Part (3) Nursing Education and Research

Transcription

1 Part (3) Nursing Education and Research Trends in nursing education and research cannot be isolated from the dynamics of nursing practice. Likewise, nursing trends are responsive to the projected changes in the delivery, organization, and financing of health care. The health care revolution occurring in the United States is spurred by the questionable effectiveness of the current system to provide access to basic health services in an efficient and cost-effective manner. Because of the lack of a unified federal and state health care policy that directs, monitors, and ensures the basic value of health, discussion about appropriate practice roles and an adequate supply of professionals is central in the health care industry. Nursing Education Nursing Educational programs that prepare graduates to write a licensing examination must be approved by a state or provincial (Canada) Board of Nursing. Boards approve entry level programs to ensure the safe practice of nursing by setting minimum educational requirements and guaranteeing the graduate of the program is an eligible candidate to write a licensing examination. Types of educational programs Educational programs available for nurses include the following: 1. Licensed practical or vocational nursing programs 2. Registered nursing programs 3. Graduate nursing education 4. Continuing education 5. In-service. ١ University of Mosul / College of Nursing Introduction of nursing

2 1. Licensed practical or vocational nursing programs 1. Practical or vocational nursing programs are provided by community colleges, vocational schools, hospitals, or other independent health agencies. 2. These programs usually last 9 or 12 months and provide both classroom and clinical experiences. 3. At the end of the program, the graduate takes the NCLEX-PN to obtain a license as a practical or vocational nurse. 4. Licensed practical nurses practice under the supervision of a registered nurse in a hospital, nursing home, rehabilitation center, or home health agency. 5. LPNs (LVNs) usually provide basic direct technical care to clients. 2. Registered nursing programs Currently, three major educational routes lead to RN licensure: a. Diploma b. Associate degree c. Baccalaureate programs. Diploma Programs a. The first program to train women in nursing was established in 1860 at St. Thomas Hospital, England. b. Today s hospital-based educational programs vary from 2 to 3 years in length and are often affiliated with colleges or universities. c. Diploma education has always been associated with providing nursing students with strong hospital-based clinical experience. ٢ University of Mosul / College of Nursing Introduction of nursing

3 d. With the decline in hospitalized clients, diploma programs have expanded their practice sites to include community-based services (NLN, 1996). Associate Degree a. In the 1950s, Mildred L. Montag introduced the blueprint for associate degree nursing programs in response to the nursing shortage that followed World War II. Montag envisioned the associate degree graduate as a technical nurse who would work under the supervision of a professional nurse. b. Associate degree programs are typically 2 years in length and are located in community colleges but may be found as options at 4-year degree granting universities. c. Program content in associate degree programs has reflected basic skill preparation and has traditionally emphasized clinical practice in a hospital setting. However, because of the decreasing demand for hospital beds, these students are likely to spend more clinical education hours in community-based institutions (ambulatory settings, schools, and clinics). Baccalaureate Degree a. In the early 1900s, baccalaureate nursing programs were established in university settings in the United States and Canada to provide the students with a liberal arts education. b. The typical 4 year educational preparation provides the student with a Bachelor of Science degree in nursing (BSN). c. The equivalent degree in Canada is a Bachelor of Science in Nursing (BScN) or a Bachelor in Nursing (BN). d. Most baccalaureate programs have special curricula to accommodate RNs of associate degree and diploma programs to articulate to a BSN. ٣ University of Mosul / College of Nursing Introduction of nursing

4 e. The major components of baccalaureate nursing education are liberal education, professional values, core competencies (critical thinking, communication, assessment, and technical skills), core knowledge and role development (AACN 1998). 3. Graduate Nursing Education Most graduate programs are conducted by departments within the graduate school of a university, and the applicant must first meet requirements established by the graduate school. Although graduate schools differ, common requirements for admission to graduate programs in nursing include the following: a. The applicant must be a registered nurse licensed or eligible for licensure within the program's state. b. The applicant generally must hold a baccalaureate degree in nursing from an approved college or university and have had an acceptable upper division major in nursing at the baccalaureate level. c. The applicant must give evidence of scholastic ability (usually a minimum grade point average of 2.7 to 3.0 on a 4.0 scale). d. The applicant must demonstrate satisfactory achievement on a qualifying examination, such as the Graduate Record Examination (GRE) or the Miller Analogy Test (MAT) e. The applicant must have letters of recommendation from supervisors, nursing faculty, or nursing colleagues indicating the applicant's ability to do graduate study. ٤ University of Mosul / College of Nursing Introduction of nursing

5 Master's Programs The growth of university nursing programs encouraged the development of graduate study in nursing. a. In 1953, the newly established National League for Nursing encouraged educators to develop programs for master's degrees in nursing. b. The major emphasis of the programs was to be research and specialization for teaching and administration. The first "clinical" master's degree (in psychiatric nursing) was offered at Rutgers University in New Jersey in c. Today master's programs generally take from 1.5 to 2 years to complete. Degrees granted are the master of arts (MA), master in nursing (MN), master of science in nursing (MSN), and master of science (MS). d. Master's degree programs provide specialized knowledge and skills that enable nurses to assume advanced roles in practice, education, administration, and research. Doctoral Programs Doctoral programs in nursing, which award the degrees of doctor of philosophy (PhD), doctor of nursing science (DNS or DNSc), or nursing doctorate (ND). a. Began in the 1960s in the United States. b. These programs further prepare the nurse for advanced clinical practice, administration, education, and research. c. Before 1960, nurses acquired doctoral degrees in such related fields as psychology, sociology, physiology, and education. ٥ University of Mosul / College of Nursing Introduction of nursing

6 d. In 2004, the American Association of Colleges of Nursing (AACN) approved a move to prepare advanced practice nurses (nurse practitioners, nurse anesthetists, nurse midwives, and clinical nurse specialists) at the doctoral level awarding a doctor of nursing practice (DNP) and phasing out the DNS and ND designations 4. Continuing Education a. The term continuing education (CE) refers to formalized experiences designed to enlarge the knowledge or skills of practitioners. b. Compared to advanced education programs, which result in an academic degree, CE courses tend to be more specific and shorter. c. Participants may receive certificates of completion or specialization. Continuing education is the responsibility of each practicing nurse. d. Constant updating and growth are essential to keep abreast of scientific and technological change and changes within the nursing profession. e. A variety of educational and health care institutions conduct continuing education programs. They are usually designed to meet one or more of the following needs: 1. To keep nurses abreast of new techniques and knowledge 2. To help nurses attain expertise in a specialized area of practice, such as intensive care nursing 3. To provide nurses with information essential to nursing practice, for example, knowledge about the legal aspects of nursing. 5. In-Service Education An in-service education program is administered by an employer; it is designed to upgrade the knowledge or skills of employees. For example, an employer might offer an in-service program to inform nurses about a ٦ University of Mosul / College of Nursing Introduction of nursing

7 new piece of equipment, specific isolation practices, or methods of implementing a nurse theorist's conceptual framework for nursing. Some in-service programs are mandatory, such as cardiopulmonary resuscitation and fire safety programs. Nursing Research Today, nurses are actively generating, publishing, and applying research in practice to improve client care and enhance nursing s scientific knowledge base. Although the focus for all nurses is use of research findings in practice, the degree of participation in research depends on the nurse s educational level, position, experience, and practical environment. Research is a systematic method of exploring, describing, explaining, relating, or establishing the existence of a phenomenon, the factors that cause changes in the phenomenon, and how the phenomenon influences other phenomena. Nursing practice activities are substantiated as predicting valid and reliable outcomes for clients (the individual, family, group, or community) only after a body of knowledge has been established and confirmed by numerous research efforts.. Research Process The person conducting the research is called researcher, investigator, or scientist. When a researcher poses a problem or answers a question using the scientific approach, it is called a study, an investigation, or a research project. The people who are being studied are called subjects or study participants. ٧ University of Mosul / College of Nursing Introduction of nursing

8 Approaches to nursing research There are two major approaches to investigating diverse phenomena in nursing research. These approaches originate from different philosophical perspectives and use different methods for collection and analysis of data. 1. Quantitative research Quantitative research progresses through systematic, logical steps according to a specific plan to collect numerical information, often under conditions of considerable control that is analyzed using statistical procedures. The quantitative approach is most frequently associated with positivism or logical positivism, a philosophical doctrine that emphasizes the rational and the scientific. Quantitative research is often viewed as hard science and uses deductive reasoning and the measurable attributes of human experience. The following are examples of research questions that lend themselves to a quantitative approach: a. What are the differential effects of continuous verses intermittent application of negative pressure on tracheal tissue during endotracheal suctioning? b. Is the auscultatory method effective in validating the location of a feeding tube? ٨ University of Mosul / College of Nursing Introduction of nursing

9 The quantitative research process a. State a research question or problem The investigator s initial task is to narrow a broad area of interest to a circumscribed problem that specifies exactly the intent of the study. The ideas for research may arise from recurrent problems encountered in practice, questions that are difficult to resolve because of contraindications in the literature, or areas in which minimal or no research has been done. In formulating a research problem suggest that four criteria be used: significance, researchability, feasibility, and interest to the researcher. Research problems contain dependent and independent variables, except for descriptive research, which has no dependent variables. 1. The dependent variable is the behavior, characteristic, or outcome that the researcher wishes to explain or predict. 2. The independent variable is the presumed cause of or influence on the dependent variable. b. Define the study s purpose or rationale The statement of the study s purpose indicates what the researcher intends to do with the research problem identified. The study purpose includes what the researcher will do, who the subjects will be, and where the data will be collected. c. Review the related literature Before progressing with the development of the research design, the investigator determines what is known and what is not known about the problem. A thorough review of the literature provides the foundation on which to build new knowledge. Through a literature ٩ University of Mosul / College of Nursing Introduction of nursing

10 review, a researcher may also acquire information about available techniques, instruments and methods of data analysis that have been used in prior research, as well as potential flaws or problems and how to avoid them. d. Formulate hypotheses and define variables Some studies are intended to develop hypotheses, whereas others are intended to test hypotheses using statistical procedures. Hypothesis formulation requires not only sufficient knowledge about a topic to predict the outcome of the study but also operational definitions, definitions that specify the instruments or procedures by which concepts will be measured. e. Select a research design to test the hypotheses A research design is the overall plan for answering the research questions or testing the research hypotheses. The research design includes the study setting, the sample, and the type of data to be collected, as well as strategies to control extraneous variables and reduce bias. There are three major types of research design: 1. Experimental design. The investigator manipulates the independent variable by administrating an experimental treatment to some subjects while withholding it from others. 2. Quasi-experimental design. The investigator manipulates the independent variable but without either the randomization or control that characterizes true experiments. 3. Non experimental design. The investigator does no manipulation of independent variable. ١٠ University of Mosul / College of Nursing Introduction of nursing

11 f. Select the Population, Sample, and Setting 2. Qualitative research The qualitative approach is often associated with naturalistic inquiry, which explores the subjective and complex experiences of human beings. Qualitative research investigates the human experience as it is lived through careful collection and analysis of narrative, subjective materials. Data collection and its analysis occur concurrently. Using the inductive method, data are analyzed by identifying themes and patterns to develop a theory or framework that helps explain the processes under observation. The qualitative approach would be appropriate for the following type of research question: What is the nature of coping and adjustment after a radical prostatectomy? Steps in the research process Formulating a research question or problem Defining the purpose of the study Reviewing relevant literature Developing a conceptual framework (structure that links global concepts together to form a unified whole) Developing research objectives, questions, and hypotheses Defining research variables Selecting a research design (overall plan used findings, their implications, and the limitations of the study Defining the population, sample, and setting Conducting a pilot study ١١ University of Mosul / College of Nursing Introduction of nursing

12 Collecting data Analyzing data Communicating research Abstract Contents: 1. Title of the Study 2. Introduction of the Scientific Problem: Statement of the problem and purpose Identification of the framework 3. Methodology Design Sample size Identification of data analysis methods 4. Results Major findings Conclusions Implications for nursing Recommendations for further research Types of research design 1. Historical: Systematic investigation of a past event using relevant sources to describe or explain the event. 2. Exploratory: Preliminary investigation designed to develop or refine hypotheses or to test the data collection methods 3. Evaluative: Systematic investigation of how well a program, practice, or policy is working. ١٢ University of Mosul / College of Nursing Introduction of nursing

13 4. Descriptive: Investigations that have as their main objective the accurate portrayal of the characteristics of persons, groups, or situations and the frequency with which certain phenomena occur. 5. Experimental: Research studies in which the investigator controls (manipulates) the independent variable and randomly assigns subjects to different conditions. 6. Quasi-experimental: Studies that deviate from the methods of the experimental component in that subjects cannot be randomly assigned to treatment conditions even though the researcher manipulates the independent variable and exercises certain controls to enhance the internal validity of the results (Adapted from Polit, D. F., & Hungler, B. P. [1998]. Nursing research: Principles and methods [6th ed.]. Philadelphia: Lippincott.) Trends in Nursing Research The following trends in health care will have a definite impact on future nursing research. 1. Increasing numbers of doctorally prepared nurses will contribute to building and evaluating the science of nursing practice. 2. Nurse scientists will build international collaboration. 3. National research priorities will establish a strong scientific base for nursing within the priorities. 4. Nurse scientists will increasingly be educated and funded in health services research as related to clinical practice guidelines for nursing care services to reduce variance in nursing practice activities. 5. Nurses working with clients on research protocols will continue to confront ethical dilemmas that balance the goals of research with those of the client and client care. The client advocacy and ١٣ University of Mosul / College of Nursing Introduction of nursing

14 empowerment role will consume a larger component of nursing practice. 6. The collaborative efforts by national organizations to develop innovative systems strategies to identify the barriers and bridge the gaps around the process of adopting evidence-based practice. ١٤ University of Mosul / College of Nursing Introduction of nursing