Can Integrating Disciplinary Concepts and Knowledge Throughout the Curriculum Improve Professional Identity, Clinical Reasoning, and Judgement?

Contributor: Arlene McGuane, MSN-Ed, RN
EdD candidate
, Teachers College Columbia University

This is the second in a series of posts about a nursology study conducted by a student-faculty group from the Online Nursing Education (ONE) program at Teachers College Columbia University. The study, “Use of Foundational Concepts in Program and Course Descriptions: An Analysis of Prelicensure Baccalaureate Nursing Programs in the United States,” looked at the use of four nursing concepts, context, holism, health, and caring, in program descriptions and the first three nursing course descriptions of 300 BSN program websites.

In 2021 the American Association of Colleges of Nursing (AACN) released a new set of essentials that are designed to provide nursing education with a framework for preparing individuals to practice in the discipline of nursing. The introduction of the document emphasizes that for nursing to retain its status as a discipline, nursing disciplinary knowledge needs to be integrated throughout the curriculum and at all levels of the education continuum. They also identified that there are five key concepts that define the discipline of nursing: human wholeness; health; healing and well-being; environment-health relationship; and caring.

Our study “Use of Nursing Concepts in Program and Course Descriptions: An Analysis of Prelicensure Baccalaureate Nursing Programs in the United States” which focused on four of the five key concepts that are highlighted in these new essentials revealed a clear gap in the use of these foundational concepts in both the program descriptions and the descriptions of the first three nursing courses that students are exposed to early in their education. If these concepts are essential elements of the discipline, why are they not mentioned in these descriptions? This phenomenon has left me wondering where and at what time are these foundational concepts, that are necessary for nursing practice, taught in nursing programs.

Our study was a first step toward understanding how best to structure education in a way that gives students a stronger foundation in the focus and knowledge base of the discipline. We can no longer just offer one course or courses at the beginning of a program and expect our students to effectively engage and use the knowledge in practice. As a nurse educator and researcher, I am concerned that our study shows that we may not be teaching from a nursing disciplinary perspective. If so, we must ask ourselves how this will impact the practice of new nurses.

In 2006 Tanner highlighted that nursing disciplinary knowledge is a key component for effective clinical reasoning and judgment. However, Kavanaugh and Sharpnack (2021) reported that only 9% of nurses entering practice today are performing at a safe and acceptable level, and this is a direct result of poor reasoning and judgment. This begs the question, is the lack of these core disciplinary concepts in nursing education a factor in the poor reasoning and judgment of these nurses?

Further research is needed to determine if these concepts were integrated throughout a program could it lead to better reasoning and judgment. At my institution the students are only exposed to theory in one of their first nursing courses. Once they leave that class those theories are not integrated in the curriculum to assist students in connecting and applying them to their practice. How can the students understand and make connections if as educators we don’t help guide them?

In nursing education today there is a trend to prepare students for their role as nurses based on the tasks, skills, and interventions. If we do not connect the disciplinary knowledge to these actions, then we are not supporting and rooting their professional nursing identity and practice in the knowledge of the discipline. They simply become masters of the task and not the discipline. Future research is needed to explore the impact that integrating nursing disciplinary knowledge throughout a program, with a focus on the 5 key concepts, has on the development of one’s professional identity, clinical reasoning, and judgment.


American Association of Colleges of Nursing. (2021). The essentials: Core competencies for professional nursing education.

Dickinson, J.K., Juan, S., McGuane, A., McKenzie-Henry, I.A. (2022). Use of Nursing Concepts in Program and Course Descriptions: An Analysis of Prelicensure Baccalaureate Nursing Programs in the United States. Nurse Educator,

Kavanagh, J.M., Sharpnack, P.A., (January 31, 2021) “Crisis in Competency: A Defining Moment in Nursing Education” OJIN: The Online Journal of Issues in Nursing Vol. 26, No. 1, Manuscript 2.

Tanner CA. Thinking like a nurse: a research-based model of clinical judgment in nursing. J Nurs Educ. 2006 Jun;45(6):204-11. DOI: 10.3928/01484834-20060601-04. PMID: 16780008.

About Arlene McGuane

I have been an educator in undergraduate pre-licensure education for over 10 years. I am currently a doctoral candidate in the Online Nursing Education Program at Teachers College Columbia University. My research area is in the development of clinical reasoning and judgement in nurses through the use of teaching strategies and theory, along with the use of theory in nursing education. I am passionate about nursing theory and try to connect it in my teaching as much as possible.

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