Tag: education

Academic culture in Nursing: devalued, defiant or dead?

http://ac.els-cdn.com/S0020748913001521/1-s2.0-S0020748913001521-main.pdf?_tid=a32e66a0-6437-11e4-ac69-00000aab0f6b&acdnat=1415115265_ead98d7c0974d615549368b0b1a070e2

Academic culture in Nursing: devalued, defiant or dead? So wrote David Thompson in 2013.

This editorial reflects a continuing and growing concern with academic nursing in Universities, a concern which, like the science of climate change, seems to be documenting a crisis with little or no positive action in response. Gary Rolfe’s idea of the paraversity is a counter and I argue elsewhere that we can begin to build the paraversity to subvert the corporate university from within. However, the forces ranged against academic nursing are formidable and come often from clinical nursing aided and abetted by the managerial approach within a corporate university. Without a sense of irony or shame it has been reported that the desire exists in some NHS trusts and elsewhere to ‘repatriate’ nurse ‘training’ back into hospitals alongside a wish for increased use of band 4 assistant practitioners. The political imperative to save money, the drive for efficiency and effectiveness, is seemingly leaving little room for critical enquiry and provocative pedagogy. It is with sadness that I hear keen first year nurses expressing the need for just such an education just at the time when it is being devalued elsewhere. Nurses used to be called handmaidens to doctors, now I fear nursing is becoming a handmaiden to managerialism. Nurse academics seem powerless to affect a response.

“The University in Ruins”

The Corporate University, Health as commodity and the citizen as customer.

 “As universities mirror the increasingly unequal nature of English society … their role in advancing social equality, or minimising embedded disadvantage, will be traduced in a ‘meritocratic’ game of spotting talent and ensuring that it is slotted into the appropriate tier.” So writes Andrew McGettigan on the the discoversociety.org website in 2014. This comment on the ‘corporate university’ indicates that universities have functions that go beyond only meeting the needs of student consumers in their quest for a job, that indeed Universities should address aims beyond producing  ‘cognitive capitalism‘.

Should we care at all about this, or should we encourage even more market discipline?

For some, education is a commodity which should be bought and sold in a free market.  If a student wishes to borrow money to study literature or sociology then that is their choice, the State has no business in supporting study that has little direct economic benefit for individuals or society. So goes the free market apologists who places trust in the individual rational action of the student/consumer when buying the commodity of education. This is not new. Logan et al in 1989 argued in the context of the provision of health care that

“…services should be treated just like any other commodity that can be efficiently produced and consumed under market conditions”.

David  Willetts, Minister for Universities and Science, told a fringe event at the most recent Conservative party conference: unleashing the forces of consumerism is the single best means of improving the quality of undergraduate provision.

Student tuition fees have turned students into customers. This is seen as a ‘good thing’. Students will vote with their money and desert courses and institutions that they feel will not fulfill their hopes and aspirations. Competition for Elite universities will thus increase and only the best survive – a bit like the Premier League. Since its inception we have seen the loss of 50 football clubs as well as a sense of the club representing the local community values. Does that matter? Not if you are the winner – a Manchester City/Utd or a Chelsea – or a winner’s fans.

A clearer statement of the ideology of free market capitalism you will find hard to beat. Consider that this thinking has, not as yet, boldly reared its head for health. How would you feel upon hearing:

“unleashing the forces of consumerism is the single best means of improving the quality of health care provision”.

What do you think about  this:  Individuals should pay for their own health and social care needs at the point of delivery, as they are best placed to know what their needs are and how much they value health and social care. If they value beer and fags more, then that is their choice and the state should not intervene in that decision.  Individuals and families could pay for insurance for that ‘rainy day’ of dementia, cataracts or a broken leg. Hospitals and GP practices would be forced to compete for customers and those with poor reputations would have to close. Public Health England could be disbanded as a wasteful state cost base and instead individuals could be nudged to take responsibility for their health.

Well, if you have swallowed market ideology wholesale, that might sound like nirvana.

If universities are turning into warehouses for the production of cognitive capitalism in which education is a commodity to be bought and sold for instrumental purposes (“its the economy, stupid”), then their social role diminishes. Likewise, is health care a commodity to be bought and sold or does society also need a health sector that addresses the social and political determinants of health as well?

Individual rights and liberties balanced with social solidarity?

At root this is the difference between a social democratic political philosophy and a market driven neoliberal agenda. Its your choice, but remember ‘some animals are more equal than others‘ and they have the clout to ensure they stay ‘more equal’.

Funding cuts to nurse education – austerity hits students

“Universities say nursing education has reached a “tipping point”, with proposed funding cuts putting the quality of courses and ultimately the quality of nursing care at risk”

The funding cuts and increase in student numbers may well have a detrimental affect on the learning experience. To address it we have to adopt new methods – some of which we need to do anyway – such as increasing use of web 2.0 technology for example ‘webinar’ presentations and discussions. Simulations are expensive and time consuming and allied to pressures on mentors, we have an overall picture of stress on the system. This will increase the call to take education back into the NHS, to see students as part of the workforce and not supernumerary, and the adoption of training rather than education. The wider context is the increasing control of nursing for managerial reasons within the contested economic policy of austerity. The country largely believes there is no money for education, health or welfare. In addition the policy is one of creating a market for those public goods based on the idea of a ‘consumer’ exercising rational choices. That is why the student pays fees so that through a market mechanism they will drive up quality by only buying education from quality providers. That is the theory. There is money – its just that it is in the hands of the few that gov’t dare not touch.

In a report, a Tale of Two Britains, Oxfam said the poorest 20% in the UK had wealth totalling £28.1bn – an average of £2,230 each. The latest rich list from Forbes magazine showed that the five top UK entries – the family of the Duke of Westminster, David and Simon Reuben, the Hinduja brothers, the Cadogan family, and Sports Direct retail boss Mike Ashley – between them had property, savings and other assets worth £28.2bn.

The UK study follows an Oxfam report earlier this year which found that the wealth of 85 global billionaires is equivalent to that of half the world’s population – or 3.5 billion people. The pope and Barack Obama have made tackling inequality a top priority for 2014, while the International Monetary Fund has warned that the growing divide between the haves and have-nots is leading to slower global growth.

This is the real issue – inequality politics resulting in an impoverished public sector. JK Galbraith way back in 1958 argued that a feature of advanced capitalism was that public (sector) squalor went alongside private affluence. Quite.

The medics get it – sustainable literacy in education

Sustainability, health and education – Priority Learning Outcomes for health professionals.

 

 

Although some scientists and commentators such as Indur Goklany, have disputed claims about the precise impacts of climate change and human health, it is nonetheless accepted that wider environmental factors can and do impact severely upon health. Climate change, as has been pointed out before, is only one aspect of the relationship between the environment and health and focusing on it may not always be helpful. Instead, many medical and other organisations in the UK have clearly accepted that our relationship with the environment is a foundation upon which health is based. This relationship is also part of our socio-political relationships and forms the matrix of connections and systems that life on earth depend on. Oil and its production, distribution and exchange is a fact of that socio-political and environmental relationship – what John Urry calls the carbon based economy-society.

 

At this point the connection between health and social analysis might begin to seem tenuous, especially to those steeped in a biomedical frame of reference. However, within health education there are two perspectives that bring issues around sustainability, whether they be political, social and/or environmental, back into focus. The Social Determinants of Health and the Inequalities in Health literature raise issues about our relationship both to the environment and to each other and the impact this has on individual, community and population health. Both of these perspectives on health may well be addressed in undergraduate medical and nursing education, but the extent to which they are, is not currently mapped. Although these two perspective do not always explicitly discuss the environment they do focus attention beyond the individual and biology. A great example is Barton and Grant’s (2006) ‘health map’ which clearly models determinants of health. Their paper, and model for health, would or should be a foundational read in undergraduate health education emphasising as it does biodiversity, climate change and the global ecosystem as key determinants of health.

 

This has now been explicitly accepted by some in the medical profession following the publication of three specific priority learning outcomes for the education of ‘Tomorrow’s Doctors’. This publication follows calls for medical graduates to be sustainability literate and is based on a General Medical Council’s request for learning outcomes for environmental sustainability in medical education. A call for nursing in general, and the Nursing and Midwifery Council (NMC) in particular, for nursing to be more explicit on sustainability and environmental health in its educational standards for undergraduate nursing education has not resulted in a similar request by the NMC for learning outcomes of this nature. The NMC prefer to see this subsumed under general public health.

 

The priority learning outcomes just published on the Sustainable Healthcare Education network are:

 

1. Describe how the environment and human health interact at different levels.

2. Demonstrate the knowledge and skills needed to improve the environmental sustainability of health systems.

3. Discuss how the duty of a doctor to protect and promote health is shaped by the dependence of human health on the local and global environment.

 

The site helpfully expands on these outcomes.

 

An important point is that although sustainability literacy may involve explicit new curricular content for doctors, for example critical reflection on the philosophy of dualism and anthropocentrism, it is also about developing a perspective on health, a lens through which we see anew the relationship between human health and the environment. Medical schools may already address models of healthcare delivery that go beyond the biomedical to embrace and examine biopsychosocial, salutogenic and complementary approaches. The European Centre for Environment and Human Health based in Truro, Cornwall,  is an example of a research centre specifically and explicitly addressing sustainability and environmental issues.

 

Thus we have the medical profession very clearly stating that sustainability and environmental health should be explicit in the education of our doctors of the future. This of course follows on from other clear statements such as the first University College London and the Lancet Commission on managing the health effects of climate change report.

 

These learning outcomes have been called ‘priority’ learning outcomes and this perhaps reflects the seriousness with which the issues are taken. A counter is that of course Public Health is a core component of both medical and nursing education, so why the need to make sustainability specific? Why indeed have ‘priority’ learning outcomes if this is being covered already within public health education. The answer may be that ‘Public Health’ itself is a multi perspectival subject in which it is possible that biomedical and epidemiological approaches could dominate while downplaying the environmental and social determinants of health. It is certainly possible to address public health without critically examining and understanding sustainability. The General Medical Council seem to have accepted this,  and hence their call for these learning outcomes. The Nursing and Midwifery Council have considered that their own standards that inform education practice are broad enough so that sustainability can be incorporated into undergraduate programmes within Public Health teaching. This might be a mistake, because if educators do not have a sustainability perspective, or lens, then they may well miss a vital aspect of health education.

 

The publication of the medical priority learning outcomes on the other hand gives a very clear message to those developing educational experiences for doctors. The message is that to fully understand human health one has to address environmental, social and political determinants of health. This understanding then feeds into strategies and actions  to address inequities in health and the environmental health crises that may severely impact on individuals, communities and populations. Other health professions might learn from this approach taken by the GMC.

Students who acquire large amounts of debt putting themselves through school are unlikely to think about changing society

“Students who acquire large amounts of debt putting themselves through school are unlikely to think about changing society. When you trap people in a system of debt, they can’t afford the time to think. Tuition fees increases are a disciplinary technique and by the time students graduate they are not only loaded with debt but have also internalised the disciplinary culture.  This makes them efficient components of the consumer economy”.

 

(attributed to Noam Chomsky).

 

University tuition fees, and the student’s preoccupation with ‘occupation’ as the defining goal of higher education, reflect the realities of current education provision within modern capitalist societies. Societies have to reproduce themselves and education is part of that process. Getting students and society to accept this version of education requires an ideological straightjacket underpinned and reinforced by a disciplinary practice, e.g. debt or fear of unemployment, or fear of exclusion from desired goods and services, or fear of poverty in a post welfare state economy.  This fear is reinforced by the globalisation of labour power in which vast reserve armies of labour have been drafted into the relations of production in a competitive race to the bottom. A race which requires ‘flexible’ labour markets. Students, and their parents, are increasingly aware that skills and knowledge is being ‘outsourced’ to the emerging economies in a competitive globalised market. Those who cannot compete will be relegated to the poor prospects, low wage, part time, zero hours contract economy, to become the ‘precariat‘.

 

 

 

Thus, Higher Education is increasingly a commodity to be sold in a market aimed at the reproduction of the relations of production in a global competitive marketplace. This how the Corporate Class Executive and the Political Power Elite (CCE/PPE) under financial capitalism requires it to be. They inhabit, own and run this market place and compete to reap the rewards that they enjoy. To continue to do so, their vested interests in the current system has to be supported by reproducing the current conditions of production.

 

 

 

In ‘On Ideology’ Louis Althusser outlined a theory of the reproduction of labour power through a mechanism of ideology, as well as repression when required.  This operates in the following way:

 

As stated above there is a requirement to reproduce the ‘conditions of production’:  every social formation arises from a dominant mode of production and in doing so, and to survive, that social formation must reproduce the productive forces and the social relations of production. These sound very technical. What this means is that society has to ensure the next generation engages in the world of work and the social relationships that make up how we work together. So far, so what? Hunter gatherer societies had a very sustainable ‘mode of production’ – they hunted and gathered! Their conditions of production were their small group kin relationships and the natural environment they found themselves in, with property rights, if they had them, manifested in their cultural practices. The next generation had to learn the skills and knowledge required to reproduce the conditions of production they grew up in. Or die. However, even in these so called ‘primitive’ societies there was room for art, as expressed in the cave paintings that survive to this die. All their educational practices were not only to reproduce the way of life and the goods and services they required. As far as we know, early human groups also seemed to engage in ‘art for art’s sake’.

 

So, a mode of production is the way a society organises the provision of goods and services (hunter-gather, feudal, mercantile/industrial/financial/state capitalism). This ‘mode’ describes how we go about making things, growing things, distributing and exchanging things that we all want. This of course involves social relationships, which includes in the modern era communities or workers all focused on producing certain goods. This also involves the relationships these workers have with the owners of any land they work on. Another social relationship is that of ‘contract’, we promise each other to do or provide something and the terms that surround that promise. Productive forces might include the availability and bringing together infrastructures such as railways or information technologies to those with goods or services to sell. Together the forces and social relations of production are the ‘conditions of production’. The ‘means of production’ include land, capital, factories, call centres, railways, the internet.

 

Productive forces must reproduce the means of production and reproduce labour power. In order to smoothly reproduce labour power, Labour (workers/students) must learn the skills needed in the economy, and the rules that govern Labour’s place in the social relationships of production.

 

This where higher, and other forms, of education and training comes in. To ensure the smooth running of the capitalist system, Labour must accept its place and preferably not question the social relations of production. Education that focuses only on providing skills and knowledge for a job will not equip students with critical tools. The system of rewards and incentives can then be reproduced without query. In a capitalist mode of production, wages must also reproduce labour power otherwise the next generation can’t pay their bills to eat and pay rent. Competence also reproduces labour power otherwise the next generation can’t undertake the work that is required. Ideology also reproduces labour power, the work ethic must be passed on while the system of rewards for work has to be seen as legitimate and as serving the needs of all fairly rather than serving the needs of the few unfairly. Not to do this will lead to a ‘crisis of legitimation’ in which the citizenry cry ‘enough!”

 

So, the reproduction of labour power also requires the reproduction of it’s submission to the rules of the established order, to the ruling ideology, and a reproduction of the ability to manipulate the ruling ideology for the benefit of the agents of exploitation and repression so that they too will provide for the domination of the ruling class in words.

 

Ruling class interests requires that labour/students submit to the dominant rules, and that this submission is reproduced. Ruling class ideology must be seen as being the ‘normal rules’ which are required to ensure the system functions efficiently for all and not just for the ruling class. Class interests must be covered up by an ideology that masks the exploitative social relationships of production. Ruling ideas must become ‘common sense’ that everyone in society accepts.

 

Thus it is becoming common sense that one is required to pay for education on the basis that she or he who pays also is the one who benefits from education. Common sense argues that middle class beneficiaries of education must not benefit from the tax contributions of working class people who do not go to University. It is also common sense that if one has to pay for education then this should lead to paid employment, that the course above all other objectives must lead to skills for the workplace. Currently this means a focus on STEM subjects in order to prepare the UK workforce to compete in a global marketplace. Why waste an education on the Arts and Humanities when what is required is skills in the sciences, maths and technology?

 

Philosophy and Critical Sociology are luxuries we can longer afford.

 

Thus for the current system of capital to continue as a mode of production, the CCE/PPE need to ensure that Labour (students) accepts the tenets of this brand (neoliberalism) as serving not only or just the ruling elite or class but also that it serves Labour’s own interest.

 

To do that it needs an ideological apparatus, backed up by a repressive apparatus when required, i.e. when labour/students no longer accepts the ideology. The disciplinary techniques mentioned above are part of the repressive apparatus used to keep students in line. The paradox is that the more repression is required over and above the ideological, the less acceptance of the ideology there is. Repression may actually highlight that ‘the rules’ are not legitimate, but are self serving rules for the ruling class. This is evidenced by the Occupy movement, the ‘Indignados’ and what Paul Mason has called the ‘graduate with no future’ who increasingly argue that the current system is unjust.

 

The ideology supporting tuition fees is that of neoliberalism: Unfettered markets, deregulation of capital, the withering away and de-legitimisation of state provision, control of Labour and its immasculation as a force in politics, and the primacy of individualism. This is supported by a materialist culture that values consumption as an end in itself. Other social goals are relegated as useless in meeting the demands of markets and consumption. Globalisation backs this up through threats of undercutting wages and moving production to where Labour is weaker.

 

This ideology supported the development of Finance Capital as it replaces Industrial capital as a dominant mode of production in developed countries. Finance capital provides fabulous rewards for those that access and control financial assets, but it produces nothing concrete. It may provide capital for investment for actual production of goods and services but even this base function has been overshadowed by its overreach into speculation, trading on credit default swaps, hedging and betting on futures markets.

 

The promise of material rewards, the manufacture of demand for consumer products, fear of precarious work, the collapse of the structure of opportunities, fear of migrant workers, the powerlessness of social democratic control, and the loss of collective social solidarity in a liquid modern world, leads many students to accept fees and experience its disciplinary nature.

 

Students therefore get trapped into a higher education system that reproduces the social relationship of production that suits the needs of the CCE/PPE. Unless there are liberated territories for critical thinking that are not linked to ‘getting a job’, a generation of students will find it hard to articulate against power, to organise against power, to speak truth to power and will resort to credit fuelled consumption locked onto the treadmill of mortgages they can neither afford, or not to afford to have. They’ll be damned if they do, and damned if they don’t. Not getting into mortgage debt means facing a lifetime of rent and that could take an increasing share of their income. Getting into mortgage debt, on top of the fees debt, ensures they keep compliant or lose risking their home as well as the loss of their critical faculties as disciplined consumers. The other way to ‘escape’ fees debt is not too earn too much and wait for 30 years.

 

Finally, there is a small group of ‘elite’ universities who are particularly complicit in all of this. Supported by long established histories, nobel prize winners, wealthy benefactors and  huge corporate and state funding for research they provide the instrumentally based education that supplies and supports the next generation of the CCE/PPE. They get prestige, power and funding, they provide a compliant uncritical graduate whose only goals are their ‘discipline’ and naked self aggrandisement as members of an ‘elite’ group. Their failure to forecast economic collapse indicates the level of their paradigm bound understanding. Just at a time when the modern university should have been critiquing ideological policies, they capitulated, unable to analyse the systemic risk that resulted in the collapse of Lehmann’s and nearly the entire global financial system, an error that students are now also paying for.

 

The riposte to this is that the system is inevitable, that society has to reproduce a workforce that can do the ‘work’ and that someone has to pay for that education. This misses the point. It is a given that this is so, but it is the form of that education and the nature of work itself as well as the social relationships which direct reward and incentives that can be critiqued. However, while education trains for skills for the workplace it cannot focus on the ideological reasons that underpin the current system.

 

It does not have to be this way.  For the student working in a burger bar who will graduate to a precariat ‘non job’, they have little choice and little voice, in this Hobbesian educational and social environment.

 

 

 

Health, Education and buying shoes

Now,  this f**king (excuse my Cornish) Tory gov’t cannot see beyond its own ideology and its disappointing that ‘two brains’ Willets is caught up in this. Let’s be clear: students are not customers, ill people are not customers, health is not a commodity, Education is not a commodity. They are not shoes. Creating markets in health and education is not a good idea. The Economist recently argued similarly for health: see http://tinyurl.com/healthreforms and see this for what is happening in education http://tinyurl.com/educationreformss.  Now here is the point about markets in health and education:

 

 

“Most people aren’t qualified to determine which medical procedure/product is the optimal product to treat their ailment”. (from a comment by Heimdall) . In the same vein most students are not qualified to determine which University or course is the optimal product to further their careers. In  addition markets cannot serve health protection, education or the social determinants of health.

When you buy a car, you know roughly how much power you want, how much storage, etc. You can look to Consumer Reports to gather reliability data and dealer cost. You can negotiate with the dealer based on this information. Similar story with most consumer goods.

When you have a dread disease (one of a bazillion maladies, not a few dozen as with most purchasing decisions), there might be uncertainty among doctors whether it is indeed disease X, or maybe Y or Z.

Once you (kinda maybe) know what the problem is, which treatment is best? Even among doctors who agree on the disease, they may think that treatment A, B, or C is most effective based on their research, year of graduation, etc.

Thus, even if all doctors and practitioners were equally adept, you would still need to navigate the diagnosis/treatment thicket. But they’re not equally adept, and there’s no Consumer Reports to provide data on reliability, outcomes per thousand operations with doctor X in hospital Y.

In short, consumers are ill-equipped to treat medical care as if it was any “normal” market. We just don’t have the expertise to do it. And thus we are even more susceptible to the recommendations of the “experts” as to what to do than we are with a pair of sneakers.

 

‘Students at the heart of the system’

The recent gov’t white paper (http://tinyurl.com/heartofsystem) of course contains some sentiments that on the face of it few would find hard to disagree with and it seems churlish to knee jerk with negativity. Given that the view is now firmly entrenched (by many in HE it must be said) that HE’s role is primarily to produce a workforce that can compete in a global market, and that students are now consumers of a product, the statements make sense in that context. However, and you knew this would come, this does nothing to address the challenges faced by critical disciplines in the humanities and social sciences whose raison d’etre, as disciplines, does not fit this intrumentalist model of HE. I really fear that only the very well off will now spend £27,000 + to study what may be seen as esoteric subjects that are not immediately aligned to well paid employment. And don’t give me the guff about not paying that back until a threshold of earnings has been reached, as students will clearly see this as investment they have to make for payback in a career.

This is the continuing triumph of neoliberal philosophy applied to HE, my only hope is that students may see through this and that I am worrying needlessly because of an ideological position I am taking. As an afterthought, how did C Wright Mills gain employment in Columbia given the instrumentalist and often private nature of US HE? Anyone know? His ‘star status’ now may gain him entry into Grayling et al’s New College?

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