Blog by Catherine Best
Nursing through the gaze of a storytelling lens shines a light on the importance of nurses making the most of patient narratives to gain valuable insight into lives lived. This insight enables the delivery of person-centred, evidence-based nursing care, within frequently highly charged and emotional situations.
Storytelling forges connections among and between people and ideas. Telling stories is one of the most powerful means of influencing, teaching and inspiring (Boris, 2017). They convey the culture, history and values that unite each and every one of us; they are the ties that bind us (ibid.).
Storytelling, or narrative pedagogy, is a practice that occurs as a result of the lived experience (Haskell, 2021). Stories are omnipresent (Hawkins and Saleem, 2012). They can be found in our behaviours; our actions; our dialogue and our values. They can be found in our search for meaning and understanding.
Having the ability to share one’s story is considered an essential element of the humanities, and can enable a rich description of patient experiences to emerge (Wang and Geale, 2015). And while medicine has been previously steeped in the richness of the humanities, as evidenced by, for example, the work of Canadian physician Sir William Osler (Mangione and Kahn, 2019), there remains a challenge to ensure the humanities are integrated into undergraduate teaching (Kollmer Horton, 2019)—which is, perhaps, unsurprising when considering the myriad skills required by the medical profession. Such skills include the expert understanding of the scientific basis of disease (Kollmer Horton, 2019); mastering technology that enables diagnosis and treatment (ibid.); and the ability to make moral and ethical decisions requiring more than simply choosing appropriate treatment regimens (Varkey, 2021). Essentially physicians must ‘recognise and appreciate the patient in which the disease exists’ (Kollmer Horton, 2019).
Conversely, person-centred care, as Price argues (2020), requires nurses to ‘listen to patients’ narratives of illness or injury’, a process through which a powerful understanding of the complex experiences of patients can emerge, encouraging a deeper level of understanding of lives lived (Alicea-Planas, 2015) and supporting a collaborative approach to the planning and delivery of appropriate care (Price, 2020).
In recent years the importance of narrative within nursing has become a catalyst for inspiring patient-centred care, compassion and understanding (Baines et al. 2019), providing an important framework to enable effective communication to take place (Fitzpatrick, 2018).
Furthermore, patient-centred approaches to care delivery stress the importance of understanding patients’ knowledge, emotions, well-being and life experience (Johnston et al. 2016), providing a lens through which patients can experience a release of emotion and a sense of catharsis (Roebotham et al. 2018), and strengthening their otherwise silent voice (Trahar, 2013).
Expressing empathy is a highly potent cognitive and behavioural reaction enabling the building of patient trust and reducing anxiety, ultimately impacting patient outcomes positively (Stone, 2019); it is an essential element in the repertoire of a nurse’s skillset, the essence of which ‘is the ability to share and understand the emotions of others’ (Molenberghs, 2017). What better way to do this than through listening and engaging with patient narratives?
Stories can foster personal values such as courage, resilience and resourcefulness, generosity, sensitivity and respect (Boyd, 2018). They can be used to gain insight of sacrifice, understanding, fear and loss. Furthermore, with an increasing evidence base, patient narratives are used to encourage problem solving (Baldwin et al. 2017) and reinforce professional ethics, helping to close the gap between human experiences and the theories used to explain them (Tevendale and Armstrong, 2015).
Moreover, nursing narrative can be a powerful educational opportunity (McAllister, 2015), opening up a plethora of opportunities to enhance professional development, including reflective practice, and empowering nurses to express and extend their current knowledge while making clinical expertise visible and providing occasions for collective learning (Erickson et al. 2015).
Narratives, argues Traynor (2020), can support professional socialisation: the dynamic process of coming to know a professional role (Price et al. 2018), ensuring a smooth transition to professional practice (Newton et al. 2015). When a personal story is shared we catch sight of a world that is different from our own; by learning to understand another’s perceived world, the experience can both inspire empathy (The Health Foundation, 2016) and enable human connections (Petty, 2021).
Furthermore, because narratives are inherently designed to persuade; they describe a particular experience rather than assert a generalised truth, narratives have no need to validate the accuracy of such experience; the narrative itself is sufficient (Dahlstrom, 2014).
Through the medium of narrative, nurses have an opportunity to engage with and learn from each other, creating a future that promotes integrity, trust and professionalism, a future in which nurses seek to listen, to understand and, where necessary, act.
Furthermore, stories enable nursing students to develop a deeper understanding of specific issues and experiences (Tevendale and Armstrong, 2015). They can be used extensively within teaching and learning to enable learners to reframe events and alter their perspective, to focus on details or obtain an overall view (ibid.)
Moreover, they have the potential to encourage resilience (Traynor, 2020); enable critical reflection on professional experience (Walton et al. 2018); enhance learning within professional practice (Timpani et al. 2021); and improve effective decision making (Saffran, 2021).
Patient narratives can be considered a conduit through which nurses are able to gain greater insight into the world of their patients. They support empathic behaviours, encourage shared learning, and open up a plethora of opportunities to ensure the delivery of high quality, person-centred care. They can enable the building of trusting relationships, ensure effective decision making, guide diagnosis and support successful treatment plans. They can help a patient die with dignity, love and kindness bestowed. They must be treated with the value and respect they deserve (Baines et al. 2019).
Catherine is the practice educator at Saint Catherine’s Hospice in Scarborough UK. She is a Queens Nurse, an award which recognises excellence in professional nursing practice and a member of the Phi Mu Chapter of Sigma, an honorary nursing society which recognises excellence in scholarship, leadership, and service.
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