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***Faculty of Nursing Airlangga University Indonesia, Jl. Mulyorejo Kampus C Unair Surabaya
60115 Tel/Fax: (031) 5913257
E-mail: fefendi@gmail.com
ABSTRACT
Introduction: According to the Economic Partnership Agreement (EPA) between the Indonesian
and Japanese governments, the Japanese government plans to recruit Indonesian nurses and
caregivers to fulfill the demands of those positions at hospitals and health centres. However, to be
a qualified worker in Japan, one has to pass a national examination that is conducted by the
Minister of Health, Labor, and Welfare for a license as a registered nurse within 3 or 4 years of
working as a nurse or caregiver, respectively. Method: Having considered that matter, a
comparative study of the background of educational systems in Indonesia and Japan is discussed in
this paper, with particular reference to the Diploma 3 nursing program. Result: There is no
specific difference between the Indonesian and Japanese nursing education systems. Discussion:
However, the current health condition of the countries remains the focus of the curricula where
Indonesian nursing education is focused on communicable disease and surgery nursing, whereas
the Japanese system focuses on gerontology and chronic disease nursing. In terms of the
qualification method, Japanese nurses should undertake a national board examination to be a
qualified nurse. On the other hand, there is no national board examination for Indonesian nurses.
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Indonesian nurses and caregivers i.e. they and skill in nursing would be known. The
gain new experiences and learn different other advantage is to complementing their
systems in the nursing profession. Therefore, liability and majority while caring the
these experiences can be applied in Indonesia patients. Comparison of educational
or internationally, and the quality of background would be the first step to
Indonesian nurses will be considered knowing their competence and potential in
consequently. the working field. In advance, this
According to Okamoto (1992), comparison will figured their majority and
improvement in living standards among shortage in nursing knowledge. By
Japanese people and increases in medical understanding this condition, Japanese and
care usage have caused a rapidly aging Indonesian nurses will be able to have mutual
population, decreased the death rate caused charge on knowledge and experience in the
by tuberculosis for all age groups and other working field. Besides this, during the EPA
infectious disease and caused falls in agreement for nurse recruitment, Indonesian
mortality among infants, adolescents and and Japanese nurses will be better prepared
young adults. Increasing the numbers in an for future recruitment.
aging population means an increase in A comparative descriptive study was
demands on medical care. The demand for performed based on databases of published
nursing workers has outpaced the supplies, materials and electronic journals. This
due to the development of medicines, comparison focused on a curriculum that was
increasing the numbers of beds and aging stipulated by government law for a Diploma
patients (Kanai-Pak et al., 2008). 3 (D-3) degree of nursing education.
Additionally, a number of nursing workers
are required in various areas. Implementation RESULT
of long-term care insurance encourages the Indonesian Nursing
place for treating and rehabilitating patients In general, nursing educational
with chronic illnesses to be shifted from institutions in Indonesia consist of two kinds
hospitals to facilities for long-term care, of educational path, i.e. undergraduate
home medical care and visiting nursing program (S-1) and diploma program (D-3),
(Sawada, 1997). Having considered those after completing a basic educational program
conditions, through the EPA agreement, the at Senior High School (Figure 1). These
Japanese government has opened the labour nursing schools provide curricula as
market for foreign nurses as stipulated in the stipulated by the National Education Systems
memorandum of understanding (MOFA, No. 20/2003 of the Ministry of Education,
2008). which adopted the recommendation from the
Success of EPA implementation will Indonesian Nurses‟ National Association.
bring a lot of benefit for both countries and to The number of nursing educational
achieve that objective, both Indonesian institutions in Indonesia is 427 and 173 for
nurses and Japanese nurses need to D-3 and S-1 levels, respectively, while the
understand each other. Indonesia and Japan average number of graduates is 12,810 and
have different backgrounds in terms of 3,460 for D-3 and S-1 levels, respectively
language and culture. This is a big challenge (Nursalam and Efendi, 2008).
for both nurses while working in the same High school
hospital, although they have the same
background in nursing. In terms of nursing
skill, there is no question of the nurse‟s skill.
University Nursing
This is because the nurse has the same level/Bachelo school/Diploma
background in nursing education. And each r
country has its own caring character.
This paper describes Indonesian and
Japanese nursing educational backgrounds in Pre-employment test
order to figure out a general description of Being a nurse
their educational systems. Having
comprehended the educational systems, the Figure 1. Indonesian nursing educational path
capability of nurses in terms of knowledge
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A Comparative Study of Nursing Educational System (Susiana Nugraha, dkk.)
The curriculum for the S-1 program Table 1. Indonesian national curriculum for
consists of academic and professional phases. D-3 program
Having completed the academic phase in 8 Group Subject Credits Total
semesters, students are required to conduct lectures
General Religion 2 8
research that will be examined at the end of lecture Citizenship 2
the academic phase for a bachelor degree. General ethics 2
Furthermore, they have to continue to the The five basic 2
professional phase for two semesters in order principal of the
to get a Ners degree. In this phase, students Republic of Indonesia
Basic Anatomy 2 12
have to conduct nursing practices in a skill Physiology and 2
hospital under supervision in 9 divisions of lecture biochemistry
nursing science, i.e. Nursing Management, Nutrition 2
Emergency Nursing, Maternity Nursing, Microbiology and 2
paracytology
Medical Surgical Nursing, Mental Health Pharmacology 2
Nursing, Pediatric Nursing, Family Nursing, Pathology 2
Community Nursing and Geriatric Nursing. Skill Fundamentals of 4 76
On the other hand, the curriculum of lecture nursing
D-3 also consists of the academic phase and and Basic human needs 8
clinical Nursing ethics 2
the professional phase which can be fulfilled training Communication in 2
in 6 semesters, but in contrast to the S-1 nursing
program, both of the phases are integrated. Health promotion 2
At the end of each semester of academic Nursing 2
documentation
activities, students are required to continue
Medical surgical 17
directly to nursing practices in hospitals nursing
under close supervision. The nursing Pediatric nursing 6
practices from semester 1 to 4 are fulfilled by Maternity nursing 5
simple nursing practices, such as taking Mental nursing 5
Community nursing 9
temperatures or measuring the blood pressure Emergency family 3
of patients. Afterwards, for the whole of nursing
semesters 5 and 6, students are required to Emergency nursing 3
conduct comprehensive practices (Nursalam Geriatric nursing 2
Professional nursing 2
and Efendi, 2008).
Management and 2
These educational institutions leadership in nursing
provide curricula for the applicable Nursing research 2
qualifications as stipulated by law. According Total 96
to Decree of the Ministry of National
Education No. 139/U/1999, the D-3 program Nurses who graduate from Bachelor
has 96 credits and consists of class lectures, of Nursing programs are called professional
laboratory practices and clinical training with nurses and nurses who graduate from
a duration of over 4,800 hours (Table 1) Diploma III in nursing are called beginner
(Nursalam and Efendi, 2008). professional nurses. A professional nurse is a
The nursing school curriculum person who passes the higher level of
guidelines stipulate the range of class hours accredited education. The beginner
per credit i.e. 18 hours for lectures, 36 hours professional nurse is a nurse who has good
for experiment and skill practices and 72 knowledge of intellectual, technical,
hours for clinical training. Instead of the interpersonal and moral, responsibilities in
above curriculum, each institution has to delivering nursing services based on valid
apply some local curricula which are decided regulations. Currently, there is no national
by each institution for 14–24 credits. Each board examination for nursing qualifications
institution determines class hour equivalents in Indonesia. The Indonesian government and
to a credit (Ministry of Education and Indonesian nurse association are working
Culture, 1999). towards creating a national standardisation
Having graduated from nursing for nurses (Hennessy et al., 2006).
school, one is qualified to work as a nurse in However, the current valid system is
a hospital as a professional nurse. based on the regulation of Decree of the
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156
A Comparative Study of Nursing Educational System (Susiana Nugraha, dkk.)
Table 2. Japanese national curriculum for D- adult nursing, geriatric nursing, pediatric
3 program health nursing, maternal nursing and mental
Group Subject Credits Total health nursing. All items in the examination
lectures are multiple-choice (Japanese Nursing
General Introduction to 13 13 Association, 2008).
lecture scientific approach Students are required to get a score
Understanding
humans and human over a pass standard. Essential questions
living society must be correctly answered in order to pass,
Basic Structure and 15 21 otherwise in the case of errors in these
skill functions of the questions the student will fail the
lecture human body examination. The examination pass rates
Disease mechanisms 6
and recovery were 90.6% in 2007 and 90.3% in 2008.
promotion
Social security DISCUSSION
systems and people‟s In terms of educational paths, there is
health
Skill Basic nursing 10 63
no specific difference between Indonesian
lecture Adult health nursing 6 and Japanese nursing educational systems, as
and Geriatric nursing 4 shown on Table 3. The basic difference is in
clinical Pediatric health 4 the method of qualification for nurses.
training nursing Japanese nurses have to undertake a national
Maternal nursing 4
Mental health nursing 4 board examination to become a qualified
Home health nursing 4 nurse, whereas there is no national board
Integrated nursing 4 examination for Indonesian nurses. In
and practice addition, current health conditions in the
Clinical training
countries remains the focus of each
Basic nursing 3
Adult health nursing 6 curriculum. Indonesian nursing education
Geriatric nursing 4 focuses on communicable disease and
Child health nursing 2 surgery nursing, whereas the Japanese
Maternal nursing 2 education focuses on gerontology and
Mental health nursing 2
Home health nursing 2 chronic disease nursing.
Integrated nursing 2
and practice
Total 97 Table 3. Nursing educational background in
Japan and Indonesia for D-3
. program
The national examination for Aspect Indonesia Japan
registered nurses consists of essential Content of Majority in Majority in
curricula medical surgical geriatric nursing
questions (30 items), general questions (150 nursing and adult
items) and questions concerning certain nursing
clinical cases (60 items). Questions Qualificati No national board Capability to
concerning clinical cases evaluate the ability on method examination. The work selected by
capability to work the nursing
of the nurse to understand and judge the selected based on national board
situations which nurses would meet in hospital pre- examination.
hospital. Information about the patient such employee Hospitals
as symptoms, physical and mental condition, examination. conduct an
age, sex and sociological background are employment test
to hire registered
given to answer the questions. Areas of nurses.
questions are the structure and function of the Contents Written and Written test
human body (anatomy, physiology, of the test clinical practice
biochemistry, nutritional science), disease test
mechanisms and recovery promotion Midwife Separately given Given after
and public in different completing the
(pathology, pharmacology, microbiology), health institution for nursing course
social security systems and people‟s health nurse minimum three for minimum of
(public health, social welfare, related laws), course year course. six months.
fundamental nursing, residential nursing,
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