Change in contemporary society is increasing due to many factors. The rapid development of world wide communication and technology, and changing roles and lifestyles of many people are a few of the causes and/or effects of a rapidly changing society. More than ten years ago Toffler (1970) stated that the ability to deal with change would be society's most essential task.
Nursing has experienced the impact of many of society's changes as well as those peculiar to the profession. The recent changes in women's roles have changed nurses' attitudes and behaviors in health care settings. The proliferation of technology and information in the health care field has challenged nurses to "keep up" with current knowledge. A number of authors have addressed the problems of coping with future changes in the nursing profession (Holman, 1977; Montag, 1973; Partridge, 1978). Change is recognized as desirable and necessary in view of these rapidly changing conditions and needs of life.
Traditionally, nursing curricula have been crisis oriented and in a state of flux. Faculties are constantly determining what changes are needed to keep up with the tremendous knowledge explosion and evolution of the health care delivery system. Nursing curricula must be designed for the purpose of educating people to prepare them to meet the challenge of contemporary and future health needs of our society. It is therefore necessary for faculty developing curricula to have a thorough grasp of present and future health problems and health care trends in order to develop relevant, progressive nursing curricula that prepare nurses for the future.
Curriculum change should be an ongoing, planned process and not a response to crisis. Crisis oriented response to health care needs tends to create a bulging, unmanageable curriculum for both faculty and students. The planned process should incorporate analysis of past and present trends as well as systematic forecasting of future trends. The data gathered from this process would then provide a guide for decision making in planning curriculum change.
The rapidly growing field of futures research is involved in foreseeing the possible consequences of present decisions and procedures in our society. It is a systematic method, utilizing the opinions of persons knowledgeable in a specific field, to develop a definitive forecast of future events. Futures research is also directed toward stimulating new ideas, developing new insights, and promoting new attitudes conducive to informed and effective leadership in the future. Since schools of nursing are preparing nurses to practice in the future, they should look to the possibilities of futures research as a basis for curriculum planning.
The Delphi instrument is one technique of futures research that is useful in describing a plausible future environment. The Delphi instrument was originally developed by the Rand Corporation where it was used for technological forecasting. It is intended to survey the "expert" opinion of persons knowledgeable in a particular field of study. It has since been adopted for use in the social sciences including education and nursing. Two examples are studies conducted utilizing the Delphi technique for determining needs in nursing research (Lindemen, 1975) and nursing service (McNaIIy, 1974).
The Delphi technique is a tool utilizing sequential questionnaires sent to experts in a particular field who respond anonymously to the desirability and/or probability of future events occurring in their profession. The participants then receive feedback in the form of the consensus of their peers following each round of questionnaires. This feedback stimulates the participants into taking account considerations they might have missed or thought unimportant. This process tends to produce group consensus of evolving trends. Anonymity allows each participant to have an equal voice in the group consensus without the possible psychological pressure from more vocal group members. The resulting decisions of the respondents can form a base of information that can be used to examine projected curricular goals.
The authors utilized the Delphi technique with nursing educators and practitioners to provide information for curriculum planning. Faculty and registered nurse students in the Department of Nursing of Maryville College-St. Louis participated. The Department of Nursing includes two National League for Nursing accredited programs, an associate degree program, and an upperdivision baccalaureate program for registered nurses. Twenty-two faculty from both programs participated, as well as 19 registered nurses enrolled in a research class. Nurse educators and practicing nurses contributed their wisdom, experience, learning, and imagination to the process of predicting future trends and roles in nursing.
The future role of the nurse, encompassing various areas of practice, was selected as the focus for the study. It was postulated that such predictions of future nursing practice could be utilized to develop curriculum plans which would reflect emerging trends in nursing practice.
The faculty and students responded with their predictions, on a scale of 0 to 10, to the probability and desirability of 30 selected items concerning the role of the nurse in the year 2000 A.D. Each groups' results, in the form of mean scores, were fed back to the group members after the first and second rounds. The third round provided the consensus. AU three rounds were completed in one month's time. The participants received results only from their peer group, either faculty or students, during the data collection period.
Thirty items were chosen to represent several areas of potential role change. Several statements explored each area of future nursing practice. These areas included the expansion of nursing practice in the following areas: 1) psychological/sociological assessment and intervention, 2) preventive care and health education, 3) use of technology in health care, 4) nursing practice in community settings, 5) research development, and 6) the distinctions between levels of nursing practice.
Student and faculty responses revealed generally similar results with the exception that the mean scores of the student responses tended more toward the middle of the scale than faculty responses. This may indicate a more conservative estimate of possibilities in future nursing practice.
The findings are reported as the consensus of the third round indicates. They are reported in relation to the areas of nursing practice studied.
The respondents agreed that nurses will become more involved in psychosocial intervention with patients and their families. It is also expected that they will delegate more physical care. Patient education, along with psychosocial intervention, will he a focus of the nursing care of the future. Nurses will be teaching patients prevention of illness and a higher level of wellness in 2000 A.D. suggest the participants, and they agree this is highly desirable.
The use of technology in patient care and monitoring is expected to increase and the participants consider that desirable as well. This could possibly aid in freeing the nurse for the psychological care expected.
Nursing practice in community and ambulatory care settings was expected to remain constant, and the respondents in both groups think that is desirable. Both groups considered nursing input into community health planning highly desirable, though not expected.
Although research in nursing has rapidly expanded in recent years, and the respondents agreed it would be highly desirable, they did not expect it to be pursued by the majority of nurses.
The respondents felt that the distinction between baccalaureate and master's preparation would continue as it is today although the confusion of nursing roles, i.e, diploma, associate degree, and baccalaureate preparation, in actual practice would persist.
Some conclusions can be drawn from these findings. First, both educators and practitioners consider expansion of nursing activities into affective intervention probable and desirable. These areas include cultural, ethnic and religious influences on nursing care as well as establishing a therapeutic relationship with patients. In addition, preventive care and health education is forecast to be an attainable goal. Technology also is expected to increase in health care. However, an increase in nursing practice in non-acute settings is not expected. Also the number of nurses engaged in research is not expected to increase significantly in the next 20 years.
The data derived from a Delphi study can be very valuable as a guide to planning a curriculum. From the expert predictions, faculty can anticipate the behaviors, skills, and knowledge needed to prepare nurses now for future nursing practice. Decisions can then be made as to the content and processes needed in a well balanced curriculum. Specifically, knowledge and skills considered desirable and/or probable can be compared with curriculum objectives and content. Areas not covered in current curricula could be considered for curriculum revision. Also, areas currently emphasized could be reevaluated considering the respondents' replies.
The faculty of the baccalaureate nursing program at Maryville College utilized the findings from the Delphi Study in the development of their curriculum. Their philosophy, conceptual framework and objectives reflected psychosocial assessment and intervention, preventive care and health education, research, leadership and family/community concepts. The Delphi Study provided the concensus as to this faculty's philosophy of how nurses should be prepared for the future.
The implications for use of the Delphi in curriculum planning are considerable. First, the tool allows the faculty the opportunity to express their perception of future needs to those responsible for curriculum development. Secondly, all faculty have an equal voice although they are exposed to the "collective voice" of their constituents. Third, the use of practitioner/students, who are currently practicing and may continue to practice nursing into the twenty-first century, gives them a voice in planning for their future coworkers. Obviously, many other factors are considered in curriculum planning, but the Delphi technique can be a useful adjunct to curriculum development.
The authors wish to express their appreciation to the students of the Bachelor of Science in Nursing Program who assisted with the Delphi Study.
- Holman, J. Nurses target political, social issues for future action. Hospitals, 1977, 51, 83-84.
- Lindeman, CA. Priorities in clinical nursing research. Nursing Outlook, 1975, 23, 693-698.
- McNaIIy, J. A. Toward anticipating possible needs for nursing services that might emerge from anticipated social and technological developments: A demonstration of a use of the Delphi method. Unpublished doctoral dissertation, Columbia University, 1974.
- Montag, M. L. Changing patterns of nursing education and practice. Lamp, 1973, 30, 23-28.
- Partridge, K. B. Nursing values in a changing society. Nursing Outlook, 1978, 26, 356-360.
- Toffler, A. Future Shock. New York: Random House, 1970.