A Road to Excellence: The History of Basic Nursing Education at the University Hospital of the West Indies, Jamaica, 1949-2006

By Claire Duncan, Valerie Hardware, Jean Munroe and Norma Woodham

A Road to Excellence encapsulates the establishment of a school of nursing at the University Hospital of the West Indies and the progression of the basic nursing education programme from an apprenticeship system based on the British model to a partial student status system. The quality of the leadership throughout the period has been highlighted. The authors chronicle the influence of the Jamaica General Trained Nurses Association/ Nurses Association of Jamaica, the regulating role of the Nursing Council, and show how support from regional and international agencies contributed to changes in the administration and integrity of the curriculum. The flexibility of the teaching staff in adapting to current educational technologies and the response of the students as evidenced by their performance in the registration examinations are presented. Aspects of operations and functioning integral to the maintenance of standards in a school are also covered.

The authors all graduated from the University Hospital of the West Indies School of Nursing and had a history of service with many local and international nursing associations, and they have brought to this work their insiders’ understanding of the school’s journey from its inception.

• Language: English
• Publisher: The University of the West Indies Press
• Release date: Sep 1, 2017
• ISBN: 9789766530242

Claire Duncan

Claire Duncan retired in 2002 as Director of Training, Human Resource Management Department, University Hospital of the West Indies. She previously worked as a staff nurse, ward sister and nursing tutor with the University Hospital of the West Indies.

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A Road to Excellence

Canoe Press

7A Gibraltar Hall Road, Mona

Kingston 7, Jamaica

www.uwipress.com

© Claire Duncan, Valerie Hardware, Jean Munroe, Norma Woodham, 2017

All rights reserved. Published 2017

A catalogue record of this book is available

from the National Library of Jamaica.

ISBN: 978-976-653-022-8 (print)

978-976-653-023-5 (Kindle)

978-976-653-024-2 (ePub)

Set in Minion Pro 10.5/14.5 x 24

Book and cover design by Robert Harris

Printed in the United States of America

Supported by the CHASE Fund, Jamaica.

To Enid Lawrence, OD, gracious, committed and inspiring; to Valerie Hardware, meticulous, hardworking and enthusiastic, whose sense of humour kept us positive; and to members of the health team, University Hospital of the West Indies, and the staff of all agencies utilized by the University Hospital of the West Indies School of Nursing in the education of student nurses

Contents

List of Illustrations

List of Tables

Foreword

Preface

Acknowledgements

Introduction

List of Abbreviations

1Nursing Origins Education in Jamaica Prior to 1949

2The Development of the Basic Nursing Education Programme at the University College Hospital/University Hospital, 1949–2006

3The Early Years of the School of Nursing, 1949–1961

4The School of Nursing, 1962–1980

5The School of Nursing, 1981–1999

6Progress to Degree Status at the School of Nursing, 2000–2006

7Those Who Led the Way at the School of Nursing

Appendices

Appendix 1: Anecdotes

Appendix 2: Subjects Taught at the University Hospital of the West Indies School of Nursing, 1979 and 1973–1978

Appendix 3: Guide for a Survey Week, 1965

Appendix 4: Additional Data to Be Ready for Visitors on First Day of the Survey Visit

Appendix 5: Nursing and Medical Students Visiting the University Hospital of the West Indies School of Nursing, 1982–2006

Appendix 6: Grading Systems University Hospital of the West Indies School of Nursing 1974–2006

Appendix 7: Titles of Courses in the Curriculum for Basic Schools of Nursing, Jamaica, 1985

Appendix 8: Outline of Theoretical Content 2003 (1985 Curriculum), University Hospital of the West Indies School of Nursing

Appendix 9: Individuals Honoured at Graduation for Services to University Hospital of the West Indies School of Nursing

Appendix 10: Teaching Staff of the University College/University Hospital of the West Indies School of Nursing (Tutors Sisters and Staff Nurses)

Notes

Selected Bibliography

Index

Illustrations

1.1. Mary Seacole, 1805–1881

1.2. Sir Winston Churchill visiting the newly opened University College Hospital, 1953

2.1. Representatives of schools of nursing at a PAHO/WHO regional clinical teaching workshop, Jamaica, 1980

2.2. The greatest black Briton remembered, 2005

3.1. The premises of the University College Hospital of the West Indies School of Nursing prior to 1960: the Dome Building

3.2. Sign at the entrance to the new School of Nursing building, 1960

3.3. The School of Nursing building, 1960

3.4. Her Royal Highness Princess Alice visiting the University College Hospital, 1960

3.5. The nurses’ residence The Bastille, built 1953

3.6 Matron Margaret Foster Smith with the graduating class of 1953

3.7. Matron Ruth Nita Barrow with the graduating class of 1955

3.8. First principal tutor Doris Frame with the graduating class of December 1958

3.9. Matron Edith Felsted with the graduating class of 1959

3.10. Graduation certificate Batch 1–5, Government Medical Service, Kingston Public Hospital

3.11. Graduation certificate Batch 6–10, University College Hospital and Kingston Public Hospital

3.12. Graduation certificate Batch 11, 1966, University College Hospital of the West Indies School of Nursing

4.1. Senior tutor Enid Lawrence with Batches 43 and 44 in Study Block

4.2. A group of second-year student nurses in the classroom, University College Hospital of the West Indies School of Nursing, 1963

4.3. Three-year BNEP, University Hospital of the West Indies Department of Nursing Education, revised 1973

4.4. Tutorial staff, University College Hospital of the West Indies School of Nursing, c .1965

4.5. Organizational chart, University Hospital of the West Indies School of Nursing, 1971

4.6. Organizational chart, University Hospital of the West Indies Department of Nursing Education, 1975

4.7. Elaine Geissler, nurse educator of the hospital ship SS Hope , chairing the Curriculum Development Committee in 1971

4.8. The netball team, University Hospital of the West Indies School of Nursing, 1971

4.9. Violet Carby at a graduation ceremony in the mid-1960s

4.10. Graduation certificate, 1967–2006, University Hospital of the West Indies Jamaica School of Nursing

5.1. Batch 94 (1990–93), the last group to be taught using the 1979 curriculum

5.2. University Hospital of the West Indies School of Nursing, basic and midwifery programmes (1985 Curriculum), 2003 calendar

5.3. Organizational chart, University Hospital of the West Indies Department of Nursing Education, 1990s–2003

5.4. Governor General Sir Florizel Glasspole with student nurses and a clinical instructor during his Christmas visit to the University Hospital of the West Indies, 1987

5.5. Cheering students of Mary Seacole House on Sports Day, c. 1992

5.6. Student nurses singing at the valedictory service in the UWI Chapel

5.7. Staff of the Department of Nursing Education assemble for the valedictory service in the UWI Chapel

5.8. Tutorial staff and student nurses in formation outside the UWI Chapel at the end of the 1997 valedictory service

5.9. A graduate of the University Hospital of the West Indies School of Nursing at first year, third year and after graduation in 1998

5.10. Graduates attending the fortieth anniversary reunion of the League of Graduate Nurses, UHWI, 1998

6.1. Plaque commemorating the gift of the Pelican Fountain and the friendship between University Hospital of the West Indies School of Nursing and Winona State University Nursing Department, 2002

6.2. The Pelican Fountain on the lawns of the quadrangle, University Hospital of the West Indies School of Nursing

6.3. Members of staff of the University Hospital of the West Indies School of Nursing, c. 2000–2002

6.4. Members of the University Hospital of the West Indies School of Nursing award-winning choir in costume

6.5. Unveiling the plaque on behalf of all graduates of the University College/University Hospital of the West Indies School of Nursing, 1949–2006

6.6. The Enid Lawrence Learning Resource Centre, Department of Nursing Education, University Hospital of the West Indies, June 2006

6.7. Entrance to the E. Norma Woodham Building, Department of Nursing Education, University Hospital of the West Indies, June 2006

7.1. Margaret Foster Smith, matron, 1948–54

7.2. Ruth Barrow, matron, 1954–56

7.3. Edith Felsted, matron, 1956–66

7.4. Cislyn Lambert, matron, 1967–72

7.5. Lois Dujon, matron, 1972–74

7.6. Enid Lawrence, director of nursing education, 1974–79

7.7. Elaine Woodham, director of nursing education, 1981–2003

7.8. Zada Mulrain, director of nursing education, 2003–4

7.9. Veronica McCrobie, senior director nursing, 2004–5

7.10. Joy Lyttle, senior director nursing, 2006

Tables

2.1. National Performance in the Regional Examination for Nurse Registration, Jamaica, 1994–1996

3.1. Final State Examination Results, UCHWISON, 1953–1960

3.2. Intake of Student Nurses PTS and Numbers Qualified for Training, UCHWI, 1952–1961

3.3. Estimates of Expenditure, Preliminary Training School, UCHWI, October 1953

3.4. Incumbent Matrons, 1948–1961

3.5. Number of Graduates from the BNEP, UCHWI, 1953–1961

4.1. Theory and Clinical Hours, UHWISON, 1973–1979

4.2. Final State Examination Results for the UCHWISON/UHWISON, 1961–1975

4.3. Student Intake, UHWISON, 1970–1979

4.4. Attrition Rate of the UCHWISON/UHWISON, 1966–1970

4.5. Incumbents in the Posts of Matron and Principal Tutor, 1962–1974

4.6. Number of Graduates from the UCHWISON/UHWISON, 1962–1980

5.1. Structure of the UHWISON Programme for the 1985 Curriculum for the BNEPs, Jamaica

5.2. Performance in the Registration Examinations, UHWISON, 1982–1999

5.3. Intake of Students, UWIHSON, 1981–1999

5.4. Student Nurses Stipend, UHWISON, 1987–1999

5.5. Student Fees, UHWISON, 1997–1999

5.6. Values of Bonding Contracts for Student Nurses, UHWISON, 1981–1999

5.7. Estimates of Expenditure, UHWI: Nursing Education (599/099), 1981, 1987 and 1999

5.8. Establishment of Teaching Staff, UHWISON, 1981 and 1999

5.9. Number of Graduates from the UHWISON, 1981–1999

6.1. Performance of the UHWISON in the RENR, 2000–2006

6.2. Number of Qualified Applicants and Numbers Trained at the UHWISON, 2000–2003

6.3. Student Fees, UHWISON, 2000–2004

6.4. Student Nurses’ Stipend, 2000–2002

6.5. Values of Bonding Contracts for Student Nurses, UHWISON, 2000–2004

6.6. Number of Graduates from the UHWISON, 2000–2006

Foreword

There are several reasons for my pleasure in writing a brief foreword to this book. First, I applaud what is really a labour of love by a few committed nurses who have dedicated an enormous amount of time and effort in compiling the data to be incorporated into this book. Second, it evoked in me many pleasant memories of some of the times, places and people mentioned in the book. Finally, it is because I believe that it is important that those who are coming after the pioneers get a sense of history and appreciate some of the twists and turns of the fate of nursing education.

It is impressive that the authors could have traced so many of the original records and could refer with confidence to events that one might have thought were hidden among the cobwebs of history. This is not only a history of nursing education, it is a mine of fascinating information about several events that bear upon, but might not be thought to be immediately germane to nursing education. The form of its presentation and the many vignettes – some personal, some institutional – give one a glimpse into the times and lives of the nursing stalwarts of the day and show clearly the deep respect they had for the profession itself and how committed they were to seeing that the education was the best that could be offered.

The book ranges widely to incorporate both the national and the international dimension. It goes into the early history of nursing in Jamaica as a backdrop to the training of nurses in the country as a whole. The title is itself evocative, or perhaps provocative as it gives a charge to those practising now to follow a road to excellence. There is no indication that the road has an end. The book sets out the road travelled up until recently, and I would like to believe that the authors wish to convey that this is almost an unbroken road along which nurses of every age must walk. It is clear that nursing education has changed considerably, as it should, given the changes in pedagogy and technology, but I hope that those involved in teaching and learning will read this book and be even firmer in their resolve to uphold the noble principles of the profession in spite of these changes.

I wish the book well and hope it will be warmly accepted by a wide readership.

Professor the Honourable Sir George Alleyne

OCC, MBBS UCWI, MD Lond, FRCP, FACP (Hons), Hon. DSc UWI

Chancellor, University of the West Indies

Preface

This book showcases the Basic Nursing Education Programme (BNEP) as was conducted in the School of Nursing at the University College Hospital, later University Hospital of the West Indies at Mona, in Kingston, Jamaica, from 1949 to 2006, a period of over half a century. It is to be noted that in 1949 the programme began with a joint Kingston Public Hospital/University College Hospital of the West Indies Preliminary Training School programme based at the University College, Mona. Nurses trained for the University College Hospital did their complete studies and training at the Kingston Public Hospital. The full BNEP based at the University College Hospital started in 1952 when the newly built hospital accepted patients. This book highlights the structure, administration and evolution of the programme as relates to the provision of an improved standard of basic nursing education and by extension that of nursing care services. We acknowledge a limitation to this publication due to the fact that most of the school’s files were destroyed and the library dismantled, resulting in the loss of many sources referenced in the book.

This book will also serve to augment the paucity of existing literature on nursing education in the region. We believe that this book will be a useful reference to a wide cross-section of health professionals and academics. It provides a historical reference for nurses participating in the construction and delivery of nursing education programmes in Jamaica, the Caribbean and beyond. It is also a source of information for other groups involved in investigative and constructive academic activities.

The book begins with a brief introduction of the origins and progress in nursing education in Jamaica prior to 1949. Chapter 2 presents an overview of the events and issues influencing the BNEP. Relevant developments taking place at the international, regional and local levels during the period 1949– 2006 are covered. The main focus of the text, the BNEP as was conducted at the University College/University Hospital of the West Indies, Jamaica, is described in chapters 3 to 6 in the following periods: 1949 to 1961, 1962 to 1980, 1981 to 1999 and 2000 to 2006. The main features and specific elements of the programme are described. Comments made by a sample of graduates of the School of Nursing on the quality of their training and the extent to which it has prepared them to carry out their role as graduate nurses appear at the end of each chapter. Chapter 7, the conclusion, summarizes the contributions of each administrative head of the BNEP and outlines milestones along the road to excellence. In keeping with the penchant of the Jamaican personality for humour, a compilation of light-hearted anecdotes supplied by graduates has been placed in appendix 1.

We the authors, all graduates of the school, are pleased to have had the opportunity to write this historical book on nursing education at the University Hospital of the West Indies, Jamaica. We regret that Enid Lawrence, the first director of the school, who had been a member of the team, passed away shortly after the project began. Her extensive knowledge of the programme and considerable experience in nursing education have been sadly missed during the remaining period of our work.

We invite you to read this book which describes the development of the BNEP at the University College/University Hospital of the West Indies as it progressed from an apprenticeship towards student status. This road traversed by the students of the School of Nursing of the University College/University Hospital of the West Indies was the way to excellence in the education and practice of nursing. The comments made by the sample of graduates are instructive in this regard. The extent to which graduates have been sought after for employment both at home and in the diaspora also substantiates the school’s reputation for excellence.

Acknowledgements

In January 2006, we the authors accepted an assignment from the planning committee for the closing ceremonies of the School of Nursing chaired by Zada Mulrain, director of nursing education, to write a history of the University Hospital of the West Indies School of Nursing. We recognize Dr Pansy Hamilton of the Hugh Wynter Fertility Management Unit, University of the West Indies, Mona, who encouraged us to expand our assignment into a book. We acknowledge with thanks her logistical and psychosocial support during the process of writing.

We wish to record our appreciation of the support given by the University Hospital of the West Indies Board of Management, successive chief executive officers, project managers and senior directors nursing service at the University Hospital of the West Indies during the period of our work on the project of publishing this book. This sentiment is also extended to members of staff of the hospital at all levels of the hierarchy of the institution.

Our profound gratitude is extended to the Culture, Health, Arts, Sports and Education (CHASE) Fund for responding positively to a proposal seeking financial support towards the cost of publication. We appreciate their patience, understanding and advice given in respect of concerns that arose from time to time during the life of the project. We also wish to thank the following institutions and individuals: the Jamaica Nurses Association of Florida, the Winona State University School of Nursing, Minnesota, and the numerous graduates and friends for their respective financial donations and other forms of support during the period of this project.

We also wish to thank the staff of other institutions locally which provided assistance to us in our effort to obtain information needed to prepare the manuscript: the Ministry of Health of Jamaica, the Nursing Council of Jamaica and the Nurses Association of Jamaica. We make special mention of Dorrie Patterson, former sister on the staff of the University Hospital, whose interest in the preservation of nursing records made it possible for us to obtain a significant volume of relevant information.

We are indeed indebted in no small measure to Judith Umrah, who typed successive drafts of the manuscript. Her generosity, cooperation, competence, patience and ability to find her way, metaphorically speaking, guided by numerous arrows and asterisks, was enviable. Expert advice given by Linda Speth of the University of the West Indies Press has gone a long way in assisting us in the preparation of the manuscript. Her willingness to meet with us from time to time was highly appreciated. Interest displayed in our effort to publish and legal advice on copyright matters was generously given by Beverly Periera, legal counsel for the University of the West Indies, and was extremely helpful. We express our deepest appreciation to her for sharing her expertise with us.

The support of the director and staff of the nursing staff development department of the University Hospital of the West Indies, where we held our weekly meetings and were provided with secretarial support services throughout the life of the project, has been encouraging and was highly appreciated. We thank them all for their consistently high level of cooperation. We wish to express our thanks to Beverly Roper, who during her tenure as a tutor in the School of Midwifery took the initiative to allow a comfortable room to be made available on a weekly basis for us to work on the project. The encouragement and support given by so many of our nursing colleagues, members of the medical and other health care fraternities in the hospital and beyond has been a source of inspiration. We take this opportunity to express our appreciation of the contribution of a selected number of distinguished persons who read and commented on the draft manuscript: Professor the Honourable Sir George Alleyne, Peter Carr, Marva Lawson-Byfield, Dr Pansy Hamilton, Dr Hermi Hewitt, Thelma Jackson, Professor the Honourable Owen Morgan, Dr Trevor Munroe, Dorrie Patterson, Dr Una V. Reid, Pearline Cooper Sharpe and Elinora Warner. The critique provided by each of them has been most useful.

To editors Denise Gray Gooden and Maxine McDonnough, our deepest gratitude for your guidance, support and patience.

We take this opportunity to announce that we have agreed not to accept financial reward which may emanate from the sale of this book. It is our wish for an appropriate protocol to be put in place by the administrative body of the University Hospital of the West Indies for such funds to be committed to the award of an annual bursary to deserving graduate nurses employed at the University Hospital of the West Indies to facilitate postgraduate studies in nursing or attendance at nursing and related conferences.

In conclusion, the understanding and support of our respective family members during the somewhat extended period of distraction from family responsibilities has been comforting. We the authors, all graduates of and former tutors in the School of Nursing at the University College/University Hospital of the West Indies, wish to record that it was truly as a result of the love for our nursing school, mutual respect for each other and divine inspiration towards the completion of the task that we have come thus far.

Introduction

Contemporary scholars view nursing as a key profession in the planning and delivery of health services. The hallmark of the profession is safe, ethical quality care based on scientific principles and provided through a problem-solving and therapeutic approach.

Nurses provide comprehensive care to patients of all ages, at all stages of the health-illness continuum in all health care arenas, embracing primary, secondary and tertiary care. In these arenas, nurses function independently and interdependently in the promotion and maintenance of health, prevention of illness, restoration of health status, rehabilitation and supporting the patient and family at the end stage of life.

The scope of nursing practice embraces the roles of caregiver, patient advocate, administrator/manager, educator, researcher, lobbyist and advisor. The basis of these roles and outcomes of the related functions are both scientific and heuristic, guided by cognitive, ethical and legal parameters within the value system of the profession. Values of trust and therapeutic care are consonant with the healing process.

Nursing education has developed in tandem with the evolution of the nursing profession. Various models have emerged, ranging from servant to apprenticeship to the present entry-to-practice requirements of an undergraduate degree. The models of curriculum have also changed in keeping with the models of nursing education and the emphasis of health services delivery. The two prominent models which emerged are the medical model, which is hospital-based, and the scientific and health-promotion model, which is educational institution–based, with nurse educators assuming full responsibility for the educational programmes. The evolution also saw nursing education being overseen by a nursing regulatory framework.

The nurse educator facilitates learning, problem solving, critical thinking, and guiding the students through a range of learning opportunities and activities supported by appropriate technology. A foundation of knowledge in science and humanities, critical thinking, health and human functioning, care, and therapeutics shapes today’s nursing education curriculum. The graduates are prepared to function purposefully and responsibly in diverse health care environments; to contribute to health promotion and maintenance services; and to provide care to individuals across their lifespan, to families, groups and communities with a variety of health problems.

The curriculum reflects the national social and health needs and acknowledges issues in health and nursing globally. It is a dynamic document responsive to the ever-changing national, regional and global social, health and nursing scenes. Lifelong personal and professional learning is imperative in keeping abreast of developments in these dynamic environments.

The evolution of nursing in Jamaica and the wider Caribbean is comprehensive, progressive and organized. This book deals with an aspect of this evolution, noting the stages of development from apprenticeship diploma-type programmes to the present baccalaureate degree as an entry-to-practice requirement, with the graduates progressing to doctoral studies in various fields.

We continue to keep pace with national, regional and global developments in nursing – health, science and technology – in the interest of continuing professional development and in service to our people of the Caribbean and beyond.

Dr Una V. Reid

BScN, MSN, MEd, EdD, RN, RM

HRD Consultant

Abbreviations

1

Nursing Education Origins in Jamaica Prior to 1949

The past is our heritage

The present is our responsibility

The future is our challenge

All three have a place at all times.¹

—Gertrude Swaby, The Profession of Nursing

In order to understand the circumstances out of which organized nursing education developed in Jamaica, we must review the origins and progress of nursing prior to 1949, and the external and internal forces that led to the introduction of an improved standard of nursing education at the end of the 1940s.

The unique function of the nurse, as defined by Virginia Henderson and adopted by the International Council of Nurses (ICN), is to assist the individual sick or well in the performance of those activities contributing to health or its recovery . . . that he would perform if he had the necessary strength, will or knowledge and to do this in such a way as to help him gain independence as rapidly as possible.² Agnes Pavey writes:

when we reflect that birth, sickness, accidental injuries and death have played an inevitable part in the life of every human being who has ever sojourned on this earth, we cannot but realize that nursing must also have had its origin with the beginning of life itself, although we search in vain amongst the records of ancient peoples for any definite account of such work, or even allusions to the part that women must have played in the care of the helpless and sick of their time.³

Consistent with Pavey, Gertrude Swaby, renowned Jamaican nurse educator, concurs in reference to the Jamaican situation: Little is known of the primitive medical practices which prevailed in the very early days of our history, and practically nothing authentic exists for reference about nursing until the latter part of the eighteenth century.⁴ However, there is some evidence that amid the fabric of the exploitative social landscape of seventeenth-century Jamaica, embryonic nursing roles had begun to emerge.

The earliest mention of a nurse is the so-called plantation nurse of the seventeenth century. Swaby cites Barkly’s description of the nurse as one of the best disposed and most trustworthy women on the estate . . . her duty was to keep the plantation hospital and the sick in it, to clean and to cook such food for the patients as were prescribed.⁵ Other nursing roles of the period have been identified as that of grandy or nana who carried out caring roles on the plantation. The role of wet nurse, as well as other designated females attending to the sick, were also identified. These women were not known to have received any form of nursing training.

In 1776, with the establishment of the Kingston Public Hospital (KPH), men only were employed as nurses as the women were working in the plantation hospitals. Most of these male workers were illiterate and untrained. Furthermore, they worked on shifts and performing multiple roles as porters and labourers. In the post-emancipation period of the 1840s, the former plantation slaves, most of whom were illiterate, were not equipped to benefit from any form of training. The diary of Richard Rouse, warden of the lunatic asylum between 1854 and 1858, provides insight into nursing care at that institution: The nurses and servants I found generally careless. . . . I was struck by the carelessness and indifference that prevails on the part of the matron.⁶

Early Nurses

The first known historical record of a female nurse by name is Swaby’s reference to Couba Cornwallis, a lodging housekeeper who lived in Port Royal, Jamaica. No record of the date of her birth has been sourced, but there is a record of her death in 1848. Cornwallis is reputed to have saved the life of the British admiral Horatio Nelson, who, after his Nicaraguan expedition, was brought ashore in Jamaica suffering from intermittent fever. He was so pleased with her care that when he was transferred to another residence in the