WORLD HEALTH ORGANIZATION
REGIONAL OFFICE FOR THE BUREAU REGIONAL DE LA Li~t&>I rn s x'l +)A2s) db\ EASTERN MEDITERRANEAN MEDITERRAN~EORIENTALE
REGIONAL COMMIm FOR THE EM/R~lg/~ech.~isc./2 EASmN MEDITE3RRANEAN 15 August 1969
Nineteenth Session ORIGINAL: ENGLISH
Agenda item 12
TECHNICAL DISCUSSIONS
RENIEW OF T'rE EDUCATION AND TRAINING OF NURSES TO MEXT THE 1- OF THE REGION ~~/R~lg/~ech.~isc./2 page i
TABLJ3 OF CONTENTS
I1 DEFINITIONS 3
1. Tht. Nurse 2. The Auxiliary Nurse 3. Basic Education for the Nurse 4. Post-Basic Education for the Nurss
III REKEN OF NURSING Aim MIDWIFERY EDUCATION IN THE REGION
1. Administration b 2. The Students 3, !he Frogramrnes 4. The Practice Area 5. The Present Situation 6. !he Education of Aufiliaq~Nursing Personnel 7. "On-the-jab Training" 8. Midwifery Education 9. Post-Basic Nursing Ed-ucation
IV THE NEEDS OF THE REGION
I. The Needs of thc Covcrnment 2. ?he Needs of the Population 3 The Needs of the Nursing Profession
V IYEl3TING THE NEEDS OF THE REGION
1. Contributions which might be made by the Government, the Population, and the Nursing Profession 1.1 The Government 1.2 'Ihe Population 1.3 The Nursing Profession 2. Specific Pleasures Sor Meeting Needs 2.1 Definition of the Purposes and Objectives of a Sahnol of Nursing 2.2 The Organization and Management of a School of Nursing EM/R~lg/~cch.~isc./2 page ii
Page 2.3 The Organization of the Curriculun 23 2.3.1 The Corr~lctionof Theory md Practice 2.3.2 Clinical Teachbg and Supervision
2 Curricular Contont 2.4.1 The Comprehcnsive Curriculw 2.4.2 Subjscts inciuded in the Curricu1u.n 2.4.3 The Curriculum for Auxiliaries 2.4.4 Teaching Staff 2.4.5 Teaching Materials 2.4.6 Methods of Teaching 2.4.7 ?he Establishment of Degree Programmes
3. Continuing Education
VI SUMMARY AND CONCLUSION
AIJNM VITAL WEALTH STATISTICS AND PERSOKtdEL I INTRODUCTIOPJ
The education and the role of nurses are matters of universal interest and concern in the development of health programmes throughout the world, They are particularly important in countries where profound economic, social and political changes have resulted in a revolution in expectations, needs and demands for health services, including nursing care.
In each of the six Regions where health programmes are assisted by the World Health Organization there is a diversity of standards in nursing edu- cation, nursing roles and functions, and subsequently in nursing services. These are influenced by a country's history, its financial and human re- sources, and social and cultural patterns. Nursing does not exist in isolation - ito development is closely linked with that of other professions, particularly the health professions. It would be unusual for example to find a setting where there is a rr~edical school but none for professional nurses .
In this Region the diversity of standards mentioned above is particu- larly pronounced, To give an example, it was as long ago as 1955 that the High Institute of Nursing enrolled its first students in a basic degree programme at the University of ~lexandrial. Fifteen years later In 1969, there are still countries where the existing programmes for nurses are at auxiliary level only, 'Ihis is not as disquieting as it may sound, for change takes time. What would be disquieting is if we did not encourage planned and orderly change. In other words, rue must begin programmes of rlursing education in line with the human and other resources availablei but as soon as these resources increase and improve, we should use them in the process of upgrading nursing education, and consequently nursing services,
Our topic is the Review of Education and Training of Nurses to Meet the Needs of the Begion. The boundaries of this topic are somewhat elastic
-- -- '~ur-,- '~ur-,- lhe Flrst Ten Years of WHO, Geneva 1358 (pge 397). * for not only do the countries vary in their socio-economic development, their human resources and potential, but in the types of health facilities provided, It is normal that a country with a larg~population like Pakistan should place emphasis on some aspects of health services which are not yet considered to be of vital importance in another, like Saudi Arabia....the provision of family planning facilities as an iategral part of maternal and child health scrviccs for example. In turn, if family planning is to bc integrated, nurses and midwives must be qualified to provide the appropriate counselling, the available measures, and follow-up care,
Over 65 per cent of the population of the Region is rural, and therefore there is need for c-st and urgent plans for the development of rural health services. These in turn must be staffed by polyvalent nursing personnel who are fitted to provide efficient curative and preventive care in a situ- ation where communications are difficult and distailces are considerable,
This paper will consider nursing education as it is known to have pro- gressed over the recent years, as it is today, and the manner in which it might be developed to meet the needs of the countries of the Region in the future.
It should be mentioned here.that although the paper often implies a reference to female nurses only, it can on the whole be applied to the in- clusion of men as well. The education and the contribution of the male nurse is not to be dLscounted in either curative or preventive nursing care in the countries of the Regi-on, especially where cultural patterns so indi- cater In the administration and the provision of service in rural health centres, in psychiatric nursing and in teaching this contribution of the male nurse is particularly important.
Furthermore, the preparation of the midwife cannot be isolated from a discussion on nursing education. The capable midwife either doubly or singly qualified is an essential member of the health team, particularly in those countries where the infant and maternal mortality rates are still matters for concern. Therefore, many of the factors mentioned in relation to nursing education and its development in the Region 'can also be con- sidered to be applicable to .the education of midwives.
I1 DEFINITIONS
Before proceeding to a review of nursing education in the Region it may be useful to define certain terms which will be frequently referred to:
1. &e Nurse
11 The nurse is a person who has completed a programme of basic nursing education and is qualified and a;lthorized in her country to supply the most responsible service of a nursing nature for the pro- motion of health, the prevention of illness and the care of the sick111 .
This definition was formulated by the Ii~terna'tionalCouncil of'. Nurses and was accepted by the Fifth WI-IO Expert Committee on Nursing.
2. The Auxiliary Nurse
The auxiliary nurse is one with less than full professional quali- fications, who carries responsibiliti'es of a less comprehensive and technical nature, and viho works under the guidance and supervision of nurses.
3. Basic Education for the Nurse
"'A planned eciucational programme tnat provides a broad and sound foundation for the effective practice of nursing anti a basis -for advanced r) nursing .education"".
4. Post-Basic Education for the Nurse
"A programme for nurses previously prepared in basic nursing that
(a) takes place 111 a university 01- vther institute of higher education,
'~nternational council' of Nurses (1965) --special and Committee reports pre- sented to 'the ICN Board of Directors and Grand Council meetings in Frankfurt, Juhe 1965, page 6. 2 IBID, page 6. (b) is continued from year to year (i.e, is not a refresher course or a seminar), (c) is recognized by an appropriate authority, (d) has specified admission requirements, and (e) has a full-time teaching staff or faculty"'.
I11 FU3VIEW OF NURSING AND MIDWIFERY EDUCATION IN TH?l FCEGION
In 1965 the Regional Office sent out questiorxmires designed to obtain information as a background for discussion at a Nursing Seminar to be held the following year. Sixteen member countries completed 144 questionnaires on schools providing basic educational programmes for nurses2. This total excluded the Health Training Institute, Benghazi, Libya and the High Insti- tute of Nursing at the Universities of Alexandria and Cairo, United Arab ~epublic. Eleven of the 144 schools were assisted by IdHO in 1965, and three others had previously had WHO support.
The resultant data emphasi.zec1 the considerable diversity which existed in the background of general education, and in the nursing preparation of the personnel designed to provide "the most responsible service of a rlursing nature for the promotion of health, the prevention of illness and the care of the sick". ?he following points were noted:
1. Administration
- Only fifty-five of these schools had their own budget.
- ?he administrative control of approximately 34 per cent of the schuols was sepa~~atefrom that of a hospital or other health service institution.
- The entry requirements in general education varied from four to twelve years - 19 per cent required eleven to twelve yearsj
WHO Expert Committee on Nursing, WHO Technical Series, No. 347, 1966 (page 32). 2~orldHeelth Organization, "The Nursing Situation in the ~eglon", Alexandria, EMRO, WHO, Unpublished Paper EM/NURS,SEM/~, 2 November 1966, Annex I, pp.xiv. 46 per cent ten years; 7 per cent six years; 28 per cent four years (forty-four schools in one country).
- Six languages were used in 144 schools, including Arabic in sixty-four and English in forty-four; ten s~hoolsinsix cowtries used two languages.
2. The-Students
- Approximately 11 per cent of the schools had over 100 students, 57 per cent from sixty-one to 1uO students; 20 per cent from twenty-one to sixty students and 18 per cent had less than twenty- one.
- The total enrolment of all schools was 7 705.
- There was no appreciable increase in the enrolment of students (either initial or progressive) during the period 1363-1965.
- There was quantitative disparity in plans for the education of nurses* . - Provision was made for the education of male nurses in thirteen countries. Particular emphasis was placed on the training of this personnel in the Sudan.
3. 'Ihe Programmes
- The length of programmes varied from two to five years with the majority (approximately 75 per cent) of three-year duration. In one country with fourteen four-year programmes, the last year was devoted to midwifery studies.
*For example, Ethiopia with an estimated population of 23 457 000 and the United Arab Republic with 30 907 000 had enrolments of 185 and 1 410 student nurses respectively. The Syrian Arab Republic and Tunisia, each with a population of approxlmately 5 000 000 had 242 and 572 students respectively. Pakistan with 107 258 000 people had 1 980 students, and the Sudan with 14 355 000 had 1 905 students. Population statistics taken from "'The UN Demographic Yearbook, 1967" UTI, N.Y., 1968. - 142 of the schools awarded certificates or diplomas to suc- cessful students, the other two awarded a degree of Bachelor of Science in Nursing.
4. The Practice Area - All schools provided experience in medical-surgical nursing. - The students of one scliool experienced the medical-surgical nursing that was available in a psychiatric hospital only.
- The majority of schools assured practice in maternal and paediatric nursing for female students.
- The learning experiences for men in these areas were limited to formal instruction in nearly all cases. - Practice in public health and mental health (psychiatric) nursing was provided by 49 and 44 per cent of the schools, respectively.
Inadequate data was received on the following points but it was Indicated that: - The number of nursing and other instmctors available was limited in relation to student enrolment.
- The total bed capacity of the available practice area would frequently mean difficulty Irl providing adequate patient care experience for students.
In 1965 the Regional Office also acquired country and institutional level statements of minimum requirements for tl2e programme of study in schools of nursing *.
A stu* of these statements and a knowledge of the programmes con- cerned led to the following observations:
*Since then one country has submitted a statement of proposals which could lead to a revision of programmes. .. . - During the past decade, only 40 per cent at mnst of the schools have achieved evaluation and revision of programmes of study.
- In approximately 30 per cent of these no major revision has . been implemented.
- The majority of programmes provide formal teaching in the bio- logical and physical sciences, social sciences and allied studies, aspects of clinical and preventive medicine, and nursing.
- Systematic instruction is so planned that the programme is split into isolated subjects.
- ?he limited number of hours available for these subjects leads to serious questioning as to their value.
- There is little provision for general cultural studies and recre- ational activities.
- I11 possibly 15 per cent of the schools there is provision for ' the integration of theory and practioe.
- In the majority of situations the needs of the health service institution inhibit the possibility' of a sequence of theoretical instruction and field practice experience.
5: ?h'e Present Situation
There is no doubt that quantitative advance has taken place. There ape 160 schools of nursing in the Region with an estimated total enrolment of 8 955 students, Of these schools, 155 grant ceptificates or diplomas, and five offer curricula designed to qualify maduates for the l?aohelor of Science in Nursing.
Twelve of the schools mentiohed above have heen established during the past four years. 120 out of the 160 schools, and all the organized . . post-basic programmes of an academic nature have been initiated sinoe 1950 Walitative progress is evident in a limited number of nursing education programmes only. Where this exists, it has been due mainly to:
- An increase inthe interest and support of the population,
- An increase in the financial support from Government sources, - The support and collaboration of the medical and teaching professions.
- The initiative and efficiency of the relatively few qualified nursing leaders,
6. The Education of Auxiliary Nursfng Personnel ------A ---a------Statistics available on programmes of education for auxiliary nursing personnel are limited and by no means accurate, It is esti- mated that there is an ei~olmentof between 1 000 and 1 500 auxiliary nursing students in thz fifteen countries which conduct between forty and forty-five programmes of an awdliary nursing nature. Approximately twenty of these schools are in one country, and WHO assists with seven programmes in four countries, Here again there is considerable di- versity as the followimg information shows:
- The entry requirements vary from four years' general education, * .. ." . to the completion of nine years.
- The programmes are from one to three duration, while the majorlty are of two years,
The curricula of these schools are designed to produce a variety ' of auxiliary worker whose name often indicates his or her f'unctipn,' The pyogrmcs for the community nurse, lady health visitor, and ma- ternal and child health assistant, place emphasis on tl?e nursing aspects of preventive care, and midwifcry is sometimes an integral part of the training. The programmes for the assistant nurse/dresser, practical nurse, arid nurse aides, stress the nursing aspects -of cura- tive care, sometimes to the complete exclusion of prevention*
There is one often repeated similarity. Programmes provide the theoretical and practical learning experiences which are to be found in tie programmes fcr nurses. The adaptation of the programme has been made by simply decreasing the number of hours available for subject matter and practice.
7. "on-the-~obTraining"
USexists in nearly all the countries of the Region and usually stems from expediency. Many hospitals, health centres, or clinics have recruited young people with expected potential, and they are simply taught the skills which permit them to carry out functions of a nursing nature and Mch are directly related to the service provided, It is likely that this system will continue for many years in some countries where the formal programmes cannot produce an adequate number of graduates to staff the expanding health services. The quality of the performance of the "on-the- jobit trained personnel inevitabG depends up011 aptitude, and the interest and skill of the instructors and super- visors.
8. Mldwifery Education
Available information indicates that there are twenty-four schools of ~Aciwifery in the Region, with almost 50 per cent of these in Pakistan. The World Health Organization has provided teaching personnel for three of these schools. Some countries, such as Jordan, have two-year'- pro~&mmesfor midwives who are not already qualified nurses.
Pakistan and-the Sudan have a long experience in providing organized programmes for .village midwives. Many countries provide brief "refresher" cmrses for traditional midwives. EN/k~lg/~ech'.~;~sc. /2 page 10
Post-Basic Nur sii~Education
At prksent, there are seven institutions which provide post- basic study programmes of an academic nature for graduate nurses and nurse-midwives. Four of these offer courses in nursing administration and teaching, and within these fields further clinical studies can be taken in medical-surgical nursing, maternal and child health or psy- chiatric nursing. One of these four institutions, and the three other centres provide a course in public health nursing. The language of instruction used in one of these is Arabic, in one it is French, and English is used in the other five.
Two of the programmes established in 1967 and 1968 respectively, offer studies which lead to a Bachelor of Science degree, while certifi- cates or diplomas are granted upon successful completion of the others. The total enrolment in these programmes dux-iilg any one year has.never yet exceeded 100. The World Health Organizatiol? is assisting with two programmes on a long-term basis, and has provided consultant services for a third.
During the past decade, several countries have orgadzed short-term and ad hoc programmes. Many of these have been of an in-service nature for existing personnel, others have been designed to introduce new skills such as nursing administration, teaching, or psychiatric nursing as the situation demanded.
IY THE NEEDS OF THE REGION
One single document cannot attempt to deal with the specific needs of each country of the Region, nor can it bear specific reference to the various programmes already embraced in the term ducatio ion and Training".
If it is accepted that although we speak of the needs of the Region, these needs vary and are influenced by socio-economic conditions, human re- sources and potential, it is still possible to discuss certain factors which are fundament,al and are consequently tenable for all countries, These fdcto?~nlgLJ; b~ considered under the broad headings of the needs of Govcrments, of the population, and cf th~nursing profession; and of the possible, contribution of these groups tovrsrds the mesting of these nceds. Neither the 'needs nor the coiitributions can bo isolated into separate entities - the nceds of tht population will bc closely interwoven with those of the Govcrnment and the nursing profussion; th~contribution of the Government will influence those of the nursing profession and the population, and so on.
1. 'L~PNeeds of the Govcrnment
It would be rare to find a Government &osc health administration did not have the welfare of its people at hcart, A heal% population is the nation's greatest asset. The effccts of the ravages of trans- missible diseases and the subsequent effects on a country's economy are too well known to be repeated, The mental, physical and social conse- quences of a high maternal and infant morbidity and mortality rate are also obvious,
It falls to evdry binistry of Health to analyze the situation in its own countrv, and to sct up health programmes according to what it considers to hc thc imm~diatcpriorities. 'Ihcsc must inevitably be Lrithin the limits of the existing resources, Two facts rkmain, health workers including nurses and midwives, must bc mad^ available in adequate numbers; and to providL this personntl proarames of educakion must be either established, maintained or devuloped, Thc question may be asked -
?his too is a matter for on-the-spot analysis. There is no real-
istic and universally applicable formula which decrees. .. X number of nurses to X number of patients or population, The governing factor is the 'pro- vision of safe and efficient nursing care, both curative and preventive...... - . . . .
~NS?~EIN,Margaret G.: Guide for National Studies of Nursing Resources, WHO Geneva, 1953 (page 22). EM/R~lg/~ech.~sc./2 page 12
If an adequate number of nurses is to be provided for an intensive care unit, for example, the ratio of one nurse to every patient to cover
twenty-f our huurs uf care is nune tuu maw. On the o Wler' hand, where patients are ambulatory, one nurse to five patients may be sufficient. One country has established the standard of one "highest level nurse" to five auxiliary nurses for every twenty patients in hospitalL. The number of hours of nursing care needed in twenty-four hours, the length of the working day, holidays and off duty, are all matters to be taken into account in the assessment of the needs in nursing and midwifery personnel 2 . Where a domiciliary midwifery service is provided, the number of midwives must be sufficient to ensure constant availability. Birth rates, the time needed for travel to and from the home, the keeping of records, and the preparation and care of equipment must all be taken into account. One country specifies the need at one midwife for eighty live births in such a service, in another it is one to 10d, while one midwife to 200-250 live births may be adequate in the maternity unit.
Again the ratio of qualified nurses anci midwives to auxilfaries will vary according to the education and the capability of the latter, the type of service provideci, the geographic situation, and the means of corrurmnioation . Even the capable auxiliary midwife can meet with an obstetric emergency and it stands to reason that if she is within reach of a good messenger service, a maternity unit, and adequate transport, she is better placed to provide safe midwifery care than if no such facilities are available, In these circumstances the ratio of one super- visor to ten auxiliaries might apply. In less favourable conditions, one to five would be a desirable although perhaps not always a realistic ratio.
~IBID, page 25 2~AEXZ~~~~,Marguerite, A Guide for Staffing a Hospital Nursing Servfce, Public Health Pkpers, -Ne. 31, WHO, Geneva, page 26. 3~~~~~~~,Margaret, Opus Cit, page 23. The need for public health nurses will vary for similar reasons - the type of service, geography, communications and transport. One public health officer in a country of this Region recently stated that the aim was to employ one public health nurse for every 2 500 people to provide generalized public health nursing care. Others again aim at one public health nurse for one geographical unit, and others one 1 public health nurse for every 5 000 of populat.inn . The needs in teaching personnel for schools of nursing are also variable. In addition to the Director, it is desirable that there should be one teacher for introductory courses in nursing, one to co- ordinate the teaching of basic scien~es,~onein each of the clinical
specialities, and additional teachers according to the size of . the. student body *. Whatever formula is considered by national authorities to be best suited to the needs of the country, there is no escape from reality, The best possible use must be made of existing nursing and midwifery personnel, and ongoing plans are required for the education of future personnel in line with the development of health services. .
The present situation in relation to the availability of nurses and midwives in certain countries of the Region is indicated in the Annex. Total statistics are not available at this ti111e.
2. The Needs of the Population
This is a complex subject for it involve= social, economic, and cultural factors as well as the mental and physical needs of the indl- vidual, the family and the codty.
The individual of today is much better informed than he was ten years ago, excepting in the rarest of circumstance. Even if he is still
~RoJXF~TS,Doris E. r The Staffing of Public Health and Out-patient Nursiq Services, Public Health Papers No. 21, WHO, ~enevaTp'age19). LYMAN, Katherine : Basic Nursing ducati ion Programmes, Public Health Papers No. 7, WHO, Geneva, 1361 (page 61). EM/R~lg/~ech.~isc ./2 page 14
living in his traditional social pattern, he may have children with a wider education and experience, and who introduce. new ideas and knowledge into the family circle.
Modern means of colimunication are available to the majority. There may be no television or daily newspaper, but transistor radios with their transmission of news, music and talks on various subjects are numerous. Illiteracy does not preclude the dispersal of information, and with Chis, a certain measure of sophistication which in turn leads to an expectation of a better "way of life", including improved care in sickness and in health. Individuals, families and communities are now demanding curative and preventive services which in turn necessitate the education of health personnel including nurses and midwives. There are mothers who once had no antenatal care, who worked until they went into labour, and who stayed at home to deliver their infants with the assistance of a family member or the traditional midwife. Many of these mothers are now aware of the benefits of prenatal advice, and they want to be delivered in a mat.ernity unit or health centre "for a rest" even if it is only for a brief twenty- four hours.
Parents expect that their children will be protected from communi- cable diseases through vaccination or inoculation. They expect to be able to get medical and nursing care in times of illness for themselves and their families.
The community expects its share of the total health services made available to the nation. Where these services are to be paid for, they must be within t.h~family' s economic means; where they are free. they must still be provided by adequately qualified and efficient staff.
Vital statistics must be considered in an effort to assess the needs of the people in health workers. The total population, its Anticipated growth in a specific time, the birth, death, morbidity, and fertility rates will all Influence these needs.' Nursing is concerned with people - all people - the individual, the family, the cornmunitjr and thc nation. If this is true, then the nurse must be educated to translate this concern into care for the healthy as well as the sick. Only one segment of the population is sick and hospitalized, Any society which concentrates its health and its nursing services only on the sick will never be a healthy societyl,
3. The Needs of the---- Nursing Profession A great deal has been written about whether nursing meets the criteria required for professional status. For the purposes of this paper however, nursing might be considered within the context of the following broad definition: A profession is a "vocation, calling, especially one that involves some branch of learning or sciencef12.
Like any other young person, the potential nurse needs to have a sense of pride and security in his or her chosen profession. The sense of pride is considerably enhanced or depleted by the attitudes of promi-
- nent individuals and the community towards nursing and nursing education. The sense of security will be greatly influenced by national support of these two fields.
There is an intense swing towards the search for education, and the choice of a career becomes wider and more competitive every year, This applies particularly to countries of this Region where Mnere have been and still are rapid changes in patterns of general education for girls. Where once their choice of occupation might have been between teaching and nursing it can now occur that the majority of professions are open to them on the con~pletionof full secondary schooling, Nursing, therefore, must compete,
~ROGERS, Martha : Responsibilities of the Individual es a Practitioner, Paper prepared for the Michigan NursestAssociation Convention, October 1964. 2?he Concise Oxford Dictionary. ~~lg/~ech.~isc./2 page 16
The nursing profession cannot expect to attract and retain the interest of suitable young people unless the programmes of education available are stimulaLi11g and dyrmrnlu. Tfle nurse, both auxiliary and professional, should be able not only to acquire the knowledge and skills which will equip her to carry out her future functions, but there should be provision for complementation to her general education and to her ability to fulfil her accepted role in her own society.
The graduate nurse who successfully completes her studies needs to feel that there are suitable opportunities for employment, and posts available which are commensurate with her education and experience. She has the need for an adequate salary, good conditions of service, chance for promotion according to her capabilities, and security in retirement. Furthermore, members of the nursing profession need oppor- tunities for higher education to fit them for positions of leadership.
V MEETING THE NEEDS OF THE REGION
We have discussed the needs for nursing and midwifery personnel from the
, points of view of the Government and the population, and the needs of the nursing profession. It is maintained that these are closely related and complementary to one another.
The following pages will relate, in general terms, the contributions
which might be made by the Cbvernment, the pop~~lat-ton,and the profession to nursing and nursing education. It then remains to enumerate some of the specific'measures which would promote and develop nursing education in order that the needs of the Region may be met. Some of the measures suggested vdll already have been taken by the appropriate health authorities. Some
. could be.implemcnted at once in many cases, while still others can only be considered in long-term planning for certain countries. m/fi~lg/Tech.Disc. /2 page 17
1. Contributions which might be made by the Government, the Population, and the ~ursingProfession
The support and interest of the Governments are essential if progress is to be made in the development of nursing education in the countries of this Region, The authorities responsible for national health planning must all consider the availability of nursing personnel, the need for the establishment of additional programmes of nursing education or the modification of those whicu exist, and the need for policies and standards applicable to edu- cational institutions.
It has alread,y been possible for seven countries of the Region to set up a nursing division within the national health administration. The appointment of a chief nurse to this division has greatly facili- tated the establishment of national policies for nursing, the raising of standards of nursing practice, and the co-ordination of nursing services and nursing education. It has also strengthened the organi- zation and a&r&nistratiun uf nursing services at national, provincial, local and institutional levels - a necessity if these services are to provide adequate and sound experience I"ura student nurses. Many other countries have been cielayed in the setting up of a nursing division through the lack of budgetary or other faclllties, including the fact that there is no nurse yet qualified for leadership.
.Governments can also contribute through promoting the establish- ment of a nursing council and a national nurses1 association. These two groups can provide support for the division of nursing in ensuring uniformity and high standards in programmes of nursing education, and in the quality of nursing care provided by the graduates. They can
also assist the Government with the formulation of legislation which -., covers all flspee-ks of nursing education, and subsequent registration - - and practice. - - EM/~~lg/~ech,Disc ./2 gage 18
Govcrment assistance towards studies and research can greatly contributi to nursing education. In planning for national health
services and the provision of adequatel: qualified nursing personnel, it is essential to look at existing r~sourccsin all categories, what roles thcy currcrltly fulfil and thLir dispersal throughout thc country. Onct thssc facts arc known, a national rkgister of all qualified ilurscs ai?d t;l~irassigrun~nts should bc established and kept up to date.
With the present shortage of nursing personnel in the majority of countries of this Region thc question of utilizing the services of this personnel to full capacity is vital. The results of studies may be enlightening. In some parts of th; world it has been questioned for years whether "nurse shortage" may be alleviated by more effective use and assignment of nursing pkrsonnelL.
When Governments anticipate the establishment of schools of nursing, a study of th~roles and functions of practising nurses is vitally important in order to ensure appropriate prograrnm content. All Govcrnmcnto will rccognizc the dangcr of a nursc holding a post where she pcrforms functions for which she is not prepared. Nor can Governments really afford that a qualified nurse should bc "wasted" in a post which could bc held by a secretary, a receptionist, or indeed a messengkr.
11 It is a waste of scores of health pcrsonn~lif any perform tasks below the lcvel for which they are trained when others are available to do such work, and dangerous for aw- to perform tasks beyond their rcspcctive spheres of competence" 2. This statement did not originate in tinis Region, but it is interesting to consider its applihation.
'D~SI-n- ---- for statewide Nursing surveys, US Departmcnt of Health, Education and Welfare, 1956, page 35. '~calth is a Community Affair: National Commission in Community Health Services, Harvard University Press, Massachusetts, 1966, page 83, The population of a country is capable of making a consider- able contribution towards the promotion of nursing education.
Some schools of nursing have ha2, the economic support of "patrons" who have been in a position to promote activities to provide recreational and other facilities for students. In others again, the patronage of a well known personage has lent prestige to the school.
The attitudes of influential people, including those of the medical profession have a profound influence on nursing education1 . How often is it said: "NO daughter of mine shall be a nurse". In all justice, however, it must be mentioned that it is not many years ago since the same remark was being .made in~oountnlesof other Regions which are now regarded as "advanced" in matters of nursing education and nursing services.
Where the population demands rapid social change in the matter of education for girls and youn@; women, there has been an outstanding contribution made to nursing education. General education is the foundation upon which professional and higher education are laid, and without a sound basis no finished product is secure. Again there is a grcat diversity in this Region - in 1956 one country had no programmes of formal education for girls, while at least one other had women graduates in thc mcdical and legal professions years before that2.
The population of a country can also contribute towards the education of nurses by its appreciation of cultural change. In some instances it is still not acceptable that girls should leave l~uidelinesfor Assessing the Nursiw Education Needs of a Cm- National League of Nurses, USA, 1967, page 5. i?World Health Special Issue, Ma.y/~une 1962, Eastern Mediterranean Region, Page 33. EM/R~19/~ech.~isc./2 page 20
their homes to live, learn and work outsidc th.c family group. The implications for the need to establish programmes for nursing educatiori are prufound. Many countries both in this
Region and elsewhere, have seen very rapid changes in these cultural patterns either at the irisister~ct.of the girls them- selves, or throw thc influence of a strong community leader1 .
In summary thc population can makc an immense contribution to nursing education through its recognition of the importance of the nursing profession to the nation; the accephnce of the nursing profession as a respected career; a sustained support of nursing education and practice; and active participation in all matters related to the promotion of the status of the nurse,
1.3 The Nursing Profession #> .I_ The nursing profession can make its om contribution towards the field of nursing education through thc: dynamism and self de- velopment of its members.
Where a nurses' association cxists, this should receive full support from graduate nurses. Wherc there is not yet a sufficient number to establish an association, them is nothing to prevent nurses meeting in small informal groups to discuss professional problems and aspirations. Wh~renational administrations ars not yet ready to support the establishment of a nursest association, niembers of the profession might seek ways to explain the aims and benefits of such a group. Collaboration with the International Council of Nurses provides for the exchange of ideas on nursing education and the attainment of good nursing services.
The nursing profession can also contribute towards nursing education through accepting the need for research. Nurses often - - . -- - . - - - ~~/R~lg/~ech.~isc./2 page 21
losing sight of .the fact that this can be begun in a relatively simple manner. Many nursing leaders ifi this Rcgion are capable of conducting a study of the nursing resources of their countries, a must where long-tcrm and realistic plans for nursing education and nursing services ar& to be formulated. It has already been mentioned that no country can estimate the number of nurses it needs to educate, if it is not known what personnel exists in the different categori~sand what function it fulfils.
Nurse educators, administrators, and supervisors should all participate in evaluation research which is of vital importance to the ongoing development of programmes at all levels. It is only throue;h this ?valuation that it is possible to assess the ways in which programmes should be revistd and modified to fit in with changing patterns of nursing education and silbsequent nursing practice.
Finally, nurses possess the strongest means for upgrading the status of their profession. If its members make it clear that they expect recognition and respect for their calling, they will go a long way towards achieving these. Nurses after all are the best ambassadresses for nursing.
2. Specific Measures for Meeting Needs
The contributions of the Government, the population and the nursing profession will all be supportive Lo arw specific rrreasures which may be taken in order to meet the needs of the countries of the Region in nursing education and practice. Some of the suggested measures which follow deal with quantitative needs, whereas all should promote quality in the ultimate nursing care which will be provided for the population. EMr/Rclg/~ech.~is.c ./2 page 22
2.1 Definition of Lhe Purposes and Objectives of a School of Nursine
Every school of nursing should havt a clear staterner~t defining its purposes and objectives, and which has taken the following factors into consideration:
- the health and social needs of the population;
- convictions regarding nursing and nursing cducation;
- the statutory minimum requirements for schools of nursing;
- the available resources including teaching personnel;
- the type of student to be recruited;
- the level of technical competence to be achieved; - the future role and functions of thc graduate,
2.2 Tkie Organization and Management of a School of Nursing
The administration of a school of nursing should be separated from that of a health service establishment. These two insti- tutions do not have the same functions, and at times this difference leads to conflict. The one provides the care, and the other the personnel who will be responsible for this care.
It has already been suggested that there should be national policies and procedures related to the administration of schools of nursing. Thcsc policies should define the following:
- the budget allotted to the school;
- the composition and functions of the controlling authority and its advisory committee;
- the qualifications, selection, appointment, functions and responslbllitics of the adminLsLraa-Liveard techdeal head, and full and part-time teaching staff; - salaries and conditions of work (including provision for ongoing education) for full-time staff;
- the provision for stipends, uniform, board and lodging, etc. ;
- the entmj requirements for admission of students; - the major components of the total programme;
- the number or hours of theory and weeks of practice;
- the methods of teaching to be used; - the quantity, quality, selection and staffing of field practice areas;
- the types of records to be maintained and reports to be submitted;
- the tools and methods to be used in the regular evaluation of the components of the total programme.
2.3 The Oqganlzation of the Curriculum-
It Is ofbn considered efficacious to grsup the content of a curriculum under major divisions which are subsequently broken down into subjects.
The following grouping may be ussd:
- Biological and Physical Sciences
- Social.Scienccs and Allied Studies
- Aspects-of Clinical and keventive Medicine
- Nuriiing - General- Cultural Studies and Recreational Activities. This method of grouping can facilitate the correlation of theory .and practice. 243.1 The Currela-tlun of Theory and Practice
This is a matter of concern in many countries, not only in this Region. It $s extremely difficult to ensure if the school of nursing is organized and administered by a health establishment whcre students are regarded as staff for the services provided. It stands to reason that the student will be required to work in the unit where staff is depleted for some reason, regardless of whether or not this is appropri- ate to the theory she is studying at the time. Wherever possible then, it is desirable that the service personnel is sufficient in number to provide adequate nursing care without total reliance on student contribution.
2.3.2 Clinical Teaching and Supervision
Another problem which frequently arises is - who should do the clinical teaching and supervise the practice of the students? mere is often conflict between tea~hlngand service personnel on these matters and this results %nmisunderstanding on both sides. This can often be resolved through regular meetings of these two groups in which the needs of the students are discussed. In principle, service personnel are the experts in nursing care and are therefore well equipped to impart their knowledge and skills to the future graduate. In practice, the ward sister or staff nurse is often far too occupied with rou- tine work to cope with instruction and supervision of students.
'IZlis matter relates closely to an administrative problem, but which might conveniently be mentioned here - what is the role of this s~lled.and howledgeable person - is she spending too much time on non-nursing functions? Counting linen, answering telephones, serving meals are sometimes done by quali- fied nurses. The establishment providing the learning experience could contribute and even economize, through the employment of ancillary workers to take charge of these necessary but time absorbing activities. This in turn would release the professi'onal for student supervision. Only recently in one of the countries of this Region, the Director of a large hospital stated that one of his problems was staff shortage because nurses "spend too much time in nonsense", and t.hat plans were underway for the employment of housekeepers who would release staff for nursing care,
It is interesting to note that many years ago, Florence Nightingale said in her suggestiaii for the improvement of hospital nursing services: "A nurse should do nothing but nurse. If you want a charwoman, havc: one. Nursing is a . speciality"l.
?he "clinical instructor" or teacher who accompanies students to the practical setting is certainly an essential person to introduce the fundamentals of nursing to students in the early clays of her education. Furthermore, her presence can provide confidence for the student in her first entry into the services where otherwise she may feel out of place, But it is suggested that the contribution of the service personnel should b~ solicited, and encouraged through regular meetings with teaching staff.
2.4 Curricular Content
The curriculum of a school of nursing has been defined as the sum total of all experiences which the school plans and provides for its students, Evaluation and subsequent revision of these curricula should be continuous, and aimed at equipping the graduate lDO~~,Josephine, ~oodnow'sHistory of Nursing, W.B. Sauhders, London, 1963, page 229. ~~lg/%ch.Disc./2 page 26
with the knowledge and skills necessary to enable her to perform her future functions with efficiency. As roles, and functions within these roles, change according to the needs and demands of the Government, the population and the profession, so the cur- riculum should be related to these changes.
2.4.1 The Comprehensive Curriculum
It is suggested that all curricula should be compre- hensive and designed in order to prepare a polyvalent nurse - that is one who can function in first level positions in hospitals, health centres, clinics, or any other establish- ment for the provision of curative or preventive nursing care, Countries which are short of financial and human resources would find it far more economical and efficient. to prepare this category than the "specialist" in one single field.
Wherever the graduate is to functlon, in a hospital setting, a public health programme, or in the maternity unit, the additional knowledge and appropriate skills can be gained through practice, experience and ongoing education, All curricula therefore should be comprehensive, with a thorough integration of the nursing aspects of curative and preventive care as well as obstetrics.
Curricula should also include an introduction to the principles of administration, supervision, and teaching, The graduate nurse will frequently be posted iediately. into a position of responsibility where she rnay have to apply these principles to ward management and staff direction. With the existing shortage she may be assigned to a school of nursing where a knowledge of the principles of teaching and learning will provide the foundation upon which she will build her - - experience. . -. 2.4.2 Subjects included- in the Curriculum
With a view to the full usage of available time in what Is uften arl overcrowded curriculuri~, it is suggested that a serious study of subject matter is necessary. To give one example, does the student beneflt from thirty hours of pharma- cology in the early part of her education, or would it be preferable to allow half this number and integrate the subdect with her subsequent nursing practice when she is taking the responsibility for administering medications and antibiotics?
2.4.3 -The Curriculum-- for - -- Auxiliaries---- It has been stated that in defining the purposes and objectives of a school, the level of competence of the gradu- ate should be taken into account. It has been noted also that the curriculum designed for the training of auxiliary nurses is frequently an abbreviated edition of that which is used for professional nurses. This praclice Is of little ultimate value, and often constitutes a waste of time for teacher and student, If a graduate is to function as an auxiliary, does she need hours of instruction in the bio- logical sciences? Could some of these hours not be more gainfully employed in practice in a maternal and child health centre? These are questions which might be seriously posed.
The auxiliary will need to know how to organize her work to participate in health education and perhaps to super- vise other auxiliary or ancillary staff. There is rarely any provision in the curriculum for providing her with the knowledge and skills necessary to undertake these tasks. EM/k~lg/~ech..~isc./2 . page 28
2. )I .4 Tcaching--- Staff Many countries have very few nurses who are qualified in teaching, others have none. The nccd for an introduction to the art of teaching into a11 basic curricula has already been mentioned in relation to this lack.
In theory, no school should be started without provision for the employment of qualified nurse educators, and the as- smance that these would continue to be available, In practice, these provisions are often not made either becauso they are not
thought to bc important, or through the realities mentioned above.
Where this personnel is not available, qualified nurses with technical experience, potential, and interest in teaching could be assigned to the staff, with an ultimate view of further study in teaching and administration of schools of nursing. On no account, however, should a nurse be "posted to the school" in order to fill the gep in teaching staff, or for any other reason. Such an assignment can prove to be a waste of salary for the authorities, of expertise to a more compatible service, and of valuable learning time for the student. A nurse who is interested in teaching can frequently do a very efficient job even though unqualified, but her inter- est is essential.
?his of course should be a temporary measure, and the authorities concorned with educational programmes for nurses should have both short-and long-term plans for the attainment of a qualified Dlroctor and teaohing staff oornrnensurate with the number of students to be taught. 2.4.5 Teachine; Materials
The problem of the availability of suitable texts, documents, and teaching materials, particularly in the Arabic language, is one of concern in this Region.. Nurses and teachers would provide a great service to nursing edu- cation if they could systematically prepare and revise course outlines and notes Wch could be compiled and subsequently used for formal teaching. This may not be easy, particu- larly where a large number of part-time instructors is involved. Furthermore, it may be unrealistic to expect busy practitioners to contribute, and again many a good class has bean given without the teachcr having prepared any notes beforehand. Nonetheless, countries which do have this problem of the lack of suitable documents in Arabic or other languages, might set up small committees of teachers, students, and other interested persons, to find a solution first for themselves, and then to share with their neighbours.
Similarly there is a need for appropriate films and film strips. These are available in limited numbers, but the former are expcnsivc and not always suitable to conditions in this Region. There is no reason, however, why thought should not be given to the making of film strips with appropriate commentaries, The advantages of this are that they are made in the situation and therefure are appropriate and aooeptable. Bere is much less expense involved, and a begidng can be made in a simple way with photos w2lZcll are explained to students.
Related to this matter is the fact that all schools of nursing should have a library and study room no matter how simple, and which is available to the students at all times. It has been said that "the students do not like to read". me question arises as to whether- they have been encouraged to do so, and provided with suitable books and magazines and the place to read and study in relative comfort.
2.4.6 Methods of Teaching
It has frequently bee11 remarked that all too often, students take copious notes or are given notes which are subsequentl-y learnt "by heart". All students need guidelines, notes and rcfcrcncc material, but they should be encouraged to seek additional information on the subject of study, and to relate it to the work situation. Di~cussionson their own experi- ences and obscrvations during their practical experience is within the capabilities of all student nurses at both pro- fessional and auxiliary levels. The preparation of case studies and their8 preserltatiun can bc added in the more senior years. Students in post-basic programmes should have a measure of experience in the planning cf workshops and semi- nars for their colleagues and o-ther groups. Active partici- pation in the teaching and learnlng processes are excellent ways for students to achieve knowledge, poise.and confidence.
' 2.4.7 The Establishment of Degree Programmes
In this year of 1969, fevr will question the right of nurses to have the opportunity for education at university level if they so wish or if their future responsibilities so warrant. It is well recognized also that where the programmes are available in the country of origin or one nearby, thcrc i~ every opportunity for the programmes to be suited and adapted to local curlditiuns.
Timing is of vital importance, and forethought as to whether there are and will continue to be an adequate nurriber of suitable entrants. It is suggested that the authorities concerned with the establishment of such programmes might benefit from observation in those which exist in thi Region, and discussion with interssted pcrsons as to the problems which have been encountered and thcir ultimate solution.
The question of whether or not a degree programme will producb graduates who will adtquatcls~meLt tht presont nteds
of the Governmvnt, the population, and tht profession, is another mattcr to be skriously studied. A fear has been voiced by medical practitioners and othzrs that degree programmes producs "dusk rnlrscs" which are a "luxuryt'in a country short of nursing personnel. Where this fear is still voiced, it is never too late for rcvision of the objectives of the programme and of the curricular content. It should not be taken for granted that the degree programme is neither practical nor necessary in certain countries of the Region.
3. Continuing Education
Nurses and midwives at all levels have thc right to furthtr edu- cation. If a nurse is to remain in her profession and particularly if she is to takt, positioi-~sof increasing responsibility, she should have opportunities to participate in "the excitement of learning and living in a world where change is ever present and const~nt"', Some countries have aIready provided for this, but where this is not so, Government and institutional authorities would make a great contribution towards nursing if immediate steps were taken to fill this gap.
One of the biggest problems is often to release staff wen for short courses, but it is suggested that a bcgiming could bc made in allowing tvcrl one hour a week for staff cliscussions on matters of interest. This could develop into a half day a month vihcrt: a topic is reviewed from various angles, then a whole day wherein participants could invite their own
'COOPER, Signe S. Continuing Education a Must for Nurses, Ibrsing Fom Vol. VII, No. 3, 1968, page 297. resource personnel, Teachers, medical practitioners and specialists, religious and commuliity leaders will all makc a valuable contribution to the discussion of topics related to their spheres of competence. One important factor is that the selection of oile Single theme to be explored as time permits is usually much more beneficial than maw subjects which must be briefly touched upon. This theme could be chosen in advance by the participants in ordcr to cnsure their intcrest and contribution.
Particular mention should be made of the '*on-the- jobtt trained auxiliary and the traditional midwife. ?he service provided to the community by these categories is not to be underestimated, and although many countries have the intention of replacing them by formally trained personnel, it will be years before this becomes a reality. In the meantime, it will usually be possible to initiate or to strengthen the facilities for their ongoing instruction.
The "on-the- jobtt trained auxiliary has usually gained hey: slgLlls through observation and practice, and the extent to which any related principles have been explained to her usually dcpends upon the enthusiasm and interest of the person in charge of her "training". It may be neces- sary to ensure that she is aware of the principles underlying the need for aseptic techniques, and her responsibilities in applying these to her preparation and care of equipment in a dressing room, for example.
At least one country has frcquent admissions to the obstetric .ward' of mothers with ruptured utcri. These mothers have come from the villages and have not had efficient care during delivery. This has direct impli- cations for down to earth instruction of birth attendants on the necessity for safe delivery procedures, and their recngnitf-on of the limits of their capacities and responsibilities. Post-Basic Nursing Education
According to the definition on page '3 post-basic education may be provided in eitkier a university or other hstitute of highcr education. The establishment of degree programmes has already been referred to but there are still many countries where there is neither university-nor institute of higher education available to accept programmes of post- basic nursing education. It does not mean, however, that the need for their establishment should be ignored.
'Ihe necessity for preparing teachers, administrators, supervisors and nurses qualified in olinioal speoialties suoh as public hcalth and psychiatry ie acknowledged. Programmes with realistic objectives and wcll planned curricula can be set up and financed by national health authorities, and if representatives of an institute of higher education can participate in their plmiLng su much the better,.
Ihe first step,however,would be to strengthen the existing facili- ties which are expected to serve as the practice field for students In a programme of post-basic nursing education. For example, public health nurses cannot be prepared unless there is at lc-ast a pilot service which provides generalized public health nursing care and in which the student can relate principles to practice. On the same basis future teachers should have the majority of their experience in a well established school of nursing, and administrators should have access to well organized nursing services for their practice.
VI SUMMARY AND CONCUTSION
This paper has referred to the needs of Governments and populations in relation to nursing personnel, and the needs of the nursing profession to ensure its own growth and progress.
A review of the past and present situations in nursing and midwifery education in the Region has been submitted. Ways have been proposed in which tht Government, the population and the nursi~ng profession mi&t con- tribute towards meeting thcir needs, and finally suggestions-havebeen cnumerated for measures which could bk taken in the planning, organization and administration of programmes of nursing education.
Some of these measures may be acceptable, othcrs may provide a background for controversy and debate. Somc might be applicable at once, others could be envisaged in long-term plarm3n.g for the future development of nursing edu- cation. Whatever the situation and the country concerned, the adoption of any change in the existing patt~rnof nursing education will depend upon the anticipated role and functions of the graduate, and the exlsting resources and facilities which arc available.
'l'he Bibliography contains' a list of readings some of which are actually quotcd in this paper, while others have relevance to the topic for technical discussion. BIBLIOGFN PHY
BAZIAK, Anna T., What Constitutes Clinical Practice- -9 IVursing Forum, Vol. VII, No. 1, 1968, page 110.
COOPER, Signe S., Continuing Education - A Must for Nurses, Nursing Forum, ~ol.vII, No. 3, 1968, page 297.
DOWN, Josephine A., Goodnow's History of Nursing, W.B. Saunders Co., Philadelphia and London, 1963.
EUIOT, Robert H.E., The Cwrcnt Nursing Situation, The Journal of Medical Education, The Association of American Medical Colleges, Vol, 44, No. 3, 1969, pp. 1'78-183,
JAMIESON, Elizabeth M. and SENALL, Marj F,, Trends in Nursing History - Their Relationships to World Events, W.B. Saunders, 1949, page 609.
mON, Thora, Nursing Team Leadership, W.B, Saunders Philadelphia, London, 1961, page vii.
THE KORAN, SURA IV, translated from Arabic by the Rev. J.M. Rodwell,
?he Temple Press, Letchworth, 1950. '
IAMBERTSON, Eleanor C., me Emerging Health Occupations,-- page m.
LOW, T.C., Zhe Social Implications of Nursing Training in Developin@; Communities, South Pacific Commission, Noumea, 1958, page 15 + page vii,
HVGEKS, Martha, ResponsibiliLies uf the Individual as a Practitioner, Paper for the Michigan ~urses' Association Convention, October 16, 1964.
SIMMONS, Leo and HENDMSON, Virginia, PiUm3.w Rosearch, Appleton CtrlCUry -Crofts, 1964, PP. 279-283.
SPALDING, Eugene, Nursing Legislatfon and Education, Cakholic Urdversity of America Press, Washington, D.C., 1963, page 34.
WELCH, Janet, Nursing Education related to the Cultural Background in Eastern and Southeastern African Colonies, Carnegie Corporation, 1957.
WHITEHEAD, Alfred.North, The Aims of Education, The New American Library of World Publication, Tric ., New York, 1929, page 66; ' Comtdown 1968, Canadian ~urses' Association, Ottawa, 1968, page 151. , . Health is a Comrn~m€t.y Affair, National Commission on Community Health Services, Harvard University Press, Massachusetts, 1966, page 83.
~uidc-linesfor Assessing the Nursing Edilcation Needs of a Community, + National League of Nursing, 1967, page 5.
Nursing Care in a '~odernHospital, Oxford Rcgional Hospital Board, Operational Research Unit, Oxford, 1962.
Social Legislation and Nursing F'ractice, Paper for the 42nd Convention of the American Nurses ' Association, Miami Beach, American ~urses' Associatian, 1960.
Now for the Future, (pamphlet), Teachers College, Columbia University, New York, 1968.
The Columbia Viking Desk Encyclopedia, 'Ihe Viking Press, New York, 1968.
UNITED STATES DEPARTMENT OF HEALTH, EDUCATION AND WELFARE:
Design for Statewide Nursing Surveys, 1956.
Nursing Education ~acilitics,1965.
Patients and Personnel Speak, 1964,
Towards Qua1i;ty in Nursipg Needs and Goals, 1963. ------IN-TIONAL COUNCIL OF NURSES
Internatiorial CoMerence on the Planning of Nursing Studies, Florence Nightingale International Foundation, 1956.
How to Survey a ~chookof Mrsing, 1954:
?he Basic Education of the Professional Nurse, 1949, page 74 . .- HENDERSON, Virginia, Basic Principles of Nursing Care, S. Karger, Basel, 1968, _ page 42. ------. -. - .
ARNSTEIN, Margaret Gad Guide for-National Studiesof Nursing Resources, * - Geneva, 1953.
GOD&, H.A., Principles of Administration Applied. to Nursing Servicei- -- Geneva, 1958. EM/R~lg/~ech.~isc,/2 page 3
Report on First Regional Nursing Studies Seminar, Manila, 1965.
Second Nursing Edilcation Seminar, (Central Nursing School Suva, Fiji) Manlla., 1955.
Technical Advisory Committee on Nursing, Pan American Sanitary Bureau, 1969.
Nurses: Their Education and their Role in Health Programmes, (Technical Discussions at the Ninth World Health Assembly), The Chronicle, Vol. 10, No. 7, 1356, PP. 207-227.
World Health,. Speoial issue, Nursing in the world today, December 196%
Nursing Seminar, Lahore, Pakistan. Alexandria 1961.
Nul-si~~,(Twentieth Anniversary of the World Health Organization) me Chronicle, Vol. 22, No. 7, 1968, pp. 273-274. Guide for Schools of Nursing in India,- New Delhi, 1965, page 195. Nursing Seminar, Teheran, Iran, 1966, Alexandria 1968,
The Nursing Situation in the Region, Alexandria 1966.
TECHNICAL REPORT SERIES
Expert Committee on Nursix, Fifth Report, No. 347, Geneva 1966, -Working Conference on Nursing Education, No. 60, Geneva 1953, page 3. PUBLIC HEALTH PAPrnS
LYMAN, Katherine, Basic Nursing Education Programmes, A Guide to their Planning, No. 7, Geneva 1961,
ROBERTS, Doris E., The Staffing of Public Health and Out-patient Nursing Services, No. 21, Geneva 1963.
PAETZNICK, Marguerite, A Guide for Staffing a Hospital. N~~rsFngService, No. 31, Geneva, 1966.
LTJPUBLISHED PAPERS
EL BASSIR, Hawa A., The History and Experience of the Sudan in the Training and Utilization of Auxiliary Nurses and Midwives.
HASSAN, Soad Hussein, Basic Education and Training for the Professional Nurse in the Unitcd Arab Republic, 1960. ~M/~~lY/~ech.~isc./2 Annex
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