Strengthening Faculty Competencies in Teaching Community Health Nursing in the BSN Curriculum

Luz Barbara P. Dones, MPH, RN
Associate Professor UP Manila College of Nursing

August 28, 2009 Angeles 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 ³road 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 Curriculum
The 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 Framework Two 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 .

head nurse.g. at-risk/vulnerable group) Community Nursing Process Assessment Planning Implementation Evaluation/Monitoring Recording and Reporting .g.Specific Components of Curricular Content Matrix 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. staff nurse) Leader/Manager (e.g.g. adult. disability reduction) Types of Client Individual across the Life Span (e. disability prevention) Tertiary Level (Disability limitation. child. infant. prompt and appropriate treatment. older person) Family Population Group (e. adolescent. neonate. supervisor) Researcher (Beginning Opportunities for Researcher Role) Levels of Prevention Primary Level (Primordial. Health Promotion / Disease Prevention) Secondary Level (Early detection.

g.. health-illness-health) * Araceli S. birth to death. Maglaya (2002) .Integration Framework in Curricular Design* Combination and Sequencing: Organization and Placement (Process) Selection (Content) (presented as MATRIX) Bases: Educational Prescription ‡ ‡ ‡ ‡ Simple to Complex Known to Unknown Overt to Covert Logical Sequence (e.

measuring stick for public and professional accountability Competencies ± behaviors needing to be acquired to develop those characteristics Stark and Lattuca. 1997 .The Role of Outcomes and Competencies in Curriculum Frameworks Outcomes ± characteristics students should display at a designated time.

Determining desired educational outcomes of a curriculum Ask: ‡ 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? .

Ethically and Legally grounded 6. Culturally Competent 3. Politically aware 5. Knowledgeable coordinator of community resources 4. Model of professional role 9.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. Competent health care provider 8. and material resources ‡ . fiscal. Effective Communicator 7. Responsible manager of human.. Critical Thinker 2. 1996): 1.

rational inquiry. doctor. Description of context of qualities identified by linking attributes together in a meaningful way ‡ Concept clarification or analysis Example: A critical thinker who is able to demonstrate intellectual curiosity. 2. 1988): 1. problem-solving skills and creativity in framing problems .The Role of Outcomes and Competencies in Curriculum Frameworks: Identifying Curriculum Outcomes ‡ Faculty identification of core characteristics/ attributes Steps in Concept Clarification/Analysis (Avant & Walker. dentist etc. Description of qualities that most clearly express the phenomenon of ³professional´ nurse.

The Role of Outcomes and Competencies in Curriculum Frameworks: Identifying Competencies 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 studentfocused .

1995) Program Outcome: A critical thinker who is able to demonstrate intellectual curiosity.The Role of Outcomes and Competencies in Curriculum Frameworks: Identifying Competencies Example of Competency Statements (IUSON. Senior Level Competency: Evaluates decisions through logical organization. and creativity in framing problems.. validation of information. . 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 problemsolving exercises that promote critical examination of the professional care role. and critical examination of assumptions underlying the process of information and analyzes the conclusions drawn from the information (Halstead et al. problem-solving skills. rational inquiry.

The Role of Outcomes and Competencies in Curriculum Frameworks: Identifying the 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 .

Knowledge and Attitudes ‡ Intellectual ability ‡ Understanding of problem solving ‡ Ability to ask probing questions .The Role of Outcomes and Competencies in Curriculum Frameworks Example of Attributes and Antecedent Factors Related to Critical Thinking: Characteristic Valued Critical Thinking Attributes of the Characteristic ‡ Intellectual Curiosity ‡ Rational Inquiry ‡ Problem Solving ‡ Creativity Antecedents/ Skills.

and the importance of these outcomes . 1998) ‡ 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.The Role of Outcomes and Competencies in Curriculum Frameworks: Guidelines for Writing Outcomes and Competency Statements (Billings.

The Role of Outcomes and Competencies in Curriculum Frameworks: Guidelines for Writing Outcomes and Competency Statements (Billings. 1998) ‡ Outcomes must be competencybased 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. ± Competencies emphasize what is to be accomplished with the meeting of an outcome and the characteristic being valued . 1998) ± Competencies determine the readiness of the learners to meet the outcomes identified and the length of time needed to demonstrate these characteristics.

delineation.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. differentiation. or sophistication) . ‡ The language of competencies must reflect a continued sense of development (increasing complexity.

make corrections. and obtain desired outcomes. Competencies at different levels: ‡ Carries out procedures ordered for assigned client ± Realistic expectation for beginning student ± To develop this competency.The Role of Outcomes and Competencies in Curriculum Frameworks: Leveling or Specifying Competencies Guidelines for Writing Outcomes and Competency Statements Example: Outcome statement: A competent care provider who individualizes nursing care to maximize client care outcomes. ± Student is in control of care plan modification based assessment information. the student must be able to read a care plan to determine interventions to be performed. ± 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 . ‡ Develops care plans that reflect the individual goals of the client and desired medical treatment goals. the student is expected to carry out ordered procedures. ‡ Modifies a standard plan of care consistent with desired client care outcomes ± To develop this competency. ± Student should demonstrate good decision-making skills to evaluate data.

.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).

± 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 . faculty collect information on outcomes at the beginning of the program.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.

. ‡ emphasis is given on the achievement of specified objectives.Competency-based Curriculum A curriculum wherein: ‡ educational programs are designed to ensure that students attain prespecified levels of competence in a given field.

leadership. and ‡ beginning opportunities for nursing research. Maglaya (2004) .Competency-based BSN framework A systematic approach to developing and enhancing competence in ‡ nursing practice (staff level practice at hospital and community settings).S. and management. * A.

S. University of the Philippines Manila since 1978.S.N.Competency-based framework This framework has been the major approach to the curricular design of the B. * A. Program of the College of Nursing. Maglaya (2004) .

g.E. and Attitude Analysis Bases for Selecting Learning Experiences (e.g. Unit/lesson) ‡Determined through progress tests (e.The Competency-based Framework in Curricular Design* Work Setting Scenarios ‡ Demographic Profile ‡ Health Picture ‡ Socio-PoliticalEconomic Cultural Context 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. Practicum/R.g. Maglaya (2004) . Knowledge. 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 Entry Competencies ‡ Terminal competencies of previous/earlier course/year level ‡Determined through prerequisite tests * A.S. Professional Competencies (reflecting SKA required to function in the Position/Role) Student Competencies Intermediate Competencies ‡ Within course work (e.L.

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) .

Phases of Competency-based framework 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 .

families.Phases of Competency-based framework Specification of professional responsibilities related with the nursing roles identified ± Utilizes the nursing process in the care of individuals. 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 .

approach. universality. towards 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. excellence . one self or one¶s work which facilitate the execution of a skill of a particular task based on major values: integrity. nationalism. values. caring.

Phases of Competency-based framework Specific Content Areas as Foci for Each Nursing Course Design with Field Practice .

Researcher Leader/Manager Community Diagnosis/ Community Organizing Program Planning Empowerment Strategies Advocacy Goals of Care Community Competence on Health Care and Health Programs Social and Economic Productivity. Tertiary Practitioner. Beginning Family Family Wellness. Researcher. Tertiary Practitioner. Vulnerable Population Groups/ Aggregates. Primary.2 Individuals. Community Care of the Community and Population Group Care of the Community Utilizing the Multi-sectoral/ Empowerment/Partnership Strategies for Health Development Care of Individuals. Healthy Lifestyle/ wellness . Growth & Development. Healthy Lifestyle and Environmental Health Wellness/SelfActualization Effective Coping on Family Realities Competence in Health Care/use of Resources THIRD YEAR LEVEL N-119 Community Population Group FOURTH YEAR LEVEL N-121. Primary. Multi-problem families. Home and Environmental Health Primordial Primary Level Practitioner Enhancing Family Competencies for Effective & Adequate Maternal & Child Care. Secondary. Pregnancy Labor and Delivery.CONCEPTS / CONTENT AREAS Application of the Nursing Process by Type of Client Concepts of Health and Illness SECOND YEAR LEVEL N-12 Healthy Individual (focus on Maternal and Neonatal Care) Normal. Multi-Problem Families and Population Aggregates in Health and Illness Primordial. Leader/Manager Community Organizing/ Networking Conducting Clinics Training and Supervision Advocacy Empowerment/Competence-building Strategies/Health Education/IEC Strategies (including School Health Program) Management of Health Services Referrals Healthy Lifestyle/Wellness Self-Actualization Community Competence / Empowerment Effective and Efficient Management of Health Services Social and Economic Productivity Levels of Prevention Role of the Nurse Interventions Primordial. Secondary.

Phases of Competency-based framework Identification of professional competencies representing the SKA components of each task for each responsibility .

Example: N-12 (Family Level) Professional Competencies Conditions Given opportunities in actual work situations Performance The Practitioner: 1. Demonstrates competence and confidence in performing nursing interventions 4. Explains the organization. Shows compassion and commitment to the welfare of the family . functions. Illustrates/interprets public health nurse¶s role in each of the public health programs and services 3. and programs of the DOH 2.

Phases of Competency-based framework ‡ Identification of Student Terminal Competencies (end of course) and Intermediate Competencies (within segments or unit of the course) .

Explains the factors affecting community health nursing practice 4. Explains the nature and scope of community health and the different community health services offered by the DOH 2. Explains the organizational structure of the DOH . the student Performance 1.Example: N-12 (Family Level) Intermediate Competencies Condition Given relevant questions. Explains the role of the community health nurse in each of the above services 3.

Evaluates the effectiveness of interventions . Ranks health problems according to priority 4. Obtains & analyzes data necessary for the assessment of health & nursing needs/problems of the family 2. Develops with the family a nursing care plan based on priorities 5. Implements the plan of care with the family 6.Example: N-12 (Family Level) Terminal Competencies Condition Given 2 beginning/ growing families with simple health problems Performance The student: 1. Defines the health and nursing needs/problems of the family 3.

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 Designing the Instructional Plan ± Description of appropriate TeachingLearning Strategies to develop in sequence the ff: ‡ Intermediate Competencies.

. Family Service and Progress Records) Utilizes data from health records in formulating a nursing care plan Instructional Activities 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 Instructional Functions Demonstrating behaviors to be learned Allowing students to practice behaviors Providing feedback on student progress Evaluation method/tools Performance evaluation checklist 2. the student Competencies 1. Writes a relevant/ significant entry on such records (e.g.Example: N-12 (Family Level) Instructional Design Conditions Given health records used in family nursing.

Phases of Competency-based framework 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 .

Maglaya (2002) . population group.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. family. individual. community). ‡ Each student is given copies of appropriate performance evaluation tools which contain the indicators of achievement of terminal competencies. * Araceli S.

community to: ± a) develop the learning outcomes/competencies. ± b) address the learning needs/concerns and problems of the students/learners. agencies.Standards of Clinical Supervision 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. ‡ The instructional design specifies the performance evaluation methods and tools. clinic. * Araceli S. Maglaya (2002) .

knowledge and attitudes for each set of learning outcomes/ competencies. ± c) mentoring opportunities to address the students¶ affective/ attitudinal competencies and learning needs. ± b) coaching strategies to develop psychomotor competencies on the care of specific types of clients. Maglaya (2002) . * Araceli S. providing for adequate feedback on clinical performance at each stage in the learning process. and.Standards of Clinical Supervision STANDARD III: Implementation of Instructional Design ‡ The clinical supervisor/instructor implements with the students the competency-based instructional design to develop their skills. ‡ Involves active participation of students on the use of: ± selected references/ learning materials/worksheets or exercises to enhance cognitive competencies. concerns/problems.

* Araceli S.Standards of Clinical Supervision 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. Maglaya (2002) .

Specify the learning outcomes/ competencies and the testing condition under which they are to be evaluated 2.Guidelines in Determining Achievement of Learning Outcomes 1. Determine the performance standards and specific criteria/indicators to measure the achievement of the standards .

Specify the sources of evaluation data. Use the appropriate evaluation tools to measure achievement of the learning outcomes. . Identify evaluation methods appropriate to the learning outcomes. 4. 5.Guidelines in Determining Achievement of Learning Outcomes 3.

Areas evaluated in a Competency-based Curriculum 1. communication. oneself. values. and decisionTeaching making skills required to execute a professional responsibility 3. Attitudes: feelings. and general approach towards others. Skills: mutual. facts. beliefs. Knowledge: Concepts. criteria for decision. and other cognitive aspects of the responsibility 2. or one¶s work which facilitate execution of a responsibility .

modified essay Checklist Rating Scale Anecdotal report Participation chart Questionnaire: open-ended/closed item Attitude scale: Likert scale.Methods and Tools Utilized in Evaluation in Competency-based Curriculum Area Cognitive domain (Knowledge) Psychomotor domain (Skills) Methods Written exam Oral exam Practical exam (real or simulated) Observational reports Direct measures Written Oral Indirect measures Tools Objective tests Essay. memory. semantic differential Interview: structured. unstructured Behavior rating scale: tests of judgment. or perception Affective domain (Attitude) .

Interventions Interacting skills Technical skills Attitudes D. Critical thinking/Data Analysis 3. Assessment of Patient Problem 1. Identification of Problem 5% 10% 10% 5% 10% 10% 10% 10% 15% 5% 5% 5% X X X X X X X X X X X B. Evaluation of Care E. Plan of Care C.Example of a Blueprint for Clinical Activities ABILITIES WEIGHT WRITTEN EXAM/ PROJECT X EVALUATION METHODS PRACTICAL EXAM X RECORDS REVIEW X OBSERVATIONAL RATINGS/ REPORTS A. Data gathering History taking Physical Assessment Psychosocial Assessment Lab & other diagnostic exam 2. Recording x X X X x x X .

including nonverbal. Final examination for clinical courses. Communication skills.Overview of Evaluation Strategies TECHNIQUE Portfolio DOMAIN/ EVALUATION PURPOSE High-level cognitive. Psychomotor domain POSSIBLE APPLICATIONS Placement in program of study. Writing skills. Summative Cognitive. Formative. Affective domain can be evaluated. Integration of learning can be demonstrated. Affective domain. Interviews. Affective domain. Psychomotor. Affective. Psychomotor (if video). Group discussion Evidence of a learning outcome submitted to faculty. Formative. For evidence of progress. Summative (for trending) High levels of cognitive and affective domains. Shows relationship between and among topics Verbal skills. Defense: determines content mastery and evidence of synthesis Concepts expressed in a visual way. Formative High-level cognitive. Evidence of verbal skills. Outcome measure for individual/program. Formative. Affective domain. Summative (for trending) High-level cognitive. Affective. Affective. communication techniques. Application of decision making process or a controlled representation of reality Formative feedback for psychomotor skills. Analysis Evidence of thinking process with ³why´ questions. Summative Higher levels of cognitive domain. Summative High level cognitive. Synthesis of ideas Critical thinking skills. Self-assessment. Marketing tool for job placement Preclinical mastery of identified skills. Formative. Summative All ranges of cognitive domain. Free form. Psychomotor skills Simulation Role Play Critiquing Journals Paper Essays Verbal questioning Concept/ Mind mapping Audiotape Videotape . Formative All ranges of cognitive domain. Formative. decision making. Demonstrate problem solving abilities. Affective. Formative. Affective domain. Affective domain. Formative. Psychomotor. Formative. and rationale. Critical thinking can be evaluated Critical thinking skills. Appropriate for evaluating the higher level cognitive skills Integration of learning can be demonstrated. Summative High levels of cognitive and affective domains. problem-solving skills Self-assessment. Summative All ranges of cognitive domain. Develop arguments.

. Manila: University of the Philippines Manila College of Nursing . Saunders Company Maglaya. & Halstead J.B. A. (2006). Competency-Based BSN Curriculum.References Billings D. Teaching in Nursing: A Guide for Faculty. Philadelphia: W. et. (1998).al.. (Eds).

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