The influence of empowerment  of Indonesian nurses on  the quality of care: A Patient perspective (2007) By Lenny van Amei...
Patients view ’ Quality of care Empowerment Indonesian nurses <ul><li>Dissertation MA  </li></ul><ul><li>International Ser...
Steps of research Patients’ view Quality of care <ul><li>Rationale </li></ul><ul><li>Definition empowerment </li></ul><ul>...
Patients’ view Quality of care Empowerment Indonesian nurses <ul><li>Healthcare Indonesia is lagging behind in </li></ul><...
Patients’ view Quality of care Empowerment Indonesian nurses “ The ability to mobilize resources to get things done ”  Soc...
  Literature review :  4 dimensions patient-centred care  Patients’ view Quality of care Empowerment Indonesian nurses Acc...
Problem statement Patients’ view Quality of care Empowerment Indonesian nurses From the Patient’s point of view, does empo...
Objectives Patients’ view Quality of care Empowerment Indonesian nurses To analyze Patient requirements or expectations of...
Methodology Patients’ view Quality of care Empowerment Indonesian nurses Qualitative research: Subjective, understanding t...
Methodology: Methods Patients’ view Quality of care Empowerment Indonesian nurses <ul><li>Triangulation of data: </li></ul...
Main findings: 1 st  class Patients Patients’ view Quality of care Empowerment Indonesian nurses <ul><li>Quality of care :...
Main findings: 1 st  class Patients Patients’ view Quality of care Empowerment Indonesian nurses <ul><li>Have less need of...
Access to information 1 st  class   Patients’ view Quality of care Discussion healthcare team and patient
Healing environment 1 st  class   Patients’ view Quality of care Empowerment Indonesian nurses
Nursing post 1 st  class   Patients’ view Quality of care Empowerment Indonesian nurses
Patients’ view 1 st  class   Patients’ view Quality of care “ I hope there will be  specialization  in the nursing departm...
Patients’ view 1 st  class   Patients’ view Quality of care “ When the nurse serves us with a  warm friendliness and smile...
Main findings: 2nd class Patients Patients’ view Quality of care Better communication between doctors and nurses regarding...
Main findings: 2nd class Patients Patients’ view Quality of care Empowerment Indonesian nurses Nurses are task centred ins...
2 nd  class ward Patients’ view Quality of care Empowerment Indonesian nurses
2 nd  class Healing environment Patients’ view Quality of care Empowerment Indonesian nurses
Patients’ view 2nd class Patients’ view Quality of care “ How can Patients  heal fast  if they keep Patients waiting and a...
Patients’ view 2nd class “ No the nurse  never informs me  about  the side-effect of the treatment,  because  I never ask ...
Main findings: 3rd class Patients Patients’ view Quality of care <ul><li>Grateful for access to hospital </li></ul><ul><li...
Main findings: 3rd class Patients Patients’ view Quality of care <ul><li>Long waiting time before action is taken </li></u...
Access to information 3 rd  class Patients’ view Quality of care Doctor, please talk to me
Family 3 rd  class   Patients’ view Quality of care Empowerment Indonesian nurses
Compassionate human interaction 3 rd  class Patients’ view Quality of care “ Diploma nurses are most of the time in nursin...
3rd class Patients’ view Patients’ view Quality of care “ I never know any issue . I only know the information from the Pa...
3 rd  class Patients’ view Patients’ view Quality of care “ Well, you know how it feels being loved by your family. Its go...
Model empowerment of Indonesian nurses and quality of care Patients’ view Quality of care Empowerment Indonesian nurses Ad...
General Conclusions (1) Patients’ view Quality of care <ul><li>1st class patients are satisfied and able to judge the care...
General Conclusions (2) Patients’ view Quality of care <ul><li>Most important: trust and family </li></ul><ul><li>Patients...
General Conclusions (3) Patients’ view Quality of care Opinion of nurses in previous study “ Empowerment of nurses in Indo...
Conclusions four dimensions  Patient centred care (4) Patients’ view Quality of care Access to information   should be giv...
Conclusions four dimensions  Patient centred care (5) Patients’ view Quality of care Compassionate human interaction  mean...
Conclusions 4 dimensions  Patient centred care(6) Patients’ view Quality of care Social support systems : family in 3rd an...
Strategic Recommendations (1) Patients’ view Quality of care Empowerment Indonesian nurses <ul><li>Education </li></ul><ul...
Strategic recommendations (2) Patients’ view Quality of care Empowerment Indonesian nurses <ul><li>International cooperati...
Scientific recommendations Patients’ view Quality of care Empowerment Indonesian nurses <ul><li>Increase validity and reli...
Implementation Patients’ view Quality of care Empowerment Indonesian nurses Hopefully this research will be helpful to lif...
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Empowerment of Indonesian nurses and quality of care: a Patient perspective

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This qualitative single case study aims to look at the relationship between empowerment of nurses and quality of care and to determine which factors influence Patient satisfaction in the overall treatment. The research includes a comparison between the various classes of patients in Indonesia and elaborates on a previous study of the author about empowerment of nurses.

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Empowerment of Indonesian nurses and quality of care: a Patient perspective

  1. 1. The influence of empowerment of Indonesian nurses on the quality of care: A Patient perspective (2007) By Lenny van Ameijde, MA Patient centred care and empowerment of nurses Patients view’ Quality of care Empowerment Indonesian nurses
  2. 2. Patients view ’ Quality of care Empowerment Indonesian nurses <ul><li>Dissertation MA </li></ul><ul><li>International Service Management </li></ul><ul><li>London Metropolitan University/ </li></ul><ul><li>Stenden University The Netherlands </li></ul><ul><li>Single case study </li></ul><ul><li>Dr. Kariadi Hospital </li></ul><ul><li>Semarang, Central Java </li></ul><ul><li>Qualitative study </li></ul><ul><li>2006/2007 </li></ul>Patient centred care Indonesia
  3. 3. Steps of research Patients’ view Quality of care <ul><li>Rationale </li></ul><ul><li>Definition empowerment </li></ul><ul><li>Four dimensions Patient centred care </li></ul><ul><li>Problem statement and objectives </li></ul><ul><li>Methodology </li></ul><ul><li>Main Findings </li></ul><ul><li>Conceptual model </li></ul><ul><li>Conclusions </li></ul><ul><li>Recommendations </li></ul>Empowerment Indonesian nurses
  4. 4. Patients’ view Quality of care Empowerment Indonesian nurses <ul><li>Healthcare Indonesia is lagging behind in </li></ul><ul><li>comparison with the international standard </li></ul><ul><li>No recognition of own identity nursing </li></ul><ul><li>profession </li></ul><ul><li>RTC 2004 Bali about professionalism and </li></ul><ul><li>specialization of Indonesian nurses </li></ul><ul><li>One of recommendations RTC: research </li></ul><ul><li>Research in 2 phases: previous research 2006 </li></ul><ul><li>integrated in the dissertation 2007 </li></ul>Rationale
  5. 5. Patients’ view Quality of care Empowerment Indonesian nurses “ The ability to mobilize resources to get things done ” Social structures within the work environment that provide employees with access to information, support, resources, strong interpersonal relationships and opportunities to learn and grow , are empowering and allow employees to accomplish their work in meaningful ways. (Kanter,1993) Definition empowerment
  6. 6. Literature review : 4 dimensions patient-centred care Patients’ view Quality of care Empowerment Indonesian nurses Access to information Compassionate human interaction Social support systems Healing environment Source: Frampton (2003)
  7. 7. Problem statement Patients’ view Quality of care Empowerment Indonesian nurses From the Patient’s point of view, does empowerment of nurses influence the quality of care?
  8. 8. Objectives Patients’ view Quality of care Empowerment Indonesian nurses To analyze Patient requirements or expectations of the quality of healthcare and setting To identify elements of Patient care that can be improved by empowering Indonesian nurses
  9. 9. Methodology Patients’ view Quality of care Empowerment Indonesian nurses Qualitative research: Subjective, understanding the perception, feelings and views of Indonesian Patients Knowledge and insight based upon the subjective viewpoints of Patients
  10. 10. Methodology: Methods Patients’ view Quality of care Empowerment Indonesian nurses <ul><li>Triangulation of data: </li></ul><ul><li>Documents (literature review) </li></ul><ul><li>Semi structured depth interviews </li></ul><ul><li>with 8 Patients from 1 st , 2 nd , 3 rd class, </li></ul><ul><li>selected by hospital, based upon </li></ul><ul><li>criteria, assisted by Indonesian </li></ul><ul><li>professional, familiar with healthcare </li></ul><ul><li>who speaks fluently English </li></ul><ul><li>Direct observations </li></ul>
  11. 11. Main findings: 1 st class Patients Patients’ view Quality of care Empowerment Indonesian nurses <ul><li>Quality of care : get the best care provided by specialist doctors and D3 and S1 nurses </li></ul><ul><li>Have good access to information because they </li></ul><ul><li>are more educated and able to communicate with </li></ul><ul><li>doctors on an equal level: less power distance. </li></ul><ul><li>Prefer S1 nurses who give better information, </li></ul><ul><li>have a better attitude and skills </li></ul><ul><li>Get compassionate care : personal attention, </li></ul><ul><li>creating a trust-based relationship with doctors </li></ul><ul><li>and nurses. Still they would like to get more time to </li></ul><ul><li>communicate their feelings to doctor/nurse. </li></ul>
  12. 12. Main findings: 1 st class Patients Patients’ view Quality of care Empowerment Indonesian nurses <ul><li>Have less need of the presence of their family to </li></ul><ul><li>monitor and take care of them because they get the </li></ul><ul><li>best care </li></ul><ul><li>Their environment is healing because of more </li></ul><ul><li>privacy, good accommodation and equipment, </li></ul><ul><li>supporting their needs (ac, tv, bell, own bathroom), </li></ul><ul><li>the staff needs (supplies, patient/nurse ratio, space, </li></ul><ul><li>mushola) and family needs (own bed) </li></ul>
  13. 13. Access to information 1 st class Patients’ view Quality of care Discussion healthcare team and patient
  14. 14. Healing environment 1 st class Patients’ view Quality of care Empowerment Indonesian nurses
  15. 15. Nursing post 1 st class Patients’ view Quality of care Empowerment Indonesian nurses
  16. 16. Patients’ view 1 st class Patients’ view Quality of care “ I hope there will be specialization in the nursing department, may be the heart patient will be taken care of by a heart disease nurse” “ Nurses and doctors must do a lot of meetings together so that they can share the problems ” “ Usually they visit us a few minutes only. I hope nurses and doctors spend more time during the visits so that we are able to communicate what we feel”. “ My family just does the laundry and brings food. My family completely trusts the hospital” Empowerment Indonesian nurses
  17. 17. Patients’ view 1 st class Patients’ view Quality of care “ When the nurse serves us with a warm friendliness and smile , I think it is healing for the patient”. “ Most of all I trust the doctor because all the information is from the doctor” “ Sometimes they respond by making a joke . It makes me feel relaxed ” “ My servant accompanies me” “ Some have better knowledge, like one nurse who studied abroad. She pays more attention to me, explaining the disease in detail ” Empowerment Indonesian nurses
  18. 18. Main findings: 2nd class Patients Patients’ view Quality of care Better communication between doctors and nurses regarding exchange of information would make Patients feel more confident about the treatment. Lack of time doctors and nurses, lack of cooperation between doctors and nurses and lack of empathy have a negative impact on trust-based relationship between doctor, nurse and patients. Lack of initiative nurses is barrier to get quick assess to information. Nurses are reactive instead of pro-active because they are not empowered, patients/family are only informed if they ask. Empowerment Indonesian nurses
  19. 19. Main findings: 2nd class Patients Patients’ view Quality of care Empowerment Indonesian nurses Nurses are task centred instead of patient centred The power distance is high, Patients often are afraid to ask the doctor or nurse, especially after experiencing impoliteness. For their wellbeing Patients are to a great extend dependent on the care provided by family, who fills the gaps caused by imbalanced nurse-to-patient ratio.
  20. 20. 2 nd class ward Patients’ view Quality of care Empowerment Indonesian nurses
  21. 21. 2 nd class Healing environment Patients’ view Quality of care Empowerment Indonesian nurses
  22. 22. Patients’ view 2nd class Patients’ view Quality of care “ How can Patients heal fast if they keep Patients waiting and asking about the treatment without giving a fast response ? The nurse must give fast & up to date information to the doctor about the Patients. No more delaying.” “ The nurse and the doctor work separately , there is no cooperation. It is an indirect communication because they communicate through memo ”. “ For the doctor, I hope they talk more to the Patient and not just examine us and say nothing. Please talk to us, it makes us feel relieved. But if they are just silent, we will be worried. There’s a big question mark in our head” Empowerment Indonesian nurses
  23. 23. Patients’ view 2nd class “ No the nurse never informs me about the side-effect of the treatment, because I never ask . I sometimes ask the Patient next to me”. “ Some nurses pay attention but some pay less attention. Even sometimes Patients (not accompanied by family) don’t eat all day because nurses don’t help to feed them”. “ Even if the nurse answers my question, still it doesn’t satisfy me. I think the doctor and the nurse don’t communicate well ”. “ I hope in future nurses visit us more and are not just sitting in the office after visiting us”. So they are ready if there’s a sudden accident. Hopefully they are more close to Patients. Patients’ view Empowerment Indonesian nurses Quality of care
  24. 24. Main findings: 3rd class Patients Patients’ view Quality of care <ul><li>Grateful for access to hospital </li></ul><ul><li>Often already in a critical phase of disease </li></ul><ul><li>Treated by student nurses: painful interventions </li></ul><ul><li>Limited time spent by doctors and nurses is a barrier to get a trust-based relationship. They do not listen to Patients. </li></ul>Empowerment Indonesian nurses
  25. 25. Main findings: 3rd class Patients Patients’ view Quality of care <ul><li>Long waiting time before action is taken </li></ul><ul><li>High power distance, afraid to ask, therefore low or no access to information </li></ul><ul><li>Family needed to provide the most basic care and monitor to prevent accidents </li></ul>Empowerment Indonesian nurses
  26. 26. Access to information 3 rd class Patients’ view Quality of care Doctor, please talk to me
  27. 27. Family 3 rd class Patients’ view Quality of care Empowerment Indonesian nurses
  28. 28. Compassionate human interaction 3 rd class Patients’ view Quality of care “ Diploma nurses are most of the time in nursing post instead of the ward” for administrative duties
  29. 29. 3rd class Patients’ view Patients’ view Quality of care “ I never know any issue . I only know the information from the Patients next to me. They always tell me what to do during the treatment”. “ Nurses should be more active and pay more attention to us . Doctor and nurse must cooperate well. The nurse must give the doctor a report of the patients condition as soon as possible” “ The doctor is better, because the nurses just do what the doctor tells them”. “ When I got less information I felt worried about it. I always try to find some information from the nurse. But important is the doctor’s answer”. Empowerment Indonesian nurses
  30. 30. 3 rd class Patients’ view Patients’ view Quality of care “ Well, you know how it feels being loved by your family. Its good, because they provide all my needs ”. “ The most important is communication between patients to nurse and doctor or any other people involved” “ For certain things, nurses are always waiting for the doctor instructions” “ we don’t interact for a long time , for example when they do the infusion. They just help me with that and then they go. We don’t have a long conversation” Empowerment Indonesian nurses
  31. 31. Model empowerment of Indonesian nurses and quality of care Patients’ view Quality of care Empowerment Indonesian nurses Adapted from Haghbaghery et al (2005) trust trust Reforming nursing education Reforming nursing services Patients’ Perception family Empowerment Indonesian nurses Personal empowerment Professional empowerment Knowledge & Skills Authority Confidence <ul><ul><li>unity nurses </li></ul></ul><ul><ul><li>support doctors </li></ul></ul>Patient-centered care Access to information Social support systems Compassionate human interaction Healing environment trust
  32. 32. General Conclusions (1) Patients’ view Quality of care <ul><li>1st class patients are satisfied and able to judge the care </li></ul><ul><li>3rd class patients are grateful and have no option but to trust </li></ul><ul><li>2nd class patients are most critical about the care </li></ul><ul><li>Patients with a higher level of education seem be able to build a trust-based relationship, leading to better access to information and compassionate human interaction. </li></ul><ul><li>Small difference in service between 2nd and 3rd class </li></ul><ul><li>Big difference in service between 2nd and 1st class </li></ul>Empowerment Indonesian nurses
  33. 33. General Conclusions (2) Patients’ view Quality of care <ul><li>Most important: trust and family </li></ul><ul><li>Patients observe lack of trust between doctors and nurses, resulting in lack of trust by patients towards nurses. </li></ul><ul><li>They see that nurses are still in many cases treated as the doctor’s helper, with little or no authority of their own. So how can they trust the nurse, if the doctor does not? </li></ul><ul><li>A good communication and cooperation between nurses and doctors would lead to nurses who are empowered to handle situations more effective and inform doctors about Patients’ questions, doubts, anxieties and complaints, leading to reduced waiting time. </li></ul>Empowerment Indonesian nurses
  34. 34. General Conclusions (3) Patients’ view Quality of care Opinion of nurses in previous study “ Empowerment of nurses in Indonesia” (206) is in line with the perception of patients’. An exception is that nurses perceive they are valued more than the doctor, because they provide more personal attention and compassionate care. In contrast, the Patients in 2 nd and 3 rd class complain that nurses spend more time in their nursing post than in taking care of Patients. Last but not least it is likely that empowerment of nurses influences the quality of care. Empowerment Indonesian nurses
  35. 35. Conclusions four dimensions Patient centred care (4) Patients’ view Quality of care Access to information should be given about disease: treatment, side-effects, alternatives and aftercare in a proactive, empathic but honest way, sometimes with a sense of humour, taking into account the level of communication of the patient. They feel receiving information is healing. Empowerment Indonesian nurses
  36. 36. Conclusions four dimensions Patient centred care (5) Patients’ view Quality of care Compassionate human interaction means nurses being reassuring; personal attention, showing real interest and find time to listen; professional with the appropriate knowledge, skills and attitude (polite); not task centred but human centred. Patients want doctors and nurses to treat them like family…. Empowerment Indonesian nurses
  37. 37. Conclusions 4 dimensions Patient centred care(6) Patients’ view Quality of care Social support systems : family in 3rd and 2nd class is present 24 hours a day, which makes patients feel more safe. Also patients among themselves take care of each other when necessary Healing environment : a bell in case something is wrong for 2nd and 3rd class, clean bathroom nearby. Empowerment Indonesian nurses
  38. 38. Strategic Recommendations (1) Patients’ view Quality of care Empowerment Indonesian nurses <ul><li>Education </li></ul><ul><li>Integrate the model of empowerment of Indonesian nurses and quality of care in the nursing education in Indonesia </li></ul><ul><li>Implement the 4 dimensions of Patient-centred care, placed in the heart of the model, to raise education to international standards. </li></ul><ul><li>Upgrade Diploma 3 to S1 (bachelors) </li></ul><ul><li>Continue with specializations </li></ul>
  39. 39. Strategic recommendations (2) Patients’ view Quality of care Empowerment Indonesian nurses <ul><li>International cooperation </li></ul><ul><li>Curriculum development </li></ul><ul><li>Competency development </li></ul><ul><li>Education and clinical training </li></ul><ul><li>Master programs and specializations </li></ul><ul><li>National cooperation </li></ul><ul><li>Necessity to cooperate with doctors on equal terms, find modern thinking doctors who are supporting empowerment of nurses. This will be helpful creating a trust-based relationship with the patieny </li></ul>
  40. 40. Scientific recommendations Patients’ view Quality of care Empowerment Indonesian nurses <ul><li>Increase validity and reliability of this single-case study by: </li></ul><ul><li>Extending the present study to a multiple-case study in two phases: </li></ul><ul><li>Replication of study in some other provinces in </li></ul><ul><li>comparable hospitals, using the same qualitative </li></ul><ul><li>approach and methods. </li></ul><ul><li>2. Test and generalize the results of this cross- </li></ul><ul><li>case study statistically using a quantitative </li></ul><ul><li>approach. </li></ul>
  41. 41. Implementation Patients’ view Quality of care Empowerment Indonesian nurses Hopefully this research will be helpful to lift the quality of healthcare to international standards, meeting the needs of patients in Indonesia Thank you for your attention

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