March 21, 2014 Judy Hyland, PhD(c), RN Director of Live Review Workforce Readiness Pearson

Transcription

1 Considering a Concept-based Curriculum March 21, 2014 Judy Hyland, PhD(c), RN Director of Live Review Workforce Readiness Pearson

2 What is the Issue?

3 Nursing education is experiencing content overload/saturation. NLN (2003). many nurse educators continue to teach as they were taught and for a health care system that no longer exists National League for Nursing (2003). Position statement: Innovation in nursing education: A call to reform. Benner, et al. (2010) There is a significant gap between today s nursing practice and the education for that practice. Benner P, Sutphen M, Leonard V, Day L. (2010). Educating nurses: A call for radical transformation, San Francisco: Josey- Bass. Ironside (2004) The dilemma nurse educators are increasingly facing is not what to include in a course, but what to leave out. Ironside PM. (2004). Covering content and teaching thinking: Deconstructing the additive curriculum, Journal of Nursing Education, 43(1), 5-12.

4 It s not your grandma s schoolin.

5 Today s students are different.

6 What is Conceptual Learning?

7 Conceptual Learning Process by which students learn how to organize information in logical mental structures Focuses on learning organizing principles that are threaded throughout learning environments Classroom learning Clinical experiences Simulated experiences Provides context for concepts/exemplars

8 Promoting Conceptual Learning Means Focusing on big ideas students anchor to specifics. Fostering deep learning, and deep understanding through connections and reflection.

9 What is Teaching Conceptually?

10 To Teach Conceptually Focus on a CONCEPT Provide content knowledge with EXEMPLARS Illustrate how to APPLY content to interrelated concepts PRACTICE applying other content to the concept

11 To Teach Conceptually Instruction must be Student Centered Faculty role must be re-envisioned

12 What are the benefits of a concept-based curricular approach?

13 Benefits of Conceptual Approach Focus on problems Fosters systematic observations Fosters understanding of relationships Focus on nursing actions and interdisciplinary efforts Catalyst for challenging students

14 How Prevalent is this Trend? Survey of 348 nursing program administrator respondents 27% have a concept-based curriculum: majority adopted in the last 5 years. 55% are developing or considering a conceptbased curriculum.

15 What are the challenges of teaching conceptually?

16 Challenges It is different Some faculty and students may be resistant to changes Requires a different level of organization and collaboration Lack of literature detailing steps Concern over potential impact on NCLEX pass rates

17 What about NCLEX Pass Rates Survey of 57 nursing program administrator respondents who have a concept-based curriculum. 35% report higher first-time NCLEX pass rates 42% report no change in first-time NCLEX pass rates 5% reported lower pass rates 18% did not know impact on first-time pass rates

18 How do we get started?

19 We re Moving Concept-based. Now what?

20 Let s get started

21 Identify Motivations for Moving Concept-based 1

22 FILL IN THE BLANK While it may be a big undertaking, it s important that Texas Schools of Nursing moves to a concept-based approach to teaching and learning because

23 Motivations for Texas In 2011 only 50% of the RNs in Texas held a BSN. Texas Nurses Association research concludes that Texas Nursing Schools need to accomplish the following objectives in order to increase to the 80% BSN IOM challenge by 2020: Increase the number of RNs enrolling in RN to BSN programs immediately upon graduation from their pre-licensure program Encourage those already in practice to return to school for a BSN (Texas Center for Nursing Workforce data)

24 Identify Curricular Framework 2

25 Why create a curricular framework? Creates an organizing thematic structure that helps in course design and evaluation Provides an opportunity to reinforce program/institution mission, vision and/or priorities into coursework

26 Actions taking place in Texas In response to the IOM recommendation Trinity Valley Community College submitted and was awarded a Perkins Leadership Grant by the Texas Higher Education Coordinating Board (THECB) titled, Reducing Duplication in ADN & RN-to-BSN Curricula. The project deliverables were: Develop a set of cohesive courses for concept-based curriculum in ADN and RN to BSN curricula Develop a seamless articulation plan from RN to BSN with an emphasis on decreased repetition of nursing course credits and content. The Perkins Grant work identified concepts specific to an associate degree nursing curriculum, creating and developing definitions and key exemplars for each concept.

27 CABNET Consortium for Advancing Baccalaureate Nursing Education in Texas The Consortium Agreement for Baccalaureate Nursing Education in Texas (CABNET) provides a pathway between student s community college and their intended university.

28 Sample Curricular Framework PROPOSED GENERIC CURRICULUM OUTLINE First Year (Hours) Summer Semester Lec Lab Clin Credit BIOL 2401 Anatomy & Physiology I PSYC 2301 General Psychology ENGL 1301 English Composition I Total Hours Fall Semester BIOL 2402 Anatomy & Physiology II RNSG 1271 Professional Nursing Competencies RNSG 1170 Introduction to Health Care Concepts RNSG 1471 Health Care Concepts I RNSG 1171 Professional Nursing Concepts I RNSG 1161 Clinical I Total Hours Spring Semester BIOL 2421 Microbiology RSNG 2572 Health Care Concepts II RSNG 2172 Professional Nursing Concepts II RNSG 2362 Clinical II Total Hours Second Year (Hours) Fall Semester PSYC 2314 Human Growth & Development RNSG 2573 Health Care Concepts III RNSG 2173 Professional Nursing Concepts III RNSG 2363 Clinical III Total Hours Spring Semester Humanities/Fine Arts Elective RNSG 2574 Health Care Concepts IV RNSG 2174 Professional Nursing Concepts IV RNSG 2360 Clinical IV Total Hours Grand Total 60

29 Select Concepts and Exemplars to Cover 3

30 What is a Concept?

31 A concept is an abstract or generic idea generalized from particular instances (Erickson, 2008).

32 Criteria for Selecting Concepts Concepts should: Represent important conditions/situations in nursing practice One or two words Universal in application (can be used logically and consistently) Timeless (sustainable) Represented by agreed upon attributes (characteristics)

33 Concept Examples MOBILITY: Mobility is a broad concept, it is one word, it is universal in application (can be applied to any age, and virtually any situation), and it is timeless. LEGAL ISSUES: Legal issues is a broad concept, it is one word, universally applicable, timeless and can be applied in many situations in nursing (e.g., in direct patient care, in care of groups, and in the community).

34 Concept Development & Presentation Develop concepts according to template for consistency Ensure that concepts cover key areas of knowledge for today s practicing professional Consider how concepts can be taught and supported in multiple learning environments (ie. didactic, simulation, clinical)

35 An example of Texas Concept Analysis Diagram Nursing Care Directed toward what contributes to a normal concept and is thereby related to all factors involved in or with the concept. Not always needed to have a normal outcome. Attributes Defining characteristics of the concept What must occur for the concept to exist Antecedents What precedes the concept for it to exist Events or incidents that must happen before the concept Consequences Untoward events or outcomes that occur due to malfunction within the concept Positive events or outcomes that occur due to proper functioning within the concept Interrelated Concept Concepts which can affect change in the other Concepts which work together to ensure a normal process Concepts which if depleted or impaired can cause a negative consequence in the other Sub- Concept Critical components of major concept Nursing Care Antecedents Normal Respiratory and Renal functions, Normal digestion functions Absence of N & V or Diarrhea; Good nutrition Physiologic Processes of acid base balance Consequences of disruption Sub - Concepts Compensatory mechanisms Attributes Normal ph levels Normal bicarbonate levels Respiratory rate Arterial Blood Gases WNL Acid Base Balance The process of regulating the ph, bicarbonate concentration and paratial pressure of carbon dioxide of body fluids Non- labored respirations Balanced acid production Positive Interrelated Concepts Consequences (Outcomes) Normal activity for age, energy Fluid & Electrolyte Balance Nutrition Negative Cellular destruction Perfusion Gas Exchange Elimination Anxiety Changes in LOC Elevated CO2 Cardiac Arrhythmias Death

36 Texas Concepts Acid Base Balance Ethics & Legal Precepts Informa9cs Professionalism Cogni9on Evidenced- Based Prac9ce Interpersonal Rela9onships Quality Improvement Cellular Regula9on Fluid & Electrolyte Balance Intracranial Regula9on Reproduc9on Clinical Judgment Func9onal Ability Leadership & Management Safety CloFng Gas Exchange Metabolism Sensory Percep9on Comfort Grief Mobility Sexuality Communica9on Health Care Organiza9ons Mood and Affect Sleep Coping Health Policy Nutri9on Teamwork & Collabora9on Diversity Health Promo9on Pa9ent Educa9on Thermoregula9on Elimina9on Human Development Pa9ent- Centered Care Tissue Integrity End of Life Immunity Perfusion

37 Criteria for Selecting Exemplars Exemplars should: (1) Be carefully selected (and limited) otherwise, the risk of content creep increases (2) Consider prevalence and important pathophysiologic understanding (3) Reinforce a lifespan approach (4) Share common attributes with other exemplars supporting a concept

38 Organize Concepts and Exemplars within Curriculum 4

39 How could a concept-based curriculum look?

40 SEMESTER 1: About Oxygenation SEMESTER 2: COPD Asthma SEMESTER 3: SIDS RSV SEMESTER 4: Acute Respiratory Distress Syndrome

41 How is teaching conceptually different?

42 Example Old: OB Course vs Concept-based: Family

43 Introduction to Health Concepts ABOUT: Family Family dynamics Family structure & roles Family response to health promotion & alterations

44 Family Health Concepts CONCEPT: Sexuality Family planning & preconception counseling Menopause Sexually transmitted diseases Female reproductive disorders Male reproductive disorders CONCEPT: Reproduction Antepartum, Intrapartum, Postpartum care Newborn care, Prematurity

45 Family Health Concepts CONCEPT: Thermoregulation R/T Newborn CONCEPT: Grief and Loss Peri-natal loss CONCEPT: Safety Responsible sexual behavior Anticipatory guidance

46 Complex Health Concepts Family Family response to critical alterations in health Community support

47 Identify Evaluation Measures Evaluate! 5

48 Evaluating Concepts & Exemplars Faculty should review the entire process to make sure that the topics, skills, and processes identified will indeed assist the student to meet performance outcome(s) and add clarity to the concept Faculty should review to ensure than concepts and exemplars are highlighted in multiple learning environments (didactic, sim, clinical)

49 I think one's feelings waste themselves in words; they ought all to be distilled into actions which bring results." -Florence Nightingale

50 Sample Pedagogical Approaches Constructivist educational theory Collaborative learning Learning about making connections Whole Part Whole (WPW) Learning Model - Knowles (2005)

51 Learning Strategies Experiential Learning Games Jigsaw Role Play Virtual Experiential Learning (Neighborhood 2.0)

52 Learning Strategies Simulation Learning Rounds Concept Analysis Case Writing Wikis Illuminate Blogs