"Once upon a time..."--narrative in nursing.
Article Type: Editorial
Subject: Nursing education (Methods)
Author: Carroll, V. Susan
Pub Date: 10/01/2010
Publication: Name: Journal of Neuroscience Nursing Publisher: American Association of Neuroscience Nurses Audience: Professional Format: Magazine/Journal Subject: Health care industry Copyright: COPYRIGHT 2010 American Association of Neuroscience Nurses ISSN: 0888-0395
Issue: Date: Oct, 2010 Source Volume: 42 Source Issue: 5
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 238912113
Full Text: Story telling, narratives of our lives as they happen, pervades our social world. Stories allow us to make sense of our experiences and add value to our personal histories. Throughout history, narratives have been used to communicate important knowledge from the past to present-day listeners; narratives convey cultural and social norms in addition to individual experiences. Narrative has a long, time-honored tradition in nursing as well. As we care for patients and their families, we listen to their stories. We also share our practice in the stories we tell. Telling stories and listening to those of others underscore the similarities and connections among us.

Narratives may also provide us with ways in which we can mentor new practitioners, conduct research, learn and grow professionally, teach others, and reflect on our practice. Benner embedded narratives--exemplars--in her work describing the levels of competency in clinical nursing practice. In 2005, Sigma Them Tau created a resource article outlining the essentials of reflection and reflective practice in nursing. The Sigma Theta Tau document tells us that reflection is a way in which we bridge the theory-to-practice gap; it allows us to develop practical knowledge and working intelligence. One key recommendation from the scholars who developed the document centers on using reflective models, theories, and methods to guide and to enhance education; this recommendation mirrors a shift in academic culture from the traditional, teacher-focused "dissemination of knowledge" model of education to learner-focused models that look at what the learner does and why in the social context of learning.

Using reflective stories or narratives in this educational context creates a unique interaction between learner and teacher. In this encounter between the two, the teacher can create a transformational learning opportunity that the learner interprets as caring. Narrative in an academic context allows learners to use the tacit knowledge that is embedded in experience to master and apply new knowledge. Narrative fosters critical thinking. Reflective narrative requires listening; it relies on communication and relationships; it supports collaboration. Narrative--story telling--can also help us teach the patients for whom we care.

Given the huge amounts of health-related educational material available in myriad formats and the constantly shifting healthcare environment, our patients must take in, process, and use complex information that can seem overwhelming. They have to possess a high degree of health literacy. However, the true health literacy issue may not be the lack of information and the ability to read it but the individual's ability to process the information. We are neuroscience nurses--we understand the left-brain/right-brain dichotomy. Left-brain learners are typically thought of as linear learners; they are analytical, logical learners who tend to process information sequentially, step by step. Right-brain learners process information more globally, integrating experience and discovery. Adult learning theory tells us that adults want and need to incorporate practical, everyday life experiences into what they must learn.

Story telling can provide nurses with an avenue that is beneficial for teaching and motivating change. Osborne (2008) noted that "when you tell a good story, you can frame important messages in ways that make them memorable for your listeners." Story telling allows us to create knowledge by transforming experience. It actively draws the patient (learner) into the story being told. "Telling the right story at the right time can help a patient understand the importance of adherence to a treatment plan" (Day, 2009, p. 2) or decide to make critical lifestyle changes. Story telling can be a way to increase health literacy.

As we listen to our patients' stories, values and cultural practices that should guide our care can be elicited. Tolerance and culturally sensitive care are enhanced when we "hear" a patient's narrative. Story telling can also be a part of support groups; stories provide the experiential connection patients, and their families may need but open up learning opportunities as well. Encouragement from the storyteller and the group provides support and may change a patient's negative outlook to a more positive one. Patients may be telling their stories and reading those of others through blogs, in e-journals, and in chat rooms. Story telling can be therapeutic because a story crosses individual and cultural differences; a story uncovers shared meaning.

Tell tales. Listen to those of others. Create a narrative. Teach. Learn.

DOI: 10.1097/JNN.0b013e3181ee513e

Reference

Day, V. (2009). Promoting health literacy through storytelling. Online Journal of Issues in Nursing, 14(3), 1-4.

Osborne, H. (2008). In other words ... Tools of change: Telling and listening to stories. On Call. Retrieved July 15, 2010, from http://www.healthliteracy.com/article.asp?PageID=8051.

V. Susan Carroll, Editor
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