondents was 2,300 people who live in 23 regencies throughout South Sulawesi. Each regency consisted of 100 respondents with a minimum age of 17 years, and got an answer that was not good (30.40%) which was quite significant for questions concerning the quality of health services and nurse performance that was increasing, while 6.80% of other respondents answered very poorly. Accumulatively, the results of the survey cannot deny the high level of assessment that the quality of health services and the performance of nurses do not reflect actual expectations.
Makassar Labuang Baji Hospital is one of the referral hospitals in Makassar. This nursing service is still considered to be not optimal and has received the most complaints related to nursing services. This is based on the number of reports and complaints that enter the South Sulawesi Parlement of South Sulawesi Province. There are still complaints from patients and their families about the role of nurses that are less than optimal, services that are always late and convoluted, there are still nurses who do not have a standard attitude in serving patients, and patients feel mistreated.
Based on staffing data at Labuang Baji Makassar Hospital, there were 13 nurses who worked in Inpatient Room. The numbers of patients treated in that hospital were two rooms which were 46 people divided into 5 lung diseases and some common diseases such as surgery, internal, child, and ENT, nursing care for wedge patients there are two different treatments, and there are partial, total and minimal treatments depending on the patient's condition.
But most of the fulfillments that nurses fulfill are minimal fulfillment of patient needs. Based on the survey there are some patients who say that there are nurses who pay less attention to the patient's condition such as after putting an intra-venous and patient complaints are not handled quickly.

Statement of the Problem
Based on the description in the background of the problem above, then the problem can be formulated in this study. Is there a relationship between nurses' caring behavior and the level of patient satisfaction in Hospital?

Purpose of Research
To determine the level of patient satisfaction, nursing services, and the relationship of nurses caring behavior with the level of patient satisfaction in the hospital.

Study Literature
Caring can generally be interpreted as an ability to be dedicated to others, watchful oversight, feelings of love or love. Caring is ways of a dynamic approach, where nurses work to further improve its care to clients. In nursing, caring is an important core part, especially in nursing practice. The caring action aims to provide physical care and attention to emotions while increasing the client's sense of security and safety, then caring also emphasizes the individual's self, meaning that in carrying out nursing practice, nurses always respect clients by accepting the client's strengths and weaknesses so they can provide appropriate health services to patient. (  While good or bad is greatly influenced by the process (process), input (input) and the environment (environment). So it is clear that whether or not the quality of health services is strongly influenced by these elements, and to ensure the good quality of health services the three elements must be pursued in such a way as to be in line with standards or needs.
a. For input are fund and physical facilities, equipment.
It is generally stated that if labor and facilities (quantity and quality) do not comply with established standards (Standard of

Role and Function of Nurses
The  As a nurse manager is in monitoring and ensuring the quality of care or nursing services as well as organizing and controlling the nursing service system. Because nurses' understanding of knowledge is lacking so that the executing nurse manager is not maximal, the majority of positions, the scope of authority of the nurse's responsibility has almost no effect on planning and decision making.

Overview of Satisfaction
Satisfaction is a feeling of pleasure someone comes from the comparison between the pleasure of an activity and a product with expectations [7]. Another opinion from (Endang et al, 2010) that patient satisfaction is an evaluation or assessment after using a service that the service chosen at least meets or exceeds expectations.
Based on the description from several experts above, it can be

Caring Overview
Caring is an action taken in providing support to individuals as a whole. Actions in the form of caring should be taught to humans from birth, the period of development, the period of growth, the period of defense until death. Caring is the essence of nursing that distinguishes it from other professions and dominates and unifies nursing actions [9].

Copy@ Agussalim
Caring is a behavior that underlies the attitude of nurses in providing nursing services to their patients. Behavior of nurses who are friendly, considerate, caring, provide explanations to patients and families when conducting examinations and actions, respect the patient, not in a hurry, calm, gentle, and understand the feelings of the patient and the patient's family [10].

Satisfaction
Many researchers define and describe the real form of caring nurses [9] in their research, summarize some literature about nurses caring behavior, and classify nurses caring behavior into two large groups' namely effective and instrumental behavior.
Effective caring behaviors of nurses are nurses' attitudes that reflect caring values namely human values, respect, caring, empathy, and relationships of trust and help [9]. Nursing caring behaviors that are included in effective behavior include all activities of nurses in forming relationships with quality patients that are based on a relationship of trust, sensitivity and empathy. Other activities that reflect effective behavior are providing support to patients such as patient supervision, providing comfort and respecting patient privacy [9].
Nurse caring instrumental behavior is behavior that shows nurses' skills and abilities cognitive and psychomotor [9]. Nurse activities that reflect instrumental caring behavior include physical activities or actions of nurses such as giving medicines, cleaning patients, meeting the basic needs of patients and the use of medical devices. Other behaviors that reflect the instrumental behavior of caring nurses are activities that are oriented towards cognitive abilities such as learning programs, health education and problem solving with systematic nursing care methods [9]. Types of Caring Types by [9] a. Caring as a Process, Caring that is oriented towards the goal of helping others grow and actualize them. Caring as a process is a behavior that requires a large soul and is able to be tolerant. b.
Caring As a Normal Form (moral form) so that nurses must consist of people who are virtuous and have concern for patient satisfaction, which maintains dignity and respects patients as special human beings who have power, and not just physical, but also having a soul and needs must be an important part of caring behavior.
c. Caring as An Affect described as an emotion, and feeling of compassion, or empathy for the patient that encourages the nurse to provide nursing care for the client / patient. Thus these feelings must be present in every nurse in order to treat patients well.

Method of collecting data
In this study, data collection was obtained by way of: 1. Primary data is data obtained directly from the object under study and collected by the procedure, primary data obtained by researchers is to use a questionnaire measuring instrument made by researchers who then filled out by respondents.

2.
Secondary data is data obtained from the installation related to the initial data collection at Labuang Baji Hospital Makassar.
All data gathered from the participants with inform consent which are signed by them.

1.
Editing, After the data is collected the researcher will conduct a selection that is checking each questionnaire that has been filled in regarding the correctness of the data in accordance with the variable 2.
Codding, done to facilitate data processing by coding in the list of questions that have been filled in, namely every answer from the respondent 3.
Scoring is the grading of data in accordance with a predetermined score based on a structured questionnaire.

4.
Data tabulation is an activity to group data according to items determined by researchers to find out the percentage of the relationship between nurses caring behavior at Labuang Baji Hospital Makassar.

5.
Data entry is the activity of entering data that has been collected into a master table or computer database, then making a simple frequency distribution using contingency tables.
Data analysis was performed using univariate analysis and bivariate analysis as follows: (1) Univariate analysis, which is processing data carried out using a computerized statistical program. In this study, univariate analysis was conducted to find out the proportion of each research variable, namely the independent variable which is a characteristic of the research subjects also (2) Bivariate analysis is an analysis carried out to see the relationship between two variables including the independent variable and the dependent variable. In this study, bivariate analysis is used to determine whether there is an influence of the independent variable, the nurse's caring behavior with the dependent variable, which is patient satisfaction. Data obtained through a questionnaire were analyzed using the Fisher's Exact Test conducted in a statistical program.

Result of Study Univariate Analysis
The study was conducted for 2 weeks, from 11 June 2019 to namely as many as 21 respondents (51.2%), while some the small number of health service users are aged 31-44 years as many as 4 respondents (9.8%).
Based on [ Table 2] the distribution of the characteristics of respondents according to the sex above it can be seen that the majority of service users with the most 25 respondents (61.0%) are women while the minority of health service users are men as many as 16 respondents (39.0%).
Based on [ Table 3] the distribution of the characteristics of respondents according to the last education of the respondents above, it can be seen that the most are high school graduates that are 17 respondents (41.5%) and the least are S1, SD and SLTA each having 1 respondent (2.4%) .
Based on the distribution of [

Bivariate Analysis
Analysis of the relationship of nurses caring behavior with the level of patient satisfaction Labuang Baji Makassar Hospital [ Table   6]

Discussion of Study
The discussion in this study is presented in the form of a Characteristics of respondents obtained during the study and related to patient perceptions of nursing services and the level of satisfaction in nursing services, including age, gender, and education level. (Simamora , 2003).

Research conducted by (Trisnantoro, 2006) explained that is a
person's needs for a health service will increase with age because the need for curative services or treatment increases with age.
According to the researchers' assumptions most respondents of early adulthood have the ability to provide an objective assessment, Chi square test results obtained from the value of p = 0.018 smaller than the value of α = <0.05 which means that there is a relationship between caring nurses with the level of patient satisfaction [17].
The relationship between caring nurses and patient satisfaction is a very important factor in evaluating the quality of nursing services performed by nurses in hospitals and nurses caring behavior is one aspect related to nursing services, because caring includes human relationships and influences service quality and satisfaction patient.
Patient satisfaction can be assessed from several dimensions which include: tangibles, reliability, responsiveness, assurance and empathy (Kotler, 2003). This is supported by research [14] about the level of patient satisfaction in the orthopedic ward with caring nurses at the University of Malaysia hospital, found that 82.7% were satisfied with nurse services such as respecting patients, calm, gentle, caring , affection and empathy.
Research in several Indonesian hospitals related to patient satisfaction, among others [15] about the relationship between patient perceptions of the dimensions of quality of nursing services

American Journal of Biomedical Science & Research
Copy@ Agussalim with satisfaction of inpatients in Muhammadiyah Temanggung [18], shows that there is a significant relationship between patient perceptions of dimensions of nursing service quality with satisfaction patient. One way to evaluate the quality of nursing services performed by nurses in hospitals is to conduct a survey of patient satisfaction with nursing services; patient satisfaction can be influenced by nurses caring behavior.
Nurses who have a concern in providing nursing care to patients in the hospital are nurses who have caring attitude. This is supported by the theory put forward (Potter et al, 2009) that caring is the nurse's wholehearted concern for the patient, caring, empathy, gentle communication and the nurse's love for the patient will form a therapeutic nurse-client relationship [19]. Thus the patient feels comfortable, safe and a sense of stress due to illness suffered so that patient satisfaction can be realized, but the reality in practice is still less nurses who behave caring for patients. This is supported by research (Husein, 2006) found that 90% of patients said they did not feel comfortable with nurses, 84% of these had negative experiences because nurses did not pay attention to patient needs, especially at night [20,21].
Behavior caring for patients is the essence of nursing that can contribute positively to the satisfaction of patients receiving nursing services [22]. Researchers assume that nurses have an important role in improving the quality of service [23].

Summary of Study
From the results of the study and the description above with the title of the relationship between nurses caring behavior with the level of client's satisfaction in Labuang Baji Hospital [24,25] Makassar can be concluded as follows: a.
The level of patient satisfaction in Baji Ada II Hospital in Makassar Labuang Baji Hospital has a satisfied category of 33 respondents (80.5%).

b.
Nursing services in Baji Ada II hospital in Labung Baji Makassar have good caring as many as 41 respondents (82.9%). c.
There was a significant association between caring nurse with patient satisfaction level hospitals Makassar Baji Labuang with value p = 0.018 where the value of α <0.05 which means that H 0 is rejected.