HE NEED for more “thinking” practitioners of nursing T is well documented in the literature, but the educative process of developing a thinking person appears to be arbi- trary and elusive. Although terms such as “reflective think- ing,” “creative thinking,” “critical inquiry,” and “problem solving,” are used extensively, the continued overemphasis on input of knowledge suggests that many nursing curricu- lums consist of learning experiences whose contribution to the thinking process is equivocal.

In keeping with the increasing emphasis on the fostering of search-research attitudes in undergraduate students, the nursing faculty at Fresno State College (California) has developed a two-unit, one semester course, entitled “Seminar in Nursing,” which we believe is a departure from the tradi- tional teacher-initiated education. Its purpose is not to develop nurse researchers, but to encourage the students to take the initiative in learning. This course has been included as a requirement in the basic curricula since 1960, and the stu- dents may take it either in their junior or senior year. To

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facilitate the seminar method, the class enrollment is limited to twelve students.

The course evolved from the faculty’s desire to see educa- tion become less involved with teaching what to think and become more concerned with teaching how to think in prob- lematic situations.’ Subscribing to the theory that the best type of education is learning by discovery-the desire to find out for one’s self is an innate human quality-and that any innate ability can be developed through education, the fac- ulty agreed that the course should provide students with intensified experiences that would increase their interest and desire to seek more proficient answers to perplexing problems and to increase their ability to envision potential areas of improvement in nursing.? There was also agreement that “re- search” should be emphasized as an attitude towards change rather than as a method or wbject matter.

Output rather than input of knowledge is emphasized. In discussing the overview for the course, we warn students that they may not learn anything “new,” but a hoped-for outcome is the ability to use what they know in different ways and to know what to do when there is a gap in knowledge. The instructors serve to facilitate the development of condi- tions and experiences which stimulate the students’ sensitivity to their own learning needs and arouse their desire to de- velop ways of filling the voids in knowledge that are not only effective but creative.:: Since self-direction is a major focus, we do not provide a reading list; each student is encouraged to develop her own bibliography according to her particular need for knowledge. This kind of initiative in learning, we believe, fosters a sense of independence in the students.

Course content varies from semester to semester depending on the students and their particular areas of interest, but the

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process remains constant. For example, “brainstorming” is consistently used as a method to stimulate the development of “constructive discontent.” The usual preconceived norms of good or bad, success or failure are not applied. For a student to say to the instructor, “I don’t agree with YOU,” or “You make me angry,” is not considered extraordinary behavior.

However, to keep the course student-oriented is easier said than done. In this age of technological advancement and em- phasis on knowledge, it is understandable that various as- sumptions about how much is to be learned and how muqh to teach can easily make a course teacher-oriented. In spite of best intentions, we sometimes find ourselves inadvertently in the role of lecturer and the students in the role of assimi- lator.

Since the course is a seminar in nursing, the students are guided to think about problem areas in nursing. Initially the intent was for the students to limit their concern to problem areas in clinical nursing, because this was assumed to be the extent of their professional interest. However, we quickly discovered that this assumption was a teacher-conceived notion. Nursing students of today seem to reflect the restless- ness of the times and express concern not only about pro- fessional responsibility, but about the future and about the changing role of the professional nurse and their own ability to be part of this change. We have, therefore, permitted the students to explore any problem of interest and importance to them; for the purpose of the course, a problem area in nursing is now defined as any situation in nursing which pre- sents an unresolved difficulty, such as a gap in explanation, an untested conclusion, a conflict in nursing experience, or something the student would like to know more about.

For example, one semester, several students expressed con-

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cern about the stressfulness of the evaluation methods used by the faculty. ‘The students reviewed literature on the phil- osophy and purpose of evaluation, related thc iindings to their feelings of stress, and proceeded to develop a method of investigation. During the course of investigation, several faculty members questioned whether the problem was appro- priate for study by baccalaurcate students. However, we de- cided that evaluation is a part of life experience and is there- fore within the scope of study by baccalaureate students. Accordingly, we supported the students in their endeavor.

Although our students are supposed to be attuned to prob- lem solving, the word “problem” creates considerable anxiety. Students need to be assured that any problem is “important and big” as long as it has value and meaning to them. The nursing care plan is used as an example of problem-oriented, systematic study. We assist the students to approach a prob- lem not so much with evaluative judgments of good or bad, important or unimportant, but by looking at the nature of the problem. For example, a student raised a question about the old-fashioned beds used on a postpartum unit. This stu- dent’s orientation to hospital beds was limited to electrically operated ones, and she expressed great concern regarding the hazards of beds with stationary height and detachable rails. After this problem was explorcd, the student, with assistance from her peers, decided that perhaps the problem was not the “faulty, old-fashioned beds” but how the nurse can assess the mechanical features of equipment (in this case the hospital bed) and devclop a plan of care that ensures safety.

The stage for this type of exploration is set by devoting several class meetings to brainstorming about what nursing is and what it is not. The topic for brainstorming is decided

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on at a previous session so that everyone may come “prc- pared.” Preparation for class includes library research and reflective thinking on the implications the particular topic has for nursing. At the same time that the topic decision is made, students are asked to volunteer to function as leader, recorder, observer, or participant. To minimize unnecessary confusion, the roles are defined as: ( I ) the leader is responsible for keeping the flow of ideas moving and providing every member with equal opportunity to participate; ( 2 ) the observer notes the group interaction and periodically reports his observa- tion, thereby, helping the members to think about the group process; ( 3 ) the recorder frees the other students from note- taking by recording the product of the thinking; and (4) the participant is committed to become involved in group study and discussion. The proceeding, as noted by the recorder, is duplicated for distribution at the next meeting. The recorder is responsible for getting the material in readable form, but the actual typing and duplication are done by the depart- mental secretary. Because the group is small, each student has the opportunity to experience the different role functions sometime during the semester. The students are cautioned not to place value judgments on any idea that is advanced, bc- cause the flow of suggestions is frequently curbed by a nega- tive reaction to one.

Brainstorming encourages the students to think about the different ways in which an idea can be interpreted and im- presses on them the need to think about new and different ways of approaching a problem and to consider many ap- proaches rather than limit themselves to an orthodox method. The excitement in learning is evidenced by the generation of energy to make further inquiry and develop ways in which the acquired knowledge can be utilized. In one brainstorming

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session on “Rituals in Nursing” more than thirty-five ideas were presented.

This is not to imply that all students are highly motivated; since this is a required course there are students who come with a feeling of resignation and sometimes hostility. How- ever, at some time during the brainstorming sessions, it ap- pears that merely thinking and talking about the needs in nursing usually suggests to the less enthusiastic students that perhaps they, too, should join in an effort to move the profes- sion toward excellence. At first we were skeptical about hav- ing junior and senior students in the same group, but the difference in professional oricntation and maturity has actu- ally enriched the course. The younger student frequently is more altruistic in her interpretation of problems, whereas the senior student tends to be more skeptical and questioning, For example, in a brainstorming session on “What Is Nurs- ing?” the juniors were supportive of textbook definitions, while the seniors questioned the mythology of these defini- tions. However, in the summarization, the students were impressed with the importance of emotional appeal as well as reasoned argument. This session demonstrated the implica- tions of preconceived convictions and the use of knowledge to test the truth or falsity of conclusions.

In addition to the class meetings, approximately four hours of consultative time is available to each student. The student always exercises the initiativc in seeking the consultation and may use the time in whatever way she chooses. Frequently i t is used just to talk; sometimes the student secks reassurance; at other times she wants to find out ways in which she can secure assistance from other faculty members or avail herself of other resources. The confcrence provides the student with an opportunity to explore her own attitudes toward problem

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solving and to pursue her exploration of an individual interest area or need.

Because we believe that search-research attitudes result only if the student perceives a need to seek knowledge. a course requirement is that the student plan and initiate an independent study in an area that has value to nursing and meaning for her.' The problem for investigation is usually derived from the idea list compiled by the students during the brainstorming sessions. A student may elect to pursue the study in a group or as an individual project. When a de- cision for group study is made, the group is formed by the students who share an interest in the problem area.

The criteria which the students use to decide on a problem area are: ( 1 ) personal interest and ( 3 ) value to nursing. Most of the proposed studies tend to be broad and over- ambitious and require modification. For example, a study that started out as an investigation of problems of patients in pain resulted in a more limited analysis of how twenty selected nurses felt about administering a placebo as a treatment inter- vention. A study that began as an exploration of professional opportunities for men in nursing resulted in an investigation of how the directors of nursing in ten general hospitals felt about hiring men staff nurses for pediatric and obstetric services.

After a group or individual student has devised a plan of investigation, the plan is presented to the entire class. At first, analysis and criticism are very tentative, but with sup- port and guidance, peer reaction becomes quite precise and objective. The students sometimes have difficulty in differ- entiating between criticism of person and the project and need to be reminded that criticism is not personal but is a reaction to the proposed study.

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Even when students fcel that they have made a “mistake” in selecting a problem area to explore they can still develop fruitful insights into the problem-solving process. One semes- ter, a group of students developed a design to find out why some nurses belong to the professional organization and others d o not. Because of thc limitation of time, the students decided to delimit the study to an investigation of how nurses who are members of the organization perceived the purposes of the American Nurses’ Association. A tool was developed to assess the individual nurse’s value system and understand- ing of “fosters high standards of nursing practice and nurs- ing education. . . represents professional nurses and serves as their spokesmen with allied professional and governmental groups and with the public.” When the students rcqirested permission to survey members at a regular meeting of the district nurses association, a faction within the organization objected on the grounds that “the study would disrupt thi: membership’s morale and furthermore, this is no concern to students . . . not even in a baccalaureate program. . . .” Bc- cause the reaction of the nurses seemed out of proportion to what might be gained from the survey, the students decidcd not to pursue the study. However, the students felt that they had gained understanding about the implications of change, the social pressures to maintain the status quo, and the bar- riers to communication.

When a project is completed, the students who have been involved in the study have an opportunity to present their reports to the class. The oral and written reports of the study provide other students with Lidditional, although vicarious, experience in problem-solving endeavors. Each report is expected to have the crcditablc features of rationality, logical development, objectivity, clarity of style, and document a t ’ ion.

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Most of the students prefer to use Campbell’s Form a r i t l Style ir i Thesis Writing’’ as a guide to develop an appropriate for- mat. They are, however, free to select any guide for report writing. Because there are so many variant forms, the students need to be aware that decisions relating to details and organi- zation are dependent on the problem. The written report is submitted in duplicate; one copy is evaluated by the instruc- tor and the second copy is assigned to students, other than the writers of the study, for critical analysis. The instructor and students use the same categories and point system in the analysis. Five points are given to the title; fifteen points each to definition of the problem; purpose of the study; meth- odology; treatment of data, and implications of the study; originality, creativity, and organization; and ten points each are given to style and bibliography. The total possible points are one hundred.

When a project is presented orally, the students who did the critical analysis of the particular study, lead in the evalua- tive discussion. These sessions are not as stressful as one might expect; most of the students by this time know each other fairly well and their behavior suggests considerable objectivity. Sometimes it is difficult to envision these as bacca- laureate students because they are able to challenge, reflect, persist, and discern with considerable poise and sophistica- tion.

A cursory look at the following titles of studies kept on file in the instructor’s office suggest that when students are permitted to seek knowledge on their own, they demonstrate unbounded resourcefulness, range and depth in thinking: “The Concept of Self-Esteem-Image of the Nurse”; “Role Expectation and Role Function of the Baccalaureate Gradu- ate Nurse”; “Symbolism in Nursing: the Uniform”; “The

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New Profession: A Study of Nursing in the Civil War”; “A Study of Effective Methods Used by Nursing Personnel for Teaching Primiparous Mothers to Breast Feed”; “A Cultural Study: Some Characteristics of the Japanese People”; and “An Investigation into thc Staff Nurses’ Understanding of Reverse Isolation.”

How do students feel about the course? Their reaction can be suggested by such comments as:

“The course was very exciting. It really made me feel respon-

“I really felt that what I thought and wanted to learn were

“I want to continue my investigation by enrolling in the

“I know I’ve learned niorc t h a n I an1 able to tell the class

sible for my own learning.”

considered important.”

Independent Study Program.”

or write in a report.”

Teaching the course is a challenge to the instructor. There is no more gratifying experience than to see students, moti- vated by their own desire to learn, initiate efforts to pursue and evaluate knowledge.

Ref ere nces

1 Tschudin, Mary S., “Educational Preparation Needed by the Nurse in the Future,” Niirsing Ollf!ook, August, 1964, 12: 32-35.

2 Osborn, Alex F., Applied Itlingirzotion: Principles nnd Procedures of Creative Prohletii-Solviiig, 3rd Revised Edition, New York: Charles Scribner‘s Sons, 1963. pp. 69-53.

:;Ibid. , pp. 86-98. -I Stratemeyer, Florence, ct a/. , Ilc,veloping n Ci~rric~ilzini f o r Mod-

ern Living. 2nd Edition. New York: Bureau of Publications, Teachers College, Columbia {Jniversity. 1957. pp. 403-408.

,i Campbell, William Giles, For./n ccnd Style in 7‘hr.si.r Writing. Boston: Houghton Mifflin Company, 1953.

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