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Nurse Education in Practice 11 (2011) 179e185

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Nurse Education in Practice

journal homepage: www.elsevier.com/nepr

Using a storyboarding technique in the classroom to address end of life

experiences in practice and engage student nurses in deeper reflection
Sue Lillyman a, *, Robin Gutteridge b,1, Pat Berridge c, 2
a
University of Worcester, Henwick Grove, St Johns, Worcester WR2 6AJ, UK
b
University of Wolverhampton, School of Health and Wellbeing, ML113, Off Deanery Row, Wolverhampton WV1 1DT, UK
c
Birmingham City University, Birmingham City University Faculty of Health, Seacole Building, Edgbaston Campus, Birmingham B15 3TN, UK

a r t i c l e i n f o a b s t r a c t

Article history: This paper evaluates the use of storyboarding within a classroom setting as a means of addressing end of
Accepted 29 August 2010 life issues and engaging second year student nurses in creative, critical thinking and deeper reflection on
practice.
Keywords: Storyboarding is a process that was developed to encourage learners to use the creative right brain and
Storyboarding the critical left brain to formulate ideas in front of a group and then to look at those ideas critically
Deep reflection
(Lottier, 1986). The session was evaluated using a questionnaire and group discussion to elicit perceived
End of life
learning from students. The activity was to create the storyboards in small groups, then review the
Nurse training
content generated by discussion with the whole group. Main themes identified by the students included
breaking bad news, dealing with cardiac arrest situation, coping with families following bereavement
and the dying patient. Evaluation of the teaching session suggested that students found storyboarding
helped to identify cultural aspects and feelings related to the dying patient. Students valued sharing with
each other and the opportunity to have their experiences heard. It was noted that although this method
provided as valuable learning experience for the student it is staff and time intensive and attention is
required to establish a climate of trust and safety. The risk of exposing unexpected emotions within
individual students appears no greater than with other approaches to teaching about loss, death and
dying.
Ó 2010 Elsevier Ltd. All rights reserved.

Introduction ‘end of life care needs to be embedded in training curriculum’s at all

In 2008 the United Kingdom Department of Health produced
their ‘End of Life Care Strategy’ (2008) which states that of half
a million people dying in England each year fifty eight percent die
in hospital and seventeen percent in care homes. Compared to this
total of seventy five percent, only eighteen percent of people die at
home (although this percentage may shift with current policy
drivers to deliver care closer to home).
Wherever they encounter dying patients health care students
are expected to manage patients receiving end of life care, their
relatives, last offices and other procedures according to the DH.
* Corresponding author. Tel.: þ44 1905 542277.
E-mail addresses: sue.lillyman@hotmail.com, s.lillyman@worc.ac.uk (S. Lillyman),
Robin.gutteridge@wlv.ac.ukr (R. Gutteridge).
1
Tel.: þ44 1902 518641.
2
Tel.: þ121 331 7054.
levels and for all staff groups’ (DH, 2008:pg 14).
Cooper and Barnett (2005) suggest that nurse education has
a duty to explore effective means of supporting the student in this
area of practice. A review of the pre-registration nursing pro-
gramme by the teaching team concluded that end of life care and
last offices were addressed within the curriculum but required
further development to meet the local needs of NHS Care Trusts
within the geographical region. This change aimed to provide
student nurses with practical skills necessary to offer safe, effective
care and the interpersonal skills to facilitate a high quality experi-
ence for these patients and their families. The team were keen to
include an interactive process that would facilitate reflection upon
and learning from clinical experiences and assist students in
making the transition towards autonomous learning.
The Department of Health strategy (2008) notes that UK, society
tends not to talk openly about death and dying. Moreover, with
improvements in life expectancy many people do not encounter
a close family death, or see a dead body until their middle age. The

1471-5953/$ e see front matter Ó 2010 Elsevier Ltd. All rights reserved.
doi:10.1016/j.nepr.2010.08.006
 Author's personal copy
180 S. Lillyman et al. / Nurse Education in Practice 11 (2011) 179e185
storyboarding approach encourages the students to discuss holistic
care of the dying patient within the classroom setting and specif-
ically encourages them to reflect upon and identify their feelings,
concerns, anxiety and development as a result of encountering
death and dying in practice.
Although people die at all stages of life the Department of
Health note that two thirds of people who die are over 75 years of
age. Nevertheless, Gott et al. (2008) found that despite the new End
of Life strategy (2008), older people continue to die with unmet
physical, spiritual, psychological and social needs in situations that
do not respect their individuality and dignity. This lack of basic care
requires attention in nurse training curricula. Costello (2004)
suggests the way a society approaches death and dying is
evidence of the underpinning value placed on life: ‘ death is much
more than an outcome of dying and is the single most important
social factor of human existence (Costello, 2004: pg 178).
For this reason the curriculum team decided to position end of
life care within a newly revised module about ‘care of older people’.
The topic was designed to facilitate consideration about the end of
life and its final outcome, death, as the last phases of a perhaps
lengthy life journey, with continuing opportunities for involvement
and choice by the patient and their carers (Erikson et al., 1994). The
team wanted to introduce the notion that death is a natural process,
not necessarily a failure, and to ensure and that a well managed
death can be a life enhancing experience, not merely for the patient
and their families but also for the supporting staff. Even from this
more positive perspective, the team felt it important to create a safe
environment for the students. The storyboarding technique was
selected as it provides rich opportunities to interact with groups of
learners and real opportunities for the teachers to behave as facil-
itators/enablers and to share, if appropriate some of their own
experience, anxieties and strategies for managing these. Story-
boarding is also a means to enable students to discuss not only
positive and negative experiences of being with dying patients but
also to identify the components of safe, effective, high quality care
that they would wish to provide for patients in their future careers.
The teaching team have now used a storyboarding technique in
this module for more than twelve months. Students were asked to
evaluate the process and outcomes and these are discussed later in
this paper. However, evaluation, by both students and the teaching
team, was positive and the purpose of this paper is to suggest this
approach may be applicable to other health professional curricula
to facilitate learning about sensitive aspects of care.
Literature review
Teaching end of life care to student nurses is a challenging topic
that can provoke anxiety (Cooper and Barnett, 2005). Matzo et al.
(2003) suggest an interactive process that stimulates critical
thinking should be used. Although there is evidence of story telling
(Spouse, 2003) and narratives (Loftus, 1998; Greenhalgh and
Hurtwitz, 1999 and Elwyn and Gwyn, 1999; Newman, 2003) there
is little evidence within the current literature about the use of
storyboarding within nurse education.
What is storyboarding?
Storyboarding is said to have originated with Leonardo da Vinci
(Lottier, 1986) and then adapted and revised by film makers (Barnes,
1996). It encourages the students to share a story and engage in
narrative story telling. It is a technique used by some medical
colleagues (Greenhalgh and Hurtwitz, 1999; Elwyn and Gwyn, 1999;
Newman, 2003) and in nurse education by Loftus (1998) and Spouse
(2003) who used it with six student nurses in relation to their expe-
riences of sudden death. Reviewing story telling and narrative based
medicine Greenhalgh and Hurtwitz (1999) state that these
approaches involves the student living through their experience as
opposed to having knowledge about a subject and then telling their
story about that experience to a wider audience. Loftus (1998) also
notes that a story telling approach allows the students to identify
issues that are important to them. Matzo et al. (2003) suggests that
strategies exploring student’s experiences are effective types of
teaching methodology in relation to teaching loss. Through their story
telling students are able to rearrange ideas quickly and easily into
a pattern or sequence, step back, look, and then rearrange again
(Lottier, 1986). This process can help develop critical thinking
through questioning and sequential thinking as described by Fornis
and Peden-McAlpine (2007) thus providing contextual learning.
Newman (2003) suggests the human brain processes stories more
fully than other stimuli and they also note that impact is greater when
the storyteller is recounting their own experience. Spouse (2003)
proposed that this approach helps students to reframe self image
and develop further professional understanding.
Hunter (1991) noted that despite the science that underpins
clinical practice, practitioners and patients make sense of the world
by way of stories. Sternberg (1985, 1996) argues that this type of
story telling can enhance effective function. Sternberg’s Triarchic
Theory of Successful Intelligence argues that intelligent behaviour
arises from a balance between analytical, creative and practical
abilities, and that these abilities function collectively to allow
individuals to achieve success within particular sociocultural
contexts. As Ghaye et al. (2008) pointed out that we do not need
‘collected wisdom’ but instead ‘collective wisdom’, a coherent
integration of our diversity that is greater than any or all of us could
generate separately. Newman (2003) argues that stories are very
powerful memory stimuli because they were important means of
transmitting cultural identity, norms and traditions, before the
printed word. Storyboarding approach takes narrative story telling
a step further. It is useful with larger cohorts of students and by
committing that story through the written word and pictures onto
paper, it is a technique which encourages all students to engage in
the story being told and become practically involved.
The process of storyboarding
Benner and Wrubel (1989) argue that if students are to develop
caring attitudes and relevant skills they must open themselves to
the needs of other people. The team felt that this is potentially
a very sensitive area of practice and vulnerability in a professional
context needs containing within safe supportive boundaries. As
this study was deemed to be an evaluation of learning and teaching
which is expected professional practice in the Faculty where the
study was conducted, formal ethical approval was not required.
However, the team felt there were potential ethical issues to be
addressed, so advice was sought from the Faculty Ethics Committee
during the planning process. Prior to the timetabled session,
students were offered the opportunity to opt out of the session and
undertake directed study instead. Information about the content of
the session, advice about the decision to opt out and signposting to
sources of support and guidance were published on the module
website. Attention was paid to creating a safe, trustworthy envi-
ronment and rapport within the group and with the teaching staff.
Ground rules such as confidentiality and respect were paramount;
the sessions were timetabled generously to allow plenty of
opportunity to pause for guided reflection and discussion. Safe self
disclosure is important because the session is a learning process,
not a therapy group, although students were informed that
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S. Lillyman et al. / Nurse Education in Practice 11 (2011) 179e185
members of the teaching team were available for debriefing and
support outside the sessions. Information about Student Counsel-
ling services was also provided. If they wished, students could also
use the module web based discussion forum for post-session
reflection and discussion.
The classroom session was designed for second year nursing
students who had had some experience of clinical practice: almost
all had encountered a patient receiving end of life care.
Students were asked to work in self-selected groups of 6e8 to
encourage groups to work alongside peers with whom they felt
safe. Working in small groups helped to ensure there was time to
hear each other and was designed to be less daunting for those un-
used to sharing such personal experiences in a larger group. All the
group members were encouraged to share their stories within the
group and unhurried time was allowed for this. Spouse (2003)
reported the immense satisfaction and benefits experienced by
students sharing stories about their practice. The teaching team
were careful not to intrude on small groups facilitating some
discussion only when student groups signalled their need for this.
In general it was evident that students quickly began to support and
evaluate practice with each other. Some students may feel guilt
when patients die, due to perceived inability to fulfil their moral
commitments (Kelly, 1998) and the teaching team were alert for
disclosures of this type, responding with unconditional acceptance
of all negative and positive emotions but also attempting to offer
challenge where necessary, for example, if stereotypical views were
expressed or learned beliefs were posited as moral truths.
Once students had shared their stories, each group was provided
with a long piece of paper (from a roll of lining wallpaper) and
a selection of coloured pens. They were asked to adopt one story
from the group and be ready to present this to the larger group. This
self-selection allows the group to select a story that is not too
emotive for the storyteller to share within the larger cohort.
181
Once the group had negotiated a story to share, they were asked
to divide their paper into six equal boxes. The whole group were
encouraged to tell the story through words and drawings (see
photos). Each box was divided into three sections. In the top section
students were asked to describe an incident or stage in the process
of care in one or two words. In the adjacent bottom section,
students were asked to record their feelings about that particular
part of the story. In the middle section of each box, they were
invited to illustrate either feelings or story with pictures. This
process is designed to suit a variety of learning styles but is an
active process. However students who describe themselves as less
creative or preferring a more didactic approach felt they could still
relate to the session with their experiences and are able to apply
theory to practice during the final stages of the session. Engaging
the whole group in the activity also helps to contain emotion whilst
also raising the energy level of the group. Student’s evaluations of
the session suggested that many found storyboarding an enjoyable
activity and included comments such as: ‘ it is not my learning style
but I have enjoyed the lesson’, ‘it improved my confidence in public
speaking and group work skills whilst at the same time exploring
atopic’ and ‘ a different way of learning and forming discussion’.
Once the story was committed to paper, each length of paper
was exhibited for the larger group to see. Time was given so
students could read each other’s story; students were encouraged
to walk round the classroom, read through the stories and talk with
other groups. To draw the session together the facilitators then
engaged with each storyboard in turn, inviting each small group to
tell their story to the larger group. One facilitator guided the
discussion, helping students to engage in critical thinking. Initially
the other facilitator acted as an observer, alert for signs of distress
or withdrawal. Both facilitators worked jointly to support the group
in relating their experiences to theory and to develop deeper levels
of reflection (see below).
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182 S. Lillyman et al. / Nurse Education in Practice 11 (2011) 179e185
Participants
Storyboarding had not previously been used within the Faculty
and to date, six student cohorts have now experienced the story-
boarding session. All cohorts were second year, pre-registration
student nurses completing the Diploma in Higher Education
Nursing and Degree programmes.
Evaluating the process
Following positive verbal evaluations by the first pilot group of
students, a more detailed evaluation was used with successive
groups. Evaluations were designed to appraise student perceptions
about their learning and, if learning was occurring, how students
felt the storyboarding approach had enhanced their learning. Forty-
one students completed the questionnaire out of a cohort of fifty-
four, a 76% response rate. Student evaluation of teaching is
controversial according to Spooren et al. (2007) while Shelvin et al.
(2000) report that other traits such as the presenter’s personality
and skills influence the session. Nevertheless, student evaluation is
a commonly accepted and required means of evaluation within
higher education (Ballentyne et al., 2000).
The course team designed a qualitative questionnaire that
sought to identify perceived learning as well as views about
storyboarding as a teaching method. This was distributed to the
whole group at the end of each session. Open questions were used
in order to elicit perceptions about the content and delivery of the
session. Questions were developed from verbal feedback received
by the pilot student cohorts and related to key pedagogical aspects
of teaching and learning. The first two questions asked the
respondent to make a judgement about the session in relation to
usefulness and perceived impact on their learning. This helped the
module team to evaluate the content and stage of learning for
future curriculum development. Students were also invited to offer
any other constructive comments relating to their learning and the
storyboarding approach. The teaching team also shared their
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S. Lillyman et al. / Nurse Education in Practice 11 (2011) 179e185
perceptions about the value of storyboarding in an open discussion
following completion of the questionnaires.
Ethical considerations
Ethical reflection as a joint activity requires sensitivity towards
student stories ‘Humans have a moral requirement to understand the
purpose of their own actions, for personal integrity and ethical duty
towards other people’ (Regan, 2008: 220) Consent was implied by
the student’s willingness to participate in the session. Oral consent
was obtained regarding use of their storyboarding pictures.
Anonymity was preserved by the absence of identifying markers on
the pictures and evaluation forms. All students were informed that
they could opt out of the session and the evaluation process if they
wished. However, even if managing a personal bereavement,
individuals were encouraged to participate if they wished, being
assured that the staff were available and competent to contain
distress. One of the teaching team is a trained counsellor and all
have substantial pastoral experience. Only one student left the
session as they had encountered a recent family bereavement and
found the subject too emotive at that point in time. This student
was followed up by the teaching team and personal support
offered. Post session support was also offered to the entire group
should they want to discuss individual issues in a confidential
setting. A smaller number of students availed themselves of this
opportunity. A number of these students wanted to share their
feelings about the positive impact of their learning experience.
Data analysis
The storyboards were photographed after the session and copies
of the pictures offered to the students for their own portfolios.
Storyboards were then reviewed by the team to identify
recurringthemes.
These themes included
 Negative experiences and concerns about developing compe-
tence to break bad news
 Dealing with a cardiac arrest situation
 Coping with families following bereavement
 Practicalities and emotions when caring for a dying patient.
Student evaluation questionnaires and staff responses to the
teaching session were read and re read until saturation of data was
achieved and analysed through content analysis approach
described by Holloway (2008). Recurring statements, situations,
feelings and codes were categorised until identified themes
emerged in relation to the learning process. Students noted the
approach to learning, cultural aspects, shared feelings related to the
dying patient and the value of sharing stories with each other in
common with Spouse (2003) students found their stories and the
facilitated discussion provided reassurance that their practice was
an acceptable level and that competence and skills could be ach-
ieved. Students comments included: ‘it was useful to compare other
student’s experiences and feelings of death to my own’, and ‘ I found it
useful as it allows us to share our own experiences of dealing with
death with others and also making me feel I was not the only one going
through this’.
Validity and reliability
The storyboard pictures belonged to the student and it was
evident from their story telling that these were genuine stories. The
questions used in the evaluation process were unambiguous and
focused on the student’s perceptions. It was made clear that this
183
evaluation was about the session and not for the whole module.
There was no follow up evaluation to establish the extent to which
learning about end of life care had actually transferred into the
clinical setting. However this transfer of learning has been inves-
tigated by a member of the module team in relation to communi-
cation with patients about sensitive and taboo topics and will be
the subject of a further paper.
Findings from the evaluation
From the questionnaires thirty-nine students (n ¼ 41) found the
session useful describing the time for sharing with others very
useful and encouraging that they were not alone with their feelings
about end of life care. One student did not find the session useful
but noted this was because the small group did not select their
personal story. However this student had been observed to
participate in the larger group activity.
Also, as identified by Spouse (2003), thirty-one students found
the session was reassuring in relation to the care they offer or are
expected to provide to the patient receiving end of life care. One
described the session as ‘fun’ and others felt they had learnt about
cultural aspects, last offices, how to manage their own and relatives’
emotions following the death of a patient. Students also reported
learning that death can be positive and how nurses are positioned
to ensure dignity at this stage of life.
Students were unanimous about the positive aspects of having
time to discuss their own feelings and components of high quality
care with their peers and the supportive nature of the story-
boarding approach when relating learning within the larger group.
Their comments for the evaluations included: ‘ helped by listening to
other people’s stories.’ and ‘it bought people out of their shells to
work together by telling personal experiences helped people connect
with each other’. Spouse (2003) also noted that some students,
especially the quieter student, can also gain a vicarious learning
experience that can assist them in formulating their own suitable
actions if they were ever faced with the same or similar situation in
the future.
Overall, analysis of student and staff evaluations suggested that
a high proportion of the students achieved critical thinking and
deeper reflection. Also that students enjoyed integrating their
personal experiences, finding this collective group critical reflec-
tion a helpful and supportive way of discussing death of a patient in
a teaching and learning session within the university. Again
student’s comments included: ‘ learnt more about different experi-
ences’ and ‘covered areas of my training I was unaware of’.
Themes from the storyboarding
When evaluating their narrative approach with lived experi-
ences of six students Loftus (1998) identified six themes including
dying with dignity, suddenness and deterioration and death, the
vulnerability in caring, guilt and lack of support from staff
members. Using the storyboarding approach to end of life care
elicited similar themes from students. In addition our students also
identified several other themes that are more important in their
developing practice:
 Decision making for not resuscitating a patient
 Beliefs and practices around death and dying in different
religions
 Lack of confidence when dealing with cardiac arrest situations,
 Communication and interpersonal skills for approaching
a family
 Understanding the boundaries of care
 Author's personal copy
184 S. Lillyman et al. / Nurse Education in Practice 11 (2011) 179e185
 Support expected by families from professional staff when
a patient is dying.
Comments from the student evaluations included: ‘gained full
understanding of different religion and last offices,’ ‘how patients
prefer to pass away’, ‘different experiences people may encounter’,
‘how to deal with different emotions’ and that ‘dignity of patient is
paramount’.
When reviewing the storyboards the majority of the students
chose stories where they felt care had been less than adequate, or
they felt unprepared, ill equipped or insufficiently supported. A
number of stories recounted sudden death from cardiac arrest
situations or sudden deterioration of the patient and many
described lack support from other staff when a patient is dying or
following death. During the facilitated discussion it was important
for the teaching staff to acknowledge and accept these accounts but
also to indentify positive aspects of caring for patients who are
dying and their families.
Although one student had not engaged with their group in the
individual story telling, all the student evaluations suggested
storyboarding was a valuable and different way of learning.
Facilitating critical thinking and deeper reflection
Freshwater et al. (2005) noted that reflective practice is widely
adopted as a successful method for developing nursing practice and
therefore integrated within nurse education. The storyboarding
approach aims to develop critical and sequential thinking, linking
theory to application in the lived practice experiences of students
themselves, rather than a more didactic input from the teaching team.
Student evaluations suggested this was a positive approach in the
student’s evaluation with comments such as ‘good to create the
storyboard and discussion rather than just being talked to.’. Spouse
(2003) described the listeners’ ability to use story to reflect on their
own experiences. Regan (2008) concluded that this type of group
critical reflection on practice is a significant process, because it
provides space for the thinking necessary to enable deeper reflection.
Once the storyboard was completed and the story shared with
the whole group the facilitators acted as a resource to help create
meaning for the story. The intention of the teaching team was to
assist the students in synthesising the theory and practice of end of
life care. This co-created critical dialogue may be especially
important if the experience was a negative incident for the student
and/or patient because it may offer redemption to a student whose
confidence has been affected and help prevent repetition of poor
practice. Johns (1995) suggests the deconstruction and recon-
struction of a story can help confront difficult issues and reframe
thinking and behaviour. Elwyn and Gwyn (1999) suggest decon-
structing the dialogue enables sense to be made of the story.
It ‘starts out from what is actually happening e not from what
appears to be happening, or what our initially limited understanding
leads us to believe is happening’ (Svensson et al., 2008: 8). Hemlin
et al. (2004) and Lideway (2004) both propose that facilitation
and sharing can help students understand and cope with the
realisation that power, politics and resources limit action, as well as
providing opportunities for new and more creative approaches. As
recommended by Ghaye et al. (2008) facilitation included
purposeful questions, carefully constructed to attract the student’s
attention to the theory and practice of the subject being studied.
Fornis and Peden-McAlpine (2007) suggest that in order to
incorporate this reflective, dialogical, critical thinking approach, the
tutor must enable movement beyond logical reasoning to encourage
synthesis, so that the rationality and justification for actions within
the context being discussed may be evaluated. Sternberg (1985,
1996) argues that this high level cognitive thinking process must
seek not merely achievement of answers but also achieving
a coherent understanding within the context of a situation.
Habermas (1971) recognised the social values of reflection in
practice development, advocating reflective dialogue through social
interaction. The benefits of group reflection were also noted by
Bennett and Danezak (1993) and Sinclair and Harrison (2001). Pololi
et al. (2001) suggests group reflection helps decrease feelings of stress
and isolation, as illustrated by one student evaluation in this session:
‘I felt stupid at first sharing my story as I though the group would
laugh at me however most had had the same experience and now I
can move on.’
Translating learning into practice
Although this has not been demonstrated in the current study,
the intention of this approach is to develop nurses who are confident
in critical thinking about their practice and the policies underpin-
ning end of life care. Fornis and Peden-McAlpine (2007) suggest this
will lead to demonstrable improvements in outcome: in relation to
effectiveness and patient experience of care The stories belong to the
student group and are therefore real and current.
Practitioners have a moral requirement to understand the
purpose of their own actions, for personal integrity and ethical duty
towards other people (Regan, 2008) especially when managing and
supporting the final tasks of care. As Dame Cicely Saunders, founder
of the Modern Hospice, was quoted in the Preface to the End of life
Strategy stated ‘How people die remains in the memory of those
who live on’ (DH, 2008).
Overall, storyboarding provided an effective way of stimulating
theoretical learning and group critical reflection about end of life
care among these cohorts of pre-registration nursing students. It
was an enjoyable way to draw on student’s personal experiences and
provided space for sharing of those experiences about working with
patients receiving end of life care. Through story telling facilitated
discussion by the teaching team, aspects of care and theoretical
content were discussed and explored. The application of gained
knowledge has yet to be evaluated within the workplace. However,
extracts from the student evaluations below emplify the value of the
experience and the potential likely impact on future practice
‘The session was valuable as it helped me to see the importance of
what to do when someone is dying’
‘It was a good way to discuss some sensitive areas of practice’.
We acknowledge the limitations of a storyboarding process
arising from unknown or undisclosed student group dynamics,
individuals who may be hesitant or uncomfortable about sharing
personal experience and those who do not feel confident their
tutors are trustworthy or supportive. Time needs to be allowed for
the group to become confident in sharing their stories and to
honour the process of co-creating meaning. There may be insuffi-
cient time or timetabling constraints that limit the possibilities of
using storyboarding within a course programme.
It is important not to raise student expectations that all their
individual anxieties can be addressed, or their individual stories
shared in the large group. It is essential for skilled pastoral and/or
counselling staff to be available directly following the session and
the ensuing days to assist with any questions or counselling needs
of individual students. The session is also staff intensive and when
dealing with such an emotive subject should include two lecturers
so that any student becoming upset during the session can be
supported outside the class without constraining the whole group.
It maybe necessary to address undercurrents of anxiety that may
remain unspoken in the group, so in common with all semi
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S. Lillyman et al. / Nurse Education in Practice 11 (2011) 179e185
structured and student centred teaching methods, storyboarding
requires detailed planning and skilled teachers who are able to
integrate their pastoral counselling, reflective and empathy skills
into formal teaching.
Conclusion
This paper has described how a module team used and evalu-
ated storyboarding to engage student nurses in deeper learning and
reflection about managing patients who are receiving end of life
care. This paper is based on student and staff evaluations of a small
number of sessions utilizing storyboarding for a specific topic of
care within one university in the UK. Nevertheless, the team feel
that this approach could be applicable to other subjects and across
other courses within health and social care and this has since been
used with post registration students on leadership and manage-
ment programme and is currently being evaluated.
Further study is required to evaluate transfer of learning to the
workplace.
Acknowledgements
The authors would like to thank the students at Birmingham
City University for their participation in the storyboarding and for
allowing us to use their photos and evaluations in this paper. We
also extend our thanks to Tony Ghaye for introducing us to this
innovative approach to teaching.
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