The Effectiveness of Feminist Pedagogy in Empowering a Community of Learners

What factors empower general practitioners for early cancer diagnosis? A 20-country European Delphi Study

Background:

Some symptoms are recognised as red flags for cancer, causing the General Practitioner (GP) to refer the patient for investigation without delay. However, many early symptoms of cancer are vague and unspecific, and in these cases, a delay in referral risks a diagnosis of cancer that is too late. Empowering GPs in their management of patients that may have cancer is likely to lead to more timely cancer diagnoses.

Aim:

To identify the factors that affect European GPs’ empowerment in making an early diagnosis of cancer.

Methods:

This was a Delphi study involving GPs in 20 European countries. We presented GPs with 52 statements representing factors that could empower GPs to increase the number of early cancer diagnoses. Over three Delphi rounds, we asked GPs to indicate the clinical relevance of each statement on a Likert scale.

The final list of statements indicated those that were considered by consensus to be the most relevant.

Results:

In total, 53 GPs from 20 European countries completed the Delphi process, out of the 68 GPs who completed round one. Twelve statements satisfied the pre-defined criteria for relevance. Five of the statements related to screening and four to the primary/secondary care interface. The other selected statements concerned information technology (IT) and GPs’ working conditions. Statements relating to training, skills and working efficiency were not considered priority areas.

Conclusion:

GPs consider that system factors relating to screening, the primary-secondary care interface, IT and their working conditions are key to enhancing their empowerment in patients that could have cancer. These findings provide the basis for seeking actions and policies that will support GPs in their efforts to achieve timely cancer diagnosis.

Non-greeting rituals in clinical placements

BACKGROUND

This study aims to generate knowledge about how clinical placements contribute to the creation of sustainable nursing education in Denmark. The article discusses how nursing students feel socially excluded when registered nurses do not recognise them through deviating from culturally appropriate greeting rituals.

METHOD

A constructivist grounded theory study of (n = 15) individual semi-structured interviews with nursing students in their first and third years of study.

RESULTS

Nursing students feel awkward, alienated and uncomfortable when confronted with a culture where registered nurses do not greet them. They are met by the attitude that Bauman refers to as "appropriate indifference," which means that the registered nurses act as if they neither see nor hear them because they are considered faceless private failures.

CONCLUSION

Nurses' non-greeting rituals in clinical placements counteract the creation of sustainable nursing education. The aim of this article is to contribute with knowledge about socially inappropriate non-greeting rituals and recommend friendly and socially sustainable education in clinical placements.

Using popular education with health promotion students in the USA

Recent publications have called for new approaches to training the next generation of health promotion professionals, for whom effective practice depends on understanding how systemic inequities are created and function and how they can be dismantled. These approaches gain particular urgency in the context of recent trends toward commodification of knowledge at both the secondary and post-secondary levels. Popular education, a liberatory pedagogy, has been used in social movements around the world for decades. In a health promotion context, its use has been associated with increased empowerment and improved health. To explore the potential of popular education (PE) for helping health promotion students develop a systemic analysis of power and privilege and the concrete skills needed to address health and social inequities, we conducted a case study in the context of a community organizing class in a Master's in Public Health curriculum. Analysis of mixed methods data collected from students suggested that PE, with its focus on concrete practices and interactions, is a valid alternative to conventional pedagogy and a useful complement to liberatory pedagogies more common in university classrooms. Application of PE in higher education will require overcoming barriers, including student resistance and institutional pressures that discourage its use.

Critical caring theory and public health nursing advocacy for comprehensive sexual health education

Public health nurses (PHNs) often work with adolescent populations at risk for unplanned pregnancies who do not have access to comprehensive sexual health education (CSHE). Evidence-based CSHE can have a significant protective effect on adolescent sexual behaviors. This article applies critical caring theory to public health nursing advocacy for CSHE. Critical caring theory defines the social justice work of PHNs as an expression of their caring as nurses. The lack of CSHE in schools for adolescents is a social justice issue, and PHNs can be important advocates. The purpose of this article is to explore how critical caring theory can inform public health nursing practice regarding the importance of CSHE advocacy with the goal of creating equitable access to CSHE for all adolescents.

Empowerment in nurse leader groups in middle management: a quantitative comparative investigation

AIMS AND OBJECTIVES

The aim was to investigate structural empowerment in nurse leaders in middle management positions. Objectives were to determine levels of empowerment of nurse leaders and to compare levels of empowerment between nurse leader groups.

BACKGROUND

Access to formal and informal power, opportunity, resources, information and support are determinants of structural empowerment. Empowerment of nurse leaders in middle management positions is vital given their roles in enabling nursing teams to deliver high-quality care, benefitting both patient and workforce outcomes.

DESIGN

Quantitative component of a mixed methods study using survey principles.

METHODS

The Conditions of Work Effectiveness Questionnaire II was distributed to the total population (n = 517) of nurse leaders in an NHS Foundation Trust in England. Nurse leader groups comprised unit leaders (sisters, matrons) and senior staff nurses. Quantitative data entered on spss v 17/18, were analysed using descriptive and inferential statistics.

RESULTS

Overall, the unit response rate was 44·1% (n = 228). Levels of total and global empowerment were moderate and moderate to high respectively. Groups did not differ significantly on these parameters or on five elements of total empowerment, but significantly higher scores were found for unit leaders' access to information. Significantly higher scores were found for senior staff nurses on selected aspects of informal power and access to resources, but scores were significantly lower than unit leaders for components of support.

CONCLUSIONS

A moderately empowered population of nurse leaders differed in relation to access to information, aspects of support, resources and informal power, reflecting differences in roles, spheres of responsibility, hierarchical position and the constraints on empowerment imposed on unit leaders by financial and resource pressures.

RELEVANCE TO CLINICAL PRACTICE

Empowerment of nurse leaders in middle management is vital in enabling nursing teams to deliver high-quality care. Roles, spheres of responsibility, hierarchical position and constraints imposed by financial and resource pressures influence nurse leader empowerment. Administrative support is needed to sustain practice engagement.

Empowerment and being valued: a phenomenological study of nursing students' experiences of clinical practice

AIM

The aim of the study was to explore the empowerment of nursing students in clinical practice. This paper focuses on 'being valued' as an important element of empowerment.

BACKGROUND

Empowerment of nursing students is necessary in order for them to foster a sense of control and self-efficacy for those in their care. However, there is very little research on how to empower nursing students. Moreover, there is limited literature that specifically addresses the importance of students being valued in clinical practice.

METHODS

Thirteen, first-year nursing students were recruited using purposive sampling. Data were generated through the means of in-depth, semi-structured interviews. Hermeneutic phenomenology was chosen as the underpinning philosophical approach because of its emphasis on actual experiences.

FINDINGS

Being valued as a learner, being valued as a team member and being valued as a person are important factors in the empowerment of nursing students in clinical practice. These invariant themes are evident either implicitly or explicitly in the experiences of most students.

DISCUSSION

When nursing students are valued as learners, team members and people, they feel empowered. Too often however, they experience disempowerment as a result of feeling devalued. This has a detrimental impact on their learning and intention to continue on the programme. According to the accounts of many nursing students effective mentorship and a supportive environment are factors that influence empowerment significantly.

CONCLUSIONS

Strategies to promote the empowerment of nursing students in clinical practice need to address their sense of value.

Current trends in feminist nursing research

Despite an increasing number of feminist studies in nursing, few reviews on current trends in feminist nursing research have been published. This article aims to explore the current trends in feminist nursing research and provide recommendations for future feminist studies in nursing. In multiple database searches, 207 articles were retrieved. These were reviewed based on 5 criteria: (1) epistemological background, (2) research questions, (3) research participants, (4) research methods, and (5) implications for changes. The review indicated that feminist nurse researchers with diverse epistemological backgrounds adopted new research methods to ask new questions; expanded their focus to include differences in ethnicity, class, sexual preference, and disability; and incorporated these diversities among women in a global context in their research. Based on these findings, recommendations for future feminist research in nursing are outlined.

Increasing bioethics education in preclinical medical curricula: what ethical dilemmas do clinical clerks experience?

PURPOSE

The increase in bioethics education in preclinical curricula enables medical students to recognize ethical issues and determine right action. The authors sought to explore the ethical dilemmas medical students experience during clinical clerkships.

METHOD

Following an e-mail invitation, 100 of 104 graduating medical students allowed their final ethics assignment, a written description of an ethical dilemma experienced during clinical clerkship, to be analyzed. After all identifiers were removed, the narratives underwent qualitative analysis and were then reanalyzed using Jameton's determinants of moral action.

RESULTS

Four themes emerged: the clinical service rotation, target, source, and nature of the ethical dilemma. For many clinical clerks, the ethical dilemma arose because they recognized an ethical issue but neither brought it to their supervisors nor resolved it themselves for fear of incurring disfavor. The source of the ethical dilemma was most frequently the student's supervisor (46%), which may explain why, although all narratives demonstrated the Jameton criteria of "moral sensitivity" and 76% demonstrated "moral judgment," only 24% indicated "moral motivation" and only 4% suggested "moral courage." Patients were the most frequent target (76%), followed by students (14%). Students reported informed consent (18%) and inadequate care (17%) as the most common types of dilemmas under the nature theme.

CONCLUSIONS

Clinical clerks' experiences of ethical dilemmas might be mitigated if residency education and professional development mirrored the increase in preclinical ethics education, if ethics training included encouraging students to discuss ethical issues as they arise, and if educators developed innovative models of student evaluation.

The meaning of empowerment for nursing students: a critical incident study

AIM

This paper is a report of a study to explore the meaning of empowerment for nursing students in relation to their clinical practice experiences.

BACKGROUND

Empowerment and power are well-researched areas of nursing practice, particularly in relation to Registered Nurses. Furthermore, several studies have considered the experiences of nursing students in terms of nursing culture and socialization. However, few researchers have focused specifically on nursing student empowerment.

METHOD

The critical incident technique was used and anonymous data were collected between November 2005 and January 2006. One hundred and nine written critical incidents were provided by 66 nursing students relating to empowering and disempowering experiences in clinical practice. The data were content analysed.

FINDINGS

Nursing students experience both empowerment and disempowerment in clinical placements, centring on three issues: learning in practice, team membership and power. Continuity of placement, the presence of a mentor and time underpinned empowering experiences whereas their absence had a disempowering effect.

CONCLUSION

The consequences of nursing student empowerment are high self-esteem, motivation for learning and positive regard for placement. Supportive mentors play a pivotal role in the empowerment of nursing students and it is essential for the nursing profession that they are supported to undertake their mentorship role.

Using narrative pedagogy: learning and practising interpretive thinking

AIM

This paper reports a hermeneutic study undertaken to explicate students' experiences in educational courses in which teachers enact Narrative Pedagogy.

BACKGROUND

International interest in developing and implementing discipline-specific pedagogies is becoming commonplace as teachers respond to the challenges of preparing students for contemporary practice. Lifeworld Pedagogy, developed in Scandinavia, and Narrative Pedagogy, developed in the United States of America, Canada and New Zealand, are two approaches developed from nursing research for nursing education that provide teachers with research-based alternatives to conventional pedagogy. Further research is needed, however, that addresses how new pedagogies are experienced in schools of nursing.

METHOD

Teachers and students from 22 schools of nursing in the United States of America were interviewed over a 4-year period between 2002 and 2005. Using interpretive phenomenology as the philosophical background and Heideggerian hermeneutics as the method, accounts from 52 participants were analysed by a research team.

FINDINGS

The theme Learning and Practising Interpretive Thinking reveals how reform is occurring in schools of nursing that use Narrative Pedagogy. It documents how Narrative Pedagogy helps students challenge their assumptions and think through and interpret situations they encounter from multiple perspectives. Findings suggest that by focusing teachers' and students' attention on thinking and interpreting as communal experiences, interpretive pedagogies such as Narrative Pedagogy engage teachers and students in pooling their wisdom, challenging their preconceptions, envisioning new possibilities for providing care and engaging with others to ensure patient-centred care and safety.

CONCLUSION

By documenting students' experiences in courses in which Narrative Pedagogy is used, this study provides teachers with research-based evidence to guide their pedagogical decisions. It extends international efforts to develop discipline-specific pedagogies and offers a practical, student-centred approach teachers can use to enhance students' thinking.

Teaching public health through a pedagogy of collegiality

Curriculum development in masters of public health programs that effectively meets the complex challenges of the 21st century is an important part of public health education and requires purposeful thinking. Current approaches to training the public health work-force do not adequately prepare professionals to be culturally competent in addressing health disparities. Principles of community-based participatory research highlight the importance of building relationships of mutual accountability and emphasize collegial teaching. We present background and theoretical foundations for a pedagogy of collegiality and describe specific teaching methods, classroom activities, and key assignments organized around 4 essential features: principles of community organizing, building community and valuing diversity, engaging the senses, and writing across the curriculum.

A critique of Freire's perspective on critical social theory in nursing education

Nursing has been perceived as oppressed by virtue of among other things gender, occupation and class. It has been suggested that historically, nursing education perpetuated the rituals of tradition and was oppressive in terms of what was taught and how it was taught. Developments in nurse education have resulted in nurse educators seeking alternative means of educating, with the aim of emancipating nurses. Paulo Freire (1921-1997) promoted liberation through reflection and action, directed at transforming the conditions which lead to oppression. The fundamental basis of this approach is critical social theory, which is underpinned by the philosophy that social phenomena must be understood in terms of their context and history. From a critical social theory perspective, fruitful nursing education will only be possible if the history and structure of nursing are clearly understood by those involved in the educational process. We contend that the adoption of Freire's theory in nursing education may contribute towards the development of nurses who will be competent to meet the demands of contemporary healthcare practice. However, the application of this theory to nursing education can be challenging because of constraints imposed by the system in which nurse education takes place. It is therefore important that the application of critical social theory in nurse education be evaluated.