Journal of Nursing Education

Educational Innovations 

Master of Science in Nursing and Doctor of Nursing Practice Clinical Curriculum Map

Terri Fowler, DNP, APRN, FNP-C; Ruth Conner, PhD, APRN, FNP-BC; Whitney Smith, DNP, APRN, AGNP-C

Abstract

Background:

The development of a comprehensive and structured clinical curriculum map can outline the specific content covered throughout a nurse practitioner program and provide a method for identifying redundancy and omissions in the didactic clinical content.

Method:

A curriculum map outlining the specific clinical content covered in each didactic course in a Master of Science in Nursing and Doctor of Nursing Practice advanced practice program was created. The curriculum map incorporated accreditation standards, certification testing domains, and common primary care diagnoses.

Results:

A curriculum map supported the development of organized, consistent, and transparent clinical didactic content across courses and the program. The curriculum map allows for frequent curriculum and course review and updates to help meet program and accreditation standards.

Conclusion:

The development and implementation of the clinical didactic curriculum map facilitates the integration of core clinical content in an organized manner that builds learning and prepares future nurse practitioners. [J Nurs Educ. 2018;57(7):440–445.]

Abstract

Background:

The development of a comprehensive and structured clinical curriculum map can outline the specific content covered throughout a nurse practitioner program and provide a method for identifying redundancy and omissions in the didactic clinical content.

Method:

A curriculum map outlining the specific clinical content covered in each didactic course in a Master of Science in Nursing and Doctor of Nursing Practice advanced practice program was created. The curriculum map incorporated accreditation standards, certification testing domains, and common primary care diagnoses.

Results:

A curriculum map supported the development of organized, consistent, and transparent clinical didactic content across courses and the program. The curriculum map allows for frequent curriculum and course review and updates to help meet program and accreditation standards.

Conclusion:

The development and implementation of the clinical didactic curriculum map facilitates the integration of core clinical content in an organized manner that builds learning and prepares future nurse practitioners. [J Nurs Educ. 2018;57(7):440–445.]

With increasing demands for qualified nurse practitioners (NPs), faculty in Master of Science Nursing in Nursing (MSN) and Doctor of Nursing Practice (DNP) programs are expanding and transitioning from traditional on-campus learning models to online teaching. With these changes, the question becomes, how do faculty map clinical curriculum and incorporate the appropriate content areas without duplication and omission of key subject matter? The development of a comprehensive and structured clinical curriculum map can outline the specific content covered throughout the program and provide a method for identifying redundancy and omissions.

The curriculum map was initially developed in the 1980s, and faculty have modified curriculum mapping throughout health care programs to meet the evolving needs of students and faculty (Harden, 2001). A curriculum map provides a complete overview of the program, content including assessment of the content, and serves as an organized approach to curriculum design and ongoing quality improvement. Use of curriculum mapping allows faculty to facilitate critical didactic content that complements students' clinical experiences and supports the development of a strong knowledge base that informs their decision making skills. Most literature on curriculum mapping focuses on medical and pharmacy curricula (Harden, 2001; Kelley, McAuley, Wallace, & Frank, 2008); however, the concept is applicable and beneficial to nursing programs. The purpose of this article is to discuss the strategic steps implemented to construct an effective clinical curriculum map for NP students and to provide a guide that other NP programs may replicate.

Background

At a college of nursing within an academic health center, students in the Family Nurse Practitioner track were completing more didactic and practicum hours than other NP tracks (e.g., Adult-Gerontology and Pediatric Primary Care) due to separate adult and pediatric clinical courses. To provide the same didactic and practicum hours and receive the necessary content in all tracks (Adult-Gerontology, Family, and Pediatric Primary Care), the online MSN/DNP program underwent a major curriculum revision. Mirroring the nonclinical courses, the faculty also wanted to increase interdisciplinary collaboration by having the various MSN/DNP tracks learning from and about each other within each clinical course. During the revision process, a committee of MSN/DNP clinical faculty identified the need for a central repository or database outlining the specific curriculum covered in each clinical course and whether the content covered met accreditation standards (American Association of Colleges of Nursing, 2006, 2011), and certification requirements. In addition, the committee also found duplication and gaps in the clinical curriculum. Without a map or outline, faculty found it difficult to verify the extent of content gaps and duplications. Therefore, a curriculum map that faculty implemented provided clear and organized identification of all content in each individual clinical course, including the content covered, duplications, and gaps. The remainder of this article outlines the six steps for building a curriculum map.

Process of Building a Curriculum Map

Decide Which Area of the Curriculum to Map

Revising the MSN/DNP curriculum from isolated, population-focused courses into integrated interdisciplinary courses was difficult due to a lack of transparency of the specific content being taught in each individual clinical course. Curriculum mapping provided a visual and allowed for quick identification of the content covered and needed within each course. Faculty focused on the portion of the curriculum where it is unclear what content is being taught in individual courses and how the content in each course aligns with other courses and the program objectives to meet accreditation standards.

Complete a Curriculum Needs Assessment

Prior to mapping content or making curriculum changes, the committee identified and reviewed the curricular requirements to meet accreditation standards. The Commission on Collegiate Nursing Education (2013) accreditation requires incorporation of the American Association of College of Nursing Essentials of Master's Education in Nursing (2011) and Essentials of Doctoral Education for Advanced Nursing Practice (2016), the National Task Force Criteria for Evaluation of Nurse Practitioner Programs, and The National Organization of Nurse Practitioner Faculties (2017) Nurse Practitioner Core Competencies Content. In addition to the accreditation standards, the committee included the certification program testing domains to ensure the clinical content prepared graduates for certifying boards and entry-level practice. Finally, the committee reviewed the Interprofessional Education Collaborative (2016) to ensure inclusion of key interprofessional domains, as well as Quality and Safety Education for Nurses (2012) competencies focused on quality and safety (Table 1).

Clinical Course Objectives and Accreditation Standards

Table 1:

Clinical Course Objectives and Accreditation Standards

After reviewing the curricular requirements, the committee identified specific content areas essential to the clinical curriculum:

  • Common episodic, chronic medical, behavioral, and psychosocial conditions.
  • Pathophysiology and pharmacotherapy related to specific medical, behavioral, and psychosocial conditions.
  • Health promotion and disease prevention.
  • Social determinants of health and health disparities.
  • Palliative care and ethics.
  • Demographics: age, gender, race, and ethnicity.

The content areas provided a means to organize and categorize the specific clinical content. For example, when mapping the current clinical content to these areas, it was apparent that health promotion was part of the curriculum in several courses; however, ethics and palliative care needed a more primary focus in the clinical curriculum. The committee used Microsoft Excel® to design the curriculum map, dividing the spreadsheet into sections based on each clinical course (Table 2). Each row contained information about each learning module, with a total of six learning modules per course. Each course section included columns for the content areas of demographics, diagnoses, pathophysiology, and pharmacology. The secondary diagnoses columns included health promotion, social determinants of health, palliative care, and ethics.

Clinical Curriculum Map Templatea

Table 2:

Clinical Curriculum Map Template

Map Current Curriculum

The committee reviewed each clinical course to identify the specific content covered in the learning modules. Discussions, readings, online minilectures, and other resources support the educational experience for students. The content from each course, learning modules, and supporting learning materials was mapped to the six content areas noted above. Using a practical, visual approach, faculty first wrote each topic (medical condition and diagnoses, pharmacotherapy, health promotion, etc.) covered in each learning module and on-campus learning intensive on sticky notes and placed them on a wall to visually represent where content was covered within the course and within the program (Table 3). Organizing the content in a curriculum map illuminated the areas of duplications, gaps, and improvements. For example, faculty covered the chief complaint of sore throat and acute diagnoses associated with a sore throat in multiple learning modules with significant duplication, but content focused on ethics and palliative care was lacking in the current curriculum.

Current Curriculum Mapa,b

Table 3:

Current Curriculum Map,

Map New Curriculum

Identifying the necessary clinical content areas and mapping the current curriculum gave faculty easy access to areas of improvement, gaps, and duplication. The map showed redundancies for the faculty to eliminate. For example, mapping the curriculum revealed multiple areas in the adult and pediatric clinical courses focused on an acute sore throat. Because of this insight, faculty identified the best sore throat learning module and removed duplicate content. Next, faculty made an extensive list of all the diagnoses and clinical topics necessary based on the certification program outlines, National Ambulatory Medical Care Survey (U.S. Department of Health and Human Services, 2013), and Typhon annual reports (Typhon is an online student clinical tracking software used by NP students to log all patients evaluated in clinical). The college of nursing has used the Typhon program exclusively for every primary care NP student during the past 15 years; therefore, the Typhon reports on the most common diagnoses logged by students serves as an accurate resource for identifying the most common clinical diagnoses in primary care. After outlining a list of key diagnoses and clinical topics, the committee placed the current curriculum content in juxtaposition to highlight content currently covered and not covered in the clinical curriculum. The committee then inserted current content and additional needed content into the curriculum map (Table 4). The map enabled faculty to strategically place instruction into clinical courses beginning with low-complexity diagnoses and clinical issues and building on difficulty as the course progressed. Subsequent clinical courses continued to build on complexity with curriculum progressing from low- to high-complexity clinical decision making. For example, the first learning module in the first clinical course is a young adult presenting with an acute onset of sore throat. By the final learning modules in the last clinical course, students are focusing on complex cases, such as cardiac valve disease, heart failure, complex pediatric congenital diagnoses, and palliative care.

New Curriculum Mapa

Table 4:

New Curriculum Map

Implement Curriculum Changes

After the new curriculum map was complete, the course content had to be revised to reflect the curriculum map. Therefore, faculty had to ensure the learning modules incorporated the content outlined in the curriculum map. Faculty reviewed learning modules from the current curriculum and updated them to align with the map. Faculty then identified current content that did not align with the curriculum map and revised the content or new learning modules to match the curriculum map. For example, the current curriculum did not include lower extremity edema and the associated diagnoses, highlighting important missing content based on the curriculum needs assessment. Faculty developed a new learning module focused on lower extremity edema.

Updating and developing the learning modules required additional faculty time; however, because MSN/DNP faculty led the curriculum map development, they saw implementing the curriculum changes as opportunities to improve teaching and learning. With administrative support, two faculty members collaborated to update or develop the content in each module to match the curriculum map. To facilitate completion of the curriculum revision, the committee set deadlines in advance of the actual implementation of the new content. Faculty then placed the updated or developed modules in secure, online file storage easily accessed by all MSN/DNP faculty. The clinical course coordinators were then responsible for uploading and embedding the content into the specific online clinical courses.

Evaluation

Ongoing review of the curriculum map and clinical courses is essential to ensure that they comply with the frequent updates of evidence-based guidelines, practice, and program competencies. The clinical curriculum map provides faculty and administration complete transparency on what specific clinical content is being taught and its location within the program of study, allowing for a quick and easy full clinical content review and update on an Excel spreadsheet. To ensure completion of the review, the lead faculty for each NP track must review the curriculum map and program standards at least annually to identify necessary updates and revisions. The course coordinators and faculty for each clinical course review the course content and curriculum map prior to and during each course to ensure that content aligns with the curriculum map. For example, 1 year after completing the curriculum map and updating the clinical courses, lead faculty members recognized the need to enhance content regarding behavioral health in primary care. They updated current behavioral health content for consistency and comprehensiveness, providing students with the opportunity to learn about the common behavioral health diagnoses and management in primary care.

Opportunities and Challenges

The use of a clinical curriculum map provides an organized approach to curriculum development and continued transparency in the content covered within each course and across the NP program. After implementing the curriculum map, faculty identified additional opportunities and ways in which a curriculum map can support and strengthen the NP program curriculum. In addition to outlining what, when, and where content is covered, the curriculum map provides a method to outline the specific evaluation methods to ensure that learners are meeting the objectives for the content areas. For example, connecting evaluation methods such as multiple choice test, SOAP notes, or objective structured clinical examinations with clinical content areas to assist in aligning the curriculum, learning objectives, assessment, and outcomes. The curriculum map can also be implemented in all courses, not just clinical courses. Although this NP program implemented a curriculum map for clinical courses, any program or course can integrate the map to ensure all students are well prepared. For example, the college of nursing is integrating curriculum mapping in nonclinical DNP courses focused on the development, implementation, and evaluation of the DNP project. The map will ensure the DNP curriculum incorporates the DNP Essentials and strategically aligns courses and course content to build the knowledge and skills students need to demonstrate practice scholarship and complete a final DNP project.

An additional opportunity to enhance the accessibility and utility of the curriculum map is to transition the map from a manually populated Excel spreadsheet to an electronic curriculum database designed for easy entry, organization, and display of curriculum content (Harden, 2001). An online interactive platform will allow for easy review, edits, and updates to the curriculum map. An online system will also provide student access to the curriculum map that may enhance transparency, highlighting the key topics that receive emphasis in the program, and the way clinical content builds learning throughout the program. Students would then have the opportunity to critically evaluate and provide feedback on the alignment of the curriculum map to the actual content taught in the courses.

Educating faculty on the purpose of curriculum mapping to identify key content areas and competencies and to streamline course and program curriculum is important to demonstrate value and gain faculty buy-in. Identifying a faculty champion to help lead the development of a curriculum map also enhances faculty engagement. To assist with successful implementation, challenges to consider include faculty's readiness for change, workload, and willingness to engage in collaborative curriculum development. Because curriculum mapping in nursing is not as well published compared to other health professions, faculty may not be aware of or appreciate the value of curriculum mapping. Faculty may also be hesitant to buy in because of the initial additional faculty time outside of teaching workload required to carefully evaluate the curriculum, accreditation, and competency standards. Finally, because the process of developing a curriculum map promotes curricular transparency and requires faculty to share what is being taught in their courses, some faculty may perceive these changes as challenges to teaching autonomy and hesitate to disclose course content (Harden, 2001). Therefore, institutional support is necessary to facilitate faculty involvement and adoption of the curriculum map and to ensure curriculum mapping becomes the basis for all program curriculum (Harden, 2001). Also critical to successful implementation is institutional support to allocate appropriate faculty time to develop and maintain the curriculum map and provide faculty with sufficient access to technical support for assistance in creating and maintaining this living document.

Conclusion

Looking toward the future as NP programs expand enrollment and more students require external clinical experiences, faculty in academic institutions are charged with ensuring that their curricula provides essential core clinical content. The straightforward and transparent nature of the curriculum map, along with faculty collaboration and communication, ensures that faculty teach students the intended curriculum in an organized manner that builds learning across the program. Curriculum mapping provides a dynamic, accessible, and proactive solution for ensuring curriculum is transparent and reflects the essential competencies for all NP students.

References

Clinical Course Objectives and Accreditation Standards

Clinical Course Objectives
Integrate theoretical perspectives, evidence-based knowledge for the management of common episodic and chronic conditions.
Apply knowledge of specific diseases and symptom complexes to the assessment, diagnosis, and management of common episodic, chronic, and comorbid behavioral illnesses, including pharmacological management, applying emerging genetic and genomic evidence.
Apply appropriate communication models in the transmission of health assessment findings and their interpretation to clients, their families and caregivers, and other professionals.
Use community resources as an adjunct to care in the management of common episodic and chronic conditions.
Apply ethical principles when formulating solutions to complex health care issues.
Devise strategies for lifelong learning that build upon a personal philosophy of nursing, professional standards, and accountability for practice.
AACN DNP/MSN EssentialsaNONPF NP Core CompetenciesaQSEN CompetenciesaIPEC Core Competencies IP Practicea
MSN Essential I (1, 2, 4)Scientific foundation (1, 2, 3)Quality (1 to 3)Value and ethics (1 to 10)
MSN Essential III (1, 5, 6, 7)Leadership (3, 6)Safety (2, 3, 4, 7, 8)Roles and responsibilities (1 to 9)
MSN Essential IV (1, 3 to 6)Quality (1, 2, 4)Teamwork and collaboration (1 to 11, 13)IP communication (1 to 8)
MSN Essential VIII (1 to 5)Practice inquiry (3, 4, 6)Patient-centered care (1 to 11)Team and teamwork (1 to 11)
MSN Essential IX (1 to 15)Technology and information literacy (2, 3)Evidence-based practice (2 to 5, 7, 9)
Policy (1)Informatics (5 to 7)
DNP Essential III (1)Health delivery system (3, 7)
DNP Essential VII (1)Ethics (1 to 3)
DNP Essential VIII (1 to 7)Independent practice (2 to 4)

Clinical Curriculum Map Templatea

Family Nurse Practitioner CurriculumClinical Course OneClinical Course Two

Primary DxSecondary DxSystemDrug ClassLecture SeriesIntensivePrimary Dx
Learning module 1System: age, gender, ethnicity, chief complaint, primary DxSecondary Dx (including health promotion, SDOH, palliative care, ethics)Pathophysiology by systemPharmacology by drug classAdditional lecture/content developed by faculty to facilitate student learningOn-campus learning intensive focused on complex clinical content and a skills/competency check offSystem: age, gender, ethnicity, chief complaint, primary Dx
Learning module 2System: age, gender, ethnicity, chief complaint, primary DxSecondary Dx (including health promotion, SDOH, palliative care, ethics)Pathophysiology by systemPharmacology by drug classAdditional lecture/content developed by faculty to facilitate student learningOn-campus learning intensive focused on complex clinical content and a skills/competency check offSystem: age, gender, ethnicity, chief complaint, primary Dx

Current Curriculum Mapa,b

Family Nurse Practitioner CurriculumClinical Course OneClinical Course Two

Primary DxSecondary DxSystemDrug ClassLecture SeriesIntensivePrimary Dx
Learning module 1HEENT, 17-year-old Hispanic woman, sore throat (GABHS/Viral Pharyngitis)ADHDHEENT, neurologic, psychiatricAntiinfective, analgesic, neurologicCommon HEENT Dx, ADHD Dx and managementCommon chronic disease, DM I/II, HTN/HLD/CADGU 38-year-old White woman, dysuria (UTI/gonococcal cervicitis)
Learning module 2Respiratory, 22-year-old White man, cough (Viral URI/Acute Bronchitis)HTN, tobacco useHEENT, respiratory cardiovascularAnalgesic, antiinfective, respiratory, cardiovascularCommon DDx adult/pediatric cough, common HEENT Dx, hypertension guidelinesCommon chronic disease, DM I/II, HTN/HLD/CADHEENT/GI, 63 year-old African American woman sore throat (allergic rhinitis /viral URI)

New Curriculum Mapa

Family Nurse Practitioner CurriculumClinical Course OneClinical Course Two


Primary DxSecondary DxSystemDrug ClassLecture SeriesIntensivePrimary Dx
Learning module 1HEENT, 17-year-old Hispanic woman, sore throat (GABHS/viral pharyngitis)ADHD, sexually active, oral contraceptionHEENT, neurologic, psychiatric, GU/reproAntiinfective, analgesic, neurologic, endocrineCommon HEENT Dx, ADHD Dx and management, contraception managementCommon chronic disease, DM I/II, HTN/HLD/CADGU, 38-year-old White woman, dysuria (UTI/gonococcal cervicitis)
Learning module 2Respiratory, 31-year-old White man, cough (asthma exacerbation/influenza)HTN, tobacco use, Veteran, PTSDHEENT, respiratory, cardiovascular, psychiatricAnalgesic, antiinfective, respiratory, cardiovascular, psychiatricCommon DDx adult/peds cough, PTSD for primary care provider, hypertension guidelinesCommon chronic disease, DM I/II, HTN/HLD/CADHEENT/GI, 63-year-old African American woman, chest pain (stable angina/GERD)
Authors

Dr. Fowler is Assistant Professor, Dr. Conner is Assistant Professor, and Dr. Smith is Instructor, College of Nursing, Medical University of South Carolina, Charleston, South Carolina.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

The authors thank Dr. Gigi Smith, the Executive Associate Dean for Academics, and the MSN/DNP faculty at the Medical University of South Carolina for their dedication and contributions to the program curriculum.

Address correspondence to Terri Fowler, DNP, APRN, FNP-C, Assistant Professor, College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street, MSC 160, Charleston, SC 29492; e-mail: fowlerte@musc.edu.

Received: June 24, 2017
Accepted: March 06, 2018

10.3928/01484834-20180618-11

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