CHANGING THE FACE OF

NURSING CURRICULA
Donna Ignatavicius, MS, RN, ANEF
President, DI Associates, Inc.
Diassociates@earthlink.net

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).

Tyler curriculum model (1949)

components:

Philosophy (mission)
Conceptual framework
Program objectives
Behavioral, measurable level
objectives
Evaluation 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 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

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 introduced
Transformation = Change in
form, appearance, nature, or
characteristics

Selected Themes about Prelicensure 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)

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 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)

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

QSEN Competencies
(contd)
Quality improvement
Informatics
Safety
www.qsen.org

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

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

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 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)

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 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.

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 initiatives
Classroom 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.