Members' Insights

GROUP F MEMBERS' INSIGHTS ON "STORY THEORY"

In the ever stressful world where we are living, each one of us has a different story to tell. Engagement in meaningful conversations is nonetheless a basic survival requirement that one must satisfy in order to find release from all the negative energies that a certain situation may bring.  Now, how about putting this in the context of a sick individual who is confined within the walls of the hospital and experiencing the discomfort which his sickness has brought him.            Nursing, as we all know, is a discipline that serves as a platform for a certain being to be able to practice the art of caring. By caring sets the values of empathy, patience and holism. The nurse is therefore guided by these caring principles. Thus, in the process of gearing the sick individual towards resolution and wellness, the aspect of therapeutic nurse-person communication is given considerable emphasis. In the hopes to create ease, free expression of feelings and concerns in terms of the present situation or difficulty is encouraged through a series of intentional nurse-patient dialogue. This is the heart of the story theory by Smith and Liehr, as I understood it.          Nowadays, due to the increasing demands put upon into an individual, there seems to be a lost to this basic human touch. This art of communicating effectively that needs to be rebuilt and restored especially in this profession wherein the recipient of care is in great demand of a listening heart and an open mind. Generally, by experience, I must say that the patients who can communicate almost everything to a nurse who’s not bound by time, appear to have a more pleasant disposition during their hospital stay, are more at ease and in the end, recover more quickly.           In reality, all of us at some point in our lives have experienced telling stories and felt how heartwarming it is to have somebody listening sincerely.  Also, we have been recipients of great stories shared by other persons, which touched our hearts and made us smile. Then, as a way of giving back, let us play the alternating role of being a great listener-storyteller in the lives of our beloved patients and find meaning in them.

- Jorisantha E. Perez, RN - Nurse III

Medical-Surgical Unit, Philippine General Hospital, Manila, Philippines

I have been a Nurse for 12 years already and has continuously tried acceptable ways to ensure that my care and service to my patients are up to par. Studying about theories had made me realize that I could incorporate these theories in my nursing care.Learning something new such as the STORY THEORY has made me think of how it can help me in my care of post-partum patients. Most of the time we take care of patients from different walks of life. They come not only to deliver their babies but they come with their own unique stories. I realized that I should take more time to talk to my patients. Hearing their stories and learning more about them can help me device a care plan that can guide them reach their optimum level of health.        Pregnancy and delivery of every mother is different and different stories comes with it as well. I am particularly intrigued in applying story theory to adolescents and their pregnancy.  Maybe later in my thesis, I could consider this as a topic. I am inspired with this theory and its beauty that I am later on considering this applying in my work and in my future researches as well since according to Robert Mckee, Storytelling is the most powerful way to put ideas in the world today.

- Chareluck Rovan L. Santos, RN - Nurse III Department of Ob-gyne

University of The Philippines Philippine General Hospital

        The Story Theory is another theory that we can use in our daily life as a nurse. Therapeutic communication is essential in building rapport with our patients. This can help us in identifying the main problem of the patient, plan care with them and evaluate if it was effective. Different people has different kind of stories in life. The stories can be of their past, present or their future. It can greatly affect the health status of the patient as his story can reveal his environment that affected his or her current health.          There are 3 concepts of story theory. We usually use the intentional dialogue wherein we purposely engage the conversation with the patient by simply introducing yourself and giving out open ended questions. Open ended questions can encourage the patient to verbalize the full story of his health. This theory can help nurses in gathering relevant information via the stories verbalized by the patient.

- Christine Grace M. Roasa, RN - Staffing Advisor

Hewlett Packard Enterprise (Now: DXC Technology)

Nursing theories have gone so far in the realm of the clinical field, providing nurses an integral part in development, self-consciousness, involvement, expertise and so on. These theories can make huge impact in the nursing practice and the lives of health care providers. In this matter, the story-telling theory by Liehr and Smith acknowledges the sense of humanity in the clinical setting, encapsulating trust and expression to create ease, thus promoting the healing process. We have to admit that the extinction of nurses all over the world can possibly generate a hospital community with mere technicalities, omitting effective communication. So in this sense, I appreciate this story theory in creating a deeper understanding in nurse-person dialogue, building a larger scale in the meaning of empathy and holistic care. In my years of experience, creating a plan for patients to further fastened the process of their healing is very diverse, but reflecting in this theory, one may simply listen wholeheartedly and yet contribute in a huge way.

- Janna Fey P. Par, RN - Nursing Supervisor

Healthserv Los Banos Medical Center, Laguna

“Human is created by his story not by its parts or structures.” 
Each person may have similar experience but have different way in explaining the experience making in unique. Uniqueness of an individual’s story enables the nurse to create client-centered and individualized intervention.       As a psychiatric nurse for almost 4 year now, application of the story theory is very workable and relatable since I am dealing with the client’s experiences which involves his emotions and behavior. Dealing with lived-experience experiences or human phenomena can also affect not only the client but also nurse itself so it is also important the nurse should started dealing with itself or undergo process of self-awareness. Human experience is very complex that it involves different layer of human phenomena. Undergoing series of interviews and establishing rapport may sound easy but the true process lasted for weeks and months in my case handling psychiatric client. Personality of the client can also be a factor in acquiring such data.      As different body of knowledge interplay with the human being nurses are force to broaden their knowledge, skills and attitude to be able to give holistic care to our client. And human is also changing with its world and so as nursing it is real no constant thing in the world except change.

- James Patrick O. Valera, RN - Head Psychiatric Nurse/Training Supervisor

Livelife Homecare Inc., Laguna, Phillipines

 Each of us has our own story to tell…        … It could be fictional characters like the bastard-turned-lost-prince Jon Snow or the orphaned wizard, Harry Potter or your neighbor, Aling Martha who sells fishballs in the afternoon at your neighborhood or the driver of the public utility bus you rode on your way home today. Every one of us is the author of our story.         The story theory exploits this very fact, which is a genius concept, because it makes our lives easier. Through storytelling, we are able to convey our feelings, insights, and perceptions on various matters. The same thing could be said when we face our clients in the health care settings.        Clients find it easier to divulge their health care concerns when they tell it through a story rather than just describing their signs and symptoms and when they felt it. A good example of this is during history taking. As nurses, we are trained not just to identify the physical signs and symptoms experienced by the client during our interaction, rather it is our obligation to address the client's "wholeness", and that encompasses his "uniqueness".         As the client begins story-telling through intentional dialogue, the nurse forgoes all modes of bias and judgment and recognizes the patient as the expert. This in turn helps the patient increase self-awareness which can hopefully be a way towards self-healing. This is in congruence with the second and third concepts of the Story theory which is connecting with self in relation and creating ease and pose.        Through the stories our client shares, we are able to assess client's own beliefs and values, cultural background, level of understanding, perceptions about various issues, thereby enabling the nurses to plan creative ways on how to implement health care plan based on mutually identified goals.        I find the application of story theory very practical in my current field in the Home Medical Programme, wherein we are tasked to conduct regular Home Visits to various clients such as those who have been just discharged from the hospital and warrants continuous care in the home, and those who have not consulted with a Health Care Professional for a very long time.       As we have observed, the dynamics of patient care changes significantly once patient is discharged to home. Most of the care is now delegated to the family members who acts as primary caregivers. The success of our nursing care plan is dependent on the commitment of both our patients and our caregivers to implement plan of care.       Furthermore, the story theory as explained by Smith and Liehr (2008) doesn't only focus on a nurse-patient relationship, but rather on a nurse-person relationship. This means, that the Story Theory may be applied with our interactions with the family. I believe that being able to hear the stories of the family inside the home gives us not only additional insight about the patient, but also an insight about the family on their background and dynamics.      We, in the Home Medical Programme nursing team, consider the family as part of our clientele, thus hearing their anecdotes about the patient's life or how is their relationship with the patient, helps us understands on what could be done to achieve the utmost level of health promotion behaviors. This also assist us in understanding the state of commitment of the caregivers who are dealing with the patient and provide them with the support they need accordingly.     The Story Theory doesn't only benefit our clients, but we, the nurses as well. The stories that we hear from them or the stories that we share with our own colleagues, can help us learn more about ourselves, thus increasing self-awareness. Moreover, the stories we hear from our colleagues on their experiences helps us increases our knowledge and gives us a wider perspective on how to manage when faced with a similar situations.      In fact, as we continued our research on this interesting middle-range theory, I came across a research dissertation by Ms. Jennifer Reich (2011) entitled: The anatomy of the story, wherein she viewed the story theory as a self-care potential strategy for nurses, thus creating her very own Self-Health Model as shown below. It was interesting how she viewed the nursing profession as one that is in crisis and described the nurses as an "endangered species", at risk for burn out. By the end of her dissertation, Reich highly encouraged to use story as a way for nurses to share our knowledge to others and recommended to use story-based interventions to increase job satisfaction, thus improving our quality of care to patients.      In conclusion, the story theory undermines the importance of use of stories as an innate part of our daily nursing practice. It is therefore imperative for the nursing profession to develop our skills in encouraging our clients engage in story-telling, because through this we help them gain self-awareness and we are able to clarify insights in a more understandable way. Furthermore, the use of the Story Theory has a lot of research potential as we can find more ways on how to use this theory to improve our nursing practice, just like how the above mentioned research directed to use of nursing theory to help nurses deal with their struggles in the work field.

- Steffi Ramos, RN - Home Care Administration

Aseer Region, Saudi Arabia

“Story makes the implicit explicit, the hidden seen, the unformed formed, and the confusing clear.” Nursing practice is guided by nursing theory, then decision-making processes should be filtered through the theory in such a way that makes the outcomes of the process both unique and useful to nursing. As a cardiovascular practitioner, it is necessary to know their clients at depth, and to comprehend their social contexts in order to provide holistic care. It is culturally congruent way to ascertain and understand experiences. In my experience storytelling makes it easier and effective to new understandings of how symptoms correlate with life events thus, it is highly recommended.

- Fatima Anne K. Reyes, RN - SCVNPI

Philippine Heart Center

      Working in a Long-Term Chronic Care Facility, we care for patients for the duration of their life through palliative nursing care. Upon admission of a patient from the Acute Care setting we receive hand over of care through written narratives (e.g. Medical Reports and Progress Notes). This where the story theory is applicable, we engage through dialogue with previous caregivers of the patient to know every routine of care and management given, as well as past health and personal history from family members. We take great deal of importance with Patient and Family Centered Care through dialogue.      Care Plans that are patient and family centered are derived from the stories and data gathered whether be it past or present so that a better more reliable care is given in the future for all patients. As time goes by, the longer a patient stays with us, it is by a monthly dialogue and story telling that the interdisciplinary team made up of doctors, nurses and therapists (respiratory, speech and language, physical and occupational) come up with a suited plan of care that is specific for each patient inside the facility.

- Rainisa Baculi Romatho, RN - ICU Staff Nurse

Long Term Care, Abu Dhabi, UAE

Every person has different response to illness and has unique stories behind them. These stories affect the person’s perspective in how they view illness and prioritize needs. The nurse as the primary caregiver to an ill person must be able to recognize the needs of the patient not only physically but also emotionally and psychologically. Application of nursing theories will help in filling the gap between what the nurse’s intervention and patient’s need. An example of these theories is story theory that uses storytelling for nurse-patient-health promotion.
As an infection control nurse, one of our primary responsibilities is communicating with patients who have chronic illness. In order for us to able to get the information that we need and to address their needs, we need to first establish a good nurse-patient relationship. We usually talked about their past and try relate it with their current illness. Patients with chronic illness like HIV and other sexually transmitted disease are usually uncomfortable talking about their activities but after few minutes of talking to them they usually open up and tell their story. Their stories help us in assessing the problem and identifying the actions that needs to be made to improve their health.Story theory as framework of nursing intervention is more applicable in long term healthcare facilities because you have a long time to hear their story stories and plan interventions. In emergency situations like in emergency room, you don’t have time and the patient usually can’t tell the story which makes this theory not feasible for practice. 

- Jomer M. Quilao, RN - Infection Control Nurse

Story theory as defined by the respective theorists is connecting with self in relation through intentional dialogue to create ease (Liehr& Smith, 2008). Intentional dialogue is the careful searching of one person’s story concerning a complicating health issue. As nurses, according to story theory, we come to terms with the realities that in delivering a wholistic, quality and advanced nursing practice we need to understand the importance of attending to the patient’s story. We need to be reminded that through patient’s past experiences they are shaped and as their story unfolds their life unfolds as well. It is the patient’s history impacts of why they are in the current situation of medical or health challenge and that their experiences influence their perspective in dealing the current health situation and their standpoint to future. Nurses together with their patient and as they build a nurse-patient relationship they need to collectively review all facets of the story. Nurses guide the patient of how to live the current health challenge from their own personal perspectives. It is in this manner that both nurses and patient create ease in dealing out with the health challenge to move forward while accepting the past as part of the story or rather history and focus only to the newfound sense of cause to look forward for the future.
In a nutshell, story theory had enlighten me as a nurse that through paying close attention to what matters most in the patient’s story, history and respecting one person’s perspective in life  enables me to identify and postulate the needed caring or healing process that is essential to promoting health to one person’s unique health challenge. 

- Claire A. Serdoncillo, RN – Staff Nurse

Abu Dhabi, UAE

    This middle range theory utilizes the importance of a client’s story, which is said to be an inner human resource for making meaning. The personal stories told through intentional dialogue would lead to the nurse identifying possible health challenges experienced by the client. Upon identifying these health challenges, the nurse could help the client connect with his own self and eventually move towards resolving or ease.
Looking at the culture and tradition of the Philippines, I can see that using this theory to nursing research and practice in the country is promising. In my own experience in the clinical area, most patients love to interact with the health team (especially nurses), sharing their stories and experiences that are directly or indirectly related to their current health condition. Although not generally, the sense of openness in many Filipino clients could be an advantage when applying this theory to help address and resolve their identified health challenges.In my own clinical setting, however, the fast paced care at the Emergency department may be a hindrance to the proper application of this theory in practice. This theory may be more applicable to areas where long term care is practiced such as in hospices, nursing homes, or general wards.

- Ana Jeska Peñaranda, RN – ER Nurse

Philippine General Hospital

A story is based on experiences. Storytelling gives voice to what the experiences mean for an individual.  The Story Theory explained in this site will guide us nurses to better understand every patient's story in order to build rapport, trust and facilitate holistic care.

- Angelique A. Rosete, RN - Nurse II

University of the Philippines, Philippine General Hospital

Stories, as we all know, are always part of our everyday existence. It’s our way of letting other people know, what we feel and how we feel towards certain occurences in our daily lives. Through stories, we are able to deal appropriately with our surroundings by expressing ourselves and hearing others express theirs as well. Stories are pillars to give solutions to one’s own problems, may it be financial, emotional or health. Thus, Story Theory shows us the path to better health solutions and providing quality health care to our clients.

 - Maria Christina C. Quinto, RN - NICU Nurse
Villaflor Memorial Hospital, Philippines

     

I have been a nurse for a while now but honestly I have not heard of the story theory until now. Well in general, I have moved on from theories after the subject topic in college since I do not really like it. Graduate school (N207) made me realize that I am unconsciously applying some of the theories at work.                                                          As an expatriate nurse, I guess it is hard to apply story theory at work because of language barrier and could be of some cultural differences. Much more if the patient is also an expatriate who does not know how to converse in English. I had fellow Asian patients who do not speak much of English and Arabic so just conversing with them is difficult.
            One of these days, maybe I will be able to apply story theory in a more or in-depth way to be better in understanding and helping my future patients.

- Marlie Beth Pawid, RN - Staff Nurse

Prince Sultan Cardiac Center, Qassim, Saudi Arabia

            Story telling has been an art (and in some time and distance, almost a science) across the world. However, this concept of the story theory gives added weight and importance to stories  as not just source of entertainment, amusement or information – but rather as powerful tools of health restoration and life rehabilitation. The concepts of the story theory, is all too familiar to me, but it is only now that I have realized that there is a formal defining it. Throughout my nursing practice, I have personally believed in the power of stories in nursing care. It is both a tool and a process. It is the means with which we build rapport with our clients, and in doing so we can elicit more stories with which can provide us cues in promoting the client’s health and wellness as well as in addressing needs and concerns. It is also a process of intentionally eliciting, describing and explaining the client’s story in the health promotion context.
 Establishing rapport with certain special patients may seem difficult at first, but by the power of stories – through intent listening and dialogue – rapport is built easily. By this new rapport, we are able to elicit more information from our clients and therefore formulate or modify our plans of care as needed. Through these stories we may evaluate the efficacy of our care and send our patient into new beginnings of renewed health. During my stay in my area of assignment, I have witnessed the power of stories from admission to discharge – that is to say from the nurses’ assessment up till evaluation until discharge.

- Maria Khrizalyn Faye J. Quintin, RN - Nurse II, ATR BURN Center

Philippine General Hospital