111CHAPTER 6
External Frame Factors
Sarah B. Keating
OBJECTIVES
Upon completion of Chapter 6, the reader will be able to:
1. Consider the major external frame factors to examine when conducting a needs assessment for the development or revision of a curriculum
2. Analyze external frame factors from the Frame Factors Conceptual model for application to a needs assessment for curriculum development and evaluation
3. Examine a case study that illustrates a needs assessment of external frame factors for a curriculum development project
4. Apply the Guidelines for Assessing External Frame Factors in a simulated or real curriculum development situation
OVERVIEW
Most nurse educators work in an established academic setting or in a health care agency that has a program for staff development and client education. Thus, curriculum development activities usually relate to the revision of the educational program based on feedback from staff, clients, students, faculty, administrators, alumni, and consumers of the program’s participants and graduates. It is rather infrequent that new programs are initiated. Whether curriculum development involves a new program or revisions of an existing curriculum, program planners and faculty must evaluate both external and internal frame factors that affect the curriculum, their impact on the current program, and what role they play in forecasting the future.
Chapters 6 and 7 provide detailed information for conducting a needs assessment for the development of a new program and its curriculum or revising an existing curriculum. A needs assessment for curriculum development is defined as the process for collecting and analyzing information that contributes to the decision to initiate a new program or revise an existing one.
The first step in curriculum development for faculty and program planners is to examine the environmental and human systems factors that influence the curriculum. These factors can be organized into two major categories: external and internal frame factors (Johnson, 1977). Chapter 6 discusses external 112frame factors that impact an education program, while Chapter 7 discusses internal frame factors. External frame factors are defined as those factors that influence curriculum development in its environment and outside of the parent institution. Internal frame factors are those factors that influence curriculum development and are within the parent institution and the program itself. Figure 6.1 depicts the external frame factors that surround the curriculum to consider when conducting a needs assessment.
DISCUSSION
DESCRIPTION OF THE COMMUNITY
The first step in developing or revising a curriculum is to provide a description of the community in which the program exists (or will exist). A needs assessment ensures the relevance of the program to a community need and its eventual financial viability. Existing programs often identify the need for revision of their curricula based on recommendations from their consumers or an accreditation report. Whether developing a new program or revising an old one, an examination of the external frame factors is essential to assess their impact on the program and its future needs. The program under development or revision is considered in light of its fit to the community that it serves. For the purposes of curriculum development, community is defined as a place-oriented process of interrelated actions through which members of a local population express a shared sense of identity while engaging in the common concerns of life (Theordori, 2005, pp. 662–663).
113Depending on the nature of the educational program, the community can be as wide as international or as narrow as a small town within a state. Large universities or colleges with research notoriety often attract international scholars, while some state-supported programs attract students who live nearby and intend to spend their professional lives in their home community. Sectarian (associated with or supported by a religious organization) or nonsectarian (not associated with a religious organization) independent (private) colleges or universities, large or small, face the same challenges when assessing their external environment for curriculum development purposes. Therefore, it is important to identify the community in which the program is situated as urban, suburban, or rural. The location of the community influences factors such as accessibility to students, faculty, learning resources, and financial support.
The major industries and education systems in the community are identified as possible sources for students in the program and for potential partnerships for program support, scholarship, and learning experiences. Industry has resources for scholarship, and financial aid programs and experts in the field who can serve as faculty or adjunct faculty. Health care industries in particular should be participants in the needs assessment and curriculum planning to bring the reality of the practice setting and the community’s health care needs into planning. The major religious affiliations, political parties, and systems such as transportation, communications, government, community services, and utilities in the community are additional external frame factors. These factors have an effect on the curriculum as to its relevance to the community and the support it needs to meet its goal. For example, state-supported schools are very dependent upon government funding, while private schools must rely on tuition and endowments.
There are many models in the literature that discuss the major components of a community assessment. Two recent articles discussing the assessment process are Lohmann and Schoelkopf (2009), who discuss the application of a Geographic Information System (GIS) for a community assessment, and Walker, Bezyak, Gilbert, and Trice (2011), who describe the use of a community assessment to develop partnerships to improve the health of the people. The latter article provides examples for collecting and analyzing data.
DEMOGRAPHICS OF THE POPULATION
When considering a new program or revising a curriculum, it is useful to have knowledge of the people who live in the home community of the institution and the broader populace that it will serve. Demographics are the data that describe the 114characteristics of a population, for example, age, gender, socioeconomic status, ethnicity, education levels, and so forth. The demographic information that is vital to program planners includes the age ranges and preponderance of age groups in the population, predicted population changes including immigrant and emigrant statistics, ethnic and cultural groups including major languages, education levels, and socioeconomic groups. This information identifies potential students and their characteristics and to some extent, the needs of the population that the students and graduates will serve.
Educational programs and curricula must be geared toward the needs of the learners. If the student body comes from the region surrounding the institution, the characteristics of the students should be analyzed for special learning needs. For example, if there are nurses seeking to advance their careers, the curriculum needs to focus on adult learning theories and modalities. Younger students about to embark on their first professional degree will need curricula that focus on their developmental needs as young adults as well as the content necessary for gaining nursing knowledge, clinical skills, and socialization into the professional role. Program planners should learn from students coming to the institution from great distances what drew them to the program and if those factors are useful for program planning and recruitment. Faculty should identify potential students with needs for learning resources beyond the usual; for example, a need for tutoring for students whose primary language is not English. It is useful to learn about the financial resources of the potential student body and if there is a need for major financial aid programs. Ethnicity and cultural values in the community and their beliefs about higher education have an impact on recruitment strategies and are especially important in light of the need for increasing the diversity of the nursing workforce.
Another consideration related to demographics is the existence of potential faculty and identification of people who have the credentials to teach. Identifying potential faculty through partnerships with industry and the community is helpful if the program needs to recruit new faculty or seek adjunct faculty and preceptors for clinical experiences. Resources for finding demographic information are plentiful. The U.S. Census Bureau (2013) has national and regional statistical and demographic information that is helpful for assessing the population. Its website is www.census.gov/2010census.
CHARACTERISTICS OF THE ACADEMIC SETTING
Other institutions of higher learning in the nearby community or region have an influence on the program and its curriculum. Identifying other institutions, their levels of higher education (technical schools, associate degree and/or baccalaureate and higher degree), financial base (private or public), and affiliations (sectarian or nonsectarian) gives the assessors an idea of the existing competition for recruiting students, faculty, and staff. Information about the types of programs in nursing that are available from other institutions and their intentions for the future enables developers to understand the gaps in the types of 115programs and the nature of the competition from other educational programs. For example, if the institution’s curriculum offers a nurse practitioner program and two other programs in the region offer similar programs, perhaps the curriculum should be revised to a specialty primary care program such as a pediatric nurse practitioner or geriatric nurse practitioner track, discontinued, or possibly, entered into a joint venture with the other schools. A private institution that is dependent upon tuition and endowments may question whether it should continue to offer a curriculum that is redundant with a state-supported school. Other data to consider are the need for nurses in the area and its surrounds and even though there are multiple programs, the success rates of graduates finding employment in the region.
Benchmarks that the faculty can use to compare its own curriculum against those of its competitors should be identified; for example, the pass rate on the NCLEX-RN®. Other examples include costs of the program, admission, and retention rates, accreditation status, graduate employment rates, reputation in the community, and so forth. It is important to know how the nearby community agencies and health care systems view and hire the graduates of the program. Yet another important factor is the productivity of the faculty members and how their educational credentials, track records in securing grants, publication histories, and research records compare to others.
Suggested resources for collecting data on other academic institutions include the seven regional accrediting associations in the United States. They are:
1. Middle States Association of Colleges and Schools
2. New England Association of Schools and Colleges
3. North Central Association of Colleges and Schools
4. Northwest Commission on Colleges and Universities
5. Southern Association of Colleges and Schools
6. Western Association of Schools and Colleges Accrediting Commission for Community and Junior Colleges
7. Western Association of Schools and Colleges Accrediting Commission for Senior Colleges and Universities
Addresses and contact information for these associations are found in the resources list at the end of the chapter. The accrediting agencies have directories of all of the schools in their regions. The umbrella organization that lists the agencies may be found at the Council for Higher Education Accreditation (CHEA) (2014) website (www.chea.org). National databases may be found at the National Center for Education Statistics (2014) website (http://nces.ed.gov).
Another source for identifying other nursing programs in the region is the list of approved programs provided by the State Board of Nursing. A listing of the state boards and their websites and contact information may be found at the National Council of State Boards of Nursing (2014) (www.ncsbn.org/index.htm).
Once the list of other academic institutions is developed, faculty can find descriptions for each school on their individual websites or in the library. Libraries 116or admission departments in most institutions of higher learning have current copies of other college and university catalogs; however it is more common and easy to find these descriptions at the institutions’ websites.
POLITICAL CLIMATE AND BODY POLITIC
When assessing the community, part of the data describes the public governing structure. For example, if it is urban, it is useful to know if there is a mayor, a chief executive, and a city governing board. Likewise, if it is rural or suburban, vital information to have includes the type of county or subdivision government, who the chief executive is, if the officials are elected or appointed, and what the major political party is.
Equally, if not more, important is information about the body politic. A simple definition for the body politic is the people power(s) behind the official government within a community. It is composed of the major political forces and the people who exert influence within the community. The assessors should identify the major players, and their visibility; that is, high profiles or low profiles as the powers behind the scenes. Additional information that reveals the body politic is how those in power influence decisions in the community and how they exert their power by using financial, personal, political, appointed, or elected positions. Specific information that is useful to educators is how the key politicians view the college or university and during elections and other crucial times, if they recognize the power of its people; that is, students, faculty, and staff.
Relative to nursing, the politicians’ and the body politic’s specific interests in the profession are helpful. For example, if they have family members who are nurses or they have been recipients of nursing care, they are more apt to support nursing education programs. All educational programs need the support of the community and its power structure. Therefore, the information learned from assessing the political climate is vital to planning for the future and seeking assistance when the call comes for additional resources or for political pressure and support to maintain, revise, or increase the program.
THE HEALTH CARE SYSTEM AND HEALTH NEEDS OF THE POPULACE
Providing nurses to care for the health care needs of the populace is of critical interest to the health care system and the consumers of care. It is obvious that information about these two factors is essential to education program planning and curriculum development. Schools of nursing expect that the majority of their graduates will remain in the region. However, nursing is a mobile profession and its members often move to other geographic locations far from their alma maters.
To assess the health care system, it is necessary to identify the major health care providers, types of organizations, and financial bases for the delivery of health care. With the implementation of the Affordable Care Act (ACA), changes in the health care delivery system are occurring rapidly. Thus, it is unwise to discuss at length the U.S. health care delivery system. An overview of the Act is available at www.hhs.gov/healthcare/rights/index.html through the U.S. Department of Health 117and Human Services (2013). To illustrate the complexity of the impact that the ACA has on the system, Takach (2012) reports that about half of the states in the United States are implementing Patient-Centered Medical Homes for their Medicaid populations. These medical homes integrate primary care, chronic disease, and/or long-term health care as well as behavioral health services. Each participant state or locality responds in different ways to the changes in health care, thus contributing to the confusion about the impact of the changes generated by the ACA on the current system.
A list of major health care organizations and their websites is provided for the readers’ convenience in searching for the latest information regarding health care reform. The following is a list of major resources that provide information when conducting an assessment of the health care system for the locality or region that the educational program serves.
• Major health care systems such as Medicare, Medicaid, CHAMPUS, Veterans Affairs (VA), and so on
Nonprofit or for-profit health care agencies and eligibility for services
• Sectarian and nonsectarian health-related agencies and eligibility for services
City, county, and state public health services
• Services for the underserved or unserved population groups
Major primary health care agencies and providers
Voluntary health care agencies and their services
• Other community-based health related services staffed by nurses, for example schools, industry, state institutions, forensic facilities, and so on
Information about regional health care systems is available through the following websites, which contain lists of national, regional, and state health care agencies:
• American Health Care Association (2014): www.ahca.org
• American Hospital Association (2014): www.aha.org
• American Public Health Association (2014): www.apha.org
• National Association for Home Care & Hospice (2014): www.nahc.org
Last but not least, the yellow pages of telephone directories or on the web have listings of regional and local health care agencies and facilities.
The assembled list provides an overview of the health care system within which the program is located. It describes the health care resources that are available or not available to the population including the nursing school and institution’s populations. It points out the gaps of services in the community and the possibilities for community partnerships including school-based services for the underserved and unserved populations. It identifies trends in health care services and anticipated changes for the future that can influence curriculum development.
It is useful to know if resources within the system, such as health care libraries, are available to students and faculty during clinical experiences or as resources for students enrolled in distance education programs. A review of the 118list pinpoints existing clinical experience sites and the potential for new ones. Staff of agency personnel department with qualifications as preceptors, mentors, and adjunct faculty are additional resources for possible collaboration opportunities. Scholarship and research opportunities for students and faculty may emerge from the review and can influence curriculum development as well as foster faculty and student development.
An overview of the major health problems in the region contributes to curriculum development as exemplars for health care interventions. The National Center for Health Statistics (2014) website (www.cdc.gov/nchs) provides general information on leading causes of death and morbidity. Vital statistics, health statistics, and objectives for 2020 are located at the Healthy People 2020 (2014) site (www.people.gov/hp2020/comments/default.asp).
THE NEED FOR THE PROGRAM
An examination of the external environment informs the faculty about the increased or continued need for nurses. The following data points act as guides to document the need for the program.
• Characteristics of the nursing workforce and the extent of a nursing shortage, if it exists
Predictions for future nursing workforce needs
• Adequate numbers of eligible applicants to the program, currently and in the future
Specific areas of nursing practice experiencing a shortage
• Employers’ projections for the numbers of nurses needed in the future
Employers’ views on the types of graduates needed
A brief survey of health care administrators can provide this information, although it is sometimes difficult to expect a good return rate owing to the current pressures on administrators. Another strategy is to conduct focus groups that take no more than 15 minutes in the health agencies. Instructors who use the facilities for students or clinical coordinators are excellent people for collecting the information. There are several resources to identify the national and regional need for nurses. They are the state nurses’ associations that can be located through the American Nurses Association (ANA; 2014) (www.nursingworld.org/Functional-MenuCategories/AboutANA/WhoWeAre/CMA.aspx) and the U.S. Department of Health and Human Services (2014) Health Resources and Services Administration (HRSA) Health Professions (http://bhpr.hrsa.gov).
As described previously in the characteristics of the academic setting, knowledge of other nursing programs in the region is useful to avoid curriculum redundancies. The data on the need for the program demonstrate how many of its graduates are currently needed and in the future, the level of education necessary to provide the level of care required, and short- and long-term health care system needs. A current nursing workforce demand indicates the possibility for accelerated programs. Shortages in specialties indicate advanced practice curricula and increased opportunities for registered nurses to continue their education.
119THE NURSING PROFESSION
In addition to the need for nurses, it is important to learn about the nursing profession in the region. Professional organizations are rich resources for identifying leaders, mentors, and financial support such as scholarship aid. Curriculum developers should survey faculty and colleagues for a list of the nursing professions in the region. Such organizations include local or regional affiliates of the ANA; the National League for Nursing (NLN); Sigma Theta Tau International; educator organizations such as the American Association of Colleges of Nursing (AACN) and the National Organization of Associate Degree Nursing (NOADN); and the plethora of specialty organizations. Questions to gather information about the profession are: Who are the nurses in the area? Are there professional organizations with which the program can link? What is the level of education for the majority of the nurses in practice? Are there nurses prepared with advanced degrees who could serve as educators or preceptors? Are scholarship and research activities in nursing and health care underway that present opportunities for students and faculty?
REGULATIONS AND ACCREDITATION REQUIREMENTS
Whether the program is new or under revision, state regulations regarding schools of nursing should be reviewed for their requirements and any recent or anticipated changes in them that affect the curriculum. Information on regulations is available through the State Boards of Nursing. For a listing of specific State Boards of Nursing, consult the National Council of State Boards of Nursing (NCSBN) (2014) website (www.ncsbn.org).
National accreditation is not required of schools of nursing; however, it provides the standards for nursing curricula and demonstrates program quality. Sophisticated applicants to the school will look for accreditation. Alumni find it advantageous to graduate from an accredited institution when applying for positions in the job market, future advanced education, and positions in the military. Many scholarships and financial aid programs require that students enroll in accredited institutions. Nursing has two major accrediting agencies and a few specialty-accrediting bodies. The Accrediting Commission for Education in Nursing Inc. (ACEN; 2014a) accredits clinical doctorate, master’s/postmaster’s certificate, baccalaureate, associate, diploma, and practical nursing programs. Detailed information on its accrediting process and standards may be found at www.acenursing.org. The Commission on Collegiate Nursing Education (CCNE; 2014) accredits baccalaureate and higher degree programs. Information on it may be found at www.aacn.nche.edu/Accreditation/pubsguides.htm.
In addition to accreditation, there are standards and competencies set by professional organizations that serve as guidelines or organizational frameworks for curricula. Several examples for pre-licensure and graduate-level programs are those developed by the AACN for baccalaureate and master’s programs and competencies for the clinical nurse leader (CNL) and the doctor of nursing practice (DNP). Access to these documents may be found at the AACN (2013a) website (www.aacn.nche.edu). The ACEN (2014b) lists the standards for all levels of nursing education that they accredit. These standards may be found at www.acenursing.org/resources.
120Another external frame factor that influences the nursing curriculum is regional accreditation. The parent institution of a nursing program undergoes periodic review by its regional accrediting body. Members of the nursing faculty are involved in the regional accreditation process and should be mindful of the standards set by that organization as well as those set by the professional accrediting body. For contact information, refer to the Resources list of regional accrediting agencies at the end of the chapter.
Detailed descriptions of accreditation processes and standards for educational programs are described in Section V of this text. It is useful to view them for the standards and limitations they impose during the curriculum development process.
FINANCIAL SUPPORT
An analysis of the finances of the program provides curriculum developers with vital information on the economic health of the program. Indicators of financial health influence how the curriculum will be delivered. Faculty should recognize signs that demonstrate the program’s financial viability. If new sources of income for the program are indicated, possible resources need to be identified. The proposed revisions in the curriculum must be realistic in terms of cost. If it is a new program, adequate resources including start-up funds for its implementation must be available. If it is an existing program, faculty and administration should consider whether to continue it at its present level of financial support or increase or decrease support.
Other items of study include how the program is financed and the major sources of revenues such as fees, tuition, state support, private contributions, grants, scholarships, or endowments. Knowing if there are adequate resources to support the program to be self-sufficient is a critical element in the analysis of the financial viability. Although this type of information is the responsibility of administration, curriculum developers must have a basic understanding of the financial support systems that impact curriculum development. Chapter 8 discusses the role of faculty and curriculum planners in procuring funds for support of curriculum development and evaluation and an overview of budgetary planning and management.
SUMMARY
Chapter 6 introduced the first step for conducting a needs assessment in curriculum development and revision. Prior to revising or developing new curricula, an assessment of the factors that influence the education program is necessary. In examining the environment that surrounds the program, curriculum developers look at external frame factors. Table 6.1 serves as a guideline for identifying the external frame factors, collecting the data for an assessment, and analyzing the factors to determine if there is a need for a new program or if changes are necessary for an existing program. Internal frame factors within the parent institution and the nursing program that influence curriculum are considered in Chapter 7.
Analyzing external frame factors in light of proposed new programs or curriculum revisions helps faculty and administrators to determine the type of new program needed or in the case of an existing program, the extent to which changes 121in the curriculum are indicated. A review of the external frame factors provides a reality check, including the community in which the program is located, the industry for which the program prepares graduates, and the economic viability of the program.
TABLE 6.1 GUIDELINES FOR ASSESSING EXTERNAL FRAME FACTORS
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