The reading room: Exploring the use of literature as a strategy for integrating threshold concepts into nursing curricula
Introduction
Learning to nurse and to be a nurse, as it is conceived ideologically, requires students to be open to self-examination and change, because while ordinary human kindness is at nursing's core, this value alone is insufficient to guide practice. In addition to kindness and a solid foundation of knowledge and skills contemporary nurses require imagination, creativity, clinical and moral reasoning abilities and empathy (Benner et al., 2010). Development of these attributes requires educators to use transformative and creative approaches to challenge and inspire students.
While many students enter nursing programs with a keen desire to care and to make a difference in peoples' lives, there needs to be quite a lot of ‘letting go’ of ill-fitting attitudes and biases in the journey from lay person to professional nurse. Also important is the ‘taking up’ of new conceptual understandings and values to become person-centred, empathetic, skilled and effective knowledge workers.
Transformative Learning (TL) pedagogy can assist in this endeavour. Using the definition provided by the adult education theorist Mezirow (2000), TL is the process by which learners are challenged to call into question taken-for-granted ideas, beliefs, habits of mind and feelings, and to experience fundamental shifts in perspective so that they can join colleagues in committed actions for change. A key part of TL is integration of threshold concepts which Meyer and Land (2003, p.1) define as: “akin to a portal, opening up a new and previously inaccessible way of thinking about something … [they] represent a transformed way of understanding, interpreting, or viewing something without which the learner cannot progress”.
This paper aims to contribute to teaching practice as well as to the body of literature on narratives in nursing, by describing our approach for promoting emotional engagement with stories in ways that allow learners to care about problematic issues. We acknowledge that this paper is descriptive in nature rather than evaluative. However, the examples provided and the linked discussion that follows will allow other educators to further develop the ideas into teaching approaches that can be implemented and further explored.
Section snippets
Background
Transformative Learning (TL) differs from other educational approaches because the aim is to bring about a changed perspective in learners. Unlike conventional humanist educational approaches, for example, TL is not simply eliciting opinion (McKenna, 1995) and unlike behavioural approaches it is not just validating learning efforts. Rather, TL seeks to explore aspects of an issue that are problematic and puzzling, aspects that have been poorly resolved, and which require the input of critical
Exploring the complexity of care through The English Patient
The Booker Prize winning novel, “The English Patient” by Ondaatje (1993), is a romantic drama set in the mayhem of the allies' liberation of Europe during World War II, in the ruins of an Italian villa and field hospital. A man, burned beyond recognition in a plane crash, is slowly dying. He is being tended to by a young Canadian nurse, Hana, who has refused to be evacuated because she cannot abandon this patient to suffer and die alone. This sets the scene for a story in which characters (and
Exploring the concept of the “Other” in relation to self
Some students have had caring experiences that led them to nursing. For most novice nursing students, learning to care for others in comprehensive and intimate ways takes time and thoughtful reflection. On the surface, it seems simple enough; however, students can become overwhelmed when faced with caring for those from very different backgrounds or with whom they perceive they have nothing in common. Soule (2014) noted that it is essential that students have awareness of self as unique beings
Exploring the concept of stigma in mental health
Overcoming stigma, which is a sign of difference that leads to shame, is in an important threshold concept for all health professional students. Despite any personal biases or beliefs, clinicians have a duty to suspend judgement and not participate in further stigmatization or marginalization, however it is a sad fact that students do hold stigmatizing views (Cleary et al., 2012). Socially derived attitudes to people with mental illness, such as fear, avoidance, and failure to understand, often
Discussion and conclusion
There are many benefits to the use of humanities-based learning in nursing curricula, although in recent years there have also arisen numerous obstacles – the pressure of time, the crowded curriculum, and the need for students to learn and master increasing numbers of technical skills in order to be ready for beginning professional practice. Making room within the curriculum for reading novels and memoirs nevertheless claims an important space for students and educators. Narratives of health
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