Prof Khathijah Preparing Nurses Graduates To Fulfil Society Needs in Malaysia PDF

AINEC ANNUAL SCIENTIFIC MEETING
10-12TH OCTOBER 2019 BANDUNG
Preparing Nurses’ Graduate to

Fulfil the Society Needs in
Malaysia
Challenges and Strategies
Khatijah Lim Abdullah (PhD)
Professor
University of Malaya
Assalamuliakum
Greetings
from Malaysia
AINEC ANNUAL SCIENTIFIC

October 14, 2019 MEETING 2019 2
Outline of Presentation
Nursing Education
Healthcare System
Challenges
Strategies

NURSING EDUCATION
Hospital Based Tertiary Education

Education (Universities )
(College of Nursing) MINISTRY OF
MINISTRY OF (HIGHER)
HEALTH EDUCATION

Nursing Board Malaysia
The agency that establishes criteria or
standards for nursing training
- Nurses Act 1950
- Nurses Registration Regulations 1985
Aim
• Standards and professional conduct
• Policy advice
• Develop and promote patient care
Legislation
1950 - Establishment of
Nurses Act and Nurses Registration
1985 - Nurses Registration Regulations

- Implementation of the Annual
Practicing Certificate(APC)

History of Nursing Education In Malaysia
1946 - 1st School of Nursing In Johore

1947 -2nd School of Nursing :
In Penang & Kuala Lumpur
* Certificate level
(Block System, 3 years 4 months)
* Apprentice model
1992- Diploma In Nursing (Semester System)
Nurse Education in Malaysia
1993 –Degree ( Post Registration)

1998 – Degree ( Pre Registration)
2007 – Masters
- PhD
AINEC ANNUAL
SCIENTIFIC
October 14, 2019 10 MEETING 2019
A. Offering Diploma In Nursing:
Ministry Of Health - 18 colleges

Public/ Private Institutions - 64 colleges
Ministry of Defense - 1 college

B. Offering Degree In Nursing:
Universities - 7 universities : BSc

- 2 universities : MSc
Private Institutions - 10 university colleges:
BSc
- 5 university college :
MSc

POST BASICS COURSES
DESCRIP NUMBER OF NUMBER OF
TION REGISTERED NURSE WITH
NURSES SPECIALISATION
Public Sector 46254 21814 (49%)
Private Sector 23251 1192 (5.1%)
Total 69505 23006 (33.09%)
Source : NBM 2015

Introduction to
University of Malaya
(UM)
AINEC ANNUAL SCIENTIFIC MEETING 2019 14 October 14, 2019

King Edward VII
College of UNIVERSITY OF
Medicine, MALAYA
Singapore (1905) KUALA LUMPUR
1 January 1962
University of
Malaya
Raffles College Singapore
Singapore University of
(April 1949) Singapore
(1928)
(now known as
National University
October 14, 2019 MEETING 2019 of Singapore15
)
Vice Chancellor
DATUK IR. (DR.)
ABDUL RAHIM HJ. HASHIM
medicine.um.edu.my/nursing-
science-department

UM is the pioneer in Nursing Education in Malaysia
1. Bachelor (Hons) in Nursing Science – 1993

(post reg)
2. Master in Nursing Science - 2007
1. Started as a unit in 1993

2. Given Department status in 2007

Malaysia Healthcare System
Universal healthcare system co exits with
private healthcare system
Total 134 general hospitals, 9 Specialised
hospitals. Private hospitals/centres : 200
Health clinics and community clinics :2900
Total nurses : 102,564 ( 1:309)
( Source: Health Facts MoH 2016)

Public healthcare sector Private healthcare sector
Rural health services Tertiary healthcare services

AINEC ANNUAL
SCIENTIFIC
Healthcare changes
Where is healthcare headed ??
Fee for Volume Value

service based based care
care

Healthcare Transformation
FROM CURRENT HEALTH CARE TO
• episodic, • team-based,
• provider-based, • patient-centred care
• fee-for-service care • across the continuum that
provides
• seamless,
• affordable and
• quality care
Source: Susan W. Salmond and Mercedes Echevarria (2017). Healthcare Transformation and Changing Roles for Nursing. Orthopaedic
Nursing, January/February 2017; Vol. 36, No.1.

MEETING 2019 22
Changing Demands
Demographic
Economically
Technologic

Demographically
Infant mortality Maternal mortality
282 deaths at birth for
75.7 per 1000 live births every 1000, 000 live
to 5.1 birth to only 30 deaths
Live expectancy
From 56 to 71 for males
from 58 to 76 for females
it was estimated that the volume
of senior citizens will increase to 11.4% by 2040
Demographically
Ageing population
Chronic conditions
Degenerative disorders
AINEC ANNUAL
SCIENTIFIC
Economically
‘Good nutrition ‘ Rich ’ people illness
Industrialisation Industrial related

accidents
Higher standard
Chronic conditions
of living
Social related
conditions
Better education
AINEC ANNUAL
SCIENTIFIC
Technological advances
Increase use of machines and computers
 Can potentially increase healthcare costs
 Has potential to replace ‘hands on care’
 Potentially increase the skills needed by
health care providers.
 Better informed patients
 Alternative therapies and Genomics Growth
 Palliative and end of life care
AINEC ANNUAL
SCIENTIFIC
Ageing population Current Reality
Expanded services The labour force in Malaysia for
New expertise the year 2011 was 12.7 million
while those aged 60 - 64 years
were 311.9 thousand.
This shows that up to 2.5% of

the labour force was those in the
Resource Demands older person category.
Intended Outcomes
How do we
ensure
standards
of care?

Current Issues
Seamless value based patient care
Complexity in patient care =Specialization in
nursing: Geriatrics, palliative care, nursing informatics,
complementary medicine, genomics
Bridging the gap between research and practice
Computerized information system in nursing
Faculty shortage

Health care education
Health care is primarily delivered by teams of
health care professionals.
Typical, silo-effect educational approach
The need to begin the learning process with

inter professional education
Frenk J, Chen L, Bhutta Z, et al. Health professionals for the new century: transforming education to
strengthen health systems in an interdependent world. Lancet. 2010;376(9756):1923–1958.

Institute of Medicine (2003)
The 2003 Institute of Medicine (IOM) document cited
five core competencies required by health
professionals practicing in the 21st century healthcare.
These competencies included:

patient-centered care delivery,
the ability to work in multidisciplinary teams,
evidence-based practice,
a strong focus on quality improvement,
the use of information technologies.
Institute of Medicine (2011)
The Institute of Medicine (IOM, 2011) report,
The Future of Nursing: Leading Change, Advancing
Health, called for
expanded opportunities for nurses to lead and diffuse
collaborative improvement efforts and to
innovate in practice and education.
funding to advance research on models of care and
innovative solutions, including technology
urged healthcare organizations to lead the
development of innovative, patient-centered care
models

Examples of
Nursing management innovations
- Bedside computers
- Computerized nursing care plan
- Nursing information system
- Critical care maps

Barriers
Are unaware of the most authoritative and up-to-
date evidence on a particular practice or patient
need.
Struggle with disparate or incomplete evidence
that need to be made sense of before nurses can
decide whether to proceed in a planned way.
Struggle to interpret valid evidence that has been
presented in terms that are difficult to apply to
practice.

Vision
‘Nursing in Malaysia will be delivered by
capable, effective, competent,
skilful, and highly knowledgeable
nurses who will be able to provide safe
and holistic nursing care…’
( Malaysia Nursing Board 2009)

Strategies
Different strategies have been identified as
potentially useful .
Three such strategies are:
• Problem and enquiry-based forms of learning.
• Process consultancy.
• Evidence-based practice

Problem and enquiry-based forms of learning
These strategies are used to help nurses analyse practice
in a radically new way (Morrison et al 2004, Savin-Baden
and Wilkie 2004, Burns 2005).
One of their strengths is that they work with the often
untidy and confusing nature of information available to the
nurse through observation and experience (Price 2003).
They help the nurse to read situations, to define the

problem or need and then work with others to identify
what additional information needs to be gleaned and what
actions might then prove helpful.
Process consultancy
An alternative is to use process consultancy (Price
2001), where one individual works with a group to
bring about new ways of thinking or operating.
The consultant contributes expertise in managing group
dynamics, the clarification of values, exploring options
and avenues and developing action plans that are
realistic and widely supported.
The ability to remain objective and to facilitate an
honest and collegiate discussion is one of their
key skills.

Evidence-based practice
The third strategy focuses on the available
evidence that might be used to
develop new approaches to practice.
It proposes that the key challenge in
health care is the application of
authoritative evidence to what nurses
do (Roberts and Yeager 2004, Nolan 2005)

Questions
To what extent are nurses taught how
to use evidence/theory in making

decisions ?
to face and overcome the common

barriers to the use of evidence/theory in
their practice ?

We need to educate nurses …
who will think critically and question
what they and others do
who will have the ability and
motivation to seek answers to these
questions and bring practice forward
who will have the confidence and
creativity to resist pressure to conform
to traditional ways to practice

Where are we NOW.....
Consensus between educators,
policy makers, stakeholders :
• Definitions
• Scope of Practice
• Core competences
• Education

Critical Challenge
1. Integrating advanced practice nurses into
workforce planning
To ensure the presence of the
- right nurse with
- right qualification
- at the right role at the right time,
- in the right place
- with proper authority and appropriate
recognition.
Critical Challenge
2. Capacity Building
• Complementing and building on , not
replacing, the strengths and capacities that
already exists.
• Moving away from training focus to

partnership, networking, strengthening
and identifying regulatory frameworks

Critical Challenge
3. Defining Gaps and finding the evidence
Why do nurses need to be educated at
university level?
Will nurses be lost in clinical practice in the
wards with this level of education?
What do advanced practice nurse add to
quality health care provision?

Curent Challenges Faced
Persuading politicians at a policy level

The growth and changes in IT in health care.
Inter departmental, organizational, national
partnership.
Information and evidence from reliable source
Training and Education system
Ageing nursing population

CONCLUSIONS
(at last!)
AINEC ANNUAL
SCIENTIFIC MEETING
51 2019
October 14, 2019
Conclusions
"It is not the strongest

of the species that
survives, nor the most
intelligent, but the
one most responsive
to change."
Charles Darwin
Terima
kasih


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AINEC ANNUAL SCIENTIFIC MEETING

10-12TH OCTOBER 2019 BANDUNG

Preparing Nurses’ Graduate to

AINEC ANNUAL SCIENTIFIC

AINEC ANNUAL SCIENTIFIC

Hospital Based Tertiary Education

AINEC ANNUAL SCIENTIFIC

1985 - Nurses Registration Regulations

AINEC ANNUAL SCIENTIFIC

1946 - 1st School of Nursing In Johore

1993 –Degree ( Post Registration)

Ministry Of Health - 18 colleges

AINEC ANNUAL SCIENTIFIC

Universities - 7 universities : BSc

AINEC ANNUAL SCIENTIFIC

Private Sector 23251 1192 (5.1%)

Total 69505 23006 (33.09%)

Source : NBM 2015

AINEC ANNUAL SCIENTIFIC MEETING 2019 14 October 14, 2019

AINEC ANNUAL SCIENTIFIC

1. Bachelor (Hons) in Nursing Science – 1993

1. Started as a unit in 1993

AINEC ANNUAL SCIENTIFIC

( Source: Health Facts MoH 2016)

AINEC ANNUAL SCIENTIFIC

Rural health services Tertiary healthcare services

Fee for Volume Value

AINEC ANNUAL SCIENTIFIC

FROM CURRENT HEALTH CARE TO

AINEC ANNUAL SCIENTIFIC

AINEC ANNUAL SCIENTIFIC

Industrialisation Industrial related

This shows that up to 2.5% of

AINEC ANNUAL SCIENTIFIC

AINEC ANNUAL SCIENTIFIC

Typical, silo-effect educational approach

The need to begin the learning process with

AINEC ANNUAL SCIENTIFIC

These competencies included:

AINEC ANNUAL SCIENTIFIC

AINEC ANNUAL SCIENTIFIC

AINEC ANNUAL SCIENTIFIC

AINEC ANNUAL SCIENTIFIC

AINEC ANNUAL SCIENTIFIC

They help the nurse to read situations, to define the

AINEC ANNUAL SCIENTIFIC

AINEC ANNUAL SCIENTIFIC

to use evidence/theory in making

to face and overcome the common

AINEC ANNUAL SCIENTIFIC

AINEC ANNUAL SCIENTIFIC

AINEC ANNUAL SCIENTIFIC

• Moving away from training focus to

AINEC ANNUAL SCIENTIFIC

AINEC ANNUAL SCIENTIFIC

Persuading politicians at a policy level

AINEC ANNUAL SCIENTIFIC

"It is not the strongest

AINEC ANNUAL SCIENTIFIC

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