THE INFLUENCE OF MOTIVATION AND COMMITMENT OF HEALTH WORKERS ON LACTATION MANAGEMENT SERVICES AT RSIA ASIH BALIKPAPAN

ABSTRACT


INTRODUCTION
Lactation management is the management needed to support the success of breastfeeding.Lactation management is carried out as a mandate by the World Health Organization (WHO) to fulfill the needs of the first 1000 days of life in order to reduce infant mortality.The first thousand days of life consist of 270 days during pregnancy and 730 days in the first 2 years of a child's life.What happens during this period, including the nutrition the baby receives while in the womb and receiving breast milk, can prevent stunting and have a long-term impact on adult life.Lactation management is an effort made to achieve success in breastfeeding, it should be done since the beginning of pregnancy, until during the breastfeeding period.In particular, the role of health workers in carrying out lactation management is by carrying out Early Initiation of Breastfeeding after childbirth, so that the success of implementing breastfeeding with exclusive breastfeeding can be successful.
According to data from the Indonesian Demographic and Health Survey (IDHS) in 2017, the neonatal mortality rate is 15/1000 live births, infant mortality rate is 24/1000 live births and under-five mortality rate is 32/1000 live births.This figure shows a decrease compared to the survey results in 2015.This mortality rate occurs due to the influence of various factors since conception and the baby in the womb such as congenital abnormalities and low birth weight.Based on the results of the Basic Health Research in 2018, the proportion of early breastfeeding initiation in Indonesia in newborns was 58.2%, while the duration of early breastfeeding in less than one hour was 84.1% and 15.9% equal to one hour.Rumah Sakit Ibu Anak Asih Balikpapan is one of the hospitals that applies lactation management.Based on observations of the last 3 months at RSIA Asih Balikpapan, it was found that newborns who received breast milk for less than one hour were 45.7% in April, 48.1% in May and 49.5% in June.From these data, it shows that the average baby who received breast milk for less than one hour is still low, namely 47.8%, still far from what was expected.This part of the author's thesis is not yet broad, currently it is still in the literature review.Research in Indonesia regarding the factors associated with exclusive breastfeeding in infants with early initiation of breastfeeding has not been widely carried out.Based on the results of the literature review, the authors conducted research on the influence of motivation and commitment of health workers in the success of lactation management services as evidenced in the author's own research.

RESEARCH METHOD
This research method uses associative quantitative with hypothesis testing to see the influence between variables.The research method used the path analysis model.There are several Path Analysis models using multiple regression models, namely X1 (Motivation) and X2 (Commitment) with one endogenous variable.Which was carried out on 80 respondents.

RESULT AND DISCUSSION 1. Characteristics of Respondents
Based on the results of the study, it was found that the characteristics of the respondents, namely, most of the respondents were in old age (36-46 years) with the number of respondents as many as 43 people with a percentage of 53.75%.the number of 80 people with a percentage of 100%, the characteristics are based on years of service, namely most of them have a working period of 1-10 years, with a total of 50 people with a percentage of 62.5, and the characteristics of education, namely, most of the respondents have the last D3 the number of 60 people with a percentage of 75%.

Hypothesis test analysis
Primary data sources that have been processed with 2019 data In table 1, it can be seen that the interaction between variables is all significant (p <0.05) with a correlation coefficient where the P value is <0.05, so that there is a significant effect of motivation and commitment to lactation management services..

CONCLUSION
1.The Effect of Motivation (X1) and Commitment (X2) on Lactation Management Service (Y) Based on the research conducted, it was found that the contribution of motivation and commitment to lactation management services was P = 0.000.Which means that the two variables have a significant influence on lactation management services at RSIA ASIH Balikpapan.
The results of the description contained in the threebox model also show that the average value for the distribution of respondents from the motivation variable of nurses at ASIH Balikpapan Hospital is 70.56, which is in the high category.The highest index is on the indicators that must be achieved with the item "Never absent without clear reasons and work attendance is very important to me" which is 76.6 which is included in the high category, while the lowest index is on the indicator that must be achieved by the item "Achievement.my work is able to exceed the target "which is 57.8 which is included in the high category.While the average value for the distribution of respondents from the variable commitment of nurses ASIH RSIA Balikpapan is 71.07, which is in the high category.The highest index is on the indicators that should be achieved with the item "It is better now when people stay in one organization throughout their career and moving from one hospital to another seems unethical to me" which is 76.8 included in the category.high, while the lowest index is on the indicator that must be achieved with the item "I was educated to believe in the value of staying loyal to one hospital" which is 59 included in the high category.The average value for the distribution of respondents from the variable of lactation management services at RSIA ASIH Balikpapan is 72.28 which is in the High category.The highest index is on the indicator that must be achieved, the item "Vernix (white fat) should be cleaned because it makes the baby uncomfortable when breastfeeding early", which is 77.6 which is included in the high category, while the lowest index is on the indicator that the item "I can afford."provide counseling on how to breastfeed properly and correctly "which is 63.2 including in the high category.Threrbox results show all variables in the high category.but there are several dimensions of the variable that have a low index, the index with a low number is on the responsibility dimension.The responsibility of the sender is a factor for each individual to be able to carry out their duties properly in accordance with their field of work, even though the period is in the high category, but the responsibilities of health workers have not been carried out optimally.
According to Herzberg (1996) work motivation is a person's attitude towards their work in order to create a sense of satisfaction with their performance.Work motivation is the drive and desire that exists within humans to carry out their job duties properly.Motivation in carrying out tasks is considered very important, this is also accompanied by a commitment to carry out the tasks and responsibilities given, the commitment itself according to Meyer & Allen (1991) defines the degree to which workers identify themselves with the organization and their involvement in the organization.In relation to lactation management in hospitals, it requires motivation and commitment from nurses in carrying out their duties and responsibilities to be able to provide information and carry out lactation management which should be carried out by every new mother.Lactation management is the management needed to support the success of breastfeeding.Its implementation mainly starts during pregnancy, immediately after delivery and during the subsequent breastfeeding period (Directorate of Community Nutrition, 2005).Thus, lactation management is very important to do, with motivation and commitment from health workers in the hospital.
The theory describes the characteristics of each variable, which is based on the results of the study which states that the condition of midwives and nurses has high motivation and commitment to be able to run lactation management services in the hospital.According to the midwives and nurses themselves, they have the motivation and commitment to continue carrying out their duties and responsibilities.
This study is in line with the research conducted by "Khayati, N., Rachmawati, I.N., Nasution Y. ( 2013), which states that there is a significant relationship between motivation and hospital support for the implementation of lactation management in hospitals.In addition, Yunalis research (2009) states that work commitment and motivation have an influence on nurse performance.Lactation management itself is part of the hospital's services for patients.Hospitals are required to be able to provide good services and in accordance with SOPs to patients, and specifically in carrying out lactation management services, to breastfeeding mothers, this is important because it is in order to provide education to mothers about the importance of early breastfeeding.This study shows that there is a positive influence on the motivation and commitment of health workers in providing services to mothers who have just given birth.If health workers are able to carry out their duties properly, the services they want to achieve can be carried out in accordance with the SOP.
Based on the results obtained, which states that motivation and commitment have an influence on lactation management services, this shows that the importance of motivation and commitment of each midwife and nurse in carrying out their duties so that the services provided are in accordance with the standards expected by patients.In addition, the importance of implementing lactation management services is a benchmark in action to carry out services that should be.

The Effect of Motivation (X1) on Lactation Management Service (Y)
Based on the research conducted, it was found that the contribution of motivation to lactation management services was P = 0.000.Which means that the two variables have a significant influence on lactation management services at RSIA ASIH Balikpapan.The results of the description contained in the threebox model also show that the average value for the distribution of respondents from the motivation variable of nurses at ASIH Balikpapan Hospital is 70.56, which is in the high category.The highest index is on the indicators that must be achieved with the item "Never absent without clear reasons and work attendance is very important to me" which is 76.6 which is included in the high category, while the lowest index is on the indicator that must be achieved by the item "Achievement.my work is able to exceed the target "which is 57.8 which is included in the high category.The average value for the distribution of respondents from the variable of lactation management services at RSIA ASIH Balikpapan is 72.28 which is in the High category.The highest index is on the indicator that must be achieved, the item "Vernix (white fat) should be cleaned because it makes the baby uncomfortable when breastfeeding early", which is 77.6 which is included in the high category, while the lowest index is on the indicator that the item "I can afford.provide counseling on how to breastfeed properly and correctly "which is 63.2 including in the high category.
It should also be noted that even though the commitment of health workers is very good and able to carry out lactation management services, there are still things that need to be paid attention to that the threebox results have several different indexes, and there is still a low index even though it is in the high category, the statement "My work achievement.able to exceed the target "is at the lowest index, therefore from this statement we can conclude that with high commitment health workers only have a commitment to work with what they do, so that when given a higher target they are not able to carry it out.
According to Herzberg (1996) work motivation is a person's attitude towards their work in order to create a sense of satisfaction with their performance.Work motivation is the drive and desire that exists within humans to carry out their job duties properly.Motivation in carrying out tasks is considered very important, this is also accompanied by a commitment to carry out the assigned duties and responsibilities.Lactation management is the management needed to support the success of breastfeeding.Its implementation mainly starts during pregnancy, immediately after delivery and during the subsequent breastfeeding period (Directorate of Community Nutrition, 2005).Thus, lactation management is considered very important, with motivation from health workers in the hospital.
The theory describes the characteristics of each variable, which is based on the results of the study which states that the condition of midwives and nurses has high motivation to be able to run lactation management services in hospitals.According to the midwives and nurses themselves, they have the motivation to continue carrying out their duties and responsibilities in carrying out their duties.
This research is in line with research conducted by Yunalis (2009) which states that there is a positive and significant influence between work commitment and motivation with the performance of midwives in the village.Based on research which states that there is a significant influence between motivation on lactation management services, it is also supported by the threebox results which state that every midwife and nurse who has high motivation in carrying out lactation management services.
3. The Effect of Commitment (X2) on Lactation Management Service (Y) Based on the research conducted, it was found that the contribution of commitment to lactation management services was P = 0.000.Which means that the commitment variable has a significant influence on lactation management services at RSIA ASIH Balikpapan.
Based on the results of the descriptions outlined in the threebox model, it was also found that the average value for the distribution of respondents from the variable commitment of nurses at ASIH Balikpapan Hospital was 71.07, which was in the high category.The highest index is on the indicators that should be achieved with the item "It is better now when people stay in one organization throughout their career and moving from one hospital to another seems unethical to me" which is 76.8 included in the category high, while the lowest index is on the indicator that must be achieved with the item "I was taught to believe in the value of staying loyal to one hospital" which is 59 included in the high category.The average value for the distribution of respondents from the variable of lactation management services at RSIA ASIH Balikpapan is 72.28 which is in the High category.The highest index is on the indicator that must be achieved, the item "Vernix (white fat) should be cleaned because it makes the baby uncomfortable when breastfeeding early", which is 77.6 which is included in the high category, while the lowest index is on the indicator that the item "I can afford."provide counseling on how to breastfeed properly and correctly "which is 63.2 including in the high category.
According to Meyer & Allen (1991), defining is the degree to which workers identify themselves with the organization and their involvement in the organization.In relation to lactation management in hospitals, it requires motivation and commitment from nurses in carrying out their duties and responsibilities to be able to provide information and carry out lactation management which should be carried out by every new mother.Lactation management is the management needed to support the success of breastfeeding.Its implementation mainly starts during pregnancy, immediately after delivery and during the subsequent breastfeeding period (Directorate of Community Nutrition, 2005).Thus, lactation management is very important to do, with motivation and commitment from health workers in the hospital.
The theory describes the characteristics of each variable, which is based on the results of the study which states that the condition of midwives and nurses has a high commitment to be able to carry out lactation management services in the hospital.
According to the midwives and nurses themselves, they have a commitment to continue carrying out their duties and responsibilities in carrying out their duties.
This study is in line with the research conducted by "Khayati, N., Rachmawati, I.N., Nasution Y. ( 2013), which states that there is a significant relationship between motivation and hospital support for the implementation of lactation management in hospitals.
The results of the study state that commitment has a significant effect on lactation management services, where based on the threebox results it is found that midwives and nurses have high commitment, from the results are in the highest index which means midwives and nurses have a commitment to run lactation management services to patients, so that able to run according to standards.However, from each statement there are aspects that are still in a low index, "I was taught to believe in the value of staying loyal to one hospital" this statement explains that despite having high motivation, health workers have not been able to give an opinion about being loyal to a workplace maybe they also have the desire to work in another hospital.It should also be noted that the importance of paying attention to health workers in carrying out their duties, as well as providing special education about lactation management services, so that health workers can carry out their duties in accordance with the specified standards.