The Journal of Continuing Education in Nursing

Teaching Tips 

Photo Elicitation: Enhancing Learning in the Affective Domain

Sheila Linz, PMHNP-BC, MSN, RN


This column offers tips for using photo essays in both traditional and online learning settings.


This column offers tips for using photo essays in both traditional and online learning settings.

Ms. Linz is RWJF New Jersey Initiative Scholar, Seton Hall University, South Orange, New Jersey.

The author discloses that she has no significant financial interests in any product or class of products discussed directly or indirectly in this activity, including research support.


Art, photography, and narratives enhance learning in the affective domain. According to Hodges, Keeley, and Grier (2001), throughout history, visual images have described what is most important to humans. Visual images evoke emotions, abstract ideas, and the shared human experience. Regarding the use of photo elicitation, Harper (2002) states, “Images evoke deeper elements of human consciousness than do words; exchanges based on words alone utilize less of the brain’s capacity than do exchanges in which the brain is processing images as well as words” (p. 13). Images can be used as a pedagogic tool in several ways (e.g., intensive looking and photo elicitation). Visual images can also be used to tell stories and in narrative pedagogy as a way to illustrate themes.

An exercise in intensive looking at a work of art was shown to enhance observation among second-degree nursing students in an accelerated master’s program. Half of the students in a medical-surgical course received traditional classroom and clinical strategies. The rest were taken to an art museum, shown a selection of paintings, and asked to intensively look at a painting for 10 minutes, reflect on it, and describe what they had seen. The exercise lasted approximately 90 minutes. The latter students were significantly better able to offer more objective clinical findings and more differential alternative diagnoses when viewing patient photographs. Thus, their skills in the clinical setting had been enhanced (Pellico, Friedlaender, & Fennie, 2009).

Brand and McMurray (2009) used photo elicitation in an exploratory pilot study with nursing students about to embark on a geriatric clinical rotation. The students were asked to view five photographs of patients older than 65 years receiving nursing care (i.e., being shaved, showered, and dressed). Feelings and thoughts elicited from the students included anxiety and self-doubt about caring for this population, as well as fear of aging. Through reflection, questioning, and dialogue about these feelings, the students developed a better sense of core nursing values (e.g., compassion, treating patients with respect, and kindness). They were also able to challenge their stereotypes about older people. Thus, photo elicitation facilitated sensitivity, perception, empathy, and insight.

In addition to the use of visual images, the use of narrative pedagogy through vivid storytelling captures students’ attention and offers them an avenue for active participation and discourse, enhancing their learning (Ewing & Hayden-Miles, 2011). Art forms, including photography, can be considered visual narratives. The artist shares an image, which is a form of story, and provides material for critical thought on values, belief systems, and conflicts (Ewing & Hayden-Miles, 2011).

Given the different learning styles of students, it is best to use a variety of educational strategies. In a study investigating the preferred learning style among 200 nursing staff members, Frankel (2009) found that the majority preferred visual learning over kinesthetic learning, with auditory learning least favored. Photographs are particularly well suited to engaging visual learners.

When to Use Photo Elicitation

Consider using photo elicitation when teaching content that learners may be uncomfortable about, or when a visual image will more easily lead to comprehension of complex ideas than would a verbal description. For instance, photographs of older adults would be helpful in eliciting learners’ apprehension about caring for the elderly. Images of very old or sick individuals could elicit anxiety about death and allow students to openly discuss their feelings about death and dying. Photographs of homeless people may elicit various beliefs about them, leading to a better understanding of both homelessness and negative attitudes toward the homeless. Viewing and discussing photographs of mentally ill individuals may increase empathy toward them, as well as open dialogue about stereotypes and stigma. Images of breastfeeding women could lead to discussions about mothering and infant attachment and increase comfort regarding childbirth and breastfeeding.

Making Your Own Photo Essays

Photo essays can be easily made using PowerPoint. Once the proper releases have been obtained, you own the photographs, can copyright them, and can use them as class exercises for years to come. You must have signed releases specifying intended use. Adhere to Health Insurance Portability and Accountability Act (HIPAA) regulations, and do not use identifying information. Family members, neighbors, and coworkers can be photo subjects. An example of an easily accomplished photo essay is a series of photographs of older people in their homes, posing in front of their favorite objects while talking about their lives. Some of their own words could be incorporated through text boxes directly on the photographs.

Using Existing Photo Essays

A variety of photo essays exist for educational purposes. These photo essays should only be used for classroom exercises and not publication or other presentations. For an online course, provide the url for the photo essay, but do not download it to the class website. You can access the Internet and display these via a projector, as you would a PowerPoint presentation. The New York Times site has numerous photo essays that are easily accessed for photo elicitation. Once on the site, a search using the word “lens” will yield a variety of beautiful photo essays on a range of topics. Alternatively, if you wish to focus on a health-related issue, go to the health section of the site and choose the topic.

Instructions for Intensive Looking and Photo Elicitation

For an online course, you would post the photo essay file, ask learners to look at the photo essay in its entirety, and then ask learners to choose the most compelling photograph for 10 minutes of intensive looking. Alternatively, you can choose the photograph for learners. For photo elicitation, learners should be instructed to write a 2-page post describing their impressions of the chosen photograph, their emotional response, and the story or themes they gleaned from the photo essay. After posting, learners should be instructed to view and comment on fellow students’ posts.

To use photo elicitation in your classroom, you could display a photo essay via a PowerPoint presentation, elicit responses from learners about the photo essay as a whole, and then have learners vote on the particular photo that will be used for the 10-minute period of intensive looking. The learners would then write down all of their impressions and feelings about the photograph before sharing them in a classroom discussion.

Learners’ Responses

Photo elicitation was used successfully with an online class. The learners posted thoughtful and sensitive entries. It was clear that they had thought deeply about the subject of the photo essay. Their feelings related to the photo essay’s themes. Some of the learners wanted to know more about the photo subjects. Learners respectfully disagreed with one another, but also gained from hearing other points of view. Learners also voiced their anxieties related to the topic at hand. The discussion board was lively, with more than 125 comments. In response to their posts, learners were challenged to think more deeply about their own responses, without reverting to stereotypes about the individuals portrayed.

Once the module was completed, the learners were asked to evaluate its content. The responses were positive. The learners felt that the experience had been stimulating, interactive, and thought-provoking. Several were appreciative that an innovative method of teaching had been used.


The use of photo elicitation as an educational strategy enhances observational abilities and permits deep reflection, stimulating the affective domain in learning. It has improved clinical observational skills by sharpening the ability to focus on visual detail (Pellico et al., 2009). This strategy also facilitates feelings of empathy, self-reflection, and sensitivity among learners (Brand & McMurray, 2009). Photo elicitation is an effective teaching strategy when complex ideas are tied to emotional content, and it is especially suitable for visual learners.


  • Brand, G. & McMurray, A. (2009). Reflections on photographs: Exploring first-year nursing students’ perceptions of older adults. Journal of Gerontological Nursing, 35(11), 30–35. doi:10.3928/00989134-20091001-03 [CrossRef]
  • Ewing, B. & Hayden-Miles, M. (2011). Narrative pedagogy and art interpretation. Journal of Nursing Education, 50(4), 211–215. doi:10.3928/01484834-20110131-01 [CrossRef]
  • Frankel, A. (2009). Nurses’ learning styles: Promoting better integration of theory into practice. Nursing Times, 105(2), 24–27.
  • Harper, D. (2002). Talking about pictures: A case for photo elicitation. Visual Studies, 17(1), 13–26. doi:10.1080/14725860220137345 [CrossRef]
  • Hodges, H. F., Keeley, A. C. & Grier, E. C. (2001). Masterworks of art and chronic illness experiences in the elderly. Journal of Advanced Nursing, 36(3), 389–398. doi:10.1046/j.1365-2648.2001.01986.x [CrossRef]
  • Pellico, L. H., Friedlaender, L. & Fennie, K. P. (2009). Looking is not seeing: Using art to improve observational skills. Journal of Nursing Education, 48(11), 648–653. doi:10.3928/01484834-20090828-02 [CrossRef]

Ms. Linz is RWJF New Jersey Initiative Scholar, Seton Hall University, South Orange, New Jersey.

The author discloses that she has no significant financial interests in any product or class of products discussed directly or indirectly in this activity, including research support.



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