Curriculum changes for pre-registration nursing education in times of COVID-19: For the better or worse?

Abstract

The ‘crown-spiked’ severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), which was first detected among the pneumonia clusters in a seafood and live animal market located in Wuhan, China in December 2019, silently subdues the immunity of global human population precipitously. Prompt aggressive public health measures such as mandated quarantine, closure of workplaces and schools, hospital infection control, community hygiene, social distancing and public education preceded in curbing this evolving pandemic caused by coronavirus disease 2019 (COVID-19). They impacted the nursing education community. Academic nursing institutions supporting the future workforce faced initial challenges in delivering planned curriculum and assessment virtually through non in-person interactions to provide clinical knowledge and training. Generally, these virtual interactions take place online, which use the internet to bring about connectivity in learning. While what is taught has not changed materially, the mode of delivery using learning technologies has varied and expanded. In Singapore, the emergence of multiple community cluster outbreaks in early February 2020 led to the announcement of Disease Outbreak Response System Condition (DORSCON) from yellow to orange. This color-coded framework, based on the pathogen's transmissibility, virulence and spread of disease locally and internationally, guides the scale of outbreak response Singapore government takes. Essentially, this led to implementation of e-learning for large group classes and physical distancing for small group face-to-face classes. Like other affected countries, clinical postings for healthcare students were halted to reduce infection transmission and allow hospital staff to focus in managing the crisis. Our three-year pre-registration baccalaureate nursing program, which provides students with an optional fourth year for honors research project, was affected. Our nursing department decided to transit all face-to-face lectures, tutorials, skill laboratory classes and examinations online for junior (year one and two) students to minimize physical contact with academic staff. Exceptions were made for graduating (year three and four) students to have some face-to-face lessons on clinical skills practice and simulation-based learning. Prior to the outbreak, clinical learning for the year three students consisted a 4-week pre-transition clinical practicum at the hospitals, a simulation-based pre-graduation clinical transition program coupled with self-directed clinical skills practice and an Objective Structured Clinical Examination (OSCE), followed by a 9-week consolidated ‘Transition To Practice’ (TTP) clinical practicum at hospitals. On the other hand, the fourth-year students had to complete 10 weeks of practicum to hone their clinical skills prior to graduating as registered nurses. Special approval was obtained from the Singapore's nursing regulatory board to replace 160 consolidated clinical practice hours with 80 h of simulation-based learning, to develop graduating students' competence in patient care management and fulfil the accreditation requirements for professional licensing of registered nurses. Thereafter, graduating students were permitted to resume clinical postings in April 2020. This allowed the continuity of experiential clinical learning and assisted healthcare institutes with additional pair of hands to cope with manpower crunch, which arise from the contingent deployment of staff in managing COVID-19. Fortunately for the fourth-year students, they were at the stage of writing theses for their individual research projects when the outbreak occurred; otherwise the conduct on some of their primary research studies would be disrupted. To ensure students meet their academic requirements yet observing public health measures, nurse academics across the globe use their best efforts and resources at disposal to quickly revise curriculum for pre-registration nurses, demonstrating flexibility, resilience and creativity. However, has the disrupted curricular changes brought about by COVID-19 improved or worsened the teaching and learning for pre-registration nursing students? This article reflected on and discussed the immediate operational and pedagogical curricular changes on pre-registration nursing education, from the perspective of a nursing institute in a Singapore university. It aimed to identify key insights in coping with future pandemics among educators in academic nursing institutes.