Tanner

2,310 views
1,991 views

Published on

Published in: Health & Medicine, Technology
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
2,310
On SlideShare
0
From Embeds
0
Number of Embeds
8
Actions
Shares
0
Downloads
17
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Tanner

  1. 1. The Future of NursingEducation: A Collaborative Perspective Christine A. Tanner, RN, PhD Oregon Health & Science University School of Nursing
  2. 2. Calls for Reform Reexamination of curricular structures & processes (The Curriculum Revolution) Preparing a new kind of nurse
  3. 3. The Curriculum Revolution New pedagogies Preparing tomorrows leaders Multicultural diversity Caring Curriculum
  4. 4. Demands for a New Kind of NurseFueled 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. 5. Demands for a New Kind of NurseFueled by changes in demographics:Aging population with increased prevalence of chronic illnessFamilies increasingly engaged in care giving with little or no nursing supportIncreased attention to health- promotion
  6. 6. Central Competencies Critical thinking
  7. 7. Critical thinking =Thinking Like a Nurse?
  8. 8. A Short History of Nursing ProcessClinical Problem SolvingClinical Decision Making Diagnostic Reasoning Critical Thinking in other words . . . Thinking Like a Nurse
  9. 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. 10. Central Competencies Clinical Judgment: • Case based • Contextually bound • Interpretive reasoning
  11. 11. Central Competencies Clinical Judgment requires deep background knowledge for: • Noticing • Considering plausible interpretations • Collecting reasonable evidence • Choosing the best course of action
  12. 12. Central Competencies Clinical Judgment is always within • the context of a particular patient • A deep understanding the patient’s experience, values and preferences • Ethical standards of the discipline
  13. 13. Central Competencies Understanding clinical judgment in this way • Renews interest in case-based approaches to instruction • Demand new approaches to clinical education • Provides guidance to use of simulation in nursing education
  14. 14. Central Competencies: Quality-Safety Initiative Patient-centered care Team-work and collaboration Evidence-based practice Quality improvement Informatics
  15. 15. Preparing More Nurses
  16. 16. Preparing More Nurses In the face of a profound faculty shortage
  17. 17. Preparing More Nurses In the face of a profound faculty shortage Limitation in the number, type and quality of sites for clinical education.
  18. 18. Current practices in clinical education
  19. 19. A very short history of clinical education
  20. 20. Challenges in Clinical Education Traditional clinical learning driven by placement opportunities and challenges Insufficient number of “placements” using total patient care model High acuity, greater risk with neophyte students Staff nurse burden for supervision of students in rapidly changing situations Learning is dependent on… • Available patient population • Facility’s schedule availability • Availability of faculty with required expertise
  21. 21. Summary: Driving Forces for Reform Demands for Reform in Nursing Education 1985-2005 • Study of Curricular processes • Evidence of poorly prepared graduates even for acute care • Quality-safety
  22. 22. Summary: Driving Forces for Reform Demands for Reform in Nursing Education 1985-2005 Need for a “new” nurse Changes in the practice environment Emerging health care needs Practice in environment of severe shortage
  23. 23. Summary: Driving Forces for Reform Demands for Reform in Nursing Education 1985-2005 Need for a “new” nurse Other pressures: Content explosion Advances in the science of learning Outdated model of Clinical education
  24. 24. Part II: The Oregon Consortium for Nursing Education
  25. 25. OCNE 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” campus • Increase the number of nurses prepared with baccalaureate degree • Transform nursing education to more closely align with emerging health care needs
  26. 26. A very short history of OCNE 2000: Study of nursing shortage in Oregon 2001: Strategic plan developed by Oregon Nursing leaders 2002: Education plan unveiled and political turmoil ensued 2003: Launched OCNE with Project Director 2004: Began curriculum development & Phase I of Faculty Development 2005: Curriculum change approved by OSBN, NLNAC & CCNE 2006: Phase I Clinical Education Project launched 2006: First class of 255 students admitted on 6 campuses to nursing courses 2007: Phase II Faculty Development 2008: Preceptor Development 2009: First Baccalaureate class graduates
  27. 27. OCNE as a response to these challenges Committed to collaboration across programs enabling the best use of scarce resources Standard, competency based curriculum focused on preparing the “new” nurse. Teaching approaches that rest on the science of learning Faculty development as an integral part of curriculum development Reform of clinical education
  28. 28. Guiding Principles in Curriculum Design Responsive to demands for reform • NCSBN – 2001 – lack of preparation of grads • JCAHO (2002) – continental divide between education and practice • IOM reports
  29. 29. Guiding Principles in Curriculum Design Responsive to demands for reform Emerging health care needs • Aging population • Increasing acuity • Increasing prevalence of chronic illnesses • Demands placed on caregiving families with inadequate nursing care support
  30. 30. Guiding Principles in Curriculum Design Responsive to demands for reform Emerging health care needs Graduates would be practicing in an environment of chronic, severe RN shortages 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
  31. 31. Overview of the Curriculum First year: Prerequisites Second year & first two quarters of the third year: • Required non-nursing courses • Standard nursing courses on all campuses Third quarter of the third year: • Complete 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 BS
  32. 32. Transformation of the Nursing Curriculum:Some Features Courses organized around foci of care: • Health Promotion • Chronic Illness Management • Acute Care • End-of-Life Care
  33. 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 care • Leadership and outcomes management • Clinical immersion or integrative practicum for twenty weeks
  34. 34. Transformation of the Nursing Curriculum: Some Features Redefines nursing fundamentals to: • Clinical Judgment • Evidence-based Practice • Patient-centered care • Leadership
  35. 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. 36. The New Pedagogy Emphasizes deep understanding of the discipline’s most central concepts --- • Purposeful REDUCTION in content • Selection of content based on:  Prevalence of condition  Useful to teach integration across competencies • (e.g. ethical comportment, clinical judgment, evidence-based practice, health systems issues & leadership,
  37. 37. The New Pedagogy Emphasizes deep understanding of the discipline’s most central concepts Active learning through case-based instruction, integration among theory, clinical and simulation.
  38. 38. The New Pedagogy Emphasizes deep understanding of the discipline’s most central concepts Active learning through case-based instruction, integration among theory, clinical and simulation. Authentic performance assessment & promotion of self-directed learning
  39. 39. Process for Consensus Building during Curriculum Development Institutional representatives Leadership model Faculty development combined with curriculum development Frequent Review & Counsel by groups with expertise & vested interests: • Faculty on each of the 12 campuses • Specialty task forces
  40. 40. Challenges in Clinical Education Traditional clinical learning driven by placement opportunities and challenges Insufficient number of “placements” using total patient care model High acuity, greater risk with neophyte students Staff nurse burden for supervision of students in rapidly changing situations Learning is dependent on… • Available patient population • Facility’s schedule availability • Availability of faculty with required expertise
  41. 41. Desired Features of New Clinical Education Model Relationship-centered care keeping the patient and family at the center Science of learning and findings of the Carnegie study • (i.e. integration across apprenticeships, retain prep, coaching and debriefing and other best practices)
  42. 42. Desired Features of New Clinical Education Model Relies on Clinical learning activities that: • Are designed to support attainment of Competencies • Include, but not dominated by “Total Patient Care” • Developmentally appropriate for level of student • Vary faculty–student ratios & nursing staff roles by level of student, acuity of patient, nature of learning activity • Culminate in one or more Immersion experiences.
  43. 43. Types of Clinical Learning Experiences Focused direct care experiences • Patient-centered care • Therapeutic relationship • Individualized care
  44. 44. Types of Clinical Learning Experiences Focused direct care experiences Concept-based experiences: focus on learning concepts (e.g. oxygenation) through seeing many patients who exemplify the concept
  45. 45. Types of Clinical Learning Experiences Focused direct care 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.
  46. 46. Types of Clinical Learning Experiences Focused direct care experiences Concept-based experiences Case-based experiences Skill-based experiences: focused on learning basic skills through repetitive practice, includes psychomotor skills, such as interviewing.
  47. 47. Types of Clinical Learning Experiences Focused direct care experiences Concept-based experiences Case-based experiences Skill-based experiences Integrative experiences: opportunity to integrate prior learning and linking learning activities to RN role in clinical agency.
  48. 48. Types of Clinical Learning Experiences: Differentiated by:Type of learning and appropriate pedagogyDegree of accountability for patient care
  49. 49. Transformation of Clinical Education 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 IV: development of and consensus building on new model Phase V: statewide demonstration of new model through 3 years of OCNE nursing curriculum
  50. 50. 6 Major Components of Consortium Development Developmental Processes & Infrastructure Faculty Development Simulation Capacity Curriculum Development Clinical Education Capacity Comprehensive evaluation
  51. 51. A relationship-centered change processDriven by our passions with . . . Commitment to health of Oregonians Strong Leadership & persistence One leap of faith after another
  52. 52. An African Proverb:To go quickly, go alone.To go far, go together.
  53. 53. For more informationVisit us at www.ocne.org

×