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Education of nurses and nurse educators in Germany

Author of the blog is Simone Campos Silva from Charité – Universitätsmedizin Berlin

Germany is located in central Europe and has 83.1 million inhabitants, which means that it is the most populated member state of the European Union (Destatis, 2021). Germany is a federal republic with 16 federal states; each state is partly autonomous regarding its internal organisation. This independence applies, for example, to education and health.

Image: Johannes Ries, modified by NordNordWest

Nurse Education

With the new Nurse Professions Act of January 2020, there are now two ways of becoming a nurse in Germany (PflBG, 2017). One option is completing vocational training at vocational schools – this is equivalent to level 4 in the European Qualification Framework (EQF, 2017; Lehmann et al., 2019). This vocational training is the predominant way of educating nurses in Germany. There are approximately 1.200 vocational schools (BMFSFJ, 2021; Destatis, 2021). The vocational training takes up to three years and the nursing students receive a monthly salary during the training period, which increases every year (BIBB, 2020; BMFSFJ, 2021). The Nursing Professions Act introduced a new job title Pflegefachmann/ Pflegefachfrau (= nurse). This is a generalist education that combines general nursing, geriatric nursing and paediatric nursing. Still, nursing students have the possibility to specialise in geriatric nursing or paediatric nursing during their training (BIBB, 2020). In order to start vocational nursing training, students are required to have 10 years general education, meet certain health requirements and have a clean criminal record.

The second option to become a nurse in Germany is to go to university or university of applied sciences. This education is equivalent to level 6 in the European Qualification Framework (EQF, 2017; Lehmann et al., 2019). Depending on the source, there are between 30 or more than 40 universities offering nurse education, which lasts between 6-8 semesters (DBfK, 2016; BMFSFJ, 2021). When studying to become a nurse at a university or university of applied sciences, salaries are not regulated (BIBB, 2020). Nursing students receive the academic degree Bachelor of Science in addition to the job title Pflegefachmann/ Pflegefachfrau. In order to study at a university or university of applied sciences, nursing students are required to have 12 years general education.

References: BIBB (2020)1, BMFSFJ (2021)2, Destatis (2021)3, DBfK (2016)4, Lehmann et al. (2019)5, EQF (2017)6

Nurse Educator Education:

There is a very heterogeneous picture with regard to the education of nurse educators within Germany. In general, a distinction can be made between three different educational paths: Further education programs (EQF 4/5), bachelor programs (EQF 6) and master programs (EQF 7). Further education programs almost do not exist anymore but there are still numerous nurse educators teaching in vocational schools, who have been trained through these further education programs. In the last years, bachelor and master degree programs have emerged to train nurse educators. The Nursing Professions Act of 2020 specifies that a reasonable share of nurse educators must be trained at master level (PflBG, 2017). What exactly is meant by ‘reasonable share‘ is not defined.

In Germany, there are formal educational programs for nurse educators. According to the requirements of the Nursing Professions Act, these programs take place at master level at universities or universities of applied sciences – which is equivalent to level 7 in the European Qualification Framework (PflBG, 2017; EQF, 2017). Depending on the program, these master programs comprise between 60-120 ECTS and can be studied part-time or full-time. Funding is provided by the state. However, at private universities and universities of applied sciences tuition fees may apply.

References:

Bundesinstitut für Berufsbildung (BIBB) (Federal Institute for Vocational Education and Training) (2020): Pflegeausbildung aktuell. Modern, vielfältig und zukunftsfähig. URL: https://www.bmfsfj.de/resource/blob/156748/8ac8ea7bd4168380f81f658f02326621/pflegeausbildung-aktuell-broschuere-bibb-data.pdf (15.11.2021)

Bundesministerium für Familie, Senioren, Frauen und Jugend (BMFSFJ) (Federal Ministry for Family Affairs, Senior Citizens, Women and Youth) (2021): Pflegeausbildung. Alles zur Ausbildung. URL: https://www.pflegeausbildung.net/ausbildungsinteressierte.html (15.11.2021)

Destatis Statistisches Bundesamt (2021): Statistik nach der Pflegeberufe-Ausbildungsfinanzierungsverordnung – 2020. URL: https://www.destatis.de/DE/Themen/Gesellschaft-Umwelt/Bildung-Forschung-Kultur/Berufliche-Bildung/Publikationen/Downloads-Berufliche-Bildung/pflegeberufe-ausbildungsfinanzierung-vo-5212401207005.html (15.11.2021)

Deutscher Berufsverband für Pflegeberufe (DBfK) (German Nurses Association) (2016): Position des DBfK zum Einsatz von primärqualifizierten Bachelor of Nursing in der Pflegepraxis. URL: https://www.dbfk.de/media/docs/download/DBfK-Positionen/Position-BSN-Einsatz-in-Praxis_2016-07-26final.pdf (15.11.2021)

European Qualifications Framework (EQF) (2017): The European Qualifications Framework for lifelong learning and repealing the recommendation of the European Parliament and of the Council of 23 April 2008 on the establishment of the European Qualifications Framework for lifelong learning. URL: https://eur-lex.europa.eu/legal-content/EN/TXT/HTML/?uri=CELEX:32017H0615(01)&from=EN (15.11.2021)

Fachkommission nach Pflegeberufegesetz (2019): Rahmenpläne der Fachkommission nach § 53 PflBG. 2. überarbeitete Auflage. URL: https://www.bibb.de/dienst/veroeffentlichungen/de/publication/show/16560 (09.12.2021)

Lehmann Y, Schaepe C, Wulff I, Ewers M (2019): Pflege in anderen Ländern: Vom Ausland         lernen?. Heidelberg: medhochzwei.

Pflegeberufegesetz (Nurse Professions Act) (PflBG) (2017): Gesetz über die Pflegeberufe. URL: https://www.gesetze-im-internet.de/pflbg/PflBG.pdf (20.12.2021)

Fig. 1: Map of Europe. Johannes Ries, modified by NordNordWest, CC BY 2.0 https://creativecommons.org/licenses/by/2.0, via Wikimedia Commons

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Evidence based teaching in nursing education – educators as key actors

The Authors of this blog post are:

Professor Terhi Saaranen, University lecturer Juha Pajari and Project researcher Anneli Vauhkonen from University of Eastern Finland.

In nursing we all know evidence based practice and how important it is in health care related decision making. Evidence based practice have many different definitions. WHO defines evidence based practice as an interdisciplinary decision making in clinical settings including the best available evidence, care context, client values and preferences and health care professionals’ professional judgement (WHO 2017). JBI defines evidence based healthcare as a decision making process that constitutes of feasibility, appropriateness, meaningfulness and effectiveness of healthcare practices. Nurse educators are in the vital role in development of EBP and facilitating students ability and attitudes to use evidence based practice in their future professions (WHO 2017). The same principles of EBP can be applied also in nursing education – to evidence based teaching (EBT) in nursing education.

Utilization of research in education is often preferred as searching research evidence about the learning content and updating the content. Evidence based teaching in nursing is seen from larger perspective. EBT is decision making including the best available evidence about learning, teaching, teaching methods, assessment, and other areas as well as expertise and judgment of the teacher and the preferences and goals of the learners. The ultimate goal of EBT is to improve student’s learning outcomes. (Oermann 2021.) EBT requires the commitment and competence of educators as well as resources to use evidence based information in their own activities. Perhaps one of the most important is the attitude towards EBT. A positive attitude creates commitment and a desire to develop EBT, which also requires the educator to continuously develop his or her skills.

Evidence based teaching can be thought of as being linked to all didactic stages of the whole curriculum process; directive, formative, functional, and evaluation stage. The directive stage is the foundation and guides the direction of the whole curriculum containing the philosophy such as the worldview of the nursing education, terms used in the field of nursing science discipline, expected competencies of the graduate and the theoretical framework such as learning theories and models. (Adapted Torres & Stanton 1982). The decision making in EBT process is tightly related to the surrounding environmental and organizational context (eg. international The EU Directive of recognition of professional qualifications and national regulation and local organization’s teaching curriculum design and requirements). In addition, educator considers the theories and concepts about learning and teaching (Oermann 2021).

The formative stage contains the curriculum design and requirements, course objectives and content map and is tightly linked to the directive stage. The third functional stage means the action in the level of specific courses containing the planning, implementation and evaluation of the course. EBT is commonly seen in the formative and functional stage when creating and developing courses. The evaluative stage is the assessment of the curriculum design process (Adapted Torres & Stanton 1982).

Photo by Pixabay from Pexels

In this Erasmus+ funded project EBT in seen in directive stage with our bold aim to take the first steps in harmonizing the nurse educator education within Europe by research of nurse educator education and continuous education needs of nurse educators and by 30 ects transnational study programme for nurse educator and educator candidates. The study programme called Empowering the nurse educators in the changing world has been developed and it started in the autumn 2021 with positive feedback from participants. The study programme includes study units from current and future global health issues and education, competence in digital pedagogy and digital learning environments, ethics in nursing education and evidence based teaching. The usability of the study program and the learning outcomes are evaluated during the study programme. Next spring 2022, the University of Eastern Finland is leading the Evidence based teaching study unit where student can utilize EBT strategies learnt during this program in transnational teacher training. Teacher training will take place in all partner universities in this project. We hope that the COVID-19 pandemic will start to ease with the spring and that the students will be able to collaborate face-to-face and change good practices between participating countries.  

Photo by Susanne Jutzeler from Pexels

The Christmas is here, and it is time to calm down and enjoy the peaceful holiday season. This year in the project has been challenging because of corona pandemic, but also enjoyable with new encounters and learning experiences and of course evidence based action. Happy and peaceful Christmas time and joyful New Year to all.

Christmas greetings from Terhi, Juha and Anneli 

University of Eastern Finland (UEF) 

Faculty of Health Sciences  

Department of Nursing Science

A blog post from Terhi Saaranen in the blog of the Department of Nursing Science, University of Eastern Finland on 14 December 2021 has been utilized when writing this blog. Available at UEF blogs.

References:

JBI 2021. JBI approach to EBHC. Available at https://jbi.global/jbi-approach-to-EBHC

Oermann, M., De Gagne, J., & Phillips, B. (2021). Teaching in nursing and role of the educator: the complete guide to best practice in teaching, evaluation, and curriculum (third edition). Springer.​

Torres, G. & Stanton, M., 1982. Curriculum Process in Nursing A Guide to Curriculum Development. Englewood Cliffs, New Jersey: Prentice-Hall.

WHO 2017. Facilitating evidence-based practice in nursing and midwifery in the WHO European Region. Available at https://www.euro.who.int/__data/assets/pdf_file/0017/348020/WH06_EBP_report_complete.pdf​

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We wish you a very merry Christmas and a happy new year!

As the year approaches its end, we wish to take this opportunity to thank our partners, our funder Erasmus+, Finnish National Agency for Education and all collaborators for this year. We want to wish you all a joyful Christmas and happy New Year 2021.

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A peak to the future of Nurse Educator Education

Being a nurse educator is not a mundane task. Educators are responsible of assuring the competence of the newly graduated nurses hence there is vast variety of competencies that are required to accomplish that task successfully. The competence areas of nurse educators include pedagogical, research, communication, collaboration and leadership competence, substantial clinical competence, ethical competence and cultural competence. The educators in the field of nursing should also have competence in digital pedagogy. Furthermore, the educators need working life skills, such as self-direction, reflection and life-long learning skills. In addition, the educators’ competence requirements are in constant adaptation to meet the current and future global health issues.

Globalization is yet another challenge the educators especially in field of health sciences are experiencing. The world is changing rapidly, and prevalence of current health issues is estimated to increase due to population growth, aging and relocation. In addition, population growth and environmental issues increase risk of pandemics, such as the COVID-19. Health promotion, disease prevention, supportive environments and efficient, sustainable and equal health care systems within EU are emphasized in EU health program (https://ec.europa.eu/chafea/health/programme/index_en.htm). The nursing education is called to coincide these goals.

Educators have to be creative and innovative to find and develop sustainable methods to guide the students in global learning. Knowledge regarding new health issues is required before the issues have arisen, which means, the educators need constant updating of their own competence and keen interest in innovative thinking to stay one step ahead of the needs of the health care services. Ability to be innovative, requires also knowledge of historical events and understanding of social and cultural factors in regards of health and care.

In spite of the colossal efforts educators make, to stay ahead in nursing education, not all the changes are possible to predict, hence learning in higher education should focus on empowering students in health sciences to cope with the changing demands of the working life. This means, educators should be able to teach and enhance analytical thinking, problem solving, development of professional and social identity and attitudes and encouraging the students to life-long learning from the beginning of their career.

In Finland, nurse educator education as nurse education in general, are regulated. However, that is not the case in Europe. The Bologna declaration was established in 1999 to standardize higher education across Europe yet there is no common regulation for nurse educators. In addition, a recent study comparing graduating nursing students from 10 European countries, found significant differences in the competence of the students.  Hence, there is a need to harmonize the educator education to guarantee the equal education of nurses within Europe.

First in Europe, A New Agenda for Nurse Educator Education in Europe (New Nurse Educator) -project aims to take the first steps in harmonizing the nurse educator education within Europe. The New Nurse Educator is an Erasmus+ funded project implemented in collaboration between six countries and seven universities: University of Turku and University of Eastern Finland from Finland, Humboldt University from Germany, University of Malta from Malta, University of Nitra from Slovakia, University of Catalonia from Spain and The University of Edinburgh from Scotland.

The project aims to describe the current situation in nurse educator competence , education and need for continuous education in Europe, to develop, implement and evaluate a transnational educator education unit and make common recommendations for nurse educator education in Europe. This project offers an opportunity for European universities to take the first steps toward a common education program in field of nurse educator education, to harmonize and strengthen the nurse educator education and to guarantee  equal education to student nurses in Europe.

Leena Salminen, Project coordinator

References:

  1. Amerson R. (2020). Using a Global Health Blog to Prepare Nursing Students for Global Nursing Practice. Nurse Educator 45 (2), E13-E14. 
  2. McAllister M & Flynn T. (2016). The Capabilities of Nurse Educators (CONE) questionnaire: Development and evaluation. Nurse Education Today 39, 122-127.
  3. Kajander‐Unkuri, S., Koskinen, S., Brugnolli, A., Cerezuela Torre, M., Elonen, I., Kiele, V., … & Leino-Kilpi, H. (2020) The level of competence of graduating nursing students in 10 European countries—Comparison between countries. Nursing Open.
  4. Mikkonen K., Koivula M., Sjögren T., Korpi H., Koskinen C., Koskinen M., Kuivila H-M., Lähteenmäki M-L., Koskimäki M., Mäki-Hakola H., Wallin O., Saaranen T., Sormunen M., Kokkonen K-M., Kiikeri J., Salminen L., Ryhtä I., Elonen I., Kääriäinen M. (2019). Sosiaali-, terveys- ja kuntoutusalan opettajien osaaminen ja sen kehittäminen http://urn.fi/urn:isbn:9789526224794
  5. Ryhtä, I., Elonen, I., Saaranen, T., Sormunen, M., Mikkonen, K., Kääriäinen, M., … &  Salminen L. (2020). Social and health care educators’ perceptions of competence in digital pedagogy: A qualitative descriptive study. Nurse Education Today, 92, 104521.
  6. Shustack L. 2020. Integrating Google Earth in Community Health Nursing Courses Preparing Globally Aware Nurses. Nurse Educator 45 (2), E11-E12.  
  7. Van Laar E, Van Deursen A, Van Dijk J & de Haan J. 2017. The relation between 21st century skills and digital skills: A systematic literature review. Computers in Human Behavior 72, 577–588. 
  8. WHO (World Health Organization). 2016. Nurse educator core competencies. Geneva, Switzerland: WHO Document Production Services. Retrieved from https://www.who.int/hrh/nursing_midwifery/nurse_educator050416.pdf 
  9. Zlatanovic T., Havnes A., Mausethagen S. 2017. A Research Review of Nurse Teachers’ Competencies. Vocations and Learning 10(2), 201–233.