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Evaluative content analysis of the curriculum of vocational education with the view to the development of teamwork competencies

Vilma ˇyd˛iūnaitė
Institute of Educational Studies, Kaunas University of Technology, Kaunas, Lithuania

Paper presented at the European Conference on Educational Research, University of Crete, 22-25 September 2004

ABSTRACT. This research1 is focused on evaluating the orientations of vocational education curriculum of nurses with the view to the development of teamwork competencies. The two methods were used: 1) Analysis of scientific literature: a teamwork competencies as an element of professional competence were substantiated; a characteristics of nurses’ competencies and its development in the context of realization a professional role were explored; a peculiarities of the development of teamwork competencies in nurses’ population were illuminated. 2) Evaluative content analysis: The evaluation of curriculum of vocational education of nurses with the view to the development of teamwork competencies was performed. The evaluative instrument is the original/authorship matrix2. This research instrument could be a background for identifying disproportions of parameters and orientations of the development of teamwork competencies in curriculum3. The results should not be generalized for all population4, because of the specific aim5 was to use the matrix as evaluative instrument and the comparison of curriculum examples from various countries was the "working context".

INTRODUCTION

The first European Conference on Nursing was held in Vienna (Austria) in 1988, and there were formed the targets for the new role of an European nurse, that should not be limited by narrow professional education and task-oriented nursing were discussed. The mission of nursing was defined as rendering assistance and help for individuals, families, and groups within the challenging context of the environment in which they live and work (Salvage, 1993). It means, that nurses need two aspects: broad basic education as a precondition, that nurses are equipped with multidisciplinary competencies; continuous development of these competencies and their fostering, directed "to education, administration and management of health care" (International Labor Organization, 1998, p.40). Vocational training and education of nurses with the orientation to acquisition of specific skills, abilities and theoretical knowledge do not fit the changing demands of activity and the needs of society. Thus, permanent professional education of nurses as the basis for professional development, should be directed to the activity sphere, which means that nurses should be able to work in the environments, characterized by complex situations, controversial information and non-formal, flexible, dynamic collaboration. In such context the connection between the concepts of development and teamwork competencies is clearing up. Such connection is supported by Douglas & Bevis (1979), who indicate, "teamwork, which is realized in nurses’ population, facilitates possibilities of the nurses’ professional group to apply and develop competencies in full value" (p.178).

According to Janhonen (1992), in nursing that is oriented to teamwork, the main focus is on nurse’s ability to apply multidisciplinary knowledge and to carry out the role as an organizing specialist and to apply social sciences in practice: management, which includes an ability to manage a complex process to help a patient; psychology, which incorporates nurse’s ability to communicate with a patient, according to his/her needs, expectations and abilities as well as an ability to motivate a patient to strive for his(her) self-care; education that emphasizes nurse’s knowledge how to carry out nursing, what a patient should be taught and in which areas a nurse should empower her/himself for development. It means, that in nursing, oriented to teamwork, there is an overlap between social and nursing sciences. Nurses should be educated to be able to work in team, and the nursing curriculum should be based on evidence and research, that stimulates continuous analysis and experiential learning, understanding of importance of regular evaluations as an inseparable component of nursing activity (Salvage, 1993; WHO, 1998). Consequently, the study process of nursing, based on cooperative learning, reflection and experiential learning is the primary precondition for professional development of nurses.

Research problem. The research study illuminates and solves a research problem, which helps systematize the knowledge and research experiences, related to curriculum elements, oriented to the development of teamwork competencies. The following question is the background of the research problem: What kind core elements form the nursing curriculum, which integrates teamwork competencies and which is the premise for the development of teamwork competencies?

1. THEORETICAL BACKGROUND

1.1 Teamwork competencies as an element of professional competence

In spite of various investigations in the context of the concept competence a conditionally neglected research sector exists here – the qualities of teamwork competencies and the characteristics of these competencies that are urgent for nurses as well as the developmental peculiarities of teamwork competencies in vocational education of nurses. According to Mahmoodi & King (1992), Doe (2000, 2001), Salas (2002), teamwork competencies include three elements: 1) Knowledge, abilities and standpoints. 2) Orientation to the areas of management, psychology, education, sociology. 3) Orientation to an individual and team levels. Integration of the above-mentioned aspects in the environment of teamwork is the precondition for team members to understand processes of teamwork and communication, to diagnose disturbances in realization of teamwork competencies and on the basis of the diagnosis’ results to reflect activity and empower oneself to continuous professional development. In nursing that is oriented to teamwork, the main focus is on nurse’s ability to apply multidisciplinary knowledge and to carry out the role as an organizing specialist and to apply social sciences in practice such as management, psychology and education.

The concept of teamwork competencies is characterized by the following characteristics: qualification; personal traits; management competence; permanent learning. Teamwork competencies "stand" on the three columns (Salas, 2002): knowledge; abilities; standpoints and attitudes and they are directly dependent upon organizational aims and objectives. Teamwork, which includes teamwork competencies from the standpoint of: 1) theory - is an independent construct; 2) activity - is a type of work; 3) education - is a context of manifestation of professional competence, its realization and development. The development of teamwork competencies and professional competence are two autonomous processes, connected by teamwork content. The integrated development of professional competence and teamwork competencies could be interpreted only in the context of organization, where teamwork is a significant element of organizational development.

1.2 Characteristics of nurses’ competencies and its development in the context of realization a professional role

The components of a holistic role of a nurse include different professional behaviors, namely, a clinical/practitioner, a manager/administrator, a teacher and a researcher (Clifford, 1996), that reflect the areas of nursing activity competencies. For the realization of a holistic role an employee should acquire these competencies: conceptual, technical, interpersonal (Roy, 1984). According to Lutjens (1991), the key factors that influence the performance of a nurse’s holistic role are social learning, feedback mechanism, lucid aims of activity and the ability to avoid conflicts among roles. Fraser, Murphy & Worth-Butler (1997) divide nurse’s competencies into two groups – personal features and abilities. ˇyd˛iūnaitė (2000) identifies the following three groups of nurse’s competencies: social competencies, personal competencies and activity competencies.

1.3 Peculiarities of the development of teamwork competencies in nurses’ population

The realization of competencies is based on the two main aspects: developmental process and empowerment of nurses. Nurses’ competencies, urgent for teamwork, represent the four key groups: 1) Directing (open listening; sensitivity to values; personal position in ambiguous situations; collection of information; sensitivity to feelings of other people). 2) Coordinating (responsibility for the performed activity; influencing others; leadership; collaboration; searching for the opportunities and using them; personal motivation; involvement into common activity). 3) Distributing (decision making; critical thinking; experimentation, which is based on new ideas and attitudes; searching for the best decisions according a concrete problem; searching for aims). 4) Assimilating (formation of conceptual models; real experimentation; distribution and generalization of information; analysis of quantitative data; testing theories and ideas).

2. THE STUDY

2.1 Aim. To evaluate the orientations of vocational education curriculum of nurses with the view to the development of teamwork competencies.

2.2 Method. Evaluative content analysis (Charles, 1999): the evaluative curriculum analysis of vocational training and education of nurses was performed. The steps of the curriculum analysis of vocational education of nurses’are these (ˇyd˛iūnaitė, 2003): 1) Reading the curriculum content in its original structure. 2) Analyzing the content of curricula by using concrete qualitative indicators (evaluative matrix). 3) Presenting results in writing (qualitative type) in statistical (quantitative type with the descriptive statistics – numbers and percents); 4) Comparing the results of various curriculum analysis. 5) Presenting conclusions.

2.3 Sample. The six curriculum of vocational nurses’ education were analyzed: WHO (EU); curriculum examples from UK, USA, Canada, Lithuania (non–university/college and university higher education levels).

2.4 Data analysis. Research instrument. For the evaluative content analysis of the curriculum of vocational education of nurses was used the original/authorship research instrument, which is based on these qualitative indicators (ˇyd˛iūnaitė, 2003): 1) Scientific area of a study module (biomedicine, social sciences, humanities, physical sciences, technological sciences or module is integrated, i.e. integrates various scientific areas). 2) Orientations of parameters of the modules (study aims and objectives, acquiring competencies) to cognitive levels (knowledge, comprehension, application, analysis, synthesis, assessment). 3) Orientations of theme contents of the modules and the acquiring competencies to nursing receivers (individual, group, family, community, society). 4) Orientations of theme contents of the modules and the acquiring competencies to nursing activity areas: a from the standpoint of working activity (nursing practice, nursing administration, patient teaching, psychological support for a patient); a from the standpoint of collaboration (individual work, teamwork). 5) Orientations of acquiring competencies to holistic teamwork competencies (socio-psychological, educational, administrational/management and expertise). 6) Orientation of acquiring competencies to a nurse’s role: a from the standpoint of teamwork (leader, member, and non-identified role); a from the standpoint of autonomy (autonomous activity: nurse-expert; dependent activity: nurse-performer). 7) Orientations of study methods to cognitive levels (see indicator 2). 8) Orientations of study methods to the work nature from the standpoint of collaboration: a individual work (oriented to a teacher; oriented to a student); a group work;a teamwork. 9) Orientations of study character (theory, practice, integration of theory and practice). 10) Orientations of study assessment/evaluation methods to cognitive levels (see indicator 2).

3. RESULTS

1) In all the six curriculum the modules are oriented to biomedical sphere, nursing area (see Table 1):

Table 1. Orientations of curriculum modules’ content to scientific areas

 

WHO EU

UK

USA

Canada

Lithuania (University level)

Lithuania (College level)

Biomedical sciences

74%

72%

75%

75%

60%

49%

Social sciences

10%

8%

14%

17%

13%

11%

Humanities

2%

5%

4%

7%

27%

9%

Physical sciences

1%

3%

4%

-

-

2%

Integrated modules

13%

12%

3%

10%

-

29%

2) The orientations of acquiring competencies in all the analyzed curriculum are on application level and in the curriculum of UK, USA, Canada and Lithuania an urgency of mastering cognitive level of analysis is reflected (see Table 2):

Table 2. Orientations of acquiring competencies to cognitive levels

 

WHO EU

UK

USA

Canada

Lithuania (University level)

Lithuania (College level)

Evaluation

48%

69%

49%

48%

20%

71%

Synthesis

91%

56%

46%

48%

20%

82%

Analysis

78%

77%

65%

56%

40%

80%

Application

100%

54%

61%

79%

93%

84%

Comprehension

96%

56%

21%

35%

40%

78%

Knowledge

96%

13%

17%

27%

67%

40%

3) In all curriculum6 the acquiring competencies are oriented to the individual work with patients and groups of patients (see Table 3):

Table 3. Orientations of acquiring competencies to nursing receivers

 

WHO EU

UK

USA

Canada

Lithuania

(University level)

Lithuania

(College level)

Person

65%

46%

34%

54%

47%

89%

Group

52%

36%

27%

38%

20%

38%

Family

39%

18%

20%

29%

20%

29%

Community

17%

18%

16%

23%

13%

2%

Society

30%

38%

4%

23%

13%

2%

Not identified

-

21%

-

-

-

-

4) In all the curriculum the orientation of acquiring competencies is to nursing practice and nurses’ ability to work individually (see Table 4):

Table 4. Orientations of acquiring competencies to nursing activity areas

 

WHO EU

UK

USA

Canada

Lithuania (University level)

Lithuania (College level)

Nursing practice

83%

95%

89%

100%

67%

98%

Nursing management

48%

31%

51%

44%

47%

40%

Teaching

61%

28%

21%

17%

20%

36%

Psychological support

52%

26%

18%

38%

47%

31%

Individual work

61%

95%

97%

92%

100%

100%

Teamwork

39%

5%

3%

13%

-

24%

5) From the standpoint of the development of teamwork competencies in the curricula of university level in Lithuania the orientation of acquiring competencies is to mastering expertise and managerial holistic teamwork competencies, while in the other analyzed five curriculum the highest orientation of acquiring competencies is only to mastering expertise holistic teamwork competence (see Table 5):

Table 5. Orientations of acquiring competencies to teamwork competencies

 

WHO EU

UK

USA

Canada

Lithuania (University level)

Lithuania (College level)

Social – psycholo-gical teamwork competence

65%

31%

15%

56%

53%

53%

Educational teamwork competence

35%

13%

17%

31%

27%

56%

Managerial teamwork competence

35%

21%

34%

40%

60%

51%

Expertise/subject oriented teamwork competence

100%

100%

100%

94%

67%

96%

6) Nurse’s role in a team in all analyzed curriculum7 is identified:4 In WHO (EU) and UK curriculum there is an equivalent focus on nurse’s leadership and membership in a team.4 In Lithuanian non-university level curriculum the presented competencies are oriented to nurse’s membership in a team.4 All the curriculum are emphasized on autonomous work of a nurse (see Table 6):

Table 6. Orientations of acquiring competencies to nurse’s role in a team

 

WHO EU

UK

USA

Canada

Lithuania (University level)

Lithuania (College level)

Leader

13%

5%

13%

31%

-

7%

Member

17%

5%

1%

19%

-

31%

Expert

100%

100%

100%

100%

-

100%

Executor

-

-

-

-

-

-

Autonomous work

100%

100%

100%

100%

100%

100%

Not identified role

74%

95%

97%

52%

100%

62%

7) The results of the evaluative curriculum analysis illuminated that study methods are oriented to these cognitive levels: 4 In the WHO curriculum the study methods are very strongly oriented to analysis, comprehension and knowledge levels and strongly to evaluation and application levels. 4 In the UK curriculum the strongest orientations of study methods is to knowledge level, but orientations to analysis and comprehensions levels are also strong. 4 In the USA curriculum the study methods mainly are oriented to application and knowledge levels. 4 In the Canadian curriculum the study methods are strongly oriented to analysis and application levels. In the Lithuanian college level curriculum the study methods are oriented to three levels – knowledge, comprehension, application (see Table 7):

Table 7. Orientations of study methods to cognitive levels

 

WHO EU

UK

USA

Canada

Lithuania (University level)

Lithuania (College level)

Evaluation

70%

21%

13%

33%

-

40%

Synthesis

17%

18%

4%

21%

-

13%

Analysis

96%

67%

25%

63%

-

47%

Application

83%

46%

79%

50%

-

84%

Comprehension

91%

56%

14%

13%

-

60%

Knowledge

91%

95%

68%

10%

-

98%

8) The analyzed orientations of study methods to group work and/or teamwork and to student and/or teacher identified, that: 4 WHO (EU) curriculum indicates nurse’s ability to work equivalently in a group and team and the study methods are oriented to student. 4 In the UK curriculum the study methods are oriented to teacher and to nurse’s ability to work in a group. 4 The study methods in the USA curriculum there are oriented to nurse’s ability to work in a group and the methods are oriented mainly to the teacher. 4 In the Canadian curriculum study methods are oriented to teamwork and student. 4 The Lithuanian college level curriculum presented that study methods are oriented to student and teacher equivalently; the very strong orientation of study methods is to group work and enough strong to teamwork8 (see Table 8):

Table 8. Orientations of study methods to activity form standpoint of collaboration

 

WHO EU

UK

USA

Canada

Lithuania (University level)

Lithuania (College level)

Orientation to student

91%

15%

25%

67%

-

91%

Orientation to teacher

35%

100%

76%

29%

-

98%

Group work

96%

72%

37%

29%

-

69%

Teamwork

96%

38%

25%

48%

-

53%

9) The orientations of study type could be to theory, practice or could be integrated, i.e. to unify adequately the practical and theoretical parts/elements. The results illuminated these orientations: 4 In the WHO, UK and Canada curriculum the study type is oriented to integration of theory and practice. 4 In the USA and Lithuanian (college) level curriculum the orientation of study type is mainly to theory (see Table 9):

Table 9. Study type orientations

 

WHO EU

UK

USA

Canada

Lithuania (University level)

Lithuania (College level)

Theory

26%

44%

48%

19%

-

44%

Practice

-

8%

18%

27%

-

24%

Integration of theory and practice

74%

49%

37%

52%

-

31%

10) The results of evaluative content analysis illuminated the various orientations of study evaluation methods:4 In the WHO curriculum the evaluation methods are oriented mainly to knowledge and application cognitive levels. 4 In the UK curriculum the main orientation of study evaluation methods is to synthesis cognitive level. 4 In the Lithuanian (college level) curriculum the evaluation methods are strongly oriented to knowledge and application cognitive levels (see Table 10):

Table 10. Orientations of study evaluation methods to cognitive levels

 

WHO EU

UK

USA

Canada

Lithuania (University level)

Lithuania (College level)

Evaluation

22%

18%

-

-

-

-

Synthesis

17%

49%

-

-

-

27%

Analysis

48%

10%

-

-

-

42%

Application

52%

28%

-

-

-

51%

Comprehension

22%

10%

-

-

-

11%

Knowledge

52%

33%

-

-

-

73%

The results of the evaluative curriculum analysis disclosed common tendencies of the interferences with the development of teamwork competencies in vocational education of nurses: a incompatibility between curriculum parameters, i.e. methodological disproportions between study aims, objectives, acquiring competencies, themes, study methods and assessment/evaluation methods; a strong orientation of acquiring competencies to nursing practice and competences’ orientation to the development of specialized competences, without emphasis on the significance of various roles of a nurse (as an educator/teacher, manager/administrator, psychological supporter); a emphasis on individual work and individualized nursing and poor accentuation of group work, teamwork, community and family nursing; a orientation of acquiring competencies to mastering of expertise/specialized holistic teamwork competence; a poor orientation to the acquisition of multidisciplinary competencies that could stipulate effective autonomous work and teamwork.

4. DISCUSSION

The curriculum of vocational education of nurses should be always based on three ‘columns’ (ˇyd˛iūnaitė, 2003): 1) activity that includes practical, managerial, educational, primary psychological support and research elements; 2) vocational education and training, which should guarantee the acquirement of competences; 3) nurse‘s personality, which is in the environment of vocational education. WHO strategy (WHO, 2000) indicates, that nurses should be competent in order to meet the needs of society. It is important to note, that the curriculum basis of any vocation is identical: here is urgent to evaluate the knowledge, skills, abilities, competencies needs for society with respect to concrete vocation. The curriculum of nursing studies, which is oriented to the integration of teamwork competencies, should be based on cooperative learning, reflection and experiential learning, when students acquire the strategies of independent, cooperative and team learning.

As an outcome of evaluative content analysis of curriculum9 was established the theoretical–hypothetical model of the development of teamwork competencies. This model consists of the parameters of the curriculum of vocational education of nurses, which integrates: a teamwork competencies and its interrelations; a the parameters include philosophy of nursing studies on which the curriculum of vocational education of nurses is based; a nursing philosophy; a curriculum content; a parameters of modules – aims, objectives, learning outcomes/acquiring competencies; a study methods; a character of studies; a assessment/evaluation methods) (see Figure 1):

Figure 1. The theoretical-hypothetical model of the development of teamwork competencies
(ˇyd˛iūnaitė, 2003)

5. CONCLUSIONS

In modeling the curriculum of vocational education of nurses, which integrates teamwork competencies it is necessary to form and accomplish the following four key components: 1) philosophical approach to nursing studies; 2) standpoints of nursing philosophy; 3) curriculum content, which is based on integrated modules that are oriented to the nursing context; 4) integration of theory and practice of nursing studies. The curriculum of nursing studies, which is oriented to the integration of teamwork competencies, should be based on cooperative learning, reflection and experiential learning, when students acquire the strategies of independent, cooperative and team learning.

The curriculum content integrates these aspects:4 It is substantiated by research evidence and it is oriented to the global priorities in health care and the epidemiological, demographic and socio-cultural context of a concrete country. 4 The main direction of the curriculum of nursing studies’ is nursing practice and theory. 4 The modules that are not related to nursing should be integrated with nursing. 4 Nursing contextuality is the main characteristic of curriculum modules.

The modules, that compose curriculum model, include these parameters:

References

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Charles, C. (1999). Introduction to Educational research. Vilnius, Alma Littera. [In Lithuanian language].

Clifford, C. (1993). The clinical role of the nurse teacher in the United Kingdom. Journal of Advanced Nursing, 18: 281 – 289.

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Doe, J. (2000). Performance DNA: Personal Soft skills Indicator. – USA: Performance DNA International LTD.

Douglass, L., Bevis, E. (1979). Nursing Management and Leadership in Action. (3rd ed.). – St. Louis, Missouri: C.V.Mosby Company.

Fraser, D., Murphy, R., Worth–Butler, M. (1997). An outcome of the effectiveness of pre – registration midwifery programmes of education. Research Highlights, London: ENB, July, 24: 1 – 4.

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Salas, E. (2002). Team competencies and team training: what we know after 15 years of research and practice.–University of Central Florida.– http://www.iit.edu/~ciop/news/salas/tsld001.htm . (Cit. 2002 02 04)

Salvage, J. (1993). Nursing in Action: strengthening nursing and midwifery to support health for all. J. Salvage (ed.). – WHO Regional Publications, European Series, No. 48.

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ˇyd˛iūnaitė, V. (2000). Education of core competencies in vocational education of nurses as precondition for effectiveness of nursing activity. Education of adults for the present and future: collection of articles. – Kaunas: Vytautas Magnus University. – p. 111 – 118. [In Lithuanian language].

Notes:

  1. Performed in 2003 year

  2. Had been established on the basis of qualitative and quantitative research studies’ (performed in 2001 – 2003 years) results

  3. Not only in the sphere of health care

  4. Curriculum of vocational education of nurses

  5. Covered” by the general study aim

  6. Except the Lithuanian university level, where the orientation is to personality

  7. Except the Lithuanian university level

  8. More than in UK, USA, Canada curriculum from the quantitative standpoint

  9. Of vocational education of nurses

This document was added to the Education-line database on 22 September 2004