Final Report on the First Meeting of the Technical Advisory Committee on Nursing, Manila, Philippines, 10-17 December 1973

REGIONAL OFFICE FOR THE WESTERN PACIFIC OF THE WORLD HEAL'1lI ORGANIZATION MANILA

INAL REPORT ON THE FIRST MEETING OF 'HiE TECHNICAL ADVISORY CCMMITTEE ON NURSING

Manila. Philippines 10 - 17 Deoember 1973

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CONTENTS

INTRODUC'l'I ON' ......................................................................"......"........

1

1.

PIANNING FOR NURSING/MIIJiIFERY IN 'mE NATIONAL IiEA.L'!'}J PROORAMrt!E .. ".." .............. "...... •• ".... .. "......"......" .. "................ 1.1 1.2

:5 4

Guidelines to countries and territories ••.•.•••••• Proposals ............... " .... " .... " ........................ ".

5

2.

STRENGTHENING OF HEALTH SERVICES ••••••••••••••••••••••.••

5 5 6 7 7

•

Structure of the nursing/midwifery services .••••.• 2.1.1 Guidelines for countries and territories •••••••••• 2.1.2 pz.opoaals ••• " .......................................................... . 2.2 'lbe. deoision-making process in nursins!midwifery •• 2.2.1 Guidelines for c(l)untries and territories ••••••..•• An information system for nursing/midwifery ..•.••• 2.3 2.3.1 Guidelines for countries and territories •.••••..••• 2.3.2 Propo.als ............................................................. . 2.4 'lbe health worker in isolated areas ••..•••••••...• 2.4.1 Guidelines for countries and territories ••.••••••• 2.1 2.4.2 Pl"Oposal ................................................................. ..

8 8 "8 9 9

9 10

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HEALTH MANPOWER DEVELOPMENT ••...••••••••••••••••••••••••• Nursing/midwifery education •.••••••••••••••••••••• 3.1 3.1.1 Guidelines for countries and territories •••••••••• 3.1.2 PI"Oposala ............................................................. . FWllowah1ps ....................................................... .. 3.2 3.2.1 Guidelines for countries and territories •••••••••• 3.2.2 Proposals ......... ,.,.,.,.,.,. .......................................... ,.,. .. ,. .. Literature and teaching aids ••••••••••••••••••.••• 3.3 3.3.1 Guidelines for countries and territories ••••••.••• 3.3.2 Pt'Oposals ........ ,. ...................................................................... ..

11 11

12 14 14

15 15 16 16 17 17

.14.

REGULATING NURSING/MIDWIFERY EDUCATION AND PMCTICE ••••••

4.1 .-. .. 2

Guidelines for oountries and territories •••••••••• Pl'opc>sala.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..

18 18

5.

CLOSURE OF THE MEETING OF 'mE TECHNICAL ADVISORY Cc.:r~ ON' NURSING ......................................................................... ANNEX 1 - ABSTRACT OF THE INITIAL ANALySIS OF THE QUESTIONNAIRE ON THE CURRENl' NURSING/MIDWIFERY SITUATION IN THE COONTRIES AND TERRITORIES IN 'mE WESTERN PACIFIC REGION OF THE WORLD HEALTH ORGANIZATION •••••••••••••••••••••••••••••••••••

19

21

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Introd.uct1on ....................................................................

21

Limi tations of data ••••••••••••••••••••••••••• Defini tions of tenDS ••••••••••••••••••••••••••

21 22 24

Tlle questionnaire .........................................................

Part II Part III Part IV Part V Part VI

Nomenclature used for nursing/ midwifery personnel........... Overall organization and manapment of nursing-midwifery per.orma 1 .......................................... National nurses/midwives and related orsan1zations ••••••••• Legislation for nursing/ m1dw! fery .. .. .. .. . .. .. .. .. .. . .. .. .. .. .. .. .. .. .. .. ..

25 25

26 28

Part VII Part VIIl Part IX Part X

Regi.tration of nursing/ midwifery personnel ••••••••••• 29 Standing national (federal. state or provincial) nursing/ midwifery oomm1 ttees. boards an~or oouncils •••••.......... 29 Specifio long-term provisiona for the development of nurs1ng/ midwifery personnel........... 30 Participation of nursing/midwifery personnel in special eduoational and other programmes/activitie.. 34 Nursing/midwifery manpower :reSOUl'O.. ............................................

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General ooOOi tiona of employment of nursing/midwifery personnel.. 35 37

ANNEX 2 - TECHNICAL ADVISORY COMMITTE ON NURSING ••••••• ANNEX 3 - SECRETARIAT OF THE WORLD HEALTH ORGANIZATION. ANNEX 4 - MEMBERSHIP OF SUB-COMMITTEES ••••••••••••••••• ANJmX

'9 41 4-:5

5 - AG.ENDA ..............................................................................

ANNEX 6 - RULES OF PROCEDURE ••••••••••.•.••.•••••••••••

48

~ot analysed. ~ot analysed.

rnmOOOCTION

The First Meeting of the Technical Advisory Committee on Nursing was held in Manila, Philippines, from 10 to 17 December 1913, to discuss and make proposals on nursing and midwifery manpower and its development in the Region.

When officially opening the meeting, Dr Francisco J. Dy, Regional Direotor, drew attention to the fact that the Technical Advisory Committee on Nursing is the first such oommittee to be convened by the World Health Organization in this Region, and that in passing the resolution leading 'to the establishment of this Committee, the WEI) Regional Committee for the Western Pacific had given to nurses and midwives a unique opportunity to participate in planning for the future development of health services in the Region. Referring to the important part played by the nursing and midwifery professions, he stressed the conoept of the health team and the need for an integrated approach to the study of the nursing/midwifery oomponent of the Region's health servioes. The eleotion of officers (Annex

4) and the adoption of the Agenda

(Annex 5) followed the opening address. In1 tial planning for the meeting by the staff of the Regional Offioe led to the adoption of the following objectives:

(a)

to assess the various systems of preparation and utilization of nursing and midwifery personnel in the Region and identify the areas of nursing and midwifery eduoation and servioes which require speoial attention, strengthening or further study; to provide guidelines on possible approaches towards the solution of problems of training and utilization of nursing/midwifery personnel adapted to the needs and resources of the oountries; and to submit proposals to the Organization on the programmes and activities which may be ~1QR~d to assist oountries/ territories to plan for and implement the nursing and midwifery education and service systems they need and can support.

(b)

(0)

Preparation for the meeting was carried out in three phases. During Phase I, a short-term nursing consultant colleoted information on the assistance afforded by the World Health Organization to the countries and territories of the Region in nursing/midwifery eduoation and servioes, between the years 1950 and 1972 inclusive. en the basis of information available in the Regional Offioe, this consultant also prepared a draft

- 2 questionnaire designed to elicit information on the current nursing( midwifery situation in the countries and territories of the Region. After finalization by the Regional Office, " oopies of this questionnaire were sent to 24 of the Region's oountries and territories for oompletion. In addition, a special questionnaire was prepared and sent to two Frenchspeaking island territories. 'lbree short-term nursing oonsultants served during Phase II. Compilation and analysis of the information oollected on the assistanoe afforded by the World Health Organization provid~ the content for the basic working dooument for the meeting, "'l!le nursing(midwifery component of the WlI) programme of the Western Pacifio Region trom 1950-1972". An in!tial analysis of the questionnaires completed by twenty-one of the Region's oountries and territories, one being a special questionnaire oompleted by a French-speaking island territory (see Annex 1) was also prepared. During this phase, two of the snort-term nursing consultants visited two countries each in order to have direot contaot with some of the aspeots of the nursing(midwifery eduoation and servioe activities in the Region.

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Phase III consisted of a preparatory meeting which lasted :t'rom 4-7 December 'nI.e purpose of this meeting was to permit the Comm1ttee members to find common denominators for meaningful deliberations through study of the basio background documents, and on the basis of this study to prepare the agenda for the main meeting (see Annex 5). Prior to this study, a general orientation to the World Health Organization and its working system was given.

1m.

1.'

The topics for discussion were defined by the Committee as follows:

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Topio

I

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Health care planning within the context of national development (whioh reflects sooioeconomio, cultural, political, scientific and technological aspects) in the Weste~ Paoific Region and consideration of its speoifio 'implioations for nursing(midwifery planning in the national programmes. Factors :Involved :In the strengthening of health services as related to the roles and fUnotions of nursing(midwifery. Heal th manpower development as it relates to plann:lng for, preparation, and utilization of nursing(midwifery personnel for effective health services. Role of nursing/midwifery :In def:1n1ng, interpreting and implement:lng nursing/midwifery praotioe and eduoation, and :In furthering equitable working and living conditions.

Topio .II

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Topio III

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Topio

IV

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- 3 ~ time provided for general discussion on the fifth day of the meeting was used for further deliberations on certain aspects of the oontent areas covered by the agreed topics. ~ deliberations of the Committee, including the guidelines and proposals formulated, are presented below under four major areas of discussion.

1.

PLANNING FOR NURSING;MIDWIFERY IN THE

NATIONAL HEALTH PROGRAMME National health plarming is an integral part of national developnent plarming, wh1ah takes into consideration the goals of society and takes place in a political, social and economio structure. All plarming must be realistic, flexible, cyclio in nature and provide for constant feedbaok. Plarming is community-focused and takes into consideration that there are many communities within a given country. Communities vary widely in respect to such factors as the existence of geographical barriers, structure of the population, means of livelihood, economic capabill ty of implementing prograllllles, patterns of health and illness, and acceptance of health workers. In the plarming process, plan formulation which leads to the completion of the plan document takes place at three levels. ~ central level is concemed with policy detennination, preparation of general terms of reference of the national plan and, f!nally, the synthesis of the component parts into the national health plan which incorporates the linkages with the other sectors of the national development plan. '!be intermediate or regional level adapts the general terms of reference to the regional context and oversees the preparation of the local plans; it further formulates programmes best carried out at the regional level. '!be local level prepares the local plan in the national context as adapted regionally. During the implementing stage, all levels take part: operationally at the local and to some extent at the regional levels, directing and coordinating regional and local plans at the regional level, and overseeing the implementation of the national plan at the central level through reporting and other means of monitoring from the periphery. Any revisions or modifioations in the plan are based on regular formal evaluation, involving all three levels. 'Ihe whole plarming process concerns people at all levels and includes the consumers of health servioes as well. 'lbeir interest and participation in the various stages of plarming are therefore essential.

- Jt. The components of the national health plan are interdependent. The complexity of the process calls for a systematio, mu1tidisoip1inary approaoh. Nursing/midwifery education and servioes are integral parts of the national health plan. Thus the nurse/midwite is a participant in the planning prooess at all levels. To develop the planning skills whioh will make effective partioipation

in mu1tidisoip1inary health planning activities at both deoision-making and operational levels possible, nurses/midwive. require preparation wi thin their own oountries, and through intercountry eduoationa1 experiences. As the sucoess of all learning is measured by the nature ot the subsequent performance of the learner, it to11ows that an etteotive system of evaluation and tollow-up must be built into all national and international oourses in national health planning. 1.1 Quide1ines to oountries and territories tor the partioipation of nurses/midwives in national health planning are that: Ca) Aspects of the role ot nurses!midwives involved in planning at all levels of the health servioes ino1ude: (i) (ii) presentation and interpretation of the nursing/ midwifery aspeots in setting priorities; identification of the role and responsibilities of the nursing!micbdtery component wi thin the accepted priority programmes; involvement in the plan tormu1ation aotivities; evaluation and follow-up ot pertonnance.

(iii) (iv) (b)

Planning skills begin to be developed in basic eduoationa1 progranmes and from experienoe in nursing care. These skills may then be further developed tor application at decision-making and operational levels in various settings. To courses~ottered

(0)

deve~lanning

skills further to nuraes!midwives.

w~-country

(d)

Health workers, including nurse./midwives who have attended national or regional courses on national health planning, should be supported and encouraged to use their newly developed skills, and this action should be complemented by an eftective follow-up system within the country.

- 5 1. 2

Proposals

It is proposed for consideration by the WHO Western Pacific Regional Office that it should: (a) the development of nurse/midwife planners by encouraging and urging governments to / provide appropriate national counterparts who hold ..t positions which will make continued planning and implementation of programmes possible; extend f'u~er assistance to national wI tidiscipl1nary ~ eduoation programmes and to intercountry group educational activities to enable nurses/midwives and other health workers to develop capabilities for a multidisciplinary approach to national health planning; give f'urther-8lll~sis to representation of teaohers and learners alike fran the various components of the health" sector and to the need for such courses to have built-in' evaluation and follow-up systems; continue to encourage and support multidisciplinary action ~rch and other studies relating to aspects of the orgariizlftion, planning and implementation of health care delivery systems within the Region, with nursing/midwifery involvement in all phases. contri~rther to

(b)

(c)

(d)

2.

STRENGTHl!2fING OF HEAL'm SERVICES

2.1

Structure of the nursing/midwifery services

Every country requires a rationally organized and managed health service within which nursing/midwifery personnel are employed and operate. A policy or legislation on the nursing/midwifery personnel system is essential to prevent or restrain undue proliferation of categories of nursing personnel. In general, a nursing/midwifery personnel system is based on three categories: 1 (a) nursing/midwifery personnel corresponding to the nurse as defined by the International Council of

lwao Expert Committee on Nursing (1966) (Fifth Report), WHO, Geneva, WId ID.th Org. techno Rep. Ser. No. 347, 12-13.

- 6 Nurses: " ••• a pe raon who has completed a progrlllllllle of basic nursing education and is qualified and authorized in her country to supply the most responsible service of a nursing nature .for the promotion of health, the prevention of illness and the care 'of the sick,,·l , (b) nursing/midwifery peraonne1 able to provide generalized patient oare of a simpler nature requiring both teohnioal and interpenona1 skills; nursing/midwifery personnel able to perform speoified tasks related to patient care that require considerably less use of Judgement.

(c)

Each country must determine its priori ties in respect to the development of the categories within its nursing/midwifery personnel system. The relative number of personnel in each category varies greatly from country to country, and at different periods and location wi thin a country, depending on the nature of the demand for nursing/ midwifery, the general health progranmes and/or economic and human resources. Estimation of nursing/midwifery needs poses a problem, particularly in view of the ohanging expectations of individuals and the demands of the people as a whole. Effective demand is not alw&7s consistent with health needs, and this inconsistency leads to either under- or over-recruitment and utilization of staff. 2.1.1 auidelines for oountries and territories in respeot to the development and operation of the nursing)midwifery system are that: (a) the elements of nursing/midwifery should be classified in terms of the complexity of care and the level of decision-making required of the various categories; the roles of health workers should be reviewed and adapted as required to meet the goals of national policy to extend health services to the population; changes in the roles of health workers may be stUdied and assessed through operational research and other related studies;

(b)

(c)

1Intemat1ona1 Council of Nurses (1965) Special and CODIDittee Reports, presented to the ICN Board of Directors and Grand Council Meetings, Frankfurt, p.6.

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(d)

definition of the roles and funotions of nurses/midwives should be formulated in the light of a partioular country situation; clear differentiation should be made between delegation of tasks and a transfer (or incorporation) of tasks; the delegation or transfer of tasks should be effected in consultation with the disciplines concerned and with the controlling authority, and be realistically related to training and workload, and there should be improved preparation and supervision of the less prepared workers to whom more complex functions are delegated.

<e> (r)

(g)

2.1. 2

Proposals

It is proposed for consideration by the WHO Western Pacific Regional Office that it should: continue to assist on a country or intercountry basis the development of studies and continuing review of the eduoation and utilization aspects of the expanding role of nurses/midwives and other health workers. 2.2 The decision-making process in nursing/midwifery

At every level where there is decision-making in relation to health, nursing/midwifery representation is n.eded. Nurses/midwives with leadership abilities are required to look at the total situation from a nursing/midwitery viewpoint, wi thin the framework of multidisciplinary planning and implementation. The nurse/midwife in a decision-making position ensures that nursing decisions are put into practice. In view of the realistic decisions which she must make, the decision-maker in nursing/midwifery requires support from the administrative and technical levels in the various fields of nursing/ midwifery, and from other health and health-related disoiplines. Effective oommunication and ooordination are essential to the formulation of polioies and the setting of standard8. If there is an officially oonstituted advisory board, there is the advantage of a continuous two-way flow of communication, based on realities and involving the people who implement the decisions. A drawback is that such a body not infrequently includes people who are within the line of authority and theretore careers may be dependent on relationships. The strength of !2 ~ adVisory boards i8 the specialists which oonstitute such bodies, but there is the problem of a possible lack of continuity in support and advice. criteria to be.taken into consideration in constituting an advi80ry board are that:

- 8 (a) membership makes provision for feedback fran the administrative and technical components of the health services as well as from other agenoies and the community; and members are adequately prepared to afford advice and support in line with community needs for nursingjmidwifery services.

(b)

2.2.1 Guidelines for countries and territories in respect to the decision-making process in nursingjmidw1fery are that I Ca) assignment of appropriately qualified nurses/ midwives in programme-oriented units, sections or divisions at all levels of the national health administration is required; in addition, a senior nursing/midwifery position is necessary at the central level, to represent nursing/midwifery and to coordinate the nurs1ng/ midwifery components of the various programmeoriented units, sections or divisions; a major role of the senior nurse/midwife at the central level of the national health administration is that of a national health planner and, to make her funotioning in this role effective, she requires the assistance of an advisory body.

(b)

(c)

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2.3

An information system for nursingJmidwifery

The process and oontent of communication are important factors in the strengthening of health servioes. An effeotive information system oomprises oollecting, analyzing, interpreting, storing, retrieving, utilizing and disseminating data. Nursingjmidwifery must know of its resources, must be able to use reliable data when they are available and must therefore have a system or participate in a system for oollecting, storing and utilizing information needed for planning and administration. 2.3.1 Guldelines for countries and territories ln respeot to the provision of effective information on and for nursingjmldwifery are that: (a) an information system on nursing/midwifery as part of a larger system ls essential for the strengthening of the nursingjmidwifery oomponent of health services; a readlly available and up-to-date nurslngjmidwlfery personnel inventory, oomprising data related to supply, demand, produotivity, utilization, attrition, emigration and eduoation, is required; and

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(b)

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(c)

special preparation is required by the nursesjmidwives responsible for the nursingjmidwifery component of the health services information system.

2.3.2

Proposals

It is proposed for consideration by the WHO Western Paoific Regional Office that it should: (a) continue to assist governments in its area to strengthen and develop a health information system and related systems for health personnel inventory including nurses/ midwives; and encourage and support the participation of nurses/ midwives in regional and interregional group eduoational activities aimed at improving information on health manpower and services.

(b)

2.4

The health worker in isolated areas

The extension of health servioes to rural/remote areas requires speoial planning in respect to the oategory, quantity and quality of health personnel aSSigned to these areas, and to the provision of satisfaotory working and living conditions. In addition, special attention must be given to providing supervision and support for these workers, with the supervision afforded encompassing technioal guidance, improvement of quality and teaching. Implioit in this oonoept of supervision is the need for the development of a satisfactory oonsultation and referral system. 2.4.1 Guidelines for countries and territOries in respect to the health worker -in isolated areas are that: (a) it being recognized that it is not always feasible to assign qualified staff permanently to these areas, means of meeting the health needs of these oommunities should include: (i) (ii) the preparation of specially trained multipurpose workers; in all instances, the seleotion in conSUltation with the local community of one or more local persons for special training in appropriate training centres or by itinerant teaohing teams, which can also provide supervision for those trained; and the establishment of a two-way referral system to permit proper rendering of health care servioes;

(iii)

- 10 (b) as much as possible, supervision should be provided by members of the same.discipline as that of the supervisee: that is, a nurse,lmidwife supervises nursing!Midwifery personnel; there are three aspects to the support required by these workers, all of importance: (i) mutual support (that received through provisions for meetings with peers); support from technical specialists, in respect to problems identified by the worker or through the reporting system: and logistics support (two-way cOlllllUllication system, transport, supplies and equipment);

(c)

(11 )

(i11)

(d)

to attract and retain health workers in rural areas, working and 11 ving conditions can be improved through: (i) periods of assignment being olearly defined and limited in duration, to pennit continuous professional development and acoess1bility to advancement on the oareer ladder; prov1sion of the same in-servioe and continuing education facilities as are available to other health workers: provision of the tools required for the work to be done;

(11)

(11i)

(iv)

social integration of the worker in the oOlll1lUIlity; paymen t of equi table salaries; provision of reasonable hOUSing, transport facilit1es, etc.; and provision of fringe benefits, such as salary supplements for working 1n d1fficult areas.

( v) (Vi)

(v11)

2.4.2

Proposal

It is proposed for consideration by the WHO Reg10nal Offioe for the Western Pacific that it should:

- 11 -

(a)

promote and support studies and trials of alternative means for improving effectiveness and efficiency in the functioning of health workers in isolated areas.

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3.

HEALTH MANPOWER DEVELOPMENT

Planning and programming for health manpower development are based on national needs, resources, priorities and available technology. Note is taken of worldwide trends in the education of health workers, and education and training programmes are geared to enable workers to acquire the competence required to perform activities and tasks within the total health care field and have the abilities and attitudes to adjust to constant and accelerating change. In order to maximize the delivery of health care, budgetary provisions are made for the basic, continuing in-service and/or formal postbasic education of health workers wherever they may be required to serve. Constraints to health services delivery such as difficulty of recruiting staff for the remote areas and the increasing cost of health care have led to a trend to use multi-purpose instead of single-purpose auxiliary health workers at the various levels and in the various health settings. Realistic and flexible educational programmes are required to accommodate such changes. The machinery for the control of the education and practice of health workers must be able to respond to the needs for change, which may include modifications in the scope and area of function, level of practice and even in the titles of health workers. Educational programmes for new categories of health workers are always organized within the context of overall planning, with a multidisciplinary approach underlying all planning and programming for health manpower development. 3.1 Nursing/midwifery education

A methodical approach to the development of nursing/midwifery manpower avoids a plethora of categories and is based on a clearly defined and accepted nursing/midwifery personnel system. As noted above, in general a nursing)midwifery personnel system is based on three categories. 1 Each country determines its priorities in respect to the educational preparation of nursing/midwifery personnel for the technical, administrative and policy-making levels, including specialists, field practice supervisors, aides and other local workers.

lWHO Expert Committee on Nursing (1966) (Fifth Report), WHO, Geneva (WId Hlth Org. techno Rep. Ser., No. 347), pp.12-l3.

- 12 -

The system of nursing)midwifery education is planned as a whole, based on the levels of general education available in the country, geared to produce workers to function effectively in the area and at the level to which they are to be assigned, and is carried out in coordination with training programmes for other health workers. Basic nursing/midwifery education programmes are geared to the learning needs of the students and the health needs of the community to be served; they provide a foundation for practice, a basis for advancement aooording to demonstrated ability ~Id proficienoy, and motivation for oontinuing eduoation. A system of nursing/midwifery eduoation whioh is planned as a whole enables nurses/midwives to progress from basic through advanoed studies in olearly defined areas of nursin~/midwifery. Suoh planning can make possible the provision of personnel for the range and quality of nursing)midwifery services required for comprehensive health servioes. Educational opportunities for advancement are provided in order to increase or maintain competency, and to retain in the nursing/ midwifery manpower system: (a) (b) (0)

those who would leave if there is a lack of opportunities for advancement; those who are interested in upward mobility and have demonstrated their ability and proficiency; those willing to develop their olinical expertise well as those who wish to progress in the fields of administration or teaching; and

.a

(d)

those interested and involved in planning and research in nursing/midwifery.

3.1.1 Guidelines for countries and territories in respect to the development of nursing/midwifery manpower are that: (a) (b) budgetary provision should be made for the basio, inservice and continuing education of all health workers; educational programmes should be designed to prepare multi-purpose rather than single-purpose workers at both the professional and auxiliary levels; prior to planning for the introduction of a new category of health worker, a total and multidisoiplinary assessment of the need should be undertaken and consideration given to existing potential nursing)midwifery resources through an inventory of skills;

(c)

II II Ii

, , , ,

- 13 (d) to meet the needs of health workers in isolated areas, increasing use may be made of itinerant teachers and supervisors in the development and conduct of all types of education programmes for health workers; planning for health manpower education should include provision of programmes which facilitate the re-entry of the isolated health worker into the system; educational requirements for nursing/midwifery education need to be equal to those of other health workers with similar responsibilities; the organized body of the nursing/midwifery profession(s) advise the appropriate education authorities concerning the quantity and quality of general education necessary for entry to nursing/midwifery; the education of the nurse/midwife at both basic and postbasic levels should be incorporated in the system of higher education of the country as rapidly as conditions permit. l Where the pattern is not already established, particular attention is to be given to such incorporation of postbasic nursing/midwifery education programmes; where overall control of nursing/midwifery education is divided between official bodies (for example, ministries of health and education) provision is made for effective coordination; nurses/midwives should be responsible for the immediate control and direction of nursing/midwifery education at all levels within the system, and in individual programmes; emphasis should be given to the development of core curricula for programmes within the system of nursing/ midwifery education; principles of administration, the problem-solving approach and the integration of the preventive and curative aspects of health care should be included in all educational programmes in nursing/midwifery;

(e)

(f)

(g)

(h)

(i)

(J)

(k)

(1)

Committee on Nursing (1966) (Fifth Report), WHO, Geneva (WId Hlth Org. techno Rep. Ber., No. 347), p.30.

lwuo Expert

- 14 (m) nursing/midwifery eduoation programmes, partioularly those at postbasic and postgraduate levels, should make provision for students to aoquire: (i) (ii) (iii) (n) an understanding of the research process; capability of partioipating in research; and the ability to assess the quality of research and to use research findings as appropriate;

nursing/midwifery personnel should participate in in-servioe training at their plaoe of work, and for continuing eduoation, through workshops, seminars, eto., at national, intercountry and interregional levels; the establishment of experimental programmes in nursing/ midwifery education is to be encouraged.

(0)

3.1.2

Proposals

It is proposed for consideration by the WHO Regional Office for the Western Pacific that it should: (a) assist in the further development of basio and postbasic nursing/midwifery eduoation programmes through the provision of consultants and fellowships; respond to requests from member governments for the development and evaluation of experimental programmes in nursingjmidwifery education; provide increasing opportunities for nursesjmidwives to attend regional courses for the preparation of teaohers; through the provision of consultants and fellowships, further encourage the preparation of inoreasing numbers of nursesjmidwives to partioipate in and initiate research; and organize multidisciplinary regional courses to prepare nurses/midwives and other health workers to participate in research.

•

(b)

(0)

(d)

(e)

3.2

Fellowships

It is preferable that nurses/midwives reoeive both basio and postbasio preparation within their own oountries. However, to produce the required corps of well qualified people with whioh effeotively to

- 15 develop national health services, it is usually necessary for certain studies to be undertaken abroad. The proper orientation of teachers in programmes abroad to the needs and resources of the countries of origin of their students is of particular importance. 3.2.1 Guidelines for countries and territories in respect to the planning and implementation of a fellowship programme are that: (a) nurses/midwives should be represented in national bodies/committees concerned with the selection of prospective fellows; special attention should be given to providing for the development of multidisciplinary teams; in selecting educational programmes, special consideration should be given to the specific needs for the prospective fellow and to the relevance of the programme's offerings to the setting in which the fellow will work on completion of studies; efforts should be made to utilize fully the educational opportunities and facilities within the Western Pacific Region; and an increasing number of fellowships are required to prepare nurses/midwives for leadership positions.

(b) (c)

(d)

(e) 3.2.2

Proposals

It is proposed for consideration by the WHO Regional Office for the Western Pacific that it should:

(a)

draw the attention of governments to the interpretation of the criteria for the selection of fellows; follow up with governments the resolution of the WHO Regional Committee for the Western Pacific in respect .to: l (i) the importance of awarding fellowships for study within the Region;

(b)

1World Health Organization (1972), Handbook for Resolutions and Decisions of the Regional Committee for the Western PacifiC, 7th ed., covering the period 1951-1971, Manila, p.3B.

- 16 (ii) the submission by governments of full information on their training programmes which are suitable for foreign students; and the preparation and distribution to member governments of a consolidated statement on regional eduoational opportunities and facilities; I , ,

(iii)

(c)

teachers of institutions having international students as part of the regular intake to visit the countries of origin of these students.

provide~It-)to- enable

J!

3.3 Literature and teaching aids The scarcity of literature, teaohing aids and other referenoe material imposes great obstaoles and impediments to the development of eduoational programmes for all oategories of nursingjmidwifery personnel. Measures need to be taken to promote full utilization of existing literature and teaching aids, and to step up the produotion of such materials, adapted to country and regional needs. 3.3.1 Guidelines for countries and territories in respect to the proper utilization and produotion of literature and teaching aids are that: (a) budgetary provision by governments, institutions and possibly international, bilateral or private souroes are required; the best use of scaroe resources is ensured through the development of common library and audiovisual facilities for all health disciplines; the extraction from foreign publications of pertinent material, and its translation into the national language permits wide dissemination of particularly valuable information; teachers need to receive speoial preparation in the development and effective use of teaching materials; nursesjmidwi ves are to be encouraged to write textbooks, articles for professional journals, etc.; the development of a system for the exchange of literature and teaching aids within the Region is required, including reports of research, student theses, etc.; and

(b)

(c)

(d) (e) (f)

- 17 (g) interregional collaboration in the development of teaohing aids, annotated bibliographies and other appropriate referenoe materials is to be sought.

3.3.2

Proposals

It Is proposed for consideration by the WHO Regional Offioe for the Western Pacific that it should: (a) (b) arrange for a wider distribution of WHO publications; expand its preparation, publication, and dissemination of technical literature, inoluding material of a less formal nature than that oontained in the Technioal Report Series; provide continuing and increased financial assistanoe for the preparation, dissemination and utilization of the professional literature and teaching aids required for the development of education programmes in nursing/ midwifery.

(c)

4.

REGUIATING NURSING;MIDWIFERY EDUCATION AND PRACTICE

It is important to delineate clearly the structure in and through which nursingjmidwifery eduoation and practice is defined, interpreted, implemented and regulated. This structure usually consists of four elements, which mayor may not be discrete entities: the administration (usually government), the legislative body, the implementing and regulatory body, and the nursingjmidwifery association and/or other representative bodies. When more than one element exists, the obJeotives and functions of each must be clearly defined and mutually supportive. To regulate education and praotice effectively and to be spokemen for their members on all matters (including those concerned with furthering equitable working and living conditions), nursesjmidwives must have majority representation at all levels. These representatives must have the freedom and opportunity to seek assistance from other sources wi thin their own country (such as legal services and other professional bodies) and from offioially reoognized intercountry or international bodies, suoh as regional nursing/midwifery associations, the International Counoil of Nurses, the International Confederation of Midwives, the International Labour Organization and the World Health Organization. Legislation is intended to regulate rather than control or restrict nursing/midwifery activities. It clarifies the responsibilities of the respeotive groups covered but is flexibly framed so as to not require oonstant revision to enable it to be applied to changing needs. To avoid

- 18 conflict with and discrimination against the members of other disciplines, nursing/midwifery legislation is developed within the context of the general legislation applying to personnel in all health care disciplines. Where some or all members of any category of nursing,nnidwfery personnel are not qualified for the new functions expected of them, a realistic period is fixed during which such personnel are given the opportunity to become qualified. To ensure that adequate opportunities are available to undertake the required preparation and that no economic disadvantage is suffered in the process, arrangements for acquiring the additional training are made in consultation with the nursing/ midwifery personnel involved in planning the nursing/midwifery personnel system. In making these arrangements, special attention is given to both the geographical location of the personnel concerned and the educational facilities available. 4.1 Guidelines for countries and territories related to the regulation of nursing,nnidwifery education and practice are that: (a) where there is congruence of the roles and functions of more than one category of health worker, consultation between the disciplines concerned is essential in order to reach agreement in respect to areas and levels of function, educational programmes, and definition and control of practice; in each country, a governmental agency, composed of nursing/midwifery personnel, the majority of whom are active in nursing/midwifery should be established to administer the licensing and relicensing of professional and auxiliary nursing/midwifery personnel; nursing/midwifery legislation should ensure the protection of the public by permitting practice only to those who have the required knowledge and skills; ensure competency by requiring practitioners to meet defined standards; faclli tate appropriate qualification and provide for equitable conditions of employment; nursing/midwifery legislation should be drafted in consultation with other disciplines to ensure that it is compatible with changing needs and takes cognizance of the legislation for other health disciplines; and the establishment of formally organized nursing/ midwifery associations is a legitimate right, and is desirable for the development and advancement of standards of nursing,nnidwifery education and practice.

(b)

(c)

(d)

(e)

- 19/20 4.2 Proposals

It is proposed for consideration by the WHO Regional Office for the Western Pacific that it. should: (a) assist in the formulation by governments of suitable legislation for nursing/midwifery through the provision of consultants, as requested by members governments; organize regional mul tidisoipl1nary intercountry group eduoational meetings on legislation for the health professions, with the partioipation of nursesfinidwi ves : and oontinue its encouragement and support of the establishment and development of nurses'/midwives' associations.

(b)

(0)

5.

CLOSURE OF THE MEETING OF THE TECHNICAL ADVISORY CCX+1ITTEE ON NURSING

Dr Francisoo J. ny, Regional Director, declaring the first meeting of the Technioal Advisory Committee on Nursing olosed, stated that it was his hope that the Committee would be convened again before too long. Thanking the Regional Director on behalf of the Committee members, the Chairman affirmed the desire of the Committee that other such opportunities to participate in planning for the nursing/midwifery component of the Region's health programme should be afforded to nurses and midwives.

- 21 ANNEX 1

ABSTRAcr OF THE INITIAL ANALYSIS OF THE QUESTIONNAIRE ON THE CURRENT NURSING!MlrNllFERY SITUATION IN THE COUNTRIES AND TERRITORIES IN THE WESTERN PACIFIC REGION OF THE WORLD HEALTH ORGANIZATION • 1.

INTRODUcrION

To obtain data to complement the information available in the Western Pacific Regional Office, a questionnaire designed to elicit information on the current nursing/midwifery situation in the countries and territories in the Region was prepared. Thirty-three copies of this _questionnaire were sent to 24 of the Region's countries and territories. In addition, a special questionnaire was sent to two francophone island territories. As of 22 November 1973, canpleted questionnaires had been returned to the WHO Western Pacific Regional Office by 20 oountries and territories and one franoophone island territory. For reasons of time, a partial analysis of the returned questionnaires was oarried out. A complete compilation and analysis will be undertaken in 1974 and will inolude the data reoorded in the questionnaires still being reoeived. 2. LIMITATIONS OF DATA

Limitations in the interpretation of replies are due to such problems as the degree of aocuracy and completeness of answers and the degree of availability and adequacy of the data needed. This narrative abstract represents the replies to two-thirds of the questionnaires; 20 completed questionnaires and a special questionna1re from the francophone island terr1toryI be1ng received in time for partial analySis prior to the meeting of the Committee.

~pleted questionnaires received from British Solomon Islands Protectorate, Cook Islands, Fiji, Gilbert and Ellice Islands, Guam, Hongkong, Japan, Laos, Malaysia (West), New Hebrides, New Zealand, Niue, Papua New Guinea, Philippines, Republ1c of Korea, Singapore, Tonga, Trust Terr1 tory of the Pacific Islands, Republic of Viet-Nam and Western Samos. SpeCial questionnaire received from French Polynes1a.

- 22 Annex. ]

The nomenclature used for nursing/m1dwifery personnel in the 21 countries and territories for which questionnaire returns are available (Part I of questionnaire) has not been compiled. The data provided on the participation of nursing/lII1dwifery personnel in special education and other progr8llllles/ activities (Part VIII of the questionnaire) are also not included. The data compiled are for the most part described in the terms of the major areas • as listed on pages 24 and 25 covered in various parts of the questionnaire, below.

3.

DEFINITIONS OF TERMS

The following definitions were used: 3.1 The nurse, the nurse-lII1dwife (a) II The nurse is a person who has completed a prograDllle of basio nursing education and is qualified and authorized in her oountry to supply the most responsible service of a nursing nature for the promotion of health, the prevention of illness and the oare of the siok. II (International Council of Nurses' Special and Committee Reports, presented to the ICN Board of Directors Grand Council Meetings, Frankfurt, June 1965, p.6) This definition was formulated by the ICN and was acoepted by the Fifth WHO Expert Committee on NurSing (1966).

(b)

The nurse-midwife has, in addition, completed a programme of basic midwifery education and is thus specially qualified and authorized in her oountry to provide delivery services in normal obstetrics.

3.2 The midwife is a person who has oompleted a prograDle of basic midwifery eduoation and is qualified and authorized in her country to provide birth attendance in normal obstetrios.

3.3 The auxiliary nurse, the auxiliary nurse-midwife (a) auxiliary nurse is a person with less than full professional qualifications (in the hospital, the community or the hospital and commun1ty aspeots of health care), who is qualified and authorized to carry nursing responsibilities of ~ less comprehensive and technical nature, and who works under the supervision of nurses (nurse-midwives). The auxiliary nurse-midwife is a person who has, in addition to or in oombination with nursing training, preparation in m1dwifery and is qualified to provide delivery services in normal obstetrios under the supervision of nurse-midwives. ~e

(b)

- 23 Annex 1

3.4 The auxiliary midwife is a person who has reoeived training in midwifery and is authorized in her country to assist with the provision of birth attendance in normal obstetrios. under the supervision of nurse-midwives and midwives.

3.5 The nursing aide is a person who has reoeived training of a very Simple or of a single-purpose nature to serve within the nursing system of her oountry.

3.6 The traditional birth attendant is an individual (usually a woman) who assists the mother at childbirth and who initially acquired her skills by practice or by assisting other traditional (empirical) birth attendants. 1

3.7 Basic professional nurSing eduoation programmes are those

wh1~h

produce

nurses as herein defined, through diploma-or degree-level studies.

3.8 Basio professional midwifery eduoation programmes are tho. which produce midwives as herein defined.3

3.9 FOrmal post basic and post graduate programmes in professional nursing( midwifery education <a) FOrmal programmes: FUlly-organized educational experienoes whioh constitute established offerings of eduoational or health service institutions. Post basic programmes: (i) Certificate or diploma-level studies in functional. clinical or oommunity health specialities which are made available to fully qualified nurses who have completed basic nursing! midwifery studies at either the diploma or degree level.

(b)

1 Que~tionnaire for Technical Advisory Committee on NurSing, WPRO 4402 12 September 1973, p. 5 2 ~

p.45

3Ibid p. 55

- 24 -

Annex 1

(Ii)

Baccalaureate-level studies with clinical. community health or funotional specialization. for fully-qualified nurses who have oompleted diploma-level basic nursing/midwifery studies.

(c)

Post basic studies in midwifery: advanced studies in midw1fery, usually leading to teaching qualifioations in this area of spe01alization, the first oourse taken by nurses in midwifery being oonsidered to be of a basic eduoational nature. Post graduate prog~es: studies at the master's or doctor's degree level, for holders of baocalaureate and master's degrees respeotively.l

Cd)

3.10

"Teaoher Preparation" refers to the training of nurses and lII1dwives for teaohing pod tions in nursing sohools/oolleges. midwifery sohools. etc. 2 4. THE QUESTIONNAIRE

The questionnaire consists of ten parts, namely: Part I Part II Part III Part Dr Part V

Nomenclature used for nursing/midwifery personnel Overall organization and management of nurs1ng/midwifery personnel National nurses~midwives'

and related organizations

Leg1slation for nursing/midwifery Registration of nursing/midwifery personnel Standing national {federal, state or provincial) nursing/ midwifery 00I11III1 ttees, boards ancl/or councils

Part VI

1

~, p.

58-59

- 25 Annex]

Part VII Part VIII Part IX Part X Part I

Speoifio long-term provisions for the development of nursing/midwifery personnel Participation of nursing/midwifery personnel in speoia1 educational and other programmes/aotivities Nursing/midwifery manpower resouroes General conditions of employment or nursing/midwifery personnel

NCMENCIATURE USED FOR NURSING/MIDWIFERY PERSONNEL

Not oompi1ed. This information will be avi1ab1e when the questionnaire is completely analysed. Part II OVERALL ORGANIZATI~ AND MANAGEMENT OF NURSING/MIDWIFERY PERSONNEL

In considering the overall organization and management of nursing/ midwifery affairs, the poSition was examined at the oentra1, intermediate and peripheral levels of national health servioes with regard to: (a) (b) (c) (d) provision of a nursing/midwifery unit; body

responsible for national health planning, planning for health manpower development;

long-term

organization of standing oommittees, boards or councils.

Central level Of the 20 countries and territories giving information, 15 have a nursing! midwifery unit at the oentra1 level and, of these, 10 have nurses and/or midwives serving in the central level unit. Similarly, 15 countries and territories have a central level body responsible for national health planning and in 10 of these countries and territories nursing/midwifery personnel are members of the central body. Regarding long-term planning for health manpower development, 17 respondents have provision at the oentra1 level. In 12 of these oountries and territories there is partioipation by nursing/midwifery personnel.

- 26 Annex 1 In 11, there is provision within the central level organization for standinc ca.aittees, boards or oounoi1s on nursing/.idwifery. Intermediate Level Seven countries and territories have a nursins/midwifery unit at this level. In one oountry, nurses serve on all hospital boarda; in another, nurses are assigned as regional chiefs of publio health bureaus. In four oountries and territories, there is an intermediate level body responsible for national health planning and nurses serve on three of theae bodies. In six oountries and territories, there is provision for long-tara planning for health manpower development at the intermediate level. Nursinc/ midwifery personnel assist in four of these oountries and territories. Provision is made for the organization of standing cOllllli ttees, boards or oouncils on nursing/llidwifery in two countries and territories. Peripheral level None of the countries and territories has a peripheral level nursing/ midwifery unit. In three countries and territories, nursing/midwifery personnel serve in other units of the peripheral level health organization. In only one country is there provision at the peripheral level for partioipation in national health planning and long-term planning for health manpower developaent, with nursing/midwifery personnel partioipating in the latter aotivity. Part III: NATIONAL NURSFS/MI~IVES'

AND RELATED ORGANIZATIONS

In this Part, the following have been oonsidered: (a) (b) (c) (d) <e) (f) existence of assooiation (s); whether the association has branches: whether the assooiation has legal obligations suoh as lioenain&! registration: eleotion of governing body; payment of dues, and the publication of a Journal.

- 27 Annex 1 National nursing associations (a) Of the 21 countries and territories responding, 18 have national nursing associations: eight of these are members of the International Council of Nurses. For one territory, no further data in this Part was elicited, the following information relates to the responses from the remaining 17 countries and territories having nursing associations.

80

(b) (c) (d) (e)

Ten associations have state, provincial, regional or district branches. No association has legal obligations for licensing/registration. Members of the governing body are elected by the membership in all 17 associations. Seventeen associations report the payment of membership dues as a source of income. One association receives government support. All associations receive income from other sources such as fundraising activities, investment and rentals income, private donations, etc. Nine &ssociations report the publication of professional nursing journals, five being available in the English language.

(f)

National midwifery associations <a) Of the 21 countries and territories resPOndin~, five have seoarate associations for midwives. One of these associationa is formally affiliated with the national nurses' association. 'Ibree associations have branches. One association has registration responsibilities. The governing bodies of all five associations are nominated and elected by the membership. All f1 ve associations report the payment of dues as a souroe of income, one assooiation reoeives government support and two associations record receiving income from other sources. Information is not available on the publication of Journals.

(b) (c) (d) (e) (f)

- 28 Annex 1 PARI' TV: LEGISLATION FOR NURSING,MIrMIFERY

This information was not elicited from one territory. Of the 20 other country and territory respondents, 17 have legislation. The following information was provided for nursing and midwifery relating to: (a) (b) (c) (d) (e) Nursing (a) (b) Seventeen countries and territories have legislation in respect to nursing practise. Thirteen countries and territories provide for licensing in their legislation. The existing legislation in seven of these countries and territories provides a definition of the functions of the nurse. Sixteeen countries and. territories provide for disciplinary procedures related to malpractice. In 14 of these, nurse participate in these procedures either directly or indirectly.

legislation for practice licensing to practise definition of functions in the ordinance legislation in respect to disciplinary procedures, and participation of nursing)midwifery personnel in these procedures.

(e)

(d) (e)

Midwifery (a) (b) Nineteen countries and territories have legislation in respect to midwifery practice. In six countries and territories, the government issues licenses for midwifery practice. In one other country, only midwives in private practice are licensed to practice by the government and registered by the midwives' association. In another territory, legislation does not provide for the issuance of licenses to practise. In the remaining countries and territorie~, licensing is provided for by nursing/ midwifery boards or nursing boards and midwifery boards.

(c) (d)

TWo countries and territories report that definition of function is inciuded in the ordinance. Legislation in respect to disciplinary procedures for midwifery is not reported by any country and territory.

- 29 Annex 1 Part V

REGISTRATION OF NURSING/MIDWIFERY PERSONNEL

The following information relating to registration of nursing/midwifery personnel was elicited: (a) (b) (0)

provision for registration provision for annual re-registration payment of fees.

Nursing and midwifery personnel Ca) There is provision for registration of all existing basic categories of nursing/midwifery personnel in 13 of the 21 responding countries and territories. Registration is compulsory for nursing in 11 oountries and territories, for midwifery. in 9 and for nurse/ midwives in 9 oountries and territories. The registration certificate oonstitutes a lioense to praotise, for nursing in 11, for midwifery in 10, and for nurse/midwives in 12 countries and territories. Annual re-registration is required in 5 oountries and territories for nursing, in 3 for midwifery and in 5 for nursing/midwifery. In seven countries and territories, a fee is charged for registration in all oategories and in two of these countries and territories, an annual fee is charged for re-registration. In one terri tory, onlY' nurses and midwives who have trained abroad pay fees.

(b) (0)

Part VI : STANDING NATIONAL. (JiEDERAL, STATE OR PROVINCIAL ) NURSING/MIDWIFERY CQftft1I'ITEES, BOARDS AND/OR COUNCILS

Of the 20 countries and territories responding in this seotion, 14 have standing national nursing/midwifery committees, boards or oounoils. Information on these committees, boards and councils is summarized below: (a) Of the 14 having standing committees, boards and oouncils in nursing, five were established between 1919 and 1948; and six between 1952 and 1963. Information is not available on the establishment of oommittees, boards or oouncils in three countries and territories. In midwifery, of the five countries and territories reporting separate nursing and midwifery committees, boards and councils, two were established between 1910 and 1915, three between 1956 and 1960.

(b)

- 30 Annex] (c) Cd) Three countries and territories report the establishment of a combined nursing/midwifery board. Four oountries and territories report that the oOlDDittee, board and/or council is the registering body for nursing/midwifery, two oountries and territories report that the committee, board and/or council is the registering body for nursing.

Part VII : SPECIFIC LONG-TERM PROVISIONS FOR THE DEVELOPMEtfI' OF NURSING/MIDtlIFERY PERSONNEL

Ca)

Basic nursing/midwifery eduoation programmes Detailed information is available on the basic nurs1ng/ midwifery education programmes for 20 oountrie. and territories. Of this number, 14 have a oentra1 authority (or several central Authorities) which is/are responsible for the establishment of progrAlDDes for the preparation of nurses. The distribution, by type of education progranae, or the number of oountries and territories having such oentra1 authorities is as follows: Central authority (ies) for establishment of programme (8) in: Nursing/midwifery Midwifery Auxiliary level nursing! midwifery personnel Single-purpose nursing aides and others Countries and territories

11

7

15 9

(b)

Basic professional nursing education programmes (i) Provision is made for officially oonstituted adviSOry oommittee., boards or councils for basio diploma-level nursing sohoo1. in eight countries and territories. Such bodies are established for basic degree-level colleges of nursing in two countries and territories and for an associate degree programme in nursing in one territory.

" - 31 Annex 1 (ii) It is not possible to present all data reoeived on the qualifioations of the nurse teacher staffs of these programmes because of problema involved in data oollection. Certain findings are presented tor illustration. In one country, all teaohers have basic qualifioations in nursing only; in another 44.5~ are so qualified; in a third 3~ have no post-basic preparation.

(1i1) Fifteen of the oountries and territories with diploma-level basio nursing eduoation progre.llDes report that there is proVision in the schools for speoialist teaohing assistance from Members of the medioal and other health disoiplines; 11 oountries and territories report provision of such assistanoe by individuals speoially qualified 1n the sooial soienoes and the humanities. Provision of suoh teaohing assistance from health, social soienoes and humanities specialists is reported by five oountries in desoribing their basio degree-level nursing eduoation programmes. (iV) In one country there 18 provis1on for nursing students in diploma-level bado nursing schools to take oertain course. with stUdents of other disc1plines. FOr degree-level pro~., such provision exists in three oountries and territories but in two oountries and territories students in degree-level p~ogrammes do not take oourses with students of other disoiplines.

(v)

An overall plan for field praotioe w.nich extends through the entire duration of the prograDIIB and w.nioh is nonnally implemented without ohanse i8 reported for 12 countries and territories at the diploma level. This provision exists in four oountries and territories for degree-level programmes.

(vi)

In six countries and territories, graduates of the basic diploma-level nursing programmes eventually undertake midwifery training. A salary (stipend) is paid to nursing students in the basicdiploma-level sohools of twelve of the fifteen oountries and territories. Of the degree-level sohools (in five countries and territories), only one makes such payment. Pees are paid by students in the diploma-level SchOols in two oountries and territories and by students in the degreelevel prosra-s in four oountrie. and territories.

(vi!)

t

- 32 Armexl

(viii) Information has been received on three training programmes for the preparation of single-purpose nursing persormel at the professional level in two countries and territories only. In one terri tory, there is a 3-year progrume in psychiatric nursing and in another oountry there is a 3year programme to prepare psychiatrio nur.e. and a 3-year programme to prepare psyohopaedic nurses. (0)

Basio profe.sional midwifery eduoation pro'r..... :

Seven countries and territories report the provision of basio profe.sional eduoation programmes for the preparation of midwives. (i) (ii) There are offioially oonstituted advi.ory board. for the.e progrlUlllles in four oountries and territories. Information is not available on the qualifications of nur.e; midwife or midwife teaohers in these programme.

(iii) Five of the countries and territories with basic professional midwifery eduoation programmes report that there i. provision for speciali.t teaching assistance from medioal and/or other health profe•• ionals and tho.e tram the sooi&1 soience. and/or the hUJJWlities. (Iv) There is no provision in any of the midwifery education programme. for student. to take oertain oourse. with .tudents from other di.oiplines. It is reported that there i8 an overal1 plan for field experienoe which extends throughout the duration of the programme and is normally implemented without change in six of the seven countries and territories providing these programmes. A salary (stipend) is paid to professional midwifery .tudent. in all the oountries and territories exoept one, where the students paT fees.

(v)

(Vi)

(d)

FOrmal post basio and post graduate programmes in professional nursing/midwifery eduoation

or 20 oountries and territories for whioh there are questionnaire returns, nine do not have post basic or post graduate programmes in profe •• ional nursing/midwifery eduoation. The l1 oountries and territories 'With suoh programmes report as follows:

- 33 Annex 1

(i)

At university level, there are four programmes leading to a master's degree in nursing administration and one to the master of public health degree; also one post basic bachelor's degree programme in nursing. Regular programmes are offered for other post-basic studies; six in public health nursing; one in public health nursing administration; eight in nurSing administration and four in nursing education.

(ii)

(iii) The following 1n-service programmes are not necessar1ly offered on a regular basis and vary. in length from three weeks to one year; three in nursing administration, 80 in various c11nioal nursing specialties; one in public health nursing and three In nursing educat1on. (e) Problems associated wlth the education and training of nurSing and midwifery personnel (i) Eighteen of the 20 oountries and territories from which information was reoeived reported as follows: Eleven of the lB oountries and territories consider that there is, in general, a need to attain improved cooperation and 9011aboration tetween teaohing institutions and health oare servioes; ten oonsider there is in general a need to attain improved aocessibility between teaohing institutions and health care services. (il) Other problems assooiated with the eduoation and training of nursing and midw1fery personnel which were noted by respondents include: laok of superv1sion and of role models in the field praotice areas; inadequate transport and student housing facilit1es; lack of teaching spaoe in the ollnical areas; unsatisfactory administratlve organization; laok of supportive servioes such as secretarial assistance; high cost of training; insufficient budget and unsatisfactory budgetary planning and operation; large enrolments as compared with available teaching staffs and facilities;

- 34 Annex I curricular restrictions and the requirements of medical and health care agenoies for student aervioeJ laok of a national accrediting body. (iii) In reapeot to the major language (a) of inatruotion u.ed in the general eduoation progrlUlDe of the oountrie. and terri torie. and that (thoae) uaed in the nurainc!lI1dwife17 eduoation programme a (basic. post basic and po.t graduate), the alUlle language/language. (national, foreisn or national and t:ereign ) are used throughout the eduoational/training experienoe. in all countriea/territories except one, where a foreign language (English) ia uaed at the degree level only. In another oountry, instruotion at all levela ( and 1n all progralBe. ) 1s given in the national language. Part VIII - PARTICIPATION OF NURSING/MIDiIFERY PERSCIINEL IN SPECIAL EDUCATIQQL

AND OTHER PRC>GlWMES/ACTIVITIES

Not 1noluded. Part XI - NURSING/MIDWIFERY MAHFaaR RESOURCES (i) Nurse/nurse-midwife personnel: On the nurse/nurse-midwife ratio to population of the responding countries and territories:

8 report one nursejburse-midwife aerving about 500 people or less, 4 report one nurse/burse-midwife for 600-1000, 4 report one nurse/burse-midwife for 2000, 4 report for one nursejburse-midwife for 3~6000, I report for one nurse/burse-midwife for about 250 000 These figures exclude all auxiliary categories. (ii) Other categories of personnel, i. e. midwives, auxiliary nurse/midwives, single-purpose nurse aides, traditional birth attendants and others: . Responses for these categories are not included at this time in view of the wide range found in some instances, some categories not existing at all and others ranging from 0 to 174 318. This information will be avaiiable when the questionnaire is completely analysed.

- 35/36 Annex 1 Part X GENERAL CONDITIONS OF (i) ~LOYMmT

OF NURSING/MIatlFERY PERSONNEL

Of the 20 oountries and terr1tories for which there are questionnaire returns, 18 have written provisionconcern1ng employment and work conditions for certain nursing personnel. Of these 18 countries and territories, no written provisions have been made for professional midwives in two territories; professional nurses in one country; auxiliary lIidwifery personnel in one country and two terr1 tories.

(i1)

Nine of the oountries and territories have provisions for employment of part-time workers in certain catespries of nursing/midwifery personnel.

(11i) In respect to the employment of married women, one territory has restriotions on such employment: one oountry restricts employment of III&rr1ed professional and auxiliary nurses: one terri tory restricts employment of III&rried auxiliary lIidwi ves. (lv) Job incentives in the form of salary scales wh1ch compare favourably w1th those of workers with s1milar educational baokgrounds and s1mllar experienoe are not provided for profeSSional nursing and/or professional midwifery personnel 1n six countr1es and territories. FOur countries and terr1 tories Mve recorded an unfavorable oanparison of salary soale for auxiliary nursing/midwifery personnel with that of other workers with a similar eduoational background and similar experienoe. A work week of the same duration as for other workers in the country exists for professional nursing/midwifery personnel in all but three of the 20 countries and territories responding to the questionnaire. In two countries, the work week of aux:lliary nursing personnel is d1fferent from that of other workers. Social seourity benefits are provided by all but one of the 20 oountries and territories responding to the questionnaire. All countrles and territories provide social security benefits for the profeasional nursing/midwifery peraonnel employed by governments full-time. Of the 16 governments utilizing auxiliary nursing/m1dwifery personnel, all exoept one provide social seourity benefits.

(v)

(vi)

- 37/38 ANNEX 2

TECHNICAL ADVISORY C(Ht1ITTEE ON NURSING

10 - 17 Deoember 1973

Ms. Y1 Shin Hong

Assistant Professor Department of Nursing Seoul National University Seoul Hepubl1c of Korea elliet Midwife Ministry of Health Saigon Republic of Viet-Nam Protessor TOkai University School of Nursing Tokyo Japan Senior U!cturer in Nursing Studies Department of Education Viotoria University (of Wellington) Wellington New Zealand Professor University of the Philippines, College of Nursing Quezon City Philippines Matron in-oharge of In-Service Eduoation Programmes University Hospital University of Malaya Kuala Iwnpur Malaysia Principal Nursing Section Department of Health Canberrs Australia

Ms. ati Quang Hu~

Ms. Yukiko Inoue

Ms. E.Beetrice Salmon

Ms. Jul1ta SoteJo

Ms. Tan Siew Gaik

Ms. Majorie Wilks

- 39 ANNEX 3

SECRETARIAT OF 'mE WORLD HEALTH ORGANIZATIOO

secretary Ms. Mary Abbott Regional Adviser in Nursing Western Pacific Regional Office

COoperating Officer Ms. Madeleine Lenoir Regional Nursing Officer Western Pacific Regional Office

Consultants Ms. Lily M. TUrnbull Chief Nursing Officer Health Manpower Development WHO Headquarters Geneva Assooiate Professor of Nursing and Head Department of Nursing Faoulty of Continuing Medical Education Tel-Aviv University Israel Nursing Offioer Helsinki City Hospital and Sooial Servioes Planning &1reau Helsinki Finland WHO Nurse Administrator Development of Health Services ProJeot Republic of Korea

Dr Rebecoa Bergman

As. Ingrid Hlbnelin

Ms. Evelyn Matheson

Resource Persons Dr Andres A. Angara

Assistant Direotor of Health Servioes Western Pacific Regional Office WHO Public Health Nurse Publio Health Advisory Services South Paoific

Ms. Joan Bentley

- 40 Annex

3

Resource Persons (cont1nued) Ms. Madele1ne B1ssonnet WHO Nurse Educator Nursing Educat10n Project Laos Professor Nat10nal Health Planning Inst1tute of Publ1c Health Un1vers1ty of the Ph1l1pp1nes Man1la, Philipp1nes WHO Nurse Educator Fam1ly Plann1ng Field Adv1sor" Services We.tern Pao1f1c Reg10nal Otf1oe

Dr Jose Cortes

Ms. Helen F1llmore

41/42 -

ANNEX 4

MEJmER8HIP OF SUB- ca«rrrEES

1.

Steering Committee Membership of this CoaIDi ttee was establ1aheci under the :Rules

ot Prooedure (Annex 6) as the I

.,

Chaiman Vioe-Chaiman Rapporteurs

Protessor J. SoteJo MIl. Tan Siew Ga1k MIl. Y.S. Hong

Ms. B.Q.

Hu.

Ms. E.B. Salmon MIl. M. Wilks

2.

The Guideline. and Proposal Drafting Committee The following members were eleoted to serve Ms. B.Q. Hu~ OIl

this CollI 1ttee:

Ms. Y. Inoue Ms. E.B. Salmon

ANNEX 5

AGENDA Monday, 10 Deoember 8:30 a.m.

l

Opening ceremony Weloome by Dr Franoisco J. Regional Director Dy,

Self-introduction by members of the Committee and consultants Eleotion of Officers 10:00 - 10:30 a.m. Coffee break Any administrative information Adoption of Agenda 11:00 a.m. - 12:30 p.m. Topio I: Heal th oare planning wi thin the context of national development (whioh reflects socioeoonomio, oultural. politioal, soientific and teohnologioal levels) in the Western Paoifio ftegion and consideration of its speoifio implications for nursingl midwifery planning in the national programmes Umoh Topio I (continued)

12:30 - 1:30 p.m. 1:30 - 2:30 p.m. 2:30 - 3:00 p.m.

Coffee break

lworking hours to be 8:30 a.m. - 12:30 p.m. and 1:30 - 4:00 p.m. with 1/2 hour breaks at 10:00 - 10:30 a.m. and 2:30 - 3:oo.p.m. daily.

_ 44_

Annex

5

3:00 - 4:00 p.m.

Topic I

(continued)

Steering Committee and GUidelines and Proposal Drafting Committee to arrange their daily meetings

Tuesday, 11 December 8:30 a.m.

Report of previous day's meeting Topic I (continued)

10:00 - 10130 a.m. 10:30 a.m. - 12:30 p.m. 12:30 - 1:30 p.m. 1:30 - 2:30 p.m.

Coffee break Topic I Lunoh Topic II: Faotors involved in the . strengthening of health servioes as related to the roles and funotions of nursingjmidw1fery Coffee break: Topio II (oontinued) (continued)

2:30 - 3:00 p.m. 3:00 - 4:00 p.m.

Meetings of Steering Committee and Guidelines and Proposal Drafting Committee Wednesday. 12 December 8:30 a.m.

Report of previous day's meeting Topic II (continued)

10:00 - 10:30 a.m. 10:30 - 12:30 p.m.

Coffee break Topio II (oontinued)

•

-

~5/46

Annex

5

12:30 - 1:30 p.m. 1:30 - 2:30 p.m.

llmoh Topic III: Health manpower development as it relates to planning for, preparation and utilization of, nursing/midwifery personnel for effective health services Coffee break Topic III (continued)

2:30 - 3:00 p.m. 3:00 - 4:00 p.m.

Meetings of Steering Committee and Guidelines and Proposal Drafting Committee Thursday, 13 December 8:30 a.m.

Report of previous day I s meeting Topic III (continued)

10:00

~

10:30 a.m.

Coffee break Topic III llmoh Topic IV: Role of nursing/midwifery in defining, interpreting and implementing nurs1ng/midwifery practice and education, and in furthering equitable working and living conditions Coffee break Topic IV (continued) II

10:30 a.m. - 12:30 p.m. 12:30 - 1:30 p.m. 1:30 - 2:30 p.m.

(oontinued)

2:30 - 3:00 p.m. 3:00 - 4:00 p.m.

Meetings of Steering Committee and Guidelines and Proposal Drafting Committee

- 47 Annex

5

Friday, 14 December 8:30 a.m.

Report of previous day's meeting Topic IV (continued)

10:00 - 10:30 a.m. 10:30 a.m. - 12:30 p.m. 12:30 - 1:30 p.m. 1:30 - 2:30 p.m. 2:30 - 3:00 p.m. 3:00 - 4:00 p.m.

Coffee break Topic IV Lunch

(continued)

General discussion Coffee break General discussion Meetings of Steering Committee and Guidelines and Proposal Drafting Committee

Monday, 17 December 8 :30 a.m.

Presentation of draft report. including guidelines and proposals for adoption by the Committee Discussion

10:00 - 10:30 a.m. 10:30 a.m.

Coffee break Final discussion Adoption of draft report including guidelines and proposals Closing ceremony

-48 ANNEX 6

RULES OF PROCEroRE I. Rule 1. Commi ttee Members PARTICIPATION

The Temporary Advisers invited by the WHO Heaional Office tor the Western Paoific constitute the Committee Members. Rule 2. Seoretariat

The Seoretariat is oomposed of the WHO staff members of the Regional Offioe, together with seleoted field staff members, the oonsultants appointed for the meeting and the nursing representative from WHO Headquarters. Rule 3. Seoretary of Committee

The Seoretary to the Committee is the WHO Operational Officer for the Teohnioal Advisory Committee on Nursing.

II. Rule 4.

ORGANIZATION OF THE MEETING

Eleotion of Offioers

At the first meeting, Committee members will hold eleotions for the follOWing offioes:

Chuman Vice- Chatman Rapporteurs These offioes will be held by Temporary Rule 5. Advise~.

The Guidelines and Proposal Drafting Committee

5.1 The meeting shall establish a Guidelines and Proposal Drafting Committee which may oo-opt other members as neoessary. 5.2 The Guidelines and Proposal Drafting Committee shall consist of three temporary advisers. The Committee shall be assisted by one member of the WHO Regional Office staff and one consultant.

•

- 49 Annex

6

5.3

The Guidelines and Proposal Drafting Committee shall elect its own committee chairman and, if necessary, a rapporteur. Steering Committee

Rule 6.

'\

There shall be a Teohnica1 Steering Callai ttee oonaisting of the Chairman or, in her absence, the Vice-Chairman, the Rapporteurs and the Secretary of the Committee. WHO consultant. and WHO .ecretariat staff shall be available as necessary to assist this Cami twe. The CoIIIni tiee shall meet at a convenient time agreed upon after each day's sessions. This CoIIIni ttee shall be respona1b1e for preparing the report of the session for the day; and an outline of the topio for discussion the following day.

III.

COOOOCT OF BUSINESS

Rule 7. 1.1

Respona1bil1 ties of the Chaiman

In addition to exercising the duties whioh are oonferred upon her by the rules of procedure, the Cha1man shall open and close eaoh plenary session of the meeting. She shall fao11i tate the discusaions, accord the right to speak and ensure observanoe of the rules. If the Chainnan is absent during a meeting or any part thereof, her place shall be taken by the Vioe-Chainnan. The Vice-Chairman, acting as Chairman shall have the same responsibilities and duties as the Chairman. Plan for the Meeting The Secretary for the Committee shall assist the Chairman in carrying out her duties. The draft report of the Committee including guidelines and proposals shall be made available to, the meeting for review on the last day of the meeting. Any amendments proposed and aocepted by the Committee, shall then be incorporated in the draf't report on the same day for its adoption.

1.2

Rule 8. 8.1

8.2

8.3 The closing oeremony shall follow immediately after adoption of the report.

•

- 50 Annex

6

Rule 9. 9.1 9.2

Participation in Discussions The presiding officer shall call upon speakers in the order in which they signify their wish to speak. The presiding officer may limit the time allowed and see that the observations made by speakers follow the outline for the topic under discussion. The outline of the topiC under discussion shall be made available to participants in advanoe by the Seoretary of the Committee. Proposals Proposals and guidelines drafted by the Guidelines and Proposal Drafting Committee referred to in Rule 5 shall be transmitted in writing to the Secretary of the Committee who shall circulate copies to all members. Reoords

Rule 10. 10.1

Rule 11.

11.1 The Committee shall adopt a report of the meeting inoluding such guidelines and proposals as i t may already have adopted. 11.2 After the close of the Committee meeting, a final report shall be submitted to WHO for publication.

•

IV.

SECRETARIAT OF '!HE Ca;r.,ITTEE

Rule 12. 12.1

The WHO Secretariat of the Committee The technical staff will oonsist of the following: (1) (2) (3) Ms. Mary Abbott, Regional Adviser in Nursing,

western Pacific Regional Office (Seoretary) Ms. Madeleine LenOir, Regional Nursing Officer, Western Pacific Regional Office (Cooperating Officer) Ms. Lily M. Turnbull, Chief Nursing Officer,

Health Manpower Development, WHO Headquarters, Geneva (Consultant)

•

- 51 -

Annex

6

(4)

Dr Rebecca Bergnlan, Associate Professor of Nursing

and Head, Department of Nursing, Faculty of Continuing Medioal Education, Tel-Aviv University, Israel (Consultant)

(5)

Me. Ingrid Hlfmelin, Nursing Officer, Helsinki City, Hospital and Social Services Planning Bureau, Helsinki, Finland (Consultant)

(6) '\

Ms. Evelyn Matheson, WHO Nurse Administrator, Development of Health Services Project, Korea 4001 (Consultant) Dr .Andres A. Angara, Assistant Director of Health Services, Western Paoific Regional Offioe (Resource Person) Ms. Joan Bentley, WHO Public Health Nurse, Public Health Advisory Services, South Pacific, WPRO 4001 (Resource Person) . Ms. Madeleine Bissonnet, WHO Nurse Educator, Nursing Education, Laos 4401 (Resouroe Person) Ms. Helen Fillmore, WHO Nurse Educator, Family Planning Field Advisory Services, WPRO 9603 Western Pacific Regional Offioe (Resource Person) Dr. Jose Cortes, Professor, National Health Planning, Institute of Public Health, Manila, Philippines (Resource Person)

(7)

(8)

(9) (10)

(11)

V.

ADOPl'ION OF THE RULES OF PROCEOORE

Rule. 13 These rules of procedure shall be presented to the Committee during the pre-meeting for introduction of lillY needed ...nclment IIlld subsequent adopt10n.