Editor's Note: Teacher Talk" is a new feature, serving as a forum to discuss contemporary issues of nursing education. Drawing on the growing body of literature on the role of narrative in the human sciences, it provides opportunity for teachers to tell stories from their practice in nursing education. Narrative scholarship is committed to revealing our shared understandings about what matters most in teaching and learning in nursing. It can also reveal inequities and oppressive practices that are reproduced, often unintentionally, in nursing education. Narratives preserve the meaningful experiences and reflect what we have learned from our everyday practice as teachers. This month, Em Bevis, a well-known writer and consultant in nursing education, shares stories of her experiences as a teacher, and of her own paradigm shift from a behavioral model of nursing education.
-Christine A. Tanner, RN1PhD, FAAN
There is a novel called Baby Todd and the Rattlesnake Stradivarius that begins with the title of this article. And to tell the truth, that's the way I feel about my commitment to the behaviorist paradigm for curriculum development. It was a pretty good funeral and continues to be one. The thing is, you can't have a good funeral without burying something really worthwhile. Otherwise, it is a mockery, a hollow celebration of life. Good funerals occur because the life being celebrated was worthy, meaningful, and purposeful. Kühn (1970) says that "During the period when the paradigm is successful, the profession will have solved problems that its members could scarcely have imagined and would never have undertaken without commitment to the paradigm. And at least part of that achievement always proves to be permanent" (pp. 24-25). History will treat the period of behaviorism in nursing education kindly because it helped nursing achieve a quality never before attained.
I gave a great portion of my life and energy to promulgating the behaviorist paradigm. Its life was lived fully and fruitfully and the time had come for it to pass. Mourning in such cases is not less filled with loss and grief; it simply has an added component, a smattering of satisfaction in a life well lived. But let's not speak of mourning yet. Let's examine the commitment.
My First Love
I was a strong devotee of behaviorism from the time I really began to grasp its marvelous strength. That happened about 1960. I served it faithfully until about 1978, when cracks began to show in its perfect countenance, and even then I hung in there until 1987 trying to find ways to make those round pegs fit into those square holes. I understood Tyler, Taba, Bloom, Mager, and all those other people who helped make curriculum an understandable formula that I could follow to what I thought was an unambiguous prescription for successful learning. I understood philosophies, conceptual frameworks, objectives in all their levels and guises. I loved domains, units, modules, terminal behaviors, and objectivesdriven evaluation. I could and can write a curriculum using those formulas that will make your heart sing. I have to admit, though, that I always thought "terminal behaviors" rather morbid (moribund?). Well, funereal at least.
I comprehended content-driven courses and long lists of what absolutely must be covered in case the studentcome-graduate ever has the slightest need for it or hears it referred to in the hospital cafeteria. I liked test questions that have one right answer that can be memorized. I still like to lecture and I know what it feels like to talk so fast that the student brings four to five pens and pencils to class so no breakage or ink-outages will mar the flow of note-taking. The power of it all rushes through my system, stimulating my adrenals and lighting up my face with the twin smiles of familiarity and comfort.
Cracks in the Love Affair, or the Dawn's Early Light
I am still grief-stricken and devastated to realize that behaviorism is such a frightfully limiting modality. And I have all the symptoms of grief I can't believe that it is too limited for today's needs. I am angry at its limitations and that it cannot stretch to praxis, critical thinking, and caring. I negotiate with my better self to spend just half my time doing things the behaviorist way. And I despair that I am a recovering behaviorist and can never really trust myself alone with the model again. The temptation is ever present, and ever so often I find myself in the middle of a weekend bout of behaviorism before I realize what Fm doing. Oh, misery.
I have been questioning the efficacy of behaviorism as the sole basis for curriculum development for many years. One story bears telling. I was teaching in California and got into an unbelievable power struggle with a bright and wonderful student whose name I still remember but I will call her "Maria* to protect the innocent. Maria hated class (boring lecture) and loved clinical (bright girl). She always managed to find a reason to come to class at least 10 minutes late. We got into such a power struggle that I would not let her come at all if she was late. Absences were not permitted and so I was in the uncomfortable position, of my own making, of failing her on lateness-absence or losing the power struggle. I felt awful. I felt immature, angry, and in an impossible situation. Sure, I set it up, but I operated in a system that supported my falling into such a trap. It supported authoritarianism, power politics in the teacher-student relationship, right-wrong positions, emphasis on content lists and lecture, received knowledge, memorization as learning, "objective" examinations, and teacher-planned classes. The whole picture of what I was in and what I was doing came rushing at me all at once one dark and stormy night. From that moment on, I became increasingly conscious of the inherent problems in the paradigm of curriculum I loved.
You see, what I realized was that I oppressed Maria. Oppression stems from the need to maintain the status quo; most times it is designed to keep those of power and privilege in positions of power and privilege. I rightfully blamed myself for that fiasco. However, the traditions and customs that nursing education had devised for what was thought to be good educational practice had become accepted convention. Students and teachers accept oppressive ways unquestioningly and do not look for the assumptions that underlie them or the practices that uphold them. They become so commonplace that questioning them is a form of heresy. My example with Maria is extreme but, unfortunately, not that unusual.
At the same tune I was teaching the course in which Maria was enrolled, I was also co-teaching a leadership management course. We taught it in a process-oriented way that was based in the realities of nursing leadership. It was never dull, never boring, and students loved to come to class. Oh, we used the behaviorist modes of objectives, etc., but the course was much more flexible and studentparticipative.
As the Twig Is Bent, So Grows the Tree
So, how did I do the strange flip-flop from devoted behaviorist to the new paradigms? How one comes about tracking the changes that need to come about in one's own professional life, in one's own profession, and in one's thinking is, I believe, intimately tied in with how we basically perceive ourselves in the context of our professional life and in the context of OUT history. At least that has been true of me.
One must understand the fact that change for me has always been not only a way of life but an exciting part of life. I grew up in the rural South, in a small town where the freight from the railway and the ice for our nonelectric icebox was delivered by horse-drawn wagons. My sister, the other children in the area, and I would run along behind the ice wagon and jump on the tailgate, and the ice man would give us all chips of ice to eat. (I think he deliberately chipped the ice sloppily to have bits to give us.) The melting ice would run down our chins, making tracks in the dust and dirt of our faces. You must remember, the roads around our houses were not paved and dust was something we had plenty of
This picture of wagons, iceboxes, and dirty faces gives a quick glimpse of the changes in our way of life since my birth in 1932. These changes have been astounding and exciting. The rapid and immense changes during my lifetime have taught me that the accepted ways must always be under scrutiny. My life history, therefore, has taught me flexibility. Flexibility may be one of the most ignored of one's important personal assets. Getting wed to a position and looking no further is a blind commitment that negates creativity and assumes that nothing better can be developed. Loyalty is one thing, blind allegiance and consistent conformity quite another. To me, life is like wine tasting: try everything once and keep an open mind. (Well, almost everything.)
Watching my world change drastically has made me an enthusiastic participant in exploring new possibilities. So, as I began to become increasingly aware of the problems inherent in the system I had for so many years used and espoused, I began to long for some way to "fix it" but was unable to envision a way to do so.
Not only with Maria, but with student after student, I could see that the student-teacher relationship was not what I really wanted or believed in; I could see that the relationship itself was teaching students things I did not want them to learn. I could see that the curriculum was driven by content, not the realities of practice. 1 could see that we were not teaching creativity, critical thinking, caring, and autonomy. I had the insight to see the behaviorist paradigm's shortcomings and limitations for seeking truth, understanding human experience, caring, thinking critically, and transforming society, but I was too limited to envision a model that would enable one to design curriculum that would accomplish those things at which behaviorism failed.
For me, it all happened so suddenly. It was a conversion*; there is no other explanation for it. My woe was exploded by the excitement of discovery when I read Lawrence Stenhouse and glimpsed the promise inherent in his "four different processes of education" (1975, pp. 80-81) and his discussion of Raths (1971), Peters (1959), and Metcalf (1963) in his "process model" of curriculum development. This sent me running to those sources and then to others. This marked the beginning for me of one of the most exciting periods of my life, professionally, intellectually, and personally. It came at a time when I visualized myself drifting toward old age and retirement on increasingly flabby laurels, a sort of "Stepford wife" of the curriculum set.
The first year I taught (University of North Carolina, 1958) I wrote, for my eyes only, a small treatise on what I thought was the basis of teaching nursing. The only person I ever showed it to was my husband. Years later, as I was writing about caring, he remarked that my basic philosophy had not changed, only matured, and reminded me ofthat early treatise. The study of caring has stayed in the forefront of my thinking all these years. So the change in the role that I think caring has in the nursing curriculum is not so much one of substance but of the extent of my understanding and knowledge about caring.
Additionally, one of my early awarenesses in the new directions that curriculum could take led me to explore the differences between training and education, and that trail led me to seek clarification about the types of learning critical thinking. Critical thinking then led me to praxis. They are all tied in together and make a system of thought about nursing education. From those early awarenesses I have come up a wandering path to other beliefs. My beliefs, as you may begin to understand, are not a stable system. I would not have you think me wishy-washy, for I am not. I'm simply on a journey. A journey that takes me to a variety of sites from which to view the world and this variety provides me with changing world views.
For Today Only
Don't hold me to it, it's not carved in stone, and by the time this goes to press I may have changed my mind. But for now I believe the following:
1. I believe there is nothing inherently wrong with behaviorism. In fact, for some things and under some conditions it may be the best paradigm. The mistake we nursing educators made and continue to make is to try to use one paradigm to answer all our needs. For example, behavior modification really worked on my children. But it has failed to allow for connected learning and constructed knowledge (Belenky, Clinchy, Goldberger, & Tarule, 1986), for emancipatory education, for critical thinking, and for participatory power structures. It strives for objectivity and belittles intuitive knowing. I could go on but this is not a critique of behaviorism.
2. I believe critical consciousness, critical thinking, praxis, and caring compose the substructure of nursing and that they exist primarily outside the empiricist/ behaviorist paradigm and are better taught from other, more phenomenological points of view.
3. I believe caring is the central core of nursing and its moral imperative (Newman, Sime, & Corcoran-Perry, 1991; Watson, 1988). Caring guides our decisions and requires that we do things for ourselves, our patients/ clients, our society, and our profession. Caring is an end in itself (Gadow, 1988) and not just a way to work more humanely toward cure. I believe caring is an existential reality that poses problems and issues of choice for us. And to be caring, the choosing must have a moral guide, a plumbline that Modelings (1988) calls "longing after good."
4. Praxis is the fundamental modality of nursing. Street (1992) refers to emancipatory praxis. For nursing, praxis is gender-related, rooted in reality, focused on changing and improving society, centered on altering the expectations and traditions of nursing, and guided by the morality of caring. It exists in an environment of egalitarianism and engenders a sense of sororal and fraternal relationships. It moves nursing in a communityconnected way toward a more socially just society, a more caring society, and a more widely emancipated, power-sharing society. This inevitably improves the quality of ufe and, therefore, of health (Carr & Kemmis, 1986; Street, 1992; Weiler, 1988).
Praxis has four aspects (Carr & Kemmis, 1986; Grundy, 1987; Street, 1992; Weiler, 1988) that influence the new curriculum directions in nursing:
* It is connected with transforming society (critical theory and critical feminist theory).
* It changes the framework of traditions and expectations within which the field operates, e.g., the fundamental character of the social setting will be reconstructed.
* It is always guided by moral disposition to act truly, justly, and caringly.
* It is connected to a type of dialectical thinking that demands reflection back and forth between elements like part and whole, and, as Carr and Kemmis ( 1986) offer, it is fluid, not a static confrontation between two poles but discovering contradictions and requiring new constructive thinking to transcend the contradictions. It is dynamic and mutually constitutive, not separate and distinct.
Using this framework, I believe:
* The purpose of nursing education includes critical consciousness and social transformation. These require sensitization to hegemony and the responsibility for counter-hegemony, for it is the nature of praxis or reflective action to be compelling.
* To be educational (as contrasted to training), the environment must be egalitarian/sororal/fraternal/ democratic. This kind of relationship implies a teacherstudent interaction of a dialogical nature and student empowerment with shared control of learning processes. This relationship and environment has emancipatory consequences to individuals and to nursing.
5. I believe that the highest self must be a self free of coercion and oppression. It is a self educated to the awareness of, and provided with the ability to think through and resist, the hidden cultural conditioning (hegemony) that inhibits the realizations and insights that we are all creatures of that conditioning unless freed to the consciousness of it and creative in ways to counter it. Caring does not just instruct; it educates. One of the characteristics of education that distinguishes it from other types of learning, such as training, is that it frees. In other words, it is emancipatory (Freiré, 1970).
6. I believe that critical thinking is the intellectual growth goal for nurses. Brookfield (1989) says of critical thinking that it is an awareness of the assumptions under which we and others think and act; it is paying attention to the context ín which one's actions and ideas are generated, and it causes one to be open to alternative ways of looking at and behaving in the world. Langsdorf (1988) proposes that critical thinking "is concerned with being able to assess explicit and implicit claims in order to determine what one ought to do, or which claim one ought to accept on the basis of good reasons for that decision - rather than on the basis of force, chance, or custom" (p. 45). Mezirow and associates (1990) speak of critical reflection as the "assessment of the validity of the presuppositions of one's meaning perspectives, and examination of their sources and consequences" (p. xvi).
The point here is that critical thinking is informed by reflection, and without critical reflection, thinking lacks the self-awareness and insights necessary to criticality. Nurses too often confuse problem-solving or nursing process and critical thinking. Problem-solving or nursing process is a framework for solving problems; it may or may not have critical thinking as an element.
To be truly critical thinkers, we must be willing to go mentally naked: to be naked for the moment of inquiry and reflection; to be naked of our life-amassed conditioning, our familiar precepts, our world view, in short, of all of our acquired views; to view the thing and examine the idea, once again through innocence, but an innocence sophisticated in its pursuit of uncovering the true nature of the lived reality (as opposed to the supposed reality). It must be an innocence that doubts while believing and that is suspicious while trusting. This innocence, clothed in sophistication, is as difficult to evoke and as valuable as the lost mines of Ophir.
7. I believe that caring, critical thinking, and praxis must be taught in a reality context (simulated or actual) and must be taught in ways that allow the students to share a dialogue with one another around real issues and ideas. Information can be transmitted to students through lecture, reading, movies, and audiovisuels. Information can be transmitted even by watching a demonstration or by having a guided observational experience. Information can be gathered by students in reading, listening, observing.
Knowledge cannot be transmitted; knowledge assumes understanding. Knowledge is composed of patterns that make sense, insights, the building of cognitive structures. It requires reason, deliberation, interpretation, insights, reflection, dialogue, and meaning-making. Knowledge is generated by the self Through one's own efforts, one I develops a conceptual system that is always growing, developing, expanding, and being revised. This conceptual system is used to process information. It is this structure that enables a well-educated person to take an idea, concept, thought, or insight and elaborate upon it, analyze it, take parts and bits of it, and reconstitute it until the results are substantially different from the one that triggered the process. To be well educated, to know, requires that the learner exert his or her own intellectual power to make an effort to work with the information so that it leads to insights, comprehension, understanding, meanings, and generalizations. It is this involvement with the information transformed to knowledge that finally enables one to become a critical thinker. Teachers can devise strategies that provoke this process. Teacher talk-lecture does not do it.
Discovery learning is not doing it alone, wandering around in the desert waiting to stumble on some "truth" without structure or guidance. Discovery learning is a collaborative journey - where the learner is an equal partner with others. Discovery learning is actively working with data, information, insights, and knowledge, using models, cues, dialogue, maps, guidance, structures, and experience. It requires using one's own efforts and relying on one's own power to make sense, meaning, and understandings, and to comprehend the scope of the issues and assumptions surrounding ideas.
The Future Challenge, Should We Care to Accept It
In our teaching we must learn to invoke critical thinking. To invoke critical thinking requires relationships that are emancipatory and egalitarian; if we are to teach critical thinking we must learn reality-based teaching. This is because, for nursing, progress arises out of praxis situations that are reflections about reality practice and theory interactions and interinfluence. Praxis rests in active involvement with the ideas, reflections, and meanings found in the person-to-idea-to-action struggle that compels not only thinking but reading, writing, talking, and doing. This could be called dialogue, dialogue with books and papers, with pen and ink (or computers), and with persons and with practice all coming together in an existential moment. The persons involved need not agree, need not be on the same plane or equally as informed, but must be committed to investigative, thoughtful, questing conversation.
For a viable future, we must discover how to be vibrantly alive to one another, to inhabit one another's worlds insofar as one human is able to co-inhabit; we must learn to create "learning communities* (Schwab, 1976) and be committed to the welfare of the whole. We must learn to look at health problems, indeed at world problems, not from a standpoint of how they will affect me now, but how they will affect the community as a whole now and in the future. We must learn to be politically active and mobilize the vulnerable for self-protection from exploitation and injustice.
We must care and that means to be committed. Yes, more than committed - obligated, to act for, with, and on behalf of our fellow humans. To do that, we must use the best that is in us: develop our powers, study, reflect, act, grow.
Our future must hold a realliance between nurses in practice and nurses in education. We must work together to build a future that allows nurses to respond to the great social needs of this and the coming decade. Blaming one another for our failures, oppressing each other, and polite posturing are not enough. Serving on a few committees for one another is not enough. To succeed in caring for the people, we nurses must each participate in the others' affairs and remold nursing together.
No Rest for the Weary
As I mentioned earlier, there I was minding my own business, floating along on the river of complacency toward the docile state of oblivion when I was struck by a two-by-four and sent spiraling into new paradigms (no, not paradise, that's a different word). Now I rush about, barely able to keep up with my work, always a day late and a dollar short. I'm behind 18 "essential to be read" books, 73 "essential to be read" articles, and 15 unreturned phone calls, and my reflection time is reduced to driving back and forth to the airport. At my age, people have begun to say to each other as I approach (as if I were too deaf to hear the remark, or my wits too dull to understand the implications), "Doesn't she look good!" As I reflect on the title of this article, "All in all it was a pretty good funeral," I'm glad they are not looking down at me saying, "Don't she look natural!"
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