Let explores key teaching principles, common assumptions in nursing pedagogy, and evidence-based strategies to enhance learning, critical thinking. Philosophical Foundations for Excellence in Nursing Teaching.
Common Assumptions in Nursing Theory
There are several important texts that summarize the elements of major nursing theories known as grand theory (Chinn & Kramer, 2004; Fawcett, 1993; Meleis , 1991). These theories address the general, broad nature of nursing, setting forth ideas about the fundamental goals and purposes of nursing, and explanations of the fundamental dynamics that occur in a nurse-patient interaction to achieve these broad goals.
There are also many middle-range theories published in journal articles and summarized in texts (Smith & Liehr, 2003). Middle-range theories focus on specific human health experiences that commonly occur in nursing practice, such as uncertainty in illness, family stress, and unpleasant symptoms. Middle-range theory provides a comprehensive description of the specific experience, explanations of the dynamics that occur as the experience unfolds, and either explicit or implied explanations concerning the dynamics in the nurse-patient interaction related to the experience.
Similarly, situation-specific theories address specific nursing phenomena, but also incorporate specific contexts and are readily applicable to practice ( Im & Meleis , 1999). Whether a nursing theory is considered a grand theory, a middle-range theory, or a situation-specific theory, there are common fundamental tenets or assumptions upon which they are based that characterize theory as nursing theory (Chinn, 1989).
These assumptions provide the framework or the foundation for nursing as a discipline, and underpin what and how we teach in nursing. The assumptions that characterize a nursing perspective in theory should also appear in a nursing education philosophy, either explicitly or implicitly. Examine the major assumptions of the nursing theory guiding your own educational institution may be an enlightening exercise. Look for the following major assumptions of nursing theory in your school philosophy.
Health is Wholeness
There is an abiding and consistent theme running throughout nursing literature that identifies health in its fullest, whole dimension as the fundamental goal of nursing. Health is defined in various ways and specific dimensions or aspects of health vary from theory to theory. But fundamentally, health is conceptualized as a dynamic experience that embraces all aspects of human existence.
The Primacy of Human Uniqueness and Subjectivity
Nursing theories consistently point to the person’s unique perceptions and experience as the starting point from which to understand human health experience. Although theories, by definition, draw general conclusions about the nature of a phenomenon, nursing theories provide conceptual space for experience to be interpreted and understood in the context of the individual’s unique experience.
Subjectivity is typically understood to be developed within a relational, social, and cultural context, but even given certain general understandings about culture , nursing’s focus consistently seeks to understand a person’s uniqueness within their context.
Caring and Supportive Relationship
Not all nursing theories specify caring per se as the central concept, but nursing theories consistently espouse nurturing, growth-producing, healing relational contexts or interactions that support movement toward health and wellness. Some theories include or focus on the specific nature of the relationship between nurse and patient or family. Others focus on the significant relationships of family, community, society, or environment that influence the evolution of a specific health experience.
Putting It All Together
By examining your school’s philosophy, you can compare it to what you personally believe, and the ways in which you view the world, yourself, and others with whom you interact. You now have a start toward developing your own personal philosophy, which incorporates the essential tenets of nursing’s fundamental patterns of knowing in nursing and assumptions that are consistent with theoretical nursing perspectives. You may also have a start towards developing a theory of nursing education.
Your philosophy will consist of those statements that you take as givens, as assumptions that you take to be constant and enduring. A theory of education includes descriptions and explanations that you think represent your experience as accurately as possible, but that you are also aware may not yet be the best or most accurate explanations.
Theoretical ideas are built from your philosophy, but theories reside in the empirical realm; they are ideas about reality that are subject to empirical examination and change. As an example, a philosophy might have a strong component that views the nurse as an advocate for patient rights (ethical knowing). A related theory might address the kind of organizational structure that is proposed to provide a strong environment in which nursing advocacy results in a higher quality of care.
This theory would provide the structure from which to design research exploring the characteristics of the organizational structure, resulting in evidence demonstrating the extent to which this structure actually results in a high quality of care and positive patient outcomes. Noddings’ (1995) philosophy of caring education illustrates a well- developed educational philosophy (Chinn, 1999). Noddings’ philosophy is significant for nursing education because it embraces the fundamental perspective of caring relationship that underlies nursing theory.
This is a key element that must characterize nursing education if we are to know what we do, and do what we know. If we seek to teach students how to engage in caring and supportive relationships in order to promote growth, health, and healing, then as teachers we are compelled to teach in ways that demonstrate exactly this kind of relationship. If we do not do so, we are essentially sending the message “do as I say, not as I do.”
These two sections, taken together, lead you through practice—reflection on what you know (what you value and what you believe to be true, right, and good in education) and what you do (as reflected in your teaching practices). The outcome, hopefully, will be a thoughtful statement of your personal philosophy of nursing education, and a foundation from which to affirm, change, or develop teaching practices that are consistent with your philosophy.
Noddings’ Philosophy of Caring Education
There are four major processes or principles that Noddings specifies as essential to caring education: modeling, dialogue, practice, and confirmation. Each of these processes leads directly to teaching practices that demonstrate beliefs and values of caring education. The practices that are suggested for each of Noddings’ principles are drawn from Peace and Power guidelines for group process (Chinn, 2004b; Falk-Rafael, Anderson, Chinn, & Rubotzky , 2004).
Modeling
Modeling is showing in action and interaction what it means to care. Caring in teaching, as in all caring relationships, does not mean “anything goes.” Rather, it means that you care about yourself as a nurse educator; you take your role as teacher seriously; you are clear about what is required to be a nurse; and you are clear about professional and personal standards of nursing. At the same time, you care deeply about each student, and are committed to creating the best possible learning environment for everyone. Specific actions that model what it means to care as a teacher are listed.
Dialogue
Dialogue underpins all interactions between and among students and teachers. It is an interactive exchange that brings to conscious awareness of what everyone is doing, and more importantly, why. Everyone in the group is brought into the discussions with equal opportunity to participate and enter into the dialogue. The teacher creates a context for dialogue that is reflective, so that every learning experience becomes a “text”—a focus for reflection that brings forth awareness of the meaning of each learning experience.
Practice in Caring
Practice in caring is the practice of cooperation and sharing. The dominant practices of patriarchal education view cooperation and sharing as “cheating.” In the context of caring education, cooperation and sharing are valued as critical learning tools for not only gaining knowledge and understanding, but also for developing valuable human interaction skills that serve communities and societies well. Concerns for each student’s individual achievement are addressed within a context of cooperation and sharing in ways that call forth individual responsibility, and each individual’s best performance. Specific actions that promote practice in caring are listed here:
- Engage broad audiences: instead of being the only person to see and evaluate a student’s work, encourage students to share their work openly and invite everyone’s feedback.
- Provide guidelines for everyone to use in providing constructive criticism of one another’s work.
- Build in opportunities for students to receive feedback on their constructive criticism skills.
- Encourage presentations of student work both in and outside of class (to clients, or groups of nurses in the community, for example), and draw on the feedback they receive from these groups.
- Build in opportunities for students to share with the group resources and information that they discover outside of class
Confirmation
Confirmation is the practice of affirming and encouraging the best for all. As the teacher, you have the responsibility to identify basic standards of achievement that are grounded in professional standards of nursing care, and that provide for students explicit descriptions of the basic performance expectations required for the particular learning experience. At the same time, within a caring context your responsibility is to learn and know students as individuals, and encourage them to achieve the professional standards in ways that express their own desires, expectations, and highest good.
Each student’s achievement must meet the expectations of the student as well as those of the teacher. When a student cannot meet these expectations, the teacher responds with compassion and understanding and shifts the focus for interacting with the student in the direction of assisting the student to find a path that better suits her abilities or needs at this moment in time. Since confirmation in most educational contexts also involves grading, there are immense challenges in maintaining a focus on caring practices, but it is possible to do so (Chinn, 2004a).
Reflective Practice
This process of examining your philosophy and your course materials will become an on-going one. The other critical component in your practice of teaching will be to make space to reflect critically at the end of each course, going over what you intended to happen, and what actually happened. Use the student evaluations as one component that influences your reflection.
Be open and receptive to student comments, while also evaluating your own insights and inner knowing of the circumstances within which the student perspective developed. If at all possible, engage in discussion with students about their experience several weeks after the experience, when insights and understandings about what they learned and how they learned will be interpreted from a different (and possibly better informed) perspective.
Share your perspectives on the experience with the students and invite their reaction to any changes you are considering. Another often neglected source for critical reflection is that of faculty colleagues. When you invite their feedback, be aware of their own philosophy and perspectives concerning nursing education. You will benefit from learning the perceptions of those who do not share your values, but you will be particularly interested in the feedback of those who do share your values.
Feedback coming from each of these perspectives will help you continue to refine both your values and beliefs, and your practices as a teacher. It may seem that these reflective processes are too time-consuming for an already overworked nurse educator. Indeed, engaging in this kind of reflective practice places a real demand on your time, energy, and emotional/intellectual capacities. However, what you will gain is immense. You will acquire a renewed and renewable sense of satisfaction in your teaching.
You will reach a point when you avoid, and even eliminate some of the most distressing and time-consuming demands of teaching the demands coming from students who are floundering, dissatisfied, distressed, anxious, and uncertain. Your level of preparation for each new course will improve, and your well-developed course materials will provide a sound framework that makes it possible to get right to the heart of teaching and learning.
Conclusion
This process of examining your philosophy and your course materials will become an on-going process. The other critical component in your practice of teaching will be to make space to reflect critically at the end of each course, going over what you intended to happen, and what actually happened. Use the student evaluations as one component that influences your reflection.
Be open and receptive to student comments, while also evaluating your own insights and inner knowing of the circumstances within which the student perspective developed. If at all possible, engage in discussion with students about their experience several weeks after the experience, when insights and understandings about what they learned and how they learned will be interpreted from a different (and possibly better informed) perspective.
Share your perspectives on the experience with the students and invite their reaction to any changes you are considering. Another often neglected source for critical reflection is that of faculty colleagues. When you invite their feedback, be aware of their own philosophy and perspectives concerning nursing education. You will benefit from learning the perceptions of those who do not share your values, but you will be particularly interested in the feedback of those who do share your values.
Feedback coming from each of these perspectives will help you to continue to refine both your values and beliefs, and your practices as a teacher. It may seem that these reflective processes are too time-consuming for an already overworked nurse educator. Indeed, engaging in this kind of reflective practice places a real demand on your time, energy, and emotional/intellectual capacities. But what you will gain is immense. You will acquire a renewed and renewable sense of satisfaction in your teaching.
You will reach a point when you avoid, and even eliminate, some of the most distressing and time-consuming demands of teaching the demands coming from students who are floundering, dissatisfied, distressed, anxious, and uncertain. Your level of preparation for each new course will improve, and your well-developed course materials will provide a sound framework that makes it possible to get right to the heart of teaching and learning.
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