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 Table of Contents  
NURSESí SECTION
Year : 2021  |  Volume : 2  |  Issue : 1  |  Page : 79-85

Evolution and current scenario of doctoral nursing education in India


1 College of Nursing, AIIMS, Jodhpur, Rajasthan, India
2 College of Nursing, AIIMS, Rishikesh, Uttarakhand, India
3 Department of Nursing, MGM Institute of Health Sciences, Kamothe, Navi Mumbai, Maharastra, India
4 Department of Nursing & Midwifery, Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei

Date of Submission10-Mar-2021
Date of Decision18-Mar-2021
Date of Acceptance20-Mar-2021
Date of Web Publication25-Apr-2021

Correspondence Address:
Prof. Suresh K Sharma
College of Nursing, AIIMS, Jodhpur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JME.JME_29_21

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How to cite this article:
Sharma SK, Rani R, Banerjee S, Mumin KH. Evolution and current scenario of doctoral nursing education in India. J Med Evid 2021;2:79-85

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Sharma SK, Rani R, Banerjee S, Mumin KH. Evolution and current scenario of doctoral nursing education in India. J Med Evid [serial online] 2021 [cited 2022 May 19];2:79-85. Available from: http://www.journaljme.org/text.asp?2021/2/1/79/314626


  Introduction Top
Doctoral nursing education has been identified as a key factor in the delivery of realistic research, leadership, policy-making and education training in the field of nursing.[1] Doctoral nursing education has been recognised as pivotal in developing scholarly leaders in nursing practice, management, research, policy, education and training. Nevertheless, it is indispensable for the multidimensional and transformative process of personal and professional growth for nurses.[2] Globally, it has been realised that the growth of nursing capability is a crucial strategy for attaining the Millennium Development Goals, Sustainable Developmental Goals and strengthening the health-care system. Therefore, governments are incessantly investing in upgrading the nurses to earn doctoral degrees, with the hope that they will lead the development of the nursing and health-care system in their nations.[3] There has been a growing trend in doctoral nursing education worldwide, in response to advances in health-care technology and multidisciplinary efforts to enhance the quality of care.[4] According to International Network for Doctoral Education in Nursing (INDEN) 2012, more than 34 countries offer 370 nursing doctoral programs globally.[5],[6] In Asia, the growth of doctoral nursing education was also observed as in 2017, 196 universities from 11 South and Southeast Asian countries started with doctoral nursing education.[4] Modern nursing in India commenced during the British regime, which was significantly influenced by Florence Nightingale and gradually evolved from hospital-based nursing training courses to university-based nursing education. Fortunately, the bachelorette and masters nursing degree programs were started as early as 1946 and 1960, respectively, at Rajkumari Amrit Kaur (RAK) College of Nursing, New Delhi.[7],[8] Astonishingly, in the recent past, there had been mushrooming of nursing institutes offering undergraduate and post-graduate nursing courses;[9] probably because of ever-increasing national and international demand for trained nursing manpower. Such a rapidly outgrown number of nursing institutes in the country failed to sustain the quality and standards of education due to lack of adequately qualified nursing academicians. It is essential to have a competent and adequate number of faculty to ensure quality in nursing education and the educational statutory body, namely University Grant Commission (UGC) has recently made it obligatory for higher education faculty to be doctoral educated.[10],[11] Furthermore, research in the past had provided evidence that quality of education had a significant positive association with the number of doctoral educated faculty. Unfortunately, there is nearly no literature about the evolution and present status of doctoral nursing education in India. If carefully analysed, historical knowledge can provide insight into the past, leading to a better understanding of the present and anticipate the future of the nursing profession.[7] Therefore, this review was undertaken to outline major milestones in the evolution of doctoral nursing education and its present status viz-a-viz comparing with progress in the developed nations. Authors have also recommended strategies to promote quality as well as quantity of doctoral nursing education in the country, which will ultimately promote the standard of nursing education, nursing administration and nursing policy processes that are significantly associated with the quality of patient care and safety.
  Search Strategy Top
A methodical search was conducted through PubMed, Google Scholar, Medline, Embase, Clinical Key and Ovid search. Books, grey literature and reference lists of the relevant articles were also hand searched. A broad search was conducted so as to obtain all the relevant full-text articles published since the inception of doctoral nursing education in India until September 2020 in various languages. Whenever available, controlled vocabulary such as Medical Subject Headings terms was used; otherwise, a combination of keywords with Boolean operators was used for electronic literature search. The search terms used were 'doctoral nursing education', 'nursing doctorates', 'doctor of philosophy in nursing', 'challenges in doctoral nursing education' and 'doctoral nursing education evolution in India'. By using these broad terms, the search yielded more than 1000 results, although not all of them were relevant to the topic under study. Next, the terms were narrowed down several times until we found articles representing the terms and literature relevant to our topic. Finally, for our review, 36 articles were selected, but very few of the articles were from India, so very little data on the development of doctoral nursing education and research in India were found. Therefore, some unavailable information was collected directly through E-mail and telephonic interviews with distinguished emeritus nursing faculties in the country. The aim of this review was to critically analyse, summarise the evolution and current status of the doctoral nursing education system in the country while comparing it with the western world.
  Doctoral Education for Nurses in India Top
Doctoral education for nurses was first initiated at Teachers College, Columbia University in 1933, and at New York University in 1934, which offered the doctor of education (EdD) degree to nurses through the education department to prepare nursing faculty.[1] However, modern nursing in India was established during the British regime and was remarkably influenced by Florence Nightingale. Nursing education evolved from hospital-based training to university-based degree programs. Even though bachelorette and masters nursing programs were started as early as 1947 and 1960, respectively, the doctoral nursing program was started much later and unfortunately, nurses were not considered eligible for enrolling in doctoral programs available in allied disciplines in the country. Therefore, in earlier times, Indian nurses were sent to foreign nations to pursue doctoral education with help of the support from the World Health Organization. The first Indian nurse to pursue the doctoral degree was Dr. Edith Buchanan, the then Vice-Principal at RAK, College of Nursing, New Delhi. She was sent to Columbia University, USA, to pursue her EdD in 1953. Subsequently, other senior faculty of the RAK College of Nursing, New Delhi, was sent to pursue their doctoral education from various other developed nations. Later, several Indian universities started the entry for nurses in doctoral programs in allied disciplines such as public administration, sociology, psychology, community medicine and other medical specialties.[7],[8] Dr. Indarjit Walia, former Principal, National Institute of Nursing Education, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, was the first Indian nurse to pursue the doctoral degree at the Department of Community Medicine, PGIMER, Chandigarh, in 1984. Simultaneously, a few months later, Dr. Homy F Dastoor, former Principal, Government College of Nursing, Ahmedabad, Gujarat, also completed her doctoral degree in the allied discipline from Gujarat University, Ahmedabad. Subsequently, many other nursing professionals, especially who were involved in nursing education obtained their doctoral degree in allied disciplines from different public and private universities of the country. Large numbers of nurses in the country are still perusing their doctoral degrees in allied disciplines such as public administration, sociology, psychology, community medicine and other medical specialties primary due to the limited availability of doctoral nursing education program seats.
  Doctoral Nursing Education in India Top
In 1954, the University of Pittsburgh for the first time started the doctor of philosophy (Ph.D.) program in nursing. Further, during the 1950s and 1960, several schools of nursing at different universities in the USA started Ph.D. in nursing. Nevertheless, to mention in 1963, Boston University designed the first program to deal with the clinical practice of nursing and created the doctor of nursing (ND) science degree with the first graduate in 1963. The University of Alabama at Birmingham developed a doctor of science in Nursing shortly thereafter and it was designed similarly to the Doctor of Nursing Science (DNS). A new approach to doctoral education in nursing was brought in 1979 by the Frances Payne Bolton School of Nursing at Case Western Reserve University by providing the first professional degree, the ND to college graduates.[12] The Ph.D. was started for the first time in India in PGIMER, Chandigarh, in 1985. The exact roots of doctoral nursing in India are not known, but it is believed that the first doctoral nursing education regulations, i.e., Ph.D. in the nursing ordinance was prepared in 1984 at the PGIMER, Chandigarh, and the course was opened for the admission in 1985. The first Ph.D. scholar (Ms. Jogindravati Gupta) was enrolled in 1985 at the College of Nursing, PGIMER, Chandigarh, under the supervision of Dr. Indrajit Walia and she could successfully submit her doctoral nursing dissertation in June 1990.[7],[13] Furthermore, in the year 1990, the 'High Power Committee for Nursing and Nursing Profession' recommended starting a doctoral nursing education program in selected universities in India. Thereafter, doctoral nursing education evolved at a very slow pace and there seems a long way to go for achieving desired quality and quantity of doctoral nursing education in India.[14] The major milestones related to the entry of nurses in doctoral programs and the evolution of doctoral nursing education are illustrated in [Table 1].
Table 1: Evolution of doctoral nursing education in India[7],[8],[9],[13],[15],[16]

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  Current Scenario of Doctoral Nursing Education in India Top
The research-focused doctoral nursing education is imparted in selected institutions in India with minimal integration of coursework focused on nursing sciences. Primarily, it may be because the aim of doctoral nursing education was not clearly comprehended by the teaching faculty as well as the students. It is evident that the majority of the nursing scholars are enrolling in the doctoral program with the perspective to secure an upscaled, socially recognised and respected title of 'doctor' rather than just being a 'nurse'. Furthermore, they perfer to choose the part-time mode for pursuing doctoral nursing program. Unfortunately, most of part-time doctoral nursing program offered are research-focused and lack quality in absence of quality control system in place. There are various key factors responsible for the poor quality of doctoral education for nurses in the country [Figure 1]. The key factor may be the lack of a sufficient number of qualified and competent nursing faculty to mentor the doctoral nursing program. Thus, nurses are forced to either enrol for a doctor degree in allied disciplines or choose to pursue a doctoral nursing degree under the non-nursing faculty (i.e., medical faculty). Most of the medical faculty who supervise doctoral nursing scholars have limited understanding of nursing and nursing research, thus engage these students in biomedical research, which has limited contribution towards the development of 'science' in the nursing profession. Further, most of the medical faculty engaged to supervise doctoral nursing scholars in India hardly holds the Ph.D. degree; thus, their mentorship always has several shortcomings to meet the aims of the doctoral nursing program. Nevertheless, to mention that most of the nursing faculty involved in the supervision of doctoral nursing programs neither have the track record of extra-mural funding or high-quality peer-reviewed publication into their credit, which ultimately affects the quality of doctoral nursing education in the country. Second, there is hardly any funding available for nursing research scholars to facilitate the research work when they enrol in doctoral nursing education. Additionally, there is discrimination in considering nurses for the Council of Scientific and Industrial Research-Junior Research Fellowship and National Eligibility Test for Junior Research Fellowship because they have to fight competition by choosing non-nursing subjects. Consequently, most of the nurses choose to pursue a part-time doctoral nursing program, so that they can continue their job and can financially support themselves during the program. Many a time balancing between a full-time job, life and studies become difficult, which may affect the quality of doctoral nursing education program. Third, there is a significant lack of infrastructure and sufficient library resources/research laboratory to support doctoral nursing education. As it is very evident that higher nursing education is not a top priority of either government or any institute. Therefore, budgetary allocation for the nursing library and other resources always takes back seats, which ultimately distresses the quality of the higher education in nursing including doctoral nursing education.
Figure 1: Key factors associated with poor quality of doctoral nursing education in India

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Furthermore, contributing to the menaces of the quality of doctoral nursing education, are the lack of regulatory laws and the accreditation of universities providing doctoral nursing degrees in the country. The doctoral nursing degree certificates of these institutions are highly questionable as issues of fake doctoral nursing degrees to the candidates have also been surfaced in the recent past. The Ph.D. and MPhil degrees offered by around 27 private universities across the country have been labelled invalid owing to unmet standards for the doctoral programs.[17] Such private institutes engage in the trade of the Ph.D. degrees for financial gain, and thus, most doctoral courses are of poor quality that hardly contributes to the knowledge base in nursing sciences. In reality, this corruption is closely linked to the increased need for enrolments in doctoral degree programs of these universities and institutes. In this view, for people who cannot attend a conventional regular doctoral program in a university, a Ph.D. degree through distance learning is considered ideal which offers considerable flexibility in their lives, job and facilitates of higher education.[18] However, UGC in the year 2017 released a circular, stating that the degrees awarded for Ph.D. programs through distance education would no longer be accepted and only full-time or part-time for the faculty/staff of university would be considered for the doctoral degrees.[10],[11] Fortunately, in the recent past, the Indian Nursing Council issued basic guidelines for the universities to start the doctoral nursing education program, which may help to regulate the program and control the malpractices in offering doctoral nursing degrees in the country.[9] Since the inception of nursing doctoral education in the USA (1954), it has multiplied to 131 research-focused programs in the USA alone with over 333 programs in 34 countries worldwide.[19] In India, however, according to the Federation of Indian Chambers of Commerce and Industry (FICCI) 2016 report, so far, there are only 251 Ph.D. Nursing scholars in total across all the centres of the national consortium.[20] The estimated number of nursing doctorates in other central universities, state and private universities, as well as deemed universities, are not known due to the lack of the main registry system of doctoral education in India. Fortunately, Ph.D. Nursing program has been started in several governments and private universities and institutions including the Institutes of National Importance such as All India Institute of Medical Science (AIIMS), New Delhi, Rishikesh, National Institute of Mental Health and Neurosciences, Bangalore, and Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry. Further, the Expert Advisory Committee on Nursing Education and Research for the six new AIIMS in 2013, proposed to implement the Ph.D. Nursing program in all the six new AIIMS and an integrated 5-year M. Sc. Nursing and Ph.D. program was also suggested. It has also been seen that nurses who are qualified with doctorate education tend to function as academicians rather than nurse clinician or manager in clinical practice settings.[21] Also, various nursing practice and nursing education focused doctorate courses such as DNS, EdD and Doctor of Nursing Practice are offered in western countries but have not been even started in our country which widens the gap between knowledge and practice, essentially required to provide quality nursing care.[22] The quality of the research topics being taken-up for PhDs in India is also of serious concern. In an attempt to ensure the quality of the research study carried out in India, the UGC has announced to conduct a pan India study on the quality of the research thesis being carried out in the last 10 years in all the disciplines across India.[23] The research topics being selected in the Ph.D. Nursing programs are principally biomedical or psychosocial discipline-focused rather than purely related to nursing. The doctoral nursing education must focus on developing science and body of knowledge for nursing by selected Ph.D. topics which are focused towards nursing science such as research on quality assurance in nursing practice, education and administration, developing and testing nursing theories/models, developing tools to measure the nursing phenomenon, studies which could impact policies related nursing practice, education and administration, etc.[24] The poor or unstructured framework of doctoral nursing education further contributes towards the decline in the quality of doctoral nursing education. The doctorate nursing scholar's curriculum should be moulded so as to enable them to assume positions of that of a leader in diverse health and education systems. The aim of the program should emphasise developing a theoretical and empirical framework for both current and evolving health-care systems and nursing sciences. It should also aid the nursing professional training, which could contribute towards effective evidence-based clinical practice.[25] It is very important to continue assessment for the quality of doctoral nursing education in India. The universities and institutions may use Quality Standards, Criteria and Indicators of INDEN for continuing quality assessment of their doctoral nursing education program, which includes seven major criteria for the assessment: (i) the nature of the mission, (ii) the quality of faculty, (iii) the quality of doctoral students; (iv) curriculum; (v) program administration; (vi) availability of institutional resources and (vii) evaluation of the program, which also consisted of subcriteria, standards and indicators to measure the quality of each specific criterion.[26],[27] There is an acute need to look into the issues and challenges of doctoral nursing education in India which are depicted in [Table 2] and to take obligatory measures to improve the quality of doctoral nursing education in the country. The key initiatives should be focused on doctoral nursing faculty development, provision of adequate funding, strict regulatory mechanism, robust entry process, structured curriculum/coursework, aims to develop nursing faculty and leadership competencies, high standards of evaluation/assessment system, provision of rich library/research lab recourses/infrastructure and continue quality assurance through structured assessment and accreditation system [Table 3].
Table 2: Issues and challenges with Doctoral Nursing Education in India

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Table 3: Strategies to improve quality and quantity of doctoral nursing education in India

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  Conclusion Top
Doctoral nursing education in India is still in its infancy stage and gradually evolving. There is a significant quest among nurses to pursue doctoral education, but simultaneously, there is co-existence of serious issues pertaining to the quantity and quality of available programs in the country. Thus, there is an acute need to improve the quality of doctoral nursing education in the country through nursing faculty capacity building, availability of sufficient funding, well-designed regulatory mechanism, structured curriculum/coursework, nursing science-focused research work, robust assessment methods, international collaboration and continuous quality assurance. Acknowledgement We would like to sincerely thank all the faculties from various nursing institutes for providing the required information related to the doctoral education in the country. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

 
  References Top

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