TRENDS AND ISSUES IN
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CONTEMPORARY NURSING
EDUCATION
TRENDS AND ISSUES IN CONTEMPORARY
NURSING EDUCATION
 Nursing education is always concerned with
preparing nurses with enough knowledge
and skills to meet the health care needs of
the community with compassion.
 How it does this is shaped by a number of
trends and issues in society, which change
continually and with increasing complexity.
Knowledge Expansion and Use of
Technology and the Internet
 With the ever-expanding developments in
computer technology, the volume of
knowledge is expanding exponentially.
From e-mails to complex research documents
and video images, nurses and students are
communicating more frequently, with more
contacts and with the speed of light.
Knowledge Expansion and Use of
Technology and the Internet
 This ability to access and disseminate
unlimited information almost instantly has
enormous benefits but also presents major
issues.
 Computer-accessible knowledge has become
the potential content for nursing and other
courses and the standards for practice.
 Websites generally are more interactive than
texts and link to multitudes of other helpful
resources (Nicoll, 2000; Skiba, 1997)
 Knowledge Expansion and Use of
Technology and the Internet
 Issues relate to time management, the
integration of all the information available,
keeping up with changes in technology, and
meeting the expectations for immediate
responses to an ever widening web of
contacts.
 Faculty and students have similar issues
related to knowledge and technology
expansion, the scope of information, and the
time to use it.
Practice-Based Competency
Outcomes
 Trends in business and commerce often find their
way into higher education and nursing education.
 In business the outcome of spending time and
resources based on actual needs is what counts in
determining financial success.
 The same is true for nursing practice and nursing
education.
 Students (nurses) achieve the competency
outcomes that specify the skills actually needed in
practice.
Practice-Based Competency
Outcomes
 For students it means a change from memorizing
class notes and readings to learning to integrate
knowledge, make decisions, and be competent and
confident in the abilities contained in course
outcomes.
 Practice-based competency outcomes specify the
destination students need to reach, the interactive
learning strategies are the directions and guidelines
for getting there, and performance-based
assessment confirms they have arrived at the right
place.
 These changes in the entire education process pose
threats and concerns to all the stakeholders that
need to be resolved (Bargagliotti, Luttrell, and
Lenburg, 1999).
Practice-Based Competency
Outcomes
Lenburg's Eight Core Practice Competencies

• Assessment and Interventions
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• Critical Thinking

• Communication

• Teaching

• Human Caring Relationships
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• Management
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• Leadership
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• Knowledge Integration
Practice-Based Competency
Outcomes
 Competency outcomes incorporate these practice-
based skills, as well as the course content.
 Learning strategies and performance examination
are based on outcomes and content.
 Several articles describe the model, process, and
related issues as used by others (Luttrell et al.,
1999; Redman, Lenburg, and Walker, 1999).
 Critical thinking is perhaps the most pivotal
competence, as seen in many resources (Critical
thinking, 2000; Rubenfeld and Scheffer, 1995).
Performance-Based Learning and
Assessment Methods
 A change in methods used to promote learning
and evaluate competence is another trend closely
linked to competency outcomes.
 In the era of cost containment, finding the most
effective and efficient ways for students to
become competent is paramount.
Performance-Based Learning and
Assessment Methods
 Related issues include:
 • Changes in roles of teachers and learners.
 • Refocusing responsibility and accountability
 • Shifting the perception of students from
passive receivers of information to active
learners responsible for being competent in
the array of specific practice-based skills.
 Performance-Based Learning and
Assessment Methods

Rather than lectures and multiple-choice tests,
these skills are learned more effectively through
activities such as problem-based learning, case
studies, and diverse projects in many community
agencies.
 The rapid expansion of knowledge and technology
and related changes in competency outcomes in
education and practice require major changes in
teaching-learning methods and evaluation of
performance.
Performance-Based Learning and
Assessment Methods
 These trends precipitate issues for students and
teachers. Both need to change ideas about
learning.
 Sometimes students think it is easier just to figure
out "what the teacher wants" and "study for the
test" rather than engage in interactive group
projects in and out of class that require more
decision making, group process, and time.
 It is easier to take written tests than to demonstrate
actual competence through performance
examinations that require 100% accuracy of
specified critical elements.
 Performance-Based Learning and
Assessment Methods
 Issues for faculty also include creating interactive
learning strategies and making arrangements for
them. This means contracts with many agencies,
working with preceptors and community leaders,
and having students in multiple settings
simultaneously.
 The issues are time, creativity, and a very different
way of thinking about learning - means creating
more complex performance examinations both in
class and in clinical settings to help students gain
confidence and demonstrate achievement of
essential competencies .
Sociodemographic, Cultural Diversity, and
Economic and Political Changes
 From rural to metropolitan areas throughout the
United States the population is undergoing
significant transformation (Baer et al., 2000;
Nursing, 1994).
 Many articles and websites provide details about
the aging of the population (i.e., the rapidly growing
percentage of those over 65 and even 85 years of
age).
 Others describe the number of ethnic minority
groups and the increasing number of those in
poverty, homeless, or under-insured.
Sociodemographic, Cultural Diversity,
and Economic and Political Changes
 Some of the issues for students are the distinct
differences among patients in their responses to
illness, treatments, and caregivers, which are based
on differences in age, culture, religion, and life
experiences in family and community (Ryan et al.,
2000).
 For example, issues related to nursing care may
differ considerably among those in areas that are
rural or urban, mountains or plains, north, south,
east, or west.
 Sociodemographic, Cultural Diversity,
and Economic and Political Changes
Effective and thoughtful nursing care is
individualized according to client characteristics
and circumstances, which is why students need
to learn as much as possible from sociology,
cultural diversity, psychology, religion, economics,
history, and literature, as well as basic sciences.
 Moreover, learning the stories of diverse peoples,
their customs, life experiences, and expectations
is interesting and expands human understanding
and creativity for personal and professional life.
Community-Focused Interdisciplinary
Approaches
 These societal trends described in the
preceding paragraphs helped create the
current focus on community-focused health
with an interdisciplinary emphasis.
 The large-scale economic and political
influences to reduce health care costs also
played a part.
Community-Focused Interdisciplinary
Approaches
 For example, the extraordinary expansion of
knowledge and creative treatment technologies
made it common practice for complex surgery
to be performed in ambulatory settings on an
outpatient basis or for drugs to be used instead
of surgery.
 Diverse health-conscious groups slowly made
progress to change the national orientation
from "illness care" to promoting health more
efficiently and effectively.
Community-Focused Interdisciplinary
Approaches
 This health care culture incorporates
concepts of shared responsibility for health
promotion among individuals, family,
community, and multiple care providers.
 More than ever, family and neighbors need
to become competent caregivers and
members of the health care team.
Community-Focused Interdisciplinary
Approaches
 The issues for teachers and students flow
from these changes in philosophy, from
"nursing as illness care in hospitals" to
"nursing as health promotion and care
management for individuals in the context of
family, and family within the community.“
 Patients in hospital, at home, or in extended
care settings are sicker and need
interdisciplinary care that often is
coordinated and managed by nurses.
Community-Focused Interdisciplinary
Approaches
 Some issues for students include changing their image of
where they will work, the kinds of patients they will care for,
and the skills they will use.
 Although many will work in acute care hospitals, others will
provide care in diverse community settings to those who are
culturally diverse or elderly and have multiple chronic and/or
acute conditions that require long-term nursing management.
 This requires skill in all core practice competencies, especially
creative problem solving, interdisciplinary collaboration, and
ability to use computers and communication technology
effectively and independently (Engelke and Britton, 2000)
Hospital Diploma Programs
 The oldest and most traditional of nursing
education programs that prepare for
professional licensure are hospital-based
diploma programs.
 They began as training programs by
physicians and lasted a few weeks.
 Soon the nurse graduates began developing
courses and teaching them from the nursing
perspective, and programs were extended
from 1 to 2 years in length.
Hospital Diploma Programs
 In later years all diploma programs were
3 years in length and had fairly uniform
courses of study and clinical hours.
 Many of them have arrangements with
colleges to offer arts and sciences and
in some cases dual credentials, an
associate degree, and a hospital
diploma.
Associate Degree Programs
 In the late 1950s a different trend in
nursing education began to emerge in
response to social, political, and
educational changes in society and to a
growing shortage of RNs.
 During World War II (WWII) the need for
RNs who could be prepared in a much
shorter time was critical.
Associate Degree Programs
 This shortened program, offered in colleges, was in
the context of the newly developing community
college movement that offered 2-year associate
degree programs in many technical fields.
 At the same time, the increasing complexity and
expansion of medical care required more and
better prepared RNs.
 A few educators began to create a new 2-year
nursing program for the community college, which
required courses more integrated approach to
nursing content and clinical learning.
Associate Degree Programs
 The original concept was that technical RNs
(associate degree nurses) would work with
professional RNs (nurses with a bachelor of
science in nursing [BSN]), as a team.
 ADN programs were so successful that they
became the new career pathway for
thousands of students; today the majority of
RNs are ADN graduates.
Baccalaureate Degree Nursing
Programs
 The 28-month program required scientific studies
and clinical work and had the prestige and authority
of other departments, with its own dean and budget
(Kalisch and Kalisch, 1995).
 This was another first in the history of nursing
education.
 The number of colleges and universities offering the
BSN degree slowly continued to increase, and by
2001 the AACN reported 570 basic BSN programs;
609 offer RN-BSN options.
 BSN degree programs typically require 2 years of
arts and sciences as the foundation for 2 years of
Master's Degree Nursing Programs
 Currently most MSN programs are designed
to prepare advanced nurse practitioners and
clinical specialists in a wide array of specialty
areas.
 The extraordinary and rapid, changes in
health care during the 1990s highlighted the
cost-effective and quality care benefits of
using advanced practice nurses to provide
primary health care previously unavailable or
provided by physicians.
Master's Degree Nursing Programs
 Different MSN education options are available,
the most common of which is for graduates of
BSN programs; other options are designed for
graduates of nonnursing degree programs and for
nurse doctorate (ND) programs and are especially
attractive during periods of nursing shortages.
 The current trend is MSN programs that can be
completed almost entirely through Internet
courses.
Doctoral Programs
 Currently four types of doctoral degrees are used by
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nursing students:
(1) the Doctor of Education (EdD) for those interested
in education;
(2) the Doctor of Philosophy (PhD) for those
interested in research;
(3) the Doctor of Nursing Science (DNS or DNSc) for
those interested in advanced clinical nursing practice;
and
(4) the Doctor of Nursing (ND) for those with BS
degrees in other fields who want to pursue doctoral
preparation for entry into nursing practice.
 Trends and issues that influence nursing
education make it even more important to comply
with quality standards and accreditation and to
emphasize competency outcomes for students
and graduates.
 Trends and issues that influence nursing
education make it even more important to comply
with quality standards and accreditation and to
emphasize competency outcomes for students
and graduates.