New Nursing Curriculum in Sudan: New Nursing Curriculum in Sudan: History, Design and ApplicationHistory, Design and Application

Professor Abdelaziz ElaminProfessor Abdelaziz Elamin

Dean College of Nursing Dean College of Nursing SciencesSciences

University of KhartoumUniversity of Khartoum

E-mail: E-mail: azizmin@hotmail.comazizmin@hotmail.com

IntroductionIntroduction

Nursing curriculum is the basic Nursing curriculum is the basic nursing educational program which nursing educational program which qualify nurses to professional qualify nurses to professional practice.practice.

It contains the essential material It contains the essential material that covers the fundamentals of that covers the fundamentals of nursing knowledge and practical nursing knowledge and practical skillsskills

HistoryHistory

Historically the first nursing Historically the first nursing program in Sudan was designed by a program in Sudan was designed by a WHO expert panel in 1955.WHO expert panel in 1955.

The curriculum of that program was The curriculum of that program was designed to graduate diploma nurses designed to graduate diploma nurses following 3 years of theoretical and following 3 years of theoretical and practical studies.practical studies.

High Nursing CollegeHigh Nursing College

A high nursing college for girls was A high nursing college for girls was established under the umbrella of the established under the umbrella of the ministry of health in 1956, and the ministry of health in 1956, and the first patch of students admitted were first patch of students admitted were 20.20.

In 1972, the college was affiliated to In 1972, the college was affiliated to the ministry of higher education with the ministry of higher education with self autonomy .self autonomy .

The number of registered students The number of registered students increased gradually.increased gradually.

High Nursing College/2High Nursing College/2

In 1992 a new nursing curriculum In 1992 a new nursing curriculum was introduced. was introduced.

The course of the program increased The course of the program increased to 4 years and a BSc degree is to 4 years and a BSc degree is awarded instead of the diploma.awarded instead of the diploma.

The new curriculum was designed to The new curriculum was designed to prepare nurses to respond prepare nurses to respond adequately to the health needs of adequately to the health needs of their clients and the community.their clients and the community.

Faculty of Nursing Faculty of Nursing SciencesSciences

In 1994 the nursing college became In 1994 the nursing college became part of the University of Khartoum part of the University of Khartoum under a new name “Faculty of under a new name “Faculty of Nursing Sciences”Nursing Sciences”

Based on the reputable academic Based on the reputable academic heritage of the university, the heritage of the university, the university formulated a committee to university formulated a committee to modernize the curriculum of the new modernize the curriculum of the new faculty of nursing sciences to raise faculty of nursing sciences to raise the standard of the nursing care to the standard of the nursing care to individuals, families and community.individuals, families and community.

Why do we need a Why do we need a curriculum revision?curriculum revision?

Keep current with regional trends and Keep current with regional trends and reflect contemporary worldwide reflect contemporary worldwide nursing practicenursing practice

Ensure seamless articulation among Ensure seamless articulation among nursing institutions across the countrynursing institutions across the country

Outcome based and student-centered Outcome based and student-centered curriculum with integration is the curriculum with integration is the desired model, which was lacking in desired model, which was lacking in previous curricula.previous curricula.

Curriculum DevelopmentCurriculum Development

The curriculum committee started the The curriculum committee started the revision and development of the revision and development of the curriculum and worked for may years to curriculum and worked for may years to produce its document, which was passed produce its document, which was passed by the senate of the university of by the senate of the university of Khartoum.Khartoum.

The pathway was not covered with The pathway was not covered with flowers and several hurdles were on the flowers and several hurdles were on the way.way.

They start by answering basic questions.They start by answering basic questions.

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

Why new Why new curriculumcurriculum

Nursing categoriesNursing categories Currently there are 4 different Currently there are 4 different

undergraduate nursing programs in undergraduate nursing programs in Sudan:Sudan:

Three years diploma Three years diploma Tow years bridging program to Tow years bridging program to

upgrade the three years program to upgrade the three years program to BScBSc

Four years BScFour years BSc Five years honor BScFive years honor BSc

Factors Influencing Nursing Education at

Global Level Recommendations cited in 2004 report of the Recommendations cited in 2004 report of the American Nursing Council Task Force on Nursing American Nursing Council Task Force on Nursing Workforce including the need to meet Workforce including the need to meet international accreditation standardsinternational accreditation standards

Regulatory laws set by governments & Regulatory laws set by governments & professional organizations.professional organizations.

Recommendation made by experts like WHORecommendation made by experts like WHO Funding issues.Funding issues. Philosophy & vision of higher education in the Philosophy & vision of higher education in the

country.country.

Curriculum change Curriculum change requires…requires…

Courage – the willingness to take risks Courage – the willingness to take risks in order to achieve a goalin order to achieve a goal

Trust in each other and the processTrust in each other and the process Strong commitment by faculty leadersStrong commitment by faculty leaders Communication and collaboration with Communication and collaboration with

each other and key stakeholderseach other and key stakeholders Ability to balance the need for change Ability to balance the need for change

with the instinct to protect what has with the instinct to protect what has been achievedbeen achieved

It all starts with your …It all starts with your …

PhilosophyPhilosophy Identify major concepts that will be Identify major concepts that will be

threaded throughout coursesthreaded throughout courses ExamplesExamples

Evidence-based practiceEvidence-based practice Health InformaticsHealth Informatics Communication SkillsCommunication Skills Interdisciplinary teamsInterdisciplinary teams Quality in HealthQuality in Health Infection ControlInfection Control

The Second Step is…The Second Step is… Organizing frameworkOrganizing framework

ExamplesExamples Administrative Competencies: Provider of Administrative Competencies: Provider of

care, manager of care, member of the care, manager of care, member of the disciplinediscipline

Core Competencies: Professional behaviors, Core Competencies: Professional behaviors, Communication, Assessment, Clinical Decision Communication, Assessment, Clinical Decision Making, Caring Interventions, Teaching and Making, Caring Interventions, Teaching and Learning, Collaboration, Managing CareLearning, Collaboration, Managing Care

Specific competencies: Safe & Effective Care Specific competencies: Safe & Effective Care Environment, Health Promotion and Environment, Health Promotion and Maintenance, Psychosocial Integrity, Maintenance, Psychosocial Integrity, Physiological Integrity.Physiological Integrity.

Functional Health PatternsFunctional Health Patterns Systems & EvaluationSystems & Evaluation

Terminal ObjectivesTerminal Objectives

Educational Outcomes or Terminal Educational Outcomes or Terminal ObjectivesObjectives This is what you want your graduate to This is what you want your graduate to

look like or be able to do when they look like or be able to do when they graduategraduate

They will be broad statements that relate They will be broad statements that relate back to the major concepts identified in back to the major concepts identified in the philosophythe philosophy

Enabling ObjectivesEnabling Objectives

Level objectives or course objectivesLevel objectives or course objectives Determine the number of levels for your Determine the number of levels for your

program program These must demonstrate progression.These must demonstrate progression. They also provide the framework for the They also provide the framework for the

clinical evaluation tool.clinical evaluation tool. The objectives for the final course are the The objectives for the final course are the

same as the educational outcomes or terminal same as the educational outcomes or terminal objectivesobjectives

Course DesignCourse Design

Determine the content for each Determine the content for each coursecourse The major concepts identified in The major concepts identified in

philosophy are deepened throughout the philosophy are deepened throughout the programprogram

The organizing framework provides the The organizing framework provides the structure for the contentstructure for the content

It is impossible to “cover” everything – It is impossible to “cover” everything – the challenge is to identify the concepts the challenge is to identify the concepts that are criticalthat are critical

Learning & Teaching Learning & Teaching ActivitiesActivities

Use appropriate teaching methods e.g. Use appropriate teaching methods e.g. interactive lectures, seminars, small interactive lectures, seminars, small group discussions ..etc.group discussions ..etc.

Facilitate active student search, Facilitate active student search, discovery, and learning of essential discovery, and learning of essential materialmaterial

Faculty do not need to feel responsible Faculty do not need to feel responsible for “covering all of the material.for “covering all of the material.

Pre and post course students Pre and post course students questionnaires help in quality assurance.questionnaires help in quality assurance.

Assessment Assessment

All assessments should reflect the All assessments should reflect the depth and breath of content described depth and breath of content described in course objectives.in course objectives.

Continuous assessment is mandatory Continuous assessment is mandatory as well as end of course as well as end of course comprehensive examinationcomprehensive examination

Both summative and formative Both summative and formative assessment methods should be used.assessment methods should be used.

Post test validation is important Post test validation is important

Begin with the end in Begin with the end in mindmind

Used competencies as organizing Used competencies as organizing frameworkframework

Three level objectives were developed for Three level objectives were developed for each competencyeach competency Professional BehaviorsProfessional Behaviors CommunicationCommunication AssessmentAssessment Clinical Decision MakingClinical Decision Making Caring InterventionsCaring Interventions Teaching and LearningTeaching and Learning CollaborationCollaboration Managing CareManaging Care

Course DevelopmentCourse Development 8 semesters with several courses offered in 8 semesters with several courses offered in

shorter blocks or over the entire semestershorter blocks or over the entire semester Separate courses for basic sciences, Separate courses for basic sciences,

pharmacology,pharmacology,and nursing administration & leadership.and nursing administration & leadership. Geriatrics is integrated in family & community Geriatrics is integrated in family & community

nursing.nursing. Courses may be offered in any sequence, but Courses may be offered in any sequence, but

many institutions offer professional nursing many institutions offer professional nursing concepts and assessment in the first semester concepts and assessment in the first semester and nursing care of multi-system failure must and nursing care of multi-system failure must be in the last.be in the last.

Evidence-based nursing practice is Evidence-based nursing practice is emphasized in all courses.emphasized in all courses.

Staff Queries may Staff Queries may include .. include ..

What is wrong with the present curriculum?What is wrong with the present curriculum? Will there be time for more content in the Will there be time for more content in the

new curriculum?new curriculum? What will we give up?What will we give up? Can we teach the new content effectively?Can we teach the new content effectively? What if we don’t teach the “right things”?What if we don’t teach the “right things”? What if customers satisfaction rates go What if customers satisfaction rates go

down?down? What if skill levels decline?What if skill levels decline? Do we have the expertise?Do we have the expertise? How will this impact my teaching load?How will this impact my teaching load?

The 2006 CurriculumThe 2006 Curriculum

In 2006 the revised curriculum was In 2006 the revised curriculum was adopted by the university of Khartoumadopted by the university of Khartoum

A 5A 5thth year was added to give honor year was added to give honor degreedegree

The following slides describe issues The following slides describe issues related to that curriculum.related to that curriculum.

College staff were dedicated to take College staff were dedicated to take responsibilities and work in team and responsibilities and work in team and apply nursing ethics effectivelyapply nursing ethics effectively

Curriculum objectivesCurriculum objectives develop the students' affective, cognitive develop the students' affective, cognitive

and psychomotor skills for clients careand psychomotor skills for clients care provide high standard, holistic nursing provide high standard, holistic nursing

care for individual, family and the care for individual, family and the community according to policies and community according to policies and procedures procedures

be more effective in caring for clients be more effective in caring for clients according to (NANDA approved) nursing according to (NANDA approved) nursing diagnoses that reflect the client's health diagnoses that reflect the client's health needs and prioritiesneeds and priorities

Old & new curriculaOld & new curricula

The new curriculum is tailored to The new curriculum is tailored to have the following characteristics:have the following characteristics: Community-orientedCommunity-oriented Outcome-basedOutcome-based Student-centeredStudent-centered

Although the old and new curricula Although the old and new curricula are different in some specific are different in some specific objectives and contents, every objectives and contents, every program consists essentially of four program consists essentially of four parts as follow:parts as follow:

Old & new curricula/2Old & new curricula/2

First part: where the First part: where the students learnstudents learn

Nursing Ethics & history of nursingNursing Ethics & history of nursing fundamental Nursing skillsfundamental Nursing skills Communication skillsCommunication skills Basic medical sciencesBasic medical sciences Introduction to community nursingIntroduction to community nursing Psychology & sociologyPsychology & sociology

Old & new curricula/3Old & new curricula/3

Second part: Second part: Include clinical courses in medical Include clinical courses in medical

nursing, nursing,

surgical nursing, pediatric nursing and surgical nursing, pediatric nursing and

midwifery. midwifery. The students move from theory to The students move from theory to

practice. It gives them a broad practice. It gives them a broad understanding of clinical nursing understanding of clinical nursing protocols.protocols.

Third parts Third parts : : in which students learn to in which students learn to Care for specific clientsCare for specific clients practice nursing care in different practice nursing care in different

medical specialtiesmedical specialties Share in community health promotion Share in community health promotion

through specific activitiesthrough specific activitiesFourth part Fourth part application of research methodologyapplication of research methodology Specialty courses for those who progress Specialty courses for those who progress

to 5to 5thth year year

Old & New Curricula/4Old & New Curricula/4

Curriculum applicationCurriculum application General General To obtain a degree of Science in Nursing, To obtain a degree of Science in Nursing,

students are required to successfully complete students are required to successfully complete full-time study of approved:full-time study of approved:

5 semesters for bridging5 semesters for bridging 4 semesters for upgrading4 semesters for upgrading 6 semesters for the Diploma6 semesters for the Diploma 8 semesters for the general B Sc8 semesters for the general B Sc 10 semesters for honor B Sc10 semesters for honor B Sc

The academic year is often 2 semestersThe academic year is often 2 semesters The semester s varied between 15 - 18 weeksThe semester s varied between 15 - 18 weeks The total credit hours are 16-22 per semesterThe total credit hours are 16-22 per semester

Admission requirementsAdmission requirements

The BSc program was designed to The BSc program was designed to accept secondary schools graduates accept secondary schools graduates (boys & girls) who wish to study (boys & girls) who wish to study nursing and satisfy the following nursing and satisfy the following criteria: criteria: o Are 16 years or aboveAre 16 years or aboveo Score 80% or above in the secondary Score 80% or above in the secondary

school certificateschool certificateo is medically fitis medically fito pass face to face interview pass face to face interview

Dr. Rashida Abdelfatah

Teaching and learning Teaching and learning strategiesstrategies

Focus on: Focus on: practical training under supervisionpractical training under supervision Active self learningActive self learning Problem solving approach Problem solving approach

throughout the stages of trainingthroughout the stages of training Evidence-based practiceEvidence-based practice Community orientation to identify Community orientation to identify

it’s problems and shared solutionit’s problems and shared solution

Evidence-based Practice Evidence-based Practice

Is conscientious use of current best Is conscientious use of current best evidence in making decisions about evidence in making decisions about patient care.patient care.

EBP componentsEBP components Systemic research for and critical Systemic research for and critical

appraisal of the most relevant evidence to appraisal of the most relevant evidence to answer a clinical question.answer a clinical question.

The clinical experience of the concerned The clinical experience of the concerned doctor or nurse and experts opinion in doctor or nurse and experts opinion in the absence of evidence.the absence of evidence.

Patients preference & values. Patients preference & values.

Teaching and learning Teaching and learning Methods Methods

Methods for Theoretical part Methods for Theoretical part :: Group discussionGroup discussion Interactive lecturesInteractive lectures SeminarsSeminars Problem solving case studiesProblem solving case studies TutorialsTutorials AssignmentsAssignments

Methods for Practical Methods for Practical trainingtraining

Skill training on manikins (skill lab)Skill training on manikins (skill lab) Skill training on real patient under Skill training on real patient under

tutors supervisiontutors supervision Simulation & role playSimulation & role play Programmed clinical training Programmed clinical training

following the nursing processfollowing the nursing process Nursing roundsNursing rounds Writing clinical nursing reportsWriting clinical nursing reports

Practical Training Practical Training cont.cont.

Home visitsHome visits Field workField work National training tripsNational training trips International tripsInternational trips Student researchStudent research Residency program for honor Residency program for honor

studentsstudents

Students EvaluationStudents Evaluation

Theoretical:Theoretical: Continuous evaluation (Practical Continuous evaluation (Practical

training ,quiz, discussion, seminars training ,quiz, discussion, seminars presentation & projects).presentation & projects).

Final written /practical examinationFinal written /practical examination

( 60% for the practical and 40% for ( 60% for the practical and 40% for the theoretical).the theoretical).

Curriculum EvaluationCurriculum Evaluation

Achievement of objectivesAchievement of objectives Outcome qualityOutcome quality

College exams resultsCollege exams results Nursing council Qualifying examinationNursing council Qualifying examination Surveys for client satisfactionSurveys for client satisfaction Employer satisfaction surveyEmployer satisfaction survey

Nursing audit Nursing audit

Facilities Facilities

Academic institutions:Academic institutions: FacultiesFaculties Schools under the umbrella of some Schools under the umbrella of some

faculties of medicinefaculties of medicine Nursing Academy which is belonging Nursing Academy which is belonging

to the ministry of healthto the ministry of health Even the limited facilities are well Even the limited facilities are well

designed and equippeddesigned and equipped

s

Health Care InstitutionsHealth Care Institutions

HospitalsHospitals Health centersHealth centers PolyclinicsPolyclinics Specialized centersSpecialized centers Other community institutionsOther community institutions

Honor DegreeHonor Degree

In some nursing colleges including that of the In some nursing colleges including that of the university of Khartoum, the students university of Khartoum, the students enrollment in upper-division (5enrollment in upper-division (5thth year) is year) is limited to those who meet the following limited to those who meet the following criteria:criteria:

completed all required courses in the fresh completed all required courses in the fresh students semesters with a minimal grade of students semesters with a minimal grade of “clear pass”“clear pass”

maintain full-time study at nursing institutemaintain full-time study at nursing institute minimum cumulative grade point of 3.5 minimum cumulative grade point of 3.5 minimum grade of “B” in the specialty minimum grade of “B” in the specialty

subjectsubject

Challenges facing curriculum Challenges facing curriculum applicationapplication

Increased number of academic Increased number of academic institutions, compared with the very institutions, compared with the very limited number of qualified teaching limited number of qualified teaching staffstaff

The educational institutions are facing The educational institutions are facing financial difficulties that hinder financial difficulties that hinder development and maintenance of skill development and maintenance of skill laboratories & libraries laboratories & libraries

Variation of language used in teaching Variation of language used in teaching curriculum material & applications curriculum material & applications

Challenges facing curriculum Challenges facing curriculum applicationapplication

The absence of specialized nursing The absence of specialized nursing council makes it difficult to unify or council makes it difficult to unify or standardize the undergraduate nursing standardize the undergraduate nursing programs in Sudan.programs in Sudan.

The clinical educational institutions are The clinical educational institutions are not well prepared or equipped to meet not well prepared or equipped to meet the students training needs (reality the students training needs (reality shock).shock).

Difficulties in evaluation and revision of Difficulties in evaluation and revision of student-centered policies, procedures, student-centered policies, procedures, and guidelines.and guidelines.

AcknowledgmentsAcknowledgments

In preparing this lecture I used some In preparing this lecture I used some material from the following source:material from the following source:

Dr. Rashida Abdelfatah, Nursing Dr. Rashida Abdelfatah, Nursing College, University of Khartoum, a College, University of Khartoum, a lecture on nursing curriculum lecture on nursing curriculum presented at a workshop in presented at a workshop in Khartoum (unpublished).Khartoum (unpublished).

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