Journal on Roles and Trends in Nursing

New Insights About Roles of Nursing Educators

The education of nurses is currently in flux in British Columbia – similar to other regions – as a result of aging (increased patient load) and the high average age of nurses who are now retiring in record numbers (nursing shortage). Analysts have long predicted a nursing shortage, and it is now upon us. In anticipation of this event, the roles of both practising nurses and nursing educators are sure to change, particularly as a result of an expanded eighteen-month curriculum.
Already, educators in the field of practical nursing are encountering alterations in their role, in part dictated by the changeover to the new curriculum. Personally, I have thus far developed two semesters of communication course content for the new nursing program at my college. This exercise has transformed my role by increasing my awareness of how curriculum decisions influence the practice of teaching, and ultimately the learning of students. Although I have frequently pondered, experimented with, and discovered new latitudes to my teaching role during my twenty year tenure as an educator, curriculum development has transformed me in a few significant ways.
According to Mezirow’s theory of Transformational Learning, events or experiences can easily change one’s point of view, thereby resulting in a transformational shift, or learning (Merriam et al., 2007, p. 133). The experience of curriculum development has induced me to reflect on the most preferable means of enlightening students; certainly, education is a mission to unearth the truth, and in so doing, encroach on territory examined by such luminaries as Aristotle and Descartes. For example, Descartes’ awareness that reality cannot be trusted must surely have transformed his point of view dramatically. While my transformation can hardly be compared to Descartes’ “Cogito ergo sum” rationale, I have come to recognize some valuable means for improving my role as an educator in nursing communication. My students will progress more expeditiously if I assemble a seamless transition from an awareness of theory to a mastery of practice. Indeed, when students rapidly apply new theory in clinical scenarios they are able to deduce the rationales which led theorists to the mother lode of understanding in the first place. For example, if a few students in a gerontological communication class were blindfolded and led by other students using only verbal cues, both sides in this simulation would gain an accurate appreciation for limitations posed by blindness. With such comprehension internalized, students experience their own productive spasm of transformational learning.
To augment my students’ extent of transformational learning, I have re-examined my role in the class. The traditional magisterial role is still important as a foundation for learning since many students lack prior experience with concepts and even means of learning, such as critical thinking. Although I have incorporated activities and exploration into my educational regime for more than two decades, I have recently increased the incidence and scope of self-directed learning. I find myself increasingly serving as the role of a mentor as students pursue their learning in either an autonomous or collaborative mode. Often I will present students with a patient scenario involving one of more communication difficulties, and leave them to deduce the various problems and feasible responses.

It is important to remind ourselves as educators that we need to adopt roles which encourage the degree of self-directed, lifelong learning that has enriched our minds. As such, we hold the keys to the gated and walled garden where the pleasant, enriching fumes of knowledge await those sufficiently inspired to partake in the splendour of learning. As mentors, instructors may open the garden gate to offer a peek at the glories within, and then leave the students to explore at will and come to their own determination of the sense of order within. A greater emphasis on self-directed learning in my classes is paying off very well since the last three cohorts of graduates have achieved a 100 percent pass rate on the national licensing exam for practical nurses. Thus, in a changing world of nursing, those who have filtered through my classes have received invaluable opportunities to delve into the mysteries and intricacies of critical thinking.
In particular, demographic change, the expanded curriculum, and the intensified commitment to the Rogerian patient-centred approach are conspiring to transmute how nursing educators function in the class. Given the increased demand to generate graduates who function autonomously and responsibly, nursing educators now must exhibit some of the following mentoring tactics: role modelling, providing vision, helping students to learn, challenging the status quo, and achieving integrity in learning and caring relationships (Adelmann-Mullally, 2013, pp. 30-32).
Despite assuming my obligation as a role model in teaching many years ago, it is an increasingly vital aspect of my educational presence. Many of my students have entered the practical nursing field lacking academic discipline and experience. Like lapsed adherents to a religion, many students are rediscovering the path towards the promised land. Half the battle often involves attitude and motivation, and, in fact, successful students soon adopt appropriate models of conduct, whereas those destined to fail will overlook this essential step. Yet through positive and inspired role modelling in class, instructors can hasten and broaden the transition for students to academically sound strategies. My strong dedication in this area of my practice has helped many marginal students survive the transition towards positive attitudes and productive studying behaviours.
Of course, many students do wilt under the abruptly imposed rigors of nursing education. Their morale may wane and they may question the wisdom of their choice to enter the fray of nursing. As such students flounder in the sometimes unforgiving waters of academia, a will-timed life ring of visionary reinforcement from a caring educator can preserve the learning process. In fact, educators who clarify and instill a strong, ethical vision in the minds of students will enjoy the company of committed learners on an indefatigable mission of learning.
It is appropriate that Adelmann-Mullally et al. (2013) refer to helping to learn as a vital role of educators. Passing on knowledge to learners, for guiding them to it, encapsulates the triadic teaching model (Barrow & Woods, 1988). In education, it is hard to escape the relation between teacher, knowledge and learner, as indeed many learning theories are sure to express. Even Vygotsky’s scaffolding methodology takes great prominence in pedagogy, but clearly deserves due credit when educators with advanced levels of knowledge decant some of their knowledge into the sponge-like goblets of adult students thirsty for enlightenment. Countless times I have helped adult students to learn, including some recent students in a math class I teach; the students lacked prior experience yet through my thoughtful instruction came to appreciate the poetry of numbers and attained scores in the 90s on the final test. Success flows freely when educators sate the hunger and thirst of students to learn.
Education should adopt the long tradition of revisionism that has marked the rise of great minds such as Newton or Galileo. In Galileo’s case, he challenged the status quo of narrow scientific beliefs, such as the flawed view that heavy stones would hit the ground before lighter ones. Galileo’s brave demonstration of gravity from the Leaning Tower of Pisa to a rapt audience below should stand as a Halcyon cry to all educators that the greatest strides in learning are often revolutionary and critical in both theory and practice. Thus my role in the class is dedicated to the great discipline established by Socrates and Galileo. In fact, on more than one occasion I have advocated for proper educational content, facing the possibility that hemlock might be my reward for academic diligence!
Considering the social and caring nature of nursing, it is hardly surprising that the integrity of learning and caring relationships should be an important part of the nursing curriculum. Prospective nurses are expected to master both learning and caring relationships; they must multiple caring relationships that express their professional standing in the community.

Current and Future Trends
The most significant and influential trends in nursing education are related to demographics, particularly the aging of the population and the accelerated retirement rate among the current cohort of nurses. Not only will the demand for nurses increase in the
future, the educational branch of nursing will face a growing burden to recruit and educate nurses to meet the demand for nursing support. In particular, as indicated by Gulledge (2012), nursing faculty find themselves heavily burdened by a shortage of qualified faculty, since many are retiring and fewer practising nurses are willing to take the advanced education necessary to enter academia. Heller et al. (2012) acknowledge demographics and cultural change as the two leading factors of change which are driving an evolution in how nursing is to be conducted in both educational and practical terms. Accordingly, the shortage of nursing is bound to worsen as the diminished ranks of educators are already unable to accommodate the required increase in student recruitment. In 2010, American nursing schools refused entry to 75,000 students, and the situation is bound to deteriorate as more practising and faculty nurses retire.
Nursing education and practice are feeling the winds of change as nursing administrators and health regulators scramble to respond to a wintry season of demographic change. Traditionally, nursing educators have provided formal magisterial instruction in nursing knowledge and clinical aptitude and practice. In response to new theories and approaches in nursing, such as the client-centred, problem-solving approach, nurse educators are now modifying their roles in the class and lab. Certainly, nurse educators must expose their students to a broader scope of practice, particularly for those enrolled in licensed practical nurse programs; health regulators are permitting greater licence to LPNs to adopt new functions in the health care system, such as leading inoculation clinics.
Along similar lines, demographics are also influencing the evolution of content in nursing curricula, particularly with respect to gerontological issues. As noted by Cline et al. (2012), despite the rapid growth in older adult patients in the population (comprising 24 percent of all inpatient admissions), textbooks and related materials still lag in providing adequate coverage of older adult health issues. Certainly, the complex care issues of older adults already are covered in the upgraded 18 month curriculum for practical nurses in this province, and yet more could be done since older adults do form the bulk of patients under critical care, and their physiological, psychosocial and psychological issues are clearly differentiated from those of other age groups. Indeed, if one considers the symptoms of pneumonia, one finds that senior patients may not conform to the expected presentation of signs and symptoms. For example, although ill with pneumonia, an older adult may not exhibit a fever, since older bodies tend to respond more sluggishly when faced with the onslaught of infection. When the mix of other common symptoms of such conditions as anemia are thrown into the mix, the shortness of breath with pneumonia could be misconstrued as something else, and thus a nurse failing to wield critical thinking appropriately might miss a critical assessment that would aid enormously in an early intervention and cure.
Technological advances in nursing practice and education are another whirlwind effect that is driving change. New drugs and methodologies arise – and sometimes even old ones, such as using leeches or maggots in the care of burn victims – which place heavier demands on both students and educators. Flux is constant, and the spinning gyre of trends is fluctuating at an even more rapid pace these days. For example, new digital forms of technology have greatly enhanced the ability of nurses and doctors to assess the condition of patients, and new forms of concentrated nutrition, such as Boost, have added another useful arsenal in the locker of disease fighting. Student nurses need to comprehend and apply all these new modes of treatment if they are to be effective. The lab coordinator at my college has added two technologically advanced patient simulators which emulate real patient scenarios, and even offer vocal responses, respiration and other key vital signs. Allowing students to work with these advanced simulators allows them greater confidence and experience in dealing with problem solving in real time, but without the burden of rapid time management and perfection as one would have to perform with a real patient. A student could take time out to review mistakes and even reconsider the strategy and rationales being employed. As such, the thoughtful implementation of technology enhances the quality and efficacy of learning among nursing students.
The changes brought about by the rapidly evolving trends in nursing are dramatic, and undoubtedly will govern how nurse educators conduct teaching in the future. Certainly, the expanded role and complexity of care conducted by practical nurses remain wild cards in the ongoing evolution of the nursing curriculum. Nevertheless, one thing is sure. To set the scene for lifelong education, the educators themselves must be committed to ongoing learning. For my part, I am taking the Provincial Instructor Diploma program. Considering the shortage of qualified nursing instructors it is vital that those already in the fold maintain, and even extend, their qualifications. Moreover, I am deeply committed to doing my own research to ensure that the new curriculum I have written remains relevant and up-to-date. As the caregiver of a close family member who is now in palliative care, I have been fully engaged in the art of health care communication regarding critical care, ethics, patient care conferences and decisions about the end of life. This experience is invaluable as it permits me to reconsider and review the application of theory, particularly in terms of gerontological care, of which I have attained considerable experience over the years; moreover, recent care experience does indicate the current trends in how care is provided, including the methods for reducing fever at critical stages.
I am whole-heartedly committed to lifelong learning, and almost every waking moment of mine is dedicated in some way to augmenting my repertoire of knowledge and methods of teaching for the benefit of students. I see my role as much larger than just teaching Communication, English or Math. I am also teaching all modes of knowledge and experience within my grasp. Excellent instructors I had the fortune to experience in my academic career have displayed and shared the nectar of enlightenment, and I have drunk deeply. I like to think that I am continuing the tradition, so that graduates may embark on a career in nursing with a strong foundation of education, and a natural interest and delight in pursuing knowledge.
Web Conference
My group members and I enjoyed a web conference by Skype recently, whereby we were able to share our various findings and discuss such pertinent topics related to roles and trends such as demographics, the expanding role of nurses, the rise of new technologies and educational methods, and, of course, the nursing shortage.
As we all have busy schedules, and I have recently been preoccupied with caring for a seriously ill family member, Skype did offer us the flexibility to meet and discuss our research findings and impressions about roles and trends. We agreed that using such communication technology is useful for both academic or health care purposes. Since we could observe body language, and could hear our vocal cues, we had a fuller comprehension of each other’s response to comments, which ultimately enriched our understanding of the overall message. Of particular interest to us, however, is the feasibility of incorporating new technology into the curriculum. Technology does comprise a significant part of health care today, and it is important that nursing programs, like ours, reflect the higher inclusion of technology in patient care. To ignore technology would be to isolate our students from the impact and proper role of technology in patient care. Thus, we now have some simulation equipment which permits students to achieve a higher level of competence and confidence before they embark on direct patient care on practicums.
As I am not a clinical instructor, I do not spend much time in the lab, and therefore am not that aware of the function of new equipment. Our Skype session seemed, therefore, like a perfect opportunity for me to inquire about the new simulation tools which Mary, our lab coordinator, recently ordered. It was interesting to realize that one of the simulation “dummies” is able to speak, and reflect various conditions, and even vomit. This new awareness opens up new possibilities for me to take my communication students into the lab to practise particular communication scenarios. Adding some realism to communication scenarios will enhance the ability of our students to communicate therapeutically and effectively once they engage with real patients in practicums.
As we have been extremely busy with curriculum development over the past several months, we also spent some time discussing how appropriate our current content is, and how we can improve it. Naturally, we considered whether our curriculum will offer students adequate support in their quest for knowledge and eventual licensing as fully-fledged nurses. We noted with delight that our commitment to our students’ learning has paid off handsomely as of late. In the past three national licensing exams for practical nurses, graduates from our campus have achieved a 100 percent passing rate – a clear indication that we are on the right track in educational terms.

References

Adelman-Mullally, T., Mulder, C., McCarter-Spalding, D., Hagler, D., Gaberson, K., Hanner, M, Oermann, M, Speakman, E., Yoder-Wise, P., Young, P. (2013). The Clinical Nurse Educator as Leader. Nurse Education in Practice 13, 29-34.
Gullege, E. (2012). Current Trends in Nursing and Care.: Status of the Profession. Journal of Nursing & Care 1(4), 107.
Heller, B., Oros, M, and Durney-Crowley, J. (2013). The Future of Nursing Education: Ten Trends to Watch. National League of Nursing. Retrieved January 28, 2013 from http://www.nln.org/nlnjournal/infotrends.htm
Stowkowski, Laura. (2011).Trends in Nursing Education for the 21st Century. Retrieved January 28, 2013 from http://mededandtech.blogspot.ca/2011/02/trends-in-nursing-education-for-21st.html

Current Trends in Nursing

Current Trends in Nursing

J Nurs Care Volume 1 • Issue 4 • 1000e107

Current Trends in Nursing and Care: Status of the Profession

by Elizabeth D. Gulledge

The nursing profession continues to evolve and progress at a

meteoric pace. The current trends in nursing and care are multifactorial

including: the increase in the aging population, a transition

to informatics, a nursing shortage, and an overarching emphasis on

specific frameworks for the guiding of nursing practice, including

integration of evidence based practice.

It is estimated that 26% of the United States (U.S.) population

are “Baby Boomers” [1]. As the “Baby Boomer” population ages, so

does the increase in aging adults with complex health issues. Nurses

today must be more adept than ever at caring for the aging adult while

the healthcare environment struggles to accommodate this rapidly

increasing population.

In addition to an increasing aging population, another trend is the

increase reliance on informatics. The incorporation of technology into

the healthcare arena may be a challenge for many nurses. The inclusion

of the digital medical record has assisted facilities in providing for a

more streamlined, accessible, and accurate health history. There

also continues to be variation among facilities in the initiation of

informatics leading to a lack of consistency from facility to facility.

However, it is important to recognize that not all nursing professionals

possess the necessary computer literacy skills needed for proficiency

in understanding and utilizing informatics, especially those nurses that

have been in the nursing profession for quite some time. This leads

to consideration of the fact that many nurses are retiring without the

numbers to replace them.

The current nursing shortage is impacted by the high number of

nurses that are of retirement age coupled with the lower number of new

nursing graduates. Contributing to the nursing shortage is the current

nurse faculty shortage. A shortage in those nurses with advanced

degrees and the ability or willingness to enter academia affects the

ability of institutions of higher learning to educate more nursing

students. In 2010, nursing schools denied admission to over 75,000

potential students due to a lack of adequate nursing faculty [2], without

new graduates to replace retiring nurses, the burden of providing

patient-centered care rests on the shoulders of those left at the bed-side.

A nursing shortage then contributes to nurse fatigue and burnout, the

potential for medical errors and compromised patient safety, and poor

patient outcomes.

In terms of patient outcomes, the nursing profession has seen an

increased emphasis on integration of evidence-based practice. The

incorporation of best practices into nursing care has contributed to

the individual nurse claiming more ownership in the achievement of

positive health outcomes for patients. Nurses are now responsible for

being a direct line in the conducting, reporting, and implementation of

research. Most importantly, this responsibility has led to a paradigm

shift in the way nursing is viewed. No longer is nursing viewed as

task oriented discipline content on taking orders within the medical

hierarchy. Nursing can now be considered a science; contributing to the

research and discovery of new and innovative approaches to improving

health outcomes.

As nursing continues to evolve, so does the current healthcare

environment. Affected by a multitude of factors, nursing will forever

be in a constant state of flux. Trends can be both negative and positive.

Whether it is the changing face of the populations for which nursing

cares for, a rapidly changing technological environment, nurse/faculty

shortages, or an emphasis on evidence based research, nursing is up to

the challenge and will forge ahead with vigor and accountability.

References
1. http://www.census.gov/population/www/socdemo/age/agebyage.html
2. Linda EB, Geraldine DB, Katherine LH (2012) Enrollment and graduations
in baccalaureate and graduate programs in nursing. American Association of
Colleges of Nursing, USA.

Autobiography of Derek Richer

Since graduating from U.B.C., I have been an educator and writer for more than twenty years. Currently, I teach English, Math and Communication at Vancouver Career College, where I support the progress of students in the Licensed Practical Nursing program. I am currently enrolled in the PIDP program at VCC, and PIDP 3240 is my first course. When not teaching or writing I can be found climbing mountains, and traversing deserts, or enjoying my British sports cars closer to home.

Below are some petroglyphs from the Harvest display in the Maze, Canyonlands National Park, Utah.

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A Response to Article on Social Media and Community Engagement

Humans are inherently social beings, and clearly we have a propensity to experiment with new modes of communication within and without our social spheres.  It is interesting, therefore, to read Michael Meighan’s “Social Media Will Never Replace Real Community Engagement,” which was published in the Vancouver Sun (November 21, 2012).  While it is true that social media do prove eminently useful in spreading information over great distances to mass audiences, they often fail to achieve the degree of influence on people’s pathos and ethos as real face-to-face contact does.  I agree with Meighan’s sentiment that positive and profound change in society does require personal contact.  This helps to explain why, for example, the vast majority of job interviews still involve a face-to-face meeting.  After all, it should be remembered that the words in messages only comprise 7 percent of the meaning of the entire message, whereas body language presents 55 percent of meaning in a message to an audience.

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Twitter: The Good and the Bad

The world’s communication media are transforming so quickly that soon the tweets of bird species will be drowned out by the collective tweets of Twitter. As with any technology or mode of communication, Twitter is neither inherently good nor bad. Rather, the application and related effects are the means by which we can assess the value of Twitter. In fact, Twitter is proving to have positive and negative aspects, as was the case for radio-telegraphy aboard the Titanic on her ill-fated maiden voyage.

In negative terms, Twitter is wasting time, conditioning a subpar use of language and promoting the transmisson of piffle. Celebrities and ordinary souls alike are describing minute-by-minute the most banal events or choices in their days. Often we spot these obsessed Twitter users as they clench phones and stare intently at tweets. Are they discovering or creating anything profound? Unlikely.

However, all is not lost in our universe of tweets. Recent disasters or near disasters have demonstrated that the concise, mass communication of Twitter is an effective and reliable means of transmitting messages, especially when other communication methods are interrupted; wireless internet through hand-held devices is less prone to damage than conventional phones or cable-based communication.

It is interesting to note that in the wake of the recent B.C. earthquakes the B.C. government has decided to use Twitter as an effective means of warning residents and officials about the potential of an incoming tsunami. Moreover, the recent experience along the eastern seaboard of the United States proved just how useful the rapid, mass flow of news from eye-witnesses using Twitter could be.

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