Learn aNd Layer (LNL): An innovation in bridging theoretical core competencies and clinical practice in Advanced Practice nursing education

The trajectory of Advanced Practice Nurse curricula is constructed on the premise of enriching knowledge bases of students with core theoretical principles.  These principles cement the foundational core concepts that set up a clinical environment for advanced diagnostic and therapeutic decision making.    Traditionally, core knowledge precedes the population specific advanced clinical   fundamentals.   A layering technique of instruction in every clinical course is a mechanism that further supports the integration of the two learning modalities.

It is not enough to merely rely on the student’s ability to recollect the pathophysiological, pharmacological, and assessment concepts, learned in earlier semesters.  Evidence supports that students indulge in the phenomenon of ‘illusion of comprehension’ (Mkeachie & Svinicki, 2013), not being able to fully integrate fundamental concepts into the application of clinical knowledge.  In order prepare competent and confident student practitioners, the core content must be reintroduced with pertinence to clinical topics.  Core content is then layered onto with the clinical complexity matching their level of education.  With an understanding of the core knowledge as it pertains to clinical scenarios, the student experiences a clear methodological sequencing of content that fits together like puzzle pieces.   A critical examination of the concept of the ‘constructive learner’ extrapolate how our students need to be challenged  to make sense of new knowledge by building on the foundations of previous knowledge (Moss 2010; Askel-Williams & Lawson, 2006).  The premise is to create the perfect environment to make theory and practice dependent on one another (Rolf, 1993).

The theory/practice linkage has been guiding many educational innovations including this Learn aNd Layer (LNL) delivery of clinical content.  By encouraging the recollection of certain core concepts, new concepts are introduced as a direct branch from the core.  The relationship is made more relevant, due to the fact that the linkage is brought to life with new concepts.  As the metaphoric ‘gap’ between theoretical core competencies and clinical practice closes (Gallagher, 2004), the result is a portrait of well integrated clinical practice. The awareness of this layering methodology builds on the student’s confidence in the utilization of the totality of their educational knowledge base.