Don't Take Away My Spark : A Humane Approach in Nursing Education

Purpose:

Given the intense demands of the 21^st century, how can nursing educators construct a nursing curriculum that seeks to prepare competent, humanistic and globally educated professional nurses? The typical nursing student enters the nursing program overflowing with aspirations to become a nurse because of an enormous desire to care for others. However, is nursing education sustaining the student nurse’s initial spark of inspiration throughout the curriculum?

The negative impact of a joyless nurse who has lost the spark to care or who has not assimilated the ability to meet the emotional needs of a suffering patient is unconscionable.  What educational approach might be effective in sustaining engagement in the different ways of thinking that contribute to a deeper understanding of the human condition as well as supporting identity formation and the affective development of the nursing student?

Students were invited to participate in a qualitative, research study to assess the impact of a course experience titled Body, Mind and Spirit: the Humanities in Nursing grounded in the phenomenological approach of Paul Colaizzi (1978).  This course provided an opportunity to engage students in an examination of the complex human responses to health and illness conditions through writing, reflection and discussion of humanities learning modalities. Students engaged in an analysis of how human issues such as resilience,  suffering, and human flourishing, which are encountered by nurses in their professional lives, are explored and expressed in art, history, literature, music, philosophy, and religion across the full range of cultural perspectives.  Critical thinking, creativity and empathetic skill development were emphasized. The purpose of the research study was to analyze the meaning of this course experience for 31 associate degree nursing student to consider possible curricular revisions based on the findings.

Despite the tremendous contribution of scientific methodologies and evidence based practice to professional nursing, the human aspects that are so central to the quality of nursing care can be diminished (Lazenby, 2011).  The consequences of this change in professional nursing include the diminishment of the creative, subtle, and qualitative aspects of nursing care (Wilby, 2011). The scholarship of Human Caring Science of Jean Watson has had an influential impact on the nursing profession.  Watson (2012) urged nursing educators to reorient the curriculum back to its original essence; this involves what it means to truly care for another human being. Although essential, the sole focus of rigid operations, objectivism and relentless need for verification of data involved in patient care is inadequate in today’s health care world. Watson pointed out what is missing;  nursing educators must facilitate the development of nursing students in forming human caring-healing relationships with persons and patients to better serve humanity and global civilization. This facilitates multiple ways of thinking and knowing. Valiga (2012) asserted that nursing educators need to move away from developing only the intellect of the student where quantitative measures are the only measures of assessment. Affective learning and qualitative assessment are also “important as is an emphasis on the many ways to look at a situation” (p. 425) which supports multiple ways of understanding.

Over the past decades, nursing, medicine and humanities scholars and literature have supported the use of humanities learning modalities as an approach to engage students in a deeper understanding of the human condition (Bleakley & Marshall, 2013, Ford & Kerr, 2014, Ozcan, Bilgin, Eracar, 2011, Peirce, 2010.  Having the capacity to comprehend the significance of a person’s suffering and achievements is essential for all persons especially health professionals (Nussbaum, 1997).  Emphasis on the humanities enables nurses “to think critically, to transcend local loyalties in approaching global health problems as world citizens” (Lazenby, 2012, p. E10). According to Fong (2014), the higher education experience should seek to cultivate the individual identity or soul of the student rather than only educating the mind of the students. “The wisdom of the soul is knowledge of the world filtered through the median of the heart” (p. 30). Learning activities that arouse a sense of human connection have the capacity to rouse the soul and create a powerful learning experience for students.

 Since the humanities cause students to draw upon their experience and identities as human beings within a historical, social, and cultural context, they are capable of promoting a synthesis within the intellect promoting “big picture” thinking essential for 21^st century nursing graduates.  Appreciation of spiritual perspectives have the capacity to enrich the development of students as culturally competent respectful caregivers. (Kersey- Matusiak, 2013). According to Clouser (1990),  “literature is the laboratory of the person….we see the importance of fashioning from our own givens a certain kind of self that can survive” ( p. 298). An enlightened self is essential for enduring the demands of the role of the health professional.  Therefore, it is evident that the integration of the humanities can facilitate the education of humanistic nurses.

Methods:

As previously described, students were invited to participate in the research study to assess the impact of the course experience, Body, Mind and Spirit: the Humanities in Nursing. The researchers were motivated to conduct the study due to previous anecdotal student comments regarding course value for the students. During the first day of class, prior to distributing the syllabus, students were invited to voluntarily participate in the study. An informed consent statement was included that invited students to anonymously respond to an open –ended question pre- course survey. Thirty- one surveys were completed.  The survey questions focused on asking the student’s motivation for taking the course, understanding of a humanities learning modality and its’ potential value in becoming a better thinker and developing the empathy and creativity of the nurse.

On the last day of the course, the students were invited to anonymously respond to the same open ended questions post - course survey. Twenty-nine surveys were completed.  In addition, focus group discussions were held 5 months after the course was completed to assess a longer term impact of the course.

Results:

Data analysis involved extracting significant statements from the anonymous student surveys and focus group discussions to identify the major themes. Some of the major themes from the pre-survey aggregate data were practical motivation to take the course (“I needed an extra course”), unsure of the meaning of a humanities learning activity, and superficial or unclear awareness of value.  Post survey aggregate data of the course articulated an understanding of a humanities activity, new awakened personal identity as a person and nurse, overall satisfaction of a more in depth, non-judgmental understanding of a patient experience (“looking at a patient through a 3 dimensional lens”). Major themes from the focus group discussions included an appreciation of revisiting why one became a nurse, that nursing care should not be task driven but involve creativity, the need to incorporate empathy in the curriculum.  In addition, some students described the classroom environment as “therapeutic”.

The limitations of the study involve the small sample size, the participants providing socially desirable responses as well as the self-reporting nature of the study surveys.  In addition, the focus group discussions were held only 5 months after the course completion so a more longer term impact could be more meaningful in assessing a larger impact.

Conclusion:

The research findings suggest that the course experience impacted the students in augmenting an understanding of the human condition through the lens of the humanities modalities.  Students responded to the humanities activities in the course with expanded views of human responses to life events from a holistic perspective.  Furthermore, the students appreciated focusing on the emotional aspects of care; the course reawakened the inspiration to care in a way that supports nursing identity formation. Moreover, the findings affirmed that the intentional, explicit integration of the humanities in nursing education has the potential to enhance holistic critical thinking, empathy and creativity in the nursing student.

Implications for nursing education involve a reexamination of curriculum, to intentional infuse learning from the humanities as one curricular approach to facilitate the affective development and identity formation of the student nurse. Unanticipated findings revealed the irony that is perceived by some participants as they progressed through the nursing program.  Their initial desire to become a nurse had become thwarted due to the stress of nursing task completion and the need to obtain certain test scores within the nursing program.  Thus, safe havens, free from multiple choice testing where there is only one right answer, are suggested. The opportunity for students to think and reflect in multiple expressive ways on the unscripted scenarios of the human condition is a successful approach to the development of a holistic nursing perspective.  Clinical rotation debriefing must involve guided reflection and discussion on the caring aspects of nursing rather than occur as a consequence of a random opportunity.  In addition to assimilating the requisite cognitive and psychomotor competencies, the student’s spark of desire must be kept alive in every level of nursing education through insightful nursing educators who employ a humane approach to nursing education. Cultivating this holistic perspective in nursing students is key to educating competent, humanistic and globally professional nurses.