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Educating Nurses: A Call for Radical Transformation
MEDIA REVIEW Educating Nurses: A Call for Radical Transformation By Patricia Benner, Molly Sutphen, Victoria Leonard, and Lisa Day. San Francisco, CA: Jossey-Bass, 2010. 260 pages. $40, hardcover. Reviewed by: Katherine Camacho Carr, CNM, PhD, FACNM. This book is a volume in the Carnegie Foundation for the Advancement of Teaching’s ‘‘Preparation for the Professions’’series and focuses on nursing education. The purpose of this book is to profoundly influence the profession of nursing, nursing education, and nursing service providers to change radically. The authors, especially Dr. Patricia Benner, who directed the study, are well qualified to identify the challenges that nursing and nursing education face and to propose four very controversial changes for nursing education in order to overcome them. Benner, who in her paradigmatic work From Novice to Expert: Excellence and Power in Nursing Practice studied the development of nursing clinical expertise, understands that the field has changed with an explosion of knowledge with many scientific and technological advances, multiple settings for nursing practice, increasingly complex patients in need of highly skilled care, and a low margin for error with safety of the patient as paramount. These changes, along with new demands for nursing practice, are highlighted in a number of chapters in the book. The recommendations for a new direction—or the ‘‘radical transformation’’ of nursing education—are based on the study conducted by the authors. The study was ethnographic in nature, and the findings were interpreted and evaluated by the authors, making an interesting read, especially if one is involved in nursing education even peripherally. Study methods included direct observations of clinical and classroom teaching for 3 days at each of nine institutions that prepare registered nurses, including diploma and associate degree programs, baccalaureate ‘‘fast track,’’ traditional, and master’s entry programs. Administrators, faculty, staff, and students were also interviewed at each site. Conclusions were also drawn from three national surveys of faculty and students conducted by the American Association of Colleges of Nursing (AACN), National League for Nursing (NLN), and the National Student Nurses Association (NSNA). Despite the inclusion of these national surveys, one must question the adequacy and the representativeness of the sample, given the complexity and diversity inherent in nursing education. The study focused primarily on undergraduate nursing education. Advanced practice nursing, nurse-midwifery, and nurse anesthetist education are not included in the study specifically and therefore
Journal of Midwifery & Women’s Health www.jmwh.org Ó 2010 by the American College of Nurse-Midwives Issued by Elsevier Inc.
may or may not benefit from some of the same recommendations. However, because many midwifery education programs are in schools of nursing and because midwives are frequently educated post–nursing education, this study would be of interest to midwifery educators. The authors’ analysis revealed three major findings. Most importantly, US nursing programs were found to be pedagogically strong and effective in forming professional identity and ethical comportment. Second, the clinical practice working directly with real patients, inherent in nursing education, provides a powerful learning experience for students, especially when faculty integrate classroom and clinical teaching. With this second finding, the authors conclude that the nursing faculty observed frequently have a disconnect between the classroom lecture, where nursing students passively receive information, and the application of clinical knowledge and judgment in the clinical setting. The authors also conclude that nursing programs are not effective for teaching nursing science, natural or social sciences, technology, or the humanities. These three major findings are illustrated throughout the book with presentations of paradigm cases, described as a recognized practice pattern by Benner, to illustrate the necessary transformations in nursing education. The authors conclude that nursing practice today demands integrative, patient-centered teaching to develop salience, clinical reasoning and clinical imagination (to anticipate patient needs), and effective and ethical practice. Integrative teaching is explained through paradigmatic cases and appears to use problem-based learning (cases and clinical reasoning) rather than fact-filled ‘‘death by PowerPoint’’ lectures. They also conclude that nursing education must include an adequate foundation in the sciences, the scientific method, technology, nursing theory, and evidence-based practice. The authors also recommend that nursing educators be expert clinicians and teachers in order to develop innovative pedagogies to teach the complexities of nursing practice. Researchers and administrators of education programs may be interested to note that the authors support a revitalization of research that focuses on nursing education and faculty development. Although these recommendations are made on the basis of a limited sample, case examples support the recommendations made to transform nursing education. Midwifery educators, program administrators, and researchers focusing on education would all find this to be a book of interest.
e81 1526-9523/$36.00
Journal of Midwifery & Women’s Health www.jmwh.org Ó 2010 by the American College of Nurse-Midwives Issued by Elsevier Inc.
may or may not benefit from some of the same recommendations. However, because many midwifery education programs are in schools of nursing and because midwives are frequently educated post–nursing education, this study would be of interest to midwifery educators. The authors’ analysis revealed three major findings. Most importantly, US nursing programs were found to be pedagogically strong and effective in forming professional identity and ethical comportment. Second, the clinical practice working directly with real patients, inherent in nursing education, provides a powerful learning experience for students, especially when faculty integrate classroom and clinical teaching. With this second finding, the authors conclude that the nursing faculty observed frequently have a disconnect between the classroom lecture, where nursing students passively receive information, and the application of clinical knowledge and judgment in the clinical setting. The authors also conclude that nursing programs are not effective for teaching nursing science, natural or social sciences, technology, or the humanities. These three major findings are illustrated throughout the book with presentations of paradigm cases, described as a recognized practice pattern by Benner, to illustrate the necessary transformations in nursing education. The authors conclude that nursing practice today demands integrative, patient-centered teaching to develop salience, clinical reasoning and clinical imagination (to anticipate patient needs), and effective and ethical practice. Integrative teaching is explained through paradigmatic cases and appears to use problem-based learning (cases and clinical reasoning) rather than fact-filled ‘‘death by PowerPoint’’ lectures. They also conclude that nursing education must include an adequate foundation in the sciences, the scientific method, technology, nursing theory, and evidence-based practice. The authors also recommend that nursing educators be expert clinicians and teachers in order to develop innovative pedagogies to teach the complexities of nursing practice. Researchers and administrators of education programs may be interested to note that the authors support a revitalization of research that focuses on nursing education and faculty development. Although these recommendations are made on the basis of a limited sample, case examples support the recommendations made to transform nursing education. Midwifery educators, program administrators, and researchers focusing on education would all find this to be a book of interest.
e81 1526-9523/$36.00