Journal of Nursing Education

Create a Tradition: Teach Nurses to Share Stories

Kathleen T Heinrich, PhD, RN

Abstract

A resurgence of interest in the human story has occurred in the 1990s. Biographies and autobiographies abound. Professional storytellers are honing their fine art. Psychotherapists are developing a technique called therapeutic storytelling, and qualitative researchers are seeking to understand people's "lived experiences* by eliciting their stories. Over the past decade, qualitative nurse researchers such as Benner (1982) have been asking nurses to recount their experiences on clinical units. By recording nurses' descriptions of their practices, these researchers are documenting the complexity of nurses' professional lives. These stories speak eloquently to nurses because they sound themes that resonate with nurses' lives and practices.

Nurse educators can take a lesson from these nurse researchers about the power of stories to communicate deep feelings and layers of meaning through metaphor. Storytelling is one of the teaching techniques espoused by feminist nurse educators who seek to reenergize nursing classrooms by reconnecting intellectual theory with subjective feelings (Diekelmann, 1988; Hedin, 1989). Students enter the classroom with Ufe stories full of meaningful events. Teachers and students come to appreciate their shared experiences as nurses when time is allowed for listening and making meaning out of their stories. Hearing one nurse's story moves other nurses to remember their own experiences in similar situations, to develop greater empathy for practitioners in specialty areas other than their own, and to gain an appreciation for the everyday dramas in which nurses play a pivotal role.

Male hero myths dominate patriarchal Western culture's folklore and offer men blueprints for modeling their relational and professional lives. Like any minority group within a dominant culture, women have led unstoried lives (Baker-Miller, 1976). Since nursing is a "woman's" profession, nurses lack stories to help them shape their identities as professionals. Stories about nurses traditionally caricatured them as madonnas, whores, witches, iron maidens, or cheerleaders (Kanter, 1977; MufÇ 1988). The classroom can provide the place and time for nurses to begin to tell their own stories. These stories have the power to inspire, mentor, inform, or caution novices, and to validate and honor the practices of more seasoned nurses. When nurses share their experiences in the form of stories, both the storyteller and the listener are nurtured. A sense of community is created, reducing the invisibility and isolation of nurses' daily practices.

The Power of a Storytelling Classroom

We stumbled on the idea of using storytelling as a central teaching method serendipitously when we were charged with developing and teaching an advanced theory/clinical course for senior BSN students. During this course, students were expected to integrate both physiological and psychosocial assessments and interventions with clients and families coping with complex problems. The psychiatricmental health and adult health faculties teamed up to create a course that encouraged students to expand their practices to include biopsychosocial-spiritual assessment and holistically based interventions. We called the holistic interventions that did not evolve from traditional Western medical tradition "complementary approaches." This term connotes that interventions such as meditation and massage can be used to complement and augment traditional Western medical approaches. Since the holistic perspective requires that students shift paradigms from a medical model to a holistic nursing model, we turned to the holistic nursing literature for course content and to feminist nurse educators' writing for teaching strategies.

In reviewing the holistic nursing practice literature, Dossey, Keegan, Guzzetta, and Kolkmeirer (1988) introduce the metaphor of nurse as healer. They compare the tradition of healers, called shamans in many cultures, with the tradition of healing in nursing. Female or male shamans integrate the roles of storyteller-priestartist and use intuition, empathy, and emotion in the process of healing. Invoking the shamanic tradition…

A resurgence of interest in the human story has occurred in the 1990s. Biographies and autobiographies abound. Professional storytellers are honing their fine art. Psychotherapists are developing a technique called therapeutic storytelling, and qualitative researchers are seeking to understand people's "lived experiences* by eliciting their stories. Over the past decade, qualitative nurse researchers such as Benner (1982) have been asking nurses to recount their experiences on clinical units. By recording nurses' descriptions of their practices, these researchers are documenting the complexity of nurses' professional lives. These stories speak eloquently to nurses because they sound themes that resonate with nurses' lives and practices.

Nurse educators can take a lesson from these nurse researchers about the power of stories to communicate deep feelings and layers of meaning through metaphor. Storytelling is one of the teaching techniques espoused by feminist nurse educators who seek to reenergize nursing classrooms by reconnecting intellectual theory with subjective feelings (Diekelmann, 1988; Hedin, 1989). Students enter the classroom with Ufe stories full of meaningful events. Teachers and students come to appreciate their shared experiences as nurses when time is allowed for listening and making meaning out of their stories. Hearing one nurse's story moves other nurses to remember their own experiences in similar situations, to develop greater empathy for practitioners in specialty areas other than their own, and to gain an appreciation for the everyday dramas in which nurses play a pivotal role.

Male hero myths dominate patriarchal Western culture's folklore and offer men blueprints for modeling their relational and professional lives. Like any minority group within a dominant culture, women have led unstoried lives (Baker-Miller, 1976). Since nursing is a "woman's" profession, nurses lack stories to help them shape their identities as professionals. Stories about nurses traditionally caricatured them as madonnas, whores, witches, iron maidens, or cheerleaders (Kanter, 1977; MufÇ 1988). The classroom can provide the place and time for nurses to begin to tell their own stories. These stories have the power to inspire, mentor, inform, or caution novices, and to validate and honor the practices of more seasoned nurses. When nurses share their experiences in the form of stories, both the storyteller and the listener are nurtured. A sense of community is created, reducing the invisibility and isolation of nurses' daily practices.

The Power of a Storytelling Classroom

We stumbled on the idea of using storytelling as a central teaching method serendipitously when we were charged with developing and teaching an advanced theory/clinical course for senior BSN students. During this course, students were expected to integrate both physiological and psychosocial assessments and interventions with clients and families coping with complex problems. The psychiatricmental health and adult health faculties teamed up to create a course that encouraged students to expand their practices to include biopsychosocial-spiritual assessment and holistically based interventions. We called the holistic interventions that did not evolve from traditional Western medical tradition "complementary approaches." This term connotes that interventions such as meditation and massage can be used to complement and augment traditional Western medical approaches. Since the holistic perspective requires that students shift paradigms from a medical model to a holistic nursing model, we turned to the holistic nursing literature for course content and to feminist nurse educators' writing for teaching strategies.

In reviewing the holistic nursing practice literature, Dossey, Keegan, Guzzetta, and Kolkmeirer (1988) introduce the metaphor of nurse as healer. They compare the tradition of healers, called shamans in many cultures, with the tradition of healing in nursing. Female or male shamans integrate the roles of storyteller-priestartist and use intuition, empathy, and emotion in the process of healing. Invoking the shamanic tradition places intuition and empathy at the center of nurses' healing practices. The other dimension of the metaphor of healer is the wounded healer. Nurses were wounded in this scienceworshipping society because, as the male medical profession grew in power, women/ nurses were increasingly separated from their tradition as healers (Ehrenreich & English, 1973). It follows that nurses are in need of the healing that comes from reclaiming their identity as healers. Since storytelling is one of the healing mediums used by shamans, we felt that students might begin a professional self-healing process through sharing the stories of their lives and professional practices.

For these reasons, we decided to teach each other holistic nursing practice through the medium of our stories. We created a "storytelling classroom," a nurturing learning environment where teachers and students were partners in the learning process. This classroom environment supported all of us as we challenged students to explore regions they had been afraid of, skeptical of, or downright antagonistic toward - an environment where they could share their stories openly and honestly without fear of judgment.

Tb use storytelling as the central teaching method breaks a taboo that has shrouded women's lives and nurses' practices in silence. Understandably, there were many obstacles to overcome as we contemplated sharing our stories. We were reticent about telling our stories to students, and comments like, "How will my telling a story teach anyone anything?" revealed students' fears of sharing stories with us. These trivializing comments about the storytelling technique reflected how they devalued their own life stories.

When we asked students why they had not shared their stories, they often said there was no place where they felt able to share what happened to them professionally; colleagues seemed too busy and significant others might be frightened or depressed by their stories. Since they were rarely allowed to tell their stories, they believed their stories did not have value. They are unused to giving words to their intimate professional experiences with patients, colleagues, administrators, and physicians. The only acceptable stories seemed to be stories of difficult interactions with physicians. We realized that sharing touching times or vulnerable times was very threatening because all of us feared each other's judgment at a time when we most needed understanding and support.

We were able to overcome these obstacles to create a storytelling classroom. On the first day we told students that one of our goals was to begin to "think" and to "talk" story, to use our stories to teach each other holistic nursing. By sharing our own stories, including triumphant moments, funny incidents, and vulnerable times, we broke the taboo of silence. Following our lead, students cautiously began sharing their stories. These stories bonded us and created a community of learners as we shared forays into the unexplored territory of using complementary techniques in our clinical practices. In addition to our own stories, we found other stories in newspapers, magazines, films, and literature. We read tales or watched videotapes of actual people explaining how they faced human suffering with courage, insight, and humor.

Guest speakers were nurses who used complementary approaches such as therapeutic touch, massage, and guided imagery with patients and families dealing with illnesses ranging from AIDS to AIzheimer's disease. They were asked to teach by telling stories about their practices. Students chose clinical placements where practitioners were actively using such techniques or were open to these techniques being used.

Each student was expected to experience four complementary approaches to healing as a client in order to link personal understanding with professional growth (e.g., various forms of therapeutic massage, hypnosis for overeating or smoking, therapeutic touch, humor workshops). The weekly one-hour seminar was the place for sharing stories of their experiences both as clients and as practitioners applying these techniques in the clinical area and in their own professional practice settings and reflecting on their own personal transitions.

Student Stories Reflect Stages of Learning

Student stories trace the stages we moved through during this course from initial fear of the unknown, to excitement, to integration of holistic techniques into practices.

Stage 1: Fear of the unknown

We felt a combination of excitement and fear as we created this course and presented it to the students. Since neither of us had taught such a course, we had never shared with students how we integrated these holistic techniques into our own clinical practices.

Depending on their previous experiences, students reacted with initial excitement or skepticism. Several students were excited about the course because they had had previous positive experiences with complementary approaches to healing. Other students were leery of these methods, and a few were downright hostile. These students were skeptical about using storytelling to teach each other holistic nursing and fearful of exposing themselves and their clients to complementary approaches ofhealing. One student shared her concern by telling this story:

I had a dear friend who died 10 years ago of leukemia. During his illness I felt so helpless that I read everything I could get my hands on about new interventions with leukemia. I told him about every new thing I read about from meditation to vitamins. As he got weaker he refused to try any of these things. I felt angry at him for not trying hard enough. He did die and to this day I still feel guilty for putting such pressure on him.

A number of oncology nurses voiced similar concerns. One said:

I get so angry at books that say or imply that if people used things like guided imagery they could beat the cancer. When a patient who has read such a book has an exacerbation he takes it as a sign that it was his fault because he didn't do his guided visualization right. These books lay a guilt trip on people who are already suffering. When patients tell me they have read a book like this, I always caution them about not holding themselves responsible for the course of their illnesses.

These stories opened the door for us to discuss the anger and the underlying feelings of pain, fear, helplessness, and anguish that these stories conveyed. We advised students to follow Ornstein's (1990) words of wisdom, "Approach these techniques with an open mind, but not so open that your brains fall out." Students seemed relieved when they were encouraged to consider a complementary approach in the same manner as any other new technique balancing an open mind with healthy skepticism.

Stage 2: Experimentation

Over the semester, students experienced various complementary methods and selectively applied them to their clinical areas. Excitement often followed the successful use of a complementary approach; for example, students using simple deep-breathing exercises with a tense patient before surgery could see the person relax. As these successes were shared in clinical seminar, students began to experiment more freely with various techniques.

Student skepticism was often challenged and transformed into excitement by a client. The best example occurred in the homeless shelters where students had the greatest difficulty seeing the applicability of these complementary approaches to their clinical setting. In a number of classes, students angrily asserted that these methods were middle class and not oriented to people struggling with survival. Near the end of the semester, one of the students told the following story in seminar.

One night last week a man came into the shelter with a festering wound on his foot. He refused to go to the Emergency Room and he was told he would probably have to have the foot amputated. He returned the next week and his foot was healing. When I got over my shock I asked him how it was that his foot looked so much better. He said, "I got a subliminal healing tape from one of my friends. I've been listening to it ever since and my foot started feeling better." I felt like asking him, "Did my instructors plant you here to convince me that some of these techniques could be used in the homeless shelter?"

He convinced all of us that complementary approaches to healing can be used with the homeless.

Stage 3: Integration

By the end of the semester, students began to integrate these techniques into their repertoire. The methods most easily assimilated into nurses' practices were relaxation techniques and humor. One student who worked in an outpatient chemotherapy service said:

This semester I brought a hat rack and a few funny hats into work. I asked people on the staff to bring in funny hats for the hat rack. Patients started donating hats to our hat rack. Now we have "Hat Days" where everyone chooses the hat that best fits their mood. Other times, people just grab a hat to make a point. We've had more fun with that hat rack.

For a number of students, this course validated techniques they had long used in their practices but were afraid to tell anyone about. This was particularly true about the reliability of clinical intuition. As one student put it, "Now when I hear that inner voice telling me something is wrong with a patient, I listen to it. And usually I'm right."

Storytelling as a Teaching Method

There are four important principles for nurse educators who wish to use stories as a teaching tool:

Create a safe place. A storytelling classroom is a place where people "think" and "talk" story. It is a safe environment where nurses* stories can be shared without fear of judgment or censure. Since women in this patriarchal society have learned to silence their voices and to keep their stories hidden; it takes time and tender, gentle listening to elicit and honor nurses' stories.

Tell your own stories. Teachers must be willing to tell their own stories and to listen compassionately to students' stories to create a storytelling classroom. As educators in a practice profession, we often teach from stories of the people who have touched our lives. Once you start "thinking story" you will find that you can make points in a more interesting and unforgettable way by "talking story." An educator fluent in "thinking story" will begin to use stories consciously and creatively as a teaching technique. This gives permission to students to "talk story" by sharing their experiences.

AsA for stories. There are times when asking for student stories is particularly important and revealing. For example, ask students on the first day of the introductory course in an RN-completion program to share the story of their journeys in returning to school for a baccalaureate degree. This process will begin to build a community of learners as they realize there are others in the class who are experiencing similar feelings. A wonderful way to teach interviewing skills is to suggest that students see the patient as a storyteller. Fueled by their desire to understand the person's story, they will be more motivated to learn techniques like open-ended questions.

If you are teaching an intimidating or controversial subject, begin with students' stories. Many of the RN students have jaundiced views of psychiatric-mental health nursing gathered from personal or professional experiences of working on clinical units with antipsychiatry biases. Before you begin to teach any content, ask them to describe their positive and less-thanpositive experiences with psychiatricmental health clinical placements, instructors, and nurses. Telling stories about the negative experiences allows students to receive a healing, empathie response from both the teacher and other students. Based on the knowledge gleaned from these stories, the sensitive teacher shapes the subsequent classroom and clinical experiences to underline the relevance of mental health principles to nursing practice across settings. When nurses see the relevance of mental health principles, they will apply them in their practices.

Listen and hear the stories. When you ask for stories, be prepared to feel powerful emotions like joy, sadness, and anger, and allow time for students to discuss their emotional responses. At times, it is difficult to listen to a story because it stirs up strong emotions in the listener. Stories demand an emotional honesty, and sharing your own spontaneous reactions with students gives them a model for sharing their feeling responses. By listening to stories, nurses are able to vicariously live out any number of different roles in different scenarios, thereby expanding their empathy for the storyteller and for the actors in each story. Educators can encourage students to baten to stories from the myriad perspectives represented by the various actors. By learning to truly listen and to value each actor's perspective, they will be more compassionate when listening to the stories of patients and families, colleagues and physicians in their practices.

Conclusion

If nurse educators, like qualitative nurse researchers, affirm the importance of nurses' stories, then nurses will begin to value their own experiences. These stories allow nurses to develop a shared tradition in which they experience themselves as full human beings - strong, vulnerable, independent, and sensitive - involved in a challenging profession. Over time, the collective wisdom of these stories possesses the power to inspire, mentor, inform, and caution novices and to validate and honor the practices of more seasoned nurses.

References

  • Baker-Miller, J. (1976). Toward a new psychology of women. Boston: Beacon Press.
  • Benner, P. (1984). From novice to expert: Promoting excellence in clinical nursing practice. Menlo Park, CA: Addison-Wesley.
  • Diekelmann, N. (1988). Nursing curricular revolution: A theoretical and philosophical mandate for change. In Curricular Revolution: Mandate for Change. New York: National League for Nursing.
  • Dossey, B.M., Keegan, L., Guzzetta, C.E., KoIkmeirer, L.G. (1988). Holistic nursing: A handbook for practice. Rockville, MD: Aspen Press.
  • Ehrenreich, B., & English, D. (1973). Witches, midwives and nurses: A history of women healers. New York: The Feminist Press.
  • Hedin, B., & Donovan, J. (1989, July-August). A feminist perspective on nursing education. Nurse Educator, 14, 8-13.
  • Kanter, R.M. (1977). Men and women of the corporation. New York: Basic Books.
  • Muff J. (1988). Handmaiden, battle-ax, whore: Fantasies, myths and stereotypes about nurses. In Socialization, Sex and Stereotyping: Women's Issues in Nursing (2nd ed.). St. Louis, MO: C.V. Mosby.
  • Ornstein, R. (1990, March). Healthy pleasures. Paper presented at the conference on Healthy Pleasures, Los Angeles.

10.3928/0148-4834-19920301-13

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