N 584 Reconceptualization
N 584 Reconceptualization
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Assignment:
Critical Thinking Exercises :
Case Study #1: Bellemore University School of Nursing
Bellemore University , an accredited, long-standing
institution of some 150 years, with approximately 10,000 full- and part-time
students, is located in a mid-western industrial city of 350,000 inhabitants.
University departments offer programs in liberal arts, social, physical, and
health sciences. The four-year baccalaureate nursing program is one of three
others within the College of Health Sciences. Eighty students are admitted
annually to the nursing program, which has a total complement of 290 students
in the four years. The majority is female and enrolled on a full-time basis.
Approximately 25% of students study part-time, are mature, and have taken jobs
in the community in order to meet tuition costs.
Thirty full- and part-time faculty, 15 with doctoral
degrees, 12 with masters preparation, and 3 with baccalaureate degrees teach
classroom and clinical courses in the school of nursing. The nursing program
received full accreditation 4 years previously.
The main industry of the city of Bellemore, for which the
university is named, is automobile manufacture. The largest auto plant, which
employs approximately 2000 workers, offers health services to all employees.
There is concern that general downsizing of North American auto manufacturing
will soon lead to downsizing of the local auto plant.
In addition to the university, the city
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N 584 Reconceptualization
of Bellemore boasts
a 3000-student technological community college, as well as the following health
facilities and services: a 450-bed acute care general hospital; a 275-bed long
term and chronic care facility; 3 physician-serviced medical clinics; 2 walk-in
emergency clinics; 3 nurse practitioner clinics, many physicians’ offices, and
a county community health department.
Bellemore School of Nursing is preparing for a
reconceptualization of its four-year baccalaureate program. Examining the
contextual factors that will affect nursing practice, and hence the curriculum,
is recognized as integral to designing a future-oriented, context-relevant
curriculum.
Dr. Amèlie Le Blanc, the curriculum coordinator, requested a
meeting of the curriculum committee, made up of representatives from faculty,
students, and community health personnel, to discuss contextual factors
relevant to a redesigned curriculum. The group decided to schedule a faculty
development session to help them with this activity. As a result of this
session, several task force groups were formed to determine who would
participate, which relevant data to gather, the sources, methods, and tools for
this undertaking. The group agreed to meet again when the contextual
data-gathering phase was complete.
Which contextual factors would be most relevant to
Bellemore’s vision of a future-oriented nursing curriculum?
What are the essential data to collect about these
contextual factors?
Which data-gathering methods and tools might be employed to
obtain information about the contextual factors?
What would be a suitable time period for collecting and
collating these data?
Who could best participate in this data-gathering activity?
How could they organize to obtain relevant data expeditiously?
Case Study #2: Poplarfield University School of Nursing
Members of the Poplarfield University School of Nursing
completed their data-gathering about internal and external contextual factors.
A curriculum consultant was hired for a two-day retreat to help the group
derive the curriculum nucleus from the data. Dr. Werstiuk, the School Director,
stated her intention to attend and participate fully. The Dean of the Faculty
was also invited, since her support would be needed for any additional
resources that might be required for the new curriculum. Faculty believed that
the dean’s involvement would be an effective way to educate her about the
complexity of curriculum planning and the many influences on the nursing
curriculum. Additionally, members of the Curriculum Advisory Committee were
invited to attend, and two of the twelve members were able to do so.
In preparation for the retreat, data had been organized for
each contextual factor on a chart and a hard copy distributed to all faculty
members. A copy of the chart was loaded onto laptop computers, so that ideas
could be immediately recorded and preserved.
The group agreed to derive the curriculum nucleus
collectively, starting with a shared understanding of the environment. They
were committed to the ideas of inferring curriculum concepts and professional
abilities, proposing curriculum possibilities, and deducing curriculum
limitations. There was consensus to dismiss identification of administrative
issues, since “we already know what the issues are: not enough faculty and
not enough money in the budget.
Examining and Integrating Contextual Data: During the course
of discussion about contextual data, the faculty tried to focus on the meaning
of the data, and the inter-relationships among the contextual factors. They
also addressed curriculum concepts, professional abilities, and curriculum
possibilities without labeling these ideas as such, discussing ideas about how:
the presence of more aged people leads to a greater demand
for health care, which increases the requirement for health care professionals
the growing RN shortage could increase public demand for
more seats in nursing programs, and this in turn would necessitate more
resources for the School, including human resources
RN shortages could lead to more care by nonprofessionals,
increasing delegation and supervision by RNs. The RN shortage might result in
specialization by all RNs or de-professionalization of nursing
student skills in information technology could be developed
when they had limited expertise
professional standards for nursing practice, accreditation
standards, and the availability of clinical placements in and near Poplarfield
could be reconciled
local health problems can be addressed, in a society and
health care system which are focused on problems of national scope, such as
cancer
nursing priorities and mandates must be explicated for a
society with a growing proportion of elderly people and a health care system
where acute care stays are shortened and out-of-hospital care is increased
The group also talked in detail about some specific data,
and how to interpret it.
In trying to reach a shared understanding of the context in
which the curriculum would be implemented and graduates will practice nursing,
several integrated summaries were offered. Each resulted in some disagreement.
Finally, at the end of the morning, the group agreed that the environment could
be described as one in which:
there will be less institutionalized health care and growing
emphasis on community-based care
independent decision-making and supervision of
non-professional health care providers will become a stronger feature of nursing
practice
vulnerable groups in the community may grow in size
the proportion of aged people in the community will
increase, while young people will likely continue to leave the Poplarfield area
ethnic diversity will become more apparent
agriculture will continue to be a significant contributor to
the Poplarfield economy
In the afternoon, discussion progressed to identification of
the factors that should be most influential in shaping the curriculum.
Initially, there was a strong sentiment that all contextual factors were of
equal weight, apart from the internal factors of History; Philosophy, Mission,
and Goals; and Culture, all of which seemed less important. The consultant
agreed that the factors are highly inter-connected and that the division of the
data into these factors is somewhat artificial. Yet, she reminded faculty that
there must be some basis for identifying the key curriculum influences, and
thus for determining the curriculum nucleus.
The group then considered whether it was the recipients of nursing
services (Demographics), the nature of nursing (Professional Standards and
Trends), or the location and nature of health care (Health Care) that was most
important. Faculty phrased this as who, what, where, and how. Finally, they
agreed that most important were the people being served, and therefore,
Demographics and External Culture would be most significant in determining the
curriculum nucleus. History was immediately labeled as being of least
importance. After further discussion, faculty members concurred about the
rank-ordering of contextual factors:
Demographics; External Culture
Health Care; Professional Standards and Trends;
Infrastructure
Socio-politico-economics
Technology
Environment; Philosophy, Mission, and Goals of the
University and School of Nursing; Internal Culture; History
Inferring Curriculum Concepts and Professional Abilities,
Proposing Curriculum Possibilities, and Deducing Curriculum Limitations
The stakeholders wanted to complete this intellectual work
together, in the belief that it was necessary for all to participate in every
aspect. Ideas were recorded on charts, which had previously been loaded onto
laptop computers.
It became apparent that one more day would be insufficient
to complete this effort, if the group continued in the same way. The consultant
suggested that the contextual factors might be divided among smaller faculty
groups to complete the formulation of ideas about curriculum concepts,
professional abilities, curriculum possibilities, and curriculum limitations.
The group agreed to think about this proposal.
The next morning a member of the Advisory Committee proposed
that dividing into small groups would expedite the curriculum work. There was
now consensus about this. Three smaller groups were formed and each took
responsibility for some of the internal and external factors.
In reviewing the contextual data, members recognized that
curriculum concepts, professional abilities, and curriculum possibilities and
limitations did not necessarily arise from each internal factor. However, they
noted that the data about some of the factors could ultimately influence
decisions about curriculum, either limiting or propelling the curriculum
design. For example, when examining the School’s infrastructure, they
recognized that the existence of computer labs for students meant that
computer-mediated learning was a possibility, whereas the School budget and
faculty numbers could constrain the curriculum. Accordingly, they reaffirmed
their intention to identify the curriculum possibilities and limitations as
they examined each contextual factor. As the groups worked, they recognized
again that the contextual factors do not operate in isolation and that their
ideas reflected the inter-related nature of the internal and external context.
The ideas arising from the internal and external contextual data were recorded.
Identifying Administrative Issues : As they continued,
faculty quickly recognized that there were administrative issues beyond faculty
numbers and budget. Accordingly, the groups considered and recorded the
administrative issues. They also recognized that Financial Resources was an
important contextual factor.
At the end of their two days together, the participants felt
proud of their efforts. All were eager to proceed with synthesis of the
completed work, and the determination of the curriculum nucleus. See Table 7.1
for analysis of the external contextual factor of Demographics. Table 7.3
presents the internal factors of Financial Resources and Infrastructure. Table
7.4 outlines the analysis of the external factors of Culture, Health Care, and
Professional Standards and Trends. (Tables 7.3 and 7.4 follow the case
description).
Resources were not available for an additional retreat day.
Therefore, the group agreed:
to distribute hard copies of the analysis of the contextual
factors, so all could individually review the work that had been completed by
all groups
to use a regularly-scheduled faculty meeting to collectively
review the work and add ideas that might have been omitted
to reorganize individual schedules so they could meet from
3-7 PM twice in the next 2 weeks to determine the curriculum nucleus
that Dr. Werstiuk and the Dean would meet to discuss the
identified administrative issues, and plan further discussion with senior
administrators, if necessary.
There was consensus that Professor Rose, Chair of the
Curriculum Committee, would lead the discussions. As well, members were
enthusiastic about the possibility of adding ideas to the work of other groups.
Professor Rose asked that all try to ground their thinking in the work to date
and, as much as possible, to look beyond personal beliefs.
The subsequent meetings were lively, and at times, tense.
Review of curriculum concepts, professional abilities, curriculum possibilities
and limitations, and administrative issues went quickly, with some additional
ideas offered. There was a sense of accomplishment at the end of the first
meeting, and impatience to get on with the definition of the curriculum
nucleus.
Determining Curriculum Nucleus : At the first 4-hour
meeting, there was consensus that synthesis of curriculum concepts,
professional abilities, and curriculum possibilities should be completed
collectively. Some important curriculum concepts were: aging; health promotion;
nursing care of people at home, in the community, and institutions; and
nurse-client relationships.
Professor Rose reminded them of the weighting they had
assigned to the contextual factors, noting that they had not attended to all
the factors they had weighted as second in importance. With this, the group
returned to Health Care, agreeing that the curriculum should address local
health problems as well as national ones. In considering Professional Standards
and Trends, faculty confirmed that a strong emphasis on health promotion was
warranted, and agreed that illness intervention must be included. One member
noted that rural health was an important concept that had been omitted, and
there was immediate agreement to include it. Synthesis and further discussion
of the curriculum concepts led to the conclusion that the core curriculum
concepts would be: health, aging; health promotion, illness intervention,
context, and nurse-client relationships.
In synthesizing curriculum possibilities, the group decided
that the principal teaching-learning processes would be self-direction,
collaborative learning, and use of information technologies. Synthesis of the
professional abilities led to the conclusion that the key professional
abilities would be would be: critical thinking, clinical reasoning, independent
and collaborative decision-making, cultural competence, and life-long learning.
The group recognized that acceptance of these ideas would
require resolution of administrative issues related to human, physical, and
financial resources, along with faculty development. Dr. Werstiuk reaffirmed
her commitment to work toward resolution of these matters.
The group then turned to a review of the philosophical
approaches. These had been proposed by a faculty sub-group and had been
tentatively accepted, pending further refinement of the narrative. The
philosophical approaches included beliefs about nursing’s role in society,
social justice, caring, and the nature of the nurse-client relationship, and
faculty members’ and students’ responsibility in the curriculum. They
considered the fit between the philosophical beliefs and the concepts,
abilities, and teaching-learning approaches that had been identified.
The group confirmed the curriculum nucleus to be comprised
of the following:
core curriculum concepts: health, aging; health promotion,
illness intervention, context, nurse-client relationships, social justice, and
caring (the latter two from the philosophical approaches)
key professional abilities: critical thinking, clinical
reasoning, independent and collaborative decision-making, cultural competence,
and life-long learning
principal teaching-learning approaches: self-direction,
collaborative learning, and use of information technologies
philosophical approaches: social justice, caring, humanism,
phenomenology
The group felt satisfied with the curriculum nucleus and
confirmed they could support these ideas as the basis for subsequent curriculum
development. Dr. Werstiuk and Professor Rose congratulated the participants for
their hard work, creativity in reconciling varying perspectives, and
intellectual courage in envisioning a curriculum that would require
considerable change and learning by each member. All were proud of themselves
individually and collectively, and anxious to begin the intensive planning that
would bring their ideas to fruition.
Please review Tables 7.1 (p. 142-143), Table 7.3 (p.
156-161) and Table 7-4 (p. 162-168) to answer the following questions.
What strengths and limitations are evident in the processes
undertaken by the Poplarfield faculty? How might these processes be applied in
other settings?
How might the retreat have been organized differently to
advance the curriculum work?
Review Tables 7.1, 7.3, and 7.4. What gaps and overlaps are
present in the contextual data?
Examine Tables 7.1, 7.3, and 7.4. Propose other
interpretations of the data, concepts, professional abilities, curriculum
limitations and possibilities, and administrative issues.
Consider the curriculum nucleus identified by the Poplarfield
faculty. Does it seem reasonable? What changes could be proposed?
What strategies could be implemented to keep the momentum
going in the curriculum development process?
If you were to assume the role of curriculum consultant for
the Poplarfield University School of Nursing, in what way might your actions be
similar or different from those of Professor Rose?
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