Background

Working as a nurse in intensive care units (ICUs) necessitates the possession of technical and non-technical skills in providing high-quality care to critically ill patients. However, current critical care curricula often do not offer training in such skills. To address this gap, drama workshops were developed in this study to improve non-technical skills in post-graduate critical care nursing education.

Aim

We aimed to understand critical care nursing students’ perceptions of the drama programme, which focused on communication, teamwork and conflict management in the ICU.

Methods

Focus groups and one individual interview with 19 participants recruited from a post-graduate (or master’s) critical care programme were conducted. Thematic qualitative analysis was used to analyse the data.

Findings

Three themes were identified: Personal and professional development, Emotional engagement and psychological safety in learning, Struggling to maintain the professional identity and role performance. The findings suggest an increased awareness of teamwork and individual responsibilities. Participants described an increased self-awareness, particularly regarding body language and emotional responses during interpersonal conflicts. They valued the opportunity for reflection and peer discussion, which deepened their understanding of team dynamics. However, performance anxiety, especially when portraying unprofessional roles, and the lack of an authentic environment were identified as barriers to engagement.

Conclusion

The findings suggest that drama-based pedagogy can serve as an effective medium for facilitating reflective engagement and the development of non-technical professional competencies, particularly in conflict management. These findings point to the value of embodied, experiential approaches in higher education curricula aimed at fostering deeper and affective learning processes and a complement to simulation-based teaching.

Implications for clinical practice

Teamwork in the ICU can benefit from drama-based learning programmes as it increases awareness regarding the significance of collaboration within the healthcare team. Moreover, it can help develop nurses’ non-technical skills, which are essential in caring for critically ill patients and initiating effective interprofessional interactions.

Background

Nursing education institutions have sought to incorporate health equity and social justice into curricula. However, nursing students report limited opportunities to engage with these perspectives during their studies. In a campus-based clinical learning environment, efforts have been made to support students in the advancement of health equity and social justice by integrating a norm-critical approach.

Aim

This study aimed to explore how nursing students made sense of norm-criticism in a campus-based clinical learning environment.DesignThe design of the study was qualitative, informed by narrative inquiry and a Goffmanian theoretical framework.

Setting

The study was carried out in a campus-based clinical learning environment for nursing education in a mid-sized university college.

Participants

The participants of the study consist of 14 undergraduate nursing students.MethodsThis study adopted a narrative methodology where the data was analyzed both structurally and thematically.

Results

This study demonstrates that students made sense of norm-criticism by framing it in three distinct phases. First, students encounter norm-criticism through norm-critical photographs, then they engage in critical reflection on norm-criticism, both in collaboration with peers and through personal reflection on their own positionality, and lastly, they find meaning in norm-criticism as a tool to change unequal nursing practices and provide person-centered nursing care.

Conclusion

This study highlights that, by mechanisms of impression management and reframing, nursing students regard and use norm-criticism as a reflective tool that empowers them to change healthcare structures and supports them in understanding how to provide person-centered care.

This discussion paper highlights the necessity of norm-critical and norm-creative approaches in nursing education to address healthcare inequalities. Traditional curricula have inadequately engaged with intersectional perspectives, marginalizing various social groups. By integrating norm-conscious pedagogy, nursing students can critically analyze power structures and develop inclusive healthcare solutions. The “Breaking Fences” project introduces innovative tools, such as the norm-lab+, to foster reflexivity and challenge discriminatory norms. Emphasizing social justice, sustainability and self-awareness, this approach equips future nurses to recognize and counter biases, ultimately promoting equitable healthcare practices. Implementing norm-conscious education is crucial for advancing inclusivity and social responsibility in nursing. 

The development of AI services, including text-to-image models like DALL-E and Midjourney, has grown in recent years, enabling the creation of images from textual descriptions. These models are used across industries, such as entertainment and advertising, but there are also risks associated with using these text-to-image generative models, including discrimination, misuse, and the spread of misinformation. Discrimination involves cultural, racial, and gender biases; misuse includes privacy violations and harmful content; and misinformation risks destabilizing society by generating misleading or harmful content. While AI is being explored in education, there is a lack of research on how text-to-image models can challenge biases in healthcare students.

This is critical since healthcare professionals' conscious or unconscious norms, values, and attitudes have been identified as partial explanations for inequality in healthcare. Text-to-image models has a great potential to increase the emphasis on norm awareness by creating images that challenge the students’ norms. Norm criticism is an approach that identify and challenge what is generally accepted as "normal" in society, enabling students to identify various norms that may cause prejudice, discrimination, and marginalization, thereby developing their norm awareness. To achieve this, it is essential to integrate diversity and inclusion principles when using AI to ensure that we don’t maintain social biases.

In this pilot study, we have chosen to limit the analysis to the representation of nurses and patients in the generated images, focusing on age, gender, and race/ethnicity. A total of 200 images were generated using Midjourney. The initial 80 images were produced using a simple prompt, “a nurse and a patient”. Additional images were created with prompts specifically designed to create images with a higher degree of inclusiveness and diversity. Prompt number two was: “A nurse and a patient, take equity, inclusion, and diversity into consideration”, number three was “A nurse and a patient, do not be stereotypical when creating the image” and the fourth prompt was “A nurse and a patient, adapt a norm critical perspective when creating the image”.

When using the first prompt the preliminary result shows a clear tendency towards most of the nurses being represented by a young white woman. In only three of the images was the nurse depicted as a person of non-white ethnicity. The patient in the images varied more regarding age, gender and skin color, but was represented mostly by white women as well. When using the second prompt the majority of the nurses as well as the patient was represented by women of different ages and of various skin color, but white persons were in minority and there were only a few men represented. The third prompt generated images of only white nurses and patients of different ages. Five of the nurses were male but all of the patients were women. The fourth prompt generated more variation regarding age and gender regarding the nurses as well as the patients. But there were only two of the images that presented a nurse that maybe was of non-white ethnicity.

In conclusion AI models are often trained on datasets that reflect existing societal biases. Norm criticism can help identify whether these images reinforce traditional stereotypes, such as depicting nurses primarily as women or portraying patients in ways that align with racial or gendered stereotypes.

BACKGROUND: Campus-based clinical learning centres are used for practice and learning in nursing students' education and can be arenas in which to enhance students' awareness and competence in social justice issues. Norm-critical approaches can be used as pedagogical tools in these centres to prepare students for hands-on caring situations in which social norms can bias the outcome.

OBJECTIVES: To describe nursing teachers' conceptions of learning norm-critical approaches and implementing them in a clinical training centre.

SETTING AND PARTICIPANTS: The study is based on interviews with 10 teachers at a Swedish university college.

METHODS: The data was analysed using a phenomenographic approach.

RESULTS: Five categories of description emerged in the analysis that described conceptions related to norm-critical approaches. These categories were: personally developing and meaningful; easily integrated with established nursing concepts; highlighting surrounding power; something to lean on when letting students take the first steps in norm-critical initiatives; and helping implementation in teaching and education.

CONCLUSIONS: Teachers who are facing the task of providing norm-critical, practical education to nursing students in campus-based clinical learning environments are ambivalent towards the core principles of norm criticism, which they conceive as natural and provoking, at the same time. We therefore need to un-dramatise norm criticism and better prepare teachers in how to use it. Teachers would benefit from follow-up activities and formal collaborations regarding norm-critical teaching, so that they are given context to discuss, reflect, and learn from each other.

Nursing education plays a pivotal role in shaping future nurse professionals who contribute to social justice and health equity. To achieve this goal, nursing teachers must employ effective learning strategies. One such strategy is norm-criticism, which promotes a critical reflection of the normative preconceptions that impact health equity. This study aimed to identify how nursing teachers approach norm-criticism during learning activities in a campus-based clinical learning environment with a norm-critical profile. Employing an ethnographic approach, we analyzed participant observational data using reflective thematic analysis. Our results revealed three overarching themes: “Teaching nursing disengaged from norm-criticism,” “Teaching norms and deflecting norm-criticism,” and “A hesitant norm-critical teaching.” This study concludes that the teachers did not have the tools or lacked knowledge in norm-critical teaching strategies, likely as consequence of inadequate faculty support and guidance. Ultimately, teachers should have access to norm-critical education and opportunities to learn how to carry out norm-critical teaching.

A key contribution of both norm-critical pedagogy and norm-critical research is to show how established norms in the form of unwritten rules and unwritten expectations can encourage people to think and behave in stereotypical ways. However, a criticism of both this pedagogy and this research is that they can be too guided by theories that provide the answer to rather than promotes an open-minded investigation into which norms that need to be problematised. This study explores how 38 university employees in an individual course assignment reflect about the ways in which they can apply a norm-critical approach in their work. The aim is to explore what type of reflections that emerge in the data and whether these reflections represent varied or similar ways of thinking about what a norm-critical approach means and can be used for.

Open Educational Resources are learning, teaching, and research materials in any format and medium that reside in the public domain or are under copyright that have been released under an open license, that permit no-cost access, re-use, re-purpose, adaptation, and redistribution by others (UNESCO). Increasing the use of OER worldwide can be one of many steps toward reaching the United Nations Agenda 2030 sustainability goals (SDG), especially SDG 4 Quality Education, which aims to ensure inclusive and equitable quality education and promote lifelong learning opportunities for all.

The UNESCO OER recommendations from 2020 provide clear goals and aims for OER, but how are they being implemented in higher education in Sweden? Specifically, how well are teachers and students aware of and how are they using OER, specifically open textbooks? This paper presents the use and needs of OER as well as current OER guidelines at University West in Sweden and investigates teachers’ and students' perceptions and experiences of open educational resources (OER) at University West, focusing on open textbooks. The method of the intervention was student and teacher surveys, both pre- and post-pandemic. The pre-pandemic surveys were sent out in April 2020 and had 79 student respondents and 82 teacher respondents. The post-pandemic surveys were sent out in June 2022 and had 83 student respondents and 76 teacher respondents.

The aggregated results show that there were no significant differences in the use of OER and open textbooks due to the pandemic both for students and teachers. The current use of OER and open textbooks was limited and the primary motivations for using OER and open textbooks were economy, social justice, and adaptability with varying priorities among students and teachers. Additionally, OER and open textbooks are currently used marginally at University West but there is interest to increase the use of OER and student co-creation due to the three primary motivators. These preliminary results provide valuable insights regarding the key factors for increasing the use of OER and open textbooks in higher education to help achieve the UNESCO OER 2020 goals and the United Nations Agenda 2030 SDG goals, especially SDG 4 Quality Education.

Nursing education is in the process of incorporating critical thinking, social justice, and health inequality perspectives into educational structures, aspiring to help nursing students develop into professional nurses prepared to provide equal care. Norm criticism is a pedagogical philosophy that promotes social justice. This qualitative case study aimed to gain an understanding of and elaborate on an educational development initiative in which norm criticism was incorporated into the composition of a new campus‐based clinical learning environment for nursing education. By analyzing documents and interviews with the help of reflexive thematic analysis three themes were generated: “Intention to educate beyondnursing education,” “Educating in alliance with society,” and “The educative ambiguity of the Clinical Learning Centre. ”The case study indicates that the incorporation of norm criticism into a campus‐based clinical learning environment may encourage nursing students to evolve social skills for nursing practice that support health equality within healthcare. By collaborating with society, nursing education can considerably improve its educational frameworks in alignment with societal demands. However, the inclusion of norm criticism in a setting such as a campus‐based clinical learning environment entails a clash with established institutionalized norms and being perceived as too proximate to politics.

From a salutogenic perspective, relational and reflective competencies are key to the success of competence building. Reflecting on and exploring one’s (life) experience in a continuous learning process can enhance salutogenic competence.

This chapter, whose authors have many years of experience building health professionals’ salutogenic competence, is nicely illustrated with teaching and coaching examples drawn from (a) a master’s programme for students in various health professions, (b) salutogenic talk-therapy groups, (c) students in health promotion training programmes, and (d) on-the-job training of healthcare professionals working in childcare services.

The chapter discusses the concept of “self-tuning,” referring to habitual self-sensitivity, reflection, and mobilising of resources, which can play a central role in all types of training. This chapter emphasises that trainers should strive to “live the talk,” developing their personal salutogenic capacity – in other words, do what you teach and be what you teach.