Table Of ContentListening to elders’ stories: Transforming nursing students’ perceptions about
gerontology nursing
Jeanine Robinson Tweedie
Master of Science in Nursing
Faculty of Engineering, Health, Science and the Environment
Charles Darwin University
A thesis submitted in fulfilment of the requirements for the degree of
Doctor of Philosophy
in Nursing
May 2012
Candidate's Declaration
I hereby declare that the work herein, now submitted as a thesis for the degree of
Doctor of Philosophy by Research of the Charles Darwin University, is the result of
my own investigations, and all references to ideas and work of other researchers
have been specifically acknowledged. I hereby certify that the work embodied in
this thesis has not already been accepted in substance for any degree, and is not
being currently submitted in candidature for any other degree.
Signature of Candidate: ___________________________________
Date: ___________________________________
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Abstract
When teaching gerontology nursing to nursing students, their preconceived ideas,
biases and prejudices associated with ageing become barriers to effective learning
and caring for elders. Nursing literature recommends that gerontology nursing
educators address these challenges by providing nursing students with positive
learning experiences with well elders. Listening to elders’ stories has been shown to
be a positive experience but little is known about how the experience impacts
nursing students.
This thesis explores the experiences of 15 baccalaureate nursing students in Hawai`i
who were interviewed to share their experiences listening to elders tell their stories.
Using the methodology of narrative inquiry and the method of life story, each audio
taped interview was restoried into a narrative text and analysed for emerging
themes. The major theme of liminal spaces represents the transitions that occurred
throughout the nursing students’ stories. The conceptual framework of cultural
safety and the philosophical position of Martin Buber informed this study of
gerontology nursing education and practice in relation to the balance of power in the
care of elders and the nurturing of relationship.
The key findings indicate that the nursing students were transformed both personally
and professionally by listening to the stories of elders. Consequently, they
discovered that the experience changed their attitudes and improved the way they
provided nursing care to elders. This supports the desired outcomes of gerontology
nursing education and confirms that listening to elders’ stories is a valuable
educational strategy.
Key words: cultural safety, elders, gerontology nursing, nursing students, life
stories, narrative inquiry
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Dedication
This thesis is dedicated to my parents,
both heroes to me,
each with memorable stories that have shaped my life.
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Acknowledgments
It is a joy to extend my gratitude and thanks to those who helped me along the way.
I am extremely grateful to the 15 nursing students who gave their precious time and
shared with me the gift of their stories. You taught me to treasure my own stories all
the more. With a greater sense of appreciation I now realise how the stories that I
heard growing up taught me valuable lessons that helped me stay the course and
complete this thesis.
I learned about taking a stand from stories about my grandmother’s response to
injustice, the importance of family from my grandfather’s story of the birth of his
children, the delight and desire to learn new things from my mother’s stories about
her childhood, and from my father I learned about the courage to bring freedom to
those in harm’s way.
My heartfelt thanks to Rose McEldowney, my primary supervisor. I cherish your
words of wisdom, encouragement, and spirit of joy. Thank you for helping me to
grow and learn. Thank you to Peter Brown for jumping in with gusto to also
supervise my learning with cheerful support and expertise.
The Faculty of Engineering, Health, Science and Environment at Charles Darwin
University provided me with much appreciated funding to travel to Darwin. Thank
you to the staff for their friendly guidance. Victoria University of Wellington
provided me with much appreciated funding to conduct my research interviews.
Thank you to Chris Walsh and others from Vic who also cheered me on.
The phone calls, emails and bouts of laughter from my buddies from Hawai`i, I
thank you for your warm aloha. My colleagues were also a big help as
intermediaries.
Most of all, my love and thankfulness to my family, especially to my husband and
three daughters, whose enthusiastic support inspired me to work hard and to keep
going.
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Table of Contents
Candidate’s declaration…………………………………………………...………. ii
Abstract…………………………………………………………………………... iii
Dedication…………………………………………………………………..…..... iv
Acknowledgments………………………………………………………………… v
Table of Contents………………………………………………………………… vi
List of Figures……………………………………………………………………. xi
List of Tables…………………………………………………………………....... xi
Chapter One Introduction and positioning of the study…………………..… 1
1.1 Aims and objectives of the study…………………………………….…….. 4
1.2 Justification for the study……………….…..………………...................…. 5
1.3 Background to the study…………………………………..……………….. 7
1.3.1 Teaching gerontology nursing……………………………………….... 7
1.3.2 Gerontology nursing curriculum revision……………………………... 11
1.3.3 Employing life stories as an education strategy …………………….… 13
1.4 Coming to know about cultural safety…………………………………...... 15
1.5 Overview of the thesis………………………………...………………....... 21
1.6 Summary of the chapter…………………………………………………... 23
Chapter Two Review and critique of the literature………………………… 24
2.1 Search strategy……………………………………………………………. 26
2.2 Ageing and nursing students……………………………………………….. 29
2.2.1 Social context of ageing………………………………………………... 29
2.2. 2 Attitudes of nursing students towards ageing and ageism…………….. 36
2.3 Addressing ageism through nursing education…………………….……... 43
2.3.1 Gerontology nursing through the lens of cultural safety……..…….... 43
2.3.2 Pedagogical strategies to address ageism…………………………….. 48
2.3.2.1 Didactic……………………………………………………….……. 49
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2.3.2.2 Experiential………………….……………………………….…..… 51
2.3.2.3 Learning elders’ stories…………………………………………….. 56
2.4 Summary of literature review……………………………………………... 60
Chapter Three Methodology, method and design………………………….. 63
3.1 Relationship and the philosophical positioning of Martin Buber………….. 64
3.2 Narrative inquiry ……………………………………….............................. 73
3.2.1 Narrative inquiry as methodology…………………………………….. 74
3.2.2 Meaning of experience…………………………………….………….. 75
3.2.3 Dimensions……………………………………………………………. 76
3.2.3.1 Place………………………………………………………………… 76
3.2.2.2 Temporality…………………………………………………………. 77
3.2.2.3 Sociality…………………………………………………………….. 78
3.3 Life story as method………………………………………………………. 79
3.3.1 Life stories in education and nursing………………………………… 80
3.4 Rigour and life story……………………………………………………….. 83
3.4.1 Credibility, transferability, trustworthiness and reflexivity………….. 85
3.5 Design of the study………………………………………………………... 89
3.5.1 Recruitment of participants…………………………………………... 89
3.5.2 Use of an intermediary………………………………………………. 90
3.5.3 Engagement in the recruitment process……………………………… 93
3.5.3.1 Confidentiality and informed consent…………………………....... 94
3.5.4 Maintaining cultural safety in the research process………………….. 95
3.5.5 Gathering of the stories from the participants………………………... 96
3.5.5.1 Story listening…………………………………………………….… 99
3.5.5.2 Story telling………………………………………………………… 99
3.6 Analysis and interpretation of the stories…………………………………. 101
3.6.1 Transcribed interviews……………………………………………….. 103
3.6.2 Analysis and interpretation of the stories…………………………….. 104
3.6.2.1 Representing their stories…………………………………………... 105
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3.6.2.2 Restorying: writing the narratives…………………………….......... 108
3.6.2.3 Thematic analysis across the stories……………………………….. 112
3.6.2.3.1 Development of themes…………………………………………. 113
3.7 Summary of the chapter………………………………………………...… 116
Chapter Four Individual stories……………………………………………. 118
4.1 The stories……………………………………………………………...…. 118
4.1.1 Jon: I wasn’t expecting that………………………………………...... 119
4.1.2 Kanewai: Good stories………………………………………............ 122
4.1.3 Josh: Always respect them……………………………..…………… 125
4.1.4 Nalani: Life changing event…………………………………............ 128
4.1.5 Clare: Passion………………………………...……………………... 132
4.1.6 Emma: Deep Love…………………………………………...…..….. 136
4.1.7 Ana: Living a good life……………………………………………... 141
4.1.8 Lily: Now I understand………………………..……………………. 144
4.1.9 Kaleo: Reminiscence………………………………………………... 148
4.1.10 Lucky: Building rapport…………………………………………… 151
4.1.11 Malia: Giving back………………………………………………… 156
4.1.12 Nora: Attached…………………………………………………….. 160
4.1.13 Kira: Field trips……………………………………………………. 163
4.1.14 Julia: Captured my heart…………………………………………... 166
4.1.15 Lena: Who turned on the light?........................................................ 169
4.2 Summary of the chapter………………………………………….………. 174
Chapter Five Story themes………………………………………………….. 176
5.1 Liminal spaces…………………………………………………………… 176
5.1.1 Story space: Threshold……………………………………………… 177
5.1.1.1 Story listening and content………………………………………... 177
5.1.1.2 World War II………………………………………………...……. 182
5.1.1.3 Personal struggles…………………………………………………. 183
5.1.1.4 Advice…………………………………………………………….. 183
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5.1.1.5 Obstacles and challenges……………………………………….…. 184
5.1.2 Light space……………………………………………………...….... 185
5.1.2.1 Being let in……………………………………………………….... 186
5.1.2.2 Changes in elders…………………………………………………. 188
5.1.3 Reflective space: Transformation…………………………………… 190
5.1.3.1 Grandparents………………………………………………………. 190
5.1.3.2 Life lessons………………………………………………………… 191
5.1.3.2.1 Life is a story………………………………………………….…. 192
5.1.3.3 Perceptions of elders transformed…………………………………. 192
5.1.3.4 Reflections on reflections……………………………………….…. 193
5.1.4 Caring space: Renewed vision………………………………………. 194
5.1.4.1 Like their grandparents………………………………….…….…… 195
5.1.4.2 Taking time………………………………………………………… 196
5.1.4.2.1 Listening as a modality of care……………………………..…… 196
5.1.4.2.2 Collaboration………………………………………………….… 198
5.1.4.3 Caring in the future…………………………………………….…. 198
5.2 Summary of the chapter……………………………………………......... 199
Chapter Six Discussion of findings…………………………………………. 201
6.1 Close relationships with elders…………………………………………… 201
6.2 Transforming attitudes…………………………………………………… 204
6.3 Shaping participants’ lives……………………………………………….. 208
6.4 Commitment to providing care to elders……………………………….… 209
6.4.1 Learning to care with elders…………………………………....……. 211
6.4.2 Culturally safe care……………………………………….……......... 216
6.5 Summary of the chapter………………………………………………….. 218
Chapter Seven Conclusion………………………………………………….. 220
7.1 Methodological reflections………………………………………………. 220
7.2 Issues of power and ethics in the research process…………………..…... 221
7.3 Key findings for nursing education and practice………………………... 223
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7.4 Implications of the study……………………………………………….... 226
7.5 Implications for research………………………………………………… 230
7.6 Final Reflections………………………………………………………… 231
Appendices…………………………………………………………….………. 234
Appendix A………………………………………………………………….. 235
Consent form to participate in the research project
Appendix B………………………………………………………………….. 236
Participant information form
Appendix C………………………………………………………………….. 238
Memorandum from Convener VUW HEC, 11, April, 2009 re ethical
approval to undertake PhD research project
Appendix D………………………………………………………………….. 239
Memorandum from Chair Hawaii IRB, 15, April, 2011 re ethical
approval to undertake PhD research project
Appendix E…………………………………………………………………... 241
Participant recruitment flyer
Appendix F…………………………………………………………………... 242
Conversational interview guide
References………………………………………………………….…….......... 243
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