This document summarizes a study on the influence of nurse empowerment on quality of care from the patient's perspective in Indonesia. The study used qualitative methods including interviews with patients from different socioeconomic classes at a hospital. Key findings were that higher class patients were more satisfied with care due to better access to information and compassionate care. Lower class patients relied more on family and had less access to care. Overall, patients saw a lack of trust and cooperation between nurses and doctors, and felt nurses had little authority. The study recommends empowering nurses through education reform and increasing collaboration between nurses and doctors to improve patient-centered care and quality of care.

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

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. 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. 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. 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. 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

13. Access to information 1 st class Patients’ view Quality of care Discussion healthcare team and patient

14. Healing environment 1 st class Patients’ view Quality of care Empowerment Indonesian nurses

15. Nursing post 1 st class Patients’ view Quality of care Empowerment Indonesian nurses

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. 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. 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. 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. 2 nd class ward Patients’ view Quality of care Empowerment Indonesian nurses

21. 2 nd class Healing environment Patients’ view Quality of care Empowerment Indonesian nurses

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. 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

26. Access to information 3 rd class Patients’ view Quality of care Doctor, please talk to me

27. Family 3 rd class Patients’ view Quality of care Empowerment Indonesian nurses

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. 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. 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

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. 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. 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. 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

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