Transformative teaching in nursing education: preparing for the possible

Transformative learning theory applications in health professional and nursing education: An umbrella review

OBJECTIVES

This review intended to synthesise existing evidence on the application of transformative learning theory in nursing education.

DESIGN

An umbrella review, or review of reviews.

DATA SOURCES

Six databases were systematically searched: CINAHL, Cochrane Reviews, Ebscohost, OVID, ProQuest Central, and PubMed. The structured framework of PCC: Population/Concept/Context was employed to identify relevant literature, published in English between 2012 and March 1st, 2022.

REVIEW METHODS

Elements of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guided this review. A modified version of the Johanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews and Research Synthesis was applied to determine final inclusions.

RESULTS

Sixteen (16) reviews were included. Most reviews were scoping reviews. Nursing featured in 10 of the 16, medicine in half (8/16) and various allied health disciplines were reported in seven reviews. Studies reported on differing scholarly approaches to transformative learning theory. Curricula design and evaluation, developing leadership skills and a professional identity were common applications. Critical reflection and learning experiences that challenge students' and professionals' existing ideologies also featured. Few reviews reported on studies of models and tools for educators to guide them in applying the theory in lesson design and teaching practice.

CONCLUSION

Applying transformative learning theory in curriculum design, program evaluation and healthcare professional education can be beneficial. There were reported successes and some critiques. Researchers should design more rigorous studies to evaluate the theory in practice and to develop and test frameworks that guide educators in teaching with transformative learning theory.

Rethinking Goals: Transforming Short-Term Global Health Experiences Into Engagements

The authors challenge the conventional wisdom guiding what participants in short-term experiences in global health (STEGHs) should be learning. Medical students and residents from the United States have been told to focus on standardized competencies and ethical principles, in addition to the biomedical knowledge, skills, and attitudes highlighted by working internationally. The authors suggest that although these training goals are important, they may divert learners from developing their professional identities in ways that contribute to the health of all persons, especially those who are economically poor and socially marginalized. The authors postulate that such a professional transformation will occur only if STEGH participants attend to 5 key learning goals: develop contextual inquisitiveness, grow in insightful understanding, nurture global humility, cultivate structural awareness, and critically engage in the pursuit of creating equitable and just societies. Further, the authors argue that only by attending to these goals will any genuine change in the root causes of inequities in health outcomes occur. The authors review these goals and encourage their use for professional and pedagogical purposes over the duration of any STEGH-before departure, while in host communities, and upon return home.

At sea with disability! Transformative learning in medical undergraduates voyaging with disabled sailors

CONTEXT

Attitudinal objectives are difficult to formulate, teach and assess; yet good attitudes are fundamental to good practice. For instance, studies highlight negative attitudes to disability in the medical student community that contrast with the self-conceptions of disabled persons. This study was designed to better understand attitudinal learning, inadequately addressed by contemporary programmes, through the application of Mezirow's 'transformative learning theory' (TLT) to a novel educational intervention.

METHODS

Participating students went to sea, for voyages of 5-7 days, in tall ships operated by the Jubilee Sailing Trust. Each student was buddied with another sailor living with disability. Disabilities included cerebral palsy, loss of sight, loss of limbs and paraplegia. Students recorded their experiences using audio diaries, written logs, formal voyage reports and art work and in post-voyage seminars. The data were analysed using interpretive phenomenological analysis, and the results are considered under five themes suggested by Mezirow.

RESULTS

Sixteen students were recruited, with four students sailing on each of four separate voyages. Each student recorded audio-diary entries, which had a total duration of between 10 and 212 minutes. For seven of the 16 students, the five key elements of TLT were demonstrable, suggesting that transformative learning, as described by Mezirow, was occurring. Drawing on diverse qualitative data, insights into different aspects of this transformation are provided.

CONCLUSIONS

TLT can be used to characterise, and thus design, educational interventions to meet attitudinal learning objectives. Students can be helped to discover their less helpful frames of reference. In safe environments these frames can be challenged and subjected to personal and communal reflection. Drawing on audio diaries and other evidence, and in answer to critiques of contemporary medical teaching on disability, we demonstrate such transformation in students 'at sea with disability', highlighting elements that could potentially be transferred to the mainstream curriculum.

The importance of teaching and learning resilience in the health disciplines: a critical review of the literature

This paper, based on a review of the literature, discusses resilience and the application of resilience research to nursing education. The paper advances the educational discourse on professional preparation, arguing that resilience theory should be part of the educational content and taught in a way that promotes reflection and application in order to give students strength, focus and endurance in the workplace. In addition, we argue that resilience and similar qualities ought to be emphasised in clinical experience courses, internships, work integrated learning and other work experience courses. Recommendations for building resilience in health professionals through education, training and modifications in workplace culture, as well as suggestions for priorities in research are presented.

Teaching and Learning Practice Development for Change

The current expectation in health care for nurses to use research evidence when making decisions about patient care practices requires a change in the culture of nursing service delivery. There are many different approaches to support this change. One approach frequently referred to in contemporary literature is practice development, which aims not just for understanding and acquiring new knowledge, but also for implementing change by improving clinical practice and increasing effectiveness in patient care. Its success depends on skilled change agents or facilitators. This article discusses strategies used in a workshop to educate and prepare practice development facilitators for effecting change.