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Therapeutic storytelling in nursing practice

By: Edie Devers Barbero, PhD, RN, APRN, BC

For centuries, myths, parables, fairy tales, and fables have provided structure, meaning, and guidance to people struggling to come to terms with life problems. Stories can warn a child of dangers, allow family members to share grief and healing after the loss of a loved one, and help the elderly find value in the lives they’ve lived.
In the caregiving context, therapeutic storytelling serves a powerful purpose. It supports nurses’ interest in holistic care—our desire to know what’s important to and for the patient. We frequently ask patients such questions as “What’s important for me to know about you, so I can provide better care?”
Learning about your patient’s inner world is just as important as learning about his or her outer world. Sharing stories provides one way to learn about this inner world while helping to create an emotional bond between caregiver and patient.

Defining the focus
Depending on the nurse’s skill set, storytelling can focus on a simple issue and require minimal time—or it can focus on a complex problem that’s explored in multiple group sessions over the course of an entire day. An all-day seminar might address such topics as coping with cancer or empowering abused women through storytelling. The facilitator might tell a story in a morning session and have the participants share their own stories later that day.

Selecting stories
Choose stories wisely. Before telling a story, review its content closely. Otherwise, listeners might not be able to relate to it—or might relate to it negatively. Consider such factors as the listener’s age, cultural and religious background, intellectual level, and general fund of information as well as the desired outcome of the storytelling session.
Stories can be oral or written, fiction or nonfiction. Stories on audiotape, video, or DVD can work well, too.

Who tells the story?
Depending on the goal of the session, the storyteller may be the nurse, the patient, a family member, or other healthcare professional. If the goal is to describe the experience of having a particular health problem, ask the patient or another person to tell a story based on personal experience. If the goal is to describe the scope of coping responses for a specific problem, you might want to tell several stories that depict various coping strategies.

Storytelling with children
To a child, the hospital is a scary place. To better understand your patient’s fears, ask the child to make up a story about something scary, and then engage him or her in a dialogue about it. This helps the child gain distance from the real threat (such as illness, surgery, or hospitalization) and focus instead on the imaginary threat in the story. A child-generated story gives you insight into the child’s fears and may provide ideas for interventions to relieve these fears.

Storytelling with families
For most patients, families are the primary source of support. One member’s illness affects the entire family. Sometimes the patient or a family member feels the need to talk about the illness to come to terms with it. In such situations, you can use therapeutic storytelling to strengthen the family as a whole.
Nervous family members accompanying a patient to the hospital can exacerbate the patient’s stress. To reduce stress levels, you could meet with the families of newly admitted patients to relate stories of typical courses of hospital stays and describe how family members can promote the patient’s well-being. These stories can help them understand what will happen in the hospital and recognize the benefits of more positive behaviors.

Storytelling with geriatric patients
For geriatric patients, storytelling provides a way to connect with one another, find meaning in their lives, and examine ways of coping. A storytelling program commonly includes some type of reminiscing. Patients aren’t the only ones who can benefit; caregivers who hear seniors tell their own life stories can gain a new appreciation for them as individuals.

Storytelling with groups
Group storytelling allows both a personal and a shared interaction. Usually, therapeutic group storytelling takes place within a formal program or support group. For instance, in Alcoholics Anonymous, members tell their stories to the group as part of the recovery process. Group storytelling can focus on caregivers as well as patients.

Supplementing storytelling with additional interventions
By itself, storytelling may be inadequate to achieve improved coping. A severe or complex problem may require additional interventions, such as pastoral care, psychiatric therapy, or further one-to-one time.
Say, for example, you conduct a storytelling group to provide support to new mothers whose infants have medical problems. Some mothers may find the storytelling session alone gives them adequate support to cope with the problem. But others may need additional interventions, such as counseling from an advanced practice psychiatric mental-health nurse.A story of personal success
The few quantitative studies that have looked at therapeutic storytelling suggest this intervention promotes coping. Although more studies are needed to determine specific benefits, I’ve personally found storytelling to be a creative, humanistic way to achieve a therapeutic goal both in my clinical practice and educational settings.

Selected references
Bomar P. Families as resources, caregivers, and collaborators. In: Bomar P, ed. Promoting Health in Families. Philadelphia, Pa.: Saunders; 2004.
Clarke A, Hanson E, Ross H. Seeing the person behind the patient: enhancing the care of older people using a biographical approach. J Clin Nurs. 2003;12:697-706.
Kaufert J, Koch T. Disability or end-of-life? competing narratives in bioethics. Theor Med Bioeth. 2003;24:459-469.

Edie Devers Barbero, PhD, RN, APRN, BC, is an Assistant Professor of psychiatric nursing, mental health nursing, and community health nursing at the University of Virginia in Charlottesville.

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