The nursing curriculum has long been the subject of educational debate with calls to reform it occurring at periodic intervals. This issue of the Journal of Nursing Education is devoted to the reflections of major nursing education leaders who have pioneered a curriculum revolution. Reacting to decades of rigidly prescribed nursing curricula, preconceived ideas about the ways students learn and should be taught, and the repression of creativity, these nurse educators have become the driving force to encourage new approaches to teaching and learning based on a philosophy consistent with modern demands.
The elements for curriculum building include the needs of society and the characteristics of the students, both of which are changing. The impetus for the current curriculum revolution is the discontent of some of nursing's visionary academic leaders. As aptly pointed out by several contributors in this issue, the curriculum revolution is a reaction to the past 40 years when nursing educators have tended to go overboard in some aspects of curriculum building. As Tanner argues, a model can limit vision. A manifestation of past devotion to a singular way for building a curriculum has led to the slavish polishing of objectives to meet predetermined behavioral goals with the expectation that all students will meet all objectives. It led to an educational philosophy depicted in terms so broad as to be virtually useless for any purpose other than impressing accreditation visitors.
Tanner identifies major themes and core values that form the foundation for the curriculum revolution. Nursing's mission and the development of its programs must remain responsive to the changing health-care needs of our nation. Foremost among these is nursing's social responsibility toward transforming the health delivery system from the current acute care model to one that focuses on a care system designed to keep people healthy and functional. The future environment for practice for all the health professions is changing from being acute care oriented and institutionally based. A different approach is needed to meet the needs of a vulnerable population suffering from chronic health problems. This must emphasize continuity of care and shift the locus of care to the community. This has profound implications for the education of nurses. The highly bureaucratic, specialized, territorial, fragmented, and rigid model for acute care has long dominated the nursing curriculum. The very adjectives that describe it have been applicable to the nursing curriculum.
A major philosophical shift in the continuity-community based model is empowering the recipient of care. Bevis eloquently describes the effects of the overuse of narrative teaching in exerting authority over another's mind and will. Nursing students must experience empowering experiences firsthand to be able to provide this kind of care to their clients.
A major gripe of nursing students has been that they have been passive recipients of experiences selected for them by their teachers and curriculum committees. The teacher-centered curriculum has remained subject-based with the student expected to recall facts and concepts in isolation. As the knowledge domain for nursing has continued to grow at a tremendous pace, the curriculum has become filled to capacity. Preparing for the unknowns of tomorrow requires that students learn to be effective problem-solvers and understand they will be learners throughout their career.
The need to respond to the different student population nursing is attracting provides another major impetus for change. Students are now older, often they are pursuing a second career, and they are increasingly goal directed. The "traditional" nursing students of yesterday no longer exist. Their rich diversity includes differing life experiences and values. A singular manner of organizing learning experiences can no longer effectively serve the complex demands of our students.
The continuing mandate to curb health-care costs, coupled with a nursing shortage that will never end, requires the organization of a nursing care delivery system that promotes the efficient and effective use of nursing's scarce resources. The future care delivery will require a mix of professionals and community helpers. Tanner and Waters eloquently suggest it is time to lay to rest the entry into practice issue that has diverted and sapped nursing's energies inward instead of focusing on the diverse health care needs of the population.
As I read the views of some of nursing's most articulate nurse educators, I recollected my path as a nurse educator. There is a saying, "What goes around, comes around." Although there is some modification from the traditional curriculum development I learned when I studied with Hilda Taba at San Francisco State University in the mid-1950s, many ideas about education, curriculum, and teaching bear similarity to today. Taba was motivated to develop her classic book Curriculum Development: Theory and Practice in 1962 because of what she termed a crisis in public education. It was her view that the development of any curriculum must be based on sound methodology and a clear analysis of its elements. She warned that overemphasizing any one element, such as the content, the needs of society, or the needs of the learner, can lead to an unbalanced curriculum. She cautioned against versus thinking: method versus content; student-centered versus subject-centered; anything versus anything else.
Taba's work was a modification and elaboration of the work of the great curriculum planner of the 1950s, Ralph Tyler. The behavioral school of educational psychology was prevalent during that era. New concepts and facts about how people learned, new ideas about perception, thinking, creativity, and learning filled the pages of the journals of psychology and education. The concepts of culture, socialization, and group interaction became integrated into the curriculum. The new educational technologies - educational television, programmed instruction, computer assisted learning - gave promise for reforming the educational process toward the goal of helping students learn more effectively. It was a heady time for pedagogy, emphasizing the need for a theory of curriculum development as an organizing dimension for making choices about learning experiences.
It has been 25 years since I developed the course on teaching at the University of California, San Francisco, from which came my book Strategies for Teaching Nursing. I went back to the first edition, published in 1971, and reread the last chapter, in which I attempted to predict what nursing education would be like in the -year 2000. I forecasted the way education would be as follows:
On a typical student day, the nursing student will go, equipped with notebook and manual, to the learning laboratory to engage in learning activities. The nursing Btudent will require less clinical supervision because she will not test her nursing knowledge and skills on real patients before she has the opportunity to practice in a highly realistic simulated setting.
The nursing instructor will meet students independently and in small groups, after they have mastered the knowledge and application of principles, to carry out those learning objectives that involve higher-order functions, such as creative problem solving. The nursing instructor of 2000 will serve as learning diagnostician, manager, counselor, commentator, and role model.
I concluded my glimpse into the future by declaring that perhaps I was being too conservative in how long it would take to achieve individualized education for the everincreasing numbers of students who must enter our nursing schools to provide the kinds of nurses to meet the needs of our increasing population. I still hope that we can achieve this goal by the year 2000.
The curriculum revolution is about teacher-student partnerships. It is about flexibility and individual differences in how and what one learns. It is about instructors spending their time doing what no text, no program of learning, no computer, or learning resource can accomplish: developing the mind of the individual student through intimate give and take based on sound knowledge and understanding.
But, as Taba warned, let us be cautious as we change our curricula. Let us keep what has worked, what is inherently good, and hold our mandate clearly in our vision. Let us remember that although much of the care of people will take place in the community in the future, hospitals will continue to exist for the acutely ill, and both settings will continue to need well-prepared nurses. We cannot afford to replace one rigidity with another. More than anything else, I support Water's hope that the current thinking will bring baccalaureate, graduate, and associate degree educators to a common forum. A multilevel system of education to meet the diverse needs of a population in need of personal and professional nursing services in many settings remains essential.
Let us realize that, although worshiping them is not the answer, there continues to be an appropriate place for educational objectives. In the early 1960s, Mager, the instructional objectives guru, emphasized that if you don't know where you are going, you may well end up someplace else. Instructional objectives that are stated precisely in behavioral terms may be too mechanized and not appropriate for many learning goals, but unplanned learning experiences without clear purposes are equally dangerous. This is a call for moderation.
The nurse educators writing for this issue have eagerly and openly shared their views about nursing education. Their perceptions have evolved through significant experiences as learners and teachers, sometimes positive; sometimes, negative. Through their eyes and their feelings the profession is given a rare accounting of the events and philosophy that has stimulated an alternative view for curriculum development. Each author is an accomplished professional nurse and seasoned educator. Each is committed to changing nursing education because of profound discontent in the way things have been, for themselves as learners and for their students.
These are the personal stories of nursing education leaders who have come together because of their commitment and diligence for educational reform in nursing. So, we have deviated from the traditional style for a scholarly journal by using the singular pronoun often in this issue. The authors model the principles being promoted by the curriculum revolution. They draw on and share their personal experiences freely. They boldly state their views and their feelings. They connect the present to the past, often by stories. They clarify their views by using personal examples. They explore where they are now, how they came to this point in their lives, and where they hope to go. They are willing to hold their ideas tentatively, changing with new views and impressions.
Students are interested in learning what their teachers think, feel, and believe. They like personal interchange. We hope that you will like this approach also.