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PubMed2002

Insight and personal narratives of illness in schizophrenia.

Insight in schizophrenia tends to be assessed as the degree to which one possesses specific knowledge. It therefore often fails to account for the fact that awareness of illness is an inextricable part of a personal narrative and may be incoherent or incomplete for many different narrative reasons. Accordingly, we have developed a means of eliciting narratives of illness: the Indiana Psychiatric Illness Interview, and a method for rating the coherence of those narratives: the Narrative Coherence Rating Scale. In this article we describe these methods and present data on their reliability and validity in a study of the illness narratives of 33 outpatients with schizophrenia or schizoaffective disorder. Results suggest our measures possess sufficient internal consistency and good to excellent interrater reliability. Additionally, as predicted, our measures of narrative coherence were significantly correlated with traditional measures of insight and with measures of cognitive impairment and hopelessness gathered earlier.

Awareness↗
PubMedDate not supplied

Evolving narratives in the course of retirement: a longitudinal study.

This paper presents results from the second phase of a longitudinal study of retirement. Data were gathered through interviews with 29 participants (65 to 66 years of age) who had previously been interviewed when they were 63 to 64 years of age and still working. Data were analyzed by characterizing each subject's narrative about retirement in terms of its narrative slope--progressive, stability, or regressive. These current narratives also were compared with the earlier narratives these participants told. It was found that, while anticipatory narratives may predispose persons toward action, they are not so much a fixed "script for action" as an orientation to act within circumstances. While participants' narratives anticipating retirement often turned out as expected, they were sometimes reshaped as a consequence of personal action, external events, and unexpected experiences within new retirement occupations. The study suggests that, while narratives play a role in shaping the direction of persons lives, they also interweave with and change directions as a result of ongoing life events and experiences.

Activities of Daily Living↗
PubMed1999

Story grammar analysis of pre-schoolers' narratives: an investigation into the influence of task parameters.

This study aimed at examining the influences of the parameters of the narrative task (administered to the pre-schooler) on narrative structure. Seventeen pre-school children were selected as subjects. Five narrative tasks were administered to each subject. The narratives were analysed for length and structure. Mainly two factors were found to influence the length and structure of the produced narratives; firstly, the presence or absence of a 'model' on which the child could base his/her narrative, and, secondly, the structure inherent in this 'model'. The implications of the study for clinical assessment of narrative skills as well as for further research are considered.

Child↗
PubMed2000

The communicative function of clinical narrative in radiology reporting.

Clinical narrative is often taken as a direct representation of real objects and events such as patients, diseases and treatments. We refer to this conceptualisation as the 'referential function' of clinical narrative. We introduce a complimentary perspective, taking clinical narrative as a construction relative to the situated intentions and routines of communication between author and reader. This perspective, that we call the 'communicative function', highlights the value of some underused features of clinical narrative. In this paper we bring together models of narrative structure and of communication to present a theory of the communicative function of clinical narrative. We pay particular attention to clinical narrative in radiology reporting.

Communication↗
PubMed1997

The manic defence in analysis: the creation of a false narrative.

The author presents clinical material from the analysis of a patient who made sense of his chaotic life by creating seamless narratives in the analytic situation. Initially, his experience of meaning was derived from the form of his narrative. He repeatedly constructed the 'perfect' narrative, which he related to as a real object and as an object of reparation. There was a significant change in his narrative style and his experience of meaningfulness when he was able to struggle with the contradictions, ambiguities and inconsistencies in his life. The author argues that the patient's earlier narrative style, which he calls the manic narrative, is an aspect of the manic defence, whereas his later approach, when he relinquished the manic narrative in favour of a genuine experience of meaningfulness, was a move towards accepting depressive anxiety and acknowledging the state of his objects.

Adult↗
PubMed1998

Standardized or narrative discharge summaries. Which do family physicians prefer?

OBJECTIVES: To determine whether family physicians prefer discharge summaries in narrative or standardized format and to determine factors affecting this preference. DESIGN: Mailed survey. SETTING: Internal medicine ward at a teaching hospital. PARTICIPANTS: Random sample of 180 family physicians practising in the Ottawa-Carleton area. Of the original sample, 20 were not family physicians and were excluded. Of the 160 physicians remaining, 126 responded for a response rate of 78.8%. INTERVENTION: For a stratified random sample of patients, medical records and narrative discharge summaries were abstracted using a data acquisition form to capture essential information. Information on completed forms was transformed into standardized summaries. Physicians were sent both narrative and standardized summaries. MAIN OUTCOME MEASURE: Physicians' format preference as indicated on an ordinal 7-point scale. RESULTS: The standardized format was preferred with a score of 4.28 versus 3.84 for the narrative (P < .05). Responses indicated the standardized format provided information most relevant to ongoing care, with a mean score of 4.82 (95% confidence interval [CI] 4.48 to 5.15), and easier access to summary information (5.60, CI 5.30 to 5.89). The narrative summary better described patients' admission (3.54, CI 3.18 to 3.90). Preference for standardized summaries correlated with lengthier narrative summary (P < .05), shorter length of stay (P < .05), and physicians' dissatisfaction with previous summaries (P < .001). Standardized discharge summaries were significantly shorter (302 versus 619 words, P = .004) than narrative summaries. CONCLUSIONS: Physicians preferred a standardized format for discharge summaries. Format preference is influenced by physician, patient, and discharge summary characteristics.

Attitude of Health Personnel↗
PubMed2006

Trauma narratives in posttraumatic stress disorder: a review.

Nineteen empirical studies providing evidence about the nature of trauma narratives in posttraumatic stress disorder (PTSD) were reviewed. Selected studies had participants with a diagnosis of PTSD or with PTSD symptoms. The studies used either linguistic indices or participants' rating of narrative quality. There was evidence of a relationship between PTSD specific pathology and the occurrence of sensory/perceptual references and disturbed temporal aspects. Evidence for PTSD-related narrative fragmentation was inconclusive, and there were little data about specific self-referential content. Poor validity and confusion of content and syntactic aspects of narrative organization limited the data on the organization of PTSD narratives. Approaches that address some of these limitations and allow narrative-based evaluation of memory for trauma in PTSD are outlined.

Affect↗
PubMed2003

The narratives of 12 men with AIDS: exploring return to work.

Analyses of life stories has increasingly been used to understand how different individuals interpret and respond to an experience such as the onset of disability. This paper presents findings of a prospective qualitative study of 12 men living with AIDS who attempted to return to paid employment. Narrative analysis of four interviews over 12 months was used to explore the relationship between return-to-work efforts and whether participants' narratives progressed, remained stable, or regressed. Findings suggest that the men who demonstrated progressive narratives recreated an identity including a view of themselves as workers and recaptured a sense of competence. Men with regressive narratives demonstrated decreased identity and competence while men with stable narratives showed little change in either identity or competence. This paper contributes to our understanding of how the framing of an illness or disability by an individual may influence the progression of his life history narrative.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Narratives in and about families: an examination of coding schemes and a guide for family researchers.

This article aims to provide the reader with a general overview of narrative methods as they apply to the study of family relationships. How narratives are collected and issues pertaining to training raters are considered. Scoring systems have been developed that code for thematic content, relative coherence, and co-constructive processes. Validity for these methods is examined through (a) concordance between narrative codes and directly observed behavior within similar domains, (b) links between narratives and self-report measures, and (c) the relation between narratives and psychological functioning. A guide for researchers in their consideration of adopting narrative methods is offered. The article concludes with a consideration of linking different coding schemes and challenges for future researchers.

Family Relations↗
PubMed2004

Narrative inquiry: Locating Aboriginal epistemology in a relational methodology.

BACKGROUND: This methodology utilizes narrative analysis and the elicitation of life stories as understood through dimensions of interaction, continuity, and situation. It is congruent with Aboriginal epistemology formulated by oral narratives through representation, connection, storytelling and art. Needed for culturally competent scholarship is an experience of research whereby inquiry into epiphanies, ritual, routines, metaphors and everyday experience creates a process of reflexive thinking for multiple ways of knowing. Based on the sharing of perspectives, narrative inquiry allows for experimentation into creating new forms of knowledge by contextualizing diabetes from the experience of a researcher overlapped with experiences of participants--a reflective practice in itself. AIM: The aim of this paper is to present narrative inquiry as a relational methodology and to analyse critically its appropriateness as an innovative research approach for exploring Aboriginal people's experience living with diabetes. NURSING APPLICATION: Narrative inquiry represents an alternative culture of research for nursing science to generate understanding and explanation of Aboriginal people's 'diabetic self' stories, and to coax open a window for co-constructing a narrative about diabetes as a chronic illness. The ability to adapt a methodology for use in a cultural context, preserve the perspectives of Aboriginal peoples, maintain the holistic nature of social problems, and value co-participation in respectful ways are strengths of an inquiry partial to a responsive and embodied scholarship.

Communication↗
PubMed2006

Recollection rejection of false narrative statements.

Our research was focused on a false-memory editing operation that is posited in fuzzy-trace theory-recollection rejection. The main objectives were (a) to extend model-based measurement of this operation to a narrative task that ought to ensure high levels of recollection rejection and (b) to study five manipulations that ought to influence recollection rejection by affecting the accessibility of verbatim traces of narrative statements: recency of narrative presentation, narrative repetition, type of false-memory item, testing delay, and repeated testing. The results showed that the narrative task did indeed yield high levels of recollection, with an estimated 49% of gist-consistent distractors being rejected in this way on initial memory tests. Consistent with current theoretical conceptions of false-memory editing, the results also showed that recollection rejection increased as a function of manipulations that should enhance the accessibility of verbatim traces of narrative statements, with repeated testing delivering especially large increases in verbatim accessibility.

Attention↗
PubMed2006

Using narrative pedagogy: learning and practising interpretive thinking.

AIM: This paper reports a hermeneutic study undertaken to explicate students' experiences in educational courses in which teachers enact Narrative Pedagogy. BACKGROUND: International interest in developing and implementing discipline-specific pedagogies is becoming commonplace as teachers respond to the challenges of preparing students for contemporary practice. Lifeworld Pedagogy, developed in Scandinavia, and Narrative Pedagogy, developed in the United States of America, Canada and New Zealand, are two approaches developed from nursing research for nursing education that provide teachers with research-based alternatives to conventional pedagogy. Further research is needed, however, that addresses how new pedagogies are experienced in schools of nursing. METHOD: Teachers and students from 22 schools of nursing in the United States of America were interviewed over a 4-year period between 2002 and 2005. Using interpretive phenomenology as the philosophical background and Heideggerian hermeneutics as the method, accounts from 52 participants were analysed by a research team. FINDINGS: The theme Learning and Practising Interpretive Thinking reveals how reform is occurring in schools of nursing that use Narrative Pedagogy. It documents how Narrative Pedagogy helps students challenge their assumptions and think through and interpret situations they encounter from multiple perspectives. Findings suggest that by focusing teachers' and students' attention on thinking and interpreting as communal experiences, interpretive pedagogies such as Narrative Pedagogy engage teachers and students in pooling their wisdom, challenging their preconceptions, envisioning new possibilities for providing care and engaging with others to ensure patient-centred care and safety. CONCLUSION: By documenting students' experiences in courses in which Narrative Pedagogy is used, this study provides teachers with research-based evidence to guide their pedagogical decisions. It extends international efforts to develop discipline-specific pedagogies and offers a practical, student-centred approach teachers can use to enhance students' thinking.

Education, Nursing↗
PubMed2005

Narrative ARTifice and women's agency.

The choice to pursue fertility treatments is a complex one. In this paper I explore the issues of choice, agency, and gender as they relate to assisted reproductive technologies (ARTs). I argue that narrative approaches to bioethics such as those by Arthur Frank and Hilde Lindemann Nelson clarify judgments about autonomy and fertility medicine. More specifically, I propose two broad narrative categories that help capture the experience of encounters with fertility medicine: narratives of hope and narratives of resistance. This narrative typology captures the inevitable conflict that women feel when they become subjects of fertility medicine. On the one hand, they must remain hopeful; on the other, they must not surrender themselves completely. Nelson's account of counterstories as narratives of resistance helps us see how women can reconcile the experience of a strong desire to have children with the desire to remain authentic and whole.

Coercion↗
PubMed2006

A narratological methodology for identifying archetypal story patterns in autobiographical narratives.

Based on Jung's definition of archetype the concept 'archetypal story pattern' is developed as well as a research method drawing on narrative analysis and biographical research to identify these archetypal story patterns in life stories. Jung pointed out that personal myths, archetypal patterns found, e.g., in mythology, can govern the life course of individuals unconsciously. In the Theory of Narrative Identity comparable concepts have been mentioned but were never fully developed. In my research I try to combine Jung's concept of the archetype with the elaborated methodology of narrative analysis. Archetypes can manifest as narratives and the identity construction of a person via narrating the life story can be influenced or even totally structured by archetypal stories which give a specific form as well as a specific meaning to the person's identity. The method of extracting an underlying archetypal pattern from an autobiographical narrative is demonstrated. The results of the research on 20 autobiographical interviews and the inherent archetypal patterns are summarized. The major aim of this paper is to describe in detail the application of a well established method of the social sciences on a key concept of Jungian psychology to show that these concepts can be integrated into recent research frameworks of academic sciences. On the other hand it shows that Jungian concepts can be investigated through established and well defined research methods in empirical research settings.

Anecdotes as Topic↗
PubMed2005

Struggling with the fragility of life: a relational-narrative approach to ethics in palliative nursing.

In nursing ethics the role of narratives and dialogue has become more prominent in recent years. The purpose of this article is to illuminate a relational-narrative approach to ethics in the context of palliative nursing. The case study presented concerns a difficult relationship between oncology nurses and a husband whose wife was hospitalized with cancer. The husband's narrative is an expression of depression, social isolation and the loss of hope. He found no meaning in the process of dying and death. The oncology nurses were not able to recognize his emotional and existential problems. A narrative perspective inspired by relational ethics indicates that participants may develop a relational narrative that seeks good for all involved in a situation. In palliative nursing this entails open communication about the fragility of life and approaching death. In relational narratives, answers to these ethical dilemmas are co-authored, contingent and contextual.

Adaptation, Psychological↗
PubMed2006

Narrative as an outcome domain in psychosis.

A recent renewed interest in psychosocial treatments for psychosis has only minimally included considerations of narrative therapy and other interventions based in post-modernism. This lack of attention is curious given the profound narrative disruptions often seen in psychotic illness. In this review article we describe several studies in which narratives and narrative dimensions have been utilized to assess outcomes in psychosis. Valid and reliable measures of narrative change in psychosis are possible and can coexist with and complement traditional outcome measures. Perhaps more significantly, considerations of narrative changes may offer unique insights into the process of recovery from psychosis as well as leading to beneficial psychosocial treatments for the same.

Humans↗
PubMed1986

Informative content of narrative discourse in right-brain-damaged right-handers.

Thirty-six right-brain-damaged (RBD) right-handers and 20 controls (C) were submitted to a narrative production task using the pictorial representation of a trivial story. Each subject's narrative was analyzed, using a "propositional analysis," in order to study amount as well as nature of informative content. Results show that RBD subjects' narratives contain a smaller amount of information that did not appear to be related to a smaller amount of verbal output or to the presence of a visual neglect, that the information contained in RBD subjects' narratives appears to be a subset of that contained in C subjects' narratives, and that these results do not pertain to all C or RBD subjects, since both groups are nonhomogeneous. Even though these results are not linked to the presence of some visual neglect or visual agnosia per se, they could be, at least in part, the expression of some degree of perceptive difficulties of the iconography. However, they are also interpreted as expressing a problem with the organization of narrative discourse at levels of cognitive processing which may not be exclusive to language, but which are nonetheless essential for discourse organization.

Brain Damage, Chronic↗
PubMed1994

Practicing oncology in provincial Mexico: a narrative analysis.

This paper examines the discourse of oncologists treating cancer in a provincial capital of southern Mexico. Based on an analysis of both formal interviews and observations of everyday clinical practice, it examines a set of narrative themes they used to maintain a sense of professionalism and possibility as they endeavored to apply a highly technologically dependent biomedical model in a resource-poor context. They moved between coexisting narrative frameworks as they addressed their formidable problems of translating between theory and practice. In a biomedical narrative frame, they drew on biomedical theory to produce a model of cellular dysfunction and of clinical intervention. However, limited availability of diagnostic and treatment techniques and patients inability or unwillingness to comply, presented serious constraints to the application of this model. They used a practical narrative frame to discuss the socio-economic issues they understood to be underlying these limitations to their clinical practice. They did not experience the incongruity between theory and practice as a continual challenge to their biomedical model, nor to their professional competency. Instead, through a reconciling narrative frame, they mediated this conflict. In this frame, they drew on culturally specific concepts of moral rightness and order to produce accounts that minimized the problem, exculpated themselves and cast blame for failed diagnosis and treatment. By invoking these multiple, coexisting narrative themes, the oncologists sustained an open vision of their work in which deficiencies and impotency were vindicated, and did not stand in the way of clinical practice.

Communication↗