Journal of Nursing Education

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Teacher Talk: New Pedagogies for Nursing 

Covering Content and the Additive Curriculum: How Can I Use My Time with Students to Best Help Them Learn What They Need to Know?

Nancy Diekelmann, PhD, RN, FAAN; Elizabeth Smythe, PhD, RGON, RM

Abstract

Dr. Diekelmann is Helen Denne Schulte Professor Emerita, University of Wisconsin-Madison, School of Nursing, Madison, Wisconsin; and Dr. Smythe is Associate Professor, Auckland University of Technology, Division of Health Care Practice, School of Nursing, School of Midwifery, Auckland, New Zealand.

Address correspondence to Nancy Diekelmann, PhD, RN, FAAN, Helen Denne Schulte Professor Emerita, University of Wisconsin-Madison, School of Nursing, Clinical Sciences Center H6/246, 600 Highland Avenue, Madison, WI 53792-2455; e-mail: nldiekel@wisc.edu.

Covering content is a common concern for teachers and students that reflects an emphasis on conventional pedagogies (i.e., outcomes or competency-based nursing education) (Ironside, 2004; Tanner, 2004). The problem grows as content proliferates, resulting in additive curricula. Approaches for overcoming this problem are slow to appear. The new pedagogies (i.e., critical, feminist, phenomenological, and postmodern) offer both challenges and possibilities for reform (Diekelmann & Diekelmann, in press). In a multisite study of teachers implementing the new pedagogies, teachers often described how they use the new pedagogies as ways of thinking, each in their own way, one course at a time. Their experiences call them to rethink “covering content” (Diekelmann, 2003). Linna, an experienced teacher, described a time of challenging her inclination and tendency to cover content. James, a student in Linna’s class, provided commentary of his experiences in the course.

Linna described:

I teach Med-Surg II, and the 57 students are everywhere with abilities and past experiences,...plus I have all the advanced physiology content...so all my efforts, semester after semester, as things get more and more complicated for them [the students], [are related to thinking about] new ways to “cover content”...show them links in their textbooks...the textbooks that are getting huge and overpowered by details and information.…

But this particular lecture on diabetes I knew was a good one, as my examples really work...and the only thing that sometimes gets in the way, is that I can get bored. However, this day I started with diabetes and the physiology involved, and I could tell...that lots of the students were not prepared. It is discouraging, but you go on and try to teach them what they need to know as you go along...with what you think they need to be able to do to make nursing diagnoses and to intervene as a nurse,...you know, give safe care...also providing primary care to these patients and prevention...it is really a lot!

According to Ironside (2004), one of the difficulties with conventional pedagogy is how comfortable nurse educators have become in selecting, sequencing, and transmitting content. Conventional pedagogies encourage teachers to spend their time developing strategies to present more content, or to present it in more efficient or effective ways. They carefully select reading assignments and seek to improve their skills in offering practice examples to show links between content and practice. Linna described her efforts over the years in assembling, cultivating, and constructing her lecture. (Certain phrases in this article are italicized to identify them as related to the Concernful Practices of Schooling, Learning, and Teaching, as originally published in Young, P., & Diekelmann, N. (2002). Learning to Lecture: Exploring the Skills, Strategies, and Practices of New Teachers in Nursing Education. Journal of Nursing Education, 41, 405–412.) She attends to how she gathers and brings students into learning through a lecture on diabetes. Linna understands how important knowing and connecting with students is to her class, and she worries about being bored. Perhaps she senses that handing over repackaged content year after year is not teaching, nor does it necessarily invite learning.

In this class, Linna was discouraged when she struggled to connect with students who had not completed the reading in…

Dr. Diekelmann is Helen Denne Schulte Professor Emerita, University of Wisconsin-Madison, School of Nursing, Madison, Wisconsin; and Dr. Smythe is Associate Professor, Auckland University of Technology, Division of Health Care Practice, School of Nursing, School of Midwifery, Auckland, New Zealand.

Address correspondence to Nancy Diekelmann, PhD, RN, FAAN, Helen Denne Schulte Professor Emerita, University of Wisconsin-Madison, School of Nursing, Clinical Sciences Center H6/246, 600 Highland Avenue, Madison, WI 53792-2455; e-mail: nldiekel@wisc.edu.

Covering content is a common concern for teachers and students that reflects an emphasis on conventional pedagogies (i.e., outcomes or competency-based nursing education) (Ironside, 2004; Tanner, 2004). The problem grows as content proliferates, resulting in additive curricula. Approaches for overcoming this problem are slow to appear. The new pedagogies (i.e., critical, feminist, phenomenological, and postmodern) offer both challenges and possibilities for reform (Diekelmann & Diekelmann, in press). In a multisite study of teachers implementing the new pedagogies, teachers often described how they use the new pedagogies as ways of thinking, each in their own way, one course at a time. Their experiences call them to rethink “covering content” (Diekelmann, 2003). Linna, an experienced teacher, described a time of challenging her inclination and tendency to cover content. James, a student in Linna’s class, provided commentary of his experiences in the course.

Covering Content: “It Is Really a Lot!”

Linna described:

I teach Med-Surg II, and the 57 students are everywhere with abilities and past experiences,...plus I have all the advanced physiology content...so all my efforts, semester after semester, as things get more and more complicated for them [the students], [are related to thinking about] new ways to “cover content”...show them links in their textbooks...the textbooks that are getting huge and overpowered by details and information.…

But this particular lecture on diabetes I knew was a good one, as my examples really work...and the only thing that sometimes gets in the way, is that I can get bored. However, this day I started with diabetes and the physiology involved, and I could tell...that lots of the students were not prepared. It is discouraging, but you go on and try to teach them what they need to know as you go along...with what you think they need to be able to do to make nursing diagnoses and to intervene as a nurse,...you know, give safe care...also providing primary care to these patients and prevention...it is really a lot!

According to Ironside (2004), one of the difficulties with conventional pedagogy is how comfortable nurse educators have become in selecting, sequencing, and transmitting content. Conventional pedagogies encourage teachers to spend their time developing strategies to present more content, or to present it in more efficient or effective ways. They carefully select reading assignments and seek to improve their skills in offering practice examples to show links between content and practice. Linna described her efforts over the years in assembling, cultivating, and constructing her lecture. (Certain phrases in this article are italicized to identify them as related to the Concernful Practices of Schooling, Learning, and Teaching, as originally published in Young, P., & Diekelmann, N. (2002). Learning to Lecture: Exploring the Skills, Strategies, and Practices of New Teachers in Nursing Education. Journal of Nursing Education, 41, 405–412.) She attends to how she gathers and brings students into learning through a lecture on diabetes. Linna understands how important knowing and connecting with students is to her class, and she worries about being bored. Perhaps she senses that handing over repackaged content year after year is not teaching, nor does it necessarily invite learning.

In this class, Linna was discouraged when she struggled to connect with students who had not completed the reading in preparation for class. But she accepts this as a common occurrence and continues as she enacts the central commitment of conventional pedagogies: to present or cover content. Perhaps Linna is too comfortable with students’ coming to class unprepared? The often-unarticulated, taken-for-granted assumption of conventional pedagogy is that if students are engaged and involved in the class, they will arrive prepared. If students are not prepared, the assumption is that either the teacher is doing something wrong and needs to better motivate them or the students are not committed to the class and learning. James presented another interpretation that challenges these often unchallenged and invisible assumptions:

Our Med-Surg II instructor is excellent. I heard she was good, but I knew right away what I heard was right!.. I stopped preparing for class right away, as she helps you to know what is important...so I wait until after lecture to do the reading and then I go over my notes And I study my notes before the test and fill in what I forgot or did not get.... Some teachers are a mess in their lectures, and you have to try and do their readings each week, or you don’t get anything out of the class...and their tests are like a huge guessing game.…

Another kind of teacher we have in the school is...they have gross amounts of content in their courses, and you can’t tell at all what is important.… Everything seems important, and you write and write and write in class, and it’s like dictating, and you remember nothing! Nothing makes sense. Studying for those tests is just memorizing everything, and we are all too anxious.… I want to give up in those courses.

James challenges Linna’s taken-for-granted assumption that it is the student’s role and responsibility to prepare before class by doing the readings and assignments. He also challenges the assumption that learning is greater when students read course content before class, rather than after. For James, each class period in Linna’s course is a step toward his learning, rather than the place to bring what he has learned through preparation. Whereas Linna pays attention to the preparation (learning for class), James’s focus is on learning for the sake of learning.

In describing how he knows and connects with Linna as an excellent teacher, James reveals how closely he attends to learning course content. James described how some teachers close down on learning, with classes that “do not make sense” and where memorizing for a test is an experience of anxiety and “[wanting] to give up.” He remains engaged in Linna’s class, as she has created a future of possibility for him to learn content, with her lecture serving as guide, rather than a template for the examination.

James appreciates that the links Linna makes in class point to what is important. Students are often unable to discern what is important from what is unimportant, and they can become overwhelmed by taking everything presented as important. James is freed from the overwhelming mass of seemingly disconnected information to take the signposted path Linna provides, not as an indication of what will be on the test, but rather what is important and relevant for learning.

Challenging Taken-for-Granted Assumptions and Using the New Pedagogies: “How Can I Help Students Best Learn?”

The new pedagogies, as ways of thinking, often challenge the taken-for-granted assumptions of conventional pedagogies. As teachers increase their pedagogical literacy of these approaches, they begin to discover new ways to spend their time with students. Linna described:

We were still covering physiology [in the lecture on diabetes] when one of the students who really struggles, raised her hand and said, “My grandmother has had diabetes for years, and she might lose her right leg.” Oh, gosh, I thought,...it was only 5 minutes into the lecture, and the students were already having a hard time with this content and yet...you know, this is a teachable moment, at least for this student. You know how helpful it is when you go from where the students are engaged and what they find of interest. Yet, very honestly I normally would have spent only a little time discussing with this student her grandmother’s situation and the risks of diabetes—you know the consequences of this chronic disease and then skillfully, I hope, I would have gotten us back onto pathophysiology, maybe diabetic neuropathy.

I can’t really say why I challenged my usual way of doing things, but I thought, “Go for it, Linna. How can I help students best learn?”...and so I just let the conversation flow, and I held my tongue, even when the conversation lulled, I kept as quiet as I could and let thinking happen.

Reform using the new pedagogies often begins with challenging the familiar and taken-for-granted ways of responding. Linna knows she is expected to teach and be responsible for teaching certain content to the students, but her practical knowledge, born of reflecting on her daily experiences, told her that “teachable moments” happen when teachers teach from “where the students are engaged and what they find of interest.” A moment of Linna’s feeling “Oh gosh” transformed this class for both teacher and students. In responding to the student’s question, Linna courageously does not then go back to where she left off. She lets the students’ conversation flow and does not intervene, even when it lulls. She keeps quiet and lets “thinking happen.”

In the conventional pedagogies, there is a focus on content leading to cognitive gain and application. In the interpretive pedagogies, content is accompanied by an equal emphasis on thinking. Linna takes the risk that students can learn and understand content through a different way of being together. She knows the students must know the content, but she lets go of the assumption that students only learn if she provides them with content in her lectures. When she takes her attention off the content itself and, instead, attunes herself to the students’ questions and stories, she experiences a glimpse of how learning unfolds of its own accord before her eyes. Linna shifts from being the solo performer to the conductor orchestrating emerging ideas.

However, James described his perspective of some of these lectures:

Some lectures with Linna are not so easy to take notes in, though.… She will let us get off the topic. We all love these lectures, but I notice when I go to study, I usually have few, if any, notes.… It is because you get so caught up in the class. Like this one time, a student said right off, my grandmother has diabetes, and she may lose her leg! I mean, you know, I love my grandmother and couldn’t imagine if she wasn’t able to garden...so I stopped even taking notes and sort of listened better. I found I had a lot of questions, and you couldn’t help but pay attention.

James challenges the taken-for-granted assumption that student note-taking reflects interest and engagement. Interest and engagement is commonly assumed to be equal to students’ behaving in ways teachers think students should in order to learn. Without thinking, James put his pencil down, because an experience of thinking caught him. The public, communal class conversation that followed was one to which James could not “help but pay attention.”

He attends to the conversation and brings his questioning to his experience. James knows this teacher “will let” the content be put aside. Perhaps what he means is that Linna will let her carefully prepared plans lie dormant, while the topic itself is free to connect with students’ own experiences and questions. Amputation has special meaning for James as he considers what this would mean for his own grandmother. The meaning of content, which is always self-interpreted and contextual, is as important in Narrative Pedagogy as the content itself. When James thinks of his grandmother having an amputation, the understanding is more than that of a “risk factor.” The hugeness of the imagined disruption to his grandmother’s life affects the importance of James’s learning.

Linna continued describing her experience of this class:

I resisted asking questions and answering questions. I more asked these open-ended questions that kept the thinking going [italics added]. At one point, a student asked about treating diabetic neuropathy, and I said to them, this is content [I was going to present] today, but in nursing, there will always be situations where you don’t have the information you need...so let’s imagine we need to get this information, and a teacher or book is not handy, so “How are we to think about treating diabetic neuropathy?” I am learning in this project that when you use the new pedagogies, you spend your time preparing for class by coming up with questions like this one!

Narrative Pedagogy arises out of what is, in this case, the usual and familiar approaches of covering content in a lecture Linna has given before. Linna moves to enact this interpretive pedagogy when a question and a teachable moment comes along. She sees a spark of thinking and shifts her attention to “[keeping] the thinking going.” Linna offered a question that draws out and sustains thinking. She also decenters herself as a teacher when she asks the question, “How are we to think about treating diabetic neuropathy?”—a question with more than one answer. She joins the students on an exploration that does not tell, but rather invites thinking and further questioning.

This kind of questioning resists a focus on “an answer” and on the teacher as expert. The teacher does not walk out of such a class knowing that a long list of content has been covered. Rather Linna emerges from a shared experience of learning with her students, sensing their eagerness to continue the quest to understand more, and knowing she has equipped them for the ongoing learning process. Linna went on to enact her new pedagogical practice of “coming up with” questions that invite learning for her next encounter with these students.

James described the meaning of this invitation to him:

The diabetic class was the best one because she [Linna] had us trying to figure out what to do and what we know.… It seemed like real life, and you realize you may not know a lot, we are for sure students, but we can figure out a lot! Also, it was a lot of listening to other students too...maybe you don’t like them, sort of, but when you need to know something, you have to learn to listen behind who they are.

James found the thinking experience called out by Linna to be similar to his “real-life” experiences as a beginning student in clinical courses. He also learned something about the role of engendering community and providing safe nursing care; came to understand that nursing, as a practice, is collaborative and communal; and learned to listen “behind” who a person is to hear the information he needs to know to provide safe nursing care. Such learning cannot be prescribed as content. It can only happen in a climate where respectful teachers show the class the value of every person’s insight.

Linna continued to describe this class and her use of Narrative Pedagogy:

One of the students misread a chart, and so I quickly scanned in the page from the textbook, and we looked at it together, and I helped them to read this chart. I knew this was a good session because I was learning along with them. If you had asked me before class, do the students need practice on how to read a chart, I would have said, no! But I was 100% wrong, as these were good students who were struggling,...but we quickly got through it, and off they went again. One student said, “Can we get back to this grandmother losing her leg? Mine is 93, and she says the day I can’t garden is the day I die.” And I said, “How are we, as nurses, to think about responding to a patient who might say this to you?”

Narrative Pedagogy is a student-centered pedagogy. Linna used instructional technology in responding to the student-led conversation (i.e., a student misread a chart, and Linna used the classroom scanner to show how to read it correctly). Being shown is a very different learning experience than being expected to know. The meaning of this experience to Linna was that she learned that “good” students may have trouble reading charts in the textbook. She became the teacher as learner.

Again Linna responded to a student’s comment with a call to thinking and dialogue. She asked the question, “How are we, as nurses, to think about responding to a patient who might say this to you?” She did not say, “What would you say if a patient said this?” Rather, her question focuses on thinking. When teachers and students think together, the complex tensions within many possible answers are free to emerge. Linna is learner as teacher, opening her own thinking to herself and the students.

James said:

There is always a lot of competition in class, especially over grades and doing projects and papers and stuff, but this lecture was extra good, and we just all talked together because we were all the same, sort of, because we needed each other to get the information and figure things out.… We do all share, no matter what kind of personalities we have, that we want to be good nurses.

I even asked this question about my grandmother. Linna said, “...What does it mean to you as a nurse when a patient like asks you a question about dying.” And when I left class like that you keep thinking. I went back and kept talking with my roommate who is in peds [pediatrics] now. And we talked even more, and he came up with this question about a high schooler he knows “who would die” if he couldn’t swim, and how do you manage insulin levels for him, being so active? We had to look up a lot of stuff...and not just our books but also on the Internet, and then we also looked up insulin pumps on the Internet. There was all kinds of really important information from the American Diabetic Association, so we assumed you could trust it.

James challenged the taken-for-granted importance of learning during class time. He showed how what matters is that he is engaged, wanting to learn more and able to find and evaluate the information he needs. James also shows that nursing practice is essentially a narrative experience. He took the stories from class back to his roommate, who added his own stories. Together, they keep talking, thinking, searching, and questioning. When thinking is active and ongoing, learning becomes “learning for practice,” which will continue to respond and grow, context by context, time and again. Perhaps approaches to overcoming covering content are already underway and lie embedded in letting the stories of students and teachers be free to follow the thinking they inspire.

Evidence of Narrative Pedagogy

Narrative Pedagogy appears in the converging conversations of students and teachers as they enact the new pedagogies. Narrative Pedagogy attempts to overcome the additive curriculum by decentering a focus on content to add an equal emphasis on calling out thinking and inviting learning (Diekelmann, & Diekelmann, in press; Lipman, 2003; Smythe, 2004). Content becomes the necessary, but not sufficient, background for thinking. When teachers shift attention from content to the experience of learning, how teachers and students best spend their time together is questioned. Narrative Pedagogy opens the way for students and teachers to bring one another to learning.

Questions for Further Thinking

  • In discussions about curriculum, what are some strategies schools could use to take the attention off of content?
  • How do teachers know when too much content in a course (a unit? a particular lecture?) gets in the way of learning?
  • How can we, as teachers, learn more about how students actually learn by calling out their experiences in our courses? What is the relationship between preparing for class and learning?

References

  • Diekelmann, N. (2003). Distance desktop faculty development in the new pedagogies for community-based care (Final Research Report). Madison: University of Wisconsin-Madison, School of Nursing.
  • Diekelmann, N. & Diekelmann, J. (in press). Schooling learning teaching: Toward a Narrative Pedagogy. Madison: University of Wisconsin Press.
  • Ironside, P. (2004). “Covering content” and teaching thinking: Deconstructing the additive curriculum. Journal of Nursing Education, 43, 5–12.
  • Lipman, M. (2003). Thinking in education (2nd ed.). New York: Cambridge. doi:10.1017/CBO9780511840272 [CrossRef]
  • Smythe, E. (2004). Thinking. Nurse Education Today, 24, 326–332. doi:10.1016/j.nedt.2004.02.008 [CrossRef]
  • Tanner, C. (2004). The meaning of curriculum: Content to be covered or stories to be heard?Journal of Nursing Education, 43, 3–4.

10.3928/01484834-20040801-06

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