Learning Experiences of Nursing Students from Classroom ...

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CHENG CHING MEDICAL JOURNAL
Learning Experiences of Nursing Students
from Classroom Storytelling by Parents of
Children with Disabilities
Yu-Ping Huang 1 , Yuen-Chih Chen 1 , Ursula Kellett 2
Department of Nursing, HungKuang University, Taiwan 1
School of Nursing and Midwifery, Nathan, Griffith University, Australia 2
Abstract
Purpose
The aim of this paper was to explore the learning
experiences of post-registration nursing students who
listened to parents’ classroom storytelling about their
children with disabilities.
Background
The nursing education literature provides little
information about using movies, books, or case studies
as teaching tools. Nurse educators should use a variety
of teaching methods to enhance students’ learning and
clinical competencies.
Method
For this qualitative study, focus group interviews
were used and guided by a set of semi-structured
questions. Data were collected in 2009 from nursing
students at a university in a metropolitan area of central
Taiwan. Of 156 students enrolled in three classes on
paediatric nursing, 34 volunteered to share their learning
experiences from the storytelling lesson.
Results
Analysis of the focus group interview content
revealed three main themes: facing again the important
issues (psychological, caring, and cultural) in nursing
care, enhancing learning interest and comprehensive
learning, and cherishing their lives.
Conclusions
The teaching strategy of parents telling their stories
in the classroom helped students to reflect on their nursing
work experience from the parents’ perspective. Such
reflection not only enhanced students’ professional
capabilities and ensured that knowledge was put into
clinical practice, but also added meaning to their lives by
helping them to cherish their lives.
Keywords : nursing student, storytelling, teaching
strategy
通 訊 作 者 : 黃 玉 苹
通 訊 地 址 :43302 台 中 市 沙 鹿 區 中 棲 路 34 號
E-mail:yup@sunrise.hk.edu.tw
電 話 :04-26318652 轉 7050
Introduction
Nowadays, nursing students are expected to be
confident, organized, and critical as well as reflective
thinkers who can work well with others to satisfy the
complex and multiple needs of patients and their families
in today's health care system [1,2]. However, when
nursing students have been trained in particular tasks,
they often put more emphasis on the technical aspects
of nursing. A holistic approach is important in nursing
philosophy that integrates the science and art of nursing,
but it may not be well linked by nursing students to their
practice care activities. To enhance students' integration of
a holistic approach and application of nursing knowledge
into their practice, several innovative teaching strategies
have been developed [3,4,5]. In addition, family-centred
care is important for parents of disabled children, because
it can benefit the disabled child, parent-child relationship,
and family function. Therefore, understanding parent's
experiences is in keeping with the current emphasis on
family-centred care [6].
Some teaching strategies involve self-reflection to
provide students an opportunity to integrate their own life
experiences into their practice. Reflecting is an intellectual
and affective activity in which individuals recapture
their experiences, think about them, and evaluate them
to achieve a new understanding and appreciation of their
importance or meaning [7]. Reflection can also focus on
personal feelings, on the congruence between a person's
actions and value system, and how knowledge informs
practice [8,9]. A reflective teaching strategy is storytelling
[9].
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The art or aesthetics of nursing refers to
understanding the subjective experience of patients and
the meaning behind their behaviour; to develop this
understanding, students need to develop empathy for
patients by listening to their stories [5]. At the same
time, patients' storytelling will also help students learn
about the science of nursing in terms of medical events,
diagnostic processes, and medical complications. Thus,
years), with an average of 11.5 years work experience
(range=1 to 26 years). Their paediatric training included
a 2-hour lecture in which parents were invited to tell their
stories. Of 156 students in three storytelling classes, 34
volunteered to share their learning experience in focus
groups. They were on average 33 years old (range=23 to
42 years), with an average of 7 years work experience
(range=2 to 17 years).
students combine the art of understanding patients’
experience with the science of learning about their illness,
thus seeing patients as whole persons. Storytelling helps
students to think beyond the empirical by allowing them
to meaningfully link their personal experiences with
classroom learning [5]. Storytelling not only strengthens
traditional teaching methods in terms of lectures and
clinical practice, but also helps students apply class
learning to clinical learning [10,11]. However, in most
research on storytelling, students tell their own stories
[9,12] or read novels [2,10], but do not learn from
storytelling from patient's or family's perspective [3].
Data collection
Data were collected from April to December 2009
in focus group interviews guided by semi-structured
questions. For example, ‘What are your feelings and
thoughts about this class?’ This question was followed
by specific questions related to the research purpose
[13]. For example, ‘How has the parent's story affected
your practice as a nurse?’ Focus groups were held 1
week after the storytelling class. After the class, students
received a flyer about the study. Interested students
could phone a research assistant (RA) to indicate their
willingness to participate. Six focus groups were formed,
The Study
Aim
The purpose of this study was to explore nursing
students' learning experience after classroom storytelling
by parents of children with disabilities.
Design
A focus group design was used to obtain students'
learning experiences with the teaching method of parents'
storytelling. Focus group interviews were chosen to help
gain rich information through group interaction about
students' opinions, feelings, and attitudes towards parents
telling their stories in the classroom [13].
with 5-6 students each and two focus groups from each
class. The first author acted as the interviewer. She
has been trained as a qualitative researcher when she
studied in her doctoral degree and she performed several
qualitative studies as well. Also she has been prolonged
engagement in the field of children with disability.
Interviews lasted from 50 to 90 minutes. All interviews
were tape recorded. After six focus group interviews,
the interview data reached saturation in terms of no new
information emerging from analysis and interviewing was
stopped [13]. The interview setting was in a university
conference room.
Participants
The participants were recruited from 156 part-time,
post-registration nursing students in their second year of
a 2-year baccalaureate degree program at a university in
central Taiwan. Students worked full time as registered
nurses and attended classes at the university 1 day a week.
Students were on average 31 years old (range=23 to 51
Selecting parents
A key element to the success of parents' storytelling
as a teaching strategy is selecting suitable parents [3].
In selecting parents, the first author fully informed them
about the storytelling and considered several factors:
the parents' willingness to and comfort in telling their
personal stories to a classroom of students and the first
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author knew the parents' stories well and had a good
relationship with them. Three parents were contacted
by the first author and explained the proposed teaching
plan and the reasons for asking them to tell their stories
to students. They were happy to share their experiences,
were informed of their right to withdraw from the study at
any time and that their confidentiality would be protected.
After students were informed, they signed informed
consent. Parents who told their stories in class also signed
informed consent before the class.
because they felt that it might help improve the students'
understanding and the quality of care provided to other
children and families in the future. In order to let students
understand the lived experience of parents of disabled
children, the inclusion criteria for parents were parents
having a disabled child at home, Chinese as parent's first
language who were willing to share their stories.
Data analysis and rigour
All interviews were transcribed verbatim. The
transcripts and field notes were analyzed by thematic
analysis. First, the first author read through all the
transcripts to gain a general understanding of students'
experiences. Next, transcripts were coded and labelled
line-by-line to highlight the significant parts related to
Student preparation for parent storytelling
Students in the three classes were prepared for
parent storytelling in two ways. First, they received a
1-hour lecture with a general outline on care of children
with disabilities before the parent-in-the-classroom class.
Second, before the class started, the lecturer explained in
detail how the class would proceed. The process for each
class was the same, even though a different parent told
each class his/her story about the caring experience. That
is, one class listened to a mother of a child with cerebral
palsy (CP), another class listened to the mother of a child
student's learning experience with storytelling. Finally,
codes were integrated into core categories, which were
then organized into major themes, or broad and specific
themes [14]. Trustworthiness of the study was enhanced
by inviting an expert in qualitative research to validate the
findings and by member checks, giving participants an
opportunity to comment on the developing interpretation
of their experience, by providing a detailed description of
the process and context of the research in great detail, and
by showing how the data were gathered and analyzed to
keep an audit or decision trail [15].
with encephalopathy and CP, and the other class listened
to the father of a child with Joubert syndrome. Students
were allowed to ask questions and share their thoughts
during class. The students were also told that the teacher
would ask them questions to link the parent's experience
with their nursing knowledge and their own clinical
practice.
Results
Analysis of the focus group interview data led to
three main themes regarding students’ experiences:
re-facing the important issues of nursing care, enhancing
learning interest and comprehensive learning, and
cherishing their lives.
Ethical considerations
Before data collection, the study was approved by
the hospital institutional review board, which examines
ethical applications from both the university and hospital.
The flyer given to students about the study explained its
purpose, research process, potential risks and benefits.
Importantly, students were told that participation in the
study would not be related to their grade in the paediatric
nursing course. Before focus group interviews, students
Re-facing the important issues of
nursing care
The parents shared their experiences in caring
for their disabled child from finding something wrong
with the child to the present day. These experiences
covered interactions among the parents, disabled child,
family members, and health care professionals. Thus, the
parents’ stories prompted students to examine their own
clinical performance in terms of three important issues:
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psychology, caring, and culture.
The importance of approaching psychological
issues
The parents experienced fear, helplessness,
powerlessness, difficulties or ambiguity when they talked
about the process interaction with the health system.
Such sharing gave the students valuable insights into the
parents' inner world, leading students to feel that they
didn't do enough for these parents in terms of dealing with
their psychological issues.
We knew that parents feel sorrow when raising
a disabled child. They need help from us. … We
just didn't know how to talk to them, so we just
ignored them on purpose. Sometimes we were
busy with clinical routines and technical work,
so we didn't initiate talking to these parents about
their feelings and thoughts even though we saw
their worried and sad expressions. (Group 4)
Dealing with psychological issues of patients or
families makes them feel uncomfortable. They also do not
have much experience in managing this issue, so they lack
confidence to face this critical issue.
I am a nurse so I should be able to handle my
job well, so I would like to finish my duties
on time, such as giving medicine to patients or
teaching them how to care for themselves. But
a psychological problem was an aspect I didn't
want to touch. I didn't know how to handle
it well. After hearing parent's story, I need to
change the ways I work to care for patient's or
family's psychological aspect. (Group 6)
The importance of caring with heart
The students acknowledged the importance of
compassion and caring when carrying out all nursing
activities. The students did not have much time to find
out how patients and families felt about the care they
had received at the hospital due to busy doing clinical
routines and paper work. The students realized that their
patients' needs might have been ignored due to their lack
of sensitivity and not looking at things from the patients'
perspective.
When a child is hospitalized, the parents don't
take any action or say anything if they feel that
we [nurses] didn't take good care of their child,
but only accept whatever we do. However, they
might have felt upset and sad when they went
home. … Mostly, we know their reactions to our
services by asking them to fill out 5 close-ended
questions before their discharge. … I now think
that we should ask them [patients and families]
how they feel and think about our nursing care.
(Group 1)
Nursing students appreciate that nurses are the key
persons to help parents and their families overcome their
negative emotions and difficulties. Thus, having a work
attitude filled with caring, empathy, and support was vital
since such a warm and caring medical environment can
benefit patients and family members.
After this class, I have changed my work attitude.
Now, when a family comes to visit their child at
the hospital, I give them positive feedback and
support. They react really different. The parents
have been coming to massage their child every
day. The child has been lying in bed for half a
year. This time I told them, ‘You are great.
You massage him every day and talk to him'
… Usually, we only tell the parents about the
child's heart rate, blood pressure and whether the
temperature is normal or not. That's all, and then
we walk away and go care for other patients.
(Group 1)
The importance of cultural issues in the health
care system
Students learned how a family support system is
vital to parents when raising a disabled child at home in a
traditional Chinese culture, because support from parentsin-law
and other family members can ease the parents'
stresses and reduce feelings of marginalisation. Thus,
students were willing to make a commitment to involve
family members in children's care.
I can understand how hard it was for the mother
to deal with her feelings when her parents-in-
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law rejected her disabled child, because I also
have a difficult relationship with my parents-inlaw,
even though my child is healthy. Thus we
[nurses] should include family members in the
nursing care plan to allow them to understand
and be involved in caring for the disabled child,
especially in the Taiwanese context. (Group 6)
To ensure that family members were involved
in the medical care team, students thought that
they should act as advocates and negotiators for
the family so that better medical decisions could
be made. One student said, ‘Nurses should act
as negotiators on the medical team, so that the
care plan will meet the needs of both patients and
families.’ (Group 2)
Enhancing learning interest and
comprehensive learning
This learning experience was the first time students
had experienced parents coming to the classroom to
directly share their experiences. The first-hand story
not only captured the students' attention and interest,
but also helped them understand disabled children and
their parents in terms of improving their comprehensive
learning. As one student stated,
Usually, we sit in the classroom and listen to
the teacher talk to us from the podium. Some
students will doze off during class. But that does
not happen in a class like this, because it piques
our interest, and we pay attention and think about
the mother's story and teacher's questions and
classmates' sharing. … From this lesson, I learned
more about cerebral palsy and mother's stresses
and coping strategies. (Group 1)
Having an opportunity to listen to the parents' stories
allowed students to experience the meaning and impact
of parenting a disabled child. The students realized that
parents' stories could help them fill a clinical nursing gap
and increase their sensitivity to the needs of their patients
and families. One student said,
Actually we don't have too much time to read
our textbooks as we are both students and fulltime
nurses. This teaching method allows us to
think more about our clinical work. … Although
we have dealt with patients and their families as
nurses, we have never had an opportunity to listen
to their stories. I felt this lesson was valuable.
… I didn't need to spend time to remember
the important issues that I learned in this class,
because I already absorbed it by listening to the
mothers' stories. (Group 4)
Cherishing their lives
Students were deeply moved by the parents' stories.
They were amazed by all the attention, love, and patience
parents gave to the care of their disabled child, regardless
of the child's disability. Students reflected on what they
had taken for granted in their lives. This reflection made
them feel deep contentment and appreciation for what
they had in their lives.
I talked about what I heard from class with my
husband and my child. ... My husband said,
‘We always complained about our lives, but we
are fortunate to have a healthy child.’ So we
can work on the goals and dreams that we already
planned. I should learn to appreciate my life
more. (Group 3)
The students taught their children how to face
their disabled classmates and to help them. The students
believed these teachings would not only contribute to a
better environment and acceptance of disabled children in
society, but help their children become better people, with
more empathy and caring.
I know there is a child with Down syndrome
in my child’s classroom. I told my child that
he should treat his disabled classmate as a
normal child and play with him normally. Most
importantly, he should actively offer help to him.
We should not discriminate against them. I should
encourage my child to have a positive attitude
toward disabled children. (Group 2)
Discussion
When parents of disabled children told their
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原 著 研 究
stories in the classroom, it was filled with energy and
every student was totally concentrated on the parents
and listened to their stories. This type of class provides
multiple interactions among parents, students, and teacher.
Students learn not only from the parents, but also from
the teacher and other students. Davidson (2004) stated
that using storytelling as a teaching method promoted
participatory learning in the class by encouraging students
to actively listen, express their opinions, participate,
and discuss the stories [16]. Content from storytelling is
much easier to remember than from textbooks because
it provides concrete information and vivid images for
listeners [10]. Our findings are consistent with those
of previous reports of classroom storytelling. In these
studies, students' listening to stories encouraged them
to look at things from a different perspective, to try and
see the whole picture, to work out the problem, to think
about the consequences, and to develop reasoning and
critical thinking ability [1,6]. Thus, listening to a parent's
story provided students with an opportunity to reflect on
their personal clinical performance and on their reactions
to possible scenarios in the future, allowing them to
incorporate other possible approaches [2,16]. Thus nurses
should not only open up to listening to their patients'
stories, but also show their willingness and make time to
listen to their stories by being with them, even under busy
working conditions [17].
Students in our study pointed out their weakness
in being afraid to approach psychological issues, but
they started to realize the importance of such issues after
hearing the parents' stories. This appreciation of the
patient's wholeness in terms of physical, psychological
and spiritual aspects has been reported as a crucial
team to help parents of disabled children successfully
cope with difficulties in managing the child's care.
Similarly, cultural sensitivity was found to be fostered by
storytelling [10,17]. Students in the present study showed
that they understood the importance of compassion and
caring, listening, empathy, of keeping an open mind, and
of looking at things from another person's perspective.
Listening to parents' stories helped students understand
how patients and their families felt and motivated students
to respond to their patients and their families and to help
them more [1,5].
Listening to the parents' stories helped the students
in our study learn real knowledge from real stories [19].
After listening to parents' stories, students in the present
study cherished their lives. This finding is supported by
a previous report that stories about children with illness
or disability helped students to appreciate their lives
more and to view hope as important coping strategy in
overcoming life’s difficulties [2]. Stories related to
class content also add meaning to students’ learning by
helping them become aware of what is valuable for them
[11].
Conclusion
The teaching strategy of parents sharing stories
about their disabled child in the classroom helped
students to reflect on their nursing work experience from
the parents’ perspective. Such reflection enhances
students’ professional capabilities and ensures that
knowledge is put into clinical practice. Therefore, nurse
educators should invite patients or family members to tell
their stories in the classroom, thus facilitating students’
ability to learn and reflect as well as to link theory with
practice.
reason for using storytelling in clinical teaching for
nurses [17,18]. Listening to parents' stories has been
found to help nursing students become more empathetic
professionals due to increased awareness and sensitivity
to the emotional needs of families with sick children [3].
Students also realized the importance of cultural issues
when having a child with disability in a family, so they
were willing to involve family members in the medical
Limitations and Suggestions
This study contributes a valuable teaching method
for nurse educators, but it had some limitations. First,
the sample included only part-time, post-registration
nursing students, so future research should include nursing
students without working experience. Second, the size of
the three classes was 50-52 students, which may be too
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big for storytelling lessons because it reduced the chance
of interactions among parents and all students. There are
two suggestions for classroom storytelling in the future.
Students should be provided 1- or 2-hour discussion after
class in order to recap and re-organize the information
covered in the parents’ stories. The classroom venue
should be a suitable place such as a conference room that
allows the students to form a semi-circle around the parent
and so provide a better environment for interactions.
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17.Nicholl HM, Tracey CAB: Questioning: a tool in the
nurse educator's kit. Nurse Educ Pract 2007; 7:285-92.
18.Schwartz M, Abbott A: Storytelling: a clinical
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9.Koenig JM, Zorn CR: Using storytelling as an approach
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障 礙 兒 童 父 母 到 課 室 說 故 事 帶 給 護 理 學 生 的
學 習 經 驗
黃 玉 苹 1
、 陳 月 枝 1
、Ursula Kellett 2
弘 光 科 技 大 學 護 理 系 1
、 澳 洲 葛 里 菲 斯 大 學 護 理 及 助 產 學 院
2
摘 要
目 的
本 研 究 目 的 旨 在 探 討 在 職 專 班 護 理 系 學 生 在 課 室 聆 聽 殘 障 病 童 父 母 親 訴 說 故 事
的 學 習 經 驗 。
背 景
現 今 護 理 教 育 較 少 探 討 以 電 影 、 故 事 書 、 或 個 案 研 究 為 教 學 工 具 的 相 關 文 獻 ,
但 護 理 教 育 工 作 者 需 運 用 不 同 的 教 學 方 法 以 促 進 學 生 的 學 習 及 臨 床 能 力 。
方 法
運 用 質 性 研 究 的 焦 點 團 體 作 為 本 研 究 方 法 , 團 體 訪 談 以 半 結 構 式 訪 談 為 導 向 ,
資 料 收 集 時 間 為 2009 年 , 以 台 灣 中 部 某 大 學 的 護 理 系 學 生 為 研 究 對 象 , 三 個 班 級 共
有 156 位 學 生 研 修 兒 科 護 理 學 , 其 中 有 34 位 學 生 自 願 參 與 本 研 究 分 享 他 們 的 學 習 經
驗 。
結 果
自 焦 點 團 體 訪 談 的 結 果 呈 現 三 個 主 題 , 包 括 重 新 面 對 護 理 照 護 ( 心 理 層 面 、 關
懷 及 文 化 ) 的 重 要 議 題 ; 促 進 學 習 興 趣 及 理 解 性 的 學 習 ; 及 珍 惜 生 活 。
結 論
運 用 父 母 親 至 課 室 說 故 事 的 教 學 策 略 可 協 助 學 生 從 父 母 的 角 度 反 思 自 己 的 護 理
工 作 經 驗 , 這 種 反 思 不 僅 可 以 促 進 學 生 的 專 業 能 力 及 確 保 將 知 識 運 用 於 臨 床 情 境 ,
也 可 因 為 珍 惜 自 己 的 生 活 而 在 自 己 的 生 活 中 添 加 意 義 。
關 鍵 詞 : 護 理 系 學 生 、 說 故 事 、 教 學 策 略
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