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A New Focus for Allied Health Occupations

Trends and Issues Alert

by Bettina Lankard Brown
1997

 

This project has been funded at least in part with Federal funds from the U.S. Department of Education under Contract No. ED-99-CO-0013. The content of this publication does not necessarily reflect the views or policies of the U.S. Department of Education nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. ERIC/ACVE publications may be freely reproduced.

 

Health care reform is changing the way in which health care is provided and altering the role ofallied health professionals, especially nurses. Managed care, shrinking health care resources, andpublic health are some of the issues that are refocusing nursing practice. This Trends and IssuesAlert examines how education can be more responsive to the emerging needs of nurses and otherallied health professionals and can empower them to assume their new and expanding roles.

The movement away from acute care and illness to health promotion and disease prevention istriggering changes in medical care delivery, moving health care away from theinstitutional/hospital settings and into the home/community. Walk-in clinics, home health careservices, hospice agencies, and other outpatient services/facilities are assuming a greater share ofpatient care (Hillestad and Hawken 1996). These diverse settings in which diverse populationsare served require the collaboration of teams of health care providers, rather than the individualperspective of a sole practitioner. Hillestad and Hawken predict the emergence of two types ofhealth care teams: The first team will consist of a professional nurse, a variety of multiskilledhealth care assistants, and clerical staff, who will work together on a regular basis to address allaspects of the singular patient's care. The second team will be responsible for the health care ofthe community at large.

Few schools for health professionals provide opportunities for interdisciplinary experiences, eventhough the holistic care of patients requires such perspective. When experiences are provided,they typically focus on a single disease or patient group, such as diabetes. With the complexityof the health care demands of the public, an interdisciplinary approach to health care is essential(American Association of Colleges of Nursing 1996).

Effective interdisciplinary education involves members of various disciplines in collaborativeefforts that foster interprofessional interactions and enhance the practice of each discipline. Suchefforts engage health care professionals in joint planning, decision making, and goal setting andrequire skills of critical thinking and reasoning, problem solving, communication, informationretrieval/management, and collaborative teamwork (Skiba 1997). To meet these challenges, it isimportant that health education programs and curricula incorporate collaborative,interdisciplinary classroom and clinical experiences for nursing and other allied health students.

To accommodate the shift in health care focus from disease and illness to health and wellness,clinical experiences must reflect the movement to the community. Ryan et al. (1997) report that"community-based experiences for students foster learning about people and their health withinthe context of home and community and offer the best promise for students to learn the complexhuman dynamics of real life and develop a holistic perspective required for independent nursingpractice" (p. 139).

One example of a student community-based experience is provided by St. Joseph'sChurch/George Mason University College of Nursing and Health Science: Partnership forHEALTH. To initiate their community health experiences, students first engaged in a needsassessment of the primarily Hispanic and Vietnamese school population of St. Joseph's. Toidentify the population's health care needs, the students conducted preschool health screening. With the results of their assessment, the students planned the appropriate health care delivery. They held parent health education classes on topics such as preschool nutrition and day careworkers'/children's classes on safety, and growth and development.

Such experiences are effective ways to foster links between students and the community andprepare nurses and other allied health professionals for work in the emerging consumer-drivenhealth care market. "Bringing health care to where clients live, work, and worship has expandedstudents' vision of the real world experiences in which nurses must be able to intervene" (Nobleet al. 1996, p.71).

Teaching philosophies, teacher/student relationship, classroom structure, and evolution ofcurriculum are at the heart of pedagogical change. The shift from a teaching to a learningparadigm is triggered by the growing number of students, their increasing diversity, theavailability of information telecommunications, and the global nature of work. The traditionalstudent (18-22 years old and full time) is no longer dominating the educational scene,representing less than 25 percent of the student population. Many of the nontraditional studentsare older and reflect an employee and consumer learning market (Skiba 1997).

In the health professions, learning has moved beyond mastery of content/skill to lifelong-learningconcepts that require continuous engagement in critical thinking, questioning, and problemsolving in context (Kupperschmidt and Burns 1997). With the focus of health care moving fromthe individual/family to the populations/aggregates, "perpetual learning with unbundled learningexperiences based on learner needs will be a predominant force" (Skiba 1997, p. 129).

Within the realm of health care reform, educational experiences must involve active learningwith regard to health care access, quality, and cost containment. Clinical and communityexperiences working with practicing health care professionals and engaging in self-directedlearning enhance students' acquisition and application of knowledge and promote lifelonglearning.

The following resources contain relevant information about health care reform and itsimplications for allied health occupations education.

Print Resources

American Association of Colleges of Nursing. "Position Statement Interdisciplinary Educationand Practice." Journal of Professional Nursing 12, no. 2 (March-April 1996): 119-121.

Defines interdisciplinary education and describes its role in preparing nurses for work in a healthcare environment in which collaboration is essential and quality of care is based on recognitionand appreciation of the contributions each discipline brings to the health care deliveryexperience.

Goodloe, N., and Cloud, R. "Health Education and Allied Health: Collaboration in theTwenty-First Century." American Journal of Health Behavior, Education, & Promotion 19,no. 4 (July-August 1995): 3-9.

Describes a collaborative partnership model that links academia with health practitioners for thepurpose of improving the educational preparation of health educators. The Baylor Universityhealth education model for higher education is highlighted.

Hall, J., and Stevens, P. "The Future of Graduate Education in Nursing: Scholarship, The Healthof Communities, and Health Care Reform." Journal of Professional Nursing 11, no. 6(November-December 1995): 332-338.

Examines graduate nursing education and ways it can be made more responsive to health careneeds: reflection on the roles of nurse practitioners and others, advocacy for vulnerable groups,expertise in community-based practice and research, understanding of the broader environmentalcontext of health, and commitment to making a difference in public health.

Hillestad, E., and Hawken, P., eds. "Editorial: Nursing in the Year 2000." Journal ofProfessional Nursing 12, no. 3 (May-June 1996): 127-128.

Predicts the direction of nursing in the year 2000, noting a movement toward more integrationand systemization of the health care system, an increase in home health care services, theemergence of the health care specialist, and a demand for accountability for objectively measuredpatient outcomes.

Kupperschmidt, B., and Burns, P. "Curriculum Revision Isn't Just Change: It's Transition!" Journal of Professional Nursing 13, no. 2 (March-April 1997): 90-99.

Considers the status of curriculum revision in nursing programs across the country triggered bythe dynamic changes occurring in the health care industry. Suggests that a focus on curriculumrevision rather than change may assist faculty more readily in engaging in the thinking necessaryto develop new curriculum for the 21st century.

McEwen, M. "Promoting Interdisciplinary Collaboration." Nursing & Health Care 15, no. 6(June 1994): 304-307.

Presents collaboration as intrinsic to the improvement of health education across the professions. Suggests that changes in health care provision should begin during the education of health careproviders and that cross-discipline courses should be encouraged to enable providers to betterunderstand the variety of roles and practices that contribute to collaboration and the delivery ofcare.

Meservey, P. "Fostering Collaboration in a Boundaryless Organization." Nursing & HealthCare 16, no. 4 (June 1995): 234-236.

Discusses how the demand for more efficient delivery of health care services has created aboundaryless organization that links hospitals, primary care, home care, and rehabilitativeorganizations. Recommends that today's health care leaders become skilled in negotiation andpolitical awareness while addressing the human resource needs of those providing service.

Noble, M. et al. "Education for the Nurse of Tomorrow: A Community-Focused Curriculum." Nursing & Health Care 17, no. 2 (March-April 1996): 66-71.

Describes a baccalaureate nursing program's efforts to implement a community-focusedcurriculum that will prepare nurses for a changed health-care system. Describes a studentprogram that includes mental health experience, health screening for preschoolers, and otherclinical experiences.

Osterle, M., and O'Callaghan, D. "The Changing Health Care Environment: Impact onCurriculum and Faculty." Nursing & Health Care 17, no. 2 (March-April 1996): 78-81.

Looks at the problems associated with the rapidly changing health-care system and the anxietycaused by it. Suggests a shift in nursing education is necessary to provide competent primaryhealth-care practitioners.

Pruitt, R., and Campbell, B. "Educating for Health Care Reform and the Community." Nursingand Health Care 15, no. 6 (June 1994): 308-311.

Proposes that nursing education should focus on less expensive prevention instead of costly careafter the disease has become full blown, and should encourage the involvement of customers indecision making.

Ryan, S. et al. "A Faculty on the Move into the Community." Nursing & Heath Care 18, no. 3(May-June 1997): 139-141.

Describes how faculty at the University of Rochester School of Nursing use the concept of"Learning Communities" to prepare students for the evolving demands of the health care jobmarket and the changing nature of the nursing profession.

Sims, G., and Baldwin, D. "Race, Class, and Gender Considerations in Nursing Education." Nursing & Health Care 16, no. 6 (November-December 1995): 316-321.

Explains the curriculum revolution in nursing education as a direct result of outdated modes ofteaching and learning that fail to prepare students for nursing in a diverse society. Notes thatlittle dialog is occurring on the topic of the inclusion of multiculturalism into the curriculum.

Skiba, D. "Transforming Nursing Education to Celebrate Learning." Nursing & Health Care18, no. 3 (May-June 1997): 124-129.

Explains that, as the teaching infrastructure becomes redefined, schools of nursing will need toshift from a teaching to a learning paradigm. Describes the challenges this presents to nursingeducation and the themes that direct the movement toward educational change.

Watson, M. "President's Message: From Discipline Specific to Inter to Multi toTransdisciplinary Health Care Education and Practice." Nursing & Health Care 17, no. 2(March-April 1996): 90-91.

Examines the recent shift from curriculum and teaching to creating environments for learningthat are postinstitutional, interdisciplinary, and community in nature and notes the return to arelationship-centered caring and healing that transcends any one health profession.

Zungalo, E. "Interdisciplinary Education in Primary Care: The Challenge." Nursing & HealthCare 15, no. 6 (June 1994): pp. 288-289.

Presents a number of barriers to an equitable collaboration between the medical and nursingprofessions. Identifies the primary barrier to collaboration as medicine's traditional dominanceover nursing, which reflects the differences in professional socialization, age and academicscholarship, educational curriculum, and relationship with higher education.

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