TRADITIONS IN NURSING EDUCATION
In keeping with the traditional instructional teaching model, nursing education continued to hear a loud voice from educators such as Lysaught (1970) who argued that such soft academic nursing education ought to be dropped in favor of more scientific and rationality-based education. He equated the nurturing side of nursing with being a feminine trait and thought it should be taken out of the training process. Prior to 1960, nursing education was primarily a hospital-based program that had demanding lectures that were integrated into many hours of practice and strict supervision. However, hospital-based nursing education was not seen as being scientific, and it was perceived to lack rational and objective thinking. Lysaught wanted to see that changed and for nursing to be more aligned with medicine.
Nursing education has been bombarded with the need to objectify all the various content that was being built around nursing taxonomies, nursing diagnoses, and nursing theory. Nearly 50 years ago, Krathwohl, Bloom, and Masia (1964) developed a learning taxonomy that focused on educational objectives in the affective domains of learning. These authors began their study
by examining affective objectives in various college courses in the 1940s. Their findings indicated a continuous erosion of affective objectives as they watched the courses change over 10 and then 20 years. By 1964, Krathwohl et al. concluded that there was little, if any, attempt to include affective course objectives in curricula that had previously incorporated them.
During the same period as Lysaught's push for more objectivity, we started hearing from our first nursing theorists. King (1971), Orem (1971), Roger (1971), and Roy (1976) were presenting various ways to articulate nursing practice. However, not everyone was willing to call nursing a rational scientific practice. King stated, “Teachers who create a climate for learning help individuals see things in new ways, explore meaning, feelings, attitudes, and behavior of self and others, and understanding relationships between knowledge and its use in nursing practice” (p. 43). What a contrast to Lysaught (1970) who was looking for higher levels of rational technical approaches to reduce the subjective side of nursing.
Other academic challenges preventing affective learning models have come from our historical reliance on rationalism and objectivity. From Plato to the turn of the 20th century, philosophers and educational leaders alike attempted to separate the intelligent, educated mind from the mind associated with experience and emotions. Physicians also wanted to eliminate the idea that they were empirical, as this would imply they were using trial-anderror strategies for practice and were therefore lacking in scientific training (Dewey, 1916/1944, p. 264) to guide their practice. (Note that the definition of empirical had a different meaning in 1916 and was called a trial-and-error approach by Dewey in contrast to a scientific approach.) The push was for pure reason and Kantian objectivity to guide the professional of the time and to control for researcher bias. It is also important to note that Immanuel Kant (1724–1804) was a German philosopher using Descartes's rationalism and Locke's empiricism as he refuted inductive reasoning as not valid, and then used highly complex thinking regarding how we observe things. However, he was the first to acknowledge that “some of the properties observed in objects may be due to the nature of the observer rather than the objects themselves” (Flew, 1984, p. 190).
At the same time, a mixed message was being sent regarding reality. Clinicians also integrated “pure reason thinking and Spirit as something morally praiseworthy” (Dewey, 1916/1944, p. 265). There continued to be distinctions drawn between absolute truths in the external-objective world versus what became internalized as a subjective state or a spiritual world, which was viewed as metaphysical science.
Emotions have often been perceived to be purely private and personal, having nothing to do with the work of pure intelligence, as a result of early leaders in education such as Dewey. “The intellect is a pure light;
the emotions a disturbing heat” (Dewey, 1944/1916, p. 335). At the same time, Dewey was adamant that all education is a moral concern for the building of character, which would tie in with current definitions of affective development. It appears that his main aversion was focused specifically on emotions and their role in education. Needless to say, there was an early movement to embrace objectivism and reject that which was more subjective within education.
Tyler (1949) is credited with the idea that course objectives are needed for the purpose of measuring what is being taught. Does this sound familiar?: The student will be able to describe the use of learning objectives in curriculum development. Nursing faculty continue to live by this thinking. However, what some saw as important nursing teaching methods actually misrepresented the intent of the original author. Tyler states, “Education is a process of changing the behavioral patterns of people. This is using behavior in the broad sense to include thinking and feeling as well as overt actions” (pp. 5–6). His work included “generalized patterns of behavior” (p. 46) that were not only objectively measurable verbs as we use today, but also included subjective statements. One example Tyler provides is “to develop social attitudes” (p. 46). Given the tendency toward objectivity in nursing education, imagine the response from state boards of nursing or credentialing agencies as they review syllabi and find subjective goals are being used for the course outcomes. Faculty might consider running out the door as the credentialing agencies read anything but objective adjectives that can be measured using empirical methods. It might be a good time to ask, “How did we ever get this far into objectivity?”
This era was full of push and pull by those thinking about what was needed but who found the academic environment ill-prepared to deal with so much subjective thinking. In the limited classes where affective pedagogy was being provided, there was little knowledge of how it was being implemented and how affective education might be improved. This continuous distrust of the subjective and an affective experience that involves emotions in the classroom, permeated this entire era and in many ways continues to be an academic struggle. The recent study by Benner, Sutphen, Leonard, and Day (2010) brings us right back to the conflict:
Experiential learning is one of the strengths of nursing education; we found a sharp contrast between the classroom situation, where it was the most absent, and the clinical situations, where it is common. . . . Although we applaud the exceptions to this finding, classroom teachers who make an effort to integrate the classroom and clinical experiences, and the even fewer who make the classroom a setting for rich, experiential learning. (pp. 64–65)
These authors do not articulate affective teaching methods but describe their experiential learning methods as affective methods that impact the students
more deeply and personally, and how they impact their knowing who they are becoming.
According to Smith-Coletta, the former editor of Nurse Educator and the
Journal of Nursing Administration, “Educators have the responsibility and obligation to bring values, attitudes, feelings, and beliefs into conscious awareness” (King, 1984, p. x). This type of pedagogy was not seen as easy and demanded that academia change its views of teaching and learning—but would they? Elizabeth King wrote the first book on Affective Education in Nursing in 1984. It was not considered a theory, but rather a method of teaching that centered on values clarification, moral development, and problem solving. Her work could easily be viewed today as advocating cultural awareness that includes a host of experiential classroom methods. King's (1984) methods incorporated:
■ Group discussion to include how the instructor should interact with the students
■ Case study method that included moral and behavioral dilemmas
■ Role play that was given measurement tools
■ Simulation gaming that included pros and cons for its use
King was also involved in the objectivist movement, as were most educators of the time. She continued to identify learning objectives in their most traditional sense—staying free of the subjective side of affective pedagogy. However, that would not preclude a student from having a deep growth response from these methods. What is amazing is that King's book in complete form was rarely available in any academic setting, and in 35 years of practice and nursing education I've never seen her book used.
Being tossed from one spectrum of nursing education to the opposite is a time of muddy water in our academic history. It seems to have also been true for all higher education. In an example of how challenging the muddy water can be for faculty, Vignette 2.2 provides a bit of humor regarding an instructor who thinks it is time to bring some affective pedagogy into his or her teaching, but wants to do so in the same way the instructor normally does everything.
Joan is my staff assistant and has been very helpful when I am rushed and struggling to get caught up. I have recently heard about various ways of improving my classroom, so I enlist Joan's assistance. “Joan, would you go to the university bookstore for me, and go to the affective teaching section of the store. I need two printed, paper pads of student acknowledgment and recognition sheets, a thimble of personal self-disclosure with some good examples, a classroom discussion stimulator, two posters on student follow-up reminders, one flexibility integrator, a book on acceptance of feelings in classrooms, and a tape recorder that is automatically programmed for timely feedback that has a 'being present' button on it.
“Also, pick up one 16-gig care pedagogy faculty chip that allows vocal expressive- ness and smiling, and includes an eye contact and relaxed body posture setting. It needs to be the 'CARE 4U' chip that uses active listening digital capability.
“Just tell the store to bill it to my department here at the college. Thanks for doing this for me. I have to get my slide presentation ready for class so I appreciate your help. Oh, one more thing. Bring me a can of My Way energy drink. Thanks.”
It is clear that our American educational system was born from a desire to maintain an objective method of teaching in the cognitive domain of learning. Faculty carried the information, which was then passed on to their students, and this cognitive information was banked, to be recalled at a later time. This is called an institutional paradigm or traditional teaching in this text as a means of distinguishing it from a learning-centered teaching approach. This historical foundation allows us to take this journey to examine the need to integrate the subjective domain of knowing, called affective teaching, which brings values, attitudes, feelings, and beliefs into conscious awareness for students during their learning process. There were early attempts to be more holistic, relational, and even subjectively focused, but with poor results. There was fear and a distrust of the subjective, a dedication and commitment to the rational objective where Kantianism was the philosophy of the day, and an incorrect interpretation of Tylerian objectivism as pure objectivism for purposes of measurement.
King (1971) was already asking nursing instructors to become relational educators and to look for intersubjective knowing as she presented her theory of nursing practice. As she states, “The teacher of nursing practice guides the learner as both grow and mature in the process of teaching and learning” (p. 43). Or, as noted by Watson (1985, p. 59), “We learn from one another how to be more human by identifying ourselves with others and finding their dilemmas in ourselves. What we all learn from it is self-knowledge.”