PRE-SERVICE LITERATURE GROUPS IN HEALTH PROFESSIONS AND TEACHING

Humanities Day 2011

Chris Osmond PhDAssistant Professor, Department of Leadership & Educational Studies, Reich College of Education

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PARTICIPANTSDepartment of English James Ivory PhD, Associate Professor and ChairREICH COLLEGE OF EDUCATIONDepartment of Leadership & Educational Studies Michael Dale PhD, Professor David Hostetler JD, Associate ProfessorCOLLEGE OF HEALTH SCIENCESDepartment of Nursing Karen Reesman PhD, RN, NEA-BC, Associate Professor Sharon Ann Cumbie PhD, RN, CS, Associate ProfessorDepartment of Social Work Deborah Phillips PhD, MSW, Assistant Professor

BACKGROUND3

Narrative Competence The set of skills required to

recognize, absorb, interpret, and be moved by the stories one hears or reads

Cultivated through reading, reflective writing and discussion

Charon R (2004)

BACKGROUND4

The point of such teaching is not to produce literary critics out of doctors and medical students but

to equip them with the readerly skills to follow a narrative thread,

to adopt multiple and contradictory points of view,

to enter into the teller’s narrative world and see how that teller makes sense of it…

to tolerate stories’ ambiguity, and to be imaginatively transported to

wherever the story might take the one who surrenders to it.

Charon R (2006)

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BACKGROUNDMaine Humanities Council -

Humanities at the Heart of Healthcare program

Outcomes include: strengthened empathic attitudes

toward patients, increased communication skills, decreased compassion fatigue and

burnoutBonnebaker V (2003)

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GENESIS OF PROJECT I facilitated five narrative groups

among medicine and nursing students, faculty, and staff in trauma and palliative care at UNC School of Medicine / UNC Hospitals

Found common interest in narrative and professional preparation among ASU faculty last fall within RCOE and across campus

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GUIDING QUESTIONS How might narrative enhance

professional preparation in the “caring professions” of teaching, nursing, and social work?

What common dilemmas of caregiving might emerge among those fields, and what might be the outcome of interdisciplinary exploration?

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WHAT WE READ Rita Charon, Narrative Medicine:

Honoring the Stories of Illness Ruth Nadelhaft, ed. Imagine What It's

Like: A Literature and Medicine Anthology

Cortney Davis, The Heart's Truth: Essays on the Art of Nursing

Robert Coles, ed. Teaching Stories: An Anthology on the Power of Learning and Literature

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SOME INSIGHTS English: narrative in professional training helps

reintegrate something we teach students to take apart, and gives us capacity to see anew

Education & Law: narrative helps students connect with the deeper purposes of what they are doing, and helps us resist disconnecting from ourselves in the name of professional role

Nursing: narrative reveals the relation of education to practice and reflects the complex human dimensions of nursing practice

Social Work: narrative can enhance skilled and empathic listening, to assist clients to envision and act upon possible options for working toward their goals

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ENGLISH perspectives As celebrated doctor John Keats observed long

ago, what constitutes the literary sensibility is precisely the ability to entertain a schism within one’s identity, a quality he called “negative capability”.

Rather than ignoring or decrying our negative capability—the gap we pry between our emotions and our function as doctors—rather than hiding it as a dirty secret of medical initiation, scotomizing it or pretending it is something other than it is, we need to address it: encourage it, cultivate it, learn it, and teach it. Make it not a loss but a gift, an instrument as important to medical care as any other technique at our disposal.

Holt TE 2004

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ENGLISH perspectives Seldom are there beautiful sunsets in call rooms… Something there is that doesn’t love a wall… Gazing over the horizon / past the glimmering glass

skyscrapers / deep into a glowing winder morning / I see a beautiful sunrise / countless others in this building may never see…

Will five minutes be enough? The hospital walls dissolve / and I float past

abandoned factories / hearing holy songs from an old church, / songs that become hymns to my deceased patients…

If through medicine I’m connected to humanity, then why am I so disconnected from myself?

Sachin PB, “Call Room” 2005

EDUCATION & LAW perspectives Ascending from Our Caves Let me show in a figure how far our nature is enlightened or unenlightened: Behold! human beings living in a underground cave, … here they have been from their childhood, and have their legs and necks chained so that they cannot move, and can only see before them, being prevented by the chains from turning round their heads. Above and behind them a fire is blazing at a distance, and between the fire and the prisoners there is a raised way; and you will see, if you look, a low wall built along the way, like the screen which marionette players have in front of them, over which they show the puppets.

*** [Re.] This entire allegory …. you will not misapprehend me if you interpret the journey upwards to be the ascent of the soul into the intellectual world. [Socrates, “Allegory of the Cave”]

EDUCATION & LAW perspectivesExamining Life …I say again that daily to discourse about virtue, and of those other things about which you hear me examining myself and others, is the greatest good of man, and that the unexamined life is not worth living…” [Socrates, “The Apology”]

EDUCATION & LAW perspectivesWhy the Humanities? Study in the humanities requires empathy, and often encourages compassion toward others in ways that expand our sense of community. The humanities nourish our imaginations. They provoke students to think critically about good and evil, suffering and flourishing. They introduce students to the major ways in which humankind has thought about morality and justice, giving them the conceptual resources and encouragement to live examined lives. [ Dr. Warren A. Nord (UNC-CH), “Do the Humanities Make Us Humane?”]

EDUCATION & LAW perspectivesHumanities, Professionals & Citizens “The good lawyer ... is the lawyer who possesses the full complement of emotional and perceptual and intellectual powers that are needed for good judgment, a lawyer's most important and valuable trait. The process of training to become a lawyer ... [involves gathering] the soul's powers in a way that confirms one's sense of wholeness as a person and sense of being wholly engaged by one's work….” [Anthony Kronman, former Dean and Professor, Yale Law School]

EDUCATION & LAW perspectives

How Does it Matter? The seminar [in Law and the Humanities] has …reminded me why I came to law school. [It] gave me the precious gift of renewed compassion and passion for the profession that I am about to proudly join.” [3rd-year NC law student]

In fourteen years as a high school principal I have attended many training seminars that taught practical skills or addressed the profound issues of our profession. None, however, could compare to the Humanities Seminar; it touched my soul and renewed my passion. I can't wait for the new school year. [Veteran NC school principal]

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EDUCATION perspectives A school is where they grind the grain of thought, 

And grind the children who must mind the thought. It may be those two grindings are but one…

Nemerov H1971 It was a fundamental principle of the Gradgrind

philosophy that everything was to be paid for. Nobody was ever on any account to give anybody anything, or render anybody help without purchase. Gratitude was to be abolished, and virtues springing from it were not to be. Every inch of the existence of mankind, from birth to death, was to be a bargain across the counter.

Dickens C 1854

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NURSING perspectives The National League for Nursing, in its

position statements, has challenged nurse educators to develop new research-based pedagogies responsive to the changing health care environment and reflective of new partnerships between and among students, teachers, and clinicians

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NURSING perspectives Despite the establishment of national

professional standards and competencies to guide nursing education providers, the preference for technical proficiency over professional attributes remains dominant, perhaps due to the prevailing ideology of technical-rationalism

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NURSING perspectives Preparing practitioners for rapidly changing and

demanding health care environments is challenging

A surge in knowledge development and scientific advancement has placed a priority on technical skill and a focus on content driven educational processes that prepare students for evidence-based practice

However, the most difficult health care scenarios require thinking-in-action and thoughtfulness as well as didactic knowledge

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NURSING perspectives Mindful of these elements, making use of

educational opportunities that provide a rebalance towards moral, ethical and social considerations that are also important in the delivery of healthcare is vital

Narrative can be used in nursing education to deepen students’ awareness of contemporary political and social practices that shape and can be shaped by nursing practice

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NURSING perspectives Narrative pedagogy is an interpretive

approach to teaching and learning that is being used widely in nursing education to foster educational reform

As it pertains to nursing education, narrative pedagogy is an approach to thinking about teaching and learning that evolves from the lived experiences of teachers, clinicians, and students

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NURSING perspectives

As part of these aims, we want students to develop their imaginations and to consciously examine, and challenge, nursing and healthcare paradigms and practices such as the enduring illness model of healthcare and the emphasis on technique-oriented care

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NURSING perspectives Interpretive educational methods, like narrative

pedagogy, promote judgment-based practice that includes use of evidence and delivery of thoughtful care

Narrative pedagogy is a way to enliven teaching that can facilitate students to develop and establish increasingly thoughtful practice

Interpretive methods are a way of thinking and a way to teach any content area for health care providers

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NURSING perspectives Internationally, nurse educators are exploring

and expanding narrative pedagogy in a variety of ways, developing novel teaching and learning activities to provide a regionally and globally relevant educational experience

We believe that interpretive methods offer our best educational practices to inspire reflective approaches to nursing and to habituate thoughtful practice and judgment-based care

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SOCIAL WORK perspectives The sensibility developed through a real, considered

response to literature has some correspondence with the development of intuitive understanding and capacity for discrimination demanded in work with clients

Literature extends our sense of what it may mean to be human, by presenting not a copy of life but an imaginative creation of remarkable and sometimes very difficult possibilities

Literature re-vivifies and extends the language we have at our disposal

Turner M 1991

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SOCIAL WORK perspectives To achieve a way of hearing and responding

that avoids this pitfall requires certain attitudes and sensibilities; above all giving primacy, not to knowledge about people but to “seeing people as they really are”

It is “knowledge based on imagination and recollection” and “an approach that calls for humility, patience, an attitude of respect towards the world, and an awareness of its infinite mystery and complexity”

ibid.

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SOCIAL WORK perspectives The dehumanizing of language shows, for

example, when all that happens becomes a “process’, replies are “feedback”, work is judged as to whether it is “efficient” or “cost-effective” rather than good or worthwhile; clients have become “consumers”, implying that what we offer them is commodities rather than human helping; indeed they are often offered “packages” of variously assembled resources

Literature matters to social work because it treats life whole: it expresses human nature in its complexity and unique variations and comments on its social world; it is an implicit reproof of attempts to place people in crude categories; to define, explain, predict or manipulate them

ibid.

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SOCIAL WORK perspectives Because literature presents, not

naturalistic replications of life, but imaginative creation, often very complex and with its own peculiar coherence, it allows, even compels, the reader to explore new and remarkable possibilities, to confront difficulty and despair, and take risks in imagined experience.

ibid.

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NEXT STEPSURC proposal in review for 2011-2012:

Interdisciplinary Narrative Group in Nursing, Social Work, and Teacher Education

Will bring together students and faculty of nursing, education, and social work for a year-long exploration of what the diverse experiences of becoming members of these professions have in common

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RESEARCH QUESTIONS How are students transformed as they

undergo professional preparation for the “caring professions”?

How does narrative work reveal the sometimes contradictory process of becoming part of a profession while maintaining one’s humanness?

What is the effect of interdisciplinary conversation on this becoming?

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METHODOLOGY and PRODUCTS 20 student participants will be recruited

from among the teacher, social work, and nursing education cohorts

Each month, all participants will read stories and / or poems that we’ll

select log on to the group’s ASULearn site to

write about an experience they’ve had and reflect on the “professional” and “human” aspects of the field they are preparing to join

have dinner with faculty facilitators and each other to talk about the experience

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METHODOLOGY and PRODUCTS Facilitation practices established by the “Humanities

at the Heart of Healthcare” program Student writing and transcripts of each month’s

discussion read by coinvestigators toward finding common thematic elements across research participants and the events they report

Fold “appreciative inquiry” priorities into a qualitative thematic analysis of the texts that result

Publication of a collection of student writing that represents the values of care we seek to promote for distribution to the incoming students in our Colleges in August 2012

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DISCUSSION Responses? Questions? Ideas? Collaborations?

Thank you!osmond@appstate.edu

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REFERENCESBonnebaker V (2003). Literature & Medicine: Humanities at the Heart

of Health Care: A Hospital-Based Reading and Discussion Program Developed by the Maine Humanities Council. Academic Medicine Vol. 78 (10).

Charon R (2004). Narrative and Medicine. NEJM, Feb 26.Charon R (2006). The Self-Telling Body. Narrative Inquiry Vol. 16 (1).Dickens C (1997/1854). Hard Times. New York: Penguin.Holt TE (2004). Narrative Medicine and Negative Capability.

Literature and Medicine 23, no. 2.Nemerov H (1971/2004). September, The First Day of School. In

Teaching Stories: An Anthology on the Power of Learning and Literature, ed Coles R. Modern Library.

Nord W (2006). Do the Humanities Make Us Humane? Program in the Humanities and Human Values, 2004; revised edition.

Sachin PB (2005). “Call Room”. In Between the Heartbeats: Poetry and Prose by Nurses, ed Davis C, Schaefer J, Banks JT. University Of Iowa Press.

Turner M (1991). Literature and Social Work: An exploration of how literature informs social work in a way social sciences cannot. British Journal of Social Work 21.