Nursing Education Concepts By Christine A Tanner
Who is Christine A Tanner,Interest in Teaching,Willingness for Teaching,Training For Teaching,Development as A Teacher,Research on Education,Comfortable As a Teacher,Challenges,Embarrassing Moments,Rewarding Aspects,Least Rewarding Aspects,Maintaining Excellence,Advice for Teachers.
Who is Christine A Tanner
Christine Tanner earned the BSN from the University of North
Colorado, MSN from the University of California, San Francisco, and the PhD
from the University of Colorado at Boulder.
She is the Youmann Spaulding
Distinguished Professor at the Oregon Health and Science University School of
Nursing. Prior to coming to Oregon, she served as Assistant Dean for Curriculum
at the University of Northern Colorado.
She is a Fellow in the American Academy
of Nursing and has been the recipient of numerous awards in nursing education.
She teaches courses on curriculum development and evaluation, teaching
strategies, and critical thinking.
Dr. Tanner’s research includes accessing patient’s volatility,
effectiveness of nursing telephone advice, improving nurse-physician
communication, and clinical decision making. She was instrumental in the
founding of the Society for Research in Nursing Education.
Professional Journey
Dr. Tanner believes that there are multiple models for curriculum,
multiple pedagogical theories, and multiple philosophies that can guide the
work of teaching.
She is working with a statewide group of nurse educators who
are redesigning nursing education by incorporating research evidence on student
learning, expertise development, and clinical judgment into the curriculum.
She
is passionate about new and exciting ways that can transform nursing education
and raise the level of nursing practice needed in today’s society.
Interest in Teaching
She became interested in teaching while in her undergraduate nursing
program. She had experiences with great teachers and not-so-great teachers,
and really respected the fabulous teachers.
She saw how much of a difference
they could make for students by helping them learn complicated material. Then,
when she finished her undergraduate program, she worked in the nursing intensive
care unit and found myself looking for a change.
She wanted a challenge and had
not given much thought to being a teacher. In those first few years she really
liked and enjoyed nursing, while at the same time she needed to advance myself
a bit.
So, she went back to school into the master’s program at the
University of California, San Francisco, and began to take course work to
become a clinical specialist in medical-surgical nursing.
Back then, course
work was also available and recommended for students to prepare in a “functional
area”: 1 chose nursing education courses, Marlene Kramer taught the
microteaching course which was just wonderful.
We examined various teaching
strategies, videotaped teaching sessions, and received feedback from peers
about our performance. It was a wonderful way to learn and helped her to feel
more comfortable with myself in a teaching role.
She took a course on
curriculum development from Shirley Chater and that too was a wonderful
experience. When she finished the degree, she moved back to Colorado and was
looking for either a clinical nurse specialist position or a teaching position.
She was open to either one and quite prepared to do either one too. She ended
up going back to her the University of Northern Colorado, and began
her teaching career.
Actually, she fell in love with teaching and think the most
wonderful part about it is seeing students really connect and get something for
the first time. It is such a reward to see students grow personally from their
experience in nursing and understand that nursing is meaningful work that
contributes to their own growth.
As a teacher it is exciting to see students
integrate their experiences, their view of themselves, and their worldview.
Willingness for Teaching
She had good clinical expertise in nursing before she went into
teaching. She felt solid as a clinician and had learned how to think things
through. In herpreparation we did not focus on the memorization of facts, but
rather on reasoning through something by remembering discreet facts and pulling
them together.
She valued this approach as a student and began to do the same
thing with the students she was teaching in the clinical area. A lot of herteaching
practices are modeled on how she was taught. Fortunately, she had a lot of good
teachers who were very helpful.
She was at Northern Colorado for 2 years and decided that she really
wanted to learn more about teaching and more about how people learn. She really
wanted to get the PhD. She did not think about a PhD until she was in the
master’s program and then she was very intrigued by the idea.
This was in the
mid 1970s and there were few doctoral programs in nursing. She believed that she
had a solid knowledge of nursing, and really wanted to advance myself in
teaching. So, she went back to the University of Colorado, Boulder, for a
degree in educational psychology with a minor in cognitive psychology.
Her research
interest was in studying how nurses make decisions. She had observed in herearly
teaching experience that students had enormous difficulty in making sense of
clinical situations.
Even though they could recall factual information, they
had difficulty turning that around to make good judgments about what went on in
the nursing care of patients. At that time, we were using academic nursing care
plans where students would write 40 or 50 pages in preparation for clinical
practice.
Most of what they wrote did not have very much to do with the
individual patient. These plans were more or less what students could pull out
of the textbook about a person having a particular kind of diagnosis. She found
that there was very little connection with what the students wrote on these
care plans and what they actually did in practice.
She remembers one student who was in the neuro-intensive care unit
and taking care of a patient who had a craniotomy. She wrote on her care plan
that she would be worried about him developing diabetes incipidus because of
the location of the lesion.
She had a nursing concern about the potential for
dehydration and was going to prevent this by was clamping the foley catheter.
She was reading her care plan over coffee while the students were getting
report on the unit, and she bolted up eight flights of stairs to make sure she
hadn’t followed through on her intervention.
Of course she had not, and she asked
her “What in the world were you thinking?” She said, “At 2:00 in the
morning, that was the only independent nursing intervention she could come up
with.” This is one example of many that suggested the way we were trying to
help students reason really made very little sense.
She wanted to find another
way of helping students to reason through nursing care situations, which
started heron her research career around clinical decision making/clinical
judgment. She continues to be interested in clinical decision making to this
day.
She believes it is critical to look at how this research and research like
it can be translated into the practices of educators. Over the last several
decades, research has shown us a great deal about how people learn. If this
research were used in our practice as teachers, it would truly transform
nursing education.
Training For Teaching
She was involved in staff development at a veteran’s hospital in
California, and one of her colleagues, Ann Huntsman, was an incredible mentor.
She got really nervous when she spoke in front of groups.
She helped her to make
myself feel comfortable when speaking to groups. When she started her teaching
career in Colorado, the school had one of those big 1970s style curriculum
grants to revise the curriculum.
Lida Thompson, who was in charge of the grant,
was excellent in working with faculty who had very little teaching experience.
We really worked on thinking about nursing conceptually, and then how one would
help students apply the concepts clinically.
She did not stand beside her and
helped her think about teaching, but really helped her work on conceptual
thinking. Conceptual thinking is critical to teaching effectiveness.
In addition,
Dean Phyllis Drennan was instrumental in her pursuing doctoral study in her early
career. She was a cheerleader for her who had confidence that she would make
important contributions.
She did everything to get her into national circles,
which was extremely wonderful and helpful. Having someone give you a shot of
encouragement and confidence is so important when you are taking on a new role
and not sure that you can be successful in the new role.
Shirley Chater and Marlene Kramer were in some ways also her mentors.
They were teachers in large classes of 40 to 50 people at UCSF The work they
did with us in the class, felt a lot like personal touch. That seemed, as She think
back, to be really important, even in the large classes. They commented on the
papers she wrote in positive ways.
Development as A Teacher
She thinks the study of how people learn and how people develop
expertise has really transformed her teaching in many ways. In the early 1980s, she
worked with Bill Holzemer in starting the Society for Research in Nursing
Education.
Through that group, we collected people who had a passion about
nursing education, which at that time was starting to decline because of the
national focus on clinical nursing research. We strongly believed that it was
important to continue the threads of nursing education research because nobody
else was going to be doing it.
We did not want to lose the strength in nursing
education research.Nancy Diekelmann , Pat Moccia, David Allen, Em Bevis, and several
others who were involved in the Society began to think about the kind of reform
in nursing education that was necessary.
Each of us in our respective
institutions was finding that education had become pretty stagnant, without
much movement or change. We, on the other hand, were inspired with the
educational literature and our own scholarly work in nursing education and
believed that we needed to really push things ahead.
She can remember having
this discussion about stagnation in nursing education with Pat Moccia, Pam Miraldo,
and Frank Shaeffer who were with the National League of Nursing at that time.
Although we had worked through some of the accreditation issues, we were trying
to find a way to make accreditation more of a stimulus for change that would
keep nursing education from being so stagnant.
Frank Shaeffer said that we were
asking for a revolution in nursing education. We all agreed that was absolutely
it. And so, the mid to late 1980s movement that became known as “The
Curriculum Revolution: A Mandate for Change,” was born.
Many others
inspired this movement along the way: Jean Watson, Peggy Chinn, Carol Lindeman,
and Joyce Murray, among others. We planned a series of conferences where we
brought together people to think through what changes needed to occur and what
needed to happen in order to make the changes.
The major contribution of that
movement was to challenge old ways of thinking, and to open up new
possibilities. It seemed that nursing faculty generally was stuck in accepting
the old truths about how you construct the curriculum. How you write
objectives, how you teach a course by telling students what they need to know.
Teachers had simply not questioned the behavioral model of teaching. The point
of the revolution was to say there are multiple models for curriculum, multiple
pedagogical theories, and philosophies that can guide the work of teaching.
Research on Education
She researched how students and practicing nurses cognitively
process the making of clinical judgments and continued that work after she finished
her doctoral program in 1977 and into the early 1980s.
At that point Patricia
Benner had started publishing work on novice to expert. She still remember
after her work came out in the American Journal of Nursing, She called her on
the phone to have a discussion, because She totally disagreed with her
theoretical perspective and thought she knew nothing about cognitive theory.
We
ended up having a several hour debate on the phone about the different
theoretical perspectives. She introduced her to another whole way of
understanding human thinking, that conversation began a happy collaboration.
She and She together with Margaret Grier went public with our debate, to
discuss the different theoretical perspectives about human judgment. In 1986, she
took a sabbatical to work with Patricia Benner, with her she studied philosophy
of science, focusing on the work of Martin Heidegger, and, of course, Bert
Dreyfus.
During her sabbatical we conducted some preliminary studies about
expertise in making judgments. We completed a full scale study that was
finished in the early 1990s, culminating in our book, Expertise in Nursing
Practice: Caring, Clinical Judgment and Ethics, published by Springer in 1996.
Her
work underwent a transformation through the studies with Benner and really
opened up new ways to approach expertise on how nurses go about making
judgments in nursing practice.
After we finished that work, she began to look for a way to study
how expertise in practice, and clinical judgment specifically, could be linked
to patient outcomes, and tried to find a venue in which we might be able to
demonstrate this link.
One of the criticisms of our work was that, although it
was wonderful descriptive work, the link to patient outcomes was missing. She took
another sabbatical in 2000 and went to the Kaiser Center for Health Research
here in Portland to work with Barbara Valanis, on a study on nursing telephone
advice.
Telephone advice nursing seemed to be an excellent venue for examining
unobtrusively the practice of a nurse (in this case their interaction with a
caller seeking health advice, and the nursing judgments made during the
interaction), and outcomes of that interaction.
We ended up doing a multi site
study of nurses in the Kaiser System throughout the country, by tape recording
thousands of phone calls and then analyzing the recordings for communication
style and judgments.
We then did follow-up recorded reviews and
interviews with callers to capture outcomes of care. We had virtually no
variation in caller satisfaction or in follow through on advice.
We found that
having access to advice from a nurse was critically important to Kaiser Health
plan members, and saved callers and the plan from many needless emergency
department, urgent care, and medical office visits. However, we were unable to
capture a meaningful measure of clinical judgment.
Comfortable As a Teacher
She felt comfortable within a couple of years of teaching and
confident in her ability to put together a meaningful course and to interact
with students in meaningful ways.
However, she was anxious at the beginning of
each quarter with a new class of students, and to this day it still occurs. She
am hyped a bit more at the beginning of a term when She am meeting with a new
group of students and laying out the plan for the term.
Every teacher she know
has this same experience the first day of class. It is an important point of
the course where there is important interaction with students. She fined that
in terms of comfort as a teacher, nothing ever stays the same.
She has never
taught a course the same way twice. She always makes major revisions from year
to year in courses and maintains an open flexibility about how courses are
approached.
She thinks it is so important to observe student learning and make
modifications accordingly. To walk into a classroom and do it comfortably, it
always takes a lot of thought and intellectual work. She does believe teaching
involves a high degree of intellectual work.
Challenges
She think one of the biggest challenges was working with people who
really resisted doing anything differently. Nursing education to them was just
fine the way it was. That sort of rigid and conservative view of nursing
education is a challenge for me.
She find it extremely frustrating, because as
a faculty member, you’re never alone as a teacher, in the sense that your
contribution to the students’ education is a small part of the overall
experience, and so you can only be successful to the extent that you are
working with a group of confident colleagues.
The biggest challenges were on
those occasions where she found me working with people who had been teaching
for less than a year. While we talked about using research in nursing practice,
teachers didn’t seem to be interested in using education research in their
teaching practice. She just does not understand this position.
She thinks the second challenge that has been hard to overcome is
the change in the generational differences in the student population. Some people
are saying that students come to us with a different mindset about education.
It is a stereotype of entitlement, with a customer approach. They are buying a
service and they want it delivered in the way they would like to see it. She fined
that this is a difficult challenge to bridge.
It is a chasm between how she,
the teacher, view education in nursing and the perspective of the student. It
is hard for herto think herclass is not the most important thing in the
student’s life.
It continues to surprise herwhen a student is not engaged to
learn, because they want a degree and they want to become a nurse. She has had
lots of positive challenges too. What makes the work of teaching wonderful is
when you can take the challenge and pull together a team of colleagues to work
out solutions.
Embarrassing Moments
She was teaching a class of about 100 students on decision making.
The whole course was on decision making. She really wanted to figure out ways
to have them actively engage in learning.
We started out the class by gathering
in the large lecture hall. She arrived at school this morning, which also
happened to be the first day of our accreditation visit, and it was fairly
certain that the visitors would be coming to her class.
She arrived at school,
walked into her office, looked down at her feet and noticed that she still had
her bedroom slippers on. They were the big floppy kind and she had no time to do
anything different than to wear them to class.
So, she used the slippers on her feet
as an introduction since she was teaching about decision making and
specifically about diagnostic reasoning. She had the students generate
hypotheses about why she was wearing bedroom slippers.
It became quite the
joke. The accreditation visitors were indeed there and they did comment in the
report about a faculty member appearing for her class in bedroom slippers. At
the end of the quarter, the whole class of students came to class in their
bedroom slippers.
Rewarding Aspects
The most rewarding time is right now. She just moved out of
administration into a distinguished professorship and has this wonderful
privilege of working with a group of nurse educators in the state who are
redesigning nursing education, incorporating research on learning, on
development of expertise, and on clinical judgment.
The most exciting work she has
ever done has been working with this group of people who love nursing
education. They are passionate about it, good at it, and committed to educating
graduates who will be at the level of nursing practice we need today.
We are
working on curriculum in some very new and exciting ways. She is blessed. She am
also mentoring and working with young faculty who are eager to learn the
teaching role. This is the best job she have ever had and a wonderful culmination
for hercareer.
All the research she has done on clinical judgment figures
prominently in our work. We have technology that helps us teach students in the
way that we need to teach them. We plan to admit the first group of students in
the new consortium program in 2005.
Least Rewarding Aspects
She had a year with some doctoral students who were not engaged.
Their attitude was that they were getting their union card. However, she thinks
overall there was hardly ever a time when she did not feel enthusiastic and challenged
by her work.
Maintaining Excellence
In excellence. She thinks her teaching
is definitely informed by her research. That is a big part of it. She really loves
to engage in conversations about teaching with peers here and around the
country.
She thinks in her own day-to-day practice, she is always observing and
evaluating learning. The centerpiece of her work is making sure the students are
learning what they need to know and getting what they want out of their course
work.
She tries to tap into that and then modify her courses accordingly. The
continuous quality monitoring on a one-to-one basis is quite important.
She has done a great deal of consulting work on nursing education
research and practice. Her consulting work is as informative to heras it is to
people with whom she consult.
Through consulting, She have time to really talk
with nursing faculty about challenges in nursing education, and to think with
them about how we can resolve these long standing issues.
It is truly a gift to
have time to focus on our practice as teachers, and to reflect on what works,
and what does not, and how research might inform that practice.
Advice for Teachers
New teachers should stay open to conversations with colleagues
about teaching and share openly what they are doing. Try to work with others to
create a climate where these conversations can happen.
Lee Schulman and
colleagues from the Carnegie Foundation have written about teaching as a community
activity or as community property. When we share little about our teaching with
others, it fails to grow, and we fail to grow.
Finding opportunities to engage
in conversations with colleagues and figuring a way to make it happen is really
important.
She think paying attention to student learning, and not taking it
personally when students do not like what you do is important. New teachers do
not need to get into the position of having it be very important that students
like them or that they will evaluate them well.
She have found that when you are
being most effective is when the students are going to be least content with
the way you are approaching the teaching, She think it is important to listen
with an understanding that it is not always going to be a glowing report .
Some
of her wonderful experiences have been when students come back years later and
thank her for something that was terribly difficult for them at the time and
proved to be important to their overall growth over time.
It is so easy to get looked down on the day-to-day issues, debates
with faculty on curriculum, issues in clinical placements, and the faculty
shortage that we are all experiencing.
It is important to keep faith we can
get through these times and that our aim is the education of students. This is
a most important and worthwhile goal that is sometimes hard to hang on to in
the day-to-day grind of it all.
She think teaching is like nursing in a lot of ways. It is as much
about presence and about who you are as a person. There is no way you can
separate who you are as a person from who you are as a teacher.
It is really
important for the teacher to know self, be well grounded, and to have a certain
confidence. Teachers need to engage in reflection about their work and practice
as teachers in order to grow.
This deep thinking about the work of teaching,
engagement in the work, and commitment to it has got to be there to be
successful. There are too many teachers in the world who go in and deliver
their age-old lectures, walk out, and never engage with the students.
They
never know the students as individuals, they lose sight of who they are as
people, and do not know what their commitments are. A reward of teaching is the
constant ability to grow and change as a result of interaction with people.
It
is a strong belief of mine that teachers should know themselves as a person and
know the influence a teacher can have on people’s lives.
Once a teacher is
clear about self as a person, and holds an openness and recognition of the pace
of change in higher education and health care, then one can look for
opportunities to mold and educate students.