“Environments of Care: A curriculum Model for Preparing a Ne

INSTRUCTIONAL DESIGN
Juco, Melissa,
Mananquil, Ann Marby
Marasaigan, Iza Therese
Medalla, Jerick


“Many were called, but few were chosen” a famous quotation that everyone knows. Thousands of student nurses are taking the licensure exam two times a year and only a fraction of that will pass. Most of the passers will opt to work in a hospital setting while the others will work in the many fields of nursing like in the community. Reasons for the scarcity of nurses entering community workforce is they are afraid of leaving their comfort zone and mastery. According to Ervin and colleagues and the National League for Nurses that Community-based curriculum is recommended to be used by nursing schools as a guide for undergraduate nursing education. Community-based curriculum focused on giving health education and rehabilitation not just the sick but also to the well individuals and families. For the past years the community based model is preferred but there are major concerns now being raised. These are:
1. Scarcity of CHN nurses who are willing to be a CHN professors.
2. Vague rules: Before you become a CHN nurse you need at least one year of working experience in a hospital as a staff nurse
3. The increasing population of elderly that needs hospital care also increases the demand for more nurses being employed in the hospital. This will entice more nurses to opt for hospital setting than in the community.
The Environment Care Model (ECM) perpetuated by Ervin and colleagues which is composed of four environments namely: internal environment care, social environment care, physical environment care, and global environment care. The author of the said model suggested that nursing undergraduates must be oriented to the four environments so that they will become much familiar to much wider concept of their profession. The figure below is the Environment Care Model (ECM) made by Ervin and colleagues. The aspects of each environment are needed to be realized and experienced by the nursing undergraduates for them to be able to prepare themselves to the reality of their profession.

[/img]https://2img.net/h/i3.photobucket.com/albums/y87/prtnrs_n_rhyme/ECM.jpg]



For example, in the genetic aspect of internal environment, the nursing undergraduates can interview nurses who are experts in genetics. In the cultural aspect of social environment, the nursing students may interview Muslim nurses about issues regarding post mortem care. In the water aspect of the physical environment, the nursing undergraduates may write to the city Mayor regarding clean water for drinking. In the emergency response aspect of the global environment, the nurse undergraduates may help to assist in triaging and engaging in charitable works in time of crisis such as food and water shortage.
The ECM model of Ervin and colleagues is quite commendable but there are others who opposed to their work. The phenomenon of role transition about curriculum advancement has been a topic of research and concern for practicing nurses, educators, and administrators for many years.

The Environment of Care Model (ECM) proposed a new curriculum to help prepare the new generation of nurses on other branches in a non-hospital setting. This curriculum addresses the rapid change in nursing.
Opposed feature, ECM curriculum may not be as sophisticated as it is. Their view of point in this curriculum has been implemented already in the Philippines. The only difference is they emphasize the needs to do which has been doing here in our country. Like the Associate in Health Science Education (AHSE) program constitute the general education component of all baccalaureate degrees leading to the health profession. Student are equip with competencies needed to land jobs as a nurses aid, and community health aides (CHED 1999) which mean as early as 2nd year the student were already been in training for a hospital and non-hospital setting.
In a community setting we have a family care plan, community diagnostic and emersion which is offered as early in the 2nd to 3rd year level. Their curriculum in fact is a well-researched program that was carefully developed by the country’s dedicated deans and noted nursing academicians in consultation with different nursing sectors and specialty groups. In fact, our nursing curriculum’s conceptual framework has been hailed as a blueprint for excellence and has been adopted by many Asian and western countries. And it has been presented at numerous international conventions and accepted by our nursing colleagues globally (Francisco 2009). The sited problems in ECM was deliberately answer by our curriculum under the courses of health ethics, foundation of nursing, health care 1 and etc. as early as freshmen nursing students were thought the ethics and commitment involved in the profession.

Guide Questions:
•In the current Philippine setting, would you recommend a community-based curriculum for nursing education? Why?
•What nursing issues do ECM resolve?
•If you are the Dean of a nursing institution, and would like to adopt the ECM model, what can you add to the different aspects of the four environments?
•Discuss with your group the positive and negative outcomes of ECM. What changes will evolve from the present curriculum to ECM?


References:
1.Smith, L.M.; Emmett, H.; Woods, M. 2008. Experiential Learning Driving Community Based Nursing Curriculum. Lifted from http://www.ncbi.nlm.nih.gov/pubmed/18759536 on April 7, 2010
2.Frank, B.; Adams, M.; Edelstein, J.; Speakman, E.; Shelton, M. 2005. Community-based Nursing Education of Prelicensure Students: Settings & Supervision. Lifted from http://findarticles.com/p/articles/mi_hb3317/is_5_26/ai_n29211660/ on April 7, 2010
3.Mawn, B. & Reece, S. (2000). “Teaching in nursing: a guide for faculty‎”. 2nd ed. pp100-101. St. Louis, Missouri, Saunders Elsevier.
(http://books.google.com.ph/books?id=QWk4Uz9UQSoC&pg=PA101&dq=Mawn+and+Reece&cd=1#v=onepage&q=Mawn%20and%20Reece&f=false)
4.Buerhaus, Staiger and Auerbach. (2003). “Policy and Politics in Nursing and Health Care” pp 459, 510-511. St. Louis, Missouri, Saunders Elsevier.
5.Reid Ponte, et al. (2004). “Policy and Politics in Nursing and Health Care” pp 449. St. Louis, Missouri, Saunders Elsevier.
6.Hall, L.; Doran, D. 2001. A Study on the Impact of Nursing Staff Mix Models and Organizational Change Strategies on Patient, System and Nurse Outcomes. Lifted from http://www.chsrf.ca/final_research/ogc/mcgillis_e.php on April 7, 2010
7.R. FRANCISCO May 13, 2009, “nursing education in the Philippines”. The Philippine Daily Inquirer
8.Rona (2008).‘Nursing competence’ in the global market. Under Nursing news
9.CHED Memorandum Order (MO) No. 5, series of 2008 otherwise known as “Policies and Standards for Bachelor of Science in Nursing Program”.[img]

Community based education is viewed as a means of achieving educational relevance to community needs and consequently, as a way of implementing a community-oriented educational program. It is recommended to implement this kind of curriculum in the Philippine setting in the nursing education for it consists of learning activities that utilize the community extensively as a learning environment. Wherein not only the students, but also the teachers, members of the community, and representatives of other sectors are actively involved throughout the educational experience (Iwasiw 2005).

It is during the process of service delivery that students develop work-related competencies by engaging in learning experience which closely resemble those activities of professional in real-life settings. (Quinn 2002). Maurer (2005), mentioned that if change in the basic polices of formal organizations is done, one area may feel “oppressed” and basic need changes in its institutions or practices. Aggressive actions may be taken to facilitate these changes. Another approach that may be used is involving the community for social planning. “Let’s get the facts in a logical manner to systematically solve the problem.” The changes may include a shift toward the community as the primary setting for clinical practice; integration of primary health care within different levels of the curriculum; more interdisciplinary experiences in the delivery of care; greater emphasis in the curriculum and more extensive clinical experiences in health promotion & prevention of illness expanded knowledge and skills for care of mothers, children, the aged, and critically ill patients in varied settings; also the reexamination of teaching strategies for preparing students with these expanded competencies. The nursing faculty must consider the impact of health care reform, they are called upon to reexamine the curriculum and clinical experiences provided within their programs to prepare students for practice in community-based systems. (Israel 2003).

Effectiveness of interprofessional education (IPE) for first and second year medical, nursing and dental students on a community-based placement may be also considered. Using a ‘process-based’ approach which tracked the education and social processes connected to IPE. It has helped overcome some of the problems of using before-and-after designs. Findings from this study are offered in relation to the perspectives of the three participant groups in the placement: students, tutors and service users/carers. (Reeves 2000) Most would agree that professionals should collaborate to provide care that meets the needs of users . In UK, they promulgated policies that attempt to change and re-engineer how professionals work. They explored the transition from policy to practice and rationalized the difference between their findings and experiences on the one hand and their policy agendas and human values on the other. Some claim that a concerted and continuous effort will eventually result in the merger or amalgamation of organizations and professions, thereby eliminating differences and unifying the delivery of care. (Leathard 2003).

In conclusion, community based education and the effectiveness of interprofessional education (IPE) brings together researchers and communities to establish trust share power, foster co-learning, enhance strengths and resources, build capacity and examine and address community-identified needs and health problems. (Israel 2005). Change can be threatening or stressful and relaxing or rewarding. In order to achieve a desired change on nursing curriculum, which will focus primarily on prioritizing a community-based curriculum for nursing education, a stimulus for a perceived need should be present. (Maurer 2005). True enough, change threatening and anxiety producing, once established – stabilization of the situation may occur.


Reference:

Israel, B. (2005). Methods in Community Base Participatory Research for Health, John Wiley and Sons. Page 169- 175

Iwasiw, c. et al., (2005) Curriculum development in nursing: Process and innovations page 171 -174

Leathard, A (2003). Interprofessional Collaboration: From Policy to Practice in Health and Social Care. Brunner-Routledge, Hove and New York, p 300-305

Maurer, F. (2005). Community/Public Health Nursing Practice Health for families and Populations Elservier (USA). pp.172-176

Reeves, S (2000). Community-based interprofessional education for medical, nursing and dental students. Health & Social Care in the Community, Volume 8, Number 4, July 2000, pp. 269-276