Drama as an Experiential Technique

8/9/2019 Drama as an Experiential Technique

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Teaching in Higher Education, Vol. 6, No. 1, 2001

Drama as an Experiential

Technique in Learning How toCope with Dying Patients and theirFamiliesPAT DEENY, ALPHY JOHNSON*, JENNIFER BOORE,CATHERINE LEYDEN & ELLIS McCAUGHAN

Centre for Nursing Research, University of Ulster, Coleraine, County Londonderry,BT52 1SA, and *School of Nursing and Midwifery, The Queens University of

Belfast, 13 College Park East, Belfast, BT7 1LQ, UK

ABSTRACT This paper discusses a teaching experiment in which participation and observation

of a drama helped rst year nursing students to consider ways of dealing with death and dying.

Workshops included dramatised scenarios of critical incidents demonstrating different peoples

experiences of the death of a ctional patient in hospital. Two nurse teachers performed a

two-part drama about the experiences of a patient just diagnosed with terminal cancer. Live

performances were presented to large groups of students and followed by small group discussions.

Drama as a teaching method was well received, and the combination of drama and group

discussion was considered very effective by students, who requested more similar sessions. Drama

appears highly satisfactory for achieving learning in the affective domain, and can be added to

teaching methods for improving communication skills and coping strategies with nursing

students who will be caring for the dying. However, further research is necessary.

Introduction and Literature Review

Caring for dying patients can be an emotionally painful, distressing, and sometimes

threatening experience for nurses and other health care professionals as the illness is

incurable and death imminent; nurses may feel powerless to help the patients

distress and suffering. Often this generates feelings of anger, guilt, fear and loss of

control (Mandel, 1981). Nurses may worry about what to say or do, and feel

ill-equipped to give the sympathy and support which patients and relatives need(Ferszt, 1984; Hurtig & Stewin, 1990; Servaty et al., 1996; OGorman, 1998). They

may feel anxious and this is strongly linked to fear of their own death (Popoff, 1975;

OGorman, 1998). Nurses may not have learnt to deal with their own feelings in

Correspondence: Mr P. Deeny, University of Ulster, Cromore Road, Coleraine, Co. Londonderry

BT52 1SA, UK. E-mail: PG.Deeny @ulst.ac.uk

ISSN 1356-2517 (print)/ISSN 1470-1294 (online)/01/010099-14 2001 Taylor & Francis LtdDOI: 10.1080/13562510020029635


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relation to death and dying, and may resort to coping strategies such as distancing

themselves emotionally and physically from their dying patients (Ross, 1978). These

problems can be avoided if nurses are helped to face their own personal concerns

with death and dying, and are taught ways to relate to dying patients and their

families. This should begin early in nurse education to promote personal awareness

of death-related fears so that anxieties can be dealt with before caring for thesepatients and their families.

Despite possible inner turmoil, nurses assume important roles with dying

patients in providing practical and emotional care (Haiseld-Wolfe, 1996). They are

also expected to provide support for patients families, helping to maintain

emotional well-being of all involved. This is only possible if nurses are educationally

prepared, and possess good interpersonal skills and personal coping strategies.

Nurse educators must nd teaching processes that stimulate learning in the affective

domain, that is, facilitating students understanding about emotional aspects of thesubject and the feelings and fears of all involved (Hurting & Stewin, 1990; Sawatzky,

1998).

Within the affective domain of learning Bloom (1955) described a hierarchy of

ve levels, in ascending order: receiving or attending, responding, valuing, organis-

ing (or conceptualising) and internalising. It is recognised as an area in which setting

and evaluating achievement of objectives is difcult (Mellish & Brink, 1990). Within

nursing education relatively little work has been undertaken which evaluates meth-

ods of enhancing learning within this domain, and none that assesses the intensity

and long-term stability of affective change in relation to death and dying. However,experiential learning methods are commonly recommended (Wise, 1974; Parkes,

1985; Lyons, 1988), and are reported as particularly valuable when teaching

interpersonal communication and human skills such as empathy and understanding,

as students are able to explore personal views and reactions (Ferszt, 1984; Burnard,

1985; Quinn, 1997).

Evaluation of Education Related to Death and Dying

Education about death and dying has been criticised as inadequate (Birch, 1983;

Whiteld, 1983) with nurses being prepared to give physical, but not psychological

or spiritual care (Doyle, 1982). Several authors (Birch, 1983; Hockley, 1989;

Frommelt, 1991) reported students and registered nurses criticism of their teaching

on the subject, and suggested that instruction was inadequate to prepare them for

the real situation. Mackay (1989) reported that death was a common fear of learners

entering nursing, but by their second ward experience initial apprehensions had

diminished, although students still found their early experiences trying. Where

education was adequate, there was still disparity between theory and practice (Field& Kitson, 1986; Johnson, 1994).

Stress is common when students anticipate situations concerning death or

suffering of a patient (Kieger, 1993; Rhead, 1995). Dealing with death and dying is

the second most frequently cited stressor among nurses of all levels (Lees & Ellis,

1990). In particular, seeing and handling a corpse, and the idea of losing a much


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Drama as an Experiential Technique 101

cared for patient were considered to be most distressful. Kieger (1994) reported that

at the commencement of training students expressed feelings of dread, uncertainty

and concern about the nature of the dying process, especially how it would affect

them. Much of this concern grew out of their relative inexperience with death and

fear of being unable to cope with emotional care, the pain of seeing suffering, shock

of seeing a dead body and difculty of dealing with bereaved relatives.This theme of personal inadequacy and fear of mistakes is frequently cited in

literature about stress in nursing students (McKay, 1978; Pagana, 1988; Lindrop,

1991; Sawatzky, 1998) and is not unique in caring for dying patients. Some studies

reported good and bad experiences with death where students reected upon and

discussed both satisfying and negative aspects of caring for a dying patient and their

relatives (Johnson, 1994; Kieger, 1994). Regardless of students preconceived ideas

about death, the learning through experience of caring for dying patients remained

a particular challenge.Kieger (1993) stressed the difference between knowing about and knowing.

Inevitably, there will be a disparity between the students expectations and their

experience since they cannot really know nursing until they have experienced it.

Despite perceived inadequacies about the care they deliver to the dying person and

family, many will form deep personal and emotional bonds with patients, and gain

satisfaction from providing high quality care (Melia, 1983; Kieger, 1994). How well

they then cope with death of the patient depends on numerous factors, including

personal coping resources (Sawatzky, 1998), previous experiences of death

(OGorman, 1998), support by colleagues (Mackay, 1989) and their educationalpreparation. Education which develops their emotional resources to deal with this

stressful experience will provide a foundation for continuing enhancement of the

necessary caring skills. Development of interactive abilities and knowledge about

dying must be preceded by dealing with fears and emotional needs about the

subject.

Experiential Learning about Death and Dying

In teaching about death and care of the dying patient, nurse educators must

challenge societal perceptions of death and dying, and facilitate nursing students in

developing a deeper insight into individual responses. Programmes that promote

affective learning, that is interpersonal awareness and empathy with others, are

fundamental (Burnard, 1996). A teaching method that increases students interest

and involvement, and helps them to see connections between abstract ideas and

concrete phenomena is needed.

Students learn from experiencing and participating, and learning is enhanced if

students can process their recent experience by reecting, describing, talking aboutand analysing what they have seen and done (National Society for Experiential

Education, 1997). The experiential learning cycle consists of four stages that actively

engage the participants to stimulate learning: experiencing, reecting, generalising

and applying. After a practical exercise, a skilled facilitator guides students through

a reective process which helps them improve their ability to learn and internalise


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102 P. Deeny et al.

knowledge. Reection used wisely in group or one-to-one discussions, can enliven

and sharpen the learning experience for students (Greenaway, 1999). Ideas, experi-

ences and feelings are discussed, and linked to abstract concepts so that theoretical

knowledge can be integrated with practical experience. Thoughts and insights are

transformed into generalisations, and then applied to real life situations in the

clinical area. The cycle begins again as students reect upon how well thesegeneralisations test in reality.

A range of methods can be used for experiential learning to help students get in

touch with their own feelings and fears about the subject, and provide opportunities

for discussion about death and reactions to it (Hurtig & Stewin, 1990). Lessons

learned can facilitate the transition to practical application in the clinical setting

(Wise, 1974). Role play can improve communication skills, and promote interaction

with patients and their families (Parkes, 1985), while role play, drama and small

group exercises can promote skill-building and self-learning (Lyons, 1988; Kalisch,1974). Wise (1974) and Lewis (1977) described positive results from simulation and

drama techniques.

Use of Drama as a Method for Teaching Death and Dying

Drama facilitates affective learning about death and dying because it provides

opportunities for self-exploration and personal reection (Ferszt, 1984), and enables

practice and development of effective interactional skills (Parathian & Taylor,

1993). Participation in drama, as an actor or viewer, can foster empathy: as actorsexpress characters innermost thoughts and feelings, so viewers gain a deeper

appreciation of how the patient and family may feel. This fosters creative thinking

in the following discussion, as students learn new ways of interacting with patients

and relatives (Kalisch, 1974). Drama can put students in touch with their feelings

about death (Lewis, 1977), promote interpersonal learning (Ferszt, 1984), increase

self-awareness, and assist in personal growth and development (Weil & McGill,

1989).

Fundamental to the value of this experience is the process of reection. Thiscan take place: within the drama; in class discussion following the drama; in written

work arising out of the drama; in compiling statements of insights achieved during

the drama to be shared with others; or in further reading and thinking (ONeill et al.,

1976). Through reection, individuals can arrive at personal understanding of

themselves or the world around them, and may be able to transfer learning to similar

situations or propose alternative actions.

Drama in education is a mode of experiential learning which involves students

in active participation through identication with imagined roles and situations

(ONeill & Lambert, 1984). It builds upon the knowledge, skills and experiencesthat students bring to the learning situation in order to enrich their knowledge of a

subject. The teacher engages in creating and sharing the process of learning with

students (ONeill et al., 1976). It raises awareness of facts and issues surrounding

the care of a dying patient. It is particularly benecial for dealing with emotive issues

such as death in a non-threatening way in which students rst experience this


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emotive topic in relation to the lives of ctional characters. Advocates suggest that

drama facilitates the education of the emotions by allowing students to develop

empathy with characters, mood, situation and content (OHara, 1984). The result-

ing learning helps students to order and control their emotions (Allen, 1975),

assisting them towards appropriate and creative forms of expression with patients

and relatives.Because drama in education is designed to help students connect with sensitive

and sometimes complicated human issues, and can expose students to new,

emotional, intensive, confusing or complex experiences, not all students will be

comfortable with this situation. Therefore, drama workshops need to be handled

with sensitivity and care, with experienced staff present to lead discussions and

debrieng sessions. Students may be anxious about feeling safe, especially in

relation to self-disclosure of emotions and feelings and the threat of ridicule from

other students (Burnard, 1996). When facilitating reective discussion, educatorsmust channel reection towards establishing facts and exploring, examining and

expressing feelings in a safe environment for students (Greenaway, 1999). While

expression of opinions is to be encouraged, ground rules must clearly state that

language used must be non-threatening and non-offensive to others. Staff need to be

alert for volatile areas especially when dealing with ethnic, racial and ethical issues

(Bontempo, 1995)

Research Problem

Research into the effectiveness of drama in learning has been undertaken in the

context of general education (Brossell, 1975) and the use of drama in nursing

education has been described (Hurst, 1993). However, there is little evidence of

attempts to evaluate the effectiveness of drama as a teaching method in nursing

education.

This study arose from evaluations by previous student groups who received

traditional lecture-and seminar-based teaching about death and dying. As in the

literature previously discussed, they reported difculty in coping with situations inthe ward and stated we need more. Thus, this study aimed to enhance student

understanding of this subject area, while also beginning to address the decit in

evaluation of drama as a teaching method in nursing education.

Research Methodology

Research Method

The aim of the dramatic intervention was to highlight the types and range ofemotional responses experienced by patients, families and professionals associated

with dying. Two acts of approximately 10 minutes each were presented (see Boxes

1 and 2). Both acts presented scenarios dealing with issues and feelings related to

open/closed awareness, power, ownership of information, patientprofessional rela-

tionships, touch and spirituality. Stage props were used to create atmosphere and


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Box 1. Act one

This act emphasises how nursing students may feel isolated within the ward team and bereft

of information, even though most of their day is spent giving direct patient care. Personal and

professional conicts in this situation are explored. Beginning with the patient being told not

that he has cancer, but a suspicious growth, act one shows the nursing student is in the middle

of a communication nightmare. The patient knows he has cancer, he also knows that the nursesknow he has cancer, the student knows, but no-one except the student is talking with the

patient. The student cannot disclose what he knows because of fear of being rebuked by the

Ward Sister. The student wants to support the patient, but is very clumsy in interaction, being

more evasive than helpful. Both student and patient are left feeling uncomfortable. In

particular, the patient was confused, bewildered and ultimately neglected.The nursing student

is lled with self-blame and guilt. The rst act points up the conict within the team. Failure

to recognise the learning needs of the student and the conspiracy of silence around cancer

diagnosis are presented. The handmaiden role of the nurse in relation to not giving

information unless instructed by the doctor or merely rephrasing the words of the doctor is

also explored.

Box 2. Act Two

The second act progresses to a stage when the nursing student has become a staff nurse. One

year after the diagnosis of cancer the patient returns to the ward to die. At the beginning of

Act Two, a powerful soliloquy by the patient reminds the audience of what it is like to have

a fatal diagnosis. Thepatient reminds us of the denial, despair, anger, depression and aggressiveoutbursts with the family. The nurse has established a close emotional bond with the patient

and nurse and patient relate to each others needs within a meaningful human relationship.

The intimacy that develops is emphasised. The family, in particular the wife, is unable to deal

with the death of her husband, refuses to visit and keeps the two children at home. The nurse

acts as intermediary conversing with the wife and the children by telephone. As the patient

draws near death the nurse lights a candle and prays. The patient dies. After a short silence

the nurse reects on the loss. The nurse then begins the bereavement process in a melancholic

way whilst listening some music which was a favourite of the patient. In an angry manner the

nurse then appeals to the audience (as nurses) to attend more closely to the needs of dying

people and those who care for them.

help the audience focus on elements with signicant meaning within the drama. A

short piece of music, a bed, bedside cabinet, a family photograph, a scented lighted

candle, a crucix and a bible were used to create the atmosphere around the

death-bed.

After the drama, students were divided into small groups, and asked to share

feelings and discuss issues raised. Teachers were available afterwards for one-to-onediscussion if needed. The effectiveness of this as an educational method to illumi-

nate the topic of death and dying was evaluated by using a questionnaire to obtain

student views, attitudes and opinions. Students were asked to complete the ques-

tionnaire 1 week later, having had time to assimilate learning and share feelings with

peers.


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Sample

The research sample was drawn from the total population of rst year nursing

students within Northern Ireland undertaking the Common Foundation Pro-

gramme of a Project 2000 Diploma or Degree. An important issue for consideration

was the religious mix of the sample as the scenarios presented included somereligious symbolism which could have different implications for those from Catholic

or Protestant backgrounds. Thus, it was decided to ensure that the ample ade-

quately represented students from both communities.

A cluster sampling technique was used: from a total of six nurse education

establishments within Northern Ireland, three were selected. Group A (n5 35) was

based within a predominantly Catholic and the other (Group B, n5 75) within a

mainly Protestant catchment area. These groups were used for the main study. The

third group (n5 25), which was used for the pilot study, had substantial numbers of

students from both communities. The ages of participants ranged from 19 to 30(mean 21) and most of the sample were female (91%).

The Questionnaire

The questionnaire (Table I) was developed from issues identied in the literature.

It consisted of 21 questions, comprising two items related to biographical details, 18

items which explored students opinions and feelings about the scripted drama, and

one open-ended question which allowed respondents to comment on the drama.Students were asked to rate their response to each of the 18 questions along a Visual

Analogue Scale, indicating their response by placing a mark through the point of the

line which best reected their perception (see Table I).

The Visual Analogue Scale provides interval-level data with ne discrimination

of values (Burns & Grove, 1987), and is particularly useful for scaling attitudes and

feelings (stimuli) as it discourages the respondent from always choosing the extremes

of a scale (Lodge, 1981). The scale is a line exactly 100 mm in length, with the

extremes of the response placed at each end of the line. Respondents are asked toplace a mark through the line to indicate the intensity of the stimulus. A ruler is then

used to measure the distance between the left end of the line and the mark placed

by the respondent, for example, if the mark is at 67 mm then this response is given

a score of 6.7.

The scripted drama and the questionnaire were piloted with a group of 25

nursing students not used in the main study. This enabled the actors to practice the

drama and identied errors in the questionnaire such as presentation, typographical

errors, overlapping response sets and ambiguity (Litwin, 1995). A few amendments

were made to clarify ambiguities.Content and face validity were established through scrutiny by a panel of nurse

educators and practitioners (Litwin, 1995). The questionnaire provided consistent

and accurate data, and tests of internal consistency were undertaken with the main

data set to determine the questionnaires reliability. Analysis demonstrated a high

internal consistency (Cronbachs a coefcient5 0.835).


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106 P. Deeny et al.

TABLE I. Questionnaire for evaluation of Drama for teaching about death and dying

Foreach question respondents were asked to insert a mark on that position on the line which reected

their response (as indicated).

Not at all A great deal u1. I enjoyed the drama as a method for teaching me about death and dying

2. The drama encouraged me to read the handout about death and dying

3. The drama helped me understand my own feelings about death and dying

4. The drama helped me understand how a patient might feel about death and dying

5. The drama helped me understand how a member of the family may feel

6. The drama helped me to understand how nurses might feel about caring for a dying patient

7. During the drama I felt emotional

8. I think the drama will help me prepare for the real situation

9. The drama dealt with death and dying in a sensitive way

10. The use of props and aids helped me to attend to the drama

11. I found the drama helped learning

12. The drama helped me identify the need for emotional support for nurses

13. I thought about the drama afterwards

14. The drama will help me to use touch to express feelings towards dying patients

15. The drama will help me talk with patients who are dying

16. The drama made me think about my own attitudes to death and dying

17. The drama raised more questions than provided answers

18. The drama showed me the need for peer support from fellow nursing students

19. Please comment on the drama

Results

Overall, results from this study demonstrate very positive feedback from students

regarding drama as a method of teaching students about death and dying (see

Figure 1) with scores ranging from 5 (i.e. half-way along the continuum from not at

all to a great deal) to 9 (90% of the way along that continuum). Results from Group

A (n5 35) (predominantly Catholic) and Group B (n5 75) (mainly Protestant)

were compared using t-tests and no signicant differences were noted in any of the

items. There were no age or gender differences in responses.

Eighty-four per cent of the students in Group A and 80% of those in group B

perceived that the drama helped them to learn about death and dying, and gain

insight into the patients perspective. Qualitative comments supported this:

The drama presented a life-like situation and it made me think about how

I would cope with someone who is dying and how I would communicate

with them.

It made me understand more as it was the actual patient who was talking

about his feelings and the family.

made me realise how a dying patient feels as they approach death. Since

they are in a strange hospital environment it makes it all the more

frightening and lonely. It is the nurse who must provide company.


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FIG. 1. Results from questionnaire on drama about death and dying.

I thought the drama was a very easy-to-follow and simple way to under-

stand death and bereavement.

Students also indicated that the drama helped to raise their awareness of the

emotional aspects of caring for dying patients, especially how patients, families and

nurses feel. Most of the qualitative comments referred to how they could identify

with patients and families much more after the drama.

I found it very useful because it got me into contact with my emotions/

feelings. It brought back memories of loved ones on their deathbed.

It provoked a lot of emotion and was very effective in raising issues

concerning death and terminal illness.

Very good, very emotional where a video or other approach would not getacross the same feelings.

Findings also indicate a heightened awareness of the need for support for nurses

(Group A 89%, Group B 90%). Qualitative comments such as:

I thought the drama was very powerful. It brought across how the nurse

feels in this situation. It prepared me for what is to come and gave me an

idea on how I might cope.

I found the drama very interesting, and it proved how difcult it can be forstudent nurses to discuss death with senior nurses and other members of

the team.

The drama clearly demonstrated the difference between the role of the

student and the staff nurse. It hit me how the student wasnt able to answer

the questions. This is how I feel sometimes.


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108 P. Deeny et al.

However some of the qualitative comments highlighted dissatisfaction with the

drama:

I felt that it was not realistic, it was a bit fake I thought.

It was good but afterwards I felt very unsure, I would still be insecure in

dealing with this situation.

I thought that the drama was good but I found it difcult to hear the

patient at times. I would have liked more emphasis on the family, perhaps

some actors doing the family would have helped.

I felt that the drama was too short in duration. The death was too quick.

A few students had difculty with the symbolic meaning behind various props used

in the drama. For example:

I thought that this was very Catholic, the crucix and all. They should have

been less provocative.

We do not have candles at the death. I think that this was too Roman

Catholic.

These last two comments came from the predominantly Protestant students (group

B). Interestingly, issues related to the religious symbolism did not arise as a problem

within the pilot study with the mixed religious group.

Discussion

Learning about Dying

The ndings in this study support the use of drama as an experiential method in

teaching nursing students about death and dying. As intended, the drama caused an

emotional response in students and enabled them to reect on how they might feel

and cope in the real situation, similar to the ndings of Hurtig & Stewin (1990).Drama taking place in a group setting results in participants sharing their experi-

ences with others, and discovering that they all feel and respond in similar ways.

This engenders feelings of support and afrmation from colleagues identied by

Mackay (1989) as one of the factors which inuence the ability to cope with the

death of a patient.

The evidence from the questionnaires suggest that the drama and discussion

resulted in affective learning as the students perceived it as being benecial in

understanding how others feel. However, whether it will enable students to respond

in a more empathetic manner to dying patients in their clinical placements can onlybe evaluated by undertaking a follow-up study with the same students. Some

informal feedback from these students at a later date has indicated that it did help

them in practice through enhancing their understanding of how the patient, family

and nurses might feel.

Educational preparation to care for dying patients and their families needs to be


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combined with supportive clinical experiences. Johnson (1994) highlighted that

students considered that only some aspects of death and dying can be taught in

college. Other aspects, such as how they will feel when faced with the situation of

caring for dying patients and development of coping strategies, can only be devel-

oped fully within a supportive clinical environment and this was reinforced by

student feedback. However, the approach discussed in this paper may help to bridgethe gap between academic and clinical settings, particularly when followed by

experience with effective clinical role models, and the opportunity to reect on

practice with nursing colleagues and/or academic tutors.

The affective domain within Blooms Taxonomy (1956) is a difcult area in

which to evaluate the effectiveness of learning opportunities provided. Within this

example, it was clear from the students responses to the questionnaire that learning

at the rst two levels (receiving or attending, and responding) was achieved. The fact

that over 80% of students responded positively to the statement that the drama mademe think about my own attitudes to death and dying indicates that it is likely that many

also achieved the third level (valuing). The discussion following the drama was

intended to facilitate them in reaching towards the fourth level in which they would

be able to conceptualise their knowledge and experiences. However, at this stage in

their programme, this penultimate stage and the nal level, in which they will

internalise their new understanding, are unlikely to have been achieved. It is

predicted that relevant experience in practice with appropriate support, as described

by Mackay (1989), will build on this initial introduction to enable achievement at all

levels in this hierarchy.

Limitations and Difculties of Educational Method

There are some issues related to the method and the rigour of the research that merit

discussion. This study used a relatively weak experimental design with an interven-

tion or independent variable (the drama and discussion) followed by measurement

of the dependent variable (students attitudes and opinions) 1 week later. It wouldhave been improved by some measurement of these before the intervention. Simi-

larly, the study would have been enhanced by including a comparison group who

received a more conventional educational input on death and dying. This would

have eliminated the possible inuence of the Hawthorne effect in increasing the

positive results obtained. Nevertheless, the students own evaluation of their learning

through this activity cannot be discounted.

Students in this study were asked to complete the questionnaire 1 week after the

drama. The rationale for this approach was that they required time to assimilate the

knowledge and emotional experience and discuss the experience with their peers. Italso means, however, that there is a possibility of diffusion of ideas and positive

perceptions of the drama that may bias the evaluation, and (with the Hawthorne

effect) explain the overly positive response. The two groups in the study had no

contact with each other and the similarity in responses reinforces the reliability of the

ndings. To elucidate students views, attitudes and opinions a self-report question-


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110 P. Deeny et al.

naire was the only feasible method, but does not assess the inuence on their

professional practice of the learning they have achieved.

Respondents comments that props used during the drama, such as a crucix

and lighted candle, were too Roman Catholic were made within Northern Ireland,

a divided society with many having strong afliations to either the Protestant or the

Catholic community. These comments, not surprisingly, were mainly from thepredominantly Protestant group. Nurse educators responses to these type of state-

ments need to be carefully considered. On one hand, it is easy to be critical of some

individuals unwillingness to appreciate cultures other than their own. Conversely,

it also highlights the need for educators to avoid ethnocentrism and offence

(Bontempo, 1995).

However, symbols and rituals of death and mourning are an important part of

the process of grieving for families (OGorman, 1998). Presentation of such symbols

to students in the context of teaching about death and dying is crucial if they are toreect on how they might deal with these in a respectful manner within the patient

care situation. The issue that this study raised is how do nurse educators, knowing

that such prejudicial perceptions may exist in groups of nursing students, incorpor-

ate these into their teaching without causing offence. In this situation the issue was

not foreseen, but in the future when such symbols are introduced in any form of

teaching they should reect the diversity within the particular society and should not

cause offence to any. When using drama, educators need to carefully consider

students ethnic and cultural backgrounds, and endeavour to integrate a diversity of

traditions and there should be open discussion on the topic. Indeed, the introduc-tion of such symbols could act as a catalyst for reective discussion on prejudicial

perceptions and attitudes.

Potential Value of Drama in Professional Education

The use of drama as a teaching method was well received, and the combination of

drama and group discussion was considered very effective by the students. Drama

was found a highly satisfactory method for enabling nursing students to reect ontheir understanding of the emotional aspects of death and dying in hospital. This

method has considerably wider application than nursing education. Many health

professionals have to confront similar situations and this method of introducing the

topic and enabling students to begin to consider possible coping strategies could be

used with all such groups. If undertaken within multi-professional groups, it would

have the additional advantage of enhancing inter-professional understanding and

thus enhancing patient care.

In addition to the topic of death and dying, there are many other difcult

situations which health and social care professionals encounter. Drama is a viablemethod of enabling students to begin to think about and come to terms with such

issues, and could be used much more widely to provide opportunities for students

to practice the affective skills needed.

While this study was carried out in Northern Ireland, considerations similar to

those discussed above would apply in other situations where different cultures meet,


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including many other parts of the United Kingdom. Use of this teaching method

would enhance students abilities in working empathetically with patients from

cultures other than their own.

Acknowledgements

The authors gratefully acknowledge the National Board For Nursing, Midwifery and

Health Visiting for Northern Ireland for second-line research funding related to this

project.

REFERENCES

ALLEN, J. (1975) Notes on a denition of drama, in: J. HODGSON & M. BANHAM (Eds) Drama in

Education 3 (London, Pitman).

BIRCH, J. (1983) Anxiety and conict in nurse education, in: B. DAVIS (Ed.) Research in Nurse

Education (London, Croom Helm).

BLOOM, B.S. (1956) Taxonomy of Educational Objectives (New York, McKay).

BONTEMPO, B. (1995) Exploring Prejudice in Young Adult Literature through Drama and Role Play.

http://scholar.lib.vt.edu/ejournals/ALAN/spring95/Bontempo.html

BROSSELL, G. (1975) Researching drama: a humanistic perspective, in: N. STEPHENSON & D.

VINCENT (Eds) Teaching and Understanding Drama (London, National Foundation for

Educational Research).

BURNARD, P. (1985) Learning Human Skills (Oxford, Heinemann).

BURNARD, P. (1996) Acquiring Interpersonal Skills: a handbook of experiential learning for health

professionals, 2nd edn (London, Chapman and Hall).

BURNS, N. & GROVE, S. (1987) The Practice of Nursing Research: conduct, critique and utilization

(Philadelphia, PA, W.B. Saunders).

DOYLE, D. (1982) Nursing education in terminal care, Nurse Education Today, 2, pp. 46.

FERSZT, G. (1984) Drama as an educational tool, Oncology Nursing Forum, 11, pp. 6466.

FIELD, D . & K ITSON, C. (1986) Formal teaching about death and dying in United Kingdom

nursing schools, Nurse Education Today, 6, pp. 270276.

FROMMELT, K. (1991) The effect of death education on nurses attitudes towards caring for

terminally ill persons and their families, American Journal of Hospice and Palliative Care, 8(5),

pp. 3743.

GREENAWAY, R. (1999) Reviewing Skills Training. Reviewing and Debriefing: what, why and how?http://www.user.globalnet.co.uk/ , rogg/review.htm

HAISFIELD-WOLFFE, M. (1996) Cancer nursing perspectives. End-of-life care: evolution of the

nurses role, Oncology Nursing Forum, 23, pp. 931935.

HOCKLEY, J. (1989) Caring for the dying in acute hospitals, Nursing Times, 85(39), pp. 4750.

HURST, B. (1993) Drama class, Nursing Times, 89(1), pp. 3031.

HURTIG, W . & STEWIN, L. (1990) The effect of death education and experience on nursing

students attitude towards death, Journal of Advanced Nursing, 15, pp. 2934.

JOHNSON, G. (1994) The phenomenon of death: a study of Diploma in Higher Education nursing

students reality, Journal of Advanced Nursing, 19, pp. 11511161.

KALISCH, B. (1974) Summer theatre: another way to learn, Nursing Outlook, 22, pp. 3134.KIEGER, A. (1993) Accord and discord in students images of nursing, Journal of Nursing

Education, 32, pp. 309317.

KIEGER, A. (1994) Student nurses involvement with death: the image and the experience, Journal

of Advanced Nursing, 20, pp. 679686.

LEES, S. & ELLIS, N. (1990) The design of a stress-management programme for nursing

personnel, Journal of Advanced Nursing, 15, pp. 946961.


14/14

112 P. Deeny et al.

LEWIS, F. (1977) A time to live and a time to die: an instructional drama, Nursing Outlook, 25,

pp. 762765.

LINDROP, E. (1991) Individual stress among nurses in training: why some leave while others stay,

Nurse Education Today, 11, pp. 172179.

LITWIN, M. (1995) The Survey Kit, Volume 7: how to measure survey reliability and validity

(Thousand Oaks, CA, Sage Publications).

LODGE, M. (1981) Magnitude Scaling: quantitative measures of opinions (Beverly Hills, CA, SagePublications).

LYONS, G. (1988) Bereavement and death education: a survey of nurses views, Nurse Education

Today, 8, pp. 168172.

MACKAY, L. (1989) Nursing a Problem (Buckingham, Open University Press).

MCKAY, S. (1978) A review of student stress in nursing education programmes, Nursing Forum,

17, pp. 376379.

MANDEL, H. (1981) Nurses feelings about working with death and dying, American Journal of

Nursing, 81, pp. 11941197.

MELIA, K. (1983) Students views of nursing. Nursing in the dark students are often left short

of information, Nursing Times, 79(21), pp 6263.MELLISH, J.M. & BRINK, H. (1990) Teaching the Practice of Nursing: a text in nursing didactics, 3rd

edn (Durban, Butterworths)

NATIONAL SOCIETY FOR EXPERIENTIAL EDUCATION (1997) Foundations of Experiential Education.

http://www.nsee.org/round.htm

OGORMAN, S. (1998) Death and dying in contemporary society: an evaluation of current

attitudes and the rituals associated with death and dying and their relevance to recent

understandings of health and healing, Journal of Advanced Nursing, 27, pp. 11271135.

OHARA, M. (1984) Drama in education: a curriculum dilemma, Theory into Practice, XX111(4),

pp. 315320.

ONEILL, C. & LAMBERT, A. (1984) Drama Structures: a practical handbook for teachers (London,

Heinemann).ONEILL, C., LAMBERT, A., LINNELL, R. & WARR-WOOD, J. (1976) Drama Guidelines (London,

Heinemann).

PAGANA, K. (1988) Stresses and threats reported by baccalaureate students in relation to initial

clinical experience, Journal of Nursing Education, 27, pp. 418424.

PARATHIAN, A. & TAYLOR, F. (1993) Can we insulate students from exposure to bad practice? A

study of role play in communicating bad news to patients, Journal of Advanced Nursing, 18,

pp. 801807.

PARKES, K. (1985) Stressful episodes reported by rst-year student nurses: a descriptive account,

Social Science and Medicine, 20, pp. 945953.

POPOFF, D. (1975) What are your feelings about death and dying? Nursing 75, 5, pp. 1624.QUINN, F. (1997) The Principle and Practice of Nurse Education, 3rd edn (London, Chapman and

Hall).

RHEAD, M. (1995) Stress among student nurses: is it practical or academic? Journal of Clinical

Nursing, 4, pp. 369376.

ROSS, C. (1978) Nurses personal death concerns and responses to dying patient statements,

Nursing Research, 27, pp. 6468.

SAWATZKY, J. (1998) Understanding nursing students stress: a proposed framework, Nurse

Education Today, 18, pp. 108115.

SERVATY, H., KREJCI, M. & HAYSLIP, B. (1996) Relationships among death anxiety, communi-

cation apprehension with the dying, and empathy in those seeking occupations as nurses

and physicians, Death Studies, 20, pp. 149161.

WEIL, S. & MCGILL, I. (Eds) (1989) Making Sense of Experiential Learning (Buckingham, Open

University Press).

WHITFIELD, S. (1983) A descriptive study of student nurses ward experiences with dying patients

and their attitudes towards them, in: C. COX (Ed.) Sociology: an introduction for nurses,

midwives and health visitors (London, Butterworth).

WISE, D. (1974) Learning about dying, Nursing Outlook, 22, pp. 4244.

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Drama as an Experiential Technique