Cross-National Programmatic Strategies to Strengthening Quality in Doctoral Nursing Education
Presented by Siriorn Sindhu RN, DNS.
In just 10 short years the educational options available to nurses in Thailand have expanded considerably. Before 1989, there was no capacity for doctoral nursing programs at Thai universities. Since then, however, the successful implementation of a consortium-based approach to doctoral studies means that this year individual universities are ready to instigate stand-alone doctoral nursing education programs. Furthermore, the focus on improving the research and development capabilities of Thai nurses bodes well for the establishment of centers of excellence, which will provide the next push for discipline development.
First up, however, I would like to express my deep appreciation to the organizers for their foresight in convening this conference and for providing us with the opportunity to ponder one of the most significant topics affecting the future of doctoral education in nursing.
Need for A Well-Developed Nursing Discipline
Resources Evaluation
With unlimited financial support and resources there would be a need to design program development in light of the intellectual capital at hand. Consideration should be given to the number of academics that would form part of the team as well as their areas of expertise. Under conditions of constrained financial support and resources, it would be necessary to ensure that what little money there is goes to those it will benefit the most. Pooling resources from the university community would create at least one quality doctoral program.
University Community and Host Establishment
Management flexibility for the proposed doctoral program is essential in relation to the quality and quantity of research and graduates. Furthermore, any Host University must be able to provide the necessary resources to ensure they can run the program on a stand-alone basis.
The concept of network universities sharing personnel, resources, and information, as well as any fruitful outcomes of the program for integrated research and education, is made more clear when the program is mandated with a mission to create a new culture of cross-institution, systems-oriented research and education. Another cooperative partnership to help increase the success of the program will be with the service sector, where appropriate.
First step: Collectivity & Unity: preparing and setting up intellectual capital
Through the support of the Government, doctoral education scholarships have been provided to university faculty staff in order to train educators and researchers. Recipients of these scholarships have been given the opportunity to study in various universities around the world where doctoral programs in nursing are well developed. The diversity in training experiences is expected to be one of strengthening strategies for developing ongoing programs.
Second step. Distributing host power: implementing the consortium and germinating the next programs
Third step. Setting up more quality independent programs
Both types of programs emerge during this step on international research collaboration and faculty and students exchange programs. As mentioned at the beginning of this paper, doctoral programs prepared in this day and age require additional quality for both global and local settings.
Over the years, there have been many collaborations, exchange programs and agreements made between university nursing schools in many continents of the world. Since there is no sustainable source of funding to support such international collaboration and exchanges programs, only a few of these agreements have actually been implemented. The new long-term doctoral project provides a budget for doctoral students from Thailand to spend up to one year at collaborating universities overseas and some resources to support short trips by foreign professors to follow up on the collaboration project in Thailand. It is expected that, through this mechanism, there will be many more meaningful and lasting collaborations and exchanges of students and faculty between Thai university nursing schools and nursing schools overseas over the next few decades.
There are resources available for doctoral education programs nationwide in developing programs that focus on research. Based on data from the 'Thailand Vision 2020" study, it is anticipated that Thailand will need about 25,000 doctorate researchers in all areas over the next 25 years. Therefore, the Thailand Research Fund (TRF), in cooperation with the Ministry of University Affairs, has recently received Cabinet endorsement of a resolution to allocate a few hundred million US dollars for the first phase lasting fifteen years (1997-2011). This fund will support 5,000 doctoral candidates including nursing candidates to study and carry out research mainly in Thailand. Most of these candidates will carry out their studies and research with research supervisors who are the recipients themselves of Government funding. Nursing scholars are in the process of trying to develop and obtain funds from this program.
1) Shift toward globalization vs. preserving local identity
More fluid cross-national mobilization has also proven that the competitive advantage of a nation is no longer the richness of its natural resources, but the richness of its well-educated workforce. A new form of doctoral nursing education should urge students to be more critical of health issues in the context of economic and social transformations. They must be prepared for multi-cultural interaction, value changes, a cosmopolitan way of life, yet struggle to maintain their own ideals and identities.
Economic uncertainty means that doctoral programs in Thailand will have to focus on acquiring "sustainable health care development" with a stronger emphasis on related social and environmental issues, while maintaining the program's competitive capabilities. Nursing leaders from doctoral programs need to understand major national health issues from a global perspective.
The massive influx of foreign culture through academic channels coupled with the weakening of traditional Thai values has necessitated a counter movement for academic cultural regeneration and the preservation of Thai identity. Thai nursing scholars may enter a period of massive cultural revitalization so much needed as an antidote to the "identity crisis" and "moral confusion" now facing the new generation of Thai scholars. Respect for indigenous cultures, social solutions, and right to make a living is of no less importance than the future quality of Thai scholars in Thailand.
2) Serving needs of public sector vs. private sector
The growth of the new middle class and a stronger sense of democratic values among the educated younger generation have precipitated the decline of the patronage system and the persistent demand for self-government. Furthermore, the old patronage culture and inefficient bureaucracy have hampered nursing scholars from implementing speedy changes and new developments.
3) Higher undergraduate admissions boost demand for doctoral programs.
4) More diversity of health care needs
Required critical mass
Identify fields of nursing studies
The target group of doctoral programs should be a combination of foreign-trained and locally trained nurses.
Dynamic program development
Center of excellence
In any long-term plans for producing highly trained nursing researchers, Thailand must reach a level of research and development capability that ensures self-reliance. This does not prelude exchanged or imported expertise, but implies the capability to adapt and generate more advanced expertise; to seek out new bodies of knowledge; and to train and propagate adequate numbers of first rate nursing scientists. To attain this goal, it is proposed that centers of excellence in fields of nursing be established.
There are a number of pre-qualifying conditions (ONEC, 1996) that need to be adopted by the doctoral nursing education community before centers of excellence can get off the ground:
The development of doctoral nursing education programs urgently needs fresh momentum to succeed. This momentum should bring about closer cooperation between universities, strengthen quality at all levels of nursing education in Thai universities, help to supply the projected increased requirements for highly training personnel, and play a significant role in future national health care development through sustainable research, development and health care capabilities.
The proposed centers of excellence in Thai universities, if successfully executed, would provide this momentum. These centers will also provide impetus to the country's sustainable development through the generation of manpower and new health care knowledge.
Aside from the right concepts, the right strategy, the right professionals, and right investment, translating this into realizable benefits depends largely upon the political will to invest and take risks, as well as on having both the political and academic leaderships solidly behind these strategies.
Ketefian, S. (1993). Essentials of doctoral education: Organization of program around
knowledge areas. Journal of Professional Nursing, 9(5), 225-261
Norbeck, S. J. (1998). Teaching, Research, and Service: Striking the balance in doctoral
education. Journal of Professional Nursing Education, 14, 4 197-205.
Meleis, A.I., Hall, J.M., & Stephens, P.E. (1994). Scholarly caring doctoral nursing
education: Promoting diversity and collaborative mentorship. Journal of Nursing
Scholarship, 26(3), 177-180.
NESDB, (1996). Summary of Eighth National Economic and Social Development Plan
(1997-2001), Office of the National Economic and Social Development Board, Office
of the Prime Minister.
ONEC, (1996), The Eighth National Educational Development Plan (1997-2001), Office
of the National Education Commission, Bangkok.
Faculty of Nursing Mahidol University
Introduction
The accelerated pace of world development has increased the need for improvements in education. To meet this challenge, doctoral education must be examined and, where necessary, appropriate changes made. Meetings such as INDEN, where ideas and experiences regarding doctoral nursing curricula, teaching and research practices, and administration of doctoral nursing education are exchanged, encourage educators to ensure that students obtain the maximum benefit from their years spent in educational programs.
Evolution of Doctoral Nursing Education
After the Second World War, when newly independent nations and states established many new universities. The concept of national unity through the promotion of heritage was added to the three major existing functions of a university, i.e. research, teaching, and service. Over the past few decades, the bipolar geo-political environment has lead to cooperation between universities and countries of similar ideologies, which in turn has influenced the role of graduate studies, master and doctoral, and our vision for the future directions of educational programs. Thailand's situation, especially in relation to nursing education, is no exception. Graduate nursing studies were developed at the master level and require a thesis to graduate. The question is whether the "teaching-research-service-cultural heritage promotion" master educational program will be able to service the increasingly borderless, rapidly shrinking world of the future.
Awakening
Faced with the challenge of globalization and the demand for a tremendous quantitative increase in higher nursing education enrollment, the nursing establishment has had to respond in a variety of ways to suit varying needs and demands.
Developing the First Doctoral Nursing Education Program
The development of nursing science is a scholarly adventure, one that is guided by purpose and goals and undertaken with boldness, a sense of freedom, and creativity in tandem with intellectual rigor and integrity (Hinshaw, 1989). Nursing scientists in Thailand have set out on this adventure in the past decade by developing the first doctoral nursing education program in Southeast Asia. The aim of developing the program is to generate knowledge, which can be used by any discipline, but is specifically focused on nursing practices and health care. Nursing has a societal mandate to provide health care for clients at different points in the health/illness and developmental continuum in diverse practice setting. Thus, the quality of the program was a principal consideration.
Selection Factors in the Development of a Quality Program
At least three factors are vital in the development of a strong discipline: 1) a well-developed nursing discipline, which is the primary consideration; 2) the evaluation of resources; and 3) collaborations within the university community and selection of host university.
To ensure a strong discipline it is essential to have a well-developed doctoral program (Ketefian, 1993). In the case of nursing, the establishment of a doctoral program would raise its status in Thailand. Discipline development would strengthen the capacity for applied and advanced research and foster a teamwork culture within a university, among universities, and with outside agencies. The ultimate goal is its contribution to academic self-reliance, leading ultimately to the sustainable development of health care in the country.
There are two scenarios – unlimited financing and resources and constrained financing and resources. That is, ideal versus pragmatic.
The Host University should be able to provide the best possible academic environment as well as resources to allow nurses to take part in real-life health care situations. Such supportive foundations become imperative for the kind of multi-university cooperation approach that is deemed essential for a successful program.
Program Concepts
Once we have formulated a viable concept then we are already halfway toward success. The following are deemed essential:
Consortium Program Developmental Process
There are several steps already being undertaken in Thailand. These multiplicity of endeavors help strengthen each other as well as the doctoral educational program. Let me cite some of these in order of their implementation.
Four major university-based schools of nursing in Thailand agreed to develop a consortium program to ensure a quality doctoral program. If universities had attempted to run stand-alone programs in this early stage, they would have faced a shortage of available scholars and researcher role models. In addition, the consortium program helps to sow the seeds that will become the anticipated stand-alone programs. The consortium team decides the Host University.
At the initiation of the Ministry of University Affairs, academic departments and faculties of nursing at four major public universities in Thailand formed a consortium among themselves with the collaboration of experts in doctoral education from overseas universities where programs are well developed. A blueprint for a quality program was formulated and implemented. The resulting consortium was initiated for the first 10-year program: one host for the first 5 years, with each institution taking turn as host for the second 5-year period.
The overseas experience and inter-university team teaching of faculty staff during the consortium program has sped faculty development in each university. The universities that are ready to establish new doctoral programs will design their programs according to policy and the good of the nation. There are two types of program designs: 1) a program that focuses on both course work and research and 2) a program that focuses on research only.
The Impact of Societal Forces on Re-Awakening
Now I will briefly review some social issues in Thailand that demonstrate the necessity to strengthen the quality of our doctoral nursing educational programs. To be able to maintain the program's quality we need to assess the changing needs of society periodically:
The new world socio-economic and political order affects every country; it is a world that is seeking a new balance between "global" and "local" values. Truly, the era of globalization has arrived with its many implications on doctoral education. Only a program endowed with the vision and wisdom to understand the globalization process and its ongoing threats and opportunities will be of value to the international community.
Since Thai universities were rooted in a tradition of providing highly trained personnel to the public sector, their curriculum and teaching practices were geared toward producing the best possible bureaucracy. With changing economic and social scenarios comes a call to serve the service sectors that began to expand rapidly in both private and government organizations.
The growth in demand for locally based doctoral programs is on the rise. The ratio of undergraduates going on to higher education in Thailand was 15 percent in 1996. It is expected the ratios will rise to 25 percent and 50 percent, in the year 2006 and 2020, respectively (NESDB, 1996 & TFB, 1996). Furthermore, these forecasts are considered to be on the conservative side. This will put a heavy burden on institutions' graduate studies to train teachers and researchers.
Health-care issues are similar in many countries including Thailand. At a time of economic uncertainty around the world, nurses are expected to adapt to any change. Doctoral candidates are expected to be competent in solving critical health problems with limited resources. The problems are as follows:
These trends and changes pose many challenges for nursing researchers and educators and mean that doctoral nursing education will have to develop new research questions that relevant to the experiences of health care needy, especially the disadvantage groups (Meleis, Hall, and Stevens, 1994). The program will have to formulate new curricula to meet the demand for health care in the future by balancing the roles of teaching, research and service (Norbeck, 1998). The capacity to handle interdisciplinary teamwork, to analyze and solve problem, to initiate new work, and to communicate efficiently in writing in both Thai and English languages is also required.
Continuum of Strengthening Quality of Doctoral Nursing Education Program: Diversities toward Social Necessities.
The implication of critical mass or academic expertise touches on two aspects of the program. Firstly, the intellectual capital of each field in nursing and, secondly, the number of nursing fields - the training grounds for scholars - in operation in Thailand. The latter generally reflects the state of development of both doctoral nursing study and health care.
There is a demonstrable shortage of trained researchers and leaders in Thailand to work on current health care issues. Furthermore, it is crucial that doctoral programs approve priority areas or fields of professional accelerated knowledge development and expansion. Action is being taken to provide additional physical facilities and enrollments. Upgrading of teaching staff through advanced training for doctoral degree and /or special expertise is in operation, while the recruitment of younger faculty members for further training – either overseas or locally - is also underway.
It is clear that no single model works for all cases or at all times. It should be noted that technological developments, particularly electronic mail, the internet, Tele-teaching, teleconferencing, etc., puts Thai doctoral nursing students and researchers in direct contact with colleagues abroad as well as providing access to leading scholars and libraries all over the world. The means that doctoral training in nursing abroad may be less necessary.
The idea for a center of excellence is centered on a group of highly capable academicians, who, by combining research and training activities, create and nurture new nursing staff in the lifelong pursuit of integration and excellence in teaching and research.
Conclusion
This paper provides a brief outline of development concepts, missions, and future tasks that must be concentrated upon to boost the capabilities of nursing staff at Thai universities.
References
Hinshaw, A.S. (1989). Nursing Science: The challenge to develop knowledge" Nursing
Science Quarterly, 162-171
TFB, (1996). Report of the Commission on Thailand's Education in the Era of
Globalization, Thai Education in the Era of Globalization: Vision of a Learning Society,
Thai Farmers Bank Public Company Limited.
International Network for Doctoral Education in Nursing
Copyright © 2000-2007 University of Michigan School of Nursing