Purposes, Historical Influences and Factors Influencing Undergraduate Program Design In Nursing Education

Undergraduate Program Design In Nursing Education and Purposes, Historical Influences & Factors Influencing 

Essential Purposes of Undergraduate Education in Nursing Education, Historical Influences for Understanding Today’s Undergraduate Curriculum In Nursing Education, Factors Influencing Undergraduate Program Design In Nursing Education.

Essential Purposes of Undergraduate Education in Nursing Education

    Undergraduate nursing curricula are primarily designed to prepare students for entry into practice. In addition, some curricula are designed as academic progression models for registered nurses (RNs) to achieve a bachelor of science in nursing (BSN) degree or licensed practical or vocational nurses (LPN/LVN) to pursue an RN degree. 

    Undergraduate curricula also provide a foundation essential to graduate education and advanced nursing practice. In recent years, some health care agencies have been reframing requirements for RN employment with acute care agencies often preferring or requiring applicants to hold a bachelor’s degree in nursing. 

    Designing curricula that facilitate the academic progression of the nursing workforce (National League for Nursing [NLN], 2011) will be imperative to achieve the Institute of Medicine (Institute of Medicine [IOM], 2010) recommendations for increasing numbers of baccalaureate and advanced degree–prepared nurses and to meet market demands.

    The increased expectation for public accountability has expanded the visibility of nursing education at the national, state, and local levels, which has also increased stakeholder involvement in the education and practice of nurses. 

    As a professional educational degree program, nursing is among the most regulated educational enterprises on higher education campuses. One advantage of regulation for nursing programs is the high level of scrutiny to which they are subjected, and the assurance of minimum standards for most schools of nursing, providing a competent workforce for patient care. 

    Making use of the relative similarities in curriculum plans that exist across nursing programs, in part resulting from regulatory requirements, faculty have adapted plans of study to facilitate articulation and academic progression. 

    A disadvantage to this level of control is the perceived negative effect of prescriptive guidance and rules on innovation; faculty may be discouraged from pursuing new ideas for curriculum organization, content, and teaching methodologies, perceiving too many impediments to innovate.

    Compared with curricula in other disciplines, nursing curricula across multiple schools often look quite homogeneous. This does ensure that new graduates have been exposed to knowledge that is commonly accepted to be essential to practice, but on the other hand, having a large body of knowledge that faculty perceive to be essential can potentially stifle innovation. 

    Perhaps this is one reason that examples of innovative curricular responses to the changing environment have been a challenge to initiate. However, innovation is occurring in the area of transforming curricula to meet the needs of more nontraditional students, students pursuing a second degree, and those with unique needs, leading to more creativity and flexibility in curriculum construction and delivery. The expected outcome is to entice, retain, and graduate a diverse population of students.

Historical Influences for Understanding Today’s Undergraduate Curriculum In Nursing Education

    Florence Nightingale is considered to be the founder of modern nursing. As a prolific writer who spoke in eloquent tones about the education and practice of nurses, Nightingale envisioned nursing as more than the understanding of disease. She is quoted as having said, “Pathology teaches the harm that disease has done. But it teaches nothing more” (Nightingale, 1969, p. 133). 

    Her nursing orientation focused on health as a broad and encompassing concept that requires an understanding of human nature and the ability of that nature to affect individual health. Nightingale’s thinking that nurses need to acquire an understanding of the science and art of human existence has continued to permeate undergraduate education from its original, hospital based training programs to its current degree-granting educational programs.

    Traditionally, nursing philosophy and theory have been crucial to nursing curricula because philosophy and theory state what nursing is and what it should be. Nursing theorists, starting with Nightingale, have provided nursing with the theoretical foundation for educational philosophies, mission statements, curriculum models, and delivery of curriculum content. 

    Despite differing beliefs posited among recognized nursing theorists, they, like the curriculum models that have been predicated on their thinking, have focused on the nature of humans, society, and nursing practice. It appears that the previous emphasis on the roles of nursing philosophy and theory in design of nursing curricula is decreasing as the emphasis has shifted to one that is more outcome-driven. 

    Donohue Porter, Forbes, and White (2011) point out that as our undergraduate curricula have become saturated with content, the focus on nursing theory has diminished, leading to curriculum structures that are very content laden, with decreased focus on the theoretical organizing structures of knowledge that allow students to integrate knowledge into practical action. The concept based movement in curriculum development is one means by which to address the concern about overly content laden curricula.

    The desire to understand human nature and society is still a prevailing factor shaping current undergraduate curricula, especially nursing curricula. Theory that is effectively used in the construction of curricula and teaching–learning methodologies can counter the focus on nurses mainly as “doers” rather than “thinkers” that is often a perception of students in nursing education programs today (Grealish & Smale, 2011). 

    An example of a curriculum structure that effectively uses theory to facilitate integrative thinking is the Popoola holistic praxis model (Popoola, 2012) in which a planned framework of theoretical concepts are organized into a program of study that emphasizes the explicit use of multiple theories throughout the nursing curriculum.

Factors Influencing Undergraduate Program Design In Nursing Education

    Multiple factors influence the design and development of undergraduate nursing curricula. Nursing curricula should reflect the mission, vision, and values espoused by the university or college, while retaining congruence with the school’s philosophy and vision. Further, significant national and international reports create calls to action and change. 

    Along with these influences, schools of nursing design curricula with particular learner characteristics in mind. In planning nursing curricula, schools of nursing must also respond to the expectations of key stakeholders, such as accreditors and boards of nursing. 

    Further, because nursing programs prepare students for licensed practice, attention to licensing requirements is important successfully licensed students are a publicly recognized marker of program quality. Finally, faculty constructing curricula for nursing programs should consider the present and future trends in health and health care that are likely to affect nurses’ practice in the coming years. 

    Although predicting the future issues and needs in health care is an uncertain activity, without such vision, schools of nursing will consistently lag behind the rapidly changing health care environment, to the detriment of the profession.

    Faculty designing curricula that meet these extensive design factors require creativity, political savvy, negotiation skills, analytical rigor, psychic energy, and a sense of teamwork. 

    Faculty involved in designing programs and building curricula must possess a clear sense of purpose, a commitment to procuring resources, an understanding of market forces, the ability to anticipate health care trends of the future, and the ability to know when goals have been accomplished. 

    Once programs are designed, curriculum building and revision should continue in a continuous quality improvement process that is related to, but separate from, the acts of teaching and learning. Curriculum is a dynamic, evolving entity shaped by learner needs and faculty beliefs about the science and art of nursing.