The concept of curriculum development in general has evolved over the years, often influenced by many factors in response to the ever changing dynamics of human and socioeconomic developments. The nursing curriculum has not been an exception in this curriculum evolution; it is continually influenced by the same dynamic changes of society affecting the curriculum of other professions.
Despite the solid and well cherished philosophical underpinnings of the nursing profession which has been transmitted from the Nightingale’s era through to the 21st centuary, nursing practice and education is constantly redirected by the trends and issues in the local, national and global society that influence human health care (Cherry & Jacob, 2008). Nursing curriculum is continually adjusted to take into account the emerging issues influencing health care and the nursing profession. These emerging issues on the nursing curriculum are what are termed as “the contemporary issues influencing nursing curriculum development. This paper examines the influences of five (5) key contemporary issues and how they have shaped or are shaping nursing curriculum development in Ghana and globally.
First, the issue of disasters, global violence and the threat of violence has shaped curriculum development throughout the world in no small way. Nurses have always worked in situations resulting from disasters and violence in families and communities. The effects of global climate changes are associated with more mass disasters such as hurricanes, floods and earthquakes. In some countries such as Ghana, the increasing rate of road traffic accidents has become a common source of mass casualties. In other areas of the world, volatile political climate may also result in or at least have the potential of resulting in mass casualties. From the aforesaid, nurses need to be more prepared to function effectively along with other professionals as first respondents to these unpredictable and diverse catastrophic events (Veenema, 2006, Weiner et al 2005). As a result, nursing curricula in various countries throughout the world has received tremendous revision to prepare nurses and future nurses to adequately respond to disasters, global violence and its threats. For instance, in Ghana, the Kwame Nkrumah University of Science and Technology (KNUST) has introduced a full Bachelor of Science in Emergency Nursing program to prepare nurses and future nurses to be able to efficiently handle situations of mass casualties. Also, the school of Nursing of the University of Ghana has reviewed it curriculum to include among other things, Emergency Nursing as a key course to be undertaken by all undergraduate nursing students.
Again, since the horrific terror attack on September 11, 2001 in the United States of America and the emerging threat of bioterrorism, it has been a clarion call on nurse educators to fashion out a curriculum that would prepare today and future nurses on how to appropriately cope with or respond to terrorism situations. According to Cherry et al (2008), ANA (2006) and Steed et al (2004, many nursing programs in the United States of America have added courses or entire programs on how to respond to acts of terrorism. With terrorism fast spreading across the globe and already evident in African countries like Somalia, Mali and Nigeria, it is only expected that sooner than later, the nursing curricula in African countries would be given the necessary revision to prepare future nurses to effectively function during such acts of terrorism.
Besides, demographic revolution has, and is impacting on nursing curriculum direction as many changes in socio-demographic, culture and politics influence nursing care and nursing curriculum. From the rural to urban areas of Ghana, the population is undergoing significant transformation; a) increasing phenomenon of streetism and children under five, b) increasing ageing population, c) persistence of hunger and poverty and d) emerging family types such as co-habitating families and single parent households among others. Each of these demographic dynamics has unique implication on health care and requires specific nursing response in terms of practice and curriculum development. For instance, the phenomenon of streetism and increased under five have brought the need for nursing curricula to include modules to develop political advocacy and the skills needed to influence public decision relative to resource allocation towards health and human needs. Also, increasing geriatric population together with a changing lifestyle of the Ghanaian has increased the prevalence of chronic illness. For example, although malaria continues to be top cause of morbidity in Ghana, cardiovascular disease have become the top cause of mortality (GHS, 2009).
This has certainly resulted in a spontaneous response in terms of health policy and nursing curriculum development. Nurse educators have been tasked to prepare nurses to promote health and prevent disease and disability in the large ageing population. Policy emphasis has shifted from acute care to regenerative health, chronic care and rehabilitation. In terms of nursing curricula, this has seen the KNUST introduce Bachelor of Science in Disability and Rehabilitation Studies, the University of Ghana introduce Bachelor of Science in Pediatric nursing, and Bachelor of Public Health and the University for Development Studies (UDS) introduce a Master of Philosophy in Community Health. The private universities have also responded in the same vein as exemplified by the introduction of Bachelor of Science in Community Health Nursing by the Garden City University in Kumasi.
Furthermore, technological explosion is another key influence on contemporary nursing curriculum and teaching methods. Information and digital technology have changed the pace and possibilities in communication, data management and information access and nursing care. With the ever expanding development in electronic information technology, the volume of information is growing exponentially on a global level. According to McBride (2005) and Shiba (2005), informatics has become a major part of nursing education and practice. In the Ghanaian context, the reception of technology in nursing and healthcare has been slow as compared to the banking industry. However, at least computer literacy has become a compulsory course taught at all levels of nursing education. With the Ministry of Health launching an ambitious e-health project, it is expected to further influence nursing curriculum and how nurses embrace technology in Ghana.
Moreover, globalization and the rise of global economy have impacted directly on curriculum development throughout the world. The world has become more or less like one country through multilateral international agreements. Increasingly, countries become concerned about what happens in other countries and hence curriculum changes in most influential countries tend to trickle to other countries sharing similar educational systems or philosophy. Also, with increasing global market and labour integration, many countries have structured their nursing curriculum to take into account the global racial, cultural, and religious diversity such that nurses trained in their country can safely practice in other parts of the world. Undoubtedly, the nursing curriculum in Ghana is largely synchronized with the western countries and to some extent the West African sub-region, all geared towards uniformity and labour or economic integration.
To add, the issue of affordability in one way or the other significantly determines the direction of curriculum development and the extent to which it will be implemented. In other words, the extent to which nursing curriculum could be implemented largely depends on whether the institution or the state can sufficiently meet the cost of the implementation relative to infrastructure, human resource, equipment and finance. For instance, in 1999 when the State Registered Nursing (SRN) curriculum in Ghana was revised to the present day Registered General Nursing (Diploma), it came with its associated costs in terms of upgrading lectures who did not meet the requirements to teach in Diploma institutions and building of classrooms among others. Indeed, as the saying, ‘cut the coat according to your size’; curriculum development is also influenced by the ability to afford its associated costs. Other influences on nursing curriculum worth mentioning have to also do with health policy and issues of access. These influences are intricately linked to the issues discussed above but could independently influence nursing curriculum development directly or indirectly.
In conclusion, curriculum development in nursing will always be driven by several global, national, cultural and socio-political influences. Global disasters, violence and the threat of violence, demographic revolutions, technological explosions, globalization and the rise of global economy, affordability, health policy and access among many others have emerged as key contemporary issues influencing nursing curriculum development. However, curriculum change is the sole responsibility of the individual institution and not merely the factors influencing it.
James Avoka Asamani, RN, Diploma, BScN
Adelaide Maria Ansah Ofei, SRN, RM, BA, MBA, MPhil