Presentation on theme: "The Future of Nursing Education: A Collaborative Perspective"— Presentation transcript:
1The Future of Nursing Education: A Collaborative Perspective Christine A. Tanner, RN, PhDOregon Health & Science UniversitySchool of Nursing
2Calls for ReformReexamination of curricular structures & processes (The Curriculum Revolution)Preparing a new kind of nurse
3The Curriculum Revolution New pedagogiesPreparing tomorrows leadersMulticultural diversityCaring Curriculum
4Demands 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”
5Demands 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
8A Short History of Nursing Process Clinical Problem Solving Clinical Decision Making Diagnostic Reasoning Critical Thinking in other words Thinking Like a Nurse
9Two 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
10Central Competencies Clinical Judgment: Case based Contextually bound Interpretive reasoning
11Central CompetenciesClinical Judgment requires deep background knowledge for:NoticingConsidering plausible interpretationsCollecting reasonable evidenceChoosing the best course of action
12Central 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
13Central 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
14Central Competencies: Quality-Safety Initiative Patient-centered careTeam-work and collaborationEvidence-based practiceQuality improvementInformatics
20Challenges 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
21Summary: Driving Forces for Reform Demands for Reform in Nursing EducationStudy of Curricular processesEvidence of poorly prepared graduates even for acute careQuality-safety
22Summary: 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
23Summary: 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
24Part II: The Oregon Consortium for Nursing Education
25OCNEA 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
26A 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
27OCNE 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
28Guiding Principles in Curriculum Design Responsive to demands for reformNCSBN – 2001 – lack of preparation of gradsJCAHO (2002) – continental divide between education and practiceIOM reports
29Guiding 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
30Guiding 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
31Overview 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
32Transformation of the Nursing Curriculum:Some Features Courses organized around foci of care:Health PromotionChronic Illness ManagementAcute CareEnd-of-Life Care
33Transformation 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
34Transformation of the Nursing Curriculum: Some Features Redefines nursing fundamentals to:Clinical JudgmentEvidence-based PracticePatient-centered careLeadership
35Transformation 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)
36The 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,
37The New PedagogyEmphasizes deep understanding of the discipline’s most central conceptsActive learning through case-based instruction, integration among theory, clinical and simulation.
38The 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
39Process 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
40Challenges 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
41Desired 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)
42Desired 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.
43Types of Clinical Learning Experiences Focused direct care experiencesPatient-centered careTherapeutic relationshipIndividualized care
44Types 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
45Types 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.
46Types 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.
47Types 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.
48Types of Clinical Learning Experiences: Differentiated by: Type of learning and appropriate pedagogyDegree of accountability for patient care
49Transformation 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
506 Major Components of Consortium Development Developmental Processes & InfrastructureFaculty DevelopmentSimulation CapacityCurriculum DevelopmentClinical Education CapacityComprehensive evaluation
51A relationship-centered change process Driven by our passions with . . .Commitment to health of OregoniansStrong Leadership & persistenceOne leap of faith after another
52An African Proverb:To go quickly, go alone.To go far, go together.