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Is Concept Based Nursing Flawed? (Podcast)

Is-Concept-based-nursing-flawed

Struggling in nursing school?

NURSING.com will skyrocket your grades 🚀

Some hate it, some love it and others have no clue what it is.

I interview our director of curriculum here at NURSING.com, Nicole who is a huge fan of concept based nursing so long as it’s taught properly.

The idea of concept based nursing in itself isn’t flawed however, many nursing programs fail to implement it properly.

Similar to how in nursing school we are constantly told how we must use  critical thinking but very rarely are we taught how to critically think in a nursing sense.

We break down what concept based nursing is and how to thrive using this system.

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Podcast Transcription

Welcome to the NRSNG podcast where we bring you helpful tips and stories to help you navigate nursing school and become a great nurse. NRSNG is the best place to learn nursing and created by your host, Jon Haws, RN. What’s up guys? 

Pause. RN within our S and, G. and today I’m joined by introduce yourself. 

Uh, Nicole Weaver, a curriculum director for NRSNG. 

This is Nicole. And so we’re joined today. We’re talking over Skype and over the last several months, almost about year now, we’ve been deep diving into nursing concepts and more Nicole has than I have. And so I wanted to bring her on here and have her kind of talk about nursing concepts because it’s kind of being seen as the wave of the future and the way that nursing schools are going. So Nicole, if you want to kind of just introduce us to nursing concepts, what they are, what this whole buzzword is. 

Yeah, so nursing concepts were introduced kind of as a way to replace nursing diagnoses. Um, nursing diagnoses have been used for a long time, um, and are inherently flawed for many, many reasons. And so they brought in the idea of nursing concepts to try to help students focus and focus their priorities a little bit. Um, instead of having all these really deep, detailed, long, lengthy nursing diagnoses that really addressed one problem, we can use a concept that actually addresses a group of problems. Um, and so it was an idea, um, to try to help students focus their priorities a little better. 

Okay. So the, I, the idea is, is maybe focus and simplification. 

[inaudible] I think that was the original intent. Yes. 

No, when I talked to, like, if, if on our Facebook group, the NRSNG Facebook group, I’ll, you know, randomly question who does nursing concepts? Some people know they’re in nursing concept programs, others have no clue what it is. Most of those that are in it hate it. Uh, and a lot of times those that realize they’re in it realize, Oh, well that’s why I hate it so much. Um, maybe talk to that a little bit. Like, why is it so, why is there so much maybe pushback from the student side of things? 

Yeah. Well, you know what’s interesting is there’s really inconsistent application of the nursing concepts model within nursing schools. And so some schools will say that there are concepts based program because they use nursing concepts instead of nursing diagnoses. Um, but actually they’re doing everything exactly the same as they did before except they’ve switched. Right? Um, and so they’re not really implementing the concepts based idea very well. And so it’s just confusing. It’s confusing because students are still being asked to know everything. They’re still being asked to have 17 priorities. They’re still being asked to follow that original kind of medical model. Um, even though they’re supposedly supposedly using the concept space model, um, a true concept space program, you’ll really know your end one if every single semester you may talk about things like perfusion and oxygenation and fluid balance, but then within each semester you’ll talk about different types of disease processes or the word they use as exemplars. 

So you’ll talk about a different example of a perfusion problem every semester. Um, and so they, they go by concepts as opposed to us traditional programs that’ll go by, you know, med surge, one is chronic diseases and then we happen to use concepts. And my surge two is acute diseases and we happen to use concepts. So it just kind of depends on your program. So I think the inconsistency is in implementation causes students to be really confused as to what the purpose of concepts are and what it means to be in a concept space program and what it means to use them and why they’re amazing. And yes, I said they’re amazing because I actually think they are, we’re just, we’re seeing such in consistencies that it’s really confusing our students. 

So maybe like let’s talk to that. You mean you touched on this, but if I’m, let’s say I have student a and student B, how would I know based on the syllabi or syllabus syllabi of those two students, what type of program they’re in, whether it’s traditional or concept-based [inaudible] 

so I’ve actually reviewed ’em a couple of dozen syllabi from, from our users who’ve sent them to us most of the time. What I find in a concept space program is on your syllabus it will say what concept you’re studying. So for example, perfusion and then it will tell you what your exemplars are. So, uh, you know, heart attack, myocardial infarction or it’ll talk about hypo Valenia, you know, fluid volume deficit. Um, and maybe give you some chapters in a textbook, maybe like to back up what you’re looking at in a traditional program that happens to use concepts, you probably will not see a single concept written anywhere on your, your syllabus. You’ll see chapters, you’ll see disease names, you’ll see body systems. Um, you’ll just discover as you start going through your program that uh, especially in clinicals, they have you using concepts to describe what’s going on with your patient as opposed to the traditional nursing diagnoses. So typically if you’re in a concept space program, you’re actually going to see the different concepts listed on your course schedule, on your syllabus. Um, and you’ll probably even have a concepts based textbook potentially that I think they’re still working on depending on the program. But 

yeah, I mean we just reviewed several textbooks and it looks like they’re moving toward concept based, but [inaudible] 

most of them are still body system based, 

body system based. Right? So, so if I, if I’m a student, I mean it’s, it’s a lot easier in my mind to say, you know, what study the, the cardiovascular system, let’s start the respiratory system. But if I’m in a concept based program, I’m not really caring necessarily what body system a disease comes from. I’m really caring about perfusion is going to affect and be seen in these disease processes. Is that kind of a way to say it? 

For sure. Because you might have a, like let’s take oxygenation is a great example. You’re going to have some things in your cardiovascular and hematologic system that affect oxygenation, right? Like anemia and bleeding. And then you’ll also have things in the respiratory system that affect oxygenation. And so when you’re just talking about oxygenation as a whole, as a concept, you may actually pull things from multiple different body systems. So if you try to just go to, uh, you know, one body system chapter, you’re probably not even going to actually get all of the things that you’re supposed to be talking about in that specific section. Um, or that, you know, for that test. And the other thing going the opposite direction is everything in your cardiovascular chapter. While it may all deal with perfusion, you might not actually be covering all of that this semester. It might be that you cover, you know, some of it this semester and some of it next semester. So kind of knowing which concepts in which exemplars you’re supposed to be looking at kind of helps you to narrow down, you know, what you actually need to be focusing on. 

And I think that’s where I was confused initially looking into this is we’d have students coming to us and saying, you know, on my test this week we’re doing asthma and heart failure. And I’m like, well, what the hell is the connection there? But, you know, if you look at it maybe from a profusion standpoint or from an oxygenation standpoint, it makes perfect sense, right? Um, yep. 

You got that crossover with the, you know, oxygenation and gas exchange and new, you’re seeing the bigger pictures. And that’s one of the things that I like about concepts, about nursing concepts is it really allows students to see big pictures and the big priorities for their patient as opposed to trying to isolate one, you know, very specific problem in a very specific patient. 

[inaudible] so talk to that then talk to you know, what the benefits of concept-based nursing and then we can go into maybe how to study in a concept based program 

for sure. So concert space nursing, again, if you remember, if you’ve ever used nursing diagnoses, and some of you, if you’re smack dab in the middle of a concept space program, you may have never seen a nursing diagnosis, which is so good for you. But nursing diagnoses, they tend to be very, very specific statements. For example, impaired peripheral perfusion related to presence of peripheral vascular disease as evidenced by you know, purple discoloration of the skin. So it’s this very, very specific problem for this patient that you’re literally talking about the skin on their legs is purple and therefore they have this problem, right? Um, and so it, it makes you focus. So then you end up having dozens potentially of these nursing diagnoses for your patient, and then they want you to prioritize. You’ve got two, two dozen in your mind, and then they say, okay, pick your top three. 

You’re like, what in the world? How do I pick three? Um, you know, and of course everyone wants to go ABCs, right? And so you start to kind of miss the real big picture. So the example I always use is I came up with a top 12 list of nursing diagnoses for heart failure. And honestly, there probably are another 12 that you could come up with. And all, all of those I was able to bring down into three concepts, perfusion fluid and electrolytes and oxygenation. And so then now I go, you know what? Perfusion is a problem. It’s my number one problem with heart failure. I don’t have enough fluid pumping and now I go, how can that affect my patient? Okay. They might have a low blood pressure. Okay. They might have poor profusion to their extremities. Okay. They might, you know, have, uh, a high heart rate compensating that you know, you can kind of think of all the things that may come together with a perfusion problem in heart failure. 

So you get to see that bigger picture and start making those connections between, okay, they have purple discoloration on their leg and they also have jugular venous distention. What does that mean? And so it all becomes this kind of one umbrella topic that you can really focus. Um, and so it helps you then make connections again between the disease processes. So you’re going to see that you’re seeing oxygenation problems in heart failure and in asthma and you’re going to see that those connections are there and that, you know, then imagine somebody with heart failure and asthma, we have a big problem, right? Um, it also helps students with higher levels of thinking. Again, you’re not just focusing on this one little minute detail that’s going on with your patient. You’re seeing that bigger picture. Um, and it also, when that happens and you don’t have 24 priorities, you actually do only have three priorities. 

It keeps you from being overwhelmed, keeps you from having content overload. It really allows you to pick out the important pieces as we say here at NRSNG. Pick out the Philemon Yon. Right? Um, and I personally think with concepts based nursing where you can pick one major topic and then, and see a lot of different avenues to put that together. It suits more diverse learning styles. So you could kind of, if you’re a really kinesthetic person, then you say, okay, I’ve got a profusion issue. Let me feel their skin, let me touch, let me palpate their pulse. Um, whereas if you’re more visual, it might be, let me look at the color. It might be, let’s check a blood pressure. So it really kind of suits a more diverse range of learners, which is really fantastic. Um, but I, I remember my favorite example, I remember with one of my students, they actually transitioned to concepts while she was in school. 

So bless her heart, she had nursing diagnoses in her head. And I was like, okay, what’s your guys’ number one problem? And she was like, um, impaired tissue profusion related to D. and I was like, stop, don’t give me the fancy words, just tell me his problem. And she was like, well, you have the old man’s skin. I’m like, right. So skin integrity. And she was like, Oh yeah. And so then from there from, Hey listen, my number one problem is there’s a skin integrity issue there. We were able to go, what are the things we can do about it? What might we see? What are we looking for? And so we were able to build a plan just based on that one big problem instead of trying to, you know, isolate this tiny little problem. 

Right. So with that, I mean, we’ve, uh, cause I really started to fall in love with them. I remember when I started digging into it last year, I was like, dude, Nicole, I think this is actually the right way to do things. It’s just, yeah, I think there’s the implementation problem. So maybe talk to how over the last year or so, we’ve, um, we’ve made a big shift in NRSNG to make concepts a big piece of, of, of our platform. Maybe talk about some of those changes we made and how a student concept-based or not could benefit from some of those changes. 

Absolutely. So in every single disease process lesson that you watch on NRSNG, you will see towards the end, we will give you a top two or three nursing concepts. Um, and if you, even if you’re not in a concept space program, what’s going to happen is you’re going to start making those connections. You’re going to start seeing common concepts, um, among different disease processes. You’re going to say, Hey, all three of these things are fluid and electrolyte issues. All three of these things are coping issues. Um, and so you start to make those, those connections. You start to see patterns. So inside each lesson you’re gonna start seeing those. Um, and that’ll be in the outlines as well of what our top concepts are. But what we’ve also done is we’ve actually tagged every lesson with anywhere from one to four of the top concepts. 

And so you can actually go into the search feature on NRSNG, whether just the general search feature or in looking in a study plan and actually search by concept. So you can say, I’m really looking for all of the things that have to do with comfort. And you can select comfort and you’ll see all of the lessons that have that tag. Now not all of those lessons may apply to what you’re learning, but we’ve done that for you so that you don’t have to think that, you don’t have to think about it, you don’t have to search for specific lessons. You know, you’re working on comfort. Um, you may have a chapter in front of you, you may have a syllabus in front of you that tells you what exactly you need. Um, and so then you just compare that with what we’ve pulled up cause we’ve already, anything that’s significant for comfort, we’ve already tagged it for you. 

Um, and so we hope that that makes it a little easier. Um, whether you’re in concept spaced or not to find what you’re looking for, but at the same time, if you’re not, like I said, at the end of the lessons, we have those top concepts. So if you start to see patterns you like, you know what, I want to look up a few more lessons and see what else is associated with gas exchange, then you can go in and search that concept and you can see the other lessons and start drawing those connections and making those patterns. The big thing here is it really helps with critical thinking, helps you put big pieces together, um, and really think longterm instead of focusing on like one little tiny problem at a time. 

Yeah, I think that’s key, you know, because critical thinking is one of those buzz words too in nursing school, right? Like you guys got to critically think, but no one teaches how to do it. And I think that seeing this broader picture that, you know, what I really care about is this patient is not perfusing and I’ve got to fix that now. Um, and being able to see that that includes the lungs, that includes the legs, that includes every piece of the body, uh, and then being able to tie that all together and start making those medical nursing decisions that fix the problem is much different than saying, I’m fixing a heart attack today. You know? 

Yep. Well, that’s a great point because think about, I keep going back to that peripheral vascular disease example, and you’ve got a patient with purple legs, right? Because they have vascular disease. What are you going to do that’s going to fix that today? Right? His legs are not going to suddenly turn pink by the end of your shift. That’s not how it works. And so when you start to focus just on that one problem, you, you start to realize like, what am I even doing? Right? But if you think as a whole, I need to optimize perfusion in this patient, then I may not turn his leg pink, but by golly, I’m going to make sure his blood pressure’s good. I want to make sure he’s got good pulses. Right. I’m going to check positioning. So there’s so many things you can do to optimize perfusion without worrying about the tiny little minutia and you end up doing better for your patient in the end. 

Cause I didn’t, I mean that’s what we’re doing. Uh, you know, on the nursing floor, it’s when you get that report, like you’re thinking in these concept level things, it’s like, well, I can maintain skin integrity during my shift, you know, by turning every two hours by putting skin cream online, et cetera. Right? Yeah. It can maintain profusion by optimizing blood pressure keeping, you know, rather than, yeah. Not necessarily taking care of an ischemic stroke. You know, I’m taking care of profusion, I’m taking care of, you know, all these different concepts that can optimize that patient during those 12 hours. And I think that that’s where concepts really becomes powerful is when you start seeing those things that you’re going to do during your shift to optimize those issues. 

Yup. And I think it allows you to, um, it allows some of that clinical judgment and critical thinking to come in. Because what I’ve seen from students that I’ve worked directly with is they will have a nursing diagnosis or something really specific and then they just, or they’ll say, or even they’ll say profusion and then they’ll start listing all of these things they would do for that concept. And like that doesn’t apply to your patient, but that doesn’t apply to your patient. And so by having it really, it gives you a way to say, all right, I know profusion is a problem. Now let me look at all the possible things I could do, prefer for profusion and compare them to my patient. What’s really going on with this person and what does this person need that’s related to profusion. Um, and allows that, that clinical judgment part to come in as well as opposed to, um, regurgitating a list of interventions. 

So let’s, I mean we’ve given some tips here. We’ve given some advice. Let’s, you know, tell everyone we want you to get an NRSNG account because we’re going to cater to you. If you’re in concept-based nursing, if you’re not a, we’ve kind of structured things that way because we think it’s a great way to think. Can you give some final tips for those in a concept based program who maybe feel like they don’t have the support they need to be able to get the most out of it and maybe kinda guide their own learning. 

I would say don’t be afraid to look at disease processes or lessons that are not necessarily on your syllabus. So, uh, I keep using profusion. It’s always the top one in my mind. If you looked at profusion on the study plan creator, you’re going to see maybe the disease processes that are on your list, but you’re also going to see things like cardiac anatomy and heart sounds. Um, and so don’t be afraid to grab a couple extra lessons, um, and try to see if that helps you draw some better connections, um, and put more pieces together of the puzzle. So don’t be afraid. I know this sounds like here’s my tip, do more. That’s not what I mean, but don’t, don’t be afraid to kind of grab a couple extra things to review because I think it really helps. Um, you know, we focus a lot about making connections and drawing connections to real life and connections between different disease processes. 

Um, and so don’t be afraid to grab a couple of extra lessons to help with that process. Um, and then also don’t be afraid to go back to your basics. You’ve got a new anatomy and physiology course that is phenomenal. Um, I know, I’m so excited and those are, those are basics of how does the body work. And so, you know, if I know profusion is my problem and I remember how the blood vessels work and I remember how the heart pumps, because I understand that a and P, then I can start to figure out what happens when it doesn’t work. Um, so don’t be afraid to go back to your foundation as well when you’re trying to build these, um, these disease processes in your mind, the concept space programs are designed to build on the, on each other. So like one semester builds on the other. Um, but it may not be implemented well. So don’t be afraid to kind of build it yourself if you need to and add some of those extra lessons in there. Make sure you have that good solid foundation you can build on [inaudible]. 

Perfect. I think this gave hopefully, uh, gave, uh, you know, kind of some insight into our thought process for concept-based nursing. It’ll help people kind of see where it can be beneficial even if, you know, they’re struggling through it right now, especially if they’re one of those students who is in a program that’s transitioning. I that can be incredibly hard. So hopefully this helps. Um, Nicole, do you want to do our outro? 

Yeah. So I’m like, sure. We want to say what we always say. Fabulous. Well, like, I’d like John’s, I hope this helped you guys. So as we always say, go out and be your best selves today. And as always, happy nursing. 

Thank you for tuning into another NRSNG podcast episode. Make sure to head on over to www.nrsng.com and create your free account to see why we’re the fastest growing nurse education platform. Happy nursing. 

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