PRIMARY HEALTH CARE
ABSTRACT This article describes the process of curriculum change in a baccalaureate nursing program and the design of a competency-oriented learning system in primary health care, community-focused nursing education.
A VISIT TO NEARLY ANY SCHOOL of nursing in the United States will find faculty engaged in curriculum revision. The education of confident and competent practitioners, well prepared to practice with diverse cultures and respond to the health care needs of vulnerable populations -- despite draconian shifts in health care delivery -- requires innovative curricula and new learning strtagies and assessment systems. * FOLLOWING AN EXTENSIVE DISCUSSION OF OUR MISSION AND PHILOSOPHY, NURSING FACULTY AT THE COLLEGE OF MOUNT ST.JOSEPH MADE A COMMITMENT TO RE-VISIONING THE BACCALAUREATE IN NURSING CURRICULUM. The heed for radical re visioning -- rather than simple revision of our curriculum - emerged from the strategic thinking of faculty and an assessment process that included critical reviews of the literature, analysis of nursing practice activities, and evaluation data from students, alumni, and nursing leaders in the community. By including these stakeholders as partners in this endeavor, we identified the need for a new curricular paradigm to promote healthy communities through nursing. * This article describes the process of curriculum re-vision, the creation of an organizing framework for effective learning, and the design of a competency-oriented learning system in primary health care, community-focused nursing education.The first priority, the identification of issues and trends in health care and nursing education, was accomplished through a critical review of the literature.
A Foundation for Re-Visioning the Curriculum Two concepts, namely, primary health care and competency-oriented learning, became the foundation for the re-visioning process. In recent years, nursing theorists have maintained that the education of health professionals must be reformed to support the development of a health care system that has a greater emphasis on primary health care (1). Primary health care is based on five principles: community participation, equitable distribution, multisectorial cooperation, appropriateness, and health promotion and disease prevention (2).
As educational systems are held accountable for the learning outcomes of students, the focus on evaluating student competencies becomes critical. The Pew Commission states that clinical competence is probably the most important basis for developing successful collaborative relationships among providers (3). Our faculty embraced a competency-based philosophy, derived from Carrie Lenburg's principles of competency-oriented learning and assessment, for the development and evaluation of outcomes (4). (The process of changing from a traditional behavioral objective model to a competency-oriented learning and assessment model across the cognitive, affective, and psychomotor learning domains will be described more fully in a forthcoming article.)
Analysis of Nursing Practice Activities The next priority in the assessment process was to determine the competencies necessary for beginning practitioners of nursing in community-- focused settings. This process employed a faculty-designed instrument, "Nursing Practice Activities Analysis," which was constructed from task statements in a job analysis study of newly licensed entry-level registered nurses (5). (See Sidebar 1 for an excerpt from this instrument.)
Two subject pools participated in the assessment: faculty in the Department of Nursing and prominent practicing nurses employed in a variety of settings in metropolitan Cincinnati, such as community health clinics, elementary and secondary schools, rehabilitation centers, and acute care hospitals. The practicing nurses were asked to consider each task statement in response to the question "What do entry-level baccalaureate-prepared nurses need to know to practice? …