Wednesday, 6 May 2020

Advancing the nursing profession through the synergy of praxis


Catherine Best


Webmaster for the Phi Mu (All England) Chapter of Sigma
email: catherine.best23@gmail.com


Nursing is both an art and a science (Jasmine, 2009). This understanding precipitates the need for a plethora of teaching and learning approaches that ensures the continued development of nurses who not only, have the ability to advance practice through evidence-based knowledge, but also have the capacity to act with kindness and compassion. This is supported by Renolen and Hjalmhult (2015) who argue that nurses are required to apply evidence-based practice and provide effective patient care based on the best knowledge available. Central to these tenets therefore is the ability to integrate theory and empirical research findings into professional practice.
 
Nurse education, with its emphasis on fitness to practice is experiencing fundamental change within the UK. This is no more evident than with the newly adopted Nursing and Midwifery Council Standards of Proficiency for Nurse Education (NMC 2018), the aim of which is to develop future healthcare professionals who are sufficiently skilled and knowledgeable to deliver care needs for the 21st Century. In a global healthcare arena where a shortage of healthcare professionals exist, nurses within the UK are being asked to develop new skills that were once considered solely the domain of the physician, (Neiezen and Mathijssen, 2014).

In order to develop these skills and thus build capacity however, the ability to critically reflect and act, a term coined praxis, by Paulo Freire in his work Pedagogy of the Oppressed published in English in 1970, (Freire, 2017) and developed further by Chinn and Kramer, (2018) within professional nursing practice, could be considered a fundamental requirement if nurses are to transcend the often restrictive nature of traditional learning and teaching strategies such as banking, (Freire, 2017). Banking a process through which teachers teach and learners repeat, rather than effectively applying their learning, limits the ability of the learner to reflect and act, for by its very nature it is passive. Learners, therefore need to adopt new ways of learning, such as self-directed learning through which, the capacity to challenge any given situation is increased.

To adopt this model of reflection successfully however, the learner is required to have the aptitude to self-regulate personal learning needs and therefore embrace a self-directed learning style, although essentially some level of guidance such as an inspiring curriculum, is still a necessity (Bodkyn and Stevens 2015).

Heutagogy

In order to develop a self-directed or heutagogical approach to developing knowledge; nurses can benefit from adopting a blended style of learning that sees them become active participants in their own professional development. Heutagogy empowers learners to take responsibility for ‘how, what and when they learn’ (Blaschke et al. 2014), examples of which include the use of social media technology (Blaschke, 2014) work-based learning (Nisbet et al. 2013), competency-based learning (Pijl-Zieber et al. 2013) and portfolio development (Ryan, 2011). Blaschke (2012) argues that such an approach to learning is feasible through the development of learning contracts defined by the learner, curriculum or curricula which is flexible, questions, which are learner directed; assessments which are both flexible and negotiated and collective learning. Ultimately, heutagogy is considered a powerful learning strategy - one that provides learners with the means by which, they can learn and grow throughout their lives (Davis, 2018).

By becoming self-directed learners, learners are able to effectively utilise education, undertake research and analysis, increase personal motivation and assertive behaviours (Avdal, 2013) and self-nurture high order thinking skills, an example of which is emancipatory reflection, a process which seeks to transform the way in which nurses construct, confront, deconstruct and reconstruct professional experiences (Taylor, 2010). In order to do this successfully however, requires nurse educators to be aware of how praxis can be integrated successfully, not only into nurse education but also clinical practice.

Educating the Workforce

Nurse educationalists ultimately play a significant role in educating the nursing workforce; others include, work colleagues, mentors and patients. As diverse opportunities for professional development emerges integrating praxis into nurse education at all levels can facilitate a collaborative partnership between both the student and educator; essentially learning can become of high quality, promote critical thinking and create a shared social purpose (Bono-Neri, 2019), perhaps more relevant in a world where technology has made sharing knowledge globally relatively trouble-free.

Encouragingly, nurses are now considered to be global nurses, with a role that challenges the impact of social inequality on public health and wellbeing, as evidenced in the Nursing Now Campaign (Crisp, 2017) and yet there continues to be a lack of understanding of the public health role of nurses. Not all nurses have the title of public health nurse, however in reality all nurses should have an understanding of the impact of policies that fosters social injustice; processes which Galtung (1969) called ‘structural violence’ and by their actions seek to reduce the continued inequalities, not only nationally, but globally. Nurses who are able to understand and invoke praxis (Freire, 2017) are invaluable to their professional colleagues, their workplace and the wider economic communities in which they live and work. For if nurses are able to understand the social, political and economic constraints under which healthcare is delivered and social injustice prevails, then by taking one step further from reflection to action, nurses can become the catalyst for fundamental change.

Conclusion

Nursing lecturers play a significant role in educating the nursing workforce, others include, work colleagues, mentors and patients. As diverse opportunities for professional development emerges and time constraints continue to exist, introducing the concept of praxis into nurse education may be deemed challenging, although having a capable workforce of the future may depend upon it.

Understanding praxis therefore can be the force that enables nurses to become independent heutagogical researchers, activists and a force for change. Integrating praxis into nurse education, however will not be easy and the limitation of this work has already become evident as nurses continue to work in challenging, dynamic environments where the emphasis is on the diagnosis, treatment and discharge, only to see many return through a revolving door of the same. Nurses however must begin somewhere. Through my continued research, how nurses achieve this, I hope will become evident.

In order to instigate social reform, nursing as a profession, with its increasing emphasis on global healthcare is in a strong position to continue to promote the development of advanced skills and high order thinking in order to influence future nursing care. It is important however that nurses have the support of leaders, managers and governments to do this. A nurses role is to honour humanity and foster nursing scholarship, (Taylor, 2010) for it is these behaviours along with those associated with praxis (Freire, 2017) that could begin to see the reform that is so badly needed.

References

Avdal, E.Ü. (2013) ‘The effect of self-directed learning abilities of student nurses on success in Turkey’, Nurse Education Today 33: 838-841.

Blaschke, L.M. (2012) ‘Heutagogy and lifelong learning: A review of heutagogical practice and self-determined learning’, The International Review of Research in Open and Distributed Learning, 13, 1. doi:10.19173/irrodl.v13i1.1076.

Blaschke, L.M. (2014) Using social media to engage and develop the online learner in self-determined learning, Research in Learning Technology, 22: 21635, doi.org/10.3402/rlt.v22.21635.

Blaschke, L.M. Kenyon, C. and Hase, S. (eds) (2014) Experiences in Self-determined Learning. Createspace Independent Publishing Platform.

Bodkyn, C. and Stevens, F. (2015) Self-directed learning, intrinsic motivation and student performance Caribbean Teaching Scholar, 5, 2: 79–93.
Bono-Neri, F. (2019) Pedagogical Nursing Practice: Redefining nursing practice for the academic nurse educator, Nurse Education in Practice, 37, 105–108.
doi:10.1016/j.nepr.2019.04.002

Chinn, P.L. and Kramer, M.K. (2018) Knowledge Development in Nursing. Theory and Process. St Louis, Missouri: Elsevier.

Crisp, N. (2017) ‘Nursing Now’, n.d. [Online]. Available at https://nigelcrisp.com/nursing-now/ (accessed 15 May 2018).

Davis, L. (2018) ‘Heutagogy Explained: Self-Determined Learning in Education’. [Online].

Freire, P. (2017) Pedagogy of the Oppressed. London: Penguin.

Galtung, J. (1969) ‘Violence, Peace, and Peace Research’, Journal of Peace Research, 6, 3: 167-191.

Jasmine, T. (2009) ‘Art, science, or both? Keeping the care in nursing’, Nursing Clinics of North America, 44, 4, 415-21. Doi: 10.1016/j.cnur.2009.07.003.

Niezen, M.G. and Mathijssen, J.J. (2014) Reframing professional boundaries in healthcare: A systematic review of facilitators and barriers to task reallocation from the domain of medicine to the nursing domain, Health Policy, 117, 2, 151-69. Doi: 10.1016/j.healthpol.2014.04.016.

Nisbet, G. Lincoln, M. and Dunn, S. (2013) ‘Informal interprofessional learning: an untapped opportunity for learning and change within the workplace’, Journal of Interprofessional Care, 27, 6, 469-475.

Nursing and Midwifery Council (2018) ‘Future nurse: Standards of Proficiency for registered nurses’, n.d. [Online]. Available at https://www.nmc.org.uk/standards/standards-for-nurses/ (accessed 1 June 2018).

Nursing and Midwifery Council (2018a) ‘Realising professionalism: standards for education and training’, n.d. [Online]. Available at https://www.nmc.org.uk/standards/standards-for-nurses/ (accessed 1 June 2018).

Pijl-Zieber, E.M., Barton, S, Konkin, J, Awosoga, O, Caine, V. (2014) Competence and competency-based nursing education: finding our way through the issues, Nurse Education Today, 34, 5, 676-8. Doi: 10.1016/j.nedt.2013.09.007.

Renolen Å, and Hjälmhult E. (2015) Nurses experience of using scientific knowledge in clinical practice: a grounded theory study. Scandinavian Journal of Caring Science, 29, 4: 633-41. doi: 10.1111/scs.1219.

Ryan, M. (2011) ‘Evaluating Portfolio Use as a Tool for Assessment and Professional Development in Graduate Nursing Education’, Journal of Professional Nursing, 27, 2, 84-91.

Taylor, B.J. (2010) Reflective Practice for Healthcare Professionals. 3rd ed. Open University Press: Maidenhead.

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