Each year approximately a dozen or more manuscripts cross my desk that argue for the inclusion of more time, content, or exp?riences directed toward some particular health concern, population, or disease. A sample of these are included in this issue of the Journal of Nursing Education. Few of us could argue against students having minimal competence in caring for pediatrie clients, or knowing the negative effects of tobacco and being able to help clients stop smoking, or having at least a passing acquaintance with issues in infertility. These are but a few of the topics that beg for attention.
The content squeeze is not a new issue in nursing education. In my early years as a nurse educator (circa 1972), the medical-surgical faculty would go to the mat with pediatrie faculty over what was to be covered in each segment of our new integrated curriculum. The debates were no less heated about how educators could possibly include more content on physical assessment. An insider joke of that era was that we just had gotten mustard plasters out of the curriculum, referring to nursing faculty's propensity to add content without eliminating any. Even at the turn of this century, required content was a topic of debate (Brennan, 1897/1991).
So here we are on the brink of a new century, and the content overload, particularly of undergraduate programs, has reached crisis proportions. There are several driving forces for this current state. Of course, at the heart of the matter is the knowledge explosion- we know more and, therefore, have more to teach than ever before. Nurse educators have realized the prophecy of a decade ago- individuals who have an Internet connection have information (or at least undigested data) literally at their fingertips, but great skill is needed to sort fact from fiction. Managed care has created enormous changes in how nursing ie practiced, and there are new opportunities and roles emerging for nurses in health promotion and population-based care management, among other areas. Nursing programs have added more community-based experiences and more content on health promotion, health policy, and financing. At the same time, we are in the midst of another nursing shortage with great need for experienced, competent nurses in critical care and longterm care settings, caring for the seriously ill.
Studies like the one conducted by Sherrod in this issue, grow out of a genuine concern regarding entry level nurses' ability to provide safe and compassionate care to particular populations of patients. Standards of education, prepared by specialty organizations such as the Nursing Section of the National Council of Hospice Professionals (1997) also reflect this concern. The American Association of Colleges of Nursing (AACN) recently completed a landmark work on The Essentials of Baccalaureate Education for Professional Nursing Practice (AACN, 1998). This document details professional values, core competencies, core knowledge, and role development. My study of this document suggests it is a blueprint for the 21-year curriculum; yet, I cannot identify a single competency or set of core knowledge that 1 think should be left out of a basic professional nursing curriculum. The AACN task force recognized several issues in the preparation of this document, most important, "As knowledge and practice expand, can we possibly prepare beginning-level professional nurses for the future in a 4-year time frame?" (1998, pp. 19). They pose options to consider such as requiring graduate education for entry into professional practice, or considering "a change in our generalist notion of baccalaureate graduates " or the "inclusion of mandated and structured internships that follow the baccalaureate program, but precede licensure for practice" (AACN, 1998, pp. 19-20). These are all issues which must be addressed by the profession as a whole.
Meanwhile, in our individual faculties we must cope with the 21-year curriculum. It is my observation that nurse educators feel enormous pressures from both students and colleagues to "cover" the content. Of course, to cover can mean a variety of things- to include, to address, perhaps to assign a reading about, to mention in a lecture, or perhaps to test on. Interestingly, cover also can mean to hide from view or conceal. The more we try to cover content in the first sense, the more we also cover content in the second sense. Little is gained, or retained, in the long run, as nurse educators try to cover ever-increasing amounts of content. Nursing practice requires deep learning of important concepts, the type of understanding that comes only with time to think, reflect on, connect with previous learning, and extend in practice. Surface learning that derives from coverage of enormous amounts of content simply will not do.
I look forward to receiving manuscripts that propose, demonstrate, and evaluate possible solutions to the content dilemma. New models for selecting required content for nursing curricula clearly are needed. What is now foundational to generalist nursing practice needs to be explored. Surely it has changed as the face of nursing practice has evolved. Studies are needed that link content with process (e.g., what nursing concepts are particularly robust for teaching critical thinking, decision-making, health policy, and ethical decision-making; what is considered both the necessary and sufficient level of knowledge needed to advance the development of other "process" skills). No nurse educator would disagree that we need to include every bit of content advocated in this issue of the Journal. However, we must find out how.
- American Association of Colleges of Nursing. (1998). The Essentials of Baccalaureate Education for Professional Nursing Practice. Washington, DC: Author.
- Brennen, A.S. (1991). Comparative value of theory and practice in training nurses. First and second annual conventions of the ASSTSN. In N. Birnbach & S. Lewenson (Eds.), First words: Selected addresses from the National League for Nursing (1894-1933). New York: NLN Press. (Original work published 1897)
- National Council of Hospice Professionals. (19971. Guidelines for curriculum development on end-of-life palliatue care in nursing education. Arlington, VA: Author. (Available from the Nurse Section, National Council of Hospice Professionals, 1901 North Moore Street, Suite 901, Arlington, VA 22209)