This paper explores the establishment and development of the nursing curriculum. The nursing program in educational affiliations is considered to be the sum of nursing and supportive courses aimed at achieving professional skills. It becomes the consequence of content-related, evidence-informed and unified process with clearly defined goals, as well as methodology and outcomes learning. Grounding on philosophical approaches and coherent learning theories, and in accordance with stakeholders’ recommendations, faculty members generate the curriculum that will fit the needs of society in the best way. Moreover, stakeholders are described as the main triggers of changes in response to contemporary challenges. The development of the curriculum starts with the foundation of institutional vision statements that express the mission of the educational curriculum. The efficacy of the program results in the correspondence between vision statements and terminal objectives. Behavioral, cognitivist, and humanistic learning theories support the continuity of the acquisition of professional skills. Vertical and horizontal threads of curriculum structure, which contribute to the specific professional and common social values, provide relationships among the courses. Therefore, this paper examines how all the defined elements of the curriculum relate, supplement each other and reflect contemporary healthcare.
Nursing is considered one of the most changing professional activities related to the broad set of specific skills. Thus, there is a constant need for a flexible, comprehensive and contemporary nursing curriculum. Its development means finding the optimal balance between theory and practice. Moreover, professional nursing education should respond to the need of time and social values. All the challenges are manifested in the establishment of the faculty’s curriculum work and stakeholders’ support, precise vision statements, and meaningful outcomes. The dynamic structure of a curriculum based on learning theories and congruent threads within the courses contributes to permanent improvement.
The nursing curriculum is supposed to be a program of courses designated for the learner to achieve the desired knowledge and skills in the field of competency. The curriculum is manifested in the sequence of written plans in central and supportive courses that allow achieving experiences in response to the envisioned goals of the profession (Iwasiw, Goldenberg, & Andrusyszyn, 2009, p. 4). The required experiences are developed within the theoretical and practical systems. Moreover, the efficacy of curriculum implementation highly depends on its adaptability to the current social demands. Hence, the generation of the curriculum involves concise planning of the educational process based on social, humanistic, and learning theoretical frameworks reinforced by the students’ past experiences and current needs of the community.
According to the abovementioned definition, the nursing curriculum should include the institutional mission, or purpose, strategy, context, experience, and evaluation of the program. Iwasiw et al. (2009) consider the nursing curriculum as a set of philosophical approaches, goals, program frameworks, educational courses with resources, methodologies, and close interactions in the learning environment. Moreover, the logistics of the educational process, which refer to leadership, decision-making, and the functional structure of working groups, produce efficacious outcomes.
The nursing curriculum is supposed to be a three-dimensional scholarly endeavor. It is centered on the evidence-informed, context-relevant and unified properties of the educational process (Iwasiw et al., p. 4). Evidence provides a dynamic and realistic character for curriculum development. Its relevance to the context involves the analysis of the environmental factors that shape the program of the institution. Social and professional trends of the outer environment are taken into account as well. The unification of the curriculum means close relationships and feedback of the philosophical approaches, curriculum concepts, and curricular objects.
The Role of Stakeholders
The application of nursing curriculum to the real world means taking into account the needs and interests of all participants of the healthcare system. This system incorporates the strategies of policymakers, the needs of the community, the work of medical and social organizations, as well as the missions of teaching units. The latter respond to the needs of all the mentioned stakeholders while generating the curriculum in the field.
A vibrant curriculum requires a permanent reanalysis of the programs and courses by the nursing faculty. According to the research by Keogh, Fourie, Watson, & Gay (2010), the involvement of the stakeholders in the curriculum process generated changes, broader discussions, and consideration for the needs of social groups. Nurse practitioners, doctors, and policymakers can direct the development of curriculum in the needed way. As a result, it will become context-relevant.
The reports of stakeholders on the global – such as World Health Organization – and national – like the Institute of Medicine and the American Association of Colleges of Nursing – allow the curriculum to correspond to the contemporary needs of the society (Sonenberg, Truglio-Londrigan, & Mcleod-Sordjan, 2014, p. 2). In particular, a national healthcare reform involves comprehensive population-based practices in nursing. The continuous process of implementation suggests the upgrading of the nursing curriculum in educational affiliations. The evaluation process suggests the engagement of stakeholders in the provision of accreditation standards and the monitoring of healthcare delivery.
The consensus between the stakeholders’ and the faculty’s vision can be effective only in the case of strong leadership. Leadership and collaboration during the curriculum preparation enable the stakeholders to find their places in the process. Bringing the recommendations of stakeholders into reality means making curriculum development a shared and democratic endeavor (Keating, 2011, p. 189). Therefore, curriculum developers construct some general mission and vision statements. Vision statements are fulfilled by being rooted in the terminal objectives.
Institutional Vision Statements and Terminal Objectives of the Nursing Curriculum
Institutional mission and vision statements create the grounds for terminal objectives of the nursing curriculum to be achieved. Educational affiliations provide the environment required for the generation of professionals in nursing. As a rule, vision statements of American colleges and universities refer to the learning, research, and services domains (Keating, 2011, p. 190).
The implementation of terminal objectives relies on the institutional mission. The overall mission of the institution is manifested in the generation of modern, student-centered education, the primary experience in nursing practice and research products. This approach allows the terminal objectives to be achieved. The stated vision of the institution serves as the guiding principle for curriculum development and the future of an institution. Mostly, the mission directs educational activity towards the desired outcomes and expectations of society.
Depending on the baccalaureate or master’s level of the program, terminal objectives of the nursing curricula can differ or supplement each other. Although, the core professional properties of a nurse are under consideration in all curriculum. They include the broad spectrum of acquired “skills, knowledge, and attitudes” (Keating, 2011, p. 87). The theoretical knowledge and practical skills must represent the variety of relevant learning actions that incorporate curriculum’s goals and strategy (Iwasiw et al., 2009, p. 14). Terminal objectives are the final interpretation of institutional mission and vision statements. They are assessed at the end of the modules or courses on the basis of acquired competencies.
In particular, most healthcare educational affiliations distinguish a number of common terminal objectives in nursing. According to them, students have to able to apply advanced knowledge and skills of holistic care in clinical and community settings, as well as incorporate theory, research and practice while delivering health care (Billings & Halstead, 2010, p.147). In addition, in response to the current demands of the healthcare field, terminal objectives should include such competencies as leadership, participation in the policymaking, and life-long self-development (Billings & Halstead, 2010, p.147).
Philosophical Approaches and Learning Theories
Educational objectives are based on the domains of philosophical approaches and learning theories. Institutional strategies of the curriculum depending on the theoretical framework shaped by the learning theories. The unified character of the curriculum supposes philosophical approaches to the courses threads and goals, as well as the quality of learning interactions (Iwasiw et al., 2009, p. 8). The process of finding an appropriate set of theoretical approaches requires the evaluation of past experiences in nursing teaching and practice. It means that the faculty responsible for the curriculum has to do profound work.
As a result, philosophical approaches help make the learning process more adjustable to practical needs. Successful implementation and development of nursing courses suppose the application of a set of learning theories. This theoretical framework includes classic theories and their adjustments. Classical ideas concern behavioral theories, social cognitive theory, cognitive learning, and humanistic theories, which explain how the learners and teachers will interact in the most effective way.
On one hand, behavioral concepts concern the construction of desired behavior and the processes of conditioning. Classical conditioning is manifested in the responses to the distinct stimuli, such as an emotional response of the learner to the objects and environment of learning. Operational conditioning deals with “rewarding desired behavior” to reinforce its reiteration (Keating, 2011, p. 67). This theory suits the purposes of skills acquisition well.
On the other hand, cognitive theories imply the importance of an internal character of learning based on “understanding, thinking, organizing, and consciousness” (Aliakbari, Parvin, Heidari, & Haghani, 2015). In the process of information evaluation and the exploration of new issues, the learners become able to analyze and make decisions. Moreover, students acquire skills that are essential for educational activities. Gestalt theory explains how the well-established patterns of training, instead of repetition, provide continuity of thinking and understanding (Aliakbari et al., 2015). Piaget’s theory stresses the role of the exploratory process in teaching, which is the guiding principle in the constructivist theory (Aliakbari et al., 2015). The observation of nursing practices as a new experience constitutes the key meaning of social learning theory.
Finally, the humanistic theory sustains the humanistic values of the teacher as the role model for the purposeful teaching-learning interaction. The concept of humanism means growing positive people to make them discover their potential. The humanistic approach supports student-centered learning where positive emotions and self-actualization reinforce the desired outcomes (Billings & Halstead, 2010, p. 224). Keating (2011, p. 79) supports the idea that teachers are facilitators who help students find meaning and stimuli on the way to significant learning. However, the theory appears to be almost impossible to implement. It requires high professionalism and creativity from the teacher and empathetical attitude to all the learners.
Strands and Threads in the Curriculum
The development of a curriculum requires the establishment of the educational structure, where the basic elements of the nursing program are congruent with each other. Consequently, vertical and horizontal strands of the curricular matrix should maintain context at all educational levels. They are manifested by major threads, which are related to the program’s goals and terminating objectives of the curriculum (Billings & Halstead, 2010, p .515). Well-established strands guarantee the continuity of professional knowledge and principal skills throughout the courses. Those basic elements establish the integrity of the nursing curriculum while being involved in the set of courses. Moreover, such points focus on health, caring, critical thinking, patients and professional behavior.
Vertical strands change over time in complexity, thus directing every next level of learning to the terminal objectives. Past experience of the learners and its reiteration constitute the meaning of the vertical strands (Billings & Halstead, 2010, p. 515). They may differ in response to the specialty and course requirements. Such threads are designated for both theoretical and practical application. However, there are still some essential issues that require focus while preparing nursing professionals. “Nutrition, pharmacology, individual/family/group, care (acute, rehabilitative, chronic), primary/secondary/tertiary prevention, hospital/community settings” constitute the most common threads (Novotny & Griffin, 2011, p. 87). Leadership has become an essential vertical strand over the past decades.
Meanwhile, horizontal strands provide the flow and share of specific and supportive knowledge. They refer to the processes that contribute to the application of the curricular content on all levels of mastery. Horizontal threads may focus on clinical activities as well as communication issues. Horizontal strands often serve a supportive purpose on the way to making nursing courses meaningful and successful.
Altogether, modern nursing curriculum appears to be the product of a long-term analysis of nursing practices, learning processes, and social functions. All these factors generate the model of evidence-informed, context-relevant and unified program that consists of professional and supportive courses. They are interconnected by the common vision of faculty and stakeholders and based on the theoretical and practical frameworks of learning and desired outcomes for nursing students. Therefore, the components are combined in one curricular matrix, which is dependent on the current societal and learning attributes. The multi-dimensional structure of the nursing curriculum is supported by theoretical and practical threads. As each component of the curriculum influences the efficacy of the educational system, its development should become an essential part of the preparation of nursing professionals.