Effect Curriculum Development In Nursing Education
1. Global Violence, Disasters, and Their Influence on Curriculum Development
The events of September 11, 2001, along with recent natural and man-made disasters such as the Ebola outbreak, Hurricane Katrina, the Haiti earthquake, and the 2013 Oklahoma tornado, have profoundly impacted global health systems. These incidents highlight the critical need for preparedness in disaster and mass trauma response.
In response, the healthcare sector has intensified efforts in disaster preparedness, bioterrorism response, and other strategies to handle unpredictable and diverse catastrophic events (Lewis, 2009). Nurses, regardless of their level of experience or educational background, must possess essential knowledge and skills to effectively manage mass casualty situations (International Nursing Coalition for Mass Casualty Education, 2003).
To meet these needs, nursing curricula must include training in leadership, interprofessional collaboration, and emergency response system development. Additionally, nurses should be well-versed in the management of biological agents and the psychosocial support of affected individuals and communities (Norman & Weiner, 2011; Warsini et al., 2014). Updated nursing curricula should integrate competencies established by the International Nursing Coalition for Mass Casualty Education and utilize resources from the Center for Disease Control and Prevention (www.bt.cdc.gov) for public health emergency preparedness.
2. Demographic Shifts and Their Effects on Curriculum Development
The demographic landscape of the United States is undergoing significant changes, including an aging population and increasing racial and ethnic diversity (Institute of Medicine, IOM, 2010). By 2030, individuals aged 65 and older will make up nearly 20% of the U.S. population, with a notable rise in the number of people aged 85 and older (Federal Interagency Forum on Aging-Related Statistics [FIFARS], 2012).
These demographic changes necessitate that nursing education adapt to prepare practitioners for a growing population of older adults who are more educated and suffer from a variety of chronic conditions. Educational initiatives like those from the Hartford Institute for Geriatric Nursing and the End-of-Life Nursing Education Consortium (ELNEC) focus on improving care for older adults and addressing end-of-life issues (Federal Interagency Forum on Aging-Related Statistics, FIFARS, 2012; American Association of Colleges of Nursing [AACN], 2014b).
Additionally, the increasing diversity of the U.S. population, as highlighted by census data, requires nursing programs to emphasize cultural sensitivity. Despite efforts to improve diversity within nursing education, a majority of students and faculty remain White (AACN, 2014c). Nursing schools must implement strategies to recruit and retain minority students and faculty, enriching the curriculum with diverse perspectives and improving healthcare delivery to a varied patient population.
3. Technological Advancements and Their Influence on Curriculum Development
The shift from a resource-based, industrial economy to a knowledge-based, information age economy has transformed nursing practice and education. The widespread adoption of electronic health records (EHRs) and the American Recovery and Reinvestment Act of 2009 have accelerated the need for nurses to develop competencies in digital health technologies (Winstanley, 2014; Tellez, 2012).
Nursing curricula must now include information technology education to ensure that students can effectively use, navigate, and document within EHR systems. This includes incorporating simulation and e-learning opportunities to enhance learning experiences and prepare students for complex care environments (Flynn & Vredevoogd, 2010; Hayden, 2010).
Technology also enables flexible learning through online resources and the “flipped” classroom model, which allows students to engage with foundational content outside of class and apply their knowledge in practical settings during face-to-face sessions (Murray et al., 2014). Simulation, mobile devices, and other technological advancements are essential for developing practical skills and preparing students for real-world nursing practice.
4. Globalization and Its Impact on Nursing Education
Globalization, driven by international trade, investment, and technology, has made national boundaries less significant and has affected various aspects of global health (The Levin Institute, 2014). While globalization has improved living standards and created an interconnected workforce, it has also introduced challenges such as the spread of unhealthy lifestyles and rapid disease transmission (Abbott & Coenen, 2008).
Nursing education must address these global health issues by preparing practitioners to work within an interconnected global health landscape. This includes understanding the implications of mobile technologies and addressing both the positive and negative impacts of globalization on health outcomes (Jones & Sherwood, 2014; Istepanian, 2014; World Health Organization, 2011).
By integrating these global considerations into nursing curricula, educators can ensure that future nurses are equipped to address the complexities of modern health challenges and contribute effectively to global health improvement.
Globalization and Its Impact on Nursing Education
Globalization has significantly enhanced the mobility of the nursing workforce across states, provinces, and countries. However, this increased mobility, often driven by suboptimal working or living conditions in a nurse’s home country, can adversely impact the local supply of nurses and, consequently, the health of the region or nation (Jones & Sherwood, 2014).
This global shift presents both a challenge and an ethical responsibility for educators. They must design and implement curricula that introduce students to global health concepts and the dynamics of a global society, while also preparing competent caregivers capable of operating within this global context (MacNeil & Ryan, 2013).
To address these needs, didactic and clinical teaching strategies should focus on equipping nurses with the knowledge, skills, and attitudes necessary to identify and influence social, political, and economic determinants of health for marginalized populations (Peluso, Hafler, Sipsma, & Cherlin, 2014). Nurses must also develop an understanding of the realities of a market-driven health care system, increasingly influenced by the global economy. This includes awareness of how economic forces impact health care delivery, including the transmission and treatment of diseases.
Environmental Challenges for Nursing Curriculum Development
The ease with which currency crosses borders is paralleled by the mobility of environmental and epidemiologic hazards. In addition to global health issues, concerns such as sustainable development, energy availability, pollution-free water, and climate change are paramount.
Environmental health involves understanding how environmental conditions affect human health and disease. It requires awareness of how these conditions impact individuals and populations, as well as interventions that can improve both environmental health and nursing practices (National Institute of Environmental Health Sciences, 2005; Shaner-McRae, McRae, & Jas, 2007).
As awareness grows regarding the environmental threats to public health, it becomes crucial for nurses to recognize the impact of environmental factors on health and the difference that professional and personal actions can make. Nursing curricula should integrate content and competencies related to environmental health and promote environmentally responsible clinical practices. Additionally, curricula should encourage students to consider environmental issues as part of disease causation and to implement interventions aimed at improving environmental health. The implications of global warming, for example, provide a valuable opportunity for students to explore the ethics of environmental protection, resource conservation, and the selection of environmentally friendly products. The American Nurses Association offers excellent resources on environmental health.
Issues in Higher Education Affecting Nursing Curriculum Development
Institutions of higher education are navigating the intersection of technological advancements and globalization. As knowledge and skills become critical resources, funding for quality higher education is increasingly challenging.
Colleges and universities must balance innovation with tradition in the face of shrinking resources, technological progress, growing enrollments, and demands for globalized curricula (Flynn & Vredevoogd, 2010; Hornberger, Eramaa, Helembai, McCartan, & Turtiainen, 2014). Key issues such as affordability, access, accountability, and internationalization are central to higher education’s ongoing evolution, impacting nursing education and its curriculum development.
Affordability
The concern for affordability in higher education, a topic of discussion since 1947, remains relevant today. Investing in higher education typically yields long-term benefits, including improved employment prospects, career stability, and financial gains (Baum, Ma, & Payea, 2013). Despite these benefits, current economic conditions, increased student enrollment, and rising expectations for quality and equity present challenges. Cuts in federal and state funding, combined with fluctuations in endowment values, have led to a “do more with less” scenario (Flynn & Vredevoogd, 2010). As societal concerns about living wages grow, financing higher education remains a crucial public policy issue, requiring compelling arguments for the value of education beyond salary and the importance of investing in human infrastructure.
Access
Access to higher education, a persistent issue, has become increasingly significant as society transitions to an information-based, global economy. College graduates generally have better labor market prospects than those who only complete high school (Brock, 2010). While access has improved for various demographic groups, some, such as American Indians and Alaskan Natives, remain underrepresented. Ensuring broad access to higher education requires supportive public policies and institutional efforts to provide real opportunities. Affordability and access are essential considerations as nursing schools aim to recruit diverse and talented students.
Accountability
As governments and taxpayers scrutinize the allocation of public resources, the quality and affordability of higher education face increasing pressure. This scrutiny, coupled with concerns about U.S. higher education’s effectiveness, has led to initiatives like the Spelling Commission, which recommended strategies for enhancing postsecondary education and preparing students for the 21st-century workforce (Floyd & Vredevoogd, 2010). Higher education institutions must navigate calls for efficiency, internal cost controls, and justification for funding. Nursing schools are accountable to state legislatures, Congress, and the public for producing competent nurses, adhering to regulatory standards, and meeting accreditation requirements.
Internationalization
Internationalization in higher education has accelerated the exchange of ideas and people, driven by technological advancements (Egron-Polak, 2012). Over the next decade, institutions providing English-language postsecondary education are expected to see strong demand from international students. This trend presents opportunities for institutions to attract international students and engage in global research, potentially accessing new funding sources. However, this occurs amidst financial challenges related to affordability (Egron-Polak, 2012).
Issues Specific to the Nursing Profession
This section narrows the focus to specific challenges within the nursing profession. Key issues include the context of nursing care delivery, evolving degree requirements, and competencies needed for the 21st century.
Context of Nursing Care Delivery
The nursing profession is both influenced by and influences the broader health care delivery system. Trends identified in the 2010 American Hospital Association Environmental Scan, such as advancements in science and technology, rising costs, evolving health policy, quality of care, patient safety, and human resources, have significant implications for nursing practice and education (O’Dell, Aspy, & Jarousse, 2011). These trends inform how nursing educators shape curricula to prepare future nurses effectively.
Impact of Science and Technology on Nursing Education Curriculum Development
Advancements in science and technology are transforming health care delivery and educational practices within nursing. The Human Genome Project, for instance, has introduced opportunities for personalized genetic therapies while also presenting ethical challenges.
To address these developments, nursing curricula should integrate strategies to help nurses identify, understand, and support patients facing genetic decisions (Forbes & Hickey, 2009). The American Nurses Association’s (2008) Essentials of Genetic and Genomic Nursing: Competencies, Curricula Guidelines, and Outcome Indicators outlines essential competencies for delivering competent genetic and genomic nursing care (Forbes & Hickey, 2009, p. 9), making it a valuable resource for curriculum development.
The Pew Research Center’s Internet & American Life Project (2013) highlights the pervasive role of technology in our daily lives. The survey revealed that one-third of American adults have used the internet to research medical conditions, and 72% of internet users sought health information online in the past year (Pew Research Center, 2013). This trend has empowered consumers with information previously accessible only to clinicians, leading patients to be more proactive in their health care decisions (Hegarty et al., 2009; Heller, Oros, & Durney Crowley, 2013). Consequently, nursing education must address the need for nurses to engage respectfully with well-informed patients and share decision-making (Hegarty et al., 2009, p. 6).
In response to the challenges posed by limited and complex clinical training sites, nursing schools are increasingly employing simulation technology. High-fidelity simulations enable students to practice in a controlled environment, replicating real-world patient situations without risking patient safety. Research indicates that substituting high-quality simulation for up to half of traditional clinical hours yields comparable educational outcomes (Hayden, Smiley, Alexander, Kardong-Edgren, & Jefferies, 2014).
Rising Costs as a Challenge for Nursing Education Curriculum Development
The ongoing rise in health care costs poses significant challenges for hospitals and providers to deliver efficient care within constrained budgets. Factors such as declining charitable donations, increased numbers of Medicare and Medicaid clients, labor shortages, and rising pharmaceutical and supply costs strain hospital budgets (O’Dell, Aspy, & Jarousse, 2011). To advocate for effective budget negotiations and hospital changes, research documenting nursing’s contribution to efficient, high-quality care is essential.
Health Policy Impact on Nursing Education Curriculum Development
Health policy plays a crucial role in shaping, financing, and regulating the health care system. Anticipated increases in national health expenditures from 16% to 20% of the GDP by 2017 have prompted state and federal policies to regulate costs, shift care to less expensive settings, and leverage market forces to control expenditures (Henry J. Kaiser Family Foundation, 2009; O’Dell et al., 2011).
One strategy to mitigate health care costs is ensuring universal health insurance coverage, which could reduce expenditures to 18.5% of GDP (O’Dell et al., 2011). The Patient Protection and Affordable Care Act (PPACA) represents significant progress toward making health care accessible and affordable for all Americans. Since its implementation, the percentage and number of insured Americans have increased, with the U.S. Census Bureau (2013) reporting a rise to 84.6% and 263.2 million insured individuals in 2012.
Despite a decrease in private health insurance coverage, government health insurance coverage has expanded, and the PPACA mandates the revitalization of primary and public health care infrastructures (U.S. Department of Health and Human Services, 2014). As health care shifts from hospital-based to community-based settings, nursing education must adapt by emphasizing community-based care, policy, technology, and leadership development (Institute of Medicine, IOM, 2010; U.S. Department of Health and Human Services, 2014). Innovative educators are establishing partnerships with patient-centered medical homes and nurse-managed health clinics to offer students clinical experiences in community settings that highlight principles of care, leadership, and client management (American Association of Colleges of Nursing, AACN, 2013).
Quality of Care, Patient Safety, and Nursing Education Curriculum Development
Improving patient safety and quality of care remains a critical focus. Despite gradual improvements in care quality over the past decade, significant variations in quality and safety persist (U.S. Department of Health & Human Services, Agency for Healthcare Research and Quality, 2008; O’Dell et al., 2011). The Institute of Medicine (IOM) recommended that patients and their families have access to information on hospital performance, safety, evidence-based practices, and patient satisfaction (Hinshaw, 2011). This increasing demand for transparency and accurate data collection challenges health care organizations to enhance patient care based on detailed data.
The Institute for Health Improvement’s Triple Aim framework (2009) provides a method for evaluating health care quality, public health interventions, care coordination, universal access, and cost control. In response to calls from authorities like the IOM, the Robert Wood Johnson Foundation, and the Agency for Healthcare Research and Quality, nursing education must better prepare nurses for professional practice by emphasizing core competencies related to quality and safety: critical thinking, health care systems and policy, communication, illness and disease management, ethics, and information and health care technologies (AACN, 2013).
The Magnet Recognition Program, developed by the American Nurses Credentialing Center (ANCC, 2008), honors health care organizations for excellence in patient care and nursing practice. Achieving Magnet designation represents the pinnacle of nursing quality and serves as an exemplary model for nursing students (American Nurses Credentialing Center, 2008). For additional details, visit the ANCC website: Magnet Recognition Program.
Human Resources and Curriculum Development in Nursing Education
Human resource issues, including nursing and physician shortages and the unionization of health care providers, are significant trends affecting nursing education. In February 2009, the United American Nurses National Nurses Organizing Committee formed from the merger of three nursing unions, advocating for staffing ratios, workplace safety, and national pensions for RNs (O’Dell et al., 2011).
Retention of satisfied employees is crucial, with emphasis on creating and maintaining healthy and safe work environments. Effective organizations will focus on fostering workplace cultures that attract and retain health care workers, addressing issues such as verbal abuse, sexual harassment, and workplace violence (Felblinger, 2008; Joint Commission, 2008). The American Association of Critical-Care Nurses’ 2005 standards for healthy work environments provide valuable guidelines that should be incorporated into nursing curricula and clinical training.
In conclusion, future nursing practitioners must acquire knowledge and skills to engage informed consumers, understand scientific advancements, utilize technology, manage rising costs, ensure quality care, advocate for effective health policy, and contribute to health care reform. As leaders in ensuring quality health care, nurses will play a pivotal role in shaping the future of health care delivery (Q&A with Kathy Rideout, Associate Dean for Academic Affairs, 2010, p. 11).
Emerging Degrees and Curriculum Development in Nursing Education
Recent developments in nursing education include the introduction of two graduate degrees: the Clinical Nurse Leader (CNL) and the Doctor of Nursing Practice (DNP). These degrees exemplify efforts to address evolving societal health care needs.
In response to declining nursing enrollment and other professional challenges, the American Association of Colleges of Nursing (AACN) proposed a new educational model for a master’s entry-level CNL in 2000 to enhance patient care and safety (AACN, 2007). The CNL is designed to lead across various health care settings, assuming accountability for patient outcomes and managing care for individuals and patient cohorts (AACN, 2013). Ongoing collaboration between practice and educational institutions is essential for developing CNL programs that align with practice environments and utilize their skill set effectively.
Science and Technology’s Impact on Nursing Curriculum Development
Advancements in Science and Technology
The integration of science and technology into healthcare is transforming both patient care and academic settings. For instance, the Human Genome Project has introduced a range of personalized genetic therapies, accompanied by ethical considerations. Consequently, nursing curricula must include strategies that enable nurses to assist patients with genetic decision-making (Forbes & Hickey, 2009).
The American Nurses Association’s (2008) Essentials of Genetic and Genomic Nursing: Competencies, Curricula Guidelines, and Outcome Indicators outlines essential competencies for delivering genetic and genomic-focused nursing care (Forbes & Hickey, 2009, p. 9), making it a valuable resource for curriculum developers.
The Pew Research Center’s Internet & American Life Project (2013) underscores the pervasive role of technology in health care. The survey revealed that one-third of American adults have used the internet to research medical conditions, and 72% of internet users sought health information online in the past year (2013). This shift has empowered patients with information previously reserved for clinicians. Today’s patients are well-informed and expect to be involved in their healthcare decisions (Hegarty et al., 2009; Heller, Oros, & Durney Crowley, 2013). Consequently, nursing education must emphasize respecting and collaborating with informed patients (Hegarty et al., 2009, p. 6).
In response to the evolving clinical landscape, the healthcare industry is increasingly adopting simulation technology, similar to advancements in aviation training. This technology allows nursing programs to use high-fidelity simulations to replicate real-world scenarios without risking patient safety. Research indicates that high-quality simulations can effectively replace up to 50% of traditional clinical hours, yielding comparable educational outcomes (Hayden et al., 2014).
Challenges of Rising Costs
The escalating costs of healthcare present significant challenges for curriculum development. Budget constraints are exacerbated by declining charitable donations, rising numbers of Medicare, Medicaid, and self-pay patients, labor shortages, and increasing pharmaceutical and supply costs (O’Dell et al., 2011). Evidence demonstrating nursing’s role in delivering efficient, high-quality care is crucial for advocating during budget negotiations and organizational changes.
Impact of Health Policy
Health policy is a critical factor shaping and regulating the healthcare system. With national health expenditures projected to rise from 16% to 20% of the GDP by 2017, policies are increasingly focused on cost regulation, care setting shifts, and market-driven cost control (Henry J. Kaiser Family Foundation, 2009; O’Dell et al., 2011). The Patient Protection and Affordable Care Act (PPACA) aims to reduce expenditures and improve insurance coverage, contributing to a rise in insured Americans (U.S. Census Bureau, 2013).
The shift from hospital-based to community-based care is evident, with more nurses working outside hospital settings (Benner et al., 2010). This transition necessitates a curriculum shift towards community-based care, interdisciplinary collaboration, policy, technology, and leadership development (Institute of Medicine, IOM, 2010; U.S. Department of Health and Human Services, 2014). Innovative educators are building partnerships with patient-centered medical homes and nurse-managed clinics to provide relevant clinical experiences (American Association of Colleges of Nursing, AACN, 2013).
Enhancing Quality of Care and Patient Safety
Improving patient safety and quality of care remains a priority (Forbes & Hickey, 2009). Despite progress, care quality and patient safety still exhibit geographic variability (U.S. Department of Health & Human Services, Agency for Healthcare Research and Quality, 2008; O’Dell et al., 2011). The Institute of Medicine (2010) emphasizes the need for transparency in hospital performance and increased focus on evidence-based practices.
The American Association of Colleges of Nursing (AACN) has identified six core competencies essential for ensuring quality and safety: critical thinking, healthcare systems and policy, communication, illness and disease management, ethics, and information technology. Nursing education must integrate these competencies and educate students on the proactive measures the profession is taking to define practice and advocate for quality care.
Human Resources and Nursing Education
The nursing workforce faces challenges related to shortages and labor conditions. The formation of the United American Nurses National Nurses Organizing Committee in 2009 highlights ongoing efforts to improve staffing ratios, workplace safety, and pensions (O’Dell et al., 2011). Creating and maintaining healthy work environments is critical for retaining satisfied employees, with a focus on preventing verbal abuse, harassment, and violence (Felblinger, 2008; Joint Commission, 2008).
The American Association of Critical-Care Nurses’ standards for healthy work environments should be incorporated into nursing curricula and clinical practices to foster supportive work environments (AACN, 2005).
Emerging Degrees and Competencies
The emergence of the Clinical Nurse Leader (CNL) and Doctor of Nursing Practice (DNP) degrees reflects the profession’s response to evolving health care needs. The AACN’s decision to elevate advanced practice education to the doctoral level by 2015 has led to the establishment of approximately 250 new DNP programs (American Association of Colleges of Nursing, AACN, 2014a). Despite this, some institutions face barriers to transitioning from MSN to DNP programs.
Competencies for the 21st Century
To meet the demands of modern healthcare, nursing education must focus on developing practitioners with robust knowledge, abilities, and leadership skills. The American Organization of Nurse Executives (2011) identifies five broad competency categories for nurse leaders: communication and relationship building, knowledge of the healthcare environment, leadership skills, professionalism, and business skills.
Strategies for Identifying Influential Forces and Issues
Effective curriculum development requires understanding the forces shaping nursing education, including environmental scanning, strategic planning, epidemiology, and survey research. Environmental scanning helps leaders stay informed about trends affecting healthcare and higher education, while strategic planning provides a framework for decision-making. Epidemiology offers insights into health patterns and needs, and survey research helps gauge stakeholder perspectives.
Reflecting on Evidence
- How does your nursing program curriculum adapt to societal changes and healthcare reforms? What new approaches could enhance its relevance?
- In what ways does your curriculum prepare students to engage with current societal issues and trends?
- How does your program align with recent developments in the nursing discipline?
- How do faculty incorporate new input and address influences on curriculum development? How do they respond to emerging trends?
- How is your curriculum preparing students to lead in healthcare reform and collaborative practice?