FACILITATING STUDENT EMPOWERMENT

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March 18, 2021
Literature Reviews
March 18, 2021

FACILITATING STUDENT EMPOWERMENT

ABSTRACT Nursing students in the 21st century are entering highly

complex health care systems that require advocates for so- cial justice and human rights on behalf of patients. Nurses are well positioned as patient advocates. This article pres- ents a brief overview of the historical and theoretical per- spectives underpinning emancipatory knowing and pro- poses several methods nursing faculty can use to empower nursing students to provide care informed by this way of knowing. Nursing faculty are urged to adopt a curriculum that supports an emancipatory and caring praxis and to mentor students to provide care supportive of social jus- tice, particularly for the vulnerable and marginalized mem- bers of society. Nursing students who learn to embrace and value emancipatory knowing during their educational pro- gram may likely continue this praxis after they graduate. [J Nurs Educ. 2014;53(2):65-69.]

T he complexity of the health care system and chaotic clin- ical environments beckons nurses who can conceptual- ize and integrate emancipatory knowing into their clini-

cal practice. A praxis of emancipatory knowing offers nurses a means to refl ect and act in a manner that advocates for social justice and human rights on behalf of the patients for whom they care each day (Chinn & Kramer, 2011; Cowling, Chinn, & Hagedorn, 2000; Falk-Rafael, 2005; Harden, 1996). Specifi – cally, emancipatory knowing is the aptitude to acknowledge social and political “injustice or inequity, to realize that things could be different, and to piece together complex elements of experience and context to change a situation as it is to a situ- ation that improves people’s lives ” (Chinn & Kramer, 2011, p. 64). Understanding the concept of emancipatory knowing and its theoretical basis is essential to knowing how to integrate it into practice. This way of knowing, derived from multiple perspectives and theories, offers a relevant addition to nursing research, theory, and practice (Chinn & Kramer, 2011). For many nurses, the basis for understanding this concept may or may not commence during their educational program, as it may depend on their program philosophy, curriculum structure, and the philosophical values and beliefs of the nursing faculty who teach them. Given these different variables, contextualizing emancipatory knowing may vary among nurses. Nursing stu- dents, who learn to embrace emancipatory knowing as praxis, may likely continue doing so after they graduate. The purposes of this article are to present a brief overview of the historical and theoretical perspectives that led to the conceptualization of emancipatory knowing, to discuss its signifi cance to nursing, and to offer examples of how nursing faculty can empower stu- dents to integrate emancipatory knowing into clinical practice.

HISTORICAL OVERVIEW

Historically, nurses have confronted power imbalances throughout their educational programs and careers. Emancipa- tory efforts in nursing history are often blended with feminist views, particularly during the feminist movement of the 1960s and 1970s and as characterized by Jo Ann Ashley in her book Hospitals, Paternalism, and the Role of the Nurse (1976; Chinn

Emancipatory Knowing: Empowering Nursing Students Toward Refl ection and Action Marianne Snyder, MSN, RN

Received: February 19, 2013 Accepted: September 11, 2013 Posted Online: January 7, 2014 Ms. Snyder is Assistant Professor of Nursing, Department of Nursing,

University of Saint Joseph, West Hartford, Connecticut. The author thanks her doctoral academic advisor, Dr. Carol Polifroni,

University of Connecticut School of Nursing for her support. The author has disclosed no potential confl icts of interest, fi nancial

or otherwise. Address correspondence to Marianne Snyder, MSN, RN, Assistant

Professor of Nursing, Department of Nursing, University of Saint Joseph, 1678 Asylum Avenue, West Hartford, CT 06117; e-mail: msnyder@usj.edu.

doi:10.3928/01484834-20140107-01

Journal of Nursing Education • Vol. 53, No. 2, 2014 65

EMANCIPATORY KNOWING

& Kramer, 2011). In this book, Ashley (1976) traced the histori- cal roots of oppression in nursing through a feminist lens and presented a laudable critique of a patriarchal health care system and the ongoing struggles of nurses who strive to gain control over their education and practice. It was also during this period that the concept of empowerment entered the nursing literature (Bradbury-Jones, Irvine, & Sambrook, 2007; Hage & Lorensen, 2005; Kuokkanen & Leino-Kilpi, 2000; Manojlovich, 2007; McCarthy & Freeman, 2008) and stimulated lively debate and discourse within the nursing community. Despite more than 30 years later, these struggles persist, but not without the per- severance of those who believe that change initiated through emancipatory efforts does occur. Emancipatory knowing is a call to action to advocate for social justice in a system that con- tinues to permeate inequities and oppression among the masses (Chinn & Kramer, 2011).

Throughout history, nurses have consistently advocated for improved health conditions for individuals, families, and communities, with a primary focus on addressing immediate health care needs and educating people about health promo- tion. Nursing care in the 21st century requires nurses to practice with a broader emphasis on the historical, social, and political structures in society (Clare, 1993; Falk-Rafael, 2005; Ford & Profetto-McGrath, 1994; Harden, 1996; Kagan, Smith, Cowl- ing, & Chinn, 2010; Kuokkanen & Leino-Kilpi, 2000; Rose & Glass, 2008) to understand the impact of these factors on the health and well-being of individuals, groups, and communities.

Chinn and Kramer (2011) introduced emancipatory know- ing to the nursing literature and credited the infl uence of several theories and perspectives when they developed this concept. The following discussion about these infl uential theories and perspectives aims to explicate the importance of integrating emancipatory knowing into the curricula to help broaden nurs- ing students’ awareness about hegemonic beliefs embedded in the sociopolitical system and to support their capacity to ques- tion the status quo.

THEORETICAL INFLUENCE

The concept of emancipatory knowing was developed through an eclectic process that integrated concepts from other theories and perspectives, namely critical theory, the postmod- ernist and poststructuralist views of Freire (1995) and Foucault and Gordon (1980), and White’s (1995) sociopolitical pattern of knowing (Chinn & Kramer, 2011). Important to the process of helping a student develop this way of knowing is a caring and transformative teacher who guides students to learn beyond a technical model of health care and instead uses an emancipa- tory model to emphasize refl ection and action (Ford & Profetto- McGrath, 1994; Owen-Mills, 1995).

Critical theory initially emerged during the 1920s from a synthesis of ideas offered by philosophers from the Institute for Social Research in Frankfurt, Germany, commonly referred to as the Frankfurt School (Harden, 1996; Ray, 1992). The un- derlying premise of critical theory includes three basic tenets about knowledge—specifi cally, knowledge must be practical, emancipatory, and have the potential to liberate the oppressed (Kagan et al., 2010). In the 1960s, Habermas (1987) restruc-

tured critical theory by blending philosophical and sociological perspectives to develop critical social theory (CST) grounded in rational communication, as described in his theory of com- municative action. Habermas’ (1987) theory offers a framework to explain how modern society creates many social injustices. A principle tenet of CST is to help oppressed people liberate themselves from known and unknown societal oppression; hence, CST offers a framework to study and conceptualize the social and political factors infl uencing society (Chinn & Kramer, 2011; Ray, 1992; Wells, 1995).

Much of the CST literature is rooted in the work of Freire and his pedagogy for liberation of the oppressed masses (Bradbury- Jones et al., 2007; Freire, 1995). Freire (1995) contended that the oppressed often subsume the worldview of their oppressor, thinking that doing so will lead to greater power and control. In reality, this social conformity often leads to marginalization of the oppressed group and results in low self-esteem and low self- worth (Roberts, 1983). Dialogue that asks questions of “how,” “what,” and “why” as related to the various power structures and relationships that exist in society helps frame a contextual basis for nurses to understand the infl uence of these affi liations on certain individuals and groups in society.

Discourses or symbolic representations in our culture shape how we view our world and learn what is socially valued or dis- counted (Chinn & Kramer, 2011). For example, White (1995) expanded on Carper’s (1978) empirical, ethical, personal, and esthetic patterns of knowing and added sociopolitical knowing as a means to understand the sociopolitical and cultural contexts that infl uence perceptions of health and illness, identity, lan- guage, and relationship with society. Chinn and Kramer (2008) developed emancipatory knowing and distinguished it from so- ciopolitical knowing because it “embrace[s] a wide[r] range of historical and contextual considerations, and… emphasize[s] the fundamental intent to seek freedom from conditions largely hidden that restrict the realization of full human potential” (pp. 87-88). Foucault’s poststructuralist philosophy about power imbalances created through discourse provides additional in- sight to understand emancipatory knowing (Chinn & Kramer, 2011). When new knowledge and power gain momentum and infi ltrate the prevailing discourse, they can serve once again to infl uence thought and alter future actions.

These theoretical and philosophical perspectives elucidate how sociopolitical, cultural, and historical factors can infl uence human action. Developing an awareness of these factors, as well as a belief in personal capacity to change, is an important step toward advocacy and social action. Nurses are well posi- tioned as health care leaders to advocate for social changes that mitigate oppression. To support this call, nursing students need support to exercise their power to apply an emancipatory praxis throughout their profession.

CALL TO ACTION

Some believe that nursing is not as prepared as it could be to address the plethora of health care challenges faced each day by individuals and groups (Chinn & Kramer, 2011; Falk-Rafael, 2005). Nursing education programs would do well to heed this call to action by adopting a curriculum that supports a caring praxis

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SNYDER

and mentors students to provide care supportive of social justice, particularly for the vulnerable and marginalized members of so- ciety. To acquire an aptitude for emancipatory knowing, nurses need to develop a broader understanding of the sociopolitical forces that compromise the ability of a person, family, or commu- nity to fl ourish, free from oppression, within their world. Interest and support for integrating emancipatory approaches into nursing education and curriculum development have increased (Bevis & Murray, 1990; Fontana, 2004; Ford & Profetto-McGrath, 1994; Glen, 1995; Harden, 1996; Lipp, 2003; Parker & Faulk, 2004; Randall, Tate, & Lougheed, 2007; Schreiber & Banister, 2002). Nursing is called to closely examine the disciplinary practices that suppress, rather than support, nurses who question assump- tions and challenge the status quo (Kagan, Smith, Cowling, & Chinn, 2010). Nurse educators can support this call to action by examining current pedagogical practices that minimize student critical thought and action pertaining to the curriculum or clinical experiences. Teaching guided by emancipatory action may help create a foundation for nursing students to integrate similar ap- proaches into clinical practice.

FACILITATING STUDENT EMPOWERMENT

The following section presents a variety of methods that ed- ucators can integrate into nursing curricula to guide students to- ward an emancipatory praxis. The Table outlines each method and the dimensions of emancipatory knowing to facilitate the

outcomes. It is anticipated that these approaches will inspire ad- ditional dialogue about other effective strategies to help nursing students embrace a broader understanding of the environments in which they practice.

Randall et al. (2007) suggested using critical questioning as an emancipatory method in teaching and learning, where the teacher and student engage in a “co-creating dialogue meant to serve as a trigger for thinking” (p. 61). This form of questioning aims to guide the student through open and nonjudgmental dia- logue to explore what specifi c knowledge guided their actions while caring for a patient (Randall et al., 2007). In addition, students who are able to share their experience of caring for a patient using exploratory dialogue and questioning are likely to increase their inquisitiveness as related to factors outside the patient’s immediate diagnosis (Bevis & Murray, 1990; Randall et al., 2007). Students who are empowered to refl ect critically about clinical situations and ask questions about why certain problems exist, how they can be resolved, why they occur, and who benefi ts will learn to develop a deeper understanding of their patients’ circumstances (Chinn & Kramer, 2011; Harden, 1996; Kagan et al., 2010). Use of critical questioning can help nursing students to incorporate principles of emancipatory knowing into their practice and offers those for whom they care a voice to navigate the complexities of the health care environ- ment.

Another strategy to enhance emancipatory knowing is to use fi lms to stimulate refl ection and action. Films provide a platform

TABLE

Methods to Support an Emancipatory Praxis Among Nursing Students

Method Dimensions of Emancipatory Knowing Outcome

Engage in dialectical communication Critical questions; creative processes Explore potential discord between personal preconceptions and others

Maintain a critical, refl ective journal Critical questions; creative processes Develop critical thinking and self-awareness to increase one’s capacity as a refl ective practitioner

View fi lms for implicit and explicit themes related to social justice

Critical questions; creative processes Broaden personal perspectives through critical refl ection of movie themes and identify similarities and diff erences in own practice

Participate in focus groups Formal expressions of knowledge; authentication processes

Deepen understanding of self and others’ thoughts and actions when sharing multiple perspectives about an issue

Write letters to newspapers, journal editors, and state legislators concerning matters of health care and professional practice

Formal expressions of knowledge; integrated expression in practice

Increase confi dence advocating for patients and self through praxis

Attend State Board of Nursing public meetings

Formal expressions of knowledge; authentication processes; integrated expression in practice

Expand awareness of professional practice issues and events within own state to advocate intelligently on issues of social justice as they impact patients and nursing

Join local and state student nurses’ associations and attend state legislative sessions

Formal expressions of knowledge; integrated expression in practice

Develop understanding of political processes and empower self to take action and support the health and well-being of others

Create blogs to share and communicate views on particular social issues

Critical questions; creative processes; formal expressions of knowledge

Discover personal voice and learn to communicate personal views that advocate for action to address injustices

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from which dialogue and critique can stimulate discussions and create greater insight into the meanings embedded in the story. Parker and Faulk (2004) explained how they used the fi lm My Life, starring Michael Keaton and Nicole Kidman, to encourage nursing students to share their perspectives on the superfi cial and underlying meanings conveyed throughout the story. Students received several preliminary questions to think about prior to viewing the fi lm, and they were asked to provide evidence from the literature to support their understanding of family systems, complementary health care, and dysfunctional communities (Parker & Faulk, 2004). Although students were able to explore and evaluate their feelings and attitudes as related to the real-life circumstances portrayed in the movie, they were limited because it was a situation in which none of them had any direct involve- ment (Parker & Faulk, 2004; Randall et al., 2007). The use of a similar approach based on real-life stories from personal experi- ences and those reported in the news or from patient situations students encounter during clinical rotations provides a realistic platform to develop emancipatory knowing.

An additional strategy to foster emancipatory knowing in- volves using focus groups throughout the nursing curriculum to encourage students to share the experience of being a nurs- ing student during clinical. This approach invites students to discuss and analyze institutional and sociopolitical barriers that may interfere in their ability to provide care free from these constraints. Jacobs, Fontana, Kehoe, Matarese, and Chinn (2005) conducted an emancipatory study of nursing practice. They conducted a series of focus groups over 6 to 10 weeks with experienced nurses from different regions of the northeast- ern United States to learn about their views of contemporary nursing practice. The purpose of their study was to help nurses recognize various oppressive forces within their work environ- ments and share their perspectives of nursing practice through a dialectical process. Throughout these focus groups, the nurses recognized their individual and collective power to propose changes in either themselves or their work environments to address the oppressive forces they experienced (Jacobs et al., 2005).

The dialectic is another method of communication that en- courages two or more individuals with differing views to dis- cuss their perspectives. This communication approach inten- tionally invites participants to share contradictory viewpoints and employ rational arguments to discuss and explore existing power structures in society (Fontana, 2004), and it also enables nursing students to expand their understanding about emancipa- tory knowing. Through a process of dialectic communication, participants are encouraged to express their differing views and thoughts freely and without fear of retribution (Burns & Grove, 2009). Use of a dialectical approach to teaching a class, rather than teacher-directed lectures, offers students an emancipatory approach to collectively express their views and experiences related to a common issue or concern. Using this form of dia- logue, faculty could integrate dialectical groups throughout the curriculum to help students examine the health care needs of marginalized individuals, groups, and communities. For exam- ple, sessions could begin with an open-ended inquiry to explore what marginalization means and whether any members have ever experienced marginalization. Then, group members could

express their understanding of this concept using stories, poetry, music, art, or personal experiences. Subsequent sessions may explore questions related to conditions in society that contribute to marginalization and actions that can be taken to help mitigate its occurrence. The experience of such a dialectical process af- fords each participant an opportunity to develop his or her in- ner voice and helps encourage the participant to believe he or she can make a difference through praxis (Chinn & Kramer, 2008; Jacobs et al., 2005). From the beginning of their nursing program, students could freely participate in these dialectical groups to broaden their understanding about various topics and issues of interest.

Students learn to value the knowledge and experience gained throughout their educational program when provided opportu- nities to share them with those outside the health care environ- ments. They usually learn early in their educational program how to communicate therapeutically with patients and family members, but not necessarily with elected public and state of- fi cials. Encouraging students to write letters to newspaper edi- tors and state legislators to support action for social justice can help students develop and strengthen their political voice (Falk- Rafael, 2005). Other supportive activities include having stu- dents attend sessions at the state legislature and state board of nursing, speak with lobbyists and representatives of their state nurses’ association, and join their state and local student nurses’ associations. Given the various social media platforms available today, students could also develop a professional blog or Web page from which to express their sociopolitical views. Nursing faculty who support these endeavors and explore opportunities with students to broaden their views on power structures that marginalize certain groups in society help students expand their understanding of the social and political structures that impact the health and well-being of these oppressed groups.

CONCLUSION

The profession of nursing is positioned strategically to ad- vocate for social justice through refl ection and action. Intro- ducing critical social theory and other emancipatory pedagogy into a nursing curriculum helps nursing students build a knowl- edgeable foundation for critical inquiry and praxis guided by emancipatory knowing. The different methods discussed in this article support this endeavor, but other approaches also exist. Nursing faculty who value and practice within a critical theory paradigm can mentor nursing students through this process by engaging them in meaningful discourse with an emancipa- tory aim. Patients and society as a whole benefi t when students learn early in their educational program that the professional responsibilities of a nurse include the adoption of an emancipa- tory praxis to guide education, research, and practice. Nursing students who learn to question and analyze the sociopolitical conditions infl uencing the health of their patients may be more likely to provide nursing care informed by emancipatory know- ing and develop strategies to mitigate these oppressive forces. Nurse educators are urged to support nursing practice informed by emancipatory knowing and are called upon to share their knowledge of other effective strategies to integrate emancipa- tory praxis into a curriculum.

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