Planting the Objectivist Movement in Nursing Education
As discussed in Chapter 2, except for a small minority of leaders who have focused on care theory, nursing education and professional organizations have generally been pushing to be more objective. In the broader community of higher education, we have seen the same movement. A small voice continues to be heard by such educators as Parker Palmer and Nel Nodding. Palmer (2007) put it this way:
Teaching, like any truly human activity, emerges from one's inwardness for better or worse. As I teach, I project the condition of my soul onto my students, my subject, and our way of being together. The entanglements I experience in the classroom are often no more or less than the convolutions of my inner life. Viewed from this angle, teaching holds a mirror to the soul. (pp. 2–3)
Just imagine how subjective the idea of looking at one's inner soul would be. It is not a mathematical formula, but a complex integration of physiology, anatomy, chemistry, electricity, microorganisms, mind, psychology, and a life force that many associate with his or her creator. How much of this is really objective? How much of what we present in the classroom is really objective versus subjective information? Don't judge it, but consider the reality of this fully human phenomenon.
Wilber (2000) suggests that we have three realities asking to be heard and integrated. The first is the subjective truth, the second is the objective truth, and the third is the intersubjective truth. “It is toward just such an integral model that we can now turn” (p. 73). Intersubjective truth is a very complicated subject that needs additional discussion, as we look at how quantum mechanics (physics) impacts us personally, which includes our teaching.
SCIENCE OF THE SUBJECTIVE
The period from 1980 to 2000 was filled with proposed strategies to include subjective reality—the affective domain—and has started to bring a sense of approval for the science of the subjective. During this era, more was occurring than simply pedagogy experimentation in nursing, education, and science. There was a growth of qualitative research projects by faculty and doctoral students; however, their studies continued to be called soft science and were placed on the lower levels of the research evidence pyramids (Burns & Grove, 2008).
Additionally, science was starting to receive significant challenges as to what it means to be scientific. The Princeton Engineering Anomalies Research (PEAR) Center (princeton.edu/~pear) has been conducting quantum research for years with some significant results. PEAR researchers have conducted hundreds of experiments on the mysteries of quantum physics to include human consciousness studies. Jahn and Dunne (1997) acknowledged the debate regarding objective and subjective science and suggest that both must be used to have a real understanding of what may be occurring in the real world in which we are engaged. They state:
The thesis is thus that science must soon make a deliberate and considered choice whether to continue to deny all subjective currency access to its table of scholarly business, thus excluding itself from comprehension of the universe of aesthetics and creative experience, including that which bears on objective effects, or to broaden its purview to encompass these softer parameters in some disciplined yet productive fashion. (p. 207)
There is a need to see the subjective domain as legitimate and capable of being studied in a way that gives new knowledge and understanding. “All told, some 50 million experimental trials have been performed to this date, containing more than 3 billion bits of binary information” (Jahn & Dunn, 1997, p. 209). These 50 million experimental trials show evidence of links between the subjective human experience and how they can impact our world in consistently measurable ways that are not just random outcomes. When the subjective
quantum and conscious intention experiments are totaled, the results are impressive: “The composite anomaly is unlikely by chance to be less than one part in a trillion” (p. 209), or P < 0.000000000001 for those statisticians who enjoy P values. All these studies lead to this result, “It seems inescapable to conclude that operator consciousness is capable of inserting information, in its most rudimentary objective form of binary bits, into these random physical systems, by some anomalous means that is independent of space and time” (pp. 210–211). In other words, our thoughts can influence the physical world and we can never be truly separated from that which we are studying. You can blind or double-blind but not really prevent this impact on the object under study. The act of observation in itself impacts what we are studying. This is a challenging thought for all the objectivists that believe we need to be more objective in our science, in our classrooms, in our testing, and in our pedagogical strategies. Imagine if all such thought is just an illusion to make us feel better about what we are doing—sticking to our objectivist rationalism.
Unfortunately, a meta-synthesis as described by Jahn and Dunne did not seem to impact the academic thinking in any significant way during this period or even today. We continue to want more objectivity, and therefore we associate being educated with using scientific thinking and positivistic thinking that emphasize quantitative research methods and deductive reasoning. It seems like heresy to think otherwise. Palmer (2007) suggests a different perspective on objectivism:
Objectivism, far from telling the truth about how we know, is a myth meant to feed our fading fantasy of science, technology, power, and control. If we dare to move through our fear, to practice knowing as a form of love, we might abandon our illusion of control and enter a partnership with the otherness [students] of the world. (p. 57)
Subjective reality, which encompasses the affective domain of teaching, is in direct contrast to the objectivist and rationalist movement that surrounded the philosophies that were expressed through such authors as Ayn Rand in the 1970s and 1980s (youtube.com/watch?v=1ooKsv_ SX4Y&feature=youtu.be and youtube.com/watch?v=4doTzCs9lEc& feature=youtu.be). The objectivist movement was designed to separate spirituality from science, or faith from reality, and its proponents believed that only objectivism was capable of finding reality in our world. It is said that Rand's work was seen by a host of secularists, educators, and entire institutions as a way to be more accurate with universal truths and that it supported the movement to separate what was believed to be the inferior subjective universe, including issues of faith and God, from the scientific and so-called truth-giving objective universe.
Nursing leadership, nursing state boards, and certification boards continue to ask nurses to update their knowledge. In the process of updating their continuing education, there is the expectation of having objective learning
outcomes for all such training, but inner awareness, maturational growth, or subjectivity are usually not required. Benner, Sutphen, Leonard, and Day (2010) state:
At this point, nurses are left to their own self-assessment and selection of continuing education from a range of continuing education classes. Although most health care organizations have become centers of teaching and learning in their own right, they focus mainly on teaching new technologies and new regulations, both of which are necessary but do not offer the clinical knowledge and skilled know-how needed for a self-improving practice. (p. 19)
This push toward objectively measurable nursing outcomes in continuing education further emphasizes a separation between subjectivity and objectivity and plays into our thinking about what it means to be an educated person or nurse.
During an age of mandatory separation, many, including Pearson (1911/2007) in his work The Grammar of Science, pushed the need to separate all subjective thinking from scientific inquiry in order to be an educated and credible person. Even to this day, faculty courses and evaluations do not address their affective teaching methods or outcomes (Ornstein, 1995). Ornstein states:
Depending on the instrument or checklist utilized, a teacher might be judged “good” or “effective” by coming to class on time, writing clear objectives on the blackboard, monitoring seatwork, or reviewing homework—criteria that overlook the emotional and human qualities of teaching the real “stuff” that is at the heart of teaching. Evaluation instruments tend to favor teachers adept in behaviorist tasks or teaching facts and skills, partly because the instruments focused on small segments of observable or measurable teacher behaviors, and because the tests that measured student outcomes were knowledge based. (p. 124)
Ornstein references Craig and Eisner to support his belief that faculty will “face subtle discrimination” as they attempt to stress “the abstract, divergent thinking, humanistic or moral practices, . . . and hard-to-measure processes” (p. 124).
Although there may be professional risks to incorporating the affective domain, as presented in Chapter 1, today we are learning that reforming education necessitates evaluation of the value of subjectivity in our teaching methods. The push against pure objectivism is a theme for international reformers of education such as Paulo Freire who wrote a book to teachers in 1998 and stated, “It is impossible to teach without the courage to love, without the courage to try a thousand times before giving in. In short, it is impossible
to teach without a forged, invented, and well-thought-out capacity to love” (p. 42). Darder (2002) presents an entire book, Reinventing Paulo Freire: A Pedagogy of Love, and offers a strong reminder of how love is the pedagogy of relationships, intersubjective knowing, and being present for students. We are in a struggle, or even a battle of sorts. Even if our academic mentors and professional organizations want us to accept the various ways of knowing, the push is for us to only accept one form as true knowing—the empirical or objective form. Palmer (2007) believes the abandonment of the subjective has very serious ramifications for our students, and states:
“[The] self-protective” split of personhood from practice is encouraged by an academic culture that distrusts personal truth. Though the academy claims to value multiple modes of knowing, it honors only one—an “objective” way of knowing that takes us into the “real” world by taking us “out of ourselves.” . . . The academic bias against subjectivity not only forces our students to write poorly (“it is believed . . .” instead of “I believe . . . ”) but also deforms their thinking about themselves and their world. In a single stroke, we delude our students into thinking that bad prose can turn opinions into facts, and we alienate them from their own inner lives. (pp. 18–19)
Fear of the subjective has created serious flaws in our academic system and in the thinking of our students. In nursing, the work of Lysaught (1970) pushed nursing educators to question the caring practices as moving nursing away from “the technical and instrumental work of nurses” (Benner, Sutphen, Leonard, & Day, 2010, p. 23). It did not stop there. As nursing theorists were developing their ideas of what nursing is, most did not articulate caring as a major construct of the profession. Fawcett (1995) presents the arguments from both sides, but ends up excluding caring as a major construct of what is unique to nursing. She believed a major construct (metaparadigm) must be “perspective-neutral” (p. 11). Again, nursing needed to keep things objective and free from value-laden possibilities; the profession was building its theoretical beliefs at the expense of really owning its caring practices. This was the positivist philosophy that then was used to guide the so-called “real scientific research” we call quantitative research. The more we could control the extraneous variables, the better the research.
So the question is this: Which type of nurses do you want to treat you? Which type of nurses do you want teaching the next generation of nurses? Should nursing be devoid of caring theory as a core practice found in our foundation courses, or should it be as high an expectation as getting vital signs correctly? If we provide the knowledge for our nursing students to be technically competent, will we have an equal expectation that they are compassionate, empathetic, and able to form relationships with their patients? Vignette 3.1 provides an example of how the latter might be practiced in a foundations course. Vignette 3.1
At the beginning of your shift, when you are meeting your new patient, start with this partnering exercise. (It actually takes approximately 3 minutes unless you do the assessment or pain management during this time).
1. Tell the patient your name and your role as you sit at eye level.
2. Ask the patient his or her priorities for the day, so you can assist him or her in meeting these goals.
3. Let the patient know what your practice needs are during your shift and look at integrating your needs and the patient's needs for the day.
4. Put your name, contact number, and partnered goals on the white board in the room.
5. Continue with the Five Ps:
a. You did Partnering already
b. Ask about restroom needs—Potty
c. Obtain a Pain assessment
d. Make Positioning adjustments
e. Check the Pump to reduce potential noise distractions
6. Address pain or your first assessment of the day and do both soon.
7. Before leaving, ask if there is anything he or she needs before you return after your regular rounds to provide additional care.