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Are pedagogies used in nurse education research evident in practice?
Nurse Education Today 30 (2010) 476–479
Contents lists available at ScienceDirect
Nurse Education Today journal homepage: www.elsevier.com/nedt
Are pedagogies used in nurse education research evident in practice? H.T. Allan *, P. Smith Centre for Research in Nursing and Midwifery Education, Faculty of Health and Medical Sciences, University of Surrey, Duke of Kent Building, Stag Hill, Guildford, Surrey GU2 5TE, United Kingdom
a r t i c l e
i n f o
Article history: Accepted 20 October 2009
Keywords: Pedagogies Nurse education Workplace Workbased learning Educational research
s u m m a r y This paper considers two questions: what pedagogies for teaching nursing are used in nurse education research? Are these pedagogies transferred to learning in the workplace? We argue that there are underpinning pedagogies identified in nurse education research in the area of workplace and work based learning which are broadly qualitative, action orientated and focused on knowledge generation. Such pedagogies are rooted in a philosophy of teaching and learning where learning is seen as active, reflective and socially constructed. We consider possible answers to these questions through an exploration of empirical work by Evans et al. (2009) which has focused on knowledge transfer in the workplace. Their work offers insights into how pedagogies can be applied to nurse education research which in turn may be transferred into the workplace. In particular, they argue that the concept of knowledge transfer is outdated and we should focus instead on how knowledge learnt in one context (the academy) is re-contextualised in another (the workplace). We also draw on Aranda and Law’s (2007) paper on the debates concerning the use of sociology in nurse education to explore competing narratives. We conclude that the pedagogies identified in educational research are not transferred to nurse education and practice yet offer an alternative view of knowledge transfer as illustrated by Evans et al.’s work which explores how learning in the workplace may be facilitated more effectively. We conclude that the lack of transfer of nurse education research pedagogies to practice learning undermines the position of nurse teachers within the academy as nurse education becomes a practice or professional discipline without a discrete disciplinary base. Ó 2009 Elsevier Ltd. All rights reserved.
Introduction The aim of this paper is to explore two questions pertinent to debates in nurse education around the relationship of nurse education and nursing practice (Debbell and Branson, 2009). The questions we pose are: which pedagogies for teaching nursing are used in nurse education research? Are these pedagogies transferred to learning in the workplace? We argue that there are underpinning pedagogies used in nurse education research in the area of workplace and work based learning which are broadly qualitative, action orientated and focused on knowledge generation. Such pedagogies are rooted in a philosophy of teaching and learning where learning is seen as active, reflective and socially constructed. We consider possible answers to our questions through an exploration of Evans and her colleagues’ recent empirical work which has focused on knowledge transfer in the workplace. Their research offers insights into how pedagogies can be applied to nurse education research which in turn may be transferred into
* Corresponding author. Tel.: +44 1483 689745. E-mail address: [email protected] (H.T. Allan). 0260-6917/$ - see front matter Ó 2009 Elsevier Ltd. All rights reserved. doi:10.1016/j.nedt.2009.10.011
the workplace. In particular they argue that the concept of knowledge transfer is outdated and we should focus instead on how knowledge learnt in one context (the academy) is re-contextualised in another (the workplace). Knowledge transfer has become a stale way to understand the difficulties students have in integrating theory learnt in university with practice they observe and learn in placement. We conclude that the pedagogies we have identified are not transferred to practice yet offer an alternative view of knowledge transfer illustrated by Evans et al.’s work which explored how learning in the workplace may be facilitated more effectively. We conclude that the lack of transfer of nurse education pedagogies to practice learning undermines the position of nurse teachers within the academy as nurse education becomes a practice or professional discipline without a discrete disciplinary base.
Which pedagogies for teaching nursing are used in nurse education? Pedagogy is the educational or instructional approach used to develop knowledge which can occur in many different settings
H.T. Allan, P. Smith / Nurse Education Today 30 (2010) 476–479
(Ironside, 2003). For the purposes of this paper, we focus on pedagogies for the workplace. Biggs and Tang state that ‘‘Workplace learning, variously known as placement, attachment, practicum, clinical or internship, according to the discipline, is an integral component of professional education” (2007, p. 143). They go onto suggest that the outcomes of workplace learning are to: integrate knowledge and skills learnt in university to real-life professional settings; apply theories and skills to practice; work collaboratively with all parties in workplace settings and practise with professional attitudes and social responsibilities in the profession. This learning usually takes place under supervision. In nursing, all pre-registration learning should be supervised by a qualified mentor who is a registered nurse. The term placement is most commonly used in the nursing literature to describe workplace learning. Eraut (2004) recognises the complexity of workplace learning and argues that many definitions of workplace learning do not differentiate between formal and informal learning. Workplace learning according to Eraut can be structurally separate from academic learning or less separated and further, may be formal or informal. Formal workplace learning is the planned learning identified in curricula and learning outcomes; informal learning in the workplace occurs when students learn from other people in the workplace and in other spaces than those identified in learning outcomes. It is interesting that Biggs and Tang’s (2007) definition seems to presume that workplace learning involves the transfer of learning from the academy to the workplace thereby privileging academic knowledge over work based knowledge. The nursing literature suggests that workplace learning incorporates informal, incidental and formal learning and all are essential to safe practice and effective learning (Armstrong, 2008; Phillips and Hayes, 2008; Pollard, 2008; Bjork, 2001). Workplace learning is socially constructed through interactions and relationships among staff in teams and within organisations (Levett-Jones and Lathlean, 2008; Hoel et al., 2007; Andrews et al., 2006, 2005; Spouse, 2001; Atack et al., 2000). Organisational support and effective leadership are fundamental to facilitating workplace learning (Elliott and Wall, 2008; Williams and Taylor, 2008; Barrett, 2007; Carr, 2007; Chambers, 2007; Kelly, 2007; Report of Council of Deans, 2005; Horrocks, 2005). This learning is different to the learning in academic settings which tends to be context-free, disciplinary or subject focused and certain (Burkitt et al., 2000). Effective workplace learning requires staff to provide space and time for enquiry based learning which is meaningful for students and helps them integrate their university learning with their learning in practice (Hartigan-Rogers et al., 2007; Henderson et al., 2006; Levett-Jones et al., 2006; Chesser-Smyth, 2005; Grealish and Trevitt, 2005; Chan, 2004) to practise their knowledge and skills (Hunter et al., 2008). In addition, student centred learning in the workplace needs to recognise that learning is constructed by individuals and subject to multiple influences. Therefore, the dominant pedagogy in the nurse education research literature appears to be that learning is a social activity which is constructed by learners and their environment. But is this the dominant pedagogy used in practice?
Are the pedagogies used in education research transferred to learning in the workplace? Many authors argue that learning in practice is determined largely by practitioners and not by the curriculum (Burkitt et al., 2000;
477
Boogaerts et al., 2008) and by structural arrangements between commissioning NHS trusts and the universities, otherwise known as the providers (Allan et al., 2007). In terms of our question, are pedagogies underpinned by research, used to teach nursing used in nursing practice, our reading of the literature would suggest that theory and practice for both students, mentors and lecturers has become uncoupled not least by the structural arrangements between the universities and practice which underpin the nurse education system. This system is described in a review published elsewhere where Allan et al. (2007) argue that the nature of learning in health care practice is shaped by three factors: The commissioning and contracting arrangements between institutions of higher education (HEIs) and the National Health Service (NHS). The sharing of students’ learning between practice and HEIs which has highlighted differences between HEIs and practitioners around the nature of learning as well as revealing a discrepancy between these partners over the meaning of fitness for practice. The location of nurse teachers in HEIs which has increased the theory–practice gap for both teachers and learners. As Melia (2006:1) has argued, delivering the new NHS reforms ‘‘is driven by a workforce agenda rather than an educational one”. This workforce agenda impedes student learning both in terms of supporting learning through supervision and mentoring and facilitating the adoption of new learning strategies to enhance learning and knowledge transfer between education and practice (HartiganRogers et al., 2007; Henderson et al., 2006; Levett-Jones et al., 2006; Chesser-Smyth, 2005; Grealish and Trevitt, 2005; Chan, 2004). In the view of the Council of Deans of Faculties of Health (2005), the commissioning arrangements between higher education (HE) and the NHS do not facilitate effective learning or the integration of theory and practice. But structural arrangements which underpin educational partnerships do not appear to be realised at practice level either, i.e., for individual mentors and students. In other words, mentors are busy and learning takes second place to delivering care to patients (Lloyd Jones and Walters, 2001) and workforce demands (Melia, 2006). Consequently these structural factors impede the transfer of pedagogies used in nurse education. In addition, knowledge is conceptualised very differently in the different contexts of education and practice. Jones and Graham (2004) argue that a tension exists for practitioners between theory which emerges from practice based on reflective enquiry and theory derived from evidence published in scientific journals using randomised controlled trials (RCTs). The latter form of knowledge is seen as the gold standard of research and evidence for practice, whereas reflective learning, where the goal is to learn from experience in practice, is not valued so highly. Jones and Graham argue that such practice knowledge can be used to build educational approaches as much as scientific evidence and that in education reflective knowledge is given the same value. However in this paper we argue that at present this does not happen as certain forms of evidence continue to be privileged above others in clinical practice.
Discussion We have argued that the pedagogies identified in nurse education research are not transferred to workplace learning. We draw on the recent empirical work of Evans and colleagues to understand the processes of knowledge transfer (2009) and Aranda and Law’s paper on the contribution of sociology to nurse education to understand this complex situation.
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H.T. Allan, P. Smith / Nurse Education Today 30 (2010) 476–479
Evans et al. (2009) have argued that the lack of integration between practice and academia is a longstanding problematic across many disciplines. They argue that the literature has tended to discuss this problematic in terms of the transfer of knowledge. In their view this perspective ignores the socially constructed nature of learning in different contexts which the literature suggests frames and shapes learning in the workplace for nursing students. Knowledge, in other words, is not something students transfer as an entity in itself, but is actively constructed and reshaped into personal meaning for each student in new environments. Evans et al. call this process of construction and reconstruction of knowledge in the workplace, the ‘recontextualisation of knowledge’. The literature we have cited in this paper suggests that academic knowledge is re-contextualised with difficulty by students and that mentors are either unwilling or unable to facilitate this process. In our view Evans et al.’s framework appears to address this problem by suggesting that when knowledge contextualised in education is recontextualised in practice, learning takes place but barriers may continue to prevent such recontextualisation. Aranda and Law’s paper on the debates over sociology in nursing curricula may help us to identify an important barrier to recontextualisation. Aranda and Law (2007) suggest that there are three narratives apparent in the nursing literature which comment on the role sociology has to play in nurse education: the realist, the critical and the reflexive view. They suggest that the realist position argues that sociology offers either more or less understanding of the realities of health and illness in society. Students either want more or less of it in pre-registration programmes to enable them to be fit for practice on registration. The critical view provides an emancipatory vision of nursing’s position in the world through an understanding of how power and ideologies shape knowledge in practice. Education from this viewpoint liberates practice. The reflexive position argues that our experience of practice and education is necessarily grounded in our embodied experiences which are ‘historicised, social positions’ (2007, p. 566). It appears to us that there are similar ‘tales’ present within nurse education covering a realist view, a critical view and a reflexive view. At present, from the realist standpoint and somewhat in contradiction, an idealistic attempt is made to integrate education theory into practice through evidence based practice; that is, students are taught the ‘ideal’ in university and expected to take that ideal into practice. There is no understanding of the social nature of learning or what Evans et al. (2009) suggest, the recontextualisation of knowledge from university to work. From the critical standpoint, the ideal knowledge which should underpin practice is given to students as their engine for change (Munhall, 1980; Peplau, 2009). Over the 20 years between Munhall and Peplau’s publications, the critical view of education still holds strong – that education can liberate and raise standards of patient care delivery. From the evidence discussed in this paper, the realist and critical positions within nurse education are actively rejected in pre-registration experience in practice. Knowledge is derived from practice rather than education and neither does academic research nor evidence based knowledge shape practice (Allan et al., 2007; Burkitt et al., 2000; Phillips and Hayes, 2008; Pollard, 2008). Taking the reflexive view, there may be more synergy as practitioners (often through their mentorship training if not their own pre-registration education) use this reflection to learn and improve practice in the same way as students are taught to learn from practice experiences. But we suggest this reflective learning is not a reality in practice.
Limitations The limitations of our argument is that it is confined to the literature on workplace and work based learning and there may well
be both other and different pedagogies used in the broader field of nurse education research. What was striking in undertaking the review for this paper was that while we knew of other writers in this field, it appears that professions are quite particular in which words they use to write about workplace and work based learning (Biggs and Tang, 2007). This raises a further question about whether this broader literature is integrated into the nurse education discourse. Conclusions The pedagogies predominant in nurse education research assume that to enhance learning in clinical practice, professionals and students in the workplace need to recognise that workplace learning is socially constructed and dependent on a number of variables. These variables include interpersonal, intrapersonal and structural factors. The success with which a student feels they learn and achieve the expected learning outcomes of their programme is largely dependent on the processes of socialisation into a professional milieu which occurs in the workplace (Pollard, 2008; Phillips and Hayes, 2008; Spouse, 2001). We have argued that pedagogies in nurse education are not reflective of practice in the field of workplace and work based learning and neither do they appear to develop from or influence practice. We have argued in this paper that there are underpinning pedagogies used in nurse education research in the area of workplace and work based learning which are broadly qualitative, action orientated and focused on knowledge generation. Such pedagogies are rooted in a philosophy of teaching and learning where learning is seen as active and socially constructed. Learning changes within different contexts and generates different types of research questions depending on the learner and the learning environment. We have also argued that such pedagogies in this field are not utilised in education and practice learning and for this reason we need to revisit Benner et al.’s (1996, p. 277) assertion that ‘theory is shaped by practice and in turn may influence practice’. If we rephrase Benner et al.’s original statement to reflect on nurse education, we might ask whether nurse education theory is shaped by nursing practice and, in turn, does it influence practice? Our reading of the literature would suggest not and therefore we must question Benner et al.’s assertion, not because we want to, but because we believe pedagogies should emerge from practice and influence practice. However in our view, there are constraints which prevent such a role for nurse education and also nurse education research. These constraints arise from the structural arrangements both of the NHS and higher education establishments and the contractual arrangements between the two which keeps them apart. As a result, theory does not develop from practice. Neither does research influence practice in the current UK health services. While we believe that these contractual arrangements must be considered afresh, we have suggested one way of resolving this situation in curricular design might be through the development of the concept of recontextualising knowledge between education and the workplace rather than simply talking about the transfer of knowledge (Evans et al., 2009). Recontextualising knowledge means that students and their mentors and tutors work together to make the links explicit and generate new knowledge for practice which in turn stimulates new research questions. References Allan, H.T., Smith, P.A., Lorentzon, M., 2007. Leadership for learning: a literature study of leadership for learning in clinical practice. Journal Nursing Management 16, 545–555. Andrews, G.J., Brodie, D.A., Andrews, J.P., Wong, J., Thomas, B.G., 2005. Place(ment) matters: students’ clinical experiences and their preference for first employers. International Nursing Review 52 (2), 142–153.
H.T. Allan, P. Smith / Nurse Education Today 30 (2010) 476–479 Andrews, G.J., Brodie, D.A., Andrews, J.P., Hillan, E., Thomas, B.G., Wong, J., Rixon, L., 2006. Professional roles and communications in clinical placements: a qualitative study of nursing students’ perceptions and some models for practice. International Journal Nursing Studies 43 (7), 861–874. Aranda, K., Law, K., 2007. Tales of sociology and the nursing curriculum: revisiting the debates. Nurse Education Today 27 (6), 561–567. Armstrong, N., 2008. Role modelling in the clinical workplace. British Journal of Midwifery 16 (9), 596–603. Atack, L., Comacu, M., Kenny, R., LaBelle, N., Miller, D., 2000. Student and staff relationships in a clinical practice model: impact on learning. Journal of Nursing Education 39 (9), 387–392. Barrett, D., 2007. The clinical role of nurse lecturers: past, present and future. Nurse Education Today 27, 367–374. Benner, P., Tanner, C.A., Chesla, C.A., 1996. Expertise in Nursing Practice: Caring, Clinical Judgment and Ethics. Springer, Cambridge, Massachusetts. Biggs, J., Tang, C., 2007. Teaching for Quality Learning at University, 3rd ed. McGraw-Hill Education, Open University Press, Maidenhead, Berks. Bjork, I.T., 2001. The hospital ward – an environment for learning? Nordic Journal of Nursing Research and Clinical Studies 21 (4), 4–9. Boogaerts, M., Gealish, L., Ranse, K., 2008. Policy and practice: exploring tensions to develop practice. Practice Development in Health Care 7 (1), 49–57. Burkitt, I., Husband, C., MacKenzie, J., Tom, A., Crow, R., 2000. Clinical Judgment and Nurse Education: Nursing Identities and Communities of Practice. Research Highlights ENB 44, London. Carr, G., 2007. Changes in nurse education: being a nurse teacher. Nurse Education Today 27, 893–899. Chambers, D., 2007. Is the modern NHS fit for nursing students? British Journal of Nursing 16 (2), 74–75. Chan, D., 2004. The relationship between student learning outcomes from the clinical placement and their perceptions of the social climate of the clinical learning environment. Contemporary Nurse 17 (1–2), 149–158. Chesser-Smyth, P.A., 2005. The lived experiences of general student nurses on their first clinical placement: a phenomenological study. Nurse Education in Practice 5 (6), 320–327. Council of Deans and Heads of UK University Faculties for Nursing and Health Professions, 2005. DRAFT Response to the Detailed Questions in the NMC Consultation on Fitness for Practice at the Point of Registration. Nursing and Midwifery Council, London. Debbell, D., Branson, K., 2009. Implementing graduate entry registration for nursing in England: a scope review. Journal of Nursing Management 17, 550–558. Elliott, M., Wall, N., 2008. Should nurse academics engage in clinical practice? Nurse Education Today 28, 580–587. Eraut, M., 2004. Informal learning in the workplace. Studies in Continuing Education 26 (2), 247–273. Evans, K., Guile, D., Harris, J., 2009. Putting Knowledge to Work: Integrating Workbased and Subject-based Knowledge in Intermediate-level Qualifications and Workforce Upskilling.
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Hartigan-Rogers, J.A., Cobbett, S.L., Amirault, M.A., Muise-Davis, M.E., 2007. Nursing graduates’ perceptions of their undergraduate clinical placement. International Journal of Nursing Education Scholarship 4 (1), 1–12. Henderson, A., Twentyman, M., Heel, A., Lloyd, B., 2006. Students’ perceptions of the psycho-social clinical learning environment: an evaluation of placement models. Nurse Education Today 26 (7), 564–571. Hoel, H., Giga, S.I., Davidson, M.J., 2007. Expectations and realities of student nurses’ experiences of negative behaviour and bullying in clinical placement and the influence of socialisation processes. Health Services Management Research 20 (4), 270–278. Horrocks, S., 2005. Scholarship, teaching and calculative thinking: a critique of the audit culture in UK nurses education. Nurse Education Today 26 (1), 4–10. Hunter, C.L., Spence, K., McKenna, K., Idema, R., 2008. Learning how we learn: an ethnographic study in a neonatal intensive care unit. Journal of Advanced Nursing 62 (6), 657–664. Ironside, P.M., 2003. New pedagogies for teaching thinking: the lived experiences of students and teachers enacting narrative pedagogy. Journal of Nurse Education 42 (11), 509–516. Jones, P.C., Graham, L., 2004. Shaping the facts: evidence-based nursing and healthcare. In: Smith, P.A., James, T., Lorentzon, M., Pope, R. (Eds.). Churchill Livingstone, London, pp. 197–218. Kelly, C., 2007. Students’ perceptions of effective clinical teaching revisited. Nurse Education Today 27, 885–892. Levett-Jones, T., Lathlean, J., 2008. Belongingness: a prerequisite for nursing students’ clinical learning. Nurse Education in Practice 8 (2), 103–111. Levett-Jones, T., Fahy, K., Parsons, K., Mitchell, A., 2006. Enhancing nursing students’ clinical placement experiences: a quality improvement project. Contemporary Nurse 23 (12), 58–71. Lloyd Jones, M., Walters, S., 2001. The implications of contact with the mentor for preregistration nursing and midwifery students. Journal of Advanced Nursing 35 (2), 151–160. Melia, K., 2006. R000271191 – Nursing in the New NHS: A Sociological Analysis of Learning and Working. (accessed 14.11.06). Munhall, P., 1980. Moral reasoning levels of nursing students and faculty in a baccalaureate nursing program. Journal of Nursing Scholarship 12 (3), 57–61. Peplau, H., 2009. Psychiatric mental health nursing: challenge and change. Journal of Psychiatric and Mental Health Nursing 1 (1), 3–7. Phillips, D.J., Hayes, B.A., 2008. Securing the oral tradition: reflective positioning and professional conversations in midwifery education. Collegian 15 (3), 109–114. Pollard, K.C., 2008. Non-formal learning and interprofessional collaboration in health and social care: the influence of the quality of staff interaction on student learning about collaborative behaviour in practice placements. Learning in Health and Social Care 7 (1), 12–26. Spouse, J., 2001. Workplace learning: pre-registration nursing students’ perspectives. Nurse Education in Practice 1 (3), 149–156. Williams, A., Taylor, C., 2008. An investigation of nurse educator’s perceptions and experiences of undertaking clinical practice. Nurse Education Today 28, 899– 908.
Contents lists available at ScienceDirect
Nurse Education Today journal homepage: www.elsevier.com/nedt
Are pedagogies used in nurse education research evident in practice? H.T. Allan *, P. Smith Centre for Research in Nursing and Midwifery Education, Faculty of Health and Medical Sciences, University of Surrey, Duke of Kent Building, Stag Hill, Guildford, Surrey GU2 5TE, United Kingdom
a r t i c l e
i n f o
Article history: Accepted 20 October 2009
Keywords: Pedagogies Nurse education Workplace Workbased learning Educational research
s u m m a r y This paper considers two questions: what pedagogies for teaching nursing are used in nurse education research? Are these pedagogies transferred to learning in the workplace? We argue that there are underpinning pedagogies identified in nurse education research in the area of workplace and work based learning which are broadly qualitative, action orientated and focused on knowledge generation. Such pedagogies are rooted in a philosophy of teaching and learning where learning is seen as active, reflective and socially constructed. We consider possible answers to these questions through an exploration of empirical work by Evans et al. (2009) which has focused on knowledge transfer in the workplace. Their work offers insights into how pedagogies can be applied to nurse education research which in turn may be transferred into the workplace. In particular, they argue that the concept of knowledge transfer is outdated and we should focus instead on how knowledge learnt in one context (the academy) is re-contextualised in another (the workplace). We also draw on Aranda and Law’s (2007) paper on the debates concerning the use of sociology in nurse education to explore competing narratives. We conclude that the pedagogies identified in educational research are not transferred to nurse education and practice yet offer an alternative view of knowledge transfer as illustrated by Evans et al.’s work which explores how learning in the workplace may be facilitated more effectively. We conclude that the lack of transfer of nurse education research pedagogies to practice learning undermines the position of nurse teachers within the academy as nurse education becomes a practice or professional discipline without a discrete disciplinary base. Ó 2009 Elsevier Ltd. All rights reserved.
Introduction The aim of this paper is to explore two questions pertinent to debates in nurse education around the relationship of nurse education and nursing practice (Debbell and Branson, 2009). The questions we pose are: which pedagogies for teaching nursing are used in nurse education research? Are these pedagogies transferred to learning in the workplace? We argue that there are underpinning pedagogies used in nurse education research in the area of workplace and work based learning which are broadly qualitative, action orientated and focused on knowledge generation. Such pedagogies are rooted in a philosophy of teaching and learning where learning is seen as active, reflective and socially constructed. We consider possible answers to our questions through an exploration of Evans and her colleagues’ recent empirical work which has focused on knowledge transfer in the workplace. Their research offers insights into how pedagogies can be applied to nurse education research which in turn may be transferred into
* Corresponding author. Tel.: +44 1483 689745. E-mail address: [email protected] (H.T. Allan). 0260-6917/$ - see front matter Ó 2009 Elsevier Ltd. All rights reserved. doi:10.1016/j.nedt.2009.10.011
the workplace. In particular they argue that the concept of knowledge transfer is outdated and we should focus instead on how knowledge learnt in one context (the academy) is re-contextualised in another (the workplace). Knowledge transfer has become a stale way to understand the difficulties students have in integrating theory learnt in university with practice they observe and learn in placement. We conclude that the pedagogies we have identified are not transferred to practice yet offer an alternative view of knowledge transfer illustrated by Evans et al.’s work which explored how learning in the workplace may be facilitated more effectively. We conclude that the lack of transfer of nurse education pedagogies to practice learning undermines the position of nurse teachers within the academy as nurse education becomes a practice or professional discipline without a discrete disciplinary base.
Which pedagogies for teaching nursing are used in nurse education? Pedagogy is the educational or instructional approach used to develop knowledge which can occur in many different settings
H.T. Allan, P. Smith / Nurse Education Today 30 (2010) 476–479
(Ironside, 2003). For the purposes of this paper, we focus on pedagogies for the workplace. Biggs and Tang state that ‘‘Workplace learning, variously known as placement, attachment, practicum, clinical or internship, according to the discipline, is an integral component of professional education” (2007, p. 143). They go onto suggest that the outcomes of workplace learning are to: integrate knowledge and skills learnt in university to real-life professional settings; apply theories and skills to practice; work collaboratively with all parties in workplace settings and practise with professional attitudes and social responsibilities in the profession. This learning usually takes place under supervision. In nursing, all pre-registration learning should be supervised by a qualified mentor who is a registered nurse. The term placement is most commonly used in the nursing literature to describe workplace learning. Eraut (2004) recognises the complexity of workplace learning and argues that many definitions of workplace learning do not differentiate between formal and informal learning. Workplace learning according to Eraut can be structurally separate from academic learning or less separated and further, may be formal or informal. Formal workplace learning is the planned learning identified in curricula and learning outcomes; informal learning in the workplace occurs when students learn from other people in the workplace and in other spaces than those identified in learning outcomes. It is interesting that Biggs and Tang’s (2007) definition seems to presume that workplace learning involves the transfer of learning from the academy to the workplace thereby privileging academic knowledge over work based knowledge. The nursing literature suggests that workplace learning incorporates informal, incidental and formal learning and all are essential to safe practice and effective learning (Armstrong, 2008; Phillips and Hayes, 2008; Pollard, 2008; Bjork, 2001). Workplace learning is socially constructed through interactions and relationships among staff in teams and within organisations (Levett-Jones and Lathlean, 2008; Hoel et al., 2007; Andrews et al., 2006, 2005; Spouse, 2001; Atack et al., 2000). Organisational support and effective leadership are fundamental to facilitating workplace learning (Elliott and Wall, 2008; Williams and Taylor, 2008; Barrett, 2007; Carr, 2007; Chambers, 2007; Kelly, 2007; Report of Council of Deans, 2005; Horrocks, 2005). This learning is different to the learning in academic settings which tends to be context-free, disciplinary or subject focused and certain (Burkitt et al., 2000). Effective workplace learning requires staff to provide space and time for enquiry based learning which is meaningful for students and helps them integrate their university learning with their learning in practice (Hartigan-Rogers et al., 2007; Henderson et al., 2006; Levett-Jones et al., 2006; Chesser-Smyth, 2005; Grealish and Trevitt, 2005; Chan, 2004) to practise their knowledge and skills (Hunter et al., 2008). In addition, student centred learning in the workplace needs to recognise that learning is constructed by individuals and subject to multiple influences. Therefore, the dominant pedagogy in the nurse education research literature appears to be that learning is a social activity which is constructed by learners and their environment. But is this the dominant pedagogy used in practice?
Are the pedagogies used in education research transferred to learning in the workplace? Many authors argue that learning in practice is determined largely by practitioners and not by the curriculum (Burkitt et al., 2000;
477
Boogaerts et al., 2008) and by structural arrangements between commissioning NHS trusts and the universities, otherwise known as the providers (Allan et al., 2007). In terms of our question, are pedagogies underpinned by research, used to teach nursing used in nursing practice, our reading of the literature would suggest that theory and practice for both students, mentors and lecturers has become uncoupled not least by the structural arrangements between the universities and practice which underpin the nurse education system. This system is described in a review published elsewhere where Allan et al. (2007) argue that the nature of learning in health care practice is shaped by three factors: The commissioning and contracting arrangements between institutions of higher education (HEIs) and the National Health Service (NHS). The sharing of students’ learning between practice and HEIs which has highlighted differences between HEIs and practitioners around the nature of learning as well as revealing a discrepancy between these partners over the meaning of fitness for practice. The location of nurse teachers in HEIs which has increased the theory–practice gap for both teachers and learners. As Melia (2006:1) has argued, delivering the new NHS reforms ‘‘is driven by a workforce agenda rather than an educational one”. This workforce agenda impedes student learning both in terms of supporting learning through supervision and mentoring and facilitating the adoption of new learning strategies to enhance learning and knowledge transfer between education and practice (HartiganRogers et al., 2007; Henderson et al., 2006; Levett-Jones et al., 2006; Chesser-Smyth, 2005; Grealish and Trevitt, 2005; Chan, 2004). In the view of the Council of Deans of Faculties of Health (2005), the commissioning arrangements between higher education (HE) and the NHS do not facilitate effective learning or the integration of theory and practice. But structural arrangements which underpin educational partnerships do not appear to be realised at practice level either, i.e., for individual mentors and students. In other words, mentors are busy and learning takes second place to delivering care to patients (Lloyd Jones and Walters, 2001) and workforce demands (Melia, 2006). Consequently these structural factors impede the transfer of pedagogies used in nurse education. In addition, knowledge is conceptualised very differently in the different contexts of education and practice. Jones and Graham (2004) argue that a tension exists for practitioners between theory which emerges from practice based on reflective enquiry and theory derived from evidence published in scientific journals using randomised controlled trials (RCTs). The latter form of knowledge is seen as the gold standard of research and evidence for practice, whereas reflective learning, where the goal is to learn from experience in practice, is not valued so highly. Jones and Graham argue that such practice knowledge can be used to build educational approaches as much as scientific evidence and that in education reflective knowledge is given the same value. However in this paper we argue that at present this does not happen as certain forms of evidence continue to be privileged above others in clinical practice.
Discussion We have argued that the pedagogies identified in nurse education research are not transferred to workplace learning. We draw on the recent empirical work of Evans and colleagues to understand the processes of knowledge transfer (2009) and Aranda and Law’s paper on the contribution of sociology to nurse education to understand this complex situation.
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Evans et al. (2009) have argued that the lack of integration between practice and academia is a longstanding problematic across many disciplines. They argue that the literature has tended to discuss this problematic in terms of the transfer of knowledge. In their view this perspective ignores the socially constructed nature of learning in different contexts which the literature suggests frames and shapes learning in the workplace for nursing students. Knowledge, in other words, is not something students transfer as an entity in itself, but is actively constructed and reshaped into personal meaning for each student in new environments. Evans et al. call this process of construction and reconstruction of knowledge in the workplace, the ‘recontextualisation of knowledge’. The literature we have cited in this paper suggests that academic knowledge is re-contextualised with difficulty by students and that mentors are either unwilling or unable to facilitate this process. In our view Evans et al.’s framework appears to address this problem by suggesting that when knowledge contextualised in education is recontextualised in practice, learning takes place but barriers may continue to prevent such recontextualisation. Aranda and Law’s paper on the debates over sociology in nursing curricula may help us to identify an important barrier to recontextualisation. Aranda and Law (2007) suggest that there are three narratives apparent in the nursing literature which comment on the role sociology has to play in nurse education: the realist, the critical and the reflexive view. They suggest that the realist position argues that sociology offers either more or less understanding of the realities of health and illness in society. Students either want more or less of it in pre-registration programmes to enable them to be fit for practice on registration. The critical view provides an emancipatory vision of nursing’s position in the world through an understanding of how power and ideologies shape knowledge in practice. Education from this viewpoint liberates practice. The reflexive position argues that our experience of practice and education is necessarily grounded in our embodied experiences which are ‘historicised, social positions’ (2007, p. 566). It appears to us that there are similar ‘tales’ present within nurse education covering a realist view, a critical view and a reflexive view. At present, from the realist standpoint and somewhat in contradiction, an idealistic attempt is made to integrate education theory into practice through evidence based practice; that is, students are taught the ‘ideal’ in university and expected to take that ideal into practice. There is no understanding of the social nature of learning or what Evans et al. (2009) suggest, the recontextualisation of knowledge from university to work. From the critical standpoint, the ideal knowledge which should underpin practice is given to students as their engine for change (Munhall, 1980; Peplau, 2009). Over the 20 years between Munhall and Peplau’s publications, the critical view of education still holds strong – that education can liberate and raise standards of patient care delivery. From the evidence discussed in this paper, the realist and critical positions within nurse education are actively rejected in pre-registration experience in practice. Knowledge is derived from practice rather than education and neither does academic research nor evidence based knowledge shape practice (Allan et al., 2007; Burkitt et al., 2000; Phillips and Hayes, 2008; Pollard, 2008). Taking the reflexive view, there may be more synergy as practitioners (often through their mentorship training if not their own pre-registration education) use this reflection to learn and improve practice in the same way as students are taught to learn from practice experiences. But we suggest this reflective learning is not a reality in practice.
Limitations The limitations of our argument is that it is confined to the literature on workplace and work based learning and there may well
be both other and different pedagogies used in the broader field of nurse education research. What was striking in undertaking the review for this paper was that while we knew of other writers in this field, it appears that professions are quite particular in which words they use to write about workplace and work based learning (Biggs and Tang, 2007). This raises a further question about whether this broader literature is integrated into the nurse education discourse. Conclusions The pedagogies predominant in nurse education research assume that to enhance learning in clinical practice, professionals and students in the workplace need to recognise that workplace learning is socially constructed and dependent on a number of variables. These variables include interpersonal, intrapersonal and structural factors. The success with which a student feels they learn and achieve the expected learning outcomes of their programme is largely dependent on the processes of socialisation into a professional milieu which occurs in the workplace (Pollard, 2008; Phillips and Hayes, 2008; Spouse, 2001). We have argued that pedagogies in nurse education are not reflective of practice in the field of workplace and work based learning and neither do they appear to develop from or influence practice. We have argued in this paper that there are underpinning pedagogies used in nurse education research in the area of workplace and work based learning which are broadly qualitative, action orientated and focused on knowledge generation. Such pedagogies are rooted in a philosophy of teaching and learning where learning is seen as active and socially constructed. Learning changes within different contexts and generates different types of research questions depending on the learner and the learning environment. We have also argued that such pedagogies in this field are not utilised in education and practice learning and for this reason we need to revisit Benner et al.’s (1996, p. 277) assertion that ‘theory is shaped by practice and in turn may influence practice’. If we rephrase Benner et al.’s original statement to reflect on nurse education, we might ask whether nurse education theory is shaped by nursing practice and, in turn, does it influence practice? Our reading of the literature would suggest not and therefore we must question Benner et al.’s assertion, not because we want to, but because we believe pedagogies should emerge from practice and influence practice. However in our view, there are constraints which prevent such a role for nurse education and also nurse education research. These constraints arise from the structural arrangements both of the NHS and higher education establishments and the contractual arrangements between the two which keeps them apart. As a result, theory does not develop from practice. Neither does research influence practice in the current UK health services. While we believe that these contractual arrangements must be considered afresh, we have suggested one way of resolving this situation in curricular design might be through the development of the concept of recontextualising knowledge between education and the workplace rather than simply talking about the transfer of knowledge (Evans et al., 2009). Recontextualising knowledge means that students and their mentors and tutors work together to make the links explicit and generate new knowledge for practice which in turn stimulates new research questions. References Allan, H.T., Smith, P.A., Lorentzon, M., 2007. Leadership for learning: a literature study of leadership for learning in clinical practice. Journal Nursing Management 16, 545–555. Andrews, G.J., Brodie, D.A., Andrews, J.P., Wong, J., Thomas, B.G., 2005. Place(ment) matters: students’ clinical experiences and their preference for first employers. International Nursing Review 52 (2), 142–153.
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