AACN 2020 Doctoral Nursing Education Conference Breaking ......Breaking Barriers, Building Bridges:...
Transcript of AACN 2020 Doctoral Nursing Education Conference Breaking ......Breaking Barriers, Building Bridges:...
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AACN 2020 Doctoral Nursing Education Conference
Breaking Barriers, Building Bridges: Engineering
Pathways for the Future
Plenary Session
Foresight Leadership: Anticipating the Future of
Doctoral Education in Nursing
Daniel J Pesut PhD RN FAAN
Professor of Nursing Population Health and Systems Cooperative Unit
Director of the Katharine Densford International Center for Nursing Leadership
Katherine R. and C. Walton Lillehei Chair in Nursing Leadership
University of Minnesota School of Nursing
308 Harvard St. SE
4-185 Weaver-Densford Hall
Minneapolis, MN 55455
612-626-9443
January 30, 2020
Key Points of the Presentation
1. AACN’s Vision for Academic Nursing was developed in response to the following charge: Clarify
preferred educational pathways and the preparation necessary to succeed in evolving and future roles
for nursing professionals. Evaluate the future needs of the nursing workforce; consider academic
nursing’s role in promoting population health while addressing the social determinants of health and
advancing interprofessional engagement. Propose overarching and broad-based curricular
recommendations for baccalaureate and graduate nursing programs.
2. Identified goals related to the AACN Vision for Academic Nursing include Advance diversity and
inclusion in nursing education and practice. Transition to competency-based education and
assessment. Increase collaboration between education and practice through expanded and more
formalized academic-practice partnerships. Increase emphasis on faculty development and career
advancement. Explore and adopt opportunities for resource efficiencies. Teaching Learning Challenge
(TLC): How have you used the AACN Vision for Academic Nursing document in your organization
to spark dialogue about the future of doctoral education in nursing?
3. The AACN Vision for Academic Nursing Task Force notes, “Further thinking and action will need to
address implementation strategies and actions to realize any or all the visionary goals.” The following
concepts, principles, theories, references and resources are offered to stimulate thinking and action
regarding implementation strategies to realize AACN’s Vision for Academic Nursing. Each resource
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is likely to influence the thinking, planning and development of doctoral education in nursing into the
future.
4. Dominique Tobbell (2018) traces the history of nursing science development from 1950-1980. She
suggests nurse theorists and researchers must engage in critical boundary work in order to draw
epistemic boundaries between nursing science and the existing biomedical and behavioral sciences.
She notes the boundary work of nurse theorists, researchers, and practitioners continues today. There
is some consensus about framing nursing knowledge with the meta-paradigm of person, health,
nursing and environment. Efforts to define nursing science and establish nursing as an academic
discipline were constrained by generational and intraprofessional politics, limited resources, the
gendered and hierarchical politics, and the complexity of drawing disciplinary boundaries for a
discipline that is inherently interdisciplinary. Teaching Learning Challenge (TLC): Read Tobbell, D.
A. (2018). Nursing’s Boundary Work: Theory Development and the Making of Nursing Science, ca.
1950–1980. Nursing research, 67(2), 63-73. How does her historical analysis provide hindsight to
inform foresight and reveal insights? The AACN Contrast Grid makes explicit the differences between
PhD and DNP education pathways.
5. William Hare reminds us that open-minded inquiry is an ideal and he provides a glossary of terms and
concepts that support the notion of open-minded inquiry. Citing Bertrand Russell Hare observes open-
mindedness is the virtue that prevents habit and desire from making us unable or unwilling to entertain
the idea that earlier beliefs may have to be revised or abandoned; its main value lies in challenging the
fanaticism that comes from a conviction that our views are certain. Universal intellectual standards
include clarity, accuracy, precision, relevance, depth, breadth, logic, significance, and fairness. All
doctoral nursing programs ought to be committed to open minded inquiry and universal intellectual
standards
6. Dr. Richard Paul and Linda Elder from The Foundation for Critical Thinking remind us that all
scientific thinking has a purpose and is an attempt to figure something out, to settle some question, or
solve some scientific problem. Scientific reasoning is based on assumptions and is done from some
point of view. Scientific reasoning is based on data, information and evidence. Scientific reasoning
expresses and shapes concepts and theories. Inferences, interpretations and conclusions give meaning to
scientific data. Scientific reasoning has implications and consequences. Universities have played a
crucial role in the education and development of scientific knowing and knowledge. The nature of the
University is changing.
7. Maree Conway asks the question, is there a future for the University? Her research suggests four
evolutions of the University through time. The Traditional Idea is located wholly within the
university but has a porous boundary. The Managerial Idea spans the boundary between the
university and society, having the impact of weakening the Traditional Idea. The Reframed Idea is
also on the boundary, but in contrast to the Managerial Idea, it draws its strength from the Traditional
Idea to enable it to move outside the neoliberal university. The Dismissive Idea exists outside the
university entirely and tending to move away from it, seeking out alternative structures that are
perceived to be more fit-for-purpose in the present. New ideas will also continue to emerge over time,
and these can be viewed as weak signals or latents on the periphery of the university’s broader social
environment. As Universities evolve, there is opportunity for futures conversations about what is
desirable.
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8. The future of doctoral education in nursing is nursing knowledge work, knowledge management and
knowledge leadership. Verna Allee’s (1997, 2006, 2009a, 2009b, 2015) Knowledge Complexity
Archetype informs types of learning required for different aspects of the knowledge, action and
performance through time. For example, Instinctual learning supports data sensing and information
gathering that is in the immediate moment and non-reflective. Single loop learning supports
information and action without reflection with a short here and now time perspective that involves the
effective and efficient implementation of procedures. Double loop learning supports knowledge
management through self-conscious reflection that relies on short time perspective of immediate past
and present, resulting in functional effectiveness or doing things the best way. Communal learning
supports meaning, and sense making related to knowledge management that supports understanding
of context, relationship and trends. Community consciousness relies on medium to long –historic past,
present and very near future time perspectives that results in management practices that focus on
productivity and understanding what promotes or impedes effectiveness. Duetero learning supports
the development of a philosophy of self-organization and integration through pattern recognition
consciousness and systems thinking and leading that sees where an activity fits into optimization of
the whole with a long-term plan and forecast in mind. Past, present and future are considered to
support long-term success. Generative learning is derived from wisdom values that invite renewal
and deep awareness of the power of purpose in the context of a greater ecology, resulting in integrity
and ethical consciousness. The time perspective related to generative learning is very long term and
ranges from the very distant past to the far distant future. Synergistic learning supports the unity and
connection of the larger community and environment and helps one understand values in a greater
context, which leads to sustainability. Inter-generational timeless universal consciousness supports
the realization of union and connectedness. Future developments in doctoral education ought to focus
on the nature of communal learning and philosophies that support managing productivity and
integrating optimizations. Teaching Learning Challenge: How can you use the knowledge complexity
archetype to engage in planning doctoral education knowledge work into the future?
9. Systems thinking is key future knowledge content for both PhD and DNP doctoral education. Peter
Senge is famous for creating and advancing the notions of a learning organization and advancing the
five disciplines of personal mastery, mental models, team learning and shared vision in service of
systems thinking. Derek Cabrea extends the theory about systems thinking and advocates for the
DSRP model for gaining insight, understanding into systems dynamics. Distinctions (D) Identity and
Other, Systems (S) Part and Whole, Relationships (R) Inter and Action, and Perspectives (P) Point and
View can be combined in many ways to appreciate and realize perspectives and insights related to
system dynamics and processes. Systems thinking leads to complexity thinking and complexity
thinking leads to integral thinking and integral thinking leads to Metaintegral thinking and post formal
education for complex futures.
10. Robert Dilts Logical Levels Model of Leadership, learning provides insights and strategies for turning
visions into actions and actions into visions. Dilts (1996; 2014; 2015), describes Meta, macro and
micro levels of change, learning and leadership. Meta level leadership and change involves higher
order attention and mindfulness to issues of spirit, vision, and identity. Macro level leadership and
change involves attention to path finding, culture building, beliefs, values, and identify role
configurations. Micro level leadership and change involves attention to efficiency, task, relationship,
capability, behavior and environmental opportunities or constraints.
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11. There is a complementary nature to the PhD~DNP dynamic. Efforts to discover the value and wisdom
of both PhD and DNP educational pathways support nursing knowledge work and the down sides of
negligence. Nursing has long struggled with polarities (Scott &Cleary, 2007). To be successful in the
future, nurse educators must master the art and science of polarity management and appreciate the
complementary nature of coordination dynamics and embrace the squiggle sense. One path forward to
future polarity management is to consider the value of integral theory, and integral methodological
pluralism to support nursing knowledge work and educational research.
12. Integral Theory (AQAL) is a post-metaphysical, post-disciplinary meta-theory that is useful for
imaging the future of doctoral education in nursing (Dossey, 2008; Jarrin, 2006). Being integral
involves adoption of three integrative principles (Wilber, 2002). These principles are:
• Non-exclusion: Acceptance of truth claims that pass the validity tests for their own
paradigms in respective fields
• Enfoldment: Sets of practices that are more inclusive, holistic, and comprehensive than
others
• Enactment: Various types of inquiry disclose different phenomena depending on the
quadrants, levels, lines, states, and types of the inquirer
13. According to Mark Forman (2010), integral philosophy involves attention to the following principles:
• What is real and important depends on one’s perspective.
• Everyone is at least partially right about what they argue is real and important.
• By bringing together these partial perspectives, we can construct a more complete and
useful set of truths.
• From an integral philosophy, a person’s perspective depends on five central things:
o The way the person gains knowledge (the person’s primary perspective, tools,
or discipline)
o The person’s level of identity development
o The person’s level of development in other key domains or lines
o The person’s state at any given time
o The person’s personality style or “type” (cultural and gender style)
The integral viewpoint is often expressed using the acronym AQAL: All Quadrants Levels, Lines,
states, and types.
14. Using an integral lens supports innovations in inquiry and nursing science. Esbjorn-Hargens, Reams,
and Gunnlaugson (2010) suggest the following foci, commitments, and elements help to enact integral
education:
• Exploring multiple perspectives
• Including first-, second-, and third-person methodologies of learning and teaching
• Weaving together the domains of self, culture, and nature
• Combining critical thinking with experiential feeling
• Including the insights from constructive-developmental psychology
• Engaging regular personal practices of transformation
• Including multiple ways of knowing
• Recognizing various types of teachers and learners
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• Encouraging “shadow work” within learners and teachers
• Honoring other approaches to education
15. The MetaImpact Framework provides a structure to measure four Types of Impact with 10 Types of
Capital that produce four Bottom Lines. The four types of impact are clear, high, wide and deep. The
ten types of capital are knowledge, social, cultural, natural, financial, health, manufactured, human,
spiritual, and psychological. There are three types of data for each of the 10 capitals –first person,
second person and third person data. There are four bottom line: purpose, people, planet and profit.
What might a future doctoral program in nursing look like if it used the MetaImpact Framework and
integral theories to develop and differentiate the curriculum needed to teach and learn? Teaching
Learning Challenge (TLC): How does the MetaImpact Framework prompt innovations in thinking
about the future of doctoral education in nursing? How might faculty in your school use the
MetaImpact Framework to reason about program innovations and aspirations?
16. Alpha Leadership (Deering, Dilts, and Russell, 2002) involves anticipation (detecting weak signals,
developing mental agility, freeing up resources), alignment (leading through embodiment, tasking
through relationship and creating cultures that can act) and action (using 80:20 leadership, ready, fire
aim strategies and dogged pursuit, knowing when to stop. Teaching Learning Challenge (TLC):
Imagine the future exercise with the prompts of wonder, pride, shame, memory, imperatives, obstacles
and dangers and priorities. The best way to predict the future is to create it. Creating the future
involves attention and development of futures consciousness and futures literacy and developing
foresight as an antidote to future blindness (Hudson, 1999).
17. The five dimensions of future consciousness are: 1) A time perspective that appreciates the past,
present, future and value of long-term thinking. 2) A sense of agency and trust in one’s ability to
influence things. 3) Openness that support critical questioning of established truths and possibilities for
change. 4) A systems perspectives that appreciates the complexity and interrelationships between human
and natural systems and consequences of decision-making. 5) Appreciation and concern for others
aspirations for a better world (Ahvenharju, Minkkinen, & Lalot (2018). Teaching Learning Challenge
(TLC): Which of these five dimensions is a strength for you? Which one can you develop?
18. Robert Johansen (2012; 2016) suggests leaders make (create) the future. An essential skill set is
important for leaders to develop to realize the futures they want to create. Creative thinking, an
innovation mind-set, attention to competing values, and having clarity about the complementary nature
of phenomena are embedded in his suggestions about the most important skills leaders need to navigate
into the future. The five literacies leaders need include Look backward from the future, voluntary fear
engagement, leadership for shape-shifting organizations, being there when you are not there, creating,
and sustaining positive energy. The essential skills leaders need to make the future are:
• A maker instinct – the ability to activate, build, and connect with others to remake
organizations.
• Clarity – the ability to see through complexity and distill the essence of issues in complex
situations.
• Dilemma Flipping- the ability to turn dilemmas into polarities that need to be managed
versus problems that need to be solved. (Perhaps recognize the complementary nature and
competing values of issues).
• Immersive learning – jumping into experience to learn from a first-person perspective.
• Bio-empathy – the ability to see things from natures point of view and to understand,
respect and learn from natures patterns.
• Constructive de-polarization – the ability to calm tense situations and positively engage
people even when differences are apparent.
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• Quiet transparency – the ability to be open and authentic without undue self- promotion.
• Rapid proto-typing- the ability to create versions of innovations realizing that future
success depends on early failures.
• Smart- mob organization – the ability to create, engage and link purposeful business and
social networks.
• Commons creating – the ability to seed, nurture, grow shared assets that benefit others and
allow competition at other levels in a system.
19. Transformation and re-design of a 21st
century health care and educational system requires
understanding the differences between change and transformation. Change efforts that focuses on the
past do not create inspired futures. Transformation is about responding to a desired future. Change
versus transformation and Stake are important Primes (McGoff, 2012). Transformation is informed by
open-minded inquiry, nursing foresight and futures literacy, knowledge work and integral and post-
formal educational approaches to teaching and learning as well as theory and practice. Transformation
requires open-minded inquiry with attention to intellectual standards and foundations of scientific
thinking.
20. Futures literacy invites people to create and share stories about the future to inform current practice
and realities. Nurses who want to bridge innovations across contexts must become time-conscious
future literate and embrace the dynamics of appreciation, influence and self- control as they navigate
change and transformation efforts. The development of futures literacy involved attention to the
development and cultivation of nursing foresight leadership.
21. Nursing foresight is the ability and act of forecasting what will happen or be needed in the future
considering emergent health care trends that have consequences for population and planetary health, as
well as the profession’s purpose, definition, professional scope, and standards of practice. The
University of Minnesota School of Nursing and the Katharine J. Densford International Center for
Nursing Leadership has created a Foresight Leadership The Future of Nursing and Health resource to
support the development of foresight leadership in nursing and health care. Teaching Learning
Challenge (TLC): Explore the web site and resources join the community of learning on LinkedIn.
22. Nancy Dian (2009) has defined six foresight leadership styles. They are 1) Futurists who think in
terms of 5-20 years. 2) Activists who introduce new ideas commit to a cause. 3) Opportunists who
change the future though leveraging present possibilities. 4) Flexists grounded in present, use
innovations to enhance survival. 5) Equilibrists who work in present integrate new ideas into systems.
6) Reactionists who protect and sustain organizations; wary of change and support the status quo.
Given these definitions, what is your foresight leadership style? Teaching Learning Challenge (TLC):
Which of the six foresight leadership styles resonates most with you? As you think of colleagues with
whom you work -can you categorize them with any of these foresight leadership styles?
23. Pesut (1997a; 1997b; 1997c; 2000; 2019) proposes nine principles to support the development of
foresight leadership:
✓ Know your personal and organization’s orientation toward time ✓ Appreciate the value of innovation, design, and hybrid thinking to develop foresight
leadership
✓ Develop future fluency and literacy skills.
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✓ Actively monitor industry trends, forecasts, and disruptions.
✓ Discern logical consequences of trends using futures thinking tools, methods, and techniques.
✓ Appreciate and value the use of vision-based scenarios.
✓ Stimulate strategic conversations about espoused visions looking backwards from the future
✓ Navigate change efforts using appreciation, influence and control (AIC).
✓ Create a personal and organizations leadership legacy.
24. One’s perspective of time influences the development future literacy. Zimbardo & Boyd (2008) note
time perspective is the often-nonconscious personal attitude that each of us holds toward time and helps
give order, coherence, and meaning to our lives. They have identified six-time perspectives: 1) past-
negative, 2) past-positive, 3) present fatalistic, 4) present hedonistic, 5) future, 6) transcendental future.
To discover the patterns of your time perspective, visit http://www.thetimeparadox.com/surveys/ . How
does your personal time orientation influence your thinking, feeling, doing? To what degree is it
possible to reset your psychological time clock? Organizations also have a time orientation. Does
your organization operate in the past, present or future? Present oriented organization are most interested in
efficiency and exploitation over exploration and learning – organizations that value the past are likely to
honor tradition over innovation (Bluedorn & Denhardt, 1988). Teaching Learning Challenge (TLC): Show
this video clip in your class or at your next administrative meeting the secret powers of time. What
discussions does it evoke? How can you make your organization’s orientation to time among your faculty
and students more explicit? What difference do you think such a discussion will have in terms of your
curriculum, strategic planning and or partnerships?
25. Jennifer Gidley (2016) notes “Future studies is the art and science of taking responsibility for the
long-term consequences of our decisions and our actions of today.” Riel Miller (2006; 2011; 2018)
suggests there are three levels of futures literacy with concomitant tasks and techniques: awareness,
discovery, choice.
26. Beckman and Berry (2007) note design thinking is embedded in the innovation learning process
through attention to individual learning styles. Design requires one to understand the innovation
process, and the need to move between the abstract and concrete and between analysis and synthesis to
execute that process. Second, it means assembling the right mix of people on the team to execute the
process.
27. Roberts, J. P., Fisher, T. R., Trowbridge, M. J., & Bent, C. (2016) describe design thinking as an
innovation process that highlights empathy for user desires, needs and challenges to develop
comprehensive and effective solutions. Empathic engagement leads to an analytical phase, to devise
alternative ways of achieving preferred results. Critical reviews of ideas that best meet the greatest
number of needs emerge. Finally, the design process enters a rapidly iterative prototyping and testing
phase in which multiple ideas are put into small-scale solution trial actions. After a series of critical
evaluations of these trials, an optimized solution to the situation emerges and is ready for scaled
implementation.
28. Design Thinking begins from deep empathy and understanding of needs and motivations of people.
Design Thinking benefits greatly from the views of multiple perspectives, and others’ creativity
bolstering your own. Design Thinking is a mindset and belief system that people can create change—no
matter how big a problem, how little time or how small a budget. Design Thinking gives you
permission to experiment and to fail and to learn from your mistakes, because you come up with new
ideas, get feedback on them, then iterate. Design Thinking is all about learning by doing. Design
thinking oscillates between divergent and convergent thinking processes. There are five phases to
design thinking: discovery, interpretation, ideation, experimentation, evolution.
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• Discovery: I have a challenge; how do I approach it? Understand the challenge, prepare
research, and gather inspiration.
• Interpretation: I learned something – How do I interpret it? Tell stories, search for
meaning, frame opportunities.
• Ideation: I see an opportunity –What do I create? Generate and refine ideas.
• Experimentation: I have an idea –How do I build it? Make prototypes, get feedback.
• Evolution: I tried something new – How do I evolve it? Track learnings move forward.
• Design thinking requires an adaptable mind.
29. Industry trends influence futures thinking and planning. For example, in the United States the
National Center for Healthcare Leadership convened futurists to discern trends related to the state
of health in the 21st
century:
• The US will become part of a global system focusing on wellness and preventive care
worldwide.
• Patients will receive care from “virtual” centers of excellence around the world.
• Deeper understanding of the human genome will create exciting new forms of drugs that will
prevent disease from developing. Treatment will evolve from disease management to
prevention or minimization.
• As the “baby boomers” become senior citizens around 2020, the issue of rising costs,
resource allocation and priorities will be exacerbated.
• Fueled by access to information through the World Wide Web, people will take more self-
management of their personal health decisions and demand that the system treat them as
customers rather than users.
• Most Americans will receive care from specialized centers for chronic diseases (cancers,
women’s health, heart etc.)
• Standard diagnostic health will largely be electronic, with people conducting their own
“doctor visits” from home through miniature data collection and monitoring devices.
30. The Institute of the Future for the Phoenix Research Institute has identified six drivers and ten skills
necessary for a 2020 workforce.
a. Extreme longevity – increasing global life spans change the nature of careers and learning.
b. Rise of smart machines and systems -work place automation nudges human workers out of
rote repetitive tasks.
c. Computational world- massive increases in sensors and processing power make the world
a programmable system.
d. New media ecology –new communication tools require new media literacies beyond text.
e. Superstructure organizations –social technologies drive new forms of production and value
creation.
f. Globally connected world- increased global connectivity puts diversity and adaptability at
the center of organizational operations.
The cross impacts of these drivers suggest ten vital skills for a future workforce. The design of
curriculum and teaching learning practices ought to contribute to the development of:
• Sense making ability to determine the deeper meaning or significance of what is
being expressed.
• Social intelligence: ability to connect to others in a deep and direct way, to sense
and stimulate reactions and desired interactions.
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• Novel and adaptive thinking: proficiency at thinking and coming up with solutions
and responses beyond that which is rote, or rule based.
• Cross cultural competency: ability to operate in different cultural settings.
• Computational thinking: ability to translate vast amounts of data into abstract
concepts and to understand databased reasoning.
• New media literacy: ability to critically assess and develop content that uses
new media forms, and to leverage these media for persuasive communication.
• Transdisciplinarity: literacy in and ability to understand concepts across multiple
disciplines.
• Design mindset: ability to represent and develop tasks and work processes for
desired outcomes.
• Cognitive load management: ability to discriminate and filter information for
importance, and to understand how to maximize cognitive functioning using a variety
of tools and techniques.
• Virtual collaboration: ability to work productively, drive engagement, and
demonstrate presence as a member of a virtual team.
31. Knowledge Works Foundation has developed a forecast about the future of learning in the next 10
years. The Title of the report is The Future of Learning: Education in the Era of Partners in Code. The
report suggests the learning eco-system is rapidly changing and involves remixing among several
trends. The report outlines five drivers of change: Optimized selves: discovering new human horizons.
Labor relations 2.0: negotiating new machine partnerships. Alternate economies. Smart transactional
models: Creating self-managing institution. Shifting landscapes: Innovating in volatile conditions.
Prince, Swanson and King (2016) have developed a strategy guide that suggests ways educator and
policy makers can anticipate and implement the forecasts. Forecasts include some of the following:
✓ New tools and practices will be informed by neuro and emotion science.
✓ Lifetime personal learning bots will leverage artificial intelligence and machine learning to
grow with human partners and provide smart support and feedback.
✓ Educators will create new assessments that measure applied mastery, real world impact and
social- emotional development.
✓ Social, economic and environmental turbulence will test the limits of traditional teaching
models.
✓ Shared learning and tailored personal learning experiences will be augmented with virtual
reality tools that provide immersive experiences to learners.
✓ School structures will shift from fixed structures to fluid networks and relationship-based
formats reflecting learner’s needs, interests and goals.
✓ Education will prepare learners to reskill and upskill and constructively partner with
machines.
✓ Education administration will shift from managing discrete organizations to facilitating
seamless collaboration across diverse eco-learning systems.
✓ Learning eco-systems comprised of many kinds of organizations and resources will help
the education sector adapt to changing needs.
✓ Decision-making will expand so that everyone in a learning eco-system see himself or
herself as an empowered decision maker.
32. The Robert Wood Johnson Foundation commissioned the Institute for Alternative Futures to create
four scenarios about the Future of Health Care in 2032 and Human Services in 2035. Scenarios
stimulate conversations and learning. How plausible does the scenario seem? What thoughts does it
recall? What feelings does it generate? What are the implications for society, healthcare and nursing? If
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parts of the scenario are desirable, what actions need to be taken to increase the chances of it
happening? If parts are undesirable, what actions need to be taken to prevent them from happening?
Note the Institute for Alternative Futures has announced its closure at the end of 2019. Resources once
available at the web site will be available at www.archive.org
Scenario 1: Slow Reform, Better Health: Health and effectiveness of health care vary
among states. Health, not health care, becomes the main political issue. Communities address
social determinants of health, prevention and population health while enacting “health in all
policies.” Self-care and health knowledge reduce demand for medical care and are enhanced
through risk behavior management, social networks, digital technologies, pre-disease
identification, data and new cures and therapies.
Scenario 2: Health If You Can Get It: Medicare and Medicaid experience severe budget
cuts, most Americans are underinsured, medical tourism increases, epidemics spread, and
health and inequality worsen. The primary care physician shortage hurts community health
centers, which struggle to treat many new patients who otherwise visit unreliable fee-for
service minute clinics. The public becomes highly fractured and disillusioned with the
ineffectiveness of governance.
Scenario 3: Big Data, Big Health Gains: Health becomes the primary concern. Initiatives
regarding health innovation, health equity, the social determinants of health and health in all
policies reduce health care expenditures. The public demands anticipatory democracy,
cooperation, sustainability and transparency. Innovative technologies, “big data,” and
knowledge transform manufacturing, the economy and health, yielding cures for Alzheimer’s
disease, effective management of cancers and widespread implementation of personalized
medicine and health avatars.
Scenario 4: A Culture of Health: Leaders create environments to support and improve all
domains of health as a “health culture” arises. The nation’s focus shifts to disenfranchised
youth and to the development and comprehensive health for children. Health care spending is
capped. Avatars, enhanced self-care and transparency in health education and medical
knowledge all reduce demand for medical interventions. “Health wisdom” expands as social
networks “crowdsource” health. Environmental monitoring is widely implemented among
communities.
33. In 2015 a special issue of Nursing Outlook based on work of the Council for the Advancement of
Nursing Science, related to PhD Education identified the following as emerging areas of science for
PhD study. These included the microbiome and omics, patient reported outcomes, health behavior, big
data, quantitative science, and translation science and health economics, as emerging areas of science in
PhD curriculum. The article describes the topic and offers a SWOT analysis of each knowledge area
and its relationship to the future of PhD education in nursing.
34. Jarratt, Jennifer, Coates, Joseph, Mahaffie, John, Hines, Andy (1994), Managing your future as an
association: Thinking about trends and working with their consequences 1994-2020, American Society
of Association Executives, Washington, DC. Suggest using the following questions to analyze emerging
future issues, stakeholder groups: What are the groups concerns? What are their fears? What are their
goals and objectives in relation to the issue? What would it take them to act? What are their actions
likely to be?
a. Do we know what is going on? Gather the facts and compare them with what is being reported.
b. What is at stake here? This might be in several categories, for example: Is this an environmental
question? An economic loss? Are traditions upset?
c. Has anything like this happened to us before? How was it similar?
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d. Has this happened to other organizations like us or to groups like ours?
e. What could be the outcomes?
f. Have we identified the stakeholders, and do we know their concerns?
g. What options for action are open to the concerned parties?
h. What is our public position on this? Are we being straightforward? Does the public believe we
are being honest on this?
i. Has anyone been hurt or made fearful by this issue?
j. Is it likely to involve any especially vulnerable groups, children for example?
k. What is our reputation within the community? Do they believe we are honest?
l. Does this issue have other issues connected with it? Did similar issues come before it? Is this
issue linked to other issues?
m. Are there any political elements in the community actively seeking new issues? Might these
elements be available to focus on this issue?
n. What other organizations are involved? Have they stated positions? Do they have goals or
objectives that would shape their position? Are they well regarded in the community?
o. Who are the key communicators in the community on this issue? What is the local press, the
churches, private associations, and others saying?
p. Is there anything about the issue that is going to be difficult to understand or hard to
communicate? Does the issue have a technology component?
q. Are people going to get excited about this issue? What has it got that will attract attention? Does
it involve corruption, danger, bad behavior, or a threat to vulnerable?
r. Who can make a career out of this issue? Are they otherwise occupied?
s. Can we connect this issue to large trends or social changes or to other aspects that will help
make it a familiar issue?
35. Liberating structures (http://www.liberatingstructures.com/) are easy to learn adaptable methods
that invite people to interact and learn from each other in new ways that support self-
organization, creative problem solving and development of innovations and learning. Liberating
structure principles include: Include and unleash everyone, Practice deep respect for people and
local situations, Build trust as you go, Learn by failing forward, Practice self-discovery, Amplify
Freedom and Responsibility, Emphasize possibilities: Believe before you see, Invite creative
destruction to enable innovation, Engage in seriously playful curiosity. 25/10 Crowdsourcing is
a useful Liberating Structure to generate and sift through a group’s most powerful actionable
ideas. Teaching Learning Challenge (TLC): Engage in the 25/10 Crowdsourcing Liberating
Structure exercise. What is one bold idea that would advance doctoral nursing education into
the future?
36. Attend to the development of futures literacy in yourself, others and the organizations where you work.
Shift conversations in your workplace from uncertainty to agency and influence. Shift conversations
from a discourse of regret to one of hope. Join the Foresight Leadership: The Future of Nursing and
Health community on LinkedIn. Create the future through foresight, agency and action.
Anticipate, Align, and Act. Teaching Learning challenge (TLC): Consider making a Pledge to the
Future. Teaching Learning Challenge (TLC): How might you invite people to make a pledge to the
future and make futures literacy a part of your curriculum and organizational operations?
12
Pledge to Future Generations
Although humanity is far from perfect, it is worthy of my respect, affection, compassion, and nurturance. I
am fully aware of the pain, suffering, ignorance, selfishness, and greed in the world, but I do not condemn
human civilization nor write it off as hopeless. I believe that a satisfactory future is possible if enough
people care about future generations, understand today’s options, and make appropriate choices.
For me, it is very important that humanity and other life on our planet continue to evolve in positive
directions. Nothing is more important than the continued flourishing of human culture and society over the
next few decades and beyond. Because I care deeply about humanity and its future, I do my best to live up
to the following principles.
1. I care about the well-being of future generations. Their needs are just as important as those of today
are. When I am making a major choice in my own life, when I am facing a significant ethical or
moral question, and when I am involved in policymaking or decision making, I consider the needs
of the next two or three generations. No short-term or narrow goal should be allowed to jeopardize
humanity’s long-term future. My choices support the principle of equal opportunity for each future
generation: we should not cause their opportunities and well-being to be less than ours.
2. I choose paid work or volunteer work that makes a positive contribution to humanity’s flourishing.
I do my work with conscience -- and with respect for the well-being of future generations and our
planet.
3. I play my part in halting the deterioration of our environment and I support efforts to achieve a
sustainable relationship with our planet. I try particularly hard to avoid actions that might reduce
the ozone layer or increase global warming. I understand that people who own and consume more
than they really need do even more harm to the environment than the desperate efforts of the
poorest one-fifth of the world’s population to survive.
4. I understand and support humanity’s urgent need to halt population growth in all countries. In my
own personal decisions, I am strongly influenced by this. I take highly effective steps to avoid
pregnancy except when I have made a careful and thoughtful decision to have a child.
5. Because the institution of war causes so much harm over the years, I speak up against all wars,
terrorism, organized violence, and arms manufacturing. Better ways exist for handling conflicts,
greed, anger, and the urge for revenge. Because I believe the world’s storehouse of weapons should
be kept below the level capable of ending civilization, as we know it, I support campaigns for a
huge reduction in nuclear, biological, and chemical weapons.
6. Through words and actions, I support some of the additional goals and directions that will help
human civilization to survive and flourish over the next few decades. Examples of positive goals
and directions include the following:
the health and well-being of children;
understanding and cooperation among diverse cultures;
a deeper understanding of the universe and our place in it;
a more profound body of knowledge related to world problems and our future;
widespread human rights, civil liberties, and political participation;
a designated spokesperson for future generations in all political and military decision-making;
experiments with innovative policymaking and governance.
7. I support local organizations, political parties, government policies, and international organizations
13
that foster these six principles. I oppose those that do not take seriously our responsibilities to
future generations.
8. When deciding how to spend my money and time, I seek an appropriate balance between my own
needs and those of future generations. Instead of choosing luxuries and activities that harm the
environment, I focus on my most significant underlying needs, such as relationships, learning,
giving, contributing, vigorous health, a spiritual connectedness to nature, and other simple joys of
life. I do not use material goods to meet my psychological and social needs.
9. I continue learning about the worlds’ problems in some depth, and about our various potential
futures ranging from highly positive to extinction. I face my feelings about these problems and
possibilities and avoid becoming stuck in hopelessness and paralysis. I speak up to counter
misinformation and untruths, but I also keep an open mind to new ideas and perspectives.
10. I live in a decade during which some of the most important choices in the history of human
civilization will be made. I happily join others in facing the heroic challenge of this decade -- to
move from our present catastrophic path to a new path that will dramatically improve our prospects
for a flourishing future.
Source: Tough, Allen. (1993). Making a pledge to future generations. Futures, 25 (1), 90-92. Used
with permission
14
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21
The Knowledge Complexity Archetype: Knowledge, Learning, Action, Performance and
Time Consciousness that Support the Development of Foresight Leadership
Knowledge and
Learning Mode
Action and
Performance Focus
Time Perspective
& Consciousness DATA (Instinctual Learning)
Sensing. The data mode of learning is at the
sensory or input level. Little actual learning takes place.
DATA (Feedback)
Gathering information. Receiving input,
registering data without reflection
Time Perspective:
Immediate moment
Consciousness:
Awareness
INFORMATION (Single Loop learning)
Action without reflection. Procedural
learning entails redirecting a course of action to follow a predetermined course. Learning is mostly trial and error.
PROCEDURAL (Efficiency)
Doing something the most efficient
way. Conforming to standards or making
simple adjustments and modifications. Focus is on developing and following procedures.
Time Perspective:
Very short (present – now)
Consciousness:
Physical Sentience
KNOWLEDGE (Double Loop learning)
Self-conscious reflection. A large
perspective that involves evaluation and modification of the goal or objective, as well as design of the path or procedures used to get there. Learning requires self-conscious reflection.
FUNCTIONAL (Effectiveness)
Doing it the best way. Evaluating and
choosing between two or more alternative paths. Goals are effective action and resolution of inconsistencies. Focus is on effective work design and engineering aspects such as process redesign.
Time Perspective:
Short (immediate past and present)
Consciousness:
Self-reflective
MEANING (Communal learning)
Understanding context, relationships
& trends. Learning requires the making of
meaning, which includes understanding context, seeing trends and generating alternatives. From this perspective, it is possible to detect relationships between components as well as comprehending roles and relationships between people.
MANAGING (Productivity)
Understanding what promotes or
impedes effectiveness. Effective
management and allocation of resources and tasks, using conceptual frameworks to analyze and tack multiple variables. Encompasses planning and measuring results. Also attends to working roles, relationships and culture.
Time Perspective:
Medium to long (historic past, present, very near future)
Consciousness:
Communal
PHILOSOPHY (Duetero learning)
Self-organizing. Integrative or systemic
learning seeks to understand dynamic relationships and non-linear processes, discerning the patterns that connect, including archetypes and metaphors. Requires recognition of the embeddedness and interdependence of systems.
INTEGRATING (Optimization)
Seeing where an activity fits the
whole picture. Understanding and
managing socio-cultural system dynamics. Focus is on long-term planning and the ability to adapt to a changing environment. Comprises long-range forecasting, development of multi-level strategies, and evaluating investments and policies about long-term success.
Time Perspective:
Long-term (past, present and future)
Consciousness:
Pattern
WISDOM (Generative learning)
Value driven. Learning for the joy of
learning, in open interaction with the environment. It involves creative processes, heuristic, open-ended explorations and profound self-questioning. Allows for the discovering of one’s highest capabilities and talents, purpose and intentions.
RENEWING (Integrity)
Finding or reconnecting with one’s
purpose. Defining or reconnecting with
values, vision and mission. Understanding purpose. Very long-term period leads to deep awareness of ecology, community and ethical action.
Time Perspective:
Very long-term (very distant past to far distant future)
Consciousness:
Ethical
UNION (Synergistic)
Connection. Learning integrates direct
experience and appreciation of oneness or deep connection with the greater cosmos. Requires processes that connect purpose to the health and well-being of the larger community and the environment.
UNION (Sustainability)
Understanding values in greater
context. Inter-generational time perspective
evokes commitment to the greater good of society, the environment and the planet. Performance demonstrated in actions consistent with these deeper values.
Time perspective:
Inter-generational, timeless
Consciousness:
Universal
This Knowledge Complexity Framework Easy Reference Chart is from Verna Allee’s book, The
Knowledge Evolution: Expanding Organizational Intelligence, Butterworth-Heinemann, 1997.