The emotional dimension of learning

© 2004 Blackwell Publishing Ltd.

Learning in Health and Social Care

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Blackwell Publishing, Ltd.

Editorial

The emotional dimension of learning

A Forum piece in the first issue of

Learning in Health

and Social Care

asked several questions about the

emotional dimension of learning, and I now want

to take that discussion a little further. The role of

coping has always been recognized as involving a

strong emotional strand, but how is it, or should

it be, handled by professional workers? Current

practices include suppression, reflection to bring it

within the reach of one’s professional intelligence,

formal or informal supervision from someone with

greater experience, informal buddy systems and

the development of caring communities in which

workers care for each other as well as their patients

or clients. One important question for this journal

is, how do we learn practices for including the

emotional dimension within our shared thinking

about our work? Another concerns the interactions

between professional, or interprofessional, learning

and the emotional dimension.

The aspect of emotion that dominates the litera-

ture in heath and social care is the handling of

emotion-rich incidents involving clients and their

families, presumably because both the frequency

and the saliency of such incidents is greater in health

and social care than in most other occupational sec-

tors. It is also of greater interest to the public because

it relates to their own experiences and concerns.

However, the focus tends to be more on individuals

than on groups, and the importance of learning to

handle such incidents is often under-estimated. So

also is the impact of observing others handling such

incidents well or badly, sometimes in ways that are

perceived as unethical. Such incidents are not con-

fined to health and social care environments, and

may also occur in education settings.

Another aspect of the emotional dimension being

given increasing attention is that of inclusion or

exclusion. Inclusion is not always a self-evident good.

There are circumstances where differences in values

or behavioural norms result in people not wanting to

be included in certain groups, activities or practices,

and no-one could possibly participate in all the

activities in any sizeable workplace, especially when

people have very different roles and competencies.

The main issue is the impact, on both learning and

self-esteem, of feeling excluded from certain groups,

activities or learning opportunities. Not only is

exclusion stressful in its own right, but isolation cuts

people off from the emotional support they need in

handling emotion-rich incidents over long periods

of time. Moreover, there are usually greater oppor-

tunities for instructive participation than the typical

workplace allows, and people feel angry and/or alien-

ated if they think that they have been unreasonably

excluded from activities which they value. There is

also increasing evidence that participation in new

activities, or involving new people, is an important

source of learning, as well as of developing relation-

ships that support learning.

Focusing on relationships also draws attention

to the informal activities that help to develop them,

and to create goodwill across occupations and

status barriers. Both support workers, who have direct

contact with clients, and professionals, such as

laboratory workers, who have little such contact,

can easily feel excluded, treated as cogs in a machine

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rather than people who make a difference. Yet, they

influence the organizational climate in many subtle

ways, and most acquire (formally or informally)

information that is relevant to decision-making,

either about clients or about aspects of the organi-

zation that are not working properly. Indeed, one of

the most important kinds of information exchanged

through all types of informal relationship concerns

the climate, commitment to care and morale found

in different localities. Can managers in a care-focused

organization do their jobs well if they lack access

to the emotional pulse of relevant parts of their

organization?

Closely linked to feelings of inclusion are issues of

identity. Research on professional socialization

consistently draws attention to students’ need to

confirm their career choice early in their training,

and the main factors affecting their fulfilment of this

need are direct experience of professional work and

acceptance by work-place professionals as novice

members of their chosen profession through

inclusion in some of its activities. This emotional

confirmation is at least as important as the cognitive

benefits of experiencing some of the contexts in which

their developing professional knowledge will soon be

used. In caring professions, students’ commitment

to learning is often just a subsidiary part of their

commitment to their profession, and difficulties in

understanding and appreciating the links between

what they are currently learning and what they are

about to practice are profoundly alienating.

After qualification, other aspects of identity are

likely to raise problems. First, one has to learn both

how to handle challenges to one’s authority or

judgement and how to learn from them. Then, there

are a series of issues related to self-presentation in

different work settings. Particular emotional prob-

lems arise when the expected public presentation of

oneself feels artificial or threatens one’s identity. If

one cannot find some mutual adaptation between

oneself and one’s professional persona that feels

more comfortable, the level of ongoing stress will

probably become debilitating. Sometimes the prob-

lem may lie in trying to grow into a new role too fast;

the feeling of discomfort may signal unease at not

yet having sufficient learning about the new role or

new context for the intended self-presentation to be

credible. Sometimes, the ideal projection of oneself

is unachievable for more than a few propitious

moments, because the time and conditions needed

to sustain it are never likely to arise.

This brings us to the complex relationship between

professionals or student professionals and their

work, whether it be practice or study. More than

40 years ago, Bruner characterized pupils learning at

school as being either coping or defending. The

copers felt that they were keeping up with their class

work and holding their own. The defenders lacked

confidence and concentrated on protecting them-

selves against criticism; their focus was often more

on maintaining the appearance of coping than on

the work itself, still less on learning outcomes, and

they were adept at finding plausible reasons for

under-performance. Ironically, in other contexts,

the term ‘coping’ is associated with ‘faint praise’ –

getting by, but not doing especially well or respond-

ing to anything challenging. However, it can also be

just a self-effacing response to a polite enquiry about

how things are going. Whether one is a student or

a qualified professional, one sets one’s standards

according to a combination of personal disposition,

the norms of one’s working group, self-assessed

capability, and the expectations created by the praise,

challenge or criticism of significant others. How

people feel about their work is closely linked to their

sense of identity and the standards they settle for,

aspire to, or strive to meet.

My own research on learning in different kinds of

workplace has found that confidence and com-

mitment are always important for learning. Both

have strong emotional overtones. Confidence comes

from ongoing learning and meeting challenges.

However, the disposition to accept, or even recog-

nize, challenges depends partly on the support that

one receives from colleagues and significant others,

and partly on the risk of blame or humiliating criti-

cism, accentuated in some contexts by resentment

that one has broken local norms by accepting a

challenge and put one’s head above the parapet.

Commitment comes from a climate of mutual support

within an organization or working group, collective

responses to challenges and a belief in the value of

the work that one is doing. It sustains both high

levels of achievement and learning projects of

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considerable magnitude. For some people, confidence

and commitment are fragile emotions, easily dissi-

pated by a single critic or cynic or a small disruptive

clique; others are more resilient.

In formal education, it is easier to engender

confidence in learning by designing and teaching

curricula that meet students’ needs. But commitment

to learning is more problematic. This is because

learning and working tend to be perceived as differ-

ent practices that occur in different settings. The

values that underpin commitment to professional

work will only be extended to learning if relevant

learning is seen as occurring before, during and after

work. This requires both better recognition of

workplace learning and a good understanding of

how learning in education contexts contributes to that

learning.

Organizations that provide care play an impor-

tant role in determining both working conditions

and opportunities for learning. The majority of

professionals thrive when their working conditions,

most of the time, enable them to achieve what they

see as good practice, but lose enthusiasm when they

find good practice almost impossible to achieve

under current conditions. They are elated when

new learning from any source enables then to do

something better for their clients and become

despondent when they have nothing more to offer

and little time to help.

These organizations are also located in a wider

socio-economic environment undergoing massive

change. In healthcare, the extension of what can be

treated, the ageing population in some countries

(with its concomitant increase in the complexity of

cases), the expanding population in other countries,

and the persistence of malnutrition, human

immunodeficiency virus (HIV) and ever-changing

pathogenic organisms, combine to ensure that demand

outstrips the available resources. In social care, the

growing gap in income between the most and

least wealthy, and consequent migration within and

among national boundaries, has the same effect.

The prognosis is that health and social care will be

one of the most rapidly changing features of our

global society, and with it will come all the emotional

problems and learning challenges that inevitably

accompany such change.

The research literature on change is a strange

mixture of political and cultural analysis, evaluations

of consultation processes and training interven-

tions, and disaster stories. It focuses on the manage-

ment of planned change (including formal learning

components), restructuring and developing owner-

ship of change. But the emotional dimension and

broader aspects of learning are under-researched

and under-theorized, and their interconnections

are rarely mentioned. I will return to the relation-

ships between learning and change in a later editorial.

Here, it is sufficient to focus on the emotional

dimension of learning and change.

Some might regard routines as the epitome of sta-

bility, but close inspection reveals that this ‘stability’

serves several purposes, at least one of which is

important for change. First, routines are essential

for coping with busy, crowded situations. They both

contribute to productivity and create the space for

thinking time, fragmented though it often is, to be

devoted to priorities – the more urgent and/or

difficult aspects of the situation, including those cases

where new learning is most likely to occur. Second,

routines are essential for rapidly changing situations,

because they allow prime attention to be devoted

to monitoring changes in one’s environment and

the effects of the responses to those changes, i.e. not

so much on what one is doing now as on what one

should be doing next. Other purposes served by

routines include increasing predictability, which can

be helpful for other members of one’s team, and

decreasing risk. However, their downside is that, as

they become more effective, they also become more

automatic and more tacit, and this makes them very

difficult to share, reflect upon or evaluate. Hence, it

becomes possible to develop further short-cuts in

routines to save time without being aware of the

implications.

The main problem posed by routines comes when

the routines themselves need to change; and this

requires a considerable amount of unlearning,

as well as a transition period during which new

routines are developed. If there is no change in

workload during this period, the quality of work will

inevitably decrease and the emotional stress will

increase. Without the support of routines, the mental

demands of challenging work are enormous. Not

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only do quality and productivity drop, but one also

feels disoriented because the cognitive patterns of

one’s environment ceases to be familiar when one

changes one’s practice in any significant way. One

feels like a novice, without the excuse of being a

novice. Moreover, the lack of confidence and

thinking time caused by this disorientation restricts

the learning process that is so desperately needed to

recover the situation and achieve a new state of

equilibrium in which confidence can be regained.

Such changes in personal practice require increased

support, more time and a lower workload, and

these are rarely built into planned change at more

than a token level. Either the putative change fails and

becomes an inoculation against further change, or

there is a high burnout rate of professional workers,

whose services might have been retained had there

been greater awareness of these implications.

A similar phenomenon can be observed when

newly qualified professionals are pitchforked into

situations for which they have been only partially

prepared. Even if they have previously acquired

most of the prerequisite knowledge and skills, they

may not yet be able to use all of them in practical

situations, or may only be able to do so very slowly

in a problem-solving mode because they have little

previous experience of the integrated use of differ-

ent kinds of knowledge and skills. Evidence suggests

that they have great difficulty in prioritising their

work at this stage and feel totally overwhelmed by it

unless they have a reduced workload and a lot of

support. The same transition period is needed to

build up their routines and, if no allowance is made

for this, they will probably leave their jobs. Another

danger is that they learn to cope with their workload

by constructing routines that are suboptimal, but

still difficult to unlearn at a later stage.

This brings us to another area where risk, emotion

and learning are intertwined – that of defensive

practice. This natural emotional response to intensified

accountability involves adopting practices that are

less risky but, in many cases, far from optimal. Its

aim, at the individual level, is to avoid blame and

reduce anxiety about the possible negative conse-

quences of using practices perceived as being more

risky. At the corporate level, the aims are to minimize

public complaints and to avoid any legal claims

for compensation whenever outcomes are worse than

expected. Responses at the corporate level have

been to introduce local or national guidelines

and/or paperwork to protect workers from being

wrongly accused of neglect. The quality of these

responses may range from evidence-based best

practice, or safe practice guidelines for less experi-

enced professionals, to what might be best described

as paranoid practice (still rare but widely tipped to

increase). According to the workplace culture and

the disposition of the individual workers, one will

probably find attributes with a strong emotional

content, which range from being prepared to go beyond

guidelines in certain challenging cases, where this is

judged to be appropriate, to being afraid of making

the slightest deviation from them. From a learning

perspective, it is important that people are able to

discern the status of any relevant set of guidelines,

that variations in the interpretation of guidelines are

recorded and evaluated, and that any doubts about

whether the guidelines are inappropriate for parti-

cular cases are noted and passed on for further

discussion by Trusts or professional bodies.

My conclusion is that the emotional dimension of

learning is omni-present, multifaceted and usually

of vital importance for the learning and develop-

ment of individuals, teams, organizations and

professions. It is also under-researched, oversimplified

and too easily ignored by managers, learners and

those who support the learning process.

Professor Michael Eraut

Editor

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The emotional dimension of learning