Critical review

Drivers for renewal and reform of contemporary nursing curricula: A blueprint for change

Cheryl Waters
Senior Lecturer, Faculty of Nursing, Midwifery and Health, University of Technology, Sydney NSW

Suzanne Rochester
Senior Lecturer, Faculty of Nursing, Midwifery and Health, University of Technology, Sydney NSW

Margaret McMillan AM
Conjoint Professor, Professor and Deputy Executive Dean, Faculty of Health, University of Newcastle, Newcastle NSW

PP: 207 - 216

Abstract

The creation of a curriculum blueprint appropriate to the development of a professional nurse who is practice-ready for the current and future context of health service delivery must take account of the extant context as well as an unpredictable and sometimes ambiguous future. The curriculum renewal process itself ought to challenge existing long held ideals, practices, and sacred cows within the health and higher education sectors. There is much to consider and importantly curriculum developers need to be mindful of reform within the health sector and health workforce education, as well as the concomitant vision and requirements of the nursing profession. Curriculum must develop more than discipline knowledge and skills: it must provide an infrastructure for generic abilities both social and intellectual in order to better prepare students for the registered nurse role. This paper discusses a number of forces that are essential to consider in curriculum development in undergraduate nursing education.

Keywords

Undergraduate education, nursing education, curriculum drivers, curriculum development, health services reform, health education reform, graduate abilities

Article Text

It may be over a decade in some cases that existing curricula have been in place and as could be expected, despite formative evaluations, there would have been a number of significant changes in the discipline, contexts of employment, higher education, and the health sector. We propose in this paper that these changes scaffold any considerations that drive the revision and renewal of contemporary nursing curricula and provide the blueprint on which implementation is based.  Like other professions the discipline of nursing must respond to the political, social and economic landscape. In large part agenda for change has been set down by professional bodies who have responded to drivers for change by revising standards for practice, competency standards, and curriculum accreditation requirements. 

Undergraduate nursing curriculum development is shaped by complex and competing forces.  At present there are powerful drivers for extensive curriculum renewal. This presents an opportunity for the nursing profession to develop creative curriculum blueprints that accommodate and drive change. Those involved in the education of nurses must aim to build capabilities and maintain processes to improve and sustain graduate outcomes that are consistent with consumer and health service needs. Curricula must be responsive to innovations in practice and learning and teaching. 

Nursing students are being prepared for professional practice in challenging, at times unfamiliar, and dynamic health service systems (Duffield et al., 2007) which are likely to undergo significant alteration as they respond to the changing social, political and economic landscape (National Health and Hospitals Reform Commission, 2009).  Importantly, curriculum developers need to be mindful of the current and likely future contexts of health care and the concomitant elements of vision and requirements of the nursing profession. Curriculum renewal is an opportunity to better prepare students for the likely trends in society and health care into the future. 

The identification of relevant trends, challenges and drivers from both the health care and the higher education sectors is central to the curriculum renewal process. Curriculum renewal is a process that requires inter alia careful consideration and the judicious use of information that can come from a range of sources including the government, professional literature, and external advisory committees.  This paper is focused on these sources and specifically on: changes in the discipline and contemporary context; recent health services reform; changes within the health workforce; and engaging all stakeholders and members of the broader faculty in the curriculum process by articulating their vision, aspirations and strength to produce a curriculum with some elements unique to the organization in which the students are enrolled.

What is clearly evident in the contemporary environment is a shift in health care delivery from hospital to community care, the growing importance of primary health care, the increasing acuity of in-patient care, chronicity in the general patient population, as well as changing population demographics and epidemiology of disease in our community (Garden, Moore, & Jorm, 2005).  Such developments in patterns of health breakdown and health services also call for courses that produce graduates who are focussed on the broadest spectrum of symptom management, are systematic in their thinking, have particular regard for quality and safety, and who are effective users of point of care and other technologies:  graduates who are educationally prepared to respond effectively to emergency situations and recognise the deteriorating patient, and for whom working in interdisciplinary and disciplinary teams is second nature (Clinical Excellence Commission, 2008; Duffield et al., 2007; NSW Department of Health, 2006). Given the dynamic nature of the contexts of care, in addition to those elements of a graduate profile listed above, there is now more than ever a need to acknowledge the importance of maintaining a patient-centred orientation as paramount in graduates, who also have the ability to lead, supervise and delegate to an increasingly unregulated health workforce (Duffield et al., 2007). Recent trends also support what is arguably the most important graduate attribute, that is, the ability to think critically and make sound clinical judgements (Benner, Tanner, & Chesla, 2009). These abilities are achieved through processes that aspire to the achievement of deep learning. This in turn is reliant on active learning pedagogies that generate a curiosity for practice that supports lifelong professional learning.  In essence there is an imperative to produce graduates who in the words of Benner et al. (2009, p. 370) have learnt to 'learn for practice'.

Given the complexities of contemporary health care it is critical that educators themselves reflect on both content and processes within the typical curriculum development journey and question the extent to which a thorough appraisal of changes in the discipline and curriculum context has been undertaken.

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