Undergraduate Program Design In Nursing Education and Purposes, Historical Influences & Factors Influencing
Essential Purposes of Undergraduate Education in Nursing Education, Historical Influences for Understanding Today’s Undergraduate Curriculum In Nursing Education, Factors Influencing Undergraduate Program Design In Nursing Education.
Essential
Purposes of Undergraduate Education in Nursing Education
Undergraduate
nursing curricula are primarily designed to prepare students for entry into
practice. In addition, some curricula are designed as academic progression
models for registered nurses (RNs) to achieve a bachelor of science in nursing
(BSN) degree or licensed practical or vocational nurses (LPN/LVN) to pursue an
RN degree.
Undergraduate curricula also provide a foundation essential to
graduate education and advanced nursing practice. In recent years, some health
care agencies have been reframing requirements for RN employment with acute
care agencies often preferring or requiring applicants to hold a bachelor’s
degree in nursing.
Designing curricula that facilitate the academic progression
of the nursing workforce (National League for Nursing [NLN], 2011) will be
imperative to achieve the Institute of Medicine (Institute of Medicine [IOM],
2010) recommendations for increasing numbers of baccalaureate and advanced
degree–prepared nurses and to meet market demands.
The
increased expectation for public accountability has expanded the visibility of
nursing education at the national, state, and local levels, which has also
increased stakeholder involvement in the education and practice of nurses.
As a
professional educational degree program, nursing is among the most regulated
educational enterprises on higher education campuses. One advantage of
regulation for nursing programs is the high level of scrutiny to which they are
subjected, and the assurance of minimum standards for most schools of nursing,
providing a competent workforce for patient care.
Making use of the relative
similarities in curriculum plans that exist across nursing programs, in part
resulting from regulatory requirements, faculty have adapted plans of study to
facilitate articulation and academic progression.
A disadvantage to this level
of control is the perceived negative effect of prescriptive guidance and rules
on innovation; faculty may be discouraged from pursuing new ideas for
curriculum organization, content, and teaching methodologies, perceiving too
many impediments to innovate.
Compared
with curricula in other disciplines, nursing curricula across multiple schools
often look quite homogeneous. This does ensure that new graduates have been
exposed to knowledge that is commonly accepted to be essential to practice, but
on the other hand, having a large body of knowledge that faculty perceive to be
essential can potentially stifle innovation.
Perhaps this is one reason that
examples of innovative curricular responses to the changing environment have
been a challenge to initiate. However, innovation is occurring in the area of
transforming curricula to meet the needs of more nontraditional students,
students pursuing a second degree, and those with unique needs, leading to more
creativity and flexibility in curriculum construction and delivery. The
expected outcome is to entice, retain, and graduate a diverse population of
students.
Historical
Influences for Understanding Today’s Undergraduate Curriculum In Nursing Education
Florence
Nightingale is considered to be the founder of modern nursing. As a prolific
writer who spoke in eloquent tones about the education and practice of nurses,
Nightingale envisioned nursing as more than the understanding of disease. She
is quoted as having said, “Pathology teaches the harm that disease has done.
But it teaches nothing more” (Nightingale, 1969, p. 133).
Her nursing
orientation focused on health as a broad and encompassing concept that requires
an understanding of human nature and the ability of that nature to affect
individual health. Nightingale’s thinking that nurses need to acquire an
understanding of the science and art of human existence has continued to
permeate undergraduate education from its original, hospital based training programs
to its current degree-granting educational programs.
Traditionally,
nursing philosophy and theory have been crucial to nursing curricula because
philosophy and theory state what nursing is and what it should be. Nursing
theorists, starting with Nightingale, have provided nursing with the
theoretical foundation for educational philosophies, mission statements,
curriculum models, and delivery of curriculum content.
Despite differing
beliefs posited among recognized nursing theorists, they, like the curriculum
models that have been predicated on their thinking, have focused on the nature
of humans, society, and nursing practice. It appears that the previous emphasis
on the roles of nursing philosophy and theory in design of nursing curricula is
decreasing as the emphasis has shifted to one that is more outcome-driven.
Donohue Porter, Forbes, and White (2011) point out that as our undergraduate
curricula have become saturated with content, the focus on nursing theory has
diminished, leading to curriculum structures that are very content laden, with
decreased focus on the theoretical organizing structures of knowledge that
allow students to integrate knowledge into practical action. The concept based
movement in curriculum development is one means by which to address the concern
about overly content laden curricula.
The
desire to understand human nature and society is still a prevailing factor
shaping current undergraduate curricula, especially nursing curricula. Theory
that is effectively used in the construction of curricula and teaching–learning
methodologies can counter the focus on nurses mainly as “doers” rather than
“thinkers” that is often a perception of students in nursing education programs
today (Grealish & Smale, 2011).
An example of a curriculum structure that
effectively uses theory to facilitate integrative thinking is the Popoola
holistic praxis model (Popoola, 2012) in which a planned framework of
theoretical concepts are organized into a program of study that emphasizes the
explicit use of multiple theories throughout the nursing curriculum.
Factors
Influencing Undergraduate Program Design In Nursing Education
Multiple
factors influence the design and development of undergraduate nursing
curricula. Nursing curricula should reflect the mission, vision, and values
espoused by the university or college, while retaining congruence with the
school’s philosophy and vision. Further, significant national and international
reports create calls to action and change.
Along with these influences, schools
of nursing design curricula with particular learner characteristics in mind. In
planning nursing curricula, schools of nursing must also respond to the
expectations of key stakeholders, such as accreditors and boards of nursing.
Further, because nursing programs prepare students for licensed practice,
attention to licensing requirements is important successfully licensed students
are a publicly recognized marker of program quality. Finally, faculty
constructing curricula for nursing programs should consider the present and
future trends in health and health care that are likely to affect nurses’
practice in the coming years.
Although predicting the future issues and needs
in health care is an uncertain activity, without such vision, schools of
nursing will consistently lag behind the rapidly changing health care
environment, to the detriment of the profession.
Faculty
designing curricula that meet these extensive design factors require
creativity, political savvy, negotiation skills, analytical rigor, psychic
energy, and a sense of teamwork.
Faculty involved in designing programs and
building curricula must possess a clear sense of purpose, a commitment to
procuring resources, an understanding of market forces, the ability to
anticipate health care trends of the future, and the ability to know when goals
have been accomplished.
Once programs are designed, curriculum building and
revision should continue in a continuous quality improvement process that is
related to, but separate from, the acts of teaching and learning. Curriculum is
a dynamic, evolving entity shaped by learner needs and faculty beliefs about
the science and art of nursing.