Narrative Medicine's Role in Graduate Nursing Curricula: Finding and Sharing Wisdom through Story

In nursing school, students are taught basic principles of patient care, with an emphasis on complex procedures, new technology, and the critical thinking behind nursing interventions. Therapeutic communication, empathy, and respect for patients are also defined and discussed throughout nursing education. Students apply these concepts in clinical experiences as they learn to provide competent nursing care. When nurses graduate, they embark on a challenging journey to interweave emotional aspects of care into physical patient care.

Upon graduation, a nurse begins a professional journey that is filled with patients ‘joys and suffering. Along the way, the nurse picks up mementos comprising patients ‘stories and nursing wisdom learned from caring experiences. These lessons are both human and clinical in nature. The stories that nurses experience and witness during their careers either coincide with or alter the definitions of therapeutic communication, empathy, and respect that were learned in nursing school. Nurse educators should explore with their students how nurses process and understand this journey. One of the ways in which nurse educators can help graduate-level nursing students understand their unique nursing experiences is through narrative medicine.

My first job as a nurse was on an organ transplant floor. Like other nurses, I had various patient care experiences that evoked many feelings for me. Some of my patients shared stories about themselves that I never expected to hear. They also endured complex medical journeys that had an emotional impact on me. Unsure of how to process these nurse–patient interactions and what I was feeling, I began to write about them in a private journal. Writing and reading about my nursing experiences helped me to better understand myself as a nurse and as a person. Although I was unaware of it, I was using narrative medicine to reflect on my nursing journey as it comprised my patients ‘stories.

The stories that nurses experience and witness during their careers either coincide with or alter the definitions of therapeutic communication, empathy, and respect that were learned in nursing school.

Narrative medicine is “… recognizing, absorbing, interpreting, and being moved by the stories of illness” (Charon, 2006, p. 4). Within these stories, the patient's lived experience is recognized. Also, bearing witness to these stories has the power to bring meaning to a nurse's own lived experiences and career. Drawing from the arts and humanities, narrative medicine involves deep readings and analysis of literary works, reflective writing, and attentive listening to others ‘stories (Charon, 2012).

At Columbia University, Dr. Rita Charon is teaching narrative medicine to medical students. I recently attended an intensive workshop offered by Dr. Charon's Program in Narrative Medicine. Participants included health care professionals from all over the world. At the workshop, I learned that writing, recounting, and reflecting on patients ‘illness experiences contributes to my emotional growth. I also learned that patients ‘stories give clinical practice a deeper meaning.

I realized the importance of the narrative in nursing through short story and poem analysis as well as creative writing exercises. We worked in small groups analyzing literary works together, including reviewing a text's components, such as genre and what mood the text conveys (Charon & Hermann, 2012). We also shared our own writing out loud with one another. During one activity, I listened to another person tell a story about one of her life experiences and wrote down what she had told me, then read the story out loud to the group. In this exercise, group members heard their experiences come alive. Many group members noticed details about their own stories that they had never realized before. They were able to look at their stories differently when retold from another person's perspective. In writing down another person's story, I gained a deeper respect and understanding of a lived human experience. It also made me think about a patient's story and what it means to that person to be heard and understood by a nurse. This activity created camaraderie among a group of former strangers.

The importance of relationships is emphasized in narrative medicine. Incorporating narrative medicine exercises into college courses creates a relationship-centered curriculum (Christianson, McBride, Vari, Olson, & Wilson, 2007). This type of bond and sense of community could strengthen nursing student and faculty relationships and could ultimately enhance the nurse–patient relationship by heightening the student's listening skills.

Nurses have stories that are meant to be narrated, listened to, and reflected on, so that colleagues, patients, and even the narrator can be changed by them. This change may involve viewing a clinical situation in a new light and often means that the listener is called to change the course of his or her action because of the story. Therefore, nurses can find wisdom not only in their own stories but other nurses ‘stories as well.

In order for nurses to comprehend their nursing narratives, graduate nursing students must be taught that emotional growth is an integral part of professional development. One of the ways in which graduate students can grow emotionally is by learning about narrative medicine's role in nursing practice. Through narrative medicine, nurses are able to share the wisdom they have learned throughout their careers and discover new knowledge about themselves.

Incorporating narrative medicine into graduate nursing courses should begin with a team-based approach to curriculum development. Nursing faculty should partner with English professors so that in-depth knowledge of literature and literary analysis related to narrative medicine, as well as its clinical implications, could be explored within the curriculum. Course content could contain various literary works, including some directly related to illness experiences and others that contain concepts that are essential to nursing.

Finally, students should engage in writing exercises. Topics could include writing about illness from a patient's perspective or exploring a student's personal meaning behind fundamental nursing concepts such as empathy and therapeutic communication. Students should be encouraged to read their work aloud so that the instructor may provide support and feedback. Faculty serve as facilitators, encouraging students to further explore and delve into the reflective writing (Charon & Hermann, 2012). Also, when a student reads his or her personal work aloud, fellow students can share their perspectives related to the story. Different perceptions may change the story's meaning for the author.

Further research is needed to determine narrative medicine's impact on nursing practice and patient care. It is hoped that narrative medicine's integration into master's level nursing curricula will allow students to incorporate narrative medicine's principles into their practice through understanding that witnessing patients ‘stories impacts nurses ‘professional and personal lives.

Drawing from the arts and humanities, narrative medicine involves deep readings and analysis of literary works, reflective writing, and attentive listening to others ‘stories.