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Research Proposal Rakiyah T. Jones Liberty University NURS 500 Research Professor Sanner Week 6 Chapters 14, 15, & 27 June 26, 2011

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Abstract

Nursing programs and their ability to incorporate conceptual frameworks into their curriculum is important to the future of nursing education. In general, the literature seems to indicate that it is essential that all nurse educators (faculty) be aware of how conceptual frameworks are used and implemented into the curriculum. Nursing Faculty should be able to articulate the conceptual framework of their program and recognize how the framework shapes the program. If the faculty is able to conceptualize the framework then they will be able to utilize multiple strategies and techniques for instruction to enable students to develop their knowledge base. Faculty should understand the two major areas to be addressed during development of a curriculum framework are as follows: (1) What concepts will be covered? (2) What will be the structure, ordering, or sequencing for introducing the concepts and delineating the relationships between and among them? (Rolfe, 1996)

Statement and Significance of the Problem Nursing is the process of caring for, or nurturing, for an individual known as the patient. More specifically, nursing refers to the functions and duties carried out by persons who have had formal education and training in the art and science of nursing. To promote the restoration and maintenance of health in their clients, nurses became more particular in enhancing their knowledge through integrating with health and biological sciences (Shelly, 2006). Nursing is a discipline focused on assisting individuals, families and communities in attaining, re-attaining and maintaining optimal health and functioning. Modern definitions of nursing define it as a science and an art that focuses on quality of life as defined by persons and families. Nursing is

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not only concerned about health and functioning but with quality of living and dying, lived experience, and universal lived experiences of health (McEwen & Willis, 2010)

Like other maturing disciplines, nursing has developed different theories that are aligned with diverging philosophical beliefs and paradigms or worldviews. Nursing theories help nurses to direct their activities in order to accomplish specific goals with people. Nursing is a knowledge based discipline committed to the betterment of humankind (McEwen & Willis, 2010).

Healthcare delivery has changed dramatically during the past 15 years. As a result nursing practice also has changed, causing a paradigm shift from institution-based acute care to community based care, with an enhanced focus on chronically ill individuals and older people. Despite repeated calls for changes in nursing education to keep abreast with anticipated trends in health care; schools of nursing have been slow to respond. This is contrary to assertions by nursing leaders who attest that It is the responsibility of nursing education, in collaboration with practice settings, to shape practice, not merely respond to changes in the practice environment (Berbiglia, 2011, p. 27).

A well-developed and articulated conceptual framework gives a nursing program the perspective that shapes the content and the methods that guide students learning; eventually these methods have an impact on nursing practice (Mawn & Reece, 2000). A conceptual framework provides a theoretical basis that helps nursing students define their professional philosophies and values. The conceptual framework of the nursing program influences the means by which material is presented and the methods by which learning is evaluated. Identifying whether it is important for nursing programs to incorporate a conceptual framework over an

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organizational framework is interesting because it is necessary to have a sound, identified theoretical base to serve as the framework for a nursing program. It is important to select multiple teaching strategies to deliver the material in a manner that will best support student learning. It is important to implement conceptual framework curricula that allows faculty to utilize multiple strategies and techniques for instruction; to enable students to develop their knowledge base and to develop critical-thinking abilities and problem-solving skills. It is essential that all nurse educators (faculty) be aware of how theoretical principles are used in education. Nursing Faculty should be able to articulate the conceptual framework of their program and recognize how the framework shapes the program.

Literature Review

There have been several recent shifts in nursing curricula; some are ongoing. First, increasingly, community-based and population-focused components are being added to basic curricula. This has been encouraged by changes in the health care delivery system that has moved much of patient care out of the acute care hospital. With that shift there has been a growing tension between curricula that focus on technology and pathophysiology and those that focus on a more humanistic, holistic concept of nursing. Recent changes in nursing education involve less focus on skills and tasks, and an increased focus on the integration of content and problem-solving strategies. Nursing educators recognize that the content, concepts, principles, and theories taught in nursing programs should be regularly updated (Rolfe, 1996). Conceptual frameworks in undergraduate nursing curricula: Report of a national survey analyzes the components of conceptual frameworks to assess how they are being used to organize the curricula of nursing programs and to determine whether there was a difference

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among types of programs. Numerous calls for curriculum revision have been made in recent years to provide adequate numbers of appropriately prepared nurses (McEwen & Brown, 2002, p. 5). In recent years there have been calls for nurse educators to review old assumptions and methods for educating nurses. Nurses must be able to think critically and independently, therefore, content and learning experiences must be revamped to produce graduates with the competencies needed for current and future practice.

Most undergraduate nursing conceptual frameworks minimally describe the concepts of health, person, environment, and nursing McEwen & Brown (2002). The framework may contain additional concepts or threads, such as caring, self-care, growth and development, nursing process, and adaptation, and may use age or developmental levels to influence designation of major content areas. It may use acute/chronic concepts, the health/illness continuum, practice settings, or the nursing process as the chief organizer. In addition, process threads are usually present throughout the curriculum. These may include the nursing process, problem solving, interpersonal relationships, communication, research, change, and teaching. Finally, the framework may be primarily process-oriented or content-oriented.

The most informative of the articles came from the Journal of Advanced Nursing. The journal is a peer-reviewed journal and seems to focus more on the faculty/school and their ideas and understanding of conceptual frameworks. Interesting publications such as, McEwen & Brown (2002), stated that there are two approaches to determining or developing an organizational framework for a nursing curriculum. Faculty members may choose a single, specific nursing theory or model on which to build the framework, or they may choose a more eclectic approach, selecting concepts from multiple theories or models. Several articles in recent

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nursing literature describe the use of nursing theories as the basis for the curriculum framework of nursing programs. Berbiglia (2011) described the role of tool development in an Orem-based curriculum and the role of faculty in bringing the revision to fruition. Other publications that seem will be useful in developing a research protocol are, Seng, Mirenda, and Lowry (1996), which examined the implementation of a curriculum using Neumans Systems Model in both a BSN program and an ADN program. Cook and Cullen (2003) described the use of Watsons work as a theoretical framework at an ADN program. To avoid being constrained by a single nursing theory or model, many faculties choose an eclectic approach, which combines theories and concepts in framework development. Often two or three organizing theories are used to build a curriculum (Berbiglia, 2011).

Research Questions

The main purpose of the study is to determine if it is important for nursing programs to identify and incorporate conceptual frameworks on which they base their curricula. A related purpose is to determine to what extent faculty is involved with the integration of conceptual frameworks and how does this change their educational and clinical practice style. The following research questions reflect the purpose statement:

1. To what extent does incorporating a conceptual framework into curricula allow faculty to determine what knowledge is important to nursing (i.e., the concepts, principles, skills, and theories to be covered)? 2. To what extent does incorporating a conceptual framework into curricula help faculty explain how these ideas or concepts apply to nursing practice?

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3. Is faculty able to articulate the conceptual framework of their program and recognize how the framework shapes the program? 4. Does the implementation of a conceptual framework into curricula allow faculty to implement evidenced-based practices in a way to give students planned, organized, consistent, and cohesive learning experiences? Methodology

Study Settings

This study will focus on nursing faculty at the undergraduate level from various nursing programs within the United States. The study will analyze the components of conceptual frameworks to assess how they are being used to organize the curricula of nursing programs, identify the roles that faculty play in the integration of conceptual frameworks into nursing curricula, and to determine whether there is a difference among types of programs (i.e. baccalaureate degree, associate degree, and diploma).

A quantitative correlational research design will be used, gathering information from subjects, namely nursing faculty, and correlating their responses with the type of program they instruct. A correlational research design is in keeping with the purpose of this study, as it determines a positive or negative relationship and the strength of the relationship between the integration of conceptual frameworks into nursing curricula and faculty roles within the integration. Specifically, this study will determine the type and strength of relationship between conceptual frameworks and nursing faculty.

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Research Design

A descriptive research design will be used to investigate the previously identified issues. The design will address the following questions:

1. What conceptual frameworks currently are being used to guide the curricula of undergraduate nursing programs? 2. Are you able to articulate the conceptual framework of their program and recognize how the framework shapes the program? 3. How do you utilize the conceptual framework into your curriculum design? 4. What tools, concepts, and processes are emphasized in the curriculum? 5. Does the conceptual framework allow you to implement evidenced-based practices in a way to give students planned, organized, consistent, and cohesive learning experiences?

The research design that will be utilized within the study is a descriptive survey, and is a descriptive correlational design. A descriptive design may be used to develop theory, identify problems, with current practice, justify current practice, make judgments, or determine what others in similar situations are doing (Burns, 2009, p. 237). A descriptive design does not involve treatments or interventions and there are no independent or dependent variables because there is no attempt to establish causality. Descriptive correlational studies examine variables in a situation that has already occurred or is currently occurring. No attempt is made to control or manipulate the situation (Burns, 2009, p. 246).

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Sample and Sampling Procedures

The sample will be a stratified random sample of 300 NLNAC-accredited undergraduate nursing programs taken from a listing downloaded from the NLNAC Web site. There are over 1500 accredited nursing programs currently in the United States. In 2009 38% consisted of baccalaureate programs, 58% associate programs, and 4% diploma programs. Based on the breakdown, the stratified sample will include 150 ADN programs, 125 BSN programs, and 25 diploma programs. The samples for the BSN and ADN will be stratified further by seeking to include at least on of each type of program from each state whenever possible. After inclusion of one program from each type per state, the remainder of the quota for the sample will be randomly selected from the lists. Because of the uneven geographic distribution of diploma programs, selection of the 25 diploma programs will be random.

Subjects meeting inclusion criteria must be registered nurses currently employed fulltime (36 or more per week) as nursing faculty within an accredited undergraduate nursing program. Subjects must work as head instructor/professor of an undergraduate nursing course. In order to allow for adequate adjustment time to various faculty programs, curricula and frameworks, subjects will only be included if they have held their current position for at least one year. Faculty working only as clinical instructors and no didactics will be excluded from this study. Although questionnaires will include demographic characteristics of subjects, these will be gathered for statistical purposes alone and will not determine exclusion or inclusion of subjects.

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Data Collection

Survey packets will be mailed to a faculty member from each selected nursing program. The packets will contain the questionnaire (Appendix A), but in addition to the questionnaire each packet will contain a cover letter addressed to the faculty member explaining the study and assurance that the responses will be kept confidential, and all data will be reported as group data. No identification of individual responses will be possible. A blank index card will be included in the packet for respondents who desire a copy of the results of the survey to write their name and address on the card. Finally, the packet will include a self-addressed, stamped envelope for return of the questionnaire. Subjects will be expected to respond within 30 days of receipt of packet and all packets for study must be received within 45 days of postmarked date.

Data Analysis Using subjects responses from the completed surveys analysis will be conducted to identify characteristics of the sample of nursing programs and components of conceptual frameworks. Analysis of Variance (ANOVA) will be utilized to determine whether there are variations in components of curricula based on faculty understanding and type of program.

Strengths and Weaknesses

The study will reveal a number of similarities and considerable variations in the conceptual frameworks of all levels of nursing programs throughout the United States. The challenge that faces faculty from all types of nursing programs is to develop curricula to meet the educational needs of students, while considering changing demographics, trends in health and illness patterns, and a vastly different health care delivery system. Ideas for curriculum changes

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to address current and anticipated needs can readily be found in the nursing literature. In order to accommodate changing student demographics and address the needs of more mature students, second degree students, students from a variety of cultural backgrounds, and students with a variety of family and social responsibilities nursing educators will need to identify changes and modifications in teaching methods. The future implication for new teaching strategies, based on education theories and research is great and requires more evidenced based studies to be developed and promoted. There is a great need for studies to identify content areas within nursing education programs that will need enhanced emphasis. Evidenced-based studies will need to identify ways to stress essential concepts, theories, and models in nursing programs. The implication of this study will promote future studies in removing focus from only nursing faculty to include nursing students. The limitation of this study is that it only includes faculty and could be biased based on the faculty members feeling towards the nursing school, curricula, and teaching methods. Future studies could include students and identify whether they feel they were provided the opportunity in their program to practice and use critical creative processes within their basic nursing education and whether they are able to identify the conceptual framework utilized within their nursing program. This type of research study may help nurse educators understand that nursing curricula will need to shift from being primarily content driven and controlled by the faculty; to being outcome driven and focused on the needs of the learner, the profession, and the community.

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APPENDIX A Nursing Program Type: Diploma Associate Bachelor

Nursing Program State: _______________________________ Name of Nursing Course: ________________________ Have you been an instructor at the institution more than a year? Gender: Male Female Age: BSN Yes No

18-30 31-40 41-50 51-60 60+ MSN DNP Ph.D.

Level of Nursing Education:

1. Indicate which was part of the model or conceptual framework that guided the curriculum of their nursing program: a. Nursing Theorist i. Name of Theorist: ________________________ b. Bio/psycho/social/spiritual model c. Nursing process d. Simple-to-complex model e. Integrated, medical model f. Health promotion/levels of prevention g. Other i. Please describe: __________________________ 2. Indicate the length of time the conceptual framework has been used: a. Less than 1 year b. More than 1 but less than 5 years c. More than 5 years but less than 10 years d. More than 10 years but less than 15 years e. More than 15 years 3. How do you incorporate the conceptual framework into your curriculum? a. Determine outcome b. Direct assessment c. Direct nursing interventions d. Determine objectives e. Specify nursing diagnoses f. Other i. Please describe: ___________________________ 4. Rank the top three tools, concepts, and processes utilized in the curriculum a. _______ Caring b. _______ Communication c. _______ Critical Thinking

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d. e. f. g. h.

_______ Problem solving/decision making _______ Teaching/learning _______ Therapeutic nursing interventions ______ Values/ethical reasoning/integrity ______ Other i. Please describe: ______________________________

5. Do you implement evidenced-based practices into teaching method? a. Yes b. No 6. If yes, why do you implement evidenced based practice? (Circle all that apply) a. Planning b. Organization c. Consistency d. Cohesive Learning Experience

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References Berbiglia, V. A. (2011). The Self-Care Deficit Nursing Theory as a Curriculum Conceptual Framework in Baccalaureate Education. Nursing Science Quarterly, 24(2), 137 -145. Burns, N. (2009). The practice of nursing research: appraisal, synthesis, and generation of evidence (6th ed.). St. Louis Mo.: Saunders/Elsevier. Mawn, B., & Reece, S. M. (2000). Reconfiguring a Curriculum for the New Millennium: The Process of Change, 39(3), 101-108. McEwen, M., & Brown, S. C. (2002). Conceptual frameworks in undergraduate nursing curricula: report of a national survey. The Journal of Nursing Education, 41(1), 5-14. McEwen, M., & Willis, E. M. (2010). Theoretical Basis for Nursing. Philadelphia, Pa; London: Lippincott Williams & Wilkins. Rolfe, G. (1996). Closing the theory-practice gap: a new paradigm for nursing. Oxford;;Boston: Butterworth-Heinemann. Shelly, J. A. (2006). Called to Care: A Christian Worldview for Nursing / Miller, Arlene B.; 1935-. Downers Grove, Ill.: IVP Academic/InterVarsity Press.