CHANGING THE FACE OF NURSING CURRICULA Donna Ignatavicius, MS, RN, ANEFPresident, DI Associates, Inc.Diassociates@earthlink.net

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).Definition

Tyler curriculum model (1949) components:Philosophy (mission)Conceptual frameworkProgram objectivesBehavioral, measurable level objectivesEvaluation of learning/program

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.

Changes in Higher Education in mid- to late 1990sBeginning transformation from instruction (teaching) to learning (learning college or learner-centered college)Increased accountability for student learningIncreased attention to assessment (evaluation) of learning

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.

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.

Innovation or Transformation?Innovation = Something new or different introducedTransformation = Change in form, appearance, nature, or characteristics

Selected Themes about Pre-licensure Nursing CurriculumAdditive 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)

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)

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!

National Health Initiatives that Should Influence CurriculaPew 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)

QSEN CompetenciesPatient-centered careNursing team and interdisciplinary careEvidence-based practice

QSEN Competencies (contd)Quality improvementInformaticsSafety

www.qsen.org

National Initiatives (contd)The Joint Commissions National Patient Safety Goals (NPSG)New ones added/revised every yearExamples: Hand-off communication for continuity of care, coagulant monitoringSpecific and focus on patient safety and quality care

National Initiatives (cont)The Joint Commissions Core Measures (in conjunction with Medicare and Medicaid); e.g.,Acute MIHeart failureCommunity-acquired pneumonia (CAP)PregnancyChild asthma

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)

Implications of National Initiatives on Nursing CurriculumFocus 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)

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.

Implications (contd)Focus more on evidence-based practice for patient safety and quality careResearch 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.

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).

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)

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.

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

Implications (contd)Other ideas:Post-conference discussions of EBP/best practices related to national health initiativesClassroom discussion and emphasis on top 20 DRGs Leadership course discussion about physician and other team member nonadherence to best practice guidelines

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.