Strategic PLAn for nursing education 2008 / 2012

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1 Strategic PLAn for nursing education 2008 / 2012 Lisbon July 2008

2 STRATEGIC PLAN FOR NURSING EDUCATION 2008 / 2012 LISBON JULY 2008

3 Title: STRATEGIC PLAN FOR NURSING EDUCATION 2008 / 2012 Ordem dos Enfermeiros Term of Office 2008 / 2011 Coordination: Lucília Rosa Mateus Nunes, President of the Board of Nursing of the Ordem dos Enfermeiros Maria Teresa de Oliveira Marçal Gonçalves Novo, Vice-President of the Board Directors of the Ordem dos Enfermeiros Panel of representatives: Invited experts and institutional representatives of health care delivery and nursing education institutions (see appendixes) Editors: José Joaquim Penedos Amendoeira Martins Lucília Rosa Mateus Nunes Maria Leonor Ramos de Carvalho Maria Teresa de Oliveira Marçal Gonçalves Novo Colaboration of: Carla Sofia Dias Carvalho Testa (Appendixes) training advisor The panel met twice: 20 th May and 19 th June of Electronic contributions were received until the 4 th July of The Strategic Plan for Nursing Education was reviewed and object of formal opinions from: President of the Board of Jurisdiction of the Ordem dos Enfermeiros; Board of Nursing of the Ordem dos Enfermeiros (CE Nº 36 / 2008 of 8 th July); National Standing Committee of Education of the Ordem dos Enfermeiros (CF Nº 7 / 2008 of 8 th July); The document was approved in the Meeting of the Board of Directors of the Ordem Enfermeiros of 11 th July Edition: Ordem dos Enfermeiros May 2009 Translation: Hermínia Castro Revision: Ordem dos Enfermeiros Design and Print: DPI Cromotipo Legal Deposit: /09 ISBN: All rights, including translation into other languages, reserved. No part of this publication may be reproduced in print, by photostatic means or in any other manner, or stored in a retrieval system, or transmitted in any form, or sold without the express written permission of the Ordem dos Enfermeiros. Short excerpts (under 300 words) may be reproduced without authorization, on condition that the source is indicated.

4 TABLE OF CONTENTS INTRODUCTION... 5 PART I STRATEGIC FORMULATION 1. Vision, Values and Mission Strategic Goals Development Strategies PART II DIAGNOSIS 1. Internal Analysis Brief History and Recent Evolution Strengths and Weaknesses Environmental Analysis Context Environment Transactional Environment Threats and Opportunities SWOT Analysis APPENDIXES Education data (1999 / 2007) List of Institutions represented in the panel meetings... 54

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6 INTRODUCTION More than a legacy to be preserved, the recognised evolution of Nursing in Portugal is a reference that is also a challenge to the development within the health professions and health sciences, aiming to guarantee their extremely necessary contribution to the health of the population. In this framework, Ordem dos Enfermeiros (OE the Portuguese Nurses Order), within its attributions, has expressed its views about the ongoing reforms in Health and in Higher Education, as well as about their implications for the Citizens and for Nursing. The changes to the Basic Law for the Education System and the measures leading to the creation of the European Area of Higher Education made the country face the challenge and the need to promote the qualification of the Portuguese citizens, making them better prepared for the current scientific, technical, cultural and ethical demands of the different scientific and professional areas. All this Higher Education reform process, given its implications for the Nursing education and profession, deserved the intervention of OE, timely disseminated near the various agents. It was in the follow-up of these actions that the commitment arose, by the Ministry of Science, Technology and Higher Education (Ministério da Ciência, Tecnologia e Ensino Superior, MCTES) to work together with Ordem dos Enfermeiros in the medium and long term perspectives for the development of Nursing education. Building this vision for the future and the paths for its attainment about which we believe there are already important consensus, both internal and external to the profession implies the preparation and discussion of a Strategic Plan for Nursing Education that must mobilise a large set of agents. Thus, the current document derives from the politically assumed commitment to formulate a strategic development plan for the next five-year period, 2008 / 2012 as a guiding document that shall frame and be able to manage plans of activities, leaving room for the necessary adjustment to the context of change. The followed methodology considered, besides a thorough documental research, steps for discussion and input gathering, having as a strategy the constitution of a Panel of Representatives including the Ordem dos Enfermeiros, representatives of the schools of Nursing Education and representatives of 5

7 ORDEM DOS ENFERMEIROS care giving facilities. The Panel met for the first time on the 20 th May of 2008, a group of writers 1 having been established by the end of the meeting, from the participants proposals and the documental research that was required; the Panel met again on the 19 th June of 2008 for the review of the first document in project, and discussed the intermediate and final versions of the document using web technologies. Thus, it can be stated that the methodology for the elaboration of this Plan was based on the discussion and reflection which encompassed all that accepted the invitation 2. The structure of this Strategic Plan is based on an external and an internal analysis, namely (1) of the context surroundings political-legal, scientific and technologic, socio-economic and socio-cultural which, in an indirect way, may affect higher education and, in particular, nursing education and its transactional surroundings or near surroundings, in which there is a direct interaction; and (2) the internal analysis deriving from the historical path and the recent evolution. Based on the review done, the strategy was formulated, namely the Vision, Values and Mission, as well as Strategic Objectives and Development Strategies integrated actions of strategic character, through which it is aimed to reach the strategic goals. In order to facilitate the access to the essential, in Part I the Strategic Formulation (Vision, Values, Mission, Objectives and Strategic Plans) is presented and, in Part II, the strategic analysis, i.e., the supporting elements to the strategic formulation corresponding to the Strategic Diagnosis, after which the SWOT analysis is presented. 1 The Group of Writers, made by Ana Campos, Eduardo Alves, Isabel Bragança, José Amendoeira, Leonor Carvalho, Luísa d Espiney, Margarida Vieira, was coordinated by Lucília Nunes and Teresa Oliveira Marçal, and received and included the inputs of the participants of the Panel that sent proposals and texts. 2 List of Institutions represented in the Panel meetings in Appendix. 6

8 PART I. STRATEGIC FORMULATION

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10 1. VISION, VALUES AND MISSION CONSIDERING THAT: 1. The nature of the profession is marked: by its scientific character; by the fact that it is characterised by an autonomous intervention in broad multidisciplinary contexts, in a dynamic of functional complementarity regarding the other healthcare workers; by the fact that it is gifted with an equal level of dignity and professional practice autonomy and also by the fact that it is a generator and mobiliser of research outcomes; 2. The characteristics listed are patent in the legal and regulatory framework of Portuguese Nursing; 3. Health responses imply interdisciplinary and multiprofessional dynamics, in which nurses have an intervention based on proximity, continuity and wholeness, which confers them a role as partners and mediators when dealing with complex matters helping the individual, the family and the group, around their health project; 4. Higher education must maintain dynamics of permanent relevance and adequation to society needs and to the quality control of this offer; 5. Higher education, in the field of health, must prepare, since the pre-graduate training, to participate in the definition of global and sectorial policies for organising the intervention in health and for health care providing; 6. The way the legal framework for the Portuguese Educational System, in general, and the Higher Education, in particular, has been clarifying the binary nature of Higher Education and the attributions of each of its subsystems, fully reinforced by multiple public statements from the Government, which reference data included in OECD reports about the Portuguese higher education system; 9

11 ORDEM DOS ENFERMEIROS 7. Future development shall be based in what we are as an inheritage of our past and in what we can and are capable of building as a legacy of the present, particularly in what concerns the need to develop and consolidate the subject area. IT IS STATED THAT: The Strategic Plan for Nursing Education aims to strengthen and acknowledge the contribution of higher education in the sustainable development of the profession and the subject area. The Strategic Plan for Nursing Education is firmly based on the universal values and on the principles expressed in the Nurse s Deontological Code 3, always guided by the defence of human dignity and freedom, reinforcing, in this context, the professional responsibility assumed before society. Regarding the scientific domain, it is inspired in the following values and principles: Relevance, by the conviction that the higher education, being a right of the citizens, plays an essential role in the construction and development of a more equitative, stable and inclusive society, as well as in the training of responsible and professionally competent citizens; Innovation, by the development of models that will respond to the nursing care needs of the population, by being entrepreneur and generating alternatives; Dialog and solidarity, between the Ordem, the education institutions and care providing institutions, through the conviction that the cooperation networks become disseminating agents. This strategic plan will allow projecting Nursing education into the future, so it should have the following orientations: To consolidate in a continuous way the development of education and the profession of nursing in Portugal in the present terms of its legal and regulatory framework; To aim for the reinforcement of development strategies, either in what concerns training models adapted to new realities, or within the scope of intervention in health and nursing, or in lifelong education and learning; To articulate the promotion of support measures for the development of Nursing Research with the priority areas that will respond to the needs in health care and nursing; To integrate in the dynamic of the other health subject areas and professions, in the understanding of a common purpose, centered in the promotion of citizens' health. 3 Decree-Law 104/98 of 21 st April Nurse s Deontological Code article

12 STRATEGIC PLAN FOR NURSING EDUCATION 2. STRATEGIC GOALS From the strategic analysis, in the internal and external components, after analysing the conditions that present challenges and opportunities of the SWOT analysis 4 performed (which is presented on Part II), five strategic goals arose. 1. To ensure the continuity of the process of nursing education development, recognising in the encompassing object of pre-graduate education in nursing the adequate conditions to a 2 nd cycle of studies. 2. To promote measures of research development, according to the priority areas identified and the needs in health care and in nursing. 3. To reinforce the professionals qualification in order to meet the citizens needs in health and nursing care. 4. To strengthen the visibility of the profession and the subject area, within the scientific community and society in general. 5. To promote better conditions for the reorganisation of Nursing education in the three training cycles, in the same subsystem, so as to ensure a continuum of training / research and the development of research. 3. DEVELOPMENT STRATEGIES The strategic objectives, reaffirming the importance of education development, the nursing profession and the absolute need of research in this process, all point toward the need to reinforce the qualification of the professionals and the scientific and social recognition of this evolution. Associated to this objective, we present the development strategies, recognising that it matters, next, to outline the interventions and the processes of monitoring and evaluation. 4 S (strengths), W (weaknesses), O (opportunities) and T (Threats). Analysis of the strengths, weaknesses, opportunities and threats. It is characterised by the crossing between the internal analysis (strengths and weaknesses) and the external analysis (opportunities and threats). The success of strategic management depends on this analysis and it is based on this that the organization can anticipate change and be prepared to act in the external and internal environments. 11

13 ORDEM DOS ENFERMEIROS 1. To ensure the continuity of the process of nursing education development, recognising in the encompassing object of pre-graduate training in nursing the adequate conditions to a 2 nd cycle of studies. Safeguarding the development of education and the nursing profession in Portugal in the last decades and the achievement of the ultimate purposes in the Bologna Process, in what concerns the qualification of citizens, this strategic goal is aimed at the need to: 1.1. Follow-up and reflection regarding the curricular structuring of Nursing education, in the sense of ensuring a solid humanistic and scientific, global and subject matter training, which is able to accompany / anticipate the complex realities and perspectives of scientific and technologic evolution, in the domain of health and nursing, the materialisation of which can be attained by creating an Observatory; 1.2. Creating conditions for the political recognition of the scope of the object of pre-graduate training in nursing and its framing in the descriptors of the 2 nd cycle; 1.3. Dynamics and follow-up of the evaluation processes within the Agency for Evaluation and Accreditation in Higher Education; 1.4. Promotion of the reflection about curricular development practices in Health and Nursing, leading to accompanying the reform in the pedagogic plan and to optimise lifelong learning. 2. To promote measures of research development, according to the priority areas identified and the needs in nursing care. The recognition of nursing as a subject area, both in the Portuguese and the international academia, and the already consistent research practices of nurses are two aspects that mark the challenges of consolidating research in Nursing. These challenges will imply a set of broad measures, of which we highlight: 2.1. Enrolling Nursing as a subject area of knowledge with the Foundation for Science and Technology [Fundação para Ciência e Tecnologia]; 2.2. Definition of the priority lines of research / innovation centered in the citizens needs in nursing care and in the new technologies that will support the development of care; 2.3. Supporting a policy of articulation of the R&D Units / Centres intra and interdisciplinary; national and international; 2.4. Supporting the dissemination of scientific production at the national and international level; 2.5. Creation of a consortium for a National Publication of reference, with the support of MCTES / FCT [Ministry / Foundation]. 12

14 STRATEGIC PLAN FOR NURSING EDUCATION 3. To reinforce the professionals qualification in order to meet the citizens needs in health and nursing care. A demanding vision about the qualification of the services provided to the society by the different professions, together with the inescapable and permanent challenge of the needs and responses in the domain of health make the reflection and educational action particularly demanding. The reinforcement of qualification will thus be done via strategies of: 3.1. Reflection and building of the global patterns of initial training, in their generic and specific dimensions and, within these, in the double perspective of subject area and scientific area in health, at the national and international levels Supporting the establishment of consortiums between the Higher Education Institutions / Health Institutions, in the sense of the development of training and research answers which are adequate to the needs in nursing care (current and projected) Bringing together the scientific path and clinical exercise, promoting the 3 rd cycle in a professional context, supporting the clinical PhDs and creating links between the teaching career and the clinical practice. 4. To strengthen the visibility of the profession and the subject area, within the scientific community and society in general. Regarding the strategic area of reinforcing the profession and the subject area, we absolutely have to mention its interconnection and coherence with the other areas of this plan. It is the starting and end point of the intra and interdisciplinary (re)construction work, which will include: 4.1. Promotion of multidisciplinary dynamics of training and investigation in health, in articulation with the Ministry of Health, INSA (National Institute of Health) and other entities; 4.2. Study and promotion of conditions (political, technical and professional) (internal and external) towards the intervention of nurses in the current Health Care Reform; 4.3. Promotion of the initiatives that will major the understanding of the value of health and citizens right to have access to the best qualified professionals. 13

15 ORDEM DOS ENFERMEIROS 5. To promote better conditions for the reorganisation of Nursing education three training cycles in the same subsystem, so as to promote a continuum of training / research and the development of research. The new educational and pedagogic designs to which the Bologna Process appeals, as well as the need to reinforce investigation, implicate setting conditions towards a reform that can ensure the integrality and coherence of the processes, as well as the rationalisation of the training offer, and these dimensions will implicate: 5.1. The change of the legal definition that vinculates nursing education to the polytechnic subsystem; 5.2. Supporting the reorganisation of the training offer, creating network dynamics to capitalize resources and consolidate the critical dimension (or mass), amongst the IES (Higher Education Institutions) responsible for nursing education; 5.3. Definition of a support line that will allow the reinforcement of Nursing PhDs training in the next five years. 14

16 STRATEGIC PLAN FOR NURSING EDUCATION STRATEGIC GOALS 1. To ensure the continuity of the process of nursing education development, recognising in the encompassing object of pre-graduate training in nursing the adequate conditions to a 2 nd cycle of studies. 2. To promote measures of research development, according to the priority areas identified and the needs in nursing care. 3. To reinforce the professionals qualification in order to meet the citizens needs in health and nursing care. 4. To strengthen the visibility of the profession and the subject area, within the scientific community and society in general. 5. To promote better conditions for the reorganisation of Nursing education three training cycles in the same subsystem, so as to promote a continuum of training / research and the development of research. DEVELOPMENT STRATEGIES 1.1. Follow-up and reflection regarding the curricular structuring of Nursing education, in the sense of ensuring a solid humanistic and scientific, global and subject matter training, which is able to accompany / anticipate the complex realities and perspectives of scientific and technologic evolution, in the domain of health and nursing, and regarding which can be materialised the creation of an Observatory; 1.2. Creating conditions for the political recognition of the scope of the object of pregraduate training in nursing and its framing in the descriptors of the 2 nd cycle; 1.3. Dynamics and follow-up of the evaluation processes within the Agency for Evaluation and Accreditation in Higher Education; 1.4. Promotion of the reflection about curricular development practices in Health and Nursing, which tends to accompany the reform in the pedagogic and to optimise lifelong learning; 2.1. Enrolling Nursing as a subject area of knowledge with the Foundation for Science and Technology [Fundação para Ciência e Tecnologia]; 2.2. Definition of the priority lines of research / innovation centered in the citizens needs in nursing care and in the new technologies that will support the development of care; 2.3. Support to a policy of articulation of the R&D Units / Centres intra and interdisciplinary; national and international; 2.4. Supporting the dissemination of scientific production at the national and international level; 2.5. Creating a consortium for a reference National Journal; 3.1. Reflection upon and building of global training standard, in the double perspective of subject area and scientific area of health, both at the national and international level; 3.2. Supporting the establishment of consortiums between the Higher Education Institutions / Health Institutions, in the sense of the development of training and research answers which are adequate to the needs in nursing care (current and projected); 3.3. Bringing together the scientific path and clinical exercise, promoting the 3 rd cycle in a professional context, supporting the clinical PhDs and creating links between the teaching career and the clinical practice; 4.1. Promotion of multidisciplinary dynamics of training and investigation in health, in articulation with the Ministry of Health, INSA (National Institute of Health) and other entities; 4.2. Study and promotion of conditions (political, technical and professional) (internal and external) towards the intervention of nurses in the current Health Care Reform; 4.3. Promotion of the initiatives that will major the understanding of the value of health and citizens right to have access to the best qualified professionals; 5.1. The change of the legal definition that vinculates nursing education to the polytechnic subsystem; 5.2. Support to the reorganisation of the training offer, creating network dynamics to capitalize resources and consolidate the critical dimension (or mass), amongst the IES (Higher Education Institutions) responsible for nursing education; 5.3. Definition of a support line that will allow the reinforcement of Nursing PhDs training in the next five years; Summary chart of the strategic goals and development strategies 15

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18 PART II. SITUATION DIAGNOSIS

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20 The situation diagnosis strategic analysis considers two aspects: the internal analysis and the environmental analysis. A formulation to develop the profession and the subject area of nursing must integrate in the diagnosis both the evolution of nursing education in Europe and the aspects of comparability, considering also other professions. This must include the political, social, epistemology, economic and technologic transformations, taking into account the intensification of trans-national practices, the internationalization of economy and the movement of people across nations. Both aspects significantly affect the nursing subject area and profession, highlighting the importance of contexts. 1. INTERNAL ANALYSIS The historic framework and the recent evolution in the development of nursing profession and education BRIEF HISTORY AND RECENT EVOLUTION The evolution of Nursing since the 1970 s is fundamental for understanding the development of the profession, its education and the relationship between both which, in the Portuguese reality, is marked by a great proximity and interrelation. It is also fundamental to anchor all interventions toward the consolidation of the profession and the achievement of its mission before society. When the 1 st National Nursing Congress took place, in 1973, three points were considered as relevant in the program for the development of the profession: a single professional career, nursing education integrating the national education system and the creation of a Nursing Council (which would be achieved with the creation of the Ordem dos Enfermeiros, in 1998). These significant points are highlighted, amongst other significant points 5 in the evolution of the profession since, in recent 5 Cf. NUNES, Lucília (2003). Um Olhar sobre o Ombro. Enfermagem em Portugal ( ). Loures: Lusociência; AMENDOEIRA, José (2006). Uma biografia partilhada da enfermagem. Coimbra: Sinais Vitais; SOARES, Isabel (1993). Da touca de brim à blusa branca: Contributo para a história do ensino da Enfermagem em Portugal ( ). Lisboa: APE. 19

21 ORDEM DOS ENFERMEIROS decades, they have lead to the existence of a single education level in nursing; to a single career for all nurses; to the integration, in 1988, of nursing education in the national education subsystem, in the polytechnic subsystem of Higher Education. The publication of the Decree-law Nr. 480/88 of 27 th August created the Higher Education Course [Curso Superior de Enfermagem, CSE] and the Higher Education Courses Specialised in Nursing [Cursos de Estudos Superiores Especializados em Enfermagem, CESEE]. These courses, forming a coherent whole amongst themselves, could lead to getting a degree. It was this requirement that allowed that, in 1991, the Masters in Nursing Sciences [Mestrado em Ciências de Enfermagem] would begin at Universidade Católica Portuguesa and, in 1992, at the Instituto de Ciências Biomédicas Abel Salazar. In the 90s, the publication of the Regulation of Nurses Professional Practice [Regulamento do Exercício Profissional dos Enfermeiros, REPE], came to configure the nursing practice, clarifying concepts, interventions and the scope of practice, as well as rights and duties. In the Preface of REPE (1996), it is considered that: «Nursing has registered, over the last few years, an evolution, both at the level of its basic training and in what concerns the increasing complexity and dignification of its professional practice, which makes it imperious to recognise the role of the nurse as significant within the health scientific community, as well as regarding the quality and effectiveness in the delivery of health care». 6 Nursing is stated as the «profession that, in the health area, has the goal of providing nursing care to the human being, whether healthy or sick, along their life cycle, as well as to the social groups in which they are integrated, in such a way that they will maintain, improve and recover their health, helping them towards the achievement of their maximum functional capacity as quickly as possible» 7. Less than two years afterwards, the State gave back to nurses their regulation powers and the Ordem dos Enfermeiros was created (Decree-Law nr. 104/98, of 21 st April), stating that: «Nurses currently comprise a professional and scientific community of utmost relevance in the functioning of the health system and in the ensuring of population access to quality health care, particularly nursing care. Nurses training, integrated in the national education system at the level of higher education since 1988, allowed the access to different academic degrees and assuming the highest responsibilities in the areas of design, organization and health care providing given to the population. Also, the development induced by research has made it easier to outline a specific body of knowledge and the affirmation of individuality and autonomy in health care providing ( ). The Government recognises that nurses ( ) form an institutional body sound enough to assume the devolution of the powers that are competence of the State in what concerns the regulation and control of their professional practice». 6 Preamble of the Decree-Law nr. 161/96, of 4 th September. 7 Decree-Law nr. 161/96, of 4 th September, Art. 4. nr

22 STRATEGIC PLAN FOR NURSING EDUCATION Nursing started thus having self-regulation as a guarantee of protection of the public interest and the common good, both in the access to the professional practice and in the monitoring and development of the practice and its regulation and control. In what concerns the regulation of access, it can be said, in summary, that it should derive from the analysis of the competence and capacity of the applicant. In what concerns the regulation of the practice following the ethic and quality standards of the profession this is reported to the Código Deontológico do Enfermeiro [Nurse s Deontological Code], Decree-Law nr. 104/98 of 21 st April; to the Competências do enfermeiro de cuidados gerais [Competences of the generalist nurse], defined in 2002, according to the competences that integrate the ICN Framework of Competencies for the Generalist Nurses, of the International Council of Nurses (ICN); to the Enquadramento Conceptual e Padrões de Qualidade dos Cuidados de Enfermagem [Conceptual Framework and Quality Standards of Nursing Care], defined in Deriving from the professional recognition that characterised the 1990 s, the Decree-Law nr. 353/99, of 3 rd September, established the general rules to which Nursing Education was subjected. The change in education, from the baccalaureate level to the degree («licenciatura») level, which occurred then, was not a mere change in the length of the course. Responding to the demands which arose in the meantime with REPE, namely those concerning chapter V Nurses Practice and Intervention the object of the course was changed, including thereafter aspects so far contemplated in the CESEE (specialization courses). That legal diploma established then that it is the role of the degree to «ensure the scientific, technical, humane and cultural education for the delivery and management of general nursing care» 8 and also the participation in the management, training of professionals and developing the practice of research in its domain. The same diploma created the Degrees of Post- Graduation of Specialisation, which would only be regulated in It has also approved «the general rules to which Nursing education is bound within the polytechnic higher education» but it states that «training in the area of Nursing at the masters and PhD levels will naturally be developed by university teaching institutions». This evolutionary process was deeply demanding to the Escolas Superiores de Enfermagem [Higher Education Schools of Nursing], which were continuously called upon to make deep reforms, both to the curricula development processes and to the development of the teaching body always in the sense of ensuring that training processes would be adapted to the evolution of the educational and professional context(s) in Portugal. It can be stated that the systematization of knowledge has been achieved mainly by nursing teachers, through the research of practices clinical, pedagogic and of management through the development of Masters and PhD degrees in nursing and in other areas of knowledge. 8 Decree-Law nr. 353/99, of 3 rd September, Art. 5 th, nr

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