INTRODUCTION
As said by S.Lee, written by
Zulkiple Ibrahim in his article ‘Missy Then, Misi Now’ in Bernama. Com,
‘nursing is a specialized profession that focuses on caring, nurturing,
educating and research within the healthcare’. Therefore, in order to improve
the quality of the sick, the nurses have to produce a holistic care to the
client in accordance with the present situation. To achieve an optimal holistic
care and to improve the profession, nurses should have a strong desire to gain
more and more as well as update their knowledge.
With this full current knowledge,
the skill and critical thinking can be improved among the nurses as well strengthened
the profession of nursing in our country. Therefore, each of the nurses in this
country should improve their performance by upgrading the knowledge because
this is important in nursing professionalism. Furthermore, our Health Minister
Datuk Seri Liow Tiong Lai said his ministry was working closely with the higher
education ministry to have about 2,000 graduate nurses annually, under the
Bachelor of Science in Nursing from public and private universities (taken from
Bernama).
However, now in Malaysia, we have
about 80,000 working nurses but out of this amount, how many nurses are willing
to continue their education? In the nursing field, skill and knowledge are
highly important. In addition to the rise of new diseases such as H1N1 that
require a specific method of nursing care. Not only the presence of new
diseases, but some types of chronic diseases such as Hypertension and Diabetic
Mellitus also are giving severe complication to all walks of life that have it.
In line with the theme of nurses day for year 2010, ‘Nurses Leading Chronic
Care’. As a result, every nurse should be aware that continuing education is
important to establish the status of nursing in professionalism. Furthermore,
with continuous education it can make the nurses to practice with competency,
confidence and autonomy.
PROFESSIONALISM
Nursing
is a profession and it is a unique field because in nursing, there is a
combination of art and science. Nursing is comprised of theory which is an
academic learning in order to understand the subject; while practice is an
undertaking of clinical nursing skills and care with patients and clients. And
beside of theory and practice, we have Board of Nursing which will control and
monitor nurses activities in order to ensure and maintain the quality of care. This
can be seen clearly in diagram below.
This
is synonymous with the term of ‘Professionalism’ which refer to the conducts,
goals or qualities that characterise or mark of a profession of a professional
person. (Schwirian, 1998). There are many things or challenges that need to be
considered in order to achieve professionalization. Few challenges are listed
as illustrated below:
Empowerment
is needed in nursing to influence the patients, physicians as well as other
peoples to prove content, context and competency in our practice. Without this
element, nurses will get less satisfaction in their job, tend to burnout and
depersonalization.
Autonomy
is one of the criterions of professionalization and no autonomy without
empowerment which means that, nurses need to be empowered to implement the
practice autonomously. Autonomy is referring to the ability to act freedomly on
what one knows.
Nursing
image is another challenge that needs to be faced to achieve professionalization.
Majority nurses are female compared to male and female gender is closely
related with low social standing in view of social and cultural background.
However, in some countries such in United States and as well as in our lovely
country, Malaysia, nurses have gain success to change the image of nursing.
Education
of nursing is now has been upgraded from traditionally ‘on job training’ to
‘hospital based’ and now, nurses are trained in a formal institution with a
proper nursing curriculum. However, education background needs to upgrade
higher for professionalization matter.
Specialised
body of knowledge will help to guide practice in nursing but all this while,
too many medical perspective have been adopted. Evidence based practice is
needed to improved quality care. Research as well plays an important role in
order to enhance nursing to achieve its body of knowledge.
Politics
also contribute some in nursing because; through participation in this field
will help to influence policy decision to upgrade health care system as well as
health care quality.
Professional
body in nursing will help to spread the news or the information of nursing
education, the standard of nursing practice and research to the publics.
Continuing
education is another matter in challenges in achieving professionalization. As nurses, continuing education is an important component as
time following the passage of more modern and with the appearance of new
diseases that require treatment of current methods. And besides that, the
chronic disease currently attacking regardless of age, and complications
increase morbidity and mortality. Because of that, continuing education is
important for nurses to be able to learn the latest knowledge as well as skill
and increase the level of professionalism.
WHY NURSES
NEED TO CONTINUE THEIR EDUCATION?
Why all
nurses must continue their education? Actually, in any field, of course we are
encouraged to gain knowledge because knowledge is not a matter that is finale
aired. Particularly in the field of nursing, knowledge and skills are extremely
important because this area requires a person to think and act efficiently. To become more competent in nursing, continuing education is
required.
Continuing
education in nursing will enable us to be in line with the modern era that has
technologically advanced.
Past and present technology, there are many differences. In ancient times, the
system has not developed technology. The
best example is the use of the sphygmomanometer has been replaced by the use of
digital blood pressure. We used to
use the sphygmomanometer and stethoscope to measure blood pressure patients,
and this takes a bit longer when compared with the use of new gadgets that is
digital blood pressure which only needs to press a certain button. Another example is that telemetry monitoring tool,
which allows nurses to monitor patients at all times without disturbing the patient.
With the latest technology, it can enable nurses to carry out their work in
improving the quality of patient care.
For that, nurses need to know how to use the
sophisticated equipment and therefore, nurses need to learn to get the latest
information on new health care technologies. These new technologies facilitate many things and
the first hospital that has applied this advanced technology is Selayang
Hospital where the hospital has been using the Total Hospital Information
System (THIS) to change the traditional hospital system. In general, here we
can see that, nurses also must be skilled in handling the computer system. With
this integration of multimedia knowledge, nursing profession will be
strengthened and the quality on par with the other profession.
As a nurse, our environment is often changing, other than changes in technology that has
been discussed as above; the changes also include in the pattern of disease, recent illness and treatment. In order to cope
with all of these changes, nurses have to participate in gaining latest
knowledge. Disease
patterns before and now are very different; this is caused by changes in the
increasingly polluted environment. For example, in Neonatal Jaundice, in the
era of the 1970s, the nurse will advise parents to expose their babies in the
morning sun as an alternative treatment, but at the present time when the research
was done, they found the sun in the morning is no longer safe for the baby
because the rate of UV radiation violet is too high.
So, when a research was conducted, the results of
research will be disseminated to all facilities and we will get the latest
information in a particular seminar or by reading information from printed
materials. Such actions are included in one of the components in continuous
education. According to Sarah Ellis, 2010, ‘Continuing
education for nurses is necessary for the nurse to remain up to date with the
latest practice issues and it is necessary for patients’ safety as well’. And
as refer to her again ‘...all nurses who describe themselves as professionals
need to be willing and ready to implement change in their own practice by
realizing that competence in any profession requires periodic updating’.
Other than matters relating to technological
changes, changes in methods of treatment, self-assurance
is also one of the reasons for nurses to continue their education in this
field. With continuing education especially in this field, the future of those
nurses will be more secure because each nurse who is interested in continuing
education will have its own objective. In general, the main objective in
continuing education is to improve the self performance which will result in
getting more benefits. The advantages that they can get such as personal
satisfaction enhance revenues and they can upgrade their position to a higher
level.
Career as a nurse does not stop at one level only,
with continuing education, one that will expand
employment opportunities to a higher level for example nursing instructor,
nursing professor and nursing consultant. According to Erik Johnson (2010) in
his article ‘...continued education also makes better nurses, which is
beneficial for every person who receives heath care.’
Indirectly, we can formulate here, with continuing
education, it will provide benefits for themselves, the status of nursing
profession and the public. Gaining new information and skills in this field is
important for nurses because the patient's life depends on the hands of nurses and
the method of treatment of the patients is changing time to time.
HOW TO
CONTINUE EDUCATION IN NURSING FIELD?
In Malaysia,
the Board of Nursing has been set up Continuous Professional Development (CPD)
as a hallmark to ensure that all nurses in this country are competent and excel
in their work. Therefore, in 2008, the Board of Nursing has issued policy which
every nurse should get credit CPD points to renew their annual practicing
certificate. Therefore, the board has issued some guidelines and a list of
activities related to CPD. This is also part of how to engage in continuing
education. Nurses can be involved directly or even indirectly in the activities
listed either as participants or engage in conducting such activities. The
following is a list of CPD activities which may be participated by a nurse in
Malaysia in order to maintain professional competency, to ensure high standard
of care, to broaden knowledge, to refine skills, to accept responsibility in
one’s career and to accept a greater accountability in nursing practice.
1.
Nursing congress / conference.
Involvement
in the congress or conference relating to health, whether internationally or
locally. This event must be organised by the Ministry Of Health, professional
bodies, agencies and universities that recognized by the national accreditation.
2.
Scientific meeting.
Attending or conducting a
meeting that talks about nursing, disseminating information and the latest
skills.
3.
Workshops / courses.
Participate in workshops
or courses that will assess their knowledge through quizzes or tests.
4.
Continuing nursing education
session (CNE), ward rounds/ lectures/ clinic attendance/ journal club/ topic
seminar.
Attending
or conducting a CNE such as lecture, forum or seminar. Having an incidental
teaching or case conferencing in the wards with Matrons or Sisters.
5.
Presentation at an accredited
meeting.
Giving a
Poster presentation or plenary lecture as well as being a Chairman in a
session.
6.
Publication.
Involve in
publication of original articles in Nursing Journal, bulletin or report.
7.
Self study / self directed
learning or distance learning or a group study.
This is
done by reading an articles or scientific papers from journals or from audio
visual aids. Participation in a journal club also is considered.
8.
CNE online (for registered user).
Any CNE
had done on-line basis need to be provided by a registered accredited provider,
such as the Ministry of Health.
9.
Post basic courses.
Another way of continuing
nursing education is to participate in or attend post basic courses that held
from 6 months to one year and conducted by relevant recognized authorities.
10.
Degree, Masters Programs,
post graduate programmes, PhD, advanced diploma / subspecialty training.
With this kind program
too, can increase the professionalism of a nurse and will award with CPD
points.
11.
Quality project.
Any involvement as committee or project member of
Quality Initiatives. Involving in research project as a researcher or co –
researcher, facilitators as well as local preceptor.
12.
Editor / member of
editorial broad as referee or reviewer.
Actively
involved in production of journal, special reports, bulletin and newsletter.
13.
Other supporting activities
related to personal development and self improvement.
CPD
is not restricted to nursing activities only, but nurses are encouraged to mix
with society as with the activities of these activities will promote the
exchange of knowledge.
THE
IMPLICATION OF EDUCATION TOWARD NURSING PROFESSION.
Of what has been discussed here, we certainly can
recognize that continuing education is very important, especially in the
nursing field and it will
uphold the duties of nurses as a professional duty on par with other
professional fields. Malaysian government has also played a role in promoting
continuing education by adopting policies that issued by the Malaysian Board of
Nursing in year 2008 which requires that all registered nurses to participate
in the CDP that provided with certain amount of point as a condition for
renewal of Annual Practice Certificate (APC).
Here, if we see the entire list of CPD activities
available, this shows that education can be continued in many methods. In the process of continuous education, a person is
not necessarily just to receive information only, but we are encouraged to
share the knowledge, and disseminate any latest knowledge and skills that
approved by the Board Of Nursing.
Now let us look at the implications of continuing
education on the challenges in achieving professionalization in nursing.
The availability of latest and high-knowledge, people
will respect for the nursing profession and to this, the image of nursing will
be acclaimed.
Empowerment
is needed in nursing because with empowerment it will enable nurses to make an
optimum contribution. In order to be empowered, nurses have to control three
domain that is content, context and competency in practice. Therefore, to
control this three domain, again, we need one’s knowledge and education
preparation.
According to Dr. Manojlovich
in 2007, ‘Educational
preparation and expertise represent two additional types of power nurses need
to make their optimal contribution to patient care.’
To
increase the level of autonomy in the nursing profession, the emphasis should
be given to the development of the knowledge, high level of understanding and
clinical decision making.
In
this nursing field, the level of professionalization will be built upon from
time to time and hence, with continuous professional development program, it
will let the nurses to be involved in learning activities in order to enhance
their knowledge and skills to provide a safer treatment for the patients.
To maintain high professional status in nursing, we
need a body or association recognized for strengthening the standards and to
uphold the rights of nursing. In Malaysia, the first nurses association was
established in 1950 with the name of The Trained Nurses League Penang', where
in 1980 the name was changed to the Malaysian Nurses Association (MNA). All the members of this organization are among the
leaders who have extensive experience, knowledge and high skills in practice.
Once again, knowledge is linked in this matter, because to establish such a
society, we need a strong knowledge base as this organization will promote
education in nursing, a high standard of nursing practice and research.
Political and nursing, of course we hear a bit
awkward, but these things are important to put forward because for the outcome
of any policy will be approved by political power. So here is emphasized that
continuing education will not only result in one direction only but we can
develop related to the political.
Other
than association that represented professionalization in nursing, we also
needed a group of nurses that able to conduct a research and evidence based
practice in order to improve the quality of care from time to time. By doing
this kind of research, it can enhance nursing in order to achieve its body of
knowledge. And usually in higher education level in nursing, they are often
involve in research and the number of those involved with higher level of education
in the field in is quite encouraging because nurses now have started to realize
the importance of continuing education.
Background in nursing education is now increasing as
compared to previous. Traditionally, education in this area is based on the
hospital. But now the majority of nurses are diploma holders that trained for
three years learning about theory and practice. The numbers of degree holder also
increased.
As general here, we can identify very clearly that
continuing education in nursing can give a positive effect to all the
challenges in achieving the professionalism.
RECOMMENDATION
After what has been discussed here, to achieve and
improve the level of professionalism in nursing, there are many challenges to
be faced. This shows
that there are few matters that need improvement in the nursing profession. One of the matters that can help in elevating the
level of professionalism in nursing is the continuing education among nurses. As
has been said here, continuing education plays an important role in nursing
because this field always requires the latest knowledge and skills to provide
safe care to the community.
Continuing education will benefit the nursing
profession as well as also to the nurses themselves because it will enables the
nurses to keep up with advances in technology as well as patients care. Besides
that, with the latest education, it will give self assurance
to nurses which can lead to personal satisfaction enhance revenues and able to
upgrade their position to higher level in nursing.
Therefore,
there are a few suggestions that can be highlighted to encourage continuing
education among nurses in order to enhance professionalism in nursing. First of
all, the desire to continue their education should start from inside. In other
words, one should have the intrinsic motivation and which assisted with
extrinsic motivation. To stimulate intrinsic motivation so that nurses are
encouraged to continue their education is by conducting such a motivation
lectures or seminars on the benefits of continuing education. The management of
the institution or facilities have to play a role in conducting those
motivation seminars. In
terms of rising an extrinsic motivation among nurses is, is the provision of
CPD points to renew the APC.
Apart from that, the management may
also provide remuneration to nurses
through the provision of additional allowances and promotion to a higher level
position.
Other
than that, another recommendation is to provide
facilities for nurses to increase knowledge such as having a library or reading
corner in the working area. Employers
are also encouraged to subscribe to
nursing journals published from within or outside the country for these
many journals can provide the latest information about treatment, including
health care technology. Other than, providing
facilities for study, certain management must provide more CPD activities and send the nursing staff to participate. CPD
activities can be held in-house. Not only that, the management also can provide financing facilities for
nursing staff who wish to continue their studies to a higher level.
The government also needs to produce more nurses to
reduce the workload of staff nurses who continue their studies at a higher
level no matter through part time or full time.
So by describing the importance of continuing
education among staff nurses, we become more understanding, especially about
the purpose of continuing education, policies related to the CPD and the
methods to continue their education in this field. With this also, it can raise awareness among nurses
that continuing education is important in enhancing the level of
professionalism in nursing.
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