Journal of Nursing Education

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Educational Innovations 

Celebrating a Commitment to Care: Building Concernful Practices Among Practitioners

Linda L. Burke, MSN, RN, CNE; Margaret G. Williams, PhD, RN, CNE

Abstract

Caring can be discussed and achieved in a variety of ways within various professional nursing settings. The purpose of our Commitment to Care Celebration was to share common experiences of caring among students, faculty, and staff to build community at a small midwestern college of nursing. The concernful practices of schooling learning teaching were the backbone of designing this caring experience. Narrative pedagogy invited stories of caring among participants in small circular groups to discover what was most important in caring for self and others. This event revealed a true caring experience for students, faculty, and staff, and supported how concernful practices engendered a community of learners.

Abstract

Caring can be discussed and achieved in a variety of ways within various professional nursing settings. The purpose of our Commitment to Care Celebration was to share common experiences of caring among students, faculty, and staff to build community at a small midwestern college of nursing. The concernful practices of schooling learning teaching were the backbone of designing this caring experience. Narrative pedagogy invited stories of caring among participants in small circular groups to discover what was most important in caring for self and others. This event revealed a true caring experience for students, faculty, and staff, and supported how concernful practices engendered a community of learners.

Ms. Burke is Assistant Professor, and Dr. Williams is Professor, Blessing-Rieman College of Nursing, Quincy, Illinois

The authors have no financial or proprietary interest in the materials presented herein.

Address correspondence to Linda L. Burke, MSN, RN, CNE, Assistant Professor, Blessing-Rieman College of Nursing, PO Box 7005, Broadway at 11th, Quincy, IL 62305-7005; e-mail: lburke@brcn.edu.

Received: December 04, 2009
Accepted: April 21, 2010
Posted Online: October 29, 2010

Often the caregivers who work together underestimate the power of reconnecting with one’s passion, caring about patients, and caring about each other. Caregivers can be students, faculty, nurses, and all staff in a nursing unit, long-term care facility, or college. At our midwestern college of nursing, we found a solution to reconnecting with our passion and building a caring environment by holding a Commitment to Care Celebration. This article describes our journey in the hope that it will help others design and create a similar caring experience unique to their own college, unit, or setting.

Concernful Practices

Our college has been using narrative pedagogy under the tutelage of Dr. Nancy Diekelmann and Dr. Pamela Ironside as one pedagogical approach to help educate nursing students. Narrative pedagogy is a way to share stories and interpret the lived experiences of student nurses (Diekelmann, 2003b). At our Commitment to Care Celebration, we called forth stories of caring to help us think about and discover the ways we care for one another and to engender a community of learners to improve our learning environment (Diekelmann, 2003a).

It is important to remember that narrative pedagogy “is not a strategy to be implemented but rather a way to create an environment within nursing education that invites teachers, students, and clinicians into converging conversations” (Dahlberg, Ekebergh, & Ironside, 2003, p.28). This caring dialogue is based on Diekelmann’s research of concernful practices of schooling learning teaching (Diekelmann & Diekelmann, 2009; Diekelmann & Ironside, 1998). The concernful practices are (Diekelmann & Diekelmann, 2009, p. XVIII):

  • Presencing: attending and being open.
  • Assembling: constructing and cultivating.
  • Gathering: welcoming and calling forth.
  • Caring: engendering of community.
  • Listening: knowing and connecting.
  • Interpreting: unlearning and becoming.
  • Inviting: waiting and letting be.
  • Questioning: sense and making meanings visible.
  • Retrieving places: keeping open a future of possibilities.
  • Preserving: reading, writing, thinking-saying, and dialogue.

The articles in the reference list describe narrative pedagogy and the concernful practices. The following sections detail the site-specific way we enacted the concernful practices within our Commitment to Care Celebration.

Gathering: Welcoming and Calling Forth

The invitation for all to gather as one large group created the caring environment. Everyone at the college was welcomed to the celebratory event with a personal invitation on the first day of school. Flyers were posted around the college, and informal announcements were made during the first week. Everyone at this small college was required to attend the celebration, which emphasized a commitment to care about each other.

Students were prompted to think or write about a caring story that could be shared with others. This helped to set the tone for the event. However, assembling the entire college in one place took advance planning and fine-tuning over several years. We redesigned the time and day, and lunchtime in the middle of the week seemed to work the best. Faculty and staff were committed to creating this time and space for the college community to gather by canceling classes and closing staff offices during the event. This allowed the college to bring students, staff, and faculty together and to call forth the opportunity to care about each other and to care for each other within a nursing community.

Assembling: Constructing and Cultivating

The college is a small, single-purpose institution providing baccalaureate nursing education to approximately 250 students. It was a challenge to construct an intimate arrangement of physical space when dealing with a group of this size. The space was designed to include 15 circles of 10 to 15 chairs. An intentional plan ensured that each circle had a uniform representation of faculty, staff, and student levels. It was important to show that caring was a part of everyone’s life, regardless of one’s level of experience or role in the college community.

Senior students took the leadership role and facilitated the discussion in each circle. Facilitators used a list of suggested reflective questions to assist in beginning the dialogue and guided the discourse as shown in the Table. Faculty discussed roles with the seniors prior to the event and then provided the silent support and back-up in the assembled circle. This strategy helped to construct and cultivate the seniors’ comfort level for future possibilities in assuming this role after graduation.

Reflective Circle Questions

Table: Reflective Circle Questions

Retrieving Places: Keeping Open a Future of Possibilities

The designed circles provided a safe environment and intentionally kept open a future of possibilities within the group. Multiple small circles of chairs helped to create safer spaces to share personal caring stories. The circle design allowed face-to-face interactions, which fostered sharing and connecting. No one could sit, stand, or hide behind a person, thus creating an equal and common ground for attentive listening and participation.

Established ground rules maintained confidentiality and enabled mutual valuing and respectful communication. The person who was speaking held a talking stick to denote that one had the floor and commanded the full attention of the participants.

Caring: Engendering of Community

Caring is the heart of nursing. The college’s philosophy and mission is to educate students in an environment dedicated to caring and excellence. Circle time began as noted in the Table with the following:

This is an opportunity to join together as a community of learners at our college of nursing. As professional nurses and nursing students, we will discuss the importance of caring for our peers and ourselves. Caring starts with self-care, moves to helping others such as our peers, and then translates to our patient population. How we treat ourselves and others sets the stage for how we will and do treat patients.

Students described what it was like to care for oneself and others, or how someone enacted caring toward them. Our acts of attentive listening, undivided attention, and respect for the speaker created the caring circle that fostered and engendered community. Reaching out to others in a caring manner blossomed as students returned to their classes and enacted caring environments.

Inviting: Waiting and Letting Be

The concernful practices of schooling learning teaching emerged as students were invited to respond to various questions about caring. What was most meaningful and significant to students became apparent as students easily talked about caring and responded to caring dialogue. By waiting and letting be, students responded when they were ready. Some eagerly jumped in, whereas others sat back and listened attentively. Some let the group unfold one by one until the time was right for them. Everyone eventually engaged in the discourse and became an active member of the group.

Questioning: Sense and Making Meanings Visible

Answering questions about caring and discovering what really is meaningful to students emerged during circle time. Talking about caring as a group illuminated the importance of being cared for and caring for each other. Students could be heard acknowledging the importance to care for personal needs and to reach out to each other during hard times.

What was meaningful to students was made visible by the questions directed toward the senior students. Expert advice was sought on what to expect as one moved through the nursing program. Faculty uncovered that students wanted to know what to expect in the future directly from their peers. Questioning made visible the unspoken words and hidden meanings within the experiences shared among nursing students and helped to create the spirit of perseverance.

Listening: Knowing and Connecting

Knowing others whose journey is similar to one’s own journey and connecting with them provided students with a future linkage when they felt like giving up and needed to talk with someone. Attentive listening became an important part of knowing and connecting in the group. Talking about what helped one to stay when the going got tough invited other students to stay and persist with a “can do” attitude.

Carefully, students listened to the stories of other students and learned about the importance of using resources and getting to know their professors. Professors and staff materialized as significant supporting structures for students. Students exchanged e-mail addresses and cell phone numbers to help build future connections. The camaraderie noted in the circles gave students a sense of belonging to the college and to the nursing profession.

Interpreting: Unlearning and Becoming

The enactment of narrative pedagogy within circles enabled the unfolding of hidden meanings and common themes. Interpretative practice allowed faculty to help students unlearn taken-for-granted assumptions about each other. Students learned that stigmatizing labels such as “only a freshman” or “only a nursing student” are not permissible to use and therefore must be removed to create a person of value and worth within the nursing community.

Accepting individual differences were openly applauded, and students began to realize that everyone does share commonalities of being new, scared, overwhelmed, stressed, and apprehensive. This is part of being a nursing student.

Presencing: Attending and Being Open

The geometric circle fostered each person’s presence and enabled each participant’s attending to one another. By being there in body and mind, participants worked together in creating a bonded collegial environment of learners. It was imperative that the participants were open in hearing others’ perspectives, concerns, and stories.

Being at this event created an opportunity for various expressions of caring. Coaching and guiding from peers, faculty, and staff surfaced within the community circle. Learning how to manage time, hearing others talk about similar journeys, and receiving tips from senior students were perceived to be valuable.

Preserving: Reading, Writing, Thinking-Saying, and Dialogue

As thinking and saying occurred during the event, so did the preserving of one’s thoughts and connections. Through formal and informal dialogue, students provided feedback in several ways. The meaningfulness of the ceremony came forward in class discussions, hallway conversations, and written reflective narratives, as well as during a planned evaluation meeting. A formal evaluation survey using Survey Monkey allowed students to provide responses and comments to descriptive questions.

Important meanings were revealed and uncovered participants’ thinking. Common themes emerged such as belonging, persevering, using resources, not giving up, and connecting with faculty and peers. Taken-for-granted assumptions related to traditional common gatherings at the beginning of the year were challenged in this new way of engendering community. The significance of this event may still linger in attendees’ minds today.

Blessing of Hands

Establishing new traditions of “being caring” is the core of nursing. It reconnects each person with the spiritual aspect of nursing practice. With and through our hands, individuals care about each other. Near the end of our small circle time, the event’s facilitator invited all students, faculty, and staff participants to share in the blessing of hands.

The blessing invitation began the commencing and launching of the new school year. For some students, it was a new beginning to another academic year, some students viewed it as a bridging ceremony into the profession of nursing, and other participants reconfirmed who they were and what they do as students, faculty, and staff. As students accepted the invitation, they realized that caring was the center of our being.

As students entered the dimly lit room, they heard soft instrumental music in the background. Faculty pairs were positioned at tables in the room and poured water over each student’s caring hands while reading an inspirational blessing from a card. Some students went to certain faculty members because of a preexisting connection that existed with the teacher. Students shared how important it was to form a connection with faculty.

During the blessing of hands, students realized the power and influence that one’s hands have in caring for others. The hands emerged as a significant symbol of one’s caring professional practice rather than the traditional uniform, scrub, pin, or cap. As each individual person left, one could feel the sense of belonging and the spirit of caring. The cards served as special mementos and are often treasured and valued by both faculty and students; they can be seen posted in offices and found in student folders. The blessing of hands reconfirmed the spirit of nursing and has become a rite of passage for students and a recommitment to care for faculty.

We hope others will try to create a similar event in their nursing setting to foster and engender a caring environment. This caring milieu has left a lasting impression with our students and hopefully serves as a special memory of their nursing education.

References

  • Dahlberg, K., Ekebergh, K. & Ironside, P.M. (2003). Converging conversations from phenomenological pedagogies: Toward a science of health professions education. In Diekelmann, N. (Series Ed.), Interpretive Studies in Healthcare and the Human Sciences: Vol. 2. Teaching the practitioners of care: New pedagogies for the health professions (pp. 22–58). Madison, WI: University of Wisconsin Press.
  • Diekelmann, N. (2003a). Engendering community: Learning to live together. Journal of Nursing Education, 42, 243–244.
  • Diekelmann, N. (Series Ed.). (2003b). Interpretive Studies in Healthcare and the Human Sciences: Vol. 2. Teaching the practitioners of care: New pedagogies for the health professions. Madison, WI: University of Wisconsin Press.
  • Diekelmann, N. & Diekelmann, J. (2009). Schooling learning teaching: Toward narrative pedagogy. Bloomington, IN: iUniverse.
  • Diekelmann, N. & Ironside, P. (1998). Preserving writing in doctoral education: Exploring the concernful practices of schooling learning teaching. Journal of Advanced Nursing, 28, 1347–1355. doi:10.1046/j.1365-2648.1998.00819.x [CrossRef]

Reflective Circle Questions

Beginning Circle Dialogue
This is an opportunity to join together as a community of learners at our college of nursing.
  As professional nurses and nursing students, we will discuss the importance of caring for our peers and ourselves. Caring starts with self-care, moves to helping others such as our peers, and then translates to our patient population. How we treat ourselves and others sets the stage for how we will and do treat patients.
Question for Discussion

Since you started school this year, how has someone showed or demonstrated caring to you that made a difference in your life?

Follow-Up Questions

Since we have all listened to one another, what do you think are some common characteristics of caring behavior or attitudes?

We all have times when we might want to give up. Can you share who and what helped you stick with it during the tough times?

Most students have a lot on their minds about school during the first week. Since we want to show caring to one another, is there anything on your mind today that you have a question about or that we can help you with as senior students?

A lot of students wonder what a clinical experience is like. Could those of you who have had different clinical experiences tell us a little about your experiences?

Authors

Ms. Burke is Assistant Professor, and Dr. Williams is Professor, Blessing-Rieman College of Nursing, Quincy, Illinois

The authors have no financial or proprietary interest in the materials presented herein.

Address correspondence to Linda L. Burke, MSN, RN, CNE, Assistant Professor, Blessing-Rieman College of Nursing, PO Box 7005, Broadway at 11th, Quincy, IL 62305-7005; e-mail: .lburke@brcn.edu

10.3928/01484834-20101029-07

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