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Why Nursing Education Must Emphasize a Clinical Reasoning Based Curriculum-NOT Concept

By October 14, 2016June 8th, 2023No Comments

If you are a nurse educator, don’t put the cart before the horse!

Though many nursing programs are moving to a concept based curriculum, transformational change can come much easier by simply changing the way you teach.

“Flipping your classroom” is a current “hot topic” in nursing education.

But many programs today have already or are considering doing something far more dramatic…flipping the CURRICULUM by changing to a concept-based curriculum.

But to bring needed change to your content and program you can do something far easier, TRANSFORM it by simply changing the way you teach by pursuing a CLINICAL REASONING based curriculum instead!

Concept Based Curriculum

What is a concept based curriculum?

Concepts are an organizing principle or classification of information that are considered building blocks or foundations for theory (Giddens, 2013).

In Gidden’s textbook on this topic, she identifies 53 concepts across 11 themes that include Culture, F&E Balance, Nutrition, Perfusion, Gas Exchange, Inflammation, Immunity to name just a few (Giddens, 2013).

The essence of a concept based curriculum is that it is a model of conceptual learning based on the PREMISE that “concepts can be used effectively as unifying classifications or principles for framing learning while knowledge increases exponentially.” (Giddens, 2013, p.xiii)

If concepts are understood deeply, links can be made to other aspects of nursing practice. This is in contrast to traditional educational approaches that emphasize content and facts. (Giddens, 2013)

Where’s the Beef?

Is there any research “beef” to validate improvement in student learning with a concept based curriculum? The premise that a concept based curriculum increases learning exponentially (Giddens, 2013) is just that, a premise.

I am not aware of any educational research study that validates the superiority of this curricular emphasis over the traditional systems/content based model that most programs continue to utilize.

As nurse educators we insist that “evidence base practice” must be the basis for all that a nurse does in practice related to practice and appropriate nursing interventions. If the evidence supports a practice change we expect our students to incorporate this into their practice and even write papers on this topic for our programs.

So if there is NO nursing educational research to validate the improved learning outcomes of a concept based curriculum, WHY are so many programs investing the time, money, energy, and effort to make this painful and difficult transition?

There is another way.

Educating Nurses: A Call for Radical Transformation is not just a book of suggestions to transform nursing education, but is based on educational research by the Carnegie Foundation headed by Patricia Benner.

Therefore, it is imperative to determine if your program has implemented the following three paradigm shifts that have the power to transform your program. No flipped curriculum required!

Three Transformational Shifts From Educating Nurses

  1. Shift from covering decontextualized knowledge and content (textbook) to CONTEXTUALIZING classroom content so it is situated in clinical practice (at the bedside) so students can see why the content is relevant.(see past blog for more on this topic “Where’s the Joy-The Love of Learning”)
  2. Shift from sharp separation of classroom and clinical teaching to greater INTEGRATION of classroom theory and clinical content so that they are not kept in largely separate orbits in nursing education.
  3. Shift from an emphasis of critical thinking to an emphasis of CLINICAL REASONING to multiple ways of thinking that may include critical thinking.

Clinical reasoning is the ability of the nurse to…

  • THINK IN ACTION and REASON as a situation CHANGES over time
  • Capture and UNDERSTAND significance of clinical TRENDS
  • Filter clinical data to recognize what is MOST and least important (RELEVANT)
  • Grasp the essence of current clinical situation
  • IDENTIFY if actual problem is present (Benner, Sutphen, Leonard, & Day, 2010)..

For more on clinical reasoning see my past blogs “The 5 Rights of Clinical Reasoning” & Nurse Thinking is a Skill That Must Be Practiced

Clinical Reasoning Based Curriculum

In order to TRANSFORM nursing education (which is a more important objective than making a curricular change!), CLINICAL REASONING must be integrated and emphasized in the class and clinical settings (Benner, Sutphen, Leonard, & Day, 2010)..

Another way to look at this is to see how well your curriculum integrates clinical reasoning.This is putting FIRST things FIRST!

Implement a Clinical Reasoning Based Curriculum

So how do you take clinical reasoning and make it practical in your program? The following are a few suggestions:

1. Emphasize relevance NOT content

TMI (too much information!) is an ongoing problem in nursing education. The problem of too many textbook readings and content saturated lectures…superficial learning of broad body of content, but not the DEEP learning of what is MOST important.

Use your lens of clinical practice to determine what is NEED to know that needs to be covered in your content and what is NICE to know that can be read instead by students.

For more on how to emphasize relevance in the classroom, see my recent blog, “What Every Classroom Lecture Must Cover to Transfer Learning to the Bedside.”

2. Emphasize DEEP learning of what is MOST important

  • A&P. Patho must be DEEPLY understood in order for students to make connections to the relationships of essential clinical data in practice. WHY does creatinine elevate in acute heart failure?  Integrate patho into your every lecture and pharmacology to better understand the mechanism of action.
  • F&E. What labs are most important and why? Applied understanding  of F&E is more important than memorizing the “hypo” and “hyper” of the most common electrolytes! See my past blog “Do You Know your BMP’s?”
  • Pharmacology. In order to safely pass the most common medications, students must not just memorize, but UNDERSTAND the mechanism of action. It is only when students know what a “beta blocker is blocking” are they truly safe to administer!

3. EVERYTHING taught is contextualized to the bedside

Nursing is a practice based profession. Therefore EVERYTHING that is taught must have a “hook” that contextualizes content to the bedside.

Content heavy lectures that regurgitate textbook content for students is hindering student mastery of content that must be able to be applied, NOT memorized!

4. Emphasize clinical reasoning as  “nurse thinking”

This is one of the essential paradigm shifts from Educating Nurses that must be the foundation of all that is taught in nursing education!

Closing Thoughts

The educational research contained in Educating Nurses, did not recognize a need to change curriculum to transform nursing education. Instead, it emphasized the importance to CONTEXTUALIZE to the bedside everything that is taught.

So if you are teaching a traditional content based curriculum…CONTEXTUALIZE your CONTENT!

If you have changed to a concept based curriculum… CONTEXTUALIZE your CONCEPTS!

You see, it doesn’t really matter according to the research in Educating Nurses what curriculum you use.

Contextualize content/concepts with active learning, small group discussions, or clinical reasoning case studies.

Integrate these transformational paradigm shifts at every level in your program and you can be confident that you are bringing meaningful, lasting change that will strengthen the THINKING of students in your program that will prepare them for professional practice!

Comment Question:
What have you done to bring transformational change to your program? Did a concept-based curriculum help strengthen student learning in your program?
Comment below and let the conversation begin.

1. Giddens, J.F. (2013) Concepts for Nursing Practice. St. Louis, MO: Mosby/Elsevier

2. Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating Nurses: A Call for Radical Transformation. San Francisco, CA: Jossey-Bass

Keith Rischer – Ph.D., RN, CCRN, CEN

As a nurse with over 35 years of experience who remained in practice as an educator, I’ve witnessed the gap between how nursing is taught and how it is practiced, and I decided to do something about it! Read more…

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