Advancing Nursing Education in China: Contributions of Foreign Expert Nurse Faculty

PROBLEM: Early modern nursing practice and education appeared and was developed by western missionaries, the determination of nurse leaders, and wartime experiences (Yan et al., 2015). However, the relative isolation of China for much of its history means that Chinese nursing has traversed a very different developmental history compared with nursing elsewhere. At the same time, China has experienced the challenges of rapid economic and social change as well as epidemiologic transition with increasing prevalence of chronic disease and lifestyle diseases coupled with a rapidly aging society and a diminishing family caring structure (Omran, 2005). Over the past 25 years, nurses in China have responded to these massive changes by endeavoring to advance nursing education and practice and engage in scholarship and social policy development, so the profession parallels that of developed countries. Nurse leaders in China, lacking the education and expertise to fully accomplish these goals from within, have attended nursing education programs abroad and invited foreign nurse educators, clinicians, and scholars to collaborate in building capacity of Chinese nurses. The contributions of foreign nursing experts to the advancement of professional Chinese nursing are rarely reported despite international nurses' engagement in collaboration with nurses in China.

PURPOSE: Foreign nurse experts collaborate with senior leadership and faculty within a school of nursing of a major university in central China. Their purpose has been to support the university’s aim to bring nursing education into the twenty-first century by contributing to reforming and/or implementing the education programs and building the capacity of undergraduate and graduate faculty and students.

IMPLEMENTATION: Since 2003, the reformation and expansion of the school of nursing has been led by a foreign Dean with extensive expertise in nursing leadership, administration, education and nursing practice in the United States, China, and other countries. The initiative was supported by an international non-governmental organization and a Chinese philanthropist. As the BSN program was reformed and masters and doctoral programs implemented, invited foreign faculty served as curriculum consultants, educators, research mentors, and role models aiming to align the educational and research missions and activities of the school with those of international nursing organizations and thus advance the nursing profession in China.

RESULTS: The school of nursing has graduated nurses who are highly sought after in China, and program delivery has been based on critical, reflexive thinking and problem solving so different from Chinese traditional education. Undergraduate and graduate courses at offer content not available in other Chinese schools, and teaching methodologies were introduced such as problem based learning and theory-lab-practice synchronous teaching (She, 2015). Faculty have been involved in unique nationally and internationally-funded demonstration projects in areas such as simulation, education in mental health and community and home health nursing, writing for publication, and disaster nursing. The international publication of articles began to exceed that other Chinese schools of nursing, and many faculty and students have had funded opportunities to pursue professional development, doctoral study, and collaborative research abroad. The school has received national and international awards for its achievements. Outcome data will be provided.

DISCUSSION: The Dean, the foreign experts and faculty have faced many challenges including imported theory and practices from the west that overlaid culturally-entrenched educational ideas that had implications and risks to future nursing practice capacity building. Embedding critical scholarship within unique Chinese traditions and circumstances had differing perceptions, values, goals and outcomes between faculty and other stakeholders and the foreign scholars. Differences in national and international publication standards require an ongoing building and acceptance of rigor in conducting and reporting research; and tailoring curriculum appropriately and safely to nursing practice, health care, and culture in China.

RECOMMENDATIONS: As a group of educational and practice experts we recommend that continued collaboration is required for nursing and nurses in China and other developing and developed countries to enhance equivalence with international standards, including those promulgated by the International Council of Nurses. The process of reform of nursing education and health in China is a massive undertaking that will require several decades of intensive work to accomplish. With the support of Chinese nurse leaders and officials in health and education, nursing scholars globally can work with Chinese nurses, educators and managers to develop nursing practice to higher standards, embed theory- and evidence-based practice and research into the profession of nursing, and continue to assist with the development and education of nursing leaders for the future. Especially important into the future is growing nurse capacity to become involved in appropriate policy formulation and implementation. Importantly nurses from around the world can develop and grow through ongoing, culturally sensitive collaboration with their Chinese colleagues in nursing and education, and there are important lessons to learn for work in other international contexts.