"The extant system of nursing education is totally inadequate to meet the needs of society for nursing care."
Esther Lucille Brown, 1948 (Stokowski, 2011b)
Trends in Nursing Education
Trends in nursing education are keeping pace with those in the general field of adult education, but also include factors specific to nursing such as the rapidly changing health care environment. When I ‘googled’ trends in nursing education to see what was being said in the overall on-line world, I immediately found a promising hit – “Modern Trends in Nursing Education”. In the article the author states, “Nursing education is undergoing drastic changes. History repeating herself through a new social expression has kept consistently in step with the development and progress in related fields of life activity. The demand today for a different preparation for the nurse, general and professional, is a demand not of the idealist but of the times.” Sounds accurate enough. Then I looked at the date – 1936. It seems we have been discussing trends in nursing education since Florence Nightingale opened the first formal nursing school, the Nightingale Training School for Nurses, in 1859 (MGH, 2010). The more things change, the more they stay the same.
Click Read More to learn about my personal experience with flipping the classroom in a Saudi College of Nursing.
For a more current look at Nursing Education I went to an article by Laura Stokowski. (2011a). In “Overhauling Nursing Education” Stokowski summarizes the Institute of Medicine's report on the profession of nursing, The Future of Nursing, and the Forum on the Future of Nursing: Education. These reports outlined the innovations that are needed in three areas: what to teach (ideal future nursing curricula), how to teach (methodologies and strategies), and where to teach (venues and locations for nursing education), in order to meet the future healthcare needs, of Americans in this case, but clearly transferrable to the Canadian situation, where our healthcare system is also moving out of the hospital and into the community, leaving the most seriously ill and complex patients behind. Canada has already made the BSN as the requirement for entry-to-practice. Recommendations relevant for Canadians are: increasing the proportion of nurses with bachelor's and higher degrees; increasing the number of nurse residency/transitional programs; and preparing nurses for nonhospital (ambulatory) roles. Other trends that are recommended include the need for a focus on true competency-based learning, inter-professional education, and ongoing continuing education for nurses in order that they can keep up in a rapidly changing, increasingly technological health care environment.
A key finding is that the entire nursing education curriculum is out of date and needs a major overhaul. We will never be able to teach our student nurses everything. What we need to be able to do is produce nurses who are critical thinkers, interdisciplinary team players and leaders; nurses who can navigate clinical systems, use new technologies, and who can translate future research generated knowledge into changing clinical practice. This is true in Canada, and equally true in Saudi Arabia...
My Personal Experience with Flipping the Classroom in a Saudi College of Nursing
My learning partner Rhonda and I chose ‘The Flipped Classroom’ as our research topic to explore for our Trends and Roles assignment. My personal interest in this came from my recent experience teaching a ‘blended learning’ curriculum to Saudi nursing students at the Saad College of Nursing. Our college had partnered with Ulster University to use their curriculum and faculty expertise, and our students would graduate with a UU degree. I believe Ulster won the contract because of their implementation of an “innovative format” of E-learning with face-to-face learning. It was in keeping with the future trend of nursing education internationally. Ulster had packaged on-line learning modules which the students were to work their way through prior to class, so that during class time we would be able to focus on ‘active learning’ – discussions, case studies, role playing, group work, etc. – with the teachers role being that of group facilitator. We weren’t using video lectures, as is often the format, and we didn’t call it ‘flipped classroom’, ‘flipped teaching’, or ‘flipped learning’, but now I understand that that is essentially what we were attempting. I say ‘attempting’ on purpose because it did not work, and here’s why…
Firstly, our students did not do their homework. Surprise Surprise. Saudi Arabia is very family-centered, the girls came from large families, and many had husbands and small children. Women studying to be nurses is still a concept many do not fully support, as they feel the role of a woman is in the home, and even if she does work, a profession that requires interactive, sometimes intimately, with men is even more ‘Haram’. When the girls went home they were expected to fully engage in all the family social activities, schoolwork was for school.
In addition, the Saudi educational system is still very traditional, and these students had grown up being spoon-fed content via lectures from the teachers, memorizing it, and regurgitating it back word for word in a final exam. They were VERY good at that kind of surface learning. However they were not self-directed, intrinsically motivated adult learners. In addition, the teachers had all grown up in a similar system and learned to teach using the traditional lecture format, so they also were uncomfortable with this new role. What happened in reality? The on-line modules were printed out into booklets for the students (they still did not read them before class, but at least there was a hard copy to refer to). The teachers made power point lectures based on the module content, and lectured the students in class. The students memorized the slides, and repeated the slide content back at exam time. They were not interested in engaging in activities that were not directly related to marks. Add into this situation English as a Second Language for both the students and teachers, and you actually have to chuckle, the expectations were so unrealistic.
At the time I thought the problem was ALL due to the cultural factors and Saudi’s traditional educational system. We were implementing a TREND that was theoretically engaging, but not transferable to Saudi Arabia – at least not at that point in time, and not in that manner. Now, having had a chance to explore the concept of the flipped the classroom within the western context, I understand that many academics here have faced similar challenges. Guess what? Western students also do not do their homework! They arrive at class unprepared, and so are unable to engage. Many are also happier to be fed a lecture, memorize it and spit it out later. Most only focus their effort on what is being assessed – the final grade being the bottom line.
So as a trend in nursing education, while ‘flipping the classroom’ may be the future, it is not as easy as simply asking the students to learn the content before class. It is a whole lot more complicated than that. One of the reasons I am taking this Provinical Instructors Diploma Program is so that I hopefully aquire the competencies needed to be able to thoughtfully and skillfully apply new teaching and learning methods effectively.
Goodrich, A. (1936). Modern trends in nursing education. American Journal of Public Health.
Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1562818/
Massachusetts General Hospital (2010). Florence Nightingale: Nursing a profession.
Retrieved from Promag On-Line Newsletter: http://protomag.com/assets/florence-nightingale-nursing-a-profession
Stowkowski, L. (2011a). Overhauling Nursing Education. Medscape. Jan 28, 2011.
Retrieved from: http://www.medscape.com/viewarticle/736236
Stowkowski, L. (2011b). Nurses are talking about: Overhauling nursing education. Medscape. October, 2011.
Retrieved from: http://www.medscape.com/viewarticle/751393