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Heutagogy: An alternative practice based learning approach
Nurse Education in Practice 10 (2010) 322e326
Contents lists available at ScienceDirect
Nurse Education in Practice journal homepage: www.elsevier.com/nepr
Issues for Debate
Heutagogy: An alternative practice based learning approach John Bhoyrub, John Hurley*, Gavin R. Neilson, Mike Ramsay, Margaret Smith University of Dundee, School of Nursing & Midwifery, Dundee DD14HJ 01382 388568, United Kingdom
a r t i c l e i n f o
a b s t r a c t
Article history: Accepted 4 May 2010
Education has explored and utilised multiple approaches in attempts to enhance the learning and teaching opportunities available to adult learners. Traditional pedagogy has been both directly and indirectly affected by andragogy and transformational learning, consequently widening our understandings and approaches toward view teaching and learning. Within the context of nurse education, a major challenge has been to effectively apply these educational approaches to the complex, unpredictable and challenging environment of practice based learning. While not offered as a panacea to such challenges, heutagogy is offered in this discussion paper as an emerging and potentially highly congruent educational framework to place around practice based learning. Being an emergent theory its known conceptual underpinnings and possible applications to nurse education need to be explored and theoretically applied. Through placing the adult learner at the foreground of grasping learning opportunities as they unpredictability emerge from a sometimes chaotic environment, heutagogy can be argued as offering the potential to minimise many of the well published difficulties of coordinating practice with faculty teaching and learning. Ó 2010 Elsevier Ltd. All rights reserved.
Keywords: Educational frameworks Nursing Practice based learning Heutagogy
Introduction The learning environments for undergraduate nursing students have long been described as being themed with complexity and unpredictability, and hence uncertainty (Barker et al., 1999; Mitchell and Cody, 2002; Mitchell and Pilkington, 2000). Ensuring high quality practice-based learning consequently requires a complex and responsive educational intervention. All nursing interventions initially require an overarching theoretical framework to support, guide and inform action. This paper explores the construct of heutagogy as being a potentially highly congruent framework for undergraduate pre-registration practice-based learning. The challenge for educators and educational administrators in considering heutagogy as a potential learning theory may be to relinquish some attempts to control and manage learning experiences, and instead empower the self-directive adult learner to accumulate learning experiences within dynamic and unpredictable clinical environments. Contextual issues The significance of being able to practice in rapidly changing health care environments is substantiated in the recognition that the health service of the future will need nurses with sophisticated skills * Corresponding author. Tel.: þ44 1382 388568. E-mail address: [email protected] (J. Hurley). 1471-5953/$ e see front matter Ó 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.nepr.2010.05.001
and increased knowledge, and that any assessment of the future staffing requirements for nurses must begin with consideration of the probable pattern of future demand for health care (SEHD, 2003). The indications are that the demand for nursing care will continue to grow in the United Kingdom through the first decades of this millennium and well beyond, owing to a number of demographics. Firstly, there is a growing population with a greater number of elderly people with their higher proportion of chronic disease and physical incapacity. Secondly, there is an increase in health care problems such as the expanding HIV epidemic and the impact of new diseases and infections. Thirdly, increased drug and alcohol addiction, violence and abuse will require extensive nursing input. Changes in public (‘consumer’) expectations of the healthcare system, increasingly articulate and informed patients demanding more care and lack of access to services among the indigent and homeless will also create even greater demands for nurses. Higher acuity patients, advances in medical practice and expanding technology also create a greater demand for the specialist skills of registered nurses (Alspach, 2000; RCN, 2004). The increase in the intensity and complexity of patient care has increased the demand for nursing practice over the past decade (Chang, 1995). The greater life expectancy of individuals with acute and chronic conditions also requires more complex nursing care (Heller and Nichols, 2001). Further, managed care has reduced length of stay for patients in hospital, leaving nurses to care for and stabilise patients in a shorter period of time and increased caseloads for community nursing staff (Leigh and Krier, 2001; Girot and Rickaby, 2008).
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Nurses are now frequently the first point of contact with health care in NHS 24 and walk-in centres. Nurses now also increasingly take on roles that were traditionally the function of doctors inclusive of prescribing medications and ordering and interpreting diagnostic investigations (Girot and Rickaby, 2008). High quality care consequently depends in part upon nurses who form an important element of the multi-disciplinary caring team (van der Sluis et al., 2009). A fundamental aim of student nurse education is consequently that nurses should be able to demonstrate that they have the skills to assume these roles and hence be able to be critical thinkers, analytical and reflective as well as being problem-based learners, life-long learners and researcher competent(UKCC, 2001; SEHD, 2006). Heutagogy: conceptual underpinnings and connections In seeking to achieve the fundamental aims of student nurse education programmes, nursing requires complex combinations of knowledge, performance, skills and attitudes (Cowan et al., 2005), highlighting the necessity that nursing students are afforded the best opportunity to develop both knowledge and clinical expertise. Central to these educational and training considerations is whether knowledge and learning are sought or taught, with the latter focusing predominantly upon pedagogic driven theoretical and practical reasoning (Searle, 1993). It is a very reasonable view of current nurse education and training that students accumulate knowledge and then, directly or indirectly apply this knowledge to their practice. Improved practice logically then is a process of accumulating greater knowing and better application of that knowledge, a process that has been the primary force behind nursing education, training and research, as well as being the vehicle of evidence-based practice (Ceci, 2003). Phelps and Hase (2002) contest this rationalistic view by identifying through complexity theory, that phenomena are unpredictable and significantly influenced by agent interaction. Indeed it is the relevant application of complexity theory to practice based learning environments that highlights the necessity to consider heutagogic learning theory within nurse education. Complexity theory places great importance upon both of the interconnectedness of variables and the emergent qualities from those interconnections, with outcomes arising as much from the relationship between variable as from their intrinsic characteristics (Radford, 2006). Consequently, educative attention is drawn toward outcomes derived from the point where the learner encounters novel and unexpected practice based events; an ideal scenario for the self-directed student in a clinical learning environment. Also central with complexity theory is that change within any system is continually evolving, and can be argued as being at least partially self-organised. Learning consequently requires preparation for future learning reflexivity, as well as opportunistic flexibility in terms of content, process and timing. This represents a significant shift away from preparation for pre-determined learning, and toward enabling sequential reflexive learner reactions that capture transitory learning opportunities as they arise and temporarily stabilise within a chaotic environment. Captured here is the vital differentiation between learning and competency acquisition. Teacher centric education can communicate competency related knowledge and skills that the learner can replicate and repeat in predictable environments. However, for competencies to be enacted and perhaps most vitally adapted within the unpredictable practicebased environment, the learner must have been enabled to independently integrate new work based experiences into existing schematic and behavioural structures (Hase and Kenyon, 2007). Heutagogy, a learner or self-determined approach to learning, engages with complexity theory through acknowledging that people learn through random response to unpredictable need, frequently
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when faced with the limits of their current knowledge or capabilities (Hase and Kenyon, 1999). ‘Heut’ derived from ancient Greek denotes the self and is a very recent learning theory initially developed out of the vocational sector in Australia. Heutagogy is subsequently an emergent term applied to self determined learning. Learning occurs through personal experience with the leaner being central to the process. Conceptually, heutagogy is best understood through its connectedness to both complexity theory and individual capability. Hase and Kenyon (2007), who originally devised the conceptual framework of heutagogy, see capability as the utilisation of selfefficacy competence to respond to complexity theory. These competencies partially reflect those of Daniel Goleman’s emotional intelligence framework through highlighting adaptability, initiative and team work and have been successfully applied across a broad array of leaning organisations (Cherniss et al., 1998). Learning content and timing within the constantly changing practice based environment is learner-determined. Learning is therefore highly likely to occur away from structured formal leaning environments, and can subsequently be powerfully linked to the immense value of learning within practice based settings. Indeed Hase and Kenyon (2007) describe the heutagogy curriculum as a ‘living’ curriculum, one that changes in line to what is learnt and incorporates the learner into the acquisition of learning as well as the end product. Also highlighted within heutagogy is that such learning influences holistic learner development, inclusive of capability and underpinning values. This wider view of learning therefore incorporates aspects of discourse-based transformational learning (Mezirow, 1994, 1996) and self-directed problem-based andragogic learning (Knowles, 1990). Indeed, rather than viewing heutagogy as another educational revolution, it can be viewed as an evolutionary step toward melding education and training with the life-world determinates of adult learners. Significantly, heutagogy reflects the complexities and unpredictability inherent in nursing whilst simultaneously acknowledging the requirements for individual capability in terms of knowledge, skills and values, as well as learner holistic development (Phelps and Hase, 2002; Stephenson, 1994). The potential of heutagogy e comparison with current philosophical approaches Student nurse education programmes must encourage students to develop the fortitude, knowledge and skills expected of life-long learners in 21st century health care delivery settings. To make possible life-long learning and the ability to thrive in constantly changing learning environments Ashton and Newman (2006) argue that it has become clear that new teaching approaches are necessary. While there are many teaching methods the main philosophical approaches appear to be pedagogy and andragogy. Hinchey (2004) proposes that pedagogy today means the art or science of educating children. Within a pedagogical approach the educator assumes responsibility for deciding what will be learned and when it will be learned implying that students have neither the means nor the ability to learn on their own. Pedagogy today has come to represent teacher authority and control. Andragogy is defined as the art and science of helping adult learners (Knowles et al., 2005). Andragogical approaches treat education as doing in the present rather preparation for the future. Misch (2002) states that while andragogy and the principles upon which it is based has come to refer to learner-focused education for people of all ages it has only in actual fact transformed face to face teaching. Glanville and Houd (2004) argue that none of these teaching methodologies captures the way in which knowledge needs to be created in complex changing environments and that the student needs to be placed at the centre of the learning process encouraging self-management and
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a high degree of self-efficacy that seems not to be evident in most student nurse education programmes today thus heutagogy could emerge to transform knowledge construction. It is proposed that people learn from a full range of life experiences and that educators must be guides to the development of ideas rather than force-feed the wisdom of others (Coughlan, 2004; Darling-Hammond and Bransford, 2005). Rather the responsibility for knowledge attainment using a model of heutogogy is placed categorically with the learner (Hase and Kenyon, 2000). The foundation for this concept is what Cornelius-White (2007) promotes as the idea of relationship in teaching e teachers cannot teach another person directly but rather facilitate learning. Collis and Moonen (2001) assert that in an age of rapid change and information explosion that heutagogy, unlike other teaching/ learning modes, is more likely to make possible the skills and characteristics required of the 21st century professional. Hase and Kenyon (2000) perceive heutagogy as evolutionary, naturally progressing from earlier educational methodologies. Also reflecting the changed world in which learning takes place and acknowledges the complex range of skills required for the present day workplace. Holmes (2006) in exploring the recruitment and retention challenge facing nursing also uncovers vital learning environment challenges applicable to heutagogy. Given that the baby-boomer generation are being replaced by generation X as university students, a different set of values and expectations exist. The structured, unhealthy and emotionally cold milieu of hospitals, combined with the stressful nature of nursing work generates high attrition rates both during and after nurse training. Additionally, it can be argued that a transactional style of leadership dominates nursing in the United Kingdom (Cook, 2001). This leadership style, characterised by focusing upon daily evidenced-based operations, ignores the issues of learning leadership and promoting differentiated perceptions required for the development of a successful learning environment. Heutagogy: do the conceptual underpinnings reflect practice based learning and are the current educational programmes preparing students to be life-long learners? It has been suggested that current student nurse education programmes are not actually preparing students for life-long learning and not preparing students to deal with the complex unpredictable health care delivery environment (Jeffreys, 2004). It is proposed that the main aims of student nurse education programmes are to develop nurses who are life-long learners, problem solvers and critically analytical as well as being researchers or at least readers of research (Darbyshire and Fleming, 2008). Some research studies have alleged that student nurses feel that they can be constrained from developing these life-long learning skills and that student nurses independent of branch will all confront a complex, unpredictable and exigent environment of practice based learning (Chesser-Smyth, 2005). This is further supported by the suggestion that many students leave because they feel ill-equipped to deal with the demands of patient care in that what they are taught and how they are taught in schools of nursing does not prepare them for the unpredictable care delivery environment (Murphy et al., 2008). Teaching and learning methodologies can still be didactic and teacher centred in their approach thus suppressing the learner (Tiwari et al., 2005; Kapborg and Bertero, 2003). Life-long learning and learners are concerned with continually developing themselves and others. Life-long learning encompasses a whole of learning philosophy towards people, work places and communities This fits with the philosophy of nursing for the 21st century as nurses constantly strive to develop the health status of the patients and clients but also the health status of communities and places of work (Bartels, 2005).In
order to achieve this nurses must constantly and continually develop themselves and their practice (Callan, 2009). The challenge of the complex learning environment Heutagogy is underpinned by Roger’s (2007) hypothesis that focuses upon the relationship within teaching. Within this theory, learners are seen as only facilitated toward learning, rather than being directly taught. This facilitation reduces the opportunity for the learner to experience being under threat, subsequently allowing a relaxation of ego boundaries and hence being more open to learning. Effective learning environments can consequently be seen as those that minimise threat to the self and that promote differentiated perception of experience (Ashton and Newman, 2006). This consideration of the learning environment returns us to the central issue of change, within the context of heutagogy and complexity theory. Arguably, heutagogy offers a conceptual framework that acknowledges this dynamic environment most accurately for nurse education when contrasted with Rogers or transformational learning models. Health Service organisations over the past decade have experienced significant discontinuity as they have shifted away from bureaucratic structures towards neo-corporate bureaucracies (Hurley and Linsley, 2007). This environment is one characterised by frequent randomly episodic discontinuity that has challenged health organisations to blend structures designed to fluidly respond to change, with existing rigid structures that allow accountability and bureaucratic governance (Limerick et al., 2002). Consequently, the foundations of the practice-based learning environment for qualified staff acting as mentors and practice facilitators, has been rapidly and frequently altered toward a paradox of simultaneous expectations of collaborative individualism and diminished professional autonomy (Stronach et al., 2002). Additionally, the learner can be argued as not only experiencing threats on this organisational level, but is also frequently confronted with physical challenges of potential violence and aggression (Linsley, 2006). Yet it is within this complex environment in which learning, as distinct from competency acquisition alone is required to occur, subsequently altering educators to the importance of building learner capability to cope with uncertainty and complexity. Assuredly each nursing discipline can forward unique challenges within their particular learning environment. Heutagogy: can it be applied to problems of faculty and practice, and how might heutogogy be implemented into nurse education? As this paper is designed to encourage debate proposed solutions are offered for discussion and not from a proponent standpoint. Hase and Kenyon’s (2007) positioning toward educational frameworks suggests that the present day work environment is no place for the inflexible and unprepared; therefore, educators and programmes of education must develop students’ capabilities, not just their skills and knowledge. In nurse education, in order for this to occur, it could be argued that teachers will have to hand over some control. Knowledge-sharing is needed not knowledgehoarding in that nursing students need to know how to learn, which will be a fundamental educational skill for their future learning. Ashton and Newman, 2006 states about ensuring that students are empowered, self determined, self actualising and able to create new knowledge from existing experiences. Within nurse education many academics are accustomed to traditional teaching and learning methodologies (Carr, 2007), and this could prove an initial obstacle. However this is deemed not to be insurmountable as discussion needs to be initiated to examine the possibilities of this new approach. It is also considered important for nursing
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academics to engage with experts in the field and to express their thoughts, opinions and apprehensions to determine if heutagogy has a place within nurse education. Mentors have been criticised regarding their input into the educational experience of the student this can have a detrimental impact on the student developing skills to deal with the unfolding diverse clinical situations (Nettleton and Bray, 2008). Spouse (1996) also states that perhaps not all mentors are committed to the role of being a mentor and that this can impact negatively on the developing skills of the student. Heutagogy might be the approach which is embraced by the mentors which truly acknowledges the importance of their experience and skills in developing the life-long learning student nurses of the 21st in which reflexivity or reflection is an important component of this suggested new approach and this must be incorporated into the student’s educational day. Recalling Radford’s (2006) identification of the importance of interconnectedness of variables, and the emergent qualities from those interconnections within complexity theory that supports heutagogy, an examination of the emergent qualities of the relational variables of key education and training stakeholders is vital. As nurse education is often a shared endeavour, it is obvious that both academics and clinical staff have an equal responsibility for the quality of learner’s educative and training experiences (Timmons et al., 2005). Yet despite considerable attention, the issue of structuring effective links between academic and practice-based stakeholders, nurse education and training lacks a conclusive best practice model. There exists an unambiguous recognition throughout the literature that practice-based learning is an essential component of education and training, and that melding practice-based learning with academic components is a challenge for all stakeholders (Pollard et al., 2006). An exploration of the literature focused toward the emergent qualities of faculty and practice highlights the complexities of coordinating nurse learning. Allen and Simpson (2000) offer a preceptorship-focused evaluation of mental health stakeholders in pre-registration training identifying common problem areas. Through drawing on the experiences of tutors and preceptors the study also highlights a disparity between the perceived focus and priorities of each professional group. Additionally, the link tutor role was identified by both students and preceptors as vital in terms of support and communication yet a clarification of what this support should entail was absent. Management was also identified as playing a key role in terms of preceptor support and in maintaining communication with academic based stakeholders. The pivotal role of preceptors is further highlighted by Mullen and Murray (2002) who identify a causal relationship between the attitudes, skills and experience of mentoring clinicians and student’s experience of their placements. Key issues included the level of organisational knowledge, ability to manage workloads and the level of confidence of the preceptor in performing this aspect of their role. Regardless of the linking model being utilised, tutor roles specifically resonate with themes of competing work commitments and role ambiguity. Brown et al. (2005), emphasise that student’s place high value upon lecturer placement visits despite being unable to identify what their expectations of the tutor are. Owen et al. (2005) also highlight additional issues of tutors being in clinical settings. Citing loss of tutor clinical competencies and clinical staff’s perceptions of tutors as lacking clinical credibility, the role of link tutors is undermined. Also apparent is that attempts to re-engage tutors in clinical roles and consequently regaining clinical credibility are fraught with either organisational or individual tutor-based challenges, as well as tensions being generated when tutors challenge perceived poor practice. Viewing these difficulties through the underpinning constructs of heutagogy makes it quickly apparent that two significant
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variables within the nurse learning environment faculty and practice, while sharing the irrefutable valuable vision of enhanced nurse learning, are fundamentally incongruently situated to each other. The emergent quality from this partial and arguably unavoidable incompatibility between faculty and practice is often uncertainty and inconsistencies, consequently rendering learners to be seeking a degree of certainty in an already confusing and foreign environment. Through adopting heutagogy as an overarching theoretical framework for practice based learning the emphasis for responsibility to accumulate learning experiences shifts toward the learner, effectively negating the well established tension points between tutors and clinicians. The learner, from a heutagogic perspective, is the only relative constant within an environment of unpredictable variables and is hence best placed to direct and embed learning as it arises. Heutagogy: a route to tailored student learning? Students identify with attainment, and successfully attaining clinical competencies is no exception, indeed this may be the most highly prized of all learning (Tiwari et al., 2006). It has been recorded that the most significant adult learning occurs around issues of exercising independence, self-awareness, being creative and achieving personal growth (Rogers,1993). The learning culture within a given placement also matters and whilst students may enjoy being guided towards certain experiences they appear to also require selfdirection to consolidate these into meaningful learning (Mallik and McGowan, 2007). This androgogical component could conceivably be extended a stage further to allow the students, especially senior learners, to self-direct and select learning experiences for themselves that meaningfully address their needs in terms of both developing clinical expertise and linking theory to practice. This approach that may be viewed as consistent with Franks (2004) who identifies the complex interplay of practice and evidence in mental health care (practice-based evidence) suggesting, to us, that rounded learner exploration of these complexities via heutagogy, can maximise student understandings. Experience can be guided by core competencies and negotiated and supervised under the auspices of the mentor, but the depth and nature of the learning derived can become very specifically tailored to individual needs by the student in this approach, maximising learning ownership. Such heutagogical ownership of learning can be coupled with the opportunity to capitalise on opportunistic, transitory educational experiences, maximised by ready student self-identification or evaluation of events to personal learning. Such transient experiences may be missed by more traditional mentoreled approaches as by the time they have been identified as meaningful they may equally have gone. This also minimises the one-size-fits-all approach to clinical mentorship as the students are guided to the placement opportunities and determine themselves what they need to learn from them. Notions around ideological schisms of what is the best way or care ethos to learn can then disappear as the student selects what they need from a situation be it biomedically-based, interaction-centred or combinations of both, underlining that the knowledge derived is relevant due to it being personalised. Conclusion Without doubt heutagogy is an emergent rather than established learning approach. Its recent appearance from adult based training education fields is however arguably more of an evolutionary advance from andragogy and transformational learning, than a radical leap into the educative unknown. That notwithstanding, we accept heutagogy provides challenges to educators and learners alike, in addition to the opportunities expressed within the course of
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this paper. Underpinning and interconnected constructs of complexity theory and capability are also well embedded in existing and accepted knowledge bases. Additionally, the construct of complexity theory has powerful resonance with practice learning environments and hence the challenges facing all educative stakeholders. Learner capability, central to heutagogy, also has significant resonance with the aspirations of nurse education further indicating potential application. Heutagogy, therefore, is a potential-packed approach to clinical learning that provides an alternative lens from which to both view and construct practice-based educational components of pre-registration courses pertinent to each branch. In many ways when used as a framework to place around practice based nurse education, heutagogy makes sense of the necessary uncertainties that defines nursing. It probably would be imprudent to ignore heutagogy but research as to the efficacy of heutogogy within nurse education needs to be carried out as there is an obvious paucity of research studies within this area. References Allen, C., Simpson, A., 2000. Peers and partners: working together to strengthen preceptorship in mental health nursing. Journal of Psychiatric & Mental Health Nursing 7 (6), 505e514. Alspach, G., 2000. Another nursing shortage wake up call? Critical Care Nurse 20, 8e12. Ashton, J., Newman, L., 2006. An unfinished symphony: 21st century teacher education using knowledge creating heutagogies. British Journal of Educational Technology 37 (6), 825e840. Barker, P., Jackson, S., Stevenson, C., 1999. What are psychiatric nurses needed for? Developing a theory of essential nursing practice. Journal of Psychiatric & Mental Health Nursing 6, 273e382. Bartels, J., 2005. Educating nurses for the 21st century. Nursing and Health Sciences 7 (4), 221e225. Brown, L., Herd, K., Humphries, G., Paton, M., 2005. The role of the lecturer in practice placements: what do students think? Nurse Education in Practice 5 (2), 84e90. Callan, B., 2009. Ready for the world: preparing nursing students for tomorrow. Journal of Professional Nursing 25 (5), 292e298. Carr, G., 2007. Changes in nurse education: being a nurse teacher. Nurse Education Today 27, 893e899. Chang, A., 1995. Perceived functions and usefulness of health service support workers. Journal of Advanced Nursing 21, 64e74. Ceci, C., 2003. Midnight reckonings: on a question of knowledge and nursing. Nursing Philosophy 4, 61e76. Cherniss, C., Goleman, D., Emmerling, R., Cowan, K., Adler, M., 1998. Guidelines for best practice. Retrieved 20th February, 2008, from. http://www.eiconsortium. org/reports/guidelines.html. Chesser-Smyth, P., 2005. The lived experience of general student nurses on their first clinical placement: a phenomenological study. Nurse Education in Practice 5, 320e327. Collis, B., Moonen, J., 2001. Flexible learning in a digital world: experiences and expectations. Koogan Page, London. Cook, M., 2001. The renaissance of clinical leadership. International Nursing Review 48 (1), 38e46. Cornelius-White, J., 2007. Learner-centred teacher-student relationships are effective: a meta-analysis. Review of Educational Research 77 (1), 113e143. Coughlan, R., 2004. From the challenge to the response BITE Project Conference Proceedings. Adastral Park, December, 2004. Cowan, D.T., Norman, I., Coopamah, V.P., 2005. Competence in nursing practice: a controversial concept e A focused review of literature. Nurse Education Today 25, 355e362. Darbyshire, C., Fleming, E., 2008. Governmentality, student autonomy and nurse education. Journal of Advanced Nursing 62, 172e179. Darling-Hammond, L., Bransford, J., 2005. Preparing teachers for a changing world: what teachers should learn and be able to do. Jossey-Bass, San Francisco. Franks, V., 2004. Evidence-based uncertainty in mental health nursing. Journal of Psychiatric & Mental Health Nursing 11, 99e105. Girot, E., Rickaby, C., 2008. Education for new role development: the community matron in England. Journal of Advanced Nursing 64 (1), 38e48. Glanville, I., Houd, S., 2004. The scholarship of teaching: implications for the nursing faculty. Journal of Professional Nursing 20 (1), 7e14. Hase, S., Kenyon, C., 1999. From andragogy to heutagogy. Unpublished paper. [Online]. Retrieved August 17, 2007, from. http://ultibase.rmit.edu.au/Articles/ dec00/hase1.pdf. Hase, S., Kenyon, C., 2000. From andragogy to heutagogy. Ultibase, Royal Melbourne Institute of Technology December. Hase, S., Kenyon, C., 2007. Heutagogy: a child of complexity theory complicity. An International Journal of Complexity & Education 49 (1), 111e118. Heller, B.R., Nichols, M.A., 2001. Workforce development in nursing: priming the pipeline. Nursing & Healthcare Perspectives 22, 70e74.
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Contents lists available at ScienceDirect
Nurse Education in Practice journal homepage: www.elsevier.com/nepr
Issues for Debate
Heutagogy: An alternative practice based learning approach John Bhoyrub, John Hurley*, Gavin R. Neilson, Mike Ramsay, Margaret Smith University of Dundee, School of Nursing & Midwifery, Dundee DD14HJ 01382 388568, United Kingdom
a r t i c l e i n f o
a b s t r a c t
Article history: Accepted 4 May 2010
Education has explored and utilised multiple approaches in attempts to enhance the learning and teaching opportunities available to adult learners. Traditional pedagogy has been both directly and indirectly affected by andragogy and transformational learning, consequently widening our understandings and approaches toward view teaching and learning. Within the context of nurse education, a major challenge has been to effectively apply these educational approaches to the complex, unpredictable and challenging environment of practice based learning. While not offered as a panacea to such challenges, heutagogy is offered in this discussion paper as an emerging and potentially highly congruent educational framework to place around practice based learning. Being an emergent theory its known conceptual underpinnings and possible applications to nurse education need to be explored and theoretically applied. Through placing the adult learner at the foreground of grasping learning opportunities as they unpredictability emerge from a sometimes chaotic environment, heutagogy can be argued as offering the potential to minimise many of the well published difficulties of coordinating practice with faculty teaching and learning. Ó 2010 Elsevier Ltd. All rights reserved.
Keywords: Educational frameworks Nursing Practice based learning Heutagogy
Introduction The learning environments for undergraduate nursing students have long been described as being themed with complexity and unpredictability, and hence uncertainty (Barker et al., 1999; Mitchell and Cody, 2002; Mitchell and Pilkington, 2000). Ensuring high quality practice-based learning consequently requires a complex and responsive educational intervention. All nursing interventions initially require an overarching theoretical framework to support, guide and inform action. This paper explores the construct of heutagogy as being a potentially highly congruent framework for undergraduate pre-registration practice-based learning. The challenge for educators and educational administrators in considering heutagogy as a potential learning theory may be to relinquish some attempts to control and manage learning experiences, and instead empower the self-directive adult learner to accumulate learning experiences within dynamic and unpredictable clinical environments. Contextual issues The significance of being able to practice in rapidly changing health care environments is substantiated in the recognition that the health service of the future will need nurses with sophisticated skills * Corresponding author. Tel.: þ44 1382 388568. E-mail address: [email protected] (J. Hurley). 1471-5953/$ e see front matter Ó 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.nepr.2010.05.001
and increased knowledge, and that any assessment of the future staffing requirements for nurses must begin with consideration of the probable pattern of future demand for health care (SEHD, 2003). The indications are that the demand for nursing care will continue to grow in the United Kingdom through the first decades of this millennium and well beyond, owing to a number of demographics. Firstly, there is a growing population with a greater number of elderly people with their higher proportion of chronic disease and physical incapacity. Secondly, there is an increase in health care problems such as the expanding HIV epidemic and the impact of new diseases and infections. Thirdly, increased drug and alcohol addiction, violence and abuse will require extensive nursing input. Changes in public (‘consumer’) expectations of the healthcare system, increasingly articulate and informed patients demanding more care and lack of access to services among the indigent and homeless will also create even greater demands for nurses. Higher acuity patients, advances in medical practice and expanding technology also create a greater demand for the specialist skills of registered nurses (Alspach, 2000; RCN, 2004). The increase in the intensity and complexity of patient care has increased the demand for nursing practice over the past decade (Chang, 1995). The greater life expectancy of individuals with acute and chronic conditions also requires more complex nursing care (Heller and Nichols, 2001). Further, managed care has reduced length of stay for patients in hospital, leaving nurses to care for and stabilise patients in a shorter period of time and increased caseloads for community nursing staff (Leigh and Krier, 2001; Girot and Rickaby, 2008).
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Nurses are now frequently the first point of contact with health care in NHS 24 and walk-in centres. Nurses now also increasingly take on roles that were traditionally the function of doctors inclusive of prescribing medications and ordering and interpreting diagnostic investigations (Girot and Rickaby, 2008). High quality care consequently depends in part upon nurses who form an important element of the multi-disciplinary caring team (van der Sluis et al., 2009). A fundamental aim of student nurse education is consequently that nurses should be able to demonstrate that they have the skills to assume these roles and hence be able to be critical thinkers, analytical and reflective as well as being problem-based learners, life-long learners and researcher competent(UKCC, 2001; SEHD, 2006). Heutagogy: conceptual underpinnings and connections In seeking to achieve the fundamental aims of student nurse education programmes, nursing requires complex combinations of knowledge, performance, skills and attitudes (Cowan et al., 2005), highlighting the necessity that nursing students are afforded the best opportunity to develop both knowledge and clinical expertise. Central to these educational and training considerations is whether knowledge and learning are sought or taught, with the latter focusing predominantly upon pedagogic driven theoretical and practical reasoning (Searle, 1993). It is a very reasonable view of current nurse education and training that students accumulate knowledge and then, directly or indirectly apply this knowledge to their practice. Improved practice logically then is a process of accumulating greater knowing and better application of that knowledge, a process that has been the primary force behind nursing education, training and research, as well as being the vehicle of evidence-based practice (Ceci, 2003). Phelps and Hase (2002) contest this rationalistic view by identifying through complexity theory, that phenomena are unpredictable and significantly influenced by agent interaction. Indeed it is the relevant application of complexity theory to practice based learning environments that highlights the necessity to consider heutagogic learning theory within nurse education. Complexity theory places great importance upon both of the interconnectedness of variables and the emergent qualities from those interconnections, with outcomes arising as much from the relationship between variable as from their intrinsic characteristics (Radford, 2006). Consequently, educative attention is drawn toward outcomes derived from the point where the learner encounters novel and unexpected practice based events; an ideal scenario for the self-directed student in a clinical learning environment. Also central with complexity theory is that change within any system is continually evolving, and can be argued as being at least partially self-organised. Learning consequently requires preparation for future learning reflexivity, as well as opportunistic flexibility in terms of content, process and timing. This represents a significant shift away from preparation for pre-determined learning, and toward enabling sequential reflexive learner reactions that capture transitory learning opportunities as they arise and temporarily stabilise within a chaotic environment. Captured here is the vital differentiation between learning and competency acquisition. Teacher centric education can communicate competency related knowledge and skills that the learner can replicate and repeat in predictable environments. However, for competencies to be enacted and perhaps most vitally adapted within the unpredictable practicebased environment, the learner must have been enabled to independently integrate new work based experiences into existing schematic and behavioural structures (Hase and Kenyon, 2007). Heutagogy, a learner or self-determined approach to learning, engages with complexity theory through acknowledging that people learn through random response to unpredictable need, frequently
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when faced with the limits of their current knowledge or capabilities (Hase and Kenyon, 1999). ‘Heut’ derived from ancient Greek denotes the self and is a very recent learning theory initially developed out of the vocational sector in Australia. Heutagogy is subsequently an emergent term applied to self determined learning. Learning occurs through personal experience with the leaner being central to the process. Conceptually, heutagogy is best understood through its connectedness to both complexity theory and individual capability. Hase and Kenyon (2007), who originally devised the conceptual framework of heutagogy, see capability as the utilisation of selfefficacy competence to respond to complexity theory. These competencies partially reflect those of Daniel Goleman’s emotional intelligence framework through highlighting adaptability, initiative and team work and have been successfully applied across a broad array of leaning organisations (Cherniss et al., 1998). Learning content and timing within the constantly changing practice based environment is learner-determined. Learning is therefore highly likely to occur away from structured formal leaning environments, and can subsequently be powerfully linked to the immense value of learning within practice based settings. Indeed Hase and Kenyon (2007) describe the heutagogy curriculum as a ‘living’ curriculum, one that changes in line to what is learnt and incorporates the learner into the acquisition of learning as well as the end product. Also highlighted within heutagogy is that such learning influences holistic learner development, inclusive of capability and underpinning values. This wider view of learning therefore incorporates aspects of discourse-based transformational learning (Mezirow, 1994, 1996) and self-directed problem-based andragogic learning (Knowles, 1990). Indeed, rather than viewing heutagogy as another educational revolution, it can be viewed as an evolutionary step toward melding education and training with the life-world determinates of adult learners. Significantly, heutagogy reflects the complexities and unpredictability inherent in nursing whilst simultaneously acknowledging the requirements for individual capability in terms of knowledge, skills and values, as well as learner holistic development (Phelps and Hase, 2002; Stephenson, 1994). The potential of heutagogy e comparison with current philosophical approaches Student nurse education programmes must encourage students to develop the fortitude, knowledge and skills expected of life-long learners in 21st century health care delivery settings. To make possible life-long learning and the ability to thrive in constantly changing learning environments Ashton and Newman (2006) argue that it has become clear that new teaching approaches are necessary. While there are many teaching methods the main philosophical approaches appear to be pedagogy and andragogy. Hinchey (2004) proposes that pedagogy today means the art or science of educating children. Within a pedagogical approach the educator assumes responsibility for deciding what will be learned and when it will be learned implying that students have neither the means nor the ability to learn on their own. Pedagogy today has come to represent teacher authority and control. Andragogy is defined as the art and science of helping adult learners (Knowles et al., 2005). Andragogical approaches treat education as doing in the present rather preparation for the future. Misch (2002) states that while andragogy and the principles upon which it is based has come to refer to learner-focused education for people of all ages it has only in actual fact transformed face to face teaching. Glanville and Houd (2004) argue that none of these teaching methodologies captures the way in which knowledge needs to be created in complex changing environments and that the student needs to be placed at the centre of the learning process encouraging self-management and
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a high degree of self-efficacy that seems not to be evident in most student nurse education programmes today thus heutagogy could emerge to transform knowledge construction. It is proposed that people learn from a full range of life experiences and that educators must be guides to the development of ideas rather than force-feed the wisdom of others (Coughlan, 2004; Darling-Hammond and Bransford, 2005). Rather the responsibility for knowledge attainment using a model of heutogogy is placed categorically with the learner (Hase and Kenyon, 2000). The foundation for this concept is what Cornelius-White (2007) promotes as the idea of relationship in teaching e teachers cannot teach another person directly but rather facilitate learning. Collis and Moonen (2001) assert that in an age of rapid change and information explosion that heutagogy, unlike other teaching/ learning modes, is more likely to make possible the skills and characteristics required of the 21st century professional. Hase and Kenyon (2000) perceive heutagogy as evolutionary, naturally progressing from earlier educational methodologies. Also reflecting the changed world in which learning takes place and acknowledges the complex range of skills required for the present day workplace. Holmes (2006) in exploring the recruitment and retention challenge facing nursing also uncovers vital learning environment challenges applicable to heutagogy. Given that the baby-boomer generation are being replaced by generation X as university students, a different set of values and expectations exist. The structured, unhealthy and emotionally cold milieu of hospitals, combined with the stressful nature of nursing work generates high attrition rates both during and after nurse training. Additionally, it can be argued that a transactional style of leadership dominates nursing in the United Kingdom (Cook, 2001). This leadership style, characterised by focusing upon daily evidenced-based operations, ignores the issues of learning leadership and promoting differentiated perceptions required for the development of a successful learning environment. Heutagogy: do the conceptual underpinnings reflect practice based learning and are the current educational programmes preparing students to be life-long learners? It has been suggested that current student nurse education programmes are not actually preparing students for life-long learning and not preparing students to deal with the complex unpredictable health care delivery environment (Jeffreys, 2004). It is proposed that the main aims of student nurse education programmes are to develop nurses who are life-long learners, problem solvers and critically analytical as well as being researchers or at least readers of research (Darbyshire and Fleming, 2008). Some research studies have alleged that student nurses feel that they can be constrained from developing these life-long learning skills and that student nurses independent of branch will all confront a complex, unpredictable and exigent environment of practice based learning (Chesser-Smyth, 2005). This is further supported by the suggestion that many students leave because they feel ill-equipped to deal with the demands of patient care in that what they are taught and how they are taught in schools of nursing does not prepare them for the unpredictable care delivery environment (Murphy et al., 2008). Teaching and learning methodologies can still be didactic and teacher centred in their approach thus suppressing the learner (Tiwari et al., 2005; Kapborg and Bertero, 2003). Life-long learning and learners are concerned with continually developing themselves and others. Life-long learning encompasses a whole of learning philosophy towards people, work places and communities This fits with the philosophy of nursing for the 21st century as nurses constantly strive to develop the health status of the patients and clients but also the health status of communities and places of work (Bartels, 2005).In
order to achieve this nurses must constantly and continually develop themselves and their practice (Callan, 2009). The challenge of the complex learning environment Heutagogy is underpinned by Roger’s (2007) hypothesis that focuses upon the relationship within teaching. Within this theory, learners are seen as only facilitated toward learning, rather than being directly taught. This facilitation reduces the opportunity for the learner to experience being under threat, subsequently allowing a relaxation of ego boundaries and hence being more open to learning. Effective learning environments can consequently be seen as those that minimise threat to the self and that promote differentiated perception of experience (Ashton and Newman, 2006). This consideration of the learning environment returns us to the central issue of change, within the context of heutagogy and complexity theory. Arguably, heutagogy offers a conceptual framework that acknowledges this dynamic environment most accurately for nurse education when contrasted with Rogers or transformational learning models. Health Service organisations over the past decade have experienced significant discontinuity as they have shifted away from bureaucratic structures towards neo-corporate bureaucracies (Hurley and Linsley, 2007). This environment is one characterised by frequent randomly episodic discontinuity that has challenged health organisations to blend structures designed to fluidly respond to change, with existing rigid structures that allow accountability and bureaucratic governance (Limerick et al., 2002). Consequently, the foundations of the practice-based learning environment for qualified staff acting as mentors and practice facilitators, has been rapidly and frequently altered toward a paradox of simultaneous expectations of collaborative individualism and diminished professional autonomy (Stronach et al., 2002). Additionally, the learner can be argued as not only experiencing threats on this organisational level, but is also frequently confronted with physical challenges of potential violence and aggression (Linsley, 2006). Yet it is within this complex environment in which learning, as distinct from competency acquisition alone is required to occur, subsequently altering educators to the importance of building learner capability to cope with uncertainty and complexity. Assuredly each nursing discipline can forward unique challenges within their particular learning environment. Heutagogy: can it be applied to problems of faculty and practice, and how might heutogogy be implemented into nurse education? As this paper is designed to encourage debate proposed solutions are offered for discussion and not from a proponent standpoint. Hase and Kenyon’s (2007) positioning toward educational frameworks suggests that the present day work environment is no place for the inflexible and unprepared; therefore, educators and programmes of education must develop students’ capabilities, not just their skills and knowledge. In nurse education, in order for this to occur, it could be argued that teachers will have to hand over some control. Knowledge-sharing is needed not knowledgehoarding in that nursing students need to know how to learn, which will be a fundamental educational skill for their future learning. Ashton and Newman, 2006 states about ensuring that students are empowered, self determined, self actualising and able to create new knowledge from existing experiences. Within nurse education many academics are accustomed to traditional teaching and learning methodologies (Carr, 2007), and this could prove an initial obstacle. However this is deemed not to be insurmountable as discussion needs to be initiated to examine the possibilities of this new approach. It is also considered important for nursing
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academics to engage with experts in the field and to express their thoughts, opinions and apprehensions to determine if heutagogy has a place within nurse education. Mentors have been criticised regarding their input into the educational experience of the student this can have a detrimental impact on the student developing skills to deal with the unfolding diverse clinical situations (Nettleton and Bray, 2008). Spouse (1996) also states that perhaps not all mentors are committed to the role of being a mentor and that this can impact negatively on the developing skills of the student. Heutagogy might be the approach which is embraced by the mentors which truly acknowledges the importance of their experience and skills in developing the life-long learning student nurses of the 21st in which reflexivity or reflection is an important component of this suggested new approach and this must be incorporated into the student’s educational day. Recalling Radford’s (2006) identification of the importance of interconnectedness of variables, and the emergent qualities from those interconnections within complexity theory that supports heutagogy, an examination of the emergent qualities of the relational variables of key education and training stakeholders is vital. As nurse education is often a shared endeavour, it is obvious that both academics and clinical staff have an equal responsibility for the quality of learner’s educative and training experiences (Timmons et al., 2005). Yet despite considerable attention, the issue of structuring effective links between academic and practice-based stakeholders, nurse education and training lacks a conclusive best practice model. There exists an unambiguous recognition throughout the literature that practice-based learning is an essential component of education and training, and that melding practice-based learning with academic components is a challenge for all stakeholders (Pollard et al., 2006). An exploration of the literature focused toward the emergent qualities of faculty and practice highlights the complexities of coordinating nurse learning. Allen and Simpson (2000) offer a preceptorship-focused evaluation of mental health stakeholders in pre-registration training identifying common problem areas. Through drawing on the experiences of tutors and preceptors the study also highlights a disparity between the perceived focus and priorities of each professional group. Additionally, the link tutor role was identified by both students and preceptors as vital in terms of support and communication yet a clarification of what this support should entail was absent. Management was also identified as playing a key role in terms of preceptor support and in maintaining communication with academic based stakeholders. The pivotal role of preceptors is further highlighted by Mullen and Murray (2002) who identify a causal relationship between the attitudes, skills and experience of mentoring clinicians and student’s experience of their placements. Key issues included the level of organisational knowledge, ability to manage workloads and the level of confidence of the preceptor in performing this aspect of their role. Regardless of the linking model being utilised, tutor roles specifically resonate with themes of competing work commitments and role ambiguity. Brown et al. (2005), emphasise that student’s place high value upon lecturer placement visits despite being unable to identify what their expectations of the tutor are. Owen et al. (2005) also highlight additional issues of tutors being in clinical settings. Citing loss of tutor clinical competencies and clinical staff’s perceptions of tutors as lacking clinical credibility, the role of link tutors is undermined. Also apparent is that attempts to re-engage tutors in clinical roles and consequently regaining clinical credibility are fraught with either organisational or individual tutor-based challenges, as well as tensions being generated when tutors challenge perceived poor practice. Viewing these difficulties through the underpinning constructs of heutagogy makes it quickly apparent that two significant
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variables within the nurse learning environment faculty and practice, while sharing the irrefutable valuable vision of enhanced nurse learning, are fundamentally incongruently situated to each other. The emergent quality from this partial and arguably unavoidable incompatibility between faculty and practice is often uncertainty and inconsistencies, consequently rendering learners to be seeking a degree of certainty in an already confusing and foreign environment. Through adopting heutagogy as an overarching theoretical framework for practice based learning the emphasis for responsibility to accumulate learning experiences shifts toward the learner, effectively negating the well established tension points between tutors and clinicians. The learner, from a heutagogic perspective, is the only relative constant within an environment of unpredictable variables and is hence best placed to direct and embed learning as it arises. Heutagogy: a route to tailored student learning? Students identify with attainment, and successfully attaining clinical competencies is no exception, indeed this may be the most highly prized of all learning (Tiwari et al., 2006). It has been recorded that the most significant adult learning occurs around issues of exercising independence, self-awareness, being creative and achieving personal growth (Rogers,1993). The learning culture within a given placement also matters and whilst students may enjoy being guided towards certain experiences they appear to also require selfdirection to consolidate these into meaningful learning (Mallik and McGowan, 2007). This androgogical component could conceivably be extended a stage further to allow the students, especially senior learners, to self-direct and select learning experiences for themselves that meaningfully address their needs in terms of both developing clinical expertise and linking theory to practice. This approach that may be viewed as consistent with Franks (2004) who identifies the complex interplay of practice and evidence in mental health care (practice-based evidence) suggesting, to us, that rounded learner exploration of these complexities via heutagogy, can maximise student understandings. Experience can be guided by core competencies and negotiated and supervised under the auspices of the mentor, but the depth and nature of the learning derived can become very specifically tailored to individual needs by the student in this approach, maximising learning ownership. Such heutagogical ownership of learning can be coupled with the opportunity to capitalise on opportunistic, transitory educational experiences, maximised by ready student self-identification or evaluation of events to personal learning. Such transient experiences may be missed by more traditional mentoreled approaches as by the time they have been identified as meaningful they may equally have gone. This also minimises the one-size-fits-all approach to clinical mentorship as the students are guided to the placement opportunities and determine themselves what they need to learn from them. Notions around ideological schisms of what is the best way or care ethos to learn can then disappear as the student selects what they need from a situation be it biomedically-based, interaction-centred or combinations of both, underlining that the knowledge derived is relevant due to it being personalised. Conclusion Without doubt heutagogy is an emergent rather than established learning approach. Its recent appearance from adult based training education fields is however arguably more of an evolutionary advance from andragogy and transformational learning, than a radical leap into the educative unknown. That notwithstanding, we accept heutagogy provides challenges to educators and learners alike, in addition to the opportunities expressed within the course of
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this paper. Underpinning and interconnected constructs of complexity theory and capability are also well embedded in existing and accepted knowledge bases. Additionally, the construct of complexity theory has powerful resonance with practice learning environments and hence the challenges facing all educative stakeholders. Learner capability, central to heutagogy, also has significant resonance with the aspirations of nurse education further indicating potential application. Heutagogy, therefore, is a potential-packed approach to clinical learning that provides an alternative lens from which to both view and construct practice-based educational components of pre-registration courses pertinent to each branch. In many ways when used as a framework to place around practice based nurse education, heutagogy makes sense of the necessary uncertainties that defines nursing. It probably would be imprudent to ignore heutagogy but research as to the efficacy of heutogogy within nurse education needs to be carried out as there is an obvious paucity of research studies within this area. References Allen, C., Simpson, A., 2000. Peers and partners: working together to strengthen preceptorship in mental health nursing. Journal of Psychiatric & Mental Health Nursing 7 (6), 505e514. Alspach, G., 2000. Another nursing shortage wake up call? Critical Care Nurse 20, 8e12. Ashton, J., Newman, L., 2006. An unfinished symphony: 21st century teacher education using knowledge creating heutagogies. British Journal of Educational Technology 37 (6), 825e840. Barker, P., Jackson, S., Stevenson, C., 1999. What are psychiatric nurses needed for? Developing a theory of essential nursing practice. Journal of Psychiatric & Mental Health Nursing 6, 273e382. Bartels, J., 2005. Educating nurses for the 21st century. Nursing and Health Sciences 7 (4), 221e225. Brown, L., Herd, K., Humphries, G., Paton, M., 2005. The role of the lecturer in practice placements: what do students think? Nurse Education in Practice 5 (2), 84e90. Callan, B., 2009. Ready for the world: preparing nursing students for tomorrow. Journal of Professional Nursing 25 (5), 292e298. Carr, G., 2007. Changes in nurse education: being a nurse teacher. Nurse Education Today 27, 893e899. Chang, A., 1995. Perceived functions and usefulness of health service support workers. Journal of Advanced Nursing 21, 64e74. Ceci, C., 2003. Midnight reckonings: on a question of knowledge and nursing. Nursing Philosophy 4, 61e76. Cherniss, C., Goleman, D., Emmerling, R., Cowan, K., Adler, M., 1998. Guidelines for best practice. Retrieved 20th February, 2008, from. http://www.eiconsortium. org/reports/guidelines.html. Chesser-Smyth, P., 2005. The lived experience of general student nurses on their first clinical placement: a phenomenological study. Nurse Education in Practice 5, 320e327. Collis, B., Moonen, J., 2001. Flexible learning in a digital world: experiences and expectations. Koogan Page, London. Cook, M., 2001. The renaissance of clinical leadership. International Nursing Review 48 (1), 38e46. Cornelius-White, J., 2007. Learner-centred teacher-student relationships are effective: a meta-analysis. Review of Educational Research 77 (1), 113e143. Coughlan, R., 2004. From the challenge to the response BITE Project Conference Proceedings. Adastral Park, December, 2004. Cowan, D.T., Norman, I., Coopamah, V.P., 2005. Competence in nursing practice: a controversial concept e A focused review of literature. Nurse Education Today 25, 355e362. Darbyshire, C., Fleming, E., 2008. Governmentality, student autonomy and nurse education. Journal of Advanced Nursing 62, 172e179. Darling-Hammond, L., Bransford, J., 2005. Preparing teachers for a changing world: what teachers should learn and be able to do. Jossey-Bass, San Francisco. Franks, V., 2004. Evidence-based uncertainty in mental health nursing. Journal of Psychiatric & Mental Health Nursing 11, 99e105. Girot, E., Rickaby, C., 2008. Education for new role development: the community matron in England. Journal of Advanced Nursing 64 (1), 38e48. Glanville, I., Houd, S., 2004. The scholarship of teaching: implications for the nursing faculty. Journal of Professional Nursing 20 (1), 7e14. Hase, S., Kenyon, C., 1999. From andragogy to heutagogy. Unpublished paper. [Online]. Retrieved August 17, 2007, from. http://ultibase.rmit.edu.au/Articles/ dec00/hase1.pdf. Hase, S., Kenyon, C., 2000. From andragogy to heutagogy. Ultibase, Royal Melbourne Institute of Technology December. Hase, S., Kenyon, C., 2007. Heutagogy: a child of complexity theory complicity. An International Journal of Complexity & Education 49 (1), 111e118. Heller, B.R., Nichols, M.A., 2001. Workforce development in nursing: priming the pipeline. Nursing & Healthcare Perspectives 22, 70e74.
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