CENTRAL PHILIPPINE UNIVERSITY School of Graduate Studies

Lopez-Jaena Street, Jaro, Iloilo City

Master of Arts in Nursing MAN 606 (LAB) Nursing Education Administration

SUBMITTED BY:
Woody Vic Engle, R.N. Janelene Galindo, R.N. Maria Reylan Garcia, R.N.

A. FUNCTIONS OF THE DEAN

(As per CHED Memorandum Order 14) As a manager: a) Prepares short term and long term plans b) Initiates curriculum development programs c) Plans a rational faculty, academic and non-academic load d) Manages human, financial and physical resources e) Manages student development programs f) Manages department/college office operations g) Monitors proper implementation of the programs h) Collaborates with the health services, affiliation agencies and other academic units in the implementation of instructional programs i) Obtains recognition/accreditation of the nursing program j) Evaluates the performance results of the nursing program As a leader: a) Leads in the faculty and staff development programs b) Leads development and utilization of instructional resource materials c) Pursues personal and professional development d) Initiates research and community extension projects/programs e) Establishes internal and external linkages

B. NURSING EDUCATION TIMELINE

PAST: Intuitive Period
International and Local Care of the sick during the early civilizations was carried out through either of the following: magical thinking, superstitious rituals and religious beliefs. In Egypt, the early people believed that it was their goddess Isis and her son Horus who manipulated their health in terms of through controlling their dreams. In Greece, the ancient Greeks had the belief that the family of the god Askiepios intercedes for health and well-being of the mortals. Also, it was the female slaves, under the direction and command of healers, masters and priests, who took care of the sick and nurse them to health.

PAST: Apprenticeship Period

International and Local Prior to the era of Florence Nightingale, nursing education was initially viewed as an apprenticeship. This means the students learn by doing or by practice and have no or little classroom instructions. The early nurses were mostly trained by religious orders. The Knights of Saint John of Jerusalem, the Teutonic Knights and Knights of Saint Lazarus were the leading care providers during the time of the Crusades. In 1846, Theoder Fliedner opened a small hospital and a training school for nurses in Kaiserwerth, Germany. This is the same deaconess school from which Florence Nightingale received her training. Prior to the educative era, nursing seemed more as a vocation and a calling rather than as a profession.

PAST: Educated Nursing Period Contemporary Nursing Period

International Florence Nightingale in 1860 founded the first training school for nurses, the Nightingale Training School for Nurses at St. Thomas Hospital in London. Although, there was already a development of a curriculum for nursing practice, it is yet to be standardized and accredited. There are still fewer hours spent in the classroom and majority in providing care to patients in the hospitals. The programs tend to meet the service needs of the hospitals rather than the educational needs of the students. Despite the limitations, the 3-year diploma program of Nightingale became the major source of graduates until the mid-1960s. In 1909, the University of Minnesota established the first school of nursing in a university setting. Ten years after, the University of Minnesota developed a 5-year undergraduate baccalaureate degree in Nursing, 3 years diploma program and 2 years liberal arts program. In 1953, The National League for Nursing encouraged the nursing educators to develop masters degree programs in nursing specializing on research and teaching and administration. It was responded by the offering of the first clinical masters degree in physchiatric nursing at Rutgers University in 1954. Doctoral programs in nursing began in the 1960s in the United States. These programs were already specific to the nursing practice such as doctor of nursing science or nursing doctorate. In the 1950s the community college or associate degree nursing programs were developed. This was initiated by Dr. Mildred Montags idea of having 2-year educational program for RNs to produce nursing technicians or bedside nurses who perform lesser and within a smaller scope of nursing functions than of the professional nurse. However in 1978, the American Nurses Association, proposed a resolution that Dr. Montags idea will be converted to a career upward mobility plan.

PAST: Educated Nursing Period Contemporary Nursing Period

Local In 1909, the Iloilo Mission Hospital Training School for Nurses produced its first trained nursing graduates in the Philippines after starting the school in 1906. The first BSN course in the Philippines was offered in the University of the Philippines in 1948; however, the first college of nursing in a university setting was at the University of Santo Tomas.

The nursing education curriculum in the Philippines started out as a Graduate Nurse (GN) program which comprised a 2-year course. But, in the 1970s an order from the Department of Education (No.41 s.1976) was released phasing out the GN program to make way for the implementation of the BSN curriculum. In 1993, the nursing curriculum was revised and at that point in time, intends to produce competency based and community oriented nursing graduates. In 1996, CHED Memorandum Order 59 mandated a general education component for all Baccalaureate degree leading to the health profession which should only be offered in colleges and universities with recognized health programs. In 1998, CHED released a memo, CMO 27 s. 1998 which presented the recommended curriculum for the common two-year Associate in Health Science Education that of which includes Nursing. In 2001, the CHED Memorandum Order 30 was released which enumerated new policies on the curriculum, faculty, research and even accreditation. In 2002, another set of revisions were made for the curriculum and now focuses on producing functioning critical thinking nurses. Also, accreditation was already undertaken to nursing schools and those with Level II accreditation status were allowed to make revisions and modifications in the new curriculum. In 2009, two CHED Memorandum Orders were released: the CMO No. 4 and the CMO 14 which delineated the policies and standards for the BSN program and enumerated the key areas of responsibility respectively.

PRESENT: Contemporary Nursing Period

International Currently, there are two types of entry level generalist nurses. These are the RNs or registered nurses and the LPNs or LVNs or the Licensed Practical/Vocational nurses. The LPN program lasts for 9 to 12 months and provides both classroom instruction and clinical experiences. The graduates of this program take the NCLEX-PN to obtain the license. For Registered Nursing Programs, there are three major educational routes to choose from, the diploma, associate degree and baccalaureate programs. The present-day diploma degree has been transformed dramatically from the original model of Nightingale in the 1800s to 1960s. In the United States, the diploma programs provide a rich clinical experience for nursing students and are associated with colleges and universities. Associate degree programs in the United States are offered in community colleges and some 4year colleges. The graduates receives an AND or associate of arts, associate of science or associate in applied science degree with a major in nursing. It is already a trend for many students to enter associate degree programs with the intentions of continuing their nursing education to a higher level such as the BSN degree. BSN or baccalaureate nursing degree programs are four years in length, in comparison to the five years in the past. The curricula offer courses in the humanities, liberal arts, sciences and nursing. There is also the presence of accelerated BSN programs which include summer semesters that can narrow down the entire BSN program into a continuous 12-18 months of study. The masters program today usually takes 1 to 2 years to be completed. These programs were developed to provide specialized knowledge and skills to allow nurses to assume more advanced roles in varied health care settings. Currently, degrees granted are the master of arts, master in nursing, master of science in nursing and master of science.

The two doctoral programs in nursing: the doctor of nursing science and nursing doctorate were already phased out by the Association of Colleges of Nursing in 2004. This was to make way for the new doctoral program that will prepare nurse practitioners, nurse anesthetists, nurse midwives and clinical nurse specialists. This new doctoral program is called the doctor of nursing practice (DNP). Two new educational programs are of trend globally; the continuing education and in-service education programs. The continuing education was established to keep nurses abreast of new techniques and knowledge, help nurses attain expertise in a specialized area of practice and provide nurses with information essential to nursing practice. In the United States, the law requires CE contact hours of 15 to 30 hours for every 2-year relicensure period. The in-service education program on the other hand is given by an employer to upgrade the knowledge and skills of the employees.

PRESENT: Contemporary Nursing Period

Local Presently, the CHED Memorandum Order that governs the policies and standards for the BSN degree in the Philippines is the CMO 18 which was released in 2011. In this memorandum order certain revisions were made in response to the dwindling and decreasing passing rates in the licensure examinations. The major point in this memo was the immediate closure of nursing schools whose average passing percentage in the Philippine Nurse Licensure Examination (NLE) is 30% and below for three (3) consecutive examination years (starting 2008, 2009, 2010, and thereafter). The Philippine version of continuing education is the CPE or Continuing Professional Education in accordance with PRC Resolution No 2008-465. The purpose of which is to assure that the professional have good standing and are globally competitive. It is followed that for three years, the professional with a bachelors degree must attain at least 60 CPE units.

FUTURE
International and Local Because of the steady increment of life expectancy and better prognosis for both acute and chronic conditions, nursing education in the future will be challenged to provide effective and efficient continuing care. In addition to patient demographics, the students taking up nursing are also getting more and more varied in terms of racial and ethnical backgrounds. Thus, a richer cultural environment for learning is really needed. Also, a lot of older students are entering nursing which would surely necessitate the formation of curriculums that can cater to their educational needs amidst the demands of their work and family. With the recent advancements in health technology nursing education must adjust its instruction for the likes of nanotechnology, telemedicine and even electronic charting. Nurses will need to be trained further in the area of informatics to meet with the new trends. Patients too are enfaced with the benefits and convenience of more accessible sources of information. Thus, the nurses must anticipate that patients in the future will turn out to be more informed about their conditions and may be more meticulous and inquisitive. There is also a growing need for Interdisciplinary Education that can facilitate a better collaborative practice. Registered Nurses must know how to lead the growing number of midlevel

workers such as the LPNs while also knowing how to work more harmoniously with the other members of the health team. Nursing Research has broken ground and is continually revolutionizing and strengthening nursing practice. Thus, nursing education must soon enhance the mentorship for new researchers since there are only few doctorally prepared nursing professionals who can lead such.

C. PARADIGM SHIFT IN NURSING

Prewar Period 1945
Health: The image of the hospital was an institution that only took care of the sick and the dying. When a patient is brought to the hospital, people had the notion that the condition of the patient is already worse and that the patient is already dying. Health care was doled out. Limited private medical practitioners. Technology: There is absence of electronic devices. Everything was done manually. Transportation was slow. Status of Nursing: Nursing service had no participation in hospital operations planning since the nurse is not yet equipped with managerial knowledge. Nursing service was task-oriented and there was a broad of responsibilities; from cleaning the rooms, fixing the linens and even dietary tasks. There was lack of theoretical knowledge to back-up the skills of nurses. Nurses were doing the dirty job so there were few takers of nursing. It was seen as a vocation. Nurses were handmaiden of the doctors. The Nursing Education was only a three-year graduate program. Bed-side nursing was emphasized. Curriculum content included only physical therapy Environment: The lifestyle of people was socially simple. Because of the two world wars, people had to start from scratch to earn their living. Cultural values were strong.

Professionalization Period of Nursing: 1946-1950s

Health: The image of the hospital improved in terms of its curative and rehabilitative functions. However, the preventive function was not yet fully emphasized. Rural development was the thrust in the national health program. Unavailability of nurses in the RHUs led to the maintenance of midwives. Also hilots were provided training.

Technology: There is already use of electronic devices. Chemotherapy for tuberculosis and cancer were introduced and radiation diagnostic exams were already available. Bedside apparatus such as cardiac monitors made bedside monitoring easier. There was faster and smoother flow of communication in the health institution because of the advent of computerization. Status of Nursing: The Chief Nurses still had no say in the operations planning of the hospital. There were no provisions on the qualifications and term of office; tenure was the only basis for succession. The Exodus of nurses started in the 1950s. Nursing was identified as a profession because of the establishment of the BSN program. However, the Graduate Nurse program still existed. There was a growing competition between BSNs and GNs. Environment: Life was economically hard-up, still coping with the remnants of wars. Cultural changes: mixed western-oriental values preferred foreign good and products

Professionalization Period of Nursing: 1960-1970s

Health: Development of levels of healthcare delivery: primary, secondary, tertiary No nurses in the RHUs led to the training of Barangay Health Workers Emphasis on Family planning programs Health problems: drinking/smoking, malnutrition, sanitation

Technology: There is already use of electronic devices. Same as in the 1940s-1950s Status of Nursing: Mushroom growth of schools led to conversion of GN program to BSN program Brain-drain led to dwindling quality of nursing care Nursing specialization started POMR charting started problem oriented medical recording Standards of nursing practice Environment: Social unrest because of the Martial Law Rural to urban migration started to give problems Cultural values suffered; family ties loosened due to lure of dollars abroad

Era of Fragmentation: 1980s to 1990s

The Health: The hospital is already an institution for both the sick and the well. There are already many people coming in the hospital for executive check-ups because of the growing awareness to health promotion and maintenance. Also, there was emphasis on diagnostic programs.

Health for all by year 2000 Highly-specialized care was also provided. However, there was an increase in the occurrence of communicable diseases and problems in social disintegration. This was addressed by including the community, alongside the hospital planning of patient services. HIV detection and control

Technology: Work became simpler because of computerization. However, clinical practice became less handson because all pertinent patient data are already in the computer. High technology hospital services: diagnostics, treatment, records, reports Status of Nursing: Because of the Exodus of Nursingmore and more nurses are going abroad, understaffing became a problem. Nursing care activities were delegated to non-nursing personnel. Continuing education units were introduced, but did not prove much of its worth. Nursing management was introduced but without a clear job description for nursing managers. Soon, nursing managers found the management of nursing service to be complicated, that they called for the development of the following specific to the nursing practice: (a) business management (b) clinical orientation (c) labor relation which demands for strong orientation to legal aspects of nursing administration (d) education of patients and staff (e) nursing management systems that respects the major administrative principles of planning, organizing, directing and controlling (f) service coordination with other departments, operational and budgetary planning . Environment: The socio-economic condition remained poor alongside the rising healthcare cost. Many hospitals are already ran by private corporations, thus the motives are focused on profit. Home care was introduced and became popular in the United States of America because of the high cost of hospitalization.

21st Century (2000s) and Beyond

The Health: Emphasis is on the coordination and continuity of patient care. In the United States of America, the influx of migrants especially those coming from the third world countries necessitates the use and application of Transcultural nursing. Home care and palliative care Detection and management of HIV Bioterrorism Lifestyle diseases

Technology: Nursing care documentation will become more comprehensive whilst computerized and not merely the check-list type.

Nurses become the integrator of patient information management techniques which would also include internet utilization. Fast communication system

Status of Nursing: Nursing service administration need to focus on two domains: Nursing Science and Business. Clinical knowledge tied to business skills yields favorable outcomes and is key to the survival of nursing as a profession. The new roles of nursing administrations would be: supporter, reinforcer and facilitator. The Nursing service as a whole should have a client-centered focused and unyielding with the strategic innovations. Unemployment of nurses leads them to engage in entrepreneurship Nursing specialization further strengthened Environment Socio-economic status will gradually improve Political interference will still affect employment of nurses