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Thursday Review: “Enabling Narrative Pedagogy: Listening in Nursing Education”

Writing in the journal Humanities, Wendy Bowles addresses the question, How do nurse educators who enable Narrative Pedagogy experience Listening: knowing and connecting?

This article discusses the education of nurses in light of the “Concernful Practices” framework for Narrative Pedagogy, and centers on its “Listening: knowing and connecting” element. Bowles specifically presents how “Listening as Dialog” is present in nurse educators who implement Narrative Pedagogy strategies. Bowles is specifically addressing one facet of one element of an academic classification aimed at one specific profession.

If that sounds like a niche presentation, you’d be right. Bowles work exists inside the discussion of a specific set of tools. After reading the paper, though, let me see if I can zoom out, and give a broader context for why I think some of the elements Bowles writes about are compelling.

I’ll begin at the end, with the conclusion of Bowle’s Discussion. I’ll see if I can pull apart — piece by piece — why her discussion is useful outside of nursing education:

By attending to listening and responding to a dialogue, nurse educators are able to connect with how students are thinking about nursing care, address their understanding of the content, and help interpret how the content relates to the critical care of patients. The focus towards the student as a person allows nurse educators a way to attend to the dialogue at the moment and address the student’s biases and decision-making processes in patient care at that time.

[My emphases]


“Dialog” and “dialectic” are big words in philosophy and communication. Bowles never makes this explicit, but by centering on “Listening as Dialog”, she’s emphasizing that even when only one person is talking, there’s still dialog happening.

Students of acting are taught to make monologues interesting by turning them into inner dialogs. There has to be some reason a character is talking to themselves. The archetype for this is Shakespeare’s famous To be, or not to be. There are two “characters” present in that one sentence: one advocating being, and one advocating not being.

On a more abstract level, film students are taught that when recording a person, there are always two characters present: the actor and the camera. The fact that we are hearing our own words or hearing someone else’s presupposes that there are at least two individuals: the listener and the hearer, and two individuals means there is dialog happening.


In the framework of Narrative Pedagogy as explained by Concernful Practices, “Listening” is subtitled “knowing and connecting”.

It is a central complaint of patients that doctors aren’t listening, even if they’re silent. To connect with someone is to listen to their story, fully and without judgment. In her article, Bowles writes of a nurse educator whose students had a profound moment of realization after reading about racial privilege:

Well, this past week in class a woman that … grew up in Kenya … was the first person to talk and that was the first time in three weeks that she’s said more than a couple of sentences at a time … [The student] started talking and had a five-minute, almost a soliloquy about the difficult topic of power and privilege and how unless you are a person of a different color you don’t understand that. … That was really interesting. There was silence a little bit afterwards. … And a student, sort of leaning [forward], very thoughtfully said, “Wow, I hadn’t really thought about it like that before.”

Only when the abstract ideas are connected with a person who has experienced them can we know both the idea and the person.


A connection by means of listening reveals this dialog. If we give a speaker our attention not for the purpose of responding, but for the purpose of listening, we soon hear not only the speaker’s thoughts, but our own thoughts, as well.

Bowles mentions Heiddiger’s view that silence is an essential possibility for dialogue. In the silence after the Kenyan nursing student spoke, only then did another student acknowledge, I hadn’t really thought about it like that before.

The idea that listening and telling are intertwined goes back to Ursula K. Le Guin’s essay on the subject.


The awareness of our own thinking and our own understanding of what’s right in front of us is key for a deeper knowledge of our profession. It’s difficult to address an issue that we never acknowledge as an issue. As an example of how this relates to medicine as a whole, in Jerome Groopman’s book How Doctors Think1, Groopman — himself an MD — recommends asking a doctor who seems certain of a diagnosis, “What else could it be?”

This question isn’t meant to second guess a physician. It’s an attempt to help the thinking process of a professional who’s probably pressed for time. By asking, “What else could it be?” the doctor is called on to rearrange the symptoms in their own mind to see if there’s a possibility they might have missed.

Connecting with our own thinking means we can better address the issues which are right in front of us. If intellectual knowledge were enough for understanding, an essay on, for example, racial privilege would be enough. It isn’t. Something experienced by a colleague in close, everyday physical proximity (for example, a Kenyan-born student), can’t be addressed without this connection and thinking.


Talking about Narrative Pedagogy, or narrative in general, it’s important to note that content is still important. In medical education, one can’t become a doctor without knowing the various symptoms of pathologies, just like one can’t become a nurse without knowing the functions of various electrolytes.

Bowels discusses a nurse educator who is frustrated at the lack of dialogue around that exact topic: When we cover a topic like fluid and electrolytes, I think it gets a little, I don’t know, it gets a combination of boring, or I’m a little over [the students’] heads.

The author discusses Narrative Pedagogy being “phenomenological”, in other words, a way of learning concerned with our personal experience of the world.

The Concernful Practices provide faculty and students with a new way of talking about their experiences that exceeds (but includes) the common focus on content, objectives, or outcomes throughout nursing education2.

It’s important that any professional learn the basics of their profession, whether it’s riveting, or dull like learning terminology associated with electrolytes. It’s equally important that professionals learn about their own personal interaction with those skills, which is the point of the Concernful Practices.


More than just phenomenology, Narrative Pedagogy is “hermeneutic phenomenology”. Narratives and stories help us interpret and understand the world around us.

An understanding of content is the first layer of learning. An understanding of what someone else thinks and feels about that content is another layer. The next layer is understanding my relation to that content and my relation to the other person and their thoughts and feelings.

To emphasize the last layer, the relation, is to emphasize the story that includes us both. This is the reason for “narrative pedagogy”: learning how to construct meaning and interpret it via narrative.


If learning is only an understanding of content, the relationship between student and teacher is one-dimensional. This dissemination of facts is the furthest that some educational methods ever get.

Parker Palmer’s The Courage to Teach3 emphasizes that a teacher is not a loudspeaker blaring knowledge. A teacher is an active facilitator who brings an object for study into the presence of students, and gathers them around it as investigators. Parker explains that the specific method isn’t important, whether lecture or hands-on learning, it’s the attitude of group investigation that matters.

Bowels mirrors these ideas:

The communal experience was neither teacher-centered nor student-centered, but rather teachers and students were learners together. Rossetti and Fox4 indicated characteristics of successful teachers were those who continued to learn along with the students and continuously refreshed their knowledge. The communal experience draws on the knowledge already known and builds interpretive practices to envision new ways of thinking.

Importantly, Heather[, one of the successful teachers the author interviews,] is not quiescent in the discussion she described, but rather she participates in the discussion by asking questions and inviting other students to contribute to the dialogue as it unfolds.


The focus on dialog and listening always serves to emphasize the fact that patients and healthcare providers alike are people. As health systems are increasingly routinized and automatized, emphasizing narrative always returns us to the profound simplicity that healthcare is a person caring for a person.

Noddings5 identified how educators can shift the way they think about teaching towards a focus more on the student as a person. Heather referred to this as “preserving the personhood” of the students.


One of the additional benefits to an awareness of one’s own thinking on a given topic is the challenge to biases. Dialog and listening reveals one’s own thought processes that might happen unconsciously:

So [the student] was actually able to verbalize through that dialogue and the reflection on the dialogue to actually realize something about herself and her own beliefs. I think anyone, any health professional, that’s absolutely crucial, isn’t it? … As a professional, you have to acknowledge your own beliefs, put them to one side… I thought that was a really good thing to happen through dialogue and could all be verbalized and then hopefully when she goes into practice, she can just put that in the back of her mind. It’s not going to come bubbling up again.

Patient Care

And that is the cornerstone of all of this Narrative Pedagogy: more effective patient care. Bowels’ article begins with a reminder that the landscape of health care delivery systems has changed dramatically in the past twenty years.

The complexity of those systems demands that all healthcare workers, not just nurses, are able to listen to, understand, and connect with an increasing variety of coworkers and patients.

It’s not good enough to merely have medical knowledge, it’s essential that healthcare providers know the meaning of their own work and thinking, and are able to address it when possible. That ability is to listen and to acknowledge one another not as another item to process, but as a person to be listened to, is becoming more and more important.


The article reviewed: Bowles, Wendy. “Enabling Narrative Pedagogy: Listening in Nursing Education.” Humanities 5, no. 1 (2016): 16.

1 Groopman, Jerome E. How Doctors Think. Houghton Mifflin, 2008.

2 Ironside, Pamela M. “Using Narrative Pedagogy: Learning and Practising Interpretive Thinking.” Journal of Advanced Nursing 55, no. 4 (August 2006): 478–86.

3 Palmer, Parker J. The Courage to Teach : Exploring the Inner Landscape of a Teacher’s Life. Jossey-Bass, 1998.

4 Rossetti, Jeanette, and Patricia G. Fox. “Factors Related to Successful Teaching by Outstanding Professors: An Interpretive Study.” The Journal of Nursing Education 48, no. 1 (January 2009): 11–16.

5 Noddings, Nel. Caring: A Feminine Approach to Ethics & Moral Education. University of California Press, 2003.

Featured image: Cropped from “Paediatric nurse with infant” by Adrian Wressell, Heart of England NHS FT, part of the Wellcome Collection, shared under a Creative Commons BY 4.0 License.