Does technology flatten authenticity? Exploring the use of digital storytelling as a learning tool in mental health nurse education

ABSTRACT The article reflects on digital storytelling as an approach designed to apply the theory of authentic learning in a co-productive context. It explores the suitability of digital stories as pedagogical tools and examines the connection made between the individual and group interpretation of these stories. A participant group (n = 7) comprising family carers, people with lived experience and mental health nursing students were invited to join two facilitated workshops. The group reviewed four contrasting forms of digital stories with the aim of eliciting and sharing their perspectives. It was found that digital audio compared less well to visual media in authenticity scales. Still photobook-style images were also perceived to be less authentic than dramatic film employing professional actors. Furthermore, it was found that the essence of authenticity became richer as the process and activities of co-productive engagement developed. It is proposed that creating digital scenarios co-productively provides a relational environment in which the essence of authenticity can be felt and expressed. The article will explore the suitability of digital stories as pedagogical tools and examine the process of co-production as an approach which accentuates realism.


Introduction
When individuals experience something perceived as authentic, the experience is intense and deeply trusted as being 'true' to a reality that connects symbiotically with their own unique world. Efforts to contextualise the phenomenon of authenticity in higher education have alternated between surface interpretations of simply generating 'understanding', through to Freire's (1970) more complex interpretation whereby authenticity must be a conscious, challenging and transformative experience (Freire in Serrano et al., 2018).
In this study, the enquiry focused on examining the relationship between digital media and authenticity in scenario-based learning. In the study, action research was employed as the enquiry's methodology with co-production the approach to knowledge generation.
As in many other people-centred occupations, mental health nursing is essentially an activity focused on two people: the nurse and 'the patient'. The role of the nurse is to engage with the patient through relational care to support and guide during them episodes of acute psychological distress (Peplau, 1952). As the scope of the profession has expanded to include specialist areas such as forensic care, so increasingly complex challenges present themselves (Norman & Ryrie, 2018). It is within the principles of humanism, inclusion and recognition of individuality (Evans & Hannigan, 2016) that nurses are deemed, by virtue of a professional Code of Conduct (Nursing and Midwifery Council, 2018), to respond. These principles informed the design of this study. They also provided the motivation within the principle enquiry question: do digital scenarios present an authentic reality and therefore an effective learning tool?
The participant group comprised family carers, people with lived experience and mental health student nurses and aimed to reflect the co-collaboration of the nurse/patient relationship. Data were gathered from two facilitated workshops. The workshop facilitator aimed to create an environment in which the expression of authenticity could be identified, extrapolated and examined in an approach similar to the ethos of relationship-based care. A significant difference, however, was that the selected scenarios, all familiar in some way to the participant group, were presented through digital media rather than through written word or real-world encounters. Cockelbergh and Reijers (2016) asserted that technologies do have narrative capacity, but their value is dependent on the ethical standpoint of the individual. The study aimed to examine the strength of each of the digital scenarios from the perspective of the participants. In addition, it aimed to explore if authenticity can be achieved using digital media, particularly those formed around simulation, drama or reconstruction of a real-life event.

Background
Stories are omnipresent across cultures and time (Palacios et al., 2015). They are tools of communication which create connections, and challenge realities (Alterio & McDrury, 2016;Moon & Fowler, 2008). In nurse education, as in other educational contexts, narrative is an essential pedagogical tool utilised to enable students to apply knowledge, to build understanding and to test assumptions. Narrative is utilised in a wide range of teaching and learning contexts. In mental health nurse education, stories are commonly used to examine constructs such as stigma, power and medical hegemony. Herrington et al. (2006), amongst others, postulated that the presence of authenticity in narrative theory is an essential ingredient to transformative learning. The experience of sensing authenticity provides the learner with the possibility to liberate themselves from previously held assumptions (Serrano et al., 2018). In this study, the hypothesis was that when a digital story is employed as a learning tool, a higher blend of authenticity may be experienced. For this to be achieved, pedagogical consideration must be given to the students as individuals as well as a collective group, the objectives of the learning task and the influence of the type of media utilised. In addition, consideration must be given as to whether the selected choice of the scenario should be in the control of the teacher, or more democratically within the overall learning design.
In the context of the educational needs of mental health nurses, as with other people-led occupations, storytelling and the personal narrative have a place of significance in knowledge construction and relationship building. Mental health professionals and mental health services have been profoundly affected by the emergence of the survivor movement in the 1980s. This initiated a seismic change in the way in which mental health is understood (CAPS, 2010) with a growing recognition that the person is an expert of their own experience, thus impacting on the power dynamic with paid professionals. The Recovery Movement, as it became known, asserted the importance of the unique experience of the individual. People began to tell their personal stories and challenged the medical hegemony which laid claim to mental illness as a largely biological event that required the expertise of professionals to manage 'symptoms'. In this context service users started to gain voice and strength through storytelling, with the consequence that attitudes, behaviours and values began to shift (Byrne et al., 2014).
The influence of the Recovery Movement has had a profound effect on the education of mental health nurses. Over the past 10 years, there has been widespread agreement that involving people with lived experience in professional programmes of education will produce a workforce capable of improving the outcomes and experience of people using mental health services (Lathlean et al., 2008;Mckeown et al., 2012). However, the evidence on which to base this assertion is lacking in relation to measurable impact and added value for health and social care education (McIntosh, 2018;Rhodes, 2013). Yet, the inclusion of personal narratives in mental health education is now expected as a quality indicator of nurse education. It has also become a method of demonstrating the role of the service user as an equal partner whose views have equal importance. Crookes et al. (2013, p. 242) concluded that stories offer students a vital link between theory and practice and an 'engagement beyond the classroom'. However, the exponential growth in online learning (Selwyn, 2014), combined with the increasing pressure on finding classroom space, has led to more learning activities simply being placed on learning platforms as Word documents. Activities such as these have been shown to limit students' ability to engage with the scenario. Instead, more creative approaches are required to ensure deeper learning (Ackland-Tilbrook & Warland, 2015).
Drawing on findings from a small-scale study, this article examines the theoretical and philosophical questions that arise from seeking to enable authenticity in digital storytelling and better understanding its value to mental health nurse education.

Literature review
Literature surrounding storytelling in nurse education, authenticity and use of digital technologies was examined to provide context to the enquiry. Perhaps confusingly, stories are variously described as narratives, case studies, critical incidents, life histories, anecdotes, scenarios and illustrations, amongst others, making identifying relevant literature complex. Stories may also be spoken, written, filmed, mimed or acted, and might be in digital format (Moon & Fowler, 2008).
When stories are formalised in educational contexts, Alterio and McDrury (2016) understood that the potential learning power of stories relates to their capacity to capture the everyday, turning it into the focus for learning and reflection, with the intention of enabling deeper understanding and critical thinking. Given this, we should not be surprised then that the use of stories in educational practice is commonplace, in both school-based and higher education settings. Focusing on the higher education context specifically, Moon and Fowler (2008, p. 232) recognised the power of stories to 'capture the holistic and lived experience of the subject being taught'. As such, they can facilitate learning in ways that traditional lectures and tutorials cannot, an assertion which owes much to their ability to 'tap into imagination, emotions and form new and meaningful connections between existing areas of knowledge' (p. 232). Kinsey and Moore (2015) picked up the potential of stories and their capacity to enrich learning opportunities in subjects where they might not seem to fit, in their case, mathematics. Citing Aristotle, they identify the key component of a story as being a well-constructed plot, into which they add the need for conflict and its resolution. Hendry (2009) pushes thinking a little further, explaining that the purpose of stories is to facilitate meaning and knowing with the intention of effecting altered perspectives and/or new insights. Crookes et al. (2013) explored the value of stories, alongside other techniques, in the specific context of nursing education, where they see particular challenges for nursing students who have to develop within a very practical discipline within which they are expected to learn, but may not always be exposed to all of the experiences they need. Thus, stories can afford insight into the unfamiliar, with Jack and Hampshire (2016) suggesting the value of student nurses writing the stories to express their ideas and feelings. Again in the context of nurse education, Chan (2013) had another perspective, proposing that stories can be used to maintain student interest and motivation to learn. Gidman (2013) added another possibility into the mix, reporting the success of a project within which student nurses actively sought out patients' stories in the practice setting.
Moving now to authenticity, the word 'authentic' derives from the Greek autonthenkes, auto being 'self' and thenkes being 'genuine'. In each of the scenarios selected for this enquiry, the potency of genuineness was largely created by the choice of story, the form of the digital media and the impressions of the teacher making the selection. However, 'believability' is only truly sensed when the individual viewer is able to release and relate their own experience to the viewing. The ability of the teacher to manipulate the believability factor in either a pre-formed podcast or film is limited as the media presents as a finished product that cannot be adapted. This contrasts with the world of online gaming, where the creation of a believable 'other world' is an art and a craft. If there is an absence of a believable reality, the 'gamer' is likely to disengage and consider the product undesirable. Klabbers (2003) examined the craft of constructing believable worlds and considered the way in which the parts of the simulated world are constructed. He concluded that it requires individual parts to be organised and controlled manually to produce a 'natural' effect. These perspectives resonate with Mitty's (2010) view that storying can be mutually beneficial, validating and transformative for the listener, not least because learning to listen to a story, and to engage with the storyteller, can significantly enhance communication skills, as well as gain insight.
If stories are to be effective tools, the experience of watching or listening must be immersive and connect in some way to the professional or personal world of the student. Herrington et al. (2006) identified this as authentic learning and suggested that it is only likely to occur when the individual student is challenged with competing perspectives and interpretations of a situation. This raises an important point in that in their quest to ensure the alignment of learning activities with intended outcomes and assessment (see, for example, Biggs & Tang, 2011), educators create stories, or even perhaps over-engineer them, with the consequent loss of authenticity from a student perspective.
The New Media Consortium Report (Adams Becker et al., 2017 seems to concur with the argument that ensuring authentic learning opportunities is a significant challenge. Although stories can provoke curiosity and stimulate critical thinking, their production can also risk superficial interpretation and a narrow projection of human relationships. Matthews (2014) speculated that digital media have the potential to provide the platform for transforming the story or narrative into a format that is open and flexible. However, this brings to the fore another challenge in that while good teaching includes technology, its effective use requires digital competence alongside an awareness of the potential effect of each component part of the learning activity. This issue of the relational influences between the digital media and genre of story is one that will be returned to in the discussion section of the article.

Study design
The initial research enquiry focused primarily on a comparative analysis of digital media and their ability to convey realism and authenticity as perceived by individuals in the participant group. The objective was to generate knowledge and understanding about the felt experience of authenticity from each of the selected media. A secondary objective was to explore the pedagogical capability of digital storytelling for creating and selecting digital resources that hold a high tariff of authenticity.
The suggestion that authenticity requires a 'natural' effect leads to the question about the pedagogical approach of storytelling. Rule (2006) proposed that employing a sociocultural approach is necessary. In this, real-world problems connect with workplace roles, and provide open-ended enquiry and opportunity for discourse among a community. Students can then self-regulate learning and have a sense of empowerment in the process. This approach somewhat mirrors the views of the researcher's choice of methodology and design of the enquiry. A co-productive approach was taken in which the participant group were equal creators of the enquiry as it developed, thus representing the social constructivist views held by the researchers and played out in the process of the enquiry.
However, the purity of the co-productive approach was restricted by the teachers selecting the scenarios to be reviewed.
The participant group (n = 7) comprised family carers, people with lived experience and mental health student nurses. Membership of the group aimed to replicate and represent the two protagonist roles in the nurse/patient relationship, that is, the 'student nurse' and the 'individual with lived experience or their family member'. The group viewed four digital scenarios in which the subject matter presented a narrative that would resonate with the group participants. With the exception of one scenario, the stories were selected with the two protagonist groups prominent in the story. In addition, woven through the scenarios, was an issue of social, moral or value-based conflict. It was this conflict that provided the fertile ground for group members to exchange perspectives, interpretations and emotional connections with the story, articulated through the lens of their own realities. Details of the selected scenarios and the digital medium are as follows: (1) A filmed simulation using amateur actors depicting a mental health nursing assessment of a child and his mother. The two facilitated workshops enabled qualitative and quantitative data to be generated. In the first workshop, participants' perceptions of authenticity were rated using Herrington et al.'s (2006) Scale of Authenticity. The qualitative data were extrapolated into the second workshop where the rating results were revealed to the group, facilitating group discussion which was recorded and thematically analysed.

Findings
The findings can be most effectively summarised into three areas: The relationship between the form of digital media, the content and the experience of immersion Of the four scenarios, the drama (3) had the highest rating on Herrington et al.'s (2006) Scale of Authenticity, with the storybook (1) having a slightly lower rating. The challenging nature of the narrative story in the drama along with the power of the imagery in conveying atmosphere and emotion accounted for it having the highest rating on Scale of Authenticity. The audio podcast (4) performed the poorest, accounted for by its lack of relevance and shortness of length. The activity of listening was a factor in the poor scoring. The students were unfamiliar with listening as a single activity. These findings can be partially attributed to the sense of immersion the participants experienced when watching or listening to the scenario. The film was a powerful exposé of life for young people on the margins of society. The kernel of the story centred on a young woman battling addiction and choosing to have her baby despite professional advice to do otherwise. This provoked some contentious discussion between the participant members.
The student nurses related to scenarios (2) and (3) through their own learning experiences of supporting individuals with addiction issues. They reflected on the challenges of understanding choices made by 'patients' which seemed to lead to further disadvantage and ill health. The scenarios led them to reflect back on these experiences and reconsider the view that people ('drug users') simply made 'bad choices'. The participants with lived experience, on the other hand, reinforced the sense of dehumanisation that can occur when individuals are exposed to a chronic sense of community marginalisation.

The difference in realities and interpretative explanations between the protagonist groups
The level of projected realism and explicit conflict in the scenario was proportionate to the expression of difference of interpretation between the two groups. So, the two scenarios that featured individuals with addictions (2 & 3) provoked most dissent. The student nurses expressed largely patriarchal views around the need for care and control, whilst the family members dwelt on the impoverished living conditions and limited life choice opportunities available to the characters. This was in contrast to scenario (1) whose amateur production seemed to fail to convey sufficient authenticity to warrant much attention or conflict in the group. The subject matter of death and dying in the audio podcast was considered to be largely irrelevant to mental health nursing by the student nurses. This was in contrast to the family and users of mental health services who were tearful and saddened by the listening experience.

Challenging perceptions and confronting stereotypes
The form of media and the content of the material were significant in tempering the sense of immersion in each of the narratives. Immersion presents as an essential quality in which the individual experiences a simultaneous sense of absorption with the media alongside a disconnection with immediacy in reality. Challenging nurses to think beyond the boundaries of widely accepted societal attitudes and explanations for mental ill health is central to any undergraduate nursing programme. However, this study would suggest that to do that effectively, the scenario must convey realism.
The participant group agreed that digital scenarios provided an important medium for challenging beliefs, concurring on the importance of the story having a sufficient level of complexity for exploration and critique if new learning is to be achieved.

Discussion and reflections
The aim of the enquiry was to generate new understanding about the relationship between digital media and authenticity in the learning journey of mental health nursing students. Data gathered from the workshops provided a platform from which the relationship between the media, the subject matter and the elements of the narrative such as length and genre could be examined. A further enquiry aim was to examine the influence of employing a co-productive approach to the methodology.
The two workshops only served to begin to signal some of the more complex and subtle issues around the use of digitally conveyed storytelling as an educational tool. The capacity and rationale for a second phase of research are now explored in relation to the findings and reflections of the author group.
It can be readily concluded that the formal use of stories in education generally, and nursing education specifically, is uncontested. However, this study generates new knowledge about the importance of considering the nuances of the digital media as well as the method of producing the scenario. Despite the different ways in which stories might be employed, stories can initiate reflective learning, a practice which promotes the contemplation of new knowledge and invites in challenge to that which is already accepted as true (Adamson & Dewar, 2015). The findings from this enquiry would concur with the assertion that stories can be effective learning tools. Meier and Stremmel (2010, p. 249) identified an alternative conception of a story. They diverged from the conception of a story having as 'a beginning and an end', and as 'something you fix, frame and give meaning to'. Instead, they regarded the story as being inseparable from the person, and which lives with them, extending its relevance 'in a multitude of ways and situations'. From this frame of reference, stories are not 'out there' and may therefore not be benign in their influence, despite the intention of the teller. Rather, for Meier and Stremmel (2010) stories present 'as universal mirrors that show us the truth about ourselveswho we are and why we do what we do' (p. 49). In this sense, they reflect something of Frank's (2010, p. 3) view which is that 'stories animate life' because that is 'their work' and then they go on 'to instigate'. As such, they have agency and are therefore neither passive nor necessarily innocuous.
In some ways, this explains the diverging explanations between the participant groups. The protagonists in the scenarios were reflected in the composition of that group. The student nurses seemed compelled to protect and defend their own professional values exhibited in the scenarios, though there was a sense of unexpressed discomfort. The family members and service users, on the other hand, readily, but gently, drew attention to the social, cultural and economic complexities of each of the stories. A third and fourth workshop may have enabled the group to feel emotionally safe to explore, express and work through these conflicts and, in doing so, enable the participants to construct alternative realities.
The two workshops left the enquiry feeling a little 'unfinished'. However, this sense of incompleteness does not diminish what the authors were able to learn. The need for nurses to engage with people who may have different values, beliefs and perspectives is essential, however not always directly available. Enquiry/scenario-based learning using genuine stories offers educationalists an opportunity to maximise the value of stories while maintaining the level of involvement of people with lived experience through the co-production of the learning resources. The impact of sharing stories with individuals with lived experience requires attention to ensure the intense 'reality' of the shared experience does not impact negatively on either party (McIntosh, 2018). Digital stories offer a practical and accessible alternative that avoids the labour of work on the service user as stories can be developed, recorded and replayed without the presence of the service user and all the pressure that might cause. In addition, if the stories are co-produced then the authenticity value is likely to be enhanced.
Co-creating stories would serve to capture essential knowledge around technological, pedagogical and conceptual aspects of mental health nursing education. Key participants would include educationalists, students and people with lived experience. As a group, digital stories can be created that can authentically capture layers and detail of human experience.
As previously noted, authenticity involves the experience of reviewing and reconsidering previously held assumptions. It is assumed perhaps that values are fixed and shared with some certainty. Typically, the teacher selects the scenario with the objective of exploring a particular ethical or moral dilemma. Values, however, are unique to the individual, dynamic in nature and subject to individual interpretation. Individual attribution of a specific value is very much mediated by experience. If the teacher selects the scenario, the 'real-world' issue is somewhat manufactured working on the assumption that the students hold similar or the same concerns. However, personal values require expression and discussion. The role of the community becomes extremely important in ensuring one reality does not dominate.
In the workshops, the facilitator predicted that the podcast (4) was likely to hold the strongest potency. However, this was the least favoured by the participant group. This signals the need for coproduction in the selection of the teaching and learning materials if dominant views of the teacher are not going to overshadow the realities of the student nurses and service users alike. So, the process of selection and perhaps also production of the scenario has to some extent to replicate the values of authentic learning.

Recommendations
The study focus was to explore the value of digital storytelling through the prism of authenticity. The theory of authentic learning was exercised through digital stories as a stimulus learning tool to support the critical development of ethical values such as compassion and empathy, essential to all relational encounters in nursing activities. The study evaluated the way in which authenticity was perceived by viewers and listeners of digital stories whose own stories, in some way, resonated with those being presented. When reflecting on the theorising of creating authentic learning experiences, we conclude • that authenticity can be manipulated to some extent. The word 'manipulated' is used purposefully as it is suggestive of a didactic approach to learning which, if employed, is likely to significantly distil the potency of authenticity. • therefore, the quality of authenticity is dependent on the way the media is produced and on who selects it. • that the quality of authenticity is similar to a 'value' in that it is not 'present' unless (a) articulated and (b) contested. • that, in visual stories, there is much more dependence on the quality of the visual cues (so in content; tone; realism of images). The inability to be able to check back as one would in a twoway conversation. • that if the digital story is not experienced as authentic, it is largely discarded. Experiences are quite polarised which may be interpreted as tangible evidence that the theory of authenticity is being applied.
Given these reflections on the theorising the application of authenticity, the authors suggest two recommendations:

Recommendation one
Scenarios are selected and produced using a co-productive approach. Digital media must be selected carefully not just in relation to the learning and teaching needs of the student group, but also in relation to social and cultural norms and the digital skills of the student group.
Reflection on the study demonstrated that relevance of content is a necessity, but that it should be judged not by the teacher, rather by the participant group it concerns. A significant limitation of this enquiry was that the scenarios were selected by the teaching team, introducing bias in perspective and in preference of specific forms of digital media. Yet, a co-productive approach to the methodology attempted to mirror the shifting of power and from the teacher to the participant group and produced some very different results to those anticipated in the choice of the story presenting the greatest authentic quality.
Two workshops alone were not sufficient to work through the deeper learning in a meaningful manner. Conflict between participant members was felt, but relatively little was expressed. However, there was a real sense by the end of the second workshop that the respective group were beginning to hear one another in a new way. Mutuality of trust and understanding was tentatively growing and if further workshops had taken place, this participant connectedness may have enabled values and beliefs to be challenged and explored safely. From this, there was potential for new stories to grow, created and finally narrated by the members of the participant group.

Recommendation two
Educationalists demonstrate caution when using simulation to present scenario-based learning.
The findings from the study suggest that the genre and form of digital media significantly influence the authentic quality of the learning experience. Whilst simulation is a relatively accessible form for producing materials, the power of drama, specifically drama which is professionally produced, as opposed to amateur simulated drama-based scenarios, supersedes any of the other digital media in its ability to provide an immersive quality that sat with the participants for some days following the first viewing. The experience of listening alone offered by the podcast was unfamiliar to the student participants and their difficulties with focus and concentration obscured the potential for immersion in the scenario.

Conclusion
The aim of the enquiry was to generate more understanding about the relationship between digital media and authenticity in the learning journey of mental health nursing students. The enquiry provided a platform from which the relationship between the media, the subject matter and the elements of the narrative such as length and genre could be examined. Viewing the study through the prism of authenticity enabled new learning about the theory of authentic learning. The feedback from the participant group enabled insights into the construction of digital stories that can be applied in the development of future educational resources.

Disclosure statement
No potential conflict of interest was reported by the authors.

Notes on contributors
Margaret M. M. Conlon is a Lecturer and Field Lead of the Undergraduate Mental Health nursing programme at the University of Stirling. As a Senior Fellow of the Higher Education Academy since 2016, Margaret is a passionate teacher and experienced mental health nurse whose interests include developing contemporary digital teaching approaches in nursing education.
Dr Fiona Smart is an Associate Professor in Learning and Teaching and Head of the Department of Learning and Teaching Enhancement at Edinburgh Napier. She is a Principal Fellow of the HEA and an International HE Consultant.
Gwenne McIntosh is an experienced senior lecturer and mental health nurse with a keen interest in co-production in education and has research experience surrounding the impact of co-production in nurse education from a student and family carer perspective. Gwenne is a Senior Fellow of Higher Education Academy (SFHEA), holds an MSc in Nursing and Applied Education and is a Registered Mental Health Nurse.