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INTRODUCTION

According to the World Health Organization (1946), the highest attainable standard of health is a fundamental right of every human being. Demands on healthcare change due to various reasons, including the needs of the patients and it is crucial to pay attention to these demands (The George Washington University, 2019) to ensure that nursing education is able to prepare the graduates to demonstrate the set of competencies needed to meet these and other future changes in healthcare demand.

In the Philippines, the Commission on Higher Education (CHED) serves as the governing body for Higher Education Institutions (HEIs) in the country. The provisions of R.A. 7722, otherwise known as the “Higher Education Act of 1994” gave the commission the power and authority to set the minimum requirement for specific academic programs, general education distribution requirements, and specific professional courses. With this authority, they released CHED Memorandum Order (CMO) No. 15, Series of 2017 promulgating the policies, standards, and guidelines for the Bachelor of Science in Nursing (BSN) Program in the country and implementing the shift of the BSN Program from competency-based standards to outcomes-based education.

CMO No.15, s.2017 specified how Nursing Programs in the country should be conducted and also set the outcomes expected from nursing graduates upon completion of the program. Recognizing the Outcomes-Based Education’s “design down” approach in curriculum planning and development, CHED, through this CMO has provided HEIs with academic freedom to design their own curriculum allowing them to incorporate their missions, visions, and goals into the curriculum as long as it will produce the same outcomes set by the same Memorandum Order.

The Outcomes-Based Approach in Curriculum Development was used in the creation of this curriculum. Since it will be used in a hypothetical nursing school in the Philippines, the policies, standards, and guidelines for the Bachelor of Science in Nursing (BSN) Program set by the Commission on Higher Education through CMO No. 15, s.2017 were utilized together with the 5-Step Curriculum Process in Outcomes-Based Education (OBE) proposed by Uys & Gwele on their book “Curriculum Development in Nursing Process and Innovation” which was published in 2005.

5-Step Curriculum Process in Outcomes-Based Education (OBE) proposed by Uys & Gwele

1. Developing Graduate Role Statement
2. Determining Graduate Competencies in the form of Program Outcomes
3. Deciding on the Program Structure
4. Identification & Designing of Modules/Course Outlines
5. Planning the Assessment and Evaluation of Learning

1. Developing Graduate Role Statement

Specific Roles & Careers for Graduates
The National Nursing Core Competencies Standards of 2012 include the three (3) major roles of the professional nurse. A nurse generalist can assume the roles:

1. Primary Health Care Nurse – Utilizing the Nursing Process in the care of needs of individuals, groups, and communities of different races, religions, and cultures through the entire life span and health states in different levels of health care settings.
2. Nursing Leadership & Management – Direct nursing staff, oversee the organizational structure of medical processes, and lead nursing teams in providing patient care.
3. Nursing Research – Engage in research contributing to further development of the nursing profession and delivery of updated nursing care.

Beyond the beginning professional roles, the nurse can pursue any of the following career options:

1. Advanced Practice Nursing
   Ambulatory Care, Cardiovascular Nursing, Critical Care Nursing, Diabetes Educator, Emergency Care Nursing, Enterosmal, and Wound Care Nursing, Entrepreneurial Nursing, Gerontology Nursing, Hospice/Palliative Nursing, Nephrology Nursing, Neurologic Nursing, Nursing Informatics, Oncology Nursing, Orthopedic Nursing, Renal Nursing, and Telehealth Nursing
2. Public Health / Community Health Nursing
   Occupational Health Nursing, School Nursing, Home Health Nursing, Health and Wellness Nursing, Military Nursing.
3. Nursing Education
   Nurse Educator and Nurse Education Specialist
4. Leadership and Governance
   Middle Nurse Manager and Nurse Executive

Mission Statement
The School of Nursing’s mission is to prepare compassionate, innovative, and competent nurses who are leaders in addressing the changing health care needs of all people and in advancing the nursing profession through state-of-the-art education, service, and research.

Vision Statement
The School of Nursing’s mission is to become a nationally recognized center for excellence and a passionately committed group of highly trained students, educators, and scholars dedicated to educating the next generation of nursing leaders who are equipped to meet the demands of a rapidly evolving and culturally diverse health care system.

Goals and Objectives
The Bachelor of Science in Nursing (BSN) Program is a full-time four-year program designed to prepare nursing students for entry into the nursing profession as beginner nurses with the ability to:

• Apply knowledge of nursing and related sciences, including research evidence in nursing practice.
• Provide holistic nursing care in response to the needs of individuals, groups, and communities of different races, religions, and cultures through the entire life span and health states in different levels of health care settings.
• Develop systematic and critical thinking and make clinical judgments including solving problems creatively.
• Use research and innovation processes to solve nursing and health problems.
• Demonstrate leadership and management skills in working collaboratively with a health care team, clients, and related persons.
• Demonstrate an inquiry mind, and ability to perform self-directed learning and self-development continuously.
• Demonstrate a good attitude towards the self, the nursing profession, and awareness of professional values and rights.

2. Determining Graduate Competencies in the form of Program Outcomes Program Outcomes

The expected outcomes of the Nursing programs are derived from the School of Nursing’s mission, goals, philosophy, program goals, and professional nursing standards and guidelines. Upon successful completion of the nursing program, students will be able to:

• Form nursing practice decisions based on a liberal education foundation and expanding knowledge from nursing science, biological and behavioral sciences, and the humanities.
• Apply leadership concepts, skills, and decision-making in the provision of high-quality nursing care, healthcare team coordination, and oversight and accountability for safe care delivery in a variety of settings.
• Integrate reliable evidence from multiple credible sources of knowledge including basic and health sciences to inform practice and make clinical judgments.
• Demonstrate basic understanding of the role of nurses in advocating for patients, communities, and populations in discussions related to healthcare policy, finance, and regulations.
• Demonstrate basic understanding of the role of health promotion, and disease/injury prevention in improving population health across the lifespan.
• Demonstrate the values central to nursing practice including altruism, autonomy, human dignity, integrity, advocacy, social justice, and lifelong learning.
• Demonstrate knowledge, skills, and healthy attitudes needed to facilitate safe, holistic, and effective patient-centered outcomes through the use of highly effective analytical and critical thinking skills and evidence-based research to promote and maintain health, prevent diseases, manage illness, and if recovery is not feasible, towards a peaceful death

3. Deciding on the Program Structure

This is a 4-year basic program for the degree of Bachelor of Science in Nursing. Staying true to Outcomes-Based Education, this program has different exit points allowing students to shift to other allied health programs of their choice after completion of the common 2-year program consisting of general education components of all baccalaureate degrees. The program follows the same structure set by CHED in CMO No.15, s.2017 with the incorporation of Related Learning Experiences, Skills Laboratory/Clinical Exposure to allow for the application of theoretical knowledge into actual practice under the supervision of a competent Clinical Instructor

COURSES	UNITS
I. General Education Courses a. 24 Units for Core Courses b. 09 Units for Elective Courses c. 03 Units for Life & Works of Rizal	36 units
II. Physical Education & NSTP 1-2	14 units
III. Major Courses	17 units
IV. Professional Courses	125 units
Total No. of Units	192 units

4. Identification and Designing of Modules/Course Outlines

First Year of 4-Year Nursing Program

Description	Expected Outcomes
Focused on the study of physical, biological, social science, and humanities. The fusion of science and humanities is envisioned to build a solid foundation in acquiring an understanding of oneself in relation to his /her environment.	At the end of the first year, given simulated situations in selected settings, the learners demonstrate basic nursing skills in rendering safe and appropriate care utilizing the nursing process.

Second Year of 4-Year Nursing Program

Description	Expected Outcomes
The second level provides a more intensive and deeper insight cognizant of the concept of man as a bio-psychosocial-cultural being. Specifically, the second level focuses the study on health’s common stress of life from womb to tomb and one’s roles and responsibilities in the family, community, health care delivery system, and the nursing profession.	At the end of the 2nd year, given a normal and high-risk mother and newborn, child, family, communities, and population groups in any health care setting, the learners demonstrate safe, appropriate, and holistic care utilizing the nursing process

Third Year of 4-Year Nursing Program

Description

Expected Outcomes

The third level concentrates on the study of maternal & child care and basic human function. It also examines the concept of illness particularly from the social, epidemiological, ecological, economic as well as cultural facets. An emphasis is given to pathological processes and coping techniques of the individual, the family, and the community, all of which are considered intrinsic components of the nursing process.

At the end of the 3rd year, given individuals, families, population groups, and communities with physiologic and psychosocial health problems and maladaptive patterns of behavior in varied health care settings, the learners demonstrate safe, appropriate, and holistic care utilizing the nursing process and applying research and evidence-based practice.

Fourth Year of 4-Year Nursing Program

Description

Expected Outcomes

The fourth level extends the nursing care of a sick client to include the promotion of health in the prevention and control of illness and disabilities, cure, and rehabilitation. It is also focused on the acquisition of competencies necessary in professional practice. Students work independently and/or in collaboration with others in the promotion of health, prevention, and control of illnesses and disabilities in hospital and/or community settings.

At the end of the 4th year, given groups of clients (individuals, families, population groups, and communities) with health problems and special needs, the learners demonstrate safe, appropriate, and holistic care utilizing the nursing process and can assume first-level entry positions in any field of nursing.

5. Planning the Assessment and Evaluation of Learning

In Outcomes-Based Education, Learning is evaluated by determining if the expected outcomes at every educational level are met. Performance indicators are utilized to identify the observable processes and products of learning which serve as culminating demonstrations of learners’ achievement of the established program outcomes and learners’ competence and degree of independence in the performance of products of learning

DISCUSSION

A gap between theoretical knowledge and practice has been observed. Newly hired nurses enter the clinical practice academically equipped, yet with limited ability to apply their knowledge. To address this, healthcare institutions had senior nurses in their institutions to help new nurses make the transition and spend time and resources to bring new nurses up to speed. While this method proved to be effective up to some extent, a more direct solution that would bridge this gap is needed – this is where outcomes-based education comes in. As an approach to education that focuses on outcomes as its core, stakeholders in curriculum planning and development, in this case, the Commission on Higher Education’s Technical Working Team must identify what nursing entails and what nurses are expected to do upon entry into the profession. Foresight on future developments in healthcare and technology should also be analyzed to establish the future roles of nurses that will contribute to the growth of both the healthcare institutions and the nursing profession – these will ultimately result in the identification of the graduate competencies that learners must achieve upon completion of the program

Once graduate competencies are established the program structure must be developed. The structure includes fundamental modules, core modules, and elective modules. It is important that these modules are structured to support the attainment of the established outcomes of the program. As part of OBE, the modules should also offer different exit points for learners who cannot complete the course of the study, this way they will have the opportunity to shift to another field of study with their prior learnings being recognized and the transfer of the learning credits they already earned, thus avoiding unnecessary duplication of learning

To ensure that learners achieve the set outcomes of the program, an assessment criterion should be established and utilized. It is helpful to assess learning on every level as the learners progress through the program to ensure that they meet the required competencies to progress to the next level of their nursing education. Assessment of learning also allows both the teachers and learners to know where the learner is in the process of learning. This also allows teachers to make adjustments to how teaching and learning activities are conducted to address the learning needs of each student.

In OBE, assessment should facilitate the growth of the learners, therefore, the assessment should help the learners monitor their own development. This necessitates active participation of the learners in the assessment of learning. The most important thing to take note of is that assessment procedures should be valid, reliable, fair, and reflect the knowledge and skills that are most important for learners.