The Whole Brain Creativity Model : Implications for Nursing Education and Practice

Research Article abstract Recent nursing literature has repeatedly proclaimed the need for creativity in nursing. Effective nursing practice in the new millennium will require innovative and creative nurses who can adapt to change and have the courage to take risks in order to provide holistic, individu­ alised, context-specific care. An analytical study of the literature re­ vealed interesting information on the concept creativity and teaching for crea­ tivity. The aim of this article is to describe the Whole Brain Creativity Model and its implications for nursing education and practice. opsomming Die behoefte aan k rea tiw ite it in verpleging word herhaaldelik aangespreek in hedendaagse verpleegliteratuur. Effektiewe verpleegpraktyk in die nuwe millennium, sal innoverende en kreatiewe verpleegkundiges verg wat kan aanpas by verandering en die moed het om te waag ten einde holistiese, gei'ndividualiseerde, konteksspesifieke sorg te kan lewer. ‘n Ana litiese literatuurstudie het interessante inligting oor d ie konsep krea tiw ite it en die on tw ikke ling van krea tiw ite it deur onderrig, openbaar. Die doel van hierdie artikel is om die Heelbrein Kreatiwiteitsmodel te beskryf en die implikasies daarvan vir ve rp leegonderw ys en praktyk, aan te dui.

'n A n a litie s e literatuurstudie het interessante inligting o o r d ie ko n s e p k re a tiw ite it en die o n tw ik k e lin g van k re a tiw ite it d eu r onderrig, openbaar.Die doel van hierdie artikel is om die H eelbrein Kreatiwiteitsmodel te beskryf en die implikasies daa rva n v ir v e rp le e g o n d e rw y s en praktyk, aan te dui.

introduction
The fostering of creativity in nursing edu cation has been the subject of much debate in recent years.Nurse educa tors have expressed increasing concern with regard to the expression and devel opm ent of creativity in nursing.Seen against an accelerating changing soci ety, marked by changing human values, expanding know ledge and im proved technology, nursing is becoming an in creasingly diverse profession.The nurse in the 21st century will have to be a crea tive and innovative practitioner to be able to cope effectively with new and unique elements in a complex health care set ting.
Nursing as an evolving and m aturing professional discipline is experiencing a major paradigm shift as a result of the rapid changes in health care delivery throughout the world: The nursing pro fession today seeks a nurse who can function in a highly scientific and tech nological milieu.The nurse practitioner of tomorrow will have to accept the am biguities of a modern and dynamic medi cal and health care setting -a complex world in which there are no certainties or any clear and easy solutions.Bevis and Watson in Towards a caring curriculum: a new pedagogy for nursing summarises the new paradigm for nurs ing as follows: "We must find a balance, a truce, a truly liberated climate for teaching of inquiry, so that we fuse the scientific with the metaphysical, and infuse a new respect for those things uniquely human: moral ity, judgement, intuition, reflection, imagi nation, creativity, values, meaning and spiritual sensitivity."(Bevis & Watson 1989:64)

research methodology
An exploratory descriptive design com prising an analytical study of the litera ture on creativity, was utilised.The most im portant m ethodological considera tions in descriptive studies are to gather accurate data about a phenomenon.As sumptions (not hypotheses), are there fore stated in this type of research de sign.This study is based on the assump tion that there is a pressing need for crea tivity in nursing and the aim is to analyse and describe the Whole Brain Creativity Model and indicate the implications for nursing education and practice.

the concept creativity
The word creativity has been both mis used and overused and the concept it stands for is vague, general and confus ing.As it refers to a very complex as pect of human behaviour, it has many different meanings to as many different people.It is therefore not possible to offer a universally acceptable definition.However, when we use the concept crea tivity we open ourselves to m isunder standing unless we define and explain how we view creativity.The literature on creativity generally discloses two oppos ing approaches.The traditional view regards creativity as a special talent be longing to a few superior individuals, creative geniuses as they are often re ferred to.According to this view the crea tive ability is unchangeable and exists only in individuals who have inherited it genetically.It is believed that this kind of creativeness cannot be fostered, nor can it be fully comprehended because of the eccentricity of the creative genius.The only way to partially understand this kind of creativeness is through the crea tive product as delivered by people such as D arw in, E in stein , Da V inci and Poincaré.
A more recent approach towards crea tiv ity results from co n te m p o ra ry re search.Creativity is viewed as an au thentic human ability which manifests it self in different human activities.It is not the prerogative of a few selected human beings, but exists in all human beings and can be encouraged by education and a suitable environm ent (Prinsloo 1973:44-45;Oschse 1990:3).
The focus of the article is on the more recent approach towards creativity and I shall suffice by the following two defini tions of creativity: HenleThe creative solution, the creative idea, is one which the individual achieves by freeing himself from his own concep tual system, and by which he sees in a d e e p e r o r m ore c o m p re h e n s iv e or clearer way the structure of the situation he is trying to understand.
Abraham Maslow: Selfactualising crea tiveness -these people can see the fresh, the raw, the concrete, the idiographic, as well as the generic, the abstract, the rubricised, the categorised and the clas sified.Consequently they live far more in the real world of nature than in the ver balised world of concepts, abstractions, expectations, beliefs and stereotypes that most people confuse with the real world.(Prinsloo 1973:47, 49) Henle expresses the necessity for the individual to free himself from his own conceptual systems, in other words his usual way of thinking, in order to enable himself to see deeper and more com prehensively.Maslow focuses on this very same phenomenon, the individual's ability to perceive the concrete and the ideographic, as well as the abstract and th e g e n e ric , im p lie s p e rc e iv in g holistically.

whole brain creativity
The split brain studies which started dur ing the 1960's, demonstrated significant differences between the functions of the left and the right hem ispheres of the brain.These studies together with the vast amount of research studies initiated since, have led to the psychophysiological approach to the analysis of mental functioning which has gained great im petus.The new knowledge generated through this approach which includes the concept of cerebral dominance (im plying that one hemisphere tends to play a more important role than the other in each individual), has resulted in a new understanding of the nature and proc ess of learning with far-reaching impli

LEFT HEMISPHERE SPECIALISATION RIGHT HEMISPHERE SPECIALISATION
•Verbal: encoding and decoding speech, reading, writing, spelling, mathematics, musical notation •Analytic: things are figured out part-by-part •Linear: think in terms of linked ideas, process information sequentially, often leads to a convergent conclusion •Non-rational: do not require a basis of reason or facts, will ing to suspend judgement •Visio-spatial: see the relationship between things and how the parts go together to form a whole •Emotional: a product of the limbic system, but the right hemisphere is more in touch with feelings (Kolb 1984 :49; Sisk 1987:291; Williams 1983:26; Zdenek 1985:13-14 The research that has been done on brain functioning and specialisation, at tributes the left cerebral hemisphere with linear, verbal and analytic thinking proc esses, and the right hem isphere with non-verbal, synthesising and holistic processes.This clarifies why certain in dividuals tend to approach problem s logically, analytically and factually (left brain m ode); whereas others tend to approach problems intuitively using im ages, concepts and patterns (right brain mode).
The list of thinking processes of the left and right hemispheres of the brain illus trates the results of various research studies.
The myth that the right hemisphere is the one and only responsible for creativity, has been found to be untrue by recent research studies.The contem porary view on the nature of creativity is sum marised in the follow ing quotation by Williams (1983:4): ... the differences be tween the hemispheres should not ob scure the fact that it is their complemen tary functioning that gives the m ind its pow er and flexibility.
Creative work requires the com bined abilities of intuitive awareness and logi cal thinking -a scientist needs his logi cal left hemisphere for analytical reason ing but it is his intuitive right hemisphere which provides that leap of insight that solves a complex problem.This concept is confirm ed by Rubenzer in Gowan, Khatena and Torrance (1981:280) in the following quote: the most productive and creative intellectual functioning is theo rised to occur when there is cooperation between hemispheres.

From the split brain theory to the four quadrant model (Whole Brain Creativity Model)
The W hole Brain Creativity Model ex plains how the brain functions while en gaged in the creative process.It was developed by Herrmann (1989), and is based on the triune and left brain/right brain theories.The triune brain theory divides the brain into a Neomammalian (neocortex), Paleomam malian (lim bic system) and reptilian brain.Whereas the left brain/right brain theory splits the brain into tw o cerebral hem ispheres, Herrmann's whole brain creativity model divides the brain into four quadrants.
The four quadrant concept includes the left and right cerebral hemispheres and the left and right halves of the limbic sys tem.
The Whole Brain Creativity M odel was developed from data gathered during Brain Update Workshops during which Herrmann shared the results of the split brain research of the 1970s with others.
He distributed questionnaires containing questions on educational background, job focus, preferred academic subjects and hobbies, and choices between ad jectives describing different functions of the specialised brain in which subjects had to select those pertaining to them selves.The instrument initially showed a linear profile which reflected the basic d ichotom y between left brain related modes of mental processing and right brain related modes.As more people completed the questionnaire, the data base grew to show four distinct clusters (Herrmann 1989:50-53).
It took Herrmann some time to compre hend this phenomenon of the four clus ters.He finally merged the triune brain th e o ry and the left b ra in /rig h t brain theory as the link he was looking for, appeared to be the limbic system.The two upper quadrants represent the left and right cerebral hemispheres and the two lower quadrants the left and right halves of the limbic system.
Although Herrmann originally thought of the whole brain model as a physiologi cal map, he moved away from this inter pretation to present the model as a meta phor.He stopped using the terms cer ebral hemispheres and limbic system to soften the re la tio n s h ip betw een the physiology of the brain and the meta phoric m odel, and renam ed the four quadrants, A, B, C and D (Herrmann 1989:63-65).Figure 1  Quadruple dominant = 3 % (Herrmann 1989:85) According to Herrmann the HBDI meas ures preference for a mental activity but this does not necessarily means com petence in performing it.Competence comes through training and experience, but world class competence can only be achieved in an area of preference.This is a very important statement as creativ ity is no superficial, aha-experience -it requires a lot of hard work, a thorough knowledge of a specific field, dedication and motivation and the use of all four quadrants of the brain.
Herrmann views people who are crea tive as having a primary preference for the D-quadrant, but says that they are supported by strong secondary prefer ences in other quadrants which enable them to function situationally in order to complete a creative task.Supporting capabilities, when strengthened, often e n h a n ce the o rig in a l p re fe re n c e (Herrmann 1989:197).This concept is affirmed by Wenger who states that in order to improve any area of the brain, an individual should first work in the lan guage of that part of the brain, and then com bine the behaviour with the lan g ua ge o f a n o th e r p art o f th e b rain (Parnes 1992:254).
The premise that creativeness is a prod uct of whole brain functioning has been expressed by m any authors and re searchers.Rubenzer quotes several, in c lu d in g C h is e lin (1952), G ilc h ris t (1970), Kraft (1976) and Norman (1977), as having suggested that creative gen iuses are most adroit at utilising both the left and the right hemispheric process ing modes (Gowan, Khatena & Torrance 1981:280).Herrmann expresses his view on this matter as follows: What becomes clear when one studies the lives and writ ings o f scientific and artistic geniuses is that what made many o f them extraordi nary was their use and trust o f modes that are non-dominant in their particular fields (Herrmann (1989:196).
The distinction between artistic and sci entific creativity is made on the basis of the difference in prim ary processing modes.The artistic creative process is regarded as stronger right mode (C-and D-quadrant) oriented, relying on non verbal, visual, imaginative and spatial abilities, whereas scientific creativity re lies on the left mode (A-and B-quadrant) processes which include logic, analyti cal, verbal and mathematical skills (see figure 1).The relation between the four quadrant model and creativity can be illustrated by the examples of creative geniuses such as Da Vinci, Eistein and Kekulé.Leonardo da Vinci has been regarded as a multiple dominant scientific and ar tistic giant, as a result of his art works and scientific designs.Albert Einstein and August Kekulé are perceived to have been double dominant (in the A-and Dquadrants) with the ability to move back and forth between these two specialised modes through iteration.This enabled them to bring two different mental proc esses into a synergistic whole.Einstein conceived his theory of relativity after he had a dream of himself riding on a light beam.He regarded his gift for fantasy as much more important than his gift for logic and analysis (Herrmann 1989:196-197).Kekulé, a Dutch Chemist, discov ered the molecular structure of benzene, the benzene-ring, through a dream af ter struggling with this problem over a very long period.He dreamed of atoms g a m b o llin g , tw in in g and tw is tin g in snake-like motion until one snake seized hold of its own tail and whirled mockingly -this lead to a sudden insight -the benzene-ring (Gowan, Khatena & Torrance 1981:250).
Apart from Herrmann's metaphor, the interactive effects of the left and right h e m isp h e re s ' p rocesses have been emphasised by other recent cognitiveoriented metaphors for the creative proc ess.Parnes (1977) regards the integra tion of the special abilities of both the left and right hemispheres as essential for creativity.Torrance (1978) supports the concept as manifested in his words: In creative thinking, it is especially impor tant to understand the specialised func tions o f the right and left hemispheres, since almost by definition both kinds of fu n c tio n in g are re q u ire d (E llio tt 1986:204).

the whole brain teaching and learning model
In addition to the whole brain creativity m odel, Herrmann developed a whole brain teaching and learning model.The learning process is divided into the four brain quadrants and summarised into two categories; structured and unstruc tured.The structured modes (A-and B-quadrants) focus on logical, rational, analytic and quantitative activities as well as the planned, organised, sequential and procedural elements of the learn ing process.The structured modalities are in sharp contrast with the unstruc tu re d m odes (C-and D -q ua d ra nts) which focus on non-verbal, visual, con ceptual and sim ultaneous processes, involving emotional, interpersonal and e x p re s s iv e a c tiv itie s (H e rrm an n 1989:220-221) (figure 2).
The whole brain teaching and learning model can serve as a guide for nurse educators who wish to stimulate and fa cilitate whole brain learning and creativ ity in their students.

Whole brain learning and design considerations
A c c o rd in g to H errm ann A -q u a d ra n t dominated individuals learn by acquir ing and quantifying facts, applying analy sis and logic, thinking through ideas, building cases and formulating theories.
They respond to formal lectures, case studies, programmed learning and text books with the focus being on the ver bal, rational and abstract processes of the left hemisphere.Teaching strategies such as seminars, individual projects and reading assignments can be added to Herrmann's list to assist A-quadrant d o m in a te d le a rn e rs (H e rrm an n 1989:419).
The B-quadrant dominated individuals learn by o rganising, structuring and sequencing content, evaluating and test ing theories, acquiring skills through p ra c tic e and im p le m e n tin g co n te n t (Herrmann 1989:419).They respond, like the A-quadrant individuals, to formal lectures, program m ed learning, case discussions and textbooks but thorough planning and sequential order is added and emphasised.There tend to be a stronger focus on organisation and prac tical application in the B-quadrant and learning could be assisted by providing opportunities for demonstrations, prac tice sessions in the simulation laboratory, clinical learning experiences and group discussions (Potgieter 1996:79).
The A-and B-quadrants of the left hemi sphere have some aspects in common.There is a need for a structured teaching-learning environm ent wherein the learners are disciplined, rational and verbally oriented concerned with the know how of inform ation.The differ ences between A-and B-quadrants re sult from the differences between the left cerebral hemisphere (perceived as intel lectual and fact based and the left half of the limbic system (kinaesthetically ori entated and controlled).This explains the phenomenon that A-quadrant dom i nant individuals are achievement driven whereas B-quadrant dominant individu als are task driven.
In contrast to the left hemispheric think ing processes are the right hemispheric thinking processes which are divided into the D-and C-quadrant.D-quadrant dom inated individuals learn by taking initiative, relying on intuition and self-dis covery, exploring hidden possibilities, constructing concepts and synthesising content (Herrmann 1989:419).They re spond to visual displays, experiential opportunities, aesthetic qualities, and future oriented case discussions.They tend to be spontaneous, playful, indi vidualistic and enjoy being involved in the learning process.Compared to the left hemispheric functions the preference for non-verbal information and analogy, holistic perception, synthesising abilities and intuitiveness, are evident in D-quad rant functioning.Teaching strategies which could assist learning include indi vidual patient case histories, guided fan tasy, metaphorical thinking, simulation, role play and challenging clinical assign ments such as developing health edu cation brochures for individual patients.
The C-quadrant dominated individuals learn by feeling, moving and emotional involvem ent, integrating experiences with the self and harmonising with the content, listening and sharing ideas.They tend to respond to sensory move ment and music, experiential learning, people oriented case discussions and group interaction.It can be deducted that because of the emphasis on the af fective aspects in the C-quadrant, learn ing can be assisted by teaching strate gies including group discussion, values clarification, role play, simulation games, clinical post conferences and field trips (Potgieter 1996:81).
Considering the whole brain teaching and learning model, it is obvious that the right hem ispheric oriented individuals prefer experiential learning opportunities which allow for an unstructured teach ing-learning environment providing op portunities for spontaneous and explora tive learning.These individuals are good at non-verbal learning and are c o n cerned with the know why of information.The differences between the D-and Cquadrants result from the specialisation of the right cerebral hemisphere which is more intellectually oriented and openminded, in contrast with the right half of the limbic system, which is kinaestheti cally oriented with a strong emphasis on feelings and emotions.This clarifies why the D-quadrant dominant individuals are independence driven whereas the Cquadrant dominant individuals are feelings-driven.

implications for nursing education
The whole brain teaching and learning m odel can assist nurse educators to implement a holistic approach towards teaching.By utilising a variety of teach ing strategies, the nurse educator can stimulate all four quadrants of the stu dent nurse's brain.For example, a stu dent who is double dominant in the Aand B -quadrants w ill prefer to learn through formal lectures, case studies, learning packages, programmed learn ing, reading assignments, etc (see fig ure 3).However, these students need stim ulation of the D and C -quadrant thinking processes in order to develop whole brain learning and creativity.They should therefore also be exposed to teaching strategies including simulation, clinical assignments, patient case histo ries, role play, values clarification, field trips, etc (see figure 3). Figure 3 serve as an example, there are however many other teaching strategies which could be added.

implications for nursing practice: whole brain creativity and the expert nurse practitioner
The hum an s c ie n c e o f n u rsin g is founded upon an epistemology that in cludes metaphysics, aesthetics, humani ties, art and empirics.It respects intui tion, compels logic and reason, exacts discipline, necessitates critical thinking, requires creativity, views the individual holistically and has caring as its ethical imperative (Bevis & Watson 19890:220, 221;Chaska 1990:101, 227;Watson 1985:29).These assets refer to a com bination of left and right brain processes.Intuition is a D-quadrant process; logic, reason and critical thinking are A-quadrant processes; exacting a discipline re quires both A-and B-quadrant p ro c esses; and caring originates in the Cquadrant.
Aydelotte in Benner (1984:V) refers to the mystery of expert nursing practice and calls for respect for this mystery rather than to dispel or standardise practice by subm itting it to rules and procedures.Schein (1972) refers to the im portant c o m p o n e n t o f a p ro fe s s io n a l p ro gramme as training for uncertainty.It im plies a willingness to take responsibility for key-decisions that may be based only on partial information and the willingness to make decisions under conditions of high risk (Reilly & Oermann 1992:7-8).
A ccording to Benner (1983), nursing practice is always more complex (than to put theory learned in the classroom into practice) and presents many more reali ties than can be captured by theory alone (Reilly & Oermann 1992:5).Nurses are confronted daily by unique and complex patient-or setting-oriented problems which require the ability to use concepts and theories in order to find solutions.Not all problems lend them selves to resolution through application of theory and a technical approach.Analytical reasoning is useful in struc tured settings but nursing practice invari ably involves highly complex interacting elements which require analytical and non-linear thinking processes.Recent studies question the merits of exclusive attention to a logical, analytical and lin ear process of reasoning in practice re lated problems (Miller & Rew 1989:84-85; R eilly & O e rm a nn 1992:221).Whereas these thinking skills relate to Aand B-quadrant processes, specific Cand D -quadrant processes, which in-  --------------------------------------► Non-verbal  The expert nurse gets a gestalt on a situ ation and has an intuitive grasp of the situation.She zeroes in on the accurate region of the problem without considera tion of unfruitful alternative diagnoses and so lu tio n s because of her b ack ground of experience.By using concrete situations as paradigms, evaluating al ternatives on the basis of comparison of salient elements, and perceiving the situ ation as a whole, the expert nurse arrives at a holistic decision.
A study conducted by Davies to deter mine whether observation of clinical role m odels could lead to knowledge and discovery, revealed the following.Stu dents reported th a t they recognised creativity and flexibility in nurse practi tioners and related these attributes to the ability to provide individualised, contextspecific care.They labelled the more experienced nurses as calm, pleasant, spontaneous, helpful, flexible, very inter ested, e xcellen t, o rg an ised , w e ll-in formed, brilliant, capable and outgoing (Davies 1993:631, 635).
The expert nurse thus appears to utilise whole brain thinking as thinking proc esses from all four quadrants are appar ent in these attributes." Intuitive grasp" and " holistic perception" refer to the Dquadrant; "calm " , "pleasant" and "spon taneous" refer tot he C-quadrant; " or ganised" and "using concrete situations as paradigms" refer to the B-quadrant; " e v a lu a tin g a lte rn a tiv e s " , " w e ll-in fo rm e d " and " excellence" refer to Aquadrant processes.
When asked to cast their role models in the care provider role the students in Davies's study recognised the following abilities and skills.The abilities of the nurse practitioners to constantly adjust and adapt to changes in the profession to modify approaches to suit the context, and to deal with conflicting needs.Prac tical competence in divergent situations -where problems were contextually spe cific and not well-defined and which re sulted in conflicting values -were also noted.Bevis andClayton (1988), Smyth (1988) and Speedy (1989) regard con text specificity as the hallmark of crea tivity and individualised nursing practice (Davies 1993:634).

summary
The Whole Brain Creativity Model pro vides a sound basis for understanding the concept "creativity" as illustrated in the works of scientific geniuses.It also offe rs hope to each in d iv id u a l w ho wishes to develop his/her own creativity.
The principles of whole brain learning and teaching provide a strong argument for the development of creativity in stu dent nurses with the ultimate aim of pro ducing an innovative and effective nurse practitioner.
) c a tio n s fo r e d u c a tio n (Q o rb a llis 1980:286; Zdenek 1985:10).

Figure
Figure 1 : The whole brain model

Figure
Figure 2 : Whole brain teaching and learning model

Figure 3 :
Figure 3 : Teaching s tra te g ie s fo r w h o le brain teach ing and learning