OUTCOME PRESENT TEST METHOD (OPT) IMPROVE THE SATISFACTION OF CLINICAL REASONING STUDENT PROFESSION IN MEDICAL NURSING SURGERY STAGE (Outcome Present Test Method (OPT) Meningkatkan Kepuasan Dalam Penalaran Klinik

Introduction: Nursing clinical education is an instrument in improving the clinical reasoning skills of students. One of learning models of clinical reasoning that is used to improve clinical reasoning skills in nursing education is the Outcome-Present Test Model (OPT). OPT is a nursing process model that is designed to develop the skills of learners’ clinical reasoning and the focus of the model are the results (outcomes) and thinking behind (backward) to change the client from his health status at this time (the present state) to the desired state (outcome). In other words, a very simple model that consists of only 1 (one) page makes the learning improving clinical reasoning skills more easily and reduce the element of copy and paste in the documentation. While peer learning is an eff ective strategy to address the problem in which the students will be divided into several groups of 2-3 students. Methode: To obtain the result, this learning model uses research development method with the respondents 10 clinics and institutions preceptor and 30 students who practice in medical, surgical nursing state. Result: The research results show the level of student satisfaction after using Outcome-Present Test (OPT)-peer learning for 4 weeks, it aff ected with the value of α: 0,001. Conclusion: By using this model, not just a clinical reasoning that they get, but they also will understand about how to use the diagnosis of NANDA, NIC, and NOC. The next suggestion, this model can be a format in clinical learning in other departments


INTRODUCTION
Learning in the professional nurses are learning at this stage of clinical education is learning that focuses on direct engagement with patients and a wide variety of problems. In this environment, students learn to be a real nurse. A wide variety of skills like history taking, physical examination, communication with the patient, and very precise professionalism studied and trained at this educational stage. Knowledge of nursing science can be applied directly to provide care to patients so that students are motivated to teach (Siegel et al. 2007).
The fact the hospital, clinic guidance does not match the expectations of students due to some problems in the implementation of such guidance clinic; clinical instructor has double duty in addition to conducting clinical guidance. Coaching clinics do not have enough time to implement the guidance, not provided an adequate tool to implement nursing actions, lack of information on the academic part, do not understand the purpose of learning the clinic, do not have a special room for counseling or discussion, tend to use the old style in guiding curriculum instructor training clinics give less equipped to undertake coaching clinics, lack of interest in becoming a clinical instructor. While some of the problems faced by the students are the lack of motivation to learn and the high stress in a program of professional nurses, especially in medical-surgical nursing states for SKS greater burden.
Student of profession nurses Stikes Mandala Waluya sometimes complains of clinical learning models that they get in each field of practice, especially if they are doing clinical practice in hospitals in Southeast Sulawesi. Although some of the clinical instructors have conducted training preceptor, they have not been able to implement and even puzzled to implement. So that the expected results of the academic that nursing students have the ability to provide nursing care in the short term and the long term is not achieved with the maximum. This can be corrected through some effort, which is to improve the learning process of the clinic, the hospital environment, improve clinical instructor and increase student involvement in clinical learning.
Repairs to all the components is a big job and give a long time, so in this study was limited to efforts to improve the clinical learning process, such as the development of clinical teaching model to achieve competence in hospital nursing care in the medical-surgical course.

The Specifi c Objective
The specific objectives of this research are: 1. Knowing picture learning model hospital clinics used in a clinical learning process especially medical-surgical nursing course at this time. 2. Finding the clinical learning development model that is used in the process of learning a special clinic medical-surgical nursing courses. 3. Testing the quality of clinical teaching model in hospitals result of the development, especially in the subject of medical-surgical nursing.

Urgency Research
Selection of research problems is done by two considerations. The first development of clinical teaching model of choice because it is considered necessary to the development of clinical learning models that can improve the quality of clinical learning in accordance with the real situation in the hospital that performed at the time of the survey. The second output is expected that the nurse is able to take decisions effectively, quickly and precisely in treating patients. So that it can train students' critical thinking skills when facing cases experienced by the patient under management during clinical practice. Clinical Reasoning is an essential component in nursing practice. In the face of the needs of the service system is complex and dynamic, requires nursing practice nurses who are able to think and make decisions effectively. Hopefully, with OPT-peer learning methods can be overcome faced by nurses and professional program participants the program manager for this study.

Study Library
Clinical learning as a behaviorist learning, the learning means behavioral development. The process of behavioral development is affected by two aspects namely cognitive and environmental aspects. In the process of behavior formation occurs observational learning from what is seen and observed, resulting in attention, retention, production, and motivation to do a new behavior. Model behavior that students are found in the order of the clinic will be adopted and adapted, so behavior in providing nursing care services in the future later. Which should be a clinical learning is a hospital that can provide exemplary in providing nursing care so that the behavior model that is adopted provide quality nursing care. Level achievement of clinical competence is divided into four levels, namely knows, knows how, shows how and does (Miller 1990). At the level knows, such as the ability to recall facts, principles, and theories. The level knows how is the form of the ability to solve problems and describe the procedure. The level shows how typically have involved a patient simulation, a computer simulation which has been able to do a demonstration of skills in standardized situations. The level does have observations on actual patients, who have been able to perform the protocol, to apply the principles in familiar situations, adapting the principles to new situations and new links between knowledge and principles that have been studied previously.
Paul, Lisa, and Vanessa (2006) in Sukmadinata stated that peer learning is one method of learning in which students will be assisted by teacher or friend who has the same level of learning a concept or the capabilities (skills).
As disclosed in some of the results showed that the peer learning provides a significant inf luence on student learning outcomes. This is in line with the theory of Slavin (1991) that the peer learning is a form of cooperative learning that can be used to improve student learning outcomes.
It can be caused due to the application of peer learning on learning allows each student gets more attention than Preceptor and have plenty of time in talking or listening. This gives students the opportunity to participate actively in building knowledge. This approach usually focused on solving the problem, and this is very effective to enhance creativity, execution of experiments, problem-solving abilities, and learning difficult concepts.

Preliminary studies
Preliminary study is the first step of development, at this stage, there are three steps namely literature study, field survey, and preparation of the initial product. Literature study aimed to learn the concepts or theories relating to the products to be developed; field surveys to collect data to support the product; based on the concepts and theories and field survey data, the design of the models can be developed.
A field survey in this study was conducted to describe the learning process in hospital clinics. The survey was conducted two stages. The first stage in the clinical instructor and the institution and the second stage to professional students and nurses of Mandala Waluya who do stage services in medicalsurgical nursing at the hospital Southeast Sulawesi Province.
The first stage of the survey with a common objective to determine the department of nursing faculty votes STIKES Mandala Waluya on the implementation of clinical learning of nursing at the hospital. There are three specific objectives, namely: to know votes against the implementation of clinical learning faculty of nursing at the hospital; the problem that is felt by the lecturer in clinical learning in hospitals and suggestions for improvement the clinical learning in the hospital. The sample of the research is 10 lecturers of study program as a preceptor of the institution and 10 clinic supervisors' clinic preceptor. The survey was conducted on the 1 st until 5 th April 2016. Descriptive study with quantitative data processing techniques. A second survey on the implementation of clinical learning at the hospital to achieve competence in the nursing care professional students and nurses STIKES Mandala Waluya Kendari is to obtain an overview of the characteristics of student nurses; clinical learning process, clinical learning content and clinical learning outcomes. The survey was conducted for 30 students while in the stage of surgical departments spread across in two hospitals in Southeast Sulawesi. The survey was conducted for 5 days starting on 6-10april 2016.
Based on the results of the survey of Preceptor institutions and clinics are founded apply any kind of clinical learning pattern that is conditioned in guiding the student nurses: still using the old pattern. On average they find out some clinical learning models but not applied because the format is not understood as well as a high workload so that the application of clinical learning they know that it is not applied. From the results of student surveys are temporary agency nurses in medical-surgical stages acquired them confused with the pattern of a given task, supervisor implements the writing task so that the orientation of students complete a task in terms of feedback from the supervising institutions and clinics still felt lacking. Based on the survey and study of literature then formulated product design of clinical learning in the hospital, which is supposed to improve the quality of the clinical learning process in the hospital is a model of outcome present models test peer group.

METHOD
The method used in this study is a research and development method. This research method is used to produce a particular product, and test the effectiveness of the product. Learning product that will be developed in this study is a clinical learning model that is expected to improve clinical learning in performing nursing care in hospitals.
Based on the development model steps Borg and Gall (1989) and then the study steps are simplified by Sukmadinata (2008 : 189), into three main steps, namely a preliminary   Figure 2. implementation measures outlined in the study study, development, and testing , which clearly can be seen in the image below: Research conducted on student nurses profession were 30 people while doing in the medical-surgical nursing stage in two hospitals. As for the implementation measures outlined in the study the chart RESULT Based on the above table it is known that out of 30 respondents, the mean age of the respondents is 22.93 years with a standard deviation of 0.691.
Based on the above table it is known that the distribution of respondents by sex Most women are 18 respondents (66.7%), while men are 9 respondents (33.3%).
Based on the above table it is known that shows the mean of 27 respondents in the pretest is 28.07 (SD = 2.205), while the mean post test is 52.85 (SD = 2.239). From the results of the analysis obtained by value p = 0.001, which means that there are significant differences of student satisfaction before and after the use of models with a model clinical learning outcomes present test (OPT)-peer Learning student nurses profession stages MSN.

Statistically, the use of models Present Outcome Test (OPT) with the approach of Peer
Learning on Student nurse profession stages medical-surgical nursing has proved effective and significantly increase student satisfaction in the clinical learning process.
According to Barlet, at al. (2008) OPT is a model of clinical reasoning learning in the nursing process that is designed to help improve clinical reasoning skills in learners. Porpoises andHerman (1999 cited in Barlet, et al., 2008), adding that the main focus of the model OPT are the results (outcomes) that guide learners thinking behind the (backward) to change the client of his health status at this time (the present state), to state desired (outcome). Thus, this model can improve the management of client problems simultaneously.
The development of OPT models are applied to 27 nurses stages KMB professional students, researchers found that a simple form of this model facilitate learners in understanding and conducting of clinical reasoning problems experienced by clients. This is evidenced by initial tests conducted by researchers with a case that has been designed previously to all learners, found only 6 students (22.2%) were able to establish appropriate nursing problems with the condition of the client, specify a destination, intervention, and evaluation, and at the end of stages KMB (after the participants are given the learning model OPT) test with the participants again given the same case and discovered that 19 students (70.4%) have been able to determine the client's nursing problems appropriately. This shows the good progress shown by learners, even from interviews with five students researchers found a picture which suggested that the model of OPT students find it very easy to learn and develop the mindset critically and creatively in determining any problems experienced by clients to be able to evaluate the results that have been specified in the client's care.
The statement above is in line with studies conducted by Barlett et al. (2008), which concluded that the use of the OPT at learners in the clinic is able to practice their skills in making comparisons, identifying key client issues, determine the intervention, and evaluate carefully. In addition, this model also supports learners to be more creative, critical, and able to think on an ongoing basis to determine the next nursing action.
It is the one of who supports the results obtained by researchers where learning model OPT student nurses profession can improve student satisfaction during follow stages KMB clinic. By learning practically and easy, students can develop skills in accordance with desired competency targets. One of who contributed the achievement of good results from this study is due to the use of peer learning methods. As has explained by Paul, Lisa, and Vanessa (2006) in Sukmadinata stated that Peer Learning is one of learning method in which students will be assisted by a teacher or a friend who has the same level of learning a concept or the capabilities (skills).
Peer learning approach essentially focused on training problem solving and highly effective way to improve creativity, execution of experiments, problem-solving abilities, and learning difficult concepts. This is supported because of the cooperative learning methods, allowing each student to get attention from the Preceptor and have plenty of time in talking or listening. And, of course, this gives students the opportunity to participate actively in building knowledge.
It is not only from the aspect of students, but OPT-Peer Learning models also provide a good impact on the precept. From the evaluation conducted by researchers using interview techniques, found the information from one of the precepts that suggest "... with OPT models, simplify preceptor and preceptee in studying the case of nursing so that existing problems can be developed ..." From this information, researchers assume that with OPT-Peer Learning model of learning can be a media development is not for students only, but also for his own precept to further enhance the capabilities and knowledge needed in the clinic.
In addition, the implementation of Peer Learning used by precept changes the paradigm of the relationship between precept and students. Comparing the results of a preliminary study conducted by researchers obtained information that they are confused with the pattern of a given task, the task of supervising the writing implement much so that the orientation of students complete a task while in terms of feedback from the supervising institutions and clinics still felt lacking. That is communication between tutors and students more emphasis on the completion of tasks and fewer help students in solving the problems experienced during clinic practice. However, from the process of implementing the model OPT-Peer Learning researchers discover new things related to the pattern of the relationship between the precepts of the students. From interviews, found information that the model OPT-Peer Learning can change the pattern of relationships not only as educators between the two but can be partners who jointly carry out treatments to clients, the intensity of the meetings to be better so that students are able to solve the problem by better anyway. It supported the statement on one precept which says "... the OPT-Peer Learning model can create relationships between preceptor and preceptee be a partner in finding /solving the problems of nursing that happens ..." From the results obtained in this study, suggests that the clinical learning for students should be directed to the simpler without losing the essence of the expected standards of competence to the students. One of them with the application of OPT model with the Peer Learning approach that could form the clinical reasoning abilities of students; be more creative and critical in resolving the problems experienced by clients in many other cases the order.

CONCLUSION
Model OPT student nurses profession can improve student satisfaction during because it is a very simple to model and able to develop clinical reasoning, but they also will understand about how to use the diagnosis of NANDA, NIC, and NOC.
OPT model with the Peer Learning approach not only used in the medical-surgical nursing stage but also can be used in any professional nurses stage.