The Communicative Relationship Between Dialogue and Care, Student Edition
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At this stage, I had to explain to the mother that she was a student which the student should have made clear at the outset and completed the visit myself. I recall experiencing feelings of discomfort immediately after the visit and, unsure how to manage the situation, I discussed it with a senior colleague who advised that I address the issue with the student at the next opportunity.
Thanks so much, Liz!!! Bonhoeffer's rhetoric of responsibility. Buber recognized that there was insufficient shared narrative ground to permit such engagement. Between facts and norms: It is almost like a private lesson without explicit instruction. Timely reflective discussions within a non-judgemental environment foster mutual respect. The rule of metaphor:
Subsequently, I identified my concerns with the student about her performance and we agreed an action plan, which included a teaching session to help develop her clinical knowledge, alongside a discussion around the health visitor attributes. The student was receptive and completed the programme to a satisfactory standard.
Adult education andragogy supports the notion that humans develop fixed concepts about themselves and their environment Weiss et al, Knowles suggested that, when adults are in situations where they are not allowed to be self-directing, they experience a tension between that situation and their self-concept. Indeed, the NMC , p. I now try to integrate the four indicators of authenticity suggested by Brookfield In the incident above, I failed to address the issue in order to avoid conflict, thereby mitigating the effectiveness of congruence. I have incorporated learning objectives and student expectations and, where necessary, raised uncomfortable viewpoints, thereby making full disclosure of my intentions in advance as advised by Brookfield Descriptive messaging can be an effective alternative to judgmental and prescriptive feedback.
By explaining these feelings, I was able to facilitate the final stage of helping the student understand why I felt as I did.
Descriptive messaging requires a degree of self-awareness — as Farber suggested, full disclosure and self-awareness are inextricably connected. Moreover, Kondrat , p. I have learned to step back, and reflect on my listening and observation behaviours, and this has enabled me to develop a learning environment that is student-centred. By critically reflecting on the incident with my own qualified practice teacher, I was able to explore the tensions arising from the incident. Previously, I used the sandwich model of feedback Von Bergen et al. Von Bergen et al propose that, because the positive comment is a precursor to criticism an unintended consequence , reinforcement is less credible.
Credibility is essential for feedback to be perceived as meaningful Watling et al, , and this is particularly important in healthcare where there may be tensions around professional boundaries and status McKimm, Therefore, I now focus on the essential goals of feedback, encouraging learners to reflect as a motivation for performance improvement Cantillon and Sargeant, This involves conversations with the student based upon a developmental dialogue, which can be incorporated routinely into the learning environment.
Ramani and Krackov also suggest using descriptive and neutral wording when delivering reinforcing or corrective feedback. Whilst this can be challenging for the practice teacher, it represents a means of helping the learner focus on features of their performance that need to be addressed and is less likely to be perceived as a personal attack Cantillon and Sargeant, Five cue questions are used, enabling a breakdown of experience and reflection of the process and outcome:.
Both teacher and student participate equally and should be partners in the process of feedback Ramani and Krackov, This can be facilitated by both non-verbal implicit and verbal explicit behaviours, which convey warmth and availability Mehrabian, Therefore, it can be argued that it is the non-verbal behaviours that dominate when there is conflict between the verbal and non-verbal communication.
Sharing a conscious awareness of the impact of non-verbal behaviours has also surprisingly resulted in more trust and rapport with the student. My development as a practice teacher has highlighted the complex and multi-dimensional process of ensuring that the student-centred learning environment is based upon an open student-teacher relationship. Embedded in this concept is critical reflective practice, which I have used to analyse my communication, assumptions and ways of supporting a student health visitor in the transfer of domain-specific skills and knowledge into her new health visiting role.
Since this incident, attention to the nuances of communication has framed the way in which I am now able to be flexible in managing difficult situations by giving me new communication strategies. In my pursuit of knowledge to enhance my abilities in establishing effective working relationships and facilitation of learning, I have learned that emphasis on interpersonal values influences the development of inter-professional learning and working.
The incident allowed me to understand that fostering professional growth and development involves empathy, tolerance, responsiveness and courage, and that the balance of cognition and emotion fosters transformative learning. The incident has highlighted that students may require additional support in the transition of moving from clinical nursing into health visiting, where different skills or practice are required.
Oman Medical Journal 24 2: Cantillon P, Sargeant J. British Medical Journal Journal of Student Engagement: Education Matters 2 1: British Journal of Hospital Medicine 70 3: Osterman K, Kottkamp R. Ramani S, Krackov S. Medical Teacher 34 Sanders J, Wiseman R. Communication Education 39 4: Journal of Behavioral Studies in Business 7: Medical Education 46 2: Establishing and maintaining effective professional relationships is an essential prerequisite in ensuring students achieve the standards set by the NMC.
Communication Ethics Literacy: Dialogue and Difference
Critical reflection on communication within the learning environment supports the practice teacher in eliciting student competence, thereby equipping them with the knowledge and skills to enable them to lead and influence others. One of its aims is to show strategies for managing conflict and tension within the student and practice teacher relationship.
It acknowledges the difficulties of teaching adult experienced learners and offers a theoretical framework for supporting the practice teacher in her role in leading the next generation of health visitors. It is to reflect. In summary, the reflection instigated by a professor originated from a demand of the training context in which the professor reflected on the provocation occurred the day before and encouraged students to continue to reflect on the use of the phone. The dialogue established within the pedagogical relation is a challenge to be faced in practical-reflective teaching, so professors and students can build a relationship that foster thought and action in the theoretical context and in the field of practice.
This relationship must provide reflection considering behavioral impasses that pervade the teaching-learning process. In this perspective, professors has many ways to "tell" their students. Specific instructions can be given on how a given task should be performed, a student's product or process can be criticized, suggesting how this student can improve performance.
The professor may, also, instruct them on how to set priorities and propose experiments that enable doing, analyzing, and reformulating problems or reflecting on the process demonstrated by the professor 2. The different ways to communicate are present in the pedagogical relationship of the undergraduate program. Professors, by means of dialogue, provide specific instruction on certain procedures to be performed in the field of practice, criticize the medical care provided, giving suggestions on how students can improve their knowledge, and demonstrate how to set priorities. Regardless of what the professor will tell the student, it is important that this dialogue occurs in the context of doing, while the students are performing a certain task or about to start a new one, leading to reflection about this task or instigating to imagine tasks that may be performed in the future 2.
This movement of reciprocal reflection between professor and student is a network that interweaves dialogue into the pedagogical relationship and enables breaking impasses in the teaching-learning process. In the context of pedagogical relationship, the professor should find alternatives and raise awareness as for the conduct of the reflective process, making the opportunities of training and service a fertile soil for the acquisition of skills for the reciprocal reflection in nurse training.
Bringing to the daily life of the training process the reflection on the impasses generated, as for example the technological tools, enables that professors and students find alternatives so such impasses turn into fertile soil for the teaching-learning process and into reciprocal reflection-in-action. It is undeniable that the changes in the contemporary world have generated transformations in the relations among individuals, mainly by the use of information technology, which caused changes in the living habits of the persons and, consequently, in human relations established in the social context and in the work context 7.
From the data presented, concerns emerge on how educating a professional to be critical and reflective can contribute to solving the problems of practice, taking as example the use of cell phones during the teaching-learning activities, which should be consistent with the curricular proposal and, consequently, with the knowledge generated and focused on the needs of society 8. A study developed to know the conception of undergraduate students in nursing about their training points that we need to consider the importance of the humanist aspects in the training of nurses, because this professional will develop in society not only a role of carrying out, but of proposing humanized policies and practices 9.
These practices should be experienced in the dialogue established within the pedagogical relationship during the teaching-learning process and, to this end, the training should emphasize the pursuit of knowledge and not just the transmission of information. In this sense, it is believed that the conception of knowledge assumes, among several factors, the subject-object relationship student-content , in a dynamic and permanent exchange, which becomes richer and more effective according to the professor's position of mediator It is observed that the pedagogical relationship in the practical-reflective teaching is based on the premise that the field of practice is fertile soil for the reflection-in-action and on the action.
In this perspective, the professor, being aware of the gamut of situations of the actual context of health services and of the training itself, creates opportunities for students to exercise reflection on their own training process, thus building a repertoire of knowledge that addresses the actual problems in the context of practice. Stimulus for reflection is directly related to the professor's role and motivation in guiding the pedagogical process.
However, the student must be open to the dialogic-reflective process, acting with responsibility, autonomy, and reflecting on the potentialities and weaknesses in the training. In analyzing the pedagogical relationship, it was possible to perceive that the development of theoretical-practical activities and supervised internships is permeated by moments of professor demonstration and student imitation.
The teaching and learning processes, present in the pedagogical relationship, occur naturally in the daily training, with professor and student not even realizing that a form of reflection-in-action is being developed. The training, when focused on a reflective teaching, challenges, stimulates, and aids students in building skills and competencies that strengthen the professional commitment In addition, strengthening the dialogue stimulates the building of a relationship of trust between professional and client, through a serene, open, and dialogic attitude A research developed with professors about the meaning of the teaching-learning process points that teaching and learning are complex and do not depend solely on the will of the professor, as it involves the building of knowledge necessary for the training of the future professional.
It is a process of shared responsibility, guided by the professor's pedagogical conceptions and the student's commitment to the training The professor, considering the situations occurred in the training of nurses, will determine the kind of relationship established with the student. Thus, the professor has the possibility of building a pedagogical relationship of trust, which allows for receptivity to dialogue, for approach to the student's reality, for listening of their personal and academic experiences.
Adoption of this attitude by the professor is also supported by other authors that advocate that the strengthening of their pedagogical practice stimulates autonomy, leadership, communication, and prepares the student for team work 17 , Thus, these aspects enable the solid building of knowledge.
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However, the professor's view cannot be focused only on the syllabus, but must also aim at raising the student's awareness as to human values This process of demonstration and imitation can, at first, deserve no special attention, but reconstruction by imitation is a type of process for solution of a given problem or situation. The imitators, in the case the students, build and test, in their own actions, the essential characteristics of the action observed, hence developing reflection in action. During academic activities carried out in the daily life of health services, professor and student are closer to each other than in a theory class, because the student group is reduced 1.
In the context of training, both have the opportunity to establish a dialogue founded on a concrete reality of medical care, which favors the education of a critical and reflective professional, able to reflect on the practice to transform it In the practical-reflective teaching, the professor's acts of showing and telling are intertwined in the same way that the student's listening and imitating.
By means of this combination, the student can learn that which would not be learned solely by imitation or by following the professor's instructions. Each process can help fill the communication spaces inherent in the other 2. These are connected so an intervention or response triggers or builds another one, connecting the acts of asking, answering, advising, demonstrating, observing, imitating, and criticizing 2. The dialogue established between professor and student can be built by a chain of reciprocal actions and reflections, in which professors have the opportunity of reflecting on the message implicit in their own performance.
Student, in turn, can also reflect on problems arising from their performance. This reflection on prior performance instigates the professor to provide a new demonstration, and allows for the student to find a new way of performing certain action 2.
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In the context of training, students can reflect on their construction of knowledge and on the medical care process. The dialogic moment between those involved in medical care encourages students to act responsibly, evaluating and modifying their practices, exercising at the academic context their ability to exercise the profession of nursing with quality and respect for the client of health services Successful dialogue in the pedagogical relationship does not necessarily mean that the student will accept and agree with all the intentions of the professor. The more students understand what the professor is telling them, the greater the conditions to define whether or not they want to learn what the professor wants to teach.
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When a student has difficulty in understanding by an apparent inability or lack of will, the professor should consider that this failure may not be related to limitations of the student or to the instructions, but to refusal to give up something the student values 2. The professor, when faced with these difficulties, can seek teaching-learning strategies that are more appropriate to the needs and particularities of a certain group or of a student and of society in general 20 , Feedback from professor to student, pointing out their fortes and weaknesses, as well as the combination of students with higher performance with those that have some difficulty also contribute so the training process become of excellence The teaching-learning process, during nurse training, aims to educate professionals so they are not only scientifically trained, but aims to educate nurses as human beings, by means of an approach in which professor and students are increasingly close, with a high degree of satisfaction, tranquility, and confidence as for the professional training The diversity of methodological options to which professors have access today enables them to organize their communication with students, to introduce a certain subject.
Thus, each professor can find ways that are appropriate to their needs and to those of the students, seeking to integrate various methodological procedures and technologies, through pedagogical planning This organization also involves the perception of students as a persons in training, their difficulties, facilities, and successes in the routine of classroom and in health services Establishment a pedagogical agreement is an alternative found by the professor so technological tools are used in a conscious way.
However, this, by itself, does not comprise the complexity of factors that can aid or hinder the establishment of the pedagogical relationship considering these technologies. It is necessary to go beyond the agreement, establishing a reflective dialogue with students so they, with the professor, can find ways to enhance the use of these tools in the pedagogical relationship.
In the nursing care teaching-learning process, professor and student need to act in tandem, seeking, defining, and effecting new ways of teaching so, together, they carry out the action of learning When the dialogue between professor and student is effective, it becomes reflection-in-action and on mutual action 2. The training of the professor fosters a constant revitalization in the context of training, by seeking methodological strategies to teach and learn which allow the transformation of educational practices, of the development of skills and competencies so the future nurse becomes critical and reflective to work in health services Teaching strategies are a key aspect of faculty action in the teaching-learning process; however, the success of each strategy depends on factors related to both professors and students, involving motivation, knowledge, and persistence in the act of teaching and learning The development of this research enabled the identification of significant elements for the establishment of the pedagogical relationship in practical-reflective teaching.
Dialogue between professor and student is the fundamental guide to stimulate reflection both in the theoretical context and in the field of practice. Activities carried out in the daily life of the services become more challenging for the pedagogical relationship, as demands arise from real and concrete needs. Professor and student need to reflect upon this demand so the answers provided to clients of the services can satisfy their needs of medical care.
However, the proximity of professors and students promotes a more effective pedagogical relationship and allows for the professor to have a pedagogical and reflective practice. The teaching-learning process in the program is founded on the professor's acts of telling and demonstrating and on the student's listening and imitating; however, these processes need to be more organized so reflection occurs in the four moments, and, especially, is formed by a chain of reciprocal actions and reflections.
Another relevant aspect in the pedagogical relationship is the impasses resulting from the use of technologies, both in the theoretical context and in the field of practice. In this sense, professors and students, in becoming receptive to the process of reflection-in-action and on reciprocal action, can eliminate the pedagogical impasses and find possibilities for negotiation and enhancement of these tools in nurse training.
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We note that the professor, when establishing a dialogic-reflective tone in the pedagogical relationship, opens paths to new discoveries, enabling the creation of teaching-learning spaces that stimulate autonomy, abilities, and critical and reflective attitudes of students in the course of their education.
The pedagogical relationship intertwined by a reflective dialogue creates opportunities so the actual and concrete situations of health services and of the education itself become elements that foster reflection in the training of the nurse. In this sense, the professor must seek strategies that best meet the needs of different moments, contexts, and subjects involved in the training process. Acta Paul Enferm [Internet].
Educando o Profissional Reflexivo: O desafio do conhecimento: Professional knowledge and the epistemology of reflective practice. Rev Bras Enferm [Internet]. Reflecting about assessment by reflective-critical and creative thinking in nursing education in Brazil. J Nurs Care [Internet]. Invest Educ Enf [Internet]. Education for the unified health system: Invest Educ Enferm [Internet].
Comprehensiveness as a pedagogical principle in nursing education. Texto Contexto Enferm [Internet]. Nursing students' perception of the learning process in a hospital setting.
J Prof Nurs [Internet]. From "being to the self" to "become to be": Margarete Maria de Lima. Services on Demand Journal. Context and participants of the study This study had participation of eight professors of nursing that developed activities in the theoretical context and in the field of practice, in the courses of the integrator axis educational actions aimed at the development of specific competencies of nurses of the last four semesters of the curriculum. Data collection and organization The data were collected through non-participant observation of teaching-learning contexts and individual interviews with professors.
Data analysis Process guided by the operational proposal 6 , consisting of two operational moments. OP7TC Professor criticizes a table and a schedule made by the students and gives suggestion by drawing a sketch of the ideal. OP6TC In the theoretical-practical activity, professor gives specific instructions to students, points priorities in the medical care, makes observations and directs criticism to the care provided by the student, after completion of the procedure, suggesting what can be done to improve performance. IP2 The student couldn't set the Speculum, she signaled me, I excused myself to the patient, set it and she made the collection, so that it wouldn't be evident to the patient that she couldn't have skill, competence, or ability.
IP4 During a visit to hospitalized patients, a professor, after observing the student who is talking with the patients, draws her attention as soon as she leaves a room, due to the manner the student talks. OP7PC Dialogue between professor and student on specific care provided is not always conducted in the daily practical activities, as they believe the student already acquired certain skill and autonomy, thus this communication before and after the procedure would not be necessary. IP4 The professor monitors the passage of duty of the student.
OP6PC Professor does not make observations on student performance after passing duty.
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OP5PC In the field of practice, some rich moments for reflection in and about the action, as the nursing consultation provided to the woman and the correction of nursing developments made by the student, are not explored by the professor, who does not let a student know how the performance during the activity was evaluated.