The Need for Change in Nursing Education: Forces, Pressures, Challenges

1. The Need for Change in Nursing Education: Forces, Pressures, Challenges New Mexico Statewide Nursing Faculty Conference June 3-4, 2009 Jean Giddens, PhD RN, Professor Interim Senior Associate Dean for Academic Affairs College of Nursing, University of New Mexico

2. Forces, Pressures and Challenges in Nursing Education •  supply of nurses •  supply of nurse educators • Multiple educational paths • Maintain high retention • Graduate Success (NCLEX/Certification exams) • Faculty shortages • Increased workload • Increased student enrollment • Diversity of learners • Content saturation • Information management • New technologies • Rapid changes in health care • Increased complexity of health care • Diverse populations CHANGE !

3. Forces •  supply of nurses •  supply of nurse educators • Multiple educational paths • Maintain high retention • Graduate Success (NCLEX/Certification exams) • Content saturation • Information management • New technologies • Rapid changes in health care • Increased complexity of health care • Diverse populations • Faculty shortages • Increased workload • Increased student enrollment • Diversity of learners CHANGE !

4. Pressures •  supply of nurses •  supply of nurse educators • Multiple educational paths • Maintain high retention • Graduate Success (NCLEX/Certification exams) • Faculty shortages • Increased workload • Increased student enrollment • Diversity of learners • Content saturation • Information management • New technologies • Rapid changes in health care • Increased complexity of health care • Diverse populations CHANGE !

5. Challenges •  supply of nurses •  supply of nurse educators • Multiple educational paths • Maintain high retention • Graduate Success (NCLEX/Certification exams) • Faculty shortages • Increased workload • Increased student enrollment • Diversity of learners • Limitations in clinical sites • Content saturation • Information management • New technologies • Rapid changes in health care • Increased complexity of health care • Diverse populations CHANGE ! Giddens - ODU, 2008

6. Focus • Content Saturation • Information Management • Learning Environments

7. The Need for Change: The Dilemma of Content Saturation

8. Health Sciences Education Health sciences education is experiencing content saturation; there is more content than can possibly be taught in any given curriculum.

9. Common Terms Content Saturation Additive Curriculum Curriculum Obesity Content Overload

10. The Curriculum Revolution • Late 1980s, the NLN led a curriculum revolution effort to transform the design of nursing programs. • Rejection of long-standing content-loaded, behaviorist model of nursing education. • New focus on selection of content • New interest in facilitation of student learning with new pedagogies

11. Themes from the Literature • Bevis (1988) “…..reform efforts in nursing rarely change the substance of the curriculum itself but merely ‘switch, swap, and slide content around’."

12. Themes from the Literature • Burton (2000) students… “are expected to learn a large volume of material in a short period of time. As a consequence, students tend to rely on rote memorization to pass exams.” • Diekelmann (2002) “….textbooks are thicker and course content more complex. Students complain of ‘too much content’ as they appear to have reached their limits with memorization.”

13. Themes from the Literature • IOM (2003) specifically cites “overly crowded curricula” as one of many challenges in health education reform (p. 38). • NLN (2003) …. “many nurse educators continue to teach as they were taught and for a health care system that no longer exists…”

14. Themes from the Literature • Ironside (2004) “The dilemma nurse educators are increasingly facing is not what to include in a course, but what to leave out.” • AACN (2006) “Generalist education at the baccalaureate level is foundational to specialty practice”

15. Themes from the Literature • Belleck (2008) “Most of our teaching ‘innovations’ offer incremental ideas for tinkering at the edges, rather than true transformation in the way we conduct nursing education……By and large, nursing education is still ‘teaching heavy’ and ‘learning light.’

16. Causes of Content Saturation INFORMATION AGE The National Library of Medicine’s Medline archives 31,000 new citations per month.

17. Changes in Health Care Delivery Shift in focus from inpatient/acute care to community focused care. Problem not in change in focus, but the failure of nursing education to eliminate content.

18. Persistence in Conventional Pedagogy • Most nurse educators learned in a content-focused, highly structured curricula. • Ongoing belief that all nursing content is learned in a nursing curriculum and the teacher is responsible to ensure all content is delivered.

19. Academic-Practice Gap • Desire for graduates who are prepared to enter specialized settings. • Exposure to specialty content versus becoming a specialist • Emergence of “core competencies” by specialty groups – recommendations for nursing education.

20. Competencies In an examination of the National Council Licensure Examination Test Plan, Belleck (2006) claims to have identified >1000 discrete competencies required of new graduates! • Information management • Evidenced-based practice • Bioterrorism • Public Policy • Environment • Mass Casualty Response • Genetics • Gerontology • Oncology • Critical Care • Critical Thinking • Vulnerable Populations • Cultural Competence • End of Life Care

21. The Need for Change: Managing Information

22. The Information Age • Information age has lead to exponential changes in the generation of information and diffusion of knowledge. • youtube shift happens: http://www.youtube.com/watch?v=ktZl3CImXKU

23. Link to Nursing • Old Paradigm: How Much You Know • New Paradigm: Locating, Analyzing, Interpreting, Applying Information “Nursing faculty are gatekeepers of specialized knowledge….. The nursing instructor has control of the class!” (Belleck, 2008)

24. The need for change: Learning Environments & The Nursing School Experience

25. Higher Education: Historical Perspectives Two minute breakout: • Higher education emerged from 18th century Europe. • At that time, what did students look like? • What were the primary teaching methods?

26. Learners have changed….. • Generational • Gender Diversity • Racial/Cultural • Socioeconomic • Educational ……but teaching strategies have not!

27. What is the “Culture” of Nursing? • The “culture” of nursing is predominantly from a homogenous perspective of the “WWW” • O'Lynn (2009) “…we need to move beyond describing differences among diverse students. We need to realize that simply removing barriers only facilitates student retention, thus making students vulnerable to being forcibly molded.” Youtube - http://www.youtube.com/watch?v=RbKWIYMUkgE

28. Impact of Diverse Learners in our Learning Environment • Multiple Perspectives • Diverse Experiences • Diverse Learning Needs One size does not fit all!

29. Meeting Needs of Diverse Learners Low Context High Context Multicontextual Approaches Something for all learners Focus on Relationships Social Learning Case Study Reflective Writing Focus on Words Reading Writing Lectures Goal: Transformation of Nursing Programs into Learning Environments Theory of Context Diversity – R. Ibarra

30. Questions • What is another term for a student with low context strengths? • Answer: Honor Student • What is another term for a student with high context strengths? • Answer: At Risk Student

31. Aiming for a New Kind of Graduate If you teach them to fish….

32. What are the desired characteristics of nurse graduates? • Critical thinkers • Clinical judgment • Life-long learners • Play well with others • Reflective Thinkers • Consider alternative points of view

33. Challenges for Nursing Education • Design nursing curricula that reflect contemporary nursing practice. • Provide essential content (knowledge) without an overburdened curriculum. • Offer multicontexual learning approaches by promoting student-centered learning. • Transform into learning communities that are inviting and in which all learners can thrive.