Application of Practice Theory to Nursing Education Programs

Nursing theory is based on a philosophical framework. According to Phillips, “without an understanding of philosophy in nursing there can be no science of nursing” (Bredow & Peterson, 2009, p. 8). Hence, philosophy makes significant contributions to nursing knowledge in correlation with research methods. Therefore, philosophy, theory, and research studies conducted through evidence-based practices are inextricably linked (Bredow & Peterson, 2009, p. 8). Philosophy is therefore imperative as it aids in the development of nursing theories. As health care organizations, particularly nurses and other health care professionals, analyze nursing theories, nurses will be able to determine the appropriate fit between the values and beliefs proposed in the theory as compared to their own set of values and beliefs. Philosophy plays a quintessential role in identifying issues in nursing practice, utilizing information obtained from previous research and evidence-based practices, in addition to developing and analyzing nursing theories and their use in practice. Nursing theory is “a conceptualization of some aspect of reality (invented or discovered) that pertains to nursing. The conceptualization is articulated for the purpose of describing, explaining, predicting, or prescribing nursing care” (Parker, 2001, p.5). Nursing theory helps to provide a framework for the healthcare sector as well as other disciplines to help resolve issues that may arise. Since nursing theory has influenced nursing education, research, nursing practice, as well as the ongoing development of new nursing theory, nurses and health care professionals often utilize evidence-based research to apply theories within their organizational culture (Parker, 2001, p. 5). Due to the fact that different nursing theories provide varying information, each type of theory must be properly assessed to help determine whether the application of the nursing theory to practice will hinder or benefit the health care organization or nursing education program.

Nursing practice theory has a limited scope and is used within a specific range of nursing situations because theories developed at this level tend to have more of a direct impact on nursing practice through nursing interventions and assessment of outcomes as compared to more abstract theories (Parker, 2001, p. 7). The Adaptation Model of Nursing developed by Callista Roy views an individual as an interrelated system consisting of biological, psychological, and social components. The model is based on four domains: person, health, environment, and nursing (Parker, 2001, p. 10). The individual serves as an adaptive system who utilizes coping mechanisms to deal with stressors and other stimuli within their environment. The Adaptation Model of Nursing is useful if applied to conditions and stressors present in nursing education programs. Strategies aimed at targeting issues in nursing education programs should be used to evaluate the current academic performance of a diverse student population in nursing education programs. These strategies will be utilized in order to ensure suggestions are made to improve the attrition rates of students graduating from nursing education programs.

In an effort to develop highly skilled and knowledgeable future health care leaders, nursing education programs must understand the current dynamics involved in the health care sector from an organizational perspective. Although continuing changes and trends are still prevalent in such a popular career field, nursing education has encountered a set of challenges that has created a shift in staffing patterns. In the United States, as the current population continues to age, a growing concern has arisen about the substantial shortage of nursing graduates, especially those able and willing to teach within a dynamic thriving nursing program (NACNEP, 2010, p. 5). Although a large number of nurse graduates are needed to meet the demands of nursing programs, high nursing student attrition rates make it a rather cumbersome task (Harris et al., 2014, p. 31). The problem stems from an inadequate number of qualified facilitators who teach nursing education programs, therefore requiring a nurse educator to take over a large class of undergraduate nursing students from a diverse population, which typically consists of a combination of young students and adults returning for a second degree. Due to the difficulty of the material covered in nursing programs, students are becoming frustrated with the material, displayed in their academic performance in the nursing education program. A number of factors are attributed to student success within a nursing program; however, the focus will primarily be on reducing the attrition rate of students enrolled in nursing programs.

In an article entitled “Factors affecting attrition from associate degree nursing programs in North Carolina,” attrition rates from Associate Degree Nursing (ADN) programs remain relatively high with only 58% of students who enroll in ADN programs actually completing a degree (Belsky et al., 2010, p. 214). As a fewer number of students obtain associate degrees in nursing, fewer students will seek to enroll in bachelor's and master's level nursing programs, thereby contributing to the shortage of nursing teachers needed to educate prospective nursing students during their clinical experience.

In late 2007, the Cecil G. Sheps Center for Health Services Research conducted a study on Associate Degree Nursing program attrition rates and causes in North Carolina. Although the research study was performed in only one state, the information obtained from “the substantive finding – as well as the methodological approach – may be useful to other states and other countries” especially in identifying both the student and program-level characteristics and qualities associated with ADN programs that vary in graduation success rates (Belsky et al., 2010, p. 214). Moreover, high-performance programs are associated with highly stringent admission policies as well as more educated teachers and faculty members. Due to the increases in nursing shortage on a state and national level, nursing education programs have undoubtedly received a heightened amount of attention. However, attention has been solely focused on expanding program capacity, which is not matched by attention to program completion and graduation rates among students enrolled in nursing education programs. Since it is evident that faculty shortages, in addition to recession-induced resource constraints, limit further expansion to nursing education programs, addressing attrition issues can “expand RN production in the short-term at relatively lower costs” (Belsky et al., 2010, p.218).

High attrition rates and the reduced number of nursing graduates are quite common in nursing education programs at different schools. In fact, the attrition rate for students enrolled in baccalaureate nursing programs is approximately 50% as compared to 47% for students entering an associate degree nursing program (Belsky et al., 2010, p. 223). Such high attrition rates serve as a warning sign of a program’s success. As health care demands continuously rise due to the implementation of the Affordable Care Act, which legislators passed mandating that all U.S. citizens have health care coverage, including the 32 million Americans who were considered uninsured at the time, more and more nurses and nurse educators will be required to fill the expanding gap in staffing (Belsky et al., 2010, p. 223). Nursing education programs must carefully examine and assess their attrition rates so they could better understand the needs of their student population and develop strategies to increase student success rates while enrolled in nursing education programs.

Despite the alarmingly high attrition rate among nursing students successfully completing nursing education programs, an overwhelmingly high number of applicants are seeking admission into nursing education programs. Yet, problems are still evident as there is an insufficient number of highly skilled and qualified nurses to teach within nursing education programs. As a result, the American Association of Colleges of Nursing (AACN) reported that over 75,000 qualified nursing school applicants were declined admission to nursing education programs in 2011 (American Association of Colleges of Nursing, 2012, p. 1). An inadequate number of instructors leads to larger class sizes and many more prospective nursing school applicants being rejected from nursing education programs because the student population needs to remain at maximum capacity.

Based on research findings from nursing literature, an approach was utilized to increase student success within nursing education programs using multiple strategies and techniques (Belsky et al., 2010, p. 234). The strategies were designed and implemented to decrease the attrition rate in an effort to increase the number of students graduating from nursing education programs. This approach in applying practice theory included a student success program as well as faculty development. The student success program portion of the approach was offered to students enrolled in the fundamentals nursing course who were identified as at-risk. The at-risk student population was determined using selected criteria from nursing literature findings and reviews in accordance with student transcripts (Belsky et al., 2010, p. 234). An Excel database consisting of each student's prerequisite and co-requisite course grades revealed that an average of nine failures or withdrawals per cohort of 25-26 students occurred while enrolled in the fundamentals nursing course (Belsky et al., 2010, p. 235). Each student in the program received a binder which consisted of eight learning modules including Introductions/Learning Style Inventory, Study Skills/Test Taking Strategies, Time Management/Budgeting, Student Stressors/Positive Coping Mechanisms, Organization, Problem Solving, Simulation/Critical Thinking, and Moving Forward/Future Plans for Success (Belsky et al., 2010, p. 235). Nursing students were also introduced to other services offered by the nursing education program including financial aid, career services, tutoring, and previous nurses provided current nursing students with their own personal tips for success (Belsky et al., 2010, p. 235). Implementation of the student success program in nursing education programs leads to fewer students failing nursing courses, especially the fundamentals nursing course which covers Middle-Range and Caring Theory. One ethical aspect of the strategy concerns making the student success program mandatory in nursing education programs rather than voluntary. Although making the program mandatory may potentially lead to fewer students failing and a lower attrition rate, this serves as an ethical concern that must be considered and addressed accordingly.

Application of the practice theory to nursing education programs will create an understanding of the current attrition rates among nursing schools, at-risk student characteristics, and attempts at increasing student success, therefore, enabling nursing school administrators and faculty members the ability to “gain insight into the issues related to attrition and determine the potential methods to increase success within their own programs” (Belsky et al., 2010, p. 231). The Adaptation Model of Nursing demonstrates that stressors are present within a person’s environment and must be identified in order to ensure adaptation over a certain period of time. In order to reach their goal, nursing education programs must develop strategies accordingly. A strategy primarily consisting of recruiting, retaining, and graduating students representative of diverse populations is in place through student success programs implemented within nursing education programs. In addition to the shortage of qualified nursing graduates able and willing to teach within nursing education programs, the issue lies in graduating competent and diverse nurses. This has been proven to be an utterly challenging yet rewarding methodology because it helps decrease the attrition rate of students successfully completing nursing education programs.

References

Addressing new challenges facing nursing education: Solutions for a transforming healthcare environment. (2010). National Advisory Council on Nurse Education and Practice (NACNEP). Retrieved from http://www.hrsa.gov/advisorycommittees/bhpradvisory/nac nep/ Reports/eightreport.pdf

American Association of Colleges of Nursing. (2012). Nursing faculty shortage. Retrieved from http://www.aacn.nche.edu/media-relations/fact-sheets/nursinf-faculty-shortage

Belsky, D.W., Carpenter, J., Fraher, E., Gaul, K. (2010). Factors affecting attrition from associate degree nursing programs in North Carolina. Cah Sociol Demogr Med, 50(2), 213-46.

Bredow, T.S., & Peterson S.J. (2009). Middle range theories: Application to nursing research. Philadelphia, PA: Wolters Kluwer Health and Lippincott Williams & Wilkins

Harris, R.C., O’Rourke, M.E.G., Rosenberg, L. (2014). Addressing the challenges of nursing student attrition. Journal of Nursing Education, 53(1), 31-37.

Parker, Marilyn E. (2001). Nursing theories and nursing practice. Philadelphia, PA: F.A. Davis Company.