Adaptive Psychosocial Competencies: Toward a Development of a Framework for Life Skills-Based Philippine Nursing Education Curricula

In the Philippines, the nursing curriculum has a solid liberal arts and sciences education with a transdisciplinary approach. In their formative years, the most common source of stress for student nurses was related to academics. However, countries around the world formalize initiatives on life skills education to promote adaptive psychosocial skills and abilities to achieve holistic development. The study aimed to explore and examine the Bachelor of Science in Nursing program and its implications for life skills education in the curricula. This study employed a qualitative research design, mainly through needs analysis, literature review, and theoretical synthesis. The investigation revealed that the academic rigor and practice of the nursing program influenced students’ ability to cope with stress. The full nursing curriculum is considered eclectic; however, life skills competency integration needs to be more obscure. The nursing curriculum must have a striking balance of cognitive, psychomotor, and affective domains. Furthermore, life skills education in nursing must uphold caring as the core value proposed in the Humanistic Life Skills Framework for Nursing. Life skills education should be strengthened, which is imperative in the current nursing program.


Introduction
Countries around the world formalize initiatives on life skills education to promote psychosocial skills that are unprecedented nowadays. The changing landscape of education brought by inevitable changes in economic, political, sociocultural, and the advancement of innovations in technology -significantly affects everyone, including the learners. Life skills promote mental wellbeing and competence in young people facing drastic changes in the contemporary world (Prajapati et al., 2017;Vranda & Rao, 2011;Tuttle et al., 2006). The life skills program being initiated recently was to help students know and understand themselves better (Madsgaard et al., 2022;Nabolsi et al., 2012;Taylor, 2014). Thus, students are more conscious and deliberate in achieving their goals in both personal and academic endeavors. Recently, life skills education initiatives have been implemented to address adolescent learners' behavioral and emotional well-being (Prajapati et al., 2017).
The Universal Declaration of Human Rights, Article 26 (2), states, "Education shall be directed to the full development of the human personality and the strengthening of respect for human rights and fundamental freedoms."Education is a basic human right, equipping individuals with the skills and knowledge to lead better lives and underpins human development (UNESCO, 2014). The World Health Organization (WHO) defines life skills as the abilities and adaptive positive behavior to deal effectively with everyday demands and challenges. In addition, the United Nations International Children's Emergency Fund (UNICEF) also defined life skills as a behavioral development approach designed to address three areas: knowledge, skills, and attitude. In this study, life skills education promotes adaptive psychosocial skills and abilities to deal with unwanted stress and demanding situations effectively.
Nursing has been regarded as one of the most stressful professions for young people (Ewertsson et al., 2017;Kostantinos & Ouzouni, 2008;Ohler et al., 2010;Olvera Alvarez et al., 2019;Pulido-Martos et al., 2011;Senturk & Dogan, 2018;Farnia et al., 2016). Student nurses must manage their time efficiently to accomplish countless assignments, pass various significant examinations, and perform clinical and community internships, to name a few. Inevitably, failure in such a condition would lead to poor chances of academic success (Farnia et al., 2016). Furthermore, life skills bridge the gap between basic functioning and capabilities in dealing with problems and challenges in daily human life (Papageorgiou & Kavga, 2009). It strengthens the ability of an individual to meet the needs and demands when uncertainty arises. Also, life skills education for student nurses helps deal with countless issues, such as occupational stressors, mental health problems, harmony in self-attribution, and other unwanted stimuli.
Globally, the Philippines is known for producing competent and compassionate nurses. However, despite the accolade, in the formative years of student nurses, insurmountable challenges are being faced, especially in completing the academic requirements of the bachelor's degree. In a study conducted by Labrague et al. (2018), Filipino student nurses' main stressors came from their assignments and workload. Nursing, as a solid liberal arts and sciences education with a transdisciplinary approach, makes it more tedious and challenging to study.
More professional literature needs to explore and examine life skills education inclusion employing competency integration in the nursing program in the Philippines. Various factors affect the overall well-being of student nurses, which are as follows: managing and coping rightfully with the pressing demands of academics (Kostantinos & Ouzouni, 2008;Labrague, 2013); clinical training (Jamshidi et al., 2016); learning environment (Borzou et al., 2009); and even personal needs (Pryjmachuk & Richards., 2007). The attempt to analyze the Bachelor of Science in Nursing (BSN) program, policies, standards, and other pertinent documents concerning life skills education was sought.
Furthermore, in the Philippines, one of the challenges was attributed to the "present curriculum" (Labrague, 2013, p. 428). These situations are indicative of how nursing has been regarded as one of the most stressful professions (Ewertsson et al., 2017;Olvera Alvarez et al., 2019;Kostantinos & Ouzouni 2008;Pulido-Martos et al., 2011;Sentruk & Dogan, 2018;Farnia et al., 2016) in their formative years of nursing education and even beyond after program completion. Consequently, the paper explored and examined the current policies, standards, and guidelines of the BSN Program as approved by the Philippine Commission on Higher Education. The recent CHED Memorandum Order No. 15 s. 2017. Furthermore, this paper draws on research from relevant professional literature on life skills education in nursing.

Research Question
This study will specifically answer the following question: What are the implications of life skills education in Philippine Nursing Education?

Research Design
This study used a qualitative research design that examined the prescribed policies, standards, and guidelines of the Bachelor of Science in Nursing in the Philippines. In addition, a qualitative inquiry through literature review and theoretical synthesis (Jaakola, 2020) was initiated to reframe and solidify what is presently known about the recent attributes of the Philippine Nursing Education Curriculum regarding life skills education. The study provides a conceptual foundation through a framework incorporating essential competencies of like skills and relevant elements as input for curriculum development. Also, it presents a discussion of relevant concepts and identifies knowledge gaps across these bodies of work.

Data Collection
Furthermore, a desk review (Sileyew, 2019) was employed to provide a structured data search on published data, review articles, enabling laws, and other pertinent documents. The data sources of this paper are categorized into two: the primary sources; and the secondary sources. The primary sources in this paper mainly consist of the CHED Memorandum Order and other executive orders. The primary data were collected through online government repositories. On the other hand, the secondary data sources primarily include policy briefs, news articles, peer-reviewed articles, and other relevant written materials that can be accessed online. A systematic search was conducted using various online databases: Google Scholar, ERIC, Medline, and other Philippine databases. The keywords used for this review were "life skills education in nursing" or "life skills in the nursing program," with limitations to studies conducted in nursing and other related fields from 2006 to the present.

Data Analysis
A document analysis was instigated in a deductive manner (Braun & Clarke, 2006). Generally, the study applied various document analysis techniques to integrate life skills education into the nursing curriculum. First, the qualitative inquiry was conducted with guide questions for the primary sources, and the answers were tabulated and rationalized. Second, for the secondary sources, the data were analyzed with consideration of purpose and findings and were organized through pertinent codes that served as a guide in identifying relevant themes in abstracting the conceptual foundation of this study. In addition, the study conducted a needs assessment of the program and the curriculum analysis (Lau, 2001), mainly based on post-modern perspectives (Doll, 1993). Lastly, the triangulation (Creswell, 2005) of data was initiated through cross-case analysis based on the expected meanings, nuances, and central issues among the various data sources as anchored through the theoretical underpinnings of the study.

Results and Discussion
The data sources of this paper utilized both primary and secondary sources. Generally, the study applied various stages of document analysis techniques in the abstraction of the conceptual foundation and discussion of the study. The results of this review article focus on its conceptual emphasis on the implications of life skills education in the nursing program.

Academic Rigor and Practice of the Nursing Program
According to the thematic analysis, student nurses usually experienced much stress during their formative years and before the completion of the program. Most of the time, student nurses experience various challenges, which are as follows: rigor to comply with academic requirements; completion of the related learning experience (RLE) both in clinical and community settings; application of nursing theories and practice (Labrague, 2013;Labrague et al., 2018;Olvera Alvarez et al., 2019); master the nursing core competencies and standards which is multidisciplinary; experience inevitable burn-out and increase in stress as the year in the program progresses (Farnia et al., 2016;Ewertsson et al., 2017); the drop-out rate rises on the higher years of the course; and the pressure to maintain good scholastic standing were apparent.
These deplorable situations mentioned above indicate how nursing has been regarded as one of the most stressful professions to study (Ewertsson et al., 2017;Olvera Alvarez et al., 2019;Pulido-Martos et al., 2011;Sentruk & Dogan, 2018;Farnia et al., 2016). Consistent with the study of Pulido-Martos et al. (2011) and Labrague et al. (2018), the most common source of stress for student nurses is related to their academics. According to Papageorgiou and Kavga (2009), there is a dire need to develop life skills among student nurses as remarkably; evidence shows that depression and anxiety are common problems among nurses (Kostantinos & Ouzouni, 2008;Ohler et al., 2010). A Life Skills-Based Nursing Program in the Philippines is sought, where curriculum components must be inclusive and integrative of the life skills competencies. Furthermore, there is a dire need to perform a mapping of the life skills competencies in the present program and curricular offerings, which is imperative to the holistic development of the students.
While the pressure of completing academic requirements is standard among student nurses, the clinical and community aspects of student internships are another challenge. The program entails students practicing and applying the essential nursing competencies in various clinical and community settings. Remarkably, during the actual nursing practice, the self-confidence and even self-esteem of the student nurses are tested, especially since medical errors are highly discouraged in practice. It is permanently ingrained in the students' minds to avoid clinical errors for the safety of the patients' lives (Kostantinos & Ouzouni, 2008). However, enabling an environment for learning must be upheld, at least for the benefit of the students to maximize their learning and the application of their nursing competencies in practice. For instance, providing an enabling environment is challenging, especially if the imbalanced ratio of nurse to the patient in the clinical setting is present (Kostantinos & Ouzouni, 2008;Papageorgiou & Kavga, 2009;Wall, 2010).

Packed Curriculum
Based on the data analysis, the Bachelor of Science in Nursing Curriculum has 192 units compared to the Bachelor of Science in Biology Curriculum with 158 units, respectively, in the merit that both are pre-medicine undergraduate programs. A student nurse should undergo from 46 to 53 units related to the learning experience (approximately 2,346 hours to 2,703 hours of clinical and community exposure), while a B.S. Biology student follows the three units of internship (approximately) 150 hours. The Nursing Curriculum has a solid liberal arts and sciences education with a transdisciplinary approach -making it a diverse discipline. Furthermore, Labrague (2013) mentioned that one of the challenges of Filipino student nurses was attributed to the "present curriculum" (p. 428).
The nursing curriculum has strong liberal arts and sciences education with a transdisciplinary approach. For instance, the clinical instructors utilize various pedagogical approaches to teaching and learning about the various subjects -especially the major courses which are specialized and tedious (e.g., Maternal and Childcare, Medical and Surgical Nursing, Psychiatric Nursing, Public Health Nursing) which add rigor to the program to develop student's nursing competencies. In the analysis of the prescribed courses in the CHED Memorandum Order No. 15 s. 2017, the Social Sciences and Humanities subjects constitute a portion of the total units of the nursing program (approximately 21 units). Surprisingly, the emphasis on life skills education, including life skillsrelated courses in the curriculum, needs to be explicitly stated; hence, life skills competency integration and inclusion of it needs to be clarified. According to Fernandez-Distajo (2013), Filipino college students are expected to assume the role of adults and want to be treated as such, where greater independence is apparent. Directly integrating life skills or even developing a separate course in the nursing curriculum gives nursing schools and higher education institutions the upper hand to prepare students in the program holistically and effectively. Most importantly, student nurses' abilities for adaptive and positive behavior will enable them to deal effectively with the demands and challenges of everyday life. In addition, if institutionalized, a life skills program should guide the students to be holistically prepared for the demanding academic tasks of developing and enriching their psychosocial skills and overall well-being, to mention a few. In nursing, the mastery of crucial core competencies anchored to UNICEF's essential knowledge, skills, and attitude is sought in life skills education. However, despite achieving the desired competencies, self-awareness is pivotal. With this, nursing students must learn to control and lead themselves to achieve goals by improving their selfleadership (Kim & Kim, 2012). Furthermore, according to Park and Kim (2017), leadership life skills and achievement motivation influence self-leadership. The authors argued that it is necessary to develop intervention programs to enhance task orientation, responsibility, and future orientation.

Caring as a Core Value
According to the analysis results, incorporating life skills education and anchoring 'caring' as the core value of the nursing profession becomes a vital component, for instance, in developing a holistic curriculum. Therefore, the striking balance of cognitive, psychomotor, and emotional prowess is unprecedented (Sali, 2020b). Consequently, Pryjmachuk and Richards (2007) found that stress in nursing students arises from personal and extracurricular factors. Thus, it should anchor the WHO definition of life skills, like the abilities for adaptive and positive behavior that enable individuals to deal effectively with the demands and challenges of everyday life. The premise is for the nurses to develop a personal development process and to better handle inevitable stress and stimuli in their years of learning (Kim & Kim, 2012;Park & Kim, 2017;Papageorgiou & Kavga, 2009). The student nurses should be well grounded in life skills education, which needs to be improved in the current nursing curriculum.
Furthermore, the concept of life skills has been attributed to the model instigated by Gerald Weinstein and Mario Fantini (1970) that links socio-psychological factors with cognition so learners can deal with their problems and concerns. For this reason, the study anchors its life skills education inclusion to curriculum development design, primarily considering the unprecedented importance of the 'effect' toward learning (Madsgaard et al., 2022;Nabolsi et al., 2012;Taylor, 2014), which is often neglected. Weinstein and Fantini's Humanistic Model was rooted in progressive philosophy and the child-centered movement of the early 1900s. As a humanistic approach to curriculum development, it advances strong arguments that the total person-the cognitive, the affective, and even the spiritual self is involved in gaining knowledge toward wisdom. The students' self-concept and self-esteem are essential factors in this process. With this, I argue that a more responsive nursing curriculum must consider the need for self-reflection (Sali, 2020a;Sali, 2021) as part of the teaching strategies and assessment tasks, which is integral in addressing some inevitable challenges of the program concerning developing a total person. Further, the CHED Memorandum Order No. 15 s. 2017 serves as a guideline for the policies and standards of the BSN Program in the Philippines. The program is being offered by Higher Education Institutions (HEIs); thus, rationalizing the nursing profession allows the country to provide a relevant and quality program. Cognizant of the salient provision of the CMO, the vision and mission of the HEIs offering the course, and Republic Act no 9173 or the 'Philippine Nursing Act of 1991', the Bachelor of Science in Nursing program aims to develop graduates that are competent in the profession and possess the 21 st -century skills needed nowadays. However, various factors must be considered in addressing personal, social, and academic stressors of the student nurses (Ewertsson et al., 2017;Olvera Alvarez et al., 2019;Kostantinos & Ouzouni 2008;Pulido-Martos et al., 2011;Sentruk & Dogan, 2018;Farnia et al., 2016). The curriculum should prepare nursing graduates to be professionally competent, lifelong learners, and critical and creative thinkers but also cultivate personal development towards self-awareness with emphasis on psychoemotional equilibrium and even psychosocial competencies (Vranda & Rao, 2011).

Humanistic Life Skills Framework for Nursing
The proposed Humanistic Life Skills Framework for Nursing (see Figure 1) is guided by the following philosophy: A curriculum should have a striking balance among cognitive, psychomotor, and affective domains. It is essential to teach the crucial competencies for knowledge production, develop 21st-century skills (especially critical learning skills, life skills, and creative learning skills), and hone adaptive psychosocial skills and abilities to survive the fast-changing world. The Bachelor of Science in Nursing program is both a competency-based and a skills-oriented profession (Borzou et al., 2009). Caring must be the core of the nursing profession that strongly links the humanistic approach. The framework is anchored to Weinstein and Fantini's Humanistic Model among the models.
The framework is also anchored to the Humanism approach in nursing that attempts to take a broader perspective of the individual's potential and emphasize the individual's free choice, selfdetermination, and self-responsibility. Furthermore, the curriculum and its components must prepare nurses to deal with the complexities of the profession in the fast-changing world (Prajapati et al., 2017;Vranda & Rao, 2011;Tuttle et al., 2006). As such, the desired holistic outcome is realized by correctly conceptualizing nursing graduates with cognitive, psychomotor, and affective domains in the framework that emphasizes life-skills education.
The framework is attuned to preparing student nurses to hurdle academic rigors and can surpass stress-related scenarios in the formative years and beyond the program completion. The student, as the center of the framework, should be acquainted with the Ten Core Life Skills recommended by the World Health Organization (1996), which are as follows: self-awareness; empathy; coping with stress and emotions; interpersonal relationship; critical & creative thinking; decision making; problem-solving; and effective communication. This will enable students to thrive and cope with the unprecedented demands of the profession/program. As individuals, the premise, each of the students is unique in their way, especially in coping and dealing with stresses -which is essential in integrating life skills competencies in the nursing curriculum.

Nurse as Creator
Nurses as Critical Thinkers

Nurse as Communicator
Humanistic

Nursing (Care) Curriculum
By integrating the Ten Core Life Skills, the curriculum ensures the holistic formation and balance of the three areas of UNICEF's Life Skills Education Model, which is also being utilized by the current nursing program in the respective domains: Knowledge, Skills, and Attitude. Undertaking the said process through the outward approach is based on the premise that the student nurses should develop their cognitive processes, nursing practices, and professional attitude alongside life skills as emphasized and integrated into the curriculum to be more inclusive. Therefore, it also prepares them to transition from student nurses to professional life. Furthermore, the desired outcomes of the proposed curriculum design are to produce 21 st -century nurses who also embody the four essential 21 st -century skills: Nurses who are critical thinkers; Nurses who are effective communicators; Nurses who are collaborators; and creative Nurses and creators. In totality, the framework acknowledges 'care' as the core value and component of the proposed framework (see Figure 2).

Figure 2. The Desired Outcomes
On the other hand, there is a dire need to mitigate the harmful effects of chronic stress among student nurses to maintain balance in their physical, psychological, and emotional well-being. The proposed framework shows the importance of developing essential skills among student nurses to identify their susceptibility to developing stress resulting from their academic environment. Also, the framework serves as a significant impetus in crafting effective interventions and strategies to mitigate various stressors from the formative to professional years of the nurses. Lastly, since the framework is anchored to the Humanism approach in nursing, it prioritizes the person's full potential to self and others, which takes a broader perspective to emphasize the individual's free choice, self-determination, and self-responsibility a unique individual.

Conclusion
The study emphasized the dire need for life skills education inclusion in the Philippine Nursing Curriculum. Remarkably, based on the analysis of data, the nursing curriculum has a solid liberal arts and sciences education with a transdisciplinary approach which makes it more eclectic as a discipline. Consistent with the professional literature on stress among student nurses, the most common source of unwanted stimuli was related to academics. The essence of incorporating life skills education and anchoring 'caring' as the core value in the nursing profession is unprecedented. The premise is for the nurses to develop a personal development process and to know themselves better in handling inevitable stress and stimuli in their formative years of learning and beyond professional practice. The student nurses should be acquainted with developing life skills lacking and obscure in the current nursing curriculum. The proposed Humanistic Nursing Care Curriculum Design requires a striking balance among cognitive, psychomotor, and affective domains. The said curriculum design is an impetus for curriculum development, especially in the post-modern world. Although it is essential to teach the crucial competencies for knowledge production and develop 21 st -century skills, it is also unprecedented to hone adaptive psychosocial skills and abilities in contemporary education to survive the fast-changing world.