How Global Violence, Disasters, Demographic Revolution, Technology, Globalization, Effect Curriculum Development In Nursing Education
.png "How Global Violence, Disasters, Demographic Revolution, Technology, Globalization, Effect Curriculum Development In Nursing Education")
Global Violence, Threat of Violence, and Other Disasters Effect on Curriculum Development
It has been more than a decade since hijacked airplanes hit the World Trade Center towers in New York City and the Pentagon near Washington, DC, with a fourth plane crashing in rural Pennsylvania.
The tragic September 11, 2001, events along with the emergence of new infectious diseases like Ebola and the aftermath of natural disasters like Hurricane Katrina in 2005, the Haiti earthquake in 2010, the tsunami that struck Japan in 2011, and the 2013 Oklahoma tornado have changed our nation and the world.
In response to these events and others, the health care system has focused resources on disaster and mass trauma preparedness, bioterrorism responses, and a multitude of strategies to prepare for unpredictable and diverse catastrophic events (Lewis, 2009).
Nurses worldwide, regardless of their experience or educational preparation, must have basic knowledge and skills to respond appropriately to mass casualty incidents (International Nursing Coalition for Mass Casualty Education, 2003).
To achieve this goal, nursing curricula must prepare practitioners with leadership skills and the ability to work inter professionally and function as a team member so that nurses can fully participate in the creation of emergency response systems, work within the public health infrastructures characterized by communitywide collaboration and communication, and take their rightful place at the public policy table.
Nurses also need clinical knowledge related to biological agents and skills to manage and support surviving individuals, families, and communities experiencing the psychosocial effects in the aftermath of disaster events (Norman & Weiner, 2011; Warsini, West, Mills, & Usher, 2014).
Therefore new and redesigned nursing curricula should consider the educational competencies for professional nurses responding to mass casualty incidents developed through the collaborative work of the International Nursing Coalition for Mass Casualty Education (2003).
Additionally, the Center for Disease Control and Prevention website
(www.bt.cdc.gov) is another useful resource for information and resources
related to public health emergency preparation and response.
Demographic Revolution Effect on Curriculum Development In Nursing Education
The United States is getting more populous, older, and racially and ethnically diverse (Institute of Medicine, IOM, 2010). By 2030 it is estimated people age 65 and older will represent almost 20% of the total U.S. population.
The age 85 and older population is also increasing, with a significant trend in “the increase in the proportion of men age 85 and older who are veterans” (Federal Interagency Forum on Aging Related Statistics [FIFARS], 2012, p. xv).
These demographic changes increase the likelihood that nurses and other health care providers will encounter increasing numbers of older and diverse adults who are better educated than prior generations, suffer from a variety of chronic health conditions, and face increased health care costs (Federal Interagency Forum on Aging-Related Statistics, FIFARS, 2012; Institute of Medicine, IOM, 2010).
Aging “boomers,” including veterans, will enter assisted living or long-term
care facilities or be cared for by their families and communities. Initiatives
such as those of the Hartford Institute for Geriatric Nursing provide nurse educators with excellent examples of
how to incorporate best practices, and other resources to improve the quality
of health care of older adults.
End-of-life issues also loom large for the geriatric population and nursing profession. In 2009 the percentage of older Americans dying in hospitals declined while use of hospice services and dying at home increased (Federal Interagency Forum on Aging-Related Statistics, FIFARS, 2012).
In 2000 the Robert Wood Johnson Foundation began funding the End-of-Life Nursing Education Consortium (ELNEC) administered by the American Association of Colleges of Nursing (AACN) and the City of Hope National Medical Center. This consortium project is a national education initiative dedicated to educating nurses in excellent palliative care.
To date more than 19,300 nurses and other health care professionals, from all 50 U.S. states and 85 countries, have received ELNEC training and are using this innovative strategy to equip the nursing workforce with needed palliative care–related skills and knowledge.
More recently, in an effort to improve
palliative care for American veterans, the ELNECfor-Veterans curriculum has
been developed to meet the unique needs of nurses caring for those with
life-limiting illness (American Association of Colleges of Nursing, AACN,
2014b).
Another important demographic phenomenon affecting nursing curricula is diversification of the U.S. population. Data from the 2010 census revealed the majority of growth in the total U.S. population over a 10-year period came from those reporting their races as non White, Hispanic, or Latino.
Although the population
of all major race groups increased during this same time frame, the Asian
population experienced the fastest rate of growth and the White-alone
population the slowest rate of growth (Humes, Jones, & Ramirez, 2011). By
2050 minority groups are anticipated to compose more than half of the total
U.S. population (U.S. Census Bureau, 2008).
The changing composition of America has turned this country into a microcosm of the world’s peoples. In response, the nursing profession has long recognized the challenges this increasing diversity creates to the provision of high-quality nursing care.
Therefore cultural sensitivity has been an essential curricular component of baccalaureate and graduate nursing education (American Association of Colleges of Nursing, AACN, 2008, 2011; Sanner, Baldwin, Cannella, Charles, & Parker, 2010).
Although curricular efforts to ensure cultural sensitivity and awareness have been designed and implemented, the fact remains that most nurses, nursing students, and faculty are of White descent (American Association of Colleges of Nursing, AACN, 2014c; Sanner, et al., 2010).
It is incumbent on schools of nursing to create and initiate mechanisms to attract, recruit, and retain higher numbers of minority students and faculty from diverse backgrounds (Sanner, et al., 2010).
Doing so infuses nursing curriculum
with alternative perspectives and helps to establish a nursing workforce that
is diverse and equipped to serve a cultural and racially diverse patient
population, which is essential to meet the nation’s health care needs and
reduce health care disparities and feelings of exclusion from the health care
system (American Association of Colleges of Nursing, AACN, 2014c).
Whether the demographic shifts include age, diversity, or other population features, there are implications for health and the resources needed to promote health. Future nurses need “the skills to influence policy formulation and the development of creative solutions to respond to changing demographics and the aging chronically ill” (Hegarty, Walsh, Condon, & Sweeney, 2009, p. 5).
Preparation of tomorrow’s nursing practitioners requires attention to all demographic revolutions of both developed and developing areas of the globe, including patterns of growth, migration, and ethnic or racial composition.
Regardless of the venue in which a culturally diverse and aging population receives care, issues surrounding diversity and geriatric health require educators to equip nurses to promote culturally sensitive health and self care, prevent disease and disability in an aging population, and provide opportunities to develop political advocacy skills needed to influence public policy decisions related to the allocation of resources toward health and human needs.
The responsibility to prepare future nurses in this manner is in keeping
with a vision for quality health care explicated by the IOM’s 2010 report, The
Future of Nursing: Leading Change, Advancing Health, which includes discussion
of accessible health care for diverse populations, disease prevention,
promotion of wellness, and provision of compassionate care across the lifespan.
Technological
Explosion and Effect on Curriculum Development In Nursing Education
America’s transition from a resource based, industrial economy characterized by semiskilled factory workers and raw materials to a knowledge based, information age economy has been reshaping society for decades. Today technology continues to transform nursing practice and education.
Most recently, nationwide adoption and use of electronic health record (EHR) systems has required nurses, educators, and students to “use, navigate, and accurately document in the EHR” (Winstanley, 2014, p. 62).
The American Recovery and Reinvestment Act of 2009 helped to accelerate the development of standardized EHRs as a means to capture clinical information that could be used to improve health outcomes and lower health care costs.
To ensure meaningful use of this
new technology and to function in the increasingly complex health care
environments, all nurses are expected to “have basic computer competencies, be
information literate, and have information management skills” (Tellez, 2012, p.
230).
High tech, digitalized nursing practice requires educators to incorporate concepts related to information technology into the curriculum and develop teaching strategies requiring students to access, document, collect, and retrieve health care data and other information from electronic sources such as the EHR.
Inclusion of informatics education within schools of nursing will assist students to understand data, combine data and knowledge, and make decisions, often through the use of technology (Tellez, 2012).
As technology becomes embedded into
nursing curricula and health care systems become increasingly automated and
digitalized, nurse educators and practitioners must remain mindful of the need
to balance the essence of caring and nursing presence at the bedside
(Winstanley, 2014).
Technological advancements have also greatly affected nursing education by offering “new opportunities to enhance and broaden learning experiences” (Flynn & Vredevoogd, 2010, p. 7), and by preparing students who are working within complex care environments to be decision makers (Institute of Medicine, IOM, 2010).
As technology evolves, increased numbers of nursing programs have found that e-learning, simulation, and mobile devices offer much potential for nursing education (Institute of Medicine, IOM, 2010). Web enhanced or online learning in particular provides opportunity for practicing nurses to pursue educational programs at times convenient for learners (Institute of Medicine, IOM, 2010; Murray, McCallum, & Petrosino, 2014).
As a result, technology allows for educational mobility, provides 24/7 access to education and knowledge, enhances opportunities for teaching and learning or career advancement, and contributes to the availability of a qualified nursing workforce (Institute of Medicine, IOM, 2010).
Technology is also responsible, in part, for how educators have changed their approach to learning in the face-to-face classroom. Educators increasingly are using the “flipped” classroom approach to move select content to an online format.
Doing so provides students access to online resources such as voice over lectures, videos, or links to additional relevant information as a way to learn foundational or knowledge-based content prior to attending a face to face class meeting.
This instructional strategy allows nurse educators to use class time for applying content learned to new situations, guiding students as they engage in problem solving, as well as engaging students in higher level thinking (Murray, et al., 2014).
Along with the incorporation of the “flipped” classroom, nursing curriculum should take into account how students and educators will engage with and use other available technologies to deliver course content, access information during class and clinical rotations, complete assignments, and communicate with each other.
Simulation is another instructional strategy widely incorporated into nursing curriculum that has come a long way thanks to technological advances (Hayden, 2010; Sanford, 2010).
The advent and use of medium- or high-fidelity manikins as well as digital recording capabilities has turned simulation centers into learning environments demanding high levels of technical expertise and the ability to authentically simulate real work nursing practice; they allow students to learn and practice in a safe environment.
Simulation, along with the use of mobile devices such as smart phones or tablets, teaches students real-life skills and prepares them for nursing practice in authentic settings (Institute of Medicine, IOM, 2010; Wolters Kluwer Health, 2014).
Globalization
and Global Health and Curriculum Development In Nursing
Globalization refers to “a process of interaction and integration among people, companies, and governments of different nations” (The Levin Institute, 2014, para. 1). This process, driven by international trade, investment, and information technology, affects environment, culture, political systems, economic development, prosperity, health, and the well-being of people around the globe (The Levin Institute, 2014).
As a result, national boundaries have become less
relevant in an era of instantaneous telecommunications, free trade, and
multinational corporations. In contrast, global health focuses on issues
affecting health that transcend national boundaries and embrace prevention and
health equity for all people around the world (Koplan, et al., 2009).
The consequences of globalization are staggering, depend in part on a country’s state or development, and have both a positive and negative effect on global health. In the positive sense, globalization has resulted in trade expansion, which in turn increases living standards and improves social and economic status (The Levin Institute, 2014).
It has also created an interconnected workforce, including nursing, which “crosses international boundaries, systems, structures, and processes to provide care to and improve the health outcomes of people around the world’ (Jones & Sherwood, 2014, p. 60).
Another positive and emerging health outcome of globalization is related to the unprecedented spread of mobile technologies such as mobile phones, patient monitoring devices, personal digital assistants, and other wireless devices that are being used to strengthen health systems and achieve health related goals.
In particular, the smart phone and its corresponding medical applications is one example of how mobile technology has transformed the way health information and services are retrieved, delivered, and managed.
All of this is made possible by the infiltration of mobile phone networks into a multitude of low and middle income countries, resulting in greater than 85% of the world’s population being covered by a commercial wireless signal (Istepanian, 2014; World Health Organization, 2011).
However, advances in globalization have also served to negatively affect health. For example, adoption of unhealthy Western habits and lifestyles has resulted in increased obesity and chronic disease. Additionally, open borders and access allow for rapid transmission of infectious agents and disease (Abbott & Coenen, 2008).
Globalization has
positively increased the mobility of the nursing workforce within and between
states, provinces, or countries. However, increased mobility secondary to poor
working or living conditions in a nurse’s home country, for example, can
decrease the local supply of the nurses and thus health of the country or
region (Jones & Sherwood, 2014).
Globalization presents a challenge and ethical responsibility for educators to design and implement curricula that will introduce students to the tenets of a global society and global health as well as prepare competent caregivers within a global society (MacNeil & Ryan, 2013).
To this end, didactic and clinical teaching and learning strategies should be aimed at developing knowledge, skills, and attitudes nurses need to “identify and influence social, political, and economic determinates of health for marginalized populations” (Peluso, Hafler, Sipsma, & Cherlin, 2014, p. 371).
In addition, nurses must gain
understanding about the realities of a market driven or demand driven health
care system based increasingly on a global economy; that health care is a
significant industry whose profit margins, stock prices, and bottom lines
influence salaries and employment opportunities; and how globalization
influences transmission and treatment of disease. Nurses best prepared for
changes resulting from economic forces understand the significance of
globalization and the global economy.
Environmental
Challenges for Curriculum Development In Nursing
Just as currency more readily crosses borders, so can environmental and epidemiologic hazards. Besides health issues across the globe, there are concerns regarding sustainable development, energy availability, pollution-free water, and climate change, to name a few.
Environmental health involves
understanding how the environment influences human health and disease. It
involves an awareness of the effect that environmental conditions have on the
health of individuals and populations and of interventions that can improve the
effect nurses and others have on the environment and the effect the environment
has on the health of the people (National Institute of Environmental Health
Sciences, 2005; Shaner-McRae, McRae, & Jas, 2007).
Increasingly, Americans are becoming aware that the threats to public health and life are found in the frailty of our earth and our delicate interdependence. Therefore it is important for nurses to be aware that the environment affects our health and that actions in our professional and personal lives can and do make a difference.
Nursing curricula should address the content and competencies related to environmental health as well as environmentally responsible clinical practice. Additionally, curricula should encourage and prepare nurses to factor environmental issues into the web of disease causation and to intervene to improve environmental health.
The implications of global warming provide an
excellent platform for students to discuss the ethics of protecting the
environment as well as ways to conserve resources and make educated choices
among products that are environmentally friendly. Excellent environmental
health resources are available on the American Nurses Association website.
Issues in Higher Education for Curriculum Development In Nursing Education
Institutions of higher education sit at an interesting juncture of at least two global themes: the technological explosion and globalization. As learning, knowledge, and skills become the primary resources of a country, the public and private financing of quality higher education becomes more challenging.
Colleges and universities, faced with shrinking resources, technological advances, increased enrollments, and the call for globalization of curricula must strive to find a balance between innovation and tradition if they are to remain relevant and current in an ever-changing and evolving world (Flynn & Vredevoogd, 2010; Hornberger, Eramaa, Helembai, McCartan, & Turtiainen, 2014).
Therefore
affordability, access, accountability, and internationalization continue to be
key issues facing higher education. Each issue affects the other, as
affordability determines access and, as public concerns related to these issues
mount, there are increasing calls for accountability. These challenges must be
met in the face of shrinking public higher education budgets.
Affordability for Curriculum Development In Nursing Education
The concern for affordability, noted as early as 1947, persists today as economic and societal factors promote an increased value of a college degree. Current evidence supports that investment in higher education exceeds the cost of that education in the long run.
For example, for most people, higher education is associated with a secure lifestyle, significantly increased likelihood of employment, and stable careers, as well as positive financial earnings. It is also associated with a healthier, more satisfying life as well as active participation in civic activities (Baum, Ma, & Payea, 2013).
Today, higher education faces many challenges caused by the current economic situation, increasing student enrollment, and rising expectations for quality and equity (Flynn & Vredevoogd, 2010; Heyneman, 2006).
Cuts in federal and state
funding have affected publicly funded institutions while fluctuations in the
stock market have contributed to the declining value of endowments. In short,
higher education “will be asked to do more with less” (Flynn & Vredevoogd,
2010, p. 6).
Because
of societal concern for a living wage, the financing of higher education
becomes a crucial public policy debate. Within that debate, the academy should
prepare persuasive arguments for the merits of education beyond salary,
society’s obligation to invest in human infrastructure, and the importance of
public commitment to higher education. The specific charge for schools of
nursing is to articulate the cost-effective contribution that nursing makes to
the improvement of the health of the nation.
Access to Higher Education as Hurdle for Curriculum Development In Nursing Education
Another issue with historical roots that persists today is access to higher education. The issue of access is important considering society’s transformation from an industrial economy to an information-based, global economy because college graduates have “substantially better prospects in the labor market than peers who stop their formal education after high school” (Brock, 2010, p. 110).
While access to higher education has increased substantially for women, Hispanics, Asians, and Pacific Islanders, other racial and ethnic groups, such as American Indians and Alaskan Natives, remain underrepresented (Brock, 2010).
The ability
of all Americans to take advantage of the multiple benefits and opportunities
that higher education affords requires public policies and political will that
support access, as well as higher education institutions that make real those
opportunities. As administrators of nursing schools pursue robust enrollments
of diverse and talented students, affordability and access are crucial considerations
for the profession.
Accountability as Hurdle for Curriculum Development In Nursing Education
Worldwide, governments and the taxpaying public are questioning the allocation of scarce public resources. The concept of high-quality, affordable public education is threatened by the competition for funding of other public needs.
This, along with rising fear about the deterioration of the U.S. higher education system, low completion rates, and poor preparation of a workforce ready and able to compete in a global marketplace, led to the formation of the Spelling Commission.
The purpose of
this commission was to recommend a national strategy for postsecondary
education reform, with an emphasis on “how well colleges and universities are
preparing students for the 21st century workforce” (Floyd & Vredevoogd,
2010, p. 19).
Several forces prompt this increased accountability for higher education. In times of cost cutting and corporate downsizing, business and private sector management looks to education, and its products, for competitive strategies. Also, drastic state budget cuts have caused policy makers and taxpayers to require justification for higher education funding.
Legislatures have tended to
disallow tuition hikes and request internal moves toward efficiency.
Additionally, “publicly funded institutions must be accountable to their
principal stakeholder the public” (Floyd & Vredevoogd, 2010, p. 10). Each
of these forces promotes increased public scrutiny and higher expectations.
Accountability therefore becomes a multidirectional force. Institutions of higher education depend on the government for funding and are therefore highly accountable to the public for academic productivity and fiscal prudence. Governments, in response to their perceived accountability to the public, act to regulate and reform higher education. Schools of nursing are accountable to state legislatures, Congress, and the public regarding the preparation of adequate numbers of competent nurses. This accountability includes incorporation of and adherence to regulations set forth by state boards of nursing, accrediting bodies, and others who set standards for prelicensure and graduate nursing education. Clearly accountability will continue as a significant theme in higher education.
Internationalization as Hurdle for Curriculum Development In Nursing Education
In higher education internationalization has served to intensify the “mobility of ideas and of people” in large part because of the technology explosion that continually shrinks time and space (EgronPolak, 2012, p. 1).
It is anticipated over the course of the next 10 years that educational institutes providing English language based postsecondary education will experience strong demand from international students who have the desire to study outside of their home countries (Ruby, 2013).
In turn, institutes of higher education are increasingly open to attracting more international students as well as able to offer faculty opportunities to engage in international research.
As a result,
new funding sources become available at a time when academic institutions are
struggling financially for reasons explicated in the preceding discussion on
affordability (Egron-Polak, 2012).
Issues Specific to the Nursing Profession as Hurdle for Curriculum Development In Nursing Education
This
chapter began by looking through the lens of the broad socioeconomic and
sociopolitical issues that shape the world and influence contemporary life.
This section focuses the lens more specifically on the nursing profession and
highlights issues of particular consideration within the profession. Included
are the context of nursing care delivery, new and reemerging degrees, and
competencies for the twenty-first century.
Context of Nursing Care Delivery as Hurdle for Curriculum Development In Nursing Education
The nursing profession influences and is
influenced by the health care delivery system, which provides a context for
nursing services. The 2010 American Hospital Association Environmental Scan
provided insight into several trends affecting the health care field, five of
which have great implications for nursing practice and education: science and
technology, rising costs, health policy, quality of care and patient safety,
and human resources (O’Dell, Aspy, & Jarousse, 2011). These trends inform
educators as they determine what and how to teach the next generation of
nurses.
Science and Technology Effect on Curriculum Development In Nursing Education
Science and technology continues to revolutionize the health care possibilities at the point of care and within the academic community. For example, from a science perspective the Human Genome Project presents a multitude of individualized genetic therapies, as well as ethical quandaries.
As a result, nursing curriculum should incorporate strategies aimed at helping nurses identify, understand, and support patients facing genetic decisions (Forbes & Hickey, 2009).
The American Nurses Association’s (2008) Essentials of Genetic and
Genomic Nursing: Competencies, Curricula Guidelines, and Outcome Indicators
details basic competencies nurses should possess to “deliver competent genetic
and genomic focused nursing care” (Forbes & Hickey, 2009, p. 9) and thus is
an excellent resource for those charged with curriculum development and
redesign.
A national survey from the Pew Research Center’s Internet & American Life Project (2013) indicates just how pervasive technology is in our world. Findings from the Pew survey revealed that one in three American adults have gone online to figure out a medical condition, and 72% of internet users say they looked online for health information within the past year (2013).
Through the Internet, consumers have become armed with and have access to information previously available only to clinicians. Today’s health care consumers know what they should expect from their health care providers and expect to participate in decisions affecting their health care (Hegarty et al., 2009; Heller, Oros, & Durney Crowley, 2013).
Internet savvy health care consumers
often approach providers with extensive information, requesting treatments or
drugs and expecting quality ratings on provider and institution report cards.
Therefore nursing needs to appreciate these empowered consumers and “respect,
affirm, and share decision-making with increasingly knowledgeable patients”
(Hegarty, et al., 2009, p. 6).
The health care industry is following the lead of the aviation industry in providing increased education and assessment using simulation technology, particularly in this era of scarce and complex clinical sites for training. As a result, schools of nursing are challenged to use sophisticated simulations as a way to help students acquire skills and develop critical thinking (O’Dell, et al., 2011).
With high fidelity simulation, nurse educators can replicate many “real-world” patient situations in which students can practice nursing in an environment that does not endanger patients.
Findings from a recent randomized
control study indicated that substitution of high-quality simulation
experiences for up to half of traditional clinical hours produced comparable
end-of-program educational outcomes (Hayden, Smiley, Alexander, Kardong-Edgren,
& Jefferies, 2014).
Rising Costs as Hurdle for Curriculum Development In Nursing Education
The second trend involves the continued surge in health costs and the need for hospitals and providers to manage care more efficiently within finite budgets.
Hospital budgets will be challenged by declining charitable donations and investment income; increasing numbers of Medicare, Medicaid, and self-pay clients; labor shortages; and increased pharmaceutical and supply costs (O’Dell, et al., 2011).
Research that documents
nursing’s contribution to efficient, quality care is needed to advocate in
budget negotiations and hospital changes.
Health Policy Effect on Curriculum Development In Nursing Education
Health policy, the third trend, becomes an increasingly significant strategy to shape, finance, and regulate the health care system. With the cost of national health expenditures anticipated to rise from 16% to 20% of the gross domestic product (GDP) by 2017, state and federal policies seek to regulate costs, shift care to less expensive settings, and use market forces to control costs when possible (Henry J. Kaiser Family Foundation, 2009; O’Dell, et al., 2011).
Ensuring that everyone in the United States has health insurance is one strategy that would help reduce health care expenditure to only 18.5% of the GDP (O’Dell, et al., 2011). The PPACA represents great progress toward making health care available to and affordable for all Americans.
Since its inception, the number of insured
Americans has continued to rise. The U.S. Census Bureau (2013) reported that in
2012 both the percentage and number of Americans with health insurance
increased to 84.6% and 263.2 million, up from 84.3% and 260.2 million in 2011.
The number of people covered by private health insurance continues to drop while increasing numbers receive coverage by government health insurance. Another feature of the PPACA is the mandate to revitalize primary and public health care infrastructures (U.S. Department of Health and Human Services, 2014).
The focus of health care is shifting away from acute and chronic hospital-based care toward community-based care. Nursing will continue to be called on to coordinate collaborative interdisciplinary community-based care and to act as primary care providers, practicing to the full extent of their education and training.
The expansion of nursing roles under the PPACA will create a shift in
nursing employment statistics and create additional career opportunities for
new graduates (Institute of Medicine, IOM, 2010).
The
predicted shift from hospital-based to community-based employment has already
begun. In 2008, 62.2% of all employed registered nurses (RNs) worked in
hospitals. Currently, more than 50% of nurses work outside the hospital setting
(Benner, Sutphen, Leonard, & Day, 2010). In 2010 the HRSA estimated a 109%
increase in the need for community based RNs compared with a 36% increased need
for hospital-based RNs by 2020.
In response to this shift in where care is delivered, governing agencies are recommending that schools of nursing restructure their curriculums and move away from the traditional primary focus on acute and chronic hospital-based instruction to one that includes more team-focused, community-based practice emphasizing policy technology and leadership development programs (Institute of Medicine, IOM, 2010; U.S.
Department of Health and Human Services, 2014).
Innovative nurse educators are responding to these recommendations by building
collaborative relationships with patient-centered medical homes and
nurse-managed health clinics to provide nursing students with clinical
experiences that demonstrate the principles of community care, leadership, and
client care in community settings (American Association of Colleges of Nursing,
AACN, 2013).
Quality of Care and Patient Safety and Curriculum Development In Nursing Education
A need exists to improve patient safety and provide quality care (Forbes & Hickey, 2009). Although the quality of care has improved steadily during the past decade, further improvement continues at a low pace. Not only is health care quality suboptimal, patient safety is also lagging, and there remains a significant geographic variation in quality of care (U.S. Department of Health & Human Services, Agency for Healthcare Research and Quality, 2008; O’Dell, et al., 2011).
In 2010 the IOM recommended that patients and their families have access to information regarding a hospital’s performance on safety, evidence based practice, and patient satisfaction (Hinshaw, 2011). This, along with increasing reporting requirements, will challenge health care organizations to collect the most accurate data possible and then improve patient care based on that data.
In response to this trend, the Institute for Health Improvement
recently developed the Triple Aim framework (2009) as a means to measure health
care quality data, interventions in public health, care coordination, universal
access to care, and cost control through a financial management system.
Given the loud call from several authorities, including the IOM, the Robert Wood Johnson Foundation, and the Agency for Healthcare Research and Quality, in tandem with the key role nurses play in protecting patient safety and providing quality health care, there exists a need to better prepare today’s nurses for professional practice.
To this end, the AACN identified the following six essential core competencies for nurses related to ensuring high quality and patient safety: critical thinking, health care systems and policy, communication, illness and disease management, ethics, and information and health care technologies.
Additionally, educators should assist students to understand the proactive steps that the nursing profession is taking within the changing health care environment to define nursing practice and educate the public on nursing’s role in quality care.
The Magnet Recognition Program developed by the American Nurses Credentialing Center (American Nurses Credentialing Center, ANCC, 2008) recognizes health care organizations for quality patient care, nursing excellence and innovations in professional nursing practice.
Magnet designation
is the ultimate credential for high quality nursing and a powerful example of
nursing action that students should understand. Please see the ANCC website for
additional information on the Magnet Recognition Program®
(http://www.nursecredentialing.org/Magnet/ProgramOverview/NewMagnet-Model.aspx).
Human Resources for Curriculum Development In Nursing Education
Human capital becomes a significant trend with nursing and physician shortages and the unionization of health care providers. In February 2009 three nursing unions merged to form the United American Nurses National Nurses Organizing Committee.
The legislative priorities of this union, which has 150,000 members,
include a push for nurse staffing ratios, workplace safety rules, and a
national pension for RNs (O’Dell, et al., 2011).
Retention of satisfied employees will be the goal of viable organizations, which is related to the creation and maintenance of healthy and safe work environments. Creation of “workplace cultures that can attract and retain health care workers” will be an important element of hospitals of the future given the “average voluntary turnover rate of new hospital nurses is 27%” during their first year on the job (Joint Commission, 2008, p. 29).
In part, respecting human capital means attention to the work environment and relationships as well as sanctions against verbal abuse by physicians, patients, and nurse colleagues; sexual harassment; and workplace violence, including horizontal violence or hostile behaviors within a group of nurse colleagues (Felblinger, 2008; Joint Commission, 2008).
In 2005 the American Association of Critical Care Nurses created a document that details six essential standards for establishing and maintaining healthy work environments. Educators would do well to adopt these standards into their curriculum and academic and clinical workplaces. The AACN Standards for Establishing and Sustaining Healthy Work Environments.
In
conclusion, future practitioners will need knowledge and abilities to assist
informed health care consumers, understand science, use technology, stem rising
costs, provide quality health care and protect the safety of patients, advocate
for effective health policy, actively participate in the process of health care
reform, and work to create a health care system with competent, empowered human
capital. In short, “nurses will need to take leadership roles in ensuring
quality health care” (Q&A with Kathy Rideout, Associate Dean for Academic
Affairs, 2010, p. 11).
Emerging Degrees and Curriculum Development In Nursing Education
Two
graduate degrees, the clinical nurse leader (CNL) and the doctor of nursing
practice (DNP), have been created and implemented within the profession in the
last decade. These two emerging degrees provide one example of efforts within
the profession to create roles and curricula to meet changing societal needs
for health care.
In 2000, considering declining nursing enrollment among other professional issues, the AACN determined that changes must be made in education, practice, licensure, and credentialing. The AACN recommended a new educational model for a master’s entry, the CNL, to improve patient care and maximize patient safety (American Association of Colleges of Nursing, AACN, 2007).
To this end, the CNL is intended to be a leader within all health care settings who assumes accountability for patient-care outcomes and provides and manages care to individuals and patient cohorts (American Association of Colleges of Nursing, AACN, 2013).
Other fundamental aspects of CNL practices are outlined in Box 5-1. Programs to educate CNLs require ongoing partnerships between practice and education so that both arenas shape the learning and graduates enter practice environments designed to use their skill set.
Fundamental Aspects of CNL Practice
Clinical leadership for patient care practices
and delivery, including the design, coordination, and evaluation of care for
individuals, families, groups, and populations Participation in identification
and collection of care outcomes.
Accountability for evaluation and improvement
of point-of-care outcomes, including the synthesis of data and other evidence
to evaluate and achieve optimal outcomes. Risk anticipation for individuals and
cohorts of patients. Lateral integration of care for individuals and cohorts of
patients.
Design and implementation of evidence-based
practices. Team leadership, management, and collaboration with other health
professional team members.
Information management or the use of
information systems and technologies to improve health care outcomes.
Stewardship and leveraging of human, environmental, and material resources.
Advocacy for patients, communities, and the health profession. CNL, Clinical
nurse leader.
In 2004 the AACN voted to move the current level of preparation necessary for advanced practice nursing from the master’s degree to the doctorate level by 2015, creating the clinical doctorate, the DNP.
The drive to create the DNP was the complexity of current health care and curriculum creep that results in some advanced practice degree programs far exceeding the credit hours of a usual master’s degree.
Since the AACN’s membership vote that education for all advanced practice nurses will transition to the DNP, approximately 250 new doctoral programs consistent with the DNP essentials and standards from the particular specialty focus of the program have been created (American Association of Colleges of Nursing, AACN, 2014a).
However, other schools
perceive budgetary, regulatory, or philosophical barriers to transitioning
their MSN degree programs to the DNP degree and will likely continue to offer
master’s degree advanced practice education as the nursing profession further
addresses graduate-level education issues related to advanced practice nursing.
Competencies for the Twenty First Century
The nursing profession needs not only robust workforce numbers, but also practitioners with requisite knowledge, abilities, and work behaviors to meet the health demands of the population as well as nurses who possess leadership skills.
Educators are challenged to prepare individuals who, on graduation, can
lead; deliver competent, safe, quality, patient-centered, compassionate care;
have the ability to navigate future changes in the system; and acquire future
abilities associated with evolving roles (Institute of Medicine, IOM, 2010).
Recently, the American Organization of Nurse Executives (2011) released an updated document outlining the competencies common to nurse leaders regardless of educational level or title. These competencies are clustered into five broad categories:
(1) communication and relationship building
(2) knowledge of the health care environment
(3) leadership skills
(4) professionalism
(5)
business skills
AONE Nurse Leader Competencies
1. Communication and
relationship-building competencies
a. Effective communication
b. Relationship management
c. Influencing behaviors
d. Diversity
e. Shared decision-making
f. Community involvement
g.
Medical, staff relationships
h. Academic relationships
2. Knowledge of the health care environment
a. Clinical practice knowledge
b. Delivery models, work design
c. Health care economics
d. Health care policy
e. Governance
f. Evidence-based practice, outcome
measurement
g.
Patient safety
h. Utilization, case management
i. Quality improvement, metrics
j. Risk management 3. Leadership
a. Foundational thinking skills
b.
Personal journey disciplines
c. Systems thinking
d. Succession planning
e. Change management
4. Professionalism
a. Personal and professional accountability
b. Career planning
c. Ethics
d. Evidence-based clinical management practice
e. Advocacy
f.
Active membership in professional organizations
5. Business skills
a. Financial management
b. Human resource management
c.
Strategic management
d.
Marketing
e. Information management and technology AONE,
American Organization of Nurse Executives
More than a decade ago, Bellack and O’Neil (2000) discussed the recommendations from the Pew Health Professions Commission’s fourth and final report, which represented a continuing effort to support the health professions’ education reform and align educational programs more fully with the health needs of the population.
They presented five recommendations for all health professions schools, including nursing:
(1) update professional training to meet new health care demands
(2) ensure diversity in the health professions workforce
(3) require interdisciplinary competence
(4) continue to move health care education into the ambulatory care setting
(5) encourage health care students to engage in public service.
Despite being issued more than 10 years ago,
these recommendations continue to provide excellent guideposts for nurse
educators as they pursue the preferred future via the current reality.
In many respects, nursing education is still grappling with developing educational models that successfully address the Pew Commission’s recommendations from 2000. Most recently, the IOM’s (2010) report offers a new set of recommendations that call for significant changes in how nurses are educated and prepared for practice in an era of health care reform.
The four key messages delivered in the Future of Nursing report are that nurses should:
(1) be able to practice to the full scope of their educational preparation
(2) seek higher levels of educational preparation, and be able to do so in seamless academic progression systems
(3) function as full partners in interdisciplinary teams to redesign health care delivery
(4) benefit from improved data collection and information infrastructures.
The IOM report
promises to be influential in focusing attention on solutions to the barriers
that have kept nurses from being as influential as they can be in leading and
advocating for changes in health care.
Strategies to Identify Influential Forces and Issues
The
forces and issues that influence the nursing profession and curriculum
originate in the external, higher education, and internal environments. This
section presents strategies that may be useful to nurse leaders in identifying
these influences.
Environmental Scanning
“Strategic planning is critical to the survival of health care organizations in today’s turbulent environment” (Layman & Bamberg, 2005, p. 200). Environmental scanning, a component of strategic planning, involves various activities that monitor and evaluate information from the external environment (Layman & Bamberg, 2005).
The goal of environmental scanning is for leaders and managers to become aware of general trends and events affecting health care and higher education generally and nursing specifically.
Information from the environment
can be acquired in various ways, including careful review of scientific and
professional journals as well as lay literature and newspapers and attendance
and networking at professional meetings. Information gathered from these
activities becomes “the basis of future initiatives” (Layman & Bamberg,
2005, p. 200).
Environmental scanning continues to be successfully used by colleges and universities to determine the context of the forces affecting curriculum development. For example, use of strategic environmental scanning led one southeastern university to develop a non nurse practitioner program designed to prepare nurses for other types of advanced practice roles.
Following review of program
evaluations and assessment of graduates and other nursing leaders in the
community, the Master of Science in Nursing in Advanced Care Management and
Leadership program was developed with the goal of preparing nurse leaders who
are “equipped to manage and improve client care outcomes” (Aduddell &
Dorman, 2010, p. 171).
In curriculum development, environmental scanning allows faculty to be simultaneously reactive and proactive. Through awareness and acknowledgment of significant trends (reactive), faculty can more actively choose a future direction for nursing education and curriculum (proactive).
The use of
environmental scanning as a strategy to obtain a broad scope of information and
evaluate its relevance to nursing is the foundation of the other strategies
that follow.
Strategic Planning
Often educators, leaders, and managers are so preoccupied with the “tyranny of the urgent” that they lose sight of their ultimate goals and objectives. Strategic planning is one strategy educators and organizations can use for quality checks, assessments, planning, or analysis.
A
strategic plan serves as a framework for decisions, provides a foundation for
detailed planning, is used to explain “the business” to others, assists with
benchmarking and performance monitoring, and stimulates change (PlanWare, 2014).
The
process of strategic planning may include the use of the Strengths, Weaknesses,
Opportunities, Threats (SWOT) analysis. Educators charged with curriculum
development or redesign can use SWOT to guide development and analysis of
curricular objectives and key strategies to meet them. SWOT can also be used as
an instructional strategy to assist students with job searching and career
planning (Weiss & Tappen, 2015).
Epidemiology
Epidemiology is the study of the distribution and determinants of states of health and illness in human populations. Epidemiology provides nursing faculty with systematic ways to understand patterns of disease, characteristics of people at high risk for disease, environmental factors, and shifts in demographic characteristics of the population.
Using epidemiologic data with groups or populations, nurses
understand and document the need for programs and policies to reduce risk and
promote health. Epidemiology can therefore be seen as a method for planned
change.
In the same way, nursing faculty responsible for the development of curriculum can use epidemiological data and methods to understand factors affecting the health of populations and trends occurring in health and illness states.
Epidemiologic
analysis provides faculty with methods for understanding that part of the
context that involves the broad determinants of health and patterns of disease
and disability in the population.
Survey Research and Consensus Building
Another tool at the disposal of faculty is survey research. Surveys involve systematically collecting information from individuals and deriving statistical statements, such as some measure of central tendency, or consensus statements from groups of experts or involved individuals.
If the design is iterative and
involves a series of surveys, feedback, and more surveys, it is considered a
form of Delphi technique. Surveys and consensus- building processes provide an
opportunity to sample the perspectives of various stakeholders and
knowledgeable persons, for example, employers or consumers. They facilitate
tapping the rich diversity of group wisdom related to complex issues.
The
strategies of environmental scanning, forecasting, epidemiology, and survey
research and consensus building have utility in preparing for curriculum
development or revision. Using some combination of the four strategies
presented here, faculty can be equipped to develop curriculum compatible with
the current and projected issues influencing nursing and health care.
The forces and issues that influence and are influenced by nursing curriculum originate in the external, higher education, and internal environments. Educators sensitive to major sociopolitical and economic trends can develop curriculum that matches global characteristics.
Educators aware of prevailing higher education issues can assist schools of nursing to be leaders in the academy. Educators attuned to prevailing and visionary thinking within the profession can shape the future through progressive curriculum and pedagogy. Nursing deserves curriculum that is both compatible with the contemporary health care context and flexible enough to be relevant for emerging circumstances and needs.
Reflecting on the evidence
1.
How does your nursing program curriculum remain relevant to the broad societal
changes, issues, or health care reform? In what new ways can it become more
relevant to broad societal changes, issues, or health care reform?
2.
How does your nursing program curriculum prepare students to be engaged
citizens in society whose practice matches current issues and trends?
3. How is your nursing program curriculum
compatible with new developments in the discipline?
4. In what ways does the faculty in your
nursing program incorporate new input and acknowledge new influences on
curriculum development? How do faculty respond to those voices of change?
5. How is your nursing program curriculum
preparing students to engage in health care reform and collaborative practice
as leaders?
Give your opinion if have any.