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Supporting and supervising district nurse students through patchwork text writing
Nurse Education in Practice 11 (2011) 6e13
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Supporting and supervising district nurse students through patchwork text writing Gaynor M. Mabbett 1, Emrys R. Jenkins*, Andrea G. Surridge 2, Joanna Warring 3, Elizabeth D. Gwynn 4 Swansea, United Kingdom
a r t i c l e i n f o
a b s t r a c t
Article history: Accepted 8 May 2010
This article reports research and supervision practice experiences of teachers on a community nursing module, assessed by a patchwork text. The nature, relevance and characteristics of support and supervision involve judging use and relevance of story, personal memory and imagery as means of illustrating creativity and self-evaluative questioning interlinked with empirical evidence, research and policy discourses. All of these diverse elements require synthesis by practitioners if they are to demonstrate essential skills of community working, including responding to situational challenges, unpredictability and use of evidence in context. Supervision is characterised less by information provision and more by assisting students to understand connections and significance with the reflective diary assuming a crucial role in helping students appreciate personal and aesthetic dimensions. Challenges for supervisors include allowing students freedom to write in imaginative ways bounded by indexes of quality; and to act as role models, making explicit their own reflecting, open mindedness, connecting and synthesising. Use of an extended epistemology has helped supervisors appraise and value; balancing advice and direction with facilitation; diversity and homogeneity; parts and whole, expression, style and overall coherence. Finally, limitations and negative resource implications are identified and considered. Ó 2010 Elsevier Ltd. All rights reserved.
Keywords: Student support Supervision Role modelling Aesthetics Interrelationships Reflective diary
Introduction An MSc/BSc (Hons) Community Health Studies (district nursing) module designed to develop students’ knowledge and skills in practice development, is assessed via a patchwork text (Jenkins et al., 2009; Surridge et al., 2010; Winter, 2003; Winter et al., 2004). The module runs annually from October to March/ April, delivered mainly via action learning (AL) sets, supplemented with other methods, seminars and E learning. Between 2 and 4 AL sets usually run, comprised of 6e8 students plus facilitator meeting at 4e6 weekly intervals with facilitators debriefing collectively after each set. Module content includes leadership, change management, practice development and action learning. This paper focuses on the nature, characteristics and relevance of student supervision and support by us (authors), the teaching
* Corresponding author. Tel.: þ44 01792 205678x5611; fax: þ44 01792 295487. E-mail addresses: [email protected] (G.M. Mabbett), E.R.Jenkins@ swansea.ac.uk (E.R. Jenkins), [email protected] (A.G. Surridge), J.Warring@ swansea.ac.uk (J. Warring). 1 Tel.: þ44 01792 205678x8535; fax: þ44 01792 295487. 2 Tel.: þ44 01792 205678x2232; fax: þ44 01792 295487. 3 Tel.: þ44 01792 205678x8538; fax: þ44 01792 295487. 4 Tel.: þ44 01792 895770; fax: þ44 01792 839051. 1471-5953/$ e see front matter Ó 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.nepr.2010.05.006
team. Mansell et al. (2002) outline disparate approaches to student supervision (in relation to essays and assignments). Our use of the term ‘supervisor’ refers to the authors as university teachers and matches the ‘negotiated order’ model (Acker et al., 1994) whereby supervisors are participative and facilitative, avoiding being directive. A comprehensive account of the module and research into it can be found in Jenkins et al. (2009), specific elements Relating to patchwork text as suImative assessment can be found In Surridge et al. (2010). The patchwork text consists of the incremental construction of separate components (patches) either as accounts of, or stories from, practice, and literature/research that are shared reflexively in small group action learning sets. These reflections enable retrospective interpretation on of the earlier pieces and lead to the text illustrating starting points/experiences, reflections, ongoing learning and practice experiences and eventually, an overall coherent synthesis. The patchwork text asks students to combine different ways of writing (e.g., a story, a personal memory, a book review, a commentary on a lecture, notes from a placement experience, etc.) and to move between description, imaginative creation and analytical commentary. Students are encouraged to integrate the diversity of parts of the course/module in order to make learning a process of constructing meaning (as opposed to merely
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mastering information). Students should keep a record of their experiences and reflections using a reflective diary (Hays, 2005; Heath, 1998). This record will inform the creation of ‘patches’ that identify particular parts of the student’s learning journey as well as eventually providing an overall coherent account of personal learning and development, theory, and practice in relationship. No types of patch or minimum/maximum number of patches are
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prescribed. Students literally create their own and develop the overall text as the module proceeds. Combinations of different ways of writing, using story, personal memory or imagary help develop students’ creative thinking and encouragement to explore feelings and perceptions as well as knowledge and skills through self-evaluative questioning. Self-evaluative skills are essential when preparing nurses for
Box 1: An illustrative extract taken from assignment guidelines.
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community working, where they are challenged situationally, often alone, where unpredictability is the norm and evidence needs to be used in context (Scott et al., 2008). To prepare students better for their role in critically informed and situational decision making, educators need to challenge traditional ways of teaching and assessing to ensure learning is recognised and appraised in context. Action Learning provided a suitable mode for helping teachers meet individual student need through linking individuals with peers in their own set(s) and through their practice accounts. These functions warrant careful facilitation, including using the ‘one at a time rule’ and supportive challenge (Gribben and Cochrane, 2006; McGill and Brockbank, 2004). Our own research (Jenkins et al., 2009) has supplemented these qualities with explicating the value of role modelling by facilitators.
Supervision challenges Our planned approaches to facilitation and supervision were informed predominantly by our own education practice experiences and literature relating to action learning, practice development and clinical supervision (Jenkins, 2007; McCormack et al., 2004; McCormack and Slater, 2006; McGill and Brockbank, 2004; Rafferty et al., 2003). Mansell et al. (2002) supplemented work we had valued formerly, particularly Winters’ (2003) comprehensive explanations of assessment applicability, including Youngs’ (1999) suggestions relating to assessment and learning, individual differences, feedback, reflection and assessment as an integral element of courses (rather than being ‘bolted on’). Supervising students through patchwork text writing was a new experience for us. Some teachers had used action learning extensively, others less so. The importance of facilitating (well) caused some of us continuing anxiety.
Teacher 1: I was again surprised by [colleagues’] anxiety in relation to running the action learning sets e all of them facilitate group work and are involved in reflective practice, I felt that this experience would help them. I remember when I first reflected with students and remembered my own anxiety it must have been a similar issue. I do not know but as teachers we are perhaps worried about what other teachers think of us and in this situation would be concerned that we did not let the students “down” i.e. another facilitator would be better at this and the students in their action set would have better results at the end of the course. . we must not forget that students have a responsibility too in the learning process. (Teacher 1 diary extract) During planning and later, we sought likely solace in using existing criteria. Teacher 1: Have you come across any criteria for assessment?. Teacher 2: Some work has been done by Melanie Jasper and Christine Web, also, Endacott. I think that work is useful e it had limitations, hence my re-reading of Peter Reason and the idea of appraising quality through articulating choices. (Co-inquiry notes, July 10th, 2007) Supervisor input was characterised by assisting students to understand connections and significances. Writing the patchwork text became a means to connect selected diary and/or other reflective pieces into a coherent whole, illustrating student judgements about what and how they had learned. Supporting students was challenging for supervisors, not least in allowing them freedom to write in ways that did not follow the typical essay/academic format, yet was indicative of quality. Winter et al. (1999) suggests that students might write a patch from the perspective of one of their clients, imagining how the
Box 2: Examples of patches from an assignment (with permission).
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client would view them (the nurse) and how that view would have implications for professional practice. This imaginative way of writing can then be compared with relevant research to consider similarities, differences and implications. We followed this style and it pushed us to think that formerly, we had resisted this type of writing by students, encouraging traditional styles that excluded the imaginative in favour of the objective. Co-inquiry revealed that writing in more imaginative ways challenges students more, to produce work that demonstrates their attempts at synthesis through making explicit their perceived connections between theory, practice and reflection. An obvious challenge for supervisors was that we act as good role models through making explicit our own connecting and synthesising. These qualities were illustrated well by one student who created short poems to illustrate her learning (Box 2). Poems were elaborated comprehensively in the main body of the assignment where relevance to theory, research/evidence, literature and policy were clarified. The quality of poetry writing per se did not figure in judgements about assignment quality. Rather, we were interested in the students’ presentation of her learning about theory and practice interrelationships and also, her expressions of her own self-evaluative strategies, in ways that contributed to overall quality. The poems and accompanying text provided evidence of thoughtful, reflective practice as distinct from thoughtless adherence to prescribed directions. This view of practice, as routinely complex is especially true of community nursing where practitioners are faced with unpredictable situations and complex needs of patients and families, where “off the shelf” solutions are often inadequate because of contextual factors and limits. Prompting students to write more creatively is not without difficulty, a point illustrated by one district nursing student during a conversation with a supervisor: It was quite unexpected; universities don’t usually use that language to describe assessments. Once I found out a little bit more about it I felt less confused and although because I’m a very factual sort of person, I thought it involved creative writing to a degree, and a level of imagination. This is something I’ve never been particularly good at. I like things to be black and white, organised and filed. It was a challenge to me to try and open my mind to think in a different way. (Reflective discussion notes, 08-08-07) Supervisors were challenged to remain open to the widest variety of expressions of learning. For example, the extract (08-0807) shows how different people have different attributes, and we sought evidence and expressions of learning that clearly illustrated practice-theory linking with reflective analysis. This is likely to include presentation of ‘facts’ as well as poems (for example). Crucially, interconnecting a wider variety of expressions requires more critical thought and application by students and also by supervisors who have to judge assignments on their overall aesthetic qualities as well as specific content. Teacher: That’s what the patchwork text showed me, a different way of doing assessment, better quality. People learned to be better nurses than if we had given them an essay. We need to articulate it all so that the academic community can look at it and say, yes there is something here. (Co-inquiry notes, July 10th, 2007) Judgements about assignment quality require consideration of parts, whole and their interrelationship. To develop students’ creative and critical thinking skills, students are encouraged to reflect formally with community practice teachers (CPTs),
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lecturers and peers as well as during AL sets. We advocated appraising and choosing reflective frameworks/models and diary use. Reflective diary e it’s part in assignment construction Assignments are invariably made up of diverse yet interrelated parts. These include theory, practice experiences, reflective analysis relevant to practice development, management of change, innovation and leadership. Students who present this diversity through critical reflection (as distinct from descriptive though accurate accounts) and interrelationship, produce exemplary assignments. These demonstrate creativity, analysis and synthesis. Supervisors/ markers are similarly challenged to adopt more eclectic appraisals of student writing to provide feedback on strengths and weaknesses, content and presentation, expression, style and overall coherence. Importance of the reflective diary was a recurrent theme in our research (Jenkins et al., 2009; Surridge et al., 2010). Students who diligently kept a diary, particularly through following suggestions by Heath (1998) on making it critical rather than mere description and on writing as reflection (Hays, 2005; Rolfe et al., 2001) found it easier to write the assignment and produced higher quality work. One student explained that had she not kept a diary, she would have been unable to recall the events that had occurred and would have found writing up the work much more difficult. In fact this student felt that she had too many diary entries, too much material and that it was difficult at times to know what to use in the final writing up of the assignment. Teacher: “But you kept your diary” Student: “Yes and it saved me in the end” [laughter]. I felt so afraid of failure that I wrote every single thing down. I even found myself writing when stopped at the traffic lights. I advise next year’s students that they try to identify the most pertinent issues. That is, those most relevant to the module, or course. (Reflective discussion notes, 16-08-07) This reinforces the value of students prioritising and being selective in maintaining diaries, and other writing for assignment work. Of course, what may seem relatively unimportant at the outset could be reappraised as being very valuable at the end. There seem to be no right, wrong or discrete responses to these concerns. Our advice to students is that generally, they should try to more consciously notice and attend to their experiences and perceptions; should a student feel an issue is important at the time of recording then it is worth noting, and even in instances where there is doubt about relevance or importance/value. It is preferable to have more rather than fewer experiences to work with and we repeatedly see examples where the seemingly unimportant has become regarded as significant. Writing about AL set work and the patchwork text were perceived as helping students relate theory to practice: “It definitely opened my mind and it definitely enabled me to relate theory to practice. . the other thing I realised was that whereas in an essay you start it and stop it within one piece of time so to speak, the patchwork text basically started at the beginning of the course and lasted until the end, which was another aspect that I was not used to” (Reflective discussion notes, 08-08-07) Aesthetic appreciations and an extended epistemology Carper (1992) and Johns’ (1995) illustrations of Carpers’ ways of knowing fit well with the patchwork text. It includes explicitly,
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elements of artistry and creativity rather than the exclusively techno-rational. We recognise contentious aspects of Carper, particularly the aesthetic dimension (see for example, Austgard, 2006; de Raeve, 1998; Duff Cloutier et al., 2007; Wainwright, 2000). We offer no philosophical or conceptual analysis of the term ‘aesthetics’ in nursing here, though we shall attempt to clarify our understanding and use of the term. In appraising experience and writing that presents (and represents) experience, we see aesthetic appreciation as juxtaposing, making explicit connections between patterns, gracefulness and integration of parts and whole (see, for example de Raeve, 1998; Gaydos, 2004; Leight, 2002). In summary, our aesthetic appreciation involves noticing and confirming meaningful links between parts and whole, including multiple ways of knowing, valuing equitably the empirical, ethical, personal and aesthetic. We have grounded this way of understanding experience and writing, in the extended epistemology of John Heron and Peter Reason (Heron, 1996; Heron and Reason, 2001, p. 183), outlined as: 1. Experiential knowing, including tacit, intuitive, felt knowing; 2. Presentational knowing, sharing experiences using words, pictures, poems and stories to clarify meaning and appreciation; 3. Propositional knowing or knowing about e ideas, concepts and theories; 4. Practical knowing: skills and abilities, knowing how to do. We use Carper (1992) pragmatically, without raising it to panacea status. When reviewing patchwork texts we usually see a range of students who use Carper, some illustrating better understanding than others. Those who use the model most effectively seem to have a better aesthetic appreciation of what they are trying to convey, mainly in keeping with presenting a clear “emic perspective” (Duff Cloutier et al., 2007, p. 8) that is often enhanced through use of story, imagery or poetry. Other students also illustrate admirable aesthetic appreciations without reference to Carper, choosing alternate models/frameworks and reading (for example, Greenwood, 1998; Hannigan, 2001; Johns and Freshwater, 2005; Mezirow, 1990; Rolfe et al., 2001). We have identified elements that are difficult to express yet which we wish to make explicit, and not ‘disappear’ (Fletcher, 1999) or deny, including the value of aesthetic appreciations, as distinct from factual accuracy. I feel that I am at the stage of seeing the whole of a piece of work, I am less concerned with minor details and I am more concerned with understanding, clarity, application and an aesthetic appreciation of what the student is trying to convey. Surely this is what nursing is about? The complex nature of caring for an individual and family with needs that are health and socially related in context of a particular culture requires a diverse set of skills that are holistic in nature as opposed to reductionism akin to the biomedical approach that predominates medicine in the western world. (Teacher personal diary extract, 24/11/08) This resonates with the relationship of aesthetics to factual knowing that Gillespie et al. (2009) identify (albeit in an operating theatre context), whereby nurses valued aesthetics more than, for example, theatre technicians who value more the technical/factual. In a district nursing context, we notice and concur that recent policy and service changes have led to district nurses’ personal and aesthetic knowing of patients being: “.replaced by a knowing about or knowing by proxy. In place of personal knowing, a new discourse of ‘‘techno-care’’ or empirics
was replacing the old patterns of knowing, relegating personal, moral and aesthetic knowing to secondary positions”. (Speed and Luker, 2004, p. 929) We are not claiming that empirical knowing is better or inferior to personal, moral or aesthetic knowing in improving patient care. Our claim is that patient care is improved by valuing (and using) diverse ways of knowing more proportionately. So what, re supporting and supervising students? We revisited local (earlier) research into clinical supervision (Jenkins, 2007; Jenkins et al., 2000; Rafferty et al., 2003) to illuminate process issues that might relate to student assignment supervision. Regular feedback, dialogue, reflection and mutually agreed ground rules all apply to both contexts (clinical and student supervision), yet the most significant revelations came from reviewing work on research supervision by Judi Marshall and Peter Reason (Marshall and Reason, 1993; Reason and Marshall, 2001). In similar ways, we adopt process oriented approaches, seeking to ‘mirror’ student practice and learning experiences during supervision (for example, some students have used notes of supervision sessions as part of their diary materials and patches). We continually balance giving advice and direction (suggesting reading, or review of methods etc) with withholding advice and direction, being more facilitative. Supervision, like AL set facilitation, requires challenge with support (McGill and Brockbank, 2004) if we are to avoid simply giving advice, complaining (or moaning) and complacency (Davis and Curzio, 2003). During AL sets, facilitators carry responsibility for role modelling constructive behaviour and attitudes. During individual supervision the dynamic is different, potential for unchallenged power imbalances warrants continuing attention. We offer strategies to assist self-reflection on supervision experiences. Attending to our role modelling, to what extent do we present students with exemplary and poor skills and attitudes? Do we adopt a dialectic mindset, seeking and valuing difference and similarity, diversity and homogeneity? Do we engage with peers (other supervisors) in critical dialogue to assist our reflections? Explaining our experiences and learning in writing is challenging, particularly in terms of interrelationships and connections. Fig. 1 is an attempt at an illustrative, more aesthetic presentation. ‘Doing’ (supervision) illustrates our recognition of Heron’s (1996, p. 34) “primacy of the practical”. Experientially, we continue to be surprised at; the variety and quality of student efforts; evidence of our own weaknesses and strengths; and we enjoy and value these surprises. Presentationally, we are striving to develop sharing (rather than retaining) that creates/helps create informative and expressive learning materials, including discourse contributions such as this article. Propositionally, we are struggling to understand how ever-changing interrelationships between the complexity of practice, epistemological diversity, critical appreciation, and our own emotional and intellectual competence, inform judgements about, for example, giving students feedback and awarding grades. Practically, we see evidence that our experience, presenting and conceptualising have helped us be better supervisors with the caveats that we can always be better supervisors and sometimes we remain poor supervisors. Readers may ponder limitations and negative resource implications of supervising as we do. Dalrymple and Smith (2008) explain how they (using patchwork text as assessment) provided extensive, formative feedback that was labour intensive. They aimed to feedback to students within 2 or 3 days of receiving drafts,
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Fig. 1. Supervision and support.
in keeping with what is generally held as sound educational practice.5 To manage the volume of work, they suggest a progressive limiting of numbers of drafts to be seen by supervisors, frequency reducing as time proceeds. Our experiences of supervision and feedback provision echo much of Dalrymple and Smith (2008), though the relative burdens are reduced for us because of at least 3 situational elements: 1. The module begins and continues via AL sets wherein students present and appraise their experiences, reading, ideas and decision choices. This is largely analogous to the functions of supervision. Appraising learning and practice through reflection, challenge and support are intrinsic to the AL mode of teaching/learning. As they learn, students generally require reduced amounts of feedback. 2. CPTs are required to verify that patchwork texts represent honest and accurate accounts as experienced by students in practice. This invariably involves critical dialogue and appraisal of student work as time proceeds.
5 The principle of providing feedback with minimal delay is one we value and try to adhere to. We have begun to question this though. Recently, a student presented work and sought a response. Unusual and demanding circumstances meant a delay of 5 days, including time over a weekend. When the teacher made contact, the student explained how she had reconsidered the issues, read, spoken with peers and clinicians and had reappraised key contentions independently. The types of questions we are asking now are:
a. Is it possible to give feedback too soon e and deny students opportunities for independent struggle with dissonance that leads to more meaningful learning (effectively spoon-feeding them)? b. What constitutes the optimal timing of feedback provision e and how might supervisors judge when it is wiser to delay?
3. Latter AL sets (those towards the end points of the module) involve more explicit appraisals of patches and/or written materials. This is coupled with an emphasis on interrelating written work with practice experiences and implications so that any perception of ‘paper exercises’ is avoided. Even so, our formal academic supervision on the module is more labour intensive than on other modules/courses, because of accommodating an extended epistemology, ensuring patchwork texts constitute meaningful assessment of students’ learning in multiple domains of knowing including critically informed practice application. Supervision on other modules/courses normally involves according priority to students’ empirical/conceptual presentations, which is less demanding. We question our conceptualising of supervision, as a means of providing feedback (relatively straightforward identification of strengths and weaknesses in written drafts) and more as an intrinsic mode of
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learning with more emphasis on factors identified by Snowball et al. (1994) 15 years ago, albeit in relation to dissertation supervision: “. partnership; signposting. and also contextual issues of humanness; time; and energy, which were needed to sustain the supervisory processes. The role of the dissertation supervisor was illuminated and the potential of using reflection as a tool for developing professional educational practice was realized. The importance of constructive support while engaged in processes of reflection cannot be underestimated. (Snowball et al., 1994, p. 1234) Summary & conclusion We sought to assess student learning in terms of appreciations of ever-changing complexities of practice and their informed, creative responses. This is quite distinct from assessment of knowledge, rules or procedures that we characterise as ‘off the shelf solutions’. The patchwork text functioned as a valid assessment of desirable attributes, and allowed individuals to express themselves in ways evidential of their self-evaluative development and application. Teachers, as supervisors, faced challenges similar to those faced by students. Each part of the assignment had to be appraised in context of the whole assignment and this required a level of analysis of parts and synthesis of whole that we claim represents an aesthetic appreciation. This synthesis or connection between constituent parts and whole is enhanced by explicating and interrelating different ways of knowing that are ultimately tested through practice relevance and application, including supervision practice. Supervisors were mindful they were constantly role modelling being self-evaluative, avoiding simple, often linear solutions such as when balancing advice and direction with withholding advice/ direction. This capacity for tolerating relative ambiguity without avoiding making decisions, is best sustained through regular peer support and dialogue. Of course, this in turn adds to the already labour intense supervision process. Our experience and research illustrates that patchwork text student supervision is challenging and demanding of time. For us, these costs are manageable and worthwhile because the action learning process mirrors much of the supervision process, and leads to quality of learning outcome. Using action learning sets enabled supervisors to engage with students in reflective dialogue that functioned to role model creative and critical development. Teacher: It is not to claim that the patchwork text assesses theory and practice together perfectly that would be utopian. But it does assess them better than an essay would. (Co-inquiry notes, October 1st, 2007) Finally, as a somewhat open-ended epilogue we present a patchwork text extract (including an image of a London bus) from a BSc student district nurse that provided supervisors with a wealth of material to explore. At the beginning of the course I felt I had been hit by a bus and dragged along. As I progressed with my increased knowledge and confidence I sat at the back watching people, eventually moving towards the middle and then the driver’s seat, the team being passengers on my bus. Now I feel like I am driving the bus, in control going in the right direction. I feel I will stop, pull over and have a break to reflect on future practice. The journey on the bus has taken many routes; narrow, windy, bumpy lanes and sometimes I have stopped at the crossroads to look at my map. However I now feel I am driving down the motorway, in the fast lane, in control knowing which turning to take picking up speed as I go. I
must remember speed, no more “hurry up” ways for me, best stay in third gear. (BSc student assignment extract, May 2009 with permission)
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Contents lists available at ScienceDirect
Nurse Education in Practice journal homepage: www.elsevier.com/nepr
Supporting and supervising district nurse students through patchwork text writing Gaynor M. Mabbett 1, Emrys R. Jenkins*, Andrea G. Surridge 2, Joanna Warring 3, Elizabeth D. Gwynn 4 Swansea, United Kingdom
a r t i c l e i n f o
a b s t r a c t
Article history: Accepted 8 May 2010
This article reports research and supervision practice experiences of teachers on a community nursing module, assessed by a patchwork text. The nature, relevance and characteristics of support and supervision involve judging use and relevance of story, personal memory and imagery as means of illustrating creativity and self-evaluative questioning interlinked with empirical evidence, research and policy discourses. All of these diverse elements require synthesis by practitioners if they are to demonstrate essential skills of community working, including responding to situational challenges, unpredictability and use of evidence in context. Supervision is characterised less by information provision and more by assisting students to understand connections and significance with the reflective diary assuming a crucial role in helping students appreciate personal and aesthetic dimensions. Challenges for supervisors include allowing students freedom to write in imaginative ways bounded by indexes of quality; and to act as role models, making explicit their own reflecting, open mindedness, connecting and synthesising. Use of an extended epistemology has helped supervisors appraise and value; balancing advice and direction with facilitation; diversity and homogeneity; parts and whole, expression, style and overall coherence. Finally, limitations and negative resource implications are identified and considered. Ó 2010 Elsevier Ltd. All rights reserved.
Keywords: Student support Supervision Role modelling Aesthetics Interrelationships Reflective diary
Introduction An MSc/BSc (Hons) Community Health Studies (district nursing) module designed to develop students’ knowledge and skills in practice development, is assessed via a patchwork text (Jenkins et al., 2009; Surridge et al., 2010; Winter, 2003; Winter et al., 2004). The module runs annually from October to March/ April, delivered mainly via action learning (AL) sets, supplemented with other methods, seminars and E learning. Between 2 and 4 AL sets usually run, comprised of 6e8 students plus facilitator meeting at 4e6 weekly intervals with facilitators debriefing collectively after each set. Module content includes leadership, change management, practice development and action learning. This paper focuses on the nature, characteristics and relevance of student supervision and support by us (authors), the teaching
* Corresponding author. Tel.: þ44 01792 205678x5611; fax: þ44 01792 295487. E-mail addresses: [email protected] (G.M. Mabbett), E.R.Jenkins@ swansea.ac.uk (E.R. Jenkins), [email protected] (A.G. Surridge), J.Warring@ swansea.ac.uk (J. Warring). 1 Tel.: þ44 01792 205678x8535; fax: þ44 01792 295487. 2 Tel.: þ44 01792 205678x2232; fax: þ44 01792 295487. 3 Tel.: þ44 01792 205678x8538; fax: þ44 01792 295487. 4 Tel.: þ44 01792 895770; fax: þ44 01792 839051. 1471-5953/$ e see front matter Ó 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.nepr.2010.05.006
team. Mansell et al. (2002) outline disparate approaches to student supervision (in relation to essays and assignments). Our use of the term ‘supervisor’ refers to the authors as university teachers and matches the ‘negotiated order’ model (Acker et al., 1994) whereby supervisors are participative and facilitative, avoiding being directive. A comprehensive account of the module and research into it can be found in Jenkins et al. (2009), specific elements Relating to patchwork text as suImative assessment can be found In Surridge et al. (2010). The patchwork text consists of the incremental construction of separate components (patches) either as accounts of, or stories from, practice, and literature/research that are shared reflexively in small group action learning sets. These reflections enable retrospective interpretation on of the earlier pieces and lead to the text illustrating starting points/experiences, reflections, ongoing learning and practice experiences and eventually, an overall coherent synthesis. The patchwork text asks students to combine different ways of writing (e.g., a story, a personal memory, a book review, a commentary on a lecture, notes from a placement experience, etc.) and to move between description, imaginative creation and analytical commentary. Students are encouraged to integrate the diversity of parts of the course/module in order to make learning a process of constructing meaning (as opposed to merely
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mastering information). Students should keep a record of their experiences and reflections using a reflective diary (Hays, 2005; Heath, 1998). This record will inform the creation of ‘patches’ that identify particular parts of the student’s learning journey as well as eventually providing an overall coherent account of personal learning and development, theory, and practice in relationship. No types of patch or minimum/maximum number of patches are
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prescribed. Students literally create their own and develop the overall text as the module proceeds. Combinations of different ways of writing, using story, personal memory or imagary help develop students’ creative thinking and encouragement to explore feelings and perceptions as well as knowledge and skills through self-evaluative questioning. Self-evaluative skills are essential when preparing nurses for
Box 1: An illustrative extract taken from assignment guidelines.
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community working, where they are challenged situationally, often alone, where unpredictability is the norm and evidence needs to be used in context (Scott et al., 2008). To prepare students better for their role in critically informed and situational decision making, educators need to challenge traditional ways of teaching and assessing to ensure learning is recognised and appraised in context. Action Learning provided a suitable mode for helping teachers meet individual student need through linking individuals with peers in their own set(s) and through their practice accounts. These functions warrant careful facilitation, including using the ‘one at a time rule’ and supportive challenge (Gribben and Cochrane, 2006; McGill and Brockbank, 2004). Our own research (Jenkins et al., 2009) has supplemented these qualities with explicating the value of role modelling by facilitators.
Supervision challenges Our planned approaches to facilitation and supervision were informed predominantly by our own education practice experiences and literature relating to action learning, practice development and clinical supervision (Jenkins, 2007; McCormack et al., 2004; McCormack and Slater, 2006; McGill and Brockbank, 2004; Rafferty et al., 2003). Mansell et al. (2002) supplemented work we had valued formerly, particularly Winters’ (2003) comprehensive explanations of assessment applicability, including Youngs’ (1999) suggestions relating to assessment and learning, individual differences, feedback, reflection and assessment as an integral element of courses (rather than being ‘bolted on’). Supervising students through patchwork text writing was a new experience for us. Some teachers had used action learning extensively, others less so. The importance of facilitating (well) caused some of us continuing anxiety.
Teacher 1: I was again surprised by [colleagues’] anxiety in relation to running the action learning sets e all of them facilitate group work and are involved in reflective practice, I felt that this experience would help them. I remember when I first reflected with students and remembered my own anxiety it must have been a similar issue. I do not know but as teachers we are perhaps worried about what other teachers think of us and in this situation would be concerned that we did not let the students “down” i.e. another facilitator would be better at this and the students in their action set would have better results at the end of the course. . we must not forget that students have a responsibility too in the learning process. (Teacher 1 diary extract) During planning and later, we sought likely solace in using existing criteria. Teacher 1: Have you come across any criteria for assessment?. Teacher 2: Some work has been done by Melanie Jasper and Christine Web, also, Endacott. I think that work is useful e it had limitations, hence my re-reading of Peter Reason and the idea of appraising quality through articulating choices. (Co-inquiry notes, July 10th, 2007) Supervisor input was characterised by assisting students to understand connections and significances. Writing the patchwork text became a means to connect selected diary and/or other reflective pieces into a coherent whole, illustrating student judgements about what and how they had learned. Supporting students was challenging for supervisors, not least in allowing them freedom to write in ways that did not follow the typical essay/academic format, yet was indicative of quality. Winter et al. (1999) suggests that students might write a patch from the perspective of one of their clients, imagining how the
Box 2: Examples of patches from an assignment (with permission).
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client would view them (the nurse) and how that view would have implications for professional practice. This imaginative way of writing can then be compared with relevant research to consider similarities, differences and implications. We followed this style and it pushed us to think that formerly, we had resisted this type of writing by students, encouraging traditional styles that excluded the imaginative in favour of the objective. Co-inquiry revealed that writing in more imaginative ways challenges students more, to produce work that demonstrates their attempts at synthesis through making explicit their perceived connections between theory, practice and reflection. An obvious challenge for supervisors was that we act as good role models through making explicit our own connecting and synthesising. These qualities were illustrated well by one student who created short poems to illustrate her learning (Box 2). Poems were elaborated comprehensively in the main body of the assignment where relevance to theory, research/evidence, literature and policy were clarified. The quality of poetry writing per se did not figure in judgements about assignment quality. Rather, we were interested in the students’ presentation of her learning about theory and practice interrelationships and also, her expressions of her own self-evaluative strategies, in ways that contributed to overall quality. The poems and accompanying text provided evidence of thoughtful, reflective practice as distinct from thoughtless adherence to prescribed directions. This view of practice, as routinely complex is especially true of community nursing where practitioners are faced with unpredictable situations and complex needs of patients and families, where “off the shelf” solutions are often inadequate because of contextual factors and limits. Prompting students to write more creatively is not without difficulty, a point illustrated by one district nursing student during a conversation with a supervisor: It was quite unexpected; universities don’t usually use that language to describe assessments. Once I found out a little bit more about it I felt less confused and although because I’m a very factual sort of person, I thought it involved creative writing to a degree, and a level of imagination. This is something I’ve never been particularly good at. I like things to be black and white, organised and filed. It was a challenge to me to try and open my mind to think in a different way. (Reflective discussion notes, 08-08-07) Supervisors were challenged to remain open to the widest variety of expressions of learning. For example, the extract (08-0807) shows how different people have different attributes, and we sought evidence and expressions of learning that clearly illustrated practice-theory linking with reflective analysis. This is likely to include presentation of ‘facts’ as well as poems (for example). Crucially, interconnecting a wider variety of expressions requires more critical thought and application by students and also by supervisors who have to judge assignments on their overall aesthetic qualities as well as specific content. Teacher: That’s what the patchwork text showed me, a different way of doing assessment, better quality. People learned to be better nurses than if we had given them an essay. We need to articulate it all so that the academic community can look at it and say, yes there is something here. (Co-inquiry notes, July 10th, 2007) Judgements about assignment quality require consideration of parts, whole and their interrelationship. To develop students’ creative and critical thinking skills, students are encouraged to reflect formally with community practice teachers (CPTs),
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lecturers and peers as well as during AL sets. We advocated appraising and choosing reflective frameworks/models and diary use. Reflective diary e it’s part in assignment construction Assignments are invariably made up of diverse yet interrelated parts. These include theory, practice experiences, reflective analysis relevant to practice development, management of change, innovation and leadership. Students who present this diversity through critical reflection (as distinct from descriptive though accurate accounts) and interrelationship, produce exemplary assignments. These demonstrate creativity, analysis and synthesis. Supervisors/ markers are similarly challenged to adopt more eclectic appraisals of student writing to provide feedback on strengths and weaknesses, content and presentation, expression, style and overall coherence. Importance of the reflective diary was a recurrent theme in our research (Jenkins et al., 2009; Surridge et al., 2010). Students who diligently kept a diary, particularly through following suggestions by Heath (1998) on making it critical rather than mere description and on writing as reflection (Hays, 2005; Rolfe et al., 2001) found it easier to write the assignment and produced higher quality work. One student explained that had she not kept a diary, she would have been unable to recall the events that had occurred and would have found writing up the work much more difficult. In fact this student felt that she had too many diary entries, too much material and that it was difficult at times to know what to use in the final writing up of the assignment. Teacher: “But you kept your diary” Student: “Yes and it saved me in the end” [laughter]. I felt so afraid of failure that I wrote every single thing down. I even found myself writing when stopped at the traffic lights. I advise next year’s students that they try to identify the most pertinent issues. That is, those most relevant to the module, or course. (Reflective discussion notes, 16-08-07) This reinforces the value of students prioritising and being selective in maintaining diaries, and other writing for assignment work. Of course, what may seem relatively unimportant at the outset could be reappraised as being very valuable at the end. There seem to be no right, wrong or discrete responses to these concerns. Our advice to students is that generally, they should try to more consciously notice and attend to their experiences and perceptions; should a student feel an issue is important at the time of recording then it is worth noting, and even in instances where there is doubt about relevance or importance/value. It is preferable to have more rather than fewer experiences to work with and we repeatedly see examples where the seemingly unimportant has become regarded as significant. Writing about AL set work and the patchwork text were perceived as helping students relate theory to practice: “It definitely opened my mind and it definitely enabled me to relate theory to practice. . the other thing I realised was that whereas in an essay you start it and stop it within one piece of time so to speak, the patchwork text basically started at the beginning of the course and lasted until the end, which was another aspect that I was not used to” (Reflective discussion notes, 08-08-07) Aesthetic appreciations and an extended epistemology Carper (1992) and Johns’ (1995) illustrations of Carpers’ ways of knowing fit well with the patchwork text. It includes explicitly,
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elements of artistry and creativity rather than the exclusively techno-rational. We recognise contentious aspects of Carper, particularly the aesthetic dimension (see for example, Austgard, 2006; de Raeve, 1998; Duff Cloutier et al., 2007; Wainwright, 2000). We offer no philosophical or conceptual analysis of the term ‘aesthetics’ in nursing here, though we shall attempt to clarify our understanding and use of the term. In appraising experience and writing that presents (and represents) experience, we see aesthetic appreciation as juxtaposing, making explicit connections between patterns, gracefulness and integration of parts and whole (see, for example de Raeve, 1998; Gaydos, 2004; Leight, 2002). In summary, our aesthetic appreciation involves noticing and confirming meaningful links between parts and whole, including multiple ways of knowing, valuing equitably the empirical, ethical, personal and aesthetic. We have grounded this way of understanding experience and writing, in the extended epistemology of John Heron and Peter Reason (Heron, 1996; Heron and Reason, 2001, p. 183), outlined as: 1. Experiential knowing, including tacit, intuitive, felt knowing; 2. Presentational knowing, sharing experiences using words, pictures, poems and stories to clarify meaning and appreciation; 3. Propositional knowing or knowing about e ideas, concepts and theories; 4. Practical knowing: skills and abilities, knowing how to do. We use Carper (1992) pragmatically, without raising it to panacea status. When reviewing patchwork texts we usually see a range of students who use Carper, some illustrating better understanding than others. Those who use the model most effectively seem to have a better aesthetic appreciation of what they are trying to convey, mainly in keeping with presenting a clear “emic perspective” (Duff Cloutier et al., 2007, p. 8) that is often enhanced through use of story, imagery or poetry. Other students also illustrate admirable aesthetic appreciations without reference to Carper, choosing alternate models/frameworks and reading (for example, Greenwood, 1998; Hannigan, 2001; Johns and Freshwater, 2005; Mezirow, 1990; Rolfe et al., 2001). We have identified elements that are difficult to express yet which we wish to make explicit, and not ‘disappear’ (Fletcher, 1999) or deny, including the value of aesthetic appreciations, as distinct from factual accuracy. I feel that I am at the stage of seeing the whole of a piece of work, I am less concerned with minor details and I am more concerned with understanding, clarity, application and an aesthetic appreciation of what the student is trying to convey. Surely this is what nursing is about? The complex nature of caring for an individual and family with needs that are health and socially related in context of a particular culture requires a diverse set of skills that are holistic in nature as opposed to reductionism akin to the biomedical approach that predominates medicine in the western world. (Teacher personal diary extract, 24/11/08) This resonates with the relationship of aesthetics to factual knowing that Gillespie et al. (2009) identify (albeit in an operating theatre context), whereby nurses valued aesthetics more than, for example, theatre technicians who value more the technical/factual. In a district nursing context, we notice and concur that recent policy and service changes have led to district nurses’ personal and aesthetic knowing of patients being: “.replaced by a knowing about or knowing by proxy. In place of personal knowing, a new discourse of ‘‘techno-care’’ or empirics
was replacing the old patterns of knowing, relegating personal, moral and aesthetic knowing to secondary positions”. (Speed and Luker, 2004, p. 929) We are not claiming that empirical knowing is better or inferior to personal, moral or aesthetic knowing in improving patient care. Our claim is that patient care is improved by valuing (and using) diverse ways of knowing more proportionately. So what, re supporting and supervising students? We revisited local (earlier) research into clinical supervision (Jenkins, 2007; Jenkins et al., 2000; Rafferty et al., 2003) to illuminate process issues that might relate to student assignment supervision. Regular feedback, dialogue, reflection and mutually agreed ground rules all apply to both contexts (clinical and student supervision), yet the most significant revelations came from reviewing work on research supervision by Judi Marshall and Peter Reason (Marshall and Reason, 1993; Reason and Marshall, 2001). In similar ways, we adopt process oriented approaches, seeking to ‘mirror’ student practice and learning experiences during supervision (for example, some students have used notes of supervision sessions as part of their diary materials and patches). We continually balance giving advice and direction (suggesting reading, or review of methods etc) with withholding advice and direction, being more facilitative. Supervision, like AL set facilitation, requires challenge with support (McGill and Brockbank, 2004) if we are to avoid simply giving advice, complaining (or moaning) and complacency (Davis and Curzio, 2003). During AL sets, facilitators carry responsibility for role modelling constructive behaviour and attitudes. During individual supervision the dynamic is different, potential for unchallenged power imbalances warrants continuing attention. We offer strategies to assist self-reflection on supervision experiences. Attending to our role modelling, to what extent do we present students with exemplary and poor skills and attitudes? Do we adopt a dialectic mindset, seeking and valuing difference and similarity, diversity and homogeneity? Do we engage with peers (other supervisors) in critical dialogue to assist our reflections? Explaining our experiences and learning in writing is challenging, particularly in terms of interrelationships and connections. Fig. 1 is an attempt at an illustrative, more aesthetic presentation. ‘Doing’ (supervision) illustrates our recognition of Heron’s (1996, p. 34) “primacy of the practical”. Experientially, we continue to be surprised at; the variety and quality of student efforts; evidence of our own weaknesses and strengths; and we enjoy and value these surprises. Presentationally, we are striving to develop sharing (rather than retaining) that creates/helps create informative and expressive learning materials, including discourse contributions such as this article. Propositionally, we are struggling to understand how ever-changing interrelationships between the complexity of practice, epistemological diversity, critical appreciation, and our own emotional and intellectual competence, inform judgements about, for example, giving students feedback and awarding grades. Practically, we see evidence that our experience, presenting and conceptualising have helped us be better supervisors with the caveats that we can always be better supervisors and sometimes we remain poor supervisors. Readers may ponder limitations and negative resource implications of supervising as we do. Dalrymple and Smith (2008) explain how they (using patchwork text as assessment) provided extensive, formative feedback that was labour intensive. They aimed to feedback to students within 2 or 3 days of receiving drafts,
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Fig. 1. Supervision and support.
in keeping with what is generally held as sound educational practice.5 To manage the volume of work, they suggest a progressive limiting of numbers of drafts to be seen by supervisors, frequency reducing as time proceeds. Our experiences of supervision and feedback provision echo much of Dalrymple and Smith (2008), though the relative burdens are reduced for us because of at least 3 situational elements: 1. The module begins and continues via AL sets wherein students present and appraise their experiences, reading, ideas and decision choices. This is largely analogous to the functions of supervision. Appraising learning and practice through reflection, challenge and support are intrinsic to the AL mode of teaching/learning. As they learn, students generally require reduced amounts of feedback. 2. CPTs are required to verify that patchwork texts represent honest and accurate accounts as experienced by students in practice. This invariably involves critical dialogue and appraisal of student work as time proceeds.
5 The principle of providing feedback with minimal delay is one we value and try to adhere to. We have begun to question this though. Recently, a student presented work and sought a response. Unusual and demanding circumstances meant a delay of 5 days, including time over a weekend. When the teacher made contact, the student explained how she had reconsidered the issues, read, spoken with peers and clinicians and had reappraised key contentions independently. The types of questions we are asking now are:
a. Is it possible to give feedback too soon e and deny students opportunities for independent struggle with dissonance that leads to more meaningful learning (effectively spoon-feeding them)? b. What constitutes the optimal timing of feedback provision e and how might supervisors judge when it is wiser to delay?
3. Latter AL sets (those towards the end points of the module) involve more explicit appraisals of patches and/or written materials. This is coupled with an emphasis on interrelating written work with practice experiences and implications so that any perception of ‘paper exercises’ is avoided. Even so, our formal academic supervision on the module is more labour intensive than on other modules/courses, because of accommodating an extended epistemology, ensuring patchwork texts constitute meaningful assessment of students’ learning in multiple domains of knowing including critically informed practice application. Supervision on other modules/courses normally involves according priority to students’ empirical/conceptual presentations, which is less demanding. We question our conceptualising of supervision, as a means of providing feedback (relatively straightforward identification of strengths and weaknesses in written drafts) and more as an intrinsic mode of
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learning with more emphasis on factors identified by Snowball et al. (1994) 15 years ago, albeit in relation to dissertation supervision: “. partnership; signposting. and also contextual issues of humanness; time; and energy, which were needed to sustain the supervisory processes. The role of the dissertation supervisor was illuminated and the potential of using reflection as a tool for developing professional educational practice was realized. The importance of constructive support while engaged in processes of reflection cannot be underestimated. (Snowball et al., 1994, p. 1234) Summary & conclusion We sought to assess student learning in terms of appreciations of ever-changing complexities of practice and their informed, creative responses. This is quite distinct from assessment of knowledge, rules or procedures that we characterise as ‘off the shelf solutions’. The patchwork text functioned as a valid assessment of desirable attributes, and allowed individuals to express themselves in ways evidential of their self-evaluative development and application. Teachers, as supervisors, faced challenges similar to those faced by students. Each part of the assignment had to be appraised in context of the whole assignment and this required a level of analysis of parts and synthesis of whole that we claim represents an aesthetic appreciation. This synthesis or connection between constituent parts and whole is enhanced by explicating and interrelating different ways of knowing that are ultimately tested through practice relevance and application, including supervision practice. Supervisors were mindful they were constantly role modelling being self-evaluative, avoiding simple, often linear solutions such as when balancing advice and direction with withholding advice/ direction. This capacity for tolerating relative ambiguity without avoiding making decisions, is best sustained through regular peer support and dialogue. Of course, this in turn adds to the already labour intense supervision process. Our experience and research illustrates that patchwork text student supervision is challenging and demanding of time. For us, these costs are manageable and worthwhile because the action learning process mirrors much of the supervision process, and leads to quality of learning outcome. Using action learning sets enabled supervisors to engage with students in reflective dialogue that functioned to role model creative and critical development. Teacher: It is not to claim that the patchwork text assesses theory and practice together perfectly that would be utopian. But it does assess them better than an essay would. (Co-inquiry notes, October 1st, 2007) Finally, as a somewhat open-ended epilogue we present a patchwork text extract (including an image of a London bus) from a BSc student district nurse that provided supervisors with a wealth of material to explore. At the beginning of the course I felt I had been hit by a bus and dragged along. As I progressed with my increased knowledge and confidence I sat at the back watching people, eventually moving towards the middle and then the driver’s seat, the team being passengers on my bus. Now I feel like I am driving the bus, in control going in the right direction. I feel I will stop, pull over and have a break to reflect on future practice. The journey on the bus has taken many routes; narrow, windy, bumpy lanes and sometimes I have stopped at the crossroads to look at my map. However I now feel I am driving down the motorway, in the fast lane, in control knowing which turning to take picking up speed as I go. I
must remember speed, no more “hurry up” ways for me, best stay in third gear. (BSc student assignment extract, May 2009 with permission)
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