The Study of Learning Outcomes under Thai Qualifications Frameworks for Higher Education ( TQF : HEd ) in Community Health Nursing Practicum Course of 4

Introduction: This was descriptive research which aimed to study the learning outcomes based on the Thai Qualifications Frameworks for Higher Education (TQF: HEd)) after completing community health nursing practicum of 4th year students, the Faculty of Nursing, Naresuan University. Methods: The samples were 113 4th year nursing students. Data were collected using the evaluation form of opinions on learning outcomes in six areas, namely morals and ethics, knowledge, intellectual skills, interpersonal skills and responsibility, numerical analysis, communication and information technology skills and professional practice skills. Data were analyzed using frequency distribution, percentage, mean and standard deviation. Results: The research results showed that the mean score of the opinions of the 4th year students, Faculty of Nursing, Naresuan University, toward their learning outcomes based on the TQF: HEd was quite high in all six areas. The overall score was at a high level (X̄=4.36, S.D. =0.42). The area with the highest level was morals and ethics (X̄ = 4.50, S.D = 0.39), followed by professional practice skills (X̄ = 4.48, S.D. = 0.49), interpersonal skills and responsibility (X̄ = 4.43, S.D. = 0.53), numerical analysis, communication and information technology skills (X̄ = 4.31, S.D. = 0.55), intellectual skills (X̄= 4.31, S.D. = 0.52) and knowledge (X̄ = 4.11, S.D. = 0.55), respectively. Conclusion: The research results can be used as the guidelines for the development of learning outcomes and assessment in accordance with the TQF: HEd. ARTICLE HISTORY Received: May 16, 2020 Accepted: July 8, 2020


INTRODUCTION
The Thai Qualification Framework for Higher Education (TQF: HEd) refers to the framework presenting the educational system of higher education in the country developed by the Office of the Higher Education Commission, which helps promote life-long learning. There are systems and mechanisms that assure the effectiveness of implementation of the TQF: HEd in producing graduates to achieve quality according to learning outcomes, consistent with the National Education Act and Amendments (Second National Education Act B.E. 2545), National Educational Standards, Higher Education Standards and Qualifications of Bachelor's Degree in Nursing Science Program B.E. 2560. committed to enhancing the quality of Thai education to be equal and accepted in the Association of Southeast Asian Nations (ASEAN) and at the international level.
Therefore, the quality development tools that are recognized in ASEAN and at the international level as the effective tools in the development of the organization to excellence have been adopted.
The policy of AUN-QA (Asean University Network Quality Assurance) has been adopted. It is the collaboration of the international higher education institutions in ASEAN and Education Criteria for Performance Excellence (EdPEx), which is the educational quality assurance in the European countries. Its objective is to establish the mechanisms for quality assurance and higher education standards of Thai higher education institutions in order to have quality and to be developed equivalent to the international standards. The administrators of each institution have to consider their institution's readiness and implement AUN-QA (Asean University Network Quality Assurance) or Education Criteria for Performance Excellence (EdPEx). However, the TQF: HEd must be implemented in every institution.
The main objective of the Community Health Nursing Practicum Course is to allow students to prepare their own learning plan and practice community health nursing. Management of teaching and learning to enhance students to think critically together with having nursing knowledge is important. Reflection should, therefore, be the teaching method used to promote critical thinking of students (Wichainate, 2014). For the management of teaching and learning focusing on practice, followed by reflection by the coach who gives advice, encouragement and suggestions for improvements (Panich, 2013), learning activities can be designed in many ways, such as conducting projects in groups so that group members are involved in analysis, determining objectives, planning and evaluating by themselves. From the literature review, it has been found that this type of teaching and learning can be applied in the management of nursing education as well as nursing teaching. It can be done by increasing abilities in practice which contribute to building nursing standards (Ahmed, Alostaz, & Al-Lateef Sammouri, 2016;Alotaibi, 2016;Fujino-Oyama, Maeda, Maru, & Inoue, 2016;Tao, Li, Xū, & Jiang, 2015). Therefore, in the Community Health Nursing Practicum Course the students are divided into a small group of 7-8 people. After that, they have to practice nursing practices in the training areas in rural and suburban communities. They will be trained to provide care for service recipients by focusing on promotion, prevention, treatment and rehabilitation of health at the individual, family, group and community levels. This gives the students the opportunity to learn on their own in the wider world by using the community health nursing process, including community assessment, diagnosis of community health problems, planning and practice in the form of project activities whereby students think together, and help each other conduct and evaluate project activities with the created tools ( Intaranongpai & Kotchakot, 2017;Inthonhongpai, 2011). Previously, the Faculty of Nursing, Naresuan University realized the importance of educational management in response to Qualifications of Bachelor's Degree in Nursing Science Program B.E. 2560. The lecturers were promoted to integrate research into teaching and learning in the Community Health Nursing Practicum Course of the Bachelor of Nursing Science Program (Revised Curriculum, 2016), which is due for revision in the year 2020 in order to provide this course with information about improvements, new teaching methods that will make students achieve the learning outcomes defined in the learning outcomes of Community Health Nursing Practicum Course and to organize the teaching and learning process enhancing students to be able to integrate theoretical knowledge and relevant theoretical concepts in operation. The focus is on promoting students to learn and practice on their own; use critical thinking skills to solve problems systematically and be able to practice nursing practices in the community responding to the problems and needs of people in all levels. In the academic year 2019, the Community Nursing Academic Group, the Faculty of Nursing, Naresuan University, organized teaching and learning and expected that the obtained results would lead to the improvement of the Bachelor of Nursing Science Program in 2020.
For the course details, it was the course of practicum of the 4 th year nursing students organized in the last semester of the Bachelor of Nursing Science Program, Academic Year 2019. It is about the community health nursing process which applies nursing science knowledge and focuses on nursing practices in family, schools, establishments, and communities. The Community Nursing Academic Group is responsible for the teaching and learning of this course. The 4 th year students of the Faculty of Nursing will experience community survey, data collection, community diagnosis, health promotion projects in the community as well as health innovations focusing on strengthening families and communities by using appropriate resources and technology combined with local wisdom and selfcare. In addition, students will gain experiences of occupational health nursing, family nursing, school health nursing and community health nursing. The Community Health Nursing Practicum Course of the Bachelor of Nursing Science Program in the academic year 2019 provided teaching and learning in accordance with the TQF: HEd. The results of the evaluation of teaching and learning of this course in the previous year obtained from the supervisor and the nurse mentor from each training area and the 4 th Year nursing students revealed that the training duration was short. In addition, there were many assignments for professional practice, so the students had to quickly do these. This can reduce the quality of assignments. Therefore, these issues were improved for the teaching and learning in the academic year 2020. The 4 th year students of the Faculty of Nursing can search for knowledge from a variety of learning sources to respond to the learning outcomes according to the Qualifications of Bachelor's Degree in Nursing Science Program in terms of content, teaching methods, measurement and evaluation and to achieve learning outcomes as specified in the program learning outcomes of this course in all six areas. The student-centered learning process was more emphasized. There was an integration of theoretical knowledge which can be implemented. In addition, critical thinking skills and systematic problems solving skills responding to problems and needs of people at all levels were also enhanced. For these reasons, the researcher was interested in studying the opinions of the 4 th year nursing students after finishing the Community Health Nursing Practicum Course of the Bachelor of Nursing Science Program (Revised Curriculum, 2016) regarding the learning outcomes in accordance with the Qualifications of Bachelor's Degree in Nursing Science Program in all six areas. The research findings were expected to be the guidelines for development of teaching and learning management to meet the learning standards as specified in the Thai Qualifications Frameworks for Higher Education and desirable characteristics of nursing students.
To study the levels of the learning outcomes in accordance with the TQF: HEd after completing the community health nursing practicum based on the perception of by 4 th year students of the Faculty of Nursing, Naresuan University.

MATERIALS AND METHODS
This was descriptive research which aimed to study the learning outcomes based on the TQF: HEd) after completing the Community Health Nursing Practicum of the 4th year students of the Faculty of Nursing, Naresuan University. The data were collected in October 2019 and February 2020.
The population included 113 4 th year nursing students in the academic year 2019 who completed the community health nursing practicum from Tambon Health Promoting Hospital in Bang Rakam District and Bang Krathum District, Phitsanulok Province. They were selected by a purposive sampling method. All 4 th year students were asked to consider the results of the use of the TQF: HEd in six areas in teaching on the Community Health Nursing Practicum Course.
Inclusion criteria: 113 4 th year students of the Faculty of Nursing, academic year 2019 who completed community health nursing practicum in Tambon Health Promoting Hospitals in Bang Rakam District and Bang Krathum District, Phitsanulok Province and agreed to participate in the study.
Exclusion criterion: 4th year students of the Faculty of Nursing, academic year 2019 who were sick and unable to respond to the questionnaire during the data collection period.
The researcher constructed the instruments, including the general information questionnaire consisting of five questions asking about gender, age, GPA, group of students, Tambon Health Promoting Hospitals where the students practiced community health nursing, and the questionnaire assessing the opinions, consisting of 36 questions based on the TQF: HEd of Community Health Nursing Practicum Course of the Bachelor of Nursing Science Program (Revised Curriculum, 2016), covering six areas, namely morals and ethics, knowledge, intellectual skills, interpersonal skills and responsibility, numerical analysis, communication and information technology skills and professional practice skills. It was adapted from the nursing practice evaluation form of the Faculty of Nursing, Naresuan University, 2016. The answers were 5-point rating scales where 5 means the highest level; 4 means high level; 3 means moderate level; 2 means low level and 1 means the lowest level. The reliability of the instruments was tested by the Cronbach's alpha coefficient which was 0.94.
After the research had been approved by the Human Research Ethics Committee, Naresuan University, the researcher collected data on her own. The data were collected in October 2019 and February 2020. The researcher distributed the questionnaires to the population and explained to the population the research objective and the details in answering the questionnaires.
The population returned the questionnaires to the researcher after completing them. The researcher checked the completeness of all questionnaires. The responses were obtained from all 113 people, accounting 100%. Data were analyzed by using a statistical package program and descriptive statistics to find out mean and standard deviation.
The researcher protected the rights of the population by explaining the details of the research objective, data collection process, research methodology and benefits from the research; asking for cooperation in answering the questionnaires and clarifying the rights of the population in accepting or denying participating in this research, which would not affect the evaluation of the course. The researcher kept the information confidential and only an overview of the data would be presented. First and last names of the population would not be revealed. Once the population accepted to participate in the study, they had to sign the consent form. This study was approved by the Human Ethics Committee of Sciences, Technology and Human Sciences Program, Naresuan University. Code of Ethics was NU-IRB 4452.
The learning outcomes of the students according to the TQF: HEd: The students' score toward their learning outcomes in the Community Health Nursing Practicum Course was at the highest level. The area with the highest score was morals and ethics (X̄  Table 2.

DISCUSSION
The overall perceived learning outcomes based on the TQF of 4 th year students of the Faculty of Nursing, Naresuan University, after completing community health nursing practice was at a high level ( X̄ = 4.36, S.D.= 0.42). This was consistent with previous studies (Intaranongpai & Kotchakot, 2017;Janjaroen, 2011;Wattanatornnan & Sangsongrit, 2017). The Community Nursing Academic Group, the Faculty of Nursing, Naresuan University, used the assessment results from the supervisors, the mentors and the students to improve the teaching and learning management, knowledge management and preparation of nursing students before starting to practice in the training areas. In addition, morals and ethics were included in lessons. The students were encouraged to adhere to the principles of the sufficiency economy and search for new knowledge. There were supervisors and nurse mentors in the training areas. There was the availability of training resources and evaluation tools consistent with learning outcomes. There was support of the use of information technology in searching for health information and continuous self-development. There was an increase of the use of online media while practicing for communication. The students were encouraged to think and solve problems creatively. Therefore, the students had skills in collaboration with local health teams and were able to adapt themselves by being open to new things. For these reasons, the students' learning outcomes were in accordance with the TQF: HEd after practicing nursing practices at a high level. This is in line with the integrated teaching and learning in accordance with the educational management and learning process specified in the National Education Act. The integrated learning process focuses on being studentcentered and relies on transfer of learning. The students understand content in a holistic way, see the relationship between subjects and reduce duplication of content in each subject. They can also learn from real experience. Knowledge, moral process and desirable characteristics are combined to increase the potential of the students unlimitedly because they have learned how to proceed lifelong learning.
When each aspect had been considered, the highest level of the students' opinions on learning outcomes was on morals and ethics (X̄ = 4.50 S.D. = 0.39). In addition, the sub-competencies that were at the highest level were as follows. 1) Being able to distinguish rightness, goodness and badness (X̄ = 4.74, SD = 0.44): The example of behaviors was that the students learned that, when working in every community, everyone must be good, honest, scarified and not steal things. 2) Respecting human value and dignity (X̄ = 4.85, S.D. = 0.36): The example of behaviors included respecting service recipients in the community, not disclosing service recipients' information, not lying to service recipients while working in the community, being a good role model in terms of both self-care and community nursing practices for service recipients at all levels, such as practicing community health nursing with intention and diligence and behaving appropriately while working in the community. 3) Being responsible for   = 0.56). The findings of this study were consistent with the studies of Janjaroen (2000) and Chanchareun and Amphansirirat (2012) which found that the nursing students' opinions on learning outcomes in morals and ethics were at the highest level (X̄=4.38, S.D.= 0.46). The overall knowledge was at a high level (X̄ = 4.11, S.D. = 0.55), and all sub-competencies of the learning outcomes were rated at a high level, such as having knowledge and understanding of culture, changing situations of the country and global society (X̄ = 4.28, S.D. = 0.71). For example, they could understand the social and cultural context of each area and the situation of health changes at both a global level and in Thailand. In addition, the Community Nursing Academic Group had prepared the students and organized orientation for them before they went to practice in the community. So, the perceived knowledge of the students was a high level. This was consistent with the study by Wattanatornnan (2017) on the effect of skillenhancing activities on knowledge and the confidence of the students of Thai Red Cross College of Nursing, enrolling in Nursing Care of Adult and Aging Practicum II. It was found that in terms of knowledge, most of the students perceived that skill-enhancing activities allowed them to be able to apply knowledge before starting practicum.
The overall intellectual skills were at a high level (X̄ = 4.31, S.D. = 0.52). The competency with the highest level was being able to use information and evidence as references and to solve problems critically (X̄ = 4.44, S.D. = 0.61). For the teaching and learning management of the Community Health Nursing Practicum Course, activities were organized for the students to apply knowledge from nursing science and other fields of science by using the nursing processes in individual, family, and community nursing, covering physical and psychosocial aspects in health promotion, disease prevention, medical treatment and rehabilitation because community health nursing practicum is practice in a real area. A project for human health was also organized for the students, so that they could apply scientific processes and create appropriate innovations for searching and analyzing data in various sources in order to find out the solutions to health problems that change according to sociocultural context. Therefore, the learning outcomes of the students on knowledge and intellectual skills were at a high level.
The overall interpersonal skills and responsibility were at a high level (X̄ = 4.43, S.D. = 0.53). The competency with the highest level in this area was having social responsibility and responsibility for professional development (X̄ = 4.56, S.D. = 0.55) and being able to work in a team as a leader and team member (X̄ = 4.50, S.D. = 0.62). For the community health nursing practicum, it must be operated as teamwork. The students had to collaborate with the multidisciplinary team, community leaders, Tambon Health Promoting Hospitals, village health volunteers and the public sector. For this reason, the students could build relationships and adapt themselves to the socio-cultural context of the area in order to be able to work together with others. While practicing, the students were divided into 7-8 people per group. The roles and responsibilities were shared to all students. They had to play the roles of both leaders and followers, which might not be in accordance with their abilities. However, everyone could perform the assigned tasks. They were developed by themselves. Reflection with the lecturers and the group members was also organized. In addition, the students also lived together in the community throughout the practice period. Therefore, the learning outcome of interpersonal skills and responsibility was at a high level.
The overall of numerical analysis, communication and information technology skills was at a high level (X̄=4.31, S.D. =0.55), and all sub-competencies of the learning outcomes were rated at a high level. This might be because the students had the skills in searching for information and using information technology. They were also able to manage information, communication, and presentation using electronic media. They also had skills in using basic computer programs. This was in accordance with Kungvon and Suksaen (2014) who found that the students assessed themselves on the learning outcomes in numerical analysis skills, communication and the use of information technology at a high level (X̄=-3.79, S.D. =0.71).
In terms of professional practice skills, the students' opinions on learning outcomes in this aspect were at a high level (X̄=4.48, S.D. =0.49). Also, the first two learning performance aspects rated with the highest level were as follows. 1) Practicing nursing with kindness and generosity by adhering to morals, ethics, law and patients' rights (X̄=4.72, S.D= 0.50): The example of behaviors included expressing concern for service recipients, talking to service recipients in a friendly manner and providing consistent care for patients. 2) Practicing community health nursing with consideration of individual and cultural diversity (X̄=4.66, S.D= 0.52): The example of behaviors included not violating privacy of patients, not revealing information of patients, doing activities based on the differences of each service recipient, organizing health promotion activities in the community, providing health knowledge and demonstrating health care practices. These results were in accordance with Janjaroen (2011) and Kungvon and Suksaen (2014) who found that graduate quality based on the TQF: HEd n terms of professional practice skills was at a high level (X̄=3.95, S.D.= 0.42).

CONCLUSION
The research results can be used as the guidelines for the development of learning outcomes and assessment in accordance with the Thai Qualifications Frameworks for Higher Education (TQF: HEd).
Recommendations for application of research findings in teaching and learning management are as follows. 1) Teaching strategies and learning evaluation should be developed in accordance with the context of the course.
2) The research findings should be used as the guidelines for improving learning outcomes and evaluation in accordance with the TQF: HEd in order to improve the curriculum efficiently.
Recommendations for further research: The comparative study on learning outcomes of the Community Health Nursing Practicum Course perceived by nursing students, mentors and supervisors should be conducted.