Running Head: NURSING EDUCATION REFORM 1

College Of Nursing Sciences

St. Gerard’s Catholic Hospital

Kakuri, Kaduna.

Nursing Education Reform: An X-ray of the Global and National Scheme of Nursing
Education Reforms

Submitted by Group 7 Members

To Mr Samaila

February 7th, 2024.

 Running Head: NURSING EDUCATION REFORM 2

GROUP 7 MEMBERS

Abstract

Worldwide because of the link between education and development. What appears
not to have been fully explored in the Nigerian context is the responsiveness of
various professions, especially nursing, to the constantly changing educational
system. Yet innovative advances in the health care system in the twenty-first century
demand that Nursing as a profession should prepare practitioners who are well
equipped to meet the challenges of care within the context of a complex milieu. This
paper, therefore, examines the Nigeria educational system, its reforms and current
status of nursing education in Nigeria. Some of the challenges in the emergence of
professional nursing in Nigeria and the progress made so far to advance
professional as well as university education for nurses are articulated with
propositions of possibilities and the gains for the Nigeria nation.

Introduction
What is nursing education?
Nursing education is a nursing program which prepares a person for initial licensure
to practise Nursing. It will be necessary to identify and analyse the key terms in this
topic before going into the discussion.

Reforms: refers to changes leading to a permanent improvement in the quality or

function of something

Nursing education reforms: refers to changes and re-organization of the

conventional system of nursing education in line with the National Policy on
Education with the ultimate aim of improving the quality of Nursing education and
competences of practitioners for effective delivery of quality care to the population as
a cofactor to reducing poverty as an effort o thef government.

Need For Nursing Education Reform

The Nursing Education Reform in Nigeria is based on the Health sector reform in
Nigeria which is also based on the global health reform. As stated by the Health
 Running Head: NURSING EDUCATION REFORM 3

Minister (FMOH 2004), the Health Sector reform is a broad based purposeful and
sustainable fundamental change in function, structure and performance of health
system in order to deliver efficient, quality, affordable accessible, effective and
equitable health care services to the population and ultimately improve the health
status of the people.

The Current Nursing education reform therefore is a response to the changes

needed in the function, structure and performance of Nursing education and practice
in Nigeria so as to provide high quality care to the society.

Rao (2007) stated this basic fact, “there is no educational system in the world that
has not undergone some reforms and restructuring”.
The truth is that the more pragmatic the reforms embarked upon, the more dynamic
the educational system that evolves.

Brief history of Nursing Education in Nigeria reveals that formal Nursing education in
Nigeria started in 1930 (Adelowo, 1988).
This system was bequeathed to the country by the British Colonial Administrators, in
fashion with what was operated in Britain at that time. This was the apprenticeship
type of training obtained from a hospital based on a training post.
This system of Nursing education metamorphosed from the apprenticeship type of
training to tertiary education in hospital – based Schools of Nursing, Midwifery and
Post Basic Nursing programme (Ndatsu, 1999; Adelowo, 1988)

Nursing education in Nigeria is eighty one (81) years old and therefore is overdue for
re-organization and restructuring. The weaknesses of this conventional system of
Nursing education necessitating reforms are as follows:

1. The students are not issued with any academic certificate from
the Nursing educational institutions but only receive their professional
certificates of registration from the Nursing and Midwifery Council of
Nigeria on passing the Council Final Qualifying Examination. This
situation can engender a feeling of inadequacy in the professional
nurses thereby affecting the confidence and output of the practitioners.

2. Academic progression along already established educational line is

long and complex.

3. Is not in line with the National Policy on Education.

4. Employers have difficulty placing and remunerating nurses and

midwives because of the system of education.
 Running Head: NURSING EDUCATION REFORM 4

Preparation of student nurses and midwives in an educational system whereby the

graduates are awarded academic certificate provides the following advantages:

● Promotes confidence of the professionals

● Guides employers on proper placement and remuneration of the nurse

practitioners thereby promoting job satisfaction and better productivity.

● Promotes academic progression thereby helping the practitioners to

develop additional knowledge and skills in the already established
education system, which are pre requisite for quality service delivery.
● Promotes quality of education of nurses: Prior to the Nursing reforms the
conventional system of nursing education depended on tutors with
Diploma as the highest qualification. This was a great variance with
education in tertiary institutions where M.Sc. degrees are the acceptable
entry point for lecturers.

Recently the Federal Government of Nigeria quantified the General Nursing

(RN Certificate) and the Basic Midwifery (RM) Certificate as equivalent to
HND, for employment purposes. If this is the situation, it therefore follows that
the qualifications of core nursing tutors as well as other lecturers in any
Nursing institution must be reviewed upward. This is logical since an educator
must have a higher qualification than the students he or she teaches. The
quality of educators has a direct effect on the quality of the professionals
produced while the quality of the professionals ultimately determines the
quality of service delivery. It is therefore part of the Nursing education reforms
that core nursing tutors in schools of nursing , midwifery and post basic
nursing programmes must have at least first degree in Nursing while Heads of
such institutions should have higher qualifications. This will ensure that these
educators have the broad base of nursing knowledge, concepts and theories
to teach. However, to ensure also that the teachers know how to pass the
knowledge across to the students, it is a requirement for them to have training
in education. To further assist in the education of qualified educators, the
Nursing and Midwifery Council of Nigeria in collaboration with the Department
of Hospital Services, Federal Ministry of Health set up a sub-committee of
nurse educators and experts in education to develop a curriculum for Post
Graduate Diploma in nursing education (PGDNE). The aim of this programme
is to boost the availability of competent nurse educators for the Nursing
institutions. This curriculum has been accepted by the National Universities
Commission (NUC) and is already for implementation by interested
Universities.

The Nursing educational system will withstand the test of time if it is

reorganised to meet the national policy on education, needs and expectations
 Running Head: NURSING EDUCATION REFORM 5

of nurses, the labour market and the society, hence the need for Nursing
education reforms.

The focus of a sound Nursing educational system should be:

● Optimum academic and professional development of nurses who are

equipped to build a strong and virile profession.

● Effective and efficient health care delivery.

● Maximum satisfaction of societal needs and expectations.

A well structured Nursing education system will not only eliminate difficulty in
academic progression of nurses but will also promote job satisfaction, build
competence and confidence of practitioners; thereby promoting quality
nursing care delivery.

It is however worthy to note that the goal of nursing education reforms is not
just to produce nursing practitioners with educationally acceptable academic
qualifications, degrees and higher degrees. Higher or nationally accepted
nursing qualifications in itself alone cannot guarantee excellent nursing care.

The unique objectives of Nursing education reforms therefore are to equip

individuals with:

● General and specialised nursing knowledge

● Scientific and practical skills required for excellent Nursing care.

● The age long ideals, virtues and attitudes that will enable them to render
professional nursing care to patients and clients with a passion.

According to Leininger (1991) care is the essence of nursing while Watson (2003)
describes Nursing as a human science within the major focus being the process of
caring for individuals, families and groups. This means that no nursing reforms will
be complete if it does not translate into better patient care. A successful nursing
education reform should translate into more humane, more caring and more
conscientious nurses.
In all health care settings, the success of care is directly related to the quality of
Nursing care.
Sick people are usually anxious, afraid and suspicious even if they do not show it and
reactions to illness are not always logical or rational.
It takes a skillful and caring nurse to:
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▪ evaluate circumstances critically

▪ bring to bear the needed inter personal skills required to keep the
patient in a relaxed state for treatment and care.

▪ Adopt the most suitable attitudes in order to ensure the patient/client

receives effective, efficient and safe Nursing care at all settings.

From the foregoing it is necessary to look at the various aspects of Nursing

education reforms and how these can translate into quality nursing care delivery.

▪ Review of entry requirement/qualification into Nursing

educational institutions: Entry requirements for nursing and midwifery
education at all levels is five O level credits in English, Mathematics, Biology,
Chemistry and Physics at not more than two sittings. This took effect in
November 2006, for General Nursing and March 2006 for Basic Midwifery
institutions. Higher and better entry qualifications into nursing institutions
ensures that the students admitted are trainable. Everything being equal,
better quality of student intake will lead to better quality of professionals turn
out and ultimately better quality of nursing care.

▪ Movement of nursing education into the University: The Nursing and

Midwifery Council of Nigeria in its position paper on Nursing education
reforms stated clearly that quality health care, client satisfaction through
utilisation of evidence based practice, support for research and research
utilisation among other things can be possible if nursing education is moved
into the University. This is so because university nursing education is
designed to produce polyvalent nurses who are equipped through a high
standard of education to render effective and efficient health care to
patients/clients. The aim of the programme is to improve the quality of Nursing
care to citizens.

▪ Upgrading of Nursing institutions into full fledged Monotechnics: The

National Policy on Education categorises Schools of Nursing as
Monotechnics. Such schools are designed as financially and administratively
autonomous tertiary institutions with the objectives of preparing professionals
to meet the manpower needs of the country. It can be appreciated that this
system has many merits. For one thing the structure is clearly defined and
academic progression is easier. The schools that are accredited by the
regulatory organ of the Federal Government are authorised to issue academic
qualifications to the graduates. The Nursing and Midwifery Council of Nigeria
is working with the relevant agency of the Government and stakeholders to
ensure this aspect of the reforms is embarked upon smoothly for better
 Running Head: NURSING EDUCATION REFORM 7

nursing education to be achieved. This is expected to lead to better job

satisfaction and increased output.

● Accreditation of Nursing Training Institutions and Areas of

Clinical Practice.
The Nursing and Midwifery Council of Nigeria as part of its Nursing
education reforms has embarked upon a series of accreditation and
re-accreditation exercises to ensure Nursing educational institutions
have adequate physical and human resources to meet the required
standard for education of nurses and midwives.

Emphasis is placed on the standard of the School because it has a

direct correlation with the performance and competence of the
professionals that graduates from such Nursing institutions.

● Review of the curriculum

As part of the current reforms the various curricula for Nursing and
Midwifery education have been reviewed and updated in line with
current trends in the healthcare delivery system. The review takes
cognizance of new trends in the clients/patients care, national health
care needs and demands and as global best practices. This aspect of
nursing education reforms is very critical for producing competent
nurse practitioners who are equipped to render qualitative Nursing care
in a dynamic society like ours.

● Manpower Development and Capacity Building

As part of nursing education reforms the Nursing and Midwifery Council
of Nigeria has achieved the following:
● Collaborated with various local and international
agencies/organisations for capacity development of nurses and
midwives in areas geared towards better service delivery.
Among these areas are: Obstetric Emergency Care /Life Saving
Skills, Integrated Management of Childhood Illness, use of
Anti-Pneumatic Anti Shock Garment in the management of
postpartum haemorrhage, HIV testing and Counseling, Infant
and Newborn Feeding, etc.
● The Council is also exploring ways of further partnership aimed
at boosting nursing manpower capacity development particularly
in the area of preparation of Nursing lecturers/tutors. This is
critical for qualitative service delivery because the various
nursing and midwifery schools and departments need highly
qualified educators if competent professionals are to be
produced.
 Running Head: NURSING EDUCATION REFORM 8

● The Council has also encouraged more nurses to undertake

degrees and higher degrees in Nursing. This is not necessarily
for teaching in schools alone but also for the clinical areas.
Nursing is a practice profession, the full impact of higher
education in Nursing will be felt when nurses with degrees and
higher degrees in Nursing work hand in hand with other health
care professionals in the clinical setting to render care to
patients/clients. Currently the nursing profession is rated by the
input of the nurses at clinical areas of which majority are
Diploma holders.

● Internship Scheme for Nurse graduates

The Nursing and Midwifery Council of Nigeria as part of the Nursing
education reforms is working with all stakeholders to ensure that
internship schemes for fresh Nurse graduates are commenced in
Nigeria. This is necessary to improve the competence of these new
nurse practitioners thereby contributing to excellent Nursing care. This
is necessary because in University based education there is demand
for liberal knowledge acquisition from undergraduates and they are
usually under intense learning pressure with inadequate time for
integration of theory and practical knowledge. The period of internship
will therefore help to strengthen the skills of the practitioner leading to
quality service.

● Mandatory Continuing Professional Development

Learning is a lifelong process, therefore for quality Nursing care to be
maintained the Board of the Nursing and Midwifery Council of Nigeria
has directed that nurses must keep up to date with current trends
through mandatory continuing professional development programmes.
This form of education is part of the Nursing reforms which is required
from the nurses in order to ensure competence is maintained. Nursing
is the art and Science of using clinical judgement and the provision of
care to promote, improve and maintain health. Caring is the
fundamental and critical component of nursing practice. It is
accomplished with wisdom, knowledge, compassion and competence.
These knowledge, virtues and attitudes cannot all be acquired in
school but must be while in professional practice. It is based on this
that from January 2012 evidence of attendance of MCPDP shall be
required for renewal of licence.

Health care reform, regardless of the specific proposal ultimately accepted, calls for
changes in baccalaureate nursing education to prepare students for
community-based practice. These changes include a shift toward the community as
 Running Head: NURSING EDUCATION REFORM 9

the primary setting for clinical practice; greater emphasis in the curriculum and more
extensive clinical experiences in health promotion and prevention of illness;
integration of primary health care within different levels of the curriculum; more
interdisciplinary experiences in the delivery of care; expanded knowledge and skills
for care of mothers, children, the aged, and critically ill patients in varied settings;
and the reexamination of teaching strategies for preparing students with these
expanded competencies. As nursing faculty consider the impact of health
care reform, they are called upon to reexamine the curriculum and clinical
experiences provided within their programs to prepare students for practice in
community-based systems.

Community As The Primary Setting For Clinical Practice

Enhancing Community Education Through Innovative Teaching

Strategies Background: Nurse educators are relentlessly in search of innovative

measures that enhance student learning and offer opportunities that prepare them
for clinical practice. Collaborative opportunities between schools of nursing and
community settings are beneficial for students and the community.

Method: One strategy was developed by a southeastern baccalaureate nursing

program through the assistance of the National Institutes of Health mini-grants
program, related to their Safe Sleep campaign. Safe Sleep subject matter was
integrated into the curriculum, where students learned content, developed teaching
strategies, and taught community members components of Safe Sleep.

Results: The project provided faculty and baccalaureate nursing students with an
opportunity to implement a community outreach education project addressing
Safe Sleep. Students learned cultural assessment, teaching, and communication
skills, and community members benefited from learned knowledge of health
promotion programs.

Conclusion: Future educational outreach projects are recommended to further

examine program effectiveness and the value of teaching-learning strategies.
Below is a systematic review of an evidence-based nursing protocol based on
maternal-child simulation indicating the role of innovative teaching strategies in
enhancing community education

Review question/objective: The overall aim of this systematic review is to identify the
appropriateness and meaningfulness of maternal-child simulation-based learning for
undergraduate or pre-registration nursing students in educational settings to inform
curriculum decision-making.
 Running Head: NURSING EDUCATION REFORM 10

1. What are the experiences of nursing or health professional students

participating in undergraduate or pre-licensure maternal-child
simulation-based learning in educational settings?
2. What are the experiences of educators participating in undergraduate or
pre-licensure maternal-child simulation-based learning in educational
settings?
3. What teaching and learning practices in maternal-child simulation-based
learning are considered appropriate and meaningful by students and
educators?

Background: Maternal-child care is one of the pillars of primary health care.

Health promotion and illness/ injury prevention begin in the preconception period
and continue through pregnancy, birth, the postpartum period and the childrearing
years. Thus, lifelong wellness is promoted across the continuum of perinatal and
paediatric care which influences family health and early child development.
Registered nurses (RNs) are expected to have the knowledge and skills needed to
provide evidence-based nursing with childbearing and child-rearing families to
promote health and address health inequities in many settings, including inner
city, rural, northern, indigenous and global communities. The Canadian Maternity
Experiences survey and the Report by the Advisor on Healthy Children and Youth
provide information on current shortages of perinatal and child health care
providers and stress the importance of the role of nurses as providers of rural and
remote care. From a global health perspective, continued concern with both
perinatal and child health morbidities and mortalities highlight the importance of
maintaining and strengthening the presence of maternal and child health learning
opportunities within undergraduate nursing curriculum. Despite this importance,
educators in many countries have acknowledged difficulties providing nursing
students with maternal-child hospital learning experiences due to declining birth
rates, women's changing expectations about childbirth (i.e. birth as an intimate
experience), increased outpatient and community management of early childhood
health conditions, and increased competition for clinical placements. Canadian
nurse educators and practice leaders have also identified gaps in recent RN
graduates' readiness to provide safe, competent and evidence-based care for
childbearing and child-rearing families. Newly graduated RNs working in acute
care hospitals and in rural/remote community practice settings report feeling
unprepared for providing maternity, neonatal and early childhood care. Recent
concerns about the clinical reasoning skills of new graduates and the link to poor
patient outcomes (e.g. not recognizing deteriorating patients) have led to calls to
reform nursing education. In the Carnegie report, Benner, Sutphen, Leonard and
Day identified four essential themes needed in the thinking and approach to
nursing education, including the following:

1. A shift in focus from covering decontextualized

knowledge to "teaching for a sense of salience, situated cognition, and identifying
 Running Head: NURSING EDUCATION REFORM 11

action in particular clinical situations";

2. Better integration of classroom and
clinical teaching;
3. More emphasis on clinical reasoning; and,
4. An emphasis on identity formation rather than socialisation.

Brown and Hartrick Doane propose that nurses need to draw on a range of
knowledge that enhances the nurse's "sensitivity and ability to be responsive in
particular moments of practice". Theoretical or decontextualized knowledge becomes
a "pragmatic tool" used to improve nursing practice. Simulation has been identified
as a promising pragmatic educational tool for practice learning that can be integrated
with theoretical knowledge from nursing and other disciplines. Bland, Topping and
Wood conducted a concept analysis and defined simulation in nursing education as:
"simulated learning is a dynamic concept that deserves empirical evaluation not
merely to determine its effects but to uncover its full potential as a learning
strategy". Simulation usually involves student(s) providing nursing care to a
simulated patient who might be a manikin or actor based on a standardised scenario.
Following the experiential learning opportunity the scenario is debriefed
and the clinical situation analysed with opportunities for reflection on
performance. In nursing education, simulation is usually used in a way that
complements learning in practice settings. However simulation has also been
used: to make up some clinical practice hours, to provide opportunities to practise
and assess particular clinical skills, and for remedial learning when students
encounter difficulties in practice settings. In addition simulation provides the
opportunity to focus on quality and safety competencies (QSEN) that have been
identified for nurses. New forms of simulation are being developed with multiple
patients so that nursing students can learn to prioritise care needs and delegate
care to other team members.Nurse educators have identified several advantages
for learners using simulation, including: providing a safe environment to improve
nursing competence, allowing learners to become more comfortable with
receiving feedback about their clinical performance, providing consistent and
comparable experiences for all students, and learning a mix of technical and non-
technical skills including communication, teamwork and delegation. Within the
Canadian context, students and instructors have reported positive learning
experiences with simulation, particularly in understanding complex patient care
scenarios, multidisciplinary team scenarios, team-based learning, and reflective
debriefing. Furthermore, simulation technology has been proposed as a strategy
for developing clinical reasoning skills, enhancing nurses' abilities to build upon
previous knowledge and past experiences, and manage new or unfamiliar
situations. Simulation has previously been integrated into nursing curricula in a
"piecemeal" fashion that lacks an integrative pedagogy or theoretical approach.
More recently a number of theoretical and pedagogical frameworks and best
practice standards have been published. In April 2014 a preliminary search of
literature (in CINAHL, Medline, Academic Search Complete and Web of Science)
 Running Head: NURSING EDUCATION REFORM 12

was conducted with guidance from our library specialist to test the search
strategy and ensure that there would be enough qualitative findings to include in
the systematic review. A preliminary scan of the abstracts from these searches
demonstrated that many experiential case reports with qualitative findings were
missed with the use of research limiters (including our search strategy specifically
constructed to retrieve qualitative research) so the decision was made to err on
the side of caution by searching more broadly and review a larger number of
abstracts for inclusion in the study. However, a number of reports with qualitative
findings were identified. For example, from a review of the abstracts from a CINAHL
search dated April 17, qualitative research papers (including two
dissertations), 12 evaluation study reports, six mixed methods studies and nine
case reports with qualitative findings were identified. It is timely then to review
qualitative studies to better understand the meaningfulness and appropriateness
of integrating maternal-child simulation-based learning activities in undergraduate
nursing education programs.A search of both the Cochrane Library of Systematic
Reviews and the Joanna Briggs Institute Database of Systematic Reviews and
Implementation Reports have been conducted. No systematic reviews of qualitative
studies of maternal-child simulation-based learning for undergraduate or pre-
Registration of nursing students in educational settings is evident in the literature.
Although a systematic review of the meaningfulness and appropriateness of using
human patient simulation manikins as a teaching and learning strategy in
undergraduate nursing education had been planned and a protocol registered in
October 2009, we learned from contacting the lead author that this systematic
review was not completed. Currently little is known about how nursing students
and/or educators have experienced maternal-child simulation or their
understandings of the appropriateness and meaningfulness of particular
simulation-based learning practices. Our proposed systematic review therefore
fulfils all requirements for the PROSPERO database.

Definitions: For this review we will use the definition of "simulation-based learning
experience" adopted by the International Nursing Association for Clinical
Simulation and Learning (INACSL):We will include any use of simulation in an
educational setting (with pre-registration or pre-licensure or undergraduate
nursing or health professional students) with a focus relevant for maternal-child
nursing. Maternal-child nursing has been variously defined in literature to include
maternity care and paediatric nursing. For the purposes of this review, we will
include perinatal, neonatal and paediatric contexts of care that focus on families
with children under the age of five. We will exclude studies that focus on school
age children, adolescents and/or youth.We have adapted an earlier definition of
"appropriateness" as the "best conditions under which simulation can be
integrated into undergraduate nursing education". In this review "meaningfulness"
refers to the experiences and reflections of undergraduate nursing or health
professional students and educators as presented in the studies reviewed. The
research was retrieved from abstracts with qualitative reports on the
 Running Head: NURSING EDUCATION REFORM 13

experience and reflections which this article above calls “meaningfulness” missed
and although the review fails to depict the usefulness of the review on simulation-
based protocols in the enlightenment of nursing students, it proved useful in
giving them the opportunity to put to use their nursing skills, assessing nursing
procedures and allowing learners to become more comfortable with receiving
feedback about their clinical performance, providing consistent and comparable
experiences for all students. Therefore this attempt to improve community
approach delivery of nursing care based on the initial education reform was a
success in showing its role in innovatively achieving community centred practice
for clinical practice.

Greater Emphasis In The Curriculum And More Extensive Clinical Experiences In

Health Promotion And Prevention Of Illness

In the terms of education reform, the curriculum is currently and constantly under
changes due to the shift from the theoretical to evidence-based literature in
nursing strengthened by collaboration with other health professionals.
It would be tempting to declare that transformation of nursing education in the
current context of faculty shortages and other scarce resources as Mission
Impossible. But I believe that the opposite is true. It is my sense that the rapid
changes in healthcare, the shifting population needs and the acute nursing
shortage have catalysed fundamental change, perhaps the most profound in the
50 year history of WIN. The first steps of that transformation are becoming
increasingly apparent as nursing faculty begin to challenge their long-standing,
taken-for-granted assumptions; as they set aside differences and their internecine
warfare of the entry-into-practice debates; as they begin stronger and deeper
collaborations with their clinical partners. We won't see the evidence of these
changes in the literature for a while, because they are just getting started. There's
not a lot to report yet. Here are some examples of the changes afoot: The Oregon
Consortium for Nursing Education has resulted from unprecedented collaboration
between community college and university faculty, with an eye to develop a
standard, competency-based curriculum to prepare the "new" nurse, and to
improve access to a seamless baccalaureate curriculum. The first students were
enrolled in nursing courses in fall, 2006 on 8 campuses- the four campuses of
OHSU and 4 community colleges, with additional community college campuses
admitting students in '07 and '08. In this curriculum, fundamentals of nursing have
been redefined as evidence-based practice, culturally sensitive and relationship-
centred care, leadership and clinical judgement, with these concepts and others
introduced early and spiralled throughout the curriculum. Through a 2-year faculty
development program, faculty leaders in the OCNE partner programs have taken
to heart the many lessons about learning, intentionally attending to content
selection that will help reduce the volume while focusing on the most prevalent.
 Running Head: NURSING EDUCATION REFORM 14

Instructional approaches have been tremendously changed, with an emphasis on

case-based instruction, integrating distance delivery technologies, and using
simulation, drawing on best practices in the development of these approaches
(Billings, et al., 2001; Issenberg, et al .2005; Jeffries, 2005). OCNE leaders
obtained funding from Kaiser Permanente Northwest to begin the long,
collaborative, consensus building process to transform clinical education.
Evaluation has and will continue to be an integral part of this work, with an eye to
adding to our collective knowledge of best practices in nursing education. We see
evidence of similar efforts, mostly state or regional, in order to build on prior
alliances, acknowledge geographic particularities, and respond to local needs in
many other parts of the country, from Hawaii to New Jersey, Texas to Montana.
The nursing shortage has been a primary catalyst. It has captured the interest of
potential funders, individual donors, foundations to the Federal government. The
keys are collaboration and a collective voice for nursing, a willingness to work
through long-standing and divisive issues, and most importantly, a moral
commitment to the populations we serve.
Reexamination of teaching strategies for preparing students with
these expanded competencies

Introduction: Clinical judgement is necessary for clinical decision making and

enhancing it in nursing students improves health care quality. Since clinical
judgement is an interactive phenomenon and dependent on context and culture, it
can be affected by many different factors.

Aim: To understand the experiences of Iranian nursing students and teachers

about the factors influencing nursing students' clinical judgment.
Materials and methods: A qualitative study was conducted using a directed
content analysis approach. In this study, purposive sampling and semi-structured
interviews were applied with seven nursing students, six faculty member teachers
and four clinical instructors from Guilan University of Medical Sciences, Gilan,
Iran.

Results: The factors influencing nursing students' clinical judgment consisted of

five main categories including thoughtful behaviour, professional ethics, use of
evidence based care, the context of learning environment and individual and
professional features of clinical teachers.
Conclusion: Relying on the results of this research, teachers can create an
appropriate educational condition and a safe psychological atmosphere, use
instructional strategies strengthening deep thought processes, applying
professional ethics and scientific evidence and principles to establish clinical
judgement in nursing students.
 Running Head: NURSING EDUCATION REFORM 15

Conclusion
The quality of nursing is dependent on the quality of education given to nursing
students. A poorly educated nurse cannot provide the quality health care needed for
the highly technological health care system and complex society of today. It is on this
note that the Nursing and Midwifery Council of Nigeria is committed to
implementation of the Nursing education reforms. This will surely not only promote
excellence in Nursing practice but will stimulate the much needed growth and
development of the Nursing profession in Nigeria.

References

Adelowo E. O. (1988) The Nursing Profession In Nigeria. Lagos: Lantern Books.

Bryan Brown, C. & Dracup, K. (2003) Professionalism, American Journal of Critical

Care, 12 (5), 394.

Federal Ministry of Health (2004) Health Sector Reforms.

Leininger M. M. (1991) Culture Care Diversity and Universality: A Theory of

Nursing. National League of Nursing Press New York.

Ndatsu, P. N. (1999) Practising Nursing and Midwifery in Nigeria (Ordinances and

Laws 1930 -1992) Lagos: Nursing and Midwifery Council of Nigeria.

M Oermann. J Nurs Educ. 1994 May. National Institution Of Health (.gov).

Rao, E. (2007) The Sociology of Education. London: Oxford University Press.

Watson J. (2003) Jean Watson and the Theory of Human Caring.