Public Hospitals In Indonesia Research Articles

The Feeling of Surrender: Patients’ Perceptions of their Interactions with Nurses

Background Meaningful nurse-patient interaction is crucial to achieving better health outcomes. A nurse should understand the importance of tailored effective communication to understanding how each patient prefers to be treated. Nurse-patient interaction is a potential resource to promote hope, meaning and purpose in life, which results in harmony and healing environment. Previous studies have shown a variety of aspects of nurse-patient interaction, however the process of interaction have not been thoroughly investigated from the patients’ viewpoint. This qualitative study aimed to investigate patients’ perceptions of their interactions with nurses in the hospital wards. Method A phenomenological approach was undertaken in one public hospital in Indonesia. 10 participants were recruited from general wards by purposeful sampling method. The data were collected through observations of nurse-patient interaction, the ward atmosphere as well as the activities by semi-structured interviews. Transcripts were then examined and analyzed by Interpretive Phenomenological Analysis (IPA) approach. Result Three themes were extracted from data analysis including saying sorry for neglecting me, calming the atmosphere for nurses’ openness and feeling surrender to destiny. Discussion and Conclusion Based on the results, issues such nurses’ openness and positive atmosphere in the hospital wards are shown to be important in maintaining the best quality of nurse-patient interactions. Nurses should be aware of these factors during interactions with patients

When Conflict be a Trigger of Depression: between Job and Life Satisfaction

The objective of this study is to investigate the effect of work-family conflict and family-work conflict on depression behavior mediated by job satisfaction and life satisfaction. The respondents in this research were 133 female nurses in two public hospitals in Indonesia. Methods of data collection were by using observation, interviews, and questionnaires. The sampling technique used the technique of proportional random sampling. Methods of data analysis were by using factor analysis, regression analysis and path analysis. Data analysis were by using SPSS software version 21. The results show that all hypothesis in the research were supported. Work-family conflict has an effect on depression behavior either directly or mediated by job satisfaction and life satisfaction. Similarly, the work-family conflict has an impact on the behavior of depression either direct or mediated by job satisfaction and life satisfaction. Our findings bear out the notion that job satisfaction and life satisfaction mediates the influence of dual role conflict on depression, highlighting the effect of individual satisfaction within this area. The suggestions for nurses, they should improve job satisfaction and life satisfaction so that it can overcome the dual role conflict they suffered.

28. The massive problem of preeclampsia in indonesia: In need of a redesigned national health care system

Preeclampsia is a global maternal health burden due to its high maternal mortality and morbidity, especially in low income countries like Indonesia. The present national multicenter study was conducted to evaluate the characteristics and outcomes of preeclampsia in Indonesia, that has never been published before. This is a one year (2016) retrospective multicenter study of all preeclampsia cases in seven tertiary referral centers in Indonesia: Medan, Bandung, Semarang, Solo, Surabaya, Bali, and Manado. Among the total 1232 preeclampsia (PE) cases registered, late-onset preeclampsia (>34 weeks) was the most common PE phenotype; 54% compared with 48% early-onset PE. Many of the preeclamptic women had known risk factors for preeclampsia, including anemia (26%), obesity (10%), and chronic hypertension (8%). Maternal mortality was quite high (2.2%). Maternal complications were dominated by HELLP syndrome (9.8%) and pulmonary edema (6.5%). About 11.9% of the mother required ICU admission. Most of our patients underwent cesarean Section (52.8%). Perinatal mortality rate was 12%. The most frequent perinatal complication was asphyxia (27%). 11% of these newborn needed NICU admission. In contrast to most Western countries, the rate of preterm PE and pulmonary edema in Indonesia seems much higher than published. The new format of our national health coverage (BPJS) does often not cover the real cost of hospital treatment. The true hospital costs is in more than 93% of preeclampsia patients exceeding the BPJS funding, and the excess costs must be borne solely by the hospital. As such PE represents also a major financial problem for the already struggling public hospitals in Indonesia. Preeclampsia stands out as a massive health care problem in Indonesia. Improving quality and consistency of antenatal care and a complete redesign of the national health care insurance system will be the pivotal steps forward to reduce its terrible impact.

Utility of SOFA score, management and outcomes of sepsis in Southeast Asia: a multinational multicenter prospective observational study

BackgroundSepsis is a global threat but insufficiently studied in Southeast Asia. The objective was to evaluate management, outcomes, adherence to sepsis bundles, and mortality prediction of maximum Sequential Organ Failure Assessment (SOFA) scores in patients with community-acquired sepsis in Southeast Asia.MethodsWe prospectively recruited hospitalized adults within 24 h of admission with community-acquired infection at nine public hospitals in Indonesia (n = 3), Thailand (n = 3), and Vietnam (n = 3). In patients with organ dysfunction (total SOFA score ≥ 2), we analyzed sepsis management and outcomes and evaluated mortality prediction of the SOFA scores. Organ failure was defined as the maximum SOFA score ≥ 3 for an individual organ system.ResultsFrom December 2013 to December 2015, 454 adult patients presenting with community-acquired sepsis due to diverse etiologies were enrolled. Compliance with sepsis bundles within 24 h of admission was low: broad-spectrum antibiotics in 76% (344/454), ≥ 1500 mL fluid in 50% of patients with hypotension or lactate ≥ 4 mmol/L (115/231), and adrenergic agents in 71% of patients with hypotension (135/191). Three hundred and fifty-five patients (78%) were managed outside of ICUs. Ninety-nine patients (22%) died. Total SOFA score on admission of those who subsequently died was significantly higher than that of those who survived (6.7 vs. 4.6, p < 0.001). The number of organ failures showed a significant correlation with 28-day mortality, which ranged from 7% in patients without any organ failure to 47% in those with failure of at least four organs (p < 0.001). The area under the receiver operating characteristic curve of the total SOFA score for discrimination of mortality was 0.68 (95% CI 0.62–0.74).ConclusionsCommunity-acquired sepsis in Southeast Asia due to a variety of pathogens is usually managed outside the ICU and with poor compliance to sepsis bundles. In this population, calculation of SOFA scores is feasible and SOFA scores are associated with mortality.Trial registrationClinicalTrials.gov, NCT02157259. Registered 5 June 2014, retrospectively registered.

The Effect of Internal Control by using COSO Framework on Revenue Toward Employee Performance: A Case Study in Public Hospital of South of Tangerang, Indonesia

The study aims to investigate the effect of internal control by using COSO Framework on Employee Performance in public hospital in South of Tangerang, Indonesia. The study use public hospital which owned by Indonesian local government as sample of the study In addition, twenty respondents are participated of the study which consists of accounting & finance staff, cashier, internal audit/control unit and head of finance department. There are five elements of COSO framework that implement in the business activities and the study finds only two element of COSO framework i.e., control activities and risk assessment have significant effect to employee performance in a public hospital in Indonesia while the others element such as, control environment, information and communication and monitoring have not significant effect to employee performance. It indicates that implementation of policies and rules regulations play significant role to enhance employee performance. in addition, it also indicates rewards and punishment as a tool to control the employee and lead to employee performance.

Risk Factors for Multidrug Resistant (MDR) in Tuberculosis Patients at Public Hospitals in Indonesia

Risk Factors for Multidrug Resistant (MDR) in Tuberculosis Patients at Public Hospitals in Indonesia

Causes and outcomes of sepsis in southeast Asia: a multinational multicentre cross-sectional study.

BackgroundA better understanding of pathogens causing sepsis is important for management and antimicrobial selection. Here, we explored the causative pathogens of sepsis in Southeast Asia (SEA).MethodsWe prospectively recruited children (age≥30 days and <18 years) and adults (age≥18 years) at 13 public hospitals in Indonesia (n=3), Thailand (n=4) and Viet Nam (n=6). Hospitalised patients with suspected or documented community-acquired infection, with ≥3 diagnostic criteria for sepsis according to the Surviving Sepsis Campaign 2012, and within 24 hours of admission were enrolled. Blood from every patient, and nasopharyngeal swab, urine, stool and cerebrospinal fluid, if indicated, were collected for reference diagnostic tests. This study was registered with ClinicalTrials.gov, number NCT02157259.FindingsFrom December 2013 to December 2015, 1,578 patients (763 children and 815 adults) were enrolled. Dengue viruses (n=122, 8%), Leptospira spp. (n=95, 6%), rickettsial pathogens (n=96, 6%), Escherichia coli (n=76, 5%) and influenza viruses (n=65, 4%) were commonly identified in both age groups, while Plasmodium spp. (n=12, 1%) and Salmonella enterica serovar Typhi (n=3, 0.2%) were rarely observed. Emerging pathogens identified included hantaviruses (n=28, 2%), non-typhoidal Salmonella spp (n=21, 1%), Streptococcus suis (n=18, 1%), Acinetobacter spp. (n=12, 1%), and Burkholderia pseudomallei (n=5, 0.3%). 28-day mortality was 2% in children (14/731) and 13% in adults (108/804). Severe sepsis was identified on enrolment in 27% of children (204/763) and 68% of adults (550/815), and was associated with increased mortality (adjusted odds ratio 5.3, 95% confidence interval 2.7–10.4, p<0.001).InterpretationSepsis in SEA is caused by a wide range of known and emerging pathogens, and is associated with substantial mortality.FundingNational Cancer Institute (HHSN261200800001E) and National Institute of Allergy and Infectious Diseases, National Institutes of Health, and Wellcome Trust (106680/B/14/Z and 106698/B/14/Z).

Approaches Used in the Interactions between Health Care Professionals and Patients in Diabetes Care in Indonesia

Background: Patients with diabetes require self-management support in order to manage the disease. Little is known about how patients with diabetes have been supported by the health care professionals in Indonesia. Objective: This study explored the nature of interaction between health care professionals and patients in a major public hospital in Indonesia and, specifically, identified the approaches used in the care of patients. Methods: A single case study strategy was employed and 37 direct observations of clinical encounters of patients with diabetes with the health care professionals were conducted. Results: The main themes emerging from analysis across the sources of data included: the outcome of blood sugar level results are suspected as patient noncompliance; communication is mostly driven by the health care professionals; medical content is the focus of clinical encounters; patient education is reactive and focused on the negative aspects of having diabetes; the privileging of medical care approach; passive role shown among patients with diabetes; nurses focus on the heavy administrative workload; and low health literacy issues among the patients with diabetes. These findings demonstrate that Indonesia as a developing country is embracing a medical approach of care while struggling to provide quality care with limited health care resources. Conclusion: The medical paradigm was still embedded and guided the daily care provided for patients with diabetes. Thus, a critical adoption of an approach that supports patient self-management to the Indonesia's diabetes care is necessary.

Does corporatisation improve organisational commitment? Evidence from public hospitals in Indonesia

This study aims to investigate the consequences of corporatisation on organisational commitment and to explain the relationship between work values, job satisfaction and organisational commitment. The research was carried out in 54 public hospitals in East Java, Indonesia, applying a multilevel structural equation model to survey data on 1282 workers in those hospitals. Analysis suggests that the longer a hospital has been corporatised, the greater the organisational commitment of its employees. Incentives have positive and substantive association with organisational commitment, while training and resource availability do not. We found that employees in larger hospitals are more committed than those in smaller hospitals and that work values and job satisfaction have a positive and significant relationship with organisational commitment. Our findings shed light on the debate on corporatisation as a lever for improving organisational commitment in public hospitals in developing countries.

Effects of Introducing Xpert MTB/RIF on Diagnosis and Treatment of Drug-Resistant Tuberculosis Patients in Indonesia: A Pre-Post Intervention Study.

BackgroundIn March 2012, the Xpert MTB/RIF assay (Xpert) was introduced in three provincial public hospitals in Indonesia as a novel diagnostic to detect tuberculosis and rifampicin resistance among high risk individuals.ObjectiveThis study assessed the effects of using Xpert in place of conventional solid and liquid culture and drug-susceptibility testing on case detection rates, treatment initiation rates, and health system delays among drug-resistant tuberculosis (TB) patients.MethodsCohort data on registration, test results and treatment initiation were collected from routine presumptive patient registers one year before and one year after Xpert was introduced. Proportions of case detection and treatment initiation were compared using the Pearson Chi square test and median time delays using the Mood’s Median test.ResultsA total of 975 individuals at risk of drug-resistant TB were registered in the pre-intervention year and 1,442 in the post-intervention year. After Xpert introduction, TB positivity rate increased by 15%, while rifampicin resistance rate reduced by 23% among TB positive cases and by 9% among all tested. Second-line TB treatment initiation rate among rifampicin resistant patients increased by 19%. Time from client registration to diagnosis was reduced by 74 days to a median of a single day (IQR 0–4) and time from diagnosis to treatment start was reduced by 27 days to a median of 15 days (IQR 7–51). All findings were significant with p<0.001.ConclusionCompared to solid and liquid culture and drug-susceptibility testing, Xpert detected more TB and less rifampicin resistance, increased second-line treatment initiation rates and shortened time to diagnosis and treatment. This test holds promise to improve rapid case finding and management of drug-resistant TB patients in Indonesia.

Distribution and engagement of specialist doctors in public hospitals in Indonesia

Background Unequal distribution of specialist doctors in Indonesia has been identified many years ago. Government has taken several measures to address this issue. However the phenomenon is still present today. In the year 2014, Indonesia will apply universal health coverage which needs specialist doctors to support it. The failure to provide specialist doctors would increase inequity, particularly for those who live in islands, border, and remote areas. On the other hand, specialist doctors who are appointed by public hospitals as full-time doctors, do a dual practice. They spend more time in other institutions rather than in public hospitals. This study aimed to examine the association among demographic factors, number of hospitals, type of hospitals with distribution of specialist doctors, and to measure the level of engagement of specialist doctors in the public hospitals as their main designation.

The Prevalence and Subtype Distribution of Hepatitis C Virus Infection among Hemodialysis Patients in a Private Hospital in Surabaya, Indonesia

The prevalence of hepatitis C virus (HCV) infection has been as high as approximately 80% in patients with maintenance hemodialysis in public hospitals in Indonesia. However, the prevalence in private hospitals has not been examined yet. The aim of this study was to investigate the prevalence of anti-HCV antibody and the subtype distribution in patients with hemodialysis in a private hospital in Surabaya, Indonesia. Sera were obtained from 41 hemodialysis patients in a private hospital in Surabaya. The positive prevalence of anti-HCV antibody was carried out by the enzyme-linked immunosorbent assay (ELISA). Anti-HCV-positive sera were subjected to reverse transcription-PCR (RT-PCR) to detect HCV RNA and then direct sequencing. The HCV subtype was examined by phylogenetic analysis. Twenty five patients (61%) out of 41 were positive for anti-HCV antibody, and HCV-RNA was detected in 19 patients. The positive prevalence of anti-HCV antibody was 7.7% (one out of 13 patients) among patients who had undergone hemodialysis for less than one year, whereas it was 85.7% (24 out of 28 patients) among patients who had undergone hemodialysis for over one year. Phylogenetic analysis revealed HCV-1a (52.6%) was the most common subtype, followed by 1b (15.8%), 1c (15.8%), 2a (5.3%), and 3k (5.3%). In conclusion, the prevalence of HCV infection among hemodialysis patients in a private hospital was as high as that in general hospitals. The predominant subtype was HCV-1a, which is in accordance with the previous studies in general hospitals in Surabaya, Indonesia.