Abstract

Introduction: Project TEMPUS IV – CCNURCA (Competency Based Curriculum Reform in Nursing and Caring in Western Balkan Universities) is currently under way in the international cooperation, which initiates European standards in order to innovation the content of training in nursing. The main objective of this paper is presentation of transforming education in European countries and supporting the modernization of higher education. It also focuses on the cooperation and modernization of higher education in partner countries in the wider neighborhood.

Methods: Methodology for theoretical education in study program nursing includes working groups were created and questionnaire was implemented a survey in order to fulfill the objectives of the project.

Results: The evaluation of a curriculum and the schedule of a study program of nursing were running in the theoretical level. The activity to support the education of teachers themselves, so-called program TOT (Training of Trainers), where the participating specialists from the ranks of teachers were giving trainings in new techniques within the theoretical and practical training to each other, was deemed inspirational.

Discussion: The new program in nursing was verified in this way and monitored the suitability of students, self-evaluation and teacher satisfaction. Results of the project consortia CCNURCA represent innovative changes for the countries of Western Balkan. Educational institutions, health care institutions and government organizations shall unite their efforts for the sake of reforming the curriculum.

Keywords

Nursing; curriculum; train-the-trainers courses, ECTS credits; knowledge-skills-competences

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Introduction

The transformation of education in the European Union has led to many changes in the modification of teaching, curriculum and the allocation of hours within courses, the introduction of new teaching methods into studies [1].

The project TEMPUS IV - CCNURCA (Competency Based Curriculum Reform in Nursing and Healthcare in Western Balkan Univer­sities, No. 544169-TEMPUS-1-2013-1-BE-TEMPUS-JPCR) was implemented within the framework of international cooperation, the main aim of which was to use methods, and activities to modernize the curriculum in nursing.

The profile of the study program in Slovakia (at the Faculty of Health Care of Presov, University of Presov and other faculties) meets the criteria recommended by the standards of the European Union, the recommendations of the Munich Declaration (2000) and the criteria of the Bologna Declaration (1999). The key competencies for nursing as recommended by the European Union are: communication skills and competences, critical thinking skills and effective problem solving skills, ability to use modern information technologies, ability to adapt to the role of teacher, consultant, lawyer, patient lawyer, and personal and interpersonal skills [2].

The range of time allocation for the nursing study department is total 4,600 hours, where half of it is practical education (2,300 hours). The student's workload is the ratio between contact and non-contact hours in accordance with the EU directives [3]. Reforming the curriculum for adapting, upgrading and restructuring existing curricula focuses on developing, testing, creating / accrediting new curricula, and disseminating results. The curriculum reform will also focus on the content, structure, teaching methods and use of new learning materials in the context of the program, and the modernization of European higher education (Europe 2020 Strategy, Strategic Framework for European Cooperation in Education and Training (ET 2020) and Bologna Process).

The aim of the transformation of education is to develop and introduce study programs and recognition agreements between higher education institutions in the European Union and in partner countries. The newly opened courses must be structured according to the three-cycle system and must use the European Credit Transfer System (ECTS) and mechanisms for recognizing different levels of education.

Methods

The aim of transforming education in European countries is to support the modernization of higher education. It also focuses on the cooperation and modernization of higher education in partner countries in the wider neighborhood. In particular, the program supports voluntary convergence with developments in higher education in the European Union, stemming from the Europe 2020 strategy, the Strategic framework for European Cooperation in education and training and the Bologna process.

This paper deals with TEMPUS IV – CCNURCA, the specific aim of which was to implement current European requirements in nursing education and to analyze curriculum at nursing institutions in the countries of the Western Balkans (WB). Another objective of the project was to propose a framework for nursing education that would be in according with the Bologna Declaration and European standards that would include ECTS credits in the curriculum of the nursing study program.

The implementation of the pilot phase of the new curriculum in accordance with good educational standards, the introduction of new methods in nursing education and the attempt to outline proposals for new legislation corresponding to changes in nursing education programs within the trans-European network is essential.   

The aim of the project is to ensure successful evaluation and accreditation of the new study program of nursing and the subsequent changes in legislative standards of the countries involved in the project [4]. Strengthening networking between higher education institutions and research institutions in partner countries and European Member States is also essential.

As part of the planned activities of the international project TEMPUS IV – CCNURCA, consortiums were conducted on the territory of participating countries, during which seminars, workshops, and working meetings were held.

Working groups, whose task was to jointly develop modifications to the content of the curriculum in accordance with the partner countries, were created in the initiation phase of the project. In the next phase of the project, questionnaires focusing on research itself, teaching and teaching methods were distributed in order to fulfil the objectives of the project. Training courses for teachers were being carried out in order to innovate the technical education in the study program of nursing.

The leader of the project is educational institution Odisee in Belgium (older name is HUB-KAHO) and co-operative in­stitutions are Department of Nursing, Faculty of Health Care University of Presov in Presov (Slovak Republic) and other 15 participating partners from Albania, Bosnia and Herzegovina, Switzerland, Nether­lands, Serbia and Montenegro [5].

Results

The outcome of the solution for the studied issues in nursing education in the WB countries was the international profile of the nurses training within selected European countries (see Table 1) [6].

Table 1. Higher education of nursing in selected European countries [4]/em>

Country	1st degree of nursing study					2nd degree of nursing study
	Sector		Length of study in years	Qual	General/specialist	Title	Length of study  in years
Belgium	HE	SN in UC sector	3	Degree	General	Diploma	3
Denmark	HE	SN in UC sector	3.5	Degree	General
Finland	HE	Polytechnics	3.5	Degree	General	Practical	3
France	FE	SN	3	Diploma	General
Germany	FE	SN	3	Diploma	DE	Nurse assistant	1
Ireland	HE	University	4	Degree	DE
Italy	HE	University	3	Degree	General (some DE)
Netherlands	HE	SN	4	Degree	General	MBOV	4
Norway	HE	University/UC	3	Degree	General
Spain	HE	University	3	Degree	General
Sweden	HE	University	3	Diploma	General	Licensed	3
Switzerland	Voc HE	SN University	3	Diploma	General
UK	HE	University	3	Diploma and degree	Branch

HE: higher education; SN: school of nursing; UC: university college; DE: direct entry; FE: further education; Voc: vocational.

From the data collected, it is evident that five of the thirteen EU countries (Belgium, Finland, Germany, Netherlands and Sweden) provide two-degree nursing education. United Kingdom among other countries of the European Union is characterized by the fact that the education of nurses moved to the university degree. France, Germany and Switzerland offer the training of nurses in nursing schools and in France, a campaign for nurses is running in order to transfer the nursing education to a higher education [7,8].

Nursing education in the WB countries is in the transition period: implementation of new methods, development of new methods based on existing competences, creation of joint programs with other institutions. There are differences in the basic training of nurses (bachelor studies). Impact on nursing education is represented the establishment of private universities offering education programs in nursing with a different standard than the public universities. This creates a room for improvement in theoretical and practical fields. The current study programs are oriented towards biomedical way and not holistically. Most systems do not cover the required allocation - 4600 hours of education (including half of them in the clinical conditions). Methods for theoretical and practical training required innovation [9].

Despite these deficiencies, there are also positive trends in nursing education, such as the ongoing reforms in the context of European criteria for the higher education, implementation of new strategies and cooperation with the concerned organizations, cooperation within individual faculties, investments in the material equipment of educational institutions, and, finally, national projects in the interest of the innovation of nursing education. CCNURCA project represents a dominant basis for resolving these issues [5].

Inspired by the knowledge and insights gathered during the former meetings and supported by the strategic document on competences, goals and outcomes for new nursing curriculum on the WB universities, each WB partner sent a proposal with the competences to their mentoring European partners. Following core competences were identified and agreed upon: Management of patients health; Quality of care; Management competences; Educational and legal issues; Ethics; Research; Administration of documentation; Communication skills; Teamwork competences. In general it can be stated that the curriculum reform for the WB needs to focus on: practical skills; communication skills, nursing concepts (e.g. nursing diagnoses), problem based critical thinking, integrated learning (integration of theory and practice) and Evidence Based Practice [10].

The staff of the WB partners involved in the training have active roles in teaching in nursing education and are closely involved in the modification of the existing curriculum. There was presence of hierarchical officers to ensure and support dissemination of the experience gained at department and faculty level upon their return. The evaluation of a curriculum and the schedule of a study program of nursing were running in the theoretical level. The activity to support the education of teachers themselves, so-called program TOT (Training of Trainers), where the participating specialists from the ranks of teachers were giving trainings in new techniques within the theoretical and practical training to each other, was deemed inspirational [4].

Questionnaires (Figure 1) evaluated mittings and workshops they were implemented in partner countries and focused on:

• progress of project in general,
• program Training of Trainers,
• relevance of the project contents for your own work,
• organization the overall project management,
• feedback in general and recommendations.

Demonstrations, discussions and mutual exchange of knowledge were highly appreciated by all participating partners.

Trainings and training sessions focused on the content of the practical training in nursing among the partners of the EU and WB were held, likewise, the very management of capabilities and skills within the practical training, its organization and the possibilities of e-learning in the education of students. It was necessary to monitor the feedback of a practical training and training evaluation in the clinical environment. The evaluation of a curriculum and the schedule of a study program of nursing were running in the theoretical level. The activity to support the education of teachers themselves, so-called program TOT (training of trainers), where the participating specialists from the ranks of teachers were giving trainings in new techniques within the theoretical and practical training to each other, was deemed inspirational [4].

During consortium, theoretical methodology of teaching in nursing, the use of traditional and innovative methods, such as: lecture, group instruction strategies: snowball, learning based on problems, role playing methods, simulations, etc., were presented. The evolution of evaluating the capabilities and skills of students in the clinical environment was presented from the historical perspective (a detailed description of the schedule for the study program of nursing) [11].

The comparison of individual study programs in terms of allocated hours, the ratio of theoretical and practical training, qualifications of mentors of the practical training, a description of ECTS credits, defining competencies and learning outcomes, and others, were required. The action plan shall be designed to be able to implement new teaching methods and evaluation procedures in the study program [15].

In the future we will prepare bilateral agreements regarding the placement of students and teachers and participation in joint international projects.

Discussion

The evolution of evaluating the capabilities and skills of students in the clinical environment was presented from the historical perspective (a detailed description of the schedule for the study program of nursing) [11].

Representatives from WB countries formed working groups with the project co-workers from European countries, where each group worked on the creation of the matrix of students´ competences and skills, time allocation for the course, creation of adequate workload for a student and analysis of study program schedule. The comparison of individual study programs in terms of allocated hours, the ratio of theoretical and practical training, qualifications of mentors of the practical training a description of ECTS credits, defining competencies and learning outcomes and others, were required. Studied curriculum proposals, information sheets and study plans were discussed with experts from European countries and then modified according to the recommendations [12].

The meetings of representatives of the countries involved in the project supported the presentation of alternative teaching methods with regard to the learning process. At the same time, thought maps were presented that promote critical thinking, the ability to see problems and improve the patient's capacity for creativity among students. Simulation methods have been presented in order to innovate technical skills [13].

Presented suggestions within the pilot program, such as learning objectives, learning outcomes, theoretical and practical competences, teaching methods, the methodology of evaluation, and ECTS credits (program guide, curriculum handouts), were implemented in the new curriculum and were offered in the study programs of nursing and midwifery in the countries of the Western Balkan.

CCNURCA project leaders recommended to implement a curriculum reform in the education of the health care as a national priority for the three partner countries - Montenegro, Bosnia and Herzegovina and Albania, whereas the main objective of the project is to reform the curriculum in nursing, which is also in line with the Bologna Declaration [14]. The validation of the curriculum as a pilot project and the translation of materials into English and German were carried out. A pilot project aimed at testing new curriculum was planned for the academic year 2015-2016.

The new program in nursing was verified in this way and monitored the suitability of students, self-evaluation and teacher satisfaction. All stakeholders - teachers, coordinators, representatives of ministries worked closely together to implement of the project. In the last phase of the project, the partial results of a questionnaire survey focused on the innovation of the teaching itself were evaluated. The action plan is designed for pedagogical practice to be able to implement new study methods and assessment procedures in the study program [15].

The implementation of learning outcomes at the level of study courses is clearly linked to their definition within the content of information sheets of the particular courses in the study programs. The full content of learning outcomes in the curriculum is primarily based on revised Bloom's taxonomy [16].   

The education of nurses in Slovakia shall be compatible with European criteria, the curriculum shall be oriented to the whole personality of the patient, not just the process of a disease treatment. Basic principles of nursing training in European countries are based on the principles of the European Federation of Associations of Nursing (EFAN), International Council of Nursing (ICN) and the World Health Organization (WHO) (Regulation (EC) No. 1638/2006, Regulation (EC) No. 1905 / 2006) [17,18,19,20].

In the future, the intention of the current cooperation between the countries within the consortium is to prepare bilateral agreements regarding the placement of students and teachers and participation in joint international projects.

Conclusions

The project TEMPUS IV – CCNURCA promotes institutional cooperation and focuses on the reform and modernization of higher education systems in the partner countries. It contributes to an area of cooperation in the field of higher education involving the European Union and partner countries in the surrounding area.

Project is implemented in close coordination with the program Erasmus Mundus which provides scholarships to third country students allowing them to participate in top level master courses and doctorate programs inside the European Union. With regards to the Western Balkans, project TEMPUS contributes to preparing the candidate countries and potential candidates for a participation in the integrated Lifelong Learning Program.

As project TEMPUS IV is designed to support the modernization of higher education systems in the partner countries, its themes are structured around the main policy areas governing the current trends of higher education worldwide. The themes for cooperation are structured in the following three building blocks:

1. Curricular Reform - modernization of curricula in academic disciplines identified as priorities by the partner countries, using the European Credit Transfer System , the three cycle system and the recognition of degrees.
2. Governance Reform - university management and services for students, introduction of quality assurance, institutional and financial autonomy and accountability, equal and transparent access to higher education, development of international relations.

Higher education and society include: training of non-university teachers; development of partnerships with enterprises; knowledge triangle: education-research-innovation;  training courses for public services (ministries, regional/local authorities); development of lifelong learning in society at large and qualifications frameworks [8].

Dissemination of the project tasks results and publication of created and modified teaching materials is scheduled in the specified time period. Establishment of a network among the participating countries of the European Union and WB assumes the planning of modifications in legislative standards [10]. The results and ongoing information are exchanged by the participating countries on various meetings and consortia, which are simultaneously a prerequisite to stimulating proposals and planned changes. The domain of education shall be the evidence-based practice, taking into account the specification of each individual and creating professional nursing standards in nursing.

Results of the project consortia CCNURCA represent innovative changes for the countries of the Western Balkan. Educational institutions, health care institutions and government organizations shall unite their efforts for the sake of reforming the curriculum. European partner countries represent a supervisor role and support participating countries in the innovation of study programs.

Conflict of interest

Neither author has any financial or personal relationship with people or organizations that could inappropriately influence their work.

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References

1. Zabalegui A, Macia L, Márquez J, Ricomá R, Nuin C, Mariscal I, Pedraz A, Germán C, Moncho J. Changes in Nursing Education in the European Union. J Nurs Scholarsh 2006; 38: 114-118.

2. Kuriplachová G, Magurová D, Hloch S, Chattopadhyaya S. Effectiveness of Education in Nursing. Dhanbad: Indian School of Mines in Dhanbad. 2014. p.144. ISBN 978-93-5212-000-0.

3. Charakteristika študijného odboru. Fakulta zdravotníckych odborov Prešovskej univerzity v Prešove. 2015. [On-line] [2018-05-24]. Available at WWW: <http://www.unipo.sk/7456/>.

4. Current Situation in Nursing Education in the EU with Emphasis on Belgium. Analysis of Current Situation in Nursing Education in EU and in the WB Region. 2014. [On-line] [2018-06-21]. Available at WWW: <http://www.ccnurca.eu/node/78>.

5. Competency Based Curriculum Reform in Nursing and Caring in Western Balkan Universities. Newsletter No.1. (September 2014). [On-line] [2018-06-04]. Available at WWW: <http://www.ccnurca.eu/newsletters>.

6. Nolan P, Brimblecombe N. A Survey of the Education of Nurses Working in Mental Health Settings in 12 European countries. Int J Nurs Stud 2007; 44: 407-414.

7. Debout C. The French Healthcare System at a Glance. Presentation to European Academy of Nursing Science Summer School, York. International Council of Nursing. 2007. [On-line] [2018-06-09]. Available at WWW: <http://www.icnapnetwork.org>.

8. Moreno-Casbas T. Nursing Research in Europe. Scoping report. National Board for Health. 2005. [On-line] [2018-04-16]. Available at WWW:  <http://www.fepi.org/docu/countryprofile/Prof_DK_EN.pdf>.

9. Members of the CCNURCA Consortium. Analysis of Current Situation in Nursing Education in EU and in the WB Region. 2014. [On-line] [2018-06-14]. Available at WWW: <http://www.ccnurca.eu/node/78>.

10. Competences, Goals and Outcomes for New Nursing Curricula on WB Universities.  Analysis of Current Situation in Nursing Education in EU and in the WB Region. 2015. [On-line] [2018-05-27].  Available at WWW: <http://www.ccnurca.eu/node/78>.

11. Kuriplachová G, Magurová D, Hudáková A, Andraščíková Š, Rybárová Ľ. New Teaching Methods for Practical Training in Nursing Within the Project Tempus IV – CCNURCA.  Mefanet J 2015; 3(2): 64-68.

12. Consortium Meeting and Seminar in Presov. Project Newsletter No.2. (September 2015). [On-line] [2018-05-16].  Available at WWW: <http://www.ccnurca.eu/newsletters>.

13. Winterton J, Delamare F – Le Deist, Stringfellow E. Typology of knowledge, skills and competences: clarification of the concept and prototype. Luxembourg: Office for Official Publications of the European Communities, 2006. [On-line] [2018-04-06]. Available at WWW: <https://cedefop.europa.eu/files/3048_en.pdf>.

14. Coordination Meeting Preparation of Future Activities. Project Newsletter No.2. (September 2015). [On-line] [2017-05-06]. Available at WWW: <http://www.ccnurca.eu/newsletters>.

15. Oruč M, Bokonjic D, Dumez F, Kaaijk M, Rybárová Ľ, Tandir S, Mujezinovic A, Jovic D. Nursing Education in BiH: Roadmap toward the EU Directive. Sanitas Magisterium 2015, 1(2): 73-82.

16. Atherton JS. Bloom’s taxonomy. Learning and Teaching. [On-line] [2018-06-29]. Available at www: <http://www.learningandteaching.info/learning/bloomtax.htm>.

17. European Directive 2013/55/EU of European Parliament and of the Council of 20 November 2013 Amending Directive 2005/36/EC on the Recognition of Professional Qualifications and Regulation (EU).

18. Council Regulation (EC) No. 1085/2006 of 17 July 2006 Establishing an Instrument for Pre-Accession Assistance (IPA); [On-line] [2018-06-29]. Available at WWW: <https://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2006:210:0082:0093:EN:PDF>.

19. Council Regulation (EC) 2006. No. 1638/2006 of the European Parliament and of the Council Laying Down General Provisions Establishing a European Neighbourhood and Partnership Instrument, 24 October 2006; [On-line] [2018-06-29]. Available at WWW:  <https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX%3A32006R1638&from=EN>.

20. Council Regulation (EC) 2006. No. 1905/2006 of the European Parlament and of the Council Establishing a Financing Instrument for Development Cooperation, 18 December 2006; [On-line] [2018-06-29]. Available at WWW:  <https://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2006:378:0041:0071:EN:PDF>.

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