Resilience, depression and their effect on nurse retention: a survey in rural Indonesia.

INTRODUCTION: Health professionals' maldistribution and retention in underserved areas are global problems. Burnout drives health professionals to leave rural areas. Chronic burnout is linked to depression, and nurses have a higher risk for depression than the general population. Studies suggest that increasing resilience may reduce depression. However, little is known about the effect of resilience on nurses' depression and their rural retention. This study aims to understand the impact of resilience and depression on nurses' retention in rural areas. METHODS: An online cross-sectional survey on registered nurses was conducted in July - August 2021 in a rural province in Indonesia. The survey measured the nurses' resilience, depression level, and work duration. RESULTS: A total of 1050 participants joined the study. The results suggest that resilience in nurses is negatively correlated to depression and retention. The mildly depressed group had the shortest retention. There was no difference in the work duration, depression, and resilience scores between the underserved and non-underserved regencies in the province. DISCUSSION: Although not all our hypotheses are supported, some interesting results were obtained. In a previous study, the more senior the doctor, the higher the resilience; in this nurse analysis, the opposite was true - senior nurses were the least resilient. As found in other studies, resilience is negatively correlated to depression. So, resilience training may still benefit the depressed group. CONCLUSION: Improvement of health professionals' rural retention requires approaches tailored to each profession. Resilience training may be beneficial to retain nurses through mild depression treatment.

The importance of developing meaningfulness and manageability for resilience in rural doctors.

INTRODUCTION: Retention of rural doctors is a problem in many countries. A previous study has identified resilience as a factor associated with longer retention. However, this needs a deeper study to understand what local and personal factors are at play. Studies suggest resilience can be developed during training. We propose that a better understanding of factors associated with resilience might assist in training students for rural practice and increase retention. AIM: This study aimed to understand the differences in resilience development between the more and the less resilient rural doctors. A secondary purpose was to identify how to assist this developmental process through health professional education. METHODS: This study employed a mixed-method design and was part of a more extensive study aiming to develop rural doctors' resilience in a low-resource setting. A prior survey assessed rural doctors' resilience levels. This study sampled high-level and low-level resilience participants to be interviewed. A total of 22 rural doctors participated in the individual semi-structured interviews. The interviews were analyzed qualitatively based on Richardson's Resilience Model and the six resilience dimensions looking for factors that explained high or low resilience. RESULTS: Two important themes emerged during the qualitative analysis: 'meaningfulness' and 'manageability.' The different responses of high and low-resilient participants can be explained through cases. CONCLUSIONS: The participants' perceived meaningfulness and manageability of the stressor determine the responses. We suggest that teachers may better construct students' resilience by focussing on assisting them in finding meaning and developing a sense of manageability.

Personal resilience and rural doctors retention: a study in Indonesia.

INTRODUCTION: Retaining the health workforce in rural areas is a global problem. Job dissatisfaction or work-related distress are among the factors that drive doctors to leave rural places. Resilience has been recognised as a key component of wellbeing and is associated with better satisfaction with life. Building personal resilience has the benefits of lowering vulnerability to work-related adversity. This study examined the association between rural doctors' personal resilience and the duration of rural practice. METHODS: This cross-sectional study was set in a rural province in Indonesia. A total sampling procedure was implemented. A total of 528 participants responded to an online survey. The survey tool measured six dimensions of a resilience profile (determination, endurance, adaptability, recuperability, comfort zone and life calling) and collected personal data such as date of birth, practice location and duration of rural practice experience. These participants were classified into four groups: intern, general (GP) with 10 years experience. The data were analysed quantitatively using Oneway analysis of variance (ANOVA). RESULTS: Doctors with longer durations of rural experience showed higher resilience levels in four of the dimensions of personal resilience: endurance, adaptability, recuperabilit­y and comfort zone. Among those four dimensions, endurance and comfort zone showed significant differences between groups with >10 years of difference in rural experience (p<0.05). The other two dimensions, determination and life calling, showed fluctuations across groups with different rural durations. CONCLUSION: This study provides a preliminary result for understanding the relationship between personal resilience and rural doctor retention. It suggests that resilience is partly associated with rural doctor retention. Further studies are needed to examine the causal relationship between resilience and retention.

Learning global health: a pilot study of an online collaborative intercultural peer group activity involving medical students in Australia and Indonesia.

BACKGROUND: There is limited research to inform effective pedagogies for teaching global health to undergraduate medical students. Theoretically, using a combination of teaching pedagogies typically used in 'international classrooms' may prove to be an effective way of learning global health. This pilot study aimed to explore the experiences of medical students in Australia and Indonesia who participated in a reciprocal intercultural participatory peer e-learning activity (RIPPLE) in global health. METHODS: Seventy-one third year medical students (49 from Australia and 22 from Indonesia) from the University of Tasmania (Australia) and the University of Nusa Cendana (Indonesia) participated in the RIPPLE activity. Participants were randomly distributed into 11 intercultural 'virtual' groups. The groups collaborated online over two weeks to study a global health topic of their choice, and each group produced a structured research abstract. Pre- and post-RIPPLE questionnaires were used to capture students' experiences of the activity. Descriptive quantitative data were analysed with Microsoft Excel and qualitative data were thematically analysed. RESULTS: Students' motivation to volunteer for this activity included: curiosity about the innovative approach to learning; wanting to expand knowledge of global health; hoping to build personal and professional relationships; and a desire to be part of an intercultural experience. Afer completing the RIPPLE program, participants reported on global health knowledge acquisition, the development of peer relationships, and insight into another culture. Barriers to achieving the learning outcomes associated with RIPPLE included problems with establishing consistent online communication, and effectively managing time to simultaneously complete RIPPLE and other curricula activities. CONCLUSIONS: Medical students from both countries found benefits in working together in small virtual groups to complement existing teaching in global health. However, our pilot study demonstrated that while intercultural collaborative peer learning activities like RIPPLE are feasible, they require robust logistical support and an awareness of the need to manage curriculum alignment in ways that facilitate more effective student engagement.