Problem statement

In today’s highly technological and sophisticated health milieu a humanistic and caring nurse is required. However, the problem that exists in nursing education is that the favoured Tylerian rationale or objectives model does not provide for all aspects of a “caring science” and for professionalism (Bevis 1989(a):4-5). Tylerian behaviourism is excellent for the mere memorisation of knowledge and skills but caring involves more than knowledge and skills

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(van der Wal 1999(b):189). Caring needs to be transmitted and translated during interactions and transactions in the theoretical and clinical situation, not only on a cognitive dimension but also on an interpersonal, humanistic, humane and caring dimension (van der Wal 1999(b):191-192).

Unfortunately, behaviourism has led to an oppressive curriculum that has in turn, led to the nurse being professionally socialised in an oppressive and controlling manner. Consequently, the nurse finds it difficult to care and to be caring in such an oppressive environment (Bevis & Murray 1990:328).

According to Paterson and Crawford (1994:168-169), the educational milieu has many behaviouristic constraints that inhibit the implementation of the caring imperative. One such constraint is the extremely limited period of time spent individually with students in the classroom and in the clinical situation. Time limitations in the classroom have been compounded by the overloading of the curriculum with unnecessary content which has led to the implementation of learning and teaching strategies, such as lecturing and learning by the evaluation method of teaching, that is, learning what the tutor expects the student to know. The latter aspects are corroborated by de Villiers (1996:14-15, 17, 19) and Waterson et al (2006(a):56, 64; see section 5.2.1). These strategies have resulted in a student who is dependent on the teacher and values pleasing the teacher more than the actual generation of knowledge. Clinically, the student spends a short period of time in any one practice situation and this is exacerbated by the fact that the tutor lacks adequate preparation for her clinical teaching role. During evaluation, the tutor is seen to be both the coach and the referee. The evaluator-student power structure during evaluation has led to separateness or distancing between the tutor and the student which is not conducive to fostering a humanistic-educative- caring ambience. Additionally, the student is assessed according to measurable and observable standards and norms derived from experts. Criteria such as risk taking, creativity and humanitarian values are either negated as trivial or not taken into consideration during assessment. At this point it is important to note that it is not the intention of the researcher to discard substantive knowledge, but to add a humanistic dimension to it.

Nurse educators need to move from the implementation of a behaviouristic (stimulus- response) curriculum paradigm, to a humanistic-educative-caring curriculum paradigm. This

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paradigm shift will ensure that the concept education remains the focal point throughout the educational programme of students. To accomplish the latter, the nurse educator needs to determine the present point at which students find themselves regarding the Humanistic- Educative-Caring Curriculum Paradigm versus the Stimulus-Response Paradigm.

Additionally, when the current socio-economic situation is viewed, South Africa emerges as a nation at risk. This is due to the emergence of changing values; instability of society, the home and family; high levels of poverty and unemployment; increasing divorce rates; crime; illegitimate births; drugs; alcohol, women and child abuse; and a general questioning of values by people of all ages (see sections 5.2.5; 5.2.6). Neither the home nor the schools have been able to address these problems. As an adjunct, the caring ethic in nursing has either been eroded or is absent from the nursing milieu. The erosion of caring is corroborated by Mackintosh (2006:958, 960) who found that during the professional socialisation of student nurses, the importance of caring was reduced, cynical attitudes were adopted and students became disillusioned about caring due to time constraints and just seeing to the physical needs of patients. Consequently, we need to incorporate a humanistic philosophy as part of our curriculum. There has to be a practical blending of the affective, cognitive and behavioural aspects of the curriculum. It is time to stop paying lip service to formal documentation and time to see that the curriculum is implemented to produce caring nurses. A departure point could be the development of an instrument that a tutor and a student could use to assess whether students are either being trained to get the job done or for financial gain, or being educated to equip them to become lifelong, caring professionals and also getting the job done.

Tutors and students require a readily available instrument to determine whether their educational focus is behaviourist or educative. As no research instrument has as yet been developed to test the Bevis and Watson model in South Africa, such an instrument was designed during the present research. It provides for the objective evaluation of the nursing education focus of students at a college. This instrument was designed according to the Bevis and Watson conceptualised four mini models namely: Learner Maturity Continuum, Typology of Learning, Criteria for Teacher-Student Interactions and the Criteria for Selecting and Devising Learning Experiences. Each of these mini-models provides a continuum ranging between behaviourism (stimulus-response) and a humanistic-educative caring curriculum paradigm.

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For the present study, the researcher added the two conceptual continuums Teacher-student relationship and Teacher-student structure to the four Bevis and Watson mini-models. The Teacher-student structure conceptual continuum is a combination of the concepts teacher structure and student self-structure (see figure 1.1).

Consequently, throughout this study the six concepts depicted in the conceptual framework are referred to as conceptual continuums.