Concept-Based Learning in Nursing: Cultivating Critical Thinking and Enhancing Educational Performance

Introduction

In the ever-evolving landscape of healthcare, nurses are increasingly confronted with intricate challenges that demand astute critical thinking and sound decision-making. Traditional educational paradigms, often characterized by rote memorization of isolated facts, may fall short in equipping nursing students with the necessary skills to navigate the complexities of real-world clinical practice. The concept-based approach to learning nursing has emerged as a promising alternative, emphasizing the interconnectedness of knowledge and fostering the development of critical thinking, clinical reasoning, and problem-solving abilities. This article explores the concept-based approach to learning nursing, examining its benefits, implementation strategies, and outcomes, with a focus on how it cultivates critical thinking and enhances educational performance.

The Imperative for Critical Thinking in Nursing

Critical thinking is an indispensable attribute for nurses, empowering them to effectively diagnose patient needs and make judicious nursing decisions. It enables nurses to analyze information, evaluate evidence, and draw logical conclusions, ultimately leading to improved patient outcomes. The ability to think critically is particularly crucial in clinical settings, where nurses must adapt to dynamic situations, prioritize tasks, and make informed judgments under pressure.

Traditional educational systems often inundate students with theoretical information, but may not adequately cultivate the ability to apply this knowledge to practical problem-solving. The conventional teaching method in universities conveys a mixture of information and theoretical concepts to students but does not convey to them the ability to analyze, prioritize, and organize emerging knowledge, which is a requirement for critical thinking and will lead to effective and meaningful learning. To develop critical thinking, the role of educational centers as a reservoir of information and professors as speakers and transmitters of information should be changed. Despite the importance of critical thinking, recent studies in educational and clinical environments have shown that nursing students largely lack appropriate critical thinking skills. Therefore, they cannot be used in the current complex educational environment.

Unveiling the Concept-Based Approach

The concept-based approach to learning transcends the limitations of traditional, fact-based education by focusing on overarching concepts and principles that underlie nursing practice. Instead of memorizing isolated facts, students are encouraged to explore the relationships between concepts, analyze complex scenarios, and apply their knowledge to diverse clinical situations. This approach fosters a deeper understanding of the subject matter and promotes the development of critical thinking skills.

At its core, concept-based learning challenges students to think critically and use prior knowledge to navigate new scenarios. Nursing leaders are recognizing the merits of a concept-based curriculum to provide a structured framework for learning outcomes, instructional delivery, lesson objectives, and assessments. Students explore concepts tied to patient care and examine interconnected examples. This helps them identify patterns and apply knowledge across varied conditions.

Read also: Concept Maps for Students

A concept-based design consists of concepts and exemplars or examples. “A concept is an organizing principle, or a classification of information”. Faculty choose concepts that reflect nursing practice and organize the concepts in domains such as biophysical, psychosocial, health care systems, and professional practice. An example of a concept in the biophysical domain is perfusion and is defined as “the flow of blood through arteries and capillaries delivering nutrients and oxygen to cells and removing cellular waste products”. After selection of the concept, faculty choose exemplars or examples to help students understand the concept. The exemplars reflect essential clinical knowledge related to the concept. For instance, potential exemplars for the perfusion concept include heart failure, stroke, and shock. Exemplars provide the way for students to gain a deep understanding of the concept. In-depth understanding of the concept and exemplar support the ability for students to transfer understanding to new situations. Conceptual learning requires the student to link facts and exemplars to concepts through an active process such as completing case studies, questions, or problem-solving activities-encouraging students to practice thinking. Practice thinking in the classroom evolves from a teacher-centered learning to a student-centered learning environment, focusing on clinical practice.

One way to do so is by using concepts. A concept, or set of concepts, organizes information; therefore, it is easier to understand and remember information compared to a list of facts. Exemplars are used to provide specific contexts for a concept, helping students understand the concept more thoroughly. The type of exemplar used can increase the level of learning. For instance, the exemplars, adult respiratory distress syndrome and pneumonia, can be used for the gas exchange concept.

An example of how concept-based learning is applied is in the School of Nursing D.N.P-F.N.P. For example, students will learn inflammation starting in pathophysiology, with understanding the physiologic and psychologic processes. As they progress into pharmacology and health assessment, they will see how to diagnose and treat inflammation, deciding the best methods for assessment and prescription recommendations.

In the new School of Nursing program, concept-based curriculum begins on the very first day of instruction. “Our patients don’t come with boxes around their hearts and lungs. They present as an integrated complex person,” Sandholdt said. Graduates of the new D.N.P.-F.N.P. program benefit from this approach first in how it builds the clinical skills needed to deliver evidence-based care.

“Our curriculum is based on three large concept groupings: health care recipient, health and illness, and professional nursing and health care,” Sexson said. “Sometimes when we teach things in boxes, we expect students to make metacognitive links between concepts,” Sandholdt said.

The purpose of this paper is to first discuss the purpose of a concept-based curriculum, the advantages and disadvantages of having this type of curriculum, and then lastly the outcomes of operationalizing this type of curriculum in a pre-licensure nursing program.

Concept Map as a Metacognitive Approach

Concept map is a novel metacognitive approach in education that can improve critical thinking and decision-making skills in students and nurses. A concept map is a schematic presentation of the connection of one concept with another concept, as well as their connection with other concepts around a specific topic, which is arranged in a hierarchical pattern.

Benefits of Concept-Based Learning in Nursing

The concept-based approach to learning nursing offers a multitude of benefits for both students and educators:

Enhanced Critical Thinking: By emphasizing the application of knowledge to real-world scenarios, concept-based learning cultivates critical thinking skills, enabling students to analyze complex situations, evaluate evidence, and make sound judgments.
Improved Clinical Reasoning: The ability to connect concepts and apply them to diverse clinical situations enhances clinical reasoning skills, allowing nurses to effectively diagnose patient needs and develop appropriate care plans.

Read also: What is Project-Based Learning?
Deeper Understanding: Concept-based learning fosters a deeper understanding of the subject matter, moving beyond rote memorization to promote meaningful learning and knowledge retention.
Increased Engagement: The active learning strategies employed in concept-based education, such as case studies and problem-solving activities, increase student engagement and motivation.
Better Preparation for Practice: By bridging the gap between theory and practice, concept-based learning better prepares nursing graduates for the challenges of real-world clinical practice.
Streamline content: Students were able to streamline content, which is very useful for school and professional success.
Emphasize nursing actions and understanding relationships: Utilizing a concept-based curriculum also helped to emphasize nursing actions and understanding relationships.

Implementing a Concept-Based Curriculum

The implementation of a concept-based curriculum requires a significant shift in teaching practices and learning strategies. Educators must transition from traditional lecture-based instruction to active learning methods that promote student engagement and critical thinking.

Changing to a concept-based curriculum required a major shift in thinking and application. Faculty need to learn ways to present concepts and exemplars in classroom activities that require problem-solving, and students need to understand how to connect facts and concepts with exemplars for in-depth understanding.

Nurse educators are looking for ways to promote thinking in the classroom while using problem-solving skills; consequently, many nursing programs are changing to a concept-based curriculum.

The preparation may include PowerPoints with voice, video lectures, readings, and quizzes. When students are prepared for class, they are ready to apply concepts and exemplars into real life situations reflective of current practice in health care.

The learning paradigm supports collaborative learning with the teacher described as a coach or facilitator of student learning and focuses on education for understanding and learning in context. Both the educator and student take responsibility for the students to learn and achieve learning outcomes.

Here are some key strategies for implementing a concept-based curriculum:

Identify Core Concepts: Faculty must identify the core concepts that are essential to nursing practice and organize the curriculum around these concepts.
Develop Exemplars: Exemplars, or real-world examples, should be used to illustrate the application of concepts in diverse clinical situations.
Incorporate Active Learning Strategies: Active learning strategies, such as case studies, simulations, and problem-solving activities, should be incorporated to promote student engagement and critical thinking.
Assess Conceptual Understanding: Assessment methods should focus on evaluating students' understanding of concepts and their ability to apply them to new situations, rather than simply memorizing facts.
Provide Faculty Support: Faculty development programs should be provided to support educators in transitioning to concept-based teaching methods.
Integrate active learning through reflective assignments and peer feedback.

One of the advantages of operationalizing a concept-based curriculum, is that this type of curriculum helped to develop critical thinking skills. Students were encouraged to interpret, analyze, and integrate knowledge more frequently.

Challenges and Considerations

While the concept-based approach offers numerous advantages, it is essential to acknowledge the challenges and considerations associated with its implementation:

Faculty Resistance: Some faculty members may resist the shift from traditional teaching methods to concept-based learning, requiring adequate support and training to overcome this resistance.
Time Commitment: Developing and implementing a concept-based curriculum requires a significant time commitment from faculty, necessitating careful planning and resource allocation.
Curriculum Development: The actual development of the curriculum, like choosing which concepts to use, was challenging. At the community college, faculty expressed how difficult and time consuming it was to remake all of their lesson plans and alter their teaching strategies to center around the concepts.
Student Adjustment: Some students may initially struggle with the shift to concept-based learning, requiring guidance and support to adapt to the new learning environment.
Decrease in enrollment: After speaking with the program director, it was also evident that initially there was a decrease in enrollment. This is because some of the students transferred because they were not comfortable with learning in a concept-based way.
High heterogeneity: One of the limitations of this study was the high heterogeneity in the studies (more than 90%). This heterogeneity forced us to use meta-regression based on potential factors such as publication year and sample size, as well as subgroup analysis based on the study population, which resulted in some reduction of heterogeneity, but still high heterogeneity within subgroups, Which may be due to cultural factors and educational contexts.

Evidence Supporting the Effectiveness of Concept-Based Learning

Numerous studies have demonstrated the effectiveness of concept-based learning in nursing education, with results showing that the educational performance in the intervention group increased significantly more than the control group, which indicates the positive effect of using the concept map approach in nursing education.

The results of the present study showed that the use of the concept map model can significantly impact the teaching process outcomes, particularly in enhancing learning among nursing students and nurses. The findings of various studies also indicate this effect. In the study by Chen et al., the use of the concept map model significantly influenced critical thinking and learning in students. Similarly, in the study by Dehghanzadeh, the use of this model had a significant effect on the teaching and learning process of nursing students.

In explaining the results, it can be said that the use of the concept map model can enhance the understanding of concepts and their relationships among learners. It improves critical thinking and clinical reasoning in learners and enriches learning experiences.

The meta-regression results showed that with the increase in the year of conducting the study, the effect of the intervention also has an upward trend.

The results of the subgroup analysis showed that the positive effect of the intervention was greater in the population of nursing students than in the group of nurses. Because students are in the middle of their studies and usually have no other job than studying, but nurses are usually more busy and may have other responsibilities such as wife and father/mother roles, so nurses show less interest in learning than students.

For example, this type of curriculum helped to develop critical thinking skills. Students were encouraged to interpret, analyze, and integrate knowledge more frequently. The students were able to streamline content, which is very useful for school and professional success. For instance, if the student takes the NCLEX exam and he or she is asked about a perfusion disorder, then the student should be able to think critically about the nursing care for perfusion disorders, and may do just fine with that question, even if the student was not taught about that diagnosis specifically. Utilizing a concept-based curriculum also helped to emphasize nursing actions and understanding relationships. At the community college in Baltimore metro area, a senior student even mentioned that in clinical and in simulation lab, all of the concepts she learned in the classroom were coming together and everything was starting to make sense.

Even though there are some advantages of operationalizing a concept-based curriculum, there are also drawbacks. For example, the actual development of the curriculum, like choosing which concepts to use, was challenging. At the community college, faculty expressed how difficult and time consuming it was to remake all of their lesson plans and alter their teaching strategies to center around the concepts. After speaking with the program director, it was also evident that initially there was a decrease in enrollment. This is because some of the students transferred because they were not comfortable with learning in a concept-based way.

Research and real-life experiences have shown mostly positive outcomes for the operationalization of a concept-based curriculum. McGrath (2015) found that there was an increase in faculty satisfaction with teaching concepts that linked together. At the community college, the faculty mentioned how it has become second nature to teach using concepts. In regards to the National Council Licensure Examination for Registered Nurses (NCLEX- RN®), Duncan and Schulz (2015) have showed that there was an initial decrease in pass rates, but it gradually reached its baseline within a couple of years. For example, the NCLEX-RN pass rate for the first cohort was 83%, which was a drop from a baseline of 90%. However, the second cohort’s pass rate increased to 89% (Duncan & Schulz, 2015). The community college in the Baltimore, Maryland metro area followed this trend as well. It is believed that a drop in pass rates is partially due to the students getting used to learning on a concept basis and due to the faculty trying to fine tune their lesson plans and teaching strategies. The last outcome examined was retention and on-time graduation rates. Lewis (2014) showed that retention rates increased by 2.3% and on-time graduate rates increased by 1.3%.

The Nurse Educational Framework

There is a growing acknowledgment of the need to develop consistent approaches to guiding nursing education and responding to changing health environment issues. In this regard, frameworks for nursing education have been proven to be effective, and the benefits of integrating nursing theories in the context of practice have been demonstrated. Several studies have found that nursing educational frameworks are the most influential in the development of nursing competencies and professional socialization.

It is essential that nurse educators work for providing learning that is theoretically and conceptually informed, within a structure that builds and transmits knowledge that prepares students to assume their role as future leaders in a variety of care settings.

The constituent elements are central to the advancement of the NEF. In reality, current political, social, and economic issues sometimes pose challenges to the development and implementation of the nursing discipline. Despite the considerable achievements throughout time, it remains critical for educators to maintain a clear perspective on distinctive nursing knowledge, and to be diligent about its dissemination when preparing nursing students. The lack of emphasis on the disciplinary focus in nursing education has been defined as one of the most important threats for educators to contribute to nursing growth as a unique discipline.

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