Welcome to this episode of the NLN podcast Nursing Edge Unscripted the Surface track and thank you for joining us this episode is entitled celebrating the year of the nurse educator the evolution of Nursing education and its impact on curricula where we discuss how nursing education's Evolution during recent years impacts curriculum integration and design we will discuss two key influencing factors The educause Horizon report and the
ncspn's clinical judgment measurement model please join Dr Susan feneres and I as we discuss why these resources are important considerations when designing and integrating curricula and consider how the resources can challenge our teaching strategies to match the evolution I would like to formally introduce my co-host for today Dr Susan gross veneres Dr Paneras is the director for the national league for nursing division for Innovation and education excellence
Sue is instrumental in the design and implementation of nln Faculty development resources focused on the pedagogy of teaching and learning her expertise is in curriculum and teaching learning strategies with an emphasis in simulation and debriefing her research and publication focus on the development and use of reflective teaching strategies to enhance critical thinking she co-authored the publication critical conversation the nln guide for teaching thinking and most
recently critical conversations from monologue to dialogue Sue is an admired mentor of mine and to many others so let's Jump Right In thanks Michelle for taking time um to have a conversation with me about this notion of journeying through nursing education I'd like to spend the next 10 minutes really trying to set the stage for how we see Nursing education our roles as Educators and maybe some of the reframing that may need to happen in order for us to meet Learners where
they're at so I appreciate you taking a little bit of a deeper dive with me here that sounds good Sue and you know I think this is important I'm hoping our conversation can help nurse Educators understand a little bit more about what needs to get pulled into curriculum design what things we need to consider what challenges might we need to overcome to help us create a thoughtful mindful curriculum for our our Learners absolutely so sue I'd like to invite you to share um your
perspective on some pedagogical assumptions and to do so I'd like to do a little time travel if you can take us back to help us understand some of the historical contexts around Nursing education and nursing practice and then we'll we'll do a little comparison to what was and what is now yeah as we think about that absolutely time travel uh for sure because I am not a new educator and so as you think about this journeying through nursing education we really do have to use our
past to help inform us as we think about the now and into the future and so um maybe the way to look at it in this time capsule is to consider both practice and education so if we were to think of ourselves as uh nurses who maybe began practice over 40 years ago now perhaps Michelle you weren't born then um 40 years ago but some of us were entering practice 40 years ago and um and back then you know as we think about um that practice environment when we were Learners
in nursing um you know faculty accompanying us to clinical um it was a situation where we may have seen a faculty student ratio of one to ten uh students in the clinical environment most of the time we were assigned post-op patients to learn kind of that post-op piece or um perhaps we were in nursing homes caring for the Aging but um back then we maybe were assigned to patients probably not as much we still stayed with that one patient model and uh you know spent eight
hours and we did all of the patient care we were taught to be in practice to um to meet the needs of the patient um all of the needs of the patient um in addition to the usual nursing interventions that you were being taught in the classroom some of the assumptions underlying that form of teaching pedagogically was that it was this notion of applying Theory so you learned you got your theory dump in class and then you would go to practice and just by the process of doing
you'd merge the theory and apply it in practice that's generally what it was there seemed to be a preponderance of focus on psychomotor skills so you were in clinical to practice psychomotor skills because it was not likely that you got a chance to do that in the real world and that you'd build on past knowledge it was always building on past knowledge moving from simple to complex and your instructor would be guiding that whole piece um and and that's kind of what um what
we're seeing um what we saw 40 years ago that's that's really helpful to understand that perspective and I'd like to take a little time to compare that now to what we're seeing now both in practice and nursing education and I think by having this conversation it might help us to understand you know what's brought us to today and what we need to do as Educators how we might need to shift um our thinking and our approach to curriculum so if you can share now what what's happening
today well today you know it's interesting the pedagogical assumptions really haven't changed much um you know we still believe that we're using clinical as our way to apply the theory that we're teaching in our didactic so again we go to class there's this knowledge dump and then we expect them to use that information in clinical um again there is still this emphasis on psychomotor skills um and probably more so even now as people use
the word competency because you immediately go to psychomotor skills when there really seems to be this push to develop clinical reasoning clinical judgment that that whole piece we're still using this this assumption that we are building on simple to complex using your past knowledge keep adding to it and then as you go to clinical you keep informing um you know your own learning as a as a student in in nursing um in terms of what practice we might see on
the practice side with teaching is we're we're probably seeing maybe a one to ten or possibly one to eight ratio uh trying to account for a little bit of complexity in the patient population but not much if 40 years ago we were still at one to ten um you know we're we're taking care of medical surgical patients we may get assigned more than one patient nowadays because that seems to be a little bit of an emphasis but definitely not the
status quo and we spend maybe eight to ten hours on a clinical shift in the instructors in charge of of doing everything what's interesting about this is that you know it hasn't changed we're 40 years ago we're still using those same assumptions to guide how we prepare Learners in real life in a clinical experience except for the patient population and the health care industry has changed dramatically in the last 40 years I always make the analogy that when I was
in post coronary or ICU 40 years ago those patients exist today on General Med search floors we're going to see nurses encounter vent patients and and very critically ill that were once in icus now and they stepped down in in some of the main mainstreaming of these patients into the the general med-surg population and into the community and and patients that today are in ICU they they weren't alive 40 years ago there wasn't the Science and Technology uh advances so where we
seem to be at a little bit of a disadvantage with our our Learners in that we're trying to continue to prepare them pedagogically for patients that existed 40 years ago and so we wonder why we have a a difficult time saying our Learners are prepared for today's you know client population yeah I was just thinking you know with you saying that that everything you just described it really impacts and in influences the academic practice Gap that we're seeing there are many
other factors I think that have created that that um space or that uphill climb that that our Learners our new graduates have to make as they transition into practice successfully and some don't some really struggle um and and some need a lot of guidance so I think this conversation is timely um to talk about how we can get out of our own thinking shift our thinking get out of our own way to making a shift where we can really meaningfully try to narrow
this academic practice Gap with some thoughtful changes to our curriculum how we design our curricula and then how that curricula at a program level or an institution level than a program level and then how it plays out in our classrooms and how it actually is then consumed from a learning perspective by our Learners so I think this is I find this an exciting conversation and an exciting time to be able to do this work absolutely as a
nurse educator yeah maybe a little overwhelming maybe a little bit but I think we can take small chunks and move it forward you know small pieces so I'd like to transition a little bit to talk about some of the consideration that we need to incorporate into our thinking our rethinking reframing our thinking and curriculum design what are some um now that we've talked about the changing dynamics of education and practice what are some of the resources or the the guidance that
informs that that Dynamic um change what's telling us as Educators that this is the direction we might need to move if we can discuss some of those those pieces yeah well I think two of them are most prevalent is uh the Horizon report and the other factor that is really informing Nursing education is the new ncsbn clinical judgment model so let's talk a little bit about the Horizon Project The Horizon Project was an initiative by New Media Consortium where they would chart
a lot of the emerging Technologies for teaching and learning and it was launched back in 2002 um and since that time they would publish a report that would detail some of the trends happening in the workforce around technology that would definitely Drive what's happening in education to prepare individuals to practice in those technological environments since then taken over by educause which is a non-profit Association of the largest community I I would say of Technology
academic industry campus leaders that are looking to advance higher education and how they use I.T in in the learning so in these reports they they talk about these emerging Trends and probably the most influential as you think about Trends in education are some of the more contemporary things so the use of artificial intelligence or AI that informs learning analytics how do we know our Learners are learning we've become much more sophisticated over the course
of the years to identify how Learners are learning we've had to adapt our learning spaces to account for both online and face-to-face so lot of hybrid learning we've had to create tools that Embrace AI especially in our entertainment areas Learners are using AI every day in their gaming on their phones and how do we Embrace that and bring that into our learning environments and so those are some of the the factors and so really what it gets down to is what we call reframing
the practice of teaching you know it's no longer us as Educators transmitting knowledge which is really kind of how we've always seen our role focus is the transmission of knowledge but more how do we facilitate knowledge with our Learners and that requires us to rethink this practice of teaching the information coming out and the technology is really going to be driving that and that is a report that helps us understand where our consumers are our our Learners
are and so that would be one driving force that's great soon I love this idea of moving us as nurse Educators as a community of practice um from transmitter of knowledge to facilitator of knowledge um that it's not just the information's coming from my head and going to your head um it's really about how we can help facilitate this experience of learning from practicing different skills using knowledge and applying it to different contexts that we can do
that with and for our Learners um yeah more being more intentional about our roles as Educators and the Art and Science of teaching becomes a front front stage that's great and you know I think um the second thing that you had mentioned which I I can uh jump in and talk about absolutely is the clinical judgment measurement model um that the ncsbn uh has designed to really guide the item writing and Analysis um the test blueprint for um the NCLEX next gen
so um I'm going to show a screen here a slide that has the model and I want to guide you to the left side of the model has the layers layer zero layer one two three and four and then along the bottom you have the nursing process that really underpins um this entire model uh that we've had you know we've always used the nursing process to guide what we do um and then I'm going to skip around a little bit uh to orient you to the model so at the top at layer uh one you have clinical
judgment that's kind of the ultimate goal right we want to use our judgment a clinical decision-making process to inform a judgment um to make a decision that informs that informs our care for our patients um how we communicate uh our interventions uh and and how we can help meet our patients needs I'm going to skip down to layer three so layer three has a recognizing cues uh analyzing cues prioritizing hypotheses generating solution taking
action and then evaluating outcomes so this really covers the cognitive processing that goes on under the hood of a nurse to gather information make meaning of it um and and to to consider different options different situations and then come to a solution come to a a decision but you can see I want to jump back up to Layer Two where you can see where this cognitive processing at a ride at a at arriving at a decision is iterative it goes back and forth you gather information you're
like I need some more information uh you get more information and then you you add that into hopefully you add that into now your new analysis so that's the cognitive piece and then the layer four is um really the context in which you do clinical judgment right it's it's this context in which the thinking has to occur and there's two buckets on layer four there's the environmental piece and then the individual piece and this is really important because the environmental
piece is are the environmental context in which we have to do this work it includes task complexity time pressures interprofessional team members it involves a lot of variables that go into how and when we make decisions and then we've got the individual factors that's us right so how much uh prior knowledge do I have how much experience can I draw from to make this decision that may impact how quickly I make a decision so you can see that the individual
factors and the environmental factors certainly do impact one another right but nonetheless this entire layer four is the context in which we are doing this clinical judgment so it's not a matter of just simply taking information doing some thinking and do doing the action you have to do all of that quickly and independently right depending on where you are in your in transitioning into nursing practice so but that being said I think this model is really
helping us to well it's helping the ncsbn guide what kind of items right the question items they have new items now and these items are doing a better job now at measuring this clinical judgment clinical judgment's always been around in nursing we've always wanted our nurses to learn how to think critically right but now it's being better measured so I'm going to show you another slide here uh going to compare and contrast what we are looking at and our the current or the old
what will soon be the old uh NCLEX um test item alignment how the items line up to the different pieces of this clinical judgment measurement and the environmental factors are along the top and you can see there's a lot of yellow or even a lot of red and there's very little green the green indicates how well these current items exam items are measuring these pieces of the layer 3 and layer four which may have changed a little bit with the new model but you kind
of understand these pieces of clinical decision making it really wasn't hitting the mark with so much yellow and red with regard to measurement uh and then if you go down to the next slide um you'll see uh this is the comparing to the new um NCLEX next-gen uh clinical judgment measurement model and how it's integrating with the new items and what you'll see is that these new items are doing a much better job at measuring these layer three and layer four on that model that we
just went through um you'll see a lot more green okay so this is the real takeaway Point here is that as Educators in order to help our Learners better perform and not protest but perform in clinical practice the ability to take information make assign some meaning Implement you know come to a decision implement the decision with time pressure with my my knowledge of anatomy and physiology um and pharmacology right drawing from my individual knowledge the ability to do
all this is now going to be measured in a much more rigorous way um so that really uh I think inspires us as nurse Educators to change the way we're teaching to create opportunities for more practice absolutely um yeah and development in this area yeah it forces us really Michelle to begin with the end in mind and for once we have something that it provides a little bit more of the rationale for why you know when we think about clinical judgment and measuring and it's not only
measuring that but how do we help reinforce all of the skills that come with that you talk about analyzing information generating hypotheses you know all of those pieces take practice and that helps us to rethink our roles as Educators where we want to give our Learners opportunities to do that in the classroom in different places because it's a skill they're going to have to practice that's part of what it means to think like a nurse teach one to to to think like a nurse if
we're preparing and so you know all of these these factors around us that drive us to rethink the practice of teaching is part of how do we get out of the way of our own thinking it's sort of an unthinking process to realign to where are we today and and how do we really truly begin with the end in mind in our roles as educators that's great soon I think the call to us as Educators now um or at least for the context of this conversation the invitation is for nurse
Educators to reflect on these um considerations that impact our curricula and our teaching down at the um classroom and lab and clinical areas um have conversations and dialogue with your colleagues in your um your curriculum committees uh and and with leadership um to help to make these changes I think it's just that that would be my invitation to people to reflect and to have conversations about this good stuff absolutely thank you for joining us on this episode
of nln nursing Edge on scripted surface we hope you join us next time until then remember whether your water is calm or choppy stay connected get vulnerable and dare to go beneath the surface