This study has revealed interesting information about the teaching of science to nursing students. In 2008, Logan identified the proportion of science taught in nursing programs to be around 16% [25]. Subsequent work by Logan and Angel [6] suggests that this figure is decreasing, although these authors acknowledge that science content is less distinctive and the true proportion of science may be masked in curricula that are becoming increasingly integrated. The number of academics teaching dedicated science content across the institutions that are accredited to conduct these programs in Australia is therefore similarly small, as reflected in the sample size in this study.
The results confirm that all topics contained within the survey are addressed in nursing programs. Earlier work has consistently indicated that the bioscience content of nursing programs is inadequate [1,24,27,28] yet few additional items were suggested by respondents when given the opportunity to do so. The identification of so few outstanding topic areas infers that academics either believe the science content of nursing programs is adequate or are unsure of what science content warrants inclusion in what is recognized to be an increasingly crowded curriculum [29].
Respondents ranked the majority of topics presented in the survey in the ‘moderate’ priority range. Most of the items that were ranked ‘high priority’ for teaching were macroscopic topics, such as gross anatomy and basic concepts above the cellular level. This finding is consistent with those of Davis who also found that anatomy was the bioscience topic given the greatest coverage in pre-registration curricula [24]. Topics such as microbiology and chemistry were noticeably not ranked in the ‘high priority’ category, once again reflecting the findings of Davis [24]. It is possible that concepts associated with more concrete elements of science such as anatomy, terminology etc., may be easier for students to grasp and thus easier to teach. It might also be the case that such subject areas are easier to deliver in a mass lecture or via online delivery thus reducing the resource requirements associated with the teaching of topics such as microbiology and physics.
The physiology and pathophysiology of all body systems was ranked ‘3’ or above. Of concern, however, is that with the exception of cardiovascular system, respiratory system and renal system, all these systems were ranked only as ‘moderate priority’. Effective and safe nursing practice is dependent upon highly developed assessment skills that can distinguish normal and deviations from normal. Furthermore, a comprehensive understanding of both physiology and pathophysiology is fundamental to the ability to accurately undertake nursing health assessment. Why the cardiovascular, respiratory and renal systems were the only systems identified as being given the highest priority in teaching is not clear. It is possible that in the case of a patient’s health deteriorating in an acute situation, an understanding of these systems is seen as most critical to informing a nursing response. The literature suggests that nurses’ collection and interpretation of clinical cues explained by these science domains is vital [29,30].
The reproductive system and genetics both ranked lowest in respect of the teaching of physiology and pathophysiology. It may be that respondents were focused on generic knowledge that was essential education for novice nurses, whereas reproduction could be considered the domain of more specialist disciplines, such as midwifery. With the exception of genetic control and malignancy, which was rated in the ‘high priority’ category, genetics was the lowest ranking topic in the category of physiology and pathophysiology. In spite of the increasing significance of genetics in ensuring a preparedness for practice from a contemporary evidence base [31], a generalist philosophy in undergraduate nursing curricula combined with a low number of specialist nurse geneticists in Australia may contribute to the low ranking of this category.
Few other topics in the survey ranked as ‘low priority’. Chemical reactivity may have been considered by respondents to be an overarching term for many of the items in the chemistry category. In spite of nursing practices no longer including lifting and moving patients, the low ranking of topics related to biomechanics of movement is concerning given the need for knowledge in this topic area remains a workplace health and safety issue. The low ranking of topics related to nuclear medicine and radiation may once again be considered areas of specialised practice and thus not seen as important for inclusion in a preparatory nursing program.
In approaching this study, the authors were acutely aware of a broad consensus in the literature that the bioscience content in nursing programs is inadequate. Ironically it would seem that the inclusion of science content in nursing curricula is being guided by a comprehensive philosophy in which quantity is emphasised over quality. Although a small sample size may limit the ability to draw conclusive inferences from the data, it is nevertheless surprising that so few topic areas were strongly identified as being given ‘high priority’ by respondents to this survey. In a study on bioscience content in nursing, Friedel and Treagust [1] identified a discrepancy between the intended and enacted curriculum, concluding that the aims of preparing students for clinical practice were not being fulfilled, a finding further validated by Davis [24]. The findings of these authors, along with those described in this paper, may indicate a problem with curriculum informants and decision-making processes that ultimately impact on curriculum content. The issues surrounding science content in nursing programs are therefore complex and require exploration of the large context in which curriculum development and delivery occur.
Recommendations
A number of questions are raised by the preceding discussion that has implications for the profession: is the emphasis on a comprehensive philosophy of preparatory nursing education in Australia impeding the development of a solid foundation in the biological sciences? To what extent are these challenges the result of crowded curricula where the opportunity to pose solutions is being compounded by reducing academic teaching periods? Is the inadequacy in the teaching of science content in nursing reflective of a lack of decision-making responsibility in respect of curriculum design by key stakeholders?
Addressing these questions requires a commitment to understanding the drivers of educational practice in nursing and a rethinking of current practices in respect of nursing curricula. For example, while it may seem counterintuitive to improving the delivery of bioscience in nursing programs, a philosophy of “less is more” may rationalise the teaching of bioscience content and ensure that the content of curricula is clearly focused on preparing students for the demands of contemporary nursing practice. Similarly, the same philosophy may be applied to non-bioscience content as an increasing assortment of specialist nursing knowledge encroaches on curricula, leaving little room for the inclusion of science. Results of the subsequent phase of this research will inform such focus and further research is recommended to identify and adequately scope the issues related to academics’ teaching of bioscience in nursing programs. Academics responsible for the design and implementation of nursing curricula are encouraged to review the content of current programs in light of the findings of this and future work.
Limitations
The major limitation of this study is the low sample size derived from a small population of science-teaching academics in Australia. This limitation has prohibited a more extensive analysis of the quantitative data. The sample is considered representative of the target cohort, with respondents located in all but one jurisdiction. Distribution of the survey link was at the discretion of the CDNM and subsequently the Deans and heads of schools of nursing nationwide. A potential limitation therefore relates to the constitution and responsiveness of the membership of the CDNM. A number of concepts may also have been subject to interpretation, for example: what constitutes ‘undergraduate nursing programs’ as referred to in the survey; what is considered to be science content; and who in any department is classified as a science teacher. In addition, there may be differences between the views of nursing academics and non-nursing academics, owing to their various educational backgrounds, that cannot be explicated as a result of the small sample size. The results nonetheless indicate that the responding cohort possess a comprehensive understanding of the science content of nursing curricula which can guide future curriculum review.