Assessment of AACN Baccalaureate Nursing Education …€¦ · · 2015-07-29Additional transcultural and comparative studies are ... liberal education, professional values, core

1

Assessment of AACN Baccalaureate Nursing Education Curriculum

Model in the People’s Republic of China: A Transcultural Explorative Study

Yu Xu

[email protected]

Debra C. Davis [email protected]

Carol Clements (deceased)

University of South Alabama College of Nursing, Mobile, Alabama

Zhaomin Xu [email protected]

Zhengzhou University, Zhengzhou, P. R. of China

2

Abstract

This study examines the relevance of The Essentials of Baccalaureate Education for Professional

Nursing Practice (American Association of Colleges of Nursing [AACN], 1998) as a guide for

baccalaureate nursing curriculum development in the People’s Republic of China. A Likert-type

survey was developed to measure Chinese nurse educators’ perceptions regarding the 21 key

concepts extracted from The Essentials document in both the present curriculum and an ideal

curriculum across three dimensions: importance, cultural relevance, and extent of exposure.

Surveys were sent to all known baccalaureate nursing programs in China (N = 22) with a 50%

return rate. Descriptive statistical analyses supported the universality of the majority of the 21

key concepts from The Essentials document. Some of the concepts, however, were not as readily

transferable due to differences in the Chinese sociopolitical and cultural contexts for

baccalaureate nursing education. Findings from this study lend support for the potential global

relevance of The Essentials document. Additional transcultural and comparative studies are

recommended to further test the relevance of The Essentials document in other cultures.

Meanwhile, international nurse educators need to be aware of the possible limits of adopting The

Essentials document without values clarification, critical discrimination, and adaptation to their

home cultures.

[Key words : China, American Association of Colleges of Nursing, baccalaureate nursing

education, curriculum model/framework]

3

Assessment of AACN Baccalaureate Nursing Education Curriculum

Model in the People’s Republic of China: A Transcultural Explorative Study

This study examines the perceived relevance of The Essentials of Baccalaureate

Education for Professional Nursing (The Essentials hereafter, American Association of Colleges

of Nursing [AACN], 1998) to curriculum development for baccalaureate nursing education in the

People’s Republic of China. Similar to the United States, China has a multi- tier nursing

education system consisting of programs at the secondary, associate, baccalaureate, and graduate

levels (Xu, Xu, & Zhang, 2000). To a large extent, baccalaureate nursing education is perceived

as the pinnacle of nursing education in China. There are only about 10 master’s programs in the

country and the first doctoral program is still in the planning stage.

Chinese baccalaureate nursing education has been expanding rapidly since the restoration

of the first five-year program at Tianjin Medical College (now Tianjin Medical University) in

1983. Prior to this time there was a 30-year abolition of collegiate nursing education in the

country. Accurate statistics on the actual numbers of baccalaureate nursing programs in China

are difficult to obtain because the administrative control of baccalaureate nursing programs was

delegated to provinces in the last few years. Published sources have reflected this challenge. For

example, there were 18 baccalaureate nursing programs in 1998 according to Chang (1999). Just

one year later in 1999, Li (2001) reported 67 programs. However, the vice-president of the

Chinese Nursing Association could only identify 22 programs in existence in spring 2000

(Guifang Guo, personal communication, February 22, 2000).

Following in the footsteps of medical education, the Chinese nursing education has

adopted the medical model to construct curricula (Xu, Xu, & Zhang, 2000). This model relies

heavily on knowledge of pathophysiology, pharmacology, and medical interventions with an

4

emphasis on illness care rather than prevention. Recent reforms in the nursing education system

led to on-going debates on baccalaureate nursing curricula. The tenor of these debates indicate

that Chinese nurse educators are interested in restructuring the baccalaureate nursing curriculum

by using a nursing model (Shen, 1998, 2000). For Chinese nurse educators, it is logical that the

initial step to develop this new nursing curriculum framework is to examine what is available

from other countries.

The Essentials Document

The Essentials serves as a blueprint for curricular development in baccalaureate nursing

education programs in the United States (AACN, 1998). This landmark document was first

released in 1986 after a two-year consensus building process that synthesized the input from

nurse educators, administrators, researchers, and clinicians across the country (Johnson, 1987).

In 1998, it was revised in light of the major changes in the health care system after its initial

publication. The document “provides a framework for developing, defining, and revising

baccalaureate nursing curricula” (AACN, 1998, p. i).

According to The Essentials, five components (domains) are essential for the

baccalaureate nursing curriculum: liberal education, professional values, core competencies, core

knowledge, and role development. Liberal education consists of course content from the arts,

sciences, and humanities that develop critical thinking skills and higher order problem-solving

skills. According to AACN (1998) “Liberal education is not a separate or distinct segment of

professional education, but an integrated educational experience” (p. 7).

Baccalaureate nursing programs must also structure learning experiences that facilitate

the development and internalization of professional nursing values. These values provide for

socialization into the professional nursing role and “support empathetic, sensitive, and

5

compassionate care for individuals, groups, and communities” (AACN, 1998, p. 9). Professional

nursing values include caring, altruism, autonomy, human dignity, integrity, and social justice,

with caring as a central concept to the practice of professional nursing.

Core competencies for the baccalaureate prepared nurse include critical thinking,

communication, assessment, and technical skills. These competencies, along with the core

knowledge of health promotion, risk reduction, and disease prevention, illness and disease

management, information and health care technologies, ethics, human diversity, global health

care, and health care systems and policy, are essential to the safe and comprehensive practice of

professional nursing.

Additionally, The Essentials outlines areas of role development for the baccalaureate

nurse. These roles include provider of care, designer/manager/coordinator of care, and member

of a profession. Grounded in the Western philosophy, values, and assumptions, The Essentials

has been well accepted and integrated into educational programs that prepare baccalaureate

nurses in the United States.

A systematic literature review through the Cumulative Index to Nursing and Allied

Health Literature and Medline has generated two studies on the application of The Essentials in

curriculum assessment and revision in the United States (Elfrink & Lutz, 1991; Henley &

Anema, 1989). However, no studies were located that address the relevance of The Essentials in

a different cultural context, particularly its application to professional nursing education and

practice within the Eastern cultural and values system. With increasing numbers of nurses

traveling across international borders to practice nursing and to pursue additional education in

our global society, it is imperative to understand the differences in the philosophies, values, and

assumptions underlining baccalaureate nursing education worldwide.

6

Methods

A survey approach was used to obtain the perceptions of Chinese nurse educators

regarding the relevance of 21 key concepts extracted from The Essentials. In keeping with the

intent of The Essentials, this study was limited to baccalaureate nursing programs in China. The

principal author, in consultation with the research team and other experienced nurse researchers,

developed a three-part survey instrument.

The first part of the survey was designed to seek demographic information on the targeted

programs. The second part of the questionnaire was developed to obtain the perceptions of the

respondents regarding the importance, cultural relevance, and extent of exposure of the 21 key

concepts from The Essentials in their present as well as in an ideal nursing curriculum.

Respondents used a six-point Likert-type scale (with “6” as highest and “1” as lowest) for each

of the 21 key concepts extracted from the five domains of baccalaureate nursing education as

outlined in The Essentials. To ensure the accuracy of its intended meanings, each concept was

defined using direct quotations from The Essentials. The third part of the survey was designed to

elicit qualitative data concerning any additional areas that the Chinese nurse educators

considered important for inclusion in a baccalaureate nursing education curriculum. A content

analysis procedure was used to analyze the respondents’ comments.

The instrument was then translated into Chinese by the principal author. Linguistic

accuracy of the instrument was ensured by having it reviewed by two independent Chinese

health sciences scholars (one nurse educator and one medical doctor/educator) with extensive

knowledge of the Chinese healthcare system and teaching experience in nursing. The instrument

was then piloted on a Chinese visiting nurse educator in the United States. Refinement to the

7

instrument was made according to feedback received. Subsequent approval for the study was

obtained from the Institutiona l Review Board (IRB).

Following IRB approval, the surveys were mailed to the chief executive administrators

(i.e. deans or directors/chairs) of all known baccalaureate nursing programs in China (N = 22).

Each survey was completed by the chief executive administrators or by a designated faculty with

the most knowledge of the program’s curriculum. Eleven programs returned their completed

surveys (50% return rate). One of the returned surveys was improperly completed and therefore

was excluded from the study. Data from the remaining 10 valid surveys were then coded and

entered into SPSS 10.0. Descriptive statistical analyses were performed on the demographic and

quantitative data, and content analysis was used to analyze the qualitative data.

Findings

Demographics of the Baccalaureate Nursing Programs

All of the programs (N = 10) were established between 1985 and 1998. Of the 10

programs, nine programs also offered the associate degree in nursing; six had an associate-

bachelor mobility program; and three offered a master’s program. Nine of the programs had a 5-

year curriculum at the time of the survey. Annual admission of students to the freshmen class

ranged from 20 to 105 across all programs, with total enrollments ranging from 90 to 530. Two

of the programs were new and had not graduated any students. The remaining eight programs

reported having graduated from 35 to 277 students each. Full-time faculty ranged from 10 to 52.

Analysis of Quantitative Data

Part two of the survey employed a six-point Likert-type scale to obtain the perceptions of

Chinese nurse educators. Means and ranges are used to display the respondents’ perceptions

regarding the importance of the 21 key concepts from The Essentials in their present curriculum

8

and in an ideal curriculum, the cultural relevance of each concept to their present and ideal

curriculum, and the extent of exposure of each concept in their present and in an ideal

curriculum.

The dimension of “importance.” The means of the 21 key concepts for the dimension of

importance in the present curriculum ranged from 3.40 to 6.00 (Table 1). Concepts receiving the

highest ratings (5.0 and above) were “technical skills” (6.00) “integrity” (5.70),

“communication” (5.50), “illness and disease management” (5.50), “human dignity” (5.40),

“assessment” (5.40), “caring” (5.33), “social justice” (5.20), “ethics” (5.20), “liberal education”

(5.11), and “provider of care” (5.00). In contrast, “autonomy” (3.40), “global health care”

(3.40), “healthcare systems and policy” (3.70), “human diversity” (4.00), and

“designer/manager/coordinator of care” (4.10) were rated the lowest in importance in the present

curricula. For the ideal nursing curriculum, the means for the 21 key concepts ranged from 4.50

to 6.00. Only three of the concepts (“global health care,” 4.50; “healthcare systems and policy,”

4.60; and “human diversity,” 4.70) received mean scores below 5.00 (Table 1).

Mean scores for each concept were used to determine the amount of discrepancy or

difference between the perceptions of the nurse educators regarding the importance of each

concept in their present curriculum and perceptions of the same concept in an ideal curriculum.

As indicated in Table 1, concepts that had the least discrepancies were “technical skills” (0.00),

“ethics” (0.10), “illness and disease management” (0.20), “integrity” (0.30), and “social justice”

(0.30). The largest discrepancies were found for the concepts of “autonomy” (1.70),

“designer/manager/coordinator of care” (1.40), “global health care” (1.30), “critical thinking”

(1.30), and “healthcare systems and policy” (0.90).

9

Insert Table 1. Importance of 21 Key Concepts in Present Curriculum and Ideal Curriculum

The dimension of “cultural relevance.” When the 21 key concepts were rated on the

dimension of cultural relevance in the present curriculum the mean scores ranged from 3.00 to

5.90. Concepts that received the highest mean scores were “technical skills” (5.90), “integrity”

(5.60), “human dignity” (5.30), “illness and disease management” (5.20), “communication”

(5.10), “ethics” (5.10), and “caring” (5.00). In contrast, “autonomy” (3.00), “global health care”

(3.20), “healthcare systems and policy” (3.20), “human diversity” (3.60), and

“designer/manager/coordinator of care” (3.90) were rated as having the least cultural relevance

in the present curriculum (Table 2). In the ideal curriculum, the means for the 21 key concepts

ranged from 4.90 to 5.90. Five concepts scored below 5.00 (“global health care,” 4.40;

“healthcare systems and policy, ” 4.40; “human diversity,” 4.70; “autonomy,” 4.90; and

“information and health care technology,” 4.90) (Table 2).

Concepts with the least discrepancies for cultural relevance between the present

curriculum and the ideal curriculum were “technical skills” (0.00), “member of profession”

(0.10), “integrity” (0.20), “healthcare systems and policy” (0.20), “ethics” (0.20),

“communication” (0.50), and “social justice” (0.50). By contrast, “autonomy” (1.90),

“designer/manager/coordinator of care” (1.50), “critical thinking” (1.20), “global health care”

(1.20), and “healthcare systems and policy” (1.20) presented the largest discrepancies (Table 2).

Insert Table 2. Cultural Relevance of 21 Key Concepts in Present Curriculum and Ideal Curriculum

10

The dimension of “extent of exposure.” When the 21 key concepts were examined for the

dimension of extent of exposure in the present curriculum, mean scores ranged from 3.00 to

5.90. The highest means were for “technical skills” (5.90), “integrity” (5.50), “human dignity”

(5.30), “illness and disease management” (5.20), “communication” (5.10), and “ethics” (5.10).

The lowest scores were for “autonomy” (3.00), “global health care” (3.10), “healthcare systems

and policy” (3.20), “human diversity” (3.40), and “designer/manager/coordinator of care” (3.90)

(Table 3).

When discrepancies were calculated between the means for concept exposure in the

present curriculum and in an ideal curriculum, concepts that presented the least discrepancies

included “technical skills” (0.10), “ethics” (0.20), “integrity” (0.30), “illness and disease

management” (0.30), “human dignity” (0.60), and “social justice” (0.60). Consistent with

findings for the other two dimensions, concepts with the largest discrepancies were: “autonomy”

(1.90), “critical thinking” (1.40), “designer/manager/coordinator of care” (1.40), “human

diversity” (1.40), “member of profession” (1.30), “healthcare systems and policy” (1.30), “liberal

education” (1.22), and “global health care” (1.20) (Table 3).

Insert Table 3. Extent of Exposure of 21 Key Concepts in Present Curriculum and Ideal Curriculum

Discussion. Several observations merged from the data. First, there was a similar data

pattern or trend across the three measured dimensions in the present curriculum, indicating an

internal consistency across the measurements. Second, with the exception of “technical skills”,

the mean scores for concepts in the ideal curriculum were rated consistently higher than in the

present. These findings indicate that Chinese nurse educators were unsatisfied, in various

degrees, with the current status of 20 out of the 21 key concepts from The Essentials in their

11

present curricula. Third, the highest- and lowest-rated concepts and their respective rank orders

remained relatively stable across the three measured dimensions in both the present curriculum

and the ideal curriculum. Concepts that were perceived as most important, most culturally

relevant, and most exposed included “technical skills,” “integrity,” “communication,” “illness

and disease management,” and “human dignity,” indicating that these concepts have the highest

transferability to the Chinese baccalaureate nursing education. In contrast, “autonomy,” “global

health care,” “healthcare systems and policy,” “human diversity,” and

“designer/manager/coordinator of care” were ranked the lowest consistently in the present

curriculum, suggesting the greatest deficits in these areas (Table 4). Last, “autonomy”,

“designer/manager/coordinator of care,” “critical thinking,” “global health care,” “healthcare

systems and policy,” and “human diversity” consistently presented the largest discrepancies

between the present curriculum and the ideal curriculum across the three measured dimensions.

Insert Table 4. Rank Order of Means of 21 Key Concepts by Importance, Cultural Relevance, and Extent of Exposure in Present Curriculum

Analysis of Qualitative Data

Professional values. In addition to the existing concepts in the professional values

domain of The Essentials, the respondents recommended the following concepts as important

professional values to include in a baccalaureate nursing curriculum: “respect for patient

privacy,” “informed consent,” “initiative to help others,” “collectivism and team spirit,” “self

perfection,” and “nurses' rights and obligations.” Two of the suggested professional values (i.e.

“respect for patient privacy” and “informed consent”) were implied by the concepts of “human

dignity” and “autonomy” from The Essentials and mirrored the progress of the Chinese society

12

as a whole toward a genuine concern and respect for the individual. Other added concepts (i.e.

“initiative to help others,” “collectivism and team spirit,” “self perfection,” and “nurses' rights

and obligations”) reflected the preservation of traditional cultural values and the awakening of

the profession’s self-consciousness.

Core competencies. The respondents added the following concepts that further expanded

The Essentials competencies: “innovation and pioneering spirit,” “courage and vision,” “the

capability and perseverance to deal with adversary,” “pedagogical competence,” and

“management skills.” The emphasis on the affective domain of professional socialization from

the respondents might grow out of the concern for the maturity of the Chinese baccalaureate

nursing graduates to provide adequate patient care. Virtually all Chinese students in generic

baccalaureate nursing programs are traditional college females. Each is likely to be an only child

in the family as the result of China’s one-child family planning policy. Brought up in a

prevailingly over-protective family environment, many graduates from the generic baccalaureate

nursing programs have demonstrated deficits in their ability and skills of decision-making,

conflict resolution, collaboration, delegation, and leadership (Chan & Wong, 1999; Xu, Xu, &

Zhang, 2000).

In addition, the suggested additions of “pedagogical competence” and “management

skills” were a response to the dire demand for nursing faculty, the increasing need for patient

education and the administrative skills required of the baccalaureate nurse both in the clinical

setting and academic contexts.

Core knowledge. Additional knowledge areas identified by respondents as important

included “fundamentals of medical knowledge,” “epidemiology,” and “nursing research.” The

recommendation to incorporate “nursing research” into the baccalaureate nursing curriculum

13

signified the recognition that research must assume greater prominence if nursing practice in

China is to advance scientifically. However, the request to build into the curriculum more

“fundamental medical knowledge,” if defined as knowledge of anatomy, pathophysiology, and

other medicine-related courses, is controversial since the present Chinese baccalaureate nursing

education curriculum is perceived predominantly as “physiologically-based and disease-

oriented” (Chan & Wong, 1999). This recommendation is also in conflict with the nation-wide

efforts to build a nursing education model independent of medical education (Shen, 1998, 2000;

Xu, Xu, & Zhang, 2000).

Role development. Only one addition was suggested to the domain of role development:

“Contributes to the development of the profession.” This suggests that the respondent did not

interpret the existing key concept “member of a profession” to be inclusive of role development.

Interpretation and Discussion

Findings from this study suggest that baccalaureate nursing education in China and the

United States share some pedagogical components (universality). This universality derives from

the shared dimensions of the philosophies, beliefs, and values underpinning baccalaureate

nursing education in the two countries. Moreover, the universality stems from the identical or

similar outcomes (i.e. desirable professional values, core competencies, core knowledge, and

roles) required of baccalaureate nursing graduates for professional practice in the two countries.

This study also indicates a diversity dimension of baccalaureate nursing education in

China and the United States. The suggestion of the universality dimension does not diminish, in

any sense, the differences in the two systems that derive from the sociopolitical and cultural

differences between the two countries. The universality does not reduce the importance and

challenge to adapt The Essentials to the Chinese context. The perceived differences and even

14

conflicts were reflected from the low ratings on a number of the 21 key concepts, as well as from

the contrasting values for baccalaureate nursing education revealed through the qualitative

comments by the respondents. These perceived differences and conflicts warrant further

intellectual scrutiny. The following interpretation and explanations intend to be provocative and

explorative rather than conclusive.

Autonomy. While autonomy is one of the core values that have been upheld by the

Western, including American, nursing profession, this value orientation poses a challenge and

conflict to the traditional Chinese cultural values. In the West, particularly in the United States,

autonomy is deeply rooted in the belief in individualism that values and promotes self- reliance

and self-determination. In a sharp contrast, collectivism is the predominant and preferred value

in the Chinese society; in other words, collectivity, rather than individuality, is the common

denominator in most Chinese contexts. Family as a unit making treatment decisions for its sick

members, the expectation of the individual to sacrifice self interest for the good the family, and

promotion of team spirits are just but a few manifestations. There is, however, growing empirical

evidence that the Chinese nursing profession is gradually accepting, to some degree, the Western

value of autonomy as evidenced by giving patient treatment options.

A number of scholars (Davis, 2000; Doutrich, 2001; Hisama, 2001; Minami, 1985; Shin,

2001) documented and examined conflicts between Western and Eastern cultural values in

nursing. Davis (2000) demonstrated in her case study of Japan that some of the endearing

American values in nursing such as autonomy were on a direct collision course with the

dominant Japanese cultural values that cherish group cohesion over individuality as embodied in

“we” coming before “me.” Even the Japanese word for self (jibun) literally means a part of the

15

larger whole that consists of groups and relationships and interdependency. “There is no man

without another man according to the Japanese concept” (Minami, 1985).

Logically, this values orientation is also extended into the medical and nursing practice in

Japan. For example, terminally- ill patients are not always informed of their diagnosis and

prognosis. Usually, the physician informs the family members who then decide whether or not to

tell the patient (Davis, 2000). Families may decide to withhold information from the patient

because they believe that to reveal “the truth” would unduly burden the patient and hasten a poor

outcome. It is the family as a unit that most often makes all treatment decisions for its ill

member. On the other hand, the individual patient expects to be protected and supported by

family decisions.

Another example of this collectivistic orientation in Japan was a recent legislative ruling

that the family could override an individual’s pre-made decision to donate their organs. The idea

that one family member has individual rights that are independent of the family is an unaccepted

notion in Japan (Davis, 2000). The idealized Western professional nursing value of autonomy, as

evidenced in the promotion of independence and the ethical/legal concept of informed consent

and advanced directive, is incongruent with dominant Japanese cultural values (Davis, 2000;

Doutrich, 2001). Consequently, ethical conflicts were created in value orientations for those

Japanese nurses whose professional socialization was heavily influenced by the Western nursing

paradigm, but whose private lives were rooted in the traditiona l Japanese culture (Minami,

1985).

Doutrich (2001) also documented dissonance and confusion of sampled Japanese nurse

scholars in U.S. graduate programs when they were asked to adopt American views of nursing.

The incongruence included, but not limited to, role and power, patient expectations,

16

conceptualization of aspects of nursing, and caring practices. The study also recorded difficulty

of one nurse scholar’s re-adjustment to Japanese nursing practice upon her return after practicing

many years in the United States.

Human diversity. Human diversity is another cardinal value promoted by the American

nursing profession and has evolved from the basic premises upon which this country was

founded. The United States is a melting pot for immigrants from all over the world. According to

the census projection, racial and ethnic minorities combined will become the majority in the

population by 2050, hence the birth of the new notion “the emerging majority.” A mosaic

multitude of cultural, religious, and lifestyles characterize American society. In stark contrast,

many Asian countries are largely homogeneous. In China, for example, more than 99% of the

population belongs to the Han nationality (Lin & Li, 2000). The variety of religious faith and

beliefs is also considerably fewer than in the United States since the country claims officially to

be an atheist nation. Variations of lifestyles such as different sexual orientations are perceived

predominantly as socially deviant, and thus still largely confined behind closed doors.

Health care system and policy. Political consciousness and involvement are highly

advocated by American nursing leaders and are a core value for the profession as a method of

establishing an independent professional identity and political clout. As the largest group of

health professionals in the United States, nurses are encouraged by professional organizations to

make their voices heard and to become politically astute. China also has a national nursing

organization - the Chinese Nursing Association (CNA). However, CNA is a semi-political

bureaucracy rather than an autonomous professional organization in the Western sense because

its entire budget comes from government appropriations. Moreover, CNA functions under the

direct leadership of the Chinese Communist Party. Consequently, independent thinking and

17

involvement in policy-making are not encouraged. This sociopolitical context underscores the

reason why policy making and political involvement were not emphasized in the curriculum.

Global health care. Globalization has been one of the driving forces not only for

international economic activities, but also for the nursing profession internationally, including

nursing education. With modern means of transportation, the global community is becoming

increasingly intertwined. National public health issues can no longer be confined within national

borders. Moreover, as a consequence of the technology advancement in the age of the Internet,

telemedicine, and distance learning, nation states are becoming increasingly interdependent. In

many developing countries such as China, integration into the global community has not

achieved the desired level due, in part, to limited domestic resources and unequal international

power relationships. However, China joined the World Trade Organization in 2001. Building

upon this and other major inroads made within the past two decades, China will quickly become

more globally integrated. It is predicated that more content on global health care will be

incorporated into the baccalaureate nursing education curriculum in the future.

Designer/manager/coordinator of care. The responsibility for the professional nurse to

assume responsibility and accountability for the design, management, and coordination of care

received only minimal emphasis in the Chinese baccalaureate nursing curriculum. This may be

attributed to the lack of independent professional identity of nursing in the country. Medicine has

assumed this responsibility and nurses tend to function in the traditional handmaiden role as

evidenced in the popular metaphor: “A doctor’s mouth directs a nurse’s legs.” As a

“handmaiden” critical thinking skills are devalued and therefore have not been an important

consideration within the existing baccalaureate nursing curriculum. Clearly, the data from this

study supports that these concepts are of increasing importance to the Chinese nurse educators.

18

Implications and Conclusions

This study examined the relevance of The Essentials as a guide for the development of

baccalaureate nursing curriculum in the People’s Republic of China. Findings from the study

revealed that universality and diversity co-existed in the baccalaureate nursing education

curricula in China and in the United States. While the universality dimension recognized the

shared concepts underpinning both systems, the diversity dimension alerted international nurse

educators to the potential pitfalls of transplanting The Essentials without first assessing its

cultural relevancy. Therefore, values clarification, discrimination, and adaptation to home

cultures are imperative if The Essentials is to be applied to a new cultural context.

Further, this study suggested the feasibility of adopting The Essentials as a plausible

launching board to conceptualize a baccalaureate nursing education curriculum model that has

global relevance. It is hypothesized that this proposed model will consists of two components.

One component, which encompasses most concepts from all five domains in The Essentials, can

be readily transferred across cultures (universality). The second component, which is likely to be

made up of a number of concepts primarily from the domains of professional values, core

knowledge, and role development that deal with the ethical, cultural, and sociopolitical

dimensions of nursing, is culture-specific (diversity) and, therefore, requires adaptation in

varying degrees. Further, a few concepts might defy transferability to a particular culture

completely.

Nursing education and professional nursing practice are never value free. On the

contrary, both are deeply embedded, either explicitly or implicitly, in the cultural values and

norms of a given group. Self-awareness, caution, sensitivity, and in-depth studies of the host

culture must be undertaken to prevent ignorance, imposition, and ethnocentrism if cross-cultural

19

transplantation of The Essentials is attempted in a non-Western setting, because the document is

rooted in the Western, American in particular, values, norms, and assumptions. Such cognizance

is vital to international nursing organizations and nurse educators/scholars involved in education,

research, and consulting in international and transcultural nursing.

In a recent article, Ludwick & Silva (2000) discussed the challenges of cultural values

and ethical conflicts in the context of globalization, and cautioned “North Americans and others

with Western ethical perspectives” against unwitting cultural imposition through export of

textbooks, curricula, and used products, even though these academic and humanitarian activities

were well intentioned. Such advice is well warranted since about 70% of the world cultures are

collectivistic rather than individualistic (Davis, 2000).

Meanwhile, American nurse educators involved in training international students need to

become aware that international students may find what they have learned in the United States

may be incongruent with their traditional cultures and professional values. Consequently, these

Western-educated nurses may have to go through the re-socialization process after returning to

their home countries. Such awareness and specific strategies to address this issue are not only an

educational challenge, but also an ethical and moral imperative.

The global influence of American nursing is mounting (Davis, 2000; Lash, Lust, &

Nelson, 2000; Ludwick & Silva, 2000). As long as the United States is perceived as the country

with the most progressive nursing profession, including nursing education, many countries will

continue to turn to the United States for insights, suggestions, and cultural borrowings. In order

to build a baccalaureate nursing education curriculum model that is of global relevance, it is the

shared challenge and responsibility for both American and international nurse educators/scholars

to conduct more transcultural and comparative studies to (a) test the validity and reliability of

20

The Essentials and (b) to substantiate the universality as well as the diversity of baccalaureate

nursing education around the world.

Limitations of Study

Small sample size is one limitation imposed upon the study. This limitation was also

directly related to the fact that there was a limited number of known Chinese baccalaureate

nursing programs in existence at the time of the study (N= 22). Consequently, more rigorous

statistical analysis on the returned data was not an option.

Another limitation might have derived from the different definitions of “patient”. AACN

(1998) defines patient as “recipient of nursing care or services” and patients “may be individua ls,

families, groups, or communities” (p. 2). Possible unawareness of this difference might have

affected the responses from the Chinese nurse educators.

21

References

American Association of Colleges of Nursing. (1998). The essentials of baccalaureate education

for professional nursing practice. Washington, D.C.: Author.

Chan, S., & Wong, F. (1999). Development of basic nursing education in China and Hong Kong.

Journal of Advanced Nursing, 29, 1300-1307.

Chang, W. Y. (1999). Interview with visiting health administrators from the Ministry of Health,

Beijing, China. Image: Journal of Nursing Scholarship, 31, 185-187.

Davis, A. J. (2000). Global influence of American nursing: Some ethical issues. Nursing Ethics:

An International Journal for Health Care Professionals, 6, 118-125.

Doutrich, D. (2001). Experiences of Japanese nurse scholars: Insights for U.S. faculty. Journal of

Nursing Education, 40, 210-216.

Elfrink, V., & Lutz, E. M. (1991). American Association of Colleges of Nursing essential values:

National study of faculty perceptions, practices, and plans. Journal of Professional

Nursing, 7, 239-245.

Henley, J. E., & Anema, M. G. (1989). Curriculum assessment using The Essentials of College

and University Education for Professional Nursing. Nurse Educator, 14, 18-20.

Hisama, K. K. (2001). The acceptance of nursing theory in Japan: A cultural perspective.

Nursing Science Quarterly, 14, 255-259.

Johnson, B. M. (1987). Essentials of college and university education for professional nur sing.

Journal of Professional Nursing, 3, 207-213.

Lash, A. A., Lust, B., & Nelson, M. A. (2000). American nursing scholars abroad, 1985-1995.

Journal of Nursing Scholarship, 32, 415-420.

Li, S. Z.. (2001). Today’s nursing education in the People’s Republic of China. Journal of

22

Nursing Education, 40, 217-221.

Lin, L. Q., & Li, M. (Eds.). (2000). China: Facts & figures 2000. Beijing, China: New Star

Publishers.

Ludwick, R., & Silva, M. C. (2000, August 14). Nursing around the world: Cultural values and

ethical conflicts. Online Journal of Issues in Nursing. Retrieved October 6, 2001, from

http://www.nursingworld.org/ojin/ethicol/ethics_4.htm

Minami, H. (1985). East meets West: Some ethical considerations. International Journal of

Nursing Studies, 22, 311-318.

Shen, N. (1998). Facing 21st century: exploring a new model of educating baccalaureate nurses.

China Higher Medical Education, 4, 10-12. (in Chinese)

Shen, N. (2000). A holistic approach to a new model of baccalaureate nursing. China Higher

Medical Education, 2, 32-33. (in Chinese)

Shin, K. R. (2001). Developing perspectives on Korean nursing theory: The influences of

Taoism. Nursing Science Quarterly, 14, 346-353.

Xu, Y., Xu, Z., & Zhang, J. (2000). Nursing education system in the People’s Republic of China:

Evolution, structure, and reform. International Nursing Review, 47, 207-217.

23

Table 1

Importance of 21 Key Concepts in Present Curriculum and Ideal Curriculum

Present Curriculum (M)

Ideal Curriculum (M)

Difference

Technical Skills 6.00 6.00 0.00

Integrity 5.70 6.00 0.30

Communication 5.50 6.00 0.50

Illness and Disease Management 5.50 5.70 0.20

Human Dignity 5.40 5.90 0.50

Assessment 5.40 5.90 0.50

Caring 5.33 5.89 0.56

Social Justice 5.20 5.50 0.30

Ethics 5.20 5.30 0.10

Liberal Education 5.11 5.67 0.56

Provider of Care 5.00 5.50 0.50

Information and Health Care Technology 4.90 5.20 0.30

Critical Thinking 4.80 5.90 1.10

Member of Profession 4.80 5.70 0.90

Altruism 4.70 5.50 0.80

Health Promotion, Risk Reduction, & Disease Prevention

4.70 5.40 0.70

Designer/Manager/Coordinator of Care 4.10 5.50 1.40

Human Diversity 4.00 4.70 0.70

Healthcare Systems and Policy 3.70 4.60 0.90

Autonomy 3.40 5.10 1.70

Global Health Care 3.40 4.50 1.10

Means are based on a scale of 1.00 to 6.00, with 6.00 as the most important.

24

Table 2

Cultural Relevance of 21 Key Concepts in Present Curriculum and Ideal Curriculum



Difference


Integrity 5.60 5.80 0.20




Ethics 5.10 5.30 0.20

Caring 5.00 5.78 0.78









4.50 5.30 0.80

Altruism 4.30 5.20 0.90





Autonomy 3.00 4.90 1.90

Means are based on a scale of 1.00 to 6.00, with 6.00 as the most relevant culturally.

25

Table 3

Extent of Exposure of 21 Key Concepts in Present Curriculum and Ideal Curriculum



Difference


Integrity 5.50 5.80 0.30




Ethics 5.10 5.30 0.20



Caring 4.67 5.67 1.00




4.50 5.40 0.90




Altruism 4.10 5.10 1.00




Autonomy 3.00 4.90 1.90


Means are based on a scale of 1.00 to 6.00, with 6.00 as having the most extensive exposure.

26

Table 4

Rank Order of Means of 21 Key Concepts in Present Curriculum by Importance, Cultural Relevance, and

Extent of Exposure

Importance of Concept

Cultural Relevance

Extent of Exposure

Technical Skills 1 1 1

Integrity 2 2 2

Human Dignity 4 3 3

Illness and Disease Management 3 4 4

Communication 3 4 5

Ethics 6 5 5

Assessment 4 8 7

Caring 5 6 8

Social Justice 6 8 6

Liberal Education 7 7 11

Provider of Care 8 9 8

Information and Health Care Technology 9 11 12

Critical Thinking 10 10 9

Member of Profession 10 11 10

Altruism 11 12 13

Health Promotion, Risk Reduction, & Disease Prevention 11 11 9

Designer/Manager/Coordinator of Care 12 13 14

Human Diversity 13 14 15

Healthcare Systems and Policy 14 15 17

Autonomy 15 15 17

Global Health Care 15 16 16

27

Documents

Assessment of AACN Baccalaureate Nursing Education …€¦ · · 2015-07-29Additional transcultural and comparative studies are ... liberal education, professional values, core