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Developing critical ability in nurse education

Philip Burnard

This paper argues that all nurses need to develop critical ability, through the process of nurse education. The characteristics of critical ability are described and suggestions are offered for how nurse teachers may develop that ability in their learners.

INTRODUCTION

Nurses need to be educated as well as trained. In a sense, the statement is self-evident and yet, in another sense, it is important that the word &~cuted is emphasised. In the past, much of what nurses have received has been training. If we want a creative, assertive, research minded and rational workforce we must continue to strive for nurse education - and lifelong education at that (Boshier 1980). No longer can we assume that what we learn today will serve us for a reasonable length of time nor can we believe that once we have finished a course we are adequately pre- pared for all future nursing situations. Just as the initial 3 year preparation course for regist- ration should not be thought of as an end in itself, nor should post basic education be viewed as an ‘adding on’ or even a ‘mopping up’ process. Yost-basic educators should never be merely the people who are brought in to ‘put things right’ after it has been identified that a wide range of staff are unfamiliar with modern practices or theories. Boshier (1984) refers to this as the

Philip Burnard MSc RGN RMN Cert Ed DipN RNT Lecturer in Nursing Studies, University of Wales College of Medicine, Heath Park, Cardiff (Requests for reprints to PB) Manuscript accepted 10 October 1988

‘ambulance driver’ concept of education, in which helpers ‘arrive at the scene of the psycho- logical, social or international accident, after the damage is done’. Both initial and post-basic programmes should be continuous and have a close relationship with each other, throughout the working life of the nurse. The over-riding principle being that nurse education is con- cerned with the education of adults and all professional adults require lifelong education in order to stay abreast of developments and changes in knowledge and skills.

EDUCATION OR TRAINING?

What is the difference between education and training? An American nurse recently summed up the difference quite pointedly when she said that ‘you train dogs and educate people’ (Miller 1988). Unfortunately, she went on to add about nurses in the UK ‘Your nurses are trained, ours are educated!’ Education suggests an evolving, critical process which enables the learner to make decisions for herself through the exercise of rational thought. Training, on the other hand, suggests rote learning and the blind absorption of other people’s thoughts, beliefs and skills. Training, in this sense, is restrictive in

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that it leads learners to become dependent on teachers for learning. Education, on the other hand, is liberating in that it encourages learners to become autonomous and self-determining (Boud, Keogh & Walker 1985). Education would seem to be more appropriate a process for the development of nursing given that nursing cur- rently aims at developing patient autonomy. It would seem difficult to argue for a system which encouraged patient-centred nursing and yet did not encourage practitioners who were autono- mous in their learning practices. Further discussion of the differences between education and training and exploration of the need for continuous professional education may be found elsewhere (larvis 1983a; 1983b). It is

basic training and beyond it, seems to be a fundamental requirement in the development of modern nursing. This paper considers what are the characteristics of critical ability and offers some suggestions as to how such ability may be developed. We may not want to go as far as Marx, one of whose favourite maxims was ‘doubt everything’ (Singer 1980) but we certainly need a sharpened sense of how to make decisions about the value of what we hear, read, learn and do. It is important to note, too, that ‘critical’ need not only mean ‘negatively judgemental’. To be critical is to weigh-up, to evaluate and to decide upon the validity of something. It does not mean only to criticise.

worth noting that training also has a place. Certain psychomotor skills and some basic inter-

The characeristics of critical ability

personal skills can be learnt through training Drawing from the work of Brookheld (1987), it is and it may be justifiable both in terms of the possible to identify a number of issues that go to effective care of patients and in terms of make up the concept of critical ability. These economy, to train nurses in certain respects. may be enumerated as follows:

Identifying and challenging assumptions is central to

CRITICAL ABILITY wit&i ability.

- -

It is easy for all of us to carry on through our

One of the keys to successful education would seem to be the development of critical ability. To be able to think critically is to be able to generate options, to see other possibilities, to intelligently discriminate, to identify new ideas. Without critical ability we stick to the well known, we distrust our own abilities and imagine that only the ‘experts’ have the real answers. Also, we ‘believe’ research, without having the faculty to discover for ourselves whether or not it is valid and appropriate. We slavishly take on board other people’s theories without questioning whether or not they hold together in a reason- able and reasoned way. Berger and Kellner (198 1) sum up the spirit of critical ability when they suggest that the realisation can occur that:

working and personal lives with a set of assump- tions that seem to have served us well. The secret, here, is to continually challenge those assumptions - what we believe, think, feel and do. It is only through such challenging of assumptions that we expand our frame of reference and begin to break new ground.

Challenging the importance of context is crucial to

critical ability.

Everything that happens, happens within a par- ticular context. That context may involve time, culture, patterns of living, personality types, belief systems and so on. There is a great danger in thinking that what is appropriate in one context is necessarily appropriate in another. We must continue to question the context that we

not only is the world not what it appears to be find ourselves in and to discover the context that

but it could be different to what it is’ research is carried out in or the context in which models and theories are evolved. A particular

Given the increasing interest in nursing research example of this in nursing, is the development of and the plethora of nursing models that have research and models building in the USA. All of been developed in recent years, the need to it occurs within a very different context to that develop critical ability in all nurses, both during which is found in the UK. We must be careful not

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to transport ideas from one continent to another without acknowledging the question of cultural differences.

People with critical ability try to imagine and explore

alternatives.

Central to the notion of critical ability is the idea of constantly looking for new ways of doing things, new ways of thinking. Such new ways of living allow for creativity and growth as opposed to routine and stasis. If nursing is to continue to develop as a profession, such creativity is to be welcomed. It will only come if people begin to think and act differently. There may be an argument, here, for encouraging the develop- ment of the ‘deviant’ nurse - the nurse who goes against the grain and resists traditional voc- ational socialisation to some degree.

Imagining and exploring alternatives leads to ‘reflec-

tive scepticism ‘.

Critical thinkers do not take things as read. They do not believe everything they read or are taught. They learn to consider, sift and evaluate ideas for their worth and for their practical application. They distrust the educator or theo- rist who claims to have found ‘the answer’. The ability to discriminate between that which is worthwhile and that which is not is surely a

hallmark of someone who has learned to be critical. Nursing needs such people.

The notion of reflective scepticism is very similar to the reflective stage in Kolb’s (1984) experiential learning cycle. In both concepts alluded to above, the idea is that we inwardly reflect on what we have heard, seen or experi- enced, compare it with our past experience and knowledge, critically examine it and then modify our self-concept in the light of what we learn from it. Reflective scepticism is occurring when- ever we call into question the belief that just because an idea or a social structure has existed unchanged or unchallenged for a period of time, it must therefore be both right and also the best possible arrangement (Brookfield 1987). Elbow (1973) has referred to this as ‘paying the doubting game’. Freire (1970, 1972) called it ‘problematization’.

Developing critical ability

How, then, can nurse educators encourage the development of critical ability in students? Drawing from and developing Brookfield’s (1987) work, the following guidelines are offered:

Af$rm critical thinkers’ self worth.

The critical thinker is an innovator. She is going out on a limb and trying out new ways of thinking. She is also challenging her own self- concept. For what we think and feel constitutes our sense of self. We are our knowledge, feelings and actions. For these reasons, the critical thinker needs to be encouraged and made to feel that their ideas are appreciated. This does not mean wholehearted acceptance of any ideas that are put forward but it means that the educator, herself, remains open to new ideas, as she hears them, and supports the student who offers them.

Listen attentively to critical thinkers.

Listening is an important aspect of any nursing practice. It is also a vital prerequisite for helping to develop critical ability. When someone is expressing critical ideas, she is challenging the status quo and offering new views on a particular situation. The temptation is to react - to attempt to bring the student back onto the well-worn path. The effective listener, however, develops the ability to follow the critical student’s thought processes and enters her ‘frame of reference’. Such listening is always a challenge, for what we hear, when we listen to critical expression, may challenge our own views of the world, as a teacher. This notion of an expanding and changing frame of reference on the part of the teacher is at some variance with traditional views of education. Peters (1972) for example, argues that education is ‘initiation into ways of knowing’ and that the teachers task is to lead the students into fields of study, In the version offered here, both students and teacher are co-travellers and develop their knowledge, feelings and skills alongside each other. Each challenges the other.

Be a critical teacher.

A number of writers on education have discussed the notion of critical teaching. Shor

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(1980) defines critical teaching as assisting people to become aware of their taken-for- granted ideas about the world. Paulo Freire (1970, 1985) has called for ‘problem-posing’ education. He contrasts such education with the more traditional ‘banking’ concept of education, where students are filled with pre-prepared and pre-digested ‘facts’, by the teacher. In problem posing education, the teacher acts as a catylyst, challenging the students to develop new ideas and to question the world that they find them- selves living in. Freire (1986) has suggested that the characteristics of critical teachers include: competence, courage, risk-taking, humility and political clarity. Setting out to engage in a session of critical teaching is always something of an act of faith. There is no way of pre-judging how such a session will end. Either students or teachers (or both) may change their ideas con- siderably during such a session as a result of heated, critical debate. Certainly, pre-written learning objectives or outcomes are not appro- priate, here, for the educational enterprise is one of process and is thus everchanging and developing. The teacher who practises critical teaching ‘lives on the edge’ and is prepared to take risks, both with herself and with her students, in order to move thinking forward.

One point needs further clarification here: the concept of ‘critical teaching’ does not involve the teacher being critical of the student as might be the case in a more traditional use of the ex- pression. Indeed, the notion represents almost the opposite position. The teacher is accepting of the student but prepared to question both her own and the student’s ideas.

Model critical ability.

If students are to learn to question and to criticise, it is important that teachers demon- strate their own critical ability. This requires that the teacher stays open to new ideas, herself, and continues her own education process. In this sense, the teacher stays open to the idea of learning from her students, too. Thus nurse education can become a reciprocal process: the students and teachers switch roles throughout the educational encounter - a notion that Freire has also frequently referred to in his writings

(Freire 1970, 1972, 1985). Also, as the teacher models the ability to listen to critical students without defensiveness, so the students may learn to become better listeners and to be less defen- sive and reactionary.

Encourage breadth of reading.

Given the notion of context, referred to above and the fact that knowledge is forever changing - Whitehead (1932) states: ‘Knowledge keeps no better than fish!’ - we need to encourage learn- ers to read widely. This means that they should read a wide selection of books and papers on nursing theory and practice and also that they should read widely in other domains: literature, psychology, sociology and so forth. It is only by absorbing a wide range of perspectives on the world that we can begin to become questioning and critical.

Learn to shut up!

Most teachers talk too much. This can be demon- strated by entering almost any classroom in any school or department of nursing. If we are to encourage critical ability, learners must have the chance to talk about what they think and feel. This clearly cannot happen if the teacher is talking. Further, silence has much to commend it as an educational experience. The notion that the teacher must always ‘fill in the gaps’ during an educational encounter may be an erroneous one.

Be conversational.

Much can be achieved if the teacher adopts a fairly ‘normal’ tone of voice and relates to the learners as equals and as interesting people. Many interviews are spoiled by the artificial manner adopted by the interviewers (Zweig 1965). Many potentially interesting lessons are probably also spoiled by the teacher playing out a ‘teacher role’. Much of the learning we do takes place outside of educational institutions (Illich 1973) and this may be because in ‘everyday life’, people talk normally to each other. A conver- sational exchange in a classroom can do much to enhance the free development of critical ability.

Other methods of helping to develop critical ability include, at least, the use of ‘open’ ques-

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tions that challenge the learners’ thinking, the

use of role-play to explore alternative behav-

iours, playing ‘devil’s advocate’ and purposely

arguing a contrary case to enable clarity of argument. Other methods are described in the

considerable literature on the topic (Houle 1972; Johnston 1986; McPeck 1981; Meyers 1986).

CONCLUSION

The development of critical ability in nurses can

enhance their writing ability, can challenge their

assumptions about their nursing practice and

can make them more confident in their ability to

meet other health care professionals on an equal footing. It can also help them to identify future

fields for research and encourage them to

explore such fields from a sound basis.

This paper has explored the notion of critical

ability in nurse education. It has characterised

critical ability and has offered guidelines for the

development of such ability in learners by nurse

teachers. Such critical ability has applications in

all fields of nursing from general to psychiatric

and at all levels, from basic nurse education to

postgraduate courses.

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