By Brenda Boussard, Anne Hirsch, Lindsay Leeder, Terri Clark, and Patricia Benner
Preliminary to a curriculum revision, the College of Nursing at Seattle University began a process of discerning who are we, what are our foundational values as an institution and a profession, and how do we believe nursing education should commence? A hallmark of the Jesuit tradition is certainly caring for the sick, poor, and marginalized. Understanding the Jesuit commitment to justice in the world was essential in defining our goals, values, and overarching vision.
Ignatian Pedagogy
To deepen our understanding of Ignatian Pedagogy, Jesuit colleagues provided a two-day retreat on the guiding principles. Much like professional nursing education, the retreat focused on the formation of persons actively engaged in the world; reflecting on and learning from experience, and a commitment to compassion, mercy, and justice. From this similarity, we identified “formation” as central to our philosophical perspective because it reflects the student’s own agency and sense of vocation. Margaret Mohrmann’s metaphor of dance captures the relational aspects of formation of nurses:
Moreover, it is generally the case that one is formed toward something, some telos, some ideal shape or condition. …A better metaphor [for being true to form] is dance: having and displaying integrity is more a matter of being able to move in ways that are consistent with the originating and developing themes of our lives. Teachers, guides, and practice make us better dancers because they help us listen more carefully and follow the music we hear more confidently. We learn which movements fit the rhythms and which do not. [in Carol Taylor and Roberto Dell-Oro, ed., (2006) Health and Human Flourishing, Religion, Medicine, and Moral Anthropology (Washington D.C.: Georgetown University Press): 90-102.]
We envision a relational, compassionate performance that is not bound by a rigid conformity to rules, but rather one that is attuned to the context of the partner (patient, family members, community, etc.) and the dance (nursing care, practice, and knowledge).
With an emphasis on professional formation, Jesuit education aspires to address the whole person and empower them to become leaders for a just and humane world; to become men and women for others. According to Peter-Hans Kolvenbach, S.J., it reaches beyond a basic and simplistic view of learning and knowledge acquisition or as simply an exchange of services for remuneration. It is not enough to merely be a receptacle for information and skill sets for a particular career; instead the intention is the full development of the person such that they are compelled to “action.” In essence, to act is to do justice in the world and to have compassion for those who are vulnerable and suffering—an understanding held by the nursing profession as an ethic of care and responsibility.
Teaching and learning within Ignatian tradition is an interrelated, three-part process or a way of being in the world that calls both student and educator to (a) be attentive(learning begins with paying attention to the experiences we encounter), (b) be reflective (new ideas and ways of thinking are created and discovered from being attentive when we examine, analyze, clarify, and understand the significance of the experiences), and (c) be loving (what one intends to do or act in the world once this new realization or knowledge has been acquired). Experiential learning that extends beyond the classroom setting, inclusive of those that arise from daily interactions is essential. Being acutely attentive and reflective, and subsequently translating to one’s actions, is precisely the quality we desire to foster in our students. Furthermore, these three key movements elegantly parallel the ways of being and thinking as a nurse who is engaged in caring practices, patient advocacy, and clinical reasoning and judgment.
Multiple Approaches to Thinking
Nursing practice requires the ability to pay attention to and understand the clinical encounter, draw upon past and present experiences, discern what is before you, and then act. This practice involves seven essential ways of nurse thinking that includesSituated Thinking, Clinical Reasoning, Critical Thinking, Creative Thinking and Clinical Imagination, Diagnostic Reasoning, Nursing Process, and Practice as a Context for Learning and Knowing [Patricia Benner, Journal of Medicine and Philosophy 36(2011): 342-353.]
Each of these helps students better understand the patient within the context of their particular circumstance. Moreover, it calls them to make deeper connections between theoretical knowledge and what is transpiring in real time; with the ultimate goal being ongoing improvement of practice, patient care, and outcomes.
Integrating Knowledge Acquisition, Use, and Reflective Self-Improving Practice
The desire and inclination to know and understand the world is a life manifestation, a pre-given way of being in the world. Our philosophy of nursing includes deep learning of essential content that uses Ignatian pedagogy and ways of being and multiple modes of thinking and theoretical perspectives. The aim is to integrate knowledge acquisition with situated thinking and action in clinical practice.
Faculty members selected concepts, such as leadership, that would be taught deeply, and then in subsequent courses where the concept would be revisited in a more complex context. The goal was to diminish redundancy. Rather than teaching about concepts incrementally or in a cursory or even beginning level, faculty chose to teach them deeply upon introduction within contexts of high use, and then re-contextualize the use of the concept in different clinical conditions and settings where understanding might be changed by new purposes and situations.
Teaching strategies that would integrate knowledge acquisition and use, while promoting immersion in the clinical use of theory and science were purposefully selected. For example, faculty were taught and supported in techniques of deep learning:
- how to use unfolding case study in the classroom,
- “flipping preparation and classroom interactive teaching,”
- Problem Oriented Guided Inquiry Learning (POGIL),
- the Ignatian strategies of openness, curiosity, and reflection on learning; high-fidelity simulation
- Interactive and Improvisational “Standardized” Patients. . . and more.
Nursing Standards and Core Values
In addition to the integration of Ignatian Pedagogy, the Essentials of Baccalaureate Education for Professional Nursing Practice7 and The Essentials of Master’s Education in Nursing were used as guides for the formulation of the philosophy on nursing education and subsequent development of the undergraduate and graduate curricula. Faculty members endorsed the values delineated in the essentials document (altruism, autonomy, human dignity, integrity, and social justice). The commitment to integrate our Ignatian roots and pedagogical principles with the values of professional nurses described by the AACN was established throughout this process.
Conclusion
Faculty members embraced the challenge of rethinking and articulating beliefs about nursing education, practice, and research. Core values that had previously been implicit were made explicit. The process ultimately resulted in a philosophy document that integrated central notions of good nursing practice and the Ignatian tradition. The philosophy draws on the many parallels between nursing education and Jesuit values, while providing opportunity for curiosity and exploration where principles diverge. The unique blend of institutional and professional nursing identity has allowed us to co-create a curriculum that embraces diverse ways of thinking, knowing, and learning; and cultivates a spirit of attentiveness, curiosity, inquiry, and compassion that compels students to understand and act respectfully and lovingly to the world and others.
The philosophy summary statement of the College of Nursing may be found athttp://www.seattleu.edu/nursing/about/philosophy/. Complete references to this article are available from the authors.
Authors: from the Seattle University College of Nursing: Brenda Broussard,broussab@seattleu.edu; Anne Hirsch, hirscha@seattleu.edu; Lindsay Leeder,leeder@seattleu.edu; Terri Clark, clarkt@seattleu.edu; and from the University of California San Francisco: Patricia Benner, Patricia.benner@ucsf.edu