Forum for Innovations in Nursing Education Pearson Education, Jacksonville, Florida 10/24/14 We re Moving Concept-Based Not What

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1 We re Moving Concept-based. Now what? Forum for Innovations in Nursing Education Jacksonville, Florida October 24,2014 CONGRATULATIONS! AGENDA 1.Outlining Key Steps in Transitioning to a Concept-based Curriculum 2.Reviewing Sample Curriculum Documentation and Tools 3.Sharing Speedbumps (ie. Considerations and Challenges to Anticipate) 4. Learning Strategies Creativity is the power to connect the seemingly unconnected. William Plomer

2 Motivations for North Carolina Standards were previously updated in 1996 Major advances in healthcare sciences & services since 1996 update Create a curriculum that prepares graduates with competencies to: Provide patient-centered care Work in interdisciplinary teams Employ evidenced-based practice Apply quality improvement processes Utilize informatics Motivations for North Carolina Changing curriculum focus Conceptual learning and methods that include: Increased use of technology Improve Distance learning capabilities Incorporate more Simulations Research Based Health People 2020 IOM CDC National Institute of Mental Health Institute for Healthcare Improvement National Center for Health Statistics NCLEX test plan The Joint Commission Most common causes of death Leading cause of death in your state Chronic disease prevention from CDC Most common office/ed visits ED admissions Chronic disease management 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 Sample Curricular Framework Domains: Individual, Healthcare and Nursing Care QSEN Holism Community-based Care Accountability Advocacy Ethics Evidence-Based Practice Health Care Systems Health Policy Informatics Legal Issues Quality Improvement Safety Assessment Caring Interventions Decision Making Collaboration Communication Managing Care Professional Behaviors Teaching and Learning Quality Of Life Health Care Achievement of Potential Curriculum Health Health, Wellness, & Illness Spiritual Developmental Biophysical Acid-Base Balance Cellular Regulation Comfort Elimination Fluids & Electrolytes Immunity Infection Inflammation Intracranial Regulation Metabolism Mobility Perfusion Sexuality Reproduction Sensory Perception Tissue Integrity Thermoregulation Psychological Addiction Behaviors Cognition Grief & Loss Mood & Affect Stress & Coping Socio-Cultural Culture Diversity Self Violence

3 So.. What is a concept? An abstract or generic idea generalized from particular instances (Erickson, 2008). Help students see patterns & connections places facts in context so they can be retained are ABSTRACT are TIMELESS should remain constant through time The fact-base that supports the concepts may change over time are UNIVERSAL Big ideas that can be applied across fields of knowledge Allows students to see big picture The frameworks of meaning almost work like VELCRO facts can go back and re-attach. And the facts become more memorable because they have a purpose and a context. Carol Ann Tomlinson Concept and Possible Exemplars Pulmonary Pnuemothorax RDS Edema PE Asthma Pneumonia RSV COPD

4 SEMESTER 1: About SEMESTER 2: COPD Asthma RSV SEMESTER 3: SIDS SEMESTER 4: Acute Respiratory Distress Syndrome 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). 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) Criteria for Selecting Exemplars Be carefully selected (and limited) otherwise, the risk of content creep increases Consider prevalence and important pathophysiologic understanding Reinforce a lifespan approach Share common attributes with other exemplars supporting a concept & Exemplars Per Semester mfiles/exemplars. pdf SEQUENCING OF COURSES IN THE CURRICULUM Admission Summer NUR 111 (8) NUR 113 (5) NUR 112 (5) BIO 168 (4) PSY 241 (3) NUR 212 (5) PSY 150 (3) Total: 9 Credits BIO 169 (4) CIS 111 or 113 (2/3) ENG 111 (3) Total: 17/18 Credits Total: 16 Credits NUR 214 Summer NUR 114 (5) NUR 213 (10) NUR 211(5) Humanities (3) ENG 115 (3) Total: 13 Credits Total: 13 Credits Admission Summer NUR 111 (8) NUR 112 (5) NUR 113 (5) BIO 168 (4) NUR 212 (5) PSY 241 (3) PSY 150 (3) BIO 169 (4) Total: 8 Credits CIS 111 or 113 (2/3) ENG 111 (3) Total: 17/18 Credits Total: 17 Credits NUR 214 NUR 114 (5) NUR 213 (10) Total program credits 68 NUR 211 (5) Humanities (3) Nursing credits 43 ENG 115 (3) Total: 13 Credits Related course credit 25 Total: 13 Credits

5 NUR st semester Cognition Safety Comfort Mobility Elimination Health &Wellness INDIVIDUAL Infection Fluid & Electrolytes Perfusion Tissue Integrity Sensory Perception Psychosocial NUR 112/212 or 113 (2 nd /3 rd semester) NUR 214 (LPN transition) Cellular Regulation Acid Base Health / Wellness Development Grief/Loss Cognition Metabolism Safety Comfort Thermoregulation Mobility Elimination INDIVIDUAL Reproduction Violence Inflammation Fluid & Electrolytes Perfusion Tissue Integrity Behavior Sensory Perception Stress/Coping Sexuality Infection NUR 114/211 (4 th semester) NUR 213 (5 th semester) Cellular Regulation Comfort Grief/Loss Intracranial Regulation Cognition Metabolism Safety Thermoregulation Mobility Elimination Immunity Acid Base Self INDIVIDUAL Health / Wellness Violence Reproduction Development Fluid & Electrolytes Perfusion Tissue Integrity Mood/Affect Sensory Perception Stress/Coping Behavior Sexuality Infection Inflammation SEQUENCING OF COURSES IN THE CURRICULUM Recent Change Effective 2015 Admission Summer NUR 111 (8) NUR 112 (5) BIO 168 (4) NUR 212 (5) PSY 150 (3) BIO 169 (4) CIS 111 or 113 (2/3) ENG 111 (3) Total: 17/18 Credits Total: 16 Credits Summer NUR 114 (5) NUR 113 (5) NUR 213 (10) NUR 211(5) PSY 241 (3) Humanities (3) ENG 115 (3) Total: 9 Credits Total: 13 Credits Total: 13 Credits NUR 214 Admission Summer NUR 111 (8) NUR 112 (5) NUR 113 (5) BIO 168 (4) NUR 212 (5) PSY 241 (3) PSY 150 (3) BIO 169 (4) Total: 8 Credits CIS 111 or 113 (2/3) ENG 111 (3) NUR 214 Total: 17/18 Credits Total: 17 Credits NUR 114 (5) NUR 213 (10) Total program credits 68 NUR 211 (5) Humanities (3) Nursing credits 43 ENG 115 (3) Total: 13 Credits Related course credit 25 Total: 13 Credits Class Lab Credit NUR 111 Intro to Health Objective II: Upon completion of the course, the learner will be able to internalize foundational principles of professional nursing Prerequisites: None Co requisites: None practice to provide safe, culturally competent, therapeutic care for Course Description individuals. Learning Outcomes: This course introduces the concepts within the three domains of the individual, 1.Receives an awareness of the values, attitudes, behaviors, healthcare, and nursing. Emphasis is placed on the concepts within each domain including medication administration, assessment, nutrition, ethics, interdisciplinary and beliefs important to professional nursing. teams, informatics, evidence-based practice, individual-centered care, and quality improvement. Upon completion, students should be able to provide safe nursing care incorporating the concepts identified in this course. 2.Incorporate all concepts within the domain of nursing to safely provide therapeutic care to individuals. 3.Competently perform holistic assessments, caring nursing interventions, and clinical decision-making. Course Objectives Objective I: Upon completion of the course, the learner will be able to 4.Communicate professionally and effectively while providing relate to the individual as a holistic, complex, multidimensional, unique, care to individuals. and significant being. Learning Outcomes: 1.Articulate all concepts within the domain of the healthy individual. 2.Distinguish between the healthy individual within a changing 5.Effectively collaborate with the individual/individuals and members of the interdisciplinary healthcare team to safely provide therapeutic care. 6.Facilitate the acquisition of knowledge and learning to internal and external environment and individuals with simple enhance self-care for each individual. alterations in health. 7.Collaboratively manage care of the individuals.

6 Objective III: Upon completion of the course, the learner will be able to transfer knowledge of the concepts within the domain of the healthcare system to safely and ethically administer care to the individual. Learning Outcomes: 1.Practice safely and ethically within the healthcare system according to the nursing practice act, healthcare policy, and National Patient Safety Goals. 2.Employ information technology to support clinical decision making. 3.Utilize principles of evidence-based practice while safely providing therapeutic nursing care to individuals in the healthcare system. How is teaching conceptually different? Example Old: Maternity vs Concept-based: NUR 111 Introduction to Health 1 st semester dynamics structure & roles response to health promotion & alterations Lab NUR 113 Health 3 rd / 4 th semester Sexuality planning & preconception counseling Menopause Sexually transmitted diseases Menstrual dysfunction Thermoregulation R/T Newborn Grief and Loss Perinatal loss Safety Responsible sexual behavior Anticipatory guidance NUR 213 Complex Health 5 th semester response to critical alterations in health Community support Example Old: Peds Course vs Concept-based: Across Lifespan NUR 111 Introduction to Health 1 st semester r/t Nursing Assessment Holistic health assessment across the life span Assessing normal Assessing abnormal Lab NUR 112 Health-Illness 2 nd semester 1 st 8 weeks Cellular Regulation Cancer RSV Asthma Inflammation Appendicitis Metabolism Diabetes Mellitus NUR 212 Health System 2 nd semester 2 nd 8 weeks Violence Child abuse NUR 113 Health 3 rd / 4 th semester Infection Conjunctivitis Otitis Media Development ADHD Autism Failure to thrive Cerebral palsy Health, Wellness, & Illness Immunization Sudden Infant Death Syndrome

7 NUR 114 Holistic Health 4 th semester 1 st 8 weeks Inflammation Nephritis NUR 211 Health Care 4 th semester 2 nd 8 weeks Cellular regulation Leukemia Sickle Cell Anemia NUR 213 Complex Health 5 th semester Care of hospitalized child Perfusion Ventricular Septal Defect Lab Acute care peds Example Old: Mental Health Concept-based: Integrated NUR 111 Introduction to Health 1 st semester Stress and Coping Anxiety assessment Cognition Confusion Self Self-esteem identity, Self-perception Body image NUR 112 Health-Illness 2 nd /semester 1 st 8 weeks Stress and Coping Phobias Panic disorder Crisis Generalized anxiety disorder NUR 212 Health System 2 nd semester 2 nd 8 weeks Violence Assault Abuse elder, child, sexual, intimate partner Rape-trauma syndrome NUR 113 Health 3 rd / 4 th semester Mood and Affect Post-partum depression Behavior Prenatal substance exposure NUR 114 Holistic Health 4 th semester 1 st 8 weeks Mood and Affect Bipolar disorder Depression Stress and Coping Obsessive-Compulsive Disorder Cognition Schizophrenia Alzheimer s disease / Dementia NUR 211 Health Care 4 th semester 2 nd 8 weeks Self Eating disorders Personality disorders Violence Suicide Behavior Addiction nicotine use, alcohol abuse, substance abuse I think one's feelings waste themselves in words; they ought all to be distilled into actions which bring results." -Florence Nightingale Speedbumps: Redesign Identify methods of incorporating and tracking key standards and competencies (ie. QSEN, IOM, AACN) Develop a process for engaging faculty at key points during redesign Redesign didactic, labs and clinical Support faculty, students, administrators and partners during change Identify methods of evaluating effectiveness

8 Speedbumps: Change Management and Policies Policies: progression, readmission New student orientation Engaging retention specialists Mentoring and on-boarding process for nurse faculty Speedbumps: Nuts & Bolts Standardization of course syllabi Revision of philosophy & conceptual framework Development of concept maps Development of clinical evaluation tools Revision and review of clinical paperwork across curriculum Structure collaborative and team teaching process Example of Content Outline Develop concepts according to template for consistency Concept of Assessment of Alterations in Interdisciplinary Care Exemplar Asthma Pathophysiology/Etiology Risk factors manifestations Nursing care Nursing Simulation Lab Demonstration =3Ks2jolom-A National Average 2010 ALL National RN 3 yr average % Dec % 1 st graduating class of concept curriculum NCLEX Results National Average 2011 ALL N.C. 3 yr average % May 12 98% National Average 2012 ALL Dec % National 3 yr average % May 13 96% graduated 68 National Average 2013 ALL North Carolina 3 yr average % % % % Dec 13 National Average 2014 ALL yr average % 1/1/14 6/30/14 99% 75 out of 76 NC state average (1 st time) 94% Evaluating & 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)

9 Evaluation of Curriculum Is your nsg program teaching conceptually? 97.6% Is majority of nsg faculty following principles of teaching conceptually in a concept-based curriculum? 85.4% Have nsg faculty at your college added content (exemplars) to curriculum? 44.2% Yes 55.8% No Evaluation of Curriculum What percent of current faculty teaching at your college was there when concept-based curriculum was implemented? 51.2% stated >60% Evaluation of Curriculum If nsg program could change one aspect of concept-based curriculum, what would it be? Limited class hrs / lab hrs Ability to move concepts/exemplars Group exemplars that have to do with peds Pleased - has been great improvement needed to throw out old & bring in new approach Pedagogical Approaches and Educational Strategies for Today s Educator As educators, we need to Give students ownership of their learning Utilize theories such as Constructive Theory Be willing to bring clinical to the classroom "I lift, you grab... Was that concept just a little too complex, Carl?"

10 Learning Pyramid As educators, we need to Make lab experiences as contextual as possible... Create scenarios Learning modules Teach what is relevant... Judgment Model Ex - Conceptual Learning Activity Related to Infection This activity will be done in pairs, however, PART I and PART V (the reflection) must be done individually. PART I (bring the results to clinical for discussion during pre-conference) Healthy People 2020 provides evidence-based objectives for improving national health. This program has helped to establish benchmarks to measure the impact of prevention activities so patients can make more informed health care decisions. One of the goals of Healthy People 2020 is to "Increase immunization rates and reduce preventable infectious diseases." Access the Healthy People 2020website ( ), choose at least one objective under each of the following and report on the baseline and target information given. Also report on one or more community or consumer interventions and one or more available resources using the list of interventions and resources found on the website Reduce invasive pneumococcal infections Increase the percentage of children and adults who are vaccinated annually against seasonal influenza Increase the percentage of adults who are vaccinated against pneumococcal disease Answer the following questions: What background knowledge (theoretical, practice or empirical) do you have regarding assessing a patient with an infection? What background knowledge (theoretical, practice or empirical) do you have regarding patient s with an infection? PART II Respiratory Assessment Review the infection control policy in your acute care setting Work in teams of 2 or 3 to gather information about each patient that has an infection or is at risk for developing an infection on your assigned unit (up to 3 patients maximum) Patient initials #1 #2 #3 Diagnosis/reason for admission Age B/P Age B/P Age B/P M/F P M/F P M/F P Ht. R Ht. R Ht. R Wt. O 2 sat Wt. O 2 sat Wt. O 2 sat Identify risk factors for developing flu and/or pneumonia. Did you see these in this patient? WBC WBC WBC Bands Bands Bands Neutrophils Neutrophils Neutrophils Eosinophils Eosinophils Eosinophils Basophils Basophils Basophils Lymphocytes Lymphocytes Lymphocytes Monocytes Monocytes Monocytes BUN BUN BUN Creat Creat Creat ABGs ABGs ABGs ph ph ph PaCO 2 PaCO 2 PaCO 2 HCO 3 HCO 3 HCO 3 Other diagnostic test results related to infection (i.e. chest x-ray, sputum cultures, other cultures etc.) What diagnostic test results are you most worried about in this patient and why? Identify if patient is receiving current antibiotic therapy include classification, trade name, frequency, & route complete Medication Info Sheet for each Compare antibiotic start date and WBC counts thereafter. What is your interpretation of this data? Identify other treatment modalities ordered to manage the infection. Include the rationale for each. SaO 2 SaO 2 SaO 2

11 Complete for the patient assessed What did/might you notice if the patient is experiencing an infection? As a nurse, what measures can you put into place to prevent a hospital acquired infection? When entering the room, what did you notice about the patient? What specific findings did you see in relation to managing a patient with an infection? What are the possible causes/reasons for any abnormal assessment findings What information do you need to look up & interpret from the chart that substantiates your assessment findings? What data did you find in the chart to support your assessment findings? What is your interpretation of the data? Review the plan of care for this patient. What other actions would you implement if you are the nurse caring for this patient with an infection in relation to health promotion and management/prevention? PART V (to be done individually and submitted with weekly paperwork) Write a reflection regarding: What you learned by doing this activity? What was your biggest aha moment while doing this (or reflecting on) this activity? If you were going to do this activity over, would you change the way you did it? Why or why not? How will the lessons learned from this activity affect your future nursing practice? Carnegie Study learning experiences are powerful when integrated with concepts taught in the classroom Patricia Benner Research Says In clinical Students spend too much time doing routine pt. care Faculty spend majority of time supervising students during procedures During Extend theoretical knowledge Develop habits of thought Develop identity as a nurse Practice collaboration and communication Develop practical skills Institute for Healthcare Improvement Open School Mobile app Patient safety Quality improvement Managing health care operations Patient and family centered care Leadership Population health

12 Concept Based Learning Strategies Steps Address the barriers Build the activities My contention is that creativity now is as important in education as literacy, and we should treat it with the same status. Sir Ken Robinson When Developing an Activity Begin with the end in mind Level of student learning Learning outcomes to be achieved facility involvement Type of assessment for competency Best Practices preparation Coaching post-conference Debriefing and reflection Questioning