FORMULATING PRIORITIES FOR Research in Nursing Education: A CONSENSUS-BUILDING APPROACH
Stevens, Kathleen, Valiga, Theresa M., Nursing and Health Care Perspectives
To expand the scientific foundation for nursing education, the National League for Nursing is establishing a national agenda for research in nursing education. This groundbreaking effort will define research priorities that can serve as a rallying point for education researchers across the nation. The goal of this consensus-building effort is to focus nursing education research efforts on discovering the core of knowledge needed to bridge education and practice as we move into the 21st century. This article describes the process being used in this historic dialogue.
The Background Since its inception in 1893, as the American Society of Superintendents of Training School for Nurses (ASSTSN), the National League for Nursing has been dedicated to, and considered the pioneer of, nursing education. The initial purpose of the ASSTSN was to establish and maintain a universal standard of training for nursing -- not to be prescriptive and limiting, but to establish a standard of excellence that would guide the development of nursing education programs.
Over the past 106 years, the NLN's commitment to excellence in nursing education has not wavered, despite its attention in recent decades to health policy formulation and the improvement of the health of communities. Health policy initiatives and the emphasis on improving health clearly are significant concerns to members of the academy, but they are more indirect, rather than direct, concerns.
In 1998, the NLN reaffirmed its one definitive mission, to advance "quality nursing education that prepares the nursing workforce to meet the needs of diverse populations in an ever-changing health care environment." Such clarity of mission recognizes the need to prepare graduates who can deliver quality, evidence-based care. Further, it also acknowledges that nursing practice and nursing education take place in an environment that is characterized by unprecedented change, uncertainly, unpredictability, and ambiguity.
This reaffirmed, definitive mission of the NLN has guided the Board of Governors and the organization's leadership staff to identify a number of strategic initiatives that will make the mission "come alive." Such initiatives are intended to achieve several purposes:
* Position the NLN as the leader in shaping the development of nursing curricula and educational models.
* Enhance the professional development of faculty.
* Develop and articulate nursing education standards and methods of accountability.
* Strengthen the use of technology as an instructional strategy.
* Promote and support evidence-based teaching and curricula.
In light of this last goal, the Board of Governors voted in 1998 to establish the Blue Ribbon Panel on Priorities for Research in Nursing Education and to empower the Panel to play a significant role in creating a preferred future for nursing education. Specifically, the Blue Ribbon Panel was charged to "consider the future needs and demands of the health care system and set priorities for research to define and test ways for preparing the nursing workforce for the future."
Through this action, the Board of Governors affirmed that research in nursing education is a vital part of the scientific enterprise of preparing nurses for practice. The currency of previously established priorities for such research (1) must be called into question in light of the tremendous social and industrial changes that have occurred during the past decade. The vast number of powerful forces that have evolved since 1987 should be reflected in nursing education research.
The forces affecting nursing education emanate from changes in general curricular approaches, the nature of students, public sentiment, higher education funding, the distribution of education via technology, health care system reform, and the dominant clinical theme of nursing research. Although these forces have acted together to lead faculty toward major revisions in nursing education, revisions of the priorities for developing the attendant scientific underpinnings of education have not followed sufficiently. There is, then, an urgent need for a long-range plan for nursing education research, and the work of the Blue Ribbon Panel is designed to meet that need.
Initial Work of the Panel With Dr. Kathleen Stevens as chair, the Blue Ribbon Panel began its work before the end of 1998. Members of the Panel had been carefully selected to include individuals with expertise and extensive involvement in nursing education in various types of educational programs.
In its first telephone conference call, the charge to the Panel was reviewed. Each member was asked to share her primary interests in or concerns related to the future of nursing education and research in nursing education. These interests and concerns included, but were not limited to, the enhancement of the critical thinking skills of students, the cost of nursing education, interdisciplinary learning experiences, the development of students' leadership skills, distance learning and other technology-mediated approaches to education, and the implications for nursing education of a managed care environment.
Each member of the Panel was asked to contribute to an annotated bibliography of material that had relevance for our task. The resources contributed could relate to future trends and predictions in general, or to health care in particular, new educational paradigms, the changing role of the nurse, expectations for faculty and students, or any other topic that was meaningful, given our charge.
Based on what each member read and what each person thought about the future, we were asked to formulate priority knowledge/research needs, or gaps, regarding nursing education in the next five to 10 years. The most important knowledge gaps formulated by one of the authors, for example, included the following:
* The Nature of the Academy -- what it really will mean to be a faculty member in the university in 2010 -- how to effectively balance the roles of expert teacher, competent practitioner, involved professional, community activist, and productive scholar.
* Principles of Creativity -- how to incorporate principles of creativity into what we teach, how we teach, how we facilitate learning, how we design curricula, how we evaluate learning.
* Measurement of Program Outcomes -- how to document significant program outcomes using valid, reliable, feasible measures.
Explicating Assumptions and Deriving Implications for Nursing Education The Blue Ribbon Panel then convened for its first face-to-face meeting. With the assistance of a group facilitator, Susan Haecker, and the support of Dr. Ruth Corcoran and Dr. Martha Kelly, CEO and Membership Council Manager of the NLN, respectively, the Panel undertook the following tasks:
* Articulate assumptions about the future -- the future of the world, our society, health care, education, the role of the nurse, and so on.
* Identify the implications of these assumptions for nursing education.
* Establish priorities from among these implications.
* Formulate priorities for nursing education research that arise from these trends and implications.
* Arrive at a consensus about nursing education research priorities to present to the nursing educator community for validation and endorsement.
Beginning with the assumption that the future will happen with or without us -- and that a preferred future can be created if we engage in thoughtful, purposeful action today -- a list of more than 50 assumptions was generated. Among them were the following:
* The future will be increasingly chaotic, unpredictable, and constantly changing.
* There will be a growing emphasis on individual involvement in disease management, self-growth, and personal empowerment.
* Cooperation, collaboration, partnerships, and a sense of community will be increasingly necessary.
* There will be more ethical dilemmas in our daily and professional lives.
* There will be a greater emphasis on health promotion, disease prevention, and community-based care.
* Demands for quality, accountability, and evidence-based practice will increase.
* Technology will continue to evolve and dramatically reshape the landscape of our lives.
In addition, the Panel noted ramifications of certain changes in population demographics:
* Strengthened demand for culturally competent care, a more global perspective, and new access models.
* A widened gap between the supply of RNs prepared with specific skill sets (i.e., baccalaureate and master's preparation) and the demand for such RNs.
* Greater need for creative and innovative approaches to health care and education.
The assumptions that were explicated were reflective of the current literature about the future. There was little disagreement among Panel members that all of these predictions -- and more -- would come together to describe the world of 2010. What has been less clearly articulated in the literature are implications of these trends for nursing education. Thus, the next task undertaken by the Panel was the creation of an extensive list of implications for nursing education to prepare the nursing workforce for this future. Included in the list was the need for the following:
* Continued efforts to refocus curricula toward community-based care, prevention, and community partnerships.
* Greater integration of technology-mediated approaches to learning.
* More emphasis on thinking and the integration of knowledge than on doing and the absorption of isolated pieces of information.
* Increased emphasis on a global community and cultural diversity.
* Recognition of each educational program's responsibility to enhance the health of its surrounding community(ies).
* Heightened need to explore and develop models for multidisciplinary preparation and a core knowledge base for all health care providers.
The Panel articulated a number of additional implications for nursing education that would evolve from anticipated future trends.
* Nursing students need to realize that as nurses, we have the responsibility as professionals to create our own preferred future, rather than to be victims of the decisions and actions of others.
* Graduates of our programs need to see themselves as individuals who can articulate a vision for the profession and provide leadership in making that vision become a reality.
* Nursing programs/curricula, along with our approaches to teaching and learning, need to be less rigid so that students can become increasingly comfortable with ambiguity and unpredictability.
Finally -- although many other implications were expressed -- the Panel noted that faculty will need different skills to be effective in their roles in the future. Ongoing faculty development will be critical to the success of any educational program, and evidence-based teaching will need to become the norm in the academy.
Building Consensus and Establishing Priorities Armed with this vast array of assumptions about the future and implications for nursing education, three small groups of Blue Ribbon Panel members were then asked to determine priorities from among them. After extensive discussion, the following emerged as priority implications for nursing education:
* The role of the faculty will change dramatically. Among their other roles, faculty will be interpreters and "brokers" of information. There may be a need for fewer faculty if the "reach" of true experts can be expanded through technology and mentoring.
* Educational institutions will be held accountable for quality outcomes for nursing programs. Part of their accountability may include the health status of surrounding communities.
* Students need to be prepared to practice in a world where they will create partnerships and work collaboratively with consumers, as well as with other health care professionals, to achieve desired client outcomes and deliver quality, cost-effective care to increasingly diverse populations.
* There will be a significant shift in responsibility to the learner, which will "drive" the use of technology and other approaches to make education available, accessible, and relevant.
* Students will need to be prepared to practice in a world that is increasingly characterized by competing realities that must be balanced (e.g., both the specialist and the generalist are desired, both centralization and decentralization have merit, both technology and humanism are important).
The Blue Ribbon Panel was established to create consensus on a National Agenda for Nursing Education Research and to recommend strategies for achieving this agenda. The consensus statement that the Panel will generate is intended to promote excellence in the science underlying nursing education and create a national environment to support knowledge development for nursing education.
The presentation at the NLN Biennial Convention in June 1999 and the published Proceedings of the work of the Blue Ribbon Panel -- including the explicated priorities for research in nursing education -- will provide opportunities for nurse educators to talk with one another about the future of our programs and the scientific foundations for them. (Portions of the Proceedings will be published in Nursing and Health Care Perspectives, September/October 1999.)
The role of research in nursing education in the future is exciting and vital, as are the contributions of the National League for Nursing toward building this preferred future. Opportunity abounds. Carpe diem!
Members of The Blue Ribbon Panel on Priorities for Nursing Education Research
Kathleen Stevens, EdD, RN, FAAN Chair Professor, University of Texas Health Science Center San Antonio, TX Marsha Howell Adams, DSN, RN Associate Professor, University of Alabama Tuscaloosa, AL Nancy Diekelmann, PhD, RN, FAAN Professor, University of Wisconsin Madison, WI Belinda Downing, DSN, RN Director, Nursing Wallace State Community College Dothan, AL Susan Haecker, MSN, RN Principal WellSpring San Antonio, TX Marsha L. Heims, EdD, RN Associate Professor Oregon Health Sciences University Portland, OR Janice R. Ingle, DSN, RN Dean, Health Sciences Southern Union State Community College Opelika, AL W. Kaye McDonald, PhD, RN Chairperson North Carolina Central University Durham, NC Patricia E. Mihalcin, PhD, RN Division Chair Westmoreland County Community College Youngwood, PA Patricia A. Miller, MSN, RN Director, School of Nursing, Baystate Medical Center Springfield, MA Ramona Nelson, PhD, RN Associate Professor Slippery Rock University Slippery Rock, PA Karen Medina Outzs, MS, RN Director, Nursing Programs Western Wyoming Community College Rock Spring, WY Sheila Ryan, PhD, RN, FAAN Dean, School of Nursing and Director, Medical Center Nursing University of Rochester Rochester, NY Susan Sherman, MA, RN President, Independence Foundation Philadelphia, PA Mary B. Tittle, PhD, RN Interim Associate Dean, College of Nursing University of South Florida Tampa, FL Theresa M. Valiga, EdD, RN Dean, School of Nursing, Fairfield University Fairfield, CT Maria daGloria Miotto Wright, PhD, RN Coordinator, International Program School of Nursing, Georgetown University Washington, DC Cynthia Zane, PhD, RN Dean, College of Health Professions University of Detroit, Mercy Detroit, MI
(1.) Tanner, C. A., & Lindeman, C. A. (1987). Research in nursing education: Assumptions and priorities. Journal of Nursing Education, 26(2), 50-59.3…
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Publication information: Article title: FORMULATING PRIORITIES FOR Research in Nursing Education: A CONSENSUS-BUILDING APPROACH. Contributors: Stevens, Kathleen - Author, Valiga, Theresa M. - Author. Journal title: Nursing and Health Care Perspectives. Volume: 20. Issue: 3 Publication date: May 1999. Page number: 167. © 1997 National League for Nursing, Inc. COPYRIGHT 1999 Gale Group.
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