Shaping Nursing Pedagogy to Support Client-Focused Care for the Practitioners of Tomorrow

Nursing education has undergone profound change during the past several decades.  A rapidly changing healthcare landscape and the globalization of healthcare faces present day nurse educators.   The health care delivery system of the future will rely on teams of nurses, nurse practitioners, physicians, dentists, social workers, pharmacists, and other providers to work together.  Team-based, interdisciplinary approaches have been shown to be highly effective for improving clinical outcomes and reducing cost; it is therefore imperative that schools of nursing focus on teaching methods that incorporate opportunities for interdisciplinary education.  Demonstration of leadership and competence in collaborative settings aligns with preparation of nurses for their unique professional role.  Through carefully determined pedagogy and curriculum, nurse educators can engage students in ways that will amply prepare them to shape and partake in the emerging health care system.  As education continues to shift toward a more holistic paradigm, research in areas related to intellectual stimulation is an integral part of the scientific initiative of improving the nation's health. Interprofessional simulation in education provides a platform for healthcare professionals and students to practice the critical skill of effective communication, and in turn, improve health outcomes (SSIH, 2015). Effective communication skills and teamwork are fundamental to quality patient care. Simulations have been the most frequent strategy employed to improve competence in interprofessional education (Hudson, Sanders, & Pepper, 2013). Baker et al. (2012) found a positive response when curricular programs incorporating interprofessional simulation education (IPSE) were evaluated; it was concluded that IPSE for skill learning was a valuable educational approach.

     Transformation learning is vital to undergraduate nursing education. Development of skills for ongoing autonomous thinking allows emerging nurses to be empowered, engage in critical dialogue with associated healthcare disciplines, and poised for use of evidence-based practices.  The culture of nursing education is to produce graduates who have been educated to provide care that is distinctly client-centered.  Furthermore, education focuses on preparing nurses entering the workforce to be confident in influencing change whilst developing empathy and respect for each unique client.  In her landmark study, From Novice to Expert: Excellence and Power in Clinical Nursing Practice, Patricia Benner (1984), described how nursing students are enculturated to develop what she calls "nursing connoisseurship," a hallmark of growing expertise within nursing culture.  Primarily, student nurses learn about the nursing culture and profession through the lived experience of the clinical practice that they are exposed to.   

     A study was developed and implemented, using the National League for Nursing/ Jeffries Simulation Framework (Jeffries, 2012) incorporating key principles of evidence-based practice to effectively teach safe patient discharge.  This was performed using a multi-disciplinary approach with focus on student nurses developing skills for autonomous thinking, a key component of transformational learning. The facilitator was a nurse educator involved in curriculum design and trained in TeamSTEPPS, an evidence-based framework with a goal of optimizing team performance across the healthcare delivery system.  TeamSTEPPS was created by The Department of Defense Patient Safety Program in collaboration with the Agency for Healthcare Research and Quality. Participants in this research included 53 undergraduate accelerated nursing students and 28 first-year internal medicine residents. Objectives were set forth and presented to all participants. Pre-reading, focusing on importance of safe patient discharge was distributed to all participants two weeks prior to the study’s implementation. Standardized patients were trained and provided a human aspect to the research. Educators facilitated pre-workshop activities with a focus on communication, and safe, quality patient care.  During this phase, motivation played a large role. Students learned of faculty vision, supporting the need for further research in an area of developing autonomous individual thinkers, along with the ability to strongly perform as part of a collaborative interdisciplinary team. Research design included randomized interdisciplinary teams being provided a door note of a newly diagnosed diabetic in need of clear discharge instructions to ensure safe care upon leaving the hospital environment. The team mission was to perform as a functioning unit, with nursing and medicine affording each other input to ensure clear understanding from the patient perspective. A supportive environment during pre-workshop, the simulation experience itself, and throughout debriefing sessions was demonstrated by nursing facilitators via active engagement and simulation feedback. Debriefing sessions allowed for individual consideration, validated by encouraging each team member to identify strengths and weaknesses not only of the group, but to additionally reflect on their contribution to the student-patient interaction. A safe environment was provided to all students to share their experiences with one another and the facilitator. Nurse leaders engaged with students in such a way that raised their level of performance and motivation, a key principle in transformation leadership (Harrison, 2011).

     Quantitative data was collected using a pre- and post- survey with a Likert scale and overt observations. Furthermore, anecdotal feedback during debriefing discussions was fundamental in understanding the nurse educator role modeling leadership.  Results indicate a strong need for further transformative strategies in undergraduate nursing education. It was viewed by 96% of the nursing participants as a valuable learning experience in which they developed communication skill acquisition and increased learning of roles/ responsibilities as both a patient advocate and team member. Moreover, a significant finding regarding emerging nurse leadership of students was concluded from ‘strongly agree’ on the Likert scale post-survey when compared to pre-study survey data.  

     With the current focus on healthcare, interdisciplinary models whereby educators serve as leaders in the skill development of the student nurse as they become more secure in their responsibilities and roles and develop an autonomous thinking style with the ability to communicate effectively and work in a collaborative environment. Group models fit the requirements for quality and transparency in healthcare as outlined by the Institute of Medicine (2010). Continued formal evaluation and dissemination of learning outcomes that validate the use of transformative strategies is necessary.