Islamic University of Gaza Faculty of Nursing

1. Islamic University of GazaFaculty of Nursing Trends And Issues Ali H. Abu Ryala NURSING IN PALESTINE

2. Introduction • The nursing profession has grown significantly in the past recent years in Palestine. • Now there is advanced technology used to provide the advanced health care consistent with these development nurses needs to be qualified, efficient and effective. • Specialty nursing education future plan for nurses/midwives need to concentrate on fields with least available such as oncology, health education, women health, management, orthopedic, rehabilitation etc.

3. Introduction… cont • It has become an extremely important component in health care system, taking to fact that nurses represent the majority group among all health care professionals. • Therefore, the increased awareness of the Palestinian nurses, together with the possibility to promoting and developing the nursing profession, has seen in the last years.

4. Statistics • The total number of employed nurses in Palestine 5910 at the end of 2003, out of which 2524 are working in MoH (42.7%), 1602 in NGOs (27.1%), 944 in UNRWA (16%) and 840 in Military Medical Services (14.2%). • More nurses were employed by the public sector in Gaza Strip (68%) than in the West Bank (40.3%). • The local and International NGOs employed about 45.2% of the nursing population in the WB and 9.8% in GS. • This can be attributed to the fact that the NGOs health sector represents a large constituency in the WB than in GS. The UNRWA employed 6.8% of the WB nursing personnel and 16.9% of those in GS.

5. Statistics…cont • This is related to the fact that there are more refugees residing in Gaza Strip than in the West Bank (MoH 2003). • Improving the working condition for nurses, especially for aged nurses. • Increased allowances, salaries, full overtime payment, active association and professional body to put the legislation and control of nursing profession.

6. Statistics…cont • In addition of effort undertaken in the last few years to improve nursing profession, there are still many problems and challenges. • These include shortage of nursing and midwives, absence of standards for nursing and midwifery practice, lack of nursing regulatory system. • Nursing research is another issues needs development and support, establishing nursing information database for nursing personnel in Palestine.

7. In a recent speech the present President of International Council of Nursing (ICN), Dr Margarita Styles summed up today's challenge for nursing. • It is to build a profession that can realize the potential of nursing that comes from a vision based on a moral passion for the health of people and the belief that nurses are essential members of society. • At the same time, if nursing is to fulfill its social obligations, it must become firmly rooted in a rock solid foundation of high standards of education and practice; demonstrate political skills in working with others for effective health policy and planning show economic sense in allocation and utilization of resources; and create a strong solidarity amongst nurses.

8. Historical Overview of Nursing in Palestine. • Nursing has passed through four historical eras: • The Turkish rule. • The British Mandate. • Jordanians control over the West Bank and the Egyptian control over Gaza. • The Israeli occupation of the West Bank and Gaza Strip.

9. The Turkish Era (1517-1917). • In this period of time which lasted about 400 years left all Arab countries including Palestine in total darkness and regression. Then Christian commission started spreading out in Palestine building clinics. • The health services were poor and primitive. • Herbs and popular medicine were generally used for treating diseases. • In this period nurses were trained by physicians who work in the hospitals.

10. The British Mandate (1921-1948). • In this era, people continued to suffer from poverty, ignorance and sickness because primitive agriculture was the main source of living except in big cities. • In 1925 in Jerusalem, the only children hospital was established which served East Jerusalem and the West Bank. • In this hospital, a nurse training program was started for those wished to avail themselves children services. • Either during this period some hospitals were established in major cities in Palestine one of which was the government general hospital in Jaffa city in which British nurses taught Arab girls nursing for three years those girls who study nursing where mainly from well known Christian families from major cities.

11. The British Mandate…cont • The graduates of this program were offered certificates from (the diploma of health government of Palestine). • Also the British government hospital in Jerusalem city- which is called after that Al-Hussein hospital sincs1957- had nursing school which offered three years training program for nurses till 1948 and it was closed because of the second war for a while. • After the war the nursing students has to continue their studies in the Swedish hospital, (mental health hospital) and from 1948-1953 the ministry of health of Jordan granted the certificates, the total of graduated nurses are 52 nurses. (Shahin1994)

12. Jordanian Control over West Bank and Egyptian Control over Gaza Era

13. Augusta Victoria School Nursing • 1951 on jabal Ezytoon in Jerusalem under the supervision of (UNRWA) and Lutheran world federation British curriculum until 1969 then the Jordanian curriculum (practical and diploma degree) the program were accredited in occupation as well in Jordan. Saint John School for Practical Nurse 1960. • Offers a practical nurse certificates

14. Saint Luke’s School for Practical Nurse 1965 • The course should continue in 18 months and the ministry of health in Jordan recognized the curriculum. • In Gs the situation was different some how. • In the early fifties the Christian Missionary society started on the job of training programs were several girls from the sixth elementary school were trained in the British hospital now called (Al- Ahli- Arabi Hospital).

15. Practical School of Nursing in Gaza (shifa) 1963. • Hospital’ the student should continue a course of six months to complete the shortage of nursing needs. • Teachers were doctors and nurses from European countries, after that the program developed to 18 months recognized by the occupation government the school closed on 1990. • Midwifery programs were established after that until the (PNA) anotherprograms started.

16. The Baptist Nursing School Gaza 1965 • Established and the students should continued three years training with a degree diploma of nursing accredited by the occupation government until 1984. After that the student started to examine by the occupation government to be licensed. • In this era the number of nurses in both (WB-GS) was limited. So the UNRWA with the Baptist school administration brought nurses from Egypt and Lebanon since a limited number of girls from Gaza were allowed to continue their education.

17. The Baptist Nursing School 1965…cont • The enrollments of male nursing students and already male practicing nurses have further affection on the recruitment of female nurses. • The main event on this era was initiation of the Palestinian nursing association (PNA) in 1956 in Jerusalem. • In some years (PNA) by the staff nurse Betty Najaj obtained membership of international council for nursing in England (Shahin 1994).

18. Israeli occupied (West Bank-Gaza Strip) 1967-1994. • In this era there are several factors affected nursing. Some of these factors were either external to the profession as the political situation in the region or internal factors to the nursing profession as low salary poor promotion and limited continuing education opportunities. • All health services institutions run by the Jordanian and Egyptian governments were taken over by the Israeli government as a result of Israeli occupation in June 5th 1967. • Many highly populated refugee camps were created and suffered from the complex health and social problems, which needed to be taken care of.

19. Israeli occupied (West Bank-Gaza Strip)…cont • As result of political and economical situations in the region, the number of nurses affected so many nurses left the country to work in the Arab Golf countries. • The outbreak of Intifada in 1987 Furthermore the economy weakened by strikes, curfews and restrictions imposed by the Israeli Authorities indirectly affected the nursing profession. Several practical nursing schools were established to cover the needs for nurses or to make money by attracting third secondary schools (Tawjihi).

20. Caritas School of Nursing • In Bethlehem in 1969 it recruited girls who were already working as nurses in “Caritas Baby Hospital” to overcome the shortage in nurses. In 1980, the school adapted an 18 months practical program and 6 months specialized in pediatric nursing (Shahin 1994).

21. Makassed Islamic Charitable Hospital • School of nursing (Jerusalem) 1971 Until 1975 females only accepted in the school programs for 18 months training after that male students were accepted, and then closed in 1989 due to thinking 3 years diploma, but because of Intifada, the course did not started, and then the previous course restarted in 1990. • Post-graduated midwifery diploma and intensive nursing is provided.

22. Ibn Sina College for Registered Nurses • 1971, It has 3 branches, one in Ram Allah city for female students, the second in Bethlehem city for male students (1990) and the third one is in Nablus for midwives diploma.

23. Al Itihad School Nursing in Nablus 1975 • 18 months course Nursing College at Bethlehem University 1976 it offers Bsn degree and many post-graduated programs in midwifery and clinical instructors (Shahin 1994).

24. The Qualified School of Nursing in Gaza 1976 • The school recognized the nursing division Ministry of Israeli Health since it’s beginning the course was for 3 years diploma. Doctors were sharing in teaching this course. • The nurse’s teachers in this school upgraded themselves to BSc at Al-Quds University and they start to learn most of subjects. • In 1997, BSc degree started to hold and the name changes to “Palestinian College of Nursing”.

25. School of Nursing at the Arab College • Medical profession of Al-Quds University 1979 Al Bereh. It plays a major role in developing nursing profession in Palestine by qualifying RN to Bsn in both (WB and GS). In 1992, post graduated diploma in nursing management and others programs.

26. College of Nursing at Islamic University Gaza (IUG) 1992 • The students graduated with BSc degree tow courses of upgrading from RN to BSc in 1995 and 1998. Palestinian National Authority (PNA) 1994 until now • In this period of time start noticed improvement were made immediately the PNA assumed the responsibility for the health sector. • Nursing received a strong support item of both human resources development and institution building tow departments were established in both Gaza and Nablus in order to develop nursing practice and training. (Shahin 1994).

27. Nursing syndicate in Gaza Strip. Public image about nursing in Gaza Strip. Patient nurse ratio in Gaza hospitals. Medical errors. Nursing documentation in Gaza strip hospitals. Work load and it’s affect on the quality of nursing services in Gaza Strip. Nursing theory tow theories at least. Chances to be employed in in Gaza Strip. Nursing in Islam. Nosocomial infection, Control infection protocol, and health waste. Communication (patient nurse) in Gaza Strip. Job description. Patient exposure in Gaza Strip.

28. Thank you Abu Al Hassan