Who keeps watch? Structural safeguarding against epistemic erosion in integrated nursing curricula

To examine how integrated nursing curricula protect vulnerable knowledge domains once those domains are distributed across a program and to propose a conceptual framework for understanding and responding to this challenge.

Integrated curriculum design is widely valued in nursing education for its capacity to reduce fragmentation and support learning across complex practice contexts. However, integration alone does not protect essential knowledge domains from dilution, containment, or invisibility over time.

Discussion paper.

The paper undertakes a critical analysis of curriculum scholarship relevant to integrated nursing education, vulnerable knowledge domains and whole-of-program coherence. It develops a conceptual argument supported by an illustrative example from a recently redeveloped undergraduate nursing program.

The paper introduces epistemic erosion as a concept for understanding the gradual weakening of knowledge domains whose visibility, developmental progression, assessability and stewardship are not explicitly protected within integrated curricula. It argues that domains such as mental health, cultural safety, trauma-informed care, disability, health promotion and end-of-life care may be especially vulnerable when responsibility for their ongoing integrity becomes diffuse or when formal inclusion creates a false sense of security. In response, the paper proposes structural safeguarding as a curriculum design principle and curriculum stewardship as the ongoing work required to sustain such protection beyond initial design and accreditation.

Integrated nursing curricula require not only thoughtful design, but durable forms of stewardship and governance capable of resisting epistemic erosion over time.