key: cord-1000491-x9d4dtwb
authors: Christopher, Roberta; de Tantillo, Lila; Watson, Jean
title: Academic caring pedagogy, presence, and Communitas in nursing education during the COVID-19 pandemic
date: 2020-09-25
journal: Nurs Outlook
DOI: 10.1016/j.outlook.2020.08.006
sha: b93b94ea207a03ebd5d74a133bf78e0743a4dc4d
doc_id: 1000491
cord_uid: x9d4dtwb

BACKGROUND: Strong faculty academic human caring presence is paramount during the exponential use of asynchronous, remote learning during the COVID-19 pandemic. PURPOSE: The purpose of this article is to provide a holistic, theoretical foundation for evidence informed-caring pedagogical practices. METHODS: Watson's (2008; 2018) Unitary Caring Science theoretical approach offers one pedagogical caring framework for advancing teaching-learning in the digital age. DISCUSSION: Examples to humanize the virtual classroom and remote or online teaching include narrative, theory-guided pedagogical approaches, such as creation of caring spaces and other modalities to transcend physical distancing and nurture Communitas (caring community) among of faculty and students. CONCLUSION: A theory-guided, holistic caring pedagogical approach supports the needs of both faculty and nursing students.

Strong academic leadership, faculty presence, and flexible policies are paramount as a result of COVID-19. Physical separation and social distancing, intertwined with new expectations of asynchronous remote learning, impact student psychological well-being and learning through heightened stress, fear, and anxiety (Center for Disease Control and Prevention (CDC) 2019; Gritsenko et al., 2020) . Human caring has long been established as a central value in nursing education Declarations: This publication did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The contributing authors declare that there is no conflict of interest. *Corresponding author. Jacksonville University, 2800 University Boulevard, North, Jacksonville, FL 32211. E-mail address: rchrist6@ju.edu (R. Christopher). 1 Personal Permanent Home Address: 94120 Fiddlers Walk LN, Fernandina Beach, FL 32034. (Tanner, 1990; Hills & Watson, 2011 , 2021 and can be considered an essential practice. Thus, optimizing caring pedagogical practices in a remote learning environment may foster further expressions of caring presence. The purpose of this article is to provide theoretically based, evidence-informed caring practices that nursing faculty may use to augment remote learning pedagogy.

According to Duffy (2018) , caring pedagogy is the art of teaching which integrates caring factors through a student-centered learning environments and genuine relationships. Motta and Bennett (2018) added that caring pedagogy nurtures time-spaces for co-creation of knowledge, and faculty embracing the whole student and their unique learning needs. Therefore, caring pedagogy includes a) the engagement in reciprocal, transpersonal caring relationships, b) the sustainment of safe, culturally responsive, and structurally accessible learning spaces, c) the use of inclusive and strength-based teaching practices, and d) ultimately, the cultivation of flourishing and meaningful student learning (Levinas, 1969; Motta & Bennett, 2018; Chinn & Falk-Rael, 2018; Duffy, 2018; Hills & Watson, 2011 , 2021 Soto, 2005) . Watson's (2011, 2021) germinal works in the caring science curriculum provide global best practices for academic leaders and faculty to use as a guide to optimize caring pedagogy during this unprecedented time and beyond. Schools of nursing, such as Florida Atlantic University and the University of Victoria, are further examples of full integration of caring science throughout the school's philosophy, curriculum, and academic policy. Though full integration of caring pedagogy throughout the curriculum may take years to enculturate, caring pedagogical practices may be implemented at the course level in real-time. Watson's (2008 Watson's ( , 2018a Watson's ( , 2018b Unitary Caring Science theoretical approach offers a framework for advancing pedagogy through a caring science lens. This involves humanizing physical distancing, while ensuring a caring presence in remote teaching, learning, and leading.

When transitioning to remote learning, faculty who have traditionally taught face to face may feel disconnected from their students, while those accustomed to teaching online may desire to nurture their connection further to support students during the pandemic. Moreover, not only may students feel physically distanced from faculty and peers, but also socially distanced (keeping space between oneself and others). Thus, teaching presence, or immediacy, nurtures psychological closeness and caring through communications, as well as course structure and processes (Ekmekci, 2013) .

Ekmekci conceptualized presence as "being there" (2013, p. 29). Grumme, Barry, Gordon, and Ray (2016) described three key attributes of virtual caring presence: (1) physical, (2) spiritual and transcendental, and (3) sociopolitical. Plate and Asselin (2014) identified social presence as vital in demonstrating caring in remote learning. Blending the conceptualizations of presence for use in the virtual classroom may provide students the awareness that though faculty and classmates are not physically and socially with them, their connectedness to both faculty and classmates transcends close physical proximity. Therefore, the use of caring practices and processes when designing or redesigning instruction during times of crisis promotes student wellbeing through virtual presence.

Caring science and Caritas-Veritas processes (Watson, 2018a) provide a theoretical framework for humanizing the remote learning experience through caring pedagogy. The key terms used throughout this paper have been summarized in Table 1 . Watson (2008) defines Caritas as "to cherish, to appreciate, to give special, if not loving, attention to" (p. 39), where love is "the greatest source of healing in the world" (p. 40). Caritas, therefore, conveys a deeper convergence between caring and love, whereby pedagogy is heartcentered, and the faculty-student transpersonal relationship is transformed through caring consciousness. Watson (2018a) further adds that the Caritas Processes are "underpinned and motivated by our humanisticaltruistic value system" (p. 49). Thus, each Caritas Process is aligned with a corresponding moral value, or Veritas. Table 2 provides for descriptions of each Caritas process that will be used throughout the offered strategies. Watson proposed that by "affirming the oneness of being-belonging, awakening to the reality that what we do to others we do to ourselves, and working from a moral Veritas value system of caring and Love, we live joy" (Watson, 2018a, p. 49) . Hence, caring pedagogy offers the opportunity for joy in teaching and learning through caring consciousness and the Caritas-Veritas Processes, both during the COVID-19 pandemic and beyond into the new normal. Watson's (2018a) fourth Caritas process (CP4) of sustaining trusting and caring relationships is paramount during times of crisis. Treating students with compassion, loving-kindness, and equanimity exemplifies Watson's first Caritas process (CP1). As instruction and pedagogy are adapted to remote learning approaches, faculty may use creativity and solution-based approaches (CP6), while creating and sustaining caring learning environments. Watson (2002) further noted the power of transpersonal virtual caring communities, or Communitas, in fostering transformative learning. Within Watson's metaphysics of virtual caring framework, the collective group and resulting presence within the virtual caring Communitas potentiates (celeritas) caring consciousness and the human Caritas field. Though in this example, caring Communitas is used in the virtual learning environment, such caring communities may also extend to face-to-face classroom experiences. According to Watson, the caring Communitas radiates high energy, positive streams which produce powerful transformative learning paradigms. Thus, during times of crisis and physical distancing, the choice of faculty and students to co-create and engage in high energy caring practices may help to mitigate lower energy levels resulting from the COVID-19 pandemic. Rodgers (2002) noted that it is the in the moment process of active reflection that results in presence. Thus, caring presence is furthered by listening (CP2; CP5) and speaking without judgment (CP8), heart-centered teaching (CP1), and suspending role and status to generate the transpersonal connection (CP4) and energetic Caritas field (CP8). In their comprehensive review of virtual presence, Grumme et al. (2016) noted that caring in the online environment requires extending the traditional conceptions of space, place, and time. Thus, the Caritas field (CP8), in the context of caring presence requires faculty to extend relationships formed through face-to-face caring moments to connections with students across these new virtual dimensions (Watson, 2002) .

Incorporating video communication in the virtual classroom may provide additional opportunities for faculty to connect with students to cultivate a sense of caring and closeness during remote learning (de Tantillo & Christopher, 2020) . For asynchronous, typewritten narrative or video discussions, faculty can create short videos to introduce the week's learning focus. Such videos permit students to see and hear the faculty as another medium of caring presence and connection. A variety of web-based and smartphonebased applications may be used to create the videos, or they may be created in the learning management system (LMS). Platforms, such as Canvas, have video discussion functionality available directly in the discussion board forum. Other asynchronous video discussion tools, such as Flipgrid (https://blog.flipgrid. com/news/remotelearning), provide a virtual and secure password protected environment for critical caring dialogue. Both faculty and students can see each other's body language and hear each other's voices as added context not available in traditional discussion boards without video.

Research suggests that student learning and satisfaction in online learning are associated with faculty engagement, conceptualized as being there and caring presence, through posts in the discussion forum. A study by Claywell et al. (2016) found that faculty who used strategies to foster presence and student engagement yielded improved student evaluation scores in understanding course material, interest, meeting learning objectives, increased knowledge, and overall effectiveness of faculty. Additionally, Claywell et al. detected differences between RN-BSN and MSN student mean evaluation scores related to levels of faculty posts in online discussions. For the RN-BSN group, low levels of faculty posts in discussions corresponded to lower mean faculty effectiveness scores, medium levels of faculty posts yielded higher mean faculty effectiveness scores. Conversely, for the faculty who were rated as high-level discussion board posters, their 

N u r s O u t l o o k 0 0 ( 2 0 2 0 ) 1 À8 mean faculty effectiveness scores decreased. For the MSN students, mean faculty effectiveness scores directly reflected the level of posting in the discussion board. Thus, faculty presence may be adapted to the unique student learning needs through caring pedagogy.

Narrative pedagogy was developed by Diekelmann (2005) as an interpretive pedagogy, where narrative cases are used via a variety of methods and mediums to foster a caring, learning environment. Faculty and students engage in dialogue through shared experiences, interpretations, reflection, and problem solving. In narrative pedagogy, the faculty facilitates converging conversations and serve as facilitators. Scheckel and Ironside's (2006) findings support the use of narrative pedagogy to enhance interpretive and analytic thinking through reflection, sharing, and finding meaning. Further, the authors suggested reenvisioning learning spaces to allow for student interpretive thinking of caring moments from practice and clinical experiences. Ironside's (2015) review of 15 years of narrative pedagogy literature found continued evidence to support for such practices. Phillips, Bassell, and Fillmore (2017) discovered that the use of storytelling and reflective pedagogy, in the online or e-learning platforms, fostered transformative learning through perspective transformation. According to Phillips et al., storytelling and reflection are used for scholarly discourse during virtual lectures to provide students a safe space to question assumptions related to clinical practices and caring. As part of the scholarly discourse process, faculty and students use authentic listening during the progression of the narrative story to interpret and reinterpret each other's stories, which sparks the transformative process (CP2; CP4; CP5; and CP6). Additionally, Caritas processes may be employed to nurture deep contemplation and clarity (Watson, 2018a) .

Haines and Maurice-Takerei (2019) found that use of collaborative learning and caring spaces, Communitas, transformed instruction to a more learner-centered and heart-centered facilitative approach. The use of storytelling and caring pedagogy in the online Communitas nurtures knowledge development and caring presence. Moreover, narrative pedagogy provides rich details that humanize the context of the critical caring dialogue in the virtual classroom. Frameworks, such as Hart's (2016) model for facilitating higher-order learning in graduate discussions, may be adapted to operationalize this approach from an assessment perspective. Covington (2005) found that faculty ways of being included being available, authentic, open, and going beyond. An example of authentically being with would be faculty hosting virtual office or "caring" hours that allow students to be with faculty through the relational connectedness of being seen and feeling seen (Rodgers & Raider-Roth, 2006) . Ways of behaving noted by Covington (2005) included listening, reassuring, and nonjudgment allowing for a safe caring space where students feel validated, comforted, and nurtured (CPs 1-9).

Watson's (2018a) integration of Levinas' (1969) ethics of belonging grounds caring spaces as sacred spaces for faculty-student connectedness. Caritas micro-practices (praxis) when used by faculty foster a) ethics of face, b) heart-centeredness, and c) virtual touch (Caritas hands). Table 3 provides suggested Caritas micropractices within each area of Caritas praxis that have been adapted for use by nursing faculty. Caring Space, open discussion forums, may be created for students to be and belong. The Caring Space discussion forum fosters caring capital (consciousness) through mutual 

empathy, connectedness, and potentially resilience (Aldrich & Meyer, 2015; Watson, 2018b) . Faculty may facilitate the Caring Space using loving-kindness (CP1) to inspire hope (CP2), while honoring the student's dignity and expression of self, whether positive or negative (CP5). This protected caring space, within the internal confines of the secure LMS, is therefore transformed through caring pedagogy and presence infrastructure, and creates a healing environment (Caritas field, CP8). Faculty may address student needs (CP9) by offering words of hope, love, and support. Faculty may also role model and recommend strategies for selfcare, resilience, meditation, and openness to the existential-spiritual unknowns (CPs 7À10). A helpful video created by Dr. Watson (Care for the Journey) helps to remind both faculty and students of the sacred nature of nursing practice and is available at https://www.wat soncaringscience.org/portfolio-item/theory-of-caringmeditation/.

To evolve caring pedagogy a step further, faculty may intentionally design safe and engaged, caring educational cultures. Such cultures foster not only transpersonal relationships among faculty and students, but generate an academic caring community, or Communitas, that is limitless and has global reach (Watson, 2018a) .

Caritas Ethics of Face Micro-Practices (Praxis) "The only way to sustain our humanity at this point in human history, is through the face-to-face connection. . .when we look into face of another it mirrors the infinity and the mystery of the human soul and reflects back our own soul" (Levinas, 1969; Motta & Bennett, 2018) , as cited in Watson, (2018b) . Through face to face connection, we "see" the "other. Hold live lectures so you and your students may synchronously "see" each other 1. Offer complete presence and compassion when listening and speaking with students 2. Seek 'to see' the student as a person-Ask about their lives and families before starting the formal lecture 3. Hold the still point during presence through eye to eye (Ethics of Face) and the heart to heart connection (Caritas Heart) Caritas Heart Micro-Practices (Praxis) Before engaging in a virtual encounter with students through face-to-face live streamed lectures: 1. Centering self: The centering process serves as the pause that allows for authentic presence of self by the student and educator. Pause-Stop-Center "Ground self" 2. Take deep cleansing breaths 3. Heart focused breathing-Imagine your heart is warm and radiating love and light a). Feel your heart-Through your breathing, experience the high vibration feelings in your heart, feel your gratitude, compassion, caring, and loving-kindness for your students and for yourself

Caritas Hands/Touch Micro-Practices (Praxis) Once you are heart-centered and enter into the virtual face-to-face learning and caring space:

1. Read the energetic field of the class-Is the class unusually quiet or are they enthusiastic and conversing amongst themselves? 2. Authentically be there-Ensure caring presence 3. Identify yourself and encourage students to do the same 4. Address students by name 5. Hold silence and allow time for thoughtful contemplation 6. Compassionately listen to students by quieting your mind and opening your heart 7. Accurately detect others' feelings and energetically comfort, soothe, or calm as appropriate 8. Stay within other's frame of reference 9. Hold another with kindness and dignity 10. Intentional use of virtual loving touch-Send a loving air hug or a joyful emoji via the learning platform's chat feature 11. Radiate loving-heart presence through discussions, presentations, and narrative pedagogy 12. Approach skills as caring-healing acts 13. 'See'; 'hear', honor other's subjectivity

To foster and create Communitas and belonging within the virtual space, several structures and Caritas Processes may be used. 1. Cultivate a community of dialogue and collective identity 2. Virtual chat rooms 3. Caring spaces to provide students safe space to share of experiences without the need of formal structures for togetherness, caring, support, encouragement, and joy 4. Support spontaneous student created Communitas, such as class Facebook groups or use of other social media platforms 5. Promoting shared Veritas values while recognizing and honoring diversity and inclusivity 6. Improvisation-based pedagogy through student collaboration and involvement in an unfolding co-creation activity that fosters engagement and belonging Sources: Watson (2003 , 2018a , 2018b . Adapted with permission.

N u r s O u t l o o k 0 0 ( 2 0 2 0 ) 1 À8

Communitas is described by Turner (2012) as a sharing of experiences, without the need of formal structures, for togetherness and joy. Pedagogical Communitas may therefore, evolve through Caritas-Veritas processes, the ethics of belonging, methodological wholeness, and emancipatory pedagogy (Hills & Watson, 2011 , 2021 Watson, 2018a) . Thus, creation of unstructured caring and relational Communitas spaces, within the structured and ritualistic virtual classroom, promotes inspired fellowship, inclusivity, and emancipatory nursing praxis (Bevis & Watson, 1989; Hills & Mullett, 2000; Hills & Watson, 2011 , 2021 Turner, 2012; Watson, 2000) .

Caring Communitas, as conceptualized by Watson (2011, 2021) , may also be fostered within the virtual classroom by use of critical caring dialogue. Faculty present ambiguous issues or problems that require students to challenge assumptions, critically think and reflect, and discover personal meaning. Critical caring dialogue within the classroom Caring Communitas results in the development of new knowledge. Hills and Watson (2011) , emphasize that authentic listening is central to such an emancipatory learning process.

One example, proposed by Watson (2011, 2021) , is the use of role-play and dialogue (2011, p. 90 ). Using Hills and Watson's format, the learning activity would invite students to engage in role-play focused to illuminate critical aspects of authentic presence (CP2), and the corresponding Veritas to inspire faith and hope while honoring others. Students are then asked to have critical dialogue within Communitas pairs or larger size groups. Tools, such as Blackboard Collaborate, allow faculty to divide the class into breakout groups, within the LMS platform, during the live virtual (remote) class lectures. Faculty are able to enter and leave each group, during the dialogue and roleplay, without being intrusive. The participants in the breakout groups would identify an issue upon which they do not agree and about which they feel passionate. Students utilize Caritas micro-practices (Table 3 ), such as centering-self, for quiet contemplation on the selected issue. During contemplation, they are asked to recall how they felt during the last discussion of the issue. Next, the student attempts to convince another student in the group of the merits of their perspective on the issue. Following the critical caring dialogue, each student shares how they felt being part of this type of discussion. The student then shares their sense of authentic presence (CP2) during the dialogue and whether they felt their perspective was considered and honored (CPs 3-5). The classroom Communitas comes together to further elucidate commonalities and differences in the aspects of authentic presence and caring they experienced. Chinn and Kramer (2018) suggest that praxis is an integrated expression of emancipatory knowing through the continuous interface between action and critical reflection. The Model of Knowing and Knowledge Development, proposed by Chinn and Kramer, may be used to further frame critical dialogue in the virtual Caring Communitas classroom. For example, faculty may pose a critical question, such as, "Should healthcare be a right in the United States?" Ethical knowledge questions may be situated in a social context, including social economic status and social determinants of health. Students then engage in the creative processes of clarifying and exploring, with the use of dialogue and justification. Dialogue compels the Communitas to explore formal expressions of ethical principles and codes. Moral and ethical values are clarified to understand alternative points of view more fully through dialogue and justification.

Dialogue and justification may be framed through the Caritas processes and micro-practices, such as ethics of face and hands (Watson, 2003 (Watson, , 2018b . Watson (2003 Watson ( , 2018b surmised, from the work of Levinas, 1969 , that it is during the face to face connection that we "see" the "other" and when one looks into face, it mirrors the infinity of human soul and reflects back one's own soul. Additionally, Watson (2003) derived from the work of Logstrup that such ethics are not only framed from a perspective of face, but also hands. From a nursing perspective when we care for another, the other's trust is "placed in our hands" (Logstrup, 1997, p. 19) . Watson (2003) further noted that metaphorically, "facing and holding another in our hands" connects one to another through love (p. 3). Thus, framing dialogue and justification through the ethical lens of heart, face, and hands is foundational to transpersonal caring and informs clinical reasoning (Watson, 2003) (See Table 2 ). Knowledge authentication ensues resulting in an integrated expression in caring praxis by way of moral and ethical comportment (Chinn & Kramer, 2018) .

As learning is transitioned to the remote methodologies and platforms, healing and caring for both faculty and students, may be produced (CP8) through use of the Theory of Transpersonal Caring and Unitary Caring Science (Watson, 2018b) . By doing so, faculty may be authentically present and engaged to offer hope (CP2) that the COVID-19 pandemic will resolve in the near future. Moreover, caring presence (CP2) in nursing education is most visible in a faculty's pedagogy, both as science and art. Thus, academic practices may be adapted, to ensure ongoing caring presence, as instruction is transitioned to remote learning methodologies during the pandemic and beyond.

Caring micro-practices (praxis) help to center faculty on their heart-centered calling and Caritas field created in their remote classroom Communitas. Like students, faculty are also exposed to the negative influences of the pandemic through their own lived experiences. As pedagogy is adapted or reconceptualized to remote learning, caring approaches may be accomplished through the suggested Caritas-Vertias processes and intentional, transpersonal relationship attunement. Caring instruction may be furthered viewed as a reciprocal, mutual exchange through conversations with students versus lectures to students. Face to face, synchronous and asynchronous caring touch points, through virtual live lectures, promote belonging, support, and the Caritas field that is much needed during the COVID-19 pandemic. Classroom dialogue may be grounded in the ethics of face and hand, and Caritas heart (Logstrup, 1997; Watson, 2003 Watson, , 2018a Watson, , 2018b . Further, classroom and faculty-student interactions attend to the learning process and include not only observation, analysis, and response, but also caring and active reflection. Otherwise, connectedness and the transpersonal caring moment is compromised. Caring Spaces are offered for unstructured Communitas to encourage social support and resilience through collective caring consciousness-the Caritas field. In conclusion, caring pedagogy, despite the required physical distancing demanded of nursing faculty and students during this global crisis, supports the holistic needs of the nursing education Communitas.

Social capital and community resilience

Illuminating the issues: probing the past, a history of nursing curriculum development-The past shapes the future

Knowledge development in nursing theory and process

Embracing the focus of the discipline of nursing: critical caring pedagogy

Influence of nursing faculty discussion presence on student learning and satisfaction in online courses

Caring presence: Providing a safe space for patients

Transforming graduate nursing education during an era of social distancing: Tools from the field

Engaging the students and the teacher: Co-creating substantive reform with narrative pedagogy

Quality caring in nursing and health systems: Implications for clinicians, educators, and leaders

Being there: Establishing instructor presence in an online learning environment

COVID-19 fear, stress, anxiety, and substance use among Russian and Belarusian university students

On virtual presence

The impact of new collaborative learning spaces on tertiary teacher practice

Designing a graduate discussion board rubric to facilitate higher-order learning

Community-based research: Collaborative action for health and social change

Community health promotion coalition

Creating a caring science curriculum: An emancipatory pedagogy for nursing

Creating a caring science curriculum: An emancipatory pedagogy for nursing

Narrative pedagogy: Transforming nursing education through 15 years of research in nursing education

Totality and infinity

The ethical demand

Pedagogies of care, carefull epistemological practice and 'other' caring subjectivities in enabling education. Teaching in Higher Education

Storytelling and reflective pedagogy: Transforming nursing education through faculty development

Best practices for creating social presence and caring behaviors online. Nursing Education Perspectives

Defining reflection: Another look at John Dewey and reflective thinking

Presence in teaching. Teachers and Teaching

Cultivating interpretive thinking through enacting narrative pedagogy

Caring and relationships: Developing a pedagogy of caring

Stress and coping

Caring as a value in nursing education

Communitas: The anthropology of collective joy

Transformative thinking and a caring curriculum

Metaphysics of virtual caring communities

Love and caring. Ethics of face and hand À an invitation to return to the heart and soul of nursing and our deep humanity

Nursing. Philosophy and science of caring (New revised 2nd edition)

Caring science À Caritas theory and practice

Unitary caring science: The philosophy and praxis of nursing