Nursing Education in Nigeria

Nursing Education in Nigeria

Nursing education has witnessed various forms of reforms since it’s inception in Nigeria. This is very imperative because health care delivery involves multidisciplinary approach. Nursing education lays the foundation for nursing practice and whatever nursing care given is a reflection of the nursing educational training one has received. A standard nursing education will produce quality nursing care. Whereas if the education is shoddy nothing significant can be expected from the clinical practice, it will lead to production of mediocrity.

Nurses occupy a very significant position in the multidisciplinary health care team making major in-puts into the promotion and maintenance of clients optimum well – being and they are expected to diagnose and treat clients problems comprehensively. This can only be achieved through a reform in nursing education. The goals of the on-going transition from hospital to university based nursing education in Nigeria are to reposition nursing education into the main stream of education like other professionals in the health care delivery system and to improve the quality of nursing education thereby enhancing the competence of the practitioners for effective delivery of quality care to the consumers of nursing services (NMCN Newsletter, 2006).

STATEMENT OF THE PROBLEM

The ongoing transition in Nursing education presently in Nigeria is a national issue. The transition is geared towards moving nursing education from hospital to university  based. However, many nurses are of the opinion that hospital trained nurses are more practical oriented than the university trained nurses. Secondly, nurses are criticizing  the generic programmes in nursing education, they said that the generic graduate are deficient in practical skills, citing their example from the first group generic graduates from university of Ife who were so deficient in clinical practice (Erinosho, 2001).

Thirdly nurses are of the opinion that the five years duration of nursing programme in the university is too long for nursing training, that nursing education in the university should not exceed more than four (4) years and from general observation of nurses complaints and comments, it seems that many nurses have not seen the need for making basic nursing education university based. The question then is what are the nurses view about the on-going transition in basic nursing education from hospital to university based nursing education in Nigeria?

The study was therefore designed to establish nurses opinion or views concerning the on-going transition of basic nursing education from hospital to university.

OBJECTIVES OF THE STUDY

1. To establish nurses opinion about the current move of basic nursing education from hospital to university.
2. To determine benefits or otherwise of university based education as perceived by nurses.
3. To determine nurses opinion about hospital based education for nurses.
4. To determine if nurses anticipate any problem with the transition from hospital to University based training for nurses
5. To elicit suggestions from respondents on how best to transit to university based education.

RESEARCH QUESTIONS

(1) What are the views of nurses about the transition of basic nursing education from hospital to university – based?

(2) What do nurses thinks are the benefits of the transition of nursing education from hospital to university

(3) What are the problems nurses anticipate from the transition of nursing education from hospital to university based?

(4) How best can the transition of nursing education from hospital to university based be carried out based on nurses view point?

SIGNIFICANCE OF THE STUDY

The transition of basic nursing education from hospital to university is a dynamic issue which requires a lot of investigations before it can be positively achieved. This implies changing from the existing order to a more refined setting. In order to achieve a positive change in any area of study, it is imperative to seek the view of those affected in all ramifications. Based on this, the present study was conceived to investigate the views of nurses on the transition from hospital to university based nursing education in Nigeria.

Investigating the nurses perception of the transition of the basic nursing education from hospital to university based education is very important because the findings will help to show nurses view about the transition. Secondly, understanding the nurses views towards the on-going transition in basic nursing education will enable the policy makers to know the type of problems nurses anticipate from the transition and thereby fortify ways of articulating the problems.

SCOPE OF THE STUDY

This research work intends to study the nurses perception of the on-going transition of basic nursing education from hospital to university based.

The Study will involve those nurses in tertiary and secondary hospitals in Ebonyi State.

DEFINITION OF TERMS

BASIC NURSING EDUCATION: this is a formally recognized programme of study providing a broad and sound foundation in the behavioural, life and nursing sciences for the general practice of nursing resulting in leadership role and preparation for post basic education in specialty or advanced nursing practice (Okorie, 2004).

EDUCATION: Education is referred to as the process, of helping an individual discover, develop and make use of his inner abilities, potential and capabilities for successfully living in the society (Ethim, 2001).

Higher Nursing Education: This Symbolically refers to nursing education programme which is beyond the level of a nurse generalist preparation (Okorie, 2004).

HOSPITAL BASED NURSING EDUCATION

This is the nursing education offered in hospital settings.

NURSING: This is an integral part of health care system which encompasses the promotion of health, prevention of illness and care of physically ill, mentally ill and disabled peopled of all ages in all health care and other community settings

NURSE: A nurse is a person who has completed a programme of basic generalized nursing education and is authorized by the appropriate regulatory authority to practice nursing in his/her country.

PERCEPTION: This is the act or process of perceiving

PERCEIVING: To becomes aware of something through the senses.

REFORM: Improve by removing faults

UNIVERSITY BASED NURSING EDUCATION: This is nursing education offered in the university. It includes studies leading to B. N. Sc, M.N. Sc and Ph. D.

TRANSITION: The act or state of passing from one place, condition or action to another.

 EDUCATIONAL REFORM IN NURSING

Nursing education reform entails improvement in the existing nursing education in order to meet up with the challenges of the society. Reform implies making or becoming better (Mube, 2006). Reform indicates improvement or progress over what has always been. It involves positive change from any aspects of the society. Mube (2006) defined nursing education reform as the improvement of nursing education for expert nursing care.

Ofi (2006) defines nursing education reform as a change in the educational preparation of nurses, which entails movement of nursing education into the university through integration, absorption and affiliation of schools of nursing into the university.

Nursing education reforms entails the reposition of nursing education into the main stream of education like other professionals in the health team and in line with the national educational policy of the 6, 3,3, 4 system (Ofi, 2006).

In conclusion, nursing education reform in Nigeria entails the movement of nursing education from the hospital based to university, with curriculum modification geared towards producing expert nursing care to consumers of nursing services and the production of scientific nurses that are experts in national decision making, hospital administration and public relations.

AREAS OF NURSING EDUCATION REFORM IN NIGERIA

The on-going reform in nursing education is receiving attention in the following areas:

PROPOSAL FOR ASSIMILATION OF SCHOOLS OF NURSING INTO THE UNIVERSITIES OFFERING NURSING EDUCATION.

In spite of all odds, all proprietors of schools of nursing are encourage to get their schools of nursing assimilated into federal, state or private universities.

The change is expected to be gradual with a good percentage (75%) becoming degree awarding by the year 2010 and (100%) by the year 2015 (Mube, 2006).

ENTRY REQUIREMENT INTO THE SCHOOLS OF NURSING:

Taking into consideration the requirement for universities which schools will assimilate into, entry requirement has been endorsed by nursing and midwifery council of Nigeria to be 5 credits at not more than two sittings (WAEC – WAEC or NECO- NECO papers). The credits are required in English language, mathematics, Biology chemistry and physics. This will facilitate the assimilation of schools of nursing into the university.

Proposal to introduce post graduate diploma (PGD) for registered nurses who possess degree in areas other than in nursing: Intellectuals in nursing have started putting heads together towards bringing those affected back into nursing stream through a designed programme in the department of nursing.

UPWARD REVIEW OF THE CURRICULUM

The curriculum have been reviewed and adopted to cover more grounds. Programme for generic students now covers five years in the university with one year mandatory internship after graduation. The new curriculum has been adopted by some universities in this country including the Ebonyi State University Abakaliki.

Proposal for one year Internship after graduation for generic students are part of the transition which is receiving attention.

Re-accreditation of schools of nursing and midwifery

In the effort to ensure standard in nursing education and practice, national re- accreditation exercise was put in place by the Nursing and midwifery council of Nigeria in 2005. manpower, facilities and infrastructure in the schools, hospital based clinical areas community based clinical areas and nursing care approach and other things were assessed as to their suitability in meeting the requirements as set out by the council. This exercise helped to improve the situations of some schools of nursing thereby preparing them for assimilation into university.

Part- time degree (Nursing) programmes for registered nurses:-

This programmes for mature students is now being run by the department of nursing, Obafemi Awolowo University, lle – Ife and National Open University of Nigeria and Ebonyi State University, Abakaliki. This programme is designed to accommodate Registered Nurses who have been yearning to obtain degree in nursing. National Association of Nigeria Nurses and midwifery is even considering entering into discussion with countries like Ghana, South Africa and some others so that more of such programme can be floated to assist mature students in achieving their goal and also move nursing forward (www.nannm.com). The zeal for the reform must be sustained if nursing profession will eventually meet the target by the year 2015.

PROPOSAL OF THE TRANSITION FROM HOSPITAL TO UNIVERSITY  BASED NURSING EDUCATION.

The following were identified by Mobe (2006) as the main purpose of nursing education transition from hospital to university based.

1. To curb the challenges of the health sector reform which involves polices, strategies and intervention designed to strengthen the health system for better results.

A reform in nursing education will enable nurses to face the challenges.

2. Non inclusion of nurses in strategic areas in the health care industry due to their low educational background which will be highly taken care of through the transition from hospital to university based nursing education.

3. Ineffective and inefficient nursing services in the light of people who are aware of their right. The transition will enable nurses to face the challenges of these people.

4. Changes in disease patterns and emergence of new disease has necessitate the need for nursing education reform in Nigeria.

5. Unimpressive image carved for nursing profession as a result of poor human relations exhibits by nurse.

All the factors enumerated above and others are the main purpose of the on- going transition to university based nursing education in Nigeria.

RATIONALE OF THE TRANSITION TO UNIVERSITY BASED NURSING EDUCATION IN NIGERIA

Nursing education is the foundation for nursing practice. A standard nursing education will yield quality nursing care to the consumers of nursing services.

Secondly, nursing education reform will bring about nurses involvement in health policy formation, strategic planning and implementation.

The transition to university based nursing education will bring nursing to the highest pedestal of professionalism (www.nanm.com) www.icn.ch)

CHALLENGES OF THE TRANSITION FROM HOSPITAL TO UNVERSITY BASED NURSING EDUCATION

• Manpower: Currently, there is a national shortage of nursing academic staff. According to Nursing and Midwifery Council of Nigeria (2006), this should be addressed through various staff developmental strategies such as:-

–      Soliciting for technical support for new programmes from international Non- governmental organizations (NGOs) interested in health.

–      Identifying eligible individuals for state to sponsor with a commitment to return to service.

–      Encouraging part time professional and academic pursuit with or without pay.

–      Directive for those with health education and other first degree relating to nursing after RN to obtain postgraduate diploma in Nursing and then a master in nursing.

–      Training of clinical instructors.

• Creating of more Department of nursing in Nigeria universities. At present there are about fourteen (14) Departments of Nursing running the B. N.Sc programme and in many instance with limited number of students. More departments are required to take up colleges of nursing.
• Funding: Adequate source of funding should be designed from the onset for quality and sustainability of programmes
• Upgrading Clinical Facilities:- clinical facilities should be inspected, accredited, cost of and responsibility for upgrading should be determined. Cost can be shared and support solicited through donor agencies, state philanthropist etc.

Above are some of the identified challenges that have to be resolved for effective transition to university based nursing education in Nigeria.

HISTORICAL REVIEW OF NURSING EDUCATION REFORM IN NIGERIA

Reform in nursing education has been taking place in one form or the other especially from the time of Miss Florence Nightingale. Miss Nightingale came up with better ways of carrying out nursing care which resulted in infection control and noticeable reduction in mortality rate in Scutan (Janice, R.E et al 1984). Recognizing education as very crucial, she established the first formal school of nursing in St. Thomas’ Hospital with prescribed curriculum.

In Nigeria, various changes in nursing education have taken place since it’s inception in the second half of 19^th century by the missionaries and colonial masters. The colonial medical officers recruited young men and girls and trained them to carry out specific patient care such as would dressing, feeding of patients, bed bathing and drug administration (Orumuyiwa, 2006).

The first real training program for nurse started after the world war 11  in the Anglophone countries of West Africa in which Nigeria is inclusive.

Nursing at this period remained a vocation or at best, a trade and people came into the service for the job it offered or because there was nothing better to do. The aim at that time was to recruit and train young girls and boys with secondary education, but there were not enough of such boys and girls. Provision was therefore made for the inclusion of middle school leavers (modern school certificate and primary six) and some with a few years of secondary education. During this early years of education in Nigeria, there was no regulatory body but this was put in place later for the purpose of nursing education, examination, registration/ licensing and practice (www.nmcnigeria.org). In this early stage of nursing education in Nigeria, not much was expected of the nursing practice as every action was based on Doctor’s directive/instruction (Omowumi 2001).

Changes took off on entry requirement till a stage was reached where 5 credits in school certificate (including English language and at least one science subject) became the rule. The training still remain hospital based with few hours of block studies. (Adegoye 1986).

Nursing at the university level took off in 1965 at Department of Nursing, University of Ibadan with the purpose of preparing registered nurse as professional nurse tutors and administrators to meet the needs of rapidly expanding health services in Nigeria. 1968 marked the beginning of another era in nursing in Nigeria when the first set of degree holders in nursing graduated from the university of Ibadan.

In 1981, nursing was awarded the full- fledged profession by the industrial Arbitration panel, further pressure were mounted towards ensuring movement of hospital based nursing education to university based nursing education. (www.nmc.nigeria.org)

EMPIRICAL REVIEW OF LITERATURE

Nursing education is a global issue in the history of nursing. Studies have been conducted on issues affecting nursing education reform.

In 1960’s the American Nurses Association (ANA) began to look with concern at nursing education, delivery of nursing  care. In the light of this Gideon et al (1960) carried out a study on the nurses perspective towards Baccalaureat degree programme. The study was conducted with 250 nurses who were randomly selected at five different hospitals in United States of America. The research was based on sorting the opinion of nurses toward baccalaureat degree programme. Out of the 250 nurses studied 210 nurses were of the view that nursing education should be geared towards the level of baccalaureat degree programme.

In another study, conducted by Dr. Jaime in 1998, on the view of nurses towards Ph. D in nursing education in Phillippines, the study revealed that nurses welcomed the idea of  pursing nursing education to PH.D level, provided that such nurses with PH.D will be addressed as Doctor” in the clinical areas. In the above study in Phillippines it can be inferred that the Phillippines nurses want PH.D in nursing for aesthetic reason, but not for upgrading the nursing care standard.

The study conducted by Frances Kam et al (1990), in Hong Kong on health care reform, has brought about a dramatic change to the nursing discipline. The ethnographic study which aimed at exploring the transformation of nursing in a regional hospital in Hong Kong during this period of reform, reveals that the restructuring of nursing work, it associated dynamic and resulting impacts upon the nursing profession were examined. A methodological triangulation approach to data collection encompassing interviews, participant observation and review of documents was used. The findings in this study suggest that the majority of nurses working in the case study hospital continue to  be subject to medical dominance and are under management control. The emphasis on cost – effective care has however, fostered qualified nurses to claim more ownership of their professional judgment and autonomy. The health care reform has confirmed the status of two newly established groups of nurse the nurse specialists and nurse manager. The development of the nursing profession is found to be closely connected to its work development. The preparation of the new generation of nurses, as revealed in this study need to emphasize the cognitive dimension of the professional competence. Some nurses need to be further educated in specialist practice and clinical management to maximize the contribution of nursing in health care delivery.

SUMMARY OF LITERATURE REVIEW

Reform has been taking place in one form or the other. Nursing education in Nigeria has witnessed a lot of changes since its inception in Nigeria. Changes started with modification of entry requirement to present movement from hospital based nursing education to university based. The aim of the ongoing nursing education reform in Nigeria is to reposition nursing education into the main stream of education like other professional in the health team and in line with National Education Policy on the 6 – 3- 3- 4 system, and to improve the quality and competences of practitioners for effective delivery of quality care to the consumers of nursing services. It is long overdue for nursing professional to belong to the main stream in the health care system. The means towards achieving this, is through the transition from hospital to university based nursing education in Nigeria.

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This article was extracted from a Project Research Work/Material Topic “NURSING EDUCATION IN 21ST CENTURY”