THE DEVELOPMENT of NURSING EDUCATION in the ENGLISH-SPEAKING CARIBBEAN ISLANDS by PEARL I

THE DEVELOPMENT OF NURSING EDUCATION IN THE ENGLISH-SPEAKING CARIBBEAN ISLANDS by PEARL I. GARDNER, B.S.N., M.S.N., M.Ed. A DISSERTATION IN HIGHER EDUCATION Submitted to the Graduate Faculty of Texas Tech University in Partial Fulfillment of the Requirements for the Degree of DOCTOR OF EDUCATION Approved Accepted Dean of the Graduate School August, 1993 ft 6 l^yrr^7^7 801 J ,... /;. -ô ACKNOWLEDGEMENTS C?^ /c-j/^/ C^ ;ô.^^ I would like to thank Dr. Clyde Kelsey, Jr., for his C'lp '^ ûnflagging support, his advice and his constant vigil and encouragement in the writing of this dissertation. I would also like to thank Dr. Patricia Yoder-Wise who acted as co-chairperson of my committee. Her advice was invaluable. Drs. Mezack, Willingham, and Ewalt deserve much praise for the many times they critically read the manuscript and gave their input. I would also like to thank Ms. Janey Parris, Senior Program Officer of Health, Guyana, the government officials of the Caribbean Embassies, representatives from the Caribbean Nursing Organizations, educators from the various nursing schools and librarians from the archival institutions and libraries in Trinidad and Tobago and Jamaica. These individuals agreed to face-to-face interviews, answered telephone questions and mailed or faxed information on a regular basis. Much thanks goes to Victor Williams for his computer assistance and to Hannelore Nave for her patience in typing the many versions of this manuscript. On a personal level I would like to thank my niece Eloise Walters for researching information in the nursing libraries in London, England and my husband Clifford for his belief that I could accomplish this task. 11 TABLE OF CONTENTS ACKNOWLEDGEMENTS ii ABSTRACT vi LIST OF TABLES viii LIST OF FIGURES ix CHAPTER I. INTRODUCTION 1 The Caribbean Area 1 II. STATEMENT OF THE PROBLEM 4 Conceptual Framework 9 Purpose of the Study 13 Delimitations and Limitations of the Study 18 Assumptions 19 Definition of Terms 19 Methodology 22 III. IMPACT OF EUROPEAN NURSING EDUCATION ON CARIBBEAN NURSING EDUCATION PRIOR TO THE RENAISSANCE AND REFORMATION 26 Summary 35 IV. THE EMERGENCE OF A NEW ERA OF LEARNING THE RENAISSANCE AND THE REFORMATION--IMPACT ON CARIBBEAN NURSING EDUCATION 37 Summary 45 V. THE BEGINNING OF EUROPEAN EXPLORATION AND EXPANSION--IMPACT ON CARIBBEAN NURSING EDUCATION 47 The Colonial Period 53 Summary 60 111 VI. CARIBBEAN NURSING EDUCATION IN TRANSITION.. 62 Current Educational Programs 73 Nursing Schools in Jamaica 82 Nursing Schools in St. Lucia 83 Nursing Schools in Trinidad and Tobago 84 Caribbean Nursing Schools—Trends in Unification 85 Summary 87 VII. DEVELOPMENT OF PROFESSIONAL NURSING ORGANIZATIONS IN THE CARIBBEAN AREA 90 The Nurses Association of Jamaica 90 The Caribbean Nursing Councils 93 The Trinidad/Tobago Nursing Council 93 The Caribbean Nurses Organization 95 The Regional Nursing Body 97 Contributions of Caribbean Nurses to the International Arena 101 Contributions to the Larger International Arena 102 Summary 107 VIII. CONCLUSIONS 114 Projections for the Future 123 Recommendations for Further Study 125 REFERENCES 127 APPENDICES A. INTERVIEW AND SURVEY QUESTIONNAIRES, LETTERS TO EMBASSIES AND CARIBBEAN NURSING SCHOOLS 134 IV B. JAMAICA NURSING SCHOOLS AND AREAS OF SPECIALIZATION 173 C. PROCEDURE FOR EVALUATION AND APPROVAL OF SCHOOLS OF NURSING WITHIN THE REGIONAL NURSING BODY 185 ABSTRACT During the past several hundred years, historians have elaborated on nursing care practices and the teaching modalities that were implemented to meet the exigencies of the times. These writings have described primitive eras, scientific trends, technological developments and research discoveries, and they have concentrated on the nursing developments in Europe, Asia, and North America. In the case of the Caribbean area, there is very little literature regarding the developments of nursing and the teaching of nurses; the fragmented information that is available, however, seems to convey a long adaptive process from Arawak existence to the current modern nursing educational system. The primary objective of this study was to identify the various factors, processes and people that influenced the adaptive growth and the progressive change from Arawak spiritualistic rites and rituals in the care of the sick and in the education of nurses, to the modern scientific approach currently used in the Caribbean area, which is comparable to more developed countries. Besides the adaptation over time, the study looked for new trends in nursing education in the Caribbean area and identified the projections of nursing educators for the future and the contributions that Caribbean trained nurses are currently making to the international arena. VI An extensive search for historical material was done through the Central Library of Trinidad and Tobago; the West Indian Reference Library in Trinidad; The World College of Nursing Library in London, England, the Jamaica Archives, the Jamaica Institute, The Daily Gleaner, The Jamaican Nurse, Index Medicus. the International Nursing Index, the Cumulative Index to Nursing and Allied Health Literature and the Nursing Studies Index. Questionnaires were sent to all the Caribbean Embassies. Structured telephone and face-to-face interviews were also done. Results from the study indicated a protracted course of events from spiritism, through an era of British brutality and servant girl approaches to modern nursing education. Societal pressures and the influence of the church emerged as significant factors in this adaptive process. In addition, significant contributions made by Caribbean nurses to the international arena through collaboration with various world health organizations were documented. vii LIST OF TABLES 1. Regional Nursing Body English-Speaking Schools in Caribbean 86 2. Presidents of the Nursing Association of Jamaica 92 Vlll LIST OF FIGURES 1. General Adaptation Syndrome Model 9 2. Process Model of Stress and Adaptation 10 3. Adaptation on the Life Continuum 11 4. Historical Time Line of the Development of Caribbean Nursing Education 109 5 . Nursing Education Sponsorship 178 6. University Hospital of the West Indies Courses 184 IX CHAPTER I INTRODUCTION The Caribbean Area There is little recorded information on the history of nursing education in the Caribbean area. For one to understand the development of nursing in this region however, one needs to have some knowledge of the Caribbean territory. The Caribbean area is a number of islands in a sea between North and South America. They were discovered by Columbus in 1492. This island chain measures approximately 1800 miles long and between 400 and 700 miles wide. The islands are bordered by the Gulf of Mexico on the North, and the Yucatan Channel on the South and are clustered by the Bahama Islands on the East. The Caribbean Sea which surrounds the islands is navigable, facilitating transportation between islands, while also serving as a pathway to both the Atlantic and the Pacific Oceans. Although hurricanes are prevalent between the months of June and October, rain that follows generally abates the long periods of drought, and therefore, much of the destruction by storms is generally minimized and accepted by the inhabitants. The Caribbean area has many good natural harbors: Havana and Santiago, Cuba; Kingston, Jamaica; the Mole, St. Nicholas and Samana Bay, Hispaniola; San Juan, Puerto Rico; and Castries, St. Lucia. These harbors facilitate commerce and shipping internationally. The Europeans migrated to the Caribbean Islands during the Reformation and Renaissance of the sixteenth century. It was a time when the Europeans were searching for new territories and new learning. The early settlers concentrated on the development of the region not only agriculturally and sociologically, but also educationally which likely included nursing education (Roberts, 1940). Columbus' plan provided for Spain to have sovereignty over the Caribbean Islands. England, France, and a host of other countries, however, had other plans for the area. In the fifteenth century, the Caribbean waters were filled with European pirates and buccaneers who fought for possession and sovereignty (Roberts, 1940). Saint Lucia changed hands four times between the French and the British during the struggle. Barbados remained permanently British while Guadelupe and Martinique remained French. This admixture of peoples has left its imprint on the Caribbean area to this day. The population includes people from nearly every nationality (Williams, 1970). The greatest number of people is of African descent, and in smaller numbers are Chinese, Indians, Germans, British, Spanish, Portuguese and Lebanese. Columbus described the Caribbean area as a land of gold (Roberts, 1940), but the islands were not devoid of problems. In his terms, the people were illiterate. Columbus could not understand their language nor could they understand Spanish. The island people represented two distinct groups: the Caribs (after whom the Caribbean is named) and the Arawaks. The behaviors of the two groups were markedly different. The Arawaks were a peace-loving red-skinned people who wore only feathers while the Caribs were aggressive and murderous (Williams, 1970). These aborigines had no reasonable plan for nursing care nor nursing education but neither did the Europeans at that time. The aborigines practiced magic and used herbs for treatment of the many epidemics, such as yellow fever, which was then highly prevalent. CHAPTER II STATEMENT OF THE PROBLEM

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