Narrative relations : resources for meaning-making and person-centred practices in geriatric care
Author: Herulf Scholander, Lisa
Date: 2023-11-10
Location: Erna Möller-salen, NEO, Blickagången 16, Karolinska Institutet, Flemingsberg
Time: 09.30
Department: Inst för neurobiologi, vårdvetenskap och samhälle / Dept of Neurobiology, Care Sciences and Society
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Thesis (1.070Mb)
Abstract
Narrative approaches in healthcare have attracted a lot of academic attention,
suggesting a strong potential in narrativity to help shift healthcare towards more
compassionate and person-centred practices. Yet, there is still a need to better
understand how narrativity might be understood, made relevant, and realized by
healthcare staff in their everyday practices. Drawing on ethnographic fieldwork,
healthcare professionals’ practice-based experiences shared in focus groups
discussions, and narrative theory, this thesis puts everyday healthcare practices at the
centre of inquiry, with the overall aim to develop a deepened understanding of
narrativity as a potential resource for person-centredness and meaning-making in
inpatient geriatric care practice. This compilation thesis includes four academic papers,
each contributing to illuminating different aspects of narrativity in everyday practices.
The initial studies shaped the design of the latter, thus building cumulative knowledge
pertaining to the overall aim. Drawing on ethnographic fieldwork, Paper I explores how
narrative meaning-making takes place and unfolds on a geriatric ward and discusses
that in relation to contextual conditions and person-centred care. The findings render a
multifaceted portrayal of the relational and intersubjective character of narrative
meaning-making in healthcare practices and show how mundane events and activities
of everyday life on a ward were often undervalued in terms of offering opportunities for
exploring and co-creating possible understanding of patient situations between them
and staff. Papers II & III are based on a constructivist grounded theory methodology.
Vignettes developed from the previous ethnographic fieldwork were used to prompt
focus group discussions with healthcare professionals. Paper II explores healthcare
professionals' experiences and reflections about the use of narration in their everyday
work. The findings reflect narration as an ongoing practice of mutual narrative
interchange between multiple narrators, including patients, significant others, and staff,
and thus introduce the notion of engaging in narrative relations. Moreover, the findings
suggest potential consequences for clinical practice of people’s engagement in
narrative relations. Paper III expands understanding about the notion of narrative
relations by exploring how and where narrative relations are adopted and enacted in
everyday practice on a geriatric ward. A main finding was the existence of a twofold
practice whereby some activities and actions were generally approved as authorized
tasks or routines, i.e. acknowledged practice, while other activities were not assigned
this status, and thus took place as underground practices. Together with the concepts
of clinical frontstage and backstage, the analysis constructed four distinct arenas for
engaging in narrative relations. The findings discuss the transboundary function of
narrative relations to interconnect these arenas and contribute to continuity in
everyday practices. Finally, Paper IV explores conditions for engaging in narrative
relations on a geriatric ward by delving into how healthcare staff interpret conditions for
their practices. The findings from a hermeneutic analysis contribute to a deepening
understanding of how everyday healthcare practices unfold not only governed by
predefined organizational conditions, but that these conditions are continuously
interpreted by people, which affect how practices are enacted. Whilst some
interpretations were aligned with attitudes and activities enhancing narrative relations,
others simultaneously thwarted narrative relations by enacting task-orientation, division,
and a focus on measurable biomedical or functional improvements and outcomes.
In summary, this thesis suggests a broadened understanding of narrativity that expands the focus beyond eliciting verbal narratives and coherent stories when aiming for fostering person-centredness, to entail a relational approach of continuously tapping into the ongoing narrative meaning-making that people – both staff and patients – engage in. This approach builds on the notion that multiple narratives continuously communicate through narrative relations. When consciously and ethically cultivated, staff practices of engaging in narrative relations may contribute to uphold foundational relational qualities in healthcare.
In summary, this thesis suggests a broadened understanding of narrativity that expands the focus beyond eliciting verbal narratives and coherent stories when aiming for fostering person-centredness, to entail a relational approach of continuously tapping into the ongoing narrative meaning-making that people – both staff and patients – engage in. This approach builds on the notion that multiple narratives continuously communicate through narrative relations. When consciously and ethically cultivated, staff practices of engaging in narrative relations may contribute to uphold foundational relational qualities in healthcare.
List of papers:
I. Scholander, L. H., Vikström, S., Mondaca, M., & Josephsson, S. (2021). Stories under construction: Exploring meaning-making on a geriatric ward. Journal of Aging Studies. 58, 100940.
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II. Scholander, L. H., Boström, A-M, Josephsson, S., & Vikström, S. (2023). Engaging in narrative relations in everyday work on a geriatric ward: A qualitative study with healthcare professionals. Journal of Clinical Nursing. 32, 3954–3966.
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III. Scholander, L. H., Boström, A.-M., Josephsson, S., & Vikström, S. (2023). Hidden or approved? Exploring arenas for narrative relations in geriatric care. [Submitted]
IV. Scholander, L. H., Vikström, S., Boström, A.-M., & Josephsson, S. (2023). Inquiring into the conditions for engaging in narrative relations on a geriatric ward – how interpretation matters in everyday practices. [Manuscript]
I. Scholander, L. H., Vikström, S., Mondaca, M., & Josephsson, S. (2021). Stories under construction: Exploring meaning-making on a geriatric ward. Journal of Aging Studies. 58, 100940.
Fulltext (DOI)
Pubmed
View record in Web of Science®
II. Scholander, L. H., Boström, A-M, Josephsson, S., & Vikström, S. (2023). Engaging in narrative relations in everyday work on a geriatric ward: A qualitative study with healthcare professionals. Journal of Clinical Nursing. 32, 3954–3966.
Fulltext (DOI)
Pubmed
View record in Web of Science®
III. Scholander, L. H., Boström, A.-M., Josephsson, S., & Vikström, S. (2023). Hidden or approved? Exploring arenas for narrative relations in geriatric care. [Submitted]
IV. Scholander, L. H., Vikström, S., Boström, A.-M., & Josephsson, S. (2023). Inquiring into the conditions for engaging in narrative relations on a geriatric ward – how interpretation matters in everyday practices. [Manuscript]
Institution: Karolinska Institutet
Supervisor: Josephsson, Staffan
Co-supervisor: Vikström, Sofia; Boström, Anne-Marie
Issue date: 2023-10-02
Rights:
Publication year: 2023
ISBN: 978-91-8017-134-2
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