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(., (::C)TEACHING AND LEARNING IN NURSING EDUCATION:
A CRITICAL APPROACH
JUDITH M. R. CLARE RGONMA
A T HESIS S UBMITTED I N TOTAL FULFILMENT OF THE REQUIREMENTS FOR T HE DEG REE OF
D O CTOR OF PHILOSOPHY
MASSEY UNIVERSITY NEW ZEALAND
JUNE 1991
This thesis investigates tutors ' and students ' experiences of teaching and learning nursing during the final year of one three year comprehensive (polytechnic) nursing course. The use of critical social science exposes for critique the ways in \vhich sociopolitical forces cons trai n i ndividual and professional action. The critical reflexive analysis of the perceptions of nine tutors and thirty eight students illustrate the w ays in which dominan t ideologies embedded in the social practices of nursing education and health care shape the consciousness of tutors and students towards conformity, compliance and passivity.
A l th o u g h previous s tu d i e s provide u seful description s of social isation and educ a ti o n a l proce s s e s , they overlook t h e im portance of t h e refl e x i v i ty o f understanding and action, and of the structural consrraints in nursing education and prac t i c e . By foc u s s i n g on e i ther i n d i vidual agency and deficiencie s , or on bureaucratic conditions of education and practice, previous studies directed attention away from generating the political knowledge which m ay have assisted nurses to overcome some of the contradictory and constraining conditions of their practice.
It is the political processes of teaching and learning and their practical effects which are revealed for critique and transformation using a critical reflexive methodology.
It is claimed that this methodology motivates research participants themselves to become aware that their preconceptions are shaped by aspects of the pre vailing social order such that they are preven ted from achieving their nursing ideals and educational goals . Thu s , through the processes involved in becoming soc ia l ly cri t i c a l , tu tors and s tude n ts would b e able to trans form those sociopol itical
11
constraints. Although collective political action is not fully demonstrated in the time frame of this study, it is suggested that engaging in this research has had ongoing liberating effects for the participants.
A CKNO\VLEDGEMENTS
This thesis is the culmination of many years of reflection and experience in nursing education and practice. I wish to thank m any people for their assistance and support throughout this project. Without them the thesis may not have been completed.
Associate Professor John Codd, a s uperb supervisor and academic mentor whose e ncourage m e n t, patience a n d scholarlin e s s allowed me to be m yself and who constantly chal lenged me to think critically and rigorously.
Professor Norma Chick a11d Professor Ivan S nook, supervisors and mentors who have provided suppon and cri ticism at imponant points in the study.
I especially acknowledge the tutors and students who willingly and e nthusiastical ly became eo-researchers reflecting on their own teaching and learning experiences . I hope that the experience of sharing i n this research has i n some way enhanced the ir u nderstandi n g of nursing knowledge and its transmission as it has m ine.
My special thanks go to Laraine Ruthbom who provided practical, emotional and i n tellectual support especially when it all seemed impossible.
Abstract
Acknowledgements
TABLE O F CONTENTS
PART ONE - INTR ODUCTION
CHAPTER ONE -The Context
Historical and educational issues and thesis outline Formal nursing curricula
G raduate employment Professional socialisation Thesis Outline
PART TWO - THEORY AND METHOD CHAPTER TWO-Previous Studies
Empirico analytical studies and interpretive studies Empirico analytical studies
focal points of empirico-analytical studies The interpretive tradition
studies of nurses in the interpretive tradition challenges to interpretivism
Critical social science
studies using a critical theory approach S ummary
C HA PTER TH REE- Critical Social Theory Critical theory - a £eneral outline Challenges t
o
critic
::ll social theory Critical theory and nursing educationculture
culture and the hidden curriculum relations of power
emancipatory knowledge and communicative competence hegemony
ideology S ummary
PAG E
111
") 8 12 13 17
22 2 2 24 27 "I �-
34 37 39 40 43
44 44 48 5 0 5 1 5 2 5 9 64 69 7 2 7 5
Inrroduction
The specific context of this study the sites
the participants the curriculum the fi eldwork The discourse
the interv iews the journals
Objectivity and subjectivity in research Ethical concerns:
confidenti ality, negotiation and reciprocity V alidity concerns
S ummary
PART THREE- THE RESEARCH ACCOUN T Inrroduction to Chapters Five and Six
CHAPTE R FIVE -Tutor Discourse The experience of reflexivity
the past the present the future
Reproducing cultural knowledge knowledge as information studen t cenrred learning knowledge through enquiry knowledge through dialogue Classroom and clinical experience:
working in two worlds S ummary
CHAPTER S IX-S tudent Discourse Themes
S tudent centred versus tutor directed learning Reproducin g nursing culture
specific classroom experiences examinations
specific clinical experiences power and conformity
classroom and clinical congruence separation of theory from practice developing professional competence Tutor-student relationships
Post graduate employment S ummary
76 76 76 77 79 80 83 85 87 89 92 96 98
100 104 105 105 107 1 14 1 18 119 120 1?_) 127 130 143
145 145 146 15 2 154 154 155 158 161 164 167 170 174 177
C H A PTER SEVEN-Further In terpretation and Discussion Hegemony and consciousness
Cultural paradox and compliance S ociopolitical domination
Knowledge and power
Tutor - student relations of power
CHAJ>TER EIGHT- Revisiting the S tudy Concluding S tatement
APPE NDICES
1 . Massey University Ethics Committee for Research on Human Subje cts
2 . Consent Form
3. Project Timetable
4. 1 Interview Transcript - tutor
4.2 Interview Transcript - student group
5 . Field Notes
6. Letters to Participants
REFERENCES
179 184 1 87 1 89 1 9 3 1 97
201 206
208 2 1 1 2 1 2 2 1 5 2 3 1 247 / 2 5 0 2 5 4
