Nursing Inquiry

2002

9

(3) 170ndash178

S p e c i a l a r t i c l e

copy 2002 Blackwell Science Ltd

Blackwell Science Ltd

Transformative unlearning safety discernment and communities of learning

Geraldine Macdonald

Faculty of Nursing University of Toronto Toronto Ontario Canada

Accepted for publication 1 March 2002

MACDONALD G

Nursing Inquiry

2002

9

170ndash178

Transformative unlearning safety discernment and communities of learning

This paper aims to stimulate awareness about the intellectual and emotional work of lsquounlearningrsquo in knowledge workersin the emerging learning age The importance of providing a safe space for dialogue to promote transformative learningthrough building lsquocommunities of learningrsquo is highlighted Unlearning is conceptualized within a transformative educationparadigm one whose primary orientation is discernment a personal growth process involving the activities of receptivityrecognition and grieving The author utilizes the metaphor of an unfolding spiral path to explore her experience ofneeding to lsquounlearnrsquo a trusted nursing practice prior to lsquolearningrsquo new best caring practices related to infant sleep positionsMacro and micro approaches to facilitating unlearning in organizations in learners and in nurses are suggested

Key words

creativity infant practice safety transformation unlearning

Healthcare professionals in the twenty-first century practisewithin the context of an emerging learning age (Jarvis2001) Nurses like other knowledge workers in thisinformation-rich age face the challenge of learning to selectand manage increasing volumes of readily accessibleinformation (Pepitone 2000 McNair 2001) The currentresponse is organized around promoting an evidence-based orientation to nursing practice Practising nurses parti-cipating in professional practice development activitiesare guided to develop evidence-based practices and toutilize best practice guidelines to direct ongoing changein their nursing practice The importance of developingan evidence-based practice is stressed with undergraduatenursing students while graduate nursing students developexpertise in critical appraisal of research evidence andconduct research studies Nursing researchers develop thenursing knowledge and nursing administrators are com-mitted to promoting workplace cultures that support inno-vative evidence-based practice

The commitment to an evidence-based practice hasnot eliminated either controversy about the nature of reasonand truth (Roger et al 2002) nor the value of sound nurs-ing judgment (Kearsey 2001 11) When new best practiceguidelines are introduced they remain guidelines Nursesretain the professional responsibility for making soundjudgments about quality nursing care (Kearsey 2001 11)However excellent the evidence it can never replace theneed to have thinking practitioners who are prepared tostruggle to synthesize research knowledge with their prac-tice knowledge and whose caring practices reflect soundjudgment based on their nursing assessment of particularclients living andor being cared for in specific contexts

Thinking nurses are knowledge workers and in thelearning age knowledge workers are both responsible for theirown decisions and add value to organizations (Pepitone2000) The author suggests that thinking nurses providedwith new evidence or practice guidelines that argue forchanging caring practices engage in a process of lsquounlearn-ingrsquo before they can effectively open to lsquolearningrsquo newcaring practices The process of unlearning begins withappreciating accumulated knowing reflecting positivelyon its contribution and our indebtedness to those who

Correspondence Geraldine Macdonald Faculty of Nursing University of Toronto50 St George Street RM 116A Toronto Ontario M5S 3H4 Canada E-mail ltgmacdonaldutorontocagt

NIN_150fm Page 170 Thursday August 22 2002 753 PM

Transformative unlearning

copy 2002 Blackwell Science Ltd

Nursing Inquiry

9

(3) 170ndash178

171

createdpassed on that knowing and opening to the threatof undoing our psyche and our identity (Buchen 1998)

This paper aims to stimulate awareness about the intel-lectual and emotional work of unlearning in knowledgeworkers to identify the positive relationship betweeneffective unlearning and effective learning of new evidence-based nursing practices and to highlight the need tocreate safe nursing workplace environments that supportunlearning The intellectual and emotional work of un-learning is conceptualized within a transformativeeducation paradigm one whose primary orientation is dis-cernment a personal growth process involving the activitiesof receptivity recognition and grieving (Boyd and Myers1988) The process of discernment requires active dialoguewith the self and with informed trusted and engagedcolleagues it is a process undertaken at a time of vulner-ability a process that challenges the nursersquos professionalidentity (Boyd and Myers 1988) The author utilizes themetaphor of an unfolding spiral path to explore herexperience of needing to lsquounlearnrsquo a trusted nursing practiceprior to lsquolearningrsquo new best caring practices through severalevolutions The importance of building lsquocommunities oflearnersrsquo with whom nurses can safely engage in dialogueto promote transformative unlearning is highlighted

UNLEARNING LITERATURE

Unlearning is most evident in the literature on manage-mentorganizational change education and professionalpractice Limited references to unlearning were identifiedin literature from each of the disciplines of nursing medi-cine pharmacy health-care public health engineeringarchitecture art poetry religion psychology adult educa-tion and womenrsquos studies The number of references tounlearning has increased in each of the past three decadeswith the largest number of references being publishedsince the 1990s

Managementorganizational change

Managementorganizational change literature advancedthinking about unlearning guided by market values ofenhanced competition and profit Concerns raised abouthow to support timely unlearning in workers were moti-vated by the intent of increasing the pace of unlearningto maximize product competitiveness and profitability ofthe company and minimize delays and lost business (Bettisand Prahaled 1995 Bott 1995 Rogers et al 1995)

Unlearning was introduced to the management worldthrough psychologists and change theorists (Lewin 1947)

as cited in Schein (1972) Rescorla and Wagner (1972) as citedin Wasserman and Miller (1997) Schein (1972) Sowder (1973)By the 1980s increasing references to unlearning wereidentified in the management literature itself Unlearningwas defined as lsquothe process of reducing or eliminatingpreexisting knowledge or habits that would otherwise repre-sent formidable barriers to new learningrsquo(Newstrom 198336)

Unlearning was identified as a difficult process (Short1981 Newstrom 1983) requiring reorganization of theold and system-wide transformation (Short 1981) involvingchanging an ecological system of feelings thoughts andbehaviors that trigger a process of grieving (Short 1981)involving disconfirmation or disequilibrium initiallyrelated to change (Short 1981) a challenge to the safetyand security of the worker (Short 1981 Newstrom 1983Prather 1985 Leymann and Kornbluh 1989) and a processthat flourishes in highly secure and challenging environ-ments that support creativity and legitimize unlearning(Pelz 1976) as cited in Leymann and Kornbluh (1989) Short(1981)

Newstrom (1983 38) highlighted the vulnerabilityposed by the process of unlearning a process that shiftsworkers into the unknown the uncertain and towardsinstability and unpredictability of rewards Contexts thatinvolve either sustaining or changing an existing behaviorpattern were seen to require a moderate level of unlearn-ing while replacing one behavior with a totally differentone was seen to require maximal unlearning of deeplyentrenched behavior patterns (Newstrom 1983)

In the 1990s organizational change theory was sig-nificantly influenced by publications on the learning organ-ization with authors such as Garratt (1990) and Senge (19911994) building on the seminal work of Argyris and Schon(1978) The learning organization was identified as a con-cept that is growing in credibility (Cook Stamforth andStewart 1997) yet well-articulated critiques are emerging(West 1994 Baptiste 2000) including the need to balanceorganizational learning with unlearning (Wijnhoven 2001)

Organizations intending to be innovative were advisedto become unlearning organizations (Hamel and Prahalad1994 Buchen 1998 Sherwood 2000) Sherwood (2000)argues for a simple unlearning process first employeesgather and each employee writes down the details of whatthey know about how their organization functions nextthey systematically examine each point asking how it mightbe different and finally they make decisions about whatthey will change The creative challenge is to take what isalready known and form new patterns that then becomeinnovations (Sherwood 2000)

NIN_150fm Page 171 Thursday August 22 2002 753 PM

G Macdonald

172

copy 2002 Blackwell Science Ltd

Nursing Inquiry

9

(3) 170ndash178

The relationship between unlearning and creativity wasa central theme for Buchen (1998) who argued thatwith few exceptions failure or unsolvable problems usuallyforce creative responses Buchen (1998) suggested thatunlearning creates the threshold for needed creativityand is not incremental or hierarchical in nature but ratheris characterized by interchange flexibility and flowingself-organizing systems Unlearning is a process of appre-ciation positive regard and opening to the vulnerability ofchange defined as lsquoan innovative response to the challengeof differencersquo (Buchen 1998 4) Mariotti (1999) offers asupporting vision of the distinct change associated withunlearning what emerges is multiple reconfigured differentsurprising not totally containable an insight that offersa vision of a whole Effective unlearning reformulates theold ecological system to a new system one that has fullyincorporated the new and creates sustainable change(Mariotti 1999)

In the growing volume of managementorganizationliterature the importance of supporting workers parti-cularly experienced workers through unlearning wasstressed with the focus on increasing the speed of unlearn-ing and transforming organizational culture Bettis andPrahaled (1995 10) proposed the equation L

1

= F[f(t

minus

1)]learning in a particular period was a function of theamount of unlearning in the previous period They main-tained that the dominant logic of the organization hadto be challenged that resistance would be a factor of thelength of time the dominant logic was in place and thatexperienced workers do not come to new learning witha clean slate Workers have to lsquorun down the unlearningcurve in order to be able to run up a learning curversquo (Bettisand Prahaled 1995 10)

Strategies proposed to overcome physical emotionaland psychological sources of unlearning delays includedtotal immersion rather than a gradual transition betweenthe new and the old determining the level of expertiseneeded and learning to that level learning with otherswho are at the same level requesting mentoring supportand taking time-out for studied introspection (Magrath1997) Paradoxically although his efforts were focusedon increasing the pace of unlearninglearning Magrathexplicitly valued the process of reflection demanded inunlearning This process allows workers to be more con-nected to and more conscious of our human historiesorients our evolution and increases the potential for insight(Magrath 1997) lsquoUnlearning is as necessary to learningas light is to shadow in an oil painting

mdash

without one theother has no depth no definition no brightnessrsquo (Magrath1997 41)

Education

The managementorganizational change literature sug-gested that organizational change managers favor macro orsystems approaches to unlearning that focus on changingcorporate culture (Lei Slocum and Pitts 1999) The educa-tion literature suggests that educators tends to advancepractice through a micro approach one that promotes trans-formational sustainable learning in learners (Goldstein1997) References to unlearning in education literaturehighlight concerns about the process of unlearning theneed to ensure a safe environment for unlearning and con-cern for supporting social justice personal transformationand developing a peaceful sustainable planet (Hauser1992 Massin 1992 Nicole 1996 Goldstein 1997 Brown 1998Satcher 1999 Soto-Crespo 1999 Cochran-Smith 2000Kohn 2000) Soto-Cresporsquos (1999) classical pedagogicalmodel of unlearning guides the learner through grief andmourning while maintaining hope in the possibilities fora new vision

The process of unlearning signals not indoctrinationbut rather a critical process of weighing previously ac-quired beliefs when confronting new ones Unlearningaddresses the issue of critically maintaining current or newperspectives on values thereby diminishing residues ofisolationism and its dangerously reactive responses to lifeand change The Nietzschean question is After I acquirenew eyes what do I do with the old ones (Soto-Crespo1999 43)

Unlearning educational references cluster around anti-racistantidiscriminatory education (Nicole 1996 Goldstein1997 Brown 1998 Cochran-Smith 2000) feminist edu-cation (Hauser 1992 Massin 1992) antineoliberalismin education (Kohn 2000) and antiviolence education(Satcher 1999) The people who are engaged in unlearningare named as learners and there is emphasis on makingmeaning and working through intense feelings rather thanincreasing the pace of unlearning Unlearning educationalinitiatives challenge deeply held cultural beliefs in thewestern world including deeply held individualfamilyattitudes and beliefs

Powerful feelings may be aroused when teachers attemptto celebrate diversity and develop an antidiscriminatoryteaching practice during the move through phases ofdenialresistance disequilibrium and reconstruction(Brown 1998) Just as learning and change co-exist changeand conflict coexist with possibilities for learners feelingthreatened insecure and overcome by feelings of blamerage and anger the intent of such unlearning is bothpersonal and social transformation (Brown 1998) Conflictmanagement and antidiscriminatory training lsquorequire

NIN_150fm Page 172 Thursday August 22 2002 753 PM

Transformative unlearning

copy 2002 Blackwell Science Ltd

Nursing Inquiry

9

(3) 170ndash178

173

participants to be willing to listen to and consider newideas to explore feelings reflect and actrsquo (Brown 1998133)

Making unlearning racism explicit in teacher educa-tion has been found to be risky compared with theorizingas it threatens safety and security in the classroom par-ticularly when students share personal stories of racism(Cochran-Smith 2000) Cochran-Smith concluded thatpersonal and fictional stories both read and writtenhelp to construct an antidiscriminatory practice butthey do have the potential to be misused to unleashpowerful emotions that can harm students if not workedthrough

The graduate school program of the World Council ofChurchesrsquo Ecumenical Institute in Bossey Switzerlandaddressed the need to unlearn cultural ethnic and reli-gious stereotypes by immersing students in a pluralisticcommunity one that reflects diversities of religion racecontinent and gender (Nicole 1996) Facing the conflictsand discomforts in such an immersion experience is ahealing experience and the lsquoprocess leads the participantsto unlearn the sterotypes inherited from the past thanksto this daily existential encounter of the ldquootherrdquorsquo (Nicole1996 483) Nicole (1996) reported that such an immersionexperience is intended to prepare faith leaders for honestand existential encounter in the pluralistic world of theirministries

Exploring literature and personal feelings in the class-room encouraged students to unlearn patriarchy andlearn about feminism students were encouraged to makeconnections between their feelings and literature andbetween themselves and their peers thus promotingpersonal transformation (Hauser 1992 Massin 1992)Unlearning violence in schools (Satcher 1999) remainsdifficult when business political and media communitymembers force tougher standards in education despite theresistance of teachers parents and students to a neo-liberaleducation agenda (Kohn 2000)

It is in the transformative education context one ofunlearning injustice and learning to live together in atransformed world that a significant contribution of unlearn-ing was revealed Strategies identified that effectivelypromote unlearning racism patriarchy and violenceinclude total immersion personal reflection storytellingreading and writing These strategies require time open-ness to vulnerability and are holistic in nature In contrastto the managementorganizational change literature thatpromoted the pace of unlearning Chalmers and Fuller(1996) caution against rushing unlearning as it mightundermine a sustainable change and they suggest that

time spent working through transformative unlearningwas time well spent

Professional practice

The health professions have responded to the learning ageby lobbying for public policies that are evidenced-based andlinking evidence-based practice with excellence Bothmacro and mico approaches to implementing an evidence-based practice the former emphasizing systems thinkingand the latter attending to the importance of humanagency in practitioners are identified as having theoreticalmerits however caution is raised that evidence-basedpractice change diffused too quickly without the benefitof careful analysis may have unforeseen and potentiallyharmful effects (Nutely Davies and Tilley 2000) Professionalspreoccupied with acquiring the latest information currentlygive little attention to the need to displace accumulatedinformation (Soto-Crespo 1999) Yet unlearning lsquogettingpeople to stop doing things as well as getting new practicesstartedrsquo has been identified as an important step inmoving towards an evidence-based practice (Nutely et al2000 5)

Unlearning references appear in diverse professionalpractice literature including nursing (Begun and White1995 Wellard and Bethune 1996 Young 1996 SmithBattle1997) medicine (Roberts and DeWitt 1996) law (Ward2000) architecture (Powell 1994) pharmacy (Ray 1997)and social work (Pearlmutter 1998) and emphasize amicro over a macro approach to unlearning This microapproach favors reflective practice human agency and per-sonal transformation within the context of best practicesHowever the limited number of references on unlearningin the professions particularly in the health professionsindicates that the professions are not well attuned to theirunlearning needs

References to unlearning in the nursing literature arescarce and lack theoretical development Four referencesdiscussed unlearning in nursing education in the nursingprofession and in research Young (1996) acknowledgedincreased difficulty with unlearning in experienced facultyclinicians Begun and White (1995) suggest that thenursing profession must unlearn the lsquodominant logicrsquoWellard and Bethune (1996) argue that nursing studentsneed space to face the upheaval of unlearning andSmithBattle (1997 8) identified unlearning in one youngmother as learning to let go lsquowhich involved unlearningwell established emotional responses familiar ways of see-ing and habits of control and dominationrsquo The lack ofreferences to and acknowledgement of the importance of

NIN_150fm Page 173 Thursday August 22 2002 753 PM

G Macdonald

174

copy 2002 Blackwell Science Ltd

Nursing Inquiry

9

(3) 170ndash178

supporting and transforming unlearning in experiencednurses may be a significant barrier to personal and organiza-tional change

TRANSFORMATIVE UNLEARNING A NARRATIVE OF DISCERNMENT

In response to new practice guidelines experienced prac-titioners by nature of their knowledge of local realities andtheir accumulated experiential knowledge are called toengage in a complex and thoughtful process of reflectionIn a profession such as nursing experienced practitionersare the bridge between established practices and emergingpractices They play a critical role in reflecting upon thesuitability of new evidence for local practice environmentsThis process of reflection may be considered through thetheoretical stance of transformative education specificallythe process of discernment lsquoviewed as constituted by threeactivities receptivity recognition and grievingrsquo (Boyd andMyers 1988 276)

The transformative education paradigm focuses onfacilitating meaning in a learnerrsquos life seeks to make con-nections with both the learnerrsquos personal unconsciousand the collective unconscious is energized by the dynamictensions between the self and the Self (total psychic beingpersonality) and the self and primordial archtypes andutilizes the processes of discernment during receptivitythe person listens and opens to discomforting messagesnext the person recognizes significant connections andduring grieving the person faces loss lsquothe loss of priorways of seeing reality

mdash

the loss of fundamental assumptionswhich until now had brought certainty and securityrsquo (Boydand Myers 1988 277)

The process of discernment is illustrated through thefollowing narrative which relays the change in bestpractices in the sleep position of infants illustrated by theimage of an unfolding spiral a spiral that moves upwardpeaks loops back on itself and then moves upwardsagain an ongoing evolution In the 1970s and 1980s whenI was employed as a public health nurse and then nurseeducator I taught new parents to lay their babies in theprone position when sleeping This was the beginning ofthe first ascending loop in my spiral of learning but at thattime I didnrsquot expect this practice to ever change Workingwith new mothers and fathers and their infants wasrewarding and I enjoyed my identity as a public healthnurse and educator

In the early 1990s population-based case-controlledstudies were undertaken in England New Zealand andTasmania followed by intervention programs in the

Netherlands Norway New Zealand Australia Englandand the United States all substantiated newborn supineor side-lying positions as effective in reducing SIDS deaths(Sadler 1992 Hunt 1995) Despite the quality of theevidence guiding this change in practice initially I foundit uncomfortable to teach parents supine and side-lyinginfant sleeping positions As a nurse I was challenged to be

receptive

to be open to the new evidence to my response tothe evidence and to my fears As one health visitor with 20years of experience expressed lsquomy instinct tells me this[back lying] puts them in danger of choking so I recom-mend they lie on their sides I have read the official DoHinformation but it would have been reassuring and helpfulto have had more detailrsquo (Sadler 1992 19) At the time theevidence sounded strong that the prone position was nolonger one of choice in terms of preventing SIDS but itwas less reassuring about preventing choking I had troublefinding articles written from a nursing perspective whichwould share my perspective of loss and discomfort Forover 10 years I had been advising parents not to put theirinfants in the supine position and I had positioned myown four children all born during the 1980s in the proneposition I began to wonder if my work had added value topeoplersquos lives or endangered them

As research studies became available

recognition

grewthat the evidence was strongly in support of the new prac-tices I experienced a mounting pressure to change myestablished practice of teaching the prone sleeping posi-tion to new mothers and nursing students but there was asignificant gap of time before I was able to access evidencethat I found convincing This evidence included low SIDSrate associated with low prone sleeping position no harmassociated with back or side-lying newborn sleeping and nosignificant impact on decreasing other epidemiological riskfactors for SIDS (Hunt 1995) My colleagues and I were con-vinced it was time to unlearn teaching the prone newbornsleeping position but we needed to work through ourthoughts and feelings before we were ready to change ourpractice and engage fully in teaching the supine and side-lying sleep positions

While the activities of receptivity and recognition werechallenging it was the activity of

grieving

that was mosttroubling that touched the emotional core of my identityas a nurse Before changing my teaching to the supine andside-lying positions it was important to process my sense ofloss and confusion my shaken identity as an expert prac-titioner and to grieve for the possibility that my parenteducation may have led to even one child dying of SIDSand concern that I positioned my four children in theprone position thus exposing them to unnecessary risk

NIN_150fm Page 174 Thursday August 22 2002 753 PM

Transformative unlearning

copy 2002 Blackwell Science Ltd

Nursing Inquiry

9

(3) 170ndash178

175

As a faculty member I had colleagues whom I couldtalk with about my concerns and when I took studentsto the postpartum floor I spoke with nurses and administra-tors reassuring myself that we were changing our practicestogether and that I was up to date in terms of teachingmy students We exchanged practice stories about infantswho had been found choking and families who had experi-enced an SIDS death This sharing of stories researchknowledge and personal feelings facilitated my unlearn-ing One of the postpartum units included several articlesfor staff in the policy binder and displayed a poster toremind parents and staff alike of the changes in bestpractices and the public health nurses shared pamphletsfor prenatal parents An effective media education campaignaimed at expecting parents was established by the healthministry an example of planned change that was compre-hensive and promoted health

Once I had completed this discernment process Iwas ready to move forward adopting the new best prac-tice guidelines of back and side-lying newborn sleepingInterestingly health professionals trained in the 1940sand 1950s when babies were laid on backs or sidesnever prone wrote to the Foundation for the Study ofInfant Deaths applauding the return to traditionalpractices (Sadler 1992) What for me was the first loopin my unfolding spiral was for these more experiencednurses a second loop in their unfolding spiral WhenHealth Canada brought out their Back to Sleep Cam-paign (Health Canada 2002) I found myself revisiting asimilar although briefer and less intense discernmentcycle

First I spoke with a public health nurse who shareda practice story about a mother she was currently visitingwho had a child who lsquospit uprsquo after every feeding The motherwas insistent that it would be dangerous to place the babyon the back right after a feed The public health nurse hadlistened to this mother and had negotiated a compromiseThe mother would lie the baby in the side-lying positionfor approximately 20 minutes after a feed keeping a closewatch on the baby and then turn the baby to the back-lyingposition She had used her judgment and found a wayto maintain safety and respond to the motherrsquos concernsWe shared stories about our own children and sleep posi-tions and reassured ourselves that Health Canada was clearabout back-lying being the preferred position This time Ididnrsquot have to struggle to find information I went directlyto the Internet and looked up the Health Canada web siteand linked the SIDS Foundation web site and found thelsquoSIDS Sleeping Information for Health Care Professionals

mdash

Fact Sheetrsquo (The SIDS Foundation 2000)

I was surprised to find that my spiral was again loopingback on itself and to realize that I had not been aware ofthe evidence identifying that side-lying sleep positions hada higher rate of SIDS deaths than back positions Despitemy surprise I was confident that the Joint Statement (1999)identified the best synthesis of research and practiceknowledge available Still I noted that the fact sheet didnot list any collaborating nursing partnerships and Iprinted out the references so that I could read the originalresearch studies I shared the update with colleagueschecked and found that my new text book was not up-to-date with this best practice and I made a note to make sureand alert my students to check the Health Canada web sitefor the latest practice guidelines

My spiral is now on its third loop and I am anticipatingthat it will begin to accelerate its looping as research know-ledge expands Irsquom beginning to sense that my future willoffer ever-increasing moments of discernment and thatmy identity must incorporate my role as knowledge workerMy roles as caring practitioner and thinking practitionerare intertwined in a bothand holistic and dynamic dancesustained by a network of virtual and real life colleaguesThese colleagues form my lsquocommunity of learningrsquo andplay an essential role in supporting me through trans-formative unlearning

CREATING COMMUNITIES OF LEARNING

Transformative learning theorists Mitchell and Sackney(2000) articulate their world-view drawing upon physicistDavid Bohmrsquos (1980) interpretation of the universe asbeing essentially one connected whole Instead of a worldof fragmented parts Bohm (1980) saw a world of con-nections relationships and common origins Like Bohm(1980) Mitchell and Sackney (2000) see the world as awhole and perceive close connections between personallearning and community learning As such individuals areseen as being responsible for the needs of the collectivesuch as a learning community a group of practitionersin an identified practice environment or the planetarycommunity

Mitchell and Sackney (2000) argue convincingly thatone must attend to both the individual and the collectiveto achieve the best of both individual life and communitylife They espouse a social constructivist orientation andlsquotry to deconstruct what things mean and how they gotthat way and to reconstruct what else they might look likersquo(Mitchell and Sackney 2000 xiii) For Mitchell andSackney (2000) the critical processes of deconstructing andreconstructing create both personal and collective shifts

NIN_150fm Page 175 Thursday August 22 2002 753 PM

G Macdonald

176

copy 2002 Blackwell Science Ltd

Nursing Inquiry

9

(3) 170ndash178

shifts that move towards wholeness social responsivenessand unity This process of change is non-linear ongoingcircular and evolving and resembles a spiral more than astraight line They believe that constructing learning com-munities within practice environments will enhance bothpersonal and social transformation

Building learning communities involves personal inter-personal and organizational capacity building Learn-ing communities consist of lsquoa group of people who takean active reflective collaborative learning-oriented andgrowth-promoting approach toward the mysteries prob-lems and perplexities of teaching and learningrsquo (Mitchelland Sackney 2000 9) Linked to the term lsquolearning com-munityrsquo is the concept of lsquocommunities of practicersquo a termused to describe the contexts of informal learning at homeand work places (Wenger 1998) Communities of practiceshare dynamic and engaged relationships a focus on ashared enterprise and a set of shared resources a reper-toire (Wenger 1998) Learning communities and commu-nities of practice both support the importance of learningwithin a social context one that creates community andenhances learning Such lsquocommunities of learningrsquo areideally designed to sustain transformative unlearningand new learning But how are these communities of learn-ing initiated developed and sustained Who is responsi-ble What supports them and what barriers must beovercome

Nursing educators administrators practitioners andresearchers need to work together to support the develop-ment of lsquocommunities of learningrsquo in nursing workplacesNursing educators begin this process by role modelingcolleagiality with students and encouraging students towork co-operatively in communities of learning As Bohm(1980) states beginnings are important they set a trajectoryfor the future

Nurse administratorsleaders can learn aboutidentifying and planning for lsquotransformative unlearningrsquofrom management and education literature Nurse lead-ers committed to excellence are encouraged to reflectupon the values that guide the development of an evidence-based practice within their local context If as Dingwalland Allen (2001) suggest local nursing practice is mov-ing away from engaging emotional relationships withclients and moving towards a highly technical practicea macro approach may provide important support fortransformative unlearning For example nurse adminis-trators could review their setting to see if and howinformal relationships are nurtured Consider coffeeand lunch facilities Does the space and design promote col-legiality

Ferguson-Pare and Mitchell (2001 8) argue poignantlythat removal of nursing shift reports to improve efficienciesand reduce costs contributed to nursesrsquo

loss of community with each other I did not realize untilnow that shift reports were not only about patients theywere also about nurses and their being with each otherReport time gave nurses a chance to hear about eachotherrsquos struggles and joys hellip report time was also a time tobuild relationships hellip Report times were times when nursesbuilt community and cared for each other

To their credit Ferguson-Pare and Mitchell (2001) invitereaders to contact them through mail or e-mail and discusstheir practice experiences with building community Thepossibilities for building lsquocommunities of learningrsquo forunlearning on the Internet are strong

Alternately consider opportunities for immersionextended unlearning Is it possible to block off 2 hoursonce a month to engage in some learning activities thatwould address an identified need for unlearning suchas developing awareness about diversity practice A lunch-eon with invited guests and diverse foods perhaps sharedby diverse clientsguests with a cultural celebration mayinitiate unlearning racism in a meaningful manner Is itpossible to facilitate a journal club once a month at lunchor afternoon break Encouraging dialogue about the latestevidence creates a lsquocommunity of learning who are con-nected and hopefully supportive of the need to supporttransformative unlearning

Where values are being developed an antidiscrimina-tory practice fostered and individual practitioner changesupported educationrsquos micro approach may provide thebest unlearning Reflecting upon managementrsquos role inaccelerating unlearning of ineffective management prac-tices is an essential part of transformative unlearning(Lei Slocum and Pitts 1999) Consider having staff learningpartners to promote dialogue about changing practicesBuilding in a reward for excellence such as a draw for a freelunch for learning partners will provide clarity about agencyvalues and the importance placed on building workplacecommunities of learning

Novice and experienced practitioners engaged inunlearning and new learning need to negotiate time tothoughtfully reflect on new evidence and work through theirfeelings about the change prior to changing practicesInitiating communities of learning in the practice environ-ment with valued colleagues who share a passion for excel-lence is encouraged Experienced nurses may find as haveexperienced teachers that the intellectual work of changecreates tensions between lsquooutside-inrsquo or research know-ledge and lsquoinside-outrsquo or practice knowledge (Hargreaveset al 2001 132) As they struggle with tensions they are

NIN_150fm Page 176 Thursday August 22 2002 753 PM

Transformative unlearning

copy 2002 Blackwell Science Ltd

Nursing Inquiry

9

(3) 170ndash178

177

building personal capacity for practice development butare cautioned that changes in cognition that do not leadto changes in practice are considered meaningless whilechanges in practice that are not associated with change incognition will not lead to profound improvement (Mitchelland Sackney 2000)

Finally researchers promoting an evidence-based changeare encouraged to include suggestions for facilitatingunlearning of outdated practice in published articles Thisoffers an important strategy to support critical researchto practice links Additionally completing research toexplicate the process of lsquounlearningrsquo within practice willcreate the practice to research to practice link that is suchan important value in an evidence-based professionalpractice

REFERENCES

Argyris C and D Schon 1978

Organizational learning Atheory of action perspective

Reading MassachusettsAddison-Wesley

Baptiste I 2000 Beyond reason and personal integrityToward a pedagogy of coercive restraint

The CanadianJournal for the Study of Adult Education

14(1) 27ndash50Begun JW and KR White 1995 Alternating nursingrsquos

dominant logic Guidelines from complex adaptivesystems theory

Complexity and Chaos in Nursing

2(1)5ndash15

Bettis RA and CK Prahaled 1995 The dominic logicRetrospective and extension

Strategic Management Journal

16 5ndash14Bohm D 1980

Wholeness and the implicate order

LondonRouteledge amp Kegan Paul

Bott E 1995 The unlearning curve

PCComputing

8(2) 338ndash9Boyd RD and JG Myers 1988 Transformative education

International Journal of Lifelong Education

7(4) 261ndash84Brown B 1998

Unlearning discrimination in the early years

Oakhill Stoke-on-Trent Staffordshire Trentham Books

Buchen IH 1998 An organizational New Yearrsquos resolutionTo unlearn

National Productivity Review

18(1) 1ndash4Chalmers D and R Fuller 1996

Teaching for learning at uni-versity Theory and practice

London Kogan PageCochran-Smith M 2000 Blind vision Unlearning racism

in teacher education

Harvard Educational Review

70(2)157ndash90

Cook JA D Staniforth and J Stewart 1997

The learningorganization in the public services

Aldershot GowerDingwall R and D Allen 2001 The implications of health-

care reforms for the profession of nursing

NursingInquiry

8(2) 64ndash74

Ferguson-Pare M and GI Mitchell 2001 Letrsquos get realDestroying-restoring community in nursing

CanadianJournal of Nursing Leadership

14(2) 7ndash9Garratt B 1990

Creating a learning organization

HemelHempstead Director Books

Goldstein T 1997 Unlearning homophobia through apedagogy of anonymity

Teaching Education

9(1) 115ndash9Gregson RPW AG Meal and M Avis 2002 Meta-analysis the

glass eye of evidence-based practice

Nursing Inquiry

9(1) 24ndash30Hamel G and CK Prahalad 1994

Competing for the futureBreakthrough strategies for seizing control of your industry andcreating the markets of tomorrow

Boston Harvard BusinessSchool Press

Hargreaves A L Earl ES Moore and S Manning 2001

Learning to change Teaching beyond subjects and standards

San Francisco Jossey-Bass

Hauser K 1992 Unlearning patriarchy Personal develop-ment in Marge Piercyrsquos lsquoFly Away Homersquo

Feminist Review

42 33ndash43Health Canada 2002 Back to sleep SIDS http

wwwhc-scgccahppbchildhood-youthcyfhsidsjoint_statementhtml

Hunt CE 1995 Relationship between infant sleep positionand SIDS In

Sudden infant death syndrome New trends inthe nineties

ed TO Rognum 106ndash8 Oslo ScandinavianUniversity Press

Jarvis P 2001 The changing educational scene In

The ageof learning Education and the knowledge society

ed P Jarvis27ndash38 London Kogan Page

Joint Statement Health Canada The Canadian Foundationfor the Study of Infant Death Canadian Institute ofChild Health and The Canadian Pediatric Society 1999

Reducing the risk of sudden infant death syndrome in Canada

Catalogue H39ndash4662ndash1999 Ottawa Health CanadaKearsey K 2001 Launch of nursing best practice guidelines

Envisioned as next step to more effective patient care

Registered Nurse Journal

13(6) 8ndash11Kohn A 2000 Unlearning how we learn

Principal

79(4)31ndash2

Lei D JW Slocum and RA Pitts 1999 Designing organiza-tions for competitive advantage The power of unlearningand learning

Organizational Dynamics

27(3) 24ndash38Lewin K 1947 Group decisions and social changes In

Readingsin social psychology

eds TM Newcomb and EL Hartley330ndash44 New York Henry Holt amp Company

Leymann H and H Kornbluh 1989

Socialization and learningat work

Aldershot AveburyGowerMagrath AJ 1997 The importance of unlearning

Across theBoard

34(2) 39ndash41

NIN_150fm Page 177 Thursday August 22 2002 753 PM

Transformative unlearning

copy 2002 Blackwell Science Ltd

Nursing Inquiry

9

(3) 170ndash178

171

createdpassed on that knowing and opening to the threatof undoing our psyche and our identity (Buchen 1998)

This paper aims to stimulate awareness about the intel-lectual and emotional work of unlearning in knowledgeworkers to identify the positive relationship betweeneffective unlearning and effective learning of new evidence-based nursing practices and to highlight the need tocreate safe nursing workplace environments that supportunlearning The intellectual and emotional work of un-learning is conceptualized within a transformativeeducation paradigm one whose primary orientation is dis-cernment a personal growth process involving the activitiesof receptivity recognition and grieving (Boyd and Myers1988) The process of discernment requires active dialoguewith the self and with informed trusted and engagedcolleagues it is a process undertaken at a time of vulner-ability a process that challenges the nursersquos professionalidentity (Boyd and Myers 1988) The author utilizes themetaphor of an unfolding spiral path to explore herexperience of needing to lsquounlearnrsquo a trusted nursing practiceprior to lsquolearningrsquo new best caring practices through severalevolutions The importance of building lsquocommunities oflearnersrsquo with whom nurses can safely engage in dialogueto promote transformative unlearning is highlighted

UNLEARNING LITERATURE

Unlearning is most evident in the literature on manage-mentorganizational change education and professionalpractice Limited references to unlearning were identifiedin literature from each of the disciplines of nursing medi-cine pharmacy health-care public health engineeringarchitecture art poetry religion psychology adult educa-tion and womenrsquos studies The number of references tounlearning has increased in each of the past three decadeswith the largest number of references being publishedsince the 1990s

Managementorganizational change

Managementorganizational change literature advancedthinking about unlearning guided by market values ofenhanced competition and profit Concerns raised abouthow to support timely unlearning in workers were moti-vated by the intent of increasing the pace of unlearningto maximize product competitiveness and profitability ofthe company and minimize delays and lost business (Bettisand Prahaled 1995 Bott 1995 Rogers et al 1995)

Unlearning was introduced to the management worldthrough psychologists and change theorists (Lewin 1947)

as cited in Schein (1972) Rescorla and Wagner (1972) as citedin Wasserman and Miller (1997) Schein (1972) Sowder (1973)By the 1980s increasing references to unlearning wereidentified in the management literature itself Unlearningwas defined as lsquothe process of reducing or eliminatingpreexisting knowledge or habits that would otherwise repre-sent formidable barriers to new learningrsquo(Newstrom 198336)

Unlearning was identified as a difficult process (Short1981 Newstrom 1983) requiring reorganization of theold and system-wide transformation (Short 1981) involvingchanging an ecological system of feelings thoughts andbehaviors that trigger a process of grieving (Short 1981)involving disconfirmation or disequilibrium initiallyrelated to change (Short 1981) a challenge to the safetyand security of the worker (Short 1981 Newstrom 1983Prather 1985 Leymann and Kornbluh 1989) and a processthat flourishes in highly secure and challenging environ-ments that support creativity and legitimize unlearning(Pelz 1976) as cited in Leymann and Kornbluh (1989) Short(1981)

Newstrom (1983 38) highlighted the vulnerabilityposed by the process of unlearning a process that shiftsworkers into the unknown the uncertain and towardsinstability and unpredictability of rewards Contexts thatinvolve either sustaining or changing an existing behaviorpattern were seen to require a moderate level of unlearn-ing while replacing one behavior with a totally differentone was seen to require maximal unlearning of deeplyentrenched behavior patterns (Newstrom 1983)

In the 1990s organizational change theory was sig-nificantly influenced by publications on the learning organ-ization with authors such as Garratt (1990) and Senge (19911994) building on the seminal work of Argyris and Schon(1978) The learning organization was identified as a con-cept that is growing in credibility (Cook Stamforth andStewart 1997) yet well-articulated critiques are emerging(West 1994 Baptiste 2000) including the need to balanceorganizational learning with unlearning (Wijnhoven 2001)

Organizations intending to be innovative were advisedto become unlearning organizations (Hamel and Prahalad1994 Buchen 1998 Sherwood 2000) Sherwood (2000)argues for a simple unlearning process first employeesgather and each employee writes down the details of whatthey know about how their organization functions nextthey systematically examine each point asking how it mightbe different and finally they make decisions about whatthey will change The creative challenge is to take what isalready known and form new patterns that then becomeinnovations (Sherwood 2000)

NIN_150fm Page 171 Thursday August 22 2002 753 PM

G Macdonald

172

copy 2002 Blackwell Science Ltd

Nursing Inquiry

9

(3) 170ndash178

The relationship between unlearning and creativity wasa central theme for Buchen (1998) who argued thatwith few exceptions failure or unsolvable problems usuallyforce creative responses Buchen (1998) suggested thatunlearning creates the threshold for needed creativityand is not incremental or hierarchical in nature but ratheris characterized by interchange flexibility and flowingself-organizing systems Unlearning is a process of appre-ciation positive regard and opening to the vulnerability ofchange defined as lsquoan innovative response to the challengeof differencersquo (Buchen 1998 4) Mariotti (1999) offers asupporting vision of the distinct change associated withunlearning what emerges is multiple reconfigured differentsurprising not totally containable an insight that offersa vision of a whole Effective unlearning reformulates theold ecological system to a new system one that has fullyincorporated the new and creates sustainable change(Mariotti 1999)

In the growing volume of managementorganizationliterature the importance of supporting workers parti-cularly experienced workers through unlearning wasstressed with the focus on increasing the speed of unlearn-ing and transforming organizational culture Bettis andPrahaled (1995 10) proposed the equation L

1

= F[f(t

minus

1)]learning in a particular period was a function of theamount of unlearning in the previous period They main-tained that the dominant logic of the organization hadto be challenged that resistance would be a factor of thelength of time the dominant logic was in place and thatexperienced workers do not come to new learning witha clean slate Workers have to lsquorun down the unlearningcurve in order to be able to run up a learning curversquo (Bettisand Prahaled 1995 10)

Strategies proposed to overcome physical emotionaland psychological sources of unlearning delays includedtotal immersion rather than a gradual transition betweenthe new and the old determining the level of expertiseneeded and learning to that level learning with otherswho are at the same level requesting mentoring supportand taking time-out for studied introspection (Magrath1997) Paradoxically although his efforts were focusedon increasing the pace of unlearninglearning Magrathexplicitly valued the process of reflection demanded inunlearning This process allows workers to be more con-nected to and more conscious of our human historiesorients our evolution and increases the potential for insight(Magrath 1997) lsquoUnlearning is as necessary to learningas light is to shadow in an oil painting

mdash

without one theother has no depth no definition no brightnessrsquo (Magrath1997 41)

Education

The managementorganizational change literature sug-gested that organizational change managers favor macro orsystems approaches to unlearning that focus on changingcorporate culture (Lei Slocum and Pitts 1999) The educa-tion literature suggests that educators tends to advancepractice through a micro approach one that promotes trans-formational sustainable learning in learners (Goldstein1997) References to unlearning in education literaturehighlight concerns about the process of unlearning theneed to ensure a safe environment for unlearning and con-cern for supporting social justice personal transformationand developing a peaceful sustainable planet (Hauser1992 Massin 1992 Nicole 1996 Goldstein 1997 Brown 1998Satcher 1999 Soto-Crespo 1999 Cochran-Smith 2000Kohn 2000) Soto-Cresporsquos (1999) classical pedagogicalmodel of unlearning guides the learner through grief andmourning while maintaining hope in the possibilities fora new vision

The process of unlearning signals not indoctrinationbut rather a critical process of weighing previously ac-quired beliefs when confronting new ones Unlearningaddresses the issue of critically maintaining current or newperspectives on values thereby diminishing residues ofisolationism and its dangerously reactive responses to lifeand change The Nietzschean question is After I acquirenew eyes what do I do with the old ones (Soto-Crespo1999 43)

Unlearning educational references cluster around anti-racistantidiscriminatory education (Nicole 1996 Goldstein1997 Brown 1998 Cochran-Smith 2000) feminist edu-cation (Hauser 1992 Massin 1992) antineoliberalismin education (Kohn 2000) and antiviolence education(Satcher 1999) The people who are engaged in unlearningare named as learners and there is emphasis on makingmeaning and working through intense feelings rather thanincreasing the pace of unlearning Unlearning educationalinitiatives challenge deeply held cultural beliefs in thewestern world including deeply held individualfamilyattitudes and beliefs

Powerful feelings may be aroused when teachers attemptto celebrate diversity and develop an antidiscriminatoryteaching practice during the move through phases ofdenialresistance disequilibrium and reconstruction(Brown 1998) Just as learning and change co-exist changeand conflict coexist with possibilities for learners feelingthreatened insecure and overcome by feelings of blamerage and anger the intent of such unlearning is bothpersonal and social transformation (Brown 1998) Conflictmanagement and antidiscriminatory training lsquorequire

NIN_150fm Page 172 Thursday August 22 2002 753 PM

Transformative unlearning

copy 2002 Blackwell Science Ltd

Nursing Inquiry

9

(3) 170ndash178

173

participants to be willing to listen to and consider newideas to explore feelings reflect and actrsquo (Brown 1998133)

Making unlearning racism explicit in teacher educa-tion has been found to be risky compared with theorizingas it threatens safety and security in the classroom par-ticularly when students share personal stories of racism(Cochran-Smith 2000) Cochran-Smith concluded thatpersonal and fictional stories both read and writtenhelp to construct an antidiscriminatory practice butthey do have the potential to be misused to unleashpowerful emotions that can harm students if not workedthrough

The graduate school program of the World Council ofChurchesrsquo Ecumenical Institute in Bossey Switzerlandaddressed the need to unlearn cultural ethnic and reli-gious stereotypes by immersing students in a pluralisticcommunity one that reflects diversities of religion racecontinent and gender (Nicole 1996) Facing the conflictsand discomforts in such an immersion experience is ahealing experience and the lsquoprocess leads the participantsto unlearn the sterotypes inherited from the past thanksto this daily existential encounter of the ldquootherrdquorsquo (Nicole1996 483) Nicole (1996) reported that such an immersionexperience is intended to prepare faith leaders for honestand existential encounter in the pluralistic world of theirministries

Exploring literature and personal feelings in the class-room encouraged students to unlearn patriarchy andlearn about feminism students were encouraged to makeconnections between their feelings and literature andbetween themselves and their peers thus promotingpersonal transformation (Hauser 1992 Massin 1992)Unlearning violence in schools (Satcher 1999) remainsdifficult when business political and media communitymembers force tougher standards in education despite theresistance of teachers parents and students to a neo-liberaleducation agenda (Kohn 2000)

It is in the transformative education context one ofunlearning injustice and learning to live together in atransformed world that a significant contribution of unlearn-ing was revealed Strategies identified that effectivelypromote unlearning racism patriarchy and violenceinclude total immersion personal reflection storytellingreading and writing These strategies require time open-ness to vulnerability and are holistic in nature In contrastto the managementorganizational change literature thatpromoted the pace of unlearning Chalmers and Fuller(1996) caution against rushing unlearning as it mightundermine a sustainable change and they suggest that

time spent working through transformative unlearningwas time well spent

Professional practice

The health professions have responded to the learning ageby lobbying for public policies that are evidenced-based andlinking evidence-based practice with excellence Bothmacro and mico approaches to implementing an evidence-based practice the former emphasizing systems thinkingand the latter attending to the importance of humanagency in practitioners are identified as having theoreticalmerits however caution is raised that evidence-basedpractice change diffused too quickly without the benefitof careful analysis may have unforeseen and potentiallyharmful effects (Nutely Davies and Tilley 2000) Professionalspreoccupied with acquiring the latest information currentlygive little attention to the need to displace accumulatedinformation (Soto-Crespo 1999) Yet unlearning lsquogettingpeople to stop doing things as well as getting new practicesstartedrsquo has been identified as an important step inmoving towards an evidence-based practice (Nutely et al2000 5)

Unlearning references appear in diverse professionalpractice literature including nursing (Begun and White1995 Wellard and Bethune 1996 Young 1996 SmithBattle1997) medicine (Roberts and DeWitt 1996) law (Ward2000) architecture (Powell 1994) pharmacy (Ray 1997)and social work (Pearlmutter 1998) and emphasize amicro over a macro approach to unlearning This microapproach favors reflective practice human agency and per-sonal transformation within the context of best practicesHowever the limited number of references on unlearningin the professions particularly in the health professionsindicates that the professions are not well attuned to theirunlearning needs

References to unlearning in the nursing literature arescarce and lack theoretical development Four referencesdiscussed unlearning in nursing education in the nursingprofession and in research Young (1996) acknowledgedincreased difficulty with unlearning in experienced facultyclinicians Begun and White (1995) suggest that thenursing profession must unlearn the lsquodominant logicrsquoWellard and Bethune (1996) argue that nursing studentsneed space to face the upheaval of unlearning andSmithBattle (1997 8) identified unlearning in one youngmother as learning to let go lsquowhich involved unlearningwell established emotional responses familiar ways of see-ing and habits of control and dominationrsquo The lack ofreferences to and acknowledgement of the importance of

NIN_150fm Page 173 Thursday August 22 2002 753 PM

G Macdonald

174

copy 2002 Blackwell Science Ltd

Nursing Inquiry

9

(3) 170ndash178

supporting and transforming unlearning in experiencednurses may be a significant barrier to personal and organiza-tional change

TRANSFORMATIVE UNLEARNING A NARRATIVE OF DISCERNMENT

In response to new practice guidelines experienced prac-titioners by nature of their knowledge of local realities andtheir accumulated experiential knowledge are called toengage in a complex and thoughtful process of reflectionIn a profession such as nursing experienced practitionersare the bridge between established practices and emergingpractices They play a critical role in reflecting upon thesuitability of new evidence for local practice environmentsThis process of reflection may be considered through thetheoretical stance of transformative education specificallythe process of discernment lsquoviewed as constituted by threeactivities receptivity recognition and grievingrsquo (Boyd andMyers 1988 276)

The transformative education paradigm focuses onfacilitating meaning in a learnerrsquos life seeks to make con-nections with both the learnerrsquos personal unconsciousand the collective unconscious is energized by the dynamictensions between the self and the Self (total psychic beingpersonality) and the self and primordial archtypes andutilizes the processes of discernment during receptivitythe person listens and opens to discomforting messagesnext the person recognizes significant connections andduring grieving the person faces loss lsquothe loss of priorways of seeing reality

mdash

the loss of fundamental assumptionswhich until now had brought certainty and securityrsquo (Boydand Myers 1988 277)

The process of discernment is illustrated through thefollowing narrative which relays the change in bestpractices in the sleep position of infants illustrated by theimage of an unfolding spiral a spiral that moves upwardpeaks loops back on itself and then moves upwardsagain an ongoing evolution In the 1970s and 1980s whenI was employed as a public health nurse and then nurseeducator I taught new parents to lay their babies in theprone position when sleeping This was the beginning ofthe first ascending loop in my spiral of learning but at thattime I didnrsquot expect this practice to ever change Workingwith new mothers and fathers and their infants wasrewarding and I enjoyed my identity as a public healthnurse and educator

In the early 1990s population-based case-controlledstudies were undertaken in England New Zealand andTasmania followed by intervention programs in the

Netherlands Norway New Zealand Australia Englandand the United States all substantiated newborn supineor side-lying positions as effective in reducing SIDS deaths(Sadler 1992 Hunt 1995) Despite the quality of theevidence guiding this change in practice initially I foundit uncomfortable to teach parents supine and side-lyinginfant sleeping positions As a nurse I was challenged to be

receptive

to be open to the new evidence to my response tothe evidence and to my fears As one health visitor with 20years of experience expressed lsquomy instinct tells me this[back lying] puts them in danger of choking so I recom-mend they lie on their sides I have read the official DoHinformation but it would have been reassuring and helpfulto have had more detailrsquo (Sadler 1992 19) At the time theevidence sounded strong that the prone position was nolonger one of choice in terms of preventing SIDS but itwas less reassuring about preventing choking I had troublefinding articles written from a nursing perspective whichwould share my perspective of loss and discomfort Forover 10 years I had been advising parents not to put theirinfants in the supine position and I had positioned myown four children all born during the 1980s in the proneposition I began to wonder if my work had added value topeoplersquos lives or endangered them

As research studies became available

recognition

grewthat the evidence was strongly in support of the new prac-tices I experienced a mounting pressure to change myestablished practice of teaching the prone sleeping posi-tion to new mothers and nursing students but there was asignificant gap of time before I was able to access evidencethat I found convincing This evidence included low SIDSrate associated with low prone sleeping position no harmassociated with back or side-lying newborn sleeping and nosignificant impact on decreasing other epidemiological riskfactors for SIDS (Hunt 1995) My colleagues and I were con-vinced it was time to unlearn teaching the prone newbornsleeping position but we needed to work through ourthoughts and feelings before we were ready to change ourpractice and engage fully in teaching the supine and side-lying sleep positions

While the activities of receptivity and recognition werechallenging it was the activity of

grieving

that was mosttroubling that touched the emotional core of my identityas a nurse Before changing my teaching to the supine andside-lying positions it was important to process my sense ofloss and confusion my shaken identity as an expert prac-titioner and to grieve for the possibility that my parenteducation may have led to even one child dying of SIDSand concern that I positioned my four children in theprone position thus exposing them to unnecessary risk

NIN_150fm Page 174 Thursday August 22 2002 753 PM

Transformative unlearning

copy 2002 Blackwell Science Ltd

Nursing Inquiry

9

(3) 170ndash178

175

As a faculty member I had colleagues whom I couldtalk with about my concerns and when I took studentsto the postpartum floor I spoke with nurses and administra-tors reassuring myself that we were changing our practicestogether and that I was up to date in terms of teachingmy students We exchanged practice stories about infantswho had been found choking and families who had experi-enced an SIDS death This sharing of stories researchknowledge and personal feelings facilitated my unlearn-ing One of the postpartum units included several articlesfor staff in the policy binder and displayed a poster toremind parents and staff alike of the changes in bestpractices and the public health nurses shared pamphletsfor prenatal parents An effective media education campaignaimed at expecting parents was established by the healthministry an example of planned change that was compre-hensive and promoted health

Once I had completed this discernment process Iwas ready to move forward adopting the new best prac-tice guidelines of back and side-lying newborn sleepingInterestingly health professionals trained in the 1940sand 1950s when babies were laid on backs or sidesnever prone wrote to the Foundation for the Study ofInfant Deaths applauding the return to traditionalpractices (Sadler 1992) What for me was the first loopin my unfolding spiral was for these more experiencednurses a second loop in their unfolding spiral WhenHealth Canada brought out their Back to Sleep Cam-paign (Health Canada 2002) I found myself revisiting asimilar although briefer and less intense discernmentcycle

First I spoke with a public health nurse who shareda practice story about a mother she was currently visitingwho had a child who lsquospit uprsquo after every feeding The motherwas insistent that it would be dangerous to place the babyon the back right after a feed The public health nurse hadlistened to this mother and had negotiated a compromiseThe mother would lie the baby in the side-lying positionfor approximately 20 minutes after a feed keeping a closewatch on the baby and then turn the baby to the back-lyingposition She had used her judgment and found a wayto maintain safety and respond to the motherrsquos concernsWe shared stories about our own children and sleep posi-tions and reassured ourselves that Health Canada was clearabout back-lying being the preferred position This time Ididnrsquot have to struggle to find information I went directlyto the Internet and looked up the Health Canada web siteand linked the SIDS Foundation web site and found thelsquoSIDS Sleeping Information for Health Care Professionals

mdash

Fact Sheetrsquo (The SIDS Foundation 2000)

I was surprised to find that my spiral was again loopingback on itself and to realize that I had not been aware ofthe evidence identifying that side-lying sleep positions hada higher rate of SIDS deaths than back positions Despitemy surprise I was confident that the Joint Statement (1999)identified the best synthesis of research and practiceknowledge available Still I noted that the fact sheet didnot list any collaborating nursing partnerships and Iprinted out the references so that I could read the originalresearch studies I shared the update with colleagueschecked and found that my new text book was not up-to-date with this best practice and I made a note to make sureand alert my students to check the Health Canada web sitefor the latest practice guidelines

My spiral is now on its third loop and I am anticipatingthat it will begin to accelerate its looping as research know-ledge expands Irsquom beginning to sense that my future willoffer ever-increasing moments of discernment and thatmy identity must incorporate my role as knowledge workerMy roles as caring practitioner and thinking practitionerare intertwined in a bothand holistic and dynamic dancesustained by a network of virtual and real life colleaguesThese colleagues form my lsquocommunity of learningrsquo andplay an essential role in supporting me through trans-formative unlearning

CREATING COMMUNITIES OF LEARNING

Transformative learning theorists Mitchell and Sackney(2000) articulate their world-view drawing upon physicistDavid Bohmrsquos (1980) interpretation of the universe asbeing essentially one connected whole Instead of a worldof fragmented parts Bohm (1980) saw a world of con-nections relationships and common origins Like Bohm(1980) Mitchell and Sackney (2000) see the world as awhole and perceive close connections between personallearning and community learning As such individuals areseen as being responsible for the needs of the collectivesuch as a learning community a group of practitionersin an identified practice environment or the planetarycommunity

Mitchell and Sackney (2000) argue convincingly thatone must attend to both the individual and the collectiveto achieve the best of both individual life and communitylife They espouse a social constructivist orientation andlsquotry to deconstruct what things mean and how they gotthat way and to reconstruct what else they might look likersquo(Mitchell and Sackney 2000 xiii) For Mitchell andSackney (2000) the critical processes of deconstructing andreconstructing create both personal and collective shifts

NIN_150fm Page 175 Thursday August 22 2002 753 PM

G Macdonald

176

copy 2002 Blackwell Science Ltd

Nursing Inquiry

9

(3) 170ndash178

shifts that move towards wholeness social responsivenessand unity This process of change is non-linear ongoingcircular and evolving and resembles a spiral more than astraight line They believe that constructing learning com-munities within practice environments will enhance bothpersonal and social transformation

Building learning communities involves personal inter-personal and organizational capacity building Learn-ing communities consist of lsquoa group of people who takean active reflective collaborative learning-oriented andgrowth-promoting approach toward the mysteries prob-lems and perplexities of teaching and learningrsquo (Mitchelland Sackney 2000 9) Linked to the term lsquolearning com-munityrsquo is the concept of lsquocommunities of practicersquo a termused to describe the contexts of informal learning at homeand work places (Wenger 1998) Communities of practiceshare dynamic and engaged relationships a focus on ashared enterprise and a set of shared resources a reper-toire (Wenger 1998) Learning communities and commu-nities of practice both support the importance of learningwithin a social context one that creates community andenhances learning Such lsquocommunities of learningrsquo areideally designed to sustain transformative unlearningand new learning But how are these communities of learn-ing initiated developed and sustained Who is responsi-ble What supports them and what barriers must beovercome

Nursing educators administrators practitioners andresearchers need to work together to support the develop-ment of lsquocommunities of learningrsquo in nursing workplacesNursing educators begin this process by role modelingcolleagiality with students and encouraging students towork co-operatively in communities of learning As Bohm(1980) states beginnings are important they set a trajectoryfor the future

Nurse administratorsleaders can learn aboutidentifying and planning for lsquotransformative unlearningrsquofrom management and education literature Nurse lead-ers committed to excellence are encouraged to reflectupon the values that guide the development of an evidence-based practice within their local context If as Dingwalland Allen (2001) suggest local nursing practice is mov-ing away from engaging emotional relationships withclients and moving towards a highly technical practicea macro approach may provide important support fortransformative unlearning For example nurse adminis-trators could review their setting to see if and howinformal relationships are nurtured Consider coffeeand lunch facilities Does the space and design promote col-legiality

Ferguson-Pare and Mitchell (2001 8) argue poignantlythat removal of nursing shift reports to improve efficienciesand reduce costs contributed to nursesrsquo

loss of community with each other I did not realize untilnow that shift reports were not only about patients theywere also about nurses and their being with each otherReport time gave nurses a chance to hear about eachotherrsquos struggles and joys hellip report time was also a time tobuild relationships hellip Report times were times when nursesbuilt community and cared for each other

To their credit Ferguson-Pare and Mitchell (2001) invitereaders to contact them through mail or e-mail and discusstheir practice experiences with building community Thepossibilities for building lsquocommunities of learningrsquo forunlearning on the Internet are strong

Alternately consider opportunities for immersionextended unlearning Is it possible to block off 2 hoursonce a month to engage in some learning activities thatwould address an identified need for unlearning suchas developing awareness about diversity practice A lunch-eon with invited guests and diverse foods perhaps sharedby diverse clientsguests with a cultural celebration mayinitiate unlearning racism in a meaningful manner Is itpossible to facilitate a journal club once a month at lunchor afternoon break Encouraging dialogue about the latestevidence creates a lsquocommunity of learning who are con-nected and hopefully supportive of the need to supporttransformative unlearning

Where values are being developed an antidiscrimina-tory practice fostered and individual practitioner changesupported educationrsquos micro approach may provide thebest unlearning Reflecting upon managementrsquos role inaccelerating unlearning of ineffective management prac-tices is an essential part of transformative unlearning(Lei Slocum and Pitts 1999) Consider having staff learningpartners to promote dialogue about changing practicesBuilding in a reward for excellence such as a draw for a freelunch for learning partners will provide clarity about agencyvalues and the importance placed on building workplacecommunities of learning

Novice and experienced practitioners engaged inunlearning and new learning need to negotiate time tothoughtfully reflect on new evidence and work through theirfeelings about the change prior to changing practicesInitiating communities of learning in the practice environ-ment with valued colleagues who share a passion for excel-lence is encouraged Experienced nurses may find as haveexperienced teachers that the intellectual work of changecreates tensions between lsquooutside-inrsquo or research know-ledge and lsquoinside-outrsquo or practice knowledge (Hargreaveset al 2001 132) As they struggle with tensions they are

NIN_150fm Page 176 Thursday August 22 2002 753 PM

Transformative unlearning

copy 2002 Blackwell Science Ltd

Nursing Inquiry

9

(3) 170ndash178

177

building personal capacity for practice development butare cautioned that changes in cognition that do not leadto changes in practice are considered meaningless whilechanges in practice that are not associated with change incognition will not lead to profound improvement (Mitchelland Sackney 2000)

Finally researchers promoting an evidence-based changeare encouraged to include suggestions for facilitatingunlearning of outdated practice in published articles Thisoffers an important strategy to support critical researchto practice links Additionally completing research toexplicate the process of lsquounlearningrsquo within practice willcreate the practice to research to practice link that is suchan important value in an evidence-based professionalpractice

REFERENCES

Argyris C and D Schon 1978

Organizational learning Atheory of action perspective

Reading MassachusettsAddison-Wesley

Baptiste I 2000 Beyond reason and personal integrityToward a pedagogy of coercive restraint

The CanadianJournal for the Study of Adult Education

14(1) 27ndash50Begun JW and KR White 1995 Alternating nursingrsquos

dominant logic Guidelines from complex adaptivesystems theory

Complexity and Chaos in Nursing

2(1)5ndash15

Bettis RA and CK Prahaled 1995 The dominic logicRetrospective and extension

Strategic Management Journal

16 5ndash14Bohm D 1980

Wholeness and the implicate order

LondonRouteledge amp Kegan Paul

Bott E 1995 The unlearning curve

PCComputing

8(2) 338ndash9Boyd RD and JG Myers 1988 Transformative education

International Journal of Lifelong Education

7(4) 261ndash84Brown B 1998

Unlearning discrimination in the early years

Oakhill Stoke-on-Trent Staffordshire Trentham Books

Buchen IH 1998 An organizational New Yearrsquos resolutionTo unlearn

National Productivity Review

18(1) 1ndash4Chalmers D and R Fuller 1996

Teaching for learning at uni-versity Theory and practice

London Kogan PageCochran-Smith M 2000 Blind vision Unlearning racism

in teacher education

Harvard Educational Review

70(2)157ndash90

Cook JA D Staniforth and J Stewart 1997

The learningorganization in the public services

Aldershot GowerDingwall R and D Allen 2001 The implications of health-

care reforms for the profession of nursing

NursingInquiry

8(2) 64ndash74

Ferguson-Pare M and GI Mitchell 2001 Letrsquos get realDestroying-restoring community in nursing

CanadianJournal of Nursing Leadership

14(2) 7ndash9Garratt B 1990

Creating a learning organization

HemelHempstead Director Books

Goldstein T 1997 Unlearning homophobia through apedagogy of anonymity

Teaching Education

9(1) 115ndash9Gregson RPW AG Meal and M Avis 2002 Meta-analysis the

glass eye of evidence-based practice

Nursing Inquiry

9(1) 24ndash30Hamel G and CK Prahalad 1994

Competing for the futureBreakthrough strategies for seizing control of your industry andcreating the markets of tomorrow

Boston Harvard BusinessSchool Press

Hargreaves A L Earl ES Moore and S Manning 2001

Learning to change Teaching beyond subjects and standards

San Francisco Jossey-Bass

Hauser K 1992 Unlearning patriarchy Personal develop-ment in Marge Piercyrsquos lsquoFly Away Homersquo

Feminist Review

42 33ndash43Health Canada 2002 Back to sleep SIDS http

wwwhc-scgccahppbchildhood-youthcyfhsidsjoint_statementhtml

Hunt CE 1995 Relationship between infant sleep positionand SIDS In

Sudden infant death syndrome New trends inthe nineties

ed TO Rognum 106ndash8 Oslo ScandinavianUniversity Press

Jarvis P 2001 The changing educational scene In

The ageof learning Education and the knowledge society

ed P Jarvis27ndash38 London Kogan Page

Joint Statement Health Canada The Canadian Foundationfor the Study of Infant Death Canadian Institute ofChild Health and The Canadian Pediatric Society 1999

Reducing the risk of sudden infant death syndrome in Canada

Catalogue H39ndash4662ndash1999 Ottawa Health CanadaKearsey K 2001 Launch of nursing best practice guidelines

Envisioned as next step to more effective patient care

Registered Nurse Journal

13(6) 8ndash11Kohn A 2000 Unlearning how we learn

Principal

79(4)31ndash2

Lei D JW Slocum and RA Pitts 1999 Designing organiza-tions for competitive advantage The power of unlearningand learning

Organizational Dynamics

27(3) 24ndash38Lewin K 1947 Group decisions and social changes In

Readingsin social psychology

eds TM Newcomb and EL Hartley330ndash44 New York Henry Holt amp Company

Leymann H and H Kornbluh 1989

Socialization and learningat work

Aldershot AveburyGowerMagrath AJ 1997 The importance of unlearning

Across theBoard

34(2) 39ndash41

NIN_150fm Page 177 Thursday August 22 2002 753 PM

G Macdonald

172

copy 2002 Blackwell Science Ltd

Nursing Inquiry

9

(3) 170ndash178

The relationship between unlearning and creativity wasa central theme for Buchen (1998) who argued thatwith few exceptions failure or unsolvable problems usuallyforce creative responses Buchen (1998) suggested thatunlearning creates the threshold for needed creativityand is not incremental or hierarchical in nature but ratheris characterized by interchange flexibility and flowingself-organizing systems Unlearning is a process of appre-ciation positive regard and opening to the vulnerability ofchange defined as lsquoan innovative response to the challengeof differencersquo (Buchen 1998 4) Mariotti (1999) offers asupporting vision of the distinct change associated withunlearning what emerges is multiple reconfigured differentsurprising not totally containable an insight that offersa vision of a whole Effective unlearning reformulates theold ecological system to a new system one that has fullyincorporated the new and creates sustainable change(Mariotti 1999)

In the growing volume of managementorganizationliterature the importance of supporting workers parti-cularly experienced workers through unlearning wasstressed with the focus on increasing the speed of unlearn-ing and transforming organizational culture Bettis andPrahaled (1995 10) proposed the equation L

1

= F[f(t

minus

1)]learning in a particular period was a function of theamount of unlearning in the previous period They main-tained that the dominant logic of the organization hadto be challenged that resistance would be a factor of thelength of time the dominant logic was in place and thatexperienced workers do not come to new learning witha clean slate Workers have to lsquorun down the unlearningcurve in order to be able to run up a learning curversquo (Bettisand Prahaled 1995 10)

Strategies proposed to overcome physical emotionaland psychological sources of unlearning delays includedtotal immersion rather than a gradual transition betweenthe new and the old determining the level of expertiseneeded and learning to that level learning with otherswho are at the same level requesting mentoring supportand taking time-out for studied introspection (Magrath1997) Paradoxically although his efforts were focusedon increasing the pace of unlearninglearning Magrathexplicitly valued the process of reflection demanded inunlearning This process allows workers to be more con-nected to and more conscious of our human historiesorients our evolution and increases the potential for insight(Magrath 1997) lsquoUnlearning is as necessary to learningas light is to shadow in an oil painting

mdash

without one theother has no depth no definition no brightnessrsquo (Magrath1997 41)

Education

The managementorganizational change literature sug-gested that organizational change managers favor macro orsystems approaches to unlearning that focus on changingcorporate culture (Lei Slocum and Pitts 1999) The educa-tion literature suggests that educators tends to advancepractice through a micro approach one that promotes trans-formational sustainable learning in learners (Goldstein1997) References to unlearning in education literaturehighlight concerns about the process of unlearning theneed to ensure a safe environment for unlearning and con-cern for supporting social justice personal transformationand developing a peaceful sustainable planet (Hauser1992 Massin 1992 Nicole 1996 Goldstein 1997 Brown 1998Satcher 1999 Soto-Crespo 1999 Cochran-Smith 2000Kohn 2000) Soto-Cresporsquos (1999) classical pedagogicalmodel of unlearning guides the learner through grief andmourning while maintaining hope in the possibilities fora new vision

The process of unlearning signals not indoctrinationbut rather a critical process of weighing previously ac-quired beliefs when confronting new ones Unlearningaddresses the issue of critically maintaining current or newperspectives on values thereby diminishing residues ofisolationism and its dangerously reactive responses to lifeand change The Nietzschean question is After I acquirenew eyes what do I do with the old ones (Soto-Crespo1999 43)

Unlearning educational references cluster around anti-racistantidiscriminatory education (Nicole 1996 Goldstein1997 Brown 1998 Cochran-Smith 2000) feminist edu-cation (Hauser 1992 Massin 1992) antineoliberalismin education (Kohn 2000) and antiviolence education(Satcher 1999) The people who are engaged in unlearningare named as learners and there is emphasis on makingmeaning and working through intense feelings rather thanincreasing the pace of unlearning Unlearning educationalinitiatives challenge deeply held cultural beliefs in thewestern world including deeply held individualfamilyattitudes and beliefs

Powerful feelings may be aroused when teachers attemptto celebrate diversity and develop an antidiscriminatoryteaching practice during the move through phases ofdenialresistance disequilibrium and reconstruction(Brown 1998) Just as learning and change co-exist changeand conflict coexist with possibilities for learners feelingthreatened insecure and overcome by feelings of blamerage and anger the intent of such unlearning is bothpersonal and social transformation (Brown 1998) Conflictmanagement and antidiscriminatory training lsquorequire

NIN_150fm Page 172 Thursday August 22 2002 753 PM

Transformative unlearning

copy 2002 Blackwell Science Ltd

Nursing Inquiry

9

(3) 170ndash178

173

participants to be willing to listen to and consider newideas to explore feelings reflect and actrsquo (Brown 1998133)

Making unlearning racism explicit in teacher educa-tion has been found to be risky compared with theorizingas it threatens safety and security in the classroom par-ticularly when students share personal stories of racism(Cochran-Smith 2000) Cochran-Smith concluded thatpersonal and fictional stories both read and writtenhelp to construct an antidiscriminatory practice butthey do have the potential to be misused to unleashpowerful emotions that can harm students if not workedthrough

The graduate school program of the World Council ofChurchesrsquo Ecumenical Institute in Bossey Switzerlandaddressed the need to unlearn cultural ethnic and reli-gious stereotypes by immersing students in a pluralisticcommunity one that reflects diversities of religion racecontinent and gender (Nicole 1996) Facing the conflictsand discomforts in such an immersion experience is ahealing experience and the lsquoprocess leads the participantsto unlearn the sterotypes inherited from the past thanksto this daily existential encounter of the ldquootherrdquorsquo (Nicole1996 483) Nicole (1996) reported that such an immersionexperience is intended to prepare faith leaders for honestand existential encounter in the pluralistic world of theirministries

Exploring literature and personal feelings in the class-room encouraged students to unlearn patriarchy andlearn about feminism students were encouraged to makeconnections between their feelings and literature andbetween themselves and their peers thus promotingpersonal transformation (Hauser 1992 Massin 1992)Unlearning violence in schools (Satcher 1999) remainsdifficult when business political and media communitymembers force tougher standards in education despite theresistance of teachers parents and students to a neo-liberaleducation agenda (Kohn 2000)

It is in the transformative education context one ofunlearning injustice and learning to live together in atransformed world that a significant contribution of unlearn-ing was revealed Strategies identified that effectivelypromote unlearning racism patriarchy and violenceinclude total immersion personal reflection storytellingreading and writing These strategies require time open-ness to vulnerability and are holistic in nature In contrastto the managementorganizational change literature thatpromoted the pace of unlearning Chalmers and Fuller(1996) caution against rushing unlearning as it mightundermine a sustainable change and they suggest that

time spent working through transformative unlearningwas time well spent

Professional practice

The health professions have responded to the learning ageby lobbying for public policies that are evidenced-based andlinking evidence-based practice with excellence Bothmacro and mico approaches to implementing an evidence-based practice the former emphasizing systems thinkingand the latter attending to the importance of humanagency in practitioners are identified as having theoreticalmerits however caution is raised that evidence-basedpractice change diffused too quickly without the benefitof careful analysis may have unforeseen and potentiallyharmful effects (Nutely Davies and Tilley 2000) Professionalspreoccupied with acquiring the latest information currentlygive little attention to the need to displace accumulatedinformation (Soto-Crespo 1999) Yet unlearning lsquogettingpeople to stop doing things as well as getting new practicesstartedrsquo has been identified as an important step inmoving towards an evidence-based practice (Nutely et al2000 5)

Unlearning references appear in diverse professionalpractice literature including nursing (Begun and White1995 Wellard and Bethune 1996 Young 1996 SmithBattle1997) medicine (Roberts and DeWitt 1996) law (Ward2000) architecture (Powell 1994) pharmacy (Ray 1997)and social work (Pearlmutter 1998) and emphasize amicro over a macro approach to unlearning This microapproach favors reflective practice human agency and per-sonal transformation within the context of best practicesHowever the limited number of references on unlearningin the professions particularly in the health professionsindicates that the professions are not well attuned to theirunlearning needs

References to unlearning in the nursing literature arescarce and lack theoretical development Four referencesdiscussed unlearning in nursing education in the nursingprofession and in research Young (1996) acknowledgedincreased difficulty with unlearning in experienced facultyclinicians Begun and White (1995) suggest that thenursing profession must unlearn the lsquodominant logicrsquoWellard and Bethune (1996) argue that nursing studentsneed space to face the upheaval of unlearning andSmithBattle (1997 8) identified unlearning in one youngmother as learning to let go lsquowhich involved unlearningwell established emotional responses familiar ways of see-ing and habits of control and dominationrsquo The lack ofreferences to and acknowledgement of the importance of

NIN_150fm Page 173 Thursday August 22 2002 753 PM

G Macdonald

174

copy 2002 Blackwell Science Ltd

Nursing Inquiry

9

(3) 170ndash178

supporting and transforming unlearning in experiencednurses may be a significant barrier to personal and organiza-tional change

TRANSFORMATIVE UNLEARNING A NARRATIVE OF DISCERNMENT

In response to new practice guidelines experienced prac-titioners by nature of their knowledge of local realities andtheir accumulated experiential knowledge are called toengage in a complex and thoughtful process of reflectionIn a profession such as nursing experienced practitionersare the bridge between established practices and emergingpractices They play a critical role in reflecting upon thesuitability of new evidence for local practice environmentsThis process of reflection may be considered through thetheoretical stance of transformative education specificallythe process of discernment lsquoviewed as constituted by threeactivities receptivity recognition and grievingrsquo (Boyd andMyers 1988 276)

The transformative education paradigm focuses onfacilitating meaning in a learnerrsquos life seeks to make con-nections with both the learnerrsquos personal unconsciousand the collective unconscious is energized by the dynamictensions between the self and the Self (total psychic beingpersonality) and the self and primordial archtypes andutilizes the processes of discernment during receptivitythe person listens and opens to discomforting messagesnext the person recognizes significant connections andduring grieving the person faces loss lsquothe loss of priorways of seeing reality

mdash

the loss of fundamental assumptionswhich until now had brought certainty and securityrsquo (Boydand Myers 1988 277)

The process of discernment is illustrated through thefollowing narrative which relays the change in bestpractices in the sleep position of infants illustrated by theimage of an unfolding spiral a spiral that moves upwardpeaks loops back on itself and then moves upwardsagain an ongoing evolution In the 1970s and 1980s whenI was employed as a public health nurse and then nurseeducator I taught new parents to lay their babies in theprone position when sleeping This was the beginning ofthe first ascending loop in my spiral of learning but at thattime I didnrsquot expect this practice to ever change Workingwith new mothers and fathers and their infants wasrewarding and I enjoyed my identity as a public healthnurse and educator

In the early 1990s population-based case-controlledstudies were undertaken in England New Zealand andTasmania followed by intervention programs in the

Netherlands Norway New Zealand Australia Englandand the United States all substantiated newborn supineor side-lying positions as effective in reducing SIDS deaths(Sadler 1992 Hunt 1995) Despite the quality of theevidence guiding this change in practice initially I foundit uncomfortable to teach parents supine and side-lyinginfant sleeping positions As a nurse I was challenged to be

receptive

to be open to the new evidence to my response tothe evidence and to my fears As one health visitor with 20years of experience expressed lsquomy instinct tells me this[back lying] puts them in danger of choking so I recom-mend they lie on their sides I have read the official DoHinformation but it would have been reassuring and helpfulto have had more detailrsquo (Sadler 1992 19) At the time theevidence sounded strong that the prone position was nolonger one of choice in terms of preventing SIDS but itwas less reassuring about preventing choking I had troublefinding articles written from a nursing perspective whichwould share my perspective of loss and discomfort Forover 10 years I had been advising parents not to put theirinfants in the supine position and I had positioned myown four children all born during the 1980s in the proneposition I began to wonder if my work had added value topeoplersquos lives or endangered them

As research studies became available

recognition

grewthat the evidence was strongly in support of the new prac-tices I experienced a mounting pressure to change myestablished practice of teaching the prone sleeping posi-tion to new mothers and nursing students but there was asignificant gap of time before I was able to access evidencethat I found convincing This evidence included low SIDSrate associated with low prone sleeping position no harmassociated with back or side-lying newborn sleeping and nosignificant impact on decreasing other epidemiological riskfactors for SIDS (Hunt 1995) My colleagues and I were con-vinced it was time to unlearn teaching the prone newbornsleeping position but we needed to work through ourthoughts and feelings before we were ready to change ourpractice and engage fully in teaching the supine and side-lying sleep positions

While the activities of receptivity and recognition werechallenging it was the activity of

grieving

that was mosttroubling that touched the emotional core of my identityas a nurse Before changing my teaching to the supine andside-lying positions it was important to process my sense ofloss and confusion my shaken identity as an expert prac-titioner and to grieve for the possibility that my parenteducation may have led to even one child dying of SIDSand concern that I positioned my four children in theprone position thus exposing them to unnecessary risk

NIN_150fm Page 174 Thursday August 22 2002 753 PM

Transformative unlearning

copy 2002 Blackwell Science Ltd

Nursing Inquiry

9

(3) 170ndash178

175

As a faculty member I had colleagues whom I couldtalk with about my concerns and when I took studentsto the postpartum floor I spoke with nurses and administra-tors reassuring myself that we were changing our practicestogether and that I was up to date in terms of teachingmy students We exchanged practice stories about infantswho had been found choking and families who had experi-enced an SIDS death This sharing of stories researchknowledge and personal feelings facilitated my unlearn-ing One of the postpartum units included several articlesfor staff in the policy binder and displayed a poster toremind parents and staff alike of the changes in bestpractices and the public health nurses shared pamphletsfor prenatal parents An effective media education campaignaimed at expecting parents was established by the healthministry an example of planned change that was compre-hensive and promoted health

Once I had completed this discernment process Iwas ready to move forward adopting the new best prac-tice guidelines of back and side-lying newborn sleepingInterestingly health professionals trained in the 1940sand 1950s when babies were laid on backs or sidesnever prone wrote to the Foundation for the Study ofInfant Deaths applauding the return to traditionalpractices (Sadler 1992) What for me was the first loopin my unfolding spiral was for these more experiencednurses a second loop in their unfolding spiral WhenHealth Canada brought out their Back to Sleep Cam-paign (Health Canada 2002) I found myself revisiting asimilar although briefer and less intense discernmentcycle

First I spoke with a public health nurse who shareda practice story about a mother she was currently visitingwho had a child who lsquospit uprsquo after every feeding The motherwas insistent that it would be dangerous to place the babyon the back right after a feed The public health nurse hadlistened to this mother and had negotiated a compromiseThe mother would lie the baby in the side-lying positionfor approximately 20 minutes after a feed keeping a closewatch on the baby and then turn the baby to the back-lyingposition She had used her judgment and found a wayto maintain safety and respond to the motherrsquos concernsWe shared stories about our own children and sleep posi-tions and reassured ourselves that Health Canada was clearabout back-lying being the preferred position This time Ididnrsquot have to struggle to find information I went directlyto the Internet and looked up the Health Canada web siteand linked the SIDS Foundation web site and found thelsquoSIDS Sleeping Information for Health Care Professionals

mdash

Fact Sheetrsquo (The SIDS Foundation 2000)

I was surprised to find that my spiral was again loopingback on itself and to realize that I had not been aware ofthe evidence identifying that side-lying sleep positions hada higher rate of SIDS deaths than back positions Despitemy surprise I was confident that the Joint Statement (1999)identified the best synthesis of research and practiceknowledge available Still I noted that the fact sheet didnot list any collaborating nursing partnerships and Iprinted out the references so that I could read the originalresearch studies I shared the update with colleagueschecked and found that my new text book was not up-to-date with this best practice and I made a note to make sureand alert my students to check the Health Canada web sitefor the latest practice guidelines

My spiral is now on its third loop and I am anticipatingthat it will begin to accelerate its looping as research know-ledge expands Irsquom beginning to sense that my future willoffer ever-increasing moments of discernment and thatmy identity must incorporate my role as knowledge workerMy roles as caring practitioner and thinking practitionerare intertwined in a bothand holistic and dynamic dancesustained by a network of virtual and real life colleaguesThese colleagues form my lsquocommunity of learningrsquo andplay an essential role in supporting me through trans-formative unlearning

CREATING COMMUNITIES OF LEARNING

Transformative learning theorists Mitchell and Sackney(2000) articulate their world-view drawing upon physicistDavid Bohmrsquos (1980) interpretation of the universe asbeing essentially one connected whole Instead of a worldof fragmented parts Bohm (1980) saw a world of con-nections relationships and common origins Like Bohm(1980) Mitchell and Sackney (2000) see the world as awhole and perceive close connections between personallearning and community learning As such individuals areseen as being responsible for the needs of the collectivesuch as a learning community a group of practitionersin an identified practice environment or the planetarycommunity

Mitchell and Sackney (2000) argue convincingly thatone must attend to both the individual and the collectiveto achieve the best of both individual life and communitylife They espouse a social constructivist orientation andlsquotry to deconstruct what things mean and how they gotthat way and to reconstruct what else they might look likersquo(Mitchell and Sackney 2000 xiii) For Mitchell andSackney (2000) the critical processes of deconstructing andreconstructing create both personal and collective shifts

NIN_150fm Page 175 Thursday August 22 2002 753 PM

G Macdonald

176

copy 2002 Blackwell Science Ltd

Nursing Inquiry

9

(3) 170ndash178

shifts that move towards wholeness social responsivenessand unity This process of change is non-linear ongoingcircular and evolving and resembles a spiral more than astraight line They believe that constructing learning com-munities within practice environments will enhance bothpersonal and social transformation

Building learning communities involves personal inter-personal and organizational capacity building Learn-ing communities consist of lsquoa group of people who takean active reflective collaborative learning-oriented andgrowth-promoting approach toward the mysteries prob-lems and perplexities of teaching and learningrsquo (Mitchelland Sackney 2000 9) Linked to the term lsquolearning com-munityrsquo is the concept of lsquocommunities of practicersquo a termused to describe the contexts of informal learning at homeand work places (Wenger 1998) Communities of practiceshare dynamic and engaged relationships a focus on ashared enterprise and a set of shared resources a reper-toire (Wenger 1998) Learning communities and commu-nities of practice both support the importance of learningwithin a social context one that creates community andenhances learning Such lsquocommunities of learningrsquo areideally designed to sustain transformative unlearningand new learning But how are these communities of learn-ing initiated developed and sustained Who is responsi-ble What supports them and what barriers must beovercome

Nursing educators administrators practitioners andresearchers need to work together to support the develop-ment of lsquocommunities of learningrsquo in nursing workplacesNursing educators begin this process by role modelingcolleagiality with students and encouraging students towork co-operatively in communities of learning As Bohm(1980) states beginnings are important they set a trajectoryfor the future

Nurse administratorsleaders can learn aboutidentifying and planning for lsquotransformative unlearningrsquofrom management and education literature Nurse lead-ers committed to excellence are encouraged to reflectupon the values that guide the development of an evidence-based practice within their local context If as Dingwalland Allen (2001) suggest local nursing practice is mov-ing away from engaging emotional relationships withclients and moving towards a highly technical practicea macro approach may provide important support fortransformative unlearning For example nurse adminis-trators could review their setting to see if and howinformal relationships are nurtured Consider coffeeand lunch facilities Does the space and design promote col-legiality

Ferguson-Pare and Mitchell (2001 8) argue poignantlythat removal of nursing shift reports to improve efficienciesand reduce costs contributed to nursesrsquo

loss of community with each other I did not realize untilnow that shift reports were not only about patients theywere also about nurses and their being with each otherReport time gave nurses a chance to hear about eachotherrsquos struggles and joys hellip report time was also a time tobuild relationships hellip Report times were times when nursesbuilt community and cared for each other

To their credit Ferguson-Pare and Mitchell (2001) invitereaders to contact them through mail or e-mail and discusstheir practice experiences with building community Thepossibilities for building lsquocommunities of learningrsquo forunlearning on the Internet are strong

Alternately consider opportunities for immersionextended unlearning Is it possible to block off 2 hoursonce a month to engage in some learning activities thatwould address an identified need for unlearning suchas developing awareness about diversity practice A lunch-eon with invited guests and diverse foods perhaps sharedby diverse clientsguests with a cultural celebration mayinitiate unlearning racism in a meaningful manner Is itpossible to facilitate a journal club once a month at lunchor afternoon break Encouraging dialogue about the latestevidence creates a lsquocommunity of learning who are con-nected and hopefully supportive of the need to supporttransformative unlearning

Where values are being developed an antidiscrimina-tory practice fostered and individual practitioner changesupported educationrsquos micro approach may provide thebest unlearning Reflecting upon managementrsquos role inaccelerating unlearning of ineffective management prac-tices is an essential part of transformative unlearning(Lei Slocum and Pitts 1999) Consider having staff learningpartners to promote dialogue about changing practicesBuilding in a reward for excellence such as a draw for a freelunch for learning partners will provide clarity about agencyvalues and the importance placed on building workplacecommunities of learning

Novice and experienced practitioners engaged inunlearning and new learning need to negotiate time tothoughtfully reflect on new evidence and work through theirfeelings about the change prior to changing practicesInitiating communities of learning in the practice environ-ment with valued colleagues who share a passion for excel-lence is encouraged Experienced nurses may find as haveexperienced teachers that the intellectual work of changecreates tensions between lsquooutside-inrsquo or research know-ledge and lsquoinside-outrsquo or practice knowledge (Hargreaveset al 2001 132) As they struggle with tensions they are

NIN_150fm Page 176 Thursday August 22 2002 753 PM

Transformative unlearning

copy 2002 Blackwell Science Ltd

Nursing Inquiry

9

(3) 170ndash178

177

building personal capacity for practice development butare cautioned that changes in cognition that do not leadto changes in practice are considered meaningless whilechanges in practice that are not associated with change incognition will not lead to profound improvement (Mitchelland Sackney 2000)

Finally researchers promoting an evidence-based changeare encouraged to include suggestions for facilitatingunlearning of outdated practice in published articles Thisoffers an important strategy to support critical researchto practice links Additionally completing research toexplicate the process of lsquounlearningrsquo within practice willcreate the practice to research to practice link that is suchan important value in an evidence-based professionalpractice

REFERENCES

Argyris C and D Schon 1978

Organizational learning Atheory of action perspective

Reading MassachusettsAddison-Wesley

Baptiste I 2000 Beyond reason and personal integrityToward a pedagogy of coercive restraint

The CanadianJournal for the Study of Adult Education

14(1) 27ndash50Begun JW and KR White 1995 Alternating nursingrsquos

dominant logic Guidelines from complex adaptivesystems theory

Complexity and Chaos in Nursing

2(1)5ndash15

Bettis RA and CK Prahaled 1995 The dominic logicRetrospective and extension

Strategic Management Journal

16 5ndash14Bohm D 1980

Wholeness and the implicate order

LondonRouteledge amp Kegan Paul

Bott E 1995 The unlearning curve

PCComputing

8(2) 338ndash9Boyd RD and JG Myers 1988 Transformative education

International Journal of Lifelong Education

7(4) 261ndash84Brown B 1998

Unlearning discrimination in the early years

Oakhill Stoke-on-Trent Staffordshire Trentham Books

Buchen IH 1998 An organizational New Yearrsquos resolutionTo unlearn

National Productivity Review

18(1) 1ndash4Chalmers D and R Fuller 1996

Teaching for learning at uni-versity Theory and practice

London Kogan PageCochran-Smith M 2000 Blind vision Unlearning racism

in teacher education

Harvard Educational Review

70(2)157ndash90

Cook JA D Staniforth and J Stewart 1997

The learningorganization in the public services

Aldershot GowerDingwall R and D Allen 2001 The implications of health-

care reforms for the profession of nursing

NursingInquiry

8(2) 64ndash74

Ferguson-Pare M and GI Mitchell 2001 Letrsquos get realDestroying-restoring community in nursing

CanadianJournal of Nursing Leadership

14(2) 7ndash9Garratt B 1990

Creating a learning organization

HemelHempstead Director Books

Goldstein T 1997 Unlearning homophobia through apedagogy of anonymity

Teaching Education

9(1) 115ndash9Gregson RPW AG Meal and M Avis 2002 Meta-analysis the

glass eye of evidence-based practice

Nursing Inquiry

9(1) 24ndash30Hamel G and CK Prahalad 1994

Competing for the futureBreakthrough strategies for seizing control of your industry andcreating the markets of tomorrow

Boston Harvard BusinessSchool Press

Hargreaves A L Earl ES Moore and S Manning 2001

Learning to change Teaching beyond subjects and standards

San Francisco Jossey-Bass

Hauser K 1992 Unlearning patriarchy Personal develop-ment in Marge Piercyrsquos lsquoFly Away Homersquo

Feminist Review

42 33ndash43Health Canada 2002 Back to sleep SIDS http

wwwhc-scgccahppbchildhood-youthcyfhsidsjoint_statementhtml

Hunt CE 1995 Relationship between infant sleep positionand SIDS In

Sudden infant death syndrome New trends inthe nineties

ed TO Rognum 106ndash8 Oslo ScandinavianUniversity Press

Jarvis P 2001 The changing educational scene In

The ageof learning Education and the knowledge society

ed P Jarvis27ndash38 London Kogan Page

Joint Statement Health Canada The Canadian Foundationfor the Study of Infant Death Canadian Institute ofChild Health and The Canadian Pediatric Society 1999

Reducing the risk of sudden infant death syndrome in Canada

Catalogue H39ndash4662ndash1999 Ottawa Health CanadaKearsey K 2001 Launch of nursing best practice guidelines

Envisioned as next step to more effective patient care

Registered Nurse Journal

13(6) 8ndash11Kohn A 2000 Unlearning how we learn

Principal

79(4)31ndash2

Lei D JW Slocum and RA Pitts 1999 Designing organiza-tions for competitive advantage The power of unlearningand learning

Organizational Dynamics

27(3) 24ndash38Lewin K 1947 Group decisions and social changes In

Readingsin social psychology

eds TM Newcomb and EL Hartley330ndash44 New York Henry Holt amp Company

Leymann H and H Kornbluh 1989

Socialization and learningat work

Aldershot AveburyGowerMagrath AJ 1997 The importance of unlearning

Across theBoard

34(2) 39ndash41

NIN_150fm Page 177 Thursday August 22 2002 753 PM

Transformative unlearning

copy 2002 Blackwell Science Ltd

Nursing Inquiry

9

(3) 170ndash178

173

participants to be willing to listen to and consider newideas to explore feelings reflect and actrsquo (Brown 1998133)

Making unlearning racism explicit in teacher educa-tion has been found to be risky compared with theorizingas it threatens safety and security in the classroom par-ticularly when students share personal stories of racism(Cochran-Smith 2000) Cochran-Smith concluded thatpersonal and fictional stories both read and writtenhelp to construct an antidiscriminatory practice butthey do have the potential to be misused to unleashpowerful emotions that can harm students if not workedthrough

The graduate school program of the World Council ofChurchesrsquo Ecumenical Institute in Bossey Switzerlandaddressed the need to unlearn cultural ethnic and reli-gious stereotypes by immersing students in a pluralisticcommunity one that reflects diversities of religion racecontinent and gender (Nicole 1996) Facing the conflictsand discomforts in such an immersion experience is ahealing experience and the lsquoprocess leads the participantsto unlearn the sterotypes inherited from the past thanksto this daily existential encounter of the ldquootherrdquorsquo (Nicole1996 483) Nicole (1996) reported that such an immersionexperience is intended to prepare faith leaders for honestand existential encounter in the pluralistic world of theirministries

Exploring literature and personal feelings in the class-room encouraged students to unlearn patriarchy andlearn about feminism students were encouraged to makeconnections between their feelings and literature andbetween themselves and their peers thus promotingpersonal transformation (Hauser 1992 Massin 1992)Unlearning violence in schools (Satcher 1999) remainsdifficult when business political and media communitymembers force tougher standards in education despite theresistance of teachers parents and students to a neo-liberaleducation agenda (Kohn 2000)

It is in the transformative education context one ofunlearning injustice and learning to live together in atransformed world that a significant contribution of unlearn-ing was revealed Strategies identified that effectivelypromote unlearning racism patriarchy and violenceinclude total immersion personal reflection storytellingreading and writing These strategies require time open-ness to vulnerability and are holistic in nature In contrastto the managementorganizational change literature thatpromoted the pace of unlearning Chalmers and Fuller(1996) caution against rushing unlearning as it mightundermine a sustainable change and they suggest that

time spent working through transformative unlearningwas time well spent

Professional practice

The health professions have responded to the learning ageby lobbying for public policies that are evidenced-based andlinking evidence-based practice with excellence Bothmacro and mico approaches to implementing an evidence-based practice the former emphasizing systems thinkingand the latter attending to the importance of humanagency in practitioners are identified as having theoreticalmerits however caution is raised that evidence-basedpractice change diffused too quickly without the benefitof careful analysis may have unforeseen and potentiallyharmful effects (Nutely Davies and Tilley 2000) Professionalspreoccupied with acquiring the latest information currentlygive little attention to the need to displace accumulatedinformation (Soto-Crespo 1999) Yet unlearning lsquogettingpeople to stop doing things as well as getting new practicesstartedrsquo has been identified as an important step inmoving towards an evidence-based practice (Nutely et al2000 5)

Unlearning references appear in diverse professionalpractice literature including nursing (Begun and White1995 Wellard and Bethune 1996 Young 1996 SmithBattle1997) medicine (Roberts and DeWitt 1996) law (Ward2000) architecture (Powell 1994) pharmacy (Ray 1997)and social work (Pearlmutter 1998) and emphasize amicro over a macro approach to unlearning This microapproach favors reflective practice human agency and per-sonal transformation within the context of best practicesHowever the limited number of references on unlearningin the professions particularly in the health professionsindicates that the professions are not well attuned to theirunlearning needs

References to unlearning in the nursing literature arescarce and lack theoretical development Four referencesdiscussed unlearning in nursing education in the nursingprofession and in research Young (1996) acknowledgedincreased difficulty with unlearning in experienced facultyclinicians Begun and White (1995) suggest that thenursing profession must unlearn the lsquodominant logicrsquoWellard and Bethune (1996) argue that nursing studentsneed space to face the upheaval of unlearning andSmithBattle (1997 8) identified unlearning in one youngmother as learning to let go lsquowhich involved unlearningwell established emotional responses familiar ways of see-ing and habits of control and dominationrsquo The lack ofreferences to and acknowledgement of the importance of

NIN_150fm Page 173 Thursday August 22 2002 753 PM

G Macdonald

174

copy 2002 Blackwell Science Ltd

Nursing Inquiry

9

(3) 170ndash178

supporting and transforming unlearning in experiencednurses may be a significant barrier to personal and organiza-tional change

TRANSFORMATIVE UNLEARNING A NARRATIVE OF DISCERNMENT

In response to new practice guidelines experienced prac-titioners by nature of their knowledge of local realities andtheir accumulated experiential knowledge are called toengage in a complex and thoughtful process of reflectionIn a profession such as nursing experienced practitionersare the bridge between established practices and emergingpractices They play a critical role in reflecting upon thesuitability of new evidence for local practice environmentsThis process of reflection may be considered through thetheoretical stance of transformative education specificallythe process of discernment lsquoviewed as constituted by threeactivities receptivity recognition and grievingrsquo (Boyd andMyers 1988 276)

The transformative education paradigm focuses onfacilitating meaning in a learnerrsquos life seeks to make con-nections with both the learnerrsquos personal unconsciousand the collective unconscious is energized by the dynamictensions between the self and the Self (total psychic beingpersonality) and the self and primordial archtypes andutilizes the processes of discernment during receptivitythe person listens and opens to discomforting messagesnext the person recognizes significant connections andduring grieving the person faces loss lsquothe loss of priorways of seeing reality

mdash

the loss of fundamental assumptionswhich until now had brought certainty and securityrsquo (Boydand Myers 1988 277)

The process of discernment is illustrated through thefollowing narrative which relays the change in bestpractices in the sleep position of infants illustrated by theimage of an unfolding spiral a spiral that moves upwardpeaks loops back on itself and then moves upwardsagain an ongoing evolution In the 1970s and 1980s whenI was employed as a public health nurse and then nurseeducator I taught new parents to lay their babies in theprone position when sleeping This was the beginning ofthe first ascending loop in my spiral of learning but at thattime I didnrsquot expect this practice to ever change Workingwith new mothers and fathers and their infants wasrewarding and I enjoyed my identity as a public healthnurse and educator

In the early 1990s population-based case-controlledstudies were undertaken in England New Zealand andTasmania followed by intervention programs in the

Netherlands Norway New Zealand Australia Englandand the United States all substantiated newborn supineor side-lying positions as effective in reducing SIDS deaths(Sadler 1992 Hunt 1995) Despite the quality of theevidence guiding this change in practice initially I foundit uncomfortable to teach parents supine and side-lyinginfant sleeping positions As a nurse I was challenged to be

receptive

to be open to the new evidence to my response tothe evidence and to my fears As one health visitor with 20years of experience expressed lsquomy instinct tells me this[back lying] puts them in danger of choking so I recom-mend they lie on their sides I have read the official DoHinformation but it would have been reassuring and helpfulto have had more detailrsquo (Sadler 1992 19) At the time theevidence sounded strong that the prone position was nolonger one of choice in terms of preventing SIDS but itwas less reassuring about preventing choking I had troublefinding articles written from a nursing perspective whichwould share my perspective of loss and discomfort Forover 10 years I had been advising parents not to put theirinfants in the supine position and I had positioned myown four children all born during the 1980s in the proneposition I began to wonder if my work had added value topeoplersquos lives or endangered them

As research studies became available

recognition

grewthat the evidence was strongly in support of the new prac-tices I experienced a mounting pressure to change myestablished practice of teaching the prone sleeping posi-tion to new mothers and nursing students but there was asignificant gap of time before I was able to access evidencethat I found convincing This evidence included low SIDSrate associated with low prone sleeping position no harmassociated with back or side-lying newborn sleeping and nosignificant impact on decreasing other epidemiological riskfactors for SIDS (Hunt 1995) My colleagues and I were con-vinced it was time to unlearn teaching the prone newbornsleeping position but we needed to work through ourthoughts and feelings before we were ready to change ourpractice and engage fully in teaching the supine and side-lying sleep positions

While the activities of receptivity and recognition werechallenging it was the activity of

grieving

that was mosttroubling that touched the emotional core of my identityas a nurse Before changing my teaching to the supine andside-lying positions it was important to process my sense ofloss and confusion my shaken identity as an expert prac-titioner and to grieve for the possibility that my parenteducation may have led to even one child dying of SIDSand concern that I positioned my four children in theprone position thus exposing them to unnecessary risk

NIN_150fm Page 174 Thursday August 22 2002 753 PM

Transformative unlearning

copy 2002 Blackwell Science Ltd

Nursing Inquiry

9

(3) 170ndash178

175

As a faculty member I had colleagues whom I couldtalk with about my concerns and when I took studentsto the postpartum floor I spoke with nurses and administra-tors reassuring myself that we were changing our practicestogether and that I was up to date in terms of teachingmy students We exchanged practice stories about infantswho had been found choking and families who had experi-enced an SIDS death This sharing of stories researchknowledge and personal feelings facilitated my unlearn-ing One of the postpartum units included several articlesfor staff in the policy binder and displayed a poster toremind parents and staff alike of the changes in bestpractices and the public health nurses shared pamphletsfor prenatal parents An effective media education campaignaimed at expecting parents was established by the healthministry an example of planned change that was compre-hensive and promoted health

Once I had completed this discernment process Iwas ready to move forward adopting the new best prac-tice guidelines of back and side-lying newborn sleepingInterestingly health professionals trained in the 1940sand 1950s when babies were laid on backs or sidesnever prone wrote to the Foundation for the Study ofInfant Deaths applauding the return to traditionalpractices (Sadler 1992) What for me was the first loopin my unfolding spiral was for these more experiencednurses a second loop in their unfolding spiral WhenHealth Canada brought out their Back to Sleep Cam-paign (Health Canada 2002) I found myself revisiting asimilar although briefer and less intense discernmentcycle

First I spoke with a public health nurse who shareda practice story about a mother she was currently visitingwho had a child who lsquospit uprsquo after every feeding The motherwas insistent that it would be dangerous to place the babyon the back right after a feed The public health nurse hadlistened to this mother and had negotiated a compromiseThe mother would lie the baby in the side-lying positionfor approximately 20 minutes after a feed keeping a closewatch on the baby and then turn the baby to the back-lyingposition She had used her judgment and found a wayto maintain safety and respond to the motherrsquos concernsWe shared stories about our own children and sleep posi-tions and reassured ourselves that Health Canada was clearabout back-lying being the preferred position This time Ididnrsquot have to struggle to find information I went directlyto the Internet and looked up the Health Canada web siteand linked the SIDS Foundation web site and found thelsquoSIDS Sleeping Information for Health Care Professionals

mdash

Fact Sheetrsquo (The SIDS Foundation 2000)

I was surprised to find that my spiral was again loopingback on itself and to realize that I had not been aware ofthe evidence identifying that side-lying sleep positions hada higher rate of SIDS deaths than back positions Despitemy surprise I was confident that the Joint Statement (1999)identified the best synthesis of research and practiceknowledge available Still I noted that the fact sheet didnot list any collaborating nursing partnerships and Iprinted out the references so that I could read the originalresearch studies I shared the update with colleagueschecked and found that my new text book was not up-to-date with this best practice and I made a note to make sureand alert my students to check the Health Canada web sitefor the latest practice guidelines

My spiral is now on its third loop and I am anticipatingthat it will begin to accelerate its looping as research know-ledge expands Irsquom beginning to sense that my future willoffer ever-increasing moments of discernment and thatmy identity must incorporate my role as knowledge workerMy roles as caring practitioner and thinking practitionerare intertwined in a bothand holistic and dynamic dancesustained by a network of virtual and real life colleaguesThese colleagues form my lsquocommunity of learningrsquo andplay an essential role in supporting me through trans-formative unlearning

CREATING COMMUNITIES OF LEARNING

Transformative learning theorists Mitchell and Sackney(2000) articulate their world-view drawing upon physicistDavid Bohmrsquos (1980) interpretation of the universe asbeing essentially one connected whole Instead of a worldof fragmented parts Bohm (1980) saw a world of con-nections relationships and common origins Like Bohm(1980) Mitchell and Sackney (2000) see the world as awhole and perceive close connections between personallearning and community learning As such individuals areseen as being responsible for the needs of the collectivesuch as a learning community a group of practitionersin an identified practice environment or the planetarycommunity

Mitchell and Sackney (2000) argue convincingly thatone must attend to both the individual and the collectiveto achieve the best of both individual life and communitylife They espouse a social constructivist orientation andlsquotry to deconstruct what things mean and how they gotthat way and to reconstruct what else they might look likersquo(Mitchell and Sackney 2000 xiii) For Mitchell andSackney (2000) the critical processes of deconstructing andreconstructing create both personal and collective shifts

NIN_150fm Page 175 Thursday August 22 2002 753 PM

G Macdonald

176

copy 2002 Blackwell Science Ltd

Nursing Inquiry

9

(3) 170ndash178

shifts that move towards wholeness social responsivenessand unity This process of change is non-linear ongoingcircular and evolving and resembles a spiral more than astraight line They believe that constructing learning com-munities within practice environments will enhance bothpersonal and social transformation

Building learning communities involves personal inter-personal and organizational capacity building Learn-ing communities consist of lsquoa group of people who takean active reflective collaborative learning-oriented andgrowth-promoting approach toward the mysteries prob-lems and perplexities of teaching and learningrsquo (Mitchelland Sackney 2000 9) Linked to the term lsquolearning com-munityrsquo is the concept of lsquocommunities of practicersquo a termused to describe the contexts of informal learning at homeand work places (Wenger 1998) Communities of practiceshare dynamic and engaged relationships a focus on ashared enterprise and a set of shared resources a reper-toire (Wenger 1998) Learning communities and commu-nities of practice both support the importance of learningwithin a social context one that creates community andenhances learning Such lsquocommunities of learningrsquo areideally designed to sustain transformative unlearningand new learning But how are these communities of learn-ing initiated developed and sustained Who is responsi-ble What supports them and what barriers must beovercome

Nursing educators administrators practitioners andresearchers need to work together to support the develop-ment of lsquocommunities of learningrsquo in nursing workplacesNursing educators begin this process by role modelingcolleagiality with students and encouraging students towork co-operatively in communities of learning As Bohm(1980) states beginnings are important they set a trajectoryfor the future

Nurse administratorsleaders can learn aboutidentifying and planning for lsquotransformative unlearningrsquofrom management and education literature Nurse lead-ers committed to excellence are encouraged to reflectupon the values that guide the development of an evidence-based practice within their local context If as Dingwalland Allen (2001) suggest local nursing practice is mov-ing away from engaging emotional relationships withclients and moving towards a highly technical practicea macro approach may provide important support fortransformative unlearning For example nurse adminis-trators could review their setting to see if and howinformal relationships are nurtured Consider coffeeand lunch facilities Does the space and design promote col-legiality

Ferguson-Pare and Mitchell (2001 8) argue poignantlythat removal of nursing shift reports to improve efficienciesand reduce costs contributed to nursesrsquo

loss of community with each other I did not realize untilnow that shift reports were not only about patients theywere also about nurses and their being with each otherReport time gave nurses a chance to hear about eachotherrsquos struggles and joys hellip report time was also a time tobuild relationships hellip Report times were times when nursesbuilt community and cared for each other

To their credit Ferguson-Pare and Mitchell (2001) invitereaders to contact them through mail or e-mail and discusstheir practice experiences with building community Thepossibilities for building lsquocommunities of learningrsquo forunlearning on the Internet are strong

Alternately consider opportunities for immersionextended unlearning Is it possible to block off 2 hoursonce a month to engage in some learning activities thatwould address an identified need for unlearning suchas developing awareness about diversity practice A lunch-eon with invited guests and diverse foods perhaps sharedby diverse clientsguests with a cultural celebration mayinitiate unlearning racism in a meaningful manner Is itpossible to facilitate a journal club once a month at lunchor afternoon break Encouraging dialogue about the latestevidence creates a lsquocommunity of learning who are con-nected and hopefully supportive of the need to supporttransformative unlearning

Where values are being developed an antidiscrimina-tory practice fostered and individual practitioner changesupported educationrsquos micro approach may provide thebest unlearning Reflecting upon managementrsquos role inaccelerating unlearning of ineffective management prac-tices is an essential part of transformative unlearning(Lei Slocum and Pitts 1999) Consider having staff learningpartners to promote dialogue about changing practicesBuilding in a reward for excellence such as a draw for a freelunch for learning partners will provide clarity about agencyvalues and the importance placed on building workplacecommunities of learning

Novice and experienced practitioners engaged inunlearning and new learning need to negotiate time tothoughtfully reflect on new evidence and work through theirfeelings about the change prior to changing practicesInitiating communities of learning in the practice environ-ment with valued colleagues who share a passion for excel-lence is encouraged Experienced nurses may find as haveexperienced teachers that the intellectual work of changecreates tensions between lsquooutside-inrsquo or research know-ledge and lsquoinside-outrsquo or practice knowledge (Hargreaveset al 2001 132) As they struggle with tensions they are

NIN_150fm Page 176 Thursday August 22 2002 753 PM

Transformative unlearning

copy 2002 Blackwell Science Ltd

Nursing Inquiry

9

(3) 170ndash178

177

building personal capacity for practice development butare cautioned that changes in cognition that do not leadto changes in practice are considered meaningless whilechanges in practice that are not associated with change incognition will not lead to profound improvement (Mitchelland Sackney 2000)

Finally researchers promoting an evidence-based changeare encouraged to include suggestions for facilitatingunlearning of outdated practice in published articles Thisoffers an important strategy to support critical researchto practice links Additionally completing research toexplicate the process of lsquounlearningrsquo within practice willcreate the practice to research to practice link that is suchan important value in an evidence-based professionalpractice

REFERENCES

Argyris C and D Schon 1978

Organizational learning Atheory of action perspective

Reading MassachusettsAddison-Wesley

Baptiste I 2000 Beyond reason and personal integrityToward a pedagogy of coercive restraint

The CanadianJournal for the Study of Adult Education

14(1) 27ndash50Begun JW and KR White 1995 Alternating nursingrsquos

dominant logic Guidelines from complex adaptivesystems theory

Complexity and Chaos in Nursing

2(1)5ndash15

Bettis RA and CK Prahaled 1995 The dominic logicRetrospective and extension

Strategic Management Journal

16 5ndash14Bohm D 1980

Wholeness and the implicate order

LondonRouteledge amp Kegan Paul

Bott E 1995 The unlearning curve

PCComputing

8(2) 338ndash9Boyd RD and JG Myers 1988 Transformative education

International Journal of Lifelong Education

7(4) 261ndash84Brown B 1998

Unlearning discrimination in the early years

Oakhill Stoke-on-Trent Staffordshire Trentham Books

Buchen IH 1998 An organizational New Yearrsquos resolutionTo unlearn

National Productivity Review

18(1) 1ndash4Chalmers D and R Fuller 1996

Teaching for learning at uni-versity Theory and practice

London Kogan PageCochran-Smith M 2000 Blind vision Unlearning racism

in teacher education

Harvard Educational Review

70(2)157ndash90

Cook JA D Staniforth and J Stewart 1997

The learningorganization in the public services

Aldershot GowerDingwall R and D Allen 2001 The implications of health-

care reforms for the profession of nursing

NursingInquiry

8(2) 64ndash74

Ferguson-Pare M and GI Mitchell 2001 Letrsquos get realDestroying-restoring community in nursing

CanadianJournal of Nursing Leadership

14(2) 7ndash9Garratt B 1990

Creating a learning organization

HemelHempstead Director Books

Goldstein T 1997 Unlearning homophobia through apedagogy of anonymity

Teaching Education

9(1) 115ndash9Gregson RPW AG Meal and M Avis 2002 Meta-analysis the

glass eye of evidence-based practice

Nursing Inquiry

9(1) 24ndash30Hamel G and CK Prahalad 1994

Competing for the futureBreakthrough strategies for seizing control of your industry andcreating the markets of tomorrow

Boston Harvard BusinessSchool Press

Hargreaves A L Earl ES Moore and S Manning 2001

Learning to change Teaching beyond subjects and standards

San Francisco Jossey-Bass

Hauser K 1992 Unlearning patriarchy Personal develop-ment in Marge Piercyrsquos lsquoFly Away Homersquo

Feminist Review

42 33ndash43Health Canada 2002 Back to sleep SIDS http

wwwhc-scgccahppbchildhood-youthcyfhsidsjoint_statementhtml

Hunt CE 1995 Relationship between infant sleep positionand SIDS In

Sudden infant death syndrome New trends inthe nineties

ed TO Rognum 106ndash8 Oslo ScandinavianUniversity Press

Jarvis P 2001 The changing educational scene In

The ageof learning Education and the knowledge society

ed P Jarvis27ndash38 London Kogan Page

Joint Statement Health Canada The Canadian Foundationfor the Study of Infant Death Canadian Institute ofChild Health and The Canadian Pediatric Society 1999

Reducing the risk of sudden infant death syndrome in Canada

Catalogue H39ndash4662ndash1999 Ottawa Health CanadaKearsey K 2001 Launch of nursing best practice guidelines

Envisioned as next step to more effective patient care

Registered Nurse Journal

13(6) 8ndash11Kohn A 2000 Unlearning how we learn

Principal

79(4)31ndash2

Lei D JW Slocum and RA Pitts 1999 Designing organiza-tions for competitive advantage The power of unlearningand learning

Organizational Dynamics

27(3) 24ndash38Lewin K 1947 Group decisions and social changes In

Readingsin social psychology

eds TM Newcomb and EL Hartley330ndash44 New York Henry Holt amp Company

Leymann H and H Kornbluh 1989

Socialization and learningat work

Aldershot AveburyGowerMagrath AJ 1997 The importance of unlearning

Across theBoard

34(2) 39ndash41

NIN_150fm Page 177 Thursday August 22 2002 753 PM

G Macdonald

174

copy 2002 Blackwell Science Ltd

Nursing Inquiry

9

(3) 170ndash178

supporting and transforming unlearning in experiencednurses may be a significant barrier to personal and organiza-tional change

TRANSFORMATIVE UNLEARNING A NARRATIVE OF DISCERNMENT

In response to new practice guidelines experienced prac-titioners by nature of their knowledge of local realities andtheir accumulated experiential knowledge are called toengage in a complex and thoughtful process of reflectionIn a profession such as nursing experienced practitionersare the bridge between established practices and emergingpractices They play a critical role in reflecting upon thesuitability of new evidence for local practice environmentsThis process of reflection may be considered through thetheoretical stance of transformative education specificallythe process of discernment lsquoviewed as constituted by threeactivities receptivity recognition and grievingrsquo (Boyd andMyers 1988 276)

The transformative education paradigm focuses onfacilitating meaning in a learnerrsquos life seeks to make con-nections with both the learnerrsquos personal unconsciousand the collective unconscious is energized by the dynamictensions between the self and the Self (total psychic beingpersonality) and the self and primordial archtypes andutilizes the processes of discernment during receptivitythe person listens and opens to discomforting messagesnext the person recognizes significant connections andduring grieving the person faces loss lsquothe loss of priorways of seeing reality

mdash

the loss of fundamental assumptionswhich until now had brought certainty and securityrsquo (Boydand Myers 1988 277)

The process of discernment is illustrated through thefollowing narrative which relays the change in bestpractices in the sleep position of infants illustrated by theimage of an unfolding spiral a spiral that moves upwardpeaks loops back on itself and then moves upwardsagain an ongoing evolution In the 1970s and 1980s whenI was employed as a public health nurse and then nurseeducator I taught new parents to lay their babies in theprone position when sleeping This was the beginning ofthe first ascending loop in my spiral of learning but at thattime I didnrsquot expect this practice to ever change Workingwith new mothers and fathers and their infants wasrewarding and I enjoyed my identity as a public healthnurse and educator

In the early 1990s population-based case-controlledstudies were undertaken in England New Zealand andTasmania followed by intervention programs in the

Netherlands Norway New Zealand Australia Englandand the United States all substantiated newborn supineor side-lying positions as effective in reducing SIDS deaths(Sadler 1992 Hunt 1995) Despite the quality of theevidence guiding this change in practice initially I foundit uncomfortable to teach parents supine and side-lyinginfant sleeping positions As a nurse I was challenged to be

receptive

to be open to the new evidence to my response tothe evidence and to my fears As one health visitor with 20years of experience expressed lsquomy instinct tells me this[back lying] puts them in danger of choking so I recom-mend they lie on their sides I have read the official DoHinformation but it would have been reassuring and helpfulto have had more detailrsquo (Sadler 1992 19) At the time theevidence sounded strong that the prone position was nolonger one of choice in terms of preventing SIDS but itwas less reassuring about preventing choking I had troublefinding articles written from a nursing perspective whichwould share my perspective of loss and discomfort Forover 10 years I had been advising parents not to put theirinfants in the supine position and I had positioned myown four children all born during the 1980s in the proneposition I began to wonder if my work had added value topeoplersquos lives or endangered them

As research studies became available

recognition

grewthat the evidence was strongly in support of the new prac-tices I experienced a mounting pressure to change myestablished practice of teaching the prone sleeping posi-tion to new mothers and nursing students but there was asignificant gap of time before I was able to access evidencethat I found convincing This evidence included low SIDSrate associated with low prone sleeping position no harmassociated with back or side-lying newborn sleeping and nosignificant impact on decreasing other epidemiological riskfactors for SIDS (Hunt 1995) My colleagues and I were con-vinced it was time to unlearn teaching the prone newbornsleeping position but we needed to work through ourthoughts and feelings before we were ready to change ourpractice and engage fully in teaching the supine and side-lying sleep positions

While the activities of receptivity and recognition werechallenging it was the activity of

grieving

that was mosttroubling that touched the emotional core of my identityas a nurse Before changing my teaching to the supine andside-lying positions it was important to process my sense ofloss and confusion my shaken identity as an expert prac-titioner and to grieve for the possibility that my parenteducation may have led to even one child dying of SIDSand concern that I positioned my four children in theprone position thus exposing them to unnecessary risk

NIN_150fm Page 174 Thursday August 22 2002 753 PM

Transformative unlearning

copy 2002 Blackwell Science Ltd

Nursing Inquiry

9

(3) 170ndash178

175

As a faculty member I had colleagues whom I couldtalk with about my concerns and when I took studentsto the postpartum floor I spoke with nurses and administra-tors reassuring myself that we were changing our practicestogether and that I was up to date in terms of teachingmy students We exchanged practice stories about infantswho had been found choking and families who had experi-enced an SIDS death This sharing of stories researchknowledge and personal feelings facilitated my unlearn-ing One of the postpartum units included several articlesfor staff in the policy binder and displayed a poster toremind parents and staff alike of the changes in bestpractices and the public health nurses shared pamphletsfor prenatal parents An effective media education campaignaimed at expecting parents was established by the healthministry an example of planned change that was compre-hensive and promoted health

Once I had completed this discernment process Iwas ready to move forward adopting the new best prac-tice guidelines of back and side-lying newborn sleepingInterestingly health professionals trained in the 1940sand 1950s when babies were laid on backs or sidesnever prone wrote to the Foundation for the Study ofInfant Deaths applauding the return to traditionalpractices (Sadler 1992) What for me was the first loopin my unfolding spiral was for these more experiencednurses a second loop in their unfolding spiral WhenHealth Canada brought out their Back to Sleep Cam-paign (Health Canada 2002) I found myself revisiting asimilar although briefer and less intense discernmentcycle

First I spoke with a public health nurse who shareda practice story about a mother she was currently visitingwho had a child who lsquospit uprsquo after every feeding The motherwas insistent that it would be dangerous to place the babyon the back right after a feed The public health nurse hadlistened to this mother and had negotiated a compromiseThe mother would lie the baby in the side-lying positionfor approximately 20 minutes after a feed keeping a closewatch on the baby and then turn the baby to the back-lyingposition She had used her judgment and found a wayto maintain safety and respond to the motherrsquos concernsWe shared stories about our own children and sleep posi-tions and reassured ourselves that Health Canada was clearabout back-lying being the preferred position This time Ididnrsquot have to struggle to find information I went directlyto the Internet and looked up the Health Canada web siteand linked the SIDS Foundation web site and found thelsquoSIDS Sleeping Information for Health Care Professionals

mdash

Fact Sheetrsquo (The SIDS Foundation 2000)

I was surprised to find that my spiral was again loopingback on itself and to realize that I had not been aware ofthe evidence identifying that side-lying sleep positions hada higher rate of SIDS deaths than back positions Despitemy surprise I was confident that the Joint Statement (1999)identified the best synthesis of research and practiceknowledge available Still I noted that the fact sheet didnot list any collaborating nursing partnerships and Iprinted out the references so that I could read the originalresearch studies I shared the update with colleagueschecked and found that my new text book was not up-to-date with this best practice and I made a note to make sureand alert my students to check the Health Canada web sitefor the latest practice guidelines

My spiral is now on its third loop and I am anticipatingthat it will begin to accelerate its looping as research know-ledge expands Irsquom beginning to sense that my future willoffer ever-increasing moments of discernment and thatmy identity must incorporate my role as knowledge workerMy roles as caring practitioner and thinking practitionerare intertwined in a bothand holistic and dynamic dancesustained by a network of virtual and real life colleaguesThese colleagues form my lsquocommunity of learningrsquo andplay an essential role in supporting me through trans-formative unlearning

CREATING COMMUNITIES OF LEARNING

Transformative learning theorists Mitchell and Sackney(2000) articulate their world-view drawing upon physicistDavid Bohmrsquos (1980) interpretation of the universe asbeing essentially one connected whole Instead of a worldof fragmented parts Bohm (1980) saw a world of con-nections relationships and common origins Like Bohm(1980) Mitchell and Sackney (2000) see the world as awhole and perceive close connections between personallearning and community learning As such individuals areseen as being responsible for the needs of the collectivesuch as a learning community a group of practitionersin an identified practice environment or the planetarycommunity

Mitchell and Sackney (2000) argue convincingly thatone must attend to both the individual and the collectiveto achieve the best of both individual life and communitylife They espouse a social constructivist orientation andlsquotry to deconstruct what things mean and how they gotthat way and to reconstruct what else they might look likersquo(Mitchell and Sackney 2000 xiii) For Mitchell andSackney (2000) the critical processes of deconstructing andreconstructing create both personal and collective shifts

NIN_150fm Page 175 Thursday August 22 2002 753 PM

G Macdonald

176

copy 2002 Blackwell Science Ltd

Nursing Inquiry

9

(3) 170ndash178

shifts that move towards wholeness social responsivenessand unity This process of change is non-linear ongoingcircular and evolving and resembles a spiral more than astraight line They believe that constructing learning com-munities within practice environments will enhance bothpersonal and social transformation

Building learning communities involves personal inter-personal and organizational capacity building Learn-ing communities consist of lsquoa group of people who takean active reflective collaborative learning-oriented andgrowth-promoting approach toward the mysteries prob-lems and perplexities of teaching and learningrsquo (Mitchelland Sackney 2000 9) Linked to the term lsquolearning com-munityrsquo is the concept of lsquocommunities of practicersquo a termused to describe the contexts of informal learning at homeand work places (Wenger 1998) Communities of practiceshare dynamic and engaged relationships a focus on ashared enterprise and a set of shared resources a reper-toire (Wenger 1998) Learning communities and commu-nities of practice both support the importance of learningwithin a social context one that creates community andenhances learning Such lsquocommunities of learningrsquo areideally designed to sustain transformative unlearningand new learning But how are these communities of learn-ing initiated developed and sustained Who is responsi-ble What supports them and what barriers must beovercome

Nursing educators administrators practitioners andresearchers need to work together to support the develop-ment of lsquocommunities of learningrsquo in nursing workplacesNursing educators begin this process by role modelingcolleagiality with students and encouraging students towork co-operatively in communities of learning As Bohm(1980) states beginnings are important they set a trajectoryfor the future

Nurse administratorsleaders can learn aboutidentifying and planning for lsquotransformative unlearningrsquofrom management and education literature Nurse lead-ers committed to excellence are encouraged to reflectupon the values that guide the development of an evidence-based practice within their local context If as Dingwalland Allen (2001) suggest local nursing practice is mov-ing away from engaging emotional relationships withclients and moving towards a highly technical practicea macro approach may provide important support fortransformative unlearning For example nurse adminis-trators could review their setting to see if and howinformal relationships are nurtured Consider coffeeand lunch facilities Does the space and design promote col-legiality

Ferguson-Pare and Mitchell (2001 8) argue poignantlythat removal of nursing shift reports to improve efficienciesand reduce costs contributed to nursesrsquo

loss of community with each other I did not realize untilnow that shift reports were not only about patients theywere also about nurses and their being with each otherReport time gave nurses a chance to hear about eachotherrsquos struggles and joys hellip report time was also a time tobuild relationships hellip Report times were times when nursesbuilt community and cared for each other

To their credit Ferguson-Pare and Mitchell (2001) invitereaders to contact them through mail or e-mail and discusstheir practice experiences with building community Thepossibilities for building lsquocommunities of learningrsquo forunlearning on the Internet are strong

Alternately consider opportunities for immersionextended unlearning Is it possible to block off 2 hoursonce a month to engage in some learning activities thatwould address an identified need for unlearning suchas developing awareness about diversity practice A lunch-eon with invited guests and diverse foods perhaps sharedby diverse clientsguests with a cultural celebration mayinitiate unlearning racism in a meaningful manner Is itpossible to facilitate a journal club once a month at lunchor afternoon break Encouraging dialogue about the latestevidence creates a lsquocommunity of learning who are con-nected and hopefully supportive of the need to supporttransformative unlearning

Where values are being developed an antidiscrimina-tory practice fostered and individual practitioner changesupported educationrsquos micro approach may provide thebest unlearning Reflecting upon managementrsquos role inaccelerating unlearning of ineffective management prac-tices is an essential part of transformative unlearning(Lei Slocum and Pitts 1999) Consider having staff learningpartners to promote dialogue about changing practicesBuilding in a reward for excellence such as a draw for a freelunch for learning partners will provide clarity about agencyvalues and the importance placed on building workplacecommunities of learning

Novice and experienced practitioners engaged inunlearning and new learning need to negotiate time tothoughtfully reflect on new evidence and work through theirfeelings about the change prior to changing practicesInitiating communities of learning in the practice environ-ment with valued colleagues who share a passion for excel-lence is encouraged Experienced nurses may find as haveexperienced teachers that the intellectual work of changecreates tensions between lsquooutside-inrsquo or research know-ledge and lsquoinside-outrsquo or practice knowledge (Hargreaveset al 2001 132) As they struggle with tensions they are

NIN_150fm Page 176 Thursday August 22 2002 753 PM

Transformative unlearning

copy 2002 Blackwell Science Ltd

Nursing Inquiry

9

(3) 170ndash178

177

building personal capacity for practice development butare cautioned that changes in cognition that do not leadto changes in practice are considered meaningless whilechanges in practice that are not associated with change incognition will not lead to profound improvement (Mitchelland Sackney 2000)

Finally researchers promoting an evidence-based changeare encouraged to include suggestions for facilitatingunlearning of outdated practice in published articles Thisoffers an important strategy to support critical researchto practice links Additionally completing research toexplicate the process of lsquounlearningrsquo within practice willcreate the practice to research to practice link that is suchan important value in an evidence-based professionalpractice

REFERENCES

Argyris C and D Schon 1978

Organizational learning Atheory of action perspective

Reading MassachusettsAddison-Wesley

Baptiste I 2000 Beyond reason and personal integrityToward a pedagogy of coercive restraint

The CanadianJournal for the Study of Adult Education

14(1) 27ndash50Begun JW and KR White 1995 Alternating nursingrsquos

dominant logic Guidelines from complex adaptivesystems theory

Complexity and Chaos in Nursing

2(1)5ndash15

Bettis RA and CK Prahaled 1995 The dominic logicRetrospective and extension

Strategic Management Journal

16 5ndash14Bohm D 1980

Wholeness and the implicate order

LondonRouteledge amp Kegan Paul

Bott E 1995 The unlearning curve

PCComputing

8(2) 338ndash9Boyd RD and JG Myers 1988 Transformative education

International Journal of Lifelong Education

7(4) 261ndash84Brown B 1998

Unlearning discrimination in the early years

Oakhill Stoke-on-Trent Staffordshire Trentham Books

Buchen IH 1998 An organizational New Yearrsquos resolutionTo unlearn

National Productivity Review

18(1) 1ndash4Chalmers D and R Fuller 1996

Teaching for learning at uni-versity Theory and practice

London Kogan PageCochran-Smith M 2000 Blind vision Unlearning racism

in teacher education

Harvard Educational Review

70(2)157ndash90

Cook JA D Staniforth and J Stewart 1997

The learningorganization in the public services

Aldershot GowerDingwall R and D Allen 2001 The implications of health-

care reforms for the profession of nursing

NursingInquiry

8(2) 64ndash74

Ferguson-Pare M and GI Mitchell 2001 Letrsquos get realDestroying-restoring community in nursing

CanadianJournal of Nursing Leadership

14(2) 7ndash9Garratt B 1990

Creating a learning organization

HemelHempstead Director Books

Goldstein T 1997 Unlearning homophobia through apedagogy of anonymity

Teaching Education

9(1) 115ndash9Gregson RPW AG Meal and M Avis 2002 Meta-analysis the

glass eye of evidence-based practice

Nursing Inquiry

9(1) 24ndash30Hamel G and CK Prahalad 1994

Competing for the futureBreakthrough strategies for seizing control of your industry andcreating the markets of tomorrow

Boston Harvard BusinessSchool Press

Hargreaves A L Earl ES Moore and S Manning 2001

Learning to change Teaching beyond subjects and standards

San Francisco Jossey-Bass

Hauser K 1992 Unlearning patriarchy Personal develop-ment in Marge Piercyrsquos lsquoFly Away Homersquo

Feminist Review

42 33ndash43Health Canada 2002 Back to sleep SIDS http

wwwhc-scgccahppbchildhood-youthcyfhsidsjoint_statementhtml

Hunt CE 1995 Relationship between infant sleep positionand SIDS In

Sudden infant death syndrome New trends inthe nineties

ed TO Rognum 106ndash8 Oslo ScandinavianUniversity Press

Jarvis P 2001 The changing educational scene In

The ageof learning Education and the knowledge society

ed P Jarvis27ndash38 London Kogan Page

Joint Statement Health Canada The Canadian Foundationfor the Study of Infant Death Canadian Institute ofChild Health and The Canadian Pediatric Society 1999

Reducing the risk of sudden infant death syndrome in Canada

Catalogue H39ndash4662ndash1999 Ottawa Health CanadaKearsey K 2001 Launch of nursing best practice guidelines

Envisioned as next step to more effective patient care

Registered Nurse Journal

13(6) 8ndash11Kohn A 2000 Unlearning how we learn

Principal

79(4)31ndash2

Lei D JW Slocum and RA Pitts 1999 Designing organiza-tions for competitive advantage The power of unlearningand learning

Organizational Dynamics

27(3) 24ndash38Lewin K 1947 Group decisions and social changes In

Readingsin social psychology

eds TM Newcomb and EL Hartley330ndash44 New York Henry Holt amp Company

Leymann H and H Kornbluh 1989

Socialization and learningat work

Aldershot AveburyGowerMagrath AJ 1997 The importance of unlearning

Across theBoard

34(2) 39ndash41

NIN_150fm Page 177 Thursday August 22 2002 753 PM

Transformative unlearning

copy 2002 Blackwell Science Ltd

Nursing Inquiry

9

(3) 170ndash178

175

As a faculty member I had colleagues whom I couldtalk with about my concerns and when I took studentsto the postpartum floor I spoke with nurses and administra-tors reassuring myself that we were changing our practicestogether and that I was up to date in terms of teachingmy students We exchanged practice stories about infantswho had been found choking and families who had experi-enced an SIDS death This sharing of stories researchknowledge and personal feelings facilitated my unlearn-ing One of the postpartum units included several articlesfor staff in the policy binder and displayed a poster toremind parents and staff alike of the changes in bestpractices and the public health nurses shared pamphletsfor prenatal parents An effective media education campaignaimed at expecting parents was established by the healthministry an example of planned change that was compre-hensive and promoted health

Once I had completed this discernment process Iwas ready to move forward adopting the new best prac-tice guidelines of back and side-lying newborn sleepingInterestingly health professionals trained in the 1940sand 1950s when babies were laid on backs or sidesnever prone wrote to the Foundation for the Study ofInfant Deaths applauding the return to traditionalpractices (Sadler 1992) What for me was the first loopin my unfolding spiral was for these more experiencednurses a second loop in their unfolding spiral WhenHealth Canada brought out their Back to Sleep Cam-paign (Health Canada 2002) I found myself revisiting asimilar although briefer and less intense discernmentcycle

First I spoke with a public health nurse who shareda practice story about a mother she was currently visitingwho had a child who lsquospit uprsquo after every feeding The motherwas insistent that it would be dangerous to place the babyon the back right after a feed The public health nurse hadlistened to this mother and had negotiated a compromiseThe mother would lie the baby in the side-lying positionfor approximately 20 minutes after a feed keeping a closewatch on the baby and then turn the baby to the back-lyingposition She had used her judgment and found a wayto maintain safety and respond to the motherrsquos concernsWe shared stories about our own children and sleep posi-tions and reassured ourselves that Health Canada was clearabout back-lying being the preferred position This time Ididnrsquot have to struggle to find information I went directlyto the Internet and looked up the Health Canada web siteand linked the SIDS Foundation web site and found thelsquoSIDS Sleeping Information for Health Care Professionals

mdash

Fact Sheetrsquo (The SIDS Foundation 2000)

I was surprised to find that my spiral was again loopingback on itself and to realize that I had not been aware ofthe evidence identifying that side-lying sleep positions hada higher rate of SIDS deaths than back positions Despitemy surprise I was confident that the Joint Statement (1999)identified the best synthesis of research and practiceknowledge available Still I noted that the fact sheet didnot list any collaborating nursing partnerships and Iprinted out the references so that I could read the originalresearch studies I shared the update with colleagueschecked and found that my new text book was not up-to-date with this best practice and I made a note to make sureand alert my students to check the Health Canada web sitefor the latest practice guidelines

My spiral is now on its third loop and I am anticipatingthat it will begin to accelerate its looping as research know-ledge expands Irsquom beginning to sense that my future willoffer ever-increasing moments of discernment and thatmy identity must incorporate my role as knowledge workerMy roles as caring practitioner and thinking practitionerare intertwined in a bothand holistic and dynamic dancesustained by a network of virtual and real life colleaguesThese colleagues form my lsquocommunity of learningrsquo andplay an essential role in supporting me through trans-formative unlearning

CREATING COMMUNITIES OF LEARNING

Transformative learning theorists Mitchell and Sackney(2000) articulate their world-view drawing upon physicistDavid Bohmrsquos (1980) interpretation of the universe asbeing essentially one connected whole Instead of a worldof fragmented parts Bohm (1980) saw a world of con-nections relationships and common origins Like Bohm(1980) Mitchell and Sackney (2000) see the world as awhole and perceive close connections between personallearning and community learning As such individuals areseen as being responsible for the needs of the collectivesuch as a learning community a group of practitionersin an identified practice environment or the planetarycommunity

Mitchell and Sackney (2000) argue convincingly thatone must attend to both the individual and the collectiveto achieve the best of both individual life and communitylife They espouse a social constructivist orientation andlsquotry to deconstruct what things mean and how they gotthat way and to reconstruct what else they might look likersquo(Mitchell and Sackney 2000 xiii) For Mitchell andSackney (2000) the critical processes of deconstructing andreconstructing create both personal and collective shifts

NIN_150fm Page 175 Thursday August 22 2002 753 PM

G Macdonald

176

copy 2002 Blackwell Science Ltd

Nursing Inquiry

9

(3) 170ndash178

shifts that move towards wholeness social responsivenessand unity This process of change is non-linear ongoingcircular and evolving and resembles a spiral more than astraight line They believe that constructing learning com-munities within practice environments will enhance bothpersonal and social transformation

Building learning communities involves personal inter-personal and organizational capacity building Learn-ing communities consist of lsquoa group of people who takean active reflective collaborative learning-oriented andgrowth-promoting approach toward the mysteries prob-lems and perplexities of teaching and learningrsquo (Mitchelland Sackney 2000 9) Linked to the term lsquolearning com-munityrsquo is the concept of lsquocommunities of practicersquo a termused to describe the contexts of informal learning at homeand work places (Wenger 1998) Communities of practiceshare dynamic and engaged relationships a focus on ashared enterprise and a set of shared resources a reper-toire (Wenger 1998) Learning communities and commu-nities of practice both support the importance of learningwithin a social context one that creates community andenhances learning Such lsquocommunities of learningrsquo areideally designed to sustain transformative unlearningand new learning But how are these communities of learn-ing initiated developed and sustained Who is responsi-ble What supports them and what barriers must beovercome

Nursing educators administrators practitioners andresearchers need to work together to support the develop-ment of lsquocommunities of learningrsquo in nursing workplacesNursing educators begin this process by role modelingcolleagiality with students and encouraging students towork co-operatively in communities of learning As Bohm(1980) states beginnings are important they set a trajectoryfor the future

Nurse administratorsleaders can learn aboutidentifying and planning for lsquotransformative unlearningrsquofrom management and education literature Nurse lead-ers committed to excellence are encouraged to reflectupon the values that guide the development of an evidence-based practice within their local context If as Dingwalland Allen (2001) suggest local nursing practice is mov-ing away from engaging emotional relationships withclients and moving towards a highly technical practicea macro approach may provide important support fortransformative unlearning For example nurse adminis-trators could review their setting to see if and howinformal relationships are nurtured Consider coffeeand lunch facilities Does the space and design promote col-legiality

Ferguson-Pare and Mitchell (2001 8) argue poignantlythat removal of nursing shift reports to improve efficienciesand reduce costs contributed to nursesrsquo

loss of community with each other I did not realize untilnow that shift reports were not only about patients theywere also about nurses and their being with each otherReport time gave nurses a chance to hear about eachotherrsquos struggles and joys hellip report time was also a time tobuild relationships hellip Report times were times when nursesbuilt community and cared for each other

To their credit Ferguson-Pare and Mitchell (2001) invitereaders to contact them through mail or e-mail and discusstheir practice experiences with building community Thepossibilities for building lsquocommunities of learningrsquo forunlearning on the Internet are strong

Alternately consider opportunities for immersionextended unlearning Is it possible to block off 2 hoursonce a month to engage in some learning activities thatwould address an identified need for unlearning suchas developing awareness about diversity practice A lunch-eon with invited guests and diverse foods perhaps sharedby diverse clientsguests with a cultural celebration mayinitiate unlearning racism in a meaningful manner Is itpossible to facilitate a journal club once a month at lunchor afternoon break Encouraging dialogue about the latestevidence creates a lsquocommunity of learning who are con-nected and hopefully supportive of the need to supporttransformative unlearning

Where values are being developed an antidiscrimina-tory practice fostered and individual practitioner changesupported educationrsquos micro approach may provide thebest unlearning Reflecting upon managementrsquos role inaccelerating unlearning of ineffective management prac-tices is an essential part of transformative unlearning(Lei Slocum and Pitts 1999) Consider having staff learningpartners to promote dialogue about changing practicesBuilding in a reward for excellence such as a draw for a freelunch for learning partners will provide clarity about agencyvalues and the importance placed on building workplacecommunities of learning

Novice and experienced practitioners engaged inunlearning and new learning need to negotiate time tothoughtfully reflect on new evidence and work through theirfeelings about the change prior to changing practicesInitiating communities of learning in the practice environ-ment with valued colleagues who share a passion for excel-lence is encouraged Experienced nurses may find as haveexperienced teachers that the intellectual work of changecreates tensions between lsquooutside-inrsquo or research know-ledge and lsquoinside-outrsquo or practice knowledge (Hargreaveset al 2001 132) As they struggle with tensions they are

NIN_150fm Page 176 Thursday August 22 2002 753 PM

Transformative unlearning

copy 2002 Blackwell Science Ltd

Nursing Inquiry

9

(3) 170ndash178

177

building personal capacity for practice development butare cautioned that changes in cognition that do not leadto changes in practice are considered meaningless whilechanges in practice that are not associated with change incognition will not lead to profound improvement (Mitchelland Sackney 2000)

Finally researchers promoting an evidence-based changeare encouraged to include suggestions for facilitatingunlearning of outdated practice in published articles Thisoffers an important strategy to support critical researchto practice links Additionally completing research toexplicate the process of lsquounlearningrsquo within practice willcreate the practice to research to practice link that is suchan important value in an evidence-based professionalpractice

REFERENCES

Argyris C and D Schon 1978

Organizational learning Atheory of action perspective

Reading MassachusettsAddison-Wesley

Baptiste I 2000 Beyond reason and personal integrityToward a pedagogy of coercive restraint

The CanadianJournal for the Study of Adult Education

14(1) 27ndash50Begun JW and KR White 1995 Alternating nursingrsquos

dominant logic Guidelines from complex adaptivesystems theory

Complexity and Chaos in Nursing

2(1)5ndash15

Bettis RA and CK Prahaled 1995 The dominic logicRetrospective and extension

Strategic Management Journal

16 5ndash14Bohm D 1980

Wholeness and the implicate order

LondonRouteledge amp Kegan Paul

Bott E 1995 The unlearning curve

PCComputing

8(2) 338ndash9Boyd RD and JG Myers 1988 Transformative education

International Journal of Lifelong Education

7(4) 261ndash84Brown B 1998

Unlearning discrimination in the early years

Oakhill Stoke-on-Trent Staffordshire Trentham Books

Buchen IH 1998 An organizational New Yearrsquos resolutionTo unlearn

National Productivity Review

18(1) 1ndash4Chalmers D and R Fuller 1996

Teaching for learning at uni-versity Theory and practice

London Kogan PageCochran-Smith M 2000 Blind vision Unlearning racism

in teacher education

Harvard Educational Review

70(2)157ndash90

Cook JA D Staniforth and J Stewart 1997

The learningorganization in the public services

Aldershot GowerDingwall R and D Allen 2001 The implications of health-

care reforms for the profession of nursing

NursingInquiry

8(2) 64ndash74

Ferguson-Pare M and GI Mitchell 2001 Letrsquos get realDestroying-restoring community in nursing

CanadianJournal of Nursing Leadership

14(2) 7ndash9Garratt B 1990

Creating a learning organization

HemelHempstead Director Books

Goldstein T 1997 Unlearning homophobia through apedagogy of anonymity

Teaching Education

9(1) 115ndash9Gregson RPW AG Meal and M Avis 2002 Meta-analysis the

glass eye of evidence-based practice

Nursing Inquiry

9(1) 24ndash30Hamel G and CK Prahalad 1994

Competing for the futureBreakthrough strategies for seizing control of your industry andcreating the markets of tomorrow

Boston Harvard BusinessSchool Press

Hargreaves A L Earl ES Moore and S Manning 2001

Learning to change Teaching beyond subjects and standards

San Francisco Jossey-Bass

Hauser K 1992 Unlearning patriarchy Personal develop-ment in Marge Piercyrsquos lsquoFly Away Homersquo

Feminist Review

42 33ndash43Health Canada 2002 Back to sleep SIDS http

wwwhc-scgccahppbchildhood-youthcyfhsidsjoint_statementhtml

Hunt CE 1995 Relationship between infant sleep positionand SIDS In

Sudden infant death syndrome New trends inthe nineties

ed TO Rognum 106ndash8 Oslo ScandinavianUniversity Press

Jarvis P 2001 The changing educational scene In

The ageof learning Education and the knowledge society

ed P Jarvis27ndash38 London Kogan Page

Joint Statement Health Canada The Canadian Foundationfor the Study of Infant Death Canadian Institute ofChild Health and The Canadian Pediatric Society 1999

Reducing the risk of sudden infant death syndrome in Canada

Catalogue H39ndash4662ndash1999 Ottawa Health CanadaKearsey K 2001 Launch of nursing best practice guidelines

Envisioned as next step to more effective patient care

Registered Nurse Journal

13(6) 8ndash11Kohn A 2000 Unlearning how we learn

Principal

79(4)31ndash2

Lei D JW Slocum and RA Pitts 1999 Designing organiza-tions for competitive advantage The power of unlearningand learning

Organizational Dynamics

27(3) 24ndash38Lewin K 1947 Group decisions and social changes In

Readingsin social psychology

eds TM Newcomb and EL Hartley330ndash44 New York Henry Holt amp Company

Leymann H and H Kornbluh 1989

Socialization and learningat work

Aldershot AveburyGowerMagrath AJ 1997 The importance of unlearning

Across theBoard

34(2) 39ndash41

NIN_150fm Page 177 Thursday August 22 2002 753 PM

G Macdonald

176

copy 2002 Blackwell Science Ltd

Nursing Inquiry

9

(3) 170ndash178

shifts that move towards wholeness social responsivenessand unity This process of change is non-linear ongoingcircular and evolving and resembles a spiral more than astraight line They believe that constructing learning com-munities within practice environments will enhance bothpersonal and social transformation

Building learning communities involves personal inter-personal and organizational capacity building Learn-ing communities consist of lsquoa group of people who takean active reflective collaborative learning-oriented andgrowth-promoting approach toward the mysteries prob-lems and perplexities of teaching and learningrsquo (Mitchelland Sackney 2000 9) Linked to the term lsquolearning com-munityrsquo is the concept of lsquocommunities of practicersquo a termused to describe the contexts of informal learning at homeand work places (Wenger 1998) Communities of practiceshare dynamic and engaged relationships a focus on ashared enterprise and a set of shared resources a reper-toire (Wenger 1998) Learning communities and commu-nities of practice both support the importance of learningwithin a social context one that creates community andenhances learning Such lsquocommunities of learningrsquo areideally designed to sustain transformative unlearningand new learning But how are these communities of learn-ing initiated developed and sustained Who is responsi-ble What supports them and what barriers must beovercome

Nursing educators administrators practitioners andresearchers need to work together to support the develop-ment of lsquocommunities of learningrsquo in nursing workplacesNursing educators begin this process by role modelingcolleagiality with students and encouraging students towork co-operatively in communities of learning As Bohm(1980) states beginnings are important they set a trajectoryfor the future

Nurse administratorsleaders can learn aboutidentifying and planning for lsquotransformative unlearningrsquofrom management and education literature Nurse lead-ers committed to excellence are encouraged to reflectupon the values that guide the development of an evidence-based practice within their local context If as Dingwalland Allen (2001) suggest local nursing practice is mov-ing away from engaging emotional relationships withclients and moving towards a highly technical practicea macro approach may provide important support fortransformative unlearning For example nurse adminis-trators could review their setting to see if and howinformal relationships are nurtured Consider coffeeand lunch facilities Does the space and design promote col-legiality

Ferguson-Pare and Mitchell (2001 8) argue poignantlythat removal of nursing shift reports to improve efficienciesand reduce costs contributed to nursesrsquo

loss of community with each other I did not realize untilnow that shift reports were not only about patients theywere also about nurses and their being with each otherReport time gave nurses a chance to hear about eachotherrsquos struggles and joys hellip report time was also a time tobuild relationships hellip Report times were times when nursesbuilt community and cared for each other

To their credit Ferguson-Pare and Mitchell (2001) invitereaders to contact them through mail or e-mail and discusstheir practice experiences with building community Thepossibilities for building lsquocommunities of learningrsquo forunlearning on the Internet are strong

Alternately consider opportunities for immersionextended unlearning Is it possible to block off 2 hoursonce a month to engage in some learning activities thatwould address an identified need for unlearning suchas developing awareness about diversity practice A lunch-eon with invited guests and diverse foods perhaps sharedby diverse clientsguests with a cultural celebration mayinitiate unlearning racism in a meaningful manner Is itpossible to facilitate a journal club once a month at lunchor afternoon break Encouraging dialogue about the latestevidence creates a lsquocommunity of learning who are con-nected and hopefully supportive of the need to supporttransformative unlearning

Where values are being developed an antidiscrimina-tory practice fostered and individual practitioner changesupported educationrsquos micro approach may provide thebest unlearning Reflecting upon managementrsquos role inaccelerating unlearning of ineffective management prac-tices is an essential part of transformative unlearning(Lei Slocum and Pitts 1999) Consider having staff learningpartners to promote dialogue about changing practicesBuilding in a reward for excellence such as a draw for a freelunch for learning partners will provide clarity about agencyvalues and the importance placed on building workplacecommunities of learning

Novice and experienced practitioners engaged inunlearning and new learning need to negotiate time tothoughtfully reflect on new evidence and work through theirfeelings about the change prior to changing practicesInitiating communities of learning in the practice environ-ment with valued colleagues who share a passion for excel-lence is encouraged Experienced nurses may find as haveexperienced teachers that the intellectual work of changecreates tensions between lsquooutside-inrsquo or research know-ledge and lsquoinside-outrsquo or practice knowledge (Hargreaveset al 2001 132) As they struggle with tensions they are

NIN_150fm Page 176 Thursday August 22 2002 753 PM

Transformative unlearning

copy 2002 Blackwell Science Ltd

Nursing Inquiry

9

(3) 170ndash178

177

building personal capacity for practice development butare cautioned that changes in cognition that do not leadto changes in practice are considered meaningless whilechanges in practice that are not associated with change incognition will not lead to profound improvement (Mitchelland Sackney 2000)

Finally researchers promoting an evidence-based changeare encouraged to include suggestions for facilitatingunlearning of outdated practice in published articles Thisoffers an important strategy to support critical researchto practice links Additionally completing research toexplicate the process of lsquounlearningrsquo within practice willcreate the practice to research to practice link that is suchan important value in an evidence-based professionalpractice

REFERENCES

Argyris C and D Schon 1978

Organizational learning Atheory of action perspective

Reading MassachusettsAddison-Wesley

Baptiste I 2000 Beyond reason and personal integrityToward a pedagogy of coercive restraint

The CanadianJournal for the Study of Adult Education

14(1) 27ndash50Begun JW and KR White 1995 Alternating nursingrsquos

dominant logic Guidelines from complex adaptivesystems theory

Complexity and Chaos in Nursing

2(1)5ndash15

Bettis RA and CK Prahaled 1995 The dominic logicRetrospective and extension

Strategic Management Journal

16 5ndash14Bohm D 1980

Wholeness and the implicate order

LondonRouteledge amp Kegan Paul

Bott E 1995 The unlearning curve

PCComputing

8(2) 338ndash9Boyd RD and JG Myers 1988 Transformative education

International Journal of Lifelong Education

7(4) 261ndash84Brown B 1998

Unlearning discrimination in the early years

Oakhill Stoke-on-Trent Staffordshire Trentham Books

Buchen IH 1998 An organizational New Yearrsquos resolutionTo unlearn

National Productivity Review

18(1) 1ndash4Chalmers D and R Fuller 1996

Teaching for learning at uni-versity Theory and practice

London Kogan PageCochran-Smith M 2000 Blind vision Unlearning racism

in teacher education

Harvard Educational Review

70(2)157ndash90

Cook JA D Staniforth and J Stewart 1997

The learningorganization in the public services

Aldershot GowerDingwall R and D Allen 2001 The implications of health-

care reforms for the profession of nursing

NursingInquiry

8(2) 64ndash74

Ferguson-Pare M and GI Mitchell 2001 Letrsquos get realDestroying-restoring community in nursing

CanadianJournal of Nursing Leadership

14(2) 7ndash9Garratt B 1990

Creating a learning organization

HemelHempstead Director Books

Goldstein T 1997 Unlearning homophobia through apedagogy of anonymity

Teaching Education

9(1) 115ndash9Gregson RPW AG Meal and M Avis 2002 Meta-analysis the

glass eye of evidence-based practice

Nursing Inquiry

9(1) 24ndash30Hamel G and CK Prahalad 1994

Competing for the futureBreakthrough strategies for seizing control of your industry andcreating the markets of tomorrow

Boston Harvard BusinessSchool Press

Hargreaves A L Earl ES Moore and S Manning 2001

Learning to change Teaching beyond subjects and standards

San Francisco Jossey-Bass

Hauser K 1992 Unlearning patriarchy Personal develop-ment in Marge Piercyrsquos lsquoFly Away Homersquo

Feminist Review

42 33ndash43Health Canada 2002 Back to sleep SIDS http

wwwhc-scgccahppbchildhood-youthcyfhsidsjoint_statementhtml

Hunt CE 1995 Relationship between infant sleep positionand SIDS In

Sudden infant death syndrome New trends inthe nineties

ed TO Rognum 106ndash8 Oslo ScandinavianUniversity Press

Jarvis P 2001 The changing educational scene In

The ageof learning Education and the knowledge society

ed P Jarvis27ndash38 London Kogan Page

Joint Statement Health Canada The Canadian Foundationfor the Study of Infant Death Canadian Institute ofChild Health and The Canadian Pediatric Society 1999

Reducing the risk of sudden infant death syndrome in Canada

Catalogue H39ndash4662ndash1999 Ottawa Health CanadaKearsey K 2001 Launch of nursing best practice guidelines

Envisioned as next step to more effective patient care

Registered Nurse Journal

13(6) 8ndash11Kohn A 2000 Unlearning how we learn

Principal

79(4)31ndash2

Lei D JW Slocum and RA Pitts 1999 Designing organiza-tions for competitive advantage The power of unlearningand learning

Organizational Dynamics

27(3) 24ndash38Lewin K 1947 Group decisions and social changes In

Readingsin social psychology

eds TM Newcomb and EL Hartley330ndash44 New York Henry Holt amp Company

Leymann H and H Kornbluh 1989

Socialization and learningat work

Aldershot AveburyGowerMagrath AJ 1997 The importance of unlearning

Across theBoard

34(2) 39ndash41

NIN_150fm Page 177 Thursday August 22 2002 753 PM

Transformative unlearning

copy 2002 Blackwell Science Ltd

Nursing Inquiry

9

(3) 170ndash178

177

building personal capacity for practice development butare cautioned that changes in cognition that do not leadto changes in practice are considered meaningless whilechanges in practice that are not associated with change incognition will not lead to profound improvement (Mitchelland Sackney 2000)

Finally researchers promoting an evidence-based changeare encouraged to include suggestions for facilitatingunlearning of outdated practice in published articles Thisoffers an important strategy to support critical researchto practice links Additionally completing research toexplicate the process of lsquounlearningrsquo within practice willcreate the practice to research to practice link that is suchan important value in an evidence-based professionalpractice

REFERENCES

Argyris C and D Schon 1978

Organizational learning Atheory of action perspective

Reading MassachusettsAddison-Wesley

Baptiste I 2000 Beyond reason and personal integrityToward a pedagogy of coercive restraint

The CanadianJournal for the Study of Adult Education

14(1) 27ndash50Begun JW and KR White 1995 Alternating nursingrsquos

dominant logic Guidelines from complex adaptivesystems theory

Complexity and Chaos in Nursing

2(1)5ndash15

Bettis RA and CK Prahaled 1995 The dominic logicRetrospective and extension

Strategic Management Journal

16 5ndash14Bohm D 1980

Wholeness and the implicate order

LondonRouteledge amp Kegan Paul

Bott E 1995 The unlearning curve

PCComputing

8(2) 338ndash9Boyd RD and JG Myers 1988 Transformative education

International Journal of Lifelong Education

7(4) 261ndash84Brown B 1998

Unlearning discrimination in the early years

Oakhill Stoke-on-Trent Staffordshire Trentham Books

Buchen IH 1998 An organizational New Yearrsquos resolutionTo unlearn

National Productivity Review

18(1) 1ndash4Chalmers D and R Fuller 1996

Teaching for learning at uni-versity Theory and practice

London Kogan PageCochran-Smith M 2000 Blind vision Unlearning racism

in teacher education

Harvard Educational Review

70(2)157ndash90

Cook JA D Staniforth and J Stewart 1997

The learningorganization in the public services

Aldershot GowerDingwall R and D Allen 2001 The implications of health-

care reforms for the profession of nursing

NursingInquiry

8(2) 64ndash74

Ferguson-Pare M and GI Mitchell 2001 Letrsquos get realDestroying-restoring community in nursing

CanadianJournal of Nursing Leadership

14(2) 7ndash9Garratt B 1990

Creating a learning organization

HemelHempstead Director Books

Goldstein T 1997 Unlearning homophobia through apedagogy of anonymity

Teaching Education

9(1) 115ndash9Gregson RPW AG Meal and M Avis 2002 Meta-analysis the

glass eye of evidence-based practice

Nursing Inquiry

9(1) 24ndash30Hamel G and CK Prahalad 1994

Competing for the futureBreakthrough strategies for seizing control of your industry andcreating the markets of tomorrow

Boston Harvard BusinessSchool Press

Hargreaves A L Earl ES Moore and S Manning 2001

Learning to change Teaching beyond subjects and standards

San Francisco Jossey-Bass

Hauser K 1992 Unlearning patriarchy Personal develop-ment in Marge Piercyrsquos lsquoFly Away Homersquo

Feminist Review

42 33ndash43Health Canada 2002 Back to sleep SIDS http

wwwhc-scgccahppbchildhood-youthcyfhsidsjoint_statementhtml

Hunt CE 1995 Relationship between infant sleep positionand SIDS In

Sudden infant death syndrome New trends inthe nineties

ed TO Rognum 106ndash8 Oslo ScandinavianUniversity Press

Jarvis P 2001 The changing educational scene In

The ageof learning Education and the knowledge society

ed P Jarvis27ndash38 London Kogan Page

Joint Statement Health Canada The Canadian Foundationfor the Study of Infant Death Canadian Institute ofChild Health and The Canadian Pediatric Society 1999

Reducing the risk of sudden infant death syndrome in Canada

Catalogue H39ndash4662ndash1999 Ottawa Health CanadaKearsey K 2001 Launch of nursing best practice guidelines

Envisioned as next step to more effective patient care

Registered Nurse Journal

13(6) 8ndash11Kohn A 2000 Unlearning how we learn

Principal

79(4)31ndash2

Lei D JW Slocum and RA Pitts 1999 Designing organiza-tions for competitive advantage The power of unlearningand learning

Organizational Dynamics

27(3) 24ndash38Lewin K 1947 Group decisions and social changes In

Readingsin social psychology

eds TM Newcomb and EL Hartley330ndash44 New York Henry Holt amp Company

Leymann H and H Kornbluh 1989

Socialization and learningat work

Aldershot AveburyGowerMagrath AJ 1997 The importance of unlearning

Across theBoard

34(2) 39ndash41

NIN_150fm Page 177 Thursday August 22 2002 753 PM

G Macdonald

178

copy 2002 Blackwell Science Ltd

Nursing Inquiry

9

(3) 170ndash178

Mariotti J 1999 Change requires learning

mdash

and unlearn-ing

Industry Week

248(12) 59Massin T 1992 Unlearning to not speak Adult educators

and the female learner

Adult Learning

4(1) 30ndash1McNair S 2001 Social economic and political contexts In

The age of learning Education and the knowledge society

edP Jarvis 16ndash26 London Kogan Page

Mitchell C and L Sackney 2000

Profound improvement Build-ing capacity for a learning community

The NetherlandsSwets amp Zeitlinger

Newstrom J 1983 The management of unlearningExploding the lsquoclean slatersquo fallacy

Training and Develop-ment Journal

37(8) 36ndash9Nicole J 1996 Unlearning in order to learn Towards an

ecumenical theological formation

The Ecumenical Review

48(4) 476ndash88Nutely S HTO Davies and N Tilley 2000 Editorial Getting

research into practice

Public Money amp Management

20(4)3ndash6

Pearlmutter S 1998 Self-efficacy and organizational changeleadership

Administration in Social Work

22(3) 23ndash38Pelz DG 1976 Environments for creative performances

In

Individuality in learning

ed S Messick 229ndash47 SanFrancisco Jossey-Bass

Pepitone JS 2000

Human performance consulting

HoustonTexas Gulf Publishing

Powell R 1994 The great unlearning

Architectural Review

196(1171) 68ndash9Prather JP 1985 Philosophical examination of the problem

of the unlearning of incorrect science concepts

Paperpresented at the 58th Annual Meeting of the NationalAssociation for Research in Science Teaching FrenchLick Springs Indiana 15ndash18 April 1985 Abstract inERIC

Ray MD 1997 Letters from the edge

American Journal ofHealth-System Pharmacy

54(16) 1827ndash32Rescorla RA and AR Wagner 1972 A theory of Pavlovian

conditioning variations in the effectiveness of reinforce-ment and nonreinforcement In

Classical conditioning IIcurrent research and theory

eds AH Black and WF Prokasy64ndash99 New York Appleton Century Crofts

Roberts KB and TG DeWitt 1996 Faculty developmentof pediatric practitioners Complexities in teachingclinical preceptoring

American Academy of Pediatrics

97(3)389ndash93

Rogers EF W Metlay IT Kaplan and T Shapiro 1995

Self-managing work teams do they really work

HumanResource Planning

18(2) 53ndash8Sadler C 1992 Sleeping like a baby

Nursing Times

88(7)18ndash19

Satcher D 1999 Unlearning violence

Public Health Reports

114(5) 478ndash82Schein EH 1972

Professional education Some new directions

New York McGraw-Hill

Senge PM 1991

The fifth discipline The art and practice of thelearning organization

New York DoubledayCurrencySenge PM 1994

The fifth discipline fieldbook

London Nicho-las Brealey

Sherwood D 2000 The unlearning organization

BusinessStrategy Review

11(3) 31ndash40Short RR 1981 Managing unlearning

Training and Develop-ment Journal

35(7) 37ndash44SmithBattle L 1997 Change and continuity in family car-

egiving practices with young mothers and their children

Image the Journal of Nursing Scholarship

29(2) 145ndash9Soto-Crespo RE 1999 The bounds of hope Unlearning

lsquoOld Eyesrsquo and a pedagogy of renewal

Thresholds in Edu-cation

25(23) 42ndash6Sowder C 1973 Mediated unlearning

Journal of ExperimentalPsychology

100(1) 50ndash7The SIDS Foundation 2000 Sleeping information for health

care professionals Fact sheet Toronto The Cana-dian Foundation for the Study of Infant Deaths httpwwwsidscanadaorgorgresearch_sleepinfoprofhtml

Ward RP 2000 Unlearning bad habits

For the Defense

42(3) 47Wasserman EA and RR Miller 1997 Whatrsquos elementary

about associative learning

Annual Review of Psychology

48573ndash607

Wellard S and E Bethune 1996 Reflective journal writing innurse education Whose interests does it serve

Journalof Advanced Nursing

24(5) 1077ndash82Wenger E 1998

Communities of practice Learning meaningand identity

Cambridge Cambridge University PressWest P 1994 The learning organization Losing the luggage in

transit

Journal of European Industrial Training

18(11) 30ndash8Wijnhoven F 2001 Acquiring organizational learning

norms A contingency approach for understandingdeutero learning

Management Learning

32(2) 181ndash200Young CE 1996 Statewide articulation plan for nursing

education A study of change

N and HC Perspectives onCommunity

17(4) 190ndash5

NIN_150fm Page 178 Thursday August 22 2002 753 PM