F.A. Davis 9 Steps to Developing/Revising Curriculum

F.A. Davis Nine Steps to Developing/Revising a Nursing Curriculum

Nine Steps TO DEVELOPING OR REVISING A NURSING CURRICULUM

Susan Sportsman, PhD, RN, ANEF, FAAN Managing Director Collaborative Momentum Consulting

So, you want to—or think you should—revise your current nursing curriculum or even start fresh with a novel approach. Congratulations for taking this step! A curriculum should be dynamic, reflecting innovations in nursing or in health care in general. Sometimes maintaining an up-to-date curriculum can be accomplished by making minor “tweaks” as recommendations from regulators, policymakers or accrediting bodies are published. Ultimately, however, these small tweaks may lead to a curriculum that is inconsistent, with gaps and overlaps that may not prepare students for licensing exams, and more importantly, practice following graduation. All faculty recognize that developing or revising a curriculum is difficult, time consuming, and exciting, depending on your perspective. This paper is designed to help you plan the most efficient and effective way to develop or revise a curriculum by following these nine steps.

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Determine the focus of the curriculum change. 1. Do you plan to move from a block curriculum to one structured around concepts? Will this require a change in the courses offered or the sequence of the content? Are you integrating the evaluation of competencies into your curriculum? Are you emphasizing the development of clinical judgment in your curriculum? Do you want to “update” the curriculum while maintaining most or all the structure of the current curriculum? Are you beginning a new program of study? Answering these questions is key to determining the goal of the endeavor. Once the purpose of the curriculum change is decided, develop a goal statement for the work (e.g., “Revise the curriculum to meet the 2021 AACN Essentials” or “Develop and implement a concept-based curriculum”). This goal clarifies for everyone involved the desired outcomes to be achieved at the end of the development or revision process. Billings and Halstead (2019) describe three types of curricular design: 1) Blocks of content, often reflecting clinical specialties; 2) Concept-based curriculum; and 3) Competence-based curriculum. 1 Blocks of curriculum , the most traditional approach in nursing curricula, typically require sequencing courses and content, usually structured around clinical specialty areas, patient populations, pathological conditions, or physical systems. Concept-based curricula are built around concepts integral to nursing practice that are threaded throughout the curriculum. Competency-based curricula focus on helping students achieve observable and measurable metrics throughout the program in order to be considered competent. In some cases, curricula may combine these types to achieve expected outcomes for students. For example, the blocks of content may be the structure of the curriculum, yet competencies for each course are identified and measured. 2. Think and read broadly about both the process of curriculum change and the content to be included in the change. Remember, the relevance of the curriculum for the next several years will be important for the success of students. The box below suggests general sources that might be helpful to ensure that changes made are current and appropriate for the immediate future. Review relevant literature that addresses the desired curriculum change.

Resources for Review

§ American Association of Colleges of Nursing (AACN) Essentials for Practice § National Counsel of State Boards of Nursing (NCSBN) Clinical Judgment Measurement Model § NCLEX ® Test Design (for undergraduate curricula) § Accreditation criteria for ACEN, CNEA, and/or CCNE, as well as specialty organizations § State Nurse Practice Acts and related regulations and position statements § Scope and Standards of Practice (various specialties) § The Future of Nursing: 2020-2030 § Healthy People 2030 § Review of relevant nursing textbooks and related support materials

Identify the concepts/ constructs you want to include in the revised (or new) curriculum.

For example, Social Determinates of Health figure prominently in the Future of Nursing 2020-2030, Healthy People 2030, the AACN Essentials , and numerous other professional recommendations. An up-to-date nursing curriculum will provide opportunities for students to address the impact of social determinants of health on the delivery of nursing care in a variety of contexts. Note: If you plan to revise an existing curriculum, evaluating the content currently in place to determine which concepts/constructs can be omitted is a critical next step. Only through thoughtful analysis to determine repetitions and unneeded content will you be able to add important updated content without overloading the curriculum.

Choose or develop an organizing framework.

Billings and Halstead (2019) describe the purpose of an organizing curriculum framework as an educational blueprint that provides a mental picture to help teachers and learners determine what knowledge is valuable to nursing practice and how that knowledge should be defined, categorized, and linked to illustrate the whole of nursing practice. This framework may be drawn from theory or may be a combination of concepts or constructs considered crucial to nursing education and practice. These important concepts/constructs will likely be reflected in the program’s philosophy and mission, vision, and values. Although there is no one right way to develop an organizing framework, principles for crafting the framework may include: § Choose concepts/constructs that accurately reflect faculty beliefs about nursing education and practice AND are relevant in health care today and in the immediate future. § Frameworks developed by professional entities may be used if they are sufficiently broad to cover all necessary aspects of professional nursing practice. Examples of such frameworks may include the AACN Domains found in the new The Essentials: Core Competencies for Professional Nursing Education or the Differentiated Essential Competencies of Graduates of Texas Nursing Programs , (DECs) established for entry level nurses by the Texas Board of Nursing. § The linkages between and among concepts/constructs in the chosen framework should be explained via both diagram and narrative. Such an explanation helps students to understand, apply, analyze, synthesize, and evaluate the knowledge necessary for nursing practice.

Develop Program Goals to describe the outcomes graduates should demonstrate.

Think broadly about what knowledge and skills are reasonable for new graduates from your school to have upon entering the workplace, regardless of the clinical area they choose. The Program Goals, sometimes called Learning Outcomes, should be written at the application level of cognition or higher and reflect the expectations of regulatory entities and/or accreditation requirements.

Name and outline the sequence of courses that form the program’s course of study.

Writing the course descriptions and objectives will help clarify the focus of each course. Importantly, the brief course descriptions should highlight relevant content, competencies to be achieved in the course, if applicable, and clinical applications. Course objectives for both didactic and clinical courses should also be written at the application or higher level of cognition. Completion of the initial draft of course descriptions and objectives provides an opportunity to review the span of the curriculum by asking yourself the following questions: § Can the objectives of each course be categorized according to the program goals? Developing a chart that categorizes the course and/or clinical objectives by specific program goal is a straightforward way to see if the course objectives are congruent with program goals and if they are appropriately distributed across the curriculum. § Do the course objectives and competencies, if included, represent essential knowledge and skills required by regulators and accreditors as students move through the program (e.g., categories of the NCLEX-Test Plan for undergraduate programs)? § Are the course and clinical objectives in the correct course and are there gaps and overlaps throughout the curriculum? If competencies are used to measure student outcomes, review of the AACN Competencies 2 will be helpful in constructing competencies, regardless of the level of your program.

Skills or competencies students should attain in each course to meet the program’s goals.

For each class period in each class, identify the content, activities, and evaluation strategies. 8. For example, one of the program goals (learning outcomes) might be to “Provide appropriate patient teaching to meet the needs of clients, families, and staff members.” To demonstrate this competency in a beginning level course, the competency might be to “Provide appropriate patient teaching regarding basic self-care to clients and their families.” The competency in Pharmacology might be to “Prepare a teaching plan for a client receiving medication in a specific classification.” In a Maternity Course, it might be to “Support a new mother as she learns to breastfeed her new infant.” In a management course, it might be to “Provide an in-service program for UAPs regarding delegation rules.” When all of these objectives are reviewed, the question must be asked: When students are successful in demonstrating competence in each of these individual objectives, does the faculty believe that the new graduate is indeed competent to “Provide appropriate patient teaching to meet the needs of clients, families and staff members?”

Use the course objectives as a guide: Will the chosen content, pre-class activities, including readings, class/ clinical learning activities, and evaluation processes allow students to meet the objectives for the course?

Evaluate the curriculum as a whole.

Use the course objectives as a guide: Will the chosen content, learning activities, and evaluation processes allow students to meet the objectives for the course?

Helpful Questions to Ask

§ Are the connections among the philosophy, program goals, course objectives, learning strategies and evaluation tools clear? § Are there a range of learning resources that will allow faculty to adapt course work to meet the needs of a variety of students? § Is there a breadth of learning experiences in various clinical settings threaded throughout the curriculum? § Does this curriculum address relevant knowledge, skills, and trends that will prepare students for current practice, as well as nursing in the near future? § Are methods in place to evaluate various aspects of the curriculum over time?

General Advice Remember, developing or revising a curriculum is a team sport. The curriculum belongs to the faculty. Thus, they are responsible for its development, teaching, evaluation, and revision. However, this does not mean that every faculty member must be intimately involved in every aspect of the curriculum change. Administration should identify a leader(s) and/or a consultant for the project; proactively involve key personnel in the process; and set a plan with a timeframe for completing various aspects of the curriculum. Opportunities for review, feedback, and discussion by faculty members during the process will ensure transparency. Yet, there will always be barriers to the development and revision of a curriculum. Lack of time to commit to the work, lack of experience in curriculum development, fear of change and a lack of control, and fear of having to learn new clinical skills, content, or teaching strategies may all play a role in “slowing down the process” (Billings & Halstead, 2019). Following the steps above and agreeing upon goals, establishing a timeframe to keep the project on track, ensuring transparency of the process, and respect for everyone’s opinions will go a long way toward facilitating a positive outcome to your curriculum development or revision.

References 1 Billings, D.M., Halstead, J.A., (2019) Teaching in Nursing: A Guide for Faculty . Elsevier. Sixth Edition. 2 AACN (2021) The Essentials: Core Competencies for Professional Nursing Education . American Association of Colleges of Nursing. https://www.aacnnursing.org/Portals/42/AcademicNursing/pdf/Essentials-2021.pdf About the author Susan Sportsman, PhD, RN, ANEF, FAAN , is a nationally recognized speaker and consultant with over 10 years of consulting experience, providing program development and other consultation services to nursing and health professions programs throughout the United States and Canada. Previously, she served as Dean of the College of Health Sciences and Human Services at Midwestern State University in Wichita Falls, Texas.

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