1 Recognizing, Absorbing, Interpreting, and Responding to Stories of Illness Julie M. Aultman, Ph.D Family and Community Medicine
2 Workshop Overview Hour 1: Understanding the Narrative Approach in Medicine Value of Narrative Medicine Types of Narratives of Illness Narrative Elements Reflective Practice Hour 2: Reflective Practice Exercise Interpreting and Responding to Stories of Illness Role of Facilitator Healthcare Professional as Writer
3 Part I.
4 Our lives are ceaselessly intertwined with narrative, with the stories that we tell and hear told, those we dream or imagine or would like to tell, all of which are reworked in that story of our own lives that we narrate to ourselves in an episodic, sometimes semi-conscious, but virtually uninterrupted monologue. We live immersed in narrative. Peter Brooks, Reading for the Plot
5 The Value of Narrative Narrative opens up the life world of oneself and others, particularly the experience of being sick. Narrative can prompt one to recognize and reflect on one s own values Narrative competence allows one to recognize, interpret, and be moved to action by the predicaments of others (Charon, 83) Engaged reading reading with openness, a willingness to learn from the text promotes solidarity with others Reading literature in medical settings may help ward off selective reality, or the belief that your vision of the world is the most accurate, most complete, most true.
6 Narrative can develop and strengthen the following skills critical for clinical work: Moral imagination Overall critical and reflective thinking Communication (writing) skills Commitment to decision-making Conflict awareness and resolution Reasoning for alternative approaches Organization skills Ethical and moral knowledge
7 Consciousness Narrative theorists argue that narratives can be categorized by the way consciousness is presented in a story: A third-person narrator can look into a character s mind (the narrator is the perceiver and the character s mind is perceived) or, Look through the character s mind (the character is the perceiver and the world is perceived) ( e.g., Story -Playing God ) Todd Chambers, The Fiction of Bioethics, p. 11.
8 The Use of Stories Stories as cases for teaching principle based medical ethics Narratives as moral guides for living a good life Narratives of witness Narratives to help healthcare professionals examine their ethical practices Jones, 1999
9 Physician as Writer The more I wrote about my patients and myself, the more confident I became that the act of narrative writing granted me access to knowledge about the patient and about myself that would otherwise have remained out of reach. I also realized that writing about patients changed my relationships with them. I became more invested in them, more curious, more engaged, more on their side. Rita Charon, 2001, Annals of Internal Medicine
10 An example The principle of autonomy may tell us to respect patient s autonomy, but it may not tell us what it means to respect the autonomy of Mr. Smith in room 1303 Howard Brody, p. 151, Stories Matter
11 Different types of Medical Narratives Medical interview Medical history Patient s story Family s story Healthcare professional s story Ethics consultation and case; ethicist s point of view Legal case; lawyer s point of view
13 The Illness Narrative Arthur Frank (1995) sees illness as itself a call for stories in two ways: becoming ill demands that one re-create one s selfstory, and, ill persons are asked to engage in storytelling by those who surround them (e.g., healthcare professionals, family, friends, employers, and so on). His narrative ethic focuses on thinking with stories which entails allowing one s own thoughts to adopt the story s immanent logic of causality, its temporality, and its narrative tensions. His focus is on the re-telling.
14 Restitution narrative This is the story most people tell: Yesterday I was healthy, today I m sick, but tomorrow I want to be well again... back to normal. Rests on the broken down metaphor of the body that must be repaired.
15 David At the end of the day what I am doing is I am buying time, I am buying time by concentrating on good health, no alcohol, low fat, high fiber, and exercise in order to buy time so the medicos of the world can come up with the panacea that addresses, resolves and extinguishes my hepatitis C So in answer to your question, would I go back on treatment, well I d go back on treatment if it is going to buy me time.
16 Chaos narrative No movement toward remedy or cure Feelings of futility and impotence Lack of control
17 Sarah Well today I am sick. I was going to clean up the house and move, but I am too sick to do it, I can t do it, I don t have the nerve to do it, I don t have enough nervous stamina to get through. The more I think, I think it s your fault, and then I think back and I have actually got no clothes, I am sitting here with my pajama jacket on and trousers with holes in them, I ve got two pairs of socks and an old pair of shoes, a pair of stockings that need replacing There is no money for clothes or haircuts or anything like that. There is nothing.
18 Quest narrative Yesterday I was healthy, today I m sick, but I have been so transformed by my illness that I can never go back. Desire to use one s suffering to move themselves and others to deeper levels of living Often involves testimonials, memoirs, activism A narrative of self-discovery; illness becomes accepted.
19 Laura Back then when I was using if you had told me I could have got a disease it wouldn t have mattered, I still would have done it, I had no self respect, and today I have learnt, I have become a better person because of it, a sick person, but a better person. I ve learnt so much about myself because of this.
20 Narrative Elements Character Desire Conflict
21 Reading literature helps healthcare professionals think narratively, in terms of stories Plot and Theme Point of View Setting Tone
22 PLOT AND THEME Plot is movement, events in time. It is what an author does to the simple narrative account to make it a story, to give it a purpose or meaning. The Theme is the central or dominant idea expressed by a piece of writing or a spoken story.
23 POINT OF VIEW First person - narrator tells story from his/her point of view (as a character in story) Third person - narrator is not a character in the story Omniscient - sees all minds, all characters, all actions Limited omniscient - sees only through one (or sometimes more) character's mind or experiences Objective - sees no minds, but all characters, all actions
24 SETTING The setting is the physical, geographical, historical, cultural, and/or temporal location(s) in which a story takes place. Tends to influence the interpretation of actions and events Can establish a mood or feeling about the characters or action
25 TONE Tone is the atmosphere or mood expressed by the writing. Tone refers to the author s (or storyteller s) attitude toward his or her subject or audience. By the selection of incidents an author chooses to focus on, or to omit, he or she establishes a tone. It may indicate contemptuous, respectful, or other attitudes toward his or her audience/listeners.
26 Part II
27 Reflective Practice Objectives Recognize/resolve personal and professional issues/dilemmas as they relate to life in medicine; Engage in collective discussions aimed to promote respectful and trusting relationships with colleagues and a sense of community; Develop a broadened appreciation for and understanding of a wider range of human experiences; Clearly recognize and be fully conscious of the forces intrinsic to their own professional identity development and socialization in medicine; and Develop a broader understanding of the commitments and obligations that attend the privilege of service in medicine.
28 Short story Read the following short story. Answer a set of questions (next slide) and write a short reflective paragraph on how the story resonates with you. Discuss in small group Michael A. LaComb, M.D. Playing God
29 Reflective Practice Who is the narrator? Identify the characters, and interpret the meaning as to why these particular characters are in the story Identify the elements: plot and theme, point of view, setting, and tone (e.g., how would the story be different if the setting were here?) Identify the type of the (illness) narrative What may be the desire? (e.g., to get better) What may be the conflict? (social, financial, moral, clinical) How might there be resolution? If there was resolution, would you act differently? In what ways? How does the story personally resonate with you? What feelings does this story elicit? Were you reminded of your own past personal encounters (patients, others)? Is this story a work of fiction or non-fiction does it matter?
30 I would continue medicine, for I am determined to be a poet; only medicine, a job I enjoyed, would make it possible for me to live and write as I wanted to. I would live: that first, and write, by God, as I wanted to if it took me all eternity to accomplish my design William Carlos Williams, Poet, Physician, Scholar
An exploration of how male adolescents who had childhood cancer make sense of infertility Sophie Roher Hon. BA & Sc. MSc student Health Services Research and the collaborative program in Bioethics Institute
SHORT STORY ELEMENTS What is a short story? It s a relatively brief fictional narrative in prose. Short usually 10 pages max. Not real Tells a made up plot/story Written in sentences and paragraphs. Not
Core Analysis Frame: Fiction D24 These questions will help you understand any story you read. For more advanced, in-depth analysis of each element, use the following frames: Setting Plot Author s Craft
Prestwick House Sample Pack B y P a u l o C o e l h o Click here to learn more about this Pack! Click here to find more Classroom Resources for this title! More from Prestwick House Literature Literary
FOR USE WITH FOCUS LESSON 1: NARRATIVE STRATEGIES I 1a The plot is the sequence of events in a story. Each event causes or leads to the next. Events of the plot reveal a problem called the conflict. The
Writing Emphasis by Grade Level Based on State Standards Grade K K 5.1 Draw pictures and write words for specific reasons. Grade 1 1.5.1 Write brief narratives describing an experience. Grade 2 2.5.2 Write
Curriculum Map BOE Approval November 2013 CURRICULUM MAP WRITING GRADE 4 SEPTEMBER OCTOBER NOVEMBER DECEMBER JANUARY Creating a Buzz About : It s All About Me! Tell Me A Story Realistic Fiction Tell Me
Story and Novel Terms 9 This list of terms is a building block that will be further developed in future grades. It contains the terms you are responsible for learning in your grade nine year. Short Stories:
Building a Collaborative Community of Writers Session Goals Review a framework for and the core elements of effective writing instruction Examine the role of talk in the writer s workshop Discuss strategies
Why I want to be a Doctor On this slide you should consider the following Why you want to be a Doctor? Show the audience that you are serious about why you want to be a Doctor. Be sure you speak with enthusiasm.
KEY SKILLS OF JUNIOR CYCLE Key skills of junior cycle Learners need a wide range of skills to help them face the many challenges presented to them in today s world. They develop specific skills in their
CanMEDS 2005 Framework MEDICAL EXPERT Definition: As Medical Experts, physicians integrate all of the CanMEDS Roles, applying medical knowledge, clinical skills, and professional attitudes in their provision
Key Ideas and Details Anchor 1 / Literature Reading Anchor 1: Read closely to determine what the text says explicitly and to make logical inferences from it; cite specific textual evidence when writing
How to Write a Book Analysis A book analysis is a description, critical analysis, and an evaluation on the quality, meaning, and significance of a book, not a retelling. It should focus on the book's purpose,
Running Head: GOOD NURSE 1 Literature Review: The Characteristics of a Good Nurse 1234567 Faculty of Nursing University of Manitoba December 04, 2009 Seminar in Professional Nursing Foundation, NURS 3430
Name: Date: #: English Period: LITERARY ELEMENTS NOTES -Literary elements are elements that make up a work of literature (characters, characterization, conflict, setting, theme, symbolism, point of view,
How to Write a Research Paper/Book Review An analytical book review will identify the book s thesis, and evaluate / critique the author s argument, evidence, and conclusions. In the first paragraph you
F OR USE WITH F OCUS L ESSON 1: PLOT, SETTING, AND T HEME 1a Plot is the series of events in a story. Exposition is the author s introduction to the characters and setting. The conflict, or problem, sets
New National Curriculum 2014 Reading s Year 1 To make the assessment of reading slightly easier we have split the objectives up into three groups. Guided Reading; these are objectives easily assessed through
Spiritual Gifts Inventory Instructions: As you read each sentence, write the number that best describes you in the appropriate box on the separate Answer Sheet. To what degree do these statements reflect
National Center for Healthcare Leadership Health Leadership Competency Model SUMMARY The NCHL Health Leadership Competency Model was created through research by the Hay Group with practicing health leaders
Excerpt Temple University Press Introduction Life, Practice, and Promise I am a practicing sociologist, and this book is about what it is that I practice, what it means, and why it matters. This book is
Unit One Understanding the play and the production 11 Mind Map Unit 1: Understanding the play Focus: Developing an understanding of the play using creative approaches Mind map adapted from Buzan, Tony.
ANALYZING SHORT STORIES/NOVELS When analyzing fiction, you should consider the plot, setting, characters, point of view, imagery, symbolism, tone, irony, and the theme. PLOT Plot refers to what happens
Writing Assessment Focuses The I Can statements link to the Assessment and Progression sheets and support children in their involvement in the targets setting process. They will need to be mediated and
GRADE ONE THEATRE CURRICULUM Module 3: We All Have Stories to Tell Enduring Understanding Theatre in the World: We all have stories to tell. Essential Question Why are stories used to explain ideas? What
Short Story SUGGESTED Learning Strategies: Think-Pair-Share, Brainstorming, Marking the Text, Graphic Organizer, Skimming/Scanning, Visualizing, Drafting, Role Playing, Self-Editing/Peer Editing, Webbing,
O R I G I N A L R E S E A R C H Rural nursing unit managers: education and support for the role PS Paliadelis University of New England, School of Health, Armidale, New South Wales, Australia Submitted:
Introduction to Narrative Giovanni Boskovich LACHSA English Department Is reading still in vogue? Reading is like thinking, like praying, like talking to a friend, like expressing your ideas, like listening
Slide 1: Preparation and introduction This lesson was initially created for use by two researchers visiting a school, but we have provided all the materials and guidance needed to allow teachers to use
READING mallard primary school NAME CLASS LEARNING LADDERS CONTENTS Ladder Title EYFS Reading Decoding Comprehender Reading Detective Targets Language Lover Targets Responder Targets Big Reader Targets
Why Listening Is So Important There is a saying about listening that eloquently summarizes the nature of the process. The source of the words is unknown, but the message is universal God gave us two ears,
Year 7 Introduction to Drama Aim: Introduce year 7 students to the drama environment and start to build on drama space procedures. To encourage whole group cooperation. To build trust and learn names of
WRITE A ONE ACT PLAY I. PREWRITE A. What is a play? B. What are basic elements of a play script? 1. 2. 3. 4. 5. C. What kind of character does your group wish to write about? D. As a result of reading/seeing
Page 1 MS Learn Online Feature Presentation Invisible Symptoms in MS Featuring Dr. Rosalind Kalb >>Kate Milliken: Hello, I m Kate Milliken, and welcome to MS Learn Online. No two people have exactly the
Third Grade Language Arts Learning Targets - Common Core Strand Standard Statement Learning Target Reading: 1 I can ask and answer questions, using the text for support, to show my understanding. RL 1-1
WHAT ARE WAR AND CONFLICT? WHAT ARE WAR AND CONFLICT? Think about what conflict, peace and war mean and what an absence of peace means OBJECTIVES 2 Examine the notion that conflict inside and between countries
Area of Learning: ENGLISH LANGUAGE ARTS 10 12 Ministry of Education Description SPOKEN LANGUAGE 10 (2 credits) Spoken language skills are increasingly necessary in everyday, educational, and professional
Michael Murray Keele University Daring to make a difference: Dynamic Qualitative Research Conference Keele University, 22-23 march 2014. Not one of the most popular forms of qualitative research in the
English Language Arts Key Terms & Definitions 5 W s of newspapers - who, what, when, where, why Abbreviation shortened form of a word Affix group of letters and sounds added to a root word Alliteration
Lesson 8 Descriptive Essays Description is not a distinct mode of writing, like expository, narrative, and persuasive, but the ability to write descriptively is essential to a host of writing genres. Many
MAIN IDEA (LA.6-18.104.22.168) MAIN IDEA What is the main idea of this article? What would be another good title for the article? Which accomplishment/idea was most valuable? Which sentence gives the best summary?
Memoir Upper Grades Classroom Goals and teaching points for Memoir Unit 1. Students will be able to define and identify characteristics of 2. Students will generate memories and ideas for a theme or focus
Narrative Therapy by Hermann A. Peine, Ph.D. and Louis S. Allen, M.D. Adapted from the book - What is Narrative Therapy? by Alice Morgan * Narrative therapy is a non-blaming approach to human problems.
The following strategies have been shared by Kate Christensen from William Colenso College. Kate offers detailed explanations for how each strategy support learners to develop comprehension skills, how
NATIONAL VISUAL ARTS STANDARDS DEFINITIO N OF VIS U A L A R T S Glimpse Visual Arts painting, printmaking, photography, sculpture; media arts emerging technologies; architectural, environmental, industrial
English long term planning Years 1 to 6 Herts for Learning Ltd 01438 845111 www.hertsforlearning.co.uk The Long Term Plans allow for two planning approaches: Planning which follows the teaching sequence
There s a Boy in the Girls Bathroom by Louis Sachar This unit lasts three weeks This book has as its main character Bradley Chalkers, a bad boy who is always in trouble. In this story, we are allowed to
Summary Report for: 31-9092.00 - Medical Assistants Perform administrative and certain clinical duties under the direction of physician. Administrative duties may include scheduling appointments, maintaining
Reading Reading instruction is divided into two main areas. Reading for information is actually used in all content areas and is the main reason that we learn to read! Thus the standards here focus more
Candidate s Guide to Assessment This guide will help you to understand and prepare for an assessment process at E.ON. Contents 1 What is Assessment? 2 E.ON Competency models 3 Assessment methods Interviews
ACADEMIC LANGUAGE AND LEARNING SUCCESS PROGRAM Writing a research proposal Aim The aim of this workshop is to teach the skills of designing and formatting a research proposal. Purpose of a proposal What
The Power of Positive Thinking The Power of Positive Thinking Optimism is the most important human trait, because it allows us to evolve our ideas, to improve our situation, and to hope for a better tomorrow.
Unit Title: Literary Essay Concepts: 1. Essayists analyze literary essays for reasoning and evidence. 2. Essayists read texts closely and respond to them in writing. 3. Writers learn strategies for revising
Graphic Organizers for Common Core Standards-Based READING In-Depth Analysis GRADES 9-10 Created by Tracee Orman www.traceeorman.com www.teacherspayteachers.com/store/tracee-orman CCS RL Graphic Organizers
23 You have: TASC subjects May lead to: D/E in Year 10 Australian Curriculum English An interest or need for literacy skills in work and everyday life Practical English 1 Essential Skills - Reading and
Nordic Congress in Family Therapy Workshop, Wisby, Gotland 19. august 2011 Anette & Allan Holmgren "A word, a tune, a story, a line Keys in the wind t'unlock my mind." Bob Dylan Program: 1. Why we have
In Defense of Kantian Moral Theory University of California, Berkeley In this paper, I will argue that Kant provides us with a plausible account of morality. To show that, I will first offer a major criticism
How To Be A Highly Effective Course Module 1 A Elevator Pitch: Purpose, Promise, Offer and Difference by Glen Cooper Copyright 2015 by Colorado Association of Business Intermediaries (CABI) www.coloradobusinesses.com
GENERAL BIOETHICS COMMISSION BIOETHICS FORMATION FRAMEWORK GENERAL OBJECTIVE HOSPITALLER ORDER OF ST JOHN OF GOD To provide a framework to help the Provinces and the Centres of the Order to design their
Grades 9-10 Learning Targets and I Can Statements Quarter 1 Provide an objective summary of the text. I can identify first person point of view. I can identify third person-limited point of view. I can
D Youville College Department of Liberal Arts Writing English Minor in & New ew Media Create your future THE MINOR IN WRITING & NEW MEDIA AT D YOUVILLE! As new information communication technologies and
SESSION 5: RIGHT TO GOOD HEALTH - Writing a persuasive speech Outline Age range: 8-11 years Time: 1 hour In role as members of a school health club in Sierra Leone, learners will consolidate their learning
ACTIVITIES 3 -- IDENTIFYING AND OVERCOMING ROADBLOCKS TO DOING PLEASANT ACTIVITIES GOALS FOR LEADERS Help participants identify potential roadblocks to doing pleasant activities Help participants problem
The charts below were created as a common language for teachers and students in the Wallingford Public Schools in kindergarten through eighth grade. The level of the chart selected for use in the classroom
Lesson Da 2 Day 1 Point of View, Perspective, Audience, and Voice A story can be told from more than one point of view. If a story is written by someone who is a character in the story, then it is said
What are My Goals for Quarter 2? Common Core- I Can Statements: Literature RL.6.1 Cite textual evidence to support analysis of what the text says explicitly as well as make inferences. I can define textual
www.englishbiz.co.uk 2014 Steve Campsall Essay Writing Guide WHAT IS AN ESSAY? An essay can never give answers it can only offer views ; and these need to be argued for. You need to argue in support of
Year 1 reading expectations Year 1 writing expectations Responds speedily with the correct sound to graphemes (letters or groups of letters) for all 40+ phonemes, including, where applicable, alternative
Religious education Programme of study (non-statutory) for key stage 4 and years 12 and 13 (This is an extract from The National Curriculum 2007) Crown copyright 2007 Qualifications and Curriculum Authority
GOD CHOOSES DAVID (C.1.Fall.5) Biblical Reference 1 Samuel 16:1-13 Key Verse 1 Samuel 16:7 Key Concept When I see other people, I should look at not only their appearance, but their inner qualities. Educational
Interview Techniques. Preparing for the medical school interview www.careers.utoronto.ca University of Toronto Career Centre @UofTCareerCtr Interview Purpose The purpose of the interview for medical or
Overcoming Resistance to Stopping Tobacco Use: A Motivational Approach Lowell C. Dale, MD Associate Professor of Medicine Mayo Clinic Nicotine Dependence Center & Division of Primary Care Internal Medicine
Page 1 of 57 Grade 3 Reading Literary Text Principles of Reading (P) Standard 1: Demonstrate understanding of the organization and basic features of print. Standard 2: Demonstrate understanding of spoken
Lesson Plan English First Additional Language Grade 5 Content in context: Text from other Learning Area - Whether Los and ASs Learning Activities Details of Assessment Barriers to Learning LO 1 Listening
The Johari Window Model The Johari Window is a disclosure/feedback model of awareness, named after Joseph Luft and Harry Ingham. It was first used in an information session at the Western Training Laboratory
Guide To Patient Counselling page - 1 - GUIDE TO PATIENT COUNSELLING Communication is the transfer of information meaningful to those involved. It is the process in which messages are generated and sent
Successful Models of Faculty Development Train the Trainer Model Kelly Skeff, M.D., Ph.D. Transcript from session. Presenting to you today reminds me of running a seminar with our residents. We were trying
Book Club Assignment Welcome to your new book club group. Your group will be studying the same book. You will be given class time to read; as well, you will be responsible to read at home. There will be
Mercer County Schools PRIORITIZED CURRICULUM Reading/English Language Arts Content Maps Third Grade Mercer County Schools PRIORITIZED CURRICULUM The Mercer County Schools Prioritized Curriculum is composed