Journal of Nursing Education

Educational Innovations 

A Review of Narrative Pedagogy Strategies to Transform Traditional Nursing Education

Sylvia T. Brown, EdD, RN, CNE; Mary K. Kirkpatrick, EdD, RN; Dana Mangum, MSN, RN; Jeanette Avery, MSN, RN

Abstract

Traditional nursing pedagogies using teacher-centered learning approaches have produced efficient, knowledgeable nursing graduates for many years. However, 21st century learners will require and demand new educational approaches. The information age of computers has challenged all facets of education to keep pace. Nursing education must evolve with ever-changing forms of communication and technology and recognize generational differences in learning. The creation of partnerships in learning, rather than the traditional hierarchy of education, is projected to meet the needs of today’s learners more effectively. The National League for Nursing, in its position statements, has challenged nurse educators to develop new research-based pedagogies responsive to the changing health care environment and reflective of new partnerships between and among students, teachers, and clinicians. This article will explore examples of one approach, narrative pedagogy, and its usefulness in nursing education as a way to expand the pedagogical literacy of nurse educators.

Abstract

Traditional nursing pedagogies using teacher-centered learning approaches have produced efficient, knowledgeable nursing graduates for many years. However, 21st century learners will require and demand new educational approaches. The information age of computers has challenged all facets of education to keep pace. Nursing education must evolve with ever-changing forms of communication and technology and recognize generational differences in learning. The creation of partnerships in learning, rather than the traditional hierarchy of education, is projected to meet the needs of today’s learners more effectively. The National League for Nursing, in its position statements, has challenged nurse educators to develop new research-based pedagogies responsive to the changing health care environment and reflective of new partnerships between and among students, teachers, and clinicians. This article will explore examples of one approach, narrative pedagogy, and its usefulness in nursing education as a way to expand the pedagogical literacy of nurse educators.

Dr. Brown is Professor and Acting Dean, Dr. Kirkpatrick is Professor and International Coordinator, Ms. Avery is Instructor, College of Nursing, East Carolina University, Greenville, and Ms. Mangum is Nursing Instructor, School of Nursing, Carolina College of Health Sciences, Charlotte, North Carolina.

Address correspondence to Sylvia T. Brown, EdD, RN, CNE, Professor and Acting Dean, College of Nursing, East Carolina University, 3166A Health Sciences Building, Greenville, NC 27858; e-mail: brownsy@ecu.edu.

Received: July 26, 2006
Accepted: November 22, 2006

The need for educators to increase their pedagogical literacy has never been greater (Diekelmann, 2003). Traditional methods no longer satisfy the demands of today’s learner, nor do they answer health care reforms’ continuous calls for nursing education innovation (Greiner & Knebel, 2003; National League for Nursing [NLN], 2003). Nurse educators, realizing the constraints of conventional pedagogy, have begun to develop and implement alternative, interpretive pedagogies. These nontraditional pedagogies result in a learning climate that is more cooperative and egalitarian. A shift in focus to reflecting, learning, connecting, and thinking together with students is occurring.

Narrative pedagogy incorporation into nursing education was first researched and analyzed by Diekelmann (2001). Diekelmann conducted extensive analysis of the lived experiences of teachers and students within the discipline of nursing (Andrews et al., 2001; Diekelmann, 2001; Ironside, 2001, 2003; Swenson & Sims, 2000). Narrative pedagogy, as an adjunct to course content, focuses on processes such as teaching; interpreting; critically thinking; and analyzing concepts, ideas, and situations. The ability to know and connect with students becomes the focus of the learning environment. Using this approach, teachers and students form a partnership and publicly share and interpret their experiences.

This article’s purpose is to explore examples of narrative pedagogy and its usefulness in nursing education as a way to expand the pedagogical literacy of nurse educators. A variety of modalities from art, film, music, storytelling, and journaling will be reviewed as strategies for infusing narrative pedagogy into nursing curricula as a humanistic educational approach.

Use of Art, Film, and Literature

A literary pedagogy in nursing encompasses three interrelated skills—reading, interpreting, and critiquing. The goal is to enable students to change reading strategies from reading for information, key points, main ideas, or answers, to taking authority for their own learning by reading reflectively, observing both their own reactions and the questions the work evokes and actively creating meaning (Sakalys, 2002). The depictions of illness, disease, and caring found in fiction, poetry, drama, film, and paintings are far more powerful and sensitive than the explanations contained in standard nursing textbooks. Therefore, the study of art, film, and literature can be a vital contribution to nurses’ different ways of knowing; experiences are no longer seen primarily through the collection of factual material (Darbyshire, 1994).

The importance of lecture and clinical experiences is not in question; however, literature and other media (e.g., film, art, music) have a great influence on society’s perception of illness and the cultural construction of disease (Wall & Rossen, 2004). The understanding of certain truths of human experience such as the nature of self, anguish, guilt, and choice is central to the discipline of nursing (Wall & Rossen, 2004). Lecture alone struggles to produce these insights.

Kirkpatrick & Brown (2004) chose literary narrative pedagogy to teach an undergraduate geriatric course. The concepts of living and dying, loving, forgiving, and finding meaning in life were explored using films including Iris (Fox, Rudin, & Eyre, 2001), Fried Green Tomatoes (Avnet & Kerner, 1992), Wild Strawberries (Bergman, Ekelund, & Fischer, 2006), and On Golden Pond (Gilbert, Rydell, & Thompson, 1981). For example, the story told in the film On Golden Pond conveys the ideas related to intergenerational conflict, the effects of aging both physically and emotionally, and the importance of reminiscence. In Wild Strawberries, students are exposed to the concept of reminiscence as a tool to calm anxieties and aid in finding forgiveness in the resolution of past conflicts. Literature used in the course taught by Kirkpatrick and Brown (2004) included The Fall of Freddie the Leaf: A Story of Life for All Ages (Buscaglia, 1982), Tuesdays with Morrie (Albom, 1997), The Death of Ivan Ilych (Tolstoy, 1960), and On My Own at 107 (Delany, 1997). In Tuesdays with Morrie, for example, learners are led to discern their own values and beliefs about living and dying. On My Own at 107 allows readers insight into the life of an older adult who, despite many losses, is able to move on and see life as meaningful. Cognitively, narratives help improve learning and problem solving; affectively, they help instill hope; interpersonally, they serve as a socialization tool, helping to establish trust and promote bonding; finally, they help foster personal growth (Kirkpatrick & Brown, 2004).

Wall & Rossen (2004) used literature, film, and music as a narrative teaching strategy in psychiatric nursing courses. Excerpts from Styron’s Darkness Visible: A Memoir of Madness (1992) and Kaysen’s Girl, Interrupted (1994) increased the students’ sensitivity to individuals with mental illness. The class examined films such as Rain Man (Levinson, Hoffman, Cruise, & Golino, 1998); ‘Night, Mother (Norman, Spelling, & Greisman, 1987); and A Beautiful Mind (Grazer, Howard, & Goldsman, 2002) for deeper comprehension of child and adolescent disorders, suicide, and schizophrenia. Chemical dependency was discussed using John Lennon’s lyrics from “Cold Turkey” (1969, track 1). “Stuck in a Moment You Can’t Get Out Of,” made popular by U2 (Hewson, 2000, track 2), was used to explore the concept of anxiety and the strategies that can be used to handle it. As a result of incorporating these narrative strategies, the authors reported students’ critical thinking and analytical skills were enhanced, along with introspection and selfreflection (Wall & Rossen, 2004). This approach resulted in a context for evaluating the core beliefs and values that students held about mental illness (Wall & Rossen, 2004).

Use of Storytelling

One of the most effective modes to transfer information is story telling. Stories capture interest and attention, enable recall of details by association, and bring facts to life by putting them in personal scenarios (Davidhizar & Lonser, 2003). Bergman (1999) concluded that stories better demonstrate values and therefore may have a greater influence on learning. Story telling has been described as a means to discover knowledge, uncover the knowledge embedded in practice, and recover the art of nursing (Sandelowski, 1991). Hearing one nurse’s story may move 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). A narrative framework affords nursing scholars a special access to the human experience and obligates them to listen to the human impulse to tell tales (Sandelowski, 1991).

This approach includes stories of success, crisis, and misfortune to provide valuable learning experiences for students and teachers. Telling personal experiences promotes empathy and understanding; it allows the students to vicariously benefit from the experiences of an expert and thus avoid repeating painful experiences (Lunt, 2000). As stories are shared about clinical experiences, students examine their values and attitudes in ways that would be difficult to achieve by other methods (Hensel & Rasco, 1992). In addition, students have attributed success in testing to being able to associate or recall facts with a story (Davidhizar & Lonser, 2003).

Kirkpatrick & Brown (2006) used storytelling in geriatric nursing education through students’ engagement with older adults and their stories. Students often found this activity enlightening and reported learning more than they were taught. Nehls (1995) implemented this kind of narrative pedagogy with the use of paradigm cases. She had undergraduate and graduate clinical students share situations that altered their understanding of the present, reflections on the past, and visions of the future. Benner (2001) shared many similar paradigms in her book, From Novice to Expert: Excellence and Power in Clinical Nursing Practice.

Personal narratives and stories create the capacity for developing ethical knowledge in nursing, as well as an understanding of caring and culture. Severtsen (2004) contended that caring taught as a reflective process, rather than in a traditional conceptual approach, allows one to think about specific shared lived experiences of caring and thus helps one to identify the caring embedded in nursing and health care situations. Severtsen’s students identified the lecture format as a barrier to learning about caring; however, the narrative approach helped them learn about the meaning of caring.

After telling a caring story to the graduating class of 2002, Tanner (2002) addressed the graduates:

Remember today and always why you came into this crazy, challenging, heart-wrenching, and wonderful profession of nursing. Remember your stories, and the sustaining wonders of our work. No matter what the future holds, you will be prepared by keeping a story in your heart. (p. 240)

The value of story telling becomes more obvious.

Use of Reflective Journaling

Reflective journal writing as an instructional or learning tool in education has gained credibility during the past few decades. As early as 1965, psychologist Ira Progroff and his colleagues began seeing the value of personal journals in enhancing growth and learning (Hiemstra, 2001). Adult educator, Malcolm Knowles, introduced readers to personal reflection through activities such as self-assessment and proactive reading of materials (Hiemstra, 2001). Journal sharing expands the dissemination of relevant clinical experience and facilitates both cognitive and professional growth while also increasing access and expanding the opportunity for reflection (Daroszewski, Kinser, & Lloyd, 2004).

Developing a voice through journaling is another way of telling one’s story; creating the images that shape the profession; and carrying on nursing’s caring, healing tradition (Heinrich, 1992). Nurses, nurse educators, and nursing students striving to find meaning through voice can use the narrative pedagogy of journaling so individual nurses and the profession will come to know themselves within the context of the health care culture (Kobert, 1995). Journal writing is an opportunity for students to explore ideas; to understand situations; to share thoughts, feelings, and beliefs; and in developing an increasing sense of self-awareness, to discover their own voice (Pierson, 1998). The evolution of critical thinking can be noted in journal writings, through reflection on personal actions taken, analysis of patient situations, and evaluation of outcomes.

Gillis (2001) views journaling as a process and a product. As a product, journals are personally written accounts that promote expression of perspectives, ideas, and feelings. As a process, journaling promotes exploration and facilitates reflection on learning and new experiences in the context of the manner in which learning unfolds. The benefits of journal writing for adult learners include personal growth and development, use of intuition and self-expression, problem solving, stress reduction and health benefits, and reflection and critical thinking. A sense of trust between the student and the teacher is essential. This environment of trust also encourages learning.

Conclusion

A paradigm shift that is occurring in nursing education today is the move from a passive to a more active, self-directed, participative learner; and nursing faculty are shifting from a teacher-dominated to a learner-centered teaching approach. Many nurse educators consider themselves facilitators for active participants through the learning experience, rather than vessels pouring wisdom into passive listeners (Zimmermann, 2003). The banking concept of education, an idea formed by Freire (1993), in which students passively accept deposits of knowledge from a teacher, will not work for our current and future generation of learners. Reflective and critical thinking is essential for effective nursing practice, and teacher-centered, conventional pedagogies do not foster the development of these skills (Kawashima, 2005). Narrative pedagogy does not seek to rid the educational environment of the conventional approaches that are so well known, but instead to create a space within the conventional attitude to approach learning in new and innovative ways. When teachers invite students in a collaborative fashion to approach educational challenges for the creation of a greater understanding and learning, commitments are made between teachers and learners, strengthening their relationship within the educational community.

According to Nehls (1995):

The issue is not whether narrative pedagogy is better than other approaches, but rather, how it can be employed as a useful philosophical and practical approach to rethinking nursing education. (p. 209)

The use of narrative pedagogy allows other pedagogies to occur and thus strengthens the learning experience (Diekelmann, 2002). The creation of learning environments that are characterized by collaboration, understanding, mutual trust, respect, equality, and acceptance of difference will transform tomorrow’s nursing education (NLN, 2005). Educators are challenged to use the best of the old and the best of the new, as they reform the way they teach to enhance nursing education. Limited research exists about the effectiveness of narrative pedagogy and how its use actually strengthens the learning experience. As the science of nursing education develops, research is critically needed to examine which approaches and strategies are most effective in enhancing critical thinking, promotion of cognitive and ethical growth, and individual autonomy in professional practice. Educators are challenged to establish effective partnerships between and among students, teachers, and clinicians. Reformation and transformation of the nursing education milieu is essential as research-based pedagogies are used to enhance the scholarship of teaching for 21st century learners.

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Authors

Dr. Brown is Professor and Acting Dean, Dr. Kirkpatrick is Professor and International Coordinator, Ms. Avery is Instructor, College of Nursing, East Carolina University, Greenville, and Ms. Mangum is Nursing Instructor, School of Nursing, Carolina College of Health Sciences, Charlotte, North Carolina.

Address correspondence to Sylvia T. Brown, EdD, RN, CNE, Professor and Acting Dean, College of Nursing, East Carolina University, 3166A Health Sciences Building, Greenville, NC 27858; e-mail: .brownsy@ecu.edu

10.3928/01484834-20080601-01

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