1 Constructing Nursing Knowledge Via Playback Theatre in Professional Training of Community Nurses: A Study of the Effect on Learning and Behavior Patterns By Carmela Lipsker This material is made publicly available by the Centre for Playback Theatre and remains the intellectual property of its author.
2 1 Constructing Nursing Knowledge Via Playback Theatre in Professional Training of Community Nurses A Study of the Effect on Learning and Behavior Patterns Carmela Lipsker A THESIS SUBMITTED FOR THE DEGREE DOCTOR OF PHILOSOPHY University of Haifa Faculty of Education Department of Education November, 2005
3 2 Constructing Nursing Knowledge Via Playback Theatre in Professional Training of Community Nurses A Study of the Effects on Learning and Behavior Patterns By: Carmela Lipsker Supervised by: Dr. Shifra Schonmann A THESIS SUBMITTED FOR THE DEGREE DOCTOR OF PHILOSOPHY University of Haifa Faculty of Education Department of Education
4 3 November, 2005 Constructing Nursing Knowledge Via playback theatre in the professional training of community nurses A study of the effects on learning and behavior patterns By Carmela Lipsker Abstract This study offers a controlled approach to the construction of professional knowledge within the framework of a nurse-training workshop, using a theatrical-dramatic instrument called Playback Theatre (Fox & Dauber, 1999). It aims to observe the effects of experiential learning using Playback Theatre on the professional behavior of community nurses and on the process of acquiring professional knowledge, both during and following the training course. The construction of nursing knowledge, which here takes place through the playback theatre method, adheres to events garnered from the nurses' practical experiences. The method is based on processes that link the clinical experience with the theoretical knowledge, while developing insights about the professional behaviors that are "acted out."
5 4 Playback Theatre is a means for processing social and personal issues in an experiential and creative manner. It is an educational instrument used in community frameworks as well as among teachers and social workers in centers worldwide (Salas, 1999). The method clears the way for acquiring new knowledge; moreover, it gives rise to a change one's approach towards real events through the process of their dramatization (Fox & Dauber, 1999). The underlying assumption of this study claims that there is an advantage to be gained by integrating thought, emotion, and behavior in the learning process. This is particularly important for the population of adult students, who bring to the process their personal and unique practical experiences and values, which they observe, review, and test in light of the learning experience. When teaching an adult population, the training agents (counselors, teachers, and training organizers) must offer an approach that is optimally suited for on-the-job type training, an approach that will take into consideration the adult student's personal interests, attitudes, and need for control and involvement, both in decision-making and in learning-related processes (Schonmann, 1995; Mezirow, 1991). Therefore, it is necessary to develop a framework that enables the students to express their experiences and attitudes actively, and which incorporates these as a significant component of the learning process. Based on their own conscious and practical experience, adult students must be convinced of the efficacy of this alternative as a means for shifting attitudes and paradigms, and for introducing practical changes (Schon, 1987; Mezirow, 1991). The need for a knowledge construction method that would be new and scientifically controllable/measurable stemmed from the practice of training the nursing staff while on the job, that is, providing what is termed Professional Continuing Education (Waddell, 1996).
6 5 The fundamental importance of this study is that it provides an opportunity to observe a new educational tool for continuing education in nursing, and to learn during the process about how it is constructed. On a pragmatic level, this study is significant in that it offers a way to use playback as an organically integrated method that implements a theatrical-dramatic concept into the curricula of professional education. The dynamic process that unfolded on the stage of the playback theatre during the professional training course gave way to a human laboratory, in which the experiential processing of information and knowledge (i.e., the contents of the course) fused with the nurses' personal and professional know-how. Enabling the knowledge components of nursing to coalesce by employing a scheme of theatrical-dramatic activity created a synthesis of new professional insights. A major aspect of this study was to link the nurses' theoretical knowledge with their professional experience. The convergence point took place in the realm of experiential learning through play, which establishes systems for conscious experiential reflection using dramatic-theatrical instruments (Wildman & Reeves, 1997; Ulion, 1983). At the heart of the dramatic-theatrical endeavor incorporated in the framework of a playback theatre workshop is a narrative. The workshop draws on these personal narratives, which in turn become powerful motivators for reflecting upon the professional self and the reciprocal relations within the group. While acting and playing, members of the group present the narrator's personal experience, as they attempt to provide an accurate reflection of the narrator's experience of the event and convey its significance precisely as the narrator intended. This technique affords a piercing insight into the individual's perception of the events and his or her reactions
7 6 to them, which in turn enables both the narrator and the other participants to acknowledge and respect one's own or another's reality. The study group included 21 nurses working in professional clinics in three areas related to sensory systems: ear, nose and throat; dermatology, and ophthalmology. The playback workshop was integrated into the curriculum once every four weeks (the entire course consisted of one day a week of intensive studies over a period of one year), at the intersection between two subject matters, which could be formulated and conceptualized using the theatrical experience. Our report on the process of experiential, cognitive, and behavioral learning using the playback method emphasizes the dynamics that formed among the class members. We paid special attention to the nurses' attitudes regarding basic professional principles and their role perception in terms of therapeutic service, teamwork, and professional level. During the course, the group processes that evolved during the playback theatre sessions were documented through observations, video recordings, and semistructured questionnaires. In addition, nurses were interviewed before and after the workshop, to observe how they perceived the change in their professional attitudes and behaviors after the learning experience. All of the materials analyzed in the study were converted into texts, which constituted the core of the research process. Of the many conceptual approaches to qualitative analysis, we chose three traditional philosophies, to provide a theoretical basis that would guide the textual analysis in this study: phenomenology, hermeneutics, and aesthetics. The need for a combined philosophical approach stems from the uniqueness of this educational tool, which
8 7 utilizes a dramatic-theatrical artistic tool as a covert system for increasing selfawareness and delving into deeper levels of self-knowledge. Phenomenology offers an observational approach that emphasizes experience, experience-based memory, and self-reflection, especially about the conscious representation of the outside world through thought and reflection (Husserl, 1972). In the hermeneutical approach, the process of interpreting a text is intended to shed light on hidden meanings and to lead us to understand something in the author's world that is beyond words. The act of reading a text is a type of interaction intended to reveal new meanings, which are the product of the meeting between text and reader. The written text enables the realization of pure hermeneutical interpretation. In other words, a hermeneutical interpretation of phenomena approximates perfection as it distances itself, in terms of time and connection, from the event itself (Svenaeus, 2001, pp. 142). The aesthetic approach to the study of phenomena, which adds yet another component into the analysis, describes experience from a perspective absent from all other systematic approaches (Adorno, 1992; Breadsley & Schueller, 1967), i.e., the sensual component. This element considers the fit between the parts and the whole a qualitative attribute embodied in the aesthetic experience, and this quality has the ability to arouse in the observer a sense of awe not unlike that experienced when facing an impressive work of art. The actors, the narrator, and the audience created and simultaneously experienced an aesthetic event. The aesthetic characteristics of the acting experience are embodied in the change that takes place when shifting one's subjective consciousness to focus on the object (the story or the play), with a sense of amazement, awe, fascination and
9 8 self-immersion in the sounds and sights. The actor's chance to comprehend a dimension of an experience in which he or she was not involved in personally is an added advantage in terms of his or her interpretive attitude, which is freed from the emotional burden that the narrator brings to it (Schonmann, 2001; Tzur, 1971; Haezrachi, 1965). The personal experience, designed and formulated into a story, is emowered through the actors' body language, movements, mimicry, voices, and sounds. Amplifying the narrator's experience reflects it very powerfully, which in turn redefines the meanings and the significance of the experience (Zankay, 1999). The "space" in the theatrical sense, the stage and the surroundings, become reflections of the personal inner space of each student/participant. On one hand, the students contributed their experiences to be shared within the public space of the stage that encompasses their stories and their acting, while on the other hand, the scenarios that unfolded in the common space of the classroom molded the inner space of each and every participant. Playback theatre goes directly to the heart of the adult's mechanism for development, that is, overcoming distorted and subjective concepts through reflection that gives new meanings to life's experiences (Schon, 1987; Mezirow, 1991). Despite the emotional and conceptual exposure of the individual in front of the group, the rules of the game ensured that each step in the development was sufficiently controlled to maintain the individual's human dignity, and his or her right to privacy and confidentiality (Fox, 1999b). The nurses' went through a course of personal development through playback theatre, in which they experienced a mixture of expressions of cognition, emotion, and
10 9 movement, a balance that became tangible in the process of acting. This paved the way for a process of observation of their own narrated and acted experiences, seen now from an aesthetic distance and in a different light, which shed a new meaning on the same experiences. The method can be described as the realization of a latent value, made manifest through the process introduced and formulated in the workshop. The processes that took place in this course changed the nurses' self-image, their confidence in their skills, and their commitment to maintaining professional standards when confronted with challenges, resulting in personal and professional empowerment. In their opinion, acting helped the learning process, as it facilitated inward observation, the expression of emotions, a glance into the other's inner world, a return to suppressed creativity and spontaneity, the development of conscious reflection, and the interpretation of therapeutic interactions. The participant's impression of personal gain was described as a sense of legitimization, "I can and I'm allowed" (quoted in paragraph ); the ability to assertively carry out changes that follow professional principles; and the acquisition of strength that comes from listening to your inner voice. The use of dramatic-theatrical principals for professional education was a catalyst for the development of three distinct aspects in the acquisition of nursing knowledge: One aspect relates to the study habits acquired through tasks such as group work, homework, and the preparation of projects presented orally and in written form. The second aspect developed was the achievement of coherent expression related to thoughts, emotions, and actions, as practiced through the personal stories that emerged in the workshop, and which required a high level of knowledge and self-awareness.
11 10 The third aspect is the attainment of inter-personal communication skills, which were exercised in the reciprocal relationships established among the students and between the students and the human element in their work environment. In these three dimensions we noted an increase in the depth and level of complexity of the professional discussions, and an improvement in the ability to process phenomena from their professional lives, using the tools acquired during the community nurses' training course. Based on the textual analysis of all the research materials, progress was noted in the students' knowledge and understanding of various areas, expressed as: Increased professionalization (from the point of view of nursing) of the stories narrated; Confident display and conceptualization of personal knowledge; Professional critiques of work teams observed in the OR; Clearly formulated questions that were required as part of the students' weekly assignment, and later were integrated into the final exam; Stages of increased control and precision in verbal formulations, in the use of professional terminology, and in the ability to present medical diagnoses; Ability to reinterpret past events; Facility in defining their beliefs and vision regarding nursing in a professional clinic; Conceptualization of their process of personal change and development over time.
12 11 There is a dependent relationship between the dramatic-theatrical concepts and those used to organize and clarify the proceedings of the educational endeavor being studied. Operating a playback theatre workshop imposed theatrical dimensions and concepts on the context of training processes, such as "space and stage," "actors and audience," and "spontaneous improvisation." The combination of the creative-theatrical dimension with structured educational elements enabled, through a reconstructed and intensified process, the development of professional awareness in an organizational environment. In other words, whatever took place in the "creative space" affected the direction of developments in the "procedural space," and the fusion of the two created a new formula for focusing on nursing values and regulating its functions. Playback theatre is a dynamic dramatic-theatrical method, which previously had not been integrated into the curricular structure of professional training of nurses, although it has been the subject of increasing interest in organizational institutions since the 1990s, as a framework for handling professional processes. The innovation and main contribution of the current study is in the forging of a connection between theatre and the construction of professional knowledge, a combination unprecedented in nursing. The desire to make a significant contribution towards the professional development of workers and the formulation of their professional understanding led to the choice of the unique playback theatre method, its synthesis with the professional training of community nurses, and the creation of a first experimental study of the effects of the method of playback theatre on the nurses' learning experience. The
13 12 nurses' empowerment, achieved by allowing them to demonstrate their professional abilities on stage, serves as a boost in their professional development, and may open new paths for professional education in the field of nursing.
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