Implementing a Caring Curriculum

If caring is an essential concept of the discipline of nursing, then the substantive nature of this concept must be studied by student nurses (Touhy & Boykin, 2008:8). From the perspective of care ethics, the primary aim of moral education is to produce carers who will engage successfully in caring relations. Student nurses should be prepared to care for those they encounter directly, and to care about the suffering of people at a distance (Noddings, 2010b:394). Educators could manifest their care in the choice of curriculum, and an appropriately chosen curriculum could contribute to the growth of student nurses as carers (Begum & Slavin, 2012:332; Noddings, 1995:24). Such a curriculum must seek to create authentic, egalitarian human-to-human relationships. This will enable student nurses to have authority in their own knowing and experiences. Sharing and jointly critiquing this knowing and experience will enhance deeper knowledge, understanding, integrative insights and wisdom, ultimately leading to transformation of a caring consciousness (Hills & Watson, 2011:17).

Professional nursing behaviours are highly dependent on teaching and learning transactions that occur in the academic setting, and are eventually transferred and honed in clinical practice environments. Nursing is continuously challenged with technological advancements that could potentially dehumanise the nurse-patient encounter, cause incivility in lecture rooms that may transcend to clinical practice, and other personal agendas that student nurses may find difficult to isolate when interacting with patients. The imperative for teaching caring behaviours must therefore be transparent in the nursing curriculum, and structured with hierarchical levels of expectation. Student nurses must be held accountable to those standards of practice. In

addition, curricula should be developed that focus on the study of nursing theories and conceptual frameworks in the discipline of nursing. It is in the theories and conceptual frameworks that the values and ethics of bearing witness to suffering and demonstrating care and concern for others is brought forward (Brown, 2011:360; Bunkers, 2010:293).

Nursing education has traditionally emphasised the development of cognitive and psychomotor skills, in order to produce competent clinical practitioners. While the acquisition of knowledge and skills is important to professional practice, student nurses are also required to develop attitudes, beliefs and values that are central to the nurturing and caring perspective of nursing. It is therefore important that the cognitive, psychomotor, and affective domains of learning are integrated into curriculum design. This will enhance the graduates’ knowledge and skills for competent practice and their capacity for attitudes and mindsets that promote humanistic, caring, interactions with patients. Transformation could occur if all three learning domains are engaged. It is the personal, internal learning prompted by the cognitive and psychomotor knowledge that leads to affective growth and transformation (Brown, 2011:361; Herbst, Swengros & Kinney, 2010:E7; Hughes & Quinn, 2013:110).

Currently, there exists a lack of information in the literature that establishes best practice for educational strategies that effectively integrate professional nursing values into nursing curricula(Einhellig, Hummel & Gryskiewicz, 2015:121).Furthermore, affective learning is most challenging, because it deals with the realms of feelings and attitude, which constitute the caring function and requires personal behavioural changes. In addition, it is almost impossible to formulate objectives for the affective domain (Herbst, Swengros & Kinney, 2010:E7; Hughes & Quinn, 2013:110). Mastering the affective dimension of caring, similar to the acquisition of affective knowledge, is built on the premise of hierarchical learning. However, hierarchically designed affective learning strategies are not readily evident in nursing curricula. Unlike developing cognitive or psychomotor objectives that are more readily manifested, the integration of affective caring objectives may require one to specify behaviours indirectly by inferring from what can be observed (Brown, 2011:361-364).

A caring curriculum that involves caring-focused teaching strategies with case analysis, group discussion, role modelling, and self-reflection is an effective means by which to teach student nurses caring behaviours encompassing both theory and practice (Blum & Gordon, 2009:33; Wu, Chin, & Chen, 2009:877). In a study conducted by Drumm and Chase (2010:35), student nurses educated in a caring curriculum could describe caring behaviours of clinical instructors directed at both patients and student nurses. Those who chose to attend a nursing school, based on a caring philosophy were aware that they were innately caring but not entirely aware

of the value of caring in nursing when they first started their programme. At the end of the programme, they appreciated the significance of the caring philosophy in their nursing education and their ability to be caring nurses in the clinical setting. Student nurses also affirmed the value of holistically caring for the patient and how this enhanced the personhood of both patient and nurse. They clearly articulated that the learning of caring was understood best in the clinical setting, and soon discovered that the integration of caring into their nursing practice had a positive impact on patient care.

Student nurses should be assisted to develop moral sensitivity which implies the ability to recognise the moral or ethical component within situations. Educational programmes should consider ways to help support the transition of student nurses into the role of a nurse, emphasising how to cope with moral issues that could result in moral distress. Patient simulations, case studies and narrated stories are effective in cultivating the development of moral sensitivity (Comrie, 2012:126). Nursing education based on the caring relationship with patients throughout the academic years encourages student nurses to cultivate moral sensitivity. In a study by Park, Kjervik, Crandell and Oermann (2012:576) about the development of moral sensitivity in student nurses, it was found that senior student nurses agreed to a greater extent than junior student nurses with moral sensitivity concepts, and they could more readily identify moral conflict than junior student nurses.