Transforming Nursing Education:Leading a Way,and Advancing Health

ZHAN Lin

（Loewenberg College of Nursing,University of Memphis,TN 38152,USA）

【国际护理论坛】

编者按：

从20世纪20年代至今，美国护理教育的层次和类型都有了较大的转变。为了适应护理教育的变化和日益增长的医疗保健需要，让护理毕业生的能力满足“better health care,better population health,and cost effectiveness”等目标，美国护理教育在受到了较多冲击的同时，也相应做出了有针对性的调整。为了更好地了解与借鉴美国护理教育的发展与转变，本刊名誉主编、美国护理科学院院士、孟菲斯大学鲁文贝格护理学院院长、终身教授、护理学博士詹林教授撰写了专题论文，通过对美国护理教育历史的回顾，从最初的实践、学历教育到现在大量的护理专业型/学术型博士，提出学术性护理的概念，接着论述了护理学术的影响与变革、护理学术的职责与认证标准、不同层级护理学术核心课程设置及革新等。从护理教育课程设置的变革、高等教育认证、教学方法转变等角度介绍美国护理教育的转型和变化，旨在引发护理同仁针对护理教育“如何转变以更好地适应临床需要”的思考与讨论，欢迎广大读者就该主题撰稿探讨。投稿方式为登录护理学报网站在线投稿，文题后加括号注明“讨论”二字。

Transforming Nursing Education:Leading a Way,and Advancing Health

ZHAN Lin

（Loewenberg College of Nursing,University of Memphis,TN 38152,USA）

American Nursing education has been significantly transformed in both types and levels of nursing educational programs in the past decades.For the purpose of discussion and communication with nursing educators and managers in China on how to enhance academic nursing education,the study present sums up the changes and expansions of the transformation and impact of the academic nursing in the United States; the responsibility and accreditation standards of academic nursing; the reforms and essentials of curriculum in different levels of academic nursing.

academic nursing;transformation;accreditation standards;curriculum

Nursing education in the United States has been significantly transformed.Historical transformation has showed changes and expansions of the types and levels of nursing educational programs,from practical or diploma schools to doctoral education.In the early 1900,there were practical,diploma or nighting schools.Between 1920s and 1930s,the Baccalaureate degree in Nursing(BSN)and post-graduate programs were offered while some nurses pursued available doctoral degree in education. In the 1940s and 1950s, there were Associate degree in nursing(ADN),Master’s Science degree in Nursing(MSN),and Doctoral degree in nursing.Since 1960s,nursing education has expanded to include a PhD degree in nursing,Doctorate in Nursing Science(DNS),and recently,Doctoral degree in nursing practice(DNP).To date,of 3 million nurses in the USA,55%have a BSN degree.Concurrently,doctoral programs in nursing have grown significantly. According to American Association of Colleges of Nursing (AACN,2013),in 2006,there were 20 DNP programs and 103 PhD programs in nursing.In the year of 2012,there were 217 DNP programs and 131 PhD programs in nursing.

1 TransformationandImpactofAcademic Nursing

The purpose of academic nursing is to prepare graduates that are qualified and competent to meet ever-changing healthcare needs.Increasing complexity of healthcare,advanced science and technology,aging and diversifying populations,existing health disparities,and emerging threat of global health issues,all require academic nursing to be responsive,proactive,and nimble to serve interests of the community,healthcare,and health of the public[1].

Academic nursing therefore needs to integrate new and essential knowledge in curriculum such as gerontology,management of chronic illnesses,home and community-based care,person and environment interaction,epidemiology,and genetics and genomics.Values and ethics in healthcare are taught to prepare graduates for being patient-family centered and being advocates for patients and their families.To prepare nursing students with advocacy skills, courses in poli tics,economics,ethics and assertiveness are designed and implemented.Course contents related to continuity of and transitional care and global health are integrated. To promote health for all, nursing students must learn how to attend and care for vulnerable populations[2].

2 Responsibility and Accreditation Standards of Academic Nursing

Academic nursing is part of efforts to help reach the national goals termed “Trip Aims” that include better health care,better population health,and cost effectiveness[3].Better quality of care requires health providers to make concerted efforts for patient safety,care effectiveness,patient-centeredness,timeliness,efficiency,and equity.Better population health means to improve overall health outcomes for aging and diverse populations,to manage patient chronic illnesses,to reduce health disparities,and to help aging population live longer and live better while to find ways to reduce cost and healthcare waste.Most importantly,health care providers must improve care quality,improve patient experience,and improve efficiency(USA Center for Medical Services,2014).Healthcare delivery has been transformed to support teamwork,collaboration,delegation and inter-professional education(IPE)for inter-professional practice(IPP).Caring,compassion, and therapeutic communication are emphasized including understanding cultural differences in care and appreciating different languages.

These changes have an impact on academic nursing.Major impacts are to integrate knowledge in teamwork,collaboration,health education,primary care and ambulatory care with family/community focus,and“alternative” therapies with nursing curriculum,design inter-professional education,use competency-based clinical education,integrate simulation and technology,create seamless educational pathways, use conceptbased approaches,design self-paced and self-directed programs,increase flexible and reduce rigidity,and use service learning to meet community needs.

Academic nursing is part of higher education.Higher education has increasing responsibility and accountability to ensure high quality teaching,rigorous research,and accessible and affordable higher education to students.Student success,from recruitment,retention,progression,to degree completion,is placed in the center of strategic thinking in higher education while advanced technology enables higher education to use digital educational delivery and modules to maximize accessibility of higher quality education to students.

Nursing is an applied science.How to prepare graduates to think and act like a nurse in real world prompts nursing to use simulation.Simulation framework is used to guide use of simulation in nursing to cultivate clinical reasoning and critical thinking, to conduct self-reflection in patient situations,to understand and identify therapeutic interventions in complex patient situations for safety and quality care, and to help build students’confidence when they go to clinic.Simulation has proven to be effective in clinical de-velopment of nurses.It provides a safe zone to keep student engaged,to learn real skills,and to apply theoretical knowledge.As well,nursing faculty is challenged to learn how to integrate simulation in teaching and practice.

Academic nursing is held responsible and accountable to meet accreditation standards.American Commission of Collegiate Nursing Education (CCNE)is a nationally recognized nursing accreditation agency established in 1998 by vote of the American Association of Colleges of Nursing memberships(Nursing Deans and Directors).The CCNE’s accreditation scope includes baccalaureate and graduate nursing education programs.There are four standards to evaluate quality of the nursing program,including 1)program quality I:mission and governance;2)program quality II:institutional commitment and resources;3)program quality III:curriculum and teaching-learning practices;and 4)program effectiveness:program outcomes[4].Program outcomes are measured by student outcomes,faculty outcomes,and program outcomes to serve the interest of the community.For example,the nursing program is assessed if it is in line with interests of the community.Quite often,each school/college may have advisory board consisting community major stakeholders to advise the school/college.Student outcomes involve enrollment growth,retention and progression rates,graduation rates,employment rates,graduates pursuing advanced studies(lifelong learning)and career advancement.Faculty outcomes involve teaching effectiveness,research productivity,professional service,and continuing development.

3 Reforms and Essentials of Curriculum in Different levels of Academic Nursing

Nursing Curriculum Program Outcomes

●Patient-centered Care(IOM,QSEN,AACN,Value)

●Clinical Reasoning and Judgment(AACN)

●Evidence-based Practice(IOM,QSEN,AACN)

●Inter-professional Collaboration(IOM,QSEN,AACN)

●Safety and Quality(IOM,QSEN,AACN)

●Health Promotion(AACN)

●Human Diversity and Cultural Sensitivity(AACN,Value)

●Professionalism(AACN,Value)

●Information Management and Patient Care Technology(IOM,QSEN,AACN)

●Communication(IOM,QSEN)

BSN curriculum reform

●Design Gerontology Practicum Course

●Design Nursing Profession Seminar

●Flip flop Mental Healthamp;Community Health courses

●Design Transition into Practice Course

●Integrate service learning

Academic-Practice Partnerships

●Nurse Residency Programs

●Dedicated Educational Units

●Clinical Preceptors/Educators

●Endowed Professorships

●Innovation

●Collaborative research@bedside and/or system levels

●Quality sustainability

Students Practice readiness Clinical Knowledge

●Technical Skills

●Clinical Reasoning

●Therapeutic Communication

●Professionalism

●Management of Responsibilities

BSN Essentials[5]

●Liberal education

●Organizational and system leadership for quality care and patient safety

●Scholarship for evidence based practice

●Information managementamp;application of patient care technology

●Healthcare policy,finance,amp;regulatory environment

●Inter-professional communicationamp;collaboration for improving patient health outcomes

●Clinical preventionamp;population health

●Professionalismamp;professional values

●Generalist practice at the BSN level

MSN essentials[6]

●Sciencesamp;Humanities

●Organizationalamp;System Leadership

●Quality Improvementamp;Safety

●Translatingamp; Integrating Scholarship into Practice

●Informaticsamp;Healthcare Technologies

●Health Policyamp;Advocacy

●Inter-professional collaboration for improving outcomes

●Clinical interventionamp;population health

● Master’s-level nursing practice

DNP Essentials[7]

●Scientific underpinning for practice

●Organizationalamp;system leadership for quality improvement and system thinking

●Clinical scholarship and analytic methods for evidence based practice

●Information system/technology and patient care technology for improvement and transforming healthcare

●Healthcare policy for advocacy in health care

●Inter-professional collaboration to improve patient and population health outcomes

●Clinical intervention and population health for improving nation’s health

●Advanced nursing practice

In 2010,after a decade of studies,the Institute of Medicine(IOM)issued the landmark study Future of Nursing:Leading a way,advancing health[8].The IOM recommended that nurses be better educated, play a major role in transforming nation’s healthcare,designing seamless educational pathways to advance nursing education,and building better data to know types of workforce and needed knowledge that guide nursing practice[9].

Reference

[1]Buerhaus,P,Auerbach D I,Staiqer D O.The Recent Surge in Nurse Employment:Causes and Implications[J].Health Aff(Millwood),2009,28(4):657-668.

[2]Health Resourceamp;Services Administration.Shortage Designation[EB/OL].[2016-11-18].https://bhw.hrsa.gov/shortagedesignation.

[3]Centers for Medicareamp;Medicaid Services.Health Care Innovation Challenge[EB/OL].(2011-11-14)[2016-11-18].https://innovation.cms.gov/files/x/health-care-innovationchallenge-funding-opportunity-announcement.pdf.

[4]Commission on Collegiate Nursing Education.Standards for Accreditation of Baccalaureate and Graduate Nursing Education[EB/OL].(2013-10-01)[2016-11-18].http://www.aacn.nche.edu/ccne-accreditation/Standards-Amended-2013.pdf.

[5]American Association of Colleges of Nursing.The Essentials of baccalaureate Education for Professional Nursing Practice[EB/OL].(2008-10-20)[2016-11-18].http://www.aacn.nche.edu/education-resources/BaccEssentials08.pdf.

[6]American Association of Colleges of Nursing.The Essentials of Master’s Education in Nursing[EB/OL].(2011-03-21)[2016-11-18].http://www.aacn.nche.edu/education-resources/MastersEssentials11.pdf.

[7]American Association of Colleges of Nursing.The Essentials of Doctoral Education for Advanced Practice[EB/OL].(2006-10-01)[2016-11-18].http://www.aacn.nche.edu/dnp/Essentials.pdf.

[8]Institute of Medicine.Future of Nursing:Leading change,Advancing Health.Author[EB/OL].(2010-10-05)[2016-11-18].http://www.nationalacademies.org/hmd/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx.

[9]Robert Wood Johnson Foundation.Nursing Research Network Products:New Frontiers in Health Workforce Research:Rethinking the Data Infrastructure[EB/OL].(2010-10-14)[2016-11-18].http://thefutureofnursing.org/nursingResearch-Network9.

[本文编辑：方玉桂 王 影]

护理教育转型：引领方向，倡导健康

詹 林
（孟菲斯大学鲁文贝格护理学院，孟菲斯 38152，美国）

美国学术性护理的类型和水平，从最初的实践、学历教育到现在大量的护理专业型/学术型博士。为了与中国护理教育者和管理者加强学术性护理的讨论和交流，笔者总结了美国学术性护理的变化和扩展以及带来的冲击和影响；学术性护理的责任和认证标准；不同层次的护理教育课程的要点。（1）美国护理教育转型的变化和扩展以及带来的冲击和影响。随着越来越复杂的医疗需求，先进科学和技术的出现，人口老龄化和多样化，现有的卫生差距和新出现的全球卫生问题的威胁等，需要学术性护理不断调整教学内容和方向。护理教育需要纳入的新课程有老年学、慢性疾病管理、家庭和社区护理、人与环境的相互作用、流行病学、遗传学和基因组学，以及医学伦理学。（2）学术性护理的责任和认证标准。美国国家保健目标强调学术性护理，应注重将知识整合到团队合作、部门协作、健康教育、家庭或社区的初级保健及门诊护理；护理课程中的替代疗法；传统的护理课程；设计跨专业教育课程，注重临床胜任力的培养；整合仿真和高科技，创造无隙的教育途径，以概念为基础的学习方法等，鼓励学生自主学习，增加弹性学习的内容，通过服务在实践中学习社区护理的需求。美国大学护理教育委员会评估护理教育质量的4个标准包括：任务和管理；制度承诺与资源保障；课程质量（课程和教学实践）；计划效果（学生成果，教师成果和项目成果）。（3）不同层次的护理教育课程的要点。包括护理课程预期的效果、护理学士学位课程改革、学术实践合作、学生实践的引导知识、学士学位核心课程、硕士学位课程要点、博士学位课程要点等。

护理教育；转型；认证标准；课程

G42

A

10.16460/j.issn1008-9969.2017.08.075

2016-11-18

ZHAN Lin,female,PhD,RN,FAAN,Dean and Professor.