Nursing Education and Significant Sources Requiring Substantive Curricular Changes
National Reports, Nursing Education Trends, and Recommendations of Significance
In recent years, several seminal position statements, reports, and recommendations have been issued by prestigious organizations or groups that require substantive curricular change, and in some cases disruptive innovation.
Five of the most significant sources requiring
substantive curricular changes are reviewed to contextualize the definitions of
and processes related to curriculum in nursing.
1:Quality and Safety Education in Nursing
In 2001, the Institute of Medicine (IOM) released a seminal report titled Crossing the Quality Chasm (Institute of Medicine (IOM), 2001) that called for substantive reform of health professions education to enhance quality and safety practices within health care.
Simply stated, the report identified five competencies as essential for health professionals of the twenty first century: patient centered care, teamwork and collaboration, informatics, evidence based practice, and quality improvement (including safety).
It was also recommended that the disciplines develop common
language in important areas, integrate learning experiences, use evidence-based
curricula and teaching strategies, and offer faculty development to model these
competencies.
The Quality and Safety Education in Nursing (QSEN) project was launched in 2005 with the overall goal of ensuring that all graduating registered nurse students had developed the relevant quality and safety competencies that would prepare them for practice.
From feedback received from nursing faculty and practice leaders of the time, it was clear there was an urgent need for faculty development to ensure that faculty were teaching contemporary and accurate information regarding quality and safety practices, and that quality and safety content be integrated into all prelicensure nursing programs as quickly as possible (Sullivan, Hirst, & Cronenwett, 2009).
To provide information to
nursing faculty that could be immediately incorporated into courses, the QSEN
project developed a KSA curricular framework (Quality and Safety Education for
Nurses, QSEN, n.d.) that addressed each of the five competencies (separating
quality and safety for a total of six) identified in the Institute of Medicine,
IOM, 2001 report (Cronenwett, 2012). A QSEN website was
established to assist in the dissemination of the KSA framework and serves as a
clearinghouse for teaching and learning resources.
The QSEN project was expanded to include graduate-level nursing competency development, resulting in KSAs for this level of nursing program to advance quality and safety competency development (Cronenwett et al., 2009). A partnership with the AACN and communications with the NLN have resulted in continuing faculty development opportunities related to QSEN.
Finally,
essential content from the QSEN project has been integrated into nursing
education program accreditation standards so that a formal review of the
presence and effectiveness of QSEN content in nursing education programs is
ensured.
2:Carnegie Foundation for the Advancement of Teaching In Nursing Education
The Carnegie Foundation for the Advancement of Teaching launched a multiyear comparative study titled “The Preparation for the Professions” focused on professional education in medicine, nursing, law, engineering, and preparation of the clergy in the United States.
The goals of this significant initiative were to better understand how the various professions are prepared to practice through identification of educational approaches and how the outcomes of professional education could be strengthened and improved.
The fourth volume of
this series of studies on the professions was Educating Nurses: A Call for
Radical Transformation (Benner et al., 2010). Four major recommendations
emerged from the Benner et al. (2010) study, which have many implications for curriculum
development and implementation:
1.
Emphasize teaching for a sense of salience, situated cognition, and action in
particular situations, instead of covering decontextualized knowledge. This
recommendation is often expressed as teaching students how to “think like a
nurse.”
2. Integrate clinical and classroom teaching,
instead of maintaining a separation of the two. Given the complexity and
breadth of knowledge required for today’s nursing practice, it is essential
that faculty design strategies to better link classroom and clinical teaching
to reflect the actual complexities and pace of nursing practice.
3. Emphasize clinical reasoning and multiple
ways of thinking, instead of critical thinking. Examples of the multiple ways
of thinking include clinical reasoning, clinical imagination, and scientific
reasoning.
4. Focus on the formation of professional
identity, rather than socialization and role taking. Nursing students need
experiential learning environments that provide the opportunities to learn
about and internalize the elements of being a “professional.”
These four recommendations, especially when coalesced into actual teaching practices, require educators to think very differently about how curricula are created and to acquire and effectively use many new teaching and learning strategies within the context of a health care system that is evolving rapidly to achieve the “triple aim” of health care.
The
triple aim seeks to improve the patient experience of care (including quality
and satisfaction), improve the health of populations, and reduce the per capita
cost of health care (Institute for Health Care Improvement (IHI), 2007).
3:Use of Simulation
The use of simulation technology in nursing and health professions education has exploded during the last decade in frequency of use, sophistication of the technology, and the teaching and learning strategies employed, and has introduced a number of implications for curriculum development.
Specifically, current students expect that simulation
activities, including access to a clinical laboratory environment, will be
readily available and resemble actual clinical settings. Simulation can be
simply defined as activities or events that mimic real world practice and
include both low and high fidelity activities.
4:Interprofessional Education and Collaborative Practice
The importance of interprofessional education (IPE) and collaborative practice to achieving the quality, safety, and innovation goals of the overall health care system within the United States is supported by numerous major reports and statements, including most notably three Institute of Medicine (IOM) (2001, 2003, 2010) studies.
The World Health
Organization (WHO) (2010) and several organizations promoting interprofessional
education have offered definitions of IPE that are guiding efforts in this
area. These definitions state that interprofessional education may be described
as students from multiple professions learning with and about the various
health professional roles so that the foundation for professional collaboration
around care will more easily occur in real-world setting.
In 2009 six national education associations representing different health professions (nursing, allopathic and osteopathic medicine, dentistry, pharmacy, and public health) joined forces to create the Interprofessional Education Collaborative (IPEC) and to develop core competencies related to interprofessional collaborative practice (Interprofessional Education Collaborative Expert Panel, 2011).
These organizations have the ability to
influence curricular changes across the named disciplines. The goals of IPEC
include the advancement of substantive IPE to prepare future clinicians for
team-based patient care. Thus, IPE is considered a precursor of promoting
effective interprofessional collaborative practice across settings. S
The Interprofessional Education Collaborative Expert Panel (2011) core competencies have been incorporated into virtually all of the involved health disciplines’ accreditation standards, leading to more widespread adoption within the various curricula.
Many colleges have published examples of how the IPEC core
competencies are being addressed with numerous evaluation studies of these
activities also provided (Sullivan & Godfrey, 2012). Going forward, nursing
and other health professions curricula will include substantive IPE experiences
to prepare graduates with the now widely accepted IPEC competencies
(Thistlethwaite & Moran, 2010).
5:Web-based Technology and Online Learning
The number of nursing students studying fully or partly in online learning has exploded over the last five years. The reasons for this surge in demand for online learning include easier access, convenience, adult friendly education and services, and flexible programming schedules that online learning can provide.
Established top-tier universities as well as newer nonprofit and
for-profit institutions of higher education have increasingly embraced the
trend toward online learning, with many incorporating aspects of web based
technologies into campus-based classes resulting in hybrid (blended) courses.
A systematic review of online learning in undergraduate health professions that focused on student knowledge, skills, satisfaction, and cost-effectiveness yielded positive conclusions. In 12 of 50 studies included, significant positive differences in those studying online were noted.
And 27 of 50 studies showed no significant differences in learning, or mixed results, suggesting that incorporating online learning is most likely at least as effective as traditional methods (George & Shocksnider, 2014). Evidence exists that similar positive outcomes with online learning can be achieved in graduate study, including doctoral programs (Broome, Halstead, Pesut, Rawl, & Boland, 2011).
A metaanalysis of blended learning and technology use in higher
education concludes that in terms of achievement outcomes, blended learning
worked better than traditional face-to-face classroom instruction.
Additionally, the kind of computer support used and the presence of one or more
interactions (student-teacher content) enhance student achievement (Bernard,
Borokhovski, Schmid, Tamim, & Abrami, 2014).
Having an awareness of and planning for predicted changes to web-based learning technologies is critical when developing or redesigning curricula at all levels. One of the most important trend reports is the New Media Consortium’s (NMC) Horizon Report (New Media Consortium (NMC), 2015).
The annual Horizon Report details key trends, significant characteristics impeding higher education technology adoption, and important developments in educational technology for higher education.
Some of the key trends of this recent report with significant implications for nursing education include continued focus on and growth of integrated or hybrid learning and the ubiquity of social media.
Characteristics reportedly impeding adoption of education technology in higher
education included low digital fluency of faculty, relative lack of rewards for
teaching, competition from new models of education, and scaling teaching
innovations.
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