GUEST EDITORIAL doi: 10.1111/nicc.12087

Innovation in critical care nursing education Although nursing care has changed significantly over the past decades, the methods to clinically train (undergraduate) nurse professionals have, despite exciting and revolutionary initiatives, changed only partly. Curriculum building in nursing has its origins in the USA in the early 20th century with the publication of the Standard Curriculum for Schools of Nursing (National League of Nursing Education, 1917). Yet the world has evolved, largely because of widely accessible and versatile technologies. However, much of the current nurse education system is still based on the Tylerian model particularly emphasizing content, structure and measurable, behavioral outcomes (Bevis and Watson, 1989). Objectives for learning focused mainly on ‘what’ to teach, rather than ‘how’ to teach. Against this background, nurse educators find themselves pulled toward an alignment to ‘content’ to be taught, rather than to the ‘process’ of learning. Mere additions to or changes in the content of what undergraduate nurses are required to learn does not constitute innovation. Contrary, innovation implies a significant reorganization in how undergraduates, and nurse professionals, are educated and fit for practice. Current society demands new ways to learn and advancing understanding, and require new ‘innovative’ ways of developing depth of learning through stimulating, reflective, interactive and engaging teaching strategies. Today, technology intertwines with almost all daily activities, including social contact. With the exception of some progressive minds, numerous educators however lag behind the technological curve and challenge to shift toward increasingly technological means of communication and interaction, or introduce technological,

enhanced learning tools as legitimate educational forums (Schwarz et al., 2013). What is needed today is to uphold the true spirit of innovation and overhaul traditional training methods to effectively improve the way the nursing workforce is educated. Given the aging nurse workforce, the rapidly changing health care environment where short stays in acute-care facilities are common and high-tech care is being provided to an often complex case-mix, current (critical care) nurse professionals are required to have a broad range of different skills and knowledge (Vandijck et al., 2008a, 2008b). One might consider the efforts needed to cope with the above mentioned challenges to be enormous, but it can be considered a very exciting one as well. Moreover, it is almost a perfect storm that requires us to really rethink and examine what should be done in the classroom, and outside. Transforming how nurse professionals are educated and trained, not only at the entry level but also throughout their careers, will become critically important if we (also) want to ensure the highest quality patient care in the future. What we need are nurse professionals who on the one hand are team players, who can combine health promotion, (evidence-based) infection prevention, who function effectively in ambiguous, unpredictable and multidisciplinary settings, and who are able to execute a wide variety of roles and advanced skills throughout a lifetime career on the other (Vandijck et al., 2010). These competencies are, however, crucial in a dynamic and diverse health care environment. Consequently, nurse educators must think in new ways, ways that challenge everything present and absent in current approaches to nursing education and explore new possibilities

© 2014 British Association of Critical Care Nurses • Vol 19 No 2

for nurse professionals, including preparing future generations of nurses. A noteworthy initiative was the one of the Institute of Medicine that released a groundbreaking report about the future of nursing by discussing innovation in nursing education (Institute of Medicine, 2011). The report included a call to nurse educators, researchers, academics, and administrators to form partnerships and redesign nursing curriculum to better meet the demands of current and future nursing practice. Nurse educators and administrators are responding to that call by adopting new pedagogies and with innovations that will better prepare graduates for the ever-changing health care environment and will help nurses provide higher quality of care in a range of settings. Many of these new pedagogical innovations fall into one of several broad categories; respectively, educational technology (i.e. the study and ethical practice of facilitating e-learning and improving performance and quality of care by creating, using, and managing appropriate technological processes and resources) and narrative pedagogy (i.e. approach to thinking about teaching and learning that evolves from the lived experiences of nurse educators, professionals, and students); new and stronger partnerships between academia and practice; and new educational systems that help (undergraduate) nurse professionals earn specialized degrees and advance their education (Richey, 2008). However, electronic e-books, integration of social media outlets, video and podcasts during classes and creating virtual ‘second life’ teaching scenarios (i.e. interactive way of teaching course in which students can, from a distance, collaborate for instance through chat and/or used as a more suitable ‘low risk’ simulation 59

Guest Editorial

tool) do not necessarily represent innovation in nurse education (Baker et al., 2009). The use of dynamically sophisticated simulation-based technologies (e.g. for cardiopulmonary resuscitation, triage/disaster-, fluid-, pain management, etc.) will become one of the hottest trends in nursing education. In these situations, it will be possible to create specific scenarios about a fictional patient in need of medical attention. Nurse professionals will be able to, in a high-fidelity manner, respond and provide appropriate treatment and care to the fictional patient that responds as if it were an actual person. This kind of technological innovations is what will change the way today’s (undergraduate) nurse professionals learn. The classroom of the future will be very interactive and technologically wellequipped. (Undergraduate) nurse professionals won’t come into the classroom and line up in chairs and have content delivered ex-cathedra to them. Rather, they will be very much engaged in interactive learning. An inspiring evidence-based example consists of an interactive web-based e-course bundling the essentials of infection prevention for evaluating the value of e-learning, which was developed after significant knowledge gaps were found among a large international sample of (undergraduate) critical care nurse professionals (Blot et al., 2007; Vandijck et al., 2008a, 2008b; Labeau et al., 2008; Labeau et al., 2009; Labeau et al., 2010). The study revealed that this innovative way of education yielded significant and even residual learning effects, promoting the widespread use of such advanced tools for training purposes for undergraduates, including experienced nurse professionals (Labeau et al., 2011). Conclusively, discussions about innovation must no longer be limited to a discussion of content, although barriers to change are present and have to be recognized, not the least of which is the pressure to meet education and regulatory requirements set by academic institutions and professional organizations. Notwithstanding, it will 60

be of utmost importance to scientifically document the effects of the innovative initiatives being undertaken (respectively, how education can impact upon patient safety and outcome), and adapt if necessary, as it will be at least as important to ensure that the patient voice is added to curriculum innovation. Above all, in a time of limited resources it is also needed to evaluate the cost-effectiveness of any approach. The ultimate objective will be getting evidence-based approaches better and sustainably embedded into (critical care) nursing education in which (undergraduate) nurse professionals learn to provide skillful and compassionate care in the rapidly changing health care environment. Dominique Vandijck Professor of Health Economics & Patient Safety, Department of Healthcare Management & Patient Safety, Faculty of Business Economics, Hasselt University, Diepenbeek, Belgium, and Department of Health Economics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium E-mail: [email protected] Johan Hellings Professor of Patient Safety, Department of Patient Safety, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium

REFERENCES Baker S, Wentz R, Woods M. (2009). Using virtual worlds in education: second life as an educational tool. Teaching of Psychology; 36: 59–64. Bevis E, Watson J. (1989). Toward a Caring Curriculum: A New Pedagogy for Nursing. New York: National League for Nursing Press. Blot S, Labeau S, Vandijck D, Van Aken P, Claes B, Executive Board of the Flemish Society for Critical Care Nurses. (2007). Evidencebased guidelines for the prevention of ventilator-associated pneumonia: results of a knowledge test among intensive care nurses. Intensive Care Medicine; 33: 1463–1467. Institute of Medicine. (2011). The Future of Nursing: Leading Change, Advancing Health. Washington: National Academia Press.

Labeau S, Vandijck D, Rello J, Adam S, Rosa A, Wenisch C, B¨ackman C, Agbaht K, Csomos A, Seha M, Dimopoulos G, Vandewoude K, Blot S, for the EVIDENCE study investigators. (2008). Evidence-based guidelines for the prevention of ventilator-associated pneumonia: results of a knowledge test among European intensive care nurses. The Journal of Hospital Infection; 70: 180–185. Labeau S, Vandijck D, Rello J, Adam S, Rosa A, Wenisch C, B¨ackman C, Agbaht K, Csomos A, Seha M, Dimopoulos G, Vandewoude K, Blot S, EVIDENCE study investigators. (2009). Centers for Disease Control and Prevention guidelines for preventing central venous catheter-related infection: results of a knowledge test among 3405 European intensive care nurses. Critical Care Medicine; 37: 320–323. Labeau S, Witdouck S, Vandijck D, Claes B, Rello J, Vandewoude K, Lizy C, Vogelaers D, Blot S, and on behalf of the Executive Board of the Flemish Society for Critical Care Nurses. (2010). Nurses’ knowledge of evidence-based guidelines for the prevention of surgical site infection. Worldviews on Evidence-Based Nursing; 7: 16–24. Labeau S, Vandijck D, Brusselaers N, Vandewoude K, Vogelaers D, Blot S. (2011). Webbased resources for critical care education. The EVIDENCE crash course: a web-based interactive e-course on infection prevention for critical care clinicians. Critical Care Medicine; 39: 2202–2203. National League of Nursing Education. Committee on Education. (1917). Standard Curriculum for Schools of Nursing. Baltimore: Waverly Press. Richey R. (2008). Reflections on the 2008 AECT definitions of the field. Tech Trends; 52: 24–25. Schwarz D, Stourac P, Komenda M, Harazim H, Kosinova M, Gregor J, Hulek R, Sm´ekalova O, Krikava I, Stoudek R, Dusek L. (2013). Interactive algorithms for teaching and learning acute medicine in the network of medical faculties MEFANET. Journal of Medical Internet Research; 15: e135. Vandijck D, Blot S, Labeau S. (2008a). Critical care nursing: towards 2015. Nursing in Critical Care; 13: 286. Vandijck D, Labeau S, De Somere J, Claes B, Blot S, on behalf of the Executive Board of the Flemish Society of Critical Care Nurses. (2008b). Undergraduate nursing students’ knowledge and perception of infection prevention and control. The Journal of Hospital Infection; 24: 6–7. Vandijck D, Labeau S, Vogelaers D, Blot S. (2010). Prevention of nosocomial infections in intensive care patients. Nursing in Critical Care; 15: 251–256.

© 2014 British Association of Critical Care Nurses

Innovation in critical care nursing education.

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