Stilwell : An Online, Multimedia Approach to Learning About Childhood Sexual Abuse

1. Stilwell : An Online, Multimedia Approach to Learning About Childhood Sexual Abuse Dr. Mike Walsh : Reader in Nursing Janet Major : Senior Lecturer in Nursing (University of Cumbria)

2. Narrative Pedagogy We have based our approach on Diekelmann’s Narrative Pedagogy (2001) Learning from story by interpreting the meaning of story Shared perspectives Discussion leading to sharing of understanding and challenging assumptions, conventional wisdom. Insights into emotions such as guilt, pain, anguish and the dilemmas of choice Stories are told thru a narrative therefore we need to create a narrative that will cover a wide range of health and social care issues. Stilwell is an online multimedia narrative that fulfils this function

3. Educational Approaches for Health and Social Care Students Conventional pedagogy can cover the content of a curriculum and the competencies required. But can this approach engage students with the meanings, emotions and experiences of health and social care problems? Can it place facts and skills in a human context and explore the interaction between subjectivity and objective reality? In other words the patient’s perspective (one of Sackett’s 3 sources of EBP) Combining narrative pedagogy with conventional approaches can make practice come to life in a much more realistic way and better prepare students for the reality of life after they qualify.

4. Stilwell and the Narrative Our narrative device is Stilwell, a fictional community (based on a real location) created as a learning tool for health / social care students. Stilwell is a neighbourhood of the town of Brigstow and has a diverse social and ethnic mix. It has parallels in Canada (Ontario Stilwell; Dr Mary van Soeren) and in the USA ( The Neighborhood Dr Jean Giddens) Stilwell is a multimedia simulation of a diverse but typical neighbourhood and the stories of the people that live there.

5. What Does Stilwell UK Consist of? At present Stilwell is a BBd site containing: • Medical case notes and social histories for a cast of 60 characters • A video introduction for students and a video tour of Stilwell • Photographs of Stilwell and the town in which it is located (Brigstow) • Videos of critical incidents in patients’ lives • Podcasts and other audio files relating to staff and patients • Front page of the local paper (Brigstow Herald ) published frequently • Blogs kept by health care professionals such as Bernadette (NP) and Tanya (paramedic). Also features a blog from a citizen’s advice bureau worker. • A blog kept by Annette, a 17 year old resident of Stilwell. This brings the community to life and sets a realistic context within which the patients’ stories unfold in real time.

6. Aerial View Stilwell

7. Stilwell : St Peters Lane

8. Rehearsing Season 3 Autumn 2009 Derek : The Rough Sleeper Eva & Max : Alzheimers

9. Getting Ready to Shoot : Season 3 Autumn 2009 Wendy : Bullying / childhood obesity Jimmy : Drugs, probation and the law

10. So How Do You Use It? • The Stilwell site exists as a resource for students/ teachers to use. It creates a virtual practice placement in which students can apply their theoretical learning to realistic problems. • It can be used equally well online or face to face. • One story can be used to for different learning outcomes on different modules. Stories do not have an ‘academic level’. • Stilwell opens up challenging areas that are difficult to explore using conventional approaches. • Time now to look at Debbie Ryan’s story.

11. Using Stilwell: Debbie’s Tale • Debbie is a young woman with a history of self harm and substance abuse. There are no easy answers for Debbie • Her story requires interprofessional working between paramedics and nurses/doctors in mental health, primary care and emergency care. It also involves social work and the criminal justice system. (multiple perspectives) • Debbie’s story raises some challenging professional and ethical issues as we explore a very disturbing area that is never far from the headlines but which it is very difficult to teach about using conventional approaches. • It also demonstrates the multimedia nature of Stilwell.

12. Shooting Debbie Ryan’s Story Getting ready to shoot Debbie and the practice nurse

13. Debbie Ryan’s Last Known Address

15. Resources Used in Debbie’s Tale • Electronic patient record to understand Debbie’s backstory. • Photographs and video tour set context of where she lives. • Newspaper story concerning the conviction of a pedophile points to the source of her problems • Podcast of the pedophile rationalising his actions presents the perpetrator’s perspective of child sex abuse. • Videos featuring (1) crisis intervention during self harm, (2) Debbie confronting her mother about her abuse and (3) seeing the practice nurse and Debbie telling her childhood story in flashback • Blog by NP reveals unhelpful CPN but a very helpful GP, many links to key websites. • Podcast of a real survivor’s story. • Note that this story reflects the true experiences of survivors.

16. What do Students Get from Stilwell? • Realistic, dynamic community, modelling complexity of life. • Strong links to the social determinants of health • Patients are not isolated case studies, they are placed in the context of families, neighbours, schools and work places. Events interact with real events happening today→ realism • Professional /ethical dilemmas can be explored • A safe practicum where students can work on individual, family or community problems in a safe supportive environment. Can be introduced to difficult & challenging topics with good support . • An interprofessional learning environment.

17. Stilwell : A Different Way of Knowing, Understanding and Learning • Focus is less about the disease, more about the individual and family response to health problems in context of daily lives. • Enhanced understanding of issues associated with vulnerable populations. • Enhanced understanding of diversity (i.e. cultural, age, socioeconomic, sexual orientation). • Facilitates multi disciplinary, student-centered learning, using a range of learning styles. • Standardized patients →equivalent learning opportunities for all students • Online and/or face to face use.

18. If you Prefer Diagrams…This is What we are Doing.

19. The Future • Swansea and Wolverhampton universities are working with us to develop Stilwell as a national resource to be a multimedia, online simulation learning tool. • Stilwell has zero funding, we must bid for resources to create customized packages to meet specific needs of educational clients in order to develop Stilwell. (Any Suggestions?) • Research into how students use this new way of learning. • Research into staff use and resistance to use (Rogers Innovation Diffusion Theory) • International connections such as Stilwell Ontario and the US Neighborhood extend the scope for collaboration.

20. Further Reading Brown S et al (2008) a review of narrative pedagogy strategies to transform traditional nursing education. Jour. Nurse Ed June 2008; 47:6, 283-86 Diekelman N (2003) Teaching the practitioners of care; new pedagogies for the health professions. Madison, University of Wisconsin Press. Freire P (1993) Pedagogy of the oppressed (20th revised edition) New York, Continuum International Giddens J (2007) The Neighborhood: a web based platform to support conceptual teaching and learning. Nursing Education Perspectives 28(5) 251-6 Hazel P (2008) Towards a narrative pedagogy for interactive learning environments. Interactive Learning Environments Dec. 2008; 16:3, 199-213 For more information, Contact Dr Mike Walsh : mh.walsh@cumbria.ac.uk