An important issue in the development of nursing curricula is the selection of essential content that comes from both nursing and related disciplines. Nursing curricula consist of content from related sciences, humanities and professional disciplines as well as from the discipline of nursing. The purpose of this article is to describe the development and testing of a process model to identify guidelines for selecting essential content for nursing curricula that emanates from multiple disciplines. The goal was to develop a process rather than an explanatory or predictive model.
Curriculum research is complex. It is enhanced by theoretical and conceptual models that promote systematic and thorough study. Use of such models for curriculum research increases the possibility of replication and generalization. Also, models guide decision-making during the research process and in the application of findings. The development of a process for selecting essential content would permit a systematic scholarly approach to the identification of conceptual guidelines. Such guidelines would enhance curricular development without being prescriptive about specific content, placement or pedagogy.
Development of the model reported here was initiated by the first author when challenged to identify essential nutrition content for a baccalaureate nursing program. An examination of curriculum, nursing and nutrition Literature revealed little in the way of theoretical perspectives or conceptual models to guide this progress. Thus, this general model was developed and tested (Morse, 1990).
In the following sections, development of the model presented in the Figure is described, followed by a report of a study in which the model was used as a framework for curriculum research. Finally, an evaluation of the model's usefulness is presented.
Development of the Model
Building on Existing Curriculum Models to Identify Essential Content
Stember (1984) noted that most nurse educators do not approach curriculum research or curriculum development and revision using curriculum theory and scientific approaches. In the absence of an "adequate nursing curricular paradigm" (p. 256), nurse educators usually design pragmatic studies to address specific problems for particular programs (Stember, 1984; Tanner & Lindeman, 1987; Wadel & Munns, 1983). Consequently, findings are not generalizable to other nursing programs.
The literature was reviewed for existing theoretical perspectives and conceptual models for identifying essential curricula content. A review of higher education literature revealed models that focused on the development of a total undergraduate curriculum (Carnegie Foundation, 1977; Chickering, Halliburton, Bergquist, & Lindquist, 1977), the curriculum change process (Conrad & Pratt, 1983), and curriculum evaluation (Gardner, 1977). Halliburton (1977) addressed the implications of "interdisciplinary" curriculum approaches. He identified ways of structuring such approaches and discussed aspects of curriculum design, but he did not address identification of essential content. Models were sought that would allow a researcher or educator to focus on a specific curriculum content area rather than on the entire curriculum. A narrower focus was of interest because of rapid changes in health care knowledge and practices in particular areas. A process was needed for enhancing relevance and currency of curricular content between times of comprehensive curricular review and revision.
Two curriculum evaluation models from elementary and secondary education curriculum literature addressed the study of specific content: A Model for a Program Audit (Kimpston, Barber, & Rogers, 1984) and A Procedure for identifying Innovation Configurations CHaII & Loucks, 1981). In A Model for a Program Audit, Kimpston and colleagues (1984) presented a process that allowed for specific areas of a curriculum to be reviewed. The author indicated that such audits, regularly spaced in a review cycle, permitted curricular areas to remain current between total curricular reviews.
In the second model, Procedure for Identifying Innovation Configurations, Hall and Loucks (1981) were concerned with the assessment of curriculum fidelity. Fidelity was defined as the degree to which program components such as objectives, content, and methods were implemented as intended by the curriculum designers. By identifying which curriculum components were essential and which were discretionary, educators could make curricular adaptations while maintaining curriculum fidelity. While Hall and Loucks emphasized the importance of distinguishing between essential and discretionary content, the model did not explain how to do this.
Although both of these models were designed for use in elementary and secondary education curriculum, they were relevant to the model development described here in that they highlighted the value of focusing on selected content areas, and the importance of distinguishing between essential and discretionary content. These two models were limited in that they required the use of specific curriculum objectives that are consistent across academic settings. Such specific objectives are neither available across post-secondary programs nor consistent with higher education values. Thus, a more general model was needed to determine essential content for baccalaureate nursing curricula.
A model appropriate for use in higher education settings would identify the steps to be taken and the tasks to be accomplished that would bring together the perspectives from several disciplines about a content area, while maintaining the authority of nurse educators to determine specific essential curricular content and to implement such content in a manner appropriate for their own schools. In order to achieve these goals, a process model for identifying essential curricular content for nursing curricula would need to be designed to lead to conceptual content guidelines rather than prescriptive content specifications.
Schul m an (1984), a renowned curriculum expert, indicated that educational research in general, and curriculum research in particular, should be characterized by "disciplined inquiry.'' He described disciplined inquiry as a family of methods, quantitative and qualitative, that distinguish results from opinions and beliefs. Disciplined inquiry is conducted so that results can be subjected to and withstand careful review by other disciplinary experts.
Schwab (1978, 1983) addressed a major problem inherent when incorporating theoretical content in the education of students for practice disciplines. The problem from his viewpoint is that theory consists of generalizations and abstractions while practitioners (e.g., teachers or nurses) work in specific settings with individuals dealing with particular situations. He concluded that there is a need to draw together theoretical and practical content. These two types of content need to be brought together in a systematic way so that the strengths of each will be complementary rather than contradictory. According to Schwab, a group, rather than one person, is needed to obtain multiple perspectives. A group is required because no one person has full knowledge of all phenomena and because a group is more likely to generate multiple alternatives for curriculum development (Schwab, 1983).
The curricular process described by Schwab was designed to maximize curriculum development. It has value for the identification of essential content, for the inclusion and integration of various theoretical perspectives, and for combining theoretical and practical knowledge. Leading nurse educators concur with this approach for the development of nursing curricula.
Bevis (1990b), indicated that curriculum revision for nursing education begins with some form of assessment to determine curricular directions and capabilities. Faculty examine the nature and direction of health care and the roles of nurses in providing that care. Bevis specifically addressed the need to consult with clinical experts and other relevant non-nurses in the community, so that the realities and scope of professional practice are considered along with the realities of education in determining curricular directions.
Curriculum content is frequently determined using a consensus approach such as the Delphi technique. Diekelmann (1988) rejected the notion of "consensual validation of essential knowledge" (p. 148) for curriculum development, stating that the process of consensus tends to identify what is obvious or trivial. Instead, she, like Bevis and Schwab, called for a process of dialogue among faculty, practitioners, and students to identify curriculum content. This dialogue takes into account everyone's interest and allows for curricular modifications as needs change.
The model described in this article builds on the models and theories described above. The model developed by Kimpston, Barber, and Rogers (1984) provided an example of a process model as well as rationale for focusing on a selected content area within the curriculum. Hall and Loucks (1981) explicated the importance of differentiating between essential and discretionary content in order to allow for curricular adaptations. Bevis (1990b) emphasized the importance of working with clinical experts. Diekelmann (1988) proposed conceptualizing curriculum development as a dialogue among faculty, clinicians and students. Diekelmann (1988), Bevis (1990b), Schulman (1984), and Schwab (1978, 1983) all addressed the importance of bringing together theoretical aspects of nursing and related disciplines with the knowledge and experiences of educators and practitioners from these fields in order to "bring a principle to its case," (Schwab, 1978, p. 331).
A Process Model to Identify Essential Curriculum Content
Based on the literature review, a preliminary process model was designed. It was intended that the "essential content" of the model be developed as conceptual statements or guidelines which identified major areas of essential content, rather than lists of facts to be included in a curriculum. The use of conceptual areas provides more flexibility for application to a wide variety of curricular research and development, allowing the specification of essential content while preserving schools' curricular independence and diversity. Conceptual areas can be addressed and emphasized in a wide variety of ways in many different curricula. The use of conceptual guidelines also permits curricular adaptations without major curricular revisions as disciplinary knowledge and needs of a profession change. Also, conceptually stated guidelines are consistent with the characteristics of higher education and with newer views of nursing curricula (Bevis, 1988a, 1990b; Diekelmann, 1988). The process consisted of four steps: 1) delineating the content area, 2) reviewing the literature of the relevant disciplines to develop initial content guidelines, 3) interviewing educators and practitioners from the primary and related disciplines to obtain their input, and 4) revising the guidelines accordingly.
Implementing the Model as a Framework for Curricular Research
The procedure for implementing the model is described here to illustrate its use in curricular research. Once the initial process was developed, a study was conducted to test its usefulness. The selected content area for model testing was nutrition content in baccalaureate nursing curricula. A qualitative approach was used to operationalize each step of the model and evaluate the model's usefulness. The model was designed to generate practical, flexible conceptual nutrition content guidelines based on strong theoretical underpinnings and on the realities of nursing education and practice that could be used for curricular research and development.
After the content area was delineated, the next step consisted of reviewing nursing and nutrition literature for the purpose of developing initial content guidelines. Because the literature of both professions was sparse, literature also was reviewed on related topics, such as descriptions of particular nutrition COiU1SeS in nursing programs and reports of the process used to identify other content areas such as ethics and research. Based on information from this review, eight conceptual guidelines for essential nutrition content with supporting rationale were identified. These guidelines served as the basis for the completion of the third and fourth steps of the model.
Implementation of the third step of the model consisted of face-to-face interviews with educators and clinicians from nursing and nutrition to assure the inclusion of both theory and practice perspectives. An interview-dialogue methodology was selected because it most closely resembled actual curricular decision-making practices and permitted a theory-practice interaction noted to be essential by curricular experts (Bevis, 1990b; Diekelmann, 1988; Schon, 1987; Schwab, 1978, 1983; Schulman, 1984).
Theoretical sampling was the process used to select the sample. Theoretical sampling emphasizes the selection of participants based on their potential to contribute information that will answer the research questions (Taylor & Bogdan, 1984). This approach maximizes information while minimising problems associated with convenience samples. A minimum of two subjects were contacted to be interviewed from each of four categories: nursing educators, nursing clinicians, nutrition educators, and nutrition clinicians. However, theoretical sampling allowed the investigator to include other participants with valuable insights as they were subsequently identified.
Prospective subjects residing in Minnesota and Wisconsin were contacted by telephone to determine their willingne8s to be interviewed. If they agreed, an interview was scheduled. A cover letter, consent form, a copy of the eight guidelines, and a copy of the criteria to evaluate if the guidelines were practical, purposive, realistic, and judicious (Short, 1983) were mailed to them one week prior to the scheduled interview. None of the individuals contacted declined to be interviewed. The final sample consisted of two nurse educators, three nurse clinicians, four nutrition educators, and two nutrition clinicians.
A semi-structured interview guide (Borg & Gall, 1983; Patton, 1987) was reviewed by content experts and by other researchers with expertise in using interview methodology. The guide was evaluated for completeness and adequacy for eliciting data to test the model. It was pilot-tested to assure that there were no duplicative, leading or threatening questions, and that the language used was appropriate and clear. Minimal editorial revisions were made.
The interviews began with a question asking subjects about their general reactions to the initial draft of eight guidelines for essential nutrition content in baccalaureate nursing education. Then they were asked to critique each guideline. This discussion was followed by questions related to the internal validity or credibility of the guidelines (Sandelowski, 1986). Credibility addressed issues of clarity, accuracy, and essentiality of the guidelines. A discussion of external validity or fittingness addressed whether or not the guidelines were practical, purposeful, realistic, and judicious (Sandelowski, 1986; Short, 1983). A brief, one-page form to gather demographic data was developed for participants to complete in a few minutes at the end of the interview itself. AU interviews were audiotape recorded and later transcribed verbatim.
Miles and Huberman (1994) provided guidelines for data analysis using matrix displays. Matrix displays were helpful in organizing data so that it could be described, coded, compared, and analyzed while permitting others to follow the investigator's thought and decision processes.
The results indicated that all subjects thought that the guidelines "made sense." They described the guidelines as balanced in addressing both important nursing and nutrition issues. Also, they viewed the guidelines as practical, realistic, educationally sound, and useful in designing either integrated curricula or a separate nutrition course. Finally, they perceived the guidelines to be clinically sound and useful in a variety of settings. They offered suggestions to increase the visibility of the rationale from nursing literature to clarify the depth of expected student learning, and to organize the findings into content and process guidelines. In the final step, the initial content guidelines were revised based on the suggestions obtained.
The findings of this study in the form of guidelines for essential nutrition content for baccalaureate nursing education and the rationale for each are published elsewhere (Morse & Corcoran-Perry, 1993).
Evaluating the Model's Usefulness
The model was evaluated by the authors for its usefulness as a framework for investigations designed to develop guidelines for selecting essential content for nursing curricula that emanates from multiple disciplines. Usefulness was defined as a judgment made of the relative merits of the model for the identification of essential content in nursing curricula and for curricular research. Short's (1983) four criteria for evaluating curriculum development strategies were used to judge usefulness. These criteria were defined as follows:
1) Practical: The model is sufficiently concrete to be operationalized, yet flexible enough for the operationalization to be adapted to specific situations. It provides guidance for what is to be included in a particular circumstance, but recognizes that content cannot be determined by a single theoretical prescription nor a common rule.
2) Purposive: The model provides guidance for content selection by: a) being oriented to curricular content, b) identifying issues to be addressed and decisions to be made, and c) promoting rational and orderly approaches toward the achievement of tasks and goals. It is presented using language that communicates effectively among participants.
3) Realistic: The model is flexible enough to be adapted to political, economic, and environmental realities. User interpretation and judgment are accommodated. It guides the development of curriculum specifications and guidelines that can be enacted feasibly within the possibilities and constraints of particular contexts. It is economical to use.
4) Judicious: The model is supported by rationale to guide and support decisions. It promotes an open, unbiased search for educationally and clinically sound content, involving all relevant bodies of expertise.
Overall, the model was evaluated as being useful for identifying guidelines for essential nutrition content in baccalaureate nursing curricula. The model helped to organize the process of identifying this essential content, and it allowed a systematic approach to the task. Information related to the specific criteria of practicality, purposiveness, realism, and judiciousness follow.
The model was practical in that it was specific enough to guide the identification of essential curricular content guidelines. Specificity was provided by the clearly identified steps of the model. The successful use of the model in this instance suggested that a variety of content areas emanating from multiple disciplines could be studied using this model. This reflected the flexibility of the model. The literature review was practical in this instance because the first author was knowledgeable about relevant literature from both disciplines. When this is not the case, reviewers from each discipline might be required. The model did not place boundaries or limits on the extent or depth with which the literature review was conducted. The numbers of those interviewed could vary as needed.
The process identified in the model was indeed purposeful. The steps detailed in the model kept the study on track and on task. The study progressed in a logical and organized fashion. The model indicated what needed to be addressed and helped set boundaries for the selected content area. The process language of the model was clear. The investigator and study participants were able to communicate effectively about goals and activities. Investigator perception and peer review of results served as validity and reliability checks while keeping the process both thorough and reasonable in scope.
The process described by the model was realistic to use for the type of study described here. Furthermore, it appeared that this same model realistically could be used by educators in other professional preparation programs carrying out similar curriculum research. The time and resources used in this study might not be realistic for studying a narrow content area in only one school. However, the flexibility of the model would allow more Limited implementation for smaller projects. The model as presented is most realistic for systematically addressing a particular content area in situations where knowledge has expanded significantly, professional roles have changed, or when educators or accrediting bodies need to have guidelines to assure the adequacy of curricula content to prepare students for selected areas of professional practice.
The criteria of judiciousness was met. The model provided guidance for decisions about what should constitute essential content in a selected area. The resulting guidelines described essential content that were supported by rationale. The process assured an objective approach that resulted in guidelines that were educationally sound,
Based on the above evaluation, some model adaptations were identified. First, the need for the researcher to collaborate with members of the related discipline to gain familiarity with the discipline's body of knowledge and information sources was incorporated. Second, while the use of interviews was appropriate for this study, the methodology of the second step need not be limited to interviews. Other potentially useful methods include telephone interviews, focus groups, and mailed surveys. The second step was revised to read, "Obtain input from educators and clinicians..." allowing for more flexibility in procedures. Finally, there would have been merit to building in a method to obtain a follow-up reaction from participants to the revised guidelines. This would have provided further verification for the manner in which their original comments were interpreted. The revised model was that presented in the Figure.
Summary and Conclusions
Content identification and selection are critical in curriculum development (Bevis, 1988b, 1990b; Diekelmann, 1988). Because nurses focus on people and on their healthrelated experiences, an approach is needed to achieve adequate content breadth and balance (Bevis, 1990b). This process model provides a framework for approaching curriculum development, for selecting essential curriculum content and for curriculum research.
The usefulness of the model was supported in a study to identify guidelines for essential nutrition content in nursing curricula. This model can now be tested in other content areas of nursing curricula as well as in selected content areas of other practice disciplines.
The model was developed to specifically address curriculum development in post-secondary settings, thus the result of implementation was the development of conceptual guidelines grounded in theory and research. The conceptual guidelines with appropriate rationale are an appropriate alternative to behavioral objectives in higher education. They provide curricular direction while allowing for adaptation to meet particular needs in individual curricula. Also, guidelines are more appropriate than behavioral objectives for promoting higher cognitive skills. Such guidelines are congruent with the most recent literature concerning needed changes in professional nursing curriculum development (Bevis, 1988a, 1988b, 1990a, 1990b; Diekelmann, 1988; Moccia, 1988; Woolley & Costello, 1988).
In addition to further testing in other practice disciplines, the model could also be tested when developing interdisciplinary courses. Implementing the model using alternative methodologies, such as surveys, telephone interviews, or focus groups rather than interviews, would provide information on the flexibility of the model in different situations. It would also be interesting to test whether the model is useful in the identification of essential content for graduate curricula.
The systematic, qualitative approach used to operationalize and test this model addressed Stember's (1984) concerns that nursing education research be based on curriculum theory and scientific methodologies. This process model is consistent with Schul man's (1984) views on curriculum development process and with the characteristics of disciplined inquiry. The model brings together theoretical (reviews of literature) and practical (views of educators and clinicians) aspects of curricular research, and developments that are consistent with Schwab's (1978) ideas of "bringing a principle to its case" (p. 331).
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