Conflicts between Sound Educational Practices and Meeting the Needs of Practice for a nursing Graduate in the era of COVID-19

Submitted by Josephine Kamera RN, EdD

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Conflicts between Sound Educational Practices and Meeting the Needs of Practice for a nursing Graduate in the era of COVID-19

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Introduction

Health care delivery in the United States is changing. Not only is the population shifting towards diversity, but also covid-19 pandemic is greatly shaping health care delivery (Al-Tawfiq et al., 2020; Migration Policy Institute, 2022). Blended cultures are creating complex multicultural health care needs. Thus, nursing programs are called to prepare comprehensively skilled nursing graduates who can function in today’s complex health care environment. Sound educational practices are vital in educating nursing graduates, particularly in this challenging environment. Due to demands of the nursing curriculum and profile of today’s nursing students, conflicts arise in implementing best educational practices and meeting the needs of practice for a graduate.  It is therefore important for nursing programs to implement teaching strategies that promote integration of skills required in nursing practice. Nursing education programs should take cognizance of trends that are changing the healthcare environment and prepare graduates who can function in contemporary healthcare settings. This paper will analyze the conflicts between sound educational practices and meeting the needs of practice for a nursing graduate who can function in today’s health care environment.

Sound Educational Practices

The discipline of education refers to sound educational practices as best practices that support the development, use and management of resources (Murphy, 2013). Particularly in nursing, sound educational practices promote evidence-based practice, create active learning, allow candidates to be competent, challenged, and empowered throughout their careers (Al-Mugheed & Bayraktar, 2021; Edmonds, 2007).  Best educational practices prepare a student for globalization and a graduate who unfolds and becomes the best that a graduate can be (National League for Nursing, 2022; Murphy, 2013).

Sound educational practices in the discipline of nursing are shaped from expected outcomes and competencies for graduates of nursing programs stipulated by advisory bodies of nursing. The National League for Nursing (NLN) advocates for safe and quality public healthcare delivery.  NLN believes in preparing nursing graduates who can function in an evolving, dynamic health care environment by implementing values of caring, integrity, excellence and diversity (NLN, 2022). NLN calls for these values to be implemented in nursing curriculums.

The American Association of Colleges of Nursing (AACN) core competencies for professional nursing education identifies essential learning outcomes that enable graduates to practice within complex healthcare systems. Nursing graduates are expected to be knowledgeable in evidence-based practice, patient centered care with emphasis on diversity, equity, and inclusion (AACN, 2022, domain 2). In addition, they should be knowledgeable in-patient care technology skills, population health and healthcare policies to function in diverse population communities (AACN, 2022). AACN requires these concepts to be included in nursing curriculums.

Similarly, the Institute of Medicine (IOM) advocates for highly educated nurses with the right skills who can function in diverse socioeconomic and cultural environments (IOM, 2011). The Joint Commission, an organization committed to providing safe and effective quality health care, supports hands on experiences that help to transform new nursing graduates from school to practice (The Joint Commission, 2022).

Professional nursing associations furthermore uphold fundamental roles of nurses within the healthcare system.  Except from the president’s message of the official publication of the Georgia Nurses Association (GNA) states, “since nurses are the largest part of the health care workforce, we are a lynchpin in the implementation of any health care reform efforts” (Wheeler, 2013). Nurses must be well informed about healthcare policies to improve nursing and patient care (AACN, 2022; Wheeler, 2013). Given all the competencies expected of a nursing graduate, it is vital that nursing programs prepare graduates who are comfortable and competent in functioning in today’s evolving health care environment.

Nature of Nursing Education

To better understand conflicts between sound educational practices and meeting the needs for a nursing graduate, it is important to examine existing trends in the nursing profession and how these trends are impacting nursing education. Most importantly, it is important to investigate essential proficiencies for a graduate to function in the current health care environment. 

A major trend that has changed delivery of healthcare is advancement of technology, and the changes are obvious in health care settings (Huston, 2013). Information technology is growing at a fast rate. Accordingly, covid-19 has brought in potential for modern technology to propel changes in health care delivery (Litwin, 2020).

Computers have become greatly affordable that almost every household owns a computer. Computers have enabled patients to research their disease condition before they consult a health care provider. Furthermore, covid-19 pandemic put the patient at the center of the healthcare quality and delivery; and rapidly forced healthcare providers to implement telemedicine services (Doraiswamy et al., 2020; Mann et al., 2020; Wosik, 2020). It is evident that technology has enabled patients to communicate directly with health care providers through online services. Due to technology, patients are actively involved in their virtual care (Mann et al., 2020; Wosik, 2020).

Another huge issue impacting health care delivery is medical technology which is exploding at an alarming rate. Nurses are expected to use technology to access data, medical records and evidence to guide patient care (Brown et al., 2020). Almost every procedure in health care utilizes some type of medical equipment. Medical machines span from simple blood pressure machines to a wide range of complex machines such as ventilators, dialysis machines and computed tomography (CT) scanners. Nurses are not only expected to use these medical machines, but also to be proficient with computers and electronic health records (Brown et al., 2020; Huston, 2013). Technology skills are arguably the most imperative skills that a new nursing graduate needs. Nursing programs are expected to produce graduates with technological skills.

Demographic changes in the United States have also impacted nursing education. Data from the Migration Policy Institute 2022 indicated that immigration population is growing. Immigrants and their children have a very significant impact on many areas of American life including healthcare needs, delivery, and services (AACN, 2022; IOM, 2011).  The immigrants bring with them their own cultures creating multicultural communities that demand healthcare providers from diverse backgrounds to meet their healthcare needs. Diversity continues to increase in nursing schools resulting in dynamic changes in student profile (AACN, 2022). Nursing programs are therefore challenged in finding ways to integrate necessary skills that adequately prepare nursing graduates to function in multicultural communities.

Preparing nursing graduates 

There are several ways to prepare a competent nurse graduate who can function in today’s world. A variety of teaching strategies should be included in the nursing curriculum to increase student knowledge. One way is a curriculum that focuses on cultural competency and cultural awareness (Dyches et al., 2019). For example, culture immersion experiences are some of the best practices to increase student awareness, confidence, and skills in working with culturally diverse patients (Alexander-Ruff & Kinion., 2019; Gower et al., 2019). Other strategies include clinical experiences in the form of service-learning projects in diverse populations to increase student cultural knowledge, awareness, and competency (Gower et al., 2019, Turale et al., 2020).

The use of simulation is another effective teaching strategy for curriculum enhancement. Simulation scenarios depicting diverse patient needs are effective in promoting interprofessional and intercultural communication (Long, 2012). Using high fidelity simulation in training and educating nursing students is another way of preparing them to face diverse healthcare delivery needs (Jiménez-Rodríguez & Arrogante, 2020).

During the covid-19 pandemic, some nursing schools resorted to simulation and telenursing. Using teach-back processes with student active engagement in telenursing and simulation not only facilitates learning but also meets the direct care requirement (Hargreaves et al., 2021). Furthermore, Hargreaves et al., states that clinical settings that incorporate telenursing will help prepare students for the future of nursing. 

Another way of preparing nursing graduates is using clinical education models that provide strategies to meet expected outcomes of nursing graduates. One such model is The Oregon clinical education model which integrates skill-concept based learning, focused direct client care, and integrative experiences to assure that students meet identified competencies in the curriculum (Nielsen et al., 2013). 

Conflicts in Meeting Educational Practices

Demands of the nursing curriculum present conflicts that hinder nurse educators from implementing sound educational practices. Thus, meeting the needs of practice for a graduate who can function in today’s healthcare environment is a challenge. Since the nursing curriculum is designed to meet certain competencies prescribed by nursing education advisory bodies, there is little flexibility in including extra educational competencies (Billings & Halstead, 2023; Carpenter & Garcia 2012).

Lack of time in nursing programs presents conflict in meeting sound educational practices. According to Billings & Halstead (2023), the curriculum demands a strong general education for all undergraduates resulting in lack of time to integrate some needed contemporary nursing skills. The already full programs make it difficult for nurse educators to fit learning experiences that support best educational practices (Carpenter & Garcia, 2012). However, some nursing schools are compressing curriculums with instructional information, and encouraging early application of fundamental concepts to build a strong foundation in knowledge and skills (AACN, 2020; IOM, 2010).

Barriers in technology can be addressed by integrating computer courses in the curriculum (Schutt & Hightower, 2009). Including a computer course in the curriculum enhances technology literacy skills of students. Collaborating with librarians, Schutt & Hightower (2009) implemented a one-hour computer class to provide nursing students with the foundational computer technology skills needed in today’s computerized health care environment. A computer course can improve nursing students’ database search skills, enhance nursing informatics and technology literacy skills essential for evidence-based practice as mandated by AACN (Koster Y, van Houwelingen, 2017; Schutt & Hightower, 2009).

Additional conflicts between sound educational practices and meeting the needs of practice for a graduate lie in the profile of today’s nursing students. A shift towards globalization and population diversity has also resulted in a higher increase in minority student enrollment (Johannesse et al.,2022; Kaufman, 2010). To some minority students, English is not their first language, posing challenges for nurse educators in delivering education to these students in ways that address their individualized learning needs (Adedokun et al., 2022; Kaufman, 2010).

Cultural differences make it difficult for foreign born nursing students to cope with competitiveness in nursing school and a fast-paced learning environment (Junious, Malecha, Tart, & Young, 2010).  Language barriers present predicaments in learning. Communication skills are major conflicts predominant in educating nurses, and nurse educators spent more time in meeting learning needs of foreign-born and minority nursing students (Adedokun et al., 2022 Johannesse et al., 2022; Junious et al., 2010; Moore, & Waters, 2020).

One way of improving nursing skills is the use of simulation. Use of simulation in nursing education enhances students in developing critical thinking skills, and offers a safe, non-threatening environment for students to practice their nursing skills (Klemm, & Jafrey, 2022). Prescott, & Garside, 2009).

Lack of finances to meet course costs and to acquire equipment such as fidelity human patient simulation manikins (Lapkin & Levett-Jones, 2011) can present barriers to methods that enhance teaching best practices. Nursing programs are faced with economic challenges when considering approaches that have the lowest cost but offer best support of nursing education practices (Levett-Jones, 2011). Financial issues add to conflicts in meeting best educational practices.

Conclusion

United States population is now largely diverse, and the healthcare system is becoming increasingly changing. Blended cultures have created multicultural communities with unique healthcare needs; therefore, nursing graduates must have necessary skills to function in diverse communities. Advancement in technology has changed the face of health care delivery and healthcare settings. Additionally, covid – 19 pandemic presented challenges in having nursing students attend clinicals in clinical settings.

The paper has discussed essential educational practices of graduates of nursing schools mandated by nursing advisory bodies. Full curriculum, lack of computer skills in nursing students, the profile of today’s nursing students, language barriers and financial issues have been identified as conflicts between educational practices and meeting the needs of practice for a nurse graduate.

A challenge for nursing programs is to prepare nursing graduates knowledgeable in cultural competency; skilled in technology; and comprehensively competent nursing graduates who can function in today’s complex health care environment. The dominant position in literature is a wide support of integrating innovative learning strategies that enhance sound educational practices in nursing education.  Thus, flexibility in the curriculum is vital to meet essential outcomes and competencies for graduates of nursing programs. 

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