Nursing is an applied discipline that is implemented differently based upon the social, political, and cultural climate within which it is practiced. This issue of OJIN presents five geographic views of nursing as it is practiced in Australia, Japan, Zimbabwe, Great Britain, and Israel. Despite the fact that different issues are apparent in the five countries, there are themes of commonality. These themes include the fact that: there are different levels of educational preparation for nurses with a movement of education into institutions of higher education; there are definite standards for credentialing to maintain safe practice; the majority of nurses are women; nursing is practiced within a general medical model; and a nursing shortage exists with particular emphasis on the need to care for an aging population in the country.
The first article, by Jane Stein-Parbury, PhD, RN, MED, FRCNA, emphasizes that although nursing in Australia has been influenced strongly by the British nursing tradition, the apprenticeship style of nurse education, based on the British system, has been replaced by education in the higher education sector for registered nurses. Important in Australia is the principle of universal access to health care with the state and territory governments operating the public hospital system; thus, the health care system is largely government-run. Stein-Parbury focuses on the role of nursing education in Australia, indicating that it has only been since 1991 that nurses achieved the educational level of a bachelor degree for entry into practice. Presently, nurses can study at a university to receive varying levels of degrees from a bachelor's degree to a PhD in nursing. Professional doctorates include a Doctor of Nursing and a Doctor of Midwifery. Unique to Australia is the distinction between the Registered Nurse and the Enrolled Nurse. Enrolled Nurses undertake educational programs of study in the vocational higher education sector for about one year of full time course work and generally work under the direction of a registered nurse. Registered nurses have the bachelor's degree as the entry level of practice. Key issues for nursing in this country include anticipated shortages of nurses and how to deal with the poor health of the indigenous peoples of Australia.
Janet Primomo, PhD, RN, in the second article, notes that Japan is a highly modern, yet traditional society that is undergoing change due to an aging population. The aging of the Japanese society is a driving force in nursing, nursing education, and health care reform in Japan. In the next century, one quarter of the Japanese population will be over 65 years of age. Nursing, as a profession, is responding to this change through involvement in policy decisions and service enhancement for the elderly. Again a description is given regarding standards for licensure and movement of nursing education into the university setting. As more nurses obtain graduate education, nursing science is developing. Recently there has been an increase in the amount of nursing research conducted. Unique to Japan is the emphasis on an aging population. Other key issues for nursing in this country include the limited autonomy in practice in relation to the physician, and a nursing shortage.
In the third article, Drs. Kudakwashe Mapanga, PhD, RN and Margo Mapanga, PhD, RN, state that nursing in Zimbabwe is conceptualized within the context of primary health care which was adopted when the country became independent in 1980. The ten year National Health Strategy for Zimbabwe and the Zimbabwe Patients Charter provide the overall framework for the health care delivery system. Nursing is considered crucial to the backbone of this primary care approach. Specifically, nursing practice reflects a self-care orientation which compliments the primary health care approach. As in Australia and Japan, there is an educational move toward participation in higher education with five levels of university nursing education outlined, ranging from a baccalaureate in nursing to a PhD in nursing. Until recently, however, access to clinical specialization at the post baccalaureate level was nonexistent in the country. Currently, nurses holding Doctorates in Nursing are prepared in either the United States or the United Kingdom. All nursing programs are accredited by the Zimbabwe Health Professions Council. All practicing nurses are required to register with the Zimbabwe Health Professions Council regardless of their professional educational level. Nursing practice takes place at various levels ranging from urban and rural health centres to central hospitals. Urban and rural health centers are the first point of contact for the patient. Unique to Zimbabwe is the need to provide the nursing care that is congruent with client's expectations of an ever-changing Zimbabwean society. Key issues in this country are the challenges for nurses to advance in their preparation and to attain cost effective, socially and culturally relevant nursing care.
The fourth article by Helen Chin, MSc., RN and Elaine Mc Nichol, MSc, PG. Dip., RMN, RNT, describes the framework for the Practice Development Credentialing Program provided by the Centre for the Development of Nursing Policy and Practice at the University of Leeds in the United Kingdom. Fourteen criteria have been set out by the Centre with the goal of promoting best practice, disseminating innovation in nursing practice, and developing practitioners. For a Unit to be fully credentialed, all of the criteria must be met. Chin and McNichol describe in detail the process by which the Units are credentialed. Unique in this article is the emphasis on evaluation of clinical outcomes. The Centre encourages a spirit of inquiry approach whereby the Units implement quantifiable tools to measure the clinical outcomes as well as service user satisfaction.
The final article, written by Greer Glazer, PhD, RN, FAAN and Freda DeKeyser, PhD, RN, is more specifically focused and discusses the prerequisites and priorities for nursing research in Israel. They emphasize that nursing research has come a long way in Israel since the first reported research study in 1959. They outline the historical development of nursing research in this country, showing how there have been shifts by decades from the 1960s through the 1990s. Critical emphasis is placed on the need for Israeli nursing research to include the development of a master plan that reflects the country's unique culture and geography. Key in the development would be funding of a National Institute of Nursing Research. Such an institute would allow for development of a national research agenda so that priorities for research could be identified and agreed upon.
Obviously this Nursing Around The World posting is limited in scope. Only five countries are presented and there are many more. OJIN is an international journal and we welcome and urge potential authors from other countries to tell us about how nursing is conceptualized and practiced in your country. What are the key issues and how do these issues differ from other countries? Please let us know by submitting a manuscript.