Unit 6 Trends and Issues in Nursing Education PDF

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Unit 6: Trends and Issues in Nursing Education Textbook------Chapter 3: The Influence of Contemporary Trends and Issues on Nursing Education Key Terms: ● Competency outcomes: The results, or end products, of planned study and experience that are focused on specific abilities required for practice. ● Contemporary issues: The problems, changes, and concerns that are current for the present time. ● Core competencies: The essential cluster of abilities and skills required for competent nursing practice. ● Educational mobility: The progressive movement from one type or level of education to another, often based on flexible, self-directed, or advanced placement options. Examples are progression from diploma preparation to an academic degree, such as RN to BSN or MSN; DSN to doctoral degree; or non-nursing degree to BSN, MSN or doctoral degree. ● Education trends: Shifts in conditions and concerns that emerge from and influence various aspects of society; broad changes in the United States and the world that influence the practice of nurses and other providers. ● Performance examinations: Standardized evaluation based on objective demonstration of specific required competencies; used in conjunction with written tests of knowledge about those abilities. They may require performance in actual or simulated situations, related to physical psychomotor skills or the observable evidence of other skills, such as critical thinking, communication, teaching, planning, writing, or analysis and integration of data. INTRODUCTION ● Competency Outcomes and Performance Model (COPA) ○ Developed by Lenburg in 2008 ○ Useful for nursing instructors to use when identifying essential competencies and outcomes for practice, indicators that define competencies, ways to learn competencies, and effective ways to document that learners achieve the competencies ○ Given the complexities of patient care, and health delivery systems, the COPA framework is useful at all levels of nursing education and within professional nursing practice. EDUCATIONAL ISSUES AND TRENDS ● Education trends: Shifts in conditions and concerns that emerge from and influence various aspects of society; broad changes in the US and the world that influence the education and practice of nurses and providers ● Contemporary issues: The problems, changes, and concerns that are current for the present time. ● These trends influence the number and types of nursing programs for basic and experienced students at the undergraduate and graduate levels. ● Students who are aware of these trends are better prepared to cope with a rapidly changing nursing education models and health care systems. It is imperative that nursing

Unit 6: Trends and Issues in Nursing Education Textbook------Chapter 3: The Influence of Contemporary Trends and Issues on Nursing Education

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students at all levels stay abreast of change in nursing education and health care landscape as they become competent health care practitioners and meet the complex needs of patients from diverse multicultural and demographic backgrounds. As American society becomes increasingly diverse and complex, new trends precipitate different issues (This chapter describes 10 contemporary trends- we are focusing on 5.). These contemporary trends influence the way students and nurses learn, become competent practitioners, and meet the needs of patients. Knowledge expansion and use of technology and the Internet Practice-based competency outcomes Sociodemographics, cultural diversity, and economic and political changes Patient-centered care: engagement, safety, and privacy Shortage of nurses

TRENDS AND ISSUES IN CONTEMPORARY NURSING EDUCATION KNOWLEDGE EXPANSION AND USE OF TECHNOLOGY AND THE INTERNET ● A major part in education and practice ● Information volume growing exponentially ● Ability to create, access, and disseminate information rapidly is beneficial ● There is a tremendous volume of information available on a global level and this is growing everyday. ● Informatics has become a major part of education and practice (Cipriano and Murphy, 2011). The ability to create, access, and disseminate unlimited information rapidly has enormous benefits. ● Benefits in nursing education ● Communication at Internet speed ● Use of chat rooms, blogs, and online sources in nursing education ● Use of social media has become so common in nursing that guidelines and code of ethics statements are being developed by national organizations. ○ The use of social media has become a concern for nurses, nursing students, and educators. ○ Using this digital forum to communicate requires an understanding of policies and potential legal implications. ● Websites allow for rapid access to online and printed material. ○ Digital health-related materials can be updated quickly, allowing educators to create and revise online course content, assignments, and examinations. ○ Using computers for written assignments reinforces the development of effective writing skills and the use of standard protocols required in academic and professional documents. ■ They also help students prepare more effectively for computerized licensure examinations. ● When providing nursing care, there is an increase in information technology or computer use as part of patient care and nursing workflow process, which does not take

Unit 6: Trends and Issues in Nursing Education Textbook------Chapter 3: The Influence of Contemporary Trends and Issues on Nursing Education away from direct patient care time and allows nurses to access and analyze information. ● The Healthcare Information and Management Systems Society (HIMSS) identified that nurses at all levels of education need health informatics competencies. ● The Technology Informatics Guiding Education Reform (TIGER) identified three basic informatics competencies: basic computer competencies, information literacy, and information management. ● The shift toward competency-based education and evaluation with known informatics competencies for students and faculty will help guide nursing curriculum toward inclusion of clinical and simulated experiences that help students develop basic informatics competency. ● Distance learning opportunities ○ Allow students to participate in networks, team projects, and research that expand the understanding of universal health needs and cultural differences ● The Internet and changes in perspectives of nurse educators also makes it possible for nursing courses or entire degree programs to be delivered online. ● Smart phones access information quickly. ○ Help students, faculty, and nurses access valuable current information to manage complex patient data and thus reduce emotional stress and error ○ Associated in acute care settings to quickly connect the nurse with the provider, allowing critical information to be sent and expeditiously address patient needs ● Learning to access and use digital resources on mobile devices has been found to be more effective when introduced early into the nursing curriculum and embedded throughout the program. ● Learn to select valid and reliable sources ○ Faculty and students need to work together to promote efficient and effective use of electronic learning tools and networking; reducing overload and frustration requires disciplined focus and clear guidelines and outcomes. ○ Learning from the Internet can help students develop skills in analytical thinking, decision making, and reflective judgment that are essential for selecting valuable and reliable resources; these are difficult but essential competencies for evidence-based practice. ● Acquire competencies required for information-intensive nursing practice ○ The Quality and Safety Education for Nurses (QSEN) project identified competencies for nurses to achieve knowledge, skills, and attitudes (KSAs) to become successful health care providers. ○ The National Organization of Nurse Practitioner Faculties (NONPF) core competencies also include information technology and information literacy. ○ Nurses, nursing students, and nurse educators must stay abreast of the rapid changes related to nursing informatics and information technology. PRACTICE-BASED COMPETENCY OUTCOMES ● The National League of Nursing (NLN) has developed outcomes and competencies for

Unit 6: Trends and Issues in Nursing Education Textbook------Chapter 3: The Influence of Contemporary Trends and Issues on Nursing Education

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graduates of nursing programs at all levels (LVN, ADN and Diploma, BSN, MS, Practice and Research Doctorate programs). The competencies include four core values, integrated concepts and program outcomes for nursing graduates at all levels: ○ Human Flourishing ○ Nursing Judgment ○ Professional Identity ○ Spirit of Inquiry The NONPF has developed one set of core competencies for all graduating nurse practitioners. Specify expected results ○ Measurable results of time and effort spent in learning Competence ○ Purpose of study and education or target to be reached The outcomes approach requires a mental shift from trying to memorize voluminous readings and class notes (resulting in the frustration and the attitude of “just tell me what I need to know”) to actually learning to think like a nurse, to integrate information in problem solving and decision making, and providing competent patient care. Typical objectives begin with words like describe, discuss, list, or recognize; they are directions for learning, not what nurses do. Outcomes include actions such as: ○ Implement ○ Integrate ○ Plan ○ Conduct Validation of competencies ○ Often causes anxiety and stress in some students, faculty, nurses, and others ○ Major incentive to promote patient safety and effective care Quality and Safety in Nursing Education (QSEN) ○ Funded by the Robert Wood Johnson Foundation ○ Competencies at both the pre-licensure and graduate level assess the knowledge, skills, and attitudes of nurses with six areas: ■ Patient-Centered Care ■ Teamwork and Collaboration ■ Evidence-Based Practice ■ Quality Improvement ■ Safety ■ Informatics Changed from giving care to helping patients

SOCIODEMOGRAPHICS, CULTURAL DIVERSITY, AND ECONOMIC AND POLITICAL CHANGES ● Aging population - people living longer ● Number of the very elderly is increasing more rapidly than other age groups

Unit 6: Trends and Issues in Nursing Education Textbook------Chapter 3: The Influence of Contemporary Trends and Issues on Nursing Education

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○ More people live with chronic disease and disability. ○ Many live in institutions, substandard conditions, or alone. ○ Subject to increasing needs for health care and assistance ■ Nursing and other provider programs have increased geriatric content and clinical experiences; geriatric patients require very different care than younger populations. ○ Since 2000, 13 Hartford Centers for Geriatric Nursing Excellence have been developed to advance the knowledge and care of older adults. ○ Advancing Care Excellence for Seniors (the ACES Project) ■ Aims to advance the care of older adults through innovations in nursing education Diverse population ○ Use of traditional practitioners and treatments other than traditional Western medicine ○ Increasing number of diverse ethnic minorities and illegal immigrants with multiple socioeconomic consequences Increasing number of people living in poverty, homeless, and/or uninsured Diversity is often unwanted and leads to disrespect, intolerance, conflicts, abuse, and violence. Domestic abuse of women and children Various forms of violence in homes, schools, and public places Substance use disorders have consequences for the safety and health of nurses, patients, and others; the increase in stress and anxiety often triggers violence and mental health and economic problems. Obesity epidemic ○ Leads to the most prevalent health problems that strain health care facilities and financial resources ○ Paramount for health care providers to teach prevention of obesity and it consequences in schools ○ Learning to help people change their dietary habits is a major role for nurses. Nontraditional families ○ Often have limited finances and lack access to nursing and health care ○ May be resented by those with more traditional values and attitudes ○ Nurses must learn to respect and provide essential care regardless of differences.

PATIENT-CENTERED CARE: ENGAGEMENT, SAFETY, AND PRIVACY ● The 2002 Health Insurance Portability and Accountability Act (HIPAA) law mandates protection of an individual’s privacy by health care providers and throughout society and has changed many previously careless and harmful practices. ● Patients use Internet resources, sponsored by the government and private entities, to become more informed about illness and health care. ○ Better able to make effective decisions in collaboration with health care

Unit 6: Trends and Issues in Nursing Education Textbook------Chapter 3: The Influence of Contemporary Trends and Issues on Nursing Education providers ● Makes critical thinking, communication, and teaching essential nursing competencies ● Shift from “giving care” to “working with” the patient as a member of the health care team ● Increased number of medical errors leading to lawsuits have supported the need to insist on competency-based examinations in schools of nursing and as part of employer evaluations and accreditation ○ Precipitated increased requirements for competency-based education and performance assessment in schools of nursing and other health disciplines, in annual employment evaluations, and in agency accreditation criteria, all for patient safety ● Many injuries and deaths in medical institutions are preventable, and Medicare recently decided that it will no longer pay for preventable incidents, many of which are attributed to nurses. ○ Preventive care is being emphasized even more in nursing education ● QSEN, the COPA model, Interprofessional Collaboration, and similar initiatives in every specialty organization are designed to change nursing education and practice to promote competence and patient safety. Defining Medication Errors A medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. Such events may be related to: ● Profession Practice ● Health Care Products ● Procedures and Systems ● Product Labeling, Packaging, and Nomenclature ● Dispensing ● Distribution ● Administration ● Education ● Monitoring SHORTAGE OF NURSES AND FACULTY ● Has caused serious issues for students, teachers, and health care consumers ● Inadequate clinical staff - use of part-time and agency nurses ○ Reduces quality of care ○ Contributes to stress and burnout ● Fewer clinical instructors and preceptors ○ May or may not be prepared for these roles or receive adequate orientation ● 78,089 qualified student applicants denied admission due to faculty shortages, lack of clinical sites, and space

Unit 6: Trends and Issues in Nursing Education Textbook------Chapter 3: The Influence of Contemporary Trends and Issues on Nursing Education ● Faculty are aging and retiring - limited replacements ● Some schools are expanding enrollments by using more part-time, adjunct, and clinical faculty and by expanding the use of online courses and simulation. ● The number of students in Master of Science in Nursing (MSN) or doctoral programs is not adequate to meet current needs. ● Many organizations and associations have initiated collaborative partnerships to improve education in all types and levels of nursing education; some are state-wide or regional arrangements. ● The NLN has implemented initiatives to improve nursing education and faculty development. NURSES ● LPN/LVN ● RN ○ Diploma ○ Associate Degree ○ Bachelor’s Degree ○ Master’s Degree ○ Doctoral Degree ● Advanced Practice RN ○ Master’s Prepared ○ Doctoral Prepared LPN/LVN ● Licensed Practical Nurse or ○ Licensed Vocational Nurses (California and Texas) ● Shortest programs (9 to 12 months) ○ May be offered by high school adult education programs, community colleges, vocational and proprietary schools, and hospitals ● The main reason cited for individuals who were qualified, but not accepted into a PN/VN program was a lack of clinical placement sites for 51% of the applicants. ● Each state board sets the responsibilities and scopes of practice. ● Most restricted form of practice ● Must work under the supervision of an RN or physician ● May be employed in hospitals, nursing homes, offices, and other structured settings ● Cannot perform all skills ● Limited work in critical care areas ● Practice focuses on technical skills ● NCLEX-PN licensing exam [NCLEX=National Council Licensure EXamination] ● Of the diploma nurses who responded to a recent survey: ○ 66% were still employed in nursing ○ 40% were employed full-time with the highest practice setting being in a nursing

Unit 6: Trends and Issues in Nursing Education Textbook------Chapter 3: The Influence of Contemporary Trends and Issues on Nursing Education home, extended care, or assisted living facility ● In 2010, the highest number of LPN/LVN graduates who took the NCLEX-PN as first time candidates were from the Midwest and Southern Regions of the United States. ● The workforce analysis found that 66,734 candidates sat for the NCLEX-PN in 2010; however, from 2010-2011, there were a deceased number of individuals who passed the examinations. ● A workforce survey conducted in 2008 found that 5% of individuals who qualified for their first U.S. Nursing License were at the LPN-PN level, but less than 1% of the respondents (n=41,018) reported their highest level of education to be at the LVN-PN level. ● In the last decade, the full-time salary for LPNs has increased about $11,500 to an average in 2010 of $39,360. ● Some BSN programs accept LPN graduates based on outcomes of written and performance examinations for placement. HOSPITAL OR DIPLOMA PROGRAMS ● Oldest, most traditional RN programs ● Developed in the United States in the 1800s in general hospitals in cities such as Boston, New York, Hartford, and Philadelphia and subsequently spread across the country. ● Modeled after Nightingale programs in Europe ● Began as training programs taught by physicians, usually only several weeks in length ● Approximately 2-3 years in length ● 1950-1960: increased in the number of hospitals led to the increase in the number of diploma programs. More than 1300 programs operational ● By 2012, only 64 diploma programs remained. ● NCLEX-RN licensing exam ● Now are more similar to associate degree programs, typically 2 years in length; many have arrangements with colleges so that students can simultaneously earn an associate or baccalaureate degree. ● The American Association of Colleges of Nurses report pre-licensure programs at the diploma level to be less than 10% of all basic RN programs, citing the transition from hospital instruction to college or university instruction. ASSOCIATE DEGREE PROGRAMS (ADN) ● Emerged in 1950s; response to societal changes and RN shortage ● During World War II, the need for RNs who were prepared more quickly than in diploma programs became critical; the 2-year Cadet Nurse Corps was developed and proved to be very successful. ● Began as 2-year program in community colleges ○ Required college courses in arts and sciences and a more integrated approach to nursing content and clinical learning ● A “first” in nursing - now possible for all RNs to be educated in college setting and obtain

Unit 6: Trends and Issues in Nursing Education Textbook------Chapter 3: The Influence of Contemporary Trends and Issues on Nursing Education a college degree ● Intended to be the “technical nurse” ● In 2012, approximately 1048 ADN programs were operational, which is an increase of 84 programs since 2007. ● The majority of ADN programs are found in the Midwestern and Southern regions of the United States. ● 45% of qualified applicants are rejected due to difficulty with placements. ● Individuals admitted to ADN pr...