A total of 221 in-service nurses from hospitals in Taiwan were surveyed using Web-based Continuing Learning Survey (AWCL), this is to know the nurses’ attitudes toward web-based continuing learning. Nowadays, use of the web as a method of learning is very common among schools and universities, like us in FEU; we have what we called E-Learning. It is wherein we have to watch and answer some questions via web in a certain period of time; it was even included in our curriculum.
Within that E-Learning we are watching discussions and how to do a certain procedure via the internet. Continuing Education A study was conducted at Ontario, Canada that sought to determine the continuing education needs of primary health care nurse practitioners across Ontario. 83% of the nurse practitioners that was being surveyed indicated that continuing education was extremely important to them. They also identified barriers to engaging in continuing education offerings that includes the ff: time intensity of the courses, difficulty taking time off work, family obligations, finances and fatigue.
The most common reason for withdrawal from a continuing education offering was the difficulty of balancing work and study demands. Continuing education opportunities are important to Ontario primary health care nurse practitioners. The rise of digital curriculum and reading The rise of digital reading is certainly a reality in the consumer space, but textbook providers are just starting to build out next-generation content experiences. I think we’ll finally start to see the transition and some schools like this one in Turkey as early adopters.
While many schools will use the opportunity to save money on traditional textbooks to fund devices, schools have to think about this holistically and not just buy a device to replace a textbook. Digitizing textbooks in and of itself is not transformative, but by focusing on the entire learning continuum and how digital curriculum and content created by students and teachers can be connected to back-end systems that can link the student outcomes to assessments, personalized learning and increased student achievement.
These textbooks and new content will be able to be consumed by students on a variety of devices, from Windows 7 notebooks to tablets and slates, Windows Phone, Xbox, Kinect and Office 365, reflecting the diversity and personalization required as part of the learning experience. ?Bring your own devices (BYODs) In education, this problem exists not only among employees within the organizations, but students as well. What kind of sensitive data is leaving with employees when they walk out the door with their smartphones?
If a student’s laptop or smartphone becomes infected with malware after accessing a link via Facebook, is the educational organization immune from that malware when the student logs back into the organization’s network? “More than half of those responding to the survey indicated they had no policy in place to protect themselves against new mobile devices being introduced to their networks,” says Clark. ?Brain Train Developments in neuroscience and cognitive psychology are powering new ways of thinking about the brain and the perceptions and emotions that contribute to learning.
Music education classes, for example, have shown to enhance education performance by interacting with many different areas of brain function. A concept obvious to those who study while listening to Bach or Mozart, and an important one when placed against the backdrop of standardized-test-driven cuts in music classes nationwide. Moreover, two Vancouver engineers (and dads) are banking that the launch of their after-school education program, Einstein Wise, will help students compete globally in math and all things tech.
Their “brain training center” combines chess with a computer tablet to create a K-6 program that incorporates math, Mandarin Chinese, Lego robotics, even yoga. The duo hopes that public schools will incorporate its smart programs into their curriculum in the near future. ?Anti-Bullying Backlash Also trending for 2012-13, is an anti-bullying backlash. Educators in states such as New Jersey, which just passed perhaps the toughest anti-bullying legislation in the country, are already feeling overwhelmed by the number of reports they’re receiving and the amount of time it takes to investigate each bullying complaint.
Also troubling to teachers, students and parents is how to police bullies outside the classroom and schoolyard. We will see lines drawn by angry parents who feel that schools invade the privacy of their children when they investigate their lives out of school ? Outdoor Education Makes a Comeback And in a twist on what we now think of as a digital classroom without walls, Salzman says we should look for an upstick in outdoor education programs designed to combat everything from obesity to digital burnout to Vitamin D deficiences.
According to the Burlington Free Press, classes in farming and nature studies, including the study of back-to-the-woods authors such as Henry David Thoreau, will become part of expanded green learning iniatives ?Decrease in Enrollment One interesting trend that many nursing educators have noticed in the last year is a drop-off in enrollment of new nursing students at various schools around the nation. The Adelphi University School of Nursing in Garden City, New York saw a decline in new applications, for example, which some experts attribute to a decline in confidence that new nurses will be able to get a job.
The economy is definitely a factor in higher education for all fields, and experts across the board have attributed this type of declining confidence to reduced applications for a variety of programs at colleges around the nation. Most data still suggests, however, that there is a shortage of qualified nurses throughout the nation. There just might not be a shortage of nurses in more desirable places to live, which is the problem. ?Easier, Newer, and More Advanced Systems On a brighter note, there are also systems coming into place that will make it easier to apply for nursing school.
For example, the American Association of Colleges of Nursing recently unveiled a central application service that simplifies the process by making it possible to apply for numerous programs at the same time. Several technological advancements have also been made which enhance the educational process for nurses recently. These include more advanced simulation systems that provide a more realistic clinical experience for nurses in training. This can never completely replace actual experiences with patients, but schools such as NYU are using these for as much as half of their nurses’ clinical experience training.
Growing Number of Field Specialties Another one of the hot trends in nursing education at the moment is a growing number of specialties in the field. Forensic nursing, for example, is becoming a very popular area of specialization. Trends like this show that the field of nursing is diversifying, which means many new opportunities for the nursing students of today and tomorrow. Issues ?Patient Autonomy Nurses must be prepared to face issues regarding patient autonomy. Patient information is covered under the Health Insurance Portability and Accountability Act (HIPAA), and nurses cannot disclose information about the patient without consent.
Because nurses interact with a patient’s family, they may have to negotiate the ethics of what to disclose and what not to disclose. Patient autonomy also extends to do not resuscitate (DNR) orders and decisions to discontinue care. End-of-Life Care Nurses spend more time with patients than any other member of a health care team. End-of-life care issues are one of the most common ethical issues faced by nurses. Nurses must decide how to best respect patient directives, how to provide the best end-of-life care, and whether and how to communicate that information to the patient’s family.
Living wills, advanced powers of attorney, and organ donation are all issues that nurses must help patients and their families negotiate at the end of life. ?Unemployment and Underemployment Here in the Philippines is unemployment and underemployment is common, and it greatly affects the enrollment of nursing students. What Part of the Crisis Does Nursing Education Own? What are nursing education’s responsibilities related to both the devaluation of fundamental nurse caring and for restoring public confidence in nursing as an elementally caring service? If we believe the UK Council of Deans of Health (2012), then the answer is ‘very little’.
Their response to the UK Chief Nurse’s ‘6Cs manifesto’ is a masterpiece of self congratulation about how ‘we are already doing this’ combined with the usual rent seeking suggestions about needing greater ‘investment’ that will doubtlessly allow nursing education to do more of the same for longer. Add to this the recent ‘phrase that pays’ from nursing education’s own echo chamber, the Willis Commission Report that, “The commission did not find any major shortcomings in nursing education that could be held directly responsible for poor practice or the perceived decline in standards of care. (Willis, 2012, p. 6) and it seems that nursing education is off the hook.
We are not so sure nor so reassured. Nursing education needs to do its own critical thinking that we so value in our students. Similar red flag concerns about nursing education are invariably raised by nurses, whether they be in Australasia, North America or Europe. These should not be new to anyone in nursing education, so what do we intend to do about them? Let’s take primarily the abandonment of ‘basic nursing care’ to a growing army of unqualified and largely unregulated care assistants.
A hospital CEO in Australia has recently suggested that training nurses to undertake e. g. , colonoscopies, endoscopies, cystoscopies and X-rays “was an innovative way of stretching them to their full potential while sparing them more basic tasks (our emphasis) such as washing and feeding patients — jobs he said less skilled and lower paid nursing assistants could do” (Medew, 2013). What role has nurse education played in devaluing and marginalising such care?
What have we done or failed to do in our curricula, in our teaching or in our relationships with ‘service partners’ that contributed to the situation where such essential nursing care is being seen, even by default, as being the realm of the HCA (health care assistant)? The Willis Report stopped stroking nurse education long enough to note that: “The commission finds it unacceptable that staff whose competence is not regulated or monitored are caring for vulnerable citizens (…) It is equally unacceptable that registered nurses must take responsibility for supervising colleagues on whose competency they cannot rely. (Willis, 2012, p. 28). This is painful to read, especially when accompanied by the even more excruciating question that should be rhetorical, but isn’t, “The question of core purpose was also posed: was nursing education preparing nurses to manage care delivered by others, or to nurse patients themselves, or a combination of both? ” (Willis, 2012, p. 24). We are now entering Nursing’s ‘Heart of Darkness’ and this is Kurtzian Horror.
When health services and clinicians complain of students or graduates lacking a clear sense of nursing purpose (we almost said ‘vocation’) or struggling to find a coherent professional nursing identity, or being ambivalent towards the importance of fundamental nurse caring and their role in providing this, we know they are not imagining this. By this same token, it is not hard to see how fundamental nursing care can become an option that nurses can choose to engage with to whatever degree, or not.
Perhaps their ‘core purpose’ is simply to ‘manage care delivered by others’ — others who, paradoxically, may have more skill and experience in providing this ‘basic care’. As Hasson et al. (2012) ask so pointedly in a new study showing how HCAs in the UK now “play a major part in the education of student nurses with regard to basic, clinical, and non-clinical tasks”, (p. 1), “If one accepts that HCAs are delivering the majority of patient care, (our emphasis) should they be teaching such skills and not the RN? ” (Hasson et al. , 2012, p. 8). Logically, why not?
Have we ‘progressed’ from the much maligned “see one, do one teach one” approach of yesteryear to today’s ‘austerity measures special’: “Hear about one, simulate one, supervise all the others”? How has nursing education contributed to this malaise? What happens or doesn’t happen in a school’s “education process” that would “reduce students’ caring behaviours” (Murphy et al. , 2009, p 254)? Does your school have explicit and hidden curricula and an ethos where nurse caring, kindness, compassion and ‘basic care’ are little more than ghosts in the machine?
These are the culpable curricula wherein “basic/fundamental nursing care” is the practice that dare not speak its name, occluded by acres of well meaning, faculty-friendly filler about ‘autonomy’, ‘ethics’, ‘health promotion’, ‘empowerment’, ‘equity’, ‘reflection’, ‘issues’, ‘leadership’, ‘wellness’ and their ilk. In such curricula, fundamental nursing care and caring, are, we are told, ‘implicit’, ‘integrated’, ‘blended’ or ‘thematised’, in other words, largely invisible, languishing at the bottom of any “hierarchy of care skills” (Thomas et al. 2011, p. 662). That we can even have such a discussion about the place of caring and kindness in nursing education and whether ‘nursing patients’ is a ‘core purpose’ of nurses is beyond embarrassing. It is a professional affront. If nursing education cannot provide a clear answer to the question, ‘What are nurses for? ’ that includes, in large flashing lights: ‘caring for patients and people’, then we deserve all the opprobrium coming our way.
Worse, we will surely need to move aside for the next manifestation of nursing education that does not see caring, compassion, kindness, service and the ability to ‘assist the individual, sick or well’ (you know the rest) as a professional or intellectual insult. If you think this is ‘scaremongering’ think again. As one example, a social enterprise company in Canada, ‘Nurse Next Door’ (www. nursenextdoor. com) was created following their founding partners’ underwhelming experiences of ‘standard home care services’ for their loved ones.
Thinking, ‘this shouldn’t have to be this way’ and embodying the clear idea that: “It’s about caring, not just health care™” as a unique selling point, what differentiates them from other home nursing services, is Caring. It is hardwired into their values, operations, hiring and firing and everything they do. Without that caring ethos, their service has no meaning. Nurse Next Door is a successful business using Caring as its unique foundation.
The ‘gap in the market’, that they fill is, incredibly, the ‘Caring’ we used to believe was inalienable within Nursing. How long before other social entrepreneurs look o hospitals and mainstream health services and realise that they could offer and organise such services significantly better? Not too long, some would say. Back to Article Outline Intelligent or Caring? We absolutely need intelligent, smart, thoughtful, hard-working, enterprising, creative and questioning students and nurses who have a verve for becoming more enthusiastic, more knowledgeable and even more humbled by just how much about the world, nursing and the human condition they don’t know. This is never a battle between ‘intelligence’ and ‘caring’. The public is adamant that they want nurses who are the complete package.
Numerous studies have shown that people want skilled, competent nurses who confidently manage and help them manage the technical, procedural and treatment elements of their condition and care. They want nurses who listen, understand and communicate with them as fellow human beings. They want nurses who are ‘in their corner’ and who ‘have their back’, to help them navigate often alien and impersonal health systems. Above all, they want nurses who do all of this while bringing care, kindness, compassion and thoughtfulness to their everyday health encounters. Is this a ‘big ask? ’ Damn right it is.
This is why great nursing is not easy and why not everyone who might want to do it can or should do it. In a recent study, Griffiths et al (2012) rediscovered and reaffirmed this: “Service users and carers reported that nurses need to be technically competent and knowledgeable, and able to find information or to seek help when they lack knowledge or skills. However they unequivocally prioritised ‘softer’ nursing qualities, attitudes and skills such as empathy, listening, a non-judgmental attitude and individualised care, which they perceived have sometimes become lost within nursing.
They also expressed concern that the softer skills they valued were incompatible with ‘academic’ nursing. ” Griffiths et al. , 2012, p. 125 The sting in the tail is the perceived incompatibility with ‘academic nursing’. Does the public not want their nurses to be smart, knowledgeable and well educated? We do not believe so. People are more discerning than some may imagine and patients and their families will quickly differentiate between a smart nurse and a smart arse.
Being intelligent, critically hinking, well qualified and knowledgeable are valuable and admirable but the nurse who carries these qualities badly does so at his or her peril. In the plethora of current nightmare nursing stories we know of none where the complaint was solely that the nurse was ‘too intelligent’ or ‘too well educated’. If the nurses so described were doing the other vital aspects of their job wonderfully well, then we suspect that for patients and families, their ‘intelligence’ or qualification level would never be an issue.
Where patients and public do take umbrage, with justification, is with the nurse whose attitudes and behaviours convey that they couldn’t care less. Perhaps the public is not rabidly ‘anti-intellectual’, but simply struggling to comprehend, as Christina Patterson (2011) so painfully discovered, “Why nurses aren’t kind” They cannot understand why someone lacking care and kindness would want to become a nurse in the first place. They cannot understand why a system of nursing education would admit them and then allow them to successfully qualify as an RN.
They cannot understand how a hospital or health system indulges and tolerates such uncaring behaviour and lamentable ‘nursing’. As they look around for reasons that may make sense to them they see a miasma of self-interest, self-justification and buck passing, with education blaming the corrupting influence of the service side, services blaming the ‘ivory-tower’ irrelevance of ‘today’s education’ and governments worldwide thinking that austerity economics can be imposed upon their favourite political plaything, a health service, without any negative consequences. The words ‘plague’, ‘all’ and ‘houses’ spring to mind.
If these two systems cannot work together significantly more convincingly, we will assuredly be entering the ‘Endgame’ of this era’s nursing education system. There is no single quick-fix for this crisis in nursing and every nurse in practice, education, research and management needs to step up and play their part. Nursing education cannot simply clutch its Willis security blanket and wait for the health service culture to change, for the Francis Report recommendations to become reality, for the public to ‘change their mind’ about nursing, or for any other perfect alignment of societal and professional planets.
In an exquisitely articulated observation on the rise and effect of ‘managerialism’ (not management) in nursing, Bernie Carter wrote that: “Our collective memory of nursing is being overwritten by a new programme of managerialism. Nursing is subtly and insidiously being reformatted, re-engineered, processed to become something which may be efficient and effective in a managerial, commercial and business sense but which is unrecognisable as something nurses or patients wish to engage with”. Carter, 2007, p. 270
Does managerialism, we wonder, have an ‘evil twin’ called ‘educationalism’ (not education) that is similarly helping to overwrite and reformat nursing into something that may make curricular, professionalising and academic sense, yet which is similarly ‘unrecognisable’ to health services, other nurses and the patients, clients, families and communities whom we serve? This crisis shows few signs of abating, as the latest update from UK Patients Association (2012) and the full horror of the second Francis Report (2013) suggests.
Until the devaluation and downgrading of whatever we want to call ‘fundamental care’, ‘basic care’, ‘core nursing’, or ‘skilled compassion’ in Nursing and in our health services is arrested, the public and the media will rightly continue to ask why nursing and health care “cannot get basic care right” (Triggle, 2012). If our current system of nursing education cannot lead the movement for change, in lockstep with our clinical colleagues, then another system, as yet perhaps unimagined, surely will.
The ever-expanding role of APRNs: The final rule on physician fees for 2013 allows Medicare to payCertified Registered Nurse Anesthetists for services to the full extent of their state scope of practice. And in many states, APRNs have been fighting for—and winning—autonomy. But expect the battle to continue into 2013 and beyond; in fact, ANA president Karen Daley tells me via email that it’s among the organization’s top issues for 2013. “Advanced practice registered nurses in many states still face regulatory barriers preventing them from practicing to their full scope,” she said. These barriers should be removed throughout the country. “
The rise of care coordination and the “medical extensivist”: The term medical extensivist caught my eye when it showed up in the top 13 healthcare buzzwords for 2013. According to the article, the medical extensivist is a clinician, such as an advance practice nurse, who extends their scope of practice outside the hospital and into home or other settings. These professionals aim to help people with chronic illness keep patients healthier outside the hospital.
The idea is that regular, routine patient visits could help keep patients out of the emergency room and hospital, ultimately reducing readmissions, keeping patients healthier, and saving money. The term might be a relatively new one, but the movement is one that nurses have been leading for years. And with a new Medicare rule that will pay nurses when they help patients make the successful transition from hospitals to other settings, look for possible job creation, too.
Extending the culture of safety to nurses: That professional caregivers are often poorly cared for themselves is one of the great ironies of nursing. But nurses need to be safe themselves in order to properly care for patients. Issues range from ensuring a work environment where nurses are safe from violence and abuse to encouraging nurses to make healthy lifestyle choices and get enough sleep.
Among the top issues for the ANA this year is safe patient handling in an effort to prevent musculoskeletal disorders that can come with lifting patients. Currently, ANA is leading the development of national interdisciplinary safe patient handling standards to help hospitals and other health care employers develop safe, effective, and enduring programs,” ANA president Karen Daley tells HealthLeaders via email. “Standards are expected to be released in spring 2013. “
Continuing to advance nurse education: The year 2013 brings us one year closer to the goal set by the Institute of Medicine’s Future of Nursing report that calls for increasing the proportion of nurses with a baccalaureate degree to 80% by 2020. That, coupled with evidence that increasing the number of nurses with specialty certifications can lead to better patient care, will certainly lead to more nurses expanding their educations. Look for an increasing number of innovative programs to help nurses do this, such as portfolio credentialing alternatives.
Quality, quality, quality What do the four issues above have in common?
They all aim to improve healthcare quality in some way. In fact, in the 2012 HealthLeaders Industry Survey’s Nurse Leaders Report, nurse leaders cited patient experience and satisfaction and clinical quality and safety as their organization’s top two priorities for the next three years. According to the survey, 72% of nurse leaders rank patient experience and satisfaction among their top three priorities; 55% said the same about clinical quality and safety. Language Barrier can hinder the execution of Nursing care—Global