Development of Nursing Care infrastructure in India & Future perspective

1. Development of Nursing Care infrastructure in India & Future
perspective
Asokan R
Associate Professor
KINS, KIIT (DU), Bhubaneswar.
20-06-2021 1

2. Focus on,
• Vision of Nursing profession
• Understanding of the heritage behind Nursing
• Highlights the contributions towards development of the nursing
profession & future perspective
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3. NURSING
Nursing encompasses autonomous and collaborative care of
individuals of all ages, families, groups and communities, sick or well
and in all settings. It includes the promotion of health, the prevention of
illness, and the care of ill, disabled and dying people.
- WHO
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4. Nursing Education should not be
linked with Para-Medical Education and
neither be clubbed with Para-Medical,
as Nursing Profession itself is an
independent profession which is
approved by the W.H.O. and
International Council of Nurses.
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5. Florence Nightingale
• “Mother of Modern Nursing”
• 1854, left with 38 women for the Crimean War—
British casualties were high; within 6 months, death
rate cut in half
• Made rounds at night with a lamp “Lady of the
Lamp”
• First to stress on aseptic precautions while caring
for the patient.
• Nightingale developed basic philosophy: the
profession of nursing different from other existing
programs.
(12 May 1820 – 13Aug 1910)
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6. Her accomplishments at Crimea in two years included
• Death rate decreased drastically
• She established cleanliness and sanitation rules
• Patients received special diets and plenty of food
• Improved water supply
• Patients received proper nursing care
• Nightingale established a reputation which allowed her to
improve nursing standards at home
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7. NURSING IN MODERN INDIA
• Military nursing was the earliest type of nursing.
• Florence Nightingale had a great influence over nursing in India especially in
the army.
• St Stephens Hospital at Delhi was the first one to begin training the Indian
girls as nurses in 1867.
• 1871, the first School of Nursing was started in Government General
Hospital, Madras.
• 1897, Dr.B.C.Roy did great work in raising the standards of nursing and that
of male and female nurses.
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8. • 1908, the trained nurses association of India was formed
• In 1926, Madras State formed the first registration council
• The first four year basic Bachelor Degree program were established in 1946 at
the college of nursing in Delhi and Vellore.
• The Indian Nursing Council was passed by ordinance on December 31st 1947.
The council was constituted in 1949.
• First master’s degree course, a two-year postgraduate program was begun in 1960
at the College of Nursing, Delhi.
• 1963, the School of Nursing in Trivandrum, instituted the first two years post
certificate Bachelor Degree program.
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9. NURSING IN INDIA
⚫ 1935 onwards- State-wise councils
started developing
⚫ Now India has 23 State Nursing
Councils
⚫ Nursing education in the country integrated
into the system of higher education.
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10. Men in Nursing in India
Great British Government has brought the reformations
in bringing up the working standards of male nurses.
The reformation and revival of male nurses started in
1938, and it reached a level of recognition in 1950.
The male nurses were recruited in 1938, but they
reached the position of a head nurse by 1950.
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11. 20-06-2021 11

12. NURSING IN INDIA
Nurses are two-thirds of health workforce in India.
Aim of the Nursing.
Achieving UN millennium development goals (MDG) and sustainable development
goals (SDG) are very crucial.
Achieving universal coverage, increasing health financing, recruitment, training and
retention of health workforce in India.
Nurses have widened their scope of their work, & roles and responsibilities have
multiplied, still have concerns with development of nursing, workforce, selection and
recruitment, placement as per specialization, pre service, in service training and human
resource (HR) issues for their career growth.
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13. Nursing and Nursing Education
In the ancient era, until 17th century, formalized nursing was not traced.
Every village had a dai/traditional birth attendant to take care of maternal and
child health needs of the people.
Military nursing was the earliest type of modern nursing introduced by the
Portuguese in the 17th century.
Florence Nightingale was the first woman to have great influence over
nursing in India and brought reforms in military and civilian hospitals.
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14. The first four-year Basic B.Sc. program was established in 1946 at RAK
College of Nursing in Delhi and CMC College of Nursing in Vellore.
In 1960, M.Sc. was established in RAK College of Nursing, Delhi.
In 1951, a two-year ANM course was established in St. Mary’s Hospital at
Punjab.
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15.  In 1908, the Trained Nurses Association was formed to uphold the dignity
and honor of nursing profession.
 The first state registration council at Madras Nursing Council was
constituted in 1926 and Bombay Nursing Council was constituted in 1935.
 In 1949, Indian Nursing Council (INC) was established to maintain a
uniform standard of training for nurses, midwives and health visitors and
regulate the standards of nursing in India.
 INC act was passed in 1947 that was amended in 1950 and 1957.
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16. The nursing scenario at the time of independence was not bright and there were about 7000
nurses for the population of 400 million.
The hospitals were grossly understaffed, nursing lacked professional and social status,
and the working and living conditions of nurses were far from satisfactory.
In the fifties, more number of girls from different parts of the country joined nursing.
By 2000, Nursing advisor post was instituted at the national level; three nursing posts were
increased to five with the introduction of Asst. Director General Nursing and Dy. Asst.
Director General (recently changes in .
The College of Nursing PGI, Chandigarh and College of Nursing, CMC Vellore were
designated as WHO collaborating centers for nursing and midwifery development in
2003.
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17. The government of India,
health and family welfare
department has issued a
notice on 9 sep 2016 for
nomenclature of nursing
cadre, nurse will be
replaced by nursing officer.
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18. The development of various committees such as Bhore Committee (1943), Shetty
Committee (1954), Mudaliar Committee (1959-61), Kartar Singh Committee (1973),
Srivastava Committee (1974), High Power Committee (1987) alongside five year
plans have brought about a transition in the status of nursing and midwifery.
The recommendations made were in relation to staffing in hospital nursing service,
public health settings, and schools/colleges, working and living conditions,
infrastructure and equipment, regulations, and intensification of training
programmes to meet the staff shortage.
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19. The reports of the above mentioned all Committees and National Health Policy (NHP, 2002)
have put forward very sound recommendations for nursing management capacity.
The NHP laid emphasis on improving the skill-level of nurses and on increasing the ratio of
degree-holding nurses vis-à-vis diploma-holding nurses.
It also recognized the need for establishing training courses for super-speciality nurses
required for tertiary care institutions. However, gap existed in actual implementation.
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20. Following independence, reorganization of the health services took place in the
light of the Bhore Committee recommendations (1946).
Health services were provided in the rural areas through the establishment of
primary health Centre (PHC) to provide an integrated curative and preventive health
care for the population.
In 1952, a post-certificate Public Health Nursing programme was instituted at the
college of Nursing, New Delhi.
Community Health Nursing was integrated in the curriculum of GNM and BSc
Nursing courses.
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21. Introduction of Multipurpose Health Worker’s following Kartar Singh’s Committee report
in 1973.
Most of the health services in the homes were provided by the Health workers, health
visitors, ASHAs and Trained Dais whose activities were and are still concerned primarily with
maternity and child welfare.
The auxiliary nurse midwife (ANM) gradually replaced the Dais to serve in the village
through the primary health Centre and its sub-centres.
Under NRHM scheme in 1996, every PHC was manned with 2 staff nurses to provide RCH
services.
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22. The formulation and adoption of the global strategy for “Health for All” by the
34th World Health Assembly in 1981 through Primary Health Care approach got of
a good start in India with the theme “Health for All” by 2000 AD.
In 1987, The Government of India appointed a High Power Committee on
Nurses and Nursing Profession to go into the working conditions of nurses,
nursing education and other related matters and submitted manpower requirements
for nursing personnel.
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23. Contemporary Perspectives
The complexity of the healthcare influenced by the increasing longevity,
shortening of hospital stays, scientific and technological advances, equality, poverty,
discrimination, disasters, violence and cultural diversity leads to several challenges
that threaten the health and wellbeing of the Indian Population.
Currently India has only 0.7 doctors (Global average is 1/1000) and 1.7 nurses
(Global is 2.5/1000) available per thousand population.
The ratio of hospital beds to population in 0.98/1000 against the global average of
3.5 beds/1000 population (WHO).
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24.  The roles of nurses are evolving and changing.
 Nurses undertaking research.
 Nurses contributing towards strengthening systems to work efficiently in
interdisciplinary teams.
 Effectively participating and influencing policies related to nursing at local, state and
national levels.
 Specialized and highly skilled Nurses.
 The number of registered nurses/midwives was 6.7 lakhs in 1998 and has reached
17,91,285 nurses/midwives in 2014.
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25. In India, Nursing educational programs such as Auxiliary Nurse Midwifery,
General Nursing and Midwifery, BSc(N), MSc(N), MPhil and PhD(N) exist.
The growth in nursing educations is phenomenal. From 2000 to 2016, ANM
schools have increased from 298 to 1927, GNM schools from 285 to 3040, B.Sc
colleges from 30 to 1752, and M.Sc colleges from10 to 611.
The 12th five-year plan suggested establishing 24 centers of excellence in
Nursing.
Up gradation of schools to colleges, strengthening of existing schools, faculty
development, and establishment of 6 AIIMs like institutions are taking place.
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26. INC initiatives include capacity building of 55 nursing educational institutions,
training of 1,20,000 nurses and 3500 faculty in HIV/AIDS & TB through GFATM
project.
E Learning module was developed.
Every registered nurse will be provided with a nurse unique ID (NUID) after live
registration in INC.
License linked with CNE.
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27. A national consortium for PhD in nursing was constituted by INC in 2006 to
promote research activities in various fields of nursing.
INC is in collaboration with JHPIEGO has taken initiative to strengthen the
foundation of pre-service education resulting in better prepared service provider.
In order to promote competency based training INC in collaboration with JHPIEGO is
going to set up state of the art simulation center in India.
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28. Some states have developed mechanism to conduct CNE through State nursing councils.
Integration of service and education model that is practiced in CMC Vellore is also
introduced in a few more institutions.
Florence Nightingale awards instituted by MOH & FW in 1973 to recognize and honor the
meritorious services of outstanding nursing personnel in the country are given to 35 nurses
every year on May 12, the International Nurses Day.
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29.  Many universities are running PhD programmes in nursing and many colleges have
been recognized as research departments.
 INC is in the process of developing a practical model for the country.
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30. Public Health Nursing
According to the INC (Snapshots, 2016), 789,740 ANMs and 56,096 LHVs are registered
in the different state nursing councils of the Country. They are responsible for
implementing all national and state health programmes at ground level.
Critical activities related to maternal and child health, disease control, immunization,
epidemic management and health promotion are carried out by peripheral public health
nursing personnel.
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31. Future Perspectives
The future of healthy India lies in primary, secondary and tertiary care services to serve
the rural (70%) and urban (30%) population.
NHP 2017 recommends setting up new Nursing Institutions, standardization of clinical
training, revisiting entry policies into educational institutions, ensuring quality of education,
continuing nursing education, strengthening human resource governance, regulation of
practice, establishing cadres like Nurse Practitioner, HR policy for faculty, centers of
excellence in nursing in each state, and career progression to nursing cadre.
Use of mid-level service providers to provide comprehensive primary care.
National license exit exam for entry into practice, periodic renewal of license linked with
continuing nursing education.
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32. • The World Health Organization declared 2020 to be the “Year of the Nurse and
Midwife”.
• In subsequent decades, nurses answered the call again and again, serving as front line
providers during some of the world’s most recent infectious disease outbreaks, including
H1N1 Swine Flu, Ebola, severe acute respiratory syndrome (SARS), Middle East
respiratory syndrome (MERS), and Covid-19.
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33. Nursing in 2021
• Self-Care for Nurses
• Increased Specialization and Career Path Options
• Traveling Nurses
• The Rise of TeleNursing
• Nurses are retiring later
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34.  Online nursing education programs more popular
 Increasing need for nursing educators
 Increasing need for doctoral education programs
 Bilingual nurses in more demand
 Holistic Care become more popular
 Nurses need to be technology savvy
 Value-based care is the new model
 Patients become more educated
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36. CONCLUSION
Today we think of our healthcare system as more sophisticated than that of
previous generations because it is based on technology and science.
Much of the care nurses provide for individuals and communities is based on
the needs of society and is driven not only by need and tradition, but by changes in
society brought on by environmental changes.
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37. Bibliography
1. https://healthyindiachronicle.in/shri-t-dileep-kumar-president-indian-nursing-
council-growth-nursing-india/
2. Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses : A
call for radical transformation. Danvers, MA: Wiley
3. FICCI Report, 2016
4. Indian Nursing Council, 2016
5. Indrani, TK (2004). History of Nursing, New Delhi: Jaypee Brothers
6. National Health Policy, 2002 & 2017
7. Trained Nurses’Association of India (2001). History and Trends in Nursing in
India, New Delhi: TNAI
8. https://www.altus-inc.com/blog/nursing-trends-for-2020
9. https://blogs.scientificamerican.com/observations/nurses-are-playing-a-
crucial-role-in-this-pandemic-mdash-as-always/
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