Mutual Development through Authentic Relationships: Adventures, Journeys and Appreciative Stories of Service User Engagement in Student Nurse Education

Abstract

Current educational guidelines require clear evidence of the involvement of service users across the nursing curriculum, but give no real direction as to how to achieve this, or clarity about what would constitute successful engagement. There is a limited body of literature that specifically addresses service user engagement in the classroom and this literature is largely evaluative in nature, small scale, single site, often atheoretical and many do not include service user perspectives. The studies present evidence of the value of service user engagement, albeit not in great breadth or depth, but fail to critically examine the actual processes and practices that contribute to the perceived success of service user engagement in the classroom. This study seeks to develop and strengthen the current understanding of service user involvement in nurse education and the way in which it is enacted in the classroom setting. In this study, the term ‘service user’ encompasses people, carers and families with experience of healthcare who are involved in teaching sessions with pre-registration nursing students for the purposes of sharing their life experiences.
A participatory, Appreciative Inquiry approach was taken, using a series of appreciative workshops (n=8), observations of teaching (n=5) and interviews (n=3). These approaches ensured that there were opportunities for the participants to generate and share their stories and experiences of service user engagement. This participatory appreciative approach also ensured that all voices within the study were respected and that ethical considerations were attended to with high levels of sensitivity. These approaches also facilitated the critical consideration of the interactions, dialogues and relationships that occur between pre-registration nursing students, service users and lecturers. Data were analysed using a thematic narrative approach drawing on the principles of socio-narratology and considering three key components: setting, character and plot.
Three themes were identified: the first ‘real world as opposed to what?’ focuses on setting; the second ‘students, service users, lecturers - there is a togetherness about it all’ addresses the characters within the classroom; and the third ‘involving service users has helped me grow as a student nurse’ considers issues related to plot. The overarching meta-theme, ‘mutual development through authentic relationships’, encompasses the idea that service user engagement is more than merely an action carried out by service users (sharing life experiences) for the benefit of students in their development as compassionate nurses. Instead, service user engagement is a complex and mutual set of interactions and relationships between service users, students and lecturers. These interactions and relationships occur within a distinct setting, are grounded in authenticity (where authenticity is interpreted as something which is real, genuine or true), and influence the development of shared narratives of service user oriented practice.
The core contribution to knowledge from this study is summarised within a model of best practice for service user engagement that is built from the findings and based within contemporary theoretical thinking on service user engagement. The model presents a map of the journeys of students, service users and lecturers and the ideal classroom conditions for successful service user engagement. It also reveals the processes and practices that occur in classrooms and the profound, positive impact of service user engagement, such as nourishing the emotional lives of student nurses in a way that consolidates compassion. Recommendations for practice, policy and research are presented.