Nursing Education and Types of Curriculum and Role of Faculty In Its Development
Types
of Curriculum In Nursing Education
Regardless
of the ideological interpretation of curriculum, several types of curricula may
occur concurrently. The official (or legitimate) curriculum includes the stated
curriculum framework with philosophy and mission; recognized lists of outcomes,
competencies, and learning objectives for the program and individual courses;
course outlines; and syllabi.
Bevis (2000) stated that the “legitimate
curriculum . . . [is] the one agreed on by the faculty either implicitly or
explicitly” (p. 74). These written documents are distributed to faculty,
students, health care practice partners, and accrediting agencies to document
the planned curriculum, including what is to be taught and expected learning
outcomes and competencies at program completion.
The operational curriculum consists of “what
is actually taught by the teacher and how its importance is communicated to the
student” (Posner, 1992, p. 10). This curriculum includes knowledge, skills, and
attitudes (KSAs) emphasized by faculty in the classroom and clinical settings.
The
illegitimate curriculum, according to Bevis (2000), is one known and actively
taught by faculty yet not evaluated because descriptors of the behaviors are
lacking. Such behaviors include “caring, compassion, power, and its use” (p.
75).
The hidden curriculum consists of values and
beliefs taught through verbal and nonverbal communication by the faculty.
Faculty may be unaware of what is taught through their expressions, priorities,
and interactions with students, but students are very aware of the “hidden
agendas” of the curriculum, which may have a more lasting influence than the
written curriculum. The hidden curriculum includes the way faculty interact
with students, the teaching methods used, and the priorities set (Bevis, 2000;
Posner, 1992)
The
null curriculum (Bevis, 2000) represents content and behaviors that are not
taught. Faculty need to recognize what is not being taught and focus on the
reasons for ignoring those content and behavior areas. Examples include content
or skills that faculty think they are teaching but are not, such as clinical
reasoning. As faculty review curricula, all components and relationships need
to be evaluated.
Curriculum
Development in Nursing Education
From
an historical perspective, how nurse educators approached curriculum
development was greatly influenced by the work of Bevis. Bevis defined
curriculum as “those transactions and interactions that take place between
students and teachers and among students with the intent that learning takes
place” (2000, p. 72).
Bevis challenged nurse educators to move from what she
termed the Tylerian behaviorist technical paradigm of curriculum development to
one that focuses on human interaction and active learning, and incorporates a
focus on students’ and teachers’ interactions.
Since Bevis’ time, several
educational scholars in nursing have extended these concepts, most notably
Diekelmann and Diekelmann (2009) and Ironside (2014).
The
nursing curriculum is often based on current practice, accreditation standards,
regulatory requirements, and faculty interests, which leads to lack of
curricula standardization. New opportunities abound to foster collaborative
debate and dialogue on a number of issues, including how to accomplish the
following goal:
• Enhance students’ delegating, supervising, prioritizing, clinical reasoning,
decision-making, and leadership skills to effect change.
• Focus on health promotion, disease
prevention, and care transitions to improve outcomes in health care disparities
across health care settings.
• Enhance student–faculty–preceptor
interactions in the learning process.
• Design clinical models that allow for
student immersion in the practice setting.
• Develop learner-centered environments.
• Use evidence-based research and nursing
practice to deliver efficient and effective care.
• Integrate culture of safety concepts,
including care coordination and transitions, in specifically designed
interprofessional education and collaborative practice experiences.
• Focus on patient-centered care within the
overarching “tripleaim” goal of improving the patient care experience
(including quality and satisfaction); improving the health of the populations;
and reducing the per capita cost of health care (Berwick, Nolan, &
Whittington, 2008).
• Expand culturally sensitive nursing practice
with a focus on reducing health disparities.
As Valiga (2012) summarized: “Nurse educators
must be proactive, anticipate the future, and not wait until history tells the
story of our times. We must act despite uncertainty, and we must be innovative
and scholarly as we shape the future of nursing education. Transformation is
not easy but it is desperately needed. . . .” (Valiga, 2012, p. 432).
The need
to craft a national agenda for nursing education research is believed to be
crucial to support the necessary transformation in nursing education (Valiga
& Ironside, 2012).
Role
of Faculty in Curriculum Development In Nursing Education
The
development of curricula has historically been the responsibility of faculty,
as they are the experts in their respective disciplines and the best
authorities in identifying the knowledge and competencies students need to
acquire by graduation.
The NLN’s Scope of Practice for Academic Nurse Educators
(National League for Nursing, NLN, 2012) outlines nurse educators’
responsibility for “formulating program outcomes and designing curricula that
reflect contemporary health care trends and prepare graduates to function
effectively in the health care environment” (National League for Nursing, NLN,
2012, p. 18).
As
the emphasis for designing contemporary and cost effective curricula continues
to increase, so does the need to involve a broader community of stakeholders in
the curriculum development process. Practice disciplines such as nursing are
actively engaging a diverse array of stakeholders in curriculum design,
development, implementation, and evaluation.
The desire to increase engagement
can and does add to the complexity of the development process and the ability
to alter curricula in a timely manner. To address the need to create curricula
that are responsive to workforce expectations requires faculty to develop
curricula that are flexible in design, open to broader interpretation as
expectations change, and capable of being implemented using a variety of
different methodologies.
Traditionally,
curriculum development has been built on the concepts of frameworks,
objectives, and closely orchestrated learning experiences. This approach
envisions curriculum development as a logical, sequential process. Although
some of this structure is necessary to plan and develop curricula, the more
contemporary approach shifts the emphasis from an epistemological to an
ontological orientation (Doane & Brown, 2011; Ironside, 2014).
An
epistemological orientation to education is focused on knowledge, or the
“content to be covered.” An ontological orientation to the educational process
is more learner-centered and focused on the student’s “way of being a nurse”
(Doane & Brown, p. 22). In this shift in philosophical orientation,
knowledge is applied for the purpose of facilitating the learner’s
transformation into a nursing professional.
The move from epistemology to
ontology has a profound effect on how curriculum is designed and the
teaching–learning strategies chosen to help students think like a nurse and
develop competence in their practice.
Nursing
faculty have come to approach curriculum development from an outcomes
perspective, rather than the traditional teaching process orientation used in
the delivery of nursing curricula.
Focusing on learning as the product
(outcome), the emphasis is placed on how students can use knowledge to practice
competently in changing and often uncertain clinical situations. This approach
assumes that both students and faculty have some latitude in individualizing
the learning experience and related processes used in creating knowledge.
Traditionally,
faculty autonomy has been closely tied to curriculum; in fact, faculty are
considered to “own” the curriculum. This means faculty are accountable for
assessing, implementing, evaluating, and changing the curriculum to ensure
quality and relevance in programs.
In today’s educational climate the value of
education is measured against job marketability. In the discipline of nursing,
emphasis has been placed on what knowledge and competencies graduates have on
completion of their programs as it relates to the expectations of the settings
and roles within which they will practice.
Inevitably,
when curriculum development is undertaken, the concepts of academic freedom
versus curricular integrity arise. As suggested by the prior statements,
faculty are collectively charged with using their significant expertise and
diverse talents to construct curricula that will produce successful,
high quality graduates.
Curricular integrity is achieved through faculty
striving for, but not always arriving at consensus decisions. Communication
throughout the curriculum is a key determinant in the quality and consistency
of the curriculum and the student experience. A statement from the American
Association of Colleges and Universities specifically addressed this topic.
There
is, however, an additional dimension of academic freedom that was not well
developed in the original principles, and that has to do with the
responsibilities of faculty members for educational programs.
Faculty are
responsible for establishing goals for student learning, for designing and
implementing programs of general education and specialized study that
intentionally cultivate the intended learning, and for assessing students’
achievement.
In these matters faculty must work collaboratively with their
colleagues in their departments, schools, and institutions as well as with
relevant administrators.
Academic freedom is necessary not just so faculty
members can conduct individual research and teach their own courses, but so
they can enable students through whole college programs of study to acquire the
learning they need to contribute to society (American Association of Colleges
and Universities, 2006, p. 1)
This
statement emphasizes that academic freedom does not mean that individual
faculty can arbitrarily or unilaterally decide what they will teach in their
classroom, but that faculty, through faculty governance processes, must work
collaboratively to determine curriculum and then are expected to uphold that
collective decision to achieve curricular integrity and effectiveness.