Maki Iwase in front of bookshelf

“Thinking through theory is one way to approach and engage with ‘the story behind the story’ in any clinical phenomenon.”

After less than one year in U of T Nursing’s master’s program, Maki Iwase’s command of nursing and socio-cultural theories led to her being fast-tracked into the PhD program. Her doctoral thesis is titled The Social Effects of Gestational Diabetes in High-Risk Ethnic Groups.

Formerly a certified diabetes educator, Iwase now instructs in how theory underpins the relational work of health care providers. For example, in the undergraduate Caring for Adults and Older Individuals in the Community course, Iwase uses the home as an entry point to analyze how the broader macro issues of race, gender and class affect the micro-politics of patients in the community setting. This approach furthers the understanding of how neighbourhoods and institutions — as well the broader social, political, economic and historical context — shape a patient’s everyday reality.

In the nomination, the student states that you “create a sense of community in each class…and advocate on behalf of the students to lighten the workload and decrease the stress experienced by second year nursing students.” Could you tell us a bit more about how you accomplish this, and why it’s an important aspect of your approach to teaching?

Before responding to your question about how I accomplished this, I’d first like to share the reasoning behind the student’s comment.  When I was revising this course, I carefully considered, first and foremost, the students who are enrolled in my course. They are second/final-year nursing students who have intensive clinical placements in acute care settings (working two 12 hour shifts/week with very sick and vulnerable patients) or community settings (working two 8 hour shifts/week with marginalized and barriered clients living with persistent illness) and three intellectually challenging courses (my theory course, a research course, and their seminar/course related to their acute care/community setting). Some students work part-time to support a family or work as unpaid family caregivers (elder care/ child care).  

I also seriously considered a concern raised by former students from the previous year (fall 2015) who approached me at the end of term to disclose the following comment which left me feeling sad and disheartened: Even though they found my lectures stimulating and exciting and they wanted to attend class with their peers, they simply did not have the physical fortitude and mental health to do so because they had difficulties with juggling their classes, multiple assignments, and intensive clinical practice caring for vulnerable patients/clients (physically and emotionally difficult work), as well as work and family obligations. They candidly and regretfully stated that my course ended up at the bottom of their priority list due to these competing interests and this compromised their academic success and future practice.

Having taken these concerns into account, I reconfigured the intentions/objectives of the course (why this course matters), methods of evaluation (3 blog posts and final written exam instead of the mid-term and final paper, and included participation marks for coming to class and engaging in collaborative learning activities), and pedagogical approach that 1) incited curiosity and enthusiasm for topics related to nursing practice and matters of social justice, 2) affirmed their contributions in class and in their clinical practice of caring for highly complex clients, and 3) cultivated a safe space to have candid conversations about their observations and clinical experiences about ethical issues. 

I made a conscious effort to avoid teaching at the podium for long stretches of time, and instead, I did 10-15 minute lecturettes, followed by a collaborative learning activity (such as 3-2-1 while viewing a short clip, a clinical reflection pair-share, small group and class discussion related to their clinical practice and everyday lives). I would put on a microphone and circulate around the lecture room, join in on conversation, and hold the microphone up to students (Oprah Winfrey-style) who were willing to share their insights and narratives with the rest of the class. In the process of doing so, I became familiar each student, and by the end, I knew all of their names (all 180 students in the lecture which impressed them to no end—they appreciated that I knew who they were individually and collectively).  

More importantly, the students appreciated that I etched out time and space for them to reflect on their clinical practice and to render clinical phenomenon intelligible through theoretical ideas from the humanities and social sciences. This course donated a vocabulary to articulate the complexity of nursing work and affirm the significance of nursing to positive patient outcomes within and beyond the hospital walls. The lecture hall became a space to have genuine and authentic conversations about inclusionary practices that foregrounded a shared humanity and galvanized solidarity as soon-to-be nurses. 

At the beginning of the term, I held on to this mantra/affirmation to set the tone and tenor of this theory course:

A culture of compassion, well-being, inclusivity, equity and social justice starts in the classroom. As bell hooks reminds us in Teaching to Transgress, “the classroom remains the most radical space of possibility in the academy.” 

I took this to heart because I knew the students would grow into the conversations I create around them.  

I also wanted to demonstrate that I am deeply invested in their learning as soon-to-be nurses and that I was there to care for them as they were learning how to care. Not only was I investing in their intellectual development, I was also investing in innovative strategies that would fortify their physical and emotional well-being in the class. So, when the opportunity presented itself to include a MoveU Movement Break into the lecture, I reached out to the MoveU Crew and invited a volunteer, Becky, to facilitate this for the students. This was a huge success as evidenced by an endearing question one of the students posed to Becky: “Can you also come to our research class this afternoon?” This Movement Break enhanced the quality of the classroom discussion thereafter. 

Discussions about health are often related to concerns about healthy eating, physical activity, managing stress and sleep. We’d be interested to hear from you, your thoughts on the concept of a healthy campus and how it can be integrated into the classroom setting?

To me, this goes beyond individual lifestyle behaviours but takes seriously the notion of ‘healthy campus’ as a constitutive site that’s made up of places/spaces of inclusion and belonging, health and healing practices, including religious observance, and people from all walks of life who inhabit this space collectively.  Also a ‘healthy campus’ necessitate policies, practices, and the structural and material conditions to it possible. Bringing innovative initiatives like MoveU into the classroom is one example for fostering a healthy campus. 

In the nomination, the student describes you as “an incredible teacher” and that “it was such a privilege to be in her class. Her class was an important eye opener for so many tough issues that rarely get discussed in traditional nursing courses but are SO IMPORTANT. She is a teacher who will leave a lasting impact on so many of her students.” Please let us know what this nomination as a Healthy Campus Champion means to you personally and/or professionally?

This nomination is meaningful to me, both personally and professionally, because it validates two things that are closely intertwined: First, this nomination acknowledges the hard work of preparing and delivering a thoughtful lecture as well as personal sacrifices that instructors make every day to teach and invest in the future of our students. And second, this nomination speaks to the significance of cultivating an inclusive space of belonging to share clinical narratives and talk through the complexities of care. What the student is referencing in the above quote is that nursing is not just about clinical knowledge, skill and judgement, but it’s also about the history, politics and ethics of practice. This course encourages students to engage in critical reflexivity and thoughtful critique of taken-for-granted assumptions that our practice rests. And what students appreciate most from the course was being able to do just that: participate in difficult conversations in a supportive and affirming environment.    

We would also be interested to hear if you have any suggestions about what more could be done to foster campus environments that support the wellbeing of students?

For me, ‘fostering campus environments that supports the well-being of students’ means any initiative that invests in and supports the structural and material conditions that foster the practices, people (students, faculty and staff), and places/spaces therein. The campaign for Building a Healthier Campus and this Community of Champions project is one of many innovative ways to accomplish precisely this. Thank you so much for the nomination!  And yes, arranging a photographer would be much appreciated.