Birks, Glennis, Lindsay, David, Lichtwark, Sue, and Borthwick, Nick (2017) Curriculum review: Kiribati Institute of Technology Diploma of Nursing. Report. Waikato Institute of Technology, New Zealand.

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Abstract

In Kiribati, as in all PICs, a robust and high-quality nursing workforce constitutes the backbone to the country’s health service. Nurses require broad skills and abilities, as autonomous practitioners serving on the front lines of health provision, and as members of a multi-disciplinary team. Nurse education is provided by the School of Nursing and Health (SONH) at the Kiribati Institute of Technology (KIT), mainly under its core Kiribati Diploma of Nursing program. Midwifery education is also provided by SONH and undertaken by Registered Nurses as an 18 month, postgraduate qualification. The curriculum for the Diploma program currently being taught in Kiribati was imported many years ago from New Zealand, and there is recognition that it needs to be updated and contexualised for unique Kiribati needs. The Government of Kiribati receives assistance from New Zealand to examine the relevance and quality of the Diploma of Nursing curriculum in relation to the specific health challenges, needs, plans, identified gaps and workforce requirements in Kiribati. The vision, health goals and targets for Kiribati’s health service delivery are outlined in the Kiribati Ministry of Health Strategic Plan 2016-2019, the Kiribati Development Plan 2016-2019 (KDP) and the Kiribati 20-Year Vision 2020-36 (KV20). This review fits with the Kiribati strategic objective to address gaps in health service delivery and strengthen the pillars of the health system. It also considers opportunities and pathways for Kiribati nurses under the strategic aim of promoting the employability of Kiribati nursing graduates nationally and providing a standard of training that prepares students to enter the international workforce. Wintec was contracted by New Zealand Ministry of Foreign Affairs and Trade (MFAT) to carry out the review in 2017. Appropriate supporting documents were made available to provide important contextual information on the special character of Kiribati’s situation as a nation, its current health challenges and goals, the healthcare system, the nursing workforce and the current nursing program. During September 2017, a team of three experts from New Zealand and Australia undertook a series of consultative and participatory meetings with relevant people in Kiribati, including from SONH, KIT, Government Ministries, Nursing Council and health sector service providers. A draft report describing their analysis and findings from those meetings was presented to involved stakeholders in Kiribati in November (see Appendix 2 for schedule of meetings), and feedback from those stakeholder meetings has been incorporated into this final version of the report. The reviewers took a holistic approach to the Terms of Reference that went beyond a narrow focus on only the existing Diploma program curriculum to adequately address wider priorities of concern. They identified 28 specific recommendations that are fully detailed in this report; only the most significant findings are outlined in this summary. There is good evidence that the current curriculum prepares graduates with an adequate level of basic nursing skills. However, there are content and teaching and learning process gaps evident, for example in the areas of aged and disability care, critical reflection, legal and ethical reasoning, and evidence informed clinical decision-making. There is evidence of some alignment to the Kiribati Nursing Council (KNC) Competencies for Registered Nursing (RN) Practice within the eleven Clinical Units within the programme. Students currently undertake substantial amounts of clinical placement across a range of clinical settings over the 3 years of the program. These settings include primary health care and community settings, medical, surgical, pediatric and obstetric wards within hospitals, and outer island health centres. Clinical facilitators are used to supervised students and there appear to be links made between student capability across the 3 years and the Standards for nursing practice. Review - KIT Diploma in Nursing Final Report 1 December 2017 4 The KNC has legislative power to set and govern standards of competency for Registered and Enrolled Nurses and to set standards of education for nursing programs and approve education institutions and the nursing curricula they deliver. A necessary and important first step therefore is a review and agreed update of the KNC Competencies for RN Practice. Following on from this a set of education program accreditation standards must be developed, which draw upon relevant available standards for nurse education. These steps need to be undertaken before developing a new curriculum that reflects a contextualized and contemporary graduate profile. Course and subject learning outcomes will be developed throughout the curriculum development process, which would be tightly aligned with a variety of assessment processes to ensure learning outcomes are achieved. A process of external benchmarking of new subjects would enable important feedback to be obtained, and strengthen links with the international and Pacific nurse education communities. The overall aim of the new Diploma curriculum should be to provide a course of study that leads to registration with the KNC and to enable novice nurses to capably function in a broad range of clinical contexts specific to Kiribati needs and priorities. It is important the curriculum incorporates the specific local geographic and demographic elements and reflects the unique i-Kiribati cultural values pertinent to effective local health service delivery. Career extension pathways for specific local health needs, such as midwifery, Public Health and specialized care can be provided as additional local courses, where feasible, or internationally where more appropriate due to budgetary and capability constraints. A stronger focus on Primary Health Care and health promotion is required, which will help address serious concerns over the increasing prevalence of Non-Communicable Diseases (NCDs) such as diabetes, cardiovascular and respiratory deseases. To produce a contemporary, locally appropriate curriculum the development must be owned ‘in country’ and involve all key stakeholders, a process that can be informed and guided by external technical experts and internationally available standards, curricula and resources (such as the WHO global standards for the initial education of professional nurses and midwives). A curriculum review working group with representatives from key stakeholders would lead this process. The international support integrated into this locally owned process would assist program articulation to quality frameworks, such as the Pacific Qualifications Framework (PQF), and ensure any Kiribati Quality or Competency Framework is underpinned by a robust quality assurance system that informs institutional internal quality management systems, accreditation and audits. Doing this will also enhance transfer of credit opportunities to facilitate international opportunities in nursing-related roles elsewhere. This report contains some analysis of nursing workforce trends and potential migrant work opportunities in Fiji, New Zealand and Australia. A refreshed, contemporary curriculum would include maximizing the use of available IT infrastructure to promote blended learning approaches, increase student engagement and improve the student experience. Utilizing practicing RNs as sessional or guest tutors and lecturers would further enhance the relationship between SONH and its clinical partners, provide opportunities for clinicians to share their knowledge and expertise with students, and augment the teaching role of Registered Nurses. The provision by KIT of English language training courses, and re-location of the SONH from its current site to the KIT facility at Betio will realise cost savings through increased usage and consolidation of teaching spaces, administration, IT infrastructure and teaching personnel. Sharing facilities with other KIT programs, developing affordable and sustainable clinical simulation and library facilities and ensuring adequate workforce planning and underpinning support systems are all important processes to consider in association with the Review - KIT Diploma in Nursing Final Report 1 December 2017 5 curriculum review. It is important to note that in 2017, KIT received provisional accreditation from the Educational Quality and Assessment Programme (EQAP) of the Secretariat of the Pacific Community (SPC) and KIT-SONH facility improvement and consolidation will be vital in securing full accreditation with this body. A coordinated approach to achieving these aims is essential, driven by local Kiribati leaders and supported by ongoing technical assistance from donor partners. Improving the quality of health services and the care provided to Kiribati people is at the heart of this review process. The team have listened carefully and sought to accurately capture the voices of the many individuals and groups with whom we have engaged and we trust that this is reflected within this report. We commend this report to you and thank you for the support provided in its development.

Item ID:	55761
Item Type:	Report (Report)
Keywords:	Curriculum review, nursing, Kiribati, MFAT, Pacific health,
Date Deposited:	30 Jul 2021 02:42
FoR Codes:	13 EDUCATION > 1302 Curriculum and Pedagogy > 130209 Medicine, Nursing and Health Curriculum and Pedagogy @ 100%
SEO Codes:	93 EDUCATION AND TRAINING > 9303 Curriculum > 930301 Assessment and Evaluation of Curriculum @ 100%
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