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(Neha Ellis) TRENDS and ISSUES in Nursing Education
(Neha Ellis) TRENDS and ISSUES in Nursing Education
(Neha Ellis) TRENDS and ISSUES in Nursing Education
FARIDKOT
SEMINAR
ON
CURRENT TRENDS AND ISSUES IN NURSING
EDUCATION IN INDIA
(SUBJECT: NURSING EDUCATION)
The changes that are occurring in the social and cultural life of the society as a result of the impact of
advancements in the science based technology are broadly described as modernization. Since education is a
multipolar process, it is influenced by the modernization in different ways. A profession is a dynamic
integration of various faculties of knowledge. Since nursing education is a professional education, it is
dynamic by its own nature and thereby giving rise to trends .A number of issues and controversies now face
educators and communities: social issues and ethical issues.
DEFINITION OF EDUCATION
“Education is the all-round drawing out of the best in child and man body, mind and spirit.”
- Mahatma Gandhi.
Nursing education is a professional education which is consciously and systematically planned and
implemented through instruction and discipline and aims the harmonious development of the physical,
intellectual, social, emotional, spiritual and aesthetic power or abilities of the student in order to render
professional nursing care to people of all ages, in all phases of health and illness , in a variety of settings , in
the best or highest possible manner.
Indian medicines are found in the sacred books of "Vedas". The ;Ayur-veda&; is thought to
have been given by Brahma. 1400 BC Sushruta, known as ;Father of Surgery; in India wrote book on
surgery and years later ;Charaka; wrote a book on internal medicine. By these writings we can learn that
those days surgery had advanced to a high level, also had 4 wings of treatment ;ChatushpadaChikitsa.
1.Physician - Bhishak
2.Nurse - Upacharika (Attendent - Anuraktha)
3.Therapeutic drugs - Dravya
4.Patient – Adhyaya
Characters of Upacharika (Nurse)
● Shuchi - Pure or clean in physical appearance and mental hygiene.
● Daksha - Competency
● Anuraktha - Willing to care
● Buddhiman - Co-ordinator with the patient and doctor / intelligent.
3. Nursing Post Vedic Period (600 BC - 600 AD)
Medical education was introduced in ancient Universities of ;Nalanda; and;Thakshashila;. King Ashoka
(272-236 BC) constructed hospitals for the people and animals. Prevention of the disease was given first
importance and hygienic practices were adopted. Cleanliness of the body was religious duty. Doctors and
midwives were to be trustworthy and skillful. They should wear clean clothes and cut their nails short. Lying
rooms were kept well ventilated. Religious ceremonies and prayer precedes co-operations. The nurses were
usually ;men or old women;. Women are restricted activities at home and cared for sick members in the
family during 1 AD period superstition and black magic replaced more in daily practices. Medicines are
remained in the hands of priest - physicians, who refused to touch the blood and pathological tissues.
Dissection was forbidden. Other religious restriction and superstitious practices probably declined the
development of nursing.
4. Nursing in Mogul Period (1000 AD)
;Unani system of medicine developed during the Arab civilization. It was practiced in Indo-Pakistan
subcontinent. The basic framework consists of blood, phlegm, yellow bile and back bile. Temperament,
strengthening of body and nature are the real physician. Not believed in eradication of disease greatly
depend on defense mechanism of the body and self-care and positive health habits. Therefore, it becomes
part of Indian medicine practice.
5. British period (16th Century onwards)
After the mogul period the nursing in India hindered due to various reason like low state of women, system
of “pardha” among Muslims, caste system among Hindus, illiteracy, poverty, political unrest, language
difference and nursing looked upon as servants work. During the 16 th century, nursing development in
India taken three dimensions.
1. Military Nursing
2. Civilian Nursing
3. Missionaries Nursing
1. Military Nursing
Military nursing born during 1st world war but developed very slowly. British officers informed need of
nurses to take care British officials and soldiers in India. On 1888 February 21 st – 10 fully qualified nurses
from Florence Nightingales, arrived to Bombay to lead nursing in India. This paves the way to develop one
of the best nursing in the world. 1894 regular system of training for men for hospital work started. Medical
officers given lecturing to them. Some men were voluntary did the course and applied for nursing certificate.
After two months of practical posting to word, on the account of supervised sister’s report, first time hospital
‘orderliness’ issued certificate and had official status. This system laid the possible foundation to existing
system of training and higher education.
1927- Description of Indian Military Nursing services formed with 12 matrons, 18 sisters, 25 staff nurses.
They are responsible for supervision, instruction and training of nursing services for entire Indian hospital
corps.
2nd world war expanded nursing services to India and overseas under the direction of chief principal Matron.
3 years training carried out in selected military hospital preliminary training schools. After completion sent
to military hospital for training. After successful training certificate issued as “ Registered Nurse” and they
are a member of Indian Military Nursing services Auxiliary Nursing Services. Shortage of trained nurses in
India after the 2 nd world war the government initiated short course of intensive training in 1942 which led
to the Auxiliary Nursing Services. Basic training for 6 months in selected civil hospital after passing
examination at military hospital in India sent to overseas to serve in the capacity of ; Assistant Nurses; 3000
women given auxiliary training.
2. Civilian Nursing in India
● 1664 - East India company built Government General Hospital at Madras for civilian.
● 1871 – This hospital undertook training of nurses. On 1854 midwives training school granted
certificates of ‘diploma in Midwifery’ for passed students and ‘sick nursing’ for failed students. First
time 6 nurses came out as Diploma in Midwifery Nurses.
3. Missionary Nursing
Missionary nursing started training for Indian people as nurses. Various other countries supported. This
brought fully qualified Indian nurses. Those days there were several obstacles for nursing development.
Girls were not allowed to do work. Degrading and unworthy attitude of people. Hindus were hold back due
to deep seated caste system. Muslims held under ‘paradha’ system. So Christian girls encouraged and
trained first. Frequent disappointment, degradation difficulties nursing training came into existence and
looks its own shape. In the beginning there is not uniformity in nursing education. There is no particular
standards were given.
After the course of lecturing 18 months to 2 years, written examination conducted. If failed training
extended to 3 years.From 1888-93 five years various experts like doctors, surgeons, nursing superintendent,
pharmacists- draw up a curriculum for training. 1907-10 North India united board of Examiner formed to
maintain nursing administration and standards.
● 1928- Hindi text book for nurses developed.
● 1939- helped to develop postgraduate school for nurses.
Community Health Nursing:William Rathbone foamed visiting Nurses Association at England. She
emphasized on charity free care etc. Florence Lees improved the visiting Nurses by giving specialized
training for their work. It is influenced in india, because of the terrible conditions under which children were
born recognized as cause for high mortality rate. Because untrained ‘Dais’ are attending women at the time
of child birth. Dais was unwilling to train and patients will accept the old customary methods.
● 1926 – Midwives Registration Act formed for the purpose of better training of midwives. Slowly
community Nursing Training needs felt by the Government.
● 1946 – Community Health Nursing was integrated in Basic Nursing Programme at Delhi, Vellore
and Madras.
TRAINED NURSES ASSOCIATION OF INDIA (TNAI)
● In 1908 – TNAI formed to uphold the dignity and honor of the nursing profession. Florence Mac
Haughton was the first president of TNAI.
● In 1910 – TNAI published journals.
● In 1912 – TNAI affiliated to international Nursing Council as a 8 th Association in the world.
● In 1917 June 16 th under the registration Act No:21 of 1860
● In 1922 – SNA formed.
DEVELOPMENT OF NURSING EDUCATION IN INDIA : POST INDEPENDENCE
On 15th August 1947 India became independent and self govermentation. Social changes were taking
place rapidly but an alarming absence of public health and sanitary measures continued. The ratio of nurse
to patient remained dangerously low. The opening of nursing schools associated with college gave
nursing profession a higher social and economic status, than it had previously known. The formation of
many commission and committees, establishment of INC and tremendous work of TNAI brought about
change in nursing education post-independence.
TRAINED NURSES ASSOCIATION OF INDIA:
TNAI helps the initiation of university level education in India.
Recommendations of the Bhore committee were implemented within a year .
1. Passing of the INC act
2. Deputation of Indian nurses abroad for post basic education
The TNAI made significant achievements in the field of nursing education. It creates awareness among
nurses through Nursing journal of India and organizing continuing education programmes. TNAI also offers
scholarships to deserving candidates to take up studies within the country and abroad.
● Knowledge Expansion:
Expanded Nursing Literature: the last decade had witnessed a great expansion in nursing literature.
The CINAHL, Cochrane, PubMed databases serve as the excellent treasure for nurses & nursing
students. This has considerably helped a lot in disseminating the research findings across the
geographical and economical barriers.Expansion of research based literature fosters EBP as
‘retrieving evidence from different sources’ is one of the main components of EBP.
Research in Nursing Education: Research has become a major area in curriculum. Action research and
the use of qualitative methodologies in research is getting wider acceptance now. Educational research
focuses on enhancement of the teaching and learning process.
● Evaluation System:
University Based Education: Previously, the GNM and ANM courses were offered in Schools of
Nursing that were not affiliated to any University. Now, B Sc. Nursing and MSc. Nursing courses are
being offered to nursing students in Colleges of Nursing which is either affiliated to, or a constituent of
a university.
Innovative Evaluation Strategies: Innovative evaluation strategies like ‘Objective Structured Clinical
Evaluation’(OSCE), Rubrics, are now widely being used in nursing education. OSCEs are widely used
to evaluate clinical skills and competencies. In clinical nursing education, rubrics are used to
objectively assess student performance and it focuses on aspects of patient safety.
● Modes Of Education:
Distance Education in Nursing: Different universities all over the world have started offering nursing
courses through distance education. Foreign universities provide courses such as accelerated RN
program, LPN to RN programs in distance education modes. In India; Indira Gandhi National Open
University (IGNOU) offers various courses in nursing via distance mode.
E Learning & Online Education: E learning and online education are becoming important icons of
nursing education which increases the scope of universal learning. Education is becoming accessible in
the tips of every nurse by the technological advancements and the implementation of e learning in
nursing. wide number of free online Continuing Education (CE) programs helps nurses to keep
updated with the current knowledge.
Interprofessional Education (IPE): The need of collaborative practices among health care professionals
led to the emergence of IPE. Individuals from different professions learn together in the milieu of
interprofessional education.
3. Educational Quality Assuranceis a process for monitoring and evaluating the efficiency and
effectiveness of educational provision and to institute remedial measures as & when needed.
Educational Quality Assurance: The trend of educational quality assurance has emerged recently. It is
a process of monitoring and evaluating the efficacy and effectiveness of educational provision and to
institute remedial measures as and when needed. In India nursing education is flourishing in an
unprecedented manner, naturally this will lead to the dilution in the quality of nursing education.
Accrediting agencies like ISO has taken the initiative of accrediting colleges of nursing in India.
Advanced Nursing Courses: In recent years nursing is finding new arenas for its development and
autonomous practice. Nurses in clinical area is also now focusing on their carrier advancements by
continuing nursing education programs and in-service education. Higher studies in abroad is also
becoming more popular in developing countries like India. There is a high demand for; Nurse
Practitioner, Clinical Nurse Specialist, MPhil and PhD programmes.
4. More Reliance On Technology for teaching & learning with judicious use of educational psychology
in the development & practice of educational technology being user-friendly in nature. Technology
exerts greater influence on nursing education as a tool for teaching and learning. Computers are used in
all fields of healthcare with the advent of advanced technology. That’s why computer education has
been introduced in the revised nursing curriculum.
5. Emphasis On High Tech- High Touch Approachto preserve the humancomponent of nursing care
without undermining the advantages of technological advancements in field of patient care. Present
day nursing education is preparing students to maintain the human element of nursing care with the
help of sophisticated technology and gadgets.Advanced educational technology media like projectors,
Smart boards, computer models and simulation labs are now widely used by nursing teachers to
provide effective teaching experiences to students. Nursing students widely use smartphones, tablets
and android applications as means for educational support. Android apps provide information to the
fingertips of the students in no time and is increasingly used in clinical nursing education.
Simulations in Nursing Education: Simulations are getting wider acceptance in nursing education
system, where concepts of patient safety and consumer protection are accent. Simulation is the
“process of designing a model of a real system and conducting experiments with this model for the
purpose of either understanding the behavior of the system and/or evaluating various strategies for the
operation of the system”
Animations & Cinematic Technology: Animations are now widely used to enhance the learning
experience. Video assisted teachings with the help of animation are being widely used in nursing
education. Nursing procedures, physical examination, breath sounds and stages of labor can be made
clear and thorough with the help of this visual learning technologies. The use of cinematic technology
in the classroom teaching provides a varied learning experience which engages students in learning
complex material through visual illustrations.
6. Preparation Of Global Nursesto reap benefits created by globalisation&liberalisation by way of
preparing global nurses.
7. Transational Acceptanceof national education programmes of one nation by other nations for
development of nursing education in countries like India.
8. Ensuring A Promising Career in India & abroad to maintain this status for long term.
9. Emergence Of New Specialitiesto meet the needs of the community.
10. Increased Opportunities For Higher Studies so that an eligible candidate can easily pursue higher
education without much time lag.
11. Diminishing Government Role in preventing shortage of funds with taking certain policy decisions
to prevent the govt. From investing further in the field of nursing education.
12. Uniformity And Standardizationin universities & nursing boards by conducting nursing programmes
similar to each other.
13. Coping With The Impact Of Globalizationto inculcate the traditional values of nursing profession
during their student period because the status of nursing is shifted from a caring to a rewarding
profession.
14. Enhanced Student Statusto consider nursing students as ‘nursing students’ & not ‘student nurses’.
Enrolment of Men as Nursing Students: Nursing was considered as a female profession at least in
India. In present generation, the trend is changing. In the past few decades the number of males
enrolled for Nursing has increased, it is expected to increase this number in the coming years.
Changing demography of Nursing Students: In older days nursing care was provided by nun sisters and
many of the major hospitals were established by missionaries. Present day nursing students represents
a diverse population in terms of gender, age and socio economic status.
THE CURRENT TRENDS AND THEIR RELATED ISSUES IN NURSING EDUCATION IN INDIA
1. Sociodemographics, cultural, diversity, economic, and political changes, and global issues:
● Increased aging population; increasing multicultural, ethnic diversity requires increased learning
● Immigration conflicts, protests; consequences for access and health care
● Global community, globalization health issues; global nursing networks
● Social, economic, and political changes 5. Multidimensional content, client care, clinical learning
sites.
CONCLUSION
Trends are the changes that takes place and become vogue. The technological changes, changes in
demographics and health patterns have contributed to various trends in nursing education. The dynamic
nature of nursing education strive to enhance the quality of care, the core of nursing
BIBLIOGRAPHY
1. Sandaranarayanan, B. and Sindhu, B. (2003), ‘Learning and Teaching Nursing’, Calicut, Brainfill.
2. Honda, U. and Gulani, K. K. (1995). ‘Community Health Nursing’, New Delhi, Ignon Publications.
3. Neeraja K. P. (2003), ‘Text Book of Nursing Education’, New Delhi: Jaypee Brothers.
4. Hurndr, R. and Letiman, B. (183). ‘Nursing Education in India’, New Delhi.
5. TNAI (1995). ‘Indian Nursing Year Book’, 1993-95, New Delhi – TNAI.
TNAI (2002), ‘Indian Nursing Year Book’, 2000, New Delhi – TNAI
6. Cherry, B., & Jacob, S. R. (2013). Contemporary Nursing, Issues, Trends, & Management, 6:
Contemporary Nursing. Elsevier Health Sciences. Annette Debisette et al., (2010), Addressing New
Challenges Facing Nursing Education: Solutions for Transforming Healthcare Environment, The
National Advisory Council on Nurse Education and Practice (NACNEP), PP: 1-34
7. http://www.hrsa.gov/advisorycommittees/bhpradvisory/nacnep/Reports/eight hreport.pdf.