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Current 11/23/09

Evolution of Nursing Education in India

We can summarize the history of nursing education in India as follows: 1871 - School of nursing started in general hospital Madras. 1886 - School of nursing in a full-fledged form was started in J.J. hospital, Bombay. 1892 - Many hospitals in Bombay started nursing associations which were intended to provide additional facilities for the training of local nurses. 1908 - TNAI established. 1909 - Bombay presidency nursing association was formed. 1910 - United board of examination for nurses was organized. 1913 - South India Board was organized. 1926 - First nurses registration act passed in Madras. 1935 - Madras and Bombay nursing councils were established. 1942 - ANM programme started. 1943 - School of Nursing at RAK college, New Delhi. 1943 - Diploma programme in nursing administration started in New Delhi. 1946 - Four year B.Sc nursing programme started in RAK college and CMC, Vellore. 1947 - INC act was passed. 1949 - INC was established. 1959 - MSc Nursing started in RAK college. 1963 - Post basic B.Sc programme started in various institutions

1968 - M.Sc nursing at CMC, Vellore 1972 - Basic degree programme started in Kerala 1985 - M.Sc nursing stated in CMC Ludhiana. 1985 - IGNOU established. 1986 - Curriculum change for GNM programme from three and a half years to three years. 1986 - M.Phil programme started in RAK, Delhi. 1987 - MSc Nursing started in Kerala 1987 - Separate directorate of nursing was created in Karnataka State. 1988 - M.Sc Nursing at Nimhans 1992 - Ph.D in RAK College, New Delhi 1992 - Post basic programme started under IGNOU 1994 - M.Sc nursing at Mahe, Manipal 1994 - Basic B.Sc programme under school of Medical education in Mahatma Gandhi University, Kottayam.

1996 - M.Phil and Ph.D at Mahe, Manipal. 2001 - Ph.D at NIMHANS Uncategorized

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Phd Nursing in India Teacher Educatin in India Development of nursing education in india: Post-indpendence Development of nursing education in india: Pre-indpendence Evolution of Nursing Education in India Adult Education Flannel Group DOs and DON'Ts in Lecture Blackboard Overhead Projector Focus Group Discussion Challenges in Nursing Education Micro-Teaching Active Lecture as a Method of Teaching HIGH POWER COMMITTEE ON NURSING IN INDIA Project Method Brainstorming Problem-based learning PBL Dramatization in Teaching and Learning Process ANIMATIONS IN MEDICAL EDUCATION

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Globalization of Higher Education in Nursing: Trends and Future Directions in Harmonizing Nursing Education Internationally
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Abstract and Introduction Globalization and the Internationalization of Education Exporting of Education Challenges and Current Solutions Related to Nurse Migration Current Standards and Harmonization in Transnational Nursing Education Trends and Future Directions in Harmonizing Nursing Education Internationally Conclusion
References

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Trends and Future Directions in Harmonizing Nursing Education Internationally

Nurses have existed in many cultures since ancient times (Sapountzi-Krepia, 2004). In Europe and North America, modern nursing developed in the mid 19th century and spread to much of the world through the globalizing mechanisms of warfare, colonialism, and missionary activities (Basuray, 1997; Nestell, 1998). The roots of nursing in the Middle East, however, can be traced even further back, to the Islamic Period (570-632 AD) and to Rufaida Al-Asalmiya, the first Muslim

nurse (Miller-Rosser, Chapman, & Francis, 2000). From its foundation in 1899, the International Council of Nurses (ICN) has envisioned an international federation of national nursing organizations that would ensure high standards of nursing education and practice globally. Its founders reasoned that principles governing nursing education and practice should be the same in every country (ICN, n.d.). Unfortunately in the early 20th century, as nursing established itself as a profession, globalization waned. Two world wars

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TRENDS IN DEVELOPM ENT OF NURSING EDUCATION IN INDIA

DEVELOPMEN T OF

NURSING EDUCATION IN INDIA: PREINDEPENDEN CEINTRODUC TION

Nursing had originated

independently and existed many centuries without contactwith modern medicine. The members of the family at

home met the nursing needs of thesick. Evolution of medicine, surgery and public health into complicated

technical arearequiring many procedures by persons specially trained and having understanding

of scientific principles, which brought two professions closer and together.

1. Nursing in Pre-historic Times

There is no historical evidence available on ancient history on nursing

care of sick. In primitive times discovered through myths, songs and archeologist to get rid of 'evil spirit'unpleasa nt conditioning

like beating, starving, magic rites, nauseous medicines, loud noisessudden fright are used methods. Primitive man

had the skill of massaging, fermentation bonesetting, amputation, hot and cold bath, heat to control hemorrhages.

Role of Nurse in Primitive Period

Women were protecting and caring for their children, aged and sick members of

thefamily. Nursing evolved to response to the desire to keep healthy as well as provide comfortto sick.

This was reflecting in caring, comforting, nourishing and cleansing aspect of the patient. These love and hope

were expressed in empirical practice of nursing.

2. Nursing Vedic Period (3000 B.C 1400 B.C)

Indian medicines are found in the sacred books of "Vedas". The 'Ayur-veda' is thought tohave been given by Brahma. 1400

BC Sushruta, known as 'Father of Surgery' in India wrotea book on surgery and years later 'Charaka' wrote

a book on internal medicine. By thesewritings we can learn that those days surgery had advanced to a high level,

also had 4 wingsof treatment 'Chatushpada Chikitsa'.1. Physician Bhishak 2.

Nurse Upacharika (Attendent Anuraktha)

. Therapeutic drugs Dravya4. Patient Adhyaya

Characters of Upacharika (Nurse)

y

Shuchi - Pure or clean in physical appearance

and mental hygiene.

y

Daksha Competency
y

Anuraktha Willing to care

y

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'Thakshash

ila'. King Ashoka (272-2

36

BC) constructed hospitals for the people and animals.Preven tion of the

disease was given first importance and hygienic practices were adopted.Cleanl iness of the body was religious duty.

Doctors and midwives were to be trust worthyand skillful. They should wear clean cloths and cut their nails short.

Lying rooms were keptwell ventilated. Religious ceremonies and prayer precede cooperations. The nurses

wereusually '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 indaily practices. Medicines are

remained in the hands of priest physicians, who refused totouch the blood and pathological tissues.

Dissection was for bidden. Other religiousrestric tion 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 practicedin Indo-Pakistan subcontinent. The basic framework are

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 andself-care and positive

health habits. Therefore, it becomes part of Indian medicine practice.

5. British period (16
th

Century onwards)

After the Mogul period the nursing in India hindered due to various reasons like low stateof 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 1

6
th

century, nursing development in India taken three dimensions.1. Military Nursing2.

Civilian Nursing
3

. Missionaries Nursing
1. Military Nursing:

Military nursing born during 1

st

world war but developed very slowly. British officersinforme d need of nurses to take

care British officials and soldiers in India.On 1888 Feb. 21

st

- 10 fully qualified certified nurses

from Florence Nightingales, arrived toBombay to lead nursing in India. This paves the way to develop one of the best

nursing inthe world. 1894 regular system of training for men for hospital work (orderliness) started.Medical officers given

lecturing to them. Some men were voluntary did the course andapplied for the nursing certificate. After two

months of practical posting to ward, on theaccount of supervised sister's report, first time hospital

'orderliness' issued certificate and hadofficial status. This system laid the possible foundation to existing

system of training andhigher education.1927 - Description of Indian Military Nursing services formed with 12

matrons, 18 sisters, 25staff nurses. They are responsible for supervision, instruction and training of nursing servicesfor

entire Indian hospital corps.2

nd

world war expanded nursing services to India and

overseas under the direction of chief principal matron.

3

year training carried out in selected military

hospital preliminarytrai ning schools. After completion sent to military hospital for training. After successfultraini

ng certificate issued as "Registered Nurse" and they are members of Indian Military Nursing Services

Auxiliary Nursing ServicesShorta ge of trained nurses in India after the 2

nd

world war, the Govt., initiated

short course of intensive training in 1942 which led to the Auxiliary Nursing Services. Basic training for
6

month in selected civil hospital after passing examination at military hospitals in India sent tooverseas to

serve in the capacity of 'Assistant Nurses'

3

000 women given auxiliary training.

2. Civilian Nursing in India

1
66

4 - East India company built Government General

Hospital at Madras for civilian.1871 this hospital undertook training of nurses. On 1854 midwives training school

grantedcertific ates of Diploma in Midwifery' for passed student and 'sick nursing' for failedstudents. First time

nurses came out as Diploma in Midwifery Nurses.

3. Missionary Nursing:

Missionary nursing started

training for Indian people as nurses. Various other countriessuppo rted. This brought fully qualified Indian nurses. Those

days there were severalobstacl es for nursing development.1 .

Girls were not allowed to do work.2. Degrading and unworthy attitude of people.
3

Hindus were hold back due to deep seated caste system.4. Muslims held under 'paradha' system.So Christian girls

encouraged and trained first.Frequent disappointmen t, degradation difficulties nursing training came into existence

andlook its own shape. In the beginning there is not uniformity in nursing education. There isno particular

standards were given. After the course of lecturing 18 months to two years,written examination conducted. If

failed training extended to

3

years.From 1888-9
3

five years various experts like doctors,

surgeons, nursing superintendent , pharmacists draw up a curriculum for training. 190710 North India united Board of

Examiner formed to maintain nursing administration and standards. 1928 - Hindi Text book for

nurses developed. 19
3

9 - helped to develop post graduation school for nurses.

Community Health Nursing:

William Rathbone formed Visiting Nurses Association at England. She

emphasized oncharity free care etc. Florence Lees improved the Visiting Nurses by giving specialized

training for their work. It is influenced in India, because of terrible condition, under whichchildren were born

recognized as cause for high mortality rate. Because untrained 'Dais' areattending women at the time of child

birth.Dais was unwilling to train and patients will to accept the old customary methods. In 192
6

-Midwives Registration Act formed for the purpose of better training of midwives. SlowlyCommun ity Nursing Training needs

felt by the Government. In 194

6

- Community Health Nursing was integrated in Basic Nursing

Programme at Delhi, Vellore and Madras.

Trained Nurses Association of Indian (TNAI)

In 1908 - TNAI formed to uphold the dignity and honor of the nursing profession. FlorenceMac 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 1917June 1

6
th

under the Registration Act No:XXI of 18

6

0 - TNAI got registered. In 1922 SNAformed.

DEVELOPMEN T OF NURSING EDUCATION IN INDIA: POSTINDEPENDEN CEINTRODUC TION

On 15th August 1947 India became independent and self governing. Social changeswere taking place

rapidly but an alarming absence of public health and sanitarymeasu rescontinued. The ratio of nurse to

patient remained dangerously low. The opening of nursing schools associated with college

gave nursing profession a higher social and economicstatu s, than it had previously known. The formation of

many commission and committees,est ablishment of INC and tremendous work of TNAI brought about

change in nursingeducati on post independence.

DEVELOPMEN T OF NURSING EDUCATIION.

Nursing Council Act came to existence in 1948 to constitute a council of nurses whowould safe

guard the quality of nursing education in the country. The mandate was to

Trends in Development of Nursing Education in India

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and the Cold War meant that the profession diversified. This resulted in a great deal of variation in the way nurses were educated. For example, until recent years, all nursing education in the Soviet

Union and the Eastern Bloc occurred exclusively at the secondary school level and was subordinate to medicine (Jones, 1997). In other countries, professional education was increasingly taught at the tertiary level, but curricula content and program length varied. In addition to differences in education, the nursing profession varies by country in how it is regulated. In a number of countries, to protect the public, regulated professions have designated standards for their members and reinforced these standards by withholding registration from individuals lacking appropriate educational or other credentials (ICN/World Health Organization [WHO], 2005). In other countries, regulation has taken a variety of forms; and in some countries, nursing has not yet become an autonomous, regulated profession. Differences in regulatory criteria are barriers to internationalization. Where regulation occurs at the regional or provincial level, mobility within a country is an issue (WHO/Sigma Theta Tau Honor Society of Nursing [STTI], 2007). Yet data collected from the Organization for Economic Cooperation and Development's (OECD's) 30 member countries (listed in the Table 1 ) shows that about 11% of nurses in these countries are foreign educated (2007). This high proportion of foreign nurses indicates that a measure of accommodation exists among the divergent systems of education and regulation allowing nurses to practice outside their countries of origin. Although the ideal of worldwide standards for nurses promoted by the ICN for over a century remains unrealized, the forces of globalization have created an impetus for change. Education of health professionals, specifically nurses, cannot be entirely homogenous given population health issues, such as endemic diseases, along with social, cultural, and economic differences. However, standards for nursing education need to be established throughout the world to provide a guide for local services and to assure a minimum standard for important issues such as essential qualifications for nurse educators. There have been several initiatives to identify and address barriers to achieving global standards. Among the projects focusing on quality of nursing education is the recently formed Joint Task Force on Creating a Global Nursing Education Community. This initiative is designed to share information and promote quality standards. A meeting led by WHO and STTI was held in Bangkok, Thailand, in December 2006. The goal was to initiate the development of global standards for basic nursing and midwifery education and to address patient safety and quality of care issues that result from the large-scale migration of healthcare providers. Major themes included the development of global standards for program admission criteria, program development requirements, program content components, faculty qualifications, and program graduate characteristics (WHO/STTI, 2007). Further work in this area is important and necessary. Aspects of globalization such as professional mobility, health sector reform, and public concern with the quality of healthcare services have led to greater interest in nursing regulation. In conjunction with WHO, the ICN has established a regulation network as both a forum for exchanging ideas, experience, and expertise in regulatory issues affecting nursing and also as a source of information and guidance to deal with emerging issues (ICN, n.d.). Conferences are held at regular intervals, with the most recent, as of this writing, held in Geneva in May, 2008 (World Health Professions Alliance, 2008). While international and national nursing bodies are focusing on international standards for nurses, more inclusive movements for educational harmonization that involve national governments are under way. One of the most significant is the Bologna process or Bologna accords. The purpose of this undertaking is to make academic degree standards and quality assurance standards more comparable and compatible throughout Europe. The process extends beyond the EU to include some 45 countries (Zgaga, 2006).

Clearly, further harmonization is required. Academic records or diploma titles enable European Union (EU) nurses to register and work in any EU country. Currently, nursing programs that enable nurses to practice in the EU have been subjected to two European directives regarding the qualifications of "nurses responsible for general care." Directives 77/453/ECC and 89/595/EEC stipulate that a "registration program should be at least 3 years long or 4,600 hours" (Zabalegui et al., 2006, p. 115). However, a survey of nursing education in the EU indicates programs take place in a variety of universities, colleges, and schools and that curricular and degree structures vary greatly (National Nursing Research Unit, 2007). Despite these differences, entrance examinations are not required when nurses migrate. The Bologna process offers the opportunity to standardize nursing education, with the bachelor's degree as the entry level to the profession, and master's and doctoral degrees recognized in all EU countries (Zabalegui et al., 2006). Some European countries have already adopted a three-year bachelor's degree as the criterion for entry to practice. Other countries, including some in Eastern Europe, are moving toward this standard (Krzeminska, Belcher, & Hart, 2005; Marrow, 2006). The Tuning Educational Structures in Europe project, a component of the Bologna process, builds on previous endeavours to enhance inter-university cooperation and aims to identify generic and specific competencies for nursing graduates at bachelor's, master's, and doctoral levels (for additional information on these specific competencies see Gobbi, 2004). Graduates, academic faculty, and employers participated in the project, which included a method designed to make the different nursing curricula understandable across countries. The process used by these team members led to the identification of 30 generic and 40 specific nursing competences that will serve as a framework for evaluation. Zabalegui et al. (2006, p. 117) noted that "within this new structure, a bachelor in nursing or nursing science will denote achievement of the specified competencies in an academic environment." While the Bologna process directly concerns Europe and its immediate neighbors, it has generated global attention because harmonization of nursing in this large geographical area will have worldwide repercussions (Zabalegui et al., 2006). It has aroused the interest of countries such as Australia and New Zealand, rival providers of educational services (Australian Department of Education, Science and Training, 2006; New Zealand, Ministry of Education 2007), as well as countries in the Far East (Zgaga, 2006). Schools of nursing in the Philippines, India, and China will need to take the stipulations of the Bologna process and the competencies identified in the Tuning project into account if they wish their graduates to be eligible to work in Europe. Other economic and political partnerships elsewhere in the world may be interested in participating or developing their own harmonization projects. While educators in North America may prefer alternative approaches to nursing education, they will need to address educational equivalences and differences in nursing education and nursing qualifications. Careful comparisons between education systems may be necessary. For example, competencies and hours of instruction or clinical practice may need to be considered when calculating equivalencies.

Next: Conclusion

Previous Page

Section 6 of 7

Abstract and Introduction

Globalization and the Internationalization of Education Exporting of Education Challenges and Current Solutions Related to Nurse Migration Current Standards and Harmonization in Transnational Nursing Education Trends and Future Directions in Harmonizing Nursing Education Internationally Conclusion
[ CLOSE WINDOW ]

References

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3. 4.

American Association of Colleges of Nursing. (2000). AACN position statement: The 2, 2008, from www.aacn.nche.edu/publications/positions/ baccmin.htm Australian Department of Education, Science and Training. (2006). The Bologna process and Australia: Next step. Retrieved December 15, 2007, from http://aei.dest.gov.au

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Basuray, J. (1997). Nurse Miss Sahib: Colonial culture-bound education in India and transcultural nursing. Journal of Transcultural Nursing, 9(1), 14-19.

Baumann, A. (2006). Safe staffing saves lives. Information and action tool kit [Developed for the International Council of Nurses]. Geneva, Switzerland: International Council of Nurses.

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Baumann, A., Blythe, J., Rheaume, A., & McKintosh, K. (2006). Health Human Resource Series 3. Internationally educated nurses in Ontario: Maximizing the brain gain (2nd ed.). Hamilton, Ontario: Nursing Health Services Research Unit, McMaster University. 8. Blythe, J., & Baumann, A. (2008). Health Human Resource Series 9. Supply of Hamilton, Ontario: Nursing Health Services Research Unit, McMaster University. internationally educated nurses in Ontario: Recent developments and future scenarios.

9.

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Table 1. Member Countries of the Organization for Economic Cooperation and Development

Australia Czech Republic Germany Ireland Luxembourg Norway Spain

Austria Denmark Greece Italy Mexico Poland Sweden

Belgium Finland Hungary Japan Netherlands Portugal Switzerland

Canada France Iceland Korea New Zealand Slovak Republic Turkey

United Kingdom United States

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Authors and Disclosures

Andrea Baumann, PhD, RN, is the Associate Vice-President, Faculty of Health Sciences, (International Health), McMaster University and the Director of the Nursing Health Services Research Unit (McMaster site). She is the Director of the World Health Collaborating Centre in Nursing Human Resources. Her research interests include clinical decision making, human health resources, and international health. Her recent publications include Safe Staffing Saves Lives and Positive Practice Environments: Quality Workplaces = Quality Patient Care. Both are Information and Action Tool Kits developed for the International Council of Nurses. In addition to her research, she has directed several international projects in relation to capacity building and higher education for women. E-mail: baumanna@mcmaster.ca Jennifer Blythe, MLS, PhD, Jennifer Blythe is an Associate Professor in the School of Nursing at McMaster University and Senior Scientist in the Nursing Health Services Research Unit (McMaster site), funded by the Ontario Ministry of Health and Long-Term Care. The unit is multidisciplinary and focuses on health human resources and health services. Dr. Blythe's research interests include health human resources and nurse migration, both of which encouraged her to contribute to this article. She is one of the authors of a recent government report that addresses the integration of internationally trained nurses into the Canadian workforce. E-mail: blytheje@mcmaster.ca

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