by Josephine DeVito
Nursing education was initially based in a school of nursing associated with a hospital. Students were educated during the day with classes on nursing skills and immediately placed in hospital units to work long hours on various day or night shifts. They were used in staff positions and many times learned as they worked. After three years of education and clinical experience, students were eligible to take the NCLEX exam to become Registered Nurses. As the nursing shortage continued, the need to educate nurses in a professional role became evident and associate degree programs emerged in community college settings. Basic nursing skills to educate nurses to return to bedside care were the priority while students took courses in a college setting. After two years, students received an associate degree in nursing and were eligible to take the NCLEX exam to become Registered Nurses. Nursing education was being challenged in the medical field and struggling to establish the professional, autonomous role of the nurse. Amid these struggles it became evident that the place most appropriate was an academic setting in a university. A baccalaureate education in a four-year program incorporated both the sciences and liberal arts with students receiving a BSN degree in nursing. These students were eligible to take the NCLEX exam to become Registered Nurses. For many years, there were 3 entry level programs students could select from to take the NCLEX exam and become a professional Registered Nurse. Eventually, for various reasons, including the economy, three-year hospital nursing programs closed. This controversy continued since unlike the inception of nursing with Florence Nightingale and religious orders of men entering the profession, nursing needed to be more than a handmaiden of the physician and more autonomous in their role. Within the university setting, additional programs of advanced nursing education continued, including, MSN programs for nurse practitioners, administrators, and educators. Doctoral programs continued to increase with students receiving Ed.D. and Ph.D. degrees in evidence-based nursing research as well as advanced clinical expertise in programs for DNP degrees.
Cardinal John Henry Newman believed that a university education is the pursuit of universal knowledge and truth. A Catholic university must be committed to following its mission of excellence while providing an atmosphere of scholarly education. There needs to be a commitment to knowledge and truth with a unity between faith and reason. According to the American Association of Colleges of Nursing (AACN), there are nine Essentials of Baccalaureate Education for Professional Nursing Practice.[1] They are:
- Liberal Education for Baccalaureate Generalist Nursing Practice
- Basic Organizational and Systems Leadership for Quality Care and Patient Safety
- Scholarship for Evidence-Based Practice
- Information Management and Application of Patient Care Technology
- Healthcare Policy, Finance, and Regulatory Environments
- Interprofessional Communication and Collaboration for Improving Patient Health Outcomes
- Clinical Prevention and Population Health
- Professionalism and Professional Values
- Baccalaureate Generalist Nursing Practice
Liberal education for baccalaureate nursing, Essential I, can be compared with Newman’s philosophy on education in a university. The Association of American Colleges and Universities (AAC & U) defines liberal education as one that intentionally fosters, across multiple fields of study, wide-ranging knowledge of science, cultures, and society. This includes high-level intellectual and practical skills, an active commitment to personal and social responsibilities, and demonstrated ability to apply learning to complex problems and challenges.[2] Newman addresses two methods of education, philosophical and mechanical. Mechanical includes instruction and involves an immediate outcome of the process with a narrow scope. In contrast, Philosophical education is much broader and denotes the liberal education, which Newman advocates for since it is not characterized by physical instruction but by the exercise of reason, mind, and the cultivation of the intellect.[3] As an administrator, Newman promoted science as well as arts, to encourage professional education, to provide for research as well as good teaching, and to broaden the curriculum by including more modern subjects.[4] A liberal education in nursing includes both the sciences and the arts. The sciences included: physical sciences (physics and chemistry), life sciences (biology and genetics), mathematical and social sciences (psychology and sociology). The arts included: fine arts, performing arts, and humanities. Newman considered university learning as a setting where a student is exposed to various subjects, then considers each perspective, and forms a habit of mind that will last a lifetime, which he refers to as, “philosophical habit.”[5] According to Newman the core of the curriculum is the humanities which represents the highest attainment of cultivated minds.[6]
Liberal education is critical to the generation of responsible citizens in a global society. Newman states that being devoted to intellectual excellence is how the university can assist students to understand themselves, to use resources to become critical thinkers, and to solve problems in society. Paul and Elder in 2009[7] characterized a well cultivated critical thinker as the following:
- Raises vital questions and problems, formulating them clearly and precisely
- Gathers and assessed relevant information, using abstract ideas to interpret these effectively
- Establishes well-reasoned conclusions and solutions, testing them against relevant criteria as well as standards
- Ability to think open-mindedly within alternative systems of thought, recognizing and assessing, as needed, their assumptions, implications, and practical consequences
- Communicates effectively with others in figuring out solutions to complex problems
Nurses work within a healthcare team to address issues important to the profession of nursing, question dominant assumptions, and solve complex problems related to individuals and population-based communities. Graduate nurses exercise appropriate clinical judgment, understand the reasoning behind policies and standards, and accept responsibility for continued professional development and the discipline of nursing practice. In health care, critical thinking for nurses is essential. Each nurse seeks awareness of reasoning as he or she applies the criteria and considerations as thinking evolves throughout their career.
The goal of the Essentials of Baccalaureate Education is to transform nursing education for the twenty-first century. Learning opportunities include direct clinical experiences to attain practice focused outcomes while integrating knowledge and skills for professional nursing. According to the Essential[8] liberal education additionally allows the graduate nurse to form the values and standards needed to address changes in healthcare medical technology. These trends will enhance care for the aging population and culturally sensitive, diverse families. Liberal education provides the baccalaureate graduate nurse with the ability to integrate knowledge, skills, and values from the arts and sciences to provide safe, quality care.
ENDNOTES
[1] American Association of Colleges of Nursing (AACN) The Essentials of Baccalaureate Education for Professional Nursing Practice (Washington DC: AACN Publications, 2008), pp. 1-2.
[2] Association of American Colleges and Universities (AAC & U) College learning for the New Global Century. (Washington, DC, 2007), p. 4.
[3] Newman, John Henry, and Ed. Martin J. Svaglic, The Idea of a University (Notre Dame, IN: University of Notre Dame Press, 1982), pp. 84-85
[4] Newman, John Henry, and Ed. Martin J. Svaglic, The Idea of a University (Notre Dame, IN: University of Notre Dame Press, 1982), p. 13.
[5] Newman, John Henry, and Ed. Martin J. Svaglic, The Idea of a University (Notre Dame, IN: University of Notre Dame Press, 1982), p. 179.
[6] Newman, John Henry, and Ed. Martin J. Svaglic, The Idea of a University (Notre Dame, IN: University of Notre Dame Press, 1982), p. 92.
[7] Paul, R. & Elder, L. Miniature Guide to Critical Thinking Concepts and Tools (Foundation for Critical Thinking Press, 2009), p.2.
[8] American Association of Colleges of Nursing (AACN) The Essentials of Baccalaureate Education for Professional Nursing Practice (Washington DC: AACN Publications, 2008), p. 12.