E-Journal of Philosophy of Education:
International Yearbook of the Philosophy of Education Society of Japan, Vol. 2, 2017

Structure of Mutual Learning Between a Teacher and aStudent in a Nursing Practicum

Yukiko MAEKAWA
Konan Women’s University
Abstract
This paper aims to identify how mutual learning is structured by approaching the realities of theexperiences of students and teachers in a nursing practicum. This was done by requiring students andteachers to rethink how they experience the world being humans. Nursing depends on the relationshipbetween the patient and the nurse; various views and perceptions stemming from that relationship are
not caused by only one of them, but manifest themselves in both nurses as well as patients. Similarly,
education is created not in the dualism of teacher and student, but somewhere in between. Accordingly,
an attempt was made to rethink the mutual relationship between the student and the teacher without
separating the two, as a means of examining the state of learning for students and teachers in a nursing
practicum. In doing so, the following points were clarified. 1) Although students meeting patients
understood the necessity of interacting with the patients in the “here and now,” they were aware that
this does not lead to tangible nursing. 2) When teachers understood that students cannot practicenursing in response to patients, the teachers themselves practiced nursing on patients using thepractical sense and nursing skillsets they had developed. 3) Even as they are engaged in nursing,teachers urge students toward the world of nursing by demonstrating what nursing is and guiding
students with verbal instructions. 4) Students are attracted to nursing by the presence of their teachers.
Nursing tailored to patients and education tailored to students are created as teachers open up to others(patients and students) and guide them. Based on the above, it was shown that a passivity wherein an
acceptance of circumstances that did not lead to the tangible nursing of students is necessary to develop
an educational approach by teachers in a nursing practicum. In addition, patients themselves, as
recipients of nursing, strongly attracted students and teachers—the providers of nursing—to nursing
and enticed them to the practice of nursing. Education that appears to be an active act becomes an act
whereby teachers teach through the passive activity of sensing students. Accordingly, it was shownthat having students and teachers learn in a nursing practicum presupposes a mutual relationshipStructure of Mutual Learning Between a Teacher and a Student in a Nursing Practicum

41

without a clear separation between the two sides; the relationship is rather renewed when both work
together as a single system.
Keywords
mutual learning, experience, nursing practicum, learning structure

1. A Display of Practical Learning
A nursing practicum is an endeavor comprising an assumed relationship between apatient and a nurse in which the nurse physically feels the pain and suffering of the patientand adapts accordingly. The way in which this occurs is defined by the circumstances ofthe patient. Thus, nurses cannot work with patients in a unidirectional or manipulative
fashion because the relationship between the two is entwined within nursing practiceeven as it occurs. Students learn about this type of practice through training. Nursing
training in which nursing students learn through practice is often referred to as the coreof nursing education owing to its role and the number of practicum credits in a nursing
curriculum. A review of related prior research reveals topics such as aspects that are
taught to students, aspects related to the patient, student relationships, teaching activities
for teachers training nurses, and capabilities required in teachers. The characteristics oflearning and education in a nursing practicum are identified by means of an analyticalview of students and teachers. However, learning and education are not treated as
different aspects, but rather as efforts that are simultaneously created on the spot.
Students begin to explore the meaning of living, falling sick, and growing old as
they are placed in actual nursing scenarios and encounter patients; in other words, they
explore about sick patients and their lives. In addition, by involving with these people,
they can feel the joys and difficulties of nursing, become aware of their own
preconceptions by understanding others, and discover opportunities for introspection. In
such times, how do we as teachers view these students?
Nursing occurs between a patient and a nurse. Approaching the facts of nursing
requires a new awareness regarding a living world that is experienced by nurses asindividuals or, put differently, in interactions directly in front of us and hidden to science.
When closely examining this phenomenon, we cannot separate actions and responses ofnurses and patients; nursing practice relies on the patient–nurse relationship, and theawareness and views created in that relationship are not caused by one of them but by

E-Journal of Philosophy of Education: International Yearbook of the Philosophy of Education Society of Japan, Vol. 2, 2017

42

Y. MAEKAWA

both of them 1 . Similarly, educational practicum does not exist within a dualism ofteachers and students, but rather arises somewhere between the two. Based on this, one
way of approaching a nursing practicum is to attempt to rethink mutual relationships
without separating teachers and students.
2. Encounters with Sick PatientsJun (names have been changed) is a second-year nursing student who has accepted
responsibility for S, a 70-year-old male patient who is forced to rest in bed due to anillness. On the second day of training, Jun, who was assisted by Professor Minami,
decided to give S a sponge bath while he was in bed. When Jun unbuttoned the patient’s
pajamas, she was paralyzed by the sight of his body, which had several tubes inserted
because of his ongoing medical treatment. Noticing this, Professor Minami quickly
responded to S by talking to him as Jun wiped his chest with a warm towel. Professor
Minami lightly held his rib cage down with an open fist so the towel could make contact
with his chest; then, S breathed deeply.
After wiping S a couple of times, Professor Minami asked Jun if she would wring
out the towel. Jun then came to her senses, looked at Professor Minami, and then faced
S. Jun said to Professor Minami, “I will clean the arms next,” and appeared to follow
nursing explanations as her cue. As the assistance with washing the patient’s bodyprogressed, he gradually began to relax his body and the soft sound of him sleeping could
be heard through the oxygen mask, despite his complaints that he was unable to sleep atnight.
Reflecting on the event, Jun said that she knew that S “had tubes inserted into hisbody for treatment.” However, she could not hide her shock of seeing the raw scars fromsurgery and the “unexpected wasting away of S.” Jun felt the reality of S’s body but could
not simply provide the hygienic assistance of cleaning his body the way it had beenplanned. At that moment, she did not know what to do, and could not move. For Jun, thiswas the beginning of her search for a nursing practicum; it was in response to helping an
individual that was new and different from S.
In this setting, Professor Minami used discretion to determine the direction of future
1“Descriptions, patient stories, and outward-facing expressions are all distorted in phenomenological posturing,upon which a phenomenological view, observations, and awareness are created. This awareness does not comefrom patients, nor does it come from us. Rather, it is positioned somewhere in between.” Bin Kimura (1985).
“Seishin Igaku ni okeru Genshougaku no Imi” [The Meaning of Phenomenology in Psychiatric Medicine]. ed.
Nihon Genshougakkai, Genshougaku Nenpou 2.

Thematic Research: Educational Practices, from Which Philosophy Emerges: Frontiers of Philosophy of Education

Structure of Mutual Learning Between a Teacher and a Student in a Nursing Practicum

43

nursing by understanding Jun’s situation as she interacted with S; this was based on Jun’s“tendency to diligently interact with patients” and how she had handled herself in school
up to that point. For Jun, who was unable to predict nursing methods, a setting for anursing practicum where teachers themselves explain and demonstrate nursing by
explaining future nursing steps was developed.
3. Engendering Interest in Nursing
When one gets an illness, one experiences various symptoms including pain. This
experience is inseparably linked to various characteristics that make up our lives2. Thus,
while nursing, a nurse cannot forget about his/her values or emotions at a moment. The
actions of a person in everyday life, which in our example is about good hygiene, arehindered by illness and therefore, one may not be able to perform his or her duties. Nurses,
therefore, must engage with patients using greater cleanliness compared with thecleanliness already present around the patient in a way that allows the patient toexperience comfort and relief. This “process of interaction” leads to easing and calminga person in their pain and suffering and, further, to a heightened ability for natural healing.
As it is specific and individual patients and nurses mutually interact with each other, thiscannot be explained by the causality theory of natural sciences. Therefore, nursing
requires natural actions reasonable to the patient. Along with resulting actions andprocedures, a nursing practicum has a flow and rhythm that matches the individual.
Students who are beginners in nursing may remember what must be done next, but may
not have the means of creating a flow and rhythm in their nursing practicum that meetsthe circumstances of their patients is an unknown world. Jun was bewildered during thefirst step.
Professor Minami continued with the nursing workflow for S, which appeared tocome to a halt. Moreover, as per the practical nursing sense developed as a nurse and anextensive educational skillset, Professor Minami was able to bring Jun into the real worldof nursing by demonstrating her own nursing skills and providing direction verbally.
Moreover, Professor Minami engendered an interest in nursing within the student by
noting the difference in the patient’s condition compared with his condition on theprevious day and asking if that bothered Jun instead of asking a more relevant question.

2

Kleinman, Arthur (1988). The Illness Narratives: Suffering, Healing, and the Human Condition，Basic Books.
Translated into Japanese by S. Eguchi, S. Gokita, G. Ueno (1996) Yamai no Katari: Mansei no Yamai o Meguru
Rinshō Shinrigaku. Seishin Shobo.

E-Journal of Philosophy of Education: International Yearbook of the Philosophy of Education Society of Japan, Vol. 2, 2017

44

Y. MAEKAWA

At that time, Professor Minami did not require adherence to matters within herframework; rather, the student and the patient attempted to understand their current
experiences. The feelings that informed Professor Minami’s foundation were personal,
even though those feelings were open to patients (and students), and guided them.
Regardless of one’s role as a nurse, those feelings did not allow one to overlook
circumstances and be disinterested, but rather brought about a desire to take action whenconfronting someone in pain. One actively engages in the practice of nursing by offering
one’s will to others and passively accepting their existence.
How are nurses from the perspective of patients? Arthur W. Frank3, in a writing of
his experience with illness, stated that due to a desire to share their new phase of life (ofillness) with nurses, patients manifest their illness and entrust it to them. Thus, this mutualstate does not become polarized with the sick and their pain at one end and healing nurses
at the other. The experience pain and suffering does not arise only within the patient;nurses, through their nursing, can also share that experience. The experience of accepting
suffering is brought about by encounters with patients, and is both spontaneous andunpredictable. Accordingly, the answer to the question of whether one’s nursing wasappropriate can only be given after introspection.
A nursing practicum cannot be performed entirely according to a plan and problems
cannot be solved beside a patient through the strict application of scientific theory andtechnology. Nursing is not dominated by a pre-existing awareness, but is an ethicalpractice created out of an orientation toward what the individual perceives as good at agiven time, and insight into the methods used in practice. This is the same for students
who learn nursing at their workplace. As teachers sometimes make students anxious andshed tears in their encounters with patients, they support their students in pondering what
nursing means to them personally, which makes the ethical practice a work of education.
Ethical practice in this type of education then comes back to nursing as practical work bystudents for the benefit of thoughtful patients.
4. Uniqueness of Experiences
Experiencing others’ illnesses is something that goes beyond one’s own experiences,and can be difficult to comprehend. Approaching the incomprehensible state of sufferingwith those that suffer and attempting to heal them can only be done if one puts one’s
3Frank, Arthur W. (1995). The Wounded Storyteller: Body, Illness, and Ethics, The University of Chicago Press.
Translated into Japanese by T. Suzuki (2002) Kizutsuita Monogatari no Katarite: Shintai Yamai Rinri. Yumiru
Shuppan.

Thematic Research: Educational Practices, from Which Philosophy Emerges: Frontiers of Philosophy of Education

Structure of Mutual Learning Between a Teacher and a Student in a Nursing Practicum

45

nursing skills to work in response. The means of doing this is a process that creates thenext action4, by reflecting on how we are viewed by others. In other words, quickly
responding to the circumstances of patients is thought to be nursing practice that puts
one’s skills to work, but when that inclines to the mere application of techniques within
one’s skill-set, a nurse focuses on the patient by his or her side to maintain a practicum
that does not become stagnant.
Practical knowledge employing various nursing methods appropriate to the patientis needed. Thus, nursing practice is not the routine mastery or application of technicalprinciples according to any theory in a book, but rather the ability to perform thoseprinciples with an orientation toward mutual understanding in the present.
This can be seen in educational practice as well. Students and teachers are unique.
An educational practicum that is brought about through interactions with others that areinvolved with the students and teachers can be made up of various patterns. The matterof whether my educational practicum is good should not be determined by my standards,
but by those of the student. I believe that the meaning of my interactions in the context ofa student’s life can only be reflected upon through dialog.
Nursing practice and educational practice by nature have an element of uniquenessacross the ebb and flow of experiences. However, these experiences permeate our mutualfeelings. While I know that my feelings cannot be transferred to a student (or others) asis, we have retrospectives based on reflective dialogs. By enriching our practice skillset,
we can begin to interact with others (students) in a way that is best for them.
5. Education Premised on Co-Existence
It can be seen through the nursing practicum of Jun and Professor Minami on S thatan educational practicum is created by mutually and simultaneously sharing the same
event. When Jun cleaned the patient’s body with Professor Minami, her mind went blankand she was unable to move because of her confusion over the treatment S was receiving
and the tubes in his body. Realizing this, Professor Minami continued with her nursing
work by explaining to Jun how to nurse and encouraging her to practice. At a first glance,
this scene may appear to be unidirectional: a teacher giving instruction and a student
following. However, is that really the case?
Certainly, teachers teach students; however, that interaction alone is a one4

Ikegawa, K. (1991). Kango: Ikirareru Sekai no Jissenchi [Nursing: Practical Knowledge of a Living World].
Yumiru Shuppan, p.103.

E-Journal of Philosophy of Education: International Yearbook of the Philosophy of Education Society of Japan, Vol. 2, 2017

46

Y. MAEKAWA

dimensional view because the actions of students that bring about an educational
approach used by teachers cannot be seen, and a passivity that received such action is thepremise of the approach. Moreover, further thought shows that patients, who receive
nursing, are themselves strongly attracted to students and teachers or to those that provide
nursing, and entice them toward nursing practice. Learning through practice cannot beviewed only as the category of science known as reductionism, upon which modern
science is built. It means living, acting, and discovering knowledge, at times throughchance and circumstance.
Education that appears to be active becomes the act of teaching by teachers, whether
or not the education is intentional, because the teachers feel what their students arethinking. Accordingly, learning by both students and teachers in a nursing setting requires
a mutual relationship; it does not occur individually and cannot be made individualspecific. While dualistic, it is continually renewed, with “me” and “you” working
together as a single system5.

5Maurice Merleau-Ponty (1961). L’Œil et l’esprit. Translated into Japanese by S. Takiura and G. Kida (1966) Meto Seishin. Misuzu Shobo. pp. 135-136

Thematic Research: Educational Practices, from Which Philosophy Emerges: Frontiers of Philosophy of Education