CHANGING THE FACE OF NURSING CURRICULA

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CHANGING THE FACE OF NURSING CURRICULA

• Donna Ignatavicius, MS, RN, ANEF
• President, DI Associates, Inc.
• Diassociates_at_earthlink.net

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Definition

• Curriculum is the formal and informal content and
  process by which learners gain knowledge and
  understanding, develop skills, and alter
  attitudes e.g. caring, appreciations, and
  values to meet educational goals (outcomes)
  (Bevis).

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Tyler curriculum model (1949) components

• Philosophy (mission)
• Conceptual framework
• Program objectives
• Behavioral, measurable level objectives
• Evaluation of learning/program

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Tyler (contd)

• Assumptions within Tylers model
• Teacher has to cover all content in curriculum.
• Teacher knows what needs to be included.
• Teacher has ownership in the curriculum.

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Changes in Higher Education in mid- to late 1990s

• Beginning transformation from instruction
  (teaching) to learning (learning college or
  learner-centered college)
• Increased accountability for student learning
• Increased attention to assessment (evaluation) of
  learning

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Innovation in Nursing Education A Call to Reform
(NLN, 2003)

• Need to be truly innovative! (revolution in
  1988)
• Base curricula on pedagogical research (learning
  model).
• Be responsive to unpredictable nature of health
  care system.
• Discard or rethink old models.

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NLNs Recommendations for Faculty (Summary)

• Collaborate with peers, students, and nursing
  service colleagues.
• Explore new pedagogies focus on learning.
• Utilize current local and national health care
  trends to guide reform.
• Conduct research to create an evidence base for
  nursing education.

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Innovation or Transformation?

• Innovation Something new or different
  introduced
• Transformation Change in form, appearance,
  nature, or characteristics

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Selected Themes about Pre-licensure Nursing
Curriculum

• Additive curriculum (Diekelmann Smythe, 2004
  Ironside, 2004)
• Focus on diseases (medical model) more than on
  nursing care (content saturation) (IOM, 2003
  Giddens, 2007)
• More teacher-centered (content) than
  student-centered (process of thinking) (OBanion,
  1997 Candela, et al., 2006)

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Themes (contd)

• Focus on memorization and application of facts
  rather than thinking like a nurse (Ironside,
  2005 Tanner, 2006)
• Perceived limitations by nursing education
  accreditation bodies (e.g., NCLEX pass rates)
• Use lecture more than other learning strategies
  (Ironside, 2005)

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Which two of these themes are representative of
your curriculum?

• Think-pair-share
• Think about the answer to this question and write
  it down.
• Share what you wrote with your new partner!

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National Health Initiatives that Should Influence
Curricula

• Pew Commission (need to change health
  professions curricula 21 competencies for 21st
  century)
• Institute of Medicine (IOM) (2003) (5
  competencies for health professions curricula)
  (www.iom.edu)

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QSEN Competencies

• Patient-centered care
• Nursing team and interdisciplinary care
• Evidence-based practice

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QSEN Competencies (contd)

• Quality improvement
• Informatics
• Safety
• www.qsen.org

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National Initiatives (contd)

• The Joint Commissions National Patient Safety
  Goals (NPSG)
• New ones added/revised every year
• Examples Hand-off communication for continuity
  of care, coagulant monitoring
• Specific and focus on patient safety and quality
  care

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National Initiatives (cont)

• The Joint Commissions Core Measures (in
  conjunction with Medicare and Medicaid) e.g.,
• Acute MI
• Heart failure
• Community-acquired pneumonia (CAP)
• Pregnancy
• Child asthma

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National Initiatives (contd)

• Institute for Healthcare Improvement
  (www.ihi.org)
• Save 5 million lives (by Dec. 2008)
• Proven and new interventions (see handout)
• Evidence-based practice bundles (e.g., ventilator
  bundles, sepsis management bundles)
• Transforming Care at the Bedside (TCAB) in
  med-surg units (see handout)

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Implications of National Initiatives on Nursing
Curriculum

• Focus on patient safety and quality care (need
  to know content)! (individual and system)
  (Gregory, et al., 2007)
• Remember that you are preparing nurse
  generalists, not APNs.
• Take out trivial facts, such as
  incidence/prevalence statistics indepth,
  advanced pathophysiology too much physical
  assessment (Giddens, 2007)

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Implications (contd)

• Rethink about time spent on specialties like MCH
  add more on care of older adults (well and ill)
  (Gilje, et al., 2007).
• Include class and clinical time on how nurses
  work with nursing teams (e.g., delegation and
  supervision) and ID teams.

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Implications (contd)

• Focus more on evidence-based practice for patient
  safety and quality care
• Research course (BSN) early in program
  (sophomore or first semester junior) present
  course as EBP incorporate EBP throughout program
  (clinically-associated or clinical component
  August-Brady, 2005)
• Incorporate core measures and IHI bundles as
  examples.

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Implications (contd)

• All programs should be helping students learn how
  to integrate findings into clinical practice
  rather than just learn how to conduct research
  (August-Brady, 2005, Montgomery, 2007).

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Implications (contd)

• Five competencies for implementing EBP
• Accessing the information (informatics)
• Critically appraising the information (CT)
• Selecting appropriate findings (using rating
  standardized rating scale)
• Interpreting findings (CT)
• Applying findings into practice (leadership
  skills, change process)

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Implications (contd)

• Discuss how to read and interpret research
  article.
• Identify clinical question or concern that
  relates to clinical course.
• Search database (directed) or articles provided.
• Discuss articles in class to guide students
  understanding.
• Help students interpret and discuss implications
  for and changes in practice.

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Implications (contd)

• Other ideas
• Use EBP to support learning psychomotor skills
  (Aronson, et al., 2007).

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Implications (contd)

• Other ideas
• Post-conference discussions of EBP/best practices
  related to national health initiatives
• Classroom discussion and emphasis on top 20 DRGs
• Leadership course discussion about physician and
  other team member nonadherence to best practice
  guidelines

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Now what? Where do we begin?

• Rethink philosophy (and organizing framework).
• Dont just tweak your curriculum avoid the
  tendency to switch, swap, and slide content
  around (Bevis, 1988).
• Use the national initiatives as a major guide for
  redirecting your curriculum towards better
  practice reality.