Nurse Education Today 34 (2014) 1414–1416
Contents lists available at ScienceDirect
Nurse Education Today journal homepage: www.elsevier.com/nedt
Contemporary Issues
Does the Slow movement have anything to offer nursing education? Keywords: The Slow movement Nursing education Reflection Donald Schön
Introduction The ideas of the Slow movement continue to gain support among those weary of the apparent incessant need for speed endemic in the 21st century. Currently the demands of efficiency require, if not doing more with less, then at least doing more within existing resources. Nursing education has not escaped this efficiency requirement and nurse academics will be familiar with pressures that accompany demands to accomplish more with less. For good reason the pre-registration nursing curriculum remains under review, and revisions tend to add content to an already crowded curriculum. Without additional time then either something must be removed or something must be done faster. Given that things are rarely removed from the curriculum then it would seem that nursing education must speed up even if the educational value of faster learning and teaching remains dubious. The Slow movement offers an alternative. Perhaps somewhat misnamed, the Slow movement does not call for everything to slow down, rather Slow invites reflection on the effects on the human experience of doing everything faster. The Slow movement claims, that sometimes slowing down can afford significant improvements to the human experience; and may, perhaps somewhat counter-intuitively, result in increased efficiency. If nursing seeks an education rather than a technical training then perhaps nurse educationalists should apply some of the ideas of Slow to the work of educating nurses. Background Influenced by Schön’s (1983) critique of technical rationality, the idea of reflective practice has been adopted as necessary for nursing. Explicit in pre-registration nursing education, there can be few nursing schools that do not include reflection as a component of assessment. Against this backdrop the continued content additions to the curriculum betray a tendency towards the technical rational approaches against which Schön warned — witness a congested pre-registration curriculum which now forms part of the normative expectations of faculty and students. Nursing's regulatory bodies maintain this state by generating detailed and comprehensive lists of competencies required by nursing students before they can join the ranks of registered nurses (see, for example, College and Association of Registered Nurses of Alberta, 2013; Nursing and Midwifery Council, 2010). Nurse education institutions
http://dx.doi.org/10.1016/j.nedt.2014.08.008 0260-6917/© 2014 Elsevier Ltd. All rights reserved.
respond by producing complex matrices to demonstrate where each competency will appear and be tested. And each addition to the curriculum is subject to the same fate. Thus competency lists for nursing students get longer as content gets added to the nursing curriculum; rarely is content removed. In the UK, 3 years has been standard for pre-registration nursing programmes for more than 100 years during which it is fair to suggest that the content has changed out of all recognition. The additions of the 20th century alone require more theoretical and practical learning than required by probationers at the end of the 19th century. The early apprenticeship system required a singular devotion combined with physical stamina. Nowadays, despite the emphasis on reflective practice, the cumulative effect of more than one hundred years' worth of additions is a curriculum packed with theory from a variety of disciplines together with a demand for technical proficiency in skills that 19th century probationers would have considered medical, not nursing, tasks. If the programme duration is to remain unchanged, and if the same depth of learning is expected then, assuming nothing is removed from the curriculum with each new addition, students and faculty must do something (everything?) just a little bit faster. Insidiously then, nursing education has adopted a crowded curriculum that fosters a rushed learning and teaching experience. Thus a tension exists between on the one hand, reflection with its requirements for time and space for thinking and for deep learning — after all, reflection does not lend itself to being hurried and more reflection is not necessarily better reflection — and on the other, the pragmatics of making sure no programme content is left undisturbed. A tension felt most keenly by those educationalists who retain the ideals of an unhurried learning experience for students and by students forever rushing to meet assignment deadlines. The continuing existence of a crowded curriculum indicates a triumph of technical rationality over opportunities for reflection. In a speed obsessed environment the attraction of a technical rational approach is compelling even while it is recognised that much nursing work falls outside the realm of technical knowledge standardly applied. Nursing education may thus be caught in a trap of its own invention; a trap from which the Slow movement might offer some ideas for an escape. The Slow Movement Not a movement as such, Slow began in 1986 with Slow food when Carlo Petrini took exception to the positioning in the Piazza di Spagna in Rome of a well-known fast food outlet (Honoré, 2004). Ideas of Slow have since become associated, to a greater or lesser extent with many areas of human activity including but not limited to: art, architecture, education, fashion, science, parenting, and travel. Slow seems to be slowly capturing the imagination of those resisting fast for fast's sake and while Slow does not demand deceleration in all things, it does call
Contemporary Issues
for a recognition that everything need not be fast and that some things, especially things that reflect important human values, might indeed benefit from slowing down. Perhaps the thing that unites the various Slow movements is an underlying desire for a pace of life that enhances rather than diminishes human experience. For example, the pressure that many parents find themselves under to ensure their offspring don't lag behind in a competitive school system may result in exhausted family members as the children are ferried from one extra-curricular activity to another, just as parents juggle increasingly congested work schedules in order to get their children to music lessons, football practice, and extra-tutorial sessions. Slow would suggest that family life is impoverished by this focus on cramming, and would further suggest that family life is enhanced by, for example, allowing children to become bored or encouraging mealtimes around the kitchen table. Slow food relishes the idea of eating as social and encourages the idea of taking time to prepare food, adapting recipes to make use of locally grown and sourced ingredients, and savouring the results in the company of family and friends. While Slow food in particular is in danger of being seen as a luxury available only to the idle rich, it does nevertheless capture the spirit of environmental and social concern witnessed by the rise in popularity of, for example, farmer's markets and small cooperative food producing endeavours. Moreover, Slow encourages a step back from haste in all things, a re-appraisal of the obsession with quantity towards the appreciation of quality, and the development of wisdom sufficient to know when there is and when there is not a need for speed. There is nothing new about any of this for approaches of a similar type can be found in various forms but what Honoré (2004, 2013) does is to capture similarities in groundswell activities that reflect a growing objection to the idea that speed is always superior. Slow Nursing Education While Slow has made inroads into many human activities, its influence on education in general and on nursing education in particular remains muted. Time and space are acknowledged as important requirements for education just as are individual learning styles. Yet teaching practices in pre-registration nursing programmes, as elsewhere, are often constrained by things beyond the classroom and things beyond the needs of individual students: things such as institutional efficiency requirements, departmental teaching strategies, and the allocation of teaching loads. Educationalists are subject to the efficiency demands of their institutions where calls for ‘moving forward’ always seem to be accompanied by calls for more: more research; more grant applications; more publications; more students; more assessments; more marking; more audits; more monitoring; more appraisal; more surveillance; more reporting and so on. Time and space are at a premium, yet students are exhorted towards more; to read more, to think more, to reflect more, to learn more, to show more innovation, to reach higher academic levels of attainment and so on. To thrive in this environment, pre-registration nursing students must quickly to learn to extract and apply appropriate amounts of knowledge from a range of discrete subjects (physiology, sociology and so on) each with its own particular tradition of language use and standards for evidence. This alone makes the nursing curriculum demanding while assessments come thick and fast as students rush from one topic to another. For Barnett (2011) this state of affairs might be said to reflect a failure of nursing education to recognise that its basic premises remain rooted in an outmoded way of thinking about learning. In identifying three earlier epochs of learning each with its own distinct features, Barnett indicates a current need to recognise that we have entered a fourth epoch, what he calls the “learning-amid-contestation” epoch (Barnett, 2011, p. 7). Each epoch can be understood as a function of its time: so epoch 1 was concerned with the metaphysical; epoch 2 with the scientific revolution; epoch 3 with knowing how to function in a rapidly changing
1415
world; and now the emerging epoch 4 in which the role and possibilities of learning are uncertain. Vestiges of each remain of course, and it may be that nursing understood as a practical occupation should rightly remain in epoch 3 except that nursing isn't just a practical activity. Or rather it isn't just a practical activity in the sense of technical rationality. Rather nursing requires a reflective component of the type that Schön describes. On this account, nursing education can be identified as reactionary; attempting to retain the assumptions of an earlier epoch of learning that may be appropriate for the fast learning of some of the technical aspects of nursing but unsuited to the vast majority of learning required by nurses if they are to be the type of professional practitioner needed in the 21st century. And it is here that ideas of Slow may offer some respite from the relentlessness of pre-registration nursing education. There are numerous ways in which the ideas of Slow might impinge on the ‘forever faster’ mindset of existing nursing education. A Slow nursing education might be many things but assuming the basic tenets of Slow — that is, a move away from haste in all things — it would require asking just how much content and assessment a student should endure before they can be considered to be a threshold safe and effective beginning practitioner. Of course, this question has long exercised nursing's regulatory bodies and nurse educationalists even as both tend towards content and assessment creep. So perhaps the primary task for adopting elements of Slow in nursing education would be to find some way to resist the creeping tide of additional content and assessment; to find some way to free up time and space for students to flourish in an environment that capitalizes on individual student interest, motivation, and learning capacity; to learn, as Barnett puts is, in the epoch of learning-amid-contestation — and this requires reflection which in turn requires an environment in which time and space are made available for that purpose. Ideas of Slow are consistent with much that is known about learning. It is known that students learn in different ways and at different speeds. Many nursing educationalists understand and respond to the former by varying teaching methods and assignment strategies, but few acknowledge the latter beyond conforming to institutional and mandatory accommodation requirements for students with diagnosed learning needs. Indeed, regulatory body requirements militate against adjustments of learning times. In the UK, pre-registration nursing students must complete 4600 h of learning (2300 h of theory, 2300 h of practice); other jurisdictions have similar but different hour requirements. Leaving aside the question of ‘why 4600?’ a minimum hour requirement betrays a belief within nursing education that learning is and should be time limited; that the ability to learn and demonstrate competence x in time y equates with safe and effective post-registration practice while an inability renders students unsuited to nursing. Most programmes provide opportunities for students to recover by taking time out or by re-taking a module but such deviations single out students as nonstandard. A Slow nursing education would be inclusive by providing each student with the time they need to learn whatever it is that must be learned. One Slow idea might be to devise a programme that, with appropriate but loose boundaries, allows students choices in sequencing and duration. After all, there is no reason to expect that all students will learn the same amount of material or be ready to demonstrate competence in a particular thing within the same time period. Yet this is exactly what current curriculum design assumes. This averaging out of different learning styles and speeds does no favours for either ‘quick’ or ‘not so quick’ learners. Indeed the idea of the quick learner may be an illusion as most students will exhibit different learning speeds in different learning situations — which points to the desirability of individual learning plans. Radical as this might sound, it merely reflects that which faculty require of students: that is, the creation of individualized care plans for patients. The irony of requiring this from students vis-à-vis patients while dismissing it for faculty vis-à-vis students is likely to be lost on nurse educationalists and their respective institutions as well as on nursing's professional and regulatory bodies.
1416
Contemporary Issues
Conclusion Always rushing from one module/course or assignment to the next may not be in the best learning interests of individual students nor for nursing generally. A generation of nurses that only know the way of haste will surely struggle to distinguish between necessary speed and speed for speed's sake and this may have negative implications for patients and clients. Incorporating ideas from Slow might offer a way to think about how nurse education might respond to calls for more content that does not rely on faster learning and more assessment. Radical as the idea may seem, it is reasonable to suppose that the average pre-registration nursing student has a life outside of nursing and anything that recognizes and accommodates this is to be welcomed. Slowing down learning requirements so that students might better balance study with things other than nursing must surely be a precursor not only to improved student satisfaction but also to a more rounded educational experience. References Barnett, R., 2011. Learning about learning: a conundrum and a possible resolution. Lond. Rev. Educ. 9 (1), 5–13.
College and Association of Registered Nurses of Alberta, 2013. Entry to practice competencies for the nursing profession. http://nurses.ab.ca/Carna-Admin/Uploads/2013_ Entry_to_Practice_Competencies.pdf (Accessed 4th March, 2014). Honoré, C., 2004. In Praise of Slow: How a Worldwide Movement is Challenging the Cult of Speed. Vintage Canada, Toronto. Honoré, C., 2013. The Slow Fix: Solve Problems, Work Smarter and Live Better. Vintage Canada, Toronto. Nursing and Midwifery Council, 2010. Standards for pre-registration nursing education 2010. http://standards.nmc-uk.org/PreRegNursing/Pages/Introduction.aspx (Accessed 4th March 2014). Schön, D.A., 1983. The Reflective Practitioner: How Professionals Think in Action. Basic Books, New York.
Derek Sellman Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, Alberta T6G 1C9, Canada Tel.: +1 780 492 6481; fax: +1 780 492 2551. E-mail address: [email protected].
Contents lists available at ScienceDirect
Nurse Education Today journal homepage: www.elsevier.com/nedt
Contemporary Issues
Does the Slow movement have anything to offer nursing education? Keywords: The Slow movement Nursing education Reflection Donald Schön
Introduction The ideas of the Slow movement continue to gain support among those weary of the apparent incessant need for speed endemic in the 21st century. Currently the demands of efficiency require, if not doing more with less, then at least doing more within existing resources. Nursing education has not escaped this efficiency requirement and nurse academics will be familiar with pressures that accompany demands to accomplish more with less. For good reason the pre-registration nursing curriculum remains under review, and revisions tend to add content to an already crowded curriculum. Without additional time then either something must be removed or something must be done faster. Given that things are rarely removed from the curriculum then it would seem that nursing education must speed up even if the educational value of faster learning and teaching remains dubious. The Slow movement offers an alternative. Perhaps somewhat misnamed, the Slow movement does not call for everything to slow down, rather Slow invites reflection on the effects on the human experience of doing everything faster. The Slow movement claims, that sometimes slowing down can afford significant improvements to the human experience; and may, perhaps somewhat counter-intuitively, result in increased efficiency. If nursing seeks an education rather than a technical training then perhaps nurse educationalists should apply some of the ideas of Slow to the work of educating nurses. Background Influenced by Schön’s (1983) critique of technical rationality, the idea of reflective practice has been adopted as necessary for nursing. Explicit in pre-registration nursing education, there can be few nursing schools that do not include reflection as a component of assessment. Against this backdrop the continued content additions to the curriculum betray a tendency towards the technical rational approaches against which Schön warned — witness a congested pre-registration curriculum which now forms part of the normative expectations of faculty and students. Nursing's regulatory bodies maintain this state by generating detailed and comprehensive lists of competencies required by nursing students before they can join the ranks of registered nurses (see, for example, College and Association of Registered Nurses of Alberta, 2013; Nursing and Midwifery Council, 2010). Nurse education institutions
http://dx.doi.org/10.1016/j.nedt.2014.08.008 0260-6917/© 2014 Elsevier Ltd. All rights reserved.
respond by producing complex matrices to demonstrate where each competency will appear and be tested. And each addition to the curriculum is subject to the same fate. Thus competency lists for nursing students get longer as content gets added to the nursing curriculum; rarely is content removed. In the UK, 3 years has been standard for pre-registration nursing programmes for more than 100 years during which it is fair to suggest that the content has changed out of all recognition. The additions of the 20th century alone require more theoretical and practical learning than required by probationers at the end of the 19th century. The early apprenticeship system required a singular devotion combined with physical stamina. Nowadays, despite the emphasis on reflective practice, the cumulative effect of more than one hundred years' worth of additions is a curriculum packed with theory from a variety of disciplines together with a demand for technical proficiency in skills that 19th century probationers would have considered medical, not nursing, tasks. If the programme duration is to remain unchanged, and if the same depth of learning is expected then, assuming nothing is removed from the curriculum with each new addition, students and faculty must do something (everything?) just a little bit faster. Insidiously then, nursing education has adopted a crowded curriculum that fosters a rushed learning and teaching experience. Thus a tension exists between on the one hand, reflection with its requirements for time and space for thinking and for deep learning — after all, reflection does not lend itself to being hurried and more reflection is not necessarily better reflection — and on the other, the pragmatics of making sure no programme content is left undisturbed. A tension felt most keenly by those educationalists who retain the ideals of an unhurried learning experience for students and by students forever rushing to meet assignment deadlines. The continuing existence of a crowded curriculum indicates a triumph of technical rationality over opportunities for reflection. In a speed obsessed environment the attraction of a technical rational approach is compelling even while it is recognised that much nursing work falls outside the realm of technical knowledge standardly applied. Nursing education may thus be caught in a trap of its own invention; a trap from which the Slow movement might offer some ideas for an escape. The Slow Movement Not a movement as such, Slow began in 1986 with Slow food when Carlo Petrini took exception to the positioning in the Piazza di Spagna in Rome of a well-known fast food outlet (Honoré, 2004). Ideas of Slow have since become associated, to a greater or lesser extent with many areas of human activity including but not limited to: art, architecture, education, fashion, science, parenting, and travel. Slow seems to be slowly capturing the imagination of those resisting fast for fast's sake and while Slow does not demand deceleration in all things, it does call
Contemporary Issues
for a recognition that everything need not be fast and that some things, especially things that reflect important human values, might indeed benefit from slowing down. Perhaps the thing that unites the various Slow movements is an underlying desire for a pace of life that enhances rather than diminishes human experience. For example, the pressure that many parents find themselves under to ensure their offspring don't lag behind in a competitive school system may result in exhausted family members as the children are ferried from one extra-curricular activity to another, just as parents juggle increasingly congested work schedules in order to get their children to music lessons, football practice, and extra-tutorial sessions. Slow would suggest that family life is impoverished by this focus on cramming, and would further suggest that family life is enhanced by, for example, allowing children to become bored or encouraging mealtimes around the kitchen table. Slow food relishes the idea of eating as social and encourages the idea of taking time to prepare food, adapting recipes to make use of locally grown and sourced ingredients, and savouring the results in the company of family and friends. While Slow food in particular is in danger of being seen as a luxury available only to the idle rich, it does nevertheless capture the spirit of environmental and social concern witnessed by the rise in popularity of, for example, farmer's markets and small cooperative food producing endeavours. Moreover, Slow encourages a step back from haste in all things, a re-appraisal of the obsession with quantity towards the appreciation of quality, and the development of wisdom sufficient to know when there is and when there is not a need for speed. There is nothing new about any of this for approaches of a similar type can be found in various forms but what Honoré (2004, 2013) does is to capture similarities in groundswell activities that reflect a growing objection to the idea that speed is always superior. Slow Nursing Education While Slow has made inroads into many human activities, its influence on education in general and on nursing education in particular remains muted. Time and space are acknowledged as important requirements for education just as are individual learning styles. Yet teaching practices in pre-registration nursing programmes, as elsewhere, are often constrained by things beyond the classroom and things beyond the needs of individual students: things such as institutional efficiency requirements, departmental teaching strategies, and the allocation of teaching loads. Educationalists are subject to the efficiency demands of their institutions where calls for ‘moving forward’ always seem to be accompanied by calls for more: more research; more grant applications; more publications; more students; more assessments; more marking; more audits; more monitoring; more appraisal; more surveillance; more reporting and so on. Time and space are at a premium, yet students are exhorted towards more; to read more, to think more, to reflect more, to learn more, to show more innovation, to reach higher academic levels of attainment and so on. To thrive in this environment, pre-registration nursing students must quickly to learn to extract and apply appropriate amounts of knowledge from a range of discrete subjects (physiology, sociology and so on) each with its own particular tradition of language use and standards for evidence. This alone makes the nursing curriculum demanding while assessments come thick and fast as students rush from one topic to another. For Barnett (2011) this state of affairs might be said to reflect a failure of nursing education to recognise that its basic premises remain rooted in an outmoded way of thinking about learning. In identifying three earlier epochs of learning each with its own distinct features, Barnett indicates a current need to recognise that we have entered a fourth epoch, what he calls the “learning-amid-contestation” epoch (Barnett, 2011, p. 7). Each epoch can be understood as a function of its time: so epoch 1 was concerned with the metaphysical; epoch 2 with the scientific revolution; epoch 3 with knowing how to function in a rapidly changing
1415
world; and now the emerging epoch 4 in which the role and possibilities of learning are uncertain. Vestiges of each remain of course, and it may be that nursing understood as a practical occupation should rightly remain in epoch 3 except that nursing isn't just a practical activity. Or rather it isn't just a practical activity in the sense of technical rationality. Rather nursing requires a reflective component of the type that Schön describes. On this account, nursing education can be identified as reactionary; attempting to retain the assumptions of an earlier epoch of learning that may be appropriate for the fast learning of some of the technical aspects of nursing but unsuited to the vast majority of learning required by nurses if they are to be the type of professional practitioner needed in the 21st century. And it is here that ideas of Slow may offer some respite from the relentlessness of pre-registration nursing education. There are numerous ways in which the ideas of Slow might impinge on the ‘forever faster’ mindset of existing nursing education. A Slow nursing education might be many things but assuming the basic tenets of Slow — that is, a move away from haste in all things — it would require asking just how much content and assessment a student should endure before they can be considered to be a threshold safe and effective beginning practitioner. Of course, this question has long exercised nursing's regulatory bodies and nurse educationalists even as both tend towards content and assessment creep. So perhaps the primary task for adopting elements of Slow in nursing education would be to find some way to resist the creeping tide of additional content and assessment; to find some way to free up time and space for students to flourish in an environment that capitalizes on individual student interest, motivation, and learning capacity; to learn, as Barnett puts is, in the epoch of learning-amid-contestation — and this requires reflection which in turn requires an environment in which time and space are made available for that purpose. Ideas of Slow are consistent with much that is known about learning. It is known that students learn in different ways and at different speeds. Many nursing educationalists understand and respond to the former by varying teaching methods and assignment strategies, but few acknowledge the latter beyond conforming to institutional and mandatory accommodation requirements for students with diagnosed learning needs. Indeed, regulatory body requirements militate against adjustments of learning times. In the UK, pre-registration nursing students must complete 4600 h of learning (2300 h of theory, 2300 h of practice); other jurisdictions have similar but different hour requirements. Leaving aside the question of ‘why 4600?’ a minimum hour requirement betrays a belief within nursing education that learning is and should be time limited; that the ability to learn and demonstrate competence x in time y equates with safe and effective post-registration practice while an inability renders students unsuited to nursing. Most programmes provide opportunities for students to recover by taking time out or by re-taking a module but such deviations single out students as nonstandard. A Slow nursing education would be inclusive by providing each student with the time they need to learn whatever it is that must be learned. One Slow idea might be to devise a programme that, with appropriate but loose boundaries, allows students choices in sequencing and duration. After all, there is no reason to expect that all students will learn the same amount of material or be ready to demonstrate competence in a particular thing within the same time period. Yet this is exactly what current curriculum design assumes. This averaging out of different learning styles and speeds does no favours for either ‘quick’ or ‘not so quick’ learners. Indeed the idea of the quick learner may be an illusion as most students will exhibit different learning speeds in different learning situations — which points to the desirability of individual learning plans. Radical as this might sound, it merely reflects that which faculty require of students: that is, the creation of individualized care plans for patients. The irony of requiring this from students vis-à-vis patients while dismissing it for faculty vis-à-vis students is likely to be lost on nurse educationalists and their respective institutions as well as on nursing's professional and regulatory bodies.
1416
Contemporary Issues
Conclusion Always rushing from one module/course or assignment to the next may not be in the best learning interests of individual students nor for nursing generally. A generation of nurses that only know the way of haste will surely struggle to distinguish between necessary speed and speed for speed's sake and this may have negative implications for patients and clients. Incorporating ideas from Slow might offer a way to think about how nurse education might respond to calls for more content that does not rely on faster learning and more assessment. Radical as the idea may seem, it is reasonable to suppose that the average pre-registration nursing student has a life outside of nursing and anything that recognizes and accommodates this is to be welcomed. Slowing down learning requirements so that students might better balance study with things other than nursing must surely be a precursor not only to improved student satisfaction but also to a more rounded educational experience. References Barnett, R., 2011. Learning about learning: a conundrum and a possible resolution. Lond. Rev. Educ. 9 (1), 5–13.
College and Association of Registered Nurses of Alberta, 2013. Entry to practice competencies for the nursing profession. http://nurses.ab.ca/Carna-Admin/Uploads/2013_ Entry_to_Practice_Competencies.pdf (Accessed 4th March, 2014). Honoré, C., 2004. In Praise of Slow: How a Worldwide Movement is Challenging the Cult of Speed. Vintage Canada, Toronto. Honoré, C., 2013. The Slow Fix: Solve Problems, Work Smarter and Live Better. Vintage Canada, Toronto. Nursing and Midwifery Council, 2010. Standards for pre-registration nursing education 2010. http://standards.nmc-uk.org/PreRegNursing/Pages/Introduction.aspx (Accessed 4th March 2014). Schön, D.A., 1983. The Reflective Practitioner: How Professionals Think in Action. Basic Books, New York.
Derek Sellman Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, Alberta T6G 1C9, Canada Tel.: +1 780 492 6481; fax: +1 780 492 2551. E-mail address: [email protected].
