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PubMed2006

From perpetrator to victim in a violent situation in institutional care for elderly persons: exploring a narrative from one involved care provider.

In order to reach a more comprehensive understanding of the dynamics in violent situations in institutional care for elderly people the aim of this study was to explore involved parties' positions, and to illuminate forces and moves related to these positions. One involved care provider's narrative was analysed using narrative analysis and positioning theory. In the narrative the involved parties' positions were fluid and often overlapping, and not exclusively as victim or perpetrator. Across the narrative the narrator altered the involved parties' positions by using available discourses. We understand that the altered positions were a salient way for the care provider to make sense of her experiences. By reading the care provider's narrative we further understand that she was much more than just a perpetrator, which was the origin for her narrative. This study led us to two assumptions important for implications in nursing practice. First, it is of significance how we position ourselves and others in narratives and conversations. Second, there is a difference between being categorised in advance and getting the opportunity to narrate one's own story.

Aged↗
PubMed2005

Mood and narrative entwinement: some implications for educational practice.

Moods are one way of existentially reading the authenticity of people and are entwined within any narrative. Attunement between narrative and its mood is crucial for understanding the implicit message of the narrator. Sometimes, a master narrative is interrupted by counternarratives, so that narrative recognition becomes problematic. People can disguise their existential state when narrating, but the mood discloses it nonetheless. The authors explore the relationship between mood and narrative, and how the two are connected with how a person acts authentically or inauthentically. They provide selected empirical examples of narratives from medical students to support their argument. The educational relevance of their discussion comprises the final section. Educators in any educational program must first reflect on, then make explicit the manner in which narrative and mood are used to communicate knowledge.

Affect↗
PubMed1997

The black box in somatization: unexplained physical symptoms, culture, and narratives of trauma.

Stimulated by our clinical work with patients who manifest unexplained "somatoform" symptoms in the primary care setting, this article addresses a theoretical black box in our understanding of somatization: how does culture mediate severe stress to produce symptoms that cannot be explained by the presence of physical illness? Despite various problems in his explanation of hysteria, Freud broke new ground by emphasizing narratives of traumatic experiences in the development and treatment of unexplained physical symptoms. Except in anthropologically oriented cultural psychiatry, contemporary psychiatry has traveled away from a focus on narrative in the study of somatization. On the other hand, recent interest in narrative has spread across many intellectual disciplines, including the humanities and literary criticism, psychology, history, anthropology, and sociology. We operationally define narratives as attempts at storytelling that portray the interrelationships among physical symptoms and the psychologic, social, or cultural context of these symptoms. Regarding somatization and trauma, we focus on the ways that narrative integrates the cultural context with traumatic life events. In explaining the black box, we postulate that extreme stress (torture, rape, witnessing deaths of relatives, forced migration, etc.) is processed psychologically as a terrible, largely incoherent narrative of events too awful to hold in consciousness. Culture patterns the psychologic and somatic expression of the terrible narrative. Methodologically, we have developed some techniques for eliciting narratives of severe stress and somatic symptoms, which we illustrate with observations from an ongoing research project. In designing interventions to improve the care of somatizing patients, we are focusing on the creation of social situations where patients may feel empowered to express more coherent narratives of their prior traumatic experiences.

Adult↗
PubMedDate not supplied

Aging, narrative organization, presentation mode, and referent choice strategies.

We examined age differences in referent choice strategies when narrative organization and presentation mode taxed working memory. Readers could use the following cues to choose referents for an ambiguous pronoun: (a) thematic cue (main/minor character), (b) foreground cue (character in main/subordinate clause), and (c) recency of mention of character. Subjects read short narratives with a critical sentence that mentioned the main character in the main clause of the critical sentence (congruent condition) or in the subordinate clause of this sentence (incongruent condition). They chose the main or minor character as referent for a pronoun in the next (target) sentence. Experiment 1 examined how older and young readers use these cues with the Memory narrative presentation (target sentence presented on a separate page from the rest of the narrative). Young readers used similar strategies as those in Morrow (1985), where narrative presentation did not tax memory. Thus, the Memory presentation had little influence on their strategies. However, older readers were less consistent and tended to split in choosing the two characters. In Experiment 2, where narrative presentation did not tax working memory, older readers used similar strategies to the young readers in Experiment 1. Experiment 3 found that elders reading narratives with the Memory presentation recalled the nonpreferred character name after the narrative, suggesting that both characters were accessible from working memory. The study suggests that the Memory presentation mode in Experiment 1 interfered with elders' consistent use of narrative cues in choosing referents, especially when these cues conflict.

Adolescent↗
PubMed2003

Routine narrative analysis as a screening tool to improve data quality.

AIM: To determine whether narrative information in emergency department surveillance systems can be systematically interrogated to improve our understanding of the causes of injury. METHODS: Screening algorithms for location, intent, and activity were developed from structured analysis of narrative data from 98999 records. The algorithms were then tested on a 50000 record database containing entries in both of the two narrative fields. A proxy gold standard was defined as the total extract using both code and narrative. Sensitivity and specificity of the emergency department coding and narrative algorithms was calculated. RESULTS: The proportion of records carrying an informative emergency department code was higher in records containing narrative-the percentage of causes coded "not know" dropped by 28.3%. The sensitivity of coded data varied from 42% to 98 % and from 33% to 99% for narrative data. Narrative analysis increased the percentage of home injuries identified by 19%, assaults by 26%, and rugby injuries by 137%. CONCLUSIONS: Using a small amount of narrative is a practical and effective means of developing more informative injury causation data in an emergency department based surveillance system. It allows for internal validation of the codes and for the identification of emerging hazards without adding more "tick boxes" or further burdening data entry clerks.

Algorithms↗
PubMed2002

Physician-patient co-construction of illness narratives in the medical interview.

Researchers and medical educators in the area of physician-patient communication encourage physicians to elicit patient narratives during medical encounters to facilitate data collection, rapport building, and patient satisfaction. These scholars, however, provide little information about the nature of the narrative, especially in the context of the medical interview. This article reviews the multidisciplinary literature on narrative and reports the results of a narrative analysis of 21 physician-patient interviews. A set of criteria for defining narrative is derived from the literature and applied to these interviews, demonstrating the limitations of previous conceptions of narrative and suggesting an expanded definition. This expansion emphasizes the notion that narratives are co-constructed through the interaction of both participants in the conversation in which they occur. Application of the expanded definition to the same interviews reveals 3 new narrative forms: narratives that emerge through the co-constructed chronology of key events, the co-constructed repetition and elaboration of key events, and the coconstructed interpretation of the meaning of key events.

Anecdotes as Topic↗
PubMed2004

Children's narratives and patterns of cardiac reactivity.

The present study examines the associations between narrative processing, narrative production, and cardiac rate and variability in children. Heart period (HP) and vagal tone (VT) were computed for fifty-eight 7-year-olds (29 males) during a resting baseline and during epochs in which the children listened to and completed a selected set of story-stems from the MacArthur Story-Stem Battery (I. Bretherton, D. Oppenheim, H. Buchsbaum, R. N. Emde, & the MacArthur Narrative Group, 1990). Significant decreases in HP and VT were observed between a resting baseline and epochs of story-stem presentation by the experimenter. In addition, HP was shorter and VT lower during children's narrative production to emotionally laden story-stems compared with narration to a neutral story-stem. Furthermore, narrative and cardiac responses to stories containing separation-reunion themes reflected increased emotional and cognitive load compared with responses to stories that did not contain such themes. Finally, children who showed VT suppression in response to emotion-laden stories produced more coherent and adaptive narratives compared to those of children who did not show VT suppression. The findings suggest interplay between the cognitive-emotional processes associated with narrative processing and production and cardiac activation patterns.

Affect↗
PubMed2005

Customizing clinical narratives for the electronic medical record interface using cognitive methods.

OBJECTIVE: As healthcare practice transitions from paper-based to computer-based records, there is increasing need to determine an effective electronic format for clinical narratives. Our research focuses on utilizing a cognitive science methodology to guide the conversion of medical texts to a more structured, user-customized presentation in the electronic medical record (EMR). DESIGN: We studied the use of discharge summaries by psychiatrists with varying expertise-experts, intermediates, and novices. Experts were given two hypothetical emergency care scenarios with narrative discharge summaries and asked to verbalize their clinical assessment. Based on the results, the narratives were presented in a more structured form. Intermediate and novice subjects received a narrative and a structured discharge summary, and were asked to verbalize their assessments of each. MEASUREMENTS: A qualitative comparison of the interview transcripts of all subjects was done by analysis of recall and inference made with respect to level of expertise. RESULTS: For intermediate and novice subjects, recall was greater with the structured form than with the narrative. Novices were also able to make more inferences (not always accurate) from the structured form than with the narrative. Errors occurred in assessments using the narrative form but not the structured form. CONCLUSIONS: Our cognitive methods to study discharge summary use enabled us to extract a conceptual representation of clinical narratives from end-users. This method allowed us to identify clinically relevant information that can be used to structure medical text for the EMR and potentially improve recall and reduce errors.

Cognitive Science↗
PubMed2006

Teachers and laypersons discern quality differences between narratives produced by children with or without SLI.

PURPOSE: To examine the functional impact of specific language impairment (SLI). Specific goals were to determine whether (a) subjective ratings of narrative quality differentiate children with SLI from their normally developing (ND) age-mates, (b) laypersons and teachers differ in their ratings of narrative quality, (c) objective measures confirm previously reported problems in narration among children with SLI, and (d) objective measures of narrative structure and quality ratings relate. METHOD: Twenty-seven laypersons and 21 teachers used interval scaling to rate the quality of narratives produced by 20 5-7-year-olds, 10 with SLI and 10 ND age-mates. The narratives were also analyzed objectively for fluency, length, sentence-level syntax, and story grammar and themes. RESULTS: Subjective ratings differentiated the SLI and ND groups with 70% nonoverlap. No differences were observed between the laypersons' and teachers' numeric ratings; however, laypersons reported that they paid more attention to the "sparkle" or charm of the narratives. Objective measures of story length, grammaticality, and thematic development differentiated SLI and ND groups. Mean length of C-unit and number of thematic units positively predicted quality ratings. Clinical implications Intervention efforts aimed specifically at improving the quality of these children's oral narration may focus on increasing length, grammatical accuracy, and story development. Future clinical and research efforts aimed at addressing the broader functional impact of SLI are also critical given that the manifestations of SLI are noticeable to both teachers and laypersons.

Adult↗
PubMed2006

Exploring the elements of narrative that emerge in the interactions between an 8-year-old child who uses an AAC device and her teacher.

Narrative abilities have been identified as a link to successful school achievement and, in particular, to the acquisition of literacy. Children who use AAC may be at risk of impaired narrative facility due to the differences in their language learning experiences, limitation of their AAC systems, and limitations from constrained access to physical and social environments. In this study, the elements of narrative that emerged in the interactions between an 8-year-old child who used an AAC device and her teacher are described. This assessment was achieved through use of the Narrative Assessment Profile (Bliss, McCabe, & Miranda, 1998) in the context of five tasks designed to elicit a spectrum of narrative features. Results indicate that the interactions between the child and her teacher made it difficult to assess whether or not the child had control of certain features of narrative. From a purely structural analysis, most narrative discourse dimensions appeared to be severely compromised and therefore in need of immediate intervention. Discussion includes aspects of narrative intervention and suggested topics for further research.

Adult↗
PubMed2005

Understanding personal narratives: an approach to practice.

AIM: This paper explores the need for and nature of personal narratives and their relevance to nursing practice. It proposes that the co-creative aesthetic process can be used to understand and co-create personal narratives through an emphasis on self-defining memories and metaphor. BACKGROUND: Many authors in nursing and other human sciences have recognized the need for and importance of personal narrative, its relationship to aesthetic knowing and its value in qualitative research and in practice. The role of memory and metaphor in the creation of meaning in personal narratives, however, has not been sufficiently explored in nursing literature. DISCUSSION: The nature of personal narrative is explored, focusing on the way meaning is created from self-defining memories using metaphor. Then, the importance of personal narratives in nursing practice is considered, followed by discussion about how meaning in personal narratives may be co-created between clients and nurses using an aesthetic process developed by the author. CONCLUSION: The co-creative aesthetic process is an example of nursing as art and can be used to co-create personal narratives in practice. The experience of co-creating a self story with a nurse can be healing, as the self story is heard by a caring person, memories are understood in new ways, and the self story is both confirmed and recreated.

Communication↗
PubMed2006

To cope with uncertainty: stroke patients' use of temporal models in narratives.

Stroke victims have to cope with a disrupted autobiography and anxiety because of an uncertain future. Professionals share this uncertainty. The patients reveal their experiences in narratives, and when they try to regain coherence and confidence in life, they use narratives in the reconstructions. Because they have a temporal problem, time might be an important issue in these narratives. The aim of this study was to elucidate the use of time models in stroke patients' narratives. Nineteen stroke patients, who had recently been discharged to their homes after the stroke, accepted to participate in the study. Their age span was between 56 and 89 years. They had lived active urban lives before the stroke, and poststroke only three had more serious physical impairment, and none was demented. They were asked to talk about their present life and their conceptions of future life. The interviews were audio-taped and transcribed verbatim and narratives that referred to temporal aspects were thematically analysed with reference to narrative time models. The stroke accident had caused an autobiographical disruption and a temporal split because of a new awareness of human temporality and an uncertainty of the future. Confronted with these problems of time, the stroke victims constructed narratives based on the time models: time cycles and dissolution of time limits, exchange of time and exclusion from time. Hence, the time models worked as tools when the stroke victims re-established coherence in their present and future life. Stroke patients handled an uncertain future by using temporal models in their narratives. Professionals can support stroke patients by reinforcing these models.

Adaptation, Psychological↗
PubMed2003

Narrative transformation as an outcome in the psychotherapy of schizophrenia.

Assertions that changes or transformations in narratives contribute significantly to recovery from schizophrenia persist as a cornerstone of some psychotherapies. Yet when narrative transformation occurs in schizophrenia, what is there about the client's story that tangibly changes, and how might that be measured? To address this issue, we review literature on the importance of narrative transformation and identify narrative qualities that might theoretically change. We then report content and thematic analyses of the qualities of narratives that might potentially change over 14 months of psychotherapy. These analyses suggest that narratives in schizophrenia may gain complexity and dynamism, but the changes do not entail the creation of a new story or the 'awakening' of an 'old' self. From these analyses, the hypothesis that narrative transformation may occur in terms of growth in the richness of the internal dialogue that produces narrative is posed for future research.

Adult↗
PubMed2004

A model of narrative development: implications for understanding psychopathology and guiding therapy.

Story-telling is one of the psyche's basic functions. All of us organize our experience in the form of narratives in order to give meaning to events, make forecasts about how situations will evolve, guide our actions in relationships and make our self-experience coherent. Here we present a theoretical model which starts out from the hypothesis that, when they are created, the narratives we continuously relate to ourselves and others do not have a pre-existing form. We propose a model for understanding the way each organizational level is formed in the mind, and works and interacts with other levels; and what psychological disorders could affect it, ranging from the basic, where there are simple aggregates of mental images, to the more complex, where there are true and proper stories, in which the characters of the internal scenario interact with each other. According to our model, it is possible to hypothesize the existence of: (1) a pre-narrative level, and (2) a proto-narrative level, followed by three extended narrative levels: (3) a procedural unconscious narrative level, (4) a conscious propositional narrative level, and (5) a verbal interactive narrative level. Our hypothesis is based on: (1) a review of various theories from different fields of research; and (2) illustrative clinical material obtained by recording psychotherapy sessions with severely personality-disordered patients.

Conscience↗
PubMedDate not supplied

[Narratives as a research technique in nursing].

The text introduces the narrations as a possibility of approach in nursing research, specially as a technique of data collection and analysis, emphasizing its theoretical and practical aspects. A review of the narrative concept is included, through the understanding of authors from different knowledge areas: philosophy, anthropology, linguistics and nursing. With respect to the practical aspect of its application to research, three different types of narrative are introduced, identified based on the accounts rendered by individuals: short narrations, narrations of lived experiences, and popular narrations. The study also includes ways to present the narratives in scientific texts and their process of interpretation. Authors highlight that the narrations create a field of collective action, allowing health professionals to build up knowledge based on the individuals' experience.

Empirical Research↗
PubMed2005

Women's narratives of long-term urinary incontinence.

PURPOSE: The purpose of this study was to use narrative analysis as a method for examining the lived experience and meaning of long-term, female urinary incontinence (UI). METHOD: Cognitive anthropology and critical medical anthropology provided the overall framework for this study. Theoretical saturation (Strauss, 1987) was achieved after 17 community-dwelling women with long-term (greater than 5 year's duration) UI were interviewed. Informants participated in two face-to-face, audiotaped, interviews and a semi-structured, topical outline for each interview was used. A field journal was used to supplement and validate other data. Informant's narratives were analyzed to emphasize the overall plot type of their stories. FINDINGS: In this study, three dominant plot types emerged from women's narratives: the UI Quest Narrative, UI Restitution and Redemption Narratives, and the UI Victim Narrative. These plot types provide a beginning understanding of the lived experience and meaning of long-term female UI. CONCLUSIONS: Study findings suggest (a) long-term female UI is primarily conceptualized as a condition integrated into a larger life story, (b) women with long-term UI relate stories that follow a narrative format, and (c) long-term, female UI is heterogeneous. Findings go beyond existing literature by suggesting that women's UI narratives serve an important function in understanding the lived experience and the meaning of UI.

Activities of Daily Living↗
PubMed1986

Making reference: the cohesive use of pronouns in the narrative discourse of hemidecorticate adolescents.

The cohesive use of referential language in narrative production reveals communicative goals as well as specific aspects of language use. A formalism for analyzing pronominal cohesion was developed and applied to the narrative discourse of three hemidecorticate adolescents. The results revealed hemisphere-dependent differences in overall narrative skill as well as distinct individual discourse strategies. Neither left hemidecorticate planned narration in extended discourse units: One demonstrated a linear and highly explicit discourse style with redundant over-statement of referent nouns and the other produced narratives cluttered with pronouns of both correct and ambiguous reference, relying on nonpersonal pronouns at considerable cost to narrative specificity. The right hemidecorticate produced narratives that were more economical in form and richer in content: He was the only subject able to maintain simultaneous story lines with multiple pronouns and referential relationships cohesively embedded. All subjects expressed at least some story content, but only the right hemidecorticate narratives conveyed suggestion and implication as well as explicit statement.

Adolescent↗
PubMed2005

Language in context: emergent features of word, sentence, and narrative comprehension.

Context exerts a powerful effect on cognitive performance and is clearly important for language processing, where lexical, sentential, and narrative contexts should differentially engage neural systems that support lexical, compositional, and discourse level semantics. Equally important, but thus far unexplored, is the role of context within narrative, as cognitive demands evolve and brain activity changes dynamically as subjects process different narrative segments. In this study, we used fMRI to examine the impact of context, comparing responses to a single, linguistically matched set of texts when these were differentially presented as random word lists, unconnected sentences and coherent narratives. We found emergent, context-dependent patterns of brain activity in each condition. Perisylvian language areas were always active, consistent with their supporting core linguistic computations. Sentence processing was associated with expanded activation of the frontal operculum and temporal poles. The same stimuli presented as narrative evoked robust responses in extrasylvian areas within both hemispheres, including precuneus, medial prefrontal, and dorsal temporo-parieto-occipital cortices. The right hemisphere was increasingly active as contextual complexity increased, maximal at the narrative level. Furthermore, brain activity was dynamically modulated as subjects processed different narrative segments: left hemisphere activity was more prominent at the onset, and right hemisphere more prominent at the resolution of a story, at which point, it may support a coherent representation of the narrative as a whole. These results underscore the importance of studying language in an ecologically valid context, suggesting a neural model for the processing of discourse.

Adult↗