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Where is the “radical transformation” in nursing education?

O’Lynn, Chad

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JBI Database of Systematic Reviews and Implementation Reports: April 2018 - Volume 16 - Issue 4 - p 802-804
doi: 10.11124/JBISRIR-2017-003777
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It's been nearly a decade since the publication of the groundbreaking book, Educating nurses: a call for radical transformation.1 Sponsored by the Carnegie Foundation of the Advancement of Teaching, the book's authors examined the literature, conducted surveys and observed nurse educators in classroom and clinical settings to discern the strengths and shortcomings of how nurses are prepared for the reality of current and future practice. The authors also offered compelling and sweeping recommendations for necessary changes. Although the text focuses on American education, nursing practice and healthcare models, the challenges and imperatives described in the book have international generalizability. The authors advocate a radical transformation in nursing education through much stronger integration of (a) the acquisition and use of knowledge and science; (b) the use of clinical reasoning and skilled know-how and (c) the development of ethical comportment and formation.

Soon after, Benner et al.2 noted in an editorial on the progress made in reforming nursing education that the book had been enthusiastically received by the nursing education community; it had been translated into multiple languages and large nursing organizations had already disseminated the book's recommendations. Furthermore, many educators had reported that they were developing and implementing innovations congruent with the recommended strategies described in the book. These innovations are encouraging, but Benner noted that there was yet no evidence that the necessary systemic changes had begun. Some 10 years after the book's publication, it is worth considering what evidence there is that any implemented innovations or policy changes have yielded positive outcomes. Perhaps more importantly, one should question whether sufficient foundational evidence is available to support specific transformation efforts.

What does and does not constitute appropriate evidence for behavioral, structural and paradigmatic change remains open for debate; diverse perspectives on this are widely published in the literature and beyond the scope of this editorial. What is clear, however, is that evidence is situational and dynamic, and that effective and sustainable change does not occur through simplistic and linear processes.3 Nevertheless, the primacy of evidence in affecting positive change is well understood, as demonstrated by the evidence-based practice (EBP) movements in medicine and nursing,4,5 even though mere evidence, in and of itself, is not sufficient to result in positive systemic change.3,4

The EBP movement in nursing has been facilitated by decades of clinical research, advancements in the science of evidence synthesis, translation and implementation, and by efforts of the Joanna Briggs Institute (JBI) and its global collaborators. Although EBP remains imperfect,4 today nurse clinicians are better positioned to affect positive clinical outcomes than in the days of exclusive reliance on custom, trial-and-error, intuition and personal anecdotes for clinical decision-making. Such a conclusion cannot yet be drawn for evidence-based nursing education (EBNE). Ferguson and Day5 questioned over a decade ago whether EBNE was a reality or simply a myth, despite the pervasive teaching of EBP for clinical care in nursing schools. The authors questioned whether or not nurse educators walk their talk and apply principles of evidence-supported judgment, decision-making and action in the educational setting. The authors lamented the dearth of high quality evidence to support EBNE. Since then, others have echoed concerns about the low rigor in many nursing education studies.6-8

There is room for optimism, despite these negative assessments. First, one must recognize that EBNE is still in its infancy, not too unlike the status of EBP in clinical nursing in the 1970s and 1980s. EBNE can benefit from the lessons learned by the EBP movement. Next, as more nurse educators attain advanced degrees, they will develop the skill set to engage in the scholarship of discovery and improvement science, thus creating a larger cadre of nursing education scientists. Further, nursing education journals and manuscript reviewers are demanding that studies be conducted with greater rigor and larger samples, and be reported according to best international conventions.9,10 Additionally, the National League for Nursing's 2016–2019 nursing education research priorities advocate increased rigor and improved integration between the science of nursing education and the science of learning.11 Finally, recent issues of the JBI Database of Systematic Reviews and Implementation Reports (JBISRIR) include systematic reviews and protocols for reviews of a variety of nursing education topics such as self-directed learning, practice-academe partnerships, learning preferences of Generation Y students, clinical education and others.12-19 Additionally, the JBISRIR runs a collection on education in health care. It is possible that the resulting systematic reviews will find minimal evidence in some topics, but the reviews will do much in directing nursing education scientists to areas in need of research as well as providing nurse educators with at least minimal guidance for EBNE. Some of the reviews will likely identify areas appropriate for implementation studies and reports.

Is there evidence that a radical transformation in nursing education is underway? The question is probably premature. Increased support for high-quality nursing education research is greatly needed. Also, nurse scientists must be encouraged and rewarded for engaging in nursing education research. If the road traveled by the EBP movement in clinical nursing is any indication, it may be some years before EBNE is visible and pervasive. The JBI and its global collaborators, however, are well poised to help clear the path forward. In embracing nursing education as an area of concern and priority, JBI will be instrumental in encouraging reviewers to synthesize current evidence from nursing education research and innovation implementation studies.


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