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An Analysis and Critical Evaluation of Nursing Education: Past, Present and Future

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Published: 8th Jun 2020

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An analysis and critical evaluation of nursing education: past, present and future.


Nursing profession in Thailand has been established for 100 years. The advanced progression from the initial period can be evidenced by the lowering of infant and maternal mortality rates and the raising of the life expectancy rate at birth (Thaweeboon et al., 2011). During this transformation, the period has developed from a hospital-based, training module trained by female physicians, to the development of doctoral degrees educated by nurses who are responsible at the doctoral level.

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In recent years, due to the noticeable impacts of globalisation in Thai nursing and comprehend the consumer, technology, expenditure, clinical performance, managed care, health policy, workforce, and integration (WHO, 2000). Furthermore, the substantial development of professional nursing had been influenced by Western nations, especially the United States (Liu, et.al, 2015). For instance, Thailand is undergoing health-care reform focusing on equity, quality, and efficiency, particularly in areas such as accessibility and transparency. These responsibilities include health promotion, disease prevention, care and rehabilitation of patients both in hospitals and in the community.

Many happened about nursing during the early years of nursing education in Thailand. The founding of the nursing profession helped not only to bring even more emphasis on the roles that nurses played but also drawn the attention of politicians and representatives to the significance of Thai nursing education.

Understanding the advanced improvement of the nursing profession in Thailand and the evolution in particular areas of nursing education could provide new insights and perspectives regarding nursing professional development. This essay intends to evaluate the advanced progress of nursing education in Thailand. This essay will determine a historical nursing education in the initial time, then comparing its programs with the current years and speculate as to its future directions.

According to Anders and Kunaviktikul (1999), nurses and midwifery employees encompass 70 per cent of all the health personnel of Thailand’s health care system. With regard to the nursing staff, shortages are projected in the future due to an ageing workforce (Kunaviktikul, 2006). Therefore, this could not be achieved without development in nursing education. In addition, the maintaining of education level for all nurses, both in the clinical setting and the community setting, is considered valuable due to the ever-changing circumstance in a globalising world, the improvement of technologies, and the emergence of new diseases.

Nursing education in Thailand began in 1896, developed from training system to hospital – training and then to higher education scheme. According to the Queen’s Sripatchariantra of King Rama V, it became evident that the first school of nursing and midwifery has established at Siriraj hospital in 1896. Priority to decreasing maternal and infant mortality rates. The early nursing program trained by male physicians from foreign nations. All of the nursing modules were a hospital-based at a diploma level (Thaweeboon et al., 2011; Liu et al., 2015). Therefore, the nursing profession was likely to assistants’ doctor rather than independent.

Because of many people living in rural and remote areas, where health-care services were commonly non-existent, thus the government has supported the concept of vital health services that were intended to meet the everyday needs of the population. (Thaweeboon et al., 2011). In 1956, the first program of the baccalaureate degree in nursing education started at the School of Nursing and Midwifery at the Siriraj of Mahidol University. After World War II, the number of nursing schools increased due to the shortage of nurses. Thus, a short nursing program has established as such a two-year technical nurse and one and half year practical nurse (Thaweeboon et al., 2011).

In 1971, with the establishing of the first Nursing Faculty at Khon Kaen University. As university-base programs, therefore, nursing became an independent profession (Kunaviktikul, 2006; Liu et al., 2015).

Then, the master’s degree level in nursing had existed in the country since 1973 at the education faculty of Chulalongkorn University (Kunaviktikul, 2006; Liu et al., 2015).

Regard to Anders and Kunaviktikul (1999) the nursing curriculum was mainly concerned with supportive of the National Health Policy.

The international doctoral nursing program began in 1999, by the collaboration among the Faculty of Nursing at Mahidol University, Chiang Mai University, and Khon Kaen University (Liu et al., 2015). Therefore, the strength area of nursing education in Thailand is midwifery. In addition, with the establishment of the international doctoral nursing program, it can increase the highest level of nursing education development in Thailand (Liu et al., 2015).

During the past decades, as a result of the number of nursing schools has increased considerably under both private institutions and governmental. The Nursing Council of Thailand was established in 1985, primarily goals to education and research and regulate the professional conduct of nurses and midwives. Through this long development, the School has progressively made Thai nursing a strong profession,with international standards and recognition (Thaweeboon et al., 2011 ) (Wittayasooporn, 2015)

Meaningful improvements of Thailand’s nursing education in the 1990s was included establishing of quality assurance system,  leading to achieving international standards, such as ISO 9002, ISO 1400; magnification a system for licensing and relicensing of professionals by the Nursing Council. (Citation) Wittayasooporn

Regard to WHO (2000) there were 66 nursing schools which fell under the authority of several divisions, Ministries of University Affairs, Health, Interior, Defense; Bangkok Metropolitan Administration; Red Cross, and the private sector.

At present-day, the nursing curriculums in Thailand includes at least 84 undergraduate, 45 masters, 12 doctoral programs and two programs of post-master internship training. (citation) There are now 85 nursing schools providing different levels of nursing education around the country in Thailand (Liu et al., 2015).

In recent year, several university schools of nursing in Thailand has cooperated with the school of nursing from abroad and hosting international nursing conferences. Association with Japanese and Taiwanese nurses, for example. (Wittayasooporn, 2015)

 (Citation) For nursing and midwifery services, the main activities within the past ten years focused on the improvement in the quality of nursing services at all levels of the health system. The Nursing Division had initiated the Quality Improvement Project in 1987 to improve the quality of nursing care in the country in both hospital and community settings. (Citation)

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 Activities under this mission included job analysis to verifying required improvements; advance and development of principles for patient care, and development of several nursing routine manuals. Primarily only 19 provincial hospitals were elaborated in this development. Nurses and customers were satisfied with this initiative, and therefore, it was established to every hospital throughout the country.

Future trends

With the population growing older and living longer, demand is likely to rise further, and the Thailand Nursing and Midwifery Council estimate that there will be a shortage of 50,000 nurses by 2020. (Anon, 2016).

Kunaviktikul (2006) suggests that the up-to-date in nursing point to a substantial increase in demand for health care and the need for health-care personnel to be informed of the newest information on medical innovations and latest treatments. Therefore, patient care-centre tend to considerable importance in the healthcare system. Nursing education is very likely to changes and improvements on alternative and complementary therapies, for instance. According to WHO (2000), nursing education should focus on community-nurses in the conducted with an emphasis on prevention and control of infectious diseases.

As Thailand is a tourist country. It has some experience in providing multicultural nursing care for various tourists. (Liu et al., 2015). Therefore, the results of reviewing the selected countries’ programs of nursing education can be used to establish academic credit recognition of the international exchange programs, and certainly to expand nurses’ horizons of intercultural nursing care. (Liu et al., 2015).

Another improvement for the future of nursing education in Thailand is for institutions to work in collaboration with each other, not just nationally but also internationally as a partnership.( Kunaviktikul,2006)

 Furthermore, to meet future challenges, ongoing research is vital to provide evidence-based teaching, critical thinking, and learning strategies that are appropriate to the environment and the present day (Kunaviktikul, 2006)

Linking among research, education, and practice in nursing is also of vital importance for the improvement of nursing. Collaboration between nursing institutions should be actively encouraged to allow for cross-cultural research, education, and the sharing of knowledge for the benefit of all involved. (Kunaviktikul , 2006).

This is because based on Thailand Nursing and Midwifery Council’s mission, they would like to upgrade the professional level of nurses to the same as other health alliance professions. Therefore, baccalaureate prepared nurses are currently required as the minimum level of nursing education in Thailand. In addition, the requirement is also related to the fact that different levels of nursing students hold different nurse working licenses in Thailand. When nurses with different levels of education work in clinical settings, they have different responsibilities. However, various nurses working in the same unit with different responsibilities makes patients confused about what kinds of nurses they should call to help them under different situations.(Liu et al., 2015).

The changes in  students’ profiles are requiring more male nurses to provide the nursing care to priests/monks, (2) education mobility: changes from classroom teaching to community or projects based areas teaching, (3) a shortage of registered nurses, with unequal distribution, (4) a shortage of qualified nursing faculty, (5) education technology (e-learning and distance learning), (6) changes in the health care settings from inpatient to community based, (7)an aging population, and (8) disaster nursing. .(Liu et al., 2015).

With the exception of Thailand, the epidemiologic data in the other three countries suggest a need to address the health care issues associated with aging. Course content could address such topics as osteoporosis, osteoarthritis, vision changes, depression, urogenital changes, difficult mobility, widowhood, and alterations in bodily appearance and function. Particular emphasis should be made in the women’s health curriculum on health promotion activities that are congruent with each country’s cultural values and beliefs. Thailand. Nursing education, in Thailand, should address prevention of anemia among pregnant women, access to healthcare services by women, and continuity of care from the hospital to the community. Consistent with the emphasis given on women’s rights and their quality of life in Thailand, nursing courses should focus on the changing healthcare needs of women, issues of abuse and violence, and the prevalence of HIV/AIDS. Nurses need to receive knowledge and skills in the assessment of women’s healthcare needs, factors contributing to abuse and violence, the availability of societal resources for abused women, and the use of preventative measures in the spread of HIV/AIDS (e.g., the use of condoms).


Looking at the history of nursing education, the beginning of nursing education in the aforementioned countries was at a similar time and it usually started at the hospital based nursing education level. During the development of nurse education, special historical events happened in each country. Some of those events contributed to the development of special nursing programs to fit the society’s needs. . (Lambert et al. 2004).

Although in Thailand, currently the lowest level of nursing education is baccalaureate, it may not be appropriate for other countries. On the other hand, the global shortage of nurses is recognized around the world. Furthermore, as our world is facing the problem of aging populations, the nursing program should focus on gerontology. Last but not least, with the increase in health care expenses, community based nursing programs should be considered in order to reduce the expenditure.(Liu et al., 2015; Kunaviktikul, 2006). The monitoring of population growth, infant mortality, life expectancy, leading causes of death, and current healthcare concerns is one way to assist in keeping nursing education related to women’s health relevant and current. Women’s healthcare has a bright future as long as all healthcare professionals maintain a creative and knowledgeable approach to educating the next generation of providers. (Lambert et al. 2004).

Five issues and challenges: that impact the career pathways of nursingstudents and nurses in Thailand including the identity of the nursing profession, limited faculty resources, English language barriers, transitions of nursing education, and the provision of culturally competent care.


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