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PubMed2005

The development of expressive elaboration in fictional narratives.

PURPOSE: This study analyzed the development of expressive elaboration in fictional narratives for school-age children. METHOD: The analysis was derived from high-point analysis, but it was tailored to capture the artful aspects of fictional storytelling. Narratives were elicited with a short picture sequence of a likely life event from 293 children whose ages ranged from 5 to 12 years. RESULTS: Results showed a significant age effect for expressive elaboration with narrative length controlled. For three age clusters (5-6 years, 7-9 years, and 10-12 years), the 13 types of expressive elaboration showed diverse patterns of acquisition in terms of presence, frequency, and developmental change. Appendages (introducer, abstract, theme, coda, ender) were lowest in both presence and frequency, and increased in presence with age. Orientations (names, relations, personality) were more common and increased in presence with age. Evaluations (modifiers, expressions, repetition, internal states, dialogue) were most frequent and showed age changes in both presence and frequency. CLINICAL IMPLICATIONS: This study provides an additional window on narrative competence. The analysis and results can guide narrative assessment and intervention.

Age Factors↗
PubMed2006

Memory impairment following right hemisphere stroke: a comparative meta-analytic and narrative review.

We examined the evidence for widely held clinical beliefs about memory impairment following right hemisphere stroke (RHS), conducting both narrative and meta-analytic reviews of the literature [MEDLINE (1966-January 2003), PsycINFO (1974-January 2003), and CINAHL (1982-December 2002)]. We sought to determine whether RHS patients experience more problems with non-verbal memory than non-stroke controls (NSCs) and left hemisphere stroke (LHS) patients. Secondarily, we sought to determine whether RHS patients experience more problems with verbal memory than NSCs and fewer verbal memory problems than LHS patients. We also examined the effect of type of memory assessment (recall versus recognition) on reported findings. As regards non-verbal memory, narrative and meta-analytic reviews found that RHS patients had deficits relative to NSCs, on tests of both recall and recognition. The evidence for RHS non-verbal memory deficits relative to LHS was mixed in the narrative review, whereas the meta-analysis found RHS deficits on non-verbal recognition tests, but no difference between RHS and LHS patients on non-verbal recall tests. Deficits on recognition tests imply problems with early encoding of material or possibly its storage. Regarding verbal memory, the narrative review found that RHS patients performed more poorly than NSCs in about half of all studies. The meta-analytic review confirmed poorer RHS performance on tests of verbal recall, but none of the studies that compared RHS and NSCs on verbal recognition could be included in this type of review. The narrative review found mixed evidence as regards the performance of RHS and LHS patients on verbal memory tests, but the meta-analysis pointed to RHS superiority for both verbal recall and recognition. The relative strengths of both types of review are discussed.

Functional Laterality↗
PubMed2006

The Scale to Assess Narrative Development: association with other measures of self and readiness for recovery in schizophrenia spectrum disorders.

While changes in self-experience have been suggested as an element of recovery from schizophrenia, little is known about how they are linked with other subjective indicators of recovery. To examine this, we have developed methods of eliciting narratives of self and illness in schizophrenia and quantitatively rating self-experience expressed within those narratives. In this study, we rated the narratives of 34 persons with schizophrenia spectrum disorder prior to entry into rehabilitation using the Scale to Assess Narrative Development (STAND). STAND scores were then correlated with concurrent assessments of self-esteem using the Rosenberg Self Esteem schedule and readiness for change using the Stages of Change Questionnaire. Results indicated that higher ratings on the STAND were associated with greater levels of self-esteem and greater overall readiness for change. This may suggest that qualities of self-experience within personal narratives of persons with schizophrenia are linked to objective and subjective assessments of recovery.

Attitude to Health↗
PubMed2004

Emergency care and narrative knowledge.

BACKGROUND: Nursing knowledge is a composite of many influences. In an attempt to strengthen nursing knowledge and practice, there have been significant developments in the codification of nursing knowledge as part of the evidence-based practice movement. Using established research techniques; this has the capacity to enhance clinical practice. However, not all knowledge can be incorporated into this type of academic discourse, and there is growing interest in narrative knowledge. This paper contributes to this sometimes implicit and sometimes explicit critique of dominant paradigms. AIM: The aim of this paper is to examine the usefulness of narrative as a means of exploring the world of emergency nursing practice and its contribution to the emotional lifeworld of clinicians. METHOD: A discourse analysis of nursing narratives in their natural settings was carried out. This involved exploration of stories that were not produced for the purposes of research. FINDINGS: Narratives can open up social worlds, which escape or be deliberately erased by more formal methods. Contingent and subversive knowledge can contribute to understanding the emotional impact of emergency care. CONCLUSION: These narratives have their own 'truth', which should be incorporated into an understanding of what constitutes the lifeworld of emergency nurses.

Adaptation, Psychological↗
PubMed2005

Being hurt and hurting others: children's narrative accounts and moral judgments of their own interpersonal conflicts.

Children's narrative accounts and moral evaluations of their own interpersonal conflicts with peers were examined. Girls and boys (N = 112) in preschool (M= 4.8 years), first grade (M = 6.9 years), fifth grade (M = 10.9 years), and tenth grade (M = 16.2 years) provided one narrative of a time when they had been hurt by a peer ("victim"), and one of a time when they had hurt a peer ("perpetrator"). Victim and perpetrator narratives were equally long and detailed and depicted similar types of harmful behaviors, but differed significantly in terms of various measures of content and coherence. Narratives given from the victim's perspective featured a self-referential focus and a fairly coherent structure. When the same children gave accounts of situations in which they had been the perpetrators, their construals were less coherent and included multiple shifts between references to their own experience and the experience of the other. Children's moral judgments also varied by perspective, with the majority of victims making negative judgments and nearly half the perpetrators making positive or mixed judgments. These differences in moral judgments were related to the distinct ways in which victims and perpetrators construed conflict situations. Age differences were also found in both narrative construals and moral evaluations, but regardless of their age children construed conflict situations differently from the victim's and the perpetrator's perspectives. By integrating, within the study of moral development, children's interpretations of the social interactions that are at the basis of moral thinking, this approach brings us a step closer to conceptualizing the study of children's moral behavior.

Child↗
PubMed2003

Coherent accounts of coping with a chronic illness: convergences and divergences in family measurement using a narrative analysis.

Researchers and clinicians have shown increasing interest in family narratives as an avenue for accessing the family meaning-making process. In this study, we examine the convergences and divergences between narrative assessment, family self-report, and verbal accounts of family climate. Sixty-two families with a child with pediatric asthma were interviewed about the impact that asthma had on family life. These interviews were coded for narrative coherence, relationship expectations, and engagement with the interviewer. Primary caregivers were also interviewed using the Five Minute Speech Sample (FMSS) and completed self-report assessments of family functioning (Family Assessment Device [FAD]; Impact on the Family Scale [IOF]). Contrary to prediction, narrative coherence was higher in those cases where Emotional Over-involvement (EOI) was present on the FMSS. Narrative coherence and engagement with the interviewer were positively related to self-report of family problem solving, communication, and affective responsiveness as measured on the FAD. Divergences and convergences between different types of family measurement are discussed in light of meaning-making processes associated with coping with a chronic illness.

Adaptation, Psychological↗
PubMed2004

Ontogenesis in narrative therapy: a linguistic-semiotic examination of client change.

In this article I investigate how the narrative therapy process facilitates client change. The kind of change that I focus on is linguistic-semiotic; that is, how clients develop their meaning potential through language. What I will demonstrate is how an examination of the linguistic-semiotic level provides new insights into narrative therapy's role in endowing clients with the semiotic materials to make new meanings. An examination of six conjoint sessions involving a narrative therapist with one couple revealed that client change or ontogenesis is composed of three semiotic phases. In the first phase of ontogenesis clients display a beginning semiotic repertoire by formulating "extreme case" descriptions of self and other's behaviors. In the second phase clients are scaffolded by therapist's questions and reformulations into construing events as problems and problems as the agents of negative behaviors. In the final phase clients display a development in their semiotic potential. Clients are able to eliminate problems and construe themselves as agents without prior therapist scaffolding. Therefore, in the latter stages of the narrative process clients are able to deploy meanings that have been generated throughout therapy, in order to produce narratives of self agency and self control.

Cognition↗
PubMed2003

Restoring the patient's voice. The therapeutics of illness narratives.

Reflective and insightful autobiographical accounts of illness not only illuminate fundamental disruptions in selfhood and continuity of life that accompany illness, but authors of such accounts also maintain that narration is an important way to make sense of an illness episode, to restore personhood and connectedness, and to reclaim the illness experience from the medical meta-narrative. That witnessing and helping to order illness narratives can be a caring/healing nursing practice modality with significant healing potential is supported both by narrative theory and by nursing's theoretical and philosophical legacy. The challenge for the nurse guided by narrative ideas is to give primacy to the patient's voice, to listen for meaning rather than for facts, and to provide a relationship enabling the evolution of the patient's story.

Anecdotes as Topic↗
PubMed2003

Evocation of meaning through poetic condensation of narratives in empirical phenomenological inquiry into human suffering.

The phenomenological interest to gain insight into the human being with lived experiences characterized as composite, diverse, ambiguous, vague, obvious, and concealed challenged this researcher in the process of doing life-world phenomenology. While researching the phenomenon of suffering, the author sought ways to intensify and evoke the embedded meanings in oral narratives, and he presents a model for poetic condensation of oral narratives to enhance the evocation of the meaning of suffering. Examples of narrated text are compared to the condensed narrative. Reading poetic condensed narratives of suffering has the potential to create a sense of the phenomenon responsive to and shaped by the way suffering is experienced.

Humans↗
PubMed2006

The role of narrative in discussing end-of-life care: eliciting values and goals from text, context, and subtext.

This article reports a qualitative study of elderly veterans' perceptions of and preferences for end-of-life care. At a large urban Veterans Affairs (VA) hospital, we asked 30 veterans and 30 health care providers to define 4 terms in the VA form of the advance directive: life-sustaining treatment, terminal condition, state of permanent unconsciousness, and decision-making capacity. The veterans commonly used narratives to construct meaning, and analysis showed that the resulting texts had both a subtext (the values and goals driving the narrative) and a context (life experiences that filter and shape the current interpretation). We found that all 3 components--text, subtext, and context--are crucial to understanding the central theme of an individual's narrative and the decision-making processes associated with it. In this article we examine 1 lengthy narrative using Chafe's (1994) notion of intonation units. We then present a series of short narratives to demonstrate 3 subthemes that emerged from the data: quality of life versus quantity of life, benefit of treatment versus cost of treatment, and, most common, control versus lack of control. Our goal was to demonstrate the centrality and usefulness of storytelling in the patient-provider interaction when listeners are willing to consider the subtext and context of the story and its role in the decision-making process. As demonstrated in this study, deciphering people's stories gives us insight into their values, the mental constructs that drive their decision making, and the goals that they have for their own health care.

Adult↗
PubMed2005

Personal narratives of illness in schizophrenia: associations with neurocognition and symptoms.

Controversy exists regarding whether unawareness/denial of illness in schizophrenia results from neurocognitive deficits or a rejection of stigmatized social roles. One possibility is that some elements of a narrative of mental illness are primarily a matter of personal/social construction while others may be uniquely curtailed by neurocognitive deficits. Accordingly, we gathered narratives of illness among 52 persons with schizophrenia spectrum disorders using a semi-structured interview. Ratings of the plausibility, adequacy of detail, and temporal conceptual organization of each narrative were correlated with assessments of neurocognition, symptoms, and traditional insight measures. Degree of plausibility was significantly related to performance on the Wisconsin Card Sorting Test (WCST), a measure of executive function and levels of Positive symptoms on the Positive and Negative Syndrome Scale (PANSS). When entered into a regression to predict plausibility, positive symptoms and WCST performance made unique contributions (R2 = .51, p < .0001). Higher levels of Positive symptoms were associated with poorer temporal conceptual organization within narratives. Adequacy of detail within narratives of illness was related to traditional insight measures but not neurocognition or symptoms.

Attitude to Health↗
PubMed2005

Actually, a picture is worth less than 45 words: narratives produce more false memories than photographs do.

Most memory "implantation" studies have elicited false memories by using fake narratives. Recently, Wade, Garry, Read, and Lindsay (2002) showed that doctored photographs can be used to create false childhood memories in adults. Fifty percent of Wade et al.'s sample reported details of taking a childhood hot air balloon ride, although they had never been in a balloon. In this experiment, we investigated whether photos or narratives influence memory more than the other. We exposed subjects to either a fake photograph or a fake narrative of a childhood hot air balloon ride. Subjects tried to remember the false event and three real events over 1 week. Narratives were more likely to produce false memory reports than were photos. We offer a fluency-based account of our results and suggest that narratives promote more familiarity in subjects than do photographs.

Adult↗
PubMedDate not supplied

Enacting narrative pedagogy. The lived experiences of students and teachers.

Reforming nursing education to meet contemporary challenges in educational and clinical environments is needed through the development and implementation of new pedagogies. Nancy Diekelmann is advancing the science of nursing education by describing a new phenomenological pedagogy, Narrative Pedagogy, identified through interpretive research in nursing education. Narrative Pedagogy is an approach to reforming nursing education that is always site specific and not generalizable from school to school. However, the processes of Narrative Pedagogy are transferable and can be enacted in many contexts. This study describes the common experiences and shared meanings of teachers and students engaging in or enacting Narrative Pedagogy. Diekelmann gathered seven teachers and students in five schools of nursing in four midwestern states to share their experiences. Interpretive phenomenology was used to analyze the group interview. One of the findings identified during this analysis, Enacting Narrative Pedagogy, is explicated, and two themes, Decentering Skill Acquisition and Content and Attending to the Practices of Thinking, are described.

Education, Nursing↗
PubMed1999

Cognitive narrative psychotherapy: research foundations.

There has been an increased interest in the study of language processes in psychotherapy. More recently, research and theoretical formulations of the therapeutic process suggested that we must move from the microscopic study of verbal modes to a macroscopic approach in which these modes are organized into narratives. Narratives are conceived, in this perspective, as the basic instruments for meaning making. In this article the research on narrative processes in psychotherapy is reviewed and discussed in terms of its implications for the theory and practice of cognitive narrative psychotherapy. Additionally some of the main data coming from research projects on cognitive narrative psychotherapy are presented.

Cognitive Behavioral Therapy↗
PubMed1999

Some functions of narrative in the assimilation of problematic experiences.

We present three current, complementary formulations of the assimilation model: (a) the schema formulation, based on cognitive developmental concepts: (b) the voices formulation, in which assimilation is understood as the construction of a meaning bridge between active internal voices; and (c) the cognitive science formulation, which uses cognitive concepts of memory types to understand the failure of memory in cases of warded-off and avoided experiences. These views of assimilation are used to understand the varied functions that narratives (stories about real or imagined events outside of therapy) may play in psychotherapy, including narratives that avoid encounters with threatening material, narratives that approach such material indirectly or symbolically, narratives by which clients reexperience trauma, and narratives that help construct a mature understanding.

Cognitive Behavioral Therapy↗
PubMed1994

The content of narrative discourse in children and adolescents after early-onset hydrocephalus and in normally developing age peers.

The development of narrative content was studied in 100 children aged 6-15 years (49 with early-onset hydrocephalus and 51 age-matched controls) by analyzing transcripts of oral texts produced from their narrations of two fairy tales. In relation to those of their age-matched peers, the narratives of the children with hydrocephalus were less cohesive and less coherent. They conveyed less of the content needed for the narrative message, included more referentially ambiguous material, included uninterpretable or implausible content, and were more verbose and less economic in quality. In relation to their age-matched peers, then, children with hydrocephalus produce narratives that are difficult to process, unclear, uneconomic, and less fully elaborated for meaning. These data add to an emerging body of information that shows children and adolescents with early-onset hydrocephalus to be at risk for several types of discourse and pragmatic impairments. The language of children with hydrocephalus is discussed with reference to the theoretical distinction between interpersonal pragmatic conventions and constraints relating to textual rhetoric (processability, clarity, economy, and expressivity). By showing impaired textual rhetoric coexisting with apparently preserved interpersonal rhetoric in individuals with developmental anomalies of brain development, the present data provide some support for a functional dissociation between the two classes of pragmatic constraints.

Adolescent↗
PubMed1990

Contextual influences on narrative discourse in normal young adults.

In an effort to provide some expectation regarding the influences of task and rehearsal, the narrative ability of 20 normal young adults was examined under the conditions of story retelling and story generation. Each task was repeated after a 1-week interval in order to investigate a possible practice effect. Sentence production, intersentential cohesion, and story grammar organization were analyzed. Results indicated that the subjects' performance varied as a function of task presentation as well as the measure used to describe narrative production. The only across-trials difference noted was an increase in cohesive adequacy from trial 1 to trial 2 for one of the story generation tasks. It may be concluded that (a) context does influence the manner and competence of narrative presentation, and (b) that rehearsal of a complex narrative improves narrative coherence.

Adolescent↗
PubMedDate not supplied

Ideational and semantic contributions to narrative production in adults with dementia of the Alzheimer's type .

The narrative production of adults with probable dementia of Alzheimer's type (DAT) was investigated to determine the extent to which cognitive or linguistic deficits might explain the breakdown of discourse production. The structure of narrative tasks was manipulated so that the relationships among task structure and language production corresponded to predictions about the suspected origin of deficit. Sixteen DAT and 16 normal control subjects were administered four narrative tasks that were controlled for the amount of content and picture format display. The DAT subjects exhibited reduced content in terms of propositions and lexical items, shorter sentence lengths with more sentence fragments and reference errors. The mode of picture display failed to influence the amount of target content, or the grammatical performance of subjects. However, when compared to the normal controls, the amount of information pictorially represented significantly influenced the content provided by the DAT subjects; they performed better when the message to be related contained relatively less information. These findings support the contributions of both semantic-lexical and ideational systems to narrative discourse to narrative discourse production.

Aged↗