Content area
Background
As Abraham Maslow asserts, belonging is essential to achieving self-esteem and self-actualization. With increasing numbers of novice nurse burnout and a perceived education-practice gap, promoting a sense of belonging is important to nurses' growth and psychological well-being and should start in nursing school.
Method
An elective course, Belonging in Nursing, was developed to assist undergraduate nursing students in understanding the importance of belonging through narrative pedagogy. Course topics include the concept of belonging, managing moral distress, professional identity and boundaries, and readiness for practice.
Results
Student feedback was positive, including the promotion of belonging in the class through hearing others express their fears and doubts and an increased awareness of moral distress and professional boundaries.
Conclusion
Teaching Belonging in Nursing through narrative pedagogy aids in integrating this vital concept into the undergraduate nursing curriculum. Promoting belonging should start in nursing school and continue into novice nurse practice. [J Nurs Educ. 2025;64(7):e79–e82.]
With increasing numbers of novice nurse burnout, promoting a sense of belonging in nursing is vital for professional growth and psychological well-being (Patel et al., 2022). Belonging is defined in nursing literature as, “the perception of acceptance, security, and respect in the nursing profession,” which instructors should nurture in nursing school (Patel et al., 2022, p. 1). According to Maslow's hierarchy of needs, the motivation of love and belonging are situated above physiological and safety needs and must be attained before building self-esteem and achieving self-actualization (Ching et al., 2022).
To introduce this vital concept to undergraduate associate's degree nursing students with at least two terms of clinical experience, an elective course, Belonging in Nursing, was created. This course is not required for degree completion and is unique in that it utilizes the teaching method of narrative pedagogy with learning through storytelling. Narrative pedagogy is a powerful educational tool in which “instructors and students co-create, negotiate, and transform knowledge” through personal narratives that describe human experiences and assist in ascribing meaning to them (Armstrong & McCain, 2021, p. 61). Topics discussed in Belonging in Nursing include an introduction to belonging as a concept, moral distress, professional identity and professional boundaries, and readiness for practice.
While research shows that teaching concepts such as belonging in traditional undergraduate nursing programs is beneficial, the current nursing curriculum is robust, vast, and influenced by accreditors and boards of nursing (LeBlanc, 2021). Throughout a nursing program, nursing faculty are tasked to teach nursing students all they need to know to succeed on the national licensure exam, the NCLEX-RN®, and prepare them for entry-level practice, leaving little room for concepts outside the traditional curriculum. Due to robust curriculum and assessment requirements, there may also not be an opportunity to utilize narrative pedagogy effectively in undergraduate nursing courses, making an elective course a pragmatic option to introduce this teaching style.
Statement of Problem
With the high numbers of burnout reported in seasoned and novice nurses, the learning objectives of Belonging in Nursing were created to assist in combating that burnout risk in new graduate nursing students (Laws, 2022). Inconsistencies between imagined and actual nursing environments could lead to early career burnout and high turnover, increasing the nursing shortage and crisis staffing issues and decreasing patient safety (Rudman et al., 2020). Nurse burnout negatively impacts cognitive function and causes symptoms of depression and insomnia, which can affect a nurse's career (Rudman et al., 2020). Developing a sense of belonging in nursing can increase self-esteem, learning, motivation, and confidence, leading a new graduate nurse to want to continue working in nursing and decrease burnout (Ching et al., 2022; LeBlanc, 2021).
Research shows an education-practice gap in nursing, as reported by hiring managers and new graduate preceptors, secondary to the lack of higher-level concepts, such as belonging, being included in the nursing curriculum (Pillai et al., 2023). Belonging in Nursing was designed to help nursing students be better prepared to enter the nursing workforce equipped with the necessary communication and collaboration skills often seen as lacking in new graduate nurses (Pillai et al., 2023). Through narrative pedagogy, the students in the course are encouraged to share their experiences during discussions with the understanding that the course is a safe and nonjudgmental environment to do so. The goal of this practice is to provide students with professional communication tools they can carry into practice with the hope that they are not afraid to speak up to the health care team when needing to advocate for their patients.
Theoretical Framework
The narrative pedagogy model presented by Dvir (2021) is a guideline for Belonging in Nursing, with Steps 1 through 3 completed during the course and Step 4 completed after each session and at the end. Step 1, telling the story, is done by each student in the course as they tell personal stories when reflecting on the session topic. These stories serve as the basis for analyzing the presented issue, which is Step 2 of the narrative pedagogy model (Dvir, 2021). Interpreting and conceptualization, Step 3 of the model, occur during the wrap-up at the end of the session and are carried into Step 4, reflecting on the topic when each student posts their takeaway of the session on a discussion board (Dvir, 2021). Hsu et al.'s (2022) emphasis on self-reflection in narrative pedagogy is related to Dvir's (2021) Step 3 of the narrative pedagogy model and incorporated into the Belonging in Nursing takeaway discussion board. At the end of the course, the instructor compiles all the session reflections into a course summary sent to the students (Hsu et al., 2022). After completing the course, this summary helps students finalize Step 4 by integrating personal and theoretical knowledge (Dvir, 2021).
Method
Narrative pedagogy utilizes hermeneutic principles and constructivist epistemology to place personal narratives at the center of the teaching and learning process (Dvir, 2021; Hsu et al., 2022). When narrative pedagogy is used to teach professional development, the results show that it relies on a dynamic curriculum, the role of the learner is changed in the learning process, and the gap between emotional-personal and theoretical knowledge is bridged (Dvir, 2021). In other words, learning topics presented in a narrative pedagogical style stems from the analysis of personal stories and their relation to theory (Hsu et al., 2022). The steps taken in developing Belonging in Nursing include aligning course design with the narrative pedagogy model, creating course objectives, and developing course session content based on current research (Dvir, 2021).
Establishing Student Learning Course Outcomes
The Belonging in Nursing course description states, “Utilizing narrative pedagogy such as storytelling, discussion, and reflection to address the importance of developing a sense of belonging in nursing and how it affects integration into professional practice.” (Lambert, 2022). The course learning objectives for Belonging in Nursing, listed in the following, were established, considering that nursing students had little to no education on belonging as a concept in the nursing program.
By the end of the course, the student will be able to:
Communicate therapeutically with peers through discussion, reflection, and storytelling to develop an understanding and acceptance of diverse viewpoints
Develop an understanding of what belonging means and why it is important in the profession of nursing
Apply principles of managing moral distress and self-care to aid in developing a sense of belonging in nursing
Collaborate with peers during discussions to identify ways to establish a professional identity through belongingness
Create strategies for establishing a sense of belonging in nursing to carry into practice and patient care
Course Session Topics and Content
Belonging in Nursing initially consisted of four sessions conducted in a classroom set-up to enhance narrative pedagogy concepts of storytelling and discussion. The resources provided for each session include peer-reviewed articles, TED Talks, YouTube videos, and podcast recommendations. The students were instructed to watch or read the provided materials while considering the session discussion prompts. The resources are used to introduce each session, with the instructor highlighting key points to guide storytelling. Due to narrative pedagogy's dynamic, student-led curriculum nature, the session is deemed valuable regardless of how many discussion prompts are addressed, as long as the students are engaged in professional conversation through storytelling.
Session 1: Introduction to Belonging as a Concept. Session 1 introduces belonging as a concept and addresses what it is, what it affects, and how it can positively or negatively affect clinical practice. High-stress clinical environments can lead to nursing students' psychological stress and feelings of doubt about belonging in the clinical setting (Patel et al., 2022). The discussion of Session 1 centers around the importance of developing a sense of belonging to aid in psychological safety and security in practice.
Session 2: Moral Distress and its Effect on Belonging. Session 2 centers around moral distress and how developing a sense of belonging can help decrease its adverse effects on nurses. Seminal literature on moral distress defines it as knowing the right thing to do, but institutional or other constraints make doing the right thing impossible (Jameton, 1984). Research shows that moral distress is prevalent in nursing students, linking its development to fear of consequences and intimidating relationships with nursing faculty (Bordignon et al., 2019). Awareness of the risk of moral distress better equips new graduate nurses with the knowledge to recognize it in themselves.
Session 3: Establishing Professional Identity Through Belonging. Session 3 involves the concept of professional identity and how it can be developed through belonging. A secondary topic of professional boundaries and how they help maintain a sense of belonging is also discussed. While professional identity and boundaries are included in leadership content in the last term of nursing school, this discussion relates these concepts to belonging and professional practice.
Session 4: Preparation for Practice and Developing a Sense of Belonging. Session 4 centers around the importance of being prepared for practice, the education-practice gap, and how a sense of belonging can lead to more robust competency as a new nurse. Care was taken when introducing the research behind the education-practice gap to avoid teaching students to doubt the quality of their education.
Results
Student feedback was solicited utilizing an anonymous Institutional Review Board–approved questionnaire. Participation was voluntary, and an electronic questionnaire link was sent out to all students enrolled in the course after final grades were rewarded to avoid acquiescence bias of overly positive responses. Eight of the 26 students enrolled in the course during its trial period provided feedback (30.7%). All students enrolled in the course had at least two terms of clinical experience in the nursing program behind them. Standard demographic data was not solicited to avoid possible disclosure of student identity on the anonymous survey form.
Themes found in the feedback included participants developing a sense of belonging in the course as they got to know their peers better and heard their stories, feeling less alone, and enjoying the storytelling aspects of the course. When asked how this course helped them grow professionally, the following comments were received: “It was a safe space and allowed me to feel empowered and supported to move into (nursing) practice” and “I was able to voice, develop, and share my own experiences in a way that allowed me to process more of the person I want to be as I open this new chapter of my life.” When asked how narrative pedagogy assisted in learning about the concept of belonging, the overall theme was that the students enjoyed the storytelling aspect of the course, learned from each other, and “realized they were not alone (in their) personal struggles, thoughts, and experiences.”
The themes noted regarding the course aspects that the students enjoyed included the “small group dynamic,” “listening to each other's perspectives and honesty,” “the open discussion format,” and the “welcoming and relaxed environment” that was established. They appreciated that the course was instructor-guided but not instructor-led. In response to the use of the takeaway discussion board as a means of assisting in learning the concepts, responses were provided, such as, “Participating in the discussion board assisted in my learning because it was a space for reflection” and “It helped me process and evaluate my own feelings and insecurities about becoming a nurse.” When asked what could be improved, the overwhelming response was that the students wished the course included more sessions on the topics of imposter syndrome, overcoming fear, and sharing perceptions of each other's strengths.
An unintended benefit of Belonging in Nursing was the promotion of inclusivity while developing belonging within the naturally competitive environment of nursing school. This theme was expressed by quotes such as, “It helped me foster a sense of belonging with my peers and grow as a nursing student” and “I went from feeling like I was alone watching everyone else succeed around me to feeling like we're all on the same team, in this together.” All students expressed that they got to know classmates they did not previously know and realized that everyone struggles to some degree through quotes like, “It was interesting to hear how other students have the same challenges throughout nursing school as I do.” In creating a safe space for storytelling, the students felt comfortable being vulnerable and opening up without fear of retaliation or judgment, emphasized by quotes such as, “This is definitely the way I learn best, by discussion and feedback. It was so comfortable and really gave me the chance to feel I could open up and share.” Keeping the group small, with 26 students split into three sessions, helped this inclusivity and vulnerability happen.
Implications for Nursing Education and Research
Future research into integrating narrative pedagogy throughout a nursing curriculum is needed to expose more nursing students to this teaching style. Narrative pedagogy could be incorporated in elective courses (e.g., Belonging in Nursing), as part of a lecture, or during clinical postconference. Training adjunct faculty to utilize this in the clinical setting is another way to incorporate narrative pedagogy. Future research could include following up with students enrolled in Belonging in Nursing to find ways they have incorporated belonging into interactions with their peers in the classroom, laboratory, and clinical experiences. Ideally, this follow-up would be continued throughout the first year of their nursing practice to evaluate if knowledge of the importance of belonging aided in the adjustment to life as a new graduate nurse.
Conclusion
As Abraham Maslow asserts, developing a personal and professional sense of belonging is essential, making it a concept that should be prioritized in nursing schools (Ching et al., 2022). When belonging is perceived, it helps early career nurses feel valued as part of the team. Belonging can be emphasized in the practice setting by establishing a supportive and positive work environment where new graduate nurses feel included and welcomed by all staff (Ching et al., 2022). Another strategy to increase belonging in new graduate nurses is providing more education during onboarding on the unit expectations, patient population served, and commonly used skills to decrease the expectation vs. reality gap (Ching et al., 2022; Rudman et al., 2020). Incorporating these strategies into the practice setting enhances the belonging of new graduate nurses and aids in combatting early career burnout and reducing the education-practice gap.
Narrative pedagogy is an appropriate technique for teaching the concept of belonging. Making sense of personal narratives and feelings around belonging can help students recognize the importance of seeking it out and promoting it in practice. Due to the nature and stress of nursing school, developing belonging does not always happen. Because belonging is crucial to success in the clinical setting, the concept of belonging should be introduced to students early in their nursing school careers and emphasized throughout (Rudman et al., 2020).
Belonging is important. Sharing narratives and developing support systems in nursing is also important and should start in nursing school. Teaching an elective course, like Belonging in Nursing, through narrative pedagogy and its emphasis on storytelling is one way to accomplish this.
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From Central Oregon Community College, Bend, Oregon and University of Northern Colorado, Greeley, Colorado.
Disclosure: The author has disclosed no potential conflicts of interest, financial or otherwise.
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