NUR 7000 Module 3 Concept-Based Curriculum Paper: Rescuing a Medical-Surgical Sequence From Content Saturation Example

One Hundred Forty Diseases in Three Courses: Rebuilding a Hudson County Medical-Surgical Sequence Around Concepts

Student Name

M.S. in Nursing, Nurse Educator, Thomas Edison State University

NUR-7000: Curriculum Theory and Development in Nursing Education

Mentor Name

Month Day, Year

One Hundred Forty Diseases in Three Courses: Rebuilding a Hudson County Medical-Surgical Sequence Around Concepts

Too Much to Cover

The program and its faculty are invented. A nursing program in Hudson County teaches medical-surgical nursing in three courses over three semesters. A count of the course outlines found 140 diseases and conditions, each with its own lecture slides, taught in about 135 hours of classroom time. Faculty describe racing through slides; students describe memorizing lists before each exam and forgetting them after. Each time a new treatment or condition appeared, it was added to a course and nothing was removed. The program's licensure results are acceptable, but graduates report feeling unprepared to think through a patient whose problem does not match a lecture.

A curriculum committee member, an MSN student in nursing education, proposed a concept-based redesign.

Content Saturation

Giddens and Brady (2007) argued that nursing education suffered from content saturation: faculty, trying to keep up with an expanding body of knowledge, kept adding content until curricula became overloaded. Students learned facts in isolation and had little time to develop understanding or clinical reasoning. The authors proposed a concept-based curriculum, in which students learn a limited number of key concepts in depth and study selected exemplars, specific conditions that illustrate each concept, rather than attempting to cover every disease. Students who understand a concept, they argued, can apply it to conditions they were never taught.

How Knowledge Is Structured

Erickson (2002) described a structure of knowledge in which facts and topics sit at the bottom, concepts are mental constructs that organize many facts, generalizations and principles state relationships between concepts and theories explain those relationships. She argued that teaching aimed only at facts and topics produces shallow learning, while teaching that moves students to concepts and generalizations produces understanding that transfers to new situations.

For a medical-surgical course, the structure looks like this: the fact that a patient with heart failure gains weight, the topic of heart failure, the concept of perfusion, the generalization that when the heart cannot move blood forward, fluid backs up in the body and the theory of cardiac output and its determinants.

Concepts in the Essentials

The 2021 Essentials (American Association of Colleges of Nursing, 2021) identify eight concepts that run across their domains, including clinical judgment, communication and evidence-based practice. While these are professional concepts rather than physiological ones, their presence in the Essentials signals that concept-based thinking is now part of how nursing competencies are framed, and many programs pair them with health and illness concepts such as perfusion, oxygenation and infection.

The Redesigned Sequence

The committee chose twelve health and illness concepts for the three courses: perfusion, gas exchange, fluid and electrolytes, glucose regulation, infection, inflammation, cellular regulation, mobility, cognition, elimination, nutrition and pain. For each, faculty chose two to four exemplars, conditions that are common or high-risk and that illustrate the concept well. Perfusion, for example, uses heart failure, myocardial infarction and peripheral arterial disease. Gas exchange uses chronic obstructive pulmonary disease, pneumonia and asthma.

Each concept unit begins with the concept itself, its scope, risk factors, assessment, related concepts and the interventions that apply across conditions. Exemplars then show how the concept looks in particular patients. To test transfer, students then reason through a condition the course never covered. Clinical judgment and communication run through every unit as professional concepts.

The 140 diseases became 34 exemplars. Faculty identified 22 conditions that were dropped but appear in a reference list that students use in clinical placements.

A Unit in Detail

The perfusion unit shows how teaching changes. The first class introduces perfusion as the flow of blood through vessels to deliver oxygen and nutrients, its central and peripheral forms, risk factors across the lifespan and the assessments that reveal problems, such as capillary refill, pulses, blood pressure and skin changes. Students then work through exemplars: heart failure as a problem of central perfusion with fluid backing up, myocardial infarction as a sudden loss of flow to heart muscle and peripheral arterial disease as a chronic problem of peripheral flow. For each exemplar, students identify which assessments matter most and which interventions follow from the concept. The unit ends with a case of a condition not taught, such as a patient with a deep vein thrombosis, and students reason from the concept to an assessment and plan. Faculty observed that students who had struggled to memorize lists could explain why a patient's legs were cold.

Helping Faculty Let Go

Letting go of content was the hardest part. Faculty worried that students would fail licensure questions on conditions no longer taught. The committee responded in three ways: it reviewed the licensure test plan and confirmed that it tests clinical judgment and common conditions rather than lists; it agreed to monitor standardized exam results by concept; and it offered faculty development on teaching concepts. Faculty who had taught a dropped condition for years were invited to write a case for the reference list.

Clinical Alignment

The redesign also changed clinical courses. Clinical instructors receive the concept schedule and ask students to identify, for each assigned patient, the concepts that apply and how they interact. A patient with pneumonia and diabetes, for example, involves gas exchange, infection and glucose regulation together. Students who learned concepts separately in class practice seeing them combined at the bedside, which is how patients present. Post-conferences use concept maps that students draw for one patient.

Evaluation

The program will compare standardized exam scores by concept, licensure pass rates, students' ability to apply concepts to untaught conditions in a final case examination and graduates' self-reported preparedness with those of cohorts before the change.

Limits

Concept-based curricula vary widely, and research on their outcomes is still developing. Some faculty may teach concepts as relabeled lectures. A three-semester change takes years to evaluate.

Conclusion

Trying to cover 140 diseases left little time for understanding. Giddens and Brady's argument against content saturation, Erickson's structure of knowledge and the concepts in the Essentials gave the committee a rationale for teaching twelve concepts in depth with selected exemplars. The redesign aims for graduates who can reason about a patient they were never taught about.

References

American Association of Colleges of Nursing. (2021). The essentials: Core competencies for professional nursing education. American Association of Colleges of Nursing.

Erickson, H. L. (2002). Concept-based curriculum and instruction: Teaching beyond the facts. Corwin Press.

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