Context of the Inquiry
About the Course
As of fall 2011, I have co-taught the community/public health part of the Health I: Nursing Therapeutics theory course (NS315) 16 times since fall 2004. The course is an integrated one, and it introduces junior level nursing students in the baccalaureate nursing program for the first time to community/public health nursing concepts and to maternity/obstetrical nursing. The theme that brings these two fields of nursing together is “Families in Transition”. Families, culture and community are the major concepts of this integrated course.Students have readings from a community/public health text and from a maternity/obstetrical text throughout the course. The faculty member with whom I co-teach and I take turns presenting the didactic classes on our topics. Due to the short seven and a half weeks trimester of the course, the theory classes are four hours long twice a week. They are not mandatory for students to attend; thus, some students choose not to attend. The content I cover is “birth to death in 24 hours” along with introductory community/public health concepts as they relate to the nurse’s role with family and culture in the community. Power points with study guides, guest speakers, DVDs and case studies with discussion groups are the methodologies that I’ve used regularly with this course. Exhibit 1 is a synopsis of the theory course, and Exhibit 2 is the list of the student outcomes through 2011.
Exhibit 1 – Synopsis of Theory Course
Discipline: Nursing in the Community
Course: Health I: Nursing Therapeutics
Course Level: Junior level in Baccalaureate Nursing Program
Number of Students: Full cohort is 40 students. This cohort was 31 students.
Type of Course: The last junior level course, and the introduction to community/public health concepts.
Meeting time: Two 3 hour and 50 minute classes twice a week – Monday and Friday.
Exhibit 2 – List of Student Outcomes Through 2011
1. Apply wellness principles to clients and their families.
2. Utilize critical thinking and the nursing process to promote and maintain wellness for individuals and families.
3. Describe community resources and how they can be utilized to provide care to individuals and families.
4. Develop a health care plan for individuals and families that is based on scientific evidence.
5. Utilize appropriate verbal and written communication skills with peers, instructors, clients and/or health team members.
6. Integrate the concepts of caring into addressing the needs of individuals and families.
7. Explore the roles of the nurse as an educator, advocate, collaborator and professional.
Since this is the first time that students are assessing, planning, implementing, and evaluating a health promotion teaching for a whole family, taking into consideration its culture, within a community setting in the clinical part of this course, it is important for students to have a foundation in family theory. It is also essential for students to be aware of his or her own perceptions of family, culture, and community and to be receptive to the perceptions of their classmates and of the families in transition whom they follow for four home visits in the clinical part of the course. Some students have difficulty transferring the theory information that they learn in the didactic part of the course to the “real live” families with whom they work in the clinical part of the course. For the clinical part of the course, students write a paper regarding a teaching project that the student develops and presents to the family they follow in the community, and they provide an oral report about the family and project to their clinical cohorts. These assignments focus primarily on assessing the family, planning the health promotion project, implementing the project, and evaluating the project process, as well as the strengths and areas in need of improvement for the student.
Focus of the Inquiry
In their book, Educating Nurses: A Call for Radical Transformation, Benner, Sutphen, Leonard, & Day (2010) make a number of challenging recommendations regarding the improvement of nursing education at the program level and engagement of nursing students through the use of multiple interactive methods relevant to their clinical experiences and practice. Among these recommendations is the need to “…support educators in learning how to use narrative pedagogies in the classroom and skills labs” (p. 225). Benner, et al. (2010) observed that “Narrative pedagogies are among the best teaching strategies…they are effective in developing students’ sense of salience, clinical reasoning, and clinical judgment” (p. 225-226). The use of narrative pedagogies also “develops clinical imagination” in nursing students for them to envisage how they may approach the care of individual clients, families, populations and communities (Benner, et al., 2010, p. 226).
In their review of narrative pedagogy strategies, Brown, Kirkpatrick, Mangum, and Avery (2008), found that nursing education is shifting “from a passive to a more active, self-directed, participative learner” and that nurse educators are moving to a more “learner-centered teaching approach” (p. 285). The use of narrative pedagogy in a learning environment can enhance collaboration, mutual trust, respect, and equality. Brown, et al. (2008) states that more research is needed to examine how narrative pedagogy strengthens the learning experience.
The faculty member who teaches the senior level community nursing course and I decided to use narrative pedagogy with one cohort in each of the seven and a half weeks courses that we taught in the spring and fall trimesters of 2011to focus on the main concepts of each of our courses. The intent of the study was to:
1. Introduce “narrative thinking” through the use of published literature that would develop students’ skills with narrative structures and narrative thinking (Benner, et al, 2010)
2. Illustrate the importance of the significant course concepts by engaging the students in real world situations through the use of ‘story’.
The text used in the junior and senior level community nursing courses taken the spring and fall respectively could be described as “dry reading”.The exams in the Health I: Nursing Therapeutics course are 100 multiple choice questions, half community and half maternity/obstetrics, with one or two short answers for extra credit and taken over a two hour time period. This method of examination did not give me enough information regarding the depth of the students’ understanding of the main concepts of the course.
Through the in-class discussions regarding the case studies of the role of the nurse working with families in different stages of development, I heard various nursing approaches to the presented scenarios, but students did not reveal their personal perceptions about families, culture and community. I wanted to help students learn, not only the facts and theories about families, culture and communities, but also to “touch their heart/spirit/feelings” through a narrative experience so that they could gain a deeper meaning and understanding of these concepts. Individuals, families, and communities have a past, present, and future all intertwined with their cultures, and they communicate through narratives, not bullet points on a slide or in a text. Paying attention to “the story” can facilitate students’ skills when they listen to and learn the histories of individuals, families and communities.
· Will introduction of a narrative pedagogy with family, culture and community concepts in a short story form help students to articulate their perceptions of family, culture and community in a narrative format?
· Will use of narrative pedagogy effectively engage students in learning about the course concepts of family, culture and community?
· Will use of narrative pedagogy give students insight as to their role as a community health nurse working with families?
Course Design and Implementation
For the Health I: Nursing Therapeutics theory course, I planned the following:
· Added The Bean Trees fiction book by Barbara Kingsolver to the list of required readings. This is a short novel with diverse “family, culture, and community” concepts woven throughout the chapters.
· Deleted the case study discussions in the didactic.
· Included two thirty minute small group discussions with questions assigned about the concepts in the book. The first discussion used the questions in Exhibit 3 covering Chapters 1 through 6. At the end of the first discussion, students were asked to make an Ecomap of the Taylor/LouAnne family support system (Exhibit 4). The second discussion had the same format with questions (Exhibit 5) covering Chapters 7 through 12. At the end of the second discussion, students were asked to complete a “five-minute-write-up” about a concept presented in discussion that interested them (Exhibit 6).
· Two extra credit questions were added to each of the first and second exams (Exhibit 7).
· One extra credit in-depth question was added to the exam on Black Board (Exhibit 8).
· Feedback Guidance for the Instructor (Exhibit 9) was the final input from the students. (See Exhibit 9 under “Findings” in this site.)
Cathy Sullivan, Ph.D.