In the era of quality orientation, human rights and a consumer-driven society, the
quest is for the best quality of education. The NMEI are expected to provide quality
education and perform their roles effectively in producing qualified graduates who
will meet the needs and expectations of society. Each institution is required to
develop its own mechanism to ensure quality; this is sometimes called quality
assurance.
|
 |
The quality of nursing and midwifery education could be evaluated by many
indicators such as standard curriculum, number of qualified teachers, number of
students (a) passing the examination, (b) receiving a nursing license upon graduation, (c) getting
jobs upon graduation, and (d) number of research grants and number of publications in journals.
The Indian Nursing Council (INC) prescribes the syllabus, including detailed plan and hours of
each subject, scheme of examination and admission criteria. This ensures that the education offered
in all member nursing institutions is uniform. Minimum standards are also set for the physical
facility, teaching facility and clinical facility to start a nursing programme. The INC conducts
periodic inspections of the institutions to ensure that the set standards are implemented. NMEI
should establish a quality assurance system.
The gap between nursing practice and education has its historical roots in the separation of
nursing schools from the control of hospitals to which they were attached. At the time when schools
of nursing were operated by hospital, it was the students who largely staffed the wards and learned
the practice of nursing under the guidance of the nursing staff. However, service needs often took
precedence over students’ learning needs. The creation separate institutions for nursing education
with independent administrative structures, budget and staff was therefore considered necessary
to provide an effective educational environment towards enhancing students’ learning experiences
and laying the foundation for further educational development.
While this separation has been beneficial in advancing nursing education, it has also had adverse
effects. Under the divided system, the nurse educators are no longer the practicing nurses in
the wards or directly involved in the delivery of nursing services, nor responsible for the quality of
care provided in the clinical settings used for students’ learning. The practicing nurses have little
opportunity to share their practical knowledge with students and no longer share the responsibility
for ensuring the relevance of the training that the students receive. As the gap between education
and practice has widened, there are now significant differences between what is taught in the
classroom and what is practiced in the service settings. The need for greater collaboration between
nursing education and services calls for urgent attention. We have two institutions which are
practicing dual role, education & practice : NIMHANS, Bangalore and CMC, Vellore. More institutions
need to adopt this model. This will help improve the quality of Nursing Education with overall
objective of improving the quality of nursing care to the patients and community at large.
Government of India conducted a pilot study on bridging the gap between education and service
in select institutions like one ward of AIIMS. The project was successful, patients and medical
personnel appreciated the move but it required financial resources to replicate this process.
In order to improve the quality of nursing care, INC initiated the project of quality assurance by
selecting one ward in Dr RML Hospital in New Delhi and one ward in PGI, Chandigarh; continuous
& continuing education were planned to all category of nursing personnel for three months in these
wards. A nursing audit was conducted and it was found that quality of nursing care improved in
these wards and medical personnel appreciated the INC initiative. During this process Teaching
Material was developed. We are in the process of finalising quality assurance model which many of
the corporate hospitals would be interested to adopt. There is an urgent need to adopt such a quality
assurance models in nursing education to improve the quality of nursing education.
As a method, competency-based education is used to compare the learner’s achievement to a standard. This is fairer and more goal-oriented than comparison with the performance of peers.
When competency expectations are based on high quality standards, quality in practice is promoted.
Primary benefit of a competency-based orientation is the assurance of consistency in the
assessment and validation of initial and ongoing competency. Thus, all employees within the nursing
service have a clearer understanding of role expectations. The competency plan creates an
environment in which all employees participate in continuous quality improvement activities. A
competency-based orientation is tailored to the individual needs of the new employee, that often
leads to an increase in confidence because of regular feedback and daily observation. Whether the
curriculum is self-paced or the structured, competency-based education is described as an efficient
system that focuses on reaching a clearly depicted endpoint.
Competency-based education is learner-centred because it is based on objective statements of
expected competencies. Learners claim that they learn more thoroughly and explore more intellectually
if they are responsible for their own learning and can choose the methods that work best
for them. Competency-based education provides flexibility, allowing learners to adapt quickly and
communicate their changing requirements. It also benefits the educator. Educators working within
organisations recognise that there is a relationship between lifelong learning and employability.
Experts caution that competency-based education cannot be developed in isolation, and that
support from administration is required during the planning phase. Developing a basic framework
for all the departments within nursing services assures consistency in assessment and validation of
competency statements. Collaboration is essential among the various groups inside and outside of
nursing. Without this collaboration, development and implementation will be less than successful.
However, this criterion can also be levelled at other educational approaches since most effective
educational changes require administrative support.
Educating current and new employees about competency-based education is of vital importance.
Administrative personnel need to be educated because the development, implementation,
and evaluation of the competency plan is initially going to be time-consuming and labour-intensive.
When considering implementing a competency-based orientation it is wise to factor in these challenges
before implementing a competency-based orientation for nurses in a hospital setting.
Clinical Learning Environment
Learning gained from placement experience is much more meaningful and relevant than that
gained in the lecture room. It helps to understand the key factors that influence this learning
environment. The four key characteristics of an effective clinical learning environment are:
The use of a humanistic approach to learning;
A good working team spirit in the clinical team;
An efficient but flexible management style with teaching being recognised;
Teaching and learning support from qualified staff.Something as simple as teaching a student how to administer an oral drug can illustrate this.
Psychomotor Skills
You would wish the student to actually be able to open the bottle and decant the capsule/tablet
appropriately. They should also be able to read the drug prescription sheet and to record the administration
of the drug appropriately.
Cognitive Skills
It is not enough just to be able to administer the drug; the student should also be able to understand
such things as why they are giving the drug, its effects, side effects and correct dosages.
Affective Skills
It should never be forgotten that on the end of the administration of the drug is a client/patient. To
be able to be competent in this procedure the nurse/midwife must also be able to display the appropriate
communication, interpersonal and intrapersonal skills.
The lists of strategies that can be implemented are many and varied and the choice of which to use is very much related to the preferences of the facilitator and the learning situation. Facilitators
tend to use strategies that they themselves have found useful in their own learning but must be
conscious of the preferred learning style of the student.
Development of Nursing Services in India
We have 620 ANM Training School, 2055 Diploma Nursing Schools, 1271 B.Sc. (Nursing) Colleges, 281
M.Sc. (Nursing) Colleges with a capacity of 15250, 80129, 63790 and 4368 respectively, functioning in
the country. We have gone in for quantitative expansion; quality issues also need to be attended, the
same has been addressed in XI plan.
Steps taken by Indian Nursing Council (INC)
1. Syllabii of all nursing courses have been revised, the concept of NRHM, SBA and IMNCI has
been integrated into the syllabus. 2. One-year post basic speciality course (Nurse Midwifery
Practitioner) has been developed and some of the states have already started. 3. About 80
students have been enrolled under National consortium for Ph.D in Nursing. 4. A sum of $ 33.00
million i.e. about Rs. 160.00 crore has been sanctioned by Global Fund for Aids, Tuberculosis and
Malaria (GFATM) for INC for training about 95,000 nurses under HIV/AIDS and capacity building
of 55 nursing educational institutions. We have trained about 9,000 nurses in HIV/AIDS, the
duration of the project is 5 years. 5. Indian Institute of Advanced Nursing Foundation for HIV/
AIDS is being set up at Tambaram, Tamil Nadu with an estimated cost of about Rs. 25.00 crore.
This institution will be established by way of public-private partnership. This institution will be
set up under the Societies Act with an autonomous status; 25 percent seats of this institute will
be earmarked for foreign students. Short and long-term courses for nurses on HIV/AIDS will be
organised.
Budget
A sum of Rs. 280.00 crore have been allocated for XI plan after the existing schemes against Rs. 70.00
crore in X plan which is about four-times increase.
Again, to give boost to human resources in health i.e. for nursing a new scheme have been
initiated in XI plan with an allocation of Rs. 2900.00 crore.
Plan of Action
1. A sum of the Rs. 1.25 lakh per continuing education programme for 30 participants for 7 days to
update nursing personnel i.e. Nursing Education, Nursing Administration and Staff Nurses.
2. In order to improve the quality of nursing education, an increase from Rs. 10.00 lakh to Rs. 25.00
lakh per nursing education institution in Government sector in a plan period towards a capacity
building of nursing schools/colleges has been made.
3. In order to train more graduate nurses in government sector, a scheme for upgrading the
school of nursing into college of nursing attached to medical college has been initiated. An
increased financial assistance from Rs. 1.5 crore to 6.00 crore has been made.
4. Opening of ANM and GNM School in high focused states.
5. Opening of 6 Colleges attached to 6 new AIIMS-like institution with a cost of Rs. 20.00 crore per
institution.
6. Scheme for Faculty Development Programme of M.Sc. (Nursing) for high focused states has
been initiated and necessary financial assistance for training M.Sc. (Nursing) has been made
for which an additional capacity has been created.
7. Opening of Centre of Excellence at state level with an estimated cost of Rs. 20.00 crore. This
institution will act like a think tank for nursing at the state level.
8. Opening of 4 Regional Institutes with an estimated cost of Rs. 50.00 crore will be developed. This
institution will focus on faculty development and research.
9. A sum of Rs. 1.00 crore has been sanctioned to each state towards strengthening of State Nursing
Council including developing live register and also Rs. 1.00 crore towards capacity building
of State Nursing Cells attached to the Directorate.
10. Monitoring and Evaluation unit at National Level.
