Understanding narratives in health care
Understanding narratives in health care

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Understanding narratives in health care

2 Identifying others’ narratives

Others’ personal narratives may be partially available to you through the accounts they share – those that betray their interests, fears, uncertainties, delights, motivation and state of comfort. However, individual conversations, in which they share ideas and feelings, might not be enough to formulate a clear understanding of their narratives.

It may require examination of many such conversations before observations about possible narratives in play can reasonably be suggested. Reflective practice requires that you interrogate, and invite others to interrogate, your tentative ideas about what concerns and issues relevant individuals may have. Descending into the swampy lowlands of reflective practice, Schon (1983) emphasizes that the individual still needs to scrutinize what they encounter. It is necessary to make notes on what you hear and to refer to these frequently. By doing so, competing interpretations of what has been heard can be aired.

In both counselling and research interviewing, enquirers are frequently required to check their understanding of what the individual has said. Such pauses, ‘to let me just check what you are telling me’ are more readily managed in formal interviews. During the flow of healthcare interaction few such chances to evaluate a personal understanding of what has been said arise. The understanding check has to be lightly handled and offered periodically as a summary of what you think has been agreed. The onus is on the reflective practitioner to listen harder and to relate that heard today to what has previously been understood in the days before. Insights into narratives grow incrementally and at first are rarely certain (Schultz and Flasher, 2011).

Attending to accounts from the same people over time is necessary too because the narrative that underpins what they say, may itself still be forming and could be dynamic. This is especially true where individuals find themselves in new situations – for example as patients, carers, project colleagues, leaders or as those responsible for new services. The individual incrementally explores what they feel, what they want to do, how they wish to seem and what they hope to contribute. Additional revelations (relating to a health diagnosis or perhaps to a treatment plan on a project concerning a revised time table) could all challenge the narrative. This may lead the individual to develop different perspectives and attend to different personal priorities.

Activity 2

Conduct an exercise that helps you practise this interpretation of what someone else says and under conditions that allow you to go back and think again about what you heard. Practising this, before you return to interpreting real time accounts shared at work, is a worthwhile activity as it helps you attend to what might be important.

Step 1: Select a patients’ stories website from the internet. These can be found by searching ‘patient stories’ on your browser. Some websites present their stories in written form (e.g. www.healthtalkonline.org/ [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)] ) Many others sites provide more interesting short video clips for you to view (e.g. www.patientstories.org.uk or www.nhs.uk/ Planners/ Yourhealth/ Pages/ Realstories.aspx. Both forms of account are valuable as, within your practice, you might be examining written (e.g. letters of complaint or commendation, patient diaries) or oral accounts (your face-to-face encounters with patients, or accounts heard over the telephone). However, for this exercise, the shared video accounts may be the best.

Step 2: From the catalogue of stories on offer, select one that relates well to either your area of practice, or something which simply intrigues you. Note down what you believe is the narrative that the individual is sharing. Remember, this may relate to different things, e.g. ‘how I am feeling’, ‘what I have been doing’, ‘what I expect of you or other practitioners’. Make a brief comment on the emotional state of the individual and whether that seems to affect how the individual talks about their experiences and what they focus on. Shared accounts are likely to be reflections on past experiences. Do you think that the passage of time, in some way, affects the account and helps to arrange narratives in ways that can more readily be reported?

Step 3: Run the video clip several times to help you attend closely to what is being said. In this step we suggest that you write nothing down and listen attentively to what is said and how it is expressed.

Step 4: Now make a careful note of the reference for this video clip, its title, website source (the URL) and then write a single paragraph regarding what you thought the narrative was. What is important in this account and what do you sense concerns the individual?

Next, write a second short paragraph regarding what was interesting or difficult as you tried to interpret the account. Did you find yourself cautioning yourself about what could reasonably be interpreted? Were other things ‘much more obvious’? If so, provide details as to why.

Step 5: Repeat the review process with a further one or two video or written accounts so as to ascertain whether different voices, different people (and their circumstances) make it easier or harder to examine what is being conveyed. Make two paragraph records for each and note what you discover. Whose account was harder for you to hear? For example, if someone from another culture shares an account, was that harder for you to understand? Were there reference points in their account that you didn’t completely comprehend?

Step 6: Invite a colleague to review one of the video clips. Did they think the individual was expressing the same narrative as you?

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