EXPLORING AUSTRALIAN UNDERGRADUATE PRE-REGISTRATION NURSING CURRICULA: WHERE DO SCIENCE SUBJECTS FIT?

Despite several attempts to define what foundational science is required by and for the nursing profession, uncertainty has long existed in this area. Several attempts have been undertaken to elicit the appropriate level and depth of foundational science with the only clear result being that science has been recognised as key to good practice. The aim of this research was to review the amount of science content in pre-registration curricula and explore how science was incorporated into educational programs. Two sets of data were obtained: approved curriculum documents supplied by universities, and public university website course subject information. Heads of Schools at Australian universities teaching pre-registration Nursing were invited to provide approved curriculum documents in 2007 and again in 2014. The 2007 documents demonstrated diverse approaches with no convergence towards one theory, philosophy or teaching strategy. In 2014, a clear move to flexible, online, case-based or inquiry learning and simulations strategies was observed. The volume of science was calculated by determining the proportion of science content based on credit point allocations to subjects for all publicly available course descriptions in 2006 and 2012. This calculation was also undertaken for the nine matched 2007 and 2014 volunteered curriculum documents. Results indicate a decrease in overt science content between 2006 and 2012. However, there is evidence of an increase in science content integration into nursing subjects in the 2012 and 2014 documentation.


Introduction
The positive relationship between improved knowledge of bioscience among nurses and patient care outcomes provides evidence to support the incorporation of science into undergraduate nursing curricula (Jordan & Hughes, 1998;Prowse & Heath, 2005;Prowse & Lyne, 2002).The study reported here examines Australian university subject lists, abstracts and curriculum documentation, to review how and to what extent science subjects are incorporated into the written curricula for pre-registration nursing education.Science subjects are defined as including anatomy, physiology, microbiology, and the foundational aspects of chemistry and physics which support learning in human biology, pharmacology and pathophysiology.
To ensure that graduates are eligible for national registration, programs are designed to meet the standards for pre-registration nurse education prescribed by the Australian Nursing & Midwifery Accreditation Council (ANMAC, 2012).These guidelines give no indication of necessary content other than that it "comprehensively addresses the National Competency Standards for the Registered Nurse … best practice perspectives on nursing … and emerging national and regional health priorities" (p.14).As of June 2013, this document supersedes the previous versions of the guidelines of the Australian Nurses and Midwives Council (ANMC) -(the Accreditation Guidelines ( 2009)), which were approved by the National Nurse and Midwives Board (NNMB) in February 2010.The ANMC document stated that "the central focus should be on nursing and contemporary nursing practice" (p.27) so that students can meet national competency requirements.That document had only one statement with respect to science-based content; science content had to be sufficient to support pharmacology and medication management (p.13).Individual state registration guidelines that preceded the NNMB guidelines indicated that human bioscience subjects should be included to support clinical practice subjects, but detail to support this statement was lacking (Logan, 2008).
Furthermore, it has been proposed that the presentation of a multiplicity of professional theoretical approaches in student programs may reveal conflicting worldviews and may result in increased student anxiety (Logan, 2008) and, potentially, a rejection of program content (Jegede & Aikenhead, 1999).Freshwater (2000) claimed that education based on a hegemonic philosophy which is unsympathetic to the discipline being taught will generate student frustration with that discipline.An exploration of curricula and subject descriptions to demonstrate how nursing educators view the incorporation of science content within the chosen pedagogies, and their relationship with nursing theories, could be expected to inform science educators of nursing students' needs.
Concerns over the science content of nursing programs have been expressed.Brown and Seddon (1996) estimated the proportion of science in nursing programs in the United Kingdom in 1993 to be 21%.In 2006, as part of a PhD project, Logan (2008) estimated the explicit science content of Australian programs using website information.The exercise resulted in questions of how science content was incorporated into nursing so that, in 2007, she collected nursing curriculum documents to examine the descriptions of underlying nursing theories and pedagogies supporting the curriculum frameworks.In this study, the estimation of science content was repeated in 2012 using website information, and

Background to science education in nursing
Studies to determine the level and depth of science being taught to nursing students have a long history with one of the earliest formal studies being undertaken in the UK (see Wilson, 1975).However, stereotypical views of nursing as "hands-on-care" persist, with students in a recent U.K. study reporting that they thought the academic load and the complexity of knowledge required was much higher than was needed for the actual work (O'Donnell, 2011).In contrast, 81% of New Zealand students felt that sufficient bioscience was incorporated in their nursing course (Friedel & Treagust, 2005).The challenge for nursing students in learning any biology-related science is that it draws from many science sub-disciplines, and consequently requires the student to possess an appropriate level of scientific understanding to cope with the complexity in order to develop inductive and inferential reasoning skills (Donald, 2002).The ability to create mental abstractions in science is important for the retention of scientific information (Donald, 2002).
The majority of Australian programs provide science classes in a service-taught mode (i.e.taught by a school other than the nursing school) rather than integrated into nursing subjects (Logan, 2008).The curriculum for these subjects is usually developed in a consultative manner based upon nurse teachers' perceived requirements.However, Minasian-Batmanian, Lingard and Prosser (2006) found that students perceive service-taught subjects as "tools" to be stored for later application, rather than deliberately integrating this knowledge into their other subjects.This approach can reinforce the perception of a theory-practice dichotomy.In addition, it has been claimed that the rapid increase in detailed scientific knowledge of the last few decades has made it increasingly difficult to identify just what foundational knowledge is required to support practice (Estabrooks et al., 2005).Regular course reviews are recognised as contributing to an increase in the material to be covered (Arthur & Baumann, 1996) and most programs undergo revision on a five-year cycle (van de Mortel & Bird, 2010).
There have been calls to "re-envision" nursing since its incorporation into the university sector (Giddens & Brady, 2007).These have been based on the disparate backgrounds of the entering students, or content saturation and additive curriculum (Giddens & Brady, 2007), and/or issues related to attrition (Andrew et al., 2008).Student attrition in pre-registration nursing programs was estimated at 24.5% (10 universities in Queensland: range 9.7 -41.8%) (Gaynor et al., 2006), which is a slight improvement on the 1994 Australian national estimate of 27% (Harvey & McMurray, 1994).Bioscience subjects are recognised as causing nursing students the most anxiety (Andrew, 2002), and as a major reason for student drop-out (Andrew et al., 2008).Perceptions of the lack of content relevance to practice appear to contribute to students' anxiety levels (Jordan, Davis, & Green, 1999;McVicar, 2009;Thornton, 1997); it has been noted that despite nursing students perceiving pharmacology modules as the most relevant, they also found them the most challenging (Jordan et al., 1999;Manias & Bullock, 2002).This is an indication that relevance to practice, of itself, is not enough to lessen study-associated anxiety.
Exposure to professional practice before learning the theory has been suggested in order to alleviate the theory-practice gap tension (Jordan & Hughes, 1998;McVicar, 2009).However, nursing students' understanding of bioscience material has not been shown to benefit from previous experience in health care settings (O'Donnell, 2011;Salamonson, Andrew & Everett, 2009;Whyte, Madigan, & Drinkwater, 2011) unlike other areas of health science practice such as paramedicine (Whyte et al., 2011).Bradley, Blackshaw and Nolan (2006) found that nurse lecturers had variable levels of bioscience knowledge and thus lacked the confidence to integrate foundational science into their teaching.In their observational study of nursing practice, Estabrooks et al. (2005) found that, despite the recognition that pre-practice foundational knowledge was important, it alone was insufficient to support practice.This is reinforced by the study reported by Davis (2010) where 40.5% of Registered Nurses (RN) (n=42) claimed that their undergraduate human bioscience studies did not prepare them for postregistration training.A qualitative study by McVicar, Clancy and Mayes (2010) confirmed that most nurses viewed their science knowledge as "weak."How this impacted on their confidence to practise was not raised in that study although there have been several attempts at determining the role of science in practice (see, for example, Prowse & Heath, 2005;Prowse & Lyne, 2002).However, students in preceptor relations have reported that their understanding of complex care was greatly influenced by their perception of the RN's level of expertise (Stockhausen, 2005), and potentially inhibited their ability to connect theory to practice.
Nursing students' pre-entry perceptions of nursing (Logan, 2008), their varied educational backgrounds (Dwyer & Higgs, 1999;Heath, 2002;Logan, Cox, & Nielsen, 2013) and the range of ages from 17-68 (Gaynor et al., 2006;Logan et al., 2013) suggest that adult learning approaches should not be assumed as the most appropriate.The bionursing model proposed by Akinsaya and Hayward (1980) was intended to provide explicit links between nursing practice and life science theories, but there are no reports of it being implemented and tested.
To overcome the shortcomings of traditional teaching, Problem-based Learning (PBL) has been implemented in nursing education (Bebb & Pittam, 2004;Don, 2001;Turner, Davies, Beattie, Vickerstaff, & Wilkinson, 2006).However, PBL programs have not consistently incorporated foundational science content (Logan, 2008).Integration of all discipline areas requires clear PBL curriculum design (Turner et al., 2006) and provides the opportunity not only to provide relevance to practice, but also to delineate discipline approaches, whilst integrating foundational knowledge.Don (2001) maintained that a PBL approach not only engaged the students but removed their sense of being overwhelmed by the science material.PBL is not universally agreed to be appropriate for nursing due to its illness-centred nature when contrasted with a framework for maintaining wellness (Bebb & Pittam, 2004;Kocaman, Dicle, & Ugur, 2009).Inquiry-based Learning (IBL) is similar to PBL except that it removes the focus on a problem to be solved, enabling incorporation of the exploration of wellness (Bebb & Pittam, 2004).
Students' prior learning experiences greatly influence their success in PBL because those with well-developed problem formulation and research skills are most likely to benefit, whereas group learning can allow those without these skills to flounder and go unnoticed (Forbes, 2000;Wells, Warelow, & Jackson, 2009).Consequently, the wide range of educational backgrounds of nursing students may hinder implementation of PBL, both from the students' and the lecturers' viewpoints.Other strategies such as case-based frameworks and narrative formats have been devised (Diekelmann, Ironside, & Gunn, 2005) but there is no clear evidence that these approaches improve student outcomes.
The narrative framework approach takes advantage of students' life experience and stories and was specifically designed for nursing education (Diekelman, et al., 2005), and has been used as a tool to emphasise the relevance of theory to clinical practice.This has the potential to overcome the variability in students' educational backgrounds (Diekelmann et al., 2005;Ironside, 2006;McAllister, 2001;Swenson & Sims, 2000).While such phenomenological approaches have been criticised as risking sentimentality and lacking precision (Ironside, 2001), other situated frameworks also exist to facilitate student-centred learning such as work integrated learning (WIL) associated with clinical practice subjects.
The university curriculum documents submitted for program accreditation in this project include reference to the nursing philosophy or theory as well as the teaching framework used for the program.Many nursing philosophies and theories have been proposed for nursing practice (Tomey & Alligood, 2005) but it has been suggested that differences between the philosophy of science, the biomedical model, and nursing discipline philosophies with their influence on teaching approaches would increase the potential for study tension and conflict in the student classroom (Logan, 2008;Logan & Angel, 2010).Evaluation of the effectiveness of any one undergraduate degree curriculum appears only in the curriculum documents to the extent that it provides justification for the changes made since the last iteration.This is despite many publications in nursing journals, such as Nurse Education Today, outlining the benefits of specific program designs or educational frameworks.

Method
The aims of this study were to: • identify the teaching philosophies and frameworks used by Australian universities for nursing education; • determine the level of specific science content, and if or how that content was incorporated into the programs; and, • assess if and how changes have occurred over time.
The project used curriculum documents to identify existing approaches, and the alignment of subjects within these approaches.After an initial review of subject documentation available on university websites in 2006, the Heads of Australian university schools offering nursing degrees were asked in 2007 for access to curriculum documents used for accreditation.If the whole document was not available, access was requested to the sections relating to the teaching and nursing philosophical frameworks.University anonymity was preserved by numbering the documents in the order they were received, namely, U1-16.The contents were compared with the current literature to ascertain whether innovative frameworks were being incorporated into teaching programs.In 2014 Heads of Schools were again asked for access to approved curriculum documents and nine were provided.
A subject, as defined by the Australian Qualifications Framework (AQF), is an accredited single component of study within a qualification (AQF, 2011).Some universities are now naming what in Australia was traditionally named a "subject" a "course" aligning to the international term.The AQF does not give an indication of how many hours of study are associated with a single accredited unit.To facilitate transparent credit transfer, the Bologna process undertaken by the European Commission Education and Training gives one credit for each hour of study.In the United Kingdom, this translates to 4,600 hours for a three-year degree.For a nursing program, this time is allocated equally between practice and theory components (Snelling, Lipscomb, Lockyer, Yates, & Young, 2010).
Because Australian universities have yet to set such a regulation definitively, this study used allocated credit points to determine the proportions of science content.
The course guides available on university websites in 2006 and in 2012 were used to ascertain any change in the level of science content.Subjects were identified as science subjects based on their titles and abstracts, for example: anatomy and physiology; microbiology; pathophysiology and pharmacology; bioscience.
Examples of subject descriptions are provided in Table 1.The estimate of science content was calculated by determining the number of credit points dedicated to explicit science content as defined by the abstracts and titles as a proportion of the total credit points for the pre-registration program.For example, if human bioscience, pathophysiology and pharmacology subjects made up 32 credit points of a degree totalling 192 credit points, then the component of explicit science was calculated as 16.7%.[This subject] focuses on the anatomy and physiology of the normal human body.Emphasis is on the development of both knowledge and understanding of a broad range of core concepts such as anatomical organisation along with chemical and physical processes and homeostatic balance.Changes through the lifespan will be discussed by taking an integrated and exploratory approach to teaching.Topics covered include introductory chemistry, cells and tissues, integument, skeletal, muscular, nervous and special senses and the endocrine systems.• arthritis and musculoskeletal conditions

Results
Universities treat curriculum documents as intellectual property and so they are not easily accessible despite it being expected by approving bodies that they are publicly available for scrutiny by stakeholders.Almost all universities who volunteered their documentation reiterated the need for confidentiality to be maintained.Each university was provided with the original summary of the University Nursing Theories and Pedagogies Table from the 2007 curriculum collection (Logan, 2008) as part of the 2014 invitation to volunteer their latest documents, demonstrating the identification system to be used for this current comparison.
Table 2 presents the proportion of science content in pre-registration nursing programs.The proportion of credit points or hours allocated to science subjects is calculated as a proportion of the total.The fourth column shows the differences between 2006 and 2012 programs, based on changes for each of the 26 universities for which paired data were available.Despite no net difference being evident over the four-year period (end 2006 to beginning 2012) for the matched pairs, the minimum increased but the maximum decreased giving a fall of four per cent in the median values.In some cases, only superficial name changes had occurred or material had been moved from one subject to another.When the original search of subject outlines was carried out in 2006, only one university had clearly incorporated all the science material into the nursing subjects through PBL.In 2012, PBL was being used by another university but only for nursing subjects.The 2012 search revealed that at least three universities now incorporate science into the nursing subjects.However, in the nine 2014 curriculum documents, which included one university that had previously been specific about using PBL, inquiry based (IBL) or case based strategies predominate.For the nine matched universities, there has been on average a 1.85% decrease in specific science content (see Table 3 for individual university changes).Notes to Table 2. 1. 27 universities used in calculation.One university had a fully integrated program and so was not included in the calculation.2. 27 providers included in calculation (includes 2 non-university providers).Three universities had fully integrated programs so were not included in the calculation.3. 24 universities with matching paired data.
The same method was repeated in 2006 and 2012 to calculate the estimates providing overall trends.The calculations did not take into account those programs for which the subjects were not available and integrated programs were not included.The main limitation of the website data was its lack of curriculum detail that is generally available in a specific university's accredited program documentation.The science estimate was restricted to publically available information which may be further truncated to meet website restrictions.Individual subject descriptions (abstracts and syllabuses) were not definitive for the level of detail often giving only an overall guide to topics to be covered.Where it was indicated that content had become integrated into nursing subject abstracts, an indication of the level of integration was difficult to define and not consistent across all documentation and so cannot be estimated.Also, the use of credit point values per subject for the calculations does not reflect the hours students spend on a particular subject.Nor does it include revision aspects of moving science classroom content to nursing and practice subjects or the evidence-based practice components of those practicum and nursing theory subjects.
Table 2 indicates that the median in 2006 of 17% decreased to 13% for 2012.These estimates are much lower than the previous 1993 UK estimate of 21% (Brown & Seddon, 1996).Table 3 provides the change over time for the matched pairs of university documents available in 2007 and 2014 along with the educational approaches.The average change was a decrease of 1.85% for these nine universities with a maximum decrease of 15.6 %.Integration of level 2 pathophysiology and pharmacology subjects into nursing subjects is the main cause for the larger changes, for example, U1 and U16 in Table 3.The apparent overall decrease of 4% in explicit science content between 2007 and 2012 does not give an indication of how much of that content has become incorporated into nursing subjects.Thus the values in Table 1 and 3 could be expected to be underestimates of the true amount of science included in a nursing pre-registration program.
From the 2007 documents, the theories of nursing associated with practice as a philosophy of "care" were identified and are tabulated in Table 5.The theory expressed by U6 was reminiscent of the work of Erickson's Theory of Caritative Caring (Tomey & Alligood, 2006) although no specific reference is given in the curriculum document."Nursing as Caring" uses story as a method of understanding nursing knowledge and the complexities of the "nursing situation," and was used in narrative pedagogy by U12 (Diekelmann et al., 2005).U4 and U5 placed science within their chosen philosophies, U5 stating that nursing is a scientific activity.Both universities espoused philosophies that acknowledge the humanistic aspect of nursing.U13 and U15 both used the nursing framework that four understandings -"nursing, person, health and environment" -are central to nursing practice.No particular theorists are given as references.In 2014, nine universities supplied their revised documents either in full or part and these are included in Table 5.  (Shuell, 1986:411)." Three major themes provide framework for the curriculum: 1. professional identity 2. dynamics of being human 3. dynamics of practice "Coherent, explicit philosophy of teaching and learning; problem/inquiry based, scenario based approach to teaching and learning throughout the curriculum; competency based approach to assessment; fundamental commitment to diversity of delivery and assessment; a core driving focus on nursing practice, in which supporting disciplines adapt to the needs of nursing" Teaching & Learning: Authentic, Engaging, Integrated, Interdisciplinary

U16
Not supplied Philosophy and theoretical framework of the curriculum "Nursing is a practice based discipline…The philosophical basis … centred on a belief in the centrality of practical knowing to nursing.In privileging the primacy of practice as something complex and profound, we position practical knowing in nursing as both a way of knowing and a kind of knowledge that both grounds abstract theoretical knowledge and is informed by this knowledge.We believe that, the primacy of practice is a more satisfactory characterisation of that reality nursing than distortions such as 'theory and practice': distinctions sustained through technical and rational understandings of nursing.""praxis is a pragmatic, context dependent and ethics orientated form of knowledge (Flyberg, 2001:56).Fundamental to this form of knowing is the capability for informed situational judgement, and a habitual

ID Nursing theory and/or educational philosophy 2007
Nursing theory and/or educational philosophy 2014 receptivity and self-awareness best described as 'mindfulness'.""Applying the principles of being and knowing as outlined by Heidegger the curriculum is designed to call the student into a learning circle which involves an iterative process of exposure to and engagement with knowledge and its application in nursing practice.The hermeneutic process of interpretation is circular, where understanding is sought through a dynamic movement between the part and the whole of narrative."

Discussion
The longstanding tension regarding the delineation of the "art and science" of care in nursing practice reflects, and potentially reinforces, perceptions of a hegemony supported by medical technicity and economic rationalisation.The actual discussion of "what is science" is rarely entered into at pre-registration level.A qualitative study undertaken as part of a doctoral thesis indicated that nurses deemed science content as foundational knowledge based in factual content, not science as a process for gaining knowledge.This factual knowledge was expected to support critical thinking and rationales for clinical practice to create a nurse who was termed by some to be a "bedside scientist" (Logan, 2008).
Understanding the scientific process and the benefits of that understanding were delegated to research and evidence-based practice subjects.Experimental design and understanding limitations of results were deemed the realm of the stereotypical scientist who wore a white coat.Certainly, the distinction between technology as a product of science and science as a knowledge development process was not made.In fact, they were often confounded (Logan, 2008).
A student of Level 1 human bioscience stated upon returning from nursing practicum: I have seen a lot of terminology we have learnt in science … it is nice to see the relevance and application of the uni work.This statement illustrates the challenge for service taught subjects to provide practice contexts particularly when more than one discipline group is represented in the student cohort.Yet the value of science to practice, as rated by students, is high (Birks, Cant, Al-Motlaq, & Jones, 2011).There has been recognition that students do not autonomously transfer knowledge between discrete subjects unless they are given a context for such transference (Minasian-Batmanian, et al., 2006).As a result, the separation of theory from practice such as foundational science content being separated from practice-based subjects, is thought to reinforce a theory-practice gap.Practice provides the opportunity for a nexus between discrete subjects to develop while students are experiencing practicum.It can be seen in the comparison between 2007 and 2014 that this nexus is being brought more prominently to the forefront of the curricula through simulations, case-based programs and inquiry based formats for teaching and learning.The increase of the integration of pathophysiology and pharmacology subjects into nursing subjects would also support a practice-theory knowledge nexus.
The 2014 U16 document deems the "theory-practice gap" a distortion of nursing practice in an attempt to reject the theory-practice gap concept through undertaking a course philosophy where "privileging the primacy of practice" dominates the curriculum.Further examination of Table 5, however, indicates the "science versus care" divide has not been entirely lost to nursing.For example, U5's 2007 documentation refer to "humanistic and scientific" aspects of nursing and have reinforced the "scientific" statement using "nursing is a scientifically based profession" in 2014.U9 in 2014 claims nursing requires scientific understanding and evidence based care that is enhanced by a "deep knowledge of bioscience" whereas such a strong statement is lacking in the 2007 documentation.U4 referred to nursing as an art and a science in 2007 but this reference has been lost from the 2014 curriculum.U8 stated in 2007 "our curriculum blends the basic and applied sciences that ground our knowledge with the art of nursing" yet this is not present in the recent document though the term 'evidence based practice' is given and deemed an "important influence."U1 and U11 have omitted the words "science" or "scientific" in either time period although practice is said to be evidence-based.Certainly, an emphasis on implementing established nursing theories as part of the curriculum is less evident than was apparent in the 2007 documents and a minimisation of the theorypractice gap is highlighted through increased use of education formats that provide practice situational contexts.
For the scientist teaching into applied health fields such as allied health and nursing professions, a challenge arises to provide situational context.As noted earlier in this discussion, it can be even more difficult in multidisciplinary cohorts.When interdisciplinary differences exist in practice philosophies and these differences are not clearly understood, then the challenges are further compounded for the scientist.Content determined directly from the supplied curricula provides minimal insight by listing the foundational aspects of body function relevant to practice but the context aspects of practice are not overtly expressed or prioritised.Individual subject curriculum documents usually outline an abstract or summary of the topics to be covered with a series of learning objectives provided.The entire subject outline may cover only two pages of a preregistration curriculum document.The challenge is therefore to determine the appropriate level of the detail and context from these documents.Several researchers have undertaken this challenge at various times (Jordan & Hughes, 1998;Logan, 2008;Prowse & Lyne, 2002;Wilkes & Batts, 1998;Wilson, 1975) yet it remains a contested component for educational design.
Responses to a survey of 100 registered nurses suggested that nurses intuitively know the level of science content for practice and how it can best be taught (72%) yet 41% indicated that they felt a nurse teaching fundamentals of science should also hold qualifications in a traditional science area (Logan, 2008).Nursing academics comprise only 35% of the lecturers teaching the bioscience subjects in New Zealand (Nicol, 2002) and in the UK only 15% of basic science lecturers had nursing qualifications (Wharrad, Allcock, & Chapple, 1994).More recent data is not available for international or national programs.It may be possible to overcome the challenges through team teaching -nurses and scientists together, enabling perceived gaps to be bridged.Donald (2002), whose work outlines discipline specific differences within science fields, indicated that interaction facilitates the integration of scientific principles whilst enabling the understanding of relevance to specific areas of knowledge.This approach supports educational formats such as IBL and case based learning and may be ultimately evident in simulation-based assessments.In using a team-based approach the explicit understanding of foundational science content that practitioners may fail to recognise (Estabrooks et al., 2005;Titchen & McGinley, 2004) may become more apparent to scientists and so better communicated to students.Curriculum design that makes practice -science theory links explicit requires effective nurse and scientist teamwork embedded within a pedagogy that recognises the links, strengths and weaknesses of both disciplines with respect to the totality that is patient care.

Conclusion
Despite representing approximately only one third of all courses offered by Australian Universities, the longitudinal comparison of the nine supplied nursing curriculum documents demonstrates a clear trend in the changes that have occurred.It is evident that although explicit science content, as designated by labels such as human bioscience, pathophysiology or pharmacology, has decreased, much of this content has been integrated into nursing subjects.It has become less conspicuous and less defined in newer curriculum documents.There is an increased undertaking by nursing higher education programs to incorporate case-based, inquiry based and simulation learning experiences for students that provide clear contexts for theoretical knowledge within practice.Further research independently evaluating full program designs in order to compare educational approaches for nursing practice would be beneficial.An exploration of how the concepts of science and foundational science content is incorporated into casebased and inquiry based frameworks would assist those who undertake teaching for health practice professions.Further, a study of the potential benefits of discipline team teaching upon learning for students in subjects where science is integrated might also elicit those linked practice concepts for dissemination and provide a clear indication of where science fits within curriculum.
] will introduce the processes of disease and injury in the human body.It builds on knowledge acquired in [pre-requisite level 1 subject].Learning objectives include descriptions of illness trajectories, connections between structure and function of the body and processes of disease and injury; explain and articulate the logic of signs and symptoms that manifest during a disease process; explain how pharmacological interventions and contemporary practice affect pathophysiology, patient therapy and patients outcomes; pharmacokinetics and pharmacodynamics of drug interventions for the conditions listed.Topics covered are drawn from the AIHW 2011 Australian Health Priorities:

Table 1
Subject description examples

Table 2
Explicit science subject content within pre-registration nursing programs as presented on university websites

Table 3
Educational approaches from matched curriculum documents 2007 and 2014 Examination of the 2007 curriculum documents revealed that six of the university documents did not allow the identification of specific teaching approaches.The educational formats provided in these documents are summarised in Table4.For the paired 2007 and 2014 documents this information is given in Table3.

Table 5
Nursing theory and/or educational philosophy from matched curriculum documents 2007 and 2014 "The development of close clinical associations to provide practice experience for nursing students enables the melding of a humanist philosophy with the pursuit of clinical excellence and scientific critical enquiry.Habermas (1978) …identified three forms of knowledge: technical, practical and emancipatory knowledge… .Curriculum is designed to assist students develop self-reflection, and independence in their own learning style.… lectures, tutorials, problem based learning sessions, laboratory skills sessions, clinical practice, reflection, journaling, reading and study are integrated within the curriculum to provide students with the tools to develop and use technical, practical and emancipatory knowledge.…to continue life-long learning within the discipline of nursing."

ID Nursing theory and/or educational philosophy 2007 Nursing theory and/or educational philosophy 2014 facilitate
health and wellness.At the same time, issues such as risk, consequences and best practice will all be examined in order to … fully engage in effective health care."

ID Nursing theory and/or educational philosophy 2007 Nursing theory and/or educational philosophy 2014 Educational philosophy:
"The philosophy of the school is based on the following values: social justice; cultural sensitivity; autonomy and independence; caring; adaptability; quality; and integrity.The school believes that the patient must be viewed in an holistic manner.Nursing … we believe is based on three tenets.