Undergraduate nursing and healthcare students often struggle in learning to effectively respond to their own and other’s suffering and grief. Students may lack exposure to these situations, with limited personal and professional experience in grasping the profound and complex issues that surround suffering and grief. Students’ growth in personal understanding and in skill development—both needed for practice in clinical contexts—can be hindered by an overwhelming sense of fear and intimidation, especially when faculty guidance is limited (Ferrell & Coyle, 2008; Pessagno, Foote, & Aponte, 2014). A collaborative partnership between nursing, social work and theology faculty was established in 2012 to implement and evaluate an interview project designed to support students’ learning about suffering and death (Braband, Gaudino, & Rogers, 2015). A Pedagogy of Suffering model emerged from the evaluation and guided a publication with theological applications and a continuing education program for nurses in practice (Gaudino, Braband, & Rogers, 2017; Mudge, Fleming, & Lovat, 2014). Further project innovations followed when photovoice methodology was embedded in the interview reflection process to encourage students to reflect on the impact of death and grief on their own lives as well as their clients’ lives. Photovoice is an experiential teaching tool that helps students explore feelings and concepts and give voice to their learning and discovery (Gallagher & Stevens, 2015; Garner, 2014; Holm, 2014). An evaluation of the innovative implementation of photovoice with the interview project in the Death and Dying course was conducted (Rogers, Braband, & Gaudino, in press) with another follow-up evaluation currently in progress in 2018.
Purpose:
This paper presents the collaborative interprofessional process regarding how an interview project was implemented and adapted over a span of six years in a small, private, urban northwestern university in the U. S. by three faculty members in nursing, social work and theology disciplines. The goal of the faculty collaboration was to implement and evaluate the impact of the interview and the recent adaptation with photovoice to better support students’ understanding of how suffering and grief impact others, how students react to suffering and grief, and how students learn to effectively respond to other persons’ suffering and grief.
Methods:
The project was implemented in two courses including a theology/nursing course, Theological Dimensions of Suffering and Death (2012-2018), and a Death and Dying social work class (2017-2018). Similar project implementation models were used in each course based on an in-depth collaborative planning process. Each student in both classes completed a series of two or three guided conversational interview sessions with a personal contact outside the clinical setting. Sessions were based on a series of focused questions for each interview asking the contact about their experience with grief and/or suffering. Prior to the first interview and immediately following each interview session, students completed personal reflection activities, including taking three to four photos and writing narrative responses. For each interview students were asked to respond to the same question for their photovoice reflection: “What images capture your feelings and thoughts about interviewing someone who has experienced or is experiencing grief and loss or suffering?” In addition, group discussion was threaded through each course based on this assignment. Evaluation of the initial interview project and the recent photovoice interview project adaptation was completed for each course based on an eight-item Likert-type scale questionnaire and open-ended questions inquiring about students’ experiences with either grief or suffering. The faculty team guided student research assistants in the collaborative project analysis for all phases of project evaluation.
Results:
From its initial implementation to the more recent adaptation with photovoice, several mixed methods evaluations have generated positive support for the achievement of student learning outcomes as students learn about themselves and others through this project. The recent qualitative evaluation of the interview with photovoice methodology implemented in the Death and Dying course indicated three main trajectories related to students’ growth in their learning about grief and loss. These trajectories included: 1) movement from feelings of uncertainty and discomfort to feelings of preparedness and confidence; 2) movement from feelings of aloneness and separateness to feelings of human connection; and 3) movement from intense pain and grief to feelings of hope and possibility (Rogers, Braband, & Gaudino, in press). Further findings for the 2018 evaluation of the interview with photovoice adapted for the suffering course will also be offered for comparison.
Discussion and Implications
The findings from the pedagogical research have demonstrated promising congruence with the new Pedagogy of Suffering Model (Braband, Gaudino, & Rogers, 2015; Gaudino, Braband & Rogers, 2017) by providing students tools from multiple disciplines for deepening their critical reflection based on direct encounters with persons who suffer or grieve. The interview and photovoice project offer students a holistic process, supported by contemporary educational neuroscience, for critical thinking, learning, and change (Costa & Costa, 2016; Kirsch, Urgesi, & Corss, 2015). Encouraging students to actively discover and express images supports the integration of their feelings and reflective learning about challenging encounters with suffering and grief (Lown, 2016; Moffett & Fleisher, 2013; Montgomery, 2013). These educational innovations and the pedagogical framework continue to offer promising results that better prepare students to effectively accompany those who suffer and grieve with informed and compassionate care.
Conclusion:
The collaborative interprofessional faculty partnership has yielded many benefits including the opportunity to reach across our disciplines to discover more “common ground” than differences. The evolution of strong professional and personal relationships and the development of a new Pedagogy of Suffering Model have offered a supportive base to continue to develop and broaden our own views on suffering and grief, as well as our teaching skills surrounding palliative care. Our work has given us confidence and motivation to continue to pursue further innovations and evaluative research to address students’ challenges to learning and growth in this area. We are committed to preparing clinicians with more developed personal and professional coping skills. With the focused faculty guidance and accompaniment that our collaborative project has developed, students are learning to more effectively embrace their encounters with clients who suffer and grieve.