|
A
philosophy underlying excellence in teaching
Nili Tabak * RN PhD LLB, Livne Adi † and Mali
Eherenfeld ‡ RN PhD
*Dean of Nursing Department, Head of Ethics and
Law Units, School of Health Professions, Faculty of Medicine, Nursing
Department, Tel Aviv University, Tel Aviv, Istael †Psychologist, Tel Aviv
University, and ‡ Head of MA Program, Tel Aviv University, Tel Aviv, Israel
Introduction
The
aims of the contemporary university include excellence in both teaching and
research. Despite the public pronouncements of universities to both these
achievements, research typically receives more attention.
This
article focuses attention on teaching and the place of the educator in
nursing education. What is excellence in teaching and what does it entail?
Who is the worthy teacher? Responses to these questions will vary in
accordance with the moral and political meanings of education in given
locales and cultures as well as the identity and values of those being
asked. McDonald & McIntyre (2002) articulate a moral challenge that
arises in providing knowledge and educating.
They
observe the important fact that all knowledge is contextual, i.e. knowledge
based on certain assumptions in certain historical periods, and obtained
through specific sources. Every area of knowledge, including nursing, has
its authoritative sources, ideological approach and specific point of view.
Nursing educators meet students who are in the intersection of clinical
work, theory and research and they need to make important decisions
regarding the knowledge and underlying assumptions they will teach and, the
language they will use.
Education
and changing paradigms of knowledge
A
current criticism of research and practical nursing, by which we mean
direct, hands-on care of patients, indicate that nursing is often
disconnected from paradigmatic changes that occur in other areas of research.
While there is significant discussion of the shift from a positivist to a
postmodern theoretical paradigm in the disciplines of philosophy, sociology
and education, nursing still clings to positivist teaching techniques
adopted from the educational model of medicine where objective knowledge is
deemed sacred (Whall & Hicks, 2002). While this educational model
limits critical thinking, teaching methods that consider the connections
between individuals and their environments show knowledge as socially
situated. Such methods can teach nursing students to see patients as
individuals who, like themselves, are influenced by specific economic and
social circumstances (McDonald & McIntyre, 2002).
Failure
to take a critical approach to education has resulted in several
consequences. Reflecting on education and practical nursing led some
scholars to examine the philosophical assumptions underlying nursing and
conclude that some central concepts in nursing are incoherent. Nyatanga
& Dann (2002), for example, claim that empowerment is impossible in
nursing. Educationally, nursing espouses the rhetoric of patient empowerment
but in the clinical world, there is an interventionist milieu in which the
patient is viewed as passive, and nursing practices focus on acting for the
patient. Taken together, these leave little space for the patient to make
decisions for him
or
herself.
Another
consequence of the failure to take a critical approach to nursing education
is that new graduates are unprepared to think critically either about
nursing theories and concepts or the social context in which nurses
practise. The ‘reality shock’ described by Kramer (1974) decades ago still
exists and students are unprepared to deal critically with the
discrepancies between the ideologies of nursing education and the
complicated reality of professional nursing practice.
When
nursing teachers accept the traditional paradigm of knowledge without
questioning the underlying assumptions and helping students to think critically
about them, students are less likely to see the implications of socially
situated knowledge in the workplace. Yet in the workplace, nurses’
knowledge is likely to be discounted through the social organization of
health care, a hierarchical and patriarchal organization that privileges
scientific knowledge and physicians who control it.
In
contrast, our position is that a critical education provides students with
some preparation for encountering and confronting patriarchal concepts of
knowledge. Furthermore, in our experience, students find this critical approach
as liberating, having been equipped with tools of resistance. These tools include
recognition
of the connection between power structures and knowledge, the recognition
that the latter are mediated by language and practices, and the ability to
ask questions that probe beyond the obvious. Such an approach to nursing
education requires teachers not only convey knowledge to students but also
help lute truth, a teacher who does not teach that certainty is the only
acceptable student response, but rather one who teaches that doubt allows
for other possibilities.
In
this model, the teacher locates the starting point of the inquiry, pointing
out to students that the starting point positions both teacher and students
to expand their understanding of some issues even as it limits their
understanding of others (McDonald &
McIntyre,
2002).
The
teacher must interpret and clarify ideological positions in nursing
knowledge, including her or his own, in order to enable the students to do
the same, thereby demonstrating in action a critical approach to knowledge
development and education. In bringing underlying assumptions and values to
the foreground, teachers can demonstrate that such a practice allows people
the opportunity to change. In promoting these educational practices in the
classroom, the teacher offers a model of integrity that involves an ongoing
critique of oneself in relation to what one takes to be knowledge of the
world.
Teachers
able to enact a critical approach to education must be: self-aware and able
to promote and participate in discussions that leave one’s assumptions and
values, both their own and students’, open to public view; able to tolerate
uncertainty and ambiguity; and comfortable with the limits of their own and
the disciplines’ knowledge. Attaining an adequate number of such teachers
for nursing education is neither a simple nor an unimportant matter. In the
next section, we turn to the issue of power differentials between teachers
and students because it has been suggested that teachers must eliminate or
minimize power differentials if they are to teach critically (Humphris,
1993).
Power
to do evil and power to do good
Although
we stated earlier that the practice of nursing education clings to
positivist educational models, there is a growing literature that
interprets the relationship between knowledge and power as a potential source
of injustice and inequality and argues that the elimination of these wrongs
requires the dissolution of the power differences. One expression of these trends
is found in the term partnership that characterizes those in traditionally
unequal relationships such as teacher and student, nurse and patient as working
together towards similar goals (Jewell, 1994; Gaines & Baldwin, 1996).
From this perspective, no one has complete knowledge; the teacher learns
from the student just as the student learns from the teacher with their
encounters an example of mutual openness to each other’s needs. Similarly,
Cody & Mitchell (1992) argue for the importance of recognizing
differences such that teacher, nurse, researcher are sensitive to and
honour the right to being that is the student’s, patient’s, research
participant’s. This concept effaces the typically taken-for-granted power
of the privileged knower. These concepts are encouraging in that they are attempts
to lessen the distance between those of unequal knowledge and privilege that
follows from hierarchically organized groups (Humphris, 1993). In the
practice of education, such concepts create space for the subjective
experiences of students, for the truth they experience as their own. In
this way, space is created for the voice of those in weaker positions
(Brown & Gillis, 1999).
There
are those, however, who caution that commitment to equality and the
effacing of power differences is not unproblematic. For example, Thorne
& Henderson (1999) argue that, frequently, those who advocate for
equality and the effacement of differences have of a narrow understanding
of equality and actually deny important differences. Understanding
equality
in individual terms focuses on the possibilities and privileges that the
powerful person has over the weaker and, to rectify this, on ways to
equalize these privileges between them; it does not offer alternatives to
social organization that create conditions of unequal power and privilege,
nor does it aim at fostering a collective awareness (Cloud, 1994; Thorne &
Henderson, 1999).
While
students may experience the annulment of hierarchical relationships in the classroom
and the expression of their subjectivity as a privilege, these practices do
not necessarily lead to the resolution of problems like poverty,
discrimination and the unfair distribution of medical resources.
Thorne
& Henderson (1999) observed that the sweeping enthusiasm nurses have
for theories of equality derive from their marginal positioning in the health
system and from their attempt to create an alternative system of values to
the system that treats students to cope with the knowledge by attaining a critical
stance. This is accomplished by presenting knowledge in a way that necessarily
involves a thorough examination of the social situatedness of knowledge claims,
including underlying assumptions and values and the inclusiveness or
exclusiveness of the discourses and practices that mediate that knowledge. Questions
for nursing students indicative of a critical approach to education
include:
|
1.
|
Does knowledge in nursing relate to the health
of specific vulnerable groups such as the poor, medically indigent,
mentally disabled and homosexuals?
|
|
2.
|
From what point of view was the knowledge
about these groups written?
|
|
3.
|
Who decides the meaning of vulnerable and whether
a given group is vulnerable?
|
|
4.
|
Did members of the group figure in the
representation of the knowledge?
|
|
5.
|
|
What
professional values are expressed in the knowledge of vulnerable groups?
The
requirements for critical thinking in education demand a teacher who does
not subscribe to an abso them as unworthy and appreciates their research as
less important. Yet, in the process of adopting theories of equality and
practices that separate power as a source of oppression from experience as
a source of valid and exclusive knowledge, there is danger to education.
There
is a possibility that the field of nursing will indulge in the marginal
position and will enjoy the over-righteousness of being in the position of
the weak. While producing texts that express experience and the subjective,
nursing might give up altogether the struggle and the position of power in
the world.
Regardless
of whether teachers are more persuaded by the arguments showing the
benefits or those discussing the problems of the dissolution of hierarchical
power relationships, there remains the issue of how power in the classroom
is managed. Some might interpret the critical approach to education as too
relativistic in that it could be conceivably implemented in an extreme
manner whereby students come to think that their subjective experience is
sufficient – that no further knowledge is necessary. If the teacher has a
fear of confronting this view through a fear of using power, education is
compromised. Using examples from clinical practice, Nyatanga & Dann (2002)
declare their preference for managing this tension as one in which nurses
take the position of a witness to the patient’s action but does not
intervene and does not think for him or her. Yet, as Thorne & Henderson
(1999) point out, this position is problematic when, in the case of
education, it limits learning because students are not required to move
beyond their subjective experience, or in the case of patient care, a
psychotic patient is permitted to commit suicide because they express a
desire to do so.
In
these examples, the failure of teachers and clinicians to recognize and use
their power would be an injustice. To the extent that teachers fail to
challenge students’ experience as instances of what is the case about the
world, teachers limit what students can learn. The loss to students is not
only other perspectives but the loss of an actual experience of how people of
unequal power can come to more complete knowledge. Another harm is the
failure of teachers to challenge students intellectually. While teachers
must adjust their explanations according to the students’ cognitive level and
familiarity with material, compromising the complexity of ideas in order to
make them understandable to all is problematic. In this case, the teacher
retains the power of knowledge and the group of students, as a whole, is
left with partial knowledge. Of course, this does not address the problem for
the teacher of those students who have conceptual difficulties in grasping
the material.
A
critical approach to education requires that teachers acknowledge the
relationship between power and knowledge and come to terms with the fact
that both can be used for multiple ends. Foucault (1980) demonstrated that
power solely for the sake of power has no positive role and cannot exist
for long. This is clearly seen in several domains of human experience. For
example, in a developmental context, the need of the child for the parents’
power and decisiveness in terms of the child’s education and overall development
seems obvious. Although the term education is broad and one could take
issue with the moral worth of the specific content of a child’s education, it
would be unreasonable to deny the developmental need for children to be
subordinated to their parents’ authority during, at least, the earliest years
of their life. In the context of gender relations, Gilligan (1982)
differentiated between power activated permanently and temporarily, e.g.
the injustice of the permanent subordination and oppression of women. On
the other hand, Gilligan acknowledged that power exercised temporarily
could foster growth and development in situations of unequal power relationships.
In
our view, in the context of education, a teacher who is aware of and shares
his or her power and knowledge with students in the appropriate ways and times
acts responsibly towards students. In this case, the annulment of power
differentials is not a matter of reducing the educator’s power, but rather
in sharing the educator’s power; in the process, both teacher and students
are strengthened and empowered (Tanner, 1999).
In
nurturing students to be open to the views of others, to voice their views,
to critique knowledge claims, teachers experience a sense of continuity and
revival (Lamish, 2001). In making connections between theoretical knowledge
and their own experiences, students gain knowledge of the limits and
possibilities of knowledge (Tabak, 2001).
Power
to do good in the everyday world of practice
In
the everyday world of nursing education, the possibility that the teacher’s
power can be both positive and negative is a daily challenge. This is
especially the case with subjects such as nursing ethics, law and feminist
theories that challenge both teachers and students to locate and take
responsibility for themselves in a given discourse and set of practices. In
what follows, the authors provide examples of the positive use of power by
teachers. We believe they show that a critical approach to education
requires that the teacher be aware of the power differences between
themselves and students. When coupled with methodological and intellectual
skills, students gain knowledge.
The
first example is taken from a class in nursing and law. The teacher, a
nurse specializing in ethics, had an education in law. The teacher used a
variety of methods, including formal knowledge, simulations, group
discussions, models of moral decision making, and analysis of actual situations
to facilitate critical thinking in students. A student who was a midwife raised
a concern regarding loyalty in nurse–physician relationships. The issue was
discussed in class and the teacher used a decision-making model to mediate
the discussion with the outcome that all students and the teacher agreed
with the decision that was reached. In keeping with the discussion and
decision, the student returned to work and tried to change relationships.
Initially
the student met with resistance, even to the point that the physician
called the teacher asking for an explanation of the demand for change.
Using her professional authority and her knowledge of ethics and law, the
teacher was able to convince the physician.
In
this case, the teacher openly discussed her knowledge and power with a
clear statement of intentions, which served to support the student while
confronting a senior physician to the benefit of all.
The
second example comes from a class in feminist theory. At the beginning of
the class, students were asked to describe what they thought feminist
theory was and if they counted themselves a feminist. In response, students
related numerous personal experiences of injustice, struggle, and
unpleasant and depressing confrontations with the medical profession.
The
teacher used this material to explore the accuracy and depth of their
knowledge of feminist theory by comparing the students’ assumptions with the
assumptions of feminist theories. A series of questions was used to help
students reflect on how their fantasies and fears of feminism were related
to their lack of or inaccurate knowledge of feminist theory.
Following
this, students were asked to consider the political implications to
themselves of their inaccurate or limited knowledge of feminist theory.
This example shows that a critical approach to education can use power in a
non-abusive and productive way.
The
teacher, aware of her own commitments and extensive knowledge, allowed
space for the subjective understandings of the students. The teacher used
the experience of students to bridge their personal experience with theoretical
knowledge, thus forming a basis from which to further extend their knowledge.
The
final example is from a course for public health supervisors and senior
nurses working with families with multiple, severe needs. This example
illustrates the challenges of legitimizing students’ inner struggle and
differing perspectives regarding interventions when there is no one truth.
In this course, several senior clinicians from the field of nursing and
social work were the mediators. Classes were structured around case
presentations of families and how nurses worked with them. The point of
discussion was not supervision, i.e. the senior people were not concerned with
immediately making pronouncements on the most correct intervention. Rather,
the focus of the discussions was the enactment of the equality approach
regarding interventions with difficult families with complex needs.
Emphasis was placed on the importance of understanding the situation from
the perspective of the other.
In
this format, students had the advantage of sharing and reflection with colleagues
and the opportunity to hear different perspectives and proposed
interventions. They gained knowledge and a sense of competence and,
importantly, students continued the fruitful and mutual relationships to
consult with each other after the class was over. According to the
students, what they learned in the class contributed to a sense of
empowerment that contributed to their work style with col leagues and to
their approach with families, which worked towards families’ full
participation with decision making. and significantly, in our view,
students reported that the course helped them to cope with those situations
where students could not solve the complex and difficult problems in the
family.
We believe
that this critical approach to education gives students both knowledge and
power and recognition of their limits. Perhaps modesty and humility come to
those who cannot act because they know that not all is within one’s power –
those who know this have reached the place of knowing what they do not
know.
Conclusion
Postmodern
theories of critical education pose a complex challenge for nursing
educators. On one hand, teachers must critique themselves and their sources
of knowledge, examining basic ideological assumptions while being cognizant
of the limits of the point of view they are able to offer students. On the
other hand, teachers who are models of the critical approach must be cautious
not to deny power relations and knowledge differences between themselves and
students. Ignoring the relationship between knowledge and power does not
help students to develop a critical approach in relation to their own knowledge
and power; neither does giving undue importance to their subjective
experience help students.
Whereas
the first is likely to undermine the knowledge and competence they do have,
the latter can leave them unprepared for the realities of practice.
Rational
awareness of the difference between the use of power to oppress and the use
of power to liberate, to nurture, to foster and to give might enlighten a
path for the teacher who seeks to be a model of a critical approach to
knowledge for students.
In
contrast, teachers wary of owning and using their knowledge and power
interfere with the development with cooperative relationships with students
and education does not occur. Through examples from actual classrooms, the
authors have attempted to show how teachers meet these challenges to the
benefits
of students, faculty and, ultimately, patients.
References
Cloud D.L. (1994) ‘Socialism of the mind’. The
new age of post-Marxism. In: After Post-Modernism: Reconstructing the
Ideology Critique (eds H.W. Simons & M. Billig), pp. 222–251. Sage,
London.
Cody W.K. & Mitchell G.J. (1992) Parse’s
theory as a model
of practice: the cutting edge. Advanced Nursing
Science , 15 (2), 52–65.
Foucault M. (1980) Power/Knowledge (ed. C. Gordon).
Pantheon Books, New York.
Gaines S. & Baldwin
D. (1996) Guiding dialogue in the transformation
of teacher-student relationships. Nursing Outlook , 44 (3), 124–128.
Gilligan C. (1982) In A Different Voice:
Psychological Theory and Women’s Development . Harvard University Press, Cambridge,
MA.
Humphris D. (1993) Rites, rights and power: the
balance of power. Nursing Times , 89 (44), ii–viii.
Jewell M.L. (1994) Partnership in learning:
education as liberation. Nursing and Health Care , 15 (7), 360–364.
Kramer M. (1974) Reality Shock: Why Nurses Leave
Nursing . Mosby, Saint Louis, MO.
Lamish D. (2001) Teaching in the Center – Point
of View . The Center of Advanced Teaching, Tel Aviv University, No. 1, December,
pp. 10–11.
McDonald C. & McIntyre M. (2002) Women’s
health, women’s health care; complicating experience, language and
ideologies. Nursing Philosophy , 3 , 260–267.
Nyatanga L. & Dann K.L. (2002) Empowerment
in nursing: the role of philosophical and psychological factors. Nursing
Philosophy , 3 , 234–239.
Tabak N. (2001) Teaching in the Center – Point
of View . The Center of Advanced Teaching, Tel Aviv University, No. 1, December,
pp. 8–9.
Tanner C. (1999) Teaching: beyond technique.
Journal of Nursing Education , 38 (8), 339.
Thorne S.E. & Henderson D.J. (1999) Are
egalitarian relationships a desirable ideal in nursing? Western Journal of
Nursing Research , 21 (1), 16–34.
Whall A.L. & Hicks F.D. (2002) The
unrecognized paradigm shift in nursing: implications, problems, and
possibilities. Nursing Outlook , 50 (2), 72–76.
|
