Introduction of DIII Nursing Education in Indonesia

By: Robyn L. Aitken, School of Nursing and Social Work, The University of Melbourne
DIII nursing education is a nationally mandated six-semester program (Pusat
Pendidikan Educasi dan Kebudaya, Directorate Jenderal Tinggi Educasi, 1999a) for
high school graduates. The DIII curriculum was introduced in 2000 as part of
Indonesian government policy to increase both the quantity and quality of nurses
entering the Indonesian health care workforce (Departmen Kesehaten R.I (DepKes),
2003; Sugiharto, 2005). At this time Indonesia was ranked amongst the poorest
performing countries when benchmarked against international health and welfare
indices (Fukuda-Parr, Birdsall, Sachs, Bonacito & Boudard, et al., 2003; WHO,
2004a). While poverty was at the heart of such poor performance (Watkins, Fu,
Fuentes, Ghosh, & Giamberardini, et al., 2005), government intervention into nursing
education was also seen as making an essential contribution to improving health
outcomes (Nursing & Midwifery Working Group, Ministry of Health (NMWGMOH),
1998).
Although there were a small number of degree-level nursing programs conducted in
Indonesia, University education was beyond the reach of the majority of Indonesians
(Fukuda-Parr et al., 2003). Therefore, the majority of nurses entering the Indonesian
workforce graduated from Sekolah Perawatan Kesehatan (SPK) (School Health
Nursing) training. The SPK program incorporated nursing training alongside the
general education content in the last two years of high school (NMWG-MOH, 1998).
However, in 1999 SPK training did not contribute the number of nurses, or the quality
of practitioners considered necessary to improve Indonesia’s performance against
international benchmarks such as the Millennium Development Goals (Hennessy,
2001). As a result, government legislation was passed to establish both government
and private Akademi Keperawatan (AKPER) where diploma level entry-to-practice
nursing education could be conducted (Wea, 2000). While permitting private
providers to establish AKPER promised to increase the number of graduates from
entry-to-practice programs, of critical importance was that legislation was also passed
to replace SPK training with DIII education as the minimum qualification required for
practice as a nurse or midwife in Indonesia (Pusat Pendidikan Educasi dan Kebudaya,
Directorate JenderalTinggi Educasi, 1999b). Replacing SPK training with diploma
level education was seen as a critically important step to professionalize Indonesian
nursing and improve the quality of the nursing workforce (Directorate of Nursing and
Technical Medics, Directorate General Medical Care, WHO SEARO & Ministry of
Health Indonesia (DONMT-WHO), 2002).
In contrast to SPK training, the DIII curriculum incorporated a greater focus on the
scientific underpinnings of nursing and aimed to provide graduates with a more in
depth knowledge of the theoretical underpinnings of nursing practice. There was also
an increase in the time students were allocated to engage in supervised learning
experiences within the clinical setting. Prior to the introduction of the DIII,
Indonesian nurses were predominantly described as a ‘sub-professional’ workforce
(IBRD, 2001), occupying a low status as ‘doctor’s helpers’ (Shields & Hartarti, 2003).
The ‘Nursing Process’ with its four steps of assessment, planning, intervention and
evaluation (Doenges, Moorhouse & Murr, 2006) appears as an integrating theme
within the curriculum to specifically support Indonesian nursing’s transition from
sub-professional to professional status (Pusat Pendidikan Educasi dan Kebudaya,
Directorate Jenderal Tinggi Educasi, 1999a).