NUR 645 Module 6 Concept Paper Example

Rescuing the Adult Health Sequence From Content Saturation: Concepts, Exemplars and a Rule for Removing Content

[Student Name]

Southern New Hampshire University

NUR 645: Curriculum Design in Nursing

Module Six Concept Paper

[Instructor Name]

[Date]

Rescuing the Adult Health Sequence From Content Saturation: Concepts, Exemplars and a Rule for Removing Content

Every nursing faculty member can name a topic that should be added to the curriculum. Few can name one that should be removed. Over time, this pattern produces courses so crowded that faculty race through slides and students memorize facts they cannot use. Cedar Valley's composite baccalaureate program shows the result. The two adult health courses now list more than 90 disease topics, each with its own lecture slides, and the curriculum map from Milestone Two confirmed repeated content across courses. In focus groups, students described studying lists of signs and symptoms without understanding why they occur. This paper examines content saturation, proposes a concept-based redesign of the adult health sequence and argues that the redesign succeeds only if it includes an explicit rule for removing content.

How Saturation Happens

Ironside (2004) interviewed nursing teachers and students and described what she called the additive curriculum. Faculty felt responsible for covering an ever-growing body of content, and each new development in practice added material to courses without anything being taken away. Teachers wanted students to think critically, but the pressure to cover content left little time for it, so thinking was treated as a separate skill rather than something learned through engaging deeply with fewer topics. Students experienced the curriculum as a stream of information to be memorized for the next exam. Ironside's findings match Cedar Valley's experience: each past revision added a topic in response to a new guideline, a sentinel event or a faculty member's specialty, and no process existed for deciding what to remove.

The Case for Concepts

Giddens and Brady (2007) argued that nursing education cannot keep up with the growth of health care knowledge by adding content, and proposed a concept-based curriculum instead. In this approach, students learn a limited number of concepts in depth, such as perfusion, gas exchange or glucose regulation, and study each through a few exemplars, specific conditions that illustrate the concept well. Understanding the concept of perfusion deeply, with heart failure and shock as exemplars, prepares students to reason about other perfusion problems they have not studied. The aim is transferable understanding rather than coverage. The approach also fits the clinical judgment thread in Cedar Valley's framework, because judgment depends on understanding why findings occur, not only on recalling them.

Choosing Concepts and Exemplars

Concept lists can become as crowded as topic lists if faculty simply relabel existing content. To avoid this, Cedar Valley used the benchmark approach described by Giddens et al. (2012), comparing the concepts used by several established concept-based nursing programs and identifying those most commonly shared, rather than relying only on faculty preference. The adult health sequence adopted fourteen concepts, six of which are shown in Table 1. Exemplars were chosen with three criteria: prevalence in the region's hospitals, value in illustrating the concept and frequency in entry-level practice. Each concept appears in both courses, first through a common, stable condition and then through an acute, complex one.

Table 1. Selected Concepts and Exemplars for the Adult Health Sequence (Excerpt)

Note. Adult Health I uses common, stable exemplars; Adult Health II revisits each concept with an acute, complex exemplar, so every concept is met twice at increasing depth.

A Rule for Removing Content

The most important part of the redesign is the rule that keeps saturation from returning. Any proposal to add a topic to the adult health sequence must identify the concept it illustrates and either replace an existing exemplar or show that it teaches something no current exemplar does. The curriculum committee will not approve additions that fail this test. Conditions that are no longer taught as exemplars are not ignored: students meet them through a case library that asks them to apply concepts to unfamiliar conditions, which is itself practice in transfer. When faculty removed lectures on eighteen conditions, including several rare endocrine disorders, the time saved went to unfolding cases and to clinical judgment practice.

Answering Faculty Concerns

Two concerns arose in every faculty discussion. The first was licensure preparation: if students do not study every condition, will they fail questions about them? The response is that the licensure examination increasingly tests clinical judgment applied to unfamiliar situations, which rewards conceptual understanding more than memorized lists, and that the case library gives students practice applying concepts to conditions they have not studied directly. Pass rates will be monitored closely. The second concern was identity. Faculty who built expertise in cardiology or oncology worried that their specialty would disappear. In the new design, specialists lead concepts rather than disease lectures, the cardiology expert leads perfusion across both courses, which keeps their expertise central while changing how it is used.

Teaching a Concept Well

Concepts do not teach themselves, and a concept-based syllabus delivered through the old lecture slides would change little. Each concept unit will follow the same pattern. Students first study the concept itself: its definition, the normal physiology behind it, the populations at risk and the assessment findings that signal a problem. They then work through the first exemplar in class with an unfolding case, and in the second course they revisit the concept with an acute exemplar and a simulation. Each unit ends with a transfer exercise in which students apply the concept to a condition they have not studied, for example using their understanding of perfusion to reason about peripheral arterial disease. Faculty will receive a short template for building units in this pattern so that concepts are taught consistently across instructors.

Evaluating the Change

The redesign will be evaluated over three years. Measures include student performance on clinical judgment items on course exams, performance on case library questions about conditions not taught directly, first-time licensure pass rates, student reports of workload and depth of understanding in focus groups and faculty time spent on preparation. Because concept-based teaching changes how students study, early results may dip as students adjust, so one semester of data will not be treated as a verdict.

Conclusion

Content saturation is the natural result of a curriculum that adds without removing. A concept-based adult health sequence, with concepts chosen by benchmark and exemplars chosen by explicit criteria, gives students fewer topics studied more deeply and practice transferring what they understand. Its survival depends on a rule that requires removal before addition and on answering faculty concerns honestly, which together can keep the curriculum from filling up again.

References

Giddens, J. F., & Brady, D. P. (2007). Rescuing nursing education from content saturation: The case for a concept-based curriculum. Journal of Nursing Education, 46(2), 65-69. https://doi.org/10.3928/01484834-20070201-05

Giddens, J. F., Wright, M., & Gray, I. (2012). Selecting concepts for a concept-based curriculum: Application of a benchmark approach. Journal of Nursing Education, 51(9), 511-515. https://doi.org/10.3928/01484834-20120730-02

Ironside, P. M. (2004). "Covering content" and teaching thinking: Deconstructing the additive curriculum. Journal of Nursing Education, 43(1), 5-12. https://doi.org/10.3928/01484834-20040101-02