On the way to learning.
Background and Limitations
A review of the scholarly literature offers thousands of articles, papers, and books that provide commentary on the subjects of teaching and learning. I considered the cited articles to be relevant because they exemplify pedagogical strategies as alternatives to the classical classroom-lecture, note-taking, rote-memorization format.
Lave (1996) argued it is crucial to frame the study of education within explicit accounts of its different theoretical perspectives. He emphasized that learning is the identity-making life project of individuals and evolves from participation in socially situated engagements in communities of practice.
Hultgren (1995) operated within a theoretical framework of existentialism and ontology. She followed Heidegger's lesson in arguing that teaching is to "let-learn" and that the teacher engages in the process as a learner. With regard to the blurring of teacher and learner, Hultgren stated, "To let learn means: To prepare a space for listening that intertwines identities (self/other and self/society) in retrieval of being, a leading in itself that withdraws from teacher to being-in-teaching-together" (p. 377).
Gibbs and Angelides (2004) used Heidegger's concept of let-learn to present some important ideas related to phronesis or practical wisdom and being-in-the-world. Although limited, their work may stimulate interest in Heidegger's writings on the topic. They argued that experiential learning leading to phronesis or practical wisdom is preferable to models of learning currently in use. Accordingly, acquiring practical wisdom should be a goal of the education process, and students would be better served under a Heideggerian model of let-learn rather than present models that rely on assessment practices. An interesting nuance on the conception of active learning is found in Jamieson (2005). Jamieson discussed the learning techniques used by the painter Goya, who was educated as a boy by the Escolapian Fathers in a monastic school. Goya was taught to rely on his own faculties, observe, make deductions from his personal experience, discover the flexibility of his own mind, and assume responsibility for assimilating as much knowledge as possible.
I have adopted the teachings of Heidegger, who spent most of his career as a teacher. Heidegger's life work totals some 80 volumes, each presenting a challenge to proper translation and interpretation. In addition, innumerable papers and books offer differing opinions and interpretations about Heidegger's intentions. Heidegger (1993) and Richardson (2003) were selected for this article as relevant for teaching and learning and for their insight into Heidegger's philosophy of learning. In the preface to Through Phenomenology to Thought, Heidegger himself indicated that Richardson gives the most lucid commentary on his (Heidegger's) work (Richardson, 2003).
This article is not intended as an exposition of Heidegger's work. Rather it is an attempt to inquire into some of Heidegger's thoughts on teaching, learning, and thinking, and offer them as possibilities for formulating a philosophy of learning appropriate to nursing. It also is offered as an augmentative pedagogical strategy for educators and students in institutions of higher learning.
What Calls for Thinking?
In his essay "What Is Called Thinking?" Martin Heidegger (1993) described how he guided his students to define thinking by raising the issues of learning and to a lesser extent teaching. Heidegger believed that the processes of learning and teaching are related to, and reside in, a larger framework of a certain type of thinking. He did not want to direct attention to the type of thinking that encompasses calculating, figuring, planning, or problem solving. These forms of mental processes usually are associated with the scientific and the demonstrable, and are found in acquiring or implementing useful scientific and technical knowledge. They are represented by the processes of calculation and manipulation practiced in business, mathematics, engineering, and technology.
In health care, and in nursing in particular, this type of thinking is needed for the acquisition and implementation of technical knowledge and practical skills. Indeed, many nursing skills require technological, mathematical, engineering, and business competencies. Furthermore, many nursing topics and skills, particularly those taught in the early years of nursing education, such as pharmacology, physical assessment, microbiology, blood pressure measurement, injection techniques, and medication dosage calculation, depend on a calculative and deductive form of thinking. These topics and skills are essential for licensure, certification, and safety. However, nursing requires more than calculating and manipulating scientific and technical knowledge. A mode of thinking is needed that is appropriate to the nursing occasion represented by one person calling out to another for recognition and help.
What Is Thinking? What Is Its Relevance for Nursing?
Heidegger (1993) noted that "thinking holds to the coming of what has been, and is remembrance. It is a question raised on all sides and always with a sense of urgency, it hinges on nothing less than the survival of the species man and the planet earth" (p. 307). What is meant by the "coming of what has been?" Remembrance, or recollection, in a very broad sense is a process of presencing, bringing into, or letting come into, presence--unconcealing--that which lies hidden in past consciousness (Richardson, 2003). In nursing, being hidden in past consciousness refers to those aspects of nursing that have been forgotten, disregarded, overshadowed, or otherwise pushed into the background of dialogue about nursing amidst the pursuit of daily activities.
Basic Structure of Thinking in a Heideggerian Sense
Thinking is understood as the experience of attaining to or presencing, letting emerge into current consciousness, and unconcealment. And what is it that is unconcealed? It is the very nature of "some-thing," its essence. "That which has been brought into presence--is non-concealed--is truth" (Richardson, 2003, p. 373). Thinking engenders possibilities or, according to Heidegger (1993), is the way to the self-manifestation of human beings. Understanding, or a seeking of truth as a mode of being-in-the-world, is consistent with the formulation of a philosophy of learning articulated in this article.
What Calls for Presencing?
What comes to presence is some idea or image that appeals to the senses and is manifested in expressions of emotion, such as joy, sorrow, fear, pity, and exuberance. "Appealing to the senses" means a process analogous to the Greek aisthesis, loosely translated as aesthetics. Here the meaning is quite different from the usual understanding of aesthetic as a way to relate to beauty and experience art (painting, sculpture, poetry, music) as objects of sensation. For the purposes of this discussion, the nuance of the Greek sense of aisthesis is retained, that is, the idea of sensual apperception giving access to, and awareness of, some universal or primordial truths of existence.
How does this relate to nursing? The sense of touch, according to Aristotle in his De Anima, is the primary form of sense (Aristotle, trans. 1931). In his discussion of the I/thou phenomenon in inter-subjective relationships, Buber (1965), spoke of the primacy of touch in nursing activities and its elucidation as coincidence and correspondence with the knowledge of universal truths. Kleiman (2005) identified touch as the primary mode of overcoming separation between nurse and patient.
That which comes into presence calls for thinking and is available for thought or, colloquially, is "food for thought." It is more expansive and inquisitive than calculative thought and offers possibilities for questioning, wondering, awe, revealing, or interpretation by the beholder; in short, it is learning.
What Calls for Learning?
A key point Heidegger (1993) made in his lectures was that students and teachers are of equal status in the learning process. The teacher is not an elite personality dictating what is to the subordinate student, who nods in acquiescence to the teacher's brilliance. Rather, because the teacher has at least as much to learn as the student, the teacher is a participant in the learning process who helps the student to learn "learning."
What does it mean to learn learning? Heidegger (1993) used the example of the cabinet maker's apprentice, a person who learns to build cabinets and similar objects under the tutelage of the master. The apprentice's project is not merely to learn how to select and use the tools necessary to cut, carve, shape, and color wood, but also to learn how to bring forward the hidden potential of the wood in all its possibilities for transformation into furniture. The apprentice's proper learning is in bringing forth the beauty of wood as the essence of cabinet making.
In this simple but profound example, Heidegger (1993) showed how an individual, in this case the apprentice, asserts proper learning by bringing out the beauty of an object in its essential form. The proper place of the teacher is to guide the student in the process of learning by way of thinking in order to help the student learn learning, that is, to bring forward the essential nature of the object of investigation or construction. Heidegger (1993) denoted this style of participation in learning as to let learn, with the proper function of teaching as to let learn.
This metaphor can be carried to the nursing experience. Although they are necessary tools and skill, the nurse's main concern is not learning how to select and use the stethoscope, thermometer, or blood pressure device measurement, or to give an injection or calculate a medication dosage. Instead, the nurse is concerned primarily with bringing forth the essence of nursing. The nursing student asserts proper learning by bringing out the beauty of an object as it is manifested in patient care in health, sickness, or dying. That, in its essential form, is nursing. The essential form of nursing is being and becoming, participating with patients, families, students, and colleagues, in a process of becoming as much as a person can be regardless of the situation in which he or she is occupied. The reflections of a nursing student in an RN-to-BSN program exemplify this concept.
"As a practicing registered nurse, I appreciate the new technologies that assist me with my nightly duties, but on more than one occasion I have come to realize that some of the instruments remove the therapeutic touch from my care activities. When I have assessed patients' blood pressure using the manual instead of the automatic blood pressure cuff, palpating the radial or brachial pulse, patients have held onto my hand making various comments, such as 'Your hands are so nice and warm' or they would rub my hand. This never happened when I used the automatic blood pressure machines as it was a wrap, or the press of a button, and blood pressure and pulse reading would be on the screen. Some times as nurses, because of the various duties we have to perform during our shift, we do not take time to touch or speak to our patients. I have realized that most of my patients, especially the elderly, value this touch. Because of this, I now assess my patients' blood pressure when possible with the manual cuff and palpate their radial or brachial pulse."
Another nursing student wrote: "I think that my nursing care function is being stretched to a level where you cannot see the patient, only the computer screen, and all the red and green lights around him. The sound that beckons is not the scared voice of old Mr. John Doe, but the alarm on the machine that quickens my step while I remind myself to check the want ads for nurses wanted to do nursing."
Creating Out of What Has Come into Presence
Thinking always entails inquiry and wonder that inspire an act of creation from what has become known (present). This is called creative learning. Children at work in a kindergarten class can serve as a metaphor to explain this term. Starting with very basic elements, such as blocks and finger paints, children create things using their imaginations (bringing forth potentialities). They thus begin to learn principles, such as the properties of structures in stacking, balance, and center-of-gravity. In the case of paints, they learn how colors can be mixed and contrasted to create certain moods. It may be difficult, or seemingly impossible, to recognize or understand what is the object of creation because sometimes the observer must ask the creator what it is that was made with blocks, finger paints, toys, and imagination. Of course the child will hold the object up or point to it affectionately, asking the observer to recognize the truth of its reality, offering it as a token of accomplishment or affection. The observer, on the other hand, tries mightily to guess what it is, to share in the value of the work and more importantly, to be for and with the child in his or her creation.
Thus, a fundamental characteristic of the subject or object of a creative learning adventure is that it often cannot be measured by normal means of assessment, such as scores on tests or papers by which teachers measure success or failure. Part of this problem exists because teachers may not be certain about what they are attempting to measure. Creative learning responds to questioning, bringing into light through inquiry that helps overcome the limitations of language as participants try to understand what it is that appears before them. It is even possible that the image or idea formed in the mind of the creator is unexplainable as it does not have any correlate in the creator's or observer's life experience. Coming to understand something previously unknown may be called an epiphany.
The dynamic is similar to starting with an abstract construct (experience or phenomenon) and bringing forth both latent and obvious potentialities that offer possibilities for finding its essential nature or personal meaning, including discovering and affirming truths and values that contribute to an individual's identity. The nurse as creator holds up his or her creation through some linguistic form or artful presentation or the gift of presence and offers it in being for and with another.
What Calls for Teaching?
Relative to the nursing experience, to let learn is, at the highest level of abstraction, to show students how to learn by thinking. It is important to keep in mind that the learning process in nursing does not end in the classroom but is a continuous process of enhancement that carries forward in each nurse's career.
Teachers must point out to students that which is thought provoking, that which calls on them to think, that which has relevance for their essential being-in-the-world with others. For students and practicing nurses, this object of thought is fundamental, despite the ever-changing technological and business model that pervades every aspect of health care institutions.
According to Heidegger (1993), the urgency to continue to exercise thinking ability is not an option. Complacency, deference to someone or something, or rejection or subordination in any way, holds dire consequences for the human race and in particular what is known as nursing. By letting learn, the teacher thus sets the student on the road to learning by thinking, encouraging the student to think by giving him or her things to think about. By learning through thinking, the student is able to unconceal the truths of existence or essential nature of being-in-the-world.
One concern for educators is to find a way to grant each student an equal opportunity to learn. The teaching and learning strategy described here offers all students, regardless of their intelligence, capacity for memorization, energy, or physical stamina, cognitive or artistic ability, background or age, exactly the same engagement with the learning experience as every other student.
Letting Learn in the Classroom or Clinic--Authentic Presence
Before the learning process in which the teacher is a true participant can begin, the teacher must prepare to think and learn. That is, the teacher must open the way into a field of potential within which the student discovers possibilities for thought. The teacher opens the way to thinking by assuming an attitude similar to that which he or she presents to patients in a clinical setting: an attitude of open and attentive apperception, without prejudice and with an awareness of the student's presence and uniqueness. The teacher is ready to listen and to hear, and is willing to make a connection with each student that entails mutual respect for personal dignity and history. There is recognition that the student relates to the scholarship project as it imposes itself, complementing or interfering with his or her mode of being-in-the-world.
This attitude or state-of-being is characterized as authentic presence. Moving toward authentic presence assumes that individuals have as part of their historical, cultural, and environmental identity certain values and life experiences that affect how they make decisions, as well as how they will act and react to events and situations in which they become engaged. Some of these values will manifest readily in interactions with others. Some will lie hidden, latent, or quiescent, in the depths of memory. These values must be brought into current awareness to make them present for thinking, as they hold possibilities for enabling the individual's self-actualizing potential.
One of the ways to stimulate interest and participation in this process is to invite the student to engage in exercises of reflection on class activities, clinic events, and readings from the literature. Sharing personal experiences is part of this process. As the student uncovers values that are evoked by his or her awareness of, and engagement in, life's experiences, the teacher gains insight and refines and augments personal values and ethical bases.
The phenomenon of sharing intermediates the learning and presencing process, allowing what has come into presence to be brought into discourse. Not sharing what has been unconcealed is the most serious of defects because sharing is a fundamental property of being and becoming in the nursing experience (Paterson & Zderad, 1976). From a practical point of view, sharing among students can be fruitful, bringing experiences into discourse that help to illuminate the meaning and value of the experience for introspection by other nurses.
In a class of registered nurses who were pursuing their bachelor's degrees, one student shared, "Some nights I just don't want to be a nurse anymore." She described events of the previous evening, when a young father was brought into the emergency room after choking on food. Health care providers had been unable to dislodge the obstruction, and he died. The student had assisted with the patient, but also interacted with the young wife and patient's parents as the realization of what had happened dawned upon them. She said, "It was awful. There was nothing I could do. I haven't slept all night."
As the student told her story, the rest of the class members were absorbed intently and supportive of her. There was an aura that a cocoon was being formed around this student made of kindred spirits who totally identified with not only this experience, but also the truth of what it is to be a nurse. They helped her to realize the value that her offer of comfort provided for the family as they in turn comforted her.
The shared experience helped everyone in the class to connect with what it means to be a nurse, and how nurses in the community of nurses share and understand that meaning. Being present to patients and their loved ones during times of emotional turmoil evokes emotional responses that can create distress. The pain is eased through affiliation and connection to other nurses that understand and relate to this experience.
When this type of reflection is shared in class, the lecture or clinic is transformed. The gathering of a group of people attending to a particular subject becomes a moment of intersubjective ecstasy, an occasion of learning together where students and teacher affirm their own identities and that of others. It is here that the idea of let-learn comes to full bloom. It comes into being--a poiesis--like a flower blossoming from a bud. Students, especially young ones with little worldly experience, find, develop, and shape their ideas, values, personal ethics, and conceptions of relationships with others of diverse and similar backgrounds. More experienced individuals have the opportunity to explore possibilities, to rethink their values, personal ethics, and relationships with others. All students have the opportunity to locate or relocate their place in the nursing community in which they are engaged.
Wondering about thinking and learning in a Heideggerian sense offers possibilities for both theoretical and practical conceptualization and participation in the way to learn and experience nursing. However, goals of the process must be kept in mind. Unpredictable events can become distracters or send the process off course. It is letting-learn, the object and essence of the efforts of teachers and learners, that guides the wondering.
Nursing students and teachers travel together, turning their attention to thinking and learning, uncovering possibilities, and actualizing their potentialities and those of members of their community. Together they take part in learning, valuing their scholarship and nursing experiences, becoming more as persons, helping others grow, and finally, enjoying a nursing career marked by self-actualization and personal and professional growth and satisfaction.
Aristotle (350 BC/1931). De anima. (J.A. Smith, Trans. 1931). Retrieved November 13, 2006, from http://etext.library.adelaide.edu.au/mirror/classics.mit.edu/ Aristotle/soul.mb.txt
Buber, M. (1965). The knowledge of man. New York: Harper & Row.
Gibbs, P., & Angelides, P. (2004). Accreditation of knowledge as being-in-the-world. Journal of Education and Work, 17(3), 333-346.
Heidegger, M. (1993). Basic writings. San Francisco: Harper Collins.
Hultgren, E (1995). The phenomenology of "doing" phenomenology: The experience of teaching and learning together. Human Studies, 18(4), 371-388.
Jamieson, A. (2005). An essay on the life and work of Francisco Goya. Work Based Learning in Primary Care, 3(3), 236-252.
Kleiman, S. (2005). Discourse on humanism in nursing. International Journal for Human Caring, 9(1), 9-15.
Lave, J. (1996). Teaching, as learning, in practice. Mind, Culture, and Activity: An International Journal 3(3), 149-164.
Paterson, J., & Zderad, L. (1976). Humanistic nursing. New York: John Wiley & Sons.
Richardson, W. (2003). Through phenomenology to thought. New York: Fordham University Press.
Susan Kleiman, PhD, RN, CS, NPP, is the Founder of the International Institute for Human Centered Caring and is the standard-bearer of the Humanistic Nursing Theory as handed down by Josephine Paterson and Loretta Zderad. She teaches at Lehman College, Bronx, NY, and is on the doctoral faculty of The Graduate School and University Center's Doctor of Nursing Science Program, both are part of the City University of New York.
|Printer friendly Cite/link Email Feedback|
|Title Annotation:||Professional Issues|
|Date:||Jan 1, 2009|
|Previous Article:||Mixed methods studies.|
|Next Article:||A competency-based approach to expanding the cancer care workforce: proof of concept.|