Patient Safety / Quality

Preparing nurses for tomorrow’s healthcare system

In the last few years, major healthcare and nursing initiatives have sparked important changes in nursing education. The Carnegie Foundation’s 2010 report “Educating Nurses: A Call for Radical Transformation” and the Institute of Medicine’s (IOM) 2010 report “The Future of Nursing: Leading Change, Advancing Health” found that nursing curricula haven’t been preparing tomorrow’s nurses adequately. Passage of the Protection and Affordable Care Act in 2010 has also influenced trends in nursing education.

From passive to active learning

The Carnegie Foundation report helped launch a change from viewing students as passive learners to seeing them as active participants. Student-centered learning creates active engagement, with students becoming partners in the educational journey. Today’s nursing faculty promote student engagement through unfolding case studies, high-fidelity simulations and debriefings, and virtual learning environments. They engage students in discussing clinical scenarios, focusing not just on signs and symptoms related to a particular diagnosis but also on the nurse’s ethical development.

Today’s educators are helping nursing students gain the clinical reasoning skills they need in the practice arena. Revamped educational programs promote clinical reasoning through situated cognition-the concept that knowing is inseparable from doing and that learning occurs in context. New nursing curricula are helping students apply critical thinking skills acquired in an arts and science foundation to the context of a nursing situation. This helps them gain the skills they need to think and reason in clinical settings.

Flipping the classroom, learning how to learn

To create a more engaged classroom, many nursing programs have adopted a trend similar to the revolution in K-12 education known as “flipping the classroom.” For homework, students read and review lecture materials and then arrive at class ready to discuss and integrate content into clinical scenarios or exemplars. Students assume the nurse’s role and use clinical reasoning skills to promote patient-centered, evidence-based care.

Content overload from today’s knowledge explosion has left yesterday’s nursing curriculum laden with details and insurmountable amounts of information for nurse educators to deliver. One trend in nursing education moves away from previous content-delivery methods to engage students to “learn how to learn” rather than focusing only on content delivery. Also, educators help students glean what’s important in the nurse-patient experience so students can take this forward to their next nurse-patient interaction. These methods help students gain a deeper understanding of patient needs and extrapolate salient information from one patient experience to the next.

The importance of helping learners learn how to learn has been reinforced by educators Diane Billings and Judith Halstead, who support a transformative curriculum that gives students a big-picture view of what they’re learning. This, in turn, helps them interact with the knowledge in a critical and reflective way and encourages them to construct meaning and actions appropriate to what they’re learning.


Concept-based learning

Content overload and the call for curriculum reform have led many educators to support concept-based learning curricula, which help students gain a deep understanding of major nursing concepts. Concept-based learning emerged from the initiatives of the Oregon Consortium of Nursing Education and the North Carolina Associate Degree Nursing Curriculum Project. The work of nursing education expert Jean Giddens also has been influential. Teachers link concepts to each other while presenting exemplars of concepts; this approach helps learners to extrapolate meanings from one concept to another and identify commonalities among exemplars and concepts.

By developing and linking concepts, the concept-based curriculum prepares students in five competencies identified by the Carnegie Foundation and IOM as essential to nursing practice today:

  • providing patient-centered care
  • working in interdisciplinary teams
  • using evidence-based practice
  • applying quality improvement
  • using informatics.

Together with a sixth competency, patient safety, these five competencies serve as the guiding framework for today’s nursing curriculum development.

Using data and electronic systems

The new nursing curriculum emphasizes data access and management. Today’s nursing students must know how to access, sort, manage, and apply data. Nurturing skills in data mining, using electronic resources to obtain data and evidence, using quality-improvement data focused on improving care delivery, and electronic medical-record technology integration have become a major educational focus. The power of information technology and data management explodes when nurses understand improvement sciences, population health, and systems leadership. This understanding can help them successfully lead in a reformed healthcare system. The Affordable Care Act highlighted the national emphasis on an electronic health information system that supports transparency and patient-data transferability to all care providers. (See Technology in the classroom by clicking the PDF icon above.)

Online nursing education

In response to the IOM report and the Magnet Recognition Program® of the American Nurses Credentialing Center, many online nursing programs now offer courses enabling associate-degree nurses to obtain bachelor’s degrees. Online education will continue to expand as administrators and educators learn how to scale up these programs while maintaining quality. Online nursing education is a welcome trend as nurse educators race to educate enough nurses to help ease nursing shortages.

New roles for nurses

Nurse educators are rethinking the arena for delivering nursing education. The acute-care setting may not remain central to health care the same way it currently is. New care-delivery models mandate new delivery systems, which will drive new roles for nurses-including those of patient navigator and care coordinator.

The medical-home approach to care delivery also will lead to new roles for nurses in the primary-care setting, including those of improvement scientist and roles that focus on patient safety in care transitions. These emerging roles require skills in communication, interprofessional teamwork, quality-improvement sciences, and leadership.

Innovator: New nursing leadership role

Nurse innovator is a new leadership role emerging in nursing educational curricula. Nurse innovators will be skilled in using improvement tools and techniques to design changes. To create nurse innovators, curricula must cover the use of improvement tools and techniques to design system changes. Nurses interested in this role will learn the science of innovation and will seek innovation immersions. To nurture and sustain a culture of innovation, certain processes must be put into place. The role of nurse innovator is particularly exciting and will be crucial in the evolution of high-performing care-delivery systems.

Care integration

Care integration has grown more important. Currently, some patients falter and decline as they transition from one care level to another. The goal of care integration is to provide an integrated healthcare system that connects primary care, acute care, long-term care, and other levels of care into one coordinated delivery system.

Geriatric care

The aging of the U.S. population emphasizes the need for nurses to understand how to manage chronic medical conditions. Healthy aging and chronic-care management are key focus areas in nursing curricula. Nurses interested in geriatrics also learn basic competencies in genetics, genomics, informatics, and more recently, best practices in the care of military veterans and their families. These content areas reflect the increasing depth of knowledge required to promote health in communities.

Interprofessional teams

Educating students to work in interprofessional teams is a mandate in the education of all healthcare professionals today. Nursing educators across the country are meeting the challenge to create opportunities for interprofessional education for nursing students.

Reinventing nursing education

Nursing educators are challenged to stay in step with the fast-paced, ever-changing practice environment. They are reinventing the approach to education in both classroom and clinical settings through innovative teaching practices, use of technology, and revised curricula focusing on conceptual learning and new roles for nurses, as well as refocused nursing competencies for practice.

Nursing faculty must be prepared to teach what new nurses who will practice in tomorrow’s care-delivery system must know. Their ability to change teaching methods and give students contemporary learning experiences is crucial to the future of nursing-and to patients’ and our nation’s health.

Selected references

Billings DM, Halstead JA. Teaching in Nursing: A Guide for Faculty. 4th ed. St. Louis: Saunders/Elsevier; 2012.

Benner P, Sutphen M, Leonard V, et al. Educating Nurses: A Call for Radical Transformation. San Francisco: Jossey-Bass; 2009.

Cronenwett L, Sherwood G, Barnsteiner J, et al. Quality and safety education for nurses. Nurs Outlook. 2007;55(3):122-31.

Giddens JF. Concepts for Nursing Practice. St. Louis: Mosby/Elsevier; 2013.

Green A. Accountable care organizations: a new approach to care delivery. Nurs Spectrum. 2012;9:160-5.

Institute of Medicine. Best care at lower cost: The path to continuously learning health care in America. www.nap.edu/openbook.php?record_id=13444&page=3. Accessed March 10, 2013.

Institute of Medicine. The future of nursing: leading change, advancing health. October 5, 2010. http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/workforce/IOM-Future-of-Nursing-Report-1. Accessed March 10, 2013.

Patient Protection and Affordable Care Act. H.R. 3590—111th Congress. Enacted March 23, 2010. www.gpo.gov/fdsys/pkg/BILLS-111hr3590enr/pdf/BILLS-111hr3590enr.pdf. Accessed March 10, 2013.

Tanner CA, Gubrud-Howe P, Shores L. The Oregon Consortium for Nursing Education:
a response to the nursing shortage. Policy Polit Nurs Pract. 2008;9(3):203-9.

Patricia Allen is a professor and director of the Center for Innovation in Nursing Education at Texas Tech University Health Sciences Center in Lubbock, Texas.

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