Modes of knowing in simulated human pedagogies: The uncanny double of performance in nursing education

Abstract

Computerised simulated human technologies are often considered to be the gold standard in clinical education, but calls to critically enhance the theoretical and philosophical foundation of this pedagogy have largely been left unanswered. The simulation learning literature is vast, but it is concerned mostly with measuring student outcomes and learning satisfaction, and little is known about how these technologies influence the practices of clinical educators or how professional practice learning is embodied in this complex, contentious, and uncanny space. This thesis explores the ways in which nurse educators enrol computerised simulated human patients into the assemblages within their pedagogical practices. Guided by the sensibilities of actor-network theory (ANT), and Mol’s (2002) notion of praxiography, ethnographic observations were undertaken with nurse educators at two nursing schools. The educators wore digital videoglasses to record their teaching practices from their own visual perspective during the observations. In-depth elicitation interviews were held to further explore these practices. The ANT sensibilities of allegory, translation, and multiple worlds guided a posthuman analysis of the assembled materials. The analysis revealed an understanding of the practices of simulation education as being doubly performative. The hybrid assemblages of simulation and educator tell stories that act on multiple levels; simultaneously specific and allegorical, theatrical and practice-focused. These multiple layers of the uncanny are integral to the allegorical practices that must contend with the tension of teaching students to pretend to be nurses while they are learning to become nurses. While professing to enact ‘scientific’ and evidence-based approaches to teaching, the nurse educators’ practices are inextricably bound with storytelling, indicating that the scientific and folkloric are not in binary opposition. Further, the thesis has refined the use of allegory in and beyond ANT-inspired approaches to conceptualise research in education and practice settings.