Encouraging Patient Narrative as a Humanitarian Act of Kindness

This blog post comes from Catherine Kelsey, a nursing lecturer at the University of Bradford.

The ability to tell our stories is as crucial to human life as the air we breathe, the food we eat and the functioning of our senses (Robertson and Clegg, 2017). The communicating of stories can help us to create a deeper meaning from our personal experiences (Price, 2011) and enable us to make connections, as we begin to realise the commonalities we share (Holmes, 2015).

Definitions abound as to the meaning of storytelling. However, the common elements define storytelling as being the effort used to convey events using words, pictures and sounds, which can often be creative in nature. In much of the literature authors use the words storytelling and narrative synonymously; stories being considered “reflective, creative and value laden”, which often discloses something significant about what it means to be human, whereas narrative can be defined as principally factual (Haigh and Hardy, 2011).

Storytelling has emerged as a valuable tool for health care organisations as they seek to understand the impact of healthcare delivery on patients and their families (Roebotham et al. 2018). Schwartz and Abbott (2007) suggest that storytelling can be utilised as a means for both teaching and learning, whilst Wang and Geale (2015) opine that the use of narrative allows for a full portrayal of patient experiences and an examination of the meanings derived. Disappointingly, however, as Warne and McAndrew (2007) purport, patients stories have been under-utilised as a resource for learning.

The importance of healthcare professionals, who have the capacity to listen well and engage appropriately, is crucial if patients are to be empowered to tell their story (Robertson and Clegg, 2017). Nurses in particular can play an important role ‘in the narratives of others’ (Alicia-Planas, 2016). The skills needed to be able to recognise, understand and construe a patient’s story and to act accordingly is defined by Charon (2001) as ‘narrative competence’. Within social work, Pack (2013) argues that the experience of having the opportunity to converse with service users and listen to their stories of recovery ‘echoes for students throughout the academic year’.

Whilst Grassley and Nelms (2009) purport that storytelling can enable the exploration of significant events, help to validate choices and provide catharsis, not all the literature extols such value. As Happell et al. (2015) indicate, the vulnerability associated with storytelling for some patients can mean that they can be re-traumatised by the recollection of their experiences. It is important therefore that storytelling is not deemed to be the panacea for all ills. However, what is important is that nurses create an environment in which patients feel comfortable to share their stories.

The importance of creating space in which patients are able to tell their stories, in a cathartic and meaningful way should be considered an important aspect of nursing practice. For such ‘stories can offer the kind of contextual richness that promotes and nourishes empathy’ (Krisberg, 2017). Giving patients the time and opportunity to share their experiences therefore, is essential if nurses are to encourage a sense of wellbeing and through their actions seek to reduce further suffering. Undertaken with compassion, nurses can gain a greater understanding of patient experience and through this develop high-level communication skills that facilitate the emergence of benevolent, empathic and caring humanitarians. Through this therapeutic experience nurses become empowered and more adept in providing care that is person-centred.

According to Langer (2016), storytelling is possibly ‘the most natural form of communication’ and is the way in which we infuse resilience and social norms within society.  Listening and giving attention he argues, is perhaps the most basic and powerful way to connect with others.

Whether you are an advocate for storytelling or a sceptic, it is evident that much of the literature extols the value of storytelling as a means of helping patients to keep memories alive and create meaning from their life’s work. Although the stories told can often be complex in nature, (Alicia-Planas, 2016) nurses, through the act of listening, can gain a deeper level of understanding of what it means to suffer and in so doing plan and deliver care which is patient-focused. Despite the potential risks, listening to the stories of patients must ultimately be considered an important aspect of person-centred care and nurses should be prepared to develop the skills required at a deeply personal level in order to make this happen.

 

References

Charon, R. (2001) Narrative Medicine. A model for Empathy, Reflection and Trust. The Journal of the American Medical Association 286 (15), 1897-1902.

Robertson, C. and Clegg, G. (2017) ‘The Power of Narrative and Story’. In Robertson, C. and Clegg, G (editors) Storytelling in Medicine. How Narrative Can Improve Practice. Taylor and Francis Group.

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