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Voices from the heart: the use of digital storytelling in education.

Introduction

People who tell stories have a need to share their thoughts, feelings and information with others, and to create meaning about an event. Individuals may tell their stories to come to terms with or understand their experience, legitimise their behaviour or share with others the emotional experience. The use of these stories gives the teller a voice, empowering and enabling vulnerable individuals, and offering the professional an ideal vehicle with which to really listen to and engage with their clients.

Digital storytelling is the practice of people using digital tools to share their stories. These stories are often powerful, use emotionally engaging images and can cover a wide range of digital formats. This can include web-based stories, interactive stories and computer games and films, which may be used for education, promotion, advertising and charitable enterprises. With the advent of new technologies and accessible equipment, such as mobile phones and digital cameras, individuals can now make and share their experiences across the internet to a global audience. These digital stories may include photographs, animation, video, sound, music and the storyteller's own voice to convey an intimate insight into a lived personal experience.

Legislation and professional practice

The Equality Act (Department of Health (DH), 2010) and the Health and Social Care Act (DH, 2012a) have been instrumental in the government's legislation to drive forward patients' inclusion in their care. No Decision About Me Without Me (DH, 2012b: 4), the 'Big Society' and the government's declared desire to promote research, recruiting and involving patients in their care to give them a 'voice', puts them at the very heart of the NHS and decisions about planning care.

The government's aim is to increase democratic accountability and public voice, and embedding research is seen as a core function of the health service. The Health Visitor Implementation Plan (2011) feeds into this drive for public health improvement and the specialist community public health nursing course (SCPHN) has trained health visitors and school nurses as ambassadors to build on social capital, resilience and family wellbeing.

Digital storytelling in education

Digital storytelling can be a valuable tool for education in health as a means of enhancing understanding to help practitioners reflect on their communication skills and positively improve their practice. Figure 1 illustrates how digital storytelling can be used in education in health.

Individuals may wish to attribute responsibility, praise or blame following an experience; for example, women's birth experiences can provide insight for students and midwives to explore their role and to give the women a 'voice' with which to influence policy makers, thereby improving maternity services (Mercer and Brannigan, 2012). Digital storytelling has been a vital and successful part of the current SCPHN course (Holloway and Freshwater, 2007).

As a teaching aid, the narrative of an individual's story is a useful form of feedback in being able to let 'people know the score' (Rock, 2006), offering an opportunity to improve their professional nurturing skills by practising discourses. Robin (2008) lists the seven elements of digital storytelling (see Box 1) as a potent way to expose students to the human experience. These elements aim to encourage the development of sensitive, individualised and compassionate practice, enabling professionals to engage in reflective and meaningful learning, keeping the storyteller (client) at the centre of care.

However, Judge et al (2004) warn that their use in the classroom may be dependent on the teacher's own technological expertise. In education, the term 'technological pedagogical content knowledge' (TPCK) focuses on the relationship between knowledge about content, pedagogy and technology. Good teaching with technology requires an understanding of the concepts of constructively using multi-media to the best advantage for the subject.

Box 1. The seven elements of digital storytelling

* Point of view: What is the main point of the story and what is
the perspective of the author?

* A dramatic question: A key question that keeps the viewer's
attention and will be answered by the end of the story

* Emotional content: Serious issues that come alive in a personal
and powerful way, and connects the story to the audience

* The gift of your voice: A way to personalise the story to help
the audience understand the content

* The power of the soundtrack: Music or other sounds that support
and embellish the storyline

* Economy: Using just enough content to tell the story without
overloading the viewer

* Pacing: The rhythm of the story, and how slowly or quickly it
progresses


An example of digital storytelling used in healthcare education can be found on the website 'Patient Voices' (www.patientvoices. org.uk), which was funded by the NHS Clinical Governance Support Team, with ongoing research into making healthcare education and delivery more 'patient-shaped'.

Communication

While working as a medical volunteer with the international charity Operation Smile (www.operationsmile.org.uk) in Mexico in November 2011, I was involved in assessing and caring for Mexican children with cleft lip and palates. My experience of working in a multinational team of volunteers was challenging on many levels. Communication was key, so written and verbal information given to the patients was in their language. The mission was televised and the patients' stories were used for educational and fundraising purposes.

On reflection, the experience of being part of their stories was hugely influential and caused me to question my priorities and personal values. Similarly, the Patient Voices programme (Hardy and Sumner, 2001) aims to facilitate the telling and hearing of some of the unwritten and unspoken stories of ordinary people, informing professionals to provide their care in a more informed and compassionate manner.

Holloway and Freshwater (2007) state that human beings 'narrate past events and experience throughout their lives for a diversity of reasons' (p. 703) including information giving, 'sharing thoughts and feelings, justifying their actions or beliefs or by way of giving meaning to their experience' (p. 703). How do professionals ensure they hear their clients' voices in order to gain a greater understanding of individual needs and include clients in their assessments? Digital storytelling provides a lens through which we can look at personal life experiences, and how the stories we tell to, and about ourselves construct and define us. We reflect on our own stories and those of our clients, and how we relate accordingly.

User involvement

Chase (2005) suggests that during the 1960s and 1970s, the liberation and political movements (feminism and women's rights, gay pride, trade unions) influenced the importance and re-emergence of personal narrative. Today's social media culture, with instant access to people's lives, their stories and experiences, and their willingness to share these narratives, gives healthcare providers a rich and powerful insight into exploring their world and a privileged opportunity to reflect on our practice for the good of each individual. However, there is a known risk that personal and potentially delicate information may not be censored, nor treated with the respect for confidentiality it warrants (NHS England, 2013). The danger is that unscrupulous individuals can use the internet as a scam for deceiving the vulnerable.

With the current political climate of promoting empowerment, the patient-as-consumer influence and expectations of healthcare, it would appear that the narrative approach to encourage an individual's story allows the person at the heart of the issue to make a distinctive contribution to future development of services. Nettleton (2009) describes patients as 'prosumers' who both 'produce and consume knowledge'; while Bury (2001) acknowledges the power and value of their 'lay knowledge', realising the potential for the 'patient experience to inform better healthcare'.

However, these stories should not be limited to confessional, 'self-indulgent' accounts (Bleakley, 2000) but serve to enhance the listener's experience through insight into living with their experience, emotionally, practically and spiritually. Bleakley (2005: 538) writes of the challenge of analysis of these narratives and states the reader should have 'high levels of ethical and critical engagement and the cultivation of narrative sensibility'.

To achieve greater participation, patients are now involved in user involvement strategies.

For example, the Patient Experience Framework (National Institute for Health and Care Excellence (NICE), 2011), patient forums, survivor groups, the INVOLVE project (2004, 2013) and access to local and global information via the internet mean that technology is now widely available and used across most socio-economic, cultural and environmental groups in society. Coulter (2012) wrote that when clients are asked for feedback and to give their story, the most common complaint is that they have failed to receive clear written and verbal information.

Good involvement practice is inclusive and participatory, describing a wide range of ways of working to involve the public and to give them a 'voice', including web chat, e-panels, surveys, interviews and workshops. Schwartz (2010) states the importance of the professional 'giving voice to vulnerable people' (Schwartz, 2010) by enabling them to express their story and to facilitate it being heard. Examples of this might be the health visitor working with vulnerable families at risk, recording their stories and representing them in a professional context; for example, by contacting other agencies on their behalf, such as housing or their GP.

By moving from passive recipients to active participants, and being enabled by telling the stories of what health care, illness and recovery (survivorship) have meant to each individual, the public has become empowered. This individual empowerment feeds into the capacity-building ethos promoted by the government, both at an individual and a community level.

Actively listening to how people describe their own journey shows respect from the professional, following Rogers' (1961: 116) humanist approach: 'Unconditional, positive regard involves showing complete support and acceptance of the person'. This would indicate a shift in power to a more participatory continuum between patient (client) and professional (Hickey and Kipping, 1998). In practice, this is being encouraged and effectively used in health visiting; the action plans for targeted family care are co-constructed around the family's needs, then discussed and agreed by both client and professional with accurate, contemporaneous documentation of paramount importance.

Conclusion

A personal story may be 'unexpected and distressing' (Gregory, 2010: 634) and uncomfortable to hear. In practice, health professionals need to safeguard their own emotional health by seeking supervision and self-reflexivity; digital storytelling facilitates an insight into another's lived experience (Denscombe, 2003) and we should not underestimate the effect this knowledge might have. Reissman (2008) wrote of the many layered expressions of human thought and imagination, and by embracing these with flexibility, empathy and a humanistic approach we endeavour to cultivate a respectful and democratic experience.

Frank (2000: 354) and Pennebaker (2000) write of the cathartic effects of storytelling, allowing narrators to 'reaffirm, possibly to create and possibly to redirect the relationship within which the story is told'. Establishing relationships and trust to enable the narrator to express themselves in this way highlights issues of potential exploitation and therefore increased vulnerability. Professionals may also experience vulnerability within their role, and seek a mentor to support them and listen to their story. This a key part of our responsibility as professionals and colleagues; empowering and enabling our clients, working reflexively and collectively, and listening out for the hidden messages. It is our privilege to be part of another's story, to listen to their voices and enable them to be heard.

Key points

* Digital storytelling is an educational tool for sharing stories and enhancing practice

* Giving a voice to the vulnerable and enabling their story to be told

* Building on social capital, resilience and wellbeing through effective communication

* How health visitors and other professionals can be ambassadors for the government's drive for user involvement through improved understanding of an individual's needs, professional growth and reflexivity

No conflict of interest declared

References

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Jackie Matthews RGN BSc PG Dip

Health Visitor, Kent Community Health

NHS Trust

Correspondence: Jackie.Matthews5@nhs.net
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Title Annotation:PROFESSIONAL AND RESEARCH: PEER REVIEWED
Author:Matthews, Jackie
Publication:Community Practitioner
Article Type:Report
Date:Jan 1, 2014
Words:2483
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