Building the science for nursing education: Vision or improbable dream
Article Outline
Education is not the filling of a pail, but the lighting of a fire.
—William Butler Yeats
Thirty years ago leaders in nursing had visions of building a science of nursing that would provide nurses with knowledge to improve the care of patients. Nurse theorists wrote about their world views and developed theories of nursing that excited and resonated with many nurses who viewed the world from something other than a disease-focused perspective. Researchers, who sought doctorates in other fields (as there were few PhDs in nursing), brought their knowledge and skills and created Doctor of Philosophy (PhD) and Doctor of Nursing Science (DNS) programs all over the country, with a strong emphasis on and commitment to building the science of nursing. At times, however, it appeared to a young person like me that those 2 groups of pioneers in the discipline were on different pages in terms of what they thought should be the focus of study and “what counted for truth.” Hence, so many of our nursing models were not tested as were those in other disciplines such as sociology and psychology. In addition, during that time so much valuable time was spent arguing about whether these nursing conceptualizations were grand theories or models, testable or not, and whether quantitative or qualitative research was appropriate to further their development. As a result, it took us a while to get on with the work of developing nursing science—but we did. Although there is still more to be done, we developed a knowledge base from which to frame complex questions and methods to test the efficacy and effectiveness of interventions to promote health, ameliorate symptoms, and improve the quality of life of individuals and families experiencing illness. Those who worked so hard and devoted their careers to this should be proud.
But are we re-enacting that era of thought in our discipline again? We now face another important area of nursing in which there is a considerable knowledge deficit which has a major impact on the profession: nursing education. The absence of a substantial knowledge base, a critical mass of trained nurse researchers, and a commitment to building a science of nursing education is costing the profession in so many ways. Our models of educating nurses of the future are often staid and outmoded and, at times, irrelevant. Some would argue the lack of innovation and evidence-based practices in our classrooms and clinical teaching has cost us the interest of a generation of young educators who do not see the excitement in teaching. As a discipline, we have not lit the fire of inquiry in the younger generation related to teaching.
Over the past few years I have heard many interesting observations and opinions about what knowledge one needs to effectively prepare the next generation of nurses. Some ask “Why do nurse educators need science to prepare the next generation of nurses?” and “Why can't educators just use findings from general educational science to answer their questions?” Others argue that the phenomenon of nursing education is not about developing science but, rather, evaluating what teachers “do.” Interestingly, if one applies the 5 components of science to the study of the phenomenon of teaching nursing1—testability, reliability, precision and definition, coherence or systematic character, and comprehensiveness and scope—it appears the phenomenon is all too real (and amenable to research). Others claim that there is no funding, anyway, to support nursing education research and that we cannot “afford” to train a critical mass of education researchers, as this would take away from the potential pool of nurse educators who could be clinical scientists. Of course, all of these statements are unburdened by data and may even be steeped in traditions of how we all learned to be a nurse.
Why should we care? Nursing education is a very expensive endeavor in terms of time, effort, and talent. As with any clinical discipline, nursing is one that is incredibly complex to teach. Frankly, with few exceptions, we are wasting so many resources (fiscal and human) by teaching using the same methods we have used for 40 years. There are pockets of nurse educators across the country who conceptualized some innovations but who, too often, implemented them without employing rigorous research and methods to evaluate their effectiveness. Similar to medical education,2 educational studies in nursing are most often not funded by external sources, and they use single sites, small samples, and test one intervention at a time. The typical intervention study does not include a well-developed theoretical framework. Have we learned no lessons from the past 30 years building a clinical science? Or do the 2 groups of educators just not talk to each other or value the others' contributions?
Instead of viewing this very real problem from a deficit model, we need to come to some consensus about whether we actually have the disciplinary will to do what it would take to name the problem and take the steps necessary to address it. If there really is a need to systematically build a knowledge base (science) that could guide nurse educators to develop high quality, relevant, and cost-effective models of education that produce graduates who can make a difference in the health system, then we have lots of work to do. For starters, we need to stop pretending that all PhD graduates are interested in and trained well to engage in clinical science. The reality is that only a relatively small percentage of PhD graduates do go on to develop research-intensive careers devoted to building knowledge in clinical science, and most of those teach in the large academic medical centers. That leaves many other PhD students who must gain knowledge and skills requisite for developing knowledge about the phenomenon of nursing and testing educational innovations. To do this well will require 3 things: (1) funding, (2) multidisciplinary research training programs in PhD programs, and (3) the commitment of doctoral faculty in schools of nursing who focus most of their effort on education to develop the advanced research skills necessary to mentor this new generation of PhD students who will build the science of nursing education.
There are real costs to conducting any research. Time that is protected for investigators to actually conceive, design, and conduct their studies must be acknowledged. Deans and directors of nursing would have to provide time and, in some cases, even divert resources to support this time. The use of multiple sites, a critical component of rigorous research that can yield generalizable findings, also necessitates funding to support travel, communication, research assistants, etc. The statement that “no one will fund educational research” is far too simplistic. If logical, evidence-based proposals making a case for the critical need for new knowledge and models of nursing education were developed, I am sure that various funding bodies would pay attention. The US Department of Education, the Health Resources and Services Administration (HRSA),3 and others currently fund the development of educational innovations; one could ask what additional steps are needed to develop rigorous tests of these innovations across settings to determine whether the funding currently invested is a good use of resources and extends knowledge. Reed et al2 found that 71% of medical education research is not funded, but that those studies that were for > $100,000 were rated as significantly higher quality than those that were funded for less. I would imagine the tool used in that study (ie, The Medical Education Research Quality Instrument) to assess quality of various reports of educational research would reveal the similar patterns in our literature. It is time for those in nursing education who are vested in developing the science of nursing education to address this issue.
A related and critically important need is to train a future generation of nurse researchers in education committed to intensive research careers. I receive 2–4 online surveys of educational practices per month conducted by doctoral students, presumably for their dissertation. A quick read of these indicate we have much training to do. The explanation introducing the survey is rarely accompanied by any statement of how important the research is or what potential contribution it might make to the knowledge base. We must have more PhD students trained in the newest models of educational research, working closely with collaborative teams of nurse educators and scholars in education. The potential for collaboration with like-minded educators in other clinical disciplines such as medicine, dentistry, physical therapy, etc., is unlimited. The addition of education scholars from the field of education would strengthen these teams and enhance our PhD students' experiences dramatically. These teams could also lobby much more effectively for resources to support their research.
Finally, there will be a need for post-doctoral training for those current and future faculty members interested in developing programs of research in education. This was certainly needed in the early years of clinical science development, and the need continues to this day. And many more nurse educators must return for doctoral degrees. Over 50% of faculty members teaching in this country are masters-prepared and, with more education, some of these individuals would bring the experience to ask important questions, and they would be young enough to build education-focused research careers in the future. The American Association of Colleges of Nursing (AACN) has called for faculty to be prepared at the doctoral level,4 so those returning to school for a doctorate should choose very carefully the program that will provide them with the knowledge and skills that match their career goals.
Solving this gap in the knowledge base that could guide us to develop cost-effective, high quality education initiatives at all program levels in nursing will require the support of deans who must value this career path, as well as the support of nursing colleagues in clinical science, and collaborators in education and other clinical disciplines. But valuing and collaboration will not be enough. Funding and the commitment to lifelong learning by nurse educators will be necessary as well. It is only then that we will have a chance to light a fire in the minds of younger generations who see the excitement and value of education in nursing.
References
- . Perspectives of Science in Nursing. Boston, MA: Lippincott Publishing; 1999;
- . Association between funding and quality of medical education research. JAMA. 2007;298:1002–1009
- . www.bhpr.hrsa.govAccessed May 28, 2009
- The Preferred Vision of the Professoriate in Baccalaureate and Graduate Programs. 2008. http://www.aacn.nche.edu/Publications/positions/preferredvision.htmAccessed May 21, 2009
Marion E. Broome, PhD, RN, FAAN, is a Professor and University Dean, School of Nursing, Indiana University, Indianapolis, IN.
PII: S0029-6554(09)00085-2
doi:10.1016/j.outlook.2009.05.005
© 2009 Mosby, Inc. All rights reserved.
