Exploratory review on designing and developing core anatomy education programmes for undergraduate nurses

Abstract

BACKGROUND: For nurses to be deemed safe and competent to practice, they require a working knowledge and understanding of several subspecialties within the life sciences, including anatomy, physiology, genetics, biochemistry, pharmacology, microbiology, pathology and radiography subjects. Yet, a plethora of evidence asserts that nursing biosciences are not at the level anticipated by the profession in the United Kingdom and internationally. Several underlying causes have been posited. First and foremost is the need for more regulatory guidance on the level and depth of bioscientific knowledge required at pre-and post-registration levels. Concurrently, the ambiguity surrounding bioscientific standards in nursing education has created disagreement on what works pedagogically alongside challenges in communicating and highlighting the explicit role of the life sciences across multiple areas of practice, manifesting as a gap between theory and nursing applications. Simultaneously, broader sociohistorical factors implore nurses to preserve uniprofessional power and autonomy, generating disagreement on who should teach biological science to nursing students; a 'medical', 'purist' or 'applied' scientist?

The multifaceted nature of the 'bioscience problem' has led to calls for a wide-scale educational evaluation to gain in-depth insight into the current issues to improve the quality of nurses' bioscience education.

OBJECTIVE: To explore the enablers and constrainers for designing and delivering quality anatomy education to pre-registration nurses?

Review Questions: (i) Historically, how have nursing and anatomy programmes evolved, changed, or maintained the status quo? (ii) What are student nurses, academics and registered nurses’ views on anatomy education and provision within the undergraduate nursing programme? (iii) Can a national consensus be reached on the level and depth of anatomical knowledge required for undergraduate nurses by formulating specific core learning outcomes? (iv) What are the current structural arrangements, interactions and dynamics between anatomists and nursing educators?

METHODOLOGY: A realist approach was adopted. Initially, the literature was analysed using social realist theory (a grand theory) to elucidate initial explanatory middle range and programme theories that informed the intervention, a non-prescription, national anatomy syllabus and subsequent realist evaluation that highlighted various influencing factors within higher education and regulatory organisations, systems and processes that were explained using realist principles.

METHODS: The realist research that was carried out was an iterative process that utilised mixed methods to refine the underlying theories using multisource evidence that was acquired through systematic searches to synthesise the historical and contemporary literature. Based on the key findings, a Delphi process was subsequently undertaken to reach a national consensus on the level and depth of anatomical required by undergraduate nurses, followed by a questionnaire on interprofessional collaboration and a secondary analysis of the data to explore themes and trends on the facilitators and barriers in quality assuring anatomy education in undergraduate nursing programmes in the United Kingdom.

MAIN RESULTS: Setting Standards: A consensus >80% was reached on the level and depth of anatomical knowledge. The advisory syllabus produced sixty-four systems-based ‘core’ learning outcomes required at the pre-registration level in nursing throughout the United Kingdom. Provision: Anatomy belies a significant proportion of nurses’ professional standards.

Traditionally anatomy was correlated with technical tasks. However, it is discernibly present in the non-technical and safety-critical components of practice. The linked nature of theory to practice see’s nursing programmes deliver anatomy as an integrated component with pathophysiology. Yet, there is variability in teaching anatomy alongside other integrated components ranging from 0.26% to 13% of the overall time allocated for bioscience theory in the curriculum, suggesting that the biosciences are being marginalised. Anatomy was found to be a ‘name and locate’ topic instead of building a conceptually descriptive three-dimensional map to ensure that pathophysiology was covered in more depth, Facilitators and Barriers: There are tenuous or no collegiate links between anatomists and nursing educators. Both groups deem a collegiate relationship essential for increasing learner (and faculty) knowledge and creating opportunities to enhance research and education tailored to nursing. While anatomists are open to working together, there are differences in the level of expertise and pedagogical approaches alongside a lack of information and resource sharing between schools and colleges. For example, 87% of anatomy departments actively use cadaveric specimens to teach compared to 4% of nursing cohorts suggesting inequality of opportunity. This was attributed to significant staff shortages in anatomy, a medical monopoly on resources, under-funding in nursing biosciences and factionalism in nursing that generates a teacher-centred approach to anatomy provision. Along with administrative and geographic issues were ongoing stereotypes about nursing in scientific circles. Nevertheless, there is a desire to break down silos if education is to align with healthcare needs.

CONCLUSION: The quality of undergraduate nurse anatomy education is compromised at the university level as the current ideologies, structures, and dynamics are out of step with the needs and interests of students, necessitating the need for an urgent review and interdisciplinary dialogue at an institutional and departmental level throughout the United Kingdom. The issues have been attributed to the design, organisation and delivery of bioscientific curricula in nursing programmes due to a broader underappreciation and devaluation of the sciences in nursing education and research frameworks.