Learning Module 6

Teaching Patient-Centered Care Using Narrative and Reflective Pedagogies

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Introduction

As nurses we have a strong tradition of providing patient-centered care. In all types of programs faculty value patient-centered care and introduce and reinforce this as students move through the curriculum. Rarely, however, do we pause to consider the extent to which the learning experiences we create for students help them actually deliver patient-centered care. How do we know if the care students are providing is patient-centered? What are the assumptions we make about when and how students learn to provide patient care? With the delineation of the QSEN competencies and knowledge, skills and attitude statements, our traditional understanding of patient-centered care has been articulated, extended and, in many cases, challenged. This module provides the opportunity to consider ways to extend our current teaching practices by using narrative and reflective pedagogies to explicitly foster students' abilities to provide patient-centered care.

Objectives

Upon completion of this section, you will be able to:

  • Examine the power of nurses attending, listening and being present in practice
  • Analyze the difference between interaction and connection among faculty, students, clinicians and patients
  • Explore how current teaching practices enable and/or inhibit the development of students' abilities to provide patient-centered care

Contributors

  • Sara Horton-Deutsch PhD, CNS, RN
  • Pamela Ironside, PhD, RN, FAAN, ANEF

Reviewers

  • Patricia Young, PhD, RN

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Content

As nurses we have a strong tradition of providing patient-centered care. In all types of programs students are introduced to the importance of patient-centered care right from the start, and this emphasis continues across levels, specialty courses and clinical experiences. Yet, how do we know if the care students provide is patient-centered? With the delineation of the QSEN competencies and knowledge, skills and attitude statements, our traditional understanding of patient-centered care has been articulated, extended and, in many cases, challenged. This module provides the opportunity to consider ways to build upon our current teaching strategies to explicitly foster students' inquiry into and provision of patient-centered care using narrative and reflective pedagogies.

Teaching Patient-Centered Care Using Narrative and Reflective Pedagogies

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Resources

Bibliography

Boud, D., Keogh, R. & Walker, D. (1985). Promoting reflection in learning: a model. In Reflection: Turning Experience into Learning (Boud, D., Keogh, R., & Walker, D. eds.) pp. 18-40. Kogan Page: London.

Boyd, E.M., & Fales, A.W. (1983). Reflective learning key to learning from experience. Journal of Humanistic Psychology, 23(2), 99-117.

Dewey, J. (1933). How we think: A restatement of the relation of reflective thinking to education process. Heath: Boston, MA.

Diekelmann, N., & Diekelmann, J. (2009). Schooling learning teaching: Toward narrative pedagogy. Bloomington, IN: iUniverse Press.

Gibbs, G. (1988). Learning by doing: A guide to teaching and learning methods. Further education unit, Oxford Polytechnic, now Oxford Books University. http://www2.glos.ac.uk/offload/tli/lets/lathe/issue1/issue1.pdf#page=5
(accessed 10/8/10).

Girdley, D., Johnsen, C., Kwekkeboom, K. (2009). Facilitating a culture of safety and patient-centered care through use of a clinical assessment tool in undergraduate nursing education. Journal of Nursing Education, 48(12), 702-705.

Horton-Deutsch, S. & Sherwood, G. (2008). Reflection: An Educational Strategy to Develop Emotionally Competent Nurse Leaders. Journal of Nursing Management, 16, 946-954.

Ironside, P.M. (2006). Using narrative pedagogy: Learning and practicing interpretive thinking. Journal of Advanced Nursing, 55, 478-486.

Ironside, P.M., Diekelmann, N.L., Hirshmann, M. (2005). Student voices: On listening to experience in practice education. Journal of Nursing Education, 44, 49-52

Ironside, P.M., Diekelmann, N.L., & Hirschmann, M. (2005). Learning the practices of knowing and connecting: The voices of students. Journal of Nursing Education, 44, 153-155.

Johns, C. (1999). Becoming a reflective practitioner. (2nd ed.) Blackwell: London, UK.

Johns, J. (2006). Engaging in reflection in practice. Blackwell: London, UK.

Mezirow, J. (1991). Critical theory of adult learning and education. Adult Education, 32 (1), 3-24.

Schon, D.A. (1983). The reflective practitioner: How practitioners think in action. Basic Books: New York.

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Discussion

After you have reviewed the module presentations and resources, consider how this material is relevant to your own work and experience. The following is a list of questions for self-reflection or for use in class.

  1. How do we teach the practices of listening, attending and being present in practice currently? Are these practices part of the formal curriculum? Are they taught across the curriculum?
  2. Do students in our program recognize the importance of the practices of listening, attending and being present in practice? Do they understand these as critical aspects of patient-centered care?
  3. How might we create ways to foster the practices of listening, attending and being present in every course? What would be gained (or lost) by doing so? How would we know if our efforts to create these experiences were successful?

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