Nursing faculty have been called to “radically transform” classroom instruction (Benner, Sutphen, Leonard, & Day, 2010, p. 1). However, many faculty members struggle with how to achieve this goal of teaching in a way that fosters a sense of salience, clinical imagination, and professional development, while maintaining the academic rigor necessary to ensure student success. Case studies that use narrative pedagogy can provide students with a unique perspective of disease in context by demonstrating the full trajectory of patients’ lived experiences from initial symptoms through rehabilitation, recovery, and possible death (Day, 2011; Ironside, 2006). This article describes the use of the children’s book My Grandpa Had a Stroke (Butler, 2007) as a robust, illustrated case study to teach beginning nursing students about the concepts surrounding the nursing care of a patient who has had a stroke.
Description of Learning Activity
Overview. My Grandpa Had a Stroke (Butler, 2007) is written from the perspective of a young boy named Ryan whose grandfather has had a stroke, and it carries the reader through the experience of stroke from the initial symptoms to recovery. Due to the story’s rich details, this learning activity, which takes approximately 15 minutes, provides an ideal case study for discussion about the nursing responsibilities involved in caring for patients who have experienced a stroke.
Process. To focus more time on the core nursing concepts that are demonstrated in the book but still allow students to understand the bond between Ryan and his grandfather, the instructor provides a summary of the book’s first few pages. Following the summary, the instructor reads the book aloud to the class.
Class Discussion. After reading the story, the instructor poses questions about the signs and symptoms of stroke that are included in the book. For example, the book describes and graphically illustrates Grandpa’s mouth as looking like “someone pasted it on crooked” (Butler, 2007, p. 12). In addition, Grandpa combs only one side of his hair and can hug Ryan with only one hand because he cannot move his left side. These and other vivid details allow students to visualize the patient, while discussing Grandpa’s care, including risk for aspiration, falls, skin breakdown, impaired communication, and nutritional needs. Later in the story, the author describes a physical therapist’s interventions to help Grandpa maintain an upright posture and safely transfer to his wheelchair. This visit allowed discussion of an interdisciplinary approach where nursing, medicine, nutrition, and speech and physical and occupational therapies work together to maximize outcomes for patients and families.
Interspersed throughout the story, many details emphasize the psychosocial impact of stroke on patients and their families. For instance, Ryan is frightened when he first visits Grandpa in the hospital, and he does not want to see him again. Grandpa also experiences outbursts, such as calling someone “fatty,” which embarrasses Ryan (Butler, 2007, p. 21). Such details lead to students’ discussion regarding the impact of stroke on Grandpa, Ryan, and the entire family. The conclusion of the story, when Grandpa moves in with Ryan and his parents, allows the instructor to explore the adjustments necessary to provide a safe environment for Grandpa, who requires use of a wheelchair.
In a classroom of 100, the students listened intently, and some even cried during the emotional descriptions and the happy conclusion. Given the challenges of capturing and maintaining the attention of large groups of undergraduate students, using children’s literature as a case study provides students with rich context that enhances their understanding of holistic care as a useful tool to transform the classroom from a place of passive learning into an atmosphere of active discovery of the unique role nurses play in the healing process.
Amy Ponder, MSN, RN
University of Alabama at Birmingham
School of Nursing
- Benner, P., Sutphen, M., Leonard, V. & Day, L. (2010). Educating nurses: A call for radical transformation. San Francisco, CA: Jossey-Bass
- Butler, D.H. (2007). My grandpa had a stroke. Washington, DC: Magination Press.
- Day, L. (2011). Using unfolding case studies in a subject-centered classroom. Journal of Nursing Education, 50, 447–452. doi:10.3928/01484834-20110517-03 [CrossRef]
- Ironside, P.M. (2006). Using narrative pedagogy: Learning and practicing interpretative thinking. Journal of Advanced Nursing, 55, 478–486 doi:10.1111/j.1365-2648.2006.03938.x [CrossRef] .