Universidad de Manitoba, Canadá

Facultad de Enfermería

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NURSING EDUCATION: WHERE HAVE WE BEEN; WHERE ARE WE GOING?*

 

Dr C. W. Dean Care

Decano y Profesor. RN (Enfermero Registrado). BN (Licenciado en Enfermería). Master en Educación. Dr. C. Educacionales. [e-mail]

 

Historically, nursing education has its roots in hospital schools of nursing and technical colleges. These date back to the days of the Nightingale Schools in Britain in the 1870's. This popular model of nursing education quickly spread throughout the world. This hospital-based model of education still exists in many places today. It served us well as these programs graduated hundreds of thousands of qualified nurses who were trained to work primarily in hospitals and other health care institutions. These programs had a heavy emphasis on apprenticeship and training with minimal attention to a theoretical basis of nursing.

Around the mid 1900's nursing education began to move into institutes of higher education (universities and colleges). This move was precipitated largely by the need to educate public health nurses, teachers, and supervisors who could oversee the work of nurses. There were many driving forces that precipitated this movement. Certainly the expectation of the public for more highly educated (not trained) health care providers was a major factor. The public was and still is becoming a more informed consumer of health care. Access to the Internet, print materials, higher education, and the news and television media have raised knowledge levels about health problems, interventions, and have increased demand and expectation for higher quality care.

Similarly, our students are a more informed and demanding consumer of higher education. They realize that their future careers will be based upon the quality of the education they receive. Our students are arriving at our university doors with many life experiences and prior learning that challenge us as faculty and administrators to think differently about education and learning.

The world of academia is changing because of the vast amount of knowledge that is being generated world wide. We are in the midst of a knowledge explosion in health care. In medicine and nursing for example, the “half life” of knowledge” (that is, the length of time for half of the knowledge to become obsolete) is 3-4 years! This means that our practice as teachers of focusing on content needs to change. Students need to be provided with the tools and experiences that teaches them how to think; that promotes an understanding and an embracement of life long learning. If we simply deliver content to our students (open up the top of their heads and pore content in), we have failed them and we have failed the patients and the health care system who we serve. The complexities of health care are changing so rapidly that we need to move beyond lower order knowledge of recall and comprehension to higher order thinking skills like analysis, critical thinking, problem solving, and evaluation.

We also need to embrace advanced and emerging technologies in education as tools to help students learn. In many cases our students are more technologically advanced then our teaching staff. There is a new generation of students who learn differently then we learned. The techniques that our teachers used on us will not necessary work on this or the next generation of students. We as faculty and administrators need to adjust to these changes in our students and the expectations of the workforce and clients that we serve.

Nursing education belongs in universities. We have taken our rightful place beside other health care professionals who receive their education in institutes of higher learning.

Let me share with you some of my thoughts about how nursing education in a university environment can prepare competent, well-educated practitioners of the future.

•  We need to build a culture in Nursing where students are challenged to think creativity and critically. These are the hallmarks of university education and higher learning.

•  Teachers of nursing, more then ever, need to be facilitators of knowledge acquisition and less transmitters of information (content) to our students. Students need to be move from being passive recipients of information to active participants in the learning process. The current and next generations of nurses are increasingly being seen as “knowledge workers”. They need to know what they don't know, where to find it, how to retrieve it, how to process it, and how to judge and evaluate its quality and merit.

•  Students need to develop more fully the ability to interact and communicate with others. Learning is as much a social process as well as it is a mental process. Opportunities for interaction, debate, and exchange of ideas need to be built into classroom and practical learning activities.

•  There needs to be a focus on defining problems, gathering information, and developing solutions to complex problems facing clients and patients. These problem solving skills are highly valued in health care.

•  We know that learners learn best when they can apply what they know to real situations and to their own experiences. This problem based learning approach and reflective practice allows students to be actively involved and build upon what they already know. Learners learn best when they can discuss and contextualize what they are learning, ascribe personal meaning for application, and demonstrate their achievements. This means moving beyond the rhetorical and the theoretical to a practical level of application.

•  As university faculty, our teaching needs to be driven and supported by research. It is through research that we evolve and develop our knowledge base. So much of what we have done in nursing has been based upon ritual, routine, and intuition. In order for nursing to progress and evolve as a discipline, our practice must increasingly be based upon empirical knowledge. This means that our faculty are conducting research and sharing their research with their students and others in their field. We need to teach our students how to critically appraise research. By doing so we create a culture of inquiry and discovery. Hallmarks of a university education.

•  In nursing education, we are involved in a continuous pursuit of an understanding of human nature, response to illness, models of health (or unhealthy) behaviors, the science of nursing, and the philosophical underpinnings that help to bring structure to our thinking. Being situated in a university environment helps to move these processes forward.

•  We also need to be addressing the internationalization of our programs. We live in a global village where we are impacted by the effects of war, genocide, poverty, famine, and the spread of infectious diseases. Students need to develop awareness and an appreciation of issues and evolving knowledge in their area of specialization.

What you are doing at the Havana Medical University , the Faculty of Nursing, and through this CIDA funded project is to push forward the advancement of nursing in your country. The introduction of a PhD in Nursing Science and revisions to the Master's program will serve the public, the profession, and the university for years to come. These new and revised programs are and will challenge students (and faculty I might add) to think differently about the nature of nursing knowledge. These new and revised programs are designed to emphasize the empirical, aesthetic, personal, and ethical dimensions of knowledge embodied in nursing practice. These knowledge dimensions resonate well in a caring, evidence-based practice discipline like Nursing. The introduction of the new PhD in Nursing program will ensure that future generations of nursing faculty and students in your country are provided with the highest level of learning in a student-centered environment.

In this project, we are challenging students and faculty to think differently. We are exposing them to multiple forms of knowledge and to explore and find alternative ways to look at the world of health care and nursing. We are challenging them to ask questions, to thinking creatively, and to disrupt the status quo.

Our challenge in nursing education is simple, to create a new generation of nurses and nursing faculty who can offer us new ways of thinking about the nature of nursing. From one generation to the next, from past to the future, we are inspired by how beautifully simple is the art and yet how incredibly complex is the science of nursing.

I believe quite strongly that the Faculty of Nursing and the Havana Medical University are meeting these challenges. They know where they are going and the future is bright!

Gracias.

*Dr. W. Dean Care´s speach during the act of delivery of the condition of invited Professor of the Hight Institute of Medical Sciences of Havana, March 27, 2007

RESUMEN: La educación en Enfermería: ¿Dónde hemos estado; hacia dónde vamos?*

La historia reciente de la educación en Enfermería tiene sus raíces en los hospitales-escuelas en Gran Bretaña en 1870. Este modelo de enseñanza fue muy útil ya que graduó miles de enfermeros calificados.

A mediados del siglo XX, la educación de Enfermería se movió a instituciones de educación superior. Esta tendencia se debió, en gran medida, a las crecientes expectativas de la población por contar con profesionales de la salud con más alta calificación.

Los cambios de la academia son el resultado del vasto cúmulo de conocimientos que se está generando en todo el mundo. Ya no es posible darles a nuestros estudiantes todo el conocimiento existente en Enfermería. Esto significa que la tendencia de enfocarse en los contenidos solamente necesita cambiar. Es necesario que se les provea a los estudiantes con las herramientas que los enseñen a pensar, que promuevan la comprensión y el aprendizaje para toda la vida.

Este artículo presenta importantes reflexiones sobre cómo la educación de Enfermería en un contexto universitario puede preparar profesionales competentes y bien educados.

La creación de la Facultad de Enfermería y el desarrollo de un proyecto de colaboración para el fortalecimiento de esta especialidad en Cuba, están impul-sando su avance como ciencia en nuestro país.

La introducción del doctorado en Ciencias de la Enfermería y la revisión del Programa de su Maestría asegurarán que las futuras generaciones de los profesionales de esta Carrera tengan el nivel más alto de aprendizaje en un contexto centrado en el estudiante.

 

*Conferencia del Dr. W. Dean Care en ocasión del acto de entrega de la condición de Profesor invitado del Instituto Superior de Ciencias Médicas de La Habana (ISCM-H), 27 de marzo de 2007.