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Patient Voices: The shock of reality


The shock of reality: stories from the University of Nottingham

These stories were created in a Patient Voices workshop in 2008.

Even the best education and training cannot prepare newly-qualified nurses for the often shocking experience of working on the ward or in the community. These stories were created by young mental health nurses in an attempt to explain the need for support and reassurance in those early days as they learn to navigate the responsibilities, difficulties and dangers of clinical practice.

The transition from student to qualified nurse is widely acknowledged to entail a difficult period of adjustment, involving significant personal and professional challenges. Kramer [1974. Reality Shock–Why Nurses Leave Nursing. Mosby, St. Louis] originally described this as a “reality shock” due to the dissonance experienced between the expectations of the newly qualified nurse and the actuality of clinical practice.

This experience continues to be echoed throughout the literature exploring factors influencing 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 of professional socialisation. This paper aims to report on an educational development which attempted to challenge these negative experiences and outcomes.

The Division of Nursing at the University of Nottingham worked alongside the Patient Voices Programme to create reflective digital stories of newly qualified nurses. In their own words and using personal photos, the newly qualified nurses relate stories about 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 to reconsider the curriculum to facilitate preparation for the world of clinical practice.

A learning environment was developed and piloted that utilises the digital stories to encourage student 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 unique opportunity to walk in the shoes of the storyteller. As a consequence, an altered story might be told through encouraging newly qualified nurses to develop their core strengths and, in doing so, maintain their capacity to care.

An article about the project, “Challenging the shock of reality through digital storytelling” by Gemma Stacey and Pip Hardy was published in the Nurse education in practice, March 2011.

True colours
As professionals, how do we care, and how much can we allow ourselves to care? As a young nurse, Gemma finds that the professional and emotional difficulties she must navigate have a deep personal resonance.

Are we there yet?
When Rachel qualifies she is idealistic, determined to help and fix her young patient. When circumstances mean that she cannot help her client reach the end of the journey, her resulting uncertainty and self-questioning are helped by the support and understanding of her professional peer group.

What if the relationship is not enough?
The human relationship between mental health nurse and client is one of the most powerful tools available to a mental health nurse. But when Gemma’s carefully-nurtured professional relationship with a client breaks down, what other avenues are open to her?

Who is an expert?
As an enthusiastic, committed, newly-qualified nurse, Susanna values and acknowledges her patients’ own expertise in their conditions and care, but can she maintain her belief when the system seems to feel otherwise?

Maybe it just isn’t the right job for you?
After qualifying, Vicky begins her career as a mental health nurse with excitement and enthusiasm, but when the therapeutic relationship with a patient breaks down dramatically, she is shocked and fearful. Is this the right job for her.

Breaking bad news: Is there a right way?
How should we break bad news? How can we train and prepare nurses for this situation? Early in her career, Rebecca is emotionally affected by a patient’s death. She is thanked by the family for her professionalism and friendly, caring manner – but her openness is seen by a colleague as wrong and unprofessional.

Nurse in charge
Heather has always wanted to be a nurse. A challenging night shift soon after qualification shakes the foundations of her belief in herself, but she is able to start the process of rebuilding through the small, but important successes that make up her day-to-day practice.

A cold sunny day in December
Lindsay is a committed, enthusiastic and newly-qualified mental health nurse – eager to learn and dedicated to caring. But one day, early in her career, she is brought face-to-face with aspects of practice that are totally in conflict with her vocation.

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