“In two minds…’the space between functional and transformational approaches to teaching and learning in mental health nurse education

 

by Warren Stewart (Senior Lecturer in Mental Health Nursing)

In this blog, I articulate my reflections on the changes to mental health nurse education introduced after the publication of the new professional standards, Future Nurse – Standards for Proficiency (NMC 2018). My personal experience is quite mixed, but over two years on, my sense is standards still pose some problems for mental health nurse educators and practice assessors/supervisors, for a number of reasons, which I outline below.

 

My problem isn’t necessarily with the specific proficiencies or the changes in the pedagogical approaches required to teach the skills. Pedagogical approaches and underpinning philosophies should be mixed to suit specific skills and learning outcomes, and as a profession, we know we need to do more to support our service user’s physical health. I have observed students enjoying simulated learning and skills sessions, often appearing to derive greater confidence from them. Moreover, I feel I have been able to adapt some of these teaching and learning activities to complement my philosophical position and style of teaching, which involves inductive learning, social learning and reflection based on a reflexive framework. I can see that when managed well, simulation can provide opportunities for students to receive peer and staff feedback on practical elements of their performance, with the potential to encourage greater self-regulation.

 

However, the changes to the standards and subsequent changes to the curriculum are representative of a deeper change to pedagogic discourses and practices. There is a disjuncture from inductively developed skills, involving the development of relational skills and self-awareness, towards objective (realist) based, measurable, performative skills (Brockbank and McGill, 2006). The changes are characterised by the instrumental application of techniques with less requirement for questioning, for sociological imagination, or the development of self-knowledge. The shift incorporates a general de-prioritisation of relational and values-based teaching and learning, and a greater emphasis on functional physical health skills.

Over recent decades we have seen a drift in which nursing practice is more structured and prescribed than before. Objective skills are designed to align with evidence and reduce uncertainty, yet paradoxically the nature of mental health nursing involves engagement in the swampy lowlands of messy social interaction (Schon, 1988), where it is difficult to provide certainty in terms of process or outcome (Parton and O’Byrne, 2000). In real terms practice modules have had to include more physical skills teaching in order to align with the new assessment criterion, at the expense of narrative approaches to lived experience and relational skills. Moreover, there is currently little constructive alignment (Biggs and Tang, 2007) between the new standards and the learning opportunities available in practice, and between the standards and professional roles, particularly for community mental health nursing roles.

 

From a critical perspective (Brookfield, 2017), the changes are arguably representative of wider political shifts, such as the extension of standardization and commodification into new areas of social life and learning (Gregory, 2010). While I recognize the benefits of objective teaching and learning, I am cautious of an uncritical focus on immediate problems, without analysis of why or how these issues may have arisen, or questioning of the sources of the problems. Academics from other disciplines such as social work and probation have written about similar paradigmatic changes, from relationally based approaches to technical rationalist approaches (Gregory, 2010). The risks of such disparities are we are not preparing students fully for the role, and the development of a hidden curriculum.

 

 

Our challenge as educators includes striking the right balance between functional and transformational approaches to people, practice and learning. To achieve the aim of transformational learning teaching processes we need to encourage an approach that challenges the subjective world of individual learners, challenges assumptions and problematises dominant frameworks, (rather than the individuals within it). We need to balance practical and relational care skills in such a way that is not instrumental, and retains an emphasis on fairness and equity, critical reflection and reflexivity. We need to retain a subjective perspective of the nursing role as a socially enacted, practical-moral activity that is not simply an uncritical application of a technique, but inclusively and creatively meets the needs of others.

 

 

Reference List

 

Biggs, J. and Tang, C. (2007). Teaching for Quality and Learning at University, 4^th Edition. SHRE and Open University, Maidenhead.

 

Brockbank, A. and McGill, I. (2006). Facilitating Reflective Learning Through Mentoring and Coaching. Kogan Page. London.

 

Brookfield, S. (1987). Developing Critical Thinkers: Challenging Adults to Explore Alternative Ways of Thinking and Acting. Open University Press, Milton Keynes.

 

Future Nurse – Standards for Proficiency (NMC 2018)

 

Gregory, M. (2010). Reflection and Resistance: Probation Practice and Ethics of Care. British Journal of Social Work. 40, 2274-2290.

Parton, N., and O’Brien, P. (2000). Constructive Social Work. London, MacMillan.

Schon, D. A. (1988). From Technical Rationality to Reflection-in-Action. Eds Dowie, J. and Elstien, A. Professional Judgement: A Reader in Clinical Decision Making. Cambridge University Press, Cambridge.