Community health specialist nurses and primary health care in Macao: Linking core competencies with curriculum development

This study focuses on curriculum development for competency-based training of advanced practice nursing and smoking cessation in Macao. The aims of this thesis are: (a) to link the core competencies of Advanced Practice Nursing (APN) to curriculum development; (b) to make recommendations for improved specialist nurse training to address current problems of nursing; and (c) to gather data to indicate the scope and the severity of the issues related to nurse training in Macao. The thesis presents a comprehensive literature review of theoretical frameworks of competency-based nursing curricula, curriculum development and design, quality assurance, best practice in competency based models of nursing education, theories of change and innovation, needs analysis and stakeholder satisfaction. The thesis develops and implements a needs analysis and situational analysis of nursing education in Macao, using a „mixed methods‟ approach that integrates quantitative and qualitative data to identify the needs for, and perception of, core competencies in Community Health APNs by the health professionals and clients of the community. This includes an empirical survey of stakeholders, semi-structured interviews with professionals in the field of nursing and nurse training, structured questionnaires from clients, observational data on training and implementation of competency-based curricula, and evaluation of a piece of curriculum implementation of an APN training program on smoking cessation. Through action research cycles, the thesis synthesizes a range of literature and empirical data, and, from these, gains feedback for improvement and refinement of the new curriculum to be implemented. As well as conducting client satisfaction surveys of the primary health care provision and services in Macau and how these could be improved, the thesis provides the framework for a competency-based curriculum for nursing education in Macau. The thesis argues that, in order to keep abreast with current developments in nurse training and practice worldwide, it is essential for APN education and training to adopt a competency-based approach and for curricula to be framed in terms of competencies and outcomes. It indicates that these are currently under-developed in Macao, and that there is an urgent need for them to be addressed, in terms of general, core and specific competencies (e.g. smoking cessation). The thesis argues that, for such developments to iii happen, fundamental changes will be required to curricula and to APN nursing practice, as, even though there may be changes to curricula, the opportunity to put general and specific competencies into practice by APNs is currently severely restricted because of a range of constraints in Macao. The thesis argues that there is an urgent need for APNs to receive competency-based training and practice for smoking cessation, and the opportunity to put this training into practice. It indicates that even short workshops and training programs can be effective. The thesis argues that current obstacles to such practice can be identified, but that overcoming them presents serious challenges to the current system, and will require action on many fronts, including revisions to local legislation, nurse credentialing, facilitation by senior managers of the health service, and an increase in the supply of nurses. The thesis indicates that there is a strong and united will for changes to be made to bring about competency-based training, curricula and practice in Macao, but that there are many practical barriers to be overcome in order to bring about these changes