Current State of Health Care Delivery System and Nursing Curriculum Response
The national healthcare delivery model has changed drastically over the past few years and further changes are underway. These changes include who provides primary healthcare, where the healthcare is delivered, guidelines for health management of populations, and reimbursement and accountability for healthcare services payment (Dykema Sprayberry, 2014; Forbes, 2014; Scott, Matthews, & Kirwan, 2014; Spetz,2014). The nursing workforce in the United States is approximately 3.5 million and is expected to increase over the next ten years (U.S. Department of Health and Human Services HRSA, 2014). Nurses are being called to increase their leadership skills, scientific knowledge and practice competencies, educational preparation and to practice to the fullest extent of their education (IOM, 2011).
As the educational and competency requirements increase and role definitions for practice models expand, nursing curriculum content and delivery methods have changed in response (AACN Essentials for Education, 2010, 20111, 2012). However, faculty is insufficient to provide the expertise required to deliver the curriculum and evaluate student learning. Faculty are insufficient in number and often in training to meet the suggested curriculum essentials (IOM, 2011). Faculty lack of preparation in research and statistical knowledge are cited across programs as a roadblock to preparing our students to meet the new educational and practice environment demands (Hyat, Eckardt, Higgins, Kim, & Schmeige, 2013).
Nursing student populations are more diverse than ever. Many students are now entering nursing programs after attaining undergraduate and graduate degrees in other disciplines, and some specific student populations, such as males and minorities, are increasing as compared to the trajectories of the past twenty years (Banister, Bowen-Brady, & Winfrey, 2014). To increase the number of nurses educated to practice, and meet the new guidelines, nursing programs now offer many different pathways to the entry and advanced levels of practice (AACN, 2012). For example, some schools admit students from high school for programs that lead to doctoral degrees, while in contrast, others admit only master’s prepared nurses to doctoral programs of study (Starr, 2010).
In addition to the changes within the healthcare system in the US, and the nursing professional and educational environments, the way that information is shared on an individual, local, and global level has been revolutionized by the computer and the internet. Like much of the world’s citizens, nursing students and faculty rely on the internet and computers for personal, social, and educational needs. The reliance on the internet and computer usage for daily information has a significant impact on the needs and learning patterns of students and educators and should be considered when structuring curriculum delivery and evaluation (Costa, Cuzzocrea, & Nuzacci, 2014).
Nursing educators have been incorporating elements of computer –based learning into nursing curriculum for both students and practitioners for over thirty five years (Johnson-Hofer, & Karasic, 1988; Love, 1974). However, the incorporation has not been uniformly implemented or evaluated across the discipline. Reasons for lack of continuity in implementation are resource availability, attitudes and beliefs towards technology adoption, and organizational constraints (Chow, Herold, Choo, & Chan, 2012). Regardless of reasons for lack of continuity across the discipline in using computer-based learning to deliver curriculum, the need for nursing students to have access to the most current state of nursing science education persists and must be addressed.
Varied approaches to implementing computer-based learning that will successfully meet this need and prepare nurses for practice are currently in practice. Successful adoption of computer-based delivery of curriculum requires evidence of its effectiveness in real-world settings. Due to the resources required for this type of research, investigator-initiated adoption of the various approaches to implementing computer-based learning is feasible only with a pilot or case study design. Funding mechanisms are available for implementation and evaluation of nursing education programmatic redesign in response to the changes in the external environment (Stevens & Ovretveit, 2013). These funding opportunities are from private and governmental sources that are stakeholders in the future of the delivery of health care services (Blum, 2014; Thompson & Darbyshire, 2013). However, these funding sources remain very competitive and most require some evidence of an intervention on a pilot or case study level before consideration for funding support of research of a larger scale. Our faculty have been implementing and evaluating small investigator-initiated studies to lay the foundation for programmatic research initiatives centered on computer- based or computer-supported curriculum delivery. This chapter outlines three investigator-initiated pilot case studies on computer-based curriculum delivery: a social cognitive constructivist approach, a team-based learning approach, and an interprofessional approach to computer-based learning. Each approach provides evidence that supports further investigation on a larger scale.