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CHANGING THE FACE OF NURSING CURRICULA

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

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CHANGING THE FACE OF NURSING CURRICULA

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

  2. 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).

  3. Tyler curriculum model (1949) components: • Philosophy (mission) • Conceptual framework • Program objectives • Behavioral, measurable level objectives • Evaluation of learning/program

  4. Tyler (cont’d) Assumptions within Tyler’s model: • Teacher has to “cover” all content in curriculum. • Teacher knows what needs to be included. • Teacher has ownership in the curriculum.

  5. 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

  6. 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.

  7. NLN’s 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.

  8. Innovation or Transformation? Innovation = Somethingnew or different introduced Transformation = Change in form, appearance, nature, or characteristics

  9. 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) (O’Banion, 1997; Candela, et al., 2006)

  10. Themes (cont’d) • 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)

  11. 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!

  12. 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)

  13. QSEN Competencies • Patient-centered care • Nursing team and interdisciplinary care • Evidence-based practice

  14. QSEN Competencies (cont’d) • Quality improvement • Informatics • Safety www.qsen.org

  15. National Initiatives (cont’d) • The Joint Commission’s 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

  16. National Initiatives (con’t) • The Joint Commission’s Core Measures (in conjunction with Medicare and Medicaid); e.g., • Acute MI • Heart failure • Community-acquired pneumonia (CAP) • Pregnancy • Child asthma

  17. National Initiatives (cont’d) • 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)

  18. 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)

  19. Implications (cont’d) • 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.

  20. Implications (cont’d) • 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.

  21. Implications (cont’d) • 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).

  22. Implications (cont’d) • 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)

  23. Implications (cont’d) • 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.

  24. Implications (cont’d) • Other ideas: • Use EBP to support learning psychomotor skills (Aronson, et al., 2007).

  25. Implications (cont’d) • 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

  26. Now what? Where do we begin? • Rethink philosophy (and organizing framework). • Don’t 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.”

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