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.