by Carrie B. Lenburg, EdD, RN, FAAN

Article originally published September 30, 1999

Overview of Conceptual Frameworks

Fundamental problems associated with developing and implementing competency-based programs can be linked to a lack of emphasis on them in teacher preparation, with resulting deficits in programs preparing nurses for general or specialized practice. The historical use of individual, subjective and inconsistent methods and lack of established conceptual frameworks perpetuates the problems in both education and practice settings. The reorganization of existing programs to integrate outcomes-oriented learning and performance assessment concepts, however, presents a broad array of issues and concerns for those involved in developing them or being evaluated by them. They range from determining what content to include or exclude, where and how it should be distributed, which teaching methods to use, and the ever-worrisome question of how to evaluate achievement objectively and legally. The challenge has become even more problematic with the escalating and complex changes in demographic, socioeconomic, and political circumstances and the resulting domino effects on education and healthcare systems.

A number of issues relate to changing teaching methods to meet the performance expectations of academics and employers. Typically, instructors find it difficult to give up content and skills traditionally considered essential. It is easier to keep adding rather than to make the hard choices to deliberately reorganize content and methods to be more consistent with actual current practice needs. Their questions frequently include: What should we give up? How can we justify not "covering all the content"? How can we include the exploding volume of information available on the Internet and in encyclopedic textbooks? And how much more can we expect of students who already are overloaded with multiple other responsibilities? The situation is amplified by employers and practitioners who question what teachers are teaching and expecting of students, and why new graduates are not as competent as they need to be in the current work environment. They resent spending time and funds to "reteach" graduates and to provide extensive orientations before they can safely implement the skills required in professional positions (del Bueno, 1995; del Bueno & Beay, 1995). And graduates are caught in between, feeling that they have had tremendous work loads while in school, and yet are under-prepared and lacking in confidence in practice.

The most troubling and insightful questions go to the heart of the issue: If instructors teach and evaluate everything possible, will learners be competent for practice? Is competence determined by the volume of what is taught and evaluated? Is it acceptable to continue to use traditional educational methods in spite of revolutionary changes in healthcare delivery? The reflective response is "No." Programs of learning and evaluation need to be redesigned, not patched up. A growing number of responsible leaders in many facets of the profession believe it is time to work collaboratively to create rational and comprehensive models to promote effective and efficient learning and validation of competencies essential for beginning and advanced practice. This author believes that such models have more potential for success, in spite of resistance, if they are grounded in a conceptual framework that is comprehensive, cohesive and consistent with the realistic needs of the practice community.