Dr Richard Talbot and Dr Debbie Roberts investigate approaches to teaching and learning students to act like a nurse, informed by a Performance Studies perspective. The presentation discusses paradigms for nursing performance in simulated environments, and features video footage of work with Level 4 HND & BA Physical Theatre students and colleagues (Lisa Moore) in the School of Media, Music & Performance at the University of Salford as well as colleagues in The School of Nursing & Midwifery (including Leah Greene).
10. Studentmanship: “playing for an audience by processes of divining appropriateness, of choosing alternative modes of projecting and finally exerting the self” (Olesen and Whittaker 1968. p183) Each successive performance involves fewer painful deliberations, and embarrassing blunderings.
12. Initially the student is said to be like an actor when “[a] lack of conviction and quality of inauthenticity felt about his (sic.) performance, will somehow communicate itself to the audience and ‘give the show away’. “In other words, will the audience dismiss his performance as ‘mere front’ or ‘show’ and accordingly view him as inept and untrustworthy?” (Davis 1975. p126).
14. “what is difficult becomes habitual, the habitual easy, and the easy beautiful… habit can unburden attention, freeing the performer.” (Stanislavski in Whyman 2007. p117)
18. Conclusions. A simulated and relatively safe rehearsal environment, which is nevertheless open to the unknown, the unexpected, and the excessive, through an agreed approach to improvisation with these social scripts and nursing rituals may produce opportunities for “relaxation” and “flow” by actors/nurses.
19.
Editor's Notes
The Performance Directorate is in a building with large stark rooms with high ceilings and whitewash walls. The ward where I did my first placement was very much like that with large floor to ceiling windows and the beds underneath so it was really stark. I went to observe some work and all of these students were in their pyjamas and it really felt like a hospital ward. A lot of them are getting out of breath looking very tired They were expected to going keep going and I found it very difficult to watch that. Some of them were shaking a little bit because of the exertion and it made me think about controlling your body and how difficult that is. I wanted my nursing students to consider what it would be like what it would be like to not have that control because of course nurses are in control so there were two sides to it I wanted to the students to feel what your students felt and I wanted to consider that relationship between somebody else ‘s body and having control of your own.
Situated or context specific learning is influenced by a student’s prior experience of education and their expectations and assumptions of Higher Education. (Prosser and Trigwell 1999; Ramsden 1997).Both new actors and beginning student nurses tend to imitate, drawing on widely available influences from theatre and film productions.The inclination of a new actor may be to signal or indicate their intentions and to exaggerate the effort involved in practising expressive skills, to work at being an actor. At the same time, the cultural legacy of realism in theatre and film encourages an effort at nonchalance and normality, so the actor, like the nurse is caught in a demonstration of professionalism that a) must disguise their apprenticeship and b) is confronted with the context or medium of performance, over which the student has little or no control, and can experience a crisis of volition
It seems that learning the act like a nurse may be important in the development of competence together with understanding and learning generally (Grindle and Dallat 2001). Olesen and Whittaker (1968) refer to a concept which they term ‘studentmanship’ said to intricately involve expectations and definitions, with a front encouraged by skilled execution of a clinical practise. Similarly, Davis (1975) asserts that during role simulation students will fashion performances before instructors, patients, staff nurses and peers which are in accord with the doctrinal practices of the school of nursing. Through repeated performance Davis suggests that the initial incongruity which the students feel (guilt, hypocrisy and role illegitimacy) diminishes.
Stanislavski, one of the first practitioners in the West to devise a systematic and practical process for educating professional actors for the theatre, it is necessary for actors to move through ten stages of learning to act. For example, he posits that the actor must first learn to relax the muscles and eliminate physical tension at the same time as maintaining concentration, and thus learns to invest in a characterisation by thinking as the character. The same could be said of learning to be a nurse, as the students need to relax in their encounters with patients, mastering technical psychomotor skills and learning to think like nurses. Similarly, the Stanislavski method suggests that the actor must develop a sense of truth in the performance, one which is organic rather than artificial. The actor begins to develop the ability to interact with other performers (colleagues, disciplines) and with an audience (the patient/s) without violating the world of the play (clinical practice). The role of the nurse is one that can be learned and if the performance is truthful, and “engages the audience at a level far below the surface” then the “actor will become completely engaged in the performance, in a state of flow where everything proceeds to just work, quite naturally, without apparent effort” (Stanislavski). It appears that there are similarities between Benner’s (1984) notions of nursing expertise and this classical paradigm for learning to act.
Evans (2009) suggests the terms "docile body" and "unruly body" may be used to make a distinction between the body which has been disciplined and trained to be efficient in various rehearsal processes and the "unruly body" which he applies to actor training which allows the artist to unleash excessive, unrestrained and idiosyncratic modes or forms of expression and gestures. A similar tension may appear in nurse education in the balance between technical aptitude and the instinct or intuition required to care for another. It is this tension that educators may be able to address through an interdisciplinary immersive or simulated situation in which both actors and nurses make an account of the technical skills they are drawing on from respective disciplines.
Ramsey (2005) outlines what is termed the “performance of professional practice”, arguing that it is possible for professional practice to be developed through social performance. A model is presented which enables the student to progress from narrative through to action. The model is suggested to overcome some of the shortcomings of experiential modes of learning through three essential shifts:“a shift from concrete experience to multiple stories; a shift from individual action to social performance; and a shift from an emphasis on cognitive learning to development of practice” (p279). This is similar to the view presented by Ekebergh et al (2004) whereby drama is not so much about public performance but is more about mutual interaction where students can explore caring issues and personal action.
Through our discussions we have discovered that there are some similarities between learning to act and learning to become a nurse. In particular, it would seem that the notion of role modeling and imitation in nurse education requires further investigation as it may not be the second rate learning mechanism previously reported. Indeed it may be an essential mechanism that student nurses use in order to overcome both the unruly and docile body, and develop intuitive fluid performance.
