Appreciation of the neonatal care experience through the eyes of student nurses

The development of a storytelling learning resource

Julia Petty - Senior Lecturer in Children’s Nursing, School of Health and Social Work, University of Hertfordshire

Baby

This Thought-piece outlines the background and development of a storytelling resource about neonatal nursing, developed from the narratives of student nurses who had spent time in this area for a practice placement during their nursing undergraduate programme. It also briefly reports on a preliminary evaluation of the resource in relation to the learning contribution for children’s nursing students at the University of Hertfordshire. Results overall highlighted how storytelling based on peer experiences was a useful and insightful approach to learning about a different speciality and preparing for practice in a new area.

Introduction

Within healthcare education, it has been well documented for some time that storytelling is particularly appropriate for student learning and exploration about patients (Greenhalgh and Hurwitz, 1998; Gidman, 2013; Hoggan and Cranton, 2015), in a field that focuses on humanistic understanding. As a learning strategy, storytelling can encourage students to explore experiences and emotions of others which can heighten their ability to communicate thoughts and feelings (Hardy and Haigh, 2011) and empathise with others. This is particularly important within nursing, a profession that requires such skills to develop therapeutic relationships with patients. In the current fast-paced, media-driven climate, storytelling can be a nurturing way to remind health professionals that spoken words are powerful, that listening is important, and that learning from each other is of great value for empathic understanding (Fix et al, 2012). In essence, stories inform the listener or observer about experience through narrative. Storytelling offers a compassionate approach to learning that enables health professionals to understand individualised experience and this is seen as a valuable strategy within both higher and health education to develop person-centred skills in clinical settings (Wright et al, 2014).

Context

Within nursing, there is an emerging body of literature to support the value of storytelling for teaching and learning (Charon, 2006; DasGupta, 2007; Christiansen, 2011) which has mainly emerged from the adult field. Within children’s nursing however, limited research has been undertaken into the value of narrative and this is significantly less prevalent within the neonatal specialty. Moreover, little is known about how narrative can inform education strategies in specific areas such as neonatal care.

Neonatal care is a distinct area of children's nursing and one that offers the learner a wide variety of diverse skills and knowledge areas including one very important topic, that of preterm birth and it many facets. The implications of preterm birth and the subsequent neonatal care for neonate and family are significant (Green et al, 2015) and the often protracted ‘journey’ through the neonatal unit is one that offers huge opportunities for learning for students or health professionals working in this specialised field. Traditionally, education has focused on technological skills necessary to care for these very vulnerable patients and their parents. However, less attention has always been centred on person-centred care defined as that involving compassion, dignity, empathy and an understanding of patient as well as parent experience.

Project development

With this above rationale in mind, a story-telling resource was developed that centred on the creation of stories collected from the narratives of student nurses that aimed to enhance learning and understanding in student nurses about person-centred neonatal care.

The project followed on from a recent small-scale research study undertaken by the author, titled ‘Storytelling in the neonatal unit; Appreciation of the neonatal care experience through the eyes of student nurses’. This study collected narratives from student nurses who had worked in a neonatal unit for a clinical placement, by interviewing them about their experiences of the field from the start of their placement until completion nine to eleven weeks later. The research question for the study was: ‘What can be learnt about the neonatal care experience from the stories of student nurses?’

From the raw narratives, stories were created using ‘core story creation’, a process that involves the principles of employment based on the work of Emden (1998) and used in subsequent work by Kelly and Howie (2007). In this type of narrative inquiry, the data collected consisted of actions, events and happenings. The subsequent data analysis involved their synthesis and configuration to produce or construct stories. The latter is akin to what Bruner (1991) terms ‘story making’, in other words, narrative ‘structuring’. This is similar to Polkinghorne’s (1995) narrative configuration. Rationale for the use of this strategy centres on its links with the constructivist theoretical approach whereby the reconfiguration of raw narrative leads to a coherent whole, ‘constructed’ from individual experience.

Subsequent narrative analysis of the created stories revealed key, common themes offering rich data that had the potential to be shared with peers as a way to learn about this specialty. In order to achieve this therefore, a digital resource was developed by the author in conjunction with an educational technologist (Figure 1). Six participant stories were ‘told’ by the author’s recorded voice and selected extracts of 1st person text quotations from the participants’ narratives were added to a series of PowerPoint slides as the initial template. Text was kept to a minimum but each slide contained an image relating to neonatal care. Once six story boards were prepared, the resource was built by an educational technologist using ‘Captivate’, a web-based interactive software package enabling the development of web-based reusable learning objects and the ability to navigate through a series of slides at one’s own pace. A web page was also developed to host the six stories along with a brief introduction, seen below in Figure 1.

website Access this resource.

Preliminary evaluation

A group of students have undergone an initial evaluation of this resource based on the effectiveness and value of storytelling for learning by both questionnaire method combined with a group evaluation session using an electronic voting system (EVS). Overall, the results were positive with students expressing benefits in relation to key emerging themes; namely storytelling as an interesting and novel approach to teaching and learning, learning from their peers, preparation for practice, insight into a new specialist area and the perceived value of interactive, multi-media learning packages. Evaluation will continue at a later date once the students have had more time to use the resource in full. Dissemination will also take place to other, future groups of students.

Implications for Learning and Teaching

The anticipated contribution of this project to learning and teaching practice relates to how storytelling could be an alternative and innovative approach for understanding the neonatal care experience through the eyes of learners. Storytelling has not been used as a teaching strategy with the current nursing students in this area of children’s nursing.

This will now be offered to the children’s nurse pre-registration curriculum in an identified module and others thereafter, with evaluation informing subsequent adaptations where necessary. In addition, stories written from student nurses narratives which are then offered to other student nurse groups is congruent with the concept of peer learning.

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References

Bruner, J. (1991). The Narrative Construction of Reality. Critical Inquiry, 18 (1), pp.1-21.
Charon, R. (2006) Narrative Medicine: Honoring the Stories of Illness. Oxford University Press: Oxford and New York.
Christiansen, A. (2011). 'Storytelling and professional learning: A phenomenographic study of students' experience of patient digital stories in nurse education'. Nurse Education Today, 31(3), pp. 289-293.
DasGupta, S. (2007). 'Between Stillness and Story: Lessons of Children’s Illness Narratives. Pediatrics'. 119(6), e1384-1391.
Emden, C. (1998). Conducting a narrative analysis. Collegian. 5(3), pp.34-39.
Fix, G. M., Houston, T. K., Barker, A. M., Wexler, L., Cook, N., Volkman, J. E., & Bokhour, B. G. (2012). 'A novel process for integrating patient stories into patient education interventions: incorporating lessons from theater arts'. Patient education and counseling, 88(3), pp.455-459.
Gidman, J. (2013). 'Listening to stories: Valuing knowledge from patient experience'. Nurse Education in Practice, 13 (3), pp.192-196.
Greenhalgh, T and Hurwitz, B. (1998). Narrative Based Medicine. Dialogue and discourse in clinical practice. London, BMJ.
Green, J., Darbyshire, P., Adams, A., & Jackson, D. (2015). 'Looking like a proper baby: Nurses' experiences of caring for extremely premature infants'. Journal of Clinical Nursing, 24(1-2), pp.81-89.
Hoggan, C., & Cranton, P. (2015). 'Promoting Transformative Learning Through Reading Fiction'. Journal of Transformative Education, 13(1), pp.6-25.
Kelly and Howie (2007). Working with stories in nursing research: Procedures used in narrative analysis. International Journal of Mental Health Nursing, 16, pp.136-144.
Haigh, C. and Hardy, P. (2011). Tell me a Story: A conceptual exploration of storytelling in healthcare education. Nurse Education Today. 31(4):408-11.
Polkinghorne, D.E. (1995). Narrative configuration in qualitative analysis, in Hatch J.A. and Wisniewski, R (eds) Life History and Narrative. London: Falmer Press
Wright JM, Heathcote K, Wibberley, C. (2014) 'Fact or fiction: exploring the use of real stories in place of vignettes in interviews with informal carers'. Nurse Researcher. 21(4), pp.39-43.