Di Brown, Indonesia
27 May 2010
Di Brown, working as a Nurse Educator at Sanglah Hospital in
Bali, introduces patient-centred care and a nursing handover
card, changing attitudes, improving care and garnering the
attention of the Indonesian Minister of Health.
There is no culture in Indonesian hospitals of patient
empowerment or practice of involving them directly in decisions
about their care. One of the first changes introduced by the AVI
volunteer at Sanglah Hospital last year was a move from nurses
giving handover between shifts at the whiteboard to nurses giving
handover by the patient's bed. This was a big change but one that
was embraced enthusiastically by both patients and nurses.
Initially the nurses were very nervous about giving their
handover in front of the patients, they were worried that they may
not know how to answer patient's questions and also that patients
may not like being discussed in front of other patients in the
ward. Training was provided and a series of protocols and
guidelines were developed. The item that proved the most useful was
a Handover Card which outlined the process step by step and which
was given to each nurse. The left had side of the card summarises
each step and the right hand explains the process and principles of
the changes. The underlying philosophy for patient-centred care
is..."if it's about me...not without me."
Evaluation of the improvement has shown that nurses' caring
behaviours such as touching, talking, smiling, and explaining have
increased by more than 50% following the introduction of this
process. Patients and families say they feel much more satisfied
with their care as they are introduced to the oncoming nurses each
shift and have an opportunity to ask questions and to understand
what the plan of care is for each day. The process has enhanced the
professional standing of the nurses who are taking a more active
role in responding to patient questions.
The Handover Card won the annual Quality Award at Sanglah
Hospital and it will be presented at the National Quality Awards
later in 2010. The Indonesian Minister of Health was at Sanglah for
the presentation and has asked that this process be implemented in
Government Hospitals throughout Indonesia. The AVI volunteer is
working with the nurses at Sanglah to develop a learning package
which can be distributed nationally during 2010.
Di Brown, RN, PhD