A Need for Change in Nursing Education

1. A Need for Change in Nursing Education Jean Foret Giddens, PhD APRN-BC, Associate Professor College of Nursing , University of New Mexico jgiddens@salud.unm.edu Infusing Conceptual Learning Into the Classroom North Carolina Associate Degree Nursing Council Fall Conference, October 23, 2007

2. Overview and Background • Understanding Content Saturation • College Students: Circa 2010 • Aiming for a New Kind of Graduate

3. Understanding Content Saturation

4. Health Sciences Education Health sciences education is experiencing content saturation; there is more content than can possibly be taught in any given curriculum.

5. Emerging Terms Content Saturation Additive Curriculum Curriculum Obesity Content Overload

6. The Curriculum Revolution • Late 1980s, the NLN led a curriculum revolution effort to transform the design of nursing programs. • Rejection of long-standing content-loaded, behaviorist model of nursing education. • New focus on selection of content • New interest in facilitation of student learning with new pedagogies

7. Themes from the Literature • Bevis (1988) …..reform efforts in nursing rarely change the substance of the curriculum itself but merely “switch, swap, and slide content around”….

8. Themes from the Literature • AACN (1998) “…is it possible to “prepare beginning level professional nurses for the future in a four-year time frame” (p.19). • Tanner (1998) questioned if the expectations set forth in Essentials was a “blueprint for 21-year curriculum” p. 383

9. Themes from the Literature • Burton (2000) students… “are expected to learn a large volume of material in a short period of time. As a consequence, students tend to rely on rote memorization to pass exams.” • Diekelmann (2002) “….textbooks are thicker and course content more complex. Students complain of ‘too much content’ as they appear to have reached their limits with memorization.”

10. Themes from the Literature • IOM (2003) specifically cites “overly crowded curricula” as one of many challenges in health education reform (p. 38). • NLN (2003) …. “many nurse educators continue to teach as they were taught and for a health care system that no longer exists…”

11. Themes from the Literature • Duchscher (2003) “…the focus was, and to a certain extent continues to be, on what to teach, rather than how to teach…” • Ironside (2004) “The dilemma nurse educators are increasingly facing is not what to include in a course, but what to leave out.”

12. Themes from the Literature • NLN (2005) Faculty with expertise in nursing education should “take the lead in promoting innovation and moving away from a focus on content coverage” • AACN (2006) “Generalist education at the baccalaureate level is foundational to specialty practice”

13. Causes of Content Saturation • Information Age • Changes in Health Care Delivery • Teacher-centered Pedagogy • Academic-Practice gap

14. How much information is there? • The National Library of Medicine’s Medline archives 31,000 new citations per month. • A clinician would need to read 17 articles a day every day of the year simply to remain current in their field of practice. (Hall & Walton, 2004) • www.youtube.com Did You Know2

15. Changes in Health Care Delivery • Shift in focus from inpatient/acute care to community focused care. Problem not in change in focus, but the failure of nursing education to eliminate content.

16. Conventional Pedagogy • Most nurse educators learned in a content-focused, highly structured curricula. • Ongoing belief that all nursing content is learned in a nursing curriculum and the teacher is responsible to ensure all content is delivered.

17. Perceived Faculty Barriers to Change • Investment in Time • Student Expectations • Curriculum Mandates • Faculty Evaluations

18. Academia – Practice Gap • Desire for graduates who are prepared to enter specialized settings. • Emergence of “core competencies” by specialty groups – recommendations for nursing education.

19. Competencies In an examination of the National Council Licensure Examination Test Plan, Belleck (2006) clams to have identified 1185 discrete competencies required of new graduates! Genetics Gerontology Oncology Critical Care Critical Thinking Vulnerable Populations Cultural Competence Information management Evidenced-based practice Bioterrorism Public Policy Environment Mass Casualty Response End of Life Care

20. College Students: Circa 2010

21. Historical Perspectives: Higher Education • Where did Higher Education originate? • What were the characteristics of students attending these universities? • What was the primary method of teaching?

22. Characteristics of Today’s Learner • DIVERSITY • Generational • Racial/Ethnic • Gender • Socioeconomic • Educational Preparation

23. Impact of Diverse Learners • Multiple Perspectives • Diverse Experiences • Diverse Learning Needs One size does not fit all!

24. Theory of Context Diversity Low Context High Context MulticontextualApproaches Focus on Relationships Social Learning Case Study Reflective Writing Focus on Words Reading Writing Lectures

25. Aiming for a New Kind of Graduate If you teach them to fish….

26. What are the desired characteristics of nurse graduates? • Critical thinkers • Clinical judgment • Life-long learners • Play well with others • Reflective Thinkers • Consider alternative points of view

27. Challenges for Nursing Education • Design nursing curricula that reflect contemporary nursing practice. • Provide essential content (knowledge) without an overburdened curriculum. • Offer multicontexual learning approaches by promoting student-centered learning. • Transform into learning communities that are inviting and in which all learners can thrive.

28. Questions and Discussion