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Putting a piece of poetry into practice

Ann Robinson focuses on the use of poetry as an aid to develop skills, in the use of reflective practice, to improve communication and raise levels of self-awareness. It offers practical advice on how to introduce the idea of using poetry in every day nursing practice

Ann Robinson
BSc(Hons) RGN
District Nursing Sister
Meadowside Medical Practice

Reading and writing poetry is increasingly recognised as a valuable resource in nursing either within care delivery or in educational settings.(1,2) It has the potential to benefit patients, relatives and health professionals alike.
In an article last year (NiP 2006;30:104-8), Sue Spencer stated that using poetry in her teaching had helped experienced nurses regain a sense of perspective and proportion in their busy working lives.(3) I endorse this sentiment and have written on the use of poetry in palliative care, and also given talks to general practitioners on palliative care courses.(4)
Sue's article made me think again particularly around initiating the use of poetry within everyday practice given the pressures of our daily work routines. I wanted to do it in a practical way that would be nonthreatening to nurses who may not have thought about poetry being used as a tool to aid reflection or self-awareness.
Gillie Bolton, in her book Writing Works, offers practical advice and exercises on how to use writing in this way.(5) Feeling inspired by my reading I decided to have a go.

Setting the scene
I was working as a district nurse team leader on a weekend shift. There were six other colleagues in the team of different grades and experience. It was a very warm sunny October Sunday afternoon, the team had just finished their morning visits and a clinic session in the district nurse base. It was an unusually quiet weekend. The phone had not rung and there were no new visits to attend. We were just about to have a handover before lunch so I thought this would be an ideal time to ask my colleagues to take part in a creative writing exercise.
The aims were:

  • To raise awareness of the benefits of creative writing.
  • To gain experience of writing "freely".
  • To develop writing and listening skills.

I also wanted to ensure that the session would be fun and that my colleagues would enjoy the experience. I knew that there might be some hesitation at the thought of writing poetry. In order to establish a "safe" group and to break down any potential barriers or reservations they may have felt about the use of poetry, I emphasised that there is no such thing as bad writing and that spelling, punctuation and grammar were not an issue. I also wanted to keep the session upbeat so I suggested we choose something positive, enjoyable or something that had gone well during the course of our morning's work to write about.

Method
The idea was to write a collective/group poem.(4) This was developed by asking each person to write a sentence, then fold the paper over and pass it to the next person, and so on through the group (a bit like the game children play called consequences). The poem created is shown below - it has been edited very slightly to make it flow.

[[nip39_poem_80]]

Discussion
The session worked well as a taster to introduce some of the benefits of poetry into nursing practice. The process of coming together as a team and writing collectively had many positive outcomes. It created a spontaneous opportunity for team building and facilitated discussion and reflection on various issues, such as how does one ask or answer awkward or difficult questions. A team member offered creative suggestions as to how the session could be adapted and used in her own team. The poem brought out the fact that as district nurses we feel it is important to consider patients holistically, and part of this can be summed up by one of the lines from the poem - "The small things in life make all the difference". One nurse, who admitted to feeling unease at the beginning of the session as she did not know what to write, wrote these words: "We shared the sunshine, laughter and a few tears". For me, this illustrates what poetry has the potential to do, to say so much in just a few words. Another nurse who was also initially apprehensive about the thought of writing was moved to write the following reflective account on the session.

Reflection on an "Experiment" by Louise Sutcliffe*
It was Sunday afternoon and I had returned from my morning visits and was about to commence my computer journals, when I was asked by one of the sister's if I would like to participate in an experiment, an idea that she wanted to try out. Myself and six other members of staff were all asked to think about something positive we had experienced or felt that day. We had to condense our thoughts into one sentence and write it on a piece of paper. The same piece of paper was sent around the room, folding it over each time so that no one could read the previous statement. Once it had been completed by everyone in the room it was read out and discussed openly within our small group.
Writing freely was an activity that I regularly undertook throughout my own personal and professional development. In spite of this I initially felt apprehensive and hesitant about this particular exercise, which was possibly due to expressing my thoughts in a group environment. I was trying to think of something that had really stood out that morning, but all that came to mind were the small but extremely valuable aspects of my day, such as passing on a smile, a caring touch and being able to connect with others through verbal and nonverbal communication. I presumed that these would be too insignificant for this exercise, but the piece of paper arrived on my lap, so, without much more thought, I wrote the following line:
"The sun is shining, I am happy, and feel privileged to do the job I do."
It was mid-October, the sun was shining and I indeed felt very happy and privileged to do the job I do. I felt that there were plenty of positive aspects about this experiment as it was good to listen to everyone's comments and to realise that each sentence expressed was what we all felt and did every day. For me it also made me sit back and think about the reasons why I love my job. I considered it valuable for team morale to be able to take time out to reflect and have a discussion on the positive areas in our working day.
Within our profession we are taught to continuously reflect on all aspects of our practice, which I believe is an essential and fundamental process, although the aspects we critically analyse are often negative and described as "critical incidents". What I have learnt from this experiment is that, if we are to truly progress as professional practitioners, it is necessary to reflect on both the positive and the negative aspects of our day-to-day life, however small, and to never forget the reasons why we chose our vocation.
I thoroughly enjoyed this experiment and consider that it should be repeated within our own individual teams on a regular basis to make us all think and think some more.
*Gibbs' reflective cycle has been used as an aid to undertake this reflective account(6)

Conclusion 
The whole session took just over half an hour - fortunately there were no further calls to attend to during this period. As a group we thought it was time well spent. It allowed the opportunity for us to bond as a team, share concerns and values, and in a simple way celebrate our successes, leaving us with a sense of optimism and a positive feeling about our work.
There are, however, considerations for the use of poetry that should to be taken into account. Ground rules need to be discussed and put in place to provide a safe environment. Confidentiality needs to be maintained. Issues raised should not be discussed outside of the group without permission. Topics should be chosen that the group feel safe writing about. For this taster session I purposely chose a positive light subject as sometimes emotions may be brought to the surface that can be difficult to deal with. It should be acknowledged that it is acceptable to cry during a session, and this may happen listening to someone who is sharing their writing or something you have written yourself. Finally, the facilitator of a group needs to be aware of their own skills and limitations.
I would like to thank all the participants who took part in the session as it can be daunting to share one's writing with others. All have given permission for their contribution to be published.

References

  1. Hunter L. Poetry as an aesthetic expression for nursing: a review. J Adv Nurs 2002;40:141-8.
  2. Tamba K. The use of personalized poems in palliative care: one Japanese health professional's experience. Int J Palliat Nurs 2004;10:534-6.
  3. Spencer S. Writing your way to wellbeing. NiP 2006;30:104-8.
  4. Robinson A. A personal exploration of the power of poetry in palliative care, loss and bereavement. Int J Palliat Nurs 2004;10:32-8.
  5. Bolton G, Field V, Thompson K. Writing works. A resource handbook for therapeutic writing workshops and activities. London: Jessica Kinsley Publishers; 2006.
  6. Gibbs G. Learning by doing - a guide to teaching and learning methods. Oxford: Further Education Unit; 1988.

Resources
Schaefer J, editor. The poetry of nursing, poems and commentaries of
leading nurse-poets. Ohio: The Kent State University Press; 2006.

Poetic Medicine
W: www.poeticmedicine.com
North American website created by John Fox who is a poet and poetry therapist. This website provides useful information on how to start writing poetry, giving examples of exercises to complete

Poetry Therapy
W: www.poetrytherapy.org
National Association of Poetry Therapist's website. A North American website that provides a wealth of information and links to other websites on poetry therapy