National comparative curriculum e

2022-11-25 来源：易榕旅网

NurseEducationToday(2005)25,418–429

Nurse

EducationToday

intl.elsevierhealth.com/journals/nedt

Nationalcomparativecurriculumevaluationofbaccalaureatenursingdegrees:Aframeworkforthepracticebasedprofessions

LaraLeibbrandt

aa,*

,DianeBrown

b,1,JillWhite

c,2NorthernClinicalSchool,TheUniversityofSydney,15FredbertStreet,Lilyﬁeld2040,AustraliaFacultyofNursing,MidwiferyandHealth,UniversityofTechnology,Sydney,P.O.Box222,Lindﬁeld2070,AustraliacFacultyofNursing,MidwiferyandHealth,UniversityofTechnology,Sydney,P.O.Box222,Lindﬁeld2070,Australia

bAccepted15March2005

KEYWORDSNursingeducation;Comparativecurriculumevaluation;Curriculumdevelopment;Curriculumevaluationframework;Practicebasedprofessions*Correspondingauthor.Tel.:+61298101229;fax:+61295145049.E-mailaddresses:laral@bigpond.net.au(L.Leibbrandt),diane.brown@uts.edu.au(D.Brown),jill.white@uts.edu.au(J.White).1Tel.:+61295145043;fax:+61295145049.2Tel.:+61295145043;fax:+61295145049.

󰀁SummaryTheprimaryaimofthestudywastodeterminewhetherAustralianunder-graduatenursingcurriculaincorporatethenecessaryskillsandknowledgetopreparegraduatesforthecurrenthealthcareenvironmentinAustralia.TheeligibilitycriteriaforinclusioninthisevaluationincludedAustralianuniversityundergraduatepre-regis-trationnursingprograms.Allofthe29universitiesofferingsuchprogramsinAustraliawerecontactedbylettertotheDeansofNursingandtheircurrentcurriculumdocu-mentrequested.Twentysixof29(90%)eligibleAustraliancurriculawereincludedinthecurriculumevaluation.Acomprehensiveandﬂexiblecurriculumevaluationframeworkwasdevelopedfortheanalysisofthe26curricula.Theevaluationrevealedthewaysinwhichnursingcurriculabalancevariousaspectsofcourses,respondtochangesinsociety,educationandhealthcareindustries.Overallitwasfoundthatgraduatesarewellpreparedforpractice.Howeverquestionsofqualityandcoordina-tionofclinicallearningwerehighlightedforfuturefocusandmajorchallengeslieinaddressingexcessiveworkloadandassessment.Alsoworkneedstobedoneinimprov-ingtheinclusionofissuesaroundthehealthofAboriginalandTorresStraitIslander(ATSI)peoples,peoplelivinginremoteorruralAustraliaandolderpeople.c2005ElsevierLtd.Allrightsreserved.Introduction

Thiscurriculumevaluationdevelopedandimple-

0260-6917/$-seefrontmatterc2005ElsevierLtd.Allrightsreserved.doi:10.1016/j.nedt.2005.03.005

󰀁

Nationalcomparativecurriculumevaluationofbaccalaureatenursingdegrees419

mentedaframeworkthatwouldallowevaluationofallAustralianuniversitynursingundergraduatecurricula.ItwaspartofanAustraliangovernmentfundedtri-universitystudyintocurriculum,clinicaleducation,recruitment,transitionandretentioninnursinginAustralia(Clareetal.,2002).Theaimofthestudywastodeterminewhethercurriculumdocumentsshowedevidenceof:

󰀂relevant,accessibleandﬂexibleprograms;

󰀂balancingofprofessionalcontentandgenericcapabilitiesincludingculturalsensitivityandtechnologicalliteracy;

󰀂usingassessmentasameaningfullearningexperience;

󰀂linksbetweenAustralianNursingCouncilIncor-porated(ANCI)competenciesandcourseout-comes;and

󰀂facilitatingofpositivestudentlearningoutcomes.

FullresultsofthestudyarepublishedintheAustralianUniversitiesTeachingCommittee(AUTC)ﬁnalreport(Clareetal.,2002).

Background

Thestudywasundertakeninacontextofchang-ingregulatory,professional,workplaceandsocie-talinﬂuences.Between1984and1990nurseeducationinAustraliawastransferredtothehighereducationsector.Priortothis,curriculawerederivedfrommedicalknowledge,trainingnurseswhattodoratherthannecessarilyfocusingonthehealthneedsofcommunities(Bevis,1989;Brown,1997).Parallelwiththetransfer,thedevelopedworldhasfacedanunaffordableexplo-sioninhealthcareexpenditurerelatedtoanage-ingpopulation,technologicaladvancesandincreasedexpectationsofconsumers.Adoptionofnewmodelsofhealthcaredeliveryhavebeenimperativewithshorterhospitalstays,dischargeintothecommunityofmoreacutelyillandcom-munitytreatmentofpatientswithchronicmedicalconditionsandillnesses(Clareetal.,2002).Fina-lly,nursingworkforcesinAustraliaandoverseasfaceintractableshortages.

Questionshavebeenrasedconcerningtheprep-arationofnursesastowhetherthecurrentsystemproducesgraduateswiththeabilitytomeetchal-lengespresentedaboveandwhetherthereareconnectionsbetweennursepreparationandissuessuchastransitionandretention.Manystudieshavebeenundertakenintonurseeducation(Aged

andCommunityServicesAustralia,2001;Fitzger-aldetal.,2001;JohnsonandPreston,2001;KPMG,2001;CommonwealthofAustralia,2002a)mosttosomeextentfocussingintheseareas.Theprimaryaimofthisevaluationwastodeter-minewhetherAustraliancurriculaaddressthenecessaryskillsandknowledgetopreparegradu-atesforthecurrenthealthcareenvironment.Despitemuchdiscussionanddebatenouniquemethodofteachingandlearninghasbeende-scribedfornursingundergraduateprogrammesintheliterature(Williams,1999).Arecentsystem-aticliteraturereviewofnursingcurricula,under-graduateclinicaleducationandtransitionsupportcommissionedbytheQueenslandNursingCouncilfailedtoﬁndsufﬁcientevidencetoprovidespeciﬁcguidelines(Fitzgeraldetal.,2001).AﬁndingalsosupportedinareviewofcurriculummodelsbyMcKinleyetal.(2001)which,alsoapplyingstrictevidencecriteria,failedtoﬁndevidencetoeitherrecommend,orrecommendagainst,anyparticularnurseeducationmodelcurrentlyinuseinAustralia.

Researchinnursingeducationhasbeenfoundtobefragmented,smallscale(WhileandRob-erts,1998;Fitzgeraldetal.,2001)andlackinginmanyareas,includingcurriculumdevelopment((Chavasse,1994;Reid,1994;Fitzgeraldetal.,2001;McAllister,2001;Clareetal.,2002).Manynursingstudiesfocusonindividualcurriculum.Includingmanysmallstudies,discussionpapersandnarrativeaccountsthatareconcernedwithaimsofeducators.Thesehavelimitedapplicationoutsidetheirsphere.

Researchersdoacknowledgethatproducingexternallyvaliddataoncurriculaandlearningmethodsisdifﬁcult,primarilybecauseoftheimportanceoflearningoutcomestothecontextsinwhichindividualstudiesareconducted(McKeachie,1974;Cronbach,1975;Simons,1996)allcitedbyMcAllister(1999).Onthewholeinthenursingliteraturethereisbroadagreementthatevaluationandcurriculumdevelopmentshouldbecollaborative,broadandmulti-faceted(Smillieetal.,1984;O’Neill,1986;PoteetandPollock,1986;PoteetandHodges,1987;Winteretal.,1987;DiFlorioetal.,1989;Hogg,1990;WatsonandHerbener,1990;Hengstberger-SimsandMcMil-lan,1991;Sohn,1991;Sutcliffe,1992;DwyerandMcMillan,1994).Itisgenerallybelievedthatevalu-ationneedstobecomprehensiveandﬂexibleen-oughtorespondtotheparticularcontextofthenursingprogramunderstudy(Marrineretal.,1980;YoderWiseandCox,1984;Sarnecky,1990a;Sarnecky,1990b;Cowelletal.,1991;Whiteley,1992;Chavasse,1994).

420

Acrossthehealthcaredisciplinesfewstudieshaveevaluatedmultiplecurricula.Onestudy(Jonasetal.,1993)comparedmedicalundergradu-atecoursesinrelationtostandardsandimplemen-tationintermsofaccreditation,medicalschoolfaculty,students,evaluationofstudentperfor-mance,curriculumevaluation,specialtychoiceandprimarycare.

ACanadiannursingstudy(Sohn,1991)comparedall18genericundergraduateprogramsidentifyingareasofcommonalityinconceptualframeworksandcurriculumpatterns.Itfoundcurrentviewsofnursingwerebasedaroundnursing,ratherthanmedicalframeworksthatwerepreviouslyused.Ithighlightedthewaysnursingprogramstypicallyorganisetheirnursingframeworksandpointedtotheneedformoreopencommunicationandcollab-orativeapproachesaroundnursingcurriculumdevelopment.Anothercomparativenursingstudy(Frenchetal.,1996)whichanalysedsixinterna-tionalundergraduatecurricula,(eachcurriculumfromadifferentcountry),focussedonsimilaritiesanddifferencesinaims,content,methodsandassessment.Itprovidedusefulinformationandraisedissuesrelevantforinternationalcomparativeevaluations.Finally,intheUnitedKingdomanac-tionresearchstudy(Fraser,2000)undertooksevencasestudies.Itaimedtoidentifyfactorsfacilitatingorinhibitingeffectivenessofundergraduatemid-wiferyprogrammesviainputfromstudentinter-viewsandobservation,documentanalysisandcourseevaluationprocesses.Theissuesraisedinthisstudywerealsorelevanttonursingcourses.

L.Leibbrandtetal.

Althoughtherewereanumberofcommonthemesintheaboveevaluations,noneweresimilarenoughintheirresearchquestionsorframeworktodirectlycomparewiththisevaluation.ThisstudywastheﬁrstofitskindinAustralia.

Methodology

Thestudyexaminedthecurriculumdocumentsonly.Whileitmustbeacknowledgedevaluationofcurriculumdocuments(curriculuminintention)cannotrepresentanevaluationof‘curriculuminaction,’ascurriculawillalwaysevolvewhenimple-mented.Itisalsotruehoweverthatevaluatingcur-riculainintentionwilldemonstrateessentialelementsofthefullpictureofthelearningmilieu.Thismethodologyisavalidapproachinaddingtowhatweknowaboutthelearningmilieuinnursingprogrammes.Stenhouse(1976)assertsacurricu-lumdocumentmustgivesufﬁcientinformationtoallowittobeeffectivelytranslatedintopractice.

Developmentoftheframework

TheframeworkbuiltonworkbyBrown(1997).Itevolvedfromadeﬁnitionof‘‘curriculum’’thatconsideredittobeasocialconstructionwhichfo-cusesonstudents’experiencesandvaluesteacherjudgements(Schwab,1969;Stenhouse,1976;Stenhouse,1983;Grundy,1987;JacquesandGibbs,1993),andcurriculumevaluationisconcernedwithilluminatingwhatishappeninginaprograminthe

InputElements: Interacting Elements:•Context: Psycho-socio-political-economic-culturalStudent approach to learning•Studentcharacteristics •Institutioncharacteristics •Teacher characteristicsTeaching and Learning encounters Learning OutcomesAssessment approach and variety •Curriculum: course design-content-organisation-aims-expectations-pedagogical approach(Balla and Boyle 1994; McAllister 2001) Figure1Elementsofthelearningmilieu.Seeabovementionedreferencesforfurtherinformation.Nationalcomparativecurriculumevaluationofbaccalaureatenursingdegrees

Table1Item

1.Organisationalissues

Curriculumevaluationframework

Descriptionofdatacollected

󰀂Documentyear;󰀂Courselength;

󰀂Entrycriteria(recentschoolleaver,alternatepathways)󰀂󰀂󰀂󰀂

Conceptualframework;Viewofnursing;

Educationalphilosophy;Pedagogicalstructure

421

2.Curriculumorientation

3.Clarityandcoherence

󰀂Coursephilosophyandcoursestructure;

󰀂Linksbetweengoals,objectivesandcoursestructure;󰀂Linksbetweencoursegoals,philosophyandprocesses

4.Natureofteachingandlearning󰀂Varietyandrangeofteachingandlearningencounters;encounters󰀂Total:facetofaceteachinghours,clinicalpracticehours,subjectsin

course;

󰀂Averageandrangesubjectspersemester,averageandrangeassessmentspersubject;

󰀂Varietyandrangeofassessmentapproaches;

󰀂Anymodeoflearningofferedthatisdifferentfromtraditionalmethods5.Keyevents

󰀂󰀂󰀂󰀂

Semesterstructure;

Numberofsemestersperyear;Numberofweekspersemester;

Pointincoursewhereclinicalpracticeisintroduced

6.Clinicallearning

󰀂Modelofclinicalsupervision;

󰀂Strategiestoincreaseconsistencyandqualityofclinicallearningexperiences;

󰀂Strategiestolinktheoryandpractice;

󰀂Healthorganisationpartnerships/relationships;

󰀂Approachtoclinicalpractice(clinicalblock,dedicatededucationunits)Evidenceofprogressionofcoursematerialfromsimpletomorecomplex󰀂Progressionofcourseassessmentsfromlessﬂexibleandguidedtoincreasingindependenceandﬂexibility;

󰀂Evidenceofcomponentsofthecurriculumseekingtobeprovideabroadereducationalperspective;

󰀂Evidenceofdevelopmentofhigherorderskills(reasoning,problemsolving,criticalthinking,creativity);

󰀂Developmentofrelevantattitudesandvalues

Workload

󰀂Comparisonofassessmenttasks(numberofstudentformulatedobjectives,selfassessments,examinationsandweightings,teachingandlearningapproachesandvariety,otherassessmentapproachesandvariety);

󰀂Inclusionofstudentcentred,participatoryandlifelonglearningobjectives;󰀂Overallﬂexibilityofchoicesinthecurriculumandprogressionofﬂexibilitytowardtheendofcurriculum;

󰀂Contentintegration(Whattypeofplanwassetoutforthis?Wasthislogicalforencouragingdeeperapproachestolearning?)

Reﬂectingtherolesandcontributionsofallmembersofsociety:IndigenousAustralians,Multiculturalsociety,rural/remote

󰀂Amountandqualityofcoverageinthecurriculumoftheabovetheabovespeciﬁcallyregarding:

󰀂Didthecurriculumdedicatespeciﬁcsubjectsand/orpracticumstotheissue?󰀂Didthedocumentoutlineanyexplanatoryofstatementinregardtotheissue?󰀂Wastheissueintegratedthroughoutcoursestructure?

(continuedonnextpage)

7.Genericskilldevelopmentandgraduateoutcomes

Enhancestudentsintellectualdevelopment

Deepvs.surfaceapproachtolearning

8.ContextualfactorsrelatedtohealthcareandnursinginAustralia

422

Table1(continued)Item

9.Professionalcompetenciesandgenericskills

Descriptionofdatacollected

L.Leibbrandtetal.

CapacitytomeetANCI(Table2),Nursingregistrationauthorityrequirements:󰀂Learninginavarietyofareasacrossmedicalsurgicalnursing,familyhealth,mentalhealthanddevelopmentallydisabledacrossthelifespan;󰀂Anydifferentfocionhealthornursing;󰀂Numberofclinicalpracticehours;󰀂Integrationoftheorytopractice

UseoftechnologyandInformationTechnology:

󰀂Universitystatementclarifyingstanceontheseissues;󰀂Evidencethisisintegratedthroughoutcurriculum

󰀂Anythingexceptionalorunusualaboutthecourse;

󰀂Evidenceofconsumerparticipationincurriculumdevelopment;󰀂Approachestoissuesrelatedtohealthofolderpeople

10.Other

contextofparticularsocialcircumstances(ParlettandHamilton,1977),thatis,thelearningmilieu.Learningoutcomesaredeterminedbyacombi-nationoftheinteractingelementsdescribedinFig.1.However,studentapproachestolearningandteacherapproachestoteachingarecriticalfactorsindetermininglearningoutcomes.Theevaluationframeworkbroughtattentiontohowtheelements(Fig.1)inthelearningmilieuimpactonstudentapproachestolearning,teacherap-proachestoteachingandultimatelylearningout-comes.Theframeworkiscomprehensiveinthatitaddressedalloftheelements.

Theframeworkwasfurtherdevelopedtakingintoaccountfactorsidentiﬁedintheliterature,informationgainedfromaspecialistacademicfo-cusgroupandapilotexaminationofthreecurricu-lumdocuments.InTable1theframeworkissummarised.

Datacollectionandanalysis

Theeligibilitycriteriaforinclusioninthisevalua-tionincludedAustralianuniversityundergraduatepreregistrationnursingprograms.Allofthe29universitiesofferingsuchprogramsinAustralia(Hobsons,2001)werecontactedbylettertotheDeansofNursingandtheircurrentcurriculumdoc-umentrequested.

Eachdocumentwasreadinfullbyonememberoftheprojectteam,appliedtotheevaluationframework(Table1)andalldatarecordedonadatabase.Thiswasdiscussedwithothermembersoftheteamandagreementaboutcategoriesandscoringreached.Analysisofthedatainmostcasesinvolvedcalculationoffrequencydistributions,andwhereappropriate,contentanalysiswascarriedout.Theapproachtodatacollectionandanalysis

wasconsultative,withallissuescomingunderclosescrutinyofthewholeresearchteam.

Someaspectsoftheevaluationframeworkwerenotwellarticulatedinthecurriculumdocuments.Inthesecasesakeywordsearchwasconductedandthelanguageinthedocumentwasusedtointerpretdata.Forexample,languageimplyinga‘student-centred’approachtoteachingandlearn-ingwouldincludestatementslike‘interactiveworkshop/discussion’,‘participatory’,versusa‘teacher-centred’approachconsideredtoincludelanguagesuchasa‘lecture’.

Theareasof‘Clarityandcoherence’,‘Clinicallearning’and‘Professionalandgenericskills’re-quiredmorecomplicatedapproachesandtheseareoutlinedbelow.

Item3:Clarityandcoherence

Thisitemexaminedtheclarity,coherenceandconsistencyofcurriculaandthelinksbetweencoursephilosophyandgoalsandcoursedetails.Ineachdocumentthecoursephilosophy,teachingandlearningapproaches,viewofnursing,courseobjectivesandgraduateoutcomeswerenoted.Thesewerecross-checkedagainstthecoursestruc-turetodeterminethedegreetowhichtheywereevidenced.Forinstance,didsubjectoutlinescon-sistentlyshowevidenceofstudent-centredap-proaches(ifthiswastheintention)?Didthelanguageinthecurriculumsupportthis,andwereteachingandlearningencountersreﬂectiveofthis?Analysisofthedocumentsinthisitemalsoin-volvedeachdocumentbeingcategorisedonascalefrom1to10.Thescaleandcategoriesarede-scribedindetailbelow(Table2).Item6:Clinicallearning

Manycurriculahadlittledetailabouttheorgani-sationofclinicallearning.Also,approacheswerevariable,makingitdifﬁculttodrawcomparisons.ItwasdecidedtofurtherexplorethiskeyissuebyapproachingtheDeansofNursingofuniversities

Nationalcomparativecurriculumevaluationofbaccalaureatenursingdegrees

Table2

Clarity,coherenceandconsistencyscale

CategoryInInInInIn

allcases

themajorityofcases

morethanhalfofthecaseslessthanhalfofthecasesnocases

423

Expectedstandard

Thecoursestructure,(subjectobjectivesanddescriptions)addressthecourseobjectives

Rating9–107–85–63–41–29–107–85–63–41–2

Thecoursestructure,(subjectobjectivesanddescriptions)isconsistentand/orreﬂectiveofcoursephilosophy,

viewofnursing,pedagogicalstructureandgraduateoutcomes

AlwaysMostlyGenerallyNotalwaysNotatall

notprovidingsufﬁcientdetailsintheircurriculumdocumentandaskingthefollowingquestions.󰀂Howdoesyouruniversitycollaboratewiththeclinicalareas?

󰀂HoworwhatstrategiesdoesyourcoursehaveinplacetolinktheoryandnursingclinicalpracticeintheBNcurriculum?

Thisenablednationalcomparisonstobemade.Questionsaboutthefrequency,length,locationandcoordinationofclinicalblockswerealsoclari-ﬁedwithmanyuniversitiesindividually.

Table3

Professionalcompetenciesandgenericskills

Item7:Professionalcompetenciesandgenericskills

Thecurriculumdocumentswereanalysedastotheextenttowhichprofessional(ANCI)competen-cies(ANRAC,1990)andgenericskills(West,1998)wereevident(Table3).Thisanalysis,althoughattimeslimitedinscope(asmanyoftheserelatedtocurriculuminaction),answeredthefollowingquestions.

󰀂DidthecourseobjectivesandgraduateproﬁlesrelatetoANCIandWestReportdomains?

Professional/ethicalpractice󰀂

󰀂󰀂󰀂Reﬂectivepractice

󰀂󰀂󰀂󰀂

Accountability(attitudesandvalues);Knowledgeforsafepractice;

Protectsrightsofindividualsandgroups(attitudesandvalues);Conductsnursingpracticeinawaythatcanbeethicallyjustiﬁed(attitudesandvalues)

Recognizesownabilities(Reﬂection);

Actstoenhancedevelopmentofselfandothers(Reﬂection);Recognizesvalueofresearch;

Critical/conceptualthinking–capacityfor(Reﬂection)

Enabling

󰀂Maintainsphysicalandpsychosocialenvironmentthatsustainssafety,securityandoptimalhealth;Actstoenhancedignity&integrityofindividuals/groups(attitudesandvalues);

󰀂Assistsindividuals/groupstomakeinformeddecisions(attitudesandvalues);󰀂Communicateseffectively(inc.writtendocumentation)(attitudesandvalues);󰀂Effectivelymanagesnursingofindividualsandgroups(attitudesandvalues)󰀂Comprehensivelyandaccuratelyassesses;

󰀂Formulatesacareplaninconsultationwithindividualsorgroupsandhealthcareteam;Implementsplannedcare;󰀂Evaluatesprogress

󰀂Collaborateswithhealthcareteam󰀂󰀂󰀂󰀂

Technicalcompetence;

Intellectualopennessandcuriosity(creativity);

Understandingofbroadconceptualandtheoreticalelements;Selfdirectedactivity–capacityfor(CreativityandReﬂection)

Problemframingandsolving(andreasoning)

TeamworkMiscellaneous

Professionalskills/ANCIcompetencies(ANRAC,1990)Genericskills/WestReportDomains(West,1998).

424

Table4

Analysisexemplarsprofessionalandgenericskills

Teachingandlearningencounters

L.Leibbrandtetal.

Professional/genericskillProblemsolvingCreativity

Criticalthinking

󰀂Classexercises,casestudies,groupdiscussion,debate;

󰀂Openendedlearning,devisingownobjectives,independentlearning,reﬂectiveexercises,classexercises,ﬂexibilityofcourseand/oraspectsofthecourse,assessmenttypesandvariation;

󰀂Reasoningexercises,assessmenttypes,opendiscussion,debate,reﬂectionexercisesanddiscussions,criticalfeedbackmechanisms,debate

󰀂DidthecurriculumdocumentdiscussANCIandWestReportdomainsandinwhatwaysdotheyinformthecurriculum?

󰀂DidanyotheraspectsofthecoursedemonstrategeneralendorsementofANCIandWestReportdomains?

Insomecasesitwasdifﬁculttoassessoutcomes.Teachingandlearningencounterswereusedtocross-checkforachievementinthesecases.Exem-plarsarepresented(Table4).

Results

Thisevaluationincluded26of29eligiblecurricula,aresponserateof90%.Allcurriculumdocumentsinthestudyweredevelopedbetween1996and2001

Table5

Approachtoteachingandlearning

andwereallaccreditedbyrelevantnursingregis-teringauthorities.Ahighlevelofentryﬂexibilitywasfoundincludingspecialprocessesforoverseasstudents,EnrolledNurses,disadvantagedstudents,graduatesfromotherdisciplines,studentsfromnon-EnglishspeakingbackgroundsandIndigenousAustralians.Thedocumentsshowedevidenceoftheincorporationoftherangeofpracticeexperi-ences(medical/surgical,communityhealth,devel-opmentallydisabledandmentalhealthnursingforindividualsacrossthelifespan)mandatedbythevariousNurses’RegistrationBoards(NSWHEB,1984;NSWNRB,1984).

Themajorityofuniversitiesfavouredaliberalorientationtoteachingandlearning(Table5)withanemphasisonnursingintheircourseframeworks(Table6).

Principlepedagogicalstructure

Adultlearning,studentcentred,humanisticTeachercentred,behavioural

NothingmentionedornotabletojudgeProblembasedlearningTotal

󰀂Percentagesrounded.

Numberofuniversities2032126

%77%12%8%4%100

Table6Viewofnursing

Numberofuniversities74332111111126

%27%15%12%12%8%4%4%4%4%4%4%4%100

Principleviewofnursing

HolisticNone

PrimaryHealthCare

Interactive,partnership,relationalCaring

ConstructivistapproachDialectical

Therapeuticrelationships,artandsciencePractice/solutionbased

ClinicalcompetencereﬂectionExperientialreﬂective

Nursingbasedoncognitive,affective,andpsychomotorskillsTotal

󰀂Percentagesrounded.

Nationalcomparativecurriculumevaluationofbaccalaureatenursingdegrees

Table7

Nursingcourseworkload

Range654–1415600–136512–312–61–72–42

425

Totalperprogram

Facetofaceteachinghours(n=19)Clinicalpracticehours(n=26)Subjectsinprogram(n=26)Subjectspersemester(n=26)Assessmentspersubject(n=19)Assessmentspersemester

Average1009913234312

󰀂Threecourseshavefullyearsubjects.

󰀂Facetofacehours:Sevenarebasedonestimatesoftheinformationinthedocument.󰀂Clinicalhours:Sixarebasedonestimatesoftheinformationinthedocument.

Subjectoutlinesindicated,inthemain,useoftraditionalapproaches(lectureandtutorial).However,generallyteachingandlearningstrate-giessupportedaliberalapproachtoteachingandlearning(Table5),withmanyinteractiveandinnovativestrategiesdocumentedinthecurricula.

Mostdocumentshadclearlinksintheirstatedcourseaimsandstructure.Twenty-two(85%)ofthe26courseswereratedasﬁveoraboveonthescaleofoneto10(Table2).(Sixdocumentsdidnotshowallinformationrequiredforcompleteanalysisinthisarea.Howeverinthesecasesthere

wassufﬁcientinformationtomakedeductionsbasedontheinformationinthedocuments).

Totalteachingandclinicalhoursandthenumberofsubjectsandassessmentsundertakenbystu-dentswerecalculated(Tables7and8).

Mostuniversitiesusedclinicalblocksalthoughtherewasnopatternorconsistencyaboutmethodsforimplementingandorganisingthem.Clinicalpracticehoursdidincreasefromsemesteronethroughtosemestersix.Numerousstrategieswerefoundtocombattransitionalissuesinnursingandotherstointegratetheoryandpractice.

Table8Nursingcourseworkload

Average10098951904

Standarddeviation192132

Perprogram

FacetofaceteachinghoursClinicalpracticehoursTotalhoursperprogram

󰀂Basedon19coursesonly.

Table9ContextualfactorsrelatedtohealthandnursinginAustralia

HealthissueATSI

Multi-cultural202

Rural/Remote123

144

AmountofrepresentationincurriculumdocumentFeaturedovertlyinthecoursestructure

Mentionedinthecurriculumdocument,withnoevidenceofitbeingfeaturedinthecoursestructure

NotmentionedinthedocumentatallTotal

8264261126

Table10Courseoutcomes:ANCI

No.ofuniversities138526

ANCIcompetencyrepresentation

ANCIcompetenciesusedtoguideclinicalassessment

ANCIendorsedinanotherway(courseobjectives,coursestructure,graduateproﬁle)NoevidenceofANCIinthedocumentTotal

426

InclusionofissuesassociatedwiththehealthofATSIpeoples,multiculturalcommunitiesandrural/remotecommunitieswereassessed(Table9).

ThestudyconﬁrmsANCIcompetenciesinformcurriculumdesign,teachingpractices,assessmentpracticesandlearningoutcomes.Twenty-onedoc-umentsspeltouttheintegrationofANCIcompe-tenciesintotheirprograms(Table10).

Consumerparticipationinnursingcurriculumdevelopmentwasneglected.Althoughseveraluniversitiesdiscussedthis,onlyonecoursehadaconsumerontheircourseplanningcommittee.Anotherweaknesswasthehealthofolderpeopleoverallwasnotwelladdressed,withvariedmeth-odsforinclusionincurricula.Somehadagedcaresubjectsandassociatedclinicalpractice,how-everothersusedagedcarefacilitiesforearlypracticeplacements.

Finally,therewerewideinconsistenciesinthewaythecurriculumdocumentspresentedinfor-mation.Forexample,intheareaof‘curriculumorientation’somedocumentsclearlydescribedaframeworkbasedonliteratureanddemon-stratedhowthisframeworkrelatedtotheircoursestructure.Othershowever,gavelimitedinformation.

Discussion

Toreachjudgementabouthowwelltheevaluationframeworkworkeditisnecessarytoexaminewhattheevaluationwas,andwasnot,abletoﬁnd.Thestudywasabletoconﬁrmthatmostcurriculahaveclearlinksbetweentheirstatedcourseaimsandstructure.Itfoundlikeotherstudies(Jonasetal.,1993;Frenchetal.,1996)thebroadprinci-plesforthepreparationofan‘educated’person(Candy,1994;West,1998)wereevidentinthedoc-uments.Thedocumentsalsodemonstratedsoundpedagogicalunderpinnings(Table5)andshowedevidenceoftheincorporationoftherangeofprac-ticeexperiencesmandatedbythevariousNurses’RegistrationBoards(NSWHEB,1984;NSWNRB,1984).

Currentviewsofnursingarebasedaroundnurs-ingmodelsorcombinedwithotherapproachessuchasinteractiveandprimaryhealthcaremodels(Table6)ratherthanmedicalmodelspreviouslyused.ThisalsoconﬁrmedbyanotherstudyinCan-ada(Sohn,1991),demonstratingnursingcoursesaredevelopingtheirownapproaches.

AlsoimportantwastheendorsementofANCIcompetencies(Table10)inthecurricula.ANCI

L.Leibbrandtetal.

competenciesaretheonlynationalstandardfornursingcoursesinAustralia.AllregistrationboardsuseANCIforaccreditationofcoursesandallbegin-ningRegisteredNurseshavetomeetANCIcompe-tencies.Itwouldbesigniﬁcantifthesewerenotaddressed.

Thereisconsiderableevidenceindicatingwork-loadinprofessionalcoursesishigh(GraduateCa-reersCouncilofAustralia2003)andthiswasconﬁrmedfornursingcourses(Tables7and8).However,manyexamplesofteachingandlearningencountersandassessmentstrategieswereidenti-ﬁedinthenursingcurriculathatwerelikelytofos-terdeeperapproachestolearning.

Althoughtherewasawiderangeoftheoreticalandclinicalhours(Table8)thebalancebetweenclinicalandtheoryhourswasgenerally50:50.Gi-venthatallcurriculawerecurrentlyaccrediteditseemsthatarangeofclinicalhoursisproducingsatisfactorygraduates.Theﬁndingspointtoaneedforashiftinfocustoqualityandcoordinationofclinicallearning.Questionsaboutqualityinclinicallearningmayinclude:

󰀂Howistheclinicallearningenvironmentenhanced?

󰀂Whatstrategiesimprovelinksbetweenclinicallearningandtheory?

󰀂Whataretheprinciplesofqualityclinicaleducation?

Thereisaclearneedforresearchtoexaminetherelativeimpactoflengthofclinicalexperienceonclinicallearningascomparedwithotherstrategies.

Theneedformoreopencommunicationandcol-laborativeapproachestoclinicaleducationhasbeenhighlightedinpreviousstudies(Sohn,1991;Reid,1994;Fitzgeraldetal.,2001;Clareetal.,2002).Thisevaluationconﬁrmed,81%oftheuni-versitiesaddressedthisissuetovaryingdegreesintheircurriculumdocument.However,inmanyuni-versitiesthemainlinkwastheclinicalcoordinatororequivalent(consistingofcoordinationofclinicalexperiences).Clearlyworkhadbeendoneinthisarea,howeverstrongrelationshipswithhealthcareorganisationsspellingouthowhighqualityclinicallearningwasachievedwerenotalwaysevident.GapswereidentiﬁedinrelationtoinclusionofissuesassociatedwiththehealthofAboriginalandTorresStraitIslanderpeoples,ruralhealthis-sues(Table9)andolderpeople.Consumerpartici-pationincurriculumdevelopmentwasdiscussedinthedocumentsbutgenerallynotevidenced.Thesegapshighlightedchallengesahead.Theseareasneedtobebetterincludedincurricula.

Nationalcomparativecurriculumevaluationofbaccalaureatenursingdegrees427

Limitationsofstudydesign

Althoughtheevaluationframeworkhasbeenabletoprovideacoreofinformationthereisanimpor-tantrestrictioninthatitcollecteddatafromthecurriculumdocuments(curriculuminintent).Theﬁndingswouldhavebeenenhancedbycoordinatedevaluationsofcurriculainaction.However,withthecontextofthelargerstudy,validityofcurricu-lumevaluationresultswasachievedbytriangulat-ingthedatafromanumberofsourcesincludingfocusgroups,interviewsandquestionnaires.

Therewaspotentialforsomebiasasitwasnotpossibletobeblindtotheidentityofeachuniver-sity.Thiswouldhaveincreasedthecomplexityandtheresourceintensivenessofthestudy.Theaimofthestudyhoweverwasnottomakejudgementsaboutthe‘best’curriculumbuttodevelopbench-marksforbestpractice,thisthereforewasnotcon-sideredaproblem.

Themajorityofthedocumentanalysiswasundertakenbyonepersonwithregularconsultationandcheckingwithothermembersoftheresearchteam.Theresearchteamwerealreadyfamiliarwithcurrentnursingcurriculaduetothenatureoftheirposition.Futureresearchersconductingsimilarstudiesmayﬁndithelpfultoimprovecon-sistencyofdataiftwoormorepeopleundertakethedocumentanalysis.

Recommendationsforfutureresearchersofsimilarstudies

Studiesthat(wherepossible)triangulatedatacol-lectionmethodswillincreasereliabilityoftheirdata.

Wherecurriculumdocumentdetailsareincon-sistent,usinginformal(aswellasformal)liaisonchannelslikeemailandtelephoneseemedtoin-creasechancesofforthcomingresponses.Anomi-nated/appropriatecontactpersonateachuniversitywasespeciallyhelpful.SmallerqueriesmaybeaddressedviatheInternet(websitesofuni-versities)orotherappropriateliterature.Weoftenfoundinformalmethodsofcommunicationachievedbetterresultsthanformalones.

Howhavetheresultsoftheevaluationbeenused

ThisstudyhasbeenundertakenatatimeofunprecedentedinterestinNursingeducation,prac-tice,recruitmentandretention.Thecomprehen-sivereportfromthelargerstudyreﬂectssuch

concernsandaddressestheminavarietyofways.Thestudydrewfrommanysimilarstudiesandaddedtocurrentresearchandreports,mostnota-blytheNationalReviewofNursingEducation2001–2002andtheSenateInquiryintoNursingPractice2001.

Thelargerstudyutilisedthecurriculumevalua-tioninconjunctionwithprocessesforgainingcriti-calfeedbackfromkeystakeholders.Fromthekeyissuesidentiﬁedcontextuallyappropriate‘bestpractice’principlesforAustraliannursingcurriculaandcurriculumdevelopmentwerederived(pub-lishedinﬁnalreport:(Clareetal.,2002)).Oneofthemajorﬁndingsbeingtheneedforcloserrelation-shipsbetweenuniversitiesandhealthcareorganisa-tionswasthefocusPhasetwoofthestudy.PhasetwoevaluatedclinicallearningenvironmentsofundergraduatenursesandestablishedbenchmarksforpracticepartnershipsbetweenhealthcareorganisationsanduniversitiesinnursinginAustralia.

Conclusion

ThecurriculumevaluationcomparativelyevaluatedundergraduatenursingcurriculainAustraliaprovid-ingacomprehensivepictureofcurrentpreparationofnursinggraduates.Theevaluationresultssetabenchmarkforotherstoevaluateagainstandhavebeneﬁtsforallstakeholdersinnurseeducation.Graduatesaregenerallywellpreparedforpractice(WhileandRoberts,1998;Fraser,2000;Clareetal.,2002)howeverthereneedstobecloserandmorecooperativeapproachesestablishedbetweenuni-versitiesandhealthcareworkplaces,improve-mentsmadeinaddressinghealthofminoritygroupsandinworkloadandassessmentmethods.Themodeldescribedheremaybeusedforevalua-tionsinnursing,otheralliedhealthcareprofessionsandoutsidethesphereofhealthinpracticebasedprofessionssuchasteachingandengineering.

References

AgedandCommunityServicesAustralia,2001.SenateInquiryinNursing.Canberra,AgedandCommunityServicessubmissiontotheAustraliaSenateCommunityAffairsReferencesCommittee.

ANRAC,1990.NursingCompetenciesAssessmentProjectvol.1–theprojectreport.Brisbane,AssessmentandEvaluationResearchUnit,EducationDepartment,UniversityofQueensland.

Balla,J.,Boyle,P.,1994.Assessmentofstudentperformance:aframeworkfroimprovingpractice.AssessmentandEvalua-tioninHigherEducation19(1),17–28.

428

Bevis,E.W.J.,1989.TowardaCaringCurriculum:ANewPedagogyforNursing.NationalLeagueforNursing.NewYork,NationalLeagueforNursing.

Brown,D.,1997.PreparationforPractice.FacultyofEducation.UniversityofWesternSydneyMacarthur,Sydney.

Candy,P.C.,1994.DevelopingLifelongLearnersthroughUnder-graduateEducation.Canberra,AustralianGovernmentPublicService.

Chavasse,J.,1994.Curriculumevaluationinnursingeducation:areviewoftheliterature.JournalofAdvancedNursing19(5),1024–1031.

Clare,J.,White,J.etal.,2002.Curriculum,ClinicalEducation,Recruitment,TransitionandRetentioninNursing.AustralianUniversitiesTeachingCommittee,Adelaide.

CommonwealthofAustralia(2002a).Thepatientprofession:Timeforaction.In:ReportoftheSenateCommunityAffairsCommitteeontheInquiryintoNursing.Canberra,SenateCommunityAffairsCommittee.

Cowell,J.M.,Kahn,E.H.etal.,1991.Theschoolnursedevelopmentprogram:anexperimentinoff-sitedelivery.TheJournalofContinuingEducationinNursing23(3),127–133.

Cronbach,L.J.,1975.Beyondthetwodisciplinesofscientiﬁcpsychology.AmericanPsychologist30(2),116–127.

DiFlorio,I.,Duncan,P.etal.,1989.Curriculumevaluation.NurseEducationToday9,402–407.

Dwyer,J.,McMillan,M.,1994.AProblem-basedLearningMethodology–ACurriculumEvaluation.Unpublishedpaper.FacultyofHealth,UniversityofWesternSydney,Macarthur.

Fitzgerald,M.,Pincombe,J.,McCutcheon,H.,Evans,D.,Wiechula,R.,Jordan,Z.,2001.AnIntegrativeSystemicReviewofNursingCurricula,UndergraduateClinicalEdu-cation&TransitionSupportforNewGraduates,Commis-sionedbytheQueenslandNursingCouncilandconductedbytheDepartmentofClinicalNursing,AdelaideUniversityinConjunctionwiththeJoannaBriggsInstituteforEvidenceBasedNursingandMidwifery,Adelaide,SouthAustralia.

Fraser,D.M.,2000.ActionresearchtoimprovemidwiferycurriculumPart2:CasestudyevaluationinsevensitesinEngland.Midwifery16(4),277–286.

FrenchJr.,P.A.,Burnard,P.R.,Holmes,C.R.,Mashaba,G.R.R.D.e.P.,Wong,T.r.,Bing-hua,Z.,1996.Internationalcomparisonofbaccalaureatenursingdegrees:collaborationinqualitativeanalysis.JournalofAdvancedNursing23(3),594–602.

Grundy,S.,1987.Curriculum:ProductorPraxis.FalmerPress,Deakin,Victoria,Australia.

Hengstberger-Sims,C.,McMillan,M.,1991.Stakeholderevalu-ation:amodelfordecisionmakinginproblem-basedlearn-ing.NurseEducationToday11,439–447.

Hobsons,2001.NewHobsonsDirectoryofHigherandFurtherEducationCourses2002.NorthHobsonsPressPtyLtd,Sydney,Australia.

Hogg,S.A.,1990.Theproblem-solvingcurriculumevaluationanddevelopmentmodel.NurseEducationToday10,104–110.

JacquesJ.,GibbsG.R.C.,1993.DesigningandEvaluatingCourses.Sydney,Australia,ReprintedbytheProfessionalDevelopmentCentreoftheUniversityofNewSouthWalesEducationalMethodsUnit,OxfordBrookeUniversity.

Johnson,D.,Preston,B.,2001.AnOverviewofIssuesinNursingEducation,EvaluationsandInvestigationsProgramme,HigherEducationDivision,DETYA.

L.Leibbrandtetal.

Jonas,H.S.,Etzel,S.I.etal.,1993.EducationalprogramsinUSmedicalschools.JournaloftheAmericanMedicalAssociation270(9),1061–1068.

KPMG,2001.StrategicReviewofUndergraduateNursingEduca-tionfortheNursingCouncilOfNewZealand,NursingCouncilofNewZealand;Health,EducationandCommunityServices.Marriner,A.,Longford,T.etal.,1980.Curriculumevalua-tion:wordfact,ritualorreality.NursingOutlook(April),228–232.

McAllister,M.,1999.Thecompetinginterestsofassessment:anAustralianoverview.CurriculumandTeaching14(1),45–62.

McAllister,M.,2001.PrinciplesofcurriculumevaluationinAustraliannursing:anexaminationoftheliterature.NurseEducationToday21,304–314.

McKeachie,W.J.,1974.Thedeclineandfallofthelawsoflearning.EducationalResearcher3(3),7–11.

McKinley,S.,Aitken,L.,Doig,G.,JinZhuLiu,X.,2001.FinalreporttotheNationalReviewofNursingEducation:asystematicreviewoftheliteratureonmodelsofnursingeducationandtraining,RoyalNorthShoreHospital,NothernSydneyAreaHealthService.

NSWHEB,1984.BasicNurseEducation:GuidelinesforAdvancedEducationInstitutionsinthePreparationofCourses.Sydney,NewSouthWalesHigherEducationBoard.

NSWNRB,1984.Competenciestobedevelopedincollegebasednursingprogrammes.Sydney,NewSouthWalesRegistrationBoard.

O’Neill,E.L.S.,1986.Comprehensivecurriculumevaluation.JournalofNursingEducation25(1),37–39.

Parlett,M.,Hamilton,D.,1977.In:Parlett,M.,Dearden,G.(Eds.),EvaluationasIllumination.IntroductiontoIllumina-tiveEvaluation:StudiesinHigherEducation.PaciﬁcSound-ingsPress,California,pp.10–29.

Poteet,G.,Hodges,L.,1987.Strategiesforensuringasuccess-fulcurriculumconsultation.NurseEducator12(5),25–28.Poteet,G.,Pollock,C.,1986.Increasingaccountabilitythroughprogramevaluation.NurseEducator11(2),41–47.

Reid,J.,1994.NursingEducationinAustralianUniversities:ReportoftheNationalReviewofNurseEducationintheHigherSector.1994andBeyond.Executivesummary,Com-monwealthofAustralia1994.

Sarnecky,M.T.,1990a.ProgramevaluationPart1:fourgener-ationsoftheory.NurseEducator15(5),25–28.

Sarnecky,M.T.,1990b.ProgramevaluationPart1:aresponsivemodelproposal.NurseEducator15(2),8–11.

Schwab,J.,1969.ThePactical:ALanguageforCurricu-lum.Curriculumtheorising:beyondreproductiontheory.S.KemmisandL.Fitzclarence.1986.GeelongVictoriaAustralia,DeakinUniversityPress,Schoolreview,78:pp.1–24.

Simons,H.,1996.Theparadoxofcasestudy.CambridgeJournalofEducation26(2),225–240.

Smillie,C.,Wong,J.,1984.Aproposedframeworkforevalu-ationofsupportcoursesinanursingcurriculum.JournalofAdvancedNursing9,487–492.

Sohn,K.,1991.Conceptualframeworksandpatternsofnursingcurriculum.JournalofAdvancedNursing16,858–866.

Stenhouse,L.,1976.AnIntroductiontoCurriculumResearchandDevelopment.Heinemann,London.

Stenhouse,L.,1983.Curriculumresearchandtheartoftheteacher.Curriculumhistory.D.Hamilton.1990.Deakin,Victoria,Australia,DeakinUniversityPress,pp.95–102.

Sutcliffe,L.,1992.Anexaminationoftheimplicationsofadoptingaprocessapproachtocurriculumplanning,imple-

Nationalcomparativecurriculumevaluationofbaccalaureatenursingdegrees

mentationandevaluation.JournalofAdvancedNursing17,1496–1502.

Watson,J.E.,Herbener,D.,1990.Programevaluationinnursingeducation:thestateoftheart.JournalofAdvancedNursing15,316–323.

West,R.,1998.FinalReport:LearningforLife.Canberra,AustralianCommonwealthDepartmentofEmploymentEdu-cation,TrainingandYouthAffairs.

While,A.E.F.J.M,Roberts,J.D.,1998.Anexploratorystudyofsimilaritiesanddifferencesbetweenseniorstudentsfromdifferentpre-registrationnurseeducationcourses.NurseEducationToday18,190–198.

429

Whiteley,S.J.,1992.Evaluationofnursingeducationpro-grammes–theoryandpractice.InternationalJournalofNursingStudies29(3),315–323.

Williams,A.,1999.Anantipodeanevaluationofproblem-basedlearningbyclinicaleducators.NurseEducationToday19(8),659–667.

Winter,E.J.S.,Bender,A.W.etal.,1987.Analysingandevaluatingabaccalaureatenursingcurriculumframework.NurseEducator12(4),10–13.

Wise,P.,Cox,H.,1984.Yoderevaluatingacontinuingnursingeducationprogram.TheJournalofContinuingEducationinNursing15,117–121.

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