Journal of Psychiatric and Mental Health Nursing, 2015, 22, 1–2

Editorial Narrative in nursing practice, education and research

The recent development of a Consumer and Practitioner Narratives section in the Journal of Psychiatric and Mental Health Nursing represents recognition of the importance and value of people’s unique experiences within contemporary nursing research scholarship and evidence. Developed as part of the Journal’s revitalised Aims and Scope, it offers space in which to support the inclusion of diverse voices of expertise and to demonstrate the translation of research into actual practice. The guidelines for this section are clear: “The narrative can be authored by a single person concerning their own experience, or jointly, for example, one person relating their own experience and another person providing context and analysis. In either case, the paper should contextualise the experience with reference to relevant literature (in the arts and/or the sciences) and answer the following questions: how does this experience fit within the context of the literature and how does it inform other consumers, practitioners or researchers?”

Importantly, the narrative should not be written by a professional about a person (in traditional case study format) – it should be a genuine co-production, which offers equal respect to different sources and types of knowledge. Our definition of co-production includes co-authorship and single authorship. However authors must have the permission to express the experiences or views of another person or support these in the traditional way by providing a citation or paragraph exploring how the ideas were developed jointly. The narrative could be structured in a type of essay format with an introduction, the narrative itself, an analysis of the narrative with reference to relevant theory, research evidence and other literature, and a conclusion. Other structures that may work well include alternate perspectives within each paragraph, each responding to points raised in the above or below section. Over time, this area of the journal will represent a body of narrative-based evidence offered by people with lived experience of mental health and illness and of mental health nursing practice – practitioners are of course welcome to submit under this heading with narrative accounts of their own experiences, and have been doing so recently. At the heart of mental health nursing lies relationships between individuals and the people who care for them, no © 2015 John Wiley & Sons Ltd

matter which ‘model’ of nursing is practiced, taught or researched. People’s ways of describing, formulating, reflecting upon and recording their subjective experience of mental health and illness, of distress or happiness, of strange or unfamiliar experiences and beliefs, of anxiety and fear, or of crisis or success are important when considering approaches that may or may not be effective. Someone may respond well to a staunchly professional directly questioning assessment, another to a warm and gentle approach that allows important elements to emerge more naturally. The development of a range of attentive and interpretative skills can help to tease out the elements of a person’s experience that they feel are most relevant. The use of narratives in a range of formats may help practitioners and students to develop different types of reading skills (around elements such as metaphor, temporality, characterisation, differing meanings, structure and tone, for example) which can then further aid communication and information analysis (Charon, 2006). Further developments in the use of the narrative can be seen in the expansion of the established discourse of narrative medicine (Charon 2006). Hamkins recent text focuses on narrative approaches to working with people, which she argues can be at least equally beneficial to individuals than a traditional assessment-diagnosis-treatment approach. Hamkins describes this as follows: “In narrative psychiatry, rather than privileging only stories of loss, suffering, conflict, neglect, or abuse in someone’s life, I also search for stories of joy, connection, intimacy, consistency, and success, for these are the wealth of the people who consult with us. Instead of privileging a story of failure, we co-author a story of success in overcoming problems, no matter how small those successes may be” (2014, p. 50).

This resonates with strengths based and recovery oriented nursing practice, in terms of the focus on success, resilience and self-defined recovery as opposed failure, pathology, or disorder. Autobiographical collections which collate and demonstrate the diverse lived experiences of people with different challenges to their mental health and wellbeing, are of course not a new phenomenon (i.e. Read and Reynolds, 1996), but have come to the fore once again through a recent and expanding series of books spearheaded by Alec 1

Editorial

Grant, the late Fran Biley and a range of individuals who have lived experience of mental health challenges, published by PCCS. These offer to highlight the individual at the centre of care during a challenging time of austerity; to counter the homogenising potential of diagnostic formulation and outcome measures; to demonstrate the expertise people have around their own experiences; and show a range of perspectives that offer different and complimentary insights to those found in textbooks or research (Baker, Shaw and Biley, 2013; Grant, Biley and Walker, 2011; Grant et al. 2013). Collections of narratives (and narrative approaches more generally) face potential criticisms. These are not generalisable, replicable, or subject to the stringent requirements of positivist methodologies. They are, by their nature, unique and subjective, which can raise issues around narrative ‘truth’, memory, authenticity and reader interpretation (Holloway and Freshwater, 2007a, 105– 124). They can be critical or supportive of existing practice. However, they can provide emotionally powerful individualised perspectives that may not be accessed through traditional research and evidence bases, such as metaanalysis or systematic reviews. They focus on the person and their life within a clinical presentation. This is particularly important when reflecting upon elements of mental health presentations that can be challenging to respond effectively to, emotive or hard to understand, for example self harm, histories of abuse or unusual beliefs. They have the power to relate to others who find themselves in similar situations, struggling or in distress, as Clare Shaw suggests in relation to the strength she was able to draw from her reading about people who experienced self harm (Baker et al. 2013). The autobiographical narrative also offers rich possibilities for discussion and development of critical and empathetic thinking in mental health education (i.e. McKie &

References

Gass 2001; McKie et al. 2008). Other genres, such as fictional narratives focusing on mental health and illness have also been collated and analysed by a range of different scholars in psychiatry and mental health nursing (i.e. Baker et al. 2010). Liam Clarke’s Fictions Madness (2009) and Femi Oyebode’s Mindreadings: Literature and Psychiatry (2009) focus on literary portrayals of mental health challenges and the way in which these can be used to inform the education of students and practitioners from nursing and medicine. This subgenre of research forms part of the broader tradition of narrative research in nursing and medicine (Frid, Ohlen and Bergbom, 2000; Holloway and Freshwater, 2007; Holloway and Freshwater, 2007a). Both clinical narrative research (collating one or many stories for thematic or content analysis, for example, often with the author/s themselves) and literary based scholarship necessitates the use of skills in attentive reading, interpretation and contextualisation, not aiming to ‘prove’ a particular thing, but instead highlighting the nuances of experience, drawing out the elements of care that are important in terms of the meeting of people as well as that the treatment of a body or mind, and both the diverse and the common thoughts and feelings of people who may share a diagnosis or similar experiences. The new Consumer and Practitioner Narrative section of the Journal of Psychiatric and Mental Health Nursing will, I hope, develop further over the next few years and I suspect take time to become established. It represents a new way in which narrative approaches can become legitimised as knowledge, not to replace the scientific or the objective. Seen in this way it gives voice to consumers and practitioners and sits well with our status as a professional based journal. CHARLEY BAKER BA MA Lecturer in Mental Health University of Nottingham

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