Political Action as a Strategy to Enhance Critical Thinking
AEJNE Volume 4 - No.1 October, 1998.
Margarete Lieb Zalon,
PhD, RN, CS
Associate Professor
Department of Nursing
University of Scranton
Scranton, PA 18510-4595
717-941-7655
Fax 717-941-7903
E-mail ZalonM1@tiger.uofs.edu
Copyright 8 1998 by Margarete Lieb Zalon
Abstract
A political action project can be used for the development of critical thinking in students pursuing health careers. Registered nurses enrolled in a baccalaureate program transition course. Critical thinking, as a multidimensional phenomenon consisting of four domains: elements of thought, critical thinking abilities, affective dimensions, and intellectual standards, is used as a model for learning activities related to the project. Strategies to enhance critical thinking in registered nurses enrolled in a baccalaureate program transition course and examples of student projects are illustrated. Suggestions for faculty in implementing a political action project in a variety of health care disciplines are described.
Introduction
Recent transitions in health care from acute care to the community along with restructuring, downsizing and layoffs of health care professionals present a challenge to nurse educators. Health care providers who can think critically and adapt to a changing health care environment are needed for the future (American Association of Colleges of Nursing, 1993; National League for Nursing, 1993:13). Health professional schools need to develop scientific reasoning and self-directed learning skills in their students (O'Neil, 1990). Registered nurse students are anxious to obtain the requisite knowledge and skills to deal with the changing health care practice environment. Preparation for the challenges of professional nursing should include the development of analytical abilities as well as the reasoning ability to formulate solutions to complex problems. Thus, critical thinking is an essential component of nursing.
Political activism can be used to enhance the critical thinking of registered nurses returning to school. Social activism and political action have long been a part of nursing's history. A professional nursing responsibility is A 'initiating and supporting action to meet the health and social needs of the public' (International Council of Nurses, 1973). Changes in the health care environment have made political action a necessary skill for registered nurses (Winter, 1991; Zalon, 1992). Political socialization of professional nursing students should be introduced early in the curriculum (Brown, 1996). Political action requires a critical analysis of issues and the development of strategies to achieve specific purposes. It is a means of empowering students as they become aware of political realities, enhancing self-esteem, and developing negotiating skills (Vance, 1985; Mason, Backer & Georges, 1991). This paper describes using a political action project to enhance the critical thinking of registered nurses enrolled in a professional issues course. The domains of critical thinking: elements of thought, critical thinking abilities, affective dimensions and intellectual standards, as outlined by Paul and Nosich (1992: 78-123) provide structure to various activities related to the completion of the action project. Examples of learning activities designed to enhance critical thinking and the faculty member's role as a facilitator will be described.
The Assignment
A political action project, first described by Vance (1985), is the major assignment in a transition course for registered nurses returning for a baccalaureate degree. The focus of the course is on issues faced by the contemporary professional nurse. The objectives are to examine a professional issue from a personal perspective and to gain understanding of the political processes involved in the work setting, community, government or profession. Active student involvement in a specific issue is promoted and the critical analysis of problems and solutions in achieving a political objective is facilitated. Consistent with feminist pedagogy, students make choices regarding the topic and type of involvement desired (Hedin & Donovan, 1989). Activities can include volunteering at a community agency or professional association; meeting with and writing legislators and/or community representatives; or examining the political ramifications of a practice issue. A final written paper requires an analysis of experiential and theoretical knowledge as well as the synthesis of information from a variety of sources in order to formulate conclusions about directions for nursing practice.
A variety of learning activities related to the political action project are used to enhance the development of each of the critical thinking domains: elements of thought, critical thinking abilities, affective dimensions and intellectual standards. Central to this critical thinking model is the premise that the development of one domain alone is not adequate for functioning in a modern society (Paul & Nosich, 1992: 97-105). The modern professional nurse must be prepared to not only analyze issues but to articulate positions and develop strategies to achieve specific goals.
Elements of Thought
Elements of thought include identification of purpose or problem, recognition of a frame of reference and relevance of evidence, identification of key concepts, assumptions, implications and consequences and making inferences (Paul & Nosich, 1992, pp.98-100). Learning activities need to be designed in a manner that actively engages and challenges students thought processes. Strategies can include journals, class discussions, individual meetings with the instructor and the submission of a draft of the written action project.
Reflection though journal writing is a means of developing critical thinking (Lashley & Wittstadt, 1993). Journals, also used by Vance (1985), provide an opportunity to engage in dialogue with students as work in the course, and on the project progress. The most difficult component of the assignment is often the selection of the project itself: the identification of the problem and recognition of a frame of reference. At the first class meeting, students are asked to talk about themselves, their work and their objectives for the course. This enables the instructor to assist the student with topic selection. Subsequently, students are encouraged to explore their concerns about the selection of possible topics and difficulties encountered with the implementation of the project in their journals. Feedback is provided to facilitate the examination of several possible action projects, alternative points of view, and the implications of their assumptions and inferences. For example, in exploring practice issues related to conscious sedation, it is important for the student to identify how one's perspective may change if one is a certified registered nurse anesthetist or a gastroenterology nurse. Students may find it difficult to express their thoughts in a journal. The instructor's openness in responding to journals can make place the students at ease and facilitate further expression. Students benefit from the development of reflective skills (Baker, 1996). An excellent guide to assessing the level of reflection in a journal is provided by Wong, Kembler, Chung, and Yan (1995).
Students meet with the faculty member to discuss their project in greater detail. Contact people and resources can be suggested. Students are asked to examine their assumptions and explore competing viewpoints about a particular issue. They are also provided with practical information such as a directory of community agencies and examples of past projects. Topics have included domestic violence, school violence, conscious sedation, day care standards, breast cancer screening for low-income women, school nursing, nurse practitioner legislation, blood supply safety, health care reform and state legislation on HIV testing of health care workers. One student wrote a script for breast cancer screening for an audio recording and translation into Braille. As a result of her action project, one student was appointed to the Governor's Coalition Against Breast Cancer. Journal writing and dialogue are preludes to the formal written paper for the project. Students are able to share their ideas and gain practice in putting their thoughts to paper. This dialogue enables the instructor to support the value of experiential learning while encouraging students to explore solutions to problems.
Critical Thinking Abilities
Critical thinking abilities include reasoning and evaluating. Essential abilities needing development include listening, speaking, reading and writing (Paul & Nosich, 1992:101). These can be enhanced with the use of presentations to develop listening and speaking; search and literature review skills to develop reading; and a formal paper to develop writing.
Informal and formal presentations can be used to develop listening and speaking skills. Sharing the nature of the projects and their progress with classmates and making a formal presentation facilitates students' abilities to convey the logic of one's arguments in a less threatening atmosphere. Sharing also helps students to gain a broader perspective on the issue. Students are relieved to discover that their classmates may be having similar anxieties or difficulties. They are often surprised to discover the limitations some voluntary or governmental agencies which might not even have the staff to return a phone call. Students also discover which charities are more 'popular' and the political realities of championing certain causes. This was illustrated by a student's report on a halfway house for parolees which was struggling for continued existence. Classmates are generally quite supportive of each others endeavours and frequently have additional suggestions. Presenting their views about a topic to individuals who may have differing points of view or clinical backgrounds enhances the ability to support ones position. Conversely, careful listening to the efforts of their peers facilitates the analysis of problems and exploration of solutions.
Readings about professional issues are an important component of the course, as is specific reading about the chosen project. The development of reading as a critical thinking ability is supported by the text for the course, an anthology on professional issues. Additional readings are selected not only for their information on a timely topic, but for their careful analysis of an issue or the debunking of a prevailing paradigm. Skill in accessing written material is facilitated by bibliographic instruction provided by a librarian. Emphasis in placed on the electronic catalogue, CD-ROM databases and Internet search strategies. Students are encouraged to come to the bibliographic instruction class with at least the broad topic of their action project in order to leave the class with a useful literature search. Advanced searching techniques can be scheduled individually or in small groups. Computer literacy is necessary for web-based searches. One cannot assume that students have the background and expertise to evaluate the literature's quality. One method of assessing students' progress is to have them share the results of their searches, indicating which articles are selected or discarded, and bringing articles to class for discussion and analysis.
Committing ideas to papers is a way to fully articulate expression, achieve clarity and organization, and present a logical analysis. The final paper combines experiential knowledge with information from the literature. The synthesis of diverse points of view illustrates the students' growth in critical thinking abilities over a semester. Completion of the final written paper is often a source of great anxiety. Students may be uncomfortable with the mechanics of writing, citing the literature, using a standard format, formulating opinions about their experiences, and writing about their reactions to the literature. Examples of papers, the format as well as periodic clarification about expectations for the criteria are useful in reducing anxiety. Feedback on drafts is extremely helpful.
Affective Dimension of Critical Thinking
Critical thinking's affective dimension involves being open to others' views and understanding their perspectives. Affective dimensions include independent thinking, being fair, development of insight and confidence in reason, exploring thought, underlying feelings and the development of intellectual humility, courage, faith, integrity and perseverance (Paul & Nosich, 1992:103). The affective dimension of critical thinking is only partially fostered by encouraging students to use the literature and data to formulate arguments in support of a position. Complementing the more usual strategies for completing an assignment is the requirement that students interact with key people who have a vested interest in the issue. It is important that these interactions include persons who have different perspectives on a particular issue.
The development of affective traits requires perseverance and commitment to an issue in order to understand subtle nuances of its political ramifications. Often, just contacting key people requires a determination and persistence in order to begin to gain an understanding of the factors surrounding an issue. One student found a great diversity of knowledge and opinion when she interviewed administrators, teachers, parents, school nurses and school board members about their understanding of the school nurse role and problems in providing school health services. Her perseverance and commitment eventually led to her election to the school board. Another student gained first hand knowledge about the barriers to health care when she became involved in breast cancer screening for low-income women. Others had difficulty in just contacting key personnel in influential positions in order to discuss an issue. These experiences can serve as talking points about being fair and open-minded. For example, one student who examined food handling practices in private schools, witnessed apathy and experienced resistance to change. In this instance, supporting one's arguments with well-substantiated facts are just as important as being open to the perspectives of others. Class discussions can focus on the political realities of understanding and dealing with individuals who have opposing viewpoints.
Intellectual Standards
The use of the elements of thought, development of critical thinking abilities and affective traits can be enhanced through various learning activities related to the action project. However, it is the adherence to intellectual standards which is necessary in order to achieve significant outcomes related to critical thinking. The action project can be used as beginning step in enabling students to master intellectual standards. This mastery requires the ability to recognize clarity, accuracy and relevance, consistency in positions; discriminate depth, evaluate fairness, preference for well-reasoned accounts and distinguishing good reasons from bad reasons (Paul & Nosich, 1992:110). The final paper describing the political action project is the mechanism for addressing adherence to intellectual standards.
The final paper includes a description of the project and an analysis of issues and trends on a local, state or national level in order to place the issue or project within the context of health care events. These are combined with an evaluation of experiential activities which serve to put the issues in perspective in terms of political realities. Thus, successful completion of the paper results in a synthesis of experiential and empirical information. Synthesis is a difficult task. Students typically find it easier to describe issues and data trends. Often, they are hesitant or uneasy about formulating their opinions, particularly if they differ from prevailing viewpoints. Students need encouragement to share their ideas, an environment in which it is comfortable to do so, and freedom to disagree with the teacher. Once students have clarified their opinions, they also need encouragement in substantiating their positions with well-reasoned arguments.
Essential to making the action project a productive learning experience in terms of the development of critical thinking, is the articulation of standards for the final written paper and a healthy dialogue about the interpretation of those standards. Clearly delineated expectations for written work can be used as a guide to assess the intellectual rigor of the written work. A guide for content analysis can be developed in order to achieve consistency in the application of intellectual standards and set the tone for expectations in subsequent courses. Such a guide could include selected elements of thought, critical thinking abilities and a disposition to the examination of issues from alternative points of view as illustrated in Table 1. A learning contract can further clarify expectations and standards for grading (Schoolcraft, 1989:45). Since one course over one semester is probably too limited a time frame for the substantive evaluation of critical thinking outcomes, the information obtained from the guide can be used for grading, making revisions to the course, and identifying areas to be developed in subsequent courses. These strategies would avoid confusing the teaching/learning process with the assessment of outcomes, a criticism of nursing programs as they try to meet the critical thinking accreditation criterion (O'Sullivan, Blevins-Stephens, Smith, &Vaughan-Wrobel, 1997).
Summary
In summary, a political action project assignment in a transition course for registered nurses can be used as a method for the development of the elements of thought, critical thinking abilities, affective dimensions of critical thinking, and the adherence to intellectual standards. The instructor needs to combine the sensitivity necessary to facilitate the learning of registered nurses returning to school while challenging traditional thinking. The action project provides a foundation for working with community leaders which may be required as students plan subsequent clinical experiences and research activities. Political action can be personally empowering as students learn that they can have a positive influence on the health care system (Vance, 1985). As a personally meaningful assignment, it can have a lasting impact on registered nurses' subsequent involvement in workplace, professional and community affairs by providing them with the abilities, skills and affective traits to think critically about their ever changing environment for nursing practice.
Acknowledgment
Dr. Connie Vance, FAAN is gratefully acknowledged for her critique of the manuscript.
1. Is the relationship of the political action project to the nursing profession clearly stated? Not clearly identified Some aspects clearly identified, other aspects unclear Clearly identified What information is needed to improve clarity in stating the problem? 2. Does the literature review present a
careful analysis of the available information on
the Literature review is minimal Literature is described, but not analyzed in a consistent manner Literature is evaluated describing strengths, weaknesses and gaps What would strengthen the literature review? 3.Have alternative viewpoints been presented and evaluated well? Not mentioned Mentioned, but some evidence disregarded Mentioned and carefully evaluated What should be included in order to indicate that different viewpoints have been carefully considered? 4.Has a logical argument been presented for the position on the issue? Serious gaps in logic Some point made, other concerns related to the issue not addressed Points are substantiated or an acknowledgment is made about gaps in information What would strengthen the arguments in support of this position on the issue? 5.Has a resolution for the problem taken into consideration a broad perspective and the political realities of achieving a specific outcome? Unrealistic evaluation of the political situation Considers some information from a realistic perspective Synthesizes information from a variety of perspectives into a coherent plan What would strengthen the plan to influence an outcome related to the issue?
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