This twelve month study was undertaken by a research team based at University College Suffolk and aimed to compare the learning outcomes and content of pre and post registration nursing degrees. Curriculum doccuments from 50 pre and post registration degree programmes from 32 instutions were catalogued and coded for descriptive characteristics. A subset of 15 doccuments was subject to in-depth analysis. This subset was selected to reflect the characteristics of the main sample of doccuments. The Research Highlights outline the context in which this study was undertaken and presents summaries of both the descriptive , and categorical data and the findings of the indepth analysis. Finally, the major implications of these findings are summarised

Leamon, Jen

Robinson, Jill

English

Bournemouth University Research Online

r e s e a r c hH I G H L I G H T ST H I RT Y- E I G H TJULY 1999Research Team MembersProject Director: Dr. JillRobinson, Centre for AppliedResearch in Education,University of East Anglia,formerly of University CollegeSuffolkProject Researcher: JenLeamon, BournemouthUniversity, formerly of UniversityCollege SuffolkSteering Group Professor Helen Simons (Chair),University of SouthamptonHamza Aumeer, EducationOfficer, English National BoardSonia Crow, Assistant Directorfor Education Policy (Research& Development), EnglishNational BoardDr. Kate Gerrish, SeniorResearch Fellow, SheffieldHallam UniversityBev Labbett, Lecturer inEducation, University of EastAngliaEnglish National Boardfor Nursing, Midwiferyand Health VisitingVictory House170 Tottenham Court RoadLondon W1P 0HATelephone: 0207 388 3131Fax: 0207 383 4031A Documentary Analysis of Nursing Degree Curricula AbstractThis 12 month study was undertaken by a research team based atUniversity College Suffolk and aimed to compare the learningoutcomes and content of pre- and post-registration nursing degrees.Curriculum documents from 50 pre- and post-registration degreeprogrammes from 32 institutions were catalogued and coded fordescriptive characteristics. A subset of 15 documents was subject toin-depth analysis. This subset was selected to reflect thecharacteristics of the main sample of documents. The Re s e a r c hHighlights outline the context in which this study was undertakenand present summaries of both the descriptive, and categorical dataand the findings of the in-depth analysis. Fi n a l l y, the majorimplications of these findings are summarised. rMain Findings1. ContextThe recent proliferation in nursing degrees over the last 10 years has occurred against a backdropof changes both in practice and in higher education. The NHS reforms (DoH, 1990) created newdemands on the skills needed for practice with increasing emphasis on management, leadershipand research. Promotion of lifelong learning and continuing professional development (ENB, 1994;UKCC, 1994) have extended the market for a broader range of post-registration qualifications.Lastly the implementation of Project 2000 heralded the integration of nurse education into HigherEducation Institutions which were themselves also subject to major changes. Further information For copies of the ResearchHighlights and the Report,please contact:ENBPublications DepartmentVictory House170 Tottenham Court RoadLondon W1P 0HADr. Jill Robinson, Centre forApplied Research inEducation, University ofEast Anglia, NorwichNR4 7TJjill.robinson@uea.ac.ukR E S E A R C HH I G H L I G H T SPublished byEnglish NationalBoard for Nursing,Midwifery andHealth VisitingJuly 1999© English National Board forNursing, Midwifery andHealth VisitingThis 12 month project was commissioned by the English National Board forNursing, Midwifery and Health Visiting and was undertaken between May 1997and June 1998. Its findings contribute to wider philosophical debates about thekind of knowledge and structures which underpin degrees in nursing and theextent to which nursing degrees prepare students with the specific professionalknowledge and competence required to support advance level practice.Details about the ProjectBenner P. (1984) From Novice to Expert: Excellence and Power in Clinical Nursing Practice,Menlo Park, California: Addison-WesleyBloom B. (Ed) (1956) Taxonomy of Educational Objectives, Book One, Cognitive Domain,London: LongmanDoH (1990) The NHS & Community Care ActENB (1994) Creating Lifelong Learners: Partnerships for Care, London: English National Boardfor Nursing, Midwifery and Health VisitingHEQC (1997) Graduate Standards Programme: Final Report, Vol. 1, London: Higher EducationQuality CouncilSteinaker N. and Bell M. (1979) The Experiential Taxonomy - A New Approach to Teaching andLearning, New York: Academic PressUKCC (1994) The Future of Professional Practice - the Councils Standards for Education andPractice following Registration , London: United Kingdom Central Council for Nursing,Midwifery and Health VisitingWinter (1993) “The problem of education levels (part 1): conceptualising a framework forcredit accumulation and transfer”, Journal of Further and Higher Education 3 90-103ReferencesTable 1: Title of awardTable 2: Shared LearningTable 3: Credit RatingTable 4: Features of graduateness* Credits per module for each course has been identified as the credit value most frequently attached to modules within one course.** Not all course documents provided both total hours per module and contact hours per module.rH I G H L I G H T SBachelorofNursingBachelorofScienceBachelorofArtsTotalsTitle of awardType of coursePre-registrationPost-registration withHigher AwardPost-registrationTotals41161491437412722111750Pre-reg courses Post-reg courses Higher AwardSharing with:Other nursesMidwivesPAMsDoctorsNon-health prof. students201051517950796100Credits/module*1-4 credits 5 credits 10 credits 12 credits 15 credits 20 credits Complex UnknownNumbercoursesn=3 n=4 n=6 n=5 n=10 n=11 n=2 n=11Hrs/modulewhereprovided**Notionalworkloadbased onsummativeassessmentof theoryTotal hours permodule rangefrom 90-160Ranges from2000 wordassessment to2000 word +examNo timeequivalentsgiven indocumentsavailable2000-5000wordassignmentsTotal hoursrange from75-180Contact hours20-401500-3000 wdassignment ora combinationof assignmentand examTotal hoursrange from90-120Contact hours30-402000-5000wordassignmentTotal hoursrange from120-150Contact hours25-451500-6000words orcombination ofassignmentand examTotal hoursrange from150-225Contact hours36-802000-5000wordassignment orcombination ofexam/essay orportfolioCourses withwide variationof credit valuesfor eachmoduleEither not clearin thedocuments ordocumentmakesreference toinstitutionalpaper which isnot availableConceptCompetenceManaging changeCreativity, innovation &leadershipCriticalityCaring and reflective practiceResearch-based practiceUsed as an overarching concept to describe the complex and varied skills demandedat this level.The flexibility to cope with the changing nature of practice and changes in location ofcare. A recognition of the need to develop new skills.Ability to do things in new and creative ways in a context which is unpredictable andvariable. In post-reg courses often combined with concepts of leadership and skillsrequired for resource management.The ability to take a critical stance to information and experiences. Being able tohandle conflicting ideas and data.These two concepts often portrayed together as a way of re-conceptualising caringpractices as graduate level activity.Level of research activity/engagement was frequently the means by which coursesarticulated the difference between graduate and non-graduate course outcomes.Representation in curriculum documents20997-3 ENB Research 38  4/1/0  11:25 am  Page 1These changes included increasing diversity incourse provision, modularisation, credit ratingand sector unification. Research focussing onU K graduate standards found a lack ofcomparability generally in UK undergraduateprovision, that employers had difficultyunderstanding the purposes of HigherEducation and that there was a need to enhancecommon understandings and standards inassessment processes (HEQC, 1997). Our studywas therefore part of a much wider debateabout the comparability of UK degrees ingeneral.2. Characteristics of CurriculumDocumentsThirty-two institutions participated in the studyand provided a total of 50 courses leading to theaward of a degree in nursing. This total wasdistributed across three main types of course inthe following way:• 22 pre-registration degrees• 11 post-registration degrees with HigherAward• 17 post-registration degrees (non HigherAward)There was wide diversity in the range andnature of information provided in curriculumdocuments. The extent of variation in terms ofstyle and content was more than we hadanticipated and comparisons betweendocuments were therefore difficult to make.Some examples from the data highlight the wayin which courses varied in relation to somesimple descriptive variables. Table 1 shows therange of variation in title of award for eachmajor category of course. There did not appearto be any consistent relationship between titleof award and type of degree although the titleBachelor of Nursing was used only for coursesoffered within old universities which had a longhistory of offering degrees in nursing.Table 2 shows the extent of shared learningover 5 different categories of student. Mostshared learning appeared to be with studentsfrom other nursing courses or with midwiferystudents but there were a number of courseswhich claimed to encourage sharing withstudents outside nursing.There was considerable variation in the way inwhich credit frameworks were structured.Table 3 shows the variation for modules ofdifferent credit values. For example, six courseshad predominantly 10 credit modules. Withinthese six courses, a ten credit module couldrange from 75 to 180 total learning hours, 20-40hours of formal contact and were assessed byassignments which ranged from 1500 to 3000words or by a combination of assignment andexamination. So courses were not onlystructured around basic modules of differingcredit value, but there was also littleconsistency across courses of the notional valueof credits in terms of teaching, learning andassessment.Through an analysis of course structure 5pathway models were constructed todemonstrate the range of variation in structurein terms of progression, opportunities forshared learning and choice. The models rangedfrom a relatively simple structure withsequential progression and limitedopportunities for shared learning or pathwaychoice, through to highly complex structureswith multiple pathways and a range of possibleoutcomes. The most complex structures wereonly found within post-registrationprogrammes.The findings which were generated from the in-depth analysis of a subset of 15 documentsfocussed primarily on an examination of theintended aims and learning outcomes of coremodules. These findings are presented hereunder the following headings:• discourses of level and progression• discourses of graduateness• discourses of practice and assessment3. Discourses of level andprogressionWhat was most apparent in the curriculumdocuments studied, was the almost universaluse of level descriptors originating fromBloom’s Taxonomy (Bloom, 1956). This waseither explicitly referenced or implicitlyrevealed in the terminology used. These leveldescriptors were often linked in some way tothe experiential taxonomy of Steinaker and Bell(1979) or Benner (1984) particularly in relationto the way in which students were expected torH I G H L I G H T S• there was a common emphasis on flexibilityof delivery in post-registration courses.7. Summary of the ways in whichdocuments were not comparable• there was considerable variation in whetheror not practical skills were assessed by directobservation, particularly apparent in post-registration degrees.• there was variation across the sample inwhether or not courses went beyond basiclevels of competence in their assessment ofpractice.• there were fundamental differences in theway courses were structured.• there was a lack of comparability in the wayin which the 360 credits of a degreeprogramme were distributed throughout itsvarious components.• there was no sense of a common currencyrelating to credits in terms of either notionallearning time or student achievement.• there was variation in whether or notstudents were expected to carry outempirical research within their dissertation.• there was considerable variation in theinformation which was presented incurriculum documents, both in terms of theamount and type of information and its styleof presentation.• the complexity of offering multiple pathwaysthrough a single course framework createdconsiderable variation in post-registrationcourses.8. Developmental implicationsOur research suggests that, in relation todegrees in general there is a need to:• develop mechanisms for sharing goodpractice across institutions which encouragemovement away from an industrial secrecymodel of protecting curriculum documents,towards one based on collaboration andcommon aspirations.• gather empirical evidence about therelationship between the level descriptorsused in curriculum documents, and students’actual progression towards degree outcomes.• improve the currency and clarity of coursedocumentation. This could be achievedthrough some standardisation of courseinformation to be submitted in the annualmonitoring and review process.In relation to nursing degrees specifically, thereis a need:• for professional and statutory bodies to workwith the QAA to ensure that nursing is fullyrepresented in debates about thresholdstandards and quality assurance.• for standards relating to the HE sectorgenerally, to apply equally to degrees innursing wherever possible.• to develop a clear rationale for the title ofawards given to nursing degrees.• to clarify further the attributes expected ofthe graduate nurse.• to develop standards to guide the teaching ofresearch to degree level.• to clarify responsibility for the qualityassurance of various components of post-registration degrees.• to encourage debate about how best tosupport both the academic and clinicalaspects of the nurse teachers role.MethodSeventy courses from 52 institutions wereidentified using the following inclusion criteria:• all pre-registration nursing degrees.• all post-registration degrees offering the ENBHigher Award.• other post-registration degrees whichspecifically targeted registered nurses.Thirty-two institutions agreed to participate and50 curriculum documents were collected fromparticipants. These documents were cataloguedand coded for discreet descriptive variables. Asubset of 15 documents was selected torepresent the broad range of course typespresent in the main sample. This subset wassubjected to in-depth analysis focussingparticularly on course philosophy, learningoutcomes and structures relating to teachinglearning and assessment. rrH I G H L I G H T S H I G H L I G H T Sprogress in their practical skills development.Winter (1993) suggests that there is an absenceof empirical evidence to show that incrementallearning follows the sequence of leveldescriptors which most courses use, nor can itbe assumed that cognitive level descriptorsfunction in a similar way to experientialdescriptors. Therefore, although there wasconsiderable similarity in the ways in whichlevels were described in course learningoutcomes, it seems likely that this is an artefactof the heavy influence of Bloom’s Taxonomy onthe language of level and progression thanevidence of similarity beyond superficiallabelling.Evidence of comparable notions of level wasmore apparent where documents attempted todiscriminate between graduate and non-graduate level activity or outcome. We havedealt with this separately as a discourse ofgraduateness.4. Discourses of graduatenessIn course aims and learning outcomes therewas evidence of a number of common featuresin the way the concept of graduateness wasarticulated. The range of features of thisconcept, which were commonly included incurriculum documents, are represented inTable 4.For most courses the added value of degreelevel research was that students moved beyondmere appreciation and appraisal towardsactively doing research and contributingempirical knowledge to their area of practice.All degree programmes included a substantial,in-depth, independent project undertaken overan extended period of time although the natureof such a project varied from course to course.5. Discourses of practice andassessmentAs well as a distinct construct of caring andreflective practice in the way documents triedto articulate a notion of graduateness, otheraspects of practice were evident in the data.The complexity of the clinical environment inwhich students developed their practice wasreflected by the wide range of organisationalpartnerships which many HE institutions hadto construct and maintain in order to deliverpractice based components of the curriculum.There were similarities across courses in thatclinical assessors would normally havecompleted an ENB 998 course and have hadsome experience of qualified clinical practice.However, the way in which the role of lecturersin clinical areas was described suggestedconsiderable variation ranging from hands-onpractitioner to more distant educationalresource for formal teaching and learningevents.Where practice was assessed as part of thecourse outcomes there were a number of waysin which this was achieved, including tick boxcompetency statements, skills logs, learningcontracts and portfolios. It was clear that someinstitutions found it particularly difficult tofind strategies to award academic credits forpractice based components.6. Summary of the ways in whichdocuments were comparable• all pre-registration courses had to meetexternal requirements relating to structure,process and outcome.• in most courses the graduate nurse wasconceptualised as an innovative leader whowas flexible and able to manage resourcesand handle change.• comparable terms were used as leveldescriptors in both the assessment of theoryand assessment of practice.• all courses seemed to have difficulty inarticulating higher levels of practice.• preparation for clinical assessors was similaracross most courses although the adequacyof this preparation for assessment of higherlevels of practice requires evaluation.• all courses required students to undertake asubstantial piece of independent work overan extended period of time. This usuallyincorporated some research activity aroundthe subject of nursing.• all courses appeared to be struggling with thecomplexity of meeting the requirements ofboth higher education and the NHS.• all post-registration and most pre-registrationcourses were fully modularised.20997-3 ENB Research 38  4/1/0  11:25 am  Page 2

of Nursing Bachelor of Science Bachelor of Arts Totals Title of award Type of course Pre-registration Post-registration with Higher Award Post-registration Totals

A Documentary Analysis of Nursing Degree Curricula

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