Nursing Education Seminar, Taipei, Taiwan, November 1952 : meeting report

· I I ,.

.,,""'"

.'

_.. .

.- , .

HURSING BDUClTION SDnNAR

SponsOred by lUtLD· HEALTH OBGAHIZATION Western Pacific RegiOQ,

.. Taipei, Taiwan

November I 19S2

-....

-i .'

"J-"'" ':~'<4.

,.... -,

I

,.."!':'...

TABLE

OF

C O'N TEN T S

, "-

f!i! Preface section I ••••••••••••••••••••••••••••••••••••••••••••••••••••

1

~

A. Origin. and Growth of the \lbrkshop Idea • ••••••••• B. Overview of the Seminar • •••••••••••••••••••••••••• Section II A. B.

2

4

Preparation by the Local Preparatory CoJlllllittee in Taiwan •••••••••••••••••••••••••••••••••••••••••••• Preplanning for the Semi nar by the Committee

S 8

.. .. ..

C. Resource Material ••••••••••••••••••••••••••••••••• 16 Section III A. The Seminar Program Gb.l~J.;o.l r~

••••••• . .•••• . . •. ••••••.• •• •••.•• 17 ••••••••••••••••••••••••••• 18 19 ••••••••••••••••••••••••••••••••• •••••••••••••••••••••••••••••••• ••••••••••

txplorator.y st~

Gro~s

Groups

Field Trips Film Sho~s

•••••••••••••••••••••••••••••••••• h2

., " B.

GeneraJ. Session on Visual Education

Pl,-bUcity

•••••••••••••••••••••••••••••••••••••••••

43 44 16

C.

EvaJ.u:ltion of the Seminar as an Educational Experience Ev31uo.tion by the Participants •••••••••••••••

b6 E7'aluntion by the Coordinating CoJlllli.ttee ••••• 48 D. SUmmar.J ••••••••••••••••••••••••••••••••••••••••••• S2 E. Expressions of appreciation ••••••••••••••••••••••• . section IV 1\.

55

Evaluation of the Administrat1veAspects of the Seminar and Suggestions for future Workshops Evaluation by the participants

•••••••••••••••• •••••

Evaluation by the Coordinatirul Committee Section V .\ppendix A. A Wor:..shop Approach to st~ Local Problems

••••

62

B. Directory Local Preparatory CoJllllittee ••••••••••••••••••

Particjpants

•••••••••••••••••••••••••••••••••

64 64

" -1PREFACE Herein is submitted a report of the first Nursing Education Seminar of the western Pacific Region of the W:>rld Health Organization, held in Taipei, Taiwan from November 3 - 21, 1952. Although cwed a Seminar, this being a familiar term, methods used were those of the Worksho and thiS, therefore, would be the more accurate title. Twenty-nine iridivi uals participated in the conference • Twelve Governments were represented by one or more nurses. Four members of the WHO permanent staff attended as well as two short-term consultants. The Mutual Security Agency of the United states Government sent a representative from each of two countries.

a

The report attel1llts to describe the preparation which was made for the Seminar by the World Health Organization and the Government of China('llliwan), including the living and working facilities which were provided. It includes also the preplanning of the Seminar, a description of the w~ the conference was comucted, an evaluation of the program, a summary of group thinking, and expressions of appreciation. A directory is included in the appendix. It is hoped that the detail in which the report is written will not only serve as a record of the program but will be of assistance in planning future workshops for the Region. The participants would like to express their sincere appreciation to all those whose personal interest contributed so effectively to the success of the Seminar: Miss Hsu Ai-Chu, Chief of the Nursing Division of the National Institute of Health, who served as Liaison Officer and directed the local arrangements in a way that won the admirB:tion of everyone, The Local Preparatory Committee for the arrangements for the Seminar meetings and living accomnvdation" courtesies at the airport, convenient transportation and enjoyable entertainment, Provincial SChool of Nursing and Midwifery for the generous use of their new building, , Government officials and individuals for their cordial hospitality, Mr. Edmund F. Overend, UNESCO specialist in 'audio-visual aids, for his practical discussion and demonstration of visual aids and his personal interest in offering continuous assistance to the group,

..

The nurses of China (Taiwan) for their many personal kindnesses, The staff of UNICEF for aSsistance in administration and finance, Secretaries, drivers, and staff of the Seminar, The many voluntary contributors, both orgalizations and individuals, who assisted the progress of the Seminar by the provision of services and supplies.

,-

-2,..

• SECTION I A. ORIGIN AND GROWTH OF THE WRKSHOP IDEA

The idea of the Workshop originated early in 1951 and was developed and strengthened until it reached fruition a year and a half later in the first Western Pacific Regional Seminar in Nursing Education.. The seed was planted when the Regional NurSing Adviser visl ted governments, talked with nursing leaders and was frequently asked questions regarding nursing practices elsewhere in the Reg~n. Schools of nursing were being developed in countries where nurses' training had not heretofore existed. These schools needed teaching materials and governments were asking what teaching aids were available for use with stwent nurses in this part of the world, mat kinds of materials were suitable 1'0:' students whose cultural background was different from that of the teachers who were developing the schools of nursing. Traditional teaching aids were not felt to be alwa;vs suitable. WHO and UNICEF were helping to supply books, films, filmstrips, and other visual aids for nursing schools, but it was realized that much more information was necessary if a wise solection was to be made. Teachers in schools of nursing expressed interest in an opportunity to come together to consider some of these common problems. They felt that there was a good deal they could learn from one another. When the Nursing Adviser was in China (Taiwan) early in 1951, the nursing leaders there were discussing problems that affected nursing throughout the Region. A workshop was proposed and the hope expressed that nurses from neighbouring countries could attend. The idea was presented to the Director of the ~stern Pacific Regional Office who gave his enthusiastic support. The plan and the necessary funds were approved by the Regional Committee at its second annual meeting in Manila in September, 1951. The invitation of the Government of China (Taiwan) to act as host tiaS accepted. The approval of WHO Headquarters soon followed and arrangements for the Nursing Seminar then began. Considerahle interest in a regional nursing conference developed as a result of the Nurses' study week which was held in Wellington, New Zealand, in March, 1952. Nurses from Austr<llia, Malaya, the Philippines, Japan, and China (Taiwan) gave this conference a real international flavour. One of the reconunendations brought forward in the meetings was that \olIO should sponsor regional nursing conferences. The enthusiasm of the nurses who attended the study \"i'eek was reflected in the interest of their Governments in making it possible for nursing leaders to attend the Seminar. Early in October, 1951, the Goverrunent of China (Taiwan) set up a Local ColIBIIittee on Arrangements. Miss Hsu Ai-chu, Chief of the NurSing Division of the National Institute of Health, was designated local Liaison Officer. The Government set aside an ample fund for local expenses. Early plans provided for a nursing education consultant, an educational director, and twenty participants to be invited from the various countries inihe Region. Four WHO nursing education team leaders were included and also the three Nursing Consultants assigned to MSA. ProviSion was also made to obtain resource material and clerical staff. Assistance from WHO Headquarters and from the WHO Regional Office for the Americas was obtained for the recruitment of the two consultants and the selection of resource materials. '!he faculty of the College of Nursing, University of the Philippines, UN?SCO and the United States Information Service all cooperated in conpiling lists of teaching aids. A Manila Office supply house loaned charts and models. Miss Jean Barrett, Professor of Nursing Education and Director of the Department of NurSing Education, Syracuse Universii:q, Syracuse, New York, was selected on February 4, 1952, for the position of Nursing Education Consultant. She was appointed 1'or 1'OIlX' months, from August 1$ to December15.

-3Before coming to the Region, she suggested some of the resource materials that were obtained for the Seminar. After her arrival in Manila,· she worked with the Regional office staff in organizing the materials for ready reference. Letters were sent to tne participants to let them know the types of problems that were being proposed for discussion. In order for the Nursing consultant to have an opportunity to obtain first-hand information on nursing education in the Region, it was arranged for her to visit schools of nursing in the Philippines, Singapore, and China (Taiwan). Dr. Dorothy Hayes, Chairman of the Education Division and Director of Elementar,y Education at the State Universi41 Teachers' College at New Paltz, New York, was appointed Educational Director in June, 1952. It had been hoped that the assistance of Dr. Hayes could be obtained for four months, but, due to earl¥ delays in recruitment, she was available for onl¥ six weeks. The criteria established for the selection of participants were as follows: 1.

Each should be a graduate registered nurse active~ engaged~ nursing education. Her position could be in a basic school o~ nurSing or in midwifer,y, public health nursing, or in a school for the training of auxiliar,y nursing personnel. She should have at least one year of college study in nursing education. period of time.

?

3. She should plan to continue in nursing education for a reasonable

4. 5.

It must be possible for her to be released from her duties in order to be free to attend the full three weeks' period of the Seminar. She should be able to participate in English language discussions.

The proposed program of stu:ly included: 1.

The understanding of student background. ' The development and e valuation of teaching materials. and student background.

2.

3. The development of a teaching program based upon communi41 needs Invitations were sent to the Governments in Februar,y, 1952. These invitations went out eight months in advance of the Seminar in order (a) to provide anple tiIlB for correspondence with the participants, and (b) to make it possible for the participants to arrange to be relieved from their teaching duties. Although nomination of candidates was to be the responsibility of the Governments, it was suggested that the professional nurses' associations of the countries be invited to p,,,;; ~::"(;::"::;~~" :!..~ tha selection of nominees. The final choice of· participants was left to the Organization. Nurses were invited to attend the seminar under the prOVisions of WHO short-term fellowships. This enabled the Organization to pay the cost of travel and a per diem allowance. .ls each fellowship was awarded, the participant was invited to send her suggestions of problems for discussion. From the beginning, it was pointed out that the Seminar vrould be centered around the interests of the group. PartiCipants were also invited to bring teaching materials which they had found to be of particular value. Most of them responded to the request by sending a list of subjects they wished to have considered in the Seminar and reporting the visual materials they proposed to bring.

-4B. OVERVIEW OF THE SEXINAR

1.

Preliminary Preparation by the Local Preparl\t.ory Committee in Taiwan. This Committee, composed of representatives of various Governments, agencies, nursing organizations and others, worked for many months to arrange a meeting place, housing, and ent-ertainment for the Seminar participants.

2.

Meetings of the Preplanning Committee, October 20 :" November 1. This group of nine included the WHO Nursing .i.dviser for the Western Pacific Region, the Educational Director, the Nursing Education Consultant, three members of mo nursing teams serving in different areas of the Region, a Chinese nurse leader and dean of a school of nursing in Taipei, an American nurse with IOa1V years experience in China in the 19,301 s m.o is on leave from her position in New York to serve as visiting professor in the nursing schools of Taiwan, and a New Zealand nurse educator in charge of a postgraduate program to which marv graduate nurses from this area are sent for preparation in public health nursing or nursing education. During the two-week period the committee members were trained, through experience, in the workshop procedure and discussed plans for the thret:> weeks of Sominar m\:JI;l~~ings. COlll'tesy calls were made on Government officials and others Who were contributing in-many ways to make the Seminar successful.

3. The Seminar Meetings, November 3 - November 21. Participants met d~, Monday through Friday, in general sessions or in small groups, to work on problems of their own choosing. Film showings, field visits and individual and informal small group conferences rounded out the program. Provision was made for continuous evaluation. Week-end trips, dinners and teas added relaxation and pleasure in a busy schedule. The coordinating committee (heretofore known as the preplanning committee) met-at frequent intervals throughout the period.

4.

The Post-Seminar Meetings, November 22 - November 26. The ooordinating committee remained in Taipei for the five days following the Seminar to outline the official report, to consider outcomes and to make recommendations for succeeding workshops. The report, although coordinated and edited by one person, is the product of the committee ~ich met as a whole and in sub-groups to decide on its organization and content and to write large portions of it.

-5SECTION II

... .,

A.

PREPARATION BY THE LOCAL PREPARATORY COMMITTEE

m

TAIWAN

Participants in the Seminar were at all times considered to be the guests of the Government of (}hiM (Taiwan). Every possible courte~ was shown to them from the moment of their arrival in Taiwan until their departure. This entailed careful. synchronization of plans. For over a year preceding the opeDing of the Seminar, representatives of the various departments of the Provincial and Central Governments and the local medical, public health, and nursing organizations met reguJ.a.rl¥ to formulate and expedite plans. Included in the representation on the Local Prep~tory Committee were the following: (1) Department of Health .J.dministration, Ministry of the Interior (2) Provincial Health J'l.dministration (3) Ministry of Education (4) Ministry of Foreign Affairs

(5)

The Red Cross Society of China

(6) Department of Education, Provincial Goverrunent (7) Foreign Affairs Office, Provincial Government (8) Police Department, Provincial Government (9) Nursing Department, National Institute of Health (10) Nursing Department, National Defense Medical Center (11) School of ::U!'cing, Taiwan University Hospital (12) Provincial Cchool of NurSing and Midwifery, Taipei (13) Ar,my Medica~ Service, Surgeon-General

(14) Medical Service, Chinese Air Force (15) National Defense Medical Center

(16) College of r~edicL"le, National Taiwan University (17) Provincial Taipei Hospital (18) Taiwan University Hospital (19) Rural Her-tJ.t.". Dhri s ion, J oint Commission on Rural Reconstruction (20) MBA Mission to China

(21) UNICEF lows: Three committees were set up, with delegated responsibilities as folGeneral Administration: Accommodation, transportation of participants, and plans for maintaining their health (the latter through the CAT Health Department in1lhe Friends of China Club).

1.

-62. Working Facilities: Specially made furniture to be used in the new maternity hospital of the Provincial School of Nursing and Midwifery for meeting rooms, offices, library, projection room, room for charts and models; typing and printing facilities; flowers, signs, and decorations.

3. Recreational Activities: contacts with the different governmental establishments, including the PreSident, Premier, Ministers, Air Force, Provincial Governmental Officials, et cetera, to coordinate plans for social engagements for the participants. The Administrative Personnel selected for the Seminar were as follows: Hsu, Ai-chu, Exacutive Director

c.

S. Chen, Secretary in Provincial Health Administration, in charge of all office documents.

S. Y. Chen, Business Manager in Provincial Health Administration, in charge of transportation, personnel, building, et cetera. When the first members of the preplanning group of the World Health Organization arrived in Taipei, they were welcomed at the airport, and their entrance into Taiwan was g~eat1y facilitated b,y persons who took immediate charge of passport checking and clearance with immigration and customs inspectors. Comfortable rooms had been arranged for them at the Friends of China Cl.ub from the very beginning, automobile transportation was available to the members of the prepl.anning group to take them to and from the seminar building, to drive them to see the countryside outside Taipei and to transport them to social engagements.

aoo,

Not onJ,y were the physical needs of the participants woll planned for, but from the very moment of setting foot in Taiwan, each person coming to the Seminar was made to feel that peopl.e were glad she was there. In addition to the planned Schedule of social activities which included mal\Y interesting teas, dinners, and trips, there were several invitations to private homes. There were also numerous personal services, such as hel.p with shopping and other evidences of a warm wel.come. In the final days of the preplanning meetings, the l.ocal committee continued to function effectivel¥ in meeting other participants and in pl.ann1ng for their entertainment and visits to schools ·of nursing "I'iliJ.e they were waiting for ·the Seminar to begin. To the final moment of departure of each person attending the Seminar, there was continuous evidence of the thoughtful.ness and efficiency of the members of the Local Preparatory Committee and all others lobo worked to make the participants' visit to Taiwan a truly unforgettabl.e one. The Seminar Buildi.'lg The opening of the new maternity hospital of the Provincial School of Nursing and Midwifery, which was ready in early october to be equipped and put into use, was postponed and the entire blliJdjng given over for the Seminar meetings. h special and most impressive archway was constructed bearing the words "WORLD HEl..LTH ORGl.NIZATION NURSING EDUCATION SEMIN.'"tR," in both Chinese and English, and holding the flags of the host country and all the other countries represented. The "seminar buildingl' as it came to be called, provided ample facilities for the following: First Floor: Offices, reception room, room for charts and mode1s, room for projection of films.

-7-

.'"

Communication between all members of the Seminar was facilitated An infonnation desk, located in a convenient place near the entrance, made it possible for participants to procure stamps, leave letters to be mailed, purchase cigarettes, papers, and pictures, leave messages, receive infonnation on numerous questions concerning the city of Taipei, et cetera. by a large bull.etin board in the center of the front hall.

Second Floor: Office, secretaries' room, large conference room. This last contained a blackboard, chars, tables arranged in a rectangle (in the beginning, sections of the table for participants from each country were designated by large cards printed with the name of the government represented but, as the conference progressed, it seemed best to reorganize the seating to pennit individuals to sit where and with whom they wished. There were also four small conference rooms with tables, chairs and blackboards; library ..nth bookshelves, tables, chairs, lamps; workroom with tables, chairs, shelves, slide projector and screen; social room which had comfortable chairs and end tables, provided the meeting place for the preplanning and post-seminar meetings.

,

.

II

-8B. PREPLANNING FOR THE SEMINAR BY THE COMMITTEE

For the two weeks just preceding the official" opening of the Seminar on November .3rd, nine of the twentY-nine participants (see Appendix II) met daily to learn the -workshop method and to plan the educational program for the Seminar. Preplanning meetings have been described in considerable detail since the philosophy of the workshop is illustrated in the way the grou;p wrked. Likewise, the problems discussed were considered to be of sufficient importance to nursing in the Region that the discussion should be recorded. At the first meeting, the WHO NurSing Adviser introduced members of the group and summarized the origin and growth of the idea for a workshop in nursing education and the earJ;y planning am preparation made by WHO and the IDcal Preparatory Committee. The meeting was then turned over to the Educational Director .mo briefly described the workshop-~ype approach to probJ.ems. In the discussion which followed several members expressed a lack of experience in and understanding of the method but stated that they were keenly interested in learning about it. The Way the Committee Worked The committee members decided to acquaint themselves with the method through experience. Since an important first step in a workshop approach is the identification of problems, the manbers accordingly brought out the eslucational problems" they were facing in their local communities Each member took her turn at recording the day's meetings. The Educational Director acted as leader during the first we:..k, but in the closing days of the preplanning period, the chairmanship "'"as taken over by members of the grou;p in turn. The Educational Director attempted to help the group ~eate a sense o:f needed participation by each member, consideration for each person's feelings, and an atlOOsphere of mutual respect for the opinions expressed by others. Throughout the period the Director frequentJ;y brought into focu.s a number of generalizatio~ from research in the psychology of learning and related problems in teacher education which she believed might have applications for a group Wilich was eval.uating and planning for nursing education. The meetings in the earJ;y preplanning sessions were unhurried. Time

was taken for individuals to e:xplore and discuss what they personal.J¥ wanted to gain from a nursing education seminar and to know one another well before beginning to make plans for the additional participants who would be joining the group later. During the second week when members of the committee expressed some doubts as to their ability as group leaders, individuals helped one another to see possible approaches for assisting the too-quiet member of a group, understanding and working with the too-talkative member, and tactfully getting problems brought out into the open without violating confidences.

\Ilen problems were raJ.Sed for whien there could be no quick deciSion, they were referred to a committee which was instructed to report its suggestions at a specified period. Considerable time was spent in committee work during the last week. In addition, several afternoons were set aside for such technical details as the writing of biographies and general information for a Handbook; classifying and cataloguing books, films and filmstrips; preparing a bibliography of materials in the libraryj arranging the model alld chart room. Subjects Discussed

BY

the Committee

'lbe following subjects which were discussed during the two-week preplanning period will be briefly described in turn: 1. Exploration of local problems

-92. 3. Goals for the Seminar

Planning for the participants Planning the structure of the Seminar

4. 1. a.

Exploration of local problems. The first of four general problems raised pertained to methods of teaching and the school of nursing curriculum. An attempt was made to identify some approaches in teaching which would insure that students would become good nurses in the communities they are to serve. These included a discussion of the desirability of the student beginning her education in nursing b,y learning to know the normal (non-sick) individual as a "llbole" person, the product of his mental, physic?J., e::totional and social characteristics; the importance of integrating sociaJ. and health concepts in teaching; the relative value of different types of experience and instruction for developing ability to think critica.lJ¥; the ways to use effectively human beings, including patients, as "teaching material"; the advantages of speciaJ. teaching wards in the early stages of a student's experience. Other local problems centered around the guidance of individual nurse students. Discussion brought out the importance of the nurseteacher being familiar with the family and collllllW'lity background from which individual students come and the need to look for the causes of a student's behaviour, recognizing that internal conflicts affect an indiv.·J.ual's ability to accept herself and others and to profit from the learning opportunities proVided: for her. The need for taking into account individual difference was recognized. Considerable discussion centered around the problems relating to the student who stUdies in a foreign country, ways in which she can be he:q,ed to feel accepted in the country in which she is studying, her difficulties in adjustment on returning to her own country. Lack of adjustment was felt to be due,in part, to the limitations in background of some students who are selected for study abroad, failure on the part of educational institutions visited to help the student see that the practices of t hat community are related to its particulur cultural pattern and may not apply in the student's countIj'"; lack of concern on the part of the institution to which the stooent returns in he:q,ing her make the adjustment. Sometimes returning stUdents are put into situations where success is extremely difficult to attain. The third ,local problem deaJt with the teachers of nurses and effective ways of gaining cooperation among all those engaged in teaching nurse students - those who work exclusi veJ;v in the hospital as well as those who work exclusively in the classroom. The need for teachers who have a broad point of view concerning community problems and an appreciation of the possible contributions from other health and educatioual .L'it::lds was recognized. The fourth problem pertained to standards of nursing and the concepts of the nurse which are held by the medical profession and society in ·general. It was recognized that the position of women in the c011lmunity and the concepts of women-who-work set limitations on the development of nurs:ing in any country; that nurse educators must build a teaching program based on the needs and readiness of the country but should make continuous effort to improve both nursing education and nursing service; that schools of nursing should aim to attract the well-educated girls and boys of the community. It was felt that, in oountries where plans to start a program for the education of nurses were being made, it is important, before opening the school to 1) gain the interest and cooperation of the com-

b.

c.

d.

-10munity leaders in adequate education for nurses, b) bring the level of nursing care up to an acceptable standard through staff education programs for personnel, provision of facilities, et cetera, and c) provide suitable living accolllIOOdation for students.

2.

Goals for the Se+ninar. One preplanning session was devoted to the formulation of goals for the Seminar. At the end of the meeting a committee was selected to phrase a statemant of the objectives which members of the preplanning group could accept. The goals listed below are those:fi.nalJy agreed upon. It Should be pointed out that the preplanning group members agreed that these were the goals as they S3.W them as a result of sharing their experiences and thinking. Th~ realized that when the twenty additional participants joined the group, the formulation of new goals or modification of these might be necessary. The goals accepted The Seminar should a. Contribute to an appreciation of the need for an integrated nursing education curriculum that, in addition to professional skill, encourages the development of the nurse as a person mth . 1) 2) A concept of the dynamics of human relations, a mllingness to accept herself and others.

qy

the committee were stated as follows:

An awareness that sociological and economic forces affect the people of the world. An appreciation of the vital part that nursing should p~ in the solution not onl¥ of health but also of other social problems of a community. A desire and an ability to utilize the resources of the community and to develop the highest standard of nurSing 'Which is practical for that community. A compelling motivation to continue her personal and professional growth.

3)

4) 5) b.

Increase the ability of each participant to evaluate 1) ways of teaching 2nd 2) teaching materials, in order to determine their effectiveness in the total development of the nurse. Develop increased appreciation of the human being as a teaching resource and an understanding of the problems of individuals.

c.

3. Planning for the participants.

-

In addition to the detailed plann:ing done by the Local Preparatory Committee the preplanning committee gave careful consideration. to its responsibility for assisting the newcomers to make a comfortable adjustment.. The following plans were made: a. Members of the preplanning committee would consider themselves Karticitirants in the Seminar - not a faculty group. It was oped t s loIluld minimize barriers of communication among the total group. A concerted effort would be made, from the beginning, to call people by their given names and to encourage the others to do likemse. Name tags -were to be prepared for all participants.

b.

-llc. Biographies of partic:ipants would be printed :ill the Handbook of information being prepared by the Local Preparatory Committee with the help of members of the preplanning group. Names of participants would be :ill alphabetical order and those of the preplanning committee indicated with an asterisk. No other enphasis would be given to differentiate this group from the rest of the participants. Members of the committee would strive to be sensitive to the needs of the newcomers and to do everything possible to facilitate their adjustment. Participants would be given some choice in the selection of roommates. An ear~ suggestion that no two members of one country share a room was discarded because it was felt that it might be relaxing for individuals to live with someone who couJd converse in the s ame :;Language a.rxi that persons from the same country Who became better acquainted through room-sharing might form a team for lDrking together on their return home. Newcomers would be invited by the preplanning committee to a buffet supper the night before the Seminar was to be offici~ opened. The WHO team leader in Taipei, a member of the committee, inrlted the group to hold the party in her home.

d.

e.

f.

4.

Planning the Structure of the Seminar. Many questions were raised relative to the conduct of the Seminar, the aJlYJunt of structuring deSirable, how the consultants should be used, how the results were to be evaluated. To some questions there were immediate and spontaneous decisions. Others required more thought and were referred to committees with periods set at which each would report back to the total group. The following plans were arrived at by Friday, the last day of the preplanning sessions:

a. b.

The newcomers w:>uld have an experience similar to that of the committee, with an opportunity to explore their problems. To facilitate diSCUSSion, exploratory groups ~uld be formed with two members of the preplanning committee in each. The Educational Director would spend approximatel¥ a half day with each group. Minutes would be kept of meetings. There would be a general session the first morning to present the background of the seminar, to introduce the newcomers to the method that had been used by the committee, to explain .the plans for eJq>loratory groups, to describe the library resources, present the bibliqgraphy and invite the group to suggest titles not on the list if they knew some which were especia~ usei'ul. No definite time would be set for the conclusion of the exploratory sessions though it was felt tha t probab~ groups would be ready to report. on ~dnesday afternoon. by representatives of exploratory groups.

c.

d.

..-

e.

-' f.

Problem areas would be listed on the blackboard when presented I f final selection of problems to be studied could not be made by the entire group a comaittee would be appointed for this purpose.

When problem areas had been identified, each individual would have a chance to choose the one or two on lIhich she wished to concentrate. Study groups WJuld be formed i f the participants wished to wo rl<: in this way. Plans were set up for the first two days and arrangements made for putting a mimeographed copy into the hands of every parti-

g.

-12cipant on the Sunday evening before the Seminar was to be official.J¥ opened. This TtIOuld give some introduction to the activities of the first days of the Seminar. h. i. Every effort TtIOuld be made to have the total group engage in the rest of the planning and in the valuation of progress. A committee drew up suggestions for some evaluative instrumem.s arrlplans '\'ere made for week~ general aessions when groups could share their activities and evaluate progress. Beyond these weekly general sessions the preplanning group would not set general sessions, field trips, or working-day schedules without consultation with the group. A tentative time schedule was made: Morning meetings (except Saturday and Sunday): 8:30 - li:30, with a half hour break around 10 a.m. Afternoon meetings: 2:30 - 4:30 No regular evening meetings TtIOuld be held but there would be an opportunity for those who ~t.Lahed to return to the Seminar Building for work in the library or for special meetings. Tentative plans were made: a. b. To spend a half day for field trips with time for planning and for evaluation. Attendance TtIOuld 're optional. . To hold a general session on visUal education and provide opportunities to see films, filmstrips and slides with a demonstration and discussion as to their possible construction and use. A committee was appointed to contact the Visual education specialist who had recently come to Taipei as a UNESCO representative and to enlist his help should the group decide it wanted such a demonstration. To plan a short general session concerning the liOrk of the World Health Organization and its relationship to other organizations, should such be desired. To arrange a general session to present some provocative issues related to methods of teaching if this seems indicated. To accept the offer of the health administration officials of Taipei to act as resource persons for the Seminar where and when their help can fit in with the activities of a group or a combination of groups. To plan an opportunity to hear persons living in China (Taiwan) teli about the country I since this would no doubt be deSired • The evening the group TtIOuld be at Sun-Moon Lake was suggested as a possible time for this talk. It was agreed not to set up times for consultations but to urge participants to seek out other individuals in the group i f they wish an opportunity to talk about their particular problems. The committee members in the exploratory or study groups would help individuals make the necessary contacts.

j.

k.

c.

d. e.

.. -

f.

g.

-13h. The Nurse Consultant and the WHO Nursing Adviser would each work with an exploratory group. The Director would spend approJCimateJ;y one-fourth of her time· with each group. The role of these three persons would be reviewed later when study grotps were set up. The nature of the study groups selected, in relation to the particular background or interests of these individuals, might dictate the ways in which they oould best function. Evaluation of the Preplanning ~erionce

The Friday afternoon session of the second week of the preplanning sessions was given over to hearing the summary report of the two-week period and evaluating the effectiveness of the sessions. No form had been prepared, but the committee suggested that the eValuation might be informal, with the group responding frankJ;y to the follOWing nine questions: 1. How do you feel about the past two weeks? a. b. c. 2. 3. Was the time long enough? Was the time too long? Was the time used to the best advant~e?

Did the plan of action come at the right time?

Should more have been done about handling the visual aids and other resources before the group assembled? Do you feel we have been a group? In what areas did we need IOOre he:Lp? Would you have liked more opportunities to be a group leader? Were small oommittees so planned that they could work effectiveJ;y? What are the good and weak points of the preplanning sessions? ' What suggestions would you make for preplanning for the next seminar? follo~

4. 5. 6. 7. 8. 9. The 1.

·generalizations represent the consensus of group opinion:

The two-week period for the preplanning sessions seemed long enough as a whole, but there were some very rushed times during the second week. It was suggested that the time oould have been better organized the second week qy an earlier listing of remaining tasks. It was L'ecognized, however, that the slowness and ease of the first week ~ have been necessary to produce the feeling of groupness which enabled people to get so much done the second week. A competent secretary or librarian would have relieved members of the preplanning group of much physical work in assembling resource· material. This activity interrupted the smooth functioning of the total group. ness and functioned as a group.

2.

3. The members of the preplanning group realJ;y built a sense of group-

4.

Members of the committee would have liked more opportunity to be the leader. People working on two or more committees had difficulty in working effectiveJ;y, since in some cases the two committees had to report on the same day.

5.

-146. The good points of the preplanning sessions were noted as follows: physical facilities~ oontacts of the group members, amount of time allowed and opportunity for everyone to act as recorder.

7. A weak point was the fe,ct that people did not know enough about the workshop approach prior to coming to the Seminar.

.

In addition to the informal comments that were made at this meeting, group members agreed to write out their feelings in the following three categories: (1) things I especially liked about the preplanning meetings, (2) things I feel would have improved the effectiveness of the preplanning period, and (3) further suggestions. A summary of these evaluations corroborated the expressions of opinion at the Friday session. Excerpts of comments on the questionnaire follow: Things especially liked: "The feeling of friendship and freedom among the group." "The general atmosphere and attitude of all the members." "Co-operative, kindly spirit among the group. "The feeling of being in and with a group." "The very friendJJr at.:!losphere." "Having the, opportunity to mrk as part of a team made up of people' with widely different experiences. It "Strength of each menber of th3 group. tI "Increasing L"ee e.xcha.'1.ge of ideasl' "General appreciaij:"on that this ,,>as a lear!ling experience. II "Unhurried be ginning .Il "Arrival a-t, a place trat tl'e group considered good." "The physical facili'.;ies and service were excellent." Things that would ha'lo iIrr.::-ro'lerl the effecti'loness: "Earlier identification of work still to be done." "If every member had had sor.:e experience of this kind." "Chairmanship might have been divided earlier." "A little earlier budgeting of tir:l8." "We should have got clown to brass tacks earlier, say Wednesday." Deroocratic leadership."

•-

.

"Working on tm committees (':. once, each of which had to report at the same time, was difficult but partJJr overcome by the fact that we knew each other well and mrked together easily." "Absence of two group mem'oe!'s part of the time." "Slowness :in making decisions .men action was required." "Too IllUCh detailed work that could have been done beforehand." "SLow motion at beginnine r,f 3econd week that oontributed toward a l:acklog at the end."

-15"Adequate technical help, especia.lJy a librarian." tlMore definite time table in the begirming, related to the work which had to be done during the two weeks." liThe committee could have been used to very good advantage in planning from the begirming."

. ..

-1.6C. RESOURCE MATERIAL

."

-

For months before the Seminar the WHO Regional Office for the Western Pacific, with the help of WHO Headquarters in Geneva, and the Regional Office for the Americas, was assembling educational resource materials. Suggestions for these materials were solicited from the individuals who were to participate in the meetings. As a result 250 books plus pamphlets, film strips, slides and posters were received from various parts of the world, mainly from the United States, England and Canada. The posters and pamphlets were free materials solicited from drug firms, suppJ,y houses and health as soc~ations. Periodicals were reviewed and pertinent articles photostated. Charts and anatomical models were borrowed from a suppJ,y house in Manila. Materials for making slides am posters liare brought to the Seminar in order that the participants might experiment with the construction of teaching. aids for use in their work. In addition to the items supplied by WHO, many participants brought materials to the workshop including books, films am' filmstrips and local.J.y made IOOdels, posters and flannel art. A card file was prepared using a different colored card for each type of material - books and pamphlets, films and filmstrips, IOOdels, charts and posters, leaflets, reprints and photostats. The latter were placed in large envelopes in a file cabinet. In so far as possible the materials were catalogued in Manila but all the books and films which were shipped direct to Taipei had to be handled by members of the planning committee during the preplanning period. This group also prepared a complete list of the books, films and filmstrips available for the Seminar and had it mimeographed for the participants. All this proved to be very time-consuming am utilized time that could have been IOOre profitabJ,y spent in other ways. A librarian would have been most useful and also better prepared than the members to handle these details. If such a person had been available she could have k¢ the materials in order during the seminar and assisted the participants in !1'Iru\Y wa;ys •

•

In the seminar building four rooms were set aside for resource materials one as a libra.I7, one as a we rkroom for making aQd showing slides, one for the display of models and charts and one for the projection of films am filmstrips. A large rack for storage of charts and posters and several small ones for their display were made localJ.y as was a felt or flannel board. Although a complete collection of materials could not be mRde, the marv items which were provided were used extensiveJ,y, not only as a resource for the Sem:1Jlar itself ,but to let the participants know materials which are available. Duplicate photostatic copies of magazine articles and marv posters and leaflets which could be replaced were given to nurses from countries in which procurement is difficult or impossible.

..,

-17SECTION III A. THE SEMINAR PROGRAM (November 3 - 21) General Plan The Seminar began with an open meeting held in the auditorium of the Taipei Police Department attended by officials of the National and Provincial Governments, representatives from the Embassies and Consulates of the Governments which had sent nurses to the Seminar, delegations from the Nurses I Associations and Schools of Nursing, members of the press and others. Addresses of welcome were made by the Governor of Taiwan and the Minister of the Interior. Reaponses were givim by the Educational Director of the Seminar and the WHO Nursing Adviser. ·.Fo11ow¥lg the warm. reception r.eceived there the Seminar members were' trarisported. to the seminar building where they assembled in the large conference room decked. with flowers for the occasion. The meeting was opened by the WltP. NurSing Adviser who briefly described. the origin of the plan for the SeIlti.nal" as she had done previously for the preplanning collDittee •.' Her talk was ·followed by an introduction to the workshop method of appron.ching problems giv¢l' by the Educational Director after which the participants were arbitrariiy, divided into groups for the .purpose of exploring the problems which were uppermost in their minds. In order to have a cross-section of thinking in each exploratory group, no two individuals from the same oountry were placed together. Two members of the preplanning colllllittee were 'assigned to each. group. The Educational Director was left free togo from group to group. Progress was reported. in a general session on the afternoon of the second day and on the third afternoon the exploratory groups were ready to present their suggested lists of problem areas to be studied. lion elected committee rev~ewed the proposals combining them in such a way that eight problems seemed to represent the interests of the group. Of these, four appeared. to be of major interest while the other four, although wide in scope, were of less immediate concern. At a general meeting on the morning of the fowd;h day, eight study groups, were formed and each member Signed. up for both a major and a minor area of interest. After two days, however, it was decided to concentrate on the major problems and to dispense with the minor study groups. (For full discussion see next chapter on Exploratory Groups.) Members of the coordinating committee announced their willingness to confer with individuals or small groups on problems not covered in the areas of major interest. As a result many infOI'll\1U conferences were held in the reSidence, usually in the evening or during the luncheon period. Each of the nine members of the;: coordinating committee selected the problem area in which she felt most conpetent and joined that group. There was at least one member of the committee in each study group. Groups ranged in size from four to nine persons. It was understood by all that any individual could be inn ted to leave her group to act as a resource person in another group. Three individuals were used in this w~. The Nur~a:>nsultant spent considerable time working with various groups, largo and small • At the end of the first and second weeks. progress reports were given to the entire membership by representatives of tho study groups and on Thursday and Friday of the last week final reports were made and were fol.lowed b.r general discussion. General seSSiOns, presided over by the Educational Director, were also held at the end of each week for the purpose of evaluation. The large group likewise met at intervals for other purposes - to plan and evaluate field trips, discuss visual aids and review films.

.... ....

-18One whole day and an evemng during the third week were used to discuss visual education and, beginning with the second week, fUms were shown ~ from 4 - 5:00 p.m. for those who wished to review them. Projectors of IIlalV types were available for individual use and study b,y the participants. Shortage of time prevented materials brought for the construction of homemade lantern slides and posters being used to the fullest extent desired although most individuals eXJ:,lerimented with making one or two slides of different types. One day was set aside for field trips to nursing schools and health centers and for evaluation of the experience. At the final session, the Seminar heard a talk by the Director of the western Pacific Region of the ilJrld Health Organization. This was followed b.Y a brief description of the meaning of the Seminar for nurSing in the Region, a review of the way in which the Seminar had reen conducted, a summary of conclusions reached and a report of the resolutions committee.. So ended the first Nursing Education Seminar of the Western Pacific Region. Exploratory Groups There is no doubt that the decision to divide into small groups to explore problems was a wise one for it not only helped to break down barriers which can quick1;y build up when people of different backgrounds try to talk together in large groups, but it also helped the participants to understand the workshop method. By the time study groups were formed, therefore, no time was lost in getting down to work. One m~ber of the coordinating committee (as the preplanning committee was now known) assumed the role of leader in each group in order to help start the discussion. A recorder was appointed at the beginning of each meeting. Discussion was free, each member telling about nursing education in her situation and indicating the problems involved. Since many problems were si.-nila.r in nature it was possible for each exploratory group to identif,y four or five areas of interest to be presented to the whole group for consideration as subjects for study. When these areas were reported in a general session on the third day they were listed on a large blackboard. As was to be expected there was considerable overlapping. Differences in thinking were ironed out and the following list agreed upon, as an expression of the interests of all groups: 1. 2. ~s

;:

of developing a nurse who has appreciation of the person as a member of the community.

Ways of helping a nurse trained under an earlier system to teach and supervise the present-day nurse.

3. Ways of selecting students. Recruitment.

4. 5. 6. 7. 8. 9. 10. 11.

Effective ways of teaching nurses in an underdeveloped area. Health teaching for peoples in underdeveloped areas. The goals of nursing education for a particular community. Curriculum construction based on local.needs and goals. experience needed. Theory and

.. .

Teaching methods and materials based on local needs and goals • Evaluation of student progress • Personal relationships and adjustments. Education for teachersci nursing. nurses abroad. Practical problems in sending

-19A committee was set up to suggest possible combinations in order to reduce the subjects to a workable number for study in the Seminar •. Four subjects were presented by the committee for concentrated study (~Jor subjects) and four others were listed which seemed to be of less general concern, (known as minor subjects) on which it was felt less time could be spent. Major subjects: 1. 2.

•

111e problems of training nurses in an underdeveloped area. curriculum planning based on local needs and goals.

3. Teaching Methods.

4. 1.

Interpersonal relationships.

Minor subjects: Teacher training Evaluation Recruitment of students Selection of students

2.

3.

4.

Each individual signed up for one'.,major and one minor area. As indicated previousl¥, the groups fomed to study minor subjects were disbanded earl¥ in the Seminar when participants decided they needed the full time for study of the major subjects. stucJ.y Groups I,

.

Each study group gathered in a separate conference room to give serious consideration to the problem chosen for study. It had been suggested that each group set boundaries for the limitation of its st\Xly since the topics for discussion were broad and the time short. Each group was free to decide its own organizational plan for working. Accordingly each group appointed a recorder and a leader. In some instances these responsibilities were rotated. Other groups, after a few meetings, decided to have a permanent chaiman or a permanent recorder. Some groups had minutes typed for each member. Within the limits set for general sessions each group made its own time schedule setting aside certain periods for library study, working in groups of two and three on special related problems, drawing conclusions, et cetera. Progress reports were made to the entire Seminar group on Fridays of the first two weeks at which time questions ;were enciiuraged. Final reports were submitted on Thursday afternoon and Friday morning of the last week. These reports are included herein in the form presented with but minor editing. Each presents, in some detail, the areas discussed, the way the group worked, the major implications and conclusions reached Qy the group.

~. '.

SUMMARY OF STUDY GROUP I ON THE PROBLEM OF TRAINING NURSES IN UNDERDEVELOPED AREAS OR AMONG PRIMITIVE PEOPLE Members of the Group: 1. 2. Dorothy Beale Margaret Denham 3.

4.

Terttu Tela Tjitske Kerkhof

The group studying ways and means of helping cOWltries that are in the beginning period of professional nursing felt there were many problems in-

-20volved and no special solutions could be found. But it was believed that with an objective point of view and good will, ways of approaching solutions could. be found. Each member of the group represented a professional nurse Who had been invited into the area to give leadership in providing better nursing service for the people in a country, not her own. In considering the problems peculiar to the stage of development in the countries, these aspects were raised:

1.

What are the cultural patterns that cannot be changed and 'What are ~he f~entals that are essential to be changed, if good nursJ.llg pract~ces and more Wholesome community liVing are to result? Examples: The status of women in the countries represented by the group. Promiscuous polution of water.

2.

To 'What extent does the cultural pattern of the people who are working to develop nursing in a given country influence the leadership they give? Examples: Attitudos tOl1ard colonization Men in nursing. The failure to put into practice information basic ,to good health, such as use of unpolished rice.

3. 'What are the best ways to develop leaders in countries which ara on the threshold of improving nursing?

4.

'What knowledge and skills are needed by nurses in these countries at their particular stage of development? To what extent can the people themselves participate in planning and deciding their own needs for nursing am the knowledge and skills students in nursing in their own country should have? Can professional interest be developed through studying their own history and social background? ~le:

5. 6.

What value is it to teach about Florence Nightingale in the Crimean War when the student nurse has not yet learned to recognize the beginning of nursing among her own people?

7.

'What value is there in teaching sciences, et cetera, unJ.ess the knowledge becomes a functioning part 0 f the nurse I s everyday work and life?

These represent the ohief considerations of the group during our time together. We are agreed that more consideration needs to be given to arousing self activity and responsibility among the people in improving their own education and services. Discussion The discussion which followed the presentation of this report brought out many interesting, wrthwhile comments some of which are included below: Comments by the group representative 'Who gave the rseort: IIWe are not sure that any of us have settled in our minds a solution to aru of these problems. We recognize the need for continuous, long,de-

-21tailed study befo~e we will know how to improve the status of nursing. We do not refer to the status of women,. but to nursing, whether the service is given by men or women. Such a study will require a vast amount of time and will take generations. The ansWers will be different in each place. There will be no set pattern. We should keep our sights high and at the same time work on a practical level in the actual situation. We have studied a new nursing curriculum for one country. We have an increased understanding of how involved the problem is, and how small is the individual who approaches it. we believe that it is not as important to stress skills as to study principles, because once the principles are understood, skills can then be learned." Contribution of another Parlicipant: "Some of the ways of living are not always because of the cultural pattern. Ignorance is due to lack of education and superstituion to the the lack of knowledge." This nurse went on to describe her experience with the "Mass Education Movement in China" and expressed her confidence that an improved standard of living can be seen once people are given an opportunity to learn.

-.

REPORT OF GROUP II ON CURRICULUM PLANNING BASED ON LOCAL NEEDS & GOALS

Members of the Group:

1. Herminia Reyes 2. patricia Church

5.

Emi.J.y Smith

8. Chow Mei-yu ., We took as our ceritral objeq-tive "To consider the principles of a bal,,:, anced curriculum" the contriblltot'y factors being: Nora Conway 1. The number and educational standard of students available, the faCilities, and the socio-economic and cultural background of the students. The necessityto educate a nurse to meet the needs of her community. It soon became obvious that we could not have any group thinking on the subject until we knew more about the different methods of nurse training as carried out in each country represented. ioJJ therefore used some time for each member to report on nurse training in her country. These reports were summarized in chart form and given to each member of the Seminar.

3. Ong Poh-teen

4.

6. Barbara Sumner 7. Soon Ai Ryu

2.

Asa result of these discussions we decided to work on the foD-owing problems: 1. 2. The correlation of theory and practice .• The problem of supervision of the stUdent during practice. the basic curriculum. We also arrived at the conclUSion that a curriculum should be based·on the aim, purposes, and standards of the school and should specify the preparation it p;t'Oposes to give to students to achieve these. The essential principles of curriculum planning should include consideration of: 1. 2. The health needs of the community. The current trends of nursing education' .and. practice.

3. The integration of the social and health aspects of nursing into

-22,3.

The capacity of the students. The minimum state requirements; also the requirements of countries with which reciprocity is considered. (We wish to stress here that even for the sake of a reciprocal agreement with another country its syllabus should not be followed blindly.)

4.

We then divided into three small groups to work on the problems and met together as a group to consider. the reports of the IIsub-groupSIl. These we now present. final~

Report on the Correlation of Theory and Practice 1.

Philosophy We feel the most essential part of a student nurse's training is obtained in the ward and not in the classroom, that the ideal w~ to teach clinical nursing is to center it around the patient. Many hours of classroom instruction can never compensate for lack of experience in the wards, but unless standards of nursing in hospital wards are high, it is impossible to educate good nurses.

2.

Possible Relationships 1Jetween Theol',f Wl.d Practice a. b. c. Theory may precede practice. The two may run side by side. Practice ~

precede the related theory.

For practical purposes all three situations may exist in a single school of nursing, but the first and second Situation, only, are regarded as education~ sound. It is generally accepted that theory and practice should be correlated because:

•

a. b.

The intangible becomes reality, and all learning becomes more thorough and rapid. Skills develop along with the increasing of theoretical Jedge • .> know~

.~

3. Conditions Which Must Prevail if Correlation is to be Achieved a. Full cooperation of medical, nursing, and administrative staffs in carrying out the program of the school of nursing. 1) These people must be given clear understanding of the objectives of the school by frequent~ meeting with the teaching staff. In planning the broad outlines of the curriCulum, the aid of the med.ical staff should be enlisted.

2) b.

Realistic methods of teaching in the classroom with stress laid on under~ing principles. 1) In teaching nursing arts procedures must be demonstrated in a manner in which they can be executed in the ward, and furnishings and equipment in ward and demonstration room should be similar. The usc of elaborate demonstration equipment which is not available for practice in the hospi~al, creates an air of artificiality.

c.

Adequate ward teaching and superv1s~on, especially when complete correlation of classroom teaching and ward practice is not possible. Method of Eichieving this has been discussed elsewhere.

-23d. Adequate ward facilities :if1cluding reference books. 1) 2) Hospital equipment should conform to school standards. Up-to-date reference books must be read~ accessible to all nursing staff in each department and students encouraged to refer to these. for the

The Problem of

Supervision is a process of "working together" between the supervisor and the student for common goals; to help the student to "independent thinking, sound judgment, intellectual resourcefulness and self-masteryll; to stimulate her "to grow and develop in effectiveness". 1. Possible Cause of Inadequate Supervision a. Limitation iIrposed by the policy and set-up of the organization. Problems in supervision arise wen a school has to take in groups of students of varying educational preparation, three or more times a year. There are other schools which affiliate in hospitals whose set-up mqy be quite different from what the school would like it to be. Shortage of qualified supervisors as -well as of other nursing .personnel. Ward sisters or head nurses are often very busy with administrative duties an? have little time for teaching and supervision. Too much stress on hospital neads instead of students I educational needs. Difficulties resulting from physical set-up: 1) e. 2. Housing 2) Transportation 3) EqUipment

b.

c. d.

Lack of understanding of the educational objectives of the school on the part of the hospital nurSing staff.

Suggestion for Inprovement a. Motivation for professional growth by in-service education. 1) 2) 3) 4)

Orienting new staff nurses. Staff meetings and discussions. Seminars, workshops, conferences. Cultivation of good potential supervisors among the graduate nurses.

b. c.

Planning a systematic clinical rotation for students. Supervision becomes easier When a long-range rotation plan is made. A clear definition of the objectives of nursing service and nursing education contributes to good nursing service; each is close~ related to the other. However, since nursing education centers around the students, the school, at least to some extent, should be administratively independent from hospital service. Physical set-up and facilities needed for convenient supervision. 1) . Smaller wlits.

d.

2)

Adequate spacing between beds for clinical teaching. Work rooms, utility rooms,ba.thro'~, nurses' stations convenient~ located. -'.

3) e.

The use of the "nursing team" in which supervision is shared by the head nurse with a staff nurse or senior student who acts as a leader and has one or two students working under her supervision and direction in the care of a selected group of patients. Non-nursing activities should be done by personnel other than nurses so as to give the ward sister more time to plan for the care of her patients and the teaching of students.

f.

Re ort on the Integration of the Social & Health Aspects of Nursin ~to e Basic Curric urn

1.

Objective of this report. The objective of this report is to suggest pertinent ways by which social and health aspects of nursing can be infiltrated throughout the curriculum, in both theory and practice. We were aware of the following problems that have deterred nursing schools from introducing this subject or caused them to introduce it in such a manner that there was no ful~hering of the nurses' education towards nursing and knowing the "whole patient".

a. b.

An over-flowing curriculum with no time for extra subject matter to be added.

The interpretation of a curriculum is often geared to a stereotyped examination which does not always recognize "total nursing care" (or the effect of the community on a patient). "Public Health Nursing and Community Health" is sometimes added to the curriculum as theory and practice at the beginning or end of a nurse's training. This results in the student thinking of the community as ap~ from the hospital and she fails to recognize that her patient comes from and goes back to a home, a job, and SOCiety.

c.

We consider that the integration of the health and social aspects of nursing can be effected by taking the curriculum as it stands and bringing out these aspects in each subject as it is taught and practiced. 2. Examples of how this may be done. Subject Perional Hygiene Suggested Method of Integration The healthy body. Maintenance of health in the student herself. Visits to a well-baby clinic or a school health service followed by a visit to an average home with a public health nurse during the preliminary period. The dangers of cross infection in the hospital and how to prevent spread of disease. This can be related to home and industry q,nd can be studied as it affects a patient known to the students. Can be related to the nurse, to the patient in hospital, and to the teaching the nurse can give the patient regarding good f~ nutrition. The study of each disease gives ample opportuni4Y for stressing the effect of the community on the

Bacteriology

Normal Nutrition

Nursing

-2.5patient in the hospital. The cause of the illness, its prevention, What an illness m~ mean to a patient and his family. It is useful to ask a public health nurse and doctor to participate in some of the teaching exanples being cOlllIllunicable diseases and pediatrics. Nursing Care Studies These should aJ;w"coYs include the type of work, the cause of accident or illness and how this could have been avoided, What teaching is given to the patient and his fami~, the home conditions and the effect these may have on his illness and what cOlllIllunity resources can be contacted to care for him on his return home. These points Should be considered naturally throughout the study and not tagged on at the end under the heading of social conditions or almoner's (social worker 1 s) report. It is important that the tutor (instructor) develop an awareness of the social aspect of nursing in her stUdents but the ward sister (head nurse) . has the most important part to play as it is through her example the concept" comes alive". Exanples: The head nurse in the outpatient department can show the nurse how necessary it is to know the patient's home conditions, his place and kind of work, the wages he earns. The ward sister in giving her report can show the nurses how to help a new patient adjust to his new surroundings, and explain Why he :is worried at the thought of being off work. She should also tell the nurse What each patient and his relations are being taught regarding prevention of spread or recurrence of his illness. The student should do some of this teaching herself.

II II

Practical Experience

Field Experience

This is extreme~ valuable if it is well-planned and is carried out throughout the studen~s experience. A few well-organized and meaningful home visits are far more valuable towards training a nurse to give total nursing care than a month spent on observation with an organization remote from the hospital where the student will not see the home of a patient she has nursed. Examples: A follow-up visit to the home of a new~ discharged maternity patient. During her experience in a chest ward the student could Pa.Y a visit with the public health nurse to the home of a new patlant.

Field visits should always be followed by a discussion between the student, the tutor and 'Where possible the public health nurse. ,3.

Conclusions and Summary. a. b. Social and public health aspects can be integrated in nursing by using a curriculum as it stands.

The tutor sister must herself have an interest and understanding of social services in order to weave this point of view into all subjects.

-26c. Public Health given only as an unrelated subject or experience at the beginning or end of training is of little value and m~ only help to divorce the hospital from the community in the student's mind. The ward sister or head nurse is of extreme importance as it is she who makes social and public health aspects vital. She must herself have knowledge of all the local public health services and be interested in teaching students how to use thern for their patients and also be alert to the rnany opportunities for health teaching in a.l':\Y hospital ward. REPORT OF STUDY GROUP IlION TEACHING 11ETHODS Members of the Group: 1.

d.

5.

4.

2. 3.

Jean Barrett Chung Hsin-hsin Manuela Gonzales Hsu Ai-chu Mary Harling (Recorder)

6. 7. 8. 9.

Gertrude Hodgman Kwi Haing Lee Valerie Smith Shun Takahashi

Introduction "NurSing in its broadest sense m~ be defined as an art and a science lIlhich sees the patient as a whole -- body, mind and spirit; promotes his physical, mental. and spiritual health 1:u teaching and by example; emphasizes health education and the preservation of health as well as the care of the sick; involves the care of the patient's environment -- social and psychological as well as physical; provides for the health care of the family, the community, and the individual. 1I - Sister Olivia The members of the study group on Teaching Methods agreed to accept Sister Olivia's definition of nursing, as it included all the factors Wbich we felt ,were a part of total nursing care. We felt that we could consider methods" 6t teaching nurses only on the basis of this broad concept of nursing. We agreed that the goal of nursing oducation was to produce a nurse who could carry out this total concept of nursing in any situation. In order to do this a nurse must

",

1. 2. ;.

be able to think and reason and to define and solve problems using the scientific method. be able to adjust and adapt to different situations.

be self-disciplined. have an understanding and acceptance of herself and of others. continue to grow and develop both persona~

4.

5.

and professionally.

It was felt that a study of teaching methods at this time was essential, as often older methods of teaching did not encourage thinking, failed to meet the nurse's needs even for basic information, failed to teach the nurse to adjust in varying situations and encouraged her to become narrow and rigid in her professional and social outlook. Further, we based our study on certain factors which we felt to be essential to good nursing education:

1.

That nurses are responsible for the education of nurses and that they must gain the understanding and cooperation of doctors and others lIlho assist in nursing education. That the teacher has a responsibility for arranging the e~eriences in the community or in the hospital, through which a student learns

2.

-27to nurse. Such experience must be varied and well-organized and all who teach students in these situations must understand and be in sympathy with the aims and program of the school of nursing. That the student must have her vital nursing experience Where good total nursing care is always practiaed. In order to ensure this vital necessity for good education the teacher must a. b. arrange for good supervision of student nursing practice. cooperate with the staff in the nursing situation to avoid disruption of necessary nurSing service to patients through careful planning of the; time for classes and by insisting that the student should be on duty promptly as assigned.

4.

That the students must have comfortable, sanitary, attractive, and pleasant living conditions. Methods of Teaching

The group felt that the actual methods of teaching could best be studied through the attitudes, skills and knowledge which contribute to the central, vital experience of nursing gained by the student in the care of people in the community and in the hospital. Therefore these teaching methods are presented as 1. 2. Methods of teaching the attitudes and appreciations required in order that a student may give total nursing care. Methods of teaching the furrlamental and functional knowledge on Which good nursing is based. Methods of teaching the skills required for the patient's comfort, safety, and general well-being. Methods of teaching within a real nursing situation in order that the student may understand and carry out total nursing care.

L 3.

4.

It was recognized b,y the group that good teaching methods imply the teach.ing of attitudes and appreciations as well as skills and knowledge, that the teaching of a nursing skill involves the teaching of marw appreciations and the reinforcing of the scientifific principles on Which the method is based. 1. Teaching Methods Used to Develop Attitudes and j~ppreciations.

It was recognized that attitudes and appreCiations are acquired throughout the experience of the growing-up period and that by the time the student enters a school of nursing in late adolescence many of these are relatively fixed and tinged with emotion. However, since good nursing depends largely upon the attitudes of the nurse toward the people with ·whom she comes in contact, it is IOOSt important to consider ways of developing the right attitudes, appreciations and behaviour, social as well as professional. The following conclusions were reached: a. The exa.nple of others is one of the IOOst vital factors in teaching attitudes. All Who teach nurses should remember this and exenplify in their social and professional life all that they would wish the student to learn. The total experience of the student in her residence and social life, co-curricular activities, classroom and nursing experience should be planned and organized so that she may al~s experience satisfaction from acceptable attitudes and behaviour.

b.

-28c. A careful orientation to new situations both in the residence • and in nursing should be planned. The teaching and administrative staff should share the responsibility of making and carrying out these arrangements with the staff nurses and with the students. ' Co-curricular activities are valuable, if wise~ planned and guided, to develop initiative, social skills, a sense of responsibility and to stimulate the development of the student as a mature and well-rounded person. Co-curricular activities include, both social activities and student councils. It was suggested that the students, with wise guidance from the staff, should share the responsibility of making the rules which control their residence life, should take part in enforcing them and that assisting with disciplinary measures should be useful in developing a better understanding of people and problems and in learning to keep confidences. It was further suggested that, under wise guidance, the student council might take part in the consideration of disciplinary problams in profeSSional as well as in social situations. Counselling - SOCial, personal, and professional - is an in¥'ortant factor in the development of attitudes and appreciations. The following basic comments were made: 1) Counselling is the responsibility of all members of the staff of a school of nursing, administrative and supervisory as well as teaching. The staff must be aware, individual~ and collectively, of their responsibilities and opportunities, must be sincere in their interest, and work harmoniously for the benefit of the students. The person who counsels must be mature, well-balanced emotiona~, intelligent, wise and have an understanding of and a liking for students. Special preparation in the technique of counselling is desirable. Where sui table people, with such preparation are not available, assistance should be sought to help the teacher understand and develop such techniques. It was suggested that, where a fully prepared person is aVailable, her services might be used for staff education and staff consultation instead of (or in addition to) direct work with the students. Professional counselling must be done by nurses, but social and personal problems may be effectiv~ handled by others. It was suggested that the pOSitions of Home Sister or Recreational Director offer ma~natural opportunities for counselling as does the guidance of cocurricular activities. Such duties should be on a fulltime basis. The person in such a position should not be burdened with housekeeping duties, should be available outside the usual 9 - 5 working hours and should be able to guide the students in a graceful, harmonious and happy residence life. She should be given a definite place as a member of the faculty, should be academicallY qualified to function as such, and should partiCipate in any staff meeting which does not deal solelY with professional matters. '

d.

e.

2)

3)

4)

, .$.

f.

Certain courses in the school of nursing are planned prirnari~ to teach attitudes and appreciations. Psychology, sociology, history, ethics, professional problems supp~ some basic facts and principlos which contribute to the nurse I s education, but do not, unless reinforced by good teaching and dailY e~erience, increase

-29true understanding of people or an ability to develop good interpersonal relationships. 2.

The Methods of Teaching Fundamental and Functional Principles. In considering the question of how the facts, upon mich nursing may depend, can be taught, the group listed certain courses in the nursing curriculum as being essential~ factual or informational courses. It is recognized that the student nurse requires knowledge of facts, not for the facts themselves but as functional information in relation to their possible usee. It is appreciated that methods of teaching influence the students' likes or dislikes for any subject and thus inevitably there is much learning which goes in any course which cannot be included under IIfacts". The study of any science, for instance, may teach, and perhaps should always teach, an "appreciation of the sci~ti£ic method" an appreciation whiCh should be included in the education of nur3es and mich they in turn may pass on to the others. For our purposes however we have listed the following courses as primarily II factual" : physiology and anatomy, materia medica and ther.apeutics; bacteriology, parasitology, pathology; chemistry and physics; food and nutrition; the sciences of medicine, surgery, pediatrics, obstetrics, psychiatry; personal and public hygiene. These subjects of the nursing curriculum are usually taught by the lecture or lesson method in which may be included a variety of other methods to supplement and enrich, such as: a. b. 'ftle use of the blackboard for new words, topic outline, charts and statistical data, et cetera.

..

Note taking. With note books checked. for accuracy and completeness by an instructor - may be valuable for the younger student if the teacher has sufficient time to do it thoroughly and to have a conference with each student afterwards. Questions and discussion. Verbal and written quizzes. study assignments. Reports, written and verbal, mich offer an opportunity for the student to study and think independently and to learn to find resource material. Illustrative or visual materials which must be carefully chosen and used. Demonstrations. There was some some doubt that demonstrations of chemistry or physics were very valuable and they certa~ do not replace laboratory work effectively. Laboratory work. This is not always possible and when it is not the contents of the course should be reviewed to eliminate topics which are inadequately learned without it and mich are not essential. Field trips. These must be used to enrich the student's knowledge and appreciation, must be prepared for by teacher and student and followed by discussion. They are most valuable if they arise from an interest expressed by the stUdents. Examinations, tests - verbal and written. If such tests and examinations are used as a teaching method, rather than merely as

c. d. e.

f. g.

h.

i.

j.

-30a means of judging and evaluating the student's knowledge and ability, it is important that the student know her mistakes and the correct answers to the test questions as immediately as possible •. In discussing the value of the teaching methods used in connection with a teacher planned lecture or lesson, the group considered whether or not the "workshop" or "seminar" method as demonstrated in these three weeks in Taipei, in which the study may be said to be student-teacher or teacher-student planned and directed, and which IIti\Y use any or an: of the methOds described above may not result in a great9r interest and activit.y, and greater resultant learning to the student. It was also pointed out that the activities involved in the teaching of nursing arts and in nursing practice, in both contrived and real situations, serves a very valuable purpose in enriching, increasing and reinforcing tha factual knowledge which has already been taught in these course~ 'Which were actually on1¥ partially learned in the classroom or laboratory. 3. Method of Teaching Nursing Procedures. a. The objective in teaching nursing procedures is to prepare the nurse to give nursing care, not just to develop a technique. Involved in the learning of a procedure are skills, understandings, and attitudes and the method of teaching helps to determine whether the objective is achieved. The Meaning of Skill. "Skill consists of the ability to bring about some end result with maximum certainty and minimum outlay of energy or time, or time and energy." by Guthrie. A Skilled person can make adjustments in movements if a change in the situation calls for it. The nurse needs to possess knowledge, sympathy, understanding and judgment in the performance of skills; Le., bed-making requires not only the accurate making of a perfect bed rut s,y.m-' pathy and an understanding of the comfort needs of the patient so that the bed is as we~de and neat as possible and the patient is comfortable. c. Ways of Effecting Uniformity in Nursing Procedures. 1) Techniques to be taught to students must be agreed upon by both the school and hospital authorities and it must be possible for them to be changed from time to time.

b. "

2)

It is advisable to have a manual of techniques or one attached to the hospital routine book. It should be the loose leaf type. All new staff nurses who join the hospital staff should be given demonstrations of the techniques used in the hospital to ensure that uniform methods are always used when teaching the student.

3)

d.

The Teacher's Preparation for Teaching a Nursing Procedure includes: 1) Complete planning of the procedures to be taught in a given period in relatl.ooship to the other subjects taugJ.t during that period.

-312) 3)

Practice by the teacher of the pro~dure in the way in in which it is to be demonstrated. Planning of the situation for demonstrating a particular procedure: . a) Type of room (lighting, ventilation, etcQtera) Arrangement of the room (e.g., to resemble a ward as nearly as possible, et cetera)

•

b) c) d)

Seating accommodations for students so that they can all see clearly. Division of the whole groups of students into smaller groups for demonstration if necessary to ensure that each member can see clearly.

4) Reference assignment to students. e. Presentation of the Nursing Procedure. This will include several methods of teaching: 1) Discussion of purpo.ses, reasons for and/or uses of the method of carrying out the procedure. Charts, models, slides and posters may be used to reinforce the principles on which the procedure is based. 2) Presentation of an overview of the procedure to give a picture or concept of the method as a whole without giving the details of the technique. for the treatment. 1!)

3) Presentation of a situation describing a patient's need Demonstration of the total responsibility of the nurse in carrying out the procedure. This inclUdes: a) 1"""\

Preliminary steps

(1) Checking the doctor's or head nurse's orders (2) (3)

Conferring with the head nurse i f necessary Preparation for the procedure, including assembling of all material, using the necossary safeguards such as sterilization, checking of labels, testing of temperature of solutions, et cetera. gically and physically

(4) Preparation of the patient psycholoto

.!'"

b). Demonstration of the procedure itself showing every consideration for the comfort of the patient • c) Follow up care

(1) After-care of the p.atient leaving him comfortable and the room .in order. (2)

After-care of equipment.

-32d) Recording of the treatment given according to the hospital policy; i.e., nurses notes, narcotic sheet, order sheet, et cetera.

5)

Class discussion to analyze dangers involved, measures for the patient's comfort, and factors in the administration which influence the effectiveness of the procedure. A film or film strip may be used to reinforce the demonstration. (Films showing modifications in technique may be shown in a later class after the student has gained a concept of one method through practice.) Dramatization b,y the students of a situation in the home or hospital to demonstrate nursing procedures in the care of an individual or family. The purposes of such dramatizations are a) b) To present a situation in which a nurse might find herself functioning. To show a method of total nursing care including the relationship between the nurse, the patient, his family and other people concerned, as well as nursing procedures involved in the patient'S care. To stimulate the student's interest in the patient, his family, and in giving good nursing care. To develop sensitiveness towards patients and families through role playing. To develop the student's ability to organize and work in a group. To stimulate the stUdent to broaden her interests: e.i., in drama, et cetera.

6)

7)

c)

d) e) f) 8)

Observa'tion of treatments in the hospital or home which cannot be demonstrated in an artificial situation. (In this case the preparation of the student includes the same steps as those used in the classroom presentation.)

f.

Practice. 1)

Early practice by the student under supervision (within one or two days). Individual practice by the student. Return demonstration b,y the student. Practice in the actual situation (on ward), with supervision whenever nocessary.

2) '3)

4) Ward Teaching.

Objectives:

a.

To develop the studentls ability to understand and appreciate the individual needs of each patient in order to give total nursing care. To develop the student's ability to define and solve nursing problems.

b.

-33In order to achieve these objectives, the following factors must be considered: a. Administrative organization - essential 1) Good management of the ward which requires a) b) c) d) e) f) 2) team work of personnel clear delegation of responsibility clear lines of responsibility clear and complete orders from physicians and nurses clear and complete reports enough suitable equipment and supplies for good nursing

Good rapport between members of the staff staff education program

3) b.

Facilities for teaching on the ward - recommended 1)

Ward library, reference books, dictionaries, magazines, pamphlets, leaflets, et ceter-ao A quiet place on or >::',aar the ward 1.mere conferences can be held. Visual aids a) pictures and poste:c's

2)

3)

b) c) d) e)

X-ray films laboratory specimen:> clinical charts equipment for the care of tlw patient

4) 5)

Ward manual (polic:T book) Nursing procedure manual

6) Reference file c. Type of assignmen~

of experience - essential

1) 2) 3)

Correlated with theoretical experience Graded according to the individual! s ability Size of assignment should be in accordance with the individual1s capabilities Students should be assigned to patients for a sufficient~ long time to develop understanding of their problems and skill in giving them care.

4)

-345)

Experience with various nursing problems found in the serviae such as a) care of a patient who is unconscious care of a patient with fever care of a patient with many psychological problems

,.

b) c) d.

l1ethods of teaching The "situation" method of teaching is probabl3" the best for achieving the objectives of ward teaching. (This same method is applicable in teaching in the classroom, the home, the clinic.) Some of the ways of using this method are listed: 1) Patients presenti."l.g the types of nursing problems with which the student needs experience should be assigned to her for care. The student should care for these patients for a long enough period of time (perhaps several weeks) for her to know them, understand their problems and needs, to make plans for their care and to carry out the plans. Such plans would include: pbysical care psychological approach patient's special needs 3) Supervision by the teacher and head nurse should be such that it will help the student to understand her patients and their families and assist.her in meeting their needs. Methods of supervision shouJ.d include: a) b) c) actually helping the student in giving bedside care asking questions which will help the student think through situations discussing problems involved in each patient's care, helping the stUdent to analyze them and make nursing care plans suggesting reading materials pertinent to the patient's care health teaching plans for care after discharge

2)

d)

4) Nursing care conference or bedside clinic The student nurse who knows her patients and their problems can help other nurses to understand and develop an interest in them if she discusses her patients in a nursing care conference or clinic. During the conference other members present may partiCipate by giving suggestions for the improvement of nursing care. Thl3se can be tried by the student and incorporated in the nursing care plan if they prove to be of worth.

-35SUMMARY REPORT OF STUDY GROUP IV ON INTERPERSONAL RELATIONSHIPS

Members of the Group: 1. 2. Hsia Teh-chen Yung Bok Lee Chizuko Nakamichi Leonor Aragon

5. 6. 7. 8.

•

4.

3.

Rhoda Applebee Elizabeth Hill (part time) Dorothy Hayes Ragnhild Lund-Jensen (Recorder)

Af'ter Some preliminary discussion by individuals in the group concerning their immediate problems in the area of interpersonal relationships in nursing education, the following suggestions that had been drawn up by one of the exploratory groups as to possible areas for discussion were reviewed: 1. 2. 3. Creating an environment in which the personality of the student may

be fully developed. Influence of the graduate nurse on the student. Understanding of the older nurses with an old type of training. Cooperation with other members of the community. Problem of the person ~o has been given recent authority. nurse Who is given a better position. 7. Dealing with the aggressive, bossy tYpe of authority.

4. 5.

6. The experienced nurse I s attitude towards a younger, better qualified

Following this, group members indicated additional areas into Wbich their immediate concern seemed to fall Which were not covered by those presented above. A grouping of the total areas covering the interests of the group members resulted in a classification into two main diviSions, as follows: 1. Interpersonal relationships involving the people with whom the nurse must often work: a. b. c. The older nurse or doctor with an older type of training. The nurse-administrator Who has over others. recent~

been given authority

The experienced nurse toward an energetic, better trained younger nurse who has been given a better position than she has. The aggressive, bossy type of authority. The ward nurse who is working with students. Doctors. Administrators of schools of nursing working with administrators of hospitals. Nurses l«>rking with other nurses. The patient. The:family of the patient.

d. e. f. g. h. i. j.

2.

The creation of an environment in which the personality of the student ma.Y be f'ulJ.¥ developed, including such areas as: . a. Some of the student problems which it helps a be aware of. n~

to

-36b. Some of the things nurse-teachers do in their relationships with students that prevent the student from developing emotional adjustment. Some of the possible conflicts within the nurse-teacher herself that m~ affect students.

c.

In a general approach to these two areas, the group considered resources that were available for increasing understanding of how to work with people and some time was spent b,y group members in reviewing library resources. Throughout the discussions numerous generali.zations in mental hygiene were pointed up by Dorothy Hayes and others as examples were given to illustrate seemin~ successful or unsuccessful ways of working with people. These generalizations are presented at the end of this report. People with l::hom Nurse Must Work It was recognized b,y the group members that the nurse needs to have good relationships with those with whom she works - in fact, that her success as a nurse and as a person is dependent on the skill she has in human relationships as well as her technical skill in carrying out nursing duties. Many obstacles confronting the nurse and nursing educator in her attempts to work with people were noted, including the following: 1. 2. Doctors may not have a high respect for the nurse. '!he community may not hold the profession of nursing in high regard. Persons who are in ad.'11inistrative positions in the hospital or School of nursing may be bossy and aggressive. Nurses with an older type of training may malee it very difficult for a younger nurse trained in more modern procedurec. Administrators of hospitals may be more concerned vnth the needed service than with giving the nurse student a 1Tariety of good experience. nursing rray have different requirements placed upon them, and one group resent the freedom given the other. 7. The nursing educator may not understand the age group with whom she is working.

3.

4.

5.

6. Students in university schools of nu.:"s:i.n.g and hospital schools of

Growing out of the group 1 s reCOgnition that in working for good relationships it is important to understand how the other person looks at things, and since grollp members felt that doctors and nurses often fail to work as a team because each does not understand the other', it wns suggested that a doctor be invited to come to the group as a resource member. From him the group would try (1) to determine what some of the nurse 1 s problems look like to the doctor, and (2) to attempt to gain an understanding of the doctor 1 s point of view. To facilitate the planning for the coming of such a resource person, each member of the group agreed to suhnit in wri'~:L'lg the questions she would like to ask the doctor. The submitted questions were compiled b,y a committee and presented to the group for further consideration of what had been meant in the case of certain questions. Thi:3 procedure itself brought out further questions and additional information concerning the local sit.uations of a number of the members of the group. It was decided to group the questions under four main headings, as follows: 1. Suggestions the doctors may have for improving the relationships of a. Doctors and nurses.

b •. Administrators of schools of nursing and the administrator of the hospital Where the student nurse gets her practical experience.

-37c. 2. Fellow nurses.

status of nurses a. Does the doctor believe that the nurse has (or should have) as high professional status in her community as the elemtary-school teacher, the high-school teacher, the college teacher? Does the doctor have suggestions to· make as to ways in which the public and doctors will come to have a higher regard for the nursing profession? Does the personal appearance of doctors and nurses affect the respect the public gives them? Does the doctor have further suggestions for raising standards of nursing and professional training during the transition period in Taiwan?

~

b.

c. d.

3. Preparation of nurses a. b. c. d. e. What does the doctor think should be emphasized in the training of nurses? What does the doctor think has been neglected in the training of nurses? Does the doctor feel that nurses should be prepared to think of their job as one of total community service? Are there suggestions for giving the nurse this concept? What courses in nurSing-education are doctors better qualified to teach nurses than nurse-educators?

4.

Preparation of burse-teachers How can it be done without opportuni~ being available to graduates of nursing schools to go on to college?

The group prepared for the consultant's visit by haVing ready copies of the foregoing questions, so that the consultant and group members each had copies. It was also agreed that the occasion would be used: 1. 2. To learn from him -- not use the occasion to try to convince him of a certain point of view. To make him feel comfortable as the guest of the group, and to realize that the group could learn from him the point of view of doctors as he saw this point of view.

).

To have him participate in the group as a group member whom the group respected.

From the point of view expressed by the resource person invited (the Director of the Provincial Health Administration) and the discussion that ensued, the following generalizations were arrived at: 1. The responsibilities of the nurse (it was agreed that the term "nurse" refers to the qualified graduate nurse) and the doctor are often not clear~ defined, and this leads to confusion and misunderstanding. An attempt should be made t a work out these responsibilities careful~, perhaps by a re~resentative committee of doctors and nurses. A plan should also be made for caring for uorolpected situations that ma;r arise for which no line of responsibility has as yet been worked out.

-382. Traditions and customs vary from locality to locality, but particularly in certain areas, there is some feeling on the part of doctors that ~men are inferior to men; this may be a salient force in the attitude of some doctors toward nurses. There is need for an interchange of knowledge between doctors and nurses. Doctors may not know how much the nurse has had in her training, nor the nurse know what the doctor has had in his training.' Where a doctor has been trained in a system where the nurse is a helper or an apprentice, he may fail to understand another type of nurse. It is easier for·doctors and nurses to work together if there has been Similarity i~ their backgrounds, and when ways are found for them to do things together. There is need for correlating the training given in a school of medicine with that in the school of nursing. A dean of the school of medicine and a dean of the school of nursing can wrk together to correlate the training. Advisory committees that contain representatives from nursing, medicine, public health nursing, et cetera, often work effectively in correlating hospital nursing, medical, and public health training. A nurse in the ward lIDO is instructing students should be recognized as a nursing teacher and hence considered a member of the school of nursing. She should be invited to faculty meetings. much stress on the differences in background between nurses within a hospital or school of nursing. '!hese differences should not be allowed to interfere with standards of practice •

3.

4.

5.

·6. Difficulties in relationships sometires come about because of too

•

7. Doctor's judgments of nurses are ofton conditioned quality of her training.

by the amount end

8. Raising the salary of the nurse oft.en increases her self-respect. In some coWltries the salary of the nurse is the same as that of a maid. 9. The person teaching nurses should be the one best qualified to develop understanding; this does not mean the one who ht.s done the most research. Two iIrportant areas that should be emphasized in the training of the

10.

nurse and which are often neglected are a. b. li. 12. Health teaching of the patient. Relationships with colleagues. Team wort< is necessary.

Coliege preparation is needed for nursing-educators, preferably in her ow country. Nurses in training need experiences that wili help them know 'Where to go for iIrportant information they need, instead of so much stress on pure memorization of facts. Examination papers are best graded by the person giving the course, rather than an outside examiner. sons ~o have experience in and understandOUlg field. L~ ~he

13. Where outside examiners are USGd, care should be taken to choose pernursing-education

An Environment for the Development of Emotional Stability Many points were brought forth in the group1s consideration of the factors to be kept in mi.xxl. in teaching students in such away that emotional

-39development is fostered. be kept in mind: The group agreed that the following should definitely

•

1. 2.

The most valuable resource in the classroom is the teacher herself' • Student's feelings;,ilIlUSt be considered; strong negative feelings block learningS. Very young student nurses require special consideration. It is the teacher's responsibili4Y to know the characteristics of the age-level with which she is working. Too much crowded into a course, and too much service required in the hospital affects the attitude of students toward their work. Enthusiasm is infectious. The enthusiasm of the teacher for the subject she is teaching often helps students enjoy what they are expected to learn. if' good communication between the instructor and the student is to be insured.

3.

4. 5.

6. Sirnplici4Y in language is essential

Small groups contribute to a feeling of freedom in the classroom.

8. If you want students to feel free, if an instructor really wants to learn mat they are thinking and feeling, it is inportant that she learn to listen to them. It may take better preparation and more background to teach in an info.t'lllt>l way than to prepare lectures. Teaching for Better Understanding of Others '!be committee working on teaching methods was invited to participate with the group to discuss the question as to effective ways to teach nurse students so that they develop understanding of others arid ~bilities to work with people. lhis arJd succeeding discussions brought out the following points: 1. Attitudes and appreciation are essential to make people use the knowledge they have. Knowledge about psychology may have little effect on an individual's ability to use that knowledge in working out good relationships with others. An understanding of the reasons

,

2. 3.

whY children act as they do may increase understanding and acceptance of persons of other ages.

Praise for success often increases the general competence of a nurse student. Highly competitive situations may focus attention of the student on learning to pass an eXamination, rather than application of what is learned. The fallacy of many of our procedures for grading was recognized. A facul4Y-student committee may be helpful to obtain the critical reactions of students to their curriculurrl and procedures in the classroom, and this information may be helpful to faculty in revision of their plans, guiding students, et cetera. Again, it is inportant that if' such a plan is followed, student opinion be respected, even though it is not always possible to change existing procedure because of it. Some of the ways in which students may have experience in developing tolerance and urrlerstanding, include: a. b. Committee work sports and entertainment

4.

5.

6.

-40c. d. Workshop-seminars, in which they share and solve problems Use of a suggestion box, where ideas from students are invited •

• 7.

Homework ought to be limited, and have a purpose, in order for it to be of value to the student • The method of "punishing" for infraction of school rules is importart,. The "daydreaming" student is irrlicating to her instructor that she has an important sympton of maladjustment.

•

8. 9.

Generalizations in the Area of Interpersonal Relationshjps Noted by the study Group Concerned with These (Some generalizatiOns about causes of people feeling and acting the w~ they do, and hence necessary to understand when one is concerned about better human relationships) 1. Social forces are often responsible for people acting as they do. (For example, doctors who do not show respect for nurses ~ be reflecting the attitude of the whole society toward women in particular and/or women who work.) It is a slow process to change cultural patterns, and man;y individuals resist change because there is greater security in doing things in the w~ one is accus-OOmed. . People who feel insecure are more disturbed by change than those who have greater feelings of security. People mo do not feel adequate for the job they are doing, who feel personalJ.y threatened by suggestions from others, often "take it out on" others with whom they work. They become bossy and aggressive and "hard to get along with." 1.. person who feels appreciated by others, one who feels that he and his opinions are valued does better work and gets along better with others than one who feels others do not appreciate him. Appreciation by others is essential to acceptance of self; acceptance of self is essential to acceptance of others.

2.

3.

4.

5.

6.

An individual who feels free to expr~ss his opinions honest4r, is in a better pOSition to make an honest evaluation than one who feels he must careful.1y weigh every word he says because he distrusts the people who hear his words. It is a fundamental human need to want recognition and support from those who work with you. Lack of understanding and communication are often at the root of a person's inability to get along well with another person. Effort should be made to try to see the situation from the point of view of the person with whom one has serious differences,· even "lhough this is often difficult to do. This new perspective -- seeing something temporari4r through another person's eyes is an experience mich decreases antagonism one may be feeling toward another indiVidual. A first step in learning to work with people with whom one is having difficulty involves fiming some way to let that person know you need his help. Showing a little personal interest in the person who is hard to get along w.i..th often provides a way of finding out what it is that person can be asked to help with. Attitudes are formed very ear4r in the child, and are learned from his parents and the people he associates with. Attitudes formed

7. 8.

9.

10.

-41earJ.¥ often persist through the whole personality patterning of the individual, and are not easiJ.¥ changed. They may cause serious conflicts wi thin the individual as he grows older. 11. strong negative emotionalized feelings may seriousJ.¥ retard an individual's ability to take advantage of a learning opportunity --. he is not 'I free to learn" because of the strong emotionalized feelings. (An example is the tenporary loss of memory one has in an intense emotional situation.) A person's general appearance, posture, et cetera, gives clues as to that individUal's concepts of himself -- the way he feels about himself shows in his carriage, his dress, et cetera. The general public also judges an individual by his appearance.

• 12.

Implications from a study of Interpersonal Relationships for Teaching Nurses in such a W~ that They Will Understand People Better and Be Able to Work with Them 1.

The relationships of nurse teachers (all those from whom nurse students learn) to their students are extremeJ.¥ :important. The teacher is the most inportant resource for learning, because individuals learn as they were taught, rather than as they were taught to teach. Nurse students should have an opportunity to express their olitl opinions and evaluate the judgments of others. A nurse instructor should strive to learn how her students are feeling; onJ.¥ by an understarding and acceptance of these feelings can she bring about good guidance of students. students need praise and encouragement in their work. Careful consideration should be given to the type of punishment thEit is used for students who do not adhere to the rules of the school; student judgment in this respect has often proved valuable. Students should be given opportunity to work together in committees, and share experiences with one another. HighJ.¥ conpetitive measures should be discouraged, since this may result in cramming for examinations rather than for application of knowledge. The teachers of nurses should work in an environment where their own feelings and needs are considered, and where they feel free and adequate. Without this they will have difficulty in creating such an atmosphere for students. All personnel from whom the student learns nursing should be considered members of the faculty. Nurse teachers need to understand the famil¥ and community backgrounds of the students whom they are guiding. They need also to know something about the community in which the studentm~ be expected to give service. Individual differences in abilities, leadership qualifications, adaptability in students need to be taken into consideration in planning the curriculum and teaching methods • Faculties should work together in outlining their philosophy and planning ways to bring about greater understanding of human relationships in students. . Concentration on the ways children do things, feel, and react often helps in developing understanding of one's own behavior and others.

2. 3.

4. 5.

6. 7.

8.

9.

10. .

, 11.

12.

-4213.

, 14.

Exposure to courses in IIpsychologyll, IIsociologyll, et cetera, does not guarantee any greater facility in working with people. APplication of the principles studied is the important thing. Nurse teachers have a responsibility to demonstrate acceptance of differences in opinion, concern and respect for others in their own relationsh:ips with colleagues and students, because in all the day-to-day contacts students are learning al:x>ut people and their inter-relationships. Field Tr~s and Visual Education

1.

Field Trips Since all participants were interested in seeing the health and nursing education facilities in Taiwan ;i. twas decided to use one day for the purpose and to make the experience one wnich would demonstrate the proper use of the field trip as a method of teaching.

a.

Preplanning. At the end of the first week, participants were requested to sign on the bulletin board indicating their preference for visiting either a health ceQter or a school of nursing. It was suggested that each person think through what she wished to see and what she hoped to gain from the trip. Three days before the visits were scheduJ.ed the participants came together in two groups according to their field of interest -- public health or schools of nursing. Members of the coordinating committee met with each group to discuss plans for the trips and values the members hoped to attain, questions which they wished to have answered, parts of the institution or agency they desired to see. Individuals indicated mich of the three schools of nursing they wished to visit or the type of public health visit they desired to make. Following this conference the requests of the participants were discussed with the Chief of the NurSing Division of the National Institute of Health and the principals of the schools of nursing. A sumrnary of the purposes and requests for information fonnulated by the group which was planning to visit schools was typed and given to t he principals of the three schools and to the group members. Two members of the coordinating committee had previousJ.,y visited all schools of nursing and several health centers in mich student nurses receive experience.

...

I ..··"

b.

The Visits. 1) To Public Health Agencies Some partic:ipants visited the outpatient depart~ ment. of the Provincial School of NurSing and Midwifery mile others visited rural health centers of the Provincial Department of Health. Each of the latter visited homes with a public health nurse. 2) To Schools of Nursing Groups of four and five visited one of the following: a) National Defense Medical Center, Department of NurSing, the school of nursing for the a.t'II\Y which has two pro grams, each four years

-43in length. One is on a collegiate level with entrance requirements of four years high school and the passing of entrance·examinations. The other is a technical program. based on two years of high school.

.

b)

Taiwan University Hospital, School of Nursing• which has a three-year program and a junior high School that the WHO Nursing Team of four is wo rki.ng • Taiwan Provincial School of Nursing and rlidwifery, a four-year program which prepares all students for both nursing and midwifery. This School not only uses the facilities of the Provincial Hospital but has an outpatient department and a maternity hospital of its own thus making it possible to control the educational field for midwifery experience. students must have cOllq)leted junior high School before admission.

c)

Conferences were held with members of the school faculty and administrative personnel who atte~ted to give the infonnation which had been requested and freely answered questions. Following the conference the school and parts of the hospital were visited.

c.

Follow-up conference. In -cpe afternoon on the day of the field trips, all participants came together in general session. A member of the coordinating committee who had been on a health center visit led the discussion. Representatives reported on their visits in order that all might have the benefit of information gained by others. ThereW!.s lively discussion and !llaI\V questions were asked. No attempt was made to evaluate the educational program or the field trip itself.

d.

Evaluation of the Experience Although the steps essential for a successful field trip and the responsibilities of the teacher for making it a worthwhile experience were not pointed up, it is hoped that the principle that IIpeople learn more from the way they are taught than from the way they were taught to teach" operated in this instance. Some members of the coordinating committee were of the opinion that the experience could haye been improved had more thor~ugh preparation been made for the visit. Time would have been saved and information been more accurate had each school or agency been given questions long enough in advance to have prepared typewritten summaries of pertinent data. These could have been put in the hands of participants for study before the visits. Conference time could then have been spent in clarification of points and in a discussion of the relative merits of various edu-cational practices rather than to a report of obServations.

..

2.

Film Showings It was not possible to preview all the films, filmstrips, and slides as planned. Some films were known to members of the committee, others were not. PartiCipants, as a group, therefore acted as a previewing committee and, following the showing of films on the first two days, discussed the films from the point of view of their purpose, the individuals for whom they would be useful, how they could be used, et cetera. After the

-L4first two days, the request of participants that they view films and omit discussion was honored. Each felt ~eu could evaluate a film's usefulness for her own situation and time saved by omitting discussion could be used to see more films. All felt the urgency to use the opportunity afforded them by the rather wide selection of visual materials assembled for the Seminar. In most countries in the area films, f:iJnstrips and slides cannot be borrowed, even for preview, and must therefore be selected for purchase on the basis of title and catalogue description. A c ollD1littee, af1ier informal consultation with members of the Sem:U1ar, posted a list of films to be shown each day. Those on the biological sciences seemed most useful for all areas. Those on the social a:iences and mental hygiene were considered of doubtful value for use outside the country for which they were made. Films on nursing procedures were felt to be of little value, these techniques being better taught by the direct method and related to the actual situation.

3. General Session on Visual Education. On Monday, November loth, Mr. Edmund Overend, the new4r arrived UNESCO specialist in audio-visual aids, came tv a general session of the Seminar to assist participants with some of the problema involved in the use of visual aids in an educational program. He discussed the value of various teaching methods in relation to Edgar Dale's "Cone of Experience", pointing out that the best learning was always gained through direct purposetul eJqlerience -- real, or, i f necessary, contrived. He pointed out that visual aids are onl¥ tools, rot teaching methods, and that they must be selected careful4r in relation to a particular situation to make . a learning experience meaningful. Some of the advantages, disadvantages am methods of using such visual experiences as field trips, demonstrations, exhibits, slides and motion pictures were presented, with particular emphasis on local facilities and materials which may be made, in the area, to fit a particular situation. Mr. Overend expla:ined and demonstrated various methods of making slides, for which he had provided some very useful homo ra® tools, and spent some time helping participants to experiment in the maldng of slides. A special session was arranged in the evening of November 17, when Mr. Overend cama for a further discussion of visual aids. He had prepared for the participants a list of the various types of projectors which are available for use with regular electric supplies, with batteries and 'With kerosene lamps, and discussed some of the special points in the' choice and use of these projectors. He explained how various countries oould utilize the facilities of UNESCO in the purchase ...q;t: such materials especi.al.J3: ll!.ere the ordinary exchange of currency is :di'£ficult •

...

, • B.

-45PUBLICITY

An encouraging feature of the Seminar was the interest shown by the press. Newspaper reporters, fiJJn cameramen, photographers and radio commentaW's gave wide coverage to the meetings, on both a national and international scale. Accounts of the Seminar, together with a number of photographs, were published in Taiwan newspapers almost dai4', while short-wave broadcasts were picked up and relayed to audiences thousands of miles distant. Films of the Seminar were shown for man,yweeks ai'terwards in newsreel programsin countries overseas. The fact that tllis gathering so clearl¥ had news value is illustrative of vide interest and an augury of increasing public support •

..

-46C. EVALUAnON OF THE SEMINAR AS AN EDUCATIONAL EXPERIENCE

...

One of the essential parts of the learning process is to decide to what extent the activities through which an educational experience has been carried on have brought success or failure 1 partial success or partial failure. It is necessary therefore to plan some means of, testing or evaluating the success or failure of an,y group actiVity undertaken for an educational purpose 1 in relation to each individual's feelings or beliefs as to its success or failure in meeting her own desired purposes. It was decided, therefore, that in this Seminar some plan should be made to find out how each individual felt about her own activities and those of the group or groups in which she was participating. This plan took the form of several questionnaires or eValuation sheets filled ou\; at various periods by each member of the group. None of these were signed, in order that they might be filled out as objectively and studied as :iJnpersonally as possible. Evaluation by the Participants 'lhree e:valuations of the Seminar, its conduct and values, were made two of lihich were entirely structured: i. e., specific questions were asked to be checked on a grading scale. These questionnaires were given at the end of the first, second, and third weeks respectively. The results of the first of these evaluation sheets, which twenty-siX participants conpleted were tabulated as follows: :Very:Fairlyz Not up to :Good: Good IExpectation

1. I feel the 2.

Seminar up to this date has been:

19

.3

The General Sessions have been:

.

.3. The Exploratory Group meetings have been:

· • · : 19 15 :

10 6 II

· · Too

4.

The study Groups have been: has been: a. b. c. d. e. f. Length of the working day Time to explore library resources Talking with other participants General Sessions Exploratory group meeting Interest (Study) group meetings

1.3

5. The time planned for each of the following

Too: About: :Long: Right I

Short

1

25

· 1

8

16

· . 2· • · 4

.3 • 20 23

· · · · • · · · :

18

7 .3 1

17

.3

6. What have you liked about the Seminar? There was a generally favorable reply to this question, indicating appreciation of the methods of conducting the meetings.

7. What would you suggest for improvement?

" (Note:

Most of the group indicated they were not ready to answer this question. Two expressed a wish for some lectures in the general sessions ~ specialists in some aspects of nursing education. this question might have brought a better response i f it had asked i f there were any criticism which the individual felt !he wished to raise at this time.)

-478. What subjects would you especially ~.ike to have covered in the rema:i.ning meetings? It seemed that all subjects suggested in answer to this question wo~ 00 brought up in the discussions of the study groups which had Just been formed. Results of the second weeki s questionnaire to which all 29 participants replied were as f01J.Ows: Check one of the three Possible Choices The time planned for each of the follotdng : Too: About: Too during the second seek has been: :Long: Right: Short : a. Length of the working day : 1: 28 : i

i

1.

.

b. c. d.

Time to expl.ore library resources Talk with other participants General sessions Visual education presentation Time to work on visual aids Study (interest) groups 2

7

22 6 1

23

L.: 23 : 21

e. f. g.

6 11

16 19 Yes :

4 No

Check One Column

2.

Do you now feel you would prefer to be in another group? group

1

27

3. Would you now like to move to another study

. 17

. :

28

4.

Would you like to have an opportunity to come back in the evening next 'Week to work in the library

8

5.

What do you think you are personalJ¥ getting out of being here for the Seminar? The ans1lers to this question enq:>hasized the better understanding of nursing am problems in other countries at the same time that the individual's own personal understanding and appreciation of teaching methods was being enriched.

6. What do you hope you may still get? The desire for help with her own particular problems was expressed by a number of persons, who wished personal counselling and a better understanding of -guiding principles".

7. What do you feel you might be able t 0 contribute to the Seminar that you have been prevented from doing so far? This question was not answered

qy most of the group.

8. What reorganization in schedule de> you think 'WOuld bring about either 6 or 7? The only suggestion made was that the consultants might have helped all groups i f they had been available all the tiloo in their consultant capacity rather than a part of any one group.

-48. The. final evaluation asked only one question: "What do You think about thl.s eenunar (wi'kBhop) as a method of teaching?" Twenty-seven replied. ~lmost ~ of the participants felt that the Seminar had been a great learnl.ng experJ.~nce and gave an opportunity for the free expression of ideas for becoming acquainted with nursing problems and conditions in different ~untries and for realizing that these problems are often similar to their own. It had ' stimulated thinking, renewed inspiration and given courage to solve their own problems. 'lhe wealth of resource materials which had been brought was great~ appreciated. The spirit of cooperation was frequent~ mentioned. The method had stimulated individual activity and the desire to e:xperiment with the workshop method on the part of some. Some questioned their ability to use the method in their own teaching; others felt it could only be used in certain type. of situations or in the teaching of graduate nurses or more advanced students. One participant said she would have. preferred the lecture-discussion method. Some felt that the time was not long enough in terms both of the method and the content. The need for a more general use of the oonsultants to guide, clari.t'y, and summarize was felt by some. Individual Comments The expression of the feelings of severaJ. individua.J.s are given here since they seem typical of the general reaction to the workshop experience. "The first few days we were disappointed because we e:xpected to hear lectures from nursing leaders. The wrkshop is much better, as we have been given help in working on our own problems. We could have written lecture notes and showed people in our country what we had done, but it would not have solved our problems. We must work on these ourselves. .~ have learned. that students need to be encouraged to ask 'why? why?'. We need much better teachers to teach this way, but the students will learn more." "The Seminar has helped to gain the interest and support of the community for nursing. 1I (Taiwan) One member was impressed by the interest of men, especi~ doctors, in Taiwan toward nursing education and hopes to influence the men in her own oountry. "Nursing textbooks in our country are not written by nurses. They are written by doctors. Textbooks from another country have been translated for our nurses but the translated books lead to oonfusion because we do not have the same nursing or the s ame equipment as that country. The teachers can use the translated textbooks but the students do not understand them. II " We have decided that even though our teaching program is expected to follow a syllabus that has been laid down we can still find a ~ of adapting our teaching to student needs and background."

II

II II

..

.. ...

Evaluation by the Coordinating ColTIIIittee In trying the evaluate the Seminar the committee felt a deep sense of responsibility for recognizing reaJ. outcomes or learnings and to. avoid reading into situations values that the committee hoped had been ac:hl.eved. In approaching the problem of evaluation the following decisions were made I 1. 2. To consider whether individual goals of partiCipants had been met. To consider outcomes in tems of the goals which the preplanning cormli.ttee set up and the objectives stated bY the study groups.

-49.3. To consider the suggestions made tu some of the particjpants for a different procedure which might have given them more than they felt they had received from the Seminar.

.. 1.

4.

To plan for continuous evaluation.

5.

To suggest inplications for the next workshop •

Evaluation in terms of irdividual goals. It was recognized b.Y the committee that each individual came to the Seminar with personal objectives and that some of these were, in aU probability not met by the meetings. However, it was felt that man;v were achieved in other ways. A. broader viewpoint was developed as a result of working with individuals liho had similar problems and, if the pe.rticipants expressed their true feelings, there was every indication that they discovered new avenues of approach to problems, gained ideas as to possible sources of help in their own coDlllunities, and especially found courage to continue their struggle to inprove nursing service and . nursing education. It is also probab~ true that man;v individuals changed, enlarged, and re-evaluated their objectives during the period of the meetings so that although those with mich they came may not have been met, others which were broader and more inclusive may have been achieved. Ka.o.v sought and received help with professional problems through personal conferences with consultants and others. The committee recognized that it is inpossible to know the full value of the IOOetings now and that, in fact, this may never be known. The real test will come as individuals meet situations back on the job in the way they feel toward people, the way they attack problems, the W83' they feel about the Seminar three. months and a)'Bar from now.

2.

Evaluation in terms of committee and study group goals. It had been recognized that the objective set up by the preplanning committee (see page 10) might not be the goals accepted by the Seminar group as a whole. However, it seemed to the members of the committee, as they were evaluating in the postseminaI' period that, although not so stated, theirs had been at least the implied goals of the Seminar. In reviewing them the committee was of the opinion that although there was no objective evidence to that effect, all objectives had been met to some extent but in var,ying degrees.

It was believed also that the partiCipants had at least partia~ attained the goals forlllUJattd in their study groups although the pressure of t:ime at the end prevented some groups from summarizing and consolidating their thinkJ.ng to the extent that they had wished •

.3.

J,raluation of the methods used in the Seminar • . Evaluation reports of participants were carefulJy reviewed. tain criticisms seemed to warrant special consideration. a. Cer-

There was an apparent felt need on the part ofsoms for more lectures and discussions by specialists. The committee thought this perhaps indicated that a more conuoon grolUld of understarxl.ing would have helped the participants to define their problems and might have facilitated the setting of boundaries in the selection of subjects for study. Some members of the committee believed that in the next seminar, to which will come nurses. liho have entire~ dilferent educational and cultural beckgrolUlds and who must particjpate in a language other than their mother tOl'l!JYe, it will be well to consider starting nth a few lectures which ldll raise questions and promote discussion. Socio-drama

-50was also Suggested as a possible means of achieving the des:ired r7 sults= It was suggested, too, that lectures or well-led dl.scussl.ons near the close of the sessions might have served to clarify l1'lalV issues. b. Lectures discussi?ns at the end would also have provided the sumrnanzation idll. dl a few participants indicated was needed There was some feeling that too much dependence had been placed on reporting study group discussions and that there had been too little i'i'ing together, pulling out inplications and drawing conclusions. Several evaluation reports expressed the opinion that the consultants had not been available to all groups equally since in the beginning, each had allied herself with one Particul:u. study group. It was felt by the committee that this criticism had been handled to some extent by the end of the conference since consultants had gone, by invitation, to the different groups and had worked with many small committees. Likewise, one of the partic:ipants who was not designa~ed as a consultant but ;bose experience made her an invaluable source of heJ.,p was called from the group which she had joined for consultation with anoth",". She was also in frequent demand for individual conferences. The committee appeared to agree, however, that there should have been a IOOre general understanding from the beginning that consultants were available to all groups, and that others than those designated as consultants could be called upon if it was felt that they had a contribution to make:ia any particular area. Although early in the Seminar participants were told that consultants were available for conference on problems outside the study group areas, this fact might have been emphasized more .U the original idea of the committee to set up a plan for making appointments had been followed.;[t was learned at the close of the Seminar that Soote individuals ,had hesitated to ask for conferences thinking the consultants to be "too busy."

0:

... c.

~

•

4.

Plans for continuous eValuation. While it may not be for some time, if ever, that each individual will be aware of all she may have gained from the Seminar, the committee felt certain that everyone who came learned of the nursing problems and condi~ tions in other countries and became conscious that her own problems were duplicated in other places, or at least that others were similar to hers. There was developed in all the group a feeling of warmth and friendship. The common bonds of interest and of human understanding broke down barriers which had existed between certain groups, often over a period of many years. Means of communication were opened up, which should be perpetuated and strengthened. Recognizing that it was too early at the close of the Sem:inar to evaluate the true outcomes, the committee suggested that the Regional Office request evaluations from the participants at intervals during the next year or so. Each representative has been asked to send a report to WHO as soon as she returns home. These will no doubt include some expressions of opinion as to the value of the conference as individuals have reflected on it since leaving Taipei. In three IOOnths a questionnaire will be sent out asking participants to indicate to idlat use, if any, they had been abJ.e to put their learnings and, as they look back upon the experience, ;bat aspects of the conference they had found roost helpful. At the end of one year a similar questionnaire will be sent out. It is hoped, in this way, to gain valuable. assistance in planning the. next seminar.

-51Various ways of keeping in touch with one another were discussed at the last general session of the Seminar~ No decisions were made. However, it was thought that individuals would no doubt communicate personaJ.J.y with certain others and it was suggested that a!\Yone writing the WHO Nursing Adviser include news of persons from whom she had heard. From time to time it may be possible to send out a newsletter from the Manila Office. The colll11ittee agreed that the way in which the members of the Seminar kept in communication with one another ~uld, be, to some extent, a form of evaluation •

•

•

-52D. SUMMARY

An attempt was made by the committee during the post-seminar period to pull out conclusions and implications which eJlPressed the general thinking of the participants. However, since t:ime did not permit these to be formulated, anaJ,yzed, discussed, reformulated, and accepted by the entire group it is impossible to know whether they do eJlPress the views of all as. to what was achieved. The points were thoroughly discussed by the coordinating com-, mittee and the ideas eJq>ressed here embody the opinions of its members as to the conclusions reached by the Seminar. The committee likewise felt that certain implications could be drawn from the conclusions and that these .should also be stated. It was recognized that while much of the philosoph,y eJq>ressed may be ideal for nursing service and nursing education, resources and conditions in some countries may not make it possible to reach this level immediately. It was felt, however, that the ideas expressed might serve as goals which communities should strive to reach as rapidly as possible.

Philosophy of Nursing It was generaJ.l;y' agreed by the members of the Seminar that nursing is concerned not only with caring for the sick but also with the physical, mental and social well-being of the people. Every nurse, therefore, should be prepared to teach health to individuals, in am out of the hospital, and to take her part as a citizen participating actively in community projects pertaining to health and welfare. 'Ihe goal of nurse-teachers, therefore, is to prepare nurses qualified to assume these responsibilities which means that the student needs to have experience in activities in which she will be expected to participate as a graduate nurse. Approach to the Problem of Preparing Nurses Each study group attacked the problem of preparing nurses thl'Ough a different approach -- one, a study of the curriculum; another, teaching methods; a third, the development of the nurse as a person. The fourth group tried to find ways to help countries that are in the begirUling period of professional nursing, to improve their education and service. Conclusions The following points, it is believed, eJlPress the thinking of the Seminar as revealed, primarily, in reports of the study groups; 1. Since nursing is an integral part of the community in which it is being developed, it is essential that nursing education be based upon the situation and needs in the particular country. Therefore, curriculum, teaching methods, and teaching materials cannot be taken from one place and transplanted into another. They need to be based on the actual functions the nurse is called upon to perform. The practice of scientific medicine, both in its preventive and curative aspects, can be greatly aided in any country by the recognition of nurses as essential partners in planning and carrying out a program in public health and medical care. Such nurses require a sound background and knowledge of the social and biological sciences on which modern nursing must be based and adequate practical experience in applying this knowledge. A student nurse needs clean and attractive living quarters with as much privacy as possible in. order that she may experience t.\:le type of environment which is conducive to good hygiene and self-esteem. She cannot be expected to maintain cleanliness and order in the hospital or to teach good health habits unless she has an opportunity to practice these in her daily life. While many other professions should be recognized as having important contributions to make in the education of nurses, the school of

2.

..

•

3.

4.

-.53nursing faculty must have the final authority in the selection of students, planning curricula, and administering the school.

5. 6.

All individuals who pla;v a part in the education of nurses should understand the objectives of the school. If nurse students are to become good nurses, it is essential that they practice in situations where nursing care and nursing service are of the highest quality attainable in that country, since students learn more from the nursing they see practiced than from that mich they are taught in the classroom. This means that nursing service, nursing service administration, and hospital admihistration need to be developed concurrently with nursing education. A high quality of nursing is possible only when hannonious working relationships and team-work exist, there is a sufficiently large staff of qualified nursing personnel, lines of responsibility and authority are clearly defined, individuals in the organization participate in the formulation of policies which gqvern them, supplies and equipment are adequate. I f patients are to be provided with a high quality of nursing care, the staffs of the school of nursing and the hospital need to have

7.

an understanding of one another's problems and both need to be aware of their responsibilities as a part of the larger community. 8. Since the head nurse, b,y her example and administration, determines the quality of nursing on her ward, she is in the best position to teach in the practical situation. 'She not only 'needs to be well prepared for her responsibilities but must be free to perform this very important function. Sufficient personnel, both professional and non-professional, is necessary if the head nurse is to have enough time to know her patients and to work with the students. starf education for all graduate nurses is essential, especially when preparation for teaching and supervision has been limited by past educational practices and facilities. Good interpersonal relationships are iInlJortant for everyone in nursing. Nurse teachers, supervisors, and administrators can work best in an environment where their own needs are considered and where they are encouraged to express their opinions. When teachers' feelings are respected and they feel personally adequate, their ability to create such an atmosphere for students is increased. I~lications

• 9.

10.

The following points seemed to the coordinating committee to have been inq:llied by the conclusions: 1.

It is i~ortant that the nurse educator play a part in striving to raise the educational, political, and socio-economic level of the whole community. She should be willing to work with educators in other fields, discuss the problems in nursing which arise as a result of poorly prepared students, and work with teachers to improve the general education of the country. To do this the nurse needs knowledge of the educational and cultural patterns of the country. One of the main goals of nursing education in any country should be to prepare nurse leaders to assume responsibility for educating nurses to meet the needs of their own country. When such leadership is presently being given by nurses from other countries, this goal Should be kept constantly in mind, even though the position of women, educational opportunities, economic and social conditions are at the moment on a level well below the possibility of attaining this objective in the foreseeable future.

2.

-543. Nurse students, if they are to be able, as graduates, to meet community responsibilities and participate in a team with other health workers, need to be drawn from groups Which represent the best the country offers in education and social backgroWl<i. Both nursing education and nursing 8ervice should be of a quality to attract such individuals •

4. The method of nursing education Which depends upon student nurses to render all or a large part of the essential nursing service in any situation is recognized as detrimental to the adequate education of the nurse for future usefulness, and to the ultimate improvement of nursing services. This in no way implies that the student nurse should not feel herself a part of the nursing service of the hospital or other agency in Which she is receiving experience, nor that she should not be helped to appreciate that nursing is of vital importance and the welfare of the patient and his family of first concern.

-,-~

-55E. EXPRESSIONS OF APPRECIATION

The participants in the Seminar felt deep appreciation for ~ that had been done by the Government to facilitate the holding of the SelllJ.llar at Taipei, Taiwan. They were deeply impressed. by. t~e kinru:esse~ e~ended and the personal consideration given to them by indi-nduals ~n TaJ.Pe~. Rather than official visitors, they felt like private guests st~ing with friends.

--

The participants felt that it would be impossible to fully express their gratitude. They wanted to express their appreciation in a concrete way, and . after receiving the suggestions of the Board of Directors of the Nurses' Association of China and in response to requests that had been offered by government officials, decided to share a part of the Seminar with the local nurses. It was therefore arranged for talks to student nurses in the three schools of nursing in Taipei to be given by participants who wcuU..d tell about activities of student nurses in other countries. Programs were arranged in the evening so that all the students at each school oould attend. Manuela Gonzales from the Philippines and Patricia Church from Australia spoke to the students at the Provincial SChool of Nursing and Midwifery. Valerie Smith from Australia and Rhoda Applebee from Mal~a met with the students at the School of NurSing, National Taiwan University Hospital. Shun Takahashi from Japan and Nora Conway from ,singapore spoke to the students at the National Defense Medical Center. Talks to graduate nurses were given on topics which local nurses had particularly requested. Nurses camefrom all over the Island. Each talk was repeated for different groups of nurses, and their response was indeed stimulating. Doctors who. attended showed their interest by their comments and questions. Two informal lectures were given on each evening program, with local nurses providing interpret.ations. The speakers ,were Dorothy H~es who discussed the seminar method, Jean Barrett who talked about the teaching of nursing arts, Mary Harling whose presentation was on the use of visual aids, and Barbara Sumner who told about child health work in New Zealand. Open hetse at the Seminar Building was held two days, November 18th and 19th" from 5:00 to 7:00 p.m. Guests were invited to see the building am the teaching materials. Several hundred visitors came, mostly nurses and nurse students, but also doctors and representativesfBom the press. Interest was shown in the books, models, charts and posters, as well as the slides made by participants. The film showings which had been arranged attracted a full house. Arrangements were made for individual nurse-teachers to have access to the library and model roomllt other times than during the "open house." Several took the opportunity to copy posters and slides. A Resolution of Appreciation was draw up by a committee selectee; by participants of the Seminar. The chairman of this committee, Margaret DE:lIham, presented the resolution at t he closing meeting. It read as follows: "We, the representatives of twelve countries each with her ow national heritage of culture, language" and ideals, but with the desire to understand each other, and appreciate the problems of the profeSSion of which we are members have functioned as a team during these weeks in Free China. "We are all aware that this would not have been possible i f

maqy people in Taiwan had not worked together for a common objective. Those who were responsible for our welfare, the phySical facilities for the Seminar, the program and our entertainment have blended their activities to provide us an experience which helped us better t 0 understand and accept ourselves and others. As a result of this experience we shall strive toward better nursing for the people of this Region. "'lb each of you, we thank you.

World Health Organization Nursing Education Seminar PartiCipants"

-56SECTION IV A. EVALUATION OF THE ADlUNISTRATIVE ASPECTS OF THE SEMINAR AND SUOOESTIONS FOR FUTURE mRKSHOPS

Evaluation by the Participants Two questionnaires relating to methods of planning for the conference were used to ~btain information Which was expected to serve as the basis for better planning of future meetings of a siITJilar nature.

The first was given out three days after the Seminar started. lowing questions were aSked. Twenty replies were received. Question AnSwer Yes No Yes No Yes No

The folNumber

1. 2. 3.

Did you have sufficient notice? Did you have enough information about the Seminar? Did you have enough information about facilities in Taiwan? How could your first few days have been made easier or more pleasant?

l~ 12 8 15

4

4.

Well pleased No reply Trip around city might have helped

14 2

4

5. i4hat suggestions do you have for arrangements for a future Seminar? The main suggestions indicated a need for more information concerning a llworkshopll since the word and its meaning was new to the large majority. It was also suggested, by several, that more general information concerning living arrangements, clothing requirements, expenses, prices, shopping opportunities, and the names of participants and countries from m.ich they were coming, would have been helpful. ,/"""'0,

The second questionnaire J returned the day before the e'nd of the conference, brought the following answers: Twenty-eight replies were raceived. Question 1.

Answer Every year Every two years Longer than 3 weeks Three weeks Two-three weeks

' Number

How often do you thhlk a Regional NurSing Seminar is practical? Every year? Every two years? How long Should the Seminar last?

13

15 19 4

2.

..

3. Could you have arranged to come for

4~

6 weeks1

4 - 6 weeks -could not say

.

3

25 3

4.

How much advance notice would you like to have? 6 - 9 IOOnths by the largemajority. What subjects would you suggest for the next Seminar? The question brought a wide variety of answers which emphasizedespecially the need for st~ of administrative problems in schools,

5.

-57nursing service and hospitals. Also mentioned were maqy aspects of nursing education, including social and community relationships and health education methods. Several mentioned educational programs for gt'aduate nurses. Several persons made the suggestion that mambers of other professional groups be brought into the discussions, such as hospital administrators, sociologists, anthropologists, psychologists and sanitary engineers. 6. With the subject in mind, lIlho should attend the next Seminar?

The answers to this question related to the suggestions made in question 5 as to II subjects II and included administrators, teachers and "potential nurse leaders~ 7. How do you feel about the rooming arrangements? While there was general satisfaction with the rooming arrangements, it was suggested that single rooms for those carrying heavy duties 'WOuld be deSirable, two in a room might prove more restful than three, and those six who mentioned it were equally divided as to their preference for rooming with someone from their own country or a nurse from another country. Evaluation by the Coordinat~

Committee

During the post-seminar period the committee gave serious consideration to ways in lIlhich the Seminar might have functioned more smoothly for the administrative point of view. Since this was the first wolJkshop in the Region, groups planning other such conferences will have much to profit from the experience. It was important, therefore, to think through those aspects of planning and management which proved to be wise and those which could have been improved. 1. Selection of participants. Two of the criteria for chOOSing participants were a) that she be able to converse in English, and b) that she have had post-graduate work in nursing education. These s·tipulations were not strictly adhered to because it seemed advisable to have representation from countries lIlhere the best qualified person, although she had had experience, had not had" post-graduate education. Likewise, facility in the use of the English language was decidedly limited in some individuals. The committee was of the opinion that although the original criteria had definite merit because a group needs seme common background in order to have a basis for discusS1on, the World Health Organization had been . wise in making exceptions since a. b. Those lacking p~eparation were a small minority and therefore did not, in a~ way, hamper progress toward a common goal. Most of these individuals found much in the discussions that stimulated their thinking even though they Were unable to contribute as they would have wished. Nursing education in their areas will no .doubt profit as a result of their experience. It was possible for bilingual individuals to sit next to those those understanding of English was limited and to translate· parts of discussions which were not clear. As the days· passed it was Obvious, however, that all individuals were following most of the discussions in English.

c.

-582. ;;,

Countries which should be represented. The question was raised as to whether nurses representing countries with unique problems, such as those who are conducting schools of nursing in underdeveloped areas, should meet in the same conference with nurses from areas where nursing education is more high4r developed. The following conclusions were reached: a. WHO has a responsibility to try to help every area to work more effectively irrespective of its flunique fl : problems. b. There should be; in a workshop, enough persons with common problems to form a study group sufficiently large for individuals to stimulate one another. (Six. would probably 'be the minimum, nine or ten the maximum.) A consultant familiar with the problems and competent to assist this group would be needed. It will probably be advisable, in the next nursing education workshop to include a French-speaking group. It seemed desirable to have them and the English-speaking nurses work together since this would heJ.p to build understandings and to bring the two groups together. In chOOSing representatives from any country it would be highly desirable to have at least two individuals who can communicate easily with one another on return to their work since their effectiveness would be greatly enhanced i f this were possible.

-.

c. d.

e.

3.

Need for understanding the workshop method. The committee agreed with the rest of the participants that even more information regarding the workshop method was needed prior to coming to Taipei. It was agreed that, the participants Should receive the information regarding a workshop long enough in advance to have time to think about it and to write for answers to questions or for further data if they wished. Even though the two-week training period in the workshop approach to problems helped to give the preplanning comwittee some understanding of the method, members agreed that they would have welcomed an opportunit,r to do some reading on the subject beforehand. It was genera~ agreed that, if at all possible, most members of a preplanning committee should have had experience in the method. For this reason it was suggested that members of this group fonn the nucleus of such a committee for the next workshop.

4. Consultants. The following suggestions as to the use of consultants were arrived at after considerable discussion: a. Some person, preferably from the educational field, who has had extensive experience with workshops is essential. This individual should be termed a consultant and not the diraotor of the workshop. Her chief function should be to prepare the preplanning committee for leadership of the workshop proper, to assist its members in the development of the program am. to consult with any group which requested her help. There should be no one person designated as nursing consultant but rather members of the preplanning committee should serve in this capacity. This would necessitate great care in the

b.

-59selection of the committee the following points being considered important:

l} Nursing consultants should be familiar with the area from which participants are drawn - with cultural patterns, health problems, the general level of education, the status of nursing and nursing education. Leadership within the Region should be found and developed. 2) At least one person in the group should be familiar with the unusual problems that exist in some places as for example those in underdeveloped areas. At least one person should be on a long-term appointment so that she may participate in earlJr planning, visit the contries from which participants are to come and have t:ilne for follow-up evaluation and assistance in the home situation.

3)

c.

Resource people from allied professional groups should be invited for part of the period i f not for all of it. Sociologists, anthropologists, psychologists, phySiCians, sanitary engineers, public health and hospital administrators might have an important contribution to make depending upon the subject under considera-

tion. d. Consultants should be released" as far ~s possible, from aclJn:i.nistrntive responsibility. The ~O NurSing Adviser should not be burdened with the handling of technical detail which could be assumed by other personnel but should be free to assist with the management of the workshop.

5.

Administrative personnel. All-details relative to facilities, transportation, visas, et cetera, were admirab~ handled by the Local Preparator,y Committee appointed by the Government of China (Taiwan). Two secretaries and three typists were available for use ot the Seminar personnel. The Regional Office provided an officer to handle finance and travel arrangements, to check books and other resource material on arrival and supervise their packing for return to 11anila. The WHO Public Information Officer was in Ta:ipei for part of the period of the Seminar. He conferred with representatives of the press and handled all publicity. The following recommendations were made relative to the administrative . aspects of future workshops: a. It is of paramount importance to have one secretary who is familiar with the functioning of the Regional Office, knows English well, is able to grasp directions eaSily, and can direct the work of typists. The expenditure of time by workshop personnel on details that could be as well or even better handled by a competent secretary, is not o~ uneconomical but it takes the experts away from the jobs for which they <.rre being paid and which they alone can do. A librarian or a good secretary with the rudiments of knowledge in cataloguing books and preparing card files is needed during the period of preplannLng, especi~, but could also render valuable help to partiCipants throughout the workshop period. During the preplanning weeks of this Seminar committee members, who needed to be planning the program spent marv hours directing stenographers in the preparation of file cards, checkingfue data for completeness" and arranging books on the shelves.

• -. .... /

/'

b.

-60c. The arrival of the WHO Public Information Officer in Taipei on the day before the opening of the Seminar removed a big load.f~m the shoulders of the Nursing Adviser, especially, and ~t ~s recommended that, if at all possible, his work be So planped that in other workshops he can be on hand during the preplanning period also.

1

1

6. Length of time for seminars. a. The two weeks allowed for preplanning was considered to be about right for this pafticular group. It was believed,however, that i f members of the committee had been familiar with the workshop method and if administrative details had been taken care of qy an administrative assistant, a shorter period, perhaps one week, would have been satisfactory. Some felt that had the committee been used in very early planning it could have rendered valuable assistance in helping decide policy, collect resource materials, et cetera. Three weeks was considered too short a period for the workshop considering the variety of ba~rounds, the language barriers, and the lack of familiarity ·with the method. Four or five ~eks were suggested as a desirable length of time for future workshops. Only five days with the full membership present were spent by the committee for evalUation, outlining the report, summarizing, and making recommendations for future workshops. A fifth day was spent by eight of the group after the necessary early departure of one member. The time was too short and too crowed, primarily because no weekend break was taken following the close of the Seminar. Fatigue and a sense of pressure interfered with clear thinking. Probably i f Saturday and Sunday had been used for rest and relaxation, the first five days of the following week would have been sufficient.

b.

c.

~

•

7.

Number of participants. There was no general agreement as ·to the number of participants lho cauld function satisfactor~. Important considerations are that there be a common interest, that there be enough consultants including individuals "Who are familiar with the least common situations and problems in the area, that there be adequate working space, that the group not be so large that individuals fail to know one anotherpersonally or to develop a sense of I1groupness."

8. Working and living facilities. Nothing more could have been desired in the way of rorking facilities than those which were provided. Had it been possible for the participants to live in the same or in an adjoining building the arrangements would have been ideal. opportunity to come and to go to the library, at will, is i"ilortant i f reso.urces are to be utilized to the full. Where iDdividuals live and work and play in the same place, they learn to know one another well and the whole experience becomes a unified and vital one. Ideally, workshoppers should have a building to themselves with facilities for social actiVities and yet opportunity for privacy for those who wish to study, read, write letters, visit with another individual, or be alone. Such facilities are, of course, hard to·find. The twenty-two participants who came to this Seminar from outside Taipei were ho~ in the Friends of China Club. Ten people had double rooms; twelve 1I8re in rooms with two other people. All rooms had private baths. Special arrangements were made for serving breakfast to the participants and J'lk)st people ate their other mealO in the ClUb also. The rooms were somewhat EU'Owded and the halls were noisy at night but for the J'lk)st part the partiCipants enjoyed living together and accepted cheer-

-61ful~ the slight inconveniences. Private rooms for those who were carrying particularly heavy responsibilities for the Seminar would have been desirable and a room in which small group meetings could have been ~ at night, would have added materially to the convenience of the participants.

Members of the committee recommended that, if at all possible, . future workshops be held away from a busy city in a secluded spot free from outside distractions. This was felt to be important from the point of view of work and relaxation and also because it would permit participants who live in the community to be relieved of the responsibilities of their jobs during the period of the workshop. It is almost impossible, i f one is within reach of one's office, to avoid answering mail, making deCiSions, and being on call. Local individuals should have the same privileges, satisfactions, and opportunities to contribute that other members have am should not feel the need to carry on tw jobs at once.

9. Subject and time for the next workshop. The committee felt that this Seminar should be considered but the beginning of a long-term educational plan for the development of nursing and nurSing educa·~iuH .in the Region, and that oonducting wrkshops is one wa:y WHO can give leadership in this development. The committee recommemed that the next nursing education workshop include nursing school administrators, hospital nursing directors and supervisors as well as nurse-teachers. If progress is to be made in nursing education, it is imperative that teachers, school administrators, hospital administrative and nursing personnel have common educational goals for nurses and an understanding of one another's problems. The workshop approach would help them to gain this mutual understanding. The committee was likewise of the opinion that another nursing workshop should be held as soon as possible, at least within tho next two years, in order a. b. c. To capitalize on the enthusiasm and interest engendered at this conference. To give the participants the support they need to put to use oome of the learnings of this Seminar. To be able to use members of the present coordinating committee to give leadership in the next workshop. If too long a time elapses, these people will be scattered and it will not be possible to capitalize on their experience with the workshop method.

~

SECTION V ~'

APPENDIX C.ilL oACH TO STUDYING LO A. A hORKSHOP APPR PRoBLEMs h' ac Te ,_ R of n y ma Wa Hu (One l.ll g fo r B et te r e~tionships)

I

I

1

•

2.

3.

4..

. en ac h Pa rt ic ip an t in WO:kshop is ac ti veJ.,yand g~g~ ~n th e id em i.1'ia s m le ob pr of n rk ca tio rd ' ~ wIll.ell sh e can wo ur 1n e st ep s to wa so r~ e th e so lu tio n of wh~ th es iv ce re me e sh ot he r mur ce he~p ~f 'so re bel'S of th e ro m fro lp (b oo ks , he ls as l ~a as w el ce ma er ). pe ri od ic al s , g ra , et ce te A pa rt ic ip an t in a wor~shop re al ly Pa rt ic i at t ju st e do es nom" 1r - sh ". si t pa ss iv eJ .,y by nd.ll.~ten to le ct ur es gi~n eb~.., o wh s on pe rs ." -' " g. no t ev en know thea 6Xl.Stl1l.g pr ob l ems of th e c0mmunit in rV ;Y sh e u se Sh works on pr ob l he r. to t an rt po in e e ar at ems th to If th e workshop is in th e gr ou p comes l ua id iV ~d ~h ~: U; . S~ gs ~~ th e m ee tin ' e has a s~ to pl ay in al ~~~w th at shrk bi lit . p si l. on Sp by l'e d ed an ar sh s; e ar J.es ry on e wo th e m ee tin gs must b~ Such th a t each member fe el s The at m os ph er e of own id ea s th at fr ee to ex pr es s he r r in th e' and b: J.n g. ou t ~he,problems rk in g _ wo he .ty J.n wIuch sh e is personalJ.,y co nc er nas su ra nc e wu mm co tr ea te d sh e m us t ha ve th e ex pr es si on s w ill be se teh fth at e~ mb me r e gr ou p. s 0 professlona~ by ot he

E

fJ:s

"

>

S.

-,

.

d rs on in ve s to ac ce t an nre~he~t ~ach ot he r pe di Each in di vi du al st ri .n ta r~ de un p lo ve de th e gr ou p, and to th eY ,d o, rom on e so w n. cessari~ of a group is no t ne p th in ker mb me t ie qu a at 6. It ~s re~ognized th pa rt of th e gr ou e mqy de fi ni te ly be th w ar t he r ac tiv ity ra sh ; er ~b ve t1 ac ~n J.n y on ly ' he r in to ta lk in g ma J.ng. Pres~urJ.ng se . it ea th er th an J.n cr ar ti fi ci al n he lp s to br ea k downth e way fo r te of s me na n ve gi by 7. Ca lli ng pe rs on s an d ot he r th in gs sh ou ld be done to pa ve el in g th at is Th . rs ie ba rr g ex pe rie nc es an d fe in ar sh in om ed fre gr ea te r fe el in g of s. one is among fr ie nd ot he r memby a RECORDER fr ee s ca n th en pt ko g tin ee m e th rd s of no te s; th ey 8. Ca re fu l re coou g from haVing to ta ketin g, an d fe el as su re d tin ee m " p gr a in ee be rs rt ic ip at io n in th e m gi ve at te nt io n to pa re co rd of th e m ee tin g. a th at the.y w ill ha ve and di ff er en ce s by gr ou p co ns en t, de ma be t us m s pl an 9. D ec is io ns as to te d. ec sp re n of op in io th at ea ch e must work to se e ng means on l ia nt se es ry n is ve rs on sp ea ki 10 . Communicatioe th e id ea th at th e pe ts ge p ou gr qu es tio ns fo r th in pe rs on be af ra id to as k t no t us m rs be em g id ea s bu t to co nv ey . Group l!J th e w ~ of co nv ey in to va rio us in t ge s ap ic nd ha cl ar it y. Language ng ua ge words ha ve di ff er en t meaning st st ri ve ev en in th e same la ei r in di vi du al ex pe rie nc os , and ea ch mu th pe op le be ca us e of rs to od . to make he rs el f un de ut ili ze d in shop pr oc ed ur es ar e es co nt in uo us rk wo ich wh in ar in m al so in vo lv 11 . Working in a se ALS an d PLANS ; it ng to th e OOALS ag re ed GO of up g in aw dr es di ee vc lv ;:r th e gr ou p is pr oc EVALUATION of th o wa up on .

l~~e~:~ffafndereantctfas

even:ho~ th~~: ~~~~:o~~~_

,

•

-6.312. This way of working :in a conference mBiY be new to ma.ny. Some are used to having others plan a conference for them, set up lectures, et cetera. There is nothing magical, however, about this ~ of working on the solution to problems. It involves the acceptance of the following assumption: a. b. Each member of a group is interested in finding beginnings of solutions to her OWl problems. Each member of a group has something to contribute to the thinking of others. People with varied experiences can be valuable resources to each other. Group interaction may result in suggestions that no one person would have thought of herself. A person m&QY times clarifies her ideas best b.Y discussing them with others. People are important - showing genuine respect for each individual is essential.

c. d. e.

-64B. DIRECTORY

Local Preparatory Committee

... •

Dr. T. HSiang Wang, (Chairman), Director, Department of Health Administration, Ministry of Interior Dr. C. H. Yen, (Vice Chainnan), COmmissioner, Provincial Health Administration Dr., Ross Cameron, Chief, Health Division, MSA Mission to China Mr. Peter Chang, Director, Information Department, Provincial Government

(concurrently Director of Foreign Affairs Office) Dr. K. Y. Chen, Superintendent, Provincial Taipei Hospital Dr. L. K. Chen, Surgeon General, Arrru Medical Service Miss Stella. Chen, Principal, School of Nursing, Taiwan UniverSity Hospital Mr. Y. S.

Ching, Head, School Inspection Division, Department of Education, Provincial Government

Miss Mei-Yu Chow, Dean, Arrrry Nursing School, National Defense Medical Center Miss T. C. Hsia, Principal, Provincial School of NurSing and Midwifery, Taipei Miss A. O. Hsu, Head, NurSing Department, National Institute of Health Dr. S. C. Hsu, Chief, Rural Health DiviSion, Joint Commission on Rural Reconstruction Dr. H. C. Li, Chief, Medical Sorvice, Chinese Air Force Dr. J. Heng Liu, Chairman, The Red Cross Society of China Dr. C. T. Loo, Acting Director, National Defense Medical Center Mr. Henry T. Samson, Mission Chief, UNICEF Mr ••'1..

T. Sun, Representative of the Ministry of Education

Mr. Y. S. Tao, CommiSSioner, Police Department, Provincial Government

Dr. C. M. Tu, Dean, College of Medicine, NatiorUu Taiwan University Dr. H. Y. Wei, Superintendent, Taiwan University Hospital Mr. Ping Wu, Representative of the Foreign Affairs

Participants 1. Preplanning and coordinating committee.

Name Jean Barrett

Present Position Professor of Nursing Education Syracuse University, New York Nursing Education Consultant for Seminar Professor and Dean of Nursing National Defense 'Medical Center Taipei

country U. S. A.

Chow Mei-yu

China (Taiwan)

-65Dorothy Hayes Chairman of the Education Division Director of Elementary Education state University Teachers' College New Paltz, New York Educational Director of the Seminar WHO nurse instructor Penang Nursing Adviser in the Western Pacific Region of lVHO Director of the School of Nursing Russell Sage College Troy, New York Visiting Professor to Schools of Nursing, Taipei U. S. A.

'"',; Malaya W.H.O. China (Taiwan)

• ;.;

~

I

'il

~

Mary Harling Elizabeth Hill Gertrude Hodgman

Ragnhild Lund-Jensen Team leader in the WHO assisted nursing education program Taipei Barbara SUIlI,[lElr Principal of the Post Graduate School of NurSing Well:ington Team leader in the WHO-assisted nursing education program Jesselton

China (Taiwan)

New Zealand

Terttu Te;t.a

North Borneo

... ",.

2.

other ,Earticipants . Name Present Position I

Country Malaya PhilippineS " "

,.

Rhoda K. Applebee Leonor Aragon

Senior Tutor Sister Penang School of Nursing Instructor and Secretary College of Nursing University of the Philippines Matron, Methodist Mission Hospital New Ireland •• ssociate Director Tainan Medical Personnel Tra:in:ing Course Senior Sister Tutor Royal Perth Hospital School of Nursing Tutor Sister, General Hospital School of Nurs ing Chief Nurse, Special Technical and Economic Mission Vietnam Assistant Chief Nurse and Principal of the Occidental Negros Provincial Hospital School of Nursing, Bacolod City Director, Provincial School of Nursing and Nidwifery Taiwan

Dorothy Beale Chung Rsin-hsin

New Guinea China (Taiwan)

Patricia Church

Australia

Nora CO,nw8¥'

Singapore Vietnam

,.

Margaret Denham

4

Manuela

V • .Gonzales

Philippines

Hsia Teh-eben

China {TaiwarV

-66Hsu Ai-chu Head of the Nursing Department National Institute of Health Ministry of Interior Hatron of the Biak Hospital Director, Seoul Nursing School Chief, .t'ublic Health Nursing Div:i.sion" Institute of Public Health, Tokyo Sister Tutor, General Hospital Penang Clinical Instructor, st. Luke's Hospital School of Nursing Manila Principal, Presbyterian Hospital School of Nursing Taegum Chief Nurse, Hutual Security Agency to China Sister Tutor, Maternal and Child Welfare Department Brisbane Nursing Instructor, st. Luke's College of Nursing and Red Cross Hospital College of Nursing Tokyo China (Taiwan)

-.....

-

Tjitske Kerkhof Kwi Haing Lee Chizuko Nakamichi

Hew Guinea

Korea Japan

Ong Poh Teen Herminia Reyes

Malaya Philippines

Soon Ai Ryu

Korea

Emil.Y Myrt;Le 8mith Valerie Smith

China (Taiwan) Australia

-

Shun Talrohashi

Jap<lJl

-