Journal of Nursing Education

Major Article 

First-Year Nursing Students—Developing Relational Caring Practice Through Inquiry

Michelle Spadoni, DNP, RN; Gweneth Hartrick Doane, PhD, RN; Patricia Sevean, EdD, RN; Karen Poole, MA (Nursing), RN

Abstract

Background:

In the current chaotic health care milieu, it is a challenge to create learning environments that support students to become respectful and community-engaged practitioners who are able to care for self and others. Aesthetic and transformative learning approaches foster students to develop caring attributes.

Method:

Using relational inquiry and the general principles of transformative learning theory, an aesthetic curriculum project for first-year nursing students exploring the interrelatedness of self, other, and caring was developed and evaluated by nursing faculty.

Results:

Students’ in-the-moment experiences of transitioning into nursing school were enlisted to (a) open the space for deeper learning, (b) support the development of relational caring practice, and (c) foster personal and professional transformations.

Conclusion:

Aesthetic learning opportunities create experiential moments, where novice students can begin to explore the interconnectedness of self, other, and caring as it relates to their being and becoming a nurse. [J Nurs Educ. 2015;54(5):270–275.]

Dr. Spadoni is Associate Professor, Dr. Sevean is Associate Professor, and Ms. Poole is Director and Associate Professor, School of Nursing, Lakehead University, Thunder Bay, Ontario; and Dr. Hartrick Doane is Professor, School of Nursing, University of Victoria, Victoria, British Columbia, Canada.

This project was supported by a 2012 AMS Phoenix Project: Call for Caring grant. The content is solely the responsibility of the authors and does not necessarily represent the official views of Associated Medical Services, Inc.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

The authors thank Yolanda Wanakmik, Office of Aboriginal Initiatives, Lakehead University, and Amanda Nesbitt, Athletics’ Coordinator of Programs and Initiatives, Lakehead University, for their guidance in the mask making and talking circles activities. The authors also thank Socorro Woodman and Heidi Zettel for use of their correspondence in this article.

Address correspondence to Michelle Spadoni, DNP, RN, Associate Professor, School of Nursing, Lakehead University, 955 Oliver Road, Thunder Bay, Ontario P7B 5E1, Canada; e-mail: mmspadon@lakeheadu.ca.

Received: July 25, 2014
Accepted: February 04, 2015

Abstract

Background:

In the current chaotic health care milieu, it is a challenge to create learning environments that support students to become respectful and community-engaged practitioners who are able to care for self and others. Aesthetic and transformative learning approaches foster students to develop caring attributes.

Method:

Using relational inquiry and the general principles of transformative learning theory, an aesthetic curriculum project for first-year nursing students exploring the interrelatedness of self, other, and caring was developed and evaluated by nursing faculty.

Results:

Students’ in-the-moment experiences of transitioning into nursing school were enlisted to (a) open the space for deeper learning, (b) support the development of relational caring practice, and (c) foster personal and professional transformations.

Conclusion:

Aesthetic learning opportunities create experiential moments, where novice students can begin to explore the interconnectedness of self, other, and caring as it relates to their being and becoming a nurse. [J Nurs Educ. 2015;54(5):270–275.]

Dr. Spadoni is Associate Professor, Dr. Sevean is Associate Professor, and Ms. Poole is Director and Associate Professor, School of Nursing, Lakehead University, Thunder Bay, Ontario; and Dr. Hartrick Doane is Professor, School of Nursing, University of Victoria, Victoria, British Columbia, Canada.

This project was supported by a 2012 AMS Phoenix Project: Call for Caring grant. The content is solely the responsibility of the authors and does not necessarily represent the official views of Associated Medical Services, Inc.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

The authors thank Yolanda Wanakmik, Office of Aboriginal Initiatives, Lakehead University, and Amanda Nesbitt, Athletics’ Coordinator of Programs and Initiatives, Lakehead University, for their guidance in the mask making and talking circles activities. The authors also thank Socorro Woodman and Heidi Zettel for use of their correspondence in this article.

Address correspondence to Michelle Spadoni, DNP, RN, Associate Professor, School of Nursing, Lakehead University, 955 Oliver Road, Thunder Bay, Ontario P7B 5E1, Canada; e-mail: mmspadon@lakeheadu.ca.

Received: July 25, 2014
Accepted: February 04, 2015

Supporting students to develop the knowledge, skills, and capacities to competently meet their nursing obligations within the ever-increasing complexity of contemporary health care milieus is a growing challenge in nursing education. Compounding this challenge is the diverse nature of students entering the profession and the differences among them in terms of age, gender, social–cultural backgrounds, and career and life goals.

A part of the larger challenge, and a specific aspect with which the authors have been grappling, is how relational caring practice has begun to take a back seat within nursing curricula. Although caring has always been an essential thread running through nursing practice and education, relational practice is central to nursing as the amount of content to be covered grows, and the relational aspect of nursing is increasingly being viewed as a nice to know versus a need to know. Frequently equated with hallmark-like moments, there is a failure to understand the central role that relational caring practice plays in sound clinical decision making and skillful nursing action (Hartrick-Doane, 2014). Subsequently, faculty and students alike often devalue relational caring practice, compared with other content that they deem to be of higher priority.

The significance of relational caring practice in nursing education is more vital than ever, as the nature of our world and the way we live within it continues to change, with globalization and advances in science and information technology (Hegarty, Walsh, Condon & Sweeney, 2009), standard organizational practices increasingly impact the quality of nursing care and reshape beliefs about good nursing and what it is to be a good nurse (Rankin & Campbell, 2006). How do students learn to be caring, relationally responsive practitioners if that learning is not given priority in the educational process? As Van Manen (2010) described, technology is changing people’s ability to negotiate their own solitary and intimate existence. Technology is profoundly shaping the self–other relationship, thus affecting personal and professional boundaries, serving at times to trivialize the private (i.e., our inner world) and distance people from what is depthful and innermost (Van Manen, 2010). One example (and the lament of faculty) of how technology is shaping the lives of nursing students is that students seem to be more connected to their cellular telephones than to individuals in their immediate presence.

Thus, the authors attempted to address our changing world and the challenges it generates for nursing and nursing education and have questioned how to more effectively infuse relational caring practice into the curricula and educational process. The specific question that is explored in this article is: How might we support the learning and development of relational caring practice and create learning spaces for students to experience the meaning of caring in nursing and in their own lives? The authors describe the experience of teaching beginning baccalaureate students in a first-year nursing course that is focused on core concepts of the self, others, and relational caring practice. The authors redeveloped their teaching approaches to engage students in an interactive process of mask making and storytelling to enable them to experience moments of deep caring and to understand the meaning and significance of relational caring practice in nursing.

Educational Context

The course and the teaching–learning process described in this article was developed at the Lakehead University School of Nursing, a Canadian university located on the traditional lands of the Anishinaabe people, who are signatories of the Robertson–Superior treaty, particular of Fort William First Nations. At any given time, 700 to 800 nursing students are enrolled in the baccalaureate nursing program, with approximately 200 students beginning each year. In the first year, students take four nursing courses while completing courses in anatomy and physiology, psychology, chemistry, and two half-credit electives. In the fall, students complete an introductory nursing theory class that is focused on exploring fundamental concepts in nursing, including caring, cultural, and moral agency, critical thinking, ethics, regulatory standards of practice, and relational practice. In their laboratory theory class, students critically explore the meaning of the nurse–client relationship and therapeutic communication. In the winter term, students’ studies include physical assessment, critical thinking, and skills development around the provision of care and comfort.

The authors’ challenge is translating relational caring practice into a concrete curriculum and redesigning teaching–learning processes to support the praxis process. Toward that end, relational inquiry (Hartrick Doane & Varcoe, 2005; 2015) was used as scaffolding for the undergraduate nursing curriculum and as the pedagogical approach to guide teaching–learning practices. A curriculum based on relational inquiry to support nursing students in becoming (a) respectful, collaborative, and community-orientated relational practitioners; (b) able to care for themselves and others in a manner that appreciates the diversity of personhood; (c) able to think creatively, with critical awareness of themselves and others and the contextual nature of nursing practice; (d) open to multiple ways of knowing; (e) competent in applying theory (critical, feminist, postcolonial) and research in practice; and (f) able to promote socially just care.

Students are evaluated by six interwoven learning objectives: (a) caring based on professional values; (b) self-reflection, critical thinking, and self-directed learning; (c) professional judgment that integrates theory and research; (d) advocates at many levels for policies that enhance the health of individuals; (e) supports, promotes, protects, and restores the health of clients; and (f) designs practice within the various roles and responsibilities of the professional nurse. The primary focus of the first semester is exploring caring, self-reflection, critical thinking, and self-directed learning.

By redeveloping the first course of the self–other stream, the authors sought to create a more embodied integrative learning experience that brought ontology to the forefront (Dall’Alba & Barnacle, 2005; Hartrick Doane & Brown, 2011). The authors wanted the students to experience relational caring practice (Hartrick Doane & Brown, 2011), rather than just talk about it in the typical abstract, conceptual way. Although experiential elements had always been included in the course, the authors wanted to extend knowledge development to move student learning beyond intellectual understanding to embodied living experience and action. With this experiential learning imperative in mind, the following question arose: What if students were invited into a living experience of self–other–caring (privileged personal, aesthetic, and sociopolitical knowledge), instead of putting the primary focus on the history and theory of caring in nursing, and instructing students about to whom and to what they should aspire as caring nurses (privileging empirical, ethical knowledge)?

Reorienting Learning Within a Relational Inquiry Lens

The current project included 209 first-year undergraduate nursing students in the first 6 weeks of their academic life. Drawing on the teachings of Dewey (1938), who proposed that all experience is educative (and potentially miseducative), the authors’ intent as educators was to purposefully enlist the students’ current experience—including the vulnerability and uncertainty that is often part of the transition into nursing school. For many students, entering into an undergraduate nursing program is a transition point in their lives, with rites of passage marked by moments of uncertainty, ambiguity, and confusion. Thus, this short window of time at the beginning of the nursing program is a particularly opportune time in the students’ development and transformation. Their uncertainty and unknowing in this new landscape is comparable to what Mezirow and Taylor (2009) termed a disorienting dilemma (p. 19), where solid foundations are shaken up and space is opened for rich learning. As within practice settings, where nurses are learning in the moment and where moral and ethical issues are part of the decision-making process (Benner, Tanner, & Chesla, 2009; Newman, 2008), the authors’ intent as educators was to purposefully work within moments of uncertainty and enlist the disorientation and struggle that students often experience as they enter a nursing program and begin to develop their nursing identity (Sevean, 2012).

Structuring the Course Experience

In this first-year course, the relational inquiry process took the form of a 6-week storytelling and mask-making project. Table A (available in the online version of this article) presents the specific 6-week learning activities and demonstrates how relational inquiry and transformative learning theory support the development of relational caring practice. It is important to emphasize that mask making in itself is not a new idea or strategy in nursing education and that reorienting the teaching and creating of an aesthetic learning experience was not simply a matter of introducing arts-based teaching strategies. The relational inquiry, experiential approach fundamentally changed how student learning was structured, including the nature of student–student relationships, student–teacher relationships, the imperatives that shaped that process, the theoretical content that was offered (and how and when it was offered), the timing and sequencing of content, and so forth. It also shifted what was paid particular attention to and what took precedence during the learning process.

Developing Relational Caring Through InquiryDeveloping Relational Caring Through Inquiry

Table A:

Developing Relational Caring Through Inquiry

Importantly, this reorientation required the authors as teachers to undertake a relational inquiry process and engage in careful and ongoing deliberations as the classes were planned. It involved careful moment-to-moment scrutiny of how and what was being done. Would it be structured for students to pick partners—why or why not? Would the computer system be used to randomly pair the students? How would they meet? Would their first meeting be on the day they made masks? Regarding content, would a class on self-concept and caring for self and others be presented first? How was learning occurring? What evaluative criteria would be used? Along with these critical pedagogical questions, the logistics of all 209 students making masks at the same time had to be considered, which included everything from physical space and disposal of plaster-infused water to ordering supplies (e.g., Plaster of Paris [masks], plastic wrap [cover the face], plastic garbage bags [protect clothing], plastic floor covering, children’s acrylic paint sets and brushes). The cost of the kit per student was $5.00, which was paid for by the school. However, more challenging and more important than the logistics of mask making were the deeper learning objectives (i.e., the pedagogical why and how) and the philosophical premises and educational imperatives that were inspiring the teaching.

As the project planning and beginning processes progressed, the authors continually stepped back and sorted through their own values and beliefs about teaching–learning. Concerns about where to position formal teaching about theory were discussed—What happens when the process is reversed and students are purposefully engaged in practice first, rather than theory? What happens if a teaching–learning moment is introduced with no explicitly taught preconceptions? To address these concerns, inspiration was taken from Irwin and O’Donoghue’s (2012) and Butler’s (2008) description of reverse pedagogy, where the learners were asked to come with no expectations or preconceptions and just see where they end up. Reverse pedagogy inherently holds certain values, such as “patience, trust, generosity, uncertainty, chance, respect, complexity, free organization, consensual decision-making and ambiguity” (Irwin & O’Donoghue, 2012, p. 223). Although reverse pedagogy may sound like a recipe for chaos, it actuality requires the educators to become very detailed in their planning and rigorous in how things are done.

To guide decision making, the authors referred to the transformative learning theory. Taylor (as cited in Mezirow & Taylor, 2009) suggested that fostering transformative learning is seen as teaching for change; it is a means for students and teachers to challenge their values, beliefs, and world views. Transformative learning celebrates individual experiences, critical reflection (questioning the integrity of deeply held beliefs and values), dialogue (authentic dialogue between individuals about truths, values, and beliefs), holistic orientation (engagement with multiple ways of knowing), awareness of context (appreciation of personal and social–cultural factors), and authentic relationships to build trust (Mezirow & Taylor, 2009). For example, although the authors’ conventional inner voices continued to suggest giving two lectures on the theory of self, other, and caring before conducting the mask-making activity, the transformative learning theory reminded us to open up and allow space for disorientation and confusion. Thus, freedom from the reliance on content and skills-based pedagogy to engage a more experientially driven learning process was consciously chosen. It was through intrapersonal and interpersonal philosophical and teaching dialogues and inquiry that the teaching objectives and student learning objectives to guide the educative process were created (Table).

Teacher–Learner Objectives for the Developing Relational Caring Through Inquiry Project

Table:

Teacher–Learner Objectives for the Developing Relational Caring Through Inquiry Project

Week 1: Getting to Know Self and Others

The students were sent a letter regarding the mask making project, which briefly outlined what the first few weeks together would involve, and the students were provided with a link to the authors’ online learning site. On this site, students could find their names and their partners’ names (they were randomly assigned in pairs), the course outline, a mask-making PowerPoint® resource, and a dialogue assignment. Students came to their first class with the knowledge that they would be finding their partner in class. Try to imagine the scene of students—all new to one another—attempting to find their partners. Students quickly adapted, holding up signs like as in a busy airport—“My name is Joe! I am looking for Stephanie!” Some chose to call out their name, ‘I am Sam—I am looking for Darlene!” However, it took less than 10 minutes, and the group had sorted themselves into pairs. The teachers stood back, listened, and watched the faces of students change from apprehension to excitement and recognition. The sound of voices lifted—“I wondered what you looked like,” “You really gave me a good description of yourself,” and “I would never have pictured you.” The students were asked to spend the next 45 minutes getting to know one another. To support that process, a set of questions were offered, which the Indigenous Elders often use when helping people to orientate to making a change in their lives: “Tell me about who you are? Where are you right now? Where have you been? Where are you going?”

Week 2: Mask Making

Students were nervous when entering the mask-making room and tended to stick close to their partners. Some thought it was a foolish activity, but when they began they said, “it takes skill” and “you really have to pay attention to what you are doing.” While watching the students, moments of purposeful caring were observed, where students felt obligated to enter into the relational space in ways that were responsive to their partners’ needs (Hartrick Doane & Varcoe, 2007). For example, students reported being “concerned” when they saw the panic in their partners’ eyes as the plastic wrap was applied, and they felt compelled to alleviate their partners’ distress. However, in all of their uncertainty, they tapped into their inner nurturing skills, quickly creating breathing holes in the plastic wrap to ease their partners’ sensation of breathlessness. The students discovered and actually experienced the way in which relational caring is a shared experience of You and I (Bergum & Dossetor, 2005).

A deep connection and concentration was observed as the students’ hands carefully smoothed the plaster over their partners’ faces, “wanting to make a good mask.” They related verbally—for example, wondering out loud whether they were pushing too hard and asking their partners whether they were doing it right. Afterward, the students recalled how challenging it was to assess their partners’ needs, as their partners could not easily verbalize while their faces were wrapped in plastic and Plaster of Paris. They described how they had to depend on their ability to observe their partners’ body language and how relational caring practice required “a deep sensitivity to what is significant to patients in particular situations” (Hartrick Doane & Varcoe, 2007, p. 194). As one student stated, “it involves all your senses until you are overwhelmed with a feeling of wanting to help—to act.”

As teachers, the authors were caught up in the moment of witnessing learning about caring in the moments of doing—from the careful hand movements of smoothing the plaster, to the careful removal of the masks from faces, and to the reverence in all when the masks were handled, carried, and given over.

The masks, all lined up, held a fascination for the students. They would point to their own and each other’s masks, at times noticing the likeness, the images of themselves, and commenting on the differences. Students brought out their cellular telephones, taking pictures of the masks. It was as if the masks served as mirrors of reflection, where they could consider themselves and each other—motionless faces, form, and beauty. One student remarked that she was amazed about how much we are all alike when you strip away those things that we normally see as recognizing one another.

Week 3: Mask Painting

The students were instructed that the outside of the mask was to be painted as they believed the world sees them, and the inside of the mask was to be painted as they see themselves. The students noted that it was difficult to paint the outside of the mask. At times, they were unsure as to how others saw them, and they wondered if how they thought they were presenting themselves to the world was indeed how others actually saw them. Some students called close friends and family members and asked: “Is this how you see me?” Some students were surprised and some did not see their own qualities.

However, painting the inside of the mask as how they saw themselves and what they did not show to the world was a more difficult task. For some, it was painful and risky, and, at times, they realized the incongruence between their outer and inner self. Many students thought about how they were in transition; they were at a turning point in their lives and were uncertain of the outcomes, as their perceptions of self were changing. Students talked about how scary it was to come to university, about the expectations of others, and about their fear of failure, but as they talked about these issues, they had the experience of being held in a caring presence. They spoke about how their decision to come to university changed their personal relationships with others and that the familiarity and security in everyday life was replaced with uncertainty, as some were leaving family and friends behind, moving away from home, or leaving high school or well-established jobs for a career change. Yet, the students painted words, symbols, and images of home, family, friends, and activities that tied them to community life and security, safety, and support. Even the paint colors the students chose reflected the interconnectedness of emotions and, in particular, the relationships with the significant people, pets, and landscapes (e.g., trees, water, sun, clouds) of their lives.

All of those involved with the project discovered that relational caring has to do with being honest and seeing oneself—rough edges and all. This process mirrored Gottlieb’s (2013) suggestion that for students to develop self-reflective habits, they need space to think about the context of their own lives and the transition points—where they come from, where they are now, and where they see themselves in the future. The mask painting opened this reflective space and highlighted the intrapersonal, interpersonal, and contextual nature of the self–other–caring experience (Hartrick Doane & Varcoe, 2015). As they painted their masks, some students recalled how they began to consider what it means to appreciate life, and they drew on Jean Watson’s (2008) reflection, “Just take a deep breath and appreciate yourself, your life, in all its fullness/emptiness” (p. xviii). They became aware of how their family and friends were a part of their journey to becoming nurses.

Weeks 4–5: Coalescing the Story of the Mask

The students used the online course site to continue to communicate and work out their stories together through the 6-week learning experience. It was made explicit that although the teachers had access to the online course site, they would not look at the students’ online discussion space. The space was set up for the students as a personal communication link and to help them to eventually glean from their online dialogue the parts of their discussion they felt would best create the narrative of their formal paper. The focus of their narrative paper was to explore their evolving understanding of the concept of caring, which included articulating their preunderstandings of caring in a short narrative of their experience of caring for another and being cared for (mask making). In the body of the paper, the students were to broaden their emerging understandings of caring through critical analysis of the caring literature. Students were provided with a reading package and were encouraged in week 3 to explore readings on caring, and in week 4 to begin the outline of their formal paper (see Table A, Week 3 for the reading package). Readings included Hartrick Doane’s and Varcoe’s (2015) chapter on nursing obligations and compassion; Watson’s (2013) carative factors, Roach’s (2013) caring ontology, and Gottleib’s (2013) mindfulness and self-reflection practices. In their analysis, the students broadened their understanding of caring; for example, exploring Gottleib’s relational caring practice and how it requires reflection-in-action). Others explained how their senses were heightened when they saw panic in their partner’s eyes and turned to Roach’s work to understand the meaning of compassion as caring and action.

Week 6: Talking Circles, Telling Stories

The first class began with the students talking about the importance of a story and how all stories must be brought into the learning space. Through the process of making and painting masks, the students began to create the story within their masks. Many suggested that their mask represented their story of coming into nursing—of being and becoming a nurse. As teachers, the authors recognized in the planning stages that space needed to be created for the students and their evolving stories. Thus, sharing stories (through listening and telling) was a central feature of the relational inquiry learning experience. In the authors’ community, Indigenous knowledge practices are integral to the culture of many First Nation and Métis students. From the practices of Indigenous scholars, it has been learned that talking circles created with purposeful intention can create a safe space in which to share different perspectives and views. Of foremost importance to this process is developing the skill to listen and respect the views of others (Alberta Education, 2005), as “each member has equality—no one is above or below anyone else” (p. 51). To listen is to listen with an open heart, without judgment or criticism, to understand and connect with one another (Alberta Education, 2005).

Occurring over 3 days and carefully structured on the heels of the mask-making experience, the talking circles provided a doorway through which to experience and consciously practice caring presence and deep listening. Each student was given 3 to 5 minutes to share their mask and the story it told, while the rest (e.g., 10 students and a clinical teacher per talking circle) listened and learned. Talking circles lasted approximately 1.5 hours, but the timing depends on the number of students. In a talking circle, it is important for students and teachers to have time to reflect on the experience and talk as a group. As part of this process, the authors emphasized that the stories held, told, and received requires a responsibility for both the teller and the listener. In this way, the talking circles further enabled students to connect their personal story to the life and caring intention of nursing.

Redeveloping Approaches to Teaching and Learning

Planning on how teaching is going to occur is different than actuating it. Redeveloping the teaching approach described in this article produced many moments of doubt, particularly when the authors found themselves challenged to explain to colleagues how a mask-making process would meet student learning outcomes. Some colleagues saw the approach as simply introducing arts-based teaching strategies, whereas others expressed doubt that such an approach would enable important content to be acquired. This project was also faced with doubt and surprise from students, with many wondering how mask making could possibly support their learning of nursing.

However, witnessing the depth of the learning that was occurring in students throughout the process helped the authors to stay the course. As the students progressed through the mask making, they literally embodied the concepts that the authors sought to teach. At the same time, their written assignments confirmed that they had developed both a theoretical and historical understanding of relational caring practice in nursing. The following student’s comment demonstrates the meaningful learning that occurred:

Trusting someone to cover your mouth and nose, however brief, is incredibly humbling. The creativity and self-reflection required to decorate these forms of our faces was such an apt activity for nursing. How do we see ourselves as people who are going to care for others in their most vulnerable moments? How do others see us in these moments? Are they congruent? Does it matter? The amount of time, effort, and emotion that went into these masks would suggest it matters more than I imagined.

Also striking were the anecdotal comments and stories that were offered from other teachers following the mask-making process. Other clinical, laboratory, and theory teachers described how students seemed more engaged, asked questions more freely, and interacted with each other more than in previous years. From their perspective, more listening and respect seemed to occur among the students. As the year continued, the students also made comments. One student recalled:

As a group, we were immediately vulnerable to each other’s stories, and as a result we deeply connected with each other. We learned at the very beginning of our nursing student career that knowing ourselves directly relates to the quality of care that we are able to provide to our future patients. We are now aware that every person has their own story, and that each of those stories is invaluable.

Conclusion

From the ongoing student remarks, such as those indicated above, the authors have been reminded that learning does not occur all at once but continues over time. As Dewey (1938) suggested, each experience influences future experiences—learning is cumulative. The challenge, then, is to recognize the experiential momentum and willingly enlist that momentum to create worthwhile learning experiences (Dewey, 1938).

References

  • Alberta Education, Aboriginal Services Branch and Learning and Teaching Resources Branch. (2005). Our words, our ways: Teaching First Nations, Métis and Inuit learners. Edmonton, Alberta, Canada: Author.
  • Benner, P., Tanner, C. & Chesla, C. (2009). Expertise in nursing practice: Caring clinical judgment and ethics (2nd ed.). New York, NY: Springer.
  • Bergum, V. & Dossetor, J. (2005). Relational ethics: The full meaning of respect. Hagerstown, MD: University Publishing.
  • Butler, P. (2008). Reverse pedagogy. Canadian Art, 25(4), 60–61.
  • Dall’Alba, G. & Barnacle, R. (2005). Embodied knowing in online environments. Educational Philosophy and Theory, 37, 719–744. doi:10.1111/j.1469-5812.2005.00153.x [CrossRef]
  • Dewey, J. (1938). Experience and education. New York, NY: Touchstone.
  • Gottlieb, L.N. (2013). Strengths-based nursing care: Health and healing for person and family. New York, NY: Springer.
  • Hartrick-Doane, G. (2014). Beyond relational oblivion [Guest editorial]. Advances in Nursing Science, 37, 84–86. doi:10.1097/ANS.0000000000000021 [CrossRef]
  • Hartrick Doane, G. & Brown, H. (2011). Recontextualizing learning in nursing education: Taking an ontological turn. Journal of Nursing Education, 50, 21–26. doi:10.3928/01484834-20101130-01 [CrossRef]
  • Hartrick Doane, G. & Varcoe, C. (2005). Family nursing as relational inquiry. Developing health-promoting practice. Philadelphia, PA: Lippincott Williams & Wilkins.
  • Hartrick Doane, G. & Varcoe, C. (2007). Relational practice and nursing obligations. Advances in Nursing Science, 30, 192–205. doi:10.1097/01.ANS.0000286619.31398.fc [CrossRef]
  • Hartrick Doane, G. & Varcoe, C. (2015). How to nurse: Relational inquiry with individuals and families in changing health and healthcare contexts. Philadelphia, PA: Lippincott Williams & Wilkins.
  • Hegarty, J., Walsh, E., Condon, C. & Sweeney, J. (2009). The undergraduate education of nurses: Looking to the future. International Journal of Nursing Education Scholarship, 6(1), Article 17. doi:10.2202/1548-923X.1684 [CrossRef]
  • Irwin, R.L. & O’Donoghue, D. (2012). Encountering pedagogy through relational art practices. The International Journal of Art and Design Education, 31, 221–236. doi:10.1111/j.1476-8070.2012.01760.x [CrossRef]
  • Mezirow, J. & Taylor, E.W. (2009). Transformative learning in practice: Insights from community, workplace, and higher education. San Francisco, CA: Jossey-Bass.
  • Newman, M.A. (2008). Transforming presence: The difference that nursing makes. Philadelphia, PA: F.A. Davis.
  • Rankin, J.M. & Campbell, M.L. (2006). Managing to nurse: Inside Canada’s health care reform. Toronto, Ontario, Canada: University of Toronto Press.
  • Roach, M.S. (2013). Caring: The human mode of being. In Smith, M.C., Turkel, M.C. & Robinson Wolf, Z. (Eds.), Caring in nursing classics: An essential resource (pp. 165–179). New York, NY: Springer.
  • Sevean, P. (2012). Learning to transition: Nurses’ entry into cancer nursing practice (Doctoral thesis, University of Toronto Research Repository, Toronto, Ontario, Canada). Retrieved from http://hdl.handle.net/1807/32884
  • Van Manen, M. (2010). The pedagogy of Momus technologies: Facebook, privacy, and online intimacy. Qualitative Health Research, 20, 1023–1032. doi:10.1177/1049732310364990 [CrossRef]
  • Watson, J. (2008). Nursing: The philosophy and science of caring. Boulder, CO: University Press of Colorado.
  • Watson, J. (2013). Nursing: The philosophy and science of caring. In Smith, M.C., Turkel, M.C. & Robinson Wolf, Z. (Eds.), Caring in nursing classics: An essential resource (pp. 143–153). New York, NY: Springer.

Teacher–Learner Objectives for the Developing Relational Caring Through Inquiry Project

Teacher ObjectiveLearner Objective
Design a learning space where experience is forefront. Create an experience for students to encounter caring praxis (doing and being caring) through face-to-face and heart-to-heart learning. Put epistemology to the service of ontology; enlist theory in ways that inform and transform not only students’ understandings but their ways of being and acting.Experience embodied caring; gain an experiential understanding of care relevant to nursing practice. Develop self, other, and relational caring narratives. Broaden personal knowledge and understanding of caring by drawing upon empirical, ethical, aesthetic, and sociopolitical forms of knowledge. Develop an awareness of relational intelligence (Hartrick-Doane, 2014) and an understanding of caring as being central to every nursing moment.

Developing Relational Caring Through Inquiry

Inquiry-Based LearningDeveloping Relational IntelligenceFostering Transformative Learning
Week 1—Day 1 Getting to know self and other In-class activity:What is your story? (Sharing narratives about wanting to become a nurse)Relational Intelligence—Each person is unique, having a social–historical location that informs who they are, how they experience the world, how they interact with others, what they hold to be important in their lives (values, beliefs, attitudes, knowledge); how they live their lives through relational interactions—intrapersonal, interpersonal and contextual (Hartrick Doane & Varcoe, 2015)Individual Experience—Each learner brings their life experiences into the classroom; prior experiences act as starting points to examine their currently held assumptions, values, and beliefs (Mezirow & Taylor, 2009)
Week 1 Online journaling question:What is your preunderstanding of caring?Conscious Inquiry—Students examine how they came to understand their assumptions and beliefs by reflecting on how they are privileging certain ideas; what they value or do not value, and what knowledge inform their assumptions, values, and beliefs. Furthermore, they examine how assumptions, values, and beliefs shape the way they relate to others, themselves, and their environment (Hartrick Doane & Varcoe, 2015)Critical Reflection—Transformative learning requires critical reflection, where learners question their own assumptions and beliefs based on prior experience; a process of inner awareness whereby conflicting thoughts, feelings, and actions are challenged (Mezirow & Taylor, 2009)
Week 2—Mask making Online journaling question:What is your experience of having the mask applied and applying the mask to your partner?Nursing as Dialogue—More than communication through words, it is a mutual two-way process involving intentionality, which requires presence, learning to listen with all one’s senses, including glances, touch, and voice tone; it requires learning to be nonjudgmental and open to other(s) (Hartrick Doane & Varcoe, 2015)Dialogue—Bringing your true self to the dialogical moment, requiring truth, authenticity, and a critical understanding of norms, values, beliefs and feelings (Mezirow & Taylor, 2009)
Week 3—Mask painting Online journaling question: How does nursing theory broaden your perspective of the experience relational caring practice? Explore readings on caring (see reading package below)Human Science in Nursing—Appreciates different nursing theories and world views. For example, Jean Watson’s (2013) and Simone Roach’s (2013) articulation of the meaning of human caring. Human science philosophically addresses human rights, freedoms, choice, and responsibility, which suggests a way of being in the world that is relational and process orientated, open, and ever changing (Hartrick Doane & Varcoe, 2015)Holistic Orientation—Ongoing engagement with multiple ways of knowing that include the affective (critical reflective process) and expressive (art, dance, music, narratives) domains (Mezirow & Taylor, 2009)
Weeks 4–5—Coalescing the story of the mask Online journaling question:What is your story of the meaning of your mask—inside/outside?Begin formal paper outlineNursing is Contextual—People experience and embody different context(s) that shape how a person understands self, others, and their environment. For example, the health care environment shapes students’ perceptions of illness, health, nursing, and caring for self and others. One’s context is a weave of personal history, economy, sociopolitics, and linguistics. Students’ ability to understand context(s) enables them to intervene at a contextual level (Hartrick Doane & Varcoe, 2015)Awareness of Context—Appreciates the relationship among personal, social, and cultural influences that support the learner to make connections between events and personal experience, which. In turn, shapes their perceptions and interactions, ultimately helping them to develop a broader contextual perspective of what influences societal change (Mezirow & Taylor, 2009)
Weeks 5-6—Talking circles—presentation of mask story Online journaling question: How do you understand the meaning of caring today?Submit reflective paper:Understanding CaringCultivating Habits to Support Relational Inquiry—Students are challenged to consciously consider and name what they know and do not know, to approach learning moments with humility, openness, curiosity and conscious inquiry; it requires students to take a closer look at what they take for granted and look beyond their selected interests (Hartrick Doane & Varcoe, 2015)Authentic Relationships—Requires both teacher and learner to establish meaningful and authentic relationships based on trust, where people can question openly what is known and unknown to gain deeper awareness of needs, abilities, and how context shapes practice, striving for a more genuine and authentic practice (Mezirow & Taylor, 2009)
Reading Package:Used in weeks 3 to 6 to facilitate the students’ integration of practice and theoryReading package: Hartrick Doane, G., & Varcoe, C. (2015). Chapter 3: Nursing obligations and ontologic capacities: The five C’s supporting relational inquiry. In G. Hartrick Doane & C. Varcoe (Eds), How to nurse: Relational inquiry with individuals and families in changing health and health care contexts (pp. 97–134). Philadelphia, PA: Lippincott Williams and Wilkins. Watson, J. (2013). Nursing: The philosophy and science of caring. In M.C. Smith., M.C. Turkel., & Z. Robinson Wolf (Eds.), Caring in nursing classics: An essential resource (pp. 143–153). New York, NY: Springer. Roach, M.S. (2013). Caring: The human mode of being. In M. C. Smith., M.C., Turkel., & Z. Robinson Wolf (Eds), Caring in nursing classics: An essential resource. (pp. 165–179). New York, NY: Springer. Gottlieb, L.N. (2013). Chapter 5: Essential nurse qualities required for strengths-based care. In L.N. Gottlieb (Ed), Strengths-based nursing care: Health and healing for person and family (pp. 129–162). New York, NY: Springer.

10.3928/01484834-20150417-04

Sign up to receive

Journal E-contents