The Future of Nursing Education: A Collaborative Perspective

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The Future of NursingEducation A
CollaborativePerspective

• Christine A. Tanner, RN, PhD
• Oregon Health Science University
• School of Nursing

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Calls for Reform

• Reexamination of curricular structures
  processes (The Curriculum Revolution)
• Preparing a new kind of nurse

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The Curriculum Revolution

• New pedagogies
• Preparing tomorrows leaders
• Multicultural diversity
• Caring Curriculum

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Demands for a New Kind of Nurse

• Fueled by changes in the nursing practice
  environment
• Increasing complexity and acuity
• Decreased length of stay
• Shift of care to home community
• Exponential growth of knowledge
• Explosion of technologies
• Identification of the Quality Chasm

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Demands for a New Kind of Nurse

• Fueled by changes in demographics
• Aging population with increased
• prevalence of chronic illness
• Families increasingly engaged in care giving with
  little or no nursing support
• Increased attention to health-promotion

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Central Competencies

• Critical thinking

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Critical thinking Thinking Like a Nurse?
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A Short History ofNursing ProcessClinical
Problem SolvingClinical Decision
MakingDiagnostic ReasoningCritical Thinkingin
other words . . .Thinking Like a Nurse
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Two decades of Research on CT

• Critical thinking and clinical thinking (i.e.,
  decision making, clinical judgment) are different
  constructs.
• No relationship between education critical
  thinking.
• No relationship between critical thinking and
  patient outcomes

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Central Competencies

• Clinical Judgment
• Case based
• Contextually bound
• Interpretive reasoning

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Central Competencies

• Clinical Judgment requires deep background
  knowledge for
• Noticing
• Considering plausible interpretations
• Collecting reasonable evidence
• Choosing the best course of action

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Central Competencies

• Clinical Judgment is always within
• the context of a particular patient
• A deep understanding the patients experience,
  values and preferences
• Ethical standards of the discipline

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Central Competencies

• Understanding clinical judgment in this way
• Renews interest in case-based approaches to
  instruction
• Demand new approaches to clinical education
• Provides guidance to use of simulation in nursing
  education

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Central CompetenciesQuality-Safety Initiative

• Patient-centered care
• Team-work and collaboration
• Evidence-based practice
• Quality improvement
• Informatics

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Preparing More Nurses
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Preparing More Nurses

• In the face of a profound faculty shortage

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Preparing More Nurses

• In the face of a profound faculty shortage
• Limitation in the number, type and quality of
  sites for clinical education.

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Current practices in clinicaleducation
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A very short history of clinicaleducation
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Challenges in Clinical Education

• Traditional clinical learning driven by placement
  opportunities and challenges
• Insufficient number of placements using total
  patient care model
• High acuity, greater risk with neophyte students
• Staff nurse burden for supervision of students in
  rapidly changing situations
• Learning is dependent on
• Available patient population
• Facilitys schedule availability
• Availability of faculty with required expertise

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Summary Driving Forces for Reform

• Demands for Reform in Nursing Education 1985-2005
• Study of Curricular processes
• Evidence of poorly prepared graduates even for
  acute care
• Quality-safety

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Summary Driving Forces for Reform

• Demands for Reform in Nursing Education 1985-2005
• Need for a new nurse
• Changes in the practice environment
• Emerging health care needs
• Practice in environment of severe shortage

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Summary Driving Forces for Reform

• Demands for Reform in Nursing Education 1985-2005
• Need for a new nurse
• Other pressures
• Content explosion
• Advances in the science of learning
• Outdated model of Clinical education

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Part II The Oregon Consortium for Nursing
Education
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OCNE

• A collaboration among 8 community colleges and 5
  campuses of OHSU to
• Deliver a standard competency based curriculum
  with an AAS exit and completion of Baccalaureate
  in nursing on home campus
• Increase the number of nurses prepared with
  baccalaureate degree
• Transform nursing education to more closely align
  with emerging health care needs

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A very short history of OCNE

• 2000 Study of nursing shortage in Oregon
• 2001 Strategic plan developed by Oregon Nursing
  leaders
• 2002 Education plan unveiled and political
  turmoil ensued
• 2003 Launched OCNE with Project Director
• 2004 Began curriculum development Phase I of
  Faculty Development
• 2005 Curriculum change approved by OSBN, NLNAC
  CCNE
• 2006 Phase I Clinical Education Project launched
• 2006 First class of 255 students admitted on 6
  campuses to nursing courses
• 2007 Phase II Faculty Development
• 2008 Preceptor Development
• 2009 First Baccalaureate class graduates

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OCNE as a response to these challenges

• Committed to collaboration across programs
  enabling the best use of scarce resources
• Standard, competency based curriculum focused on
  preparing the new nurse.
• Teaching approaches that rest on the science of
  learning
• Faculty development as an integral part of
  curriculum development
• Reform of clinical education

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Guiding Principles in Curriculum Design

• Responsive to demands for reform
• NCSBN 2001 lack of preparation of grads
• JCAHO (2002) continental divide between
  education and practice
• IOM reports

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Guiding Principles in Curriculum Design

• Responsive to demands for reform
• Emerging health care needs
• Aging population
• Increasing acuity
• Increasing prevalence of chronic illnesses
• Demands placed on caregiving families with
  inadequate nursing care support

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Guiding Principles in Curriculum Design

• Responsive to demands for reform
• Emerging health care needs
• Graduates would be practicing in an environment
  of chronic, severe RN shortages
• More efficient effective with dwindling supply
  of nursing faculty
• Competencies of the new nurse would require at
  least 4 years, but there would need to be AD exit

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Overview of the Curriculum

• First year Prerequisites
• Second year first two quarters of the third
  year
• Required non-nursing courses
• Standard nursing courses on all campuses
• Third quarter of the third year
• Complete Precepted Scope of Practice Practicum,
  graduate with AAS and be eligible to sit for
  NCLEX OR
• Continue directly into 400 level nursing courses
  for 4 remaining quarters, complete 15 credits of
  upper division arts science, and graduate with
  BS

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Transformation of the Nursing CurriculumSome
Features

• Courses organized around foci of care
• Health Promotion
• Chronic Illness Management
• Acute Care
• End-of-Life Care

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Transformation of the Nursing Curriculum Some
Features

• Last 4 clinical nursing courses toward Bachelors
  degree, students may select a population for
  focus in
• Public health and population-based care
• Leadership and outcomes management
• Clinical immersion or integrative practicum for
  twenty weeks

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Transformation of the Nursing Curriculum Some
Features

• Redefines nursing fundamentals to
• Clinical Judgment
• Evidence-based Practice
• Patient-centered care
• Leadership

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Transformation of the Nursing Curriculum
ApplyingThe New Pedagogy

• Draws on tremendous advances in the science of
  learning from a variety of disciplines (cognitive
  science, psychology, higher education)

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The New Pedagogy

• Emphasizes deep understanding of the disciplines
  most central concepts ---
• Purposeful REDUCTION in content
• Selection of content based on
• Prevalence of condition
• Useful to teach integration across competencies
• (e.g. ethical comportment, clinical judgment,
  evidence-based practice, health systems issues
  leadership,

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The New Pedagogy

• Emphasizes deep understanding of the disciplines
  most central concepts
• Active learning through case-based instruction,
  integration among theory, clinical and
  simulation.

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The New Pedagogy

• Emphasizes deep understanding of the disciplines
  most central concepts
• Active learning through case-based instruction,
  integration among theory, clinical and
  simulation.
• Authentic performance assessment promotion of
  self-directed learning

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Process for Consensus Building during Curriculum
Development

• Institutional representatives
• Leadership model
• Faculty development combined with curriculum
  development
• Frequent Review Counsel by groups with
  expertise vested interests
• Faculty on each of the 12 campuses
• Specialty task forces

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Challenges in Clinical Education

• Traditional clinical learning driven by placement
  opportunities and challenges
• Insufficient number of placements using total
  patient care model
• High acuity, greater risk with neophyte students
• Staff nurse burden for supervision of students in
  rapidly changing situations
• Learning is dependent on
• Available patient population
• Facilitys schedule availability
• Availability of faculty with required expertise

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Desired Features of New Clinical Education Model

• Relationship-centered care keeping the patient
  and family at the center
• Science of learning and findings of the Carnegie
  study
• (i.e. integration across apprenticeships, retain
  prep, coaching and debriefing and other best
  practices)

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Desired Features of New Clinical Education Model

• Relies on Clinical learning activities that
• Are designed to support attainment of
  Competencies
• Include, but not dominated by Total Patient
  Care
• Developmentally appropriate for level of student
• Vary facultystudent ratios nursing staff roles
  by level of student, acuity of patient, nature of
  learning activity
• Culminate in one or more Immersion experiences.

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Types of Clinical Learning Experiences

• Focused direct care experiences
• Patient-centered care
• Therapeutic relationship
• Individualized care

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Types of Clinical Learning Experiences

• Focused direct care experiences
• Concept-based experiences focus on learning
  concepts (e.g. oxygenation) through seeing many
  patients who exemplify the concept

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Types of Clinical Learning Experiences

• Focused direct care experiences
• Concept-based experiences
• Case-based experiences focused on learning
  clinical judgment through working through
  clinical problems presented in text-based through
  fully simulated scenarios.

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Types of Clinical Learning Experiences

• Focused direct care experiences
• Concept-based experiences
• Case-based experiences
• Skill-based experiences focused on learning
  basic skills through repetitive practice,
  includes psychomotor skills, such as interviewing.

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Types of Clinical Learning Experiences

• Focused direct care experiences
• Concept-based experiences
• Case-based experiences
• Skill-based experiences
• Integrative experiences opportunity to integrate
  prior learning and linking learning activities to
  RN role in clinical agency.

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Types of Clinical Learning Experiences
Differentiated by

• Type of learning and appropriate pedagogy
• Degree of accountability for patient care

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Transformation of Clinical Education

• Phase I II consensus building on need for
  change
• Phase III 8 pilot projects, evaluating
  innovative clinical learning activities that when
  combined may lead to a new model
• Phase IV development of and consensus building
  on new model
• Phase V statewide demonstration of new model
  through 3 years of OCNE nursing curriculum

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6 Major Components ofConsortium Development

• Developmental Processes Infrastructure
• Faculty Development
• Simulation Capacity
• Curriculum Development
• Clinical Education Capacity
• Comprehensive evaluation

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A relationship-centered change process

• Driven by our passions with . . .
• Commitment to health of Oregonians
• Strong Leadership persistence
• One leap of faith after another

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An African Proverb

• To go quickly, go alone.
• To go far, go together.

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For more information

• Visit us at www.ocne.org