Curriculum Development in Nursing

Process and Innovations Education for nurses and allied health professionals is being radically overhauled both in the UK and overseas. Curriculum Development in Nursing offers nurse educators a single text that covers curriculum development processes, and highlights case study examples of innovation in approaches to nurse education. The book has been written by internationally well-known authors, who take a truly international perspective looking at education in the UK, Europe and the US, as well as in Africa and the Middle East.

This book will be an essential guide to curriculum development and will be an invaluable resource for nurse educators and postgraduate nursing students internationally.

Leana R.Uys is Deputy Vice Chancellor of the University of KwaZulu-Natal, South Africa and also Head of the College of Health Sciences at the same university.

Nomthandazo S.Gwele was Professor and Head of the School of Nursing, University of KwaZulu-Natal, South Africa during the preparation of this book, but is currently Executive Dean of Health Sciences at the Durban Institute of Technology in South Africa.

Curriculum Development in Nursing Process and Innovations

Leana R Uys and Nomthandazo S Gwele

LONDON AND NEW YORK

First published in 2005 by Routledge 2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN

Simultaneously published in the USA and Canada by Routledge 29 West 35th Street, New York, NY 10001

Routledge is an imprint of the Taylor & Francis Group This edition published in the Taylor & Francis e-Library, 2005.

“ To purchase your own copy of this or any of Taylor & Francis or Routledge’s collection of thousands of eBooks please go to http://www.ebookstore.tandf.co.uk/.”

© 2005 selection and editorial matter, Leana R Uys and Nomthandazo S Gwele; individual chapters, the contributors.

All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanlcal, or other means, now known or hereafter invented, including

photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers.

British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library

Library of Congress Cataloging in Publication Data A catalogue record for this book has been requested

ISBN 0-203-31334-8 Master e-book ISBN

ISBN 0-415-34629-0 (hbk) ISBN 0-415-34630-4 (pbk)

Contents

Preface v

Contributors vii

Abbreviations ix

Glossary x

1. Education philosophy and the curriculum 1 2. An overview of the process of curriculum development 20 3. Establishing the context and foundations 30 4. Developing a macro-curriculum 40 5. Developing a micro-curriculum 61 6. Implementing a new curriculum 82 7. Curriculum evaluation 98 8. A problem-based learning curriculum 112 9. A case-based curriculum 128

10. Developing problem scenarios and cases 140 11. Developing a community-based nursing education 153 12. Developing an outcomes-based curriculum 176 13. A curriculum for interprofessional learning 195 14. Conclusion 204

Index 207

Preface

Nurse educators always have a dual role—they are both nurses and educators. As nurses they often have a specialty, such as psychiatric nursing or nephrology nursing, and they need to keep up with developments in that specialty, both in terms of the literature and the practice. When such nurses become educators, they also have to master the field of education, and keep up with what is new in the field of education, both in terms of theory and practice. We therefore believe that such nurse educators need constructive, stimulating and up-to-date texts to assist them in their task as educators of the new generation of nurses.

Nursing and midwifery are facing increasing demands the world over, but especially in developing countries. Healthcare quality is often dependent on the quality of nurses and midwives, since they provide the bulk of the human resource capacity. Their traditional hospital-based, lecturer-dependent and narrowly focused training often does little, however, to prepare them for the realities they face in practice in under-served areas, where they need to work and think independently, and where they need to lead the health team and the community. The fact that resources are often scarce, and support for nursing education compares poorly with that for medical education, does not help. The challenge is therefore often how to do more with less.

We, Leana and Thandi, have been active in our own country, and internationally, assisting nurse educators to interrogate their own curricula, their own teaching practice and their own views on nursing education. In many places we have found enthusiastic colleagues who want to deliver quality nursing education, but who are caught in old paradigms, and outdated methods. Often they have had limited exposure to higher education settings, but are expected to develop new nursing schools in universities. In such circumstances they often carry poor educational practices from other settings into new programmes and schools. Under pressure to develop new curricula fast with limited resources, and implement these curricula for groups of students used to traditional teaching/learning, they fall back on what they have been used to in their own school and nursing education.

As we worked in such settings over time, we often felt the need for a book that we could leave with them to assist them when we had left. We could find nothing that articulated our belief in innovative process-outcome curricula, based on solid preparation of the curriculum, staff and students. There was nothing that gave the simple information one needs when leading a nursing programme: how you plan for clinical learning experiences, how you decide how much clinical learning is enough, how you balance process with content and outcomes.

The purpose of this book is to offer nurse-educators a single textbook that brings together two aspects:

• the generic process, outlining each step carefully to support faculty who actually have to develop a curriculum, and

• innovative approaches which have developed over the last 20 years, and are still new to most nurse-educators.

This book gives enough detail to enable a group of nurse educators to use it to work through the process of developing a curriculum. It is a ‘how to’ guide, but it outlines adequately the theoretical and philosophical reasoning behind the decisions made. It also gives more detail of specific types of innovative curricula, to support groups who want to implement such models. Since most of the authors are second-language English speakers, the writing is usually easy to understand, and is also illustrated with examples, both in the text and in the form of recommended readings.

Chapter 1 provides a philosophical basis for the process of curriculum development, and anchors the more practical chapters which follow.

Chapters 2–7 deal with the process of curriculum development, implementation and evaluation. In each chapter one step of the process is described, explaining what it entails, and how the educators should go about completing the tasks.

Chapters 8–13 give examples of the more common types of innovative curricula. In each case the author deals with the characteristics of the specific type of curriculum, the advantages and disadvantages, and then describes the specific tasks involved in developing such a curriculum. The specifics about the implementation of each kind of curriculum are also given, and often the author refers to a real life curriculum as an example. Since more than one type of curriculum uses cases of problem-scenarios, one chapter (Chapter 10) is dedicated to the development of such components. Problem- based, case-based, outcomesbased, community-based and interprofessional learning are all innovations that have built up some credibility over the last 20 years, but can still all be seen as innovative.

At the end of each chapter we recommend a few readings which give examples of either research done in the topic covered by the chapter, or give a description of implementation of the topic of the chapter. For instance, at the end of Chapter 6 on the implementation of a new curriculum, one article describes an example of such an implementation process, while the other describes a research project on staff concerns during the implementation project. We also list one or two points for discussion, to assist groups to engage around the issues raised in the chapter. Having read and studied the chapter the reader might be stimulated by these points to apply the new knowledge, or search further for answers.

Curriculum development is something all the authors of this book feel passionately about. We hope that the book will stimulate readers to create something new in nursing and midwifery education, and to facilitate the creation of a new cadre of nurses and midwives who can confidently lead us towards the ideal of ‘Health for All’.

Leana Uys and Nomthandazo Gwele Durban, March, 2005

Contributors

Henry Y Akinsola is a registered nurse and a registered nurse tutor. He trained in Nigeria as a diploma nurse in 1973. He did his first degree (B.Sc. in Nursing, 1978) and PhD in Community Health (1991) at the University of Ibadan, Nigeria. He holds the degree Master of Science in Community Medicine from the University of Manchester, England (1983). He has been involved in the training of nurses and doctors for the past 21 years, having worked in Universities in several African countries, including Nigeria, Kenya and Botswana. Currently he is the team leader of project designed to integrate quality assurance principles in the nursing training curricula of the College of Nursing and Health Technology, Ministry of Health, Asmara, Eritrea.

Nomthandazo S Gwele (Thandi) is a registered nurse and midwife, and a registered nurse educator. She started her nursing career in a Diploma programme at Frere Hospital in East London, South Africa. While working as a midwife and a community health nurse, she obtained her BA (Nursing) in 1984 from the University of South Africa. In 1985 she travelled to the USA on a bursary, and obtained both the M Education and the MS (Nursing) at the University of Missouri-Columbia before returning to South Africa. Having worked at the University of Transkei, she joined the staff of the University of Natal (now KwaZulu-Natal) in 1992, where she obtained her PhD in 1994. Over the last 10 years she has acted as curriculum consultant to numerous nursing colleges and universities in South Africa, she also worked closely with the Nursing Institute of the United Arab Emirates. She was Head of the School of Nursing at the University of KwaZulu-Natal, Durban, South Africa.

Marilyn R Lee began her nursing career in 1971 as a Staff Nurse after completing her Diploma in Nursing at the Barnes Hospital School of Nursing in St. Louis, Missouri, USA. She was Head Nurse, Clinical Nurse and Inservice Instructor there over the next 10 years. She subsequently obtained BSN (1976) and BA (1975) from the University of St. Louis and her M Nursing (1982) from the University of South Carolina. In 1983 she taught in the School of Nursing at McMaster University, where for the next 16 years she taught nursing students using problem- and case-based approaches to learning in Canada and later in Pakistan. While in Pakistan, she was coordinator and team leader in two projects in nursing education and leadership development. She received her PhD in Nursing from Wayne State University, Detroit, Michigan, USA in 1996. In 1999 she moved to the University of Botswana (in Gabarone), where she is currently the first Deputy Director in the new Academic Programme Review Unit.

Fikile Mtshali is a registered nurse and midwife, and also registered operating room nurse, nurse educator and nurse administrator. She has worked in a range of clinical

settings for many years before embarking on an academic career. She obtained her PhD in 2003 with a study on Community-based Education in nursing in South Africa. She has been working as a consultant in different African countries, including Rwanda and Tanzania, as part of the work of the School of Nursing at the University of KwaZulu-Natal. She is currently Post-graduate Programme Director in the School of Nursing, University of KwaZulu-Natal, Durban, South Africa.

Mouzza Suwaileh graduated from the B.Sc Nursing programme in the College of Health Sciences in 1987, and also has a qualification in health professional education from the same institution. She obtained an M.Sc in Adult Health Nursing from the University of Texas Medical Branch in Galveston in 1990 and then a PhD in Nursing from the University of Texas in Austin, USA. She also did a Diploma in Health Care Management from Royal College of Surgeons, Ireland in 2002. She worked in various units in Bahrain hospitals, and is a certified haemodialysis nurse. She is currently the Chairperson of the Nursing Division at the College of Health Sciences, Kingdom of Bahrain, and the Director of WHO Collaborating Center for Nursing Development, Kingdom of Bahrain.

Leana R Uys is a registered nurse and midwife, and also a registered psychiatric nurse, nurse educator and nurse administrator. She started her nursing career by doing a B Nursing at the University of Pretoria in South Africa, and joined the University of the Free State after spending 2 years in a rural hospital. There she did her Masters (1975) and D.Soc.Sc (1980), and also an Honours degree in Psychology (1973) and another in Philosophy (1984). In 1986 she joined the School of Nursing at the University of Natal (now KwaZulu-Natal) as Head, and led the change of the nursing programme from a traditional curriculum to a problem-based learning and community-based education curriculum during the 1990s. When the school became a WHO Collaborating Centre for Nursing and Midwifery development in Africa in 1996, she became the first Director of this centre. She has written a number of nursing textbooks, and has been an active researcher in nursing education. She is currently Executive Dean of Health Sciences of the University of KwaZulu-Natal, Durban, South Africa.

Abbreviations

AACN American Association of Colleges of Nursing

CBAM Concerns-based Adoption Model

CBE Community-based education

CBL Case-based learning

CIPP Context-Input-Process-Product

IPL Inter-professional learning

MPL Multi-professional learning

OBE Outcomes-based education

PBL Problem-based learning

PHC Primary health care

SDL Self-directed learning

UNFPA United Nations Population Fund

WHO World Health Organization

ZPD Zone of Proximal Development

Glossary

Case A comprehensive description of a clinical or practical case, which may be an

individual, a group, a setting, or an organization, used as the basis for teaching or learning. In this text, it is used mainly with regard to the case-based curriculum.

Case-based curriculum (CBC) A curriculum in which students are given a set of complete cases for study and research in preparation for subsequent class discussions.

Course A building block of a programme, consisting of a time-limited component, usually over one term (3 months), one semester (6 months) or 1 year, and usually ending with a summative evaluation.

Community The community is regarded as a learning space in which students are exposed to live dynamic contexts, conscientizing them to the socio-economic, political, cultural and other factors influencing the health of individuals, families and the public at large.

Community-based education (CBE) A curriculum which focuses on learning activities that utilize the community extensively as a learning environment in which not only the students, but also the teachers, members of the community, and representatives of other sectors are actively involved throughout the educational experience.

Competence The ability to deliver a specified professional service. Course outline A brief description of a course which allows the reader to understand the

curriculum. Curriculum Planned learning experiences offered in a single programme. Curriculum strand A repetitive idea or concept which appears throughout the

curriculum and forms the framework for the choice of content and learning experiences.

Discipline A field of study and practice often associated with a specific profession, or the group of scientists studying a specific subject.

Head of School The Head of School is the person, usually a nurse, who is the executive director of the school. The title might be Dean, Principal, Professor, but the job is to give academic and administrative leadership.

Interprofessional learning (IPL) Educational approaches in which disciplines collaborate in the learning process to foster interprofessional interactions that enhance the practice of all disciplines involved.

Learning opportunity A learning situation created by a nurse educator for a student to use to achieve a learning outcome.

Level (of a programme) A period during which the subjects or courses taken are at a similar level of difficulty, at the end of which a decision is usually made about the progression of the student, based on comprehensive assessment of performance.

Macro-curriculum The overall design or blueprint of the programme, done by a Curriculum Committee.

Micro-curriculum The course outlines and unit plans, usually developed by the individual teacher.

Mission statement A mission statement is a relatively permanent and broad statement of the objectives of an organization, distinguishing it from other similar organizations, and illustrating the main reason(s) for its existence.

Module A unit within a programme or a course, which can be examined separately (modular instruction) or at the end of the course.

Occupational map A document that identifies the role components of the group of nurses being prepared by the programme. For each role component, the map describes the competencies that make up the role.

Outcome A relatively self-contained achievement, describing the expectations of a particular work role which acts as a benchmark against which individual performance is judged.

Outcomes-based education (OBE) A competency-oriented, performancebased approach to education which is aimed at aligning education with the demands of the workplace, and at the same time develops transferable life skills, such as problem-solving and critical thinking skills.

Post-registration programmes Offered to people who are already nurses or midwives, to equip them for a specialized field of practice.

Pre-registration programmes Those programmes which non-nurses take to become nurses.

Problem-based learning (PBL) An approach to learning and instruction in which students tackle problems in small groups, under the supervision of a teacher or facilitator.

Programme A coherent set of courses, leading to a certain degree, diploma or certificate. Courses might be core (compulsory) or optional courses (electives).

Regulatory body Usually a statutory body established to maintain the standards of a profession by a range of activities, which usually include keeping a list (register) of practitioners who meet the required standard of education and practice.

Scenario A brief description of a clinical or practical case that is relevant to the learner, used as the basis for teaching or learning. In this text it is used mainly with regard to problem-based learning, and is used interchangeably with ‘vignette’.

School of Nursing A department within a university, or a college or any other higher education institution that is in charge of offering formal nursing and midwifery programmes. It may also refer to the total higher education institution, in the case of a single-discipline institution.

Situation analysis A comprehensive study of the context which shapes a school of nursing and its programmes.

Stakeholders Individuals or groups who have an interest in the outcomes of an endeavour.

Subject A clearly identifiable area of knowledge that studies a specific set of phenomena from a particular perspective, often using unique research methods.

Unit The building block of a course, used interchangeably with ‘module’.

Chapter 1 Education philosophy and the curriculum

Nomthandazo S Gwele

Introduction

The term curriculum means many things to many people. Any attempt to define the concept within the context of this chapter is not aimed at seeking consensus of interpretation but rather an understanding of the meaning attached to the concept in the context of this book. Curriculum here refers to planned learning experiences that the educational institution intends to provide for its learners. This definition does not deny the existence of hidden and null curricula (that which the educational institution chooses to exclude from its curriculum (Eisner, 1994), in educational institutions, but is seen as an appropriate point of departure for a book on curriculum development, since what is not planned or cannot be planned would be difficult to articulate in such a book.

Despite the lack of agreement on the meaning of the term, there seems to be consensus that educational institutions, as institutions charged with the all important societal function of educating citizens, have the sole claim to curriculum. Furthermore, most agree that in education of all forms, there is no such thing as being neutral (Bode, 1937; Moore, 2000; Smeyers, 1995). Some authors believe that education should be directed towards helping learners become intelligent and critical citizens in a democratic society (Dewey, 1916, 1961); yet for some, education is a political act that ‘demands from educators that they take it on as a political act and that they consistently live their progressive and democratic or authoritarian and reactionary past or also their spontaneous, uncritical choice, that they define themselves by being democratic or authoritarian’ (Freire, 1998:63). Put simply, either the learners have to be taught to fit as a cog into the existing social machinery, or to recognize their own responsibility for the transformation of the social, political and economic world in which they live (Bode, 1937). In Cuffaro’s words ‘philosophy of education represents choices, values, knowledge and beliefs of teachers as well as their aspirations, intentions and aims. It serves to guide and inspire and contributes to determining the detail of every day life in the classroom’ (1994:1).

Central to making educational choices is a need to make explicit the philosophical beliefs underpinning what the educational institution sees as worthwhile for learners to experience. Such beliefs, whether made explicit or not, permeate the curricula experiences of all the learners in whatever context they find themselves. As noted by

Wiles and Bondi ‘at the heart of purposeful activity in curriculum development is an educational philosophy that assists in answering value-laden questions and selecting from among the many choices’ (1998:35). This is specifically true about choices and questions related to the purpose of education, the nature and role of the learner, the nature and role of the teacher and the teaching/learning process.

Choices and decisions about curriculum are, hopefully, not random choices, but are based on thorough understanding of the educational ideologies on which they are based. Three broad streams of educational philosophy underpin curricula choices and decisions; the conservative, the progressive and the radical views. It should be noted, however, that most of what has been written in educational philosophy has been directed to formative education, that is, that aspect of education that takes place during the years of primary and secondary education. For some reason, it seems that educational philosophers have preferred to stay clear of tertiary education, especially professional education. On the other hand, educators in the professions have been drawn to the philosophical debates underlying their practice.

The conservative view

The basic premise underpinning the conservative vision is that there are certain enduring worthwhile truths that should be taught and learned. According to this view, the purpose of education is to transmit worthwhile bodies of information to generations of learners so that that which is worthwhile is conserved. Two schools of thought, perennialism and essentialism, fall within the conservative vision. Although the two schools of thought differ somewhat in how they view education, they agree on various fundamental aspects about education. For both the perennialists and the essentialists, education should concern itself with the cultivation of the intellect and not learner needs or interests (Tanner and Tanner, 1995). Furthermore, the two schools of thought agree that:

• social change should be slow • there is need to conserve and therefore to oppose reform • methodology should be teacher directed • emphasis should be placed on ensuring content-centred curriculum (Hearne and

Cowles, 2001:54).

Differences between the two schools of thought revolve around specifications of exactly what is to be taught and for what purpose. Perennialists’ views of education have limited relevance to professional education because of their focus on the basics such as the reading, writing and arithmetic. Hence, this chapter focuses mainly on a brief analysis of the essentialists’ view of education.

The decision to focus mainly on essentialism is not to negate the tight grip that perennialists’ views on education have had on nursing education in particular. It has been noted that ‘perennialists contend that there is an organized body of knowledge that children (learners—insertion mine) need to know so that society might cohere around a common identity’ (Gaudelli, 2002:198). That nursing education has always largely been, and continues to be, in many parts of the world a content-driven and transmission- dominated educational system is by no means an accident. The biomedical approach, and

Curriculum development in nursing 2

its foundational sciences in the form of applied medical sciences, continue to dominate what is learned in nursing schools globally. Attempts to marginalize the concepts of disease and the pathophysiological processes affecting body organs and systems, through the introduction of integrated curricula in nursing education have not been very successful. Regulatory nursing organizations implicitly or explicitly continue to demand clear indications of how much medical nursing, surgical nursing, paediatric nursing or obstetric and gynaecological nursing a prospective practising nurse has been exposed to during her/his period of education and training. The pervasive and enduring quality of perennialism in education, including professional education, cannot be underestimated. Admittedly, this is not the list of topics that one would find in the Great Books of western civilization, but it is a list of topics that one would find in western medical and/or nursing textbooks.

Essentialism

Rooted in idealism and realism, essentialists contend that both body and mind are important in education and as such ‘core knowledge and skills are essential to a successful society, because those requisite abilities allow the individual to be an economically productive member of society’ (Gaudelli, 2002:198). Four broad presuppositions that underpin essentialism are identified by Gaudelli (2002:199) as follows:

• human nature tends to be bad • culture is outside the individual • consciousness should be focused on the present and the future • the centre of value is found in the body and to a lesser degree in the mind.

The mind, however, has value in so far as it can be manipulated, cultivated and moulded to deal with the demands of an academically demanding education. In the words of Tanner and Tanner ‘like the perennialist, the essentialist conceives of the mind as a vessel or container. Individual differences are marked off according to mental capacities, and education is simply a matter of filling and stretching each mind with the same curricular brew to the utmost of each mind’s capacity’ (1995:314).

The purpose of education

The purpose of education, from the essentialists’ perspective, is the preservation, through transmission to generations of learners, of that which is essential to learn. The goal of education is to instil in learners the academic and moral knowledge which should constitute those ‘essential things that a mature adult needs to know in order to be a productive member of society’ (Hearne and Cowles, 2001:54). There is no doubt that education is the most contested sector in any country. Power and politics often dictate which path in education will hold sway at any point in time in any part of …

Fill in all the assignment paper details that are required in the order form with the standard information being the page count, deadline, academic level and type of paper. It is advisable to have this information at hand so that you can quickly fill in the necessary information needed in the form for the essay writer to be immediately assigned to your writing project. Make payment for the custom essay order to enable us to assign a suitable writer to your order. Payments are made through Paypal on a secured billing page. Finally, sit back and relax.

About Wridemy

We are a professional paper writing website. If you have searched a question and bumped into our website just know you are in the right place to get help in your coursework. We offer HIGH QUALITY & PLAGIARISM FREE Papers.

How It Works

To make an Order you only need to click on “Order Now” and we will direct you to our Order Page. Fill Our Order Form with all your assignment instructions. Select your deadline and pay for your paper. You will get it few hours before your set deadline.

Are there Discounts?

All new clients are eligible for 20% off in their first Order. Our payment method is safe and secure.

Hire a tutor today CLICK HERE to make your first order