Perdana, Melyza
(2025)
RenNers: Design and evaluation of a nurses’ training model in management of early-stage chronic kidney disease in Indonesia.
PhD thesis, University of Nottingham.
Abstract
Early detection and effective management of chronic kidney disease (CKD) in at-risk populations significantly reduces the progression to end-stage kidney failure. Unfortunately, Indonesia, a lower-middle-income nation, has relatively few initiatives focused on early-stage CKD management, with most treatments directed towards advanced stages of the disease. While early CKD management strategies have shown to be successful elsewhere, simply transferring these approaches to Indonesia is not feasible; adaptations are necessary to ensure interventions align with the local culture and address the challenges posed by limited healthcare capacity, including a scarcity of nephrologists.
In the Indonesian context, enhancing the role of nurses in educating patients on self-management of early-stage CKD is a promising strategy to slow the progression to advanced stages of the disease. However, many nurses working with CKD patients possess limited knowledge of the condition and lack formal training, particularly in early-stage management. Consequently, continuing education is crucial for nurses to acquire the necessary skills to effectively optimise their role in CKD care and enhance patient quality of life. There is an urgent need to develop a tailored training model that addresses nurses’ educational requirements while considering potential barriers to participation, such as their existing workload.
This research seeks to bridge the theory-practice gap in delivering modern CKD care in Indonesia by developing the RenNers blended training programme and conducting a thorough assessment of its feasibility and acceptability for the studied context. A systematic approach was employed to design, implement, and evaluate the training programme using the ADDIE model. The implementation and evaluation phases have been successfully carried out through a pilot study, which has provided valuable insights into the programme’s acceptability among general nurses at two hospitals in Indonesia.
This study makes several important contributions to nephrology care and the nursing profession in Indonesia. The primary contribution is the development of the RenNers blended training programme, which is firmly based on insights gathered from a comprehensive scoping review of existing research on blended learning in long-term care management and semi-structured interviews with 33 key stakeholders involved in CKD care. These interviews revealed a strong desire among nurses, nephrologist experts, and patients for nurses to enhance their knowledge in the CKD field. Additionally, a series of expert panel reviews, which informed the design and development of the RenNers training programme, emphasised the principle of co-creation to ensure the training package is relevant for nurses in Indonesia.
RenNers was piloted with a clinical nurse sample, and the results indicated that participants were extremely satisfied with the overall training. The blended learning approach effectively accommodated their busy schedules, and beyond improving their confidence and knowledge in CKD care management, participants expressed a growing interest in evidence-based practice, which may enhance their overall work performance. This positive feedback strongly suggests that the RenNers training shows great promise and is well-suited for future large-scale randomized controlled trials. Recommendations for programme enhancement included integrating supplementary training activities and addressing specific technical challenges related to the learning platform and internet connectivity issues.
Furthermore, the findings from this research hold the potential to motivate policymakers and hospital administrators to endorse digital transformation initiatives aimed at the ongoing professional development of healthcare professionals in Indonesia and also contributing to the maturation and development of the national learning platform launched in 2024, which remains largely underutilised nationwide at the current juncture. The RenNers training programme, meticulously crafted through a systematic and rigorous process that engaged a diverse array of stakeholders, including patients themselves, can serve as an exemplary model for developing additional healthcare-related training initiatives. Establishing a well-structured training programme that addresses the concurrent needs of patients is essential for enhancing the quality of healthcare services in Indonesia.
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