Nurse Educator Vol. 39, No. 3, pp. 122-125 Copyright * 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nurse Educator
Understanding Backward Design to Strengthen Curricular Models Jan Emory, PhD, RN, CNE Nurse educators have responded to the call for transformation in education. Challenges remain in planning curricular implementation to facilitate understanding of essential content for student success on licensure examinations and in professional practice. The conceptual framework Backward Design (BD) can support and guide curriculum decisions. Using BD principles in conjunction with educational models can strengthen and improve curricula. This article defines and describes the BD process, and identifies reported benefits for nursing education.
T
he call for radical transformation in nursing education has been recognized and embraced both in the United States and internationally.1 Nursing leaders recognize that education reform is essential to prepare future nurses with the skills necessary to provide the most knowledgeable and safe care possible.2 In 2010, the Carnegie Foundation for the Advancement of Teaching called for changes in nursing education, referring to the lack of a prepared workforce to face the profound changes in science, technology, and the dynamic nature and settings of nursing practice.3 It is recommended that coursework reflect clear connections to patient care concepts rather than the more abstract approach of targeting the relationship between acquiring and applying knowledge.4 Educators must rethink approaches to curriculum development, implementation, and evaluation to generate models that effectively address the realities of the current and projected workplace and varied care settings.4,5 Integrative teaching approaches may offer a method to support this shift by combining classroom and clinical emphasizing clinical judgment and critical thinking.4,6 In response to these changes, nursing educators should revise and organize curriculum models and design instructional strategies to achieve outcomes and competencies. This reality can be reached through understanding, retention, and generalization of content and concepts in authentic, measurable ways.7 Traditionally, in nursing education, clinical activities are developed as separate but related learning experiences from the classroom.8 The Backward Design (BD) conceptual framework can support curriculum planning and alignment to achieve congruence between student outcomes in the classroom yet provide clear evidence of knowledge Author Affiliation: Assistant Professor, Eleanor Mann School of Nursing, University of Arkansas, Fayetteville. The author declares no conflicts of interest. Correspondence: Dr Emory, Eleanor Mann School of Nursing, 606 Razorback Road, Office 245, Fayetteville, AR 72703 ([email protected]). Accepted for publication: February 10, 2014 DOI: 10.1097/NNE.0000000000000034
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transfer in clinical applications.9 With clear direction, the BD process and existing curriculum models work in conjunction to focus on major concepts, methods of assessment, and evidence-based teaching and learning strategies to support the body of knowledge required of the entry-level generalist nurse. The BD process developed by Wiggins and McTighe9 is outcome and competency driven and provides a means to clarify and align relevant content and concepts within a discipline. Backward design is focused on developing and deepening understanding of the important ideas identified by stakeholders of the educational process.9 Backward design is not a prescriptive method but a purposeful guide to curricular design offering standards of development and a conceptual framework to move educators toward sound evidence-based principles of education delivery resulting in transfer of information in new situations.9,10 Backward design is used and referenced widely as a pedagogical approach in secondary education in the United States.10 More recently, the strategies outlined in the BD framework have guided and informed implementation of curriculum models, and teaching and learning strategies in higher education, health-related fields.10,11 This process may be viewed as innovative by nurse educators, but the principles of BD have been used in elementary and secondary education for a number of years with the 1st edition of Understanding by Design published in 1995.12 The purposes of this article are to (1) identify challenges for education in cultivating knowledge acquisition for application in practice, (2) identify BD as an option to strengthen curriculum models, (3) provide an overview of the progressive stages of the BD process, and (4) identify implications for programs of nursing considering the BD approach.
Background The Content Squeeze An important theme in the debate surrounding curricular reform is identifying the minimal competencies required for Nurse Educator
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
entry-level generalist nurses and the essential content required to teach those competencies.5,7 Some claim that the body of knowledge required of the entry-level generalist nurse far exceeds the available credit hour limits of educational programs.7 Nursing programs must also consider accreditation requirements for student achievement in meeting program outcomes and competencies that reflect changes in current practice.13 Essential competencies required by accrediting bodies include genetics, informatics, community and population health, gerontology, and multicultural competency, all competing for curricular inclusion.6 Regardless of educational strategy, students are consistently assigned exhaustive pages of readings from textbooks, articles, and online references. The vast amount of information students are expected to retain can result in content overload, confusion, and the inability to identify the most important concepts and how those concepts will apply in nursing practice.14 Learning and, thus, true knowledge construction are more likely to promote transfer of concepts to the clinical setting resulting in critical thinking compared to memorizing information.15 The necessity to squeeze in more content creates an opportunity for nurse educators to redesign content delivery and curriculum implementation. The BD framework processes serve to strengthen and improve curricular implementation to meet the challenges faced by the content squeeze and saturation present in nursing education.1,7 This is accomplished through clear focus on learner-centered outcomes to prioritize content and concepts and create meaningful understanding for transfer to practice.
Backward Design Backward Design uses a 3-stage process to assist in identifying outcomes, determining the acceptable evidence for outcome attainment, and planning authentic evidence-based learning activities.9 Authentic tasks and activities emphasize learning in situations where the knowledge will be applied. Authentic learning tasks and activities should contain complex problems that result in multiple solutions that bring about new problems, thus testing application knowledge.15 Healthcare professionals agree that care environments are complex. Safe nursing care in today’s healthcare settings requires a thoughtful, intentional approach to delivery of nursing education and teaching as a foundation for safe practice. Intentionality results in deliberate connections between student outcomes and course structure, content, and delivery methods.15 The 3 stages of BD build upon expected outcomes or competencies at the program, course, and class level to assist educators by keeping the end in mind. The desired outcomes or competencies identified in stage 1 of the process dictate the nature of the assessment evidence needed in stage 2 and suggest the types of instruction and learning experiences planned in stage 3.9
Stage 1: Desired Results The BD framework begins with the development of a clear conception of the desired outcomes. The focus is to recognize desired outcomes or competencies and design backward. When identifying the desired outcomes, several questions should guide the process, including (a) What should students know, understand, and be able demonstrate? (b) What Nurse Educator
content is important for understanding? and (c) What enduring or long-term understandings are desired?9 Entry-to-practice nursing education curricula are guided to desired program outcomes by resources such as The Essentials of Baccalaureate Education for Professional Nursing Practice6 and the National Council State Boards of Nursing Licensure Examination (www.ncsbn.org). These organizations provide a framework for identifying concepts and processes expected of the entry-level generalist nurse for consideration in determining desired outcomes. In addition, the mission and goals of the institution of higher learning should serve to guide and develop nursing curriculum to identify desired program outcomes. Of course, selection of concepts and content goes beyond those generalized by these sources. Nurse educators should also consult with clinicians at the forefront of patient care to determine what nursing students will be required to know and do to demonstrate competence based on the intense changes in clinical practice settings.
Stage 2: Acceptable Evidence The next step in the BD model is development of assessment strategies to determine achievement of desired outcomes or competencies to inform teaching and learning strategies.9 Backward design can facilitate quality improvement through evidence displayed by students in the 6 different facets of knowledge transfer9 (Table 1). These facets of understanding provide the evidence for outcomes achievement and competency measurement. Understanding is demonstrated by a student’s ability to explain, interpret, apply, perceive, empathize, and self-evaluate.9 The more facets used to demonstrate or explain a concept, the more likely the student understands.10 However, not all facets must be evident for understanding,
Table 1. 6 Facets of Understandinga Facet
Characteristics
Explanation
Use generalizations or principles providing justification and systematic accounts of phenomena, facts, and data; make insightful connections and provide illuminating examples or illustrations. Interpretation Tell meaningful stories; offer translations; provide a revealing historical or personal dimension to ideas and events; make the object of understanding personal or accessible through images, anecdotes, analogies, and models. Applications Effectively use and adapt what is known in diverse and real contexts. The subject can be performed. Perspective See and hear points of view through critical eyes and ears; see the big picture. Empathy Find value in what others might find odd, alien, or implausible; perceive sensitivity on the basis of prior direct experience. Self-knowledge Show metacognitive awareness; perceive the personal style, prejudices, projections, and habits of mind that shape and impede our own understanding; are aware of what we do not understand; reflect on the meaning of learning and experience. a
Adapted from Wiggins and McTighe.9(p84)
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Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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and the educator will often have to make choices on which to clarify or emphasize to guide learning activities. Guiding questions to assist the development of the assessment evidence are as follows: (a) What kind of evidence is needed as indicators of desired outcome achievement, including that of understanding? (b) What specific characteristics in student responses, products, or performances should be examined to determine the extent the desired outcomes were achieved? (c) Does the proposed evidence enable faculty to conclude student’s knowledge, skill, or understanding? and (d) Does the evidence align with the desired outcomes?9 Assessment of students’ knowledge and skill should be augmented with evidence of transferability to authentic practice environments. Assessments should be based in authentic performance-based tasks. A task is considered authentic if it (a) is realistically contextualized; (b) requires clinical judgment and innovation; (c) asks the student to apply the subject; (d) replicates key challenging situations in which students are truly tested in the workplace; (e) assesses the student’s ability to efficiently and effectively use a variety of knowledge and skills to critically analyze complex and multistage tasks; and (f ) allows appropriate opportunities to rehearse, practice, consult resources, and get feedback on, and refine performances and products.9 Well-developed methods of assessment can ensure that authentic learning with understanding has occurred and outcomes achieved by keeping the end in mind.
Stage 3: Learning Experiences and Instruction The final stage of the process considers teaching and learning strategies used to achieve the desired outcomes to reach expected competencies. ‘‘Teaching on its’ own never causes learning; only successful attempts by the learner to actively participate to learn causes learning. Achievement is the result of the learner successfully making sense of the teaching.’’9(p228)
Student needs within the specific domain of nursing must be considered when developing learning activities. Content and concepts to be presented, previous knowledge learned in courses, student experiences, diversity, developmental level, and class size influence teaching and learning activities and strategies. Throughout the process, the student must clearly understand the concepts and desired outcomes of the learning activity. Educators should focus on learners’ needs to achieve the desired outcomes and not just task-oriented sessions where the relationship to the major ideas and concepts are unclear.10 Learning strategies should be selected with intentionality and should lead to the identified methods of assessment and desired outcomes.11 Educators should use a variety of strategies to address student needs for opportunities to learn with understanding. Table 2 describes the components and applications of the process by displaying a course outcome associated with a healthy-heart diet education plan. The stages of BD are identified with the corresponding actions to create deeper understanding of the application.
Conclusion A primary goal for nurse educators is to facilitate students’ transfer of the abstract concepts and skills from the classroom to performance in the authentic nursing environment.8 Understanding is needed for retention and recall for transfer to the practice setting. Understanding requires the ability to thoughtfully and actively perform the skill, as well as the ability to self-assess, justify, and critique the work.9 Teaching for transfer requires student engagement in the learning process through authentic activities. Authentic learning takes place if students are fully engaged in thinking about how the content applies to professional practice.5 Student engagement should take place in authentic ways through the use of
Table 2. Classroom Example of Backward Design Applicationa Stage
Facet
Desired outcome for classroom and clinical courses Evidence of achievement in classroom and clinical courses
Student will understand the essential concepts of nutrition appropriate for a healthy-heart diet for a diverse population. Explain Apply Apply, empathize Explain, interpret Empathize Self-reflection
Plan learning experiences from the educator
a
Course Outcome
Student will identify US Department of Agriculture–recommended food pyramid and evidence of foods appropriate for a healthy-heart diet through quizzes and testing. Student will create a brochure to use as a tool to teach cardiac patients about diet and relationships to a healthy heart. Student will develop a meal plan appropriate for the patient considering assessment of food preferences and cultural implications. Student will present a teaching session with a cardiac patient to explain the diet and medical terms associated with nutrients and other associated aspects. Student will answer questions and ask for the patient’s concerns for implementing the diet. Student will evaluate his/her own diet in relation to the healthy-heart diet guidelines. Illustrate the effects of cholesterol on the cardiac vessels using pictures and videos. Use questioning: Does your current diet align with guidelines for a healthy heart? Assign groups of students to develop a meal plan using the evidence from resources to develop a weekly meal plan for a healthy-heart diet. Allow students to view an echocardiogram in the clinical facility on a cardiac patient. Arrange for observation experiences in the cardiac catheterization laboratory for patients with cardiac disease and arterial blockage.
Adapted from Wiggins and McTighe.9
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Nurse Educator
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
innovative pedagogies supporting knowledge transfer. Teaching approaches should be domain specific to develop the deep understanding needed in nursing practice.1,4 Examples include (a) narrative storytelling of relevant experiences, (b) clinical case studies with increased complexity, and (c) simulation with appropriate debriefing and discussion.1,4,8,9 It is essential to connect major concepts presented through authentic activities to program outcomes. The ability to transfer knowledge and skill effectively involves the capacity to use what is known and to use it creatively, flexibly, and fluently in different settings and situations.8,9 An innovative strategy to curricular design, BD begins with clear outcomes and then assessment development that informs teaching and learning strategies.9,10,11 The BD framework has the potential to improve the quality of nursing education and ultimately patient care by clarifying the desired outcomes of academia and practice with evidence of integration, determining the appropriate evidence for outcome achievement, and purposefully guiding evidence-based teaching and learning practices that are best suited to the practice of nursing.5,9,11 Benefits of BD are viewed as (a) increasing the strength of curriculum and assessment design; (b) clarifying desired outcomes and assessment methods for curriculum and course planning; (c) applying evidence-based standards for teaching and learning practices for professional nurse educators; (d) providing a conceptual framework to guide nurse educators at all levels of preparation in educational practices; (e) minimizing content expansion without clear alignment with outcomes, competencies, or standards of practice; (f ) guiding priorities for content inclusion; (g) providing evidence of student performance and outcomes achievement expected by governing bodies for purposes of accreditation; and (h) contributing to the transformation of nursing education.9,10,11,16
Implications for Nurse Educators The rapid changes in healthcare should prompt nursing educators to integrate educational research, theory, and curricular innovations into practice.1,17 Nurse educators should evaluate innovative education practices such as BD to identify and address the relevant challenges to prepare future nurses to transfer knowledge in meaningful ways with deep understanding. Achievement of outcomes and competencies expected of the nursing student begins with a solid foundation of knowledge and skills acquired during basic education that are transferrable to practice in the workplace.4,5,8 The BD conceptual framework principles are consistent with the recommendations of leaders in nursing education to create a nursing workforce prepared for the complexities of the healthcare environment by intentional teaching and learning strategies directed to create measureable understanding. Aligning curricula begins with identifying the desired outcomes. Working backward can facilitate the ongoing transformation in nursing education by shifting away from coverage
Nurse Educator
of content and separation of clinical and classroom teaching, toward informed clinical decision making.17
References 1. Benner P. Educating nurses: a call for radical transformation—how far have we come? J Nurs Educ. 2012;51(4):183-184. doi:10.392.8/ 01484834-20120402-01. 2. TIGER Summit Summary Report. Sigma Theta Tau International Web site. Available at http://www.nursingsociety.org/Education/ ProfessionalDevelopment/Documents/TIGER_Final_Summit_ Report.pdf. Published 2006. Accessed February 5, 2014. 3. Schmidt P. Carnegie foundation calls for ‘‘radical transformation’’ of nursing education. Chronicles of Higher Education. January 6, 2010. Available at https://chronicle.com/article/Carnegie-FoundationCalls-for/63443. Accessed February 5, 2014. 4. Benner P, Sutphen M, Leonard V, Day L. Educating Nurses: A Call for Radical Transformation. San Francisco, CA: Jossey-Bass; 2010. 5. Forbes MO, Hickey MT. Curriculum reform in baccalaureate nursing education: review of the literature. Int J Nurs Educ Scholarsh. 2009;6(1). 6. American Association of Colleges of Nursing. Essentials of baccalaureate education for professional nursing practice. 2008. Available at http://www.aacn.nche.edu/education-resources/ baccessentials08.pdf. Accessed February 5, 2014. 7. Giddens J, Brady D. Rescuing nursing education from content saturation: the case for a concept-based curriculum. J Nurs Educ. 2007;46(2):65-69. 8. McDonald M. Laboratory and clinical evaluation. In: The Nurse Educator’s Guide to Assessing Learning Outcomes. 3rd ed. Brooklyn, NY: JB Learning; 2014:305-322. 9. Wiggins G, McTighe J. Understanding by Design. 2nd ed. Alexandria, VA: Association for Supervision and Curriculum Development; 2005. 10. Carlson DL, Marshall PA. Learning the sciences of research, learning the art of teaching: planning backwards in a college genetics course. Biosci Educ. 2009;13(4). Available at http:// journals.heacademy.ac.uk/doi/full/10.3108/beej.13.4. Accessed February 6, 2014. 11. Fox B, Doherty J. Design to learn, learn to design: using backward design for information literacy instruction. Commun Inf Literacy. 2012;5(2):144-155. 12. Childre A, Sands J, Pope S. Backward design. Teach Exceptional Child. 2009;41(5):6-14. 13. Dillard N, Siktberg L. Curriculum development: an overview. In: Billings DM, Halstead JA, eds. Teaching in Nursing: A Guide for Faculty. 4th ed. St Louis, MO: Elsevier; 2012:76-91. 14. Scheckel M. Selecting learning experiences to achieve learning outcomes. In: Billings DM, Halstead JA, eds. Teaching in Nursing: A Guide for Faculty. 4th ed. St Louis, MO: Elsevier; 2012:170-187. 15. Woolfolk A. Educational Psychology: Active Learning Edition. Boston, MA: Pearson Publications; 2011. 16. Graff N. An effective and agonizing way to learn: backwards design and new teachers’ preparation for planning curriculum. Teachers Education Q. 2011:151-168. 17. Boland DL, Finke LM. Curriculum design. In: Billings DM, Halstead JA, eds. Teaching in Nursing: A Guide for Faculty. 4th ed. St Louis, MO: Elsevier; 2012:119-137.
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Nurse Educator
Understanding Backward Design to Strengthen Curricular Models Jan Emory, PhD, RN, CNE Nurse educators have responded to the call for transformation in education. Challenges remain in planning curricular implementation to facilitate understanding of essential content for student success on licensure examinations and in professional practice. The conceptual framework Backward Design (BD) can support and guide curriculum decisions. Using BD principles in conjunction with educational models can strengthen and improve curricula. This article defines and describes the BD process, and identifies reported benefits for nursing education.
T
he call for radical transformation in nursing education has been recognized and embraced both in the United States and internationally.1 Nursing leaders recognize that education reform is essential to prepare future nurses with the skills necessary to provide the most knowledgeable and safe care possible.2 In 2010, the Carnegie Foundation for the Advancement of Teaching called for changes in nursing education, referring to the lack of a prepared workforce to face the profound changes in science, technology, and the dynamic nature and settings of nursing practice.3 It is recommended that coursework reflect clear connections to patient care concepts rather than the more abstract approach of targeting the relationship between acquiring and applying knowledge.4 Educators must rethink approaches to curriculum development, implementation, and evaluation to generate models that effectively address the realities of the current and projected workplace and varied care settings.4,5 Integrative teaching approaches may offer a method to support this shift by combining classroom and clinical emphasizing clinical judgment and critical thinking.4,6 In response to these changes, nursing educators should revise and organize curriculum models and design instructional strategies to achieve outcomes and competencies. This reality can be reached through understanding, retention, and generalization of content and concepts in authentic, measurable ways.7 Traditionally, in nursing education, clinical activities are developed as separate but related learning experiences from the classroom.8 The Backward Design (BD) conceptual framework can support curriculum planning and alignment to achieve congruence between student outcomes in the classroom yet provide clear evidence of knowledge Author Affiliation: Assistant Professor, Eleanor Mann School of Nursing, University of Arkansas, Fayetteville. The author declares no conflicts of interest. Correspondence: Dr Emory, Eleanor Mann School of Nursing, 606 Razorback Road, Office 245, Fayetteville, AR 72703 ([email protected]). Accepted for publication: February 10, 2014 DOI: 10.1097/NNE.0000000000000034
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transfer in clinical applications.9 With clear direction, the BD process and existing curriculum models work in conjunction to focus on major concepts, methods of assessment, and evidence-based teaching and learning strategies to support the body of knowledge required of the entry-level generalist nurse. The BD process developed by Wiggins and McTighe9 is outcome and competency driven and provides a means to clarify and align relevant content and concepts within a discipline. Backward design is focused on developing and deepening understanding of the important ideas identified by stakeholders of the educational process.9 Backward design is not a prescriptive method but a purposeful guide to curricular design offering standards of development and a conceptual framework to move educators toward sound evidence-based principles of education delivery resulting in transfer of information in new situations.9,10 Backward design is used and referenced widely as a pedagogical approach in secondary education in the United States.10 More recently, the strategies outlined in the BD framework have guided and informed implementation of curriculum models, and teaching and learning strategies in higher education, health-related fields.10,11 This process may be viewed as innovative by nurse educators, but the principles of BD have been used in elementary and secondary education for a number of years with the 1st edition of Understanding by Design published in 1995.12 The purposes of this article are to (1) identify challenges for education in cultivating knowledge acquisition for application in practice, (2) identify BD as an option to strengthen curriculum models, (3) provide an overview of the progressive stages of the BD process, and (4) identify implications for programs of nursing considering the BD approach.
Background The Content Squeeze An important theme in the debate surrounding curricular reform is identifying the minimal competencies required for Nurse Educator
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
entry-level generalist nurses and the essential content required to teach those competencies.5,7 Some claim that the body of knowledge required of the entry-level generalist nurse far exceeds the available credit hour limits of educational programs.7 Nursing programs must also consider accreditation requirements for student achievement in meeting program outcomes and competencies that reflect changes in current practice.13 Essential competencies required by accrediting bodies include genetics, informatics, community and population health, gerontology, and multicultural competency, all competing for curricular inclusion.6 Regardless of educational strategy, students are consistently assigned exhaustive pages of readings from textbooks, articles, and online references. The vast amount of information students are expected to retain can result in content overload, confusion, and the inability to identify the most important concepts and how those concepts will apply in nursing practice.14 Learning and, thus, true knowledge construction are more likely to promote transfer of concepts to the clinical setting resulting in critical thinking compared to memorizing information.15 The necessity to squeeze in more content creates an opportunity for nurse educators to redesign content delivery and curriculum implementation. The BD framework processes serve to strengthen and improve curricular implementation to meet the challenges faced by the content squeeze and saturation present in nursing education.1,7 This is accomplished through clear focus on learner-centered outcomes to prioritize content and concepts and create meaningful understanding for transfer to practice.
Backward Design Backward Design uses a 3-stage process to assist in identifying outcomes, determining the acceptable evidence for outcome attainment, and planning authentic evidence-based learning activities.9 Authentic tasks and activities emphasize learning in situations where the knowledge will be applied. Authentic learning tasks and activities should contain complex problems that result in multiple solutions that bring about new problems, thus testing application knowledge.15 Healthcare professionals agree that care environments are complex. Safe nursing care in today’s healthcare settings requires a thoughtful, intentional approach to delivery of nursing education and teaching as a foundation for safe practice. Intentionality results in deliberate connections between student outcomes and course structure, content, and delivery methods.15 The 3 stages of BD build upon expected outcomes or competencies at the program, course, and class level to assist educators by keeping the end in mind. The desired outcomes or competencies identified in stage 1 of the process dictate the nature of the assessment evidence needed in stage 2 and suggest the types of instruction and learning experiences planned in stage 3.9
Stage 1: Desired Results The BD framework begins with the development of a clear conception of the desired outcomes. The focus is to recognize desired outcomes or competencies and design backward. When identifying the desired outcomes, several questions should guide the process, including (a) What should students know, understand, and be able demonstrate? (b) What Nurse Educator
content is important for understanding? and (c) What enduring or long-term understandings are desired?9 Entry-to-practice nursing education curricula are guided to desired program outcomes by resources such as The Essentials of Baccalaureate Education for Professional Nursing Practice6 and the National Council State Boards of Nursing Licensure Examination (www.ncsbn.org). These organizations provide a framework for identifying concepts and processes expected of the entry-level generalist nurse for consideration in determining desired outcomes. In addition, the mission and goals of the institution of higher learning should serve to guide and develop nursing curriculum to identify desired program outcomes. Of course, selection of concepts and content goes beyond those generalized by these sources. Nurse educators should also consult with clinicians at the forefront of patient care to determine what nursing students will be required to know and do to demonstrate competence based on the intense changes in clinical practice settings.
Stage 2: Acceptable Evidence The next step in the BD model is development of assessment strategies to determine achievement of desired outcomes or competencies to inform teaching and learning strategies.9 Backward design can facilitate quality improvement through evidence displayed by students in the 6 different facets of knowledge transfer9 (Table 1). These facets of understanding provide the evidence for outcomes achievement and competency measurement. Understanding is demonstrated by a student’s ability to explain, interpret, apply, perceive, empathize, and self-evaluate.9 The more facets used to demonstrate or explain a concept, the more likely the student understands.10 However, not all facets must be evident for understanding,
Table 1. 6 Facets of Understandinga Facet
Characteristics
Explanation
Use generalizations or principles providing justification and systematic accounts of phenomena, facts, and data; make insightful connections and provide illuminating examples or illustrations. Interpretation Tell meaningful stories; offer translations; provide a revealing historical or personal dimension to ideas and events; make the object of understanding personal or accessible through images, anecdotes, analogies, and models. Applications Effectively use and adapt what is known in diverse and real contexts. The subject can be performed. Perspective See and hear points of view through critical eyes and ears; see the big picture. Empathy Find value in what others might find odd, alien, or implausible; perceive sensitivity on the basis of prior direct experience. Self-knowledge Show metacognitive awareness; perceive the personal style, prejudices, projections, and habits of mind that shape and impede our own understanding; are aware of what we do not understand; reflect on the meaning of learning and experience. a
Adapted from Wiggins and McTighe.9(p84)
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and the educator will often have to make choices on which to clarify or emphasize to guide learning activities. Guiding questions to assist the development of the assessment evidence are as follows: (a) What kind of evidence is needed as indicators of desired outcome achievement, including that of understanding? (b) What specific characteristics in student responses, products, or performances should be examined to determine the extent the desired outcomes were achieved? (c) Does the proposed evidence enable faculty to conclude student’s knowledge, skill, or understanding? and (d) Does the evidence align with the desired outcomes?9 Assessment of students’ knowledge and skill should be augmented with evidence of transferability to authentic practice environments. Assessments should be based in authentic performance-based tasks. A task is considered authentic if it (a) is realistically contextualized; (b) requires clinical judgment and innovation; (c) asks the student to apply the subject; (d) replicates key challenging situations in which students are truly tested in the workplace; (e) assesses the student’s ability to efficiently and effectively use a variety of knowledge and skills to critically analyze complex and multistage tasks; and (f ) allows appropriate opportunities to rehearse, practice, consult resources, and get feedback on, and refine performances and products.9 Well-developed methods of assessment can ensure that authentic learning with understanding has occurred and outcomes achieved by keeping the end in mind.
Stage 3: Learning Experiences and Instruction The final stage of the process considers teaching and learning strategies used to achieve the desired outcomes to reach expected competencies. ‘‘Teaching on its’ own never causes learning; only successful attempts by the learner to actively participate to learn causes learning. Achievement is the result of the learner successfully making sense of the teaching.’’9(p228)
Student needs within the specific domain of nursing must be considered when developing learning activities. Content and concepts to be presented, previous knowledge learned in courses, student experiences, diversity, developmental level, and class size influence teaching and learning activities and strategies. Throughout the process, the student must clearly understand the concepts and desired outcomes of the learning activity. Educators should focus on learners’ needs to achieve the desired outcomes and not just task-oriented sessions where the relationship to the major ideas and concepts are unclear.10 Learning strategies should be selected with intentionality and should lead to the identified methods of assessment and desired outcomes.11 Educators should use a variety of strategies to address student needs for opportunities to learn with understanding. Table 2 describes the components and applications of the process by displaying a course outcome associated with a healthy-heart diet education plan. The stages of BD are identified with the corresponding actions to create deeper understanding of the application.
Conclusion A primary goal for nurse educators is to facilitate students’ transfer of the abstract concepts and skills from the classroom to performance in the authentic nursing environment.8 Understanding is needed for retention and recall for transfer to the practice setting. Understanding requires the ability to thoughtfully and actively perform the skill, as well as the ability to self-assess, justify, and critique the work.9 Teaching for transfer requires student engagement in the learning process through authentic activities. Authentic learning takes place if students are fully engaged in thinking about how the content applies to professional practice.5 Student engagement should take place in authentic ways through the use of
Table 2. Classroom Example of Backward Design Applicationa Stage
Facet
Desired outcome for classroom and clinical courses Evidence of achievement in classroom and clinical courses
Student will understand the essential concepts of nutrition appropriate for a healthy-heart diet for a diverse population. Explain Apply Apply, empathize Explain, interpret Empathize Self-reflection
Plan learning experiences from the educator
a
Course Outcome
Student will identify US Department of Agriculture–recommended food pyramid and evidence of foods appropriate for a healthy-heart diet through quizzes and testing. Student will create a brochure to use as a tool to teach cardiac patients about diet and relationships to a healthy heart. Student will develop a meal plan appropriate for the patient considering assessment of food preferences and cultural implications. Student will present a teaching session with a cardiac patient to explain the diet and medical terms associated with nutrients and other associated aspects. Student will answer questions and ask for the patient’s concerns for implementing the diet. Student will evaluate his/her own diet in relation to the healthy-heart diet guidelines. Illustrate the effects of cholesterol on the cardiac vessels using pictures and videos. Use questioning: Does your current diet align with guidelines for a healthy heart? Assign groups of students to develop a meal plan using the evidence from resources to develop a weekly meal plan for a healthy-heart diet. Allow students to view an echocardiogram in the clinical facility on a cardiac patient. Arrange for observation experiences in the cardiac catheterization laboratory for patients with cardiac disease and arterial blockage.
Adapted from Wiggins and McTighe.9
124
Volume 39 & Number 3 & May/June 2014
Nurse Educator
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
innovative pedagogies supporting knowledge transfer. Teaching approaches should be domain specific to develop the deep understanding needed in nursing practice.1,4 Examples include (a) narrative storytelling of relevant experiences, (b) clinical case studies with increased complexity, and (c) simulation with appropriate debriefing and discussion.1,4,8,9 It is essential to connect major concepts presented through authentic activities to program outcomes. The ability to transfer knowledge and skill effectively involves the capacity to use what is known and to use it creatively, flexibly, and fluently in different settings and situations.8,9 An innovative strategy to curricular design, BD begins with clear outcomes and then assessment development that informs teaching and learning strategies.9,10,11 The BD framework has the potential to improve the quality of nursing education and ultimately patient care by clarifying the desired outcomes of academia and practice with evidence of integration, determining the appropriate evidence for outcome achievement, and purposefully guiding evidence-based teaching and learning practices that are best suited to the practice of nursing.5,9,11 Benefits of BD are viewed as (a) increasing the strength of curriculum and assessment design; (b) clarifying desired outcomes and assessment methods for curriculum and course planning; (c) applying evidence-based standards for teaching and learning practices for professional nurse educators; (d) providing a conceptual framework to guide nurse educators at all levels of preparation in educational practices; (e) minimizing content expansion without clear alignment with outcomes, competencies, or standards of practice; (f ) guiding priorities for content inclusion; (g) providing evidence of student performance and outcomes achievement expected by governing bodies for purposes of accreditation; and (h) contributing to the transformation of nursing education.9,10,11,16
Implications for Nurse Educators The rapid changes in healthcare should prompt nursing educators to integrate educational research, theory, and curricular innovations into practice.1,17 Nurse educators should evaluate innovative education practices such as BD to identify and address the relevant challenges to prepare future nurses to transfer knowledge in meaningful ways with deep understanding. Achievement of outcomes and competencies expected of the nursing student begins with a solid foundation of knowledge and skills acquired during basic education that are transferrable to practice in the workplace.4,5,8 The BD conceptual framework principles are consistent with the recommendations of leaders in nursing education to create a nursing workforce prepared for the complexities of the healthcare environment by intentional teaching and learning strategies directed to create measureable understanding. Aligning curricula begins with identifying the desired outcomes. Working backward can facilitate the ongoing transformation in nursing education by shifting away from coverage
Nurse Educator
of content and separation of clinical and classroom teaching, toward informed clinical decision making.17
References 1. Benner P. Educating nurses: a call for radical transformation—how far have we come? J Nurs Educ. 2012;51(4):183-184. doi:10.392.8/ 01484834-20120402-01. 2. TIGER Summit Summary Report. Sigma Theta Tau International Web site. Available at http://www.nursingsociety.org/Education/ ProfessionalDevelopment/Documents/TIGER_Final_Summit_ Report.pdf. Published 2006. Accessed February 5, 2014. 3. Schmidt P. Carnegie foundation calls for ‘‘radical transformation’’ of nursing education. Chronicles of Higher Education. January 6, 2010. Available at https://chronicle.com/article/Carnegie-FoundationCalls-for/63443. Accessed February 5, 2014. 4. Benner P, Sutphen M, Leonard V, Day L. Educating Nurses: A Call for Radical Transformation. San Francisco, CA: Jossey-Bass; 2010. 5. Forbes MO, Hickey MT. Curriculum reform in baccalaureate nursing education: review of the literature. Int J Nurs Educ Scholarsh. 2009;6(1). 6. American Association of Colleges of Nursing. Essentials of baccalaureate education for professional nursing practice. 2008. Available at http://www.aacn.nche.edu/education-resources/ baccessentials08.pdf. Accessed February 5, 2014. 7. Giddens J, Brady D. Rescuing nursing education from content saturation: the case for a concept-based curriculum. J Nurs Educ. 2007;46(2):65-69. 8. McDonald M. Laboratory and clinical evaluation. In: The Nurse Educator’s Guide to Assessing Learning Outcomes. 3rd ed. Brooklyn, NY: JB Learning; 2014:305-322. 9. Wiggins G, McTighe J. Understanding by Design. 2nd ed. Alexandria, VA: Association for Supervision and Curriculum Development; 2005. 10. Carlson DL, Marshall PA. Learning the sciences of research, learning the art of teaching: planning backwards in a college genetics course. Biosci Educ. 2009;13(4). Available at http:// journals.heacademy.ac.uk/doi/full/10.3108/beej.13.4. Accessed February 6, 2014. 11. Fox B, Doherty J. Design to learn, learn to design: using backward design for information literacy instruction. Commun Inf Literacy. 2012;5(2):144-155. 12. Childre A, Sands J, Pope S. Backward design. Teach Exceptional Child. 2009;41(5):6-14. 13. Dillard N, Siktberg L. Curriculum development: an overview. In: Billings DM, Halstead JA, eds. Teaching in Nursing: A Guide for Faculty. 4th ed. St Louis, MO: Elsevier; 2012:76-91. 14. Scheckel M. Selecting learning experiences to achieve learning outcomes. In: Billings DM, Halstead JA, eds. Teaching in Nursing: A Guide for Faculty. 4th ed. St Louis, MO: Elsevier; 2012:170-187. 15. Woolfolk A. Educational Psychology: Active Learning Edition. Boston, MA: Pearson Publications; 2011. 16. Graff N. An effective and agonizing way to learn: backwards design and new teachers’ preparation for planning curriculum. Teachers Education Q. 2011:151-168. 17. Boland DL, Finke LM. Curriculum design. In: Billings DM, Halstead JA, eds. Teaching in Nursing: A Guide for Faculty. 4th ed. St Louis, MO: Elsevier; 2012:119-137.
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