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Citation for this article:
Nursalam, Efendi F, Ngoc Dhang LT, Sufyanti Arief Y. 2009. Nursing Education in Indonesia: Todays and Future Trends. Shanghai International Nursing Conference, November 2009, Shanghai, China
Societal and health care changes have presented many challenges for nursing. The challenge for nursing education is to ensure that professional education remains relevant and keeps in track with the needs of the market. These challenges include globalization, changes of patient characteristics, impacts of technology information, migration, future tendencies and other current issues in nursing development in Indonesia. A desk study was performed from relevant published materials. Literature was reviewed from means and databases of the International Council of Nurses, Indonesian Nurses National Association and electronic journals. The aim of this paper is to consider possible future societal and healthcare changes and how they may impact the development of future nursing education. A clear understanding of these factors is critical to face tomorrow challenges within global context.
Keywords: nurse, education, curriculum
History of Nursing Education in Indonesia
In line with the rapid economical growth and technological development, nursing education in Indonesia has also been developed positively over the last decades, starting with the issues of “The doctor?s servant” and “Nurses as the second class”. Nurses want their voices heard together with their profession more highly recognized.. As the result, in some urban provinces of the country a Diploma Program in Nursing was set up in the 1970s. In 1982, Indonesia University opened a Bachelor degree in nursing science as a pilot project. Since then, several medical faculties followed the step of Indonesia University and provided Bachelor?s Degree Program in Nursing. Moreover, Self-study Education Program in Nursing started in Indonesia and, this type of education quickly spreads to other cities, which included Diploma Program, Diploma IV at the beginning and Bachelor’s Degree Program after several years.
In addition, a continuing education program called “Program Khusus” leading to a diploma was also established, which is a 3-year part time program for clinical nurses with professional training education background. This program provides good opportunities for clinical nurses in pursuing higher education while working and overall, in improving their professional knowledge and skills. With the increasing number of higher nursing education programs, there is lack of nurse educators who have higher educational background.
Recognizing the necessity, the Ministry of Health has sent a number of nurses to study abroad to get higher education, master and doctoral degrees. However, that effort seems to be insufficient compared to the actual requirement. More importantly, competencies of nurse educators need to considerably improved, in accompany with increasing the number of qualified nurse educators. The diversified levels of nursing education programs and also increased nurse students number have resulted in an over workload for nurse educators. This unfortunately creates a challenge for them in renewing and gaining more knowledge. Not only more nurse educators with Master’s and doctoral degree are needed, but also each educator would put more attention to researches and theoretical development and the development of cognitive skills in teaching and clinical practice as well. The current situation of Indonesia is that most of nurse educators have only Bachelor?s degree; this has caused constraints in taking roles of teaching, guiding and coaching their students. Meanwhile, this situation is not an issue for many western countries, where most of nurse educators possess their PhD or Master’s degree.
With the development of nursing science and the constant influence of modern education notions, continuing reforms in nursing education have been made since 1982. Nursing education has changed from a biological paradigm to a humanistic or holistic paradigm. The reforms covered a wide range of areas, from curriculum development, contents, teaching methods to human resource aspects. More efforts have been made in curriculum design and development for courses related to sociology, psychology, psychoneurotic immunology; researches in nursing science have been put more emphasis. Contents of different courses, especially those relating to clinical nursing and community setting have been adjusted with strong focus on consumers? needs. As to the teaching methods, besides traditional class teaching, multi-media teaching have been used widely. In addition, internet teaching has also attracted more and more interests (Nursalam & Efendi F, 2008).
Recent Issue in Nursing Society in Indonesia
Nurses across the country are pushing for the government and the House of Representatives to speed up deliberation of the Nursing Practice Bill, which is to recognize this profession as a main component in the national health system (The Jakarta Post, 2009). The purpose of the bill is to clarify the rights and duties of nurses. The author believes that nurses have the right to a safe work environment, to practice in a manner that assures the provision of safe care through adherence to professional standards and ethical practice, and to advocate freely for themselves and their patients. The draft bill was submitted to the House in 2005 and has since been revised 20 times.
Indonesia is still implementing the Ministry of Health Decree No. 1239/2001 as a legal basis for nurses? jobs. However, the decree is not sufficiently clear in defining nurses’ rights and duties; this has resulted in misunderstanding and misperception of nurses jobs. In fact, nurses? legal position is not protected adequately. Evidently, nurses in East Java, West Java and Central Java have been detained by authorities or harassed by locals for providing emergency assistance, which they believed that only doctors could do. In fact, the decree states nurses are allowed to give medical treatment if they have approval from the doctors in charge. However, the majority of people still believe (misbelieve actually) that all medical treatments, even as simple as giving injections should be done by doctors and only doctors.
This problem has definitely hampered nurses? job which basically doing dependent job. To resolve the problem, Indonesia needs a specific law regulating nursing practice and defining nurses’ responsibilities. The bill under discussion covers nurses’ competence and protection during practice, which means they are defined as professional practitioners. If the bill is passed into law, it will be Indonesia’s first national standard for nurses.
A summary of today, future challenges and the curriculum implication are listed in the table below.
Table 1. Today and future trends in nursing education in Indonesia
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