Story Theory and Patient Dealing In Nursing Education
Whats is Story Theory In Nursing Education
Story is an inner human resource for meaning making (Smith & Licht, 2014). The pure pose of this middle range story theory is to describe and explain story as the context for a nurse-to-person health promoting process. Fundamental concepts of story theory include intentional dialogue, connecting with self in relation, and creating ease. Story is connecting with self in relation through intentional dialogue to create ease (Smith & Liehr, 2014).
Story Theory of Middle Range and Holistic Care
Prioritizing the holistic aspects of care in nursing education can be challenging for educators (McMahon & Christopher, 2011) This middle range theory is particularly applicable in nursing education because it focuses on the true work of the nurse, which is caring. The theory is based on the premise that telling a story to a nurse who is truly present to really hear the person's concerns about what matters most is a caring process that has the power to create a nurse-person process that leads to healing.
Using story theory to plan nursing care begins with a focus on the person's response to a complicating health challenge. This approach is consistent with the American Nurses Association (ANA) definition of nursing: “The protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of the human health response, and advocacy in the care of individuals, families, communities, and populations” (ANA, 2003). The human response is multidimensional, assessed through story, and addresses the physical and psycho-social needs of patients, thus creating a holistic assessment.
Integrating story theory into an existing course is based on the belief that students must first understand the concepts of the theory before they can apply them in practice (Flanagan & McCausland, 2007), Story theory concepts are intentional dialogue, connecting with self in relation , and creating ease. Because of the abstract nature of these concepts, faculty guidance is essential in understanding and applying the concepts. Intentional dialogue is the purposeful engagement with another to gather the story of a health challenge.
Intentional dialogue centers on true presence by focusing on the story teller, and querying emergence is clarifying what is not understood as the person is telling the story. Connecting with self in relation is an awareness of self in the present moment. Creating ease is an energizing release that comes from telling the story to a person who is truly present to listen and to hear what matters most to the person about his or her health situation (Smith & Liehr, 2014).If the student is expected to apply story theory in practice, then the student needs to be shown how to use it.
Students begin by reading the literature to gain an understanding of the concepts of the theory, and how the theory can be used to provide care. Faculty guidance is critical through discussions of the theory, as well as during role modeling use of the theory in the clinical setting Sharing story theory applications in the clinical group in post-conferences offers students further understanding of the theory as it can be applied to practice. This approach to applying story theory in practice takes place over an entire semester so that students can develop deep meaning of the theory.
Implementations of Story Theory In Nursing Education
Story theory has been applied in an honors program (Carpenter, 2010). The following objectives were developed for the honors student based on two goals:
(a) The student will use the theory to plan the care for a person experiencing a complicating health challenge and
(b) the student will facilitate clinical group interaction and dialogue assist other students in the clinical group to relate story theory concepts to clinical practice.
The student gathered a story about what mattered most, that is, what was most important to the patient. The story served. as data to clarify the human response to illness that was made manifest by the patient. To put the theory into practice, the student was instructed to gather two perspectives the acute care perspective and the patient perspective. The acute care perspective was the usual care information that all students gather, and includes subjective and objective data from the patient grouped into nursing diagnostic categories for the planning of care. The patient perspective was the story about what mattered most to the patient.
This was gathered through intentional dialogue, which requires being truly present in a quiet and undisturbed manner.Students were asked to describe insights about nursing care that came from the post-conference discussions (Carpenter, 2010) Comments made by students include a noted difference between the acute care perspective and the patient's perspective for example what is important to the patient may not be his or her dressings or medication. The patient's concern about living from one day to the next is understandable, given the situation.
When asked to describe the most important learning experienced in this situation, student comments included: developed a sense of importance in listening to the patient, developed an increased understanding of the big picture that we often lose in regular clinical, pulled together information we get from all of our classes, and tied the priorities of patients into the plan of care.
The honors student evaluation of the experience was positive. She indicated she developed insight into holistic care through learing that health care providers have different priorities than those of patients, that the experience had a huge impact on her nursing practice, and led to an interest in continuing work with a future independent study. Incorporating story theory into the clinical course was effective in expanding the existing curriculum and raising the quality of the clinical experience
Impact of Story Theory In Nursing Education
The following implications can be drawn for applying the middle-range theory of story with students in the clinical practice experience.This approach takes student learning beyond the emphasis on disease to the complicating health challenge as experienced by the patient, and thus increases the level of student learning in clinical courses Story theory provides a theory-guided method to teach caring. It is generally noted that caring can be a difficult concept to teach. Framing caring as intentional dialogue to be truly present with the person to gather the story shows students a way to engage in a caring relationship, which is the essence of nursing.
Therefore, students come to get a sense of the difference between a medical perspective and a nursing perspective, focused on the patient's experience of the complicating health challenge.Story theory can be applied to any clinical course when there is the intention to put theory into action. Middle-range theory is at a level of abstraction that can be readily applied to the practice situation. The use of a particular theory in practice requires a value for educating students to come to know the unique perspective of nursing, which is caring about the human response.
This means that the faculty member values the nursing perspective, and holds a commitment to integrate this perspective in the education of students. And lastly, application of story theory enriches the faculty and student experience by focusing on the true work of nursing-caring about the person's experience of the complicating health challenge.
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