Caring for Patients, Caring for Student Nurses

Developments in Nursing and Health Care 15

Annette M. Jinks

• Publisher: Routledge
• Year: 2018
• eBook ISBN: 9780429861239
• Topic: Social Sciences
• Subtopic: Sociology
• Index: Social Sciences

First published in 1997, The nursing and health care fields are developing rapidly. This new series of monographs offers reports of projects completed in 1997 in the fields of nursing and health care. The aim of the series is to report studies that have relevance to contemporary nursing and health care practice. It will include reports of research into aspects of clinical nursing care, management and education. The series will be of interest to all nurses and health care workers, researchers, managers and educators in the field.

1 Introduction

The subject of this book is a study which examines the interrelationships between student-centred teaching and learning and patient-centred nursing care. The focal area of interest is if student nurses are taught using the principles of student-centred learning theories will these behaviours be replicated by students in their attitudes to the delivery of nursing care. Student-centred learning and teaching is defined as a cognitive theory of learning which has self-directed, experiential and problem-solving learning as key features. In nurse education the application of student-centred learning and teaching methods is shown to have been influenced by andragogical tenets. Patient-centred care is defined as nursing care delivered through use of the nursing process.

The study is conducted during a time of radical change in nurse education in Great Britain. For example, the advent of Project 2000 and changes to post-registration training have inherent aims to produce nurses who are ‘knowledgeable doers’ (United Kingdom Central Council 1986). An implicit purpose of these reforms in nurse education is to raise the quality of professional nursing care (Chandler 1991). Much interest has centred on learning and teaching philosophies and methodologies which will assist in achieving these aims (D’A Slevin and Lavery 1991). The English National Board (1989) also state that educational processes should be directed towards students being encouraged to ‘take personal responsibility for their learning’ and ‘developing their intellectual abilities, self-awareness and self-direction’. Attention has therefore focused on student-centred learning as a means of delivering nurse education programmes which have the aim of improving the quality of professional nursing care.

Improving the quality of nursing care through the delivery of effective nurse education programmes is central to the debate regarding the theory.practice divide in nurse education (Hawkett 1989, Jarvis 1992a, McCaugherty 1991b). For example, endeavours to design nurse education programmes which marry with the realities of clinical practice, and produce nurses who are able to deliver effective nursing care are central aims of all nursing curricula. This study examines one area of this broad topic.

The nature of the research described in this book is attitude analysis. That is analysis of the attitudes of senior educational managers, nurse teachers and pre-registration student nurses with regard to student-centred learning and teaching and patient-centred nursing care. Radford and Govier (1980) state that in analysing attitudes a distinction is usually made between three components: cognitive, affective and behavioural. The cognitive component consists of beliefs or ideas which a person holds towards an attitude issue, the affective component being the feelings or emotional reactions which an individual displays towards an attitude issue, and the behavioural component the tendency or disposition to react in certain ways to an attitude issue.

In the study the first two components identified by Radford and Govier (1980) are of central interest. That is the beliefs and feelings the sample groups hold with regard to student-centredness and patient-centredness. The latter component, or the study of actual behaviours regarding student-centredness and patient-centredness, are not addressed in the present study. Therefore the findings are used to illustrate beliefs and feeling regarding the attitude issues at a given point in time. There is no attempt made to examine the consistency between espoused beliefs and feelings and actual behaviours due to the need to keep the present study within manageable limits. For example, classroom observations have not been undertaken to establish articulation of student-centred principles in nurse teacher/student nurse teaching and learning interactions. Neither have clinical observations been conducted to verify the extent of patient-centred philosophy is evident in student nurses’ care delivery. The findings of the study therefore, cannot be used to establish current behaviours or to predict future behaviour. It is, however, recommended in the conclusions of this book that these areas are subject areas for future research.

With these limitations acknowledged it is, however, clear that inferences can be made between ideas and beliefs and actual behaviours regarding attitude issues. Therefore any consensus picture which may emerge pertaining to ideas and beliefs of either student-centredness or patient-centredness would give some indication of how teachers and student nurses may act in teaching, learning or nursing care situations.

The general consensus picture which emerges from the findings of the study is that care and care giving are identified as being of key importance in analysis of attitudes towards student-centredness and patient-centredness. Care is, however, defined not merely as cherishing or nurturing behaviours but in the context of the theoretical concepts pertaining to student-centred learning and teaching and patient-centred nursing care. Effective teaching behaviours through application of the ideas and beliefs inherent in concepts of individualism, humanism and empowerment are identified as underpinning the definitions of care used in the study, whether this be care for students or care for patients.

A national survey approach is taken in the study. Initial investigations are directed at establishing senior educational managers or ‘official’ attitudes towards student-centredness. At later points in the study the attitudes of nurse teachers and pre-registration student nurses are examined towards both student-centredness and patient-centredness. Data triangulation is the central feature of the research design. The aim being to achieve convergent validity with regard to the research findings. An investigation, at a national level, which examines the attitudes of senior educational managers, nurse teachers and pre-registration student nurses with regard to student centredness and its relationship to patient-centredness is therefore the focus of the study.

Initially, however, the research began with an interest to if student nurses are taught in a student-centred fashion by nurse teachers will this behaviour be replicated in nursing care settings. A review of literature review was subsequently conducted using student-centredness and patient-centredness as focal areas of investigation. The first part of the review is given in the following chapter, and relates to student-centred teaching and learning theories and how these theories are articulated in nurse education.

2 Theories of learning and teaching

This chapter is directed towards examining and evaluating the literature pertaining to student-centred learning, its philosophies and methodologies, and exploring how student-centred learning can be seen to improve the quality of professional nursing care in the context of patient-centred care.

Definitions of student-centred learning and teaching

Woods and Barrow (1985) state that the term ‘person’-or ‘pupil-centredness’ is open to widely differing interpretations. Beckett and Wall (1985) and Nielsen (1992) describe how the term grew out the propositions of Rogers (1969), who placed emphasis on processes of learning and dismissed ‘teaching as a vastly over-rated function’. Inherent in Rogers’ beliefs are that independence in the process of seeking information is a more stable base for education than of transmitting static knowledge. The underpinning assumption in the latter is what is taught is learnt. Rogers’ therefore advocated a move away from lecture methods towards active student participation in teaching and learning processes.

Rogers’ (1969) position can, however, be related to a broader debate in the arena of educational philosophy. For example, the concept of learner-centredness can be seen to stem out of beliefs about how learning occurs.

Learning theories

Child (1986) identifies two major perspectives of learning theory, those of the behaviourists and cognitivists. These broad conceptualizations can be seen to arise from differences in philosophical views about the way human beings learn. For example, behaviourist theory is chiefly concerned with externally observable input and output, a stimulus and response theory. Cognitive theory, however, is based on beliefs that inner functions of human beings affect human behaviour and therefore learning. Examples of these inner functions include the part motivational and perceptual factors play in teaching and learning.

A central debate in the arena of nursing education relates to which learning theory should have primacy. Byrnes (1986), Carter (1979), Darby shire (1991), Duffy (1986), Gott (1982), McKenzie (1985) and Mutzebaugh and Dunn (1976) describe the application of these theories of learning to teaching nursing. Explicit advocacy of a cognitivist approach in nursings’ national statutory bodies in the United Kingdom may be demonstrated in the quotation given in the introduction to this book (ENB 1989). For example, the quotation gives promoting personal responsibility and self-direction as key aims of nurse education processes. Development of both of these qualities are associated with cognitive learning theories. Carter (1979), Darbyshire (1991), and McKenzie (1985) may be given as further examples of advocates of a cognitivist approach to teaching and learning in nurse education programmes.

Some authors, however, see an implicit adherence to behaviourist-type beliefs by nursings’ statutory bodies in Great Britain. For example, Farmer (1992) sees Project 2000 proposals as predominantly following behaviourist training models of education. Similarly Rolfe (1993a) identifies that the transition to higher education ushered in by Project 2000 has signalled a return to traditional teaching methods in nurse education. Ashworth and Morrison (1991) give similar criticisms of the identification of registered nursing competences in the 1989 Nurses, Midwives and Health Visitors Act.

Application of behaviourist theory is also seen by some as appropriate in certain discrete areas of nurse education. Gott (1982), Mutzebaugh and Dunn (1976), and Stotts (1982) give examples of how behaviourist theory may be of relevance for skills training. Beattie (1987) gives a four-fold model of curriculum and identifies that the application of behaviourist theory as being appropriate to teaching and learning practical skills. Sturmey (1988) also describes how a behaviourist approach is pertinent to nursing those with learning disabilities. Sturmey concludes that more compliance by carers is achieved when behavioural objectives are used in care planning.

It is therefore seen that there is still controversy in nursing education surrounding the behaviourist/cognitivist dichotomy, and frequently an eclectic approach is still evident in respect of broader issues of nursing education theory.

Learner-centredness, however, can be seen to relate directly to Bruner’s (1966) theory of learning which stems largely from a cognitivist perspective. For example, Burnard and Chapman (1990) and Byran (1991) discuss how theories and concepts of student-centred learning in nurse education are underpinned by cognitivist theory and Bruner’s theories in particular. Therefore in this literature review, as the concept of learner-centredness is the focal issue, a broadly cognitivist type perspective will form part of the theoretical framework.

Student-centred learning and teaching in nurse education

Bevis and Murray (1990), Burnard (1986b), Coombe et al (1981), French and Cross (1992), Gott (1982), Hurst (1985), and Sweeney (1986) describe traditional nurse education as being teacher-centred and pedagogical in orientation. In contrast, progressive nurse education is described as being student-centred and andragogical in orientation (Hurst 1985).

There is a wealth of literature in the field of nurse education which advocates a student-centred approach or progressive orientation in nurse education programmes. Much North American literature relating to nurse education over the last decade has had learner-centredness as a focal issue (Coombe et al 1981, Chally 1992, Bevis and Murray 1990, Di Rienzo 1983, Nielsen 1992, Pugh 1976, Tanner 1990). In the United Kingdom similar interests can be demonstrated (Beckett & Wall 1985, Bell 1984, Brookes et al 1983, Burnard 1985, Burnard 1989a, Carter 1979, Chiarella 1988, Crout 1980, Duffy 1985, Goodall 1985, Hurst 1985, Jarvis 1992a, Richardson 1988, Sweeney 1986, Webb 1979). For example, in the United Kingdom context Burnard and Chapman 1990 epitomise this advocacy of student-centred learning by saying:

that the accent in nurse education should be towards the educational encounter being student-centred rather than teacher-centred and appropriately adult-centred, (p.65)

In the literature reviewed there was no literature found which explicitly questioned the educational value of adopting a learner-centred approach in nurse education.

There has, however, been limited research conducted into learner-centredness of nurse education programmes in the United Kingdom. For example, Alexander (1984) conducted a survey of pre-registration student nurses’ (n=l 18) experiences of clinical teaching. It was concluded that much of the teaching was conducted by ward staff whose earlier experiences of nurse education had been of a passive nature, with an accent on didactic forms of teaching. However, although these conclusions were hypothesised by Alexander, their validation was not sought in the research conducted.

Gott (1982) in a comparative observational study of classroom teaching sessions (125 sessions were observed), used as a sample pre-registration nursing students in three schools of nursing. It was found there was little evidence of application of student-centred approaches and the main teaching format used was the traditional lecture method. However, Clarridge et al (1992) conducted a similar study to that of Gott’s but used a post-registration student group as a sample and non-comparative quantitative methodologies (teaching sessions were observed over a two week period). They found that a high degree of learner-centred approaches were used.

The concept of adult learning and validity of use of chronological stages in learning will be examined in more depth at a later point in this literature review, however, it is appropriate at this point to identify the differences in pre-registration and post-registration nurse training with regard to these findings. Recruitment profiles show that there is still an outstanding need to recruit more mature entrants, those from ethnic minorities and males into nursing in Great Britain. The ‘average’ nursing recruit’s profile continues to be that of a young, white and female (Casey and Buchan 1989, Hanson and Patchett 1986, Lathlean 1987). However, Miers (1992) states that the needs of mature pre-registration nursing students differ from those of younger pre-registration nursing students. In the very limited context of the studies of Gott (1982) and Clarridge et al (1992) it would seem that there is a small amount of evidence that pre- and post-registered courses do differ in their learner-centredness. Therefore there is also the implication that teaching young and older adults in nursing needs to viewed differently.

Sweeney (1990) conducted a comparative study of the learner-centredness of two registered general and two registered mental health nursing courses as perceived by third year student nurses. The research tool utilised was Boydell’s Scale for Measuring the Learner-Centredness of a Course. Sweeney found first-level courses were generally highly teacher-centred in terms of planning, direction, sequence, pace and evaluation of learning. The climate of learning was moderately learner-centred, though teacher-student relationships were perceived as formal. A significantly higher level of perceived learner-centredness was found with regard to the of mental health courses studied.

A further point can therefore be drawn from the limited findings of Sweeney’s (1990) coupled with those of Gott (1982) and Clarridge et al (1992). Not only may there be differences in pre- and post-registration courses’ learner-centredness but there may also be differences in learner-centredness with regard to the type of pre-registration training which is being undertaken. These studies into learner-centredness, however, have a number of individual methodological weaknesses. For example, all have relatively small samples taken from limited locations in the United Kingdom. The validity of the findings is therefore low. However, a more fundamental weakness is that of the nature of the research questions. For example, learner-centredness as referred to earlier is a broad concept which may incorporate differing facets of meaning. To conduct meaningful research into a multi-faceted concept is a difficult endeavour, which is perhaps why there is only very limited research into the topic. Therefore in order to explore the pertinent literature further a more precise definition is needed.

A number of authors have linked the tenets inherent in the concept of andragogy with learner-centredness (Burnard 1985, Happs 1991, Ho 1991, Myles 1991, Raudonis 1987). Burnard, for example, relates that many writers use the concepts felt to be inherent in an andragogical approach as being synonymous with student-centredness. Therefore in the following section the concept of andragogy will be explored in order to provide a more exact definition and a subsequent framework for the first part of this literature review.

Concept of andragogy

Mazhindu (1990) recounts that the term andragogy was a word first used by the Yugoslav adult educator Dusan Savisevic and was later developed as a theory by Knowles (1970). Andragogy refers broadly to the art and science of helping adults learn and pedagogy to the art and science of helping children to learn. In Knowles’ early work clear distinctions are made between the learning and teaching implications of the chronological andragogy and pedagogy models proposed.

Knowles I (1970) early distinction between pedagogy and andragogy, however, has generated much academic debate. For example, Jarvis (1986) states that initially McKenzie (1977) sought to provide Knowles’ pragmatic formulation with a more substantial philosophical base and ar...

Table of contents

• Cover
• Half title
• Dedication
• Title Page
• Copyright Page
• Table of Contents
• Figures and Tables
• Acknowledgements
• 1 Introduction
• 2 Theories of learning and teaching
• 3 Patient-centred nursing care and student-centred learning and teaching
• 4 Conclusions drawn from the literature review and the research questions
• 5 Research methods
• 6 Results of the study
• 7 Discussion of the findings of the study
• 8 Conclusions and recommendations
• Bibliography
• Appendix 1: SAQ survey instrument
• Appendix 2: Respondent details, SAQ survey
• Appendix 3: Nurse teacher interview schedule
• Appendix 4: Respondent details, nurse teacher interviews
• Appendix 5: Student nurse questionnaire
• Appendix 6: Respondent details, student nurse questionnaire