Nursing Education and Novice to Expert, Humanism & Caring Theory
Novice to Expert Theory In Nursing Education
As patient acuities continued to increase during the past several decades, it was becoming clear that new nurse graduates would require ongoing development and guidance throughout their early practice and beyond. Benner (1984) used the Dreyfuss model of skill acquisition, to explain the differences in proficiencies of nurses at various levels.
Benner described these levels as novice (more concrete level of knowledge; needs close supervision), advanced beginner (developing more working knowledge of practice, more use of judgment; needs overall supervision), competent (increasing working knowledge of practice, mostly able to use own judgment), proficient (growing depth of understanding of practice and of nursing, responsible for self and some others), and expert (authoritative knowledge of practice and discipline, responsible for self and others, creating new interpretations beyond standards).
Premise of Novice to Expert Theory In Nursing Education
The premise of this theory is that nursing expertise develops over time. Nurses pass through five stages as they fully develop their expertise as nurses. Student nurses begin as novices and may progress to advanced beginner stages, but it is the experience of real-world nursing practice that provides opportunities for progressive development of expertise.
Implications for Novice to Expert Theory In Nursing Education
Although the novice-to-expert model was developed with practicing nurses in mind, it is relevant to nursing students who progress in levels of knowledge and experience throughout their nursing program.
The educator must first understand what level of students they are working with, such as those in the first semester versus the final semester of the program as well as what learning and experiences they have previously had.
Ways to gather more information include reviewing the sequence of the curriculum and course descriptions, discussions with other nursing faculty who have taught previous courses, and querying the students. Throughout the learning process, the skills of student self-reflection on what is known, what needs to be learned, and how it can be learned should be fostered.
Continual assessment of student performance in didactic and clinical settings is necessary to make adjustments to teaching. These adjustments could involve reinforcing previous concepts, breaking down abstract concepts, or increasing the depth and scope of what is being learned and related assignments.
The novice to expert theory is used to guide the development of capstone experiences, internships as well as orientation programs, internships, and residency programs.
Humanism Theory In Nursing Education
Humanism, sometimes referred to as the human potential movement, became an important force during the 1970s as a strong reaction to the excessive use of behaviorism and focus on skills development. Humanistic psychologists are primarily concerned with motivating students for growth toward becoming self-actualized.
Individual behavior is described according to the person rather than the observer. Humanistic education has been defined as an educational practice in which the teaching–learning process emphasizes the value, worth, dignity, and integrity of all individuals. Two humanistic learning theories are relevant for nursing education: humanism and caring.
The humanistic approach supports and promotes the dignity of the individual, values students’ feelings, and promotes the development of a humanistic perspective toward others. Learning is defined as a process of developing one’s own potential with the goal of becoming a self-actualized person. Proponents of the humanistic movement in education include theorists such as Combs, Glasser, Kohlberg, Learn, Leininger, Maslow, and Rogers.
Premise of Humanism Theory In Nursing Education
Education motivates students to develop their human potential so that they can progress toward self-actualization.
Implications for Humanism Theory In Nursing Education
Educators adopting this approach use learning experiences that emphasize the affective aspects of development, promoting the students’ sense of responsibility, cooperation, and mutual respect. Honesty and caring are considered equally important as the learning goals that focus on the cognitive and psychomotor domains.
Humanistic education involves a climate in which there is recognition and valuing of individual freedom and worth. It may be used in academic courses, continuing education courses, staff development programs, and personal development seminars and courses.
Faculty create a learning environment that fosters and promotes self-development by establishing an informal and relaxed climate. This can be accomplished by taking a few minutes at the beginning of the first few classes to use “icebreaker” strategies that invite students to mingle and become familiar with each other and the teacher.
One way to help students learn the behaviors consistent with the humanistic movement is through modeling. Faculty can model the desired behaviors and attitudes that are integral components of humanistic education: being a caring, empathetic person and demonstrating genuineness while being consistently respectful of self and others.
Faculty’s recognition of themselves as a co-learner in educational transactions encourages more egalitarian student–teacher relationships. Faculty help students recognize and develop their own unique potential by facilitating their growth process.
This may be facilitated by praising students’ positive behaviors, asking students to draw on and share their own experiences, asking questions that enable students to contribute to discussions, and elaborating on students’ responses and questions. Students are responsible for their own learning; determine their own needs, goals, and objectives; and behavioral self-evaluations.
Students become actively engaged in the learning process, assume responsibility, are open to discussion, and are able to use reflection and introspection. In addition, students adopt the respectful and caring behaviors modeled by faculty.
Caring Theory In Nursing Education
The caring theory, as proposed by Watson (1989), integrates within a human science orientation concepts and principles drawn from the humanistic existentialist perspective and feminist philosophy, as well as from phenomenology. The primary concepts of the theory are:
• Practice of loving-kindness and equanimity
• Authentic presence: enabling deep belief of others (patient, colleague, family, etc.)
• Cultivation of one’s own spiritual practice toward wholeness of mind/body/spirit beyond ego
• “Being” the caring-healing environment
• Allowing miracles (openness to the unexpected and inexplicable life events
Premise of Caring Theory in Nursing Education
The main premise of this theory is caring for self and others based on a moral, ethical, philosophical foundation of love and values. Essential to the theory is the use of 10 curative factors which are vital in caring for another.
The 10 factors include promotion of transpersonal teaching learning; assisting with gratification of human needs; systematically using a scientific (creative) problem solving caring process; humanistic-altruistic values; promoting and accepting expressions of positive and negative feelings; instilling and enabling faith and hope; allowing for existential phenomenological spiritual dimensions; cultivation of sensitivity to one’s self and others; providing a supportive, protective, corrective mental, social and spiritual environment; and cultivating sensitivity to one’s self and others (Watson, 2007).
These factors move thinking from the more curative realm to one in which the caring of self and others in the moment is a treatment unto itself.
Implications for Caring Theory In Nursing Education
Watson’s theory of caring and the practices of caring have been used as a model for clinical practice and as a curriculum framework. The goal of the caring curriculum is to create an educational experience in nursing that is more in accordance with true education and consistent with the professional nursing philosophy and values that are an integral part of contemporary nursing practice, research, and education.
Bevis and Murray (1990) described the caring curriculum model as providing education for professional nursing that emphasizes analytical, problem-solving, and critical-thinking skills. Content and student learning experiences must be based on the science of human caring and grounded in and derived from the actual reality of lived experience as assured from phenomenology rather than merely the content that nurse educators have traditionally taught or the content as they believe it should be .
Although theory has traditionally been taught to inform practice, in the new models, theory and practice are viewed as informing each other. A restructured focus of learning is based on clinical practice and uses content as the substance to actively involve students in scholarly endeavors. Caring theory is also well described in practice.
Mitchell (2005) lays out the assumptions underlying caring theory as used to develop a model of clinical practice that considers patient and staff perspectives. It can also be used as a framework for nursing leadership (Britt Pipe, 2008). Incorporation of caring concepts in the curriculum can lay a solid foundation for how future practice is perceived and realized.
Faculty implementing a caring curriculum work to discover ways to eliminate adversarial relationships with students; faculty also strive to maintain open, honest, caring, and supportive relationships. It is within this context that faculty create a climate and structure that promotes the desired learning environment.
Faculty develop and model the spirit of inquiry that helps students to develop maturity in their learning and cognitive abilities. Students are guided as they examine information, concepts, and principles, and as they struggle with uncertainty (Bevis, 1989). The content selected is basic to what is needed in accordance with the program’s philosophy and desired graduate outcomes.
Faculty focus their efforts on helping students see beyond the information presented to discern the underlying assumptions. To provide students with an in-depth educational learning experience, faculty function in different roles and become experts in learning and in the subject matter.
Frequent use of instructional strategies that facilitate active learning, such as the use of questioning and dialogue, is important. Faculty-initiated dialogues with students focus on developing the attributes of intellectual curiosity, caring, caring roles, ethical ideals, and assertiveness.
Dialogues occur within the context of a spirit of inquiry and should stimulate and enhance faculty and student learning as meanings of the content are explored. Students assume responsibility for active learning and seek support and guidance from faculty.
It is important that students shift their conception of faculty as authority figures to that of colleagues in the learning enterprise because students are expected to function as active participants in the decision-making structure.
Changes in the faculty’s relationship with students promote an energized climate in which faculty become allies with students. Students’ active engagement in the teaching learning process allows more opportunities for faculty to observe increases in students’ self-esteem, self-confidence, and competence. Students experience an increase in their internal motivation and sense of responsibility.