New Nursing Curriculum in Sudan: History, Design and Application

1. New Nursing Curriculum in Sudan: History, Design and Application Professor Abdelaziz Elamin Dean College of Nursing Sciences University of Khartoum E-mail: azizmin@hotmail.com

2. Introduction Nursing curriculum is the basic nursing educational program which qualify nurses to professional practice. It contains the essential material that covers the fundamentals of nursing knowledge and practical skills

3. History Historically the first nursing program in Sudan was designed by a WHO expert panel in 1955. The curriculum of that program was designed to graduate diploma nurses following 3 years of theoretical and practical studies.

4. High Nursing College A high nursing college for girls was established under the umbrella of the ministry of health in 1956, and the first patch of students admitted were 20. In 1972, the college was affiliated to the ministry of higher education with self autonomy . The number of registered students increased gradually.

5. High Nursing College/2 In 1992 a new nursing curriculum was introduced. The course of the program increased to 4 years and a BSc degree is awarded instead of the diploma. The new curriculum was designed to prepare nurses to respond adequately to the health needs of their clients and the community.

6. Faculty of Nursing Sciences In 1994 the nursing college became part of the University of Khartoum under a new name “Faculty of Nursing Sciences” Based on the reputable academic heritage of the university, the university formulated a committee to modernize the curriculum of the new faculty of nursing sciences to raise the standard of the nursing care to individuals, families and community.

7. Why do we need a curriculum revision? • Keep current with regional trends and reflect contemporary worldwide nursing practice • Ensure seamless articulation among nursing institutions across the country • Outcome based and student-centered curriculum with integration is the desired model, which was lacking in previous curricula.

8. Curriculum Development The curriculum committee started the revision and development of the curriculum and worked for may years to produce its document, which was passed by the senate of the university of Khartoum. The pathway was not covered with flowers and several hurdles were on the way. They start by answering basic questions.

9. Why new curriculum According to the 2001 Sudan Health declaration, by the year 2015 all nurses in Sudan should be certified nurses with Bachelor degree (BSc) or in line to bridge their nursing diploma to BSc level.

10. Nursing categories Currently there are 4 different undergraduate nursing programs in Sudan: • Three years diploma • Tow years bridging program to upgrade the three years program to BSc • Four years BSc • Five years honor BSc

11. Factors Influencing Nursing Education at Global Level • Recommendations cited in 2004 report of the American Nursing Council Task Force on Nursing Workforce including the need to meet international accreditation standards • Regulatory laws set by governments & professional organizations. • Recommendation made by experts like WHO • Funding issues. • Philosophy & vision of higher education in the country.

12. Curriculum change requires… • Courage – the willingness to take risks in order to achieve a goal • Trust in each other and the process • Strong commitment by faculty leaders • Communication and collaboration with each other and key stakeholders • Ability to balance the need for change with the instinct to protect what has been achieved

13. It all starts with your … • Philosophy • Identify major concepts that will be threaded throughout courses • Examples • Evidence-based practice • Health Informatics • Communication Skills • Interdisciplinary teams • Quality in Health • Infection Control

14. The Second Step is… • Organizing framework • Examples • Administrative Competencies: Provider of care, manager of care, member of the discipline • Core Competencies: Professional behaviors, Communication, Assessment, Clinical Decision Making, Caring Interventions, Teaching and Learning, Collaboration, Managing Care • Specific competencies: Safe & Effective Care Environment, Health Promotion and Maintenance, Psychosocial Integrity, Physiological Integrity. • Functional Health Patterns • Systems & Evaluation

15. Terminal Objectives • Educational Outcomes or Terminal Objectives • This is what you want your graduate to look like or be able to do when they graduate • They will be broad statements that relate back to the major concepts identified in the philosophy

16. Enabling Objectives • Level objectives or course objectives • Determine the number of levels for your program • These must demonstrate progression. • They also provide the framework for the clinical evaluation tool. • The objectives for the final course are the same as the educational outcomes or terminal objectives

17. Course Design • Determine the content for each course • The major concepts identified in philosophy are deepened throughout the program • The organizing framework provides the structure for the content • It is impossible to “cover” everything – the challenge is to identify the concepts that are critical

18. Learning & Teaching Activities • Use appropriate teaching methods e.g. interactive lectures, seminars, small group discussions ..etc. • Facilitate active student search, discovery, and learning of essential material • Faculty do not need to feel responsible for “covering all of the material. • Pre and post course students questionnaires help in quality assurance.

19. Assessment All assessments should reflect the depth and breath of content described in course objectives. Continuous assessment is mandatory as well as end of course comprehensive examination Both summative and formative assessment methods should be used. Post test validation is important

20. Begin with the end in mind • Used competencies as organizing framework • Three level objectives were developed for each competency • Professional Behaviors • Communication • Assessment • Clinical Decision Making • Caring Interventions • Teaching and Learning • Collaboration • Managing Care

21. Course Development • 8 semesters with several courses offered in shorter blocks or over the entire semester • Separate courses for basic sciences, pharmacology, and nursing administration & leadership. • Geriatrics is integrated in family & community nursing. • Courses may be offered in any sequence, but many institutions offer professional nursing concepts and assessment in the first semester and nursing care of multi-system failure must be in the last. • Evidence-based nursing practice is emphasized in all courses.

22. Staff Queries may include .. • What is wrong with the present curriculum? • Will there be time for more content in the new curriculum? • What will we give up? • Can we teach the new content effectively? • What if we don’t teach the “right things”? • What if customers satisfaction rates go down? • What if skill levels decline? • Do we have the expertise? • How will this impact my teaching load?

23. The 2006 Curriculum In 2006 the revised curriculum was adopted by the university of Khartoum A 5th year was added to give honor degree The following slides describe issues related to that curriculum. College staff were dedicated to take responsibilities and work in team and apply nursing ethics effectively

24. Curriculum objectives • develop the students' affective, cognitive and psychomotor skills for clients care • provide high standard, holistic nursing care for individual, family and the community according to policies and procedures • be more effective in caring for clients according to (NANDA approved) nursing diagnoses that reflect the client's health needs and priorities

25. Old & new curricula • The new curriculum is tailored to have the following characteristics: • Community-oriented • Outcome-based • Student-centered • Although the old and new curricula are different in some specific objectives and contents, every program consists essentially of four parts as follow:

26. Old & new curricula/2 • First part: where the students learn • Nursing Ethics & history of nursing • fundamental Nursing skills • Communication skills • Basic medical sciences • Introduction to community nursing • Psychology & sociology

27. Old & new curricula/3 • Second part: • Include clinical courses in medical nursing, surgical nursing, pediatric nursing and midwifery. • The students move from theory to practice. It gives them a broad understanding of clinical nursing protocols.

28. Old & New Curricula/4 Third parts : in which students learn to • Care for specific clients • practice nursing care in different medical specialties • Share in community health promotion through specific activities Fourth part • application of research methodology • Specialty courses for those who progress to 5th year

29. Curriculum application General • To obtain a degree of Science in Nursing, students are required to successfully complete full-time study of approved: • 5 semesters for bridging • 4 semesters for upgrading • 6 semesters for the Diploma • 8 semesters for the general B Sc • 10 semesters for honor B Sc • The academic year is often 2 semesters • The semester s varied between 15 - 18 weeks • The total credit hours are 16-22 per semester

30. Admission requirements Dr. Rashida Abdelfatah • The BSc program was designed to accept secondary schools graduates (boys & girls) who wish to study nursing and satisfy the following criteria: • Are 16 years or above • Score 80% or above in the secondary school certificate • is medically fit • pass face to face interview

31. Teaching and learning strategies Focus on: practical training under supervision Active self learning Problem solving approach throughout the stages of training Evidence-based practice Community orientation to identify it’s problems and shared solution

32. Evidence-based Practice • Is conscientious use of current best evidence in making decisions about patient care. • EBP components • Systemic research for and critical appraisal of the most relevant evidence to answer a clinical question. • The clinical experience of the concerned doctor or nurse and experts opinion in the absence of evidence. • Patients preference & values.

33. Teaching and learning Methods Methods for Theoretical part : Group discussion Interactive lectures Seminars Problem solving case studies Tutorials Assignments

34. Methods for Practical training Skill training on manikins (skill lab) Skill training on real patient under tutors supervision Simulation & role play Programmed clinical training following the nursing process Nursing rounds Writing clinical nursing reports

35. Practical Training cont. Home visits Field work National training trips International trips Student research Residency program for honor students

36. Students Evaluation • Theoretical: • Continuous evaluation (Practical training ,quiz, discussion, seminars presentation & projects). • Final written /practical examination ( 60% for the practical and 40% for the theoretical).

37. Curriculum Evaluation • Achievement of objectives • Outcome quality • College exams results • Nursing council Qualifying examination • Surveys for client satisfaction • Employer satisfaction survey • Nursing audit

38. Facilities s Academic institutions: Faculties Schools under the umbrella of some faculties of medicine Nursing Academy which is belonging to the ministry of health Even the limited facilities are well designed and equipped

39. Health Care Institutions Hospitals Health centers Polyclinics Specialized centers Other community institutions

40. Honor Degree • In some nursing colleges including that of the university of Khartoum, the students enrollment in upper-division (5th year) is limited to those who meet the following criteria: • completed all required courses in the fresh students semesters with a minimal grade of “clear pass” • maintain full-time study at nursing institute • minimum cumulative grade point of 3.5 • minimum grade of “B” in the specialty subject

41. Challenges facing curriculum application Increased number of academic institutions, compared with the very limited number of qualified teaching staff The educational institutions are facing financial difficulties that hinder development and maintenance of skill laboratories & libraries Variation of language used in teaching curriculum material & applications

42. Challenges facing curriculum application The absence of specialized nursing council makes it difficult to unify or standardize the undergraduate nursing programs in Sudan. The clinical educational institutions are not well prepared or equipped to meet the students training needs (reality shock). Difficulties in evaluation and revision of student-centered policies, procedures, and guidelines.

43. Acknowledgments In preparing this lecture I used some material from the following source: Dr. Rashida Abdelfatah, Nursing College, University of Khartoum, a lecture on nursing curriculum presented at a workshop in Khartoum (unpublished).

44. Enjoy Nature The End