British Council Researcher Links initiative – Call for workshop proposals

The British Council has re-opened the call for workshop proposals under the Researcher Links initiative. They are inviting Leading Researchers to propose themes for bilateral workshops to be held in one of the 18 partner countries (see below), which will bring together early-career researchers to discuss their research and start to build international relationships. Successful workshops will receive funding, and the applicants (Leading Researchers) will, with the exception of certain countries, be responsible for organising the workshop. Some countries have priority areas, and only themes within these will be considered. Please read the guidelines document for details.

Country list 2014-15: Azerbaijan, Bangladesh, Brazil, Colombia, Egypt, Indonesia, Kazakhstan, Malaysia, Mexico, Morocco, Nigeria, Pakistan, Qatar, Russia, South Africa, Thailand, Turkey and Vietnam.

For full details on application, please go to the British Council website: http://www.britishcouncil.org/society/science/funding-opportunities/researcher-links-workshops-call

A COMPARATIVE STUDY OF NURSING EDUCATIONAL SYSTEM IN INDONESIA AND JAPAN

Citation for this article:
Nugraha S, Tanaka M, Efendi F. A Comparative Study of Nursing Educational System in Indonesia and Japan. Vol. 3 No.2 October 2008-March 2009, Jurnal Ners

ABSTRACT
According to Economic Partnership Agreement (EPA) between Indonesia and Japanese governments, Japanese government plans to recruit Indonesian nurses and caregivers to fulfill the demand of those positions at the hospital and health centers. However, to be a qualified worker in Japan, one has to pass a national examination that is conducted by the Minister of Health, Labor and Welfare for a license of a registered nurse within 3 or 4 years of working as a nurse or caregivers, respectively. Having considered that matter, a comparative study of the background of educational systems in Indonesia and Japan is discussed in this paper, with particular reference to the Diploma 3 nursing program.
There is no specific difference between Indonesian and Japanese nursing educational systems. However, current health condition of the countries remains as the focus of the curriculums where Indonesian nursing education is focusing on communicable disease and surgery nursing, whereas Japanese is focusing on gerontology and chronic disease nursing. In case of qualification method, Japanese nurses should undertake national board examination to be a qualified nurse. On the other hand, there is no national board examination for Indonesian nurses.
Keywords: nursing educational system, Indonesia, Japan

  1. INTRODUCTION
    Japan and Indonesia have been working toward Economic Partnership Agreement (EPA), a comprehensive bilateral economic agreement that will include liberalization of trade in goods and services, as well as cooperation in the fields of investment, competition policies and people movement (Antara, 2008). As a part of the implementation of Article 7 of EPA regarding with the “people movement”, Japanese government plans to recruit approximately 400 nurses and 600 caregivers within a 2-year-period.
    On 5th August 2008, the first group of Indonesian nurses arrived in Japan. Having been trained for Japanese language and introduced with Japanese nursing systems for the first 6 months since the arrival, they have to face a nursing national board examination. The examination will be conducted in Japanese, using Japanese characters and Chinese characters (Kanji). Furthermore, the nurses and caregivers have to pass a national test within 3 and 4 years working period, respectively, as a requirement to continue the works in Japan.
    The agreement has opened an opportunity for Indonesian nurses to find a new labor market. Indonesian nursing educational institutions graduate approximately 15,000 nurses annually. However, due to inappropriate health care and worker distribution systems, Indonesian labor market can only accept 25% of total nurses (MOHRI, 2006). This agreement also brings some benefits to Indonesian nurses and caregivers i.e. gain new experiences and learn different systems in nursing profession. Therefore, these experiences can be applied in Indonesia or internationally, and the quality of Indonesian nurses will be considered consequently.
    According to Okamoto (1992), improvement in living standards among Japanese people and increasing of medical care usage caused aging population rapidly, decreased the number of death rate for all age groups caused by Tuberculosis and other infectious disease, and falls in mortality among infants, adolescent, and young adult. Increasing the number of aging population means the increasing of demand in medical care. The demand of nursing worker has outpaced the supplies, due to the development of medicines, increasing the number of bed and aging patients. Additionally, a number of nursing workers is required in various areas. Implementation of long?term care insurance encourages to shift the place for treating and rehabilitating patients in chronic illness from hospital to facilities for long term care, in home medical care and visiting nursing. Having considered those conditions, through the EPA agreement, Japanese government has opened the labor market for foreign nurse to meet the demand of nursing staff and caregiver.
    Success of EPA implementation will bring a lot of benefit for both countries, and to achieve that objective, both of Indonesian nurses and Japanese nurses need to understand each other. Indonesia and Japan have different background on language and culture. It will be a big challenge for both nurses while working in the same hospital, although they have the same background on nursing. In case of nursing skill, there is no wonder about the nurse’s skill. It’s because the nurse has the same background on nursing education. And each country has their caring character.
    This paper describes about Indonesian and Japanese nursing educational backgrounds in order to figure out general description of their educational systems. Having comprehended the educational systems, the capability of nurses in knowledge and skill of nursing would be known. The other advantage is to complementing their liability and majority while caring the patients. Comparison of educational background would be the first step to know their competence and potential in the working field. In advance, this comparison will figured their majority and shortage in nursing knowledge. By understanding this condition, Japan and Indonesian nurse will be able to have mutual charge on knowledge and experience in the working field. Besides that, during the EPA agreement on nurse’s recruitment, Indonesian and Japanese nurses will have better preparation in the future recruitment.
    A comparative descriptive study was performed based on databases of published materials and electronic journals. This comparison focused on curriculum that was stipulated by government law for Diploma 3 (D-3) degree of nursing education.
  2. INDONESIAN NURSING
    2.1 Present nursing condition based on educational path
    2.1.1 Educational institution

Figure 1. Indonesian nursing educational path

In general, nursing educational institution in Indonesia consists of two kinds of educational path, i.e. undergraduate program (S-1) and diploma program (D-3), after completing basic educational program at Senior High School (Figure 1). These nursing educational institutions provide the curriculums as stipulated by National Education Systems No. 20/2003 of Ministry of Education, which adopted the recommendation from Indonesian Nurses National Association. 
The numbers of nursing educational institutions in Indonesia are 427 and 173 for D-3 and S-1 levels, respectively, while the average numbers of graduates are 12,810 and 3,460 for D-3 and S-1 levels, respectively (MOHRI, 2006). 

2.1.2 Curriculums
The curriculum of S-1 program consists of academic and professional phases. Having completed academic phase in 8 semesters, students are required to conduct a research that will be examined at the end of the academic phase for a bachelor degree. Furthermore, they have to continue to the professional phase for 2 semesters in order to get a Ners degree. In this phase, students have to conduct nursing practices in a hospital under supervision at 9 division of nursing science, i.e. Nursing Management, Emergency Nursing, Maternity Nursing, Medical Surgical Nursing, Mental Health Nursing, Pediatric Nursing, Family Nursing, Community Nursing, and Geriatric Nursing.
On the other hand, the curriculum of D-3 also consists of the academic phase and the professional phase which can be fulfilled in 6 semesters, but in contrast to the S-1 program, both of the phases are integrated. At the end of each semester of academic activities, students are required to continue directly to the nursing practices in hospitals under a close supervision. The nursing practices from semester 1 to 4 are fulfilled by simple nursing practices, such as taking temperature or measuring blood pressure of patients. Afterwards, for the whole semester 5 and 6, the students are required to conduct comprehensive practices.
These educational institutions provide curriculums for the applicable qualifications as stipulated by law. According to Decree of Ministry of National Education No. 139/U/1999, D-3 program has 96 credits and consist of class lectures, laboratory practices, and clinical trainings with the duration over 4,800 hours (Table 1).

Table 1. Indonesian national curriculum for D-3 program

The nursing school curriculum guideline stipulates the range of class hours per credit i.e.  18 hours for lectures, 36 hours for experiment and skill practices, and 72 hours for clinical trainings. Instead of the above curriculum, each institution has to apply some local curriculums which are decided by each institution for 14 - 24 credits. Each institution determines class hour equivalent to a credit. 

2.2 Professional nurse
2.2.1 Qualification of the nurses
Having graduated from nursing school, one will be qualified to work as a nurse in a hospital as a professional nurse.
Nurses who graduate from Bachelor of nursing called professional nurse and nurse who graduate from Diploma III in nursing called the beginner of professional nurse. Professional nurse is a person who passes the high level of accredited education. The beginner of professional nurse is a nurse who has good knowledge on intellectual, technical, interpersonal and moral, responsible in delivering nursing services based on valid regulation.
2.2.2 Method of qualification
Currently, there is no national board examination for nursing qualification in Indonesia, and Indonesian government and Indonesian nurse association are working toward on creating the national standardization for the nurses.
However, the current valid system is based on the regulation on Decree of Ministry of Health No. 1239/2001 about Nurse Registration and Practice. Having graduated from the nursing school (D-3 and S-1 programs), a student should apply a nursing permit (Surat Ijin Perawat) to the local government at least one month after graduation. Since they hold the nursing permit, they can apply to work in the hospital or other health care center. In addition, each hospital has their own standard on accepting the nurse. In general, the nurses have to pass the hospital pre-employment examination in written and clinical practice test. Having been accepted as an employee of a hospital or health care center, the nurse should apply a working permit (Surat Ijin kerja) which is published according to the results of skill and knowledge assessments, and compliance on nursing ethics.
3. JAPANESE NURSING
3.1 Present nursing conditions based on educational path
3.1.1 Educational institution
There are several educational institutions to be professional nurses in Japan. For registered nurses, the basic route would be to complete senior high school, after that, study at a nursing university (4-year bachelor degree course), junior nursing college (3-year associate degree course) or nursing school (3-year course) (Figure 2). Besides a registered nurse, there is a 2-year course for a nurse assistant. A nurse assistant is defined as a nurse engaged in providing nursing care under instructions from medical doctors or registered nurses.

Figure 2. Japanese nursing educational path

In addition 6-month (normally one year) education is prepared in nursing schools and universities for public health nurses and midwives. Students who graduate from these educational institutions are entitled to take the examination for a registered nurse. In 2006, the numbers of nursing educational institutions in Japan were 158 for universities, 37 for junior colleges, and 512 for nursing schools. 11,906 or 32.7% of nurses graduated from universities, whereas 1,982 or 5.4% of nurses were from junior college, and 22,549 or 61.9 % were from nursing school.
3.1.2 Curriculum
This part would be focused on the curriculum for a registered nurse. The educational institutions provide curriculums for the applicable qualifications as stipulated by law. The credits required to be entitled to take the governmental examination are 97 units for a registered nurse (in 2009, the public health nurse, midwife and nurse regulation have been revised in credits for the enrichment of nursing skills and the ability to deal with nursing ethics, nursing administration and residential nursing in nursing students). The duration of the curriculums is three years (over 3,000 hours of lectures and clinical training).
Each institution determines class hour equivalent to a credit. The nursing school curriculum guideline stipulates the range of class hours per credit i.e. 15-30 hours for lectures, 30-45 hours for experiment and skill practices, and 45 hours for clinical trainings.

Table 2. Japanese national curriculum for D-3 program
3.2 Professional nurse
3.2.1 Qualifications of the nurses
A registered nurse is qualified as a professional nurse by government examination. Having graduated from educational institution that provides curriculum for the applicable qualifications, graduates are entitled to take the governmental examination that was conducted by The Minister of Health, Labor and Welfare, for a license of a registered nurse.
3.2.2 Method of qualification
The national examination for registered nurses consists of essential questions (30 items), general questions (150 items) and questions concerning certain clinical cases (60 items). Questions concerning clinical cases evaluate the ability of nurse in understanding and judgment the situations in which nurses would meet in hospital. Information about the patient such as symptoms, physical and mental condition, age, sex and sociological background are given to answer the questions. Areas of questions are the structure and function of the human body (anatomy, physiology, biochemistry, nutritional science), disease mechanisms and recovery promotion (pathology, pharmacology, microbiology), social security systems and people’s health (public health, social welfare, related lows), fundamental nursing, residential nursing, adult nursing, geriatric nursing, pediatric health nursing, maternal nursing and mental health nursing. All items in the examination are multiple-choice.
Students are required to get a score over a passing standard. Essential questions must be correctly answered in order to pass, otherwise in the case that there are errors these questions the student will fail the examination. The examination pass rates were 90.6% in 2007 and 90.3% in 2008.
4. DISCUSSION
In term of educational path, there is no specific difference between Indonesian and Japanese nursing educational systems, as shown on Table 3. The basic difference is on the method of qualification for the nurses. Japanese nurses should undertake national board examination to be a qualified nurse, whereas there is no national board examination for Indonesian nurses. In addition, current health condition of the countries remains the majority of the curriculums. Indonesian nursing education is focusing on communicable disease and surgery nursing, whereas Japanese is focusing on gerontology and chronic disease nursing.
Table 3. Nursing educational background in Japan and Indonesia for D-3 program
Aspect Indonesia Japan
Content of curriculums Majority in medical surgical nursing Majority in geriatric nursing and adult nursing
Qualification method

No national board examination.  The capability to work selected based on hospital pre-employee examination.
Capability to work selected by the Nursing national board examination. Hospitals conduct an employment test to hire registered nurses.

Contents of the test Written and clinical practice test Written test
Midwife and public health nurse course Separately given in different institution for minimum 3 years course. Given after completing the nursing course in minimum 6 month.

To be qualified as a nurse in Japan, Indonesian nurse also have to pass Japan nursing national board examination, which is held once a year at the end of February. Upon arrival nurses and caregivers will be taught Japanese language and introduced Japanese nursing systems for six months. For the first period of the arrival in the middle of August, the nurse will have 3 chances of examination, and will finish in the middle of February. The probability of Indonesian nurses to pass the first chance of examinations would be questionable, since there is no special preparation on Japanese language and Japanese nursing systems before coming to Japan.
Japanese people are very respect on psychological condition of the patients, and Japanese nurse thought to always pay special attention on their psychological condition. Therefore, intensive learning on Japanese language, culture and Japanese nursing systems in the working field would be an important point to help Indonesian nurses to pass the nursing examination and be accepted to work as a real nurse. Consequently, a regulation from Japanese government is needed for the hospitals which recruit foreign nurses to reach this purpose.
People believe it is unreasonable to insist that the Indonesian nurses take exactly same examination that Japanese nurses do, and such a strict requirement could cause a lot of valuable workers to be simply thrown away (www.japanprobe.com). However, based on the long term experiences on sending the nurses abroad, most of Indonesian nurses have been acknowledged by the receiving countries as having good personalities, such as kind, sympathetic attitudes for patients, and are likely to have a good relationship with the patients, and this in turn supports their job effectively. These conditions were believed those Indonesian nurses are able to survive against the language and difference nursing system.
5. CONCLUSION
This paper describes insights about nursing education and nursing system of Indonesia and Japan. Nevertheless, the illustration only given in general appearance, further research would be needed to describe in details. Comprehension in educational background of nursing and nursing system of both countries will enhance the relationship between the nurse from Indonesia and Japan.

References
Department of Health of Republic Indonesia. 2006. Pedoman Pengembangan Jenjang Karir Profesional Perawat, Direktorat Jenderal Pelayanan Medis Departemen Kesehatan Republik Indonesia.
James. 2008. Indonesian nurse head to Japan. Accessed on 24th October 2008 from http://www.japanprobe.com/?p=5582
Japan Nursing Association. 2008. Basic Nursing Education in Japan. Accessed on 20th October 2008 from www.nurse.or.jp
Kawonal, Yohana, R. 2008. Standard Practice for Professional Nurse in Indonesia. Accesed on 21st August 2008 from www.inna-ppni.or.id.
Ministry of Education and Culture. 1999. Decree No. 23/U/1999: Kurikulum Nasional Program Diploma III Keperawatan.
Ministry of Health of Republic Indonesia. 2001. Decree No. 1239/Menkes/SK/XI/2001: Nursing Registration and Practice.
Okamoto,Y., Health care for the elderly in Japan: Medicine and welfare in an aging society facing a crisis in long term care, BMJ 1992; 305:403-405
The Japan Times Online. 2008. Indonesia nurses, caregivers coming in July. Accessed on 17th May 2008 from http://search.japantimes.co.jp/cgi-bin/nn20080517a4.html
The Jakarta Post. 2008. Indonesian nurses in Japan under free trade pact. Accessed on 7th August 2008 from http://www.thejakartapost.com/news/2008/08/07/indonesian-nurses-japan-under-free-trade-pact.html

NURSING EDUCATION IN INDONESIA: TODAYS AND FUTURE TRENDS

Citation for this article:
Nursalam, Efendi F, Ngoc Dhang LT, Sufyanti Arief Y. 2009. Nursing Education in Indonesia: Todays and Future Trends. Shanghai International Nursing Conference, November 2009, Shanghai, China
Abstract
Societal and health care changes have presented many challenges for nursing. The challenge for nursing education is to ensure that professional education remains relevant and keeps in track with the needs of the market. These challenges include globalization, changes of patient characteristics, impacts of technology information, migration, future tendencies and other current issues in nursing development in Indonesia. A desk study was performed from relevant published materials. Literature was reviewed from means and databases of the International Council of Nurses, Indonesian Nurses National Association and electronic journals. The aim of this paper is to consider possible future societal and healthcare changes and how they may impact the development of future nursing education. A clear understanding of these factors is critical to face tomorrow challenges within global context.
Keywords: nurse, education, curriculum
History of Nursing Education in Indonesia
In line with the rapid economical growth and technological development, nursing education in Indonesia has also been developed positively over the last decades, starting with the issues of “The doctor?s servant” and “Nurses as the second class”. Nurses want their voices heard together with their profession more highly recognized.. As the result, in some urban provinces of the country a Diploma Program in Nursing was set up in the 1970s. In 1982, Indonesia University opened a Bachelor degree in nursing science as a pilot project. Since then, several medical faculties followed the step of Indonesia University and provided Bachelor?s Degree Program in Nursing. Moreover, Self-study Education Program in Nursing started in Indonesia and, this type of education quickly spreads to other cities, which included Diploma Program, Diploma IV at the beginning and Bachelor’s Degree Program after several years.
In addition, a continuing education program called “Program Khusus” leading to a diploma was also established, which is a 3-year part time program for clinical nurses with professional training education background. This program provides good opportunities for clinical nurses in pursuing higher education while working and overall, in improving their professional knowledge and skills. With the increasing number of higher nursing education programs, there is lack of nurse educators who have higher educational background.
Recognizing the necessity, the Ministry of Health has sent a number of nurses to study abroad to get higher education, master and doctoral degrees. However, that effort seems to be insufficient compared to the actual requirement. More importantly, competencies of nurse educators need to considerably improved, in accompany with increasing the number of qualified nurse educators. The diversified levels of nursing education programs and also increased nurse students number have resulted in an over workload for nurse educators. This unfortunately creates a challenge for them in renewing and gaining more knowledge. Not only more nurse educators with Master’s and doctoral degree are needed, but also each educator would put more attention to researches and theoretical development and the development of cognitive skills in teaching and clinical practice as well. The current situation of Indonesia is that most of nurse educators have only Bachelor?s degree; this has caused constraints in taking roles of teaching, guiding and coaching their students. Meanwhile, this situation is not an issue for many western countries, where most of nurse educators possess their PhD or Master’s degree.
With the development of nursing science and the constant influence of modern education notions, continuing reforms in nursing education have been made since 1982. Nursing education has changed from a biological paradigm to a humanistic or holistic paradigm. The reforms covered a wide range of areas, from curriculum development, contents, teaching methods to human resource aspects. More efforts have been made in curriculum design and development for courses related to sociology, psychology, psychoneurotic immunology; researches in nursing science have been put more emphasis. Contents of different courses, especially those relating to clinical nursing and community setting have been adjusted with strong focus on consumers? needs. As to the teaching methods, besides traditional class teaching, multi-media teaching have been used widely. In addition, internet teaching has also attracted more and more interests (Nursalam & Efendi F, 2008).
Recent Issue in Nursing Society in Indonesia
Nurses across the country are pushing for the government and the House of Representatives to speed up deliberation of the Nursing Practice Bill, which is to recognize this profession as a main component in the national health system (The Jakarta Post, 2009). The purpose of the bill is to clarify the rights and duties of nurses. The author believes that nurses have the right to a safe work environment, to practice in a manner that assures the provision of safe care through adherence to professional standards and ethical practice, and to advocate freely for themselves and their patients. The draft bill was submitted to the House in 2005 and has since been revised 20 times.
Indonesia is still implementing the Ministry of Health Decree No. 1239/2001 as a legal basis for nurses? jobs. However, the decree is not sufficiently clear in defining nurses’ rights and duties; this has resulted in misunderstanding and misperception of nurses jobs. In fact, nurses? legal position is not protected adequately. Evidently, nurses in East Java, West Java and Central Java have been detained by authorities or harassed by locals for providing emergency assistance, which they believed that only doctors could do. In fact, the decree states nurses are allowed to give medical treatment if they have approval from the doctors in charge. However, the majority of people still believe (misbelieve actually) that all medical treatments, even as simple as giving injections should be done by doctors and only doctors.
This problem has definitely hampered nurses? job which basically doing dependent job. To resolve the problem, Indonesia needs a specific law regulating nursing practice and defining nurses’ responsibilities. The bill under discussion covers nurses’ competence and protection during practice, which means they are defined as professional practitioners. If the bill is passed into law, it will be Indonesia’s first national standard for nurses.
Conclusion
A summary of today, future challenges and the curriculum implication are listed in the table below.
Table 1. Today and future trends in nursing education in Indonesia
More on http://ners.unair.ac.id/materikuliah/3-NURSING%20EDUCATION-14-17Nov-2009-CINA.pdf