by Susan Sportsman, PhD, RN, ANEF, FAAN
For the last fifteen years, nurse educators have struggled to offer a curriculum that prepares students for successful practice after graduation (and success on the NCLEX examination), without falling into the trap of content saturation. This struggle is well documented in the nursing literature. For example, in 2004, Tanner wrote of a qualitative study of teaching practices which explored strategies that addressed “boring lectures,” “too much content,” and “not enough time.” In 2007, Giddens and Brady identified changes in the health care delivery system, a teacher-centered pedagogy, content repetition, and an academic-practice gap as barriers to an effective nursing curriculum. Since that time, a number of nurse educators have embraced the notion of a concept-based curriculum (CBC), designed to address these challenges and foster conceptual learning. Fifteen years later, it is time to review the evidence in the nursing literature to determine the impact of a CBC on students, faculty, and practice outcomes.
In preparation for this blog, I reviewed selected articles on concept-based curricula found in the nursing literature. Below you will find an overview of these articles. I recognize that some of you reading this blog are considering moving to a CBC; some of you are involved in the implementation of your own CBC, and others are evaluating the results of a CBC that has already been implemented. Regardless of your location on the CBC journey, I hope this review will be helpful.
I have organized this review by themes that consistently appeared in the literature I reviewed. I have included a brief sketch of the conclusions of each of the article. Some of the articles chosen describe a research project; other provided a case study; and still other articles are opinion pieces. Regardless of the level of evidence that each article provides, my hope is that this overview will stimulate you to review the articles carefully and use the results in charting the course of your CBC own development and evaluation.
- Selected concepts serve as the framework for a CBC.
Giddens, et al. (2008) described the development of a concept based curriculum for undergraduate nursing students at the University of New Mexico. This curriculum was based upon the use of a conceptual approach in teaching-learning, including in clinical experiences.
Giddens, et al. (2012) presented a benchmark approach to validating and finalizing concept selection in a statewide CBC nursing consortium. The group identified concepts from other nursing programs using a conceptual approach, identifying those concepts that at least 50 percent of the schools surveyed had included in their curriculum. This list provided the consortium with information to make final decisions regarding concepts to be included in their curriculum.
Magnussen, et al. (2013) described the transformational changes that occurred in the development of the Hawaii Statewide Nursing Consortium CBC curriculum aimed at increasing the number of BSN prepared nursing.
Getha-Eby, et al. (2014) provides a model to help educators to understand concept-based teaching and meaningful learning as it applies to nursing education.
McGrath (2015) described the development of a concept-based learning approach within the revised Bachelor of Nursing curriculum in New Zealand. The article presents Year One Concepts as an example of how concept –based learning can be used in a nursing curriculum. It also provides feedback from students and faculty after the first year of implementation.
Patterson, et al. (2016) reported on the development of a curricular guide designed to identify the appropriate placement of concepts across the curriculum. This grid aligns courses vertically and horizontally. The horizontal organization of a curriculum considers which concepts of the curriculum should be taught during the same semester and how those concepts relate to one another. The vertical organization refers to how the elements of the curriculum were sequenced and expanded.
- Reviewing others’ experience in implementing a CBC can guide your own development plan.
Schreirer et al. (2009) describes the first phase of a concept-based curriculum by East Carolina University to prepare non-nursing baccalaureate students for a master’s degree in Nursing.
Kantor (2010) made a decision to change the pedagogy she used to teach her course in order to answer the questions: Could a change in pedagogy provide greater opportunity to work more collaboratively with students? Would a move toward concept-based and student-centered learning further promote the critical-thinking skills necessary for today’s new graduates?
Dean and Asselin (2015) described a process of transitioning to a CBC through the use of the three phases of the Bridges change model (letting go, the neutral zone, and new beginnings) The authors also suggested that the use of reflective teaching practice strategies may enhance the transition.
Higgins and Reid (2017) reported the development of a concept analysis diagram created for each concept in the Texas Concept-based Curriculum. The diagram was created to provide a succinct “conceptual approach” to understanding the correlation and interrelatedness among concepts and between patients and fosters “conceptual thinking rather than rote memory.”
Landen et al. (2017) reported on the work of the New Mexico Nursing Education Consortium to implement a CBC in all 18 state-funded pre-licensure nursing CBC programs in order to provide seamless transferability for students in ADN programs and increase the number of BSN graduates in the state.
Sportsman and Pleasant (2017) documented the experiences of nurse educators who have implemented a CBC. The article provided advice for implementing a CBC based upon responses to two faculty surveys and a faculty focus group. The article also provides a CBC development and implementation check-list.
- Active Learning in the classroom setting promotes critical thinking.
Stanley and Daugherty (2010) presented a model for nursing education that takes into account the student, the faculty, and influencing factors, to shift from “content-laden” curriculum to teaching key concepts allowing students to focus on essential content that is “need to know.”
Hardin et al. (2012) outlined three core components necessary for conceptual learning (addressing misconceptions, developing enduring understanding, and acquiring metacognitive skills) and a framework for teaching conceptually. Five teaching methods that are particularly fitting for concept based curricula were also considered.
Lanz and Davis (2017) reported on the development, implementation and evaluation of a pharmacology course that used concept-based learning. The course emphasized drug classification, where a prototype drug is used as an exemplar.
- Concept-based clinical activities may impact acquisition of clinical learning.
Nielsen (2013) reported on a clinical education model developed by the Oregon Consortium for Nursing Education undergraduate curriculum. This approach moves away from “random access opportunity” for clinical experience that relies only on total patient care to an intentional design of clinical learning, which includes case-based, concept-based, intervention skilled based, focused direct patient care and integrative experiences.
Fletcher and Meyers (2015) reported on the development of Focused Learning Assignments (FLAs), competency based exercises that that faculty can be use during clinical time when students are not providing patient care. The FLAs were centered on the 6 QSEN competencies, as well as the concepts of professionalism and systems-based practice.
Nielson (2016) used a multi-case study research to explore concept-based learning in the context of clinical education in inpatient setting. The study used the Lasater (2007) Clinical Judgment Rubric to measure aspects of clinical judgment in a group of students (n = 13) who had no exposure to Concept-based Learning Activities (CBLAs) and a group (n = 15) who were exposed to two, three, or four CBLAs. The CBLA group scored statistically significantly higher in each of the four phases of clinical judgment, as well as in total clinical judgment.
- There is an ongoing need to evaluate the impact of the concept-based nursing curriculum on teaching-learning processes and outcomes.
Lasater and Nielson (2009) compared students who were and were not exposed to concept-based clinical learning. Students were asked to complete the Lasater Clinical Judgment Scale and the results suggested exposure to 2, 3, or 4 concept-based learning activities improved clinical judgment performance.
Giddens and Morton (2010) described the evaluation of the concept-based baccalaureate nursing curriculum at the University of New Mexico. The article identifies strengths and weaknesses of the initial implementation and approaches used to strengthen the curriculum.
Lewis (2014) described the outcomes of a curriculum change in a pre-licensure diploma nursing Program, using the NCLEX-RN scores, retention and graduation rates and program satisfaction before and after a change to a concept-based curriculum. The results indicated improvement of outcomes of students in one diploma nursing program.
Murry, et al. (2015) described the comprehensive evaluation process of a concept-based pre-licensure nursing curriculum and the tool used for documentation. Benefits and problems associated with the process and tool were shared.
Duncan and Schultz (2015) compared selected baccalaureate nursing program outcomes (NCLEX-RN pass rates, graduation rates, national assessment of critical thinking, and student satisfaction, efficacy and confidence and self-efficacy) in a traditional curriculum and a CBC. The analysis found few differences on outcomes between the two groups.
Kyle (2015) reports a qualitative study that explored faculty experience of a transition from a systems-based to a concept-based curriculum, using semi-structured interview questions.
Fromer (2017) described the result of a study to evaluate the effects of conceptual learning by comparing the scores on the ATI Nursing Education test scores for students in a traditional curriculum and those enrolled in a CBC. No statistically significant differences were noted in the ATI scores for the two groups.
Hensel (2017) described the use of Q methodology to evaluate the extent to which graduates were prepared to practice in diverse environments before and after a concept-based revision. The article discusses the process of evaluation and the successes and challenges of the revision.
Despite the importance of student outcomes, evaluation of any type of nursing curriculum is difficult because of the complexity of the educational process. Admission standards, faculty competence, available resources, and testing policies and processes may all affect the outcomes. As a result, it is important that we all pay attention to the accumulation of evidence related to CBC as we develop and revise CBC for individual nursing programs and collaborations. I hope this information will be helpful for you all. Should you require assistance in any stage of the CBC process, please know that Collaborative Momentum is eager to help you.
Dean, W.H., Asselin, M., (2015) Transitioning to concept-based teaching: A discussion of strategies and the use of the Bridges change model. Journal of Nursing Education and Practice 5(10)52.
Duncan, K. and Schultz (2015) Impact of change to a concept-based baccalaureate nursing curriculum on student and program outcomes. Journal of Nursing Education 54(3), Suppl. S17-S20.
Geta-Eby, T., Beery, T., Xu, Y., O’Brien, B. (2014) Meaningful learning: Theoretical Support for concept-based Teaching. Journal of Nursing Education. 53(9) 494-500.
Giddens, J.F., Brady, D.P. (2007) Rescuing nursing education from content saturation: The case for a concept-based curriculum. Journal of Nursing Education. 46(2) 62-66.
Giddens, J.F., Morton, N. (2010) Report Card: An evaluation of a concept-based curriculum. Nursing Education Perspectives. November/December, 31(6) 372-377.
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Fletcher, K.A., Meyers, M. (2016) Coaching Model plus Clinical Playbook=Transformative Learning. Journal of Professional Nursing. 32(2) March-April. 121-129.
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Hardin, P., Richardson, S., (2012) Teaching the concept curricular: Theory and method. Journal of Nursing Education. 51(3) 155-159.
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Ironside, P.M. (2004) “Covering content” and teaching thinking: Deconstructing the additive curriculum. Journal of Nursing Education. 43(15) 6-12.
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Lasater and Nielson, A. (2009) Developing concept-based learning clinical activities on students’ clinical judgment. Journal of Nursing Education. 48 (8) August. 441-444.
Landen, J., Evens-Prior, D., Dakin, B., Liesveld, J. (2017) Innovation in academic progression: Progress of the New Mexico Nursing Education Consortium. Nursing Education Perspectives. 38(5) E 26-E 29.
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