Curriculum Design and Models In Nursing Education

Nursing Education and Curriculum Design & Models

What Is Curriculum Designs In Nursing Education, Curricular Design Models In Nursing Education, Blocked Course Content Curricula In Nursing Education, Concept Based Curricula In Nursing Education

What Is Curriculum Designs In Nursing Education

    A well conceived curriculum is critical to the preparation of practicing nurses at all levels. Once a program’s curriculum is designed, curriculum building becomes an on-going task that is indispensable to, yet separate from, the acts of teaching and learning. 

   Curriculum is a dynamic, evolving entity shaped by learner needs and desired achievement, faculty’s beliefs about the science and art of nursing, and emerging needs of the populations served within changing health care services, delivery structures, and organization.

    Creating a specific curriculum design for a given program must take into account many factors, including the mission, vision, and goals of the educational entity; the philosophy of the educational entity and that of the school of nursing; and the priorities of major stakeholder groups (e.g., students, faculty, employers, alumni, and others). 

    After deciding on desired program outcomes and competencies, faculty are positioned to design the curriculum. It is important to note, however, that it is helpful to create a working organizing framework to guide the development of program outcomes and competencies, as these two components must become synchronized for curricular integrity.

    The topic of curriculum design models is complex because of the numerous and often overlapping nomenclature or differential use of the same terms. This discussion is further complicated because nursing education programs frequently use a combination of design models. Descriptions of two of the most commonly used models for curricular design currently in use in nursing education curricula are presented.

Curricular Design Models In Nursing Education

    The overall organization of a curriculum may be identified as based primarily on one of three models of design: 

(1) blocks of content (often in nursing education reflecting clinical specialties)

(2) concepts (that often reflect subjects within nursing and from other disciplines thought to be critical for nursing practice)

(3) competencies (that reflect broad areas of expected graduate performance that are sequentially “leveled” throughout the curriculum by semester, year, or other time parameter to enable students to advance in knowledge and skill development and achieve desired learning outcomes). 

    Virtually all nursing education programs incorporate a strong focus on competencies because nursing is a practice profession and because program accreditation and professional licensing requirements incorporate expected results or competencies. Competencies can be imbedded throughout either “blocking” or concept design models. 

    A specific challenge that nursing and other practice disciplines share is how to best plan for clinical or practice experiences. The more traditional model consists of a mostly concurrent plan, wherein didactic courses are paired with clinical experience courses with the goal of matching the two. 

    In reality, this rarely works and the logistical issues can be insurmountable. Many programs use a mixed approach, in which some didactic nursing courses have associated clinical experiences and others do not. 

    Some programs are experimenting with frontloading didactic content and sometimes clinical simulation activities after which a clinical intensive or immersion occurs with the goal of integrating the targeted KSA competencies to be achieved. 

    Faculty should also carefully consider clinical learning sites that will provide students with exposure to clinical experiences across the care continuum and in collaboration with learners from other disciplines.

Blocked Course Content Curricula In Nursing Education

    Faculty who wish to design a curriculum primarily using blocks of content must first carefully enumerate the major blocks or clusters of information that need to be represented within the curriculum. Patterns can be built on the premise of sequencing specific courses and corresponding clinical learning experiences. 

    This approach assumes that there is a logical order to sequencing content that will facilitate learning and requires faculty to consider what evidence exists to help them make evidence-based decisions regarding what the “logical” order might be.

    Courses in a blocked curriculum are usually structured around clinical specialty areas, patient population, pathologic conditions, or physical systems. Historically, nursing programs have been organized by type of patient (medical condition, specialty, or age) and sometimes by settings (predominantly acute care hospitals with some ambulatory or skilled nursing focus and clinical experiences as well as within the community). 

    Courses with titles based on medical or clinical specialty areas such as adult medical-surgical, pediatric, maternal-child, and community nursing are examples of a blocked approach to curriculum design. Other important content or concepts are taught in separate courses such as research and evidence-based practice, foundations of professional nursing, among others. 

    Additionally, some important content or concepts are placed in courses that seemed to be the best match; such examples include quality and safety, leadership, and cultural diversity topics. 

    It is also possible to have a predominately blocked approach to curriculum design, with selective integration of some content areas across the curriculum, such as pharmacology and nutrition, or some concepts such as pain or inflammation.

    The idea of blocking content organizes both teaching and learning. It facilitates faculty course assignments and complements faculty expertise, allowing faculty to teach primarily in their areas of expertise in a specific location within the curriculum. It is also relatively easy to trace placement of content in the curriculum.

    However, the segregation or blocking of content into specific courses can cause content to become isolated from previous or subsequent coursework and can impede the learner’s ability to integrate knowledge and transfer concepts, information, and experiences from one course to another. 

    By and large, this curriculum design model produces a curriculum that is highly structured, with little latitude for deviation and meeting individual learning needs. 

    Faculty who design curriculum with a block design also need to guard against the tendency for a strong sense of course ownership to develop among faculty who consider a course to “be theirs,” and thus become resistant to changes within their course that need to occur to maintain curricular integrity. 

    Open, ongoing communication and shared faculty decision-making around curriculum development and revision is essential to maintain curricular integrity.

    Blocked curriculum design also has the potential to obscure issues with learner development and growth as a professional. When a student does not pass a course, it is not uncommon to hear faculty say that the student failed “pediatrics” or “intensive care,” for example. 

    In reality, although the student was not able to apply the expected knowledge, skills, or behaviors to a given population, it was actually the student’s inability to transfer and apply the key concepts required to demonstrate safe clinical reasoning skills that led to the failure. Faculty must look beyond the “content” to the “concepts” to gain an understanding of what has led to the failing performance.

Concept Based Curricula In Nursing Education

    Today there is growing interest in a more conceptual approach to curriculum design and the use of core concepts as a focal point of curriculum construction (Giddens, Wright, & Gray, 2012). 

    Concept based curricula are designed to better reflect the complexity of nursing and health care while using core ideas or concepts important to nursing practice to help learners grasp the connections and master deeper learning of how these concepts explain a variety of conditions and situations they will encounter in nursing practice. 

    These goals are in contrast to a traditional curriculum organized around medical diagnoses or patient groups that use a less flexible and encompassing schema, such as described when “blocking” curriculum.

    In a concept based curriculum, faculty identify and define concepts considered to be core to nursing practice and integral to achieving the program’s established end of program outcomes for graduates. 

    The concepts are integrated (threaded) throughout the curriculum in a manner that facilitates acquisition of competencies that are leveled throughout the curriculum, ultimately leading to student achievement of expected end of-program outcomes. 

    Faculty develop learning experiences that will guide the students’ application of the concepts across a variety of patient populations and care settings.

    Although there is significant variation in the concepts chosen to organize a nursing curriculum, some concepts have emerged across the majority of undergraduate nursing programs. 

    Some examples of these common concepts include oxygenation, cognition, pain, nutrition, pharmacology, and lifespan development. Additionally, nursing roles, communication and teamwork, quality and safety, and ethics and legal issues are also frequently present.

    An example of content integration may be seen in the following description of the concept of pain. Early in the curriculum, students first learn about the pathophysiologic causes of pain, causes and cardinal characteristics of pain, factors that shape or affect pain, and how to assess and evaluate the characteristics of pain. 

    As students move through the curriculum, they increase their understanding about the manifestations of and treatments for pain, review research related to the concept of pain, and identify appropriate therapeutic nursing interventions related to the care of a patient with pain, thus progressing from a global understanding of pain to a more specific, in depth understanding of the concept. 

    Eventually, students learn about pain as it relates to acute and chronic health issues, to physical or non disease based causes, or to specific situations such as surgery and childbirth in various clinical populations.

    In an example of a curriculum that was developed around four conceptual themes, D’Antonio, Brennan, and Curley (2013) described the process used to develop an undergraduate curriculum framework based on judgment, inquiry, engagement, and voice. 

    Faculty used a shared decision making model to identify concepts that would be meaningful to faculty and students. Additionally, the QSEN standards provide key concepts related to quality and safety that can be used to create a framework to organize curricula along with other important concepts (Chenot & Daniel, 2010; Pollard et al., 2014).

    Historically, accreditation standards and performance expectations have had a significant effect on many organizing frameworks as faculty recognize the need to directly address these expectations that include such concepts as clinical reasoning, problem solving, communication, caring, diversity, and therapeutic nursing interventions (Kumm & Fletcher, 2012; Mailloux, 2011). 

    The concept of clinical reasoning or “thinking like a nurse” is increasingly replacing the more general critical thinking concept to better focus on situated knowledge development that leads to action rather than a general intellectual skill (Benner et al., 2010).

    Faculty adopting a concept-based, outcome orientation to curriculum must be able to construct the context and meaning that the outcomes will have in the curriculum structure. 

    An outcomes focus reflects the need to achieve designated competencies that students are expected to demonstrate at the completion of the program to demonstrate expected program outcomes. Faculty must identify and integrate the curriculum concepts that will support the students’ achievement of the identified competencies and outcomes.

    In a concept based curriculum design, there are no boundaries to knowledge development and skill acquisition, as noted in the blocking approach. The concepts that form the curriculum must be clearly and visibly explicated for students so that they can see and experience the integration of the concepts across the curriculum. 

    Students use clinical experiences to learn the essence of identified concepts and are encouraged to transfer and expand their knowledge and skills to different settings, populations, and experiences. Active, engaged teaching and learning strategies pair naturally with this conceptual approach to nursing education. 

    Problem based learning, team-based learning, case studies, and reflection are just a few examples of teaching and learning strategies that can be used to facilitate student understanding of the concepts being studied and help them to become “users” of knowledge. 

    Disadvantages to a more conceptual approach to curriculum design include difficulty in maintaining the integrity of the curriculum because of the lack of discrete boundaries for content and the potential for inadvertently eliminating from the curriculum key aspects of the concept. 

    Faculty must carefully map the concepts across the curriculum to ensure that the students’ knowledge of the concept will grow in depth and breadth, and not become mired in repetition or omission. See the “Guiding Principles to Developing an Organizing Framework” for further suggestions on how to select curricular concepts.

    Another potential disadvantage is that student learning styles may favor a more traditional and less conceptual approach to learning, as that is how they have likely become accustomed to learning. 

    Faculty need to consider the various learning styles of students in their classroom and design approaches that will facilitate students adjusting to a more conceptual approach to learning.