Teaching and assessing on course for change Peter French and Dennis Cross
This paper argues that the concept of change is a valuable tool for the development of continuing education which is relevant to the personal needs of nurse practitioners and to clinical practice. The context for this discussion is a teaching and assessing course which holds the concept of change as the central philosophy for curriculum structure. The paper begins by describing the course philosophy, curriculum models and outline structure which typify this course. The second part of the paper describes research used to evaluate the 13 courses which have been held and the main conclusions of this research. It is concluded that this course has proven educational benefits and effects on clinical practice which include the development of critical reflectivity, acceptance of change, increase in self confidence and an increase in self-directed learning.
an appropriate
INTRODUCTION During 1987 the South Tees District School of Nursing
Continuing
undertook ‘I‘eaching English
to
plan
Education for
and Assessing National
the
Department
provision
course validated
Board.
convey the key philosophies evaluation
of
a
by the
It is our intention
to
of this course and an
of the course based on our experience
of the 13 courses which have been completed
by
I he time this paper was written.
the outline
which arose, when identifying
Peter French, PhD BA(Hons) RGN RMN RMN Principal Lecturer in Nursing Studies, Hon Staff Nurse, South Tees Health District, Department of Health and Community Studies, Teesside Polytechnic, Middlesbrough, Cleveland Dennis Cross, MA BEd(Hons) RGN RMN, Senior Lecturer in Nursing Studies, Teesside Polytechnic, Hon CPN, South West Durham Health District (Requests for offprints to PF) Manuscript accepted 19 July 1990
was related
of the course.
syllabus
for
to the
A scrutiny
the ENB
998
of’
course
confirmed
that the course was to be targeted
Registered
Nurses who were actively involved in
clinical practice.
We decided
at
that the purpose of
the course was to enable ward sisters and senior staff nurses to adequately support nurse learners in their own clinical environment and this was confirmed
by the outline
curriculum
pro-
vided by the ENB. This decision was also supported by the work of researchers in nurse education
THE CORE PHILOSOPHY ‘l‘he first question
philosophy,
aims and purposes
(Ogier.
1982: Marson,
1982;
Orton,
1979;
Fretwell,
1981). This work encouraged
us
to adopt the idea that the role of the nurse, in this setting, was to create a suitable learning
environ-
ment rather than to ‘teach’ per se. By adopting this proposition, and taking account of the suggested course content in the outline curriculum, it was decided
that the unifying
theme for
the course would be the concept of ‘change’. The following premises were the basis of the course philosophy: 1. Learning
is a change
concept.
20
NURSE EDUCATION
2. The
qualified
her/his others
TODAY
practitioners
own
learning
must manage
in order
to
to learn.
3. Helping
student
nurses to learn is synony-
mous with helping them to change. 4. The process of course development be seen as a process of continual 5. The
help
context
influenced
of
the
by professional,
is
organisational
and societal change.
in change,
it was assumed
active participants during
rather
When designing ourselves The
to participate
that they should experiences.
the course
it was anticipated
to bring
about
as well as in the course
following
be
than passive observers
their own learning
that we would need
were the crucial
change
in
participants. factors
in this
change:
to ‘participative’ 2. Change which
in
the
existed
strategies
from didactic
authority between
relationships teachers
and
3. Changes
in the teacher’s
knowledge
values
and skills. These
changes
designers,
would
course
affect
facilitator
sons as well as the course premises
were
Knowles
and resource by the (1975)
(1972) and the reader is encouraged such work for a greater rationale student
behind
course
participants.
substantiated
et al (1968),
the
work
to follow up
understanding between
were seen to be of primary
b)
4
case
was defined
in
detected point
that teachers
learning.
Another
tells tutor learning
of a
should
lecture
this is immediately
teacher
to encourage
in their students.
who
self-directed
The mode of learning about learning
and
noticeable.
In much the same way speaking
about diction
uses the mode which is the same as
the content which is being conveyed. that
an
elocutionist
people
to ‘speak proper’
student
teachers
In the same
cannot
encourage
the tutor
can not tell
to adopt participative
learning
This point has been laboured
it is central
to the philosophy
was adopted
for this course.
were adopted
because
of change
In order to achieve the required models
A
which
use experiential
is the didactic
students
dissonance
by the learner.
is the
does not fit the proposition
to guide
change,
which three
the curriculum
design. They were:
4
The
concept
of spiral
guide the curriculum
b)
The
experiential
and Bell
of the
(1975)
curriculum
-
to
structure.
taxonomy
of Steinaker
- to guide
the teaching
methodology. teacher
and
importance speci-
cl
A cyclic teaching knowledge
problem-solving process
model
of
- to guide the forms
the of
which were selected. (Adapted
from Kilty, 1982).
as:
A facilitator of learning A senior student
b) A role model c) 2. The student was defined a)
of
is an example
must match otherwise
advocates
and Sieber
in achieving change, and the following fications were outlined:
a)
common
these assumptions.
relationships
1. The teacher
perThese
of learning
are one and the same.
teaching
will be immediately
methods.
learners.
The
about
by
situation in which the disjunction between the mode of teaching and the propositions held
way
methods.
acquired
are very few learning
where the actual content
or language
1. Change in teaching
Fisher
to the attitudes
and the mode of learning
rel-
were seen to
There
about teaching
In order to enable course members
the unique
have in relationship
Teaching
process
to emphasise
course participants. situations
must
change.
learning
It is important
evance which these role definitions
as:
An equal and active participant/contributor in learning An enquirer A tester
THE COURSE DESIGN The course philosophy and selected curriculum models determined that the process of learning, rather than the outcome of learning was most important. Given that the course would be awarded
a statement
of attendance,
summative
NURSE EDUCATION
assessment describe each
was not necessary
and it was easy to
the course in process terms. The aims of
course
planning,
unit
emphasised
implementation
learning climates. with learning
the
and
assessment,
evaluation
of
methods
would be used on the course (Briefing
in nature
planning
completed
units. Students
which
Day) and
and the identification
then returned
presented
and
to clinical practice
returning
on the review day
their report on the attempted
in the learning
:, 1
by the end of the study
for 10 weeks before to present
The first units were concerned
about the teaching
formative
TODAY
climate
change
on the course.
to students
This was
on unit 6 of the course
an analysis of self (unit 1). The aims for each unit
which followed, enabling
were:
ing course to pick up ideas for their own change
linit aim
course
projects
BriefingTo
help the course participants
prepare
and look forward to the course units. Day Unit 1 To enable course participants to explore
and to make judgements
decisions LJnit 2
To
on themselves
enable
explore,
course
judge
make
about their own learning Unit 3
To
enable
develop
the course
Unit 4
To
enable
prepare
the
to
environment. participants
skills in methods change
course
of enquiry current
To
enable
the
participants learning
practice
course
project Keview dav
to current
and
to
activities
participants
to
change
issues in nursing
education
using
course
work. to stimulate
projects
cational
the oppor-
methods of
learning
obtained
Four
methods
first three progress
to participants
days to record
cation of responses Finally longer
their
The
were analysed
working
six
2-3-day
study units held weekly in blocks. These were to be completed in 5 weeks, each unit being separated
from the other by clinical practice and
days off. One of the processes which course members were to be involved in was the identification, planning and implementation of a smallscale change in ward organisation relevant to learning in that setting. The project would be
interviewees sampling course.
on the briefing
and
were
in the partici-
Twenty
interviews
classifi-
were evaluated with four sisters
participants This
and five of
data collection
out on a small sample so selected
by
opportunity
6 months after they had completed
The interviews were audio-recorded sciptions
Statements
1977).
term outcomes course
Nomthe was
(Zurcher.
could only be carried of
second,
by Zurcher’s
colleagues.
First a
to measure
third, 1970)
changes
pant’s self-perception.
data the
1975), to obtain
data on the course progress; and Twenty Statements Test (Hartley,
change
consisted
1981)
(Delbecq,
were
of
participants.
outcomes;
technique
who had been
design
bv analysis
the course.
test (Mezoff,
test results
THE CHANGE PROJECT
during
on learning
inal Group
review
in edu-
self-report
were used to collect
sharing
to their attempted
outcomes
occurred
through
with regard activities.
1989)
from 35 course
colleagues
and
dissertation
(Cross,
were used to evaluate the achievement
course
personalised
descriptive
course
a key element
OF CHANGE
for a Master’s
development
mainly by in-depth
‘The
become
of the course and philosophv.
THE EVALUATION
administered
To allow course participants tunity
change
pre-then-post
make decisions and recommend with regard
These
of the realisation
material
in a clinical setting. IJnit 5
for
their skill in small
group presentation.
As a subject to
in nursing.
and facilitate
an opportunity
to develop
and
decisions
with a view to understanding and future
as well as giving members
of the follow-
and peers. participants
and
members
analysed
using
gested by Jack Mezirow’s ‘Perspective Transformation’,
the
and tran-
categories
sug-
10 categories of (Merirow. 198 1).
First a structural analysis of interviews Mezirow’s 10 categories was completed
into and
22
NURSE EDUCATION
TODAY
Table 1 Frequency of sisters’ responses into 10 stages of perspective transformation Stage No
Sister 1
1 2 3 4 5 6 7 ! 10 Totals
Total No of Responses
Rank order of Frequency
1 1 4 1 2 1 0 0 2
1 1 2 2 1 3 1 2
0 1 2 1 0 2 1 0 3
2 4 10 6 4 8 3 4 9
10 6 1 4 6 3 9 6 2
2 15
1 13
3 18
0 10
6 56
4
(Table 1). Mezirow (198 1) considers the following
Sister 4
0 1 2 2 1 2 1 2
cross-checked by independent frequency of response chart
perspective
Responses Sister 3
Sister 2
transformation
judges, then a was constructed
that the dynamics of appear
to include
levels.
had increased their
their ability to critically reflect on
role as a nurse
with an improved
nalised
responses of personally
role assumptions
alieniation
This structural
dilemma;
2. self-examination; 3. a critical assessment
inter-
and a sense of
from traditional
social expec-
tations; 4. relating one’s discontent to similar experiences of others or to public issues recognising
that one’s problem
and not exclusively
is shared
a private matter;
5. exploring options for new ways of acting; 6. building up self-confidence and competenance in new roles; 7. planning
a course of action;
8. acquiring knowledge and skills for implementing one’s plans; 9. provisional efforts to try new roles and to assess feedback; into society on the basis of 10. a re-integration conditions dictated by a new perspective (Mezirow,
1981).
The results of the analysis of the interview data were considered to be the most relevant to this paper. These results indicated that the major effects of the course appeared to be that students
The
inter-
ability to stand back from their
working environment
to makejudgements,
sions and implement 1. a disorientating
and teacher.
viewees suggested that the primary effect of the course was a rise in their consciousness coupled
analysis and quantification
indicated
increased
that
course
in confidence,
learners
not
sing practice
and
the course
their
The
working
information
participants
of
participants
only
but also in their attitudes
with colleagues.
deci-
action.
in helping
towards nurrelationships provided
in interview
by
was con-
firmed by interviews with their colleagues
and by
the other three tools which were used to gather self-evaluations course.
during
Opinions
gested
that
and at the end of the
recorded
student
at interview
nurses’
emotional
were now central to the planning of clinical experience
sugneeds
and provision
as a result of the course.
Furthermore, there were many references in interview data and in data provided by other tools which indicated vided
the initial
planning grammes.
their
that the course
impetus
for nurses
own
developmental
had proto begin pro-
Diplomas in Nursing, degree prodistance learning and counselling grammes, courses were specifically described. These references to further professional post-registration education suggested that following the 998 course nurses had begun to take responsibility for their own further development.
In conclusion, tinuing
education
it is argued
of change has numerous as well as positive
here
course-based
educational
consequences
that a con-
on a philosophy advantages
in the clinical
setting. This paper has tried to demonstrate utility of a model for change
the
and the advantages
which can be gained.
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