Storytelling is the oldest form of education; storytelling has been used to communicate critical information about safety, recipes, teach lessons, remove bad habits, and explain events. In our various cultures we hear stories from our family members, in school, and at work. It is part of our oral tradition and how history is shared. I remember hearing stories as a child that explained why we have certain practices and why humans have internal ethical struggles. The lessons from these stories stuck with me in a way that made me evaluate my choices carefully when making a critical decision. When these tools are used to teach nursing students they can have a wondrous effect.
Storytelling and mental modeling often go hand in hand; when people are told of a situation or told a story, they will work out the process of that situation within their brains to see how the situation resolved or could have resolved if other steps were taken. The individual may go through different algorithms to work out the most correct path for the situation. This is a clear demonstration of critical thinking and may help with improving clinical reasoning in nurses.
Research shows that storytelling is a method of learning that can be transferred; students remember the “war stories” that their nursing instructors have told them about their clinical experiences. I can remember being told a story by an instructor about a congestive heart failure patient that she had that was receiving fluid and developed wet lungs and frothy pink sputum. She was so vivid in the way that she was describing the sputum that I never forgot to correlate strict intake and output with congestive heart failure patients. As a nursing educator myself, I have told stories of patient care that aligned with what I was teaching to the students to the students didactically and have later gotten a phone call or email from a student saying that they saw a similar case in clinical or in their practice and remembered what I told them.
Storytelling is an excellent method of instruction and provides auditory and visual stimulation to learners in a manner that connects to the concepts being taught to the students. And they provide an opportunity for reflection and transference. Telling a story in the right context that links to the concepts being taught may help the individual visualize the situation in their mind and then practice the concept/skill.
How are you using storytelling in your instructional practices?
“Stories are a communal currency of humanity.” —Tahir Shah, in Arabian Nights
One of the hottest topics amongst nurse educators today is finding strategies to promote safe learning in the classroom environment. According to the American Association of Colleges of Nursing (AACN), it is estimated that over 73% of “nontraditional” students are studying in undergraduate nursing programs. The term “nontraditional” refers to all students who meet the following criteria: over the age of 25, ethnic minority groups, speaks English as a second language, a male, has dependent children, has a general equivalency diploma (GED), required to take remedial courses, and students who commute to the college campus. Nurse educators have a responsibility to ensure that all of their nursing students are learning in a safe environment.
For instance, microaggression is something that nurse educators must address in order to promote a safe classroom environment. Microaggressions are subtle, verbal and nonverbal snubs, insults, putdowns, and condescending messages directed towards people of color, women, the LGBTQ population, people with disabilities, and any other marginalized group. These insults are often automatic and unconscious in nature, according to Derald Wing Sue, PhD, author of Microaggression in Everyday Life: Race, Gender, and Sexual Orientation. Microaggression can cause a person to question themselves regardless of whether the microaggression occurred or not because they were unsure if they were just being oversensitive to the offense or if the perpetrator really intended to harm them with what they said. Microaggressions are usually committed by “well-intentioned folks” who are unaware of the hidden message that is being transferred.
Types of Microaggression
Microaggressions are similar to carbon monoxide—“invisible, but potentially lethal”—continuous exposure to these types of interactions “can be a sort of death by a thousand cuts to the victim,” says Sue. He further outlines three themes in three microaggression categories. The three themes are: racial, gender, and sexual orientation. The themes appear to occur in three different forms of microaggression: microassaults, microinsults, and microinvalidations.
Microassaults. Also known as “old-fashioned racism,” microassaults are conscious verbal or nonverbal attacks meant to hurt, oppress, or discriminate against the marginalized groups. This can range from telling racial jokes, name-calling, or isolating a student base on their racial, sexual, or gender identity. For instance, a student may deliberately refer to an Asian classmate as an Oriental. (Hidden message: You are not a true American. You are a perpetual foreigner in your own country.) Another example of a microassault is a teacher asking an African American male student, “Are you a first-time generation college student?” (Hidden message: African American males usually do not go to college.) Microassaults leave the students feeling unwanted, uncomfortable, and invisible.
Microinsults. A microinsult is an unconscious and unintentional discriminatory action against one’s identity. For instance, a teacher not asking a transgender student what pronoun to use when addressing the student (Hidden message: You are not acknowledging my identity.) Another example of microinsult is a teacher calling on an Asian student to come to the blackboard to work out a drug calculation problem. (Hidden message: All Asians are supposed to be good at math.) Or a student jokingly making the comment “that’s so gay.” (Hidden message: Being gay is associated with negative and undesirable characteristics.) A microinsult can also be nonverbal. For instance, when a white professor fails to call on the African American students in the classroom. (Hidden message: People of color contributions are unimportant.) Microinsults can have a far-fetching negative impact on a student, and they can affect a student’s motivation and commitment as well as mental health.
Microinvalidations. Microinvalidations are unconscious communications or environmental cues that faintly exclude, negate, or nullify the psychological thoughts, feelings, or experiential reality of a person’s identity. One example of microinvalidation is a student asking an Asian student, “Where are you from? You speak perfect English.” The Asian student replying, “I was born and raised in Florida.” (Hidden message: You are not American.) Or when a teacher continues to mispronounce the name of a student even after the student has repeatedly corrected the teacher. (Hidden message: I am not willing to learn how to pronounce a non-English based name.) Or a white science professor asking the male nursing students, “Why are you going into a nursing? It’s a female profession.” (Hidden message: Nursing is not “a real man’s job.”) Or the classic case of a white student telling her black roommate, “I don’t see color. There is only one race: the human race.” The color blindness offense is one of the most frequently delivered microinvalidations. Another example of microinvalidation is a student who unconsciously opens the door for a classmate who is in a wheelchair. (Hidden message: You are not able to independently take care of yourself.) The student should wait for the student in the wheelchair to ask for help if she or he needs it. Microinvalidation is one of the most harmful forms of microaggression because it leaves the victim feeling ashamed and asking themselves “Am I being oversensitive or paranoid?”
How to Address Microaggressions in the Classroom
Professors and students are the most common perpetrators of microaggressions in the nursing classroom environment. In the course of interaction, the professor or student may say something that offends a student intentionally or unintentionally. Since microaggressions are usually invisible to the perpetrator and may seem to have reasonable alternative explanations, the student may be left feeling uneasy and questioning themselves about what the implied message was.
Microaggression is processed in five different phases, Sue says. Phase one is the incident (verbal, nonverbal, or environmental). The perpetrator intentionally or unintentionally commits the offense. Phase two is the receiver’s perception of the offense. For instance, the receiver may ask themselves, “Was I just discriminated against?” or “Did she say what I think she said?” Phase three is the receiver’s immediate response to the offense. The receiver may respond by taking a defensive stand. Phase four is the receiver’s interpretation of the meaning of the offense. They may even ask themselves, “Should I say something?” or “If I say something it may make it worse.” Phase five is the consequence that may happen to the receiver of the offense. For instance, students may lose confidence in their ability to complete the course. Microaggressions can cause psychological consequences on the students over time, such as anxiety, depression, helplessness, and loss of drive, which can impede the student’s academic performance.
Therefore, the first step to addressing microaggression in the classroom environment is to acknowledge that it exists, says Jared Edwards, PhD, a psychology professor at Southwestern Oklahoma State University. Nurse educators need to get to know their students. You should be aware of their campus cultural environment and the specific challenges that your students from different backgrounds may face. Do not dismiss the classroom experience of microaggressions as “isolated” incidents. You should work with your students to create a safe classroom atmosphere by establishing solid ground rules and classroom expectations. You can incorporate open classroom discussions about microaggressions into your courses. For instance, have students conduct a group presentation on the impact of microaggressions in a classroom environment. This will promote teambuilding skills and communication and writing skills as well as help create awareness surrounding the common occurrences of microaggressions. Nurse educators need to be aware of what programs (e.g., student counseling center, disability services) are available on their campus so they can refer students who may need help dealing with the psychological consequences of microaggressions.
Nurse educators must be prepared to teach and advocate for culturally diverse students in a multicultural classroom setting. Additionally, they can show they value their students in many ways. For instance, taking the time to learn how to properly pronounce every student’s name can show the students that you value the student’s identity.
This month, New York University (NYU) Rory Meyers College of Nursing welcomed Jacquelyn Taylor, PhD, PNP-BC, RN, FAHA, FAAN, as the inaugural Vernice D. Ferguson Professor in Health Equity.
Taylor has already had a notable career. In January 2017, she was awarded the Presidential Early Career Award for Scientists and Engineers by President Barack Obama, the highest honor awarded by the federal government to scientists and engineers, where she will examine next-generation sequencing-environment interactions on cardiovascular outcomes among African Americans.
Vernice D. Ferguson (1928-2012) was a distinguished nurse leader, educator, and executive who championed the health of all people throughout her career. Ferguson, who received a baccalaureate in nursing from NYU, pioneered leadership positions for nurses and elevated the nursing profession through advocating for increased opportunities, respect, and wages, as well as fostering nursing research.
Taylor says it’s a tremendous honor to be selected to serve as the inaugural Vernice D. Ferguson Professor in Health Equity. “It is my sincere hope that the research I lead is as beneficial to the public as the work of the iconic Vernice D. Ferguson.”
Over the course of Taylor’s career her work has focused on health equity in Black populations for common and chronic diseases such as hypertension, both in the United States and in Africa.
“African Americans have the highest incidence and prevalence of hypertension than any other ethnic group in the U.S.,” says Taylor. “In particular, African American women have the highest incidence and prevalence of hypertension than any ethnicity or gender. Understanding the genomic underpinnings and social factors that contribute to this disparity can help providers to intervene early in life to eliminate such disparities. On a personal level, my father had hypertension and had a stroke, and my mother had cardiovascular complications as well. I would like for the work that I do to help others to avoid these complications.”
Another primary goal for Taylor is to study the genomics of lead poising in Flint, Michigan. She says the purpose of this project is to better understand the harmful effects of chronic lead exposure, the psychosocial insults of the Flint water crisis, and the underlying omic mechanisms involved that may contribute to increases in blood pressure in this already at-risk African American population in Flint.
“An intergenerational, multi-omic (genetic and epigenetic), and psychosocial approach will be utilized to understand one of the major symptoms of chronic lead exposure—high blood pressure—among African American families in Flint,” Taylor explains. “This research will provide critical insights that will add a layer of functional outcomes for health providers to best understand, assess, and intervene with tailored treatments based on an individual’s unique environmental, omic, and psychosocial profile and will help in mitigating long-term cardiovascular and other health risks.”
Taylor says her primary goal during her professorship is to continue to build on the work she has done in omic-environment interaction studies among minority populations by utilizing multiple advanced genomic techniques and expanding to more minority populations across the USA and abroad.
“I would also like to expand my reach as a leader in nursing science by taking on a more key administrative role that will aid in building up the next cadre of minority nurse scientists.”
Keondra Rustan, RN, MSN, PhD(c), visiting assistant professor at Linfield College in Portland, OR, has overcome many challenges in her decade-long career as a nurse and nurse educator. Raised in a single-parent home with limited resources, she discovered how she could channel her interest in science into a nursing career by reaching out to mentors along the way.
Today, she shares her story and offers advice to other minority nursing students and nurses who may face similar challenges in their education and careers.
How long have you been in the nursing field and what has been your career history until now?
I have been a nurse for nine and a half years. I started out working in cardiac health care in Virginia. I did cardiac stepdown, some cath lab work, and I floated to some cardiac ICUs. I then went to the ICU where I learned a great deal and developed some professionalism and leadership traits. I then went on to become an assistant manager of an ICU and IMCU. I finished my master’s degree and became a professor at a private college where I rediscovered simulation and developed a great love for it. I became the simulation lab coordinator and for a time was the interim director of the LPN program, and went on to become the assistant director of the LPN program so that I could make more time for my doctoral schooling.
I am currently working in the dissertation phase of my doctoral program and enjoying my work at Linfield College as a visiting assistant professor working in simulation as lead faculty.
What inspired you to enter the nursing profession?
At first I didn’t want to be a nurse. I went through all of my primary schooling without having the decision of wanting to be a nurse. I wanted to be a scientist at first like those scientists in Jurassic Park.
Later on in high school I decided that I wanted to be a scientist that could help cure diseases and study microbes. However, I lost my grandmother when I was in high school and some of the care that she received wasn’t the best and lacked empathy. I decided that I wanted to help people more directly and show them that they aren’t just a room number but a thriving person who was deserving of care. I wanted to be a person who made a difference in the lives of others.
As nurses we often aren’t remembered individually; but if a patient has less exacerbations and starts feeling better because of your care and the education that you provided, it is very rewarding.
What inspired you to become a nurse educator?
I discovered that I liked teaching by precepting new nurses and nursing students. I enjoyed seeing the potential in them. I loved teaching them how to do things based on evidence and why it was so important for it to be done that way. I wanted to show them how to provide holistic care to patients and help them grow into future leaders.
I also enjoyed telling them stories so they could directly apply the teachings to their practice. Most importantly, I wanted them to have things I did not have prior to becoming a nurse: resources and a mentor. I wanted to apply these principles on a broader and larger scale so I went into the field of nurse education.
I would say the first year or so I was not very good at it. Or at least I did not feel as though I was a good teacher. I did not have a mentor or anyone to show me the ropes so I just taught them the way I was thought, which did not work.
What challenges have you faced in your career and how have you overcome them?
In my career my biggest challenges have come from lack of resources and lack of mentors. I grew up in a low-income single parent home with no vehicle. We did not have the funding or access to resources to get informed about career programs while in high school or even most scholarships. I wasn’t aggressive enough in thinking of my future and did not have enough drive when I was younger to seek those resources.
Once I decided to become a nurse, I didn’t really know how to become one, what nurses actually did, and what type of nurse I wanted to be (even when I graduated I still did not know that part). I had a lot of ideas, but I did not know how to bring them into fruition.
I overcame the lack of resources and lack of mentoring by joining organizations (good old-fashion Google search) based on my interests. When I was obtaining my BSN I got accepted into Sigma Theta Tau (the nursing honor society). Going to those conferences really opened a lot of doors for me. I am so grateful for the aid of the nurses and educators that I have met throughout my nursing career. They were able to point me into a lot of great directions. I am still growing and have a great deal more that I want to accomplish.
What challenges do you see minority nursing students face and what is your advice for them?
I see lack of resources as a big one and lack of mentors. Minority students (and I include males in this) have a high risk of falling through the cracks in nursing school. There seems to be a reluctance to seek aid when dealing with difficulties. It is hard to get over, because typically it is culturally ingrained.
My advice is to seek help right away when you are having trouble. If your school does not assign faculty mentors, seek out an instructor that you feel you can connect with. Shadow a nurse if you are not experienced with the duties of a nurse, so you have an idea of if it is right for you. Don’t be afraid to ask for help; if you do not understand, seek help (think of the patient’s safety).
Most nursing schools have scholarships, open labs, writing labs, and tutors available for their students; make use of these resources and give yourself support. View any setback as a learning opportunity and grow from the experience. Never stop learning even after you are licensed and working on the floor. Google search some nursing organizations (you can even join some as a student for a cheaper price) and they can lead you down some interesting paths. Also, once you obtain your knowledge, pass it on. You never know who you will be helping with your expertise and experience.
Where do you see yourself in 5-10 years?
I see myself with at least 10 articles published and maybe a book, of course having obtained my PhD. I want to still be educating nursing students and maybe have obtained my NP. I want to continue to learn and grow each day to become the best educator that I can be. I want to do more in community and be a greater help to those in need.
Having a strong mentor and academic advisor can make a huge difference in the lives of undergraduate and graduate nursing students. Being that mentor is what motivates Ronald Hickman, PhD, RN, ACNP-BC, FNAP, FAAN, associate professor of nursing at the Frances Payne Bolton School of Nursing at Case Western Reserve University in Cleveland, OH.
Hickman has been honored with two esteemed awards for student mentorship at Case Western Reserve University: the John S. Diekhoff Award for Excellence in Graduate Mentoring, which is presented to four full-time faculty members who make exemplary contributions to the education and development of graduate students; and the J. Bruce Jackson Award for Excellence in Undergraduate Mentoring, which celebrates faculty and staff who have guided a student in their academic and career paths; fostered the student’s long-term personal development; challenged the student to reflect, explore, and grow as an individual; and supported and/or facilitated the student’s goals and life choices.
“Mentoring has been a cornerstone approach to making a difference in the lives of undergraduate and graduate nursing students,” says Hickman. “The receipt of two of the university’s top honors for mentoring undergraduate and graduate students is a testament to my commitment to making sure that I pay it forward.”
Hickman says the mentorship he received across his undergraduate and graduate studies has been invaluable. “My mentors shared their lived experiences and lessons learned to help me avoid pitfalls and inspire me toward a career in academe. These honors highlight my commitment to mentoring and acknowledge the impact of effective mentorship on the lives of emerging leaders in nursing practice and research.”
However, nursing was not Hickman’s original career plan. “As an undergraduate student, I majored in biological sciences with the intention to attend medical school after graduation.”
He was not admitted to medical school, but upon reflection about potential career paths he decided to pursue nursing because it aligned with his personal philosophy of health. “Although nursing was not my first choice for a career, it was the right choice for me,” he says.
Hickman acknowledges that pursing a nursing career can be challenging for minorities.
“Many minority nurses are the first in their families to attend college and are standouts in their communities,” he says. “When entering the nursing profession, the academic preparation is challenging and, in most instances, the diversity of nursing faculty is often not representative. This can create situations where minority nurses do not wish to speak up and seek help when needed. Whether you are pursuing a nursing degree or transitioning to a new role in nursing, do not suffer in silence. Asking for assistance often facilitates your success and delivery of safe nursing care.”
Another key to success that Hickman recommends for minority nursing students is to find a strong mentor and strongly consider pursing a doctoral degree in nursing.
Hickman is truly paying it forward. “As a nurse educator, I am inspired daily by helping students develop as competent nurse clinicians and scientists,” he says. “Helping others achieve their goals is an invaluable and enduring experience for most educators. The opportunity to inspire and challenge future nurse leaders is a priceless reward.”
Hickman sees himself in a senior leadership position in a school or college of nursing in the future. “My aspiration to secure a senior leadership position aligns with my commitment to help an organization and its’ faculty achieve their goals and impact the health of Americans.”
Each year, National Nurses Week brings celebrations across the United States. But within that week is an important reminder of the work that nurses do across the globe, under varying conditions, with dramatically different equipment, but with the same steely determination to protect the health of the people they care for.
This year, International Nurses’ Day is celebrated on May 12, Florence Nightingale’s birthday. Nightingale, as many know, is considered an early healthcare innovator who founded modern nursing practices and helped shape nursing to such an extent that her influence remains to this day. Nightingale’s passion for aiding the ill and injured and keeping nursing practices focused on sanitation helped saves lives of those in her care and countless lives today.
The International Council of Nurses (ICN) sponsors the day and has designated this year’s theme as “Nurses: A Voice to Lead, Achieving the Sustainable Development Goals (SDGs).” Nurses around the world can participate and unite their nursing voices by using the hashtags #VoiceToLead and #IND2017 in their social media posts.
The SDGs are a collection of more than 17 goals that impact nurses and the care they provide. The health inequities experienced by people around the world result from a mix of factors, but all impact the sustainable development issues facing nurses today. The issues range from ending poverty (that’s goal number one) to improving health and education and fighting climate change.
In honor of International Nurses’ Day, which debuted in 1965, the ICN is providing case studies from nurses across the globe—for instance there’s the story about addressing COPD in China to reducing the HIV stigma in Zambia.
For nurses who are interested in finding out more or adding their voice to the international nursing community, a Resources and Evidence toolkit is available for download.
According to the International Council of Nurses website, the organization “is a federation of more than 130 national nurses associations representing the millions of nurses worldwide. Operated by nurses and leading nursing internationally, ICN works to ensure quality care for all and sound health policies globally.”