TRENDS AND ISSUES IN CONTEMPORARY NURSING EDUCATION

1. TRENDS AND ISSUES IN CONTEMPORARY NURSING EDUCATION

2. 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.

3. 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.

4. 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)

5. 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.

6. 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.

7. 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).

8. Practice-Based Competency Outcomes Lenburg's Eight Core Practice Competencies • • Assessment and Interventions • • Critical Thinking • • Communication • • Teaching • • Human Caring Relationships • • Management • • Leadership • • Knowledge Integration

9. 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).

10. 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.

11. 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.

12. 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.

13. 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.

14. 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 .

15. 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.

16. 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.

17. 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.

18. Community-Focused InterdisciplinaryApproaches • These societal trends described in the preceding paragraphs helped create the current focus oncommunity-focused health with an interdisciplinary emphasis. • The large-scale economic andpolitical influences to reduce health care costs also played a part.

19. 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.

20. Community-Focused Interdisciplinary Approaches • This health care culture incorporates concepts ofshared responsibility for health promotion among individuals, family, community, and multiplecare providers. • More than ever, family and neighbors need to become competent caregiversand members of the health care team.

21. Community-Focused Interdisciplinary Approaches • The issues for teachers and students flow from these changes in philosophy, from "nursingas illness care in hospitals" to "nursing as health promotion and care management for individualsin the context of family, and family within the community.“ • Patients inhospital, at home, or in extended care settings are sicker and need interdisciplinary care thatoften is coordinated and managed by nurses.

22. 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)

23. 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.

24. 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.

25. 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.

26. 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.

27. 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.

28. 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.

29. 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.

30. 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.

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

32. Trends and issues that influence nursing education make it even more important to complywith quality standards and accreditation and to emphasize competency outcomes for studentsand graduates. • Trends and issues that influence nursing education make it even more important to complywith quality standards and accreditation and to emphasize competency outcomes for studentsand graduates.