This paper examines the role of nursing theoretical frameworks as organizing structures for healthcare curricula. It begins by debating the advantages and limitations of using a nursing metaparadigm as a curricular foundation, then applies those principles to two case studies. The first case study addresses curriculum committee procedures, cost analysis, resource identification, and required curriculum components for a university nursing program. The second case study examines course design parameters, active learning strategies, student needs assessment, and the structure of an accelerated baccalaureate nursing program. Drawing on authorities such as Keating, Iwasiw et al., and McKimm, the paper defends the value of nursing theoretical frameworks while acknowledging the need for more rigorous evidence-based research.
A nursing theoretical framework represents a valuable starting point for developing timely and relevant curricular offerings for both nursing and non-nursing courses in healthcare settings today (Keating). According to Keating, "Although the debate continues about nursing as a science and a discipline, in most nursing education circles, a metaparadigm for the nursing discipline is recognized and included in the philosophy and organizing framework of the curriculum" (p. 167). In addition, Keating points out that a nursing theoretical framework helps to ensure that nothing is omitted from the curricular offerings.
A theoretical framework from nursing also provides practitioners with a way to organize curricular offerings in ways that align with educational developmental goals (Cook & Cullen, 2003). For instance, McKimm emphasizes that "the aim of educational development is to ensure that the official curriculum is delivered as the functional curriculum and there is not a mismatch as development turns into implementation" (p. 3). Many nursing theoretical foundations also incorporate diversity and cross-cultural factors that make their application across a wide range of healthcare practice settings possible (Scisney-Matlock, McCloud & Barnard, 2001). Despite these advantages, there remains a paucity of evidence-based practice research in the nursing literature, and some of the nursing research to date is based on anecdotal accounts and individual case studies that lack the rigor and robust qualities required for gold-standard clinical research (Cook & Cullen, 2003).
Because the curriculum committee has received approval of the outcome statements and formulated the level competencies, the next step involves developing and receiving approval of the course design. In this regard, Iwasiw, Andrusyszyn, and Goldenberg advise: "Course design proceeds once the curriculum design is approved. The level, year, or semester competencies, brief course descriptions, and draft course competencies developed during curriculum design become the starting point for designing courses."
According to Keating, a useful factor to consider next is the cost analysis of the budget, in order to identify specific costs and provide funding for the different supporting functions of the curriculum. Keating states: "Academic and infrastructure support systems are analyzed for congruency with the mission. An example from nursing is an institution's support and commitment to a nurse-managed primary care clinic that serves the underserved and unserved populations of the community in which the institution is located."
The curricular design process can be facilitated by drawing on resources such as nursing professional organizations, guidelines from national accrediting organizations, standards required by federal and state laws, and other localized and regional issues that should be taken into account.
Although every healthcare classroom situation will be unique in some ways, there are minimum components that should be included in the curriculum design, including the following:
1. Mission and Vision. 2. Philosophy — encompassing beliefs about teaching and learning processes, critical thinking, diversity and cultural competence, genetics, social justice, research and evidence-based practice, informatics and technology, quality health care and patient safety, and the nursing paradigm. 3. Organizational framework and concept mapping. 4. Overall program goal and purpose. 5. Implementation plan — including student learning outcomes (SLOs; end-of-program objectives), level objectives, course objectives, course prerequisites, course descriptions, content outlines, course schedules, learning activities, and evaluation methods (Keating, pp. 149–150).
According to Iwasiw et al., "The curriculum nucleus simultaneously comprises the foundation and the essence of the curriculum. It is composed of the core curriculum concepts, key professional abilities, principal teaching-learning approaches, and the philosophical approaches" (p. 137). Although the curriculum nucleus will influence the initial curriculum design, the process is iterative and dynamic, with new experiences informing subsequent thinking (Iwasiw et al.).
The curriculum design committee or other groups or individuals tasked with curriculum design could distinguish between nursing and non-nursing courses, and these groupings could be reviewed by peers and superiors to provide inter-rater reliability in the categorization of courses where such a distinction is required.
Institutional policies concerning the disciplines being offered should be taken into account during the curriculum design process (Keating).
"Design parameters and active learning influence on courses"
"Student needs, clinical experiences, and course components"
An accelerated baccalaureate nursing program generally requires between 12 and 18 months to complete, including prerequisites, and achieves its programmatic objectives in intensive learning settings (Mason, Isaacs & Colby, 2008). According to Mason et al., "Instruction is intensive with courses offered full-time with no breaks between sessions. Students receive the same number of clinical hours as their counterparts in traditional entry-level nursing programs" (2008, p. 174). A nursing theoretical framework, when used as the organizing structure of such a curriculum, provides both the philosophical coherence and the practical scaffolding needed to ensure that all essential competencies — from cultural diversity to evidence-based practice — are systematically addressed across every level of the program.
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