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,...
What this article is about
Quick Answer
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, not an empirical study, for building clinical reasoning, reflective practice, and interprofessional collaboration.
Student takeaways
Key Takeaways
- 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.
Student summary
Why This Research Matters
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.
Source abstract
Study Overview
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.
Evidence appraisal
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.
Practice transfer
Clinical Relevance
- 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.
Faculty notes
Educational Relevance
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?
- How does using stories written from multiple standpoints, such as patient/family, nurse, or other health team member, support interprofessional collaboration skills?
- What ethical or emotional risks might arise when students write and share personal or emotionally difficult practice stories, and how might faculty mitigate them?
- How does SBL's inclusion of critical appraisal of professional and textual information connect classroom learning with evidence-informed nursing practice?
- What kind of research design would be needed to evaluate whether SBL actually improves student learning outcomes compared with case method teaching or problem-based learning?
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
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
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
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
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
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.
6. Which theorist's concept of 'patterns of wholeness and disruption' is used in Phase three of the SBL model?
- Newman
- Benner
- Dewey
- Schon
Rationale: The article states: 'Phase three involves identifying patterns of wholeness and disruption (Newman, 1999) and ensuring that the context of health and health care is explored fully and critically.'
7. Which pillars of quality health professional education does the article say SBL integrates?
- Client-centred care, interprofessional education, teamwork/collaborative learning, evidence-based practice, reflective/lifelong learning, and mastery of practice
- Punctuality, dress code compliance, and charting speed
- Standardized testing performance, GPA, and clinical hours logged
- Simulation attendance, skills lab checklists, and licensing exam pass rates
Rationale: The article states: '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.'
8. What challenge did the authors identify for faculty implementing SBL?
- Faculty must give up being the expert and instead guide learners to lead their own learning
- Faculty must administer standardized national exams after each session
- Faculty must limit class size to fewer than five students
- Faculty must eliminate all group work in favor of individual assignments
Rationale: The article states: 'One of the challenges identified for faculty using SBL is to \'give up\' being the expert and instead develop the capacity to guide learners in leading their own learning by providing a wide range of resources and asking carefully worded questions.'
9. According to the article, what did faculty in curriculum reviews suggest about when SBL should be introduced?
- Earlier in the curriculum, rather than only in upper-level courses
- Only after graduation, during continuing education
- Exclusively in doctoral programs
- Only during clinical placements, never in the classroom
Rationale: The article states: 'Faculty suggested that SBL could be introduced earlier in the curriculum, rather than only in upper level courses, because of its emphasis on group learning and the development of skills for information literacy and clinical reasoning.'
10. What type of article is this piece by MacKinnon and Young, in terms of research design?
- A conceptual/discussion paper describing a pedagogical model, not an empirical study with reported sample size or statistics
- A randomized controlled trial comparing SBL to lecture-based teaching
- A systematic review and meta-analysis of narrative pedagogy studies
- A grounded theory study based on interviews with nursing students
Rationale: The article presents and discusses the SBL model, links it to theory, and describes 'what we have learned' from 'formal and informal evaluations,' but reports no methods section, sample size, or statistical results characteristic of an empirical study.
Study cards
Flashcards
What does SBL stand for?
Story Based Learning.
Who developed the SBL model discussed in this article?
Karen MacKinnon and Lynne E. Young, faculty in the School of Nursing at the University of Victoria.
In what type of nursing program was SBL originally developed and used?
A Canadian baccalaureate nursing program, initially in upper-level courses.
What are the three pedagogical traditions blended into SBL?
Narrative pedagogy, case method teaching, and problem-based learning (PBL).
What is the first way SBL differs from PBL?
SBL uses stories or narratives of lived experience rather than decontextualized cases.
What is the second way SBL differs from PBL?
SBL draws particular attention to contextual issues, including socioeconomic, ethical, and political factors.
What is the third way SBL differs from PBL?
SBL presents learning as a circular and iterative process rather than a linear one.
What does the 'outer circle' of the SBL model represent?
Ongoing participatory dialogue and critical appraisal of textual/professional information.
What happens in Phase I and Phase VI of the SBL inner circle?
Attending: reading the story for detail, meaning, and emotion.
What is the focus of Phase II of SBL?
'What is going on here?': interpreting the story, sharing interpretations, identifying strengths/health issues, learning needs, and 'big questions.'
What theory informs Phase III of the SBL model?
Newman's (1999) concept of patterns of wholeness and disruption.
What does Phase IV of SBL focus on?
Identifying and imagining nursing support, potential resources, and referrals, drawing on nursing knowledge and evidence-informed practice (e.g., journals and clinical practice guidelines).
What does Phase V of SBL involve?
Reflection-praxis: reflecting on the learning process, personal biases/assumptions, and implementation issues.
What are the 'pillars of quality health professional education' the article says SBL integrates?
Client-centred care, interprofessional education, teamwork/collaborative learning, evidence-based practice, reflective/lifelong learning, and mastery of practice.
Which report is cited for identifying 'pedagogies of integration' as a goal for nursing education?
The Carnegie report, Educating Nurses: A Call for Radical Transformation (Benner, Sutphen, Leonard, & Day, 2010).
How does the article describe patients within the SBL framework, in contrast to problem-based learning?
As 'storied lives' rather than 'problem cases.'
What challenge did faculty report in implementing SBL?
Selecting practice stories at an appropriate level of complexity (scaffolding) and supporting students unfamiliar with active/self-directed learning.
What role shift does SBL require of faculty?
Faculty must give up being the 'expert' and instead facilitate students leading their own learning.
How can SBL be used with graduate or advanced practice nurses, according to the authors?
As a form of peer consultation and simulation focused on interprofessional collaboration and conflict transformation.
What is the overall educational goal the authors say SBL is designed to develop in learners?
A habit of mind for clinical reasoning, reflective practice, and the delivery of quality nursing care.
Search-ready answers
Frequently asked questions
What is Story Based Learning (SBL) in nursing education?
SBL is a student-centred teaching strategy that uses stories from nursing practice, rather than decontextualized cases, to guide learners through a structured six-phase process of interpreting, reflecting on, and responding to clinical situations.
Who created the SBL model?
Karen MacKinnon and Lynne E. Young, nursing faculty at the University of Victoria, developed and describe the model in this article, building on Young's earlier (2007) work.
How is SBL different from problem-based learning (PBL)?
SBL uses storied, first-person narratives instead of decontextualized cases, deliberately attends to socioeconomic, ethical, and political context, and moves through a circular, iterative process rather than a linear one.
What are the six phases of the SBL model?
Attending (I), What is going on here? (II), Identifying patterns of wholeness/disruption (III), Nursing support (IV), Reflection-praxis (V), and a return to Attending (VI).
What is the 'outer circle' of the SBL model?
It represents continuous participatory dialogue and critical appraisal of textual and professional information among learners in small groups.
Is this article based on a research study with data and statistics?
No. It is a conceptual and discussion paper describing the SBL model and the authors' program-level teaching experience; it does not report a formal research methodology, sample size, or statistical results.
What evidence do the authors give that SBL works?
They cite general, unspecified 'formal and informal evaluations' and curriculum reviews from their own program indicating SBL helped students integrate core content and move beyond a narrow biomedical focus.
What challenges do faculty face when implementing SBL?
Selecting stories at an appropriate level of complexity, supporting students with little experience of active/self-directed learning, and faculty needing to shift from being the classroom 'expert' to a facilitator.
Can SBL be used with graduate students or interprofessional teams?
Yes; the authors describe using SBL with graduate nursing students and note it can support peer consultation, leadership development, and conflict transformation in interprofessional contexts.
What is the overall educational purpose of SBL, according to the authors?
To develop in learners a habit of mind for clinical reasoning, reflective practice, and the delivery of quality, client-centred nursing care.