Teaching Strategies for Implementing a Concept-Based Curriculum
Susan Sportsman, PhD, RN, ANEF, FAAN Managing Director Collaborative Momentum Consulting
Introduction Melissa Breadmore, RN, MSN, has been hired as a new faculty member in a pre-licensure nursing program which, in the last year, transitioned from a systems-based to a concept-based curriculum. Ms. Breadmore has taught for the past ten years in two pre-licensure nursing programs in different parts of the country; however, neither program used a conceptual curricular approach. From her graduate studies, she knows that she should change some of her teaching-learning strategies to support the design of this new program. Yet, she wonders how she should proceed. Read more for some suggestions.
FADavis.com
1
Active Learning 1. Since the 1990s, the emphasis on active learning processes in nursing has intensified and is a hallmark of concept- based curricula. The growth of active learning has resulted in a paradigm shift from teacher-centered to learner- centered educational approaches, designed to encourage students to be totally engaged in the learning process. Franco-Tantuico (2022) described the characteristics a learning activity must have in order to be considered “active.” 1. The activity selected must provide a dynamic (often changing), meaningful and engaging learning environment.
2. Collaboration must occur between and among the instructor and the learners. 3. The instructor must provide ongoing constructive and nonjudgmental feedback . 4. The students must have an opportunity to reflect upon their performance.
To be effective, students must consider the topic important and interesting, and they must have the requisite knowledge to participate fully in the activity. Thus, students should complete a pre-activity study assigned by the instructor. Table A provides examples of a learning activity that incorporates characteristics of active learning and one that does not. Table A: Examples of an Effective and Ineffective Learning Activity
Effective Learning Activities
Ineffective Learning Activities
§ Ms. Peters provided her students with a learning activity on hypertension.
§ Mr. Jones presented a lesson on diabetes.
§ In addition to a reading assignment on this topic, during an introduction session, she gave a short 5-question quiz in class (no grade). § After a brief discussion of the correct quiz answers, small groups of nursing students developed a plan of care for a patient with this diagnosis. § Students reported on their plan of care.
§ Students were assigned to read an article about the management of diabetes in the elderly.
§ Mr. Jones lectured on diabetes for ½ of the class, providing students with many anecdotes from his experience as an ER nurse. § The nursing students then completed a worksheet on A1C values.
§ Ms. Peters facilitated a debriefing session where students reflected on their actions and then she clarified students’ concerns with nonjudgmental feedback.
§ Following this activity, Mr. Jones answered student questions regarding diabetes.
The structure for each learning activity may vary depending upon its goal. Table B provides a number of approaches designed to engage students with the content.
2
Table B: Types of Structures for Active Learning
Types
Definition
An intensive analysis of an individual unit (such as a person or community), stressing developmental factors in relation to environment.
Case Studies
Unfolding Case Studies A case study where the analysis is completed over a period of time.
A collaborative learning strategy where students work together to solve a problem or answer a question about an assigned reading. This strategy requires students to (1) think individually about a topic or answer to a question; and (2) share ideas with classmates. At the end of a class section or lecture, students have 60 seconds to jot down a response on paper about an aspect of that day’s class session. These papers, which don’t require names or grades, are then submitted to the instructor. This activity prompts students to reflect and offers instructors insight into their understanding of the class material.
Think-Pair-Share
Minute Paper
Debates
A formal discussion of various sides of an issue.
A group problem-solving technique that involves the spontaneous contribution of ideas from all members of the group. A method where the instructor asks a rhetorical question, then allows 20 seconds for students to think about the problem before they go on to explain. This technique encourages students to take part in the problem-solving process even when discussion is not feasible. Requiring students to write something down helps ensure that they will work on the problem. A process by which something proposed (such as for research or a paper) is evaluated by a group of experts in the appropriate field (in this case, other students). The instructor replaces lecture by posing a series of thought-provoking questions. Each question is crafted to guide the conversation toward a learning outcome (or major driving question) that was desired from the beginning. The instructor requires students to ask him/her questions, and the instructor answers in such a way as to stimulate another question immediately, while steering the question in a certain direction. The instructor illustrates a concept, idea, or principle with a real-life application, model, or case study. A method where a complex or detailed image is displayed on the screen and volunteers are invited to identify key features or ask questions about items they do not understand. This is particularly helpful for learning psychomotor skills. A technique that involves instructing students to perform five steps: listen, stop, reflect, write, give feedback. This approach fosters self-monitoring listeners. A teaching tool involving the presentation of an image without accompanying explanation. Students are tasked with identifying the image, providing explanations and justifications for their answers. Additionally, students may be prompted to write about the image using terms from class/reading or to name the processes and concepts depicted. This also works well as a group activity, with the withholding of the “answer” until all options have been explored.
Brainstorming
Think Break
Peer Review
Socratic Questions
Reverse Socratic Questions
Storytelling
Pass the Pointer
Punctuated Lectures
Picture Prompt
Adapted from Iowa State University 226 Active Learning Technology ( https://www.celt.iastate.edu/wp-content/uploads/2017/03/ CELT226activelearningtechniques.pdf); Merriam Webster Dictionary Thesaurus. (https://www.merriam-webster.com/dictionary/ ).
3
A helpful tool within a concept-based curriculum is the assignment of concept maps to enhance comprehension of each concept addressed. Concept maps are visual representations of information which can take the form of charts, tables, flow charts, or Venn diagrams. Numerous references can be consulted to describe methods for developing a concept map. Specifically, to support conceptual learning in a nursing concept-based curriculum, Higgens and Reid (2017) described the use of a Concept Analysis Diagram (CAD). This CAD illustrates a visual representation of a concept analysis by presenting the correlation between concept, antecedent, attributes, related concepts, consequences and sub-concepts, in a consortium of nursing schools who were implementing a Concept-Based Curriculum. Students must complete this diagram with information pertinent to each specific concept in the curriculum and use it as a reference as they move through the curriculum. This analysis fosters an understanding of the correlation and interrelatedness of concepts and patients, thus encouraging higher level thinking and reinforces safe and effective clinical practice. Utilizing Concept Maps 2. Developing Clinical Judgment 3. Regardless of which active learning structure is chosen, the ultimate goal of their use is to help students focus on ways in which the concept or exemplar under discussion can be applied in a variety of clinical situations. Barrett, et al., 2022 noted that one of the benefits of a concept-based curriculum is a shift from a focus on medical diagnoses to an emphasis on resolving clinical problems. This change in focus requires increased clinical judgment to transfer learning across concepts and situations. This benefit is consistent with the National Council of State Boards of Nursing (NCSBN) research to develop the Clinical Judgment Measurement Model. The 2018 NCSBN Strategic Practice Analysis, the national survey of the practice of new graduates which served as the basis of the development of the new Next Generation NCLEX ® testing approach, found that clinical judgment, problem solving, and critical thinking were among the top five skills required of entry-level RNs. ” Clinical judgment was linked directly to more than 46 percent of tasks performed by entry-level nurses, while problem solving and critical thinking were linked to more than 30 percent of tasks completed by entry level nurses.” These initial findings provided evidence of the importance of clinical judgment, problem solving, and critical thinking to the competent practice of entry-level nurses and the necessity of measuring these skills within the NCLEX. As a result, the NCSBN constructed the Clinical Judgment Measurement Model which then guided the development of innovative item types that can validly and reliably measure clinical judgment and decision-making in nursing practice. (https://www.ncsbn.org/public-files/18-Strategic-Practice-Analysis.pdf). If the goal is to prepare students for the Next Generation NCLEX (NGN) and practice after licensure, students’ course of study must focus on the application of clinical judgment in a wide range of clinical scenarios. Focusing on developing students’ skills to apply concepts across situations is an ideal way to prepare students for the NGN—and to practice safely in clinical practice following graduation.
4
4.
Concept-based Curriculum in the Clinical Setting
When a program moves to a concept-based curriculum, how should the clinical experiences be structured? While there is much similarity between clinical experiences in a CBC and a systems-based curricular approach, there are nuances that must be considered. Specifically, the emphasis should be on the concepts that are highlighted in the didactic course. For example, when students are assigned to a labor and delivery or post-partum unit and one of the important concepts to be integrated into the plan of care is perfusion in the context of post-partum hemorrhage (the exemplar), the students should be encouraged to review the concept of perfusion and the exemplar of post- operative hemorrhage and be able to differentiate between their nursing care, including medications, of these two exemplars. Recognizing the similarities and differences in the care of patients with these different diagnoses will strengthen the students’ use of clinical judgment in each situation. In addition, close communication among didactic and clinical faculty guided by the course and clinical objectives/outcomes is essential to ensure that learning from the class and clinical are congruent. After students have participated in a clinical assignment, Brandon, and All (2010) suggested that case studies from the students’ experience can provide significant reinforcement of the concept(s) being addressed during the clinical assignments. The authors noted that as students talk through the case being presented, they are given the opportunity to increase their clinical knowledge and skills, clinical judgment, and confidence in their ability to provide patient care. In subsequent post-clinical conferences, different students can take the lead by sharing a different case situation. This variation in presentation, followed by robust discussion, allows students to see the relevance between the concepts and exemplars discussed in class and actual clinical practice. During these discussions, the clinical instructor models expert clinical judgment; however, students provide the direction for the discussion. This approach to clinical experiences encourages students to continuously assess their progress. During these discussions, students are given an opportunity to talk about their own strengths and weaknesses as well as respectfully discuss the performance of others. Such an opportunity helps students to develop communication skills and learn to use constructive criticism and positive feedback. (Brandon, All, 2010). Conclusion The learning processes in both didactic and lab/clinical experiences chosen for a concept-based curriculum are central to effective student outcomes. The learning processes must be dynamic, meaningful, and engaging, while encouraging collaboration, reflection, and ongoing constructive and nonjudgmental feedback. Consistent use of activities that meet these criteria will increase students’ clinical judgment competency and their ability to consistently provide safe and effective nursing care.
5
References Barrett, T., Likes, W. (2023) Development of a Concept-Based Curriculum. Teaching and Learning in Nursing. 18. 330-334. Brandon, A., All, A. (2010) Constructive Theory Analysis & to Curricula. Nursing Education Perspective . March-April 31(2) 89-92. Franco-Tantuico, M. (2022) Active Learning: A Concept Analysis with Implications for Nursing. Nursing Education Perspective . 43 (2) 89-92. Higgins, B., Reid, H., (2017) Enhancing Conceptual Teaching/Learning in a Concept Based Curriculum. Teaching and Learning in Nursing . 12. 95-102. Iowa State University Center of Excellence Learning and Teaching. 226 Learning Teaching Activities. ( https://www. celt.iastate.edu/wp-content/uploads/2017/03/CELT226activelearningtechniques.pdf ). Merriam-Webster Dictionary Thesaurus. (https://www.merriam-webster.com/dictionary/ ). National Council of State Boards of Nursing (2018) Strategic Practice Analysis. NCSBN. Research Brief. Vol. 71 January. ( https://www.ncsbn.org/public-files/18-Strategic-Practice-Analysis.pdf). Qwens, R., Christian, S. (2021) A Hybrid Concept-Based Practicum Course: An Innovative Approach to Baccalaureate Nursing Education in a Rural Area. Nursing Education Perspective . 40(4) 233-237. Pyatt, A. (2021) Lessons Learned: Implementation of a Concept-Based Curriculum in the Development of a New Prelicensure Nursing Program. Nursing Education Perspective . Nov.-December. 42 (6) E 103-E-104.
© F.A. Davis
6
Page 1 Page 2 Page 3 Page 4 Page 5 Page 6Powered by FlippingBook