Vol. 2 No. 2 (2023): Promoting Integrative Healthcare: Education, Policy, and Management

Original Research Article

Understanding the issues and challenges in the implementation of nursing services in primary health care: A qualitative study in Garut, West Java, Indonesia

Iwan Wahyudi
Faculty of Nursing, University of Indonesia, Depok, West Java, Indonesia | College of Health Sciences Karsa Husada, Garut, West Java, Indonesia
Junaiti Sahar
Faculty of Nursing, University of Indonesia, Depok, West Java, Indonesia
Hanny Handiyani
Faculty of Nursing, University of Indonesia, Depok, West Java, Indonesia
Dian Ayubi
Faculty of Public Health University of Indonesia, Depok, West Java, Indonesia


challenges, issues, nurse, nursing services, primary health care center, Indonesia

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Accepted for publication: 2023-09-07
Peer reviewed: Yes

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Background: Primary healthcare centers provide a wide range of healthcare services, with nurses playing pivotal roles in maintaining the quality of care. To enhance nurse performance, it is essential to gain insights into their experiences regarding the implementation of nursing services in these institutions.

Objective: This study aimed to explore the issues and challenges related to nursing services in primary health care centers through the perspectives of Indonesian nurses.

Methods: Qualitative research using a phenomenological approach was conducted. Twelve nurses from primary health care centers were purposively selected as study participants. Data were collected through face-to-face, semi-structured interviews between January 2022 and March 2022. Thematic analysis was employed for data analysis.

Results: The analysis yielded five main themes: 1) Working with additional roles and duties, 2) Uncertainty regarding nurses’ roles and functions, 3) Nurses' concerns about the nursing profession, 4) Barriers to implementing nursing services, and 5) Nurses' expectations concerning nursing services.

Conclusion: Nurses in primary health care centers face challenges in fully carrying out nursing services. Numerous issues and obstacles exist in the provision of nursing services at primary healthcare facilities. Therefore, it is essential to strengthen the authority and autonomy of nurses working in primary health care settings.

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Funding Description

This study was supported by the Indonesia Endowment Funds for Education (LPDP) Ministry of Finance of the Republic of Indonesia


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Declaration of Conflicting Interest

The authors declared no conflict of interest in this research.


The authors would like to thank all participants for their time and effort in contributing to this study.

Authors’ Contributions

Authors (IW, JS, HH, DA) participated in the concept, study design, and analysis. The first author (IW) conducted the interviews, data collection, and writing. All authors approved the final version of the article to be published.

Data Availability Statement

All datasets generated and analyzed during the study process are not made public but available from the corresponding author upon reasonable request.

Declaration of the Use of AI in Scientific Writing

Nothing to declare.


Agustanti, Y. A. D. (2016). Kinerja perawat dalam pelaksanaan perkesmas [The performance of nurses in the implementation of community health center]. Jurnal Kesehatan, 4(1), 204-213. http://dx.doi.org/10.26630/jk.v4i1.1

Anderson, D. R., & St Hilaire, D. (2012). Primary care nursing role and care coordination: An observational study of nursing work in a community health center. Online Journal of Issues in Nursing, 17(2). https://doi.org/10.3912/OJIN.Vol17No02Man03

Barbiani, R., Nora, C. R. D., & Schaefer, R. (2016). Nursing practices in the primary health care context: A scoping review. Revista Latino-Americana de Enfermagem, 24, e2721. https://doi.org/10.1590/1518-8345.0880.2721

Barnes, H., Richards, M. R., McHugh, M. D., & Martsolf, G. (2018). Rural and nonrural primary care physician practices increasingly rely on nurse practitioners. Health Affairs, 37(6), 908-914. https://doi.org/10.1377/hlthaff.2017.1158

Busca, E., Savatteri, A., Calafato, T. L., Mazzoleni, B., Barisone, M., & Dal Molin, A. (2021). Barriers and facilitators to the implementation of nurse’s role in primary care settings: An integrative review. BMC Nursing, 20(1), 171. https://doi.org/10.1186/s12912-021-00696-y

Chiang, Y.-M., & Chang, Y. (2012). Stress, depression, and intention to leave among nurses in different medical units: Implications for healthcare management/nursing practice. Health Policy, 108(2-3), 149-157. https://doi.org/10.1016/j.healthpol.2012.08.027

Colaizzi, P. F. (1978). Psychological research as the phenomenologist views it. In R. S. Valle & M. King (Eds.), Existential Phenomenological Alternatives for Psychology. Open University Press.

DeLucia, P. R., Ott, T. E., & Palmieri, P. A. (2009). Performance in nursing. Reviews of Human Factors and Ergonomics, 5(1), 1-40. https://doi.org/10.1518/155723409X448008

Ferreira, S. R. S., Périco, L. A. D., & Dias, V. R. F. G. (2018). The complexity of the work of nurses in Primary Health Care. Revista Brasileira de Enfermagem, 71, 704-709. https://doi.org/10.1590/0034-7167-2017-0471

Finch, J. (2019). Autonomy in district and community nursing. British Journal of Community Nursing, 24(9), 453-455. https://doi.org/10.12968/bjcn.2019.24.9.453

Guba, E. G., & Lincoln, Y. S. (1989). Fourth generation evaluation. California: Sage Publication.

Gunawan, J., Marzilli, C., & Aungsuroch, Y. (2022). Online ‘chatting’ interviews: An acceptable method for qualitative data collection. Belitung Nursing Journal, 8(4), 277-279. 10.33546/bnj.2252

Gunawan, J., Wahab, N. A., & Elmiati, E. (2015). Concerns in qualitative research and nursing science. Belitung Nursing Journal, 1(1), 4-7. https://doi.org/10.33546/bnj.2

Haddad, L. M., Annamaraju, P., & Toney-Butler, T. J. (2023). Nursing shortage. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK493175/

Hämel, K., Toso, B. R. G. d. O., Casanova, A., & Giovanella, L. (2020). Advanced practice nursing in primary health care in the Spanish National Health System. Ciência & Saúde Coletiva, 25, 303-314. https://doi.org/10.1590/1413-81232020251.28332019

Kusano, Y., & Ehrhardt, E. (2015). Nursing profession’s contribution to person- and people-centered primary health care. International Journal of Person Centered Medicine, 5(4), 197-203. https://doi.org/10.5750/ijpcm.v5i4.552

Masriati, M., Abdullah, R., & Nongkeng, H. (2018). Pengaruh beban kerja, karakteristik individu dan disiplin kerja perawat terhadap kinerja perawat di Puskesmas Palanro Kabupaten Barru [The influence of workload, individual characteristics and work discipline of nurses on the performance of nurses at the Palanro Community Health Center, Barru Regency]. YUME: Journal of Management, 1(3). https://doi.org/10.37531/yum.v1i3.339

Moriel, D., Felix, K., & Quinlan, P. (2017). Roles and responsibilities: asking nurses and physicians what they know, do not know and want to know about the other’s profession. Journal of Research in Interprofessional Practice and Education, 7(1). https://doi.org/10.22230/jripe.2017v7n1a253

Mutshatshi, T. E., & Munyai, V. (2022). Challenges experienced by primary health care nurses rendering 24 hours service at designated clinics in Musina Local Area , Limpopo Province The Open Public Health Journal, 15(1), e187494452202241. http://dx.doi.org/10.2174/18749445-v15-e2202241

Pasthikarini, P., Wahyuningsih, A., & Richard, S. D. (2018). Peran manajer keperawatan dalam menciptakan motivasi kerja perawat [The role of the nursing manager in creating the work motivation of nurses]. Jurnal Penelitian Keperawatan, 4(2), 117-125. https://doi.org/10.32660/jurnal.v4i2.322

Polit, D. F., & Beck, C. T. (2018). Essentials of nursing research: Appraising evidence for nursing practice (9th ed.). Philadelphia: Wolters Kluwer. https://books.google.co.th/books?id=Z6DwjwEACAAJ

Rabie, T., Coetzee, S. K., & Klopper, H. C. (2016). The nature of community health care centre practice environments in a province in South Africa. Africa Journal of Nursing and Midwifery, 18(2), 27-41. https://doi.org/10.25159/2520-5293/216

Rasheed, S. P., Younas, A., & Sundus, A. (2019). Self‐awareness in nursing: A scoping review. Journal of Clinical Nursing, 28(5-6), 762-774. https://doi.org/10.1111/jocn.14708

Rouhi-Balasi, L., Elahi, N., Ebadi, A., Jahani, S., & Hazrati, M. (2020). Professional autonomy of nurses: A qualitative meta-synthesis study. Iranian Journal of Nursing and Midwifery Research, 25(4), 273-281. https://doi.org/10.4103%2Fijnmr.IJNMR_213_19

Shihundla, R. C., Lebese, R. T., & Maputle, M. S. (2016). Effects of increased nurses' workload on quality documentation of patient information at selected Primary Health Care facilities in Vhembe District, Limpopo Province. Curationis, 39(1), 1-8. https://doi.org/10.4102/curationis.v39i1.1545

Spetz, J., Skillman, S. M., & Andrilla, C. H. A. (2017). Nurse practitioner autonomy and satisfaction in rural settings. Medical Care Research and Review, 74(2), 227-235. https://doi.org/10.1177/1077558716629584

Tamata, A. T., & Mohammadnezhad, M. (2023). A systematic review study on the factors affecting shortage of nursing workforce in the hospitals. Nursing Open, 10(3), 1247-1257. https://doi.org/10.1002/nop2.1434

Torabizadeh, C., Mahnazrakhshan, Z., & Njimehbeygi, B. (2019). Professional capability in nursing. International Journal of Pharmaceutical Research, 11(1), 556-566. https://doi.org/10.31838/ijpr/2019.11.01.075

Weiland, S. A. (2015). Understanding nurse practitioner autonomy. Journal of the American Association of Nurse Practitioners, 27(2), 95-104. https://doi.org/10.1002/2327-6924.12120

Yoder-Wise, P. S., Waddell, J., & Walton, N. (2019). Leading and managing in Canadian nursing (2nd ed.). Canada: Elsevier Health Sciences.

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