Nursing programs are an outcome of a dynamic relationship with social, educational, legislative, economic, and professional forces in contemporary society. Nursing and health care in the 1900s will emerge in forms and patterns unlike those of the 1980s. Nurse educators must therefore be responsive to contextual change and develop and revise nursing programs to prepare graduates as citizens and professionals.
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The social context in which nursing programs are embedded is changing. In the United States, for example, there is an increase in the number of older adults and a decrease in the birth rate. There are increasing numbers of Hispanics and Asians, but the numbers of black Americans and Caucasians are decreasing. Furthermore, the epidemiology of health problems is canging as an aging society copes with increasing chronic diseases, new communicable diseases such as AIDS, and other health problems caused by a polluted and shrinking environment.
Educational Context
A discussion of the context of nursing education must address the current issues facing post-secondary education and nursing education. Post-secondary education, and particularly higher education, is criticized for graduating students unprepared for the future and maintaining curricula that perpetuate a lack of purpose and learning. In response to public criticism and a demand by state commissions for higher education for assessment of outcomes and accountability, colleges and universities are revising curricula to prepare liberally educated individuals with an area of study in depth, as well as informed citizens and graduates able to contribute to an information based society.
Nursing education programs must accommodate to the curriculum revolution of the institution of higher education and the mandate for change in nursing curricula. Regardless of debates about professional versus technical education and preparation for entry into practice, schools of nursing are raising questions about what is learning, what should be taught, how should it be taught, and how can performance and outcomes be assessed. As nurse educators question historical models of curriculum development and urge reform of both undergraduate and graduate education, new patterns in nursing curricula are emerging to integrate theory and practice, to redefine learning, and to use teaching-learning strategies that facilitate learning as nurses move from novices and beginning practitioners to expert clinicians.
Economic Context
Nursing education programs must accommodate to the curriculum revolution of the institution of higher education and the mandate for change in nursing curricula. Regardless of debates about professional versus technical education and preparation for entry into practice, schools of nursing are raising questions about what is learning, what should be taught, how should it be taught, and how can performance and outcomes be assessed. As nurse educators question historical models of curriculum development and urge reform of both undergraduate and graduate education, new patterns in nursing curricula are emerging to integrate theory and practice, to redefine learning, and to use teaching-learning strategies that facilitate learning as nurses move from novices and beginning practitioners to expert clinicians.
Legislative Context
Nursing education is influenced by legislation at local, state, national, and international levels. Such legislation defines nursing practice and nursing education and sets standards for determining who will be the practitioners. At the state level, for example, state boards of higher education have responsibility for planning and recommending numbers and types of programs, whereas state boards of nurses registration and education establish standards for licensure and quality of nursing education programs, qualifications of faculty, and curriculum requirements.
State legislation also enables nurse practice acts. Legislation in North Dakota, for example, has separate licensure for two categories or nurses, the technical and the professional nurse. This same legislation specifies two types of nursing education programs, associate and baccalaureate, to prepare graduates for entry into practice.
Federal legislation, however, influences nursing education at the national level. Example include funding nursing research, providing student financial assistance, and funding innovative nursing education programs.
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Closely related to legislative forces, economic forces affect nursing education by influencing supply and demand for nurses, salaries, and health care delivery systems. Staffing patterns, utilization of nurses in defferentiated practice, and employment opportunities can contribute directly to recruitment into educational programs, as well as numbers and geographic location of these programs.
Professional Context
Also important are the professional forces and organizations that are shaping the direction of nursing education programs and curricula. These forces are related to the marketplace, practice environment, and strategies for effective use of nurses with varied educational preparation. The work of two nursing organizations can be traced to demonstrate the relationship of nursing`s professional organizations and the development of nursing education programs.
In 1965 the American Nurses` Association (ANA) proposed two entry levels for the practice of nursing; the technical nurse, with an associate degree as educational preparation, and the professional nurse, with the baccalaureate degree as educational preparation. In 1984 the ANA reaffirmed its position on the baccalaureate degree in nursing as entry for practice, and in 1985 voted to support two categories of nurses, the technical and the professional with education in associate and baccalaureate programs. At the same time, the National Commission on Nursing Implementation Project (NCNIP), composed of a governing board representing a variety of nursing and health care organizations, including the American Association of Colleges of Nursing, American Organization of Nurse Executives, the National League for Nursing (NLN), and the ANA, was established for the purpose of implementing recommendations of earlier studies by identifying trends and establishing consensus for action to effect the future of nursing. In 1987 NCNIP identified characteristics of professional and technical nurses of the future and established a timeline for changes in the educational system, developed a model for describing nursing care systems that are cost effective and assure quality, explored how nursing research can be used to influence public policy, and advocated an information system to assure to data for education, practice, and research.
Nursing specialty organizations affirm the ANA position and the direction established by NCNIP. For example, in 1989 the American Association of Critical Care Nurses identified competence statements for the technical and professional nurse in differentiated practice. It is in these contexts, then, that nursing programs are designed to prepare graduates with the knowledge, skills, and values to practice in a complex and changing health care arena.
References :
Bloom A : The closing of the American mind, New York, 1987, Simon and Schuster.
Benner P : From novice to expert : excellence and power in clinical nursing practice, Menlo Park, Calif, 1986, Addison-wesley.
Diekleman N : Curriculum revolution : a theoritical and philosophical mandate for change. In Curriculum revolution : mandate for change, New York, 1988, The National for Nursing.
Lindeman CA : Curriculum revolution : reconceptualizing clinical nursing education, Nurs Health Care, 1989.
Tanner C : Curriculum revolution, the practice mandate, Nurs Health Care, 1989.
McCarty P : North Dakota educates under new rules, Am Nurs, 1989.
Stull MK : Entry skills for BSN`s, Nurs Outlook, 1986.
National Commission on Nursing Implementation Project : Overview of the project, Milwaukee, WI, 1987, NCNIP.
DeBack V : Competencies of associate and professional nurses. In looking beyond the entry issue : implications for education and service, New York, 1986, The National League for Nursing.
National Commission on Nursing Implementation Project : An introduction to timeline for transition into the future nursing education system for two categories of nurse and characteristics of professional and technical nurses of the future and their educational programs, Milwaukee, WI, 1987, NCNIP.
Hickey MR : Competence statements for differentrated practice in critical care, Newport Beach, Calif, 1989, American Association of Critical Care Nurses.
