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Nurse Education in Practice 11 (2011) 159e164

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Nurse Education in Practice

journal homepage: www.elsevier .com/nepr

Challenging the shock of reality through digital storytelling

Gemma Stacey a,1, Pip Hardy b,*

aDivision of Nursing, University of Nottingham, London Road Community Hospital, London Road, Derby DE1 2QY, United Kingdomb Patient Voices Programme, Pilgrim Projects Limited, 91 Waterbeach Road, Landbeach, Cambridgeshire CB25 9FA, United Kingdom

a r t i c l e i n f o

Article history:Accepted 9 August 2010

Keywords:Digital storiesProfessional socialisationReality shockReflectionPatient Voices

* Corresponding author. Tel.: þ44 7721 751784.E-mail addresses: gemma.stacey@nottingham.ac.uk (G

co.uk (P. Hardy).1 Tel.: þ44 1332 347141x2558.

1471-5953/$ e see front matter � 2010 Elsevier Ltd.doi:10.1016/j.nepr.2010.08.003

a b s t r a c t

The transition from student to qualified nurse is widely acknowledged to entail a difficult period ofadjustment, involving significant personal and professional challenges. Kramer [1974. Reality Shock e

Why Nurses Leave Nursing. Mosby, St. Louis] originally described this as a “reality shock” due to thedissonance experienced between the expectations of the newly qualified nurse and the actuality ofclinical practice. This experience continues to be echoed throughout the literature exploring factorsinfluencing the quality of compassionate care, post-qualification support strategies, and attrition rates.Despite this, the phenomenon of a reality shock appears to have been accepted as an inevitable aspect ofprofessional socialisation.

This paper aims to report on an educational development which attempted to challenge these negativeexperiences and outcomes. The Division of Nursing at the University of Nottingham worked alongsidethe Patient Voices Programme (www.patientvoices.org.uk) to create reflective digital stories of newlyqualified nurses. In their own words and using personal photos, the newly qualified nurses relate storiesabout an event that they have found particularly challenging during the transition from student to nurse.The stories were intended to provide opportunities for future students to learn and educationalists toreconsider the curriculum to facilitate preparation for the world of clinical practice.

A learning environment was developed and piloted that utilises the digital stories to encouragestudent nurses to reflect upon the challenges of this transition by engaging with the storytellers,empathising with their experience and considering ways they might respond in similar situations.Evaluation of this educational forum suggests that the digital stories offer the audience a uniqueopportunity to walk in the shoes of the storyteller. As a consequence, an altered story might be toldthrough encouraging newly qualified nurses to develop their core strengths and, in doing so, maintaintheir capacity to care.

� 2010 Elsevier Ltd. All rights reserved.

1. Literature review

The evidence base that reports on the transition from student tonewly qualified nurse acknowledges that it often entails a difficultperiod of adjustment involving many significant personal andprofessional challenges. Kramer (1974) originally described thisphenomenon as a ‘reality shock’ and defined it as ‘the reactions ofnew workers when they find themselves in a work situation forwhich they have spent several years preparing and for which theythought they were going to be prepared, and then suddenly findthey are not’. This experience continues to be echoed throughoutthe recent literature exploring the lack of post-qualification supportstrategies, low job satisfaction and high attrition rates (Robinson

. Stacey), pip@pilgrimprojects.

All rights reserved.

et al., 2005; Forsyth and McKenzie, 2006). The consequences aresignificant as the coping strategies that newly qualified nursesemploy to rectify this dissonance are shown to have negativeeffects on quality of care andmaintenance of person-centred values(Mackintosh, 2006). Despite this issue being reported first in 1974,the phenomenon of a ‘reality shock’ appears to remain and seemsto have been accepted by education and practice as an inevitableaspect of professional socialisation.

The process of professional socialisation, often described in theliterature, suggests that the nursing profession exists as a powerfulstructural reality and that newcomers are little more than passiverecipients of knowledge who are being moulded into what theprofession defines as ‘good’ professionals. Clouder (2003) explainsthis apparent conformity in two ways: ‘learning to play the game’and ‘presentation of self ’. Playing the game involves becomingaware of rules, both written and unwritten, and learning to complywith the systems in place. This process requires recognition of thepower differentials inherent in being a newcomer seeking to join

G. Stacey, P. Hardy / Nurse Education in Practice 11 (2011) 159e164160

the profession. Clouder (2003) recognised that students perceivea need to present or act in accordance with expectationsthroughout the identification process. Clouder (2003) draws uponthe work of Goffman (1959) who emphasises how people negotiatedaily life and make conscious decisions about how they presentthemselves in the public arena to fit in with social practices iden-tified by the profession. It is, therefore, vital that newcomers beginto position themselves in relation to expectations.

Contemporary research into the professional socialisation ofnurses has also recognised the relevance of the values that areassociated with a profession. Fagermoen (1997) emphasises theimportance that values and beliefs play in shaping the profes-sional identity and consequent socialisation of a nurse, sayinga nurse’s identity is defined by these values and ‘represent herphilosophy of nursing,’ (p. 436). Similarly, Mackintosh (2006)identified a juxtaposition between different and opposing setsof values within nursing. Despite the assumption that a personalrelationship and emotional support are essential elements of thenurse’s role, Mackintosh maintains that this emotional caringethos is discouraged to enable nurses to prioritise-task-based careneeds. The result is personal disillusionment amongst nursingstudents and the development of cynical attitudes about thecaring aspect of their role.

Maben et al. (2006) attempted to consider the specific aspects ofnursing practice which may be contributing to this kind ofemotional and moral distress. This research indicates that althoughnurses emerge from their educational programmewith a strong setof professional values, a number of organisational factors sabotagetheir implementation. The factors at play include a lack of support,poor nursing role models, time pressure, role constraints, staffshortages and work overload. Kelly (1998) supports these themesand identified the importance of ‘preserving moral integrity’ as thebasic psychosocial process when newly qualified nurses adapt tothe ‘real world’ of work. She suggests moral distress results whennewly qualified nurses believe they are not living up to their moralconvictions and highlighted the prevalence of self-criticism andself-blame in this process. Here, newly qualified nurses becomeintensely aware of the discrepancy between their perceptions ofgood nursing and what they observe in practice. They cope withthis by redefining their perceptions of their role.

This process allows the student to rationalise the accepted poornursing practices rather than questioning or confronting them. Thisview is supported by Mackintosh (2006) who maintains thatnursing students are coping with this moral distress and identifiedthat the minority of students recognised the practice of poor rolemodels and rejected its influence. However, others rationalisedthese practices as a consequence of the working organisation or thetype of service users they were working with. Some felt that theability to ‘switch off’ from the emotional aspects of nursing practicewas essential to cope with the emotional demands of the nursingrole and therefore a skill which they whished to acquire.

A body of evidence presents a view of how established staff mayinfluence the experience of newly qualified nurses entering theprofession. Evidence suggests poor role models who devalue carehave been shown to cause personal disillusionment and havea negative influence on the maintenance of humanistic values(Greenwood, 1993; Mackintosh, 2006). Adding to this concern,several studies recognise the danger of newly qualified nursesbecoming desensitised to poor nursing practice habits and adoptingthem as their own (Greenwood, 1993; Holland, 1999). It has beensuggested that this can lead to a tendency amongst students to shifttheir self-identity in order to justify the loss of ideals and becomeproficient in their new role. Newly qualified nurses who initiallychallenge issues of concern are quickly discouraged if not supportedbysenior colleagues and so the disposition to resistmaycoexistwith

a desire to appear to conform. It is suggested that this process willhave a negative effect on newly qualified nurses, whomay lose theirskills as ‘knowledgeable doers’ and ‘confident analytical thinkers’ asthey become socialised into a culture where routine and task-basedwork approaches are more highly valued (Jowett et al., 1991).

Even more seriously, Brookfield (1993) referred to the term‘cultural suicide’ in suggesting that practitioners who choose totake ‘a critical stance towards conventional assumptions andaccepted procedures face the prospect of finding themselvesexcluded from the culture that has defined and sustained them upto that point’ (p. 200). This interpersonal conflict among nurses,termed ‘horizontal violence’, was explored byMckenna (2003) whoidentified this as a significant issue confronting new graduateswithin the nursing profession. This is the phenomenon underpin-ning nurses’ references to their profession ‘eating their young’(Longo, 2007, p. 177) referring to an act of subtle or overt aggressionperpetrated by one colleague toward another colleague (Mckenna,2003; Randle, 2003; Longo, 2007).

The research evidence offers a number of explanations for thecontinued experience of “reality shock” and the reasons whycurrent models of preparation for practice are not addressing thecomplexity of the issues. Despite this vast evidence base, it appearsthat there have only been limited attempts to prepare students forthis difficult transition process during their pre-registrationtraining. This paper will report on an educational development thathas attempted to challenge this negative experience. The devel-opment project encompassed 3 distinct phases. Phase 1 involvedthe development of 8 digital stories with newly qualified nursesfollowed by a focus group discussion on their experiences of thestory making process. Phases 2 focused on designing an educa-tional forum for the use of the digital stories through the facilitationof a workshop with individuals who had expertise in the area. Thefinal phase involved the implementation and evaluation of theeducation forum with student nurses.

2. Digital storytelling and Patient Voices

We learn, according to Dewey (1938) and others, not from ourexperience, but by reflecting on experience. Reflection is a key skillfor professionals, offering them ‘a structured means of studyingprocesses and challenges and making connections between theirpersonal and professional lives’ (Hardy, 2007). However, as Schön(1987) reminds us, ‘Stories are products of reflection, but we donot usually hold onto them long enough to make them objects ofreflection in their own right.’

The first stage of our project, therefore, offered eight newlyqualified nurses an opportunity to reflect on recent experiencesthrough the creation of their digital stories during a three-dayworkshop facilitated by Pilgrim Projects’ Patient Voices Programme.

The Patient Voices Programme is a social enterprise that aims tofacilitate the telling and sharing of the unwritten and unspokenstories of ordinary people’s experiences of healthcare in the hope ofinfluencing clinicians, managers and decision-makers to commis-sion, design and deliver more compassionate and humane health-care (Patient Voices Website) (www.patientvoices.org.uk). All ofthe stories in the Programme are created in small, carefully facili-tated workshops. The Patient Voices methodology has been refinedover the past seven years, based on the workshop process designedand developed by the Centre for Digital Storytelling (www.storycenter.org) over nearly twenty years.

Using techniques drawn from creative writing, communitytheatre, narrative and art therapy, storytellers are gently guidedthrough the stages of: considering the elements of a good story;sharing their initial story idea and developing it in the story circle;editing, refining and distilling the story to reveal its essence and

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discover its meaning; recording their story; selecting appropriatephotos; learning the basics of image and video editing; and, finally,becoming directors of their own movies. Storytellers have controlover their story at all times, and participate fully in every stage ofthe process that results in the finished short movie, so that the end-of-workshop premier is a true celebration of a significant accom-plishment, shared by storytellers and facilitators alike.

A careful, two-stage consent and release process ensures thatstorytellers are fully informed at every stage of the process andreinforces the sense of safety that allows storytellers to tell e andshare e uniquely personal stories that, paradoxically, often havedeep meaning for a wide audience. Unlike statistics, which canusefully reveal the system’s experience of the individual, storiesreveal the individual’s experience of the system (Sumner, 2008).Because stories touch hearts as well as minds, they remind us of ourcommon humanity and our shared need for compassionate andhumane care. Indeed, the digital stories have been shown topromote empathy and to sow the seeds of change in student nursesand others involved in delivering healthcare (Hardy, 2007).

Once released, stories are freely available for use in healthcareeducation and service improvement programmes via the PatientVoices website. Their brevity, authenticity and flexibility ensurethat they are widely used in medical and healthcare education(Hardy, 2007), while the licence under which the stories arereleased ensures that the integrity of the story will be preservedand the intentions of the storyteller honoured.

Stories created during a process such as that outlined abovehave been found to be particularly Effective, Affective and Reflec-tive (Sumner, 2008): they provide an effective means of conveyingimportant messages partly because they create a connection andtherefore affect the viewer. Created in a spirit of reflection, thesepowerful, short stories also prompt reflection in others, invitingthem to consider their ownpractice, whatever that practice may be,in the light of the storyteller’s experience.

3. Phase 1: the stories that emerged

Whilst the digital stories that were created do not claim to berepresentative of all newly qualified nurses’ experiences, the contentof the stories is supported by events reported in the wider researchliterature exploring this transition process. These digital stories reit-erated the overarching impact of a reality shock stemming from thegap between expectation and actuality. However, the cause of thisshock appeared to be varied and resulted from different challenges.

The stories that emerged related to the following issues andconcerns. Firstly, to the conflict thenewlyqualifiednurses experiencedwhen their values where questioned or disregarded by establishednurses (illustrated by Susanna Morris’ story, ‘Who is an expert?’ avail-able at www.patientvoices.org.uk/un.htm). This situation appeared toresult in the newly qualified nurses questioning their personal beliefsand identity as nurses due to lack of support and dismissal from thosethey were looking to for guidance. Discussions within the literatureregarding how values are shaped by the professional socialisationprocess are reflected in these stories (Fagermoen, 1997; Mackintosh,2006). The stories present detailed reflections on the potentialconsequences of negative interactions with established nurses whileoffering powerful illustrations of horizontal violence uncovered inprevious research (Randle, 2003; Longo, 2007).

A further issue related to the challenges of the therapeutic rela-tionship (Illustrated byRachel Hadland’s ‘Arewe there yet?’ availableat www.patientvoices.org.uk/un.htm). The content of these storiesrelates closely to the conceptof emotional labour,which refers to theinternal regulation of emotions required of nurses in order to adopta ‘workpersona’which still enables them to express their (surface ordeep) emotions during patient encounters. This concept has been

discussed by Huynh et al. (2008) who recognise that ignoring theimpact of emotional labour can result in nurses employingdefensivestrategies to enable them tomaintain emotional distance from theirpatients. The research on this issue in relation to professionalsocialisation implies that newly qualified nurses are encouraged byorganisational culture to ignore this aspect of their work in order toprioritise practical tasks (Mackintosh, 2006). These stories illustratethe personal impact on nurses of engaging on an emotional levelwith their patients and shed light on how this may becomeburdensome if ignored or unexplored.

The final issue relates to the emotional consequences of dis-tressing events occurring in practice (illustrated by Vicky Baldwin’s‘Maybe this just isn’t the right job for you’ available at www.patientvoices.org.uk/un.htm).

In these stories, newly qualified nurses described distressingincidents in their work and reflected on how these situationsimpacted upon them emotionally. These events representedextreme illustrations of emotional labour and storytellers’ reflec-tions mirrored those typical of reactions to traumatic experiences.Despite this, there appeared to be a lack of recognition fromwithinthe service of the longer-term consequences of these experienceson individual nurses. As a result the newly qualified nurses becameembarrassed by their reactions and felt the need to presentthemselves to others as coping, a response that reflects Goffman’s(1959) view about how people negotiate daily life and makeconscious decisions about how they present themselves in thepublic arena. Goffman refers to creating a ‘front’ or image of oneselfas an acceptable person and argues that such impressionmanagement is a fundamental component of all social interaction.These stories illustrate the ways in which the newly qualified nurseresponds to expectations in order to evoke confirmatory feedbackwhich may lead to the verification of conceptions about how theyshould behave as ‘professionals’ which, in turn, ultimately involvesattempts to “switch off” emotions (Clouder, 2003).

4. Evaluation of the storytellers’ experiences of the digitalstorytelling process

Thestorytellerswere invited totakepart ina focusgroupdiscussionto consider their experiences of the digital storytelling process. Thefocus groups were facilitated and analysed by the first author. Athematic content analysis was conducted, which involved identifyingcommon views and perspectives expressed by the participants. Thethemes that were generated were presented to the participants whoverified that they were representative of their experience. The focusgroup participants gavewrittenpermission for extracts from the focusgroup to be included in subsequent publications.

The group considered their motivation to create a digital storyand take part in the storytelling process. The most significantmotivation appeared to be underpinned by a desire to take theopportunity to reflect on their experiences. One participant stated:

‘Just to take a breath and think about that [incident] intensively fora couple of days meant a lot. I could have just carried on and on andon and not really processed it, whereas I was able to get away fromwork and talk about it.’

For other storytellers, the opportunity to create a teaching resourcewhich would communicate an important message was a motivatingfactor. These individuals felt dissatisfiedwith their own experiences ofthe transition process and passionate about making a difference forothers. They identified the digital storymediumas awayof expressingtheir experiences in amannerwhichwould command the attention ofeducators, service managers and even policy makers.

Despite these motivating factors, the storytellers found theprocess challenging for a number of reasons. Firstly, some felt

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conflict with disclosure of their personal experiences into thepublic arena. They felt this placed them in a vulnerable position asthey were allowing others to judge them, their feelings and theirpractice. For example:

‘I was worried about how people may judge my practice and whatwas the message they would take from the story.’

The storytellers also reflected on how surprised they were bythe emotional consequence of the process. Whilst they identifiedthis as a challenge, they also described it as a benefit, as they feltthis was due to the depth of reflection that they engaged in. Thiswas helped by them gaining validation on their reaction to eventsfrom sharing with others. One storyteller reflected:

‘When you speak about it you are quite detached e I speak about itbut I’m not really thinking e it’s just words. Whereas this made mestop and think for a longer period of time, away from work, withpeople who are nothing to do with my work, this was good, tovalidate my experience. It was really helpful.’

The storytellers were also reminded of how difficult theirexperiences had been and realised how they had already becomedetached from certain emotional elements of their work throughexposure and self-protection. They felt the storytelling processwould enable them to maintain an awareness of challenges andencourage them to offer support to future newly qualified nurses asthey developed through their career.

5. Phase 2: designing the learning environment

The second phases of the educational development involveda group of five educationalists with varied expertise in utilisingtechnological resources in education, developing safe learningenvironments for addressing personal development issues andpromoting skills for reflective practice. Additionally a member ofthe University counselling service attended to provide advice onapproaches to developing self efficacy and making links with thepersonal development workshops currently provided by thecounselling services. A focus group discussion was initially facili-tated to explore the group’s impressions of the stories, their viewson the potential use of the stories and any concerns they had aboutthe proposed development.

The group commented on the power of the medium of digitalstorytelling and the stories’ ability to communicate significantmessages in a short time. They felt that the content of the storiesreflected their experiences of the difficulties reported by newlyqualified nurses and reemphasised to them the vulnerability of thenewly qualified nurse.

‘I think you got over some really, really complex and subtlemessages in a beautifully simple, well-crafted way.’ (Counsellor)‘I think, you read it all the time and I’ve seen it in surveys but I don’tthink I’ve seen anything as powerful how it comes across in thestories.’ (Educationalist e Technology)‘It really communicates their vulnerability in the workplace, you sortof think, four years, all that training, they’ll be prepared for anything,but, well, they’re nothing like prepared.’ (Educationalist e Reflectivepractice)

There was a consensus that the stories should be used insensitive and safe environments, due to the potential emotionalimpact they may have on the student. While this was recognised asa strength of the stories, there were concerns about the implica-tions for the skills and confidence of the lecturers.

‘I think we have a moral responsibility to keep students safe andoften you don’t know what you’re letting yourselves in for until you

start opening the discussion up.’ (Educationalist e Personaldevelopment)‘There’s huge implications though for the teachers. Because there isa whole issue about managing students and emotional safety. You’vegot to think about the teachers skills in doing this and the teachers’emotional safety as well.’ (Educationaliste Personal development)

Despite the recognition that the emotional content of the storiespresented a challenge to the facilitators, itwas felt that the educationalexperience resulting from showing the stories would be extremelyvaluable. Thiswas due to their power to acknowledge and uncover theemotional vulnerability of the student group which some felt was notrecognised and therefore forced students to develop negative copingstrategies that are modelled and continually replicated in practice.

‘But it’s about somehow acknowledging that, it’s almost inevitablethat there’s going to be times when you’re going to hear somethingthat’s going to press your buttons and be tough for you to deal with,and that’s okay, but it is important to dealwith it, not to just squash itdown,becauseoftenyougetagroupofpeople togetherwhocopewithawful things by pulling the shutters down, do the defensive thing, yougive the message that you’ve got to tough it out.’ (Counsellor)

Following the focus group discussion, the group designed theenvironment which would enable a safe, supportive and reflectivelearning process to be initiated by the digital stories. A workshopformat was recommended to take place over one day with up to 15students and a facilitators guide was developed. Additionally,preparation sessions for facilitators were planned to enable skillsdevelopment and discussion of how student’s vulnerabilities couldbe safely explored within the classroom environment.

6. Phase 3: implementation and evaluation of theeducational development

Phase 3 of the educational development involved implementingand evaluating the workshops with 58 students in the final moduleof their pre-registration program. The students were asked tocomplete a semi-structured questionnaire to gain insight into theirexperience of taking part in theworkshop. All 58 students who tookpart in the workshop completed the questionnaire. Below are someof the comments made by students to illustrate their perspective ofthe learning process.

There were a number of comments which related to theauthenticity of the stories which appeared to enable students torelate to the storyteller.

‘It made my learning more meaningful and real.’‘I felt many newly-qualified nurses would feel the same way and ithelps to hear first hand from someone in a real life situation.’‘It made the session come to life.’

The students also acknowledged how it raised issues that wereof concern to them. This presented a challenge to somemembers ofthe group. However, it does support the hope that the stories can beused as a means of exposing students to some of the challenges themay encounter in a safe and supportive environment before theencounter them in practice where support may be less available.

‘It raised issues and problems which I had been thinking about inthe back of my mind.’‘I felt sympathy for the storyteller and fearful for my ownprogression to a qualified nurse in relation to the responsibility.’‘It was a good way of discussing these issues and to identify yourown that you perhaps hadn’t realised you had until this.’

Students commented on the reassurance they gained fromsharing their concerns with others and realising that others had

G. Stacey, P. Hardy / Nurse Education in Practice 11 (2011) 159e164 163

similar concerns through the group discussions. This suggests thatthe workshop also had a supportive function.

‘It helps you to realise the things you worry about are what othersgo through too, so you’re not alone.’‘I now realise that other people have the same worries as me andthat most people are feeling the same as I am.’‘It’s good to know I am not alone when I feel my confidence is not ashigh as it could be.’

The authenticity of the stories and reflective discussions alsoappeared to enable the students to place themselves in the positionof the newly qualified nurse and consider how they might respondto the challenges faced. This indicates that the students werestarting to recognise their personal resources that would enablethem to regain a feeling of control.

‘I recognised the fears, values and first expectations that thestoryteller had as what I would have. It was encouraging to see howshe dealt with them and that I am not on my own.’‘I felt I could relate to the feelings she was experiencing. It made melook at how I would deal with that scenario.’‘Makes you think about how you would act in this situation whichis good as it challenges your values and ideas.’‘I appreciated thinking about strategies for conflict resolutionand gaining a wider experience of seeing the points of view ofothers.’

The students were asked to compare this experience to otherteaching approaches which aimed to encourage reflective learning.The students identified that the open structure of the workshopgave them space to reflect whereas other approaches focused moreon teaching reflective models. They also identified that the story-tellers were modelling the reflective process, enabling them toobserve reflection in action. Some students noted that this helpedthem to go onto reflect on their own experiences.

‘Normal reflection sessions are set out and structured. I felt able toexplore more.’‘I have always struggled with reflection but listening to someoneelse reflect made me also reflect.’‘A lot better, more interactive and helped me to reflect in a deeperand more meaningful way.’‘Probably the most I have reflected on anything as I was able to putmyself in Susanna’s shoes as she was the one telling the story, notjust reading it.’

Fig. 1. Kolb’s learning cycle.

7. Discussion: a different kind of story

The distillation of experiences and emotions into a shortdigital story that has ‘clarity, purity and potency’ (Patient Voices,2009) appeared to offer profound opportunities for learning andgrowth for the newly qualified nurse storytellers. The opportu-nity for reflection and creative consideration of strategies thatmight enable the student viewers to cope in similar situationsleads to the kind of transformative learning that occurs as weunderstand and seek to be understood in a dialogue that allowsfor ‘redefinition through reflection and the accretion of newlayers of meaning’ (Mezirow, 1991). This project bears out thefindings in an earlier study which concluded that ‘the creationand use of digital stories, through careful facilitation, offersstorytellers and viewers the opportunity to grasp and transformtheir experiences and, in so doing, participate more fully in thecommunity, learning from peers and colleagues rather than fromexperts’ (Hardy, 2007).

The opportunity to exchange stories and engage in such a dia-logue at this stage in their nursing career is likely to both ease and

hasten the journey to qualified nurse. Full participation is, in turn,likely to ensure the kind of support and sense of belonging that hasbeen highlighted by students and newly qualified nurses alike as animportant factor in the transition process. The digital stories areone way of helping student nurses become more conversant withthe ‘activities, identities, artefacts and communities of knowledgeand practice’ (Lave and Wenger, 1991) that will help them masterthe knowledge and skill they need to take up their place in thenursing community.

It has been traditional to think of the stages of learning asarticulated by Kolb in his Learning Cycle (Kolb,1984) (see Fig.1) andit may be helpful to consider the stages of this project in relation toKolb’s model.

1) The newly qualified nurses’ stories are grounded in concreteexperience.

2) Observation and reflection are essential elements in the crea-tion of the stories, while sharing the stories allows others toobserve and reflect.

3) After seeing and reflecting on the stories, abstract concepts areformed about, for example, coping strategies.

4) These concepts can be tested out, initially in the workshopcontext and later, when concrete experiences in the early daysof practice will provide plenty of new situations for reflectionand observation. and so the cycle continues.

However, during this project, the authors have observed a newmodel of learning emerging. We have named this model, illustratedin Fig. 2, The Spiral of Growth Through Stories (SGTS), This modelextrapolates from and extends Kolb’s Learning Cycle, recognisingthat the potential for growth and learning extends beyond theindividual learner to a community of students, educationalists,preceptors and other audiences to initiate further cycles of learning.

In the centre of the SGTS spiral is the concrete experience, whichin this case, refers to the reality shock. The newly qualified nursesreflect on and create stories based on their experiences. Learningfor storytellers takes the form of new understanding about them-selves and theworld inwhich they nowwork. Sharing stories offerspreceptors, mentors, students, educators (and others) an opportu-nity to learn through gaining insights into the newly qualifiednurses’ world.

It is to be hoped that, as a result of seeing, and reflecting on, thestories, there will be changes in educational practice, not only forthe student group, soon to be newly qualified, who are now betterequipped to cope with the reality shock, but also in the practices ofpreceptors and educators, who now have a new set of tools with

Fig. 2. Spiral of growth through stories.

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which to prepare future students. The result should be differentstories, stories that tell of greater resilience and more confidence indealing with the reality shock, stories that reveal a greater capacityfor empathy and more humane care for colleagues as well aspatients.

The Nautilus shell provides a useful metaphor for nurtured,protected, supported and organic growth through stories that areexperienced, developed and sharedwithin communities of practice.

8. Conclusion

It appears that the digital stories delivered in this context offeran opportunity for students to step into the shoes of the storytellerand give insight into what can be a difficult journey, from therelatively safe and predictable world of university to the maelstromof clinical practice. This may enable them to identify personalstrategies to better manage this transition period. Careful consid-eration of the curriculum by educationalists to make more inten-tional use of these stories and others like them might enablestudents to be better prepared for the real world of clinical practice.Integration of the stories into mentor and preceptor preparationprogrammes could serve as powerful reminders of the challengesassociated with becoming a nurse. It is hoped that this would resultin different stories being told, stories that challenge the accepted‘reality shock’ through the development of a core strength and

robust support strategies which enable newly qualified nurses tomaintain the capacity to care.

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