Accepted Manuscript

Historical imagination, narrative learning and nursing practice: Graduate nursingstudents’ reader-responses to a nurse’s storytelling from the past

Pamela J. Wood , PhD, RN, Associate Professor

PII: S1471-5953(14)00050-X

DOI: 10.1016/j.nepr.2014.05.001

Reference: YNEPR 1871

To appear in: Nurse Education in Practice

Received Date: 26 July 2013

Revised Date: 13 January 2014

Accepted Date: 4 May 2014

Please cite this article as: Wood, P.J, Historical imagination, narrative learning and nursing practice:Graduate nursing students’ reader-responses to a nurse’s storytelling from the past, Nurse Education inPractice (2014), doi: 10.1016/j.nepr.2014.05.001.

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NEP-D-13-00155 Title Page

Title:

HISTORICAL IMAGINATION, NARRATIVE LEARNING AND NURSING PRACTICE: GRADUATE NURSING STUDENTS’ READER-RESPONSES TO A NURSE’S STORYTELLING FROM THE PAST

Word count:

5075

Author’s name & affiliation:

Pamela J Wood, PhD, RN

Associate Professor, School of Nursing & Midwifery, Federation University Australia

Contact details:

School of Nursing & Midwifery

Federation University Australia

Gippsland Campus

Northways Rd

Churchill

VIC 3842

Australia

Ph: +61-3-5122-6670

Email: Pamela.wood@federation.edu.au

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Historical imagination, narrative learning and nursing practice: Graduate nursing

students’ reader-responses to a nurse’s storytelling from the past

ABSTRACT

Storytelling and narrative are widely used in nurse education and the value of narrative-

based curricula, such as those governed by narrative pedagogy, is well recognised.

Storytelling stimulates students’ imagination, a central feature of narrative learning. One

form of story and imagination yet to be fully considered by educators is the historical

story and historical imagination. The use of historical storytelling creates a temporal

dissonance between the story and reader that stimulates readers’ imagination and

response, and enables them to gain rich insights which can be applied to the present.

Reader-response theory can support educators when using narrative and storytelling. This

article presents an analysis of graduate nursing students’ reader-responses to a nurse’s

story from the past. This narrative learning group used their historical imagination in

responding to the story and prompted and challenged each other in their interpretation

and in translating their responses to their current nursing practice. The article discusses

this analysis within the context of reader-response theory and its potential application to

narrative-based learning in nurse education. Historical stories stimulate historical

imagination and offer a different frame of reference for students’ development of textual

competence and for applying insights to the present.

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KEYWORDS

Narrative learning, reader-response theory, storytelling, history of nursing, nurse

education

Nursing is steeped in stories. The use of narrative and storytelling is embedded in nurse

education, and the value of narrative-based curricula is evident in undergraduate and

graduate programs (e.g., Crookes et al 2013, Diekelmann 2001, Ironside 2006, Koenig &

Zorn 2002, Swenson & Sims 2000). Responding to stories requires imagination and this

is central to narrative learning (Koenig & Zorn 2002, Swenson & Sims 2000). Educators

have taken different approaches to narrative learning but the influence of reader-response

theory in this has received limited attention (Sakalys 2002). As students respond

imaginatively to stories, educators can support them in developing textual competence in

interpreting their meaning (Ironside 2006, Koenig & Zorn 2002, Sakalys 2002) and

applying this to practice. While nurse educators have therefore considered the role of

narrative, storytelling and imagination in nurse education, one form of these yet to be

explored is the historical story and historical imagination. The aim of this study was to

examine one example of engaging students’ historical imagination, in order to identify its

relation to narrative learning approaches in nurse education and potential for stimulating

discussion of nursing practice. This article therefore addresses imagination and

particularly reader-response theory in narrative learning in nurse education, explains

historical imagination, and describes graduate nursing students’ reader-responses to a

nurse’s story from the past to illustrate how narrative learning can extend to practice.

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BACKGROUND

Imagination

The key form of imagination in nursing practice is empathy, the ability to see situations

from the patient’s perspective. Empathy, or ‘imaginative identification’ (Scott 1995,

p.1196), is crucial for ‘constructive caring’ in nursing practice, but it must be an

‘informed imagination’ (p.1199). Strengthening students’ imaginative capacity is

therefore a key issue in nurse education. Educators have guided the development of

students’ imagination by using storytelling as an approach to teaching and learning

(Koenig & Zorn 2002, Swenson & Sims 2000). Narrative learning is a significant way to

strengthen students’ imagination and empathy, and therefore their capacity to nurse

effectively.

Narrative learning and reader-response theory

Narrative learning has been applied in a variety of ways within nursing and medical

education (Crookes et al 2013, Dieklemann 2001, Ironside 2006, Koenig & Zorn 2002,

Swenson & Sims 2000, Weisberg & Duffin 1995). Narrative pedagogy, as one form of

narrative learning, stresses the centrality of communal thinking and dialogue to interpret

practice narratives and experiences from multiple perspectives in order to discover new

meanings and understandings (Ironside 2006). The educator functions as a guiding

partner (Swenson & Sims 2000). Another version of narrative learning is literary

pedagogy, where fictional accounts of people’s experiences with illness, for example,

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enrich students’ understanding of the human condition (Sakalys 2002). The goal in

literary pedagogy is developing textual competence, with its interrelated skills of reading,

interpretation and criticism. This changes the focus of students’ reading strategies from

locating information in texts, to ‘taking authority for their own learning by reading

reflectively, observing both their own reactions and the questions the work evokes, and

by actively creating meaning’ (p.387).

Sakalys’s (2002) explanation of four theoretical approaches to literary pedagogy includes

reader-response theory. This theory challenges the author’s role as the sole source of the

text’s meaning and brings the reader to the fore. Although most forms of narrative

learning emphasise the interpretive theoretical underpinnings of hermeneutics and

phenomenology (e.g., Ironside 2006, Swenson & Sims 2000), narrative learning based on

reader-response theory focuses more on the reader’s action in responding to the story and

the way this response is drawn from a particular social, aesthetic, interpretive context.

Just as the story’s writer draws on an aesthetic context – a store of tradition and literary

allusions – in relating the story, so too does the reader in responding to it. In the narrative

learning group or ‘interpretive community’, shared frames of reference will inform the

individuals’ and group’s responses (Chase & Hynd 1987, p.531). As Sakalys (2002)

noted for literary pedagogy in nurse education, it is the nursing profession’s ‘value base,

its theoretical heritage, and its practice wisdom’ that forms this social background. ‘It is

from this community base, formed by professional socialization, nursing’s world views,

and the social, political, and cultural stances of the profession, that the process of

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criticism occurs. In turn, this criticism has the potential to create shared knowledge and

meanings that can inform professional nursing practice’ (p.391).

Whatever form of narrative learning is used, engaging with stories means ‘participating

imaginatively in other lives’ (Weisberg & Duffin 1995, p.249). In this way, narrative

learning strengthens students’ capacity for imagination. One form of imagination that can

be developed is historical imagination.

Historical imagination

Broadly, historical imagination is the ‘creative capacity to envisage possibilities of

engaging with the past’ (Wood 2010, p.55). It is envisioning how a sense of its value can

be expressed and harnessed – in this case, in narrative learning. More specifically,

students can engage their historical imagination by reflecting on nurses’ stories or

narratives from the past, to identify things of value or cautionary tales to bring into the

present, and to consider how these might be translated into their current nursing practice.

Tosh (2012) has noted that we respond to an encounter with the past with a sense of both

familiarity and difference. Points of familiarity and difference can help us recognise what

is enduring over time and what is transient. Tosh’s view of the purpose and value of

history and how we respond to the past forms the historical theoretical framing for the

use of nurses’ stories from the past in narrative learning.

RESEARCH DESIGN

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Graduate students in a Master of Nursing programme in a New Zealand university

participated in a group discussion of a New Zealand nurse’s story from 1911. Class

discussions were regularly recorded so any student could request a copy if they had been

absent or wanted to refer back to a session. Following completion of that unit of study,

ethical approval was granted by the university’s ethics committee for the educator to

write to the students as a researcher who had no continuing connection with their tuition

or progress in the course. Their consent was sought to use the recording for analysis of

the discussion in order to determine its features in relation to narrative learning. All

students individually granted written consent. Pseudonyms are used here to distinguish

between different students’ contribution to the discussion.

As no aspect of the discussion could be explored in more depth through further

conversation with the students, the research design aligned most closely with a qualitative

descriptive study with the audiotape and a transcript of the discussion forming the

research material. As Sandelowski (2000) pointed out, this is a valuable methodology.

Although researchers might ‘stay closer to their data and to the surface of words and

events’ than researchers using other methodologies, ‘surface readings should not be

considered superficial, or trivial and worthless’ (p.336). Sandelowski noted that analysis

in qualitative descriptive studies can use pre-existing templates. Preliminary analysis or

initial in-depth reading of the transcribed discussion indicated that reader-response theory

was the most appropriate in explaining identified features, as students’ comments

demonstrated their personal and professional response and engagement with the text and

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translation of their responses to the practice context. In this way, the study was ‘hued’

(p.337) by a reader-response research approach.

Researchers studying students’ reader-responses have generated a number of frameworks

or classifications for understanding the development of a reader’s responses through time

or demonstration of this within one reading episode (e.g., Sebasta et al. 1995, Smith

1991). The taxonomy or hierarchy of aesthetic response by Sebasta et al. was chosen as a

template for the second layer of analysis. Although developed and tested in research with

US middle and high school grade students, it described a progression in the way a reader

responds, from lower to more sophisticated levels. In the two levels of the first or

Evocation stage, the reader relives the experience of reading, and imagines or pictures

characters, the setting or events in order to elaborate on them. In the four levels of the

second or Alternatives stage, the reader applies their own experience to the work, applies

other readings or media, applies other readers’ views or re-examines their own view, and

re-examines the text from different perspectives. The third or Reflective Thinking stage

involves interpretation, with the reader generalising about the meaning of the reading

experience to their own life. In the two levels of the final Evaluation stage, the reader

considers what they got from the reading and evaluates the “goodness” of the text

according to criteria they have set. Sebasta et al. warned that aesthetic stance is ‘fluid and

emergent’ and ‘more holistic than categorical’ (p.450). Similarly, Sandelowski (2000)

noted that in descriptive qualitative research an analysis template can be modified in use.

The congruent flexibility of these two positions led to the choice of this analytical

approach.

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A NURSE’S STORY FROM THE PAST

The story used in the group session was from a nurse recalling her work in 1911 at the

small hospital in Naseby, an old goldfields town in the Otago province (Brown 1940).

New Zealand was the southernmost colony in the British Empire and gold was

discovered in the Naseby area in the 1860s. Some goldminers who came from Britain had

been soldiers in the Crimean War. Many remained in the area into later life. One was

James Crawford who treasured the memory of helping Florence Nightingale down the

gangway at Scutari and therefore took a personal interest in the hospital and its nurses.

He would sit outside his cottage to talk to nurses as they passed by. In summary, the

nurse recounts that on Christmas Eve morning she walked down to the township to

borrow some vases for a large floral display she was planning for her ward, ‘a delicate

colour scheme in pink, blue and mauve’. James Crawford was sitting at his gate and

presented her with three posies of flowers, picked with very short stems, and told her they

were for her ward the next day. He and his wife would be there to see it. The nurse

thought with dismay of her planned large display and careful colour scheme, and then

thought of Florence Nightingale, and the decision was obvious. She arranged the little

flowers in small jars filled with damp sand and put them on patients’ lockers on

Christmas morning. The patients loved them.

Among the patients were some very old goldminers from Scotland. As the nurse

recounts, one who was over 80 noticed a geranium and remembered his mother growing

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some in her kitchen window in the old country. He enjoyed the ‘fine scent’ of a sweet

william. A snowy haired Highlander aged 86 lifted from his locker a pot containing three

moss rosebuds. His eyes became misty as he recalled his Highlands sweetheart of 64

years before, who had loved the moss rose. She died before they could marry and he

placed moss roses ‘in her white hands. The scent o’ these brings far thoughts to me.’

The nurse ends her story by saying: ‘No long stemmed flowers arranged in tall vases

could have wakened such memories. That afternoon the veteran and his wife visited the

hospital. The quiet look of pride on their faces more than repaid me for side-tracking my

colour scheme’ (Brown 1940, pp.293-294).

STUDENTS’ READER-RESPONSES

Sandelowski (2000) asserted that there was ‘no mandate’ in qualitative descriptive

studies ‘to produce anything other than a descriptive summary of an event’ organised in a

way ‘most relevant to the audience’ (p.339). This section therefore provides an excerpt of

the discussion and a summary of the application of the aesthetic hierarchy. Only one part

of the group’s discussion is reported here. It is chosen as it illustrates how students’

historical imagination can be effectively used within a narrative learning approach and

how it relates to reader-response theory. The discussion started with an opening question

from the facilitator, asking students for their initial impressions of the story and what had

struck them about it.

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Angela: It was such a simple thing that she did but it prompted the memories and

conversations between the patients. And it was such a simple thing to brighten the

ward but to those patients it meant so much more. It was great.

Belinda: For me, I’m really smell-sensitive. I absolutely believe how smells can

bring back memories for people. That really struck me. The whole smell thing, at

that personal level.

Catherine: It’s all about communication.

Diana: I noticed the attention to detail, in writing the detail about the flowers, and

the pride in it as well.

Facilitator: The pride in it?

Diana: The man talking about Florence Nightingale and the flowers, it was his gift

to the nurse, it was like him giving what he’d got from helping Nightingale.

Belinda: She didn’t have to use his flowers. She could have easily just got to work

– mind you, she probably felt a little bit obliged because he said he was going to

come and have a look, and she probably thought, ‘Oh, well, into the sluice!’

Jane (an older nurse manager): And she knew what the flowers meant to him.

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Belinda: Yes, even though the stalks were short, she was still going to use them.

Jane: They became symbols of the goldminers’ younger days. I absolutely agree

with you, Belinda, I could smell the sweet williams too. And the nurse was highly

esteemed, because he stopped her and said, ‘I’ve got something here for you.’

Students were then asked what the significance of the story was to them.

Jane: To me there was so much symbolism in the whole story. The flowers, and

the link with Florence Nightingale. Nightingale’s focus was completely on the

environment, she changed the environment to suit the patients, not herself. And so

if I was talking to a group of young nurses I’d be trying to say, ‘What do we need

to be mindful of about the environment for the patients? It’s to suit their feeling of

comfort, not ours.’ I do see it like passing knowledge from one generation to

another. And if you drop the basket it’s not available to the next generation.

Because I learnt a lot from the generation before me.

Facilitator: So that basket has to keep on being filled and passed?

Jane: Yes. And the heritage of that man’s memory. How things endure even on

the other side of the world. And she also valued the gift, even though the gift was,

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in one way of looking, not as wonderful as the flowers she had in her mind, she

knew it was more precious.

At this point, the students’ historical imagination was turned to making the link between

the past and present, and between the story and current practice.

Facilitator: So what do these things have to say to nurses today, if anything? What

would nurses gain by knowing this nurse’s story from the past?

Belinda: Don’t disregard anything. It may not be important to yourself, it may be

important to the patient.

Facilitator: Can you think of a situation nowadays that this might relate to?

Belinda (an emergency nurse): Yes. Even to give a phone to a patient, it’s

important to them to be able to communicate with a family member. You may be

really busy on your shift and running around and the last thing you think is, ‘Oh

gosh, they need a phone,’ but to them it’s really important. It’s the small things.

It’s what they remember. And it’s evident when you get complaints (laughs).

They say, ‘I didn’t get a cup of tea.’ And you look back and they had an ECG,

blood tests and so on, they were seen by three doctors, but that’s not what they

remember, it’s the cup of tea they missed out on, you know?

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Facilitator: So, the value of small things.

Jane: But what would smell as evocatively as that? You were talking about how

smells bring memories, Belinda. And if you were working in an aged care facility,

how could you use that evocation of something through smell? And to be really

careful too. In this particular story it was a happy smell associated with a happy

memory, but it could easily be not that at all.

Facilitator: Also a bitter-sweet memory for that man who had given the moss

roses.

Jane: And to me it’s the ordinariness of the patients’ lives that’s so rich. That

everybody has a beautiful remembrance of something really emotional or sad or

wonderful – and she could draw that out of them.

Facilitator: So how does that relate to today, do you think?

Angela (an emergency nurse): To be honest, I think nursing’s lost a lot of that

personal touch. And that listening, stopping and listening to patients. I know to be

honest it’s probably the biggest thing I lack in my practice. I’m very good at my

practical work but I don’t put much importance on to that because it’s probably a

time factor and I’ve become conditioned to working hard and fast.

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Jane: Now wait a minute, she would have worked pretty hard.

Belinda: Yeah.

Angela: I’m just talking about the Emergency Department.

Jane: You’re connected with people all the time. This story had lots of symbols in

it. Would you see a symbol if one came past you?

Angela: I don’t know whether I would, to be honest. I don’t know. I honestly do

think at times I would say, ‘Oh, no, they need the phone,’ or, ‘Gosh, they want a

cup of tea, I haven’t got the time to get it.’ I don’t know whether I would see the

importance. That’s pure honesty.

Jane: That’s what we’re trying to get to.

Facilitator: So does this story help in any way, in that?

Angela: It does, because it brings me back to why I went nursing. When I first

became a registered nurse, I spent more time listening to patients then, and I got

so much out of patients. I think the quickest thing I dropped was that.

Jane: Was it too big a burden?

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Angela: No, I just think I’ve become conditioned to work, just the practical work,

the physical work of the job, so I’ve just sort of dropped it. It might be the area I

work in, emergency nursing.

Jane: Is that part of why you chose it?

Angela: Possibly. But I don’t think so. I chose emergency nursing because I like

the acute work. But to be honest, I can see myself when I started my practice, and

where I am now, where my priorities and my skills are. And that story just sort of

makes me think, ‘Gosh, I must stop and remember.’

Jane: Well, what I’ve noticed, I have a bit to do with the new graduate nurses and

the patients tell the new graduate nurses all kinds of things that they haven’t told

the others. And it’s because they’re slower at doing the technical tasks. And the

new graduate nurses are connecting with them in a way that a busy person, who

walks past them and doesn’t make eye contact with them, can’t do.

Angela: Exactly what’s happened to me.

Jane: But the other thing that happens is the longer you stay nursing the more that

comes back to you. You realise that some technical stuff just has to wait. And you

have to put that person’s hands in yours and say, ‘Tell me.’

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Belinda: And that’s funny because sometimes as a nurse the people that you work

with who do all of that are perceived as frustrating to work with. You think, ‘Oh

well, yeah, she’s talking to the patients all the time while I’m doing all her work,

because she’s yap, yap, yapping.’ And then I think, if I came into hospital, she’s

the one I’d want to look after me because I know she would make sure I had the

phone, to make sure someone had the kids, that she would sort out a neighbour to

feed the cat and make sure the car didn’t get towed away. She’s the one I’d want

to look after me.

Application of the Sebasta et al. (1995) hierarchy of aesthetic response showed that in the

initial part of the discussion students’ comments were, quite reasonably, at a relatively

lower level in the hierarchy. They applied the reading experience to themselves in a

simple or direct way (first level Stage 2), as in Belinda’s comment about being smell-

sensitive. Similarly, Belinda’s and Jane’s acknowledgement of the nurse’s decision to use

the old man’s flowers related to their own imaginative understanding of the context

(second level Stage 1) and to their appreciation, as nurses, of the implications of

accepting the gift (first level Stage 2). However, most of the discussion demonstrated

more sophisticated application of their reader-response to their own experience as nurses.

This was particularly at the levels related to interpreting and generalising the meaning of

their reading experience to their own contexts (Stage 3), and evaluating what they got

from reading the text (first level Stage 4). This was seen especially in the later part of the

discussion, in Belinda’s comments and the interaction between Jane and Angela. For

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Belinda, the story reminded her of the importance of small actions in nursing. Jane gently

challenged Angela to consider the symbolism of the story and whether she would

recognise something symbolic in her own practice. The story reminded Angela of why

she chose to be a nurse and how she needed to reorient her priorities to listen more to

patients. Jane translated her reading experience to her work with new graduate nurses

and, as with Angela, the importance of listening.

In accordance with the congruent flexibility in the positions of Sebatsa et al. (1995) and

Sandelowski (2000) related to using analytical templates, in this second layer of analysis

no rigid application of the hierarchy was made. It was used more to gain an

understanding of how the students’ reader-responses highlighted particular aspects of

their reading experience and its relation to practice, and their use of historical

imagination.

It should be noted that the direction of the discussion itself was to a degree shaped by the

facilitation. At different points, students were asked to consider the story’s significance

for them and how it related to current practice. This might be seen as a limitation of the

study, as shifts in the focus of students’ responses were not always spontaneous.

However, this approach was congruent with the educational goal of the session, which

was to encourage students to use their historical imagination.

DISCUSSION

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The students’ discussion needs to be considered in relation not only to reader-response

theory, but more broadly to narrative learning and more specifically to historical

imagination. The students in this small, narrative learning group were all registered

nurses. Even though their practice settings differed (emergency nursing, aged care, acute

care and nursing management), they shared the social, aesthetic, interpretive context of

nursing. In this way, they formed an interpretive community (Chase & Hynd 1987) that

would in part have shaped their response to a text. As nurses, they drew on a common

understanding generated by their professional background and experience that had the

potential to ‘create shared knowledge and meanings’ (Sakalys 2002, p.391). The initial

discussion showed their recognition and common understanding of the evocative nature

of smells, the importance of attention to detail and to small things in nursing, and the

richness encompassed in the ordinariness of people’s lives. That these are shared

understandings in nursing and are therefore part of both the storyteller’s and nurse-

reader’s aesthetic interpretive contexts can be seen in the way nurses in the past also

discussed the importance of small things. Nightingale wrote about ‘doing common things

uncommonly well’ and paid attention to the ‘small things’ in nursing (Nash 1914, p.95).

Nurses in the early 1900s wrote articles on nurses’ duty in small things, and on the

quality of thoroughness in nurses’ work (Lucas 1905, Robb 1903). Similarly, nurses in

the present have also illuminated the importance of ordinariness (Taylor 2000). The

students recognised these from the story and their own understanding of professional

values and current practice.

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The educator’s role was to provide the learning material (in this case the nurse’s story),

create the setting for the discussion, and facilitate and guide it with questions and

prompts when needed. In this way, the educator was fulfilling the role in narrative

learning stipulated by Swenson and Sims (2000). The experienced narrative-learning

educator also knows when to let students take direction of the discussion. A central role

in this discussion was played by Jane, the older nurse manager. She gently questioned

Angela’s assumption about the story, her practice and the reasons for choosing

emergency nursing, always relating this back to the story. The group was used to working

together and there was therefore a feeling of safety that enabled this kind of discussion.

Chase and Hynd (1987) also identified this as an important practice in teaching based on

reader-response theory. The discussion let Jane prompt a younger, less experienced

nurse’s insights into practice and in doing so in some way meet her own need to pass the

basket of knowledge on to the next generation of nurses.

The movement of the discussion from the story’s past to the students’ present is a key

feature of engaging students’ historical imagination and facilitated the translation of the

group’s interpretation of the story to their practice. As Sakalys (2002) noted, developing

students’ textual competence also ‘entails moving beyond initial reactions to discoveries

about one’s self’ (p.390). This can more easily occur through ‘participation in

communities of learners who share observations, question their own and each other’s

assertions, and search for common understandings’ (p.391). This could, of course, be

achieved by using a story from the present. However, as Sakalys also pointed out,

‘differentiating the reader’s subjectivity from that of the author is a critical step toward

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textual competence and intellectual independence’ (p.391). This can be achieved when a

reader’s interpretation is activated by an experience of inconsistency, and this ‘gap

between the reader and a literary work can be temporal’ (p.389). This aligns with Tosh’s

(2012) assertion that we respond to the past by noticing points of familiarity and

difference, and that the ability to recognise these is essential to any social movement in

the present. Students took notice of the aspects of nursing in the nurse’s story that were

different from their own experience but equally searched for points of familiarity.

The students’ imagination was certainly engaged with the story and how it could translate

to practice. Their empathy or in Scott’s term ‘imaginative identification’ (1995, p.1196)

for the perspectives of the nurse, the patients and the Crimean veteran was evident. Their

‘informed imagination’ (p.1199) enabled them to understand the various standpoints and

experiences in the story and what these might mean for practice today. Again, this relates

to the last level in Stage 2 of the Sebasta et al. (1995) hierarchy of aesthetic response

where readers re-examine the text from various perspectives, and to Stages 3 and 4 where

readers generalise their interpretation to their own context and evaluate the text’s

contribution. As Weisberg and Duffin (1995) noted, engaging with a story ‘encourages

readers to construct their own stories in relation to the ones they are reading.

Consequently, readers come to know themselves better, to connect who they are to what

they are doing’ (p.249). There is particular value when this story is from the past, as it

creates the temporal dissonance that stimulates interpretation (Sakalys 2002). It is not

surprising that Weisberg and Duffin regretted abandoning their objective to use historical

literary material in their course with medical students, in the face of the students’ strong

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resistance and intolerance to it. As this work with graduate nursing students has shown, a

nurse’s story from the past evoked thoughtful interpretation and translation to practice.

Although narrative learning approaches to nurse education are well recognised, the

application of reader-response theory has received little attention. Sakalys’s (2002)

inclusion of it in her account of literary pedagogy is an isolated example. However, as

Sebasta et al. (1995) pointed out, teachers can use reader-response theory to focus their

teaching. While narrative pedagogy focuses principally on communal thinking and

dialogue (Ironside 2006), teaching based on reader-response theory can also use specific

written exercises to help students structure, organise, consolidate and express their views

(Chase & Hynd 1987). Nurse educators could gain from considering these as they plan

educational sessions incorporating narrative – sessions designed to elicit students’

interpretation of text and develop their textual competence.

Nurse educators’ inclusion of the history of nursing in courses, while receiving growing

attention (e.g., Lait 2000, Lewenson 2004, McAllister, Greenhill, Madsen & Godden

2010), could be strengthened by focusing on engaging students’ historical imagination by

applying their interpretation of historical stories to current and future practice. This story

and others from the past have been used effectively with other graduate and

undergraduate nursing students in New Zealand and Australia. Only one example has

been considered here as, in Sandelowski’s (2000) terms, it was a typical instance of a

phenomenon that allowed it to be described it ‘as it tends to appear’ (p.338). The New

Zealand context of this chosen story and student group could be considered a limitation

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of this study. However, it does not restrict the transferability of the insights from the

analysis of this student discussion to other contexts. Similarly, stories written by nurses in

the past in one country or context can usefully be used in teaching students in a different

context as they stimulate a spatial as well as temporal gap (Sakalys 2002) between the

reader and the story and enable the identification of points of difference (Tosh 2012).

More research is needed in how these approaches and factors can be further interrelated

and developed to inform effective teaching practice.

CONCLUSION

This analysis of graduate students’ reader-responses to a story from the past demonstrates

that using historical narratives engages students’ historical imagination as they discuss,

question assumptions, and translate the past to the present. It is a different, vibrant and

effective way to facilitate learning. Reader-response theory offers a valuable foundation

for narrative learning. It extends the focus more clearly from the text to the reader, and to

the way the reader’s active response to the text is drawn from their social, aesthetic,

interpretive context, in this case the profession and practice of nursing.

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