Modelling nursing teacher education and training in Lithuania

Liudmila Kirikova
Kaunas Medical University

Laima Sajienė
Vytautas Magnus University

Introduction

Rapid development of the society and changes in the demands for people and society health care exert influence upon the changes in the nursing institution concept. Current situation in Lithuania demands from nursing to recover people’s and societal health as well as to create all necessary conditions for people to learn to adequately take care of one’s own health and develop abilities to preserve it, aiming at reaching the health level achieved in the advanced countries of the world. It is the development of a new attitude to nursing as a science that cannot be identified with other areas of the medical science. Therefore, the most important and inevitable aim is to educate and train a new type of nurses whose core activity would be independent qualified teaching people to take care of their health. Having access to direct contact with people on various levels of health care system, nurses form people’s attitude to their health, assist in helping them to understand that health is a value, teach how to maintain and strengthen one’s health, develop one’s way of life and acquaint with the basics of early disease prevention.

In the context of these tendencies, the priorital areas of Lithuania nursing institution reform should be the changes in the nursing positions in the initial health care stage, where the main action direction is health education and teaching of people, as well as basic education and training of nurses and teachers who educate and train them.

This article attempts to solve the following issue: what are the ways of preparing a nursing teacher and nursing practice supervisor able to effectively implement the demands of nursing science and vocational education and training reform.

The research is based on the most important theoretical assumptions: "pedagogisation" of vocational training is one of the main conditions of successful vocational education and training reform (Šernas V., 1995); vocational training should provide vocational qualifications that are dictated by the changes and demands of the society; the methodological cause of vocational education and training is the contradiction that exists in the concept of vocation; the interaction between the subjective and objective aspects of a vocation and their contradiction determine the nature of other phenomena and processes related to vocation, including vocational education and training (Laužackas R., 1998).

DIMENSIONS OF CHANGE IN NURSE EDUCATION AND TRAINING

Change in nurse vocational education and training depends on many factors: the concept of nursing; nursing practice law; health care reform conception; regulations of the World Health Organisation (WHO); vocational education and training system that guarantees provision of qualifications in the scope and quality that satisfy dinamic demands of the society. It depends on the theoretical foundation of the nurse vocational education and training reform, its correspondence to WHO and Lithuanian health care reform requirements and importance for the society. Initial nurse training in Lithuania is provided at medical colleges; the qualification acquired here very often creates conditions only to clinical technical activity. Whereas the acquisition of new, especially general competencies, requires new nurse education and training content that enhances personality growth, vocational mobility and corresponds to the world nursing science development tendencies, as well as satisfies constantly changing societal demands. Therefore, one of the most urgent nurse vocational training issues is the contradiciton between rapid changes in nurse activity, qualification demands and possibilities to satisfy these demands in the institutions of vocational education and training.

Nurse vocational training development is based on the quality of pedagogical process, subject and pedagogical preparation of collegiate dons and nurse practice supervisors. Hence, strategical and tactical directions of nurse teacher education and training will be further explored in the article.

PEDAGOGICAL QUALIFICATION OF NURSE TRAINING TEACHERS

The most important agent of vocational education and training system is a vocational teacher. Teachers and nursing practice supervisors are the people who work at high medical schools and clinical student practice bases. In all West Europe their qualification has to satisfy a formal requirement – these teachers have to be prepared at higher educational institutions paying equal attention to both, their subject (nursing) and pedagogical preparation. In Lithunia, there exists a different practice. As research findings indicate, the majority of high medical teachers were doctors - 194 out of 273 respondents, i.e. 71%; only 3 respondents had pedagogical preparation, i.e. 1%.

Nurse training teachers’ qualification changes depending on the development of the society that raises new demands for nurse vocational activity. Up to now, there have been no institutions in Lithuania where nurse teachers or practice supervisors are prepared. Recently Health Care Ministry, together with the publication of nurse vocational education and training standard, has started being concerned with teacher qualification upgrading. High medical school teachers participate in international projects that provide opportunities for inservice training (PHARE, Danish, etc.) and are enrolled in university Master programmes. However, nurse training and education should be systematic, consistent and correspond to the strategic principles and directions of change in vocational education and training, as well as tendencies of the nursing science development. Hence, the importance of education and training of nurse teachers and nurse practice supervisors has been determined by the following factors:

• General vocational education and training change;
• Criteria for the competence of nurse preparing teachers and their specificity in nursing teaching programmes;
• Specific economic, social and cultural conditions that influence the change of nursing as a science in Lithuania.

NURSE TRAINING TEACHERS’ EDUCATION AND TRAINING STRATEGY

The White Papers of vocational training (1999, 51-53) presents a general scheme for education and training of vocational teachers. There is a list of qualifications that are to be acquired by potential vocational teachers. According to this scheme, teachers working in high medical schools should acquire the qualifications necessary for their activity in the following ways:

• Subject (nursing) qualification is acquired at high or higher medical schools;
• Pedagogical qualification is acquired at high schools in 1 year;
• Practical experience is acquired in 3 years working as a nurse according to the acquired speciality;
• Academic qualification is acquired at the university in a Master study programme in 2 years or Doctoral studies in 4 years.

It is emphasised that "<...> teachers working in high schools must have higher education. The qualification acquired at high schools is sufficient for those teachers who conduct speciality subject practicums".

V. Compter (1998) states that recently qualification concept has become an essential purposeful category of vocational pedagogy; it includes ordinary and particular functional abilities and is revealed in activity, social and consciousness competencies. Today vocational teacher’s qualificational requirements depend on the changed understanding of vocational teacher activity. In the European context, according to V. Compter (2000), they value a teacher who is able not only to convey vocational knowledge and experience but also to develop general abilities. Pedagogical competence is given priority to subject competence. As a consequence, there is a contradiction between new requirements demanded of nurse vocational activity and their vocational education and training. Investigation was carried out aiming at finding out if respondents agree or disagree with the statement that "the quality of nurse qualification depends not only on good preparation of teachers’ and nurse practice supervisors’ in the subject field but also on their pedagogical preparation". The outcomes of the research are as follows (see Fig. 1): 22% of the respondents absolutely agree with the statement, 50% - agree partly, 9% - do not agree, 19% - do not have their opinion on this question. The means of the obtained responses are 4,77, 1,98, -0,72 and - 0,51. It is necessary to note that respondents working in initial health care and clinical nursing areas (means 3,64 and 4,29) assign more attention to pedagogical teacher education and training in comparison with teachers and nurse practice supervisors themselves.

The fact that even 71% of teacher training nurses do not have adequate subject preparation is a serious impediment in the nursing reform. Even 46% of the respondents emphasised that in high and higher medical schools there should work more qualified nurses than doctors, 29% - do not agree with this idea, whereas 25% do not have their opinion.

SUBJECT-PEDAGOGICAL EDUCATION AND TRAINING IS A PHENOMENON OF NURSING STUDIES AT UNIVERSITY

Having the purpose to develop the science of nursing in Lithuania and speed up the change of practice, Kaunas Medical University (then Medical Academy), taking into account the request of Lithuanian Mercy Sisters Society and executing the recommendations accepted in the conference on the development of medical science in Lithuanian, Latvian and Estonian region (Ryga, 1990 02 05-07), established Nursing Faculty. Nursing qualification characterstics and study curiculum were developed. Medical Faculty at Vilnius University also started preparing nurses. Having acquired university education, nurses "should occupy themselves with scientific, pedagogical and administrative activity" (D. Kalibatienė, 1998, p.7). One of the main university features is university programmes. High medical schools prepare nurses of general practice, whereas Nursing Faculty at Kaunas Medical University educates and trains students for activity in several sphares. University graduates, nurses, as a professional group should work as teachers, nurse practice supervisors, administrators and nursing researchers. Therefore, the curriculum of nursing education and training at a high medical school and university is essentially different.

New concept of nursing and the changed values that determine new activity methods and new behaviour have had impact upon subject-pedagogical curriculum of nursing education and training (see Fig. 2).

There is a close dialectic relation between nurse vocational activity and pedagogical studies as they originate from each other and influence one another. Thus, pedagogical studies, their structure and content should be adequate to the principle requirements for nursing education and training. The vocational education and training of nurses, teaching people to take care of their health and staff training are separate fields of activity which have principle differences that manifest themselves in the curriculum of vocational education and training. These differences enhance the structurisation of study content. Educational aspects of nurse vocational activity are different depending on working place and position occupied; thus, the qualification is not adequate to the required one (see Fig. 3). Pedagogical education and training of nurses working in different activity spheres should be based on specialised programmes with regard to pedagogy, as educational activity of a nurse is oriented to various needs and interested of different groups of people.

Hence, designing the structure and curriculum of pedagogical studies it is important to direct attention to:

• nature of nurses’ educational activity;
• model of vocational activity qualification.

With regard to activity content and executive objectives, teachers working in the nursing system are divided to:

• nurses (teaching spedical nursing subjects in high medical schools according to programmes of vocational education level 4);
• nursing practice supervisors - mentors (training practical nursing skills and abilities in various health care institutions);
• health care teachers (teaching patients and their family members healthy mode of living, training practical skills and abilities in medical treatment and prevention areas).

The criteria of these teachers’ competence are determined by the content of their activity objectives and pedagogical purposes. The main objectives are as follows: to convey necessary knowledge, develop students’ abilities and thinking necessary for nurse vocational activity; to arouse their interest in nursing, health maintainance and strengthening problems, person’s abilities to maintain good health, their place and possibilities in health care system; to encourage them to seek vocational development; to develop learner’s life long learning need and appropriate skills; to develop the ability to use new information technologies in vocational activity.

Fig. 3. Major parameters of nursing educational activity

In order to successfully reach these objectives, nursing teachers, practice supervisors, health care teachers have to: understand the essence of nursing science and the situation of its development as well as tendencies in the country and the world context; be aware of the theoretical and practical importance of nursing science, theoretical and practical relation to medical and social sciences, tendencies of qualificational vocational activity change; be able to flexibly achieve educational purposes, develop the corresponding content, forms, methods and ways of evaluation; be able to evaluate and analyse one’s activity, have characteristic personal features that help learners to develop dispositions with respect to themselves, one’s health, environment and activity development; be able to use new teaching technologies; have a good knowledge of various teaching methods and their peculiarities.

According to K. Pukelis (1995), pedagogical study structure and curriculum should reflect everything that helps a future educator to learn the essence of human nature, as well as prepare him to help a person to develop his potential powers. An educator should be able to define educational purposes that correspond to the person’s needs and help the person to believe in the meaning of these purposes. On the basis of the scheme presented in Fig. 3, seven different teaching programmes should be designed for nurse subject-pedagogical education and training. It is obvious that an introductory part - introduction to pedagogical studies – which is very important for the success of pedagogical activity, should be general. Its content should cover the following important aspects:

• teacher’s philosophical world outlook;
• concept of educational content and philosophical direction of education determined by the person’s world outlook;
• ability to know a person and foresee educational purposes with regard to every persons’ s needs.

The structure of pedagogical studies consists of the following areas:

• general pedagogical studies;
• studies of didactics;
• studies of vocational pedagogy;
• pedagogical practice.

The selected direction of pedagogisation of university nursing studies means the following: including pedagogical science subjects into the curriculum of general studies (nursing pedagogy, special pedagogy and nursing, family pedagogy and nursing) and paralel certificate pedagogical studies, covering knowledge, abilities and skills, directly related to pedagogical activity and providing vocational teacher’s qualification (see Table 1). General number of credits of the study programme is 42 credits (1680 hours).

Table1.

The programme of initial training is a new subject in Lithuanian vocational education and training. Such programmes have been prepared for general education secondary schools by Šiauliai University and Kaunas Technological University. A programme for vocational teachers has beed developed by Vytautas Magnus University according to a PHARE project.

The curriculum of pedagogical studies guarantees the preparating of nurses for independent pedagogical activity, creating possibilities to acquire pedagogical qualification that corresponds to the requirements for vocational teacher education and training; guarantees the development of general abilities that allow to flexibly react to rapidly changing societal needs for health care; the acquisition of education necessary for foreseen pedagogical activity and further vocational career.

The qualification of general practice nurse acquired at a high medical school, expanded in the aspect of nursing science in the nursing studies programme at Medical University and 3 year practical experience in the vocational field create conditions for pedagogical studies and provide a possibility to acquire the qualification of health care teacher and/or vocational teacher.

Pedagogical studies make an important part of university nurse education and training. It is a reaction to the contradiction between the activity change demands and their satisfaction in the system of vocational training. Nurse pedagogical education is their preparation for communicative, meaningful, with regard to educology, activity with people of various ages and various needs in nursing institutions, as well as with nursing students.

CONCLUSIONS

1. Under the influence of societal health care change the contradiction between the actual and formal side of the nurse qualification increases. The changing structure of nurse vocational qualification influences the changes in the most important dimensions of vocational education and training. The condition for an effective nursing satisfying the demands of the society is appropriate vocational education and training of nurses that provides perspective qualifications.
2. Although educational aspect penetrates all spheres of nurse vocational activity, its comparative weight and nature of educational activity differs depending on the object of the activity. Education is not the main subject in clinical nursing, nursing administration, scientific research areas; however, its function is essential in nursing teaching and initial health care spheres, where pedagogical abilities of nurses are the main factors that determine the efficiency of the activity.
3. Some nurses have direct contacts with people aiming to develop and expand their conscious attitude towards their health, personal way of life and reorganise the patients’models of thinking and life, others teach future nurses to work with people. Thus, nurses as educational agents can relatively be divided into two groups: health care teachers and vocational teachers. The pedagogical preparation of the latter is an exceptional objective of nursing policy.
4. In Lithuania, up to now the nurse teachers have not been prepared. As research findings indicate, out of 71% of doctors working at high medical schools only 3% have acquired pedagogical education.
5. Nursing teachers and nursing practice supervisors in their vocational activity solve various objectives – related to their speciality–subject, pedagogical-didactical, general personality development and others. Therefore, the qualificational structure of their vocation consists of subject abilities in nursing as their speciality, vocational experience, pedagogical-didactical abilities and social abilities.
6. The development of nursing science and expansion of nursing education and training curriculum determine the university education and training of nurses, where serious attention is paid to subject-pedagogical content of nurse education and training that guarantees the acquisition of pedagogical qualification corresponding to the demands raised for vocational teacher education and training; the development of general abilities that allow to more flexibly adapt to rapidly changing societal demands; and the acquisition of intercultural education that is significant for nurse pedagogical activity and vocational career.
7. The level and nature of merging university nurse studies with pedagogical education and training are determined by the fact that their students have graduated from high medical schools and have 3-year practical activity experience. These factors correspond to the specific requirements for education and training of teachers and nursing practice supervisors.

8. The model of nurse vocational education and training consists of: twofold study purposes (subject and pedagogical), university study curriculum (nursing and teaching), methods fostering pedagogical and general competencies, teachers (in nursing and educational sphere), nursing students (high medical schools graduates who have work record). The interaction among these elements of the model guarantees coherent and systematic preparation of nurses stipulating the direction and success of nursing institution change.

RECOMMENDATIONS

1. Nurses of general practice are prepared at high medical schools, whereas Medical University should prepare nursing administrators, managers, teachers and nursing practice supervisors and scientists. Appropriate study programmes and study content should be developed.
2. As there are no professional nursing teachers and nursing practice supervisors in Lithuania, and Nursing Faculty students at KMU have acquired initial vocational preparation at high medical schools, the majoroty of them have 3-year vocational activity experience, and this corresponds to the regulations of vocational teacher education and training, it is quite realistic that they should be trained as vocational teachers.

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Authors:
Liudmila Kirikova email: liudak@takas.lt
Laima Sajiene email: l.sajiene@smf.vdu.lt

This document was added to the Education-line database on 02 November 2004