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Nursing education in the United Arab Emirates
Inr. J. Mm Srud., Vol. 23, NO. I. Printed m Great Britun
PP.
I-IO,lY86
OOZO-748906 13.00 + 0.00 Pcrgamon Press Ltd
Nursing education in the United Arab Emirates NABIL M. KRONFOLt, M.D., Dr. P.H. and MAROUF M. ATHIQUE, S.R.N., R.C.N.T., D.A.M.S., Ed.D. Department of Health Services Administration, American University of Beirut, Beirut, Lebanon.
Abstract-This paper reviews the development of the nursing manpower situation in the United Arab Emirates, with particular emphasis on the trends and currents that have had an impact on the national school of nursing in Abu Dhabi, in the last decade. Special attention is placed on the design of the nursing curriculum. This is based on a framework of core concepts derived from a philosophy relating to man, health and nursing. A competency-based model, designed for three levels of nursing personnel, each with well defined responsibilities, is presented along with an educational and professional career ladder for nurses* in the United Arab Emirates. A phased implementation of the proposed system of nursing education is undertaken, with the first phase nearing completion. Preparations are well underway to initiate the second phase of nursing education, that has been successfully implemented earlier in the state of Bahrain.
Background
The United Arab Emirates (U.A.E.), formally known as the Trucial States, is a federation of seven Emirates or Sheikdoms. It covers an area of approximately 77,700 km* and has a population of just over one million people (1980 census). The Emirates that form the federation, in geographical order from west to east, are: Abu Dhabi, Dubai, Sharjah, Ajman, Umm Al Quwain, Ras Al Khaimeh and Fujeirah. All of the seven Emirates except for Fujeirah lie on the southern shores of the Arabian Gulf and form a continuous coastal *For the sake of simplicity the female gender is used for nurses throughout. tProfessor and chairman. To whom correspondence should be addressed.
1
2
NABIL M. KRONFOL AND MAROUFM. A THIQUE
line stretching over 600 km from near the base of the Qatar peninsula in the west, to the Musandan peninsula in the east. The seventh Emirate, Fujeirah, is situated entirely on the Batinah coast of the Gulf of Oman with no access of its own to the Arabian Gulf (Fenelon, 1976). The high national revenue from oil has reflected on the high standards of living in the country; of greater importance has been its impact on the social fabric of society. Rapid changes have occurred in the socioculturai attitudes of people, more particularly in women and young adults. The cultural changes are enhanced by the interaction of the local population with the large number of expatriates from a multitude of nationalities who immigrate into the United Arab Emirates to work. In the field of health manpower, nursing is one of the largest labour intensive sectors. Within the last few decades, the technological and scientific advances in medicine and health care have led to a substantially higher rate of utilization of physician services and hospitalization than ever before. The health care facilities have expanded rapidly to accommodate the increasing demands for medical care. This has produced an unparalleled strain on the manpower situation. 5,m 4,5oG 4,m 3,500 3,m z ::
2,5m
z’ w
2oco ’
0
1,500 i il
loo0 ’ I
n Fig. 1. Employment of nurses in the U.A.E., 1972-1982.
In 1972, there were eight hospitals and a few clinics and mobile health services in the U.A.E., employing 465 nurses. A decade later, there are over 22 hospitals and scores of health centers and clinics scattered throughout the country, employing over 4500 nurses (Fig. 1). This does not take into account the nursing services provided by the oil companies, the Medical Corps, the Local Governments and the Private Sector (Ministry of Health, _ 1983). In 1983, nurses constituted 53% of the total health manpower in the U.A.E. The diagram (Fig. 2) shows the relationship between the number of nurses and the other groups of
NURSING EDUCATIONIN
THE UNITED ARAB EMIRATES
3
NURSES
PRYSICIANS
TECHNICIANS
Fig. 2. The relationship in the number of health professionals.
health professionals employed by the Ministry of Health. The majority of the nurses are expatriates. They are recruited from India, Pakistan, Egypt, the Philippines, Jordan, Somalia and other neighbouring Arab countries. With the consolidation and improvement of the health services during the next few years, the demand for qualified nurses is likely to increase. The need to train nurses locally will therefore become more acute, to assure quality of care to the residents of the U.A.E. (Kronfol and Athique, 1982). There are currently three nurse training institutes in the U.A.E. The Nursing School in Abu Dhabi is funded and administered by the federal government, through the Ministry of Health. This school prepares nurses to serve in the health facilities run by the federal government and has the largest enrollment. The Nursing School in Dubai comes under the aegis of the local government through the Dubai Department of Health and Medical Services. This school prepares candidates for the hospital services run by the local government. The third School of Nursing is also funded by the federal government, but is administered by the Medical Corps of the U.A.E. defence force. Graduates usually serve in the health care facilities maintained by the Ministry of Defence for the servicemen and their dependants. However, when the nurses complete their service commitments, they are free to move to any health agency they prefer.
Tbe Abu Dhnbi School of Nursing
Nursing education in the U.A.E. began in 1974 with the establishment of the School of Nursing in Abu Dhabi. The Nursing School was then staffed by one full-time director, one full-time tutor and two part-time instructors. The medical staff from the Abu Dhabi Central Hospital contributed to teaching. The School of Nursing was then housed within the grounds of the Central Hospital, whose clinical facilities were used for teaching purposes.
NABIL M. KRONFOL AND MAROUFM.
4
A THIQUE
The Nursing School’s first enrollment consisted of 15 students, nine girls and six boys, from the U.A.E. and other Gulf countries. The training program lasted 18 months and students graduated as Assistant Nurses. In the following year, the school admitted its first intake of six students for the three-year diploma in the nursing program to prepare General Nurses. Up to 1983, nine groups of students had graduated in both programs, with a total of 247 candidates (Table 1): 59 Assistant Nurses and 188 (76%) from the General Nurse program. Fifteen per cent of the graduates are Emirate nationals, the rest are nationals of other Gulf and Arab countries.
Table I. Graduates of the School of Nursing, Abu Dhabi 1975-1983 Graduating year 1975 1976 1977 1978 1979 1980 1981 1982 1983 Total
General Nurse UAE Arab Total
-
-
-
3 2 3 4 3 2 3 20
3 14 18 36 2
6 16 21 40 51 25 29 188
26 168
Assistant Nurse UAE Arab Total 7 5 3
-
8 12 13 2 2 4 2 -
15 17 16 2 2 4 3 -
16
43
59
-
1
UAE 7
5 6 2 3 4 4 2 3 36
Total Arab
Total
8 12 16 16 20 40 so 23 26 211
IS 17 22 18 23 44 54 25 29 247
The first nursing program was patterned after the Egyptian curriculum. In 1975, with the introduction of the General Nurse program, teachers seconded from the Ministry of Education contributed to the program and were responsible for the teaching of general subjects such as Arabic Language, Islamic Studies, General Sciences and English Language. The nursing content of the program was designed and offered by the Ministry of Health professionals, with contribution from the medical staff of the Central Hospital in Abu Dhabi. Physicians were in charge of teaching a wide range of subjects, such as anatomy, physiology, microbiology, principles of medicine, principles of surgery, forensic medicine, radiology, medico-legal aspects, public health, clinical pathology and psychiatry. Instruction was completely in Arabic. In that same year, the school of nursing in the State of Kuwait played an important role in the evolution of the nursing profession in the Arabian Gulf region. Many of the adopted nursing textbooks were prepared in Kuwait (Logan, 1974). This had an impact in the U.A.E. and some of the courses were accordingly redesigned to the Kuwait syllabus. A Board of Administration and bye-laws for the School of Nursing were established in September 1976. As a result, this institution was placed under the jurisdiction of the division of curative medicine in the Ministry of Health. In 1976, the Expert Committee on the Nursing and Allied Health professions was constituted by the Conference of the Arab Ministers of Health in the Arabian Gulf. Its mandate was to review, strengthen, standardize and unify the curricula of nursing programs across the Gulf States. In these formative years, the committee had a major influence in shaping the future of the nursing education in the Arabian Gulf. The main driving force
NURSING EDUCATIONIN
THE UNITEDARAB
EMIRATES
5
for change came from the College of Health Sciences in Bahrain and from nursing educators in Kuwait and Iraq. The role of the American University of Beiiut
In 1982, the Ministry of Health, cognizant of the need to develop local health manpower, invited the American University of Beirut, Lebanon, to spearhead the establishment of a College of Health Sciences, for the education and training of nursing and allied health personnel. The nucleus of this college was the school of nursing in Abu Dhabi. The American University of Beirut had previously established the College of Health Sciences in the State of Bahrain and designed and programmed its curricula and managed that institution on behalf of the Ministry of Health, for the first four years (1976-1980). A three-member team was stationed in Abu Dhabi, under the supervision of a project coordinator in Beirut. After a detailed study, the American University of Beirut team submitted a feasibility report on the Development of Health Manpower in the U.A.E. (Kronfol and Athique, 1982). The recommendations of the report were accepted and endorsed by the Ministry of Health of the U.A.E. The main theme of the recommendations called for a phased development of nursing and allied health education along a well defined career structure. Three levels of nursing education were recommended: (1) Secondary School Nursing program; (2) Associate Degree in Nursing program; (3) Bachelor in Nursing Degree program.
Educational ladder
The first phase consisted in the establishment of a secondary school nursing stream at the Ministry of Education. In the public school education system of the U.A.E., students are streamed off into different professions or vocations at the end of the intermediate school level. At present the educational tracts are Arts, Sciences, Technical, Commerce, Agriculture and Religion. After holding a series of intensive discussions by a team representing the Ministry of Health, the Ministry of Education and the University of the United Arab Emirates, the nursing stream was approved as a new educational tract in 1983. This assured the recognition of the three-year nursing diploma offered by the School of Nursing as equivalent to the official secondary school leaving certificate and as such, paved the way for the development of the educational career ladder for nurses. The secondary school nursing program is a new concept in the Gulf region, first adopted by the American University of Beirut in Bahrain. The successful students of this program receive a secondary school (Nursing) Certificate from the Ministry of Education and a Nursing Diploma from the Ministry of Health. Thus the student will meet the requirements for both secondary education and basic nursing education. This program will provide the U.A.E. with competent first level nurses that will form the backbone of the nursing service in the hospitals, primary health care centers and clinics. This new nursing program has larger implications for the nursing profession in the U.A.E. Hitherto, the graduates of the School of Nursing were not qualified for higher studies; with the implementation of the new program, a nurse from the School will have the same opportunity as any other secondary school graduate, to seek admission to
6
NABIL M. KRONFOL AND MAROUFM. A THIQUE
a university degree program or to post-secondary studies, in nursing and other health professions, provided of course, that she meets the other University admission requirements. The second phase will consist in the establishment of a post-secondary nursing program -the Associate Degree in Nursing. This program will aim at preparing competent middlelevel nurses, who would fill the role responsibilities of staff nurses, sisters and charge nurses in the nursing services of hospitals, health centers and clinics in the U.A.E. The third phase will lead to the establishment of a Bachelor in Nursing program. This will be an academic program, designed to prepare nurses to assume supervisory and leadership roles in the Nursing Service and Education of the U.A.E. and the Arabian Gulf region. This program may be regarded as the tertiary level of nursing education. It needs to be offered by a University or a College affiliated to a University. The basic level or the secondary school nursing program and perhaps the Intermediate level or the Associate degree nursing program will remain under the aegis of the Abu Dhabi School of Nursing. Curriculum framework
Nursing education can be viewed as a system that involves an input of students with different pre-requisites required by each level of training; the students then go through a process of teaching and learning new knowledge, skills and attitudes. The product or output of this process is a graduate possessing different and improved levels of competence. The whole system of nursing education is interlinked with nursing practice (Orem, 1971). In an attempt to devise a unified system of education, a curriculum framework is adapted which is applicable to all three levels of nursing education. Although the level and complexity of the attitude and skill acquisition is increased and the knowledge base expanded as the nurse passes from one level to another, there remains a coherence that binds the three levels of the nursing programs together. In this way, nurses can increase their professional competencies and personal development in a progressive and systematized manner. The three levels of nursing personnel can be distinguished by using the following criteria: (a) the ability to utilize the nursing process in increasingly complex situations, in any setting, with individuals and/or families, whether healthy or not, and (b) an increasing independence in judgement and nursing intervention. Thus, using the above criteria, the major characteristics of the three levels of nurses may be summarized in the following manner: Level one-Secondary School Nurse (Basic Nurse) A member of the nursing team. Always works in close proximity to qualified support. Looks after patients and families with uncomplicated pathologies and simple health needs in a hospital or clinic setting. Has limited adaptability. Level two-Associate Degree Nurse (Nurse Technician) A potential leader of the nursing team, capable of working with patients and families with complicated pathologies, complex health needs, in a variety of settings. Highly adaptable. Level three-Bachelor in Nursing Graduate (Nurse Manager) Potential independent nurse manager. Capable of planning and carrying out extensive and complex care programs. Is highly dependable, adaptable and innovative. The conceptual framework used in developing the nursing curriculum for the U.A.E.
NURSING EDUCA TION IN THE UNITED ARAB EMIRA TES
7
was adopted from the Bahrain Model (Kronfol and Affara, 1982). The suggested model provides a framework for nursing education that is practical and relevant to the U.A.E. and is sufficiently flexible to incorporate future changes. The core concepts are: (1) Man is a unique individual who is a bio-psycho-social being, acting in a holistic manner. (2) Man belongs to a family and to a community with its accompanying rights and duties. (3) Man varies in his ability to cope with his state of well-being, both in health and in illness. (4) Professional nursing involves the use of the problem-solving (nursing process) approach based on the knowledge of the activities of daily living. (5) Nursing care aims at helping people at all stages of their life-span to achieve their optimal level of health. In its most basic form, nursing is a complex set of acts mediated through a special relationship that the nurse establishes with the patient. The teaching of nursing uses the nursing process, to meet a patient’s health care needs and to maintain his activities of daily living (Quinn, 1980). Learning to ‘problem-solve’ as an approach to nursing education takes on further meaning in the real-life situations that confront nurses in hospitals and other health care facilities. For the most part, nurses deal with crisis situations in the lives of people, of different cultural patterns and social needs. For the purpose of curriculum planning, it is necessary to identify the factors that complicate these already difficult situations and consequently to assist the student nurse to manage these situations, as she progresses through her career. The system of nursing education in the U.A.E. is adapted from the ‘nursing model’ that was first proposed by Nancy Roper (1976) (Roper, 1976; Roper et al., 1980). This framework is based on the activities of daily living, unlike the traditional medical model, which is based on body systems and disorders. In conjunction with the process of nursing, this model allows nursing activities to be thought through, planned, designed, implemented and evaluated (Fig. 3).
HEALTH -
Fig. 3.
8
NABIL M. KRONFOL AND MAROUFM. ATHIQUE
It is pertinent here to recall the definition of nursing provided by Henderson
(1960).
“Nursing is primarily assisting the individual (sick or well) in the performance of those activities contributing to health, or its recovery (or to a peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge. It is likewise the unique contribution of nursing to help the individual to be independent of such assistance as soon as possible.”
Conelusion
Within the last decade the School of Nursing has made remarkable progress. The contribution of the American University of Beirut has had a catalytic effect to induce this change. In 1984, nearly 100 students enrolled in the basic nursing program. The school is preparing to accept yet another expansion in the number of students in subsequent years. The teaching staff of the School has increased to 16. There is, in addition, active participation by the medical staff and the nursing service in the various teaching functions. A competency-based nursing curriculum built on the model of nursing is developed to meet the needs of the U.A.E. This ensures that nursing education and practice are relevant to the social patterns of the U.A.E. population. The proposed scheme for the preparation of three levels of nursing personnel is intended to meet the needs of the Health Service in the U.A.E. The current role of the nurse in the U.A.E. is essentially supportive in nature, as well as providing care for the patients to cope with their daily needs. The education of nurses is evolved around this principle. This approach is crucial at the present moment in time. When the social awareness and the acceptance of the extended role of the nurse as an independent member of the health team has occurred, changes could be implemented to meet the new situation. The primary aim of nursing education in the U.A.E. is to provide competent nurses for the nursing services of the hospitals, health centers and clinics. Thus, the product should match the competencies required by the nursing services. The terminal competencies of the different levels of nurses are summarized in the appendices. References Kronfol, N. and Athique, M. (1982). Feasibility Study for Nursing and Allied Health Manpower Development in the United Arab Emirates. American University of Beirut and Ministry of Health, United Arab Emirates, unpublished report. Fenelon, K. G. (1976). The United Ayb Emirates-An Economic and Social Survey, 2nd Edn. Longman Group. London. Henderson, V. (1972). ICN Basic Principles of Nursing. International Council of Nursing, Geneva. Kronfol, N. M. and Affara, F. A. (1982). Nursing education in the Arabian Gulf: the Bahrain model. Inr. 1. NUTS.Stud. 19,89-98. Logan, W. (1974). Nursing services in a Gulf sheikdom. Nurs. Mirror 139,614. Ministry of Health (1983). Annuut Stutisticul Bulletin 1982. Ministry of Health, United Arab Emirates. Orem, D. E. (1971). Nursing: ConceptsofPructice. McGraw-Hill, New York. Quinn, F. M. (1980). The Principles and Practice of Nurse Educution. Croom-Helm. London. Roper, N. (1976). ClinicuiExperience in Nursing Educution. University of Edinburgh, Department of Nursing, Monograph No. 5. Churchill Livingstone, Edinburgh. Roper, N., Logan, W. W. and Tierney, A. J. (1980). The Elements ofNursing. Churchill Livingstone, Edinburgh. (Received 8 Junuary 1985; acceptedforpubtication
5 February 1985)
NURSING EDUCATIONIN
THE UNITED ARAB EMIRATES
9
Appendix 1 Terminal competencies of secondary school nurse (1) (2) (3) (4) (5)
Applies the nursing process when dealing with the immediate needs of the individual arising out of self-care and survival tasks (activities of daily living). Under supervision, or close proximity to qualified support, provides effective nursing care (health maintenance, health restoration and rehabilitation) to individuals of all ages with uncomplicated health problems and low dependency needs, in a hospital or clinic setting. Develop helpful working relationships with individuals within the health care team. Demonstrates the beginning competencies for undertaking own learning, and carries out simple instruction on basic health topics to individuals. As a member of the nursing profession, demonstrates a commitment to the attributes of the profession such as self-assessment, integrity, responsibility, dependability, confidentiality and a respect for others.
Appendix 2 Terminal competencies of associate degree nurse (1) Applies the nursing process in a variety of settings, in the delivery of nursing care to an individual or group. (2) Provides effective nursing care, with the capacity to act as the sole nursing member of a multi-disciplinary team, to groups and individuals of all ages with different levels and complexity of illness and in a variety of settings. (3) Establishes and maintains working and collaborative relationships with other members of the multidisciplinary team. (4) Manages the nursing team providing patient care to individuals and groups in a variety of settings. (3) Implements planned teaching activities for healthy and ill persons and other members of the nursing team. (6) Applies nursing research findings to improve nursing care. (7) Under guidance, demonstrates the capability to increase professional knowledge, skills and attitudes by independent learning. (8) As a member of the nursing profession, demonstrates a commitment to the attributes of the profession, such as self-assessment, integrity, responsibility, dependability, confidentiality and a respect for others.
Appendix 3 Terminal competencies of bachelor degree nurse (1) Applies wider and more specialized knowledge as well as analytic, synthetic and interpretive skills, in the use of the nursing process in a variety of settings.
(2) Provides effective nursing care, with the capacity to act as an independent nurse practitioner to groups (3) (4) (3) 6) (7) (8)
and individuals of all ages with different levels, complexities and dependencies of illness and adaptation, in a variety of settings. Establishes and maintains effective working and collaborative relationships with other health workers and professionals. Assumes leadership in the planning, delivery and evaluation of nursing care in the clinical and in the community settings. Plans and Implements patient teaching and health education programs as well as educational programs to improve the delivery of nursing care. Applies the research process to study and/or solve nursing and health problems. With minimal support, demonstrates the capability to be selfdirected and self-paced in carrying out activities to increase professional knowledge, skills and attitudes of a higher order. As member of the nursing profession, demonstrates a commitment to the attributes of the profession, such as self-assessment, integrity, responsibility, dependability, confidentiality and a respect for others.
10
NABIL M. KRONFOL AND MAROUFM. ATHIQUE
Nabil M. Kronfol, M.D., Dr.P.H., is professor and chairman of the department of health services administration at the American University of Beirut and senior consultant for health manpower development to the Ministries of Health of the Arabian Gulf States. Dr Kronfol, who was the founder and first dean of the College of Health Sciences in Bahrain, is currently the Project manager of the proposed College of Health Sciences in Abu Dhabi, U.A.E. Marouf M. Athique, S.R.N., R.C.N.T., D.A.M.S., Ed.D., is currently the Project Director of the College of Health Sciences in Abu Dhabi, U.A.E. Dr Athique was also associated previously with the Bahrain College of Health Sciences as the chairman of its department of Life Sciences.
PP.
I-IO,lY86
OOZO-748906 13.00 + 0.00 Pcrgamon Press Ltd
Nursing education in the United Arab Emirates NABIL M. KRONFOLt, M.D., Dr. P.H. and MAROUF M. ATHIQUE, S.R.N., R.C.N.T., D.A.M.S., Ed.D. Department of Health Services Administration, American University of Beirut, Beirut, Lebanon.
Abstract-This paper reviews the development of the nursing manpower situation in the United Arab Emirates, with particular emphasis on the trends and currents that have had an impact on the national school of nursing in Abu Dhabi, in the last decade. Special attention is placed on the design of the nursing curriculum. This is based on a framework of core concepts derived from a philosophy relating to man, health and nursing. A competency-based model, designed for three levels of nursing personnel, each with well defined responsibilities, is presented along with an educational and professional career ladder for nurses* in the United Arab Emirates. A phased implementation of the proposed system of nursing education is undertaken, with the first phase nearing completion. Preparations are well underway to initiate the second phase of nursing education, that has been successfully implemented earlier in the state of Bahrain.
Background
The United Arab Emirates (U.A.E.), formally known as the Trucial States, is a federation of seven Emirates or Sheikdoms. It covers an area of approximately 77,700 km* and has a population of just over one million people (1980 census). The Emirates that form the federation, in geographical order from west to east, are: Abu Dhabi, Dubai, Sharjah, Ajman, Umm Al Quwain, Ras Al Khaimeh and Fujeirah. All of the seven Emirates except for Fujeirah lie on the southern shores of the Arabian Gulf and form a continuous coastal *For the sake of simplicity the female gender is used for nurses throughout. tProfessor and chairman. To whom correspondence should be addressed.
1
2
NABIL M. KRONFOL AND MAROUFM. A THIQUE
line stretching over 600 km from near the base of the Qatar peninsula in the west, to the Musandan peninsula in the east. The seventh Emirate, Fujeirah, is situated entirely on the Batinah coast of the Gulf of Oman with no access of its own to the Arabian Gulf (Fenelon, 1976). The high national revenue from oil has reflected on the high standards of living in the country; of greater importance has been its impact on the social fabric of society. Rapid changes have occurred in the socioculturai attitudes of people, more particularly in women and young adults. The cultural changes are enhanced by the interaction of the local population with the large number of expatriates from a multitude of nationalities who immigrate into the United Arab Emirates to work. In the field of health manpower, nursing is one of the largest labour intensive sectors. Within the last few decades, the technological and scientific advances in medicine and health care have led to a substantially higher rate of utilization of physician services and hospitalization than ever before. The health care facilities have expanded rapidly to accommodate the increasing demands for medical care. This has produced an unparalleled strain on the manpower situation. 5,m 4,5oG 4,m 3,500 3,m z ::
2,5m
z’ w
2oco ’
0
1,500 i il
loo0 ’ I
n Fig. 1. Employment of nurses in the U.A.E., 1972-1982.
In 1972, there were eight hospitals and a few clinics and mobile health services in the U.A.E., employing 465 nurses. A decade later, there are over 22 hospitals and scores of health centers and clinics scattered throughout the country, employing over 4500 nurses (Fig. 1). This does not take into account the nursing services provided by the oil companies, the Medical Corps, the Local Governments and the Private Sector (Ministry of Health, _ 1983). In 1983, nurses constituted 53% of the total health manpower in the U.A.E. The diagram (Fig. 2) shows the relationship between the number of nurses and the other groups of
NURSING EDUCATIONIN
THE UNITED ARAB EMIRATES
3
NURSES
PRYSICIANS
TECHNICIANS
Fig. 2. The relationship in the number of health professionals.
health professionals employed by the Ministry of Health. The majority of the nurses are expatriates. They are recruited from India, Pakistan, Egypt, the Philippines, Jordan, Somalia and other neighbouring Arab countries. With the consolidation and improvement of the health services during the next few years, the demand for qualified nurses is likely to increase. The need to train nurses locally will therefore become more acute, to assure quality of care to the residents of the U.A.E. (Kronfol and Athique, 1982). There are currently three nurse training institutes in the U.A.E. The Nursing School in Abu Dhabi is funded and administered by the federal government, through the Ministry of Health. This school prepares nurses to serve in the health facilities run by the federal government and has the largest enrollment. The Nursing School in Dubai comes under the aegis of the local government through the Dubai Department of Health and Medical Services. This school prepares candidates for the hospital services run by the local government. The third School of Nursing is also funded by the federal government, but is administered by the Medical Corps of the U.A.E. defence force. Graduates usually serve in the health care facilities maintained by the Ministry of Defence for the servicemen and their dependants. However, when the nurses complete their service commitments, they are free to move to any health agency they prefer.
Tbe Abu Dhnbi School of Nursing
Nursing education in the U.A.E. began in 1974 with the establishment of the School of Nursing in Abu Dhabi. The Nursing School was then staffed by one full-time director, one full-time tutor and two part-time instructors. The medical staff from the Abu Dhabi Central Hospital contributed to teaching. The School of Nursing was then housed within the grounds of the Central Hospital, whose clinical facilities were used for teaching purposes.
NABIL M. KRONFOL AND MAROUFM.
4
A THIQUE
The Nursing School’s first enrollment consisted of 15 students, nine girls and six boys, from the U.A.E. and other Gulf countries. The training program lasted 18 months and students graduated as Assistant Nurses. In the following year, the school admitted its first intake of six students for the three-year diploma in the nursing program to prepare General Nurses. Up to 1983, nine groups of students had graduated in both programs, with a total of 247 candidates (Table 1): 59 Assistant Nurses and 188 (76%) from the General Nurse program. Fifteen per cent of the graduates are Emirate nationals, the rest are nationals of other Gulf and Arab countries.
Table I. Graduates of the School of Nursing, Abu Dhabi 1975-1983 Graduating year 1975 1976 1977 1978 1979 1980 1981 1982 1983 Total
General Nurse UAE Arab Total
-
-
-
3 2 3 4 3 2 3 20
3 14 18 36 2
6 16 21 40 51 25 29 188
26 168
Assistant Nurse UAE Arab Total 7 5 3
-
8 12 13 2 2 4 2 -
15 17 16 2 2 4 3 -
16
43
59
-
1
UAE 7
5 6 2 3 4 4 2 3 36
Total Arab
Total
8 12 16 16 20 40 so 23 26 211
IS 17 22 18 23 44 54 25 29 247
The first nursing program was patterned after the Egyptian curriculum. In 1975, with the introduction of the General Nurse program, teachers seconded from the Ministry of Education contributed to the program and were responsible for the teaching of general subjects such as Arabic Language, Islamic Studies, General Sciences and English Language. The nursing content of the program was designed and offered by the Ministry of Health professionals, with contribution from the medical staff of the Central Hospital in Abu Dhabi. Physicians were in charge of teaching a wide range of subjects, such as anatomy, physiology, microbiology, principles of medicine, principles of surgery, forensic medicine, radiology, medico-legal aspects, public health, clinical pathology and psychiatry. Instruction was completely in Arabic. In that same year, the school of nursing in the State of Kuwait played an important role in the evolution of the nursing profession in the Arabian Gulf region. Many of the adopted nursing textbooks were prepared in Kuwait (Logan, 1974). This had an impact in the U.A.E. and some of the courses were accordingly redesigned to the Kuwait syllabus. A Board of Administration and bye-laws for the School of Nursing were established in September 1976. As a result, this institution was placed under the jurisdiction of the division of curative medicine in the Ministry of Health. In 1976, the Expert Committee on the Nursing and Allied Health professions was constituted by the Conference of the Arab Ministers of Health in the Arabian Gulf. Its mandate was to review, strengthen, standardize and unify the curricula of nursing programs across the Gulf States. In these formative years, the committee had a major influence in shaping the future of the nursing education in the Arabian Gulf. The main driving force
NURSING EDUCATIONIN
THE UNITEDARAB
EMIRATES
5
for change came from the College of Health Sciences in Bahrain and from nursing educators in Kuwait and Iraq. The role of the American University of Beiiut
In 1982, the Ministry of Health, cognizant of the need to develop local health manpower, invited the American University of Beirut, Lebanon, to spearhead the establishment of a College of Health Sciences, for the education and training of nursing and allied health personnel. The nucleus of this college was the school of nursing in Abu Dhabi. The American University of Beirut had previously established the College of Health Sciences in the State of Bahrain and designed and programmed its curricula and managed that institution on behalf of the Ministry of Health, for the first four years (1976-1980). A three-member team was stationed in Abu Dhabi, under the supervision of a project coordinator in Beirut. After a detailed study, the American University of Beirut team submitted a feasibility report on the Development of Health Manpower in the U.A.E. (Kronfol and Athique, 1982). The recommendations of the report were accepted and endorsed by the Ministry of Health of the U.A.E. The main theme of the recommendations called for a phased development of nursing and allied health education along a well defined career structure. Three levels of nursing education were recommended: (1) Secondary School Nursing program; (2) Associate Degree in Nursing program; (3) Bachelor in Nursing Degree program.
Educational ladder
The first phase consisted in the establishment of a secondary school nursing stream at the Ministry of Education. In the public school education system of the U.A.E., students are streamed off into different professions or vocations at the end of the intermediate school level. At present the educational tracts are Arts, Sciences, Technical, Commerce, Agriculture and Religion. After holding a series of intensive discussions by a team representing the Ministry of Health, the Ministry of Education and the University of the United Arab Emirates, the nursing stream was approved as a new educational tract in 1983. This assured the recognition of the three-year nursing diploma offered by the School of Nursing as equivalent to the official secondary school leaving certificate and as such, paved the way for the development of the educational career ladder for nurses. The secondary school nursing program is a new concept in the Gulf region, first adopted by the American University of Beirut in Bahrain. The successful students of this program receive a secondary school (Nursing) Certificate from the Ministry of Education and a Nursing Diploma from the Ministry of Health. Thus the student will meet the requirements for both secondary education and basic nursing education. This program will provide the U.A.E. with competent first level nurses that will form the backbone of the nursing service in the hospitals, primary health care centers and clinics. This new nursing program has larger implications for the nursing profession in the U.A.E. Hitherto, the graduates of the School of Nursing were not qualified for higher studies; with the implementation of the new program, a nurse from the School will have the same opportunity as any other secondary school graduate, to seek admission to
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a university degree program or to post-secondary studies, in nursing and other health professions, provided of course, that she meets the other University admission requirements. The second phase will consist in the establishment of a post-secondary nursing program -the Associate Degree in Nursing. This program will aim at preparing competent middlelevel nurses, who would fill the role responsibilities of staff nurses, sisters and charge nurses in the nursing services of hospitals, health centers and clinics in the U.A.E. The third phase will lead to the establishment of a Bachelor in Nursing program. This will be an academic program, designed to prepare nurses to assume supervisory and leadership roles in the Nursing Service and Education of the U.A.E. and the Arabian Gulf region. This program may be regarded as the tertiary level of nursing education. It needs to be offered by a University or a College affiliated to a University. The basic level or the secondary school nursing program and perhaps the Intermediate level or the Associate degree nursing program will remain under the aegis of the Abu Dhabi School of Nursing. Curriculum framework
Nursing education can be viewed as a system that involves an input of students with different pre-requisites required by each level of training; the students then go through a process of teaching and learning new knowledge, skills and attitudes. The product or output of this process is a graduate possessing different and improved levels of competence. The whole system of nursing education is interlinked with nursing practice (Orem, 1971). In an attempt to devise a unified system of education, a curriculum framework is adapted which is applicable to all three levels of nursing education. Although the level and complexity of the attitude and skill acquisition is increased and the knowledge base expanded as the nurse passes from one level to another, there remains a coherence that binds the three levels of the nursing programs together. In this way, nurses can increase their professional competencies and personal development in a progressive and systematized manner. The three levels of nursing personnel can be distinguished by using the following criteria: (a) the ability to utilize the nursing process in increasingly complex situations, in any setting, with individuals and/or families, whether healthy or not, and (b) an increasing independence in judgement and nursing intervention. Thus, using the above criteria, the major characteristics of the three levels of nurses may be summarized in the following manner: Level one-Secondary School Nurse (Basic Nurse) A member of the nursing team. Always works in close proximity to qualified support. Looks after patients and families with uncomplicated pathologies and simple health needs in a hospital or clinic setting. Has limited adaptability. Level two-Associate Degree Nurse (Nurse Technician) A potential leader of the nursing team, capable of working with patients and families with complicated pathologies, complex health needs, in a variety of settings. Highly adaptable. Level three-Bachelor in Nursing Graduate (Nurse Manager) Potential independent nurse manager. Capable of planning and carrying out extensive and complex care programs. Is highly dependable, adaptable and innovative. The conceptual framework used in developing the nursing curriculum for the U.A.E.
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was adopted from the Bahrain Model (Kronfol and Affara, 1982). The suggested model provides a framework for nursing education that is practical and relevant to the U.A.E. and is sufficiently flexible to incorporate future changes. The core concepts are: (1) Man is a unique individual who is a bio-psycho-social being, acting in a holistic manner. (2) Man belongs to a family and to a community with its accompanying rights and duties. (3) Man varies in his ability to cope with his state of well-being, both in health and in illness. (4) Professional nursing involves the use of the problem-solving (nursing process) approach based on the knowledge of the activities of daily living. (5) Nursing care aims at helping people at all stages of their life-span to achieve their optimal level of health. In its most basic form, nursing is a complex set of acts mediated through a special relationship that the nurse establishes with the patient. The teaching of nursing uses the nursing process, to meet a patient’s health care needs and to maintain his activities of daily living (Quinn, 1980). Learning to ‘problem-solve’ as an approach to nursing education takes on further meaning in the real-life situations that confront nurses in hospitals and other health care facilities. For the most part, nurses deal with crisis situations in the lives of people, of different cultural patterns and social needs. For the purpose of curriculum planning, it is necessary to identify the factors that complicate these already difficult situations and consequently to assist the student nurse to manage these situations, as she progresses through her career. The system of nursing education in the U.A.E. is adapted from the ‘nursing model’ that was first proposed by Nancy Roper (1976) (Roper, 1976; Roper et al., 1980). This framework is based on the activities of daily living, unlike the traditional medical model, which is based on body systems and disorders. In conjunction with the process of nursing, this model allows nursing activities to be thought through, planned, designed, implemented and evaluated (Fig. 3).
HEALTH -
Fig. 3.
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It is pertinent here to recall the definition of nursing provided by Henderson
(1960).
“Nursing is primarily assisting the individual (sick or well) in the performance of those activities contributing to health, or its recovery (or to a peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge. It is likewise the unique contribution of nursing to help the individual to be independent of such assistance as soon as possible.”
Conelusion
Within the last decade the School of Nursing has made remarkable progress. The contribution of the American University of Beirut has had a catalytic effect to induce this change. In 1984, nearly 100 students enrolled in the basic nursing program. The school is preparing to accept yet another expansion in the number of students in subsequent years. The teaching staff of the School has increased to 16. There is, in addition, active participation by the medical staff and the nursing service in the various teaching functions. A competency-based nursing curriculum built on the model of nursing is developed to meet the needs of the U.A.E. This ensures that nursing education and practice are relevant to the social patterns of the U.A.E. population. The proposed scheme for the preparation of three levels of nursing personnel is intended to meet the needs of the Health Service in the U.A.E. The current role of the nurse in the U.A.E. is essentially supportive in nature, as well as providing care for the patients to cope with their daily needs. The education of nurses is evolved around this principle. This approach is crucial at the present moment in time. When the social awareness and the acceptance of the extended role of the nurse as an independent member of the health team has occurred, changes could be implemented to meet the new situation. The primary aim of nursing education in the U.A.E. is to provide competent nurses for the nursing services of the hospitals, health centers and clinics. Thus, the product should match the competencies required by the nursing services. The terminal competencies of the different levels of nurses are summarized in the appendices. References Kronfol, N. and Athique, M. (1982). Feasibility Study for Nursing and Allied Health Manpower Development in the United Arab Emirates. American University of Beirut and Ministry of Health, United Arab Emirates, unpublished report. Fenelon, K. G. (1976). The United Ayb Emirates-An Economic and Social Survey, 2nd Edn. Longman Group. London. Henderson, V. (1972). ICN Basic Principles of Nursing. International Council of Nursing, Geneva. Kronfol, N. M. and Affara, F. A. (1982). Nursing education in the Arabian Gulf: the Bahrain model. Inr. 1. NUTS.Stud. 19,89-98. Logan, W. (1974). Nursing services in a Gulf sheikdom. Nurs. Mirror 139,614. Ministry of Health (1983). Annuut Stutisticul Bulletin 1982. Ministry of Health, United Arab Emirates. Orem, D. E. (1971). Nursing: ConceptsofPructice. McGraw-Hill, New York. Quinn, F. M. (1980). The Principles and Practice of Nurse Educution. Croom-Helm. London. Roper, N. (1976). ClinicuiExperience in Nursing Educution. University of Edinburgh, Department of Nursing, Monograph No. 5. Churchill Livingstone, Edinburgh. Roper, N., Logan, W. W. and Tierney, A. J. (1980). The Elements ofNursing. Churchill Livingstone, Edinburgh. (Received 8 Junuary 1985; acceptedforpubtication
5 February 1985)
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THE UNITED ARAB EMIRATES
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Appendix 1 Terminal competencies of secondary school nurse (1) (2) (3) (4) (5)
Applies the nursing process when dealing with the immediate needs of the individual arising out of self-care and survival tasks (activities of daily living). Under supervision, or close proximity to qualified support, provides effective nursing care (health maintenance, health restoration and rehabilitation) to individuals of all ages with uncomplicated health problems and low dependency needs, in a hospital or clinic setting. Develop helpful working relationships with individuals within the health care team. Demonstrates the beginning competencies for undertaking own learning, and carries out simple instruction on basic health topics to individuals. As a member of the nursing profession, demonstrates a commitment to the attributes of the profession such as self-assessment, integrity, responsibility, dependability, confidentiality and a respect for others.
Appendix 2 Terminal competencies of associate degree nurse (1) Applies the nursing process in a variety of settings, in the delivery of nursing care to an individual or group. (2) Provides effective nursing care, with the capacity to act as the sole nursing member of a multi-disciplinary team, to groups and individuals of all ages with different levels and complexity of illness and in a variety of settings. (3) Establishes and maintains working and collaborative relationships with other members of the multidisciplinary team. (4) Manages the nursing team providing patient care to individuals and groups in a variety of settings. (3) Implements planned teaching activities for healthy and ill persons and other members of the nursing team. (6) Applies nursing research findings to improve nursing care. (7) Under guidance, demonstrates the capability to increase professional knowledge, skills and attitudes by independent learning. (8) As a member of the nursing profession, demonstrates a commitment to the attributes of the profession, such as self-assessment, integrity, responsibility, dependability, confidentiality and a respect for others.
Appendix 3 Terminal competencies of bachelor degree nurse (1) Applies wider and more specialized knowledge as well as analytic, synthetic and interpretive skills, in the use of the nursing process in a variety of settings.
(2) Provides effective nursing care, with the capacity to act as an independent nurse practitioner to groups (3) (4) (3) 6) (7) (8)
and individuals of all ages with different levels, complexities and dependencies of illness and adaptation, in a variety of settings. Establishes and maintains effective working and collaborative relationships with other health workers and professionals. Assumes leadership in the planning, delivery and evaluation of nursing care in the clinical and in the community settings. Plans and Implements patient teaching and health education programs as well as educational programs to improve the delivery of nursing care. Applies the research process to study and/or solve nursing and health problems. With minimal support, demonstrates the capability to be selfdirected and self-paced in carrying out activities to increase professional knowledge, skills and attitudes of a higher order. As member of the nursing profession, demonstrates a commitment to the attributes of the profession, such as self-assessment, integrity, responsibility, dependability, confidentiality and a respect for others.
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NABIL M. KRONFOL AND MAROUFM. ATHIQUE
Nabil M. Kronfol, M.D., Dr.P.H., is professor and chairman of the department of health services administration at the American University of Beirut and senior consultant for health manpower development to the Ministries of Health of the Arabian Gulf States. Dr Kronfol, who was the founder and first dean of the College of Health Sciences in Bahrain, is currently the Project manager of the proposed College of Health Sciences in Abu Dhabi, U.A.E. Marouf M. Athique, S.R.N., R.C.N.T., D.A.M.S., Ed.D., is currently the Project Director of the College of Health Sciences in Abu Dhabi, U.A.E. Dr Athique was also associated previously with the Bahrain College of Health Sciences as the chairman of its department of Life Sciences.