Handing over skills in Indonesia

Sharon Humphries finds out how volunteering can make a world of difference.

Each day brings new challenges for volunteer nurse educator Di Brown, on assignment in an under-resourced hospital in Bali. More than half way through a two year assignment with Australian Volunteers International (AVI), Brown works alongside Balinese nurses to increase their knowledge and capacity to care for patients.

Working in Bali's Sanglah Hospital - one of the most renowned hospitals in the region for its vital role in the care of the 2002 bomb victims - Brown says it didn't take long to realise how lucky Australian's are. "We live in a first world country" she says of Australia's health care standards, in comparison to where she is working attempting to make "high impact at low cost".

Reasons why skills are lacking in Indonesia's health care system, according to Brown, is that there is no registration and local hospitals are reluctant to employ graduate nurses.

"The majority of care is carried out by nurses with diploma level qualifications, more or less equivalent to an enrolled nurse in Australia. At Sanglah Hospital only 19 of 974 nurses hold degrees in nursing. This means that even senior managers may only hold the equivalent qualification of an enrolled nurse," says Brown.

Her first achievement in increasing the knowledge of this staff was the introduction of a handover card in one department.

"Traditionally handover was completed at the whiteboard at the nurse's desk. Handover would consist of stating the patient's name, their diagnosis and whether or not they were having intravenous fluids or IV drug therapy," she says.

Brown was able to encourage the nurses to move handover to the patient's bed in an effort to make treatment patient-focused.

"This change has been enthusiastically embraced by both patients and nurses" she says.

"Initially the nurses were nervous about giving their handover in front of the patients. They were worried they wouldn't be able to answer patient questions. Culturally, patients tend to be compliant and won't ask any questions about their treatment".

Training of the nursing staff was provided by Brown and a series of protocols and guidelines were developed, outlining the step by step process of handover with a focus on patient care. Each nurse received a handover card, the underlying philosophy for the change to 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 per cent following the introduction of the handover card. 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 their care plan, a standard we take for granted in Australia. The process has enhanced the professional standing of the nurses who's taking a more active role in responding to patient questions.

In conjunction with nursing managers, Brown has instigated other projects that include implementing a new manual handling program, developing the role of nurse educators and a continuing professional development program and revising nursing documentation. Some nurses have been able to travel to Royal Darwin for training. Brown is hopeful that his project will continue for the next five years improving nursing skills and assisting professional development.

Brown recognises "there is a long way to go" but enjoys observing changes that are happening and the enthusiasm and engagement of the local nurses will ensure that the changes that have been made are sustainable and ongoing.

For more information about nursing roles with AVI visit www.australianvolunteers.com

Sharon Humphries is a registered nurse and training and development consultant at Australian Volunteers International.

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