Journal of Nursing Education

The Curriculum Revolution: Radical Re-Visioning of Nursing Education

David G Allen, PhD, RN, FAAN

Abstract

For me, the "curriculum revolution" is a classic example of "the personal is political." It is all too rare to have a single enterprise articulate so smoothly with my personal understanding and values, my view of communities as requiring democratic communication, and my scholarly work in feminist and critical theory. This will be a personal journey through the curriculum revolution, starting with some of my own experiences in nursing education, then raising a number of themes addressed by various curriculum revolution participants and ending with some speculation about what some new visions of nursing education might entail.

You've Got to be Kidding

Two educational experiences in nursing stand out with particular clarity when I think about the curriculum revolution. My very first class in nursing, like many, was an "introduction to nursing." The first day of that first class, the faculty spent an entire 2 hours of my life patiently explaining that, and I quote, "man is influenced by his environment." Startling examples included wearing more clothes when it is cold than when it is hot; this was contrasted with apparently environmentally uninfluenced decisions such as personal fashion choices.

In all honesty, I waited quietly for the first half hour actually thinking this was a joke - surely the instructors would soon switch gears dramatically and make some meta-analysis point. At least discuss the archaic semantic choice of generic "man." Alas, it never happened. For the final agonizing 90 minutes, I rested my head against the brick wall at the side of the auditorium, drawing some comfort from the coolness and course texture that seemed infinitely more real than what I was listening to, and wondered why one would come to college for this! And I had a gnawing fear that it would be a very long road, indeed.

Sadly, like many of my compatriots, I gradually became numbed to this insult to my intelligence and challenge to my patience. Eventually I even resented it when a course was truly challenging: it wasn't fair to change the rules. I categorized this experience by coining the aphorism that "nursing education mistakes time consuming for difficult." Nursing school gradually took more and more time - and competed with other sustaining, nurturing activities such as my marriage, bicycling, and music. We memorized more information, saw more patients, read more textbooks and articles, but the level of thinking, of analysis, of understanding remained analogous to "man is influenced by his environment." The senior level courses were more information-dense but not much more complex.

The second crystallizing experience occurred after I had joined a faculty of nursing. A group of course professors were discussing the perennial conundrum of why students didn't do the reading before they came to lectures. Having a vivid memory of a string of lecturers assuming I could not read and summarizing the articles (or worse yet, literally reading the syllabus to me), I did not find the behavior puzzling. But thinking I was missing the point again, I listened to the conversation. One hypothesis seemed to gain a following: students didn't respect the faculty and hence didn't do the reading. This immediately suggested an intervention: if we referred to each other by our titles (Dr. Allen, Dr. Nimble, etc.), students would respect us and do the readings.

Not for the last time, I also misunderstood this and thought surely it was a joke. Never being one to avoid participation in theatre-of-the-absurd, I recalled being a high school student during the early '60s when both students and adults made the startling discovery that adolescents could express sexuality through their clothing. Hemlines crept…

For me, the "curriculum revolution" is a classic example of "the personal is political." It is all too rare to have a single enterprise articulate so smoothly with my personal understanding and values, my view of communities as requiring democratic communication, and my scholarly work in feminist and critical theory. This will be a personal journey through the curriculum revolution, starting with some of my own experiences in nursing education, then raising a number of themes addressed by various curriculum revolution participants and ending with some speculation about what some new visions of nursing education might entail.

You've Got to be Kidding

Two educational experiences in nursing stand out with particular clarity when I think about the curriculum revolution. My very first class in nursing, like many, was an "introduction to nursing." The first day of that first class, the faculty spent an entire 2 hours of my life patiently explaining that, and I quote, "man is influenced by his environment." Startling examples included wearing more clothes when it is cold than when it is hot; this was contrasted with apparently environmentally uninfluenced decisions such as personal fashion choices.

In all honesty, I waited quietly for the first half hour actually thinking this was a joke - surely the instructors would soon switch gears dramatically and make some meta-analysis point. At least discuss the archaic semantic choice of generic "man." Alas, it never happened. For the final agonizing 90 minutes, I rested my head against the brick wall at the side of the auditorium, drawing some comfort from the coolness and course texture that seemed infinitely more real than what I was listening to, and wondered why one would come to college for this! And I had a gnawing fear that it would be a very long road, indeed.

Sadly, like many of my compatriots, I gradually became numbed to this insult to my intelligence and challenge to my patience. Eventually I even resented it when a course was truly challenging: it wasn't fair to change the rules. I categorized this experience by coining the aphorism that "nursing education mistakes time consuming for difficult." Nursing school gradually took more and more time - and competed with other sustaining, nurturing activities such as my marriage, bicycling, and music. We memorized more information, saw more patients, read more textbooks and articles, but the level of thinking, of analysis, of understanding remained analogous to "man is influenced by his environment." The senior level courses were more information-dense but not much more complex.

The second crystallizing experience occurred after I had joined a faculty of nursing. A group of course professors were discussing the perennial conundrum of why students didn't do the reading before they came to lectures. Having a vivid memory of a string of lecturers assuming I could not read and summarizing the articles (or worse yet, literally reading the syllabus to me), I did not find the behavior puzzling. But thinking I was missing the point again, I listened to the conversation. One hypothesis seemed to gain a following: students didn't respect the faculty and hence didn't do the reading. This immediately suggested an intervention: if we referred to each other by our titles (Dr. Allen, Dr. Nimble, etc.), students would respect us and do the readings.

Not for the last time, I also misunderstood this and thought surely it was a joke. Never being one to avoid participation in theatre-of-the-absurd, I recalled being a high school student during the early '60s when both students and adults made the startling discovery that adolescents could express sexuality through their clothing. Hemlines crept (in teachers' perceptions, rocketed) upwards and jeans shrunk in the crotch. The girls were often asked to kneel on the floor to see if their hems met the minimum criterion of touching the floor. Surly, smirking adolescents with long hair could be seen genuflecting in hallways throughout America.

Perhaps, I suggested, we could instill respect by having the students kneel in clinical hallways to make sure their uniforms were long enough. For agonizing seconds, brows furrowed in serious consideration of this possibility. But> no, it wouldn't work because they didn't have to wear uniforms to lecture. Conversation skipped onwards considering other respect-inducing interventions while I sat in stunned silence at the realization that this entire interaction was not regarded as an extended joke. And certainly should have been.

Perhaps Benner would cite these as "exemplars" as experiences that literally "turned around" one's understanding, elevated one's expertise. Although exaggerated only in their clarity, together they represent for me the mind-numbing and authoritarian nature of all too much nursing education. Just as I do not find it puzzling that students find reading assignments before class useless redundancy when they will be summarized during class, I do not find puzzling educators' (inaccurate) characterization of staff nurses as passive and technically-oriented. What I do find puzzling is that the very nurse educators who with great good will and devotion produce our educational systems find the "products" (the metaphor itself is part of the problem, not the solution) troublesome. When I was first in nursing, I found it appalling that so many physicians were inconsiderate, egotistic jerks. Now that I understand more about medical education, I am amazed that so many kind, humanitarian and intelligent souls manage to survive medical education.

As a teacher of nursing, I always am energized and inspired by the intelligent, creative, and sensitive students who come into nursing. I delight in seeing them complete the program but I am saddened by the frequency with which I see them turned off to education. This quarter, a student wrote a letter to me saying "I hated nursing school but I still think I'll like nursing and that I'll be a good nurse."

Revolutionary Themes

The curriculum revolution, for me, represents an opportunity to step back and critically reflect on the entire educational paradigm underlying the history of nursing education and its current forms (NLN, 1989). It's a time for what Adrienne Rich calls "re-visioning," "the act of looking backward, of seeing with fresh eyes, of entering an old text from a new critical direction. . .[It] is for women more than a chapter in cultural history: it is an act of survival. . .a clue to how we live, how we have been hying, how we have been led to imagine ourselves, how our language has trapped us as well as liberated us" (Rich, 1978). Revisioning has both a collective and individual component: our dialogues together (Diekelmann, in press) enrich and sharpen our individual reflection and self-understanding.

Burdens of Unilateral Responsibility

Diekelmann says that we educators too often align ourselves, identify ourselves, primarily with content and that we'd be much better off to align ourselves with students. At one time when there were about 1,000 students in our program and 100 faculty, she suggested we should take just 10 students each and work with them until they graduated. There is much wisdom in this. A more intense, committed relationship would be more predictive of success than the most eloquently designed curriculum.

Having been educated in both Uberai arts (English, history, philosophy) and nursing, I am cognizant of the particular tensions created by nursing's perceived obligation to produce "practitioners," an obligation often sanctified by reference to some vague "social contract" (Allen, 1986b; 1987).

Any discipline with a vocational focus (engineering, teaching, carpentry) faces this obligation and it is an important difference between these fields and, for instance, the humanities. It is not assumed that all English majors will go on to be employed as writers or critics or teachers of English.

The health occupations often perceive an additional burden: our practitioners are sometimes (far less often than we portray) involved in issues of Ufe and death.

The combination of an occupational requirement and responsibilities for life and health create a sometimes morally overwhelming burden for educators. It influences our affective and ethical Uves as much as our more purely academic lives. I believe a sense of being accountable for such outcomes (whether or not we actually are) creates an anxiety that transfers to our attitude toward students. We see them as a potential threat: if they make serious mistakes in clinical or after graduation, their failure reflects on us. Consequently, we assume the burden of trying to create a fail-safe educational system.

There are many consequences of assuming this burden, understood in this way. First, we try to Umit our vulnerability by controlling students. We control them through the construction of rigid, sequenced curricula, through the creation of courses with elaborate, prespecified objectives that remain constant regardless of the varying goals and experiences of students, through direct and indirect threats about what happens if students make mistakes, through research models (Allen, 1985, Rose, 1983) and through authoritarian relationships (Pitts, 1985). We also strive to protect ourselves emotionally - by distancing and impersonal behaviors - and practically by supervising and evaluating every aspect of student behavior. Naturally, this also has significant consequences for students, encapsulated in one student's graduation speech in which faculty were implored to be "teachers first and evaluators second" (Allen, in press).

Tyranny of Content

Another consequence of assuming this burden is reflected in our understanding of "expertise" and our association of expertise with knowledge of content. Thus, we often equate expertise with knowing a lot of information about a clinical phenomenon. Often courses are a parade of "experts" who, not knowing the students, naturally have their primary commitment to content. The practice also communicates to neophytes that one has to be an expert in every aspect of care. Our most intense collégial conversations are about content, what's essential, what is not; how do we know students have acquired it. The responsibility to insure students have acquired the right content (to make them safe and employable) is often an overwhelming burden.

However, I believe that to a great extent it is overwhelming because of how we view these responsibilities and the solutions we assume they require. Here Rich's summons to a re-visioning becomes relevant: the curriculum revolution invites a revisioning of our interpretation of and responses to these obligations.

Here, also, we can find some alternative perspectives in other fields, such as English or history. People have been producing (and examining) history for as long as there have been people, and essays, poems, and plays have been created throughout the history of the English language. Although the literacy campaigns produced some simpleminded exceptions, on the whole, humanities faculty have long recognized that students can't read all of history or even everything written in English or even all of the "important" or "excellent" or even "landmark" texts. Consequently, these fields have a stronger (although not unanimous) comfort with aligning with students, helping students orient themselves to the field, facilitating students acquisition of critical skills to be employed on 16th century epic poems or 20th century novels.

The relatively short history of nursing and the fragility of information has seduced us into thinking we could "expose" students to all important, "essential" information. One favorite target of mine is the AACN document on "Essentials:" it would take 10 years to teach the essentials (AACN, 1986). In our efforts to approximate it, we pursue a process my colleague refers to as "locking students in an auditorium and hosing them down with microfacts." We overwhelm them with information to memorize, we waste perfectly good trees producing elaborate syllabi so they can jot down all our important information, and we give them 10 cents worth of knowledge about a thousand topics. I have gotten, over-reacted, to the point that when I walk by a lecture hall and glimpse a sea of passive, bored faces writing down information from an overhead projector, I am literally, physically repulsed. It makes me sad and angry to witness the harnessing of all that student intelligence, creativity, and energy to the yoke of memorizing massive amounts of information. And we know full well how little of it will be retained even a month after the final examination.

The curriculum revolution invites us to consider alternative models, indeed to shift "paradigms" away from what Friere calls the "banking model" in which faculty deposit information in student receptacles (Freiré, 1986, 1987) and toward a variety of approaches emphasizing empowering active students to acquire and analyze information on their own (Allen, Bowers, & Diekelmann, 1989; Culley, 1985; Pagano, 1988; Popkowitz, 1984; Rosser, 1986).

Partnership and Dialogue

Another analogy I find helpful is with the field of organizational participation. Although I believe they should have, American businesses did not embrace participation because they thought it the moral and ethical thing to do. Rather, they embraced it because both the external and internal environments had become so complex that management literally could not have sufficient knowledge and expertise to "direct" operations. Operations required a partnership of everyone in the organization (a partnership often voiced but rarely achieved).

The curriculum revolution presents an opportunity to acknowledge the pressure we feel to meet our social obligations, to face the impossible burden of having enough expertise in all facets of contemporary health care and to acknowledge our limited power to "produce" or otherwise force students to accomplish the goals we have set for them (and for ourselves: freedom from being accused of failure, freedom from responsibility for mistakes made by graduates). It suggests several models of new partnerships among students, faculty, practitioners, citizens (Shor, 1987).

One common theme among many of the curriculum revolution dialogues is the theme of "partnership," of revisioning students not as "raw material" to be hammered into a "product" but as participants who share some of our goals (but not others) and with whom we can negotiate. This theme of dialogue or partnership is one approach to laying down the burden of our current models of control and expertise. It's not just that we cannot prophesy the future to know what students will need; even if we could, our influence over students is far more constrained than our immodest manufacturing metaphors would ever suggest. Furthermore, we don't need to shoulder" this awesome burden alone: students and practitioners are eager to work with us, to share responsibility and, if our collective guesses are incorrect, the blame.

Dialogue and Power

Another feature of the curriculum revolution discussions has been the prominence of feminist and critical theory (Thompson, 1987). These are not unrelated to the previous themes: dialogues are not always, perhaps are rarely, democratic conversations. Certainly dialogues between teachers and students have not been. And both the content and process of conversation is related to gender and power.

Critical theory and feminist theory have in common a critique of communication that is systematically distorted by issues of power and resources. Underlying many perspectives within critical theory is a view of "rationality" as related to decision making processes. The "rationality" of a decision depends vitally on both the quality of the information considered and the perspectives brought to bear on that information. No matter what the final decision, if it has been made in a situation in which information has been suppressed or only certain perspectives considered, the outcome wiU be less than fully rational (Habermas, 1984, 1987; White, 1988). In our culture many groups have been left outside the conversational circle: women, poor people, people of color (Grumet, 1988; Weiler, 1988; Wülis, 1977). Even in environments run by and supposedly "for" women, the same conversational practices of exclusion and silencing occur (Allen, 1986a; Roberts, 1983).

Consequently, when considering either current educational dialogue or imagining models for future educational practices, critical theory, and feminist theory have an important role to play. Many nurses have argued that the authoritarian atmosphere of our schools shape or reinforce a passivity (and anger) among our students that in fact prepares them to be compliant (if angry) workers. Conformity and obethence are still highly prized behaviors, even if there is verbal genuflection toward creativity and diversity. Our manufacturing models are mixed: they espouse a diversity of "inputs" or raw materials (students . of various ethnic or experiential backgrounds) and assume a single "process" (a curriculum with limited choices and pre-set courses) will produce a uniform "output" or product (Lather, 1984; Misgeld, 1985).

We can raise these dialogues about power, control, and conformity to another level: many participants in the curriculum revolution beheve that the criteria and processes we use to accredit schools of nursing reflect exactly these same values. Accreditation enforces the transmission of certain information and the adoption of certain approaches regardless of the mission, expertise, values, and environment of any particular school. The irony is that we do to ourselves and our colleagues what we do to our students (Hedin, 1986). Compare the affective reaction of faculty to the accreditation process with the affective reaction of students to clinical evaluation processes. Anger, resentment, and resistance are common themes (Diekelmann, Allen, & Tanner, 1989).

Personal Re- Visions

Can these themes be transformed by a curriculum revolution, by a re-visioning of nursing education? What new visions are being developed? I'd Uke to conclude by highUghting a few of my personal dreams, of visions I'd Uke to see realized.

First, I'd like to see a radical democratization of our nursing schools. Second, Fd Uke to hear a radical skepticism about aU fixed solutions, about all statements about what "students need" and about how to manufacture educational "products." Third, Fd like to see a swing of the pendulum away from an extreme commitment to content and back to a caring commitment to students and each other. What would these visions look like?

Radical democratization would involve first a realization that there are multiple views, agendas, and accountabilities in nursing education. Faculty do not need to, and should not, abandon their commitments to helping students become able practitioners. Rather, we need to recognize that there are many visions of what an able practitioner is and even more paths to take to accomplish any one of those visions. And people who might participate in discussions about nursing education include students, faculty, citizens, patients, practicing nurses, nurse administrators, employers, and, yes, even physicians. AU these, and others, have a legitimate stake in nursing education and their voices should be heard in an ongoing, democratized conversation about education.

A radicaUy democratized environment would mean working to eliminate hierarchies within faculties (undergraduate versus graduate, tenured versus untenured, researchers versus teachers). It would mean active partnerships between students and faculty as we worked together to accompUsh our joint and separate goals.

Abandoning our empirically unsupported and ethically problematic metaphors of "need" and "production" would help us lighten both our sense of power and the pressures of assumed, unilateral responsibility. There is Uttle empirical evidence to suggest that we know what students "need" without asking them and even less to suggest that we can design educational processes to force them to become the "products" we envision. Ethically there is little to distinguish such metaphors of education from metaphors of propaganda, torture or fascism (AUen, in press; Kliebard, 1970).

Democratizing the environment and abandoning metaphors of paternalism and control would allow us to shift our allegiances from what I see as rather defensive alignments with content to more genuine alliances with students. I can't count the number of times I have been startled to see a faculty member angrily expostulating on what educational experiences every student "needs" and insisting that all students must take course X before course Y, only to walk out of the meeting and engage in a personal, caring way with a student who has a personal difficulty or needs academic assistance. The love and energy are simply palpable in these interactions with students. The contrast reminds me not to reduce these colleagues to a too-simple image and inspires me to help transform the environment into one in which we can all enjoy their caring, committed selves.

What would schools of nursing look like that adopted these three principles? Very different. Very different from our current schools and very different from each other because each faculty and student body would be continually changing, negotiating, and experimenting. But I don't believe many genuine dialogues among responsible faculty and committed students would result in a 2-hour lecture to a group of adult women on "man is influenced by his environment." Nor can I imagine conversations, with no students present, about how to "get them" to read their assignments before lecture. But then, maybe next time the joke will be on me.

References

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10.3928/0148-4834-19900901-07

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