This issue of JNE invites you to consider a host of curriculum issues. I know that curriculum discussion may be so much a part of your everyday world, that you would just as soon read about almost anything else. But bear with us. We have brought together a collection of papers, each of which proposes that we include or significantly increase a particular area of content or learning experiences in our curricula: care of the elderly in community-based as well as institutional settings; rehabilitation nursing; substance abuse; violence-related content; and agricultural safety and health, among others. At first blush, the response might be, "we already include a 2-hour lecture on that" (as was the response of 59% of the programs when surveyed by Woodtli and Breslin about content on woman abuse and battering). Or alternately, we might respond that there is not time for one more thing in the required curriculum; an elective might be possible.
Indeed, academic nursing would win no awards for moving content out of the curriculum, I have heard the only partially facetious remark that we got rid of mustard plasters in the curriculum just a few years ago. Faculty engage in endless debates about what is to be included, and to what depth, and what will be given short shrift as a result. Faculty from various specialty areas bemoan how ill-prepared their students will be to work in the hospital, or on a maternity unit, or in community health, or most any other specific setting. NCLEX exams, based on job analyses of the present, keep nursing curricula firmly anchored in a set of competencies for acute care, interventionist practice; yet virtually every policy document of the last 5 years has recommended that health professions education must be directed toward a different set of competencies. The articles in this issue of JNE point to some of these competencies, in particular those related to concerns identified in Healthy People 2000.
If we are to have curricula which are responsive to rapid changes in nursing practice, and to the equally rapid turnover in the knowledge base needed for practice, we need new models of curriculum development. In this issue, Morse ana Corcoran-Perry report a study which tested a model for selecting essential content in the nursing curriculum, a model deemed useful particularly when content is drawn from more than one discipline. This article is noteworthy for several reasons: the authors have synthesized contemporary curriculum theory to develop a practical model for nursing curriculum development; the model recognizes the particular needs of a practice discipline for systematically identifying both theoretical and practical knowledge. It is an example of what has become all too rare in nursing education: curriculum research.
There are several other, perhaps less obvious, takehome lessons from this collection of articles:
The value of sociodemographic and epidemiologic data in identification of essential content. It goes without saying that North America is graying, but it is not yet apparent that this demographic fact has greatly influenced nursing curricula. Fox and Wold report a study in which students had experiences and content related to gerontologie nursing in both community-based and institutional settings resulting in a significant improvement in students' attitudes toward gerontologie nursing.
In two additional articles, Murphy, and Marcus and Gerace point out that substance abuse is one of the nation's most significant public health problems, and citing relatively recent surveys, that nursing students and nurses feel ill-equipped in the identification and management of clients who use addictive substances. In a similar vein, Woodtli and Breslin, calling our attention to the escalating incidence of violence, report a survey of nursing faculty about the violence-related content in the nursing curriculum. Again, the majority of nursing curricula devote little time to this significant public health problem.
The importance of monitoring for what may have become the hidden curriculum, and its unintended effects on student learning, attitudes and values. Woodtli and Breslin suggest that failing to attend to violence against women in the nursing curriculum may communicate disturbing values and priorities of the faculty. The same possibilities should be raised about the placement and use of learning experiences with the elderly; i.e., What message is conveyed when students are provided experience with only ill or frail elderly, or when such placements are used only for teaching basic skills?
The need to provide learning experiences, even where there may be no professional nurse role models. As we increasingly attempt to educate our students for a reformed health care system, and for population-focused practices which may be more responsive to major health problems such as substance abuse and violence, by definition, there will be few nurses practicing in the role we wish to model. Marcus and Gerace, Martin, and Fox and Wold provide wonderful examples of learning experiences which can augment student learning about significant social and public health problems, and nursing's response to them.
The possibility that the content question may push the paradigm shift in nursing education. It seems to me that as long as basic nursing knowledge is conceptualized as that which is needed in the care of the sick in hospitals, areas ripe for a nursing contribution such as health promotion in the elderly, prevention of substance abuse and domestic violence will remain in the background. By focusing our attention on major health concerns and their prevention, and nursing's potential roles and contributions, the debates about essential content may be more easily resolved.