On 6th November 2019 I presented my work on the Importance of Narrative in Nursing at the Phi Mu Chapter, Northern Hub meeting at Manchester Royal Infirmary.
My presentation began with a short précis of the novel ‘The Death of Ivan Ilych” by Leo Tolstoy, which told the story of a man who instead of cultivating love, compassion and kindness in his life instead chose to cultivate a life of obsession; of success and of social trappings, and as he is forced to confront his own death, he realises the impact this has had on his family and his own life. Ivan Ilych is fortunate, he is cared for by his peasant servant Gerasim, who above all else, provides care and demonstrates kindness towards him; traits Ivan Ilych failed to demonstrate throughout his life. Ultimately, he realises as life ebbs away; he can still make amends.
Throughout history, books, film, drama, art and even cave drawings have been used to tell personal stories of suffering; of joy; of love and compassion. Tolstoy’s book along with many others, including the work of Arthur W. Frank; ‘The Wounded Storyteller’ through which he tells his own story of his life with illness, as well as that of others, and ’Somebody I Used to Know’ by Wendy Mitchell as she fights to hold on to her way of life following a diagnosis of dementia, enables people to tell their stories of suffering, disease, illness and dying in all its forms.
Today many healthcare professionals will care for people who are suffering; not primarily as a result of ill health, but perhaps as a result of social and political reform, the impact of social determinants of health and social injustice, that may have contributed to the ill health. Examples of which include a loss of their home, employment and even a loss of hope.
Nurses today live in a revolving door of patient experiences. Failure to correct these underlying issues can limit our ability to provide care that is proactive. As nurses we need to do more than simply patch people up, but instead seek to challenge the social and political injustice that exists today.
Understanding the patient through the use of narrative can serve as a window into the patients world, a lens through which as nurses, we can seek to understand life’s challenges, as experienced by the patient. Nurses are in a unique position; in that they are able to empower patients to ‘tell their story’ in a way that is meaningful and brings catharsis. For demonstrating humanitarian acts in all its form is where we, as nurses are able to be our best self.
In order for patients to tell their stories, we need to allow our minds, as nurses, to fall silent to enable us to listen and gain insight into shattered lives, but also understand those things that really matter to them, for truly listening, and being in the moment with our patients, challenges our assumptions, our prejudices, our preconceived ideas and our blinkered thoughts and once this happens, we are in a position to truly promote patient-centred care.
A Sympathetic Ear
In his work ‘On the humanities of nursing’, Lazenby (2013) argues for a Socratic critical thinking approach to nursing, a process through which nurses are able to cultivate in themselves an ‘inclusive sympathy’. Socratic critical thinking argues Lazenby (2013) involves two skills sets: the skill of self-examination, ‘especially around one’s values and goals’ and the ability to reason ‘that does not begin with the specifics of evidence, but rather, with the general goals of nursing’. Cultivating critical thinking in nursing argues Lazenby (2013) results in an inclusive sympathy, and as we nurture this in all our nurses we begin to realise that ultimately ‘there is no patient for whom we cannot care’.
Lazenby, M. (2013) On the humanities of nursing. Nursing Outlook, 61(1), E9-E14. http://dx.doi.org/10.1016/j.outlook.2012.06.018.