historical imagination, narrative learning and nursing practice: graduate nursing students'...
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Historical imagination, narrative learning and nursing practice: Graduate nursingstudents’ reader-responses to a nurse’s storytelling from the past
Pamela J. Wood , PhD, RN, Associate Professor
PII: S1471-5953(14)00050-X
DOI: 10.1016/j.nepr.2014.05.001
Reference: YNEPR 1871
To appear in: Nurse Education in Practice
Received Date: 26 July 2013
Revised Date: 13 January 2014
Accepted Date: 4 May 2014
Please cite this article as: Wood, P.J, Historical imagination, narrative learning and nursing practice:Graduate nursing students’ reader-responses to a nurse’s storytelling from the past, Nurse Education inPractice (2014), doi: 10.1016/j.nepr.2014.05.001.
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NEP-D-13-00155 Title Page
Title:
HISTORICAL IMAGINATION, NARRATIVE LEARNING AND NURSING PRACTICE: GRADUATE NURSING STUDENTS’ READER-RESPONSES TO A NURSE’S STORYTELLING FROM THE PAST
Word count:
5075
Author’s name & affiliation:
Pamela J Wood, PhD, RN
Associate Professor, School of Nursing & Midwifery, Federation University Australia
Contact details:
School of Nursing & Midwifery
Federation University Australia
Gippsland Campus
Northways Rd
Churchill
VIC 3842
Australia
Ph: +61-3-5122-6670
Email: [email protected]
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Historical imagination, narrative learning and nursing practice: Graduate nursing
students’ reader-responses to a nurse’s storytelling from the past
ABSTRACT
Storytelling and narrative are widely used in nurse education and the value of narrative-
based curricula, such as those governed by narrative pedagogy, is well recognised.
Storytelling stimulates students’ imagination, a central feature of narrative learning. One
form of story and imagination yet to be fully considered by educators is the historical
story and historical imagination. The use of historical storytelling creates a temporal
dissonance between the story and reader that stimulates readers’ imagination and
response, and enables them to gain rich insights which can be applied to the present.
Reader-response theory can support educators when using narrative and storytelling. This
article presents an analysis of graduate nursing students’ reader-responses to a nurse’s
story from the past. This narrative learning group used their historical imagination in
responding to the story and prompted and challenged each other in their interpretation
and in translating their responses to their current nursing practice. The article discusses
this analysis within the context of reader-response theory and its potential application to
narrative-based learning in nurse education. Historical stories stimulate historical
imagination and offer a different frame of reference for students’ development of textual
competence and for applying insights to the present.
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KEYWORDS
Narrative learning, reader-response theory, storytelling, history of nursing, nurse
education
Nursing is steeped in stories. The use of narrative and storytelling is embedded in nurse
education, and the value of narrative-based curricula is evident in undergraduate and
graduate programs (e.g., Crookes et al 2013, Diekelmann 2001, Ironside 2006, Koenig &
Zorn 2002, Swenson & Sims 2000). Responding to stories requires imagination and this
is central to narrative learning (Koenig & Zorn 2002, Swenson & Sims 2000). Educators
have taken different approaches to narrative learning but the influence of reader-response
theory in this has received limited attention (Sakalys 2002). As students respond
imaginatively to stories, educators can support them in developing textual competence in
interpreting their meaning (Ironside 2006, Koenig & Zorn 2002, Sakalys 2002) and
applying this to practice. While nurse educators have therefore considered the role of
narrative, storytelling and imagination in nurse education, one form of these yet to be
explored is the historical story and historical imagination. The aim of this study was to
examine one example of engaging students’ historical imagination, in order to identify its
relation to narrative learning approaches in nurse education and potential for stimulating
discussion of nursing practice. This article therefore addresses imagination and
particularly reader-response theory in narrative learning in nurse education, explains
historical imagination, and describes graduate nursing students’ reader-responses to a
nurse’s story from the past to illustrate how narrative learning can extend to practice.
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BACKGROUND
Imagination
The key form of imagination in nursing practice is empathy, the ability to see situations
from the patient’s perspective. Empathy, or ‘imaginative identification’ (Scott 1995,
p.1196), is crucial for ‘constructive caring’ in nursing practice, but it must be an
‘informed imagination’ (p.1199). Strengthening students’ imaginative capacity is
therefore a key issue in nurse education. Educators have guided the development of
students’ imagination by using storytelling as an approach to teaching and learning
(Koenig & Zorn 2002, Swenson & Sims 2000). Narrative learning is a significant way to
strengthen students’ imagination and empathy, and therefore their capacity to nurse
effectively.
Narrative learning and reader-response theory
Narrative learning has been applied in a variety of ways within nursing and medical
education (Crookes et al 2013, Dieklemann 2001, Ironside 2006, Koenig & Zorn 2002,
Swenson & Sims 2000, Weisberg & Duffin 1995). Narrative pedagogy, as one form of
narrative learning, stresses the centrality of communal thinking and dialogue to interpret
practice narratives and experiences from multiple perspectives in order to discover new
meanings and understandings (Ironside 2006). The educator functions as a guiding
partner (Swenson & Sims 2000). Another version of narrative learning is literary
pedagogy, where fictional accounts of people’s experiences with illness, for example,
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enrich students’ understanding of the human condition (Sakalys 2002). The goal in
literary pedagogy is developing textual competence, with its interrelated skills of reading,
interpretation and criticism. This changes the focus of students’ reading strategies from
locating information in texts, to ‘taking authority for their own learning by reading
reflectively, observing both their own reactions and the questions the work evokes, and
by actively creating meaning’ (p.387).
Sakalys’s (2002) explanation of four theoretical approaches to literary pedagogy includes
reader-response theory. This theory challenges the author’s role as the sole source of the
text’s meaning and brings the reader to the fore. Although most forms of narrative
learning emphasise the interpretive theoretical underpinnings of hermeneutics and
phenomenology (e.g., Ironside 2006, Swenson & Sims 2000), narrative learning based on
reader-response theory focuses more on the reader’s action in responding to the story and
the way this response is drawn from a particular social, aesthetic, interpretive context.
Just as the story’s writer draws on an aesthetic context – a store of tradition and literary
allusions – in relating the story, so too does the reader in responding to it. In the narrative
learning group or ‘interpretive community’, shared frames of reference will inform the
individuals’ and group’s responses (Chase & Hynd 1987, p.531). As Sakalys (2002)
noted for literary pedagogy in nurse education, it is the nursing profession’s ‘value base,
its theoretical heritage, and its practice wisdom’ that forms this social background. ‘It is
from this community base, formed by professional socialization, nursing’s world views,
and the social, political, and cultural stances of the profession, that the process of
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criticism occurs. In turn, this criticism has the potential to create shared knowledge and
meanings that can inform professional nursing practice’ (p.391).
Whatever form of narrative learning is used, engaging with stories means ‘participating
imaginatively in other lives’ (Weisberg & Duffin 1995, p.249). In this way, narrative
learning strengthens students’ capacity for imagination. One form of imagination that can
be developed is historical imagination.
Historical imagination
Broadly, historical imagination is the ‘creative capacity to envisage possibilities of
engaging with the past’ (Wood 2010, p.55). It is envisioning how a sense of its value can
be expressed and harnessed – in this case, in narrative learning. More specifically,
students can engage their historical imagination by reflecting on nurses’ stories or
narratives from the past, to identify things of value or cautionary tales to bring into the
present, and to consider how these might be translated into their current nursing practice.
Tosh (2012) has noted that we respond to an encounter with the past with a sense of both
familiarity and difference. Points of familiarity and difference can help us recognise what
is enduring over time and what is transient. Tosh’s view of the purpose and value of
history and how we respond to the past forms the historical theoretical framing for the
use of nurses’ stories from the past in narrative learning.
RESEARCH DESIGN
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Graduate students in a Master of Nursing programme in a New Zealand university
participated in a group discussion of a New Zealand nurse’s story from 1911. Class
discussions were regularly recorded so any student could request a copy if they had been
absent or wanted to refer back to a session. Following completion of that unit of study,
ethical approval was granted by the university’s ethics committee for the educator to
write to the students as a researcher who had no continuing connection with their tuition
or progress in the course. Their consent was sought to use the recording for analysis of
the discussion in order to determine its features in relation to narrative learning. All
students individually granted written consent. Pseudonyms are used here to distinguish
between different students’ contribution to the discussion.
As no aspect of the discussion could be explored in more depth through further
conversation with the students, the research design aligned most closely with a qualitative
descriptive study with the audiotape and a transcript of the discussion forming the
research material. As Sandelowski (2000) pointed out, this is a valuable methodology.
Although researchers might ‘stay closer to their data and to the surface of words and
events’ than researchers using other methodologies, ‘surface readings should not be
considered superficial, or trivial and worthless’ (p.336). Sandelowski noted that analysis
in qualitative descriptive studies can use pre-existing templates. Preliminary analysis or
initial in-depth reading of the transcribed discussion indicated that reader-response theory
was the most appropriate in explaining identified features, as students’ comments
demonstrated their personal and professional response and engagement with the text and
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translation of their responses to the practice context. In this way, the study was ‘hued’
(p.337) by a reader-response research approach.
Researchers studying students’ reader-responses have generated a number of frameworks
or classifications for understanding the development of a reader’s responses through time
or demonstration of this within one reading episode (e.g., Sebasta et al. 1995, Smith
1991). The taxonomy or hierarchy of aesthetic response by Sebasta et al. was chosen as a
template for the second layer of analysis. Although developed and tested in research with
US middle and high school grade students, it described a progression in the way a reader
responds, from lower to more sophisticated levels. In the two levels of the first or
Evocation stage, the reader relives the experience of reading, and imagines or pictures
characters, the setting or events in order to elaborate on them. In the four levels of the
second or Alternatives stage, the reader applies their own experience to the work, applies
other readings or media, applies other readers’ views or re-examines their own view, and
re-examines the text from different perspectives. The third or Reflective Thinking stage
involves interpretation, with the reader generalising about the meaning of the reading
experience to their own life. In the two levels of the final Evaluation stage, the reader
considers what they got from the reading and evaluates the “goodness” of the text
according to criteria they have set. Sebasta et al. warned that aesthetic stance is ‘fluid and
emergent’ and ‘more holistic than categorical’ (p.450). Similarly, Sandelowski (2000)
noted that in descriptive qualitative research an analysis template can be modified in use.
The congruent flexibility of these two positions led to the choice of this analytical
approach.
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A NURSE’S STORY FROM THE PAST
The story used in the group session was from a nurse recalling her work in 1911 at the
small hospital in Naseby, an old goldfields town in the Otago province (Brown 1940).
New Zealand was the southernmost colony in the British Empire and gold was
discovered in the Naseby area in the 1860s. Some goldminers who came from Britain had
been soldiers in the Crimean War. Many remained in the area into later life. One was
James Crawford who treasured the memory of helping Florence Nightingale down the
gangway at Scutari and therefore took a personal interest in the hospital and its nurses.
He would sit outside his cottage to talk to nurses as they passed by. In summary, the
nurse recounts that on Christmas Eve morning she walked down to the township to
borrow some vases for a large floral display she was planning for her ward, ‘a delicate
colour scheme in pink, blue and mauve’. James Crawford was sitting at his gate and
presented her with three posies of flowers, picked with very short stems, and told her they
were for her ward the next day. He and his wife would be there to see it. The nurse
thought with dismay of her planned large display and careful colour scheme, and then
thought of Florence Nightingale, and the decision was obvious. She arranged the little
flowers in small jars filled with damp sand and put them on patients’ lockers on
Christmas morning. The patients loved them.
Among the patients were some very old goldminers from Scotland. As the nurse
recounts, one who was over 80 noticed a geranium and remembered his mother growing
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some in her kitchen window in the old country. He enjoyed the ‘fine scent’ of a sweet
william. A snowy haired Highlander aged 86 lifted from his locker a pot containing three
moss rosebuds. His eyes became misty as he recalled his Highlands sweetheart of 64
years before, who had loved the moss rose. She died before they could marry and he
placed moss roses ‘in her white hands. The scent o’ these brings far thoughts to me.’
The nurse ends her story by saying: ‘No long stemmed flowers arranged in tall vases
could have wakened such memories. That afternoon the veteran and his wife visited the
hospital. The quiet look of pride on their faces more than repaid me for side-tracking my
colour scheme’ (Brown 1940, pp.293-294).
STUDENTS’ READER-RESPONSES
Sandelowski (2000) asserted that there was ‘no mandate’ in qualitative descriptive
studies ‘to produce anything other than a descriptive summary of an event’ organised in a
way ‘most relevant to the audience’ (p.339). This section therefore provides an excerpt of
the discussion and a summary of the application of the aesthetic hierarchy. Only one part
of the group’s discussion is reported here. It is chosen as it illustrates how students’
historical imagination can be effectively used within a narrative learning approach and
how it relates to reader-response theory. The discussion started with an opening question
from the facilitator, asking students for their initial impressions of the story and what had
struck them about it.
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Angela: It was such a simple thing that she did but it prompted the memories and
conversations between the patients. And it was such a simple thing to brighten the
ward but to those patients it meant so much more. It was great.
Belinda: For me, I’m really smell-sensitive. I absolutely believe how smells can
bring back memories for people. That really struck me. The whole smell thing, at
that personal level.
Catherine: It’s all about communication.
Diana: I noticed the attention to detail, in writing the detail about the flowers, and
the pride in it as well.
Facilitator: The pride in it?
Diana: The man talking about Florence Nightingale and the flowers, it was his gift
to the nurse, it was like him giving what he’d got from helping Nightingale.
Belinda: She didn’t have to use his flowers. She could have easily just got to work
– mind you, she probably felt a little bit obliged because he said he was going to
come and have a look, and she probably thought, ‘Oh, well, into the sluice!’
Jane (an older nurse manager): And she knew what the flowers meant to him.
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Belinda: Yes, even though the stalks were short, she was still going to use them.
Jane: They became symbols of the goldminers’ younger days. I absolutely agree
with you, Belinda, I could smell the sweet williams too. And the nurse was highly
esteemed, because he stopped her and said, ‘I’ve got something here for you.’
Students were then asked what the significance of the story was to them.
Jane: To me there was so much symbolism in the whole story. The flowers, and
the link with Florence Nightingale. Nightingale’s focus was completely on the
environment, she changed the environment to suit the patients, not herself. And so
if I was talking to a group of young nurses I’d be trying to say, ‘What do we need
to be mindful of about the environment for the patients? It’s to suit their feeling of
comfort, not ours.’ I do see it like passing knowledge from one generation to
another. And if you drop the basket it’s not available to the next generation.
Because I learnt a lot from the generation before me.
Facilitator: So that basket has to keep on being filled and passed?
Jane: Yes. And the heritage of that man’s memory. How things endure even on
the other side of the world. And she also valued the gift, even though the gift was,
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in one way of looking, not as wonderful as the flowers she had in her mind, she
knew it was more precious.
At this point, the students’ historical imagination was turned to making the link between
the past and present, and between the story and current practice.
Facilitator: So what do these things have to say to nurses today, if anything? What
would nurses gain by knowing this nurse’s story from the past?
Belinda: Don’t disregard anything. It may not be important to yourself, it may be
important to the patient.
Facilitator: Can you think of a situation nowadays that this might relate to?
Belinda (an emergency nurse): Yes. Even to give a phone to a patient, it’s
important to them to be able to communicate with a family member. You may be
really busy on your shift and running around and the last thing you think is, ‘Oh
gosh, they need a phone,’ but to them it’s really important. It’s the small things.
It’s what they remember. And it’s evident when you get complaints (laughs).
They say, ‘I didn’t get a cup of tea.’ And you look back and they had an ECG,
blood tests and so on, they were seen by three doctors, but that’s not what they
remember, it’s the cup of tea they missed out on, you know?
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Facilitator: So, the value of small things.
Jane: But what would smell as evocatively as that? You were talking about how
smells bring memories, Belinda. And if you were working in an aged care facility,
how could you use that evocation of something through smell? And to be really
careful too. In this particular story it was a happy smell associated with a happy
memory, but it could easily be not that at all.
Facilitator: Also a bitter-sweet memory for that man who had given the moss
roses.
Jane: And to me it’s the ordinariness of the patients’ lives that’s so rich. That
everybody has a beautiful remembrance of something really emotional or sad or
wonderful – and she could draw that out of them.
Facilitator: So how does that relate to today, do you think?
Angela (an emergency nurse): To be honest, I think nursing’s lost a lot of that
personal touch. And that listening, stopping and listening to patients. I know to be
honest it’s probably the biggest thing I lack in my practice. I’m very good at my
practical work but I don’t put much importance on to that because it’s probably a
time factor and I’ve become conditioned to working hard and fast.
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Jane: Now wait a minute, she would have worked pretty hard.
Belinda: Yeah.
Angela: I’m just talking about the Emergency Department.
Jane: You’re connected with people all the time. This story had lots of symbols in
it. Would you see a symbol if one came past you?
Angela: I don’t know whether I would, to be honest. I don’t know. I honestly do
think at times I would say, ‘Oh, no, they need the phone,’ or, ‘Gosh, they want a
cup of tea, I haven’t got the time to get it.’ I don’t know whether I would see the
importance. That’s pure honesty.
Jane: That’s what we’re trying to get to.
Facilitator: So does this story help in any way, in that?
Angela: It does, because it brings me back to why I went nursing. When I first
became a registered nurse, I spent more time listening to patients then, and I got
so much out of patients. I think the quickest thing I dropped was that.
Jane: Was it too big a burden?
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Angela: No, I just think I’ve become conditioned to work, just the practical work,
the physical work of the job, so I’ve just sort of dropped it. It might be the area I
work in, emergency nursing.
Jane: Is that part of why you chose it?
Angela: Possibly. But I don’t think so. I chose emergency nursing because I like
the acute work. But to be honest, I can see myself when I started my practice, and
where I am now, where my priorities and my skills are. And that story just sort of
makes me think, ‘Gosh, I must stop and remember.’
Jane: Well, what I’ve noticed, I have a bit to do with the new graduate nurses and
the patients tell the new graduate nurses all kinds of things that they haven’t told
the others. And it’s because they’re slower at doing the technical tasks. And the
new graduate nurses are connecting with them in a way that a busy person, who
walks past them and doesn’t make eye contact with them, can’t do.
Angela: Exactly what’s happened to me.
Jane: But the other thing that happens is the longer you stay nursing the more that
comes back to you. You realise that some technical stuff just has to wait. And you
have to put that person’s hands in yours and say, ‘Tell me.’
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Belinda: And that’s funny because sometimes as a nurse the people that you work
with who do all of that are perceived as frustrating to work with. You think, ‘Oh
well, yeah, she’s talking to the patients all the time while I’m doing all her work,
because she’s yap, yap, yapping.’ And then I think, if I came into hospital, she’s
the one I’d want to look after me because I know she would make sure I had the
phone, to make sure someone had the kids, that she would sort out a neighbour to
feed the cat and make sure the car didn’t get towed away. She’s the one I’d want
to look after me.
Application of the Sebasta et al. (1995) hierarchy of aesthetic response showed that in the
initial part of the discussion students’ comments were, quite reasonably, at a relatively
lower level in the hierarchy. They applied the reading experience to themselves in a
simple or direct way (first level Stage 2), as in Belinda’s comment about being smell-
sensitive. Similarly, Belinda’s and Jane’s acknowledgement of the nurse’s decision to use
the old man’s flowers related to their own imaginative understanding of the context
(second level Stage 1) and to their appreciation, as nurses, of the implications of
accepting the gift (first level Stage 2). However, most of the discussion demonstrated
more sophisticated application of their reader-response to their own experience as nurses.
This was particularly at the levels related to interpreting and generalising the meaning of
their reading experience to their own contexts (Stage 3), and evaluating what they got
from reading the text (first level Stage 4). This was seen especially in the later part of the
discussion, in Belinda’s comments and the interaction between Jane and Angela. For
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Belinda, the story reminded her of the importance of small actions in nursing. Jane gently
challenged Angela to consider the symbolism of the story and whether she would
recognise something symbolic in her own practice. The story reminded Angela of why
she chose to be a nurse and how she needed to reorient her priorities to listen more to
patients. Jane translated her reading experience to her work with new graduate nurses
and, as with Angela, the importance of listening.
In accordance with the congruent flexibility in the positions of Sebatsa et al. (1995) and
Sandelowski (2000) related to using analytical templates, in this second layer of analysis
no rigid application of the hierarchy was made. It was used more to gain an
understanding of how the students’ reader-responses highlighted particular aspects of
their reading experience and its relation to practice, and their use of historical
imagination.
It should be noted that the direction of the discussion itself was to a degree shaped by the
facilitation. At different points, students were asked to consider the story’s significance
for them and how it related to current practice. This might be seen as a limitation of the
study, as shifts in the focus of students’ responses were not always spontaneous.
However, this approach was congruent with the educational goal of the session, which
was to encourage students to use their historical imagination.
DISCUSSION
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The students’ discussion needs to be considered in relation not only to reader-response
theory, but more broadly to narrative learning and more specifically to historical
imagination. The students in this small, narrative learning group were all registered
nurses. Even though their practice settings differed (emergency nursing, aged care, acute
care and nursing management), they shared the social, aesthetic, interpretive context of
nursing. In this way, they formed an interpretive community (Chase & Hynd 1987) that
would in part have shaped their response to a text. As nurses, they drew on a common
understanding generated by their professional background and experience that had the
potential to ‘create shared knowledge and meanings’ (Sakalys 2002, p.391). The initial
discussion showed their recognition and common understanding of the evocative nature
of smells, the importance of attention to detail and to small things in nursing, and the
richness encompassed in the ordinariness of people’s lives. That these are shared
understandings in nursing and are therefore part of both the storyteller’s and nurse-
reader’s aesthetic interpretive contexts can be seen in the way nurses in the past also
discussed the importance of small things. Nightingale wrote about ‘doing common things
uncommonly well’ and paid attention to the ‘small things’ in nursing (Nash 1914, p.95).
Nurses in the early 1900s wrote articles on nurses’ duty in small things, and on the
quality of thoroughness in nurses’ work (Lucas 1905, Robb 1903). Similarly, nurses in
the present have also illuminated the importance of ordinariness (Taylor 2000). The
students recognised these from the story and their own understanding of professional
values and current practice.
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The educator’s role was to provide the learning material (in this case the nurse’s story),
create the setting for the discussion, and facilitate and guide it with questions and
prompts when needed. In this way, the educator was fulfilling the role in narrative
learning stipulated by Swenson and Sims (2000). The experienced narrative-learning
educator also knows when to let students take direction of the discussion. A central role
in this discussion was played by Jane, the older nurse manager. She gently questioned
Angela’s assumption about the story, her practice and the reasons for choosing
emergency nursing, always relating this back to the story. The group was used to working
together and there was therefore a feeling of safety that enabled this kind of discussion.
Chase and Hynd (1987) also identified this as an important practice in teaching based on
reader-response theory. The discussion let Jane prompt a younger, less experienced
nurse’s insights into practice and in doing so in some way meet her own need to pass the
basket of knowledge on to the next generation of nurses.
The movement of the discussion from the story’s past to the students’ present is a key
feature of engaging students’ historical imagination and facilitated the translation of the
group’s interpretation of the story to their practice. As Sakalys (2002) noted, developing
students’ textual competence also ‘entails moving beyond initial reactions to discoveries
about one’s self’ (p.390). This can more easily occur through ‘participation in
communities of learners who share observations, question their own and each other’s
assertions, and search for common understandings’ (p.391). This could, of course, be
achieved by using a story from the present. However, as Sakalys also pointed out,
‘differentiating the reader’s subjectivity from that of the author is a critical step toward
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textual competence and intellectual independence’ (p.391). This can be achieved when a
reader’s interpretation is activated by an experience of inconsistency, and this ‘gap
between the reader and a literary work can be temporal’ (p.389). This aligns with Tosh’s
(2012) assertion that we respond to the past by noticing points of familiarity and
difference, and that the ability to recognise these is essential to any social movement in
the present. Students took notice of the aspects of nursing in the nurse’s story that were
different from their own experience but equally searched for points of familiarity.
The students’ imagination was certainly engaged with the story and how it could translate
to practice. Their empathy or in Scott’s term ‘imaginative identification’ (1995, p.1196)
for the perspectives of the nurse, the patients and the Crimean veteran was evident. Their
‘informed imagination’ (p.1199) enabled them to understand the various standpoints and
experiences in the story and what these might mean for practice today. Again, this relates
to the last level in Stage 2 of the Sebasta et al. (1995) hierarchy of aesthetic response
where readers re-examine the text from various perspectives, and to Stages 3 and 4 where
readers generalise their interpretation to their own context and evaluate the text’s
contribution. As Weisberg and Duffin (1995) noted, engaging with a story ‘encourages
readers to construct their own stories in relation to the ones they are reading.
Consequently, readers come to know themselves better, to connect who they are to what
they are doing’ (p.249). There is particular value when this story is from the past, as it
creates the temporal dissonance that stimulates interpretation (Sakalys 2002). It is not
surprising that Weisberg and Duffin regretted abandoning their objective to use historical
literary material in their course with medical students, in the face of the students’ strong
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resistance and intolerance to it. As this work with graduate nursing students has shown, a
nurse’s story from the past evoked thoughtful interpretation and translation to practice.
Although narrative learning approaches to nurse education are well recognised, the
application of reader-response theory has received little attention. Sakalys’s (2002)
inclusion of it in her account of literary pedagogy is an isolated example. However, as
Sebasta et al. (1995) pointed out, teachers can use reader-response theory to focus their
teaching. While narrative pedagogy focuses principally on communal thinking and
dialogue (Ironside 2006), teaching based on reader-response theory can also use specific
written exercises to help students structure, organise, consolidate and express their views
(Chase & Hynd 1987). Nurse educators could gain from considering these as they plan
educational sessions incorporating narrative – sessions designed to elicit students’
interpretation of text and develop their textual competence.
Nurse educators’ inclusion of the history of nursing in courses, while receiving growing
attention (e.g., Lait 2000, Lewenson 2004, McAllister, Greenhill, Madsen & Godden
2010), could be strengthened by focusing on engaging students’ historical imagination by
applying their interpretation of historical stories to current and future practice. This story
and others from the past have been used effectively with other graduate and
undergraduate nursing students in New Zealand and Australia. Only one example has
been considered here as, in Sandelowski’s (2000) terms, it was a typical instance of a
phenomenon that allowed it to be described it ‘as it tends to appear’ (p.338). The New
Zealand context of this chosen story and student group could be considered a limitation
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of this study. However, it does not restrict the transferability of the insights from the
analysis of this student discussion to other contexts. Similarly, stories written by nurses in
the past in one country or context can usefully be used in teaching students in a different
context as they stimulate a spatial as well as temporal gap (Sakalys 2002) between the
reader and the story and enable the identification of points of difference (Tosh 2012).
More research is needed in how these approaches and factors can be further interrelated
and developed to inform effective teaching practice.
CONCLUSION
This analysis of graduate students’ reader-responses to a story from the past demonstrates
that using historical narratives engages students’ historical imagination as they discuss,
question assumptions, and translate the past to the present. It is a different, vibrant and
effective way to facilitate learning. Reader-response theory offers a valuable foundation
for narrative learning. It extends the focus more clearly from the text to the reader, and to
the way the reader’s active response to the text is drawn from their social, aesthetic,
interpretive context, in this case the profession and practice of nursing.
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