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The Future of Nursing Education: A Collaborative Perspective Christine A. Tanner, RN, PhD Oregon Health & Science University School of Nursing.

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Presentation on theme: "The Future of Nursing Education: A Collaborative Perspective Christine A. Tanner, RN, PhD Oregon Health & Science University School of Nursing."— Presentation transcript:

1 The Future of Nursing Education: A Collaborative Perspective Christine A. Tanner, RN, PhD Oregon Health & Science University School of Nursing

2 Calls for Reform Reexamination of curricular structures & processes (The Curriculum Revolution) Reexamination of curricular structures & processes (The Curriculum Revolution) Preparing a new kind of nurse Preparing a new kind of nurse

3 The Curriculum Revolution New pedagogies New pedagogies Preparing tomorrows leaders Preparing tomorrows leaders Multicultural diversity Multicultural diversity Caring Curriculum Caring Curriculum

4 Demands for a New Kind of Nurse Fueled by changes in the nursing practice environment: Increasing complexity and acuity Decreased length of stay Shift of care to home & community Exponential growth of knowledge Explosion of technologies Identification of the Quality Chasm

5 Demands for a New Kind of Nurse Fueled by changes in demographics: Aging population with increased prevalence of chronic illness Families increasingly engaged in care giving with little or no nursing support Increased attention to health- promotion

6 Central Competencies Critical thinking Critical thinking

7 Critical thinking = Thinking Like a Nurse?

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. Critical thinking and clinical thinking (i.e., decision making, clinical judgment) are different constructs. No relationship between education & critical thinking. No relationship between education & critical thinking. No relationship between critical thinking and patient outcomes No relationship between critical thinking and patient outcomes

10 Central Competencies Clinical Judgment: Clinical Judgment: Case basedCase based Contextually boundContextually bound Interpretive reasoningInterpretive reasoning

11 Central Competencies Clinical Judgment requires deep background knowledge for: Clinical Judgment requires deep background knowledge for: NoticingNoticing Considering plausible interpretationsConsidering plausible interpretations Collecting reasonable evidenceCollecting reasonable evidence Choosing the best course of actionChoosing the best course of action

12 Central Competencies Clinical Judgment is always within Clinical Judgment is always within the context of a particular patientthe context of a particular patient A deep understanding the patients experience, values and preferencesA deep understanding the patients experience, values and preferences Ethical standards of the disciplineEthical standards of the discipline

13 Central Competencies Understanding clinical judgment in this way Understanding clinical judgment in this way Renews interest in case-based approaches to instructionRenews interest in case-based approaches to instruction Demand new approaches to clinical educationDemand new approaches to clinical education Provides guidance to use of simulation in nursing educationProvides guidance to use of simulation in nursing education

14 Central Competencies: Quality-Safety Initiative Patient-centered care Patient-centered care Team-work and collaboration Team-work and collaboration Evidence-based practice Evidence-based practice Quality improvement Quality improvement Informatics Informatics

15 Preparing More Nurses

16 In the face of a profound faculty shortage In the face of a profound faculty shortage

17 Preparing More Nurses In the face of a profound faculty shortage In the face of a profound faculty shortage Limitation in the number, type and quality of sites for clinical education. Limitation in the number, type and quality of sites for clinical education.

18 Current practices in clinical education

19 A very short history of clinical education

20 Challenges in Clinical Education Traditional clinical learning driven by placement opportunities and challenges Traditional clinical learning driven by placement opportunities and challenges Insufficient number of placements using total patient care model Insufficient number of placements using total patient care model High acuity, greater risk with neophyte students High acuity, greater risk with neophyte students Staff nurse burden for supervision of students in rapidly changing situations Staff nurse burden for supervision of students in rapidly changing situations Learning is dependent on… Learning is dependent on… Available patient populationAvailable patient population Facilitys schedule availabilityFacilitys schedule availability Availability of faculty with required expertiseAvailability of faculty with required expertise

21 Summary: Driving Forces for Reform Demands for Reform in Nursing Education Demands for Reform in Nursing Education Study of Curricular processesStudy of Curricular processes Evidence of poorly prepared graduates even for acute careEvidence of poorly prepared graduates even for acute care Quality-safetyQuality-safety

22 Summary: Driving Forces for Reform Demands for Reform in Nursing Education Demands for Reform in Nursing Education Need for a new nurse Need for a new nurse Changes in the practice environment Changes in the practice environment Emerging health care needs Emerging health care needs Practice in environment of severe shortage Practice in environment of severe shortage

23 Summary: Driving Forces for Reform Demands for Reform in Nursing Education Demands for Reform in Nursing Education Need for a new nurse Need for a new nurse Other pressures: Other pressures: Content explosion Content explosion Advances in the science of learning Advances in the science of learning Outdated model of Clinical education Outdated model of Clinical education

24 Part II: The Oregon Consortium for Nursing Education

25 OCNE A collaboration among 8 community colleges and 5 campuses of OHSU to: A 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 campusDeliver a standard competency based curriculum with an AAS exit and completion of Baccalaureate in nursing on home campus Increase the number of nurses prepared with baccalaureate degreeIncrease the number of nurses prepared with baccalaureate degree Transform nursing education to more closely align with emerging health care needsTransform nursing education to more closely align with emerging health care needs

26 A very short history of OCNE 2000: Study of nursing shortage in Oregon 2000: Study of nursing shortage in Oregon 2001: Strategic plan developed by Oregon Nursing leaders 2001: Strategic plan developed by Oregon Nursing leaders 2002: Education plan unveiled and political turmoil ensued 2002: Education plan unveiled and political turmoil ensued 2003: Launched OCNE with Project Director 2003: Launched OCNE with Project Director 2004: Began curriculum development & Phase I of Faculty Development 2004: Began curriculum development & Phase I of Faculty Development 2005: Curriculum change approved by OSBN, NLNAC & CCNE 2005: Curriculum change approved by OSBN, NLNAC & CCNE 2006: Phase I Clinical Education Project launched 2006: Phase I Clinical Education Project launched 2006: First class of 255 students admitted on 6 campuses to nursing courses 2006: First class of 255 students admitted on 6 campuses to nursing courses 2007: Phase II Faculty Development 2007: Phase II Faculty Development 2008: Preceptor Development 2008: Preceptor Development 2009: First Baccalaureate class graduates 2009: First Baccalaureate class graduates

27 OCNE as a response to these challenges Committed to collaboration across programs enabling the best use of scarce resources Committed to collaboration across programs enabling the best use of scarce resources Standard, competency based curriculum focused on preparing the new nurse. Standard, competency based curriculum focused on preparing the new nurse. Teaching approaches that rest on the science of learning Teaching approaches that rest on the science of learning Faculty development as an integral part of curriculum development Faculty development as an integral part of curriculum development Reform of clinical education Reform of clinical education

28 Guiding Principles in Curriculum Design Responsive to demands for reform Responsive to demands for reform NCSBN – 2001 – lack of preparation of gradsNCSBN – 2001 – lack of preparation of grads JCAHO (2002) – continental divide between education and practiceJCAHO (2002) – continental divide between education and practice IOM reportsIOM reports

29 Guiding Principles in Curriculum Design Responsive to demands for reform Responsive to demands for reform Emerging health care needs Emerging health care needs Aging populationAging population Increasing acuityIncreasing acuity Increasing prevalence of chronic illnessesIncreasing prevalence of chronic illnesses Demands placed on caregiving families with inadequate nursing care supportDemands placed on caregiving families with inadequate nursing care support

30 Guiding Principles in Curriculum Design Responsive to demands for reform Responsive to demands for reform Emerging health care needs Emerging health care needs Graduates would be practicing in an environment of chronic, severe RN shortages Graduates would be practicing in an environment of chronic, severe RN shortages More efficient & effective with dwindling supply of nursing faculty More efficient & effective with dwindling supply of nursing faculty Competencies of the new nurse would require at least 4 years, but there would need to be AD exit Competencies 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: Prerequisites First year: Prerequisites Second year & first two quarters of the third year: Second year & first two quarters of the third year: Required non-nursing coursesRequired non-nursing courses Standard nursing courses on all campusesStandard nursing courses on all campuses Third quarter of the third year: Third quarter of the third year: Complete Precepted Scope of Practice Practicum, graduate with AAS and be eligible to sit for NCLEX ORComplete Precepted Scope of Practice Practicum, graduate with AAS and be eligible to sit for NCLEX OR Continue directly into 400 level nursing courses for 4 remaining quarters, complete 15 credits of upper division arts & science, and graduate with BSContinue 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: Courses organized around foci of care: Health PromotionHealth Promotion Chronic Illness ManagementChronic Illness Management Acute CareAcute Care End-of-Life 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: Last 4 clinical nursing courses toward Bachelors degree, students may select a population for focus in: Public health and population-based carePublic health and population-based care Leadership and outcomes managementLeadership and outcomes management Clinical immersion or integrative practicum for twenty weeksClinical immersion or integrative practicum for twenty weeks

34 Transformation of the Nursing Curriculum: Some Features Redefines nursing fundamentals to: Redefines nursing fundamentals to: Clinical JudgmentClinical Judgment Evidence-based PracticeEvidence-based Practice Patient-centered carePatient-centered care LeadershipLeadership

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) Draws on tremendous advances in the science of learning from a variety of disciplines (cognitive science, psychology, higher education)

36 The New Pedagogy Emphasizes deep understanding of the disciplines most central concepts --- Emphasizes deep understanding of the disciplines most central concepts --- Purposeful REDUCTION in contentPurposeful REDUCTION in content Selection of content based on:Selection of content based on: Prevalence of condition Prevalence of condition Useful to teach integration across competencies Useful to teach integration across competencies (e.g. ethical comportment, clinical judgment, evidence-based practice, health systems issues & leadership,(e.g. ethical comportment, clinical judgment, evidence-based practice, health systems issues & leadership,

37 The New Pedagogy Emphasizes deep understanding of the disciplines most central concepts Emphasizes deep understanding of the disciplines most central concepts Active learning through case-based instruction, integration among theory, clinical and simulation. Active learning through case-based instruction, integration among theory, clinical and simulation.

38 The New Pedagogy Emphasizes deep understanding of the disciplines most central concepts Emphasizes deep understanding of the disciplines most central concepts Active learning through case-based instruction, integration among theory, clinical and simulation. Active learning through case-based instruction, integration among theory, clinical and simulation. Authentic performance assessment & promotion of self-directed learning Authentic performance assessment & promotion of self-directed learning

39 Process for Consensus Building during Curriculum Development Institutional representatives Institutional representatives Leadership model Leadership model Faculty development combined with curriculum development Faculty development combined with curriculum development Frequent Review & Counsel by groups with expertise & vested interests: Frequent Review & Counsel by groups with expertise & vested interests: Faculty on each of the 12 campusesFaculty on each of the 12 campuses Specialty task forcesSpecialty task forces

40 Challenges in Clinical Education Traditional clinical learning driven by placement opportunities and challenges Traditional clinical learning driven by placement opportunities and challenges Insufficient number of placements using total patient care model Insufficient number of placements using total patient care model High acuity, greater risk with neophyte students High acuity, greater risk with neophyte students Staff nurse burden for supervision of students in rapidly changing situations Staff nurse burden for supervision of students in rapidly changing situations Learning is dependent on… Learning is dependent on… Available patient populationAvailable patient population Facilitys schedule availabilityFacilitys schedule availability Availability of faculty with required expertiseAvailability of faculty with required expertise

41 Desired Features of New Clinical Education Model Relationship-centered care keeping the patient and family at the center Relationship-centered care keeping the patient and family at the center Science of learning and findings of the Carnegie study Science of learning and findings of the Carnegie study (i.e. integration across apprenticeships, retain prep, coaching and debriefing and other best practices)(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: Relies on Clinical learning activities that: Are designed to support attainment of CompetenciesAre designed to support attainment of Competencies Include, but not dominated by Total Patient CareInclude, but not dominated by Total Patient Care Developmentally appropriate for level of studentDevelopmentally appropriate for level of student Vary faculty–student ratios & nursing staff roles by level of student, acuity of patient, nature of learning activityVary faculty–student ratios & nursing staff roles by level of student, acuity of patient, nature of learning activity Culminate in one or more Immersion experiences.Culminate in one or more Immersion experiences.

43 Types of Clinical Learning Experiences Focused direct care experiences Focused direct care experiences Patient-centered carePatient-centered care Therapeutic relationshipTherapeutic relationship Individualized careIndividualized care

44 Types of Clinical Learning Experiences Focused direct care experiences Focused direct care experiences Concept-based experiences: focus on learning concepts (e.g. oxygenation) through seeing many patients who exemplify the concept Concept-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 experiences Focused direct care experiences Concept-based experiences Concept-based experiences Case-based experiences: focused on learning clinical judgment through working through clinical problems presented in text-based through fully simulated scenarios. Case-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 experiences Focused direct care experiences Concept-based experiences Concept-based experiences Case-based experiences Case-based experiences Skill-based experiences: focused on learning basic skills through repetitive practice, includes psychomotor skills, such as interviewing. Skill-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 experiences Focused direct care experiences Concept-based experiences Concept-based experiences Case-based experiences Case-based experiences Skill-based experiences Skill-based experiences Integrative experiences: opportunity to integrate prior learning and linking learning activities to RN role in clinical agency. Integrative 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 pedagogy Degree of accountability for patient care

49 Transformation of Clinical Education Phase I & II: consensus building on need for change Phase I & II: consensus building on need for change Phase III: 8 pilot projects, evaluating innovative clinical learning activities that when combined may lead to a new model Phase III: 8 pilot projects, evaluating innovative clinical learning activities that when combined may lead to a new model Phase IV: development of and consensus building on new model Phase IV: development of and consensus building on new model Phase V: statewide demonstration of new model through 3 years of OCNE nursing curriculum Phase V: statewide demonstration of new model through 3 years of OCNE nursing curriculum

50 6 Major Components of Consortium Development Developmental Processes & Infrastructure Developmental Processes & Infrastructure Faculty Development Faculty Development Simulation Capacity Simulation Capacity Curriculum Development Curriculum Development Clinical Education Capacity Clinical Education Capacity Comprehensive evaluation Comprehensive evaluation

51 A relationship-centered change process Driven by our passions with... Commitment to health of Oregonians Commitment to health of Oregonians Strong Leadership & persistence Strong Leadership & persistence One leap of faith after another One leap of faith after another

52 An African Proverb: To go quickly, go alone. To go far, go together.

53 For more information Visit us at


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