When Benner and colleagues investigated the state of undergraduate nursing education for the Carnegie Foundation, the deficits they found led them to recommend that nurse educators develop two new pedagogies: pedagogy of inquiry and pedagogy of contextualization (Benner, Sutphen, Leonard, & Day, 2010). Benner and colleagues explained pedagogy of inquiry as teaching that depends on asking meaningful, probing questions so students will be taught how to address ambiguities in clinical situations. With pedagogy of inquiry, nursing students learn to ask good questions to solve problems in ambiguous situations.
Benner and colleagues (2010) also recommended pedagogy of contextualization. They saw an overuse of PowerPoint presentations in classroom teaching that creates learning burdens for students. The simplified, bullet point content of PowerPoint presentations and the decontextualized content that students find in their textbooks make it hard for nursing students to utilize information in clinical practice. Pedagogy of contextualization gives students context to understand clinical situations by helping them learn how to notice important details or patterns. Reading a situation is a skill of interpretation that needs to be developed, whether students learn basic or advanced practice elements of their profession.
The Theory Use Project, uses preselected motion picture film scenes as the basis for analyzing and discussing the what, the how, and the when of situations in terms of nursing theory. This teaching strategy presents opportunities to develop pedagogies of inquiry and of contextualization. For example, Orem's self-care deficit nursing theory includes nurses' consideration of the patient's "basic conditioning factors" (Orem & Taylor, 2011). A basic condition such as homelessness affects a patient newly diagnosed with diabetes in a way that is different for a patient whose basic conditions include a home, a job, and a good support system. Orem's theory asks for consideration of contextual factors, some of which can be observed and others that need to be assessed through careful, astute interviewing. Using film as the basis for classroom work, students can be taught to use nursing theory to notice relevant dimensions of clinical situations.
TEACHING THEORETICAL KNOWLEDGE SO THEORY WILL BE USED
The American Association of Colleges of Nursing's (2011)Essentials of Master's Education calls for teaching graduate students many kinds of theories because the need to use theoretical thinking has intensified. Theories help people make sense of their observations. In many disciplines, theory is taught precisely because it provides a contextual lens through which observations can be understood (Chalmers, 2013). The value of using theories in human and social sciences is that they shape how students observe, interpret, and respond to complex clinical situations. Students reap the value only if they have learned theories well enough to engage in theoretical thinking.
The Theory Use Project was designed as a film-based assignment in a graduate course on nursing theory. Students select a nursing theory to analyze a single scene from a teacher-selected major motion picture through the perspectives of three different nursing roles: staff nurse, nurse manager, and an advanced practice role (either nurse practitioner or clinical nurse specialist).
By writing three role-based uses of one theory for a single situation, graduate students learn several things. First, nursing-specific theories have not been formulated to be used in the same exact manner in all nursing roles. Some theories are more suitable for a staff nurse/direct care role, whereas other theories are suitable for management or leadership roles. Using the same nursing theory for three role-based perspectives helps students learn that each nursing role contributes something unique to the same situation, because each role is based on a different type of knowledge, role purpose, and experience. Thus, each role makes different demands on the theory, which can reveal the theory's limits (see Table available as Supplemental Digital Content 1 at http://links.lww.com/NEP/A78 for a list of films used in the course, with applicable nursing theories).
THE VALUE OF MOTION PICTURE FILMS
Films present a text-in-motion opportunity for learning that can be replayed, discussed, and considered in repeatable ways that clinical or simulated experiences cannot, even though many simulations are videotaped and replayed for educational debriefing. Recordings of simulations are not usually permitted to be taken home by individual students for repeated viewing.
Major motion pictures also provide an objective story with brief scenes that teachers and students can examine and critique in class. For this assignment, films provide templates for analysis as in a clinical situation, in the sense that the student watches a scene unfold. However, films have a different purpose than clinical experiences. Teachers can direct students before watching the scene to be attentive to aspects in the environment, body language or facial expressions, verbalized responses, and unspoken messages that are still given in some way. By pointing students in the direction of such details, the teacher helps students learn to notice details that add a valuable contextual dimension to supplement their textbook knowledge.
Pointing out aspects of the nursing theory being studied, these directions help students learn to read a situation in terms of the nursing theory. Teachers can add new possibilities for the class to discuss. For example, in one scene, a nurse violates a boundary, becomes upset, and abruptly leaves the room. The patient then states that he is scared. The teacher can ask, "What if you were that nurse's nurse manager and saw her exit the room in tears? What might you think? What might you say?" By taking the scene one step further, students are invited to talk about consequences of a conversation in a way they usually do not do. Moreover, because the scene did not personally involve the student's thinking (such as with a personal nursing experience that went awry), the emotional overlay of personal embarrassment that can become a barrier to learning is removed.
With films, teachers can detect the difference between an objective, scholarly analysis of a scene and one that is poorly formulated, superficial, or incomplete. Comments or questions can be posed by the teacher to facilitate student learning of the nursing theory if both the teacher and student are responding to the same scene. By viewing the scene in class, students can talk and bring salient points to light. It is in discussions such as these that teachers can use pedagogy of contextualization to help students notice salient details that will be important to patients. In this way, they role-model the sense of urgency needed for shifting priorities.
In Life as a House (Winkler, 2001), the main character George asks his nurse, "What would you do if you had only four months to live?" The nurse giggles and says, "Oh, I'd probably eat a lot of red meat." By analyzing this exchange in the context of the rest of the scene, students can see that the answer the nurse gave did not address George's underlying concern: that he realizes he is terminally ill. By not realizing the significance of his question, the nurse also missed the chance to address George's end-of-life needs.
Major motion pictures, especially those in DVD format, permit students to study elements of the selected issue because the film scene can be replayed and examined in the context of a known outcome (unlike real-life situations). Students need to be coached to understand what elements to notice to construct meaning about using nursing theory for clinical encounters.
Cost and availability are two reasons that motion pictures are used for this assignment. Major motion pictures are available to students through a streaming database in the college online library and are usually available in DVD format at local libraries. DVDs often permit scene selection. This feature is important for time-efficient, repeated viewing and studying of a scene. Major motion pictures are produced worldwide, so nurse educators in other countries can use films made in their own language that reflect their own culture.
Many films have multiple issues, including family dynamics issues, ethical issues, and nursing management issues. Yet, there are limitations to the use of certain films. For example, older films make it difficult for students to identify with outdated patient problems and think about the care that might be offered. Because technology and medical care have advanced beyond the time-bound situations in these films, some scenes are incomprehensible. In addition, some films have explicit scenes of sexual or violent content unsuitable if the student has small children at home. The syllabus lists the film's rating, and at least one film should have a G rating.
IMPLICATIONS FOR NURSING EDUCATION
The Theory Use Project was designed to be an independent assignment to help graduate students learn to use nursing theory. It has been used with students preparing for advanced practice or leadership roles, but it could also be used in a modified format with undergraduate students. For example, the analysis could be limited to the staff nurse perspective contrasting two theories for the same scene.
The assignment can help students understand how the intentional use of theory can affect their expanded, leadership, and advanced practice nursing roles. As with the scene from Life as a House, teachers can help students see the difference between the patient's actual question and his deeper, underlying concern. This assignment is an uplifting experience that fosters more learning about theory use than standard assignments. After completing this assignment, many students have expressed their appreciation for learning nursing theory in depth.
REFERENCES