Nursing Education: Knowledge, Practice, and Teaching Excellence

Nursing's Unique Knowledge Base and Evidence-Based Practice

Nursing does have a unique body of knowledge. As Moyer and Wittmann-Price (2008) state, "it is nursing's unique knowledge base that warrants a unique service or practice called professional nursing" (p. 6). This means that, like other health-specific sciences, nursing was founded on research that is unique to the methods required for that occupation and no other. The definition of nursing practice is bounded within that research.

Evidence-based practice assumes that the exercise of the field is predicated on what research has determined will best aid patients. From an ethical perspective, the expectation is that nurses will provide care that is not anecdotal but has been observed to represent the best available means of addressing a particular ailment. According to Moyer and Wittmann-Price (2008), research is used for "diagnosing, treating and organizing" the care given to each patient for a particular problem. Evidence-based care may require that nursing protocols change if a patient exhibits new issues, and it is the nurse's knowledge that allows this adjustment to be completed.

Caring for a patient takes on many different facets. It starts with how a nurse speaks and reacts to a patient, but it also involves how thorough the nurse is, the attention paid to body language, and the information relayed about the patient. Conducting a thorough intake seems especially critical. Allowing the patient adequate time to discuss themselves can be very valuable. Although the time allotted for this activity may be short, it is imperative that it be conducted thoroughly and with patience, as these qualities can meaningfully shape the therapeutic relationship.

Prior to the formation of NANDA in 1973, there was no coordinated group concerned with cataloging acquired nursing knowledge (NANDA, 2012). There were already theorists who had been working for years to determine best practices, but they were often working in isolation and the information they provided was not widely recognized as science. The founding of NANDA lent credibility to the breadth of nursing knowledge and provided a repository for it. NANDA also offered a platform for nursing theorists and researchers to advance the field of nursing.

According to the American Association of Colleges of Nursing (AACN), there are multiple problems constraining the retention of nursing faculty, and therefore multiple solutions are required. Some of these, from the AACN (2005) document on nursing faculty shortages, include the following: "Consolidate core curriculum; accept courses from other disciplines; utilize expert non-nurse faculty; utilize qualified non-nurse faculty to hold administrative positions; utilize the expertise of junior faculty by partnering them with senior, fully qualified faculty; seek opportunities to sponsor educational sessions that inform nurses outside the academic setting about an academic career; remove impediments to graduate study for working nurses; and attract more second-degree students to the nursing profession." These solutions address only a portion of the need, and much more has been proposed.

Learning Readiness, Learning Styles, and Faculty Shortages

The keys to ensuring that a student is ready to learn can be found in the acronym PEEK, which stands for readiness to learn in the realms of the physical, emotional, experiential, and knowledge areas (Bastable, 2008, p. 106). These factors can either enhance or hinder learning depending on how they are perceived by the student. For example, a room could be too cold (physical), a task could be considered too difficult (both emotional and knowledge), or content could be culturally specific (experiential) — all of which could hinder learning. Conversely, if these conditions were favorable, they could enhance the learning environment. Student motivation in the emotional realm also plays a central role: the connection a student feels to the teacher, engagement with the topic, and prior learning experiences can all benefit a student's motivation.

Several instruments are used to measure learning styles so that both the student and the instructor understand how the student learns best. The Dunn and Dunn model is concerned with "patterns through which learning occurs" (Bastable, 2008, p. 126); the Myers-Briggs typology determines the personality of the learner and provides instructional cues accordingly (Bastable, 2008, p. 128); and Kolb's model views learning as a lifelong process in which prior experience is used to enhance future learning (Bastable, 2008, p. 130). These and other tools — such as McCarthy's 4MAT system and Gardner's multiple intelligences framework — are all intended to provide the instructor with the knowledge needed to support the learner through the educational process.

Healthcare trends are meant to mirror the needs of the nursing community. The leading social trend is to help practicing nurses connect more effectively with schools of nursing in order to fill educator positions. Economically, schools are offering bonuses to nurses who would like to teach. The most significant political trend has been the movement toward universal healthcare, which may reduce nurses' choices and constrain salaries. Legally, nurses have always faced the risk of malpractice, and this concern may intensify as fewer nurses are available to fill existing positions, placing greater demands on smaller staffs. Ethical trends call for greater accountability from hospitals with regard to their nursing staff.

The Americans with Disabilities Act (ADA) was designed primarily to ensure equal access for people with a variety of disabilities (ADA, 2012). A major life activity is defined as "an activity that is central to daily life" (ADA, 2012), and reasonable accommodations are "modifications or adjustments that enable qualified individuals with disabilities to apply for a job and/or perform the essential functions of a job" (ADA, 2012). A person with impaired vision may need Braille or audio instructions for a task. A physical impairment may require a ramp to access the workplace or a conveyance to move around in. A person with a learning disability may need alternative forms of training instruction. In a teaching context, a hearing-impaired student often needs a secondary resource — such as audiovisual equipment or an ASL interpreter — to meet the reasonable accommodation threshold.

One of the most commonly distributed patient education materials (PEMs) in healthcare settings addresses sexually transmitted diseases. Using the Gunning Fog Index, the readability score of a selected text was 17.16, indicating that the material was difficult to read. The Fry formula placed the selection at an eighth-grade reading level, while the SMOG formula calculated the text at a 12.6, or college level. It appears that the Fry formula is the least likely to yield appropriate results, while the Fog and SMOG formulas together can be used to ensure that reading difficulty is maintained at an appropriate level — ideally somewhere in the middle-school range for broad patient accessibility.

Healthcare Trends, the ADA, and Patient Education Materials

In a recent article addressing learning strategies for teaching in a multicultural nursing student environment, Dewald (2012) suggested using a "mentoring, tutoring and advisement approach" to help retain minority students. Diversity is a goal that all nursing programs should aspire to because the patient population is diverse, and it has been demonstrated that a culturally diverse health workforce provides better overall care (Dewald, 2012). The article offered several evidence-based practices that can be used to further diversity in nursing education.

It is difficult to make a blanket statement about the appropriateness of nursing instructional materials as a whole, but healthcare organizations generally recognize the importance of inclusiveness, and most materials reflect that value. Materials assessed for this discussion gave specific attention to diverse groups of people, and supplementary material was available for specific populations when needed. Based on the examples reviewed, it appears that most situations can be adequately addressed, and that materials are largely free of gender, cultural, religious, and ethnic bias.

The stated goal of transcultural nursing is to promote understanding between cultures. One model "includes five components: communication, time, space, health beliefs and practices, and environment" (Billings & Halstead, 2011, p. 305). This model can produce nursing instruction that is acceptable to a highly diverse group of nurses and help them function together as a cohesive workforce. More students are now coming from economically disadvantaged regions because nursing offers both financial advancement and a positive community reputation. Because of the growing minority population, nurses are increasingly being recruited from traditionally underserved communities, a pattern that will result in a more diverse workforce and better overall patient care.

Billings and Halstead (2011) noted that nursing faculty report very few incidents of gross misconduct, but that program-related stress has caused some issues (p. 244). The authors identified several methods of responding to misconduct, some administrative and others related to classroom atmosphere. Administrative responses include reminding students of the code of conduct, while the teacher is responsible for creating an atmosphere in which students feel safe and trusted. The primary means of prevention, however, is to establish a clear code of conduct and ensure that students understand the consequences of their actions.

An expressive writing exercise can be an effective tool for reducing threat perception in the clinical environment. Such an exercise would begin by asking the nurse to write about the threats they perceive in the clinical setting. The nurse would then review their own words to identify underlying fears. Next, the nurse would be asked to focus on a specific situation and attempt to view it from the perspective of the person perceived as threatening. The nurse would then write about that person's feelings and how they might offer appropriate support.

When a student who has been performing well suddenly begins missing class, failing to submit assignments, and not responding to communication, something is clearly amiss in their personal life. A nursing student must learn to manage both a demanding professional role and a potentially stressful home life. In such cases, the instructor should offer as much support as is appropriate. The student may need to restart the course block at a later time once the situation has been resolved. The instructor can also connect the student with available resources to help them work through the difficulty without jeopardizing their academic standing.