China's nurses: redefining roles to improve health

Abstract

Since its birth in 1949, the People’s Republic of China has hosted a small but steady number of foreign visitors interested in the health field. Not until 1976, to my knowledge, had a group primarily composed of nurses from overseas spent 22 days travelling throughout the country to observe developments in the nursing profession. In all, our group visited more than 30 health institutions, including hospitals, nursing schools, clinics, offices of the government health ministry at all levels, and research centers. This article will report on observations and interviews collected in those 22 days, with the assistance of a team of interpreters. It is supplemented by the study of materials on health and nursing published either for internal Chinese or international audiences. Much of what we saw looked similar to nursing practice in the U.S.A. Basic training takes 2 yr throughout the country, with additional training of ‘X-1 % yr for specialties like anesthesia, physical therapy, or radiology. Nurses staff hospitals on three 8-hr rotations/day, count narcotics and report to the oncoming staff before leaving. Further, we were repeatedly told that nurses do nursing work, and doctors are responsible for the medical duties. Thus, it appeared that nursing practice in China was quite similar to that in the West. In fact, many of the recent developments in Chinese nursing have altered the nature of the profession in that country. The style and content of nursing education has changed greatly in the last 30 yr. Where once students learned primarily by the didactic classroom method, now they spend most of their time doing small group projects, rural and community health rotations, and independent study. Various instructors, only some of them nurses, teach in the predominantly hospital-based schools. The principle guiding educational practice is that teachers teach students, students teach students, and students teach teachers. In other words, the whole school is an educational community of equal partners. Knowledge of value, it is thought, comes from direct experience. Theoretical knowledge must develop from practical experience and not vice versa, so students are encouraged to question and reform the tenets and content of educational practice. As Chairman Mao Tse Tung wrote, “Reading is learning, but applying is also learning, and the more important kind of learning at that”.“’ Similarly, testing methods have changed in the last 10 yr. To speed up reform, Mao Tse