This year marks my 23rd year teaching nursing. One habit I have (there is no support group for this) is thinking and ruminating.
A few years ago, I had a student in my clinical group who had an upper extremity deformity. One arm was significantly shorter than the other, with stumps in place of fingers. At this discovery, I thought about what motor-related challenges would the student have in performing patient care? The time came when one of her patients required nasotracheal suctioning. Although aware of her inability to do the task on her own, it didn’t occur to me not to let her perform the suctioning. Instinctively, we put on sterile gloves, and she inserted the suction catheter, while I applied suction as she moved the catheter out. The procedure was completed rather seamlessly.
I regret that I didn’t debrief with the student about the situation (for example, how her disability might impact her future as a nurse). The student never raised the matter of her physical limitation during the semester. In faculty meetings, issues of students with disabilities are vaguely referred to. Faculty members recognize the issues, but how to address gray areas in meeting technical standards is unclear.
To be or not to be a nurse?
When faced with a student who has an obvious physical deformity (there are many less obvious ones), I feel a little uncertain on how to react or if I need to react. A dominant thought is “How is the student going to do this or that task at the bedside (for example, cardiac compressions with one arm)?”
For sure, the nursing profession’s obsession with the perfect execution of psychomotor skills in basic training is justified—and rightfully so—in this age of quality and safety. However, I find that what we often measure in academic assessments (for example, bed making, bed bath, administering injections, physical assessment, and selecting the correct answer in multiple choice exams) are often very different from what patients and families, government stakeholders, and regulators see as important and meaningful, such as going the extra mile in attentiveness, keeping the unit noise-free, interprofessional communication, customer service, and many others.
There is no doubt that faculty refer to these important benchmarks of patient experience satisfaction in lectures and other settings. The questions to ask are: Is there a way to teach (ennoble) the ore and core of caring? Can we inspire (enable) our students to care about caring? How can we move students and nurses towards expanded clinical imagination, beyond the task performance?
Teaching large classes (classes with more than 50 students) is now commonplace in nursing education. While this might seem a bonanza for the nursing shortage, it is a challenge for the faculty. Engaging 100 students emotionally in a lecture that has a lot more PowerPoint slides than there are minutes in an hour is a considerable feat of teaching.
Learning is social. Being social requires meaningful eye contact, a daunting task to do in a crowd. Emotional synchrony between the teacher and the students within a given space is essential to education. This is easier to achieve in smaller company. The realization that social, emotional, and academic learning as the substance of education itself is strongly emphasized in the Nation at Hope Report by the National Commission on Social, Emotional, and Academic Development (nationathope.org/report-from-the-nation/). The key message: Students learn better when the faculty genuinely care and are empathetic about them.
Small steps to connect
Emotional connectedness is possible even in teaching large classes. For instance, I typically arrive 30 minutes before class and play background classical music to ennoble the forthcoming lecture. Though I have no randomized controlled trial to prove its effect, I inwardly know that calming music do just that—calm people. And calm people learn better and more apt to be empathic.
Building relationships requires proximity. I typically ditch the podium and wander along the aisles, to be physically near the students. Addressing someone within arm’s reach is more of a conversation and less of calling out. Of course, there are students who will always be terrified on being put on the spot in a crowded lecture hall. To troubleshoot this fear, I interrupt the soporific parade of slides by asking everyone to “turn to the person behind you, introduce yourself and explain… (for example, a rationale behind a nursing intervention).” Suddenly, the room is abuzz with conversations. This simple activity breaks the monotony of dispassionate lecturing and kindles human bonds.
Engagement is in the eye of the beholder. Years ago, I read a newspaper article on the experiences of buskers. One musician explained how he sought out eye contact with a person in a crowd, to be able to anchor himself, not to play to someone, but to play for someone. Teaching is akin to performing arts such as singing in a recital. An attentive glance that is reciprocated creates an invisible thread of connectedness between teacher and student. One must not simply teach to an audience but with the audience.
Some students are incredulous when they learn I know their name. While it is true that I can remember most of my students’ name (a classroom with about 140 students), I don’t know everyone’s name on demand. But I make an attempt to do so. To call a student by their name means to honor their individuality and it lays the foundation of building a relationship.
We don’t learn by the syllabus alone
The student council once named me Best Storyteller. Not exact Nobel Prize, but I was delighted at the distinction. Mind you, not everyone likes to hear personal narratives. I think it makes some uncomfortable. However, to teach with authenticity, I need to distil my life experiences (within context) and weave them into all that has scientific currency. Experience turns knowledge into wisdom. Narratives, both personal and borrowed, can enable and ennoble the education of nurses, not just how to, but the way to becoming a good nurse.
Fidelindo Lim is a clinical associate professor at the New York University Rory Meyers College of Nursing in New York, New York.