Nursing Education

ABSTRACT

Nursing education prepares nurses to practice in a variety of settings.  The impact of modernization, globalization and liberalization on the society has brought tremendous changes in general and nursing education.  The significant trends in modern education are creativity, changes in teaching - learning process and advanced educational technology.

The current trends in nursing education are numerous.  The scientific and technological advances in medicine along with social changes have resulted in emergence of new diseases and the development of specialities and super specialities.  Advanced nurse practice enables nurses to practice in new roles such as nurse practitioners and clinical nurse specialists.  Nursing profession ensures a promising career in India with job opportunities abroad. Large number of private nursing educational institutions have been set up, which require faculty with postgraduate education.  In developed countries, great emphasis is given on preparing individuals with critical thinking and problem solving skills.

Issues and trends facing nursing education poses challenges for students and nurse educators.  Changes in the curricula in nursing education programmes must incorporate syllabus which reflect social trends and advances in medicine.  Curriculum needs periodic revision.  The programme has developed numerous types of education programmes to address the need for increased man power.

Alternate curriculum plans such as external degree programmes and part time courses are necessary for students who seek higher qualifications.  Degree nursing courses are offered through distance education by different methods such as print media, video conferencing, off campus programmes and academic or continuing education courses on the world wide web.  Use of evidence based and reflective practice in clinical settings are important for nursing students.  Improved teaching strategies such as programmed instruction, problem based learning, computer assisted learning and online learning are few examples of newer learning strategies available in nursing education.

Clinical skill laboratories help students in clinical skill development under non stress situations.  Advanced nurse practice roles have to be developed such as Family Nurse Practitioner, Adult Nurse Practitioner, Peadiatric Nurse Practitioner, Midwifery Nurse Practitioner.  Clinical nurse specialists can function as ostomy nurse, nurse in pain management etc.

With large number of graduates passing out every year, it is a challenge to maintain quality in nursing education.  Good infra structure, clinical facilities and adequately prepared faculty are important.  Linking of nursing education and practice encourages well prepared graduates for better patient care.  Faculty need to be role models especially in the aspect of caring in nursing.  Globalization challenges nurses to find effective ways to promote interaction to further scholarly efforts between countries.

Definition

"A system of controlled practice that makes it possible to concentrate on specific teaching behavior and to practice teaching under controlled condition".  Allen and Eve (1968).

Characteristics of Micro-teaching :

1. Micro element :  Micro-teaching reduces the complexity of the teaching situation in terms of.
   1. Number of students to be taught.
   2. Duration of lesson.
   3. Subject matter to be taught to enable the trainee to concentrate on a particular teaching skill at a time.  One should master the components of the task of teaching before he attempts to perform effectively the complicated task of teaching at macro-level.
   4. The number of instructional objectives and the content is kept low
   5. It reduces the teaching skill and size of the topic, it is focused on micro events.
   6. It is highly individualized training device to prepare effective teachers and provides feedback for trainees' performances.
   7. Micro analysis of the teaching process consist of analyzing the minute details of teaching.
2. Teaching skills and teaching strategies :

a.    Pre-instructional skills.

• These include writing of instructional objectives.
• Sequencing and organizing knowledge to be presented in order to achieve specific objectives.
• Appropriate content.
• Proper organization.
• Selection of proper audio-visual aids.

b.      Instructional skills :

• Skills of introducing a lesson.
• Skills of explaining and illustrating.
• Reinforcement
• Probing questions.
• Reinforcing pupil participation.
• Probing questions.
• Reinforcing pupil participation.
• Diagnosing pupils' difficulties

c. Post-instructional skills :

• Skills of writing test items
• Interpreting pupil's performance in a test.
• Planning remedial measures.

d. Feedback

1. Safe Practice ground
2. The Teaching Models

Basic Principles of micro-teaching

1. Enforcement.
2. Practice and drill.
3. Continuity.
4. Microscopic supervision.

Phases of Micro-Teaching

1. Knowledge Acquisition Phase.
2. Skill Acquisition Phase.
3. Transfer Phase.

Steps of Micro-Teaching

1. Defining a Specific skill
2. Demonstration of the skill
3. Micro-Lesson Plans
4. Teaching a small group
5. Feedback
6. Re-planning, Re-teaching and Re-evaluation

Five 'R's of Micro-Teaching

• Recording
• Reviewing
• Responding
• Refining
• Re-doing

Merits of Micro-Teaching

• Helps student teachers to acquire hard-to-attain teaching skills by providing a real situation for practicing skills.
• Since micro-teaching focuses on a particular skill at a time, student teachers can attain proficiency in teaching skills in a phased manner.
• Provision of immediate feedback makes micro-teaching more interesting and reliable.
• Since main role is played by the student teacher, it is regarded as a student centered method.

Demerits of Micro-Teaching

• Time consuming
• Produces homogenized standard robots with set smiles and procedures
• It is said to be (wrongly) a form of play acting in unnatural surroundings and it is feared that the acquired skills may not be internalized.

Prepared by: Mr.Sajith Kumar P, Asst. Professor, MIMS College of Nursing, Calicut, Kerala.

INTRODUCTION

An effective lecture can be one of the most exciting and rewarding aspects of an educator's responsibilities. The instructor who is able to maintain participant interest with an exciting, dynamic delivery using a variety of instructional methods is more likely to be successful in helping students reach the learning objectives. The time and effort invested in planning pay off as the instructor and students interact, discuss, question and work together.

A good lecture may cover the most material in the least amount of time. Given the proper audio equipment, it lends itself to groups of almost any size and can be handled with a minimum mastery of material on the part of the lecturer. For example, one does not have to be an Old Testament scholar to present a fairly comprehensive lecture on Psalm 23. Obviously since the total context of that psalm is the entire Bible, one would be a better lecturer if he had competence in all of the Old Testament Scriptures, but such competence is not necessary.

Effective lectures do not just happen-they are planned. The educator must:

• Establish the purpose of the lecture
• Consider the logistics of the lecture
• Plan a variety of approaches (e.g., use of questioning, media, small group activities)
• Prepare a set of lecture notes

POINTS TO BE ASSESSED

In what kind of setting will they receive this information?

• Large lecture hall or small seminar room or classroom.
• Lighting and sound issues.
• Time of day.

Take into account the "me, here, now."

• Picture yourself as a member of the audience and ask "How does this message affect me, here, now?"
• Me, here, now translate into what you as a sender have to offer your students/receivers-what they will be able to understand, accept, support, consider important-because it matters to them.

Establish cognitive / behavioral objectives for your audience:

• What do I want my students to know?
• What do I want my students to do

PREPARATION

You probably can't cover everything you want to in a lecture.

Decide what is essential, what is important, and what is helpful (what would be nice).

• Cover the first; try to cover the second;  forget about the third.
• Release a little control over the material and rely on the textbook or a list of supplementary readings for the nonessentials.

Set objectives.

• What do you want to have accomplished at the end of the lecture?
• What do you want the students to know at the end of the lecture?

Plan a lecture to cover less than the entire period.

• It takes some time to get going.
• Questions always take up more time than you expect.

Divide the lecture into discrete segments and follow the standard speech structure.

• Divide it both in terms of time and in terms of material.
• Try for ten or fifteen minute blocks, each one of a topic.
• Briefly summarize the previous lecture; introduce the topic(s) for the day; present the material; summarize briefly; preview any homework and the next lecture.

Lecture from notes or an outline, rather than a complete text.

• It's too tempting to simply read, rather than lecture, from a complete text.
• Reading also creates a barrier between lecturer and audience.
• Writing up an entire lecture is very time consuming.
• A written lecture often becomes a fossil that never gets updated.

DELIVERY

The "How do you get to Carnegie Hall?" Rule.  Practice, Practice, Practice.

• Be conversational; speak naturally; be yourself (or your best self).
• Vary your pacing and voice.
• Use gestures to emphasize points.
• Look at the audience.
• Use language to create pictures.
• Use metaphors, analogies, and similes.

Observe the techniques of others.

• Try out in your own class techniques you admire in others.
• Like any skill, delivery is not innate, but must be learned.

CREDIBILITY & COMMITMENT

You are the most important person in the room.

Think about antecedent image--perception is often stronger than reality.

Credibility is enhanced by:

• Your own sense of comfort and confidence presenting material.
• Your enthusiasm and interest in teaching.
• Your research and own ideas.

Commitment is enhanced by:

• Relating your own experience, ideas, and feelings.
• Taking the first person approach, not separating yourself from your subject.
• Relating your "passion" for your subject.

Delivery is tied to both commitment and credibility:

An old UCLA study of effective presentations analyzed 3 elements (verbal, vocal, visual).  Here's what it found was important in establishing credibility/believability:

• Verbal (words you say):  7%.
• Vocal (how you sound when you say them): 38%.
• Visual (how you look when you say them): 55%.

Your energy and intensity will move your audience-and help you (them) reach your objectives.

BUILDING INTERACTION

Learning is not a spectator sport.

Learning takes place best in an active, not a passive environment.

Interaction is a continuous way to

• Assess the me, here, now.
• Determine whether or not your content is understood.
• Share the responsibility of learning more equitably and appropriately.

How to build interaction?

• Have questions prepared--begin with relatively easy, accessible ones.
• Set up hypothetical, problem-solving exercises, brainstorming.
• Work to get everyone involved, even in large classes.

. Move yourself!

• Begin class from somewhere besides the front; invite students to consider the issue on board with you, so that you're looking at the board with them.  That telegraphs your expectation that learning is a joint experience.

 

CHALKBOARDS
(and other high tech media)

If your handwriting is really terrible, perhaps you should go to med school.

Use the board (slides/overheads) to reinforce your points visually.

.If you have a great deal of board work,

• Consider having most of it put on the board before class.
• Make a copy of it as a handout.
• Consider using an overhead projector.

Don't talk while you write. .

Limit the amount of material you put on a slide or overhead.

. Have a plan for your board work.

• Remember: all visuals are supplements or complements, not substitutes.

HANDLING QUESTIONS

• It's hard to answer a good question--and even harder to pose one.

Explicitly request and encourage questions.

• Be aware of how your behavior and comments can set the tone for questioning.
• Make sure everyone hears the question.
• Clarify questions.
• Answer questions as directly as possible.
• Be diplomatic when students raise tangential, overly-complicated questions, or persistently ask questions just to be asking.

GETTING FEEDBACK

• • By the time you get end-of-term evaluations, it's too late.
• Get regular feedback.
  • Ask students to spend the last five minutes of class writing down the most important thing they learned that day or one question they have as a result of the lecture.
  • Answer the questions at the beginning of the next class.
• Use eye contact as a tool for continuous feedback.
  • If you notice students with questioning looks, stop what you're doing and ask if you need to clarify.
  • If you get no response, go ahead and clarify.
• Conduct a mid term course review.
• Borrow students' class notes from time to time.
• Arrange to have your lecture videotaped.
  • You can view it yourself or with a consultant who can discuss it with you.

TESTS and GRADES

• Poor answers are often the result of poor questions, not poor minds.
• Decide what your goal in testing is.
• Consider the format of questions.
• Consider the format of the exam as a whole.
• Make your grading and testing policies clear on the first day of class.

Lecture Components

Silberman (1990) suggests five approaches to maximizing students' understanding and retention during lectures. These can be used to help ensure the effective transfer of knowledge.

• Use an opening summary. At the beginning of the lecture, present major points and conclusions to help students organize their listening.
• Present key terms. Reduce the major points in the lecture to key words that act as verbal subheadings or memory aids.
• Offer examples. When possible, provide real-life illustrations of the ideas in the lecture.
• Use analogies. If possible, make a comparison between the content of the lecture and knowledge the students already have.
• Use visual backups. Use a variety of media to enable students to see as well as hear what is being said.

The key to an effective lecture style is to break down the lecture into its component parts and use a variety of approaches within each component. This is especially critical when a group of students will be attending a series of lectures by the same educator. The three main parts of a lecture are the introduction, body and summary.

The purpose of the introduction is to capture the interest and attention of the students. It can also serve to make students aware of the instructor's expectations and encourage a positive learning climate. A good introduction is critical to the success of a lecture.

Tips for Creating an Effective Introduction Review lecture objective(s). Ask a rhetorical question. Ask for a show of hands in response to a general question. Ask a series of questions related to the lecture topic. Use an interesting or famous quotation. Relate the topic to previously covered content. Use a case study or problem-solving activity. Use a videotape or other media. Show an appropriate cartoon with the overhead or slide projector. Make a provocative statement to encourage discussion. Give a demonstration. Use a game or role play. Relate the topic to future work experiences. Share a personal experience. Relate the topic to a real-life experience.

The instructor can then make a smooth transition into the body of the lecture once the attention of the students has been captured with an interesting introduction . The body of the lecture contains the core of the information to be transferred to the students. Beitz (1994) recommends that the instructor use brain-storming, discussions, problem-solving activities, case studies and games to make the lecture more interactive.

The purpose of the lecture summary is to draw together the critical information presented and ensure that students leave the lecture with a clear under-standing of this information. The summary should be brief and address only main points. There are several techniques which can be used to summarize a lecture:

• Ask the students for questions. This gives students an opportunity to clarify their understanding of the content.
• Ask questions of the students. Several questions which focus on the main points of the content may be used to summarize the content of the lecture.
• Use a transparency, slide or flipchart to review the summary points.

Lecture Notes

Many lecturers make the mistake of thinking that they know their content well enough to deliver a lecture without notes to guide them. This is very difficult for most instructors and usually results in an unsatisfactory experience for both the instructor and the student. Instead, the instructor should prepare lecture notes to serve as a script or set of cues to follow during the lecture. Lecture notes are key words, phrases and other reminders (e.g., audiovisual cues, questions, examples, notes for activities) organized into an outline format. If a text rather than an outline format is used, the lecturer may begin to read the notes and the students will become bored.

Lecture notes help the instructor: Stay on topic and prevent getting lost. Cover the main points without forgetting anything. Glance at a specific point and quickly return attention to the students. Relax and focus on delivery instead of worrying about what point to make next.

Tips to Reduce Presentation Anxiety Avoid eating a big meal before the lecture. Not only will a full stomach make you drowsy, but it makes it more difficult to move around the room with energy. Arrive early to make sure that everything is ready before the first student arrives. Make sure all of the media equipment is working. Locate and check the lighting and temperature controls. Decide where the lecture notes will be placed (e.g., on a lectern, desk, table) when they are not being held. Have a glass of water available during the lecture. Go for a short walk just before the lecture. Look over your lecture notes one last time. Greet students as they enter the room. Shake their hands, welcome them to the lecture and talk to as many of them as possible. Take a few deep breaths to relax before beginning the lecture.

Follow this three-step process to conduct a self-evaluation: Arrange to have the lecture videotaped. Explain to the students the reason for the recording equipment. At the conclusion of the lecture, distribute a student satisfaction form (if applicable). Using a lecture skills checklist, watch the videotape (with an experienced presenter if there is one) and critique the performance.

With planning and effective presentation techniques, the lecture can be a highly effective and interactive method for transferring knowledge to students. If the lecture is carefully planned, the educator will have a clear purpose of the lecture and will have considered the logistics associated with the number of students, amount of time allocated for the lecture, room size and available media. Planning will also help ensure that the educator uses a variety of approaches to introduce, deliver and summarize the lecture. Lecture notes in outline form will help the instructor give an effective presentation.

Other key points to remember in preparing and delivering a lecture:

• The first few minutes of a lecture are important. Plan them well!
• Verbal communication skills are critical. These include appropriate voice projection, avoiding fillers, using students' names, making smooth transitions, using examples and providing praise.
• Nonverbal communication skills also are very important. These include eye contact, positive facial expressions, gestures and movement.
• Effective questioning and interaction are critical to the success of the lecture. Questioning skills include planning questions in advance, asking a variety of questions, using students' names and providing positive feedback.
• The lecture should be summarized by asking for questions, asking questions and using media to review main points.
• An evaluation using a video recording or an observer can assist the lecturer in assessing the quality of the presentation and improving lecture skills.

References

1. Arredondo MA et al. 1994. The use of videotaped lectures in surgical oncology. Journal of Cancer Education 9(2): 86-89.
2. Beitz JM. 1994. Dynamics of effective oral presentations: Strategies for nurse educators. AORN Journal 59(5): 1026-1032.
3. Cavanagh SJ, K Hogan and T Ramgopal. 1995. The assessment of student nurse learning styles using the Kolb Learning Styles Inventory. Nurse Education Today 15(3): 177-183.
4. Edlich RF. 1993. My last lecture. Journal of Emergency Medicine 11(6): 771-774.
5. McIntosh N. 1996. Why Do We Lecture? JHPIEGO Strategy Paper #2. JHPIEGO Corporation: Baltimore, Maryland.

 

 

INTRODUCTION

The retarded development of nursing and nursing profession seems to be mainly due to the fact that no serious thought has been given to this discipline by the government over the years. Timely action on the various reports submitted to the government  would have prepared nurses  to take care of all areas of health care  delivery and would have also avoided multiplication of other categories like occupational therapists, physiotherapists, social worker , health educator etc. All these are doing nursing duties.

RECOMMENDATIONS OF HIGH POWER COMMITTEE ON NURSING AND NURSING PROFESSION

Working conditions of nursing personnel

1. Employment

Uniformity in employment procedures to be made.

Recruitment rules are made for all categories of nursing posts. The qualifications and experience required or these be made thought the country.

There should not be a bond for nursing students as some of the states do not give them employment during the stipulated period. Keeping in view of the shortage of nurses in hospitals and community health field states should create posts and appointment these nurses in the appropriate positions.

2. Job description

• Job description of all categories of nursing personnel is prepared by the central government to provide guidelines.

3. Working hours

§  The weekly working hours should be reduced to 4o hrs per week. Straight shift should be implemented in all states. extra working hours to be compensated  either by leave or by extra emoluments depending on the state policy .nurses to be given weekly day off and all the gazetted holidays as per the government rules.

4. Work load/ working facilities

• Nursing norms for patient care and community care to be adopted as recommended by the committee.
• Hospitals to develop central sterile supply departments, central linen services, and central drug supply system. Group D employees are responsible for housekeeping department.
• Policies for breakage and losses to be developed and nurses not are made responsible for breakage and losses.

5. Pay and allowances

Uniformity of pay scales of all categories of nursing personnel is not feasible. However special allowance for nursing personnel, ie; uniform allowance, washing, mess allowance etc should be uniform throughout the country.

6. Promotional opportunities

For promotion to the post of ward sister, post basic Bsc Nursing is made an essential qualification. The principle of possessing higher qualification than the category to be supervised, should apply fro all levels and categories of nursing personnel in the rural and urban areas.  The committee recommends that along with education and experience, there is a need to increase the number of posts in the supervisory cadre, and for making provision of guidance and supervision during evening and night shifts in the hospital.

Each nurse must have 3 promotions during the service period.

Promotion is based on merit cum seniority.

Promotion to the senior most administrative teaching posts is made only by open selection.

In cases of stagnation, selection grade and running scales to be given.

7. Career development

-provision of deputation for   higher studies after 5 yrs of regular services be made by all states.  The policy of giving deputation to 5 -10 % of each category be worked out by each state. Every nursing personnel must have an opportunity to attend at least one refresher course every 2 years.

8. Accommodation

As far as possible, the nursing staff should be considered for priority allotment of accommodation near to work place. Hospitals should not build nurse's hostel for trained nurses. Apartment type of accommodation is built where married/unmarried nurses can be allowed to live. Housing colonies for hospital s must be considered in long run.

9. Transport

During odd hours, calamities etc arrangements for transport must be made for safety and security of nursing personnel.

10. Special incentives

Scheme of special incentives in terms of awards, special increment for meritorious work for nurses working in each state/district/PHC to be worked out.

11. Occupational hazards

Medical facilities as provided by the central govt. by extended by the state govt to nursing personnel till such times medical services are provided free to all the nursing personnel. Risk allowance to be paid to nursing personnel working in the rural $ urban area.

12. Other welfare services

Hospitals should provide welfare measures like crèche facilities for children of working staff, children education allowance, as granted to other employees, be paid to nursing personnel.

Additional Facilities For Nurses Working In The Rural Areas

Family accommodation at sub centre is a must for safety and security of ANM's /LHV.

Women attendant, selected from the village must accompany the ANM for visits to other villages.

The district public health nurse is provided with a vehicle for field supervision.

Fixed travel allowance with provision of enhancement from time to time.

Rural allowance as granted to other employees is paid to nursing personnel.

NURSING EDUCATION

Nursing education     to be fitted into national stream of education to bring about uniformity, recognition and standards of nursing education. The committee recommends that;

1. There should be 2 levels of nursing personnel - professional nurse (degree level) and auxiliary nurse (vocational nurse). Admission to professional nursing should be with 12 yrs of schooling with science. The duration of course should be 4 yrs at the university level. admission to vocational /auxiliary  nursing should be with 10 yrs of schooling .The duration of course should be 2 yrs in health related vocational stream.
2. All school of nursing attached to medical college hospitals is upgraded to degree level in a phased manner.
3. All ANM schools and school of nursing attached to district hospitals be affiliated with senior secondary boards.
4. Post certificate BSc Nursing degree to be continued to give opportunities to the existing diploma nurses to continue higher education.
5. Master in nursing programme to be increased and strengthened.
6. Doctoral programmes in nursing have to be started in selected universities.
7. Central assistance be provided  for all levels of nursing education institutions  in terms of budget( capital and recurring)
8. Up gradation of degree level institutions be made in a phased manner as suggested in report.
9. Each school should have separate budget till such time is phased to degree/vocational programme. The principal of the school be the drawing and the disbursing officer.
10. Nursing personnel should have a complete say in matters of selection of students. Selection is based completely on merit. Aptitude test is introduced for selection of candidates.
11. All schools to have adequate budget for libraries and teaching equipments.
12. All schools to have independent teaching block called as School Of Nursing with adequate class room facilities, library room, common room etc as per the requirements of INC.
13. Adequate accommodations are provided to students. A maximum of 3 students to share a room. Rooms to be furnished   with light, study  table , chair etc. Adequate dining room, toilets and bathrooms facilities to be provided in each hostel as per norms recommended.
14. Students should learn under supervision in the wards. Tutors/clinical instructors must go to the ward with students. Students should not be used for the service of the hospital.
15. Community nursing experience should be as per INC requirements. Necessary transport and accommodation at PHC be made available for safety, security and meaningful learning of students.
16. INC requirements for staffing the schools and meeting the minimum requirements are followed by all schools as these are statutory requirements.
17. Speciality courses at post-graduate level be developed at certain special centres of excellence eg; AIIMS.
18. Institutes like National Institute of Health and Family welfare, RAK College of Nursing   and several others may develop courses on nursing administration for senior nursing leading to doctorate level.
19. Provision for higher training abroad and exchange programmes is made.

Continuing Education And Staff Development

• Definite policies of deputing 5-10% of staff   for higher studies are made by each state. Provision for training reserve is made in each institution.
• Deputation for higher study is made compulsory after 5 yrs.
• Each nursing personnel must attend 1 or 2 refresher course every year.
• Necessary budgetary provision be made,
• A National Institute for Nursing Education Research and Training needs to be established like NCERT, for development of educational technology, preparation of textbooks, media, / manuals   for nursing.

NURSING SERVICES: HOSPITALS/INSTITUTIONS (URBAN AREAS)

1. Definite  nursing policies  regarding nursing practice be available in each institution .These policies include:

a)    Qualification/recruitment rules

b)    Job description/job specifications

c)    Organisational chart of the institutions

d)    Nursing care standards for different categories of patients.

1. Staffing of the hospitals should be as per norms recommended.
2. District hospitals /non teaching hospitals may appoint professional teaching nurses in the ratio of 1; 3 as soon as nurses start qualifying from these institutions.
3. Students not to be counted for staffing in the hospitals
4. Adequate supplies and equipments, drugs etc be made available for practice of nursing. The committee strongly recommends that minimum standards of  basic equipment needed  for each patient be studied , norms laid down  and provided to enable nurses  to perform some of the basic nursing functions .  Also there should be a separate budget head for nursing equipment and supplies in each hospitals/ PHC. The NS and PHN should be a member of the purchase and condemnation committee.
5. Nurses to be relieved from non -nursing duties.
6. Duty station for nurses is provided in each ward.
7. Necessary facilities like central sterile supplies, linen, drugs are considered for all major hospitals to improve patient care. Also   nurses should not be made to pay for breakage and losses. All hospitals should have some systems for regular assessment of losses.
8. Provision of part time jobs for married nurses to be considered. (min 16-20hrs/week)
9. Re-entry by married nurses at the age of 35 or above may also be considered and   such nurse be given induction courses for updating their knowledge and skills before employment.
10. Nurses in senior positions like ward sisters, Asst. nursing superintendents, Deputy NS; N.S must have courses in management and administration before promotions.
11. Nurses working in speciality areas must have courses in specialities. Promotion opportunities for clinical specialities like administrative posts are considered for improving quality nursing services.

The committee recommends that Gazetted ranks be allowed for nurses working as ward sister and above (minimum class II gazetted). Similarly the post of Health Supervisor (female) is allowed gazetted rank and district public health nurse be given the status equal to district medical/ health officers.

Community nursing services

• Appointment of ANM/LHV to be recommended.
• ANM/LHV promoted to supervisory posts must undergo courses in administration and management.
• Specific standing orders are made available for each ANM/LHV to function effectively in the field.
• Adequate provision of supplies, drugs etc are made.
• Recording system be simplified.
• Posts of public health   nurses and above are given gazetted status.

Norms recommended for nursing service and education hospital setting.

1. Nursing Supdt -1: 200 beds (hospitals with 200 or more beds).
2. Dy. Nsg. Supdt. - 1: 300 beds ( wherever beds are over 200)
3. Asst. Nsg . Supdt  - 1: 100
4. Ward sister/ward supervisor - 1:25  beds 30% leave reserve
5. Staff nurse for wards -1:3 ( or 1:9 for each shift )  30% leave reserve
6. For nurses OPD and emergency etc - 1: 100 patients ( 1 bed : 5 out patients)   30% leave reserve
7. For ICU -1:1(or 1:3  for each shift)    30% leave reserve

For specialised depts such as operation theatre, labour room etc- 1: 25 30% leave reserve.

Community nursing services

1 ANM  for 2500 population ( 2 per sub centre)

1 ANM  for 1500 population  for hilly areas

1 health supervisor  for  7500 population( for supervision of 3 ANM's)

1 public health nurse  for 1 PHC ( 30000 population to supervise 4 Health Supervisors )

1 Public Health Nursing Officer for 100000 population ( community health  centre)

2 district public health nursing for each district.

Teaching staff for schools/colleges of Nsg as per INC

1 Nurse Teacher to 10 students for post graduate programmes.

NURSING LEGISLATION

1. INC and state nursing council acts be amended to provide for control by INC on states nursing councils.
2. Provision of   more nurse members.
3. Provision for regulation of nursing education standards by timely inspections and follow up.
4. Provision of maintaining of minimum standards  of nursing practice
5. Provision of regulation for nursing care standards in private nursing homes.
6. Provision for regulation for private nursing bureaus and practice by unqualified nurses.
7. Provision of approval of INC before opening a SON or CON.
8. Provision of renewal of registration every 5 yrs.
9. Provision of independent practice of nursing by nurses.
10. INC to set up a national examination system in about 10 yr time to regulate standards of nursing education.

Ø  Also, the positions up to the DADG level are proposed to be at the office of the Directorate General of Health Services. The positions below the level of DADG are to exist at the institutions governed by the central govt.

Ø  The Principal, College Of Nursing will be equal to the rank of ADG (N)   and will be eligible for promotion to the post of DDG (N)/ Addl. (N). The salary scales and structure of the staff of colleges of nursing will be as per norms of INC   and the UGC.

ORGANISATION OF NURSING SERVICES

The position and status of nursing personnel working in   the directorates need up gradation and expansion of the nurse to enable the nurses to participate in policy making and decision making. Total nursing components, i.e., nursing education, nursing service and community nursing should be under the control of nursing personnel at all the levels. I.e. At centre, stateand district level. At every level adequate provision of budget should be made for development of nursing profession.

The organisational structure recommended for centre, state and district level is as follows.

1. Each ADG level nurse to deal with continuing education /research component for specialised areas.
2. Selection to these posts is made on merit and not by seniority alone.
3. Nurses appointed these posts must have courses in administration, management and fiscal management.
4. Railway board, state insurance (labour minister), post $ telegraph union, territories (Delhi), municipal corporations etc to create such posts for control, co-ordination and development of nursing personnel.

NB: The principal, college of nursing will be equal to the rank of ADG (N) and will be eligible for promotion to the post of DDNS/ DNS. The salary and structure of college of nursing will be as per as norms of INC and UGC.

NATIONAL NURSING POLICY

There is a need for national nursing policy within the framework  of national health policy and national health planning.

Eg. High Power Committee by Government of West Bengal

Government of West Bengal, constituted a High Power Committee with Justice Chittatosh Mookerjee, formerly Chief Justice of Bombay High Court, as Chairman and five other members on 7th January, 2004with the following terms of reference :

i) The Committee shall examine the State medical infrastructure available within the State:

ii) The Committee while examining the State medical infrastructure facilities, may invite written representation/memorandum from any individual, organization, association and local body:

iii) The Committee may examine any other aspects of the State health care system as may be considered necessary in the light of the judgement of Hon'ble Court:

iv) While giving its report, the Committee shall suggest the measures to be taken by the Government.

Recommendations on preventive and primary health care.

i) The epidemiological surveillance system should be geared up with the support of the field staff as well as the Panchayat Raj Institutions.

ii) Primary health care, public health programmes, nutrition schemes, and school health programmes should be coordinated with a view to reducing incidence of diseases.

iii) Steps should be initiated to ensure the effective functioning of rural hospitals by placement of Specialists, particularly Anaesthetists and Radiologists.

iv) Simple labour cases without complication should be tackled in BPHCs and rural hospitals for which necessary infrastructure is to be organized.

v) Special hands-on training programmes need to be organised in a nodal institution for newly recruited medical officers for at least one month. Management/administrative training programmes also need to be organised for the Superintendents of secondary level hospitals.

vi) Refresher training programmes on public health should be organized regularly for CMOH, Dy. CMOH, ACMOH and Programme Officers.

vii) Speciality and super speciality facilities outside the Kolkata metropolitan area should be organised on a regional basis, most importantly in the area of Neurosurgery and Trauma Centre, Dialysis units, Cardiology, Cardiac Surgery, Casualty and ICCU, preferably on public private partnership.

viii) Regular periodic visits of senior level health administrators to the field units for the purpose of implementation, monitoring, supervision and evaluation should be insisted upon.

ix) The present nurse-bed ratio (1:5) which was laid down in 1957 should be reviewed in the light of developments since and a more realistic ratio arrived at.

x) Adequate supply of modern Tissue Culture Anti-rabic Vaccine (ARV) is to be ensured at the earliest in the interest of a better health care delivery system.

xi) The fact remains that almost 50% of deliveries still take place in home situations. Recognising this fact it is necessary that facilities for ante-natal checkups and home delivery should be augmented in terms of expertise and infrastructure

CONCUSION

It was observed that nurses are not involved in making policies that govern their status and practice. They are invariably excluded from the govt bodies that decide decide these policies. Most of the decisions concerning nursing care and nurses are made by other people, usually physicians without the benefit of professional input from by nurses. It is possible that this situation is the direct result of lack of appropriate status accorded to the nursing staff. Nearly 97% of nursing staff are in group "c "category and their status are too low.

An old Chinese proverb states:

"I hear and I forget

I see and I remember

I do and I understand"

The validity of the project method is stressed by Jobey when she says "only in the act of doing does one discover that the process is more important than the process is more important than the product. It is in the process that the learning takes place.  Having had their own experience in creative expression, adults become more sensitive teachers and more well-rounded persons" (Learning and Teaching through the Senses, Westminister Press, Philadelphia) as cited in Gagnel.

Project is defined by various authors.  Stevenson   describes it as a problematic act carried to completion in its natural setting, while Kilpatrick states that it is a whole-hearted purposeful activity proceeding in a social environment.  The ultimate project is the learning activity which is problematic in nature aimed at a definite attainable goal, having purposeful, natural, life like units procedure to attain the goal, directed and planned by the student, practical in nature, with emphasis on a single, complete unit of purposeful activity resulting in a concrete achievement..

Types of projects: Projects may be of two forms, individual or group. Edge divides project into four categories: information, attitude, habit and service.

Values of projects: There are many values of projects.  Some of which are student involvement heightens interest; it gives students freedom for thought and action,  provides for individual differences.  A spirit of cooperation etc. benefits are related to the two dimensions i.e. the learning process which results which has values to the class/other people.

Principles for effective use of the Project Method: Preparation is key. The students should be involved in discussion of objectives of the project; securing the participation of the group at the planning stage to first phase of project is essential.  Students should be involved in discussion of objectives of the project: securing the participation of the group at the planning  stage is essential. Students should  be involved in planning which form the project should take, the time frame  the cost, the extent of its impact on other people and how it will be evaluated .  In the execution of the project, the teacher is on ever-present source of encouragement and resource; reminds the students of deadlines.  The evaluation of the project, is a critical look at the work done.  The students and teacher decides whether the project was successful whether it accomplished the goals set for it and what areas are deficient.

Problems in the Project method:

There are many values for project method. At the same time, there are problems too.  Some of the problems that are focused are that the project becomes an end in itself, at times, and one forgets that it is primarily a teaching technique.  To overcome this, the project must be determined by the objectives of the class; some times students loose interest as projects take a long time to complete.

Using projects in Teaching Nursing:

Utilising the steps of the project method effectively, several projects, individual and group can be used as a teaching method.  Information ,attitude ,habit and service project can also be used.  Some variations in the project method can also be considered i.e. as described by Tauns.

A.                Search-out - the experience of other project

B.                 Seek- the factors of an experience project

C.                 Observe - the experience project and

D.                Go - through the experience project

Research done in Nursing on Project Method:

Several studies have been done to focus on the validity of the project.  Stanley (1989)examined how a project based on the research process was effective in teaching nursing research to post-basic registered nurses.  The subjects described the practical experience as the most enjoyable aspects and least enjoyable as interpretations and writing up of results.  Attitude to nursing research and improved and or remained positive.

Conclusion: Project method is considered as a useful method of teaching learning in nursing and other sciences.

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