Concept-Based Nursing Curriculum

With so much activity in nursing education around concept-based curricular redesign, nursing educators across the United States were recently asked to provide feedback on the status of concept-based learning in their nursing programs. More than 700 nurse educators responded to the survey that showed approximately 36% of instructors are already teaching in a concept-based program. Of the remaining respondents, 48% of programs indicated they are considering integrating a concept-based curriculum into their classroom.

The benefits of a concept-based curriculum (CBC) are starting to become more and more apparent. One of the major benefits to this pedagogy is the idea that CBC meets the needs of nursing students to know content and use critical thinking skills to apply that content.

Noteworthy Data from the Research
Statistics from the report indicate that more and more nursing programs are moving towards concept-based curricula, that redesigns can take multiple years to fully implement, and that instructors have reported a mixed comfort level with the impact the new curriculum has had on the content they teach. Faculty new to teaching this format could benefit from learning about my experience and hearing my recommendations for a successful implementation.

Results include:

  • More than 60% of administrators at the schools surveyed said that they plan to introduce concept-based curriculum within the next 36 months.
  • Almost 50% of teachers reported that it took one to two years to fully redesign their course using concept-based approaches.
  • Over 40% of instructors surveyed reported that they are somewhat or very comfortable with the impact the new curriculum has had on the content they teach.
  • Thirty-one percent reported feeling very or somewhat uncomfortable with the new curriculum’s impact. Twenty-eight percent reported a neutral impact.

What is Concept-based Curriculum?
In my Health-Illness Concepts class at Forsyth Technical Community College (Forsyth Tech) in Winston-Salem, N.C., the integration of CBC has led to student success in the form of higher test scores on the NCLEX™ exam, and improved critical thinking skills. At Forsyth Tech, 72 nursing students per semester took the required, five-credit course, which teaches students how to provide safe nursing care as it relates to such concepts as infection; stress and coping; fluid, electrolyte and acid-base balance; metabolism; teaching and learning, and therapeutic communication.

Before we dig into the case study, it is important to describe the concept-based curriculum approach. According to H. Lynn Erickson, CBC designer and former instructor, “CBC frames factual content and skills with disciplinary concepts, generalizations, and principles. It contrasts with the traditional two dimensional model of topic-based curriculum that focuses on factual content and skills with assumed rather than deliberate attention to the development of conceptual understanding and the transfer of knowledge.” CBC translates to a curriculum built around central concepts within the domains of individual, healthcare, and nursing. These are taught with an emphasis on the interconnectedness of those concepts throughout a person’s life, and are illustrated via clarifying exemplars.

“Concept-based models create mental bridges between factual knowledge and conceptual understanding. Students are more able to integrate their thinking as they relate facts to organizing concepts, link new knowledge to prior knowledge, and achieve deeper levels of understanding.”1 Today, nurses must transfer their knowledge to new situations to stay current with new disorders, treatments, and evidence-based practices. A concept-based approach helps students achieve these goals. In it, students participate actively, assume more responsibility for their knowledge, integrate concepts, apply information, and use clinical reasoning. Instead of memorizing thousands of alterations, students gain in-depth knowledge of selected alterations, and learn how to apply that knowledge as new challenges and client presentations come their way.

What Does a Concept-Based Approach Consist Of?
The move towards the integration of CBC was partially spurred by the fact that in 2010, nursing classrooms in North Carolina were mandated to introduce this approach to their curricula. The mandate was motivated by a desire to streamline current content and to increase programmatic success rates. To accomplish these goals, my colleagues and I partnered with Pearson to provide concept-based course content and technologies specifically designed for use in a concept-based curriculum. Those unique resources better enabled the move away from content oversaturation and towards the interconnectedness of concepts.

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In my classroom, we group course content into modules by concept (rather than by body systems or individual courses), and follow a consistent format for content presentation. Students find most information about a topic in one place, and foundational materials are presented just once in a course and then reinforced via in-depth and active-learning activities that get built upon in subsequent courses. I cite case studies during lecture and students then prepare for simulations by completing pre-simulation activities comprising brief questions related to those same case studies. Most activities are followed by debriefing sessions in which students share and further explore their learning. The sessions enable students to recognize patient differences and similarities through the lens of specific content, such as nutrition, terminal illness, and pain. I also promote the use of games and movies that incorporate nursing skills (e.g., leadership) and class activities that provide real-time application of course concepts.

I want to emphasize, that not all of the material from the previous curriculum is covered in the new, concept-based curriculum. Industry-wide assessment shows that nursing education is experiencing content saturation, and the same amount of content should not be covered. Instead, during class, students cover fewer diseases and disorders; the time gained is used for active-learning exercises and the development of clinical reasoning skills.

Many expected average NCLEX sores to decline after the implementation of CBC, because less content is taught, but that has not been the case. State scores remained fairly steady, showing slightly higher scores than the national average. To date, 2014 Forsyth Tech scores average 16 percentage points higher than the national average: 99% compared with 83%. The scores of Forsyth Tech Associate Degree Nursing (ADN) graduates increased by 10 percentage points: 86% before implementation, 96% after.

The Student Experience

Although course success is ultimately measured by NCLEX scores, other successful student patterns have emerged. Because students are given more review work prior to lecture, there has been an increase in preparedness and engagement in lectures. I have also noticed improvements in critical thinking from the curriculum’s new, interactive, clinical-judgment activities.

Recommendations for Programs in the Midst of a Redesign
The process of implementing a concept-based curriculum requires instructors to rethink how they teach in the classroom. For this curriculum format to be successful, instructors must embrace the change and recognize that additional content shouldn’t be added. Faculty must agree that bringing additional content to the curriculum is unacceptable and that for the good of the program, areas of personal specialty should not be permitted, included, or covered. By participating in workshops that share strategies for success, instructors can better prepare to teach the curriculum and are more able to appropriately evaluate students using the new format.

To learn more about concept-based curriculum, download the Forsyth Technical Community College case study or view the new infographic in its entirety.

1. Erickson, Lynn H. “Concept-Based Teaching and Learning.” International Baccalaureate, 2012. Retrieved from

Sue Ellen Miller is lead nursing instructor, Forsyth Technical Community College in Winston-Salem, N.C.

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