An Analysis of Indonesian Rural Nurses' Competencies Across the Continuum of Care

Background: In Indonesia, rural nurses provided continuum of care (CC) services to people with communicable diseases (CD) and noncommunicable diseases (NCD) including chronic lifelong conditions (CLC). Rural nurses’ skills across the continuum of care are not fully developed. In addition, there is no inventory for rural nursing competencies across the continuum of care (RNCACC) that can be used to improve nursing education and to measure nurses’ performance.
Purpose: The purpose of this study was to develop an inventory of RNCACC that is suited to nursing practice caring for people with CD, NCD, and CLC in rural Indonesia. The specific aims were: 1) to describe rural nurses’ scope of practice, especially their roles and responsibilities in managing diseases and CLC, and understand their practice across the continuum of care; 2) to construct a pool of competency indicators across the continuum of care for people with CD, NCD, and CLC in rural areas covering knowledge, skills, and personal attributes; and, 3) to validate the RNCACC inventory.
Methods: This study used focus group discussions (FGD) with 16 rural nurses and nurse educators in a province to identify the scope of practice and areas essential for a RNCACC, followed by content analysis to create the RNCACC inventory. Face validity was done prior to Delphi rounds. Finally, 11 national rural nursing experts participated in two online Delphi rounds to determine the importance of each indicator on the RNCACC inventory, followed by quantitative analysis using content validity index (CVI) to evaluate consensus among the experts.
Results: Four themes were identified from the FGDs: ‘care for individuals of all ages,’ ‘care for families,’ ‘care for communities,’ and ‘nursing practice unique to rural settings.’ Caring for healthy and sick individuals across the lifespan in the form of wellness and episodic care appeared to be rural nurses’ initial role in primary health care (PHC). Along with delivering care for families, rural nurses fostered long-term care that focused on involving a family’s commitment to self-care, prompting family as the unit of care. Caring for family became a central role that paved their contribution across the continuum of care. Care for community enabled rural nurses to stretch their functions in disease prevention and health promotion to the population at large. The theme ‘nursing practice unique to rural settings’ covered advanced clinical and cultural nursing skills for practicing in rural settings, while balancing their role expansion in rural PHC facilities. The Delphi panelists were in agreement about 106 indicators across the seven domains on the RNCACC. These seven domains were episodic care, wellness care, long-term care, community care, communication and interpersonal, management and organizational, and caring. The 106 indicators mean ratings ranged from 3.090 to 4.00 (SD = 0.302 – 1.328) and most were highly connected with key aspects of continuum of care. The 106 indicators had a CVI ranging from 0.73 to 1.00 and the overall RNCACC inventory had a CVI of 0.954. The inventory development process is an important step to establish Indonesian rural nurse competencies across the continuum of care.