Issues and trend in Nursing education curriculum: Challenge for ASEAN www.pi.ac.th/news/file/199 Assoc. Prof. Suchittra Luangamornlert, RN, DNSc The First VP Thailand N ursing and Midwifery Council

Scope of content The current dynamic at the global and regional level striking on issues of nurse education and the international nursing job market Challenges of ASEAN Community on nursing workforce Law & Regulations in professional/education practices. Curriculum development responding to MRA

The current dynamic striking on issues of nurse education and the international nursing job market - Asian population & Global Aging population - Global economic crisis - Healthcare complexity

Continental Population 2013 Rank Continent Population 1 Asia 4,140,000,000 2 Africa 1,033,000,000 3 Europe 739,000,000 4 North America 529,000,000 5 South America 386,000,000 6 Oceania (Australia) 36,000,000 7 Antarctica 4,000 http://www.worldpopulationstatistics.com/category/world/

Population of Asia 2014 Population of Asia is estimated to be 4,426,683,000 compared to 4,299,000,000 in 2013. Asia consists of 49 countries. the largest continent of Earth, covering about 8.8% of the total surface area. 44,579,000 square kilometers, which is about 30% of the Earth’s land area.

Population of Asia 2014 People’s Republic of China with an estimated population 1.35 billion people. Republic of Maldives with an estimated population of about 330,000 in 2012. the Russian Federation with about 17.1 million square kilometers. the Republic of Maldives with a bout 298 square kilometers.

Health issues As the Asian population increases gradually, certain population have unfavorable health and have not experienced health improvements seen.

Health Issues in 2014 (February 5, 2014) - 739,000 deaths of children under the age of 5 years.  - 4,083,000 abortions.  - 33,500 deaths of mothers during birth.  - 163,500 people have died as a result of HIV or AIDS - 798,200 people have died as a result of cancer - 95,400 people have died as a result of malaria.  - 485,900 people have died as a result of smoking - 243,100 people have died as a result of alcohol.  - 131,200 road traffic fatalities. - 104,220 suicides. 

World Population Ageing 2013 United Nations , 2013 An aging population tops the list because it puts extra stress on an already overwhelmed industry. This demographic pressure continues to mount as baby boomers reach their 60s and beyond. Health care becomes a relative necessity as people age, creating a bigger demand for patient care, including progressive treatment services that often involve the use of advanced technology. The health care field needs nurses who have specialized skills and practice to provide innovative care to this aging population.

Global megatrend Women Empowerment: Women will have more decisive power over finance and business development gaining more prominence in the boardroom and at the family front. Goods, services and advertisements will be specifically targeted to women.

Global megatrend Generation Y: Most educated, affluent, assertive and IT literate generation in history, “digital natives” 15 – 35 years will have distinct values, beliefs, attitudes, lifestyle and behavioral patterns influencing product, technology development and marketing strategies in 2020. Constituting 34% of global population in 2020, Generation Y will be the most adaptive to change, ready to experiment with new technologies and a high level of purchasing power in 2020.

Next generation nurses Will be empowered to own nursing service facilities; nursing hospitals, clinics, or holistic health packages.

Megatrends in Global health care Editors of Harvard Business Review identified 12 megatrends: only 3 megatrends will be analyzed here. aging population Health care providers Medical tourism.

Nurse workforce gap คนรุ่น Baby-Boom เข้าสู่วัยเกษียณ วัยสูงอายุ ข้อมูลจาก เผยแพร่ข้อมูลเกี่ยวกับพยาบาลทั่วโลกและประเด็น พยาบาลทั่วโลกที่มีอยู่ 17+ ล้านคน ร้อยละ 50++ มีอายุ 40+ปี และร้อยละ 20 (3.4 ล้านคน) จะเข้าสู่วัยเกษียณในอีก 5 ปีข้างหน้า(ต้องผลิตทดแทนปีละเกือบ 7แสนคน) ประเทศต่างๆประสบกับปัญหานี้กันทั่ว อาทิ USA 2020 อาจต้องการพยาบาลถึง 1 ล้านคน AUS 2020 คาดว่าพยาบาลจะเกษียณถึง 9 หมื่นคน UK คาดว่าพยาบาลจะเกษียณประมาณ 1.8 แสนคน เกือบครึ่งของที่มีอยู่ในอีก10ปีข้างหน้า (www.ausmed.com.au The world without nurse.)

Nurse workshop gap (ต่อ) Nursing shortages persist globally. Serious challenges remain in nurse recruitment, education, continuing professional development (CPD) retention, and promotion. Issues and challenges: the identity of the nursing profession, limited faculty resources, English language barriers, transitioning of nursing education, CPD, and culturally competent care. (Thailand, Japan and Taiwan)

Nurse workshop gap (ต่อ) A specific career advancement opportunity for nurses in Japan is that of specializing in the area of gerontology. Japan will have the world’s oldest population by 2020 with over 31% of the population over 60 years of age (Ogawa & Matsukura, 2005). (127 m,2006) Nurses with specialized knowledge and training will be needed in order to plan and deliver quality care to meet the needs of older adult populations. a critical nursing workforce issue: the lack of advanced practice nurses trained in Gerontological nursing.

Nurse workshop gap (ต่อ) Chronic diseases: an important area for career development in Taiwan, eight out of ten leading causes of death are due to chronic diseases (Taiwan Government Information Office, 2008). Need: more nurses need to be prepared at the advanced practice level to offer palliative treatment and support in acute care hospitals, home care settings, and hospice centers.

Nurse workshop gap (ต่อ) 2011 projection of elderly was 11.5% or 7,639,000 คน Active to some extent 7,139,127 คน 499,873 คน need Long term care services. จำเป็นต้องจัดให้มีกำลังคนด้านสุขภาพ พยาบาลด้านผู้สูงอายุ พยาบาลด้านเวชปฏิบัติด้านผู้สูงอายุ เป็นต้น

Major health problems Health disparities. Health workforce shortage. Problem in achieving health equity, accessibility, and quality

Global Economic Crisis

Alameddine et al. Human Resources for Health 2012, 10:23

Economic crisis During economic crisis or resource limitation, Government reduced public workforce, resulting in a severe reduction of nurse midwives production and limited new positions for NMs in government health care facilities.

Healthcare complexity implementation of universal healthcare coverage policy in 2001, allowed more Thais to access the health care system. Hospital visits increased from 143.5 million visits in 2002 to 174.8 millions visits in 2009. Number of in-patients increased 33.36 % In 2008, Government passed new policy to increase health care access of rural population, established PCU, later Health Promotion Hospitals. Which required an additional 7000-8000 NMs to run nursing care and primary medical care services to rural community.

Healthcare complexity Increase ageing population (15.3% of total population) also increase disparities, disabilities and chronic diseases/illnesses. This needs have increased the need for new specialized competencies and a need for NMs to take on new roles as NCD nurse managers and long- term care managers in LTC system. Require more nurse managers, RNs, nurse specialized for elderly and palliative care.

Healthcare complexity Government policy to promote Thailand as Medical Hub in response to increase demand for health care of non Thais and to generate income for the country. The quality, moderate cost, and hospitality of health care in Thailand. Each year 1.5-2 million non-Thais seek health care services in Thailand. Next generation NMs, nurse specialists with language and cultural competencies. (Asian is non- English speaking)

Nurse mobilization ASEAN Mutual Recognition Arrangement on Nursing Services (MRA) Recognition of a Foreign Nurse to work in collaboration with local Professional Nurses to practice Nursing in accordance with the laws and regulations of the Host Country concerned subject to the following conditions as stated in MRA. TNMC/Nursing Education Institutions role to prepare future nurses for ASEAN and International Health (Medical Hub Policy)

Quality and responsiveness

นักศึกษาพยาบาลในอนาคต ใคร ? นักเรียนไทย นักเรียนต่างชาติ ผู้ที่เรียนสายอื่นมาก่อน พฤติกรรมการเรียนรู้: การเรียนรู้ภาคทฤษฎีและภาคปฎิบัติ

Foreign Students in Thai Higher Education Institutions 16,361 foreign students enrolling in 96 Thai higher education institutions. The top five institutions: Assumption University (2,558 students), Mahachulalongkornrajavidyalaya University (1,329 students), Mahidol University (1,069 students), Burapha University (591 students), and Rangsit University (487 students). The popular fields of study : Thai Language, Business Administration, English Language, and International Business and Marketing. (In 2008, the Office of the Higher Education Commission conducted a survey on enrolment of foreign students in Thai higher education institutions. http://inter.mua.go.th/main2/article.php?id=5)

Foreign students Number of International schools 120; International University 51 universities Total foreign students approx. 40,000 students Japan UK USA India and Korea. In 2013 number is expected to increase to 43,133 students (both Thai and foreign) An increase in Students' number from Myanmar, Vietnam, Cambodia, and Loa, PDR. (Kasikorn research center) In HE, foreign students are from China (20,155; 50%, Loa, PDR; Myanmar; Vietnam and Cambodia)(Commission on Higher Education) (http://www.khaosod.co.th/view_news.php?newsid=TURObFpIVXdOVEk1TURRMU5nPT0=)

Challenges of Asian nursing workforce Thai government has committed itself through policy: to improving health of its people through extending Universal healthcare coverage to Thai population; to improve health care access in rural areas; and its interest to be regional health care Hub. NMs as a political force must take advantage of these government interests to further the interests of the NM profession and to improve health care delivery.

Challenges of Asian nursing workforce Nursing shortage: Thailand has faced a continuous shortage of NM workforce for at least 3 decades. With 170,000 NMs to provide health care services to 67 million Thais, 40,000 NMs more are needed for the health care complexities and changes. NMs in Thailand had a working life expectancy of 22.5 years. Annual leave rates increased from 2.5 to 4.45% (health problems, low quality of life, heavy workload, and uncertainty in their employment/ job security issue) 2011 TNMC survey showed that 26.7% of faculty members in nursing schools or 1,173 Faculties will soon reach the age of 60 years – Thailand retirement age.

Challenges of Asian nursing workforce Nurse Migration (Aiken, 2007; Buchan & Seccombe, 2012) Production capacity of nursing schools; USA (Aiken, 2007) Thailand (Raymoul Nantsupawat, 2008) Generation Gap -- many current nursing professionals อาจารย์พยาบาล: nearing retirement age.

Recommended Action The need to improve nursing education and retention of NMs. Government should work collaboratively with the N&M profession in the development of competencies for educational and technical preparation of NMs, develops systems for sustaining those competencies, and give consideration to the development of the continuum of education necessary for attaining the required level of expertise of NM researchers, educators, and administrators.

Law & Regulations in Professional Practice เกณฑ์มาตรฐานหลักสูตรระดับปริญญาตรีและบัณฑิตศึกษา สกอ.* (ร่างปรับปรุงใหม่ หลักสูตรวิชาชีพ/ปฏิบัติการหมวดวิชาเฉพาะ สัดส่วน ป:ท 50:35; อาจารย์ เพิ่มเงื่อนไขภาษาอังกฤษสำหรับอาจารย์ใหม่และปรับ คุณสมบัติอจ.ประจำหลักสูตรเป็นป.โท หรือปริญญาตรีที่มีตำแหน่งผศ. และมีผลงานวิชาการอย่างน้อย 1 รายการในรอบ5ปี เป็นต้น) หลักสูตรตามข้อกำหนดของมาตรฐานของวิชาชีพและอจ.ประจำหลักสูตรต้องมีคุณสมบัติตามมาตรฐานวิชาชีพ (TQF สาขาพยาบาลศาสตร์(ต้องปรับปรุงใหม่เช่นกัน) หลักสูตรต้องสร้างสมรรถนะพยาบาลวิชาชีพตามที่สภาการพยาบาลกำหนด/

Law & Regulations in Professional Education National Education Act 1999 Higher education standards and administration. Thailand Qualification Framework (TQF) TQF Nursing Science License & Standard of Practice MRA (ASEAN; 10 countries) Professional Organization’s role on nursing shortage.

TNMC roles on nursing shortage TNMC played a crucial role in taking lead in tackle nurses’ shortage problem by seeking and working collaboratively with NAT, Dean consortium, Bureau of Nursing and the Government both Ministry of Education and Ministry of Public Health. Many actions have been proposed. Government has approved and supported The NM Production Plan in 2014. etc.

Professional N&M development plan. The 3rd Nursing and Midwifery Development plan 2012-2016 has been implemented up to this year. Nursing and Midwifery Development Plan is to be used as a roadmap of professional development in a period of time. The Budget for implementing the plan come from regular budget of all nursing organizations in both public and private.

Professional N&M development plan. Major strategies for nursing education dev. Plan. 1. Workforce planning. 2. Increase nurse production, development and retention. 3. Curriculum and teaching development at a higher education. 4. Development of practical nurse curriculum 5. Development and strengthening of nursing education institutions. 6. Development of nursing faculties and nursing students.

Working together for new challenges.

The objectives intended under the MRA 1. Facilitate mobility of nursing professionals within ASEAN 2. Exchange information and expertise on standards and qualifications 3. Promote adoption of best practice on professional nursing service 4. Provide opportunities for capacity building and training of nurses

ASEAN Mutual Recognition Arrangement on Nursing Services (MRA) Nursing regulation authorities. Nursing Board of Brunei   Ministry of Health, Cambodia  Ministry of Health, Republic of Indonesia    Ministry of Health, Lao PDR  Malaysia of Health & Midwifery Boards   Ministry of Health & Myanmar Nursing and Midwifery Council Professional Regulation Commission, Board of Nursing, the Republic of the Philippines Board of Nursing Singapore Thailand Nursing Council , Thailand.   Ministry of Health, Socialist Republic of Viet Nam ASEAN Joint Coordinating Committee on Nursing meets 2-3 times/Y

ASEAN Nursing Education Nursing Qualification means the qualification in nursing granted by a recognized Training Institution approved and recognized by the Nursing Regulatory Authority and/or the appropriate agency.(MRA) Professional Nurse/Registered Nurse. - 3 or 4 years training. - Curriculum must be developed using 5 ASEAN Nursing core competency. - Standard/quality framework of curriculum must be observed.

Future Thai nurses Comparative learning in ASEAN/ASIA context. Healthy Thais and Healthy ASEAN. Healthy life style, health believe, practice and self care practice. Practicum in ASEAN health care system. Multi-Cultural Care. Electives เช่น ภาษาประเทศเพื่อนบ้าน, การเป็นผู้ประกอบการ, การบริหารจัดการ หรือ กฏหมายสาธารณะ เป็นต้น

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