Implementing a narrative-centred curriculum in an undergraduate midwifery programme: A hermeneutic study Andrea Gilkison 2011 A thesis submitted to AUT University in fulfilment of the requirements for the degree of Doctor of Philosophy (PhD) Faculty of Health and Environmental Sciences Primary Supervisor: Associate Professor Lynne Giddings i Table of Contents Table of Contents ......................................................................................... i Table of Tables ........................................................................................... vi Table of Figures .......................................................................................... vi Attestation of Authorship ......................................................................... vii Acknowledgements ................................................................................... viii Abstract ........................................................................................................ x Chapter One: Introduction ........................................................................ 1 The research question, purpose and aims of the study ............................................ 1 Defining pedagogy ................................................................................................... 1 The context of midwifery in Aotearoa, New Zealand .............................................. 3 My journey towards this research ........................................................................... 4 My first teaching session ......................................................................................... 5 An introduction to narrative pedagogy.................................................................... 7 Justification for the study......................................................................................... 9 Consultation and preparation for the study .......................................................... 10 Pre-understandings................................................................................................ 10 Overview of methodology and methods ................................................................. 11 Organisation of the thesis ...................................................................................... 13 Chapter Two: Overview of pedagogical approaches to teaching and learning midwifery in Aotearoa, New Zealand 1904-2010 ............ 15 Introduction ........................................................................................................... 15 Revealing a pedagogical approach ....................................................................... 16 Pre 1900s: No formal midwifery education........................................................... 17 Late 1800s-early 1900s: Introducing professionalism .......................................... 19 1920s: Promoting safe birth .................................................................................. 22 1930s: Pain relief .................................................................................................. 23 1950s: The rise of the consumer movement ........................................................... 26 1950 and 1960s: The rise of educational theory ................................................... 27 1970s: Increasing technology available in obstetrics ........................................... 28 1980s: Politicisation of midwives .......................................................................... 32 1990: Midwives win autonomy and Direct Entry midwifery education ................ 34 Late 1990s: Education as an economic industry ................................................... 38 Conclusion ............................................................................................................. 40 Chapter Three: Narrative pedagogy emerges ........................................ 43 Introduction ........................................................................................................... 43 Literature emerging from Narrative Pedagogy ..................................................... 48 How has narrative pedagogy been adopted? ........................................................ 50 Students‟ and teachers‟ experiences of narrative pedagogy ................................. 51 Defining narrative and story: Is there a difference? ............................................. 53 Narrative in learning environments....................................................................... 54 Narrative centred curricula ................................................................................... 56 Conclusion ............................................................................................................. 57 Chapter Four: Methodology .................................................................... 59 Introduction ........................................................................................................... 59 Hermeneutics: The development of Paul Ricoeur‟s philosophical hermeneutics . 59 Development of Ricoeur‟s philosophy ................................................................... 60 Hermeneutic philosophers ..................................................................................... 61 ii Meaning found in text ............................................................................................ 62 Pre-understandings and interpretation ................................................................. 63 Distanciation and appropriation ........................................................................... 64 Ricoeur‟s theory of time and narrative .................................................................. 65 History and fiction ................................................................................................. 66 Emplotment and mimesis ....................................................................................... 66 Time ....................................................................................................................... 68 Narrative identity ................................................................................................... 69 Participatory inquiry ............................................................................................. 70 A critical positioning to Ricoeur‟s hermeneutics .................................................. 73 Conclusion ............................................................................................................. 75 Chapter Five: Methods ............................................................................. 76 Introduction ........................................................................................................... 76 Consultation and preparation ............................................................................... 76 External Consultation ......................................................................................... 76 Advisory committee consultation ....................................................................... 76 Planning and design ............................................................................................ 77 Consulting with Māori ........................................................................................ 77 Study design overview............................................................................................ 78 Ethical considerations: Protection of participants................................................ 78 Protection of the student participants: Anonymity and informed consent .......... 80 Protection of the teacher participants: Confidentiality and informed consent .... 80 Data collection methods: Midwifery students ....................................................... 81 Data collection 1: Midwifery students‟ focus groups ............................................ 81 Timing ................................................................................................................. 81 Protocol for students who identified as Māori .................................................... 82 Organisation ........................................................................................................ 82 Focus group interviews ....................................................................................... 82 The transcripts ..................................................................................................... 82 Drop off in participation ..................................................................................... 83 Analysis of student data ...................................................................................... 83 Data collection 2: Midwifery students‟ written reflections ................................... 84 Data collection 3: Midwifery teachers .................................................................. 85 Teachers‟ research conversations: The first meeting .......................................... 85 Transcription process .......................................................................................... 86 My thinking processes ........................................................................................ 86 Ongoing research conversations ......................................................................... 87 Number of meetings ............................................................................................ 88 Scheduling meetings