In my editorial a year ago, I proposed that we could evaluate how well JNE is doing its job as a discipline-specific pedagogical journal by two major criteria: (1) the extent to which we see on JNE's pages nursing education's response to important issues in health care and nursing practice; and (2) the extent to which we explore practical solutions to the problems that teachers of nursing encounter in their everyday practice. So how are we doing this year, measured against these criteria?
The big issues in health care have not changed significantly over the last year. Although federal legislation mandating health care reform has stalled, many states are advancing their own initiatives to increase access to primary care, reduce cost, and improve quality. There has been tremendous movement toward managed care, and changes in the reimbursement system are likely to continue to profoundly affect nursing practice in all settings. Numerous articles, published during the last year, have recognized the changing landscape of health care with greater emphasis in several significant areas: health promotion, population-oriented nursing, practice sites in the community, learning experiences which help sensitize students to the needs of a culturally diverse population, and the particular health concerns of the chronically ill and physically challenged, the homeless, and persons with HIV disease.
We have also attended much more to the practical concerns of nurse educators. In the April issue, we described numerous specific educational approaches which support active learning; we also addressed some of the day-to-day concerns in managing and implementing distance education programs, as well as using newer educational technology. And virtually every educational innovation has been described in the context of the contemporary realities of higher education: declining resources, skyrocketing enrollments, increasing faculty workloads, and concerns about safe nursing practice in the changing clinical environment.
The teaching and evaluation of critical thinking has continued to be center stage; in the October issue, we presented real advances in addressing some of the thorny conceptual issues about critical tliinking (Ford and ProfettoMcGrath; Kataoka-Yahiro and Saylor) and in measuring students' disposition toward critical thinking (Facione and associates). Studies of clinical teaching and learning have also increased during this year. In the January issue, Reeve reported the testing of a new instrument for measuring the effectiveness of clinical teaching. Our knowledge about effective clinical teaching was further advanced by a study, conducted by Krichbaum, of the relationship between teacher behaviors and learning outcomes, reported in the September issue. We have also explored clinical teaching from a new perspective: interpreting the lived experiences of basic students (Wilson), college graduates (Sheil and Wassem) and RN students in our baccalaureate programs (Rather). And the entire November issue was devoted to clinical teaching.
We have continued to explore alternative pedagogies. In February, Boughn and Wang reported the introduction of a feminist perspective to nursing curricula, and Crowley examined the relevance of Noddings Ethics of Care in the moral education of nurses. In the May issue, Hills and associates and MacLeod and Farrell described the practical uses of the human science paradigm and a practicedriven phenomenological approach in curriculum reform.
In the last year, we have come a long way in framing our response to major health care issues, including health care reform, and in addressing practical concerns of nurse educators. And we have a long way to go. In the coming year, we will see articles addressing some underrepresented areas: the teaching of ethics in nursing and the development of nursing practice centers as sites for clinical learning. In a special issue to be published in May, we will continue our exploration of alternative pedagogies, this time taking up the philosophical underpinnings and practical implementation of interpretive pedagogies.
We also need to further our thinking about preparation for advanced practice. While we have examined specialist preparation (Lipman and Deatrick) and some components of practitioner education (Bramble), new curriculum models for advanced practice in community-based, primary care settings are greatly needed. Issues regarding differential role preparation for clinical nurse specialists and nurse practitioners are yet to be fully explicated and resolved. Interdisciplinary education has not been the focus of any work published in JNE during the last year, despite its increasing importance in health care reform.
We must continue to craft our response to health care reform and, indeed, begin to envision, even more creatively, the possibilities for both nursing practice and education. Our profession, through the Agenda for Health Care Reform and the Vision for Nursing Education, set the framework; but we have much to do to demonstrate clearly that nursing can respond to the opportunities now presented to us. Lamb (1994), in a paper presented to the American Academy of Nursing, pointed out: "After years of providing care in communities, often in places where no other health care professional would tread, nurses are not necessarily recognized as major players in the rise of community-based practice, nor as capable of seizing the moment. At the same time, it is clear that many other individuals and professions are ready and very willing to take advantage of the growing opportunities in the community market. In order to capitalize on the changes, I believe that nursing needs to relook at its communitybased delivery models and place them in the context of an evolving health care system. In particular, we need to explore further the possibilities inherent in communitybased practice.
To that end, the November 1995 issue of the Journal of Nursing Education will be devoted to the topic of communitybased practice and its relation to nursing education. Janis Bellack, a member of the JNE Editorial Board and Director of University Education Planning at the Medical University of South Carolina, will serve as guest editor.
- Lamb, G.S. (1994). New delivery systems: The call to community. Paper presented at the American Academy of Nursing Annual Meeting, Transformation of the Nursing Workforce/ Phoenix, AZ.