ADPCN%2520Region%25203[1][1]

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


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.


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


– 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


• Precision is required in writing outcome statements.

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


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).


• 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


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.


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


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


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


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


Specific Content Areas as Foci for Each Nursing Course Design

with Field Practice


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


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)


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


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


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.


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.



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.



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.



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

References

Billings D., & Halstead J. (1998). Teaching in Nursing: A Guide for Faculty. Philadelphia: W.B. Saunders Company

Maglaya, A., et.al. (Eds). (2006). Competency-Based BSN Curriculum. Manila: University of the Philippines Manila College of Nursing

Documents

ADPCN%2520Region%25203[1][1]