The Education of Child Health Nurses: A Pioneer Programme in Hong Kong
The Department of Nursing Studies and the Department of Paediatrics, Faculty of Medicine, The University of Hong Kong have co-organised a Diploma programme in Child Health Nursing which is a one year part-time programme and is the first of its kind in Hong Kong. In the past, the only local training programmes available were paediatric and neonatal intensive care courses started by the Department of Paediatrics in 1982. There was no local programme to provide a comprehensive education and training in child health nursing. In-house hospital surveys, and expression by the nurse managers of the Paediatric Units of the Hospital Authority hospitals indicated a significant demand for a training programme for paediatric nurses. With increase in public expectation for more and better services towards child health, nurses have a much greater and critical role to play in the health care setting. The launching of this course was timely to prepare nurses to take on this challenge. The programme aims to provide comprehensive knowledge in preparing nurses to care for well and sick children as well as their families in a holistic manner. It emphasizes not only on the physical care of the child but also the psychosocial and cultural aspects of health and illness. Furthermore, it aims at developing critical thinking and independent judgement of nurses in their care delivery in child health nursing. The paper describes the structure and development of this pioneer programme, the process of conducting the programme, and the evaluation and outcome of the programme. The future directions of the education of child health nurses is also highlighted.
香港大學醫學院護理學系及兒科學系共同組織了一個具有畢業証書的兒童健康護理教育課程。這是香港首個一年兼讀教育課程。以往在兒童健康護理教育方面沒有一個本地課程提供全面的教育及訓練知識。自 1982 年以來，兒科系僅在兒科新生兒深切治療課程中講授部份兒童健康護理教育內容。醫院內部的調查及醫院管理局所屬醫院的護理管理人員均明確要求為兒科護士提供這樣一個訓練課程。隨著公眾對兒童健康護理質素的要求越來越高，護士在健康護理方面起的作用也越來越大，且要求越來越嚴格。兒童健康護理教育課程的開展及時地滿足了護士這方面的需求。課程的目的是讓護士和兒童的家庭成員一起應用整體護理模式照顧健康和患病兒童的全面知識，即不僅強調機體護理，而且強調心理護理及健康與疾病的科普教育。還有一個目的就是護士在護理過程中應用兒童健康護理理論發展自己嚴謹的思維和獨立判斷能力。文章闡述了這種新課程的結構、發展、管理程式、評估和效果。本文還強調了兒童健康教育未來的發展方向。
Keyword : Child health nursing; Education programme
The nursing care of children is addressed to promotion of children's health and to the support of processes that restores the health of children.1 Health and reparative processes are integrally related to a child's growth and development, both of which are nurtured within the family and the community environment. Therefore, the nurse is a partner with children and parents in the promotion of a child's health and support of restorative processes.
Nurses play an important role in child health nursing. As nurse professionals, we must remember the vital role that education plays in improving the quality of child health nursing. In view of the imminent need, the Department of Nursing Studies and the Department of Paediatrics, Faculty of Medicine, the University of Hong Kong have co-organised a Diploma in Child Health Nursing Programme started in September 1996. This is a one year part time programme and the first of its kind in Hong Kong.
Development of the Pioneer Programme
The Diploma in Child Health Nursing is the first programme offered in Hong Kong providing comprehensive knowledge and skills in preparing nurses to care for well and sick children. In the past, nurses who wished to specialize in child health nursing had to study overseas. The only local training programme available was the paediatric and neonatal intensive care courses started by the Department of Paediatrics of the University of Hong Kong in 1982. With increase in public expectation for more and better service towards child health, nurses have a much greater and critical role to play in the health care setting. The launching of this diploma programme was timely to prepare nurses to take on this challenge.2
A small scale need assessment survey conducted in the general paediatric wards and paediatric and neonatal intensive care unit of Queen Mary Hospital showed more than half of the registered nurses were keen to upgrade their paediatric knowledge and willing to engage in professional development. Initial contacts were made with the Departmental Operation Manager of the Paediatric Unit of some Hospital Authority hospitals and they all indicated a significant demand for such a programme. They were supportive and eager in sending their nurses to study in the programme. As a result, the programme have admitted a total of 34 students from nine different hospitals (Table 1). The course participants are registered nurses of different ranks, working in the paediatric wards of different hospitals in Hong Kong (Table 2).
Philosophy of the Programme
The philosophy of the programme is that professional nursing of the child and family is a dynamic process directed toward meeting the physiological, psychological, social, emotional and cultural needs of the child according to his or her stage of development.3 Child health nursing is effectively designed within the framework of Pillitteri (1987) where nurses applying nursing process, research and theory to promote, maintain or restore health in children and their family through all phases of health care: health promotion, maintenance, restoration and rehabilitation. Because childhood illness is a family crisis, crisis intervention and family support are also vital nursing implementations to help a child stay well or return to wellness.4
Aims of the Programme
The programme aims to provide comprehensive knowledge in preparing nurses to care for well and sick children as well as their family in a holistic manner. Furthermore, it aims to develop nurses with critical thinking and independent judgement and the appropriate skills in professional practice, which facilitate the delivery of care in child health nursing. It emphasized not only the physical care of the child but also the psychosocial, cultural aspects of health and illness. Nurses are prepared to perform assessment of physical, psychological and social needs as well as problems of children and their families; identify nursing goals; implement nursing actions and evaluate nursing care.
Structure of the Programme
The Diploma in Child Health Nursing was a one year part time programme and it consisted of two semesters over an academic year period. The programme comprised of three major components: A Core Module on the Overview of Child Health Nursing; a Specialty Module on either General Paediatric Nursing or Neonatal and Paediatric Critical Care Nursing; and a module on Clinical Practicum (Figure 1).
The one year programme consisted of 160 hours of theoretical studies and 600 hours of clinical experience together with the educational trips to various child health facilities in the community. The teaching staff included academics of both University Departments of Nursing Studies and Paediatrics, doctors, nurse specialists and other professionals who are experts in their respective fields.
All students must attend the Core Module, select either one Specialty Module and complete the Clinical Practicum in order to meet programme requirements. The clinical practicum was implemented in the excellent facilities of Queen Mary Hospital, the teaching hospital of the University of Hong Kong.
Process of the Programme
The theoretical component was taught in a one-week full time study block; weekly lectures in the evening; and study days throughout the two semesters. The clinical practicum lasted for 15 weeks with at least six weeks in Queen Mary Hospital for clinical rotation to various wards and clinics.
The students were highly motivated to learn and showed willingness to share experiences and discussed child health issues. The students were introduced to various teaching and learning strategies, audio-visual materials, and were encouraged to be autonomous and self-directed learners.
Outcome of the Programme
Evaluation of the student outcome in the theoretical component were conducted in various continuous assessments and final examination. The students' competence in the clinical practicum was assessed by the clinical tutor using the Clinical Practicum Assessment Journal developed by the Department of Nursing Studies, which specifies core and specific objectives to be achieved by students in the practicum.
Students' evaluation and feedback on the programme were solicited through formative and summative evaluation. In general, overall satisfaction was expressed and almost all (91%) reported that the stated objectives were met in the course. Students' feedback on the teaching quality, teaching methods, assessment and examination, critical thinking and clinical practicum were analysed.
The course was comprehensive and has covered wide aspects of relevant topics. About half of the students indicated that the lectures were logically structured and taught in an appropriate pace. The students expressed that teaching team was enthusiastic in teaching and working hard to prepare for materials. Majority of the students (60%) found opportunities to raise questions in lectures and tutorials and about half (51%) expressed that they received useful and constructive feedback from the lecturers. Nearly all (97%) reported that they understand some or most of the materials covered in the course.
Owing to the vast amount of knowledge and information to be covered in the programme, even though the lectures were already packed, there was still insufficient time to go through all the materials in the lectures. Majority (65%) found that there were insufficient lectures for the course. Some theories and concepts could only be explained briefly and further elaboration seemed necessary.
While this was the first time this programme was conducted in Hong Kong, there is always room for improvement. Firstly, the lecture notes could be given before class to allow students to make preparation at home. Hence, the time spent on explanation could be reduced and classes could be run more swiftly and more time could be allocated to questioning and difficult areas. Secondly, lectures could be taught in accordance to different body systems for more logical understanding better learning. Lastly, specific topics provided by doctors and nurses could be lengthened to allow time for more depth.
The students found the handouts well-prepared and useful for enhancing their understanding on the topics. The use of audiovisual aids was effective. Over one third of the students agreed that an innovative strategy was used in teaching. It was suggested that more teaching aids, e.g. the use of video, could make the lectures more interesting. Distributing handouts before lectures began would facilitate learning.
Assessment and Examination
Students' comments reflected that the assessment system and the assessment load need revision. It was also identified that clarity of the assessment guidelines needs to be improved. Most students preferred group to individual projects, as more support could be obtained from colleagues and that division of labour could be worked out according to one's ability. In addition, over two third (78%) of the students claimed that the workload was too heavy. There were abundant assessments and assignments during the one-year course. Moreover, too much time were consumed, especially for those projects that required clinical involvement, and that the deadline for assignments was too close to examination period, of which time for revision was discounted.
Over 60% of the students stated that they have learnt to think more critically after attended the programme. They reported that the skill of critical thinking was applied to clinical practice in their daily work. Besides, experience sharing with classmates from different hospitals has stimulated them to think more deeply and thoroughly on their own practices.
Over two-third (71%) of the students was satisfied with the clinical placements arranged for them, especially that in the Queen Mary Hospital. They found the clinical practicum useful and informative, and they appreciated the opportunities to learn new technologies and observe different nursing practices in other hospitals, of which their clinical knowledge and skills were updated and refined. Feedback from clinical supervisors was found helpful. Guided case discussion enabled them to think logically and critically, which prepared them handle real situations in the future. It was proposed that smaller clinical groups could further enhance learning and facilitate group discussion.
The comments on the length of clinical practicum varied. One third of the students stated that the time allocated to clinical practice was appropriate. Another one third commented either too much or inadequate time for practice, and suggested similar hospital visits could be cancelled to shorten the practicum hours or to arrange more clinical hours to specialty areas, such as the Intensive Care Unit, as well as for discussion.
Overall, the course objectives were clear and the content mostly adequate. Comprehensive and updated knowledge in child health nursing was provided and students were able to share their experiences with paediatric nurses from different hospitals. However, students claimed that the workload was heavy and time for lectures were limited. It is also proposed that the course could be extended to one and a half year instead of one year. The intention of the programme is to enhance standards in paediatric nursing practice and consequently to promote quality of care in clients. Alterations in knowledge, attitudes and skills do not automatically mean changes in practice. Therefore, it is important to further study the changes in practice of the course participants in evaluating the outcome of the programme.
The present shift in focus from treatment of disease to promotion of health and prevention of disease is likely to further expand the role of nurses in ambulatory care, with health promotion, disease prevention and health education receiving a major emphasis. The need for home care and community health care services will necessitate that nurses become more independent and more skilled beyond the traditional care settings. Furthermore, technological advances will also influence the paediatric nurses' roles. Increasing complexities in nursing skills related to patient care, as well as knowledge in information technology in the work setting, are inevitable future trends.
The Diploma in Child Health Nursing programme provided an educational opportunity for nurses to enhance their knowledge and skills in child health nursing. The University of Hong Kong is looking ahead and committed to promoting excellence in its contribution in the area of promoting child health. New developments are constantly changing and improving the practice of paediatric nursing. But the story does not end here. There is still a great deal of work to be done to improve the health of our children today, and many generations beyond.
I would like to thank Professor PL Sullivan and Professor CY Yeung for their expert advice and unfailing support in the development and the delivery of the programme. Queen Mary Hospital should be commended in providing the excellent facilities for clinical practicum. In addition, I am grateful to Miss SL Lo and Miss M Leung, Departmental Operations Manager of the Department of Paediatrics, Queen Mary Hospital, and all the nurses and doctors who have facilitated in different ways to the implementation of the programme. Last but not the least, being the Programme Director myself, I worked very closely with two Programme Coordinators; Ms Daisy Leung in general paediatric nursing; and Ms Andrey Chan in neonatal and paediatric critical care nursing. They are very experienced Nurse Specialist in the unit and without their hard work and effort, the success of the programme would not have been be possible.
1. Hall MB. Health for All Children. 3rd ed. Oxford: Oxford University Press, 1996.
2. Chan S. Programme Proposal for Diploma in Child Health Nursing. Hong Kong: The University of Hong Kong, 1996.
3. Hendel T, Katz S. International Cooperation for Improving Paediatric Nursing. Journal of Paediatric Nursing 1996;11:202-5.
4. Pillitteri A. Child Health Nursing: Care of the Family. Boston: Little Brown and Co., 1987.
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