Intercultural Education for Nurses in Europe: The INENE Conference

1. Intercultural Education for Nurses in Europe: The INENE Conference Keynote Address Educating for Uncertainty: Transcultural Education and the Nursing Curriculum Dr Sue Dyson: Reader in Nurse Education

2. Reader in Nurse Education “Pedagogic research is systematic and sustained enquiry, planned and self-critical, which is subjected to public criticism and to empirical tests where these are appropriate. The research is educational because it can be related to the practice of education. Pedagogic research is firmly situated in its relevant literature and high quality pedagogic research makes a substantial contribution to that literature and practice” (Stenhouse , 1985).

3. Educating for Uncertainty: Transcultural Education and the Nursing Curriculum “The need to prepare students for a rapidly changing health care system sustains teachers interests in developing students thinking abilities at all levels of nursing education and in all subject disciplines” (Ironside, 2003) • What do we mean by uncertainty in the context of transcultural care • How does this impact on nurse education • How should we think about transcultural education within our nursing curriculum

4. `Uncertainty`

5. An Uncertain World • Changing context of health care • Global Migration • Super Diversity • Financial Crises (impact on health care and access to services)

6. Changing context of health care • rising public and patient expectations • demographic change • continuing development of an ‘information’ society • advances in treatment • changing patterns of disease • changing expectations of the health workplace

7. Global migration • beginning of the 21st century estimated 175 million people were living outside of their country of birth or citizenship • most migration stems from the decision of persons to try to improve their economic well being, about 16 million of the estimated 175 million people living outside their country of origin are refugees • Non refugees, refugees, asylum seekers, women as migrants • Global/regional impacts

8. Super Diversity • Diversity in Britain is not what it used to be • 30 years of government polices, social service practices and public perceptions have been framed by a particular understanding of immigration and multi-cultural diversity • Britain’s immigrant and ethnic minority population conventionally characterised by large, well-organised African-Caribbean and South Asian communities of citizens originally from Commonwealth countries or formerly colonial territories

9. Policy frameworks and public understanding have not caught up with recently emergent demographic and social patterns • Britain can now be characterised by `super-diversity`, a notion intended to underline a level and kind of complexity surpassing anything the country has previously experienced (Vertovec, S, 2007)

10. Financial Crisis • “The social determinants of health are the circumstances of daily life—the conditions in which people are born, grow, live, work, and age—and the structural drivers of those conditions (unfair distribution of power, money, and resources). Both the conditions of daily life and the structural drivers will be influenced by the financial crisis” (Marmott and Bell, 2009). • wealth, apart from income - a potent predictor of ill health (McMunn, Nazroo, Breeze, 2009)

11. An Uncertain Nursing Curriculum • All degree 2012 • Fit for Purpose, fit for practice, fit for award • Competent practitioners • Critical thinkers • key decision makers

12. So what should the 21st Century nurse `look like` - critical thinkers and decision makers and • how should we teach transcultural nursing in order to prepare nurses to care in a context of uncertainty (global migration, economic challenge, and super-diversity

13. Transcultural Nursing and Nurse Education • Transcultural nursing is an essential area of study for nurses as it enables the nurse to acquire the knowledge and skills necessary to provide care in a society which includes groups of people from designated cultures (Dyson 2007) • The question that should concern nurse educators is what pedagogy best facilitates transcultural nursing education in an era of uncertainty

14. Traditional Pedagogies for Nursing Education • Conventional Pedagogies - content driven - teacher led (teacher as expert) - outcome based (easily evaluated) - success driven

15. Outcomes Education • Teachers assume content knowledge is the foundation for thinking • Teacher’s role is to help student increase their knowledge base as a prerequisite to learning how to think • When students apply their knowledge in practice situations, it is assumed they provide evidence of their thinking ability, for example by correctly answering a specific question regarding a particular client situation (diet, place of worship, dress, interpretation

16. Outcomes education assumes • There is a direct and corresponding relationship between content knowledge and its application in clinical contexts • The selection of the `best` answer or the correct decision is clear and uncontested • Students ability to provide such evidence in acontextual (i.e. in the classroom) situations reflects their ability to draw on this knowledge in actual clinical situations (i.e. in context)

17. New Pedagogies for Teaching Transcultural Nursing: thinking anew, narrative, critical and transformative pedagogy • Narrative – Narrative pedagogy emphasises a safe, fair respectful and site-specific learning community in which students and educators work in partnership to come up with hat is meaningful to the person being cared for (Ironside, 2003) • Critical – based on critical theory, a movement which seeks to analyse oppressive practices that lead to social inequalities experienced by members of society, especially those who are marginalised (Zimmerman, et al, 2007) • Transformative – primarily concerned with sensitising students to injustice, oppression, inequality and domination issues relevant to transcultural nursing and thus to transcultural nursing education (McAllister et al, 2006)

18. Narrative Pedagogy In narrative pedagogy….. • Teachers learn to challenge the taken-for-granted assumptions that often go unnoticed, such as engagement in learning Narrative pedagogy…. • frees teachers from a pre occupation with success, boredom, and breakdown and offers new ways of staying engaged in leaning so learning can occur (Diekelman, N 2005)

19. Clearly - content knowledge, e.g. transcultural nursing knowledge, is necessary for practice, and conscientious teachers spend time and effort designing learning activities that encourage and assess students’ thinking • However, knowledge itself is not sufficient because the complexity of current clinical situations belies the linier knowledge-application model this approach assumes

20. Competent transcultural practice requires more than content knowledge applied in clinical situations • It requires an engaged understanding of and persistent thinking about both the context of care and the client’s experience of health and illness (Ironside, 2003) • e.g teaching transcultural nursing education using narrative pedagogy, incorporating social justice principles and planned international experiences

21. Critical Pedagogy Pedagogical Knowledge Content Knowledge Pedagogical Content Knowledge Narrative Pedagogy Transformative Pedagogy

22. Transcultural Care in theNursing Curriculum

23. Preparing for the future in an `uncertain` world Nurses need to be `enabled` through the mindful and thoughtful practice of transcultural nurse education to be: • Questioning practitioners: preserving perspectival openness and • Practising thinkers: preserving fallibility and uncertainty

24. New pedagogies for transcultural nursing education and practice open up new ways of thinking around how to engage students to develop critical thinking skills and to become key decsion-makers in an era of `uncertainty`

25. References • Diekelmann, N (2005) Engaging the Students and the Teacher: Co-Creating Substantive Reform with Narrative Pedagogy. Journal of Nursing Education June 2005, vol. 44, No. 6. • Dyson, SE (2007) Fundamental Aspects of Transcultural Nursing. Quay Books. London. • Ironside, P.M, 2003) New Pedagogies for teaching Thinking: The Lived Experiences of Students and teachers Enacting Narrative pedagogy. Journal of Nursing Education, November 2003, Vol. 42, No.11. • McAllister, M. Venturato, L Johnston, A, Rowe, J Tower, M and Moyle, W (2006) Solution focused teaching: A transformative approach to teaching nursing. International Journal of Nursing Education Scholarship, 3(1), 1-10 • McMunn, A. Nazroo, J. Breeze, E. (2009) Inequalities in health at older ages: a longitudinal investigation of the onset of illness and survival effects in England. Age Ageing 2009; 38:181-7 • Stenhouse, (1985) in Ruddick ,J and Hophins, D (eds) Research as a basis for teaching: readings from the work of Lawrence Stenhouse. Heinemann Educational Books. London. • Vervotec, S (2007) Super-diversity and its implications. Ethnic and Racial Studies Vol.30 No. 6 November 2007, pp 1024-1054 • Zimmerman, LW. McQueen, L and Guy, G (2007) Connections, interconnections and disconnections: The impact of race, class and gender in the university classroom. Journal of Theory Construction and testing, 11 (1), 16-21.