Conceptual Learning in Nursing Education:
How to transition to a
concept-based curriculum
and evaluate its success
Transitioning to a
Concept-Based Curriculum
There are numerous benefits to using a concept-based curriculum, but the transition takes a great deal of planning and effort to be carried out effectively. Here are some steps you can take to make the transition process as smooth and successful as possible:
Moving to a concept-based curriculum has numerous benefits for students and faculty. But not surprisingly, switching to a new curriculum requires additional work and responsibility up front.

The first step is for faculty and administrators to determine if the program is ready to take on a new curriculum. Do faculty have time to attend workshops and meetings about the new curriculum on top of their existing workload? If the answer is yes, administrators will need to focus their initial efforts on helping faculty understand why the conceptual approach is needed, what it is, and how it will be developed at the institution. Here are some considerations and tips for accomplishing this:
  • Faculty may be resistant to the change due to a fear of losing control over the way they have taught material for years. Faculty may also cite that the current way they teach is already successful.
  • Administrators need to be prepared to combat resistance by educating faculty on all the benefits that a concept-based curriculum offers students and, eventually, every faculty member.
  • Underscore that when faculty are not consistently using the conceptual, learner-centered approach, students will become confused and frustrated, making the education disconnected.
  • To help make the transition as easy as possible for faculty, consider partnering with Elsevier Education. Our team of educators can help faculty understand the advantages of conceptual learning, and show them how to best implement a concept-based model in their course.
Choosing the concepts for a curriculum can be a daunting task. But it is a very important one. Initially, it may be helpful to find out what concepts are currently being used by other nursing schools. Another good starting point is to explore the concepts found in notable nursing books, such as Jean Giddens' Concepts for Nursing Practice, and use those as a framework for building your concept-based curriculum.

Once faculty have identified a list of potential concepts, it is time to pare that list down to a constructive amount of concepts that will cover your program's unique needs. When evaluating potential concepts, make sure to consider a concept's difficulty level, the unique makeup of your student body, and current nursing practice standards.

Choosing and defining the concepts may lead to some conflict at times. To try and avoid this, implement a pre-defined process for choosing the concepts and share it with the group up front. This will help group members work through any emotions and conflicts that might arise.
There are two rules of thumb when choosing your exemplars: choose the exemplars that best represent the concept, and avoid using an excessive number of exemplars.

Choose the exemplars that best represent the concept.
  • Use those conditions with the highest incidence and prevalence.
  • The Centers for Disease Control and Prevention (CDC) is a helpful starting point to identify priority exemplars.
Avoid using an excessive number of exemplars.
  • When too many exemplars are used, students are once again faced with content saturation and lose sight of the concept.
  • Because faculty are used to a curriculum flooded with content, they might initially feel that too much content has been removed from the curriculum. However, once students begin to apply the concepts to a number of new exemplars,even those not explicitly covered in the classroom, the effectiveness of a concept-based curriculum will be realized.
To help prevent never-ending changes that can emerge when developing a concept-based curriculum (a process that can lend itself to a “too many cooks in the kitchen” situation), make sure to assemble a core group of faculty and administration to lead the curricular change.
  • The core group should be deeply involved and educated in all aspects of a concept-based curriculum.
  • Core group members should also be authorized to make decisions on a program-wide level versus an individual course level.
  • The core group may also include an outside consultant, such as an Elsevier Academic Consultant, who can provide objectivity and guidance to faculty and administration.
  • Departments that provide support courses must also be involved, and may be part of the core group.
The core group's job is to lead faculty and administration in developing the concepts, competencies, and exemplars across the curriculum. Click here to download a printable poster outlining the steps of developing a concept-based curriculum.

Appointing a small group to make the final curriculum decisions will provide more consistency, direction, and progress in the overall curriculum development process, as it will help reduce unwanted overlap or omission of key exemplars and competencies.
Once the curriculum framework is designed, both classroom and clinical pedagogy changes must occur. When changing to a concept-based curriculum, educational models should shift from a teacher-centered environment to a learner-centered environment.

Faculty will need time to experiment and become comfortable with using learner-centered activities. Some faculty will likely be uncomfortable with the change and fearful of negative student evaluations as the change in pedagogy occurs. Here are some tips to combat this:
Depending on the unique situation and needs of an institution, it may be helpful to gradually transition to the concept-based approach in clinical simulations.
  • Prior to clinical simulation, give students a study guide specific to a concept. The study guide will direct reading, data collection, and performance of a focused assessment.
  • During the clinical simulation, you may assign students a specific patient. However, to provide a point of comparison, you should also have students perform a focused assessment for 1-3 additional patients, looking for potential or actual alterations in the assigned concept.
  • The student will then present what was learned at the end of the clinical day.
In this situation, a student may still receive an individual patient assignment, but the focus of learning is on key points of the assigned concept for that round of simulation. In this way a transition from skill and task-based learning can occur gradually, allowing all key players to understand and trust the new approach.

Using the conceptual approach in the clinical setting and assessing multiple patients helps students better understand that not every patient will demonstrate every possible alteration of the concept. This approach helps students develop solid assessment skills and build a strong foundation for clinical judgment.
The above content has been summarized from Janine L. Dailey's white paper on
The Concept-Based Curriculum: Key Points for a Transition.
Click here to download the full-length white paper.

How to Evaluate a
Concept-Based Curriculum

Evaluation of a new concept-based curriculum should be an ongoing process. Student retention, success, and ultimately, NCLEX® exam pass rates will quantifiably demonstrate the effectiveness of the transition to a concept-based curriculum.

Elsevier has a number of testing options available to help evaluate the success of your institution's concept-based curriculum.

Some of the key outcomes that these tests quantifiably measure include:
  • How well do students understand each of the nursing concepts?
  • Are students able to apply concepts to specific patient situations and content areas?
  • Are students demonstrating stronger assessment and clinical judgment skills?
  • Are students demonstrating a deeper understanding of the essential aspects of nursing practice?
  • Are students prepared to pass the NCLEX© exam?

Beyond the quantitative evaluations that Elsevier testing options can provide, administrators should also incorporate qualitative studies in determining the success of their new curriculum. Faculty members and students should be surveyed at different points throughout the curriculum to obtain further insights into the curriculum's success.

Some areas you should aim to monitor in your surveys include:
  • Do students feel they have a better grasp of nursing practice?
    • Are they able to see the “big picture” when it comes to patient care?
    • Are they noticing the varied ways in which patients present the alterations or potential alterations of the concepts?
    • Do they view medications, interventions, and treatments as combined efforts rather than individual unrelated actions?
    • Do they understand that not every patient will demonstrate every possible alteration of the concept?
  • Are faculty witnessing stronger assessment and clinical judgment skills in their students?
  • What are some of the specific successes that faculty have encountered with the new curriculum?
  • What are some of the obstacles?

Employer and clinical site surveys are another helpful evaluative tool that can monitor the curriculum's success beyond the classroom.

Ultimately, administrators should employ various methods of evaluating the success of a concept-based curriculum. Once data is collected, administrators should continue to make modifications to ensure student learning outcomes are continually improving.

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