Quality in practice: the role of education Peter Jarvis

It is argued in this paper that the role of the educator is important to quality performance in practice since learning in practice, and even learning to learn, are essential characteristics of good practice. A theory of action is presented which illustrates that certain forms of action are ones from which learning is not possible, but when the form of action is experiential or creative, then learning from it follows - as a result of both monitoring and reflecting. A model of learning from creative action is presented and discussed and educators are seen here as important resources to the practitioners’ learning process.

In a recent study of the workplace skills now necessary Society of Training to learn’

and Development,

was identified

basic skill required. listening,

‘learning

as the most important

12 others

were identified:

between

training

liberal

- regarding

form of education

adult

and training

is easy to have sympathy position

because

goal set-

learners

to use their learning

ting/motivation,

personal

and career

develop-

they

negotiation,

organizational

leadership

(Cheren

unnoticed

how each of these

intertwined,

how

skills,

effectiveness

1990, p 268). learning

teamwork,

reflects

13 basic skills are

ational

is

rather

actually

much

this is to

the centrality

Traditionally, education has been regarded as an end in itself (Dewey 1916, p 50) and, in a

important

sense,

this approach

approach

from training.

is typified

in the classical

debate between education and training. Perhaps one of the clearest expositions of this is by Paterson

(1979),

where he worked out a relation-

Peter Jarvis Dept of Education Studies, University of Surrey, Guildford, Surrey GU2 5XH. UK (Requests for offprints to PJ) Manuscript accepted 11 June 1991

reality The

sterile because

education

education

traditional

the

society.

that

separated

more

quite

conception

It

the rights

it is based

of

of the

in whatever

liberal

upon

way the

individualism

which, while very idealistic in many ways, hardly

It will not go

central to all of them and how different the

and

classical

it respects

However,

and learning.

for the classical liberal

problem

see fit.

and

as the highest as a very distant

cousin in the family of teaching

self-esteem,

interpersonal

education

the former

thinking,

skills,

communications,

ship

solving, creative ment

oral

and the basic

for work by the American

This

of contemporary traditional of, among

of the learner

and workplace paper roles

other

is now reasons.

and learning

to both

training.

seeks

to show

for

education

that

there

in practice

order to achieve quality performance, roles stem from

organis-

debate

an understanding

are in

but those of learning

rather than of a traditional understanding of teaching. However, even before learning can be understood

it is necessary

to understand

action

and the relation between practice and learning, so thal the first part of this paper introduces a tentative learning, perspective

theory of action and Its relation to although it does so from a different to that

adopted

1,~ Argyris

and

4

NURSE EDU(:A1‘ION

TODAY

Schon (1978). Part 2 expounds a theory of learning in practice from experience and this leads to an understanding of both practical knowledge and how individuals learn practical knowledge in everyday action is discussed in part 3. Part 4 examines ways in which education and educators might be involved in this process. Finally, there are a few brief concluding comments that also point the way to some practical implications contained within this argument.

PART 1 -TOWARDS A THEORY OF ACTION IN PRACTICE The distinction between action and practice might initially appear rather pedantic although it is made in order to show that practice involves a great deal more than action alone. Action, however, is one of the most observable phenomena in practice and, therefore, one which needs to be understood. Action is not a simple, single phenomenon but may occur in a number of different forms, all of which are related in some way to the process of habitualisation (Berger & Luckmann 1967, p 70-84). Berger and Luckmann (1967) made the point that: ‘In terms of the meanings bestowed by man [sic] upon his activity, habitualization makes it necessary for each situation to be defined anew, step by step. A large number of situations may be subsumed under its predefinitions (p 71). Clearly in describing this natural process, they are right and what they are suggesting is that as actions become more familiar there is less need to learn from them. Such a claim is certainly true and it has advantages and disadvantages, but the process of habitualisation goes through a number of stages as the following typology of action suggests, and each of them is related to learning in some way (Table 1). Underlying this table is the fundamental belief that action and learning are inextricably intertwined, but before learning is examined it is important to look at the different forms of action that might occur. Six action types are depicted in the above Table. Non-action is the situation in

Table 1 Tvnes of action and the learnina situation

Action type

Learning situation

Non-action Experimental/creative Repetitive Presumptive Ritualism Alienation

Potential learning situation Learning situation Potential learning situation Non-learning situation Non-learning situation Non-learning situation

which individuals do not know how to perform and so there is a potential learning situation in as much as if they are going to act in that situation they need to know how to do it. Experimental/ creative situations are those in which individuals try out what they think will work, often as a result of careful planning, and if it does, then they tend to repeat the action on future occasions; it is a situation in which actors have to reflect upon their action and evaluate it, whilst in repetitive action there is a tendency to reflect less and presume more. The final three forms of action are non-learning situations. The first is the situation in which actors take for granted the situation and perform almost unthinkingly, the second is when the presumption becomes merely going through the motions and the final one is where ritualistic action becomes oppressive and meaningless. Only when the end results of the action are other than expected will these latter forms of action produce potential learning situations. It is important to note this process of habitualisation since it is normal and is even regarded as one of the end-products of training. The point about this is that if actors do not have to think about the situation they can do it more quickly and more efficiently. Consequently, when there are bureaucratic, or other forms of procedure, it is easy for practitioners to move into action types that are essentially non-learning ones. In nursing, such actions are dangerous - but they might happen very easily. Taking an example from medicine, for instance, it is easy for general practitioners who, upon hearing the first symptoms described by a patient, begin to write out the prescription. The point is that they may have heard the same symptoms a dozen times previously in the preceding days - hence they act

training

Table 2 A typology

Learning

Reflective Learning

no learning

damental

Presumption Non-Consideration Rejection

Non-Learning

Non-Reflective

and when the skill is practised

workplace

of learning

other

mistake,

worker,

practice

Contemplation Reflective Skills Experimental Knowledge

aspect of learning

no myth about

a nurse.

to put

situation. practice

from living. Ever! body learns

life, although

they bring

their own biography their experience

which includes

response

process.

Learning

single

have

diagnosis. practise

in the description,

proven

important

It is, likewise,

easy

for

final

nurses

to

some aspects of their work in the same

manner

and

learning

fail to learn

in the workplace

1983) has become now

which

to their

and,

practice.

(Marsick

extent,

to ensure

But

1987; Schon

almost a common

to some

management

from

place idea

it is the

duty

that the practice

of

situ-

ation is one in which creative situations

occur, so

that

practice.

nurses

can learn

Nurse managers, skill to create

therefore,

from,

need to develop the

such potential

and to reverse action,

in, and

the trends

learning

situations

of habitualisation

so that they are able to encourage

colleagues

to learn

whole responsibility

in the workplace.

in their

But

the

is not that of the managers,

it is also the nurses’ own responsibility to learn

from

educator

might also be able to play an important

role. Before important

practice.

In both

to be able

instances,

that role is examined, to understand

however,

the learning

the it is

process a

little more thoroughly.

plex

set of

process.

learning

between and

confused

training training,

learning

unclear:

in

essential

discussion

of

diagram

of

in Kolb’s learning a basis for.Jarvis’

cycle.

research

processes,

elements,

experience.

and it is important learning

Now that experience

the classroom

or in practice-

ary experience ing situation.

-

situation

;my

that

the

potentially

this

practical

might occur in mighl be a learn-

Hence, it is suggested

occur in either classroom

learned

rather

of training

Consequently nursing

as a location

situations,

situations

to practise.

end-products

discussion,

here that any

or Learning can

or practice

non-learning

dangerous

to note

begins with

primary or second-

of these types of non-learning and

illustration

it contairls some of its

as pre-

for the purpose practice

for learning

in practice

are than

might

is itself’ and

the

be called

knowledge.

typical

situation action is expected to follow whilst in experiential learning action

precedes the actual learning process. However, there is a fundamental weakness about the conception of skill transfer assumed that the learning

a fuller

that in all of these instances,

regarded

the

the

to experi-

Whilst Kolb’s cycle is not a correct of the learning

of

and action is

previous

(Fig. 1).

knowledge very

responses

but a very over-simple

is contained

21

when he highlighted

learning

which actually formed

the desired

The relationship

ot

demonstrated

ence. (Table 2). Space does not permit that research

nor

and multi-

a piece

of the process

viously Illought.

PART 2 - UNDERSTANDING HUMAN LEARNING

In

(1987)

twelve different

learning

mv

but a complex

Jarvis

complexity

their previous in

is itself not a simple

phenomenon

research

to the situation

which is the sum total ot

and this is an element

might

into situ-

The point is there is

learning,

thing slightly different

or any

a skill

- it is like e\ery other

repetitively, presumptively or even ritualistically _ this is for the most part an understandable they may miss some-

in the

is a fun-

she is in an experimental/creative

ation - a learning

but in so doing

This

for when

is seeking

Pre-Conscious Skills Memorisation

from

occurs.

and that is that it is process lies in the

PART 3 - PRACTICAL KNOWLEDGE AND LEARNING FROM PRACTICE From the previous discussion that the ideal form of action

it might be seen that :I nul-se can

6

NURSE EDUCATION

TODAY

learning

Concrete Experience

from

other’s

mistakes

- and by imi-

tating and from previous knowledge ence. not

Having

\

Active Experimentation

F

Reflective Observa‘ion

\

/

/

‘One

becomes

sorbing

repetitive,

when

processes

actions there

accompanying

purpose

are three

thought

the action - planning,

argument,

cycle is introduced,

discussion learning

level of

and retrospecting/reflecting. of this

learning

is still a high

about the action. In fact, in experi-

mental/creative monitoring

of the

and the early stages of the

together in practice.

in

therefore,

a new

seeking to draw this

an

understanding

It is suggested

form of action contains

For the

of

that this ideal

four very simple stages

to break

This locates learning

into one specific form of

action - the experimental/creative, recognised

although

that it can also occur

stages of repetition. to presumptive

action,

where

of reflection

life.

Heller

to examine process.

to understand (1984,

everyday

to simulate is “hardest

to recognize out of their

to get at

what it is. So it heads

painstak-

come

from

Feigenbaum

SC

1984)

One becomes mental/creative

an expert

in practice by experi-

action and considerable

it. It is through

process described

the learning

thought in action

above. From this quotation,

that the quality

practitioner

always be able to articulate

it

may not

what good practice

and this is a critique

of the modern

lower

p

the factors that

It is here that it is

the studies of everyday 165-215),

behaviour.

She

for

instance,

of factors

that

suggests

that

/-/ Evaluate/Conclude

p’an Act/Monitor

actions are based on probability, which is ‘acting on sufficient ground’ (Heller 1984, p 169). The basis of this lies in what people have learned from others

heuristic it on the

at a time” ‘. (All citations

within the quote McCorduck

make them

- or anyone else - rarely have

one jewel

upon the action is

suggests that there are a number affect

must be mined

even more.

It is now necessary the planning

shown,

of that

the level of con-

and the likelihood

important

have

experts

or ‘heuristics’,

This practical,

as attempts

the self-awareness

involves,

Human

“a repertory

with book knowledge,

practitioners”.

because experts

about

absorb

in the early

of action is considerably

enter

rules”.

rules of thumb,

knowledge,

that is,

succeeding,

. . . getting the feel of

working

machine

experience,

It is easy to move from that

scious monitoring diminished

it is

the

by ab-

to go by the book and

gradually

is clear

(Fig. 2).

learning

thereby

ingly,

is for

of the type found

trials, “failing,

wasting time and effort

lies in the domain

whilst there

consciousness

but through

the problem,

expert in practice

p 20),

not simply

knowledge

repeated

combined

perform

(1988,

an expert

explicit

in textbooks,

cycle (Kolb 1984, p 72)

experimental/creative

Nyiri

and experi-

the process

writes:

through

Abstract Conceptualization

Fig 1 Kolbs learning

however,

straightforward.

instance,

f

planned,

previous experiences, from - not only good performers

watching but also

Fig 2 Learning

from experimental

action

practice of trying to quantify competence. support

for

partner Daloz

However, having

a mentor

in practice, (1986)

mentors

and articulate

every

or

as nursing

illustrates

mentor

is the quality mature

whom

learners

can imitate

the recipients

is clearly doing. good

are to the process of maturing,

for the

practitioner good

remembered

but

everyday

practitioners

they are also practitioners, (Jarvis 8c Gibson them,

and

another.

should be, the epitome Learning

are,

is, therefore, a

involving

so that

elements

- all of which might

aspects

which

of

concern

the

nurse

profession, or

because

not

who

their

peers

although

should they

be

are

not

regarded

members

Finally. the practitioners

own self-assessment.

Therefore.

in practice

further

as

but

involves

although

as

themselves their

recognition

a number

of

of pro-

this will not be developed

here. But it is now possiblr

some of the roles of the educator of helping

all

of a

know how good they are through

cedures,

different

be regarded

profession. should

clients

are

just

quality

a complex

number

should

or

safely by others.

process

in their

experts

term for

They

of good practice,

can be imitated

in practice

but

teacher-practitioners

1985) may be another

facilitators

their practice

are educators

But it must be

1958). But peers also know who are the

experts

Mentors

and their views

into account.

their

who can also guide and advise in the process of practice.

of it.

about being

that the quacks are individuals

satisfy

(Hughes

process,

something

of good practice

have to be taken can

from

practice,

to understand

Clearly, patients do know something

a learning

how important

Even if good practice is an unfolding it is important

it is also a very important

to improve

to elucidate

m the process

the quality of practice.

educator. Before

the

role

of

however,

discussed,

the

educator

another

can

problematic

be

ques-

tion has been implied here - the concept of good practice.

Contemporary

society

quantify

it and

number

of competences.

c,onceptual quantity

of all

fallacies

practice

However,

in this process:

to

into

there

a

are

quality and

is always a means to another this is no different.

what is ‘LO) and

the whole

is always

duce

01’ practice.

While

can never equal the whole it is possible

in this present

sion and competency be isolated sufficient

for

training,

conceptual

etc.

problems

outcome

ing - fi)r as long as the nursing

there

are

not to want to

It is perhaps

regard quality as a continuing constitutes

to sub-divi-

since specifics can

improvement,

it uncritically.

to see some

approach

better

to

oflearn-

practice situation

an experimental/creative

inhibited

presumptive, cannot

or stops because

the action

then the quality of per-

improve.

Safe

course, but that is only a starting process of unfolding good, and practice.

1983) that vocational practitioners

is over-simple. elsewhere

education

to be competent

to enter

but this is, in itself, no guarantee practice

once

the

career

(Jarvis

exists to prepare practice

for rhe level of

is embarked

upon.

However,

such a claim does not mean that nurse

educators

have no role in quality pertin-mance

they have a very important slightly

different

role is the purpose

-

role, but perhaps

one and exploration

a

of that

of this sectioll.

It is a

of unfolding - remove one layer and is there to be unfolded. Once learning is

hindered,

practitioners

it has been claimed

the

exists to pro-

perform-

ance, so the quality can keep on improving.

becomes

competent.

Indeed,

end and

However

simple claim that nurse education

advantages

f’ormance

Education in nursing

(e.g. if 10

than the sum of its parts, so that the sum

process another

PART 4 - THE ROLE OF THE NURSE EDUCATOR

concepts

the competences

accept

tried

are not comparable

is good, greater

to sub-divide

has

standards,

of

point in the even better,

Teaching

how to learn

Traditionally educators have been the providers of information and occasionally the demonstrators of skills, but now that role is undergoing some changes. Learning how to learn is the primary need,

basic skill that people in the workforce

a skill that nurses

need

when

they are

8

NURSE EDUCATION

TODAY

caring for patients in hospital or in the community. Hence, it is important for nurse educators to assist nurses to acquire this skill. But, it may be asked, is not learning a natural phenomenon? If so, why should educators be expected to teach others how to learn? These are good questions and require response at two levels. Firstly, there is now too much available knowledge to expect educators to teach courses on every single aspect of nursing, for if everbody were continually attending courses to update themselves there would not be sufficient nurses left to care for the patients. Secondly, while people do learn naturally their skills and awareness of learning can still be enhanced. It is at this point that nurse educators can play an important part, both during initial vocational education and thereafter in practice. There are a multitude of reasons non-learning occurs in the work situation and they have to be addressed and perhaps this can best be done through helping managers to understand the different types of action and how they might intervene to help their colleagues think about their actions and by running learning to learn seminars for all staff. In theses seminars, individuals can be given the opportunity to explore a variety of elements about the learning process, including: their confidence to learn, recognising when they need to learn, how they learn best, establishing short-term and medium-term learning goals, own learning, collecting managing their information, alternatives, being evaluating aware of teaching and learning provision and so on. Space forbids developing this further here but a variety of different seminars can be organised around these topics.

Learning log and learning contract Another way of helping nurses to learn whilst they are working, especially during the earlier part of their career, is to assist them with the skill of preparing and using a learning log. This is not a diary but an analytical record that is kept of learning and practice. Not all practice would be recorded since this would be too time-consuming but perhaps a short period or working with

specific patients. In the log the nurse might record case studies, what she has learned in a specific situation and any gaps in her knowledge of which she has become aware. Here she diagnoses her own learning needs - but this should not necessarily result in a self-directed learning exercise. It is something that the nurse could then work at with a nurse educator, a mentor or facilitator, a manager or peer. The next stage might be entering into a learning contract (Knowles 1986) in which the nurse discusses with her learning partner her learning needs, and the ways that she intends to respond to them. This should involve her specifying her own aims and objectives, the resources that are available to her and the time span during which she will try to meet her aims. She will then contract to report back to her learning partner at a given time, demonstrating not only what she has done but how she has achieved her aims, even to the extent of evaluating the process. Knowles advocates a written contract, although others prefer that the agreement should not be written down. However, even when the contract is not written, something might well be recorded in the learning log about the resouces etc. that will be utilised, perhaps including a description of the outcomes of the process. The advantage of having a learning partner (a tutor or a mentor) is that together they can discuss the resources that might be used and the partner can act as a stimulus to help the nurse carry out her learning.

Learning partnerships A similar form of work pairing might also be carried out between experienced nurses who or work on different either work together, wards, and who might occasionally be paired to work together, or even merely to observe each other practise, so that they can mentor each other in learning partnerships. Even the most experienced mentors and facilitators would benefit from this approach. Whatever the pairing, whether it be with a mentor or a peer, time should be made available for them to meet together, examine each other’s learning and discuss each other’s practice so that together they can diagnose their learning needs and enter into

KUKSE EI)U(:Al-loil

learning

contracts

pairing

with each other. This form of

to help each other learn has been prac-

tised in teaching,

that which occurs in a classroom

Training and nurse managers Training

might

learning

they might be short courses, department centre.

are important

ing good instead

practice,

of having

might

in them,

of audio

and

packs prepared

by nurse

experts,

locally

or

channels.

information

are prepared resource

about specialisms

for nurses

centre

might

to consult

leaflets and other information of

nursing.

courses there.

Information

and workshops They

and

networks

the efficiency

be offered librarians

and learning

be staffed

stand the learning

skilled assistance

centrr.

Students

centre,

educators

should who not

but also under-

nurse to

Training

extensively

in its in the

to nurse managers

think

continuing

available

a fully qualified

especially

who might

that the only form

professional

where nurses feel

who sets the climate

and experiment

can stifle improving

upon good practice.

Developing a learning organisation What

has been

Schon

described

role in helping a learning

1978).

education

and of is

here

has been

ations must change

organisation

(Brgyris

Hence,

of

and adapt to new situations,

individuals

that learning

must

those

be aware

learning,

them. at every

in learning.

In

who manage

the organisation

of the

for

need

change

action and learning.

facilities

nurse educator

and

change.

so on, that would learning

support, enable

but

Here again the

can play an important

staff to evaluate formances.

In this they

both in how to use the

that are at their disposal

process by providing conducive

in

must be facilitated

so that they create a climate conducive

to experimental learning

the learning

working

level by those who are experts addition,

8c

that organis-

but they can only do so through processes

the

a ward. or a hospital,

Here it is recognised

also in how to manage

first instance, acceptable

have

to any nurse using the

use might have to be offered others

eventually

centres

centre.

the

creative settings is also very

nurses to use freely as they wish. It important, thereafter, to develop a resource

appreciate

upon nurses’ learning

It is the manager

need help and support

use the learning

of nurse man-

both

situations

to all

climate that encourages

process

of the ward, and climates that are not conducive

to become

resource

be made

and also of creating

con-

above all, the

training

can

of concentrating

also be found

should be taught how to use the

but it should

qualified becomes

The

process well, so that they can

render

benefits

they

the learning

Perhaps,

and further

so that

educator’s

Libraries

by experienced

preparation

forthcoming

centre.

only know what is in the centre

out of learning

to

and the scope of what can

in a single

itself is also important.

addition, log, in the

and who

pamphlets,

might

and carrying

tracts and in understanding

to learning

can be high tech or low tech, but

computers improve

should

construction

important.

about any aspect

about

In

out in experimental,

might

them.

also contain

partnerships.

in the use of the learning

video

through

there

learning

facilita-

free to learn new things and to plan and try them

and other

purchased

In addition,

but

be data bases of people who can be contracted provide

for mentors,

who are also going to

there

of learning

educators

in

training

agers

in facilitat-

are like libraries

only books

also be collections

either

in a

resource

developments

tapes, there might also be collections

commercial

but

that occur

Learning

they

moun-

or college,

also be resources

resource

centres

factor in all of these

or other specific programmes

ted by the nursing there

work

are an important

types of approach;

also is important-

tors and also for nurses

Learning resources

workshops

under teacher

instruction.

and has been shown to be very

successful, although it does take time to develop an open and trusting relationship.

Resources

9

l‘OD.4Y

role in this

programmes

managers

and

to create

climates

and also to assist

the qualitv

of their own per-

10

NURSE EDUCATION

TODAY

CONCLUSION Traditionally, evaluated

the

educational

through

summative

evaluation:

conducted

input

two forms

during

the

continue

since

high standard. evaluation

More

emerged, important

for

that

1989)

is measured.

know

professional

tool in the evaluation new form of excellence for educators

upon

Obviously

to

evaluation,

has

of training

it is

whether

education

and, whilst there are conceptual

lems with impact

extent

it is an important

repertoire.

However,

is beginning

- they are now learning

facilities learn,

to which through

so

that

they

which their

is

prob-

are

specialists

providing

practitioners

practice

a

to emerge

and their work might now also be evaluated the

the

the idea of impact

managers

or continuing

effective

these

itself be of a

& Robinson

in which the effect

the organisation training

provision

recently,

itself

Naturally

it is important

(Robinson

and been

process

the educational

quality of the educational

been

has

former

and the latter at its conclusion. must

has

- formative

by the

might

continues

to

improve. The educator does, after all, have a significant role in practice and quality in education

should

result

in quality

in practice.

References Argyris C, Schon D A 1978 Organizational learning: a theory of action perspective. Addison-Wesley, Boston

Berger P A, Luckmann T 1974 The social construction of realitv. Allan lane, Penguin, London (Zheren M’IYYO Promoting ‘active learning in the workplace. In: Learningto learn across the lifespan. Smith K M et al (eds). Jossey Bass, San Francisco Daloz L A I986 Effective teaching and mentoring. Jossey Bass, San Francisco Dewey .J I9 I6 Democracy and education. Free Press, New York Fei!Xnbautn E A. McCorduck 1984 The fifth

&eration. Signet, New York Heller A 1984 Everyday life. Koutledge and Kegan Paul, London Huehes E C 1958 Men and their work. Free Press,

(iiencoe ,Jarvis P I983 Professional education. Groom Helm, London .Jarvis P 1987 Adult learning in the social context. Groom Helm, London ,Jarvis P, Gibson S J 19X.5The teacher practitioner in nursing, midwiiery and health visiting. Groom Helm,

London Knowles M S 1986 Using learning

contracts.

Jossey

Bass. San Francisco

Kolb D A 1984 Experiential learning. Prentice Hall, Englewood Cliffs Marsick V (ed) 1987 Learning in the Workplace. Groom Helm, London Nyiri J 1988 Tradition and practical knowledge. In: Practical knowledge. NyirisJ, Smith B (eds). Routledge, London Nyiri.1, Smith B (eds) Practical knowledge. Routledge, London Paterson K W K 1979 Values, education and the adult. Routledge and Kegan Paul, London Kobinson D G, Kobison J C I989 Training for impact. ,Jossey Bass, San Francisco Schon D A I983 The reHective practitioner. Basic Books, New York Smith K M et al 1990 Learning to learn across the lifespan. Jossey Bass, San Francisco