Nursing education should be purpose-driven

Apr 02, 2017 News

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– says founder of Degree Programme at UG

By Sharmain Grainger

“There needs to be a concerted effort to ensure that our nurses are fit for the purpose.”

This is the informed opinion of Ms. Gwendolin Tross.
Tross, who has an extensive background in nursing, is the founder and former Coordinator of the Bachelors of Science (BSc) Nursing Programme currently being offered at the University of Guyana.
She has, however, taken into consideration that the challenges for nursing in Guyana are many. “The profession is faced with the ongoing dilemma of trying to provide quality nursing care with scarce resources. Despite these challenges, however, nurses providing direct care must continually demonstrate by their actions, compassion, concern, commitment and competence, if they are to convince clients, patients and the general public, that they are fit for the purpose,” Tross asserted.
But being fit for the purpose must be evident from the inception. She pointed out that students who are admitted to the country’s schools of nursing must, at least, successfully pass five subjects at the Caribbean Secondary Education Certificate (CSEC) General Proficiency Examinations with grades one, two or three, or GCE ‘O’ level grades A, B and C at one sitting, which must include English Language, Mathematics and one science subject, (this also applies the students with CSEC passes), in order to be admitted to the programme.
Given the forgoing, Tross said that “it is therefore reasonable to assume that these students will be able to cope satisfactorily with a programme of nursing studies.”
However, from all indications this has not been the case.
Tross, as well as others in and out of the health sector, have recognized that “the failure rate of students has been alarming across all schools of nursing since the introduction of a new curriculum.”
This daunting development, according to Tross, raises many questions which need to be addressed as a matter of urgency if nursing is to fulfill its mandate and responsibility to clients and patients at various levels of the health care system.
According to Tross, even in the face of challenges, efforts must be made to ensure that only the fit are accepted to the noble profession.
There have been many searching questions that have been asked of nurses. This, Tross pointed out, has included most importantly, the role of a nurse.

Very often that role is defined in terms of functions such as: taking temperature, blood pressure and bathing patients. But according to Tross, “This is a limited view…since it dictates specifics rather than viewing the role from a broader perspective. The nurse is responsible for many aspects of patient care, for example that of advocate, teacher, and manager, to mention a few”.
“Role elements differ from nursing functions, which can change from setting to setting. Education for a practice-based profession such as nursing prepares students to undertake a responsible role that is defined by law, and thus has an obligation to produce a competent practitioner.”

CURRICULUM
The nursing curriculum currently being used in Guyana has been adapted to reflect a Caribbean approach to standards of Nursing Education and Nursing Practice. But Tross emphasised that when fundamental changes are adapted, the programme should be piloted before being implemented fully, or subjected to evaluation at regular intervals.
Tross is of the firm view that “we are only effective in the field of Nursing Service if our educational preparation addresses the reality of complex multi-systems of health care.”
Added to this, she noted that “education is the key to the development of excellence in Nursing Practice.”
According to Tross, the discipline of nursing has emerged from the needs of an ever-changing society and is a unique inter-relationship of art and science.
In fact, she made it clear that nursing is a service-oriented profession that finds expression in clinical practice, but also asserted that essential to any practice is the theory that supports it. “Theory involves intellectual functions and comprises facts, principles, and concepts that are arranged to show their interrelatedness,” noted Tross, as she pointed out that there are two crucial issues needed to be considered when planning nursing education.
Those crucial issues are: an understanding of the nature of nursing which has consequences for the value placed on different subjects in the curriculum and how they are assessed; and an understanding of what constitutes nursing knowledge, whether it comes from the Nursing Process or Nursing Models, of which there are many.
Tross said that the Nursing Process is used extensively as one of the core concepts in Nursing Education, as it provides a method of approaching patient care. The actual steps in the Nursing Process are: Assessment, Analysis, Nursing Diagnosis, Planning, Implementation and Evaluation. “It encompasses theory, practice and research, and is based on the individual needs of the patient rather than on routine care. The use of the Nursing Process in decision making situations contributes to efficiency and accuracy,”she explained.
Moreover, Tross underscored that curriculum planning in nurse education is dynamic rather than static. As such, she noted that students should be allowed to evaluate the programme in terms of its content delivery, clinical experiences and assessments.
“If no account is taken of students’ perspectives there can be no real change. Assessments should be continuous and test the different levels of knowledge. Assessment strategies should be congruent with the curriculum philosophy, aims, teaching strategies and intended outcomes,” Tross added.
She further recognized Nursing Practice as a key component of any setting, be it in the home, primary health care setting or the hospital. The increase in student numbers, despite reduced bed capacity in the tertiary institution where students are expected to be exposed to a variety of clinical experiences, creates frustration and disillusionment for both students and nurse managers, Tross opined. The problem is further compounded, she noted, by the lack of basic resources and clinical supervision.

GUIDANCE
Moreover, the need for clinical instructors who are experientially and academically prepared in current nursing practice was emphasised. “There should be a skills laboratory where students can become familiar with procedures which they may not have had the opportunity to witness in the clinical areas,” Tross said.
Added to this, she spoke of the need for evaluation of students’ performances in relation to stated objectives after each clinical placement. This result, she said, should be shared with the schools of nursing, so that deficiencies could be identified and remedial steps put in place.
“It is important for Nurse Educators and Nurse Managers to collaborate if progress in the delivery of health care is to be realized,” said Tross, as she stressed the need for Procedure Manuals, which should include general and specific care plans, to give guidance to clinical staff and students.
It is also Tross’ belief, that ward meetings to prioritize and plan patient care using the nursing process should be encouraged, even as moves are made to have in place a careful documentation of care plans and their execution. Careful documentation, she pointed out, becomes necessary in cases of litigation.
“As health systems reform and change and as nursing practice develops, the challenge of nursing education is to respond to the changes. Nurse tutors need to seek assistance in developing strategies for coping with large classes. There should be collaboration and coordination, not competition.”
Also needed within the schools of nursing is an organizational chart to determine lines of communication,” said Tross, as she emphasized, “we need nurse leaders at all levels of the health care system who can articulate the value of nurse education and practice, and are proactive in seeking opportunities for the development of nursing as a profession.”

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