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Strengthening Faculty Competencies in Teaching
Community Health Nursing in the BSN Curriculum
Luz Barbara P. Dones, MPH, RNAssociate Professor UP Manila College of Nursing
August 28, 2009Angeles University Foundation
Curriculum
Designed to provide a sequence of learning experiences that will enable students to achieve desired educational outcomes (Ratcliff, 1997).
Curriculum Frameworks
• Provide the basis of conceptualizing and organizing the delivery of the knowledge, values, beliefs and skills critical to the delivery of a coherent curriculum that facilitates the achievement of the desired curriculum outcomes (Boland, 1991)
• Considered as “road maps” to teaching and learning
Purposes of Organizing Frameworks for Curriculum
• Provide a blueprint for – determining the scope of knowledge and – a means of structuring that knowledge in a
distinctive and meaningful way for faculty and students
• Facilitate the – sequencing and prioritizing the knowledge in
way that is logical and internally consistent with theoretical explanations about the concepts included in the curriculum and
– how these concepts are applied to professional practice
Purposes of Organizing Frameworks for CurriculumThe framework must reflect the
Domain of professional health practice
The phenomena of concern to that specific health profession
How each profession relate to others who are also dealing with health concerns
Developing an Organizing FrameworkTwo general
approaches:
• Developing a single theory framework
• Developing an eclectic framework
Guiding Principles:• Choose the concepts that
most accurately reflect the practice and discipline of the profession
• Define those concepts that reflect the philosophy, mission statements or discipline
• Explain the linkages between and among the concepts
Concepts of Health and Illness Oxygenation
Fluid and Electrolyte Balance
Reproduction and Sexuality
Perception and Coordination
Metabolism
Inflammation and Immunity
Cellular Aberrations
Rehabilitation
Vulnerable populations
Aging (Geriatrics) and Chronic Illness
Psychosocial Adaptation
Population/s in life-threatening situations
Goals of Care Self-care Enhancement
Optimum Level of Functioning / Quality of Life
Performance of Activities of Daily Living
Healthy Lifestyle
Effective Coping
Self Actualization
Social and Economic Productivity
Empowerment / Client Competence
Roles of the Nurse Practitioner (e.g. staff nurse)
Leader/Manager (e.g. head nurse, supervisor)
Researcher (Beginning Opportunities for Researcher Role)
Levels of PreventionPrimary Level (Primordial, Health Promotion / Disease Prevention)
Secondary Level (Early detection; prompt and appropriate treatment; disability prevention)
Tertiary Level (Disability limitation; disability reduction)
Types of ClientIndividual across the Life Span (e.g. neonate, infant, child, adolescent, adult, older person)
Family
Population Group (e.g. at-risk/vulnerable group)
Community
Nursing ProcessAssessment
Planning
Implementation
Evaluation/Monitoring
Recording and Reporting
Specific Components of Curricular Content Matrix
Combination and Sequencing: Selection (Content)Organization and Placement (presented as MATRIX)(Process)
Bases: Educational Prescription
• Simple to Complex• Known to Unknown• Overt to Covert• Logical Sequence (e.g., birth to death, health-illness-health)
Integration Framework in Curricular Design*
* Araceli S. Maglaya (2002)
The Role of Outcomes and Competencies in Curriculum Frameworks
Outcomes – characteristics students should display at a designated time; measuring stick for public and professional accountability
Competencies – behaviors needing to be acquired to develop those characteristics
Stark and Lattuca, 1997
Determining desired educational outcomes of a curriculumAsk:• What should students know and be able
to do after the educational experience?• What competencies (SKA) must
students possess to successfully demonstrate desired outcomes?
• What learning experiences will facilitate attainment of the competencies?
• How will the attainment of the competencies be evaluated?
The Role of Outcomes and Competencies in Curriculum Frameworks: Identifying Curriculum Outcomes
• Faculty identification of core characteristics/
attributes
• Concept clarification or analysis
Example of outcomes/core characteristics (Halstead et al., 1996):
1. Critical Thinker2. Culturally Competent 3. Knowledgeable coordinator of
community resources4. Politically aware5. Ethically and Legally grounded6. Effective Communicator 7. Competent health care provider8. Model of professional role9. Responsible manager of human,
fiscal, and material resources
The Role of Outcomes and Competencies in Curriculum Frameworks: Identifying Curriculum Outcomes
• Faculty identification of core characteristics/
attributes
• Concept clarification or analysis
Steps in Concept Clarification/Analysis (Avant & Walker, 1988):
1. Description of qualities that most clearly express the phenomenon of “professional” nurse, doctor, dentist etc.
2. Description of context of qualities identified by linking attributes together in a meaningful way
Example:A critical thinker who is able to
demonstrate intellectual curiosity, rational inquiry, problem-solving skills and creativity in framing problems
Competencies are important Foundation in designing evaluation
tools used in the assessment of student learning
Determine right student (Who?), right level of behavior (What?), and right context of behavior (When/where?)
The Role of Outcomes and Competencies in Curriculum Frameworks: Identifying Competencies
Competency Statements• Identify SKA students need to develop
to achieve curriculum outcomes• Behaviorally-anchored and student-
focused
The Role of Outcomes and Competencies in Curriculum Frameworks: Identifying Competencies
Example of Competency Statements (IUSON, 1995)
Program Outcome: A critical thinker who is able to demonstrate intellectual curiosity, rational inquiry, problem-solving skills, and creativity in framing problems.
Senior Level Competency: Evaluates decisions through logical organization, validation of information, and critical examination of assumptions underlying the process of information and analyzes the conclusions drawn from the information (Halstead et al., 1994)
Junior Level Competency: Validates care decisions with appropriate persons to determine the degree to which decisions are consistent with client-system information and environmental clues.
Sophomore Level Competency: Participates in selected problem-solving exercises that promote critical examination of the professional care role.
The Role of Outcomes and Competencies in Curriculum Frameworks: Identifying Competencies
Identification of antecedents/factors for achievement of outcomes and competencies
– What are the skills needed to perform the outcome or attribute
– What are the knowledge needed to develop or foster the identified behavior
– What are the attitudes necessary to facilitate development or refinement of the skill
The Role of Outcomes and Competencies in Curriculum Frameworks: Identifying the Competencies
The Role of Outcomes and Competencies in Curriculum Frameworks
Characteristic Valued
Attributes of the Characteristic
Antecedents/ Skills, Knowledge and
Attitudes
Critical Thinking • Intellectual Curiosity• Rational Inquiry• Problem Solving• Creativity
• Intellectual ability• Understanding of
problem solving• Ability to ask probing
questions
Example of Attributes and Antecedent Factors Related to Critical Thinking:
• Should be anchored on today’s practice reality
• Should address accountability issues and these depicts the acceptable nursing practice for graduates
• Determine the critical outcomes to be measured, and the importance of these outcomes
The Role of Outcomes and Competencies in Curriculum Frameworks: Guidelines for Writing Outcomes and Competency Statements (Billings, 1998)
• Outcomes must be competency-based or behaviorally anchored– Competencies serve as program
markers that denote what knowledge and skills are needed to meet outcomes
– Competencies are useful in creating measurement indicators for assessing the degree to which students have met the outcomes
The Role of Outcomes and Competencies in Curriculum Frameworks: Guidelines for Writing Outcomes and Competency Statements (Billings, 1998)
– Competencies determine the readiness of the learners to meet the outcomes identified and the length of time needed to demonstrate these characteristics.
– Competencies emphasize what is to be accomplished with the meeting of an outcome and the characteristic being valued
The Role of Outcomes and Competencies in Curriculum Frameworks: Guidelines for Writing Outcomes and Competency Statements (Billings, 1998)
• Precision is required in writing outcome statements.
• The language of competencies must reflect a continued sense of development (increasing complexity, differentiation, delineation, or sophistication)
The Role of Outcomes and Competencies in Curriculum Frameworks: Guidelines for Writing Outcomes and Competency Statements (Billings, 1998)
Guidelines for Writing Outcomes and Competency Statements Example:Outcome statement: A competent care provider who individualizes nursing care
to maximize client care outcomes.Competencies at different levels:• Carries out procedures ordered for assigned client
– Realistic expectation for beginning student– To develop this competency, the student must be able to read a care plan to
determine interventions to be performed.• Modifies a standard plan of care consistent with desired client care outcomes
– To develop this competency, the student is expected to carry out ordered procedures.
– Student is in control of care plan modification based assessment information.– Student should demonstrate good decision-making skills to evaluate data, make
corrections, and obtain desired outcomes.• Develops care plans that reflect the individual goals of the client and desired
medical treatment goals.– Requires higher level of functioning– Student should know most acceptable medical and nursing interventions for a
specific client and is able to use this information in conjunction with assessment data and records
The Role of Outcomes and Competencies in Curriculum Frameworks: Leveling or Specifying Competencies
• Recognize level at which the knowledge and skills need to be demonstrated to obtain outcome desired
• Learning environment is modified to support students’ abilities to acquire knowledge at the level being identified
• Evaluation measures need to be consistent with level of learning identified (Billings, 1998).
The Role of Outcomes and Competencies in Curriculum Frameworks: Leveling or Specifying Competencies
• Faculty must consider learner’s ability done through establishing benchmarks– To establish benchmarks, faculty collect
information on outcomes at the beginning of the program.
– Benchmarks provide information on what skills and knowledge students bring to learning situation and can also indicate change if data are collected at the beginning and end of program
The Role of Outcomes and Competencies in Curriculum Frameworks: Leveling or Specifying Competencies
Competency-based Curriculum
A curriculum wherein:
• educational programs are designed to ensure that students attain pre-specified levels of competence in a given field.
• emphasis is given on the achievement of specified objectives.
A systematic approach to developing and enhancing competence in
• nursing practice (staff level practice at hospital and community settings), and
• beginning opportunities for nursing research, leadership, and management.
Competency-based BSN framework
* A.S. Maglaya (2004)
Competency-based framework
This framework has been the major approach to the curricular design of the B.S.N. Program of the College of Nursing, University of the Philippines Manila since 1978.
* A.S. Maglaya (2004)
The Competency-based Framework in Curricular Design*
Scenario-Setting: Analysis of Work Setting
(Current data and projections)
Professional roles required in work force
Professional responsibilities to implement each role
Professional tasks to carry out each responsibility
Skills, Knowledge, and Attitude Analysis
Professional Competencies
(reflecting SKA required to function in the Position/Role)
Student Competencies
* A.S. Maglaya (2004)
Work Setting Scenarios
• Demographic Profile
• Health Picture
• Socio-Political-Economic Cultural Context
Bases for Selecting Learning Experiences (e.g. Practicum/R.L.E.
Entry Competencies
• Terminal competencies of previous/earlier course/year level
•Determined through pre-requisite tests
Intermediate Competencies
• Within course work (e.g. Unit/lesson)
•Determined through progress tests (e.g. unit exam, quiz)
Terminal Competencies
• Should be congruent with requisites of work setting/professional competencies
• Determined through performance evaluation/post test of Achievement exam
Roles
• Practitioner
• Manager/Leader
•Researcher
Phases of Competency-based framework
Work-setting Scenario Analysis – Bases for specification of roles and
responsibilities– Bases for selection of appropriate
clinical and community practicum experiences (or Related Learning Experiences referred to by other Colleges of Nursing in the Philippines)
Specification of Nursing Roles that are
• critical in modifying or managing the current and future projections on the Philippine Health Scenario
• carried out by the nurse independently and in collaboration with others
• Roles: Practitioner Leader-Manager, Researcher
Phases of Competency-based framework
Specification of professional responsibilities related with the nursing roles identified– Utilizes the nursing process in the care of
individuals, families, population groups, and the community
– Ensures a well-organized and accurate recording and reporting system
– Shares leadership and shares effectively with others in work situations related to nursing and health
– Promotes personal and professional growth for self and others
Phases of Competency-based framework
Specification of professional tasks for each professional responsibility and the SKA analysis of each Task– Skill: the behavior needed to perform the task– Knowledge: the content needed to be able to
perform the skill– Attitude: the feelings, beliefs, approach, values,
towards others, one self or one’s work which facilitate the execution of a skill of a particular task based on major values: integrity, nationalism, caring, universality, excellence
Phases of Competency-based framework
Specific Content Areas as Foci for Each Nursing Course Design
with Field Practice
Phases of Competency-based framework
CONCEPTS / CONTENT
AREAS
SECOND YEAR LEVEL THIRD YEAR LEVEL FOURTH YEAR LEVEL
N-12 N-119 N-121.2
Application of the
Nursing Process by Type of Client
Healthy Individual (focus on Maternal and Neonatal Care) Normal, Beginning Family
CommunityPopulation Group
Individuals; Multi-problem families; Vulnerable Population Groups/ Aggregates; Community
Concepts of Health and Illness
Family Wellness;Pregnancy Labor and Delivery; Growth & Development; Home and Environmental Health
Care of the Community and
Population Group
Care of the Community Utilizing the Multi-sectoral/ Empowerment/Partnership Strategies for Health Development
Care of Individuals, Multi-Problem Families and Population Aggregates in Health and Illness
Levels of Prevention
Primordial Primary Level
Primordial; Primary; Secondary; Tertiary
Primordial; Primary; Secondary; Tertiary
Role of the Nurse
Practitioner Practitioner; ResearcherLeader/Manager
Practitioner; Researcher; Leader/Manager
Interventions Enhancing Family Competencies for Effective & Adequate Maternal & Child Care, Healthy Lifestyle and Environmental Health
Community Diagnosis/ Community OrganizingProgram PlanningEmpowerment StrategiesAdvocacy
Community Organizing/ NetworkingConducting ClinicsTraining and SupervisionAdvocacy Empowerment/Competence-building Strategies/Health
Education/IEC Strategies (including School Health Program)
Management of Health ServicesReferrals
Goals of Care Wellness/Self-ActualizationEffective Coping on Family RealitiesCompetence in Health Care/use of Resources
Community Competence on Health Care and Health Programs Social and Economic Productivity; Healthy Lifestyle/ wellness
Healthy Lifestyle/Wellness Self-ActualizationCommunity Competence / EmpowermentEffective and Efficient Management of Health Services Social and Economic Productivity
Identification of professional competencies representing the SKA components of each task for each responsibility
Phases of Competency-based framework
Example: N-12 (Family Level)
Professional Competencies
Conditions Performance
Given opportunities in actual work situations
The Practitioner:
1. Explains the organization, functions, and programs of the DOH
2. Illustrates/interprets public health nurse’s role in each of the public health programs and services
3. Demonstrates competence and confidence in performing nursing interventions
4. Shows compassion and commitment to the welfare of the family
• Identification of Student Terminal Competencies (end of course) and Intermediate Competencies (within segments or unit of the course)
Phases of Competency-based framework
Example: N-12 (Family Level)Intermediate Competencies
Condition Performance
Given relevant questions, the student
1. Explains the nature and scope of community health and the different community health services offered by the DOH
2. Explains the role of the community health nurse in each of the above services
3. Explains the factors affecting community health nursing practice
4. Explains the organizational structure of the DOH
Example: N-12 (Family Level)Terminal Competencies
Condition Performance
Given 2 beginning/
growing families with simple health problems
The student:
1. Obtains & analyzes data necessary for the assessment of health & nursing needs/problems of the family
2. Defines the health and nursing needs/problems of the family
3. Ranks health problems according to priority
4. Develops with the family a nursing care plan based on priorities
5. Implements the plan of care with the family
6. Evaluates the effectiveness of interventions
Designing the Instructional Plan– Description of appropriate Teaching-
Learning Strategies to develop in sequence the ff:
• Intermediate Competencies- developed in the classroom or laboratory setting
• Terminal Competencies - Supervised client-based experiences in clinical or field practice based on Standards of Clinical Supervision
– Specification of instructional functions to systematically ensure variety of teaching-learning experiences
Phases of Competency-based framework
Example: N-12 (Family Level)Instructional DesignConditions Competencies Instructional
ActivitiesInstructional Functions
Evaluation method/tools
Given health records used in family nursing, the student
1. Writes a relevant/ significant entry on such records (e.g. Family Service and Progress Records)
2. Utilizes data from health records in formulating a nursing care plan
Provide copies of the FSPR and instructions on how to fill-up the form
Demonstrate how entries are written on the FSPR
Provide opportunities to practice writing entries on the FSPR for each nurse-client interaction
Demonstrating behaviors to be learned
Allowing students to practice behaviors
Providing feedback on student progress
Performance evaluation checklist
Designing the evaluation tools to determine achievement of learning outcomes– Sample performance evaluation tools illustrate
specific indicators to determine achievement of Terminal Competencies
– Each course design includes an evaluation plan specifying the evaluation methods and tools
Phases of Competency-based framework
Standards of Clinical Supervision
STANDARD I: Identification of Learning Outcomes
• The clinical supervisor/instructor specifies the expected learning outcomes stated as terminal competencies on the care of specific type/s of client (i.e., individual, family, population group, community).
• Each student is given copies of appropriate performance evaluation tools which contain the indicators of achievement of terminal competencies.
* Araceli S. Maglaya (2002)
STANDARD II: Planning/Use of Instructional Design
• The clinical supervisor/instructor develops/uses a competency-based instructional design which specifies the appropriate teaching-learning activities/opportunities in the hospital, clinic, agencies, community to: – a) develop the learning outcomes/competencies; – b) address the learning needs/concerns and problems of the
students/learners. • The instructional design specifies the performance
evaluation methods and tools.
Standards of Clinical Supervision
* Araceli S. Maglaya (2002)
STANDARD III: Implementation of Instructional Design
• The clinical supervisor/instructor implements with the students the competency-based instructional design to develop their skills, knowledge and attitudes for each set of learning outcomes/ competencies.
• Involves active participation of students on the use of: – selected references/ learning materials/worksheets or
exercises to enhance cognitive competencies;– b) coaching strategies to develop psychomotor competencies
on the care of specific types of clients, and; – c) mentoring opportunities to address the students’ affective/
attitudinal competencies and learning needs, concerns/problems, providing for adequate feedback on clinical performance at each stage in the learning process.
Standards of Clinical Supervision
* Araceli S. Maglaya (2002)
STANDARD IV: Evaluation of Clinical Performance
The clinical supervisor/instructor • determines with the students their progress in attaining
specific learning outcomes/competencies on the care of specific types of clients,
• using appropriate performance evaluation methods and tools based on learning outcome indicators/criteria.
Standards of Clinical Supervision
* Araceli S. Maglaya (2002)
Guidelines in Determining Achievement of Learning Outcomes
1. Specify the learning outcomes/ competencies and the testing condition under which they are to be evaluated
2. Determine the performance standards and specific criteria/indicators to measure the achievement of the standards
3. Identify evaluation methods appropriate to the learning outcomes.
4. Specify the sources of evaluation data.
5. Use the appropriate evaluation tools to measure achievement of the
learning outcomes.
Guidelines in Determining Achievement of Learning Outcomes
Areas evaluated in a Competency-based Curriculum
1. Knowledge: Concepts, facts, criteria for decision, and other cognitive aspects of the responsibility
2. Skills: mutual, communication, and decision-making skills required to execute a professional responsibility
3. Attitudes: feelings, beliefs, values, and general approach towards others,
oneself, or one’s work which facilitate execution of a responsibility
Teaching
Methods and Tools Utilized in Evaluation in Competency-based Curriculum
Area Methods Tools
Cognitive domain (Knowledge)
Written exam
Oral exam
Objective tests
Essay; modified essay
Psychomotor domain (Skills)
Practical exam (real or simulated)
Observational reports
Checklist
Rating Scale
Anecdotal report
Participation chart
Affective domain (Attitude)
Direct measures
Written
Oral
Indirect measures
Questionnaire: open-ended/closed item
Attitude scale: Likert scale; semantic differential
Interview: structured, unstructured
Behavior rating scale: tests of judgment, memory, or perception
Example of a Blueprint for Clinical ActivitiesABILITIES EVALUATION METHODS
WEIGHT WRITTEN EXAM/
PROJECT
PRACTICAL EXAM
RECORDS REVIEW
OBSERVATIONAL RATINGS/ REPORTS
A. Assessment of Patient Problem
1. Data gathering
History taking
5% X X X
Physical Assessment 10% X X X
Psychosocial Assessment 10% X X X
Lab & other diagnostic
exam
5% X
2. Critical thinking/Data
Analysis
10% X
3. Identification of Problem 10% X X
B. Plan of Care 10% X
C. Interventions
Interacting skills
10% x X
Technical skills 15% X
Attitudes 5% X
D. Evaluation of Care 5% x X
E. Recording 5% x
Overview of Evaluation StrategiesTECHNIQUE DOMAIN/ EVALUATION PURPOSE POSSIBLE APPLICATIONS
Portfolio High-level cognitive; Affective; Psychomotor (if video); Formative; Summative
Placement in program of study; For evidence of progress; Outcome measure for individual/program; Marketing tool for job placement
Simulation High level cognitive; Affective; Psychomotor; Formative; Summative
Preclinical mastery of identified skills; Final examination for clinical courses; Application of decision making process or a controlled representation of reality
Role Play Cognitive; Affective; Psychomotor; Formative Formative feedback for psychomotor skills, communication techniques; problem-solving skills
Critiquing High-level cognitive; Affective domain; Formative; Summative (for trending)
Self-assessment; Integration of learning can be demonstrated; Appropriate for evaluating the higher level cognitive skills
Journals High-level cognitive; Affective domain; Formative; Summative (for trending)
Integration of learning can be demonstrated; Self-assessment; Affective domain can be evaluated; Critical thinking can be evaluated
Paper High levels of cognitive and affective domains; Formative; Summative
Critical thinking skills; Writing skills; Develop arguments; Synthesis of ideas
Essays High levels of cognitive and affective domains; Formative; Summative
Critical thinking skills; Free form; Demonstrate problem solving abilities, decision making, and rationale; Analysis
Verbal questioning
All ranges of cognitive domain; Affective domain; Formative; Summative
Evidence of thinking process with “why” questions; Evidence of verbal skills; Defense: determines content mastery and evidence of synthesis
Concept/ Mind mapping
All ranges of cognitive domain; Affective; Formative
Concepts expressed in a visual way; Shows relationship between and among topics
Audiotape All ranges of cognitive domain; Affective domain; Formative; Summative
Verbal skills; Interviews; Group discussion
Videotape Higher levels of cognitive domain; Affective domain; Psychomotor domain
Evidence of a learning outcome submitted to faculty; Communication skills, including nonverbal; Psychomotor skills