The search for nurses with a better bedside manner<\/p>\n
Ratih Sayidun and Santi W.E. Soekanto, Contributors\/Jakarta<\/p>\n
Rahma has worked for the past two years at a small medical clinic
\nin Depok, south of Jakarta, as well as taking patients at home,
\ndespite not having a license to open a practice of her own.<\/p>\n
The mother of three has nothing but complaints about her even
\nyounger colleagues.<\/p>\n
"Those new midwives don't even know how to insert an IUD
\n(intrauterine device, a contraceptive)," she said scornfully.<\/p>\n
"They leave a half-naked patient for so long without tending
\nto her!"<\/p>\n
Rahma expected her inexperienced colleagues to finish tending
\nto the patient without leading them or explaining the standard.<\/p>\n
"Of course they have to do it. Otherwise, they'll never
\nlearn!"<\/p>\n
Mrs. Ningsih, a mother of seven grown children in Jakarta who
\nhas been fighting cancer for the past three years, does not have
\na good impression of the nurses who cared for her.<\/p>\n
"They are so cold-hearted, so unsmiling and even rough," she
\ncomplained. "It's humiliating enough to ask for a bedpan, but
\nwhen the nurses help me with that in a rough manner, I feel like
\nI'd be better off dead."<\/p>\n
Rita, a nurse in a Jakarta hospital, has her own complaints.<\/p>\n
"Who has the time and energy to smile when you have to spend
\nall working hours at the beck and call of busy, arrogant doctors,
\nand whining patients, in addition to mopping the floor?"<\/p>\n
The experiences of the three women highlight the problem of
\nnursing in this country.<\/p>\n
As we rush to the hospital, do we ever think that we must
\nplace the lives of our loved ones, or our own, in the hands of a
\nyoung woman in a white uniform who is mopping the floor?<\/p>\n
Would we really think of entrusting the care of our pregnant
\ndaughter to a midwife at the Puskesmas (village health centers)
\nwhom we last saw carrying out the garbage?<\/p>\n
Certainly not, we may think indignantly, but that is what
\nmillions have to do all the time.<\/p>\n
A large number of the approximately 250,000 nurses and
\nmidwives here are poorly educated or trained. They work without a
\nclear job description and standards to guide, so that the actual
\nwork that they do often goes beyond the scope of nursing.<\/p>\n
Add to that the poor image of nurses and midwives as unsmiling
\nand rude caregivers, and many patients would share the sentiments
\nof Mrs. Ningsih.<\/p>\n
Ani Suryani, a midwife and official at the provincial health
\noffice of Yogyakarta, admitted that nurses, who are on the front
\nline of the health service, were often unprofessional.<\/p>\n
"They are deemed the lesser decision-maker despite spending
\nmore time with patients than doctors," she told The Jakarta Post
\nin Yogyakarta recently.<\/p>\n
"Midwives often become complacent because their job is often
\nmonotonous, and they still have inadequate support from the
\nhealth system."<\/p>\n
Another challenge for them is dealing with teenage
\nreproductive health and high maternal and infant mortality rates.<\/p>\n
"Studies conducted here have found that a large number of
\nteenagers, who make up 30 percent of the population in
\nYogyakarta, are involved in premarital sex," she said.<\/p>\n
"Unless help is being given and solutions found, the outcomes
\nare usually even worse, including unsafe abortions and sexually
\ntransmitted diseases. Can you imagine having an unskilled nurse
\ngiving advice to your pregnant teenager?"<\/p>\n
Elly Nurachmah, a professor of nursing at the University of
\nIndonesia, said many nurses were inadequately equipped with
\ntheories and concepts of nursing, with a lack of interest on the
\npart of the health centers' managers to envisage good nursing
\npractices.<\/p>\n
Other experts believe that nurses and midwives must also have
\ngood clinical skills and the standards to guide their practice.<\/p>\n
"Nurses lack understanding about their patients as human
\nbeings. Often they are insensitive to their patients' feelings,"
\nElly said. "This is because they are often trained to merely
\ncarry out tasks given by doctors."<\/p>\n
Most nurses and midwives carried out tasks beyond their
\nprofessional boundaries, had no clear job description and had not
\nreceived any professional updating in the previous three years,
\naccording to a 2001 study carried out in North Sulawesi, North
\nSumatra and East Kalimantan by the Directorate of Nursing and
\nMedical Technicians of the Ministry of Health, in cooperation
\nwith the World Health Organization (WHO).<\/p>\n
A 1997 WHO report on nursing in Southeast Asian countries,
\nciting studies carried out since 1987, found that less than 50
\npercent of the working hours of nurses in hospital were actually
\nspent on nursing.<\/p>\n
Experts and practitioners such as Elly agree that the key to
\nimproving the quality of nursing and midwifery is training and
\neducation geared to accommodating the socioeconomic
\ncharacteristics of the profession in Indonesia, where nurses are
\noften paid a meager salary.<\/p>\n
Also vital is to improve the performance management system.<\/p>\n
Based on the 2001 study, the health ministry, WHO and Gadjah
\nMada University in Yogyakarta developed a system to assess and
\nimprove the clinical performance of nurses and midwives. They ran
\na pilot project to implement the concept in Sleman in Yogyakarta
\nand Magelang, Central Java in 2001, and in Tabanan regency in
\nBali and Semarang and Grobogan, both in Central Java, in 2002.<\/p>\n
In 2003, the Clinical Performance Management Development
\nSystem (CPDMS) was expanded to another five provinces.<\/p>\n
Suhartati from the Directorate of Nursing and Medical
\nTechnician of the health ministry said the system was intended to
\nimprove the clinical performance of nurses and midwives in the
\nhealth care sector.<\/p>\n
The system developed from the realization that health care
\nhere, as in many other developing countries, suffers from poor
\nquality, poor clinical performance and that the health system
\nfails to make the best use of its human resources.<\/p>\n
The world is changing, and is moving toward the understanding
\nthat a health care system should protect patients from injury and
\nbad advice during the actual health care treatment.<\/p>\n
The public wants care that is effective, efficient, patient-
\ncentered and punctual -- and of constantly good quality. Nurses
\nand midwives in Indonesia need to improve their skills to keep up
\nwith increasing demands for quality health care.<\/p>\n
In CPDMS, nurses and midwives are encouraged to review all
\naspects of the care they give, use operational standards in
\naccordance to the official job descriptions and participate in
\ngroup learning process.<\/p>\n
Dr. Tri Djoko Hadianto, a consultant to the CPDMS in
\nYogyakarta, recounted how participants showed improvement in the
\nquality of their services by becoming more oriented toward
\npatients' needs and standard operating procedures.<\/p>\n
More importantly, the nurses and midwives liked their job
\nbetter -- and were thus more positively focused on their
\npatients.<\/p>",
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"sponsor": "Okusi Associates",
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