Storytelling can be a valuable teaching aid

Storytelling can be a valuable teaching aid

AORN Journal, Sept, 2000 by Carolyn A. Ramsey

Storytelling is not a new concept for teaching others. Narratives in the Bible and Native American folklore are prime examples. For generations, we have relied on stories from our ancestors to teach us values and expectations. Storytelling can be used to teach any topic to any group of individuals. Most people like to talk about their past experiences, and with a little refinement, storytelling can be used effectively for teaching and precepting in the perioperative setting.

Stories that capture what nursing is all about are always uplifting and can be used to encourage new nursing staff members. A group of new perioperative nurses sharing stories of critical incidents can reinforce nurses’ importance to surgical patients and also teach others. New nurses may find stories of challenging incidents the most interesting. It is a good way for them to set goals for mastering their own caring process for critically ill patients.(1) Just hearing a nurse relate a situation that had a positive outcome, like how someone who would seek help from hearing aid audiologist, overcame all odds to become successful, helps nurses realize that with teamwork and proper planning, they, too, can achieve expertise. Reliving typical or ordinary incidents reinforces basic principles of perioperative nursing practice.

USES FOR WRITTEN STORIES
Nurses are able to learn from the narratives of others’ experiences. In 1992, authors described a nurse preceptor development program that included a session on writing narratives to promote reflective thinking about their nursing practices.(2) The following guidelines were used in the narrative development.

* Details make a story more real. Give the time of day and other background information to help the listener understand the story. Include only information pertinent to the story, however.

* Use your own words, not an academic style of writing. Write as if you were telling the story.

* Use exact quotes that make the story more realistic and believable.

* Including personal thoughts and feelings will convey why this situation was meaningful to you and what you were trying to achieve.

* To maintain confidentiality, do not use real names when relating stories about patients. When telling stories about staff members, however, using names could positively reinforce a job well done.(13)

Written stories can be used to describe policies and procedures. By reading a story about what is expected, new employees of all levels may learn and understand policies more easily. One author always begins his stories with a heroic deed.(4) Regardless of how you begin, remember that the story must be true and have a clever title. The title should capture the reader’s attention and describe what is to come. Shorter stories are more attractive to read than long ones. One idea or theme should be covered in one single-spaced, typed page at the most. People’s names should be used (if it does not breach confidentiality) because everyone likes to see his or her name in print. Write informally, as you would talk to an acquaintance.(5)

PARTS OF A STORY
Whether stories are written or oral, four parts should be included:

* character,

* action,

* setting, and

* idea.

The story will be more believable if the storyteller is one of the characters. The action is a description of what actually happened, and the storyteller can use personal observations and feelings to relay the incident. Describing the setting sets the stage and gives the listener a visual picture of the situation. The idea is the message or moral of the story. By simply telling the facts, listeners can come to their own conclusions and probably envision themselves in similar situations.(6)

One method of storytelling organizes thoughts and gives the storyteller guidelines.(7) The story should be embellished by the storyteller’s voice patterns, body language, and vitality. The story should not be memorized. Instead, it should be practiced to improve the presentation. Do not overemphasize the moral of the story–people learn best if they can draw their own conclusions.

STAFF MEMBER SATISFACTION
Everyone likes to talk about past experiences, especially to a captive audience of new staff members. Seasoned preceptors can teach, express their feelings about a given situation, and satisfy their need to demonstrate their knowledge by telling stories. New staff members learn practices and culture and can develop a relationship with a preceptor by listening to stories and gleaning information about the preceptor’s personality.

Reading stories about gratifying situations can help staff members realize that they do make a difference to patients. For example, in a nursing home setting, stories of situations with grateful patients were placed in the staff lounges for staff members to read during breaks.(8)

STORY LISTENING
Other authors describe storytelling in a somewhat different light. They describe physicians as “privileged to the intimate details of others’ lives,” but not taking the time to really listen to patients.(9) By developing story-listening skills, health care professionals can better learn what is happening to their patients. Story listening also has been described as “recognizing symptom cue words as physiological/linguistic expressions of narrative pain.”(10) Many health care providers recognize the benefits of listening to their patients’ stories. Attention to patients’ verbal and nonverbal cues while they tell their stories helps practitioners assess patients’ needs.

STAFF MEMBERS’ RESPONSES TO STORYTELLING
As with patients, all staff members are different and learn in different ways. Though storytelling can be used to teach anyone, methods may be varied slightly to meet all learners’ needs. The Myers-Briggs Type Indicator test describes various individual personality preferences and learning styles (Table 1).(11) Educators or storytellers should appreciate all types of learning styles. Realizing that everyone does not think and learn in the same way can be a big step to tailoring teaching.

Table 1

THINKING STYLES(1)
Extrovert or Introvert
Sensate or Intuitive
Thinking or Feeling
Judging or Perceiving

NOTE
(1.) S K Hirsh, Using the Myers-Briggs Type Indicator in Organizations: A Workshop Leader’s Guide, second ed (Palo Alto, Oalif: Consulting Psychologists Press, Inc, 1991),

* Extroverts think out loud and draw energy from being with people. This type of individual probably would not have any trouble telling a story, but might not be so patient listening to another persons’ story. Introverts think inside and draw energy from being quiet.

* Sensate individuals perceive the world discretely through the senses; they have to feel, touch, and smell something to understand it. They also look for the facts, making true, accurate stories important. On the other hand, intuitive people perceive the world overall. They look for the meaning in situations. Intuitive people could develop their own moral to a story, and sensate people may have to be led to the conclusion.

* The next classification includes thinking and feeling personality types. Misunderstandings are more common between these two types than any others. Thinkers use objective data and seek just decisions, and feelers use subjective data and seek fair decisions. Conflict can arise when a person with a thinking preference teaches a person with a feeling preference. A feeling person needs to socialize before getting on with the task at hand, and a thinker simply wants to get the facts stated and get on with the job. Educators and preceptors should make time for small talk with people with feeling personalities, if applicable. At the same time, however, they should not bore the thinking student with trivial information.

* Judging and perceiving characteristics may be the hardest to understand. A person with a judging personality prefers order and likes to make detailed plans in advance. A perceiving person keeps things flexible and open and often acts spontaneously. It is important to remember these two types of personalities when educators and preceptors plan lessons, classes, or demonstrations. The judging type would be more comfortable knowing about a lesson or class in advance, and the perceiver would be more likely to accept an impromptu lesson.(12)

Perioperative nurses must be flexible when caring for patients. Nurses need good interpersonal and communication skills when interacting with patients, family members, and other health care team members. Realizing that there are different personality types will help nurses communicate with people of all types. Developing an appreciation of the strengths of the various personality types can be an asset in any situation. If needed, a class or seminar that describes different personality types may help new staff members develop a well-rounded personality suited for the everchanging perioperative setting.

CRITICAL INCIDENTS
Patricia Benner, RN, PhD, FAAN, is well known for her description of critical incidents in her book From Novice to Expert: Excellence and Power in Clinical Nursing Practice. She describes a critical incident as:

* an incident that made a difference in patient outcome,

* a situation that went unusually well,

* a very ordinary or typical incident,

* an incident that captures what nursing is all about, or

* an incident that was particularly demanding.(13)

Sharing these incidents through storytelling can have a lasting effect on the perioperative practitioner.

People have used storytelling to teach or share information for a long time. Storytelling can help perioperative preceptors and educators teach staff members. By developing the necessary skills and studying staff members’ acceptance of the use of storytelling, preceptors and educators will be able to vary their teaching methods and include storytelling as a part of their everyday practice.

NOTES
(1.) P Benner, From Novice to Expert: Excellence and Power in Clinical Nursing Practice (Menlo Park, Calif: Addison-Wesley Publishing Co Nursing Div, 1984).
(2.) M R Rittman, S Sella, “Storytelling: An innovative approach to staff development,” Journal of Nursing Staff Development 11 (January/February 1995) 15-19.
(3.) Ibid.
(4.) D M Armstrong, Managing by Storying Around (New York: Doubleday, 1992).
(5.) K Mayers, “Storytelling: A method to increase discussion, facilitate rapport with residents and share knowledge among long-term care staff,” Journal of Continuing Education in Nursing 26 (November/December 1995) 280-282.
(6.) Armstrong, Managing by Storying Around.
(7.) K Kerfoot, G M Sarosi, “Hero making through storytelling: The nurse manager’s challenge,” Nursing Economics 11 (March/April 1993) 102, 107-108.
(8.) J M Borkman, W L Miller, S Reis, “Medicine as storytelling,” Family Practice 9 (June 1992) 127-129.
(9.) Ibid.
(10.) W A Hensel, T L Rasco, “Storytelling as a method for teaching values and attitudes,” Academic Medicine 67 (August 1992) 500-504.
(11.) S K Hirsh, Using the Myers-Briggs Type Indicator in Organizations: A Workshop Leader’s Guide, second ed (Palo Alto, Calif: Consulting Psychologists Press, Inc, 1991).
(12.) R Alfaro-LeFevre, “Overview: What is Critical Thinking, and Why is it Important?” in Critical Thinking in Nursing, a Practical Approach (Philadelphia: W B Saunders Co, 1995) 2-17.
(13.) Benner, From Novice to Expert: Excellence and Power in Clinical Nursing Practice.
CAROLYN A. RAMSEY, RN, MSN, CNOR, is a nurse educator at Scott & White Memorial Hospital, Temple, Tex.