I don't have the answers

What makes gero education successful? The question should be “What makes gero teaching successful?” By “successful,” I refer to the ability to get messages across to an intended audience—students—molding attitudes, nurturing attributes, and so on. The truth is, after 17 years as a teacher, I don’t have answers to every question about education.

We are supposed to know how to teach, and teach well. We are expected to be knowledgeable about what strategies help students learn. The current trend in education is to focus on outcomes. By teaching content X and Y and using methods A and B, we expect students to attain outcomes i, ii, and iii—the knowledge and skills the educational institution wants students to master by the time they complete a course or graduate.

Fuse/Thinkstock

The truth is, we can plan on and account for our teaching of subject matter in a certain manner, but whether the actual outcome aligns with the intended outcome is not guaranteed. Humans are not computers. By tapping certain “keys,” we don’t always get output related to those keys.

By gauging test results and grading assignments, we can tell to a certain extent if we have “succeeded,” assuming, of course, the assignments are designed in such a way that they accurately reflect what the students should learn. I wonder if anybody ever questions the validity of these circular arguments. I am not saying that focusing on outcomes is not good, just that the usefulness of outcome-based education has to be put in perspective.

We teach, and we hope for the best. We know some students perform exceedingly well within the academic system while others barely get by, but academic performance is not the ultimate measure of whether a student turns out to a good nurse. I know, because a number of undergraduates I taught have returned to their alma mater to take a master’s program. Some who showed great promise as undergraduates return for another degree intent, it seems, on little else than earning another diploma, while others, some of whom drove me nuts when I supervised their clinical placement as undergraduates, return as delightful nurses motivated to learn more.

As teachers, we cannot know which words we say will strike a chord in which student. Such thoughts humble me as an educator. While they pain me at times, they also remind me that I need to be every bit as reflective as I expect my students to be.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Introverts make excellent nurses, too!

I don’t know about other countries, but here in Hong Kong, as part of the selection process for admitting applicants to baccalaureate programs, some universities have adopted use of admission interviews. Interestingly, I have never asked my international peers if this is done in their countries. I must do so in the future.

Nursing is a popular profession in Hong Kong with a huge number of applicants wanting to get into our programs. We admit about 180 students in each annual cohort, but there may be nine to 10 times as many applicants. Obviously, we can’t interview each one.

For a number of years, we have conducted group interviews in which approximately 10 applicants are collectively interviewed for 45 minutes and each applicant is given one minute to tell the interview panel about him or herself. The group is then given a topic to discuss on its own. There is no assigned leader, and the group just runs itself until the prescribed time is up.

As you might expect, only those who are outspoken, confident, and articulate get the higher ratings. In retrospect, the group interview process reveals some systemic biases. For example, applicants who exhibit the attributes of extroverts have a better chance of getting into the program. Extroverts are important in the nursing profession. We need leaders, change agents, advocates, and publicists in nursing. Outgoing people often fit into these categories. But we also need other kinds of nurses.

iStock/Thinkstock

We often say it takes all kinds (of people) to make the world. But we are only preparing certain types of nurses to look after all kinds of people. That does not sound logical to me. I have come across students who are quiet—they were fortunate to have gotten into the program—but are gentle and kind to patients. I have also come across students who are sociable and assertive but don’t necessarily connect well with people.

The profession needs introverts as much as extroverts. We need nurses who are reflective practitioners. I am not saying that extroverts do not make reflective professionals, just that we need to be more thoughtful in our admission practices to ensure that, as we recruit the next generation of nurses, we admit as diverse a group of individuals as possible. Only through diversity will we grow. It’s not unlike a gene pool, where the more diverse it is, the stronger will be succeeding generations.

Through diversity, we learn about tolerance and the value of accepting people who are different than us. Through group heterogeneity—our profession—we are stimulated not to take things for granted just because those are the norms, but to be creative in meeting the health-care needs of a diverse world.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Teachers as entertainers

I try to be myself when I teach. To me, being who you are as a person is just as important as what you teach. But increasingly it seems that, even in higher education, we are expected to be good actors. Like an entertainer, we are to fully engage our audience.

As a teacher, I understand that I need to teach well, but I also realize that, if willing ears are not there, there may be teaching, but no learning.

I know that, as a student or other member of an audience, there are talks and lectures I have thoroughly enjoyed but don’t remember their intended messages very well. A student may remember jokes and interesting stories that a teacher tells but, at the end of the day, what is important is that facts and knowledge required of a trade or profession be gained, not recollection of jokes.

totallypic.com/iStock/Thinkstock

Who's grading whom?
As I grow older, I have witnessed the gradual invasion of our consumer-oriented culture into all facets of society. Students are now viewed as consumers of educational “services.” As service providers, we teachers must try our best to cater to the needs of these consumers, because they rate our teaching performance in the mandatory Student Feedback Questionnaire (SFQ) and because the SFQ rating is part and parcel of our appraisal as university employees.

What is a teacher? Who is the teacher? Does the teacher teach only what the learner wants to learn? If so, is the teacher a mere facilitator, there merely to guide active, inquisitive minds? I am all for that kind of teaching-learning relationship. I am aware of the modern philosophy of teaching-learning, whereby a child is guided in his or her exploration of the world. Rather than being directly taught, they are facilitated into self-directed learning. Such practice is delightful and enlightening. It takes away the pain of learning, and only the joy of exploration remains. And given sufficient time and resources, such practice is suitable for nurturing young minds.

But given current mass education, where professors teach large classes, funding is limited, and educators have to make do within the prescribed limits of an academic semester, this approach is not exactly feasible. Individuals learn at different speeds and in a variety of ways. If all of a society’s learning opportunities were offered in a facilitated, self-directed mode, it would be extremely costly. Is this necessary in tertiary education?

What they need to know
I regard myself a teacher, not a service provider. I teach what I think is important for students to know about caring for older people, not what they think they need. I do not consider myself a businesswoman who serves clients by giving them what they want. This won’t work, and it is not education. I know that because, a few years ago, when I was leading a team to design a master’s program for community nurses on the topic of community care for older people, I conducted a survey. The results showed that the respondents (potential students in the program) wanted a curriculum plan they could finish in the shortest time and at lowest cost.

To further illustrate my point, our faculty offers an applied ageing studies baccalaureate program. When students were told they needed to study anatomy and physiology of ageing, they questioned why, because they viewed such topics as irrelevant. Yes, I know. It’s hard to believe students enrolled in an ageing studies program would think that way.

What I am trying to say is that education should not be a business, although it can be run using a business model. This is especially important for university education. Universities are supposedly the minds of a society. They are supposed to lead a society in thinking and providing directions as to where we, as a community, should be heading.

When I was a student, recognition of teachers was based on the depth of knowledge they had in the subject matter in which they specialized. Nowadays, much more is expected of a teacher. Not only do we expect the teacher to be a master of his or her field, but also, like an entertainer, to perform well in class. Our PowerPoint presentations have to be interactive, colorful, and punctuated by jokes and stories. Better still, one should show videos—anything that engages the five senses. The teacher has to make classes joyous and take all pain out of learning hard facts, theories, and formulas. He or she needs to have high emotional intelligence, excellent interpersonal skills, and mastery of motivational techniques. Meeting all of these expectations requires, I think, that one be nearly superhuman.

When I am acting out a role or making a joke, it must be for the purpose of trying to get a message across. I can’t act out a role for the entire duration of the class. I know that being a serious person does not fit well with contemporary expectations of a popular teacher, but, to teach effectively, I need to be authentic.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Learning to observe

I learn how to care for older people in practical ways by observing my mother. I notice how she can easily become tired—progressively so over the years. I see how she has become reliant on others for things she has been doing all her life without help—toileting hygiene, for instance. By watching her, I have come to see what her needs are. I also learn about caring for others by observing people in various circumstances. I take note if they are exhausted, annoyed, sad, or in pain.

As a teacher, how do I help my students value the power of observation, to notice the needs of others? Since we are in a helping profession, how do I teach development of observation skills to students who are engrossed in their own world most of the time?

How do we teach students to really "see" people?

I use public transport to go to work. In fact, I use public transport all the time. Because Hong Kong is such a compact city, I get around easily without a car. On trains and buses, people are engrossed with their smartphones, tablets, and what not, captivated with what these gadgets have to offer. Few people see an older man or woman board the train, much less offer him or her a seat. The same is true for those who are disabled, in the latter weeks of pregnancy, or carrying a baby. Few relinquish their seats, probably because most are busy playing video games, texting, watching movies, and so on. They attend to their own business, oblivious to the needs of those around them.

On those rare occasions when I do see someone offer his or her seat to another, I am sorry to say that, most of the time, the person who does so is middle-aged, not the age bracket of my students. What have we, as a society, done wrong? How do we teach our young—at home, school, in society at large—to care about others?

You will recall that I have made journaling an assignment for one of my courses. The exercise wasn’t as successful as I had hoped. Many students wrote “reflections” of what they had learned in a lecture—exactly what I asked them not to do. Despite including this assignment in my overall assessment of their performance, most students remained unobservant and unresponsive to what was happening around them with respect to elder care. Some did make excellent observations and reflections, but many did not.

My students are essentially good people. I know this when I hear them talk and get better acquainted with them as individuals. But I need to think of effective techniques to help my students “see” what is around them, not just “look” around and then go about their business.

I feel I am struggling against the current. Technological advances have changed our ways of relating to one another. As an educator, I love that technology helps me teach and engage my students in innovative ways. Yet, I am also watchful and wary of the impact that modern communications may have on how we interact with each other—whether we even “see” each other.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Friends or family?

I respect and value my students as adults. I treat them as friends. At least, this is what I used to do, most of the time.

There are varying degrees of friendship. With some friends, you can talk openly; with others, you may not be able to spill your heart. But all of them are your friends—unique individuals who may or may not listen to you. We give adequate space to our friends, even very good friends.

As teachers, our students are hardly our best friends. With new batches of students passing through each semester or year, they are more like new acquaintances or new friends.

Having taught at my university for 17 years, I have come to learn that, sometimes, being a friend is not enough. Some students seem to respond better if you speak to them as if they were your adult children. I am not suggesting that we treat our students like young children, but I have observed that some of my colleagues do treat their students like their grown-up children, and, for some, this has worked.

We expect our friends to listen to us, to be good to us. Yet, we know that, no matter what we expect, a friend is not a family member. Family members make demands on us. Family members are connected to us on a deeper level. They are part of us, no matter what.

It is not so difficult to manage expectations of students who take a course or two from you. But what if you are their academic adviser? Being an academic adviser does not mean that the students we advise are close to us or willing to talk to us. So, do we simply provide academic advice about which courses to choose, how to study, and nothing more?

What about research students who work with us for a few years? Do we treat them like friends or family? When they repeatedly make the same mistakes, a friend would probably give up and say no more. But a family member would persist. Where do we, as teachers, draw the line?

When I was younger, my students were my friends. That was the way I wanted it. As I become older, I become less sure, and I realize it is unrealistic to expect from my students what I expect from my friends. Younger adult students are not yet that mature, and, if I were only a friend, I would be frustrated. I would demand that they be like me, that they think and work like me. But if I were to regard my students as my grown children who are trying to master particular subject matter, I would be more patient, more understanding, more tolerant of repeated mistakes.

I cannot say which is right or wrong, to coach my students as friends or as adult children. I only know that, with increasing age, my attributes as a teacher have changed. I hope I am now a more effective teacher. But that is for my students to say.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Intended vs. actual outcomes: Puzzles of a teacher

In a previous post (13 March 2014), I mentioned that, to help my students become more observant of age-related issues, I ask them to write a journal. A natural follow-up question is, “So, how useful is that?” All I can say is, “I’m not sure.” Actual outcomes may be very different from intended outcomes.

When reading my students’ journals, I’m sure that some of them must have been written over a very short period of time, shortly before the due date for submitting them. I also read journals that are purely post-lecture reflections. That is, the entries are discussions of concepts I taught in class, which is not what I asked for. I wanted them to think about elder care outside of the classroom. Sometimes, I read journals that are superficial, mere recounting of what a student has read or heard in the news, but without personal reflection. Such entries are distant and somewhat “cold.”

sjenner/iStock/Thinkstock

So, how to teach elder care? How to ensure that students have learned something? These are intriguing issues.

Through group seminars (oral presentations and discussions), written papers, and tests, I know how my students have performed academically and what knowledge they have mastered. But I can never be sure whether I have prepared them to be better nurses in caring for older people.

Have I helped them develop the right attitude for interacting with older people? In the relatively few clinical practice hours required by the Nursing Council (the regulatory body for registered nurses in Hong Kong), have my students been able to translate what they have learned in the class into actual practice? Have they developed a deeper understanding about older people as unique beings? Do they care about older people who come under their care?

I have no answers to these deeper questions. By interacting with my students, I know for sure that some of them have developed such understanding and care. But, as a teacher, my goal is not to teach just a few; I have been given a class.

My students may have performed satisfactorily in their course requirements. Knowledge can be acquired, but attitudes develop over time.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

On teaching elder care, more reflections

More often than not, a college teacher is someone who is older than his or her students. That means there is already a “generation gap” and that the values and life goals of teachers and students are likely to be different. When there is a common goal, i.e., for the students to achieve certain learning outcomes in elder care, conflicts seem inevitable.

How should a teacher respond to the behavior of those who are younger and less experienced in life? More specifically, how should I respond to those whose values are vastly different from mine?

Xi Xin Xing/iStock/Thinkstock

I find myself becoming upset when students come late to class and don’t seem bothered by it. I become upset when I see them chatting in class, oblivious to the noise they are making. I get upset when they look at their iPads all the time and don’t look at the PowerPoint presentation on the classroom screen. Often, there is hardly any eye contact. And, certainly, I am upset when the student to whom I direct a question appears unaware of what is going on.

Sometimes, these classroom behaviors make me sad; other times, angry. The way I, as an older person, see it, they have nothing to do with a generation gap. Punctuality and attentiveness are classroom etiquettes expected of a learner in an educational context. To me, they are matters of common courtesy.

In the eyes of the younger generation, however, it seems that such behaviors are no longer expected and that I need to lower my expectations. To get students to accept and open up to me, I must accept what I find inappropriate. Sadly, according to my colleagues, not confronting students about their actions appears to be the new norm.

Nowadays, as a gero teacher, I need to repeatedly remind myself not to impose what I value upon my students. I know we grew up in different worlds and that our experiences shape us. I need to tell myself that being angry or sad will not help me win over my students and that I need to accept who they are before trying to change their behavior.

To know the origins of my frustrations and to stop being frustrated (because frustration will not help my teaching), I need to reflect on my own behavior, attitudes, and beliefs. In addition to knowing my self and my own limits, I must remind myself that, before I can teach the younger generation in a way that speaks to them, I need to understand and accept them.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.