Narrative Pedagogy In Nursing Education
Whats Is Narrative Pedagogy
Narrative pedagogy is a method of teaching where there is a focus on reflection and learning through reflective writing about one’s experience (Diekelmann, 2001). It involves creating and receiving stories; narrative in nursing has roots in Nightingale, where the power of her reflective writing continues to inspire our discussions and nursing directions today. Narrative offers a humanistic approach to health care, as participants derive shared meaning from the interpretation of stories (Walsh, 2011) through writing, art, and other creative practices.
The narrative process often occurs in a planned, structured situation with defined goals and guidelines including a safe, confidential space for sharing. Health care team members are provided with a prompt/creative practice (eg, literature, poetry, film, and art), which stimulates them to reflect on information about self, patients, and/or colleagues. The participants then write for a prescribed amount of time, and finally share, if desired. while others listen respectfully. The trained leader is a facilitator, creating a safe space for participants to share and their voices to be heard.
Goals of a program using a narrative pedagogy have been described as facilitating reflection, enhancing the quality of relationships, and promoting professionalism (Hofstra-North Shore LIJ School of Medicine, 2011). New knowledge and perspectives are often attained as a result of the sharing and reflection, along with a decrease in isolation, individualism, competition, and faculty centeredness (Andrews et al., 2001).
Reflection is the act of considering something, giving it serious thought, or the process of looking back. Critical reflection is the “analysis of personal experience to enhance learning and improve future professional behavior and outcomes” (Aronson, Niehaus, Hill-Sakurai, Lai, & O’Sullivan, 2012). The use of critical reflection supports one as a reflective practitioner (Schon, 1983) and may involve two processes: reflection in action and reflection on action.
Reflection in action is described as a practitioner reshaping what he or she is doing, while doing it, using past experience as a guide; this is a mindful practitioner, totally in the moment. Reflection on action refers to reflecting on a past event, often used in clinical situations, in journaling, or when one is seeking personal growth or problem solving. Reflection on action may help practitioners assess current practice or identify areas of strength, feelings, and opportunities for growth.
Implementations of Narrative Pedagogy In Nursing Education
Narrative pedagogy, rooted in the tradition of learning from stories through the use of reflection, is now being combined with competency and content-focused curriculum in both medicine and nursing education. As students, teachers, and doctors interpret and share their experiences, as well as express and analyze feelings and reactions, communication skills are enhanced and connections are increased.
As narrative gains popularity in academia, selective institutions are incorporating this pedagogy into their curriculum, forming narrative inter-professional committees, programs, electives, and workshops to foster reflection, interpersonal skills, job satisfaction, retention, and empathy.
The goals of the narrative in various programs are similar. One nursing education institute described goals as enhancing self-awareness, facilitating critical reflection and problem solving, promoting patient-centered care and safety, and identifying learning needs (Lumley, 2012). Reflection in education has been reported to improve learning and competency performance, including professionalism and clinical reasoning (Aronson, 2011) Narrative pedagogy helped nursing students and their teachers to pool wisdom, challenge preconceptions, and develop new ideas surrounding patient centered care (Ironside, 2006 ).
In medicine, one trait of professionalism enhanced by narrative is empathy, a skill that previously took years of experience to achieve (Charon, 2001). Through reflective writing, participants are provided with a mechanism to voice emotions, concerns, and feelings that we previously did not recognize
While practitioners reflect on patient encounters, educators must critically reflect on teaching behaviors to potentially improve the teaching practice Visual arts, media, and creative arts may be used in conjunction with written narrative and to enhance the reflective process. In one study, faculty participants felt viewing abstract paintings changed their mood and emotionally prepared them for reflective writing. The art and narrative increased participant’s ability to access feelings, promoted examination of educational challenges, and led to compassion for self and others.
Finally, sharing of narrative was helpful for fostering active listening and appreciating multiple perspectives (Karkabi, Wald, & Cohen, 2013).Key points in the narrative pedagogy process include teaching the learners about reflection prior to the activity, goals for the exercise, guidelines for the reflection and sharing, appropriate method for the reflection, prompt a plan for dealing with concerns raised (Peterkin, 2010 ) , and a mechanism for follow up or assessment.
The writing may or may not be subject to a rubric for formative evaluation. Thus, narrative pedagogy can foster the development of students, practitioners, and faculty in an ongoing manner, as self-development requires ongoing attention.
Trends of Educators Regarding Narrative Pedagogy
With the increased focus on practitioner and educator self development, patient centered care, health promotion, and wellness, various strategies are being sought to enhance both education and practice. The application of narrative in both life and learning is limited only by the creativity of the individual, institution, or university.The literature supports the many varied endeavors at narrative in both education and practice, including incorporation of this pedagogy into curriculum, electives, programs, and workshops.
Narrative pedagogy aligns with many of the National League for Nursing Core Competencies for Nurse Educators including facilitating learning, development and socialization, assessment and evaluation strategies, curriculum development, and change agent (Halstead, Green, Speziale, & Tomasic, 2005). Narrative pedagogy is one method of teaching where the learner is an active participant in a reflective process, and the goals of enhancing critical reflection, respect, empathy, collegiality, cultural diversity, communication, and evidence-based practice are enhanced.
The development of these skills fosters self development, lifelong learning, and patient-centered care.The many forms and possibilities of narrative partners with the complicated scenarios of the health care provider’s practice. The focus of the narrative may be an actual experience, or involve prompts and the use of modalities such as poems, close readings of short stories, art, film, and music. As the use of narrative increases, rubrics have been developed (Reis et al., 2010), and attempts to measure outcomes are being highlighted in both quantitative and qualitative research studies.
Cultural Diversity In Narrative Pedagogy
As patient populations and health care teams increase in cultural diversity, and we face ongoing challenges with ethical dilemmas, educational leaders are seeking learning opportunities for students and faculty development that provide knowledge, skills, and attitudes to meet these challenges. Narrative pedagogy is one way in which health care professionals can learn techniques to enhance their personal development, improve patient care, and collaborate with the health care team or faculty.
Incorporating narrative pedagogy in educational programs as part of the honored curriculum, in structured settings with knowledgeable faculty who provide essential feedback is critical to its success (Aronson, 2011).Further research is warranted to support current practices and identify new best practice models. Areas such as inter-professional collaboration, development of empathy skills, and the use of technology for narrative warrant attention.
Future directions may also include research on teaching methods and evaluation tools for the various forms of narrative. Finally, the link between self development of the educator and practitioner and health-promoting outcomes, job satisfaction, and retention need further investigation As practitioners and educators increase the use of narrative, the opportunity for increased use in patient care, for both individual and groups, may be realized and utilized.