Strengthening Faculty

Competencies in Teaching
Community Health Nursing in the
BSN Curriculum

Luz Barbara P. Dones, MPH, RN

Associate Professor
UP Manila College of Nursing
August 28, 2009
Angeles University Foundation
Curriculum

Designed to provide a sequence of

learning experiences that will enable
students to achieve desired
educational outcomes (Ratcliff,
1997).
Curriculum Frameworks
• Provide the basis of conceptualizing
and organizing the delivery of the
knowledge, values, beliefs and skills
critical to the delivery of a coherent
curriculum that facilitates the
achievement of the desired
curriculum outcomes (Boland, 1991)

• Considered as “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 Curriculum
The framework must reflect the
 Domain of professional health
practice
 The phenomena of concern to that
specific health profession
 How each profession relate to others
who are also dealing with health
concerns
Developing an Organizing
Framework
Two general Guiding Principles:
approaches: • Choose the concepts that
most accurately reflect the
• Developing a practice and discipline of
single theory the profession
framework • Define those concepts that
• Developing an reflect the philosophy,
eclectic mission statements or
framework discipline
• Explain the linkages
between and among the
concepts
 Specific Components of Curricular Content Matrix
Concepts of Health and Illness Goals of Care
Oxygenation Self-care Enhancement
Fluid and Electrolyte Balance Optimum Level of Functioning / Quality of Life
Reproduction and Sexuality Performance of Activities of Daily Living
Perception and Coordination Healthy Lifestyle
Metabolism Effective Coping
Inflammation and Immunity Self Actualization
Cellular Aberrations Social and Economic Productivity
Rehabilitation Empowerment / Client Competence
Vulnerable populations
Aging (Geriatrics) and Chronic Illness
Psychosocial Adaptation
Population/s in life-threatening situations

Roles of the Nurse Levels of Prevention

Practitioner (e.g. staff nurse)
Leader/Manager (e.g. head nurse, supervisor)
Researcher (Beginning Opportunities for Researcher
Role)
Primary Level (Primordial, Health Promotion / Disease
Prevention)
Secondary Level (Early detection; prompt and appropriate
treatment; disability prevention)
Tertiary Level (Disability limitation; disability reduction)

Types of Client Nursing Process

Individual across the Life Span (e.g. neonate, infant, Assessment
child, adolescent, adult, older person) Planning
Family Implementation
Population Group (e.g. at-risk/vulnerable group) Evaluation/Monitoring
Community Recording and Reporting
 Integration Framework in Curricular
Design*
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)

* 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 curriculum
Ask:
• What should students know and be able
to do after the educational experience?
• What competencies (SKA) must
students possess to successfully
demonstrate desired outcomes?
• What learning experiences will facilitate
attainment of the competencies?
• How will the attainment of the
competencies be evaluated?
 The Role of Outcomes and Competencies in
Curriculum Frameworks: Identifying
Curriculum Outcomes
Example of outcomes/core
characteristics (Halstead et al.,
• Faculty 1996):
identification 1. Critical Thinker
of core 2. Culturally Competent
characteristics/ 3. Knowledgeable coordinator of
attributes community resources
4. Politically aware
5. Ethically and Legally grounded
• Concept 6. Effective Communicator
clarification or 7. Competent health care provider
analysis 8. Model of professional role
9. Responsible manager of human,
fiscal, and material resources
 The Role of Outcomes and Competencies in
Curriculum Frameworks: Identifying
Curriculum Outcomes
Steps in Concept
• Faculty Clarification/Analysis (Avant
identification of & Walker, 1988):
core 1. Description of qualities that most
clearly express the phenomenon of
characteristics/ “professional” nurse, doctor, dentist
attributes etc.
2. Description of context of qualities
identified by linking attributes
• Concept together in a meaningful way
clarification or
analysis Example:
A critical thinker who is able to
demonstrate intellectual curiosity,
rational inquiry, problem-solving
skills and creativity in framing
problems
The Role of Outcomes and Competencies in
Curriculum Frameworks: Identifying
Competencies

Competencies are important

 Foundation in designing evaluation
tools used in the assessment of
student learning
 Determine right student (Who?),
right level of behavior (What?), and
right context of behavior
(When/where?)
The Role of Outcomes and Competencies in
Curriculum Frameworks: Identifying
Competencies

Competency Statements
• Identify SKA students need to develop
to achieve curriculum outcomes
• Behaviorally-anchored and student-
focused
The Role of Outcomes and Competencies in
Curriculum Frameworks: Identifying
Competencies

Example of Competency Statements (IUSON, 1995)

Program Outcome: A critical thinker who is able to demonstrate

intellectual curiosity, rational inquiry, problem-solving skills, and
creativity in framing problems.
Senior Level Competency: Evaluates decisions through logical
organization, validation of information, and critical examination of
assumptions underlying the process of information and analyzes the
conclusions drawn from the information (Halstead et al., 1994)
Junior Level Competency: Validates care decisions with appropriate
persons to determine the degree to which decisions are consistent
with client-system information and environmental clues.
Sophomore Level Competency: Participates in selected problem-
solving exercises that promote critical examination of the
professional care role.
The Role of Outcomes and Competencies in
Curriculum Frameworks: Identifying the
Competencies
Identification of antecedents/factors for
achievement of outcomes and
competencies
– What are the skills needed to perform the
outcome or attribute
– What are the knowledge needed to
develop or foster the identified behavior
– What are the attitudes necessary to
facilitate development or refinement of the
skill
The Role of Outcomes and Competencies in
Curriculum Frameworks

Example of Attributes and Antecedent Factors

Related to Critical Thinking:

Characteristic Attributes of the Antecedents/ Skills,

Valued Characteristic Knowledge and
Attitudes
Critical Thinking • Intellectual Curiosity • Intellectual ability
• Rational Inquiry • Understanding of
• Problem Solving problem solving
• Creativity • Ability to ask probing
questions
The Role of Outcomes and Competencies in Curriculum
Frameworks: Guidelines for Writing Outcomes and
Competency Statements (Billings, 1998)

• Should be anchored on today’s

practice reality
• Should address accountability issues
and these depicts the acceptable
nursing practice for graduates
• Determine the critical outcomes to be
measured, and the importance of
these outcomes
The Role of Outcomes and Competencies in Curriculum
Frameworks: Guidelines for Writing Outcomes and
Competency Statements (Billings, 1998)

• Outcomes must be competency-

based or behaviorally anchored
– Competencies serve as program
markers that denote what knowledge
and skills are needed to meet outcomes
– Competencies are useful in creating
measurement indicators for assessing
the degree to which students have met
the outcomes
The Role of Outcomes and Competencies in Curriculum
Frameworks: Guidelines for Writing Outcomes and
Competency Statements (Billings, 1998)

– Competencies determine the readiness

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

• Precision is required in writing

outcome statements.
• The language of competencies must
reflect a continued sense of
development (increasing complexity,
differentiation, delineation, or
sophistication)
 The Role of Outcomes and Competencies in
Curriculum Frameworks: Leveling or Specifying
Competencies
Guidelines for Writing Outcomes and Competency Statements
Example:
Outcome statement: A competent care provider who individualizes nursing care
to maximize client care outcomes.
Competencies at different levels:
• Carries out procedures ordered for assigned client
– Realistic expectation for beginning student
– To develop this competency, the student must be able to read a care plan to
determine interventions to be performed.
• Modifies a standard plan of care consistent with desired client care outcomes
– To develop this competency, the student is expected to carry out ordered
procedures.
– Student is in control of care plan modification based assessment information.
– Student should demonstrate good decision-making skills to evaluate data, make
corrections, and obtain desired outcomes.
• Develops care plans that reflect the individual goals of the client and desired
medical treatment goals.
– Requires higher level of functioning
– Student should know most acceptable medical and nursing interventions for a
specific client and is able to use this information in conjunction with assessment
data and records
The Role of Outcomes and Competencies in
Curriculum Frameworks: Leveling or Specifying
Competencies

• Recognize level at which the knowledge

and skills need to be demonstrated to
obtain outcome desired
• Learning environment is modified to
support students’ abilities to acquire
knowledge at the level being identified
• Evaluation measures need to be
consistent with level of learning
identified (Billings, 1998).
The Role of Outcomes and Competencies in
Curriculum Frameworks: Leveling or Specifying
Competencies

• Faculty must consider learner’s ability

done through establishing benchmarks
– To establish benchmarks, faculty collect
information on outcomes at the beginning
of the program.
– Benchmarks provide information on what
skills and knowledge students bring to
learning situation and can also indicate
change if data are collected at the
beginning and end of program
 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.
 Competency-based BSN
framework
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.

* A.S. Maglaya (2004)

 Competency-based framework

This framework has been the major

approach to the curricular design of the
B.S.N. Program of the College of
Nursing, University of the Philippines
Manila since 1978.

* A.S. Maglaya (2004)

 The Competency-based Framework in Curricular Design*
Work Setting
Scenarios
• Demographic
Profile
• Health Picture
• Socio-Political-
Economic Cultural
Context
Bases for
Selecting (reflecting SKA required to function in the Position/Role)
Learning
Experiences (e.g.
Practicum/R.L.E.
Entry Competencies
• Terminal competencies of
previous/earlier course/year
level
•Determined through pre-
requisite tests
* A.S. Maglaya (2004)
Scenario-Setting: Analysis of Work Setting
Roles
(Current data and projections)
• Practitioner
Professional roles required in work force • Manager/Leader
•Researcher
Professional responsibilities to implement each role
Professional tasks to carry out each responsibility
Skills, Knowledge, and Attitude Analysis
Professional Competencies
Student Competencies
Intermediate Competencies Terminal Competencies
• Within course work (e.g. • Should be congruent with requisites of
Unit/lesson) work setting/professional competencies
•Determined through • Determined through performance
progress tests (e.g. unit evaluation/post test of Achievement
exam, quiz) exam
Phases of Competency-based
framework
Work-setting Scenario Analysis
– Bases for specification of roles and
responsibilities
– Bases for selection of appropriate
clinical and community practicum
experiences (or Related Learning
Experiences referred to by other
Colleges of Nursing in the Philippines)
Phases of Competency-based
framework
Specification of Nursing Roles that
are
• critical in modifying or managing the
current and future projections on the
Philippine Health Scenario
• carried out by the nurse independently
and in collaboration with others
• Roles: Practitioner Leader-Manager,
Researcher
Phases of Competency-based
framework
Specification of professional
responsibilities related with the
nursing roles identified
– Utilizes the nursing process in the care of
individuals, families, population groups, and
the community
– Ensures a well-organized and accurate
recording and reporting system
– Shares leadership and shares effectively
with others in work situations related to
nursing and health
– Promotes personal and professional
growth for self and others
 Phases of Competency-based
framework
Specification of professional tasks for each
professional responsibility and the SKA
analysis of each Task
– Skill: the behavior needed to perform the task
– Knowledge: the content needed to be able to
perform the skill
– Attitude: the feelings, beliefs, approach, values,
towards others, one self or one’s work which
facilitate the execution of a skill of a particular
task based on major values: integrity,
nationalism, caring, universality, excellence
Phases of Competency-based
framework

Specific Content Areas as Foci

for Each Nursing Course Design
with Field Practice
CONCEPTS / SECOND YEAR LEVEL THIRD YEAR LEVEL FOURTH YEAR LEVEL
CONTENT
N-12 N-119 N-121.2
AREAS

Application Healthy Individual Community Individuals; Multi-problem

of the (focus on Maternal Population Group families; Vulnerable Population
Nursing and Neonatal Groups/ Aggregates;
Process by Care) Normal, Community
Type of Beginning Family
Client
Concepts of Family Wellness; Care of the Community Care of the Community Utilizing the Multi-sectoral/
Health and Pregnancy Labor and Empowerment/Partnership Strategies for Health
Illness and Delivery; Growth & Population Group Development
Development; Home Care of Individuals, Multi-Problem Families and
and Environmental Population Aggregates in Health and Illness
Health
Levels of Primordial Primordial; Primary; Primordial; Primary; Secondary; Tertiary
Prevention Primary Level Secondary; Tertiary
Role of the Practitioner Practitioner; Researcher Practitioner; Researcher; Leader/Manager
Nurse Leader/Manager
Interventions Enhancing Family Community Diagnosis/ Community Organizing/ Networking
Competencies for Community Organizing Conducting Clinics
Effective & Program Planning Training and Supervision
Adequate Empowerment Strategies Advocacy
Maternal & Child Advocacy Empowerment/Competence-building Strategies/Health
Care, Healthy Education/IEC Strategies (including School Health
Lifestyle and Program)
Environmental Management of Health Services
Health Referrals
Goals of Care Wellness/Self- Community Competence Healthy Lifestyle/Wellness
Actualization on Health Care and Self-Actualization
Effective Coping on Health Programs Social Community Competence / Empowerment
Family Realities and Economic Effective and Efficient Management of Health
Phases of Competency-based
framework

Identification of professional
competencies representing the SKA
components of each task for each
responsibility
Example: N-12 (Family Level)
Professional Competencies
Conditions Performance
Given The Practitioner:
opportunities in 1. Explains the organization, functions,
actual work and programs of the DOH
situations 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
 Phases of Competency-based
framework

• 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 1. Explains the nature and scope of
relevant community health and the different
questions, community health services offered by
the student 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 The student:
beginning/ 1. Obtains & analyzes data necessary for the
growing assessment of health & nursing
families needs/problems of the family
with simple 2. Defines the health and nursing
health needs/problems of the family
problems
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
 Phases of Competency-based
framework
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 Design
Conditions Competencies Instructional Instructional Evaluation
Activities Functions method/tools
Given health 1. Writes a Provide copies of Demonstrating Performance
records used in relevant/ the FSPR and behaviors to be evaluation
family nursing, significant instructions on learned checklist
the student entry on how to fill-up the
such form
Allowing
records
students to
(e.g.
Demonstrate practice
Family
how entries are behaviors
Service
written on the
and FSPR
Progress Providing
Records) feedback on
2. Utilizes Provide student progress
data from opportunities to
health practice writing
records in entries on the
formulating FSPR for each
a nursing nurse-client
care plan interaction
Phases of Competency-based
framework
Designing the evaluation tools to
determine achievement of learning
outcomes
– Sample performance evaluation tools illustrate
specific indicators to determine achievement
of Terminal Competencies
– Each course design includes an evaluation
plan specifying the evaluation methods and
tools
 Standards of Clinical Supervision
STANDARD I: Identification of Learning Outcomes

• The clinical supervisor/instructor specifies the

expected learning outcomes stated as terminal
competencies on the care of specific type/s of client
(i.e., individual, family, population group,
community).
• Each student is given copies of appropriate
performance evaluation tools which contain the
indicators of achievement of terminal competencies.

* Araceli S. Maglaya (2002)

 Standards of Clinical Supervision
STANDARD II: Planning/Use of Instructional Design

• The clinical supervisor/instructor develops/uses a

competency-based instructional design which
specifies the appropriate teaching-learning
activities/opportunities in the hospital, 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.

* Araceli S. Maglaya (2002)

 Standards of Clinical Supervision
STANDARD III: Implementation of Instructional Design

• The clinical supervisor/instructor implements with the

students the competency-based instructional design to
develop their skills, 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.

* Araceli S. Maglaya (2002)

 Standards of Clinical Supervision
STANDARD IV: Evaluation of Clinical Performance

The clinical supervisor/instructor

• determines with the students their progress in attaining
specific learning outcomes/competencies on the care of
specific types of clients,
• using appropriate performance evaluation methods and
tools based on learning outcome indicators/criteria.

* Araceli S. Maglaya (2002)

Guidelines in Determining
Achievement of Learning
Outcomes
1. Specify the learning outcomes/
competencies and the testing condition
under which they are to be evaluated
2. Determine the performance standards
and specific criteria/indicators to
measure the achievement of the
standards
Guidelines in Determining
Achievement of Learning
Outcomes
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.
 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,
Teaching 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
 Methods and Tools Utilized in Evaluation
in Competency-based Curriculum
Area Methods Tools
Cognitive Written exam Objective tests
domain Oral exam Essay; modified essay
(Knowledge)
Psychomotor Practical exam (real or Checklist
domain (Skills) simulated) Rating Scale
Observational reports Anecdotal report
Participation chart
Affective Direct measures Questionnaire: open-ended/closed item
domain Written Attitude scale: Likert scale; semantic
(Attitude) differential
Oral
Indirect measures Interview: structured, unstructured
Behavior rating scale: tests of judgment,
memory, or perception
 Example of a Blueprint for Clinical Activities
ABILITIES EVALUATION METHODS
WEIGHT WRITTEN PRACTICAL RECORDS OBSERVATIONAL
EXAM/ EXAM REVIEW RATINGS/
PROJECT REPORTS
A. Assessment of Patient 5% X X X
Problem
1. Data gathering
History taking
Physical Assessment 10% X X X
Psychosocial Assessment 10% X X X
Lab & other diagnostic 5% X
exam
2. Critical thinking/Data 10% X
Analysis
3. Identification of Problem 10% X X
B. Plan of Care 10% X
C. Interventions 10% x X
Interacting skills
Technical skills 15% X
Attitudes 5% X
D. Evaluation of Care 5% x X
E. Recording 5% x
 Overview of Evaluation Strategies
TECHNIQUE DOMAIN/ EVALUATION PURPOSE
Portfolio High-level cognitive; Affective; Psychomotor
(if video); Formative; Summative
Simulation High level cognitive; Affective; Psychomotor;
Formative; Summative
Role Play Cognitive; Affective; Psychomotor; Formative
Critiquing High-level cognitive; Affective domain;
Formative; Summative (for trending)
Journals High-level cognitive; Affective domain;
Formative; Summative (for trending)
Paper High levels of cognitive and affective
domains; Formative; Summative
Essays High levels of cognitive and affective
domains; Formative; Summative
Verbal All ranges of cognitive domain; Affective
questioning domain; Formative; Summative
Concept/ All ranges of cognitive domain; Affective;
Mind mapping Formative
Audiotape All ranges of cognitive domain; Affective
domain; Formative; Summative
Videotape Higher levels of cognitive domain; Affective
domain; Psychomotor domain
POSSIBLE APPLICATIONS
Placement in program of study; For evidence of progress;
Outcome measure for individual/program; Marketing tool for
job placement
Preclinical mastery of identified skills; Final examination for
clinical courses; Application of decision making process or a
controlled representation of reality
Formative feedback for psychomotor skills, communication
techniques; problem-solving skills
Self-assessment; Integration of learning can be demonstrated;
Appropriate for evaluating the higher level cognitive skills
Integration of learning can be demonstrated; Self-assessment;
Affective domain can be evaluated; Critical thinking can be
evaluated
Critical thinking skills; Writing skills; Develop arguments;
Synthesis of ideas
Critical thinking skills; Free form; Demonstrate problem solving
abilities, decision making, and rationale; Analysis
Evidence of thinking process with “why” questions; Evidence
of verbal skills; Defense: determines content mastery and
evidence of synthesis
Concepts expressed in a visual way; Shows relationship
between and among topics
Verbal skills; Interviews; Group discussion
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