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Abstract

Preparing students for a complex and ever-changing health-care environment is a daunting task for nurse educators. One way to accomplish this task is by reducing the gap between what is learned in school and what is practiced upon graduation. Nurse educators are challenged to create online environments that engage students with real-life activities that resemble practice—authentic learning. One authentic learning activity created for an oncology nursing course that resonated with students was Ann's Story. Ann, a nursing professor, was diagnosed with cancer, and her story was used in a course about caring for patients with cancer. Ann's goal of making something good come of her cancer diagnosis was met through student comments reflecting newfound wisdom in sharing thoughts, feelings, and compassion with patients rather than concentrating only on the completion of tasks.

Preparing students for a complex and ever-changing health-care environment is a daunting task for nurse educators. One way to accomplish this task is by reducing the gap between what is learned in school and what is practiced upon graduation (Benner, Sutphen, Leonard, & Day, 2010). Reducing this gap requires that educators become proficient in teaching face-to-face and in online educational environments. Opportunities for online education have been increasing because of the benefits provided to students, such as flexible place and time (Barber, Taylor, & Buchanan, 2014). Student enrollment in all online education programs continues to increase (Allen & Seaman, 2016). Nurse educators are challenged to create online environments that engage students with real-life activities that resemble practice—authentic learning (Blackburn, 2017; Britt, 2015; Meyer, 2014; Parker, Maor, & Herrington, 2013). Previously, online learning or e-learning reflected the traditional methods of instruction, such as slides with narration, readings, and exams, which may not have engaged all learners. Currently, online courses continue to improve through providing activities that engage learners (Barber et al., 2014). The challenge for nurse educators includes engaging learners while designing high-quality online courses that integrate the delivery of nursing care and educational approaches through technology.

Following completion of the e-Learning Online Certificate Program offered at Weber State University, a nurse educator was tasked with redesigning an oncology nursing elective for the Registered Nurse to Bachelor of Science in Nursing (RN-BSN) program. The course was not designed to lead to oncology certification; the primary objective was to prepare nurses who typically do not encounter patients undergoing cancer treatments to provide safe, high-quality nursing care to these patients. Information was provided on how to pursue certification in oncology, if desired.

Post-licensure students may encounter patients receiving cancer treatments in the home, hospital, or other places that require interventions. Unfortunately, they may not have the education or experience necessary to make sound clinical decisions. In addition, students need to know what it feels like to have a diagnosis of cancer, what treatments are required, and what survivorship involves. These topics were incorporated into authentic learning activities and rendered through case studies, problem-solving activities, multiple sources and perspectives, collaboration, reflection, interdisciplinary perspectives, and integrated assessments (Britt, 2015). However, there was one unique learning activity that resonated with students—Ann's Story. As faculty, we want to share how the creation of Ann's Story, an authentic learning activity, evolved.

ANN'S STORY

Shortly after being offered a faculty position with my current employer, I was diagnosed with breast cancer. The initial horror of the diagnosis brought to mind not only my own mother's struggle with and ultimate death from this disease, but the memories of all those oncology patients whom I had cared for over my career as a registered nurse. My cancer was caught early, on a routine mammogram. I had been reassured that I probably could expect an excellent outcome, but I was still frightened, and my family's devastation further heightened my fear while I strove to downplay the significance.

Having been reassured by my new employer that I should take whatever time I needed to deal with this diagnosis, I began my orientation to my new faculty position. During the first month of my employment, I attended a presentation given by a cancer survivor about the good she was able to derive from a diagnosis of breast cancer; I found this presentation both timely and inspiring. What could I do to make breast cancer meaningful? I also had the good fortune to meet my colleague who was in the process of designing an online oncology elective for our RN-to-BSN students. My colleague was very receptive of my offer to assist in any way I could, and we ultimately decided on a series of short videos during which I would share my story from the perspectives of both patient and nurse. Working together with our instructional design team, my colleague and I created Ann's Story, a series of six videos that followed my story from diagnosis, with all of the thoughts and feelings associated with having cancer, through surgery, radiation, and survivorship. As a result of these videos, I was able to provide unique content through online learning modules to a nurse audience invested in this educational process, with the outcome of enhanced understanding while attentively embracing my story as a patient, and basing the process on theory.

Smith and Liehr (1999) developed a middle-range theory, attentively embracing story, which highlighted story as part of the process of dialogue between nurse and patient, promoting and fostering human development. The three concepts on which this theory is built are “intentional dialogue, connecting with self-in-relation, and creating ease” (p. 189). Intentional dialogue is the nurse's role in actively encouraging the patient to share her or his unique story or experience. Together the nurse journeys with the patient as he or she recounts what happened, with the focus on the meaning of the experience to the person involved. Through intentional dialogue and undivided attention, the nurse reassures the patient that her or his experience is both meaningful and worthy of the time taken to listen; in other words, the nurse is present as the story unfolds. Carpenter (2010) describes intentional dialogue as “purposeful engagement with another person to gather that person's story of a health challenge” (p. 30). He goes on to state that intentional dialogue requires “true presence and querying emergence” (p. 30). As the nurse focuses on the narrative, he or she asks questions to further enhance understanding of the interconnectedness of the meanings attached to the story.

Through connecting with self-in-relation, facilitating story narrative allows the patient to recognize her or his personal history, in an effort to determine what is causing feelings and promoting thoughts. Reflective awareness, as a component of self-in-relation, allows the patient to stay in the present, while acknowledging new awareness of old or hidden feelings and the derivation of new meaning to past experiences. The patient seeks to create ease as the story is told through sudden insights, random thoughts, and memories which arise during the narrative. Smith and Liehr (1999) describe this as flow and anchoring: The patient narrates the story, providing flow, but is anchored as jumbled thoughts, random memories, and ideas occurring during the narrative provide new understanding of what has occurred. In the presence of an attentive nurse, the patient's story becomes whole and meaningful.

Catherine Kohler Riessman (2015) shared her own narrative of a sarcoma diagnosis through journaling. She writes of her entrance into the medical arena as a “vigorous, energetic woman in excellent health, a well-informed scholar in medical sociology, a competent and self-sufficient individual” who, following chemotherapy, radiation, and surgery, “left the hospital a week later disabled, dependent, unable to walk down the street” (p. 1058). These descriptors give readers a much more vivid impression of the true personal nature of her illness, rather than merely reading a list of symptoms from a textbook. Stories enhance memories of important details that students can retrieve and apply in similar situations.

According to Sheilds (2016), narratives shared by individuals related to experiences with health and illness may be the only way by which nurses “authentically partner” with patients (p. 713). This approach to patient-centered care partners nursing knowledge with client experience, assisting in collaborative decision-making. In my experience as a nurse educator, students may be armed with all the knowledge of disease pathophysiology, symptoms, and treatment plans while possessing expertise in skills, but the ability to talk to and listen to patients and their families is often not an intuitive process. My goal of sharing my own story through videos was to give cancer a face, to provide a personal record of my cancer experience for my children, to share the meaning of cancer to me with nurses, and to make the experience real to our students and to myself.

STUDENTS' PERSPECTIVES ON ANN'S STORY

At the conclusion of the oncology nursing course, one assignment required students to choose a concept or example that enabled them to care more effectively for patients with cancer and other health-related conditions. Next, they applied the concept or example in their existing practices, and shared the results with their peers through an online discussion. Many students were influenced by Ann's Story and shared their experiences of taking the time to listen and being present with their patients. Ann's perspective of healing enabled her to share her story from both the nursing and patient viewpoints. Her goal of making something good come of her cancer diagnosis was met through student comments reflecting newfound wisdom in sharing thoughts, feelings, and compassion with patients rather than concentrating only on the completion of tasks. Here are examples of student comments.

Her story was so real to me just because she told it through her own eyes.

She allowed me to hear a patient's perspective and from the viewpoint of a nurse as well. It allowed me to be able to see past the cancer diagnosis.

I was able to apply this to my everyday nursing career by caring for my patients in a way I can see past their disease. I try to connect with each of my patients, even if it is just in a small way.

We get so busy trying to get our tasks done that sometimes we forget to show compassion to our patients in such simple ways as a smile, touch, or kind gesture.

Remembering that sometimes just slowing down and being present is what really has the biggest impact on our patients.

I cannot wait to watch the rest of her videos to see her story.

CONCLUSION

Britt (2015) suggests using creativity and imagination to design activities that meet course outcomes. The creation of Ann's Story evolved from a serendipitous moment—Ann was diagnosed with cancer, and her colleague was assigned to redesign a course about caring for patients with cancer. The time and effort needed to create the videos was minimal, yet the videos had an engaging and lasting effect on students, as shown by the discussions in the course and post-course evaluations. Britt (2015) shares that faculty do not require costly tools or resources to create engaging online learning experiences for students. The delivery of an online course offers opportunities for faculty to become creative and imaginative in bringing nursing practice to the online environment. The results of these creative efforts include engaging students by offering multiple ways for students to practice thinking using authentic learning activities in preparation for a complex health-care environment.

REFERENCES

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Disclosure

The authors have no relevant financial interest or affiliations with any commercial interests related to the subjects discussed within this article.

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