NURSING EDUCATION AS ADULT EDUCATION a philosophical standpoint

Die outeur neem die standpunt in dat indien verpleegkundiges in Suid-Afrika die uitdagings van die toekoms te bowe wil kom verandering in fundamentele beskouings oor verpleegonderwys noodsaaklik is. Een van die beskouings wat moet verander is die siening dat basiese verpleegonderwys pedagogie eerder as andragogie is — die studentverpleegkundige moet beskou word as ’n volwasse leerder wat betrokke is by volwasse onderwys. Dit sal nuwe moontlikhede vir selfgerigte en leerdergesentreerde onderrig skep. Die vrugte hiervan sal wees goeie pasiëntsorg deur verpleegkundiges vir wie leer ’n voortdurende proses is.


DEFINING ADULT EDUCATION
T here are probably as m any defini tions of adult education as there are authors on the subject.In most cases the definition reflects the p ar ticular bias of the author.In its o p e ning statem ent on the subject, The Encyclopedia fo r Educational R e search (1 p .30) notes th at adult ed u cation m ay be defined in m any ways.
T hese m any definitions may range from very broad to very narrow perspectives.T he m ost fre quently m entioned characteristics of adult education in the literature were review ed in one study.These are th at adult education is charac terised as being: • voluntary on the p art of the learner; • part-tim e; • under organised auspices; • for persons beyond school age (1 p. 30).Each characteristic has its own problem s, depending upon o n e 's v a n t a g e p o i n t .T h e v o l u n t a r y nature of adult education is p ro b ably the least questionable.
W hen th e term adult education was first used, it was applied to the e d u c a tio n a l a c tiv itie s a s s o c ia te d with w hat is today known as rem e dial adult education.Its target pop ulation was those adults who had received little or no basic school education.L ate r, o th er m eanings w ere applied.E ach reflected the needs of the individual adults p ar ticipating in the education process.
O ne such restricting application em phasises only the organised acti vities and program m es concerned with the education of adults (2 p. 15).In this sense it em braces the whole com plex of educational insti tutions, professional and sem i-pro fessional bodies and voluntary o r ganisations which organise adult education program m es.It ignores the inform al unorganised education undertak en by individual adults who perceive their own needs.
In its broadest application, the term adult education m ay be d e fined as a means o f social adjust m ent and an educational m ovem ent (1 p. 30).This allows us to com e to grips with the very essence of its nature.W hen viewed in this way, education for adults is a m eans of adjusting to a changing w orld and is a by-product of the scientific age.T herefore, as an educational m ove m ent it is based on the needs for social adjustm ent by M odern M an.
M argaret M ead (2 p. 68) put it succinctly w hen she noted: A great deal o f what needs to be taught to adults today was unknow n when they were young.C ontinuing e d u c a ti o n t h r o u g h o u t l i f e h a s become a necessity in alm ost every field, fr o m housekeeping to atomic physics . . .In the advanced co u n tries the im pact o f change is em pha sising the need fo r continuing educa tion throughout life and forcing a fresh assessment o f the whole educa tional system in the light o f this con cept.
This quotation serves to highlight the philosophy underlying adult education.E ducation is a life-long process which does not halt at the end of o n e 's schooling.This is esp e cially true of M an in the tw entieth century.In o rd e r to adjust to his rapidly changing environm ent he m ust constantly learn new skills and gain know ledge.A dult education should then be viewed as one part of the process of education.

EDUCATION A CONTINUOUS PROCESS
The first of three principles (3 p. 58) that any adult education p ro gram m e should b ear in m ind is that education is not com plete when a m an o r a w om an leaves school and goes to w ork.T he second is th at it is a continuous process which goes on throughout life and affects all as pects of life.This includes the growth of the individual, with all facets of his developm ent: aes thetic, intellectual, physical and vo cational.
T he third principle of adult e d u cation is that m ost adults can and w ant to learn, but th eir capacity to study is lost through disuse.T h ere fore, it is im portant to provide o p portunities for the educational p ro cess to continue u n in terru p ted so th at their learning skills are not lost.
T he preceding discussion has brought our atten tio n to th e fact th at adult education is m erely part of the continuum of education.It brings in to question the present education system which does not em phasise sufficiently to young people th at they have not com pleted their education when they leave school o r even finish voca tional training.They m ust be taught, as part of this early educa tion, th at they are being prepared for fu rth er life-long study.
If education is viewed as a conti nuous process throughout life, there is a need not only fo r a change in ap proach and m ethods in education, but also fo r a com plete re-appraisal o f methods, approaches and curri cula in prim ary, secondary and terti ary education.(2 p. 68).
From this vantage point it b e com es less easy to distinguish adult and child education.The division lies in the present education system rath er than the process of educa tion.The m ethods of adult educa tion then becom e the m ethods of education for children.
Having established this philoso phical view point of adult education it m ust be linked to nursing educa tion.Nursing education suffers from the sam e erroneous division into child and adult education.

NURSING EDUCATIO N AS ADULT EDUCATION
Basic nursing education lays the foundations for the effective prac tice of nursing and a basis for ad vanced nursing education (4 p. 6).In m ost cases basic nursing has as its target population students who are relatively recent schoolleavers, the m ajority of w hom are below the age of 21 years and therefore legally m inors (5 p. 10).
This view is m ade m ore explicit in the following q uotation of a state m ent m ade by a nurse educator (6 p. 139).:

Basic nursing education is con cerned with the instruction o f the adolescent, that is, it is part o f peda gogy, as it deals with the adolescent on the way to adulthood, and specially to professional adulthood. It is education after the child has com pleted the period o f secondary education and therefore falls into the category o f tertiary education.
The student nurses who are the consum ers of basic nursing educa tion are therefore considered to be less than adults from both a legal and from a nurse educator stand point.A t best they are considered adolescents; at worst, children.
Yet in the practical ward situa tion student nurses are required to take very adult responsibilities for patient care.These responsibilities may involve, in the m ost extrem e cases, life and death decisions.D uring their entire lives some adults may never be asked to m ake similar decisions.In their private lives student nurses are able to vote, drive, m arry and have chil dren during this sam e period.All of which are very adult responsibili ties.
The language used in the preced ing paragraphs may be considered by some to be ra th e r em otive, but it serves to highlight the am biguous situation in which basic nursing education places both its student nurses and its educators.It certainly would be m ore congruent with the patient care expected of student nurses to consider them as adults.
N ursing, like o ther systems in society, is being subjected to the same pressures of a rapidly d e veloping technological society.
In the next decade nursing will be faced with som e o f its greatest and m ost exciting challenges.With the trend towards mass m edical care and the changing patterns o f health ser vices, the nurse o f tom orrow will have to accept unprecedented re sponsibilities.Minor modificatiom o f existing nursing systems will be inade quate to m eet new situations and dem ands in a rapidly changing society.Fundamental rethinking will be necessary.(

p. 7)
A fundam ental rethinking of nursing education w ould, it is be lieved, consider student nurses undergoing basic nursing education as adults.It would certainly relieve the am biguity of the current situa tion.Should this occur then the nursing education system , in its full est extent, would reap the benefits.The focus would change from basic nursing education being part of pedagogy to being part of andragogy-

SELF-DIRECTEDNESS
Nursing education would, unlike other educational systems in South A frica, then be moving tow ard the concept that adult education is m erely part of a life-long process of education.It would not em phasise artifical differentiations into adult and child education and would in still a sense of self-directedness, es sential to nursing in m odern times.This concept of self-directedness is lacking in traditional nursing educa tion: Traditionally, m ost nurses have not been exposed to the concept o f personal responsibility fo r their own continuing education.Such a con cept may be seen as a requirem ent fo r survival in society changing as rapidly as ours.Learning how to learn becomes a very significant aspect o f such a concept (8 p. 50) The developm ent of personal re sponsibility and self-directedness surely lies in the nature of adult learning.Knowles (9 p. 70) has o u t lined these principles and they are paraphrased and sum m arised here.A dult learners: • respond best to a n o n -th reaten ing learning environm ent w here there is a good student-teacher relationship • w ant to assess them selves against a relevant standard to determ ine their education needs • want to select their own learning experiences (to be self-directing) • prefer a problem -oriented ap proach • w ant to apply their new know ledge and skills im m ediately • w ant to know they are progress ing • w ant to contribute (from their own reservoir of know ledge and skills) to help others learn.Fabb (10 p. 46) notes that:

Instead o f practising pedagogy, which is the art and science o f teach ing children, teachers o f medicine should now be seeking to practice what Knowles refers to as andragogy (andra = grow n up or adult), -the art and science o f helping adults to learn. By applying the principles (o f adult learning), teachers can facili tate the growth and developm ent o f the learners with w hom they work, and in the process, as co-learners, grow and develop themselves.
Seen in this way, adult education is the process which most helps the learners how to learn.It gives them the equipm ent to becom e self-directed learners involved in the life long process of education.
T eachers who work with adult learners should em phasise the p rin ciples of adult education.They should w ork to decrease the d ep en dency of child learners on their te a chers by: • creating a com fortable, non t h r e a te n in g le a r n in g e n v ir o n m ent • providing assessm ent op p o rtu n i ties to help learners diagnose their educational needs • helping the learners plan the se quence of experiences which will m eet their educational needs and produce the desired learning • creating conditions that will m o tivate the learn er to learn • selecting, with the learners, the m ost effective m ethods of p ro ducing the desired learning • providing, with the help of the learners, the hum an and m aterial resources necessary to produce the desired learning • helping the learners m easure the outcom e of th eir learning experi ences (10 p. 37-45).
It is not proposed that basic nursing education becom es self-di rected learning from the first day of the education program m e.It would be unrealistic to expect beginning student nurses to have any m ean ingful self-directedness, given the current educational systems.Self directed learning would be intro duced gradually until, by the final year, self-directedness was fully ac com plished.
The self-directed approach, like the learner-centred approach, is based on: • identification of the m ajor gaps betw een actual and specified cri terion perform ance of skills, knowledge and attitudes, that is, determ ining educational needs • aw areness of the setting or system in which the learning is to take place • selection of those educational o b jectives th at have a high priority for a particular stu d en t's level • selection and organisation of learning activities th at will p ro duce and m aintain the desired behaviour • evaluation of the extent to which the students have m et their ed u cational needs and the educa tional objectives (11 p. 114).It can be seen th at this approach can be adapted to any level of nurs ing education, from the m ost basic to the m ost advanced.W hat will vary is the am ount of direction and guidance necessary for the learners.
A t the basic education level the educational objectives, based on know ledge, skills and attitudes n e cessary for professional registra tion, need to be clearly stated.
Once these objectives are clearly stated then the beginning student can focus on his o r her approaches to achieving them .Knox (12 p. 72) has stated the po tential benefits in organising conti nuing professional education on a self-directed approach: • it provides the basis for articula tion betw een various disciplines and betw een basic and continu ing professional education • it provides for planning of regional developm ent of health m anpow er so th at each person is encouraged to m eet that region's particular health needs • it encourages m axim um utilisa tion of the available resources • it facilitates the efforts of health professionals to increase their com petence and im prove patient care and health m aintenance.
T hese benefits could be enhanced by introducing the adult education, self-directed approach at the basic nursing education level.O n this subject Knox has noted: D uring the past decade or so, m any professional schools have m odified their preparatory educa tion curriculum and instructional m ethods in ways that have increased the likelihood that graduates will continue their education.In som e in stances, these m odifications were de liberately m ade so that a basic objec tive o f preparatory education would be the developm ent o f a questioning approach that w ould encourage and facilitate lifelong learning.(12 p. 72)

Implementation
A final, but crucial question re mains: How w ould present nursing education im plem ent fundam ental rethinking of basic nursing educa tion?
In the first instance it m ust be recognised that change is often threatening and slow in producing results.It is for this reason th at the author believes these changes, which encom pass the principles of adult learning, be introduced by in novative nurse educators at the uni versities -this phase has already begun at a num ber of universities in South A frica.First to the D iplom a in Nursing E ducation students and then later to nursing students on degree courses.In this way g ener ations of stu d en ts' approach to learning will be gradually, but fun dam entally, influenced.
If South A frican nurses are to m eet the challenges of the fu tu re, a fundam ental rethinking of nursing education is necessary.P art of this fundam ental rethinking involves the switch from pedagogy to andragogy -the recognition that the student nurse is an adult learner involved in adult education.This will open up new vistas in self-directed, learnercentred learning, which will reap its g r e a te s t b e n e fits in im p ro v e d patient care by life-long learners.