33CHAPTER 2
Curriculum Development and Approval Processes in Changing Educational Environments
Patsy L. Ruchala
OBJECTIVES
Upon completion of Chapter 2, the reader will be able to:
1. Analyze facilitators for and barriers to effective curriculum development and redesign
2. Evaluate the effectiveness of a nursing curriculum
3. Apply knowledge of potential barriers to curricular innovations in obtaining approvals for innovative curricular redesign
4. Evaluate the impact of regulatory and accreditation agencies in the development and evaluation of nursing curriculum
OVERVIEW
Faculty members have ultimate responsibility for curriculum development, ongoing evaluation, and redesign; and must work together to determine what best practices must be implemented in nursing education so that students master the knowledge and skills necessary for them to become practicing nurses. The innate complexity of nursing education, the need for collaboration with other disciplines within the college or university, the ever-changing and complex health care systems, and the requirements of regulatory and accreditation agencies can position curriculum development and redesign as a daunting process. The use of technology has exploded in both education and health care settings. We are encountering a generation of students who embrace technology not only in education but also as ordinary methods of communication and social networking, and their expectations for the use of technology at an advanced level may far exceed the capabilities of many nursing faculty. In addition to navigating the internal approval processes for curriculum approval, meeting the requirements of regulatory and accrediting agencies can also impact the approaches taken when developing or redesigning nursing curricula. This chapter provides an overview of the preparation and support needed 34for curriculum development/change, issues, and challenges that can arise from and impact the curriculum development process, innovations in curriculum development, and approvals and accreditations related to nursing curriculum.
THE PROCESS OF CURRICULUM DEVELOPMENT
Preparation and Support for Curricular Change
Nursing education has evolved using a variety of theories from other disciplines as well as newer middle range theories developed specifically for their application to nursing practice. New roles for nurses have been developed to meet the needs of the practice setting as well as the increasing demand for more emphasis on education, primary prevention, and management of chronic diseases (American Association of Colleges of Nursing [AACN], 2013; Institute of Medicine [IOM], 2010; Pew Health Professions Commission, 1995). The need for change in health professions education is overwhelming, with an emphasis on evidence-based practice, quality improvement approaches, safety standards, competency frameworks, informatics, and interprofessional education (Andre & Barnes, 2010; Callen & Lee, 2009; Phillips et al., 2013; Spencer, 2012; Stephens-Lee, Der-Fa, & Wilson, 2013; Sullivan, 2010). Given the knowledge explosion in science and the emphasis on major reform of health care education, it is no wonder that Giddens and colleagues (2008) point out that curriculum redesign in nursing “is an overwhelming undertaking.”
The support of both faculty and administration is imperative for curriculum change. According to Billings and Halstead (2012), curriculum change is inevitable. The need for curriculum change may be a result of community pressure, policy, or accreditation changes, programmatic funding, personnel changes, or the simple acknowledgement that the existing curriculum is no longer effective for current and future students. For effective change to take place, faculty must realize the need for change. This realization, however, may be more apparent to some faculty members and less apparent to others.
In addition to recognizing and embracing the need for curriculum change, faculty members need the knowledge and skills to engage in this endeavor. The engagement of faculty in ongoing curriculum development and change should begin with orientation to the university or college. It is routinely expected that faculty will update courses with cutting edge information each time a course is taught. Individual course updating over time, however, may impact the overall curriculum, resulting in “content gaps.” Faculty members benefit from serving on their school’s curriculum committee and engaging in ongoing dialogue about and evaluation of the curriculum with their faculty colleagues. New faculty or faculty who have not engaged in curriculum redesign benefit from mentoring by faculty with more experience in curriculum processes (Hagler, White, & Morris, 2011; Huybrecht, Loeckx, Quaeyhaegens, DeTobel, & Mistiaen, 2011; Sawatzky & Enns, 2009; Slimmer, 2012). Support for curriculum change includes administrative assurance of needed resources: physical space, secretarial support, workload considerations, expert consultants, and internal administrative assurance and encouragement that the work toward curricular change is valued and needed by the organization and, most importantly, for 35successful student outcomes. Successful curriculum change requires support from all levels of the organization, including students. Students bring a unique perspective to curriculum committee discussions, particularly when faculty members are charged to design a rigorous program while creating an environment conducive to students’ learning preferences (Mangold, 2007; Moch, Cronje, & Branson, 2010). In a study of faculty perceptions of implementation of curriculum change, Powell-Cope, Hughes, Sedlak, and Nelson (2008) found that administrators, other faculty, and students who were “champions for curricular change” were also identified as facilitators for successful implementation of the new curriculum.
Curriculum development and redesign always begin at the level of the school curriculum committee. This may be a formal committee within the school or for very small schools, it may consist of the entire nursing faculty. In most institutions of higher education, curriculum development and redesign must go through an extensive, multilevel approval process. Despite the number of levels in the approval process, a proposal for curriculum approval should be completed with the expectation that it will eventually be sent to the highest review body in the institution, keeping in mind all of the preceding levels of approval and the requirements and appropriate paperwork for routing of the proposal through each level. Although this process will vary at every institution, Figure 2.1 depicts an example for sequencing. Consideration should also be given as to whether or not this is a proposal for a graduate-level curricular change. If so, there may be another level of approval that would involve the graduate faculty of the school and/or the graduate school within the college or university. No matter what the individual process, completeness, accuracy, and acceptable institutional formatting are extremely important to successfully navigate all levels of curriculum approval.
FIGURE 2.1 Example of curriculum approval process sequencing.
36ISSUES RELATED TO CURRICULAR DEVELOPMENT OR REDESIGN
Faculty Development
Curriculum development is in itself a faculty development activity (Iwasiw, Goldenberg, & Andrusyszyn, 2009; Slimmer, 2012). To be successful in developing and implementing curricular change, Billings and Halstead (2012) indicate that faculty members who understand the problems inherent in the current curriculum and who can effectively evaluate strategies for solving the current problems should be the group initially involved in the change. Faculty members who have less experience in curriculum development may need to acquire the knowledge and skills necessary to engage in curriculum work. Working with more experienced faculty, engaging in group discussion and debate, knowing that their contributions to the process will be heard and valued, and providing ongoing administrative support are all part of mentoring less experienced faculty to learn the process for curriculum change.
Budgetary Constraints
Schmitt (2002) and Tanner (2004) postulate that the cost efficiency of clinical nursing education has not been properly assessed, yet nursing has always been considered one of the more costly programs in institutions of higher education. In recent years, the state of the national economy had a significant impact on all aspects of higher education, including nursing. Allen (2008) and Hinshaw (2008) both observed that the retirement of older faculty and the shortage of nurse educators stretch human, fiscal, and physical resources in nursing education. While the need for more nurses keeps growing, funding for many nursing programs has been significantly impacted. When developing or redesigning nursing curricula, assessment of current and future resources is crucial. Budgetary constraints in hiring faculty and other resources, such as the availability and use of high-fidelity simulation, will have a major impact on curriculum design/change and implementation of the curriculum (Adams, 2009; Bargagliotti, 2009; Lapkin & Levett-Jones, 2011; Nehring, 2008; Reese, Jeffries, & Engum, 2010). In 2014, over 53,000 qualified applicants were turned away from U.S. nursing schools due to insufficient numbers of faculty, clinical sites, classroom space, clinical preceptors, and budget constraints (AACN, 2014). Budget shortfalls and economic declines resulted in scarcer resources available for universities and colleges to support nursing programs, forcing programs to be much more creative in determining strategies to sustain nursing education. The creation of local and regional partnerships with nurse employers, foundations, and other stakeholders as a sustainability strategy needed by the nursing profession is highly encouraged in the current era of health care reform and budget constraints (AACN, 2012).
Amount of Curricular Content
Another issue impacting curriculum development and change is the management of curricular content. The nursing literature provides an overwhelming amount of evidence indicating that faculty and students are besieged with content (AACN, 2009; Giddens et al., 2008; Mailloux, 2011; Powell-Cope et al., 2008). As the 37information explosion in health sciences education continues to grow, an increasing amount of content is deemed essential to include in all nursing curricula (AACN, 2008; Accreditation Commission for Education in Nursing [ACEN], 2013a; Skiba, 2012). One example of essential knowledge content to include in nursing curricula relates to a series of reports issued by the IOM (Greiner & Knebel, 2003) that generated a great deal of attention to the need to improve the quality and safety of health care delivery. This led to dramatic changes in the practice of nursing, medicine, and other health disciplines. As nursing practice embraced the focus on improved quality and safety, it became clear that graduating nurses were missing critical competencies in this area. The result was a major national initiative, Quality Safety Education for Nurses, centered on patient safety and quality topics, with a primary goal to address the challenge of preparing future nurses with the knowledge, skills, and attitudes necessary to continuously improve the quality and safety of the health care systems in which they will work (Sullivan, 2010). As the amount of essential knowledge and content continues to increase, there seems, however, to be an inherent faculty perception that they must teach everything they possibly can to their students in the minutest of detail. Consequently, “content saturation” is a major problem in many nursing curricula. Giddens and Brady (2007) surmise that content saturation may be directly related to how faculty teach and that faculty should learn how to teach conceptually and, subsequently, minimize their emphasis on the amount of content students must learn.
Technology
Incorporating technology into the curriculum is a must to educate nurses in the 21st century (Skiba, 2012; Spencer, 2012). The advance of technology into our personal and professional lives marched into the arena of higher education, and the lecture method as the gold standard for teaching is rapidly being replaced by technology. The type of technology available for the classroom ranges from very low to very high fidelity (Thompson & Skiba, 2008). The methods of curriculum delivery and the use of technology must be addressed in any curriculum development or redesign, including the extent that technology will be used, resources to obtain and sustain technology, and faculty development to use technology effectively. For example, high-fidelity simulators are increasingly being used as an adjunct or replacement to some of the clinical experiences in nursing programs (Nehring, 2008; Reese et al., 2010). However, use of high-fidelity simulation requires a significant up-front investment as well as the cost for ongoing care, use and replacement of simulators, and staff for simulation centers. In addition, to effectively use high-fidelity simulation, a significant investment must be made for faculty development to use the equipment and for incorporation into the curriculum.
Hartman, Dziuban, and Brophy-Ellison (2007) identified a number of changes to which faculty must adapt as a result of diffusing technology into teaching and learning:
• Faculty who are the experts in their respective disciplines may experience a “balance-of-power shift” when confronted with technologically savvy students who know more about specific technologies than they do.
38• Net Generation students use a range of technologies and information sources that are often unfamiliar to their faculty. When faculty communicate through technology, they are likely to use e-mail. Net Generation students communicate with peers through instant messages (IMs) and cell phone text messaging.
• Faculty are reporting a sharp decline in the quality of students’ writing, which some attribute to the increasing popularity of IM and text messaging.
• Faculty see students as individual learners and regard students who complete assignments with others as cheaters. Net Generation students value social networking, working in groups, and experiential learning.
• Technology caused a shift in the way faculty use their time. Traditionally, faculty would be in class, their offices, or their labs, or they would be off campus and inaccessible to students. Students now expect faculty to be accessible via e-mail almost any hour of the day or night and to respond to e-mails within minutes.
• Faculty members think of technology as technology. Students think of technology as environment.
• A number of social networking and resource-sharing sites appeared over the past few years, including Facebook, Myspace, Flickr, YouTube, LiveJournal, Twitter, and Second Life. Students are using these sites as the nexus of their social and even academic universe. Faculty are beginning to use these sites as a means of getting to know their students, as a rapid and reliable way to reach students, and as a method for sharing faculty-produced and student-produced content.
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