What this article is about
In brief
Story Based Learning (SBL) is a Canadian-developed nursing teaching model that blends narrative pedagogy, case method teaching, and problem-based learning into a circular, six-phase process for working through practice stories. The authors, faculty at the University of Victoria, present it as a conceptual framework,...
For nursing students
Study summary
Story Based Learning (SBL) is a nursing education strategy developed by Karen MacKinnon and Lynne Young at the University of Victoria's School of Nursing. It was created through a participatory process with faculty and students in upper-level courses of a Canadian baccalaureate nursing program, and grew out of the idea that quality nursing education and quality nursing care go hand in hand. Rather than lecturing students through facts, SBL asks learners to work with real or realistic nursing stories, written in the first person and typically involving one to three characters, and use those stories as the starting point for structured, guided learning.
The article explains that health professional education is seen internationally as one of the key ways to improve the quality of health care. Documents such as the Institute of Medicine's Health Professions Education report and the Carnegie report on nursing education by Benner and colleagues describe several "pillars" that quality education should build: client-centred care, interprofessional education, teamwork and collaborative learning, knowledge mobilization and evidence-based practice, awareness of the limits of one's own knowledge as a foundation for reflective, lifelong learning, and mastery of a field of practice. SBL was designed to weave all of these pillars into one coherent teaching strategy.
SBL borrows from three established pedagogies: narrative pedagogy, which uses stories to surface lived experience and emotion; case method teaching, which asks "What are the big questions?" behind a case, especially ethical and ideological ones; and problem-based learning, or PBL, which was originally developed for medical education at McMaster University and asks learners to identify what they do not know and go find out. But the authors argue SBL is not the same as PBL. It differs in three ways: it uses stories of lived experience rather than depersonalized "cases"; it pays deliberate attention to context, including socioeconomic, ethical, and political factors around the story; and it moves in a circular, repeating process rather than a straight line, which the authors say fits better with how nurses actually think about care.
The heart of the article is the SBL model itself, shown as two nested circles. The outer circle represents ongoing participatory dialogue and critical appraisal of professional and textual information: students work in small groups, question each other, and practice the literature-searching and appraisal skills that underpin evidence-informed practice. The inner circle lays out six phases. Phase one and six are both called "Attending," meaning reading the story closely for detail, meaning, and emotion. Phase two, "What is going on here?", has students interpret the story, share their interpretations, note the person's strengths and health-related concerns, and identify their own learning needs and any "big questions," for example about power, health inequities, or informed decision making. Phase three asks students to identify patterns of wholeness and disruption in the story. Phase four focuses on nursing support: identifying and imagining appropriate nursing actions, potential resources, and referrals, and drawing on nursing knowledge, journals, and clinical practice guidelines to link recommendations to evidence-informed practice. Phase five is reflection, on what was learned, on personal biases and assumptions, and on how the learning could be applied in practice.
The authors report that in their own program's evaluations, SBL helped students move beyond a narrow biomedical lens and integrate core nursing content across settings such as hospitals, community care, home care, and residential care. Faculty in curriculum reviews suggested SBL could be introduced earlier than upper-level courses. The authors also describe using SBL with graduate students and interprofessional teams, where it supports leadership development and conflict transformation.
For nursing students today, this article is worth reading less as a study with numbers and more as a description of a specific teaching tool and the reasoning behind it. It is a conceptual and discussion paper, not a research study with a sample size or statistical results; the "findings" are the authors' pedagogical arguments and reported classroom experience, not measured outcomes. Still, understanding the SBL model can help students recognize this kind of structured story-based debrief if it is used in their own program, and can help them see the connections between narrative pedagogy, problem-based learning, and evidence-informed nursing practice.
Original publication
Source abstract and study details
Read the source abstract
Story based learning (SBL) has evolved as a way to promote quality in nursing education by assisting faculty to develop a student-centred learning environment. SBL is a teaching/learning strategy that also strengthens learners' capacities to provide quality nursing care. Health professional education has been identified as a key contributor to advancing quality care. Key documents identify the pillars of quality health professional education as client–centred care, inter-professional education, teamwork and collaborative learning, knowledge mobilization and evidence-based practice, awareness of the limits of one’s knowledge as a foundation for reflective practice and life-long learning, and mastery of a field of practice. SBL incorporates elements of problem-based learning, case method teaching, and narrative pedagogy. The student-centred orientation of SBL aligns with the philosophical principles of client-centred nursing: respect for lived experience, participatory dialogue, and critical appraisal of health–related contexts. After providing an overview of SBL, we discuss the power of stories to engage learners in focused practice learning. We show how SBL sensitizes learners to: identify learning needs, develop information literacy, and recognize ethical, personal, interpersonal, and health team issues. We address how SBL fosters collaborative and participatory learning. Through a nursing lens learners using SBL identify a focus for nursing action, a process for negotiating nursing care, and appropriate nursing supports. The SBL process concludes with learners reflecting on what they have learned about learning and nursing. SBL is designed to develop in learners a habit of mind for clinical reasoning, reflective practice, and the delivery of quality nursing care.
Reviewed findings
Main findings
- SBL blends narrative pedagogy, case method teaching, and problem-based learning into a single circular, six-phase model for nursing education.
- SBL differs from problem-based learning in three specific ways: using storied narratives instead of decontextualized cases, attending explicitly to socioeconomic, ethical, and political context, and following a circular rather than linear process.
- The SBL model is designed to integrate the pillars of quality health professional education identified in the Institute of Medicine and Carnegie reports: client-centred care, interprofessional education, evidence-based practice, reflective lifelong learning, and mastery of practice.
- In the authors' own program evaluations, SBL was reported to help students move beyond a narrow biomedical perspective and integrate core curriculum content across hospital, community, home, and residential care settings.
- The authors identify implementation challenges including selecting stories of appropriate complexity, supporting students unfamiliar with self-directed learning, and requiring faculty to shift from an 'expert' role to a facilitator role.
For teaching and learning
Education implications
- Nurses can use structured reflection on practice stories, including attending, interpreting, and identifying patterns of wholeness and disruption, as a habit of mind to sharpen clinical reasoning and recognize salient cues in real patient situations.
- The 'big questions' step encourages nurses-in-training to routinely consider power relations, health inequities, and informed decision making as part of everyday clinical judgment rather than as separate ethics content.
- Framing patients as 'storied lives' rather than 'problem cases' supports strengths-based, client-centred approaches to care planning that link nursing actions, resources, and referrals to evidence-informed practice.
- Using stories written from multiple standpoints, such as patient/family, nurse, or other team member, can help nursing students and practising nurses build interprofessional collaboration and conflict-transformation skills.
- Structured story debriefs may help students and new nurses process emotionally difficult clinical experiences, such as patient deaths, and build coping skills relevant to emotional intelligence in practice.
For educators
Teaching and appraisal notes
This paper by MacKinnon and Young, both faculty at the University of Victoria's School of Nursing, is a conceptual and discussion article rather than an empirical study. It describes the Story Based Learning (SBL) model the authors developed and have used in an undergraduate Canadian baccalaureate nursing program. Faculty considering it as a citation or teaching tool should treat its "findings" as theoretical argument and reported programmatic experience rather than measured research outcomes; no formal sample size, data collection method, or statistical analysis is reported.
The authors situate SBL within recommendations from the Institute of Medicine's Health Professions Education report and Benner, Sutphen, Leonard and Day's Carnegie report, Educating Nurses, both of which call for pedagogies of integration: blending classroom and clinical learning, fostering a "sense of salience," and shifting emphasis from decontextualized content coverage toward situated clinical reasoning and identity formation. SBL is presented as one applied answer to that call.
Structurally, SBL combines three existing traditions: narrative pedagogy, which uses stories as a vehicle for emotion, meaning, and lived experience; case method teaching, which surfaces the "big questions," ideological, ethical, and socio-political, embedded in a case; and problem-based learning, which involves self-directed identification of knowledge gaps and originated at McMaster University. The authors are explicit about how SBL departs from PBL: it substitutes storied, first-person narratives for decontextualized cases; it foregrounds socioeconomic, ethical, and political context; and its process is circular and iterative rather than linear, which the authors argue better mirrors relational, strengths-based nursing practice than a "problem-based" frame.
The model itself is presented as two nested circles. The outer circle is continuous participatory dialogue and critical appraisal of textual and professional information, the mechanism by which small-group discussion and evidence-informed practice skills are built. The inner circle specifies six phases (Attending; What is going on here?; identifying patterns of wholeness and disruption, drawing on Newman's theory; nursing support; reflection-praxis; and a return to Attending), giving faculty a concrete facilitation script rather than an open-ended discussion prompt.
For teaching purposes, the most useful discussion points are: the explicit three-way differentiation from PBL, a good prompt for comparing pedagogies in a curriculum-design seminar; the "big questions" component of Phase 2, which operationalizes attention to health equity and the social determinants of health inside a single classroom exercise; and the authors' own reported implementation challenges, including selecting stories at an appropriate level of complexity, supporting students unfamiliar with active or self-directed learning, and the faculty-development burden of asking instructors to relinquish the "expert" role in favour of facilitation. These are candid, transferable cautions for any program considering adopting SBL or similar narrative or case-based strategies.
Faculty should note the evidentiary limits: the evaluation evidence cited, that SBL helped students move beyond a biomedical focus and was seen as relevant across care settings, is attributed only generally to "curriculum reviews" and "formal and informal evaluations" from the authors' own program, with no described methodology, comparison group, or effect size. This is best used as a practice-development resource and citation for the theoretical grounding of narrative pedagogy in nursing curricula, not as outcome evidence for SBL's effectiveness.
Critical appraisal
Limitations
- This is a conceptual and discussion paper describing a pedagogical model, not an empirical study; no sample size, data collection method, or statistical outcome data are reported.
- The evidence for SBL's effectiveness is drawn from the authors' own program's 'formal and informal evaluations' and curriculum reviews, described only in general terms without methodological detail.
- The model was developed and used within one Canadian baccalaureate nursing program at the University of Victoria, so its applicability to other program types, education levels, or countries is not established in this paper.
Classroom use
Discussion Questions
- How does SBL's circular six-phase process (Attending, What is going on here?, Patterns of wholeness/disruption, Nursing support, Reflection-praxis) differ from a linear problem-solving approach, and why might that matter for nursing practice?
- In what ways does SBL operationalize the 'big questions' of power, health inequities, and informed decision making within a single classroom exercise?
- Why do the authors argue that a strengths-based, storied view of patients is more congruent with nursing practice than a 'problem case' framing borrowed from problem-based learning?
- What faculty development supports would be needed for an instructor to shift from being the classroom 'expert' to a facilitator of student-led SBL discussions?
- How might the level of complexity in a chosen practice story affect whether SBL succeeds or fails as a learning exercise for a particular group of students?
- In what ways could SBL be adapted for use earlier in a nursing curriculum, as some faculty in the authors' program suggested, rather than only in upper-level courses?
Knowledge check
Quiz
1. Where was the Story Based Learning (SBL) model developed and used, according to the article?
- A Canadian baccalaureate nursing program at the University of Victoria
- A graduate medical education program at McMaster University
- An American doctor of nursing practice program
- A UK-based interprofessional simulation centre
Show answer and rationale
Rationale: The article states SBL 'was developed within a participatory process with faculty and students during its use in upper level courses in a Canadian baccalaureate nursing program (Young, 2007),' and the authors are faculty in the School of Nursing at the University of Victoria.
2. Which three pedagogical traditions does SBL combine?
- Narrative pedagogy, case method teaching, and problem-based learning
- Simulation, lecture, and standardized testing
- Concept mapping, flipped classroom, and gamification
- Objective structured clinical examination, portfolio assessment, and peer teaching
Show answer and rationale
Rationale: The article states: 'SBL incorporates elements of narrative pedagogy, case method teaching (CMT), and problem-based learning (PBL) to encourage self-directed learning and student engagement.'
3. According to the authors, in what three ways does SBL differ from problem-based learning (PBL)?
- Using stories/narratives instead of decontextualized cases, attending to socioeconomic/ethical/political context, and using a circular rather than linear process
- Using multiple-choice tests, requiring a licensed instructor, and needing a simulation lab
- Being shorter in duration, requiring less reading, and avoiding group work
- Focusing only on physical assessment skills and excluding ethics content
Show answer and rationale
Rationale: The article states: 'The SBL model differs from PBL in three ways: (1) using stories or narratives rather than decontextualized cases, (2) drawing particular attention to contextual issues, including socioeconomic, ethical and political factors, and (3) presenting learning in a circular and iterative process.'
4. How many phases make up the 'inner circle' process of the SBL model?
- Three
- Four
- Six
- Eight
Show answer and rationale
Rationale: The inner circle is described across Phases I through VI: Attending, What is going on here?, Identifying patterns of wholeness/disruption, Nursing support, Reflection-praxis, and a return to Attending.
5. What does the 'outer circle' of the SBL model represent?
- Participatory dialogue and critical appraisal of textual/professional information
- A checklist of vital sign parameters
- A rubric for grading written assignments
- A timeline for clinical placement scheduling
Show answer and rationale
Rationale: The model figure and text label the outer circle as 'Participatory dialogue and critical appraisal of textual/professional information,' involving small-group brainstorming, appraisal, and debriefing.