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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 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.

1. Which contextual factors would be most relevant to Bellemore’s vision of a future-oriented nursing curriculum?
2. What are the essential data to collect about these contextual factors?
3. Which data-gathering methods and tools might be employed to obtain information about the contextual factors?
4. What would be a suitable time period for collecting and collating these data?
5. 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:

1. Demographics; External Culture
2. Health Care; Professional Standards and Trends; Infrastructure
3. Socio-politico-economics
4. Technology
5. 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.

1. What strengths and limitations are evident in the processes undertaken by the Poplarfield faculty? How might these processes be applied in other settings?
2. How might the retreat have been organized differently to advance the curriculum work?
3. Review Tables 7.1, 7.3, and 7.4. What gaps and overlaps are present in the contextual data?
4. 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.
5. Consider the curriculum nucleus identified by the Poplarfield faculty. Does it seem reasonable? What changes could be proposed?
6. What strategies could be implemented to keep the momentum going in the curriculum development process?
7. 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?

Required Textbooks:

Billings, D. M. & J. A. Halstead. (2012). Teaching in nursing: A guide for faculty (4th ed.). St. Louis: Saunders. ISBN: 9781455705511

Keating, S. B. (2011). Curriculum development and evaluation in nursing (2nd ed.). New York: Springer. ISBN: 978-0826107220

Iwasiw, C., Goldenberg, D., & Andrusyszyn, M. (2009). Curriculum development in nursing education (2nd ed.). Boston: Jones & Bartlett. ISBN: 978-0763755959