Routledge International Handbook of Nurse Education

Sue Dyson, Margaret McAllister, Sue Dyson, Margaret McAllister

• Publisher: Routledge
• Year: 2019
• ISBN:
  9781351121651
• Edition: 1
• Topic: Medicina
• Subtopic: Enfermería

While vast numbers of nurses across the globe contribute in all areas of healthcare delivery from primary care to acute and long-term care in community settings, there are significant differences in how they are educated, as well as the precise nature of their practice. This comprehensive handbook provides a research-informed and international perspective on the critical issues in contemporary nurse education.

As an applied discipline, nursing is implemented differently depending on the social, political and cultural climate in any given context. These factors impact on education, as much as on practice, and are reflected in debates around the value of accredited programmes, and on-the-job training, apprenticeship, undergraduate and postgraduate pathways into nursing. Engaging with these debates amongst others, the authors collected here discuss how, through careful design and delivery of nursing curricula, nurses can be prepared to understand complex care processes, complex healthcare technologies, complex patient needs and responses to therapeutic interventions, and complex organizations. The book discusses historical perspectives on how nurses should be educated; contemporary issues facing educators; teaching and learning strategies; the politics of nurse education; education for advanced nursing practice; global approaches; and educating for the future.

Bringing together leading authorities from across the world to reflect on past, present and future approaches to nurse education and nursing pedagogy, this handbook provides a cutting-edge overview for all educators, researchers and policy-makers concerned with nurse education.

Section 1

Global perspectives on nurse education

Foreword: Margaret McAllister

This section aims to provide a global view of nursing education by training a historical lens on the changes to nursing that took place in various countries. The series of chapters explores nursing education in England, Australia, the Bailiwick of Guernsey, Hong Kong, African countries including Botswana, Ghana and Nigeria and the United States. A chapter also explores the nature of working and studying across countries – a practice that offers the opportunity to create a truly global nursing profession and an approach to working globally that is sensitive to being participatory, rather than dominant.

Bill Whitehead provides an overview of the British nursing system of education concentrating on the periods between the mid to late 1800s through to the present day and explains how the clinical teaching role played a vital role in stimulating the advancement of nursing education. McAllister, Campbell and Ryan provide an overview of nursing education in Australia. Ching, Cheung and Mak provide an account of nursing in Hong Kong, detailing that country’s movement from a model of apprenticeship to one of the most advanced systems of education for nursing in the world. Korsah traces developments in three African countries that were heavily influenced by colonial rule, and the health of these nations very much challenged by endemic tropical diseases. In these nations, political independence heralded possibilities for reform to nursing, which in turn triggered improvements to flow to primary, secondary and tertiary healthcare across Africa. The Channel Islands – though home to a small population – have a fascinating history that McClean elaborates. Sandra Lewenson and Annemarie McAllister summarise developments in the United States of America.

Teresa Stone and Margaret McMillan, drawing on their years of experience working in countries other than their home base in Australia, discuss opportunities to broaden horizons by working with nurses in foreign lands.

Potter and Bragadóttir provide a timely discussion of the COIL programme – a global curriculum development approach that is grounded in principles of collaboration and respect. In today’s commodification of education, where education providers are seeking markets for their courses, it is vital that nursing scholars provide principles for ethical engagement and to guide the development of relevant, inspiring curriculum that is fit for purpose.

This important section tracing the history of nurse education globally reminds us how learning from history has many benefits – it helps one to notice change or continuity, struggle, achievements and ongoing needs for change in nursing. Historical awareness gives learners a wide vision of nursing, and in this way can illuminate thinking on what directions nursing could and should be headed towards in the future. This series of chapters shows that nurses across the world have been united in their determination to provide reliable, safe and technically skilled care to patients by establishing systems of education that provide relevant training, support and knowledge to students.

1

A history of nurse education and the clinical nurse educator

Bill Whitehead

Introduction

This chapter will provide a brief historical perspective of British nurse education from the 1860s to the present day. From a secular viewpoint this can be dated precisely to the time of the first Nightingale school at St. Thomas’ Hospital in June 1860 (Seymer, 1957).

It is necessary to gain a historical context in order to understand contemporary nurse education in any depth. Historical knowledge also ensures that we learn from the successful policies of the past and avoid repeating mistakes. Much of the ethos and content of training courses was based on the principles emanating from the late nineteenth century (Bradshaw, 2001a). Consequently, it is necessary to look back to the origins of nurse training, because this is a model to which many nurses educating and practising in the early twenty-first century refer (Rideout, 2000). The chapter is organised around the historical events influencing nurse education over this one hundred and fifty-year period. An underlying theme is the three factors of recruitment, retention and skills modernisation which have continually driven the changing delivery of nurse education throughout. For example, one turning point was a paper written following a review of a major London teaching hospital at the end of the 1950s. In this research study, it was found that students were so pressured to provide care for the inpatients that between 30% and 50% left before they reached the end of their training (Menzies, 1960). This report, amongst other factors, led to the widespread adoption of the clinical teacher (CT) role in the years that followed. The account will continue up to the current day and will comment on the resonance of these historical initiatives with contemporary British Government and Nursing and Midwifery Council (NMC) policy (DH, 2016; NMC, 2017a).

Woven throughout the account will be the clinical nurse educator roles which have fulfilled the need for student nurses to receive clinical training and education in practice. This important aspect of the infrastructure of nurse education begins during World War One with the appointment and training of the first “sister tutors” at St. Thomas’ Hospital (Martin, 1989). The majority of clinical education continued to be provided by ward sisters, but repeated attempts have been made to professionalise the role. The most well remembered of these was the CT role which was first trialled in Scotland in 1955 (McNaught, 1957) and continued until the changes brought about by the introduction of Project 2000 in the late 1980s and early 1990s (Morris, 1998). It will then examine the roles which followed the CT, such as the lecturer practitioner, practice teacher, practice education facilitator and clinical nurse educators. The chapter will end with the potential roles which will be engendered by the new NMC standards and framework for nurse education (NMC, 2017b).

History

When writing any historical account, it is both difficult and important to decide upon the starting point. Bradshaw convincingly argues, through research based on the core textbooks spanning one hundred years of nurse education, that much of the ethos and content of training courses was based on the principles emanating from the late nineteenth century (2001a). Consequently, it is necessary to look back to the origins of the apprenticeship nurse training model, because this is a model to which many nurses educating and practising in the early twenty-first century refer (Rideout, 2000). It is often seen as an ideal type for producing competent and caring nurses. It goes without saying that this is a debatable point. As an oppressed group, nurses struggle to see beyond the terms of reference of their suppression (Freire, 1972; Marcuse, 1964; Marx and Engels, 1845; Whitehead, 2010). Therefore, it is understandable that many nurses see apprenticeship training, with its accoutrements of servitude to the medical profession and self-sacrifice to the hospital administration, as a historical golden age. However, even politically aware and critical academic nurses have begun to question whether the direction of travel for nursing away from the hands-on, clinical, “knowledgeable doer”, described by the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) in Project 2000 (1986), has gone too far in the direction of the “knowledgeable” from the “doer” (Drennan and Hyde, 2009).

Origins of the apprenticeship model

The beginning of apprenticeship nurse education appears to be a good starting point, whichever explanation is selected for this phenomenon. From a secular British viewpoint this can be dated precisely to the time of the first Nightingale school at St. Thomas’ Hospital in June 1860 (Seymer, 1957). That is not to suggest that nursing began in 1860. There were nurses or people who cared for the sick going back into pre-history. Nurse historians such as Dock have attempted to trace its origins back beyond recorded history (Dock and Stewart, 1938).

In this account Dock and Stewart (1938) provides a creation mythology which is important to the sense of imagined community she was attempting to foster amongst the profession (Anderson, 1991; Samuel and Thompson, 1990). Starting with prehistoric proto-nurses, Dock charts an irregular progression from Stone Age carers through to the nineteenth-century Kaiserworth School for Protestant Deaconesses. The founders provided broad training including pharmacy, ethics and anatomy as well as cooking, cleaning and other practical skills related to the care of the sick. Kaiserworth was where Nightingale gained her inspiration for nurse training (Dock and Stewart, 1938). Nurses had been taught things prior to this and the hospitals which became the illness factories of the nineteenth century required skilled operatives to run them (Foucault, 2003). In addition, there were, of course, women who nursed the sick in warzones prior to and contemporaneously to Nightingale’s time in Scutari. Some of these were remembered either in their own words, such as Mary Seacole (Seacole, 1857), or through local campaigns of charitable giving for their retirement, such as Agnes Harkness (BBC, 2008). However, the identity of the nurse at the time was increasingly of the untrained nurse described in Dickens’ 1844 novel Martin Chuzzlewit (Dickens, 1844) and illustrated in Dock’s curve above as the “secular servant nurse”. Nursing at the time was depicted as “a particularly repugnant form of domestic service for which little or no education or special training was necessary” (Kalisch and Kalisch, 1987: 14).

This concept of dangerously incompetent care in British hospitals was supported by Nightingale’s experience in the Crimea. The Crimean War death rate had been in main part caused by disease exacerbated by poor care. This led to support for formal nurse training. Nightingale was the founder of this first real secular school of nursing at St. Thomas’ Hospital in 1860. However, it must be considered likely that some such course of events would have taken place with or without her. The hospitals were becoming an area for treatment rather than a repository for the sick poor. In addition, women were at this stage beginning to be accepted into higher education (HE) and the professions. This was, in part, a response to the radical and liberal challenges to patriarchy by thinkers such as Wollstonecraft (1792) and Mill (1869). However, it was also an empirical phenomenon that was, arguably, happening independently of philosophical theorising. For example, the first woman to join the medical register in the UK was registered in 1868. She had gained her medical degree in the USA in 1849 and she formed the women’s medical college in England in 1869 (LeClair et al., 2007). Contemporaneously, as part of this movement of history, capable women were encouraged to become student or probationer nurses in this newly professionalised discipline.

Probationer nurses

The probationers had a set period of one year at the outset. There were weekly lectures but the main form of education took place on the wards with the matron in charge of the day-to-day education and discipline. According to Bradshaw (2001a), a strict timetable of supervision and certification was imposed on the probationers. The range and content of the nurses’ duties and skills are a matter of historical dispute. Relying on official records it is tempting to point to the contents of primary source documents such as the 1860s St. Thomas’ School application form which listed duties such as: “dressing of blisters”; “application of leeches”; “bandaging, making bandages and rollers, lining of splints” and “strict observation of the sick” (Dingwall et al., 1988: 54–55).

However, Baly (2007) and Dingwall et al. (1988) convincingly cast doubt on this by citing evidence from late nineteenth-century probationers’ contemporary diaries and reports. These indicate that tasks such as temperature, pulse and respiration taking and recording were done by medical students; and the nurse’s involvement in wound dressing was mainly in preparing poultices. This disconnection between theory and practice is something which would continue to be an issue in nurse education throughout the next century to the present day. The point that Baly (2007) and Dingwall et al. (1988) were making was that this implied a lower status for the standard of education and actual work undertaken than for that laid out by the school authorities. It also meant that St. Thomas’ saw “probationers as a cheap source of labour” (Dingwall et al., 1988: 53) rather than teaching them valuable skills. The question that must be asked is: what makes the cleaning of patients and the provision of essential care less important than recording temperatures? This was precisely the point that Nightingale made over and over to her probationers and to the governing class at the time (1898, 1914). It remains an issue for nurses in the twenty-first century. In more recent years the Royal College of Nursing (RCN) debated the conference motion “are we too posh to wash?” with regard to expanding nursing careers and the retreat from the bedside (Bore, 2004; O’Dowd, 2004) and the debate continues with the new standards for nurse education being introduced (Wade, 2018). Nevertheless, whether probationers were learning how to record observations or how to make beds, they were undergoing a certificated training course.

Certification or registration

At the end of the year the probationer became a hospital nurse and was entered on the hospital register as a certified nurse. This was prior to compulsory national registration and in later years when this was discussed, Nightingale was a staunch opponent of compulsory registration. “[S]he felt it would do great damage to the cause of nursing” (Abel-Smith, 1960: 65). “Seeking a nurse from a Register” she wrote “is very much like seeking a wife from a Register, as is done in some countries” (Nightingale, cited in Abel-Smith, 1960: 65 [original capitals retained]). Other nurses, such as Bedford Fenwick, and doctors, such as Acland, argued that nurses, similarly to medical practitioners, should be registered to ensure quality and consistency of training (Bradshaw, 2001a; Dingwall et al., 1988). However, Nightingale was influential and well connected and partially due to her interventions national regi...