i EVALUATION OF BASIC NURSING EDUCATION PROGRAMME IN NIGERIA BY ONWUCHEKWA EDNA JANUARY, 2016 ii EVALUATION OF BASIC NURSING EDUCATION PROGRAMME IN NIGERIA BY ONWUCHEKWA EDNA (909003094) JANUARY, 2016 iii EVALUATION OF BASIC NURSING EDUCATION PROGRAMME IN NIGERIA BY ONWUCHEKWA EDNA (909003094) B.sc. Nursing Education, University of Ibadan M.Ed. (Curriculum Studies), University of Lagos A THESIS SUBMITTED TO THE DEPARTMENT OF ARTS AND SOCIAL SCIENCE EDUCATION, THE SCHOOL OF POST GRADUATE STUDIES, UNIVERSITY OF LAGOS IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF DOCTOR OF PHILOSOPHY DEGREE (Ph.D.) IN CURRICULUM THEORY JANUARY, 2016 iv v DEDICATION This thesis is dedicated to the Almighty God, El-Shaddai, Adonai, Nissi and Ebenezer. vi ACKNOWLEDGEMENT First and foremost, I would like to thank my first supervisor Prof. K.A. Adegoke, for his meticulous and insightful contributions. He painstakingly read through this research several times and made valuable suggestions. He is a resourceful researcher and a mentor. I wish to express my warm gratitude to Dr (Mrs) Rosita Igwe my second supervisor for her numerous corrections to improve the quality of this work, she is always there for us. I am highly indebted to Dr. (Mrs) N.R Ikonta for her calm and cheerful disposition, insightful contributions and the significant role she played towards my Ph.Dprogramme. I am most grateful to Prof. (Mrs) Opara, the Head of Department Arts and Social Sciences Education for her humility, simplicity and constructive criticism. She is always willing to help. God will surely bless her abundantly. I want to appreciate Dr. (Mrs) Maduekwe, the departmental post graduate Coordinator for her contributions towards the success of this study. I would like to thank Prof. Owhotu for his unwavering support in all my adventures till date. I also acknowledge the moral support of Prof. NgoziOsarenre and Dr (Mrs) Uzoka. I want to appreciate Mr. Obiyan the librarian, Federal College of Education Technical Akoka Lagos, for keeping a reputable library and dependable librarians. Dr. G.N Nneji and his wife were always supportive. I would also like to thank Dr. (Mrs) Dosumu, Mr. Ihekwoaba and Mrs. Duru for their useful suggestions and moral support. I must thank Prof. Adebo of University of Ibadan who encouraged me to get to the peak of my academic career. vii My profound gratitude goes to the Director Hospital services and Training, DrAdetunji, A.O. (retired) and Mrs Chika Azuike for granting me the permission to pursue the Ph.Dprogramme to enhance my knowledge and productivity. I must thank Dr. (Mrs) Adeosun, our former post graduate co-ordinator for her useful suggestions and guidance. I would like to thank the entire academic staff of the Department of Arts and Social Sciences Education for their support especially Dr. Adebayo and Dr. Ige I am grateful to the staff and students of the cooperating schools who participated in this study, for their corporation and support most especially the principals of these institutions. Notable among them are: Mrs. A.J. Adetunji, School of Nursing, Lagos University Teaching Hospital Idi-Araba Lagos; Mrs. N. Nwaogu, School of Nursing, Abia State University Teaching Hospital Aba; Mrs. E.Idiaghe, School of Nursing, AmacharaAbia State; Mrs. Edna Ubaka, School of Nursing, Queen Elizabeth Hospital, Umuahia ; MrLadan Pate, School of Nursing St. Geralds Mission Hospital Kaduna; HajiaSafiya, School of Nursing Ahmad Bello University Teaching Hospital Zaria; Mr.ElishaZogaleh College of Nursing, Kafanchan; and Col. A. Onovo School of Nursing , Military Hospital Yaba Lagos. I want to sincerely thank all those who steadfastly stood by me in all my adventures; particularly my sister Ijeoma and my brother Chibuzor. Above all, I am very grateful to the Almighty God who through personal revelations persuaded me to go for a doctorate degree programme against my wish, which has turned out to be a source of joy to me. Almighty God, I appreciate you forever viii TABLE OF CONTENTS Pages Title page i Certification iv Dedication v Acknowledgement vi Table of Contents viii List of Tables xiii List of Figures xvi Abbreviations xvii Abstract xviii CHAPTER ONE 1.0 Introduction 1 1.1 Background to the Study 1 1.2 Statement of the problem 7 1.3 Purpose of the study 8 1.4Research questions 8 1.5 Research hypotheses 9 1.6 Theoretical Framework 10 1.7 Scope and Delimitation of the study 12 1.8 Significance of the study 12 1.9 Operational definition of terms 13 ix CHAPTER TWO 2.0 LITERATURE REVIEW 2.1 Definitional issues (challenges of Definition) 14 2.2 The nature of curriculum evaluation 17 2.3 Historical trends in curriculum evaluation 18 2.4 The purpose of curriculum evaluation 21 2.5 Phases of curriculum evaluation 22 2.6 Curriculum evaluation model and their theoretical camps 24 2.7The meaning and concept of programme evaluation 32 2.8 The importance of programme evaluation 33 2. 9 Three programme dimensions that should always be evaluated 33 2.10 Historical evolution and development of basic nursing education in Nigeria 35 2.11 Basic Nursing Education Policy in Nigeria 38 2.12 The Nursing Council of Nigeria 44 2.13 Review of Basic Nursing Education Curriculum inNigeria(2001) 45 2.14 Curriculum evaluation models in nursing education 50 2.15Criteria and methods of evaluation in basic nursing education 51 2.16Emergingissues in programme evaluation 53 2.17Speculative works in Nursing and Evaluation. 54 2.18 Curriculum Enrichment 56 CHAPTER THREE 3.0 RESEARCH METHODOLOGY 3.1 Design of the study 57 3.2 Area of the study 57 x 3.3Population for the study 57 3.4Sample and sampling technique 58 3.5Research instruments used for the study 59 3.6Validity of research instruments 62 3.7 Reliability of research Instruments 63 3.8Administration of researchinstrument 64 3.9 Data Analysis Technique 64 3.10The pilot study 64 3.11 Results of the pilot study 66 3.11.1 Research Questions 66 3.11.2 Interview Result 67 3.11.3 Structured observation schedule 71 3.11.4 Checklist result 72 3.11.5 Documentary studies result 73 3.11.6Testing research hypotheses 73 3.11.7. Discussion of findings from the pilot study 78 3.11.8Implication of the pilot study on the main study 81 CHAPTER FOUR 4.0 DATA PRESENTATIONAND RESULTS 4.1 Demographic characteristics of respondent 83 4.1.1 Age distribution of respondents 84 4.1.2 Job experience of the respondents 84 4.1.3 Gender distribution of respondent according to institutions 85 4.1.4 Institution attended 85 xi 4.1.5 Basic nursing education institutions used for their study and there Characteristics 86 4.2 Analysis of Research Question 87 4.3 Analysis of Classroom Observation 96 4.4 Interview Result 98 4.5 Checklist Result 101 4.6 Analysis of Research Hypothesis 102 4.7 Summary of Findings 107 4.8 Discussion of Findings 108 4.9 Development and validation of basic nursing education programme Enrichment model 115 4.9.1 Introduction 115 4.9.2 Rationale 116 4.9.3 The procedure and development 116 4.9.4 Validation of enhanced basic education curriculum package 119 4.9.5 Proposed framework for the implementation of enriched curriculum offering at basic nursing education level 119 CHAPTER FIVE Summary, contribution to knowledge, recommendation, conclusion 5.1Summary of findings 123 5.2 Contributions to knowledge 124 5.3 Recommendations 125 5.4Conclusion 125 5.5 Suggestions for further study 126 References 127 xii LIST OF TABLES Table1: Overview of the four categories of approved BNE institutions in Nigeria and their geo-political zones. 36 Table 2: Basic nursing education curriculum (2001) courses, contact hours and Credit units 47 Table: 3: Curriculum models and their evaluation strategies 50 Table 4: BNE institutions used for the study and their population 59 Table 5: Reliability test of research instruments used for the study 63 RESULTS OF THE PILOT STUDY Table 6: Demographic data 66 Table 7: Analysis of classroom observation 71 Table 8 Checklist used for the assessment of the adequacy of BNE programme 72 Table 9: Conducivenessof basic nursing education learning environment to Enhance quality teaching and learning. 73 Table 10: Relevanceof BNE curriculum objectives 74 Table 11:Adequacy of the entry characteristics of teachersand students into BNE programme 74 Table12: Adequacy of BNE curriculum content 75 Table 13: Adequacy of Instructional Materials 75 Table 14:Teachers teaching competence 75 xiii Table15: Major constraints to the effective implementation of Basic nursing educationprogramme in Nigeria. 76 Table16: Enhanced intervention package and improvement of basic nursing 77 Educationprogramme in Nigeria. Table 17: Number of Subjects who participated in the study, their qualifications and gender 83 Table 18:Age distribution of student 84 Table 19:Job experience of respondents 84 Table 20: Gender distribution of respondents according to basic nursing education Institutions 85 Table 21;Distribution of the respondents by institutions attended 85 Table 22: Basic nursing education institutions used for the study Table 23: Conduciveness of the BNE learning environment 87 Table 24.Relvance of the BNE programme objectives to the needs of the learners and society 88 Table 25; Adequacy of the teacher and students entry requirement into basic nursing education programme 89 Table26: Adequacy of BNE curriculum content 90 Table 27: Adequacy of BNE instructional materials 91 Table 28: Adequacy of teachers teaching competence 92 Table 29: Major constraints to the effective implementation of Basic nursing education programme in Nigeria 94 xiv Table 30: Enhanced intervention package and sustenance of basic nursing education programme in Nigeria 95 Table 30: Analysis of classroom competence observed during the process of Teaching and learning. (Teachers Performance Rating) 95 Table 31:Classroom competence observed during the process Teaching and learning, 96-97 Table 32; Summary Classroom competence observed during the process Teaching and learning, ( Teachers performance rating ) 98 Table 33: Checklist, used for the assessment of the adequacy of BNE programme facilities 101 Table 34: Conduciveness of BNE learning environment 102 Table 35;Relevance of the objectives of basic nursing education programme in Nigeria 102 Table 36: Adequacy of entry requirements of both teachers and students into BNE Programme in Nigeria 103 Table 37: Adequacy of the content of BNE Curriculum 104 Table 38: Adequacy of instructional materials 104 Table 39: Teachers’ teaching competence 105 Table 39: major factors militating against the implementation of BNE programme in Nigeria 105 Table 40: Enhanced intervention package and improvement of basic nursing xv education Programme in Nigeria. 106 Table 41: Proposedframework for enriched curriculum offerings at basic nursing Education level 120 LIST OF FIGURES Figure 1: Basic Nursing Education course content. 46 Figure 2: Basic nursing education curriculum enrichment model 118 Figure 3:The six geo-political zones of Nigeria showing the states involved in the study 153 APPENDICES a) Questionnaire on the evaluation of basic nursing education programme in Nigeria. 130 b) Interview items. 138 c) Classroom observation chart used during the process of teaching and learning. 141 d) Checklist used for BNE environmental assessment. 145 e) Approved basic nursing schools in Nigeria and their geo-political zones. 146 f) Nigerian six geo-political zones showing the three geo-political zones and the states selected for the study. 152 g) Map of Nigeriashowing the area of the study. 153 xvi Abbreviations ABSUTH Abia State University Teaching Hospital ABUTH Ahmed Bello University Teaching Hospital ANA American Nurses Association JBCNS Joint Board of Clinical Nursing Studies RN Registered Nurse OND Ordinary National Diploma NCE National Certificate of Education HND Higher National Diploma BNE Basic Nursing Education CIPP Context Input Process Product BNECEM Basic Nursing Education Curriculum Enrichment Model ICT Information Communication Technology SON School of nursing CON College of nursing xvii ABSTRACT Nursing Education is a humanistic science which focuses on the intellectual development of the learner, compassionate concern for the sick, rehabilitation of the disabled and care for the dying. Hence the goal of nursing education reflects the needs, problems and aspirations of the society. Despite the series of reforms in nursing education, in response to societal needs and challenges, basic nursing education curriculum under investigation has not been evaluated since its introduction into the Nigerian educational System in the year (2001) to ascertain its strength and weaknesses and to incorporate emerging health issues and new courses such as nursing informatics, safety and security challenges in the workplace, cultural sensitive care, guidance and counselling among others. A responsive curriculum is the curriculum that is relevant to the current, anticipated needs, problems and expectations of the learner. It takes cognisance of vital social changes and challenges in the environment and prepares the learner to cope with these challenges adequately. This study examined the effectiveness of BNE programme in meeting the needs of the students and the society. It also examined the extent to which BNE programmes are provided with the required facilities and instructional materials to ensure the production of utility graduates. Descriptive survey and quasi- experimental, pre and post-test control group designs were adopted for this study. The population of the study consists of 1,190 respondents selected from seven basic nursing institutions in the south- East, South-west and North-Central states of Nigeria. A total sample size of 700 students and 70 teachers’ male and female inclusive were selected for the study using multistage sampling. The following research instruments were designed, validated and used for the study namely; structured questionnaire, observation, interview schedule, checklist and content analysis. The research questions were analysed descriptively using mean, and standard deviation. The null hypotheses were tested with Univariate Analysis of variance at an alpha level of 0.05 while Factor analysis was employed to identify the major factors militating against the effective implementation of BNE programme in Nigeria. Observed data and data obtained from structured interview schedule were qualitatively analysed. The findings of the study revealed that basic nursing education curriculum has not been evaluated since its inception in the year 2001, the state of the facilities is grossly inadequate, and some of the products of basic nursing education programme are not proficient on the job. It is therefore recommended that BNE programme should be evaluated when it has completed its life cycle after three years and every three years, and should be committed to capacity building of teachers and students to cope with the current and emerging issues in nursing profession. Key Words: Evaluation, Basic Nursing Education Programme, Nigeria. 1 CHAPTER ONE 1.0 Introduction The stateof thecurriculum at all levels of education in Nigeria has remained a source of concern. There have been persistent criticisms of the relevance of the entire educational system in meeting the needs of the students and the society (Ajeyalemi, 2008). Nigeria is passing through a transformation that will impact the socio-academic activities of the nation. This raises some curiosity on the relevance of curriculum offerings in a rapidly changing world. Individuals and funding agencies want evidence and effectiveness of basic nursing education programmes with particular reference to context, content, materials, teaching methods and techniques. Many people are interested in what students are learning and the skills they can demonstrate in work situations. 1.1 Background to the Study Evaluation as a field of study has continued to attract interest among educators, scholars,researchers and lay persons mainly because of its centrality in the attainment of the educational goal of any nation. Evaluation as a concept has been described as the process of making judgement about the merit, value or worth, strengths and weaknesses of educational programmes, projects, materials, teaching methods and techniques for the purpose of improvement (Ornstein &Hunkins1998). The growth in emphasis on evaluation as a tool for quality health care delivery motivated the world health organisation to publish a monograph(Allen, 1977) which specifies that each school of nursing must develop on-going evaluation project for study, assessment, development and to incorporate a system of evaluation within each nursing programme (Chavasse1994). The national health policy (2003) also emphasised the need for evaluation and provision of a comprehensive health care system that is educative, promotive, protective, preventive, restorative and rehabilitative.In evaluation, the two critical questions to ask are: Is it worth doing? How well is it being done? Or how well it has been done? (Adegoke, 2003). The 2 employers of labour and funding agencies want evidence and effectiveness of programme with particular reference to what is taught and the skills the learners can demonstrate. A responsive curriculum is the curriculum that is relevant to the current and the anticipated needs, problems and aspirations of the learner.It takes cognisance of vital changes and challenges in the environment and prepares the learner to cope with these challenges effectively. Such a curriculum addresses the different cultural backgrounds of the learner and recognises the learning differences and difficulties Emah (2010). Life issues are multifaceted. They transcend any single discipline or subject specialisation. .Related issues and problems need related treatment. A responsive curriculum is integrated and interdisciplinary, authentic, learner-centred, oriented to real life situations, utilises materials from the learner’s culture among others. Basic nursing school, as a social construct was established to equip the learners with knowledge, skills and attitude to contribute meaningfully to the socio- economic development of the society. Hence the goal of nursing education reflects the needs, problems and aspirations of the society (Kozier&Erbs, 2012). To achieve a balance between the aspirations of the society and the learners’ interests leads to two interconnected concerns in curriculum evaluation: what is taught and how it is taught. Nursing education is a humanistic science that focuses on the intellectual development of students, compassionate concern for the sick, rehabilitation of the disabled and care for the dying (Basavanthappa, 2009). Nursing education seeks to promote symphonic interaction between the environment and the client, strengthen the coherence and the integrity of human beings, direct and redirect patterns of interaction between the client and the environment for the realisation of maximum health potential. Neuman, (2009) argued that 21 st century nursing education is concerned with all the variables affecting an individual’s response to stressor which could be intra, inter, and extra-personal in nature. The main concern of nursing is to prevent stress invasion, or following stress invasion to protect the client’s basic structure and maintain maximum level of wellness. In the same vein, the researcher views nursing education as a systematic, scholarly inquiry which seek to 3 understand individual and group care needs in relation to health education, promotion, maintenance, rehabilitation of the sick, disaster victims and coping with emerging health issues. It describes human conditions through a continuum from illness to wellness and otherwise. The national policy on education identified as one of its major objectives, to equip the teachers with intellectual and professional competencies adequate for their assignment mostly teaching and to make them adaptable to any changing situation in the global world (FME, (2004). Students who have gone through any basic nursing education programme are expected to have acquired on graduation nursing competencies to make them self-sustaining and to create employment for others. However, some schools of nursing have continued to produce increasing number of inadequatelyskilled professionals who may not be too relevant to the 21 st century society.(Olaniyonu,2007). Junaid, (2011) observed that no significant change in education can take place in any nation unless her teaching staff are well trained. This fact was buttressed in the National policy on education (FME 2004), section eight that Teacher Education will continue to be given priority in all educational planning enterprise because no educational system can rise above the quantity, quality and the variety of her teachers. The importance of instructional materials in the teaching learning process cannot be underrated. Afangide, (2009) observed that over the years, teachers have indicated that one of the greatest impediments to curriculum implementation is inadequacy of instructional materials. Bassavanthappa (2009) stated that meaningful learning can be achieved through multi-sensory experiences than through reading and abstract reasoning. In support of their views, Nwoji, (2009) stated that instructional materials are devices which facilitate the transmission to a learner, the facts ,skills , attitude and values which promote understanding and appreciation of concepts. Ike, (2002) affirmed that instructional materials are devices which present complete body of information and are largely self-supporting rather than supplementary in the teaching learning process. The learners must be given ample and diverse opportunities to practise the skills they have come to acquire. To 4 buttress this, Madueke,(2010) quoting Ofor(1982) asserted that education is more efficient when the teaching and learning experiences are real and practical as this will enable the students gain first-hand information and experience. Instructional materials should be current and effectively utilised to enhance quality teaching and learning. Involvement of classroom teachers in curriculum planning and implementation activities cannot be ignored. Classroom teachers are arbiter of knowledge and should be actively involved in any curriculum planning and implementation activities. Unfortunately, most of the curriculum in operation in our respective institutions of learning are prepared by external bodies (non-teaching staff), who may be simply concerned with the ideal or the utopian curriculum and outcomes of learning (measurement of ex-students observable behaviours and performance assumed to be the programme effects on the graduates), without due considerations of the means to an end, the intended and the actual. It is obvious that asking teachers to implement and evaluate such a curriculum is not without problems. Bieler, (2008) pointed out that the complex integration construct developed by philosophers are difficult to translate into the curriculum of diaspora day schools because of both the complexity of the material and inability of students to function within such a system. Bieler’s argument emphasizes simplicity of curriculum package, curriculum literacy and involvement of classroom teachers in any curriculum planning, implementation and evaluation enterprise,to make the curriculum more relevant to the society in an ever changing world. Basic nursing education in Nigeria has gone through series of reformsin response to consumer demands, new scientific knowledge, advances in technology, socio-cultural changes and to keep up with the international trends in a highly competitive global village. The keyreason for these nursing reforms is to make learning relevant to real life encounter of the learner. Aculturally responsive curriculum draws materials from the learner’s culture and experiences to illustrate principles and concepts (Chion-Kenney, 1994). This engenders transfer of learning. 5 The Nursing Council of Nigeria reviewed basic nursing education curriculum in (1993) and (1999) in an attempt to modernise and provide strong scientific base for the nursing care being rendered Ndatsu, (2000). Each time the curriculum was reviewed; new topics, objectives and pieces of information were added to the existing curriculum such as nursing process, principles of management and project writing. The outcome is a curriculum which consists mainly of patch work of topics that are poorly organised Zakari, (2006). In addition, when some textbooks are updated, new bits and pieces of knowledge were added to the old content. Practically, no fundamental change in the conceptual structure of the subject matter is apparent. These incremental change and intentional effort to enhance the existing system by correcting deficiencies in policies and practices are not just enough in today’s complex health care system. There is need for planned and fundamental change to enhance the essential ways basic nursing education is put together, to introduce new goals, structures and roles that will transform familiar ways of performing duties into more solutions to persistent problem. As observed by (Neeraja 2006), change is inevitable. It is evolution, progress and adaptation; it denotes observable differences in any social phenomenon over any period of time. Planned change is positive, growth, progress and improvement wrapped up in a shiny package Jackson, (1992). The Ertwhile Board of Clinical Nursing study’s findings states clearly that course planners lacked the necessary skills and knowledge to evaluate the courses they teach and so produced a package to introduce the practice of evaluation to nurse educators in Britain, Joint Board of Clinical Nursing Studies JBCNS, (1978), Carpenito, (2004).The current basic nursing education curriculum under investigation was introduced into the Nigerian Educational System in the year (2001). Since then, basic nursing education has been facing a lot of challenges arising from rapid growth in structure, function, and the dynamic nature of the society which demands a reappraisal of the relevance of its curriculum offerings in a rapidly changing society. 6 On the importance of motivation, Olaniyonu, (2006) stated thatevery innovation is human-driven. The drivers of this change, (the nurse educators) need adequate motivation to discharge their duties with maximum effort. Some of the products of BNE programme in Nigeria have also been accused of poor performance on the job. Obasa, (2006) stated that if nursing education is shoddy, nothing significant can be expected from clinical practice. It is therefore reasonable to ask within the context of outcome-evaluation, the following critical questions; what happened to the students? What are the students learning? what have they learnt, what skills can they demonstrate as a result of exposure to basic nursing education programme to enable them develop cognitively, socially, morally and physically? (Jackson,1992). From the foregoing,the following questions arise. How adequate is the basic nursing education programmelearningenvironment in terms of infrastructure to enhance quality teaching and learning? How adequately staffed are the programmes? To what extent are the programmes provided with the required facilities and instructional materials to ensure the production of utility graduates? What are the constraints (if any) to the effective implementation of basic nursing education programme in Nigeria? What are the measures to be adopted to improve and sustain basic nursing education programme in Nigeria if the findings of this study reveal any gap in knowledge, attitude and skills? This study addressed these questions among others. 1.2 Statement of the Problem The problems of this study are as follows: Basic nursing education in Nigeria has been going through series of reforms in response to societal demands and the ever changing context of the health care system. Despite these reforms, basic nursing education curriculum under investigation has not been evaluated since its introduction into the Nigerian educational system in the year 2001.This is toascertain its strengths and weaknesses and to incorporate emerging health issues and new courses such as nursing informatics, digitalised 7 classroom, safety and security challenges in the workplace, cultural sensitive care, legal aspects of nursing practice, biochemistry, guidance and counselling among others (Aina,2013).The state of the facilities in some schools of nursing is grossly inadequate.Quality teaching and learning cannot be achieved if the basic nursing education programmes are not provided withthe required facilities and instructional materials to ensure the production of quality graduates. Some of the teachers lack teaching competency and cannot evaluate the courses they teach, while some of the products of BNE programmes seem not to be proficient on the job. There is also a major problem of paper qualification and nomenclature.Thecertificate, Registered Nurse (RN), awarded to the products of BNE programme in Nigeria is not equivalent to NCE, OND or HND which creates considerable problem for nurses seeking admission into tertiary institutions and employment in the industries. 1.3 Purpose of the Study The purpose of this study is to evaluate basic nursing education programme in Nigeria in terms of some aspects of its context, input, process and product. Specifically, the objectives of this study are to: 1. determine the conduciveness of BNE learning environment to enhance quality teaching and learning; 2. assess the relevance of the objectives of (BNE) programme in Nigeria, in meeting the needs of the students, the teachers and the society; 3. determine the appropriateness and compliance of the students and teachers entry requirements into the BNE programme in Nigeria; 4. ascertain the adequacy of the BNE curriculum content in terms of the coverage, logical sequence and articulation of topics; 5. determine the adequacy of instructional materials to enhance teaching and learning; 8 6. determine the teachers competencies in coping with the tasks and challenges encountered on the job; 7. identify the major challenges militating against the effective implementation of BNE programme in Nigeria; and 8. develop an enhanced intervention package to improve and sustain basic nursing education programme in Nigeria. 1.4 Research Questions To achieve the objectives of this study, the following research questions were raised: 1. How conducive is the BNE learning environment to enhance quality teaching and learning? 2. To what extent are the objectives of the Basic Nursing Education (BNE) curriculum in Nigeria relevant in meeting the needs of the students, the teachers and the society? 3. To what extent are the students and teachers entry requirements into BNE programme inNigeria adequate? 4. How adequate is the BNE curriculum content in terms of logical sequence and meeting the needs of the student and the society? 5. To what extent are the instructional materials adequate in the transmission to a learner knowledge, skills and attitude? 6. How competent are the teachers in handling the tasks and challenges encountered during the process of teaching and learning? 7. What are the major challenges militating against the effective implementation of BNE programme in Nigeria? 8. To what extent can an enhanced intervention package based on observations and findings of this study improve and sustain basic nursing education programme in Nigeria? 9 1.5 Research Hypotheses. The under-listed hypotheses were postulated to guide the study: 1. There is no significant difference in the views of teachers and students, on the conduciveness of BNE learning environment to enhance quality teaching and learning. 2. There is no significant difference in the views of teachers and students, on the relevance of the objective of Basic Nursing Education (BNE) Curriculum in Nigeria, in meeting the needs of the students and the society. 3. There is no significant difference in the opinion of teachers and students on theappropriateness and compliance of students and teachers entry requirements into the BNEprogramme in Nigeria. 4. There is no significant difference in the opinion of teachers and students on the adequacy of the BNE curriculum content in terms of the coverage, logical sequence and articulation of topics. 5. There is no significant difference in the views of teachers and students on the adequacy of the instructional materials in enhancing teaching and learning. 6. There is no significant difference in the opinion of teachers and students on the competence ofthe teachers in handling all the tasks and challenges encountered during the process of teaching and learning. 7. There is no significant relationship in the skill competency ratings of teachers and students on the challenges militating against the effective implementation of BNE programme in Nigeria. 8. There is no significant difference in the teaching competence among teachers in Federal, State, Mission and military nursing institutions on theeffectiveness ofenhanced BNE intervention package to improve and sustain basic nursing education programme in Nigeria. 10 1.6 Theoretical Framework The researcher adopted two theories of evaluation as the theoretical framework for this study namely;Stufflebeam (1971) context, input, process and product (CIPP) model and Baroda General Teaching Competence Scale (Basavanthappa,2009) in order to achieve a balance between theory and practice. Context Evaluation: According toStufflebeamthe main focus of context evaluation is needs assessment of the learning environment in terms of infrastructure - school building, transportation, sustainable source of water supply, electricity, and sport and leisure facilities among others and to provide direction for improvement. It also addressed the issue of whether existing priorities are attuned to the needs of the students. Input Evaluation: Refers to that which is put into a programme or a project to make it succeed. This focuses on prescribing a programme so as to produce desired changes. It is a precursor of the success, failure and efficiency of a change effort. It addresses the issue of time, knowledge, skills and finance to be precise. Process Evaluation: This is an on-going check on the implementation of a plan;it provides feedback to managers and staff on programme activities to ensure that it is being carried out as planned, using available resources in an efficient manner. Product Evaluation: Its aim is to measure, interpret and judge the effects of the programme. These include: intended and unintended effects, positive and negative outcomes. Product data is also concerned with the measurement of the ex-students observable behaviours, assumed to be the programme effects on the graduates. Stufflebeam stated that both process and product evaluation are the outcome measures needed by curriculum decision makers. Drawing from the CIPP model, the researcher conducted needs assessment of the basic nursing education learning environment to identify unmet needs. The input gave insight on what is 11 needed to make the BNE programme succeed in terms of time, human and material resources, Process refers to teachers and students interactions to achieve the desired results while product refers to the outcome of teaching and learning. The data obtained were presented to stake- holders,Nursing & Midwifery Council of Nigeria for the improvement of basic nursing education programme in Nigeria. This study was also guided by the insights provided by Baroda General Teaching Competence Scale. This package was developed by the Government College of nursing Bangalore (Bassavanthappa,2009). The rating scale is a guide to the assessment of teachers and students performance in class during the process of teaching and learning. The skills to be observed are organised into these broad categories namely planning, presentation, closure and evaluation which are rated from 0 to 5. Zero (0) represents the least performance while 5 represent the highest performance. The researcher used this appraisal guide to assess teachers and students performance in class on the relevance of BNE programme in Nigeria as well as the CIPP model with a view to develop an intervention package to bridge any gap identified.. 1.7 Scope and Delimitation of the study This study critically examined the effectiveness of BNE programme in three geo-political zones of Nigeria namely: South-East, South-West and North-Central states. This study ought to haveincluded the six geo-political zones of Nigeria, namely North-East, North-West North-Central, South-East, South-West and South-South geo-political zones of Nigeria,all the states inclusive but due to logistic constraints, the study was limited to seven (7) basic nursing education institutions selected from Kaduna, Abia, and Lagos states. 1.8 Significance of the Study This study is significant in the following ways: The outcome of this study will provide an enhanced curriculum package for basic nursing education that will meet the needs, problems and 12 expectations of the students, the teachers and the society, add to literature on programme evaluation in nursing and serve as a resource material for basic and post basic nursing institutions in Nigeria. It will provide insight on the strengths and weaknesses of the BNE programme and serve as a baseline data for researchers and scholars whose interest is in the area of evaluation and improvement of BNE programme in Nigeria. It is also hoped that the findings of this study will assist the Nursing and Midwifery Council of Nigeria to formulate more meaningful policies for Basic Nursing Education in Nigeria. 1.9 Operational definition of terms. The following terms and concepts are explained within the context of this study. Programme evaluation: Appraisal of the entire basic nursing education system to ensure that it is internally sound in terms of infrastructure, facilities, content, instructional materials, teaching methods, techniques, entry characteristics of academic, non-academic staff and students with particular reference tothe students’ abilities, staff qualifications, student –teacher interactions, resources, outcome and cost benefits. Nursing Education: This refers to acquisition of relevant knowledge, skills and attitudes to enable the nurse meet the health care needs of an individual, a family, a community or a group. Basic Nursing Education (BNE): refers to the fundamental, the minimum standard, in nursing education and practice. Reform: It involves reorientation and repositioning of an existing programme in order to achieve effective and efficient care. It focuses on financial, policy and organisational. 13 CHAPTER TWO Literature Review This section focuses on extensive literature review on available speculative and empirical studies as documented in journals, textbooks and bulletins relating to evaluation of the effectiveness of educational and nursing programmes. The area reviewed in the literature are organised under the following sub-headings:  Definitional issues  The nature and purpose of curriculum evaluation  Historical Trends in Curriculum Evaluation in Nigeria  Curriculum Evaluation Models and their Theoretical Camps  The meaning and concept of programme evaluation  The importance of programme evaluation  Historical evolution and development of basic nursing education in Nigeria  The Nursing Council of Nigeria  Basic nursing education policy in Nigeria  Review of basic nursing education curriculum (2001)  Criteria and methods of evaluation in nursing education  Emerging issues in programme evaluation  Speculative works in Nursing and Evaluation  Curriculum Enrichment 14 2.1 Definitional issues (The Challenge of Definition) Curriculum is one of the most elusive concepts in education in terms of definition and meaning as there is lack of agreement, criticism, and argument on the exact meaning of the word among curriculum theorists themselves.Definitional debates continue on what is curriculum, how to outline the basic foundations (boundaries) and domains (knowledge) of the field(Ornstein & Hunkins, 1998).Numerous definitions of curriculum exist. To some, such variety creates confusion. The plethora of definitions demonstrates dynamism of varied voices in the field of curriculum. These voices introduce diverse interpretations by drawing from specific mode of thoughts, particular ideologies, diverse pedagogies, unique political experiences and various cultural experiences. Jackson (2001) and Basavanthappa (2009) reported that the term curriculum was first used in Scotland as early as the eighteenth century.It is derived from the Latin word Currere which means to run, running, and a race course.Dike & Eze (2009) defined curriculum as an embodiment of all the knowledge, skills and attitudes which a nation through her schools imparts to her citizens. Knowledge in this context implies facts,theories, principles/generalisations and rules needed to be acquired for a student to be certified competent in a field.Curriculum also involves the acquisition of skills needed to perform tasks. William (2002) defined curriculum in relation to a shifting paradigm moving from formal definition to a focus on one’s multiple interactions with others and ones surroundings, He defined curriculum with the following five concepts namely: Currere, complexity,cosmology, conversation,and community.From the foregoing, it is apparent that the field of curriculum studies is central to education. Curriculum evaluation:The worth of any given curriculum is established through evaluation.Evaluationis a very important component of the education process and one of the cardinal elements of the curriculum. Agwu, (2009) pointed out that curriculum evaluation as a concept is quite eclectic. This implies that there is no agreement among curriculum theorists on the exact meaning of the word. The Joint Committee for the Standard of educational evaluation (1983) defined 15 evaluation broadly as a systematic investigation into the worth or merit of a programme, procedures, product, or an object for the purpose of gathering information needed for value judgement. Evaluation is the broad categoryassessment is subsumed in it, within assessment is measurement which is the narrowest form or subset of evaluation (Jackson 1992). Nneji (2009)defined curriculum evaluation as a deliberate intervention on any endeavour to justifyall the efforts and resources expended on it. Nwosu, (2003),defined evaluation as a process of finding out how far the learning experiences developed and organised are actually producing the desired results. Ohuche and Akeju (1977) opinedthat evaluation is a quality control system that is used to determine the effectiveness or otherwise of the teaching learning process. Evaluating can also be described as a tool for the clarification of significant goals and objectives of education. It involves measurement of the effectiveness, acceptability and efficiency of the curriculum for decision making. In the same vein, (Ornstein and Hunkins 1998) posit that evaluation is a process or cluster of processes that educators -mostly the teachers perform to gather data to enable them decide whether to accept, change or eliminate a phenomenon in the curriculum as a whole or an educational textbook in particular. In support of the views of (Ornstein and Hunkins 1998), Oliva (2001) stated that evaluation is a means to determine what need improvement or change and to provide a basis for effecting that improvement or change. Oliva identified five key areas of concern that calls for evaluation which include programme, provisions, procedures, products and processes(5ps). Oliva also revealed the secret of evaluation which is the ability to: ask questions, ask the right questions and to ask the right questions of the right people. It is obvious from the above views that it is difficult to get at the exact meaning of the word curriculum evaluation. However, evaluation as a concept can be describedas a process to determine the worth and the weaknesses of an educational programme.It involves assessment and judgement of both student’s performance and the curriculum itself for effectiveness and efficiency (Igwe, 2003). 16 2.2The nature and purpose of curriculum evaluation Evaluation is perceived as the best instrument to measure the failure and success of any educational adventure. Azikiwe, (2009) stated that evaluation is used to ascertain how well the objectives of the curriculum are attained after series of implementation activities and whether the curriculum as designed, developed and implemented is producing or can produce the desired results. In the same vein, Ornstein and Hunkins (1998) described evaluation as the health of education and its processes. He identified some functions of evaluation which include: to determine the adequacy of the learning environment, the objectives, content and instructional materials and to what extent the objectives of a programme have been realised. In support of their views, Stufflebeam, (1998) explained that evaluation plays a vital role in the process of delineating, obtaining and providing information for decision making about the programme. It gives the curriculum specialist an opportunity to revise, compare, maintain or discontinue their actions and programmes. Cuba and Lincoln,(1998), also argue that the role of the evaluator is systematically facilitating the placement of values on data by others. Precisely, the placement of values on data is perhaps the most essential component of the evaluator’s work. Eisner (1993) also argued that evaluation should allow for some form of communication to the public, school board, local or state government about what has been and is occurring in school. Okpara, (1991) stated that any educational adventure which neglects or omits the value system of an environment may be said to be incomplete. The foregoing indicates the pivotal nature of programme evaluation as it focuses on all components of the programme to make its task elaborate and enormous. 2.3Historical Trends in Curriculum Evaluation in Nigeria Curriculum evaluation has gone through revolutionary changes and has metamorphosed to what it is presently. Madaus and Kelleghan (1992) reported that the first recorded instance of evaluation was in 17 1444 in a contract between the Treviso town fathers and the school masters in Europe in which the teachers’ salary was based on the learners’ achievement in an oral examination. The schoolmasters received four (4) levels of reward ranging from 12 Ducats for proficiency in the alphabet, two Ducats for success in syllabus exercise or rhetoric (Arles, 1962). The idea that learning is labour to be rewarded financially and the concept of holding teachers accountable for student’s mastery of basic skills of curriculum through the device of coupling their pupils’ examination results with monetary rewards turned out to be a durable one. It reappeared in 18 th century Ireland (Buston 1979) and again in 19 th century Great Britain Bowler, (1983) etc. Madaus and Kelleghan (1992), stated that payment by result was not the only system of evaluation used in the 19 th century. The school inspectorate played a major role through their contributions to annual reports on the conditions of schools and on pupil's achievement. Inspectorate report contained a mine of information about school districts, school buildings, managers, teachers, and monitors discipline, quality of instruction and in students' achievements in a variety of curriculum areas. The school inspectors were not unaware of the problem of subjectivity and non-reliability. Payment by result had many contemporary critics.For instance, Matthew Arnold (1992), a school inspector in England rendered a classic indictment when he described it as a game of mechanical contrivance in which teachers will and must learn how to beat us. It is possible by ingenious preparation to assist students to pass examination, in reading, writing and ciphering without having a firm grip of how to read, write or cipher. This implies that it is possible to rush the students through a programme and assist them to pass their exams through various sharp practices like examination malpractices without the learners acquisition of basic skills in their field of study since all that matters is their performance in a summative evaluation. In respect of education in Germany, Matthew Arnold (1992) observed that the assigned work of the year curriculum was well within a child's power and if the learners are not fit to be promoted unless there is some special reasons, the teaching has not been right, Royal Commission of Education 18 (1886). The idea that children will not fail their examination if properly taught was popular at that point in time. Educational theorists such as Pestalozzi, Herbert Froebel, Emerson, Parker and Dewey (1992) believe that intelligence though obsolete was educable (Snow and Yallow 1982). However, towards the end of the first decade of the century, payment by result became less popular and eroded away. The ability level of students began to be used to explain why some students performed poorly in their examination(Jackson, 1992). The blame was now shifted from teachers to lack of ability in the learner, native limitations in the ability of the child or in the home environment in which the child grew up. (Jackson,1992) quoting Charles Judd (1918) who extolledthe virtue of scientific measurement said: "We now understand in definite scientific terms that children are different from one another and the best we can hope for is improvement - not absolute achievement of ideas and ideals”. Towards the later part of the 19 th century, median scores of students across a district became the standard of acceptable achievement in terms of the curriculum. The advent of IQ tests provided an explanation for poor pupils’ performance. The idea of payment by results eroded away completely. After the Second World War, Ralph Tyler emerged with his operational behavioural objective model Tyler (1934, 1949, Tyler and Waples 1930). There was also a development of taxonomies designed to help educators articulate objectives Bloom 1956, Krathwo1, Bloom and Macia (1964, 1960 – 1970). Evaluation during this period was very subjective. It was based on the 'teacher's opinion written in his diary. It was not formal. The findings were not reported to the subject sponsors. It was also not made public. Scriven (1967) came up with formative and summative evaluation. Formative evaluation is intended to inform a revision of practice. Summative judgment was meant for personnel files. Scriven argued that evaluation should not be tied to objectives and emphasized goal- free 19 evaluation. Other formsof Assessment Techniques in the 19 th century reported by Ornstein and Hunkins (1998) include:  Evaluating Products: The medieval guild required an apprentice to supply a product as a final proof of competence.  Oral Evaluation: Viva voice examination was designed to reveal the students ability in elocution (Hoskins 1969). Written examination, Qualitative ranking, Quantitative marks, Essay examination, Short answer exa1mination, multiple choice questions are other forms of evaluation in use at that point in time. The above statements indicate clearly that- (a) curriculum evaluation has come a long way and has passed through various paradigm shifts which have contributed in shaping it to its present status quo. (b)The teacher has right from time immemorial received greater portion of the blame for poor pupils performance. Same is also applicable to nursing education in Nigeria. Some of the students who participated in this study attribute their failure in external exams such as Nursing Council Exam to the teachers teaching incompetence. 2.4 The Purposeof Curriculum Evaluation Evaluation is perceived as the best instrument to measure the failure and success of any educational adventure. Ornstein and Hunkins(1998)have described evaluation as the health of education and its processes. Evaluation serves many functions which include: 1. To determine the extent to which the objectives of a programme have been realised: As pointed out by Steinhouse, (1975) every curriculum plan is designed for a particular goal or purpose. In effect, evaluation is used to determinethe extent to which the objectives of a programme have been realised. In agreement with the views of stein house, Azikiwe(2009) stated that evaluation helps to ascertain how well the objectives of the curriculum are attained after series of implementation activities. 20 2. To identify the strengths and weaknesses of the curriculum Evaluation is used to critique and identify the strengths and weaknesses of the curriculum design before, during the process of implementation and the effectiveness of its delivery after implementation. 3. To assess performance:Evaluation is used to determine individual students’ performance in school in terms of how they are succeeding in learning as well as the teachers’ curriculum delivery and its components. 4. To ascertain the expected behavioural changes in the learner: As observed by G.B Leonard (1991),to learn is to change. Evaluation enables curriculum planners to ascertain the expected behavioural changes in the learner as a result of instruction and factors that facilitate the change or otherwise Azikiwe (2009), Obiefuna (2009). In line with their views, (Oliva 2001) stated that evaluation determines what need improvement or change and providing a basis for effecting that improvement or change. 5. Decision making : Stufflebeam, (1983) explained that evaluation plays a vital role in the process of delineating, obtaining and providing information for decision making about the programme. It gives the curriculum specialist an opportunity to revise, compare, maintain or discontinue their actions and programmes and to draw conclusions and furnish data that will support their decisions regarding curriculum matters. 6. For Valuing: Cuba and Lincoln,(1989),argue that the role of the evaluator is systematically facilitating the placement of values by others. Precisely, the placement of values on data is perhaps the most essential component of the evaluator’s work. Eisner (1993) also makes the point that evaluation should allow for some form of communication to the public, school board, local or state government about what has been and is occurring in school.Scriven (1972) posit that the evaluator is free to collect whatever data that seem pertinent, in considering the total consequences of a programme which are evaluated against demonstrated needs. Okpara 21 (1991) explained that any educational adventure which neglects or omits the value system of an environment may be regarded as value-neutral and incomplete. 7 To ensure that the curriculum is in line with societal needs and problems in a rapidly changing world and to provide data for justifying investments. 2.5 Phases of Curriculum Evaluation There are various views, on the phases of Curriculum evaluation by curriculum specialists. Among them areOrnstein and Hunkins (1998) who identified six phases of curriculum evaluation namely: Determine a particular phenomenon to be evaluated and the design to use. Collection of the Needed Information: This entails identification of the source of information essential for consideration and mapping out stages for collecting the information in terms of time schedule. It is rare to find adequate time estimate in curriculum evaluation. 1. Organization of the information in such a way that it becomes interpretable and usable to the final intended audience. It involves coding, organizing, sorting and retrieving the information. 2. Analyzing the information: This involves selection of appropriate analysis techniques depending on the focus of the evaluation. 3. Reporting the information: The evaluator decides on the nature of the reporting keeping in mind the audience for the report. (Collect treat and report data). 4. Recycling the information: This involves continuous re-evaluation and assessment, a continuous attempt to improve the curriculum to meet future needs. It is not just reporting the result but interpretation and making recommendations for action (Ornstein and Hunkins 1998). Lewis (1981) identified four phases of curriculum evaluation namely: a) List Sub-goals. b) Determine antecedents: Students characteristics, teacher’s characteristics, school organization, community values and needs and a description of how the programme relates to the total curriculum. 22 c)Determine Standards: by which outcomes will be judged in terms of what is good, acceptable and what expectations are reasonable in a given situation. The critical questions to ask are as follows: d) Did the design facilitate, deter or militate against effective goal attainment. The evaluator should as much as possible make judgment based on all the available data collected, the congruence between the outcome produced by the programme and the intended outcome. 2.6 Curriculum Evaluation Models and their Theoretical Camps Curriculum theorists belong to various schools of thought or theoretical camps which reflect their views on curriculum evaluation. The Objective Model This focuses on testing the curriculum as a product against the specification it is designed to meet. As observed by Steinhouse (1975), every curriculum plan is designed for a particular goal or purpose. In effect, the objective model examines how a curriculum is attuned to the what and why of that curriculum design. Notable among the theorists in this camp are, Ralph Tyler and his rational curriculum planning model, the linear model, means to an end model and Tyler’s curriculum rational.(Obiefuna, 2009).Tyler presented four questions curriculum development should address. These include: What educational purposes should the school seek to attain? What educational experiences can be provided that is likely to attain these purposes? How can these educational purposes be effectively organised? How can we determine whether these purposes are being attained? The selection of aims, goals and objectives describes educational purposes any school can seek to attain, the educational experiences which is more of content and learning experiences answers the second question. For instance, the result of evaluation will show if the objectives has been achieved or not. Evaluation of both content and objectives will determine the effectiveness of the programme and whether actually behaviour modification has occurred. In line with Tyler’s view, Leonard (1991) posit that to learn is to change, education is a process of effecting a desired change(s) in the behaviour of the learner. 23 Curriculum experts are becoming increasingly aware of the importance of diagnoses to identify the needs of the people before objectives can be formulated. Okpara (1991) described Tyler’s model as value neutral because of its omission of the value system. Any educational adventure which neglects or omits the value system of an environment may be said to be incomplete. Same is applicable to Wheeler’s model which lacks situational analysis and diagnoses of needs. Wheeler (1980) developed the cyclical model as a modification of the objective model. The model indicates inter-relatedness. For instance, the result of evaluation will show if the objectives has been achieved. The direction of the arrows shows a sequential and cyclical progression starting from the selection of objectives to the evaluation of the effectiveness of the various phases. Decision Making Models A major proponent of this model is Stufflebeam, (1983) who views evaluation as the process of delineating, obtaining and providing information for decision making. Provus (1971) focused on whether a discrepancy exists between programme standards and programme-performance. Discrepancy information is reported to decision makers. Cronbach identified scientific approaches to evaluation as opposite extremes on an evaluation continuum and believers in true experiment. Parlett and Hamilton (1976) emphasizes illumination of problems and significant features of an educational programme Models that Place Premium on Valuing Cuba and Lincoln,(1989),argues that the role of the evaluator is systematically facilitating the placement of values by others. Precisely, the placement of values on data is perhaps the most essential component of the evaluator’s work. Eisner (1993) also stated that evaluation should allow for some form of communication to the public, school board, local or state government about what has been and is occurring in 24 school.Scriven (1972) argues that the evaluator is free to collect whatever data that seem pertinent, in considering the total consequences of a programme which are evaluated against demonstrated needs. Portraiture Model According to Lightfoot, (1983), this is naturalistic subjective kind of evaluation. The evaluator visits the schools to observe students and teachers in class to conduct  Interviews and administer questionnaire  Examine the school records  Records his finding  Based on his observation he can now evaluate the quality of instruction, learning environment, organizational structure and administration. While not strictly an evaluation model portraiture can be used much like illuminative evaluation or; Eisner's connoisseur model. Sara Lawrence Lightfoot developed this method, drawing from the field of anthropology. Illuminative Evaluation model This model was propounded by Parlett and Hamilton (1976). It is also called Anthropological and responsive model. It clarifies some of the basic concept of the curriculum. It illuminates problems and significant features of an educational programme. Baiyelo (1993) stated that its main features include methods and techniques that involve extraction of evidencefrom direct participation,observation,interaction,discussion,debate,personal testimony,historical and experimental procedure. Goal Free Evaluation model Scriven, (1972) was hostile to the stereotype, dogmatic approach to evaluation. He argued that curriculum evaluators should not be distracted by the rhetoric of programme developer’s goal statement. They should carry out an unbiased assessment of the situation. The evaluator is free to 25 collect whatever data that seem pertinent, in considering the total consequence of a programme whichis evaluated against demonstrated needs. Quantitative, Scientific, Evaluation Model The quest for evaluation model continued with Cronbach identification of scientific approaches to evaluation as opposite extremes on an evaluation continuum. Curricularists in this theoretical camp are believers in true experiment. Their emphasis is on the learners and data, in the form of text scores which are employed to compare student’s achievement in different situations. Information collected is analyzed statistically. A good example of scientific - positivistic approach to evaluation is Provus Discrepancy Evaluation Model. It consists of four components and five stages of evaluation. The four components include: 1. Determining programme standards 2. Determining programme performance 3. Comparing performance with programme standards 4. Determining whether a discrepancy exist between programme-performance and programme standards. Discrepancy information is reported to decision makers. Congruence Contingency Evaluation model This model was propounded by Robert Stake (1972) who made a clear distinction between formal and informal evaluation procedures. He argues that educational evaluation continues to depend on casual judgment, implicit goals, intuitive norms and subjective judgment. His contention is that educators should strive to establish more formal evaluation procedures which are objective rather than subjective. The model focuses on antecedents, transactions and outcomes, Ornstein &Hunksins (1998:329). 26 Antecedents refers to conditions that has been in existence prior to teaching and learning that may influence outcomes which includes characteristics of the students prior to their lesson, their aptitudes, previous achievement scores,' psychological profile scores, grades, discipline, attendance, etc. Antecedents also includes: teachers characteristics, such as years of experience, type of education, teachers behaviour ratings, entry behaviour etc. Transactions are concerned with interactions the students have with certain curriculum materials and classroom environment. It deals with interactions between student to student, to teachers and resource persons, time allocation, space arrangement and communication flow. Transactions comprises of what is known as the "process" of teaching and instruction. The outcomes are the product of learning. The outcome is the result of the antecedents and transactions. Contingencies are concerned with the relationship among antecedents, transactions and outcomes. The challenge is this; the evaluator should identify the contingencies and congruencies among these indices - antecedents, transactions and outcomes. Stakes argues that outcomes are the consequences of education,immediate, long range, cognitive, affective, personal and community wide. Stufflebeams context, input, process, product CIPP evaluation model is another form of scientific positivistic evaluation model. Stufflebeam argue that a more comprehensive view of the curriculum can be achieved through the appraisal of the antecedents and the learning environment, the input of time money and energy,the interaction between the student,the teacher and the learning environment and the outcome of learning in terms of the performance of the learner in service delivery. Qualitative, Naturalistic,Humanistic, Evaluation Models 27 Most people are beginning to realize that to obtain a more complete picture of curricula, educators need to explore and utilize alternative to traditional evaluation procedures. These include the humanistic approaches to curriculum. Some theorists are firmly rooted in the quantitative camp e.g. Cronbach and Malcom provus, believers in true experiment, others' are in the qualitative camp e.g. Robert Stake(Responsive evaluation model), Eisner, parlet and Hamilton, while some others attest to the fact that quantitative and qualitative methods are complementary representing words and figures(Robert stake). Judicial Approach to Evaluation, otherwise known as Adversary Evaluation Approach As observed by Ornstein and Hunkins (1998), this procedure encompasses numerous evaluation activities in which time is scheduled for opposing points of view to be heard. One evaluator or team member serves as the progranul1e's advocate, presenting the positive view of the programme. Another evaluator or team member plays an adversarial role, stressing problems in the progranu11e. The encounter is very much like a court trial. People to be affected by the new programme have their day in the court. By allowing individuals to present both sides and opposing views of the new programme, a more accurate view of the new program is attained. The programme stands or falls on the weight of the evidence furnished. Eisner's Connoisseurship Evaluation Model (1993)focuses on appreciation and recognition of the educational significant in any evaluation adventure. Eisner points out that educational connoisseurship is the art of appreciating the educationally significant. But such appreciation is made public through criticism-the description, inter-relation, and assessment of the situation. In discussing his approach to evaluation, Eisner relies on personal observations, expert opinion, and group collaboration instead of scientific validity. Eisner makes the point that evaluation should allow for some form of communication to the public, school board, local or state government about what has been and is occurring in school. Eisner’s 28 model is subjective and considered controversial by those who believe in objective and scientific evaluation. Stakes' Responsive Evaluation Model Like Eisner's evaluation model, stakes responsive approach to curriculum evaluation is more concerned with the portrayal of the program than standardized data, test scores, and goals what some people might label as methodological or objective data. Using the responsive approach, the evaluator tells the story of the program, presents its features, describes the clients and personnel, identifies major issues and problems and reports the accomplishments. Unlike Stakes (1972) Congruence Contingency Evaluation model in which he was supportive of quantitative evaluation but in Stakes' Responsive Evaluation Model he tried to shift grounds to strike a balance between objective and subjective evaluation which represents words and figures. Illuminative Evaluation Model Illuminative evaluation propounded by Parlet and Hamilton(1976) is naturalistic approach to evaluation. It is sometimes called explication. It strives to furnish a complete picture of the educational program. This model illuminates problems and 'significant features of an educational program. There are three steps to the model: observation, further inquiry, and explanation. The illuminative model deals with the subtle aspects of the environment, the items that are often missed or discarded by the so-called objective observer. Formative and Summative Evaluation propounded by Scriven (1972).There are two main types of evaluation namely formative and summative evaluation. In formative evaluation, the purpose is to improve the curriculum at the different stages of its planning and development Azikiwe (2009). Itprovides feedback at regular intervals which is used by planners to improve on what exists through modification, reviewing and restructuring. Evaluation is carried out at each stage of development of the curriculum to determine whether to move to the next stage or review the previous stage before 29 proceeding forward. The draft curriculum should be pilot tested after complete development in selected pilot schools before its installation in the entire school system. Formative evaluation encompasses those activities undertaken to improve an intended programme. As an on-going process, it provides feedback to enable the curriculum developer to finalise the entire programme and arrive at a curriculum to be installed in the entire school system. As the curriculum is installed in the entire school system formative evaluation continues as implementation goes on. The various tests in the school during the year,the examinations at the end of each term which are used to promote the students from class to class constitute formative evaluation. Summative evaluation is directed towards assessing the extent to which the objectives of the curriculum have been achieved.It presents a total picture of the quality of the produced curriculum package. It is usually undertaken after the project has been completed and implemented school wide or district wide. It is indeed the evaluation of the total curriculum by an external agent.To assess the performance of learners, the extent of attainment of curriculum objectives and issue certificate to the products of the programme. Ohuche and Akeju (1977)identified one function of evaluation as that which is designed tohelp the students and teacher to pinpoint what the student has failed to learn so that this failure may be rectified. They added that formative evaluation is not undertaken for the purpose of grading or certifying the learner but for identification of his or her weakness areas that need special help for overall improvement at the end. In contrast, Summative evaluation involves grading and certifying of the learner and is concerned with passing judgement. Intrinsic and Pay-Off Evaluation model As soon as the worth of a curriculum has been established, its effect when delivered must be examined. Michael Scriven calls it Pay-Off evaluation. 30 To evaluate curriculum intrinsically, the evaluator should study the particular content included, the manner in which the content was sequenced, the accuracy of the content, the types of experiences suggested in dealing with the content and the different types of materials to be used. There is an assumption that if curriculum plan has accurate content and firm basis for its unique organization, it will be effective in stimulating quality learning (e.g. Michael Scriven). Michael Scriven a major defender of intrinsic evaluation assert that it is really the only evaluation model that counts in the sense that it supplies information that allows them to determine the effect of the curriculum or course on the learners. Advocates of the pay-off evaluation model argue that based on their experiences and present state of knowledge, most of the time, evaluators undertake "arm chair" intrinsic evaluation which they cannot defend, the much they can do is to document whether the learners have attained a stated objectives. Furthermore, proponents of intrinsic and pay-off evaluation argue that a better idea of the relevance and elegance of the curriculum can be achieved through direct observation of curriculum materials, not student test scores. 2.7The meaning and concept of programme evaluation According to Pratt, (1994), programme evaluation refers to continuous appraisal of the entire educational systems to identify its strengths and weaknesses after a curriculum document has been adopted and implemented either for try-out or full-scale implementation of the programme. It focuses on examination of the programme to ensure that it is internally sound in terms of infrastructure, process, resources, instructional materials, teaching methods and techniques, students’ abilities, staff qualifications, students and staff activities, communications, outcome and cost benefits. 2.8 The importanceof programme evaluation 31 It gives the curriculum specialist an opportunity to revise, compare, maintain or discontinue their actions and programmes. Ndubuisi (2009) sums up programme evaluation to mean a continuous process of diagnosis of the strengths and the weaknesses of the programme, identification of outcome of instructions, recognition of the need for teacher improvement, identification of the need for the review of the programme. The fore-going indicates the pivotal nature of programme evaluation as it focuses on all the components of the programme to make its task elaborate and enormous.’ From these definitions, programme evaluation is a measure of success or failure of any educational programme. It enables curriculum planners to ascertain the expected behavioural changes, the extent of behavioural changes and factors that facilitate the change or otherwise. A meaningful programme evaluation must focus on infrastructure, instructional materials, content, teaching methods techniques, outcome of the programme in terms of competency and proficiency of the products. It should also include the domains of learning namely: cognitive (knowledge and intellect), psycho- productive, (skills) and affective (attitudes and values). 2.9 Three Programme Dimensions that should always be evaluated Pratt (1980) identified some critical questions evaluation should address .These include: (l) Effectiveness - Compares outcome with the intention of the programme · Did the learners achieve the objectives or preferable? · Did the minimum expected number of students achieve the minimum stipulated objectives of the minimum level? · Did grades reflect achievement of objectives; the criterion level may be stated in terms of grades? · Did 90% of those who enter the program achieve a passing grade and masters all critical objectives? 32 · Did 50% achieve a grade of honour? (2) Acceptability: A programme that achieves all its objectives may still be judged a failure if' the people involved dislike the experience. Acceptability addresses these critical questions: Is it worth doing? How well is it being done?(Adegoke,2003). Evaluation should centre on the teacher, the leaner, subject matter and milieu 'with different techniques and appropriate degrees of emphasis. · Did you support the intents of the programme? · Was the programme straight forward to implement? · Did it involve extra work? · Did you have adequate resources? (3) Efficiency - Compares outcome with input of money, energy of production and output relative to input of energy and resources. Input of time, money should be quantified as far as possible. Evaluation generally involves assessment and judgement of both students’ performance and the curriculum itself.(Igwe 2003) 2.10 Historical evolution and development of nursing education in Nigeria. Historical development of nursing as a profession reveals that socio-cultural changes have shaped nursing profession.Nursing education in Nigeria has undergone dramatic change in response to societal needs and influences. A critical look at nursing beginning reveals its continuing struggle for professionalism and competence in response to socio-cultural changes and consumer demands. According to Adelowo, 33 (1988) Nigeria received her nursing traditions from the European and American missionaries in the late 1800s. Following the establishment of the Nightingale training school for nurses, at St Thomas Hospital in England in (1860), the concept spread like wild fire to North America and to different parts of the world Nigeria inclusive. Hospital administrators welcomed the idea of training schools as a source of nursing staff for free or inexpensive staffing for the hospitals. The training took the form of apprenticeship programme with little formal classroom instruction. Students learned by providing direct care to clients. There was no standardisation of curriculum and no accreditation. Programmes were designed to meet the service needs of the hospital not the educational needs of the students. Lectures were delivered by the European sister anytime the lecturer was available, on any nursing subject and in any available room. Following the (1947) nursing ordinance, the Nursing Council of Nigeria a quasi- government body was established to oversee to the training, certification and registration of professional nurses in Nigeria. Adelowo,(1988)stated that the first basic nursing school established in Nigeria was the Seventh Day Adventist (S.D.A.) Ife. In (1952), the University College Hospital (UCH) School of Nursing Ibadan was also established followed by the School of Nursing Lagos University Teaching Hospital (LUTH) in (1962). By the time Nigeria attained political independence in (1960), there were a total of thirty Basic Nursing institutions in Nigeria but today, (2014) the total number of approved basic nursing schools in Nigeria has increased to 73.(Federal 10,State 49, Missions12,Military1) as shown in table1. Table1: Overview of the four categories of approved BNE institutions in Nigeria and their geo- political zones. Geo-political zones Federal State Mission Military Total South-East 1 9 6 - 16 South-West 3 9 3 1 16 South-South 1 10 3 - 15 North-East 1 6 - - 7 North-West 2 6 - 10 North- Central 0 5 3 - 8 FCT 1 - - - 1 Total 10 45 17 1 73 34 The entry requirement into BNE programme across the country was 5 credits in English language, Mathematics, Biology or Health Science and any other two courses at not more than two sittings. Recently, the entry requirement into BNE programme, effective from (2006) is 5 credits in English language, mathematics, physics, chemistry and biology at not more than two sittings. The duration of training is three years. The training is a hospital–based educational programme which provides rich clinical experiences for nursing students. Nursing Education Reform The society is not static but dynamic. Nursing education today is no longer what it used to be in the yester years,it has experienced tremendous growth in structure and function.There are emerging health issues such as nursing informatics,safety and security education, cultural sensitive care,biochemistry among others which should be incorporated into basic nursing education programme to make it relevant to the 21 st century society. As observed by Zakari (2006) which was confirmed by Olaniyonu (2007), nursing education in Nigeria has passed through various paradigm shifts right from its inception in the year (1930). The Nursing Council of Nigeria, a quasi-government body was established as a committee to oversee to the training and registration of nurses in Nigeria with respect to the requirements for nursing education, examination and registration of nurses. In (1965), the committee observed that sound educational principles are essential ingredients to equip the nurses with the necessary skills and knowledge to cater for the health needs of the society. The certificate that was awarded to the products of the programme was registered nurse (RN) which was considered to be lower than OND, NCE and HND as obtainable in the circular educational system. This issue of quantification of basic nursing education certificate has become a serious challenge affecting nurses seeking admission into tertiary institutions and employment in the industries. The Nursing council continuously reviewed the BNE curriculum in (1993) and (1999) respectively, which gave birth to the (2001) BNE 35 curriculum under investigation. As reported by Zakari (2006),each time the curriculum was reviewed (examined to determine whether change was needed), new topics, objectives and pieces of information were added to the existing curriculum such as Nursing process, principles of management, project writing. The outcome this incremental change was a curriculum which consists mainly of patch work of topics which are poorly organized. In practice, no change in the conceptual structure of the subject matter is apparent. There was no recorded account of thorough appraisal of all the segments of BNE curriculum to ensure that it is still relevant in meeting the needs of the learners and the society in a rapidly changing world. The foregoing has indicated clearly where nursing education in Nigeria is coming from, what development brought it to its present state? What problems were encountered during the journey? What factors obstructed or facilitated the journey? Precisely, historical development of nursing has provided the process and the content of nursing education in Nigeria, a foundation for the present and the future, to plan strategies for a smooth transition, given insight to persons and resources that has supported and strengthened nursing education over the years. Gender related issues in nursing Profession(Men in nursing). The study conducted by Alao, (2015) has shown clearly that gender disparity has become a critical issue in nursing profession right from its inception in the 18 th century. Male nurses were denied admission to the Military Nurse Corp during the Second World War based on gender. It was believed at that time that nursing was a female work and combatant was men's work Wall (2009). During the 20 th century, men were denied admission to most nursing programmes. After becoming a nurse, the American Nurses Association (ANA) denied membership to male nurses until (1930). Many state nursing associations did not allow men to join nursing profession until the (1950s) (O’Lynn& Tranbarger, 2007).The foregoing has made it abundantly clear why nursing profession is dominated by females. However in the 20 th century, the idea that nursing is a profession meant for women completely eroded away, male nurses were offered admission into various nursing institutions except for midwifery. This refusal to admit 36 male nurses into midwifery practice remains controversial and has generated a lot of debate among nurses and members of the public (Zakari, 2006). 2.11Basic Nursing Education Policy in Nigeria Nursing policies have significant impact on nursing education and practice.According to Anderson, (2005) a policy is a principle to guide decisions and achieve rational outcomes. It is a statement of intent which is implemented as a procedure or protocol. Kozier & Erbs, (2012 stated that nursing education and practice are governed by so many legal concepts. It is important for nursing students to know the basic legal concepts that affect them in the practice of their profession as they are accountable for their professional judgements and actions. Nursing students are not employees of the hospitals of their clinical experience. The nursing students are responsible for their own actions and liable to their own acts of negligence committed during clinical experiences. Accountability is an essential concept of professional nursing practice. Nursing and Law Knowledge of the laws that regulate and affect nursing practice is needed for two main reasons.(1) To ensure that the nurse decision and actions are consistent with current legal practices (2) to protect the nurse from liability. Law can be defined as the sum total of rules and regulations by which a society is governed. In effect, law is created by people and exist to regulate all persons (Guido 2010, in Kozier & Erb’s, 2012). Functions of Law in Nursing - It provides a framework for establishing which nursing actions in the care of clients are legal. - It differentiates the nurse’s responsibilities from those of other health professionals. - It establishes the boundaries of independent nursing action 37 - Assists in maintaining a standard of nursing practice by making nurses accountable under the law Legal Protection for Nurses Provision of safe, competent practice, timely, accurate, comprehensive, legible, factual and complete documentation, abiding by the nurses practice act which protects the public by legally defining and describing the scope of nursing practice, licensure, certification and accreditation are the major components of legal protection and safeguard for nurses. 1. Admission/Entry requirements into BNE programme in Nigeria. The minimum entry requirement for teachers is Bachelor of Nursing Science (B.NSc). For Students, Five credits, in English Language, Mathematics, Biology, Chemistry and Physics (Nursing& Midwifery Council of Nigeria, 2001). 2 Attendance Policy Theory Classes The students are expected to maintain 100% attendance in all theory classes. However in case of emergency and illness, the student may be absent up to 15% cumulative of theory classes. If the learner is absent for more than 15% per semester, he may be asked to repeat the semester, be withdrawn or expelled from the programme if the problem persists (Rafat, 2006). (Parkistan Nursing Council PNC rule 2006).If absence is due to justifiablereason; it is the responsibility of the learners to meet up with the missed contents of the class. In each academic year, learners are allowed annual leave of one calendar month. Sick leave of seven days is permissible; any leave beyond this will be deducted from annual leave. 3. Clinical/Laboratory skills 38 The learners are expected to maintain 100% attendance during clinical experience. However in case of emergency and sickness, learners may be absent up to 4 days cumulative of clinical experience has to be made up. If the learner is absent for more than 4days leave in a semester, he may be asked to repeat the semester or be withdrawn or expelled from the programme if pattern of leave is persistent. Clinical conferences are part of clinical experience and should be attended regularly. 4. Internship policy The purpose of the internship is to strengthen knowledge and skills. The institution will be responsible to arrange internship for their graduates in BNE affiliated teaching hospital. The candidate will be required to submit a formal letter and certificate at the completion of internship period issued by the Director nursing services to the provost of the college of nursing who will send the final list of eligible candidates for licensure examination to Nursing Council of Nigeria. 5. Provision of safe and Competent Nursing Care Competency is the ability to cope successfully with the tasks and challenges encountered on the job or any desired activity (Adegoke, 2003). It transcends scholastic and academic achievements. It is concerned with how well the educational programme equips the nursing students with adequate knowledge, attitude and skills to make them more relevant to a modern society. The emphasis is on productive work, empowerment,sustainability which addresses four components of competence namely, capability, coping,creativity and cooperative action. Competent nursing care is a major safeguard for nurses. Nurses should provide care that is within the legal boundaries of their practice and within the boundaries of employment agency 39 policies and procedures.The nurse must be familiar with their various job descriptions which may defer from one agency to another. Every nurse must ensure that his or her education and experience are adequate to meet the responsibilities delineated in the job description. She must function within the scope of her education, job description and nursing practice act and should follow the procedures and policies of employing agencies. Competency also involves care that protects clients from harm. The nurses should anticipate sources of client injury and educate clients about hazards and implement measures to prevent injury, observe and monitor the client accurately. 6. Unprofessional and Unethical conduct. Ethics in nursing is focused on matters of obligation, or what ought to be done. The moral components of knowing in nursing go beyond knowledge of the norms or ethical codes of nursing, other disciplinesand societyBasavanthappa(2007). It involves moment-to-moment judgements about what ought to be done. What is good and right and what is responsible.Ethical knowing guides and directs how nurses conduct their practice, what they select as important, where loyalties are placed and what priorities demand advocacy. Ehical knowing also involves confronting and resolving conflicting values, norms, interests or principles. Unethical conduct is considered as one of the basis for actions against the nurse’s licence which include incompetence, gross negligence, practicing without licence, falsification of client records, illegal, obtaining, utilisation or possessing controlled substances (drugs etc.), having personal relationship with a client especially a vulnerable client. Code of ethics for Nurses condemns such an act, as the code states that nurses are responsible for retaining their professional boundaries (ANA 2005). Unethical conduct may also include violation of 40 professional ethical codes, breach of confidentiality, invasion of privacy which may injure thefeelings of the client, fraud or refusing to care for clients of specific socio-economic and cultural origins and drug administration errors. 7. Drug Administration Errors Japhet (2011) identified strategies to minimize drugadministration errors: - Identify the patient by her name before administration of medication and ensure that the prescription chart on her bedside is bearing the patients name, Ensure that prescriptions are correct and complete to prevent prescription errors due to sound-alike, look-alike names e.g. administration of ergometrine to an 8yrs old child in place of ergotamine. - Ensure proper lighting for thorough check of prescription chartsand drug containers. - Be careful with zeros/abbreviations, decimal points that could lead to misinterpretations, over-dosage and death e.g prn ( when necessary), tds(three times daily), b.d (morning and evening), 1/52 (one week), 1/12 (one month), 1/7 (one day), administration of 5mls insulin in place of 5 units insulin can be very dangerous to the client. Avoid omission and inaccuracies - In case of injections, the used vial should be preserved for at least 48hrs. Administer drugs via the correct and prescribed routes - ,intramuscularly (1/m) subcutaneously sub cut, intravenously (1/v) - Maintain constant observation of the patient for any adverse drug reaction. - Ensure proper documentation after administration of medication - Organise work place (work space, work environment and work flow). - Avoid distractions which are a major cause of drug administration error. 9. Documentation and Reporting 41 Keeping records and reporting observationsare essential for effective nursing management. The client’s medical chart is a legal document that can be presented in court. Accurate and complete documentation is very important. Failure to properly document can constitute negligence punishable by law as insufficient and inaccurate assessments and documentation can hinder proper diagnosis and treatment which may lead to over dosage and may result in injury to the client. The nurse must report all incidents that involve the clients. 2.12TheNursing Council of Nigeria The Nursing Council of Nigeria, a quasi-government body was established by Decree No 89 (Registration Act).This is a constituted regulatory body for professional nursing practice. Its primary objectives are accreditation/approval of basic nursing educational programs, maintain discipline, high and uniformed standards of nursing education andpractice, conduct examinations, certification, registration of nurses and to issue license for nursing practice. The primary concern of the council is to understand the theoretical basis of any curriculum issues and the overall significance of nursing education curriculum in Nigeria. In (1965), the Nursing Councilobserved that sound educational principles are essential ingredients to equip the nurses with the necessary skills and knowledge to cater for the health needs of the society. The certificate that was awarded to the products of the programme was registered nurse (RN) which was not equivalent to OND, NCE and HND as obtainable in the circular educational system. This creates considerable problem for nurses seeking employment in the industries and ad