TRENDS IN DEVELOPMENT OF NURSING EDUCATION IN INDIA
DEVELOPMENT OF NURSING EDUCATION IN INDIA:
PRE-INDEPENDENCEINTRODUCTION
Nursing had originated independently and existed many centuries without
contactwith modern medicine. The members of the family at home met the
nursing needs of thesick. Evolution of medicine, surgery and public health into
complicated technical arearequiring many procedures by persons specially
trained and having understanding of scientific principles, which brought two
professions closer and together.
1. Nursing in Pre-historic Times
There is no historical evidence available on ancient history on nursing care of
sick. In primitive times discovered through myths, songs and archeologist to get
rid of 'evil spirit ‘unpleasant conditioning like beating, starving, magic rites,
nauseous medicines, loud noises sudden fright are used methods. Primitive man
had the skill of massaging, fermentation bone setting, amputation, hot and cold
bath, heat to control hemorrhages.
Role of Nurse in Primitive Period
Women were protecting and caring for their children, aged and sick members
of the family. Nursing evolved to response to the desire to keep healthy as well
as provide comfort to sick. This was reflecting in caring, comforting, nourishing
and cleansing aspect of the patient. These love and hope were expressed in
empirical practice of nursing.
2. Nursing - Vedic Period (3000 B.C - 1400 B.C)
Indian medicines are found in the sacred books of "Vedas". The 'Ayur-veda' is
thought to have been given by Brahma. 1400 BC Sushruta, known as 'Father of
Surgery' in India wrote book on surgery and years later 'Charaka' wrote a book
on internal medicine. By these writings we can learn that those days surgery had
advanced to a high level, also had 4 wings of treatment 'Chatushpada
Chikitsa'.1.
Physician - Bhishak 2.
Nurse - Upacharika (Attendent - Anuraktha)
Therapeutic drugs - Dravya4.
Patient – Adhyaya
Characters of Upacharika (Nurse)
Shuchi - Pure or clean in physical appearance and mental hygiene.
Daksha - Competency
Anuraktha - Willing to care
Buddhiman - Co-ordinator with the patient and doctor / intelligent.
3. Nursing Post Vedic Period (600 BC - 600 AD)
Medical education was introduced in ancient Universities of 'Nalanda'
and'Thakshashila'. King Ashoka (272-236 BC) constructed hospitals for the
people and animals. Prevention of the disease was given first importance and
hygienic practices were adopted. Cleanliness of the body was religious duty.
Doctors and midwives were to be trust worthy and skillful. They should wear
clean cloths and cut their nails short. Lying rooms were kept well ventilated.
Religious ceremonies and prayer precede co-operations. The nurses were
usually 'men' or 'old women'. Women are restricted activities at home and cared
for sick members in the family during 1 AD period superstition and black magic
replaced more in daily practices. Medicines are remained in the hands of priest -
physicians, who refused to touch the blood and pathological tissues. Dissection
was for bidden. Other religious restriction and superstitious practices probably
declined the development of nursing.
4. Nursing in Mogul Period (1000 AD)
'Unani' system of medicine developed during the Arab civilization. It was
practiced in Indo-Pakistan subcontinent. The basic framework are consists of
blood, phlegm, yellow bile and back bile. Temperament, strengthening of body
and nature are the real physician. Not believed in eradication of disease greatly
depend on defense mechanism of the body and self-care and positive health
habits. Therefore, it becomes part of Indian medicine practice.
5. British period (16th Century onwards)
After the mogul period the nursing in India hindered due to various reason like
low state of women, system of “pardha” among Muslims, caste system among
Hindus, illiteracy, poverty, political unrest, language difference and nursing
looked upon as servants work. During the 16th century, nursing development in
India taken three dimensions.
1. Military Nursing
2. Civilian Nursing
Missionaries Nursing
1. Military Nursing
Military nursing born during 1st world war but developed very slowly. British
officers informed need of nurses to take care British officials and soldiers in
India.
On 1888 February 21st – 10 fully qualified nurses from Florence Nightingales,
arrived to Bombay to lead nursing in India. This paves the way to develop
one of the best nursing in the world. 1894 regular system of training for
men for hospital work started. Medical officers given lecturing to them.
Some men were voluntary did the course and applied for nursing certificate.
After two months of practical posting to word, on the account of supervised
sister’s report, first time hospital ‘orderliness’ issued certificate and had
official status. This system laid the possible foundation to existing system of
training and higher education.
1927- Description of Indian Military Nursing services formed with 12 matrons, 18
sisters, 25 staff nurses. They are responsible for supervision, instruction and
training of nursing services for entire Indian hospital corps.
2nd world war expanded nursing services to India and overseas under the direction
of chief principal Matron. 3 years training carried out in selected military
hospital preliminary training schools. After completion sent to military
hospital for training. After successful training certificate issued as “
Registered Nurse” and they are member of Indian Military Nursing services
Auxiliary Nursing Services.
Shortage of trained nurses in India after the 2nd world war the government initiated
short course of intensive training in 1942 which led to the Auxiliary Nursing
Services. Basic training for 6 months in selected civil hospital after passing
examination at military hospital in India sent to overseas to serve in the
capacity of ; Assistant Nurses; 3000 women given auxiliary training.
2. Civilian Nursing in India
1664 - East India company built Government General Hospital at Madras for
civilian.
1871 – This hospital undertook training of nurses. On 1854 midwives training
school granted certificates of ‘diploma in Midwifery’ for passed student and
‘sick nursing’ for failed students. First time 6 nurses came out as Diploma in
Midwifery Nurses.
3. Missionary Nursing
Missionary nursing started training for Indian people as nurses. Various other
countries supported. This brought fully qualified Indian nurses. Those days
there were several obstacles for nursing development.
● Girls were not allowed to do work.
● Degrading and unworthy attitude of people.
● Hindus were hold back due to deep seated caste system.
● Muslims held under ‘paradha’ system.
So Christian girls encouraged and trained first.
Frequent disappointment, degradation difficulties nursing training came into
existence and looks its own shape. In the beginning there is not uniformity in
nursing education. There is no particular standards were given. After the course
of lecturing 18 months to 2 years, written examination conducted. If failed
training extended to 3 years.
From 1888-93 five years various experts like doctors, surgeons, nursing
superintendent, pharmacists- draw up a curriculum for training.
1907-10 North India united board of Examiner formed to maintain nursing
administration and standards.
1928 Hindi text book for nurses developed.
1939 helped to develop post graduation school for nurses.
Community Health Nursing:
William Rathbone foamed visiting Nurses Association at England. She
emphasized on charity free care etc. Florence Lees improved the visiting Nurses
by giving specialized training for their work. It is influenced in india, because of
terrible condition under which children were born recognized as cause for high
mortality rate. Because untrained ‘Dais’ are attending women at the time of
child birth.
Dais was unwilling to train and patients will to accept the old customary
methods.
1926 – Midwives Registration Act formed for the purpose of better training of
midwives. Slowly community Nursing Training needs felt by the Government.
1946 – Community Health Nursing was integrated in Basic Nursing Programme
at Delhi, Vellore and Madras.
Trained Nurses Association of India (TNAI)
In 1908 – TNAI formed to uphold the dignity and honor of the nursing
profession. Florence Mac Haughton was the first president of TNAI.
In 1910 – TNAI published journals.
In 1912 – TNAI affiliated to international Nursing Council as a 8th Association
in the world.
In 1917 June 16th under the registration Act No:21
In 1860 – TNAI got registered.
In 1922 – SNA formed.
DEVELOPMENT OF NURSING EDUCATION IN INDIA : POST
INDEPENDENCE
Introduction
On 15th August 1947 India became independent and self govermentation.
Social changes were taking place rapidly but an alarming absence of public
health and sanitary measures continued. The ratio of nurse to patient remained
dangerously low. The opening of nursing schools associated with college
gave nursing profession a higher social and economic status, than it had
previously known. T he formation of many commission and committees,
establishment of INC and tremendous work of TNAI brought about change in
nursing education post independence.
TRAINED NURSES ASSOCIATION OF INDIA
TNAI helps the initiation of university level education in India.
Recommendations of the Bhore committee were implemented within year .
1. Passing of the INC act
2. Deputation of Indian nurses abroad for post basic education
The TNAI made significant achievements in the field of nursing education. It
creates awareness among nurses through Nursing journal of India and
organizing continuing education programmes. TNAI also offers scholarships
to deserving candidates to take up studies within the country and abroad.
Establishment of Indian Nursing Council
The INC was constituted to establish a uniform standard of education for
nurses, midwives ,health visitors and auxiliary nurse midwives. The INC act
was passed following an ordinance on December 31st 1947 . The council was
constituted in 1949.
Main proposes of the council.
1. To set standards and to regulate the nursing education of all types in the
country.
2. To p prescribe and specify minimum requirement for qualifying for a
particular course in nursing.
3. Advisory role in the state nursing council
4. To collaborate e with state nursing councils, schools and colleges of
nursing and examination board.
STATE REGISTRATION COUNCIL.
Functions.
▪ Inspect and accredit schools of nursing in their state .
▪ Conduct the examinations
▪ Prescribe rules of conduct.
▪ Maintain registers of nurses, midwives, ANM and health visitors in the
state.
The state registration council are autonomous except they do not have power
to prescribe the syllabi for courses.
RECOMMENDATIONS OF VARIOUS COMMITTEES PERTAINING
TO NURSING EDUCATION.
The recommendations given by committees and commission provided
guidelines for improvement and growth of nursing education.
1. Health survey and development committee ( Bhore committee 1946)
▪ Establishment of nursing college.
▪ Creation of an all India nursing council.
2. Shetty committee 1954
▪ Improvement in conditions of training of nurses.
▪ Minimum requirement for admission to be in accordance with regulation
of the INC.
3. Health survey and planning committee (Mudaliar committee 1959-61)
▪ Three grades of nurses viz. the basic nurses (4yrs), auxillary nurse
midwife (2yrs) and nurses with a degree qualification.
▪ For GNM minimum entrance qualification matriculation .
▪ For degree course passed higher secondary or pre university.
▪ Medium of instruction preferably English in General nursing.
▪ Degree course should be taught only in English.
4. Mukherjee committee, 1966.
▪ Training of nurses and ANM’S required for family planning.
4. Kartar singh committee,1972-73
▪ Multipurpose health worker scheme
▪ Change in designation of ANM’s and LHV
▪ Setting up of training division at the ministry of health and family welfare
7. Sarojini varadappan committee, 1990 (A high power committee on
nursing and nursing profession.)
▪ Two levels of nursing personnel
▪ Post basic BSc nursing degree to continue
▪ Masters in nursing programme to be increased and strengthened.
▪ Doctorate in nursing programme to be started in selected university.
▪ Continuing education and staff development for nurses.
8. Working group on nursing education and manpower,1991.
▪ By 2020 the GNM programme to be phased out
▪ Curriculum of BSc nursing to be modified
▪ Staffing norm should be as per INC
▪ There should be deliberate plan for preparation of teachers MSc/M phil
and PhD degrees.
▪ Improvement in functioning of INC
▪ Importance of continuing education for nurses.
DEVELOPMENT OF NURSING EDUCATIION.
Basic General Nursing And Midwifery Education
1. Training of Dais(Birth Attendant )
The Dai training continued past independence. The goal was to train one Dai
in each village and ultimate goal was to train all the practicing Dais in country
Duration of training was 30 days. No age limit was prescribed, training include
theory and practice, more emphasis on field practice. This training was done at
sub Centre and equipment provided by UNICE F.
2. Auxillary Nurse Midwife
In 1950 Indian Nursing Council came out with some important decisions
relating to future patterns of nursing training in India. One of the important
decision was that there should be only two standard of training nursing and
midwifery, subsequently the curriculum for these courses were prescribed.
The first course was started at St. Marys Hospital Punjab,1951.The entrance
qualification was up to 7/8 years of schooling. The period of training was 2
years witch include a 9 month of midwifery and 3 months of community
experience.
In 1977, as a result of the decision to prepare multipurpose health worker&
vocationalization of higher secondary education, curriculum was revised a
designed to have 1.5 year of vocationalized ANM programme and six months of
general education. The entrance qualification was raised from 7th passed to
matriculation passed.
Under multipurpose scheme promotional avenue was opened to senior ANMS
for undergoing six months promotional training for which course was
prescribed by INC.
3. Lady Health Visitor Course
Training of LHV course continued post independence. The syllabus prepared
and prescribed by INC in 1951.The entrance qualification was matriculation.
The duration was two and a half years which subsequently reduced to 2 years.
4 . General Nursing And Midwifery Course
GNM course existed since early years of century. In 1951,syllabus was
prescribed by INC.In 1954 a special provision was made for male nurse.In1954
public health was integrated into basic nursing course.
First revision of course was done in 1963. In1964-65 Psychiatric nursing was
included in curriculum. The duration of course was reduced from 4 years to 3.5
years. Second revision was done in 1982. The duration of the course reduced to
3 years. The Midwifery training of one year duration was gradually reduced to 9
months and then six months, finally three year integrated programme of GNM
was prescribed in 1982.
5.Post-Basic/Post Certificate Short-Term Courses And Diploma
Programmes
During 1948-50 four nurses were sent to the U.K.by Govt. of India for mental
health nursing diploma.During 1954 Manzil Medical Health centre,Lucknow
gave psychiatric nursing orientation course of 4 – 6weeks duration. In 1951 a
one year course in public health was started at college of nursing Delhi.Govt. of
India felt urgent need for psychiatric nurses during 1953-54,this resulted in first
organized course at All India Institute of Mental Health.
In 1962 diploma in pediatric nursing was established at J.J.Group of Hospitals,
Bombay. At present there are many other courses of three months duration
which are monitored and recognized by INC. The ultimate aim of all the post-
basic/ post certificate programme is to improvement of quality of patient care
and promotion of health.
University-Level Programmes.
1.Basic BSc Nursing
First university programme started just before independence in 1946 at
university of Delhi. And CMC Vellore. In 1949, on recommendation of
university education committee and education commission(1964-66) and
conference workshop held by TNAI, The WHO and UGC,some more colleges
came up in different state affiliated to different state university.
INC prescribes the syllabus which has been revised three times, the last
revision was done in 1981.It was done on basis of the 10+3+2 system of general
education. At present the BSc Nursing programme which is recommended by
the INC is of four years and have foundations for future study and
specialization in nursing.
2. Post Basic BSc Nursing
The need for higher training for certificate nurses was stressed by the Mudaliar
Committee in1962. Two years post basic certificate BSc(N) programme was
started in December 1962.for nurses with diploma in general and midwifery
with minimum of 2 years experience. First started by university of Trivandrum.
At present there are many colleges in India offering Pc BSc(N) Course.
3. Post Basic Nursing by Distance Education Mode.
In1985 Indira Gandhi National open university was established. In1992 Post
Basic BSc Nursing programme was launched, which is three years duration
course is recognized by INC.
4. Post- Graduate Education-MSc Nursing
First two years course in masters of nursing was started at RAK College of
Nursing in 1959.and in 1969 in CMC Vellore. At present there are many
colleges imparting MSc Nursing degree course in different specialties.
5. M.Phil
INC felt need for M.Phil programme as early on 1977,for this purpose
committee was appointed. In 1986 one year full time and two years part time
programme was started in RAK College of nursing Delhi.
6. Ph.D in Nursing
Indian nurses were sent abroad for Ph. D programme earlier. From1992 Ph D in
nursing is also available in India.MAHI is one of the university having PhD
programme.
Current Educational Patterns In Nursing
1.Non University Programme
▪ Basic – ANM-GNM
▪ Advance-Post-Certificate diploma
2. University Programme
▪ Basic- BSc(N)
▪ Post-Basic BSc(Regular)
▪ Post-Basic BSc(N).IGNOU
▪ Advance:MSc (Nursing)
▪ M. phil
▪ Ph.D.
Trends in nursing education changes from basic general nursing service to
doctorate education in nursing.
Conclusion
Nursing education have expanded considerably post-independence. University
education in nursing brought about changes in nursing education. The type of
nurses required today is an “all round personality”. Education brings changes in
behavior of the individual in a desirable manner. It aims at all round
development of an individual to become mature, self-sufficient, intellectually,
culturally refined. Socially efficient and spiritually advanced.
Bibliography
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Delhi, Ignon Publications.
2. Sandaranarayanan, B. and Sindhu, B. (2003), ‘Learning and Teaching
Nursing’, Calicut, Brainfill.
3. Neeraja K. P. (2003), ‘Text Book of Nursing Education’, New Delhi:
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4. TNAI (2000). ‘History and trends in Nursing in India’, New Delhi.
5. Hurndr, R. and Letiman, B. (183). ‘Nursing Education in India’, New
Delhi.
6. TNAI (1995). ‘Indian Nursing Year Book’, 1993-95, New Delhi – TNAI.
7. TNAI (2002), ‘Indian Nursing Year Book’, 2000, New Delhi – TNAI.
