Developments in nursing education at South African Universities

Inr. 1. Nurs. Stud. Vol. 6, pp. 107-I 13. PcrgamonPress, 1969. Printedin Great Britain

Developments in Nursing Education at South African Universities CHARLOTTE

SEARLE,

D.Phil (Pret.),

R.N., R.M.,

RST.

Head, Dcjammt of Nursing, Fad& of Mdiciru, Lhitenio ofRdo?ia, P?doria, Tmnsvaal WITHIN the next twenty years nurse leaders in South Africa propose to have all professional nursing education provided at university level. They do not envisage that all nurses should be admitted to degree courses. They are planning for twenty-five per cent of all professional nurses to receive their education at 4# year degree level and the remainder at 3* year university diploma level. Such nurses will obtain state registration both as general nurses and as midwives, and, as is the case at present, will have studied public health and psychiatric nursing during the course. Whilst basic nursing degrees have been offered in South Africa since 1956, the basic nursing diploma offered at university level is new. The first students on such a course were admitted in I 968. South African universities generally offer both degree and diploma courses in those disciplines which have a professional bias. The difference between these two levels arises from the subject requirements for matriculation and also in the nature and number of subjects offered for the particular degree or diploma. There is also a difference in the range and depth of the content of each subject. However the major subjects in the particular disciplines are taken in common. Nurses in South Africa believe that the basic professional education of nurses should be organized on the same lines as that of social workers, teachers, lawyers, accountants and public administrators, to mention but a few of the professional groups who benefit from this two-tiered structure of profeJsiona1 education at university level.

for the Move

to udverdties Nurses have to reckon with man as a biological, a cultural, a social and a spiritual entity. They have to cope with the ever increasing demands of medical technology. They have to humanize the scientific aspects of health care and make it meaningful to the one on the receiving end- the patient. Without a very thorough grounding in the biological, medical, social and nursing sciences, they & not be able to cope effectively with the demands of the space age. They need to study man in all his dimensions, if they are to have success in applying medical and nursing technology Re8som

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to his needs. The university is par excellence the centre where the facilities exist for the proper interdigitation of all aspects of the study of man. The closed-circuit nursing education offered by hospital nursing schools cannot prepare the nurse for space age nursing. Nursing leaders vigorously condemn the principle that professional nurses should only be educated along with other nurses and only by nurses and medical practitioners, with here and there an interlarding of social scientists. This principle leads to tailoring of courses to meet the alleged special needs of nurses. In fact such courses never meet the real needs of the nurse nor do they form an adequate foundation for future study. Obsolescence in knowledge is a growing problem. New medical knowledge is accumulating so fast that the nurse must commit herself to a professional life-time of study. Flexibility of mind is therefore of crucial importance to the professional nurse. Professional nursing education should therefore be essentially concerned with the development of habits of thought, of attitudes of mind, with relating man’s health needs to man as a total being with biological, cultural, social and spiritual dimensions. University authorities support nurse leaders in their efforts to move nursing education into the universities, for they place a high valuation on health care. They are only too well aware that nursing colleges, hospital nursing schools and institutes of higher technology cannot provide the type of preparation which modem health care demands. Slow Progress

in

the Ileghbg

Mainly through the diffidence of the nursing profession in breaking down preconceived ideas about nursing education, and in regard to the evolving role of the professional nurse, basic professional nursing education at university level took a long time to take root, and indeed there are still nurses-note nurses, not university authorities or medical practitioners-who cannot reconcile themselves to this type of development. They prefer the hospital nursing school diploma with a post-basic diploma taken at university level. Post-basic nursing diplomas have existed at South African universities since 1935. Essential as such courses have been to meet our most urgent needs, they nevertheless fail in two very important aspects. They generally cater for persons who have their feet securely on the nursing hierarchial ladder, and who thus come to nursing education well weighted down with the traditions, and the limitations, of hospital nursing school education. A two or three semester course which by its very nature cannot reteach fundamentals, and cannot fill in too many gaps in the basic education of the nurse, is thus at best a temporary expedient in the struggle to improve nursing education. Furthermore such diploma courses cannot (at least in South Africa) provide the nurse with credits towards a degree, even though such courses are taken at higher education level. Further education is thus inevitably limited for the holders of these teaching or administration diplomas. The complexities of modem clinical nursing, of nursing education, public health care, nursing administration, nursing research, and the preparation of nursing literature in a highly industrialized, competitive, education-conscious society, such as pertains in South Africa, make it imperative for nurses to equip themselves as

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other professional groups do, to meet not only the changing needs of health care, but to do it within an educational framework which will equip them to do it adequately, and which has the recognition and approval of the community they serve.

First Nursing

Degrees

In 1956 the University of Pretoria, after a very close study of the potential of nursing science in all its dimensions as an academic discipline, introduced a B.A. (Nursing) degree in its Faculty of Arts. The concept of nursing degrees was not acceptable to the then members of the Faculty of Medicine, hence the location of the degree in the Faculty of Arts. So outstanding were the achievements of the nursing students in open competition with students from other disciplines attending common core subjects, and so high was the standard of their clinical practice, that the Medical Faculty soon urged that the nursing degree be located in the Faculty. Other universities studied the question, and by 1969 six universities had introduced basic 4 year degree courses and one had also introduced a 3 year basic diploma course. By I g7o an extra semester will be added to all of these courses. First Chair of Aksing In 1966 the University of Pretoria transferred the B.A. (Nursing) degree to the Faculty of Medicine and announced the establishment of a Department of Nursing Science within this Faculty. To crown it all a Chair of Nursing was also established. This Chair was to be known as “The South African Nursing Association Chair of Nursing-Commemoration of State registration of nurses and midwives 1891”. This was done in appreciation of a donation of R50,ooo (about 71,500 U.S. dollars) by the South African Nursing Association. The incumbent of this Chair would hold the posts of Head of the Department of Nursing and Professor of Nursing, with all the rights, responsibilities and privileges associated with a major university department. In effect this means that the nurse head of this department has a full share in, and voting rights on, all activities of the Faculty of Medicine including the duty to share in the lecturing to medical practitioners who are following post-graduate courses, and has a seat and a vote in the Senate of the University. It was indeed a moving moment when the first South African nurse took her seat in the Senate of a University. The words of praise for the nursing profession from the Chairman of the Senate, his acknowledgement of the duty universities have to nursing education, and the warm and lengthy applause which greeted the Professor of Nursing, as she took her seat, clearly indicated that the largest South African university had great pride in the fact that it had pioneered nursing education at degree level in Southern Africa. Dawn of a new approach No sooner had the B.A. (Nursing) degree been transferred to the Faculty of Medicine, than this Faculty resolved to change the designation of the degree to B.Cur. (Baccalaureus Curationis) and to introduce magister and doctors degreesto be known as M. Cur., and D.Cur., respectively. They took this step because they accepted the fact that the nurse has a special healing function of her own, hencecurationis-of healing, with the status of full partner to the medical practitioner in

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health care. Consequently the academic robes which the nurse will wear at graduation will be the same as those worn by medical graduates at the baccalaureus, magister and doctoral levels. This type of development is likely to take place at other universities as well. Masters and doctors degrees

Three universities now offer masters degrees in nursing and two offer doctors degrees as well. The masters degrees are available in nursing education, nursing administration and clinical nursing. It is hoped to add public health nursing at a later stage. All clinical courses have some common core subjects with post-graduate medical students, whilst the education and administration courses have some common core subjects with post-graduate students in general education or in public administration respectively. There are at present 16 nurses who are following master’s degrees and two have registered for a doctoral degree. The doctoral degree is primarily a research degree with study in depth of two aspects of nursing. Second Chair of Nursing

Towards the close of the 1968 academic year, the University of the Orange Free State announced the establishment of a Chair of Nursing Science, and the introduction of a full Department of Nursing Science within the Faculty of Social Science, pending the establishment of a Medical Faculty. The incumbent of the Chair would also hold the position of Head of the Department of Nursing and would enjoy full rights on the Faculty of Social Science, and would become a member of the Senate of the University, the first woman in fact to reach senate status in this particular university. Within the next five years at least three additional Chairs of Nursing should be established. A professorial Chair is the highest academic appointment in South Africa. The Chair is supported by associate professors in some cases, or by senior lecturers and lecturers. To date the Chairs of Nursing are supported by senior and other lecturers, although associate professorships might well be introduced within the next five years, depending on the availability of nurses who hold a doctorate. Proposed baccalaureus degreefor

registered nurses

In 1970 the University of Pretoria will introduce a three year baccalaureus degree for nurses who are already registered. The bias in such a course will be towards the physical, biological and social sciences, nursing education, nursing administration, public administration and a speciality subject in nursing. The course is being introduced to assist registered nurses to meet the challenges of this age. Interest in this course is so keen that all the other universities are showing interest in these developments at the Pretoria University. It can confidently be predicted that at least seven other universities will introduce such a degree in the next five years. This project is helping to reconcile registered nurses from hospital nursing schools to the development of basic nursing degree courses at universities.

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Registration of Nursing Degrees All draft nursing curricula are submitted by the universities to the statutory national registration body, namely the South African Nursing Council. Once this Council has approved a curriculum, it automatically registers the degree without further examination. It retains the right to inspect both the theoretical and practical aspects of the course, which it periodically does, so rendering a further examination for registration purposes unnecessary. Inter-university nursing committee Steps are being taken to set up an inter-university nursing committee which will be composed of all the heads of the various university departments of nursing, for the purpose of solving common problems, exchanging ideas on future development and maintaining high standards.

Broad Principlem Underlying The Various Currid

Each curriculum for the basic baccalaureus degree has from nine to twelve courses. A course means that the subject extends over one academic year. Semester courses are not listed as “courses”. Of these five to eight are common core courses open to any student in the university and four are purely nursing courses. These four however constitute the major subject group. The social science subjects constitute the second major group and the biological sciences the third major group, whilst such elective subjects as languages, philosophy or cultural anthropology constitute the supportive subjects. At present students are required to do 4000 hours of practical work, but with the compulsory inclusion of midwifery as from rg7o this will be increased to 5500 hours spread over 44 years. All universities require the student nurse to be a student member of the hospital and other services where she obtains her practical experience. Supernumerary status is not accepted. Great store is set on the value of the learning experience embodied in membership of the health team. The student thus early learns the invaluable lesson that the practical situation must always be associated with continued learning, that even in the basic learning situation she is contributing to the health care of the nation, and has responsibility for it and must therefore see it in all its facets and dimensions. Ward staff share in the supervision of clinical experience, but the major part of the clinical instruction is given by the university personnel, for the university has total control of the student except where a student in the learning situation provides patient care. Here the hospital accepts responsibility by the simple means of having the nurse lecturers appointed jointly by the university and the hospital, and the ward sisters (charge nurses) accredited by the university as practical instructors. From the South African point of view student status does not depend on whether the student is given a hospital scholarship for study at university, or whether the nation benefits in some measure from the practical work she performs during her clinical experience, or whether she is an actual member of the team, or merely an observer member. Student status really relates to the way the student is dealt with in the teaching situation, the amount and nature of the responsibility she is

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encouraged to take for her own educational development, the facilities and guidance provided for such self-activity, and the development of habits of thought, an enquiring mind and of the will to do something constructive with the education which society has placed within her reach.

RCsamCLes responsables du nursing en Rtpublique Sud-Africaine prevoient que toute la formation du personnel infirmier professionnel sera assumte par les universitb, tant au niveau du grade d&em6 aprts 44 ans qu’au niveau du diplome de 34 an&es d’ttudes. Le plan d’ttudes deviendrait done pareil a celui d’autres professions. Des autorites universitaires sont favorables a ce projet. Les responsables du nursing condamnent le principe qui veut les jnfirmieres professionnelles ne re9oivent leur formation qu’en compagnie d’autres infirn+res, alors que cette formation doit &trelike au developpement de certaines attitudes intellectuelles, de m&me qu’a l’ttude de l’humanite sous tous ses aspects. Le nursing ne peut que s’embourber s’il n’est largement base sur les sciences biologiques, physiques, mtdicales et sociales. Aprb une ttude trb approfondie du potentiel academique de la science du nursing, 1’Universitt de Pretoria a instaurt en 1956 un cows de 4 anntes de licence en nursing a sa Facultt des Lettres. Ce tours a tt6 transfkt en 1966 a la Facultt de Mkkcine, ou il a CtCorgan& en Dtpartement de Nursing, avec la premiere Chaire de Nursing existant dans une universitt sud-africaine. Le premier professeur de nursing sud-africaine a ttC chargt en 1967 de diriger ce dtpartement. En sa qualite de dirigeant d’un dtpartement universitaire, le professeur de nursing est devenu membre a part entitre du Con&l de la Fact&C de Mtdecine, ainsi que du Conseil de l’UniversitC. Reconnaissant le fait que le personnel infirmier a un droit d’exercice propre et le statut de collaborateur de mtdecin dans l’administration des soins de Sante, le Conseil de la Fact&t de Mtdecine a crtt la qualification “curationis” pour les grades de bachelier, de licencit et de docteur en nursing. Les cows de base pour le grade de bachelier en nursing se donnent a present darn six grandes universitts; une universitt dtcerne un diplome de base a l’issue d’un tours de 3 ans, tandis que trois dtcernent des grades de licencit et deux ceux de docteur. Dew universitCsont crtt une chaire de nursing. L’Universitt de Pretoria instaurera en 1970 un grade de bachelier a l’issue d’un cours de 3 ans, rtservt aux infirm&es dtjA diplomkes anttrieurement et qui pourront ainsi vaincre le handicap de page.

Remsmen-Dentro de 10s pr6ximos veinte adios las dirigentes de las enfermeras proponen ubicar toda la educaci6n profssional de la enfermera en las universidades, tanto la graduacibn de cuatro aiios y medio, coma el diploma de tres atios y media. Esto va de acuerdo con las pautas de educacidn de otros grupos profesionales. Las autoridades directivas u&e&arias apoyan ate movimiento. Las dirigentes de las enfermeras condenan el principio de que las enfermeras profesionales deberian ser educadas solamente en compatia de otras enfermeras, dado que su formacibn requiere ser conectada con urgencia con el desarrollo de la facultad de pensar, posicionea de la mente, y con el estudio de1 hombre en todas sus dimensiones. Sin una amplia base en ciencias biolbgicas, fisicas, mtdicas y sociales, las enfermeras deben hundirse. En 1956, despu&sde un estudio muy estricto de1 potential acadtmico de 10s conocimientos de las enfermeras, la Universidad de Pretoria inici6 una graduaci6n de Bachiller en Artes (Enfermeras) de 4 atios, en su Facultad de Artes. En 1966 traslad6 dichos studios a au Facultad de Medicina, en la que se establecid un Departamento de Enfermeras, y la primera cdtedra de Enkrmeras de toda la Univemidad Surafricana. En 1967 nombr6 el primer Profesor de Enfermeras surafricano coma cabexa de este

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Departamento. Como Jefe de un Departamento Universitario el Profesor de Enfermeras es miembro propietario de1 Consejo de la Facultad de Medicina al mismo tiempo que de1 Senado de la Universidad. En reconocimiento de1 hecho de1 especial sentimiento de las enfermeras dirigido hacia su condition de estado de plena asociada al medico en ejercicio para prestar atencidn sanitaria, el Consejo de la Facultad de Medicina concedio la denomination de “curationis” para sus grados de enfermera Bachiller, Maestra o Doctora. Actualmente seis de las principales Universidades desarrollan curses bhicos de grado de bachiller para enfermeras; una, ademb, desarrolla estudios de tres curses para diploma basico; tres otorgan tambien grad0 de Maestra, mientras que dos otorgan tambien grado de Doctora. DOSUniversidades han establecido Ckedras de Enfkmeras. En 1970 la Universidad de Pretoria iniciara un grado de bachiller de tres aims para enfermeras que ya estan en ejercicio, a efectos de capacitarlas para cumplir con las exigencias de la tpoca.

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