Elsevier

Nurse Education in Practice

Volume 15, Issue 6, November 2015, Pages 480-484
Nurse Education in Practice

Exploring transformative learning and the courage to teach a values based curriculum

https://doi.org/10.1016/j.nepr.2015.01.007Get rights and content

Abstract

Teaching is a complex art that takes courage to commit to, particularly in the face of stressed students, crowded curricula, tensions in preparation for the graduate role, and ongoing educator shortages. My colleagues and I have been taking on this challenge by imbuing our teaching of nursing with more passion.

As Parker Palmer (1998, p. 144), the renowned educationalist once said: “The growth of any craft depends on shared practice and honest dialogue among the people who do it. We grow by trial and error, to be sure – but our willingness to try, and fail, as individuals are severely limited when we are not supported by a community that encourages such risks”. The vision that I have is for nursing educators to come together in communities of practice to talk about the challenging aspects of nursing and ways these challenges can be reframed and reapproached through education. This work is underpinned by the pedagogy of Transformative Learning (TL).

At its heart this pedagogy is interested in problematic practices that keep afflicting a discipline such as nursing, and in pondering and revising the educational solutions. In nursing, our biggest problems are where stigma, inequality and inertia persist to make vulnerable communities experience more illness and hardship than others who are more privileged. TL treats students as critical agents – who have the potential to rethink problems and change practices. TL aims to make space within the classroom and online for a dialogue that is affirming so that students believe in their own capacity to make a better world for all people.

Section snippets

What is values based learning

Values-Based Learning (VBL) emphasises aesthetic knowing to develop human attributes conducive to the support of well-being. It seems obvious to state that VBL has a lot to offer nursing students and nursing education, considering that nursing has long been venerated for being an art. However, over recent years arts-based learning has been left languishing, in part because of the rise of ideologies such as techno-rationalism and bio-medicalism and the subsequent over-valorisation of practices

The foundations of transformative learning

Transformative Learning (TL) comes within the umbrella concept of critical pedagogy, a philosophy for teaching and learning that aims for radical social action so that entrenched social inequities are questioned and if needed, replaced (Brookfield, 2005). Briefly, Transformative Learning is that which seeks to expand a student's consciousness so that existing world views and self-perceptions are re-considered (Cranton, 2006). Such a pedagogy fits the intentions of nursing much better than

Rethinking values

The idea that ‘today's students' are missing the important values base needed to competently care is not new, but it is certainly a common complaint. Writers in the popular and scholarly press have frequently bemoaned the lack of one particular value – compassion – in the health service, and often nurses are blamed (or scapegoated) and subsequently so are students and the education system. The implications are that graduates are inherently deficient, lacking attributes with which others – such

The disappearing care dilemma

To assist learners to achieve perspective transformation, they first need to be aware of disorienting dilemmas. According to Mezirow (2000) an unprocessed disorienting dilemma is paralysing and can lead to a feeling of hopelessness and inaction. But when the dilemma is intellectually processed through reflection, dialogue, planning new courses of action, and practice, the learner can experience hopefulness and liberty in action.

One important disorienting dilemma for students is one that has

Inequalities amongst patients continue

Another insidious binary that continues to constrain the delivery of equitable and ethical health care to people, is the idea of there being deserving and undeserving patients (Tarlier, 2004). It may not be a consciously held value, but students may learn in clinical practice that some patients are treated unequally and judgements are made about them which are stigmatising, dehumanising and lead to negative health and social outcomes. This is argued because studies continue to reveal that

Knowing what to teach transformatively

There are specific, teachable concepts and acts that can assist student nurses to think about and deliver care that is not only based on technical competence but also on an explicit foundation of current nursing values. Teaching to transform is all about taking the time to engage and sensitize students to issues that need changing, but which may have become embedded, taken for granted, not noticed, or perhaps something one feels helpless to change. Once sensitized, students are ready to learn

Knowing how to teach transformatively

Because TL rests in the discourse of critical theory, which posits that understanding without change is meaningless, it follows that students learning nursing through this pedagogy need to have their learning mobilised and their knowledge put into action. Aesthetic learning has this mobilising potential (Brien and McAllister, in press).

Within the discourse known as narrative medicine, there is great value placed on health professionals developing a ‘sense of the aesthetic’, because it develops

Conclusion

This paper has argued the value of a pedagogy for nursing that moves beyond a preoccupation with techniques and medical knowledge, but also does not dismiss this learning. Transformative Learning has a hopeful vision, one that sees change is possible, it is occurring, and we can play a part in hastening, or facilitating this movement. Changes made by students do not have to be monumental for them to be significant and long lasting. Students who are equipped and confident to make change are

Acknowledgement

A version of this paper was presented as the key note address at the NETNEP conference in Noorwijkerhout, the Netherlands, in June 2014.

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