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The experience of faculty undergoing a major curricular paradigm shift in nursing education Tynski, Mary Louise 1996

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THE EXPERIENCE OF FACULTY UNDERGOING A MAJOR CURRICULAR PARADIGM SHIFT IN NURSING EDUCATION by MARY LOUISE TYNSKI B.Sc.N., U n i v e r s i t y of B r i t i s h Columbia, 1972 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING i n FACULTY OF GRADUATE STUDIES THE SCHOOL OF NURSING We a c c e p t t h i s t h e s i s as c o n f o r m i n g t o t h e r e q u i r e d s t a n d a r d THE UNIVERSITY OF BRITISH COLUMBIA December, 1995 © Mary L o u i s e T y n s k i , 1995 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. The University of British Columbia Vancouver, Canada DE-6 (2/88) 11 ABSTRACT Nursing education i s experiencing a revolutionary change where t r a d i t i o n a l l y held b e l i e f systems are being challenged and replaced with b e l i e f s and values that are based on an e n t i r e l y d i f f e r e n t philosophy of teaching and learning. This results i n a s i g n i f i c a n t challenge for the teacher who must move from one paradigm to another to be able to function i n the new world. The purpose of t h i s study i s to explore and describe the experience of nurse educators who are experiencing a major paradigm s h i f t . The newness of t h i s current paradigm s h i f t has allowed for l i t t l e research as yet being conducted concerning t h i s s h i f t from t r a d i t i o n a l to non-traditional ways of teaching. An ethnographic design was used to structure the data c o l l e c t i o n and analysis. The culture of nurse educators who had experience working i n both paradigms was sampled and f i v e interviews were held. A l l par t i c i p a n t s were employed at d i f f e r e n t educational i n s t i t u t i o n s . Analysis of the data revealed a varied experience during the paradigm s h i f t . In each pa r t i c i p a n t s experience, a small key group of ind i v i d u a l s were responsible for i n i t i a t i n g the I l l paradigm s h i f t . These individuals responded i n a unique fashion to new ideas that they discovered or were presented with. The e f f e c t of exposure to new philosophical ideas profoundly affected the i n d i v i d u a l s , so that t h e i r world view was dramatically changed and t h e i r b e l i e f and values system was transformed. The experience of t h i s key group was then communicated to colleagues who went through a process of evaluating the revolutionary concepts. Those fa c u l t y for whom there was r e l a t i v e congruence between t h e i r personal b e l i e f s and values and the b e l i e f s and values inherent i n the non-traditional curriculum accomplished the paradigm s h i f t r e l a t i v e l y e a s i l y . The wider the divergence, the more d i f f i c u l t y f a c u l t y had i n adjusting to the new paradigm. A dynamic continuum of acceptance was described, placing faculty along the continuum from acceptance to r e j e c t i o n of the new paradigm concepts. Faculty who t o t a l l y rejected the new paradigm were considered to be threats to the successful implementation of the new curriculum. The process of paradigm s h i f t involved a personal transformation of world view that required profound inner r e f l e c t i o n . This process was aided by discussion i v with others and i n some instances, formal f a c i l i t a t i o n . Implications for nursing education, research and pr a c t i c e are discussed. V TABLE OF CONTENTS ABSTRACT i i TABLE OF CONTENTS V ACKNOWLEDGEMENTS ix CHAPTER ONE: INTRODUCTION 1 Background to the Problem 1 Tr a d i t i o n a l Nursing Curricula 1 Non-Traditional Nursing Curricula 5 Paradigm S h i f t in Nursing Education 8 Research Question 10 D e f i n i t i o n of Terms 11 Nurse Educators 11 Paradigm S h i f t 11 Nursing Education . 11 Curriculum 11 Conceptual Framework 11 Transcultural Models for Nursing and Health Care Systems 12 The Sunrise Model 14 Significance of the Study 17 Overview of Thesis Content 17 v i CHAPTER TWO: REVIEW OF THE LITERATURE 19 Change 2 0 Paradigm S h i f t 2 2 Paradigm S h i f t i n Nursing Education 2 6 Paradigm S h i f t in Educational Settings 29 Paradigm S h i f t i n Related Institutions 38 Curriculum Revolution 4 0 Curriculum Revolution i n Nursing Education 41 CHAPTER THREE: RESEARCH METHODS 49 The Research Design 49 Issues of R e l i a b i l i t y , V a l i d i t y , and Ge n e r a l i z a b i l i t y 52 E t h i c a l Issues 58 Sample Selection, Recruitment and Size 59 Data C o l l e c t i o n 60 Data Analysis 62 CHAPTER FOUR: RESEARCH FINDINGS 64 Pre-Paradigm S h i f t 65 Char a c t e r i s t i c s of Early Teaching Experiences ... 65 Beginning of the Sh i f t 68 I n i t i a t i o n into the New Paradigm 72 v i i The Influence of the Few on the Many 72 Affirming the Philosophical Perspective 76 A Continuum of Acceptance 7 6 Manifestations of Faculty Who Resist a Paradigm S h i f t 7 9 Faculty B e l i e f s and Values 81 Movement Along the Acceptance Continuum 8 3 Developing a New Awareness 8 6 F a c i l i t a t i n g the Paradigm Sh i f t 88 Ef f e c t on the Working Environment 9 0 On-Going Development 9 3 Rewards of Teaching i n a Non-Traditional Curriculum 93 The Process Never Ends 9 6 Summary 99 CHAPTER FIVE: DISCUSSION OF RESEARCH FINDINGS .... 101 The Personal Process of Paradigm S h i f t 102 Gaining Revolutionary Insights 103 B e l i e f s and Values 104 Transmission of the Vis i o n 110 The Diffu s i o n of Innovations I l l Future Directions 12 0 v i i i Implications for Nursing Education 12 0 Implications for Nursing Research 121 Implications for Nursing Practise 122 Summary and Conclusions 124 REFERENCES 12 7 APPENDICES 13 6 Appendix A: Leininger's Sunrise Model 137 Appendix B: Letter of Recruitment 13 9 Appendix C: Letter of Consent 141 ix ACKNOWLEDGEMENTS I would l i k e to acknowledge those indiv i d u a l s who provided me with assistance i n the completion of t h i s research. My thanks goes to my thesis committee: Dr. Barbara Paterson who provided leadership and caring guidance; Dr. Carol J i l l i n g s who provided invaluable feedback i n the process of conceptualizing and writing the document; and to Louise Tenn and Marilyn Dewis who respectively provided major assistance i n the i n i t i a l and f i n a l stages of preparation. My thanks also goes to my many friends and colleagues who provided support and encouragement and trusted along with me in my a b i l i t i e s to complete such a major undertaking. Most p a r t i c u l a r l y , my thanks goes to Ian for helping me st a r t a journey that has led to t h i s place. 1 CHAPTER ONE Background to the Problem S i g n i f i c a n t changes are occurring i n the world of nursing education. While small modifications and f i n e -tuning of nursing c u r r i c u l a have been consistently on-, going, evolution of a major change has been slow i n coming (Watson, 1988; Bevis, 1988; de Tornyay, 1990). Nursing education i s currently at a point i n time when revolutionary ideas are being implemented i n curriculum models, r e s u l t i n g i n changes of such proportion that the current c u r r i c u l a of nursing education programs looks nothing l i k e the t r a d i t i o n a l c u r r i c u l a with which nurse educators have been previously f a m i l i a r (Chinn, 1989; Diekelmann, 1988). T r a d i t i o n a l Nursing Curricula The foundation of the t r a d i t i o n a l nursing c u r r i c u l a i s behaviourism, evolving in the late 1940's with the work of Tyler (Bevis, 1989). Tyler's use of behavioral objectives became an accepted way of ensuring standardized education by allowing educators to be able to measure educational outcomes i n terms of c l e a r l y definable and observable behaviours (Hedin, 1989; Bevis, 1988). Because of the appeal of 2 measurable outcomes i n the Tylerian model, elementary, secondary and post-secondary education quickly adopted Tyler's ideas (Tompkins, 1986). In the 194 0's, i t could be considered that a c r i s i s i n nursing education was occurring, necessitating a s h i f t to a new paradigm. According to Bevis (1989) , nurse educators in the late 1940's were experiencing a gap i n a th e o r e t i c a l foundation with which to structure t h e i r c u r r i c u l a . P r i o r to Tyler's entrance onto the scene of education, nurse educators were using the "Curriculum Guide for Schools of Nursing", f i r s t established in 1917, then revised i n 1927 and 1937. The s i g n i f i c a n t changes i n nursing r e s u l t i n g from World War II made t h i s curriculum guide t o t a l l y obsolete. Because of the great expansion of medical and nursing knowledge, a new framework was required for teaching. Tyler proposed a systematic way to select, manage, and evaluate the content. A p a r a l l e l change was also occurring i n the educational world. Up u n t i l t h i s time, education had been l a r g e l y governed by the influence of Dewey (Bevis, 1989). However, i n the mid 1940's, Dewey's influence began to diminish, leaving room for other ideas such as those 3 proposed by Tyler that incorporated behaviourism and objectives. The Tylerian method was soon adopted by the accrediting and approval processes of the professional bodies and thus became i n s t i t u t i o n a l i z e d within the system. Tyler (1949) described the purpose of presenting h i s ideas as being to outline "one way of viewing an i n s t r u c t i o n a l program as a functioning instrument of education" (p. 1). He emphasized the necessity of educators to c l e a r l y define t h e i r purposes and goals, or t h e i r educational objectives, rather than being dependent upon serendipity or i n t u i t i o n : " A l l aspects of the educational program are r e a l l y means to accomplish basic educational purposes" (Tyler, 1949, p. 3). Tyler (1949) viewed educational objectives as being "value judgements of those responsible for the school. A comprehensive philosophy of education i s necessary to guide in making these judgements" (p. 4) . In order to select content for instruction, a d d i t i o n a l information and knowledge a s s i s t i n guiding the educator i n the use of the philosophy. This information and knowledge comes from a variety of sources. Both the learner and the c u l t u r a l heritage of 4 society can be studied to provide d i r e c t i o n i n determining objectives. As well, "many s o c i o l o g i s t s and others concerned with the pressing problems of contemporary society see in an analysis of contemporary society the basic information from which objectives can be derived" (Tyler, 1949, p. 5). A f i n a l source of information i s from educational philosophers who recognize that there are basic values i n l i f e , l a r g e l y transmitted from one generation to another by means of education. They see the school as aiming e s s e n t i a l l y at the transmission of the basic values derived by comprehensive philosophic study and hence see i n educational philosophy the basic source from which objectives can be derived (Tyler, 1949, p.5). Once various sources have been tapped and the educational objectives determined, content can be selected, i n s t r u c t i o n a l procedures developed and t e s t and examinations prepared. This framework i s l i k e l y very f a m i l i a r to any educator teaching p r i o r to the evolution of the non-traditional curriculum. While the Tylerian approach made educators accountable to students and the public for objective standards of performance i n nursing education programs, i t created dilemmas for educators and students a l i k e (de Tornyay, 1990; Diekelmann, 1988). Educators i n Tyl e r i a n programs were frustrated at having to teach to 5 r i g i d l y prescribed "rules", or objectives. Consistency and p r e d i c t a b i l i t y were highly valued in the T y l e r i a n regime (Diekelmann, 1988; Bevis, 1988). L i t t l e room existed for c r e a t i v i t y in teaching. A l l students were expected to conform to set patterns of behaviour, and were expected to achieve the same minimal l e v e l of objective achievement upon graduation. Students who were achieving either at levels over or under t h i s minimal standard were often not challenged to reach t h e i r p o t e n t i a l (Bevis, 1988, de Tornyay, 1990)). Over the l a s t ten years, a considerable body of writing has been generated by educators that suggests that the Tylerian system of professional education i s not e f f e c t i v e (Benner, 1984; Bevis & Watson, 1989; Tanner, 1990; Donley, 1989; Diekelmann, 1988; de Tornyay, 1990) . Some nurse educators have shown that, for them, the system i s in c r i s i s (Diekelmann, 1989). Leaders in nursing education have taken up the challenge to revolutionize education i n nursing. The ideas of these leaders are being put into place i n various educational i n s t i t u t i o n s throughout the world. Non-Traditional Nursing Curricula New c u r r i c u l a currently being developed and 6 implemented i n nursing education are t r u l y revolutionary (Bevis, 1988; Chinn, 1989; Diekelmann, 1989; Clayton & Murray, 1989). The d r i v i n g philosophical forces of the new c u r r i c u l a d i f f e r from those i n t r a d i t i o n a l nursing education. Phenomenology, humanism and caring, feminism and c r i t i c a l s o c i a l theory, are examples of philosophies that might drive the non-traditional c u r r i c u l a . The t r a d i t i o n a l understanding of the nature of teaching and learning i s challenged by the developers of new c u r r i c u l a (Donley, 1989; Chinn, 1989; Diekelmann, 1989; Bevis, 1988) . Students and educators can no longer be expected to be experts i n a large volume of content that i s constantly changing. Instead, educators are assuming to a greater degree the r o l e of "expert learners" who together with the student explore the issues that students i d e n t i f y as being c r i t i c a l . Consequently, changes to the t r a d i t i o n a l view of student-teacher interactions i s promoted. The t r a d i t i o n a l role of the teacher i n the classroom, laboratory setting, and c l i n i c a l s e t t i n g i s now subject to much debate (Donley, 1989; Chinn, 1989; Diekelmann, 1988; Symonds, 1990; Bevis & Murray, 1990). Educators used to seeing c u r r i c u l a designed around 7 behavioural objectives and content w i l l now see c u r r i c u l a designed around outcomes, concepts, and learning a c t i v i t i e s . The emphasis of the c u r r i c u l a i s on teaching learning how to think, not what to think. Perhaps the most s i g n i f i c a n t change occurring i s an attempt to even out the power structures i n education, so that true collaborative learning can be developed. The current c u r r i c u l a often appear to a nurse educator who was educated in the t r a d i t i o n a l system l i k e a foreign world, with unrecognizable vocabulary, assignments, and content (Chinn, 1989). Largely absent i s the development of c u r r i c u l a around objectives (except for some forms of learning that are lar g e l y behavioral, such as psychomotor s k i l l s ) . Gone i s the emphasis on multiple choice examinations as the primary t e s t of the student's learning. Students are instead being encouraged to show t h e i r a b i l i t y to c r i t i c a l l y think using too l s such as jo u r n a l l i n g and q u a l i t a t i v e evaluation systems. The meaning of being a nursing professional i s being explored in depth and students are being prepared to accept an equal status with other health team members. C l i n i c a l experience i s no longer the learning laboratory used to apply theory learned 8 la r g e l y by rote i n class. Now students are being encouraged to develop t h e i r theory d i r e c t l y from t h e i r c l i n i c a l experiences (praxis). As they venture into the unfamiliar t e r r i t o r y of the new c u r r i c u l a , nurse educators are expected to grasp the complex philosophical concepts and translate them into actions i n the classroom or c l i n i c a l setting (Diekelmann, 1989; Bevis, 1989; O i l e r Boyd, 1988; Allen, 1990). Paradigm S h i f t i n Nursing Education The outcome of a successful revolution i s a s h i f t i n the way that the world i s seen (Kuhn, 1970) . A successful p o l i t i c a l revolution changes the structures of society. A successful s c i e n t i f i c revolution changes the way s c i e n t i s t s view both a p a r t i c u l a r phenomenon and the development of knowledge. A successful revolution in education changes the way teaching and learning occurs. Thomas Kuhn (1970) coined the term "paradigm", defined as "universally recognized s c i e n t i f i c achievements that for a time provide model problems and solutions to a community of p r a c t i t i o n e r s " (p. v i i i ) . Two c h a r a c t e r i s t i c s of paradigms are that they " a t t r a c t an enduring group of adherents away from competing 9 modes of s c i e n t i f i c a c t i v i t i e s " (p. 10) and at the same time they are " s u f f i c i e n t l y open-ended to leave a l l sorts of problems for the redefined group of pr a c t i t i o n e r s to resolve" (p. 10). In elaborating on t h i s understanding, Kuhn ( 1970) says that "some accepted examples of actual s c i e n t i f i c practice provide models from which spring p a r t i c u l a r coherent t r a d i t i o n s of s c i e n t i f i c research" (p. 10). A s c i e n t i f i c d i s c i p l i n e that i s s u f f i c i e n t l y mature to have acquired a paradigm i s a f a i r l y well-developed f i e l d . A paradigm of any given specialty can be characterized by "a set of recurrent and quasi-standard i l l u s t r a t i o n s of various theories" (Kuhn, 1970, p. 43). A student of the d i s c i p l i n e builds on t h e i r knowledge of the f i e l d by studying these paradigms. The paradigms allow s c i e n t i s t s to communicate i n a consistent manner so that t h e i r use of words and descriptions of events means the same thing to each other. Considering t h i s d e f i n i t i o n and these c h a r a c t e r i s t i c s , the transformation in nursing education from the behaviourist, objective-driven curriculum, to the humanistic, i n d i v i d u a l i s t i c mode of operation can be considered a major paradigm s h i f t . 10 A major deviation i n thinking, or a paradigm s h i f t , has a s i g n i f i c a n t effect on those professionals working i n the f i e l d . Kuhn (1970) describes the e f f e c t of a paradigm s h i f t on a group of s c i e n t i s t s : When, i n the development of a natural science, an in d i v i d u a l or group f i r s t produces a synthesis able to a t t r a c t most of the next generation's p r a c t i t i o n e r s , the older schools gradually disappear. In part t h e i r disappearance i s caused by t h e i r member's conversion to the new paradigm. But there are always some men who c l i n g to one or another of the older views, and they are simply read out of the profession, which thereafter ignores t h e i r work. The new paradigm implies a new and more r i g i d d e f i n i t i o n of the f i e l d , (p. 18) . I t i s the revolutionary experience of moving from one paradigm to another in nursing education that i s the focus of t h i s proposed research. Understanding the process of paradigm s h i f t among faculty members, with i t s accompanying ro l e t r a n s i t i o n and restructuring of b e l i e f s and values, w i l l ease the change for others who are yet to commit to the new paradigm. Research Question The research question to be answered i n the proposed research study i s : What i s the experience of nurse educators who teach in nursing education programs that are i n the process of redefining themselves because of a major paradigm s h i f t in the curriculum? 11 D e f i n i t i o n of Terms Nurse Educators Nurse educators are persons employed f u l l time by an educational i n s t i t u t i o n to teach nursing students enroled i n a baccalaureate or diploma nursing education program. Paradigm S h i f t Movement from a t r a d i t i o n a l l y held p o s i t i o n to a p o s i t i o n that i s tradition-shattering constitutes a paradigm s h i f t (Kuhn, 1970). Nursing Education Nursing education i s the t o t a l composite of experiences that happen to an individual as a r e s u l t of having joined a program of study that w i l l lead, i f successfully completed, to a diploma in nursing. Curriculum Curriculum i s defined as "the interactions and transactions that occur between and among students and teachers with the intent that learning occur" (Bevis & Watson, 1989, p. 5). Conceptual Framework The conceptual framework chosen to guide t h i s research evolves from Leininger's Sunrise Model and the 12 theory of "Cultural Care Diversity and U n i v e r s a l i t y " (1991). According to Leininger, "Culture r e f e r s to the learned, shared, and transmitted values, b e l i e f s , norms, and lifeways of a p a r t i c u l a r group that guides t h e i r thinking, decisions, and actions in patterned ways" (p. 47). Leininger's d e f i n i t i o n of a culture allows for nursing faculty engaged in a paradigm s h i f t to be considered a c u l t u r a l entity and thus they can be studied according to the constructs of t h i s model. Transcultural Models for Nursing and Health Care Systems Early i n her work, Leininger developed two conceptual frameworks which guided her research. Features of both frameworks are useful to consider. The f i r s t she e n t i t l e s "A Conceptual and Theoretical Model for Transcultural Nursing Theories and P r a c t i c e " (Leininger, 1978). In reference to t h i s , she states "The theory behind t h i s model i s that the focus of t r a n s c u l t u r a l nursing i s caring behaviour, processes and intervention modalities... caring i s the central unifying concept and essence of nursing theory and p r a c t i c e " (1978, p.40). Caring i s also a key concept i n the c u r r i c u l a that are currently being developed as 13 a r e s u l t of the paradigm s h i f t . The second model, "A Transcultural Conceptual Model to Study and Analyze Health Care Systems" was developed to guide Leininger in studies of various cultures directed towards obtaining an understanding of t h e i r h e a l t h - i l l n e s s systems. Components of the model that make i t p a r t i c u l a r l y useful include the examination of major s o c i a l and c u l t u r a l factors, as well as examining the s o c i a l meaning and function contained within the roles of the various health care workers (Leininger, 1978). It i s t h i s second model from which the current "Sunrise Model" seems to be most d i r e c t l y derived. Leininger (1978) also refers to the idea of " c u l t u r a l change" in developing her t r a n s c u l t u r a l theory for analysis of health care systems. Two processes are i d e n t i f i e d through which c u l t u r a l change occurs: those that are s p e c i f i c to the cultures that are changing, and those that generally guide the change process i n any culture. By allowing for a look at the process of change within a culture, the u t i l i t y of t h i s conceptual framework to guide the research of paradigm s h i f t , or major change, within the culture of a group 14 of nurse educators i s clear. The Sunrise Model The most current model, the Sunrise Model (Appendix A), has been i n development over the l a s t three decades and has the purpose of showing the integration of the major and inter r e l a t e d components of Leininger's emerging theory (1988). Leininger says of the model: "Essentially, the model helps the researcher envision a c u l t u r a l world of d i f f e r e n t l i f e forces or influencers on human conditions which need to be considered to discover human care in i t s f u l l e s t ways" (1991, p. 50). Leininger has expressed many of her e a r l i e r b e l i e f s i n the development of the Sunrise Model. For example, Leininger (1988) maintains the po s i t i o n that caring i s a d i s t i n c t concept that remains at the core of nursing and guides a l l nursing p r a c t i c e . The Sunrise Model depicts three key components of c u l t u r a l care. The f i r s t comprises C u l t u r a l and S o c i a l Structure Dimensions with emphasis on the s o c i a l structure of the culture. Systems that must be examined i n r e l a t i o n to th e i r connection with the health care system include the p o l i t i c a l , economic, s o c i a l , c u l t u r a l , educational, and technological 15 systems (1978). The c u l t u r a l and s o c i a l structure can be composed of individuals, families, groups, and i n s t i t u t i o n s . The second major component of the model i s the concept of Diverse Health Systems. There are two main categories of Health Systems, those being Folk Systems and Professional Systems. Folk Systems are defined as " c u l t u r a l l y learned and transmitted, indigenous (or t r a d i t i o n a l ) , folk (home based) knowledge and s k i l l s used to provide a s s i s t i v e , supportive, enabling, or f a c i l i t a t i v e acts toward or for another i n d i v i d u a l , group, or i n s t i t u t i o n with evident or anticipated needs" (Leininger, 1991, p.48). Professional Systems are defined as "formally taught, learned, and transmitted professional...knowledge and practice s k i l l s that p r e v a i l i n professional i n s t i t u t i o n s usually with m u l t i d i s c i p l i n a r y personnel to serve consumers" (Leininger, 1991, p.48). Both systems have a d i r e c t influence on and are influenced by nursing. The t h i r d component of the model i s included to ensure that c u l t u r a l l y congruent judgements, decisions and actions are taken. The three modes which provide t h i s guidance are: 16 1) c u l t u r a l care preservation and/or maintenance; 2) c u l t u r a l care accommodation and/or negotiation; 3) c u l t u r a l care repatterning or restructuring. Leininger explains that: the nurse grounded i n culture care knowledge would plan and make decisions with c l i e n t s with respect to these three modes of action or decision which was predicted to be in accord with the care data obtained from findings in the upper part of the model (1991, p. 42). If nurse educators who are undergoing a paradigm s h i f t i n a school of nursing are regarded as a c u l t u r a l e n t i t y , Leininger's theories of culture are applicable to the proposed research. For example, the study of the experience of nurse educators who are undergoing a paradigm s h i f t i n c u r r i c u l a should, according to Leininger's Sunrise Model, include consideration of how nurse educators ensure that c u l t u r a l l y congruent decisions are made in the curriculum change. When looking at the process of the paradigm s h i f t , both the s p e c i f i c and the general processes guiding the change should be considered. Along with the obvious educational factors, p o l i t i c a l , economic, s o c i a l , c u l t u r a l and technological systems should be considered. Influences analogous to the "Folk Systems" should be looked for, as well as those that occur v i a 17 the more obvious "Professional Systems". Significance of the Study Experiencing any change i s d i f f i c u l t and challenging. When the change i s as major as moving from t r a d i t i o n a l l y held views to revolutionary ways of being, the t r a n s i t i o n can be expected to be very d i s r u p t i v e to the individuals involved and to the environment within which they operate. The c u r r i c u l a r revolution i n nursing education i s currently i n i t s infancy but i t can be anticipated that i t w i l l grow quickly, with many educational i n s t i t u t i o n s world-wide adopting the new paradigm. Obtaining an understanding of the experience of a paradigm s h i f t w i l l lessen the trauma for those educators destined to undergo t h i s t r a n s i t i o n i n the future. As well, a s s i s t i n g nurse educators to understand and analyze the experience of a paradigm s h i f t may enable them to anticipate the needs of nursing students who w i l l also be exposed to a new paradigm. Overview of Thesis Content This thesis consists of f i v e chapters. This introductory chapter provides background information that i s necessary to understand the problem to be 18 researched, followed by a statement of the problem. The terms that are central to the research question are defined and the conceptual framework i s presented. The proposed study's contribution to nursing knowledge i s explained. Chapter Two consists of a review of the l i t e r a t u r e , relevant to the research question. The l i t e r a t u r e review w i l l be presented i n accordance with three major conceptual constructs; change, paradigm s h i f t and curriculum revolution. Chapter Three includes a description of the research design. The research findings w i l l be presented i n Chapter Four. A discussion of the research findings and the implications of the findings for nursing education, research and practice w i l l be discussed i n Chapter Five. Chapter Five w i l l also contain a summary and conclusions of the research. 19 CHAPTER TWO Review of the Literature According to the tenets of Leininger's Sunrise Model and theory of Cultural Care Diversity and Uni v e r s a l i t y (1991), a faculty member's experience of a paradigm s h i f t can be understood in the context of c u l t u r a l change and the strategies used to adapt to t h i s change. The two most relevant concepts at the core of t h i s study are that of change as experienced i n a paradigm s h i f t and 'curriculum revolution. These concepts were explored i n the l i t e r a t u r e and defined i n nursing education. A selected review of the l i t e r a t u r e was conducted to determine the scope of information related to paradigm s h i f t s and curriculum revolution i n the nursing and in the general education l i t e r a t u r e . Theoretical presentations and research studies that helped to define the concepts and that provide i n s i g h t into the process of paradigm s h i f t and curriculum revolution were considered for inclusion. Since l i t t l e l i t e r a t u r e i n these areas could be located, a l l r e l a t e d l i t e r a t u r e w i l l be presented. 20 Change As the concept of paradigm s h i f t i s grounded i n the work of Kuhn, change theory i s grounded i n the work of Kurt Lewin (1951). Lewin i d e n t i f i e d three stages i n the process of change: unfreezing the present, moving to a new l e v e l , and refreezing on that new l e v e l . In the stage of unfreezing, the motivation to create some sort of change occurs. A problem or a better way of accomplishing a task i s recognized. According to Lewin, there are three motivational forces that cause change. These are lack of confirmation or disconfirmation, meaning that expectations have not been met; induction of guilt-anxiety, meaning the f e e l i n g of discomfort about some action or lack of action; or creation of psychologic safety, meaning that a former obstacle to the change has been removed. The second stage of change i s characterized by a "shaking up" of the status quo with a r e s u l t i n g disequilibrium. Movement to establish a new equilibrium occurs. I t i s in t h i s stage that new responses to the change are developed, based on collected information that c l a r i f i e s and i d e n t i f i e s the problem. The problem i s seen from a new perspective. The t h i r d stage of 21 change, refreezing, occurs when the new changes are integrated and s t a b i l i z e d . Part of Lewin's theory of change includes the concepts of driving forces and res t r a i n i n g forces. Driving forces f a c i l i t a t e the process of change and r e s t r a i n i n g forces impede t h i s process. When dr i v i n g and r e s t r a i n i n g forces are equal, no change occurs. However, when the strength of one force i s greater than that of the other, the change w i l l proceed. Lewin's theory of change has been p a r t i c u l a r l y useful i n s o c i a l science and humanities research. Change i s usually depicted as a gradual process that can be managed i n a controlled manner. While t h i s understanding of change describes a concept c l o s e l y r e l a t e d to paradigm s h i f t , the two d i f f e r fundamentally. According to Kuhn (1970), paradigm s h i f t describes a change on the magnitude of a revolution. An implosion occurs within the culture, causing change that i s neither gradual, predictable, or e a s i l y managed. While helpful in supplying insight into the experience of major change, the l i t e r a t u r e on the change process i s of limited use in providing insight into the experiences of those i n d i v i d u a l s who 22 undergo a paradigm s h i f t . Paradigm S h i f t A sudden momentous personal change i n world view, e n t a i l i n g a complete s h i f t i n b e l i e f s and values, can be considered to be a paradigm s h i f t . The p i v o t a l work on the concept of paradigm s h i f t was Thomas Kuhn's 1962 pub l i c a t i o n of "The Structure of S c i e n t i f i c Revolutions". The second edition of t h i s work was published i n 1970. This highly i n s i g h t f u l work by a philosopher of science describes both the concepts of s c i e n t i f i c revolution and paradigm s h i f t i n a manner that can be e a s i l y related to other d i s c i p l i n e s . From Kuhn's descriptions, p a r a l l e l s can be drawn between the paradigm s h i f t s which occur in s c i e n t i f i c communities and the current revolution that i s taking place i n nursing education communities. Kuhn (1970) describes a paradigm s h i f t as being p r e c i p i t a t e d by the presence of certain occurrences i n the f i e l d of study. These occurrences can be of two forms. The f i r s t presentation i s as an anomaly which presents i t s e l f as a r e s u l t of research conducted i n the t r a d i t i o n a l paradigm, such as occurred i n the discovery of oxygen or x-rays. The appearance of an 23 anomaly i s not enough in i t s e l f to r e s u l t i n a r e j e c t i o n of the old paradigm. The discovery of anomalies can help to p r e c i p i t a t e a c r i s i s or can augment a c r i s i s that i s already present. The second presentation i s as a c r i s i s which re s u l t s from discoveries that shake the roots of s c i e n t i f i c pursuit, such as theories presented by Copernicus i n the area of astronomy or by Newton or Einstein i n the area of physics. The c r i s i s i n turn p r e c i p i t a t e s the necessity for extraordinary science that results i n the appearance of a new paradigm that accounts for the anomaly. T r a d i t i o n a l science reacts in predictable ways to the emergence of novel theories. Kuhn describes the process as follows: i t i s a reconstruction of the f i e l d from new fundamentals, a reconstruction that changes some of the f i e l d ' s most elementary t h e o r e t i c a l generalizations as well many of i t s paradigm methods and applications. During the t r a n s i t i o n period there w i l l be a large but never complete overlap between the problems that can be solved by the old and by the new paradigm. But there w i l l also be a decisive difference i n the modes of solution. When the t r a n s i t i o n i s complete, the profession w i l l have changed i t s view of the f i e l d , i t s methods, and i t s goals (1970, p.85). This response to c r i s i s i s a s c i e n t i f i c revolution that occurs v i a a paradigm s h i f t . A small portion of 24 the community i d e n t i f i e s that "an e x i s t i n g paradigm has ceased to function adequately i n the exploration of an aspect of nature to which that paradigm i t s e l f had previously led the way" (Kuhn, 1970, p.92). This i s s i m i l a r to the response in a p o l i t i c a l revolution. Kuhn (1970) provides valuable insights about how the l i v e s of those involved in the paradigm s h i f t are affected. The t r a n s i t i o n between one paradigm and another may take a great deal of time. As the t r a n s i t i o n proceeds, the world i t s e l f does not change, but the way i n which i t i s perceived i s dramatically altered. "The proponents of competing paradigms pra c t i c e t h e i r trades in d i f f e r e n t worlds" (Kuhn, 1970, p.150). During t h i s time, communication between the two worlds i s , at best, only p a r t i a l . Kuhn attempts to address the question of how conversion to the new paradigm i s induced or r e s i s t e d , but finds that "our question i s a new one, demanding a sort of study that has not previously been undertaken" (1970, p.152). He refers to the discussion of c r i s e s and states that a powerful inducer for change i s a paradigm's claim to solve crisis-provoking problems; however, t h i s i s usually not enough in i t s e l f . An 25 incentive to adopt a new paradigm may be "arguments that appeal to the individual's sense of the appropriate or the aesthetic; the new theory i s said to be "neater", "more suitable", or "simpler" than the old" (Kuhn, 1970, p.154). Another factor for consideration i s an educated guess as to which of the two paradigms i s the best candidate to support the a c t i v i t i e s of future theorists and researchers. While these factors may influence an individual's decision to move from one paradigm to another, sometimes i t i s simply necessary to make a "leap of f a i t h " . Kuhn's (1970) work makes substantial contributions to the understanding of r a d i c a l momentous change. However, there are those who c r i t i q u e his work. Perhaps the biggest problem l i e s in his inconsistent use of the term "paradigm". Masterman (1970) has i d e n t i f i e d 21 d i f f e r e n t ways in which Kuhn uses the term. Kuhn (1970) rep l i e d to the c r i t i c i s m by saying that most of the differences are largely s t y l i s t i c , but does acknowledge that on further analysis he can i d e n t i f y two d i s t i n c t understandings implied by the term. Tanner (1990), i n commenting on these anomalies, says that "one f a i r l y consistent usage i s that of a 26 world view, a way of understanding a phenomenon that i s i m p l i c i t l y or e x p l i c i t l y agreed to by a community of scholars" (p. 296). It i s i n t h i s context that the term i s considered in t h i s research. Also of interest to nurse researchers i s that c r i t i c i s m has been l e v e l l e d at Kuhn for his reference to t a c i t knowledge and i n t u i t i o n as a means of developing s c i e n t i f i c knowledge. Kuhn's (1970) response to t h i s c r i t i c i s m reads much l i k e Benner and Tanner's (1987) work on the same subject. Paradigm S h i f t In Nursing Education L i t t l e could be found in the nursing l i t e r a t u r e that r e l a t e s d i r e c t l y to the process of paradigm s h i f t i n nursing education. This l i k e l y r e f l e c t s the newness of the paradigm s h i f t currently occurring within the f i e l d . Many nursing programs are in the process of adopting revolutional educational ideas within t h e i r c u r r i c u l a . S u f f i c i e n t time has not yet passed to allow research to be completed and published. One author, Hays (1994), discusses the paradigm s h i f t i n r e l a t i o n to community health nursing. I t i s unclear i f Hays i s addressing t h i s issue as an armchair t h e o r i s t , or as a nursing faculty member who has 2 7 d i r e c t l y experienced a paradigm s h i f t . Hays has combed the t h e o r e t i c a l l i t e r a t u r e and consolidated from i t s i x constructs about what i t means to teach i n the new paradigm. Insights into faculty attitudes and behaviours needed to teach i n the new paradigm can be found within these constructs: i . e . , teaching must be congruent with a philosophy of emancipation; teaching occurs through authentic relationships between f a c u l t y and students; students must be s o c i a l i z e d to the normative value of caring; faculty must revise t h e i r understanding of what i t means to teach; a student's learning i s enhanced through confirmation of the s e l f as a knower; and faculty have to share the process of thinking, knowing, and learning with the student. In order to teach successfully in the new paradigm, Hays proposes several requisites for faculty: teachers must c l e a r l y understand the assumptions and themes of the paradigm; teachers must examine current patterns of teaching i n order to assess t h e i r compatibility with the new paradigm; teachers must believe that the new paradigm w i l l work; and faculty must experience a caring community, i n which they f e e l connected to each other and to students. 28 Paterson and Bramadat (1992) describe the process of implementing a paradigm s h i f t in c l i n i c a l education. They developed and put into practice a novel way of approaching c l i n i c a l education, based on the philosophical constructs of phenomenology and c r i t i c a l s o c i a l theory and the theoreti c a l work of Bevis and Watson (1989) and Diekelmann (1990). The r e s u l t i n g model developed by Paterson and Bramadat i s c a l l e d the "Growth Model of C l i n i c a l Education". The basic constructs of the Growth Model are: caring, learning, p a r t i c i p a t i o n , and r e f l e c t i o n . Students i n t h i s model of nursing education assume varying degrees of control over t h e i r c l i n i c a l education, increasing t h e i r l e v e l of independence as they proceed through the program. Paterson and Bramadat (1992) discuss t h e i r personal experience as faculty i n a baccalaureate nursing program implementing a new model of c l i n i c a l teaching and share insights useful to others considering a si m i l a r move. They describe the process of change as challenging, associated with losses and g r i e f , and emancipatory. They warn other educators of some of the p i t f a l l s they discovered that were inherent i n the change process. These included: (1) e s s e n t i a l 29 communication regarding the curriculum change with co-workers and nursing s t a f f was d i f f i c u l t to arrange and, as a consequence, some key players had i n s u f f i c i e n t or f a u l t y understandings of the paradigm s h i f t ; (2) some fac u l t y and s t a f f were reluctant to abandon t h e i r comfortable t r a d i t i o n a l paradigm; (3) the amount of time required by those developing new courses i n the new paradigm to understand the new philosophies had been underestimated, res u l t i n g in incomplete implementation of the new paradigm in teaching p r a c t i c e s ; and (4) students i n the curriculum expressed concerns about being the "guinea pigs" of the c l i n i c a l courses. Paradigm S h i f t in Educational Settings Few studies were located i n the educational l i t e r a t u r e that have followed up on Kuhn's observation that more work i s needed to address the process inherent i n adoption of a paradigm s h i f t . One r e l a t e d study examines the process of a group of faculty involved i n implementing educational innovation within an undergraduate teacher education curriculum. Patriarca and Buchmann (198 3) examined the process of substantive curriculum change in an attempt to i d e n t i f y 30 the stages involved in the process and to i d e n t i f y any changes i n programme goals that occur as the process unfolds. Their rationale for examining these parameters i s that while the potential for innovation i s present when a major change occurs, t h i s i s not necessarily guaranteed. They attempted to f i n d predictors for successful change. Four stages of the paradigm s h i f t experience were i d e n t i f i e d from t h e i r research: concept c l a r i f i c a t i o n ; course development; programme design; and bureaucratic approval. Several themes emerged under the overa l l t i t l e of "complicating the complex". The theme of "clouds of ideas" describes the process that occurred when the conceptual questions were discussed. B e l i e f s and attitudes were discussed and, from these, new questions and ideas arose. The process continued without the players ever attending to the main purpose of the discussion; c l a r i f y i n g the concepts. The theme of "growth as addition" describes the process of developing c u r r i c u l a r content and ideas. New content was simply added to the preexisting curriculum because the t r a d i t i o n a l attitudes were held to be sacrosanct by the players. The end r e s u l t of the two year process was that the program goals were not 31 met because the substantive issues were never properly considered. The authors postulate a reason for t h i s as "our fantasies and desires overwhelm us. We lack not i n t e l l i g e n c e or will-power, but the a b i l i t y to step back from ourselves, r e f l e c t , attend to our own feelings and the world, and hold our attention steady" (1983, p. 420). While the study by Patriarca and Buchmann (1983) was generally well conceived, some li m i t a t i o n s must be considered. The conceptual framework for the research lacks c l a r i t y . The authors acknowledge the l i m i t a t i o n s of t h e i r primary data source, written documentation. They state that t h i s method of data c o l l e c t i o n forced a greater reliance than probably should have been on the supplementary data that was also c o l l e c t e d . Another l i m i t a t i o n i s that curriculum changes before 1988 did not involve paradigm s h i f t s ; they merely entailed re-structuring and re-naming of components of c u r r i c u l a (Diekelmann, 1990). When the aforementioned factors are accounted for, the findings of t h i s study cannot be assumed to r e l a t e to the current curriculum revolution i n nursing education. In a s i m i l a r vein, Fahy (1985) examined i n s t r u c t o r 32 attitudes a f f e c t i n g adoption of i n s t r u c t i o n a l innovations. His interest in the topic stemmed from h i s observation that despite the many voices c a l l i n g for fundamental reform in education, there are many reports of teachers and educational systems as a whole that do not embrace the new v i s i o n . His quest was to examine what i s being resisted. From r e s u l t s obtained through a questionnaire completed by 37 inst r u c t o r s , Fahy i d e n t i f i e d a fundamental dichotomy in in s t r u c t o r attitudes that might also be applicable to the paradigm s h i f t i n nursing education. Instructors acknowledge that t h e i r adult educational world i s changing r a d i c a l l y , that they need to keep abreast of the changes, and that they are key players i n t h i s process of change. However, they remain unconvinced that the changes w i l l r e s u l t i n any appreciable difference i n student learning as compared to t h e i r current method of in s t r u c t i o n . Fahy summarized these findings by saying " i n s t r u c t o r resistance to change i s not monolithic or ar b i t r a r y , but that i t i s often based on s p e c i f i c assumptions and concepts, or may arise from i d e n t i f i a b l e gaps i n policy, communications, or t r a i n i n g " (1985, p. 76). 33 While Fahy's research i s useful in providing some groundwork for the present research, some l i m i t a t i o n s must be recognized. Data were collected through the use of a questionnaire and by interviews. While Fahy says i n the abstract that va l i d a t i o n procedures were i n s t i t u t e d for interview protocols and questionnaire r e s u l t s , i t appears that the v a l i d i t y and r e l i a b i l i t y of the questionnaire was not ascertained before i t was used. The sample population of 3 7 completing the questionnaire was small and no mention was made of how the indi v i d u a l s were selected. On the p o s i t i v e side, the questionnaire was developed as a r e s u l t of ind i v i d u a l interviews conducted with fourteen instru c t o r s and administrators. An expert panel was assembled aft e r the data were analyzed to c l a r i f y some problematic questionnaire r e s u l t s . The need for t h i s may have been prevented by i n i t i a l l y ensuring the r e l i a b i l i t y and v a l i d i t y of the questionnaire. The reader of t h i s research report would have been greatly assisted by presentation of the res u l t s i n a table format. A more recent example of paradigm s h i f t that seems to p a r a l l e l the process that nursing education i s 34 currently undergoing i s found i n a discussion of changes proposed in the teaching of reading/writing. Monson and Pahl describe the revolution i n t h i s f i e l d as follows: Whole language involves a fundamental change i n a teacher's b e l i e f system about the culture of the classroom; t h i s reconceptualization i s at the core of the controversy surrounding the teaching of reading and writing...We have characterized t h i s change as a paradigm s h i f t from t r a n s m i s s i o n — teachers transmitting knowledge to s t u d e n t — t o transaction—students engaging in a transaction between what i s known and what i s unknown (1991, p. 51). The movement towards a transaction model i s "creating a ruckus because i t i s pushing against 100-year old assumptions about teaching; whole language requires a new set of assumptions about learning" (1991, p.52). In e f f e c t i n g the paradigm s h i f t , Monson and Pahl observe that A paradigm s h i f t of t h i s magnitude i s no easy feat, p a r t i c u l a r l y i f one has experienced success with the transmission b e l i e f system and pr a c t i c e s . For p r a c t i t i o n e r s , i t means breaking down the p r e v a i l i n g norms of i s o l a t i o n and control and replacing them with the new norms of col l a b o r a t i o n and r e s p o n s i b i l i t y (1991, p. 53). Monson and Pahl suggest that a way to accomplish t h i s i s to s h i f t the focus of s t a f f development from the t r a d i t i o n a l "corrective orientation" to a more developmental "growth orientation", p a r a l l e l i n g the 35 paradigm s h i f t i n language education. Some assumptions of t h i s model are that learning i s a process of meaning to make and problem-solving, and that learning i s , i n large part, s e l f - d i r e c t e d . Paradigm s h i f t s within the educational system are mentioned i n more general ways by several authors. Spector (1993) described the relationship between the paradigm s h i f t that i s occurring in society and the paradigm s h i f t that needs to occur in education. The paradigm s h i f t occurring i n society i s i d e n t i f i e d by T o f f l e r (1990) as being a s h i f t in power, with knowledge being "the highest quality, most v e r s a t i l e , and the most coveted form of power, thereby placing schools i n the limelight of society" (Spector, 1993, p. 10). As well as power s h i f t s , Spector i d e n t i f i e d a new recognition of the u t i l i t y and d i s t i n c t i v e q u a l i t i e s of the a r t i s t i c mind, or c r e a t i v i t y , as compared to the s c i e n t i f i c mind. C r e a t i v i t y plays a s i g n i f i c a n t r o l e i n the changes that have occurred in science as well as those one would expect i n the arts. Spector says that This s h i f t i n g paradigm in American society f i t s Kuhn's model (1970) for how paradigm s h i f t s i n s c i e n t i f i c thinking occur, namely, the dramatic changes precipitated by advances i n science and technology and the subsequent emergence of the new s o c i e t a l paradigm focused attention on the 36 anomalies i n the educational enterprise (p. 10) . Cherem (1990) investigated paradigm s h i f t s i n the world of adult education. Cherem described the s h i f t as being one i n which adult education i s moving from being considered "night school" for various purposes such as l i t e r a c y t r a i n i n g or vocation t r a i n i n g , to a p o s i t i o n of necessity for a l l adults who must maintain currency i n t h i s rapidly changing world. Cherem added to the understanding of "paradigm s h i f t " by saying that " I t i s a leap, not an incremental evolution. Although those of us accepting the s h i f t may accommodate, and then assimilate, the change l i t t l e by l i t t l e , piece-by-piece, the paradigm s h i f t i t s e l f i s a t o t a l g e s t a l t s h i f t " (1990, p.23). Using Kuhn's (1970) descriptors of the process of paradigm s h i f t , she i d e n t i f i e d the "anomalies" as being that learning i s beginning to be perceived as a process and not merely as content coverage. This makes coverage of a body of knowledge impossible due to i t s increased volume. Other anomalies Cherem i d e n t i f i e d are the exponential growth of information, changing demographics, and the emergence of a philosophy of adults' continuing development. 37 The personal journeys of educators through paradigm s h i f t s are documented in the l i t e r a t u r e . One such documentation i s that of E l l i o t Eisner's r a d i c a l s h i f t i n thinking during the course of his career. Eisner's t r a n s i t i o n from the t r a d i t i o n a l s c i e n t i f i c paradigm to a general q u a l i t a t i v e paradigm, and then to his recent a r r i v a l as a c r i t i c a l t h e o r i s t i s revealed i n h i s many writings. His biographer, Sharon Andrews, warns that "Trying to look at a paradigm s h i f t i s l i k e t r y i n g to see the earth turning. We need the perspective of distance" (1989, p. 107). Solsken (1993), l i k e Eisner, has t r a v e l l e d through many paradigms during her teaching career, a journey that she describes i n "The Paradigm M i s f i t Blues". Solsken also began i n the p o s i t i v i s t paradigm and i s currently situated within the c r i t i c a l theory paradigm. Solsken sees t h i s experience as moving herself closer to a more useful framework for her research; that of the i n d i v i d u a l within society. Solsken expresses concern with the l a b e l l i n g of various paradigms. Solsken's f i r s t objection to the use of labels i s that i t gives "momentary s t a b i l i t y and coherence to what i s dynamic, contradictory, and h i s t o r i c a l " (p. 319). 38 Solsken's second objection, which can be equally well applied to any labels, i s that they put a distance between i n d i v i d u a l and the l i v e d r e a l i t y . As with most abstract concepts, there i s also the danger of taking the paradigm and restructuring i t to f i t personal intentions. Solsken says of her research that there i s a danger to search for the perfect paradigm instead of focusing primarily on relations with other people; the main focus of any of her work. Paradigm S h i f t i n Related Institutions McLaughlin and Kaluzny (1990) discuss the paradigm s h i f t that i s occurring in some health care i n s t i t u t i o n s . In t h i s paradigm s h i f t , the method of health care management i s described as moving from "quality assurance" to " t o t a l quality management". The two approaches to management of health care are conceptually d i f f e r e n t and have a d i f f e r e n t set of assumptions. The t r a d i t i o n a l approach to health care management i s by means of quality assurance, a process that i s i n i t i a t e d by administrators who i d e n t i f y a set of outcomes that they deem as important. A search i s then conducted for evidence that the outcomes are being met to a certa i n preset minimal standard. If the 39 outcomes are not met s a t i s f a c t o r i l y , the area s t a f f are asked to improve the quality of care that they provide. In contrast, t o t a l quality management i s a system by which the users of the system set the c r i t e r i a that measures the e f f i c a c y of the system. The r e s p o n s i b i l i t y for meeting the set c r i t e r i a rests with the entire health care team, rather than i n d i v i d u a l players. A l l members of the team are considered to be making equally important contributions. If the system does not measure up, the group c o l l e c t i v e l y i s responsible, rather than individuals within the group. Management i s directed to place heavy weight on suggestions for improvement that come from the "grass roots". McLaughlin and Kaluzny c l e a r l y i d e n t i f y and evaluate the potential areas of c o n f l i c t between the two organizational models. The authors suggest that a way to mediate these sources of c o n f l i c t are to i d e n t i f y them early and develop action guidelines that w i l l minimize the effects of the c o n f l i c t . The preparation for change in t h i s paradigm s h i f t includes such actions as clear r e - d e f i n i t i o n of key concepts such as the ro l e of the professional, the corporate culture, the role of management; empowerment of s t a f f ; 4 0 developing mentoring capacity, and setting r e a l i s t i c time expectations. The author's experiences of a paradigm s h i f t i n a health care setting o f f e r s i n s i g h t s into experiences that may occur in a p a r a l l e l fashion as a paradigm s h i f t progresses within an educational i n s t i t u t i o n . Curriculum Revolution According to Kuhn (1970), a s c i e n t i f i c revolution occurs when a new paradigm i s presented which provides explanations for occurrences which are unanswerable i n the present t r a d i t i o n . A r a d i c a l s h i f t i n b e l i e f s , values, and assumptions that creates a paradigm s h i f t i n nursing education must then be followed by a plan that w i l l a s s i s t educators to integrate the ideas inherent i n the conceptual s h i f t into the education environment. The paradigm s h i f t in nursing education has resulted in a "curriculum revolution". Kuhn (1970) defines the concept of a s c i e n t i f i c revolution as being "those non-cumulative developmental episodes in which an older paradigm i s replaced i n whole or in part by an incompatible new one" (p. 92). Kuhn further describes s c i e n t i f i c revolutions as being 41 inaugurated by a growing sense, again often r e s t r i c t e d to a narrow subdivision of the s c i e n t i f i c community, that an exis t i n g paradigm has ceased to function adequately in the exploration of an aspect of nature to which that paradigm i t s e l f had previously led the way (197 0, p. 92) . Curriculum Revolution in Nursing Education Tanner (1990) traces the inauguration of the revolution i n nursing education to the year 1986 when a group of nurse education gathered together "to consider the issues i n nursing education and the changes necessary to launch nursing education into the next century" (p. 295). At t h i s time, the movement was c a l l e d the "Curriculum Revolution". Subsequently, each year the National Conference on Nursing Education focused on t h i s topic. These conferences have resulted i n the i d e n t i f i c a t i o n of the major themes and the core values of the curriculum revolution, as reported by Tanner (1990). They are: s o c i a l r e s p o n s i b i l i t y ; the c e n t r a l i t y of caring; an interpretive stance, meaning the unveiling and understanding of " b e l i e f s and assumptions that guide our practices, but which may be covered over by formal theories, rules or procedures" (p. 297) ; t h e o r e t i c a l pluralism; and the primacy of the teacher-student relationship. 42 Much has been written since 1986 i n an attempt to characterize the revolution. de Tornyay a t t r i b u t e s the paradigm s h i f t to "decades of r i g i d l y prescribed nursing c u r r i c u l a , preconceived ideas about the ways students learn and should be taught, and the repression of c r e a t i v i t y " (1990, p.292). The other impetus towards change has been the changing s o c i a l climate towards health instead of i l l n e s s , and the curbing of health care costs. de Tornyay sees the major philosophical s h i f t as being one of empowering the r e c i p i e n t of care and says "nursing students must experience empowering experiences firsthand to be able to provide t h i s kind of care to t h e i r c l i e n t s " (1990, p. 292) . de Tornyay captures the s p i r i t of the revolution by saying: The curriculum revolution i s about teacher-student partnerships. It i s about f l e x i b i l i t y and i n d i v i d u a l differences in how and what one learns. I t i s about instructors spending t h e i r time doing what no text, no program of learning, no computer, or learning resource can accomplish: developing the mind of the individual student through intimate give and take based on sound knowledge and understanding (p. 293). In a si m i l a r theme, Moccia (1990) describes her v i s i o n of nursing education within the curriculum revolution as being "to create and extend an 43 educational community focused not on reproducing rel a t i o n s h i p s of convenience, but on transforming e x i s t i n g power relationships" (p. 308). For Diekelmann, (1990) the curriculum revolution i s "conversations among students, teachers, and c l i n i c i a n s as we seek to transform health care, and the i n s t i t u t i o n s i n which we practice nursing, teaching, and research" (p. 300). Diekelmann proposes a new c u r r i c u l a r model to help structure the new mode of teaching, "Curriculum as Dialogue and Meaning", which she says has s i m i l a r i t i e s to both the c r i t i c a l and phenomenologic models. The basis of the model i s a restructuring of the relationship between knowledge and s k i l l a c q u i s i t i o n . "The curriculum i s a dialogue among teachers, p r a c t i t i o n e r s , and students on what w i l l constitute the knowledge in the nursing curriculum and what ro l e experience w i l l play in the curriculum" (Diekelmann, 1988, p. 144). Diekelmann defines dialogue as "being-in-the-world with others through language and experience" (p. 145). For Diekelmann, the revolution i s about creating communities of care that empower and l i b e r a t e us. It i s about a form of resoluteness i n which we enter the clearing struggling to transform our c u l t u r a l p r a ctices. 44 As nurses, grounded i n a c u l t u r a l practice of caring that values human connectedness, we see c l e a r l y the present p o l i t i c a l and economic threats to our country and the world (1990, p. 301) . One of the strongest voices to be heard writing i n the "curriculum revolution" f i e l d i s that of Em Bevis. She' has authored and co-authored s i g n i f i c a n t books and a r t i c l e s that define and explain her conceptualization of the revolution. Bevis attributes the problems with the current nursing educational system, that have led to the paradigm s h i f t , to the r i g i d implementation of the T y l e r i a n model of curriculum development. Bevis says that the Tylerian model leads to t r a i n i n g , not education. The differences in the philosophies of Bevis and Tyler become apparent when examining the conceptions of each of the t h e o r i s t s . For Tyler (1949), education i s a "process of changing behaviour" (p. 5). In contrast, Bevis (1989) defines education as "that which enriches the learner i n the s y n t a c t i c a l , contextual, and inquiry categories of learning and/or helps the learner grow i n maturity" (p. 73). In expanding on t h i s view, Bevis proposes six types of learning: item learning; d i r e c t i v e learning; r a t i o n a l learning; s y n t a c t i c a l learning; contextual learning; and inquiry learning. 45 Bevis postulates that by learning s o l e l y i n the f i r s t three modes, a technical nurse i s mass produced. By adding the l a s t three dimensions of learning, a professional nurse i s educated. In providing f o r learning that occurs in the largely ignored s y n t a c t i c a l , contextual, and i n q u i s i t i v e forms, the student's education proceeds in a manner that i s v a s t l y d i f f e r e n t from the t r a d i t i o n a l , necessitating a s i g n i f i c a n t change in the role of the educator. This change occurs as a r e s u l t of the changing philosophical outlook that r e s u l t s from adding the three add i t i o n a l dimensions to learning. Bevis elaborates on the difference by stating: To mount our revolution we must dispense with the view of the teacher as an information-giver e i t h e r i n the classroom or in the practicum. The teacher's main purpose, beyond the minimal a c t i v i t y of insuring safely, i s to provide the climate, the structure, and the dialogue that promotes praxis...The teacher's role i s to nurture the learner (1988, p. 46). Rather than the t r a d i t i o n a l oppressive c u r r i c u l a , Bevis defines an emancipatory curriculum that i s s o l i d l y e g a l i t a r i a n . I t i s from a philosophical context that provides that general d i r e c t i o n s be conjointly determined and that content and teaching strategies must be selected that conform to c r i t e r i a that support c r i t i c a l consciousness, l i b e r a t i o n , r e s p o n s i b i l i t y to and for community, counter-hegemony, and c r i t i c a l - t h i n k i n g 46 scholarship (1990, p. 328). For Tyler (1949), the curriculum i s composed of learning experiences, which are defined as "the i n t e r a c t i o n between the learner and the external conditions i n the environment to which he can react" (p. 63). Learning experiences are necessary to allow the learner to practise the necessary behaviours by which learning occurs. In contrast, Bevis (1989) t a l k s about a "learning episode" which i s "a natural grouping of events i n which students engage in the process of acquiring insights, seeing patterns, finding meanings and significance, seeking balance and wholeness, and making judgements or developing s k i l l s " (p. 223). In the on-going discussion of the curriculum revolution, Bevis (1989) i d e n t i f i e s some themes which most educators working i n the area agree upon: the curriculum as teacher-student interactions or dialogue; curriculum that stresses syn t a c t i c a l learning; curriculum as c r i t i c a l and creative thinking; r e a l i t y based learning or being-in-the-world; practicum experiences; phenomenological teaching approaches; and caring as the moral imperative of nursing education. The r e s u l t i n g graduates of the revolutionary curriculum 47 w i l l have c h a r a c t e r i s t i c s of professionals, "meaning that they w i l l be creative, c r i t i c a l thinkers, e t h i c a l l y astute, professionally autonomous, independent, and c o l l e g i a l in t h e i r r e l a t i o n s h i p s " (1989, p. 131). The hope i s that r e s u l t i n g program graduates w i l l be able to a s s i s t in the transformation of the health care system and eventually i n many of our s o c i a l and p o l i t i c a l systems. In summary, from the review of the l i t e r a t u r e i t can be seen that, through Kuhn's (1970) work, a good understanding of paradigm s h i f t and curriculum revolution i n the arena of the hard sciences i s a v a i l a b l e . Much of the t h e o r e t i c a l work in nursing education describes a process of paradigm s h i f t that bears many resemblances to the process that Kuhn describes. There i s a c r i s i s that has p r e c i p i t a t e d the event ( d i s s a t i s f a c t i o n with the Tylerian approach), and a reconstruction has occurred v i a the development of revolutionary c u r r i c u l a based on very d i f f e r e n t philosophical approaches. The c r i s i s i s largely p r e c i p i t a t e d by changes in society and the nursing culture, including the rapid changes in health care, the trend towards more mature learners, and the 48 improved educational preparation of nursing i n s t r u c t o r s who have increased exposure to d i f f e r i n g philosophical outlooks. These changes in society and the nursing culture are coupled with an increased awareness of c r i t i c a l s o c i a l theory and feminist thought. The r e s u l t i s a dramatic paradigm s h i f t i n nursing education. What i s l i t t l e discussed i s the e f f e c t of the paradigm s h i f t on the individuals involved. Beginning attempts have been made to implement a paradigm s h i f t i n nursing education and i n elementary and secondary education. The process of implementation of a r a d i c a l l y new curriculum has been described and some p i t f a l l s i d e n t i f i e d . However, the in d i v i d u a l ' s experience of a paradigm s h i f t has not been investigated. 49 CHAPTER THREE Research Methods The Research Design The research design chosen for t h i s study was ethnography which l i t e r a l l y means " p o r t r a i t of a people" (Germain, 1986, p. 147). Ethnography belongs to the q u a l i t a t i v e domain of research and was o r i g i n a l l y conceived and used by anthropologists i n the 1920's. Sociologists l a t e r adopted t h i s method of study. A central tenet of ethnography, r e f l e c t i n g i t s roots, i s that "people's behaviour can only be understood i n context" (Boyle, 1994, p.162). The context of people's behaviour i s culture, the key component i n the conceptual framework guiding the research. There are c h a r a c t e r i s t i c features of ethnography that d i s t i n g u i s h i t from other forms of q u a l i t a t i v e research methods, such as phenomenology and grounded theory. Atkinson and Hammersley (1994, p. 248) i d e n t i f y ethnography as forms of s o c i a l research having a substantial number of the following features: - a strong emphasis on exploring the nature of p a r t i c u l a r s o c i a l phenomena, rather than s e t t i n g out to t e s t hypotheses about them - a tendency to work primarily with xunstructured' 50 data, that i s , data that have not ben coded at the point of data c o l l e c t i o n i n terms of a closed set of a n a l y t i c categories - investigation of a small number of cases... - analysis of data that involves e x p l i c i t i nterpretation of the meanings and functions of human actions, the product of which mainly takes the form of verbal descriptions and explanations. Two other c h a r a c t e r i s t i c s of ethnography are important i n understanding t h i s research technique. The f i r s t i s that, unlike other forms of research, researchers do not remove themselves from the s i t u a t i o n that i s being studied. As Germain states, The major ingredient i s that one become part of the subculture being studied by physical association with the people in t h e i r s e t t i n g . . . Through the essential methods of p a r t i c i p a n t -observation and intensive interviewing of the members of the subculture, the researcher learns from informants the meaning they attach to a c t i v i t i e s , events, behaviours, (and) knowledge (1986, p.147). The second c h a r a c t e r i s t i c i s that ethnography i s not a l i n e a r process in which a l l decisions about a study are made p r i o r to beginning data c o l l e c t i o n and a l l analyses are undertaken once a l l of the data are c o l l e c t e d . "Rather, ethnography i s a dynamic, in t e r a c t i v e - r e a c t i v e approach to research.... Ethnographers must continually adapt t h e i r questions and plans to the l o c a l conditions of the s e t t i n g as t h e i r studies progress" (Zaharlick and Green, 1991, p. 51 209) . More recently, ethnographic enquiry has found a place i n many d i f f e r e n t d i s c i p l i n e s . Muecke (1994, p.188) describes t h i s process. The 1980's witnessed a renaissance of ethnography, taking t h i s emblem of soci o c u l t u r a l anthropology into the realms of other s o c i a l sciences, nursing and related health sciences, l i t e r a t u r e , a g r i c u l t u r a l development, and even p o l i c y making. In the process, ethnography has been transformed by anthropologists and nonanthropologists, has been applied to novel situations, and has reached new audiences. As a r e s u l t of adoption within d i f f e r e n t d i s c i p l i n e s , the o r i g i n a l form of socio-anthropological ethnography has been modified and many d i f f e r e n t c l a s s i f i c a t i o n s of ethnography now exist. Boyle (1994, p.171) has constructed four subgroups of processual ethnographies: c l a s s i c a l or h o l i s t i c ethnography; p a r t i c u l a r i s t i c ethnography, of which focused ethnography i s a member; cross-sectional ethnography; and ethnohistorical ethnography. This study was p a r t i c u l a r i s t i c ethnography, and more s p e c i f i c a l l y , focused ethnography. P a r t i c u l a r i s t i c ethnography i s contrasted to h o l i s t i c or c l a s s i c a l ethnography i n that instead of applying ethnographic methods to the study of an entire culture, the ethnographic, h o l i s t i c 52 approach i s used to study a s o c i a l unit or group (Boyle, 1994). The term Afocused ethnography' was f i r s t used by Morse (cited in Boyle) "to describe the topic-oriented, small-group ethnographies found i n the nursing l i t e r a t u r e " (p.172). Muecke offers her perceptions of focused ethnographic research as being: time-limited exploratory studies within a f a i r l y d i s c rete community or organization. They gather data primarily through selected episodes of part i c i p a n t observation, combined with unstructured and p a r t i a l l y structured interviews. The number of key informants i s limited; they are usually persons with a store of knowledge and experience r e l a t i v e to the problem or phenomenon of study, rather than persons with whom the ethnographer has developed a close, t r u s t i n g r e l a t i o n s h i p over time (1994, p.199). Issues of R e l i a b i l i t y , V a l i d i t y , and G e n e r a l i z a b i l i t y Ethnography, belonging to the class of q u a l i t a t i v e rather than quantitative research, i s subject to many of the controversies that are raging about q u a l i t a t i v e research. For example, those imbedded i n quantitative methodology are concerned about the s c i e n t i f i c r i g o r of the q u a l i t a t i v e approach. Those supporting the merits of q u a l i t a t i v e research argue that quantitative methods f a i l to capture the true nature of human s o c i a l behaviour. They attribute t h i s to two causes: studies are conducted i n a r t i f i c i a l settings; and meaning i s 53 obtained only from that which i s observable and measurable (Atkinson & Hammersley, 1994). While the discussion seems to have abated somewhat as q u a l i t a t i v e research proves i t s value, the issues of v a l i d i t y , r e l i a b i l i t y , and g e n e r a l i z a b i l i t y remain important. In quantitative research, s c i e n t i f i c r i g o r i s ensured through the mathematical approaches involved i n sample se l e c t i o n and data analysis. In contrast, Sandelowski (1986) states that "The s c i e n t i f i c approach to q u a l i t a t i v e inquiry emphasizes the standardization of language, rules, and procedures for obtaining and analyzing data, for ensuring the r e p l i c a b i l i t y and v a l i d i t y of findings, and for presenting r e s u l t s " (p.28). Qu a l i t a t i v e research must ensure v a l i d i t y and r e l i a b i l i t y through d i f f e r e n t approaches. Although some researchers would argue that these quantitative terms cannot be applied to q u a l i t a t i v e research, other writers support t h e i r use. Germain (1993) states that the primary measurement of good ethnography i s v a l i d i t y and defines v a l i d i t y as follows: "The te s t of v a l i d i t y in ethnography i s how accurately the instrument (the researcher) captures (measures) the observed r e a l i t y and portrays t h i s r e a l i t y in the research report" (p. 262). Face v a l i d i t y i s assured by choosing as informants' i n d i v i d u a l s who have expert knowledge i n the area under invest i g a t i o n . Content v a l i d i t y i s ensured through reaching saturation and through v e r i f i c a t i o n with other experts. Internal v a l i d i t y i s affected by sample se l e c t i o n bias, observer bias, accuracy i n recording f i e l d notes, a n a l y t i c a l accuracy, and bias i n reporting (Germain). Ornery (1988) suggests these errors may be at t r i b u t a b l e to the pa r t i c u l a r s p a t i a l location of the observer, the s o c i a l skewing of reported opinion, or the p a r t i c u l a r c u l t u r a l or s o c i e t a l alignment of the observer. Germain suggests that ways to enhance the in t e r n a l v a l i d i t y or c r e d i b i l i t y of the study are to ensure the researchers d i r e c t and lengthy involvement i n the c u l t u r a l milieu, the selection of key informants, and the repeated testing of inferences u n t i l there i s va l i d a t i o n that meanings are shared. The researcher's biases in ethnography should be s p e c i f i c a l l y stated. External v a l i d i t y or g e n e r a l i z a b i l i t y i s achieved when the research findings f i t other contexts as judged 55 by readers, or when readers f i n d the report meaningful i n terms of t h e i r own experience (Omery, 1988). Suggestions for enhancing the li k e l i h o o d of t h i s occurring include the l i b e r a l use of thick d e s c r i p t i o n and verbatim quotations. Omery suggests that g e n e r a l i z a b i l i t y i s limited to those sharing the same culture or p a r t i c i p a t i n g in the same kinds of a c t i v i t i e s . R e l i a b i l i t y in the quantitative world i s usually established through r e p l i c a t i o n of the study. Since i t i s impossible to r e p l i c a t e an ethnographic study, r e l i a b i l i t y must be found in the consistent approaches of the researcher i n c o l l e c t i n g the data. Consistency can be ensured by having two or more observers observe and record the same event. R e l i a b i l i t y i s also enhanced by the asking of the same questions of d i f f e r e n t informants over a long period of time, obtaining the same information in a number of sit u a t i o n s or seeking reasons for any discrepancies found, and by comparing and contrasting verbal and non-verbal behaviours (Germain, 1993; Mackenzie, 1994). Other methods of ensuring rigor i n q u a l i t a t i v e research are suggested by Morse (1994). The leaving of 56 an "audit t r a i l " by the researcher i s important, so that the process by which conclusions have been reached can be retraced. Another suggestion i s to v e r i f y the findings of the study with the informants. Muecke (1994) proposes six c r i t e r i a for evaluating anthropologic ethnography: (1) the ethnography demystifies the people studied to the point of rendering t h e i r behaviour coherent to the reader; (2) the people described f i n d i t an honest and caring depiction of themselves in t h e i r s i t u a t i o n ; (3 ) the conceptual orientation of the ethnographer i n constructing the ethnography i s acknowledged and coherently linked to the study; (4) The r e l a t i o n s h i p of the ethnographer to the people in the f i e l d i s e x p l i c i t l y assessed for i t s influence on the information reported; (5) ethnographic depth i s achieved through thick description; and (6) the narrative i s competent l i t e r a t u r e . In a provocative a r t i c l e , Liam Clarke (1992) poses warnings to q u a l i t a t i v e researchers and questions the accuracy of t h e i r assumptions that issues of r e l i a b i l i t y and v a l i d i t y are addressed in q u a l i t a t i v e research. Clarke's thesis i s that language i s r i c h i n 57 meaning, and when an individual (researcher) attempts to interpret the language of another, mistakes can be e a s i l y made. Misunderstandings can occur when codes or abbreviations are used by the informant, such as those used by a p a r t i c u l a r occupational group. Misunderstandings can also occur because of concealed assumptions inherent i n a pa r t i c u l a r word used. I t then becomes important to take great care when any inte r p r e t a t i o n of data i s c a l l e d for. Ideally, the researcher should be a member of the professional group being researched, so abbreviations used have the same meaning to both subjects and researcher. C l a r i f i c a t i o n of any areas of ambiguity with the subject through subsequent interviews and valid a t i o n of re s u l t s are ways to ensure accuracy of the data. In t h i s research, many checks were put into place to ensure the r e l i a b i l i t y and v a l i d i t y of the r e s u l t s and to enhance the general rigour of the research process. C r i t e r i a were set to ensure the pa r t i c i p a n t s were f a m i l i a r with and involved in the phenomenon under investigation. These c r i t e r i a were r i g i d l y adhered to. The procedure for obtaining and analyzing the data was constant for a l l participants, although the questions 58 d i f f e r e d somewhat. Only one researcher was involved i n the interviews, so that observer bias was reduced. Through the tape recording of the interviews, the accuracy of the data collected was enhanced. Accuracy of the data obtained was v e r i f i e d through face to face or telephone interviews with each participant. The researcher has been involved in the general c u l t u r a l m i l i e u of nursing education and also with the phenomenon under investigation, so errors of misinterpretation were minimal. E t h i c a l Issues The ethnographic researcher must pay p a r t i c u l a r attention to e t h i c a l considerations i n order to avoid harm to the individuals with whom the researcher i s working. Germain (1986) proposes f i v e e t h i c a l considerations: (1) informed consent, described by Fontana and Frey (1994) as the careful and t r u t h f u l provision of information about the research; (2) the protection of privacy, anonymity, and c o n f i d e n t i a l i t y of members of the subculture during the period of data c o l l e c t i o n and at the time of publication of the report; (3) potential use of findings and power rel a t i o n s h i p s among various levels of the study . 59 population; (4) o b j e c t i v i t y versus s u b j e c t i v i t y with regard to selection, recording, and reporting phenomena; (5) intervention versus nonintervention i n the a c t i v i t i e s of the subculture. In addition, Mackenzie (1994) writes that i t i s important to c l e a r l y state the researcher's relationship with informants at the outset of the research. An additional point i s made by Fontana and Frey, that informants have the r i g h t to protection from harm, be i t physical, emotional, or any other kind. These e t h i c a l issues were considered and constraints were put into place to ensure that e t h i c a l parameters were not violated during the conduct of t h i s research. Sample Selection, Recruitment and Size The informants for t h i s research study were selected from a pool of applicants consisting of a l l students registered in graduate nursing education i n the School of Nursing at the University of B r i t i s h Columbia, at either the master's or doctorate l e v e l . The informants were nursing instructors who had taught i n a baccalaureate or diploma nursing education program for at least two years and who had participated i n a 60 change of nursing educational curriculum from the t r a d i t i o n a l to the revolutionary paradigm. Informants were recruited by placing a l e t t e r i n the mail box of graduate students in the School of Nursing attending university during the summer session. The l e t t e r outlined the nature of the research, the c r i t e r i a to be met for inclusion in the study, the time commitment involved, and assurance of adherence to e t h i c a l considerations (see Appendix B). When the prospective informant contacted the researcher, the study was further explained and the informant's e l i g i b i l i t y for the study was determined. Following a screening interview, f i v e female informants were considered to be good candidates and part i c i p a t e d i n the research. Data C o l l e c t i o n Data for the research was coll e c t e d by using the ethnographic interview, as defined and discussed by Spradley (1979). The length of interview was one hour for four of the informants and one and a half hours for one informant. The interviews were conducted at a place mutually convenient for the informants and the researcher. Both the informant's home and a room at 61 the School of Nursing were used. Prior to the s t a r t of the interview, any further c l a r i f i c a t i o n of the research project was provided and a consent for the interview was obtained from the informant (see Appendix C). The interviews were audio-taped with the consent of the informant. Previously determined questions were asked of the i n i t i a l informant. The questions were adapted for each of the succeeding interviews according to information previously obtained, as per the procedure outlined below. The informants always had the option of dec l i n i n g to answer any question, and of terminating the interview at any time. Following each interview, the tapes were transcribed by the researcher. According to Germain (1993), the researcher w i l l know that an adequate sample size has been reached when saturation and r e p e t i t i o n of information occurs and consistent themes emerge. Germain (1993) says that "when no new data add to the emergent themes or patterns and no new dimensions or insights are i d e n t i f i e d that can shed l i g h t on the research question, the active fieldwork phase ends" (p.256). In t h i s research, some themes that emerged from the f i r s t 62 two interviews were pursued in subsequent interviews and were found to be non-representational. Other themes discussed with a l l participants were found to be congruent with t h e i r experience. By the f i f t h interview, no new data was evident. The data was v e r i f i e d as being accurate through discussion with each informant. These exchanges occurred either as a mini focus group involving two informants, or through individual telephone v e r i f i c a t i o n . Data Analysis An i d e n t i f y i n g feature of ethnographic research i s that preliminary data analysis and data c o l l e c t i o n proceed concurrently (Germain, 1993). Germain (1993) states that "The ethnographer's c u l t u r a l inferences... are working hypotheses that must be tested repeatedly u n t i l there i s va l i d a t i o n that people share a p a r t i c u l a r system of meanings" (p.256). Data analysis consists of a search for patterns and for ideas that help explain the existence of the patterns (Boyle, 1994). The process, as explained by Mackenzie (1994), i s one of data analysis leading to the development of hypotheses or propositions and the 6 3 subsequent t e s t i n g of these hypothesized r e l a t i o n s h i p s through further data gathering and analysis. Through t h i s process, the developing theory i s either supported or challenged. In t h i s research, data analysis was accomplished by summarizing the research transcripts, then developing thematic categories for the summarized data. As the interviews progressed and the themes were explored, the categories were either retained or rejected. For themes that were retained, data supporting the concept was noted. Data supporting each theme was amalgamated and patterns of s i m i l a r i t y were i d e n t i f i e d . 64 CHAPTER FOUR Research Findings In t h i s chapter, data are presented that were obtained through the interviews of f i v e research p a r t i c i p a n t s . The respondents provided information regarding t h e i r experience as faculty members during the time when they experienced a major paradigm s h i f t while teaching i n educational i n s t i t u t i o n s . The f i v e i n s t i t u t i o n s are located throughout the province of B r i t i s h Columbia. One i n s t i t u t i o n i s a un i v e r s i t y / college that offers a degree program with a diploma e x i t point; two i n s t i t u t i o n s have u n a f f i l i a t e d diploma programs; and two i n s t i t u t i o n s have programs that are a f f i l i a t e d with a major university. The research p a r t i c i p a n t s have varying amounts of experience i n teaching i n both old models and new paradigm models of nursing education, ranging from several months to several years. Since the t r a n s i t i o n from the old to the new paradigm did not occur overnight but was a more gradual process, i t i s impossible to quantify the time the p a r t i c i p a n t s spent teaching i n each paradigm. While many areas of commonalities i n the p a r t i c i p a n t s ' experience can be described, d i f f e r i n g 65 viewpoints w i l l also be outlined. The data w i l l be presented according to the following categories: pre-paradigm s h i f t ; i n i t i a t i o n into the new paradigm; affirming the philosophical perspective; and on-going development. Emerging themes w i l l be i d e n t i f i e d under these c l a s s i f i c a t i o n s . Pre-paradigm S h i f t C h a r a c t e r i s t i c s of Early Teaching Experiences An examination of the early teaching experience of the part i c i p a n t s helps to understand t h e i r reactions to and involvement with the paradigm s h i f t . From the outset of t h e i r teaching careers, several p a r t i c i p a n t s were forced to confront t h e i r preconceptions about teachers and learners. The participants described t h e i r i n i t i a l teaching experiences as being "less than t r a d i t i o n a l " , with learners who were older than the ins t r u c t o r , and learners who were more knowledgeable and had more nursing experience than the in s t r u c t o r . This led to t h e i r rapid r e a l i z a t i o n that the t r a d i t i o n a l r o l e of the teacher, as one who had a l l the knowledge and who was the expert, was "not going to work". The participants stated they had varied reactions 66 as novice educators teaching within a behaviourist paradigm. Two participants i d e n t i f i e d an immediate d i s l i k e of teaching within the behaviourist paradigm. One described i n i t i a t i o n into teaching as follows: "I very quickly got d i s i l l u s i o n e d with how we were approaching education and so, i n terms of my own p r a c t i c e i n the classroom, I shifted very quickly". Another described the early experience with the behaviourist paradigm as "not working for me". She stated that " i t was l i k e t r y i n g to f i t round pegs into square holes". This instructor f e l t that teaching under the framework of the behaviourist curriculum was "not working for the students", that " i t was not of any i n t e r e s t to them". A component common to several p a r t i c i p a n t s that f a c i l i t a t e d making a paradigmatic s h i f t involved taking r i s k s i n the classroom. This required that the participant moved away from the formal behaviourist curriculum while s t i l l working within t h i s framework. Two instructors described a more neutral experience with the behaviourist paradigm. Making a paradigm s h i f t seemed to make sense for many reasons, but the emotional reaction experienced by the other two 6 7 p a r t i c i p a n t s undergoing a paradigm s h i f t did not occur u n t i l l a t e r , i f at a l l . One participant i d e n t i f i e d a ra p i d l y changing world as the major impetus for a paradigm s h i f t . According to t h i s participant, changing health care needs are in evidence in a changing community, leading to changes i n the pr a c t i c e arena. Other educational i n s t i t u t i o n s are engaging i n a paradigm s h i f t , causing the faculty of other programs to f e e l " l e f t behind" i f they do not also make a si m i l a r s h i f t . As well, the student population i s changing towards older, more mature students who are seeking a second career. This necessitates a s h i f t i n re l a t i o n s h i p between the student and the ins t r u c t o r from the conception of the instructor as holding a l l the power to a more e g a l i t a r i a n partnership. One participant, unlike the others, "bought in t o " the behaviourist paradigm immediately, thinking i t was the best way to teach. Upon r e f l e c t i o n , t h i s s e l f -described "highly behaviouralist" instructor perceived her s e l f as having previously been a "very bad teacher" because, i n the behaviourist paradigm, students were blamed for not learning or knowing something. Under these circumstances, the assumption was made that the 6 8 students were "bad students". Even though t h i s p a r t i c i p a n t had taken an adult education course during undergraduate studies, the p r i n c i p l e s of adult education were not applied i n her teaching. The tenets of the behaviourist paradigm superseded those of adult education. Ongoing professional development enhanced her teaching s k i l l and confidence. This led to her f e e l i n g that she was becoming a "better teacher" and had less self-involvement: "I didn't have t h i s s e l f esteem ego thing I had to protect by blaming students or s t a f f " . Beginning of the S h i f t The participants i d e n t i f i e d a number of complex and often i n t e r r e l a t e d factors that provided the impetus to move them towards a paradigm s h i f t . These included exposure to new ideas through association with colleagues, some of whom were in the process of or had completed graduate education; t h e i r own previous learning experiences; and the influence of adult educational p r i n c i p l e s . For four of the f i v e participants, exposure to new ideas was a strong impetus to i n i t i a t e a change i n the i n d i v i d u a l ' s world view. For most participants, 69 exposure to these ideas occurred through personal or c o l l e g i a l involvement in graduate educational programs. One par t i c i p a n t did not id e n t i f y t h i s as being the case. She described involvement i n an educational curriculum that was behaviouralist "on paper" but, i n fact, was focused on adult learning p r i n c i p l e s , such as emphasizing the individual learner by recognizing the value of past l i f e experiences and recognizing d i f f e r i n g learning s t y l e s . This caused an early programmatic s h i f t to a group-oriented, student-driven process i n teaching. This individual did not f e e l she experienced a true paradigm s h i f t when the program moved to a humanistic, caring curriculum. Rather, she was buffered from experiencing the f u l l e f f e c t of a paradigm s h i f t by the previous curriculum. The people that started that curriculum were quite visionary already because i t wasn't strongly based on behaviour, well, there were behavioural objectives i n the course outlines, but I never r e a l l y f e l t l i k e I was teaching in a behaviouristic paradigm. I f e l t l i k e I was teaching i n an adult learning paradigm. For one indi v i d u a l , the process of paradigm s h i f t began when a colleague, who was a recent Master's graduate, formed a reading group and gave interested people copies of Peggy Chinn's "Peace and Power" upon 70 which to base discussion. Approximately three other people from the i n s t i t u t i o n joined the i n s t i g a t o r and the research participant i n the study group. For the participant, who was o r i g i n a l l y a behaviourist, the beginning of the paradigm s h i f t occurred through a "chance conversation" with a colleague regarding the advantages of using student writing as a learning t o o l . This "opened some new doors" for the individual who then went on to explore the possible uses of t h i s t o o l . This, in turn, led to her gathering information on teaching thinking and teaching learning, instead of focusing e n t i r e l y on the teaching of content. As a re s u l t , she discovered the c r i t i c a l thinking movement and educational reform. This was the beginning of her personal paradigm s h i f t . D i s s a t i s f a c t i o n with her personal teaching grew as the p a r t i c i p a n t became better informed about the p o t e n t i a l of new paradigm ideas. Two additional s i g n i f i c a n t events occurred that fostered the paradigm s h i f t . Colleagues with recent Master's degrees in education introduced the f a c u l t y to ideas of i n f l u e n t i a l writers who challenge the t r a d i t i o n a l system. The faculty as a whole were 71 introduced to the work of Bevis (1989) and her ideas on curriculum revolution in nursing. These two events also p a r a l l e l the experience related by other p a r t i c i p a n t s . Two participants related that t h e i r previous educational experience as learners provided an impetus for making a paradigm s h i f t as teachers. One described her experience i n her undergraduate education where d i f f i c u l t i e s i n writing multiple choice exams nearly led to f a i l u r e within the program. This i n d i v i d u a l stated that "some faculty saw I was a good nurse so they were quite supportive; i f they hadn't seen that, then I would have been out. They saw the i n d i v i d u a l " . The other participant experienced an increased s e n s i t i v i t y to student's needs because of her unique needs as a student in a masters program. This led to an attempt to " l e v e l the playing f i e l d " by changing the power structures within nursing education. Two of the participants describe the importance of having adult education courses in t h e i r background and how the p r i n c i p l e s of adult education were used as a "stepping stone" in the t r a n s i t i o n to the new paradigm. In fact, one participant f e l t compelled in the paradigm 72 s h i f t to supplement her one undergraduate course i n adult education with a master's degree i n the same subject. This was found to be a useful, yet i n s u f f i c i e n t , way to a s s i s t in the task of developing a curriculum that conformed to the new paradigm. This r e a l i z a t i o n resulted in her decision to undertake further education i n nursing at the graduate l e v e l . This p a r t i c i p a n t read the work of Bevis and Watson (1989), while at the same time developing an i n t e r e s t i n c r i t i c a l thinking and philosophical issues. The accumulation of these approaches was a growing d i s s a t i s f a c t i o n with the content and medical ph y s i o l o g i c a l orientation of the current educational program and the way students were being evaluated. I n i t i a t i o n into the New Paradigm The Influence of the Few on the Many A l l participants described the process of paradigm s h i f t at t h e i r i n s t i t u t i o n s as being strongly influenced by a small key group of individuals. According to one participant, a growing awareness of the power of potential changes occurred during an on-going faculty study group. With the support of the study group, instructors i n i t i a t e d changes r e f l e c t i v e 73 of a new philosophy i n the respective courses that they were teaching. This individual described the experience of being asked to teach a "Professional" course. During preparation for teaching the course, she reviewed the behavioural objectives and course content and experienced great reluctance to teach i n t h i s prescribed, behaviourist manner any longer. She f e l t that the objectives were confining to the ins t r u c t o r i n that they did not allow for any type of "free thinking". She believed that the objectives dictated content, but not the value or meaning of the content. T r a d i t i o n a l l y , the course was perceived to be a "slacker course" and attendance was very poor. In changing the dynamic of the course from one driven by a behaviourist philosophy to one centred around humanism and caring, phenomenology and feminism, the p a r t i c i p a n t noted that the change i n the students was "remarkable". While the students were somewhat reluctant to engage i n these new ways of learning at f i r s t , attendance was excellent and the students "just flew". The pa r t i c i p a n t f e l t that the content had "meaning" for the students, regardless of t h e i r preferred s t y l e of learning. She described a sense of pride i n the 74 accomplishments of the students in t h i s course. She stated that the new ways of teaching seemed to " f i t r e a l l y well with me" and that she had much more freedom. This participant described her role change i n the paradigm s h i f t as evolving from "being all-knowing omnipotent, autocratic, and very c o n t r o l l i n g " to being "a learner with the students". Another participant described the journey of a few key indi v i d u a l s from d i f f e r e n t nursing programs who were able to make unique contributions towards the development of a curriculum based in the new paradigm for her school of nursing. She i d e n t i f i e d t h i s process as a " t e r r i f i c struggle", both personally and professionally, within the key group of people involved. She described the personal process as "sometimes I think of where I was and where I am now and the f i g h t and the struggle". The professional process was characterized by saying "We fought and we struggled, she came over to my way of thinking a b i t and I came over to her's a lot....so together we've come to t h i s wonderful spot". This p a r t i c i p a n t i d e n t i f i e d the "struggle" to exist largely between the visionary conceptualists and the visionary r e a l i s t s "who t r y to keep people grounded on firm t e r r i t o r y " . Sometimes I was l i k e , these guys have got t h e i r heads i n the clouds and honest to God how do they think we're going to do a l l t h i s and you r e a l l y can't do t h i s and what about the content? Ideas were brought back to the home campus from t h i s disparate group of individuals working across i n s t i t u t i o n s . A d i f f e r e n t small core group of indi v i d u a l s became the f i r s t year instructors i n the new curriculum. These f i r s t year instructors then became the "most committed" to the process out of necessity because they were going to be the f i r s t people who were teaching in the new paradigm. One participant, working as a team leader for a small program, developed a curriculum r e f l e c t i v e of a paradigm s h i f t . This participant stated that "a couple of us" began working on a d i f f e r e n t approach to designing the curriculum and teaching i n the c l i n i c a l s e t t i n g . Some new curriculum strategies were developed and the curriculum was rewritten. She described t h i s process as one of "struggle, c o n f l i c t and creating new knowledge and new ways of being". She had previously rejected teaching according to behavioural objectives because they "got down to such a l e v e l of minutiae that they missed the point... and could not cover every 7 6 contingency". Also, "they didn't capture the essence of what you were tryi n g to teach". Although t h i s i n d i v i d u a l was working as a part of a small team, s i g n i f i c a n t ideas for change were largely s e l f -proposed. This was because there was a gap i n educational preparation between the team leader and the re s t of the team. While the rest of the team were upgrading t h e i r education and were very supportive, the r e s p o n s i b i l i t y to develop the curriculum rested l a r g e l y with the team leader. The participant described t h i s group as "responding well to the new ideas because they were looking for themselves answers to t h e i r own discomfort. The v i s i o n was a l l kind of i n the same d i r e c t i o n " . She believed that the group's commitment to a s i m i l a r v i s i o n was largely due to the lucky circumstance that the faculty were hired by the person responsible for the curriculum change. One factor considered strongly i n the h i r i n g process was t h e i r congruency with the philosophical change anticipated for the new curriculum. Affirming the Philosophical Perspective A Continuum of Acceptance According to the participants, moving from 77 i n i t i a t i o n i n the new paradigm to affirming the philosophical foundation i s a p i v o t a l step i n developing acceptance of the new paradigm. This acceptance develops at d i f f e r e n t periods of time for d i f f e r e n t people and for various reasons. The part i c i p a n t s stated that some people are never able to accept the philosophical ideas that underscore the new paradigm. The participants concurred that taking the ideas of a small core group of individuals and transmitting them to an entire faculty group i s an important component of making a successful paradigm s h i f t . They stated that faculty experiencing a paradigm s h i f t can be placed on a continuum of degrees of acceptance from t o t a l commitment i n the old paradigm to t o t a l commitment i n the new paradigm. Placement on the continuum at any point in time i s not fixed. According to the participants, faculty are in a state of flux along the continuum but, for ease of conceptualization, can be c l a s s i f i e d into three main groups. The f i r s t group consist of the key ind i v i d u a l s previously described who instigate the paradigm s h i f t . The participants described members of t h i s group as 78 committed to the philosophical s h i f t and w i l l i n g to take informal r i s k s i n t h e i r teaching to t r i a l t h e i r b e l i e f s . Committed faculty are w i l l i n g to take a "leap of f a i t h " into the unknown, based on t h e i r readings, dialogue, experience of others outside of nursing education, personal perceptions, and informal t r i a l i n g . The second group are faculty who are interested i n the philosophical change and new ideas, but remain uncommitted. This group was described by the p a r t i c i p a n t s as " s i t t i n g on the fence", and somewhat "slow to change t h e i r position". They are l i k e l y to move along the continuum based on s o l i d evidence of the success or f a i l u r e of the paradigm s h i f t . The t h i r d group i d e n t i f i e d by the p a r t i c i p a n t s consists of those individuals who are committed to the "old world view". The participants described t h i s group as perceiving no need for a major change, bel i e v i n g that the t r a d i t i o n a l paradigm has served them well, and wishing to "stay where they are". The p a r t i c i p a n t s stated that these individuals might express t h e i r viewpoint by "passive resistance" to or "active sabotage" of the new curriculum. Not a l l p a r t i c i p a n t s f e l t that they had seen evidence of strong 79 resistance or sabotage within t h e i r school of nursing. One pa r t i c i p a n t expressed t h i s by saying: "I don't think people were a l l that resistant because people didn't know that they weren't doing i t " (teaching i n the new paradigm). Manifestations of Faculty who Resist a Paradigm S h i f t Faculty resistance to a paradigm s h i f t may take d i f f e r e n t forms. One participant described a group of re s i s t a n t faculty who chose to distance themselves from teaching within the new paradigm. She believed t h i s group consisted of instructors who have taught i n a s p e c i f i c term or course for a long time, and/or ins t r u c t o r s teaching only in specialty areas. The par t i c i p a n t hypothesized that these faculty members have a strong "comfort l e v e l " teaching in t h e i r p a r t i c u l a r area. She stated that these in d i v i d u a l s mourn t h e i r l o s t i d e n t i t y as expert c l i n i c i a n s when they are required to teach in ways i n which they have l i t t l e experience. Lack of exposure and f a m i l i a r i t y may cause them discomfort with area-specific nursing s k i l l s . The participant stated that these i n d i v i d u a l s do not pa r t i c i p a t e in committee or faculty meetings and "are not very vocal" because they see the i n e v i t a b i l i t y 80 of the change, perceiving t h e i r choices as being "either to just put up with i t " , or "to come on board". According to the participant, one or two of these instruc t o r s have l e f t her school of nursing, possibly because of t h e i r i n a b i l i t y to cope with the new curriculum. The participant reported that t h i s group of instructors i s largely treated with compassion by fellow faculty members who believe that "not everybody moves at the same speed" in making a paradigm s h i f t . Yet another group of faculty were i d e n t i f i e d by two part i c i p a n t s as being those that "talk the t a l k but do not walk the walk". These are individuals who "pay l i p service to the philosophy but do not engage i n personal c r i t i c a l r e f l e c t i o n on t h e i r own p r a c t i c e " . They t y p i c a l l y maintain "a position of power and authority over students and behave in an oppressive manner towards students". According to these pa r t i c i p a n t s , such people are d i f f i c u l t to i d e n t i f y because they "talk the talk", appearing to p u b l i c l y support the tenets of the new paradigm. Individuals such as these were i d e n t i f i e d by the two p a r t i c i p a n t s as possibly sabotaging the paradigm s h i f t . These ind i v i d u a l s were are viewed as a "danger". 81 One participant described the d i f f i c u l t journey of a fa c u l t y member struggling with the new paradigm: She found i t tremendously d i f f i c u l t to give up the exi s t i n g curriculum because that had more structure i n it . . . b u t she just couldn't make that, she r e a l l y struggled with i t and so she ended up teaching, I think because the faculty, the administration was sensitive to her dilemma and she was sort of a couple of years from retirement, and so they sort of shifted her teaching assignment and she has a perfect teaching assignment now where she's co-teaching with (type of course), the (type of course), which i s sort of perfect for her. Faculty B e l i e f s and Values The b e l i e f s and values system of faculty c l e a r l y play an important part in determining a pos i t i o n along the acceptance continuum. One participant stated that "The r e a l core of your teaching should be directed by values and b e l i e f s that you need to keep making e x p l i c i t and be aware of". She continued to say that i f the b e l i e f s and values inherent i n the new paradigm are not i n keeping with personal b e l i e f systems, i t w i l l be a d i f f i c u l t job to accept the curriculum that r e f l e c t s the paradigm s h i f t . For an in d i v i d u a l with congruent values, the paradigm s h i f t w i l l l i k e l y be made easier. An example provided by one pa r t i c i p a n t was: 82 There wasn't a great deal of importance placed on how students learned. I f , as a student, you were able to follow the usual pr e s c r i p t i o n and met ce r t a i n unwritten expectations (e.g. spoke English well, enthusiastic) you passed. Being an in d i v i d u a l was not given much weight. Another participant said, You have to recognize what teaching means for you and how much value you place on i t , whether i t ' s the b e - a l l and end-all in your l i f e , whether i t ' s just a job. If you're just in i t for the job, you figure y o u ' l l do whatever's going. Yet a t h i r d participant made reference to b e l i e f s and values i n her r e f l e c t i o n s on teaching i n the new paradigm. She compared the i n t e r n a l i z a t i o n of values held by nurses who are educators with those values held by educators who are nurses. She described how t h i s i n t e r n a l i z a t i o n helps to make the paradigm s h i f t easier. I think what we did was we started to teach from more of our nursing hat than our teaching hat, and meaning that from our roles as nurses, we could understand what i t means to care for someone and t r i e d . t o carry more of that respectful caring with us. This p a r t i c i p a n t believed that nurse r e l a t i o n s h i p s with patients can be equated to educator relationships with students; however, i n either relationship, an important value i s the a b i l i t y to be authentic or r e a l . I think with t h i s curriculum we're given more permission to be r e a l to who we are as a person, 8 3 both as students, as nurses and as teachers so I think everybody i s given more permission to be true to who they are... teaching with i n t e g r i t y . The freedom that results from being true to one's b e l i e f system i s described as follows: I remember a l o t of my colleagues saying i t f e e l s so good to be able to f i n a l l y teach the way I've wanted to teach a l l along.... quite a few of them think "Isn't i t wonderful to teach what we r e a l l y believe". So, maybe that comes back to sort of human nature and the values that nurse educators often carry with them but somehow the system kept us from r e a l l y enacting those values that we c a r r i e d before. Movement Along the Acceptance Continuum Faculty positions along the acceptance continuum can change over time. Movement by a l l four groups i n one form or another was described by a l l p a r t i c i p a n t s . Two par t i c i p a n t s described movement by some members of the f a c u l t y group who were i n i t i a l l y t o t a l l y committed, to a p o s i t i o n of uncertainty regarding the e f f i c a c y of the new paradigm. One participant believed that t h i s t r a n s i t i o n may have occurred due to larger concerns and questions such as "should we have taken t h i s t h i s f a r ? " . The t r a n s i t i o n might be temporary because "everybody just has f r u s t r a t i n g days". It may, however, r e f l e c t a "more r e a l i s t i c perception of what i s happening i n the curriculum and the growing pains 84 involved". This experience i s w e l l - i l l u s t r a t e d by one par t i c i p a n t , who remains highly committed to the new paradigm, i n describing the f i r s t year of teaching i n the new paradigm. The before-Christmas phase (Semester 1 of the new curriculum) i s described as a "honeymoon phase" as compared to the after-Christmas phase (Semester 2) that had a large c l i n i c a l component f o r which the faculty f e l t unprepared to enter i n a new paradigm mode. Both these phases are characterized as follows: It was a r e a l l y heady experience.... i t was just so e x c i t i n g and i t was so d i f f e r e n t and so HARD, because half the time we weren't sure of what we were doing was going to be right we'd had t h i s most incredible energy because of the freedom...and the p o s s i b i l i t i e s . . . . the Dean from (Name of Institution) came and we mesmerized him for 4 hours, he couldn't get out of that room because of the energy....We crashed in January....we're the f i r s t off the diving board, we're i n the water, heads barely above. The participants also described movement along the continuum of the unconvinced or uncertain f a c u l t y towards either the position of acceptance or the p o s i t i o n of re j e c t i o n of the new paradigm. In one par t i c i p a n t ' s experience, the majority of t h i s group, two years aft e r the i n i t i a t i o n of the curriculum, had s h i f t e d so that they had personally adopted the 85 curriculum. Another participant described the p o s i t i v e s h i f t of largely behaviouralist instructors by saying that "they were s t i l l t r y i n g to shove everything i n from the old into the new" but after the t h i r d term teaching i n t h i s manner, "now they can see that they can throw t h e i r check-lists away and t r u s t that i f you teach t h i s way the students w i l l s t i l l be okay, safe, able to do i t " . The participants agreed that some faculty w i l l s h i f t along the continuum towards r e j e c t i o n of the new paradigm. According to the participants, these f a c u l t y look for and emphasize the negative aspects of the new paradigm. They also introduce t h e i r negative c r i t i c i s m s of the new paradigm at faculty meetings. A s i g n i f i c a n t factor i d e n t i f i e d as influencing movement along the acceptance continuum was the amount of change recently experienced by faculty, both personal and professional. One participant stated that, at the time the key group was active i n i n i t i a t i n g a paradigm s h i f t , nursing department f a c u l t y had recently adopted a new nursing model as a conceptual framework. This adoption caused major disruption among faculty and students. As well, the 86 f a c u l t y were f e e l i n g threatened by the establishment of a new educational i n s t i t u t i o n in the geographic region. The f a c u l t y viewed t h i s i n s t i t u t i o n as competitive and were concerned about the r e s u l t i n g v i a b i l i t y of t h e i r program. Additional changes that influenced acceptance included returning to graduate education. The p a r t i c i p a n t s stated that t h i s may have a p o s i t i v e influence by exposing the individual to new ideas, but i t might also r e s u l t i n enough additional stress to cause the individual to reject any further change. Developing a New Awareness Several participants mentioned that, i n nursing education, a paradigm s h i f t largely involves moving from one world view to another e n t i r e l y d i f f e r e n t world view, based on very d i f f e r e n t philosophical outlooks. I t i s the interactions between the teacher and the learner, learning occurs through the interactions ....You can't change your interactions with the students u n t i l your world view i s i n the new paradigm. As long as somebody does not p h i l o s o p h i c a l l y teach that way, or believe or understand that way, you w i l l never be teaching in the new paradigm, you w i l l not be teaching THE curriculum, y o u ' l l be teaching something else. One p a r t i c i p a n t stated that the philosophical differences between the t r a d i t i o n a l and new paradigms became re a d i l y apparent during the process of 87 developing a new curriculum: We REALLY saw the difference between what we were t r y i n g to do i n the new curriculum and what we'd been doing before....You would do a l l t h i s work and prep but r e a l l y what you were doing was putting content together i n your head from various sources and you were giving i t to the students and you thought t h i s great learning thing was happening. The trouble with the old world-view (behaviourist) i s i t didn't have a piece that was about s e l f -awareness. I t didn't have a piece that was emancipatory or empowering. In t h i s participant's experience, the development of the new curriculum resulted i n personal as well as professional change: "Really we were learning a l l the time because once you st a r t teaching t h i s way you s t a r t being t h i s way. This whole thing about valuing r e f l e c t i o n and dialogue and being self-aware and looking at what you're doing was r e a l l y catching on". The participants recognized that, i n order to make a paradigm s h i f t , the new paradigm must be congruent with both the instructor's teaching and personal philosophy. "Your view of the world influences your view as a teacher cause i t influences who you are and you can't be other than who you are". The d i f f i c u l t y i n adopting some of the complex philosophical perspectives inherent i n the new paradigm was acknowledged. 88 I t i s r e a l l y tough to adopt a phenomenologic perspective. It i s so a n t i t h e t i c a l to nursing and health care....to r e a l l y know what i t looks l i k e for you as a person and for your practice takes time and r e f l e c t i o n and interaction amongst people. F a c i l i t a t i n g the Paradigm S h i f t Three ways were suggested by participants to ease the struggle associated with "owning the philosophy" of the new paradigm and changing one's world view. One of the p a r t i c i p a n t s suggested that instructors can learn about the new paradigm i n the same manner as the students learn within the new paradigm; that i s , by praxis. " I t ' s l i k e a praxis kind of thing, you r e a l l y have to do i t , r e f l e c t on i t , go t h i s i s what that meant...and there's that idea about over-evaluating and having your c h e c k - l i s t and make sure a l l the s t u f f i s covered". The participants concurred that much of the new paradigm "has to be experienced to make sense of i t " and to incorporate i t into one's value system. Learning about the new paradigm by the i n s t r u c t o r and learning within the new paradigm by the student happens i n the same way, namely through praxis. One p a r t i c i p a n t i l l u s t r a t e d t h i s concept by comparing the preliminary program approvals report submitted to the Registered Nurses Association of B r i t i s h Columbia 89 (R.N.A.B.C.) which was a "skimpy l i t t l e conceptual thing", and one recently submitted, a "very thick document". They could never have written that back then because we weren't there yet. This i s what praxis i s a l l about. This i s phenomenology. You can't know i t , you've got to do i t , then r e f l e c t on i t , then say these are the concepts, the theory. You don't know what i t looks l i k e u n t i l you do i t . The part i c i p a n t s stated that, once faculty have been through the process themselves, they can then help students go through the process of accepting the philosophies of the new paradigm and the r e s u l t i n g changed world view. A concept somewhat related to learning through praxis i s attaining a l e v e l of comfort through learning the language. Two participants mentioned the influence that f e e l i n g comfortable with the language of the paradigm had i n accepting the new paradigm. Both pa r t i c i p a n t s discussed t h i s i n r e l a t i o n to co-workers who were having some trouble making the paradigm switch. "People need to get to the point where they f e e l confident and competent and have the language -then they can ask for help and play a formal r o l e " . "We got them to gradually get into the language of the curriculum and be getting into the language, you can 90 come around to your world view being that way". One p a r t i c i p a n t expressed the opinion that the " i n i t i a l reaction i s to object to the language but, i n fact, i t ' s j u s t the fear of the unknown". Another highly recommended method of easing the t r a n s i t i o n i s through the use of a f a c i l i t a t o r . Two pa r t i c i p a n t s had both d i r e c t and i n d i r e c t experience with f a c i l i t a t i o n of a paradigm s h i f t . Both agree that an important piece of the process i s dialogue and i n t e r a c t i o n among people. The participants agreed that r e f l e c t i o n i s also important but t h i s i s usually conducted i n a s o l i t a r y fashion. If we had just done i t ourselves, I don't know where we'd be, but we kept having experts come. You need to have someone who i s a f a c i l i t a t o r , who can work with you. Can students learn nursing just by reading and r e f l e c t i n g or do they need an outside person l i k e a teacher? A f a c i l i t a t o r from outside came i n and made a s i g n i f i c a n t difference - somebody from outside was necessary because of uncomfortable dynamics between people moving forward and those who weren't. The f a c i l i t a t o r provided the expertise to move the group through the curriculum, and through the philosophical issues everybody has been engaged and everybody feels committed and everybody's read the s t u f f . Not everybody i s up to the same speed, but they are going i n the same di r e c t i o n . E f f e c t on the Working Environment While faculty were struggling to complete t h e i r 91 personal paradigm t r a n s i t i o n , the working climate at the various i n s t i t u t i o n s was affected to varying degrees. One participant acknowledged that "to change the whole curriculum i s just an incredibly u n s e t t l i n g thing"; therefore, "reverberations among faculty are almost to be expected". This participant went on to describe the working climate experienced at the i n s t i t u t i o n during the time of the paradigm s h i f t : "There was a r i f t in faculty between the people that hadn't bought i n and the people who had...there i s a group of people who are very te c h n i c a l l y oriented. They were r e a l l y into supervision and surveillance ....they're coming i n with that world view". In response to the question of how faculty who have changed t h e i r world view can a s s i s t those who have not, t h i s p a r t i c i p a n t stated that i t i s very d i f f i c u l t : We're caring with patients and with students but NOBODY i s caring with t h e i r colleagues... cause you're sort of the bottom of the l i s t , because you're so t i r e d with your workload. Two suggestions were made to overcome t h i s : ( 1 ) t r y to empower each other when interacting as a group; (2) a f f i r m each other. These suggestions were based on her assumption that, while unity of the group i s highly desirable, d i v e r s i t y i s valued. Another p a r t i c i p a n t 92 had hoped for more caring, sharing, and openness among fac u l t y . The participant stated she r e a l i z e d she had been naive i n thinking t h i s potential might be actualized. What she observed was a few in d i v i d u a l s who did the "bulk of the work", some of whom "burned out" l a t e r . Another participant described a s i t u a t i o n where d i v i s i o n s already existed along organizational l i n e s and, when one group started to develop i n a d i f f e r e n t way because of changes they made i n accordance with the new paradigm, the divisiveness of the faculty was increased. Things improved, however, when everyone made a decision to work together. One participant described a d i f f e r e n t experience during the t r a n s i t i o n from one paradigm to another: The faculty i s a very sort of a supportive, close-k n i t group to begin with, and so i t was a good group within which to take on t h i s sort of a change, because we're a group that i s used to looking after each other. The participants stated that the process of paradigm s h i f t tended to i s o l a t e some groups of fac u l t y . This happened both to individuals who were teaching i n the existing curriculum, while colleagues were moving ahead and teaching in the "new" curriculum, 93 and to individuals who moved ahead i n the "new" curriculum while colleagues remained teaching the f a m i l i a r . The participants described these f a c u l t y (and sometimes students) as f e e l i n g abandoned and unrecognized. " i t was hard for teachers... in that l a s t preceptorship because at one point...we needed to access the budget for some reasons, to plan a graduation party or something, and we r e a l i z e d , we were t o l d that oops, we forgot to give preceptorship a budget, in other words we just sort of forgot that preceptorship was s t i l l running and they were so busy with development of the new program and running the f i r s t program and that to me sort of captures what t h i s was l i k e to teach i n the l a s t part of that e x i s t i n g program". On-Going Development Rewards of Teaching in a Non-Traditional Curriculum Most participants described that seeing a d i f f e r e n t student develop as both teachers and students l i v e d the new curriculum was one of the greatest rewards r e s u l t i n g from the often d i f f i c u l t process of making a paradigm s h i f t . Nurses who emerge a f t e r experiencing the new curriculum are described by one pa r t i c i p a n t as having "a better grasp of what's required of h o l i s t i c type of care. They approach the i n d i v i d u a l and WILL incorporate the family, s p i r i t u a l needs, s o c i a l i z a t i o n . It i s a more global picture". 94 Another change t h i s participant had noticed i s that students interaction with the culture of nursing i s changing. "They w i l l question the t r a d i t i o n s and things we do unquestioningly". As well, she described students as being more creative, more w i l l i n g to look at problems i n d i f f e r e n t ways. Another participant, when comparing second year students within the former paradigm with second year students from the new paradigm, described present students as "being at a d i f f e r e n t stage than our second year students ever were before, and r e a l l y seeing them much more clear about t h e i r role as a nurse, much more assertive and advocating for t h e i r c l i e n t s " . She provided the following example: One of my favourite stories i s a student just standing r i g h t up to one of the gynecologists who no nurse would ever have questioned, and she did i t i n such a lovely way where she just asked, "Well, that's not how I would have seen i t . Can you explain to me how you got to that conclusion?" And she did i t i n a most non-threatening way, and the gynecologist looked at her, and the other nurses were standing around, and were coming over to me "Oh, I don't think she should be t a l k i n g to him". And I'm going, "She'll deal with i t , l e t ' s see what happens", and so I think to see...a v i s i o n of how nursing could be and how i t should be, so I think those are the moments of glory. Teachers also experience rewards teaching within the new paradigm i n other ways. One instructor 95 included among the benefits she has experienced the exposure to d i f f e r e n t ways of teaching and a broader perspective on teaching i n general. Having exposure to other educators outside nursing has broadened what i s i n her perception the t r a d i t i o n a l l y narrow focus of nursing. She has also f e l t the freedom to broaden her own teaching a b i l i t i e s , to have the "luxury of t r y i n g new things without being penalized i f mistakes are made" because " i t ' s the new curriculum and we're a l l learning". Another instructor described the freedom i t gave her i n allowing her to exercise her strong b e l i e f s i n c r i t i c a l thinking: "before we were t r y i n g to f i t c r i t i c a l thinking around heavy content, now c r i t i c a l thinking was in the centre". Participants i d e n t i f i e d that experiencing these rewards i s an important part of experiencing the paradigm s h i f t . One participant described that a b e l i e f i n the effectiveness of the new paradigm to educate nurses who are at least as capable as the nurses educated i n the t r a d i t i o n a l paradigm i s necessary i n fostering the change. And so, my f i r s t worry i s "Will they s t i l l be able to do the job with t h i s new approach?" I've got to have confidence i n t h i s . And then the second thing i s "Do the job. Hum". Then I begin, under 9 6 these new ways of thinking to say, "Hum, maybe the job should be d i f f e r e n t " . The draw-backs of teaching i n a new paradigm were also expressed by the participants. These are l a r g e l y centred around workload and student evaluation issues, p a r t i c u l a r l y c l i n i c a l evaluation. They also included discussions concerning the lack of knowledge about how students learn c l i n i c a l l y , what c l i n i c a l reasoning "looks l i k e " , and the very d i f f e r e n t role that the ins t r u c t o r plays i n c l i n i c a l teaching. Some nursing s t a f f i n certa i n c l i n i c a l areas are having d i f f i c u l t y adjusting to the new role of the teacher, as one of the part i c i p a n t s describes: Students are very understanding and forgiving, but the practice setting i s not as forgiving. They s t i l l see faculty i n the t r a d i t i o n a l role....you're supposed to know (everything) ....there's some loss i n c r e d i b i l i t y with some of the R.N.'s As long as you're open and honest with them they seem quite w i l l i n g to help you out, BUT there i s that core that think, "No, you're getting paid to do t h i s " . The participants stated that, i f the rewards are strong enough, faculty experiencing a paradigm s h i f t are motivated to "keep pressing forward" despite the fr u s t r a t i o n s . The Process Never Ends The participants described a continuing process 97 of evolution within the paradigm s h i f t . No end point had yet been reached that s a t i s f i e d the par t i c i p a n t s that they had completed the t r a n s i t i o n . One pa r t i c i p a n t described her experience, four years a f t e r beginning teaching in a new paradigm. "Even now I'm getting new insights... even though I have been teaching i n the new paradigm four years I s t i l l f a l l back, a l i t t l e piece drags me back there". In describing some of her co-workers she says, "They're s t i l l not there yet, but I'm just getting there myself". Another pa r t i c i p a n t warns about the dangers of "thinking you've arrived somewhere" and expressed concern about "people that think they are there when they are not". Part of the ongoing evolution i n a paradigm s h i f t i s the e f f e c t that changes have on the nursing profession at large. The conclusion of some of the part i c i p a n t s i s that the paradigm s h i f t they are engaged i n w i l l cause reverberations within and without the profession. Two participants expressed the concern that nursing educators are making strong changes with the intent of helping future nurses cope with the rap i d l y changing environment; however, the p a r t i c i p a n t s are seeing that the graduates from new paradigm 98 programs are r e a l l y engaging in a d i f f e r e n t type of nursing, based on the d i f f e r i n g philosophies of the programs. The graduates are having a great impact on the c l i n i c a l settings and how they deal with patients, but the c l i n i c a l settings are not changing to accommodate t h e i r new ways of being. One p a r t i c i p a n t described t h e i r c l i n i c a l f a c i l i t y as being a "dinosaur". She stated that change in the f a c i l i t y was "happening the least of anywhere i n the entire world". One participant discussed the repercussions of the paradigm s h i f t in s o c i o - p o l i t i c a l terms. As we are encouraging ourselves not to accept the educational status quo, I think that we can't accept the health care status quo....it's at the larger s o c i o - p o l i t i c a l l e v e l I think nurses have a r e s p o n s i b i l i t y , I think we have a r e s p o n s i b i l i t y to teach health problems, not just as i n d i v i d u a l responses but as the product of a whole way of thinking and being in society. Another participant expressed similar ideas i n t h i s manner: "We re a l i z e d that here we were, that t h i s i s where the future i s , a l o t of t h i s i s generative s t u f f - we are not teaching for the l o c a l community but for the world". Yet another participant expressed the following hope when discussing the curriculum that evolved at her i n s t i t u t i o n as a r e s u l t of the paradigm s h i f t : 99 I think the pace of change in our society i s so fast , I think i t ' s just going to be a constant evolution, but maybe we're on a better track than we have been i n the past. Summary In summary, the participants described various aspects of t h e i r journey through the paradigm s h i f t . They i d e n t i f i e d how t h e i r i n i t i a l teaching experiences influenced the development of b e l i e f s and values that helped f a c i l i t a t e a l a t e r paradigm s h i f t . They described how they were i n i t i a l l y exposed to the new paradigm, various experiences that were s i g n i f i c a n t i n t h e i r willingness to pursue these new ideas, and t h e i r reactions to the philosophies inherent i n the new paradigm. "Buying into the new paradigm" for both themselves and t h e i r colleagues was not a smooth process. They described a "continuum of acceptance", ranging from t o t a l acceptance to t o t a l r e j e c t i o n , along which fa c u l t y could be located at varying times during the adopting process. Those who t o t a l l y rejected the new paradigm were of some concern and are seen by t h e i r co-workers i n d i f f e r i n g ways. Making a successful s h i f t i s largely dependant upon the establishment of b e l i e f s and values that are congruent with the philosophy of the new paradigm. This takes varying 100 lengths of time for various individual and can be f a c i l i t a t e d . While faculty are working through the process of accepting the new paradigm, an e f f e c t i s f e l t on the working environment. An already u n i f i e d f a c u l t y w i l l f e e l the least e f f e c t . A l l p a r t i c i p a n t s described the rewards of being with students i n a new way, and of seeing program graduates being i n t h e i r world i n a new way. This helps to s o l i d i f y f a c u l t y commitment to the new paradigm. The process i s seen as being on-going by most participants, with r e s u l t i n g e f f e c t s that w i l l reach into the heart of society. 101 CHAPTER FIVE Discussion of Research Findings This chapter w i l l include a discussion of the s i g n i f i c a n t research findings, as elaborated i n Chapter Four. These findings w i l l be examined i n r e l a t i o n to the l i t e r a t u r e presented i n Chapter Two, and i n r e l a t i o n to the work of other theorists who can contribute to the understanding and i n t e r p r e t a t i o n of the data. In p a r t i c u l a r , Thomas Kuhn's (197 0) work on paradigm s h i f t s w i l l be r e - v i s i t e d i n l i g h t of research findings from t h i s study. Discussion w i l l be organized according to the process of paradigm s h i f t occurring within the culture of a school of nursing. Analysis of the research r e s u l t s have shown that the process of paradigm s h i f t occurs as follows. Key players pursue knowledge i n response to various stimuli and put together t h e i r knowledge i n such a way that an understanding of the p o s s i b i l i t i e s of a new world view emerges. These key players undergo t h e i r own paradigm s h i f t which primarily involves a major examination and possible change i n t h e i r personal b e l i e f s and values. Key players then transmit t h e i r understanding of the new 102 conception and t h e i r new way of being to colleagues. Other members of the culture must then undergo t h e i r own paradigm s h i f t , through gaining knowledge and incorporating the knowledge into t h e i r b e l i e f s and values system. As i d e n t i f i e d by the research pa r t i c i p a n t s , the process of paradigm s h i f t i s a dynamic one. The individual moves back and f o r t h through the stages and gaining f u l l insight into the t o t a l i t y of the new paradigm goes on for a long time a f t e r the teaching of the new paradigm i s implemented. The Personal Process of Paradigm S h i f t The findings of t h i s research study have demonstrated that the process of paradigm s h i f t begins as a highly individual endeavour. It i s apparent in t h i s study that, as colleagues within the culture become aware of the p o s s i b i l i t y and p o t e n t i a l of a revolutionary change, each individual must examine the meaning the paradigm s h i f t has for t h e i r own person. Deeply inherent i n t h i s examination are i n d i v i d u a l b e l i e f s and values. Through r e f l e c t i o n on t h i s process, two questions emerge to be answered: What are the q u a l i t i e s that enable an individual to f i r s t recognize the significance that the integration of 103 c e r t a i n ideas can r e s u l t i n a d i f f e r e n t way to view the educational world?; and how do b e l i e f s and values change when an individual i s presented with a new way to view the world? Gaining; Revolutionary Insights An answer can be found to the f i r s t question by comparing the process described by Kuhn (197 0) of paradigm s h i f t and r e s u l t i n g s c i e n t i f i c revolution, as previously presented (see Chapter I I ) , with the process of paradigm s h i f t as described by the research p a r t i c i p a n t s . When the process of paradigm s h i f t occurs i n nursing education, i t i s evident that events s i m i l a r to those found i n the s c i e n t i f i c world take place. According to the participants, nurse educators attend to anomalous data that are received as feelings of unrest and uneasiness, largely a r i s i n g from t h e i r own sense of f r u s t r a t i o n regarding the system i n which they work. The participants describe t h e i r f r u s t r a t i o n s with the system by saying that i t i s not working for either themselves or the students, they do not f i t into i t , they are not teaching the way they want to teach, and the world i s changing rapidly while the system 104 remains stagnant. This i n i t i a t e s a personal seeking process where the question i s asked, "how can I make i t better?" One of the key components in reacting to f r u s t r a t i o n associated with the system i s seeking knowledge (Kuhn, 197 0). According to the p a r t i c i p a n t s , i n nursing education t h i s occurs either through exploring material that presents a new way of looking at the world, r e v i s i t i n g older ideas that now seem to have more u t i l i t y , exposure to related movements, and/or return to graduate school. When the i n d i v i d u a l has gathered s u f f i c i e n t information, a new way of thinking and experiencing teaching and learning i s incorporated into t h e i r b e l i e f s and values system. The i n d i v i d u a l begins to entertain the hope that a revolutionary way of teaching nursing i s possible that may solve the individual frustrations with the current system. This i s analogous to the process described by Kuhn i n which the s c i e n t i s t has rigorously tracked down the source of the anomalies and, in the process, discovered a new way to view the world. B e l i e f s and Values The participants in the study i d e n t i f i e d another 105 s i g n i f i c a n t process that must occur to e f f e c t a true paradigm s h i f t . This i s an examination of and possible change i n personal b e l i e f s and values. Unlike the s c i e n t i f i c community, where a paradigm s h i f t i s p r e c i p i t a t e d by "hard data", a paradigm s h i f t among educators must be made ultimately based on ideas that make sense to the in d i v i d u a l . In the p a r t i c i p a n t s perspective, at the outset there i s no d e f i n i t i v e data that suggests these changes are going to work. The i n d i v i d u a l i n the "key group" who leads the way i n proposing a paradigm s h i f t does so based on the " f i t " of a multitude of ideas inherent within the paradigm s h i f t and within t h e i r own b e l i e f system. According to the participants, for those who do not r e a l i z e t h i s " f i t " , another process must take place before the paradigm s h i f t can be incorporated into t h e i r way of being. This process i s one of transformation. According to L i f t o n (1976, p. 458) transformations must connect with the past while going beyond mere su r v i v a l of that past i n the creations of new forms and modes. The process i s both psychological and h i s t o r i c a l , and at the same time prominently aesthetic, very much a matter of s e n s i b i l i t y . The same author puts forward the idea of "Protean man", r e f e r r i n g to the mythological character of 106 Proteus who was able to change his shape with r e l a t i v e ease. L i f t o n (1976) suggests that t h i s self-process " i s characterized by an interminable series of experiments and explorations some shallow, some profound each of which maybe readi l y abandoned i n favor of s t i l l new psychological quests" (p. 459). In a manner similar to Protean man, the "Protean" educator must undergo a transformation i n order to "be" d i f f e r e n t i n the world, as i s required of an i n d i v i d u a l who i s undergoing a paradigm s h i f t . This s e l f -exploration i s an essential part of continued growth and, because of the r a p i d i t y of change in our society, i s l i k e l y to be an on-going process. According to Lipton (1976 p. 465), t h i s self-exploration can occur i n three d i f f e r e n t s t y l e s : There i s f i r s t a shallow p l a s t i c i t y , repeated change of "color" or appearance without serious depth of immersion anywhere—a st y l e more accurately termed p l a s t i c than Protean. A second pattern i s that of intense immersion followed by equally intense rejection, so that one ends up almost where one began, with v i r t u a l l y n o t h i n g — o r what might be c a l l e d the "shedding s t y l e " . F i n a l l y there i s what I would view as the more genuinely Protean s t y l e , the one most consistent with patterns of transformation, in which there i s immersion, resurfacing, and reimmersion, with retention of certain aspects of each of the.... experiences i n which one has been immersed, so that there i s an accruing of inner forms and a constant recombining of psychic elements. 107 In t h i s research study, the f i r s t and t h i r d s t y l e s were c l e a r l y described by the participants, while the second pattern was not seen in exactly the fashion that Lipton describes i t . What was seen i s movement from a strong p o s i t i o n of acceptance to a more neutral p o s i t i o n , and from re j e c t i o n to a neutral p o s i t i o n . These indiv i d u a l s did not end up where they began. Nursing instructors who conform to the f i r s t pattern are described by the research participants as those who "tal k the ta l k but do not walk the walk". jThey are unwilling to engage i n a process of s e l f - r e f l e c t i o n . Why t h i s i s so i s a matter of conjecture, but could be related to past experiences or fear of delving deep into the psyche. Individuals engaged in the t h i r d pattern are those who have undertaken the process of self-examination and who have emerged with some degree of self-awareness. These individuals possess the c h a r a c t e r i s t i c s described by the research p a r t i c i p a n t s as authentic, or genuine. According to the research participants, i n order to achieve a true paradigm s h i f t , the transformative process must occur, or have occurred. It i s l i k e l y that those for whom the ideas contained within the 108 paradigm s h i f t make immediate sense are able to discover immediate congruency between the new ideas and t h e i r own values. This means that a personal transformation has already occurred, or that t h e i r b e l i e f s and values system were progressive enough to incorporate profoundly new ideas. For others, the transformation must occur by a process of matching personal values with the values inherent i n the new paradigm philosophies. Munhall (1988) speaks of transformation i n an analogous way with regard to both revolutions and paradigm s h i f t s . She says: t h i s transformation has to do with s h i f t s i n paradigm and with an expansion of consciousness. A curriculum revolution would e n t a i l both, of course: there would be a new way of thinking and a new scheme for understanding and explaining c e r t a i n aspects of r e a l i t y (p. 219). Grundy (1987) supports t h i s by saying "What i s required ....to inform one's practise, i s a transformation of consciousness, that i s , a transformation i n the way i n which one perceives and acts in 'the world'" (p. 99). Bevis (1990) presents a similar idea when discussing the nursing education revolution i n comparison to Kuhn's (1970) work. She c a l l s her conceptualization a "conversion" when explaining that 109 i t i s not grounded i n research. Bevis likens the response she receives to the ideas she puts forward to Saul's conversion by revelation on the road to Damascus. She warns of the dangers of dogmatization, saying that a new paradigm to replace Tyler's outmoded one must be selected c a r e f u l l y to ensure that i t i s i n fa c t better than the one i t i s replacing. According to the participants, the process of transformation for the faculty member i s akin to the process that a student w i l l experience during submersion i n the new paradigm. To some degree the fac u l t y member can read about new philosophies and s t a r t a process of s h i f t i n g but, ultimately, b e l i e f s and values are best expressed i n the doing, the being (Bevis, 1989, Diekelmann, 1988). This i s the notion of praxis that the participants discussed. Praxis, according to the participants, i s the only way to know that b e l i e f s and values have r e a l l y changed. I t may be for many that t h i s process of inner examination w i l l not occur u n t i l faculty actually are required to teach i n the new paradigm (Diekelmann, 1988, Grundy, 1987). At t h i s time, faculty w i l l probably s h i f t t h e i r world view at the same time the students are engaged i n 110 s h i f t i n g t h e i r s , and become true co-learners with the students (Diekelmann, 1988, Grundy, 1987). Transmission of the Vision The preceding discussion was primarily centred around key individuals and the transformational process that must occur on the personal l e v e l for a paradigm s h i f t to occur. The individuals referred to are those members of "key groups" who are central to making a paradigm s h i f t a r e a l i t y within t h e i r i n s t i t u t i o n . Once those individuals have experienced t h e i r paradigm s h i f t , another process must occur. This process i s one of spreading the v i s i o n to the other members i n the culture. I t i s important that as many members of the culture as possible are making congruent changes and working within the same paradigm. Failure to do t h i s w i l l cause a great deal of confusion for the students i n the program and may ultimately threaten the success of the paradigm s h i f t . After t h i s stage, repatterning or restructuring of the culture can occur, followed by some measure of s t a b i l i t y , evidenced by preservation and maintenance of the new system. In order to examine the spread of the paradigm s h i f t among members of the culture, other concepts must 111 be pursued. Kuhn's (197 0) contribution to the understanding of t h i s phenomenon i s quite li m i t e d and he admits his own weakness i n t h i s area. Kuhn does postulate several reasons why individuals adherent to the old world view w i l l come into c o n f l i c t with those who adhere to the new world view. Kuhn says that, because t h e i r standards or d e f i n i t i o n s are not the same, they w i l l disagree on what the new paradigm i s to accomplish. Often, as i s the case i n the educational paradigm s h i f t , the vocabulary and other surrounding ideas are incorporated into the new paradigm, r e s u l t i n g i n miscommunication between adherents of the two paradigms. Kuhn (1970) states that "the proponents of competing paradigms practice t h e i r trades in d i f f e r e n t worlds" (p. 150). The D i f f u s i o n of Innovations The acceptance of a v i s i o n inherent i n a new paradigm can be compared to the d i f f u s i o n of innovations. Research regarding the d i f f u s i o n of innovations evolved from a need for companies to understand how t h e i r technological advancements were received by the targeted community (Rogers, 1962). This l a t e r expanded from d i f f u s i o n of technology to 112 include the d i f f u s i o n of ideas, p a r t i c u l a r l y i n the f i e l d of education (Rogers, 1962). Many findings i n t h i s f i e l d are useful to understanding the adoption process of paradigm s h i f t in nursing education. Rogers (1962) can be credited with analyzing and synthesizing a wide variety of research concerning innovations. The outcome of his pioneer work was the development of a theory on the d i f f u s i o n of innovations. Rogers (1962) defines an innovation as "an idea perceived as new by the i n d i v i d u a l " (p. 13). This d e f i n i t i o n allows that the idea may not be new to society, only to the ind i v i d u a l . Rogers (1962) defines d i f f u s i o n as "the process by which an innovation spreads" (p. 13). At the heart of the d i f f u s i o n process i s interpersonal communication. One person must know about the idea and communicate i t i n some form to another. A f i n a l term necessary for understanding of t h i s concept i s adoption which i s "a decision to continue f u l l use of an innovation" (Rogers, 1962, p. 17). Rogers allows that culture w i l l play an important part in the adoption and d i f f u s i o n of innovations. Normal c u l t u r a l b e l i e f s and practices and group interactions w i l l influence the in d i v i d u a l 113 decision to bring the innovation into personal p r a c t i c e . Rogers (1962) i d e n t i f i e s many s i g n i f i c a n t c h a r a c t e r i s t i c s of the concept in his innovation theory. He describes an adoption process that consists of f i v e stages: awareness, during which time the in d i v i d u a l i s introduced to the idea; interest, when the i n d i v i d u a l a c t i v e l y seeks additional information; evaluation, where the idea i s submitted to an i n t e l l e c t u a l review; t r i a l , a process of implementing the idea into limited practice; and adoption or f u l l acceptance of the idea for future use. Rejection, or "discontinuance" can occur in either the t r i a l or adoption phases, or at any time aft e r adoption. In applying the stages of the adoption process to the current research, insight can be gained into the process that other members of the culture, other than the "key group" go through in accepting a paradigm s h i f t . Individuals i n the culture who are more l i k e l y to pass through the stages i d e n t i f i e d by Rogers (1962) are those not d i r e c t l y involved at the outset of defining the new paradigm, but are the receivers of a paradigm that i s at least p a r t i a l l y formalized. These 114 stages can be viewed as preliminary steps occurring p r i o r to f u l l adoption. These stages do not exclude the i n d i v i d u a l from the necessity of undergoing personal development i n order to r e a l i z e the paradigm s h i f t . As previously discussed, the deep s e l f -examination inherent i n the concept of transformation must s t i l l take place before ideas of the paradigm s h i f t are f u l l y accepted into one's personal values system. I t i s of interest to note that i n congruence with Rogers' innovation theory, most research p a r t i c i p a n t s described a period of t r i a l i n g before adoption of the paradigm s h i f t concepts were integrated into t h e i r teaching. Rogers (1962) i d e n t i f i e s f i v e c h a r a c t e r i s t i c s of the innovation that w i l l influence i t s rate of d i f f u s i o n throughout a p a r t i c u l a r c u l t u r a l group. The f i r s t i s r e l a t i v e advantage, meaning the i n d i v i d u a l ' s perception of the degree of improvement over the idea that i t i s replacing. Like Kuhn (1970), Rogers i d e n t i f i e s the role that a c r i s i s plays in innovation. Kuhn views a c r i s i s as a p r e c i p i t a t i n g event but Rogers perceives a c r i s i s s i t u a t i o n as being a useful event that w i l l a s s i s t the individual in determining the 115 r e l a t i v e advantage of the innovation. For example, research has shown that depressions and wars w i l l retard the adoption of education innovations, whereas speed of adoption i s accelerated when the c r i s e s pass (Adler, c i t e d i n Rogers, 1962). The research pa r t i c i p a n t s did not id e n t i f y c r i s e s as described by Rogers as being a factor in th e i r decision to accept the paradigm s h i f t . Other concepts i d e n t i f i e d by Rogers that influence the rate of d i f f u s i o n are compatibility of the innovation with the individual's b e l i e f s and values and past experiences as well as the complexity, d i v i s i b i l i t y , and communicability of the innovation. Transposing these concepts of d i f f u s i o n onto information obtained from the research p a r t i c i p a n t s reveals some interesting s i m i l a r i t i e s . The importance of compatibility of the new paradigm with b e l i e f s and values has already been discussed. Those respondents for whom the philosophies of the new paradigm f i t with t h e i r own b e l i e f s and values system accepted the new paradigm much more quickly as compared to those for whom the new philosophies were a l i e n . 116 Rogers (1962) and Kuhn (1970) both are i n agreement regarding the importance of the perception of the new paradigm or idea as an improvement over the old. For a nursing education program that i s adopting a new paradigm, i t w i l l take between two and one half to four years before program graduates are produced. This means that educators are functioning within the new paradigm with minimal evidence that nursing c l i n i c i a n s are being developed that meet the standards of prac t i c e . The research participants i d e n t i f i e d that the r e l a t i v e advantage of the new paradigm i s unknown for a considerable period of time, making i t appear as a very r i s k y venture to some faculty. Perhaps one of the reasons that ideas contained within the new paradigm i n nursing education are not e n t h u s i a s t i c a l l y received by a l l who meet them i s a r e s u l t of the complex philosophical ideas that must be understood. Even though various concepts i n the new paradigm are somewhat d i v i s i b l e , t h e i r complexity makes these ideas more d i f f i c u l t to communicate. Another contribution that Rogers (1962) makes to the understanding of the process of dealing with innovations i s the i d e n t i f i c a t i o n of adopter i 117 categories. He i d e n t i f i e s f i v e adopter categories and l i n k s them to personality t r a i t s as follows: "innovators", who are described as venturesome; "early adopters", individuals who usually command respect by others and often serve as ro l e models; the "early majority", deliberate thinkers who take longer to adopt the innovations than the innovators or early adopters; the " l a t e majority", characterized as being s c e p t i c a l and who may not adopt the innovation without some s o c i a l pressure; and the "laggards", the t r a d i t i o n a l i s t s who subscribe to the past. These categories are analogous to those i d e n t i f i e d by the research participants. The "innovators" and "early adopters" seem to have c h a r a c t e r i s t i c s s i m i l a r to the "small key group" that played an instrumental r o l e at each i n s t i t u t i o n by i n i t i a t i n g the process of paradigm s h i f t . These individuals were innovators who were quickly able to recognize the s i g n i f i c a n c e of the new ideas for t h e i r f i e l d . I t was through these innovators and early adopters that the concepts that structure the paradigm s h i f t were introduced to the rest of the faculty. The majority of faculty receiving and eventually accepting the new ideas would encompass 118 both the early majority and the late majority, according to Rogers' (1962) d e f i n i t i o n . The "laggards" as described by Rogers correspond to the t h i r d group i d e n t i f i e d by the respondents; i . e . those who r e j e c t the new paradigm. The idea of adopter categories or an adoption continuum provides a useful conceptual understanding of the c u l t u r a l disruption that occurs when a revolutionary new idea i s introduced. I t i s important for the early acceptors to recognize that t h e i r understanding and adoption of the complex concepts occurred at an accelerated pace as compared to the majority. The early acceptors w i l l need to be prepared to allow t h e i r colleagues time to assimilate the material. This highly individual process of making the paradigm s h i f t w i l l l i k e l y take varying amounts of time, largely depending on the congruency of the personal b e l i e f s and values system with the b e l i e f s and values inherent i n the new paradigm. The research pa r t i c i p a n t s have i d e n t i f i e d that there i s very l i t t l e that can be done to move t h i s process along i f the in d i v i d u a l has determined that the incongruence of values i s irr e s o l v a b l e . The research part i c i p a n t s also 119 i d e n t i f i e d that for some individuals, the process can be f a c i l i t a t e d through compassion and empathy for the d i f f i c u l t struggle that i s occurring, and through discussion with others, possibly using an outside f a c i l i t a t o r . Bevis (1989) speaks about the importance of creating a c u l t u r a l climate that i s conducive to f o s t e r i n g the development of faculty attitudes towards the new paradigm. She describes t h i s climate as being one of permission giving, practice, and group approval for the normal warmth, concern, caring, and moral rectitude that characterize most nursing teachers. A climate of v a l i d a t i o n of self-worth; of wholeness; of perfect person; of good intent;, respect for the needs, i n t e g r i t y , l i f e choices, and s t y l e s ; and personal and professional values i s created i n agreement and e f f o r t together (p. 176) . Keddy (1995) discusses her experience with a group of older nurses involved in a learning experience (journalling) that was i n i t i a l l y not a part of t h e i r values system. She records t h e i r progress i n moving from a highly r e s i s t a n t stage, to anger, and then to hope. For the l a s t group, the t r a d i t i o n a l i s t s or laggards who are l i k e l y to reject the new paradigm, i t 120 i s important to be aware of the p o s s i b i l i t y of t h e i r sabotaging the new paradigm way of learning. When i t i s important to have a l l individuals within the culture moving i n the same dire c t i o n , as i t i s in education, t h i s group may prove dangerous to the process. Future Directions This research i s a beginning investigation into an area where l i t t l e i s known. Although preliminary, some general statements can be made that w i l l a f f e c t nursing education, research, and practice. Implications for Nursing Education The biggest impact of t h i s research w i l l be on nurse educators. Nurse educators form a c u l t u r a l group that must be as cohesive as possible (Bevis, 1989). When a major disruption such as a paradigm s h i f t occurs, the work environment w i l l be shaken and w i l l take some time to recover. If nurse educators know that an expected part of the process i s that f a c u l t y w i l l not be together i n i t i a l l y , ways can be found to support each other through t h i s process (Bevis, 1989) . With compassion, understanding, and respect for the in d i v i d u a l , patience can be exercised during the time i t w i l l take for those who w i l l come on board to j o i n 121 i n . Education administrators should be alerted to the p o s s i b i l i t y of faculty who w i l l not j o i n i n the paradigm s h i f t . Rather than wait for the opportunity for sabotage to occur, perhaps these individuals can be given the opportunity to make a valuable contribution to the program in a way that w i l l not put the program at r i s k . An understanding of the scope of the event taking place, and a r e a l i z a t i o n that t h i s i s not just another curriculum change, w i l l a l l contribute to a successful paradigm s h i f t occurring. In the event that f a c u l t y are c l e a r l y not able to s h i f t together as a group, benefits might be obtained through the use of an outside f a c i l i t a t o r . Implications for Nursing Research Many opportunities can be i d e n t i f i e d for further research a r i s i n g out of t h i s study. Three groups of f a c u l t y emerge as s i g n i f i c a n t to a paradigm s h i f t i n nursing education: the key group or innovators, the middle group that takes longer to change, and the r e s i s t a n t group. Understanding of the process of paradigm s h i f t could be enhanced by further research concerning the nature and experience of each group. The concepts of transcendence and transformation could 122 be explored with faculty nominated as key group members. Research surrounding the middle group of f a c u l t y could focus on i d e n t i f y i n g factors that f a c i l i t a t e and i n h i b i t t h e i r experience with paradigm s h i f t . An in-depth understanding of the experience of those who r e s i s t a paradigm s h i f t could provide i n s i g h t regarding what factors cause t h e i r resistance and any movement towards acceptance of the new paradigm. I f acceptance does not occur, i t would be useful to know what supports could be put into place for r e s i s t o r s so that t h e i r work has meaning for them and they do not f e e l i s o l a t e d from the culture. This study has been retrospective i n nature, r e l y i n g on the accounts of participants about past experiences. It would also be highly useful to conduct a longitudinal study to examine a culture of f a c u l t y as they are experiencing a paradigm s h i f t . Implications for Nursing Practice The participants reported a concern that the new paradigm i n nursing education focuses on the c r i t i c a l r e f l e c t i v e a b i l i t i e s of nursing students and yet those nurses i n the practice arena of the profession appear to most often uphold the t r a d i t i o n a l values of 123 submission and dependence (Spence, 1994). If the p a r t i c i p a n t s are portraying accurately the s i t u a t i o n i n the practice arena, graduates of c u r r i c u l a i n the new paradigm w i l l face dissonance and perhaps h o s t i l i t y when they attempt to be independent thinkers within the profession (Spence, 1994). Nurse educators need to dialogue with colleagues i n the practice arena i n order to i d e n t i f y ways of minimizing t h i s dissonance. F a i l u r e to do so may r e s u l t in new graduate a t t r i t i o n from the profession. As well, researchers should investigate the experience of graduates of new paradigm c u r r i c u l a as they attempt to grapple with the " r e a l i t y shocks" (Kramer, 1984) of t r a d i t i o n a l nursing p r a c t i c e . Watson (1990) broadens t h i s scope by saying that we must transform "the values that form the basis of the health care system" (p.16). She c a l l s for transforming "the consciousness in health care, p o l i c y , p o l i t i c s " (p. 16). She advocates that nurses must become more p o l i t i c a l l y active i n order to accomplish t h i s massive change. 124 Summary and Conclusions This research has examined the phenomenon of paradigm s h i f t i n nursing education. Five nursing educators were interviewed to determine t h e i r experience during the process of paradigm s h i f t . While t h e i r experience varied, certain commonalities can be i d e n t i f i e d . Their search for a new way of being in the world took them through a process of struggle and s e l f -transformation that gave way to a change i n t h e i r b e l i e f s and values system, allowing acceptance of the philosophies inherent in the new paradigm. The process of seeking and finding meaningful knowledge, often through returning to upgrade t h e i r education, was a s i g n i f i c a n t part of experiencing the paradigm s h i f t . The end r e s u l t of the experience i s placement within a new world view. The paradigm s h i f t i s i n i t i a t e d by a small key group of individuals who then transpose t h e i r conceptions to t h e i r colleagues. Colleagues react to the new paradigm i n various ways, but ultimately most w i l l adapt t h e i r b e l i e f s and values system so that they also can be within the new world view. Varying lengths 125 of time must be allowed for t h i s process to take place. While i t i s a highly individual endeavour, discussion f a c i l i t a t e s movement. A supportive and caring, environment creates a climate that allows others to f e e l safe i n exploring new concepts. For faculty that experience d i v i s i o n s because of widely d i f f e r i n g p hilosophical perspectives, an outside f a c i l i t a t o r might be useful i n encouraging cohesiveness. Part of the process of engaging in a paradigm s h i f t i s l i v i n g i t as a new curriculum i s developed and taught. The meaning inherent in the philosophical concepts must be experienced to be made r e a l to the i n d i v i d u a l . U n t i l t h i s occurs, a paradigm s h i f t cannot be considered to have been effected. A l l p a r t i c i p a n t s agreed that the process of paradigm s h i f t i s dynamic, and there has not as yet been an end-point reached. Those individuals who share a congruent world view and f i n d meaning through congruent conceptual language are able to communicate within the framework of the new paradigm. For those individuals"for whom t h i s i s not the case, miscommunication with both students and facu l t y i s most l i k e l y . The p o s s i b i l i t y e x i s t s that some faculty w i l l choose to remain within the 126 t r a d i t i o n a l paradigm. These individuals should be acknowledged and respected, and ways found for them to ex i s t within the new framework. Faculty members who are able to use the language without undergoing the transformative experience can p o t e n t i a l l y sabotage the e f f i c a c y of the paradigm s h i f t . The goal of involvement i n a paradigm s h i f t i s achieving a new way of being in the world. As in d i v i d u a l p o s s i b i l i t i e s are explored and i n d i v i d u a l boundaries expanded, the potential for a transformation within society i s created. 127 REFERENCES Al l e n , David G. (1988). C r i t i c a l s o c i a l theory and nursing education. In Curriculum revolution: Redefining the student-teacher r e l a t i o n s h i p (pp. 67-86). New York, NY: National League for Nursing. Andrews, Sharon V. (1998). Changing research perspectives: A c r i t i c a l study of E l l i o t Eisner. Journal of Curriculum and Supervision. 4 (2), 106-125. Atkinson, P.& Hammersley, M. (1994). Ethnography and p a r t i c i p a n t observation. In Denzin N., & Lincoln, Y. S. (Eds.) Handbook of q u a l i t a t i v e research (pp. 248-261). Newbury Park, CA: Sage Publications, Inc. Benner, P a t r i c i a . (1984). From Novice to Expert. Menlo Park, CA: Addison-Wesley. Benner, P., & Tanner, C. (1987). C l i n i c a l judgement: How expert nurses use i n t u i t i o n . 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Health Care Management Review. JL5(3), 7-14. Masterman, M. ( 1 9 7 0 ) . The nature of a paradigm. In Lakatos, I. & Musirave, A. (Eds). C r i t i c i s m and the growth of knowledge (pp. 59-8 9 ) . Cambridge, MA: Cambridge University Press. Moccia, P a t r i c i a ( 1 9 9 0 ) . No s i r e , i t ' s a revolution. Journal of Nursing Education. 2 9 ( 7 ) , 307-311. Monson, R. J. & Pahl, M. M. ( 1 9 9 1 ) . Charting a new course with whole language. Educational Leadership. March, 1991, 51-53. Morse, Janice M. ( 1 9 9 4 ) . "Emerging from the data": The cognitive process of analysis i n q u a l i t a t i v e inquiry. In J. M. Morse (Ed.) C r i t i c a l issues i n q u a l i t a t i v e research methods, (pp. 2 3 - 4 3 ) . Thousand Oaks, CA: Sage Publications Inc. Muecke, M. A. ( 1 9 9 4 ) . On the evaluation of 133 ethnographies. In J. M. Morse (Ed.) C r i t i c a l issues i n q u a l i t a t i v e research methods, (pp. 187-2 09),. Thousand Oaks, CA: Sage Publications Inc. Munhall, P. (1988). Curriculum revolution: A s o c i a l mandate for change. In Curriculum revolution: Mandate for change, (pp. 217-230). New York, N Y: National League for Nursing. O i l e r Boyd, C. (1988). Phenomenology: A foundation for nursing curriculum. In Curriculum revolution: Mandate for change (pp. 65-88). New York, NY: National League for Nursing. Ornery, Anna. (1988). Ethnography. In B. Sarter (Ed.) Paths to knowledge: Innovative research methods for nursing (pp. 17-32). New York NY: National League for Nursing. Paterson, B. & Bramadat, I. J. (1992). Curriculum revolution: Implementing a growth model of c l i n i c a l education. Unpublished manuscript. Patriarca, L. A. & Buchmann, M. (1983). Conceptual development and curriculum change: Or i s i t r h e t o r i c and fantasy? Journal of Curriculum Studies. 15(4), 409-423. Sandelowski, M. (1986). The problem of r i g o r i n 134 q u a l i t a t i v e research. Advances i n Nursing Science, 8(3), 27-37. Solsken, Judith W. (1993). The paradigm m i s f i t blues. Research i n the Teaching of English, 27(3), 316-325. Spector, Barbara S. (1993). Order out of chaos: Restructuring schooling to r e f l e c t society's paradigm s h i f t . School Science and Mathematics, 91(1), 9-19. Spence, Deborah G. (1994). The curriculum revolution: Can educational reform take place without a revolution i n practice? Journal of Advanced Nursing. 19, 187-193. Spradley, J v P. (1979). The ethnographic interview. New York, NY: Holt, Rinehart & Winston. Symonds, Jean M. (1990). Revolutionizing the student-teacher relationship. In Curriculum revolution: Redefining the student-teacher rel a t i o n s h i p (pp. 47-56). New York, NY: National League for Nursing. Tanner, C. A. (1990). Reflections on the curriculum revolution. Journal of Nursing Education. 29(7) , 295-299. T o f f l e r , A. (1990). Power s h i f t . New York, NY: Bantam Books. 135 Tomkins, G. S. (1986) . S t a b i l i t y and chancre i n the Canadian curriculum. Scarborough, Ont: Prentice-H a l l Canada. Tyler, Ralph W. (1949). Basic p r i n c i p l e s of curriculum and i n s t r u c t i o n . Chicago: The University of Chicago Press. Watson, Jean. (1988). A case study: Curriculum i n t r a n s i t i o n . In Curriculum revolution: Mandate f o r change (pp. 1-8). New York, NY: National League for Nursing. Watson, Jean. (1990). Transformation i n nursing: Bringing care back to health care. In Curriculum revolution: Redefining the student-teacher r e l a t i o n s h i p (pp. 15-20). New York, NY: National League for Nursing. Wheeler, C.E. & Chinn, P.L. (1989). Peace and power: A handbook of feminist process. Buffalo: Margaretdaughters, Inc. Zaharlick, A. & Green, J. L. (1991). Ethnographic research. In J. Flood, J. M. Jensen, D. Lapp, & J. R. Squire (Eds.) Handbook of research on teaching the enqlish language arts (pp. 205-225). New York NY: MacMillan Publishing Co. 1 3 6 APPENDICES Appendix A: Leininger's Sunrise Model 138 Leininger's Sunrise Model to Depict Theory of Cultural Care Diversity and Universality Cultural Care YVorldview C u l t u r a l & S o c i a l S t r u c t u r e D i m e n s i o n s v r \ C u l t u r a l ' \ V a l u e s & / \ Life w a y s / \ / \ j Polit ical k \ K i n s h i p & y j L e g a l / \ / \ S o c i a l ^ i Factors / \ / \ ^ Factors v , / \ \ E n v i r o n m e n t a l C o n t e x t / \ j Religious & L a n g u a g e & E t h n o h i s t o r y / P h i l o s o p h i c a l I Factors Influences / \ / T e c h n o l o g i c a l Factors ^v/^ C a r e E x p r e s s i o n s , /, P a t t e r n s & Practices ' -/ * \ - ^ - p H o l i s t i c H e a l t h (Well B e i n g ) - p -Individuals. F a m i l i e s . G r o u p s . C o m m u n i t i e s , & Institutions in Diverse H e a l t h S y s t e m s / ^\ I \ \ f G e n e r i c | N u r s i n g P r o f e s s i o n a l | . or Folk . " _ _ , ' V S y s t e m s ^ ) C a r e * ~ S v s t e m ( s ) / N u r s i n g C a r e D e c i s i o n s & A c t i o n s t C u l t u r a l C a r e P r e s e r v a t i o n / M a i n t e n a n c e C u l t u r a l C a r e A c c o m m o d a t i o n / N e g o t i a t i o n C u l t u r a l C a r e R e p a t t e r n i n g / R e s t r u c t u r i n g C u l t u r e C o n g r u e n t N u r s i n g C a r e Code -*-•- Influences Appendix B: Letter of Recruitment 140 School of Nursing The University of B r i t i s h Columbia Dear Graduate Student: My name i s Mary Tynski and I am a registered nurse presently enroled i n the Masters of Science i n Nursing program at U.B.C. To f u l f i l my thesis requirement, I have chosen to study the experience of nursing in s t r u c t o r s who are undergoing a major paradigm s h i f t i n the way that nursing education i s being taught. My in t e r e s t i n t h i s stems from my own involvement with teaching under the "old" objectives-driven curriculum and the emancipation I anticipate experiencing as I s h i f t to the "curriculum revolution" paradigm. Nursing instructors with at least two years experience i n teaching i n an objectives-driven curriculum, and who have participated i n curriculum development and have taught one semester i n a curriculum that i s r a d i c a l l y d i f f e r e n t to the former curriculum, are invited to parti c i p a t e i n t h i s study. P a r t i c i p a t i o n i n t h i s research w i l l involve an i n i t i a l interview of one to one and a half hours i n length, with a follow-up interview of approximately one hour. You w i l l be free to decline to answer any of the questions I ask during the interview, and you w i l l be in v i t e d to add your own perspectives to the interview. These interviews w i l l be conducted face-to-face i n a mutually convenient location, either at your residence or at the university. The interviews w i l l be audiotaped, and the audiotapes w i l l then be transcribed by the researcher. The audiotapes w i l l be stored i n a secure place i n my home, and the audiotapes w i l l be erased and the transcriptions destroyed at the conclusion of the study. C o n f i d e n t i a l i t y i s assured. Any names or other i d e n t i f y i n g information w i l l be omitted from the tr a n s c r i p t s and from the body of the report. You are under no obligation to par t i c i p a t e i n the study. I f you do decide to part i c i p a t e , you are free to withdraw from the study at any time. Withdrawal from the study w i l l not r e s u l t i n any personal or professional repercussions. There are no r i s k s to pa r t i c i p a n t s i n t h i s study, however you might gain insight into your values regarding teaching, and professionally you might ease the t r a n s i t i o n for other nursing educators who 141 w i l l make t h i s major paradigm s h i f t . If you are interested i n learning more about t h i s study or i n p a r t i c i p a t i n g , please f e e l free to c a l l me at 980-4207. I w i l l answer your questions, and i f you are s t i l l interested i n p a r t i c i p a t i n g i n the study, we w i l l arrange a mutually convenient time to meet. When we meet to i n i t i a t e the f i r s t interview, I w i l l obtain a written consent from you pri o r to the interview and taping. I thank you for your interest i n my study and I look forward to your p a r t i c i p a t i o n . Sincerely, Mary Tynski Appendix C: Letter of Consent T H E U N I V E R S I T Y O F B R I T I S H C O L U M B I A 143 School of Nursing T206-2211 Wesbrook Mall Vancouver, B.C. Canada V6T 2B5 Tel: (604) 822-7417 Fax: (604) 822-7466 CONSENT TO PARTICIPATE IN THE RESEARCH STUDY "THE EXPERIENCE OF FACULTY UNDERGOING A MAJOR CURRICULAR PARADIGM SHIFT IN NURSING EDUCATION" I hereby give my consent to par t i c i p a t e i n the research study e n t i t l e d "The Experience of Nursing Instructors Undergoing a Paradigm S h i f t " . I understand that the student investigator, Mary Tynski, i s conducting the research i n f u l f i l m e n t of the requirements for a Masters of Science i n Nursing degree at U.B.C. The purpose of the research i s to i d e n t i f y commonalities i n the experience of nursing faculty who are making the t r a n s i t i o n from objective-driven c u r r i c u l a to a c u r r i c u l a which i s humanistic and empowering to the student. I d e n t i f i c a t i o n of common themes w i l l a s s i s t i n easing the t r a n s i t i o n of other f a c u l t y members who w i l l be involved i n making a si m i l a r paradigm s h i f t . I understand that the research w i l l involve an i n i t i a l interview of one to one and a half hours i n length, and a Focus Group interview at the end of the research study of no more than one hour i n length. Approximately one half hour w i l l be required to review a copy of the transcript of the i n i t i a l interview. The t o t a l time commitment for p a r t i c i p a t i o n i n t h i s research project i s a maximum of three hours. Each interview w i l l be audiotaped. During the interviews, I w i l l be asked questions about my experience as a nursing instructor involved i n developing and teaching a curriculum that i s s h i f t i n g from one teaching paradigm to another. I understand that c o n f i d e n t i a l i t y of my i d e n t i t y and the information I provide i s assured. Each p a r t i c i p a n t w i l l be given a code name, know only to the researcher. The audiotapes w i l l only be l i s t e n e d to by Mary Tynski and her thesis advisors. The audiotapes w i l l be transcribed by Mary Tynski and the t r a n s c r i p t s w i l l only be a v a i l a b l e to her thesis advisors. The tapes w i l l be stored i n a locked f i l i n g cabinet to which only the researcher w i l l hold the key. At the end of a ten year time period, the audiotapes w i l l be erased and the transcriptions w i l l be destroyed. No i d e n t i f y i n g information w i l l be included i n the discussion of data c o l l e c t i o n or analysis. I understand that I have the right to refuse to p a r t i c i p a t e in or withdraw from the study at any time, without any personal or professional repercussions. 144 I acknowledge t h a t t h e s t u d y has been a d e q u a t e l y e x p l a i n e d t o me by Mary T y n s k i , and t h a t I may c o n t a c t h e r a t 980-4207 i f I have f u r t h e r q u e s t i o n s r e g a r d i n g t h i s s t u d y . I may a l s o c o n t a c t Mary's t h e s i s a d v i s o r , B a r b a r a P a t e r s o n , a t 822-7490 i f I have q u e s t i o n s about; t h e s t u d y . I have r e c e i v e d a copy o f t h i s c o n s e n t form, and the l e t t e r o f i n i t i a l c o n t a c t . My s i g n a t u r e i n d i c a t e s my w i l l i n g n e s s t o p a r t i c i p a t e i n t h i s s t u d y . S i g n a t u r e Date -— W i t n e s s Date. 

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