Canadian Journal of Nursing Informatics

Assessing Nursing Curriculum: Graduate Nurse Viewpoints

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INTERNATIONAL PERSPECTIVE

Samireh Abedini, PhD Student

Dr. Ahmad Johari Bin sihes

Hesamaddin Kamalzadeh Takhti, PhD Student

Sedigheh Abedini, PhD Student

 

 Abstract

Iran Health careAim: The aim of the study was to determine graduate nurse viewpoints about the importance of particular subjects in nursing curriculum.

Background: Nursing education is divided into theoretical and practical courses that are both important and provide different aspects to learning. Nurses play an important role in designing the health care system. In view of this, the health care industry needs nurses who have the necessary qualifications to succeed and perform professionally in the workplace.

Methodology: This study used a cross sectional descriptive design. Data were collected in April and May of 2009. A questionnaire was used to collect the graduate nurse viewpoints.

Results: The findings show that anatomy was perceived as the most significant basic course while pharmacology and medical-surgical disease (pathophysiology) were seen as the most significant main and specialty courses respectively. English was the most significant general course. In addition, the most significant practice course related to medical surgical clinical work.

Conclusion: There are many distinctions between theoretical lessons learned in the classroom and practice courses. Further research is needed using curriculum mapping to identify the connection between objectives and learning outcomes in theory and practice, and to help educators recognize gaps in curriculum.

Keywords: Curriculum, nurses, viewpoint, nursing education

 Introduction

Nurses comprise the largest group of health care professionals across the globe (Aein, Heravi Karimooi, Ahmadi, & Tootoonchi, 2006; Haj Bagheri, Salsali, & Ahmadi, 2003; Vahidi, Danesh Khah, Araks, Koshavar, & Mohammadpour Asl, 2006). Nursing is a complex and difficult profession that requires well-developed knowledge and practical skills (Saberlan & HajlAghakhanl, 2003; Zamanzadeh, Abdollahzadeh, Lotfi , Aghazadeh, & 2008). Nurses play an important role in designing the health care system (Veltri, 2010). In view of this, the health care industry needs nurses who have the necessary qualifications to succeed and perform professionally in the workplace.

Nursing education is often divided into two distinctive types of courses, including theoretical and practical – both are important and provide different contributions to learning.(Veltri, 2010).In addition, practical experience is a very important constituent for the socialization of nurses (Wong & Lee, 2000). A major criticism of nursing education is related to an overemphasis in nursing curriculum on concepts and theory rather than clinical practice (Zareiyan Jahromi & Ahmadi, 2005). Nursing curriculum needs improvement to shift concepts into practice (Warda, Procter, & Woolleyc, 2004).  The World Health Organization (WHO) has reported that some countries still suffer from a defect in their healthcare systems due to the lack of nursing skills and decision-making abilities (Rifai, 2008). Moreover, due to a gap between  theoretical and practice skills, many countries including Spain, Norway,  Israel, Belgium, Finland, Sweden and the United Kingdom reported current insufficiencies in  nursing ability (Spitzer  & Perrenod, 2006).

Curriculum is the heart of every educational institute (Karseth, 2004) and every nursing program. The curriculum sets the goals, outcomes, standards, philosophy, and content that each nursing student will learn. High quality nursing curriculum plays an important role in preparing effective nurses for the current and future health care delivery system (Farahani & Ahmadi, 2006) . A particularly crucial component of  nursing curriculum focuses on  clinical education(Wong & Lee, 2000).  In order to assess the quality of education received, this study explored the perceived relevance of curriculum content in preparing graduate nurses for practice.

The aim of the study was to determine nursing graduate viewpoints about the importance of particular subjects within nursing curriculum in Iran. Four research questions were posed:

  • Which of the main subjects were more applicable in nursing education?
  • Which of the basic subjects were more applicable in nursing education?
  • Which of the specific subjects were more applicable in nursing education?
  • Which of the practical subjects were more applicable in nursing education?

 

Methodology

This study used a cross sectional descriptive research design. Data were collected in April and May of 2009. A questionnaire was used to collect the graduate nurse viewpoints. The research population included nurses employed in the educational hospital of Hormozgan University Medical Sciences of Iran. Sampling was done by census method and included the entire population (n=79).

The questionnaire was distributed to all full time nurses in the educational hospital of Hormozgan University Medical Sciences of Iran who had graduated in the last four years. Selection was focused on this sample to ensure participants had recent memory of their education as well as well-established practice experience. The questionnaire focused on the courses included in nursing curriculum that had been approved by the Ministry of Health of Iran, and included three sections.

  • Section one focused on demographic data;
  • Section two listed all subjects within the Iranian nursing curriculum and was further divided into five parts: main, basic, specific, training and internship courses. This section used a four-point likert scale ranging from  4 for ‘strongly agree’ to 1 for ‘strongly disagree’ for rater scoring;
  • The last section was in open-ended question format to collect data about their personal perceptions of specific courses relevant to them.

The collected quantitative data were analyzed using SPSS software, version 16. Descriptive statistics were used to examine the demographics of the participants and to determine the meaning of qualitative data collected regarding the relevance of course subjects to the graduate nurses.

 Ethical Considerations

Before the inception of the study, ethical approval was obtained from the university where the research was conducted. Trained research assistants explained the aim of the study to the graduated nurses and guaranteed that all data would remain anonymous. In this study, there was no compulsion to participate and all participation was voluntary.

 

Findings

A total of 68 of the 79 distributed questionnaires were collected from the educational hospitals (response rate 86%). The participants (100%) were female and the average of age was 54.27±2.68 years.

As shown in Table 1, the findings show that anatomy was perceived as the most significant basic course while pharmacology and medical-surgical disease (pathophysiology) were seen as the most significant main and specialty courses respectively. English was the most significant general course. In addition, the most significant practice course related to medical surgical clinical work.

Overall, the respondents rated the most important categories of courses in nursing education as: practical (mean=35.05), specialty (mean=22.47), main (mean=15.2), basic (mean=13.75), and general (mean=7.36). The frequency of their perceptions of the subjects’ importance is also shown in Table 1.

 

Table1: Frequency of Perceived Subjects’ importance

Strongly
Disagree

Disagree

Agree

Strongly
Agree

Credits

Title Of Course

Category

1.53

48.5

50

2

Anatomy

Basic

5.9

55.9

38.2

3

Physiology

13.2

66.2

20.6

2

Immunology

2.9

26.5

63.2

7.4

2

Biochemistry

2.9

13.2

58.8

25

2

Microbiology

2.9

17.6

57.4

22.1

2

Parasitology

10.3

32.4

44.1

13.2

2

Introductory Biostatistics And Research Methodology In Nursing

1.5

11.8

42.6

44.1

1

Information Technology In Nursing

1.5

47.1

51.5

2

Nutrition And Nutritional Therapy

Main

1.5

10.3

52.9

35.3

2

Principles Of Epidemiology And Disease

1.5

5.9

63.2

29.4

2

Individual Social Psychology

17.6

82.4

3

Pharmacology

44.1

55.9

2

Specialized Language

1.5

4.4

50

44.1

1

Learning Process And Principles Of Client Education

1.5

36.8

61.8

4

Nursing principles and skills

Specialty

2.9

8.8

72.1

16.2

2

Community health nursing (1)

2.9

10.3

69.1

17.6

2

Community health nursing (2)

2.9

10.3

66.2

20.6

1

Community health nursing (3)

1.5

1.5

47.1

50

1

Health Status

1.5

41.2

57.4

3

Maternal and infant health nursing (1)

1.5

39.7

58.8

2

Maternal and infant health nursing (2)

14.7

85.3

3

Medical surgical disease of nursing(1)

10.3

89.7

4

Medical surgical disease of nursing(2)

10.3

89.7

4

Medical surgical disease of nursing(3)

10.3

89.7

4

Medical surgical disease of nursing(4)

11.8

88.2

3

Special nursing

1.5

26.5

72.1

3

Nursing in crisis, emergency and disaster

2.9

33.8

63.2

3

Pediatric Nursing (1)

2.9

30.9

66.2

3

Pediatric Nursing (2)

4.4

48.5

47.1

2

Mental Health Nursing (1)

8.8

50

41.2

2

Mental Health Nursing (2)

1.5

10.3

69.1

19.1

2

Principles of Nursing Care Management

 

Discussion

This study revealed that practical courses were perceived to be the most important in nursing education by the participating graduate nurses. Asadullahi and Afshary (2002) showed that 80% of students preferred that their education be mostly practical and 75% of them said that practical education had the largest impact on increasing awareness and improving their professional performance. Clinical education is complex and is influenced by many factors including curriculum. Although nursing is based on practical science , most nursing curriculum is designed with an emphasis on concepts and  theory (Borzu, Safari, Khodavisi, & Torkaman, 2009; Farahani & Ahmadi, 2006; Toulabi, Janani, & Qurban Mohammadi, 2009 ; Warda, et al., 2004; Zareiyan Jahromi & Ahmadi, 2005) .

 

While theory is important, some graduated nurses feel that they do not have enough practical skill in particular procedures (Borzu, et al., 2009; Toulabi, et al., 2009 ) and support the addition of  many skills to existing nursing curriculum . Wallace (2009) showed that graduate nurses often lack the required qualification to provide quality end of life care to their patients yet they spend a lot of time with these patients. It seems that end of life care should be added to most existing nursing curriculum. This is just one example of how nursing curriculum should be developed to synchronize nurses with community needs (Fat-hi Vajargah, Guya, Aghazadeh, Abolghasemi, & Kamkari, 2008). Nursing curriculum also needs to improve in how concepts and theories are applied to practice (Warda, et al., 2004). A well designed nursing curriculum can and should prepare graduated nurses to provide the best quality services in their practice (Tsai, 2008).

Medical-surgical nursing practice was supported as the most important specialty course in nursing education, both in this study and in the literature (Azarbarzin, 2007), and is perceived as the foundation of nursing practice. However, most graduated nurses barely have entry-level competencies in medical-surgical skills and knowledge (Nasiriani, et al., 2006), which indicaes a gap in nursing curriculum theory and practice.

As shown in the results in Table 1, the participants perceived anatomy as the most important basic course. Anatomy is the foundation of medical-surgical knowledge (Strkalj, Schroder, Pather, & Solyali, 2011). In nursing education in Iran,  it is a prerequisite to pharmacology and medical-surgical nursing theory and practice, the two most important main and specialty subjects in nursing education. Almost all nursing practice skills depend on sound knowledge of anatomy, including injection, assessing vital sign, performing physical examinations and so on. Thus, anatomy is an essential foundation for clinical practice and is an important aspect of nursing education.

In the participants’ view, the most important main subject is pharmacology. Usually, the time allocated to pharmacology teaching in clinical setting is more than the time allocated in within the classroom (Meechan, Mason, & Catling, 2010). It is critical that pharmacology education is presented clearly and practically to ensure that it is useful to practice (King, 2004).

English was perceived as the important general course by the participants in this study. In the Iranian clinical setting,  most medical and nursing reports are written in English including clinical reports and pharmaceutical brochures for teaching. Thus, English language education is perceived as very important to the graduate nurses who participated in this study.

 

Conclusion

The results of this study show that there are gaps in the perceived curriculum needs of graduate nurses and the courses they study within nursing education, particularly in the amount of theory and practice courses. Better coordination between theoretical learning and their application to the real practical environment is critically needed (Azarbarzin, 2007). These gaps affect nurses ability to provide comprehensive, quality care – which is an issue, especially since there is also a global nursing shortage (Flinkman, Leino-Kilpi, & Salantera, 2010).

Educational planners must attempt to provide curriculum that reflects contemporary knowledge and enhances the ability of nursing students to effectively develop knowledge and practical skills to prepare them to practice in the future (Dehghani, Dehghani, & Fallahzadeh, 2005; Valizadeh , Abedi, Zamanzadeh, Fathiazar, & 2008). Curriculum mapping should be applied to address the  gaps between theory and practice. Further research is needed using curriculum mapping to identify the connection between objectives and learning outcomes in theory and practice, and to help educators recognize gaps in curriculum.

 

References

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Azarbarzin, M. (2007). The Evaluation of Some Academic Nursing Lessons Application in Clinical Practice from Recruiting Nurses’ Point of View in Some Selected Hospitals in Isfahan. Strides in Development of Medical Education, 4(2).

Borzu, R., Safari, M., Khodavisi, M., & Torkaman, B. (2009). The Viewpoints of Nurses towards Applicability of Nursing Curriculum in Hospitals Affiliated to Hamedan University of Medical Sciences Iranian Journal of Medical Education 8(2), 205-210.

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AUTHOR DETAILS

 

Samireh Abedini (Corresponding Author)      

 PhD student, Faculty of Education, Universiti Teknologi Malaysia and Faculty member of      Hormozgan University of medical sciences

Mailing address: A-7-3, Desa Saujana Apartment, Tmn SG Besi Indah, Seri Kenbengan, Selangor, Malaysia, Post code 43300

HP No: 006017871 3691

Email Address: Samireha@gmail.com

 

Ahmad Johari Bin sihes

Dr, Faculty of Education, Universiti Teknologi Malaysia 81310, Skudai, Johor, Malaysia.

Email Address: p-joha@utm.my

 

Hesamaddin Kamalzadeh Takhti

PhD student, Faculty of Computer Science & Information Systems, Universiti Teknologi Malaysia

Mailing address: A-7-3, Desa Saujana Apartment, Tmn SG Besi Indah, Seri Kenbengan, Selangor, Malaysia, Post code 43300

HP No: 0060178795363

Email Address: Hesamadin@gmail.com

 

Sedigheh Abedini

PhD student, Faculty of health, Shahid Sadoughi University of medical sciences and  Faculty member of Hormozgan University of medical sciences

Mailing address: A-7-3, Desa Saujana Apartment, Tmn SG Besi Indah, Seri Kenbengan, Selangor, Malaysia, Post code 43300

HP No: 00989177614328

Email Address: Sabedini45@gmail.com

 

EDITOR: June Kaminski

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