Grief is an issue nurses respond to regularly and requires examination of personal experiences, biases, and beliefs for the nurse to meet the needs of a grieving patient or family (Schreiner & Wolf Bordonaro, 2019). Reflective examination of nursing students' personal grief experiences can prepare them to attend to patients and families facing grief. Educational activities that explore grief through the lens of the student's personal narrative and life story enhance critical examination of grief and the grieving process. This enhances the affective learning domain associated with attitudes, beliefs, and emotions, providing a benefit to both the students and their future patients (Dexter, 2016).
Narrative pedagogy centers upon gaining knowledge through the understanding and interpretation of common lived experiences, expanding reflective and diverse perspectives (Ironside, 2015). Course activities involving student analysis of their personal life experiences and emotions can assist in developing internal understanding and meaning. One such activity is art-based learning, which aids student interpretation of fluid concepts such as grief, while providing an avenue for transformative knowledge beyond the basic stages of grief to the affective learning domain. Personal narrative use allows for critical reflection and cultivates patient-centeredness, empathy, and the ability to manage emotions and emotional situations (Schreiner & Wolf Bordonaro, 2019).
Narrative pedagogy and affective learning domain concepts framed the implementation of an art-based grief collage assignment in an online undergraduate hospice and palliative care course. The collage created contained words and images describing the student's lived experiences, thoughts, and beliefs concerning loss, grief, and the role of memories during the end of life. Students submitted the assignment electronically, allowing freedom in a collage format, such as PowerPoint® or creating an actual hard copy collage, and then submitting a JPEG file. With prior faculty approval, some students chose other art-based activities, such as writing poems, composing music, or choreographing dances, to reflectively engage and explore grief concepts.
The grading rubric included several aspects such as communication of the relationship between grief, loss and bereavement, use of graphics and art to support the narrative, and evidence of insight into the grieving process. The goal of the assignment included engaging students' reflection concerning grief and loss through personal narrative, as well as empathy development toward those grieving. The objectives focused on student awareness of the patient grief experience and their own beliefs and values. Multiple student comments indicated that these goals and objectives were met. Comments suggested enjoyment in exploring difficult concepts in a personal way, identifying personal thoughts and beliefs about grief and loss, and gaining empathy and awareness of the emotional impact of the grieving process.
This grief collage assignment embraces the use of art-based narrative as part of transformational learning, encouraging depth of reflection, and enhancing empathy development. Encouraging students to explore personal narratives engages the student in critical reflection and has the potential to impact meaning construction through revision of narratives that can guide future nursing practice in a positive, empathetic, and patient-centered manner.
Jayne Josephsen, EdD, RN, CCCTM, CHPN
Boise State University
- Dexter, Y. (2016). Storyboarding as an aid to learning about death in children's nursing. Nursing Children and Young People, 28(5), 16–21 doi:10.7748/ncyp.28.5.16.s21 [CrossRef]
- Ironside, P. M. (2015). Narrative pedagogy: Transforming nursing education through 15 years of research in nursing education. Nursing Education Perspectives, 36(2), 83–88 doi:10.5480/13-1102 [CrossRef]
- Schreiner, L. & Wolf Bordonaro, G. P. (2019). Using nontraditional curricular tools to address death and dying in nurse education. Journal of Hospice and Palliative Nursing21(3), 229–236 doi:10.1097/NJH.0000000000000514 [CrossRef]