Vignette Managing confidentiality
Geoffrey has just returned to university after a placement on a medical ward working with older people. To help him remember the practice issues, he kept a reflective diary and also took photos of ward situations and patients with his mobile phone. As well as bringing these to share with the tutor group he has included them in his e-portfolio as he thinks it lends authenticity to his work, an important aspect in portfolios. Geoffrey’s peer group are very impressed with his materials and there is a lot of discussion, especially as a group member recognizes one of the patients from a previous placement. The conversation focuses on the details of this patient’s situation. When the tutor arrives she stops the exercise and asks the group to stay behind over lunch.
Activity
r Thinking about the complexity of the learning environment and the relation- ships between all those involved, how do you understand what is happening in the last vignette?
r If you were the patient under discussion, or a relative, what might you think about this situation?
r How do the principles of the Nursing and Midwifery Council (NMC) Code (2008) help you to understand the issues raised in this scenario?
r As the tutor, how would you approach this situation with Geoffrey and the student group?
2009; Knewstubb and Bond 2009). We bring a set of, sometimes hardly realized, expectations and assumptions into every encounter, which can be more or less helpful to the progress and outcome of relationships and the learning experience.
Vignette Identifying and working with assumptions and expectations
Malik has joined the nursing programme expecting to learn a lot of factual information. The regular group work has come as something of a surprise− he hadn’t expected to learn much from his ‘peers’. He finds himself in a mainly female group. There is one other guy who he never sees outside of the group sessions. The ‘girls’ seem to have little in common with him and do not seem to concentrate on the group tasks. Every time they meet they have to share a reflective commentary on their practice experiences. Malik can describe what happens on the ward, but has difficulty offering a critical commentary as it would be disrespectful and disloyal to the staff in the placement. Consequently, Malik’s contribution is brief and he mutters his way through his commentary. Thankfully, no one ever asks him any questions, they just get through the task as quickly as possible before talking about ‘more interesting’ things.
Activity
Think about the complexity of the learning environment and how relationships can be influenced by personal values and attitudes.
r How do you understand what is happening in this vignette?
r What could Malik do to improve the situation he finds himself in?
r What could an academic tutor or workplace/placement mentor do to help Malik learn in the group?
Malik’s vignette highlights the importance of understanding yourself as a learner.
As Cottrell (2005: 9) notes, it is important to be critically self-aware in terms of one’s own personal and cultural ‘baggage’ in order to understand how we process information and experiences. As learners our experiences and expectations shape our engagement with others and therefore our learning. This becomes apparent when we reflect upon the following:
r the types of people with whom we feel most comfortable and to whom we can most easily talk;
r the types of information we can absorb;
r the ideas we can discuss openly and constructively.
For example, our community, cultural or ethnic experience and heritage may imbue us with strong beliefs about any number of matters – the role of women, the capacity of gender, the ethics or morality of abortion and care of the dying. Our experience and heritage may make it more or less challenging for us to explore honestly these
topics with others. As Hanley (2009: 181) argues, whatever our world view, an openness to the exploration and examination of our professional experiences and academic and social discourses about the lives and rights of others is important for us to progress in our thinking and learning, and to enable us to be receptive to others. This critical engagement with ourselves does not necessarily mean we relin- quish our beliefs or comprehension of the world, but that we develop a clearer, more informed understanding of those beliefs and comprehensions (Cottrell 2005: 9).
Vignette Responding to professional and personal challenges Alex, a third-year student, was coming to the end of his placement in the hospice, which he had found both challenging and uplifting. He was amazed at the re- silience and bravery of the patients and their families, but was quite disturbed by the realities of the physical end of life, even with the administration of painkilling drugs. In the week before the placement ended a very unwell patient was ad- mitted. The family were in agreement with the general treatment plan but were insistent on resuscitation in case of heart failure. They wanted everything to be done to save the life of the patient and would raise this point with all members of the team at every opportunity. Alex was involved in these conversations on a number of occasions and found them difficult as he thought the patient should be allowed to die peacefully. He said this to the family and a complaint was lodged.
The complaint remains outstanding as Alex reaches the end of his course.
Activity
In the case of Alex, think about the complexity of the learning environment, and the range of values and attitudes that are brought into the setting by students, service users and practitioners.
r How do you understand what is happening in this vignette?
r How could Alex have managed the situation more effectively?
r What should have been happening in the placement setting to support Alex in his learning?
Alex has experienced something that challenges his firmly-held belief system.
Long-established educational theorists, such as Freire (1972) and Mezirow (1991) argue that challenges to the self are central to authentic and transformative learn- ing, that is, learning which makes a significant difference to our perspectives of the world and our relations and actions within it. Transformative learning is argued to occur when we are shaken out of our ‘taken-for-granted’ assumptions and practices, when we critically evaluate our new experience, derive new meanings from it and assimilate those meanings into new, refreshing perspectives. If we cannot openly explore what experiences might mean (from our own or others’ perspectives), or what the limitations of a particular theoretical model might be (is it culturally or gender-biased, is it applicable only in particular circumstances, or is the evidence
base small?) then it makes sense to ask, how are we learning? Notions of transfor- mative learning are particularly important in professions such as nursing, which is located in a highly politicized and plural context. Every day, practitioners may find their understandings challenged by the introduction of a new policy or way of working, or by a patient who challenges or invokes stereotypes. Understanding and working with these challenges requires us to develop as reflective learners and practitioners. Beckett and Hager (2002: 139−46) raise a similar discussion in their theorizing of practice-based learning at work.
Reflection point
Think about your own assumptions and expectations.
r How do you respond when others express views or behave in ways that are different from what you expect? For example, do you dismiss or ignore them; become angry or defensive; or are you curious about how the other person sees things?
r How do you manage situations where your professional or personal perspectives are challenged? Again, do you dismiss or ignore the chal- lenge or take time to think about and openly respond to any such challenge?
r Given these initial thoughts, how might you develop your capacity as a reflective learner and practitioner?
As well as identifying perceptual or attitudinal barriers to learning, it is helpful to be honest with others about more tangible obstacles to effective learning. Some are more apparent than others, such as hearing impairments, while others may only become evident over time. Dyslexia and dyspraxia, for example, may be identified quite late in a student’s academic career. Such a diagnosis can be upsetting and put people ‘off course’. However, the sooner a student and their teaching team know there is a need for different learning and teaching strategies the less problems arise for everyone (see Chapter 6).
Vignette Managing your learning needs
Gillian was on the last module of her degree and assumed that the teaching team knew she had been diagnosed with dyslexia in the last semester. She was still trying to understand this diagnosis herself. It had come as a surprise−she just thought she did not understand much of the ‘fancy talk’ that went on in the university. Nonetheless, she was a bit anxious about getting into too much detail about what the diagnosis meant with anyone. As the tutors knew she thought they should come to her−she did not need to go around making a big deal
of it. Gillian managed to complete the final module but with a very low pass mark that left her feeling unhappy as she had worked hard. If what she had been drafting was not ‘good enough’, she wondered why the tutors had not talked it through with her more. She was left with a feeling of a lack of support from the tutor and teaching team, and she told them this in the evaluation at the end of the module. The module tutor was taken aback by her comments, because he had not known that Gillian was dyslexic.
Activity
Thinking about the complexity of the learning environment:
r How do you interpret what has happened in this scenario?
r What could Gillian have done to help herself as a learner?
r What could the academic team have done to help Gillian as a learner?
Reflection point As a learner:
r Do you have any particular learning needs? For example, due to a con- dition such as dyslexia, or a hearing or visual impairment.
r Have you advised the teaching team (e.g. academic tutor, placement supervisor) about your learning needs? If not, why do you think that might be, and what would help you to tell them?
r What would be the most useful things for the teaching team to know about your needs?
r Can you propose an action plan that ensures you are enabled to meet your full potential?