THE RELATIONSHIP OF KNOWLEDGE WITH NURSES' ATTITUDES IN DIGITAL DOCUMENTATION IN THE INPATIENT ROOM OF WEST INDONESIA PRIVATE HOSPITAL

World technology is now entering the era of the industrial revolution 4.0, this has an impact on advances in information and communication technology in the health sector. One of the impacts is that the nursing record system has changed from being manual to computerized. The purpose of this study was to identify the relationship between knowledge and attitudes of nurses in carrying out digital documentation in private hospitals in West Indonesia. This research method is correlated using a quantitative research design with a cross sectional approach with a sample of 113 respondents. The instrument used in this study was a questionnaire consisting of 40 questions via the Google form. Bivariate analysis was performed using Chi Square, with the result p value: 0.796. The conclusion of this study is that there is no relationship between knowledge and attitudes of nurses in digital nursing documentation. For future research, it is expected to be able to examine the factors that influence knowledge and attitudes, and to be able to examine the efficiency of digital nursing documentation.


INTRODUCTION
World technology is now entering the era of revolution 4.0, this has an impact on the advancement of information and communication technology in the health sector. Increasingly sophisticated technology leads to such rapid access to information around the world. This certainly also affects the advancement of health technology, especially in the field of nursing. One of the impacts is that the nursing record system, which was previously manual, shifted to computerization (Dewi et al., 2021).
Nursing records are a medium of communication, whether communication orally, in writing or through computers to convey client information or data related to nursing clinical decisions and interventions must be accurate and comprehensive (Potter et al., 2021).
One electronic-based nursing documentation system has been widely used, namely Electronic Medical Record (EMR). Updates in documentation become a reference for nurses to be able to do digital documentation properly and correctly. This demands the importance of implementing nursing documentation, therefore a good level of knowledge and attitude regarding digital documentation is needed.
In Indonesia, nurses' knowledge about documentation is still low, this is due to factors such as education, ability and skills as well as the use of information technology. Nurses in doing good nursing documentation, influenced by good knowledge and good attitudes as well. Research conducted by Khoirunisa & Fadilah, (2017) said there was a relationship between the level of nurses' knowledge about nursing documentation with nurses' attitudes in documenting nursing care in the inpatient room of RSUD dr. Loekmono Hadi Kudus. In the research of Fatmawati et al., (2021), it showed that 39.3% of respondents had good knowledge of the use of EMR, while in the study Hussein et al., (2021) it was found that there was no significant relationship between sociodemographic factors, such as age, education level, work experience, level of knowledge, and attitudes and electronic nursing documentation.
The implementation of the use of Electronic Medical Record (EMR) in the inpatient room of one of the West Indonesia Private Hospitals began to run from January 2022 as much as 63% to August 2022 as much as 91%. From this data, there was an increase in EMR usage from 63% to 91%. The increase means that almost all nurses have used EMR within 8 months. In a short time, nurses must change their work culture and work practices from paper to digital systems. The importance of a hospital maintaining the quality of documentation makes the role of nurses to be able to carry out digital documentation well. EMR systems can improve the quality of nursing care and practice, and can improve patient safety. Service to patients becomes more efficient and effective because data is stored systematically and well computerized.

RESEARCH METHODS
This research is a quantitativeresearch with Cross Sectional approach. The sampling technique used in the study was probability sampling. The sample in this study was all nurses in adult inpatient rooms, where the population in this study amounted to 138 adult inpatient nurses. Then researchers obtained 113 names of nurses who were respondents. Data collection will be carried out in April-May 2023. Each nurse selected as a sample was given Informed Consent for consent to participate in the study. Next, each nurse filled out a knowledge questionnaire and an attitude questionnaire towards digital nursing documentation. The research data were analyzed descriptively, namely to determine the picture of subjective characteristics (age, length of work, gender, and education). Bivariate analysis was conducted to determine the relationship between knowledge and nurses' attitudes in documenting digitally  Table 1 shows the distribution of age and length of work illustrating that of the 113 nurses, the average age of nurses in the study was 30.75 years with the youngest age 22 years and the oldest age 54 years. Researchers get a median value or middle value of 30 years and 29-32% CI (Confidence Interval for Mean). The average length of working for nurses in the study was 9.08 years with the length of time nurses who had just worked was 1 year and the longest length of work was 28 years Of the 113 nurses, the most gender characteristics were 106 women or 93.8%. And the majority of nurse education is Ners as much as 73.5%.  Table 2 shows that the majority of respondents have high knowledge about digital nursing documentation at 63% and low knowledge about digital nursing documentation at 37%. Table 3 Frequency Distribution of Nurses' Attitudes towards Digital Nursing Documentation Table 3 shows that the majority of respondents have a positive attitude of 68.14%, and some have a negative attitude of 31.85%.

RESULT AND DISCUSSION
Based on research shows that respondents who have high knowledge of digital nursing documentation as much as 63%. One of the factors affecting a person's level of knowledge is age, which is on average 30 years old. Age 22-54 is adulthood. Mubarak & Nycyk, (2017) argues that the older the age, the level of maturity and ability to receive information is better when compared With a younger age or not yet dewaasa. At the results of the study worked an average of 9 years. The longer someone works in an agency, the more experience and knowledge gained, and more rational thinking compared to someone with little work experience (Sepang et al., 2013).
In the results of the gender study, the majority of respondents were women. Wahyu et al., (2021) argues that this has similarities in the theory that the type of nurse is dominated by women, because of its history nursing emerged as a traditional care-taking role traditionally within the family and community (Rahmawati et al., 2022).
In the results of educational research, it was found that most respondents had NERS education, and a small number of S2 nursing. According to research conducted by Maryati & Nurlaela, (2021) the characteristic description of age, length of work, gender, and education has no relationship with the use of electronic nursing documentation (EMR) with a p-value of >0.05. Thus, old age or high educational attainment does not necessarily indicate that nurses are more knowledgeable about storing patient information in digital records.
The results showed that respondents who had high knowledge of digital documentation were 71 (63%) respondents. This is in line with research conducted by Utami, (2016) that the level of knowledge is influenced by educational factors. Dalami, (2011), argues that education affects the mindset of individuals. While the mindset affects one's behavior, in other words someone with a high education will have a high mindset as well.
The results showed that the majority of respondents had a positive attitude as many as 77 (68.14%) respondents, and respondents who had a negative attitude as many as 36 (31.85%) respondents. In research conducted by Sugiharto et al., (2022), it shows that attitudes towards the use of Electronic Medical Record (EMR ) have a significant effect on the use of EMR with p value = 0.000. According to Sartika et al., (2020), the factors that influence the formation of attitudes are strong experiences, the influence of others who are considered important, the influence of culture, mass media, educational institutions, and religious institutions, and the influence of emotional factors. In this study, nurses' attitudes are interpreted as a form of nurses' responsibilities in carrying out nursing documentation (Sartika et al., 2020).
In this study, no significant relationship was found between knowledge and attitudes in digital nursing documentation. This is in line with research conducted by Hussein et al., (2021) and Yontz et al., (2015), stating that most nurses have a high level of knowledge and a positive attitude towards electronic nursing documentation, and no significant relationship has been found between knowledge and attitudes towards nursing documentation. Today most nurses have used computers or other sophisticated equipment to assist in nursing services. Technology that is developing into part of nursing activities today, is included in documenting. This shows that digital nursing documentation can improve nurses' perceptions of digital nursing documentation programs.

CONCLUSION
Based on the results of the analysis that has been conducted by researchers in the study "The Relationship of Knowledge with Nurses' Attitudes in Digital Documentation in Inpatient Rooms of Private Hospitals in Western Indonesia" it can be concluded that the knowledge possessed by adult inpatient nurses in one private hospital in western Indonesia is high as many as 71 (63%) respondents. And the attitude of nurses who have a positive attitude as many as 77 (68.14%) respondents. Based on this analysis, high knowledge does not affect respondents' attitudes in conducting digital nursing documentation. Researchers concluded that there was no significant relationship between knowledge and attitudes in conducting digital nursing documentation with a p value: 0.796.