Purpose: This project highlights implementation of SHOWeD, an arts-based strategy, as a teaching method used to promote affective learning in an interprofessional clinical experience in Nicaragua.
Design/Methods: Faculty from the College of Health Professions collaborated to develop an interprofessional clinical experience in an underserved area of Nicaragua using the Interprofessional Core Competencies for Collaborative practice (IPEC, 2016). The SHOWeD method, (Schaffer, 1986), a common technique employing photovoice methods, (Woodgate, 2017), was utilized with students from laboratory science, nursing, and respiratory care. During this clinical experience abroad, students were encouraged to take photos they found personally meaningful and were also provided daily photo journaling prompts designed to enhance self-awareness. After completion of the study abroad and in preparation for a group summative debriefing, students were asked to identify and submit a favorite and a least favorite photo. For each self-selected photo, students were then encouraged to reflect and provide written responses to the five SHOWeD questions; “What do you see here?” “What is really happening here?”, “How does this relate to our lives?” “Why does this situation exist?” and “What can we do about it?” Faculty compiled the submitted photos into a PowerPoint presentation which was viewed by all participating students and faculty. During the viewing, each student was provided one to two minutes to share their photos and personal reflections. Upon conclusion of this viewing and reflective sharing, students responded in writing to the following four questions; 1. What factors influenced your choice of the favorite and least favorite photograph you submitted? 2. How did the sharing of other team members’ photos expand your experience? 3. Reflecting on your team members least favorite photos, what image(s) stand out and why? 4. Reflecting on your team members most favorite photos, what image(s) stand out and why? Written answers, oral narratives, and the photos were compiled, analyzed, and coded to provide insight into themes and student reflections of using the SHOWeD technique.
Results/Findings: Eighteen nursing students, four laboratory science students, and two respiratory care students participated in this project. Students identified emotional responses to situational experiences as influencing their choice of photos selected to submit for presentation to their peers. In choosing their least favorite photo, student’s selected images that reflected moments when they were feeling ineffective, out of place, or not contributing to the situation at hand. Their most favorite self-produced photos had a connection to personal experiences from home, were related to the practice area they hoped to pursue, or reflected moments when they perceived they were making a difference in the community being served.
In addition to reflecting on their own photos chosen for presentation, students were also asked to reflect on those photos selected by their peers. Images that were least favored among the group were those that reflected the stark differences between the Nicaraguan community and their own communities. Oddly, these photos did not include people. Photos that were most favorite among the group reflected themes of joy, remembrances of beauty, human resilience, and commonalities of people from different cultures. When asked how sharing of other tema members' photos expanded their study abroad experience, students responded that they were better able to understand the varied perspectives of other group members. They recognized similarities in photo themes even though group members had different backgrounds, motives, and desires.
Impact:
Based on student’s responses and faculty observations, the SHOWeD technique utilized in this interprofessional approach impacted this group of students by providing an avenue to engage interprofessionally and enhance affective learning. Choosing and reflecting on self-produced photos encouraged development of the affective domain of learning by capturing meaningful moments, which many times cannot be achieved by written journal, essay, or oral story telling. The act of sharing their photos and reflections with other group members helped the student’s develop mutual respect as they recognized shared values, increased their knowledge of other professional roles, and encouraged relationship building.
Discussion/Implications: Nurse educators involved in collaborative interprofessional education efforts must adopt and master strategies to promote affective learning and self -awareness that will ignite the interdisciplinary groups’ ability to maintain a climate of mutual respect and shared values, increase the knowledge of their own roles and those of other professions, and learn to communicate with other health disciplines and apply relationship- building values and principles of team dynamics to provide health programs. (IPEC, 2016). Arts-based reflection is an effective teaching strategy that can be used to encourage learning within the affective domain (Ondrejka, 2014). The SHOWeD method is one strategy that should be considered. Findings from this project indicate that students enjoy the participatory nature of these activities and believe them to be effective learning activities. Further research is needed to provide evidence of changes in values, behaviors, or critical actions that result from using this method in collaborative interprofessional learning.
Conclusions: As nurse educators participate in interprofessional education, it is essential that evidenced based teaching strategies be used that encourage affective learning focused on achieving competencies established by IPEC. The SHOWeD method of teaching is one approach that shows possibility with this challenge.