Learning from Practice: the Value of Story in Nurse Education

Abstract

The central contention of this thesis is that story as an aid to learning, particularly student nurses' own stories of practice, is not being used to its full potential in nurse education. The dominant tendencies in nurse education are briefly outlined; the first, a ‘top- down’, managerialist approach, which is theory-focused, and where ‘reflection-on-action’ from an essentially theoretical perspective, with assessment strategies related to extrinsic criteria, is predominant; and the second, a ‘bottom-up’ approach, focused on practice itself as a resource for learning, with ‘reflection-in-action’ (moment-to-moment decision-making) as its major pedagogic strategy. This thesis argues that these approaches are too often treated in isolation from one another, but that for nurse education to be effective, professional practice must unite the two, and that story is an imaginative and stimulating method by which this can be achieved. The thesis outlines the ways in which story has been explored in the literature, but the emphasis is on the ‘humanness’ of stories and the varied and diverse roles they could play in the development of nurse education. This discussion of the unique contribution that story can make to nurse education is placed in the context of two major theories of learning: constructivist and social constructivist, with particular emphasis on the seminal work of Schon. The research methodology adopted is that of narrative, and data were provided by student nurses’ written stories and learning accounts of practice, and notes taken during focus groups. The data were supplemented by the use of my own stories of experience of clinical practice. In all, 55 students’ written stories and learning accounts were collected, and then analysed using a three stage approach: first, reading the stories and learning accounts; second, a two- part analysis using content analysis and analysis of form; and third, a structured presentation of findings. Therefore, whilst accepting that direct learning from story is difficult to demonstrate, the evidence presented in this thesis illustrates the different ways in which stories can be an aid to student learning from practice, particularly by encouraging students to differentiate and structure clinical experiences that might otherwise remain undifferentiated and unstructured, and acknowledge and identify the tacit nature of their learning in practice and develop strategies for making it explicit. The evidence presented in this thesis supports the contention that inclusion in the curriculum of students’ stories of clinical practice can contribute towards the transformation of nurse education.