My Philosophy of Education as a Teacher: Complexities of Nursing Education

The Convergence of Nursing Theory and Teaching Philosophy

"The ultimate goal of nursing education is to prepare the student to think critically, communicate accurately, and perform indicated therapeutic nursing interventions in patient care situations; exhibit the caring behavior inherent in nursing actions; apply an ethical perspective in clinical decision making; and function effectively as a team member…". Nursing and education are two distinct disciplines, each profession with its own curriculum, goals, and mission. As we merge the two disciplines to create a nursing educator, it becomes a complex undertaking.

Nursing theory must now merge with learning theories to provide a way for nurse educators to teach nursing students. "Educational institutions and nurse educators have the responsibility to prepare new graduates within the competencies necessary to provide safe, competent, and ethical nursing care. Therefore, excellence in nursing education is and will continue to be central to excellence in nursing practice and optimal care".

The Various Roles of Nurse Educators

"Because of the multiple aspects of the faculty role, the demands of a career in academia can be challenging and require the ability to develop and change with the needs of the learner". All nurse educator roles, be it academic nurse educator, clinical nurse educator, or nurse in professional development, require the nurse to not only understand and be competent in nursing theory and practices but have a solid foundation of learning theories so they can educate their learners. All three roles play vital importance in the roles of nurse educators. Academic nurse educators have advanced degrees, oftentimes a doctoral degree, to teach students in the academic setting and prepare them for understanding their area of specialty.

Clinical nurse educators play a vital role in teaching students how to implement the theories and skills they have learned into real practice. Clinical instructors oversee the development of nursing skills in the clinical environment. An educator in professional development has a unique role as this educator is not necessarily preparing students but preparing nurses for their role within an organization. Professional development nurse educators assist the nurses with their competency in their practice by teaching current changes or innovations in the practice. All three roles intertwine to make nursing education a multifaceted practice for nurses in all areas and stages of development in their careers.

Watson's Theory of Human Caring and its Influence on My Teaching Philosophy

To reflect on my philosophy of teaching as it relates to the role of nurse educator, I must first acknowledge a nursing theory that I embrace in practice. "Nursing is grounded in the ethics of caring. Caring is a universal nursing phenomenon". Watson's theory of human caring first emerges as a "quest to bring new meaning and dignity to the world of nursing and patient care". Her nursing theory continues to evolve with time. Her original creative factors and the development of the Caritas processes "needed to evolve as they seemed to set in the language of an earlier era". However, her ten carative factors remain the core of Watson's Caring Theory. Watson's theory and practices "propose that nursing, individually and collectively, contributes to the presentation of humanity and seeks to sustain caring instances where it is threatened".

Watson's theory is based on "human values of kindness, concern, and love of self and others". Watson devoted her career to "studying the evolution of caring, describing caring as a value and attitude that has to become a will, an intention, or a commitment, which manifests itself in concrete acts'. Watson has conceptualized caring as a process". Watson's theory serves as a guide for nurses. It takes the basic assumption of caring and dignity and develops a nursing theory to lead nurses. Her theory is based on "nonpaternalistic values that honor another's becoming, autonomy and freedom of choice. Human caring, which is relational, connected, transpersonal, and intersubjective, is the basis for therapeutic relationships between human beings". Being a psychiatric nurse, Watson's theory of practicing with caring, dignity, and respect embraces the way any nurse in this field should practice with vulnerable and often misunderstood populations. Stigma and negative attitudes that I can dismiss and replace with caring and understanding, and accepting who the patient is to provide the best care I can.

Working from a solid foundation of caring and dignity, I can move forward to examine the learning theories that are used to help nurse educators. There are many theoretical foundations of teaching and learning, and choosing one that I feel reflects my personal philosophy is like saying one size fits all. Instead, what I have decided to do is, after reviewing most of them, do an a la carte approach and share what I feel are foundations that I can use as I enter the next chapter of my life as a nurse educator.

Building on Watson's theory of caring, Sawatzky proposes teaching excellence in nursing from a caring framework. While not a learning theory, it is worth exploring and reviewing. She contends, "Nursing is grounded in the ethic of caring. Hence, caring establishes the foundation for this unique nursing framework. Because a teaching philosophy is intimately intertwined with one's nursing philosophy and the ethics of caring, it is also fundamental to the caring framework. Ideally, this framework will contribute to excellence in nursing education and, as a consequence, excellence in nursing practice and optimal patient care". Sawatzky wrote her article to present a caring framework for nursing teaching excellence. She contends that teaching excellence must incorporate excellence in teaching practice, scholarship, and leadership. The foundation of her framework stems from the ethics of caring. She contends that teaching excellence is central to the goal of teaching nurse's knowledge and skills that are needed to provide optimal patient care. Sawatzky writes, "Although teaching excellence in nursing education shares many common elements with higher education disciplines, the nursing profession is unique because it is grounded in the ethics of caring" .

Wade examines the nursing students' perceptions of instructor caring based on Watson's Theory of Caring. In her writing, she contends, "There is theoretical agreement that caring is learned by experiencing caring interactions with faculty in an environment supported by caring faculty-student relationship (Gaines & Baldwin)". She contends when "students perceive the climate of nursing education as caring, they learn a professional way of being". Wade writes that transpersonal caring in nursing education uses teaching moments as a means of demonstrating the caring ethic.

Salehian (2017) undertook an integrative review to examine faculty-student caring interactions in nursing education. "In a pedagogic context, caring involves developing rapport and going out of one's way to provide learning experiences geared toward students' attributes. In caring-based interactions, the actions and feelings of instructors and students are considered equal" (Salehian, 2017, p. 257). The results of this study indicate that caring in nursing education is identified as "an approach in educational processes. The establishment of educational interactions based on moral and human principles is emphasized" (Salehian, 2017, p. 262). The authors contend that caring is a teaching-learning approach, and the basis for this educational strategy is rooted in caring.

The Intersection of Multiple Learning Theories in Nursing Education

"Learning theories explain the complex nature of the interactions of students with their faculty, the learning environment, and the subject matter…Learning theories provide the structure that guides the selection of instructional strategies and student-centered learning activities". I am a nurse who has spent my career working with the psychiatric/Forensic population and in education as an elementary teacher. Other than patient and family education, I have no formal education or experience teaching adults. Drawing from my behavioral health background, I identified with the Behavioral Learning theory. The main premise of this theory is "that all behavior is learned; it can be shaped and rewarded to achieve appropriate and desired ends". This certainly applies when teaching children or working as a nurse in a behavioral health environment. The objectives are clear and measurable. While I feel this applies to work in these settings, I do not necessarily see it as the best approach or theory in adult learning, but yet has a place when performing clinical skill sets.

In behavioral health, we utilize a form of therapy called Cognitive Behavioral Therapy (CBT). This pulls from the Cognitive Learning Theory of thinking that "focuses on and emphasizes the mental processes and knowledge structure that can be interfered from behavioral indices" (Billings, 2020, p. 248). DBT helps people find new ways to behave by changing their current thought patterns. It is an intervention used to assist people with identifying their current feelings, thoughts, and emotions so that their responses can be less impulsive and emotionally driven. I do think that the Cognitive learning theory has many valuable tenants; it seems a bit more primitive than some of the other learning theories.

I reviewed McSparron's article, where he examines cognitive learning theory in clinical teaching. He identified six key elements that he felt "greatly enhanced knowledge retention and application". In this article, it shares how the nurse educator can easily incorporate the principles of the cognitive learning theory to improve retention and enhance application.

Reviewing the Constructivist learning theory, I like the concept in this theory that "advocates a participatory approach in which students actively participate in the learning process". Fernando conducted a study to examine the responses to constructivism learning theory. His study signaled out three key points:

1. learning is an active experience;
2. the idea students hold about the subject and topic being taught will form a part of their learning experience; and
3. learning is socially and culturally rooted.

Fernando's study revealed that students have a high level of satisfaction with a participatory approach.

Coming from a behavioral background, the "legacies of Robert Sears and Albert Bandura's Social learning theory" have inherent merits. Grusec looked at understanding the evolution of the social learning theory. What I find to be the best contribution of the social learning theory is observational learning. "According to Bandura's theory of observational learning, there are four components involved in the process of modeling. Each of these components has a role to play either in the acquisition of information…. or in the decision to put this information to use in guided behavior". Modeling, for me, goes back to Watson's caring theory with distinct behaviors of human caring that we can show the students.

Horsburgh (2018) conducted a study utilizing a qualitative interpretive methodology to gain insight and understanding of the role of modeling in the learning process. Drawing from Bandura's theory of social learning, the study set out to examine how students learn via observational learning and modeling. The study made the following tentative conclusions: "The way students and clinical teachers describe learning in this context can be aligned with the four stages of modeling set out by Bandura".

The Adult learning theories assert that adults learn in a different manner than children. "Knowles described adult learners as persons who do best when asked to use their experiences and apply new knowledge to solve real-life problems. The implications Billings writes about for nurse educators are one that I see relating to Watson's theory of caring. "Because adults may have anxiety and even fear academic failure, faculty must create a relaxed, psychologically safe environment while developing a climate of trust and mutual respect that will facilitate student empowerment".

The final learning theory that I find useful applications is the Experiential learning theory. This "formal theory associated with Kolb…is sometimes also called learning by doing". Kolb  examines the concepts and highlights the experiential learning theory for applications for higher education. "ELT was created to provide an intellectual foundation for the practice of experiential learning responding to Dewey's call for a theory of experience to guide educational innovation". What I find to be the most impactful aspect of the theory is summed up by Kolb in her writings "For educators, the magic of experiential learning lies in the unique relationship that is created between the teacher and the learner, and the subject matter under study". I feel the learning experience is a subjective experience, as described, and the experience is processed differently for different people. As a psychiatric RN, reflection is an important aspect of the profession. Understanding a patient's diagnosis and resultant behaviors relies heavily on reflection and comparing the subjective shared experiences with other team professionals.

In closing, there are many other very valuable contributions to learning theories, many more than this reflective paper could explore, but I have highlighted a few of the ones I feel may contribute to my learning to be a nurse educator. I am sure this is an evolving process, and as I learn more and experience more, many other learning theory applications will be implemented. Learning is a journey, and I have just begun my learning to understand the nurse educator's role, implications, and process fully.

References:

1. Billings, D.M. & Halstead, J.A. (2020). Teaching in Nursing: A Guide for Faculty (6th ed.). Elsevier.
2. Falk, A. R. (2000). Watson's Philosophy, Science and Theory of Human Caring as a Conceptual Framework for Guiding Community Health Nursing Practice. Advances in Nursing Science, 23(2), 34-49.
3. Fernando, S. & Marikar, F. (2017). Constructivist Teaching/Learning Theory and Participatory Teaching Methods. Journal of Curriculum Teaching, 6(1), 110-122.
4. Grusec, J.E. (1992). Social Learning Theory and Developmental Psychology: The Legacies of Robert Sears and Albert Bandura. Developmental Psychology, 28(3), 776-786.
5. Horsburgh, J & Ippolito, K. (2018). A skill to be worked at using social learning theory to explore the process of learning from role models in clinical settings. BMC Medical Education, 18(156), 1-8.
6. Kolb, A.Y. & Kolb, D.A. (2017). Experiential Learning Theory as a Guide for Experiential Educators in Higher Education. A Journal for Engaged Educators, 1(1), 7-44.
7. O'Connor, A.B. (2015). Clinical Instruction and Evaluation (3rd ed.). Jones & Bartlet Learning.
8. Salehian, M., Heydari, A., Aghebati, N. & Moonaghi, H. K. (2017). Faculty-Student Caring Interaction in Nursing Education: An Integrative Review. Journal of Caring Sciences, 6(3), 257-267.
9. Sawatzky, J.V., Enns, C.L., Ashcroft, T.J., Davis, P.L. & Harder, B.N. (2009). Teaching Excellence in Nursing Education: A Caring Framework. Journal of Professional Nursing, 25(5), 260-266.
10. McSparron, J.I., Vanka, A. & Smith, C.C. (2019). Cognitive learning theory for clinical teaching. The Clinical Teacher, 16, 96-100.
11. Wade, G.H. & Kasper, N. (2006). Nursing Students Perceptions of Instructor Caring: An Instrument Based on Watson's Theory of Transpersonal Caring. Journal of Nursing Education, 45(5), 162-168.
12. Watson, J. (2007). Watson's Theory of Human Caring and Subjective Living Experiences: Creative Factors/Caritas Processes as a Disciplinary Guide to the Professional Nursing Practice. Texto Contexto Enferm, 16(1), 129-135.

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