RESTRUCTURING THE NURSING VISION STATEMENT FROM THE KUHNIAN CIRCLE VIEWPOINT
Jesus G. Ocapan1*, Rozzano Locsin2
1Misamis University, Ozamiz City, Misamis Occidental, Philippines
2Florida Atlantic University, Boca Raton, Florida, Tokushima University, Tokushima, Japan
*Corresponding Author’s Email: ocapan_jesus@yahoo.com
Abstract
A reliable set of nursing skills is essential in delivering high quality health care to patients. However, apart from exceptional knowledge and nursing abilities, a health service provider should have the compassion and empathy to better relate and serve their patients. These ideal characteristics of a nursing professional are developed during the formative years while studying in an academic system. Yet, a lot of nursing institutions are still using the traditional paradigm, which may not support a holistic approach in developing nursing students. This traditional pedagogy is reinforced by the nursing institution’s vision statement.
The aim of this article is to present and discuss in what way a paradigm shift that aims at restructuring the nursing vision statement from the Kuhnian circle viewpoint, is essential to invigorate a nursing pedagogy that fosters a holistic approach to nursing education in which compassion and care are expressed as ideals of nursing education.
Keywords: Nursing Vision, Kuhnian Circle, Healthcare
“Plants are shaped by cultivation and men by education. . . We are born weak; we need strength; we are born totally impoverished; we need aid; we are born stupid, we need judgment. Everything we do not have at our birth and which we need when we are grown is given us by education”. --Jean Jacques Rousseau
Introduction
Nurse educators face challenges in facilitating student learning towards developing nursing skills and forming viewpoints within a nursing perspective. There are several educational theories that influences teaching-learning; there is behaviorism, cognitivism, constructivism, humanism, and the 21st century learning method where students are provided with skills that prepare the students to the digital age (David 2015). According to a behaviorist’s point of view, a change in behavior among students can be achieved by stimulating students as the teacher waits for a response from them (McLeod, 2017). It is then easy to say that students are results of the kind of education and culture they receive from their instructors within the nursing academic system.
Several nursing strategies are used in managing nursing students. These include lectures, concept mapping, high-fidelity simulation, online course, games, role playing and others. However, the oldest and most widely used method today is lecture (Xu, 2016). Lecturing is a straightforward way to quickly impart knowledge to students. However, there are those who believe that lecturing is ineffective as an instructional method (Stein, 2008). For them, lecturing gives the students a passive-non-thinking, information-receiving role, through which they are provided with information but are not offered the opportunity to process it. Due to this, some nursing institutions are already adopting the paradigm that students are complex human beings and a
unified whole (Rogers, 1970). This phenomenon has transformed the nursing education into a complex network which demands to review the traditional management of nursing students.
The traditional approach in nursing education, although an essential concept and is still widely used in nursing institutions, delivers lessons in lecture-type with lesser teacher-student and student-student interaction. The traditional teaching approach in nursing is teacher-centered and pedagogies used in the classroom often create passive learning (Tedesco-Schneck, 2013). Thus, it limits the holistic development of nursing students since they focus on concepts, theories and lessons without honing the human aspect in nursing such as communication, empathy and the capacity to care and treatment of patients as individuals and not mere case studies. As Freire posited, an overt reaction is demonstrated, in the form of discourtesy, if a person objectively perceives the person and seemingly challenging the former (Anderson, 2016). Usually, traditional management of students results in incivility in the classroom and in clinical settings (Goodin et al., 2008). Discourtesy could easily transcend in the healthcare environment if this is not resolved during the educational process. Fortunately, innovative strategies are available that facilitate critical thinking and motivates students to be more involved in the learning process (Salani, 2017).
Students need to develop caring capacities to appreciate nursing of patients, as they will eventually apply these capacities in their nursing profession. With this challenge in mind, it is commendable to revisit the philosophy and guiding principles of the institution, such as the vision of the college of nursing.
The Vision Statement
A vision statement is defined as a public declaration that educational organizations or schools use to describe their top goals for the future and what they hope to achieve when they successfully fulfill their organizational mission or purpose (“Mission and Vision,” 2015). It may describe a school’s principles and standards, its core values, its objectives, or what the institution hopes for its students after graduating.
According to the Book of Proverbs 29:18, “where there is no vision, the people perish.” This quote from Bible infers a great impact on the life of every individual, institution, company, and others. The importance of vision is sustaining a "widely shared sense of purpose” (Boyd-Dimock, 1992). It contains information that is trustworthy for the organization, thus creating a successful program (Tallant, 2009). Vision helps to strengthen the trajectory of the institutional ambitions and heighten their energy to excellence. It is an eye for the future that directs and perpetuates the educational existence for excellence (Papulova, 2014).
By looking at how a vision statement is defined, it can be easy for a nursing professor and students to surmise that a vision statement is important. Thus, it is essential to understand and take a nursing program’s vision by heart.
Importance of Vision Statement
The vision, mission, and values play a part in the organizational strategy process (Tallant, 2009). Values provide the guidance on how an organization will arrive at its ultimate vision or goal. Without strong and well-defined values, attaining a vision would not be possible.
A vision inspires action as it pulls in ideas, people, and other resources (Graham, 2015). It generates energy to make things happen while inspiring individuals and organizations to commit, persevere and deliver their best. At the same time, a vision is a practical guide in developing plans, goal setting, decision making and evaluating the results of a project, regardless if it is small or large. So it can be said that, without a good vision, a nursing program or institution will find it hard to determine whether the program is successful, the points for assessment, and the areas for improvement before the implementation of the program.
Total Human Development: The Traditional Paradigm
The word “total” is defined as comprising or constituting a whole (Merriam-Webster, 2019). However, the whole still comes from the amount of addition, multiplication, division, and subtraction. It signifies a fragmented part that when put together becomes a whole. The total is something that can be perceived and observed with objectivity. A person doing the observation creates an evaluation because of the process. Individuals who are assessed objectively are marked as either, passed or failed (Cody, 1995). Those who are being observed are like objects or non- living organisms devoid of feeling of apprehension or reaction, whether verbal or non-verbal. During the observation process, a person is not expected to react unless a task is given to him/her to comply.
According to Sen (2004), “human development, as an approach, is concerned with what I take to be the basic development idea: namely, advancing the richness of human life, rather than the richness of the economy in which human beings live, which is only a part of it.”
Total human development as a nursing institution’s vision makes the approach relevant to this ever-changing world in finding sense and ways in improving the individual’s well-being. The human development approach is an evolving idea, not a fixed, static set of precepts (De la Torre, 2014). As the world develops, concepts and analytical tools will also evolve along with it. However, the basic view at the core of human development approach remains constant and relevant as it was several decades ago. As a whole, human development can be best measured by the impact it creates on the lives of people.
The Total Human Development approach is person-centered. It considers the developmental facets, capacities and circumstances of individuals. To achieve this, certain activities are conducted to enrich the person’s cultural and social aspects to help him develop mentally or academically and emotionally or as a socially functional person in preparation for his or her practice of the nursing profession.
Total human development, as a vision, can be achieved. However, the person’s perspectives play an important role in achieving the nursing institution’s vision. As such, students should be given the opportunity to create experiences, discover life and its meaning independently. The journey of life experience is not only the scarcely defined “basic skills” (Mamoudi et al 2012) but its unfolding (world) views should be expressed by the students’ way of understanding (Perry 1999). So that they may be able to value and appreciate life. This is something that nursing institutions should reinforce: to view individuals as human beings and not merely as patients to be studied upon and cured. Students, on the other hand, should not be mere recipients of nursing instructions but they should also be agents of learning. This perception allows students to experience and understand the essence of total human development as a nursing institution’s vision.
Imbedding care and humanistic approach to students by the professors, while they are still in the nursing institution, can help in creating awareness and values formation among students, which will ultimately contribute to the fulfillment of the nursing institution’s vision. If biological reproduction is paramount in human beings, social beings should engage in cultural reproduction as well, since it is believed to be valuable in propagating philosophy and knowledge (Snauwaert 2012).
The Paradigm Change
According to Thomas Kuhn, paradigms are defined as “universally recognized scientific achievements that, for a time, provide model problems and solutions for a community of researchers” (Thwink.org., 2014). For this particular paper, the total human development, as a nursing vision is considered to be the old paradigm. For the longest time, total human development is being used by the nursing institution as its vision. However, while it is widely acceptable and has been used by the institution for long, there is a need to evolve and shift into a new paradigm. The approach being used in the old paradigm tries to develop the different facets of students to consider them complete or whole at the end of the nursing program. Failure to develop an aspect will make the development incomplete. This means that failure in the development of a single aspect of a nursing learner will affect his or her entire performance, later during his or her nursing practice. This idea becomes the basis of developing a new paradigm
The Kuhn Cycle comprises of six steps (Kuhn, 1962); the Pre-Science, where there is no paradigm yet, the Normal Science where there is a paradigm that works and is based on scientific model, the Modern Drift step where new questions were discovered out of accumulated anomalies, the Model Crisis where unsolved anomalies appear that the model cannot explain, the Model Revolution where a new candidate emergences thereby causing resistance from members, the Paradigm Change wherein a single new paradigm emerges and the field changes from the old to the new paradigm (Thwink.org., 2014). When a new paradigm is developed, the new Normal Science emerges resulting to the completion of the Kuhn Cycle.
The total human development has been used as a vision for several decades now that field members saw the need to change the paradigm, which paved the way to the development of modern nursing teaching method to create self-directed, autonomous practitioners (Var 1997).
By looking critically at the Kuhn Cycle, this paradigm shift in nursing education, through its vision, can be categorized under the Paradigm Change step, where a new approach in nursing education has begun to change the old model to a new one.
Continuing Dynamic Engagement in Multi-Dimensional Education: The New Paradigm
Valuing life through Continuing Dynamic Engagement in Multi-Dimensional Education expresses a significant concept that a student as a whole is unified being with different layers of meaning and experience through continuous active engagement with the environment. Each student is unique in having a vibrant assemblage of experiences, emotions, thoughts, wishes, fears, and hopes (Venugopal, 2018). This new paradigm of vision in nursing education is conceptualized following Rogers’ theory which looks at the human being as more than and different from the sum of parts (Cody, 1995). This entity cannot be reduced into a part and be isolated from the whole. Each aspect of human being is interconnected with each other, harmoniously and meaningfully.
The vision defines the human being as an irreducible being that can be directly affected with the environment. A person is an open system whose personal knowledge and choices based on personal values can be a partaker of a situation with the cosmos. The vision of holistic education relates that every individual seeks identity, the meaning of life and experiences, and purpose in life through connections to community and the natural world and humanitarian values (Miller 1992). Holistic education is an attitude of openness, thus liberating students to discover themselves in the complex and dynamic world around them.
The Processes of Nursing in Realizing the New Paradigm
The new paradigm can be appreciated mostly with the relationship between the instructor and the student, either in the classroom or the clinical area. During the academic years, the presence of an adviser plays an essential role in the life of the student. Teaching nursing process of engagement is critical. Based on the new paradigm, the following process of nursing is described. This is the process of nursing:
Figure 1: The process of nursing in Restructuring the Nursing Vision Statement
Graceful connection
This process is the breaking of barriers between two entities with different cultures and priorities
– between the nurse and person being nursed. Graceful-connection as a process initiates sincere and faithful attitudes, which are necessary for a student to feel comfortable with others. The student can ‘gracefully connect’ and participate in change and co-create lived realities (Lim-Saco et al., 2018). The instructor and student are empowered to discover, transform realities, create healing, toward appreciating wholeness of persons. This connectivity between the instructor and the student commences to strengthen the vision for valuing the life of students through a continuous dynamic engagement.
Equitable engaging
This process expresses an impartial relationship between the instructor and the student. Equitable engagement is a process that goes beyond the domains of a person, while developing as a way of life at work that is characterized by robustness, dedication and captivation (Bargagliotti, 2011). The process involves winning the trust and confidence of a person so that the sphere of an individual will start so the individual will be able to express concerns, defining meanings of thoughts and emotions, and relating experiences. Student as an individual deserve equitable treatment without discrimination and prejudices. Students are entities of uniqueness who are distinct from others, and must not be compared, manipulated, and infringed upon.
Equitable engaging, as a process, is initiating a more profound sense of interest in the concerns of other people. Time is recognized as an essential element in the process of getting along with others and relating oneself with other students to know their apprehensions and anxieties. With this, it can be easier for students to relate to others without reservations or fear of sharing their thoughts and experiences within and outside the campus.
Thorough-exploring
This is a process, in making oneself available to others for connection and communication. To do this, it may be necessary to schedule meetings with the students. The environment is also a factor that may deter students to attend meetings. In this process, it is essential for an instructor to stay abreast of the situations of the academic life of their students. It is a way of making the students’ commitment and willingness to participate in the expression of meaning of their own lives.
The processes of nursing will lead the instructor and the student to connect more cohesively and forge a relationship within the four walls of the classroom or even outside the clinical area. By spending quality time inside the academic institution, the nursing institution’s vision can be realized. In nursing education, caring is the most important concept that the institution should be emphasize all throughout the curriculum (Paterson & Zderad, 2008).
Discussion
“A college is an institution that exists to provide instruction” (Barr & Tagg, 2012). However, most nursing institutions all over the world are using the old paradigm in teaching students and there is no change for very long time. The old paradigm in nursing education is generally content and curriculum-driven, and uses teacher-centered approach (Peters 2000). Thus, it must be revisited to determine if this paradigm still suits the learning demands of the dynamic and ever- evolving nursing education sector. With the rise of internet technology, through which new knowledge and information is widely accessible, nursing institutions must be abreast with the students’ educational needs. These educational or learning needs are expected to be met by the nursing institutions, lest they want the students to obtain their knowledge and information from questionable sources.
While the old paradigm is a person-centered model that recognizes the capacities of an individual, it falls short on the actual engagement between the learner and his or her surroundings, society, and culture. On the other hand, the new paradigm proposes a graceful connection with others, through co-existence in shared realities and experiences. Students have the potential to relate with other people because of their life experiences and acquired knowledge (Peters, 2000). With this approach, both the students and the teachers learn from each other, thereby promoting an
exchange of ideas and sharing of knowledge. Institutions that practice the new paradigm offer and produce more learning experiences for its students (Barr & Tagg, 2012).
Evidence-based nursing is an approach that enables nursing students to become more resourceful and develop inquisitiveness, resulting to improved service-delivery among patients (Kessenich et al., 1997). In the old paradigm, the student is assessed and evaluated based on what he or she has learned within the four walls of the classroom. On the other hand, the new paradigm offers more community exposure to the students for enhanced learning experience in nursing. It also offers a more cohesive connection between the students and teachers, and eventually, among their clients and colleagues in the workplace.
In the future, nursing educational institutions may come to recognize that in a dynamic world, old approaches may no longer be applicable, hence, passé. In a highly competitive world, students and nursing professionals alike, should remain updated and globally at par with their learning and application skills to remain relevant. This can be fostered by having a paradigm shift in the nursing educational institutions.
Incivility is a threat in healthcare settings (Sprunk, La Sala & Wilson, 2014). A modern vision suited to the demands of time will enable nursing care practitioners to be more compassionate and connected in dealing with others, especially among those who need their healthcare services.
Conclusion
Caring for patients is vital in nursing, more than providing medication to treat an illness. Caring should emanate from within. It is the ability to look beyond the physiological and pathological aspect of the patient. Such important value should be developed during nursing education and should be part and parcel of the curriculum. Thus, the vision of a nursing school, which serves as a guiding principle of the program, should be revisited to ensure that a holistic approach is conducted. Otherwise, a new paradigm should be installed as recommended from this study.
A nursing program or institution can derive its vision from various schools of thought and nursing approaches. However, given the substantial significance of a vision and mission statement of an organization, it is of utmost importance for the institution to be meticulous in choosing a statement as it will serve as the institution’s guiding principles. The vision that glorifies academic teaching approaches, extra-curricular or non-academic disciplines, activities, and other services offered to students must all be aligned to achieve the vision statement effectively.
While there are other approaches and concepts that a nursing school can utilize, the new paradigm of developing the entire being of a person to fully develop him or her for the nursing profession is an excellent approach. The concept intends to comprehensively develop a nursing student. It must be taken with utmost consideration that nursing professionals deal with human beings as their patients. Thus, it is important that instead of developing skills that merely feed their mind, they acquire skills so that they come in contact with the human side of their patients. Genuine caring, empathy or the ability to feel for another person, sincere communication, deep concern and the earnest intention of making a person well, whether palliatively or medically, are just some of the inter-personal skills that a nurse should develop during their education process starting right from the formative years while in the nursing institution.
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