1. Project title
A project to enhance educational skills in basic nursing program in Indonesia focusing on elderlynursing
2. Country namethe Republic of Indonesia
3. Background
The major causes of death in Indonesia (2012) includes stroke, cancer, or ischemic heart disease,which require advanced medical care. The aging rate of the country is currently over 6%, and ispredicted to be 7% in 2021 and 14% in 2038. The decline of family home nursing and increasing
regional disparities are the current issue. Therefore, developing nursing human resources withexpert skills and prepared with ethical perspectives for elderly people is an urgent need in thiscountry. The number of nurses and midwives in the country is about 465,000, which is several times
smaller than that in Japan. About 60% of nurses are high school graduates, about 40% is graduatedfrom a vocational school, and a few percent from a bachelor's degree program.
The Indonesian government has been working on improving the level of nurses and has
introduced a license renewal system by strengthening continuing education after graduated frombasic nursing education. In response to the need for more systematic nursing training, the Japan
International Cooperation Agency (JICA) has conducted a project to enhance nursing competency
between 2012 and 2017. The National College of Nursing has been actively involved in this project incooperation with other universities, and has dispatched specialists (nursing faculty members) in thefield of geriatric nursing.
The Indonesian universities and hospitals in the five pilot areas of the project introduced a laddersystem for evaluating the practical skills of nurses, and have been improving and implementingcontinuing education programs in areas such as disaster, emergency and elderly nursing. The JICA
project has been completed, yet the practical operation of the educational program is currently
underway. Therefore, we focus on a training program for clinical preceptors or junior nursing faculty
members who are responsible for teaching and coaching undergraduate nursing education or newgraduate nurses. The training program focus on acquiring the knowledge and skills that are thefoundation of the practical skills of nursing education in elderly nursing. The program also includes
teaching basic nursing educational methods that can foster ethical sensitivity for the elderly. Suchtraining program, designed to link between educational and clinical settings, would enhance theIndonesian nurses' practical teaching skills for students' nursing practicum or new graduate nurses.
4. Objective
The aim of this project is to train nurse preceptors in practicum hospitals or nursing faculty in nursing
universities in Indonesia to acquire more effective educational skills in relation to teaching methods and clinicalpracticum for nursing students or on the job training for new graduate nurses. Through teaching more effective skills
in providing lectures, seminars and clinical practicum in this training project (web training and/or dispatchingspecialists).
Specifically, in year 2020, a specialist dispatch or web conference/training will be held for preparation andinvestigation/consultation of needs. Based on that preliminary work, a specialist dispatch or web-based training will
be conducted and will be evaluated. Based on the results of the training, the year 2021 training in Japan on-site oron the Web will be planned. This project would contribute to improving the quality of teaching skills in basic
nursing education, especially in teaching skills for clinical practicum, in relation to the characteristics of the elderlyin Indonesia.

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5. Program outline
1) In 2020, we conduct a web conference and needs survey (dispatching experts if possible). Based on
the needs survey, we extract the current status and issues of clinical practicum teaching skills
related to basic nursing education. We, then, will develop the outline of the training method based on
the identified needs.
2) In 2020, training would be conducted via the Web (or dispatching experts if possible), and will beevaluated for its effectiveness based on outcome indices.
3) Based on the above activities, we will prepare 2021 training program either on-site in Japan (orthrough web teaching).
4) After the above training, graduates of the training 3) would hold "leader's training" (training-oftrainer) on site in Indonesia.
・ If needed, dispatch Japanese experts and conduct web conferences as a follow up.
6. Implementation structure
6-1. Japanese side
The National College of Nursing: Faculty members in gerontological nursing, adult health nursing,fundamental nursing, and international nursing will collaboratively work together to implement thisproject.
6-2. Counterpart country side
We are currently working with the JICA office in Japan and Indonesia to identify contact persons inIndonesia who can recommend one site (a university and its related hospital), including the Ministryof Health (Jakarta), Nursing Association (Jakarta), and universities.
7. Indicator

7-1. Output

1) Dispatch experts (or conduct web survey) in 2020 to extract five or moreeducational needs. Based on these, set training goals in line with the three highpriority needs.
2) Identify trainees (about 2 to 3 Indonesian nursing faculty members and clinicalpreceptors) who were recommended by the Ministry of Health and the Nursing
Association.
・ The trainees' self-evaluation score of understanding and confidence will beimproved by 10% or more.
・ Knowledge test, exercise / presentation / discussion about "achievement of goals"
will be evaluated.
3) In 2021, trainees will provide on-site leader training to a total of five or morenursing faculty members and clinical preceptors.
・ Participants of leader's training will improve their self-assessment score by over10% as compared to the pre-training score.
・ Other evaluations include qualitative data/narrative (hearing from trainees' bosses,patients, and families), are will be analyzed.

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7-2. Outcome

1) Based on the educational contents and goals extracted by the expert dispatch (orweb conference) in 2020, conduct training in Japan, or on-site, or on the web.
2) The trainee will use their skills learned through dispatch of Japanese experts orweb training in order to implement the following:a) Each trainee conduct comprehensive assessment and integrated care for at least
two adult / elderly persons.-> Submit a self-evaluation report (qualitative evaluation).
b) For each trainee who has completed the training, provide clinical practicum
teaching to two or more nursing students.-> The student's evaluation of the trainee
will be an average of 3.5 or more on a 5-point scale.
3) In 2021, the trainee will use their skills learned through dispatch of Japaneseexperts or web training:a) Each trainee will provide training for at least 5 new candidate of leaders.-> These
new candidate of leaders' self-assessment of understanding and self-confidence will
be at an average of 3.5 or more on 5-point scale.

1) The instruction skills related to clinical practicum will be improved and will
enhance the quality of nursing skills for the elderly in Indonesia (e.g., improvementin the implementation rate of integrated care based on the comprehensive
assessment of the elderly). This program would contribute to the dissemination anddevelopment of gerontological nursing (the hospitals that implement the abovementioned nursing will double in about five years).
2) With the improvement of the instruction skills in clinical practicum, the following
items will be included in nurses' assessment, or nursing care plans, or students'
practicum records. The following assessment tools will be used in clinical practice, orwill be taught to use in students' clinical practicum.
7-3. Impact(1) assessment of the geriatric syndrome, specifically aspiration pneumonia, pressure
ulcer, frailty or sarcopenia, or fall.
(2) early detection of postoperative complications (atelectasis, infection, bleeding, etc.)and delirium in older cancer patients or stroke patients.
(3) developing or drafting the educational plan for nursing students or new graduate
nurses focusing on improving nursing assessment, care, intervention, or prevention
in relation to the above.
It is expected that the quality of nursing in relation to elderly will be improved,
which would brings about improving the quality of life of the elderly in Indonesia inthe long-term perspective.
8. Main activities
8-1. Training in 2020
1)

Needs survey in Indonesia (web-based survey) in May, June, July.

2)Dispatch three Japanese experts for five days in August for on-site (or web) training3)

Dispatch three Japanese experts for five days in December/January for on-site training andevaluation conference (or web-based training/evaluation conference)

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