Yvonne Dexter Senior Lecturer Child Health Nursing College of Nursing Midwifery and Healthcare

1. Storyboarding as a pedagogical tool for learning about death situations in children’s nursing education Yvonne Dexter Senior Lecturer Child Health Nursing College of Nursing Midwifery and Healthcare

2. Reflection

3. Death education • Child deaths are falling in the UK • Child death situations are unique e.g. Hindmarch (2009) • Impact on the practitioner and quality of care e.g. Papadatou (2009) • Need to provide teaching and learning opportunities for student nurses to enable them to develop the knowledge, skills and attitudes required for caring for children and families in death situations. • Limited literature e.g. Carson (2010)

4. Terminally ill children let down by poor end-of-life care (RCN 2015) Lack of training A lack of training is also having a significant impact. A fifth (20%) of children's nurses said they have never received any specific training in this area, while one in ten of those who had found it insufficient. Consequently, nearly a quarter (24%) said they are unable to provide symptom management care at home, and almost one in three (31%) said they lacked the confidence to discuss end-of-life options with children and their families. More than a third (36%) said that their lack of training prevented them from offering the child the choice to die in the home setting.

5. Narrative pedagogy • Narrative pedagogy is an interpretive pedagogy which encourages interaction between students, teachers and clinicians (Diekelmann 2001) • It is appropriate for death education in which a common and helpful strategy for nurses caring for children and families in death situations involves sharing experiences with colleagues to construct meaning, gain emotional support and learn to manage grief (Keene et al 2010)

6. Narrative pedagogical tools e.g. • storyboarding (Lillyman et al 2011) • reflection (Johns 2009) • story telling (East et al 2010) • use of children’s books (Crawley et al 2012) • simulation (Walsh 2011) • debriefing sessions (McGrath 2011)

7. Storyboarding • Storyboarding has been used in nurse education although there is limited literature about its use • Lillyman et al (2011) found that student nurses and teachers positively evaluated its use in the classroom as a way of exploring end of life issues and promoting creative, critical thinking and reflection on practice in the classroom • Lillyman and Bennett (2012) used it in reflecting on a range of topics with diverse groups of health care professionals • Johns (2013, p. 260) suggests it ‘offers an engaging visual approach to narrative that is both simple and effective’

8. The use of storyboarding in the classroom with undergraduate student children’s nurses • Create a safe environment • A learning process not group therapy • Students share experiences from practice in small, self selected groups • One story is drawn in words and pictures in a sequence of boxes on a large sheet of paper • Each small group shares their work with the larger group • Teacher as facilitator and enabler

9. Storyboard 1

10. Storyboard 2

11. Storyboard 3

12. Evaluation and action plan • Positively evaluated by students and teacher • Continue to develop and evaluate use of the technique • Potential for use in practice, interprofessional learning and simulation • Minimal equipment is required but it needs time and staff with expertise in group process and dealing with students’ emotions • Need to provide support for students and teachers • How to evaluate teaching and learning using storyboarding?

13. References • Carson, S. (2010) Do student nurses within an undergraduate child health programme feel that the curriculum prepares them to deal with the death of a child? Journal of Child Health Care, 14, 4, 367 – 374 • Crawley, J., Ditzel, L. and Walton, S. (2012) Using children’s picture books for reflective learning in nurse education, Contemporary Nurse, 42, 1, 45 – 52 • Diekelmann, N. (2001) Narrative Pedagogy: Heideggerian Hermeneutical Analyses of Lived Experiences of Students, Teachers and Clinicians, Advances in Nursing Science, 23, 3, 53 – 71 • East, L., Jackson, D., O’Brien, L. and Peters, K. (2010) Storytelling: an approach that can develop resilience, Nurse Researcher, 17, 3, 17 – 25 • Hindmarch, C. (2009) On the Death of a Child. Oxford: Radcliffe Publishing. • Johns, C. (2013) (4th Ed) Becoming a Reflective Practitioner, Oxford, Wiley-Blackwell • Keene, E, A., Hutton, N., Hall, B. and Rushton, C. (2010) Bereavement debriefing sessions: An intervention to support health care professionals in managing their grief after the death of a patient, Pediatric Nursing, 36, 4, 185 – 189 • Lillyman, S., Gutteridge, R. and Berridge, P. (2011) Using a storyboarding technique in the classroom to address end of life experiences in practice and engage student nurses in deeper reflection, Nurse Education in Practice, 11, 179 – 185 • Lillyman, S. and Bennett, C. (2012) Using storyboarding to gain appreciative reflection in the classroom, Reflective Practice, 13, 4, 533 - 539 • McGrath, J, M. (2011) Neonatal Nurses, What about their grief and loss? The Journal of Perinatal and Neonatal Nursing, January/March, 8 – 10 • Papadatou, D. (2009) In the face of death, Professionals who care for the dying and bereaved, New York, Springer Publishing Company • RCN (2015) Terminally ill children let down by poor end-of-life care. [Online]. Available at: http://www.rcn.org.uk/newsevents/news/article/uk/terminally-ill-children-let-down-by-poor-end-of-life-care [Accessed: 23rd June 2015] • Walsh, M. (2011) Narrative pedagogy and simulation: Future directions for nursing education, Nurse Education in Practice, 11(3) p.216-219