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Nursing education in Turkey: past and present
hf. J. NUB. Stud., Vol. 21, No. 3. pp. 209-219. Printed in Great Britain.
1984.
oo20-7489/t?d s3.00 + 0.00 0 1984 Pergamon Press Ltd
Nursing education in Turkey: past andpresent GULTEN UYER*, R.N., Ph.D. School of Nursing, Hacettepe University, Hacettepe, Ankara, Turkey
Introduction
Nursing education in Turkey has advanced quite rapidly during the last two decades. In order to be able to perceive and assess the articles and products of research by the Turkish authors, which will be appearing in future issues of this journal, one needs to have background information regarding the past and present situation of nursing education in Turkey. Historical background of nursiag education
Florence Nightingale has considerable influence on the implementation of nursing in Turkey in a modern sense. Professor Dr. Besim dmer Akalin, representative of the Red Crescent Association, went to London in 1907 to attend the Red Cross Conference. When he met Florence Nightingale during this conference he was very impressed with her personality and her professional activities. Also, during the first World War, since there was no proper care provided for wounded soldiers, many of them lost their lives. Thus the need for nurses had been realized intensively. Due to these facts and influences, the first organized program was introduced to prepare voluntary nurses in Istanbul in 1912. This six-month course could be considered the start of the nursing profession in Turkey. Nursing schools+
Admiral Bristol School of Nursing The first official School of Nursing was established by the Americans in Istanbul as a 2.5year program. In 1929 this program was increased to 3 years duration, which continued until 1957, and then a 4-year program was developed, with the authorization of the *Assistant Director of the Hacettepe University School of Nursing, Instructor of Pediatric Nursing Service Administration. -j-These schools are now called ‘Professional Health Lysee’.
Nursingand
GLLTEN
210
I able 1. Social background
UYER pertinent
to nursing
Area: 779,472 km z Population: 46,864,000, mid-1982 Population density: 6O/km? Vital statistics 1975-1980 Crude birth rate Crude death rate Natural increase Infant mortality Literacy rate Life expectanq: male 60.3, female 61 .h Gross national product per capita: $1300
(per 1000population) 34.9 10.0 20.7 I34 720
Number of hospitals (excluding military hospitals) Number of hospital beds available Number of hospital beds per IO.000 population Population per one bed Number of health centres
532 96,752 21 484 290
Nursing personnel in 1979: Number of nurses Number of nurses per IU,OOOpopulation Population per one nurse Number of midwives Midwives per 10,000 population
23,791 5.08 1969 15,904 3.39
General education: Duration of the primary \chooi Duration of the secondary school Duration of high school
5 yrs
3 yrs 3 yrs
Ministry of Education. This school, which was later called ‘Health Professional Lysee’, is still offering a nursing program, with the joint effort of Turkish and American nurses. Red Crescent School of Nursing
The first Turkish nursing school of the Republic Period was the Red Crescent School of Nursing, which was established by the Red Crescent Association in 1925. The first director of the School was a Medical doctor. Until 1948, the school was managed by the German, Austrian and American nurses. In 1948, a Turkish nurse was assigned as director of the school for the first time. The duration of the program was 2 years and 3 months, after primary school. But after 1929, only secondary school graduates were accepted. In 1936, a 3-yr program was adopted, and in 1937, upon completion of this program, the graduates were required to take State Board Examination. In 1958, the duration of the program was increased to 4 yr, and started being supervised by the Ministry of Health and Social Assistance and by the Ministry of Education, from the point of view of curriculum plan. At present the State Board Examination is not practised in this school. Military School of Nursing
The Military School of Nursing was established by the Ministry of Defence, within the premises of a Military Hospital in Ankara, in 1939, but because of the financial problems the school was closed in 1947 and students who were already enrolled with the school were transferred to the Red Crescent Nursing School. In 1972-1973, there was another Military School of Nursing opened by the Ministry of Defence, within the premises of the Military Academy of Medicine in Ankara.
TURKISHNURSING
EDUCATION
211
The duration of this program was 4 years following secondary school. The graduates are granted a Nursing Diploma upon completion of the school and assigned to the Military Hospitals in general.
Tevfik Sagiam School of Nursing Another school of nursing was established by the Tuberculosis Eradication Association, in Istanbul, in 1943. This 2-yr program after secondary school was called after a doctor who is the founder of the association, was aimed at training tuberculosis nurses only. This program was increased to 4 yr duration afterwards and transferred administratively to the Social Security Department.
Nursing Schools, Attached Ministry of Health and Social Assistance The first school of nursing program by the Ministry of Health and Social Assistance was started in Istanbul in 1946. At the beginning there were only two of these programs, within the premises of two different hospitals. The aim of these programs was the training of nurse lab-technicians with a duration of 3 years after secondary school. Other schools followed, in other cities in different years, training nurse-midwife-labtechnicians. In 1958, duration of these programs became 4 yr, with more emphasis on the social cultural subjects as well as professional subjects. They were called ‘Health Colleges’,* though by 1976, the name of these colleges was converted to ‘Professional Health Lysee’ and started offering two different programs, namely, ‘midwifery’ and ‘nursing’. There were around 90 programs altogether, of which some belonged to various ministeries, universities and associations. In 1979 curriculum plans of these schools needed revision. The Ministry of Health and Social Assistance asked the assistance of the Educational Committee of the Turkish Nurses Association. The aim of this revision was to bring a kind of uniformity to these various programs, which were conducted by various schools. In 1981, because of the change in Health policy of the Ministry of Health and Social Assistance, the number of nursing schools was limited to 42, excluding 16 schools which belong to the other ministries, universities and associations. The other nursing programs under this Ministry were converted to midwifery programs, totalling 34.
Health schools
Due to the shortage of trained nurses the need for auxiliary nursing personnel was taken into account in 1954 for the first time. Young women, aged 18-30 with primary school education, took 6-month courses in the midwifery hospitals. Upon completion of these courses graduates were assigned as rural midwives. In 1957, 12-18-month courses started, composed of the theory and practice of nursing and midwifery, in the general and midwifery hospitals. These candidates were also 18-30 years of age with a primary school education. Upon successful completion of the general hospital course, graduates were given a certificate, which entitled them to work as anxiliary nurses in the hospitals, and midwifery hospital course graduates were given a certificate, entitling them to work as rural midwives. *College does not mean university education.
212
GULTEN
UYER
In 1961 the Ministry of Health and Social Assistance converted these courses into ‘Health Schools’, developing a 3-yr teaching program and providing a diploma at the end of the program. The title of these graduates were again ‘auxilary nurse’ or ‘rural midwife’ depending on the program they undertook. In 1976, the schools training auxiliary nurses were closed down, but midwifery schools continued training midwives. In 1977 the duration of these programs was increased to 5 years, but in 1978, these schools were also discontinued.
Postgraduate nursing education Postgraduate nursing course
Because of the growing need for nursing instructors, nursing service managers and public health nurses, a ‘Postgraduate course’ for nurses was established by the Ministry of Health and Social Assistance, with the collaboration of World Health Organization, in 1952. And until 1959, 108 nurses had gone thorough this course, qualifying either as instructors, administrators or as public health nurses, for various schools and health agencies. This course was converted into the Gevher Nesibe Health Education Institute in 1961.
Gevher Nesibe Health Education Institute
This institute was founded by the Ministry of Health and Social Assistance in 1961. The aim of this 3 yr program was to offer post-basic studies to midwives, nurses and sanitary technicians, to help them gain further knowledge in their respective fields and to improve their abilities in teaching, administration and community health work. Nursing Bureau
The Nursing Bureau was established, in the ministry complex by the Ministry of Health and Social Assistance in 1950. It was attached to the General Director of Curative Medicine. Two nurses were assigned to this bureau. The aim of this bureau was to promote nursing education and the profession, primarily. Also, to organize and develop nursing education programs, to supervise nursing services and to defend nursing rights. Although this bureau had contributed a lot to the establishment of the post-basic nursing course and the supervision of the schools, it was discontinued. Nursing law A law (number 6283) regarding nursing was passed in parliament in 1954. Although this law has many deficiencies, it was a start in accepting nursing as a profession. And now, it is in the process of revision, with further developments.
Nursing advisory council
This council was established in 1957, to advise the Ministry of Health and Social Assistance regarding the nursing matters. Meetings were held periodically, by the Minister’s call, whenever they were needed.
TURKISHNURSING EDUCATION
213
Bachelor of science degree in nursing
Ege University School of Nursing * The first program leading to Bachelor of Science degree in nursing was established in 1955, affiliated with the Ege University in Izmir. The school offered a 4-yr program after high school as an undergraduate education in nursing. The aim of the school of musing was to prepare young women for the musing profession as well as teaching and administration positions. In 1973, the school started offering M.Sc. and Ph.D. degrees for graduates and in 1976, the school was qualified to offer positions such as Associate Professorship and Professorship to the graduates who occupy the University School of Nursing teaching positions. Florence Nightingale School of Nursing With the support of Florence Nightingale Schools of Nursing Foundation and A.I.D., 12 Turkish nurses were offered scholarships to go to U.S.A. to obtain B.S. and M.S. degrees at the University of Columbia. The intention was to prepare future instructors for The Florence Nightingale School of Nursing. These candidates returned to Turkey in 1959, after completing their academic preparations. In April 1961, the Florence Nightingale School of Nursing was established. According to the protocol signed by the Florence Nightingale Schools of Nursing Foundation and the Ministry of Health and Social Assistance, the school was attached to the Ministry. In 1975, it was transferred to the Faculty of Medicine of Istanbul University and in 1974, Ph.D. programs were started. The duration of the program was planned for 4 yr after high school and is continuing similarly at present. Hacettepe University School of Nursing In June 1961, Hacettepe University School of Nursing was established by the Ankara University, attached to the Hacettepe Research Institute of Child Health. Duration of the school was 5 yr after high school, including one year of English preparatory training. The establishment of this school played an important role in developing graduate studies in nursing in the country (Erhan, 1978).
Nursing education at the present
(A) Basic nursing education Basic nursing education in Turkey may be classified into the following categories: (1) diploma program in nursing, (2) Bachelor of Science degree in nursing. 1. Diploma program in nursing The Turkish Ministry of Health and Social Assistance is the authority responsible for accrediting nursing schools and for controlling and administrating educational programs. There are 42 Professional Health Lysees as of 1982 excluding 16 others, run by the Social Security Department, the Ministry of Defence, universities and other institutions. Admission requirements: candidates must have completed 5 years of primary education and 3 years of secondary education. Minimum age for admission is 15 years and the *Now, this school is called ‘Ege University
Higher School of Nursing’.
214
G UL TEN UYER
maximum is 18; also, no time should elapse between secondary school and the nursing school. The duration of the training is 4 years. On completion of the program, a Nursing Diploma is granted which entitles the graduates to have employment as bed-side nurses or as public health nurses (Table 2). Table 2. Curriculum Cultural
of the school of nursing
courses
First year
Turkish literature and linguistics Mathematics History Geography Introduction to science of physics Foreign language Gymnastics Religion (elective) National security Tourism Home economics
Third year
-
3 1 2 1 1
2 -
1
-
-
First year
Second year t
year
2
2 2 1 1
1 P
Fourth
-
-
t
1 -
2 2 Third year
1 P
t
1 P
Fourth year t 1 P
3
1 1 disease
Fundamentals of nursing History of nursing and ethics Interpersonal relationship in nursing Medical nursing Surgical nursing Pediatric nursing Obstetrics and gynecology Psychiatric nursing Public health nursing Teaching in nursing Administration in nursing First aid and disaster nursing Cultural
Second year
of the course (SMP, 1979).
5 2
Basic science courses Anatomy and physiology Biochemistry Microbiology Epidemiology and contagious Pharmacology Psychology Sociology Nutrition Introduction to pathology
and the weekly distribution
1 2 2
1 1
3 2
4
1
2 2
8 8 2 2
8 8 2 4 2 2 1
12 12
courses
Cultural courses (weekly total) Basic sciences courses (weekly total) Professional courses (weekly total) Practicals (weekly total) Practicals (yearly total) Total t = theory p = practicals I = lab. G = guidance
24 7
13 6
15 2
5 4 41 41+3G
5 16 37 37+3G
4 16 38 38+3G
3 11 24 38 38+3G
TURKISH
NURSING
215
EDUCA TION
2. Bachelor of Science degree in nursing At present there are three bachelor of science degree programs provided at the Universities of Izmir Ege University, Ankara Hacettepe University and Istanbul University. These schools aim at training university-trained general-duty nurses with the expectation that they will act as leaders in nursing services, instructors in nursing schools, community nurses in preventative medicine and as nurses for more sophisticated nursing care units. The duration of the training is four years. Candidates who hold either a high school diploma or a registered nurse or midwifery diploma are qualified to enter the School of Nursing after successfully passing the General University Entrance Examination. Although the basic principles of those schools are the same, there are variations in the composition of these programs. The Hacettepe University School of Nursing could be given as an example. A five-year course is provided at Hacettepe School of Nursing in Ankara. The first year is devoted to the English language only. And the students are expected to complete a minimum 139 credits in the four-year program. One month summer practice, following the first year, is included in this sum of credits (Table 3). Table 3. Curriculum of the Hacettepe superior school of nursing and the weekly distribution of the courses First year Autumn semester
Courses
Theory
Fundamentals of nursing I Introduction to nursing I Anatomy I Physiology I Introduction to psychology Introduction to biochemistry Histology
Spring semester
3 2 4 2 3 2 2 18
Courses Fundamentals of nursing II Introduction to nursing II Anatomy II Physiology II Introduction to microbiology Total Summer practice
Practice
Credit 4 2 4 3 3 2 2 20
4 0 0 2 0 0 0 4
Theory
Practice
Credit
4 1 4 2 2 13 0
12 0 0 2 2 16 40
7 1 4 3 3 18 3 21
Theory
Practice
Credit
6 2 3 4 2 2 19
12 0 0 0 0 0 12
Total Second year Autumn semester
Courses Medical nursing Interpersonal relationship in nursing I Pathology Pharmacology for nurses Principles of nutrition History of the Turkish revolution Total
Table 3-continued
9 2 3 4 2 0 19 overleaj
216
GVLTEN
VYER
Table 3-continued
Courses
Spring semester
Theory
Surgical nursing Interpersonal relationship in nursing Diet treatment in diseases Problems in philosophy in human sciences History of the Turkish revolution Total
6 1 9 3 2 15
Practice 12 0 0 0 0 12
Credit 9 1 3 3 0 16
_ Third year Autumn semester
Courses Obstetrics and gynecological Growth and development Introduction to epidemiology of contagious diseases Basic mathematics
Theory nursing
Credit
5 3
12 0
8 3
3 3 14
0 0 12
3 3 17
and care
Total
~~____
Practice
~~ Courses
Spring semester
Theory
Pediatric nursing Introduction to research methods Educational psychology Health statistics Introduction to sociology Environmental health Total
Fourth year Autumn semester
Theory
Courses
Psychiatric nursing Disaster nursing and first aid Ethics and history in nursing Nursing service administration Introduction to social-cultural
5 1 3 3 3 1 16
anthropology Total
5 2 2 2 3 14
Practice 12 0 0 0 0 0 12
Practice 16 0 0 0 0 16
Credit 8 1 3 3 3 1 19
Credit 9 2 2 2 3 18
__~~~ Spring semester
Courses Community
Theory
health nursing Total Total credits
5 5
Practice 16 16
Credit 9 9 139
Students are instructed and supervised throughout the clinical practice by the instructors who are also responsible for teaching these courses. The Teaching Certificate in Nursing program is available for the students who may choose to take education courses in parallel with their undergraduate studies during the third and fourth years. The department of Education of Hacettepe University offers a teaching certificate program, for various disciplines, one of which is nursing. The course runs for two terms with a minimum of 21 credits. Upon successful completion of the course, the students are granted a teaching certificate in nursing, besides the diploma in nursing. This certificate entitles them to teach in a School of Nursing.
TURKISH NURSING EDUCA TION
217
Academic work is also available for the graduates either as teaching staff of the school or as degree candidates in the Faculty of Graduate Studies. (B) Graduate studies in nursing Graduate studies in nursing are offered in three Universities of Turkey. Here, an example is given from Hacettepe University. At Hacettepe University, the Faculty of Graduate Study is composed of 46 different health disciplines, such as physiotherapy, nutrition and dietetics, home economics, etc., and of course, nursing. There are three levels of graduate studies in nursing, namely, (1) Master of Science degree in nursing; (2) Ph.D. in nursing; (3) Associate Professorship and Professorship in nursing. 1. Master of Science degree in nursing. The aim of this graduate study at Master of Science Degree level in Nursing is to assist graduates to improve both theoretically and in practice and to enable them to serve both as instructors in Nursing Schools and as clinical specialists or clinicians in hospitals. Areas of specialization: Master of Science degree in nursing Medical and surgical nursing Obstetric and gynecological nursing Pediatric nursing Psychiatric nursing Community health nursing Fundamentals of nursing.
The entrance requirement to the program is that the candidates must have a bachelor of science degree in nursing, with a cumulative grade point-average of at least 2.25-2.5 points and must be successful in an English examination in the field of nursing. Also, if the candidates have not completed the courses of curriculum development and measurement and evaluation in education, they are expected to have a total of six credits of educational courses in addition. Maximum duration of the educational program is four semesters. Candidates are required to complete minimum of 18 credits and to submit a thesis. 2. Ph.D. in Nursing. This program is run by the same department as the M.S. degree. The major purpose of the study leading to a doctorate degree in nursing is: to contribute to the improvement of the existing standards of nursing care through creative investigation of the science of nursing. The graduates are expected to act as leaders in nursing education, practice and research, to analyze nursing problems, with the help of related disciplines and to improve their skills of formulating new concepts and theories. Areas of specialization in doctorate degree in nursing: Surgical nursing Medical nursing Obstetric and gynecological nursing Pediatric nursing Community health nursing.
The entrance requirement to the program are: candidates must have a Master of Science degree in nursing with a cumulative grade point average of at least 3.0. Maximum duration of the educational program is 4-5 semesters. Minimum of 18 credits need to be completed and a dissertation has to be submitted. 3. Associate Professorship and Professorship in Nursing. Other degrees following doctorate degrees in nursing are assistant associate professorship, associate professorship
GUL TEN UYER
218
and full professorship. Each of these steps has certain requirements such as a certain amount of experience, good command of English, efficiency in knowledge and experience in a field of study, efficiency in producing outstanding publications, nationally and internationally, and carrying out outstanding research work. An assistant professorship is granted by the interuniversity Council, and a professorship is granted by the University Senate. C. Post-basic nursing education Gevher Nesibe Health Education Institute. This Institute of Health is the only one which offers a post-basic study to midwives and sanitary technicians, besides nurses. Areas of specialization of the Health Education Institute: Environmental Health Maternal and Child Health and Midwifery Medical.
Entrance requirements to these branches differ, depending on the area of speciality. The Environmental Health branch is for candidates holding diplomas of sanitary technicians. Maternal and Child Health and Midwifery branch is for candidates holding midwifery diplomas, and the Medical Branch is available for graduates of diploma school programs. Besides having these diplomas, candidates are required to pass the specific entrance examination of the Institute and have a satisfactory interview result. The duration of each branch is 3 yr. Upon completion of this program successfully, graduates are granted a diploma without any degree. Graduates are assigned either as an instructor, director of Professional Health Lysees, or to various positions in the preventive or curative medicine agencies, depending on the program they have gone through.
Conclusion
Although nursing in Turkey is considered a young profession, very rapid advancements in nursing education have been noted recently. As a result of these efforts, there are two full professors, four associate professors, around 25 nurses with a Ph.D. and around 20 nurses with M.S. degrees occupying teaching positions in the University nursing schools. It is hoped that the quantity of the qualified nurses will continue to increase, with equal distribution between nursing education and nursing service positions. Thus improvements will be noted in preventive and curative medicine, parallel to these improvements in nursing education in the near future.
References Bachelor Science Degree in Nursing (1982-1983), Hacettepe University School of Nursing, Ankara. Doctorate Degree in Nursing (198221983), Hacettepe University, Faculty of Sciences Graduate Studies, Department of Nursing, Ankara. Erhan, S. (1978). Hernsire/ikTorihi.Divan Matbaacilik Tesisleri, Istanbul. Master of Science Degree in Nursing, (1982-1983), Hacettepe University, Faculty of Health Sciences Graduate Studies, Department of Nursing, Ankara. Population Division of the Department of International Economic and Social Affairs of United Nations Secretariat (1979) New York. Saglik Liseleri Mtifredat Programi (1979). Turk Hemsireler Dernegi Egitim Komisyonu Raporu. Ankara. Statistical Pocket Book of Turkey (1980). State Institute of Statistics Printing Division, Ankara.
TURKISH NURSING EDUCA TION
219
(Received 20 September 1982; acceptedforpublication 20 September 1982)
Dr Gtilten Uyer graduated from the Red Crescent School of Nursing in Istanbul, Turkey in 1950, attended a post-basic course in 1953-54, a Public Health Course in Oxford in 1955-56, and a School of Nursing administration course in Edinburgh University, Scotland. She had her B.S. at Hacettepe University School of Nursing in Ankara in 1967, her M.S. in M.C.H. Nursing at Boston University, U.S.A. in 1969, Ph.D. in Pediatric Nursing at Hacettepe University in 1974 and completed her academic requirement of Associate Professorship at the same University in 1980. Dr Uyer started working as an instructor at the Red Crescent Nursing School. Her other experiences cover: tuberculosis nursing, post-basic course instructor, teaching educational subjects and Public Health Nursing (and director of the same course), Director of Gevher Nesibe Health Institute, Director of Hacettepe Hospital Nursing Service, Instructor of Hacettepe University School of Nursing and Assistant Director of Nursing Service at William Beaumont Hospital in Royal Oak, U.S.A. At present she is acting as an Assistant Director of the Hacettepe University School of Nursing and teaching Pediatric Nursing and Nursing Service Administration with the title of Associate Professor in Pediatric Nursing in the same School.
1984.
oo20-7489/t?d s3.00 + 0.00 0 1984 Pergamon Press Ltd
Nursing education in Turkey: past andpresent GULTEN UYER*, R.N., Ph.D. School of Nursing, Hacettepe University, Hacettepe, Ankara, Turkey
Introduction
Nursing education in Turkey has advanced quite rapidly during the last two decades. In order to be able to perceive and assess the articles and products of research by the Turkish authors, which will be appearing in future issues of this journal, one needs to have background information regarding the past and present situation of nursing education in Turkey. Historical background of nursiag education
Florence Nightingale has considerable influence on the implementation of nursing in Turkey in a modern sense. Professor Dr. Besim dmer Akalin, representative of the Red Crescent Association, went to London in 1907 to attend the Red Cross Conference. When he met Florence Nightingale during this conference he was very impressed with her personality and her professional activities. Also, during the first World War, since there was no proper care provided for wounded soldiers, many of them lost their lives. Thus the need for nurses had been realized intensively. Due to these facts and influences, the first organized program was introduced to prepare voluntary nurses in Istanbul in 1912. This six-month course could be considered the start of the nursing profession in Turkey. Nursing schools+
Admiral Bristol School of Nursing The first official School of Nursing was established by the Americans in Istanbul as a 2.5year program. In 1929 this program was increased to 3 years duration, which continued until 1957, and then a 4-year program was developed, with the authorization of the *Assistant Director of the Hacettepe University School of Nursing, Instructor of Pediatric Nursing Service Administration. -j-These schools are now called ‘Professional Health Lysee’.
Nursingand
GLLTEN
210
I able 1. Social background
UYER pertinent
to nursing
Area: 779,472 km z Population: 46,864,000, mid-1982 Population density: 6O/km? Vital statistics 1975-1980 Crude birth rate Crude death rate Natural increase Infant mortality Literacy rate Life expectanq: male 60.3, female 61 .h Gross national product per capita: $1300
(per 1000population) 34.9 10.0 20.7 I34 720
Number of hospitals (excluding military hospitals) Number of hospital beds available Number of hospital beds per IO.000 population Population per one bed Number of health centres
532 96,752 21 484 290
Nursing personnel in 1979: Number of nurses Number of nurses per IU,OOOpopulation Population per one nurse Number of midwives Midwives per 10,000 population
23,791 5.08 1969 15,904 3.39
General education: Duration of the primary \chooi Duration of the secondary school Duration of high school
5 yrs
3 yrs 3 yrs
Ministry of Education. This school, which was later called ‘Health Professional Lysee’, is still offering a nursing program, with the joint effort of Turkish and American nurses. Red Crescent School of Nursing
The first Turkish nursing school of the Republic Period was the Red Crescent School of Nursing, which was established by the Red Crescent Association in 1925. The first director of the School was a Medical doctor. Until 1948, the school was managed by the German, Austrian and American nurses. In 1948, a Turkish nurse was assigned as director of the school for the first time. The duration of the program was 2 years and 3 months, after primary school. But after 1929, only secondary school graduates were accepted. In 1936, a 3-yr program was adopted, and in 1937, upon completion of this program, the graduates were required to take State Board Examination. In 1958, the duration of the program was increased to 4 yr, and started being supervised by the Ministry of Health and Social Assistance and by the Ministry of Education, from the point of view of curriculum plan. At present the State Board Examination is not practised in this school. Military School of Nursing
The Military School of Nursing was established by the Ministry of Defence, within the premises of a Military Hospital in Ankara, in 1939, but because of the financial problems the school was closed in 1947 and students who were already enrolled with the school were transferred to the Red Crescent Nursing School. In 1972-1973, there was another Military School of Nursing opened by the Ministry of Defence, within the premises of the Military Academy of Medicine in Ankara.
TURKISHNURSING
EDUCATION
211
The duration of this program was 4 years following secondary school. The graduates are granted a Nursing Diploma upon completion of the school and assigned to the Military Hospitals in general.
Tevfik Sagiam School of Nursing Another school of nursing was established by the Tuberculosis Eradication Association, in Istanbul, in 1943. This 2-yr program after secondary school was called after a doctor who is the founder of the association, was aimed at training tuberculosis nurses only. This program was increased to 4 yr duration afterwards and transferred administratively to the Social Security Department.
Nursing Schools, Attached Ministry of Health and Social Assistance The first school of nursing program by the Ministry of Health and Social Assistance was started in Istanbul in 1946. At the beginning there were only two of these programs, within the premises of two different hospitals. The aim of these programs was the training of nurse lab-technicians with a duration of 3 years after secondary school. Other schools followed, in other cities in different years, training nurse-midwife-labtechnicians. In 1958, duration of these programs became 4 yr, with more emphasis on the social cultural subjects as well as professional subjects. They were called ‘Health Colleges’,* though by 1976, the name of these colleges was converted to ‘Professional Health Lysee’ and started offering two different programs, namely, ‘midwifery’ and ‘nursing’. There were around 90 programs altogether, of which some belonged to various ministeries, universities and associations. In 1979 curriculum plans of these schools needed revision. The Ministry of Health and Social Assistance asked the assistance of the Educational Committee of the Turkish Nurses Association. The aim of this revision was to bring a kind of uniformity to these various programs, which were conducted by various schools. In 1981, because of the change in Health policy of the Ministry of Health and Social Assistance, the number of nursing schools was limited to 42, excluding 16 schools which belong to the other ministries, universities and associations. The other nursing programs under this Ministry were converted to midwifery programs, totalling 34.
Health schools
Due to the shortage of trained nurses the need for auxiliary nursing personnel was taken into account in 1954 for the first time. Young women, aged 18-30 with primary school education, took 6-month courses in the midwifery hospitals. Upon completion of these courses graduates were assigned as rural midwives. In 1957, 12-18-month courses started, composed of the theory and practice of nursing and midwifery, in the general and midwifery hospitals. These candidates were also 18-30 years of age with a primary school education. Upon successful completion of the general hospital course, graduates were given a certificate, which entitled them to work as anxiliary nurses in the hospitals, and midwifery hospital course graduates were given a certificate, entitling them to work as rural midwives. *College does not mean university education.
212
GULTEN
UYER
In 1961 the Ministry of Health and Social Assistance converted these courses into ‘Health Schools’, developing a 3-yr teaching program and providing a diploma at the end of the program. The title of these graduates were again ‘auxilary nurse’ or ‘rural midwife’ depending on the program they undertook. In 1976, the schools training auxiliary nurses were closed down, but midwifery schools continued training midwives. In 1977 the duration of these programs was increased to 5 years, but in 1978, these schools were also discontinued.
Postgraduate nursing education Postgraduate nursing course
Because of the growing need for nursing instructors, nursing service managers and public health nurses, a ‘Postgraduate course’ for nurses was established by the Ministry of Health and Social Assistance, with the collaboration of World Health Organization, in 1952. And until 1959, 108 nurses had gone thorough this course, qualifying either as instructors, administrators or as public health nurses, for various schools and health agencies. This course was converted into the Gevher Nesibe Health Education Institute in 1961.
Gevher Nesibe Health Education Institute
This institute was founded by the Ministry of Health and Social Assistance in 1961. The aim of this 3 yr program was to offer post-basic studies to midwives, nurses and sanitary technicians, to help them gain further knowledge in their respective fields and to improve their abilities in teaching, administration and community health work. Nursing Bureau
The Nursing Bureau was established, in the ministry complex by the Ministry of Health and Social Assistance in 1950. It was attached to the General Director of Curative Medicine. Two nurses were assigned to this bureau. The aim of this bureau was to promote nursing education and the profession, primarily. Also, to organize and develop nursing education programs, to supervise nursing services and to defend nursing rights. Although this bureau had contributed a lot to the establishment of the post-basic nursing course and the supervision of the schools, it was discontinued. Nursing law A law (number 6283) regarding nursing was passed in parliament in 1954. Although this law has many deficiencies, it was a start in accepting nursing as a profession. And now, it is in the process of revision, with further developments.
Nursing advisory council
This council was established in 1957, to advise the Ministry of Health and Social Assistance regarding the nursing matters. Meetings were held periodically, by the Minister’s call, whenever they were needed.
TURKISHNURSING EDUCATION
213
Bachelor of science degree in nursing
Ege University School of Nursing * The first program leading to Bachelor of Science degree in nursing was established in 1955, affiliated with the Ege University in Izmir. The school offered a 4-yr program after high school as an undergraduate education in nursing. The aim of the school of musing was to prepare young women for the musing profession as well as teaching and administration positions. In 1973, the school started offering M.Sc. and Ph.D. degrees for graduates and in 1976, the school was qualified to offer positions such as Associate Professorship and Professorship to the graduates who occupy the University School of Nursing teaching positions. Florence Nightingale School of Nursing With the support of Florence Nightingale Schools of Nursing Foundation and A.I.D., 12 Turkish nurses were offered scholarships to go to U.S.A. to obtain B.S. and M.S. degrees at the University of Columbia. The intention was to prepare future instructors for The Florence Nightingale School of Nursing. These candidates returned to Turkey in 1959, after completing their academic preparations. In April 1961, the Florence Nightingale School of Nursing was established. According to the protocol signed by the Florence Nightingale Schools of Nursing Foundation and the Ministry of Health and Social Assistance, the school was attached to the Ministry. In 1975, it was transferred to the Faculty of Medicine of Istanbul University and in 1974, Ph.D. programs were started. The duration of the program was planned for 4 yr after high school and is continuing similarly at present. Hacettepe University School of Nursing In June 1961, Hacettepe University School of Nursing was established by the Ankara University, attached to the Hacettepe Research Institute of Child Health. Duration of the school was 5 yr after high school, including one year of English preparatory training. The establishment of this school played an important role in developing graduate studies in nursing in the country (Erhan, 1978).
Nursing education at the present
(A) Basic nursing education Basic nursing education in Turkey may be classified into the following categories: (1) diploma program in nursing, (2) Bachelor of Science degree in nursing. 1. Diploma program in nursing The Turkish Ministry of Health and Social Assistance is the authority responsible for accrediting nursing schools and for controlling and administrating educational programs. There are 42 Professional Health Lysees as of 1982 excluding 16 others, run by the Social Security Department, the Ministry of Defence, universities and other institutions. Admission requirements: candidates must have completed 5 years of primary education and 3 years of secondary education. Minimum age for admission is 15 years and the *Now, this school is called ‘Ege University
Higher School of Nursing’.
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G UL TEN UYER
maximum is 18; also, no time should elapse between secondary school and the nursing school. The duration of the training is 4 years. On completion of the program, a Nursing Diploma is granted which entitles the graduates to have employment as bed-side nurses or as public health nurses (Table 2). Table 2. Curriculum Cultural
of the school of nursing
courses
First year
Turkish literature and linguistics Mathematics History Geography Introduction to science of physics Foreign language Gymnastics Religion (elective) National security Tourism Home economics
Third year
-
3 1 2 1 1
2 -
1
-
-
First year
Second year t
year
2
2 2 1 1
1 P
Fourth
-
-
t
1 -
2 2 Third year
1 P
t
1 P
Fourth year t 1 P
3
1 1 disease
Fundamentals of nursing History of nursing and ethics Interpersonal relationship in nursing Medical nursing Surgical nursing Pediatric nursing Obstetrics and gynecology Psychiatric nursing Public health nursing Teaching in nursing Administration in nursing First aid and disaster nursing Cultural
Second year
of the course (SMP, 1979).
5 2
Basic science courses Anatomy and physiology Biochemistry Microbiology Epidemiology and contagious Pharmacology Psychology Sociology Nutrition Introduction to pathology
and the weekly distribution
1 2 2
1 1
3 2
4
1
2 2
8 8 2 2
8 8 2 4 2 2 1
12 12
courses
Cultural courses (weekly total) Basic sciences courses (weekly total) Professional courses (weekly total) Practicals (weekly total) Practicals (yearly total) Total t = theory p = practicals I = lab. G = guidance
24 7
13 6
15 2
5 4 41 41+3G
5 16 37 37+3G
4 16 38 38+3G
3 11 24 38 38+3G
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NURSING
215
EDUCA TION
2. Bachelor of Science degree in nursing At present there are three bachelor of science degree programs provided at the Universities of Izmir Ege University, Ankara Hacettepe University and Istanbul University. These schools aim at training university-trained general-duty nurses with the expectation that they will act as leaders in nursing services, instructors in nursing schools, community nurses in preventative medicine and as nurses for more sophisticated nursing care units. The duration of the training is four years. Candidates who hold either a high school diploma or a registered nurse or midwifery diploma are qualified to enter the School of Nursing after successfully passing the General University Entrance Examination. Although the basic principles of those schools are the same, there are variations in the composition of these programs. The Hacettepe University School of Nursing could be given as an example. A five-year course is provided at Hacettepe School of Nursing in Ankara. The first year is devoted to the English language only. And the students are expected to complete a minimum 139 credits in the four-year program. One month summer practice, following the first year, is included in this sum of credits (Table 3). Table 3. Curriculum of the Hacettepe superior school of nursing and the weekly distribution of the courses First year Autumn semester
Courses
Theory
Fundamentals of nursing I Introduction to nursing I Anatomy I Physiology I Introduction to psychology Introduction to biochemistry Histology
Spring semester
3 2 4 2 3 2 2 18
Courses Fundamentals of nursing II Introduction to nursing II Anatomy II Physiology II Introduction to microbiology Total Summer practice
Practice
Credit 4 2 4 3 3 2 2 20
4 0 0 2 0 0 0 4
Theory
Practice
Credit
4 1 4 2 2 13 0
12 0 0 2 2 16 40
7 1 4 3 3 18 3 21
Theory
Practice
Credit
6 2 3 4 2 2 19
12 0 0 0 0 0 12
Total Second year Autumn semester
Courses Medical nursing Interpersonal relationship in nursing I Pathology Pharmacology for nurses Principles of nutrition History of the Turkish revolution Total
Table 3-continued
9 2 3 4 2 0 19 overleaj
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GVLTEN
VYER
Table 3-continued
Courses
Spring semester
Theory
Surgical nursing Interpersonal relationship in nursing Diet treatment in diseases Problems in philosophy in human sciences History of the Turkish revolution Total
6 1 9 3 2 15
Practice 12 0 0 0 0 12
Credit 9 1 3 3 0 16
_ Third year Autumn semester
Courses Obstetrics and gynecological Growth and development Introduction to epidemiology of contagious diseases Basic mathematics
Theory nursing
Credit
5 3
12 0
8 3
3 3 14
0 0 12
3 3 17
and care
Total
~~____
Practice
~~ Courses
Spring semester
Theory
Pediatric nursing Introduction to research methods Educational psychology Health statistics Introduction to sociology Environmental health Total
Fourth year Autumn semester
Theory
Courses
Psychiatric nursing Disaster nursing and first aid Ethics and history in nursing Nursing service administration Introduction to social-cultural
5 1 3 3 3 1 16
anthropology Total
5 2 2 2 3 14
Practice 12 0 0 0 0 0 12
Practice 16 0 0 0 0 16
Credit 8 1 3 3 3 1 19
Credit 9 2 2 2 3 18
__~~~ Spring semester
Courses Community
Theory
health nursing Total Total credits
5 5
Practice 16 16
Credit 9 9 139
Students are instructed and supervised throughout the clinical practice by the instructors who are also responsible for teaching these courses. The Teaching Certificate in Nursing program is available for the students who may choose to take education courses in parallel with their undergraduate studies during the third and fourth years. The department of Education of Hacettepe University offers a teaching certificate program, for various disciplines, one of which is nursing. The course runs for two terms with a minimum of 21 credits. Upon successful completion of the course, the students are granted a teaching certificate in nursing, besides the diploma in nursing. This certificate entitles them to teach in a School of Nursing.
TURKISH NURSING EDUCA TION
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Academic work is also available for the graduates either as teaching staff of the school or as degree candidates in the Faculty of Graduate Studies. (B) Graduate studies in nursing Graduate studies in nursing are offered in three Universities of Turkey. Here, an example is given from Hacettepe University. At Hacettepe University, the Faculty of Graduate Study is composed of 46 different health disciplines, such as physiotherapy, nutrition and dietetics, home economics, etc., and of course, nursing. There are three levels of graduate studies in nursing, namely, (1) Master of Science degree in nursing; (2) Ph.D. in nursing; (3) Associate Professorship and Professorship in nursing. 1. Master of Science degree in nursing. The aim of this graduate study at Master of Science Degree level in Nursing is to assist graduates to improve both theoretically and in practice and to enable them to serve both as instructors in Nursing Schools and as clinical specialists or clinicians in hospitals. Areas of specialization: Master of Science degree in nursing Medical and surgical nursing Obstetric and gynecological nursing Pediatric nursing Psychiatric nursing Community health nursing Fundamentals of nursing.
The entrance requirement to the program is that the candidates must have a bachelor of science degree in nursing, with a cumulative grade point-average of at least 2.25-2.5 points and must be successful in an English examination in the field of nursing. Also, if the candidates have not completed the courses of curriculum development and measurement and evaluation in education, they are expected to have a total of six credits of educational courses in addition. Maximum duration of the educational program is four semesters. Candidates are required to complete minimum of 18 credits and to submit a thesis. 2. Ph.D. in Nursing. This program is run by the same department as the M.S. degree. The major purpose of the study leading to a doctorate degree in nursing is: to contribute to the improvement of the existing standards of nursing care through creative investigation of the science of nursing. The graduates are expected to act as leaders in nursing education, practice and research, to analyze nursing problems, with the help of related disciplines and to improve their skills of formulating new concepts and theories. Areas of specialization in doctorate degree in nursing: Surgical nursing Medical nursing Obstetric and gynecological nursing Pediatric nursing Community health nursing.
The entrance requirement to the program are: candidates must have a Master of Science degree in nursing with a cumulative grade point average of at least 3.0. Maximum duration of the educational program is 4-5 semesters. Minimum of 18 credits need to be completed and a dissertation has to be submitted. 3. Associate Professorship and Professorship in Nursing. Other degrees following doctorate degrees in nursing are assistant associate professorship, associate professorship
GUL TEN UYER
218
and full professorship. Each of these steps has certain requirements such as a certain amount of experience, good command of English, efficiency in knowledge and experience in a field of study, efficiency in producing outstanding publications, nationally and internationally, and carrying out outstanding research work. An assistant professorship is granted by the interuniversity Council, and a professorship is granted by the University Senate. C. Post-basic nursing education Gevher Nesibe Health Education Institute. This Institute of Health is the only one which offers a post-basic study to midwives and sanitary technicians, besides nurses. Areas of specialization of the Health Education Institute: Environmental Health Maternal and Child Health and Midwifery Medical.
Entrance requirements to these branches differ, depending on the area of speciality. The Environmental Health branch is for candidates holding diplomas of sanitary technicians. Maternal and Child Health and Midwifery branch is for candidates holding midwifery diplomas, and the Medical Branch is available for graduates of diploma school programs. Besides having these diplomas, candidates are required to pass the specific entrance examination of the Institute and have a satisfactory interview result. The duration of each branch is 3 yr. Upon completion of this program successfully, graduates are granted a diploma without any degree. Graduates are assigned either as an instructor, director of Professional Health Lysees, or to various positions in the preventive or curative medicine agencies, depending on the program they have gone through.
Conclusion
Although nursing in Turkey is considered a young profession, very rapid advancements in nursing education have been noted recently. As a result of these efforts, there are two full professors, four associate professors, around 25 nurses with a Ph.D. and around 20 nurses with M.S. degrees occupying teaching positions in the University nursing schools. It is hoped that the quantity of the qualified nurses will continue to increase, with equal distribution between nursing education and nursing service positions. Thus improvements will be noted in preventive and curative medicine, parallel to these improvements in nursing education in the near future.
References Bachelor Science Degree in Nursing (1982-1983), Hacettepe University School of Nursing, Ankara. Doctorate Degree in Nursing (198221983), Hacettepe University, Faculty of Sciences Graduate Studies, Department of Nursing, Ankara. Erhan, S. (1978). Hernsire/ikTorihi.Divan Matbaacilik Tesisleri, Istanbul. Master of Science Degree in Nursing, (1982-1983), Hacettepe University, Faculty of Health Sciences Graduate Studies, Department of Nursing, Ankara. Population Division of the Department of International Economic and Social Affairs of United Nations Secretariat (1979) New York. Saglik Liseleri Mtifredat Programi (1979). Turk Hemsireler Dernegi Egitim Komisyonu Raporu. Ankara. Statistical Pocket Book of Turkey (1980). State Institute of Statistics Printing Division, Ankara.
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(Received 20 September 1982; acceptedforpublication 20 September 1982)
Dr Gtilten Uyer graduated from the Red Crescent School of Nursing in Istanbul, Turkey in 1950, attended a post-basic course in 1953-54, a Public Health Course in Oxford in 1955-56, and a School of Nursing administration course in Edinburgh University, Scotland. She had her B.S. at Hacettepe University School of Nursing in Ankara in 1967, her M.S. in M.C.H. Nursing at Boston University, U.S.A. in 1969, Ph.D. in Pediatric Nursing at Hacettepe University in 1974 and completed her academic requirement of Associate Professorship at the same University in 1980. Dr Uyer started working as an instructor at the Red Crescent Nursing School. Her other experiences cover: tuberculosis nursing, post-basic course instructor, teaching educational subjects and Public Health Nursing (and director of the same course), Director of Gevher Nesibe Health Institute, Director of Hacettepe Hospital Nursing Service, Instructor of Hacettepe University School of Nursing and Assistant Director of Nursing Service at William Beaumont Hospital in Royal Oak, U.S.A. At present she is acting as an Assistant Director of the Hacettepe University School of Nursing and teaching Pediatric Nursing and Nursing Service Administration with the title of Associate Professor in Pediatric Nursing in the same School.