An Innovative Method for Teaching the Family Systems Approach: Key Strategies That Foster Competence Development

Purpose: Systems thinking is invoked across a broad range of disciplines where complexity needs to be taken into account to better understand various phenomena such as health and the many factors involved. Frenk et al. (2010) argued that transforming the education, e.g., new instructional and institutional strategies, is required to strengthen the health systems worldwide, which are struggling to keep up with the rising costs and challenges of new environmental and behavioural risks associated with ill health and chronic diseases. They asserted that professional education has not kept pace with these challenges, in part because of fragmented and static curricula that produce ill-equipped graduates. According to King and Frick (1999), systems thinking is central to transforming education. They also pointed out that systems thinking is a difficult skill to acquire and is not commonly taught. Researchers at the Council for Aid to Education (2015) estimated that 40% of college seniors in the U.S. lack complex reasoning skills. In the health sciences, systemic practice such as family systems nursing and family systemic therapy relies on systems thinking, focusing on families as the unit/system of intervention. Training in this area can be challenging (MacKay & Brown, 2014) and research is lacking to identify effective educational strategies. To address this gap, we set out to develop and assess an innovative method for teaching the family systems approach (FSA) to undergraduate students enrolled in a nursing curriculum. The purpose of the present work was twofold: to develop a teaching method tailored to FSA and to document the experience of participants with a view to better understand the conditions that promote effective teaching and learning.

Methods: Development of the teaching method and course material took place in an educational setting involving a university and teaching hospital. It was guided by the following approaches: systems thinking, social constructivism, narrative enquiry (Connelly & Clandinin, 2006) and the reflective approach (Schön, 1983). The Calgary Family Intervention Model (Wright & Leahey, 2013) was also used. An action research, based on the narrative method, was conducted to document the experience of participants: educator, fourth-year undergraduate students and families with a member experiencing a chronic illness (one family per student). Four cohorts of students participated in this part of the study. Narratives, reflexive analyses and the systemic-constructivist approach were used to provide detailed accounts of participants’ experience in teaching and learning FSA. Qualitative data were analyzed using thematic analysis which entailed the construction of dialogic narratives for each category of meetings/consultations conducted: student with educator, student with family, and educator’s self-dialogues.

Results: The teaching method consists of distinct complementary activities that take place over the course of one semester (four months). These include some in-class sessions, laboratory sessions using the theatrical approach, five one-to-one meetings between the individual students and the educator, and three meetings between individual students and the family at its home. They are highly interactive and reflective by design. Reflective journaling is used by students and their instructor throughout the semester. Journaling is used by students to prepare their meetings with the educator and then the family. It should be noted that students were first introduced to FSA in their third year at university. Participants’ experience revealed that learning proceeded along four main paths, related to teaching and learning strategies as well as caregiving strategies and involving, respectively, narration, self-dialogue, discordance and co-creation. The results also show evidence of transformational learning for all the parties involved.

Conclusion: The teaching method developed showed promising results for the teaching and learning of FSA and contributes to the training of reflective practitioners in family nursing care. Additional studies could be conducted to assess whether it could be an effective model for teaching FSA at the graduate level and in curricula other than nursing.