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PubMed1998

The king is dead; long live the king: narrative therapy and practicing what we preach.

Narrative therapy has been associated with the assumptions of postmodernism and social constructionism; both of which support the notion that there are no truths, just points of view. Thus, narrative therapists have sought to privilege the voices of their clients in the process of delivering them from the oppressive weight of dominant, cultural grand narratives. Have they been as willing and adept at respecting the voices of other professionals, and their colleagues within the narrative camp? This question is discussed in relation to the underlying assumptions that inform narrative practice. It is concluded that narrative has perhaps unwittingly fallen prey to the human tendency to reify metaphors and make gurus of leaders.

Communication↗
PubMed2003

Sociopolitical activist or conversational partner? Distinguishing the position of the therapist in narrative and collaborative therapies.

In this article, we explore the similarities and differences of two contemporary family therapy approaches: narrative and collaborative therapies. These therapies are contrasted by describing positioning of the narrative practitioner as sociopolitical activist and the collaborative practitioner as conversational partner. The article begins with a brief overview of the two therapies. Subsequently, we outline their epistemological genealogies and the practice similarities that arise from the theoretical assumptions underpinning these therapies. The remainder of the article addresses the theoretical and therapeutic differences in narrative and collaborative approaches reflected in the positioning of therapist as either sociopolitical activist or conversational partner. While narrative and collaborative approaches share more similarities than differences in relation to their emphasis on the constitutive characteristics of language, focus on sociorelational contexts, and critique of singular objective truths, prominence is given to the starker contrasts in narrative and collaborative understandings of politics, power, dialogue, and discourse. It is proposed that by outlining some provocative contrasts between narrative and collaborative approaches, new conversations and generative practices will emerge in the therapy room.

Family Therapy↗
PubMed2001

Use of narrative analysis for comparisons of the causes of fatal accidents in three countries: New Zealand, Australia, and the United States.

OBJECTIVES: To investigate the utility of narrative analysis of text information for describing the mechanism of injury and to compare the patterns of the mechanism of injury for work related fatalities in three countries. METHODS: Three national collections of data on work related fatalities were used in this study including those for New Zealand, 1985-94 (n=723), for Australia, 1989-92 (n=1,220), and for the United States, 1989-92 (16,383). The New Zealand and Australian collections used the type of occurrence standard code for the mechanism of injury, however the United States collection did not. All three databases included a text description of the circumstances of the fatality so a text based analysis was developed to enable a comparison of the mechanisms of injury in each of the three countries. A test set of 200 cases from each country dataset was used to develop the narrative analysis and to allow comparison of the narrative and standard approaches to mechanism coding. RESULTS: The narrative coding was more useful for some types of injury than others. Differences in coding the narrative codes compared with the standard code were mainly due to lack of sensitivity in detecting cases for all three datasets, although specificity was always high. The pattern of causes was very similar between the two coding methods and between the countries. Hit by moving objects, falls, and rollovers were among the five most common mechanisms of workplace fatalities for all countries. More common mechanisms that distinguished the three countries were electrocutions for Australia, drowning for New Zealand, and gunshot for the United States. CONCLUSION: Narrative analysis shows some promise as an alternative approach for investigating the causes of fatalities.

Accidents, Occupational↗
PubMedDate not supplied

The granularity of medical narratives and its effect on the speed and completeness of information retrieval.

OBJECTIVE: Using electronic rather than paper-based record systems improves clinicians' information retrieval from patient narratives. However, few studies address how data should be organized for this purpose. Information retrieval from clinical narratives containing free text involves two steps: searching for a labeled segment and reading its content. The authors hypothesized that physicians can retrieve information better when clinical narratives are divided into many small, labeled segments ("high granularity"). DESIGN: The study tested the ability of 24 internists and 12 residents at a teaching hospital to retrieve information from an electronic medical record--in terms of speed and completeness--when using different granularities of clinical narratives. Participants solved, without time pressure, predefined problems concerning three voluminous, inpatient case records. To mitigate confounding factors, participants were randomly allocated to a sequence that was balanced by patient case and learning effect. RESULTS: Compared with retrieval from undivided notes, information retrieval from problem-partitioned notes was 22 percent faster (statistically significant), whereas retrieval from notes divided into organ systems was only 11 percent faster (not statistically significant). Subdividing segments beyond organ systems was 13 percent slower (statistically significant) than not subdividing. Granularity of medical narratives affected the speed but not the completeness of information retrieval. CONCLUSION: Dividing voluminous free-text clinical narratives into labeled segments makes patient-related information retrieval easier. However, too much subdivision slows retrieval. Study results suggest that a coarser granularity is required for optimal information retrieval than for structured data entry. Validation of these conclusions in real-life clinical practice is recommended.

Cross-Over Studies↗
PubMed2000

Coming to terms with perceived danger. A researcher's narrative.

Little attention has been given to the topic of perceived or imagined dangers in fieldwork, even though such dangers may significantly affect both collection and interpretation of data in qualitative research. Furthermore, methodological arguments persist in regard to interpreting qualitative research that gives voice simultaneously to the research participant and the researcher. In this article reflexivity and narrative methods were used to examine the concept of perceived danger(s) in a field setting using naturalistic inquiry. First, reflexivity and narrative methods were used to retrospectively construct a personal narrative that describes the impact of the field experience on the researcher. Then, narrative analysis was used to interpret this personal narrative and to further examine why the researcher "perceived" certain dangers, and how she came to know that these risks and dangers were presumed but unwarranted. This narrative is an example of how qualitative researchers can give voice to their field experiences.

Anecdotes as Topic↗
PubMed2006

Using narrative communication as a tool for health behavior change: a conceptual, theoretical, and empirical overview.

Narrative is the basic mode of human interaction and a fundamental way of acquiring knowledge. In the rapidly growing field of health communication, narrative approaches are emerging as a promising set of tools for motivating and supporting health-behavior change. This article defines narrative communication and describes the rationale for using it in health-promotion programs, reviews theoretical explanations of narrative effects and research comparing narrative and nonnarrative approaches to persuasion, and makes recommendations for future research needs in narrative health communication.

Health Behavior↗
PubMed1994

A call for narrative: the patient's story and anesthesia training.

Narrative plays a key role in medical education and knowledge, via the case history, the case presentation, or even the patient's chart. Hospitalization for elective surgery provides the structure for a discrete story in a person's life. The details make the story unique for each patient. By analyzing themes and content of narratives obtained from patients and medical trainees, the reader gains insight into the realms of patients' and residents' lives. We believe that even anesthesiologists, who work at the procedure-oriented end of the spectrum of patient care, can benefit from a narrative approach to understanding the patient's perspective. An unanticipated reward of the study is the therapeutic benefit that some of the patients express in their narratives. Patients write that they hope future patients will benefit ("Use this information to the betterment of anyone in need & etc" [patient 15]) or physicians and nurses will improve their interactive skills (patient 09). Perhaps physicians may share the rewards of narrative creation that patient 10 expresses when he triumphantly exclaims, "EUREKA!!! ... I hope you learn something from it (as I have from remembering it)." Patients can provide medical personnel not only with signs and symptoms, but also with insight into the human aspects of the medical process. Reading or writing narratives about such processes may enhance physicians' understanding of their patients' experiences.

Anesthesiology↗
PubMedDate not supplied

Recovery of cohesion in narrative discourse after left-hemisphere stroke.

Little is known about the recovery of narrative discourse after stroke. While several studies have analyzed the recovery of language in individuals with aphasia, few known studies exist on the recovery of narrative discourse in stroke survivors, particularly those who have not been diagnosed with aphasia. In this study, we evaluated the cohesiveness of narrative discourse in a cohort of individuals who had suffered a left-hemisphere stroke and had not been diagnosed with expressive language impairment. We analyzed their narrative discourse at 1, 6, and 12 months poststroke. Our findings indicate that, while the mean number of cohesive ties in narrative discourse remained generally constant during the first year poststroke, the percentage correct use of cohesive ties increased significantly during the same time period. These findings suggest that subtle disruptions in expressive language can be present initially in narrative discourse, and recovery from these disruptions can occur naturally over time.

Age Factors↗
PubMed1994

Volition as narrative: understanding motivation in chronic illness.

This paper expands the current concept of volition in the Model of Human Occupation. The present version views personal causation, values, and interests as traits that determine choices to engage in occupations. Through a detailed investigation of the life histories of two persons with psychiatric disorders, this paper illustrates how volition is embedded in a personal narrative. Two features of narratively organized volition are highlighted: (a) how narrative places decisions and actions within a plot, thus giving them meaning in the context of a whole life, and (b) how the personal narrative motivates the person by serving as a context for choosing and action. Thus, the paper illustrates how persons seek to narrate their lives and live their life narratives.

Chronic Disease↗
PubMed1999

Archaeological Narratives and Other Ways of Telling.

With a few exceptions, archaeologists have been far less concerned with the form of their texts or problems of authorship than have ethnographers. Typically, archaeologies are presented in the form of narratives understood as sequential stories. Approaches to narrative analysis drawn from literary theory, philosophy, and sociology and definitions of characters, events, and plots are examined, together with particular problems these may pose for the discipline of archaeology. It is suggested that neither literary analysis nor the tendency to write and evaluate archaeological and historical narratives in terms of explanatory value takes sufficient account of the often hybrid nature and aims of these texts and the contexts in which they were produced. This argument is illustrated with particular reference to stories of the Mesolithic-Neolithic transition in Europe. It is argued that reconsidering archaeology's positioning across the 19th-century science-humanities divide suggests a broader approach to the idea of what constitutes a narrative which can offer fresh opportunities for useful reflexivity and experimentation in presentation. Further roles and possibilities of narrative and non-narrative ways of writing archaeologies are also considered.

Journal Article↗
PubMed1999

Consultation of medical narratives in the electronic medical record.

This article presents an overview of a research project concerning the consultation of medical narratives in the electronic medical record (EMR). It describes an analysis of user needs, the design and implementation of a prototype EMR system, and the evaluation of the ease of consultation of medical narratives when using this system. In a questionnaire survey, 85 hospital physicians judged the quality of their paper-based medical record with respect to data entry, information retrieval and some other aspects. Participants were more positive about the paper medical record than the literature suggests. They wished to maintain the flexibility of data entry but indicated the need to improve the retrieval of information. A prototype EMR system was developed to facilitate the consultation of medical narratives. These parts were divided into labeled segments that could be arranged source-oriented and problem-oriented. This system was used to evaluate the ease of information retrieval of 24 internists and 12 residents at a teaching hospital when using free-text medical narratives divided at different levels of detail. They solved, without time pressure, some predefined problems concerning three voluminous, inpatient case records. The participants were randomly allocated to a sequence that was balanced by patient case and learning effect. The division of medical narratives affected speed, but not completeness of information retrieval. Progress notes divided into problem-related segments could be consulted 22% faster than when undivided. Medical history and physical examination divided into segments at organ-system level could be consulted 13% faster than when divided into separate questions and observations. These differences were statistically significant. The fastest divisions were also appreciated as the best combination of easy searching and best insight in the patient case. The results of our evaluation study suggest a trade-off between searching and reading: too much detailed segments will delay the consultation of medical narratives. Validation of the results in daily practice is recommended.

Attitude of Health Personnel↗
PubMed1998

The ethics of narrative ethics: some teaching reflections.

Narrative is reemerging as a teaching tool. Narrative ethics is being seen as a rich endeavour both for clinical practice and academic teaching and research. Narrative helps put ethics into context. However, the use of narrative increasingly raises issues in teaching and research: for instance, how do we do justice to the people and narratives we utilise, and what does our practice reveal about our ethics? In this article examples are drawn from clinical practice, teaching and case notes to draw out some lessons to help further critical understanding.

Anecdotes as Topic↗
PubMed2005

Narrative speech in aging: quantity, information content, and cohesion.

This study examined age-related changes in narrative speech of 79 adults aged 40-91 who told stories from their pictorial representations. Quantity, information content and cohesion of narratives were analysed using a detailed transcription and codification system. We carried out a LISREL analysis to study relationships between narrative performance and age, level of education and verbal capacity. Our results showed that aging increases quantity, reduces density of informational content and cohesive reference of narratives and increases the units of irrelevant content. Verbal capacity measured by a vocabulary test improves content and cohesion. The implications of the findings for the cognitive deficit and pragmatic change explanations of narrative speech are discussed.

Adult↗
PubMed2006

Dissociation in children's trauma narratives: an exploratory investigation.

This research examined the nature of children's trauma narrative themes and the relationship between these themes and concurrent and future trauma symptoms. Eighty-seven children aged 7-15 years, and their parents, participated following child exposure to a traumatic event requiring hospitalization. At 4-7 weeks post-trauma, a diagnostic interview was conducted with parents and a trauma narrative was obtained from the child. At 6 months post-trauma the diagnostic interview was re-conducted. Results provided only weak evidence of an association between dissociative trauma narrative themes and PTSD symptoms. Specifically, children who showed temporal disorganization, but not absence of emotion or dissociative amnesia, in narrative themes were more likely to report concurrent subsyndromal PTSD symptoms at 4-7 weeks post-trauma. Children who showed absence of emotion (or at least one dissociative theme) in the trauma narrative were more likely to show symptoms of hyperarousal, but not other symptoms of PTSD, at 6 months post-trauma. These findings have implications for understanding the role of dissociation and the development of PTSD in children.

Adolescent↗
PubMed2006

Storytelling, statistics and hereditary thought: the narrative support of early statistics.

This paper's main contention is that some basically methodological developments in science which are apparently distant and unrelated can be seen as part of a sequential story. Focusing on general inferential and epistemological matters, the paper links occurrences separated by both in time and space, by formal and representational issues rather than social or disciplinary links. It focuses on a few limited aspects of several cognitive practices in medical and biological contexts separated by geography, disciplines and decades, but connected by long term transdisciplinary representational and inferential structures and constraints. The paper intends to show a given set of knowledge claims based on organizing statistically empirical data can be seen to have been underpinned by a previous, more familiar, and probably more natural, narrative handling of similar evidence. To achieve that this paper moves from medicine in France in the late eighteenth and early nineteenth century to the second half of the nineteenth century in England among gentleman naturalists, following its subject: the shift from narrative depiction of hereditary transmission of physical peculiarities to posterior statistical articulations of the same phenomena. Some early defenders of heredity as an important (if not the most important) causal presence in the understanding of life adopted singular narratives, in the form of case stories from medical and natural history traditions, to flesh out a special kind of causality peculiar to heredity. This work tries to reconstruct historically the rationale that drove the use of such narratives. It then shows that when this rationale was methodologically challenged, its basic narrative and probabilistic underpinings were transferred to the statistical quantificational tools that took their place.

England↗
PubMed2003

Parents' contributions to the narrative identity of offspring of donor-assisted conception.

Donated sperm, eggs, and embryos are an increasing feature of assisted reproduction; people conceived in this way have different genetic and social histories. Although most offspring of donor-assisted conception are ignorant of their genetic history, recipient parents must negotiate increasing demand for full disclosure to offspring. This paper illustrates some of the reasons parents give for not telling their children, underlines the experience of many parents of being uncertain of how to go about telling, presents information from some parents who have endeavoured to be open with their children about conception from very early childhood, and discusses implications for the narrative identity of offspring of donor-assisted conception. Recipient parents (n=55) and offspring (12) from Australia; Canada, US, England, and Argentina were interviewed and subsequently consulted about the development of their narrative accounts and the way in which these have been interpreted. Parental narratives were found to be located along a continuum, broadly encompassing: (1). Parents who intend to exclude donor-assisted conception from the narratives they construct for their children, (2). parents who are uncertain about what they want to do, or confused about the best way to disclose and discuss donor conception with their children and (3). those have incorporated the donor in their children's narratives from the beginning. From interviews with offspring and on the basis of human rights issues and the increasing salience of genetic knowledge, it is concluded that disclosure to offspring before adolescence should be encouraged.

Access to Information↗
PubMed2004

Survivor of that time, that place: clinical uses of violence survivors' narratives.

Narratives by survivors of abuse offer compelling entries into the experiences of abuse and its effects on health. Reading such stories can enlarge the clinician's understanding of the complexities of abuse. Furthermore, attention to narrative can enhance the therapeutic options for abuse victims not only in mental health arenas, but also in other medical contexts. In this article we define the genre of survivor narratives, examine one such narrative in particular (Push by Sapphire, 1996), and explore the clinical implications of narrative in abuse victims' clinical care.

Child↗
PubMed2006

A narrative therapy approach to counseling: a model for working with adolescents and adults with language-literacy deficits.

PURPOSE: Remediation efforts with adolescents and adults with language-literacy deficits (LLD) may be hindered by concomitant factors such as decreased self-esteem and self-efficacy. Despite sound linguistically based remediation practices, treatment lacking integrated counseling components may fail to achieve optimal outcomes. In this tutorial, we recount a counseling approach, specifically a narrative therapy counseling approach based on constructivist theory, to be used with adolescents and adults with LLD. METHOD: A review of the literature includes research on the use of counseling in communication disorders settings and on the application of a narrative therapy counseling approach with individuals with decreased self-esteem. The key components and steps of narrative therapy are described, and applications for use with adolescents and adults with LLD are suggested. Sample vignettes of a counseling component for a 22-year-old student with LLD who is enrolled in literacy intervention are used to illustrate some of the key points of a narrative therapy counseling approach. IMPLICATIONS: A narrative therapy counseling approach that is integrated into language-literacy remediation may be an effective way of addressing concomitant factors such as decreased self-esteem in adolescents and adults with LLD. Readers of this article are challenged to seek additional counseling training and to begin to conduct research to determine the feasibility, effectiveness, and efficacy of integrating a counseling component into speech and language therapy.

Adolescent↗