Running Head: STORYTELLING

Storytelling Dermot Connolly Stenberg College Surrey BC

STORYTELLING Abstract Storytelling has long being recognized as playing an important role in nursing. Through the sharing of experiences and critical reflection, the role of the nurse is enhanced resulting in a higher standard of care being delivered to the patient. The purpose of this paper is to use the art of storytelling to reflect on a personal experience where a patient was in receipt of an act of

caring. Through reflection, key skills and missed opportunities are identified. The importance of these skills and opportunities play in the development of the nursing practice are also discussed. Keywords: Storytelling, reflection, empathy, therapeutic relationship.

STORYTELLING Storytelling Storytelling has become an important feature in everyday life. From a young age, the telling of stories fosters the development of a childs imagination. In Native American culture, storytelling plays an important role in the passing on of traditions and customs from one generation to the next. Rajotte, M., (2012). The role of storytelling in the nursing profession has also being recognized as being an important tool in the education and development of nurses. Storytelling provides the nurse with the opportunity to share ideas and values that transcends generations and cultures. It fosters critical thinking to reflect on the skills and weaknesses of the storyteller. It can improve the quality of nursing care administered to the patient through the education and personal development of the caregiver.

The purpose of this paper is to share a personal story where a patient in need was assisted through nursing care. It documents the personal skills identified to deliver that care and the lessons learned from the experience. Personal Account: The Hero Story I work two days a month as a volunteer for the Langley Hospice. I typically start my shift with a quick visit to each of the patients where I introduce myself and see if they need anything. I use this opportunity to try and read the patients non verbal communication to see if they are open to a visit or if they want to have a talk. Earlier this year, as I was checking in on the patients I got the impression that there was something bothering one patient in particular. She initially had told me that she did not need anything but I decided to return to her room with some juice and see if she was up for a visit.

STORYTELLING She was happy to receive the juice and then asked me to fill her a bowl of water so she could clean her dentures. As I filled the bowl from her sink I initiated a conversation which developed into her asking if I could help tidy her room a little bit if I didnt mind. She kept

apologizing for being such a bother and as I happily tidied her room I attempted to reassure her that I was happy to help. I finished tiding her room and asked her if she needed an extra pillow and warm blanket as I noticed she was shifting uncomfortably in the bed and it had being a cold day. Her face lit up in a manner that made me realize that she wanted a lot of things but was simple afraid to ask. When she was more comfortable and her room was tidied, I sat with her for a little bit as I felt we had built a relationship in which she felt she could comfortably talk to me. She began to open up to me about her illness and her frustrations while I sat and listened. She began talking about her journey with cancer and how difficult she felt it would be on her husband when she died. As I listened to her and watched the pain in her eyes she glanced over at the wheelchair in her room and as her eyes filled with tears, she told me that all she wanted to do was get out of bed and sit in that chair, but she was afraid. She was afraid that she would fall and she was afraid that she wouldnt have the strength to do it and that would mean she would be confined to her bed until she died. I felt her pain and I reached out and grabbed her hand as she began to cry. I went out to the nurses station and asked if there was any reason why the patient could not get out of bed and sit in her chair. The nurse told me she was free to sit in the chair but would need some help getting into it. They were more than happy to help but recommended she wait until the morning when it was brighter and warmer. One of the nurses even came down to the room with me and confirmed this with the patient herself. The patient was so happy to hear this and after the nurse left we made a plan where the following morning, she would get out of bed with the

STORYTELLING help of the nurse and the volunteer on duty and sit in her wheelchair. I will never forget the look of determination in her eyes when she told me that no matter what she was getting into that chair in the morning and I was convinced she meant it. I sat with her for another little bit and before I left her, she looked at me and thanked me for making her happy. This made me feel good but I remember explaining that she had done it all herself, she just needed to recognize the barriers that prevented her from getting into the chair and believing in herself that she could overcome those barriers.

I was the last volunteer on duty that night and as my shift ended, I summarized the events of the evening in our volunteer log book. In my notes I made reference to the fact that the patient had expressed a strong desire to sit in her wheelchair and it would be fantastic if someone could help her achieve that desire. The patient died before I worked my next volunteering shift two weeks later. During my next shift I read through the volunteer log book to see if she got to fulfill her wish and sit in her chair, but there was no mention of it in the log book. I read how she deteriorated within days of my last visit and died. While I will never know for sure if she overcame her fear, I like to think that she did sit in her chair that day and the reason it was never recorded in the log book was because it was something considered too small to mention without fully understanding how important it was for her. Conceptual Analysis of the event The concept of critical care plays a central role in the development of a therapeutic relationship between the psychiatric nurse and the patient. In the case study described above, the process of reflection through storytelling, demonstrates the development of this therapeutic relationship. Initially the patient is reluctant to ask for help but the hesitation in her voice

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indicated that she was in need of additional support and care. Two different skills are recognized here; the ability to recognize and foster the signs of non verbal communication and the growth of the therapeutic relationship. The growth of this relationship is displayed through the patients breaking down of barriers through her acceptance of additional requests for help and caring. Another skill is displayed later on in the interaction in the form of empathy. After the patient has being made more comfortable, she begins to open up about her illness and some of her other emotions. She discusses the affect her illness has on her husband and her fear of not being able to sit in her wheelchair. Empathy is displayed when the hand of the patient is held in an attempt to console her as she cried. It is also recognized when the storyteller relates to the pain felt as the patient cried. This empathic relationship is acted upon when the nurse is fetched to reassure the patient and a plan is developed with the patient that would enable her to conquer her fears and sit in her chair. While these acts of empathy demonstrate an important skill required in the field of psychiatric nursing, it is important to remember that the development of an empathic relationship can also be a weakness. In their paper on empathy, Cassedy and Cutcliffe (1998) cite Kalisch (1973) who describes empathy as the ability to enter the life of another person, to accurately perceive his feelings in order to fully understand them (p28). They also cite Gladstein (1983) who makes reference to instances where overreacting to the feelings of empathy can be counterproductive and even unhelpful to the patient (p30). While the act of empathy displayed in this case study could not be described as counterproductive, it could be viewed as a selfish act on behalf of the storyteller to help him deal with the pain he felt from watching the patient cry. The development of the three skills indentified above; therapeutic relationship, recognition of non verbal communication and empathy highlighted the growth in knowledge and

STORYTELLING experience displayed by the storyteller when interacting with patients in a clinical setting. This development in knowledge can enhance the quality of patient care in future practice through the recognition of these skills and the importance of their development within the patient / nurse relationship. This knowledge can help recognize signs and symptoms of distress and anxiety in

the patient. In their paper on identifying and treating depression, Handsaker, Dempsey and Fabby (2012) investigated the instances of depression in end of life patients. Their research showed that 25% of palliative care patients suffer from depression at some stage during their illness. Using the interaction described in the case study above, the patient displayed symptoms of depression and anxiety that cumulated in her breaking down when attempting to express her frustrations. These frustrations and anxieties were recognized and addressed in a manner that left the patient feeling cared for. It also highlights the importance of being able to see and recognize the signs of other psychological symptoms such as depression when working in a clinical setting. Recognition and development of this newly acquired knowledge is an important stage in the development of quality psychiatric nursing care. In dealing with patients in a clinical setting, emotions will play a part in the quality of care administered to the patient. In this case study, the emotions and actions displayed by the storyteller and the nursing staff towards the patient highlight a genuine desire to help. Recognition and control of these emotions can play an important part in the personal development of the psychiatric nurse as it enables the psychiatric nurse to critically reflect on their actions. Marchessault, Legault and Martinez (2012) recognized this in their investigation into the role of homecare nurses in a providing palliative care. Those nurses surveyed, reported that they had developed a strong connection with the patient and family under their care. They also noted that at times they were exposed to a variety of emotions that promoted their own

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personal development. Some of the nurses surveyed described projecting the patients illness into themselves where they imagined a loved one in a similar situation (p139). Much like the objectives of this assignment, this process of critical reflection helped the nurses analysis their own practice with a view to promoting personal development. One can conclude than that the simple act of storytelling plays an important role in Nursing. Through critical reflection and personal assessment, the quality of nursing care is strengthened through the act of shared experiences. In the case study described above, the process of sharing a story helps to indentify and demonstrate some of the key skills used to deliver that nursing care. These skills include empathy, the recognition of non verbal communication and the development of a therapeutic relationship. The process of storytelling allows us to share our experiences with others so as to educate and inspire. It allows us to reflect on our own actions with a critical eye and helps us indentify our own thoughts and feelings.

STORYTELLING References Cassedy, P. & Cutcliffe, J.,(1998). Empathy, students and the problems of genuineness. Mental Health Practice. (1) 9. 28-33. Handsaker, S., Dempsey, L., & Fabby, C., (2012). Identifying and treating depression at the end of life and among the bereaved. (18) 2. 91-97. Marchessault, J., Legault, A., & Martinez, A. M., (2012). Providing in-home palliative care

within a generalist caseload: a chance for nurses to reflect on life and death. International Journal of Palliative Nursing. (18) 3. 135-141. Rajotte, M., (2012). The role of storytelling in Native American tribes. Bright Hub Education. Retrieved from: http://www.brighthubeducation.com/social-studies-help/97047importance-of-native-american-storytelling/