Narrative Pedagogy: transforming nursing education through 15 years of research in nursing education.
AIM This article provides a review of current disciplinary understanding of Narrative Pedagogy and describes the implications for ongoing transformation in nursing education.
BACKGROUND Narrative Pedagogy has been enacted and investigated by teachers around the world for more than 15 years. Few nursing educational innovations or pedagogies in nursing have been adopted in such an array of settings/levels.
METHOD A review of the nursing literature was conducted to locate reports of research on and teaching innovations derived from Narrative Pedagogy.
RESULTS Narrative Pedagogy has an extensive and longitudinal body of research describing how the approach contributes to the educational transformation the discipline seeks.
CONCLUSION Narrative Pedagogy and the growing literature describing how it is enacted provides a way for teachers and students to persist in questioning their current understanding of nursing, the ways they think about the situations they encounter, and how their practice can best be learned.
Narrative Pedagogy--Nursing Education --Nursing Education Research--Teaching Methods--Hermeneutic Phenomenology
Nurse faculty continue to hear calls to transform nursing education to meet the challenges of the changing health care system (Benner, Sutphen, Leonard, & Day, 2010; Institute of Medicine, 2011). These challenges have been a catalyst, sparking renewed disciplinary conversations about the future of nursing education. In conventional pedagogies, faculty transform their courses by creating and implementing new strategies (e.g., simulation, unfolding case studies) or changing systems/ structural aspects of nursing education (e.g., moving to accelerated baccalaureate or master's-entry programs, standardizing curricula to avoid variation among programs).
While such disciplinary conversations are important, they fundamentally rely on extending or enhancing inherited views of nursing education, including what is taught and when and how it is taught. For example, even if consensus on what should be taught or how it should be taught were possible (or desirable), these proposals do little to fundamentally transform nursing education in ways that influence the relationships among teachers, students, and clinicians, the ways in which students shape and are shaped by what is being learned, and how teachers and students see, listen, and respond to matters of concern in clinical practice (Doane & Brown, 2011). For this kind of transformation to occur, multiple pedagogies must be added to the faculty member's teaching repertoire.
Substantive transformation begins with embracing research in nursing and higher education on multiple pedagogies, generally classified as conventional, critical, feminist, phenomenological, and postmodern (Diekelmann & Diekelmann, 2009; Ironside 2001). These pedagogies are not mutually exclusive but extend and enhance one another. As knowledge about other pedagogies broadens in nursing education, faculty can move away from finding new ways to teach the same content and skills toward a transformation of how students think and learn in nursing.
Narrative Pedagogy has been enacted and investigated by teachers around the world for more than 15 years. This article reviews current disciplinary understanding of Narrative Pedagogy and describes the implications its use provides for substantive transformation in nursing education and research.
Figure 1: The Concernful Practices of Schooling Learning Teaching Preserving: Attending and Being Open Assembling: Constructing and Cultivating Gathering: Welcoming and Calling Forth Caring: Engendering of Community Listening: Knowing and Connecting Interpreting: Unlearning and Becoming Inviting: Waiting and Letting Be Questionings: Sense and Making Meanings Visible Retrieving Places: Keeping Open a Future of Possibilities Preserving: Reading, Writing, Thinking-Saying, and Dialogue Copyright [c] 2009 by Diekelmann and Diekelmann. Reproduced with permission.
UNDERSTANDING NARRATIVE PEDAGOGY
Narrative Pedagogy is a phenomenological nursing pedagogy (Diekelmann, 1995, 2001; Diekelmann & Diekelmann, 2009) that was first identified during a 15-year study of teachers' and students' experiences in nursing education. It is a nursing pedagogy because it was identified from the hermeneutic analyses of how nursing teachers actually teach and students actually learn nursing. Thus, it reflects the current context in which nursing is taught and learned and the competing demands teachers and students face as they learn in rapidly evolving clinical settings.
When teachers and students together challenge assumptions of learning and practice by reflecting on and interpreting their shared experiences, they discover new possibilities for schooling, learning, and teaching that are already at hand and site specific (Diekelmann, 2001). In Narrative Pedagogy, schooling, learning, and teaching are viewed as co-occurring, collaborative, and communal experiences (Diekelmann & Diekelmann, 2009) that teachers and students co-create.
Enacting Narrative Pedagogy holds great potential for assisting nursing faculty to realize substantive transformation. This pedagogy fosters new ways of thinking about schooling, learning, and teaching and provides a new language for students and teachers that is familiar and practical (Diekelmann & Diekelmann, 2009). Narrative Pedagogy engages faculty in thinking about nursing education in ways that do not begin with selecting, sequencing, and covering content. Rather, it shifts the attention of teachers and students to interpreting their shared experiences in the process of learning nursing, challenging inherited perspectives, and envisioning ways that nursing education and practice can be improved (Brown, Kirkpatrick, Mangum, & Avery, 2008; Diekelmann, 2005a, 2005b; Ironside & Cerbie, 2012).
The shift is from a focus on particular, specified processes and outcomes toward thinking together about everyday experiences and learning how nurses listen and respond to practice encounters (Ironside & Hayden-Miles, 2012). Research has shown that when teachers shift their attention to the experiences they co-create with students, substantive transformation occurs that significantly influences the thinking and learning of all who are involved (Dahlberg, Ekebergh, & Ironside, 2003; Diekelmann, 2001, 2004, 2005a, 2005b; Diekelmann & Lampe, 2004; Ironside, 2003a, 2004, 2005a, 2006; Ironside, Diekelmann & Hirshmann, 2005a, 2005b).
The Concernful Practices of Schooling Learning Teaching
Originally published by Diekelmann in 2001, the Concernful Practices describe evolving background practices (experiences) of nursing students and teachers. (See Figure 1.) They provide a new language that shifts attention from the content or skills being learned to how teachers and students understand the situations they encounter and what these experiences mean to them as nurses.
This shift in language is important because language shapes thinking. For instance, the language of objectives, outcomes, and competencies, which belongs to conventional pedagogies, guides teachers and students to focus their attention on prespecified aspects of learning. Providing a new language and focus for teachers and students transforms both their thinking and relationships with one another. For instance, focusing on how teachers gather students into a course, welcoming them and calling out learning (Gathering: Welcoming and Calling Forth) is a different way of thinking about these common practices than merely orienting students, describing the ground rules, or delineating objectives or expectations for the course. The Concernful Practices are communal, meaning that students also gather and welcome teachers by how they are interested in, take seriously, and participate in class.
In and of themselves, the Concernful Practices are neutral. Just as teachers and students can co-create experiences that gather and call out the best in everyone, they can also co-create experiences that are oppressive and confrontational, that call out the worst in one another. What matters about the Concernful Practices is how teachers and students enact them. Adopting the language of the Concernful Practices assists teachers and students in exploring the meaning and significance of their collective experiences thinking and learning in education and practice and in moving away from an exclusive focus on teaching (to the exclusion of learning) or students (to the exclusion of teachers) (Diekelmann & Diekelmann, 2009; Ironside & Flayden-Miles, 2012; Young, Hayden-Miles, & Brown, 2010).
The literature reflects a variety of practical ways teachers, researchers, and students use the Concernful Practices to draw attention to the transformation that occurs when they enact Narrative Pedagogy. For example, some researchers have used them as a conceptual framework for their studies (Moore & Cagle, 2012); others use the language of the Concernful Practices to describe the meaningfulness of the experiences being analyzed in the study (Diekelmann, 2001; Ironside, 2004, 2005a, 2006; Scheckel & Ironside, 2006). Teachers report using the Concernful Practices to guide the design of activities in their courses (Diekelmann & Mendias, 2005; Ironside, 2003b; Ironside & Hayden-Miles, 2012) and in all-school meetings, where teachers and students collectively explore their experiences in the school of nursing (Burke & Williams, 2011; Diekelmann & Diekelmann, 2009; Ironside, 2001).
Over the past 15 years, research and scholarship has continued to describe how transformative communal experiences of thinking can be when teachers and students use the Concernful Practices to guide their thinking and learning (Diekelmann & Diekelmann, 2009; Diekelmann & Ironside, 1998; Ironside, 2003a, 2003b, 2004, 2006; Moore & Cagle, 2012; Scheckel & Ironside, 2006). Narrative Pedagogy is enabled when teachers and students attend to the how the Concernful Practices show up in their classrooms, clinical experiences, online courses, and schools. The experiences teachers co-create with students matter as much as what they teach.
Engaging in Transformative Thinking
Narrative Pedagogy is enabled when teachers and students enact hermeneutic phenomenology as a call to thinking. That is, enabling Narrative Pedagogy is not a particular instructional strategy; it already exists as a possibility and, as such, it can only be enabled. Teachers enable Narrative Pedagogy by creating places in their schools and their courses for thinking, holding current understandings, perspectives, and assumptions as open and problematic, and for thinking in new ways about nursing phenomena (Diekelmann & Diekelmann, 2009).
Narrative Pedagogy can often be seen as changes teachers and students make in their day-to-day lives in schools of nursing. While these changes are often small, they can have profound effects on their lives together (Ironside & Hayden-Miles, 2012; Walsh, 2011; Young et al., 2010). Rather than maintaining a separate and detached position, engaging in activities only to provide directions or feedback to students as they work, teachers enabling Narrative Pedagogy are part of the learning experience with students. Therefore, teachers commonly do the learning activities they assign to students and provide students copies of their work as a call to thinking. For instance, if a teacher asks students to journal about their experiences after each clinical day, the teacher also journals about his/her experiences that day and shares what was written with students (Andrews, 1998; Dahlberg et al., 2003; Diekelmann, 2003).
Importantly, Narrative Pedagogy is more than sharing stories, recounting experiences, or providing examples of particular patients, conditions, or situations. Rather, it is a way of drawing attention to what stood out as important to nurses in a particular situation, what was noticed, and how this was interpreted (Ironside & Cerbie, 2012). Enabling Narrative Pedagogy in beginning nursing courses, teachers may ask students come to class with a story describing an experience they have had caring for, or being cared for by, another person (Ironside, 2003b; Ironside & Hayden-Miles, 2012).
As stories are communally witnessed and explored from multiple perspectives, even early students begin to identify shared concerns, assumptions, and ways their past experiences inform the learning they are now doing in nursing. The ways students and teachers understand their experiences become visible, and new understandings can be explored. Discussions are markedly different than the common ways teachers talk with students about caring using conventional pedagogy (e.g., describing nursing as a caring profession, asking students to identify a list of caring behaviors).
The literature reflects that, in general, enacting hermeneutic phenomenology to enable Narrative Pedagogy takes place when teachers and students attend to how the Concernful Practices are enacted and collectively and publicly share and interpret stories of their experiences learning nursing in new ways and from multiple perspectives (Diekelmann, 2001; Ironside, 2001, Ironside & Hayden-Miles, 2012). By enacting Narrative Pedagogy, teachers create opportunities to talk with students about their thinking, how they understand (interpret) the situations they encounter, and what this means to their emerging nursing practice (Ironside, 2006; Ironside & Cerbie, 2012; Kawashima, 2005; Scheckel & Ironside, 2006; Walsh, 2011).
As accounts of their experiences are shared, teachers and students ask themselves if there are other ways to think about the experience and what assumptions they are making by offering a particular perspective of the account. When teachers and students gather to hear and interpret the meaning and significances of their experiences using the Concernful Practices, they begin to understand the common concerns and the shared meanings of contemporary schooling and practice in nursing. Thus, Narrative Pedagogy is a renewed commitment by teachers and students in schools of nursing to attend to the nature of their communal experiences. Enabling Narrative Pedagogy challenges the isolation and competition inherent in conventional pedagogy in favor of collaboration and reflects a call to gather the collective wisdom of teachers and students toward improving their schools of nursing and practice (Diekelmann & Diekelmann, 2009).
INVESTIGATING NARRATIVE PEDAGOGY
As a research-based pedagogy, Narrative Pedagogy is widely investigated and enacted by teachers and researchers in nursing. A number of studies focus specifically on how teachers' pedagogical decisions (enabling Narrative Pedagogy) influence the experiences they co-create with students. For example, studies describe:
* How Narrative Pedagogy invites thinking (Ironside, 2003a, 2004, 2005a, 2006; Scheckel & Ironside, 2006)
* How students listen and respond to practice situations they encounter (Cangelosi, 2008; Chan, 2008; Ironside, Diekelmann, & Hirschmann, 2005a, 2005b; Kirkpatrick & Brown, 2004; Swenson & Sims, 2000, 2003)
* How teachers undertake pedagogical reform by enacting Narrative Pedagogy in their curricula (Andrews et al., 2001; Burke & Williams, 2011; Capone, 2010; Evans & Bendel, 2004; Gilkison, 2011; Ironside, 2003b, 2005b, 2014; Stoltzfus, 2012; Young, 2004)
* How new nurses experience internship programs (Moore & Cagle, 2012)
* How teachers, students, and citizens can conduct and implement community-driven programs of research (Ironside et al., 2003).
Figure 2: Example of a Converging Conversation The instantiation of learning as it belongs to schooling learning teaching shows up as the origination and accomplishment of listening in any pedagogical dialogical experiences. Dialogical experiences let learning show itself as itself. (27) Humans can not not respond to the call of learning. Not responding is a kind of co-responding. What shows up as a matter of concern is the meaning and significance of attending as listening and coresponding as the call of learning. Listening is not just an aural or oral experience; it is meaningful engagement in situations. To learn means to become knowing (OWL, 143), and "to know means to be able to learn" (IM, 23). Coming into learning is presupposed by listening and understanding, not as a causal chain of events, but as a practical and prudent historically situated belonging-together. (28) David We all think we are good listeners until we tune someone out because we know what they are going to say! Or we forget to listen because we are so focused on how we will respond to what is being said. When you get right down to it, it is really hard to listen well! CP--Listening: Knowing, and Connecting; Caring: Engendering of Community Saskia And it's very hard not to start revising things by only looking at problems. In my course I started by looking at what the students really liked about the course and learning activities that meant a lot to me, and I tried to build in more of those kinds of activities. David You know we really do rush into finding problems and fixing them, don't we? We lose sight of "what is working." No wonder sometimes when we change courses or the curriculum we end up throwing out the baby with the bath water! We are always looking for problems. We become problem-oriented teachers. Our community life suffers when all we do is focus on problems. CP--Assembling: Constructing and Cultivating; Retrieving: Keeping Open a Future of Possibilities Theme: Overcoming Deficit Thinking: "Shifting from what we can't do to what we can!" Questioning: How would starting every meeting with faculty and students sharing something they were proud of influence the engendering of community? (27) For our discussion of showing showing itself, see Chapter 5. (28) See Chapter 8 for our discourse on learning as listening. Note. CP = Concernful Practice / OWL = On the Way to Language / IM = Introduction to Metaphysics (M. Heidegger) Copyright [c] 2009 by J. Diekelmann and N. Diekelmann. Reproduced with permission.
The literature contains wide-ranging scholarship to help teachers enact Narrative Pedagogy through the use of art (Ewing & Hayden-Miles, 2011), podcasts (Beard & Morote, 2010), Socratic questioning (Rogge, 2001), journal clubs (Bilodeau, Pepin, & St. Louis, 2012), and digital stories (Cangelosi & Whitt, 2006; Gazarian, 2010).
Readers can rapidly translate the following research on how Narrative Pedagogy is used in various educational programs for use in their own teaching practice:
* Doctoral (Diekelmann & Ironside, 1998)
* Graduate (Brykczynski, 2012; Ironside et al., 2003; Rogge, 2001; Swenson & Sims, 2003; Vandermause & Townsend, 2010)
* Pre-licensure (Caputi, Engelmann, & Stasinopoulos, 2006; Dahlberg et al., 2003; Ironside, 2003a, 2003b, 2004, 2005a, 2005b, 2006, 2014; Scheckel & Ironside, 2006; Young et al., 2010)
* Midwifery (Gilkison, 2011; McAllister et al., 2009)
* Staff development (Moore & Cagle, 2012).
Challenging the Practice of Identifying Themes and Patterns
Rigorous investigations into how Narrative Pedagogy is enacted must reflect a convergence of the philosophical underpinnings of the pedagogy (hermeneutic phenomenology), how teachers and students enact it, and the design of the study (Davidson, 2004; Ironside, 2003a). For this reason, much of the research on how Narrative Pedagogy is enacted and experienced is conducted using qualitative, descriptive, or hermeneutic methods. Investigators commonly report the results of their inquiries by identifying themes and patterns and using excerpts from transcribed interviews conducted with students and teachers. Although excerpts are provided with enough detail for the reader to participate in the analysis, the insights gleaned from these studies are clearly identified by the investigator.
For readers unfamiliar with this approach to research, the highlighting of important insights is helpful. However, the danger is that themes and patterns appear fixed, discrete, and static, belying the inherent movement of questioning that this approach is meant to sustain. In their latest study, Diekelmann and Diekelmann (2009) critique the consistent identification of themes and patterns, frequently reported in a manner very similar to empirical studies (background, method, findings, and implications), and propose a new way to report findings that they call Converging Conversations.
Creating Converging Conversations
Converging Conversations are an innovative approach through which investigators bring themes and patterns identified in the study data into dialogue with one another, with the literature, and with contemporary understandings of teachers and students. Investigators formulate recurring conversations between teachers and students that lay bare how themes and patterns co-occur in conversations. According to Diekelmann and Diekelmann (2009), a converging conversation is an approach to presenting data as a conversation among participants in which themes and patterns are kept in motion such that "thinking is set free for the dismissal of the narrative tellings as fictive and unreliable or free for listening to the hints they offer" (p. xvii, emphasis original).
Converging Conversations create thoughtful and thought-provoking exegeses, staying close to the themes and patterns of the narrative data while making visible the thinking of the researcher. Columns, footnotes, and text boxes are used to present the conversation, to offer interpretive insights from the researcher and the literature, to identify themes/patterns, and to raise further questions for readers to consider.
Figure 2 provides an example of a converging conversation gleaned from more than a decade of Narrative Pedagogy research. It shows the beginning of a conversation among teachers as they explore their experiences transforming their courses. Through the conversation, Narrative Pedagogy is enabled and readers are drawn into thinking that explores transformation in new ways and from multiple perspectives.
IMPLICATIONS FOR NURSING EDUCATION
Teachers around the world are seeking ways to transform their schools of nursing to meet the challenges of rapidly evolving health care systems. Narrative Pedagogy provides a research-based way to substantively transform schools of nursing and nursing courses, shifting attention away from content and skills toward an understanding of the experiences teachers and students co-create with each other and with those for whom they provide care. For instance, studies show that when Narrative Pedagogy is enabled, students' thinking is expanded from analytic thinking to thinking that is embodied, reflective, and pluralistic (Scheckel & Ironside, 2006), and that students envision new possibilities for improving care by thinking through the situations they encounter from multiple perspectives (Ironside, Diekelmann, & Hirschmann, 2005a, 2005b).
Because Narrative Pedagogy focuses on conversations among teachers and students as they collectively explore their experiences in nursing education and practice, it is site-specific. It does not require sweeping curricular changes, faculty consensus, or large investments in supplies or equipment, and it can be rapidly adopted in specific courses or across the curriculum. Narrative Pedagogy requires only that faculty and students gather in ways that foster thinking together, holding current understandings, perspectives, and assumptions as open and problematic.
The continuing research to develop and extend Narrative Pedagogy, its use in schools around the world and in courses across levels, specialties, and settings provides the discipline with a rich literature to inform pedagogical decisions, the relationships among teachers and students, and the communities in which learning nursing occurs. Few nursing educational innovations or pedagogies have been adopted in such an array of settings and levels and have such an extensive and longitudinal body of research describing how the approach contributes to the educational transformation the discipline seeks. Importantly, this body of research is also continuing to evolve as studies that reanalyze findings across studies (Ironside, 2006) and new ways of reporting findings (Diekelmann & Diekelmann, 2009) appear in the literature.
Narrative Pedagogy, as described in the current literature, should not be understood as the "one right way" to think about or engage in learning nursing; that would only reproduce the problems the discipline now faces with the ubiquitous overuse of conventional pedagogies. Rather, Narrative Pedagogy and the growing literature describing how it is enacted in schools of nursing provides a way for teachers and students to persist in questioning their current understanding of nursing, the ways they think about the situations they encounter, and how their practice can best be learned.
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Pamela M. Ironside, PhD, RN, FAAN, ANEF, is professor and director of the Center for Research in Nursing Education, Indiana University School of Nursing, Indianapolis. For more information, write to Dr. Ironside at email@example.com.
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|Author:||Ironside, Pamela M.|
|Publication:||Nursing Education Perspectives|
|Date:||Mar 1, 2015|
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