PATIENT’S PERSPECTIVES IN IMPLEMENTATION OF HEALTH PROTOCOL PREVENTING THE TRANSMISSION OF COVID-19 IN THE HEALTH SERVICE ENVIRONMENT BASED ON THE QUALITY OF LIFE (QOL) CONCEPT

Introduction: Currently, COVID-19 has become a global pandemic. The number of COVID-19 cases in Bengkulu Province in January reached 23.110 cases, while for regional cases, Bengkulu City occupies the highest position, namely 9.015 cases compared to 8 (eight) surrounding districts, which Among them, as many as 158 people died. Transmission of COVID-19 can occur airborne or through air contaminated with the coronavirus, then the virus enters through the nose, eyes, mouth, and other mucous membranes. Discipline in implementing health protocols in the community has reduced transmission. Patients' quality of life undergoing treatment in hospitals during the current COVID-19 pandemic often shows terrible symptoms. Nurses cannot be separated from their responsibilities as severing agents and preventing transmission in the family, community, or health care environment. Aspects of focus in this study's concept of Quality of Life (QOL) are biological health functions, psychological, spiritual, social, and family support. Metode: The design of this research is descriptive phenomenology with a qualitative study method. The total respondents in this study were 15 patients who were taken from 3 treatment rooms (inpatient)—sampling using the purposive sampling method. The criteria for respondents in this study were inpatients, patients with the good general condition, adult patients, and cooperative patients. The data that was explored from the respondents was an overview of the patient's perspective related to efforts to prevent COVID-19 by implementing health protocols in terms of the Quality Of Life (QOL) aspect obtained through in-depth interviews, namely an overview of (1) functions health biologically (physiological), (2) psychological, (3) spiritual, (4) social and (5) patient's quality of life.


INTRODUCTION
COVID-19 has become a global pandemic at this time. In January, the number of COVID-19 cases in Bengkulu province reached 23,110 cases. For regional cases, the city of Bengkulu occupies the highest number compared to 8 (eight) districts in Bengkulu province, namely 9,015 people, of which 158 people died. 1 Transmission of COVID-19 can occur through the airborne (air contaminated with the virus), which then enters the body through 3 main accesses, namely the nose and mouth, eyes, and other mucous membrane. The equitable distribution of socialization programs and community discipline regarding the application of health protocols has proven to suppress transmission. 2 Nurses who work in health care environments cannot be separated by their responsibilities as severing agents and preventing transmission, be it in the family, community, or health care environment, because That is why nurses have to work hard to make people avoided in  Patients' quality of life undergoing treatment in health services sometimes shows an unfavorable status when facing a pandemic like today. The risk of transmission can occur in the patient, coupled with the concern that even if a person does not show symptoms (OTG), that person may become a carrier (carrier agent) for the family at home. 4 The focus aspect in the discussion of Quality of Life (QOL) in this study refers to 5 basic aspects of human life, including biological health functions (physiological), psychological, spiritual and family support. 5

METHODS
This research design is descriptive phenomenology research with a qualitative study method. All respondents involved in this study amounted to 15 people.
Respondents taken are patients undergoing treatment (inpatient) in various rooms. The sampling method used is purposive sampling with the following criteria; patients are inpatients, patients with good general condition, and cooperative patients to the research process. Data collection was carried out through in-depth interviews by exploring the patient's point of view on the application of health protocols for the prevention of COVID-19 transmission in terms of the Quality Of Life (QOL) concept. The data that has been taken then through interviews and then analyzed using the Colaizzi method, which refers to 4 stages 6 , namely (1) the researcher collects data in the form of primary data and secondary data by listening repeatedly and then making a transcript of the recording (verbatim). (2) the researcher reads the transcript that has been written repeatedly so that he gets a significant meaning and underlines every critical statement of the respondent. (3) determine the category of each data that is considered necessary to become a sub-theme. These various subthemes collected will then become part of the essential sub-variables. (4) the last, researcher will write the report. At this stage of writing the report, the researcher must be able to write down the meaning of each phrase so that it can describe the data well.

RESULT
The age of the respondents varied from the age of 25-50 years. Male is the most common of gender, namely ten people and women as many as five people. the following table of data analysis results. "Ya… dengan mencuci tangan dan mencuci muka kan selain membersihkan dari virus, tapi kan baik untuk membersihkan muka dari debu"(R7). "By washing our hands and face, beside cleaning the face from the virus but also it will clean our face from the dust" (R7).
"The seats here are also given a barrier (physical distancing) right...! By not being close each other, we can reduce physical transmission"(R4).
The Implement ation of health protocol can prevent the transmissio n of COVID-19 physically

Psycholo gical
" Dengan kebijakan yang mengahruskan The Implement menggunakan masker seperti sekarang ini kan membuat kita tenang… tanpa harus takut tertular" (R1). "By a policy that requires wearing masks like today, it will make us calm without having to be afraid of getting infected" (R1).

DISCUSSION
Implementation of health protocols in the community will be considered new for the society. It is hoped that this situation will not make people depressed, bored, and stressed, but instead will create a society with a strong mentality, solution, and adaptability. In this research, we will discuss the patient's perspective regarding the application of health protocols in terms of the Quality Of Life (QOL) concept.

Biological health function (Physiological)
Various of studies have shown that washing hands regularly, especially after covering the mouth and nose when sneezing, is very effective in suppressing the spread of  In addition to regularly washing hands, another preventive step is to use masks. As known that one of the transmissions of COVID-19 is airborne. The proper use of N95 masks has a high level of effectiveness because it has a density so that it has maximum protection against droplets or aerosols. 8,9 The policy for physical distancing and use the mask properly is claimed to be the most effective way to break transmission. WHO (2020) states that airborne transmission can occur when a person infected with COVID-19 coughs, sneezes, or talks, and the droplets spread in the air and are inhaled directly or attached to the body of someone has not been infected. The most effective physical distancing is at least 2 (two) meters. 10

Physicological
Wiranti's (2020) research states that the community is adaptable and well-accepted regarding the PSBB policy. As known as that PSBB is part of the health protocol 11 . Restriction of visitors in inpatient rooms (hospitals) is not something new. Limiting the number of visitors has existed since before the COVID-19 outbreak. Restrictions on the number of visitors are increasingly being tightened and disciplined since COVID-19 increases day by day. The rules that form the basis for limiting the number of visitors are based on the Decree of the Ministry of Health (Kepmenkes) regarding guidelines for implementing field hospitals/emergency hospitals during the Corona Virus Disease 2019 (COVID-19) pandemic. 12 Policies related to implementing health protocols can adequately suppress the spread of COVID-19. The effectiveness of implementing strict health protocols has a very positive impact, and these positive effects have generated optimism and serenity in the community.

Social
The social aspect of this study shows that with the implementation of health protocols, such as examples related to physical distancing, this policy does not reduce the quality of interaction in the community. Physical distancing itself aims to minimize the possibility of physical contact between someone who is infected and who has not been infected. 13 People use existing communication media, such as voice calls and video calls via WhatsApp, SMS, and Facebook, as an alternative to communicating. In its implementation, physical distancing in the community is a very appropriate policy and very beneficial to the community, so it is also well-received by all circles of society. 14

Spiritual
In this aspect, there were not obstacles found in worship, even with health protocols (physical distancing). Respondents said that the physical restriction program did not discourage their intention to worship. Another respondent also conveyed that the restrictions on activities outside the home were used to increase worship at home. Akmal (2020) conducted an online survey of 18.743 respondents and found that most people are aware of the dangers of COVID-19 and have the awareness to be disciplined in carrying out the health protocol. 15 From the description of the findings of this study, it can be concluded that the attitudes and spiritual values of the community feel the urgency to prevent the spread of COVID-19.

Family Support
This study found that respondents received good support from their families regarding the implementation of health protocols. Family support will significantly affect a person's discipline in healthy living behavior 16 . The results of other studies that support these findings are research conducted by Alyssa (2021) which states that helping patients with hygiene is not only creating a personal relationship between the patient and family members but also part of maintaining the patient's health, the researcher also adds that by being aware of the limitations that the patient has is a positive view of the patient's ability to support the patient's healthy behavior.
So it can be concluded that jointly supporting each other regarding the implementation of health protocols in the community can be very beneficial for the community itself.

CONCLUSIONS
The study concluded that the implementation of health protocols in the health care environment had been appropriately implemented. The respondent's perspective in interpreting the application of health protocols in terms of the Quality Of Life aspect shows a positive image.The description of the biological function of health (physiological) shows that implementing health protocols is very beneficial for respondents. Respondent's psychological image (psychological) is adaptable and accepts the health protocol policy. Description of the social aspect (social) respondents do not feel that implementing of health protocols is a breaker of social intraction; they use alternative communication media as a substitute for faceto-face communication. The description from the social aspect of the respondent said that there were no significant obstacles with social restrictions and so on. The spiritual aspect shows that there are no significant obstacles to practicing religion; despite implementing strict health protocols, respondents use activities at home to increase worship, especially prayer. From the aspect of family support, most families provide support to other family members in carrying out health protocols.

SUGGESTION
Hopefully there will be better research in the future