Storytelling Illuminates Expert Mental Health Nursing Practice
The understanding that nursing is both a science and an art can be traced all the way back to Florence Nightingale.
While she led the way with the science of epidemiology, becoming the first woman admitted to the Royal Statistical Society, she also said that nursing was “the finest of the fine arts.”
In more recent years, the art of storytelling has been incorporated into the curriculum of health professions. For example Boudreau, Liben and Fuks (2012) reported on its utilization in medicine, and a doctoral dissertation by Linda Hunter (2008) provides considerable insight into the use of storytelling in nursing education.
The use of storytelling in practice has also been explored. Bowles (1995) titled her 1995 paper “Story telling: A search for meaning within nursing practice.” Heliker (1999) reported on the use of storytelling in long-term care settings, asserting that “Recognizing the value of story and incorporating the themes that emerge into a personalized care plan transforms nursing practice” (p. 513); and Banks-Wallace (1999) described story telling “as a tool for providing holistic care to women.”
Here at Ontario Shores, narrative expression (a written story) is one aspect of a research study for which Phase Two is entitled Transition Points in Practice: Person-centred Care as Integral to Care Delivery Innovation. Under the leadership of Principal Investigators Gail Lindsay (UOIT), Jasna Schwind (Ryerson) and Sue Coffey, I am proud to say that a few of our Ontario Shores nurses participated in Phase One of that study. Two of them shared their experience during a nursing council meeting, observing that they were surprised at how much they gained from the narrative writing component of the study. I am pleased to say that additional Ontario Shores' nurses will participate in Phase Two of the study which will soon get underway, generously funded by the Ontario Shores Foundation for Mental Health.
A highlight for me of my monthly visits with our Ontario Shores Nursing Council is asking the nurses to share a moment in their practice which has made them proud to be a mental health nurse. These stories are powerful and illuminate the mental health nursing practice. Here are three recent stories:
An older adult, well known to nursing staff was re-admitted to the unit. The nurses were shocked and dismayed by the patient’s deterioration. When last discharged, he had been able to walk independently, engage in dialogue and participate in his care. Now he was reported as palliative care and confined to bed. The nurses were determined to help this patient regain his level of independence. Enlisting the help of all members of the health care team, and with a detailed care plan in place, it was not long before the patient was up and walking. The nurses eloquently expressed the sense of satisfaction they experienced in seeing their patient regain his function and independence.
The simplest of gestures can make a profound difference. The mother of one of the nurses working over the holidays baked a large batch of Hungarian cookies for the nursing staff to enjoy. One of the nurses remembered that a patient on another unit was Hungarian. She packaged up some of the cookies and took them to him. She recounted that his eyes lit up as he immediately started munching on the homemade treats. It was evident that the cookies evoked happy memories for him and had created a very meaningful moment for him.
The last story shared was that of a patient whose condition was very poor. Prior to her admission to Ontario Shores she had been put on multiple anti-psychotic medications and her food intake was very poor. It seemed to the nurses that the patient was having pain when she ate and to explore the cause, the first step was an assessment for dysphagia. While it did not reveal any significant problem with swallowing it became clear that her dental health was poor. Plans were then made to take her to the dentist. However, her mental status remained very poor and there were concerns that she would not be able to tolerate the dental exam. The team discussed cancelling the dental appointment. However, one nurse felt strongly that the patient would manage the dental visit. She advocated that even if the patient could manage only 5 minutes, it might give important information about how she could be helped. The nurse accompanied the patient to the visit and she and the dentist were astounded when the patient settled comfortably in the dental chair and fell asleep, although happily opening her mouth for the dentist upon request! It became apparent that she had been grinding her teeth quite severely to the point where the enamel was almost all gone. The pain she appeared to experience when eating was likely due to the extremes of hot and cold food. The care plan was changed to provide modified texture and avoid extremes of hot or cold food.
These narrative stories of expert patient care demonstrate the depth of caring and knowledge of mental health nurses in action. The stories are both inspirational and instructive in illuminating excellence in nursing care—the level of care to which we aspire here at Ontario Shores. They make me very proud!
Quote from Florence Nightingale
Nursing is an art;
and if it is to be made an art,
it requires as exclusive devotion,
as hard a preparation,
as any painter's or sculptor's work;
for what is the having to do with
dead canvas or cold marble,
compared with having to do with the
living body - the temple of God's spirit?
It is one of the Fine Arts;
I had almost said
the finest of the Fine Arts