138 JNK JURNAL NERS DAN KEBIDANAN (JOURNAL OF NERS AND MIDWIFERY) http://jnk.phb.ac.id/index.php/jnk Nurse Self-Management Experience as a Covid-19 Vaccinator Dian Mitra D.S1, Achir Yani S Hamid2, Syamsul Firdaus3 1,2,3Faculty of Nursing and Health Sciences, Universitas Muhammadiyah Banjarmasin, Indonesia Article Information Abstract Changes in work patterns during a pandemic will certainly impact changes in the work habits of nurses who must be able to adapt to any work situation in the field, especially for nurses vaccinated with the COVID-19 vaccine. More than 11 billion people in the world have received a dose of the Covid-19 vaccine. Data for receiving the Covid-19 vaccine in Indonesia is 208,265,720 people. Achievements in the implementation of Vaccination in Palangka Raya City reached 223,414 people with the first phase vaccine distribution of 264,173 people, the second phase amounted to 228,457 people, and the third phase vaccine reached 88,282 people. Amost 80% of nurses experienced mental health problems, namely stress during the COVID-19 pandemic. The increased workload can affect the physical and psychological health of nurses. Based on the analysis of the data, the nurse's self-management ability is needed to deal with any job demands or workload that is obtained while being a Covid-19 Vaccinator. This study aimed to explore self-management experiences among nurses as COVID-19 vaccine providers. The study used a qualitative research method with a phenomenological approach with in-depth interviews with 11 participants who served in five areas of the city of Palangka Raya and were selected based on purposive sampling inclusion criteria. The results of qualitative analysis of thematic data using the Colaizzi technique found seven themes, four of which were very relevant to self-management, namely: 1) Professional Attitude in Discrediting Tasks; 2) Coping Strategy; 3) Job Satisfaction and Altruism; 4) Teamwork Atmosphere; and three additional themes, namely: 5) Factors that cause work stress; 6) Workload of Nurses as Stressors; and 7) Holistic Response experienced by Vaccination. History Article: Received, 07/02/2022 Accepted, 04/04/2023 Published, 30/04/2023 Keywords: self-management, covid-19 vaccine vaccination, nurse © 2023 Journal of Ners and Midwifery Correspondence Address: Universitas Muhammadiyah Banjarmasin – South Kalimantan, Indonesia P-ISSN : 2355-052X Email: diansilalahi86@gmail.com E-ISSN : 2548-3811 DOI: https://doi.org/10.26699/jnk.v10i1.ART.p138-143 This is an Open Access article under the CC BY-SA license (http://creativecommons.org/licenses/by-sa/4.0/) http://jnk.phb.ac.id/index.php/jnk mailto:diansilalahi86@gmail.com https://doi.org/10.26699/jnk.v10i1.ART.p138-143 Mitra D.S, Hamid, Firdaus, Nurse Self-Management Experience as a Covid-19 Vaccinator … 139 INTRODUCTION Corona Virus Disease 2019 was the first to spread in the city of Wuhan, China at the end of 2019 (Okada Pilailuk, 2020). This virus has spread so massively that almost all countries have reported finding cases of Covid-19, including Indonesia, where the first case occurred in early March 2020. More than 450 million cases Based on data from the Task Force for Handling Covid-19, the United Central Executive Board As of June 5, 2022, there were 9,725 confirmed nurses for Covid-19, 510 suspects, 1,656 close contacts, 228 probable, 4,503 recovered and 717 died. The development of a safe and effective Covid-19 vaccine is an important step in the global effort to end the pandemic by realizing Herd immunity so that people can return to their normal activities (Elisabeth Barnby, Mark Reynolds, & Jenny Gordon, 2021). More than 11 billion people in the world have received a dose of the Covid-19 vaccine. The Covid-19 vaccine program in Indonesia began on January 13 2021 with the issuance of the Decree of the Minister of Health of the Republic of Indonesia No. HK. 01.07/Menkes/4638/2021 concerning Technical Guidelines for the Implementation of Vaccination in the Context of Mitigating the 2019 Corona Virus Disease (Covid-19) Pandemic, the scope of which is planning needs, targets, funding, distribution, and management of vaccines and logistics, implementation of services, cooperation, recording and reporting, communication strategy, monitoring and management of Adverse Events after COVID-19 Vaccination, as well as monitoring and evaluation. At the beginning of the implementation, many challenges were faced by health workers who also played a role in educating the public to trust the government's vaccine program. In the mass vaccination program in the early stages of implementation, nurses experienced an increase in workload while serving as vaccinators. According to a survey (ICN, 2020), almost 80% of nurses experienced mental health problems, namely stress during the Covid-19 pandemic due to workload and work situations. When on duty, nurses get a workload that exceeds their abilities, so they cannot fulfill or complete it, which results in work stress for nurses (Musdalifah & Dirdjo, 2021). (Mulfiyanti, Muis, & Rivai, 2018) said work stress is a tension that causes physical and psychological imbalances, thought processes, and emotions as well as the condition of an employee. According to (Wijaya C., 2017) there are several factors that can cause work stress, namely the physical environment, role conflicts, multiple roles, workload, task characteristics, and causes of interpersonal and organizational stress. This is in line with (Budiyanto, 2019) in his research which said that most sources of stress are due to the workload of nurses, patient care problems, conflicts with other staff, and career development. According to (Rahman, Susilo, & Dewantoro, 2022) self-management is a procedure in which individuals regulate their own behavior to plan, focus attention, and evaluate the activities carried out, in which there is psychological strength that gives direction to individuals to make decisions and determine their choices and determine effective ways to achieve goals but still do not violate ethical principles to prioritize the interests of vaccine recipients and every decision and action taken does not harm them. If nurses have low self-management skills regarding the workload they get, the negative impact that has the potential to occur is increased stress levels. Increased stress levels can reduce the productivity and performance of nurses. This condition can be dangerous and threaten the safety of vaccine recipients. Self-management is one aspect that supports motivation so that someone will continue to work. There are facts in the field that show that nurses have not been able to demonstrate good self- management in dealing with work stress due to the increased workload for nurses. Based on this phenomenon, researchers feel the need to dig in-depth and comprehensively using a qualitative study with a phenomenological approach regarding the experience of self-management of nurses as Covid-19 Vaccinators at the Palangkaraya city health center. METHODS This study used a qualitative research method with a phenomenological approach that aimed to explore existing phenomena so that an overall picture is obtained of how the Nurse's Self-Management Experience as a Covid-19 Vaccinator is obtained. Participants in this study were selected using purposive sampling, with eleven participants who met the research inclusion criteria including having training certification as a vaccinator, being a vaccinator nurse who served for one year, having good communication skills, being willing to share 140 Journal of Ners and Midwifery, Volume 10, Issue 1, April 2023, page 138-143 their experiences, having program holders/no, family status/ Not married, varies in age and serves in five areas of the city of Palangka Raya. The research was conducted on November 7 – December 12 2022 using in-depth interviews and the results of thematic analysis of qualitative data were carried out using the Colaizzi technique, namely collecting data from interviews in the form of primary data and secondary data. The second stage was reading the verbatim transcript repeatedly so that the researcher found the meaning of the data that was significant. The third stage was determining the categories. The last stage was writing a research report. RESULTS The results of this study were presented in two parts, namely general information about the characteristics of the participants according to the demographic data of the participants and a description of the results of the research which presented the themes that emerged from the research obtained from the participant's point of view about the self- management experience of nurses as co-19 Vaccinators. The participants in this study were nurses who served as vaccinators for the Covid-19 vaccine in five puskesmas in the working area of the Palangka Raya City Health Service with a total of 11 people, consisting of 2 male participants and 9 female participants. The age of the participants varied with the youngest being 35 years and the oldest being 51 years. Each participant is given a code that describes the serial number of the researcher, where P1 and up to P11 are used. This research was conducted using in-depth interviews and saturation was obtained from 10 participants. In order to ensure data saturation and increase data variation, the researcher added one participant, namely P11. Based on the results of data analysis from 11 participants through in-depth interviews in this qualitative study, the researchers concluded that there were several themes obtained. The themes are Professional Attitude in Carrying Out Duties, Coping Strategies, Job Satisfaction and Altruism, Teamwork Atmosphere, Factors that cause stress at work, Nurse's Workload as a Stressor, Holistic Responses Experienced by Vaccinations DISCUSSION 1) Characteristics of Participants The characteristics of the eleven participants in this study were quite diverse, ranging from differences in age, education level, length of work, gender, and position/skill. Based on the results of interviews, researchers assume that age, length of work, and gender are factors that influence individual abilities in self-management. The self-management ability possessed by each individual is different. Based on research (Anjarsari & Sofiani, 2019) says that one of the factors that influence self-management is physical and psychological health. The results of the study, participants aged > 40 years with work experience > 20 years responded to problems calmly and wiser in making decisions while on duty, although they still felt stress due to workload, participants had minimal stress levels by expressing passive assessment as a coping strategy to deal with stress. According to (Sunar, 2012) in his research said that there is an influence of biological factors, namely gender, on employee productivity. There were two male participants and nine female participants. Male participants tend to show relaxed behavior and emotional characteristics towards pressures and problems while on duty, in contrast to female participants who tend to get stressed more quickly and change their mood when facing problems. 2) Professional attitude in carrying out duties as a Covid-19 Vaccinator. According to research (Nengsih, 2022) explaining the quality of nursing services in guaranteeing and providing nursing care requires a professional attitude. The results of the study showed that the responses from all participants showed a professional attitude towards the task given as a co- 19 vaccinator. Participants have a sense of responsibility for setting goals (goal setting) and completing assignments, even though participants get additional overtime and high workloads, it is not uncommon for Covid-19 vaccinators to receive verbally unpleasant treatment from society and a discrepancy between workload and rewards received, participants will continue to carry out their duties as a co-19 vaccinator wholeheartedly in accordance with predetermined standard operating procedures. 3) Coping Strategy According to (Batbual, 2021) said several aspects of self-management abilities, namely one of them is self-control, individuals who have the ability to control themselves will be able to manage destructive emotions and impulses effectively. Individuals who have this ability will be able to manage well the various impulses and emotions that suppress the individual. Nurses need coping strategies as a way to control themselves against the stressors they face while working. The coping strategies used can help nurses reduce anxiety and psychological Mitra D.S, Hamid, Firdaus, Nurse Self-Management Experience as a Covid-19 Vaccinator … 141 impact. In the participants who were interviewed, participants revealed that coping with work stress was done by responding to stress by carrying out positive activities such as exercising and eating healthy foods. In addition, the most important thing for participants to overcome stress is to get support from their nuclear family, participants said that while on duty, the nuclear family played the most role in helping with all activities that they could not handle. 4) Job Satisfaction and Altruism According to (Wijaya C., 2017) job satisfaction can be defined as a positive feeling about work which is the result of an evaluation of its characteristics. Participants in this study also said that the job satisfaction felt by participants was due to several things including satisfaction with the honorarium received, a sense of pride in being able to play a role in the co-19 vaccine program and the awards received. Participants thought that the additional honorarium made them feel grateful because the honorarium was outside of the monthly salary they received. Participants said that their sincerity in helping the community at that time was really based on a sense of concern for recovering quickly from the pandemic situation when viewed from the workload accepted and the job demands of the participants said they could not. However, because of a belief in and responsibility for the task, as well as positive reinforcement, the participants continue to serve the community and have a sense of satisfaction with the tasks performed. 5) Working atmosphere of the vaccinator nurse team One aspect of self-management is how to manage relationships among individuals. Close dependence on fellow individuals makes a constant strength, this is what is needed in maintaining teamwork to create a comfortable working atmosphere. The results of this study found that the working atmosphere between individuals in the team is still well established, a comfortable work environment atmosphere can coordinate in the division and implementation of tasks to run smoothly. Not a few participants also said that misunderstandings could still occur between team members and other Puskesmas members regarding the distribution of honorarium and workload that was not evenly distributed, but this was commonplace, considering the situation while on duty as a co-19 vaccinator, all teams had their own stress levels. -each of which ended up triggering problems within the team. Related to this problem, participants used self- management techniques, namely mastery of stimuli (Stimulus Control) to be able to modify the work environment so that existing problems can be resolved. 6) Factors Causing Work Stress in Nurses Vaccinating Covid-19 Vaccines According to Badri (2020), there is a demand for professional ideal nurses who experience stress every day due to role conflicts with co-workers, discrimination, high workload, and dealing with patients and the patient's family. Stress in the work environment is unavoidable, but work stress can be reduced or managed. This requires individual skills or expertise to manage themselves, if work stress is managed properly, it can be a driving force and increase work intensity, whereas if it is not managed properly work stress will cause problems that have a negative impact on individuals, vaccine recipients, and the workplace. 7) Workload of Covid-19 Vaccine Vaccination Nurses According to (Damayanti, 2019) said that managing and managing time as well as possible is very important in self-management, this is to achieve goals and objectives so that they can work efficiently and effectively. The results of this study indicate an increase in workload because some participants are not able to manage time well. The existence of unfinished tasks in the work environment requires participants to continue their work at home, which results in additional time to complete the existing tasks. Participants need to use self-management techniques, namely Self-Monitoring to observe and record everything about themselves in interacting with the environment and apply Self Contracting self- management techniques so that they can control the causes of problems that result in consequences with an increased workload. 8) The Holistic Response Experienced by Nurses who Vaccinate the Covid-19 Vaccine The results of research from (Almomani, et al., 2022) said that at the beginning of the pandemic, nurses experienced many challenges which resulted in a lack of certainty, psychological and physical stress, and social stigmatization. According to (Batbual, 2021) says that there are four aspects that a 142 Journal of Ners and Midwifery, Volume 10, Issue 1, April 2023, page 138-143 person must have in order to be able to maintain, maintain, and manage himself, one of which is the health aspect, physical and psychological conditions that can influence a person in directing activities. Several participants in this study also said the impact of work stress experienced when carrying out their duties as a vaccinator, namely feeling physical complaints such as fatigue, headaches, decreased immune system, and other symptoms of illness. In addition, some participants also felt psychological responses from the impact of work stress such as emotions, fear, anxiety, and worry. Health is a factor that influences one's self-management. CONCLUSION Based on the results of the study, four themes were found that were relevant to the self-management of nurses as Covid-19 Vaccinators, namely a professional attitude in carrying out tasks, coping strategies, job satisfaction and altruism, and a teamwork atmosphere. The researcher concluded that these four themes were the integration of aspects of self-management. In addition to the four themes related to self-management of vaccinating nurses, the researchers also determined three additional themes, namely factors causing stress, workload, and holistic responses. These three additional themes were trigger factors and responses that were obtained when participants lack the ability to manage themselves well. SUGGESTION Suggestions from this study is given to service management at the Puskesmas to consider and pay attention to every workload that nurses have so that nurses no longer have excessive workloads. In addition, leaders pay attention to the development of their employees by holding training that builds better human resources in puskesmas and provides nurses with what is rightfully theirs. For the development of nursing science, further research should be carried out regarding the themes that have been obtained in this study in various variables. ACKNOWLEDGEMENT We would like to acknowledge the nurses as Covid-19 Vaccinators who take part in this research. FUNDING STIKes Eka Harap Foundation as my place of work is the main funder of this research. CONFLICTS OF INTEREST There are no conflicts of interest to declare in this study. AUTHOR CONTRIBUTIONS The main researcher plays a role in preparing proposals, collecting data, and reporting results. Other researchers play a role in data analysis, preparation of study results, and assisting the main researcher in preparing the final report. REFERENCES Almomani, M. H., Khater, W. A., Akhu-Zaheya, L. M., Alloubani, A., AlAshram, S. A., Azab, M., & Al-Malawi, A. K. (2022). Nurses’ Experience of Caring for Patients with Covid-19: A Qualitative Study. journals.sagepub.com, 1-7. doi:10.1177/21582440221144982. Badri, I. A. (2020). HUBUNGAN BEBAN KERJA DAN LINGKUNGAN KERJA. Jurnal Human Care e-ISSN:2528-66510; Volume 5; No.1(February 2020):379-390, 1-12. Batbual, B. (2021). 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