Comparing the Nursing Education Systems
The countries of choice for this comparison research paper are the People’s Republic of China and Sri Lanka. China was chosen due to its unique historical development that is fundamentally different from the Western world. This difference in history informed the choice of China and the expectation before going through the article was that by Wong & Zhao, was that the practice of nursing in the country is still highly reliant on the use of Traditional Chinese Medicine (TCM). Sri Lanka, on the other hand, was chosen because it is a third world country and would hence provide important insights in the development of nursing education in the third world. My expectation of the nursing sector in Sri Lanka before reading the article by Jayasekara &McCutcheon, was that it was largely undeveloped and was only introduced by the colonialists. Additionally, Sri Lanka would provide a good source of comparison for the purpose of this study. This paper will, therefore, compare and contrast the different aspects of nursing education in China and Poland.
Political History and Development of Nursing Education in China and Poland
The development of nursing education in China was closely associated with the political developments that took place in the country. Before the arrival of missionaries in the country, the predominant form of health care was the TCM. Western missionaries who arrived in the early 19th Century oversaw the setting up of missionary hospitals as well as the implementation of a formal nursing training program. The government commenced formal training programs in 1933, but it had previously regarded the training of nurses as a vocational program. Due to the association of formal nursing with the Western world, as from 1949 to 1966 the development of nursing education was halted due to the Cultural Revolution but it gradually resumed after that period. Formal nursing education was re-launched in 1983 when the Nanjing Medical University was established, and it offered university diploma program in collaboration with the general hospital. Tianjin Medical University also re-commenced nursing education at the baccalaureate program during the same period, and eight other institutions of higher learning followed suit. The Beijing Medical University was the first university to initiate the Master of Nursing program in the early 1990s, and the Central South University together with the Second Military Medical University started the doctoral programs. While the country was undergoing the Cultural Revolution nursing schools that specialized in TCM were established in 1959 in Nanjing and Beijing Medical Universities. In 1999, a baccalaureate program in TCM was introduced and in 2006 a Master of the degree in TCM was started in four different universities.
The nursing profession in Sri Lanka is not as new as many people would imagine. It commenced long ago when individual outside families provided care for the sick where the family members were unable. As early as the 12th and 13th BC, the health care institutions were implemented and supported by ancient kings because evidence that exists suggest that there were hospitals and maternity homes. Western medicine and education were introduced in Sri Lanka by foreign rulers as early as 16th Century. The first hospital; was established in 1800 to take care of soldiers and Civil Medical Department was established in 1858. The first hospital-based, government sponsored nursing training program started officially in 1879 with the opening of two maternity hospitals. They offered midwifery and hospital training programs that largely contributed to a reduction in both the infant mortality and maternal mortality rates. During the colonization by the British, nursing education was by way of apprenticeship. The apprenticeship was essentially a hospital-based model of education. But this mode of learning has since been transformed into an institutionalized model of learning. The institutionalized model of learning officially commenced in 1939 with the establishment of the School of Nursing attached to the Department of Health Services.
It is important to note that in both these two countries, the formal training of nurses was jump-started by foreigners either as missionaries or colonialists. Additionally, before the introduction of foreign aspects of nursing, both systems had their indigenous systems of health care that offered nursing services. Their developmental aspects are somewhat similar.
Government and Nursing Organizations Influencing Nursing Education
The government via the Ministry of Education took over the nursing education in 1933 after it established its own nursing schools in 1933and by 1949 there were 183 nursing training institutions. The Ministry further standardized nursing training programs in 1951 to a two-year program and later changed it to a three-year program in 1954. The National Medical Higher Education Committee established a nursing branch that contains delegates from nursing institutions, issues administrative guidelines to nursing training in the country and administers the National Nurse Qualification Exam (NNQE). Another agency that influences nursing education in China is the Instructional Committee of Ministry of Education (ICNE). This body is tasked with the accreditations of institutions offering nursing education in the country.
The Department of Health Services in Sri Lanka regulates the health care sector in the country and by extension nursing education. It prepares the curriculum for training nurses in the country as well as running the administration of the 11 nursing schools in the country. The Japan International Cooperation Agency (JICA) has also contributed to nursing education as it opened the 12th nursing school in the country in 1997. The Sri Lanka Medical Council also plays a crucial role in the training of nurses as it is tasked with the registration of nurses who are permitted to practice in the country. The World Health Organization (WHO) also plays a key role in informing the policies undertaken by the country, although it is an international organization
Despite the two countries being worlds apart from each other, both countries nursing education system is highly influenced by other organizations. It is, however, important to note that the organizations in China are more regulatory in nature while those in Sri Lanka are more of policy setters and advisors. Also an international body, WHO, has influence on the policies adopted in Sri Lanka while this is not the case with China.
The Current System of Nursing Education
There are three different levels of programs for nursing education in China offered at the health school, university diploma and baccalaureate levels. The health school offers a three-year program to students from the junior high school level. The university diploma is also a three-year program available only for graduates of the senior high school. Above those two levels is the Baccalaureate program that takes 4-5 years duration at the University level. Currently, the three-year program offered at the health school is in the process of being phased out to leave only the other two programs in a bid to improve the standards of nursing training in the country. It is also important to note that all students who pass through the nursing school irrespective of the level must sit the NNQE exams for them to be registered and allowed to practice in the country. Therefore, the nursing system in China constitutes a combination of systems just like in the USA.
Just like in China the nursing education in Sri Lanka operates a three-tier model of nursing training. There exists a three-year program offering general nursing education in the in the 11 schools of nursing throughout the country. The second category of programs is the post-basic nursing education that provides diploma-level nursing education in teaching and management of registered nurses to become nurse educators and nurse managers. The program runs for 18 months. The topmost level comprises of university-level nursing education. This program offers a Bachelor of Science degree in a nursing program that is a 5-year program. The course is only offered at the Open University of Sri Lanka.
Although the nursing education system is triple-layered in the three countries, the systems are different with more specialization and advancement being witnessed in the Chinese system. Unlike in China, there are no mandatory exams after graduation before one is enrolled to practice. Another distinction is that there are many universities offering diploma and degree programs in China as opposed to Sri Lanka.
Post-Graduate (Masters) Education
As stipulated above the Master of Nursing program in China was launched in the 1990s by the Beijing Medical University. Other medical universities have followed suit and as of 2007 there were 58 Master in nursing programs across the country. As at that time also in existence was 10 Ph.D. nursing programs in China. For a student to be permitted to join the above postgraduate programs, it is mandatory that they enroll and pass the National Entrance Examination for Postgraduate studies.
Currently, there is no learning institution offering either a Masters or a Ph.D. in the discipline of nursing in the country. In 2003, there was an attempt to establish a master’s program under the auspices of the University of Adelaide in South Australia but it failed due to lack of sufficient funding.
In this respect, the two countries are not comparable because while China has close to 70 post-graduate programs, Sri Lanka has none.
The above study comparing China and Sri Lanka’s nursing education program shows a huge disparity between the first and third worlds. While the both countries nursing education training commenced around the same time, China is miles ahead of Sri Lanka in terms of development in this sector. The inequality tells a lot about the general health care systems of the two countries. Development wise, China is almost on par with the United States, and hence their nursing training systems share almost the same characteristics. Sri Lanka’s nursing training system exhibits teething problems that are characteristic of underdeveloped countries, and hence it cannot be compared with the United States in any respect.