Foundations of Nursing Education Report

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A Justification for a New BSN Program

The increasing demand for new skills to address complexities in contemporary healthcare has turned attention to the educational preparation of nurses. Advanced training would build competencies in clinical leadership, policy development, and evidence-based care (Institute of Medicine [IOM], 2011). Through a new BSN program, nurses will learn health technology and informatics, such as electronic health records (EHRs), to support critical clinical decisions, improve patient safety, and function efficiently in an increasingly complex healthcare environment.

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Need for Program

Diverse factors drive the demand for a new baccalaureate degree in nursing (BSN) program. Hiring policies enacted by healthcare organizations that favor graduate-level education are an essential institutional driver influencing registered nurses (RNs) with ADN qualifications to pursue BSN. Military clinics, Veteran’s Administration (VA), and accredited magnet hospitals all require staff nurses and administrators to possess a BSN (American Association of Colleges of Nursing [AACN], 2014). Thus, targeted institutional measures will lead to more RNs seeking BSN qualifications.

A national health policy to address the nursing shortage is a critical political factor affecting nursing education. Systematic steps, including the removal of ADN-to-BSN transition obstacles, have been taken to shift the composition of nurses towards more graduate nurses. AACN (2014) notes that BSN-prepared nurses offer safer and quality care and exhibit clinical competency, effective collaboration, leadership, and evidence-based practice. Nurses with a BSN can take on faculty, clinical, and leadership roles. Students without an ADN or RN license can attain these credentials by pursuing a diploma in nursing as a pathway to BSN. However, compared to baccalaureate nurses, ADN-graduates have lower earning potential and career prospects.

External Forces

The IOM (2011) report, The Future of Nursing: Leading Change, Advancing Health, highlights the changes in nursing education that are required to transform the practice for effective navigation through practice complexities in contemporary clinical settings. A key recommended reform is increasing BSN-prepared nurses to 80% of the nursing workforce by 2020 (IOM, 2011). The goal is to produce RNs with an expanded scope of practice to function as clinicians, researchers, and administrators and ensure safe, comprehensive, patient-centered care. The AACN (2014) requires hospitals seeking Magnet accreditation to demonstrate systematic steps taken to reach IOM’s BSN target. In response, organizations such as the VA have implemented policies requiring nurses to obtain graduate-level qualifications to be eligible for a promotion. Thus, the new BSN program is aligned with the future of nursing practice, as stated in the IOM report.

Recommendation to Guide Quality and Safety Initiatives

The Quality and Safety Education for Nurses (QSEN, 2019) defines skills that should be integrated into nurse preparation for better patient outcomes. The project has identified six clusters of quality and safety competencies to guide nursing curricular design and transition (QSEN, 2019). The selected QSEN recommendation is quality improvement (QI) programs, which entail monitoring outcomes and strategies for increasing practice performance.

Rationale for Selection

Adopting reputable QI models is critical to nursing efficiency, patient safety, and better healthcare outcomes. QSEN-proposed graduate knowledge, skills, and attitudes (KSAs) would lead to the efficient tracking and continuous improvement of quality and safety of clinical processes (QSEN, 2019). Understanding the strategies for analyzing practice outcomes will enable a BSN-trained nurse to design and implement initiatives to improve patient/family outcomes in his or her practice. Therefore, using the QI recommendation, the new BSN will train nurses on how to measure current performance, identify gaps, lead changes, and evaluate such interventions for better safety and quality outcomes.

Barrier

A potential obstacle to the implementation of QSEN-recommended QI KSAs in the BSN program is faculty shortage. According to the American Academy of Family Physicians (2019), QI, as an academic discipline, is underdeveloped due to its interdisciplinary nature. Differences in QI terminologies are a conceptual barrier to career development in this area. Further, the departmental grouping in medical schools presents an obstacle to the growth of this field, as the department that should sponsor research in QI may not be defined.

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Argument

Content-laden pedagogy limits critical thinking and reflective learning. The constructivist theory supports nurse preparation by promoting objective clinical evaluation consistent with the principles of evidence-based practice (Aliakbari, Parvin, Heidari, & Haghani, 2015). Imparting skills essential in obtaining and analyzing clinical information critically will enable BSN graduates to launch new change initiatives in hospitals. Applying constructivism to the new BSN program will ensure that teaching centers on concepts and active learning help in the student construction of knowledge (Aliakbari et al., 2015). Course material designed using the constructivist approach will lead to more student-faculty interaction in class and clinical settings. Thus, constructivism will make the BSN program learner-centered, cooperative, and interactive, which supports the development of critical thinking skills.

Theory Critique

Constructivism’s apprentice-based learning is the best approach to producing RNs with critical thinking skills. One advantage of using constructivist theory in new BSN is full student involvement in the learning process (Aliakbari et al., 2015). Thus, this approach will lead to the utilization of active learning methods to engage learners as opposed to treating them as passive recipients of content. Another advantage is higher patient responsibility for the individual construction of knowledge. Constructivist teaching will promote practical experiential learning. Students will be able to set personal objectives for the course and learn through clinical case studies with the educator as a facilitator.

A fundamental disadvantage of using constructivism in the new BSN program is the diminished role of faculty. The locus of control may shift from the instructor to students because learning objectives are negotiated by the two (Aliakbari et al., 2015). Since in the traditional model, educators follow designed course materials and guidelines, constructivism may create confusion and anxiety due to a lack of structured curriculum to build on what the learner already knows. Another disadvantage is that constructivist learning lacks standardized assessments. As a result, educators may not readily identify a struggling student in need of remedial classes.

Key Components

Narrative andragogy/pedagogy can be a useful philosophy in nursing education. In this approach, storytelling is utilized to teach clinical concepts in a productive dialogue involving educators, learners, and clinical staff (Olubummo, 2015). Lived experiences embedded in narratives can be incorporated into the new BSN program to induce behavior and attitudinal changes in student nurses and promote reflective practice for better future responses to clinical situations. The conceptual underpinnings of narrative pedagogy include understanding case content, interpreting its implications, responding to the problem, and reflecting on areas for improvement (Olubummo, 2015). Learners enrolled in the program will readily relate to stories motivating them to anticipate and prepare for complex clinical scenarios. Thus, BSN students will acquire situational awareness to make effective clinical decisions for better patient outcomes.

Philosophical Approach Critique

Narrative andragogy/pedagogy can help educators and learners to uncover new ways of thinking to tackle future healthcare problems. In this case, individuals learn by example through exposure to multiple experiences of clinicians (Aliakbari et al., 2015). Using the narrative andragogy/pedagogy philosophy in the BSN program will have the advantage of fostering active engagement and reflective thinking in students. By sharing real nursing scenarios and experiences, they will become more inquisitive, learn to resolve practice dilemmas and embrace the complexities of today’s healthcare environment.

The narrative andragogy/pedagogy approach has one major disadvantage. Theoretical experiences in patient situations or diagnoses used to support learning may not be readily transferable because each patient case is unique. Conflicting clinical priorities inherent in stories could limit their applicability to future nursing scenarios.

Modalities for Delivery

An effective pedagogical approach for nursing education must integrate theory into practice in actual clinical situations and enable learners to acquire critical thinking skills. Two models are selected for the delivery of the new BSN program: simulations/clinical education experiences and competency-based learning (CBL). Simulation- or experience-based clinical education will help expose students to authentic situational experiences to prepare them to respond in rare emergencies (Pitt, Powis, Levett-Jones, & Hunter, 2015). On the other hand, in competency-based education, the focus is on the integration of crucial KSAs into nursing practice and evaluations to improve clinical performance. In CBL programs, student advancement is subject to one’s mastery of concepts, not credit hours (Pitt et al., 2015). Thus, they present a paradigm shift from the traditional classroom system to student-centered learning.

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Justification for Selected Modalities

In simulation-based (virtual environments replicating clinical settings) or experience delivery modalities, students are exposed to diverse clinical scenarios to refine their clinical judgment skills. These pedagogical interventions involve the reasoning based on actual problems/situations (Camacho & Legare, 2016). Applying this delivery method to the new BSN program has the potential to individualize learning. Additionally, this approach allows for immediate feedback and, for simulations, the difficulty level can be increased during the learning session (Camacho & Legare, 2016). Thus, students will learn by doing, which will improve their cognitive retention and psychomotor skills.

CBL offers opportunities for training students’ specific skills important for better workplace performance. The mastery of specific degree-level competencies is required for advancement to the next level (Hirschhorn et al., 2018). These skills are developed through industry-academia collaboration. Thus, using a CBL delivery modality will ensure that BSN-graduates produced have requisite skills and knowledge to function effectively in today’s complex clinical environment.

Barriers to Implementation

Simulation- or clinical experience-based modalities and CBL can be useful in improving the learning outcomes of the BSN program. However, potential implementation barriers exist. Simulation-based learning may be hampered by financial constraints to develop high-fidelity simulations that mimic real-life patient cases (Camacho & Legare, 2016). On the other hand, clinical experience-based delivery may be limited by inadequate time for comprehensive clinical activities. Educational outcomes will not be the same for all students due to differences in learning styles and retention rates. Another potential barrier to the implementation of these interventions includes learner anxiety associated with immediate peer/educator feedback.

CBL delivery methods may face regulatory barriers. In traditional learning models, academic credit is given for skills acquired in the classroom context. A lack of standardized KSAs metrics may delegitimize CBL certifications (Spies, Seale, & Botma, 2015). However, using validated formative and summative assessment methods may increase the long-term viability of CBL delivery modality. Another potential barrier to the implementation of a CBL-based BSN program is the lack of a formal test. Only mastery of specific skills is required for one to advance to the next level (Spies et al., 2015). Thus, evaluating a student’s KSAs without a standardized test or graded assessment may be challenging.

Assessments

Formative and summative evaluations represent different methods for validating student learning in line with program outcomes. A balance between these two methods will be required to measure classroom and clinical competencies of BSN learners. The formative assessment evaluates student progress towards the achievement of learning objectives from placement to a specific time (Spies et al., 2015). This approach will be used in the BSN program because it is learner-centered, and thus, useful in having an honest discussion with the student about specific skill development (Spies et al., 2015). Further, through formative assessments, educators will offer ongoing mentorship to students for more progress towards achieving essential skills.

On the other hand, the summative assessment will be used to measure student achievements. It serves as an invaluable tool for evaluating abilities and accomplishments at the end of the BSN course. According to Camacho and Legare (2016), a summative assessment should follow a formative evaluation to address certain practice elements that would make a student fail in the final test. In the BSN program, specific weaknesses identified at earlier stages will be addressed through the support and development of action plans. Additionally, end-of-instruction evaluations will be used to identify and address individual practice/academic problems before summative assessments are conducted.

Benefits of Formative Assessments

A primary advantage of using a formative evaluation in the BSN program is that it will enhance student progress by adding to the quality of learning. According to Camacho and Legare (2016), through this test, a learner sets and works towards goals developed collaboratively with the educator. Thus, a formative assessment will support educator-learner interaction in a nurturing, learner-focused way to address student concerns and weaknesses during a course. Using this approach, educators can reflect and correct instructional methods for enhanced effectiveness. Quality instructor feedback ensures progress towards defined course outcomes (Camacho & Legare, 2016). The involvement of peers will add to the quality of the assessment and lead to enhanced learning.

Secondly, using formative methods in the program will promote student engagement. Based on learner/peer feedback, an educator can alter pedagogical methods and activities midway for optimal efficacy and impact. Further, through mentor-student relationships, learners will reflect and share their views on post-placement progress towards specified goals. Those requiring particular support will receive extra attention to achieve improvement in specific clinical or interpersonal skills. Increased student engagement in a practice setting will allow students to develop clinical and critical thinking skills.

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Benefits of Summative Assessments

Summative tests are essentially achievement-centered. A key advantage of including these assessments in the nursing program is that they will provide documentation on each student’s abilities, competencies, and outcomes (Olubummo, 2015). In-depth KSAs are required to offer efficient, safe, and quality nursing care. Thus, if a summative assessment reveals that a learner has not mastered core concepts or clinical processes, he or she should not continue in the BSN program. The grade awarded after the final assessment will indicate the learner’s accomplishments and clinical competencies.

Utilizing summative evaluations in the BSN program will also motivate learners to work harder for better results. The assessments will reveal if a student has understood the course material. Good grades can be an incentive to keep on studying hard throughout the course. The tests help identify students with below-average performance who require support and remedial classes to improve their academic outcomes. Thus, through summative assessments, it will be possible to specialize in a given clinical discipline based on the strengths and learning outcomes determined at the end of the program.

Limitations of Formative Assessments

Using a formative evaluation may be prone to some shortcomings. First, such methods can be time-consuming; instruction and learning involve acknowledgment, inclusion, and a regular review in response to instructor/peer feedback (Olubummo, 2015). Compared to graded tests, such as end-of-program exams, formative assessments need ongoing dedication by educators to evaluate learning. As such, these approaches are deemed labor-intensive, as they require more resources and time for a more effective inclusion, especially when the number of students is significant. Thus, summative evaluations may be required to complement continuous formative tests in the BSN program.

Second, the assessment lacks mechanisms for accountability. Learners may not take the evaluation and learning material seriously because it is non-graded. Further, the layered structure of the current educational system requires objectives and comparative assessment of student performance (Olubummo, 2015). Thus, in practice, formative methods lack this level of accountability, and thus, are rarely used. Adopting these assessments in the BSN program will shift focus from student achievement to personal learning, which is difficult to evaluate without standardized tests. Learners will also not feel the pressure to progress at a pace, as there is no incentive to advance to the next level.

Limitations of Summative Assessments

One problem with final or end-of-course tests is that they only focus on student advancement. Thus, summative assessments are meant to allow learners to pass from one level to the next. They may not have a good grasp of the course content or an adequate understanding of concepts. As such, learners will begin the next stage at a weaker state than their counterparts evaluated using formative tests with no chance to remediate their weaknesses (Olubummo, 2015). Using summative assessments has the potential to affect reflective practice and experiential learning of BSN graduates.

Another problem with achievement-centered testing is its limited capacity to uncover student KSA gaps. Unlike the formative assessment, the summative evaluation does not build self-awareness through ongoing tests (Olubummo, 2015). Therefore, failure to continuously assess learners will make it difficult to determine the knowledge gained from each course or learning activity. As a result, it will be challenging to adapt instructions to student needs. Additionally, effective remediation may not be possible since assessment will be done at the end of the course or program. Consequently, misunderstandings of concepts will not be addressed in time, leading to a high probability of failure.

Assessment Method Analysis

At the classroom level, it is important to assess student learning on an ongoing basis. The aim is to improve instruction and the learner’s mental processing of concepts at each stage. Classroom assessment techniques (CATs) are context-specific, enabling educators to know “how well their students are learning” at a particular point (Olubummo, 2015, p. 15). As a result, they can adjust instruction to address identified gaps in knowledge. Therefore, CATs will be central to student success in the new BSN program since the focus is on classroom-level learning. They are also formative, allowing an ongoing assessment of learner progress. The central premise of CATs is that improving instruction translates into an increased acquisition.

CATs are an essential technique for establishing what learners are learning. For the BSN program, using case studies will help faculty evaluate student knowledge and discover ways to improve acquisition and support them to become self-directed young scholars (Olubummo, 2015). Thus, CATs will empower learners and educators, resulting in high-quality learning. Further student success will come from better study habits, improved student-instructor interaction, and increased self-awareness resulting from active mental processing activities (Olubummo, 2015). CATs will help focus attention, promote information processing, and critical thinking. Assessment results will reveal individual learning weaknesses, which can be addressed by remediation.

ANA Code of Ethics

Ethics education in the new BSN program will be useful in addressing dilemmas that occur in nursing care. Issues of informed consent, confidentiality of health records, and patient involvement in clinical decisions require adequate ethical preparation at the degree level. The American Nurses Association’s (2015) Code of Ethics prescribes standards for ethical practice in nursing. Relevant procedures and curricula designs will be adopted to incorporate ANA’s nine principles in the new BSN program. Under the Code, nurses are required to be compassionate and respectful of the dignity of all individuals (Hoskins, Grady, & Ulrich, 2018). This principle will be actualized in the program through case-based instruction, team discussions on ethics, and periodic self-evaluations to demonstrate adherence to empathy and respect for all peers.

A primary commitment to the patient is a critical ANA principle. The BSN program will assess a student’s clinical competency based on the sharing of facts with patients and families and collaboration with experienced RNs during rotations. Guidelines for the promotion and protection of patient rights and safety will be a part of learners’ ethical curriculum (Carrese et al., 2015). Competency assessment during clinical rotations and placement will ensure accountability for individual practice consistent with the ANA principle of promotion of optimal care through effective decisions. Student nurses will be required to use personal protective equipment to maintain their safety, give input to create an ethical environment, undertake research (clinical practicum), volunteer in the community, and develop social policy initiatives before completing the program.

Analysis of FERPA

The Family Educational Rights and Privacy Act (FERPA) is the legislation safeguarding the privacy of the educational records of college students, especially those in athletics programs. Under FERPA, only the learner has the discretion to review or amend individual data. This federal law limits parental right to access personal information of students attending college. Third parties may also obtain confidential data, raising the potential for negligence claims. Specific actions will be taken to lower the FERPA risk in the BSN program. First, sensitive education records or individual data will be maintained electronically with limited access rights. Confidential information will not be made into hard copies.

Second, student data will be kept within university servers accessed only through secure computers. Distributing records across devices can increase the risk of unauthorized access to confidential information. Third, nurse educators, administrators, and students will undergo training on individual compliance responsibilities. All stakeholders will be obliged to comply with confidentiality requirements developed for the BSN program. Information requests from third parties will be directed to the customer care office. The goal is to limit interactions with outside actors and control the dissemination of sensitive data. Additionally, a written policy on how to handle student records will be communicated to all stakeholders.

Analysis of ADA

The Americans with Disabilities Act (ADA) guarantees nondiscrimination in academic settings. Under this law, all individuals should enjoy educational rights irrespective of their physical or cognitive impairments (Matt, Maheady, & Fleming, 2015). Specific steps will be taken to integrate ADA into the new BSN program. First, auxiliary aids will be given to learners with any form of disability that impedes their participation in educational activities. The institution will provide taped texts, braille printers, voice synthesizers, and assistive listening devices to students depending on individual needs.

Learners requiring auxiliary services will be consulted before selecting a specific aid. The devices shall be offered without any cost to the student in line with ADA provisions (Matt et al., 2015). Admission to the BSN program will not be done in a discriminatory way. Qualified disabled persons meeting the academic requirements for the course will be admitted. Sign language and interpreter services will be provided to learners who are hearing impaired. Qualified interpreters can help address communication barriers for this student population and ensure a competent and diverse nursing workforce.

Analysis of HIPAA

Health Insurance Portability and Accountability Act (HIPAA) is a critical law safeguarding patient privacy. It guides the dissemination of patient health information (PHI). Although nursing students seldom transmit electronic PHI, they must comply with HIPAA provisions like licensed RNs do. The new baccalaureate program will include a course on the ethical and legal obligations of learners. Individual responsibility for PHI and disciplinary actions for violations will be made clear to students.

Deliberate breaches of the rule will warrant termination of a student from the BSN program. This stringent measure will ensure that nursing students comply with HIPAA provisions. Web-based tutorials and other instructional materials will be made available to learners before they start their clinical experience. Tests will be administered at the end of the course to evaluate students’ understanding of HIPAA regulations. Case presentation during practices and assignments will not include PHI.

Analysis of Copyright Laws

Diverse informational materials, art, and photographs are protected from unauthorized use. Steps will be taken to ensure that student presentations and assignments are original and adequately referenced to avoid copyright violations. Learners will be required to seek permission from the publishers of copyrighted media or images before using them in their work. The institution will contact copyright owners to make specific materials available for student learning.

The BSN program will also include a course on copyright limitations and violations. The goal is to increase students’ awareness of the legal consequences of using copyrighted work. They will be advised to use media classified under Creative Commons and those from websites of federal agencies. The health-related images in these sites can be used for academic purposes provided a student cites the author. Training learners in these aspects will reduce the risk of copyright violations.

Accreditation Methods

Nursing programs are accredited to ensure that they are aligned with the best practices to enhance the quality of education. Accreditation enables students to transfer credit and be considered for graduate degree programs. The Commission on Collegiate Nursing Education (CCNE), an independent body that works to improve the quality of baccalaureate curricula, will accredit the new BSN program. The mission, objectives, and expected learning outcomes will be submitted to the CCNE for evaluation. Additionally, formative and summative assessments used to measure student performance will undergo accreditation periodically.

The new BSN program will be aligned with CCNE essentials that have been developed from the IOM recommendations to receive accreditation from the body. Among the practices promoted by the agency are patient-centered care, collaboration, evidence-based care, QI, and informatics (Commission on Collegiate Nursing Education, 2019). These concepts will be included in the BSN program courses. Adequate clinical experiences and simulations will be provided to ensure the graduate meets expected outcomes. The training will be focused on transforming students into useful inter-professional team members. Emphasis on clinical reasoning and assessment will ensure that learners acquire CCN-recommended direct care competencies. An ad hoc committee will oversee the implementation and evaluation of the BSN program in line with CCNE accreditation requirements. Additionally, faculty development and policies will be prioritized for continual compliance with the prerequisites.

Conclusion

Baccalaureate programs are becoming increasingly popular, as Magnet hospitals and VAs demand BSN qualifications for specific nursing roles. Nurse preparation should focus on improving clinical competency, collaboration, and leadership skills for better patient outcomes. Three key recommendations essential for consideration in the new BSN program can be made. First, summative assessments should be used to give a cumulative outcome of formative evaluations to gauge ongoing progress and final competency attainment. In this way, learner-instructor interaction can be optimized to address specific problems that a student may experience. Second, high-fidelity simulations can be used to deliver content for course work. Exposure to simulated cases would build clinical competency and improve clinical judgment. However, opportunities for actual clinical experiences should be provided. Third, ethical training should be integrated into the BSN program. Case studies, simulations, and self-evaluations may be used to teach students on nursing ethics and violation consequences. The goal is to ensure ethical practice and promote patient safety in practice.

References

Aliakbari, F., Parvin, N., Heidari, M., & Haghani, F. (2015). Learning theories application in nursing education. Journal of Education and Health Promotion, 4(2), 1-13. Web.

American Academy of Family Physicians. (2019). Web.

American Association of Colleges of Nursing. (2014). Web.

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Nursesbooks.org.

Camacho, J., & Legare, J. M. (2016). Shifting gears in the classroom: Movement toward personalized learning and competency-based education. Competency-based Education, 1, 151-156. Web.

Carrese, J. A., Malek, J., Watson, K., Lehmann, L. S., Green, M. J., McCullough, L. B.,… Doukas, D. J. (2015). The essential role of medical ethics education in achieving professionalism: The Romanell report. Academic Medicine: Journal of the Association of American Medical Colleges, 90(6), 744-752. Web.

Commission on Collegiate Nursing Education. (2019). Web.

Hirschhorn, L. R. Ramaswamy, R., Devnani, D., Wandersman, A., Simpson, L. A., & Garcia-Elorrio, E. (2018). Research versus practice in quality improvement? Understanding how we can bridge the gap. International Journal for Quality in Health Care, 30(1), 24-28. Web.

Hoskins, K., Grady, C., & Ulrich, C. M. (2018). Ethics education in nursing: Instruction for future generations of nurses. The Online Journal of Issues in Nursing, 23(1), 14-26. Web.

Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. Washington, DC: National Academies Press.

Matt, S. B., Maheady, D., & Fleming, S. E. (2015).Journal of Postsecondary Education and Disability, 28(4), 461-468. Web.

Olubummo, C. (2015). Classroom assessment techniques. Nursing Management, 46(12), 16-19. Web.

Pitt, V., Powis, D., Levett-Jones, T., & Hunter, S. (2015). The influence of critical thinking skills on performance and progression in a pre-registration nursing program. Nurse Education Today, 35(1), 125-131. Web.

Quality and Safety Education for Nurses. (2019). QSEN competencies. Web.

Spies, C., Seale, I., & Botma, Y. (2015). Adult learning: What nurse educators need to know about mature students. Curationis, 38(2), 1494-1501. Web.

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