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This study focuses on curriculum development for competency-based training of advanced practice nursing and smoking cessation in Macao. The aims of this thesis are: (a) to link the core competencies of Advanced Practice Nursing (APN) to curriculum development; (b) to make recommendations for improved specialist nurse training to address current problems of nursing; and (c) to gather data to indicate the scope and the severity of the issues related to nurse training in Macao. The thesis presents a comprehensive literature review of theoretical frameworks of competency-based nursing curricula, curriculum development and design, quality assurance, best practice in competency based models of nursing education, theories of change and innovation, needs analysis and stakeholder satisfaction. The thesis develops and implements a needs analysis and situational analysis of nursing education in Macao, using a „mixed methods‟ approach that integrates quantitative and qualitative data to identify the needs for, and perception of, core competencies in Community Health APNs by the health professionals and clients of the community. This includes an empirical survey of stakeholders, semi-structured interviews with professionals in the field of nursing and nurse training, structured questionnaires from clients, observational data on training and implementation of competency-based curricula, and evaluation of a piece of curriculum implementation of an APN training program on smoking cessation. Through action research cycles, the thesis synthesizes a range of literature and empirical data, and, from these, gains feedback for improvement and refinement of the new curriculum to be implemented. As well as conducting client satisfaction surveys of the primary health care provision and services in Macau and how these could be improved, the thesis provides the framework for a competency-based curriculum for nursing education in Macau. The thesis argues that, in order to keep abreast with current developments in nurse training and practice worldwide, it is essential for APN education and training to adopt a competency-based approach and for curricula to be framed in terms of competencies and outcomes. It indicates that these are currently under-developed in Macao, and that there is an urgent need for them to be addressed, in terms of general, core and specific competencies (e.g. smoking cessation). The thesis argues that, for such developments to iii happen, fundamental changes will be required to curricula and to APN nursing practice, as, even though there may be changes to curricula, the opportunity to put general and specific competencies into practice by APNs is currently severely restricted because of a range of constraints in Macao. The thesis argues that there is an urgent need for APNs to receive competency-based training and practice for smoking cessation, and the opportunity to put this training into practice. It indicates that even short workshops and training programs can be effective. The thesis argues that current obstacles to such practice can be identified, but that overcoming them presents serious challenges to the current system, and will require action on many fronts, including revisions to local legislation, nurse credentialing, facilitation by senior managers of the health service, and an increase in the supply of nurses. The thesis indicates that there is a strong and united will for changes to be made to bring about competency-based training, curricula and practice in Macao, but that there are many practical barriers to be overcome in order to bring about these changes

Chapter 7 Henrietta Hall Shuck Engendering Faith, Education, and Culture in Nineteenth-Century Macao Isabel Morais Introduction Henrietta Hall Shuck (1817–1844) is famous for being the first American female missionary in China. Despite her short period of residence in Macao in the early nineteenth century, her multiple experiences in the Portuguese colony are invaluable. Her pronouncements in her journal entries, correspondences and other writings make clear her perceptions of Christian interaction with the Chinese people. Her writings combine strong religious beliefs with an equally powerful commitment to promote gender equality through education . Excerpts from her journal openly address female child slavery, the mui tsai system (little girls sold as household servants and for prostitution), gender-based class hierarchies, and the exploitation of women and children. Henrietta helped establish the first Chinese girls’ school in Macao and promoted other important factors through her writing such as the “Camões’s Garden and Grotto” and her discussion of The Lusiad. Had Henrietta Hall not come to China, I might not be here today.1 The first four decades of the nineteenth century were critical years in the Pearl River Delta and Macao. Many examples show Chinese tightening political control over Macao and increased opposition to British incursions.2 In Portugal, several reforms aimed at reinforcing state control of the administrative, political, military, and economic colonial organizations were implemented and extended to Macao.3 In 1835, the governor of Macao ordered that Portuguese who were born in Macao or who had lived in Macao for a long time, be 106 Isabel Morais restricted to municipal affairs only and thereby reducing the political autonomy of the local elites.4 Meanwhile, other important legislation was also extended to Macao. A law passed in 1834 called for the dissolution of all religious orders and congregations, and the abolition of slavery in every Portuguese territory in 1836. These initiatives weakened the Catholic Church’s role in the education system since all schools for both Portuguese and Asian converts in Macao were church-affiliated under the Portuguese Padroado (Patronage) system in Asia.5 At the same time, the United States’ maritime expansion and foreign policy in Asia started to assume a more assertive role, promoting American social, political, and liberal ideas. In 1803, the governor of Macao prohibited the consul of the United States from spending the winter in Macao, forcing him to go to Canton.6 Driven by profits from trade, Americans were nonetheless encouraged to continue going to China, and despite restrictions in Macao, they used the city as a base for not only commerce but the promotion of religion as well. This was done despite the opposition of the British East India Company to missionary activity, the Chinese government’s prohibitions of publicly propagating religion and the local Catholic elite’s aversions to non-Catholics in the Portuguese colony.7 According to Reverend John Lewis Shuck, Henrietta’s husband, the Protestant missionaries in Macao were “strictly prohibited by the civil authority any public efforts for the diffusion of the gospel” being limited to personal conversations only.8 The persecution against Protestants in Portugal might have contributed to the intolerance among Roman Catholics in Macao. It is worth mentioning that between 1843 and 1846 around one thousand Jews fled from Portugal to the United States and West Indies (British island of Trinidad). In 1846 more than four hundred Jewish people fled from the Portuguese archipelago of Madeira to Jacksonville and Springfield, in the state of Illinois.9 On the other hand, the immigration of Catholics into the United States, resulted in the so-called “nativist” movement in the 1840s, and the rise of the anti-immigrant Know-Nothing Party of the 1850s.10 For many years Protestant missionaries in China were restricted to Guangzhou (Canton) and Macao. They concentrated on distributing literature among members of the foreign and Chinese merchant class, which gained a few converts. And they laid the foundations for more humanitarian efforts of advancing education in China among the lower classes and providing medical services to the needy. This situation would change after the Opium Wars led to Henrietta Hall Shuck 107 the imposition of treaties, and compelled the Chinese government to allow evangelization and freedom to convert Chinese to Christianity. In the 1830s, North American and British missionaries established bases in Macao to advance their evangelical operations. Amidst the restrictions and constraints of the diplomacy of the Canton system (ca. 1700–1842), which included a ban on foreign women entering China...