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Kenneth R. Conklin, "Foundations of Education for Students and Teachers of Nursing," JOURNAL OF NURSING EDUCATION, XIII, 3 (August, 1974), pp. 16-22.
By Kenneth R. Conklin
Not long ago, when I was on the faculty of Emory University in Atlanta, I taught two classes of nursing students in a master's degree program there. That may sound like an uninteresting, routine event -- except that I have never been a nurse, have no interest in becoming one, and know very little about nursing theory or practice. My Ph.D. is in philosophy of education, and most of my teaching is of students who plan to become teachers, school administrators, educational researchers, or generally well-informed citizens. It came as quite a surprise when I was asked to devote full time one term to teaching a philosophy of education course to nursing students. The idea was so unusual and the prospect of spending full time with a group of attractive nurses so enticing that I hastened to accept the challenge.
The first questions I had to ponder were, "Why should nurses study philosophy of education?" and "What should I teach them?" To help answer these questions I talked with some professors of nursing at several institutions, did some reading to find out what topics were of current interest in nursing theory, and did a lot of thinking. Now, based on my experience in teaching these classes and a lot of additional thinking, I have reached a startling conclusion.
Every teacher and student of nursing in a baccalaureate, master's, or doctoral program should devote some study to the foundations of education. Some of the content to be studied would depend upon the student's nursing specialty, but there is also some content that would be useful regardless of specialty. In the remainder of this paper I shall try to explain this recommendation. Since the recommendation is unsupported by empirical research or statistics, I shall henceforth write in a more professorial
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style, using third person, in order to lend an aura of authoritativeness to these pronouncements.
Some nurses specialize in teaching patients how to operate equipment,
ranging in complexity from hypodermic needles to dialysis machines. Obviously these nurses should study various techniques of instruction,
methods of evaluating learning, and psychological aspects of the teacher-pupil relationship. Some nurses specialize in teaching groups of people how to stay healthy -- they work in schools, factories, and community health centers, often conducting classes on diet, personal hygiene, family relationships, etc. Such nurses need to study not only the process of instruction but also the institutional aspects of education. From sociology of education and educational administration courses they might learn how to be more effective in community health centers, and from educational psychology they might learn how to teach concepts, attitudes, or procedures to children, adolescents, and geriatric patients.
As the number of baccalaureate and graduate programs grows, there will be increasing demand for some nurses to specialize in the teaching of nursing as full-time faculty members in college or university schools of nursing. Being a professional nurse is one thing, but being a professional teacher is something else. Regardless of the subject matter to be taught, educational research has things to say about how to operate a good school and how to be an effective teacher. Nurses who plan to specialize in the teaching of nursing will be more like educators than nurses, and they need large doses of study of educational problems and procedures as well as supervised practice in teaching and administrating.
Professors of education will be the first to acknowledge that the fact that
someone has had a lot of education courses does not ensure he is a good
teacher and that there are some good teachers who have never had an education course. The same is true in nursing: There are bad nurses who
went through good programs and good ones who never studied nursing. But both in education and nursing, most practitioners can be helped by studying theory and by engaging in supervised practice. Furthermore, as education and nursing become more truly professional, the practitioners must understand and make use of a rapidly growing body of both scientific research and scholarly thinking.
Any hack can teach, just as any hack can clean up a patient's mess or sponge the sweat from a doctor's brow. But the professional educator's concerns go far beyond mere school keeping, just as the professional nurse's concerns go far beyond mere body keeping. What a shame it would be if nursing students were taught by professional nurses who were hacks as teachers of nursing! Since nurses with baccalaureate or higher degrees are likely to do some teaching of nurses who have less preparation, and since some of these people will become full-time teachers of nursing, it is obvious that their curriculum should include some study of education. The following areas might be helpful: philosophy of education (the nature and purposes of
education); curriculum theory (what factors to consider in choosing course
content and sequencing); educational administration (organizational patterns and intergroup relations); instructional methods and media (how to teach a lesson and how to use teaching machines, audiovisual equipment, etc.); history of education; sociology of education; politics of education; educational psychology; and, of course, the use and design of educational research.
Obviously, no one person should be
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required to be proficient in all these subjects in order to become a teacher
or administrator in a school of nursing. Also, it may be that some of these areas are already represented by appropriate counterparts in the professional education of nurses; for example, use and design of research, instructional methods and media, (hospital) administration, psychology, sociology. A nurse who studies these subjects in relation to nursing will need to study some of the special applications to education, although such study will be easier and
briefer because of his background knowledge. For example, a nurse who has studied psychology has probably also studied personality development or abnormal psychology but would now have to study learning theory (especially reinforcement, transfer, and behavior modiication) in preration for teaching. The study of sociology for nurses would probably have included the life-styles of culturally disadvantaged people with emphasis on diet and hygiene practices, but now the prospective faculty member of a community health education center would have to study the sociology of school-community relations, the politics of education, etc.
The areas of study most needed by prospective nurse educators, and probably least represented in appropriate counterparts in the professional nursing program, are philosophy of education and curriculum theory. Philosophy of education is the systematic inquiry into the nature and function of education, seeking to formulate objectives for schools, programs, courses, and lessons, and seeking to tie in the objectives of education with the larger purposes of society and of life itself. Curriculum theory is the study of what students do study or should study; the sequencing of subject matter in view of logical structure and psychological capacities of students; the allocation of
priorities to subject matter based on intrinsic worth, the needs of students, the demands of society, etc.
This entire paper is an example of philosophy of education and curriculum theory applied to the nursing education program. In particular, recommendations have been made concerning the kind of curriculum that
teachers of nursing should study, and these recommendations have been defended in terms of the general objective of nursing education. For example, it was claimed earlier that since graduates of baccalaureate and graduate degree programs will often be teaching patients or nurses and may become full-time teachers of nursing, the curriculum in all baccalaureate and
graduate programs should include the study of foundations of education.
The remainder of this paper will be a comparison of professionalism in
nursing with professionalism in education, and along the way we shall discuss the meaning of professionalism and the kind of educational program that is needed to help prepare people for a profession. Thus, the remainder of this paper will be not only a substantive discussion of professionalism but also an illustration of philosophy of education and curriculum theory applied to professional education in nursing.
It is probably safe to say that neither nursing nor education is living up to the level of professionalism that would be desirable and possible. Professions are distinguished from skilled trades by many factors. Most obvious to the public is the fact that professions have higher status than skilled trades, although the salary is often not in keeping with the status. According to the more "dedicated" professionals, however, there are other factors more important than status and salary in distinguishing a profession from a trade or in distinguishing
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a genuine professional from a quack who plies the same skill. These other factors are a sense of long-term dedication to a "calling" and a commitment to use one's professional skill unselfishly in the service of those who need the skill. Perhaps this commitment to unselish service and this sense of being called to a profession explain why professionals are willing to accept status and esteem in lieu of better pay.
One additional factor is very important in distinguishing a profession from a skilled trade: Both require skillful performance of physical manipulations, but a profession, unlike a trade, also requires the deliberate, systematic application of abstract theory to problems of practice. More will be said about theory soon. For now, we simply note the fact that neither nursing nor education, as presently functioning, lives up to the requirements for full standing as a profession. Teachers and nurses do not begin to have the social status accorded to lawyers, judges, doctors, dentists, priests, architects, and engineers. More important, however, is the unfortunate fact that only an exceptional minority of teachers and nurses are deeply dedicated to their professions on a long-range basis, feel a calling, and know and apply abstract theory to their skillful performance.
Nursing can improve greatly as a profession by studying the history of the development of professionalism in education. Perhaps this statement sounds chauvinistic, coming as it does from an educator, but facts are facts. The problems which stand in the way of professionalism are essentially the same in both nursing and education. But education has had a longer history as a systematically organized and bureaucratized social institution. The problems therefore became more acute in education, and educators have had a longer time to confront them.
Both education and nursing in this country have historically been pressed
with a demand for service that is far greater than the supply of practitioners. One result is that standards of training and performance have been difficult if not impossible to maintain. As September approached and teaching vacancies went unfilled, principals would solicit any "warm body" to serve as teacher, and special permits would be issued to allow these normally uncertifiable teachers to teach. With easy availability of jobs and great demand for teachers and nurses, many people were drawn into these fields for the most mundane reasons. Teaching and nursing became dropout fields where people who failed academically or socially in other fields could find haven. Teaching and nursing positions were filled by people using such jobs as meal tickets while searching or even training for something "better." As a result, both teaching and nursing were characterized by instability of personnel, low professional dedication or sense of calling, poor theory-level training, and less than professional status in the public eye.
Educators are now beginning to develop a division of labor to ensure that the genuine professionals are put into positions of responsibility and authority where they can use their professional expertise on complex problems that require expertise while delegating lower-level tasks to less-well-prepared and less-dedicated subordinates who can be supervised. Nursing would do well to adopt a similar division of labor.
Within the last few years something unprecedented has happened in
education: A desperate teacher shortage has turned into an alarmingly large teacher surplus in most teaching fields. Statistical projections show that the surplus will continue to grow quite rapidly for several years before
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leveling off and that in the foreseeable future there will continue to be a sizable surplus of teachers in most fields. One possible outcome, which
everyone hopes for, might be an upgrading of the profession as employer
selectivity eliminates poorly educated, uncommitted teachers from the ranks.
But due to tenure rights, seniority privileges, and increasing union militancy, what will probably happen is that teachers already on the job will stay while newly certified college graduates will have to find work in other fields. As supply exceeds demand, there will be economic pressures to decrease salaries or at least not to increase them as rapidly as has been true over the last decade, and the result will be even stronger union militancy, perhaps augmented with work rules and featherbedding practices copied from raliroad unions. The reasons why a surplus developed are complex but include, for example, the recent economic dislocations which have forced college-educated white collar workers onto the streets looking for work. It may well be that in a few years nursing will find itself faced with a similarly dramatic reversal from shortage to surplus. The time to plan for it is now, so that the
surplus can be used to strengthen selectivity and upgrade standards for the profession, rather than allowing the surplus to crystallize the worst practices of the labor union syndrome.
Given the fact that there has traditionally been a great shortage of teachers and nurses, we would expect the salaries to be very high in these fields. Why are salaries so low? The answer is obvious: Teaching and nursing have traditionally been jobs filled almost entirely by women. Without debating the rightness or wrongness of the economic and social arrangements between the sexes, it has been a fact that men get vastly higher salaries than women. Both teaching and nursing began as caretaking services provided for parents or families who wanted someone else to do an unpleasant, time-consuming task. Since teaching and nursing began as home-related chores, it was thought that women should be employed. Since teaching and nursing were regarded as low-level, caretaker, almost-menial jobs, the salaries were comparable to those paid to maids. And because the salaries remained low, men, who could make more money in other jobs, did not enter these fields even when teaching and nursing began to get highly specialized and intellectualized. It is sadly true that salaries in nursing and teaching are far below what a man with comparable training can receive elsewhere, and it is also true that salaries in nursing and teaching are much higher than what most women could earn in any other occupation which has traditionally been open to them. The result is that teaching and nursing have been women's jobs, and that fact, together with the economic exploitation of women, has kept salaries low.
Education has succeeded over the last decade in bringing increasing
numbers of men into the field. High school teaching is now unselective by
sex, although elementary school teaching, especially in lower grades, is still
comparable to nursing as a female occupation. So successful has been the
campaign to bring men into teaching that an honorary fraternity in educaČ
tion open only to men (Phi Delta Kappa), which was founded long ago for the purpose of encouraging men in education, was besieged by complaints and has now recognized that the men-only rule is anachronistic and discriminatory. Given the fact of economic and status discrimination against women, one obvious way to upgrade nursing as a profession is to recruit more men. It would seem that such a campaign could succeed now
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better than ever before in view of the current job market and the increasing
specialization and intellectualization of nursing.
As mentioned earlier, one of the characteristics that distinguishes a
profession from a skilled trade is the intellectualization of practical problems. Abstract theory is developed and is consulted in a systematic way to
enhance the effectiveness and ensure the correct use of skilled action. Professionals insist upon, and are accorded, considerable autonomy in choosing the purposes for which their skills are to be used, as well as the practical strategy of problem solving. This autonomy is based on the fact that professionals have expert knowledge of theory which most people, including clients, do not have, and therefore professionals are recognized as the only people who are qualiied to make expert judgments.
Nursing has a great body of theory available, and more theory is rapidly
being developed. But most of the effort seems to be devoted to scientiic
theory, rather than ethical and aesthetic theory. Furthermore, it is often
apparent that theory is sought merely in order to make nursing look impressive. Specialized jargon, statistics, and high-level abstractions are
sometimes necessary in professional theory because of complex problems
or truly subtle, dificult ideas. But there seems to be an almost frantic effort underway in some quarters to produce jargon, statistics, and abstractions in nursing, even when such things are unnecessary or inappropriate.
Education went through a similar phase in developing its professional image, and much of the research and scientiic theory construction that was done turned out to be genuinely useful. But educators are now beginning to realize that science can tell us only how to be efficient in carrying out goals, not what goals are good ones. Educators are once again beginning to realize that science can help construct tools, but educational theorizing must take account the ethics of selecting good purposes for using those tools and the aesthetics of cultivating beauty and joy in the art of teaching. The useless development of jargon, statistics, abstractions, and rigorous methodology was an attempt to imitate the prestigious, well-financed physical sciences; and in some ways this campaign succeeded in getting for education some
of the status and money that the sciences have enjoyed. But education is
inherently more an art than a science so that much of the development of the science of education has been a hollow piece of public relations gimmickry which sometimes obscured the genuine need to cultivate the art
Both psychology and philosophy went through similar stages, from which those disciplines are only now beginning to recover. Humanistic psychology is starting to assert its rightful place beside behavioristic psychology, and humanistic philosophy is once again becoming respectable after a long period of dominance by analytic (i.e., linguistic) philosophy. Since both education and
nursing draw so heavily upon philosophy and psychology, there is hope that the resurgence of humanism in these parent disciplines will enable nurses and teachers to develop professionalism without suffering any more damage than they already have at the hands of extreme scientism. Behavioral objectives, operational definitions, accountability, and behavior modiication techniques are useful within appropriate limits, but the determination of those limits must be made humanistically.
The conclusion to be drawn from this discussion of professionalism is
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that a signiicant part of the education of every nursing student (underČ graduate and graduate) should be devoted to the humanistic study of nursing as a profession. Professional ethics should be taken seriously in nursing, and one way to see that that happens is to give the subject of professional ethics a prominent place in the nursing curriculum. At lower levels of study, prospective nurses should be made to confront controversial issues such as abortion, euthanasia, the conlict of life-styles between different social classes, the right of a nurse to perform or withhold services when a diference in values exists between himself and his patients, the right to strike for higher salaries, etc. At higher levels of study, when nursing students are preparing for leadership positions in the profession or for positions as teachers of nursing, they should systematically study both the foundations of nursing and the foundations of education. Nurses whose primary job is to teach should have
professional preparation as educators.
1. "NLN Will Operate on Balanced Budget in 1970," Nursing Outlook, 18(3):6, 1970.
2. Mildred E. Katzell, "Upward Mobility in Nursing," Nursing Outlook, 18(9):36-39, 1970.
3. Missouri State Board of Nursing, State of Missouri Minimum Standards for Accredited Programs of Professional Nursing and Registration of Professional Nurses in Missouri, Columbia, Mo.: Kelly Press, Inc., 1965.
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