Patient Education and Counseling 97 (2014) 432–433
Contents lists available at ScienceDirect
Patient Education and Counseling journal homepage: www.elsevier.com/locate/pateducou
Reflective Practice
‘‘I feel like you get it’’: When a classroom assignment makes a difference to a wounded warrior’s wife§ Libba Reed McMillan * Auburn University School of Nursing, Auburn University, USA
A R T I C L E I N F O
Article history: Received 18 November 2013 Received in revised form 2 July 2014 Accepted 10 August 2014 Keywords: Reflective nursing practice Health care professional education Veteran care Health promotion strategy
Once again, the first semester nursing students piled into the auditorium awaiting an orientation to the course requirements of my junior-level Professional Concepts class. My class is a tough sell as the content is rarely considered as ‘‘sexy’’ as the critical care elective, skills laboratory, or the medical–surgical course that teaches ‘‘real’’ nursing concepts, such as starting intravenous lines or learning about arterial blood gases. Having taught nursing for the past 6 years, I have strived to evolve as an educator and ensure content and assignments are relevant to the issues on the forefront of nursing practice today. I have noticed junior-level students think they understand vital concepts, perceive they have adequately reflected on their personal and professional realities, and view many aspects as common sense until faced with real life situations in clinical rotations. Some students have great expectations of touching lives while in their clinical rotations, but rarely look with equal expectancy upon a classroom assignment. Many educators may be familiar with the parable of the starfish, meant as an exemplar of ‘‘making a difference’’ in the lives of others. While this parable has meaning for each of us in our everyday lives, I believe it has far reaching impact for us as health care providers and health profession educators. The story (author unknown) is as follows: While walking along a beach, an elderly gentleman saw someone in the distance bending down, picking something
§ For more information on the Reflective Practice section please see: Hatem D, Rider EA. Sharing stories: narrative medicine in an evidence-based world. Patient Education and Counseling 2004;54:251–253. * Tel.: +1 334 844 5973; fax: +1 334 844 5654. E-mail address: [email protected]
http://dx.doi.org/10.1016/j.pec.2014.08.009 0738-3991/ß 2014 Elsevier Ireland Ltd. All rights reserved.
up and throwing it into the ocean. As he got closer, he noticed that the figure was that of a young man, picking up starfish one by one and tossing each one gently back into the water. He came closer still and called out, ‘‘May I ask what it is that you are doing?’’ The young man paused, looked up, and replied ‘‘Throwing starfish into the ocean.’’ The old man smiled, and said, ‘‘I must ask, then, why are you throwing starfish into the ocean?’’ To this, the young man replied, ‘‘The sun is up and the tide is going out. If I don’t throw them in, they’ll die.’’ Upon hearing this, the elderly observer commented, ‘‘But, young man, do you not realize that there are miles and miles of beach and there are starfish all along every mile? You can’t possibly make a difference!’’ The young man listened politely. Then he bent down, picked up another starfish, threw it back into the ocean past the breaking waves and said, ‘‘It made a difference for that one.’’ As educators, how do we know if we make a difference with assignments or if we move students toward an appreciation for improving their communication ability with patients? One assignment that has had the greatest metamorphosis over the past 6 years is a professional poster assignment. This assignment is designed to facilitate learning in junior baccalaureate nursing student’s core principles of using tailored messages for health promotion in a college setting. Nursing students learn how to effectively communicate through development of a professional poster and experience having their creative efforts recognized and utilized campus-wide. Ironically, the assignment is designed to help nurses communicate with patients, but students in the past never experienced an opportunity to talk face to face with those patients and families for whom they will provide care. In essence, there was information exchange, but no shared dialog with patients and families about the inherent emotionality of living with altered health. In the past year, I chose the topic of health issues affecting military veterans, such as post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), substance abuse, and suicide. For many students, there has been a lack of training and exposure to the unique emotional and physical needs of these veterans. As a nursing educator in a state that has a high percentage of military veterans returning from war into their communities, I am particularly challenged to address the relevance of the topic of delivering nursing care to military members and their significant
L.R. McMillan / Patient Education and Counseling 97 (2014) 432–433
others. Additionally, many nursing students are not fully aware of the health issues affecting veterans and likewise are not wellversed on the dramatic and positive impact they can have on the long-term health of hundreds of thousands of veterans. This theme of making a difference resonates with the generation of students I teach, though the concepts are oftentimes difficult for students to capture when linked with a theory assignment. I thought a lot about students’ reaction and receptivity to these topics and I hoped that they would experience the phenomenon of knowing they were making a difference with these posters. While I could not guarantee student interest, I was absolutely astounded at the quality of their work and sensitivity to honoring our veterans. The posters were of such quality that a campus veteran support center displayed them during the opening ceremonies and spotlighted the student work on the campus website available worldwide. At the end of the ceremony, a wounded warrior’s wife walked up to a few of my students and expressed an interest in the poster topics. She had clearly waited until the crowd of students thinned, leaving the student creator of the PTSD poster remaining. With tears in her eyes she stated that the posters ‘‘got it’’ and struck a chord with her, as it described her husband’s struggle with PTSD. She stated that she was emotionally moved that we chose to address a topic that was rarely publicly acknowledged in a non-military community. She shared her story of being a military spouse and having suffered such loss with her husband’s condition since returning from war. She elaborated on how different his behavior and personality had become since returning from war, and how distant he seemed at times. She said the posters, through their authenticity, gave her comfort in being ‘‘heard.’’ In essence, she was not alone, imagining things, or losing her mind. These nursing students
433
were honored that they reached their target audience, realizing an assignment could have an impact far beyond the numerical grade attached to it. In short, the students saw how real people with real concerns were affected by the shared dialog. Those posters continued to gain notoriety in the campus community and were invited to tour in the Atlanta area at veteran facilities. As impressive as that has been, the greatest impact has been witnessing the change the students felt in moving past viewing nursing school activities as mere assignments and reflecting on the impact nursing has on individuals in a community. As a nursing educator, there have been countless times I have stressed the importance of the process of reflection to student learning and how reflection aids in understanding the perspective of those in our nursing care. Through this assignment, I reflected on the wounded warrior’s wife; how isolated she must have felt and her need for shared dialog and understanding from her community. In particular, she needed and deserved this shared dialog with students in the healthcare professional community. I have been deeply affected, as a person and as a nurse educator, having a role in a process where shared understanding occurred in the form of real communication. I am challenged to develop assignments capable of making a difference in patient and family member’s lives; delivering a usable deliverable (such as a health promotion poster or a screening service) to a targeted community. I have abandoned needlessly striving to make my course as interesting or as ‘‘well liked’’ as others. I realize that there is great educational value that occurs with a few students and not always as a collective group; hence the starfish analogy. I see the beauty and importance of making a difference in actual lives and hearts through assignments seeded in promoting health of those in a community, one person at a time. I feel like ‘‘I get it’’ too.
Contents lists available at ScienceDirect
Patient Education and Counseling journal homepage: www.elsevier.com/locate/pateducou
Reflective Practice
‘‘I feel like you get it’’: When a classroom assignment makes a difference to a wounded warrior’s wife§ Libba Reed McMillan * Auburn University School of Nursing, Auburn University, USA
A R T I C L E I N F O
Article history: Received 18 November 2013 Received in revised form 2 July 2014 Accepted 10 August 2014 Keywords: Reflective nursing practice Health care professional education Veteran care Health promotion strategy
Once again, the first semester nursing students piled into the auditorium awaiting an orientation to the course requirements of my junior-level Professional Concepts class. My class is a tough sell as the content is rarely considered as ‘‘sexy’’ as the critical care elective, skills laboratory, or the medical–surgical course that teaches ‘‘real’’ nursing concepts, such as starting intravenous lines or learning about arterial blood gases. Having taught nursing for the past 6 years, I have strived to evolve as an educator and ensure content and assignments are relevant to the issues on the forefront of nursing practice today. I have noticed junior-level students think they understand vital concepts, perceive they have adequately reflected on their personal and professional realities, and view many aspects as common sense until faced with real life situations in clinical rotations. Some students have great expectations of touching lives while in their clinical rotations, but rarely look with equal expectancy upon a classroom assignment. Many educators may be familiar with the parable of the starfish, meant as an exemplar of ‘‘making a difference’’ in the lives of others. While this parable has meaning for each of us in our everyday lives, I believe it has far reaching impact for us as health care providers and health profession educators. The story (author unknown) is as follows: While walking along a beach, an elderly gentleman saw someone in the distance bending down, picking something
§ For more information on the Reflective Practice section please see: Hatem D, Rider EA. Sharing stories: narrative medicine in an evidence-based world. Patient Education and Counseling 2004;54:251–253. * Tel.: +1 334 844 5973; fax: +1 334 844 5654. E-mail address: [email protected]
http://dx.doi.org/10.1016/j.pec.2014.08.009 0738-3991/ß 2014 Elsevier Ireland Ltd. All rights reserved.
up and throwing it into the ocean. As he got closer, he noticed that the figure was that of a young man, picking up starfish one by one and tossing each one gently back into the water. He came closer still and called out, ‘‘May I ask what it is that you are doing?’’ The young man paused, looked up, and replied ‘‘Throwing starfish into the ocean.’’ The old man smiled, and said, ‘‘I must ask, then, why are you throwing starfish into the ocean?’’ To this, the young man replied, ‘‘The sun is up and the tide is going out. If I don’t throw them in, they’ll die.’’ Upon hearing this, the elderly observer commented, ‘‘But, young man, do you not realize that there are miles and miles of beach and there are starfish all along every mile? You can’t possibly make a difference!’’ The young man listened politely. Then he bent down, picked up another starfish, threw it back into the ocean past the breaking waves and said, ‘‘It made a difference for that one.’’ As educators, how do we know if we make a difference with assignments or if we move students toward an appreciation for improving their communication ability with patients? One assignment that has had the greatest metamorphosis over the past 6 years is a professional poster assignment. This assignment is designed to facilitate learning in junior baccalaureate nursing student’s core principles of using tailored messages for health promotion in a college setting. Nursing students learn how to effectively communicate through development of a professional poster and experience having their creative efforts recognized and utilized campus-wide. Ironically, the assignment is designed to help nurses communicate with patients, but students in the past never experienced an opportunity to talk face to face with those patients and families for whom they will provide care. In essence, there was information exchange, but no shared dialog with patients and families about the inherent emotionality of living with altered health. In the past year, I chose the topic of health issues affecting military veterans, such as post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), substance abuse, and suicide. For many students, there has been a lack of training and exposure to the unique emotional and physical needs of these veterans. As a nursing educator in a state that has a high percentage of military veterans returning from war into their communities, I am particularly challenged to address the relevance of the topic of delivering nursing care to military members and their significant
L.R. McMillan / Patient Education and Counseling 97 (2014) 432–433
others. Additionally, many nursing students are not fully aware of the health issues affecting veterans and likewise are not wellversed on the dramatic and positive impact they can have on the long-term health of hundreds of thousands of veterans. This theme of making a difference resonates with the generation of students I teach, though the concepts are oftentimes difficult for students to capture when linked with a theory assignment. I thought a lot about students’ reaction and receptivity to these topics and I hoped that they would experience the phenomenon of knowing they were making a difference with these posters. While I could not guarantee student interest, I was absolutely astounded at the quality of their work and sensitivity to honoring our veterans. The posters were of such quality that a campus veteran support center displayed them during the opening ceremonies and spotlighted the student work on the campus website available worldwide. At the end of the ceremony, a wounded warrior’s wife walked up to a few of my students and expressed an interest in the poster topics. She had clearly waited until the crowd of students thinned, leaving the student creator of the PTSD poster remaining. With tears in her eyes she stated that the posters ‘‘got it’’ and struck a chord with her, as it described her husband’s struggle with PTSD. She stated that she was emotionally moved that we chose to address a topic that was rarely publicly acknowledged in a non-military community. She shared her story of being a military spouse and having suffered such loss with her husband’s condition since returning from war. She elaborated on how different his behavior and personality had become since returning from war, and how distant he seemed at times. She said the posters, through their authenticity, gave her comfort in being ‘‘heard.’’ In essence, she was not alone, imagining things, or losing her mind. These nursing students
433
were honored that they reached their target audience, realizing an assignment could have an impact far beyond the numerical grade attached to it. In short, the students saw how real people with real concerns were affected by the shared dialog. Those posters continued to gain notoriety in the campus community and were invited to tour in the Atlanta area at veteran facilities. As impressive as that has been, the greatest impact has been witnessing the change the students felt in moving past viewing nursing school activities as mere assignments and reflecting on the impact nursing has on individuals in a community. As a nursing educator, there have been countless times I have stressed the importance of the process of reflection to student learning and how reflection aids in understanding the perspective of those in our nursing care. Through this assignment, I reflected on the wounded warrior’s wife; how isolated she must have felt and her need for shared dialog and understanding from her community. In particular, she needed and deserved this shared dialog with students in the healthcare professional community. I have been deeply affected, as a person and as a nurse educator, having a role in a process where shared understanding occurred in the form of real communication. I am challenged to develop assignments capable of making a difference in patient and family member’s lives; delivering a usable deliverable (such as a health promotion poster or a screening service) to a targeted community. I have abandoned needlessly striving to make my course as interesting or as ‘‘well liked’’ as others. I realize that there is great educational value that occurs with a few students and not always as a collective group; hence the starfish analogy. I see the beauty and importance of making a difference in actual lives and hearts through assignments seeded in promoting health of those in a community, one person at a time. I feel like ‘‘I get it’’ too.
