Chapter 1. Introduction 1

Chapter 1 Introduction

1.1 Introduction

Healthcare is changing dramatically due to the advancement of medical sciences and technology, the abundance of clinical research and the higher demands of consumers. As a key profession of healthcare, these changes represent a significant challenge to the nursing profession and nursing education in terms of maintaining the quality of services and preparing nurses for the future (MacLeod & Farrell 1994; Aiken, Sloane & Sochalski 1998; International Council of Nurses 1999; Long 2004; Bartels 2005; Covaleski 2005; Candela, Dalley & Benzel-Lindley 2006). Effective systems for regulation, education, research and management are key to strengthening the contribution of nursing services in order to achieve the required improvement in health outcomes (WHO 2002a). In response, nursing education is increasingly being restructured in many countries to prepare nurses for contemporary and future demands of healthcare (Spitzer 1998; Alderman 2001; Booth 2002).

Many countries around the world have realised the importance of higher education for nurses, and most countries are moving in this direction. The World Health Organisation Global Advisory Group in 1992 recommended that, when appropriate, countries should move basic nursing education to university standards (Modly, Zanotti, Poletti & Fitzpatrick 1995). This view was supported by many countries around the world, moving from hospital-based apprenticeship training to university- based education, enabling the acquisition of bachelor degree education as a minimum preparation for beginning professional nursing practice (Royal College of Nursing 1997; Pearson & Peels 2001b; Zabalegui, Macia, Marquez, Ricoma, Nuin, Mariscal, Pedraz, German & Moncho 2006; AACN 2007; CNA 2007). It is evident that bachelor of nursing (baccalaureate-nursing) graduates acquire unique skills as clinicians and demonstrate an important role in the delivery of safe patient care (Goode, Pinkerton, McCausland, Southard, Graham & Krsek 2001; McKinley, Chapter 1. Introduction 2

Aitken, Doig & Liu 2001; Aiken, Clarke, Cheung, Sloane & Silber 2003; AACN 2005, 2007).

In Sri Lanka, pre-registration nursing education is currently based on a three-year certificate level nursing program in schools of nursing that are attached to the Ministry of Health and four-year bachelor programs in nursing at universities. The government policy is that nursing education should be based on the four-year undergraduate nursing program (Ministry of Health 1992; Ministry of Health Nutrition and Welfare 2002; University Grant Commission 2007). In response, the University Grant Commission of Sri Lanka has approved four-year Bachelor of Science in Nursing programs (BScN) in three universities (University Grant Commission 2007). In addition to the proposed affiliation of existing schools of nursing to the university sector, several other universities including the Open University proposed to establish similar programs in the future (de Silva 2004; Dharmaratne, Goonasekara & Fernando 2006). However, there is no evidence to support the contention that existing and proposed undergraduate nursing curricula in universities are based on a common philosophy or an acceptable needs assessment. A lack of separate nursing council and national nursing competency standards are major challenges to develop a national level framework for nursing education in Sri Lanka.

Although Sri Lanka has achieved a relatively high health status given its low level of spending on healthcare services, a large segment of the population still experiences vital health problems at all stages of life, mainly due to lifestyle and the demographic changes accompanying the epidemiological transition (Jayasekara 2001; Jayasekara & Schultz 2007). Thus, it is essential that nursing curricula reflect the existing and future needs of healthcare in Sri Lanka, while focusing on rapidly changing technology and healthcare interventions.