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Nursing Students as Writers


Notebook collection by Dvortygirl
Notebook collection, a photo by Dvortygirl on Flickr.

A new writing course for Hunter–Bellevue School of Nursing graduate students got off to a great start this past Thursday evening. CHMP poet-in-residence Joy Jacobson and I will teach the class for the next four and half weeks of Summer Session II. Our immediate goal is to help the students sharpen their skills in writing—scholarly writing, blogging, and narrative writing—and in on-the-job communication. But we also hope to motivate students to invest more energy in their writing by developing a daily writing practice focused on their clinical and personal experience. We’ll supplement this work by close reading of literary and scholarly texts that deal with the experiences of illness and caregiving.

The combination of reflective writing and close reading is an adaptation of the pedagogical approach used in the emerging field of narrative medicine. The mission statement of Columbia University’s Program in Narrative Medicine provides a good introduction to the aims of this discipline:

Narrative Medicine fortifies clinical practice with the narrative competence to recognize, absorb, metabolize, interpret, and be moved by the stories of illness. Through narrative training, the Program in Narrative Medicine helps doctors, nurses, social workers, and therapists to improve the effectiveness of care by developing the capacity for attention, reflection, representation, and affiliation with patients and colleagues. . . .

(I wrote a previous blog post about a presentation given by the founder of the Columbia program and one of the pioneers in this field, Rita Charon, MD, PhD. An extensive bibliography with links to several publications by Charon and others can be found here.)

We adapted our guidelines for developing a daily writing practice from Writing as a Way of Healing: How Telling Our Stories Transforms Our Lives, a fascinating book by Louise DeSalvo, professor of English at Hunter and leader of a memoir workshop in the MFA Writing Program. (She also blogs at Writingalife’s Blog.) Anyone interested in writing as a means of exploring the self will find sound advice and much food for thought in this book. DeSalvo writes

This book is an invitation to engage with your writing process over time in a way that allows you to discover strength, power, wisdom, depth, energy, creativity, soulfulness, and wholeness. . . . to use the simple act of writing as a way of reimagining who you are or remembering who you were. To use writing to discover and fulfill your deepest desire. To accept pain, fear, uncertainty, strife. But to find, too, a place of safety, security, serenity, and joyfulness. To claim your voice, to tell your story. And to share the gift of your work with others and, so, enrich and deepen our understanding of the human condition.

These are not mere self-help bromides. DeSalvo draws on a growing body of evidence from research conducted by James W. Pennebaker and others that demonstrates the beneficial psychological and physiological effects of a specific kind of writing about disturbing or powerfully emotional events. According to DeSalvo, Pennebaker discovered that “to improve health, we must write detailed accounts, linking feelings with events [the emphasis is DeSalvo’s]. The more writing succeeds as narrative—by being detailed, organized, compelling, vivid, lucid—the more health and emotional benefits are derived from writing.” (Pennebaker’s Web page at the University of Texas, Austin, has an extensive bibliography of his research, with links to free downloadable files. Click on Publications. He is also the author of Opening Up: The Healing Power of Expressing Emotions.)

DeSalvo and others, such as Sara Baker, who facilitates what she calls Woven Dialog creative writing workshops with patients at the Loran Smith Center for Cancer Support in Atlanta, Georgia, and elsewhere, also note an important caveat: this kind of writing practice, especially at the beginning of the process, can stir up strong negative feelings, particularly among those who have experienced real trauma (for example, those who have survived cancer or violent abuse). It’s important not to push oneself too far; or, as Baker writes: “We must not use our work to retraumatize ourselves or put ourselves in danger.”

Baker encourages imaginative writing—using the tools of fiction and poetry to offer what she has called “an oblique route” that may give a survivor of trauma “more freedom to connect with emotional and often buried truths” than the more direct route of memoir would provide. (Sara Baker blogs at Word Medicine.)

At the first class meeting last week, students dove right into a guided writing exercise called “My Least-Favorite Patient or Colleague.” First, each of us made up a list of nouns or adjectives beginning with the letter ‘B’ that described the person we had in mind; then another list of words beginning with the letter ‘S’ that described how that person made us feel; and a third list, of verbs or verb phrases beginning with the letter ‘T,’ that described what we would like to do to or with that person. Then, based on this material, each of us wrote a simple “list poem”—that is, a poem in which each line begins with the same word or phrase (such as “I remember…”). The last line has to have a strong twist or surprise, something like the punch line of a joke. And to cap it off, the title of the poem is written last (and is often humorous or ironic in retrospect). You can imagine how this little exercise got the juices flowing.

Stay tuned. We may be publishing some of our students’ writing on the CHMP blog in August.

19 Comments Post a comment
  1. I’m not that much of a online reader to be honest but your sites really nice, keep it up!

    I’ll go ahead and bookmark your website to come back in the future.
    All the best

    September 1, 2014
  2. Karen Gold #

    Hi all,
    great to read the blog and be inspired by people’s work in narrative writing and health care practice.
    I wanted to update people on the writing sessions for social work students I posted about recently. We began our 2nd session reading & discussing a poem by therapist and writer Ronna Bloom called ‘Just this Poem’. We then wrote to the prompt, ‘Something that surprised me or has stayed with me from a clinical interaction’. Several people shared their writings on a broad range of issues including difficult disclosures from clients/patients, the emotional impact of client’s stories, dealing with trauma, and interestingly, being at a loss for words…I find it interesting to start off with a poem and has made me think about Rita Charon’s suggestion that we write in the ‘shadow of the poem’ we have just read.

    Have found myself doing alot more narrative writing about my own practice – an interesting parallel to facilitating the narrative writing/supervision group with students as well as a therapeutic narrative writing group with clients/patients.

    Would love to hear more about specific strategies that have worked, or any comments…

    Thanks,
    Karen Gold
    Toronto

    October 31, 2011
  3. Great idea!! My blog is what helped me survive nursing school, so I can attest to the value of writing.

    Take care,
    Katie

    October 21, 2011
  4. Jim Stubenrauch #

    Karen and Paul,

    How nice to find a conversation sparked by this post going on–thanks for leaving your comments!

    I’m hoping to follow up on this post in the next week or so, and include some information on the “quick write” prompts we used for in-class writing exercises. The class was an intensive summer session, and the compressed schedule had some benefits and some drawbacks, but overall I think it’s safe to say it was a terrific experience for students and instructors alike. Somehow the students came together as a supportive community of writers very quickly, and they produced and shared some amazing pieces of writing about powerful personal experiences. Class members gave us a lot of very positive feedback. And we’re offering a regular semester-length version of the course in the spring.

    In the meantime, we are facilitating a bi-weekly, eight-session reflective writing group for nurse managers at UNDNJ/University Hospital in Newark, NJ. We’re using similar in-class “quick writes” and most of the participants are happy to share their writing and read aloud. It seems so important just for the nurses to hear their own voices in the room and to find so many correspondences in each other’s experience.

    I hope to post more about this soon. Thanks for reading!

    October 4, 2011
  5. Karen Gold #

    Thanks Paul so much for your suggestion about pulse-voices. I really enjoyed the ‘Tea and Daisies’ piece. It looks like a rich source of narrative writing from a range of practitioners and will definitely be using it in my ‘research’ and teaching.

    The narrative writing seminar with the social work students went very well on Friday. They got a lot out of the ‘Events of the day’ poem – and it seemed a very good way to start the students thinking more narratively (and poetically). We gave the students a writing exercise entitled ‘Write about something that inspired you to become a social worker’. The students all read the stories aloud to the group and we got an amazing array of narratives that really spoke to how being a social worker and therapist connected to their own lives.

    regards,
    karen gold

    regards,
    Karen Gold

    September 26, 2011
  6. Karen,

    You may want to check out Pulse–voices from the heart of medicine (www.pulsemagazine.org), an online publication I edit which each week runs a story or poem by a patient, student, family member or health professional. If you look through our archives you’ll find pieces by allied health professionals, including one by a physical therapist on November 26, 2010 called “Tea and Daisies.”

    Best regards,

    Paul Gross

    September 23, 2011
  7. Karen Gold #

    This sounds like a great opportunity to integrate close reading and reflective writing into the health professional curriculum! I am a social worker and educator in a hospital in Toronto and we are beginning a 3 year project to integrate similar strategies with social work & counselling interns on clinical placements. The intention is provide a narrative and arts-based monthly seminar for the students to reflect on their practice, and their developing professional identity, through writing and making art.

    What great timing to see your blog as our initial session is today! We will be reading the ‘Events of the day’ by Michael Wynn (from the online Hektoen International Journal of Medical Humanities) and giving the students a writing exercise on a related theme… I am anxious to see how the seminar goes and look forward to hearing more about how your initiative is coming along. It would be great to hear about specific writing
    strategies and exercises you find useful.

    I am also in the midst of research for a PhD thesis exploring practice narratives in health care and am very interested in any poetry, short stories, memoirs written by health care practitioners and therapists. I have found some fantastic material out there but am having more difficulty finding personal narratives by allied health practitioners (physiotherapists, occupational therapits, social workers, dieticians, etc.) In particular, i am interested in memoirs/autobiographical writing by nurses and poetry by allied health providers. Please let me know if you are aware of anything!

    Karen Gold
    Women’s College Hospital
    Toronto

    September 23, 2011
  8. Candy Dato #

    The course sounds wonderful. The whole idea of reflective writing and reflective practice is so important. I have been looking at the use of journals with undergraduate nursing students and have found the work of Nancy Diekelmann (and others) in Narrative Pedagogy to be useful, stimulating and innovative.
    Enjoy your students’ work and do share it.

    July 31, 2011
  9. Jim Stubenrauch #

    Thanks, Cortney! There’s no doubt our students have great stories to tell. I like your thought about writing as a way to both hold on to and let go of highly charged memories, and patients being honored when nurses write about them (within HIPAA guidelines, of course, which we also cover in class as part of a larger discussion of legal and ethical issues raised in writing about clinical experiences). Also, I should have noted (and hope to expand on in a subsequent post) that the anthology you and Judy Schaefer edited, Between the Heartbeats: Poetry and Prose by Nurses, is required reading in our course.—JS

    July 23, 2011
  10. Jim Stubenrauch #

    Thanks for checking out the blog and for your comment, Josephine. Good, too, to learn about Ginsberg’s American Sentences. Ginsberg’s adaptation of the haiku into 17-syllable American English sentences had somehow gotten past me, despite a long-standing interest in the Beats. In any case, I really like the idea of working in compressed forms. (Were you in the Poetry and Philosophy of Death in Medicine session at the Examined Life conference? Rebecca Bamford and Yuko Taniguchi had us write 50-word stories about death. That was a good one!) In any case, I think there may be American Sentences in our students’ future.
    By the way, we’re spending some time looking at health care blogs and having our students write blog posts on topics that interest them. Medical Margins is in our “recommended” folder. Thanks for your writing and for your support! —JS

    July 23, 2011
  11. Faye Snider #

    As a social worker/writer, I read about your class with keen interest and look forward to more posts.

    July 23, 2011
  12. Sounds like a great class concept – it covers a topic that nursing students rarely delve into!

    July 22, 2011
  13. Sounds like a great course and I appreciate the additional resources you have used. Helping nursing students break out of the formulaic confines of academic writing (as well as the blasted traditional nursing clinical journal writing!) is a constant challenge for me–but one well worth the headaches. I recently used Ginsberg’s American Sentences in an undergrad health policy (nursing) course–where 150 students wrote at least one American Sentence at the end of each dreadfully long (3 hour) class period. There weren’t too many groans, and there were some amazingly creative sentences (Haiku). Unfortunately, I couldn’t post them on my blog (Medical Margins on health policy and nursing with narrative medicine mixed in:josephineensign.wordpress.com) because it is my own personal blog and not an ‘official’ University of Washington blog….. But for anyone interested, I do include an blog entry on American Sentences, as well as one called “Nurses and Writing: Writers and Nurses.”
    Keep up the good work!
    ~Josephine Ensign, Seattle, WA

    July 22, 2011
  14. Congratulations! I’m always moved and encouraged to learn that nursing students are being introduced not only to the rigors of science and medicine but also to the very human and humane aspects of caregiving. Through your class, you are leading these students as they journey to the self-knowledge that true caregiving requires. Nurses, like all caregivers, experience profoundly intimate, dramatic and spiritual moments with their patients. Nurses, like all caregivers, also experience moments of terror, grief, guilt and sheer emotional fatigue. Writing is a way to process, to hold on to, and also to let go of these memories. Equally important, when a nurse writes about his or her caregiving experiences, the patient is honored, as is the remarkable work that nurses do every day. I wish you and your students well!

    Cortney Davis

    July 21, 2011
  15. Nancy Gross #

    I am so happy that you have gotten your program off to what seems a wonderful start, and I am anxious to hear how it develops. I still hope we will have an opportunity to collaborate or at least come together to share our experiences. I was moved and humbled , again, last night when I met with four residents including two interns for our first parallel chart session of the new academic year. The moments of insight, the depth of reflection coupled with their uncanny ability to use the language in ways which both clearly locate their voices and hook in the listener/reader . Together with the chief of medicine, we are honored at each of these sessions to be with developing practitioners as they narrate their experiences. Best of luck as you move forward.

    July 21, 2011
  16. This sounds like a wonderful class. In my experience leading writing workshops and reflective writing sessions with medical students, PA students and family medicine residents and faculty, there is a wellspring of emotional experience that is often accessed through such supportive writing exercises. This emotional memory is part of what makes us human–and having access to it helps us maintain our humanity as we go through training as health professionals.

    July 20, 2011

Trackbacks & Pingbacks

  1. Does Writing Heal? | HealthCetera - CHMP's Blog
  2. Nursing Students as Writers, Part 2 « CHMP
  3. Short takes: Storytelling — illness narratives as healing tools « Deciphering Culture

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