- Email: [email protected]
Using multiple data sources for curriculum revision
ORIGINAL ARTICLE
PH C
Using Multiple Data Sources for Curriculum Revision A r l e n e M . S p e r h a c , P h D, R N , C P N P, & L a u ra D. G o o dw i n , P h D
C
urriculum revisions have been based on guidelines and standards developed by accrediting bodies and professional organizations. At Rush University, the Pediatric Nurse Practitioner Program was recently revised, using not only the Essentials of Master’s Education for Advanced Practice Nursing (American Association of Colleges of Nursing [AACN], 1996) but also a number of other types of data. The purpose of this article is to describe the curriculum revision process at Rush University, with particular emphasis on the multiple sources of data that were used and the ways in which the various types of data informed the revisions.
ABSTRACT Traditionally, curriculum revisions have been made based primarily on guidelines and standards set forth by professional organizations that identify a core of knowledge that pediatric nurse practitioners (PNPs) must know regardless of their practice setting. However, the number and complexity of pediatric health conditions managed by PNPs have expanded beyond this core knowledge. To meet the PNP’s changing role and employment needs, curriculum revisions based on the information gathered from surveys of alumni, employers, and a national survey of PNP graduates, as well as on traditional standards and guidelines, were made. J Pediatr Health Care. (2003). 17, 169-175.
July/August 2003
BACKGROUND Traditionally, pediatric nurse practitioners (PNPs) worked in community well-child clinics, providing primary care to healthy children. Today, as a result of changes in the health care delivery system and the ability of nurse practitioners to provide high-quality care (Brown & Grimes, 1993; Christensen, Bohmer, & Kenagy, 2000; Mundinger et al., 2000), nurse practitioners are providing care to well individuals and individuals with complex health care needs in a variety of settings. These settings include acute care hospitals, emergency departments, short-stay units, specialty practices, public health clinics, private practices, and managed care facilities (Brady & Neal, 2000; Callender, 1999; Keane & Richmond, 1993; Pitts & Seimer, 1998; Sperhac & Strodtbeck, 1997, 2000).
Arlene M. Sperhac is Professor/Coordinator, Pediatric Nurse Practitioner Program, Rush University College of Nursing, Chicago, Ill. Laura D. Goodwin is Professor, School of Education, Acting Associate Vice Chancellor for Academic Affairs, and Acting Dean of the Graduate School, University of Colorado at Denver. Funded in part by a grant from the Association of Faculties of Pediatric Nurse Practitioners, Inc. Reprint requests: Arlene M. Sperhac, PhD, RN, CPNP, Rush University, 600 South Paulina St, Suite 1080, Chicago, IL 60612; e-mail: [email protected]. Copyright © 2003 by the National Association of Pediatric Nurse Practitioners. 0891-5245/2003/$30.00 + 0 doi:10.1067/mph.2003.21
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PH ORIGINAL ARTICLE C The changing role of the PNP is well documented, as evidenced by several recent studies (eg, Brady & Neal, 2000; Jackson et al., 2001). In January 2001, the National Certification Board of Pediatric Nurse Practitioners and Nurses (NCBPNP/N) sent to all PNP program directors the New PNP Test Blueprint and Outline for 2002 (NCBPNP/N, 2001), as well as the article by Brady and Neal (2000), to assist faculty members and program directors with the maintenance of high-quality programs. Practice settings and the number and complexity of pediatric health conditions managed by PNPs are expanding. It is critical that faculty members in PNP programs monitor and analyze changes in employment patterns and role functions of recent graduates to provide students with the training and education needed to develop the competencies required by today’s advanced practice roles (Jackson et al., 2001).
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cation Programs (Commission on Collegiate Nursing Education, 1998) and the Criteria for Evaluation of Nurse Practitioner Programs (National Organization of Nurse Practitioner Faculties, 1997). The Evaluation Committee, the Grad-
T
he research course now
emphasizes utilization of evidence-based practice, and the nursing theory course includes content on communication and ethical theories.
PROGRAM EVALUATION To monitor our graduates and their changes in patterns and functions, the Rush University College of Nursing (CON) utilizes a systematic approach for curriculum revision based, in part, on the evaluation of program effectiveness. The framework that guides the evaluation plan is based on the Context, Input, Process and Product model and includes program inputs, processes, products, and the context within which they occur and their interrelationships (Stufflebeam, 2000). Context evaluation examines the program’s mission, purpose, and objectives. Input evaluation delineates resources available to the program, that is, faculty, students, and resources. Process evaluation determines if the program is being implemented as planned, that is, curriculum, structure, and governance. Product evaluation focuses on the extent to which program purposes and objectives have been met relative to the needs of various accrediting and funding agencies and consumer groups. The evaluation plan is organized according to the components of the framework and identifies evaluation criteria, potential data sources, methodologies to demonstrate compliance, individuals or groups responsible for providing data, and the frequency with which criteria are reviewed. The plan reflects the Standards for Accreditation of Baccalaureate and Graduate Nursing Edu-
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uate Curriculum Committee, and the faculty involved in teaching the courses are involved in aspects of the planning and implementation of the curriculum, based on their scope of responsibilities. Program faculty review data obtained from various data sources to determine consistency with the evaluation criteria and to identify issues that should be addressed for continuous quality improvement. Data sources on program effectiveness include academic and clinical achievements; performance on end of program capstone experiences; graduation and attrition rates; performance on certification examinations; student, alumni, employer, and faculty surveys; course evaluations; faculty productivity reports; and teaching effectiveness inventories. For this curriculum revision, the PNP faculty focused on product evaluation, looking at the accrediting agencies standards, the professional organizations guidelines, and input from consumer groups.
CURRICULUM REVISIONS BASED ON DATA/INFORMATION SOURCES Curriculum revisions within the PNP program at Rush University were based primarily on three different types of data or information sources. Each will be described, below.
Essentials of Master’s Education for Advanced Practice Nursing The Essentials of Master’s Education for Advanced Practice Nursing (AACN, 1996) describes three components of the master’s curriculum: graduate nursing core, advanced practice nursing (APN) core, and specialty curriculum content. The graduate core includes foundational curriculum content considered essential for all students who seek a master’s degree in nursing. At Rush University, this core content deals with conceptual theories and models, the research process and applications, and statistics. The APN core includes advanced assessment/diagnostics, physiology/pathophysiology, pharmacology, and role content. In addition, pediatric graduate students also take courses in advanced pediatric and neonatal nursing; content included here are concepts and theories of child and family development and current topics in health care delivery to children, women, and families. The specialty curriculum content includes management courses and clinical components; the focus here is on synthesis, application, and integration of skills and knowledge acquired in the earlier parts of the program. A review of each area of concentration was undertaken using the AACN Essentials document (AACN, 1996). Faculty from each area of specialization evaluated the courses that comprised their program of study against the essential curriculum elements described. For each core competency in each content area, faculty were asked to: • Indicate in which courses the competency is addressed • Describe how the competency is addressed within the course (teaching strategy) • Describe how the competency is evaluated As a result of this review, content was deemed to be insufficient in the following areas: • Health care policy • Organization of health care delivery • Health care financing • Ethics • Human diversity and social issues The Graduate Curriculum Committee considered the advantages and disadvantages of organizing a separate course(s) to present some of this material. The Committee also reviewed existing courses in the CON to evaluate the possibility of revising the course content to
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TABLE 1 Core curriculum revisions Title/No./ credit hours
Previous courses
New courses
Title The use of concepts, models & theories in nursing practice No. NUR 501 Credit hours 3
Theoretical foundations for advanced practice NUR 501 2
Title Nursing research: critique for practice No. NUR 521 Credit hours 2
Research for advanced practice NUR 521 3
Title Biostatistics No. PVM 541 Credit hours 4
Biostatistics NUR 577A/NUR 510W 3
Title
Issues in APN role development and transition to the APN role NUR 502A and NUR 502B 2 and 2
Rose of the nurse in advanced practice
No. NUR 502 Credit hours 2 Title
No comparable course
No. NA Credit hours NA
Health promotion and disease prevention in diverse populations NUR 522 3
Title No comparable course No. NA Credit hours NA
Master’s capstone project NUR 548 1
Title Biological basis of clinical therapeutics I No. PPH 523 Credit hours 2
Advanced physiology I PHY 551 4
Title Biological basis of clinical therapeutics II No. PPH 524 Credit hours 4
Advanced pathophysiology II PPH 512 4
Title Pharmacotherapeutics: primary care No. NUR 530E Credit hours 3
Pharmacotherapeutics: Pediatric NUR 530H 2
include the needed material. As a result, the master’s curriculum for the CON and each specialty was revised (Table 1).
The AFPNP/AP Position Statement on the Education of PNPs In 1996, the Association of Faculties of Pediatric Nurse Practitioners and Associate Programs (AFPNP/AP) revised its Position Statement, Philosophy, and Conceptual Model for the Education of PNPs (AFPNP/AP, 1996). This document was the second source of inspiration and support for the curriculum revisions at Rush University. Some of the key elements of the position statement include the belief that preparation of PNPs should occur at the master’s level; that PNP programs should be run within the aegis of accredited graduatelevel nursing programs; that such programs should emphasize a balance of
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clinical and didactic components; and that nurse practitioner education should reflect the collaborative interdisciplinary and intradisciplinary relation-
A
fter the curriculum
revision, didactic components of the courses were supplemented by clinical interdisciplinary experiences.
ships that are essential to the role of the PNP. The philosophy statement includes 30 beliefs about the nature of primary child health care and the role of PNPs in providing care. The conceptual model lays out the necessary clinical and didactic content of PNP programs, and seven terminal competency areas. The PNP faculty at Rush believed the key elements were met. However, faculty believed that the education reflecting the collaborative interdisciplinary and intradisciplinary relationships essential to the role of the PNP could be better addressed. Classroom sessions focused on key concepts in interdisciplinary care and were coupled with clinical experiences in a variety of settings offering collaborative practice opportunities. After the curriculum revision, didactic components of the courses were supplemented by clinical interdis-
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PH ORIGINAL ARTICLE C ciplinary experiences. For example, the PNP faculty received a grant to provide health programs to students from the seven Academic Preparation Centers (APC) of the Chicago Public Schools. The 13- to 16-year-old students in the APC were not successful on the test that allows them to progress to the ninth grade because of problems with learning, truancy, or behavior or social problems. In the APC, exceptions are made to the rule that students who do not have school physicals and immunizations completed by October 15 not remain in school, because this would further jeopardize their chances for success. Faculty, with assistance from the Chicago Public Schools, the Rush Pediatric Adolescent Medicine Group, and with staff from the Rush Pediatric and Adolescent Primary Care Center, implemented a program to provide school physical examinations and links for needed follow-up care for the APC students. This ongoing program provides PNP students and pediatric residents with collaborative practice experiences and gives needed services to high-risk adolescents without health care in the Chicago Public School APC.
Surveys As required by the Commission on Collegiate Nursing Education Programs (1998) Standards for Accreditation of Baccalaureate and Graduate Nursing Education Programs, alumni and employer surveys are completed. The alumni and employer surveys are used to inform curriculum revisions.
Alumni surveys. Alumni are surveyed within approximately 1 and 5 years following graduation. The surveys, with return rates greater than 50%, revealed that 95% were employed within nursing within 1 year of graduation, obtaining positions within 1 to 3 months. Nearly all respondents reported that they found the types of positions sought and believed that their positions (in large inner-city or suburban hospitals, in ambulatory care/HMO/outpatient settings, and in clinic/doctor’s offices) were commensurate with their level of education. More than 90% belonged to professional organizations and 100% were engaged in continuing education activities. They reported satisfaction with their decision to attend Rush University, felt adequately pre-
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pared to evaluate theories, function as advanced practice nurses, provide clinical consultation, plan and coordinate multidisciplinary interventions, develop and monitor continuous quality improvement programs, facilitate the conduct and utilization of research, participate in the development and implementation of standards, advocate for diverse populations, and develop educational materials. The Year 2000 graduating class reported feeling slightly less prepared to utilize strategies to initiate and facilitate organizational change and to participate in the formulation of health and social policies than did graduates from previous years. These aspects were reviewed as a component of the overall graduate curriculum evaluation and were incorporated into curriculum change.
S
tudents in the PNP
survey, as well as in the alumni surveys, suggested that the College of Nursing develop course offerings in more flexible formats.
Employer survey. Along with the alumni survey at 1 and 5 years following graduation, graduates receive an employer survey and are asked to give it to their employer. Information gathered on the employer survey focuses on the criteria that are consistent with the objectives of the program. This includes information on employers’ perceptions of graduates’ skills in assessment, decision making, communication, leadership, and consultation. Some specific areas addressed include: knowledge of medical therapeutics; ability to develop standards of care and practice in a specialty area, work with diverse populations, and conduct staff/ patient education programs; participation in and/or facilitation of research and professional development; and adherence to ethical and professional
standards. Employers consistently indicate satisfaction with the quality of the PNP graduates and indicate that they would employ other graduates from our program.
Surveys of PNP graduates. The results from surveys of Rush PNP graduates for the past 2 years (1999-2000 and 20002001) were systematically incorporated into the curriculum revision process. These surveys were part of a larger national, multisite study of graduate programs that prepare PNPs (Jackson et al., 2001). The major purpose of the larger study was to describe the characteristics of the advanced practice employment as well as the role functions of recent graduates of six different PNP programs. For the 1999-00 survey, 45 questionnaires were sent to Rush graduates from the years 1996 through 1999; 21 questionnaires were returned, for a response rate of about 47%. Because of responses suggesting that nursing theory be eliminated and the focus on research be reduced, both the research and theory courses were revised to ensure that the content would be more applicable to practice. For example, the research course now emphasizes utilization of evidence-based practice, and the nursing theory course includes content on communication and ethical theories. In addition, content was added or coverage increased in the following areas: radiographic interpretation, fever management, microbiology, lactation, telephone triage skills, case studies in pharmacology and management, growth and development in healthy children, and health policy and ethics. For the 2000-01 survey, questionnaires were sent Rush graduates from 1997 through 1999; the response rate was 49%. These data also supported revision of NUR 501, Theoretical Foundations for Advanced Practice Nursing, the course that had focused on nursing theories, and now includes change theory, ethical theories, and content more applicable to practice. Other additions and changes to the curriculum that were suggested by respondents included: have recent graduates speak to students about the PNP role; add additional case studies; increase the diversity of clinical sites and preceptors; increase content on role implementation; increase coverage of behavioral disorders; increase the number of required
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PH ORIGINAL ARTICLE C clinical hours; provide more detailed orthopedic content; and add more radiology and diagnostic testing content. Some of this same content is cited in the New PNP Test Blueprint and Outline for 2002 (NCBPNP/N, 2001). Students in the PNP survey, as well as in the alumni surveys, suggested that the CON develop course offerings in more flexible formats. These suggestions supported the belief of faculty that graduate students do not need the amount of direct socialization and monitoring that undergraduate students require, and can learn via the alternative methods. In response, the Executive Committee adopted a strategic plan objective that stated that the CON would offer all academic courses that can be provided in an educationally sound and quality enhancing manner via methods that meet adult learner’s time and travel limitations. To meet this objective, groups of faculty consultants were organized—one group for each degree level. They were given the charges of reviewing all the course offerings for that degree level and recommending their suitability for delivery via alternative teaching methods (eg, Internet courses, compressed format, and nontraditional scheduling). Faculty recommended suitable courses for redesign and assigned them to one of three priority groups for development. A decision tree for determining suitability asked for consideration of such factors as timing, different formats, alternative methodologies, learning needs, faculty availability, registration, and location. These recommendations were incorporated into a planning schedule that was added to the CON strategic plan. By the end of the 2003 academic year, courses that faculty believed were best offered in alternative formats will be implemented by using the Web or a compressed format. Table 2 contains the revised PNP program of study and available course formats. Because there are students who want Web-based courses and others who need the interaction and structure found in a “live” class, many of the courses are offered in both Web-based and on-site formats, although not in the same quarter. Courses offered in both formats include physiology, pathophysiology, and biostatistics. Some courses, such as the PNP management courses (Primary Care of the Child I, II, III), are offered on-site only because fac-
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TABLE 2 Rush University College of Nursing program of study pediatric nurse practitioner MSN option Core
Quarter hours
Graduate nursing core NUR 501* Theoretical foundations for advanced practice NUR 502A† Issues in APN role development NUR 502B† Transition to the APN role NUR 503* Physical diagnosis: assessment and evaluation across the lifespan NUR 521† Research for advanced practice NUR 577A or NUR 510* Biostatistics I NUR 522† Health promotion and disease prevention in diverse populations NUR 548* Master’s capstone project Advanced practice nursing core PHY 551* Advanced physiology I PPH 512* Advanced pathophysiology II NUR 529* Advanced pharmacology NUR 530H‡ Pharmacotherapeutics: Pediatrics BHV 522‡ Child and family development throughout the lifespan NUR 505* Diagnostics for the advanced practice nurse NUR 511† Basic concepts in human lactation and breastfeeding Speciality curriculum content NUR 533A‡ Advanced practice in maternal-child nursing NUR 533F‡ Primary care of the child I NUR 533G‡ Primary care of the child II NUR 533H‡ Primary care of the child III NUR 541* Master practica NUR 600* Nurse practitioner residency
2 2 2 4 3 3 3 1 20 4 4 3 3 3 3 2 22 3 3 3 3 12 2 26 68
Total quarter hours *Web-based and on-site. †Web-based and/or compressed weekend. ‡On-site only.
ulty believe that the problem solving, discussion, and interaction are useful in helping students master the content. Faculty believed that the lactation course (Basic Concepts in Human Lactation and Breastfeeding) and the role courses (Issues in APN Role Development and Implementation of the APN Role) had content appropriate for compressed format. In the compressed courses, students are told to review the syllabus and readings on-line during the first week of the ten-week quarter so that they will be prepared for discussion during class days. The class days are then scheduled on a Friday, Saturday, and Sunday of the second or third week. Following the class days, further communication is by e-mail. Assignments are submitted on week eight or nine of the quarter via e-mail and the
student may choose to get feedback in person or by e-mail regarding their class work.
DISCUSSION OF REVISIONS IN THE PNP CURRICULUM The new PNP curriculum (Table 2) conforms to the guidelines and standards and reflects the changes in employment patterns and role functions of recent graduates found in the surveys. The courses are organized into three areas, graduate nursing core, advanced practice nursing core, and specialty curriculum content as recommended by the American Association of Colleges in Nursing (AACN, 1996).
Graduate Nursing Core The graduate nursing core courses provide the basis for advanced practice
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PH ORIGINAL ARTICLE C nursing by providing essential content on health promotion, the APN role, physical assessment, theories, statistical analysis, the research process and evidence-based practice, and the master’s capstone project. The revised graduate nursing core courses included theories, research, and biostatistics (Table 1). The theoretical foundations course, reduced from three to two credit hours, focuses on ethical, communication, and change theories and less on nursing theories because the nursing theories content is provided in undergraduate programs. The biostatistics course, reduced from four to three credit hours, emphasizes statistics used in nursing, medical, and epidemiologic research. The research course, built on the biostatistics content, has been increased by 1 credit hour to emphasize implementing change in practice and evidenced-based practice. Courses added to the curriculum include the master’s capstone project, the health promotion course, and an additional role course. For the PNP students, the capstone is implementation of an evidence-based protocol in one of their clinical settings and the presentation of this project to faculty and students. The student works with the preceptor to identify an issue in the practice that needs to be addressed. Faculty and preceptors provide input to the students during the development and implementation of the project, which may take 2 or 3 quarters to complete. Presentation of the project generally occurs during the last quarter of the student’s program of study. For the capstone project, 1 student developed and implemented a comprehensive program to address practice inconsistencies in the management of infants with diarrhea. During her clinical, the student observed that parents of infants with diarrhea were being given different treatment information depending on which PNP or pediatrician they saw in the clinic. After surveying the seven pediatricians and two PNPs in the group practice regarding their recommendations to parents, she conducted a literature search and obtained the American Academy of Pediatrics guidelines for diarrhea management. This information was disseminated to the group for discussion and consensus on a uniform approach to managing these infants was reached. The student then developed a
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parent information sheet, a practice protocol, and provided formal inservice sessions for the professional and ancillary staff regarding their use. Another student developed and implemented a comprehensive program for identifying women with postpartum depression that was implemented by a multisite pediatric practice as well as by several neighboring obstetric practices.
P
NP programs must
continue to provide students with the training and education needed to develop the competencies required by today’s advanced practice roles.
The new health promotion course includes topics such as forces influencing life style, targeting behaviors for intervention, and designing health promotion strategies for community groups. Content on health and social policy is also included. The former role course had been divided into 2 separate courses. The first role course (Issues in APN Role Development), for the beginning APN student, explores issues such as health care policy, ethics, and organization of health care delivery. The second course (Implementation of the APN Role), taken after the student has had at least four credits of clinical practice, addresses APN role implementation. Subjects such as licensing, collaborative agreements, insurance, negotiating a position, certification and models for reimbursement are covered. The students come to this compressed format class prepared to discuss the scope and standards of practice, professional organizations, and certification examinations for their area.
Advanced Practice Nursing Core The advanced practice nursing core courses consist of advanced physiology,
pathophysiology, pharmacology, diagnostics, lactation, and child and family development. The revised courses in this area included physiology, pathophysiology, and pharmacology. Physiology and pathophysiology, each four credit hours, provide a strong scientific basis for the pharmacology, diagnostics, and subsequent specialty courses. The course names reflect the content and the increase of 2 credit hours provides the time needed to cover the depth of physiology and pathophysiology content needed. Pharmacotherapeutics. Pediatrics was increased from 2 to 3 credit hours and is now focused on pediatrics rather than primary care. In this applied case study–based pharmacology course, the focus was changed from primary care to pediatrics because pediatric content in all settings is similar, while much of the content for adult primary care was not relevant for PNP students.
Specialty Content Synthesis, application, and integration of the core graduate nursing and advanced practice nursing core content occurs in the specialty content. The PNP specialty management courses and their clinical components take place in the last year of the curriculum. The first management course focuses on the guidelines for preventive pediatric primary care. Health promotion, anticipatory guidance and counseling, and management of common pediatric conditions are emphasized for children from birth through adolescence with a supporting clinical component. The subsequent two management courses address the acute and chronic health care needs and the complex physical and psychosocial issues seen in pediatrics. Although content was added to these courses, there was no change in the titles or the number of credit hours. Added to the management courses, as requested by PNP graduates, was specific content on radiographic interpretation, fever management, and telephone triage skills. Content on cultural diversity, socioeconomics, geographic and setting specific factors, health care policy and advocacy is reinforced in the management courses and the clinical seminars. The corresponding clinical for these management courses is designed for standard and individual experiences.
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PH ORIGINAL ARTICLE C Standardized clinical experiences provide students with the basic skills, such as comprehensive primary care experiences with all ages of children and with the synthesis and application of advanced skills. Students rotate through a variety of settings including community, inpatient, and outpatient with PNP and pediatrician preceptors. The students learn flexibility as they adapt to practice settings that may be urban, rural, private, and/or public. They learn to apply these experiences to meet the clinical challenges and provide care to diverse populations. Discussions with preceptors and faculty during clinical seminars assist students with this integration. Individualized clinical experiences may also be negotiated between the student, faculty, and preceptor and provide the student with an opportunity to develop expertise in a subspecialty area such as cardiology, endocrinology, and oncology.
SUMMARY Reviewing data from the various sources to determine the degree of consistency with the evaluation criteria is essential for continuous quality improvement and to monitor actions toward problem resolution. Data from multiple sources provided a product evaluation that was the basis for this curriculum revision. The revised curriculum incorporated not only
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the changes in the accrediting agencies, standards and the professional organizations’ guidelines, but the specific PNP course content was revised to reflect the changes in employment patterns and role functions of recent graduates. PNP programs must continue to provide students with the training and education needed to develop the competencies required by today’s advanced practice roles.
REFERENCES American Association of Colleges of Nursing. (1996). Essentials of master’s education for advanced practice nursing. Washington, DC: Author. Association of Faculties of Pediatric Nurse Practitioner and Associate Programs. (1996). Philosophy, conceptual model, terminal competencies for the education of pediatric nurse practitioners. Rockville, MD: Author. Brady, M. A., & Neal, J. A. (2000). Role delineation study of pediatric nurse practitioners: A national study of practice responsibilities and trends in role functions. Journal of Pediatric Health Care, 14, 140-159. Brown, S., & Grimes, D. (1993). Nurse practitioners and nurse midwives: A meta-analysis of students on nurses in primary care roles. Washington, DC: American Nurses Publishing. Callender, D. (1999). Nursery privileging for pediatric nurse practitioners. Journal of Pediatric Health Care, 13, 278-283. Christensen, C. M., Bohmer, R., & Kenagy, J. (2000). Will disruptive innovations cure health care? Harvard Business Review, 5, 102-112. Commission on Collegiate Nursing Education.
(1998). Standards for accreditation of baccalaureate and graduate nursing education programs. Washington, DC: Author. Jackson, P. L., Kennedy, C., Sadler, L. S., Kenney, K. M., Lindeke, L. L., Sperhac, A. M., et al. (2001). Professional practice of pediatric nurse practitioners: Implications for education and training of PNPs. Journal of Pediatric Health Care, 15, 291-298. Keane, A., & Richmond, T. (1993). Tertiary nurse practitioners. Image: The Journal of Nursing Scholarship, 25, 281-284. Mundinger, M. O., Kane, R. L., Lenz, E. R., Totten, A. M., Tsai, W., Cleary, P. D., et al. (2000). Primary care outcomes in patients treated by nurse practitioners or physicians: A randomized trial. Journal of the American Medical Association, 283, 59-68. National Certification Board of Pediatric Nurse Practitioners and Nurses. (2001). New PNP test blueprint and outline for 2002. Gaithersburg, MD: Author. National Organization of Nurse Practitioner Faculties. (1997). Criteria for evaluation of nurse practitioner programs. Washington, DC: Author Pitts, J., & Seimer, B. (1998). The use of nurse practitioners in pediatric institutions. Journal of Pediatric Health Care, 12, 67-72. Sperhac, A., & Strodtbeck, F. (1997). Advanced practice nursing: New opportunities for blending roles. Maternal Child Nursing, 22, 287293. Sperhac, A., & Strodtbeck, F. (2000). Advanced practice in pediatric nursing: Blending roles. Journal of Pediatric Nursing, 16, 120-126. Stufflebeam, D. E. (2000). The CIPP Model for Evaluation. In D. L. Stufflebeam, G. F. Madaus, & T. Kellaghan, (Eds.), Evaluation models: Viewpoints on educational and human services evaluation (2nd ed., pp. 279-317). Boston: Kluwer Academic Publishers.
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Using Multiple Data Sources for Curriculum Revision A r l e n e M . S p e r h a c , P h D, R N , C P N P, & L a u ra D. G o o dw i n , P h D
C
urriculum revisions have been based on guidelines and standards developed by accrediting bodies and professional organizations. At Rush University, the Pediatric Nurse Practitioner Program was recently revised, using not only the Essentials of Master’s Education for Advanced Practice Nursing (American Association of Colleges of Nursing [AACN], 1996) but also a number of other types of data. The purpose of this article is to describe the curriculum revision process at Rush University, with particular emphasis on the multiple sources of data that were used and the ways in which the various types of data informed the revisions.
ABSTRACT Traditionally, curriculum revisions have been made based primarily on guidelines and standards set forth by professional organizations that identify a core of knowledge that pediatric nurse practitioners (PNPs) must know regardless of their practice setting. However, the number and complexity of pediatric health conditions managed by PNPs have expanded beyond this core knowledge. To meet the PNP’s changing role and employment needs, curriculum revisions based on the information gathered from surveys of alumni, employers, and a national survey of PNP graduates, as well as on traditional standards and guidelines, were made. J Pediatr Health Care. (2003). 17, 169-175.
July/August 2003
BACKGROUND Traditionally, pediatric nurse practitioners (PNPs) worked in community well-child clinics, providing primary care to healthy children. Today, as a result of changes in the health care delivery system and the ability of nurse practitioners to provide high-quality care (Brown & Grimes, 1993; Christensen, Bohmer, & Kenagy, 2000; Mundinger et al., 2000), nurse practitioners are providing care to well individuals and individuals with complex health care needs in a variety of settings. These settings include acute care hospitals, emergency departments, short-stay units, specialty practices, public health clinics, private practices, and managed care facilities (Brady & Neal, 2000; Callender, 1999; Keane & Richmond, 1993; Pitts & Seimer, 1998; Sperhac & Strodtbeck, 1997, 2000).
Arlene M. Sperhac is Professor/Coordinator, Pediatric Nurse Practitioner Program, Rush University College of Nursing, Chicago, Ill. Laura D. Goodwin is Professor, School of Education, Acting Associate Vice Chancellor for Academic Affairs, and Acting Dean of the Graduate School, University of Colorado at Denver. Funded in part by a grant from the Association of Faculties of Pediatric Nurse Practitioners, Inc. Reprint requests: Arlene M. Sperhac, PhD, RN, CPNP, Rush University, 600 South Paulina St, Suite 1080, Chicago, IL 60612; e-mail: [email protected]. Copyright © 2003 by the National Association of Pediatric Nurse Practitioners. 0891-5245/2003/$30.00 + 0 doi:10.1067/mph.2003.21
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PH ORIGINAL ARTICLE C The changing role of the PNP is well documented, as evidenced by several recent studies (eg, Brady & Neal, 2000; Jackson et al., 2001). In January 2001, the National Certification Board of Pediatric Nurse Practitioners and Nurses (NCBPNP/N) sent to all PNP program directors the New PNP Test Blueprint and Outline for 2002 (NCBPNP/N, 2001), as well as the article by Brady and Neal (2000), to assist faculty members and program directors with the maintenance of high-quality programs. Practice settings and the number and complexity of pediatric health conditions managed by PNPs are expanding. It is critical that faculty members in PNP programs monitor and analyze changes in employment patterns and role functions of recent graduates to provide students with the training and education needed to develop the competencies required by today’s advanced practice roles (Jackson et al., 2001).
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cation Programs (Commission on Collegiate Nursing Education, 1998) and the Criteria for Evaluation of Nurse Practitioner Programs (National Organization of Nurse Practitioner Faculties, 1997). The Evaluation Committee, the Grad-
T
he research course now
emphasizes utilization of evidence-based practice, and the nursing theory course includes content on communication and ethical theories.
PROGRAM EVALUATION To monitor our graduates and their changes in patterns and functions, the Rush University College of Nursing (CON) utilizes a systematic approach for curriculum revision based, in part, on the evaluation of program effectiveness. The framework that guides the evaluation plan is based on the Context, Input, Process and Product model and includes program inputs, processes, products, and the context within which they occur and their interrelationships (Stufflebeam, 2000). Context evaluation examines the program’s mission, purpose, and objectives. Input evaluation delineates resources available to the program, that is, faculty, students, and resources. Process evaluation determines if the program is being implemented as planned, that is, curriculum, structure, and governance. Product evaluation focuses on the extent to which program purposes and objectives have been met relative to the needs of various accrediting and funding agencies and consumer groups. The evaluation plan is organized according to the components of the framework and identifies evaluation criteria, potential data sources, methodologies to demonstrate compliance, individuals or groups responsible for providing data, and the frequency with which criteria are reviewed. The plan reflects the Standards for Accreditation of Baccalaureate and Graduate Nursing Edu-
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uate Curriculum Committee, and the faculty involved in teaching the courses are involved in aspects of the planning and implementation of the curriculum, based on their scope of responsibilities. Program faculty review data obtained from various data sources to determine consistency with the evaluation criteria and to identify issues that should be addressed for continuous quality improvement. Data sources on program effectiveness include academic and clinical achievements; performance on end of program capstone experiences; graduation and attrition rates; performance on certification examinations; student, alumni, employer, and faculty surveys; course evaluations; faculty productivity reports; and teaching effectiveness inventories. For this curriculum revision, the PNP faculty focused on product evaluation, looking at the accrediting agencies standards, the professional organizations guidelines, and input from consumer groups.
CURRICULUM REVISIONS BASED ON DATA/INFORMATION SOURCES Curriculum revisions within the PNP program at Rush University were based primarily on three different types of data or information sources. Each will be described, below.
Essentials of Master’s Education for Advanced Practice Nursing The Essentials of Master’s Education for Advanced Practice Nursing (AACN, 1996) describes three components of the master’s curriculum: graduate nursing core, advanced practice nursing (APN) core, and specialty curriculum content. The graduate core includes foundational curriculum content considered essential for all students who seek a master’s degree in nursing. At Rush University, this core content deals with conceptual theories and models, the research process and applications, and statistics. The APN core includes advanced assessment/diagnostics, physiology/pathophysiology, pharmacology, and role content. In addition, pediatric graduate students also take courses in advanced pediatric and neonatal nursing; content included here are concepts and theories of child and family development and current topics in health care delivery to children, women, and families. The specialty curriculum content includes management courses and clinical components; the focus here is on synthesis, application, and integration of skills and knowledge acquired in the earlier parts of the program. A review of each area of concentration was undertaken using the AACN Essentials document (AACN, 1996). Faculty from each area of specialization evaluated the courses that comprised their program of study against the essential curriculum elements described. For each core competency in each content area, faculty were asked to: • Indicate in which courses the competency is addressed • Describe how the competency is addressed within the course (teaching strategy) • Describe how the competency is evaluated As a result of this review, content was deemed to be insufficient in the following areas: • Health care policy • Organization of health care delivery • Health care financing • Ethics • Human diversity and social issues The Graduate Curriculum Committee considered the advantages and disadvantages of organizing a separate course(s) to present some of this material. The Committee also reviewed existing courses in the CON to evaluate the possibility of revising the course content to
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TABLE 1 Core curriculum revisions Title/No./ credit hours
Previous courses
New courses
Title The use of concepts, models & theories in nursing practice No. NUR 501 Credit hours 3
Theoretical foundations for advanced practice NUR 501 2
Title Nursing research: critique for practice No. NUR 521 Credit hours 2
Research for advanced practice NUR 521 3
Title Biostatistics No. PVM 541 Credit hours 4
Biostatistics NUR 577A/NUR 510W 3
Title
Issues in APN role development and transition to the APN role NUR 502A and NUR 502B 2 and 2
Rose of the nurse in advanced practice
No. NUR 502 Credit hours 2 Title
No comparable course
No. NA Credit hours NA
Health promotion and disease prevention in diverse populations NUR 522 3
Title No comparable course No. NA Credit hours NA
Master’s capstone project NUR 548 1
Title Biological basis of clinical therapeutics I No. PPH 523 Credit hours 2
Advanced physiology I PHY 551 4
Title Biological basis of clinical therapeutics II No. PPH 524 Credit hours 4
Advanced pathophysiology II PPH 512 4
Title Pharmacotherapeutics: primary care No. NUR 530E Credit hours 3
Pharmacotherapeutics: Pediatric NUR 530H 2
include the needed material. As a result, the master’s curriculum for the CON and each specialty was revised (Table 1).
The AFPNP/AP Position Statement on the Education of PNPs In 1996, the Association of Faculties of Pediatric Nurse Practitioners and Associate Programs (AFPNP/AP) revised its Position Statement, Philosophy, and Conceptual Model for the Education of PNPs (AFPNP/AP, 1996). This document was the second source of inspiration and support for the curriculum revisions at Rush University. Some of the key elements of the position statement include the belief that preparation of PNPs should occur at the master’s level; that PNP programs should be run within the aegis of accredited graduatelevel nursing programs; that such programs should emphasize a balance of
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clinical and didactic components; and that nurse practitioner education should reflect the collaborative interdisciplinary and intradisciplinary relation-
A
fter the curriculum
revision, didactic components of the courses were supplemented by clinical interdisciplinary experiences.
ships that are essential to the role of the PNP. The philosophy statement includes 30 beliefs about the nature of primary child health care and the role of PNPs in providing care. The conceptual model lays out the necessary clinical and didactic content of PNP programs, and seven terminal competency areas. The PNP faculty at Rush believed the key elements were met. However, faculty believed that the education reflecting the collaborative interdisciplinary and intradisciplinary relationships essential to the role of the PNP could be better addressed. Classroom sessions focused on key concepts in interdisciplinary care and were coupled with clinical experiences in a variety of settings offering collaborative practice opportunities. After the curriculum revision, didactic components of the courses were supplemented by clinical interdis-
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PH ORIGINAL ARTICLE C ciplinary experiences. For example, the PNP faculty received a grant to provide health programs to students from the seven Academic Preparation Centers (APC) of the Chicago Public Schools. The 13- to 16-year-old students in the APC were not successful on the test that allows them to progress to the ninth grade because of problems with learning, truancy, or behavior or social problems. In the APC, exceptions are made to the rule that students who do not have school physicals and immunizations completed by October 15 not remain in school, because this would further jeopardize their chances for success. Faculty, with assistance from the Chicago Public Schools, the Rush Pediatric Adolescent Medicine Group, and with staff from the Rush Pediatric and Adolescent Primary Care Center, implemented a program to provide school physical examinations and links for needed follow-up care for the APC students. This ongoing program provides PNP students and pediatric residents with collaborative practice experiences and gives needed services to high-risk adolescents without health care in the Chicago Public School APC.
Surveys As required by the Commission on Collegiate Nursing Education Programs (1998) Standards for Accreditation of Baccalaureate and Graduate Nursing Education Programs, alumni and employer surveys are completed. The alumni and employer surveys are used to inform curriculum revisions.
Alumni surveys. Alumni are surveyed within approximately 1 and 5 years following graduation. The surveys, with return rates greater than 50%, revealed that 95% were employed within nursing within 1 year of graduation, obtaining positions within 1 to 3 months. Nearly all respondents reported that they found the types of positions sought and believed that their positions (in large inner-city or suburban hospitals, in ambulatory care/HMO/outpatient settings, and in clinic/doctor’s offices) were commensurate with their level of education. More than 90% belonged to professional organizations and 100% were engaged in continuing education activities. They reported satisfaction with their decision to attend Rush University, felt adequately pre-
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pared to evaluate theories, function as advanced practice nurses, provide clinical consultation, plan and coordinate multidisciplinary interventions, develop and monitor continuous quality improvement programs, facilitate the conduct and utilization of research, participate in the development and implementation of standards, advocate for diverse populations, and develop educational materials. The Year 2000 graduating class reported feeling slightly less prepared to utilize strategies to initiate and facilitate organizational change and to participate in the formulation of health and social policies than did graduates from previous years. These aspects were reviewed as a component of the overall graduate curriculum evaluation and were incorporated into curriculum change.
S
tudents in the PNP
survey, as well as in the alumni surveys, suggested that the College of Nursing develop course offerings in more flexible formats.
Employer survey. Along with the alumni survey at 1 and 5 years following graduation, graduates receive an employer survey and are asked to give it to their employer. Information gathered on the employer survey focuses on the criteria that are consistent with the objectives of the program. This includes information on employers’ perceptions of graduates’ skills in assessment, decision making, communication, leadership, and consultation. Some specific areas addressed include: knowledge of medical therapeutics; ability to develop standards of care and practice in a specialty area, work with diverse populations, and conduct staff/ patient education programs; participation in and/or facilitation of research and professional development; and adherence to ethical and professional
standards. Employers consistently indicate satisfaction with the quality of the PNP graduates and indicate that they would employ other graduates from our program.
Surveys of PNP graduates. The results from surveys of Rush PNP graduates for the past 2 years (1999-2000 and 20002001) were systematically incorporated into the curriculum revision process. These surveys were part of a larger national, multisite study of graduate programs that prepare PNPs (Jackson et al., 2001). The major purpose of the larger study was to describe the characteristics of the advanced practice employment as well as the role functions of recent graduates of six different PNP programs. For the 1999-00 survey, 45 questionnaires were sent to Rush graduates from the years 1996 through 1999; 21 questionnaires were returned, for a response rate of about 47%. Because of responses suggesting that nursing theory be eliminated and the focus on research be reduced, both the research and theory courses were revised to ensure that the content would be more applicable to practice. For example, the research course now emphasizes utilization of evidence-based practice, and the nursing theory course includes content on communication and ethical theories. In addition, content was added or coverage increased in the following areas: radiographic interpretation, fever management, microbiology, lactation, telephone triage skills, case studies in pharmacology and management, growth and development in healthy children, and health policy and ethics. For the 2000-01 survey, questionnaires were sent Rush graduates from 1997 through 1999; the response rate was 49%. These data also supported revision of NUR 501, Theoretical Foundations for Advanced Practice Nursing, the course that had focused on nursing theories, and now includes change theory, ethical theories, and content more applicable to practice. Other additions and changes to the curriculum that were suggested by respondents included: have recent graduates speak to students about the PNP role; add additional case studies; increase the diversity of clinical sites and preceptors; increase content on role implementation; increase coverage of behavioral disorders; increase the number of required
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PH ORIGINAL ARTICLE C clinical hours; provide more detailed orthopedic content; and add more radiology and diagnostic testing content. Some of this same content is cited in the New PNP Test Blueprint and Outline for 2002 (NCBPNP/N, 2001). Students in the PNP survey, as well as in the alumni surveys, suggested that the CON develop course offerings in more flexible formats. These suggestions supported the belief of faculty that graduate students do not need the amount of direct socialization and monitoring that undergraduate students require, and can learn via the alternative methods. In response, the Executive Committee adopted a strategic plan objective that stated that the CON would offer all academic courses that can be provided in an educationally sound and quality enhancing manner via methods that meet adult learner’s time and travel limitations. To meet this objective, groups of faculty consultants were organized—one group for each degree level. They were given the charges of reviewing all the course offerings for that degree level and recommending their suitability for delivery via alternative teaching methods (eg, Internet courses, compressed format, and nontraditional scheduling). Faculty recommended suitable courses for redesign and assigned them to one of three priority groups for development. A decision tree for determining suitability asked for consideration of such factors as timing, different formats, alternative methodologies, learning needs, faculty availability, registration, and location. These recommendations were incorporated into a planning schedule that was added to the CON strategic plan. By the end of the 2003 academic year, courses that faculty believed were best offered in alternative formats will be implemented by using the Web or a compressed format. Table 2 contains the revised PNP program of study and available course formats. Because there are students who want Web-based courses and others who need the interaction and structure found in a “live” class, many of the courses are offered in both Web-based and on-site formats, although not in the same quarter. Courses offered in both formats include physiology, pathophysiology, and biostatistics. Some courses, such as the PNP management courses (Primary Care of the Child I, II, III), are offered on-site only because fac-
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TABLE 2 Rush University College of Nursing program of study pediatric nurse practitioner MSN option Core
Quarter hours
Graduate nursing core NUR 501* Theoretical foundations for advanced practice NUR 502A† Issues in APN role development NUR 502B† Transition to the APN role NUR 503* Physical diagnosis: assessment and evaluation across the lifespan NUR 521† Research for advanced practice NUR 577A or NUR 510* Biostatistics I NUR 522† Health promotion and disease prevention in diverse populations NUR 548* Master’s capstone project Advanced practice nursing core PHY 551* Advanced physiology I PPH 512* Advanced pathophysiology II NUR 529* Advanced pharmacology NUR 530H‡ Pharmacotherapeutics: Pediatrics BHV 522‡ Child and family development throughout the lifespan NUR 505* Diagnostics for the advanced practice nurse NUR 511† Basic concepts in human lactation and breastfeeding Speciality curriculum content NUR 533A‡ Advanced practice in maternal-child nursing NUR 533F‡ Primary care of the child I NUR 533G‡ Primary care of the child II NUR 533H‡ Primary care of the child III NUR 541* Master practica NUR 600* Nurse practitioner residency
2 2 2 4 3 3 3 1 20 4 4 3 3 3 3 2 22 3 3 3 3 12 2 26 68
Total quarter hours *Web-based and on-site. †Web-based and/or compressed weekend. ‡On-site only.
ulty believe that the problem solving, discussion, and interaction are useful in helping students master the content. Faculty believed that the lactation course (Basic Concepts in Human Lactation and Breastfeeding) and the role courses (Issues in APN Role Development and Implementation of the APN Role) had content appropriate for compressed format. In the compressed courses, students are told to review the syllabus and readings on-line during the first week of the ten-week quarter so that they will be prepared for discussion during class days. The class days are then scheduled on a Friday, Saturday, and Sunday of the second or third week. Following the class days, further communication is by e-mail. Assignments are submitted on week eight or nine of the quarter via e-mail and the
student may choose to get feedback in person or by e-mail regarding their class work.
DISCUSSION OF REVISIONS IN THE PNP CURRICULUM The new PNP curriculum (Table 2) conforms to the guidelines and standards and reflects the changes in employment patterns and role functions of recent graduates found in the surveys. The courses are organized into three areas, graduate nursing core, advanced practice nursing core, and specialty curriculum content as recommended by the American Association of Colleges in Nursing (AACN, 1996).
Graduate Nursing Core The graduate nursing core courses provide the basis for advanced practice
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PH ORIGINAL ARTICLE C nursing by providing essential content on health promotion, the APN role, physical assessment, theories, statistical analysis, the research process and evidence-based practice, and the master’s capstone project. The revised graduate nursing core courses included theories, research, and biostatistics (Table 1). The theoretical foundations course, reduced from three to two credit hours, focuses on ethical, communication, and change theories and less on nursing theories because the nursing theories content is provided in undergraduate programs. The biostatistics course, reduced from four to three credit hours, emphasizes statistics used in nursing, medical, and epidemiologic research. The research course, built on the biostatistics content, has been increased by 1 credit hour to emphasize implementing change in practice and evidenced-based practice. Courses added to the curriculum include the master’s capstone project, the health promotion course, and an additional role course. For the PNP students, the capstone is implementation of an evidence-based protocol in one of their clinical settings and the presentation of this project to faculty and students. The student works with the preceptor to identify an issue in the practice that needs to be addressed. Faculty and preceptors provide input to the students during the development and implementation of the project, which may take 2 or 3 quarters to complete. Presentation of the project generally occurs during the last quarter of the student’s program of study. For the capstone project, 1 student developed and implemented a comprehensive program to address practice inconsistencies in the management of infants with diarrhea. During her clinical, the student observed that parents of infants with diarrhea were being given different treatment information depending on which PNP or pediatrician they saw in the clinic. After surveying the seven pediatricians and two PNPs in the group practice regarding their recommendations to parents, she conducted a literature search and obtained the American Academy of Pediatrics guidelines for diarrhea management. This information was disseminated to the group for discussion and consensus on a uniform approach to managing these infants was reached. The student then developed a
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parent information sheet, a practice protocol, and provided formal inservice sessions for the professional and ancillary staff regarding their use. Another student developed and implemented a comprehensive program for identifying women with postpartum depression that was implemented by a multisite pediatric practice as well as by several neighboring obstetric practices.
P
NP programs must
continue to provide students with the training and education needed to develop the competencies required by today’s advanced practice roles.
The new health promotion course includes topics such as forces influencing life style, targeting behaviors for intervention, and designing health promotion strategies for community groups. Content on health and social policy is also included. The former role course had been divided into 2 separate courses. The first role course (Issues in APN Role Development), for the beginning APN student, explores issues such as health care policy, ethics, and organization of health care delivery. The second course (Implementation of the APN Role), taken after the student has had at least four credits of clinical practice, addresses APN role implementation. Subjects such as licensing, collaborative agreements, insurance, negotiating a position, certification and models for reimbursement are covered. The students come to this compressed format class prepared to discuss the scope and standards of practice, professional organizations, and certification examinations for their area.
Advanced Practice Nursing Core The advanced practice nursing core courses consist of advanced physiology,
pathophysiology, pharmacology, diagnostics, lactation, and child and family development. The revised courses in this area included physiology, pathophysiology, and pharmacology. Physiology and pathophysiology, each four credit hours, provide a strong scientific basis for the pharmacology, diagnostics, and subsequent specialty courses. The course names reflect the content and the increase of 2 credit hours provides the time needed to cover the depth of physiology and pathophysiology content needed. Pharmacotherapeutics. Pediatrics was increased from 2 to 3 credit hours and is now focused on pediatrics rather than primary care. In this applied case study–based pharmacology course, the focus was changed from primary care to pediatrics because pediatric content in all settings is similar, while much of the content for adult primary care was not relevant for PNP students.
Specialty Content Synthesis, application, and integration of the core graduate nursing and advanced practice nursing core content occurs in the specialty content. The PNP specialty management courses and their clinical components take place in the last year of the curriculum. The first management course focuses on the guidelines for preventive pediatric primary care. Health promotion, anticipatory guidance and counseling, and management of common pediatric conditions are emphasized for children from birth through adolescence with a supporting clinical component. The subsequent two management courses address the acute and chronic health care needs and the complex physical and psychosocial issues seen in pediatrics. Although content was added to these courses, there was no change in the titles or the number of credit hours. Added to the management courses, as requested by PNP graduates, was specific content on radiographic interpretation, fever management, and telephone triage skills. Content on cultural diversity, socioeconomics, geographic and setting specific factors, health care policy and advocacy is reinforced in the management courses and the clinical seminars. The corresponding clinical for these management courses is designed for standard and individual experiences.
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PH ORIGINAL ARTICLE C Standardized clinical experiences provide students with the basic skills, such as comprehensive primary care experiences with all ages of children and with the synthesis and application of advanced skills. Students rotate through a variety of settings including community, inpatient, and outpatient with PNP and pediatrician preceptors. The students learn flexibility as they adapt to practice settings that may be urban, rural, private, and/or public. They learn to apply these experiences to meet the clinical challenges and provide care to diverse populations. Discussions with preceptors and faculty during clinical seminars assist students with this integration. Individualized clinical experiences may also be negotiated between the student, faculty, and preceptor and provide the student with an opportunity to develop expertise in a subspecialty area such as cardiology, endocrinology, and oncology.
SUMMARY Reviewing data from the various sources to determine the degree of consistency with the evaluation criteria is essential for continuous quality improvement and to monitor actions toward problem resolution. Data from multiple sources provided a product evaluation that was the basis for this curriculum revision. The revised curriculum incorporated not only
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the changes in the accrediting agencies, standards and the professional organizations’ guidelines, but the specific PNP course content was revised to reflect the changes in employment patterns and role functions of recent graduates. PNP programs must continue to provide students with the training and education needed to develop the competencies required by today’s advanced practice roles.
REFERENCES American Association of Colleges of Nursing. (1996). Essentials of master’s education for advanced practice nursing. Washington, DC: Author. Association of Faculties of Pediatric Nurse Practitioner and Associate Programs. (1996). Philosophy, conceptual model, terminal competencies for the education of pediatric nurse practitioners. Rockville, MD: Author. Brady, M. A., & Neal, J. A. (2000). Role delineation study of pediatric nurse practitioners: A national study of practice responsibilities and trends in role functions. Journal of Pediatric Health Care, 14, 140-159. Brown, S., & Grimes, D. (1993). Nurse practitioners and nurse midwives: A meta-analysis of students on nurses in primary care roles. Washington, DC: American Nurses Publishing. Callender, D. (1999). Nursery privileging for pediatric nurse practitioners. Journal of Pediatric Health Care, 13, 278-283. Christensen, C. M., Bohmer, R., & Kenagy, J. (2000). Will disruptive innovations cure health care? Harvard Business Review, 5, 102-112. Commission on Collegiate Nursing Education.
(1998). Standards for accreditation of baccalaureate and graduate nursing education programs. Washington, DC: Author. Jackson, P. L., Kennedy, C., Sadler, L. S., Kenney, K. M., Lindeke, L. L., Sperhac, A. M., et al. (2001). Professional practice of pediatric nurse practitioners: Implications for education and training of PNPs. Journal of Pediatric Health Care, 15, 291-298. Keane, A., & Richmond, T. (1993). Tertiary nurse practitioners. Image: The Journal of Nursing Scholarship, 25, 281-284. Mundinger, M. O., Kane, R. L., Lenz, E. R., Totten, A. M., Tsai, W., Cleary, P. D., et al. (2000). Primary care outcomes in patients treated by nurse practitioners or physicians: A randomized trial. Journal of the American Medical Association, 283, 59-68. National Certification Board of Pediatric Nurse Practitioners and Nurses. (2001). New PNP test blueprint and outline for 2002. Gaithersburg, MD: Author. National Organization of Nurse Practitioner Faculties. (1997). Criteria for evaluation of nurse practitioner programs. Washington, DC: Author Pitts, J., & Seimer, B. (1998). The use of nurse practitioners in pediatric institutions. Journal of Pediatric Health Care, 12, 67-72. Sperhac, A., & Strodtbeck, F. (1997). Advanced practice nursing: New opportunities for blending roles. Maternal Child Nursing, 22, 287293. Sperhac, A., & Strodtbeck, F. (2000). Advanced practice in pediatric nursing: Blending roles. Journal of Pediatric Nursing, 16, 120-126. Stufflebeam, D. E. (2000). The CIPP Model for Evaluation. In D. L. Stufflebeam, G. F. Madaus, & T. Kellaghan, (Eds.), Evaluation models: Viewpoints on educational and human services evaluation (2nd ed., pp. 279-317). Boston: Kluwer Academic Publishers.
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