Tag: nurse education

Academic culture in Nursing: devalued, defiant or dead?

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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”

How to do thinking in Nursing?

The picture above is the colorado river cutting its way through the rocks on its way down to the Grand Canyon.

Nursing and ‘On Intellectual Craftsmanship’ (C. Wright Mills 1959)

‘Doing’ professional registered nursing involves ‘hands on’ practical skills, but it also involves ‘thinking’. If there is no thinking then nursing has been reduced to a ‘procedure’, a sequence of ‘hands on’ practical skills which requires training rather than higher education and which can then be undertaken by care assistants. The thinking required is not just the recollection of facts to be applied to a patient situation. For example knowing what a drug does, what the correct dose is, and whether it is right for the patient, is a recollection of factual information. The mere collection of thousands of ‘facts’ in your head to be applied to patient care, reduces registered nursing, again, to a procedure, albeit complicated by the sheer number of facts. In a rapidly changing world of demographic changes, new technological developments, environmental damages, shifting health care delivery systems, geo-political conflicts and global socio-economic challenges, what is required is critical thinking supported by scholarship. The professional nurse with a higher education preparation will, or ought to be, engaged in critical thinking to move beyond merely recalling facts as we cannot insulate ourselves from the social and political contexts in which we work.

How do we do this? Sociologist C Wright Mills in 1959 clearly called for scholarship and criticised some sociologists at that time for not doing this. In the appendix to ‘The Sociological Imagination’ Wright Mills outlines his view on ‘doing’ social science in which he suggests that ‘Scholarship’ (“scholarship is writing”) is more important for the social, as opposed to the ‘natural’ scientist, than empirical research. If nursing is as much a social science based practice discipline as one that is also rooted in the biomedical sciences, then this argument applies.

Wright Mills referred to empirical science as the “mere sorting out of facts and disagreements about facts”. I would argue that this equally applies to professional nursing (Goodman 2011). Student nurses study evidence based practice and the application of research to practice. A good deal of this is factual information based upon empirical research . Students will, however, we required to critique this research. This will involve studying ‘rules of method’, i.e. how do we ‘do’ research, but arguments on this, e.g. is an interview better than a survey to help us answer this research question, are just so much navel gazing which Wright Mills wished to avoid if he could possibly do so, as he argued:

“Now I do not like to do empirical work if I can possibly avoid it” (p205).

Wright Mills was clear on this. He argued that the task of social science and I would add professional nursing is thus to critically engage in the real world, joining the nurse’s personal experience and intellectual life through critical reflective reason as the

“advance guard in any field of learning” (p205).

Empirical ResearchA central concept in modern science and the scientific method is that all evidence must be empirical, or empirically based, that is, dependent on evidence that is observable by the senses. The term refers to the use of working hypotheses that are testable using observation or experiment. In this sense of the word, scientific statements are subject to, and derived from, our experiences or observations. Crudely, this means we need to be able to measure things, we need to be able to see, touch, hear…..

 

Wright Mills in arguing for craftsmanship in intellectual life implicitly acknowledges in the ‘Sociological Imagination’, the need to go beyond simple empirical knowledge in forming policy action when he asks social scientists in their political and intellectual tasks to clarify the contemporary causes of uneasiness and indifference (p13) to personal troubles and public issues.

The personal trouble of lying in soiled sheets in a hospital ward has to be linked to the public issue of the provision of care for older people in acute hospitals. This issue and our indifference to it, or our unease with it, has to be critically examined to seek answers beyond simply blaming uncaring individuals.

The social scientist is not to merely describe the contemporary elements of social life but to engage with it. The nursing ‘scientist’ is not to merely describe contemporary elements of patients’ experiences, e.g. abusive care, but to engage with it. Professional nurses charged with delivering care are thus asked to engage in critically understanding the social, political and economic structures in which care occurs.

Craftsmanship

Wright Mills uses the word ‘craftsmanship’. The use of the word ‘craft’ appears here to differentiate the activity from that of mere mastery of elaborate discussions about research method and which would quickly make one “impatient and weary” (p195). A craft suggests development of skill by diligent constant practice, honing one’s technique by reference to finished products and products in the process of being created to evaluate their flaws and strengths and then adjust accordingly. This is reflexive practice in that the work as it continues is being constantly worked and reworked as required. It suggests leaps of imagination and intuitive thinking and practice in the creation of a project. It calls for a departure from strict adherence to a rigid structure of routines, methods and frameworks. It also suggests a measure of artistry in thinking. In other words a potter ‘crafts’ his pot, as the clay spins there is a constant feedback to the craftsmanship of what is happening, he or she constantly adjusts the application of skill to fashion what they want. Some of this is under conscious control, some of it is unconscious based on years of experience and input. Likewise, thinking and scholarship can be a craft in this manner. The end product is not a pot but a theory, an argument, a series of questions, an hypothesis. In fact there may not be an end product as thinking may be continuous.

The scholarly craftsman is his or her work as their craft develops alongside who they are. Scholarly craftsmanship then is a state of being not only doing:

“Scholarship is a choice of how to live as well as a choice of career” (p196).

When Wright Mills wrote that:

“admirable thinkers…do not split their work from their lives” (p195)

…he preconceives notions of lifelong learning that are to follow.

Nursing practice if it were to take this concept on board may then have to consider a break away from a wage based employee model where a nurse works for 37.5 hours per week to a salaried professional/intellectual model whereupon the nurse would continue to critically reflect on issues pertinent to speciality and patient group outside of NHS contracted hours. Given the current context of the NHS and clinical practice this seems highly unlikely for clinically based nurses. But if not them, who? If not now, when? If not here, where?

To undertake this craft he asks students and social scientists to keep a journal to enable the development of the intellectual life, of the craftsmanship of social science. This should consist of ideas, personal notes, excerpts from books, bibliographical items and outlines of projects. He suggests that journals should record ‘fringe thoughts’, snatches of conversation and even dreams. This will also include the taking of copious notes from books and this needs developing into a habit.

Since Wright Mills outlined notes on journal keeping there has been the explosion onto the scene of information technologies, elearning and web 2.0. These are now new tools that were unavailable to Wright Mills. However the essential nature of scholarly activity should not be lost in any infatuation with new technologies, rather these gateway technologies could facilitate critical enquiry and journal keeping.

Wright Mills’ work thus calls for the development of scholarship as a core intellectual activity. However, critical scholarship within nursing is under threat both in practice and in Universities, skewed as it is towards empirical enquiries and buckling under the weight of bureaucracy, managerialism and the demands of the corporate University. There is an urgent need to rediscover it if we are to address the complex questions and serious issues of our age such as inequalities in health, care of frail older people, health service funding, diabetes, obesity and cardiovascular disease, depression, anxiety, the social and political determinants of health and climate change. Nurses can choose to engage with this agenda or not.

 

 

 

 

“The University in Ruins”

Constructing the Paraversity using the web.

 

Introduction

Higher Education institutions across the globe are changing and changing fast. Several writers have expressed dismay, as well as seeing opportunities to move in different directions, in response to what has been called the ‘University in Ruins’ (Readings 1996).

 

Gary Rolfe (2013), picking up on Reading’s work addressed ‘scholarship in the corporate university’ and suggested that academics must ‘dwell in the ruins’ in an authentic and productive way through the development of a community of philosophers who will dissent, subvert and challenge the ‘corporate university’ from within. Tools for subversion are at hand. Social media, blogging, open access journals and the development of new academic websites such as Researchgate and academia.edu, give academics new ways to reach students, and indeed anybody, way beyond the physical confines of their campus. Accepting that there are issues of peer review and hence quality, these tools allow free access and may facilitate dialogue in ways unheard of just few years ago. This paper explores the ruins, argues for critical dissensus, and shares one experience of using such tools and suggests that this might then assist in building Rolfe’s ‘community of philosophers’ or what Slavoj Žižek has called ‘liberated territories’ (Žižek 2008).

 

Following a note on pedagogy and addressing what the purpose of education  might be,  the idea of the Paraversity will be outlined, and importantly a central notion of dissensus highlighted. Why nurse educators and student nurses should engage in dissensus, as well as professional training, is a point to be debated. To do so, I will refer to the work of C Wright Mills’ on ‘intellectual craftsmanship’. Secondly, an example of constructing this Paraversity will be shared, not that this is a paradigm case, but as only one way to do so, a way that of course may prove fruitless as we acknowledge the variety of approaches and uncertainty of any outcomes. Indeed ‘outcomes’ themselves may be part of the language of a certain mindset that is antithetical to the Paraversity.

So, what follows is a thesis, which may draw forth an antithesis resulting in a new synthesis, which in turn can be challenged. Consensus and agreement is not the point; dialogue is. This paper is overtly political; drawing upon Freire’s ‘pedagogy of the oppressed’, Marx and the heirs of Marx, to argue that nursing is locked into a matrix of social systems that are oppressive and marginalising, and that Higher Education itself, in the guise of the ‘University of Excellence’ is increasingly commodified, and losing its way as it tries to meet the needs of the ‘Knowledge Economy’ in the production of ‘Cognitive Capitalism’.  I argue we need to revisit the question ‘what is education for’?

 


 

A note on Pedagogy

 

Paulo Friere’s first premise concerns a humanistic value base, upon which a pedagogy should be constructed. The human being is a ‘subject’, rather than an ‘object’ ready for construction by oppressive forces. Our ‘ontological vocation’ is towards ‘humanization’; to be able to engage in ‘conscientização’   which is learning to perceive social, political and economic contradictions and to take action against the oppressive elements of reality.

Stephen Sterling (2001) later argued that we need a paradigm shift away from transmissive forms of education towards transformative forms of education. Transmitting an education that ensures graduates are better equipped to perform clinical skills is first order learning.  However it is a partial education at best. First order learning takes place within current educational boundaries and philosophies. It is adaptivelearning, e.g. the acquisition of skills and knowledge to assist in adapting to new roles as registered nurses.

 

Education ought to be a process of transforming individuals so that base values, assumptions and paradigms are taken into account and challenged  – this is what Sterling calls second and third order learning.

 

Second order learning involves critically reflective learning. This is about examining the assumptions that underpin first order learning.

Third order learning is transformative learning and allows us to change perspectives and paradigms. It is creative, is a ‘shift in consciousness’, and involves a ‘deep awareness of alternative world views’ (Sterling 2001 p15).

 

Education in this sense is for humanity rather than just the transmission of knowledge, skills and values for the corporate, or employment, sphere. The Paraversity could be such a space in which this pedagogy operates. Thus, the process of education is as important, if not more important, than the end product. However, this is an issue for nurse education – to what degree is the product more important than the process? Do certain professional values, regulation and the needs for an NHS workforce outweigh the experience of a critical pedagogy? If so, are we constructing the student as passive object, who also self governs, rendering them unable to engage with countervailing voices against a one dimensional political hegemony in which the ‘market is king’?

We need to challenge pedagogical assumptions because, contrary to what many would have us believe, history has not ended, business can’t be ‘as usual’ and this is not ‘the best of all possible worlds’:

“The truth is that many things on which our future health and prosperity depend are in dire jeopardy….this is not the work of ignorant people. Rather it is largely the results of work by people with BAs, BScs, LLBs, MBAs and PhDs.” (Orr 2004 p.7)

The global financial crisis of 2007-8 was not caused by blue collar workers, nurses or teachers, but arose out of the activities of very clever people recruited from so called elite universities, many of whom studied economics mired in orthodoxy, rendering it unable to foresee the systemic risk building up within finance capital.

Jihadist social movements have gained ground in part to the ideologically based bumblings of Yale, Harvard and Oxbridge Educated elites, who with characteristic hubris and with appalling lack of insight, declared ‘mission accomplished’, and are now fretting about ‘radicalisation’ while doing little to address the socio-political causes of jihadist ideological narratives that drive young men and women into armed conflict.

Older people, their families, and those with mental health problems, in contemporary capitalist societies are experiencing crises in health and social care provision as successive governments have failed to put the interests of people before profits and capital accumulation.

With a few exceptions, for example Michael Burawoy’s (2004) notion of ‘public sociology’ or Paul Hawken’s notion of the ‘Blessed Unrest’, we have largely failed to produce enough countervailing voices, or a new vision of care that is fit for the 21st century. There is little in the way of critical guiding philosophies in operation for nursing beyond individualised biomedically dominated notions of ‘care and compassion’ in the context of instrumentally orientated curricula obsessed with competence – ‘doing rather than thinking’. This is not to deny the existence of critical voices in the literature, just to acknowledge the often ahistorical, apolitical and anti theoretical nature of what passes for scholarship in and for clinical practice.

This might seem irrelevant, idealistic, utopian and antithetical to professional nursing practice. Nonetheless, it is a notion that can be discussed within the paraversity as an element of dissensus.


 

What is the ‘paraversity’? (Rolfe 2013).

Gary Rolfe  suggest that the ‘paraversity’ runs alongside the visible University, going unnoticed or unseen. The paraversity is a ‘mental space’ of dissensus, seeking no unity of thought or acceptance of any grand narrative. As such, the Paraversity may well throw up an antithesis to this thesis. It is invisible, subversive and a virtual institution. It is not owned by corporate interests, it is not influenced directly by research bodies, funding streams or research programmes or corporate management strategies. The national student survey is irrelevant to its continuance. There will be no physically identified building or faculty – it exists in the form of a community of philosopher scholars exploring and deconstructing and reconstructing ideas.

In the paraversity there is no need to arrive at consensus or agreement or a system of unified thought. It does not exist to fulfil the corporate university’s aims and objectives, it is the ‘pursuit of difference’ to keep open debate and discussion and not to shut it down. It also operates to call the corporate university to intellectual account.

In this aim, it fosters countervailing voices to critique one dimensional thought and implicitly evokes the critical theory of Herbert Marcuse, Theodore Adorno and Louis Althusser, but is of course not merely the intellectual heir to such thought as if the matters regarding ontology, epistemology and philosophy were settled. This uncertainty of certainty could be potentially unsettling for nursing thought and practice which seeks certainty and truth in professional practice.

 

What are Universities for?

“In a world characterised by complexity and uncertainty, our long term survival lies…..in our willingness to bend the rules in unforeseen circumstances and even operate beyond our level of knowledge as we make our world view” (Paul Vare p2).

Vare acknowledges that the problems besetting the world require thinking differently, acting differently and challenging many long held assumptions. Academic disciplines which cannot evolve their thinking will produce graduates who will engage in ‘business as usual’ chasing fewer and fewer ‘plum’ jobs as they join the precariat (Standing 2011) as ‘graduates with no future’ (Mason 2012) .

 

The ‘University of Excellence’.

It might be argued that within the ‘Enlightenment’, the historic missions of Universities focused on ‘truth’ and ‘emancipation’. Docherty (2014) writes

“In 1946, the political theorist Hannah Arendt received a copy of The Idea of the University, which was written by her mentor, Karl Jaspers. Jaspers had revised the book, originally published in 1923, for the post-war context, when German universities needed to recover from explicit institutional and ideological conformism to Nazism. He advances a reconfiguration of academic freedom that, today, is everywhere threatened again, thanks to a failure of political will – and of leadership – that allows intellectual freedoms to be sacrificed to financial priorities. Writing to Jaspers on receipt of the book, Arendt firmly expressed the view that, given the cost of the higher education system, it must be state-funded. But it was vital that the professoriate should not thereby become tacitly politicised “civil servants”. Academic freedom meant that universities should be governed by intellectual demands, without improper political interference”.

Now, this narrative has been replaced with that of the neoliberal capitalist narrative of efficiency and profitability, i.e. the narrative of the market. Readings (1996) argued that the ‘pursuit of excellence’ within this narrative is a legitimising idea. However, ‘excellence’ refers more to administrative processes in which ‘excellence’ is a unit of measurement, devoid of qualitative content, which we now measure through such metrics as attrition, the number of firsts, impact factors, the number of research grants awarded and student perception questionnaires. An excellent nursing degree is one with low attrition, satisfied students, high employability and high numbers of firsts. Who would disagree with that?  Rolfe (2013) suggests this view of excellence is one of quantity rather than quality and brings us into the realms of ‘efficiency, profitability and administration’ (p9). He goes on to argue

“The vision and mission of the University has shifted from the production and dissemination of thought and ideas to the generation and sale of facts and data” (Rolfe 2013 p 81).

This suggests that the role of Universities now is often that of contributing to the local and national economy and to train graduates for the job market, and I would suggest that in many nursing departments that is the sole ‘raison d’etre’.

This instrumental orientation to nursing education (Goodman 2012) is evidenced by the dominance of competency based education, fit for practice, fit for purpose curricula, based on the NMC’s educational standards. The student nurse or graduate registrant who questions and critiques the ontological, political, ideological and epistemological assumptions upon which care is designed, delivered and evaluated would not be that welcome in clinical practice and perhaps only marginally tolerated in many nursing modules based on the transmission of facts and theories for clinical practice, grounded as many are in the assumptions of positivist and empiricist science. Nursing theory, let alone feminist or critical theory, may have disappeared from nurse education.  We may now be less able within nursing curricula to question the basis of social knowledge and care practices from critical perspectives that seeks to illuminate the subject positioning of women and the marginalisation of older people as unproductive burdens on society.

What is being lost is the notion of ‘intellectual craftmanship’ in favour of the search for empirical certainty, data and hard facts to guide practice. Indeed, evidence based practice education can be reduced to issues of methodology rather than issues of epistemology, philosophy and ontology. Perhaps many nurse scholars themselves have lost the ability to engage in this activity, and thus to be role models, buckling under the pressure to deliver clinical skills and other diverse teaching while also delivering empirically based research which provides facts and answers to practical questions. Many of course will have been schooled in the biomedical sciences and thus would not have had the critical epistemological enquiries and paradigms of social science. What we end up with is the pressure to produce ‘denotative’ writing – the telling and informing process through powerpoints and scientific reports as the dominant discourse of knowledge production and dissemination.  This is the ‘University of Excellence’.

 

What are academics for in the ‘University of Excellence’?

 

Brock (2014) asked “what is the function of the social movement academic’? However I would rephrase this and ask “what is one of the functions of the nurse academic? I would respond, as Brock does, with the suggestion that it is partly “to debunk the knowledge on which the powerful rest”.  One of those notions being peddled currently is that the NHS and society will not be able to afford care for older people,  that free at the point of delivery will no longer be possible, and that expensive external monitoring and inspections are worth the money spent on them. All the while corporates lobby behind the scenes for bits of the profitable NHS pie; see this list by Andrew Robertson on his site ‘social investigations’.

To engage in debunking requires ‘intellectual craftsmanship’ and is important for critical enquiry in the paraversity. What might that look like?

 

On Intellectual Craftsmanship  (C Wright Mills 1959).

 

In the appendix to ‘The Sociological Imagination’ Wright Mills outlined his view on ‘doing’ social science in which he suggested that ‘Scholarship’ is more important than empirical research for the social scientist. He considered that Empiricism was the ‘mere sorting out of facts and disagreements about facts’. Wright Mills’ critique of abstract empiricism contained in ‘The Sociological Imagination’ is that argument made manifest. Rules of method and arguments on methodological procedures and validity are just so much navel gazing which Wright Mills wished to avoid if he could possibly do so:

 

“Now I do not like to do empirical work if I can possibly avoid it” (p205) and “there is no more worth in empirical enquiry as such than in reading as such” (p 226).

 

The task of social science is thus to critically engage in the real world, joining personal experience and intellectual life through critical reflective reason as the

 

“advance guard in any field of learning” (p205).

He argued:

“It is the political task of the social scientist — as of any liberal educator — continually to translate personal troubles into public issues, and public issues into the terms of their human meaning for a variety of individuals. It is his task to display in his work — and, as an educator, in his life as well — this kind of sociological imagination. And it is his purpose to cultivate such habits of mind among the men and women who are publicly exposed to him. To secure these ends is to secure reason and individuality, and to make these the predominant values of a democratic society” (p187).

The personal trouble of obesity is a public issue not a personal moral failing of weak willed individuals. We must look to the role of fossil fuels instead of food, in providing energy; we must look at the marketing and distribution activities of the food industry; we must look to portrayals of the body in the media;  we must look to the structures od sedentary employment…..

Nurse educators might read this and think, actually, no it is not my political task at all!  Nurse students do not need to think about their personal lives and the lives of others as they relate to wider social and political issues…they need to be able to deliver care – to provide pain relief, comfort and explanations to vulnerable people, to interpret cardiac rhythms and administer medications, to assess wounds and decide upon management plans….that is the stuff of nursing and the rest of this is mere frippery. This is a view I have heard expressed by students as they cry “when are we going to learn proper nursing?”

In this they might be supported by the Corporate University which, in response to the demands of its customers, industry, commerce and the economy, has shifted the emphasis of the role of the academic from raising questions to providing answers, from problematizing to problem solving. Many nursing students want answers, not to raise questions. Thus empiricism and the tenets of positivistic science have been dragooned to support this mission. This is in opposition to many notions regarding personal and social transformation.

 

Michael Burawoy argued:

“The original passion for social justice, economic equality, human rights, sustainable environment, political freedom or simply a better world, that drew so many of us to sociology, is channeled into the pursuit of academic credentials. Progress becomes a battery of disciplinary techniques—standardized courses, validated reading lists, bureaucratic ranking intensive examinations, literature reviews, tailored dissertations, refereed publications, the all-mighty CV, the job search, the tenure file, and then policing one’s colleagues and successors to make sure we all march in step. Still, despite the normalizing pressures of careers, the originating moral impetus is rarely vanquished, the sociological spirit cannot be extinguished so easily”.

Can we replace sociology with nursing in this paragraph? Can we say our original passions have been channeled into pointless mindnumbing bureaucratically led education programmes that do nothing to challenge or change the context of care in which currently we are facing major issues in mental health and the care of older people with long term conditions?

Antonio Gramsci’s (1971) archetypal theory of the intellectual may also be illuminative and raises questions about what we are here for. Gramsci described two types of intellectual: the ‘traditional’ and the ‘organic’. The traditional is the academic who secures the status quo and the organic as the activist whose function it was to ‘construct a transformative historical bloc’, an alternative basis of consent for social order (Cresswell and Spandler 2012 p4). Although written many decades ago, this archetype may well be seen within the corporate university which supports and encourages the traditional and ignores the activist.

Nursing, and nurse academics, have a question to address. Are we engaged in the development of a practice based discipline interested only in the ‘sorting out of facts and the disagreements of facts?’ Are we traditional and/or organic academics? Is there room for both, either as separate individuals or as two roles within the same person? Justification for the ‘discovery of facts’ may be founded on its usefulness for policy and clinical practice and of course should be foundational knowledge for clinical nursing practice, after all we do not want the wrong drug to be administered because we have not sorted out the ‘facts’.

However, empirical research does not take place within a political vacuum and it would be a mistake to see the relationship of research to policy and practice as a simple linear relationship. The purist model of ‘research-policy relationships’ which takes for granted that research informs policy action by generating knowledge, or the problem solving model whereby research is driven by the need for a policy answer, do not adequately describe the process and is a far too narrow a focus for scholarship. It just does not address some of the fundamental questions underpinning human health and well-being which are as much to do with human agency and social structures within certain political economies, as to do with biomedical processes.

Research and policy then is a political activity. Wright Mills in arguing for craftsmanship in intellectual life implicitly acknowledges in the Sociological Imagination the need to go beyond simple empirical knowledge in forming policy action when he enjoins social scientists in a political and intellectual task to clarify the contemporary causes of “uneasiness and indifference to personal troubles and public issues” (p13). The social scientist is not to merely describe the contemporary elements of social life, but to engage in it.

The use of the word ‘craft’, undefined by Mills, appears here to differentiate the activity from that of (mere?) mastery of elaborate discussions of research method and ‘theory-in-general’, which would quickly make one “impatient and weary” (p195). A craft suggests development of skill by diligent constant practice, honing one’s technique by reference to finished products and products in the process of being to evaluate their flaws and strengths and then adjust accordingly. This is reflexive practice in that the work as it continues is being constantly worked and reworked as required. It suggests leaps of imagination and intuitive thinking and practice in the creation of a project. It calls for a departure from strict adherence to a rigid structure of routines, methods and frameworks. It also suggests a measure of artistry in thinking.

The scholarly craftsman is his work as his craft develops alongside who he is. Scholarly craftsmanship then is a state of being not only doing:

When Wright Mills argued that:

“admirable thinkers…do not split their work from their lives” (p195), he also argued

“Scholarship is a choice of how to live as well as a choice of career” (p196).

And:

“Scholarship is writing”.

To undertake this craft he asked students and social scientists to keep a journal to enable the development of the intellectual life, of the craftsmanship of social science. This should consist of ideas, personal notes, excerpts from books, bibliographical items and outlines of projects. He suggests that journals should record ‘fringe thoughts’, snatches of conversation and even dreams. This will also include the taking of copious notes from books and this needs developing into a habit.

Since Wright Mills outlined notes on journal keeping there has been the explosion onto the scene of information technologies, elearning and web 2.0. These are now new tools that were unavailable to Wright Mills. However the essential nature of scholarly activity should not be lost in any infatuation with new technologies, rather these gateway technologies could facilitate critical enquiry, journal keeping and the connection of a community of philosopher scholars engaged in dissensus and critique through a process of what Paolo Freire called dialogics.

To assist in this process, scholars need to write, and to write essays or blogs and not just research reports; to engage in discussion and not just to tell; write to invite commentary, to clarify one’s thoughts, to learn about oneself as well as to explore ideas and investigate one’s area of interest. Nursing is a socio-political activity and not just an applied set of techniques; and as such requires critique, understanding, discussion, reflexivity and transformation. The corporate university may not be interested in these ‘outcomes’, fixated as it may be on contracted commissioning targets, workforce development, league tables, SPQ results, attrition rates and ill defined notions of the ‘student experience’. The early career nursing academic will be faced by a host of external constraints on their intellectual development and their ‘success’ or performance development reviews may rest on targets and values not of their own making. What may be ignored by ‘impact metrics’ is any of their writing, which is createdover and above the research ‘write up’ focused on answering an empirical question according to a matrix of methodological imperatives. Graham Scambler (2014), as a now retired academic,  makes the point that he benefitted from the freedom to engage in intellectual activity unchained from the demand s of the Corporate University chasing its position in league tables:

“I was rarely during my career forced onto the back-foot, obliged to define achievement in terms of research revenue generated or publications in high-impact journals.”

And…

“I have encountered several ‘young’ sociologists whose expertise by far exceeds mine and who have played significant roles in facilitating as well as contributing to virtual networking and innovation but whose pioneering expertise in social media remain institutionally unrecognized and unrewarded” (my emphasis).

 

Karl Marx, C Wright Mills, Antonio Gramsci, Paulo Freire, Pierre Bourdieu, Michael Burawoy,  recognized that intellectuals can play a crucial role in ideological warfare against the dominant classes. The Paraversity may assist in this by creating

 

“havens of thinking into which thinkers can migrate and from which thoughts can proliferate and social change can reify” (Žižek 2008).

 


 

What might the Paraversity begin to look like?

 

The examples below are not definitive, it is up to the community of scholars to construct the Paraversity and if it is based on dissensus, it may look very different and take on a dynamic nature. If the idea is to create dialogue, to share ideas, to critique, to go beyond the physical confines of the Corporate University, the web 2.0 technologies might assist in this process.

 

1. Social Science and Nursing

2. Graham Scambler

4. Benny Goodman’s blog

5. Researchgate

6. Academia.edu

7. Facebook

8. Twitter

 

The links above will provide examples of critical thought and the sharing of ideas accessible by anyone anywhere and at anytime. They provide platforms for commentary and feedback, both synchronously and asynchronously. Their credibility may be built upon already established reputations and research outputs and/or by the clarity and force of the arguments. They will stand or fall by the readership wanting to engage and share and the commitment and enthusiasm by the creator.

 

Conclusion

 

Human health and wellbeing depend on many things. Critical education and challenging taken for granted assumptions are part of the foundations for human progress, if we still believe in progress. Universities may not provide the fertile soil for critical enquiry and discourse, but we do not have to wait for this to occur. We can right now live in the ruins of the University and engage in scholarship that is subversive, critical and potentially engaging and do so in the full knowledge that traditional rewards and recognition may not be forthcoming. That makes it risky. That also makes it fun.

References

Brock T (2014) What is the function of the Social Movement Academic? The Sociological Imagination. http://sociologicalimagination.org/archives/15545

 

Burawoy, M. (2004) Public Sociologies: Contradictions, Dilemmas and Possibilities. Social Forces, 82(4), 1603-1618.

 

Cresswell M. and Spandler H. (2012) The Engaged Academic: Academic Intellectuals and the Psychiatric Survivor Movement, Social Movement Studies DOI:10.1080/14742837.2012.696821.

 

Docherty T (2014) Austerity canard stymies funding debate. THES. July 7th  http://www.timeshighereducation.co.uk/story.aspx?storyCode=2014367

 

Goodman B (2013) What are nurse academics for? Intellectual craftsmanship in an age of instrumentalism. Nurse Education Today 33: 87-89

 

Gramsci, A. (1971) Selections from the Prison Notebooks. Lawrence and Wishart. London

 

Mason, P. 2012 The graduates of 2012 will survive only in the cracks of our economy. The ‘Graduate without a future’ series. http://www.guardian.co.uk/commentisfree/2012/jul/01/graduates-2012-survive-in-cracks-economy

 

Orr D. (2004) Earth in Mind. On Education, Environment, and the Human Prospect. Island Press, Washington.

 

Rolfe G (2013) The University in Dissent. Routledge. London

 

Readings B (1996) The University in Ruins. Harvard University Press. Cambridge. MA.

 

Scambler, G. (2014) A 100th Blog: A reflexive interlude.http://www.grahamscambler.com/a-100th-blog-a-reflexive-interlude/#respond

 

Standing, G. (2011) The Precariat: the new dangerous class. Bloomsbury. London

 

Sterling S (2001). Sustainable Education – Revisioning Learning and Change, Schumacher Briefings 6. Green Books, Dartington.

 

Vare P (2014) Sustainability Literacy: role or goal? (online) http://arts.brighton.ac.uk/__data/assets/pdf_file/0010/6202/Sustainability-Literacy-Blewitt-and-Vare.pdf in Stibbe A (2014) Handbook of Sustainability Literacy http://arts.brighton.ac.uk/stibbe-handbook-of-sustainability

 

Wright Mills C (1959) The Sociological Imagination. 40th Edition. Oxford University Press  Oxford.

 

Zizek S (2008) Violence. Profile. London.

 

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.

Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study

Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study

Young Nurse Tending to Young Woman with Neck Brace and Arm Cast

 

“Nurse staffing cuts to save money might adversely affect patient outcomes. An increased emphasis on bachelor’s education for nurses could reduce preventable hospital deaths”

This is not the only study to suggest this. Not only is the nurse to patient ratio an important factor in reducing patient mortality after surgery, their education they have is also a factor. Degree nurses have a positive impact on reducing mortality after surgery. This should finally nail the ‘you don’t need a degree to nurse’ nonsense. This is an argument that nurses have used when decrying poor standards of care.

 

Government, Society, Hospital Management and even nurses themselves need to realise their true worth as educated professionals. Care costs money, and if you scrimp on that and put pressure on staff, then you get worse mortality rates.

 

I often read comments by nurses that the problem with nursing today is education – ‘too posh to wash’ or ‘graduates lack compassion’ or ‘not enough clinical skills’ or a variant. This is nonsense and plays into the hands of those who want a cheaper workforce by increasing the care assistant to nurse ratio. If someone is too posh to wash or lacks clinical skills it is not because they are graduates. It is for other reasons, such as burn out, stress, lack of empathy or compassion per se. I’ve known many non graduate nurses who display lack of compassion, poor clinical skills and avoid washing patients. There was no ‘golden age’ of nursing when all you needed was ‘the right attitude’ and training by doctors.

Today, the evidence is stacking up – employ more RNs and get them educated!

Do you want to be nursed by someone who can take a blood pressure but can’t interpret it? No? Thought not. I once was told by a member of staff, after taking my blood pressure and being asked what it was, just a few hours after surgery,  “don’t ask me, I’m only a care assistant”.

On the same day that the Lancet study was published the Royal College of Nursing also published the result of a staff survey, now bearing mind the validity of self reported surveys, the findings do not sit well alongside the above study.

“Only 30 per cent of staff think there are enough staff to enable them to do their jobs properly and 82 per cent of nurses continue to work extra hours. 68 per cent of staff have attended work while not being well enough to perform their duties in the last three months alone.”

Another reading of that is the 70% of staff do think they have enough staff, but it is hard to spin the 82% reporting working extra hours. The issue regarding Mid Staffs reported in the media 26th February,  also highlighted the financial difficulties many Trusts are facing and following the Nicholson challenge, continue to do so. Although there are claims about the recruitment of more nurses into the NHS, the context is still one of pressure on the front line.

This directly affects nurse educators as we struggle to support mentors in practice to up the quality of students’ support and assessment. Our Placement Development Team colleagues who have the overview, can tell us both the hard data and soft metrics of the truth of clinical practice support – the areas where students can shine and feel supported and where they don’t.

We therefore still have a political battle to get results from studies such as this taken seriously by decision makers and key stakeholders. Evidence based policy on many health, social care, climate change, drugs and other issues is sadly lacking, instead we get policy driven evidence driven through by one of the most partisan, ideologically focused governments even since Thatcher. This Lancet paper will be of interest to us, but I wait without too much hope that Hunt et al will sit up and take any notice.

 Jane Salvage recently wrote “Nurse and scholar Jane Robinson and sociologist Phil Strong suggested (that nurses were invisible) in their study of the management of nursing following the introduction of general management. They suddenly realized, they said, that ‘despite the impressive statistics… nursing is relatively unimportant to government and to managers in comparison with medicine.’ They went on, ‘The tensions to which this situation gave rise – the nursing group locked into the gravitational force of its internal preoccupations, and the others, on the outside, unable or unwilling to look in and comprehend the nature of nursing’s dilemmas – seemed to us to be the social equivalent of an astronomical Black Hole’ (Robinson 1992)” .

1992. I don’t think much has changed.

 

The ‘sustainability literate’ nurse graduate – why do we need one?

“In a world characterised by complexity and uncertainty, our long term survival lies less in our ability to ‘apply the grammar’ (of sustainability literacy) and more in our willingness to bend the rules in unforeseen circumstances and even operate beyond our level of knowledge as we make our world view” (Paul Vare).

 

1. Vare’s point is that the world’s problems requires graduates to have not only an understanding and knowledge of key sustainability concepts but also to be able to act in an emancipatory fashion to engage in critical thought and action beyond merely understanding what sustainability may mean. If indeed ‘climate change is the biggest threat to public health in the 21st century’ (Costello et al 2009) then action is required.

 

2. We argue there is a ‘sustainability-climate change-health’ triad (Goodman and Richardson 2010) which makes it an imperative that we examine notions of sustainability and climate change in the curriculum (Goodman 2011).

 

3. Plymouth University itself recognises the issues, and has identified sustainability as a policy objective (a key performance indicator) at all levels of university life (campus, curriculum, culture and community).  

 

4. The NHS Sustainable Development Unit states on their website that it is working “to help the NHS fulfil its potential as a leading sustainable and low carbon healthcare service…by developing organisations, people, tools, policy and research which will enable the NHS to promote sustainable development and mitigate climate change”. Nursing staff in NHS organisations will be key people helping to achieve carbon reduction targets (NHS SDU 2009) and thus need to have the skills, knowledge and understanding to help their clinical settings achieve this.

 

5. The NMC standards for education (NMC 2010) explicitly outlines that nurses  should engage in promoting the health, not just of individuals, but also of communities and populations. Public Health is also core to the standards. We know that unsustainable lifestyles and practices lead to poorer health outcomes, and we also know that low carbon lifestyles are also healthy lifestyles, i.e. that there are health co-benefits to be had.

 

6. In ‘Securing the Future’ (DEFRA 2005) the UK government published a strategy for sustainable development and encouraged all education sectors to embrace SD. The HEA (2009) has taken this on, to support ESD in the HE sector across 17 subject centres. The HEA has a dedicated Education for Sustainable Development theme aiming to provide strategic leadership for ESD in the HE sector. HEFCE (2009) also support sustainability practices across the sector.

 

7. David Orr (1994) argues that current education practice is not the solution, it is the problem. That is to say graduates who lack an eco-perspective, or who are illiterate in sustainability matters, become part of the problem as they engage in ‘business as usual’ activities. A nurse who cannot make the links between clinical waste, resource use, carbon reduction and health inequalities will not be able to devise solutions because they are not asking the right questions.

 

8 Nurses are about health (in theory at least), understanding health requires understanding the social determinants of health, which includes the interdependence and interrelatedness of many factors including the physical and social environment. This is core to sustainability thinking.

 

9. There is increasing evidence that students themselves demand their universities encourage and develop sustainability across their programmes. Bone and Agonbar (2011) argue that first-year students believe universities should be responsible for actively incorporating and promoting sustainable development to prepare them for graduate employment.

 

10. The challenges to current and future global health (Rao 2009) that result from high carbon and unsustainable patterns of living require nothing short of mobilising healthcare professionals to not only understand but to act upon the various factors that result in disease and misery for billions on the planet. Not to do so is an abrogation of our ‘moral responsibility’ (Morrall 2009) as healthcare professionals to prevent suffering.

 

 

Finally,

 

As we reflect on the challenges to earth’s natural resources and the planetary boundaries that scientists are now beginning to reveal (Rockstrom et al 2009), we realise that we are running a huge experiment on a global scale. The time scale for evaluating the success or otherwise of this experiment, based on high carbon lifestyles of industrial and post-industrial capitalism, is some time in the future. However we are having measurable adverse effects now on both the planet’s climate and upon the ecosystem services that we all depend on. Nurses, as people, are part of the problem. We need to be part of the solution.

References

Bone, E, and Agonbar, J. (2011)  First-year student attitudes towards, and skills in sustainable development. HEA. York.

 

Costello, A. et al (2009) Managing the effects of Climate change. Available online at http://www.thelancet.com/climate-change

 

DEFRA (2005) Securing the Future. Delivering the UK sustainable development strategy. http://www.defra.gov.uk/publications/2011/03/25/securing-the-future-pb10589/

 

Goodman B., Richardson J. Climate Change, Sustainability and Health in United Kingdom Higher Education: The Challenges for Nursing In: Jones P., Selby D., Sterling S.(2010) Sustainability Education: Perspectives and Practice Across Higher Education. London, Earthscan.

 

Goodman, B. (2011) The need for a ‘sustainability curriculum’ in nurse education. Nurse Education Today. Nov  31 (8):733-7

 

HEFCE (2009) Sustainable Development in Higher education [online]

http://www.hefce.ac.uk/susdevresources/ accessed 24th may 2010.

 

Higher Education Academy (2009) HEA Sustainability Project http://www.heacademy.ac.uk/ourwork/learning/sustainability

 

Morrall, P. (2009) Sociology of Health. Routledge London.

 

National Health Service Sustainable Development Unit. (NHSSDU) (2009), Saving Carbon Improving Health. NHS Carbon Reduction Strategy for England. NHSSDU. Cambridge.

Nursing and Midwifery Council (2010) Standards for Pre-Registration nursing education. NMC. London.

Orr, D. (1994) Earth in Mind. On Education, Environment and The Human Prospect. Island press. Washington

 

Rao, M. (2009) Climate change is deadly: The Health Impacts of Climate Change. Chapter 2 in Griffiths, J. et al (2009) The Health Practitioners Guide to Climate change. Earthscan  London

 

Vare P. (no date) Sustainable Literacy: role or goal [online] http://arts.brighton.ac.uk/__data/assets/pdf_file/0010/6202/Sustainability-Literacy-Blewitt-and-Vare.pdf

 

“What are nurse academics for?”

 

“What are nurse academics for?”

Having pondered on the future of nursing education given various issues (see *), it occurs to me that we could do with some coordinated critical thinking and action in response.

The literature suggests that some (nurse) academics are very uneasy about the direction that education practice is taking (Thompson 2009, Walker, 2009, Morrall 2010, Shields et al 2011). Darbyshire (2011) suggests that many colleagues say they are too busy to research, publish, present or otherwise engage in scholarship, I have suggested similar (Goodman 2011). The main reason put forward (he writes) is that they see their job is primarily to teach and support students. However, I would add to that growing managerialism and bureaucracy of modern university life (and not just in the UK) allied to the overemphasis on reproducing ‘cognitive capitalism’ in which universities are becoming factory like, (Roggero 2011) turning out fodder for the ‘knowledge economy’ which undervalues critical thinking (Morrall, 2010).

*Issues:

Public concerns about poor quality care, NHS restructuring, funding cuts to humanities, challenges to public sector funding, global health issues linked to sustainability and the challenges of climate change, the commodification of education and its concomitant challenge to critical thinking, the triumph of neoliberal ideology in all areas of social, health and education policy, and an instrumental/vocationally oriented educational philosophy.

 

 

 

 

 

 

For nursing, our partners in the NHS are so stretched in many clinical areas that student support is at breaking point in terms of their educational development in practice. Clinical practice for too many resembles nothing more than old style apprenticeship experiences where intellect withers, let alone flowers, and the tension between getting the work done and education that Kath Melia identified in the 70’s is as strong as ever.  

In this context, Gary Rolfe (2010 p 703) recently noted:

“If the discipline of nursing is to survive and flourish as anything more than a provider of vocational training, it is imperative that we make connections and find our place in the wider community of academics and scholars in what remains of the modern University”.

Darbyshire (2011) goes further:

“nurse educators need to do what they should have been doing the moment nursing moved from the old ‘college of nursing’ world into the university sector and that is connecting with and embracing the world of scholarship that did, and hopefully still does, characterise university life”…..“As a nurse educator, you are not in the business of ‘giving lectures’, ‘marking papers’, ‘supporting students’. ‘facilitating tutorials’, ‘designing curricula’ or the like. You are in the transformation business” (Darbyshire 2011 p 723). I think this is deliberately provocative and needs to be read in its context. My personal feeling is that we are ‘in the business’ as described but without the transformation bit and struggling to juggle the competing demands placed upon us. However, I also think that some demands maybe self-inflicted, and result from acquiescence, tiredness and apathy which result from disempowerment flowing from treadmill like educational processes.

He then goes on to describe what transformation might mean. While I think his points have merit, there is just a tad too much emphasis on the utility of academic work as a criterion for assigning value, thus omitting the liberal humanistic approach to education which sees it as a ‘good in itself’.  That being said the challenge is then put:

“if you are not actively engaged in the research and scholarship of nursing education then be prepared to face the question, “what business do you have being part of a University?” (Darbyshire 2011 p 723).

Good question.

What to do?

I think there is a debate to be had here about the meaning and value and purpose of nursing education. I mean a real debate informed by philosophies, reason and evidence that informs and creates the cultural edifice in which we work. We need to examine the organisational culture which forms the scaffold for our educational values and priorities. There may be taken for granted assumptions which upon examination do not hold water. For example, that we have to account for every hour a student spends in theory and that this is achieved through attendance registers. Another assumption may be about research being too time consuming or too constrained by faculty priorities, there may be assumptions about scholarly activity v teaching or what ‘teaching’ actually means. We may consider whether (Nursing?) Theory informed education as well as research informed education itself may have disappeared from curricula replaced by narrowly defined epistemologies that close down evidence based practice into the confines of ‘empiricalitis’ and the tenets of positivistic science. There may be some bureaucratic processes that actually do not enhance the quality of the student experience at all (the standard module evaluation forms?) either because they do not have robust evaluation or because they are gathering the wrong data. This matters because every minute spent on administrative action is a minute not spent on intellectual sharing and development. The next generation of nurse educators needs mentoring, but they need the intellectual freedom to challenge orthodoxy which requires intellectual spaces or ‘liberated territories’ (Zizek 2008) which are havens of thinking into which all thinkers can migrate and from which thoughts can proliferate and social change can reify.

The reason not to discuss this will of course be time, the treadmill can’t be switched off, can it?

Benny Goodman

(refs available on demand)

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