Acting and Nursing: Engaging Through Applied Theatre

Rebecca Eaton Reardon, Associate Professor
Miami University Hamilton

I have long believed that in order to help our students to become impactful theatre artists and/or life-long theatre-enthusiasts, they must encounter theatre in a personal way. If a student can experience a truthful, believable behavior and reasoning in a one-on-one moment, she then can envision a play in a more assessable, useful way. She sees that among other things, a play is on a working level at least, a “stack” of truthful moments piled up one on top of the other. These notions sent me looking for theatre activities outside of our classroom (the comfort zone of our acting studio) that could offer acting students a unique, personal and rigorous encounter. What I found after work-shopping, reading and discussing these ideas with colleagues was applied theatre.

While not all exercises, projects and productions I have tired have enjoyed the same amount of success, The Acting and Nursing Project (The ANP) continues to enrich our students consistently each time we have offered it. It was begun in 2006 on the Hamilton, Ohio Campus of Miami University as part of a program I initiated called Theatre In Your Classroom. TIYC provides curriculum content enhancement for faculty by sending student actors’ to classes in scenes that contain material germane to the course topics. In 2006 Miami University Hamilton’s nursing department responded to a TIYC invitation, saying they were concurrently looking for some more proactive and meaningful means to help their nursing students prepare for the their first interaction with actual patience in a real clinical setting. What I aim to do in this article is to help acting instructors develop similar projects if they feel that their students might gain some insight from delving into applied theatre themselves.

First, I will speak to the needs of the general student profile on our regional campus. Next, I will look at how the up and running. Finally, I will cover some specific results from our first round ANP (Acting and Nursing Project) using a sample of the raw data and several assessments our students left with us.

Before We Go Any Further, What Is Applied Theatre?

Due to varying philosophies behind the many implementations of applied theatre (sometimes referred to as applied drama as well), pinning down a working definition of the term proved problematic. Applied theatre is a broad concept and the fact that it is very adaptable in a multiplicity of settings may be part of the reason for this. Indeed, it is hard to speak of applied theatre without including the variable participants in a given activity. Service to someone or a group of some sort is often at its core, I discovered. For instance, applied theatre methodology is frequently used in activist theatre— theatre that desires to bring about social change or at least a broadened consciousness.

Helen Nicholson has collected several definitions and descriptions in her excellent book on the subject, Applied Drama: The Gift of Theatre. Her explanation defines applied theatre as “a kind of shorthand to describe dramatic activity that primarily exists outside [the] conventional mainstream” (Nicholson 2). She notes that partners in these activities include prisons, educational institutions, health educators, community and heritage theatres and many more. She continues to include definitions from various professional and educational theatre entities that speak of theatre being used in non-traditional settings “hyper-consciously for non-traditional purposes” (Nicholson 2).

My nursing colleagues and I set out to help acting and nursing students uncover a greater amount of creative and professional courage. We saw the need for both sets of students to unearth information already available within each of them—specifically self-awareness, heightened awareness of others’ behavioral clues and needs, courage in situations outside their comfort-zones and the strength found in being truthful with another person. We were able to specify these goals for our students because we shared our own experiences as instructors and professionals. (They are professional nurses as I am a professional actor). During our semester-long planning stage, were often delighted to find unforeseen parallels among our teaching styles, practices, language and the challenges facing our students. Conversely, we became fascinated by the cultural and tangible differences between our disciplines. The further we got into our plans for The ANP, the more enthusiastic we became for our students to discover and learn from each other as we were—and continue to do.

Who Would Want to Do Applied Theatre?

Our program is small and the needs of our students are not always analogous to our main campus. Our program within our theatre department has developed over the years to suit not only the requirements of the theatre department at large, but to do so while taking into consideration the lives of our student population specifically. Like many regional campuses, our students have very demanding schedules: a large number of them are likely to be balancing full-time jobs, children, paying most or all of their own tuitions, helping aging parents and are often managing long commutes to and from campus. Their exposure to theatre ranges from little to no practical theatre experience to a consistent “handful” who have had a good amount history in both participation and study.

While I certainly do not believe the concepts uncovered using applied theatre are pertinent only to a population of students resembling ours, I do believe that encountering drama through applied theatre helps keep performance study and practicum available to groups of students who would not otherwise have the time or freedom to participate in traditional productions. For instance, an acting student who cannot commit to a traditional college production rehearsal schedule may be able to work with an applied theatre project because the instructors/directors can build flexibility into the scheduling.

Nuts and Bolts

What follows is a brief description of the first round of our project as written by one of my two nursing faculty partners, Carol Bashford; Associate Professor of Nursing, Miami University School of Nursing. Here she describes the project in broad terms.

Getting Started

The nursing faculty responded to the outreach [TIYC] with the idea of the theater students pretending to be a hospitalized patient using the nursing lab as a setting for novice nursing students to interview the “patient” using the structured health history format. The faculty met, clarified the needs of each student group and desired format. Nursing faculty provided [ ] different patient scenarios including data on the patient symptoms, possible causes, socioeconomic characteristics, sample health history assignment document and the symptom analysis format. All involved faculty completed the university’s required research training modules and submitted the Institutional Review Board document. [Check with your own institutions, but IRB certification is not difficult to obtain, usually.]

*Theater students interviewed for this unique opportunity and volunteered to participate in the research activity as the “patient.” The theater faculty mentored the theater students to deep research and developing the character’s family and situational history for the scene. All nursing students in the fundamentals lab sections were invited to participate using the health history assignment document to interview the “patient” during regular lab class time for 10 minute 1:1 encounters. The health interview activity was conducted 1 week before the nursing students scheduled health interview clinical experience. The interviews were conducted using one of the hospital bed settings in the corner of the nursing lab with the bed divider curtains pulled around the student-patient scene to provide setting and privacy. Both sets of students completed post encounter surveys (Bashford).

Once the planning was done, contact with our students began. I have chosen Alan’s (not his real name) as our representative acting student. The following is a contract between  Alan and me, established at the outset of the project as a guide and a syllabus. I re-create it here in hopes that it will be an aid to the description of the project’s particulars, which follow it.

Acting Student’s Contract/Syllabus

Project: Acting and Nursing Simulation Project: Mock Interviews

Instructor: Reardon

Student: [Alan]

Independent Study: THE 477/3 Credit Hours

Objective: To create a character and scenario from the raw data—that given by case histories provided by instructors at MUH School of Nursing.

At the end of this course, you will be able to:

• Identify and create from the both given and imagined circumstances.
• Write/create a character from non-dramatic literature.
• Improvise in a non-traditional theatrical setting.
• Improvise in a one-on-one situation with a non-actor and analyze the usefulness/non-usefulness of the experience for all parties in a personal and universal manner.
• Indentify and utilize the concepts inherent in applied theatre  in various applications in future situations

Procedures:

1. 1. You will review the case history and conduct research on health questions. This is the “given circumstances” portion of the dramaturgy. Student needs to do research guided by Gordon’s Functional Health Patterns to aid them in a deeper comprehension of how case histories are taken by health practitioners.

2. You will create a scenario based on research via improvisation, rehearsal and writing, taking into consideration at least following:

• Lifestyle
• Family  (marital status, etc…)
• Childhood events
• Living parents
• Relationships with friends, family, politics, nature, religion, economics, history—this list is open-ended.

3. Improvisational monologue presented as well as a bulleted written character profile for a grade.

4. You will rework refine your scenario, and then your instructor material sent to nursing instructors (Carol Bashford and Susan Reams) for review and comments.

5. 17 and/or 18 October—simulations take place. You will meet one-on-one with participating nursing students, in character. Nursing students conduct mock patient interviews with you, one at a time.

Evaluation and Assessment:

1. 1. Debriefing/Group Discussion

• Nursing students discuss their issues with dealing with the mock patients.
• Actor comments form his point of view about the encounter.
• Nursing students discuss the believability of the actor’s work as well as their own insights gained from the exercise.

1. 2. Individual Interview Questionnaires—After each interview, you will fill-out a     response questionnaire (provided by me). This will act as an aid in discussion and in writing your response paper. The nursing instructors and I will also use this to evaluate you, plus we plan to use the information you provide to help us further develop this project in the future.

• You will write a paper discussing all 5 of the issues listed in the “Objectives” section above, addressing what the student has discovered about yourself, others, the craft and any additional notions. Be sure to touch upon the following specific aspects, but you need not remain constrained to them alone.
• Were your acting skills enhanced by this project? If so, in what ways? If not, what got in the way?
• What did you learn about yourself through this experience?
• Are there any preconceptions that have changed about yourself/others/acting/improvisation that have changed through doing this project? Explain.

Working with the Primary Source Documents

The case histories supplied to us by the nursing professors were detailed and long. These documents are called Gordon’s Functional Health Patterns. Each is around 10-12 pages in length and contained a wide array of personal and health questions intended to help health care professionals fully assess their patients not only in terms of the presenting ailments, to get a picture of the lives of each patient in its entirety. As the acting students soon discovered, this paperwork gave us many more questions, than answers. Here is a small sampling from Alan’s ten pages of information:

• Age: 80
• Sex: M
• Admitting Medical Diagnosis/History: cellulites, ulcers both legs, knee replacements in both legs, diabetes, apnea, dementia, circulation problems, emotional problems, breathing problems.
• TPR: 97.3
• BP: 180/70
• Weight: 244
• Allergies NKA
• Miscellaneous: Married
• The rest were pages of detailed medical information, including an immense list of medications.
• In the “Health Perception/Management” section we found out the patient
  • Lived in a nursing home, had multiple wounds on both legs—between the knees and ankles. These ulcers were rather troublesome they presented green and yellow and drained.
  • Had a healthy appetite
    • In a section entitled “Safety/Physio-logical or Environmental” we saw that the patient
    • Was a fall risk, but kept trying to get up all the time
    • Confused
    • Unsteady
    • In a section entitled “Alterations in Mood/Cultural Practices” we saw that the patient
      • Had no church affiliation

The above, as noted earlier, is only a little piece of the large amount of information available to Alan. Before he made any decisions, Alan had to do his research. Thus he became his own dramaturge. He first looked into the health issues themselves— what their possible causes could be and how they would present. This was no mean task. He used academic and health profession research sources and interviewed a family member who was a doctor in order to understand the ailments, conditions, treatments and medications listed in his given history.

Alan’s next job was to differentiate clearly between the given circumstances and the imaginary ones. Keeping the distinctions clear between these two types of circumstances helped him identify the “holes” in the givens or obligations. These holes in the story are where his imagination was to work. To help, I asked him to make a chart projecting those elements of imagination on one side and placing given circumstances provided by the case histories on the other. At this point, Alan started to become a writer or actor-creator as well as a dramaturge. Then he began paring away—editing—the primary source document and into scenario and character creation.

Though one could deduce from the step-by-step structure indicated in the above syllabus that the work of creating the imaginary circumstances comes second only after one has divined all the given circumstances, the process is usually not that “neat.” Having gone through similar processes as an actor-creator myself, I was able to advise Alan to listen to the voices of inspiration throughout the entire process. As it turned out, he could hardly hold back the floodwaters of imagination while he was researching. Indeed, he did not need my advice in the least. He found that the research was, in itself, a catalyst to character and story creation. On his own, he began improvising to create. Before Alan even met his first nursing student, applied theatre was intersecting with acting, dramaturgy and playwriting methods. He was using and unearthing his own methods—learning how his particular imagination creates.

Alan and I met to work, on average, once per week for around eight weeks. We increased our meetings the closer we got to the mock interview dates. What at first were advisory sessions, guiding him through the process and purpose of the project as well as the research, turned into a rehearsal period. Rehearsals were exclusively improvisational. I often played the interviewer (nursing student), but as Alan explored a variety of Paul E’s (Alan’s name for his character) relationships, I would play these people as well. In one session, I played Paul E’s father at different stages in his (Paul’s) life. Alan would work on his own, improvising by himself, with other actor-friends and most particularly, the other simulation actors. In subsequent rounds of The ANP, the rehearsal process evolved away from a heavy emphasis upon one-on-one sessions with me into more group improvisational/divining sessions with the other actors in the project. This has proven to work much better, but can be logistically challenging because of scheduling conflicts.

Service as Instructor

In the beginning, Alan was very much interested in “playing age.” I have often found and have heard fellow acting instructors note that our acting students often want to play some attribute far away from their own persona—particularly young actors. Further, Alan’s case history was that of an older man whose ailments, medications and personal history matched his age, not Alan’s. Alan was sticking with the given circumstances of his primary source material. He was being a good and accurate dramaturge. So, the question for me became, “How do I get Alan to change his well-informed and well-intentioned desire to play age? Particularly, when I asked him to honor as many of the given circumstances as possible?” The answer came when we discussed the given circumstances required by the actual mock interviews themselves—what might be called the super-objectives of The ANP. We talked about the fact that his acting partners would not be actors at all. He was used to working with fellow acting students who freely give in to each other’s imaginary lives. Indeed, doing so is an important part of learning to improvise and act. In our talk, Alan and I focused on the nursing students’ point of view who would have little to no prior history or level of comfort with scene work. In fact, their willing suspension of disbelief might be quite challenged due to the vulnerability of a one-on-one make-believe scene for us; interview for them. Alan began to imagine the work from the Nursing student’s perspective. After he realized that playing his character as an older man would not serve his partners (nursing students) well because the mission of the engagement demands he take on the purpose of the nurses’ participation with the same attention as he pays to his own. Here this concept of mutualism instructed the actor. Alan was able to let the particulars of this situation inform his choices. I watched him adjust his actor-oriented approach into one that honored the parameters of the engagement opportunity itself. All of his choices were informed by this adjustment throughout the rest of the project.

Alan changed his character’s age and, as would be expected, the character’s, back-story and scenario changed dramatically too. Paul E became more interesting and more “playable.” I observed a deeper focus and more detail in the next round of work as Alan “youthenized” Paul E. Playing someone closer to his own age also placed him in a more in more emotional risk.  (Could this be what our students instinctively want to avoid?) Alan could not hide as completely behind his characterization. Subsequently, as he met with each of his Nursing interviewers, he was less able to hide behind layers of behavior far removed from his personal experience and much more believable to himself and to his nursing partners as we found out in our joint debriefing.

As pointed out in the above excerpt of Professor Bashford’s “Getting Started” section*, the simulations took place in one of the nursing teaching labs. These are areas set up to simulate real clinical sites. They contained working hospital beds, privacy curtains, side tables and real and mock equipment within each patient area. Acting students got in each bed and awaited their nursing interviews. There are always more nursing students than actors. This has proved to be the best situation for us. During our post-activity discussions, it allows the nursing students to compare and contrast their own interactions with each other, using the same set of circumstances. The actors learn from repeating their “scenes”—refining their choices with each interview.

Assessment

I brought my own assessment tools such as rubrics based and pre and post-activity questionnaires to the work. The nursing faculty brought a great deal of scientific method to are evaluation process. They devised readily-quantifiable questionnaires. We used these multiple means of evaluation such as pre and post interview questionnaires that were scrutinized anonymously. The raw data is available for anyone upon request. These indicators helped the students as well as the instructors.

The debriefing or discussion phase of the project is where the students and instructors synthesize their experiences by comparing and contrasting their experiences with each other. Each discussion thus far has involved what went on in the interactions on the most practical level—“Do not touch the patient” …”I noticed that I smiled and tended to have a giggle that the masked patient misinterpreted as me laughing at him” (Anonymous nursing student reflection questionnaire responses) as well as what went on underneath the surface between the inter-actors.

Is this all work worth it?

Throughout the planning and actor-preparation processes, I often wondered if all the work was worthwhile. Even the basic logistics of the project were sometimes quite an obstacle. How could taking on so much extra work in an already over-crowded production and teaching schedule ever be worth all this trouble, time and effort? The answer can be best found, perhaps, in the fact that the (just as busy) nursing faculty and I repeat this project as often as our schedules allow. From both the acting and nursing students’ assessments, we knew from the first round of mock interviews that we were on to a valuable learning tool. In her reflection paper, one acting student stated,

The ability to recognize how a character would respond, as opposed to imagining how a character would respond, has helped me achieve a new level of believability in my characters, which has allowed me to broaden and develop my skills as an actor. (Anonymous-Female)

Another student actor’s reflection paper may reveal some responses that keep me interested in continuing the project as often as possible.

This [project] gave me the chance to do believable character work, and to take a single scenario and refine it through rigorous repeated trial […] on this day I indulged myself, and delighted with the full knowledge that I was doing them a legitimate service (Anonymous-Male).

Some nursing students responses included the following,

• Talking to a “real” person is completely different when I asked questions I expected standard responses. As nurses and as patients in our own doctor’s offices we know the routine – this guy really threw [me] a curve!
• I need to do as many interviews as possible.
• I did better than I expected that I would. It is very rewarding to practice at home and then get to implement the skills.
• I am better at dealing with people than I give myself credit for. He tried to be difficult and I ended up getting the information needed and felt that I left the interview with him feeling he could trust me.
• [I learned that I need to] be prepared for anything (Anonymous nursing student reflection questionnaire responses).

The nursing faculty and I were both fascinated and gratified with the exchange of ideas and information between the two groups of students. We again appreciated how much our disciplines had in common and how much we can learn from each other. The detailed preparations both our student populations underwent were in themselves invaluable learning objects. Further and in broader terms, we reaffirmed that our students need not just human interaction to prepare them, but challenging ones—opportunities to interface outside their comfort zones. Behind those privacy curtains, during each interview, there was no buffer zone between the two participants. In each case, he tension in the interaction will either be used creatively and productively or not. Either both the actor and the nursing student believe the situation or they don’t. When both parties come up with the emotional courage and discipline to give in to the truth of such a pretend situation, they discover new depths within themselves and in another human being.

Authors Post-Script

Anyone wishing copies of pre and/or post interview questionnaires or any other materials that might prove helpful or instructive in starting your own such activities, do not hesitate to get in touch with me at eatonrl@muohio.edu.

Works Cited

• Anonymous female actor. Names withheld for privacy. unpublished reflection paper. 2007.
• Anonymous male actor. Names withheld for privacy. unpublished reflection paper. 2007.
• Anonymous nursing students. Reflection questionnaire responses. unpublished. 2007.
• Bashford, Carol; Associate Professor of Nursing, Miami University School of Nursing. unpublished. 2007.
• Boal, Augusto, Adrian Jackson, trans. Games for Actors and Non-Actors. London: Routledge, 1992. Print.
• Nocholson, Helen. Applied Drama: The Gift of Theatre. New York: Palgrave/Macmillan, 2005. Print.
• Schutzman, Mady, and Jan Cohen-Cruz, eds. Playing Boal: Theatre, Therapy, Activism. New York: Routledge, 1994. Questia. 18 Jan. 2007