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2. Nursing Education, Research, And Evidence-Based Practice LEARNING OUTCOMES After

2. Nursing Education, Research, And Evidence-Based Practice LEARNING OUTCOMES After

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2. Nursing Education, Research, and Evidence-Based PracticeLEARNING OUTCOMES
After completing this chapter, you will be able to:1.
Describe the different types of educational nursing programs.
Discuss aspects of entry to professional nursing practice.
Explain the importance of continuing nursing education.
Identify ways the nurse can participate in research activities in practice.
Differentiate the quantitative approach from the qualitative approach in nursing research.
Describe the nurse's role in protecting the rights of human subjects in research.
Identify the steps of the research process.KEY TERMSconfidentiality,
continuing education (CE),
dependent variable,
descriptive statistics,
empirical data,
evidence-based practice (EBP),
full disclosure,
grounded theory,
independent variable,
in-service education,
measures of central tendency,
measures of variability,
operational definitions,
right of self-determination,
risk of harm,
standard deviation,
statistically significant,
 Nursing education is controlled from within the profession through state boards of nursing and nationalaccrediting bodies. The traditional focus of nursing education was to teach the knowledge and skills thatwould enable a nurse to practice in the hospital setting. However, as nursing responds to new scientificknowledge and technological, cultural, political, and socioeconomic changes in society, nursing educationcurricula are revised to meet the needs of nurses working in a changing environment. Programs of nursingstudy are increasingly based on a broad knowledge of biologic, social, and physical sciences as well as theliberal arts and humanities. Nursing curricula now have a greater focus on critical thinking and theapplication of nursing and supporting knowledge to health promotion, health maintenance, and healthrestoration as provided in both community and hospital settings (see Figure 2-1).  Nursing research entails developing and expanding knowledge about human responses to actual or  potential health problems and investigating the effects of nursing actions on those responses. The major goal of nursing research is to improve client care.
Figure 2-1.
Nursing students learn to care for clients in community settings.
At the present time, there are two types of entry-level generalist nurses: the registered nurse (RN), and thelicensed practical or vocational nurse (LPN, LVN). Responsibilities and licensure differ for these twolevels. The majority of new RNs graduate from diploma, associate degree, or baccalaureate nursing programs. There are also generic master's and doctoral programs that lead to eligibility for RN licensure.For example, students entering a generic master's program already have a baccalaureate degree from adiscipline other than nursing. On completion of the program, generally 2-3 years in length, the graduatesobtain their initial professional degree in nursing. Graduates of these master's programs are eligible to takethe licensure examinations to become an RN and may continue into specialty roles such as nurse practitioner or educator.Although these programs vary considerably, all RNs in the United States take the same licensingexamination. The National Council Licensure Examination (NCLEX-RN) is administered in each state.The successful candidate becomes licensed in that particular state even though the examinations are of national origin. To practice nursing in another state, the nurse must receive reciprocal licensure byapplying to that state's board of nursing. Some state legislatures are creating a regulatory model called
mutual recognition
that allows for multistate licensure under one license (seeChapter 4). Nursesfrom other countries may be granted registration by endorsement after successfully completing the NCLEX. Both licensure and registration must be renewed regularly to remain valid. For additionalinformation about licensure and registration, seeChapter 4.The legal right to practice nursing requires not only passing the licensing examination but also verificationthat the graduate has completed a prescribed course of study in nursing. Individual states may haveadditional requirements. All U.S. nursing programs require approval by their state board of nursing.In addition to state approval, the National League for Nursing Accrediting Commission (NLNAC) provides accreditation for all levels of nursing programs, and the Commission on Collegiate NursingEducation (CCNE) accredits baccalaureate and graduate degree nursing programs. Accredited programsmeet standard requirements evaluated periodically through written self-studies and on-site visitation byexaminers.
Educational programs available for nurses include practical or vocational, registered nursing, graduatenursing, continuing education, and in-service.
Licensed Practical (Vocational) Nursing Programs
Practical or vocational nursing programs are provided by community colleges, vocational schools,hospitals, or other independent health agencies. These programs usually last 9 or 12 months and provide both classroom and clinical experiences. At the end of the program, the graduate takes the NCLEX-PN toobtain a license as a practical or vocational nurse.Licensed practical nurses practice under the supervision of a registered nurse in a hospital, nursing home,rehabilitation center, or home health agency. LPNs (LVNs) usually provide basic direct technical care toclients. The registered nurse, who has the knowledge and skill to make more sophisticated nursing judgments, is responsible for assessing the client's condition, planning care, and evaluating the effect of thecare provided.
Registered Nursing Programs
Currently, three major educational routes lead to RN licensure: diploma, associate degree, and baccalaureate programs.
Diploma Programs
After Florence Nightingale established the Nightingale Training School for Nurses at St. Thomas'sHospital in England in 1860, the concept traveled quickly to North America. Hospital administratorswelcomed the idea of training schools as a source of free or inexpensive staffing for the hospital. Nursingeducation in the early years largely took the form of apprenticeships. With little formal classroominstruction, students learned by doing, that is, by providing care to clients in hospitals. There was nostandardization of curriculum and no accreditation. Programs were designed to meet the service needs of the hospital, not the educational needs of the students.The 3-year diploma programs were the dominant nursing programs from the late 1800s and were the major source of graduates until the mid-1960s. Today's diploma nursing programs have changed markedly fromthe original Nightingale model. In the United States, diploma programs are hospital-based educational programs that provide a rich clinical experience for nursing students. These programs are often associatedwith colleges or universities.Almost 70 NLNAC accredited diploma programs in 18 states provide this avenue for students desiring aneducation in nursing ( NLNAC, 2005). The number of diploma nursing programs has declined since theANA resolution in 1965 which recommended that "education for those who work in nursing should be placed in institutions of learning within the general system of education," that "minimal preparation for  beginning professional nursing practice at the present time should be the baccalaureate degree education innursing," and that "associate degree education in nursing should be the minimum preparation for beginningtechnical nursing practice" (ANA, 1965,p. 107).
Community College/Associate Degree Programs
Community college/associate degree nursing programs, which arose in the early 1950s, were the first andonly educational programs for nursing that were systematically developed from planned research andcontrolled experimentation. Several trends and events influenced the development of these programs: (a)the Cadet Nurse Corps, (b) the community college movement, (c) earlier nursing studies, and (d) Dr.Mildred Montag's proposal for an associate degree.The Cadet Nurse Corps of the United States was legislated and financed during World War II to provideadditional nurses to meet both military and civilian nursing needs. The corps proved that qualified nursescould be educated in less time than the traditional 3 years.

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