The nursing centre as a collaborative approach to integrate community health service and nursing education in Indonesia

Introduction: The Nursing Centre (NC) Indonesia was established from a collaboration between the nursing education institutions, health services and the local government in West Java Indonesia. Its purpose is to integrate health services, nursing education and research through the optimal usage of a diverse range of potential resources in the community health system. Despite running since 2002, it has been difficult to measure the effectiveness of the NC because of a lack of consistent concepts and instruments. This research sought to establish the theoretical basis and operational components of the NC in Indonesia and to develop a framework for how this can be evaluated.
Methods: This study used qualitative case studies to examine three NCs attached to Community Health Centres (CHC) in Bandung City, Indonesia, using semi-structured interviews. Participants included the founder of the NC, the coordinator of Community Health Nursing, the heads of the three CHCs, mothers, nurses, lecturers, and students participating in the three different NCs.
Results: The results showed that there is a mismatch between the theoretical basis and the practice of the NC in the three centres examined; thus, the intended integration of community health services and nursing education could not be achieved at an optimal level as two NCs focus more on academic activities while one NC focus more on the health service. This is due to the broad concepts used in the NC and the fact that there is no operational theory or concept linking the general concepts of the NC with the strategies used to implement it. This disconnection also leads to poor evaluation systems because there is no consistency between the concepts of the NC and the instruments used to evaluate the NC.
Discussion: A shared understanding among stakeholders of the concepts of the NC model is an important factor in building a fully integrated system in which nursing education and health care personnel in community health centres share the same sites, vision, and system. We argue that the discourse and implementation of a service learning approach, which includes experiential learning, reflection, reciprocity, and getting agreement on specified outcomes with the key stakeholders, will allow for the development of an integrated system and will enhance reciprocity in the implementation of the NC.
Conclusion: Service learning can be used as a theoretical basis of the NC to facilitate communication between stakeholders. This communication would increase understanding between stakeholders of the benefits of integrating health care services in the community and nursing education in the NC. The theoretical basis of the NC, which include the concept of system, caring, service learning community health nursing, organization of profession, and research, can also be used to develop instruments for the evaluation of the NC.
Lesson Learned: Collaboration in a fully integrated system will enable the best outcomes for patients and their families as well as other stakeholders involved in the program but such collaboration depends on the development of connections and consistency between the theoretical basis, operation, and evaluation of the NC.
Limitations: This research used qualitative case study design, so the results could not be generalized, however within similar settings the findings are likely to be applicable to other NCs operating in Indonesia.
Suggestions for Future Research: The NC model may be improved by using the service learning approach. Conducting trials of the model in multiple sites may answer questions about the effectiveness of the NC model as a collaborative approach to integrate community health services and nursing education.