Nursing Education Diversity Equity and Inclusion In 21 Century

21th  Century and Nursing Education Diversity Equity and Inclusion

Nursing Education for the 21st Century,Diversity, Equity, and Inclusion In Nursing Education,Four Spheres of Care In Nursing Education.

Nursing Education for the 21st Century

    In addition to the foundational elements on which the Essentials has been developed, other factors have served as design influencers. What does the nursing workforce need to look like for the future, and how do nursing education programs prepare graduates to be “work ready”? 

    Nursing education for the 21” century ought to reflect a number of contemporary trends and values and address several issues to shape the future workforce, including diversity, equity, and inclusion; four spheres of care (including an enhanced focus on primary care); systems-based practice; informatics and technology; academic practice partnerships; and career long learning. 

Diversity, Equity, and Inclusion In Nursing Education

    Shifting US population demographics, health workforce shortages, and persistent health inequities necessitate the preparation of nurses able to address systemic racism and pervasive inequities in health care. 

    The existing inequitable distribution of the nursing workforce across the United States, particularly in underserved urban and rural areas, impacts access to healthcare services across the continuum from health promotion and disease prevention, to chronic disease management, to restorative and supportive care. 

    Diversity, equity, and inclusion-as a value-supports nursing workforce development to prepare graduates who contribute to the improvement of access and care quality for underrepresented and medically underserved populations (AACN, 2019). Diversity, equity, and inclusion require intentionality, an institutional structure of social justice, and individually concerted efforts. 

    The integration of diversity, equity, and inclusion in this Essentials document moves away from an isolated focus on these critical concepts. Instead, these concepts, defined in competencies, are fully represented and deeply integrated throughout the domains and expected in learning experiences across curricula. Making nursing education equitable and inclusive requires actively combating structural racism, discrimination, systemic inequity, exclusion, and bias. 

    Holistic admission reviews are recommended to enhance the admission of a more diverse student population to the profession (AACN, 2020). Additionally, an equitable and inclusive learning environment will support the recruitment, retention, and graduation of nursing students from disadvantaged and diverse backgrounds. 

    Diverse and inclusive environments allow examination of any implicit or explicit biases, which can undermine efforts to enhance diversity, equity, and inclusion. When diversity is integrated within inclusive educational environments with equitable systems in place, biases are examined, assumptions are challenged, critical conversations are engaged, perspectives are broadened, civil readiness and engagement are enhanced, and socialization occurs. 

    These environments recognize the value of and need for diversity, equity, and inclusion to achieve excellence in teaching, learning, research, scholarship, service, and practice.Academic nursing must address structural racism, systemic inequity, and discrimination in how nurses are prepared. Nurse educators are called to critically evaluate policies, processes, curricula, and structures for homogeneity, classism, color-blindness, and non-inclusive environments. 

    Evidence based, institution-wide approaches focused on equity in student learning and catalyzing culture shifts in the academy are fundamental to eliminating structural racism in higher education (Barber et al., 2020). Only through deconstructive processes can academic nursing prepare graduates who provide high quality, equitable, and culturally competent health care. 

    Finally, nurses should learn to engage in ongoing personal development towards understanding their own conscious and unconscious biases. Then, acting as stewards of the profession, they can fulfill their responsibility to influence both nursing and societal attitudes and behaviors toward eradicating structural/systemic racism and discrimination and promoting social justice. 

Four Spheres of Care In Nursing Education

    Historically, nursing education has emphasized clinical education in acute care. Looking at current and future needs, it is becoming increasingly evident that the future of healthcare delivery will occur within four spheres of care: 1) disease prevention/promotion of health and well being, which includes the promotion of physical and mental health in all patients as well as management of minor acute and intermittent care needs of generally healthy patients; 2) chronic disease care, which includes management of chronic diseases and prevention of negative sequelae; 3) regenerative or restorative care, which includes critical/trauma care, complex acute care, acute exacerbations of chronic conditions, and treatment of physiologically unstable patients that generally requires care in a mega-acute care institution; and 4) hospice/ palliative/supportive care, which includes end-of-life care as well as palliative and supportive care for individuals requiring extended care, those with complex, chronic disease states, or those requiring rehabilitative care (Lipstein et al., 2016; AACN, 2019).

    Entry level professional nursing education ensures that graduates demonstrate competencies through practice experiences with individuals, families, communities, and populations across the lifespan and within each of these four spheres of care. The workforce of the future needs to attract and retain registered nurses who choose to practice in diverse settings, including community settings to sustain the nation's health. 

    Expanding primary care into communities will enable our healthcare delivery systems to achieve the Quadruple Aim of improving patient experiences (quality and satisfaction), improving the health of populations, decreasing per capita costs of health care, and improving care team well being (Bowles et al., 2018). 

    It is time for nursing education to refocus and move beyond some long held beliefs such as: primary care content is not important because it is not on the national licensing exam for registered nurses; students only value those skills required in acute care settings; and faculty preceptors only have limited community-based experiences. 

    Recommendations from the Josiah Macy Foundation Conference (2016) on expanding the use of registered nursing in primary care provides a call to education and practice to place more value on primary care as a career choice, effectively changing the culture of nursing and health care. 

    A collaborative effort between academic and practice leaders is needed to ensure this culture change and educate primary care practitioners about the value of the registered nurse role.