Self-directed learning readiness of Asian students: students perspective on a hybrid problem based learning curriculum.

OBJECTIVES: To identify the student's readiness to perform self-directed learning and the underlying factors influencing it on the hybrid problem based learning curriculum. METHODS: A 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. RESULTS: The 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. CONCLUSION: A 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.

Informed consent and nurses' roles: a survey of Indonesian practitioners.

BACKGROUND: In Southeast Asia, the process of obtaining informed consent is influenced by both culture and policy at the hospital and national level. Both physicians and nurses play vital roles in this process, but physicians influence the roles of nurses. OBJECTIVES: Since the physicians and nurses often have different perspectives, it is important to investigate their views about the informed consent process and nurses' roles therein and whether there is a difference between ideal and experienced practice (reality), and whether this differs across hospitals. METHODS: A questionnaire was developed and a survey was conducted among physicians and nurses. Using exploratory factor analysis a three factor structure was determined: 'nurses' roles', 'barriers in informed consent', and 'adequacy of information'. Non-parametric tests were applied to compare nurses and physicians, and hospital setting. PARTICIPANTS AND RESEARCH CONTEXT: Responses were obtained from 129 physicians and 616 nurses from two Indonesian hospitals. Those hospitals differ in ownership, location, and size. ETHICAL CONSIDERATION: The study was reviewed by the hospital ethical committee. Participation was voluntary and confidentiality was ensured by keeping the responses anonymous. FINDINGS: Physicians and nurses differ significantly on all three factors. The scores reflecting disparity between ideal and reality regarding nurses' roles varied across professions, while barriers in informed consent differed between hospitals. DISCUSSION: The differences between ideal and reality indicated that improvement in the informed consent process and nurses' roles therein is called for. Varying views between physicians and nurses on nurses' roles may hinder collaboration. The differences between hospital settings showed interventions may have to be customized for different settings. CONCLUSION: Views on nurses' roles vary across professions. Views on barriers in informed consent vary across hospitals. Therefore interprofessional education is needed to promote interprofessional collaboration and intervention to improve informed consent practice should be tailored to the hospital context.

Nurses' roles in informed consent in a hierarchical and communal context.

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.