The revised curriculum of the BSN program in thePhilippinesas outlined in the memo of the Commission on Higher Education (CHED) incorporates new subject areas which were once integrated in other nursing subjects. Additional clinical hours are added from previous requirements which expand the exposure of the student to direct clinical practice. Most of the changes outlined in this revised curriculum articulate with the curriculum of most nursing schools in theUnited States.
One of the deficiencies of RN’s coming from the Philippines in the past was their lack of exposure to clinical assessment. All hospitals in the Philippinesare staffed by resident physicians and it is they who consult with attending physicians when a change to the patient’s condition is reported by nurses. In this present practice the nurse relies on the physical assessment findings of the physician. Although these nurses were able to identify a significant change in the clinical condition of a patient, mostly from intuition, their immediate intervention was to notify the physician.
This is quite different from the way nurses practice in the USA. In the USA, most hospitals do not have resident physicians. Attending physicians would have to be notified by phone of changes in the patient’s status. The US nurse has to perform a thorough assessment so that in consulting with the attending physician by phone, a tentative diagnosis may be made and consequently, the appropriate intervention may be ordered.
The revised BSN curriculum now includes a physical assessment course similar to that in the USA. This change is a positive move to enable the nurse to accurately identify, diagnose, and intervene in the ever changing clinical condition of a patient. The curricular placement of the course is also coherent in that it is one of the first upper division courses a student will study. This placement will allow the student to apply the nursing process completely throughout her clinical rotations. By having this course as a foundational course requisite, the student can gain skill in data-gathering, including subjective and objective.
I have one concern about this course-addition to the BSN program. I suspect that Physicians will most likely be asked to teach this course. This will dilute the focus of its application to actual nursing practice. Unfortunately, there are no advanced nurse practitioners or nurse-faculty experienced in physical assessment to teach this course. It is understood, however, that because this is new, that a less-than-ideal start would have to rely on physicians to teach this course. I just hope, however, that nursing schools will have the initiative to have non-nurse faculty teaching this course to focus on the nursing component of assessment. This can be achieved by having USA-seasoned faculty in Physical Assessment do workshops to nursing faculty so that the exit behavior of students will align with the nursing objectives of the course.
The previous BSN curriculum integrated pharmacology in several nursing courses. The old paradigm was that the subject of pharmacology could better be presented in discussions of collaborative interventions of disease processes. However, it is noted that most graduates from that old curriculum were deficient in identifying commonalities of the pharmacodynamics of drug classes. By having pharmacology separate and a distinct subject area, identifying drug classes by generic stems (as used by USAN and WHO) will now be a stepping stone to identifying generic drugs. It will also make drug study focused on generic names rather than brand names which will make adaptation to an international practice setting easier. This will facilitate the nurse’s recognition of drugs regardless of brand name once they practice outside of the Philippine setting.
In the United States, research for BSN students focuses on the nurse as a consumer of research. TheUScourse emphasizes the role of the nurse as a consumer and utilizer of research. In the BSN curriculum of thePhilippines, the student is expected to generate research with the requirement of a research project. Although this seemingly is more advanced I am afraid that the course will be diluted by this requirement. I hear anecdotes of BSN students in the Philippines preparing thesis/research projects despite their lack of understanding current research implications and recommendations. If you ask a BSN graduate to discuss a research article, they cannot articulate terms, findings, or methodology. I would rather have the BSN graduate be able to incorporate research findings in their practice rather than designing pseudo-research projects they barely understand.
The new BSN curriculum specifies 2,499 clinical hours. This is a significant increase from that required in the old curriculum. This is lauded to be one of the best revisions to the old curriculum. By having this increase in the number of clinical hours, the end result will hopefully be a better functioning new graduate. In the past, new graduates were deficient in their clinical skills-exposure not only because of the inadequate number of clinical hours but also because of the lack of opportunity for clinical practice. Too many students were being assigned to clinical settings at one time, thus there was a “competition” to learning and skill-acquisition. With the expanded number of clinical hours, I hope that the new graduate will have a broadening of their clinical learning not only in breadth but in depth as well.
The CHED memo clearly states the qualification of faculty to teach in the upper division is a degree from a graduate program in nursing plus one year clinical experience. The reality, however, is that there are not enough faculty possessing this qualification. I know of several schools that employ new BSN graduates as clinical and didactic instructors.
A requirement to be a Dean (in this CHED memo) is to have a master’s degree in nursing. I believe that to be the academic and administrative officer of a nursing program, a Dean must have a doctorate degree. A master’s degree is insufficient for this role. Other requirements should be that the individual has a demonstrated record of nursing scholarship and leadership. They must provide evidence of being explorers in developing new frontiers for nursing. They must demonstrate leadership in advancing the status of the profession. Until these requirements are mandated, the development of a coherent nursing curriculum, academically prepared faculty, and development of competent graduates will fall short.
I believe that the old 4-year course of study for the BSN in the Philippines was short of adequately preparing their graduates for international nursing practice. Graduates of these programs lacked clinical exposure as well as in-depth didactics in physical assessment and pharmacology. This necessitates agencies exporting Philippine nurses to other countries to provide transitional programs to rectify these deficiencies. I believe that a training program prior to the nurse’s departure from the Philippines is a must. However, this training program must be directed by a nurse who has had extensive nursing experience in the USA. This is an imperative because a new “culture” will have to be imbued on nurse-applicants by someone who has lived that culture.
The new curriculum expands the BSN program to five years and significantly increases the required clinical hours in its courses. This is a welcome change as it is the beginning of improving the potential of a graduate to be successful in the international arena. But until the students of this new BSN curriculum finish the program in 2014, it as an imperative that the bridging and transitioning course espoused previously should be implemented without exception.