Journal of Nursing Education

The West Virginia Plan: A Portrait of Curriculum Development

Mary Frances Borgman, RN, EdD; Lorita D Jenab, RN, EdD

Abstract

The West Virginia University School of Nursing was established in 1960 with a curriculum that was considered quite innovative. The curriculum design, widely referred to as the "West Virginia Plan," broke with the traditional block rotation pattern for clinical courses.1-3 The curriculum was based, in part, on the theory that each clinical subject should be taught at increasing depth in each of the undergraduate years.

Some of the more significant assumptions on which the original curriculum was built are:

1. Nursing constitutes a "major" in baccalaureate education.

2. Nursing is practiced in a number of environments, no one of which is prerequisite to another.

3. Learning should progress from simple to complex.

4. The basic tenets of nursing should be introduced early in the curriculum, and then be reintroduced repeatedly in increased depth as the student progresses.

5. Planned revisits to environments where nursing is practiced present an opportunity for the student to deliver a successively higher level of nursing care.

6. The vertical and horizontal interweaving of theory andclinicalendeavors creates a framework for an integrated curriculum.

The curriculum served well for the first decade. However, in the late 60s, the faculty began to recognize that the vertical articulation of curriculum "threads" within the clinical departments had overshadowed the horizontal interweaving of concepts; those concepts common to nursing irrespective of clinical setting. Commitment to nursing as a holistic process was evident in the philosophy and concepts undergirding the curriculum; but, the application of these concepts was carried out in the context of specialization borrowed from the classic medical model. Such a model contributed to some unplanned redundancy and impeded the development of a nurse generalist. Also as the inevitable faculty turnover occurred, many of the new faculty whose education had been in other curriculum systems searched for ways of maintaining the original concept of the curriculum while modifying it to the extent the present ascendancy of nursing demanded. Dimly at first and finally with great clarity, the realization dawned that the Plan must become more responsive to the rapid and enormous changes which had occurred in the nursing world. Unchecked, minor modifications which were occurring would eventually spread and transform it into exactly that which it was intended not to be - a collection of courses with no integration or continuity.

The conceptual framework and taxonomy of behaviors may be illustrated graphically as a vertical and a horizontal grid (Figure V). This grid serves as a basis for future course revisions, and ensures inclusion of both the basic concepts and necessary content in such revisions. Concepts and subconcepts are aligned vertically and the taxonomy of behaviors horizontally. Course objectives can be extracted from the vertical listing of behaviors corresponding to the subconcepts.

Figure V also provides a list of the courses in the refined West Virginia Plan. The course descriptions and behaviors depict the distinctions between the courses. The practica are evaluated on a pass-fail basis. This concept focused curriculum provides a theoretical basis for nursing, and shows various areas where further research is needed to document behaviors in nursing practice. The redeveloped sophomore and senior curricula were, in the main, implemented on a trial basis in 197778. The total revision was completed for the 1978-79 school year and the results have been gratifying. Some of the concurrent outcomes are as follows:

1. An analysis and integration of a philosophy of professional nursing and baccalaureate nursing education.

2. An identification of major concepts common to professional nursing.

3. An increasing number of faculty moving from a specialty identity to a nurse generalist identity.

4. A continuing development of a new…

The West Virginia University School of Nursing was established in 1960 with a curriculum that was considered quite innovative. The curriculum design, widely referred to as the "West Virginia Plan," broke with the traditional block rotation pattern for clinical courses.1-3 The curriculum was based, in part, on the theory that each clinical subject should be taught at increasing depth in each of the undergraduate years.

Some of the more significant assumptions on which the original curriculum was built are:

1. Nursing constitutes a "major" in baccalaureate education.

2. Nursing is practiced in a number of environments, no one of which is prerequisite to another.

3. Learning should progress from simple to complex.

4. The basic tenets of nursing should be introduced early in the curriculum, and then be reintroduced repeatedly in increased depth as the student progresses.

5. Planned revisits to environments where nursing is practiced present an opportunity for the student to deliver a successively higher level of nursing care.

6. The vertical and horizontal interweaving of theory andclinicalendeavors creates a framework for an integrated curriculum.

The curriculum served well for the first decade. However, in the late 60s, the faculty began to recognize that the vertical articulation of curriculum "threads" within the clinical departments had overshadowed the horizontal interweaving of concepts; those concepts common to nursing irrespective of clinical setting. Commitment to nursing as a holistic process was evident in the philosophy and concepts undergirding the curriculum; but, the application of these concepts was carried out in the context of specialization borrowed from the classic medical model. Such a model contributed to some unplanned redundancy and impeded the development of a nurse generalist. Also as the inevitable faculty turnover occurred, many of the new faculty whose education had been in other curriculum systems searched for ways of maintaining the original concept of the curriculum while modifying it to the extent the present ascendancy of nursing demanded. Dimly at first and finally with great clarity, the realization dawned that the Plan must become more responsive to the rapid and enormous changes which had occurred in the nursing world. Unchecked, minor modifications which were occurring would eventually spread and transform it into exactly that which it was intended not to be - a collection of courses with no integration or continuity.

The West Virginia Plan had been created de novo as a total curriculum. But, there was no blueprint that succeeding generations of faculty could follow to enable them to modify the curricular content and still maintain the basic tenets on which the Plan was founded.

But the rapid changes in the health care field and the increasing emphasis on the nature of nursing mandated a comprehensive curriculum blueprint for the decade of the 70s.

The West Virginia Plan needed a reassessment. The original tenets remained valid but a substantive organization of goals and concepts was necessary to enable the current and subsequent generations of faculty to pursue greater integration of the curriculum concept, nursing is a holistic unit, in the face of societal changes and impediments within nursing education to change. According to Bevis4 the impediments to curriculum change are as follows:

1. The norm for implementing nursing practice and nursing education is mainly within the context of an illness setting and medical specialization.

2. The nursing self-image is one of specialization.

3. The national achievement and licensing examinations purport five clinical specialization areas - the classical medical specializations.

Emphasis is still placed on the development of expertise in a specialized area of clinical nursing practice in the accrediting agencies characteristics of graduate education in nursing leading to the master's degree. This is an additional impediment to change.5 Despite these impediments the faculty established the goal to develop a curriculum design to allow a greater responsiveness to social changes to make more viable the basic principles of the West Virginia Plan.

To accomplish this, a reorganization from clinical departments to academic levels occurred almost simultaneously with the accrediting agency's declared criteria relative to conceptual framework for curriculum development.

In terms of organization, the faculty organized by clinical departments saw the need for faculty to be assigned at the respective levels (sophomore, junior, senior) in order to meet interdepartmentally as level faculty teams. It became increasingly apparent to these "level" teams, that the changing needs of society, more diverse student population, vast advances in scientific technology, the re-emergence of an emphasis on the nature of nursing, and the consumer involvement in the system mandated a comprehensive review of the curriculum.

While some faculty members felt that the many variables of curriculum revision simply could be infused into the existing courses, other faculty members challenged the original claim of an integrated or concept-focused curriculum.

Figure I shows the definition of these other major elements. Each element is dependent on the simultaneous development or understanding of the other elements. At the West Virginia University School of Nursing the concurrent development of a curriculum system and a curriculum design has played a large role in the successful development and implementation of the conceptual framework. In the curriculum design concepts and subconcepts were identified and related to the goals of the school; in the curriculum system the decision making process was analyzed and updated.

In the formative stages of the curriculum system the faculty as a whole served as a curriculum committee. In the 1960s the faculty was organized by departments similar to that found in traditional nursing schools. The various clinical departments promoted vertical articulation of concepts common to all clinical areas and in some instances required unnecessary repetition of activities related to the same concept. In 1972-73 the administrative structure was changed from a vertical structure to a horizontal structure. The horizontal structure was arranged around levels of learning, and was designed to provide the student with a holistic approach to nursing at each level. The founder of the program had said in 1962 "if we are to prepare generalists in nursing. . .and generic programs are so named for this reason... we must concentrate on one major, which is nursing. It is not medical nursing plus surgical nursing."6 Currently, there are five levels of learning: sophomore, junior, senior, graduate, and continuing education. In addition the upper division program for registered nurses who are graduates from diploma or associate degree programs is also provided through the WVU Medical Center in Charleston, West Virginia. Figure II shows the current administrative structure.

Table

FIGURE 1DEFINITIONS OF THE ELEMENTS OF CURRICULUM DEVELOPMENT

FIGURE 1

DEFINITIONS OF THE ELEMENTS OF CURRICULUM DEVELOPMENT

Table

FIGURE 2ADMINISTRATIVE ORGANIZATION OF WVUSN

FIGURE 2

ADMINISTRATIVE ORGANIZATION OF WVUSN

This structural realignment was a major change in the curriculum system and it was a requisite to a truly integrated curriculum. Theory clearly indicates that change causes confusion and frustration among those involved, and this was readily apparent during this curriculum development process. However, these characteristics of change soon became the motivating forces for redesigning the curriculum, with the ultimate reward that the faculty possessed not only expertise in curriculum development in higher level education.

The evolution of a new decision making structure forced the faculty to openly discuss and consider their individual nursing philosophies and also the school's philosophy of nursing and nursing education. This resulted in a much better understanding and strengthening of the philosophy of the school. Gradually, concepts and subconcepts were identified from the philosophical dialogue. A greater awareness of the nature of nursing facilitated faculty moving from a nurse specialty identity to a nurse generalist identity.

The conceptual framework of West Virginia University School of Nursing is based on four concepts. These are man, the nursing process, health and the environment (Figure III).

The concept of man is basic to nursing. Each man assumes many roles in his life. In nursing these roles are specific. Therefore, the concept man refers either to the nurse role and/or the client role. The second and third major concepts are health and the nursing process. Theachievement of health or a specific goal of health, is the purpose of the nurse providing assistance to the client. The nursing process is the means for achieving this end. The nursing process between nurse and client takes place in and influences a certain environment. On the other hand, the environment influences the nursing process in many instances. Therefore, the purpose of nursing is to assist the client in the performance of those activities contributing to his health, or in some instances to a comfortable death. These activities would normally be initiated and performed by the client or his family if they had the necessary strength, knowledge and motivation to do so. The conceptual framework, philosophy and terminal objectives of West Virginia University School of Nursing reflect this purpose.

In addition to the four basic concepts there are many subconcepts which are interwoven into the entire curriculum. In our curriculum the successive use of subconcepts will be with increased depth and breadth of knowledge, attitude and skill.

Figure III depicts the relationship of the curriculum to the conceptual framework. The four concepts are the focus of the sophomore, junior, and senior year objectives. The subconcepts are focused in the individual course and instructional objectives. Both faculty and students have input into the development of course and instructional objectives. This input is due to the fact that there is student representation in sophomore, junior, and senior faculty meetings where course and instructional objectives are developed. Students are also responsible for developing their learning objectives in light of the conceptual framework and course objectives.

During the curriculum redevelopment process it was discovered that certain courses were content-focused, but not concept-focused.

This point created some confusion for faculty members who had difficulty relating concepts on an abstract level. The new decision making process provided a means of communication concerning this point and subsequent solution of the problem (Figure IV).

A twofold solution was developed to serve as a plan to ensure that concepts would be included in each course. First, the objectives of each level were developed around the four main concepts, i.e., man, health, process, and environment. These objectives were related to the terminal objectives of the school in the current and evolving courses. The second solution was to develop a taxonomy that included cognitive, psychomotor and affective behaviors. This proved useful not only in course development but also in student self-evaluation.

Table

FIGURE 3CURRICULUM DESIGN: THE CONCEPTUAL FRAMEWORK CONCEPTUAL FRAMEWORK

FIGURE 3

CURRICULUM DESIGN: THE CONCEPTUAL FRAMEWORK CONCEPTUAL FRAMEWORK

FIGURE 4CURRICULUM SYSTEM - DECISION-MAKING SYSTEM

FIGURE 4

CURRICULUM SYSTEM - DECISION-MAKING SYSTEM

Table

FIGURE 5DESIGN OF THE GRID CONTAINING CONCEPTS. SUBCONCEPTS, TAXONOMY OF BEHAVIORS AND COURSES AT WVUSN (UNDERGRADUATE)

FIGURE 5

DESIGN OF THE GRID CONTAINING CONCEPTS. SUBCONCEPTS, TAXONOMY OF BEHAVIORS AND COURSES AT WVUSN (UNDERGRADUATE)

The conceptual framework and taxonomy of behaviors may be illustrated graphically as a vertical and a horizontal grid (Figure V). This grid serves as a basis for future course revisions, and ensures inclusion of both the basic concepts and necessary content in such revisions. Concepts and subconcepts are aligned vertically and the taxonomy of behaviors horizontally. Course objectives can be extracted from the vertical listing of behaviors corresponding to the subconcepts.

Figure V also provides a list of the courses in the refined West Virginia Plan. The course descriptions and behaviors depict the distinctions between the courses. The practica are evaluated on a pass-fail basis. This concept focused curriculum provides a theoretical basis for nursing, and shows various areas where further research is needed to document behaviors in nursing practice. The redeveloped sophomore and senior curricula were, in the main, implemented on a trial basis in 197778. The total revision was completed for the 1978-79 school year and the results have been gratifying. Some of the concurrent outcomes are as follows:

1. An analysis and integration of a philosophy of professional nursing and baccalaureate nursing education.

2. An identification of major concepts common to professional nursing.

3. An increasing number of faculty moving from a specialty identity to a nurse generalist identity.

4. A continuing development of a new decision making process which ensures student-faculty involvement in decision making (initiated 1976-77).

5. An increase in team planning, teaching, and evaluating.

6. A reduction in the number of nursing courses and corresponding decrease in credit hours.

7. A greater flexibility in planning and using resources.

8. An identification of new resources where nursing can be practiced.

9. An awareness of the mechanics of curriculum development and engineering.

10. A greater flexibility for each faculty member to balance teaching, research and public service in their workplans.

11. A basis for strengthening the advanced placement experience and the program for non-baccalaureate trained nurses.

12. A basis for articulation between the undergraduate and graduate programs.

The West Virginia Plan is a dynamic framework which accommodates change in terms of the needs of the learner, the needs of society, and the nature of knowledge. There is still work to be done, and such areas as credit allocation and equivalency, the arts and sciences support courses, and enhances concept identification in learning experiences need further examination. The most difficult part of curriculum development is the large expenditures of time and energy required to accomplish changes. These expenditures have proved to be most valuable and worthwhile in the estimation of faculty and students.

A curriculum and a conceptual framework are no longer abstract entities for us, but rather concrete realities. The development of the dynamic conceptual framework to serve as the underpinning for this curriculum has provided a solid foundation for the present curriculum and one which will support future curricular modifications. The framework is based on simple concepts basic to nursing education - practice-research, around which all course offerings are structured. With the addition of comprehensive and detailed subconcepts and behavioral taxonomies, documenting articulation within the academic units comprising the undergraduate program and the graduate program, future revision and refinements of the curriculum can be effected and still maintain the basic tenets of the particular plan. The conceptual framework served as a basis for the development of the program's conceptual and operational goals, 1979-81 which will guide the undergraduate, graduate, and continuing education academic units'activities; in support of the ongoing total program development. Thus, the West Virginia Plan remainsdynamic and relevant to the evolution of nursing.

References

  • 1. Beauchamp GA: Curriculum Theory, ed 3. Wilmette, Illinois, The Kagg Press, 1975, ? 196.
  • 2. Major D: The West Virginia plan. Nurs Outlook 10:36, April 1962.
  • 3. Major DM: The West Virginia plan: 1965. Nurs Outlook 13(12):22, December 1965.
  • 4. Bevis EO: Curriculum Building in Nursing: ? Process. St. Louis, CV Mosby Co, 1973.
  • 5. O'Kelley L, McKinneyG: A conceptual model for medical surgical nursing. Nurs Outlook 19:731736, November 1971.
  • 6. Major DM. The West Virginia plan. Nurs OmMmJc 10:236, April 1962.
  • Bibliography
  • National League for Nursing: Curriculum Development and its Implementation through a Conceptual Framework. NLN Publication #23-1723, NLN, New York, 1978, p64.
  • National League for Nursing: Characteristics of Graduate Education in Nursing Leading to the Master's Degree . NLN Publication #15-1759, NLN, New York, 1979, p 4.

FIGURE 1

DEFINITIONS OF THE ELEMENTS OF CURRICULUM DEVELOPMENT

FIGURE 2

ADMINISTRATIVE ORGANIZATION OF WVUSN

FIGURE 3

CURRICULUM DESIGN: THE CONCEPTUAL FRAMEWORK CONCEPTUAL FRAMEWORK

FIGURE 5

DESIGN OF THE GRID CONTAINING CONCEPTS. SUBCONCEPTS, TAXONOMY OF BEHAVIORS AND COURSES AT WVUSN (UNDERGRADUATE)

10.3928/0148-4834-19811101-07

Sign up to receive

Journal E-contents