Journal of Nursing Education

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Using Storytelling as an Approach to Teaching and Learning With Diverse Students

Jill M Koening, MSN, RN; CeCelia R Zorn, PhD, RN

Abstract

ABSTRACT

Storytelling is an approach to teaching and learning that develops from the lived experiences of teachers, clinicians, and students. This article examines the storytelling process used to help students explore personal roles and make sense of their lives, and as an approach to help diverse undergraduate students with various learning styles.

Abstract

ABSTRACT

Storytelling is an approach to teaching and learning that develops from the lived experiences of teachers, clinicians, and students. This article examines the storytelling process used to help students explore personal roles and make sense of their lives, and as an approach to help diverse undergraduate students with various learning styles.

Storytelling exists in every culture and is one of the oldest methods of communication. It is used to educate, inspire, record historical events, entertain, and transmit cultural mores (Collins & Cooper, 1997). Stories can be read, written, or recorded, but they seem most powerful when told from the heart and adapted to individual situations. There has been a renewal of interest in the human story. Biographies and autobiographies prevail. Professional storytelling is becoming an art. Storytelling is a form of entertainment, and stories can be used for private reading and personal reflection.

This article provides a description of storytelling, including its value and the theoretical framework underlying its use in teaching. In addition, because students are increasingly diverse, storytelling as a teaching and learning approach in which students can share their diversity, become socialized into the profession, and adapt to the educational system is described. Finally, a specific example of storytelling is presented as a method to discuss nursing content and create approaches for use in nursing practice.

STORYTELLING

It is generally accepted that nursing as a knowledge discipline has borrowed liberally from other disciplines for its theories, conceptual frameworks, and research methods. Stories in literature are not only for entertainment, but they also can be used for instruction (Bartol & Richardson, 1998). Reflection on the patterned details in stories enables people to reach across space and time and enter the worlds of others. The subject matter of poems, dramas, short stories, and novels, like nursing, is concerned with birth, growth and development, crisis, illness, disability, aging, and death. Stories provide an approach to teaching in which educators can use their knowledge base to extract concepts relevant to nursing.

In reading a journal article or a textbook, students do not become personally attached to the information or appreciate what the experience is like (Vezeau, 1993). Because all stories are relational, involving the teller and the authence, the authence is able to personally share the experience within the story. Storytelling is a way to provide meaning because the authence can sustain a sense of the whole through analysis, classification, and summation. As nursing education is transformed, storytelling has been recognized as narrative knowing (Diekelmann, 1993). Storytelling has been described as a means to discover knowledge, uncover the knowledge embedded in practice, and recover the art of nursing (Boykin & Schoenhofer, 1991; Sandelowski, 1991).

Value of Storytelling

Students enter the classroom with life stories full of meaningful events. Teachers and students grow to appreciate their shared experiences as nurses when time is allowed for listening to and deriving meaning from stories. As stories are shared and analyzed, practical knowledge is both taught and learned (Benner, 1991; Boykin & Schoenhofer, 1991; Diekelmann, 1993; Heinrich, 1992). The Table identifies the value of storytelling as a teaching and learning approach.

Table

TABLEValue of Storytelling as a Teaching-Learning Approach

TABLE

Value of Storytelling as a Teaching-Learning Approach

Storytelling facilitates thinking (Nehls, 1995). As students write, hear, or tell stories, they become immersed in the process of sequencing, enelyzing, end synthesizing datain doing so, they gein a comprehensive view of the situation and can critically evaluete the strengths and weaknesses of the clinical decision-making process. Stories provide a focus by which to assess and anelyze data, identify nursing diagnoses, plan nursing interventions, end eveluete intervention outcomes.

Imagination and visualizetion ere enhenced by storytelling. The storyteller provides the facts, situation, and characters. The listener must visualize the details end create images of the setting and characters. This facilitates links between the story and other sirniler situations. It becomes possible to transfer knowledge from one situetion to enother. In this way, theory and practice cen be linked.

Storytelling develops eppreciation of the beauty end rhythm of the language (Collins & Cooper, 1997). As students listen to stories, they unconsciously become familiar with the rhythms and structure of the language. Listening to words being spoken provides greater understanding of a less familiar language. In addition, storytelling can help students refine their speaking skills (Collins & Cooper, 1997). Variables such as intonation, pause, gesture, and body language ere used to enhance a story and make it more meaningful. Students learn to listen intently to spoken messages end recognize and experience nonverbal cues.

Storytelling offers an approach to teaching and learning in which aspects of a nursing situation can be reviewed and understood. Nurses sharing their stories experience acceptance and a sense of support. Storytelling provides a rich classroom and nurturing and caring experience and, thus, encourages most students and teachers in the process of learning. In both hearing end telling stories, active engagement is essential. Storytelling prompts active listening end conversations. For teachers, questions can assess the level of students' understanding. Students engaging in conversation ere eble to enhance their learning through discussion and clarification.

Caring communities are strengthened by storytelling. Palmer (1998) referred to teaching and learning within a caring community- the type of community that can help renew and express the capacity for connectedness at the heert of authentic education. Community is an outward and visible sign of an inward and invisible grade (i.e., process of growth), the flowing of personal identity and integrity into the world of relationships. Good teaching that extends beyond technique involves telling stories (Palmer, 1993). Sharing stories is a minimum essential for creation of a community. Telling stories develops relationships and provides a connectedness with one's inner self and others, empowering and strengthening one's beliefs and knowledge. Stories are used to shere ideas, explore shared practice, and enhance the individual perspective that can be provided by teachers and learners.

Theory and practice are linked by storytelling (Nehls, 1995). When teachers and practicing nurses share their experiences, students learn to appreciate that nursing knowledge can evolve by reflecting on practice. Students learn to expect differences in practice based on experience and begin to recognize areas in which they need to focus their attention. Reflection on clinical practice is not only a way of learning nursing but also a way to contribute to nursing knowledge. This link between theory and practice can be explained further by acknowledging teachers-asleamers and learners-as-teachers within the context of the clessroom and clinical experience.

Teachers-as-Learners and Learners-as-Teachers

In practice end theory, knowledge of nursing is gained through direct observation and participation in nursing situations. Storytelling can provide a learning environment where teachers and students are partners in the learning process (Heinrich, 1992; Nehls, 1995). This process permits the meaning of nursing to emerge clearly and enhances understanding end awareness of nursing (Boykin & Schoenhofer, 1991). Diekelmann (1993) used storytelling as an alternative teaching method that presupposes that teachers are learners end learners are teachers. Teachers seek to establish partnerships with students in an ongoing search for knowledge. By emphasizing reciprocity, a community of learners is formed. The members of the community-teachers and students-are jointly involved in planning, managing, and evaluating learning experiences.

Storytelling seeks to establish ß connection between students end teechers. Although it is more difficult to use in larger classes, storytelling cen be used es e way to facilitate dielogue between teachers end students. Sharing stories and experiences written by patients and other nurses offers students an opportunity to experience health and illness from a different perspective or a changing paradigm (Nehls, 1995). Through storytelling, students cen study human responses to health and illness, understand related concepts, and practice specific nursing skills and competencies.

Due to smeller class sizes and emphasis on practical knowledge, the clinical setting is an ideal place to introduce students to anecdotes, which reveal the underlying assumptions of and approaches to storytelling (Nehls, 1995). Through narratives, students can be asked to respond to questions designed to assess competency and evaluate clinical knowledge. By teaching and listening, students are able to reflect on aspects of nursing practice that often are absent in textbooks or difficult to grasp without practical experience. Storytelling offers an approach to teaching and learning in which a nursing situation can be better understood. In addition, clinical experiences and theory-based knowledge can be integrated through storytelling.

Storytelling as Communication

Storytelling is a commonly used method of communication for nurses, providing critical information about etiology, diagnosis, treatment, and prognosis. Hearing one nurse's story moves other nurses to remember their own experiences in similar situations, develop greater empathy for practitioners in other specialty areas, and gain appreciation for nursing practice (Heinrich, 1992).

Bowles (1995) suggested that storytelling is a method of communicating meaning in the nurse-patient relationship. Nurses not only create an environment in which patients feel free to tell stories but also show patients the structure and meaning of their stories. Through this process, nurses help construct a unifying story for patients' lives or interpret meaning of past or future events.

Boykin and Schoenhofer (1991) proposed that a story is a "method of organizing and communicating nursing knowledge" as practice situations clarify nursing knowledge and enhance understanding of nursing practice (p. 245). Teachers can use stories to help students value their own experiences. Stories enable nurses to develop and communicate a shared tradition. Stories can empower, inspire, mentor, inform, and validate the practice of nursing.

Theoretical Framework

Newman's (1986) theory of health as expanding consciousness may provide theoretical support for storytelling as an approach to teaching and learning. Storytelling is an expression of human consciousness and a means to expand it and, thus, move toward the wholeness that defines health (Newman, 1986). Newman's paradigm of nursing consists of nurses interacting with clients and the environment for the purpose of facilitating clients' health. Stories of illness, crisis, or transition represent clients' efforts to explain life's events, come to terms with illness, or find meaning within the health response. Stories provide clues to behavioral patterns of coping, as well as insight to and understanding of thente' ways of viewing situations (Bartol & Richardson, 1998). Recognition of this pattern represents growth, and facilitate the expansion of consciousness or client's health (Newman, 1986).

In recognizing a pattern of growth and health, Bevis and Clayton (1988) suggested that nursing has practice as its most important aspect. This necessitates that practice be viewed not only as a set of behaviors but as thoughts, feelings, perceptions, insights, ways of being and knowing, intuitions, attitudes, longings, dreams, hopes, visions, and values. Storytelling is a creative teaching and learning approach that may help nurse educators improve students' attention, retention, and comprehension of primary concepts in their nursing courses.

Hiebert (1996) theorized that storytelling is a mechanism for sharing clinical knowledge and supporting socialization into the role of nursing. Learning concepts, including reflection, sharing, and questioning, can facilitate students' ability to grasp, examine, evaluate, and apply information to clinical decision making. This demonstrates higher reasoning skills and greater critical tfrinMng strategies.

Nursing students today have diverse backgrounds, which requires that issues related to their backgrounds be considered to make learning more dynamic or multidimensional. The diverse student population in higher education is not a new phenomenon but does present new challenges.

LINKING STORYTELLING WITH DIVERSE STUDENTS

Students entering nursing programs are increasingly diverse in terms of educational preparation, physical abilities, age, gender, and ethnic backgrounds. Much has been written about storytelling in nursing education, particularly in the late 1980s and early 1990s, and more recently diversity in the student body has received considerable attention. However, there is a dearth of literature that integrates story as a method of organizing and communicating nursing knowledge to a diverse student population. This article addresses the following areas of diversity:

* Academic difficulties (e.g., reading and writing skills).

* Physical disabilities (e.g., hearing, vision, physical mobility).

* Older students and those who choose nursing as a second career.

* Culture.

Academic Difficulties

Section 504 of the Rehabilitation Act in 1973, Public Law 94-142 in 1975, and the Americans with Disabilities Act (ADA) in 1989 have allowed more individuals with disabilities access to higher education (Colon, 1997; Eliason, 1992; Letizia, 1995). These laws were instituted by the United States Congress to prohibit discrimination against qualified individuals with disabilities. According to definitions established in the ADA, a disabled person is defined as (Davidson, 1994):

* Having a physical or mental impairment that substantially limits one or more of the major life activities.

* A person with a record of such impairment.

* A person regarded as having such an impairment.

Learning disabilities are the most common form of disability found in the college-age population (Eliason, 1992; Magilvy & Mitchell, 1995; Watson, 1995). Students with both identified and undiagnosed learning disabilities are pursuing nursing education. Legal mandates concerning these students affect nursing programs. Problems encountered with students with learning disabilities include testing difficulties; deficient writing or math skills; and difficulties receiving, processing, or expressing verbal or written information (Colon, 1997; Eliason, 1992; Letizia, 1995; Watson, 1995).

Students having academic difficulties may feel safer learning through nursing stories. These studente typically struggle with the empirical knowledge of nursing- the factual descriptions, principles, theoretical schemes, and explanations. However, simply having empirical knowledge is not enough. The inclusion of ethics and personal and aesthetic knowing (Carper, 1978) in nursing stories provides another dimension to learning that is equally crucial and supports learning through multifaceted engagement. In this way, these students can move forward by participating safely in the lived experience and also strengthen their intellectual understanding. Boykin and Schoenhofer (1991) described this process as an "alternating rhythm" (p. 246), where one moves back and forth from a broad base, weaving relevant aspects into the knowing of the situation.

Physical Disabilities

According to a study by Magilvy and Mitchell (1995), a review of the literature revealed that nursing education programs have had little experience with disabled students. Although severel hearing-disabled and learning-disabled students have completed nursing programs successfully, information on the scope of disabling conditions is not readily available. For the purposes of this article, physical disabilities include visual, hearing, or mobility impairments. Magilvy and Mitchell (1995) conducted a quantitative study involving students with visual and mobility impairments. Results indicated teachers were aware of the academic potential of students with special needs but their experience with accommodations was limited.

For students with physical difficulties, it may be especially meaningful to connect intimately with nursing through stories (i.e., bringing oneself to the beauty and uniqueness of nursing knowledge). On the other hand, it may be helpful for students with physical disabilities to have the freedom of distance in which they can move from a personal view to a new and different perspective. Stories provide that choice in nursing education.

Nurse educators have a responsibility to prepare and guide students to provide skilled and compassionate nursing care. Van Boxtel, Napholz, and Gnewikow (1995) researched a hends-on approach to stimulate learning by enabling students to experience what it would be like to have a disability. An experiential activity was conducted as part of a nursing course to determine whether students' simulation of having a physical disability and using a wheelchair could be a valuable educational experience and to help meet a course objective on understanding the research process as it applies to disruption in long-term health. The approach used in this study explored students' attitudes more thoroughly than could be done through a lecture. The main themes that emerged from the introspective essays written by the students included frustration, powerlessness, helplessness, invisibility, seff-limitation, and the feeling of being treated as inferior. In an activity such as this, it is likely that these themes could be further explored through storytelling.

Older Students and Nursing as a Second Career

Adults who are returning to school or changing careers at midlife frequently challenge traditional teaching-learning models in nursing. Because of time limitations, attending lectures and taking notes or multiple-choice examinations may not be feasible for some older students. Many students hold part-time or full-time jobs while attending college, and many are balancing several roles (e.g., student, spouse, parent, wage earner). As a result, they have less time to devote to school. Although pursuing a college education is important to them, it may not be the top priority for all students.

Kornguth, Frisch, Shovein, and Williams (1994) researched noncognitive factors that put older students and those pursuing nursing as a second career at ecedemic risk. They showed that students who do not understand how to negotiate the system or feel they will not fit in may have difficulty. Recognition of these issues and initiation of activities to reduce their effect are essential in helping students achieve success in nursing éducation.

In nursing education it may be necessary to advocate the use of teaching strategies that promote more independent ways of learning. Thompson (1998) found thet the general use of such strategies can be problematic because some students currently entering nursing programs may not have the skills or resources (e.g., time) to manage their learning effectively. Thompson (1998) also found that adults returning to college (e.g., RNs and older students with no nursing beckground) may lack self-confidence or have had poor educational experiences. Students' apparent passive approach to learning may result from lack of time or academic skills, rather than motivation. Storytelling may promote more active participation in learning and, in turn, teach students how to use their time wisely.

In addition, stories may address the experiences of older students and provide opportunities to discuss their challenges end strategies. Storytelling may be an effective approach to teaching and learning because it can empower student nurses, increase self-confidence, and create opportunities for teachers and students to learn together about cultural practices, thereby promoting active participation in learning.

Cultural Diversity

Growing numbers of culturally and ethnically diverse students in the health professions has mede it increesingly important for educators to consider the differences in the classroom. Cultural differences, as well es behaviors, may have a significant effect on how students think and learn. Davidhizar, Dowd, and Giger (1998) suggested that students from different cultures should be essessed and may vary according to the following factors:

* Communication.

* Space.

* Time.

* Social organization.

* Environmental control.

* Biological variations.

Culturally and ethnically diverse students must be empowered to share their diversity, select what is important from their cultural upbringing, and adapt to the educational system in ways that will facilitate their success. Culturally diverse students must be able to obtain the necessary knowledge to succeed in an ever-changing environment, while retaining a sense of cultural identity. Storytelling helps students solidify important cultural dimensions, while blending with a new system.

A common experience for some culturally diverse students is that English is their second language. Because these students often experience challenges with language development, they may benefit from storytelling because it will increase their communication skills. Vocabulary use and speaking, listening, and writing skills, in addition to developing a greater appreciation of the beauty of the language, could be strengthened. For some of these students, the written narrative may need to be combined with the verbal approach to storytelling because reading skills may be more developed than verbal comprehension. Every effort must be made to use storytelling to elucidate, rather than obscure, the subtleties of nursing knowledge.

Rew (1996) researched a theoretical model, known as pathways, that acknowledges the diversity of educational preparation and socialization experienced by students from various cultural, economic, and ethnic backgrounds. Use of this model results in empowerment of both students and teachers, which enables them to work together within a system that focuses on potential, rather than deficit. Awareness of social and cultural biases and beliefs, knowledge about cultures and societies, and skills in adapting teaching and learning strategies to address ways of learning are essential in working successfully with culturally diverse students. Storytelling is a way to provide cultural knowledge and awareness and, in essence, is a method to help teachers and students learn about diversity.

To bring students into a nursing situation is challenging for educators. This immersion moves the learning experience from a case study to the nursing situation as a story. Boykin and Schoenhofer (1991) clearly distinguished case studies from the use of stories. They maintained that:

In the past, nursing education concentrated on the medical, psychological, epidemiological and/or sociological features of case studies, making it difficult to articulate the eontent of the discipline. ..use of story to portray nursing situations does not rely on a non-nursing context to provide meaning, but permite the nursing meaning to emerge in clarity (p. 246).

Storytelling uses the meaning of nursing. The content of nursing, rather than the content of other disciplines, emerges.

Finally, for culturally diverse students, storytelling can serve as the vehicle to bring them to the situation, Tannen (1998), a Bociolinguist, maintained that the argument culture is dominant in our society. This way of thinking and being, which permeates the press, politics, and courtrooms, urges people to approach the world and other people in an adversarial frame of mind, focusing on objective, formal knowledge, rather than relational, intuitive knowledge.

However, for many students from other cultural backgrounds, a relational and multiperspective approach is the norm. For these students, it may be extremely difficult, if not impossible, to discuss an idea by setting up a debate; to compare the most extreme, polarized views; to begin an essay by attacking someone; or to show one's best thinking by criticizing. However, these methods frequently become the dominant way of teaching and learning. Tannen (1998) noted that success in these methods identifies the superior achievers, those who exhibit strong potential for graduate study.

Tannen (1998) related a story that exemplifies the challenges students from relational, connective ways of thinking may face when confronting the pervasive conviction that knowledge is best gained out of context. A kindergarten student brought a piece of lava to school and described it to his classmates during sharing time: "My mom went to the volcano and got it." When the teacher asked what the student wanted to tell about it, the student said, Tve always been taking care of it." This placed the rock at the center of his feelings and his family (e.g., the rock's connection to his mother, who gave it to him; the attention and care he lavished on it). The teacher refrained the students' interest in the rock as informational- "Is it rough or smooth? Is it heavy or light?" She also suggested they look up "volcano" and "lava" in the dictionary. The teacher was building on the student's personal attachment to the rock to teach him a new way of thinking about it. However, this example demonstrates the focus of education on formal, rather than relational, knowledge- information about the rock that has meaning out of context, rather than information tied to the context (e.g.. Who got the rock for him? How did she get it? What is his relation to it?). Perhaps the teacher turned the student's story into a case study.

Saylor and Taylor (1993) stated that transformation is a concept that can be applied to teaching students from diverse cultural backgrounds. Transforming ideas, knowledge, and strategies to facilitate learning can result in meaningful representations for students. Transformation is the representation of concepts with analogies, examples, or demonstrations that have meaning for students. Storytelling is a way of transforming concepts and ideas into representations that will be comprehended by students.

Storytelling can provide a way for diverse students and teachers to value their own experiences as unique individuals. It can help them make sense out of their Uves. Because nursing is brought to life through the use of stories, students and teachers are empowered to participate in this lived experience.

STORY OF A SCHOOL NURSING EXPERIENCE

The following is a story of a nursing situation involving a school nurse and a young student returning to school after a traumatic brain injury. This example demonstrates story as a method for describing nursing content and creating approaches in a school nursing practice to facilitate the use of family and thent in achieving health.

This story of a school nursing experience could be used in a junior-level or senior-level nursing course that integrates interdisciplinary health cere in a more complex community situation. Prior to reading this story, students should read about school nursing, traumatic brain injury, and family dynamics. As an introduction to the class session, students would be asked to complete a story about school nursing and include some of the following content in their story. Sara, the school nurse, arrived at school at 8:00 a.m. She anticipated the following events in her day:

Similar to educational programs involving teachers and studente in learning, school health care programs support the physical, psychological, and emotional well-being of students and contribute to studente' cognitive and social development. A school nurse's day-to-day concerns might not be life threatening, but they require decision-making skills that come from proper training and experience. One of the most challenging aspects of school health nursing is the diversity of students and health problems encountered on a daily basis. Many sick studente are routinely sent to school despite fevers, coughs, and upset stomachs. In addition, mainstreaming of special education students requires school nurses to routinely help children with many complex physical and mental disabilities and dispense a variety of drugs. The day may begin with a 16-year-old student discussing fear of being pregnant, move on to providing first aid for injuries that occur in a physical education class, and end with a 10-year-old newly diagnosed diabetic student experiencing hypoglycemia. In addition, school nurses are active in health education, health counseling for students and staff, parent meetings, or student [multidisciplinary] staffing.

The class may continue by examining and discussing content related to traumatic brain injury, as well as concerns about growth and development of a 9-year-old boy:

In more recent years, there has been an increase in the number of students returning to school following traumatic brain injury. During the past 4 years, there has been a 16year-old girl involved in a pedestrian-motor [vehicle] accident; a 17-year-old boy involved in a motor vehicle accident; a 17-year-old [boy] involved in an all-terrain vehicle accident; and most recently, a 9-year-old [boy] who suffered a traumatic brain injury from falling while hiking in the mountains.

What makes this latter case interesting is the complexity of factors involved. Mike was 9 years old and visiting his father for the summer. His mother had remarried, and he [Mike] spent the majority of time with her and his stepfather. The family consisted of a 1-year-old [child] from this marriage, and Mike's siblings, ages 13 and 11, from his mother's first marriage. This was a stepparent family, but the intense bonding and support within this family struck me. His stepfather was a physical therapist, and while this initially sounded like a definite advantage, we soon found out it is difficult for a stepfather and stepson, to work together therapeutically.

Mike was initially hospitalized by his father, transferred to Wisconsin, and about 6 weeks after the accident, transferred to a hospital 30 miles from his home. I knew he would return to school soon, but did not know the prognosis. As case coordinator, the first step was to plan a multidisciplinary meeting, in which all those who provided care for Mike, as well as those who would be involved in his education, could discuss and plan his care and eventual return to school.

Whet would be the school nurse's considerations prior to Mike's return to school?

Some of the issues regarding Mike's return to school included assessment of his cognitive abilities, required therapies, and reentry into the school setting. Would he require regular or special education? How often would he require speech, occupational, and physical therapies in school? How would the other children accept him? Finally, how would he deal with his disabilities? I knew he was aware of some of his deficits, which was frustrating for him. It must be difficult to know you used to be able to shoot baskets and run the court, but now are unable to because you have to wear a leg brace. How difficult it would be to learn to write left handed when you were right-hand dominant before the accident Mike was in the process of relearning all his activities of daily living, including toileting, feeding, and dressing. He would require help with most of these activities.

What may be the school nurse's concerns about family dynamics?

I had concerns about the family dynamics. The uncertainty of the future, anxiety related to coping, increased stress related to daily therapies, and the family's response to adapting to a child with chronic health conditíons were issues that would affect the family. The family seemed to draw strength from their spiritual beliefs, and this seemed to be a positive force for them.

Three months following the accident, Mike returned to school. Prior to his return, I spoke to his classmates, as well as the other third grade classes, to update them on Mike's return, answer questions, and prepare them. We placed emphasis on things that Mike was able to do, rather than what he could not do. The other students were excited about Mike's return and were happy to have the opportunity to ask questions openly and share concerns. Mike's teachers naturally were anxious about his return. We spent time discussing traumatic brain injury specifically related to Mike.

What types of care and treatments would need to be monitored by the school nurse?

A month after Mike returned to school, things were progressing much better than expected. Ine assistant working with Mike was concerned about losing her job in a few months because he was doing so well. The family was coping well and getting back to somewhat of a pre-traumatic brain injury routine (as his mother stated). They are grateful for the gains Mike has made thus far. Mike continues to need monitoring for his activities of daily living and vision deficits, he is progressing well academically, and we are on the lookout for feelings of anger, resentment, or depression, which are common after a traumatic brain injury.

Students studying this nursing story learned to extract from their broad repertoire of nursing and related knowledge content relevant to the story. Concepts related to traumatic brain injury, growth and development, uncertainty, hope, family dynamics, and family adaptation to chronic illness are relevant to the situation. Nursing diagnoses could be established as clinical decision making is studied and evaluated. Other aspects of nursing to be discussed include school health, school nursing practice, and collaboration with other disciplines.

CONCLUSION

Storytelling is a new approach to teaching and learning, although there has not been substantial research conducted to examine this. Stories not only of success but also of crisis or misfortune must be shared because they all provide valuable learning experiences.

Storytelling is a method that can be used to enhance teaching and learning with diverse students. The value of a story begins with the insight and deepened understanding nurses can gain into the meaning of their practice and thenfives. This understanding may reflect an individual's diversity and uniqueness. Storytelling is valuable for teachers, as well as nursing students. The use of the story brings nursing situations to life, facilitates personal meaning in nursing situations, and empowers diverse students to adapt to the educational system in ways that will facilitate their success.

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Value of Storytelling as a Teaching-Learning Approach

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