Presentation on theme: "The Future of Nursing Education: A Collaborative Perspective"— Presentation transcript:
1 The Future of Nursing Education: A Collaborative Perspective Christine A. Tanner, RN, PhDOregon Health & Science UniversitySchool of Nursing
2 Calls for ReformReexamination of curricular structures & processes (The Curriculum Revolution)Preparing a new kind of nurse
3 The Curriculum Revolution New pedagogiesPreparing tomorrows leadersMulticultural diversityCaring Curriculum
4 Demands for a New Kind of Nurse Fueled by changes in the nursing practice environment:Increasing complexity and acuityDecreased length of stayShift of care to home & communityExponential growth of knowledgeExplosion of technologiesIdentification of the “Quality Chasm”
5 Demands for a New Kind of Nurse Fueled by changes in demographics:Aging population with increasedprevalence of chronic illnessFamilies increasingly engaged in care giving with little or no nursing supportIncreased attention to health-promotion
8 A Short History of Nursing Process Clinical Problem Solving Clinical Decision Making Diagnostic Reasoning Critical Thinking in other words Thinking Like a Nurse
9 Two decades of Research on CT Critical thinking and clinical thinking (i.e., decision making, clinical judgment) are different constructs.No relationship between education & critical thinking.No relationship between critical thinking and patient outcomes
10 Central Competencies Clinical Judgment: Case based Contextually bound Interpretive reasoning
11 Central CompetenciesClinical Judgment requires deep background knowledge for:NoticingConsidering plausible interpretationsCollecting reasonable evidenceChoosing the best course of action
12 Central Competencies Clinical Judgment is always within the context of a particular patientA deep understanding the patient’s experience, values and preferencesEthical standards of the disciplineIt is always in the context of the particular patient, a deep understanding of the patient’s experience, preferences and values, within the ethical standards of the discipline. It takes account of the uncertainty, the unpredicted but potentially significant variables and the process of change over time. It is more like the practical reasoning described by Aristotle as phronesis than the scientific rationality of modernity
13 Central Competencies Understanding clinical judgment in this way Renews interest in case-based approaches to instructionDemand new approaches to clinical educationProvides guidance to use of simulation in nursing education
14 Central Competencies: Quality-Safety Initiative Patient-centered careTeam-work and collaborationEvidence-based practiceQuality improvementInformatics
20 Challenges in Clinical Education Traditional clinical learning driven by placement opportunities and challengesInsufficient number of “placements” using total patient care modelHigh acuity, greater risk with neophyte studentsStaff nurse burden for supervision of students in rapidly changing situationsLearning is dependent on…Available patient populationFacility’s schedule availabilityAvailability of faculty with required expertise
21 Summary: Driving Forces for Reform Demands for Reform in Nursing EducationStudy of Curricular processesEvidence of poorly prepared graduates even for acute careQuality-safety
22 Summary: Driving Forces for Reform Demands for Reform in Nursing EducationNeed for a “new” nurseChanges in the practice environmentEmerging health care needsPractice in environment of severe shortage
23 Summary: Driving Forces for Reform Demands for Reform in Nursing EducationNeed for a “new” nurseOther pressures:Content explosionAdvances in the science of learningOutdated model of Clinical education
24 Part II: The Oregon Consortium for Nursing Education
25 OCNEA collaboration among 8 community colleges and 5 campuses of OHSU to:Deliver a standard competency based curriculum with an AAS exit and completion of Baccalaureate in nursing on “home” campusIncrease the number of nurses prepared with baccalaureate degreeTransform nursing education to more closely align with emerging health care needs
26 A very short history of OCNE 2000: Study of nursing shortage in Oregon2001: Strategic plan developed by Oregon Nursing leaders2002: Education plan unveiled and political turmoil ensued2003: Launched OCNE with Project Director2004: Began curriculum development & Phase I of Faculty Development2005: Curriculum change approved by OSBN, NLNAC & CCNE2006: Phase I Clinical Education Project launched2006: First class of 255 students admitted on 6 campuses to nursing courses2007: Phase II Faculty Development2008: Preceptor Development2009: First Baccalaureate class graduates
27 OCNE as a response to these challenges Committed to collaboration across programs enabling the best use of scarce resourcesStandard, competency based curriculum focused on preparing the “new” nurse.Teaching approaches that rest on the science of learningFaculty development as an integral part of curriculum developmentReform of clinical education
28 Guiding Principles in Curriculum Design Responsive to demands for reformNCSBN – 2001 – lack of preparation of gradsJCAHO (2002) – continental divide between education and practiceIOM reports
29 Guiding Principles in Curriculum Design Responsive to demands for reformEmerging health care needsAging populationIncreasing acuityIncreasing prevalence of chronic illnessesDemands placed on caregiving families with inadequate nursing care support
30 Guiding Principles in Curriculum Design Responsive to demands for reformEmerging health care needsGraduates would be practicing in an environment of chronic, severe RN shortagesMore efficient & effective with dwindling supply of nursing facultyCompetencies of the “new” nurse would require at least 4 years, but there would need to be AD exit
31 Overview of the Curriculum First year: PrerequisitesSecond year & first two quarters of the third year:Required non-nursing coursesStandard nursing courses on all campusesThird quarter of the third year:Complete Precepted Scope of Practice Practicum, graduate with AAS and be eligible to sit for NCLEX ORContinue directly into 400 level nursing courses for 4 remaining quarters, complete 15 credits of upper division arts & science, and graduate with BS
32 Transformation of the Nursing Curriculum:Some Features Courses organized around foci of care:Health PromotionChronic Illness ManagementAcute CareEnd-of-Life Care
33 Transformation of the Nursing Curriculum: Some Features Last 4 clinical nursing courses toward Bachelors degree, students may select a population for focus in:Public health and population-based careLeadership and outcomes managementClinical immersion or integrative practicum for twenty weeks
34 Transformation of the Nursing Curriculum: Some Features Redefines nursing fundamentals to:Clinical JudgmentEvidence-based PracticePatient-centered careLeadership
35 Transformation of the Nursing Curriculum: ApplyingThe New Pedagogy Draws on tremendous advances in the science of learning from a variety of disciplines (cognitive science, psychology, higher education)
36 The New PedagogyEmphasizes deep understanding of the discipline’s most central concepts ---Purposeful REDUCTION in contentSelection of content based on:Prevalence of conditionUseful to teach integration across competencies(e.g. ethical comportment, clinical judgment, evidence-based practice, health systems issues & leadership,
37 The New PedagogyEmphasizes deep understanding of the discipline’s most central conceptsActive learning through case-based instruction, integration among theory, clinical and simulation.
38 The New PedagogyEmphasizes deep understanding of the discipline’s most central conceptsActive learning through case-based instruction, integration among theory, clinical and simulation.Authentic performance assessment & promotion of self-directed learning
39 Process for Consensus Building during Curriculum Development Institutional representativesLeadership modelFaculty development combined with curriculum developmentFrequent Review & Counsel by groups with expertise & vested interests:Faculty on each of the 12 campusesSpecialty task forces
40 Challenges in Clinical Education Traditional clinical learning driven by placement opportunities and challengesInsufficient number of “placements” using total patient care modelHigh acuity, greater risk with neophyte studentsStaff nurse burden for supervision of students in rapidly changing situationsLearning is dependent on…Available patient populationFacility’s schedule availabilityAvailability of faculty with required expertise
41 Desired Features of New Clinical Education Model Relationship-centered care keeping the patient and family at the centerScience of learning and findings of the Carnegie study(i.e. integration across apprenticeships, retain prep, coaching and debriefing and other best practices)
42 Desired Features of New Clinical Education Model Relies on Clinical learning activities that:Are designed to support attainment of CompetenciesInclude, but not dominated by “Total Patient Care”Developmentally appropriate for level of studentVary faculty–student ratios & nursing staff roles by level of student, acuity of patient, nature of learning activityCulminate in one or more Immersion experiences.
43 Types of Clinical Learning Experiences Focused direct care experiencesPatient-centered careTherapeutic relationshipIndividualized care
44 Types of Clinical Learning Experiences Focused direct care experiencesConcept-based experiences: focus on learning concepts (e.g. oxygenation) through seeing many patients who exemplify the concept
45 Types of Clinical Learning Experiences Focused direct care experiencesConcept-based experiencesCase-based experiences: focused on learning clinical judgment through working through clinical problems presented in text-based through fully simulated scenarios.
46 Types of Clinical Learning Experiences Focused direct care experiencesConcept-based experiencesCase-based experiencesSkill-based experiences: focused on learning basic skills through repetitive practice, includes psychomotor skills, such as interviewing.
47 Types of Clinical Learning Experiences Focused direct care experiencesConcept-based experiencesCase-based experiencesSkill-based experiencesIntegrative experiences: opportunity to integrate prior learning and linking learning activities to RN role in clinical agency.
48 Types of Clinical Learning Experiences: Differentiated by: Type of learning and appropriate pedagogyDegree of accountability for patient care
49 Transformation of Clinical Education Phase I & II: consensus building on need for changePhase III: 8 pilot projects, evaluating innovative clinical learning activities that when combined may lead to a new modelPhase IV: development of and consensus building on new modelPhase V: statewide demonstration of new model through 3 years of OCNE nursing curriculum
50 6 Major Components of Consortium Development Developmental Processes & InfrastructureFaculty DevelopmentSimulation CapacityCurriculum DevelopmentClinical Education CapacityComprehensive evaluation
51 A relationship-centered change process Driven by our passions with . . .Commitment to health of OregoniansStrong Leadership & persistenceOne leap of faith after another
52 An African Proverb:To go quickly, go alone.To go far, go together.