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All Journal Jurnal NERS
Abigail, Wendy
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Nursing

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Structural constraints and patient agency in diabetes self-management: a critical case study in a primary healthcare center in Indonesia Yulia, Yulia; Abigail, Wendy; Willis, Eileen; Shifaza, Fathimath
Jurnal Ners Vol. 20 No. 3 (2025): VOLUME 20 ISSUE 3 (AUGUST 2025)
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jn.v20i3.71301

Abstract

Introduction: Effective self-management is essential for individuals with Type 2 Diabetes Mellitus (T2DM), yet patients in Indonesia often encounter persistent barriers. This study explores patients’ perspectives on the challenges they face as well as the perceived supports available within the primary healthcare system. Methods: A qualitative case study approach, based on Yin’s methodology, was employed. Guided by Habermas’s theory of communicative action and Honneth’s theory of recognition, data were collected through in-depth interviews with 14 patients, 28 clinical observations of patient–provider encounters, and one focus group with five healthcare professionals. Participants were recruited from a suburban primary healthcare center in Indonesia using purposive sampling. Reflexivity and field notes were maintained throughout the data collection process. Data were analyzed using thematic qualitative analysis. Triangulation across data sources helped enhance credibility and trustworthiness. Results: Five key themes emerged: (1) Medical dominance in care provision, (2) Communication gaps, (3) Regulation-centered care, (4) Care quality, and (5) Patient self-empowerment. These themes reveal systemic, structural, and interpersonal barriers that constrain effective diabetes self-management in primary care. Conclusions: Understanding the lived experiences of patients with T2DM is critical to informing practice and policy. To overcome these barriers, a shift toward patient-centered care, improved communication, and more inclusive support systems is essential within Indonesia’s healthcare system.
The complexities of human procedural nursing research ethical approval processes in Indonesia Abigail, Wendy; Yulia, Yulia; Christina, Juliana; Pradanie, Retnayu
Jurnal Ners Vol. 18 No. 3 (2023): SEPTEMBER 2023
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jn.v18i3.44463

Abstract

Introduction: Research requires high quality ethical practices. However, research approvals vary between developed and developing countries resulting in additional challenges for researchers wishing to participate in collaborative research projects. The aim of this paper is to describe and discuss three nursing research ethics application processes in different locations in Indonesia that had an Australian university overseeing them.  Methods: Three nurse researchers provide a reflective account of the ethics application processes of their qualitative research projects conducted between 2014 and 2021. A collective case-study methodology using descriptive analysis was applied where the information was collated and compared for similarities, differences and challenges. Results: Ethics and site approvals varied at each Indonesian site. The ethical and approval application processes were time-consuming at all levels. which delayed the start of all the projects, which varied from between one to six months. As a result, all three projects experienced delayed completion. Conclusions: Ethical approval is required for medical research prior to any data collection. Approval processes need to be consistent so that delays in the application processes are avoided. Any delays in approval to conduct research has implications for research projects. It is essential that timeframe factors need to be considered when applying for grant funding, gatekeepers are identified early, and payments are identified and planned for. It is recommended that, to improve consistency with ethical application processes, streamlining of applications and approvals in Indonesia needs to be reviewed, particularly since the introduction of the WHO March 2022 Standard Operating Procedures.
Co-Authors Christina, Juliana Pradanie, Retnayu Shifaza, Fathimath Willis, Eileen Yulia Yulia