Volume XXXII, No. 13 | April 23, 2010

The Nursing Troupe: Healthcare Learning from Theatre

Problem
“I’m afraid to talk to those patients; I don’t know what to say to them.” These remarks are shared by associate degree nursing students as they prepare for psychiatric clinical experiences. Students often are afraid to talk to clients who have mental illness. Many are afraid that they will say something to harm the patient. Others fear that their statements may antagonize the client and cause aggressive behavior. These fears and attitudes create difficulties for faculty in the development of teaching strategies that adequately prepare students to communicate with the mentally ill effectively. Through a collaborative effort with the Theatre Department, faculty at Southeastern Illinois College have developed a strategy to assist in alleviating some of the anxiety related to this experience, while providing quality acting experiences for theatre students.

Intervention
Lights, Camera, Action. As the actor enters the room, the nursing classroom becomes the stage, and members of the nursing class become the audience. The actor assumes the role of the mentally ill client. After being briefed by nursing faculty about signs and symptoms of a specific mental illness disease process, the performance begins. The actor may take on the role of the depressed client, which requires the student to utilize creative communication techniques to elicit a response from the client. The actor may portray the role of a paranoid schizophrenic and display symptoms of auditory hallucinations or delusions. Chairs or desks may be thrown across the room, indicating violent behavior. As a nursing student begins to conduct an assessment interview with the client, the client may respond by expressing thoughts of suicidal ideation or delusions of grandeur. The client may demonstrate a loss of interest in surroundings, or a total lack of emotion, or an inability to communicate effectively. As the performance continues, the actor may lash out at the student and require the student’s critical thinking skills to develop an immediate plan of action to maintain a safe environment.

Evaluation
Theatre: Acting for an informed audience—An actor or actress may be asked to play many parts in his or her career. These roles may range from characters close to their own personality and life experience to those asking them to stray far from their comfort zone. In most cases they are creating these characters as part of a scripted work by a playwright. The words are there for them to learn, the director will guide their motivations, and their fellow cast members (who are working through the same creative process) will serve as the characters with whom they interact. The audience, with the exception of the dramatic critic who is there to write his review, comes to the performance from a diverse background of theatrical experiences and expectations. They are there to enjoy a performance. They sit in the dark theatre, laugh at the jokes, cry at the tragic fate of the hero, and leave having experienced the magic of live theatre. While the “live” experience of a production is each a unique performance, the overall experience for the actor and the process he or she will go through will not be altered dramatically by the audience and their reactions.

Working with the nursing program has provided our acting students with a “once-in-a-lifetime” opportunity to hone their skills. This collaboration has provided our aspiring actors with a unique experience. They are able to put into practice the basic performance skills taught in the acting class in an interactive performance setting. In this “production,” the actor or actress is playing a patient with a predetermined illness. Unlike the security of a theatre where the audience is a “safe” distance away, the actor and the audience are working in unison to create the artistic experience as it happens. In this scenario, the role of the audience (the nursing student) is elevated to the same status as the actor (for they are acting, too). This “audience” comes to the “performance,” not for entertainment but for interacting with and gaining insight from the actor. The actor, in return, must constantly refine and redirect his performance based on the needs of and verbal cues from the “audience.” There are no words from the playwright, the director (essentially, the audience/nursing student) is guiding the performance as it happens, and the fellow actors (essentially, the audience/nursing students) are working with the actor in an interactive and ever-evolving process that has the successful completion of an agenda, that only the audience knows, as its goal. This is living theatre!

The partnership with the nursing program has been a tremendous learning experience for our theatre students. It is one thing to master the skills of improvisation when working with fellow students in an acting class. It is quite another to put these skills into practice in such a vivid and personal way. The interpersonal dynamic that exists between “patient” and nurse is not one that can be taught in a traditional acting class. It is one that must be experienced. It is essential that a well-trained actor be able to think on his feet and adapt to the uncertainty of live theatre. This exercise with the nursing classes has proven to be a powerful acting tool.

Nursing: A Successful “Dress Rehearsal”—As the nursing students conduct interviews with the “clients,” they practice therapeutic communication techniques. Students are forced to evaluate their emotions about the nurse/client relationship. They are required to think about client responses and the subtle messages within the responses. This learning opportunity allows time to evaluate the student’s fears related to communicating with the mentally ill. Some view this as a time to assess the rationale for their fears. Most discover that their fears are irrational and based on false beliefs.

After the theatre experience, the nursing class engages in valuable conversations. Classmates provide constructive criticism to those who “interviewed” the client. The critique provides an in-depth analysis of the interaction between the nurse and client. This analysis allows nursing students to evaluate skills necessary for developing effective therapeutic communication techniques to enhance the nurse/client relationship. Participation in this experience allows students to make decisions, assess the results of actions through the feedback, and learn how to adjust words and actions to produce more acceptable results.

Benefits
The benefits of this collaborative effort are remarkable. Both nursing and theatre students walk away with an increased knowledge base in their content areas. Students describe the activity as a fun and creative way to learn. Faculty view this learning opportunity as an innovative, effective use of resources and collaboration that ensures important student learning outcomes. Healthcare learning from theatre has evolved into a reciprocal educational experience with maximum benefits for all.

Gina Sirach, Faculty, Nursing
Allan Kimball, Faculty, Theatre

For further information, contact the authors at Southeastern Illinois College, 3575 College Road
Harrisburg, IL 62946.