Association Between Family Support and Nurse Motivation in Managing Patients with COVID-19

: 10 Aug 2021 : 28 Nov 2021 : 21 Dec 2021 Abstract Background: Coronavirus (COVID19) is a world public health emergency. The coronavirus transmission is highly fast that health workers are at high risk of contracting COVID-19. It raises excessive anxiety for nurses when caring for COVID19 patients, so one way to help reduce the fears and worries nurses face is by providing support and motivation from their families. Purpose: This study aims to determine the relationship between family support and nurses’ motivation in caring for Patients with COVID19. Methods: The method used was correlational quantitative, involving 84 nurses caring for Patients with COVID19. Result: The results of the spearman rank test showed a p-value of 0,001 ≤ α 0,05, which indicated a relationship between family support and the motivation of nurses in caring for Patients with COVID19. Furthermore,the coefficient correlation (r = 0,362) had a low level of relationship with a positive direction of the relationship. Conclusion: It can be concluded that family support is very important in the psychological dimension by positively affecting nurses' work motivation.


INTRODUCTION
Coronaviruses are a group of viruses that cause disease in humans and animals. It usually causes respiratory tract infections in humans, ranging from the common cold to serious illnesses such as Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). Since its outbreak in Wuhan, China, the novel coronavirus was found in humans in the past December 2019, which was later known as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) and then led to Coronavirus Disease-2019 (COVID-19) (Xu et al., 2021).
The World Health Organization (WHO) has declared a Public Health Emergency of International Concern (PHEIC) status. As of Jan14st, 2022, the total confirmed cases were nearly five million, with around 350thousand deaths (CFR 6.1%) across 226infected countries (WHO and PHEOC, 2022 Several studies have found that COVID-19 is transmitted through close contact with an infected human and human droplets or by a medical procedure that produces aerosol formation (such as bronchoscopy, nebulization, etc.), leading to airborne transmission. Due to the long contact time with COVID-19 patients, the health workers have the highest risk of being infected by the virus. China's National Health Commission reported at least 1.716 cases where the health workers in the country were infected with COVID-19, with 80% experiencing mild symptoms. If efforts to prevent the spread of COVID-19 are not addressed immediately, the trends will likely rise (Nahidi et al., 2022).
Nurses are one of the front-line health workers at high risk of being infected with COVID-19 due to direct contact with patients. In some health facilities, they can be 24-hour contact with the patients. The risk of being infected makes nurses stay in the hospital for fear of transmitting the disease to their families. Therefore, nurses do not have the opportunity to meet and gather with their family members. It is one of the factors causing them to no longer want to work in the COVID-19 patient care room (Ali et al., 2020). Nurses' nursing care to COVID-19 patients generally has no difference from other infectious diseases. The only difference is in the use of personal protective equipment (PPE) (Awano et al., 2020). It is in line with the study conducted by Fadli et al. (2020), revealingthat the availability of personal protective equipment had a 51.7% influence on the anxiety of health workers in efforts to prevent COVID-19. It will greatly affect the motivation of nurses in treating patients with Covid-19.
In 2020, Petrin, R.L., conducted a study on health workers at the RSCM, Jakarta and found that respondents were highly concerned about the possibility of being infected by the coronavirus. Excessive anxiety led to poor immunity, making it easy to get ill. Similar statements were obtained from an interview conducted in RSUD Prof.Dr. W.Z. Johannes, Kupang, NTT involving five nurses from the hospital. Generally, the nurses were saddened and uncomfortable with their taskdue to the fear of being infected or even spreading the infection to other family members. Furthermore, the nurse's family refused when assigned to the COVID-19 team. Moreover, the nurses experienced social isolation where the family members avoided getting in contact. For instance, when they were quarantined, the family would only deliver drinks, clothes, and other necessities if requested. They also thought that if COVID-19 infected a family member, they were the ones who transmitted it due to their duties (Galanis et al., 2021;Galehdar et al., 2021).
In this case, family support is essential to reduce the burden faced by the nurses to make them feel calm, recognized, loved, and increase self-confidence andcompetence. Socially supportive relationships help a person improve stress management and overall health (Kuo et al., 2020). In dealing with stressful situations, a person with family support performs better in handling stress than those who lack family support. In addition, family support effectively increases nurses' motivationto care for COVID-19 patients (Balay-odao et al., 2021).
Motivation triggers someone's heart to do or achieve a goal (Pai et al., 2020). The motivation makes nurses feel that they can achieve the desired goals and have higher responsibilities in carrying out the tasks. In other words, a nurse's motivation is a process to achieve goals to provide the optimum nursing care in the management of COVID-19 patients. A motivated nurse means that they have the strength to face all the challenges given, including fighting the COVID-19 and having the courage to leave their family and loved ones to provide the best nursing care for patients. However, there is still no research on family support on the motivation of nurses in caring for patients with COVID-19. Therefore,this study aims to identify how strong the relationship between family support and the motivation of nurses in treating COVID-19 patients is.

METHODS
This research is quantitative with a correlational analytic approach and a cross-sectional approach. The sample of this study was 86 respondents who were calculated based on the Slovin formula from 106 populations. The sampling technique used was purposive sampling with the inclusion criteria of nurses in charge of treating COVID-19 patients. The instrument used in this study was adopted from previous researchers, and each question item in the questionnaire had been tested for validity and reliability. The results of the validity test of the

NURSING PRACTICES
family support questionnaire obtained 2 invalid question items, and the questions were removed from the questionnaire; thus, a total of 18 questions were asked. Meanwhile, the nurse motivation questionnaire contained 4 invalid questions, and they were removed from the questionnaire; thus, the total questions were 27. Furthermore, Cronbach's alpha reliability test results were 0.919. It can be concluded that the family support questionnaire and the motivation of nurses were reliable. The instrument in data collection used a Likert scale, including a statement of family support consisting of 4 points, namely assessment support, instrumental support, information support and emotional support. Meanwhile, a motivational questionnaire consisted of physiological needs, security, social needs, self-esteem, and actualization. This research has been declared to have passed the ethical feasibility at the University of Nusa CendanaKupang with registration number UN02210213. This research was conducted at Prof. Hospital. Dr. W. Z. Johannes Kupang. The data collection was carried out directly or face to face by the researcher using a questionnaire. The results of univariate data analysis in frequency distributions and presentations are presented in tables and then interpreted. The bivariate data analysis used SPSS 23 Spearman Rho computer to determine whether there was a relationship between family support and nurse motivation.

RESULT General Data
(see table 1) The table above shows that of the 84 respondents at Prof W.Z. Johannes Kupang, the highest number was in the age range of 26-35 years, namely 45 respondents (53.6%). The youngest respondent was 24 years, and the oldest respondent was 54 years. Most of them were female,with a total of 63 respondents (75.0%). 49 respondents (58.3%) had completed their Diploma III of Nursing education,and most of them had more than 10 years of service,with a total of 48 respondents (57.1%).

Family Support
(see table 2) Table 2 shows that out of 84 respondents at RSUD, Prof W.Z. Johannes Kupangmostly had good family support,with a total of 64 respondents (76.2%).

Nurse Motivation
(see table 3) Table 3 shows that out of 84 respondents at RSUD, Prof W.Z. Johannes Kupang mostly had an average motivation, with a total of 43 respondents (51.2%).

Correlation analysis between family support and nurse motivation in managing COVID-19 patients in RSUD. Prof.Dr. W. Z. Johannes, Kupang
(see table 4) Table 4 shows that the results of hypothesis testing using Spearman-rank-test derived a significance of 0.001, lower than the set limit of 0.05. Thus, H1 was accepted (0.001 < 0.05). It indicated an association between family support and nurse motivation in caring for patients with COVID19 in RSUD. Prof.Dr. W. Z. Johannes, Kupang. Based on the significance of the Spearman Rank test, the above result showed a correlation score of 0.362, indicating a low association between family support and nurse motivation.

Family Support
Based on a study conducted on 84 nurse participants caring for Patients with COVID-19, 76.2% or 64 participants had good family support. In contrast to research by Rahayu et al. (2019), there is no relationship between family support and nurses' motivation to work and continue nursing education. However, in terms of the high motivation of nurses, if it is not balanced with adequate support from the family, the process of nursing professionalism also cannot run well.
According to (Thai et al., 2021), family support is defined as attitude and behavior of acceptance fromthe family, including informational evaluation, instrumental and emotional support. Thus, it can be concluded that family support is a type of interpersonal relationshipthat includes attitude, behavior, and acceptance of a family member. Social support from family refers to social supports accessible or expressed by their family, who will always help and support if needed (Erdiana, 2015).
The author assumed family is a source of good, correct, and calming information. In this case, the family supports nurses in all situations, either by giving support in information, emotional support, instrumental support, and appreciation. The objective of this support for nurses caring for patients with COVID-19 is to counter the negative effect of stress on their health (Santos, 2020). Family support has a strong external motivational influence for nurses to continue providing comprehensive care for COVID-19 patients. Furthermore, optimum family support is an asset for nurses to survive this pandemic situation.

Nurse Motivation
According to a study conducted on 84 nurse participants who managed for Patients with COVID-19, 51.2% or 43 participants have adequatenurse motivation. In other words, the higher the motivation of nurses is, the better the performance of nurses will be. It is in line with the research results by Miladiyah, Mustikasari, and Gayatri (2015), revealing a relationship between motivation and nurse performance. Nurses who have good work motivation during the COVID-19 pandemic are frequently associated with the use of appropriate Personal Protective Equipment (PPE) to avoid transmission of COVID-19. The majority of nurses who have good motivation show compliance in PPE use (Kustriyani et al., 2018). In nursing services, COVID-19 patients have a high risk of transmission. The availability of personal protective equipment when performing nursing services highly motivatesthe nurses. Moreover, support from family and coworkers is considered a guarantee of assistance provided by the organization when carrying out a job effectively and overcoming stressful situations (Brewer & Miller, 1996in Almasitoh, 2011. A report conducted by Yanti, et al (2019) derived a correlation between nurse motivation and compliance to wash hands. The higher their motivation is, the more they are willing to comply with hand washing. Itis beneficial, especially during the COVID-19 pandemic, which focuses on hand washing practice to prevent coronavirus transmission (Demirtaş-Madran, 2020).
Furthermore, motivation is a strength that pushes someone to do or not do any behavior,either internally or externally, positive or negative. To guide it, people need strong guidance. Motivation is the level of desire of an individual to do or support the organization's goal. Motivation to work is an internal process in someone's acceptance of a clear stimulus from their environment combined with internal condition (Dagne et al., 2015).
Motivation to work is affected by several factors, either negatively or positively. Those factors are a combination of energy that comes from within and outside oneself. This energy is used to behave in the working environment and determine the form, direction, intensity, and duration (Yanti et al., 2020).

The Association between Family Support and Nurse Motivation in Managing COVID-19 Patients
Based on the hypothetic test with the Spearmanranktest, the author derived a significance of 0.001, lower than the set limit of 0.05. Thus, H1 was accepted (0.001 < 0.05). It showedan association between family support and nurse motivation in caring for patients with COVID-19 in RSUD. Prof.Dr. W. Z. Johannes, Kupang. The above result showed a correlation score of 0.362, indicating that the relationship was low.
Besides, support is an effort made by other external parties, both morally and materially. Support can be given from family or colleagues. However, family support is considered the most effective support as family is the core people among others (Pai et al., 2020). This coronavirus pandemic brings about the most appropriate times to support each other. Family support is essential in each important step and crisis in life. Many people withdraw as they do not know how to support other people. Family support during this crisis is critical inincreasing nurse NURSING PRACTICES motivation in caring for Patients with COVID-19 (Ali et al., 2020).
Forms of family support during a pandemic can be appraisal support to solve a problem and ease stress. For instance, the family can listen to the nurse who cares for Patients with COVID-19, give tangible support, help in solving problems or difficulties, including providing food, mask, or medical necessities needed by the nurse, give selfesteem support in terms of thinking positively, and give belonging support such as in the form of acceptance in a social or group. In terms of the social aspect, it can be in theform of not isolating the nurse or the patient when they are ill (Xu et al., 2021) Social support from family in this pandemic era is essential psychologically. The positive effect of family support is giving confidence, comfort, life goals and safety (Vanchapo et al.,2019). Social support can lower various kinds of stress, increase coping mechanisms, and increase the quality of life and motivation (Thai et al., 2021).
Furthermore, in terms of the research limitations, this research was conducted in the midst of the COVID-19 pandemic. Therefore, the process of observing and filling out questionnaires cannot be carried outoptimallydue to hospital policies and social distancing implementation.