Tuesday, 7 April 2020

Seeing through the gaze of a storytelling lens


Catherine Best

Today is World Health Day 2020. So, let’s celebrate and support the great work that our courageous and dedicated nurses across the globe are doing right now. Nurses who are ‘pulling out all the stops’ to ensure the provision of the best care possible, at a time of greatest need.

Seeing through the gaze of a storytelling lens shines a light on the importance of narrative in nursing through which nurses can gain valuable insight into the lives of patients, colleagues and situations faced.

Introduction
Throughout history, books, film, drama, art and even cave drawings have been used to tell personal stories that help to support social and emotional processing, which in turn encourages empathy (Robson, 2018).

‘The Death of Ivan Ilyich” by Leo Tolstoy first published in 1886, for example tells explicitly and with compassion, the story of a man, who instead of cultivating love and kindness, chose to cultivate a life of obsessive behaviour and social gain. Compelled to confront his own death, he realises that his life should have been different. Ivan Ilyich is fortunate, he is supported by his servant Gerasim, who without question provides for his personal needs and throughout his illness demonstrates only compassion; traits Ivan Ilyich should have cultivated. Ultimately, he realises as his life fades away he can still, fortunately, make amends.

Tolstoy’s novella along with many others, including the work of Arthur W. Frank (2013); ‘The Wounded Storyteller’ through which he tells his personal story of life with illness, and ’Somebody I Used to Know’ by Wendy Mitchell (2019), as she shares insight into her life following a dementia diagnosis, enables people to tell their stories of suffering, disease, illness and dying in all its forms.

Nursing Narrative
In recent years the importance of narrative within nursing has become increasingly popular, both as a catalyst for research opportunities and as a process whereby patients are able to generate meaning from personal experience (Joyce, 2015).

Comprehending personal narratives contends Gaydos, (2005) is a matter of intuition and art; reasoning and science. This concept developed by Carper (1978) defines the ‘Fundamental Patterns of Knowing’; seminal work that acknowledges the inimitable contribution that nurses make to patient care.

Narrative nursing argues Fitzpatrick (2018) provides an important framework to enable effective communication to take place and supports the development of professional nursing practice. Furthermore, nursing narrative can be a powerful educational opportunity (McAllister, 2015) empowering healthcare professionals to reflect critically on their experience (Walton et al., 2018). If care is to be truly patient centred however, health professionals must acknowledge that patient stories; the illness narrative, becomes the dominant voice (Buckley, 2016).

Narratives can be used to open up a plethora of opportunities to enhance professional development, including reflective practice, allowing nurses to express and extend their current knowledge, whilst making visible clinical expertise and providing occasions for collective learning (Erickson et al., 2015). Narratives can support professional socialisation argues Traynor, (2020). Defined by (Price et al., 2018), professional socialisation is the dynamic process of coming to know a professional role, ensuring a smooth transition to professional practice (Newton et al., 2015).

Furthermore, narratives can facilitate nurse recruitment by illuminating the great work of historical nurses, (Traynor, 2020), Florence Nightingale, Mary Seacole and, Edith Cavell being the most well-known and by contrast be utilised to develop professional leadership skills, build strong cultures and connect with others (Sherman, 2012). Likewise, through the act of telling or listening to narratives can encourage resilience (Traynor, 2020). Developing this ideological approach, it could be argued has the capacity to become nursing’s most revered strength.

Our Greatest Teachers
Patients and their families, through the telling of personal stories, can be our greatest teachers, (Fitzgerald, 2015), the use of narrative allowing for a full portrayal of these experiences and an examination of the meanings derived (Wang and Geale, 2015).

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); strengthening the otherwise silent voice (Trahar, 2013).

Whilst the understanding of patients' stories requires a focused and empathically-attuned level of attention (Corbally and Grant, 2016) when a personal story is shared we catch sight of a world that is different from our own (The Health Foundation, 2016). By learning to understand another’s perceived world, the experience can inspire empathy within others (The Health Foundation, 2016).

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).

Conclusion
Through the medium of narrative, nurses have an opportunity to engage with and learn from the patients’ experience and in so doing facilitate the development of patient-centred care. Patient narratives however are futile if told to nurses who have failed not only to grasp the concept of what it means to tell one’s story but also what it means to be human, to suffer and in what context.

Giving patients the time and opportunity to share their experiences therefore is central if nurses are to promote a sense of patient wellbeing and through their actions create a future that promote a sense of integrity, trust and professionalism. One in which they seek to listen, to understand and where necessary to act.

References
Buckley, A. (2016) Using Patient Stories to Reflect on Care. Nursing Times, 112 (10)  pp. 22-25.

Carper, B. (1978) Fundamental Patterns of Knowing. Advances in Nursing Science, 1 (1)

Corbally, M. and Grant A. (2016) Narrative competence: A neglected area in undergraduate curricula. Nurse Education Today, 36 January, pp. 7-9

Dahlstrom, M.F. (2014) Using narratives and storytelling to communicate science with nonexpert audiences. Proceedings of the National Academy of Science, 111 supp 4 , pp. 13614–13620

Erickson, J.I. Ditomassi, M. Sabia, S. and Smith M. E. (2015). Fostering clinical success: Using narratives for interprofessional team partnerships from Massachusetts General Hospital. Indianapolis: Sigma Theta Tau International.

Fitzgerald, F. (2015) Medicine: The greatest of Humanities. Journal of Pain and Symptom Management, 49 (5) May, pp. 964-966.

Fitzpatrick, J. (2018) Teaching Through Storytelling: Narrative Nursing. Nursing Education Perspectives, 39 (2) March/April, pp. 60.

Frank, A.W. (2013) The Wounded Storyteller: Body, Illness, and Ethics. 2nd ed. The University of Chicago Press Ltd: London.

Gaydos, H.L. (2005) Understanding personal narratives: an approach to practice. Journal of Advanced Nursing, 49 (3) , pp. 254-259.

Johnston, C. Banner, N. and Fenwick, A. (2016) Patient narrative: an ‘on-switch’ for evaluating best interests. Journal of Social Welfare and Family Law, 38 (3)  pp. 249–262 doi.org/10.1080/09649069.2016.1228146

Joyce, M. (2015) Using narrative in nursing research. Nursing Standard, 29 (38) May, pp. 36-41.

McAllister, M. (2015). Connecting narrative with mental health learning through discussion and analysis of selected contemporary films. International Journal of Mental Health Nursing, 24 (4) pp. 304–313.

Mitchell, W. (2019) Somebody I Used to Know. eBook. London: Bloomsbury Publishing.

Newton, J.M. Henderson, A. Jolly, B. and Greaves, J. (2015). A contemporary examination of workplace learning culture: an ethnomethodology study. Nurse Education Today, 35 (1) pp. 91-96.

Price, S.L. McGillis Hall, L. Tomblin Murphy, G and Pierce, B. (2018) Evolving career choice narratives of new graduate nurses. Nurse Education in Practice,  pp. 86-91.

Robson, D. (2018) Our Fiction Addiction Why Humans Need Stories [Online]. BBC. Available from: http://www.bbc.com/culture/story/20180503-our-fiction-addiction-why-humans-need-stories [Accessed 2nd April 2020.]

Roebotham, T. Hawthornthwaite, L. Lee, L. and Lingard L.A. (2018) Beyond catharsis: the nuanced emotion of patient storytellers in an educational role. Medical Education, 52 (5)  pp. 526-535.

Sherman, R. (2012) The power of nursing leadership stories. Available from: https://www.emergingrnleader.com/nurseleaderstories/ [Accessed 5 April 2020]

The Health Foundation (2016) The Power of Storytelling. [Online] Available from: https://www.health.org.uk/newsletter-feature/power-of-storytelling [Accessed 3 April 2020]

Tolstoy, L (2016) The Death of Ivan Ilyich. London: Penguin Classics.

Trahar, S. (2013) Contextualising narrative Inquiry: developing methodological approaches for local contexts. Abingdon: Routledge

Traynor, M. (2020) Stories of Resilience in Nursing. Tales from the Frontline of Nursing. London: Routledge.

Walton, J.A. Lindsay, N. Hales, C. and Rook, H. (2018) Glimpses into the transition world: new graduate nurses' written reflections. Nurse Education Today, 60 January, pp. 62-66.

Wang, C.C. and Geale, S.K. (2015) The power of story: Narrative inquiry as a methodology in nursing research. International Journal of Nursing Sciences, 2 (2) June, pp. 195-198 

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