TRENDS IN DEVELOPMENT OF NURSING EDUCATION IN INDIA

The unique function of the nurse is to assist the individual sick or well, in the performance of those activities contributing to health or its recovery or to a peaceful death thus he would perform unaided, if he had the necessary strength, will or knowledge and to do this in such a way as to help him to gain independence as rapidly as possible -the concept of nursing according to Virginia Henderson (1958) The essential components of professional nursing practice (according to ANA) include care, cure and coordination. Nursing is based on scientific principles and an art i.e. composed of skills that require expertise ness and proficiency of their execution. Nursing is a dynamic, therapeutic and educative process in meeting the health needs of the society, assisting the individual or family to achieve their potential for self direction. Education brings change in the behavior of individual in a desirable manner. It aims at all round development of an individual to become mature, self sufficient, intellectually, culturally refined, socially efficient and spiritually advanced. Nursing education has brought changes in the behavior of the student nurse so as to prepare her to play her roles effectively as an individual and as a good responsible citizen. The practice of educational nursing began in the United States on October 1, 1902 when the initial role of the school nurse was to reduce absenteeism by intervening with students and families regarding health care needs related to communicable diseases. While the nurses role has expanded greatly from its original focus, the essence of the practice remains the same. The nurse educator supports student success by providing health care assessment, intervention, and follow- up for all children within the school setting. PROFESSIONAL ADVANCEMENT Professional advancement or development courses are either general, or skill- based. General professional development caters to general skills, through basic personal education. Skilled development on the other hand, deals with the current profession, leadership qualities, managerial skills and enhancing a person's productivity. The courses are designed with the intention of developing a person's level of competency and professionalism. The successful completion of the course opens avenues for unlimited growth.

STRATEGIES
Three phases are included in nursing education:Pre- nursing education:- spread information of nursing to the prospective Candidates, publicity and guidance about nursing education, nursing services, working conditions of nurses, career development, job avenues ,opportunities and responsibilities of nurses has to be given. Booklets can be developed like nursing as a carrier, uprofile of a nurse. The prospective students can introspect, think and make a right decision. Careful intelligent planning is required to develop personal and professional satisfaction. Nurse education:- nurse educators have to take care to produce nurses in order to provide qualitative care, select the candidate who is having interest for admission into nursing is the first step. Nurse educators monitor continuously, implement the curriculum which consists of theoretical and practical hours of training in a critical manner, give equal weight age to develop the right attitudes, social and moral values, human relations, skills, ethics, civic sense, professional etiquette to have perfect background in nursing. Along with the technical skills, the personal qualities of the students also have to be promoted. Evaluation of students performance is essential. Post nursing education:- after completion of the nursing training, nurse has to register their names in professional organization. The nurse still needs to be educated either in the form of in service or continuing education. The teacher has to develop teaching material and conduct of research to improve the standards of nursing. Post nursing education consists of orientation, supervision, in-service education, evaluation and re-registration. New graduates need to have a well planned and organized orientation to the area of their posting. They must be oriented to the staff, equipment, working conditions and clients with whom they have to work. They need guidance and supervision in achieving professional standards. Nurses on the job must be evaluated periodically, in terms of knowledge and performance and in-service education needs -to be planned on the basis of their needs. -Steps for Improving nursing education are:-Development of educational material -Conduct of research

SCOPE OF NURSING EDUCATION:The literal meaning of scope is range, field or opportunity of activity, operation and application. But in the field of education, scope means, the breadth, comprehensiveness and variety of learning experiences, to be provided in the educational process. Thus the scope of education becomes very wide and long. It is almost limitless. It is as wide as the world and as long as the history of man on the earth. Thus the term education has been interpreted in two main categories:NARROWER SENSE:- in its narrower sense, educationist regarded as equivalent to instructions, imparted in school or college. It is believed, education starts from entrance of a child to school and complete with his departure from university. Here the education of a child is measured in terms of the number and grades of examination for which, the educator has to inculcate certain habits, attitudes of influences in the learner which are considered to be essential and useful by tradition. Therefore education includes those specific influences which are to be brought to bear upon the child or student with a definite purpose, in a preplanned, suitable and methodical manner by parents, teachers and other members of the community for the welfare of younger generations and for preservation of cultural heritage. BROADER SENSE:- in its broader sense, education means the process of development from infancy to maturity. It starts at birth and continues throughout life, which includes all the knowledge and experiences , acquired during infancy, childhood, adolescence, youth, manhood or old age through any agency of education i.e the home, school, college temple, society etc. in this way, ones whole life and all activities of life become a real source of education. So education is a life long affair. Thus in the broader sense, education is not always connected with schools, colleges and universities but commencing from birth, it goes on throughout the whole life, and in the narrower sense, it is a well planned process.

DIFFERENT PROGRAMMES RUNNING UNDER NURSING EDUCATION Nursing Council Act came to existence in 1948 to constitute a council of nurses who would safe guard the quality of nursing education in the country. The mandate was to establish and maintain uniform standards of nursing education. Today, Indian nursing council is a statutory body that regulates nursing education in the country through prescription, inspection, examination, certification and maintaining its stands for a uniform syllabus at each level of nursing education. The strive for maintenance of a uniform standards and pattern of nursing education has curbed creative development and experiments for expansion of nursing in to newer horizons of nursing education. There are six levels of nursing education in India today. They are : 1. Multi Purpose Health Worker Female training (ANM or MPHW-F)

2. Female Health Supervisor training (HV or MPHS-F) 3. General nursing and midwifery (GNM) 4. B. Sc. Nursing 5. M. Sc. nursing 6. M. Phil and PhD The ANM, HV, and GNM are conducted in schools of nursing. The last 3 are university level courses and the respective universities conduct examinations. Beside there are several certificate and diploma courses in specialties. GENERAL NURSING AND MIDWIFERY The general nursing and midwifery course is conducted in 477 centers in the country. The syllabus has undergone many revisions according to the change in the health plans and policies of the Government and changing trends and advancements in general education, nursing health sciences and medical technology. The latest revision of syllabus by INC in 2004 has increased the duration of the course from three year to three and half year. The basic entrance has become intermediate or class 12 instead of earlier class 10. Both science and arts students are eligible. The focus of general nursing education is the care of sick in the hospital. Schools of nursing are generally attached to teaching hospitals. Three Board examinations are conducted, one at the end of each year. On passing the candidates are registered as registered nurse and mid wife by the respective state nursing councils. PHILOSOPHY The Indian Nursing Council believes that the basic course in nursing is a formal educational preparation which should be based on sound education principles. The council recognizes that the program as the foundation on which the practice of nursing is built and on which depends further professional education. It also recognizes its responsibility to the society for the continued development of student as individual nurse and citizens. Purpose The purpose of general nursing programme is to prepare general nurse who will function as member of the health team beginning with competence for first level position in both hospital and community. The programme is generated to the health needs of the society, the community and the individual and will assist nurses in their personal and professional development so that they may take their maximum contribution to the society as individual citizens and nurses. Objectives 1. Demonstrate awareness of and skills required in the nursing process in the provision of health care and nursing of patients 2. Apply relevant knowledge from the humanities biological and behavioral sciences in carrying out health care and nursing activities and functions.

3. Show sensitivity and skill in human relationship and communication in his or her daily works 4. Demonstrate skill in the problem solving methods in nursing. 5. Gain knowledge of health resources in the community and the country 6. Demonstrate skill in leadership 7. Demonstrate awareness of necessity of belonging to professional organizations. 8. Promotion of health, precaution against illness, restoration of health and rehabilitation. Students admission 1. Age for the entrance shall be 17 years to 35 years, provided they meet the minimum educational requirement i.e. 12 years of schooling. 2. Minimum education all students should pass 12 classes or its equivalent, preferably with science subjects 3. Admission of students shall be once a year. 4. Students should be medically fit. The selection committee should comprise tutors, nurse administrators, and educationalist/ psychologist. The principal of the school shall be the chairperson. Training programme The course in general nursing shall be of three and half years duration as follows,--- two years practice in general nursing , one year community health nursing and midwifery and six months internship which includes nursing administration and nursing research classes. There will be alternate course for male students in lieu of midwifery. The ANM who wishes to under take general nursing course will not be given any concessions. The maximum hours per week per students shall be 36 hours, which includes instructions and clinical field experiences.

ROLE OF G.N.M. STAFF: Care giver Educator

BACHELOR OF NURSING COURSE

Graduate nursing education started in India in the year 1946 in CMC , Vellore and in the RAK college of nursing at Delhi university. At present several universities in India offer the course. Eligibility for admission A candidate seeking admission should have: 1. Pass the 2 year of pre university exam or equivalent as recognized by concerned university with science subjects ie Physics, biology and chemistry. 2. Students of vocational courses 3. Obtained at least 45%of total marks in science subjects in the qualifying exam, if belongs to a scheduled caste or tribe , should have obtained not less than 40 % of total marks in science subjects. 5

4. Completed 17 years of age at the time of admission or will complete this age on or before 31stDecember of the year of admission 5. Is medically fit Objectives of study The programme is designed : 1. To provide a balance of professional and general education 2. To enable a student to become a professional nurse practitioner who has self direction and is a responsible citizen. Through planned guided experiences students are provided with opportunities to develop a broad concept of the fundamental principles of nursing care based on sound knowledge and satisfactory levels of skill in providing care to people of all ages in community or institutional setting Understanding of the application of principles from the physical biological and social sciences for assessing the health status Ability to investigate health care problems systematically Ability to work collaboratively with members of allied disciplines towards attaining optimum health for all members of the society Understanding of fundamental principles of administration and organization of nursing service understanding of human behavior and appreciation of effective interpersonal relationship with individuals families and groups ability to assume responsibility for continuing learning Appreciation of professional attitudes necessary for leadership roles in nursing Appreciation of social and ethical obligations to society.

Course of study The course of study leading to bachelor of nursing degree comprises 4 and half academic years. BACHELOR OF NURSING COURSE (POST CERTIFICATE) FOR QUALIFIED NURSES Philosophy and aims of the program The faculty believes that nursing is an integral part of the health care delivery system and share responsibility in collaboration with other allied health professions, for the attainment of optimal health for all members of the society. The faculty conceives education as a life long learning process. It seeks to render appropriate behavioral changes in students in order to facilitate their development, which assists them to live personally satisfied and socially useful lives.

The goal of post certificate degree program leading to Bachelor of Science in nursing is the preparation of the trained nurse as a generalist who accept responsibility for enhancing the effectiveness of nursing care Eligibility for admission The candidate seeking admission must: 1. Hold a certificate in General nursing. 2. Be a registered nurse 3. Have minimum of two years of experience 4. Have passed pre university exam in the arts /science/commerce or its equivalent which is recognized the university 5. Be medically fit 6. Have a good personal and professional record 7. Have working knowledge of English

Program of study
DURATION-the program of the study is two academic years from the date of commencement of program. Terms and vacations shall be as notified by the university from time to time. OBJECTIVES Administer high quality nursing care to all people of all ages in homes , hospitals another community agencies in urban and rural areas Apply knowledge from the physical, social and behavioral sciences in assessing the health status of individuals and make critical judgment in assessing the health status of the individuals and make critical judgment in planning ,directing and evaluating primary, acute and long term care given by themselves and others working with them Investigate health care problems systematically Work collaboratively with members of other health disciplines Teach and counsel individuals , families and other groups about health and illness Understand human behavior and establish effective interpersonal relationships Teach in clinical nursing situations

Identify underlying principles from the social and natural sciences and utilize them in adapting to , or initiating changes in relation to those factors Acquire professional knowledge and attitude in adapting for leadership roles

ROLE OF THE BACHELOR OF NURSING COURSE

Educator Administrative Clinical specialist Nurse practitioner

DEGREE OF MASTER OF NURSING

Philosophy Nursing faculty presents the following beliefs about the master of nursing programme: 1. The master of nursing programme is offered by institution of higher education and is built up on a recognized bachelors curriculum in nursing (in India-by Indian nursing council) 2. The programme prepares nurses for leadership position in nursing and other health fields who can function as :Specialists, nurse practitioners,consultants,educators,administrators and investigators in a wide variety of professional setting in meeting the national priorities and the changing needs of the society 3. The programme prepares nursing graduates who are professionally equipped ,creative, self directed and socially motivated to effectively meet with the needs of the social change 4. Further the programme encourages accountability and commitment to life long learning which fosters improvement of quality care

Objectives
Graduates of master of nursing programme demonstrate:

Increased cognitive ,affective and psychomotor competencies and the ability to utilize the potentials for effective nursing performance Expertise in the utilization of concepts and theories for the assessment ,planning and intervention in meeting the self care needs of an individual for the attainment of fullest potentials in the field of specialty. Ability to practice independently as a nurse specialist Ability to function effectively as nurse educators and administrators Ability to interpret the health related research Ability to plan and initiate change in the health care system Leadership qualities for the advancement of practice of professional nursing Interest in life long learning for personal and professional learning advancement

Eligibility The candidate seeking admission must: 1. Have passed B.Sc. Nursing/post certificate BSc, or nursing degree of any university 2.Have a minimum of one year of experience after obtaining B.Sc, in hospitals or nursing educational institutions or community health setting 3. For BSc, nursing post certificate, no such experience is needed after graduation the candidate shall be-a registered nurse or registered midwife for admission to medical surgical nursing, community health nursing, pediatric nursing obstetric and gynecological nursing. A registered nurse for admission to psychiatric nursing 4. The candidate shall be selected on merit judged on the basis of academic performances in B.Sc nursing, post certificate B.Sc, or nursing and selection tests. Specialties Candidate will be examined in any of the following branches 1. branch1-medical surgical nursing 2. branch2-community health nursing 3. branch 3-paediatric nursing 4. branch4-obstetric and gynecological nursing 5. branch5-psychiatric nursing

Four common papers are there included in the syllabus. They are: 1. Advanced concepts of health and nursing 2. Education and nursing education 3. Bio-statistics, research methodology and nursing research 4. Administration and nursing administration

MASTER OF PHILOSOPHY PROGRAMME IN NURSING

In 1980 RAK college of nursing started an M.Phil programme as a regular and part time course. Since then several universities started taking students for the M.Phil course in nursing. Prominent among these are: MGR Medical University, Rajiv Gandhi University of Health Sciences, SNDT University and Delhi University and Manipal Academy of Higher Education

Philosophy Nursing shares with the whole university a main focus of preparing its students for service and assisting them to achieve a meaningful philosophy of life. The student is encouraged to develop judgment and wisdom in handling knowledge and skills and achieve mastery of problem solving and creative skills. Commitment to life long learning is the mark of truly professional person. In order to maintain clinical competencies and enhance professional practice the student must stay abrupt of the new developments and contribute to the advancement of nursing knowledge. Objectives The objectives of M.Phil degree course in nursing are: to strengthen the research foundations of nurses for encouraging research attitudes and problem solving capacities to provide basic training required for research in undertaking doctoral work

Duration
Duration of the full term M.Phil course will be one year and part time course will

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be two year.

Course of study
At the time of admission each candidate will be required to indicate her priorities in regard to the optional courses .a candidate may offer one course from M Phil programme from the department of Anthropology, education, sociology and physiology or any suitable department. The M.Phil studies will be into two distinct parts, part1 and part 2. Part1----it consist of 3 courses, i.e. research methods in nursing, major aspects of nursing, allied disciplines Part2----after passing the part1 examination, a student shall be required to write a dissertation. The topic and the nature of the dissertation of each candidate will be determined by the advisory committee consist of 3 members. The dissertation may include results of original research, a fresh interpretation of existing facts, and date or a review article of critical nature of may take.

ROLE OF DEGREE OF MASTER OF NURSING

Specialists Nurse practitioners Consultants Educators Administrators Investigators

DOCTORATE OF PHILOSOPHY IN NURSING

A candidate for admission to the course for the degree of doctor of philosophy in the faculties of medical science must have obtained an M Phil degree of a university or have a good academic record with first or second class masters degree of an Indian or a foreign university in the concerned subject. The candidate shall apply to the university for the admission stating his qualifications and the subjects he proposes to investigate enclosing a statement on any work he may have done in the subject. every application for the admission of the course must be analyzed by the board of research studies. Board of research studies (medical sciences)- members Dean and the head of the departments concerned Principals/ head of institutions recognized for post graduate medical studies. Two members nominated by the medical academic council

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Three persons nominated by the medical faculty( for their special knowledge in the medical science

Eligibility criteria The candidate should be post graduate in nursing with more than 55% of aggregates of marks Should have research background May or may not published articles in journals The course duration is far regular PhD course is 3 years and for part time is 4 years

ROLE OF DOCTORATE OF PHILOSOPHY IN NURSING

Specialists Nurse practitioners Consultants Educators Administrators Investigators Clinician

ROLE OF THE NURSE EDUCATOR

The nursing educator provides direct health care to students and staff. The nurse provides care to students and staff who have been injured or who present with acute illnesses. Care may involve treatment of health problems within the scope of nursing practice, communication with parents for treatment, and referral to other providers. The nurse uses the nursing process to assess, plan, implement, and evaluate care for students with chronic health conditions. This care should begin with the development of a nursing care plan (also known as an individualized health care plan) that should include an emergency action plan. The nurse is responsible for medication administration and the performance of health care procedures that are within the scope of nursing practice and are ordered by an appropriately licensed health care provider. The nurse also assists faculty and staff in monitoring chronic health conditions. As the scope of nursing practice expands to utilize the increasingly complex

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technology needed to provide up-to-date care for clients, the school nurses body of knowledge grows through personal professional development. The nursing educator provides leadership for the provision of health services. In addition to providing health services directly, the nurse must take into account the nature of the environment of the educational institution, including available resources. As the health care expert with in the school, the school nurse assesses the overall system of care and develops a plan for assuring that health needs are met. This leadership role includes developing a plan for responding to emergencies and disasters and training staff to respond appropriately. It also involves the appropriate delegation of care within applicable laws. Delegation to others involves initial assessment, training, competency validation, supervision, and evaluation by the school nurse. The nursing educator provides screening and referral for health conditions. In order to address potential health problems that are barriers to learning or symptoms of underlying medical conditions, the school nurse often engages in screening activities. Screening activities may include vision, hearing, postural, body mass index, or other screening. Determination of which screenings should be performed is based on several factors, including legal obligations, the validity of the screening test, the cost-effectiveness of the screening program, and the availability of resources to assure referral and follow-up. The school nurse promotes a healthy school environment. The school nurse provides for the physical and emotional safety of the school community. The school nurse monitors immunizations, assures appropriate exclusion from and re-entry into school, and reports communicable diseases as required by law. The school nurse provides leadership to the school in implementing precautions for blood borne pathogens and other infectious diseases. The school nurse also assesses the physical environment of the school and takes actions to improve health and safety. Such activities may include an assessment of the playground, indoor air quality evaluation, or a review of patterns of illness or injury to determine a source of concern. Additionally, the school nurse addresses the emotional environment of the school to decrease conditions that may lead to bullying and violence and/or an environment not conducive to optimal mental health and learning. The nursing educator helps in promoting health. The nursing educator provides health education by providing health information directly to individual students, groups of students, or classes or by providing

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guidance about the health education curriculum, encouraging comprehensive, sequential, and age appropriate information. They may also provide programs to staff, families, and the community on health topics. Other health promotion activities may include health fairs for students, families, or staff, consultation with other school staff such as foodservice personnel or physical education teachers regarding healthy lifestyles, and staff wellness programs.

The nurse is a member of the coordinated school health team that promotes the health and well-being of school members through collaborative efforts. The nursing educator serves in a leadership role for health policies and programs. As the health care expert within the school system, the school nurse takes a leadership role in the development and evaluation of school health policies. The nursing educator participates in and provides leadership to coordinated school health programs, crises/disaster management teams, and school health advisory councils. The school nurse promotes nursing as a career by discussions with students as appropriate, role modeling, and serving as a preceptor for student nurses or as a mentor for others beginning school nursing practice. Additionally, the school nurse participates in measuring outcomes or research, as appropriate, to advance the profession and advocates for programs and policies that positively affect the health of students or impact the profession of school nursing. The nursing educator serves as a liaison between school personnel, family, community, and health care providers.

The nursing educator participates as the health expert on Individualized Education Plan and 504 teams and on student and family assistance teams. As case manager, the nurse communicates with the family through telephone calls, assures them with written communication and home visits as needed, and serves as a representative of the school community. The nurse educator also communicates with community health providers and community health care agencies while ensuring appropriate confidentiality, develops community partnerships, and serves on community coalitions to promote the health of the community. The nurse educator may take on additional roles to meet the needs of the school community.

Abstract
The scope of enrolled nurse practice: a grounded theory study by John Hunter Hospital, Hunter Health, Newcastle, Australia.

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This paper follows an earlier paper presented in this journal where the scope of practice of Enrolled Nurses (EN) was critically reviewed from the available literature on this topic. In this paper the authors (Milson-Hawke & Higgins, 2003) recommended the need for research into the scope of practice of ENs. The purpose of the paper presented here is to describe the outcomes of a grounded theory study that explored the nature of EN practice within an acute hospital setting and the processes that ENs used to guide their practice. Although the findings of the study are incomplete because of the limits of time and scope of the study, the theory developed provides a useful description of how of the ENs in this study determined their own scope of practice in the acute hospital setting. The processes that the ENs used emerged as 'doing the work without overstepping the mark'. 'Doing the work without overstepping the mark' required ENs to make judgments about the nature of the work they were being asked to do. The nature of the work of ENs emerged as 'doing routine work' and 'deciding to do non-routine work'. Routine work comprised 'essential nursing' and 'advancing practice'. Essentially, the ENs in this study determined their own scope of practice as they undertook nursing activities beyond their level of preparation. The impact of the care provided by ENs, however, was not within the scope of this small study. This needs to be the focus of future studies along with the impact on health care of the changing roles of ENs.

CONCLUSION
Healthy children are successful learners. The nursing educator has a multi-faceted role within the educational setting, one that supports the physical, mental, emotional, and social health of students and their success in the learning process and thus make them successful for the nation.

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BIBLIOGRAPHY
Neeraja k.p., text book of nursing education, first edition 2003, jaypee publishers,pp-8-9. E.heidgerken Loretta, teaching and learning in school of nursing, third edition 2005, konark publishers,pp187-190. Basvanthappa BT, nursing education ,first edition 2003, jaypee brothers publishers,pp77-79. Indra T.K., history of nursing, first edition 2004,jaypee brothers publishers,pp-40-45. Jogler S, Mrs. Kamal, Hospital ward management professional adjustment and trends in nursing, first edition 1990, vora medical publishers. http://www.scribd.com/doc/30794734, role and scope of nursing education, 28-09-2010, 8.05p.m. http://en.wikipedia.org/wiki/ registered nurse, role of registered nurse, 29-09-2010, 5.10p.m.

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