A new paper co-authored by a George Washington University School of Nursing researcher raises serious concerns about how nurse educators assess—or fail to assess—learning in traditional clinical environments, a model seen as the gold standard in nursing education for more than half a century.
The paper, published in the Journal of Nursing Education, highlights the need for reliable measures to evaluate clinical models and student learning outcomes. GW Today spoke with Angela McNelis, co-author, professor and associate dean for scholarship, innovation and clinical science, about the paper’s findings.
Q: As nurse researchers and educators, was your team surprised by the findings?
A: Our team’s shared area of research is nursing education, and so we were aware the evidence was scant on student learning outcomes in clinical education. We did not, however, anticipate an empty review—finding no studies meeting our criteria for inclusion in the analysis—given that the traditional clinical model has been used for more than 60 years.
When analyses were complete, we began to think in terms of evidence vs. eminence.
As experts in this area, we know that traditional clinical education has been and continues to be the gold standard against which all other clinical ways of teaching nursing are judged—this is eminence. As the use of simulation in nursing education developed, it was new and expensive and had to prove its worth. Simulationists dug in and went to work, creating and defining pedagogy, best practices and conducting research (evidence) including a multisite, longitudinal study. Thus, we have a body of evidence showing how simulation works and what you can expect from this learning modality if it is done well. This level of rigor never materialized with traditional clinical education because it was the only way to do things, or so many in nursing education believed. Evidence was never sought because it was not needed (eminence). We did not expect to find an empty review—which usually happens, as our paper says, when a topic is too new. We were surprised, but our findings support the idea of eminence with no evidence.
Q: The paper says treating patients has become increasingly complex over time. How has a nurse’s job changed and consequently education?
A: Patient health and care has become increasingly complex because advanced medications and technology have increased life expectancy. As a result, nurses’ scope of practice has expanded, and they are expected to know and do more with increasingly complicated patient care needs. Additionally, insurance, length of stay, movement of many conditions (such as chronic heart failure) to outpatient care settings, and an increase in home care result in the need for nurses to provide care in diverse environments outside the traditional hospital setting.
Classroom teaching and learning methods have evolved significantly to keep up with change through use of technology such as learning management systems, online platforms (including social media), handheld computers (e.g., smart phones) and electronic response systems for example, but clinical education has remained relatively unchanged from the historic model of teaching by apprenticeship. The addition of technology-based clinical solutions such as simulators, electronic health records, virtual reality headsets and more remains subject to high levels of proof of effectiveness despite simulation being used for over 20 years.
Q: What changes do you think need to be made to better prepare nursing students for careers in the field?
A: The empty review shows we lack an evidentiary base on which to guide education and changes must be data driven. We need to develop researchers and valid/reliable measures to evaluate clinical models and student learning outcomes. Moreover, we need to develop and test alternative learning environments to ensure graduates are prepared for safe, quality practice. The evidence may exist but has not been published. We implore researchers and educators who have strong, objective evidence of learning outcomes of traditional clinical to disseminate those findings in presentations and publications.
