Ageing has been recognized as one of the most critically important health-care issues worldwide. It is relevant to Asia, where the increasing number of older populations has drawn attention to the paramount need for health-care investment, particularly in end-of-life care. The advocacy of advance care planning is a mean to honor patient autonomy. Since most East Asian countries are influenced by Confucianism and the concept of 'filial piety,' patient autonomy is consequently subordinate to family values and physician authority. The dominance from family members and physicians during a patient's end-of-life decision-making is recognized as a cultural feature in Asia. Physicians often disclose the patient's poor prognosis and corresponding treatment options to the male, family member rather to the patient him/herself. In order to address this ethical and practical dilemma, the concept of 'relational autonomy' and the collectivism paradigm might be ideally used to assist Asian people, especially older adults, to share their preferences on future care and decision-making on certain clinical situations with their families and important others. In this review article, we invited experts in end-of-life care from Hong Kong, Indonesia, Japan, South Korea, Singapore and Taiwan to briefly report the current status of advance care planning in each country from policy, legal and clinical perspectives. According to the Asian experiences, we have seen different models of advance care planning implementation. The Asian Delphi Taskforce for advance care planning is currently undertaken by six Asian countries and a more detailed, culturally sensitive whitepaper will be published in the near future.
Objective: The issue in health is dynamic and full of development, although the more sophisticated medical technology does not mean that all diseases can be cured. In certain cases the patient is dying and tortured. Patients and/or their families sometimes ask to be freed the patient from suffering by ending their lives. This demand for euthanasia is a pro and a contra view in Indonesia, especially in terms of legality.
Method: The type of research in this article is normative research, using a statutory and conceptual approach analyzed and presented descriptively.
Results: The euthanasia is a health act that has legal implications. Although the Criminal Code does not explicitly mention the word euthanasia, however, based on the provisions of the Criminal Code it is stated that taking action to eliminate lives should not be carried out, even if the patient's family wishes. According to the law, social, religious and ethical norms of doctors, euthanasia is not allowed.
Conclusion: The euthanasia in Indonesia cannot be carried out formally because the legal basis governing it still prohibits such actions. This can be seen from the court's decision to reject euthanasia requests. In addition, norms and values are a barrier to the legalization of euthanasia practices in Indonesia.
Introduction: Patients with cervical cancer in the early period of diagnosis (0–3 months) often show denial, thus leaving the patient less cooperative with the treatment plan.
Objective: This study aims to identity the acceptance response whose diagnosed cervical cancer.
Method: This study is qualitative research study with phenomenological approach. Sampling was conducted by purposive sampling with a sample size of 12 participants. Data were collected using semi-structured in-depth interviews. Thematic analysis was performed using Collaizi steps.
Result: The themes that emerged were formulated based on the participants’ answers to interview questions and field notes during the interview process. This research produces 7 (seven) themes: responsibility, efforts to seek treatment, support, source of information, commitment, obstacles, and hope.
Conclusion: The emotional stability of cervical cancer patients was fluctuated and the feelings of loss occurred repeatedly even after reaching the acceptance state. Good self-adjustment enhance respondent's acceptance of their disease and bringing new hope for their life, so cervical cancer patients will have a positive expectation in his life. The role of health workers is important in the adjustment of early-diagnosed patients with cervical cancer by providing health education and consultation services related to the condition of the illness.
BACKGROUND: This quantitative study aimed to analyse the relationship between knowledge and nurses' self-confidence (or self-efficacy) in applying palliative care (PC) in the intensive care unit (ICU). This study was a correlational study with a cross-sectional approach. The sampling technique used was total sampling, and the sample included all nurses who were actively working at the general hospital in Bandung, West Java, Indonesia, during the study. There were 127 people in total. Data were collected using questionnaires. The Pearson correlation test was used for bivariate analysis. The results of univariate analysis showed that the majority of respondents had high self-confidence but had less knowledge related to PC in the ICU. Based on the results of the bivariate analysis, there was a significant relationship between knowledge and self-confidence variables. The results showed that a high number of respondents had less knowledge in implementing PC in the ICU. Therefore, familiarisation sessions and training related to this are needed, focusing on nurses' beliefs in their abilities.
Background: The ethical principle of justice demands that resources be distributed equally and based on evidence. Guidelines regarding forgoing of CPR are unavailable and there is large variance in the reported rates of attempted CPR in in-hospital cardiac arrest. The main objective of this work was to study whether local culture and physician preferences may affect spur-of-the-moment decisions in unexpected in-hospital cardiac arrest.
Methods: Cross sectional questionnaire survey conducted among a convenience sample of physicians that likely comprise code team members in their country (Indonesia, Israel and Mexico). The questionnaire included details regarding respondent demographics and training, personal value judgments and preferences as well as professional experience regarding CPR and forgoing of resuscitation.
Results: Of the 675 questionnaires distributed, 617 (91.4%) were completed and returned. Country of practice and level of knowledge about resuscitation were strongly associated with avoiding CPR performance. Mexican physicians were almost twicemore likely to forgo CPR than their Israeli and Indonesian/Malaysian counterparts [OR1.84 (95% CI 1.03, 3.26), p = 0.038]. Mexican responders also placed greater emphasison personal and patient quality of life (p < 0.001). In multivariate analysis, degree of religiosity was most strongly associated with willingness to forgo CPR; orthodox respondents were more than twice more likely to report having forgone CPR for apatient they do not know than secular and observant respondents, regardless of the country of practice [OR 2.12 (95%CI 1.30, 3.46), p = 0.003].
Conclusions: In unexpected in-hospital cardiac arrest the decision to perform or withhold CPR may be affected by physician knowledge and local culture as well as personal preferences. Physician CPR training should include information regarding predictors of patient outcome at as well as emphasis on differentiating between patient and personal preferences in an emergency.
Background: Strong family bonds are part of the Indonesian culture. Family members of patients with cancer are intensively involved in caring, also in hospitals. This is considered “normal”: a societal and religious obligation. The values underpinning this might influence families’ perception of it.
Aim: To explore and model experiences of family caregivers of patients with cancer in Indonesia in performing caregiving tasks.
Design: A grounded theory approach was applied. The constant comparative method was used for data analysis and a paradigm scheme was employed for developing a theoretical model.
Setting/participants: The study was conducted in three hospitals in Indonesia. The participants were family caregivers of patients with cancer.
Results: A total of 24 family caregivers participated. “Belief in caregiving” appeared to be the core phenomenon. This reflects the caregivers’ conviction that providing care is an important value, which becomes the will power and source of their strength. It is a combination of spiritual and religious, value and motivation to care, and is influenced by contextual factors. It influences actions: coping mechanisms, sharing tasks, and making sacrifices. Social support influences the process of the core phenomenon and the actions of the caregivers. Both positive and negative experiences were identified.
Conclusion: We developed a model of family caregivers’ experiences from a country where caregiving is deeply rooted in religion and culture. The model might also be useful in other cultural contexts. Our model shows that the spiritual domain, not only for the patient but also for the family caregivers, should be structurally addressed by professional caregivers.
BACKGROUND: An intensive care unit (ICU) features high mortality rates. Witnessing subsequent deaths may affect nurses psychologically and spiritually. Islam has an influence on Muslims' life and death. Nevertheless, little is known about Muslim intensive care nurses' experiences of grief in dealing with the deaths of patients.
AIM AND OBJECTIVES: This study aimed to describe the grief reactions and coping strategies of Muslim nurses in dealing with the death of patients.
DESIGN: This is a qualitative study with a phenomenological approach.
METHODS: Semi-structured individual interviews were conducted. Fourteen participants from an ICU in an Indonesian tertiary public hospital participated in this study. Data were analysed by thematic analysis. Trustworthiness was established by Lincoln and Guba's criteria.
RESULTS: The findings identified four reactions of grief, four factors influencing reactions of grief, and three coping strategies used in dealing with death in an ICU. The reactions of nurse's grief were crying, being sad, feeling disappointed, and feeling guilty. These reactions were related to several factors including the circumstances of the patient's death, nurse's expectation of patient's recovery, relationships with the patient, and the reactions of family. Coping management strategies used by nurses in dealing with their grief comprised: sharing with colleagues, avoiding dying and death situations, and engaging in spirituality.
CONCLUSIONS: The Muslim ICU nurse participants experienced their grieving through a variety of psychological reactions influenced by several factors. Personal coping strategies were revealed in dealing with their grief. However, avoiding dying and death situations affected their duty.
RELEVANCE TO CLINICAL PRACTICE: Attention to nurses' grief should be paid to maintain their psychological well-being and quality of end-of-life care. Providing formal support to enhance grief management is recommended.
There is a significant gap in the provision of palliative care for children living with HIV (CLHIV) in Indonesia. While Indonesia has one of the highest rates of HIV infection amongst children in Asia, there is limited availability and access to palliative care services for CLHIV, especially for those living in rural areas. This paper highlights the need to scale up the provision of pediatric palliative care services for CLHIV in the country through the integration of palliative care into existing HIV care. This integration would not only increase the accessibility of palliative care for CLHIV, but also improve the quality of HIV care by addressing and meeting individual needs, enhancing retention in HIV care and improving quality of life amongst CLHIV. An effective integration of palliative care may be achieved by adopting World Health Organization’s Public Health Strategy for Palliative Care, with adaptations made to accommodate the unique geographical and cultural contexts of Indonesia.
OBJECTIVE: In Indonesia, palliative care has not been uniformly implemented at all levels of healthcare facilities. Healthcare personnel play an important role in providing that care. This study aimed to explore the current conditions and expectations regarding palliative care from the perspective of healthcare personnel.
RESULTS: A qualitative study was conducted with 12 physicians and five nurses from December 2017 to June 2018. In-depth interviews of these professionals were conducted. The responses were subjected to inductive thematic analysis, generating five themes and 24 subthemes. The themes were (1) family and environment, including barriers and contributions to palliative care; (2) numbers and competence of healthcare providers; (3) accessibility of palliative care; (4) case management of patient's and family's problems by healthcare personnel; and (5) barriers or enabling factors from the healthcare system. Patients, family members, and healthcare personnel contribute to case management. Attention must be paid to improving access and the healthcare system for thorough implementation of palliative care.
Purpose: Refugees may be at risk of experiencing a complicated form of bereavement. As yet, however, the nosological status of this putative category across cultures remains in question. We apply qualitative and quantitative methods to investigate the manifestations, prevalence, factorial structure and psychosocial correlates of complicated bereavement amongst refugees from West Papua, a population with no past exposure to western concepts of grief or to formal mental health services.
Methods: Qualitative methods (focus groups and informant interviews) were used to identify cultural expressions of complicated bereavement derived from international classification systems, that is, DSM 5 persistent complex bereavement disorder (PCBD) and ICD-11 prolonged grief disorder (PGD) in developing a structured interview applied by trained field workers. Participants were adult West Papuan refugees and their offspring recruited from households (n = 486, response 85.8%) across nine villages in a remote town in Papua New Guinea.
Results: The qualitative data obtained from focus groups (n = 20) and informant interviews (n = 4) with local psychiatrists supported the cultural validity of complicated bereavement. 16% (n = 78) of the sample met criteria for PCBD based on DSM-5 criteria and 103 (21%) met criteria for PGD based on ICD-11 criteria. Confirmatory factor analysis yielded a six-factor model of complicated bereavement with a moderately good fit to the data. The model included dimensions of anger/negative appraisal (AN), avoidance/giving up, estrangement from others, and confusion and diminished identity. In contrast, the DSM-5 three-factor model and the ICD-11 two-factor model each yielded a poor fit. Cumulative traumatic losses (ß = 0.16, P = 0.03), duration since displacement [(ß = 0.10, P = 0.02)] and postmigration living difficulties (ß = 0.20, P = 0.01) were associated with an aggregated index of complicated bereavement, supporting the concurrent validity of the structure identified.
Conclusions: Culture and exposure to persecution and displacement may contribute to the content and configuration of the complicated bereavement reaction, an issue that requires recognition in international classification systems and clinical practice.
OBJECTIVE: To describe the meaning of the lived experiences of grief of Muslim nurses caring for patients who died in an intensive care unit.
METHODOLOGY: Gadamerian philosophy was used to underpin the hermeneutic phenomenological approach followed to analyse and interpret the lived experiences of nurses who cared for patients who died in intensive care units. Fourteen nurses met the inclusion criteria. They were asked to illustrate their experiences of grief using graphic representation. This was followed by face-to-face interviews during which they were asked to narrate and reflect on their experience. The graphic representation and interview transcripts were analysed using Van Manen's approach. Lincoln and Guba's criteria were followed to establish trustworthiness.
SETTING: An intensive care unit at a tertiary public hospital in West Sumatra Province, Indonesia.
FINDINGS: Five major thematic categories reflecting the five life-worlds were identified: 'empathetic understanding', 'balancing self', 'avoidance', 'anticipating the future of own death', and 'relating technologies in bargaining'.
CONCLUSION: This study provides further understanding of the meanings of the lived experience of grief among Muslim nurses in intensive care units. Nurses' grief arising from the loss of patients can affect their emotional, cognitive, spiritual, relational and professional well-being. The findings add further knowledge about the end of life in intensive care units.
Observations were done since 2008 in hospital, community concluded that end of life patients, and families did not understand how to respond to advance treatment. Besides, there were no similar standard of procedure applied into patients. There were some doctors told the families about patients' conditions and some did not. Moreover, some families understood that patients' condition could not be cured, but in dying process, the physicians suggested to be treated in an intensive care unit. In this situation, the families did not have any choice instead of to follow the physician suggestion. Indonesian's health care system that embrace doctor's domination over decision-making on patient treatment exists, although nurse has their own skills, function and knowledge that need to be incorporated in the treatment plan. On the other hand, nurses do not have initiatives to challenge this system in health care structure. This study refers to a Philosophical Carol Gilligan Theory, and Bakker & Zubair Qualitative Method of Philosophical Research. The results were divided into 2 groups: firstly were the nurses who were mostly women had their limitation to raise up their profession, and secondly, the basic nurses education was insufficient to encounter the doctors.
Indonesia is a developing country and most breast cancer patients present with terminal conditions, including discomfort. Comfort is a crucial component of nursing in palliative care, especially in breast cancer patients. However, this condition is difficult to assess and therefore assign as a diagnosis. Some comfort assessment tools have been developed in other countries are found not appropriate for an Indonesian context. This study is a sequence of prior qualitative research regarding a comfort assessment tool to be developed in Indonesia. This study piloted the comfort assessment tool in 55 patients with breast cancer to test if it is valid, reliable, and easy to use. This cross-sectional study was conducted at an Army hospital in Jakarta, Indonesia. The Comfort Assessment Breast Cancer Instrument measured many aspect of the patient comfort level including physical, psycho-social, cultural-spiritual, finance, and environmental comfort using a Likert scale from 1-4 and 34 items. Data were processed using statistical software. The face validity test yielded coefficient a of 0.299-0.691, while the reliability test produced a reasonably good result as well (a = 0.912). Therefore this measure should be further assessed by an expert panel and including construct validity.
People living with HIV (PLWH) suffer from physical and psychological distress that palliative care could alleviate. Our cross-sectional study identified HIV-related problems and demands for palliative care at different disease stages, and their interactions with quality of life (QOL) in 215 PLWH from a referral hospital and an AIDS nongovernmental organization in Indonesia. A brief survey of demographic information, the Bahasa version of Problems and Needs of Palliative Care, and the World Health Organization Quality of Live in HIV-infected Persons instrument (WHOQOL-HIV BREF; Cronbach's alpha = .89) were used for data collection. Mean age was 33.5 years (SD = 4.7); 66% were male. Fatigue (67%) was the most prevalent symptom, and the symptom sleeping problems (54.9%) was the priority for palliative care. Higher spiritual and financial demands were found in PLWH with stage IV HIV. Multivariable analysis indicated negative associations between QOL and psychosocial problems, and demands for social and financial support. Interventions focused on psychosocial issues would improve the QOL for PLWH.
Experiencing life-threatening illness could impact on an individual’s spirituality or religious beliefs. In this paper, we report on a study which explored cultural elements that influence the provision of palliative care for people with cancer. A contemporary ethnographic approach was adopted. Observations and interviews were undertaken over 3 months with 48 participants, including palliative care staff, patients, and their families. An ethnographic data analysis framework was adopted to assist in the analysis of data at item, pattern, and structural levels. Religion was identified as central to everyday life, with all participants reporting being affiliated to particular religions and performing their religious practices in their daily lives. Patients’ relatives acknowledged and addressed patients’ needs for these practices. Staff provided spiritual care for the patients and their relatives in the form of religious discussion and conducting prayers together. An understanding that religious and spiritual practices are integral cultural elements and of fundamental importance to the holistic health of their patients is necessary if health-care professionals are to support patients and their families in end-of-life care.
Purpose of review: To summarize the current status of palliative care and the role of psychosomatic medicine in Indonesia.
Recent findings: Palliative care is not a new issue in Indonesia, which has been improving palliative care since 1992 and developed a palliative care policy in 2007 that was launched by the Indonesian Ministry of Health. However, the progress has been slow and varied across the country. Currently, palliative care services are only available in a few major cities, where most of the facilities for cancer treatment are located. Psychosomatic medical doctors have advantages that contribute to palliative care because of their special training in communication skills to deal with patients from the standpoints of both mind and body.
Summary: Palliative care services in Indonesia are established in some hospitals. Future work is needed to build capacity, advocate to stakeholders, create care models that provide services in the community, and to increase the palliative care workforce. Psychosomatic medicine plays an important role in palliative care services.
En Indonésie, la pratique des soins palliatifs n'en est encore qu'à ses débuts, mais une partie de la société indonésienne est favorable au développement des soins palliatifs.
Les soins palliatifs ont été introduits dans le système de santé indonésien en 1989 dans le cadre d'un programme national de contrôle des cancers, mais les services de soins palliatifs ne sont pour l'instant accessibles que dans certaines zones. Il existe toutefois un cadre légal pour encourager leur développement.
L'Indonésie doit développer plus de services, plus de formations aux soins palliatifs, mettre en place des indicateurs de qualité et sensibiliser le public. Il est également nécessaire de mettre en place un mode d'administration des soins qui prenne en compte les spécificités culturelles du pays.
[D'après résumé revue]