Theme: Apprehending the Affective Learning Spaces

The second major theme ‘Apprehending the Affective Learning Space’ comprises the sub-themes: ‘ Shifting learning Contexts’ and ‘Bridging the cognitive-emotions gap in learning’. Apprehending the Affective Learning Spaces’ involves the experience of the student nurse encountering a connectedness between what is taught in the classroom and what is experienced in the placement setting. Not that these are seen as divided but that both learning spaces should capture the role of emotion in enabling the nurse student to blend nurse theory with nurse practice. As may be observed from the following observations from the study participants, their experience was that of a cognitive- affective interrupt in dealing with theoretical matters relating to practice applications: a gap between the theory and the practice.

For example, the following data extracts give evidence to this gap:

“…It didn't prepare you emotionally. It prepared you practically, but your

emotions...I do not think anything can prepare you emotionally for sitting and watching somebody dying or you've done all you can and they still go off and you do not see them when you come back in the morning. [Sally Int.2 L 120]

“…I preferred it in the clinical setting, because I felt I learned a lot more in

a little time. You can sit in an hour of lecture and learn one thing. You can do an hour on the ward and you can learn numerous things. It's...I would rather prefer to learn a lot more, because I get bored easy. So, just sitting in a lecture is one thing. However, we all have different abilities. [Sally Int. 2. L146]

“….The lecture was based on…it was about death and dying and how patients…it was kind of about…it was really, really bizarre because he

came out with this video on studies such as when someone dies, the tears are more healthy for you than when cutting onions and it was ridiculous stuff like that which, not ticked us off, but it was just what kind of thing. It does not make sense kind of thing [Noreen Int.2 L48]

“…the whole emotional side of it. I do not think uni deals with that at all. And we have talked about death and dying or, you know, going through cancer and things. But again, I do not think we really touch on the emotions side of it, but then also, from uni’s point of view, they can’t get too emotional because they can’t have 60 odd women all sat there bawling their eyes out. Do you know what I mean? So, but, I do think it’s important. I really do. And it’s things like…for example, my first resus, being there, doing the compressions, and maybe losing that person. I mean, the first time I did it, my patient survived, but you knew that they were going to die. But uni does not deal with that at all. [Mary Int. 2 L98]

The learning gap that has emerged from the data resonates with the gap identified by a range of authors who point to a mismatch between effective and meaning-making role models for student nurse learning in the clinical domain. Additionally an increasing distance between university lecturers, who are wholly based in a university, e.g. as cited by Smith & Allan, (2010): Carlisle et al, (1996), Barnett, (2007). It may be conjectured from these accounts that for the participants there is a lack of engagement with emotions within the University beyond tokenistic references in teaching aspects of care. For the study participants, it was in practice that the impact of emotions and how to use them effectively to negotiate care was experienced.

Educationally the challenge is the enabling of both theoretically competent and practically compassionate practitioners of nursing to emerge from three years of classroom and placement based learning in which a gap or as Smith & Allen identify (2010) an uncoupling has occurred between theory and practice consequent to learning nursing in an HEI. It is difficult not to sense a theory- practice uncoupling between nurse education’s aim and nurse education’s practice as demonstrated for example in the data transcriptions above.

Owen-Smith, (2008) has suggested that in higher education we have separated the learning heart from the learning mind. To apprehend the affective learning gap in the nurse student experience is to perhaps move beyond EI to EW-

emotional wisdom. It is this distinctive, which also differentiates emotional literacy from EI. Not withstanding the necessity of a competency based curriculum to develop safe doers of nursing predicated on a triad of knowledge understanding and skills. This I would suggest requires to be considered alongside the challenges of EI and emotional labour as a means to addressing the cognitive – affect gap in nurse education.

I agree with Owen-Smith, (2008) who alludes to a change in higher education epistemology to that which gives a focus on heart and mind as evidenced through such pedagogies as, experiential learning and attention to values and ethics. Furthermore, she argues that such is not a discarding of a education or curriculum that is grounded in theory but, rather embedding this cognitive approach in a more contemplative one that brings a focus to growth and not simply educative outcomes. Owen-Smith raises some pertinent questions that may reflect the current concern with a nursing practice that is certainly being articulated, in the extreme, as devoid of compassion and emotional adroitness.

For example, she asks:

‘What are the capacities we want our students to have and what are the

capacities that they need so that they might contribute to a more sane and compassionate world?”

“How might wisdom be incorporated as a pedagogical goal?”

“ How might we assist our students and ourselves in moving through life consciously rather than unconsciously?” (2008: 32)

This potential lack of an ontological turn in nurse education may be reflective of an out-dated rationalistic paradigm that in theory at least was supposed to be replaced by a more holistic approach to nursing care but which I would suggest has got stuck consequential to a lack of effective emotion based education within the context of behaviourist institution.

As a lecturer, Owen-Smith’s questions are just as applicable, if not more so. To separate compassionate, emotional phronesis from ourselves as carriers and teachers of nursing artistry is to disconnect who we are from what we do. Not

always written out in Journal form but always pondered was the challenge: “

how do I model the emotional wisdom I believe nursing education should embed in todays nurses”?

It may be conjectured that, as has been observed from this small study group, there are those who enter into nurse education with an ability gap with regard to any one or combinations of the Branches of Salovey’s & Mayer’s EI model (1990, 1997). A lack of ability to read people may lead to disjuncts in caring practice. The affective learning space - that space in which the student can encounter, mayhap confront her own emotional history, and re-orient towards an integrated nursing practice would appear to be lacking from these participants’ University based learning experience. Could it be that such is the case due to an over-emphasis upon a curriculum that is weighted towards an epistemology of competency with little inclusion of space for an ontological orientation in learning?

The distinction I am contending for is that of ‘knowing’ and ‘being’. Owen-Smith (2008) and Barnett, (2007) bring a focus on the learner that reflects Heidegger’s notion of Dasein as Being-in-the-world’. The student nurse, as Dasein, lives and breathes in his or her world, the nurse educative world, and in such exists in relation to other Daseins. Knowledge that does not translate into how each student nurse comports himself or herself, lacks authenticity and integrity. I would suggest that a ‘knowing what’ and ‘knowing how’ requires a conscious balance with a Being how. In terms of one’s emotional identity this speaks of emotional equanimity. To accept that such emotional poise is only limited to an epistemological curriculum is to render a lack of justice to who our students are. Barnett (2007) in his discussion of the will in a students learning, focuses on this key aspect of the student, they give themselves to learning. This giving of themselves to learning is an ontological orientation. Barnett, (2007) suggests that as a student gives of him or herself they demonstrate a ‘will’ to learn. This willingness is an act of commitment and evidences a mode of being in their world, a world of classics, and a world of literature, or of economics, or of nursing. This aspect of will as existence blends existentials such as temporality

and spatiality together in the experience of the student nurse. This blend of lifeworld existentials of time and space may present a challenge to nurse pedagogies that appear weak in connecting theory and practice based learning (Allen, 2000;Landers, 2000; Harwood, 2011). Participants in this study spoke of a gap in emotion-based learning and of the challenge of applying theoretical components of practice to the lived world of nursing practice. This is represented by the sub-themes of ‘shifting learning contexts’ and ‘bridging the

cognitive- emotions gap in learning’.

To identify the student in this way is not to seek to confuse the issue of learning from theory and from practice. It is to recognise however that the student is present in the world that they inhabit and indeed that they turn-up in that world. How they do turn up is connected with where they came from- hence the value of having raised and explored notions around kinsfolk legacy. How they turn up in their world is also connected to who they are becoming- the journey from neophyte to registrant. Student nurses are taught their craft, or their art within a competency-based curriculum. The Nursing and Midwifery Council (NMC) has set down standards of education achievement for both higher education providers and for all students to successful graduate and register as a nurse in the UK.

Theoretical competency is important in terms of nursing practice. EI is noted as being comprised of competencies as well as being a competency (Cooper & Swarf, 1997). Know-what linked to know-how is important. Competency is not in itself devoid of any associated sense of wellbeing. Griffin & Tyrell, (2013) state that we each have a need to be successful and to be achievers. Additionally, within the context of providing nursing care, a lack of competence is fraught with risk and harm. Griffin & Tyrell, (2013) remind us of the physiological response to achievement in the form of dopamine being released into our bodies and the subsequent feeling of pleasure. Along with the need for autonomy and relatedness that they cite, it may be stated that cognitive achievement, success in achieving grade passes in a theoretical competency driven curriculum, is not in itself wrong. However, this biad of competence and autonomy situates the

individual in a dynamic relationship with the ‘world’ of the other. In order to give due consideration to the challenge of apprehending the affective learning space in a meaningful way, curriculum models, and pedagogical intent requires addressing. Otherwise, we may not appreciate that a space exists, or that there is a need to address student nurses’ learning needs around emotion-based knowledge and understanding, and their desire for competency in doing and attention in ‘Being’.

Participants highlighted that, whilst in the educational setting of the classroom, they were ‘taught’ topics such as palliative care, communication, and handling relatives of the dying. It was not until they were at their placement that they were able to observe, participate, and gain insight through being-in-the-world of that context. Emotions and feelings are powerful realities in the learning experience (Dirkx, 2002). Competency based curricula that engineer the production of knowledgeable doers and safe practitioners are, I would suggest predicated on a rational approach to the role of emotions in learning where the emotional is constructed more as an obstacle to learning than a motivator. As Dirkx, (2002) highlights education is shaped by information and reason is used in order to reflect and learn from experience.

Participants in this study populated this affective gap by their own acknowledgement that they entered upon this educational process emotionally:

“I’ve just got a really good supportive husband who encouraged me to do

it. He did what he wanted to do and always has done, work-wise, which has paid the bills and now, we were financially in a position to be able to do it. It was my time. So, yeah, still very scared”. [Becky, Int. 1 L2]

“Okay, okay. We might come back to that later. (Laughter). Okay.

Super. So, here we are…what…six months in to your nursing? I think it’s scary”. [Sadie, Int.1 L29]

Denzin, (1984) states that should we seek to understand anyone then we need to understand emotion. Emotion is that expression of self that resides within each of us and is expressed in how we comport ourselves and shows up in our

‘world’. That is as true for the learner as it is for the teacher. Thus, there is a need to engage this affective gap for learning to be enhanced. To learn nursing is to expose the mind to conceptual knowledge and understanding of topics such as anatomy and physiology, care giving, nutritional balance, care of the dying, trauma care principles, and skills based learning. It is also exposing the heart to emotions, and to the demands and contradictions of emotions. For example, we get angry because of injustice observed and yet we feel guilty or sad that we lost our emotional equanimity in the first place. We find ourselves physically caring for someone, yet angry at the cause that brought him or her into our care; for example a self-inflicted wound, or illness. Hence, the challenge facing competency-based learning located in HEIs is that of bridging the theory –practice gap that has been noted in the literature (Burke, 2005, Betts, 2006) and has been highlighted by participants in this study. Neuroscience attests to the increasing recognition that the rational and the emotional are not competitors in the creation of sound decisions or meaningful actions, but rather as demonstrated by Damasio, (1994, 1999) they are complementary to one another. This collaboration serves the development of a meaningful emotional identity that values both mind and heart.

Damasio (1999) argues that the evolution of emotions was predicated on a simple dichotomy- to gain pleasure, and avoid pain. Hints are evident here of the signalling system of the emotions that guide human decision-making and adaptation as part of an individual’s coping mechanism, (Stein & Book, 2006). The point being expressed by such sentiments is that success, or, the gaining of pleasure, or happiness is not simply linked to notions of accumulation of ‘treasures’ but the ability to:

“…get along with others was crucial to the survival of the early hunter-

gatherer societies” (2006:15)

History and experience would seek to demonstrate that this reality is as true today as it was then. Cognitive excellence is weakened by a lack of ability to socialise. As Stein & Book (2006) state that being brainy but rubbing people up the wrong way is not beneficial. Cognitive intelligence may be important and

valid but it is not the full measure of an individual. That of course is not to denigrate the value of cognitive intelligence or to assert wildly (as was done in the early days EI’s popularisation in the press) that EI is of more benefit or kudos than general intelligence. Those outlandish claims undermined the development of EI then and still serve to undermine general acceptance of the concept even today (Matthews et al, 2004). As a nurse educator, this is both a cause for concern and a challenge in terms of effective pedagogy.

The effective focus of ability EI that is used as a basis for this study is its use of cognition, rather than personality. Data transcripts demonstrate that students are seeking to use their emotions intelligently as they engage in their nursing practice.

For example, the following examples evidence this link: Sally

“I think when you're in a ward, you have to kind of forget your own

emotions.

Because you cannot go into a ward if you split up with your boyfriend or something like that and sit and cry. You're there to look after people. You're not there to be...feeling sorry for yourself. It's a job. You're there to look after people. If you're there feeling sorry for yourself and look upset, the patients aren't going to be very...they're not going to think...they're going to think, "Oh, she is a bit...like she is upset." Or whatever. You just have to go in and be the nurse. You go in as student nurse. You do not go in as Sally (Sally, Int.2 L184).

Mary

Like I said, the therapeutic relationship to me is really important now because when I go in and sit down with that patient who is just come onto the ward, they’re really scared that, you know, they might not have been in a hospital before, they might not have left their partner before. I can sit there, I can explain things, and I could say, you know, “I know it’s scary, but if you’ve got any questions, I can answer it or the doctor can answer

it.” You know, just the reassurance and then get to know them so if they are scared…. Like one woman was upset because she left her cat at home. She was worried who was going to look after her cat. Then she was really agitated. But after you say, “Look, I’ve spoken to your son or spoken to your neighbour, they’ll look after the cat for you. It’s okay.” You can see them relax. And if they’re going to be relaxed and a bit more comfortable, then it’s going to speed their recovery. So again, getting to know the patient. (Mary, Int3. L.196)

Emotional literacy is as Steiner & Perry, (1979) suggests the ability to recognise