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University education and the future nurse
Ink J. Surs. SLud.Vol. I, pp. xd.,PergamonPress,1963. Printedin GreatBritain
University Education and the Future Nurse PATRICIA
E. O’CONNELL,
S.R.N.,
H.V.Cert.,
Principal Health Visitor Tutor, University
F.R.S.H.
of Southampton.
IN DEALING WITH my topic I must first define my terms of reference, because the quality of education which can be given to the future nurse is dependent not only on the course she herself undertakes, but also on the preparation of those who are to be her teachers and her supervisors in practical work. I think that it is in common agreement among nurses that University education has a place for tutors, administrators and possibly for the persons who undertake clinical instruction of nurses in hospital wards, and in the field of the public health services. It is by no means a matter of common agreement that b&c nurses education At the moment the Nurse Tutors’ Courses are should take place in universities. approved and the qualification awarded by certain universities in this country, and there has been considerable correspondence in the .Ivursing Times recently about the value of the University outlook in this regard. Space does not permit me to deal in any way with this matter at present. What I do want to say is concerned with the basic education of the future nurse, and my experience allows me only to comment on the integrated course, which we have run as a pioneer scheme to prepare not only the basic nurse, but also the prime worker in public health nursing, namely the health visitor. I think that we have first of all to consider what we need from the nursing profession. In addition to well qualified skilled nurses to look after our sick, we also require persons of integrity and skill to undertake nursing of the community, and to give the health teaching and social service which is needed by families who are bombarded by the influences and propaganda rife in this materialistic society. As the nurse is increasingly taking on the responsibility for forming the policy of her own profession, so it is more and more important for us to attract into our ranks those women who are able and adequately prepared to undertake this task. One has to look back at the pre-Education Act, 1944, era when many girls were unable to go forward for this kind of education because of the financial limitations of their parents. Many families were able to give their girls a good grammar school or high school education, but could not possibly look forward to three or four years of expense in order that their daughters might obtain a University degree and enter one of the professions open to women. Nursing was a profession for which a girl could train without causing any financial embarrassment to her parents, and many of the girls, who today go through University on public grants, in those days found their way into the nurse training schools, and went forward to be the present-day
2
P.iTRICI.4 E. O'CO.V,VELL
leaders of their profession. Today we are faced with a different situation altogether. Any girl with sufficient intellectual capacity can qualify for a grammar school, undertake a sixth form course and, having obtained her ‘A’ level subjects at a sufficiently high standard, may enter University. She may be influenced by her parents and teachers who feel that her intellectual powers will be wasted if she goes into what they feel is the more practical vocation of nursing. Naturally it is always hoped by teachers that the best girls in their schools will go on to teach the next generation, and one must appreciate that teaching is a very important profession for women. We in the nursing profession quite naturally are interested in the same pool of women, and we feel that those girls who are vocationally inclined towards the care of people, sick or well, should have the same sort of encouragement to swell the ranks of what are sometimes known as the ‘healing’ professions. It is often the case that a girl with this type of bent will be encouraged to go to medical school rather than to enter a nursing training school, and one has to be perfectly honest and recognise that this is very often a quest for status, as much as for satisfaction in the work itself. By tradition medicine is a man’s profession and nursing is that of a woman, and it is often forgotten that there are many senior appointments in nursing out of which a girl will get far greater satisfaction and give more valuable service to her fellow men than if she stayed on the lowest rung, or one of the lower rungs, of the medical ladder. During the past few years much consideration has been given to the possibility of linking nurse training with a university, but so far in the United Kingdom this has only been achieved by the University of Edinburgh where there is an Integrated Degree Course in Arts or Science with Nursing. There are Advanced Courses available in Education and Administration for already qualified nurses, a Diploma being granted to those with a recognised University Degree and a Certificate to other candidates. In England many of the leaders of the nursing profession would prefer to see a girl enter a university and take an independent degree and afterwards go on to a nursing course, perhaps in some way modified to suit her intellectual needs. Such a course has recently been approved at the Nightingale Training School, St. Thomas’ Hospital, and is due to start shortly. For myself I feel that this is not the main answer to the problem of recruiting into the nursing profession the university-level girl who is thus vocationally inclined. Such a girl who has a real drive towards serving the community through nursing, wants to have some sort of direction in her immediate post-school education. In some way she wishes to study subjects which appear to her to have some relevence in her future. She likes to feel that every step forward in her education is also one in the preparation for what she finally feels an urge to do, She wants to feel that the people planning her course at that moment are those who understand what her final aim and ideal may be, and who are willing and able to help her towards it. I foresee that the girls who enter University in order to complete their general education by taking a degree in the humanities or the sciences, may well meet while at University the pressures which will turn them from their vocational intent in nursing, and they will end by g&g into completely different professions. Three years at university and looking forward to a completely separate course in hospital (which also normally takes three years) is a very long term plan for a girl who wishes to be geared, if loosely at least, to her profession from the time she leaves school.
L:k1VERSlTk
EDL%;1TIO,c’
AVD
THE
FL-TL’RE
.\L-RSE
3
The Integrated Course for Xurse/Health Visitor training which, since 1957, the University of Southampton has organised in co-operation with the Nightingale Training School at St. Thomas’ Hospital, London, is one of the early attempts in England and Wales to link with a University in an effort to derive full benefit of that type of education, and yet turn it to the professional and vocational needs of the I think it would be useful to look first at the main principles which students. underlie that scheme, bearing in mind that it is not a degree course and neither does it prepare the student for a certificate of the University. First we recognise the health visitor as a nurse whose work calls for individual judgments and action on the part of the basic field worker to a greater degree possibly than that found in other forms of nursing. There is therefore a need to inculcate a power of criticism and assessment from the earliest part of her professional education. Secondly, the syllabus for the Health Visitor Course is a stiff one academically. When a girl comes to pursue it after she has completed her nursing training and been in the field for a few years, she finds that she is rusty and that the concentrated academic work that she has to undertake is a great burden. In adolescence, learning and critical powers are at their peak, and we recognised at the planning stage that it might be useful to harness these powers at this age rather than later. We recognise also that the health visitor should have certain maturity and some experience of people before she really studies the skills and receives the practical instruction which is needed in order that she should follow through her profession adequately. We agreed from the first, therefore, that these skills should be taught at the end rather than at the beginning of the professional preparation. The third point I would like to make concerns the more traditional approach to health visitor training, which is grafted on to a general nurse training. This means that the student has dealt with abnormalities first and, having studied the sick, then turns to the consideration of the healthy individual and how to maintain his health. It seemed to us a far more logical approach that the healthy individual and the means to keep him healthy should be studied before sickness, and we have therefore developed our scheme in this way. Looked at as a whole the course is of the ‘sandwich’ nature, the student studying at the University for eight months at the age of 18 or 19, going on to the Nightingale Training School, St. Thomas’ Hospital for three years and three months, and there undertaking general nurse training including three months of obstetric experience and observation. During this period she takes the hospital examinations and becomes State Registered, and then she enters the University for a further six months during which she receives tuition in the skills and practices of her profession as a health visitor, namely in health visiting techniques, social casework and health education method. At the end of this six months of theory and practical work she takes the statutory examination leading to qualification as a health visitor, and can then enter either the profession of nursing or health visiting according to her will. The course is outlined in the particulars which we send out to candidates and we include in these particulars some details of lectures and practical work. Briefly they are as follows. The student comes to the University in the October of the first year and undertakes courses in physiology with anatomy, psychology, social administration, personal and community health and domestic economy. She also
-1
PATRICIA
E. O’CO,\;VELL
has a course in the health services with particular attention to the health visiting services and during the time she is at the University she undertakes certain background visits of observation to various statutory and voluntary agencies in the area, and spends quite a considerable period of time observing the work of the health visitors in urban and rural areas. She spends some time in a children’s nursery where she can observe and help with the care of healthy children, and this is supported by classes in care of the normal child, which are given by the health visitor tutor. As background education, she takes a course in social history with other students in the University. During these courses of lectures she joins the various groups in the University, making contact with the health visitor students in the post-certificate course and also with students in the social workers’ and economics courses. The type of study she undertakes is based on University practice, and we find that the preparation she has had during her ‘A’ Level years at school well fits her for the individual work which we expect of her. She is in the charge of a health visitor tutor who, at the completion of the University period, goes with her to the Nightingale Training School and supervises the Preliminary School course of sis weeks. Much of the practical work of this special preliminary course is able to be carried out in the wards of the hospital. During their three years at St. Thomas’ Hospital the students carry out the same theoretical programme as nurses in the ordinary course, and they join ‘blocks’ of study with them. They have an additional advantage in that their health visitor tutor visits them every week, and makes out for them a programme of tutorial classes in public health, visits of observation to relevent agencies, contact with special departments of the hospital such as the hospital almoner, and some visits to old In this way their interest in public people at home in the area of St. Thomas’. health is kept alive during the years that they are away from the University, and they are encouraged to view their nursing generally in the context of a community health service, linking the patients they meet in the wards and in the out-patient and discussing and thinking of the departments with their home background, measures that are needed to prevent recurrence of their illness, and to help them adapt to the community when they return to it. Certain aspects of nurse training are compulsory for these public health nursing students, and, whereas an obstetric course is only possible for some nurses in the Nightingale Training School at present, all the students in the Integrated Course have this three months’ of experience in the midwifery department. They also spend a period in the out-patients and casualty departments, the psychiatric unit and special departments such as the chest department and the venereal disease department. They undertake the minimum of training in the operating theatre which is compulsory to qualify for their general nursing course, as this is felt to be a highly specialised technique and not entirely relevent to a nurse who aims to practice in public health. They follow through the examination programme of the Nightingale Training School, but they are excused their Preliminary State Examinations by the General after two years and Nursing Council. They take their State Finals examination nine months in the hospital, but their names are not placed on the General Nursing Council Register until they have completed a full three years of practical nursing. The last three months’ period of their course is flexible. Having completed their
CSVIVEASITT- EDL-CATION
A,VD THE FUTURE
JVURSE
5
studies they are in a position to benefit from any experience of a senior nature in which they can take more responsibility among their non-State Registered colleagues. If by any chance they have had a period of sick leave over and above the minimal amount allowed by the General Nursing Council, then they can make this up at this period, without missing their ‘set’ when it returns to Southampton University. In this case they take their State Final examination later than their fellows. They arrive back at Southampton in the September of their final year and they start the last section of their course by undertaking a week’s observational experience in the field of domiciliary midwifery. They then join, for the majority of their lectures, the post-certificate health visitor course and study public health in relation to the community and the individual. They have lectures in epidemiology and modern problems of public health, in the health and social services, and in physical and mental development and management of the normal child. On a seminar basis they study health visiting method and social casework, and they are given lectures in methods of education and the opportunity of trying themselves out as group teachers of health subjects. We are fortunate in having help from the University Education Department in carrying our these projects. The students spend two weeks in a local psychiatric hospital, having lectures in mental disorder and observing psychiatric patients. They are thus able to compare the type of patient treated and the sort of treatments carried out in the full-scale psychiatric hospital with the smaller more specialised psychiatric unit of a general hospital, such as the one that they worked in at St. Thomas’. They carry out planned and supervised practical work with the health visitors of the area, giving advice in child care and other subjects, as well as meeting mothers’ groups and some school groups in the health education setting. They are fortunate in being able to visit many of the health and social work agencies in order to gain a background knowledge of the services available. The traditional health visitor course covers a period of nine months, and is overloaded with lectures and classes. By extending the integrated course over its two periods of eight months and six months (albeit with a gap of three years in between) we are enabled to give the students greater opportunity for group work and private study when they approach health visiting through the integrated course. They also have additional seminars in social psychology which we find impossible to fit into the ordinary health visitor course. So far we have completed only one course in this experiment. The students in it were small in number, but last JuIy the four of them qualified in their health visitors’ examination of the Royal Society of Health, after having done very well in their nurse training. These four are now completing their midwifery training, but we look forward to seeing how they fare when they emerge into the fieId as nurses and health visitors. We found them enthusiastic and mature, and able to adapt very well to all types of people and situations. We felt that this was partly due to their own characteristic enthusiasm, but we hoped very much that the sort of preparation we had given them made a contribution to their acceptability in the public health field. The next group of students are now undertaking the final part of their course, and we look forward in April to seeing them qualified. Whether or not they are going to undertake hospital nursing or public health has yet to be revealed, but, whichever field they prefer, the broad base of their preparation will give them great advantages.
6
PA?-RICLiE. 0. O'CO.KVELL
In the space allowed I have been able to dwell only very briefly on the details of this course. The Tutor to the Integrated Course, Miss H. M. FVilliams has recently completed a detailed report of the first five years of the experimental scheme. Miss Williams has been with us three years and has been responsible for the continuity of teaching at the University and at the hospital for three out of the five groups who have completed their first year with us. The appointment of such a tutor is of prime importance in the adjustment of the students to the various aspects of their course. I would conclude by emphasising that this is an interesting project which has been carried out since 1957 as a pioneer scheme. There are other such integrated courses in the country, all of them based on some common principles but implemented in different ways. We feel that ours has a particular value in that it offers some University association for those girls whose intellectual level warrants it and I personally would very much like to see the number of students that we can cater for increased in some way. At the moment, as we all well know, there is a limit to the number of students that can be taken in at a university, and at present we have had to be satisfied with an intake of eight per year. So far the wastage has been small. During the first course we took in only five students. Of this five, four completed the course. The second intake of students has dropped somewhat due to the usual reasons of marriage, sickness and suchlike. Later groups appear to be maintaining their numbers, and recruitment is good. We are fortunate in that the students in the present courses are very keen and we all find them very satisfying to work with. It will be interesting to note over the period of the next ten years or so the type of work they take up following their nursing career.
University Education and the Future Nurse PATRICIA
E. O’CONNELL,
S.R.N.,
H.V.Cert.,
Principal Health Visitor Tutor, University
F.R.S.H.
of Southampton.
IN DEALING WITH my topic I must first define my terms of reference, because the quality of education which can be given to the future nurse is dependent not only on the course she herself undertakes, but also on the preparation of those who are to be her teachers and her supervisors in practical work. I think that it is in common agreement among nurses that University education has a place for tutors, administrators and possibly for the persons who undertake clinical instruction of nurses in hospital wards, and in the field of the public health services. It is by no means a matter of common agreement that b&c nurses education At the moment the Nurse Tutors’ Courses are should take place in universities. approved and the qualification awarded by certain universities in this country, and there has been considerable correspondence in the .Ivursing Times recently about the value of the University outlook in this regard. Space does not permit me to deal in any way with this matter at present. What I do want to say is concerned with the basic education of the future nurse, and my experience allows me only to comment on the integrated course, which we have run as a pioneer scheme to prepare not only the basic nurse, but also the prime worker in public health nursing, namely the health visitor. I think that we have first of all to consider what we need from the nursing profession. In addition to well qualified skilled nurses to look after our sick, we also require persons of integrity and skill to undertake nursing of the community, and to give the health teaching and social service which is needed by families who are bombarded by the influences and propaganda rife in this materialistic society. As the nurse is increasingly taking on the responsibility for forming the policy of her own profession, so it is more and more important for us to attract into our ranks those women who are able and adequately prepared to undertake this task. One has to look back at the pre-Education Act, 1944, era when many girls were unable to go forward for this kind of education because of the financial limitations of their parents. Many families were able to give their girls a good grammar school or high school education, but could not possibly look forward to three or four years of expense in order that their daughters might obtain a University degree and enter one of the professions open to women. Nursing was a profession for which a girl could train without causing any financial embarrassment to her parents, and many of the girls, who today go through University on public grants, in those days found their way into the nurse training schools, and went forward to be the present-day
2
P.iTRICI.4 E. O'CO.V,VELL
leaders of their profession. Today we are faced with a different situation altogether. Any girl with sufficient intellectual capacity can qualify for a grammar school, undertake a sixth form course and, having obtained her ‘A’ level subjects at a sufficiently high standard, may enter University. She may be influenced by her parents and teachers who feel that her intellectual powers will be wasted if she goes into what they feel is the more practical vocation of nursing. Naturally it is always hoped by teachers that the best girls in their schools will go on to teach the next generation, and one must appreciate that teaching is a very important profession for women. We in the nursing profession quite naturally are interested in the same pool of women, and we feel that those girls who are vocationally inclined towards the care of people, sick or well, should have the same sort of encouragement to swell the ranks of what are sometimes known as the ‘healing’ professions. It is often the case that a girl with this type of bent will be encouraged to go to medical school rather than to enter a nursing training school, and one has to be perfectly honest and recognise that this is very often a quest for status, as much as for satisfaction in the work itself. By tradition medicine is a man’s profession and nursing is that of a woman, and it is often forgotten that there are many senior appointments in nursing out of which a girl will get far greater satisfaction and give more valuable service to her fellow men than if she stayed on the lowest rung, or one of the lower rungs, of the medical ladder. During the past few years much consideration has been given to the possibility of linking nurse training with a university, but so far in the United Kingdom this has only been achieved by the University of Edinburgh where there is an Integrated Degree Course in Arts or Science with Nursing. There are Advanced Courses available in Education and Administration for already qualified nurses, a Diploma being granted to those with a recognised University Degree and a Certificate to other candidates. In England many of the leaders of the nursing profession would prefer to see a girl enter a university and take an independent degree and afterwards go on to a nursing course, perhaps in some way modified to suit her intellectual needs. Such a course has recently been approved at the Nightingale Training School, St. Thomas’ Hospital, and is due to start shortly. For myself I feel that this is not the main answer to the problem of recruiting into the nursing profession the university-level girl who is thus vocationally inclined. Such a girl who has a real drive towards serving the community through nursing, wants to have some sort of direction in her immediate post-school education. In some way she wishes to study subjects which appear to her to have some relevence in her future. She likes to feel that every step forward in her education is also one in the preparation for what she finally feels an urge to do, She wants to feel that the people planning her course at that moment are those who understand what her final aim and ideal may be, and who are willing and able to help her towards it. I foresee that the girls who enter University in order to complete their general education by taking a degree in the humanities or the sciences, may well meet while at University the pressures which will turn them from their vocational intent in nursing, and they will end by g&g into completely different professions. Three years at university and looking forward to a completely separate course in hospital (which also normally takes three years) is a very long term plan for a girl who wishes to be geared, if loosely at least, to her profession from the time she leaves school.
L:k1VERSlTk
EDL%;1TIO,c’
AVD
THE
FL-TL’RE
.\L-RSE
3
The Integrated Course for Xurse/Health Visitor training which, since 1957, the University of Southampton has organised in co-operation with the Nightingale Training School at St. Thomas’ Hospital, London, is one of the early attempts in England and Wales to link with a University in an effort to derive full benefit of that type of education, and yet turn it to the professional and vocational needs of the I think it would be useful to look first at the main principles which students. underlie that scheme, bearing in mind that it is not a degree course and neither does it prepare the student for a certificate of the University. First we recognise the health visitor as a nurse whose work calls for individual judgments and action on the part of the basic field worker to a greater degree possibly than that found in other forms of nursing. There is therefore a need to inculcate a power of criticism and assessment from the earliest part of her professional education. Secondly, the syllabus for the Health Visitor Course is a stiff one academically. When a girl comes to pursue it after she has completed her nursing training and been in the field for a few years, she finds that she is rusty and that the concentrated academic work that she has to undertake is a great burden. In adolescence, learning and critical powers are at their peak, and we recognised at the planning stage that it might be useful to harness these powers at this age rather than later. We recognise also that the health visitor should have certain maturity and some experience of people before she really studies the skills and receives the practical instruction which is needed in order that she should follow through her profession adequately. We agreed from the first, therefore, that these skills should be taught at the end rather than at the beginning of the professional preparation. The third point I would like to make concerns the more traditional approach to health visitor training, which is grafted on to a general nurse training. This means that the student has dealt with abnormalities first and, having studied the sick, then turns to the consideration of the healthy individual and how to maintain his health. It seemed to us a far more logical approach that the healthy individual and the means to keep him healthy should be studied before sickness, and we have therefore developed our scheme in this way. Looked at as a whole the course is of the ‘sandwich’ nature, the student studying at the University for eight months at the age of 18 or 19, going on to the Nightingale Training School, St. Thomas’ Hospital for three years and three months, and there undertaking general nurse training including three months of obstetric experience and observation. During this period she takes the hospital examinations and becomes State Registered, and then she enters the University for a further six months during which she receives tuition in the skills and practices of her profession as a health visitor, namely in health visiting techniques, social casework and health education method. At the end of this six months of theory and practical work she takes the statutory examination leading to qualification as a health visitor, and can then enter either the profession of nursing or health visiting according to her will. The course is outlined in the particulars which we send out to candidates and we include in these particulars some details of lectures and practical work. Briefly they are as follows. The student comes to the University in the October of the first year and undertakes courses in physiology with anatomy, psychology, social administration, personal and community health and domestic economy. She also
-1
PATRICIA
E. O’CO,\;VELL
has a course in the health services with particular attention to the health visiting services and during the time she is at the University she undertakes certain background visits of observation to various statutory and voluntary agencies in the area, and spends quite a considerable period of time observing the work of the health visitors in urban and rural areas. She spends some time in a children’s nursery where she can observe and help with the care of healthy children, and this is supported by classes in care of the normal child, which are given by the health visitor tutor. As background education, she takes a course in social history with other students in the University. During these courses of lectures she joins the various groups in the University, making contact with the health visitor students in the post-certificate course and also with students in the social workers’ and economics courses. The type of study she undertakes is based on University practice, and we find that the preparation she has had during her ‘A’ Level years at school well fits her for the individual work which we expect of her. She is in the charge of a health visitor tutor who, at the completion of the University period, goes with her to the Nightingale Training School and supervises the Preliminary School course of sis weeks. Much of the practical work of this special preliminary course is able to be carried out in the wards of the hospital. During their three years at St. Thomas’ Hospital the students carry out the same theoretical programme as nurses in the ordinary course, and they join ‘blocks’ of study with them. They have an additional advantage in that their health visitor tutor visits them every week, and makes out for them a programme of tutorial classes in public health, visits of observation to relevent agencies, contact with special departments of the hospital such as the hospital almoner, and some visits to old In this way their interest in public people at home in the area of St. Thomas’. health is kept alive during the years that they are away from the University, and they are encouraged to view their nursing generally in the context of a community health service, linking the patients they meet in the wards and in the out-patient and discussing and thinking of the departments with their home background, measures that are needed to prevent recurrence of their illness, and to help them adapt to the community when they return to it. Certain aspects of nurse training are compulsory for these public health nursing students, and, whereas an obstetric course is only possible for some nurses in the Nightingale Training School at present, all the students in the Integrated Course have this three months’ of experience in the midwifery department. They also spend a period in the out-patients and casualty departments, the psychiatric unit and special departments such as the chest department and the venereal disease department. They undertake the minimum of training in the operating theatre which is compulsory to qualify for their general nursing course, as this is felt to be a highly specialised technique and not entirely relevent to a nurse who aims to practice in public health. They follow through the examination programme of the Nightingale Training School, but they are excused their Preliminary State Examinations by the General after two years and Nursing Council. They take their State Finals examination nine months in the hospital, but their names are not placed on the General Nursing Council Register until they have completed a full three years of practical nursing. The last three months’ period of their course is flexible. Having completed their
CSVIVEASITT- EDL-CATION
A,VD THE FUTURE
JVURSE
5
studies they are in a position to benefit from any experience of a senior nature in which they can take more responsibility among their non-State Registered colleagues. If by any chance they have had a period of sick leave over and above the minimal amount allowed by the General Nursing Council, then they can make this up at this period, without missing their ‘set’ when it returns to Southampton University. In this case they take their State Final examination later than their fellows. They arrive back at Southampton in the September of their final year and they start the last section of their course by undertaking a week’s observational experience in the field of domiciliary midwifery. They then join, for the majority of their lectures, the post-certificate health visitor course and study public health in relation to the community and the individual. They have lectures in epidemiology and modern problems of public health, in the health and social services, and in physical and mental development and management of the normal child. On a seminar basis they study health visiting method and social casework, and they are given lectures in methods of education and the opportunity of trying themselves out as group teachers of health subjects. We are fortunate in having help from the University Education Department in carrying our these projects. The students spend two weeks in a local psychiatric hospital, having lectures in mental disorder and observing psychiatric patients. They are thus able to compare the type of patient treated and the sort of treatments carried out in the full-scale psychiatric hospital with the smaller more specialised psychiatric unit of a general hospital, such as the one that they worked in at St. Thomas’. They carry out planned and supervised practical work with the health visitors of the area, giving advice in child care and other subjects, as well as meeting mothers’ groups and some school groups in the health education setting. They are fortunate in being able to visit many of the health and social work agencies in order to gain a background knowledge of the services available. The traditional health visitor course covers a period of nine months, and is overloaded with lectures and classes. By extending the integrated course over its two periods of eight months and six months (albeit with a gap of three years in between) we are enabled to give the students greater opportunity for group work and private study when they approach health visiting through the integrated course. They also have additional seminars in social psychology which we find impossible to fit into the ordinary health visitor course. So far we have completed only one course in this experiment. The students in it were small in number, but last JuIy the four of them qualified in their health visitors’ examination of the Royal Society of Health, after having done very well in their nurse training. These four are now completing their midwifery training, but we look forward to seeing how they fare when they emerge into the fieId as nurses and health visitors. We found them enthusiastic and mature, and able to adapt very well to all types of people and situations. We felt that this was partly due to their own characteristic enthusiasm, but we hoped very much that the sort of preparation we had given them made a contribution to their acceptability in the public health field. The next group of students are now undertaking the final part of their course, and we look forward in April to seeing them qualified. Whether or not they are going to undertake hospital nursing or public health has yet to be revealed, but, whichever field they prefer, the broad base of their preparation will give them great advantages.
6
PA?-RICLiE. 0. O'CO.KVELL
In the space allowed I have been able to dwell only very briefly on the details of this course. The Tutor to the Integrated Course, Miss H. M. FVilliams has recently completed a detailed report of the first five years of the experimental scheme. Miss Williams has been with us three years and has been responsible for the continuity of teaching at the University and at the hospital for three out of the five groups who have completed their first year with us. The appointment of such a tutor is of prime importance in the adjustment of the students to the various aspects of their course. I would conclude by emphasising that this is an interesting project which has been carried out since 1957 as a pioneer scheme. There are other such integrated courses in the country, all of them based on some common principles but implemented in different ways. We feel that ours has a particular value in that it offers some University association for those girls whose intellectual level warrants it and I personally would very much like to see the number of students that we can cater for increased in some way. At the moment, as we all well know, there is a limit to the number of students that can be taken in at a university, and at present we have had to be satisfied with an intake of eight per year. So far the wastage has been small. During the first course we took in only five students. Of this five, four completed the course. The second intake of students has dropped somewhat due to the usual reasons of marriage, sickness and suchlike. Later groups appear to be maintaining their numbers, and recruitment is good. We are fortunate in that the students in the present courses are very keen and we all find them very satisfying to work with. It will be interesting to note over the period of the next ten years or so the type of work they take up following their nursing career.