Teaching and Learning Through Illness Narratives Dr Marie McDaniel School of Nursing and Midwifery April 2011

Narrative Inquiry  Narrative methods have been gaining popularity in the past 25 years  There are examples from sociology, anthropology  In medicine and nursing, narrative methods have manifested themselves in illness narratives 12/06/ Dr Marie McDaniel

Learning to nurse by listening to patients  Has anyone been a patient?  That essentially is what my research is about teaching and learning about nursing by listening to the stories of patients.

Defining Illness Narrative  In illness narrative, the focus of trouble is death, disability, disfigurement, distress, intractable pain, loss of freedom or social stigma.  The essence of illness narrative is how well or how badly health professionals, care givers and patients evade or face up to these adversities (Greenhalgh, 2006, p4). 12/06/ Dr Marie McDaniel

Illness Narrative and Nursing It seems paradoxical that relatively little attention appears to have been paid to the value and role of narrative in nursing practice when nursing stakes so many claims to being embedded within a dialogic, relational approach. In this respect, medicine may have stolen the march on nursing as narrative within medicine is more widely written about (Carter, 2009, p477). 12/06/ Dr Marie McDaniel

Warning Carter (2008) warns that narrative researchers can be in danger of focusing on the negative aspects of a story, of being attracted to sensationalism and while not suggesting the suppression of poor practice, she advocates a balanced view between the “good and bad” story 12/06/ Dr Marie McDaniel

Aims and Objectives  The overall aims of the study were:  To generate illness narratives through narrative inquiry  To explore the pedagogical potential in illness narrative to inform nursing education and practice 12/06/ Dr Marie McDaniel

Research Design  The study was conducted in two phases:  Narrative Inquiry with four nurse lecturers who had been patients to generate the data  Phase Two  Focus groups (students and lecturers)  Semi-structured interviews (patient participants) in their roles as nurse lecturers  The data was subjected to thematic and comparative analysis 12/06/ Dr Marie McDaniel

Summary of the Stories  All four stories occurred between  They are sourced from four different health care settings across Northern Ireland  There was variety but consistency to the stories and experiences 12/06/ Dr Marie McDaniel

The Participants PSEUDONYMTYPE OF ADMISSIONCONDITION MarieElective Day SurgeryRemoval of ganglion (wrist) JacquiEmergency Medical Admission A&E Cerebrovascular incident JohnEmergency Medical Admission A&E Pneumonia TessElective in-Patient Surgery Mastectomy and reconstruction 12/06/ Dr Marie McDaniel

Themes from the Patient Narratives  Patient advocacy  Communication  Patient vulnerability  Person-centred care  Being treated as a person  Pain management  Patient disempowerment  Privacy and dignity  Respect and team work  Confidence in the staff  Denial of the patient experience 12/06/ Dr Marie McDaniel

The Patient Narratives Marie’s Story Patient Advocacy

Marie’s story -analysis In total Marie mentioned pain 11 times in her brief narrative e.g. –The pain was atrocious …. –I never felt anything like it in my life … Lack of advocacy from the nurses Lack of communication and teamwork between nurses and surgeon Lack of person-centred care

Advantages of narrative approaches in teaching and learning  The advantages of using illness narratives are four fold These are:  The topics  The student  The lecturer  The patient The patient Topics Teaching Learning

Advantages of using illness narratives – students  Topical/ current/ relevant  Stimulating and challenging learning strategy  Develops student-centred teaching/learning  Develops student engagement  Develops critical thinking and reflective skills  Develops thinking about the caring aspects of nursing  Develops ethical knowledge  Develops concept of person-centred care  Enables transferable learning

Advantages of using illness narratives - lecturers  Content/topical/current  Challenging and student centred  Flexible  Can be used as a pedagogical strategy across a range of students from undergraduate to post graduate and with interprofessional groups

Advantages of using illness narratives – the patient Patients can be traumatised by their experiences of illness and hospitalisation Telling their story can be therapeutic and help in the healing process (Frank, 1995)

References  Carter, B. (2008) ‘Good’ and ‘Bad’ Stories: Decisive Moments, ‘Shock and Awe’ and being Moral Journal of Clinical Nursing 17 (8), pp  Carter, B. (2009) Editorial: Nursing Amidst Stories (and knowing what to do with them) Journal of Clinical Nursing 18 (4), pp  Greenhalgh, T. (2006) What seems to be the Trouble? Oxford: Radcliffe.  Frank, A. W. (1995) The Wounded Storyteller London: The University of Chicago Press.

Thank you for Listening Questions?