NUR 645 Module 3 Milestone One Example

Milestone One: A Philosophy With Consequences and an Organizing Framework for a Competency-Based Baccalaureate Curriculum

[Student Name]

Southern New Hampshire University

NUR 645: Curriculum Design in Nursing

Module Three Milestone One

[Instructor Name]

[Date]

Milestone One: A Philosophy With Consequences and an Organizing Framework for a Competency-Based Baccalaureate Curriculum

Most nursing programs have a philosophy statement, and most faculty could not recite it. Written for an accreditation visit and filed away, a philosophy often describes person, health, environment and nursing in language so general that no course decision could be traced to it. In the composite Cedar Valley University School of Nursing, the philosophy was adopted in 1998 and identifies Orem's self-care deficit theory as the organizing framework, yet a review of current syllabi found the theory mentioned in one course. The needs assessment completed in Module Two identified clinical judgment and population health as priorities. This milestone rewrites the philosophy and builds a new organizing framework. It argues that a philosophy earns its place only if each belief has a visible consequence in the curriculum, and that a framework is useful only if it helps faculty decide what to teach, where and how.

From Mission to Philosophy

The university's mission commits it to serving rural communities in its region, and the school's mission commits it to preparing nurses who improve health in those communities. The 1998 philosophy did not mention rural health or communities at all. The revised philosophy begins from the mission and states beliefs about four areas: health, the learner, learning and the nurse's role. Faculty drafted the statements in two workshops, and each draft was tested with a simple question: if we truly believed this, what would we do differently? Statements that produced no answer were removed. Keeping the philosophy short, five statements instead of the previous two pages, was deliberate, so that faculty could remember and use it.

Beliefs and Their Consequences

Table 1 pairs each belief with its consequence. The first statement, for example, is not a new idea, but writing it with a consequence commits the school to something measurable: faculty will check that every clinical course includes social and structural factors in its cases and assignments. The consequences also give future faculty a way to ask whether a proposed change fits the philosophy.

Table 1. Philosophy Statements and Their Curricular Consequences

Note. Each statement passed the test of producing a specific change; statements that did not were removed from the draft.

The Organizing Framework

An organizing framework is the structure faculty use to arrange content and competencies across the program. The new framework has three threads that run through every level. The first is clinical judgment, based on the model Tanner (2006) built from a review of research, which describes how nurses notice a situation, interpret it, respond and reflect, and which holds that a nurse's prior knowledge of this particular patient strongly colors what gets noticed at all. The model gives faculty a shared language for teaching and assessing judgment, which the needs assessment identified as the most important gap.

The second thread is safety and quality, based on the six QSEN competencies, which range from patient-centered care and safety to informatics, with teamwork, quality improvement and evidence-based practice between them (Cronenwett et al., 2007). QSEN defines knowledge, skills and attitudes for each competency, which translate readily into course outcomes. The third thread is population health, built from the needs assessment and the rural mission, and it progresses from individual social needs in early courses to community assessment and policy in later ones. The threads are leveled across three stages, beginning, developing and transitioning to practice, so that each is introduced, reinforced and mastered.

Alignment With the 2021 Essentials

The 2021 Essentials organize entry-level professional competencies into ten domains, among them person-centered care, population health and professionalism, and they thread featured concepts such as clinical judgment and social determinants of health through all ten (American Association of Colleges of Nursing, 2021). The framework's threads map onto these domains: clinical judgment supports knowledge for practice and person-centered care; safety and quality corresponds to the quality and safety, informatics and interprofessional domains; and population health corresponds to the population health and systems-based practice domains. Domains that no thread covers directly, such as scholarship and personal, professional and leadership development, will be addressed through program outcomes in the next milestone so that the framework does not leave gaps.

Testing the Framework

The framework will be tested before it is adopted. Faculty will apply it to three real decisions from the past year: whether to add a separate informatics course, how to schedule the community course and whether to keep a pharmacology course separate. If the framework does not help resolve these decisions, it needs revision. It will also be reviewed with the school's advisory board, which includes two rural hospital nurse leaders, and with a group of students. Once adopted, every course proposal will include a short statement of which threads it develops and at what level.

Conclusion

The 1998 philosophy described nursing; the new one commits the school to specific practices. Belief statements paired with consequences, an organizing framework built on clinical judgment, safety and quality and population health, alignment with the 2021 Essentials and a test against real decisions give Cedar Valley faculty a philosophy and framework they can use, which is the only reason to have them.

Faculty resistance is expected and was planned for. Several senior faculty helped write the 1998 philosophy and taught Orem's theory for years. Rather than dismissing that history, the workshops began by asking what the old framework had done well, and faculty identified its emphasis on patient participation in care. That idea was carried into the belief about learners and the person-centered care thread, which helped longtime faculty see continuity rather than rejection. A faculty member from each level will serve as a framework lead for the first two years to answer questions and review course proposals.

References

American Association of Colleges of Nursing. (2021). The essentials: Core competencies for professional nursing education. https://www.aacnnursing.org/essentials

Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J., Mitchell, P., Sullivan, D. T., & Warren, J. (2007). Quality and safety education for nurses. Nursing Outlook, 55(3), 122-131. https://doi.org/10.1016/j.outlook.2007.02.006

Tanner, C. A. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education, 45(6), 204-211. https://doi.org/10.3928/01484834-20060601-04