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Nurses and midwives teaching in the academic environment: An appreciative inquiry
Nurse Education Today 84 (2020) 104263
Contents lists available at ScienceDirect
Nurse Education Today journal homepage: www.elsevier.com/locate/nedt
Nurses and midwives teaching in the academic environment: An appreciative inquiry
T
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Lyn Eberta, , Lyndall Mollarta, Samantha J. Nolanb, Elaine Jeffordb a b
School of Nursing & Midwifery, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia Southern Cross University, Hogbin Drive, Coffs Harbour, NSW 2450, Australia
A R T I C LE I N FO
A B S T R A C T
Keywords: Midwifery Nursing Academic Appreciative inquiry Teaching
Background: The past two decades has seen significant change in nursing and midwifery education in Australia. Although, regulatory documents explicate expectations of teaching, and supervising in the context of being a nurse or midwife, the move from hospital-based to higher education learning nessitated a change in how students receive their education and who provides it. The quality of teaching by nurse or midwife academics is subject to the academic's ability to transition from a clinical educator to academic. Objective: To explore the experiences of nurse and midwife academics teaching in the academic environment. Design: Appreciative Inquiry (AI) was used to explore the experiences of academics teaching final year nursing and midwifery students. Setting: Two regional universities in Australia. Participants: Seven nursing and midwifery academics teaching a unit of study focusing on mentorship, leadership and teaching. Methods: Narrative data from interviews conducted using AI were collected, transcribed and analysed to produce themes. Results: Three key themes were identified; ‘Feeling valued’, ‘Feeling safe’ and ‘Having connections’. These themes and related subthemes impacted teaching experiences and role transition from experienced clinician to academic. Conclusion: Nursing and midwifery academics would benefit from organisational support in their role transition from clinician to academic. Further research is crucial regarding initiatives that can support academics to feel safe, valued and connected when teaching the next generation of nurses and midwives.
1. Introduction
clinical context and not the higher education environment. Although the ICM Global Standards for Midwifery Education (2013) stipulates a midwifery teacher ‘will or has obtained formal preparation for teaching and maintains competency in midwifery practise and education’ (p 4), currently there are no Australian accredited or mandated requirements for academics teaching nursing or midwifery students to have a formal teaching qualification. Rather, the academic must have:
The past two decades has seen the landscape of nursing and midwifery education in Australia change significantly. The move from hospital-based teaching to the higher education environment has resulted in the introduction of a wider variety of content relevant to the changing health care context. Becoming a health professional, in this case a registered nurse or midwife, is a process of change that requires cognitive flexibility and ongoing self-development; essential to the development of new skills and ideas (Kessler, 2013). Furthermore, innately embedded in the role of a nurse or midwife is teaching, mentorship and leadership (Nurses and Midwifery Board of Australia [NMBA], 2018; NMBA, 2016). Thus, nurses and midwives are expected to be educators. This expectation however, is largely focused at the
‘relevant clinical and academic preparation and experience’ and are qualified to at least one tertiary qualification standard higher than the program of study being taught, or with equivalent midwifery practice experience’ (Australian Nursing and Midwifery Accreditation Council [ANMAC], 2014 p 21). The transition from one identity (clinician), to another (academic),
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Corresponding author. E-mail addresses: [email protected] (L. Ebert), [email protected] (L. Mollart), [email protected] (S.J. Nolan), Elaine.Jeff[email protected] (E. Jefford). https://doi.org/10.1016/j.nedt.2019.104263 Received 30 April 2019; Received in revised form 26 August 2019; Accepted 1 November 2019 0260-6917/ © 2019 Published by Elsevier Ltd.
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phases (Cooperrider and Whitney, 2000), which Dewar (2014) adapted (shown in bold font) to better suit a health practitioner audience.
can lead to feelings of insecurity in terms of professional identity (Ennals et al., 2015). This paper explores the experiences of nurses and midwives teaching in the academic environment.
▪ Discover (Appreciate) people work together to discover what is currently working well in the organisation/unit ▪ Dream (Envision) people use knowledge from discovery phase to help them consider what practices they would like to see more of in the future ▪ Design (Co-create) people work together to plan how they could work towards achieving aspirations set out in the envision phase. ▪ Destiny (Embed) people consider what would need to happen to make this new way of working routine practice
2. Background Explicit within International and Australian regulatory documents, are expectations around teaching, mentoring and leading within the nursing and midwifery context (International Confederation of Midwives, 2018; Nurses and Midwifery Board of Australia, 2018; Nurses and Midwives Board of Australia, 2016). Upon graduation, nurses and midwives are expected to teach, supervise and assess others within the clinical context, as part of their professional scope of practice. In the higher education sector, the nurse or midwife academic is presented with the task of fostering an environment that supports and inspires student learning to graduate as safe and capable health care practitioners (Australian Nurses and Midwives Accreditation Council, 2012, 2014). New academics draw on their individualised set of skills and knowledge, gained in the clinical context, to translate theoretical knowledge into the contextual world of nursing or midwifery practice (Logan et al., 2016). Consequently, the experience, teaching skills and underpinning knowledge of the academic is key in the translation of knowledge into teaching practice. Despite this, there is limited research on how the nurse or midwife academic makes the transition from clinical mentor, teacher and supervisor to effective academic educator. While a clinical nurse or midwife may have a strong professional identity as a competent or experienced clinician, the transition from clinician to academic in the tertiary environment is often complex, with a significant difference in roles and scope of practice (Ennals et al., 2015). For a shift in professional identity to occur, academics must develop new skills, cultivate a teaching philosophy while also determining how their teaching practice and student learning is to be assessed (Duffy, 2013). Encompassed in this professional identity is the organisational requirement to deliver a unit of study in accordance with National accreditation standards (ANMAC, 2012, 2014) and quality educational frameworks (Australian Qualifications Framework Council, 2013). Understandably, Gourlay (2011) contends shifts in professional identity and changes to scope of practice can be stressful. This paper explores academics' experiences of teaching a unit of study to thirdyear, undergraduate, nursing and midwifery students at two regional universities in Australia. Although the unit of study participating academics was teaching focused on mentorship, leadership and teaching, knowledge created from this study is applicable to all nurse or midwife academics and higher education orgainisations.
In the Appreciate phase the participants collectively identified what was working well within the unit of study, then drawing on their knowledge and skills of teaching, considered what worked and what mattered in relation to their teaching to facilitate the best aspects of the teaching experience (Envision, phase). In other words the affirmative topic in this study was discovering and building upon academics' experiences of delivering a unit of study to undergraduate third year nursing and midwifery students. The intended outcome of the AI participative approach is changes being made in the way the academics are supported to teach and deliver a unit of study (Co-Create phase) through application of the senses framework. The senses framework is underpinned by the following attributes, Security (feeling safe), Belonging, Continuity (making connections), Purpose, Achievement and Significance (feeling valued) (Nolan et al., 2006). Following delivery (Embed phase) of the unit of study, using emotional touch points and caring conversations (Dewar, 2014, 2019), each participant gave their narrative drawing upon their unique, subjective historical and cultural influences and/or beliefs as well as constructing ‘in the moment’ relational views. Through an iterative process, with an affirmative focus, AI gave voice to finding out what was valued, what mattered, what was important, what worked well and potential new ways of doing (Nolan et al., 2006). 3.1. Setting Participant academics were from two Australian regional universities. University B straddles the New South Wales-Queensland border whilst University A is situated in New South Wales. Both universities provide a unit of study focusing on mentorship, leadership and teaching in the final year their nursing and/or midwifery degrees. 3.2. Participants
2.1. Objective Seven academics participated in this study. Four were full-time university employees (two at University A and two at University B), three were sessional (casual) employees (one at University A and two at University B). One participant had a teaching qualification. Four participants taught the unit to midwifery students only and three to both nursing and midwifery students.
This study explored the experiences of nurse and midwife academics teaching in the higher education sector. The aims of this study were: ▪ To develop an understanding of how the nurse or midwife academic realises their ability to deliver a unit of study. ▪ To explore, what is valued, what matters and identify facilitators to effective teaching.
3.3. Ethical considerations
3. Methods
Ethical approval was granted by relevant universities Health Research Ethics Committees (HREC). The HREC numbers were: H2018-0299 (University A) and ECN-18-021 (University B).
An Appreciative Inquiry (AI) approach was used to explore the social world and experiences of seven academics, who facilitated a unit of study to undergraduate, third-year nursing and midwifery students. The epistemology of AI is underpinned by social constructionism, whereby key elements within the social world are interwoven, created and coconstructed through narratives (Kung et al., 2013). Importantly, using AI and moving to a ‘best of what is’ focus, an emancipatory discourse begins to emerge (Reason and Bradbury, 2001). The emancipatory discourse of AI is realised through a cyclical process consisting of four
3.4. Data collection Individual interviews were conducted by one of the authors, a researcher well versed in AI methodology. Unlike traditional interviews, emotional touchpoints and visual imagery were used to facilitate a deep understanding of what academics valued about teaching the unit. Using the stem word(s) “teaching this unit” participant's were invited to share 2
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Table 1 Examples of emotional words. Positive Encouraged Excited Reassured
Negative Included Moved Confident
Inspired Respected Motivated
Powerless Unsupported Let Down
Worried Awkward Vulnerable
Confused Frustrated Misunderstood
the academic environment. “I don't know, whether I felt valued… I found you've got to have the experience or confidence behind you to present and teach them because they will easily find someone who's a phoney or doesn't know what they are talking about {Educator 5]”. Participants expressed they valued working and learning alongside students. The teaching environment was more productive when there was a sense of mutual respect and collaboration between learner and academic. “I actually learnt from some of the students, so that was lovely too, to be learning from each other [Educator 2]”. Partnerships between teacher and student were thought to facilitate safety to explore, share and express ideas freely within the teaching environment. Educators expressed that “they [students] were all quite proactive and happy to voice their thoughts and be involved and things [Educator 6,” and “it just encouraged me to keep trying new ways of imparting this information and how we could co-create in order to help them understand [Educator 1]”.
their experiences. Participants were given a list of positive and negative emotional words and invited to choose 3–5 that resonated with them in relation to the stem word(s). Alternatively, participants could create their own emotional word(s), although none elected to do so. Next participants were asked to share a narrative about their chosen words and how they related to the stem. Participants were then invited to relate their experiences to positive emotional words and what may have been needed to turn negative words into positive experiences (Dewar, 2014). Examples of emotional words are shown in Table 1. Interviews were 25–30 min duration, were digitally recorded and transcribed verbatim. 3.5. Data analysis The researchers read each interview transcript multiple times, looking carefully for the plot; the voice of ‘I’; relationships; key words, phrases as well as the cultural contexts and social structures (Doucet and Mauthner, 2008; Mauthner and Doucet, 1998). Narratives were closely analysed in terms of positive and/or negative teaching experiences. This emic interpretation, through the identification of recurrent phrases or meanings attributed to teaching experiences, was based solely on the academics' perspectives (Denzin, 1989; Denzin, 1992; Denzin and Lincoln, 2005). The research team shared their analysis to validate study findings, particularly the interpretation of narrative meaning and concept names identified. The researchers then applied an etic perspective by drawing on literature and critical reflection (Jefford and Sundin, 2013).
4.1.3. Valued unit topic Participants considered teaching students how to teach within the clinical context was an essential skill of the health care professional. They were concerned however; students would not understand the value of the unit. Providing discipline content as well as the relevance of content to professional scope of practice is an issue for academics. “I don't know whether they saw the relevance of this subject… [Educator 5]”. “I don't really approach the course from a really high theoretical perspective, because I think they are going to get lost in that [Educator 4]”. To ensure students understood the value of the unit participants used real-life scenarios. “I look at them and say, ‘what can I help you guys learn that… you can use, the first time you take a student, the first time you have to teach a patient [Educator 4]”.
4. Results
4.2. Feeling safe
Findings are presented using participants' verbatim quotes. Three overarching themes were identified: (i) being valued, (ii) feeling safe and (iii) connections. Study participants are identified as Educator followed by an assigned participant number.
4.2.1. Feeling safe to teach the topic The transition from one identity (clinician), to another (academic), can often lead to feelings of insecurity in terms of identity as well as knowledge and skills. “I felt somewhat anxious in the fact that it was a new method [of teaching] to me that I actually wasn't particularly familiar with beforehand [Educator 7].” Teaching cross-discipline was a further challenge for some. “I had to use my personal experiences [in nursing] … So, I still used the content of the subject but tried to make it more relevant for the student midwives [Educator 5].”
4.1. Being valued 4.1.1. Valued as an educator - by colleagues and organisation New academics often come to the university environment as capable and autonomous clinicians. If they do not feel their unique set of teaching skills and knowledge is valued, they can experience frustration. “I guess the frustration came about with the fact that it was very prescribed, just to what we were teaching, and the way it was set out [Educator 6]”. Participants also felt there was a lack of appreciation for new or creative teaching viewpoints aimed at enhancing teaching. “I have got particular issues with the way the hierarchy currently works and the lack of support that comes with trying to push new teaching methods [Educator 4]”.
4.2.2. Feeling safe in transitioning as an educator Identity as an academic develops over time and with the transition in self-identity comes confidence in teaching abilities. One participant (with an additional teaching and learning qualification) felt secure enough within their academic identity to make mistakes, acknowledging and correcting them in front of the students. “I was correcting myself the whole time but doing it out loud. The students said to me how good that made them feel, because when they realised, it was ok, it was a safe environment [Educator 1]”.
4.1.2. Valued as an educator - by students Participants voiced feeling valued as an educator when they received positive feedback from students. Affirmative feedback encouraged academics to continue to use the teaching methods and/or skills, viewed as positive by students. “I got a lot of feedback from the students individually about what they really liked about the content or about my delivery of it [Educator 6]”. Being valued as an educator, however, was not instantaneous when moving from the clinical environment to
4.3. Connections 4.3.1. Connections with students Creation of a safe learning environment is contingent upon the teacher's ability to build a relationship or connection with the students. 3
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“I think … establishing the connection. I felt very safe, sharing how I was feeling… showing my vulnerable side…, that was probably because we established a relationship based on trust from the very beginning [Educator 2]”. The sense of connectedness was harnessed when academics had prior interactions with students. “I really feel quite connected to the whole cohort in [unit of study] as I also taught, the same cohort back in their very first semester [Educator 5].” Conversely, an absence of connection was thought to be challenging, for the educator, when attempting to engage with students, “the students who didn't come to the tutorial… I wasn't connected to because I had no conversation face to face or via email… [Educator 5].”
rates (Cruickshank and MacDonald, 2016). Adding to the complexity of role transition is the need to appear an expert in relation to discipline specific knowledge. In the discipline of mathematics, the level of an academic's pedagogical content positively influenced the academic's professional development as well as enhancing student learning outcomes (Callingham et al., 2016). Smith and Boyd (2012) contend the translation of knowledge to another discipline can be difficult when attempting to contextualise content from a single discipline perspective. With an increasing push in higher education to have cross disciplinary teaching, the transition in role identity for new academics may be further hindered. Nursing and midwifery academics, as highlighted in this study, are often required to teach cross-discipline student cohorts or content outside their clinical area of expertise. This situation hinders role development and adds to the uneasiness that may be experienced when transitioning from clinician to academic. Nurse academics have previously voiced concerns regarding ‘feeling like a fraud’ or an imposter (Findlow, 2012; Parkman, 2016). These fears may, indeed, hold true for both nursing and midwifery academics, whose disciplines only entered the higher education environment at the turn of the millennium. Findlow (2012) asserts that fear can result in less confident engagement in team discussions and/or university activities which may hinder an academic's ability to build connections and therefore, gain support from colleagues. Whilst it has been well researched that a student's sense of belongingness and connectedness impacts on student retention, progress and success (Hagenauer and Simone, 2014; Krause and Armitage, 2014; O'Meara et al., 2017) there is less research about academics' sense of belonging, connectedness and teaching satisfaction. Schrodt et al. (2003) argue new academics tend to pursue open communication with colleagues as they confront the challenges of their new role. More recently, a study by Arian et al. (2018), conveyed new nurse academics who felt supported through teambuilding and mentoring activities had higher job satisfaction scores. Importantly, organisations that nurture supportive connections and open communication networks between colleagues and management are thought to facilitate healthier work environments, increase job satisfaction and productivity (Arian et al., 2018; Lee et al., 2017). Overall, it seems fostered connections with colleagues supports growth as an academic, facilitates the development of a teaching scope of practice and assists in feeling feel safe to experiment with teaching strategies. Whilst research is abundant on the positive learning outcomes of creating a safe teaching environment for students (Kidger et al., 2010; Segrott et al., 2013; Turner and Braine, 2015) there has been less focus on the emotional well-being or creation of a safe teaching environment for the academic. When studying high school teacher experiences, Segrott et al. (2013) found teachers enjoyed lessons in which they were able to teach creatively using their own ideas. For the nursing or midwifery academic to teach creatively autonomously, it is proffered that they must first feel safe to explore the teaching environment. In the current study, participants expressed they felt valued and therefore safe to experiment with their teaching skills when they had connections with students and/or prior knowledge of the teaching content. Therefore continuity of relationships with student cohorts can facilitate effective and creative teaching environments.
4.3.2. Connections and continuity in teaching Consistency or continuity of teaching methods and topic content was noted to enhance the learning environment while facilitating professional development. “I think next year…I will have gained from this experience, and build on the way we interact with each other, re-look at the activities, which ones worked really well [Educator 3].” Equally, a lack of continuity of content or relevant teaching resources was seen to hinder an educator's ability to teach. “Because I taught nursing the year before and then the midwifery students for the first time this year, … I was unprepared …it was focused on nursing, …had to change it quite a lot to make it relevant to the midwifery students [Educator 3].” 4.3.3. Connections with colleagues A sense of connection with colleagues was also viewed by participants as beneficial when trialing or implementing new teaching strategies or content. A participant described how, when implementing new teaching strategies, her experience was positive due to the encouragement of colleagues: “It's exciting to establish and develop a partnership with [the] midwifery faculty… It's exciting to be using a different approach to teaching and learning [Educator 2]”. In summary, findings from this study indicate that academics need to feel valued and safe to use their individual set of teaching skills and knowledge to effectively teach students and successfully make the transition from experienced clinician to educator in an academic setting. 5. Discussion Historically, nursing and midwifery education was undertaken in the clinical environment. Transition into the academic environment has impacted the delivery of educational content and the required qualifications and experiences of educators. Typically, those who enter the nursing and midwifery academic environment in Australia come from a clinical background. For academics educating future nurses and midwives outside the clinical context, a different set of skills and practice standards, against which they are appraised, is required (Findlow, 2012; ICM, 2018; NMBA, 2018; NMBA, 2016). Currently, there is scant research exploring the experiences and support mechanisms required for nurses and midwives to make the transition to academic. Consequently, discussion around being valued, feeling safe and making connections, draws on literature pertaining to teaching in other professions and contexts. Concerns voiced in this study are similar to those voiced by other nursing, and allied health academics who reported transition from clinician to academic involved considerable challenges, including the development of a teaching practice and identity (Smith and Boyd, 2012). The introduction of a mentoring program has been shown to facilitate recruitment, retention, professional development and experiences for new nursing academics in the United States (Feldman et al., 2015). Furthermore, the growing research area of ‘gratitude in education’ indicates that educators who feel valued by students and supported by colleagues, develop their teaching strategies earlier, have a smoother role transition with increased job satisfaction and retention
6. Strengths and limitations Limitations of this study include, the small number of participating academic educators (n = 7) and limited number of study sites: two regional Australian universities. The findings therefore, are not generalisable to all nursing and midwifery academics. The strength of this study is that it gives a preliminary insight into the experiences of academics and what impacts their ability to effectively teach the next generation of nurses and midwives.
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7. Conclusion
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Findings from this study indicate nursing and midwifery academics need to feel a greater sense of being valued and connected in the academic environment. They need to feel safe to successfully and positively transition from clinician to academic while developing their unique set of teaching skills. When envisioning what would be ideal, a greater degree of support from colleagues and the organisation is required. Universities have an important role to play in fostering environments that actively promote and acknowledge an academic's need to feel valued and safe as an educator and cultivate feelings of connection and engagement with students and other academics. Organisational support will allow academics to feel safe to express their individual teaching styles and further develop as an educator. Nursing and midwifery academics need to be valued as an educator by students, colleagues and their organisation. Organisational and professional support in the form of clear delineations in roles and responsibilities, scope of practice and ongoing professional development can assist academics in their professional identity transition. A prerequisite for nurses and midwives, applying for a position as an academic, to attain ‘a teaching in the higher education sector qualification’ may support the academic's professional role transition. This is a preliminary exploration into the experiences of nurse and midwifery academics. Larger studies may provide further understandings of the facilitators and barriers to effective role transition from clinician to academic in the nursing and midwifery education context. Acknowledgements This research was supported financially through a University of Newcastle (UON) Teaching and Learning Strategic Pilot Grant. The funding source had no involvement in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. Declaration of competing interest There are no competing interests for the authors. References Arian, M., Soleimani, M., Bagher Oghazian, M., 2018. Job satisfaction and the factors affecting satisfaction in nurse educators: a systematic review. J. Prof. Nurs. 34 (5), 389–399. Australian Nursing and Midwifery Accreditation Council [ANMAC]. (2014). Midwife: Accreditation standards. In. Canberra: ANMAC. Australian Qualifications Framework Council. (2013). The Australian Qualifications Framework. 2nd. Retrieved from www.aqf.edu.au Callingham, R., Carmichael, C., Watson, J., 2016. Explaining student achievement: the influence of teachers’ pedagogical content knowledge in statistics. International Journal of Science & Mathematics Education 14 (7), 1339–1357. https://doi.org/10. 1007/s10763-015-9653-2. Cooperrider, D. L., & Whitney, D. (2000). A Positive Revolution in Change: Appreciative Inquiry. In D. l. Cooperrider, P. F. Sorensen, J. Whitney, & T. F. Yaeger (Eds.), Appreciative Inquiry: Rethinking Human Organization Towards a Positive Theory of Change. Champaign, IL: Stipes Publishing LLC. Cruickshank, V., MacDonald, A., 2016. Teachers who feel appreciated are less likely to leave the profession. Retrieved from. http://www.utas.edu.au/news/2018/1/15/ 511-teachers-who-feel-appreciated-are-less-likely-to-leave-the-profession/. Denzin, N., 1989. Interpretative Interactionism. Sage, Thousand Oaks. Denzin, N., 1992. Interactionsim and Cultural Studies: The Politics of Interpretive Interactionsim. Basil Blackwell, Cambridge. Denzin, N., Lincoln, Y., 2005. The Sage Handbook of Qualitative Research, 3rd ed. Sage Publications, Thousand Oaks. Dewar, B., 2014. Appreciative inquiry: the appreciative inquiry process. In: My Homelife Scotland, Retrieved from. http://myhomelife.uws.ac.uk/scotland/what-is-
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Contents lists available at ScienceDirect
Nurse Education Today journal homepage: www.elsevier.com/locate/nedt
Nurses and midwives teaching in the academic environment: An appreciative inquiry
T
⁎
Lyn Eberta, , Lyndall Mollarta, Samantha J. Nolanb, Elaine Jeffordb a b
School of Nursing & Midwifery, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia Southern Cross University, Hogbin Drive, Coffs Harbour, NSW 2450, Australia
A R T I C LE I N FO
A B S T R A C T
Keywords: Midwifery Nursing Academic Appreciative inquiry Teaching
Background: The past two decades has seen significant change in nursing and midwifery education in Australia. Although, regulatory documents explicate expectations of teaching, and supervising in the context of being a nurse or midwife, the move from hospital-based to higher education learning nessitated a change in how students receive their education and who provides it. The quality of teaching by nurse or midwife academics is subject to the academic's ability to transition from a clinical educator to academic. Objective: To explore the experiences of nurse and midwife academics teaching in the academic environment. Design: Appreciative Inquiry (AI) was used to explore the experiences of academics teaching final year nursing and midwifery students. Setting: Two regional universities in Australia. Participants: Seven nursing and midwifery academics teaching a unit of study focusing on mentorship, leadership and teaching. Methods: Narrative data from interviews conducted using AI were collected, transcribed and analysed to produce themes. Results: Three key themes were identified; ‘Feeling valued’, ‘Feeling safe’ and ‘Having connections’. These themes and related subthemes impacted teaching experiences and role transition from experienced clinician to academic. Conclusion: Nursing and midwifery academics would benefit from organisational support in their role transition from clinician to academic. Further research is crucial regarding initiatives that can support academics to feel safe, valued and connected when teaching the next generation of nurses and midwives.
1. Introduction
clinical context and not the higher education environment. Although the ICM Global Standards for Midwifery Education (2013) stipulates a midwifery teacher ‘will or has obtained formal preparation for teaching and maintains competency in midwifery practise and education’ (p 4), currently there are no Australian accredited or mandated requirements for academics teaching nursing or midwifery students to have a formal teaching qualification. Rather, the academic must have:
The past two decades has seen the landscape of nursing and midwifery education in Australia change significantly. The move from hospital-based teaching to the higher education environment has resulted in the introduction of a wider variety of content relevant to the changing health care context. Becoming a health professional, in this case a registered nurse or midwife, is a process of change that requires cognitive flexibility and ongoing self-development; essential to the development of new skills and ideas (Kessler, 2013). Furthermore, innately embedded in the role of a nurse or midwife is teaching, mentorship and leadership (Nurses and Midwifery Board of Australia [NMBA], 2018; NMBA, 2016). Thus, nurses and midwives are expected to be educators. This expectation however, is largely focused at the
‘relevant clinical and academic preparation and experience’ and are qualified to at least one tertiary qualification standard higher than the program of study being taught, or with equivalent midwifery practice experience’ (Australian Nursing and Midwifery Accreditation Council [ANMAC], 2014 p 21). The transition from one identity (clinician), to another (academic),
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Corresponding author. E-mail addresses: [email protected] (L. Ebert), [email protected] (L. Mollart), [email protected] (S.J. Nolan), Elaine.Jeff[email protected] (E. Jefford). https://doi.org/10.1016/j.nedt.2019.104263 Received 30 April 2019; Received in revised form 26 August 2019; Accepted 1 November 2019 0260-6917/ © 2019 Published by Elsevier Ltd.
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phases (Cooperrider and Whitney, 2000), which Dewar (2014) adapted (shown in bold font) to better suit a health practitioner audience.
can lead to feelings of insecurity in terms of professional identity (Ennals et al., 2015). This paper explores the experiences of nurses and midwives teaching in the academic environment.
▪ Discover (Appreciate) people work together to discover what is currently working well in the organisation/unit ▪ Dream (Envision) people use knowledge from discovery phase to help them consider what practices they would like to see more of in the future ▪ Design (Co-create) people work together to plan how they could work towards achieving aspirations set out in the envision phase. ▪ Destiny (Embed) people consider what would need to happen to make this new way of working routine practice
2. Background Explicit within International and Australian regulatory documents, are expectations around teaching, mentoring and leading within the nursing and midwifery context (International Confederation of Midwives, 2018; Nurses and Midwifery Board of Australia, 2018; Nurses and Midwives Board of Australia, 2016). Upon graduation, nurses and midwives are expected to teach, supervise and assess others within the clinical context, as part of their professional scope of practice. In the higher education sector, the nurse or midwife academic is presented with the task of fostering an environment that supports and inspires student learning to graduate as safe and capable health care practitioners (Australian Nurses and Midwives Accreditation Council, 2012, 2014). New academics draw on their individualised set of skills and knowledge, gained in the clinical context, to translate theoretical knowledge into the contextual world of nursing or midwifery practice (Logan et al., 2016). Consequently, the experience, teaching skills and underpinning knowledge of the academic is key in the translation of knowledge into teaching practice. Despite this, there is limited research on how the nurse or midwife academic makes the transition from clinical mentor, teacher and supervisor to effective academic educator. While a clinical nurse or midwife may have a strong professional identity as a competent or experienced clinician, the transition from clinician to academic in the tertiary environment is often complex, with a significant difference in roles and scope of practice (Ennals et al., 2015). For a shift in professional identity to occur, academics must develop new skills, cultivate a teaching philosophy while also determining how their teaching practice and student learning is to be assessed (Duffy, 2013). Encompassed in this professional identity is the organisational requirement to deliver a unit of study in accordance with National accreditation standards (ANMAC, 2012, 2014) and quality educational frameworks (Australian Qualifications Framework Council, 2013). Understandably, Gourlay (2011) contends shifts in professional identity and changes to scope of practice can be stressful. This paper explores academics' experiences of teaching a unit of study to thirdyear, undergraduate, nursing and midwifery students at two regional universities in Australia. Although the unit of study participating academics was teaching focused on mentorship, leadership and teaching, knowledge created from this study is applicable to all nurse or midwife academics and higher education orgainisations.
In the Appreciate phase the participants collectively identified what was working well within the unit of study, then drawing on their knowledge and skills of teaching, considered what worked and what mattered in relation to their teaching to facilitate the best aspects of the teaching experience (Envision, phase). In other words the affirmative topic in this study was discovering and building upon academics' experiences of delivering a unit of study to undergraduate third year nursing and midwifery students. The intended outcome of the AI participative approach is changes being made in the way the academics are supported to teach and deliver a unit of study (Co-Create phase) through application of the senses framework. The senses framework is underpinned by the following attributes, Security (feeling safe), Belonging, Continuity (making connections), Purpose, Achievement and Significance (feeling valued) (Nolan et al., 2006). Following delivery (Embed phase) of the unit of study, using emotional touch points and caring conversations (Dewar, 2014, 2019), each participant gave their narrative drawing upon their unique, subjective historical and cultural influences and/or beliefs as well as constructing ‘in the moment’ relational views. Through an iterative process, with an affirmative focus, AI gave voice to finding out what was valued, what mattered, what was important, what worked well and potential new ways of doing (Nolan et al., 2006). 3.1. Setting Participant academics were from two Australian regional universities. University B straddles the New South Wales-Queensland border whilst University A is situated in New South Wales. Both universities provide a unit of study focusing on mentorship, leadership and teaching in the final year their nursing and/or midwifery degrees. 3.2. Participants
2.1. Objective Seven academics participated in this study. Four were full-time university employees (two at University A and two at University B), three were sessional (casual) employees (one at University A and two at University B). One participant had a teaching qualification. Four participants taught the unit to midwifery students only and three to both nursing and midwifery students.
This study explored the experiences of nurse and midwife academics teaching in the higher education sector. The aims of this study were: ▪ To develop an understanding of how the nurse or midwife academic realises their ability to deliver a unit of study. ▪ To explore, what is valued, what matters and identify facilitators to effective teaching.
3.3. Ethical considerations
3. Methods
Ethical approval was granted by relevant universities Health Research Ethics Committees (HREC). The HREC numbers were: H2018-0299 (University A) and ECN-18-021 (University B).
An Appreciative Inquiry (AI) approach was used to explore the social world and experiences of seven academics, who facilitated a unit of study to undergraduate, third-year nursing and midwifery students. The epistemology of AI is underpinned by social constructionism, whereby key elements within the social world are interwoven, created and coconstructed through narratives (Kung et al., 2013). Importantly, using AI and moving to a ‘best of what is’ focus, an emancipatory discourse begins to emerge (Reason and Bradbury, 2001). The emancipatory discourse of AI is realised through a cyclical process consisting of four
3.4. Data collection Individual interviews were conducted by one of the authors, a researcher well versed in AI methodology. Unlike traditional interviews, emotional touchpoints and visual imagery were used to facilitate a deep understanding of what academics valued about teaching the unit. Using the stem word(s) “teaching this unit” participant's were invited to share 2
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Table 1 Examples of emotional words. Positive Encouraged Excited Reassured
Negative Included Moved Confident
Inspired Respected Motivated
Powerless Unsupported Let Down
Worried Awkward Vulnerable
Confused Frustrated Misunderstood
the academic environment. “I don't know, whether I felt valued… I found you've got to have the experience or confidence behind you to present and teach them because they will easily find someone who's a phoney or doesn't know what they are talking about {Educator 5]”. Participants expressed they valued working and learning alongside students. The teaching environment was more productive when there was a sense of mutual respect and collaboration between learner and academic. “I actually learnt from some of the students, so that was lovely too, to be learning from each other [Educator 2]”. Partnerships between teacher and student were thought to facilitate safety to explore, share and express ideas freely within the teaching environment. Educators expressed that “they [students] were all quite proactive and happy to voice their thoughts and be involved and things [Educator 6,” and “it just encouraged me to keep trying new ways of imparting this information and how we could co-create in order to help them understand [Educator 1]”.
their experiences. Participants were given a list of positive and negative emotional words and invited to choose 3–5 that resonated with them in relation to the stem word(s). Alternatively, participants could create their own emotional word(s), although none elected to do so. Next participants were asked to share a narrative about their chosen words and how they related to the stem. Participants were then invited to relate their experiences to positive emotional words and what may have been needed to turn negative words into positive experiences (Dewar, 2014). Examples of emotional words are shown in Table 1. Interviews were 25–30 min duration, were digitally recorded and transcribed verbatim. 3.5. Data analysis The researchers read each interview transcript multiple times, looking carefully for the plot; the voice of ‘I’; relationships; key words, phrases as well as the cultural contexts and social structures (Doucet and Mauthner, 2008; Mauthner and Doucet, 1998). Narratives were closely analysed in terms of positive and/or negative teaching experiences. This emic interpretation, through the identification of recurrent phrases or meanings attributed to teaching experiences, was based solely on the academics' perspectives (Denzin, 1989; Denzin, 1992; Denzin and Lincoln, 2005). The research team shared their analysis to validate study findings, particularly the interpretation of narrative meaning and concept names identified. The researchers then applied an etic perspective by drawing on literature and critical reflection (Jefford and Sundin, 2013).
4.1.3. Valued unit topic Participants considered teaching students how to teach within the clinical context was an essential skill of the health care professional. They were concerned however; students would not understand the value of the unit. Providing discipline content as well as the relevance of content to professional scope of practice is an issue for academics. “I don't know whether they saw the relevance of this subject… [Educator 5]”. “I don't really approach the course from a really high theoretical perspective, because I think they are going to get lost in that [Educator 4]”. To ensure students understood the value of the unit participants used real-life scenarios. “I look at them and say, ‘what can I help you guys learn that… you can use, the first time you take a student, the first time you have to teach a patient [Educator 4]”.
4. Results
4.2. Feeling safe
Findings are presented using participants' verbatim quotes. Three overarching themes were identified: (i) being valued, (ii) feeling safe and (iii) connections. Study participants are identified as Educator followed by an assigned participant number.
4.2.1. Feeling safe to teach the topic The transition from one identity (clinician), to another (academic), can often lead to feelings of insecurity in terms of identity as well as knowledge and skills. “I felt somewhat anxious in the fact that it was a new method [of teaching] to me that I actually wasn't particularly familiar with beforehand [Educator 7].” Teaching cross-discipline was a further challenge for some. “I had to use my personal experiences [in nursing] … So, I still used the content of the subject but tried to make it more relevant for the student midwives [Educator 5].”
4.1. Being valued 4.1.1. Valued as an educator - by colleagues and organisation New academics often come to the university environment as capable and autonomous clinicians. If they do not feel their unique set of teaching skills and knowledge is valued, they can experience frustration. “I guess the frustration came about with the fact that it was very prescribed, just to what we were teaching, and the way it was set out [Educator 6]”. Participants also felt there was a lack of appreciation for new or creative teaching viewpoints aimed at enhancing teaching. “I have got particular issues with the way the hierarchy currently works and the lack of support that comes with trying to push new teaching methods [Educator 4]”.
4.2.2. Feeling safe in transitioning as an educator Identity as an academic develops over time and with the transition in self-identity comes confidence in teaching abilities. One participant (with an additional teaching and learning qualification) felt secure enough within their academic identity to make mistakes, acknowledging and correcting them in front of the students. “I was correcting myself the whole time but doing it out loud. The students said to me how good that made them feel, because when they realised, it was ok, it was a safe environment [Educator 1]”.
4.1.2. Valued as an educator - by students Participants voiced feeling valued as an educator when they received positive feedback from students. Affirmative feedback encouraged academics to continue to use the teaching methods and/or skills, viewed as positive by students. “I got a lot of feedback from the students individually about what they really liked about the content or about my delivery of it [Educator 6]”. Being valued as an educator, however, was not instantaneous when moving from the clinical environment to
4.3. Connections 4.3.1. Connections with students Creation of a safe learning environment is contingent upon the teacher's ability to build a relationship or connection with the students. 3
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“I think … establishing the connection. I felt very safe, sharing how I was feeling… showing my vulnerable side…, that was probably because we established a relationship based on trust from the very beginning [Educator 2]”. The sense of connectedness was harnessed when academics had prior interactions with students. “I really feel quite connected to the whole cohort in [unit of study] as I also taught, the same cohort back in their very first semester [Educator 5].” Conversely, an absence of connection was thought to be challenging, for the educator, when attempting to engage with students, “the students who didn't come to the tutorial… I wasn't connected to because I had no conversation face to face or via email… [Educator 5].”
rates (Cruickshank and MacDonald, 2016). Adding to the complexity of role transition is the need to appear an expert in relation to discipline specific knowledge. In the discipline of mathematics, the level of an academic's pedagogical content positively influenced the academic's professional development as well as enhancing student learning outcomes (Callingham et al., 2016). Smith and Boyd (2012) contend the translation of knowledge to another discipline can be difficult when attempting to contextualise content from a single discipline perspective. With an increasing push in higher education to have cross disciplinary teaching, the transition in role identity for new academics may be further hindered. Nursing and midwifery academics, as highlighted in this study, are often required to teach cross-discipline student cohorts or content outside their clinical area of expertise. This situation hinders role development and adds to the uneasiness that may be experienced when transitioning from clinician to academic. Nurse academics have previously voiced concerns regarding ‘feeling like a fraud’ or an imposter (Findlow, 2012; Parkman, 2016). These fears may, indeed, hold true for both nursing and midwifery academics, whose disciplines only entered the higher education environment at the turn of the millennium. Findlow (2012) asserts that fear can result in less confident engagement in team discussions and/or university activities which may hinder an academic's ability to build connections and therefore, gain support from colleagues. Whilst it has been well researched that a student's sense of belongingness and connectedness impacts on student retention, progress and success (Hagenauer and Simone, 2014; Krause and Armitage, 2014; O'Meara et al., 2017) there is less research about academics' sense of belonging, connectedness and teaching satisfaction. Schrodt et al. (2003) argue new academics tend to pursue open communication with colleagues as they confront the challenges of their new role. More recently, a study by Arian et al. (2018), conveyed new nurse academics who felt supported through teambuilding and mentoring activities had higher job satisfaction scores. Importantly, organisations that nurture supportive connections and open communication networks between colleagues and management are thought to facilitate healthier work environments, increase job satisfaction and productivity (Arian et al., 2018; Lee et al., 2017). Overall, it seems fostered connections with colleagues supports growth as an academic, facilitates the development of a teaching scope of practice and assists in feeling feel safe to experiment with teaching strategies. Whilst research is abundant on the positive learning outcomes of creating a safe teaching environment for students (Kidger et al., 2010; Segrott et al., 2013; Turner and Braine, 2015) there has been less focus on the emotional well-being or creation of a safe teaching environment for the academic. When studying high school teacher experiences, Segrott et al. (2013) found teachers enjoyed lessons in which they were able to teach creatively using their own ideas. For the nursing or midwifery academic to teach creatively autonomously, it is proffered that they must first feel safe to explore the teaching environment. In the current study, participants expressed they felt valued and therefore safe to experiment with their teaching skills when they had connections with students and/or prior knowledge of the teaching content. Therefore continuity of relationships with student cohorts can facilitate effective and creative teaching environments.
4.3.2. Connections and continuity in teaching Consistency or continuity of teaching methods and topic content was noted to enhance the learning environment while facilitating professional development. “I think next year…I will have gained from this experience, and build on the way we interact with each other, re-look at the activities, which ones worked really well [Educator 3].” Equally, a lack of continuity of content or relevant teaching resources was seen to hinder an educator's ability to teach. “Because I taught nursing the year before and then the midwifery students for the first time this year, … I was unprepared …it was focused on nursing, …had to change it quite a lot to make it relevant to the midwifery students [Educator 3].” 4.3.3. Connections with colleagues A sense of connection with colleagues was also viewed by participants as beneficial when trialing or implementing new teaching strategies or content. A participant described how, when implementing new teaching strategies, her experience was positive due to the encouragement of colleagues: “It's exciting to establish and develop a partnership with [the] midwifery faculty… It's exciting to be using a different approach to teaching and learning [Educator 2]”. In summary, findings from this study indicate that academics need to feel valued and safe to use their individual set of teaching skills and knowledge to effectively teach students and successfully make the transition from experienced clinician to educator in an academic setting. 5. Discussion Historically, nursing and midwifery education was undertaken in the clinical environment. Transition into the academic environment has impacted the delivery of educational content and the required qualifications and experiences of educators. Typically, those who enter the nursing and midwifery academic environment in Australia come from a clinical background. For academics educating future nurses and midwives outside the clinical context, a different set of skills and practice standards, against which they are appraised, is required (Findlow, 2012; ICM, 2018; NMBA, 2018; NMBA, 2016). Currently, there is scant research exploring the experiences and support mechanisms required for nurses and midwives to make the transition to academic. Consequently, discussion around being valued, feeling safe and making connections, draws on literature pertaining to teaching in other professions and contexts. Concerns voiced in this study are similar to those voiced by other nursing, and allied health academics who reported transition from clinician to academic involved considerable challenges, including the development of a teaching practice and identity (Smith and Boyd, 2012). The introduction of a mentoring program has been shown to facilitate recruitment, retention, professional development and experiences for new nursing academics in the United States (Feldman et al., 2015). Furthermore, the growing research area of ‘gratitude in education’ indicates that educators who feel valued by students and supported by colleagues, develop their teaching strategies earlier, have a smoother role transition with increased job satisfaction and retention
6. Strengths and limitations Limitations of this study include, the small number of participating academic educators (n = 7) and limited number of study sites: two regional Australian universities. The findings therefore, are not generalisable to all nursing and midwifery academics. The strength of this study is that it gives a preliminary insight into the experiences of academics and what impacts their ability to effectively teach the next generation of nurses and midwives.
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7. Conclusion
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Findings from this study indicate nursing and midwifery academics need to feel a greater sense of being valued and connected in the academic environment. They need to feel safe to successfully and positively transition from clinician to academic while developing their unique set of teaching skills. When envisioning what would be ideal, a greater degree of support from colleagues and the organisation is required. Universities have an important role to play in fostering environments that actively promote and acknowledge an academic's need to feel valued and safe as an educator and cultivate feelings of connection and engagement with students and other academics. Organisational support will allow academics to feel safe to express their individual teaching styles and further develop as an educator. Nursing and midwifery academics need to be valued as an educator by students, colleagues and their organisation. Organisational and professional support in the form of clear delineations in roles and responsibilities, scope of practice and ongoing professional development can assist academics in their professional identity transition. A prerequisite for nurses and midwives, applying for a position as an academic, to attain ‘a teaching in the higher education sector qualification’ may support the academic's professional role transition. This is a preliminary exploration into the experiences of nurse and midwifery academics. Larger studies may provide further understandings of the facilitators and barriers to effective role transition from clinician to academic in the nursing and midwifery education context. Acknowledgements This research was supported financially through a University of Newcastle (UON) Teaching and Learning Strategic Pilot Grant. The funding source had no involvement in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. Declaration of competing interest There are no competing interests for the authors. References Arian, M., Soleimani, M., Bagher Oghazian, M., 2018. Job satisfaction and the factors affecting satisfaction in nurse educators: a systematic review. J. Prof. Nurs. 34 (5), 389–399. Australian Nursing and Midwifery Accreditation Council [ANMAC]. (2014). Midwife: Accreditation standards. In. Canberra: ANMAC. Australian Qualifications Framework Council. (2013). The Australian Qualifications Framework. 2nd. Retrieved from www.aqf.edu.au Callingham, R., Carmichael, C., Watson, J., 2016. Explaining student achievement: the influence of teachers’ pedagogical content knowledge in statistics. International Journal of Science & Mathematics Education 14 (7), 1339–1357. https://doi.org/10. 1007/s10763-015-9653-2. Cooperrider, D. L., & Whitney, D. (2000). A Positive Revolution in Change: Appreciative Inquiry. In D. l. Cooperrider, P. F. Sorensen, J. Whitney, & T. F. Yaeger (Eds.), Appreciative Inquiry: Rethinking Human Organization Towards a Positive Theory of Change. Champaign, IL: Stipes Publishing LLC. Cruickshank, V., MacDonald, A., 2016. Teachers who feel appreciated are less likely to leave the profession. Retrieved from. http://www.utas.edu.au/news/2018/1/15/ 511-teachers-who-feel-appreciated-are-less-likely-to-leave-the-profession/. Denzin, N., 1989. Interpretative Interactionism. Sage, Thousand Oaks. Denzin, N., 1992. Interactionsim and Cultural Studies: The Politics of Interpretive Interactionsim. Basil Blackwell, Cambridge. Denzin, N., Lincoln, Y., 2005. The Sage Handbook of Qualitative Research, 3rd ed. Sage Publications, Thousand Oaks. Dewar, B., 2014. Appreciative inquiry: the appreciative inquiry process. In: My Homelife Scotland, Retrieved from. http://myhomelife.uws.ac.uk/scotland/what-is-
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