National Review of Nursing Education
Aspects of Nursing Education: The Types Of Skills And Knowledge Required To Meet The Changing Needs Of The Labour Force Involved In Nursing - Literature Review
Report
Submitted by
Victorian Centre for Nursing Practice Research
School of Postgraduate Nursing
The University of Melbourne
Ms. Robyn L. Aitken, Ms. Robyn Faulkner, Dr. Tracey Bucknall,
Professor Judith Parker
Victorian Centre for Nursing Practice Research
School of Postgraduate Nursing
The University of Melbourne
ISBN 0 642 77241 X (Online version)
DEST No. 6777.HERC01A
Acknowledgements:
The authors wish to acknowledge the following people for their contribution to the report:
Reviewers:
Ms Sue Gold RN Crit Care Cert Alfred BEd LaT GradDip MAppSc
Innovation & Service Management RMIT
Principle Consultant, Sue Gold & Associates
Educator, Education & Staff Development, Cabrini HospitalMs Catherine Barrett
Higher Degree Candidate
School of Postgraduate Nursing
The University of MelbourneMs Mary Carolan
Higher Degree Candidate
School of Postgraduate Nursing
The University of MelbourneMs Karen Edward
Honorary Fellow
School of Postgraduate Nursing
The University of MelbourneMs Donna Milne
Research Fellow
Victorian Centre for Nursing Practice Research
The University of Melbourne
Literature Retrieval:
Ms Kitty Wong
Research Assistant (Casual)
School of Postgraduate NursingMs Deb Barge
Research Assistant (Casual)
School of Postgraduate Nursing
Executive Summary
In 2001, a research team from the Victorian Centre for Nursing Practice Research, located at the School of Postgraduate Nursing, University of Melbourne was commissioned on behalf of the National Review of Nursing Education to undertake a literature review on aspects of Nursing Education.
The aim of this literature review is to identify recent and predicted changes in health care services that impact upon nursing and to identify the types of skill and knowledge the nurse has required and will require when dealing with these changes. Articles were sorted according to major recurring themes and then according to level of evidence. All articles meeting the NHMRC levels of evidence, or were descriptive and added to the body of knowledge, were included.
The literature reveals that changes in healthcare services over the past five years are largely attributed to the concept of healthcare as a commodity. As a commodity, healthcare services are scarce, with demand exceeding supply. New and innovative ways of maximizing health care funding to provide health care services to an increasingly dependent aging population are essential. In order to best manage such valuable resources healthcare services are accordingly in a state of dynamic organisation and re-organisation.
A significant trend is the move away from institutionalised care and relocating care closer to the client in his/her home or local community. Emerging from the literature are new ways of delivering such care. These delivery modes include case management/managed care, patient focused care, community nurse-led care, integrated hospital and community care, family provided care and care delivered by unlicensed personnel. While these changes have affected all care modalities, the literature also reveals specific considerations in the areas of mental health, acute care and midwifery.
The emergence of the information age and the advent of the technology to support 'remote' care delivery in the community have also impacted on the way services are delivered. Information is a critical resource in the health system. It enables the integration across settings, reduces duplication and errors, and provides timely information. Professionals are increasingly reliant on information at the "point-of-care" to make decisions crucial to patient outcomes.
At the same time the provision of care has become highly specialised. While client involvement in care is encouraged and individualisation of care promoted, the concept of population health has also emerged. Populations may be geographically identified, or may consist of a cohort of client's sharing the same diagnostic related group. Importantly, the services for each identified population not only includes disease management, but also disease prevention and health promotion services.
Each of these changes in service has impacted upon the role of service providers. New nursing roles have emerged in direct response to changes in service. As a consequence, roles have both expanded to become more generalist and extended to become more specialised. The development of roles continues to show distinct differences between the setting, locale and focus of practice.
The literature has revealed that both changes in service and changes in role have impacted upon skills and knowledge required for providing optimal care in the current and future health care settings. The main themes relating to skills and knowledge of the nurse have arisen both directly from the literature and through interpretation of the literature by the research team. The skills and knowledge that have emerged as necessary for all service settings and roles are coordination of care, patient/client assessment, clinical decision making, patient/client and family teaching, research consumption and application, and counselling.
It is important to note that the information relating to these themes/trends provided in the body of the report has largely been based on narrative accounts. To a large extent either clinical or academic experts have provided this narrative. The research-based data was predominantly qualitative in nature. This is not uncommon in the field of nursing. As a consequence, the report contains a low level of evidence in some areas. Where conclusions have been drawn, they have been based on high level evidence provided in the form of systematic reviews and randomized control trials and the pertinent details of the research have been included in the text. Appendix D & E details the breadth of literature reviewed and the corresponding levels of evidence.
Any comments or queries should be sent to: highered@dest.gov.au
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