Although the main responsibility for informed consent of medical procedures rests with doctors, nurses' roles are also important, especially as patient advocates. Nurses' preparation for this role in settings with a hierarchical and communal culture has received little attention. We explored the views of hospital managers and nurses regarding the roles of nurses in informed consent and factors influencing these roles. We conducted a qualitative study in a private, multispecialty hospital in Indonesia. Semi-structured interviews were conducted with seven managers. Two rounds of focus group discussions with nurses (n = 27) were conducted. Constant comparative approach was used in the analysis. Nurses can act as manager, witness, information giver, and advocate in the informed consent process. These roles are influenced by nurses' preparedness, hospital culture and policy, patients' understanding, family involvement, and cost-related issues. In preparation for these tasks, nurses should acquire communication skills, clinical knowledge, and legal and ethical knowledge.
Informed consent is a reflection of patients' autonomy in health decision-making. The main responsibility lies with the doctor. In practice, the nurses' contributions matter as well. This paper presents a case study that explored physicians' perceptions of the existing informed consent process, their suggestions for improvement and their views on the nurses' roles in this process. A two-phase approach was conducted. First, six physicians with different expertise were interviewed. Second, after attending presentations about informed consent and physician-patient relationship principles, 32 physicians were asked to complete an open-ended questionnaire. Data were analyzed by two independent coders and emerging themes were compared. The results of the questionnaires and the interviews were triangulated. Of 32 physicians attending the presentations, 24 (75%) completed the questionnaire. The results indicate that physicians perceive patients, physicians and the hospital as main factors influencing the process of informed consent. Physicians' misinterpretation of informed consent principles, (mis)perceptions regarding patients and their family, and deficient hospital policy and support challenge the informed consent process. Physicians value nurses' roles, provided nurses have sufficient clinical knowledge, sound comprehension of informed consent principles and effective communication skills.
This article describes the use of four-component instructional design (4C/ID), a model to plan educational interventions for complex learning. This model was used to design a continuing education course on communication skills for health professionals in a context that is hierarchical and communal. The authors describe the 4C/ID model and provide an example of its application in designing the course. In the 4C/ID model, learning tasks serve as the backbone of the course, with lectures and other supportive information organized around them. The 4C/ID model is different from traditional models that base the course on lectures on different topics and connect part-task assignments to these topics. The use of the 4C/ID model to develop the educational intervention moves the paradigm from lectures to learning tasks to better prepare learners for real practice.
ObjectivesTo identify the student’s readiness to perform self-directed learning and the underlying factors influencing it on the hybrid problem based learning curriculum. MethodsA combination of quantitative and qualitative studies was conducted in five medical schools in Indonesia. In the quantitative study, the Self Directed Learning Readiness Scale was distributed to all students in all batches, who had experience with the hybrid problem based curriculum. They were categorized into low- and high -level based on the score of the questionnaire. Three focus group discussions (low-, high-, and mixed level) were conducted in the qualitative study with six to twelve students chosen randomly from each group to find the factors influencing their self-directed learning readiness. Two researchers analysed the qualitative data as a measure of triangulation. ResultsThe quantitative study showed only half of the students had a high-level of self-directed learning readiness, and a similar trend also occurred in each batch. The proportion of students with a high level of self-directed learning readiness was lower in the senior students compared to more junior students. The qualitative study showed that problem based learning processes, assessments, learning environment, students’ life styles, students’ perceptions of the topics, and mood, were factors influencing their self-directed learning. ConclusionA hybrid problem based curriculum may not fully affect the students’ self-directed learning. The curriculum system, teacher’s experiences, student’s background and cultural factors might contribute to the difficulties for the student’s in conducting self-directed learning.
The aim of these two PhD thesis are to develop a guideline on doctor-patient communication skills based on cultural characteristics of Southeast Asian context and to develop communication skills training for nurses to enhance their contribution to the informed consent and shared decision making process, in the same context. These studies started with qualitative methods; including grounded theory methodology, by exploring doctors’, patients’, medical students’ and nurses’ perceptions on the current and desired communication skills in which influenced by culture. Based on the results, we design communication skills training and evaluate the training with quantitative methods, using pre and post test studies. Southeast Asian desired ideal partnership style in communicating with their doctors. More emphasize on basic skills such as listening to subtle non-verbal cues are needed for doctors and nurses. A guideline on doctor-patient communication tailored to local culture was developed as well as training for nurses using 4CID design to enhance their contribution to the shared decision making process. To promote two-way interaction between doctors and patients and between health professionals require mastering basic skills in communicating with people, such as explorations on the unspoken concern. In a culturally hierarchical context of Indonesia, this two-way interaction is quite a challenge. To generalize our studies to other culture, more studies with rigorous methods should follow. To promote the use of basic skills in communicating with patients to approach the desired partnership communication style in Southeast Asian context, we need to use local evidences.
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