Establishing Palliative Nursing Organization to Foster Palliative Care Literacy and Services in Indonesia: An Embedded Mixed Methods Study

Document Type : Original Article

Authors

1 Department of Medical-Surgical Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia

2 Lotus Care, Wound and Palliative Homecare Center, Private Clinic, Yogyakarta, Indonesia.

3 School of Nursing, Faculty of Science and Technology, Universitas Sembilanbelas November Kolaka, Indonesia

Abstract

Background and Objectives: The proactive activities of professional organizations have significantly contributed to improving nurses’ knowledge related-specialty in order to improve health care services quality offered by nurses. Since the palliative care improvement and development in Indonesia remain still in their infancy, and the organization of palliative care for Indonesian nurses has not been established yet, it is imperative to investigate the Indonesian nurses’ viewpoints concerning the importance of establishing a palliative nursing organization in fostering palliative care services in Indonesia. This study aimed to identify what kind of palliative care related activities are carried out by Indonesian nurses and what are the perspectives of nurses regarding the importance of establishing palliative nursing organizations in Indonesia.

Materials and Methods: A national study was conducted using an embedded mixed-methods design, for which the quantitative and qualitative data were collected and analyzed in the same time period from October – December 2020.

Results: There were a total of 552 (92%) respondents who participated through WhatsApp, and Telegram platforms, and completed our online survey. There were four themes and nine sub themes found in this study: namely, services improvement (quality improvement, and literacy improvement sub themes), human resource development (knowledge development, individual nurse development, and professional development sub-themes), boarding and information source (boarding, and information source sub themes), and policy and legality (policy, and legality sub themes).

Conclusion: While barriers exist, respondents confirmed the importance of establishing an Indonesian palliative nursing organization. Establishing a palliative nursing organization could be an important step in developing palliative care in Indonesia.

Keywords


Acknowledgments: We thank members of Forum Perawat Minat Paliatif Indonesia who provided support and voluntarily participated in the study. 


Availability of data and materials: The anonymized datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

 

Conflicts of interests: We declare that there is no conflict of interest.


Consent for publication: not applicable.


Ethical approval and consent to participate: The study was conducted in accordance with the Declaration of Helsinki. This research has been approved by Health Research Ethics Committee of Ikatan Ahli Kesehatan Masyarakat Indonesia Provinsi Sulawesi Tenggara,” with number decree (138/KEPK-IAKMI/XI/2020). Informed Consent was conducted online via google form by all nurses as participants in this research.

 

Funding: This research have no receive any fund or grants.


Author contributions: All authors equally contribute.

1- Soebadi RD, Tejawinata S. Indonesia: status of cancer pain and palliative care. Journal of Pain and Symptom Management. 1996 Aug;12(2):112-5.
https://doi.org/10.1016/0885-3924(96)00090-5
 
2- Ministry of Heatlh. Keputusan Menteri Kesehatan Republik Indonesia Nomor 812/Menkes/SK/VII/2007 tentang Kebijakan Perawatan Paliatif. 2007.    
 
3- Putranto, R., Mudjaddid, E., Shatri, H. et al. Development and challenges of palliative care in Indonesia: role of psychosomatic medicine. BioPsychoSocial Med 11, 29 (2017). https://doi.org/10.1186/s13030-017-0114-8
https://doi.org/10.1186/s13030-017-0114-8
 
4- Effendy C, Agustina HR, Kristanti MS, Engels Y. The nascent palliative care landscape of Indonesia. European Journal of Palliative Care. 2015 Jan 1;22(2):98-101.    
 
5- Witjaksono MA, Effendy C, Mulatsih S, Dwiprahasto I, Utarini A. Criteria for palliative care referral in oncology practice: an instrument development. Bali Medical Journal. 2021 Apr 30;10(1):281-290.
https://doi.org/10.15562/bmj.v10i1.2120
 
6- Effendy C, Vissers K, Woitha K, van Riet Paap J, Tejawinata S, Vernooij-Dassen M, Engels Y. Face-validation of quality indicators for the organization of palliative care in hospitals in Indonesia: a contribution to quality improvement. Supportive Care in Cancer. 2014 Dec;22(12):3301-10.
https://doi.org/10.1007/s00520-014-2343-8
 
7- Rochmawati E, Wiechula R, Cameron K. Current status of palliative care services in Indonesia: a literature review. International Nursing Review. 2016 Jun;63(2):180-90.
https://doi.org/10.1111/inr.12236
 
8- Hertanti NS, Huang MC, Chang CM, Fetzer SJ, Kao CY. Knowledge and comfort related to palliative care among Indonesian primary health care providers. Australian Journal of Primary Health. 2021 Jan 11;26(6):472-8.
https://doi.org/10.1071/PY20111
 
9- Al Qadire M. Knowledge of palliative care: an online survey. Nurse Education Today. 2014 May 1;34(5):714-8.
https://doi.org/10.1016/j.nedt.2013.08.019
 
10- Seymour J, Clark D, Bath P, Beech N, Corner J, Douglas HR, Halliday D, Haviland J, Marples R, Normand C, Skilbeck J. Clinical nurse specialists in palliative care. Part 3. Issues for the Macmillan Nurse role. Palliative Medicine. 2002 Jul;16(5):386-94.
https://doi.org/10.1191/0269216302pm586oa
 
11- Sekse RJ, Hunskår I, Ellingsen S. The nurse's role in palliative care: a qualitative meta‐synthesis. Journal of Clinical Nursing. 2018 Jan;27(1-2):e21-38.
https://doi.org/10.1111/jocn.13912
 
12- Ting R, Edmonds P, Higginson IJ, Sleeman KE. Palliative care for patients with severe COVID-19. BMJ. 2020 Jul 14;370.
https://doi.org/10.1136/bmj.m2710
 
13- Radbruch L, Knaul FM, de Lima L, de Joncheere C, Bhadelia A. The key role of palliative care in response to the COVID-19 tsunami of suffering. The Lancet. 2020a May 9;395(10235):1467-9.
https://doi.org/10.1016/S0140-6736(20)30964-8
 
14- Radbruch L, De Lima L, Knaul F, Wenk R, Ali Z, Bhatnaghar S, Blanchard C, Bruera E, Buitrago R, Burla C, Callaway M. Redefining palliative care: a new consensus-based definition. Journal of pain and symptom management. 2020b Oct 1;60(4):754-64.
https://doi.org/10.1016/j.jpainsymman.2020.04.027
 
15- Matthews J. Role of professional organizations in advocating for the nursing profession. Online J Issues Nurs. 2012 Jan 1;17(3).
https://doi.org/10.3912/OJIN.Vol17No01Man03
 
16- Lane R, Halcomb E, McKenna L, Zwar N, Naccarella L, Davies GP, Russell G. Advancing general practice nursing in Australia: roles and responsibilities of primary healthcare organisations. Australian Health Review. 2017 Apr 26;41(2):127-32.
https://doi.org/10.1071/AH15239
 
17- Lowe G, Jennings T. Nurse Practitioner Professional Nursing Organisation Engagement. The Journal for Nurse Practitioners. 2017 Oct 1;13(9):642.
https://doi.org/10.1016/j.nurpra.2017.09.007
 
18- Yoo JY, Kim JH, Kim JS, Kim HL, Ki JS. Clinical nurses' beliefs, knowledge, organizational readiness and level of implementation of evidence-based practice: the first step to creating an evidence-based practice culture. PloS ONE. 2019 Dec 26;14(12):e0226742.
https://doi.org/10.1371/journal.pone.0226742
 
19- Braun V, Clarke V. Reflecting on reflexive thematic analysis. Qualitative research in sport, exercise and health. 2019 Aug 8;11(4):589-97.
https://doi.org/10.1080/2159676X.2019.1628806
 
20- Hagan TL, Xu J, Lopez RP, Bressler T. Nursing's role in leading palliative care: a call to action. Nurse Educ Today. 2018 Feb;61:216-219. doi:10.1016/j.nedt.2017.11.037.
https://doi.org/10.1016/j.nedt.2017.11.037
 
21- Effendy, C., Silva, J. F. D. S., & Padmawati, R. S. (2022). Identifying palliative care needs of patients with non-communicable diseases in Indonesia using the SPICT tool: a descriptive cross-sectional study. BMC Palliative Care, 21(1), 1-8.
https://doi.org/10.1186/s12904-021-00881-5
 
22- Hospice and Palliative Nurses Association. (2006). Standards for clinical practicum in palliative nursing for practicing professional nurses. Accessed June, 19, 2020.    
 
23- Afolabi A, Fernando S, Bottiglieri T. The effect of organisational factors in motivating healthcare employees: a systematic review. British Journal of Healthcare Management. 2018 Dec 2;24(12):603-10.
https://doi.org/10.12968/bjhc.2018.24.12.603
 
24- Gagnon MP, Payne-Gagnon J, Fortin JP, Paré G, Côté J, Courcy F. A learning organization in the service of knowledge management among nurses: a case study. International Journal of Information Management. 2015 Oct 1;35(5):636-42.
https://doi.org/10.1016/j.ijinfomgt.2015.05.001
 
25- Brekelmans G, Maassen S, Poell RF, Weststrate J, Geurdes E. Factors influencing nurse participation in continuing professional development activities: Survey results from the Netherlands. Nurse Education Today. 2016 May 1;40:13-9.
https://doi.org/10.1016/j.nedt.2016.01.028
 
26- Schoo A, Lawn S, Carson D. Towards equity and sustainability of rural and remote health services access: supporting social capital and integrated organisational and professional development. BMC Health Services Research. 2016 Dec;16(1):1-5.
https://doi.org/10.1186/s12913-016-1359-9
 
27- Duarte MB. Organisational and professional commitments: the influence in nurses' organisational citizenship behaviours. Tékhne. 2015 Jan 1;13(1):2-11.
https://doi.org/10.1016/j.tekhne.2015.03.001
 
28- Légaré F, Borduas F, Freitas A, Jacques A, Godin G, Luconi F, Grimshaw J, CPD-KT team. Development of a simple 12-item theory-based instrument to assess the impact of continuing professional development on clinical behavioral intentions. PloS ONE. 2014 Mar 18;9(3):e91013.
https://doi.org/10.1371/journal.pone.0091013
 
29- De Lima L, Bruera E. The Pan American Health Organization: its structure and role in the development of a palliative care program for Latin America and the Caribbean. Journal of Pain and Symptom Management. 2000 Dec 1;20(6):440-8.
https://doi.org/10.1016/S0885-3924(00)00216-5
 
30- Smyth D. Politics and palliative care: Indonesia. International Journal of Palliative Nursing. 2013 Jun;19(6):310-.
https://doi.org/10.12968/ijpn.2013.19.6.310