Nursing education in Canada: historical ''Progress''—contemporary issues

Contemporary concerns in nursing education in Canada suggest that the earlier educational pathways have not always represented progress. The persistence of alternate routes for the preparation of registered nurses, and the continuing divisiveness among nurses with differing educational backgrounds are problem areas that still require resolution. Some problems, such as the development of the nursing curriculum, have been shared across educational settings. Nurse educators in Canada, as in other countries, have vested tremendous energy into this aspect of nursing education. In retrospect, it is recognized that much of this effort has been misdirected. Efforts to strengthen the theoretical underpinnings of the curriculum have resulted in the incorporation of borrowed theory from other disciplines, often without critical examination of the context in which the theory developed, or of its consistency with the philosophical perspectives of nursing. Attempts to build curricula around the major nursing models have also met with limited success. Separation of education and practice, persistence of multiple levels of preparation in nursing, and a continual search for viable curriculum models have led to uncertainty, to detours in the development of nursing education, and to occasional reconsideration of previous approaches.     

A model for establishment of educational programmes in developing countries: the nursing paradoxes in Kuwait

While American nursing attempts to deal with the multitude of dilemmas that have been plaguing it for decades, many developing countries look to the USA for a nursing model to emulate, and then become lost in this confusion of its nursing profession. However, these countries continue to reach out and seek consultants with educational and practical experience in nursing in the USA, as well as in other developed countries. A paradigm is proposed for use by educators and consultants to help delineate the major issues a developing country has to confront in establishing a stable nursing service. This paradigm is explicated by applying it to the situation in Kuwait, a Fourth World country with many social paradoxes (e.g., rich in economic resources but poor in human resources). Four major paradoxes in nursing are identified by using the proposed paradigm. They are: I educational needs vs. educational reality; 2 locals vs. cosmopolitans; 3 role congruency vs. role incongruency; and finally 4 medical vs. nursing conceptual models. Although these paradoxes became manifest through work done by the author in Kuwait, any international health care professional will quickly realize that the paradoxes are not unique to Kuwait but have parallels in many other countries which are at different stages of development.     

Pediatric nursing in the United Kingdom.

Child health matters remain low on the government agenda, and present reforms of the NHS are overtly concerned with financial aspects rather than the quality of care. Pediatric nurses must therefore become more assertive and pro-active in their role as advocates for children and their families. However, pediatric nurses are extremely fortunate in the UK because they have (a) a nurse education system that has always recognized that the nursing needs of children are different to those of adults, (b) the opportunity to work with medical and voluntary organizations committed to improving children's health, and (c) a professional organization that is not only large and powerful, but since 1984 has been committed to advancing the art and science of pediatric nursing. It employs a full-time adviser to assist its members and publishes the only pediatric nursing journal. Pediatric nurses have assisted in advancing the art and science of pediatric nursing with caring for children and their families in a holistic fashion, with families supported and participating in their child's care. But there are still many opportunities to improve the quality of health care to children and their families. Quality caring is what children and their families want and deserve, but is not as easy to measure as quantity care. At a time when in so many countries, health service managers concentrate on quantity, pediatric nurses must use every opportunity to shape the health policy of their nation for the benefit of children. We all live in interesting times and it would be interesting to see what we make of them on behalf of children.     

A professional recognition system using peer review

The concept of a Professional Recognition System or a Clinical Ladder is not new. In fact, many models appear in the literature and have been implemented in hospitals across the country. However, few models contain the element of peer review. This article describes the development process, structure, and function of a Clinical Ladder program at a pediatric tertiary level hospital. The program grew out of a desire and recognized need on the part of the professional nursing staff to reward outstanding nursing care. Based on the concept of peer review, it underwent many revisions and revealed many lessons that can be put to use by other persons attempting to implement such a program.     

Pediatric legalities

Health care practitioners must be cognizant of medical malpractice and the criteria that encompass professional liability. The 4 separate but related criteria of professional liability are discussed and explanations given on their importance. Emphasis is placed on pediatric legalities, although there are many aspects of medical malpractice applicable to both the adult and pediatric patient. Specific allegations familiar to nurses are explored and related to the care of the pediatric patient. Individual considerations such as consents, child abuse, and the withdrawal and withholding of treatmentfor the pediatric patient will be discussed. Attempts have been made to provide current, accurate information concerning legal issues in nursing practice. However, because law changes rapidly, new decisions may have been reached by a particular court or through state legislation. It is important for the nurse practicing in the perianesthesia field to keep abreast of changes in the law that have an impact on nursing practice both for the pediatric patient and the adult patient.     

Religion's support for the domination of women--breaking the cycle

Throughout history, certain religious images and symbols often have been uncritically used to legitimate the dominance of men over women. This uncritical use has had lasting effects upon our culture, and these images and symbols often continue to be used as rationale for subordinating women today. Since the nursing profession has been, and continues to be, a predominantly female occupation, nurses are especially impacted by this inherited imagery. In their role as primary health care givers, nurse practitioners often care for women who have been victimized by a pattern of male domination that culturally is bound up in and perpetuated by certain religious imagery. This article describes and analyzes the power of religious sex-role imagery to maintain the public and professional order of female subordination to the male. Practical ideas are suggested for the nursing profession that will help to reconstruct this imagery along more equitable and humane lines. Through such efforts, nurses can justly achieve more reciprocity and equality for themselves, and can take active steps to prevent the victimization of many of the women they care for.     

A practice model for patient safety: the value of the experienced registered nurse

Creating a culture of patient safety often involves developing nursing care models that effectively use nursing resources. These authors discuss a nursing care model that focuses on the experienced nurses to enhance the use of their expertise. They provide more direct oversight and surveillance for the care given to all patients through leadership, mentoring, and collaborative practice. The experienced nurse is valued as a clinical leader, instrumental to the development of a safe practice environment. Implementation of this model has resulted in dramatic improvements in safety and registered nurse retention.     

The use of case histories to assess nurses' ability to solve clinical problems

The use of case histories to assess nurses’ability to solve clinical problems Nurses’performance in written examinations often bears little relationship to their level of clinical proficiency in the ward. This paper describes a method of making written examinations more relevant to the clinical situation. It describes the development of a case history test which confronts students with the kind of information they have to interpret and act upon in the ward, and which requires them to recall the principles of nursing care and apply them in a way similar to real life. Evidence is presented that tests of this type are more closely linked to clinical performance than are conventional written examinations, and guidelines are given for constructing case history tests.     

Extracorporeal membrane oxygenation: current use and future directions

Extracorporeal membrane oxygenation (ECMO) is the process of using prolonged cardiopulmonary bypass to support patients with reversible respiratory and/or cardiac failure who are refractory to maximal conventional therapy. This process has been used extensively for critically ill neonates, with encouraging results. The use of ECMO in the pediatric population has been limited but is increasing. The history, mechanics, and current applications of ECMO are discussed in this article. Critical care nursing management of the pediatric or neonatal ECMO patient focuses on optimizing recovery of the pulmonary and/or cardiac system while preventing complications. A case study of a pediatric ECMO patient is presented which illustrates the complex nursing care issues related to use of this intervention. Future directions for ECMO are addressed.     

Comparison of the effectiveness of teaching strategies for a pediatric pain management program for undergraduate nursing students: A quantitative evaluation using an objective structured clinical examination

Pain is a common experience for hospitalized children; however, nursing students are often not adequately trained in pediatric pain management. Innovative teaching strategies, such as e-learning, have been employed for instructing students, however success of these platforms has not been quantitatively measured. This study compared students' knowledge and skill performance following a researcher-designed pain management program administered with three teaching strategies: traditional face-to-face, e-learning, or blended learning. Undergraduate nursing students in Taiwan (N = 296) randomly assigned to one of the teaching strategies participated. Knowledge of pain management, and pain management skills were quantified. A subjective assessment of attitudes towards learning found no significant difference between groups. Knowledge of pediatric pain management did not differ significantly between groups (p = 0.36). A 15-item objective structured clinical examination (OSCE) measured the competency of pain management skills; scores were not significantly different, regardless of teaching strategy (p = 0.70). Traditional face-to-face teaching was as effective as both innovative strategies. Evaluating students’ skills following a pain management program with an OSCE provided a quantitative assessment of competency. Innovative strategies for teaching pediatric pain management could be a cost-effective way to provide flexible learning opportunities for nursing students who are distant from educational institutions.     

Can the Neuman Systems Model be adapted to the Malaysian nursing context?

Nursing in Malaysia is still developing as a profession. Issues such as using nursing conceptual models or frameworks in the delivery of nursing care have not been addressed by the majority of nurses. One reason for this has been the level of education and preparation of nurses, while another reason lies with the origins of existing nursing conceptual models. Most nursing conceptual models have their origins in North America. Their utility by nurses of different cultures and academic preparations might not be appropriate. Nursing is a social activity, an interaction between the nurse and the patient. It is carried out in a social environment within a particular culture. Conceptual models developed in one culture might not be readily implanted into another culture. This paper discusses how a conceptual model developed in North America; that is, the Neuman Systems Model, can be adapted into the Malaysian nursing context.     

The nurse-patient relationship results of an examination about relationships between patients and nurses in hospitals

The nurse-patient relationship has received particular attention in the relevant literature. For patients in life threatening and existentially challenging situations, nursing activities often require a close intimacy. A good nurse-patient relationship is a precondition for effective nursing interventions, but by itself also contributes to the healing process. How such a relationship is realized in everyday nursing situations remains, however, unclear Literature predominantly details normative expectations on the nurse-patient relationship that are based on nursing theory or concepts from humanistic psychology. The operationalisation of these concepts into nursing practice is not given. In order to answer the research question "How do nurses experience their relationship with the patient?" qualitative interviews were conducted. Thus, the nurse-patient relationship was explored from the perspective of the nurses and considered in the context of their specific working situations. Nurses related their experiences, emotions and stress resulting from different kinds of nurse-patient relationships. Data were collected, organised and analysed following Giorgi's 1985 phenomenological analysis. Results show an ambivalence by nurses between closeness and distance in their relationship with patients. These relationships also show a polar vascillation between, for example, "sympathy" and "antipathy", or "being able to help" and "helplessness". The development of the relationship is often not very professional and depends on the specific situation and those individual persons participating in it. It is also apparent that those models of the humanistic psychology which have been discussed in nursing contexts cannot serve as such as a basis for the development of the nurse-patient relationship. A particular aspect of developing relationships in nursing are nursing interventions which necessitate bodily contact and physical work with patients. Concepts including these aspects of nursing can serve as valid and concrete starting points in order to find a way unique to nursing to create effective relationships with patients.     

Pressure sore prevention in the critically ill: what you don't know, what you should know and why it's important.

The critically ill are particularly vulnerable to pressure sore development. These expensive and often painful complications have been largely ignored for many years and the entire problem has been managed by nursing staff. Current methods for identifying patients at risk are inadequate and subjective. Scoring systems have been known to over-predict those at risk and this maybe because they frequently originate from elderly care settings. Additionally, their relevance to the critically ill has not yet been established. The use of pressure-relieving devices has become commonplace; however, there is a paucity of data from controlled clinical studies. No uniform approach in measuring the effectiveness of these devices exists. What is certain, though, is that a voluminous amount of work needs to be conducted in order to verify their continued use. It is increasingly apparent that the complex nature of pressure sore development means that it is unrealistic to expect a single discipline to manage the problem effectively. A multidisciplinary team approach is the most appropriate way to improve management in this vital area.     

Game playing: a way to look at nursing models

This paper deals with macrotheories of nursing and a new way of looking at them. It also shows through the use of a board game why the discipline of nursing would be greatly hindered in its development by the acceptance of only one of the nursing macrotheories available today. The board game shows that macrotheorists of nursing do not discuss death and dying as a part of their conceptual models. Since death is not incorporated into the concepts, then they are not describing or explaining all the aspects dealt with in the discipline of nursing. This is not to say that theory is not necessary but that the acceptance of only one nursing macrotheory (model) is limiting and inhibiting. It denies nursing the ability to create and use intuition.     

The challenge of achieving optimal pediatric pharmacotherapy in the developing world

Background: Legislation such as the FDA Modernization Act of 1997 and the Pediatric Rule of 1998 in the United States has fueled pediatric pharmacologic research in developed countries; however, this change has not yet reached developing countries.Objective: This article reviews the obstacles to and priorities for improving pediatric health care in developing countries.Discussion: Information provided by the social and behavioral sciences is now included with that afforded by the basic and clinical sciences in decisions about optimal pharmacologic therapy for adults. This change must also occur in pediatric health care and policy, especially in developing countries, where poverty and illiteracy are key factors in the development and treatment of disease in childhood, and where often at least 50% of the population is younger than 18 years. Maternal illness and illiterary have also been linked to illness and mortality among children in these countries. Pediatric pharmacologic research should consider the most common communicable diseases as well as those for which there are currently no satisfactory treatments, and should investigate the use of herbal and other natural health products often used to treat children in developing countries. Nutrition, dissemination of drug information, and management of supplies must also be taken into account.Conclusions: The international pediatric community must come together in pursuit of better health outcomes for all children through improved pharmacotherapy.     

Nursing PhD consortia: a model for maximizing scarce resources.

Doctoral (PhD) education in nursing is costly and requires scarce resources: qualified faculty, qualified students, research funding, and infrastructure. This article discusses the development and implementation of a five-school consortium for delivery of an established PhD in Nursing Science program throughout north Florida. Factors that contributed to the success of the Consortium, including communication, history of shared work, collaborative approaches, and a formal agreement, are described. Challenges, such as maintaining curricular integrity across settings and selecting web-based formats, are considered. Results to date have been a viable consortium with a 4-year history, three PhD consortium graduates, 22 PhD students enrolled via the consortium, and success in attracting both federal and private funding. Consortia are proposed as a strategy for the effective use of limited resources, and suggestions are provided for the development of successful consortium models capable of delivering high-quality PhD nursing education.     

Development of models and theories on the concept of nursing*

This paper shows how models can be used by practitioners of nursing as a practical tool to analyse their own practice, in particular to assess needs and to plan, implement, and evaluate care. It is argued that the impact of existing work in theory development has been relatively small, at least in the UK, because the theories arc not sufficiently specific to everyday nursing activities and the models are over elaborate and not universally applicable. A simple model of nursing, based on a systems approach is presented and applied to one particular field of nursing practice, i.e. health visiting. The model, which can be used in any field of nursing, stresses the reciprocity of the nurse–patient relationship, and the significance of the environment in determining the concepts of nurse, patient and nursing.     

A project to establish a skills competency matrix for EU nurses

Enhanced nurse workforce mobility in the European Union (EU) is seen as a remedy to shortages of nurses in some EU countries and a surplus in others. However, knowledge of differences in competence, culture, skill levels and working practices of nursing staff throughout EU countries is not fully documented because currently no tangible method exists to enable comparison. The European Healthcare Training and Accreditation Network (EHTAN) project intends to address this problem by establishing an assessment and evaluation methodology through the compilation of a skills competency matrix. To this end, subsequent to a review of documentation and literature on nursing competence definition and assessment, two versions of a nursing competence self-assessment questionnaire tool have been developed. The final competence matrix will be translated and disseminated for transnational use and it is hoped that this will inform EU and national policies on the training requirements of nurses and nursing mobility and facilitate the promotion of EU-wide recognition of nursing qualifications.     

Neoliberalism and the government of nursing through competency‐based education

Competency has become a key concept in education in general over the last four decades. This article examines the development of the competency‐based movement with a particular focus on the significance it has had for nursing education. Our hypothesis is that the competency movement can only adequately be understood if it is analyzed in relation to the broad societal transformation of the last decades—often summarized under the catchword neoliberalism—and with it the emergence of managerial models for Human Resource Management (HRM) for the reorganization of social services. Classical professions, which were characterized under welfarism by an esoteric knowledge based on ethical norms, have now become marketable commodities that can be evaluated in the same way as other commodities. We want to underline that while this development is still under way, it is the concept of competency that was the decisive political instrument enabling this profound change. With the widespread implementation of competency‐based education that now governs nursing knowledge, the development of a critical, oppositional perspective becomes more challenging, if not entirely impossible. We will be focusing primarily on nursing education in Canada, although we maintain that it has relevance for nursing internationally.