Understanding narratives in health care
Understanding narratives in health care

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Understanding narratives in health care

3 Identifying your narratives

You might imagine that everyone fully understands our own narratives: what we are currently dealing with psychologically, at a personal level, what we believe and value, what our attitudes are towards different things. But in reality, no such perfect insights exist. We are unable to account completely for all of our personal narratives (Shapiro et al., 1983). It is difficult to fully know our narratives for a variety of reasons:

  • Some issues and insights might seem too painful.
  • Your narratives don’t remain constant – they respond to circumstances that you find yourselves operating within. Sawyer (2011) ably demonstrates the ways in which narratives can become increasingly revealing.
  • Your narratives may be intimately related to another person’s (for example as a spouse or partner) and therefore be difficult to disentangle.
  • Some narratives may be more formal – those that you adopt associated with your professional life. Ambiguities can remain however, for instance where religious, cultural and personal values compete with professional values and requirements.

The fact that personal narratives can be so difficult to explore has given rise to much work by psychotherapists, other counsellors and life coaches. In this course however, you are not asked to embark on an amateur form of psychotherapy. Rather, you are encouraged to become more introspective about the narratives that you believe you are dealing with today. To consider what part these may play with regard to the improvement and interactions you are interested in. For example:

  • You are exploring a chosen skill, and have discovered that your conception of excellence is strongly associated with the volume and variety of the things you know. But it seems more difficult to examine how, and when, you use that knowledge. You therefore examine why your notion of expertise centres so much on knowledge and less on skill.
  • You are playing a leading role in a service improvement project designed to help your hospital laboratory team act in a more consultative way with those healthcare professionals who request various tests. As things progress you start to note some discomforts when liaising with medical consultants. You wonder what it is about that working relationship – and your part in it – that might impede the project’s progress.
  • As part of the work to improve annual staff appraisals, you have convened a series of speak easy sessions so that staff can share with you their perceptions of these events and what purpose they have. You are vaguely aware that you share some misgivings about these. You wonder what you must do to run these meetings and advance the project fairly, whilst attending to your employer’s, as well as staff’s, needs.

Activity 3

Note down any techniques that you think you might use to help identify and understand narratives that you are using – those that might materially affect your chosen project. Once you have noted down your ideas, look at our feedback below.

Discussion

Some of the things that you might do include:

  • Write notes about your speculations as and when they occur. Make a note of the date of your recordings. Those who conduct research using approaches such as phenomenology, grounded theory, case study research and ethnography frequently report the value of such notes and the insights available within them. The information obtained provokes questions about how they think and what they assume. The same may be true for you when you reflect on recent healthcare interactions. As your enquiries progress, an audit trail may emerge that helps you describe exactly what narratives are active for you and how these play a part in the service, skill, or system improvement.
  • Find a trusted companion to talk about your insights with. Talking about your ‘take on things’, the narratives that you deal with and which can either enhance or detract from the project, can help you to articulate your discoveries.
  • Read material on professional philosophy and values which characterizes your work and profession. This may help you to crystallize what interests, motivates or concerns you. For example, if you are motivated by more holistic healthcare, what then does holism really mean for you and how is it expressed?.
  • Think back to how your personal philosophy was formed. What influences helped to shape how you think, what you value, what challenges or worries you. Culture, family, education and formative life experiences may be important here.
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