Competency Based Education, Curriculum Elements, Organizing Frameworks Curriculum Design In Nursing

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Nursing Competency Based Education, Curriculum Elements, Organizing Frameworks Curriculum Design

Competency Based Education and Curriculum Design In Nursing Education Ordering or Constructing Knowledge within the Curriculum In Nursing Education, Curriculum Elements In Nursing Education, Organizing Frameworks for Curriculum In Nursing Education, Penn Nursing Organizing Framework In Nursing Education.

Competency Based Education and Curriculum Design In Nursing Education

    The term competency-based education (CBE) as a curriculum approach has a specific, formal definition and is used to define practices embedded in a given curriculum. 

    According to the formal definition, CBE is a “framework for designing and implementing education that focuses on the desired performance characteristics of health care professions. . . . CBE makes explicit [the implicit goal of competence in more traditional education frameworks] by establishing observable and measurable performance metrics that learners must attain to be deemed competent” (Gruppen, Mangrulkar, & Kolars, 2012, p. 1). 

    In contrast, traditional education programs employ learning objectives with definitions of competence that are less clear and precise and sometimes a weaker or inconsistent approach to actually testing and measuring competency achievement. Supporters of CBE cite its systematic and valid assessment of competencies as well as the opportunity for students to progress at their own pace rather than fit into a planned time for and sequence of learning activities. 

    Additionally, CBE may be more resource effective than traditional education methods. Challenges to fully implementing CBE in health related roles include identifying the health needs of the community, defining competencies, developing self regulated and flexible learning options, and assessing learners for competence. A formal CBE approach may also not suit all learners’ preferences and abilities. 

    As noted earlier, virtually all nursing and professional education programs incorporate some aspects of CBE as it is required for accreditation and licensure; however, the amount of and consistency to which CBE principles are employed varies widely across nursing education programs.

Ordering or Constructing Knowledge within the Curriculum In Nursing Education

    Regardless of the curriculum design model chosen, faculty must still make decisions about how knowledge will be ordered or constructed within the curriculum. Wiles and Bondi (2011) describe five patterns of ordering or constructing knowledge in a curriculum. 

    Similar to the blending of curricular design approaches, many nursing education programs use aspects of the five patterns within the overall curriculum, sometimes within the same semester or course. It is helpful that faculty be clear and guide students through how the curriculum and courses are organized to avoid confusion and provide clear expectations.

    In a building blocks design, content and learning activities commence with foundational knowledge or skills, followed by more detailed or specialized material and, if appropriate, a higher level of depth or specialized knowledge. 

    A branching design is similar to a building blocks design in that foundational knowledge or skills occur first, after which there are varied learning option pathways to achieve the desired KSAs. This pattern is typically strongly represented in the blocked curriculum design model.

    In a spiral design, selected areas of knowledge appear repeatedly through the curriculum, in greater depth or breadth. In some fields, this area is further differentiated into a spiral versus a strand design. In a spiral curriculum, many different topics are covered at designated points throughout the curriculum. 

    The points may be at regular or intermittent intervals because of concerns that students often forget previously covered information as a result of the brief instructional time devoted to each and because students do not have time to master important foundational knowledge. To minimize these issues, some education experts advocate the use of a strand (sometimes also called a thread) design. 

    In a strand design, topics are arranged into meaningful groups that are regularly repeated, building better achievement and retention rates. Spiral or strand designs are prominent in concept-based curricula.

    A tasks or skills design is characterized by presentation of specific knowledge and experiences that are expected to lead learners to achieve the desired competencies. There may be varying pathways for students as individuals or by groupings that reflect learning preferences or other characteristics. This pattern is usually prominent in CBE programs, although the tasks and skills are grouped into the larger competencies for assessment purposes.

    The fifth pattern of ordering knowledge is the process design where the focus is on the process of learning with specific information or content provided examples to illustrate the process. Some educators believe that the enhanced focus on narrative pedagogy and related teaching and learning strategies (e.g., the concept of learning to “think like a nurse”) reflect a process design.

Curriculum Elements In Nursing Education

    Curriculum development is a challenging yet rewarding endeavor that ranks among the top responsibilities of a collective faculty. While much has been written about curriculum and its associated processes, there are multiple approaches and terminologies proposed, leading to confusion and disagreements about what elements compose a curriculum. 

    For purposes of this chapter, the following curricular elements are included and discussed: curriculum design, organizing framework, end-of-program outcomes and competencies, level competencies, course design, teaching strategies and learning experiences, and resources needed to implement the curriculum. 

    The terminology and definitions reflect some of the most commonly used across schools of nursing. The influence of contemporary thinking and newer approaches to teaching and learning are highlighted within each element.

Organizing Frameworks for Curriculum In Nursing Education

    Organizing frameworks can be a means for creating access to knowledge about the phenomena of interest or importance to the discipline. Organizing frameworks do provide a logical structure for cataloguing and retrieving knowledge. 

    This structure, often depicted as a schematic conceptualization, is essential to the processes of teaching and learning as faculty guide students in the development of cognitive linkages among knowledge. This helps faculty and students understand the abstract nature of nursing. 

    Fawcett’s (1989) classic work on conceptual models and frameworks can provide readers with a discussion of theories, models, and concepts that is beyond the scope of this chapter.

    Organizing frameworks have been used in curriculum development to delineate the constructs embedded in a traditional philosophy statement that reflects the collective faculty belief. 

    It is important that organizing frameworks not be construed as a permanent feature of a program but rather as a kaleidoscope of complex patterns related to what students need to know and how they will best learn it.

    The purpose in constructing frameworks is to systematically design a mental picture that is meaningful to the faculty and students when determining what knowledge is important and has value to nursing today, and how that knowledge should be defined, categorized, and linked with other knowledge. 

    Although the majority of nurses continue to practice in acute care settings, with the increasing emphasis on transitional care there needs to be broader orientation to a continuum of care settings within a global context. 

    This thinking is consistent with the IOM’s landmark report recommendation (2010) that tomorrow’s nurse be prepared to practice across a broad range of care settings and also reflects evolving changes related to the Patient Protection and Affordable Care Act (2011); thus organizing frameworks need to reflect concepts relevant to populations and settings.

    Organizing curriculum frameworks provide a blueprint for determining the scope of knowledge (i.e., which concepts are important to include in the teachers’ and learners’ mental picture) and a means of structuring that knowledge in a distinctive and meaningful way for faculty and students. 

    As such, organizing curriculum frameworks are the educational road maps to teaching and learning. As with any road map, multiple route options are available for arriving at a given destination or outcome. A number of approaches are used in defining and shaping frameworks. 

    However, an organizing framework must reflect the sphere of nursing practice, the phenomena of concern to nurses, and how nurses relate to others who are dealing with health concerns, often referred to as nursing’s metaparadigm (Lee & Fawcett, 2013).

    On review of the organizing framework, one would expect to find the following concepts to be further developed and explicitly interconnected for students within the curriculum: nursing practice situated within a caring relationship; health, illness, and healing; nursing’s embeddedness within health care systems, social structures, and society; and judgment, inquiry, engagement, and voice. 

    Using this organizing framework as the structural curriculum guidepost for which it is intended, faculty would be held accountable for designing learning experiences that foster students’ application of these concepts in increasingly complex and contextualized clinical experiences with patients, families, communities, and populations.

Penn Nursing Organizing Framework In Nursing Education

    One University, One School, One Curriculum Penn’s baccalaureate curriculum brings structure to the school’s mission, vision, and values by centering on the primacy of nursing practice situated in caring relationships that facilitate health and healing. 

    The baccalaureate curriculum builds on this conceptualization of nursing because it moves students toward increasingly contextualized understandings of individuals, families, communities, and populations living with health and illness. 

    It also moves students into increasingly complex situations and care environments because they experience the dynamic nature of nursing’s embeddedness in health care systems, social structures, and society. The baccalaureate curriculum concentrates on four intersecting core themes that characterize the complex and contextual nature of nursing practice: judgment, inquiry, engagement, and voice.

    As faculty embrace adoption of an outcome orientation in curriculum building, organizing frameworks or models will continue to serve the same purposes but will be driven by philosophical views and futuristic mental pictures regarding the evolving practice of nursing. 

    For example, the role of nurses in telehealth and retail based clinics, in both undergraduate and graduate roles, provide new and expanding career options for nurses, so competencies must reflect a wider perspective on nursing practice essentials. Organizing frameworks directly guide development of educational outcomes and end-of-program competencies that are also leveled for more detailed planning purposes.

    The process of selecting or designing an organizing framework that will best serve a program or school is not an easy task; however, this process is an exceptional opportunity for faculty to build teamwork and innovation skills. 

    Two general approaches may be used in determining the kind of organizing framework faculty wish to construct. The first approach is to select a single, specific nursing theory or model on which to build the framework, a traditional approach that is used today in some schools. 

    A second, more commonly used approach is more eclectic and blends concepts from multiple theories or models, a method which has gained in popularity as the complexity of nursing and the health care environment has increased.

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