The social sciences – connecting theory and practice in nursing education

Iain Atherton, Reader at Edinburgh Napier University, reflects on the potential of ethnography to facilitate students connecting theory to practice.

Yesterday I had the pleasure of talking to the Council of Deans about the Social Science and Nursing Seminar Series, along with my colleagues Sara Donetto, social researcher from King’s College London, and Alexis Perreirra, a second year undergraduate nurse from Brighton who participated in our recent students’ seminar in Nottingham. Time inevitably constrained what we could say, our only being able to touch on just some of the ideas to have emerged over the past 18 months of the series.

We were especially keen to get views on an idea to have emerged from students who have taken part in the seminars, something very practical that has the potential to help students, not only nursing but also those studying the allied health professions, to draw on theoretical components of courses to a far greater extent to inform their practice. In other words, a very practical idea that addresses what is sometimes referred to as the ‘theory-practice gap’.

Exactly what is meant by this ‘gap’ is unclear to me. Academic components to courses are essential. I know many of you will not need convincing. The wonderful Guardian article by June Girvan that eloquently explains why nursing is an academic subject. For me the case is decided; the profession’s place in the academy is beneficial to patient care.

On reflection, would I have said the same thing 30 years ago, when sat in a classroom in the Fife College of Nursing and Midwifery in Kirkcaldy, a recent entrant as a student nurse? I think not. It is only with time that I have come to understand the value of academia. Rather than closing this “gap”, perhaps what we should be thinking about is how we can facilitate students to make connections. As Sara suggested yesterday, we need to think about how to break the distinction between theory and practice. And it is here, in encouraging creative and empathetic thinking, that the social sciences (and other subjects from the arts and humanities) can make a notable contribution.

Of all the issues that have arisen in our conversations through the series, one theme that links together many is the ways in which the social sciences can facilitate students to make such links between theory and practice. And in talking with students who took part in the last seminar, one specifically devoted to students, the idea that many have brought-up, including very practical suggestions, is again, the possibilities of better linking theory to practice. I’m going to relate one of those ideas here, but will blog about other ways in which theory from the social sciences can contribute to breaking down the theory-practice divide.

Ethnographies, studies that involve immersion in a particular social context, such as a ward or community placement, can highlight differences between commonly held views and what actually takes place, or between the superficial explanations given on first contact and those that become evident as more trusting relationships develop.

Take for example ideas presented at our second seminar, a meeting that focussed on culture and the ward and community environment. Kate Seers, one of our co-applicants, described an ethnographic study in which one of her PhD students had talked to nurses about their practice and observed their nursing care. What was said did not always tally with what became evident later, as the idea was discussed and reflected on by researcher and study participants. We are, I suspect, familiar (and likely accept) the idea that “pain is what the patient says it is”. And indeed, nurses often stated their agreement with the idea to Kate’s student. Yet, once the student got to know the nurses well, and talked in depth as to the use of pain control, the reality was rather different. “Pain is what the patient says it is, but…”. This qualification to the statement was added to justify a rather different approach to pain control. When I heard Kate’s presentation, that idea struck a chord with me, being familiar to my own experiences of clinical practice, and I suspect it will with many of you. But it was through ethnography, a method of the social sciences, that the disjuncture between a popular idea and reality, between theory and practice, was made clear to me.

Another example. Professor Davina Allan from the University of Cardiff presented at our Kings’ Seminar. During her presentation, she discussed her own ethnography of nursing practice on a ward. And what she saw challenged popular notions as to what a nurse does. Much of a nurse’s time, she personally observed in her ethnographic study, was spent in management roles, and not just filling-in paper work; managing beds, off duty rostas, negotiating resources. What was staggering was the percentage of this time, being around 60 per cent of a nurse’s shift. Now we might quibble about the generalizability of that study, or the degree to which such the percentage reflected a true figure. My own view, for what it is worth, is that it brought back memories of my own time in practice. Again, the ethnography opened to me a view of my own roles rather different to what I might previously have believed.

My point here is that these ethnographies bring to focuses how complex practice is, how ideas held and stated can be very different to what actually occurs. Practice has to be reflected on beyond initial observations, and not just taken at face value. Realisation that our own notions can differ from what is made clear through ethnography opens up all kinds of questions to grapple with, whether to the way we as practitioners really approach stated pain, or if nursing is about managing or direct patient care. In other words, ethnography provides a very practical means to getting in to critical reflection and critical thinking.

So how might ethnography be drawn on practically? Will Ball, one of the students contributing to the series, and now doing a PhD with us at Edinburgh Napier University, suggested the idea of an ethnography as a first placement experience. The intention here is to facilitate insight into how our understandings, others’ narratives, and realities can differ, to challenge the notion that experience can be taken at face value, and to encourage thinking critical thinking into contradictions.

My initial reaction was one of skeptisism. On reflection, I wonder – just wonder – whether the student participants might be on to something here. Of course there are many issues that would need to be thought through; the practicalities of developing expertise in ethnography (though there may be many ethnographers sat in schools of nursing just waiting for such an opportunity), of enabling such placements, thinking through whether assessment would be helpful and, if so, what form it should take. I’d be interested to hear your thoughts and ideas on this, as well as, as indicated at the start of this presentation, how we might take forward an idea such as this (or the many other possibilities offered up by the seminar series).

Work would have to be done thinking through how such a placement might be facilitated; preparation beforehand, facilitation during and afterwards, assessment. I am not an ethnographer, my own research using methods very far removed. The idea opens up the possibility of collaboration with academics in other schools, ethnographers being located in schools of anthropology, geography, sociology and so on.

The way theory develops is often iterative. Ideas are developed, and altered over time in light of experience. Ethnography, both the insights from published ethnographies such as by Davina Allan or Kate Seers, or through practical training and exposure, can provide students with a working understanding of theories and practice and how one can contribute to the other.

What do you think?

Iain Atherton is a Reader at Edinburgh Napier University.

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