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Caribbean area nursing education.Caribbean area nurses areconstantly traveling abroad to practice their profession. Forexample, during the ten year period 1959-1969, 3,034 nursesleft Jamaica to practice nursing in the United States, Canadaand/or the United Kingdom ("Nursing Council," 1969).Sincethere is continuous recruitment of Caribbean area nurses rnational Nursing," 1989), it is important that theyreceive the quality nursing education that will enable them escountries.thehostHistoricalcountrieseducational advisement over time is also crucial.withCaribbeannurses in foreign health care settings show that there is ribbean area may be of similar quality to that of the UnitedStates, Canada and Great Britain.According to "A FineRecord" (1961), nurses educated in the Caribbean area nursingprograms are as competent as nurses educated in more developedcountries.Recent data show that Caribbean area nurses pass theUnitedStates(NCLEX) atNationala higherCouncilonLicensurepercentage rateExaminationthan otherforeigngraduates; and Caribbean nurses traveling to Canada do equallywell with passing the Canadian examinations (National Councilof State Boards, 1992).With reference to Great Britain,reciprocity of basic nursing education, with the General

Nursing Council for England and Wales, was achieved by theNurses Association of Jamaica as early as 1952 (Swaby, 1980).Because of the Caribbean area trained nurses' ability ospitals and because of their high rate of success on alsemblance to nursing education in more developed countries.This represents growth in a nursing educational system thathad its vestige in the Tainos (an Arawak Indian Tribe), thewarring Caribs, pirating Spaniards, French, Dutch, BritishCompatriotsand Africanslaves(Williams, 1970).Theseproblems were further enhanced by economic deprivation, socialinequality and political dependence on Britain (Brereton,1981).Swaby (1980) postulates that:as one fearlessly looks back into the history ofCaribbean area nursing education one is "cheered bymemories of slow but sure progress, in the steepclimb from shoddiness and worthlessness to trueeducation for professionalism in nursing." (p. 35)Swaby also contends that there is a need for betterpreparation of teachers of nursing in the Caribbean area andadvocates that these teachers should have preparation at themaster's and doctoral levels.Currently they are providedadvanced course work in teaching and administration prior toteaching assignments, but this falls short of graduate degrees(Swaby, 1980).

8One United States operated nursing school in Jamaicaoperated by Seventh-Day-Adventists prepares the graduates withbaccalaureate nursing degrees. The University Hospital of theWest Indies has worked towards this goal by offering postgraduate studies.The current studentdiversity of ethnic groups.body comprises aThis is reflective of the manynationalities that make up the Caribbean population.evaluationof nursing educationamong this"ethnicThemix"creates a posture of ethnic cohesion, people motivation,survival strategies, communication patterns and leadershipstyles.Historical documentation should provide informationto the international community on nursing education by showinghow people of different races can work together objectivelywithout erunderstanding of how a health care and nursing andspiritualistic rites developed into a modern, scientificallybased educational program. Even when the Europeans came, theybrought no knowledge of germ theory or disease causation;hence, they were left to rely mainly on the crude techniquesof the aborigines, and the local natives taught them of themany benefits of herbal concoctions and the efficacy of herbalbaths(Williams, 1970).A greatrequired of these newcomers.deal of adaptation wasHistorically Caribbean areanursing education had not been well documented.The intent of

this study was to pull togetherthis information and toidentify the forces that influenced the development of nursingeducation in the Caribbean area.Conceptual FrameworkThis historical qualitative study will use the concept ofadaptation in investigating the changes in nursing educationin the Caribbean area over time.manencounterschangesinAccording to Rogers (1970),hisinternalandexternalenvironment to which he must adapt if he is to survive. Selye(1976) described the general adaptation syndrome and showedthe biological response to internal and external stressors,where man on a health continuum either survives or meets hisdemise (see Figure 1).AdHMHon ki NurafeipFigure 1.In liw En rii SpMMng CMbtMn Aran. Ad Midftnii.a KK. aid a L IWn. TTMaid ad. N«f» Yoric: Join Wlay and Sgnt. IWL Und by IGeneral Adaptation Syndrome Model.

10Adaptation may occur in the individual, the family orin groups, and occurs over the life span (Potter and Perry,1989).In order to maintain homeostasis, stressors must beprocessed effectively, individually or within the group (seeFigure 2 and Figure nwvwmn, NuraingEdiiciion.CuiTloul«RflvWon, NuraingOrganizatlorw 7\I!\7IIPerceived Situatiol- British BrutalityDocMonPiooen0Response Soioctiofi-Societal andReligious PressureAdMlaitofK Strass ResponM In Nursing Eduodion In tto Englsh SpeddnoCaribbMn flvea. Adeptod from J Ivanoevicti and M. MetlMon, Stress andWork: A Mani«erld P««pecii . Copyright 1980, by Soott. Forasman andCompany. Used by pandsaion.Figure 2.Process Model of Stress and Adaptation.

11HEALTH I11JC88 CONTINUUMuwii SSy?****'""* '*"**'"***'' *''*» amSX*roM.Figure 3 . Adaptation on the Life Continuum.In the Caribbean area, it appeared that both components(individuals and groups) in the form of nursing leaders,government officials, the church and communities combined tochange a hostile environment into one committed to universalhealth care issues.Other theorists of adaption(Roy, 1984; Hunt, 1975)advocate that in the health care arena demands are placed uponpatients psychologically, physiologically and sociologically.Hence, in this arena clients are in an adaptive mode is context, nursesclientsfailtobecomefunction

12independently. Nursing then has the responsibility to developa readiness for appropriate intervention to meet societalneeds.This readiness is achieved through nursing educationand through standards of nursing practice (Swaby, 1970).Inthis context nursing assists man to enhance the satisfactionof his needs and to achieve his highest degree of integratedfunctioning.Societal changes, however, transcend variousforms of metamorphosis.These dynamic alterations placegreater and greater demands on society.As a result the world has become a burgeoning arena ofscientific discoveries and technological rsing,nursingeducational strategies and scientific approaches to meet theneeds of a changing society (Dolan, 1958).While using thesestrategies nursing educators are involved in the teachinglearning process which creates dynamic interaction betweenteacher and learner.The teacher facilitates the acquisitionof knowledge and the generation of new knowledge about theconcepts of man, society, health and nursing.The intent isto produce a flexible environment, an open system which isconducive to meeting the ever changing needs of man in hisenvironment.Hunt (1975) supports the idea that necessity acts as anagent of change.He states:As we look back upon the history of inquiry itappears that a large proportion of the fundamentalbreakthroughs in science has been a result ofindividuals with a creative bent, originating a new

'/13interpretation which at the time of its formationseemed to most persons a complete violation ofcommon sense and of authoritative teaching,(p. 18)Nursing education in the Caribbean area seemed to haveplayed an intricate part in the arena of societal change whichis evidenced by its radical evolution.(1984), Hunt (1975), and Selye (1976)The theories of Royform the framework toexamine systems, change agents, the roles, and functions ofindividuals and some of the many behaviors that have affectedthe transition in nursing education.A review of the literature on nursing education in theCaribbean area revealed an evolution from spiritualistic ritesand rituals to a current modern educational system comparableto those of more developed countries.Some historians mayrecord only dates and events that functioned as the catalystfor this transition, but a more inquisitive investigation islikely to reveal an intricate adaptive process over time.Purpose of the StudyThe paucity of recorded information in the literaturecreates a need for an historical analysis of the processesthat are involved in the changes in nursing education in theCaribbean area.The purpose of this study was to present inchronological and cultural outline a clearer understanding ofthe adaptive forces and the cultural factors that affected thegrowth and development of nursing education in the Caribbean

14area. Attention also focused on the change from spiritism toprofessional nursing practice over indigenous cultures, selected Euro-Asian antecedents and wasThis was examined in the context of the influencesof contemporary world events upon the evolution of curricularchanges.Such a studyis important and timely since currenthistorical recordings deal with nursing development in moreadvanced countries, for example, the Florence Nightingale erain Great Britain and Dorothea Linde Dix's influence in theUnited States.These individuals were early proponents ofsound nursing education.More recently, nursing educatorshave emphasized the importance of an international orientationand a multicultural approach to nursing and nursing education(Abu-Saad, 1979; Masson, 1981; Grippando & Grippando, vemodalities among countries, but also to identify new ynon-existent or at best fragmented. This study should providea historical basis of the progressive growth and adaptation innursing education among the ethnic groups in the Caribbeanarea.

15One can assume that each ethnic group is likely to havemade its contribution to nursing education over time. landpeoples; he identifies them as having Portuguese, French,Spanish, Hindu,Lebanese, Venezuelan,American,Arabian,African Negro, Chinese, German and British backgrounds ghthavecontributed to the growth of nursing education and that shouldfacilitate the new emphasis on international orientation are:1.Congeniality among the races, evidenced by theabsence of segregation.(The opportunity to reside in a givenarea is more determined by financial status than by class orcaste. )2.The desire for group cohesion evidenced by theregional University of the West Indies founded toserve thehigher educational needs of the Caribbean Islands (Associationof Commonwealth Universities, 1965).These afforded higher standards of general education.Nursing and nursing education have also added their quota inthe formation of the Caribbean Nurses Organization which cameinto being in 1957 to link together all the professionalnursing organizations in the Caribbean Basin (Swaby, 1980, p.48).According to Bell and Oxar (1964), the British settlerswho came, as early as 1665, seemedto focus quickly on

16becoming self-sufficient in order to survive.They plantedcassava, sugar cane, tobacco, cotton, citrus and pineapple andused the wild growing pimento for spice.probablethat many healthIt is highlypractices and healthteachingapproaches were also used for survival as British, French andDutch adapted to the Caribbean area life style.In spite ofthese efforts the loss of lives to cholera and other tropicaldiseases were in epidemic proportions among the Europeans,while they remained endemic among the aborigines. The Arawakstaught the new settlers crude means of survival (Roberts,1940).It was well into the eighteenth century before fragmentedrecords of specific duties of the nurse appeared. Nurses werenow assigned to care for the sick (onpregnant women and their children.likely bytrialand errorinplantations) and forTheir practice was mostthe absenceoforganizedtraining.Today one views a changing Caribbean area in respect plines more closely resemble those of more developedcountries.(thanotherThis is supported by their higher passing ratethirdworldcountries)onthelicensureexamination in the United States. The consistent recruitmentof Caribbean nurses to the United States also seems to bereflective of a knowledge base comparable tothose of the

17host countries(Davy, 1965; Tulloch, 1965; "InternationalRecruitment," 1989).The unifying and cohesive forces seemed to reflect uniqueadaptation strategies among educational proponents, nursingand civic leaders, governmental forces, and political andsocial systems. Apparently these forces transcended the preChristian era described by Bullough and Bullough, 1984; Dietz,1963; Ellis and Hartley, 1984. The indigenous Arawaks likelyadded their contributions to the above mentioned forces ofunification and adaptationin what seemed to be an opensystem, as they selected chiefs or other leaders to manage thepeople's affairs and to perform the religious rites andrituals(Graves, 1965).The Caribs with their barbarousnature might also have left an indelible imprint on nursingand nursing education.The Spaniards came, followed by theFrench, Dutch and British.These groups were subsequentlyresponsible for the importation of many thousands of Africansinto the Caribbean (Williams, 1970).Telecommunication, computertechnologyhavecontributedtosystems and other modernanalreadyforcefulandorganized adaptive system in the area of nursing education.The Caribbean area has also been awarded national acclaim byits acceptance to membership in the International Council ofNurses in 1960. The historical documentation of the adaptiveevolution of nursing education over time in the Caribbean areawould not only broaden the Caribbean area nurses' historical

18perspective but also provide a resource for nurses of othercountries who travel to practice nursing in the Caribbeanarea.Today nursing history is a significant part of eanshould also be given a permanentspotnursingin thehistorical archives and should be added to nursing curricula.As the world becomes more interdependent and people interactmore closely it should be useful to document the history ofnursing education in the Caribbean area.Delimitations and Limitationsof the ment of nursing education primarily in the Englishspeaking Caribbean area from its discovery in 1498 until thepresent time. The study focused mainly on the Caribbeanregion.References to developments in the United States ofAmerica and several European countries were made to indicatethe influence of those developments on changes and adaptiveprocesses in the Caribbean political and nursing educational changes and adaptations.Developments in Trinidad and Tobago, Grenada, St. Kitts, St.Vincent, St. Lucia, Barbados, Dominica, Montserrat, Nevis,Jamaica, the Cayman Islands and Antigua were studied. Limitedcomparisons were made with Spanish, French and Dutch nursingeducational programs within the region.

19AssumptionsCertain assumptions were made in conducting this study.These assumptions were as follows:1.Both written and oral structured and unstructuredinterviews were conducted and the proper procedure was used.2.The journals and newspapers reviewed werereputable and contained correct information.3.The information in British literature closelyparalleled developments in the Caribbean area.Definition of TermsThe first three terms defined in this study are those ofthe National League for Nursing.They are used to showdifferences in Caribbean nursing preparation.These termsare:Baccalaureate Nursing Education,Diploma Nursing Education, andPractical/Vocational Nursing Education.The other terms defined should provide clarity and avoidambiguity in semantics.Baccalaureate Nursing aninstitution of higher learning. Generally students spend theinitial two years studying general education disciplines. Themajor in nursing is concentrated in the last two years ofupper division study. There is a strong theoretical base with

20related skills practice at this level. Nursing concentrationis on providing care to individuals and groups and workingwith health care teams. There is emphasis on research and onproviding students a sound foundation for graduate study. Thebaccalaureate graduate takes the same licensure examination asthe diploma and the associate degree graduate.Leaguefor NursinglistsThe Nationalseveral characteristicsofthegraduate from a baccalaureate program:Provide professional nursing care, which includes healthpromotion and maintenance, illness care, restoration,rehabilitation, health counseling, and education based onknowledge derived from theory and research.Synthesize theoretical and empirical knowledge fromnursing, science, and humanistic disciplines withpractice.Use the nursing process to provide nursing care forindividuals, families, groups, and communities.Accept respons

VI. CARIBBEAN NURSING EDUCATION IN TRANSITION. 62 Current Educational Programs 73 Nursing Schools in Jamaica 82 Nursing Schools in St. Lucia 83 Nursing Schools in Trinidad and Tobago 84 Caribbean Nursing Schools—Trends in Unification 85 Summary 87 VII. DEVELOPMENT OF PROFESSIONAL NURSING ORGANIZATIONS IN THE CARIBBEAN AREA 90