TRENDS AND ISSUES IN CONTEMPORARY NURSING EDUCATION

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TRENDS AND ISSUES IN CONTEMPORARY NURSING
EDUCATION

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TRENDS AND ISSUES IN CONTEMPORARY NURSING
EDUCATION

• Nursing education is always concerned with
  preparing nurses with enough knowledge and skills
  to meet the health care needs of the community
  with compassion.
• How it does this is shaped by a number of trends
  and issues in society, which change continually
  and with increasing complexity.

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Knowledge Expansion and Use of Technology and
the Internet

• With the ever-expanding developments in computer
  technology, the volume of knowledge is expanding
  exponentially.
• From e-mails to complex research documents and
  video images, nurses and students are
  communicating more frequently, with more contacts
  and with the speed of light.

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Knowledge Expansion and Use of Technology and the
Internet

• This ability to access and disseminate unlimited
  information almost instantly has enormous
  benefits but also presents major issues.
• Computer-accessible knowledge has become the
  potential content for nursing and other courses
  and the standards for practice.
• Websites generally are more interactive than
  texts and link to multitudes of other helpful
  resources (Nicoll, 2000 Skiba, 1997)

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• Knowledge Expansion and Use of Technology and the
  Internet
• Issues relate to time management, the integration
  of all the information available, keeping up with
  changes in technology, and meeting the
  expectations for immediate responses to an ever
  widening web of contacts.
• Faculty and students have similar issues related
  to knowledge and technology expansion, the scope
  of information, and the time to use it.

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• Practice-Based Competency Outcomes
• Trends in business and commerce often find their
  way into higher education and nursing education.
• In business the outcome of spending time and
  resources based on actual needs is what counts in
  determining financial success.
• The same is true for nursing practice and nursing
  education.
• Students (nurses) achieve the competency outcomes
  that specify the skills actually needed in
  practice.

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• Practice-Based Competency
• 
  Outcomes
• For students it means a change from memorizing
  class notes and readings to learning to integrate
  knowledge, make decisions, and be competent and
  confident in the abilities contained in course
  outcomes.
• Practice-based competency outcomes specify the
  destination students need to reach, the
  interactive learning strategies are the
  directions and guidelines for getting there, and
  performance-based assessment confirms they have
  arrived at the right place.
• These changes in the entire education process
  pose threats and concerns to all the stakeholders
  that need to be resolved (Bargagliotti, Luttrell,
  and Lenburg, 1999).

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Practice-Based Competency
Outcomes

• Lenburg's Eight Core Practice Competencies
• Assessment and Interventions
• Critical Thinking
• Communication
• Teaching
• Human Caring Relationships
• Management
• Leadership
• Knowledge Integration

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Practice-Based Competency
Outcomes

• Competency outcomes incorporate these
  practice-based skills, as well as the course
  content.
• Learning strategies and performance examination
  are based on outcomes and content.
• Several articles describe the model, process, and
  related issues as used by others (Luttrell et
  al., 1999 Redman, Lenburg, and Walker, 1999).
• Critical thinking is perhaps the most pivotal
  competence, as seen in many resources (Critical
  thinking, 2000 Rubenfeld and Scheffer, 1995).

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Performance-Based Learning and Assessment
Methods

• A change in methods used to promote learning and
  evaluate competence is another trend closely
  linked to competency outcomes.
• In the era of cost containment, finding the most
  effective and efficient ways for students to
  become competent is paramount.

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Performance-Based Learning and Assessment
Methods

• Related issues include
• Changes in roles of teachers and learners.
• Refocusing responsibility and accountability
• Shifting the perception of students from
  passive receivers of information to active
  learners responsible for being competent in the
  array of specific practice-based skills.

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• Performance-Based Learning and
• Assessment Methods
• Rather than lectures and multiple-choice
  tests, these skills are learned more effectively
  through activities such as problem-based
  learning, case studies, and diverse projects in
  many community agencies.
• The rapid expansion of knowledge and technology
  and related changes in competency outcomes in
  education and practice require major changes in
  teaching-learning methods and evaluation of
  performance.

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Performance-Based Learning and
Assessment Methods

• These trends precipitate issues for students and
  teachers. Both need to change ideas about
  learning.
• Sometimes students think it is easier just to
  figure out "what the teacher wants" and "study
  for the test" rather than engage in interactive
  group projects in and out of class that require
  more decision making, group process, and time.
• It is easier to take written tests than to
  demonstrate actual competence through performance
  examinations that require 100 accuracy of
  specified critical elements.

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• Performance-Based Learning and
• Assessment
  Methods
• Issues for faculty also include creating
  interactive learning strategies and making
  arrangements for them. This means contracts with
  many agencies, working with preceptors and
  community leaders, and having students in
  multiple settings simultaneously.
• The issues are time, creativity, and a very
  different way of thinking about learning - means
  creating more complex performance examinations
  both in class and in clinical settings to help
  students gain confidence and demonstrate
  achievement of essential competencies .

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Sociodemographic, Cultural Diversity, and
Economic and Political Changes

• From rural to metropolitan areas throughout the
  United States the population is undergoing
  significant transformation (Baer et al., 2000
  Nursing, 1994).
• Many articles and websites provide details about
  the aging of the population (i.e., the rapidly
  growing percentage of those over 65 and even 85
  years of age).
• Others describe the number of ethnic minority
  groups and the increasing number of those in
  poverty, homeless, or under-insured.

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Sociodemographic, Cultural Diversity, and
Economic and Political Changes

• Some of the issues for students are the distinct
  differences among patients in their responses to
  illness, treatments, and caregivers, which are
  based on differences in age, culture, religion,
  and life experiences in family and community
  (Ryan et al., 2000).
• For example, issues related to nursing care may
  differ considerably among those in areas that are
  rural or urban, mountains or plains, north,
  south, east, or west.

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• Sociodemographic, Cultural Diversity, and
  Economic and Political Changes Effective and
  thoughtful nursing care is individualized
  according to client characteristics and
  circumstances, which is why students need to
  learn as much as possible from sociology,
  cultural diversity, psychology, religion,
  economics, history, and literature, as well as
  basic sciences.
• Moreover, learning the stories of diverse
  peoples, their customs, life experiences, and
  expectations is interesting and expands human
  understanding and creativity for personal and
  professional life.

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Community-Focused Interdisciplinary
Approaches

• These societal trends described in the preceding
  paragraphs helped create the current focus on
  community-focused health with an
  interdisciplinary emphasis.
• The large-scale economic and political influences
  to reduce health care costs also played a part.

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Community-Focused Interdisciplinary
Approaches

• For example, the extraordinary expansion of
  knowledge and creative treatment technologies
  made it common practice for complex surgery to be
  performed in ambulatory settings on an outpatient
  basis or for drugs to be used instead of surgery.
  
• Diverse health-conscious groups slowly made
  progress to change the national orientation from
  "illness care" to promoting health more
  efficiently and effectively.

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Community-Focused Interdisciplinary
Approaches

• This health care culture incorporates concepts of
  shared responsibility for health promotion among
  individuals, family, community, and multiple care
  providers.
• More than ever, family and neighbors need to
  become competent caregivers and members of the
  health care team.

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Community-Focused Interdisciplinary
Approaches

• The issues for teachers and students flow from
  these changes in philosophy, from "nursing as
  illness care in hospitals" to "nursing as health
  promotion and care management for individuals in
  the context of family, and family within the
  community.
• Patients in hospital, at home, or in extended
  care settings are sicker and need
  interdisciplinary care that often is coordinated
  and managed by nurses.

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Community-Focused Interdisciplinary
Approaches

• Some issues for students include changing their
  image of where they will work, the kinds of
  patients they will care for, and the skills they
  will use.
• Although many will work in acute care hospitals,
  others will provide care in diverse community
  settings to those who are culturally diverse or
  elderly and have multiple chronic and/or acute
  conditions that require long-term nursing
  management.
• This requires skill in all core practice
  competencies, especially creative problem
  solving, interdisciplinary collaboration, and
  ability to use computers and communication
  technology effectively and independently (Engelke
  and Britton, 2000)

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Hospital Diploma Programs

• The oldest and most traditional of nursing
  education programs that prepare for professional
  licensure are hospital-based diploma programs.
• They began as training programs by physicians and
  lasted a few weeks.
• Soon the nurse graduates began developing courses
  and teaching them from the nursing perspective,
  and programs were extended from 1 to 2 years in
  length.

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Hospital Diploma Programs

• In later years all diploma programs were 3 years
  in length and had fairly uniform courses of study
  and clinical hours.
• Many of them have arrangements with colleges to
  offer arts and sciences and in some cases dual
  credentials, an associate degree, and a hospital
  diploma.

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Associate Degree Programs

• In the late 1950s a different trend in nursing
  education began to emerge in response to social,
  political, and educational changes in society and
  to a growing shortage of RNs.
• During World War II (WWII) the need for RNs who
  could be prepared in a much shorter time was
  critical.

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Associate Degree Programs

• This shortened program, offered in colleges, was
  in the context of the newly developing community
  college movement that offered 2-year associate
  degree programs in many technical fields.
• At the same time, the increasing complexity and
  expansion of medical care required more and
  better prepared RNs.
• A few educators began to create a new 2-year
  nursing program for the community college, which
  required courses more integrated approach to
  nursing content and clinical learning.

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Associate Degree Programs

• The original concept was that technical RNs
  (associate degree nurses) would work with
  professional RNs (nurses with a bachelor of
  science in nursing BSN), as a team.
• ADN programs were so successful that they became
  the new career pathway for thousands of students
  today the majority of RNs are ADN graduates.

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Baccalaureate Degree Nursing Programs

• The 28-month program required scientific studies
  and clinical work and had the prestige and
  authority of other departments, with its own dean
  and budget (Kalisch and Kalisch, 1995).
• This was another first in the history of nursing
  education.
• The number of colleges and universities offering
  the BSN degree slowly continued to increase, and
  by 2001 the AACN reported 570 basic BSN programs
  609 offer RN-BSN options.
• BSN degree programs typically require 2 years of
  arts and sciences as the foundation for 2 years
  of nursing courses, most requiring 120 to 130
  semester credits for the degree.

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Master's Degree Nursing Programs

• Currently most MSN programs are designed to
  prepare advanced nurse practitioners and clinical
  specialists in a wide array of specialty areas.
• The extraordinary and rapid, changes in health
  care during the 1990s highlighted the
  cost-effective and quality care benefits of using
  advanced practice nurses to provide primary
  health care previously unavailable or provided by
  physicians.

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Master's Degree Nursing Programs

• Different MSN education options are available,
  the most common of which is for graduates of BSN
  programs other options are designed for
  graduates of nonnursing degree programs and for
  nurse doctorate (ND) programs and are especially
  attractive during periods of nursing shortages.
• The current trend is MSN programs that can be
  completed almost entirely through Internet
  courses.

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Doctoral Programs

• Currently four types of doctoral degrees are used
  by nursing students
• (1) the Doctor of Education (EdD) for those
  interested in education
• (2) the Doctor of Philosophy (PhD) for those
  interested in research
• (3) the Doctor of Nursing Science (DNS or DNSc)
  for those interested in advanced clinical nursing
  practice and
• (4) the Doctor of Nursing (ND) for those with BS
  degrees in other fields who want to pursue
  doctoral preparation for entry into nursing
  practice.

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• Trends and issues that influence nursing
  education make it even more important to comply
  with quality standards and accreditation and to
  emphasize competency outcomes for students and
  graduates.
• Trends and issues that influence nursing
  education make it even more important to comply
  with quality standards and accreditation and to
  emphasize competency outcomes for students and
  graduates.