Seminar 4 Summary

Seminar 4: opportunities and challenges for curriculum design and delivery

Introduction

The ESRC Seminar Series on Nurse Education has been a series of meetings that have brought together academics from nurse education and the social sciences, as well as nursing students. The series is made up of six seminars. The first three of these explored theoretically the value the social sciences have to nurse education. The opening two meetings took case studies of disciplines from the social sciences – specifically geography and then ethnography – and considered how they might be usefully employed in the development of nurses, both academically and as practitioners. The third meeting then looked at how insights from the social sciences might contribute to avoiding repeats of the events that occurred at Mid-Staffordshire.

The second half of the series moves from considering the contributions of the social sciences to thinking how ideas might be moved forward. This paper reports on discussions that emerged from the first of those meetings, the fourth in the series as a whole. This meeting specifically brought together academics from schools of nursing with experience and responsibility for the delivery of programmes, whether as heads of school or through developing curriculum. Being held in Scotland, most participants were from Scottish institutions but with contributions also from English universities.

Goal setting

We asked participants at the outset what they wanted taking forward from the day, challenging them to consider if they saw value to the social sciences in nurse education, and if so, how they would consider ideas being moved forward, and what the main challenges to doing so would be. Asking these questions early provided opportunity to reflection, and especially to enable consideration in light of the morning’s papers, both of which provided context, from nurse education generally, and from the seminar series to date.

Papers

The morning session was devoted to the presentation of papers by Karen Holland, the editor of Nurse Education in Practice, who set out the contribution of the social sciences in historical context. Her presentation included the warning that we have visited this territory previously, but with little impact on education. That said, she also stated considerable excitement at what the current initiative might achieve.

Drs Kyle and Atherton then provided and overview of the opening three seminars, and in so doing provided a basis for the discussions that would be taken forward in the afternoon. The paper highlighted key themes to have emerged as to how the social sciences might contribute, including a clearer recognition as to what nursing actually involves (as opposed to what we imagine it to be)

Afternoon discussions

Responses can be conceptualized under three headings:

  1. What we are as nurses;
  2. Developing the academic dimensions to nursing education; and
  3. Challenges to universities (in other words academics) and nursing education’s regulators.

What we are as nurses

There were attributes to which participants held that came through in discussions and that were raised as a key point in the plenary session. The first of these was that nursing is a multi-faceted discipline. This diversity is a strength, and the ability to identify and draw on those subject that hold the potential to contribute to the development of practitioners, whether undergraduates, post-graduates or in Continuing Professional Development, is something to be encouraged. As such, the social sciences and the insights they provide were very much welcomed.

Indeed one discussion revolved around the idea that the social sciences involve much about what participants identified with as nurses. That it involves understanding the context of people’s lives, the realities of practice, and critical thinking was very much in line with the ethos that was seen as being at the heart of the nursing enterprise. Furthermore, there was clear agreement that nursing was both an academic and a practical endeavor. That the social sciences could usefully contribute to the former to the benefit of the latter was evident in discussions.

Given that the social sciences offer so much, a point raised was that social science qualifications should be welcomed as an entry criteria for nursing. School level qualifications in, say, sociology or geography provide indication not only that the applicant has academic ability, but that they have engaged in a subject that gives insights into the worlds of the people for whom he or she will be providing care to. A clearer alignment with the social sciences even before entrance would both signal was nursing was about whilst also encouraging pre-entrants to start engaging with the issues that will be their professional concern on entering a nursing degree programme.

Academic Development

Participants believed the academic opportunities offered by the social sciences to be an important opportunity for nursing education in developing as a distinctive academic subject. Doing so requires an explicit recognition as to the roots of where evidence has come from, for example having an underpinning of sociology, social anthropology or human geography. Recognition of these academic disciplines would facilitate a deeper engagement with those subjects and reflection of what they offer to nursing, an academic discipline in its own right.

Specific opportunities would make key links for students, enabling them to reflect on the ‘theory-practice gap’, those differences between what is taught in university and what is seen in practice (and indeed to start critically thinking through differences between expectations and realities). Participants saw the social sciences as making a notable contribution here with the opportunity for nursing students to engage in ethnographies of their own as a part of their first placement, at a time when they are still, to a large extent, seeing practice through the eyes of the ‘other’. Such an opportunity could in itself be an assessment, an exercise that would clearly link theory to practice and yet explicitly recognize and hold in tension that gap that all too often students, practitioners and academics find discomforting.

The social sciences, participants suggested, could also contribute understanding as to what actually happens in nurse education. In much the same way as participants in earlier seminars had demonstrated insights into practice that challenged preconceptions, including those held by academics in nurse education, so too they could shed light on to the realities of the student nurse experience, giving insights into the lives of students and their learning to enable an understanding beyond what we, as educationalists, believe or, perhaps even, wish to believe.

Challenges

Whilst very sympathetic towards the potential of the social sciences to nurse education, participants also saw considerable challenges. Many of those challenges represented issues not only to the effective utilization of the social sciences, but were obstacles to an effective curriculum generally. As such, the social sciences might provide a focus for much needed reforms to nurse education.

Participants suggested that a clear articulation as to the goals of nurse education was needed. Various organisations contribute to the development of curriculum, including not only the providers, the higher education establishments, but also the Nursing and Midwifery Council, Health Education England, and, north of the border, NHS Education Scotland. With so many interests, a clear focus as to what was actually trying to be achieved was often lost. Yet without articulation as to what the intensions of the curriculum are, the ability to create programmes with clear direction was lost.

Indeed there was considerable discussion amongst participants as to the extent to which the overloaded curriculum, the attempt to include too much in curriculums, was a point of discussion. The extent to which there was consensus was not clear. However, whether the overloaded curriculum was either an obstacle or an excuse for not making greater use of the social sciences, that there is a problem with too much, often uncoordinated material in undergraduate nursing courses was recognized.

Wider issues around the manner in which nursing education is validated was also a topic of discussion. There was consensus that developing curriculum was challenging given the need to revalidate programmes every five years, one of the requirements made by the Nursing and Midwifery Council. Revalidation is a considerable undertaking and does not encourage or facilitate an ongoing development. Rather, a programme has to be put in place with the explicit assumption that it will represent the curriculum until the next validation takes place. Gradually incorporating and building components, such as, for example, the social sciences, is not something the need to revalidate particularly encourages or accommodates.

The ability to develop ideas over the course of a students’ studies are currently hindered, it was suggested, by the modular programmes widely used in UK nursing education. The problem with using these modules is that they fragment learning, discouraging integration of ideas. So, a module in sociology becomes quite disassociated from other aspects of the curriculum. Nursing students are neither encouraged nor facilitated to take ideas learnt in one area and apply it to another. Repetition of material is not uncommon, but constructively revisiting to revise, develop and build is difficult to achieve. This modular structure, it was suggested, would make integration of the social sciences, as opposed to simply appending them on to courses, difficult to achieve.

Nonetheless, a closing comment suggested that we are at a tipping point in nurse education. Occurrences such as Mid-Staffordshire and the outcry that resulted provide opportunity to propel nurse education forward (something to which the social sciences can facilitate through the academic opportunities created). Yet doing so will require change to the regulatory systems. The current situation, with various organisations having input but without coordination between one another, it was suggested, is simply unsustainable.

Final thoughts

A final question raised by Karen Holland was that of “Graduateness” – what is that an academic education actually brings to a practitioner. This question is one thus far poorly articulated, but is crucial if nurses are to benefit from the wide and diverse range of subjects that might be drawn on to develop people who are able to draw on evidence in a reasoned manner, and so able to independently make informed and accountable decisions.

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